制备低剂量四氯化碳诱导小鼠慢性肝损伤模型的探讨

目的 通过注射低剂量四氯化碳（carbon tetrachloride,CCl₄）建立B/C小鼠肝损伤模型。方法 正常B/C小鼠随机分为正常对照组、油对照组、CCl₄模型组。正常对照组常规饲养;油对照组腹腔注射鲁花花生油（10 μL/g,1次/3天,连续6周）;CCl₄模型组腹腔注射0.5% CCl₄（10 μL/g,1次/3天,连续6周）。第6周,各组小鼠检测血清AST、ALT浓度,HE及Masson染色后观察小鼠肝脏结构、细胞形态及纤维化程度。结果 第6周CCl₄模型组小鼠血清ALT（P=0.00）、AST（P=0.00）浓度极显著性增高,HE及Masson染色显示CCl₄模型组小鼠肝上皮细胞呈广泛性空泡样变及大量坏死,肝小叶内出现明显的条索样纤维增生,其纤维化程度评分显著性升高（P =0.00）,纤维显色积分光密度值极显著性增高（P =0.00）。结论 注射低剂量CCl₄可以诱导B/C小鼠肝损伤模型,实验模型具备肝损伤和肝纤维化病理特征。     

母代高脂饮食诱导子代在小鼠生命早期出现糖脂代谢紊乱且具有雄性易感性

目的 探讨孕期和哺乳期的高脂饮食能否导致子代在生命早期出现糖脂代谢紊乱。方法 成年雌性C57BL/6J小鼠与正常饮食雄性小鼠进行交配,孕鼠随机分为高脂饮食组和正常饮食组,在孕期和哺乳期喂养高脂饲料或正常饲料,至交配后第一代鼠断乳时（3周龄）观察其糖脂代谢相关性指标以及肝脏病理表现。结果 较正常饮食组子鼠相比,高脂饮食子鼠出生体重更低（P<0.05）。在断乳时,高脂饮食组雄性子鼠体重较重（P =0.038）,腹腔糖耐量实验 30 min和60 min血糖明显升高（P值分别为<0.001和<0.01）,糖耐量曲线下面积较大（P=0.0016）,HOMA-IR值较大（P<0.05）,雌性子鼠腹腔糖耐量实验在30 min血糖高于正常组（P<0.01）,而糖耐量曲线下面积和HOMA-IR值在两组之间无明显统计学意义。雄性和雌性子代小鼠空腹胆固醇水平高脂饮食组均高于正常饮食组（P值分别为<0.0001和0.0004）,而两组雄性和雌性子代小鼠空腹胰岛素和甘油三酯水平差异均无显著性（P 均>0.05）。另外,在断乳时高脂饮食子鼠出现肝脏脂肪变性,雌性和雄性子鼠无明显差异。结论 母鼠孕期和哺乳期高脂饮食能够诱导子代在生命早期就能出现糖脂代谢紊乱并且雄性子鼠更易出现肥胖、糖耐量异常、胰岛素抵抗。     

同一药物不同剂量足三里穴位注射对心气虚证的效应对比研究

目的 研究参芪扶正注射液足三里穴位注射对心气虚证的效应与用药剂量的关系。方法 通过负重游泳及灌服大剂量心得安法获得心气虚证大鼠模型,对各治疗组分别进行不同剂量参芪扶正注射液的足三里穴注治疗。连续治疗10 d后,观察并记录大鼠的一般状况和症状;通过ELISA法检测各组血清心钠素（ANP）及环磷酸腺苷（cAMP）含量;通过比色法检测各组血清超氧化物歧化酶（SOD）活性;通过HE染色法检测各组心肌组织病理改变。结果 和正常对照组相比,模型对照组出现疲软无力,舌质发紫,呼吸急促等明显的心气虚症状;血清ANP浓度升高,cAMP浓度降低,SOD活性降低,均具有极其显著性意义（P<0.001）; 心肌组织病理示：炎细胞浸润明显,心肌细胞严重水肿,排列紊乱。和模型组相比,各治疗组症状缓解,血清ANP浓度降低,cAMP浓度升高、SOD活性增强,差异均具有显著性意义（P<0.05或P<0.01或P<0.001）,其中参芪0.05 mL组变化最小（P<0.05）,参芪0.20 mL组变化最大（P<0.001）;心肌组织病理改变减轻,其中参芪0.20 mL组最接近正常。结论 参芪扶正注射液足三里穴位注射能有效治疗心气虚证,且其疗效与用药剂量在一定剂量范围（0.05～0.20）mL内成正相关。     

亲代三丁基锡暴露对F1代KM小鼠血常规的影响

目的 探讨亲代三丁基锡暴露对F1昆明小鼠血常规的影响。方法 将雌、雄各40只小鼠随机分别分为空、低、中、高浓度组(0、0.2、2和20 μg/kg), 每天进行染毒, 持续45 d。在第60天时, 将同浓度组的雌:雄鼠按1:1进行同笼配种。仔鼠出生60 d后取血, 进行血常规的检测。结果 与对照组相比, F1代雄性低浓度和高浓度组的红细胞数量和血红蛋白量显著增加(P < 0.01);F1代雄性低浓度组红细胞体积、平均血红蛋白含量(P < 0.01)和淋巴细胞绝对值(P < 0.05)显著降低;F1代雌性高浓度组的红细胞数量显著增加(P < 0.01), F1代雌性小鼠的血红蛋白量、红细胞压积、血小板量三项指标随着TBT浓度的增加呈剂量依赖性。结论 亲代TBT暴露影响F1代小鼠的血常规, 且低浓度时对F1代雄性小鼠的影响最大, 高浓度时对F1代雌性小鼠的影响最大。     

牛樟芝对易卒中的自发性高血压大鼠脑蛋白质组学的影响

目的 研究牛樟芝能否延长易卒中的自发性高血压大鼠的生存时间,并运用蛋白质组学方法对其作用机制进行探讨。 方法 先选取80只雄性易卒中的自发性高血压大鼠,随机分为给药组和对照组（每组40只）,给药组每天用牛樟芝（150 mg/kg）灌胃治疗,记录卒中大鼠的自然死亡时间。另外再选取6只易卒中的自发性高血压大鼠,随机分为给药组和对照组（每组3只）,给药组给予牛樟芝灌胃治疗（150 mg/kg）,连续90 d后取大鼠脑组织进行蛋白质组学研究,用WKY大鼠作为正常对照,对用药前后产生的差异蛋白点进行质谱鉴定,并用蛋白质印迹法进一步验证组学的鉴定结果。 结果 牛樟芝延长了易卒中的自发性高血压大鼠的生存时间（P<0.05）,蛋白质组学鉴定结果显示牛樟芝上调了脑组织抗氧化酶谷胱甘肽巯基转移酶（GST）和超氧化物歧化酶（SOD）的表达（P<0.05）,这一结果得到了蛋白质印迹法的验证。对脑组织氧化应激水平的研究发现机体的总抗氧化能力增强[T-AOC：（66.48±16.17） U/g vs （124.75±28.43） U/g, P<0.05）,表现在GST和SOD的酶活性增加[GST：（40.33±5.24） U/mg vs （70.50±6.24） U/mg, P<0.05; SOD：（109.25±23.61） U/mg vs （192.60±23.95） U/mg,P<0.05],而氧化应激产物丙二醛含量减少[（3.96±0.45） nmol/mg vs （2.04±0.31） nmol/mg,P<0.05]。 结论 长期服用牛樟芝能延长易卒中的自发性高血压大鼠的生存时间,这可能与其增加脑组织抗氧化酶的表达、减轻氧化应激的损伤有关。     

2型糖尿病兼抑郁症大鼠模型的建立与评价

目的 用体重检测、空腹血糖检测、宏观表征、旷场实验行为学评价糖尿病兼抑郁症的大鼠模型。方法 采用高脂饲料喂养加腹腔注射小剂量链脲佐菌素（STZ）的方法制备2型糖尿病模型,在其基础上再用21 d慢性束缚的方法建立糖尿病兼抑郁症大鼠模型。将32只Wistar大鼠随机分为3组（n =8）：正常组（N组）,2型糖尿病组（T组）,2型糖尿病兼抑郁症组（T+D组）。2型糖尿病模型建立后,在慢性束缚的第0、7、14、21天检测大鼠的空腹血糖和体重,并对大鼠的宏观表征、饮食量、粪便、小便、精神状态进行观察,在第21天利用行为学设备分析软件,对大鼠旷场实验进行分析,检测大鼠的抑郁程度,验证评价2型糖尿病兼抑郁症大鼠模型是否成功。结果 给予高脂饲料及腹腔注射STZ制备2型糖尿病模型后,T+D组大鼠的毛发散乱,无光泽,活动迟缓,进食量、饮水量增加,粪便尿量增加,精神萎靡。第0、7、14、21天T组和T+D组组大鼠体重均下降,与N组比较差异有显著性（P<0.05;P<0.01）,21d慢性束缚刺激后,T+D组体重比T组大鼠体重增加较慢,差异有显著性（P<0.05）;第0、7、14、21天,T组和T+D组大鼠血糖均升高,与N组比较差异有显著性（P<0.01）,21 d慢性束缚刺激后,第21天T+D组大鼠血糖比T组较高,差异有显著性（P<0.01）,大鼠5 min内总移动距离有变化,与N组相比,T组差异没有显著性（P>0.05）,T+D组差异有显著性（P<0.05）;与N组相比,T组大鼠5 min内移动速度减慢,差异有显著性（P<0.05）,T+D组差异有显著性（P<0.01）。结论 利用高脂饲料喂养加腹腔注射小剂量STZ及21天慢性束缚的方法,可以成功复制2型糖尿病兼抑郁症大鼠模型,适用于后续研究。     

短波视蛋白在豚鼠频闪光诱导性近视和形觉剥夺近视眼模型中的表达差异

目的 观察豚鼠频闪光诱导性近视和形觉剥夺近视模型中短波视蛋白（S-opsin）表达差异,并初步探讨原因。方法 36只普通级2周龄豚鼠随机分成三组：频闪组（FLM组,n=13）,形觉剥夺组（FDM组,n=12）,对照组（n=11）。FLM组,饲养笼具安装有频闪仪（频率0.5 Hz）,笼具内装有发光二极管;FDM组豚鼠右眼用半透明眼罩遮盖,并确保豚鼠眼睑能正常活动;对照组豚鼠不予特殊处理。在造模第1天（0周）和第6周测量豚鼠右眼屈光度、眼轴长度和角膜曲率半径,并通过免疫荧光法观察S-opsin表达。结果 第0周,FLM、FDM组与对照组屈光度、眼轴长度、角膜曲率半径差异均无显著性（P > 0.05）。造模6周后,与对照组相比,FLM组、FDM组屈光度变化值、眼轴长度变化值差异均有显著性（P < 0.05）,而角膜曲率半径变化值差异无显著性（P=0.358）,提示成功建立近视模型。FLM组与FDM组相比,屈光度变化值、眼轴长度变化值、角膜曲率半径变化值差异均无显著性（P > 0.05）。免疫荧光结果显示：FLM组视蛋白灰度值>对照组视蛋白灰度值>FDM组视蛋白灰度值,任意两组进行比较,差异均有显著性（P < 0.001）。结论 频闪光和形觉剥夺均能建立近视模型,频闪光诱导性近视模型中S-opsin产生增加,而形觉剥夺性近视模型中S-opsin产生减少,说明两种近视模型的发生机制可能不同。     

肾上腺髓质素对人牙髓干细胞增殖和分化的影响

目的 探讨肾上腺髓质素（adrenomedullin,ADM）对人牙髓干细胞（dental pulp stem cells,DPSCs）增殖、成牙本质分化能力的影响。方法 体外培养的人DPSCs传至第3代,培养液中加入不同浓度ADM（10^-6、10^-7及10^-8 mol/L）处理细胞24 h,并设置空白对照组。流式细胞术检测细胞周期及细胞凋亡,定量PCR和蛋白质印迹法检测成牙本质分化标记物碱性磷酸酶（alkaline phosphatase,ALP）的mRNA及蛋白表达。结果 细胞周期检测结果显示,3种浓度ADM干预DPSCs后G₂/S/M期细胞比例均较空白对照组上升（P<0.05）,但各干预组间差异无统计学意义; 细胞凋亡检测结果显示,3种浓度ADM干预组的Annexin Ⅴ⁺/PI^-标示细胞比例均较空白对照组下降（P<0.05）,但各干预组间差异无统计学意义; 定量PCR及蛋白质印迹检测结果显示,DPSCs中ALP mRNA及蛋白表达较空白对照组上升（P<0.01）,但各干预组间差异无统计学意义。结论 ADM具有促进DPSCs的增殖、抑制凋亡及促其向成牙本质分化的作用。     

注血量致大鼠急性硬膜下血肿模型稳定性的探讨

目的 探讨不同体积的自体血液致大鼠硬膜下血肿模型稳定性的影响。方法 将大鼠随机分为假手术组和300 μL、500 μL、700 μL(即分别向硬膜下注射300 μL、500 μL、700 μL的自体血液)模型组。分别于术后第2、4、6、8、10、14 天,每组各取6只,以腹主动脉取血,取脑组织,并采用酶联免疫吸附(ELISA)方法测定各组大鼠血浆中NSE、S100B蛋白的含量。结果 与假手术组比较,300 μL组血液的NSE在第2、4 天时显著增加(P<0.01),在第6、8 天时渐渐减少(P<0.05),说明血肿开始消散,在第10、14 天时恢复到接近假手术组(P>0.05);500 μL组和700 μL组的NSE含量在第2、6、8、10、14 天时都显著升高(P<0.01),而在第4天时升高不明显(P>0.05)。300 μL组血液的S100B蛋白含量在第4 天时较高(P<0.01),在第2、6 天时较低(P<0.05),在第8、10、14 天时含量接近假手术组(P>0.05),说明血肿自行消散,损伤自行修复;500 μL组和700 μL组的S100B蛋白含量一直处于较高的状态(P<0.05)。结论 相对于300 μL组和700 μL组,500 μL组下的大鼠急性硬膜下血肿模型稳定性更好,能够更好的应用于大鼠急性硬膜下血肿的实验研究。     

活性氧对背根神经节P2X3受体介导的痛信号功能的影响

目的 探讨活性氧（reactive oxygen species,ROS）对P2X3受体介导的神经病理性疼痛作用的影响。方法 用成年雌性SD大鼠建立背根神经节慢性压迫（CCD）神经病理性疼痛模型,建模成功后随机分为4组（每组10只）,经腹腔分别注射生理盐水（NS）、PBN 100 mg/kg、PBN 30 mg/kg、PBN 10 mg/kg,给药30 min后,经足底注射P2X3受体特异性激动剂α,β-meATP 50 nmol,体积为50 μL,持续观察注射后15 min内的自发缩足次数和主动悬足时间,并整合计算每2 min内的综合悬足时间（PLTPM）。结果 PBN能够剂量依赖性抑制由α,β-meATP引发的自发性痛行为,与NS组比较,PBN 100 mg/kg组在前6 min内能明显抑制自发性疼痛,差异具有统计学意义（P<0.05）,而PBN 30 mg/kg组大鼠仅在2至4 min时间单位表现出差异有统计学意义（P<0.05）。结论 氧自由基清除剂可以有效缓解由CCD模型引发的神经病理性疼痛及P2X3受体激动剂诱发的自发痛,ROS可能作为信号分子参与了P2X3受体介导的痛觉信息的传递。     

Prevalence of dysglycaemic events among inpatients with diabetes mellitus: a Singaporean perspective

INTRODUCTION

As the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control.

METHODS

A retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded. Dysglycaemia prevalence was calculated as proportions of BG-monitored days with at least one reading exceeding the cut points of 8, 10 and 15 mmol/L for hyperglycaemia, and below the cut point of 4 mmol/L for hypoglycaemia.

RESULTS

Among the 288 patients recruited, hyperglycaemia was highly prevalent (90.3%, 81.3% and 47.6% for the respective cut points), while hypoglycaemia was the least prevalent (18.8%). Dysglycaemic patients were more likely than normoglycaemic patients to have poorer glycated haemoglobin (HbA1c) levels (8.4% ± 2.6% vs. 7.3% ± 1.9%; p = 0.002 for BG > 10 mmol/L) and longer lengths of stay (10.1 ± 8.2 days vs. 6.8 ± 4.7 days; p = 0.007 for BG < 4 mmol/L). Hyperglycaemia was more prevalent in patients on more intensive treatment regimens, such as basal-bolus combination therapy and the use of both insulin and oral hypoglycaemic agents (100.0% and 96.0%, respectively; p < 0.001 for BG > 10 mmol/L).

CONCLUSION

Inpatient glycaemic control is suboptimal. Factors (e.g. type of treatment regimen, discipline and baseline HbA1c) associated with greater prevalence of dysglycaemia should be given due consideration in patient management.     

Prolonged hepatitis and jaundice: a rare complication of paediatric Epstein-Barr virus infection

We herein report the case of a 14-year-old girl with Epstein-Barr virus (EBV) infectious mononucleosis who developed prolonged hepatitis and jaundice. At presentation, she had tender hepatomegaly with a markedly deranged liver function test. Abdominal ultrasonography showed hepatomegaly and a thickened gallbladder wall. During the subsequent 11 weeks, her transaminases showed two further peaks, which corresponded with clinical deterioration. Her highest alanine transaminase level was 1,795 µ/L and total bilirubin level was 154 µmol/L. She recovered fully with conservative management. EBV-related liver involvement is typically mild and self-limiting. We believe that tender hepatomegaly and gallbladder thickening may be important predictors of significant liver involvement. Although multiple transaminase peaks may occur, we do not consider this an indication for antiviral or immunosuppressive therapy. In the absence of strong evidence supporting the use of any specific therapy, we recommend a conservative approach for an immunocompetent patient.     

The effects of the Trendelenburg position and the Valsalva manoeuvre on internal jugular vein diameter and placement in children

INTRODUCTION

We compared the effects of various surgical positions, with and without the Valsalva manoeuvre, on the diameter of the right internal jugular vein (RIJV).

METHODS

We recruited 100 American Society of Anesthesiologists physical status class I patients aged 2–12 years. The patients’ heart rate, blood pressure, peripheral oxygen saturation and end-tidal CO₂ pressure were monitored. Induction of anaesthesia was done using 1% propofol 10 mg/mL and fentanyl 2 µg/kg, while maintenance was achieved with 2% sevoflurane in a mixture of 50/50 oxygen and air (administered via a laryngeal mask airway). The RIJV diameter was measured using ultrasonography when the patient was in the supine position. Thereafter, it was measured when the patient was in the supine position + Valsalva, followed by the Trendelenburg, Trendelenburg + Valsalva, reverse Trendelenburg, and reverse Trendelenburg + Valsalva positions. A 15° depression or elevation was applied for the Trendelenburg position, and an airway pressure of 20 cmH₂O was applied in the Valsalva manoeuvre. During ultrasonography, the patient’s head was tilted 20° to the left.

RESULTS

When compared to the mean RIJV diameter in the supine position, the mean RIJV diameter was significantly greater in all positions (p < 0.001) except for the reverse Trendelenburg position. The greatest increase in diameter was observed in the Trendelenburg position with the Valsalva manoeuvre (p < 0.001).

CONCLUSION

In paediatric patients, the application of the Trendelenburg position with the Valsalva manoeuvre gave the greatest increase in RIJV diameter. The reverse Trendelenburg position had no significant effect on RIJV diameter.     

An audit of preoperative fasting compliance at a major tertiary referral hospital in Singapore

INTRODUCTION

To avoid the risk of pulmonary aspiration, fasting before anaesthesia is important. We postulated that the rate of noncompliance with fasting would be high in patients who were admitted on the day of surgery. Therefore, we surveyed patients in our institution to determine the rate of fasting compliance. We also examined patients’ knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting.

METHODS

Patients scheduled for ‘day surgery’ or ‘same day admission surgery’ under general or regional anaesthesia were surveyed over a four-week period. The patients were asked to answer an eighteen-point questionnaire on demographics, preoperative fasting and attitudes toward fasting.

RESULTS

A total of 130 patients were surveyed. 128 patients fasted before surgery, 111 patients knew that they needed to fast for at least six hours before surgery, and 121 patients believed that preoperative fasting was important, with 103 believing that preoperative fasting was necessary to avoid perioperative complications. However, patient understanding was poor, with only 44.6% of patients knowing the reason for fasting, and 10.8% of patients thinking that preoperative fasting did not include abstinence from beverages and sweets. When patients who did and did not know the reason for fasting were compared, we did not find any significant differences in age, gender or educational status.

CONCLUSION

Despite the patients’ poor understanding of the reason for fasting, they were highly compliant with preoperative fasting. This is likely a result of their perception that fasting was important. However, poor understanding of the reason for fasting may lead to unintentional noncompliance.     

Short-term result of arthroscopic synovial excision for dorsal wrist pain in hyperextension associated with synovial hypertrophy

INTRODUCTION

Arthroscopic excision of the hypertrophic dorsal synovium is performed on patients with dorsal wrist pain in hyperextension. Although dorsal wrist impingement has been described in cadaveric studies, to our knowledge, there is no published clinical data on its treatment with arthroscopic synovial excision. Herein, we present the results of arthroscopic management of this condition in our hospital.

METHOD

A total of 13 patients underwent arthroscopic excision of the hypertrophic dorsal impinging synovium. All patients presented with the cardinal symptom of dorsal-radial wrist pain in extreme extension. The diagnoses were made after excluding other causes and confirmed on wrist arthroscopy. Arthroscopy was offered after nonoperative measures failed. The mean postoperative follow-up period was 14 (range 6–31) months.

RESULTS

Mean pre-and postoperative quick Disabilities of the Arm, Shoulder and Hand scores were 49 (range 34–82) and 17 (range 0–48), respectively; paired t-test revealed a significant difference between the two (p < 0.001). Mean postoperative flexion-extension arc and radial-ulnar deviation arc were 120º and 46º, respectively. Postoperatively, one patient developed complex regional pain syndrome, with tethering of the dorsal branch of the ulnar nerve, which required surgical release, while another patient required revision arthroscopic excision of the impinging tissue. Both patients had good postoperative outcomes.

CONCLUSION

When treating patients with dorsal wrist pain, dorsal wrist impingement caused by synovial hypertrophy should be included in the differential diagnosis. Arthroscopic excision of the impinging synovium can achieve reliable pain relief with significant functional improvement in the short term, although further research on its long-term benefits is required.     

Dural metastasis of nasopharyngeal carcinoma: rare,but worth considering

Metastasis of nasopharyngeal carcinoma (NPC) to the dura, an extremely rare condition, can be symptomatically silent and mistaken for a benign entity radiographically. Missed diagnosis can lead to serious consequences or prove immediately fatal. We report a woman with dural metastasis of NPC that mimicked a meningioma on radiography. Craniectomy with tumour resection was performed due to rapid progression from the onset of symptoms to disability. The patient was still alive two years after surgery. This case emphasises the need to keep in mind the possibility of dural metastasis of NPC in patients with abnormal imaging features. This would not only avoid wrong and optimistic diagnosis, but also allow for appropriate treatment in a timely manner. To our knowledge, this is the first report of metastasis of NPC to the dura. We provide detailed information on the neoplastic lesion, which masqueraded as a benign entity and caused potentially fatal consequences.     

Electrocardiographic findings in pulmonary embolism

Pulmonary embolism (PE) poses a challenge to physicians, as it can be difficult to diagnose but results in significant mortality and morbidity in patients. Diagnosing PE requires an integrated approach using clinical findings, electrocardiography (ECG), blood investigations and imaging modalities. Abnormalities in ECG are common among patients with massive acute PE and can serve as a prognostic indicator. In this article, we describe the ECG presentations of two patients diagnosed with PE, and review the literature on the various types of ECG presentations and their role in predicting the prognosis of PE.     

Clinical characteristics,outcome and early induction deaths in patients with acute promyelocytic leukaemia: a five-year experience at a tertiary care centre

INTRODUCTION

Acute promyelocytic leukaemia (APL) is a distinct clinical and biological subtype of acute myeloid leukaemia. APL is notorious for causing early death during induction therapy, resulting in induction failure. The aim of our study was to report the clinical characteristics, outcome and early induction deaths with regard to patients with APL seen at our hospital.

METHODS

This was a retrospective study carried out at Aga Khan University Hospital, Karachi, Pakistan. Patients aged > 15 years diagnosed with APL within the period September 2007–September 2012 were included in the study.

RESULTS

Within the study period, 26 patients were diagnosed with APL based on morphology and the detection of t(15;17)(q24.1;q21.1) and promyelocytic leukaemia-retinoic acid receptor alpha (PML-RARA). The male to female ratio was 1:1. The median age of the patients was 41 (range 16–72) years. In all, there were 13 (50.0%) high-risk patients, and early induction death rate was 61.5%. Causes of early induction deaths (n = 16) included haemorrhage in 7 (43.8%) patients, differentiation (ATRA) syndrome in 7 (43.8%) and infection in 2 (12.5%). The survival rate among patients who survived the early period was 70% at 42 months. The relapse rate was 30%.

CONCLUSION

Early induction death rate was very high in patients with APL. The most common cause of early induction death in our study was haemorrhage. Outcome among patients with APL was found to be better among those who survived the initial period.     

Pedestrian injuries in children: who is most at risk?

INTRODUCTION

This study evaluates the demographics of paediatric pedestrian injuries with the aim of identifying the group of children who is most vulnerable and the risk factors for major trauma (MT).

METHODS

Data was extracted from the integrated trauma system of a regional paediatric referral hospital. All paediatric cases involving road traffic accidents from January 2011 to December 2013 were studied. Demographics, injury mechanism, treatment and outcome were evaluated. Patients were categorised as MT or non-MT (NMT) based on their Injury Severity Score, admission to the intensive care unit, type of surgery (e.g. life/limb-saving) and death. Data analysis was done using nonparametric tests and Fisher’s exact test.

RESULTS

A total of 261 children were admitted for pedestrian injuries during the study period. The median age was ten years (range 14 months–16 years) and the median weight was 42.4 (range 8.6–93.7) kg. Half (i.e. 50.2%) of the children were primary-schoolers. The majority of the accidents occurred on roads (i.e. 83.1%), between 12 pm and 6 pm (i.e. 52.8%). Among the 261 children, 177 (67.8%) were unaccompanied by an adult at the time of the accident; 17 (6.5%) children sustained MT, while 244 (93.5%) suffered NMT. MT patients were more likely to have lost consciousness (p < 0.001) and been flung (p = 0.001).

CONCLUSION

Most paediatric pedestrian injuries involved primary-schoolers walking home from school unaccompanied by adults. This information should inform future road safety campaigns. Being flung and loss of consciousness predicted MT in children who sustained pedestrian injuries.     

Cerebrovascular ischaemia after carbon monoxide intoxication

Carbon monoxide intoxication is the most prevalent cause of death from carbon monoxide poisoning. We herein report the case of a 56-year-old man who was found unconscious and smelled of smoke after exposure to carbon monoxide from a heater. He scored 5 on the Glasgow Coma Scale, and had respiratory insufficiency and elevated troponin I, creatine kinase-MB fraction and carboxyhaemoglobin levels. He was treated by mechanical ventilation. After regaining consciousness, brain magnetic resonance imaging showed diffusion restriction in the left occipital lobe; there was a loss of vision (right temporal hemianopsia), which improved by the follow-up session. Carbon monoxide intoxication may cause neurologic and cardiac sequelae, and the initial treatment includes oxygen therapy. Acute carbon monoxide poisoning can cause serious injury to the brain, heart and other organs; the most severe damages that could be inflicted to the brain include cerebral ischaemia and hypoxia, oedema, and neural cell degeneration and necrosis.