Effectiveness of an Intravenous Protection Device in Pediatric Patients on Catheter Dwell Time and Phlebitis Score

PurposeThe study aimed to examine the efficacy of the I.V. House UltraDressing for protecting peripheral intravenous catheters (PIVCs) in pediatric patients.MethodsThis randomized controlled trial comprised 60 pediatric patients (aged 2–24 months): 30 in the experimental group and 30 in the control group. The PIVC dwell time and phlebitis scores were also reported for both groups. The degree of phlebitis was determined using the Visual Infusion Phlebitis Scale (VIPS) and was recorded every 8 hours from the start of antibiotic therapy until catheter removal.ResultsThe mean catheter dwell time in the experimental group (2.10 ± 1.55 days) was significantly longer than that in the control group (1.27 ± 0.45 days) (p < .01). However, there were no significant differences between the scores and signs of phlebitis in both groups (p > .05).ConclusionThe I.V. House UltraDressing is a useful device that can be used to increase catheter dwell time and protect and stabilize PIVCs in pediatric patients.     

Association of optic nerve sheath diameter measurement with hyponatremia in emergency department

ObjectiveInvestigation of association of ONSD with hyponatremia in symptomatic patients.Methods89 patients who were diagnosed to have hyponatremia (Na + <135 mmol/L) were prospectively analyzed and compared with 72 patients who have normal serum sodium levels presented to ED at the same time interval. Subjects' demographic properties including age and sex were recorded, as were admission symptoms, serum Na + level, and pre-treatment and post-treatment optic nerve sheath diameter (ONSD).ResultsThe mean age of the study population was 62.3 ± 17.6 years, and the control group 55.1 ± 20.0 years (p < 0.05). There was a significant difference between the patient group's pre-treatment and post-treatment OSNDs compared to the controls (p < 0.05). There was a significant negative correlation between the admission sodium level and ONSD in the patient group (p < 0.05). In the pre-treatment period, patients with symptoms had a significantly greater mean ONSD than those without symptoms (0.546 ± 0.068 mm vs 0.448 ± 0.081 mm; p < 0.05). The area under the curve was 0.870; the cut-off level calculated for hyponatremia was 0.49 mm, which had a sensitivity of 81% and a specificity of 81.9%.ConclusionUltrasonic imaging of ONSD measurement in the emergency department appears to reflect changes consistent with ICP changes in hyponatremia and change in serum sodium.     

Kopfschmerz – diagnostisches Vorgehen

In headache diagnosis primary and secondary “symptomatic” headache disorders have to be distinguished. Although there are more than 300 medical conditions that can cause headache, the majority of headaches are benign. The basic tool for diagnosing a primary headache disorder is a careful history, supplemented by a general and neurologic examination without neuroimaging or other confirmatory tests. If a secondary headache disorder is suspected on the basis of the history or clinical examination, further diagnostic tests have to be performed. Neuroimaging can exclude brain tumors, hydrocephalus and intracranial haemorrhage, but its yield in patients with a normal neurologic examination is quite low. Further diagnostic tools such as Doppler and duplex sonography, CSF examination, X-ray and blood tests should be employed with respect to a specific clinical question. EEG is not useful in the routine evaluation of patients with headache.     

Wnt-5a、Wnt-11、CaMKⅡ在良性转归葡萄胎和恶性变葡萄胎中的表达及意义

目的探讨无翅型MMTV整合位点家族成员5a(Wnt-5a)、无翅型MMTV整合位点家族成员(Wnt-11)及Ca~(2+)/钙调素依赖的蛋白激酶Ⅱ(CaMKⅡ)在良性转归及恶性变葡萄胎组织中的表达其临床意义。方法收集2009年3月至2020年3月本院72例葡萄胎患者首次清宫石蜡标本,其中28例为随访发生恶变的葡萄胎(恶变葡萄胎组),44例为随访未发生恶变的葡萄胎(良性转归葡萄胎组),采用免疫组织化学法(IHC)检测上述组织标本中Wnt-5a、Wnt-11及CaMKⅡ蛋白表达情况;采用ROC曲线分析Wnt-5a、Wnt-11及CaMKⅡ蛋白表达对葡萄胎恶变的预测效能。结果恶变葡萄胎组和良性转归葡萄胎组的Wnt-5a(75.00%vs 29.55%)、Wnt-11(82.14%vs 22.13%)及CaMKⅡ(89.29%vs 63.64%)蛋白阳性表达率比较,恶变葡萄胎组均显著高于良性转归葡萄胎组,差异有统计学意义(P<0.05)。多因素Logistic回归结果提示宫腔病变径线≥6 cm(OR=2.328,95%CI:1.518~3.569)、Wnt-5a阳性(OR=3.347,95%CI:1.586~7.062)、Wnt-11阳性(OR=3.873,95%CI:1.664~9.014)及CaMKⅡ阳性(OR=1.355,95%CI:1.057~1.738)是葡萄胎恶变的独立危险因素(P<0.05)。Wnt-11预测葡萄胎恶变的的AUC分别大于宫腔病变径线、CaMKⅡ预测的AUC(P<0.05),与Wnt-5a预测的AUC比较,差异无统计学意义(P>0.05)。结论恶变葡萄胎首次清宫组织中Wnt-5a、Wnt-11及CaMKⅡ蛋白表达较良性转归葡萄胎异常升高,三者对葡萄胎恶变具有较好的预测价值。     

Successful emergency endovascular treatment of juxtarenal and infrarental mycotic aortic aneurysms in patients with small diameter aortae using Cook? Zenith ESLE Stentgrafts

BACKGROUND:

Endovascular repair of mycotic aneurysm is an alternative to open repair if the patho-anatomy is suitable. The aortic size above and below the mycotic aneurysm may be small.

METHODS:

A retrospective review was made of prospectively collected departmental computerised database.

RESULTS:

Three oriental patients with juxta- and infra-renal mycotic aortic aneurysms with a small aortic diameter of 17 mm to 18 mm underwent successful emergency endovascular treatment using Cook^® Zenith ESLE stentgrafts. These are ancillary devices aimed at iliac extensions usually.

CONCLUSION:

This is to our knowledge the first case series of Cook^® Zenith ESLE iliac component endografts for the treatment of aortic mycotic aneurysms with small aortae, and short- and mid-term results are encouraging.KEY WORDS: Endovascular, Mycotic, Small aorta, Oversizing, Cook^®, Zenith ESLE Stentgrafts     

干燥综合征的靶向治疗进展

干燥综合征（SS）是一种以外分泌腺受累为主，可累及全身系统的自身免疫性疾病。患者常因口干、眼干、疲劳、疼痛、脏器受累等，严重影响生活质量。近年来，随着人们对干燥综合征发病机制的深入认识，多种靶向药物正在研发中，有望用于治疗此类患者。     

Arthroplasty in young adults: options,techniques, trends,and results

Total knee arthroplasty (TKA) has been established as a very successful and commonly performed procedure for primary and secondary osteoarthritis, and also for inflammatory arthropathies of the knee in all age groups and both genders. It has predominantly been used as a procedure in the age group of patients 65 years and above. Consequently, the literature is replete with data relevant to various issues associated with TKA in the above 65 years age group population. Although there is reasonable clarity and consensus on the broad parameters of the use of TKA in the above 65 years age group (older), this cannot be said for the same issue as relevant to the below 65 years age group (young adults). Over the last 2 decades there has been an increasing tendency toward the use of TKA in young adults, with some countries reporting a 5-fold increase in the last 10 years [1]. The present article is designed to review the most recent literature specific to this subject and assess it vis-à-vis various issues as listed in the subsequent text, with the aim of highlighting evolving thoughts and trends, which could be useful for decision making by clinicians practicing in the community.     

Schwindel und Kiefergelenkprobleme nach Halswirbelsäulentrauma

Zusammenfassung Nach einem Halswirbels?ulentrauma im Oktober 1999 begannen, begleitet von Kopfschmerzen, Schwindelbeschwerden in Form von Unsicherheitsgefühl und Fallneigung nach links. Eine unfallchirurgische, neurologische und HNO-?rztliche Behandlung konnten das Beschwerdebild nicht beeinflussen. Nach 8 Monaten wurde erstmals eine subjektive Beschwerdefreiheit durch die gezielte Manualtherapie einer funktionellen Kopfgelenkst?rung erreicht. Die Behandlungserfolge hielten jedoch auch bei wiederholter Manualtherapie nur für 2 Tage an. Erst nach dem neuromuskul?re Dysbalancen und St?rungen im Kiefergelenkbereich mit einer Aufbissschiene behandelt worden warn, konnte eine bis heute anhaltende Beschwerdefreiheit erreicht werden. Auch die Kopfgelenkst?rungen waren nicht mehr aufgetreten.     

miR-20a过表达促进VEGF表达及血管平滑肌细胞活性和迁移

目的探讨miR-20a过表达对血管内皮生长因子(VEGF)表达及血管平滑肌细胞(VSMC)活性和迁移的影响,并初步探索其可能的机制。方法将miR-20a mimics转染至VSMC,VSMC分为3组:空白对照(Con)组、阴性对照(miR-NC)组和转染(miR-20a)组。Real-time PCR检测miR-20a的表达变化,Real-time PCR和Western blot检测各组VSMC中VEGF的表达,细胞计数试剂盒(CCK-8)法检测各组VSMC活性变化,Transwell实验检测各组VSMC迁移能力,生物信息学和荧光素酶报告基因实验分析miR-20a对CNN1的靶向关系。结果与miR-NC组比较,转染miR-20a mimics后miR-NC组VSMC中miR-20a的表达明显升高,VEGF m RNA和蛋白表达明显上调,VSMC活性升高,VSMC迁移能力增强,差异均具有统计学意义(P<0.05)。与miR-NC组比较,Con组以上各指标差异均无统计学意义(P>0.05)。荧光素酶报告基因实验结果显示,miR-20a可显著抑制野生型钙调蛋白1(CNN1)相对荧光素酶活性(P<0.05),但对突变型CNN1相对荧光素酶活性无明显抑制作用(P>0.05)。结论过表达miR-20a能够促进VSMC活性和迁移以及VEGF的表达,其作用机制可能与靶向调控CNN1的表达有关。     

Stabilization of the neuromuscular response when switching between different modes of nerve stimulation at surgical degrees of neuromuscular blockade

During general anesthesia, different modes of nerve stimulation are used for estimation of the degree of neuromuscular blockade. When switching between the different modes, it is important to know whether the preceding mode influences the responses to the succeeding mode, and, if so, for how long.The object of our study was to determine the number of stimulations required for stabilization of the muscular response when switching between double-burst stimulation (DBS) applied every 20 sec, train-of-four (TOF) applied every 12 sec, and posttetanic count (PTC) at surgical degrees of neuromuscular blockade.A total of 33 women were anesthetized with fentanyl, thiopental, halothane, and nitrous oxide. A constant degree of neuromuscular blockade was maintained at a twitch height of 4 to 11% of the control twitch height using a continuous infusion of atracurium.The ulnar nerve was stimulated supramaximally at the wrist, and the contraction in the adductor pollicis was measured mechanomyographically. At surgical degrees of neuromuscular blockade, only the first twitch response to TOF stimulation (T1) and the first twitch response to DBS stimulation (D1) are consistently present.When switching from DBS to TOF, 4 to 7 stimulations (56 to 92 sec) were required for stabilization of the T1 response. When switching from TOF to DBS, 3 stimulations (36 to 52 sec) were required for stabilization of the D1 response, and, finally, when switching from PTC to DBS, 5 to 11 stimulations (81 to 201 sec) were required for stabilization of the D1 response. Stabilization of D1 was faster following TOF than following PTC (p<0.01).We conclude that, when switching between different modes of nerve stimulation, the number of stimulations required for stabilization of the responses to the succeeding mode of stimulation depends on the preceding mode.     

声触诊组织成像定量技术对涎腺干燥综合征的诊断价值

目的 探讨声触诊组织成像定量技术(VTIQ)对涎腺干燥综合征的诊断价值.方法 收集2018年11月至2019年12月兰州医科大学第二医院干燥综合征患者50例(试验组)和同期健康志愿者60名(对照组),运用VTIQ技术分别测量双侧腮腺及颌下腺剪切波速度(SWV),采用t检验比较2组患者SWV值的差异,绘制受试者操作特征(...     

Salmonella typhimurium persists within macrophages in the mesenteric lymph nodes of chronically infected Nramp1+/+ mice and can be reactivated by IFNgamma neutralization

Host-adapted strains of Salmonella are capable of establishing a persistent infection in their host often in the absence of clinical disease. The mouse model of Salmonella infection has primarily been used as a model for the acute systemic disease. Therefore, the sites of long-term S. typhimurium persistence in the mouse are not known nor are the mechanisms of persistent infection clearly understood. Here, we show that S. typhimurium can persist for as long as 1 yr in the mesenteric lymph nodes (MLNs) of 129sv Nramp1(+)(/)(+) (Slc11a1(+)(/)(+)) mice despite the presence of high levels of anti-S. typhimurium antibody. Tissues from 129sv mice colonized for 60 d contain numerous inflammatory foci and lesions with features resembling S. typhi granulomas. Tissues from mice infected for 365 d have very few organized inflammatory lesions, but the bacteria continue to persist within macrophages in the MLN and the animals generally remain disease-free. Finally, chronically infected mice treated with an interferon-gamma neutralizing antibody exhibited symptoms of acute systemic infection, with evidence of high levels of bacterial replication in most tissues and high levels of fecal shedding. Thus, interferon-gamma, which may affect the level of macrophage activation, plays an essential role in the control of the persistent S. typhimurium infection in mice.     

FibroTouch检测肝脏硬度评价慢性乙型肝炎肝纤维化程度的影响因素分析

目的：探讨影响FibroTouch检测肝脏硬度(LSM值)评价慢性乙型肝炎肝纤维化程度的相关因素。方法：收集2015年1月至11月就诊经肝组织穿刺活检确诊的慢性乙型肝炎病毒感染者144例,应用FibroTouch技术检测肝脏LSM值,同时收集患者一般临床信息及常规血液检测指标。将筛选出的自变量进行多元线性回归分析,建立回归方程,并对回归模型进行评估。结果：经多元线性回归筛选出6个独立预测因子,分别为：脾脏肋间厚度(脾厚),体质指数(BMI),血清白蛋白(ALB)、总胆红素(TBiL)、凝血酶原时间(PT)、IV型胶原(CIV),以此建立回归方程。该回归模型决定系数R方=0.648,调整R方=0.609,具有良好的拟合度。结论：在进行FibroTouch 检测LSM时,脾厚、CIV、ALB、TBiL 、PT和BMI值,可能会对检测结果产生影响,对于影响因素的探讨仍有待进一步的大样本多中心研究。     

Risk factors for seizure recurrence in a pediatric observation unit

BackgroundMost patients present with seizures to pediatric emergency department (PED) are observed for extended periods for the risk of possible acute recurrence.ObjectiveThe aim of this study is to determine the risk factors of acute recurrence within first 24 h.MethodsPatients who presented to PED with seizure during past 24 h were enrolled. Demographic features, number and duration of seizures, diagnostic studies, physical examination findings, presence and time of seizure recurrence in PED were noted.Results187 patients were eligible for the study. 46% had recurrence of seizures in 24 h, 90,8% of recurrence within the first 6 h. Univariate analysis showed that younger patients, epileptic patients who were on multiple antiepileptic drugs (AEDs), who had multiple seizures during the past 24 h, who had abnormal neurological examination or neuroimaging findings had increased risk of seizure recurrence. Multivariate analysis showed that number of seizures during the past 24 h and previous use of AEDs was significantly associated with increased risk of recurrence.ConclusionRisk factors for acute recurrence should be evaluated for each patient. Patients without risk factors and no seizures during the first 6 h should not be observed for extended periods in PED.