Efficacy of "high-intensity" blue-light and "standard" daylight phototherapy for non-haemolytic hyperbilirubinaemia

We report our clinical experience with phototherapy in 3802 infants; 3629 were exposed to "standard" daylight phototherapy and 173 to "high-intensity" blue-light phototherapy. High-intensity blue-light phototherapy was twice as effective as standard daylight phototherapy in decreasing bilirubin concentrations. No failures occurred with high-intensity phototherapy compared with an overall failure rate of 1.84/1000 with daylight lamps; these cases were transferred to high-intensity phototherapy with prompt response. Rebound after cessation of phototherapy was greater in those exposed to high-intensity blue light with a significantly greater number requiring a second exposure. However, the incidence was still low. No third exposure was required in any infant. Nursing of infants under high-intensity blue light was more difficult and inconvenient as was clinical monitoring. The light also caused more stress on the nursing and medical personnel. However, the infants tolerated both types of phototherapy equally well. High-intensity blue-light phototherapy would seem to be the treatment of choice for infants with rapidly increasing or very high bilirubin levels, as well as in those not responding adequately to daylight phototherapy.     

聚乙二醇在猪组织工程瓣膜制备中的应用

目的:观察聚乙二醇法在组织工程瓣膜准备中的应用价值,比较聚乙二醇去细胞前后组织工程瓣膜的物理特性。方法:实验于2005-10/2006-03在华中科技大学同济医学院基础医学院生物化学系实验室完成。①实验分组:取猪10只,由于猪主动脉瓣为三叶瓣结构,共取得瓣叶组织30个,麻醉后宰杀取其心脏动脉瓣膜,分为去细胞组和对照组,每组各15个。②实验方法:去细胞组用聚乙二醇和DNase I处理;瓣叶组织放入1kg/L聚乙二醇,室温下浸泡30～45min,振荡器加以振荡;含抗生素磷酸盐缓冲液浸泡24h,反复3次洗脱;以5×104U/L DNase I液浸泡处理1h;对照组仅以含抗生素磷酸盐缓冲液浸泡24h,反复3次洗脱。③实验评估:苏木精-伊红染色、扫描电镜观察去细胞情况,吸光度(A)值,计算去细胞率(%)=(对照组A值-去细胞组A值)/对照组A值×100%。猪去细胞瓣膜条置于力学测试仪测定最大负荷、最大应力、最大应变和弹性模量。结果:纳入猪10只,均进入结果分析。①去细胞组织形态学观察:去细胞组猪瓣膜组织中看不到细胞成分,且细胞外基质结构保存完整,胶原纤维排列整齐,无明显断裂,仍呈波浪状平行排列,结构紧凑,弹性纤维结构清晰,组织无明显水肿。②DNA含量分析:聚乙二醇处理后去细胞百分率为95.32%。③生物力学检测:与对照组比较,去细胞组瓣膜组织最大负荷[(12.586±1.693),(10.242±1.435)N,P>0.05]、最大应力[(2.346±0.342),(1.877±0.572)N/mm,P>0.05]、弹性模量(15.152±1.579,14.549±0.678,P>0.05)、最大应变[(31.685±7.533),(28.118±6.045)mm/N,>0.05]等均无显著差异。P结论:聚乙二醇法去除细胞完全,细胞外基质保存完整,对组织机械性能无明显影响,适于构建组织工程瓣膜。     

Should we eradicate Helicobacter pylori infection in patients receiving nonsteroidal anti‐inflammatory drugs or low‐dose aspirin?

Whether Helicobacter pylori infection alters the risk of ulcer disease in patients receiving nonsteroidal anti‐inflammatory drugs (NSAIDs) or low‐dose aspirin is one of the most controversial topics in peptic ulcer research. This is an important management issue, particularly in countries where peptic ulcer disease is common and the prevalence of H. pylori infection is high. Current evidence shows that H. pylori infection increases the ulcer risk associated with NSAIDs or low‐dose aspirin. Eradication of H. pylori reduces the subsequent risk of endoscopic and complicated ulcers in patients who are about to start long‐term NSAIDs. Among patients with H. pylori infection and a history of ulcer bleeding who continue to use low‐dose aspirin, 1 week of eradication therapy prevents recurrent ulcer bleeding. Failure of eradication and concomitant use of NSAIDs, however, account for most cases of recurrent bleeding with low‐dose aspirin. The apparent protective effect of H. pylori in long‐term NSAIDs users reported in some studies was actually the weeding out of susceptible patients who were intolerant to NSAIDs. There is no convincing evidence that eradication of H. pylori has any clinically important adverse effect on the healing and prevention of ulcers in NSAIDs users.     

The International classification of functioning,disability and health – children and youth (ICF‐CY): testing its utility in classifying information from eco-cultural family interviews with ethnically diverse families with children with disabilities in Kyrgyzstan

Purpose.?The objective of this study was to test the utility of the International classification of functioning, disability and health – children and youth's (ICF-CY) Environmental Factors component by classifying family interview data from two ethnically and culturally diverse – Kyrgyz and Uzbek – families that have children with various types of disabilities in Kyrgyzstan, Central Asia.

Methods.?The eco-cultural family interview (EFI) was used to interview four Kyrgyz and four Uzbek families. The obtained data were analysed by using manifest content analysis; identified units of meaning named as ‘EFI items’ and ‘EFI concepts’ were then linked to the ICF-CY's codes by application of ten linkage rules.

Results.?The analysis of transcribed interviews identified 669 EFI items and 745 EFI concepts. The linking of EFI items to the ICF-CY showed: 92 EFI items and concepts were linked to nd (not definable); 104 items were linked to nc (not covered by the ICF-CY); 15 items were categorised as pf (personal factors); 21 items were linked to categories found in Activities and Participation; and 3 were linked to Body Functions components. The rest of EFI items and concepts were linked to categories of the Environmental Factors component.

Conclusion.?The codes included into Chapters 1, 2 and 5 of the ICF-CY environmental component can be easily assigned to the relevant EFI items. There is a necessity to add more codes in Chapters 3 and 4 of the Environmental Factors component, and the inclusion of a separate component of Personal Factors into the classification is suggested.     

Evaluation of a rapid stoolantigen test for the diagnosis of Helicobacter pylori infection in Chinese patients

OBJECTIVE: To evaluate the accuracy of a rapid assay that wasdeveloped to detect Helicobacter pylori antigen in the stool,using the principle of immunochromatography, in the Chinese population. METHODS: Eligible patients without prior treatment of H.pylori were recruited. An in‐house rapid urease test (RUT) andhistology were used as the gold standard. The results of the rapidstool antigen test were compared with the gold standard. RESULTS: Valid rapid stool antigen test results for interpretationwere obtained from 94 consecutive patients (mean age: 52.5, range:22?82 years). Sensitivity, specificity, positive predictivevalue, negative predictive value and accuracy were, respectively, 77.5%,87.0%, 81.6%, 83.9% and 83.0%.The test was easy to perform and results were available within 15 min. CONCLUSION: The rapid stool antigen test using immunochromatography accuratelydiagnoses H. pylori infection in Chinese patients.     

Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study

Despite rather strict recommendations for antibiotic treatment of disseminated Lyme borreliosis (LB), evidence-based studies on the duration of antibiotic treatment are scarce. The aim of this multicenter study was to determine whether initial treatment with intravenous ceftriaxone (CRO) for 3 weeks should be extended with a period of adjunct oral antibiotic therapy. A total of 152 consecutive patients with LB were randomized in a double-blind fashion to receive either amoxicillin (AMOX) 1 g or placebo (PBO) twice daily for 100 days. Both groups received an initial treatment of intravenous CRO 2 g daily for 3 weeks, followed by the randomized drug or PBO. The outcome was evaluated using the visual analogue scale at the follow-up visits. The final analysis included 145 patients, of whom 73 received AMOX and 72 PBO. Diagnoses of LB were categorized as either definite or possible, on the basis of symptoms, signs, and laboratory results. The diagnosis was definite in 52 of the 73 (71.2%) AMOX-treated patients and in 54 of the 72 (75%) PBO patients. Of the patients with definite diagnoses, 62 had neuroborreliosis, 45 arthritis or other musculoskeletal manifestations, and 4 other manifestations of LB. As judged by the visual analogue scale and patient records, the outcome after a 1-year follow-up period was excellent or good in 114 (78.6%) patients, controversial in 14 (9.7%) patients, and poor in 17 (11.7%) patients. In patients with definite LB, the outcome was excellent or good in 49 (92.5%) AMOX-treated patients and 47 (87.0%) PBO patients and poor in 3 (5.7%) AMOX-treated patients and 6 (11.1%) PBO patients (difference nonsignificant, p = 0.49). Twelve months after the end of intravenous antibiotic therapy, the levels of antibodies against Borrelia burgdorferi were markedly decreased in 50% of the patients with definite LB in both groups. The results indicate that oral adjunct antibiotics are not justified in the treatment of patients with disseminated LB who initially receive intravenous CRO for 3 weeks. The clinical outcome cannot be evaluated at the completion of intravenous antibiotic treatment but rather 6–12 months afterwards. In patients with chronic post-treatment symptoms, persistent positive levels of antibodies do not seem to provide any useful information for further care of the patient.