Effect of additive selection on calculated aluminum content of parenteral nutrient solutions.

PURPOSE: The quantity of aluminum in common ingredients used to compound parenteral nutrient (PN) solutions was calculated to quantify the actual aluminum content, and opportunities to modify the aluminum content by changing the manufacturer of the ingredients were explored. METHODS: A retrospective evaluation of a random sample of 10 neonatal, 10 pediatric, and 10 adult patients who received PN solutions was performed to quantify the aluminum content in these solutions on the basis of the ingredients used at the authors' institution. A recalculation was performed using the lowest aluminumcontaining ingredients to determine the potential for aluminum minimization in each PN solution. RESULTS: Various manufacturers produce each ingredient required to make PN solutions. Significant variation exists among manufacturers, vial size, and concentrations. Statistically significant differences in the mean aluminum content of PN solutions before and after aluminum minimization were found to exist within each sample of patients. Among the neonatal PN solutions, aluminum content was significantly reduced from a mean +/- S.D. of 84.16 +/- 47.61 to 33.6 +/- 16.69 mug/kg/day. The pediatric PN solutions had a significant decline in aluminum content from a mean +/- S.D. of 16.24 +/- 3.66 to 6.84 +/- 2.66 mug/kg/day. Aluminum content in the high-risk adult PN solutions significantly decreased from a mean +/- S.D. of 4.58 +/- 2.06 to 2.31 +/- 0.63 mug/kg/day. CONCLUSION: There is wide variability in the aluminum concentration of injectable products used in the compounding of PN solutions. Selecting products with low aluminum concentration may substantially reduce the amount of the element administered to patients.     

A Case of Successful Treatment of Neuropathic Pain After a Scapular Fracture Using Subcutaneous Targeted Neuromodulation

Subcutaneous targeted neuromodulation is one part of the wider new peripheral neuromodulation development in the treatment of neuropathic pain. Although it has not received wider acceptance, there are many reports in the literature of successful use of this technique.     

各型HBV感染者血清和肝细胞β2微球蛋白的意义

目的动态观察各型HBV感染者血清β2微球蛋白（β2MG）水平及肝内表达，研究其临床意义方法HBV感染者128例中，无症状携带着（ASC）12例，急性肝炎（AH）26例，慢性肝炎（CH）56例，重型肝炎（SH）18例，肝硬变（LC）和原发性肝癌（HCC）各8例。设正常对照30例，用RIA和免疫级化法分别测定血清和肝内β2MG，与肝损害程度比较，分析临床意义结果除ASC外，各型乙肝和LC，HCC血清β2MG均有升高，其中，以SH，LC，CH和HCC为著；AH，SH肝细胞β2MG表达明显增强（正常肝细胞不表达），且其分布与肝组织炎症坏死区一致．血清β2MG水平和肝内表达强度与血清胆红素水平呈正相关．动态观察发现，AH于恢复期血清β2MG降至接近正常，SH死亡组β2MG水平明显高于存活组.结论β2MG参与HBV感染发病机制中肝组织免疫病理损害过程，动态观察血清β2MG水平可在一定程度上反映AH和SH的预后和转归。     

Primary superior oblique muscle-levator muscle synkinesis.

Congenital ocular aberrant innervations can involve oculomotor, trigeminal, abducens, facial, and glossopharyngeal nerves.(1) Involvement of the trochlear nerve is considered rare or nonexistent.(1) In this report we present a case of upper eyelid retraction while looking in the field of action of the superior oblique muscle, indicating a primary superior oblique-levator muscle synkinesis.     

Bronchial diseases and lung aeration in children.

Bronchial diseases are common in children, and are usually associated with disturbances of aeration. This article briefly summarizes the embryological development and respiratory physiology pertinent to pediatric bronchial diseases. Current diagnostic imaging tools are discussed, with an emphasis on CT, which can demonstrate bronchial pathology such as bronchial obstruction and bronchiectasis in larger bronchi, as well as indirectly show the peripheral physiologic consequences of bronchial disease, such as alterations in aeration. Computed tomography measurements of lung attenuation may aid in diagnosis in problematic cases. Diseases that affect the pediatric airways at different ages are reviewed. Knowledge of these entities is important for accurate interpretation of imaging studies.     

重组丙型肝炎病毒基因载体的构建与表达

应用基因重组技术。从载体ＣＤＺ２酶切获得１．７３ｋｂＤＮＡ片段（含１６ｄ９３ｂｐ的ＨＣＶ结构区ｃＤＮＡ，其特异性已为ｓｏｕｔｈｅｒｎｂｌｏｔ证实）。将ＨＣＶｃＵＮＡ片段插入载体ｐｃＤＮＡ３，构建ＨＣＶ重组体。经在大肠杆菌中表达，筛选、酶切分析，获得重组ＨＣＶ（ＰｃＤＮＡ３－ＨＣＶ）。以重组质粒转染Ｈ９细胞（ＣＤ淋巴细胞系），用Ｇ４１８筛选出抗性细胞。经ＲＴ－ＰＣＲ、ｄｏｔ－ＥＬＩＳＡ验证表明，ｐｃＤＮＡ３－ＨＣＶ能在Ｈ９细胞中进行复制、转录和表达。这为丙型肝炎发病机理的研究提供了一个有用模型。     

Prevention and control of viral hepatitis through adolescent health programmes in Europe

The Viral Hepatitis Prevention Board jointly organized with the European Union for School and University Health and Medicine a meeting on the prevention and control of viral hepatitis through adolescent health programmes in Europe, held in Ljubljana, Slovenia, 15–16 March 2007. Participants from some 16 countries in Europe as well as the United States of America emphasized the importance of reaching adolescents mainly through school health programmes, provided an overview of currently existing youth health systems and reviewed their experiences with childhood and adolescent immunization programmes. The meeting concluded with a discussion of issues, lessons learnt, opportunities and action points for the future.     

Baseline thymic volume is a predictor for CD4 T cell repopulation in adult HIV-infected patients under highly active antiretroviral therapy

The objective of the present study was to assess the impact of baseline thymic volume on the CD4 cell repopulation induced by highly active antiretroviral therapy (HAART) in HIV-infected adults. Therefore, 37 previously untreated HIV-1-infected adults were prospectively followed from August 1998 to September 2001. All patients underwent a thorax CT scan at starting HAART to measure thymic volume. The median follow-up time was 189 [87.5-498.5] days. CD4 cell repopulation was considered as an increase > or = 200 cells/mm3 above baseline count. Twenty-one (57%) patients achieved this CD4 repopulation. Baseline thymic volume was the main independent factor associated with CD4 repopulation (P = 0.016); this factor was a positive predictor (adjusted hazard ratio: 1.25 [95% confidence interval 1.1-1.4]). Although, CD4 cell count and non-AIDS diagnosis at baseline were associated with CD4 cell repopulation on the univariate analysis (P = 0.03 and P = 0.02, respectively), no statistical signification was found on the multivariate test. In summary, baseline thymic volume is a predictor of early CD4 cell repopulation in adult HIV-1-infected patients taking HAART.     

Absence of activation of CMV by blood transfusion to HIV-infected, CMV-seropositive patients

BACKGROUND: The Viral Activation Transfusion Study (VATS) afforded an opportunity to determine whether blood transfusions, and in particular exogenous WBCs, "activate" CMV replication in HIV-infected, CMV-seropositive patients, and whether such patients can be superinfected by additional strains of CMV transmitted via blood transfusions. STUDY DESIGN AND METHODS: A total of 531 patients were randomized to receive either WBC-reduced (WBCR) or non-WBC-reduced (NWBCR) RBC units. Plasma CMV PCR assays were performed before transfusion and weekly after transfusion for 4 weeks. NWBCR cases with evidence of possible reactivation and/or superinfection were further studied for donor viremia by DNA PCR of frozen retention segments and new genotype acquisition using gB envelope sequence analysis of pre- and posttransfusion recipient specimens. RESULTS: VATS patients received a median of two RBC units during their initial transfusion. Whether positive or negative for CMV DNA at baseline, there were no significant treatment-arm differences in the percentage of patients who had positive qualitative CMV PCR or increases in CMV viral load at follow-up. Of 50 recipients randomized to NWBCR RBC and meeting criteria for possible CMV superinfection, 25 had sufficient CMV DNA load in a baseline and one or more viremic follow-up sample to permit comparison of gB genotypes. Only two recipients showed genotype shifts. Of 125 WBC pellets prepared from the seropositive units transfused into these 50 cases, only 1 tested weakly PCR positive for CMV DNA (insufficient copy number for genotyping). CONCLUSION: There was no evidence of "activation" of CMV by blood transfusion. Among the NWBCR RBC recipients, there was little evidence of possible transmission of new CMV strains. Hence, the current policy for transfusion support of HIV-infected patients, which allows transfusion of CMV-antibody-positive blood to CMV-seropositive patients, is appropriate.