Early postoperative fever workup in children: utilization and utility

Background

Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children.

银丹心泰滴丸治疗不稳定型心绞痛的疗效观察

目的:观察银丹心泰滴丸对不稳定型心绞痛(UA)患者C反应蛋白的影响及临床疗效和安全性。方法:40例UA患者随机分为常规治疗(对照)组和银丹心泰滴丸(治疗)组,各20例,观察2组的临床疗效及C反应蛋白的变化。结果:治疗组显效率为75%,总有效率达95%,均优于对照组。治疗组治疗后C反应蛋白得到明显改善(P<0.001)。结论:银丹心泰滴丸治疗完全高效,同时能降低C反应蛋白。     

Graphite oxide bulk modified carbon paste electrode for the selective detection of dopamine: A voltammetric study

A novel electrochemical sensor for the selective and sensitive detection of dopamine (DA) in presence of large excess of ascorbic acid (AA) and uric acid (UA) at physiological pH was developed by the bulk modification of carbon paste electrode (CPE) with biocompatible graphite oxide (GO). Very small quantity of GO in carbon paste matrix imparted selectivity through electrostatic interactions. The modifier was characterized using infrared spectroscopy and powder X-ray diffraction. Large peak separation, good sensitivity and stability allow this modified electrode to analyze DA individually and simultaneously along with AA and UA. Applying differential pulse technique, DA could be detected even in the presence of 1000 fold excess of AA and UA. A linear dynamic range of 0.07–70 μM with detection limit of 1.5 × 10⁻⁸ M was obtained for DA. None of the bulk modified electrodes reported in the literature have shown such a low detection limit at the physiological pH. The practical application of the modified electrode was demonstrated by spiking the human blood serum and cerebral fluid with dopamine and the results obtained were satisfactory.     

Central sleep apnea: Pathophysiology and treatment

Central sleep apnea (CSA) is characterized by a lack of drive to breathe during sleep, resulting in repetitive periods of insufficient ventilation and compromised gas exchange. These nighttime breathing disturbances can lead to important comorbidity and increased risk of adverse cardiovascular outcomes. There are several manifestations of CSA, including high altitude-induced periodic breathing, idiopathic CSA, narcotic-induced central apnea, obesity hypoventilation syndrome, and Cheyne-Stokes breathing. While unstable ventilatory control during sleep is the hallmark of CSA, the pathophysiology and the prevalence of the various forms of CSA vary greatly. This brief review summarizes the underlying physiology and modulating components influencing ventilatory control in CSA, describes the etiology of each of the various forms of CSA, and examines the key factors that may exacerbate apnea severity. The clinical implications of improved CSA pathophysiology knowledge and the potential for novel therapeutic treatment approaches are also discussed.     

Systemic inflammation in unstable angina is the result of myocardial necrosis

OBJECTIVES: We investigated whether the source of the acute phase response in unstable angina (UA) lay within the culprit coronary plaque or distal myocardium. BACKGROUND: An inflammatory response is an important component of the acute coronary syndromes. However, its origin and mechanism remain unclear. METHODS: In 94 stable patients undergoing coronary angiography, the relationship between systemic levels of tumor necrosis factor (TNF)-alpha, interleukin-6 (IL-6) and C-reactive protein (CRP) and extent of atherosclerosis was studied. The temporal relationship between these markers and troponin T (TnT) was determined in 91 patients with UA. Cytokine levels were measured in the aortic root and coronary sinus of 36 unstable patients. RESULTS: There was no relationship found between stable coronary atherosclerosis and inflammatory marker levels. Compared with this group, admission levels of IL-6 (3.6 +/- 0.3 ng/ml vs. 10.7 +/- 1.7 ng/ml, p < 0.05) and CRP (2.3 +/- 0.1 mg/l vs. 4.6 +/- 0.6 mg/l, p < 0.05) were elevated in patients with UA. In this group, IL-6 and CRP remained elevated in those who subsequently experienced major adverse cardiac events. This inflammatory response occurred in parallel to the appearance of TnT. Both TNF-alpha (19.2 +/- 3.4 ng/ml vs. 17.1 +/- 3.3 ng/ml, p < 0.001) and IL-6 (10.3 +/- 1.4 ng/ml vs. 7.7 +/- 1.1 ng/ml, p < 0.01) were elevated in the coronary sinus compared with aortic root in patients with UA. This was principally observed in those who were TnT positive. There was no cytokine gradient across the culprit plaque. CONCLUSIONS: There is an intracardiac inflammatory response in UA that appears to be the result of low-grade myocardial necrosis. The ruptured plaque does not appear to contribute to the acute phase response.     

老年高血压患者颈动脉粥样硬化病变及相关因素

目的探讨老年高血压患者的颈动脉粥样硬化病变程度及其与血脂、血尿酸、C-反应蛋白的关系。方法应用彩色多普勒超声检测22例正常老年人(对照组)、47例老年高血压患者(A组)、43例老年高血压合并冠心病患者(B组)的颈动脉内中膜厚度(IMT)、粥样硬化斑块、血流参数[收缩期峰值流速(Vmax)、阻力指数(RI)];同时检测血脂、血尿酸(UA)及C反应蛋白(CRP)。结果A组与对照组比较,平均IMT、最大IMT及CRP增高(均为P<0.001),斑块发生率、Vmax、RI、胆固醇(TC)、低密度脂蛋白(LDL-C)、UA增高(均为P<0.05);B组与A组比较,平均IMT、最大IMT、RI及CRP增加更为明显(均为P<0.001),斑块发生率、Vmax、TC、甘油三酯(TG)、LDL-C、UA也有相应变化(均为P<0.05)。结论老年颈动脉粥样硬化病变与许多危险因素有关,防治应采取综合措施。     

Acute effects of fructose consumption on uric acid and plasma lipids in patients with impaired renal function

Objective

Metabolic disturbances are common in patients with renal function impairment and are related to high rates of cardiovascular incidents and mortality. Kidney transplantation leads to improved survival but may lead to additional metabolic alterations caused by immunosuppressive drugs and improved nutrition.

Materials and methods

The short-term effect of oral fructose load on serum uric acid (UA), plasma lipids, and blood pressure (BP) was studied in 85 patients with chronic kidney disease (CKD) and impairment of renal function (glomerular filtration rate 50–65 ml/min per 1.73 m²), comprising 55 renal transplant recipients (RTR) treated with standard triple immunosuppressive therapy including a calcineurin inhibitor (CNI) cyclosporine A (CsA) or tacrolimus (Tac) and 30 non-transplanted patients with CKD. Both non-transplanted CKD patients and RTR had stable renal function and a comparable degree of kidney dysfunction. All subjects received orally 70 g of fructose dissolved in 200 ml of water. Serum UA, lipids, and blood pressure were measured at baseline and 60, 120, 180, and 240 minutes after fructose administration.

Results

There was a significant increase of serum UA concentration (p < 0.001) in both CKD patients and RTR – CsA- or Tac-treated patients comparable in the latter. Total cholesterol (TC), LDL, and HDL cholesterol significantly decreased and serum triglycerides (TG) markedly increased in RTR, whereas in CKD patients all serum lipid fractions increased. Blood pressure was unaffected by fructose intake.

Conclusion

Both non-transplanted and transplanted patients with mild renal function impairment show similar acute purine metabolic disturbances following oral administration of fructose but in the latter dietary fructose may induce a smaller hyperlipidemic response.     

老年COPD病患营养治疗的疗效观察

目的观察营养状况及营养支持治疗对COPD患者治疗及预后的重要性。方法 76例COPD住院患者随机分为营养支持组(A组)和常规对照组(B组),各38例,观察在住院期间临床总有效率,平均住院时间,营养状况,血清尿酸,肺功能变化。结果 A组临床总有效率明显高于B组;平均住院时间A组明显短于B组;营养状况、血清尿酸、肺功能A组明显优于B组。结论在常规治疗的基础上,应用营养支持治疗可以明显改善老年COPD患者营养状况、肺功能,提高临床疗效,减少住院天数。     

黄芩苷对变异链球菌UA159体外的抑制作用

目的 探讨黄芩苷对变异链球菌国际标准株UA159的体外抑制作用.方法 采用液体倍比稀释法结合酶标仪测OD600值测定黄芩苷对变异链球菌UA159的最低抑菌浓度(minimum inhibitory concentration,MIC).利用酶标仪测定不同浓度的黄芩苷药液中变异链球菌UA159的OD600值,绘制生长曲线...     

彩色多普勒对脐绕颈胎儿脐动脉及大脑中动脉血流检测分析

目的　分析脐绕颈胎儿脐动脉（ＵＡ） 及大脑中动脉（ ＭＣＡ） 的血流参数,为临床判断胎儿脑供血情况提供客观依据。方法　比较４４ 例脐绕颈剖腹产胎儿与６１ 例脐绕颈自然分娩胎儿的脐动脉及大脑中动脉血流多普勒参数,以ＲＩ及ＶＰ为分析指标。结果　该两组脐绕颈胎儿ＵＡ 的ＲＩ及ＶＰ 有显著性差异,ＭＣＡ 的ＲＩ有显著性差异,剖腹产胎儿ＭＣＡ 的血流特点为阻力增高（ＲＩ０ ．６７ ±０ ．０２） 。结论　脐绕颈胎儿ＭＣＡ 的血流阻力增高（ＲＩ＞ ０ ．６５）应作为剖腹产术的临床参考指标。