Family history and recurrence of febrile seizures

To determine the value of a detailed family history for the assessment of the risk of recurrence of febrile seizures, 115 children who visited the emergency room of an academic children's hospital were studied prospectively. The recurrence risk of febrile seizures was analysed in relation to the child's family history and the proportion of relatives affected by febrile seizures using Kaplan-Meier estimates and Cox proportional hazard models. A first degree family history positive for febrile seizures (parents or siblings affected by febrile seizures) increased a child's two year recurrence risk from 27 to 52%. No significant increase of recurrence risk for febrile seizures was found in children with second degree relatives (grandparents and uncles/aunts) or cousins only affected by febrile seizures. Recurrence risk was significantly correlated with the proportion of first degree relatives affected by febrile seizures: risks were 27, 40, and 83% in children whose proportion was 0, 0-0.5, and > or = 0.5 respectively. Analysis of the recurrence risk in relation to a weighted proportion, adjusted for the attained age and sex of first degree relatives, showed similar results. It is concluded that the application of the proportion of first degree relatives affected by febrile seizures generates a more differentiated assessment of the recurrence risk of febrile seizures.     

达托霉素在中性粒细胞减少伴发热成人肿瘤患者中的药动学

达托霉素为第一个环脂肽类抗菌药,体外对万古霉素耐药肠球菌、甲氧西林耐药葡萄球菌及糖肽类耐药金葡菌等革兰阳性菌具有杀菌活性。作者报道了在29例中性粒细胞减少伴发热成人肿瘤患者中进行达托霉素的药动学研究结果。给予29例中性粒细胞减少伴发热肿瘤患者单剂30min内静脉滴注达托霉素6mg／kg,并分别留取用药前及用药结束后0、0．5、1、2、4、8、12和24h血样。     

An unusual presentation of spontaneous sub‐conjunctival haematoma in a patient receiving warfarin

A 65‐year‐old man on warfarin therapy with a sudden spontaneous onset of sub‐conjunctival haematoma associated with bloody tears was assessed in the clinic following a referral from an optometrist. Due to discomfort, diplopia and lagophthalmos, the haematoma necessitated suspension of warfarin therapy and a surgical evacuation. The sub‐conjunctival haematoma in a patient receiving warfarin can pose a significant management challenge.     

Metabolic syndrome among 13 year old adolescents: prevalence and risk factors

Background

Obesity and metabolic syndrome is prevalent among Malaysian adolescents and has been associated with certain behavioural factors such as duration of sleep, screen time and physical activity. The aim of the study is to report the prevalence of overweight/obesity, metabolic syndrome and its risk factors among adolescents.

Methods

A multi-staged cluster sampling method was used to select participants from urban and rural schools in Selangor, Perak and Wilayah Persekutuan Kuala Lumpur. Participants underwent anthropometric measurement and physical examination including blood pressure measurement. Blood samples were taken for fasting glucose and lipids and participants answered a self-administered questionnaire. Overweight and obesity was defined using the extrapolated adult body mass index (BMI) cut-offs of >25 kg/m² and >30 kg/m², according to the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined based on International Diabetes Federation (IDF) 2007 criteria.

Results

Data were collected from 1361 participants. After excluding incomplete data and missing values for the variables, we analysed a sample of 1014 participants. Prevalence of overweight and obesity in this population was 25.4% (N = 258). The prevalence of metabolic syndrome was 2.6% in the population and 10% among the overweight and obese adolescents. Participants who slept between 7 and 9 hours a day has a lower risk of developing metabolic syndrome OR 0.38(0.15-0.94).

Conclusion

Our results provide the prevalence of metabolic syndrome in Malaysian adolescents. Adequate sleep between 7 and 9 hours per day reduces the risk of developing metabolic syndrome.

     

Should endometrial polyps be removed in patients with postmenopausal bleeding?—an assessment of study designs and report of a failed randomised controlled trial (ISRCTN73825127)

We describe the design of a randomised controlled trial to evaluate the efficacy of endometrial polyp removal in women with postmenopausal bleeding. We designed a trial in which patients with postmenopausal bleeding and endometrial thickness >4 mm undergo hysteroscopy. If during hysteroscopy an endometrial polyp was diagnosed, patients were asked to participate in this trial and after informed consent allocated to immediate removal of the polyp or expectant management. This trial suffered from lack of recruitment related both to doctors seeking for informed consent as well as to patients' unwillingness to participate in this trial. However, a randomised controlled trial on this subject is still necessary to evaluate the efficacy of uterine cavity evaluation in the diagnostic work-up of women with postmenopausal bleeding, focussing on benign pathology. Therefore, we propose an alternative design, which might be more feasible.     

脂肪干细胞与骨髓间充质干细胞心肌样分化特性的比较

目的：骨髓间充质干细胞与脂肪干细胞均具有分化为心肌细胞的潜能。观察脂肪干细胞体外诱导分化为心肌细胞的特性及相关基因表达，比较骨髓间充质干细胞与脂肪干细胞心肌分化能力的差异。方法：实验于2006—08／2007—04在吉林省耳鼻咽喉研究所和教育部吉林大学人兽共患病重点实验室完成。①实验材料：脂肪组织标本来源于本院手术患者，所有患者知情同意，术中收集多余的皮下脂肪。（爹实验方法：分离培养人脂肪干细胞，用5-氮胞苷诱导传4～6代的脂肪干细胞分化，平行培养第5代骨髓间充质干细胞，诱导条件相同，对照组培养液不添加任何诱导因子。③实验评估：采用免疫荧光技术观察脂肪干细胞和骨髓间充质干细胞表达结蛋白Desmin和肌钙蛋白TroponinT的阳性细胞率。通过即时RT．PCR的方法检测诱导过程中细胞内GATA-4和NKX2．5的mRNA水平。结果：脂肪干细胞经5-氮胞苷诱导后3周，肌性基因标志结蛋白desmin和肌钙蛋白Troponin—T阳性细胞明显增加。与骨髓间充质干细胞组比较，脂肪干细胞表达心肌特异蛋白的阳性细胞率在诱导后第14天明显升高，而在第21天时，两组细胞的阳性表达率均达到60％左右，无明显的统计学差别，未加任何诱导条件的脂肪干细胞对照组培养14d时有2．5％和1．6％的细胞表达Desmin，Troponin．T，在骨髓问充质干细胞对照组未见心肌标记蛋白的阳性表达。即时PCR检测结果发现，诱导组与未经诱导组的脂肪干细胞均表达GATA-4和NKX2．5，骨髓间充质干细胞组在诱导后第7天出现GATA-4和NKX25的转录活性。结论：体外培养的脂肪干细胞能够被5-氮胞苷诱导分化为心肌样细胞，并且具有自发分化的能力，与骨髓间充质干细胞相比，脂肪干细胞的早期分化特性更有利于心肌干细胞移植治疗。