The place of premedication in pediatric practice

Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence-based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. Studies applicable to one culture and to one hospital system (albeit multicultural) may not apply elsewhere. Moreover, the study of hospital-related distress begins at the start of the patient's journey and ends long after hospital discharge; it cannot be focused completely on just the moment of anesthetic induction. Taking an example from actual practice experience, the trauma caused by the actual giving of a premedication to a child who absolutely does not want it and may struggle may not be recorded in a study but could form a significant component of overall effect and later psychological pathology. Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro–con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re-evaluate a practice, which was universal historically and now in many centers is more selective.     

恶性淋巴瘤贫血发生率调查分析

目的：研究恶性淋巴瘤患者的贫血发生情况及其影响因素。方法：对我院2007—05-04—2012-09—30住院的1474例恶性淋巴瘤患者（初治1145例,复治329例）进行回顾性分析,统计其贫血发生率,并根据初治或复治、不同．病理类型、性别、年龄、临床分期或是否有B症状进行分组分析。结果：初治患者的贫血发生率为23．3％（267／1145）,复治患者的贫血发生率为41．9％（138／329）,明显升高,χ2=44．5,P〈0．001。不同病理类型初治患者贫血发生率由高至低依次为淋巴浆细胞淋巴瘤75．0％,血管免疫母T细胞淋巴瘤40．0％,套细胞淋巴瘤32．6％,外周T细胞淋巴瘤（非特指型）29．4％,弥漫大B细胞淋巴瘤25．3％,霍奇金淋巴瘤24．8％,边缘区B细胞淋巴瘤24．7％,NK／T细胞淋巴瘤21．4％,Burkitt淋巴瘤16．7％,问变大T细胞淋巴瘤14．3％,淋巴母细胞淋巴瘤11．3％,滤泡性淋巴瘤10．7％,蕈样霉菌病10％,弥漫小B细胞淋巴瘤8．3％。单因素分析发现,病理类型（χ2=32．4,P=0．002）、年龄（χ2=8．0,P=0．005）、分期（χ2=60．7,P〈0．001）和B症状（χ2=127．8,P〈0．001）是初治淋巴瘤贫血的危险因素。初治的贫血患者中侵犯食管、胃和肠等部位的患者比例较高,为35．2％（94／267）。结论：恶性淋巴瘤患者有较高的贫血发生率,复治患者贫血发生率明显高于初治患者,初治患者贫血的发生与病理类型、年龄、分期和B症状有密切关系。年龄〉60岁、Ⅲ～Ⅳ期、胃肠道侵犯、有B症状患者更易发生贫血。     

Therapeutic potential of fish oil in the treatment of ulcerative colitis

In a pilot study six patients with active ulcerative colitis and six healthy controls were given fish oil (MaxEPA) containing 3-4 g of eicosapentaenoic acid daily for a period of 12 weeks. There was a significant improvement in the patients' symptoms and histological appearance of the rectal mucosa by the end of the treatment period. There was significant fall in neutrophil chemiluminescence during treatment in patients, whereas no change was observed in the control group. Neutrophil leukotriene B4 levels fell significantly during treatment. Serum from patients receiving fish oil was significantly less chemotactic for neutrophils compared with control serum. Eicosapentaenoic acid inhibited neutrophil chemotaxis and chemiluminescence in vitro. The omega-3 fatty acids, which occur naturally in fish oils, may exert a beneficial effect by decreasing the production of inflammatory mediators.     

Cutaneous calcinosis in erythromelanosis follicularis faciei et colli

A case of erythromelanosis follicularis faciei et colli is described which showed deposition of calcium in the lesional skin on the face.     

Improved Short-Term Outcomes of Primary Coronary Stenting Compared to Primary Balloon Angioplasty in Acute Myocardial Infarction at Experienced Centers: The PAMI Study Group Experience

To study the additive benefits of routine stent implantation in patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA) at experienced centers, we compared the outcomes of the 982 patients undergoing PTCA for acute myocardial infarction (AMI) in the Primary Angioplasty in Myocardial Infarction-2 (PAMI-2) trial (only 1% of whom were stented) to the 312 patients in the PAMI Stent Pilot Trial (236 [76%] of whom were stented). The inclusion and exclusion criteria, PTCA methodology, and definitions used were prespecified to be identical between the two trials. Compared to the primary PTCA approach in PAMI-2, the strategy of stenting all eligible lesions in the PAMI Stent Pilot Trial was associated with reduced rates of in-hospital death (0.6% vs 2.7%, P = 0.03), reinfarction (1.3% vs 4.6%, P = 0.008), recurrent ischemia (3.5% vs 11.6%, P < 0.0001), target vessel revascularization (7.3% vs 11.4%, P = 0.04), and a shorter hospital stay (6.4 ± 4.4 vs 7.1 ± 6.2 days, P = 0.01). By multiple logistic regression analysis in 1,294 patients, stent implantation versus PTCA only was the strongest predictor of freedom from the composite in-hospital end point of death, reinfarction, or target vessel revascularization (TVR) (8.3% vs 15.0%, multivariate odds ratio = 0.4, P < 0.0001). These data strongly suggest that despite the excellent results achieved when primary PTCA is performed by experienced operators, the short-term outcomes of mechanical reperfusion can be further improved by a primary stent strategy.     

Glycemic Control of Surgical Patients. What is Correct,What is Not

Perioperative hyperglycemia is very common among critically ill patients with or without diabetes mellitus (DM). Perioperative elevated levels of blood glucose (BG) have been linked with increases in morbidity, infections, anastomotic failure, autoimmune dysfunction, and raised mortality and prolongation of hospitalization. A variety of different approaches have been taken for the control of BG in the perioperative period, and different methods of measurement have been proposed, among which, point of care (POC) meters, arterial blood gas analysis and venous plasma analysis prevail. The aim of this literature review was to provide evidence-based answers as to how BG levels should be monitored. We conclude that more conservative glycemic control is preferable to “tight glycemic control” (TGC), in order to avoid complications associated with episodes of hypoglycemia.     

学龄前儿童普通话平均句子长度的多因素研究

【目的】探讨影响学龄前儿童普通话平均句子长度的因素,为促进儿童语言发育提供参考意见。【方法】以65名3~6岁学龄前儿童为研究对象并对其父母进行问卷调查。问卷内容包括儿童发育情况、家庭社会环境因素等39个变量。利用计算机程序计算每名儿童自然语言样本的平均句子长度。【结果】年龄、边看图书边自己讲述、父亲的文化程度、看广告、看电视后家长(或保姆)与儿童谈论电视内容与学龄前儿童平均句子长度呈正相关;边看图书边听家长讲述和语言障碍家族史与学龄前平均句子长度呈负相关。【结论】年龄、遗传因素和家庭语言环境为学龄前儿童语言发育的重要影响因素。     

IN.PACT AV access randomized trial: Japan cohort outcomes through 12 months

Purpose

There is a lack of adjudicated and prospectively randomized published outcomes on the use of drug-coated balloons (DCB) to treat dysfunctional arteriovenous fistula in Asian patients. This post hoc subgroup analysis of 112 Japanese participants from the global IN.PACT AV Access trial reports outcomes through 12 months.

Materials and Methods

Participants were treated with DCB (n = 58) or standard non-coated percutaneous transluminal angioplasty (PTA) balloons (n = 54). Outcomes included target lesion primary patency (TLPP), access circuit primary patency, and safety.

Results

Through 6 months, TLPP was 86.0% (49/57) in the DCB group and 49.1% (26/53) in the PTA group (p < 0.001). Through 12 months, TLPP was 67.3% (37/55) in the DCB group and 43.4% (23/53) in the PTA group (p = 0.013).

Conclusion

In this post hoc analysis of Japanese participants from the IN.PACT AV Access trial, participants treated with DCB had higher TLPP through 6 and 12 months compared with PTA.