Propafenone: A New Anti arrhythmic for Treatment of Chronic Ventricular Arrhythmias

Propafenone is a new anti arrhythmic agent with primarily membrane-stabilizing action. Three U.S. controlled double-blind cross-over studies demonstrated the efficacy of propafenone in suppressing ventricular premature complexes (VPCs), including repetitive forms: 67–83% of patients had greater than 80% reduction of VPCs, 62% achieved greater than 90% reduction of couplets and 80%–100% achieved 200% abolition of ventricular tachycardia runs. Other studies showed that propafenone is effective in controlling ventricular arrhythmias refractory to conventional anti arrhythmic agents. Propafenone is at least as effective as these agents. Long-term sustained efficacy of propafenone was shown in some preliminary studies. Because of the variation in individual response to the drug, therapy should be individualized for each patient. Propafenone is well tolerated: side effects of propafenone are few and involve mostly the cardiac conduction system. Propafenone would be a significant addition to the anti arrhythmic armamentarium.     

Parturition Care Planning

Nursing care planning is not a new concept, but in contemporary nursing, this tool is taking on new meaning. In an area such as labor and delivery, the concept of the nursing process must be scrutinized and adapted to facilitate its usefulness in providing optimum care of the parturient. A perspective on the scope of care planning, its benefits to the parturient, and its value and implications is presented.     

毒性中药狼毒质量标准研究

目的:建立毒性中药狼毒的质量标准。方法:采用显微、化学、液相色谱/质谱等方法进行定性鉴别,以液相色谱及液相/质谱法测定含量。结果:狼毒大戟中月腺大戟乙素含量为0.01%w/w,月腺大戟中月腺大戟乙素含量范围为0.01%~0.02%w/w,均未检出瑞香内酯、狼毒色原酮和新狼毒素A。瑞香狼毒中瑞香内酯、狼毒色原酮及新狼毒素A等成分含量范围分别为0.57%~2.12%w/w、0.86%~1.6%w/w及0.45%~0.96%w/w,但未检出含月腺大戟乙素成分。结论:各法能用于常规检测狼毒属植物。     

Differentiating attention deficits in children with fetal alcohol spectrum disorder or attention‐deficit–hyperactivity disorder

Aim The attention and inhibition problems found in children with attention‐deficit–hyperactivity disorder (ADHD) are also common in children with fetal alcohol spectrum disorders (FASDs). Attempts to distinguish ADHD from FASDs in terms of these deficits are rare and were pursued in this study. Method A total of 116 children (47 with ADHD, 31 males, 16 females; 30 with FASDs, 17 males, 13 females; and 39 comparison children, 20 males, 19 females) participated. The mean age was 9 years 4 months (SD 1y 8mo) in the ADHD groups, 8 years 10 months (SD 1y 2mo) in the FASD group, and 9 years 1 month (SD 1y 1mo) in the comparison group. Sustained attention was tested with a slow event rate continuous performance task (CPT). Inhibitory control was tested with both a slow and fast event rate Go/No‐Go task. Results On the CPT task, children with ADHD, combined type (ADHD‐C), ADHD, primarily inattentive type (ADHD‐PI), and FASDs showed greater declines in task performance as a function of time than comparison children, suggesting sustained attention problems in all clinical groups. Children’s Go/No‐Go performance was event‐rate dependent, with the ADHD‐C group being affected in the slow condition and the ADHD‐PI and FASD groups having problems with the fast condition. Interpretation Children with ADHD‐C are typically impaired in handling understimulation, while children with FASDs may have problems with overstimulation. The dissociation in responsivity to event rate between groups may have significant differential diagnostic value.     

Editorial: At the Bifurcation of the Last Frontiers

The concept of coronary angioplasty percutaneous coronary intervention (PCI) was pioneered by Andreas Gruntzig. Since then, several modifications, innovative devices, techniques, and advances have revolutionized the practice of interventional cardiology. Coronary bifurcation and chronic total occlusion are the last two frontiers that continue to challenge the skills of the interventional cardiologists. Proceedings of the second Bifurcation Summit held from November 26 to 28, 2009 in Nanjing, China are published in this symposium. In a general review, the state of the art in management of bifurcation lesion is summarized in the statement of the “Bifurcation Club in KOKURA.” A new‐presented concept was the “extension distance” between the main vessel and the sidebranch ostia and its association with restenosis. The results of two studies on shear stress (SS) after PCI showed that contradictory lower SS after stenting was associated with lower in‐stent restenosis. There was better fractional flow reserve after double kissing crush technique than provisional one‐stent technique. There was also lower rate of stent thrombosis after bifurcation stenting with excellent final angiographic results. In a negative note, the SYNTAX score had no predictive values on trifurcated left main stenting. In summary, different aspects of percutaneous management for bifurcated lesion are described seen from different perspectives and evidenced by novel techniques and strategies. (J Interven Cardiol 2010;23:293–294)     

Serial monitoring of nutritional status in Chinese peritoneal dialysis patients by Subjective Global Assessment and comprehensive Malnutrition Inflammation Score

Aim: The Malnutrition Inflammation Score (MIS) has been proposed for the assessment of nutritional status in peritoneal dialysis (PD) patients. The MIS and the Subjective Global Assessment (SGA) for serial monitoring of nutritional status in PD patients were compared. Methods: The change in the MIS and SGA overall score of 59 PD patients (28 male) over 12 months was studied. Clinical factors relating to the discrepancy between the two instruments were explored. Results: The average patient age was 55.8 ± 9.7 years. Thirty of the 59 patients (50.8%) had exact agreement in the changed MIS and SGA scores. Cohen's κ score was 0.274, indicating a modest degree of agreement. For the detection of deterioration in nutritional status and using the MIS as the reference measure, the SGA had a sensitivity of 61.9% and specificity of 86.8%; serum ferritin level was substantially higher in the ones whose SGA did not detect a deterioration in nutrition (1464.1 ± 873.3 vs 800.5 ± 561.6 pmol/L, P = 0.046). For the detection of improvement in nutritional status, the SGA had a sensitivity of 45.8% and specificity of 82.9%; patients whose SGA did not detect an improvement in nutrition were dialyzed longer (53.8 ± 35.3 vs 27.6 ± 18.9 months, P = 0.038), had higher total iron binding capacity (TIBC) (45.6 ± 5.5 vs 38.2 ± 8.1 µmol/L, P = 0.015), had higher total Kt/V (2.02 ± 0.36 vs 1.75 ± 0.23, P = 0.048) and higher normalized protein nitrogen appearance (1.16 ± 0.25 vs 0.95 ± 0.23 g/kg per day, P = 0.048). Conclusion: The longitudinal changes in the MIS and SGA score have modest agreement with each other. However, PD patients with a longer duration of dialysis, higher serum ferritin, TIBC, total Kt/V or normalized protein nitrogen appearance tend to have discrepancies between the longitudinal changes in the MIS and SGA overall score.     

辛普森悖论的范例（英文）

概述:辛普森悖论普遍存在于很多领域。它具有数据的条件性和边缘性解释之间的不一致特征。在本文中,我们通过一些例子来阐述辛普森悖论是如何在连续性、分类和时间-事件数据中产生的。     

STUDIES OF SERUM LONG-ACTING THYROID STIMULATOR (LATS) IN RELATION TO EXOPHTHALMOS AFTER THERAPY FOR THYROTOXICOSIS

Observations have been made on a series of 30 thyrotoxic patients before and after therapy, with particular attention to exophthalmos (measured by the Hertel exophthalmometer) and serial determinations of serum levels of protein-bound iodine (PBI) and long-acting thyroid stimulator (LATS). In 14 cases in which there was an exacerbation of exophthalmos (mean maximal increase of 2·8 mm. Hg) there was a greater fall in serum PBI levels (7.3 µg. per 100 ml.) than in 16 cases in which there was no such exacerbation (3.5 µg. per 100 ml.), although initial serum levels of PBI were the same in the two groups. The serum LATS level was more likely to be initially elevated in the group showing exacerbation. and a further rise was observed more frequently in this group following therapy, whether with antithyroid drugs, surgery or radio-iodine. Suppression of serum levels of LATS with azathioprine or steroids did not significantly affect the exophthalmos which had already developed in two cases. These observations suggest that a determination of serum level of LATS could be carried out advantageously before therapy. If a high level is seen, then exacerbation of exophthalmos is more likely to occur. Immunosuppressive therapy may be indicated in addition to antithyroid drug therapy. surgery or the use of radio-iodine if exacerbation is to be prevented. Further studies are suggested to try to define more clearly the susceptible group of patients and to assess the value of immunosuppressive therapy in preventing exacerbations of exophthalmos.