Phagocyte chemiluminescence in pre-term infants

Intact phagocyte function is a pre-requisite for successful defence against infection, but paradoxically, these cells may also play a major role in the pathogenesis of the infant respiratory distress syndrome. Phagocyte function is known to be deficient in pre-term infants, who are at risk of infection as a result, but these infants are also at risk of respiratory distress syndrome as a result of surfactant deficiency. Despite this, few longitudinal studies of phagocyte function have been performed in pre-term infants. We have used lucigenin-enhanced chemiluminescence to examine the respiratory burst of mixed samples containing polymorphonuclear leucocytes and monocytes of 100 pre-term infants at 48- to 72-h intervals during their admission to a neonatal care unit. Increased polymorphonuclear leucocyte chemiluminescence was associated with respiratory distress syndrome and the use of intermittent positive pressure ventilation. Multiple linear regression analysis revealed a slight, but significant depression of chemiluminescence in association with the use of gentamicin and penicillin when stronger influencing factors such as the presence of respiratory distress syndrome were taken into consideration. Measurement of phagocyte function by sensitive luminescence assays requires very little blood and may be useful in pre-term infants to follow the severity of respiratory distress syndrome. However, it is probable that other factors such as antioxidant capacity also have an important influence on the degree of tissue damage.     

Functional dependence after hip fracture

OBJECTIVES: To identify patients at high risk of functional dependence and examine the progression of disability after a hip fracture. DESIGN: This was a population-based prospective inception cohort study of all patients aged 65+ yr who fractured a hip between July 1996 and August 1997. Demographic, socioeconomic, social support, and health status information was assessed in the hospital and 3 mo postfracture. RESULTS: The analysis included 367 patients. Almost all patients with cognitive impairment were functionally dependent postfracture, with new disabilities frequently occurring in transferring. Among patients of high mental status, increased risk of functional dependence was associated with advanced age, more co-morbidities, hip pain, poor self-rated health, and previous employment in a prestigeous occupation. Bathing disability was most likely in those who functioned independently prefracture; a disability in dressing was most common otherwise. CONCLUSION: Hip pain is amenable to treatment and may improve chances of functional recovery. Patients can be assisted in regaining prefracture function if they are targeted for rehabilitation on the basis of mental status. The focus should be on bathing and dressing among patients of high cognition and transferring among those patients with mental impairment.     

EFFICACY OF TWICE-DAILY AMOXYCILLIN/CLAVULANATE (‘AUGMENTIN-DUO’ 400/57) IN MILD TO MODERATE LOWER RESPIRATORY TRACT INFECTION IN CHILDREN

SUMMARY A new amoxycillin/clavulanate regimen (‘Augmentin-Duo’ 400/57), to be given orally in two divided doses, has been proposed to overcome the inconvenience of tid dosing. This observer-blind, multicentre study randomised children aged two to 12 years with lower respiratory tract infection to seven days' treatment with either amoxycillin/clavulanate bid at a dose of 25/3.6mg/kg/day (221 patients) or the currently prescribed amoxycillin/clavulanate regimen of 20/5mg/kg/day tid (216 patients). Clinical success (cure) rates at follow up were 81.0% for the bid group and 77.8% for the tid group [difference 3.2%; 95% CI (-4.36, 10.80)], indicating that the regimens were of equivalent efficacy. Both regimens were well tolerated, and there was no statistically significant difference in the incidence of adverse experiences between the two groups. Compliance with study medication was high and similar for both groups (80% compliance: bid 90.0%; tid 87.0%).     

乌司他丁在预防不同胃肠术后吻合口瘘中的效果观察

目的探讨乌司他丁在预防不同胃肠术后吻合口瘘中的效果。方法选取2005年6月～2011年8月于本院进行胃肠术进行治疗的220例患者为研究对象,将其随机分为对照组和观察组各110例,观察组在对照组的基础上加用乌司他丁,后将两组患者中不同术式的吻合口瘘发生率及术前、术后1 d及3 d的血清超敏C反应蛋白（hs-CRP）、白介素2（IL-2）、白介素6（IL-6）、肿瘤坏死因子α（TNF-α）、血液流变学指标进行统计及比较。结果观察组不同术式的吻合口瘘发生率及总发生率均低于对照组,血清hs-CRP、IL-6、TNF-α水平低于对照组,IL-2高于对照组,血液流变学指标改变幅度小于对照组,差异均有统计学意义（均P〈0.05）。结论乌司他丁可以改善胃肠手术患者的炎性状态及血液循环情况,对于降低吻合口瘘的发生率有着积极的作用。     

Diagnostic Splenectomy for Visceral Leishmaniasis

A 57-year-old-man with a history of malaise, fever,night sweats and shortness of breath presented a diagnostic challenge to his medical team. He was pancytopaenic and had splenomegaly on admission but other investigations, including bone marrow aspiration, proved inconclusive. After the patient deteriorated clinically, the general surgical team was requested to perform a diagnostic splenectomy. The histology of this showed infection with visceral leishmaniasis. He recovered completely with Amphotericin treatment. Although this is a rare condition, particularly for the general surgeon, this case highlights the difficult position surgeons are often put in when performing major surgery diagnostically.     

多聚（ADP-核糖）聚合酶抑制剂对大鼠缺血再灌注肾脏损伤的保护作用

目的探讨多聚（ADP-核糖）聚合酶（PARP）抑制剂3-氨基苯甲酰胺（3-AB）在大鼠-肾脏缺血再灌注损伤中的保护作用及对肾组织血管内皮生长因子A（VEGF-A）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）mRNA表达的影响。方法将54只大鼠随机分为假手术组（S组）、再灌注后模型组（M组）和PARP抑制剂组（P组）,每组8只。比较各组大鼠右侧肾动脉缺血再灌注后2、6、12h后的血肌酐和尿素氮水平、肾脏组织病理学变化、肾组织PARP蛋白表达及肾组织VEGF-A和NGAI．mRNA表达。结果（1）M组各时间点的血肌酐、尿素氮水平均高于S组,P组各时间点血肌酐、尿素氮明显低于M组,差异均有统计学意义（P〈0．01）;（2）P组肾组织病理学表现较M组改善;（3）P组各时间点肾组织PARP表达明显低于M组,差异有统计学意义（P〈0．05）;（4）与M组相比,P组肾组织的VEGF-AmRNA的表达升高,NGALmRNA表达降低,有统计学差异（P〈0．05）。结论PARP抑制剂3AB对大鼠肾脏缺血再灌注损伤具有保护作用,可下调NGAL及上调VEGF-AmRNA表达。     

预防和治疗抗生素相关性腹泻的药学体会

目的:促进抗生素相关性腹泻的有效预防和治疗。方法:选用临床实例对以益生菌酸奶、活菌制剂及益生元等多种微生态制剂预防和治疗抗生素相关性腹泻的结果进行分析和总结。结果:实例表明,有抗生素相关性腹泻危险因素的患者给予益生菌酸奶和益生元后,能有效预防抗生素相关性腹泻的发生;已发生抗生素相关性腹泻的患者,应用微生态制剂后取得显著疗效。结论:合理应用微生态制剂能预防和治疗抗生素相关性腹泻。     

大连市乙肝疫苗查漏补种情况调查

[目的]了解大连市乙肝疫苗漏种的情况及其影响因素。[方法]2006年10月至2007年5月开展了大连市2002年7月1日至2006年9月3013出生儿童的乙肝疫苗查漏补种工作,对于在补种过程中新发现的漏种儿童,按照“随时发现,随时补种”的原则进行补种。[结果]本次“查漏补种”工作共摸底调查263727名儿童,查出漏种儿童2017人,漏种率为0．76％,应补种针次4198针次;实补种1933人,补种率为95．84％。大连市乙肝疫苗近5年平均接种率为99．9％,漏种率较低;流动儿童较本地常住儿童漏种率高（P〈0.05）,补种率低（P〈0．05）。[结论]流动儿童中仍存在免疫空白现象。