Survey of major chronic iIlnesses and hospital admissions via the emergency department in a randomized older population in Randwick,Australia

Objective: To find out if patients with chronic illnesses living in the community are at risk of unplanned hospital admissions through emergency departments; what types of chronic illnesses may be putative risk factors; and if an increase in the number of chronic illnesses may be associated with increased risk. Methods: The survey included the completion of a standardized questionnaire for medical illnesses in a random sample of older people dwelling in the community and analysis of admission records to our hospital. The principal diagnoses for admissions were recorded. The risk factors for admissions were analysed. Results: Five hundred and twenty‐six (239 men and 287 women) people aged 55 years and over were interviewed. Musculoskeletal disorders, hypertension, gastrointestinal disorders and ischaemic heart disease were the most frequently reported of the chronic illnesses surveyed. A total number of 70 people from the survey group with a total of 115 admissions through emergency departments were recorded. Using logistic regression model, hypertension, ischaemic heart disease and age were found to be risk factors for emergency admissions amongst this group of community‐dwelling residents. The ratios were 2.03 (95% confidence interval (CI): 1.2–3.44), 2.02 (95% CI: 1.16–3.49) and 1.05 (95% CI: 1.02–1.09), respectively. Furthermore, multiple (three or more) chronic illnesses were found to be a strong predictor of hospital admission via emergency department (chi‐square = 16.647, DF = 1, P‐value < 0.001). Conclusion: We conclude that there was significant association between multiple chronic diseases and emergency admissions for older people. Of these, hypertension and ischaemic heart disease were found to be significant predictors. Age per se was found to be of borderline significance.     

Rat heart lipoprotein lipase.

Rat heart lipoprotein lipase was highly purified by affinity chromatography using heparin-Sepharose 4B. When extracts of acetone powder were applied to columns, lipase activity was firmly bound to the gel matrix and was later eluted with 1.5 M NaCl. At this stage the eluted enzyme was purified 1500-fold. Disc gel electrophoresis yielded a single protein band corresponding with the enzyme activity. The apparent molecular weight was 60,000. The purified enzyme was highly unstable; however, its activity could be partially stabilized by glycerol or ethylene glycol. In studying the purified enzyme we observed: (i) a cofactor in serum was required for full enzymatic activity; ApoLp-Glu could be substituted for this cofactor; (ii) ApoLp-Ser was inhibitory to lipase activity; (iii) NaCl and protamine sulfate also markedly inhibited the lipase activity; (iv) heparin stimulated the enzymatic activity.     

共轭方向法在HPLC流动相条件优化中的应用——麻黄碱、伪麻黄碱的分离

麻黄碱与伪麻黄碱是中药麻黄的主要有效成分,也是一对化学物理性质很相似的差向异构体。二者的结构只是构象不同,用色谱方法进行分离有一定的难度。目前已有在苯基和腈基键合固定相上进行HPLC分离的报道^(1,2)。本文成功地引入共轭方向法在μBondapak C₁₈色谱柱上对流动相组成进行了条件优化,优化后的色谱条件下麻黄碱与伪麻黄碱的分离情况令人满意。     

Emergency embolization of spontaneous ruptured hepatocellular carcinoma: Correlation between survival and Child−Pugh classification

From February 1994 to April 2000, 29 emergency gelfoam embolizations for spontaneous ruptured hepatocellular carcinoma (HCC) performed in 28 patients were retrospectively reviewed. There were 11 patients in Child's A , 11 in Child's B and six in Child's C classification of cirrhosis. The duration of the procedure, artery embolized and complications were reviewed, and the Child?Pugh classification of each patient was correlated with their mean survival period. Embolization was done in 12 right hepatic arteries, two left hepatic arteries and 15 proper hepatic arteries. In one patient, the left hepatic artery was embolized initially but the proper hepatic artery was also embolized because another subcapsular liver tumour was found after reviewing the preangiogram CT scan. The entire procedure took 40?170 min (mean = 86 min) with no periprocedural complication. Following embolization, the mean survival period for Child's A class was 218.3 days, Child's B class was 83.4 days and Child's C class was 11.0 days. Transcatheter embolization is an effective treatment to arrest bleeding in spontaneous ruptured HCC. Patients with Child's A class cirrhosis have the longest survival. Selective embolization of either the right or the left hepatic artery alone carries the potential risk of missing multifocal HCC that might not be easily appreciated during angiography.     

原代培养猪甲状腺细胞及甲状腺过氧化物酶活性与氟化钠的影响

目的:流行病学调查结果显示,地方性氟中毒与甲状腺肿的流行有很大的重叠性。探讨氟化钠对原代培养猪甲状腺细胞及甲状腺过氧化物酶活性的影响。方法:实验于2006-10/2007-05在辽宁医学院科学实验室中心完成。①实验方法:在猪死亡1h内取其甲状腺组织,去除甲状腺组织包膜及外层活性差的组织,选取中央活性高的部位,剪成1mm3组织块,用胰蛋白酶、胶原酶Ⅳ消化分离,得到含猪甲状腺细胞的消化液,沉淀悬于含体积分数为0.15的胎牛血清、1U/L牛促甲状腺素、80万U/L庆大霉素的F12培养基中,过滤,调整细胞浓度至5×105L-1,接种培养,每3d更换培养液。常规培养48h的猪甲状腺细胞接种于96孔培养板,按氟化钠终浓度不同分为0,40,80,160mg/L组。②实验评估:染毒48h后,采用噻唑蓝法测定细胞存活量,采用改良愈创木酚法测定甲状腺过氧化物酶活性。结果:①氟化钠对原代培养猪甲状腺细胞存活量的影响:与0mg/L氟化钠比较,40mg/L氟化钠染毒后猪甲状腺细胞的存活量基本相似;80,160mg/L氟化钠染毒后猪甲状腺细胞的存活量均明显下降(P<0.01)。②氟化钠对甲状腺过氧化物酶活性的影响:与0mg/L氟化钠比较,40,80,160mg/L氟化钠染毒后的甲状腺过氧化物酶活性均明显下降(P<0.01),呈剂量-效应关系。结论:氟化钠对原代培养的猪甲状腺细胞及甲状腺过氧化物酶活性均具有抑制作用。     

RGP fitting philosophies for keratoconus

Rigid gas permeable (RGP) lenses are the choice of vision correction for most keratoconic patients. Various fitting philosophies and different lens designs are available and the question of which technique is the most appropriate is a controversial issue in the field of contact lens practice. This article reviews the different philosophies with respect to their rationale, optical performance and physiological influence on the cornea. The ‘three-point-touch’ approach is now the most widely-accepted corneal lens fitting philosophy in clinical practice. It provides a well-distributed pressure between the cone apex and the relatively normal peripheral cornea but other philosophies such as apical bearing and apical clearance also have advantages. Having considered the advantages and disadvantages of each philosophy, a variant of the three-point-touch appears to be a practical solution. Practitioners can fit keratoconic patients with a three-point-touch tending towards apical clearance to allow for disease progression and unexpected lack of follow-up. Wearing time, visual acuity and comfort are also important issues to be considered as all of these are essential to constitute a successful contact lens fitting.     

Suspected leaking abdominal aortic aneurysm: use of sonography in the emergency room

To determine the value of sonography in the emergent evaluation of suspected leaking abdominal aortic aneurysms, the authors examined 60 patients in the emergency department using sonography and a protocol involving advance radio notification from the ambulance; arrival of sonographic personnel and equipment in the triage room before patient arrival; and, during other triage activities, rapid sonographic evaluation of the aorta for aneurysm and of the paraaortic region for extraluminal blood. Sonographic findings were correlated with surgical results and clinical outcome. When performed under these circumstances, sonography was accurate in demonstrating presence or absence of aneurysm (98%), but its sensitivity for extraluminal blood was poor (4%). A combination of sonographic confirmation of aneurysm, abdominal pain, and unstable hemodynamic condition resulted in the correct decision to perform emergent surgery in 21 of 22 patients (95%). An abbreviated sonographic examination done in the emergency room can provide accurate, useful information about the presence of aneurysm; this procedure does not significantly delay triage of these patients.     

Recurrent hemoptysis with Penicillium marneffei and Stenotrophomonas maltophilia in Job’s syndrome

Pulmonary infection caused by the opportunistic organisms Penicillium marneffei and Stenotrophomonas maltophilia in patients with Job’s syndrome is rare and not well documented. The case of a 30-year-old man with Job’s syndrome who developed recurrent pneumonia and lung abscesses caused by P marneffei and S maltophilia, complicated by massive hemoptysis, is described. Bronchial artery embolization was successful in controlling the hemoptysis; however, the infection proved fatal despite appropriate antimicrobial therapy. A brief review of the literature on Job’s syndrome and its associated infective pulmonary manifestations is also presented.     

Alpha-thalassemia in two Mediterranean populations

We used restriction endonuclease analysis to determine the incidence of alpha-thalassemia in two Mediterranean islands. In a random population sample, the gene frequency of deletion-type alpha-thalassemia-2 (- alpha) was 0.18 in Sardinians and 0.07 in Greek Cypriots. All cases were the rightward crossover type. From these frequencies and the known incidence of hemoglobin-H disease in these populations, we calculated the frequency of the alpha-thalassemia-1 genotype (--) and determined that it was low. We also found that beta-thalassemia homozygotes in sardinia have a higher incidence of alpha-thalassemia than normals and beta thalassemia heterozygotes because a significantly greater number of these homozygotes are also homozygous for the alpha-thalassemia-2 lesion. These findings support the theory that coinheritance of alpha- thalassemia mitigates the severity of beta-thalassemia and suggest that the protection is most pronounced when two alpha-globin genes are deleted.