Clinical evaluation of leukocyte-depleted blood cardioplegia for pediatric open heart operation

Background. Blood cardioplegia (BCP) is widely used for myocardial protection during open heart operation. However, BCP may have a chance to induce neutrophil-mediated myocardial injury during aortic cross-clamping. We clinically evaluated the myocardial protective effect of leukocyte-depleted blood cardioplegia (LDBCP) for initial and intermittent BCP administration in pediatric patients.

Methods. Fifty patients undergoing open heart operation for congenital heart disease between January 1997 and March 1999 were reviewed. Twenty-five were administered LDBCP for myocardial protection during ischemic periods (LDBCP group), and the remaining 25 were given BCP without leukocyte depletion (BCP group).

Results. The difference in plasma concentrations of malondialdehyde between coronary sinus effluent blood and arterial blood just after reperfusion in the LDBCP group (1.68 ± 0.56 μmol/L) was significantly lower than that in the BCP group (2.35 ± 0.62 μmol/L; p < 0.01). The LDBCP group showed significantly lower plasma concentrations of human heart fatty acid-binding protein at 50 minutes after reperfusion (LDBCP group, 103.5 ± 38.7 IU/L; BCP group, 144.8 ± 48.8 IU/L; p < 0.01) and the peak value of creatine kinase-MB during the first 24 postoperative hours (LDBCP group, 17.0 ± 8.5 IU/L; BCP group, 26.0 ± 11.6 IU/L; p < 0.01) than did the BCP group. The maximum dose of catecholamine was significantly smaller in the LDBCP group (LDBCP group, 3.20 ± 2.18 μg · kg⁻¹ · min⁻¹; BCP group, 5.60 ± 2.83 μg · kg⁻¹· min⁻¹; p < 0.01).

Conclusions. These results suggest the usefulness of LDBCP for protection from the myocardial injury that can be induced by BCP administration during aortic cross-clamping.     

Mutations in the tyrosine kinase domain of the epidermal growth factor receptor in non-small cell lung cancer.

We evaluated somatic genetic alterations in the kinase domain of the EGFR gene in the tumors of 219 non-small cell lung cancer patients of primarily Caucasian and African American origins. We identified 26 patients (12%) whose tumors had a mutation in the EGFR gene, and 11 (5%) patients carried novel genomic variations consistent with germ-line polymorphisms. All but one mutation were identified in Caucasian patients affected with adenocarcinoma. EGFR mutations were more frequent in women and in nonsmokers, but a significant portion of the affected patients were men (12 of 26) and current or past smokers accounted for half of the patients affected (13 of 26). Screening subjects with EGFR mutations may identify patients whose tumors could respond to targeted therapy using tyrosine kinase inhibitors.     

Association between chronic pain with presarcopenia and central sensitization in Japanese community-dwelling older adults: A cross-sectional study

Older people with chronic pain are at higher risk of developing sarcopenia. Central sensitization (CS) has been implicated in chronic pain among community-dwelling older adults. However, a relationship between CS and chronic pain with sarcopenia has not been established. This cross-sectional study aimed to clarify the relationship between chronic pain with sarcopenia or presarcopenia and CS among community-dwelling older adults. We assessed chronic pain and sarcopenia in 104 older adults participating in community health checks. We defined sarcopenia using the Asian Working Group for Sarcopenia (AWGS) consensus recommendations based on the following outcomes: low muscle mass, low muscle strength, and slow gait speed. Pain-related assessments included pain intensity, the Pain Catastrophizing Scale, the CS Inventory-9, the pressure pain threshold, the Tampa Scale of Kinesiophobia-11, and the EuroQol 5-dimension 5-level (EQ5D-5L). Chronic pain was defined by related symptoms within the month prior to the health check that had continued for ≥ 3 months and corresponded to a numerical rating scale score of ≥ 1 at the site of maximum pain. The prevalence of chronic pain was 43.3%. In addition, the prevalence of chronic pain with sarcopenia or presarcopenia was 29.8%. A logistic regression analysis revealed that the pressure pain threshold (odds ratio: 0.82, 95% CI: 0.95–1.02) and the EQ5D-5L (odds ratio: 0.58, 95% CI: 0.36–0.76) were significantly associated with the presence of chronic pain with sarcopenia or presarcopenia. Chronic pain with sarcopenia or presarcopenia was affected by central sensitization. Therefore, CS should be evaluated in the elderly.     

In vivo studies on the effects of α1-adrenoceptor antagonists on pupil diameter and urethral tone in rabbits

α₁-Adrenoceptors mediate contraction of iris dilator smooth muscle and hence pupil dilatation. We compared the ability of i.v. bolus injections of alfuzosin, doxazosin, naftopidil, prazosin, tamsulosin and terazosin to antagonise phenylephrine-induced mydriasis relative to their potency for inhibiting phenylephrine-induced elevations of intraurethral pressure (IUP) in rabbits. Moreover, we compared the ability of these drugs to induce miosis in conscious rabbits in the absence of phenylephrine. All antagonists inhibited the effects of phenylephrine on pupil size and IUP, and the ratio of the respective ED₅₀ values was close to unity in all cases. The doses required to induce statistically significant miosis in the absence of phenylephrine were 30- to 100-fold higher than those inhibiting phenylephrine-induced mydriasis for all antagonists, except for naftopidil. Moreover, the miotic effects of all α₁-adrenoceptor antagonists were fully reversible within 8 h. We conclude that alfuzosin, doxazosin, naftopidil, prazosin, tamsulosin and terazosin inhibit phenylephrine-induced mydriasis in the same dose range as they inhibit elevations in IUP. Higher doses of all antagonists are required to induce miosis in the absence of an exogenous agonist, and such miosis is always reversible within hours.     

JCI患者安全策略及其对医疗实践的启示

介绍了医疗机构评审联合委员会国际部(JCI)在保障患者安全方面的方法与策略。指出在医疗实践过程中,应健全意外事件报告体系,营造患者安全的组织文化;设立患者安全委员会及相关机制;加强员工培训,提高安全意识;制定和执行保证患者安全的制度和操作规范;持续地测量和改进流程的绩效。     

糖尿病专科护理门诊工作现况调查分析

目的了解糖尿病专科护理门诊现况,为优化流程提供依据。方法采用自制糖尿病专科护理门诊患者满意度问卷对在糖尿病专科护理门诊就诊的200例患者进行调查;对4名糖尿病专科护士进行现场观察与访谈了解工作现况。结果患者满意度总体均分为(4.21±0.49)分,6个维度评分(3.45±0.78)~(4.36±0.64)分;专科门诊护理内容包括健康教育、胰岛素笔使用、检测血糖等13项,每个工作日实施0~48.00次;患者等待就诊时间(14.69±8.00)min。专科护理访谈提炼出工作职责不明确、工作时间未建立预约制、门诊导诊护士配合欠佳及患者健康档案登记欠全面4个主题。结论患者对糖尿病专科护理门诊就诊流程和就诊时间等方面满意度较低,专科护士健康教育工作受到影响,应改进流程,以促进健康教育的效果,提高患者满意度。     

血液透析联合腹水回输治疗顽固性腹水的临床观察

目的探讨血液透析并腹水静脉回输在尿毒症顽固性腹水患者中的临床疗效。方法回顾性研究2010年10月至2013年9月在我科接受血液透析并腹水静脉浓缩回输治疗的尿毒症患者,11例,41例次,通过分析比较治疗前后体重、腹围、血压、血浆白蛋白、尿素氮、肌酐等各项指标的变化,探讨血液透析并腹水静脉回输在尿毒症顽固性腹水患者中的临床疗效。结果 1例行2次治疗后腹水消失,1例行7次治疗后胸腔积液及腹水均消失,水肿消退,11例患者治疗后均有明显效果,表现为腹胀、活动受限等腹水压迫症状明显改善,浮肿消失,夜间阵发性呼吸困难、睡眠明显好转,食欲增加,腹围、体重明显减少（P〈0.05）,血浆尿素氮、肌酐明显下降（P〈0.01）,血浆白蛋白明显升高（P〈0.01）。结论血液透析并腹水静脉回输能显著改善尿毒症并顽固性腹水患者的临床症状,提高其生存质量,延长生存时间,临床疗效确切。     

Patterns of transcription factor programs and immune pathway activation define four major subtypes of SCLC with distinct therapeutic vulnerabilities

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