Isoprenylated flavonoids from the stem bark of Erythrina abyssinica

Three new prenylated flavanones, abyssinoflavanones V, VI, and VII (1-3), together with eight known flavanones (4-11) and two chalcones (12-13), were isolated from the stem bark of Erythrina abyssinica. Their structures were elucidated on the basis of spectroscopic and physicochemical analyses. All the isolates, with the exception of 1 and 8, strongly inhibited PTP1B activity in an in vitro assay with IC50 values ranging from 14.2 +/- 1.7 to 26.7 +/- 1.2 microM.     

The optimal scheme of self blood pressure measurement as determined from ambulatory blood pressure recordings

OBJECTIVE: To determine how many self-measurements of blood pressure (BP) should be taken at home in order to obtain a reliable estimate of a patient's BP. DESIGN: Participants performed self blood pressure measurement (SBPM) for 7 days (triplicate morning and evening readings). In all of them, office blood pressure (three consecutive readings) and 24-h ambulatory blood pressure were obtained as well. Average SBPM values, obtained from several combinations of readings, were correlated with the results of ambulatory blood pressure measurement (ABPM). In addition, we assessed whether certain patient characteristics would influence such correlations. SETTING: Patients were recruited at hospital or general practice. PATIENTS: A total of 216 untreated hypertensive patients. RESULTS: The average SBPM value calculated from day 3 to day 7, omitting the first measurement of each morning and evening session, gave the best correlation with 24-h ABPM (r = 0.70). However, similar results were obtained from a SBPM value averaged from day 3 until 5 without the first measurement of each triplicate session. Overall, younger patients had significantly better correlations than older ones. Women had significantly better correlations with ABPM than men for systolic morning and daytime SBPM, whereas men had significantly better correlations for daytime and evening diastolic SBPM (P < 0.001). In addition, all correlations increased with lower systolic office blood pressure measurement (OBPM) values. CONCLUSIONS: A minimum number of 5 days of measurement is recommended to obtain a reliable estimate of a patient's usual BP. On each day, three consecutive morning and evening measurements should be performed. For calculating the average SBPM, the first 2 days and the first measurement of each triplicate measurements should be discarded. Moreover, patient characteristics may have an impact on the number of necessary self-measurements. However, because adhering to these recommendations will make SBPM a time-consuming procedure, this type of measurement should be performed only when a decision about starting or changing antihypertensive therapy is needed or in the case of special patient groups.     

Does masked hypertension exist in healthy volunteers and apparently well-controlled hypertensive patients?

BACKGROUND: Home blood pressure (HB P) measurement is considered to reflect BP during the day better than office BP (OB P). But in some patients HB P is higher than OB P. This is called masked hypertension (MH). OBJECTIVE: To examine whether MH occurs in healthy volunteers and apparently well-controlled hypertensives. METHODS: 57 treated hypertensive patients and 31 healthy volunteers (27/22 men) participated. Mean age (+/- SD ) was 61 +/- 13 and 29 +/- 13 years, respectively. Patients were instructed to measure their BP twice daily for three days (3 readings each) with the Omron 705 CP device after at least 10 minutes rest in a comfortable sitting position. In the outpatient department, OB P was measured four times, in duplicate, every ten minutes by the physician using the same device and under similar conditions. RESULTS: Mean HB P of the treated hypertensive group was 146/84 +/- 18/10 mmHg, significantly higher than OB P 136/79 +/- 19/10 (p.     

The development of postthrombotic syndrome in relationship to venous reflux and calf muscle pump dysfunction at 2 years after the onset of deep venous thrombosis

OBJECTIVE: Postthrombotic syndrome (PTS) develops in 40% to 60% of patients with deep venous thrombosis. Factors that are important in the development of PTS include venous reflux, deep vein obstruction, and calf muscle pump dysfunction (CMD). METHODS: Reflux and CMD in relationship to the severity of PTS were evaluated in a 2-year follow-up study of patients with acute deep venous thrombosis. Duplex scanning was used to measure reflux. The supine venous pump function test (SVPT) measures CMD with strain-gauge plethysmography. The base-line examination was performed within 1 to 5 days after diagnosis. The next examinations were scheduled at 3, 6, 12, and 24 months. RESULTS: The study included 86 legs, and the 2-year follow-up period was completed for 70 legs. Significantly more reflux was found in previously thrombosed vein segments, with an odds ratio of 1.8 after 3 months, of 2.1 after 6 months, of 2.5 after 12 months, and of 3.2 after 24 months. Multiple regression results showed that the most important risk factor for early clinical signs of PTS was superficial reflux in months 3, 6, and 12 (P < or =.02). Deep reflux did not have a synergistic relationship with superficial reflux in correlation with the clinical signs of PTS. The SVPT was not able to predict the development of PTS. CONCLUSION: More reflux develops in previously thrombosed vein segments. As early as after the third month, patients with superficial reflux have an increased risk of development of the first clinical signs of PTS. Within 2 years, the SVPT shows no relationship with clinical signs of PTS.     

木通马兜铃化学成分研究

从木通马兜铃(Aristolochia manshuriensis Kom)茎皮中分得一个新化合物(5),经光谱(IR,UV,HRMS,^{1HNMR,NOEDS)鉴定为3,4-二甲氧基-10-硝基菲-1-羧酸甲酯,命名为马兜铃酸BII甲酯。另11个已知化合物是马兜铃酸Ⅰ,Ⅱ,Ⅲa,Ⅳ,Ⅳa,对羟基桂皮酸,β-谷甾醇,豆甾烷-3,6-二酮,6-羟基-豆甾-4-烯-3-酮,胡萝卜甙,二十八酸甘油单酯;其中二十八酸甘油单酯为首次从该属植物中分得。}     

大环骨架结构的倍半萜化合物——Ⅵ.马兜铃新内酯的化学结构测定

自绵毛马兜铃(Aristolochia mollissima Hance)根茎中分得九个化合物,其中已报道的七个化合物是尿囊素、马兜铃内酯、绵毛马兜铃内酯、β-谷甾醇、马兜铃酸A、9-乙氧基马兜铃内酯和9-乙氧基马兜铃内酰胺,本文报道结晶K₃的化学结构,经光谱分析(IR,¹H-NMR,¹³C-NMR,2D-NMR和MS),化学反应及X-衍射晶体分析,确证K₃为一个新骨架结构的倍半萜化合物,命名为马兜铃新内酯。     

注射用右兰索拉唑治疗急性胃和/或十二指肠溃疡引起的上消化道出血的有效性及安全性

目的：以注射用兰索拉唑为对照,评价注射用右兰索拉唑15 mg q12 h治疗急性胃和/或十二指肠溃疡引起的上消化道出血的有效性及安全性。方法：选取全国31家研究中心的急性胃和/或十二指肠溃疡引起的上消化道出血患者共202例,按照1∶1随机分配至试验组（注射用右兰索拉唑组）和对照组（注射用兰索拉唑组）。主要疗效终点为72 h有效止血率。对主要疗效终点采用非劣效评价,非劣效性界值δ是10%。结果：有效性方面,全分析数据集分析结果显示：用药72 h后,注射用右兰索拉唑组有效止血率为96.08%(98/102);注射用兰索拉唑组有效止血率为98.00%(98/100),两组率差为-1.92%(95%CI-6.58,2.74)。两组72 h有效止血率差异无统计学意义（P=0.682 9）。两组率差的双侧界值均低于δ(10%),注射用右兰索拉唑非劣于注射用兰索拉唑。安全性方面,试验组的不良事件及不良反应发生率与对照组差异无统计学意义,无非预期不良反应和严重不良反应。主要的不良反应为白细胞计数降低、中性粒细胞计数降低等。结论：注射用右兰索拉唑15 mg q12 h在治疗急性胃和/或十二指肠溃疡引起的...     

Timing of antibiotics in febrile children meeting sepsis criteria at a paediatric emergency department

Objective

Delay in antibiotic administration in paediatric sepsis is associated with increased mortality and prolonged organ dysfunction. This pre-intervention study evaluated performance in paediatric sepsis management.

Methods

Retrospective cohort study of febrile children admitted through the ED at The Children's Hospital at Westmead, Sydney, between 1 May and 31 July 2017. Participants were children aged 29 days to 60 months excluding children with simple febrile seizures, neonates and children who had received intravenous antibiotics elsewhere. We assessed the timing of antibiotic administration in children meeting local sepsis guidelines. We conducted a survey of clinicians in ED in 2018 to describe contributing factors.

Results

There were 160 febrile children admitted and 144 presentations were included in the analysis. Male 53% (n = 76); median age 20.1 months (interquartile range [IQR] 3.9–37 months). Thirty-seven (26%) febrile children met local sepsis criteria. The median time from triage to first dose of intravenous antibiotic was 109 min (IQR 62–183 min). Delay (>60 min) occurred in 26 (76%) children. Reported reasons contributing to delay included high patient load, long waiting times, difficult intravenous access, delayed prescribing, inadequate staffing and difficulty distinguishing between a viral infection and serious bacterial infection.

Conclusion

There was frequent delay in administering antibiotics in children meeting local sepsis criteria, more commonly in young infants. Reasons contributing to delay were specific to young children along with departmental factors that will require addressing through targeted quality improvement interventions.