NICE thromboprophylaxis guidelines are not associated with increased pericardial effusion after surgery of the proximal thoracic aorta

IntroductionIn 2010 the National Institute for Health and Clinical Excellence (NICE) released guidelines on venous thromboembolism. Strategy focused on risk assessment, antiembolic stockings, sequential compression devices, subcutaneous high dose enoxaparin (40mg), early mobilisation and hydration. The 40mg enoxaparin dose over the previous 20mg regimen was worrisome, and its effect on pericardial effusion rates and mortality in proximal aortic surgery was investigated.MethodsProximal aortic reconstructions performed between December 2008 and April 2011 were identified from prospectively collected data in a tertiary centre database. Retrospective analysis of patient notes was performed. Proximal aortic surgery patients were categorised as low dose (20mg) enoxaparin and high dose (40mg) enoxaparin, and compared for confounding variables. In-hospital, early and one-year readmission rates for pericardial effusion were ascertained from echocardiography reports. The primary outcome was total pericardial effusion rate. Secondary outcomes consisted of 30-day and 1-year mortality.ResultsA total of 198 patients underwent proximal thoracic aortic surgery. Nine patients were excluded due to early postoperative death (n=5) and missing patient records (n=4). This left 189 cases for analysis. There were 93 patients in the low dose group and 96 in the high dose group. Groups were comparable for age, cardiopulmonary bypass time, aortic cross-clamp time, postoperative warfarin and antiplatelet agents. Pericardial effusion rates up to one year were comparable (low dose 19% vs high dose 21%). Thirty-day mortality was lower in the low dose group (0 vs 3 deaths). There were four deaths up to one year but these were not attributable to increased enoxaparin.ConclusionsIncreased perioperative thromboprophylaxis dosage does not increase pericardial effusion rates or mortality in proximal aortic surgery.     

Herodontics – is there a place for maintaining the apparently hopeless tooth?

The population is ageing and people are keeping their own teeth for much longer due in part to the efforts of the dental profession in restoring teeth and reducing the number of teeth being extracted. Along with this there is now an increasing expectation by patients that they will retain their own teeth as they age and that dental practitioners will have the knowledge and skills to help them retain their own teeth. Contemporary restorative materials and techniques have increased the range of options available to assist with maintaining the dentition, and many of these procedures enable minimally invasive and cost effective management of the teeth as an alternative to complex and expensive procedures. This paper discusses the restoration of compromised and failing teeth in the ageing patient, and looks at the various issues facing the ageing dentate patient and the dilemma of when to restore or when to extract. Ultimately it is hoped that maintaining healthy teeth for life may not only improve oral function and quality of life, but may in fact reduce the impact of the physical and psychological aspects of ageing.     

Improved arterial oxygenation in children with the adult respiratory distress syndrome: the prone position

Seven ventilated children with the adult respiratory distress syndrome (ARDS) were studied. While supine and haemodynamically stable, baseline arterial blood-gas analyses and haemodynamic measurements, including cardiac output, were performed. Each child was then turned prone and 30 min later a repeat set of measurements were made. Following this, the children were returned to the supine position and 30 min later a final set of measurements were performed. Ventilation and inotropic support remained unchanged during these positional changes. No significant effect on heart rate, mean systemic arterial blood pressure and cardiac output occurred following these positional changes ( p < 0.05; Friedman's ANOVA). Arterial oxygen saturation significantly improved, however, when nursed in the prone position ( p < 0.02). Similarly, oxygen delivery significantly increased ( p < 0.02). The prone position improves arterial oxygenation and oxygen delivery in children with ARDS. By adopting the prone position, in ventilated children with ARDS, we surmise that realistic gas exchange targets may be reachable with lower levels of inspired oxygen and/or peak airway pressures.     

An assessment of behavioural characteristics in infants who died of sudden infant death syndrome using the Early Infancy Temperament Questionnaire

An assessment of the behavioural peculiarities of infants dying of sudden infant death syndrome (SIDS) was carried out using the Early Infancy Temperament Questionnaire (EITQ). Thirty-six infants (25 boys and 11 girls aged 14 months) in whom the diagnosis of SIDS was confirmed by full necropsy and who died in St Petersburg from 1990 to 1992 entered the study, and the families were approached contemporaneously. A control group consisted of an equal number of age, sex, geographic distribution and date of birth matched live infants from the same city. The infants who died of SIDS had significantly lower estimates of activity in comparison with the babies from the control group. Behavioural defects may be a contributory factor and a sign of increased risk in some babies presenting with SIDS.     

细粒棘球蚴TGF—βⅠ型受体全长和胞内域酵母双杂交载体的构建及白激活鉴定

目的构建细粒棘球绦虫（Eg）转化生长因子I型受体（EgTβRI）全长及胞内域酵母双杂交真核表达载体,愉测重组诱饵质粒对酵母菌株的毒性作用及自激活活性。方法采用TRIzol法提取细粒棘球蚴总RNA;采用RT—PCR扩增EgTβRI全长基因及EgTβRI胞内域（EgTβRIintracellulardomain,EgTβRII）基因片段,分别构建pGBKT7-EgTβRI和pGBKT7-EgTβRI—I真核表达载体,经PCR、限制性酶切鉴定及序列测定正确后,PEG／LiAc法转化人酵母菌株,检测诱饵蛋白对酵母菌的毒性作用及其自激活活性。结果成功构建了pGBKT7-EgTβRI及pGBKT7EgTβRI—I真核表达载体,经双酶切,分别得到1662bp和1314bp目的基因片段,大小与预测值相符。两重组质粒转化Y2HGold酵母菌形成的菌落与pGBKT7质粒转化酵母菌菌落大小一致,直径为1．5～2．0mm;两重组质粒转化酵母菌在SD／Trp／X／A平板上无蓝色菌落生长,在SD／-Trp平板上形成直径为2mill的菌落。结论成功构建了pGBKT7-EgTβRI及pGBKT7-EgTβRI—I真核表达载体,其表达蛋白对Y2HGold酵母菌无毒性作刷和无自激活活性;该表达载体可以用于酵母双杂交系统,为进一步研究EgTβRI与其配体之间的交互作用奠定了基础。     

内注电切外剥术治疗混合痔165例临床观察

为观察消痔灵注射加高频电刀内痔切除、外痔剥离术治疗混合痔的效果,对165例混合痔患者采用消痔灵注射加高频电刀内痔切除、外痔剥离术治疗。结果显示,治愈162例,显效2例,好转1例。疗程10～18d,平均14d。随访6～18个月,无复发。结果表明,该术式费用低,疗效明显,术后恢复快,疼痛轻,操作简便,易于掌握,适于临床推广应用。     

便秘患者242例精神心理特点及相关因素分析

为探讨便秘患者的精神心理特点及相关因素分析,本研究应用症状自评量表SCL-90对242例功能性便秘患者的精神心理情况进行评价,并应用SPSS17．0软件对便秘患者异常精神心理状态的相关因素进行分析。结果显示,精神心理正常77例,异常165例。异常精神心理类型依次为：焦虑89例,抑郁49例,强迫11例,躯体化7例,人际关系5例,敌对3例,偏执1例。无恐怖、精神病性。异常精神心理与患者性别、年龄、职业均有一定关系,P〈0．05。结果表明,大多数功能性便秘患者都存在异常精神心理,临床中应根据患者性别、年龄、职业等给予有针对性的心理干预。