黄花开口箭(Tupistra aurantiaca Wall.)的强心作用

用黄花开口箭根茎制成酊剂,将所含乙醇在水浴锅上蒸发后,其残渣对Legals及Keller-Kiliani应呈阳性,证明为强心甙类.酊剂蒸发乙醇后用蒸馏水溶解,过滤后所得的水溶液,通过在位蛙心及兔心、猫心电图及离体豚鼠心实验,证明有强心作用,其强心作用特点类似洋地黄.按中国药典鸽法测定其效价,折合生药为207.14±13.07毫克/公斤(标准差).     

Systemic candidiasis in premature infants

Abstract Four cases of systemic candidiasis in premature infants with different clinical presentations are reported. Diagnosis of the condition can be difficult as clinical manifestations are non-specific and Candida may not be recovered in blood culture. The condition should be suspected in predisposed babies with unabating or deteriorating infections despite appropriate antibiotic therapy. We propose routine microscopic urinary examination for Candida as a screening test for the infection.     

Impact of Interatrial Septum Anatomic Features on Short‐ and Long‐Term Outcomes After Transcatheter Closure of Patent Foramen Ovale: Single Device Type Versus Anatomic‐Driven Device Selection Strategy

Backgrounds

We reported the short‐ and long‐term results of our institutional single center registry Interatrial Septum Interventions Study (ISIS) about the impact of different anatomic characteristics and related device selection in patent foramen ovale (PFO) closure.

Methods

Over a 9 year period (September 2003–September 2012) we prospectively enrolled 340 consecutive patients (mean age 44 ± 15. 5 years, 198 females) who had been referred to our center for PFO catheter‐based closure. The first 105 patients received a single type of device independently from the anatomy (single device strategy). The remaining 235 patients received a different device based on intracardiac echocardiographic study of interatrial septum anatomy (anatomic strategy).

Results

Immediate success rate was 100% in both groups, whereas the rate of immediate complications was 10.4% and 2.5% (P < 0.01) in the single strategy group and anatomic strategy group, respectively. During a mean follow‐up of 59.3 ± 28.9 months, the occlusion rate was 86.6% and 94%, whereas the incidence of recurrences was 1.8% and 0% in the single device strategy group and anatomic strategy group, respectively.

Conclusion

The results from ISIS registry showed that anatomy of interatrial septum associated with PFO is quite complex leading to an increased rate of complications and a slightly lower closure rate if treated with a single device strategy.

     

Angiographic and Clinical Outcomes of Everolimus‐Eluting Stent in the Treatment of Extra Long Stenoses (AEETES)

Objectives

The purpose of this study was to examine the angiographic and clinical results of stent full metal jacket in treating long lesions using everolimus‐eluting stents (EES).

Background

Data are lacking regarding the use of EES for this lesion subgroup.

Methods

From 2007 to 2011, 77 symptomatic patients who had severe coronary stenoses necessitating implantation of stents with total length longer than 60 mm were treated with overlapping EES.

Results

The mean age of patient was 61 ± 11 years with male predominance (66%). Diabetes mellitus was seen in 35 (45.5%) patients. Majority of patients had class III angina with normal heart function. On average, 3.1 stents were implanted per lesion; the mean stent size and length were 2.70 ± 0.28 mm and 82 ± 16 mm. Restudy angiography was performed on 71 patients (72 lesions) at 8.9 ± 2.5 months. Angiographic restenosis was seen in 9 (12.5%) lesions; the lesion length and late loss were 67 ± 15 mm and 0.4 ± 0.6 mm, respectively. The use of intravascular ultrasound has been found to be a predictor of less restenosis (P = 0.02; HR: 0.02; CI: 0.01–0.59). The in‐hospital and 1 year major adverse cardiac event rates were 7.8% and 13%. The annual cardiac death rates were 2.6%, 3.4%, and 5.3% in the first 3 years.

Conclusions

The use of EES full metal jacket for long lesions is only associated with good short‐term clinical and angiographic outcomes. Long‐term follow‐up has revealed a high cardiac death rate which may necessitate prolongation of dual antiplatelet therapy. (J Interven Cardiol 2013;26:22–28)

     

A “tricky” subarachnoid hemorrhage

To the editor:We report a tricky subarachnoid haemorrhage (SAH).Our patient was a 59-year-old woman with generalized headache for 1 day,which was constricting in nature and rated grade 6/10.Her symptoms were aggravated by lying flat and improved with vomiting.The Glasgow coma scale was full,blood pressure was 142/83 mmHg and pulse 75 beats/min.There was neither neck stiffness nor focal neurological deficit.Fundoscopic examination was normal.She was noted to have hyponatremia (sodium (Na) 122 mmol/L) with serum osmolarity 263 mmol/kg,urine osmolarity 582 mmol/kg,urine Na 117 mmol/L,normal thyroid stimulating hormone and cortisol level.Plain computed tomography (CT) brain was normal (Figure 1A).Lumbar puncture (LP) was performed on day two,and multiple attempts were required.     

Proactive infection control measures to prevent nosocomial transmission of carbapenem-resistant Enterobacteriaceae in a non-endemic area

Background Identification of hospitalized carbapenem-resistant Enterobacteriaceae （CRE）-positive patient is important in preventing nosocomial transmission.The objective of this study was to illustrate the implementation of proactive infection control measures in preventing nosocomial transmission of CRE in a healthcare region of over 3200 beds in Hong Kong between October 1,2010 and December 31,2011.Methods The program included active surveillance culture in patients with history of medical tourism with hospitalization and surgical operation outside Hong Kong within 12 months before admission,and ＂added test＂ as an opportunistic CRE screening in all fecal specimens submitted to the laboratory.Outbreak investigation and contact tracing were conducted for CRE-positive patients.Serial quantitative culture was performed on CRE-positive patients and the duration of fecal carriage of CRE was analyzed.Results During the study period,a total of 6533 patients were screened for CRE,of which 76 patients were positive （10 from active surveillance culture,65 from ＂added test＂,and 1 secondary case from contact tracing of 223 patients with no nosocomial outbreak）,resulting in an overall rate of CRE fecal carriage of 1.2％.The median time of fecal carriage of CRE was 43 days （range,13-119 days）.Beta-lactam-beta-lactamase-inhibitors,cephalosporins,and fluoroquinolones were associated significantly with high fecal bacterial load when used 90 days before CRE detection,while use of cephalosporins,carbapenems,and fiuoroquinolones after CRE detection are significantly associated with longer duration of carriage.The duration of fecal carriage of CRE also correlates significantly with the initial fecal bacterial load （Pearson correlation：0.53; P=0.02）.Conclusion Proactive infection control measures by enhanced surveillance program identify CRE-positive patients and data obtained are useful for the planning of and resource allocation for CRE control.