The place of premedication in pediatric practice

Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence-based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. Studies applicable to one culture and to one hospital system (albeit multicultural) may not apply elsewhere. Moreover, the study of hospital-related distress begins at the start of the patient's journey and ends long after hospital discharge; it cannot be focused completely on just the moment of anesthetic induction. Taking an example from actual practice experience, the trauma caused by the actual giving of a premedication to a child who absolutely does not want it and may struggle may not be recorded in a study but could form a significant component of overall effect and later psychological pathology. Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro–con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re-evaluate a practice, which was universal historically and now in many centers is more selective.     

学龄前儿童普通话平均句子长度的多因素研究

【目的】探讨影响学龄前儿童普通话平均句子长度的因素,为促进儿童语言发育提供参考意见。【方法】以65名3~6岁学龄前儿童为研究对象并对其父母进行问卷调查。问卷内容包括儿童发育情况、家庭社会环境因素等39个变量。利用计算机程序计算每名儿童自然语言样本的平均句子长度。【结果】年龄、边看图书边自己讲述、父亲的文化程度、看广告、看电视后家长(或保姆)与儿童谈论电视内容与学龄前儿童平均句子长度呈正相关;边看图书边听家长讲述和语言障碍家族史与学龄前平均句子长度呈负相关。【结论】年龄、遗传因素和家庭语言环境为学龄前儿童语言发育的重要影响因素。     

IN.PACT AV access randomized trial: Japan cohort outcomes through 12 months

Purpose

There is a lack of adjudicated and prospectively randomized published outcomes on the use of drug-coated balloons (DCB) to treat dysfunctional arteriovenous fistula in Asian patients. This post hoc subgroup analysis of 112 Japanese participants from the global IN.PACT AV Access trial reports outcomes through 12 months.

Materials and Methods

Participants were treated with DCB (n = 58) or standard non-coated percutaneous transluminal angioplasty (PTA) balloons (n = 54). Outcomes included target lesion primary patency (TLPP), access circuit primary patency, and safety.

Results

Through 6 months, TLPP was 86.0% (49/57) in the DCB group and 49.1% (26/53) in the PTA group (p < 0.001). Through 12 months, TLPP was 67.3% (37/55) in the DCB group and 43.4% (23/53) in the PTA group (p = 0.013).

Conclusion

In this post hoc analysis of Japanese participants from the IN.PACT AV Access trial, participants treated with DCB had higher TLPP through 6 and 12 months compared with PTA.     

农村乙型肝炎疫苗接种率及影响因素调查

为了解农村地区乙型肝炎 (乙肝 )疫苗免疫效果及影响因素 ,提出相应措施提高乙肝疫苗的保护效果。在南江、旺苍两县 ,采用多阶段随机整群抽样方法 ,抽取 5 2 7名 2 0 0 0年出生儿童及其 4 99名母亲 ,采血检测血清乙肝病毒表面抗原 (HBsAg)。结果显示 :儿童乙肝疫苗免疫接种率和全程免疫接种率分别为 99 0 5 %、95 4 5 % ;首针及时接种率和全程及时接种率分别为 6 8 39%、6 1 6 9%。住院分娩和在家分娩儿童首针及时接种率分别为 83 5 9%、5 6 90 % ,两者的差异有非常显著的统计学意义 (P <0 0 1)。≥第 2胎儿童的首针及时接种率非常明显的低于第 1胎儿童 (χ2 =34 1178,P <0 0 1)。被调查儿童母亲的HBsAg阳性率为 6 6 1% ;儿童HBsAg阳性率为 1 5 2 % ,7例均为阳性母亲所生儿童。由此可见 ,在农村推广乙肝疫苗免疫接种将大大降低HBsAg阳性率。在经济欠发达的边远地区和山区农村 ,对孕妇进行HBsAg筛查 ,重点对HBsAg阳性产妇的新生儿及时接种乙肝疫苗 ,将会取得事半功倍的效果     

在聚乙氧基辛基苯基醚存在下氯米帕明的电分析特性

在聚乙氧基辛基苯基醚存在下氯米帕明的电分析特性张正奇，陈展光，陈声宗，曾鸽鸣，杨植岗（湖南大学化学化工系，长沙４１００８２）氯米帕明（ｃｌｏｍｉｐｒａｍｉｎｅ，ＣＭＩ）能选择性地抑制中枢神经系统内５－ＨＴ的重吸收，可消除抑郁心境，恢复活力。本品使用安...     

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

OBJECTIVES: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. METHODS: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an 'Assessment Questionnaire for Scrotal Pain' both before and after the surgery. RESULTS: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. CONCLUSIONS: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.     

Central haemodynamics in acute myocardial infarction in relation to mortality and peak enzyme activity

The relation of central haemodynamic changes to subsequent mortalityand peak enzyme activity was investigated in 190 patients withacute myocardial infarction. The mean delay time from onsetof symptoms to the haemodynamic study was 7.2 hours. Major exclusioncriteria were heart rate < 65beats min^–1, systolicblood pressure < 105 mmHg and lung rales to a distance of> 10 cm above the lung bases. Nine patients (4.7%) died within15 days and 16 patients (8.4%) within 90 days after the infarction.Compared to survivors, non-survivors were characterized by baselinedepression of cardiac index, stroke volume index and left ventricularstroke work index, while pulmonary capillary wedge pressureand peripheral resistance were increased. However, a wide overlapbetween survivors and non-survivors makes the predictive valuelow in the individual patient. Peak serum aspartate aminotransferase (S-ASAT) activity wasweakly related to baseline pulmonary capillary wedge pressure(r = 0.28; P< 0.001) and stroke volume index (r = –0.22;P7lt;0.01). The correlation to pulmonary capillary wedge pressurewas only found in anterior (r = 0.34) infarcts. Peak serum lactatedehydrogenase (LD¹) was not correlated with baseline haemodynamics.     

Molecular analysis of the Turkish form of deletion-inversion (δβ)° thalassaemia

Two unrelated (δβ)°-thalassaemia patients from Southern Turkey are presented. DNA studies indicated that both of them are homozygous for the Turkish type of (δβ)°-thalassaemia characterized by one large deletion of 11.5 kb including the δ and β globin genes at the 5' end and one small deletion of 1.6 kb at the 3' end, which are separated by an inverted 7.6 kb long DNA segment that includes L1 repetitive sequence. In the present study a PCR-based method was performed to produce a unique deletion-specific product and subjected to sequence analysis for the determination of the breakpoint. DNA polymorphisms in the β-globin gene cluster of deletion-inversion type of (δβ)°-thalassaemia, IVS-I-6 and β-39 globin genes were examined. Analysis of sequence variations in regulatory regions including the 5' hypersensitive site-2 of the locus control region (LCR), the δ, ^Gγ and ^Aγ 5' flanking regions and the second intervening sequence (IVS-II) of ^Aγ and ^Gγ genes indicated the presence of close similarities between the chromosome carrying the Turkish form of deletion-inversion δβ)°-thalassaemia and the chromosome associated with β-39 nonsense mutation in haplotype II. These two chromosomes are characterized by the presence of a 4 base pair deletion in the ^Aγ^T globin gene promoter. A C → T alteration at position −199 5' to the δ gene was also found to be associated with the Turkish type of (δβ)°-thalassaemia and β-39 chromosome.