Exhaled nitric oxide in paediatric asthma and cystic fibrosis

Nitric oxide (NO) is present in exhaled air of humans. This NO is mostly produced in the upper airways, whereas basal NO excretion in the lower airways is low. Children with Kartagener's syndrome have an almost total lack of NO in nasally derived air, whereas adult asthmatics have increased NO in orally exhaled air. NO excretion was measured in the nasal cavity and in orally exhaled air in 19 healthy children, in 36 age matched subjects with asthma, and in eight children with cystic fibrosis. NO levels in orally exhaled air were similar in controls and in children with cystic fibrosis, at 4.8 (SD 1.2) v 5.8 (0.8) parts per billion (ppb), but were increased in asthmatic children who were untreated or were being treated only with low doses of inhaled steroids (13.8 (2.5) ppb). Nasal NO levels were reduced by about 70% in children with cystic fibrosis compared to controls and asthmatics. Measurements of airway NO release in different parts of the airways may be useful in non-invasive diagnosis and monitoring of inflammatory airway diseases.     

How to obtain excellent response rates when surveying physicians

This paper outlines ways to maximize response rates to surveysby summarizing the most relevant literature to date and demonstratinghow these techniques have resulted in consistently high ratesof return in family practice research. We describe the methodologyused in recent surveys of physicians conducted by the Centrefor Studies in Family Medicine through its Thames Valley FamilyPractice Research Unit, located in London, Ontario, Canada andfunded by the Ontario Ministry of Health and Long-Term Care.The identification and implementation of these techniques tomaximize response rates is critical, as primary health careresearchers often rely on information gathered through questionnairesto study physicians' practice profiles, experiences and attitudes.Four separate and distinct mailed surveys of physicians usinga modified Dillman approach were conducted from 2001 to 2004.The sampling strategies, topics, types of questions and responseformats of these surveys varied. The first survey did not useany incentives or recorded delivery/registered mail and receiveda response rate of 48%. In sharp contrast, the other three surveysobtained responses rates of 76%, 74%, 74%, respectively, achievedthrough the use of gift certificates and recorded delivery/registeredmail. Sending a survey by recorded delivery/registered mailtends to result in the survey package being given priority inthe physicians' incoming mail at the practice. Gift certificatespartially compensate physicians for time spent completing thesurvey and recognition of the time required is appreciated.The response rates achieved provide strong evidence to supportthe use of monetary incentives and recorded delivery/registeredmail (along with the Dillman approach) in survey research. Itis anticipated that this evidence will be used by other researchersto justify requests for funding to cover the costs associatedwith incentives and recorded delivery/registered mail. We recommendthe use of these strategies to maximize response rates and improvethe quality of this type of primary health care research. Keywords. Response rates, surveys, physicians.     

Factorial structure of the Chinese version of the 12‐item General Health Questionnaire in adolescents

Aims. To evaluate the underlying factor structure of the Chinese version of General Health Questionnaire‐12 using exploratory and confirmatory factor analyses in Chinese adolescents and find out which factor model proposed by previous empirical research is the best‐fit model. Background. The 12‐item General Health Questionnaire has been extensively used with adolescents in the West. Yet, it has not been used with adolescents in a Hong Kong Chinese context. Design. A cross‐sectional study was employed. Method. Chinese students between the ages of 12–19 from four secondary schools were invited to participate in the study using the multiple‐stage stratified random sampling method during the period from December 2007–February, 2008. The total sample size included in the final analysed was 1883. Results. The General Health Questionnaire‐12 was found to be internally consistent. The results of exploratory factor analysis showed that there are two factors underlying the General Health Questionnaire‐12. Of nine factor models were tested by means of confirmatory factor analysis, only three factor model: the eight‐item two‐factor model, 12‐item three‐factor model and 10‐item two‐factor model, demonstrated good model fit across all model fit indices. Conclusion. This study addressed a gap in the literature by evaluating the factorial structure of the Chinese version of General Health Questionnaire‐12 using exploratory and confirmatory factor analyses in Chinese adolescents. The findings revealed that the eight‐item two‐factor model is the best‐fit model. Relevance to clinical practice. The adolescent mental health problem is alarming and aggravating and warrants special attention. It is essential for community nurses to differentiate psychological distress in adolescents and to identify those adolescents who are at a higher risk of suffering from mental health problems. The availability of a valid and reliable instrument that measures adolescents’ psychological distress is crucial before any nursing interventions to promote their mental health can be appropriately planned, implemented and evaluated.     

胰头后面的神经分布

1实验资料 经40g／L甲醛固定好的腹后壁结构完整的成人尸体标本30（男21,女9）例．运用大体解剖学方法解剖观测了这30具成人尸体胰头后面神经分支的形态和分布特征,并逐一观察各神经分支的来源、结果表明,分布到胰头后面的神经共有4个来源,即右腹腔神经节分支（27／30）,腹腔丛右侧半分支（20／30）,肝丛分支（16／30）和肠系膜上丛分支（14／30）,其中前三者为主要来源分支,后者为次要来源分支．该次要来源分支我们称其为“胰头支”．     

用气囊充气模拟结肠镜引起大鼠胃运动的变化

1 对象和方法成年雄性SD大鼠84只,清洁级,体质量(200±20) g. 置于安静、温暖(20℃)、避强光的环境中饲养. 随机均分成2组,每组42只; 再随机均分成7个亚组用于直肠顺应性检测,制定压力曲线.     

静滴青霉素致死1例

1病案资料患者,女,35岁,2004-05因发热、咳嗽、咳痰3 d而到某乡卫生院就诊.查体:T40℃,肺部有湿罗音,P 80次/min,R 24次/min,BP 120/80 mmHg(1 mmHg=0.133 kPa).医生开予青霉素钠静滴2 d,后因经济困难,患者要求出院回家治疗,回家后患者继续在本村个体诊所治疗,因疗效不佳,4d后患者再次来到乡卫生院,当时恰逢医生外出不在医院,值班护士因认识患者,出于同情,在简单了解患者在个体诊所所用的药物也是青霉素时,就自作主张给患者注射青霉素,注射青霉素后不到1 min,患者出现面色苍白,全身湿冷,血压测不到等过敏性休克表现,因抢救无效而死亡.     

献血者筛查中的病毒诊断

血液中心的主要职责是提供安全、充足和有效的血液供给。为此,致力于对传染性疾病的检测可高度保障血液成分的安全。目前,在发达国家,通过引入新一代抗体、抗原检测技术以及核酸扩增检测(NAT),经输血传播疾病的风险已很大程度地被降低了。美国采用NAT技术筛查献血者后,HIV-1和 HCV的残余危险已降至约为1:2,000,000。据报道,NAT检测的献血者中HIV-1感染者比例是1:31,000,000,HCV的感染     

Internal jugular vein vascular malformation presenting as mass at root of neck: a case report

Background

We report a case of vascular malformation arising from internal jugular vein presenting as mass at root of neck with no clinical stigmata which to the best of our knowledge is the first reported case of an intrinsic vascular malformation arising from the internal jugular vein. Magnetic resonance imaging features of this new entity have been described.

Case presentation

A 27 year male presented with a gradually enlarging, asymptomatic swelling on left supraclavicular region with normal overlying skin. A soft mass, about 7 × 7 cm with restricted mobility was found with normal cranial nerve function. Fine needle aspiration cytology showed a hemorrhagic aspirate. Doppler showed a mass displacing left carotid artery posteriorly while left internal jugular vein was not visualized. Magnetic resonance imaging showed a well defined mass isointense to hypointense on T1 weighted and hyperintense on T2 weighted and STIR images with fluid-fluid levels. On exploration, a vascular mass arising from left internal jugular vein was found with good tissue planes, which was excised after ligating the patent internal jugular vein above and below the lesion. Histopathologic examination confirmed the diagnosis of vascular malformation.

Conclusion

The diagnosis of intrinsic vascular malformation arising from internal jugular vein should be kept in differential while dealing with masses at root of neck and magnetic resonance imaging features may help in the pre-operative diagnosis of this entity.     

房间隔缺损介入封堵术并发症的预防及护理

1临床资料2003-12/2005-01收治房间隔缺损(ASD)24(男15,女9)例,年龄2～68岁,体质量10～72 kg.经心脏X线三位片、心电图、彩色多普勒超声心动图确诊为继发型ASD.经彩色多普勒超声心动图显示ASD直径为4～32 mm,选择的封堵器直径为10～42 mm.结果: 1例术中因封堵器脱落经外科手术抢救治疗无效死亡,1例术后2 d出现Ⅱ度Ⅱ型房室传导阻滞,经药物治疗7 d痊愈,余22例封堵器置入治疗患者无并发症发生,疗效满意.