HR 756--a new cephalosporin in the treatment of gonorrhoea caused by ordinary and penicillinase-producing strains of Neisseria gonorrhoeae

HR 756, a new cephalosporin, was used in single intramuscular doses of 500 mg to treat 108 men and women with gonorrhoea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) and non-PPNG. Of 102 patients followed up, 99 (97.05%) were cured. Cure rates for PPNG infections and non-PPNG infections were 98.18% and 95.74% respectively. Few adverse side effects were recorded but possible cross-sensitisation with penicillin was observed. Clinical and laboratory antibiotic susceptibility results correlated well. It is concluded that this drug is safe and effective in treating both PPNG and non-PPNG infectons.     

Predictors for intraoperative heart failure in children undergoing foreign-body removal

This study aimed to determine the predictors for intraoperative heart failure (HF) in children undergoing foreign-body removal. The clinical data of all children with tracheobronchial foreign-body aspiration admitted to the First, Second, and Fourth Affiliated Hospitals of Harbin Medical University between January 1996 and September 2018 were analyzed. The variables with significant difference in univariate analysis were involved into the multivariate Logistic model to determine the predictors for intraoperative tachycardia. In total, 300 tracheobronchial foreign-body aspiration children were eligible for the study, among whom 60 cases (20%) suffered from HF during the operation. Between the children HF and those without HF, the differences were pronounced in history of allergy, history of asthma, congenital heart disease, preoperative respiratory infection, retention time of foreign bodies, duration of operation, and poor anesthesia effect (P < .05). Multivariate analysis results showed that history of allergy (odds ratio [OR]: 1.395, 95% confidence interval [95% CI]: 1.202–1.620, P < .001), congenital heart disease [OR: 3.071, 95% CI: 1.141–8.264, P < .001], preoperative respiratory infection [OR: 2.345, 95% CI: 1.027–5.355, P = .043], retention time of foreign bodies [OR: 1.013, 95% CI: 1.010–1.016, P < .001], duration of operation [OR: 1.030, 95% CI: 1.027–1.033, P < .001], and poor anesthesia effect [OR: 1.125, 95% CI: 1.117–1.134, P < .001] were identified as the influencing factors for intraoperative HF. In conclusions, for children undergoing foreign-body removal, history of allergy, congenital heart disease, preoperative respiratory infection, retention time of foreign bodies, duration of operation, and poor anesthesia effect are associated with an increased risk of intraoperative HF.     

Stressors in the ICU: a comparison of patients' and nurses' perceptions

Aims and objectives. The aim of the study was to compare the stressors as perceived by patients in an intensive care unit (ICU) against those of nurses on the basis of their perceptions of patients’ stressors. Background. Getting admitted to an ICU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients’ perspective so that appropriate nursing measures can be directed towards minimising such stressors. Design. Survey. Methods. As a convenience sample, 60 patients and 54 critical care nurses were recruited. The Intensive Care Unit Stressor Questionnaire (Chinese) (ICU‐CSQ) was used to collect the perceptions of stressors by the patients. Nurses were also asked to rate the items in the said questionnaire according to how they believe patients would rate them. Results. In every comparison, nurses evaluated the items to be significantly more stressful than patients did. Overall perceived stress levels of nurses were also significantly higher than those of their patients (z = ?8·78, p < 0·001). Conclusions. Nurses tended to rate the items as more stressful than did the patients, perhaps over‐emphasising the stressful nature of the ICU. The findings also highlight the importance of cultural beliefs on the perceived stress levels among the Chinese population. Relevance to clinical practice. Findings in this study have strong implications in clinical practice, especially in a critical care setting. Nurses must attempt to identify and endeavour to cope with the situations that patients listed as most stressful. Moreover, attention must be drawn towards measures aimed at relieving the stress of patients by taking into account their cultural values so that culture‐specific interventions for reducing their stress can be established.     

Peri-articular steroid injection improves the outcome after unicondylar knee replacement: a prospective, randomised controlled trial with a two-year follow-up

We have performed a prospective double-blind, randomised controlled trial over two years to evaluate the efficacy and safety of an intra-operative peri-articular injection of triamcinolone acetonide in patients undergoing medial unicondylar knee replacement. We randomised 90 patients into two equal groups. The study group received an injection of triamcinolone acetonide, bupivacaine, and epinephrine into the peri-articular tissues at the end of the operation. The control group received the same injection mixture but without the addition of triamcinolone. The peri-operative analgesic regimen was standardised. The study group reported a significant reduction in pain (p = 0.014 at 12 hours, p = 0.031 at 18 hours and p = 0.031 at 24 hours) and had a better range of movement (p = 0.023 at three months). There was no significant difference in the rate of infection and no incidence of tendon rupture in either group. The addition of corticosteroid to the peri-articular injection after unicondylar knee replacement had both immediate and short-term benefits in terms of relief from pain, and rehabilitation with no increased risk of infection.     

A new experimental inbred Wistar rat varicocele model: anatomy of the left spermatic vein and the effect on histology

Because of venous anatomical differences between rats and humans and the personal interpretation of these differences, there is neither consistent animal prototype nor consistent results in the study of varicocele. We established a new substrain of Wistar inbred rats, of which the left testis vein has no significant branches to the common iliac vein up pampiniform plexus, but instead enters the left renal vein directly (similar to humans) and used them to create experimental varicocele model by partial ligation of the left renal vein. One month later, the predominant lesion of the left testis in induced group was spermatogenic arrest at the spermatid and preliminary spermatocyte phases, and considerable interstitial and Sertoli cell vacuolation. The right testis also showed spermatogenic arrest. Most important, the characteristics of the lesions differed in both testes, with the left testis having more severe lesions. Allowing for the unique anatomy of the left spermatic vein, the standard of the surgical procedure, the high rate of varicocele induction, and identical histological alteration as occurs in humans, we believe that this inbred Wistar rat substrain is suitable for the creation of an experimental varicocele model, which has promise for practical application in humans.     

Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004

OBJECTIVE: To determine whether the classical trimodal distribution of trauma deaths is still applicable in a contemporary urban New Zealand trauma system. METHODS: All trauma deaths in the greater Auckland region between 1 January 2004 and 31 December 2004 were identified and reviewed. Data was obtained from hospital trauma registries, coroner autopsy reports and police reports. RESULTS: There were 186 trauma deaths. The median age was 28.5 years and the median Injury Severity Score was 25. The predominant mechanisms of injury were hanging (36%), motor vehicle crashes (31.7%), falls (9.7%), pedestrian-vehicle injury (5.4%), stabbing (4.3%), motorcycle crashes (3.2%), and pedestrian-train injury (2.2%). Most deaths were from central nervous system injury (71.5%), haemorrhage (15.6%), and airway/ventilation compromise (3.8%). Multi-organ failure accounted for 1.6% of deaths. Most deaths occurred in the pre-hospital setting (80.6%) with a gradual decrease thereafter. CONCLUSION: There was a skew towards early deaths. The trimodal distribution of trauma deaths was not demonstrated in this group of patients.     

Prospective monitoring of BK polyomavirus infection early posttransplantation in nonrenal solid organ transplant recipients

BACKGROUND: BK virus-associated nephropathy is an important cause of renal dysfunction in renal transplant recipients. Renal dysfunction after nonrenal solid organ transplantation (NRSOT) is common; however, the impact of BK virus remains uncertain. METHODS: Sixty (7 heart, 25 liver, and 28 lung) NRSOT recipients were enrolled in this single center prospective longitudinal study. Urine and plasma were collected for detection of BK viral load using a real-time quantitative polymerase chain reaction assay at transplantation and at 3, 6, and 9 months posttransplantation. Demographic and clinical data including serum creatinine and immunosuppressive therapy were also collected. RESULTS: BK viruria was detected in 16 of 193 (8.3%) samples corresponding to 9 of 60 (15%) subjects. The median BK viral load was 1.12 x 10 (range, 1.1 x 10-2.66 x 10) copies per milliliter. No viremia was detected. In seven of nine, viruria occurred by 3 months posttransplantation. At 9 months of posttransplantation, the median Modification of Diet in Renal Disease-estimated glomerular filtration rate in those with BK viruria on at least one sample was similar to those without viruria (58.0 [IQR 43.1-60.7] mL/min/1.73 m vs. 61.4 [IQR 50.6-74.4] mL/min/1.73 m; P=0.39). CONCLUSIONS: Although BK infection was common in this NRSOT population, BK viremia was not observed and there was no association between BK viruria and renal dysfunction. Our data suggest that routine surveillance for BK virus early posttransplantation in NRSOT may not be warranted but should be further examined in a larger multicenter trial.     

Patellar reconstruction using distal femoral autograft in a patellectomized patient undergoing total knee arthroplasty

Patellectomized patients have less satisfactory clinical outcomes after total knee arthroplasty because of a decreased extensor mechanism efficiency and potential instability attributable to loss of anterior restraint. We report a patient, with a prior history of patellectomy, who underwent simultaneous patellar reconstruction using distal femoral autograft during the total knee arthroplasty. The patient has been followed up for 24 months with excellent postoperative knee scores with radiographically established graft viability.     

Non-cytolytic antigen clearance in DNA-vaccinated mice with electroporation

Aim： To explore the potential of electroporation （EP）-mediated hepatitis B virus （HBV） DNA vaccination for the treatment of chronic HBV infection. Methods： BALB/c mice were vaccinated with HBV DNA vaccine encoding for the HBV preS2-S antigen, combined with or without EP. HBV surface antigen expression plasmid was administered into mice liver via a hydrodynamic injection to mimic HBV infection. The clearance of antigen in the serum and liver was detected by ELISA assay and immunohistochemical staining. The histopathology of the liver tissues was examined by HE staining and serum alanine aminotransferase assay. Results： The immunogenicity of HBV DNA vaccine encoding for the HBV preS2- S antigen can be improved by EP-mediated vaccine delivery. The elicited immune responses can indeed reduce the expression of HBV surface antigen （HBsAg） in hepatocytes of the mouse model that was transfected to express HBsAg using the hydrodynamic injection method. The antigen clearance process did not cause significant toxicity to liver tissue, suggesting a non-cytolytic mechanism. Conclusion： The EP-aided DNA vaccination may have potential in mediating viral clearance in chronic hepatitis B patients.