Evaluation of the individual effects of a health education program for sodium restriction by a simple method for measuring 24-hour urinary sodium excretion

A simple method for measuring 24-hr urinary sodium excretion was applied to the evaluation of the individual effects of a health education program for sodium restriction in a rural community in Japan. Eighteen subjects (6 males and 12 females) between 35 and 72 years of age were advised to reduce their sodium intake. Twenty-four-hour urinary sodium, potassium excretion, and sodium/potassium ratio were measured using the simple method for seven consecutive days in three periods which were before the sodium restriction, 6 months after the sodium restriction, and 6 months after the end of the program. Mean sodium excretion of 18 subjects significantly decreased (p less than 0.05) after the end of the program. The reduced level was maintained until six months after the end of the program. Within individual cases, sodium excretion decreased significantly in subjects who had levels higher than 170 mmol at the initial stage. The reduced levels of sodium excretion were maintained until six months after the end of the program except for one subject. The subjects who had an initial level lower than 170 mmol of sodium, which is the upper limit of present recommendation for Japanese adults, did not change their levels.     

24-hour ECG monitoring in cardiac fibrillation

AIM: To elucidate clinical value of 24-h ECG monitoring followed by analysis of cardiac rhythm structure in patients with perpetual cardiac fibrillation (CF). MATERIALS AND METHODS: 24-h ECG monitoring has been performed 163 times in 142 patients aged 33-82 years. Interval histograms and cardiointervalograms of R-R intervals were performed. RESULTS: 24-h ECG monitoring has shown the phenomena which can be used for perfection of the diagnosis and treatment: features of 24-h changes in heart rate; features of ventricular ectopy; periods of asystole; preclinical signs of hyperdigitalization; frequency-related shift of ST segment. CONCLUSION: 24-h ECG monitoring in patients with perpetual CF provides valuable diagnostic information. Therefore, it should be conducted in all of them irrespective of subjective state and routine ECG data, especially in deciding on antiarrhythmic therapy.     

点尿法及24 h尿收集法估算高血压病患者24 h尿钠钾排泄量的应用比较

目的探讨利用点尿法及24 h尿收集法估算高血压病患者24 h尿钠钾排泄量的应用价值。 方法研究对象为2017年2月至2018年1月就诊于新疆医科大学第一附属医院高血压科的高血压病患者,共264例。收集患者24 h尿及相应的清晨空腹点尿,分别测定所有尿样的钠、钾、肌酐水平。采用Tanaka、Kawasaki和INTERSALT公式分别估算点尿法24 h尿钠钾排泄量,采用配对秩和检验比较公式估算值与实际测量值的差异;利用Spearman相关分析评价各公式估算的24 h尿钠钾排泄量与实测24 h尿钠钾排泄量的相关关系。 结果Tanaka法公式估算的24 h尿钠值(167.99 mmol/d)高于实际24 h尿钠值(157.73 mmol/d),差异无统计学意义(Z＝－0.23,P>0.05);Kawasaki法公式估算的24 h尿钠值(217.66 mmol/d)亦高于实际24 h尿钠值,差异有统计学意义(Z＝－8.81,P<0.01);INTERSALT法公式估算的24 h尿钠值(154.71 mmol/d)低于实际24 h尿钠值,差异有统计学意义(Z＝－3.53,P<0.01)。Tanaka、Kawasaki和INTERSALT公式估算的24 h尿钠值与实际24 h尿钠值的相关系数分别为0.68,0.55,0.58(均P<0.01);Tanaka公式估算的24 h尿钾值(39.51 mmol/d)低于实际测量值(42.90 mmol/d),差异有统计学意义(Z＝－3.47,P<0.05),相关系数为0.50(P<0.01)。 结论在高血压病患者中,公式法估算的24 h尿钠钾排泄量与实际测量值,存在不同程度的低估与高估,且相关性差。利用点尿法公式估算高血压病患者24 h尿钠钾排泄量存在一定程度的不准确性和局限性。     

GERD患者24h食管pH动态监测

目的　对 30例患有胃食管反流病 ( gastroesophagealrefluxdisease,GERD)的患者进行 2 4h食管动态pH值监测、探讨 2 4hpH值与胃食管反流 (GER)之间的关系 ,从而对GERD的发生、发展、预后提供科学依据。方法　 30例患者采用SynectisDigitrapperMKⅢ动态 pH监测仪及计算机分析用软件动态监测 2 4hpH值。采用Johson和DeMeester 6种参数指标对患者进行综合评分以反映病人的反流程度 ,通过症状指数的计算来比较有症状及无症状时食管反流 pH检测资料。 结果　 6种参数指标正常组分别为 ( 1.34± 1.10 ,1.6 0±1.2 4 ,1.10± 1.6 0 ,30 .0± 11.5 ,0 .75± 0 .2 0 ,6 .2± 5 .90 ) ,病例组分别为 ( 13.5 2± 8.4 7,12 .2 7± 4 .99,16 .94±4 .99,5 6 .2 4± 13.98,4 .12± 2 .4 8) ,两组经方差检验 ,差异显著 (P <0 .0 1)。病例组各参数诊断阳性率如下 :其中 pH <4的总时间阳性率为 90 % ,2 4h内pH <4超过 5min的反流次数阳性率为 80 % ,症状指数≥ 5 0 %的阳性率为 80 % ,总分 >14 .72的阳性率为 80 % ,立位 pH <4的总时间 %为 5 7% ,卧位 pH <4的总时间 %为87%。结论　我们认为pH <4的总时间 ( % )、pH <4长于 5min反流次数这二个参数指标结合症状指数及综合评分是判断GERD的重要指标。     

Clinical use of 24-hour ambulatory blood pressure monitoring

Knowing a patient's continuous 24-hour blood pressure measurements can be useful to the nurse practitioner in evaluating the hypertensive patient. Recent studies have demonstrated end-organ damage to have a higher degree of correlation with 24-hour blood pressure readings than with more periodic blood pressure readings. Previously, 24-hour ambulatory blood pressure determinations were evaluated primarily in research settings. The ability to obtain these readings for diagnostic information applicable to clinical situations is becoming readily available. The historical background leading to the development of the ambulatory blood pressure monitors for clinical use is reviewed. The indications for obtaining 24-hour ambulatory pressures, interpretation of specific graphs and patient outcome are explained.     

哮喘患者24小时食管酸碱度监测的护理

总结30例哮喘患者24 h食管酸碱度监测的护理。认为重点是加强心理护理,完善各项准备工作,监测时定时更换体位,正确记录,提高监测数据的准确性,同时指导患者采取健康的生活方式,以改善症状和控制疾病的复发。     

Total body potassium and 24-hour creatinine excretion in healthy males.

Total body potassium may be predicted from height, weight, and age by TBKmmol = 30.83 Hcm + 18.05 Wkg - 11 (ageyr - 20) - 3034. This equation, based on measurements of 31 men, has been compared with others in the literature. Prediction of 24-hr creatinine (CR), excretion derived from 33 control adults whose excretion rates gave a coefficient of variation less than 13%, may be made from the equation: CRgm = 0.0143 Hcm + 0.00975 Wkg - 0.00734 (ageyr -20) -1.391. For 31 chronic schizophrenics, the corresponding equation CRgm = 0.0122 Hcm + 0.0145 Wkg - 1.611 contained no age correction. The relationship between CR and TBK is expressed by CRgm = 0.000403 TBKmmol + 0.278. Discussion of significance of these equations in the light of extensive literature suggests that about half of the error variance in predicting CR may be explained by the lack of suitable data on somatotype and much of the residual variance, including the day-to-day variation in CR, relate to factors altering basal O2 consumption. The predictors given should prove generally satisfactory for many metabolic and drug studies.     

Simple spectrophotometric quantification of urinary excretion of glycosaminoglycan sulfates

We describe a simple, rapid, precise, and sensitive spectrophotometric method for measuring urinary glycosaminoglycan (GAG) sulfate excretion. The GAG sulfates are precipitated with cetylpyridinium chloride, resuspended in water, and mixed with the basic dye 1,9-dimethylmethylene blue to produce a complex with the polyanionic molecule of sulfated GAGs. Absorbance is read at 535 nm. The standard curve for reaction was linear up to 12 micrograms of the different GAGs: dermatan sulfate, heparan sulfate, keratan sulfate, chondroitin 4-sulfate, and chondroitin 6-sulfate. Within- and between-run precision (CV), measured at three different GAG concentrations (normal and pathological), varied from 1.6% to 2.5% and from 1.8% to 4.5%, respectively. Analytical recovery ranged from 71% to 107%. Urinary GAG excretion, measured by this procedure, correlates (r = 0.837; p less than 0.001) with the values obtained with the borate-carbazole reaction (Anal Biochem 1962;4:330-4).     

Simple microplate method for determination of urinary iodine

BACKGROUND: Urinary iodine is a good biochemical marker for control of iodine deficiency disorders. Our aim was to develop and validate a simple, rapid, and quantitative method based on the Sandell-Kolthoff reaction, incorporating both the reaction and the digestion process into a microplate format. METHODS: Using a specially designed sealing cassette to prevent loss of vapor and cross-contamination among wells, ammonium persulfate digestion was performed in a microplate in an oven at 110 degrees C for 60 min. After the digestion mixture was transferred to a transparent microplate and the Sandell-Kolthoff reaction was performed at 25 degrees C for 30 min, urinary iodine was measured by a microplate reader at 405 nm. RESULTS: The mean recovery of iodine added to urine was 98% (range, 89-109%). The theoretical detection limit, defined as 2 SD from the zero calibrator, was 0.11 micromol/L (14 microg/L iodine). The mean intra- and interassay CVs for samples with iodine concentrations of 0.30-3.15 micromol/L were < or = 10%. The new method agreed well with the conventional chloric acid digestion method (n = 70; r = 0.991; y = 0.944x + 0.04; S(y|x) = 0.10) and with the inductively coupled plasma mass spectrometry method (n = 61; r = 0.979; y = 0.962x + 0.03; S(y|x) = 0.20). The agreement was confirmed by difference plots. The distributions of iodine concentrations for samples from endemic areas of iodine deficiency diseases showed similar patterns among the above three methods. CONCLUSIONS: Our new method, incorporating the whole process into a microplate format, is readily applicable and allows rapid monitoring of urinary iodine.     

Clinical significance of 24-hour intraesophageal pH monitoring in GERD patients

24-hour intraesophageal pH monitoring(24-pH-M) is a method of choice to measure the esophageal acid exposure, and evaluate a patient's lifestyle who has reflux symptoms. The 24-pH-M is indicated to the cases who have at least one of the following signs/symptoms; endoscopy negative GERD(gastroesophageal reflux disease), atypical clinical course for reflux disease, atypical symptoms of GERD, and those who are subjected to have surgical treatment. In the 24-pH-M, not only the duration of gastroesophageal reflux(GER), but also reflux and symptom association should be evaluated. The 24-pH-M is useful to investigate the diagnosis and treatment of GERD including reflux esophagitis.     

Contrasting effects of lovastatin and cholestyramine on low-density lipoprotein cholesterol and 24-hour urinary mevalonate excretion in patients with heterozygous familial hypercholesterolemia

To further validate the usefulness of quantitative measurements of urinary mevalonic acid excretion as an indicator of rates of cholesterol biosynthesis, we have determined the 24-hour urinary excretion of mevalonic acid in patients with heterozygous familial hypercholesterolemia treated with drugs that have opposing effects on cholesterol biosynthesis. In patients with familial hypercholesterolemia treated with the bile acid sequestrant cholestyramine (16 gms/day), urinary mevalonate excretion increased by 28%, whereas low-density lipoprotein cholesterol concentrations decreased by 21%. In patients with familial hypercholesterolemia treated with the 3-hydroxy 3-methyl glutaryl coenzyme A reductase inhibitor lovastatin (80 mg/day), concentrations of low-density lipoprotein cholesterol and the urinary excretion of mevalonate both decreased (by 40% and 34%, respectively). When cholestyramine was used in combination with lovastatin, low-density lipoprotein cholesterol levels decreased by an additional 14% as compared to monotherapy with lovastatin; urinary mevalonate excretion rose by (25%), but the magnitude of this increase was not statistically significant. We conclude that rates of excretion of urinary mevalonic acid (which may reflect rates of whole body cholesterol biosynthesis) in patients with FH decrease on therapy with lovastatin and increase in response to cholestyramine treatment. When used in combination, these drugs counteract each other's effects on cholesterol synthesis, but low-density lipoprotein cholesterol concentrations decrease further. Measurement of urinary mevalonate excretion affords a practical means of assessing the comparable effects of different dietary or pharmaceutical manipulations on cholesterol biosynthesis in human beings.     

Urinary excretion of deoxypyridinoline in 24-hour and first-void samples in healthy Turkish children

OBJECTIVES: Collagen cross-links are formed during the maturation process of bone matrix. They have been considered as valuable markers in some metabolic, endocrinologic, and neoplastic bone disorders. As an advantage, it can be measured in urine as well as in serum samples. However, the excretion characteristics remains controversial. DESIGN AND METHODS: We investigated urinary free deoxypyridinoline (f-Dpd) excretion in first-void urine samples and in 24-hour collections in healthy Turkish children. We also evaluated the possible correlations and gender-related differences in Dpd excretion between these sampling methods. Both urine samples of 62 subjects (aged from 31 to 120 months) were analyzed by Immulite chemiluminescent technique. RESULTS: There were no remarkable differences in f-Dpd excretion between first-void and 24-hour urine samples, although f-Dpd values of the first-void samples were slightly higher (Dpd: creatinine, mean +/- SD, 20.5 +/- 5.8 nmol/mmol vs. 19.6 +/- 5.6 nmol/mmol, respectively, p > 0.05). A strong linear correlation was found between 24-hour and first-void urine f-Dpd excretions (r = 0.77, p < 0.05). In addition, f-Dpd showed no gender-related differences between boys and girls in either 24-hour or first-void urine samples (p > 0.05). CONCLUSIONS: Because of difficulties in long-time urine collection in infants and young children, f-Dpd assessment in first-void single urine samples is an easy, safe, and non-invasive method.     

Validity of urinary urea nitrogen as a measure of total urinary nitrogen in adult patients requiring parenteral nutrition

The validity of the urinary urea nitrogen (UUN) estimate of total urinary nitrogen (TUN) was tested in patients who required iv nutrition. UUN and TUN were determined in 120 urine collections from ten preoperative, 13 postoperative, and 11 stressed patients. The relationship between TUN and UUN was examined by linear regression, and analysis of covariance was used on log-transformed data to assess differences between the patient groups. Although there was a close relationship between UUN and TUN for the preoperative patients (r2 = .94, total range of differences = 3.85 g N), this was not as accurate in postoperative and stressed patients (r2 = .69 and .76, respectively, total range of differences = 16.8 and 10.7 g N, respectively). There was no significant difference between the slopes of the regression lines for the relationship between UUN and TUN for three groups (f = 1.1, df = 2114, p less than .3), but the intercepts of the regression lines differed between the preoperative and stressed patient groups (t = 3.47, v = 114, p less than .001). The relationship between TUN and UUN for the whole group was improved by the inclusion of the independent variables of both the patient's clinical state and the urinary creatinine excretion. Arm muscle circumference, which is an estimate of muscle mass, may replace creatinine excretion with little loss in prediction accuracy.     

24-hour ambulatory blood pressure monitoring in male children receiving stimulant therapy

OBJECTIVE: To determine whether cardiac indices are altered as assessed by 24-hour ambulatory blood pressure monitoring (ABPM) in male children receiving either chronic methylphenidate or dextroamphetamine/levoamphetamine (Adderall) therapy. METHODS: Boys 7-11 years old who were receiving methylphenidate or Adderall for a minimum of 2 months were asked to participate. Subjects wore ambulatory blood pressure monitors for 24-hour periods both off and on stimulant therapy. RESULTS: Subjects (n = 17; 8 methylphenidate, 9 Adderall) were well matched. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate differed between off and on stimulant therapy (p < 0.05). DBP load calculated from ABPM reference data was increased significantly (9.0% +/- 5.6% on and 4.8% +/- 4.5% off therapy; p < 0.05) while subjects were taking Adderall. There was a trend toward a greater elevation in blood pressure load during awake hours and a more pronounced decrease during the asleep hours for periods on compared with off-stimulant therapy. This trend resulted in significant (p < 0.05) nocturnal dipping on-stimulant phases compared with off-stimulant therapy for both SBP and DBP (Adderall) and SBP (methylphenidate). Two subjects (1 Adderall, 1 methylphenidate) met the criteria to be considered hypertensive based both on mean awake and 24-hour blood pressure load assessments during their on-treatment period. One additional subject receiving Adderall therapy met the criteria to be considered hypertensive based on blood pressure load criteria while off therapy only. Positive correlation coefficients (p < 0.05) were found when comparing stimulant dose (mg/kg) with the percent change of mean SBP, DBP, and heart rate between off and on therapy (r = 0.56, 0.61, and 0.58, respectively). CONCLUSIONS: These preliminary data suggest that blood pressure and heart rate appear to be altered in male patients while receiving stimulant therapy for attention-deficit hyperactivity disorder. Blood pressure and heart rate screening and monitoring during stimulant therapy to determine whether alterations become clinically significant is encouraged.     

血管迷走性晕厥儿童24h尿电解质含量变化

目的 探讨血管迷走性晕厥儿童24 h尿电解质含量变化,对临床补盐补液治疗提供依据.方法 2004-06～2007-04在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因晕厥或先兆晕厥儿童79例(晕厥组),男31例,女48例,平均年龄(11.18±2.47)岁.匹配健康儿童11例为对照(对照组).研究对象留取24 h尿,测量尿量后,采用日本HITACHI公司7600-020全自动生化分析仪检测24 h尿电解质(钾、钠、氯、钙、磷、镁)含量.结果 ①晕厥组24 h尿量较对照组减少(P>0.05),24 h尿电解质含量变化不明显(P>0.05),每毫升尿钠和尿钙增加(P<0.01或P<0.05).②晕厥儿童HUTT阳性组24 h尿钠、尿钾较HUTT阴性组明显增加(P<0.05),每毫升尿钠增加(P<0.05).③晕厥儿童24 h尿电解质含量和每毫升尿电解质含量在血管抑制型与心脏抑制型 混合型组、男女性别、<12岁组与≥12岁组、晕厥频次<4次组和晕厥频次≥4次组之间比较差异无统计学意义(P>0.05).结论 24 h尿钠含量增加与VVS发病关系密切,临床治疗VVS要强调健康教育,重视补盐补液方案.