Ureaplasma urealyticum, erythromycin and respiratory morbidity in high-risk preterm neonates

We investigated colonization with Ureaplasma urealyticum (Uu) in infants <30 weeks gestation and assessed the relationship to other risk factors influencing respiratory morbidity, plus the effect of treatment with erythromycin. Ventilated preterm infants [ n = 155; median GA 26 (23–29) weeks] were cultured for Uu in endotracheal aspirate and nasopharynx. Colonized infants were randomly assigned to treatment with erythromycin 40mg/kg/d, intravenously or orally. The rate of colonization was 29/155 (19%) and the Uu-colonized infants had lower mean gestational ages than the culture-negative infants (25 vs 26 weeks). For the colonized infants PROM (48% vs12%), chorioamnionitis in the mother (46% vs 17%) and vaginal delivery (71% vs 29%) were more common. More colonized infants needed supplemental oxygen at 36 weeks'postconceptual age ( p < 0:05). Erythromycin treatment was effective in reducing colonization with negative control cultures in 12/14 (86%) of treated infants. No significant differences were found between the colonized treated infants ( n = 14) and those not treated ( n = 14) in time with supplemental oxygen. Oxygen requirement at 36 weeks was related to lower gestational age, late appearance of PDA, late onset sepsis and signs of chorioamnionitis in the mother. We conclude that the Uu colonization is related to increasing immaturity, the presence of prolonged rupture of membranes, signs of chorioamnionitis and vaginal delivery. Treatment with erythromycin reduced colonization but did not significantly alter length of time with supplemental oxygen.     

Effects of Pediatric Chronic Physical Disorders on Child and Family Adjustment

Research conducted primarily over the past 5–8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement and intervention are discussed.     

Evolutionary Classification of Homeodomains

Purpose and Methods: We performed multiple comparisons between available amino acid (aa) sequences of homeodomain(HOM)-containing proteins from a wide spectrum of animals to create an evolutionary classification of the proteins. Results: Based on results of statistical and special computational analyses of over 500 homeodomain aa sequences (HOMs) a novel system of concepts describing complex structural correlations between homologous proteins is proposed. This system includes such notions as differentiated isofunctionality of aa, chemotype, stereotype, local functional motifs, gradual conservativeness of aa positions, and group-specific domain patterns, as well as major categories of the evolutionary classification of HOMs (Division, Type, Branch, Class, Family, Series, Variety, Sort). Using this approach, a complete structural systematics of HOMs belonging to proteomes of eukaryotic animals is proposed. Conclusions: The proposed structural classification of HOMs is in full agreement with the bulk of experimental data revealing complex functional similarities and differences among HOMs in terms of their expression patterns in developing embryos. It turn, this classification can provide answers regarding homology among homeodomains when experimental data are conflicting.     

Evaluation of three risk scores to predict postoperative nausea and vomiting

BACKGROUND: So far there are three different scores to predict postoperative vomiting (PV: Apfel et al., 1998) or postoperative nausea and vomiting (PONV: Koivuranta et al., 1997; Palazzo and Evans, 1993). All three scores used logistic regression analysis to identify and create weights for the risk factors for PV or PONV. In short, these were sex, age, history of previous PONV, motion sickness, duration of anaesthesia, and use of postoperative opioids. However, an external evaluation and a comparison of these scores has not been performed so far. METHODS: Patients undergoing a variety of surgical procedures under general anaesthesia were studied prospectively. Preoperatively, they completed a questionnaire concerning potential risk factors for the occurrence of PV or PONV implemented in the three risk scores. Balanced anaesthesia (induction agent, nondepolarising neuromuscular blocker, opioid, and inhalation agent in nitrous oxide/oxygen) was performed. No intravenous anaesthesia or any antiemetic prophylaxis was applied. Postoperatively, the patients were observed in the recovery room for the occurrence of PV and PONV and were visited twice on the ward within the 24-h observation period. Both the patients and the nursing staff were asked whether PV or PONV was present. The severity of PONV was categorised using a standardised scoring algorithm. A total of 1,444 patients was finally included into the analysis. Using information of the predicted risk for the individual patients and the actual occurrence of PV or PONV, Receiver Operator Characteristics (ROC-curves) were drawn. The area under each ROC-curve was calculated as a means of the predictive properties of each score and was compared for statistical differences. RESULTS: For prediction of PONV (any severity) the AUC-values (AUC=area under the curve) and the corresponding 95%-confidence intervals were: Apfel: 0.70 (0.67-0.72); Koivuranta: 0.71 (0.69-0.73); Palazzo: 0.68 (0.65-0.70). For prediction of PV: Apfel: 0.73 (0.71-0.75); Koivuranta: 0.73 (0.70-0.75); Palazzo: 0.68 (0.65-0.70). Thus, all three scores appeared to have a moderate accuracy as measured by the AUC. The score of Koivuranta predicts PONV (P=0.007) and also PV (P=0.002) significantly better than Palazzo's score. Furthermore, for predicting of PV the score of Apfel was also superior to Palazzo's score (P=0.005). All three scores predict PV with the same accuracy as PONV. CONCLUSION: The occurrence of PV and PONV in patients undergoing surgery under balanced anaesthesia can be predicted with moderate but acceptable accuracy using one of the available risk scores, regardless of local surgical or anaesthesiological circumstances. For clinical practice, we recommend the score published by Koivuranta, since its calculation is very simple.     

Metabolic risk factors in patients with ureteropelvic junction obstruction and renal calculi

PURPOSE: We performed a prospective study to determine the incidence and spectrum of metabolic abnormalities predisposing to stone formation in patients with ureteropelvic junction obstruction and renal calculi. MATERIALS AND METHODS: A total of 47 consecutive patients with congenital ureteropelvic junction obstruction underwent metabolic evaluation of stone risk factors. Of these patients 21 had associated stones (study group), while 26 did not (control group). Logistical regression, Wilcoxon rank sum and Fisher's exact tests were performed to determine whether there was a significant difference between these groups in regard to the presence of metabolic risk factors. RESULTS: Demographically and symptomatically the 2 groups were equivalent except that the study patients were older. The 24-hour urinary excretion of calcium was significantly higher in study than in the control patients (p = 0.007). While the incidence of hypercalciuria and hyperuricosuria was also higher in the study population, these differences were not significant (p = 0.08 and 0.07, respectively). CONCLUSIONS: Metabolic abnormalities predisposing to stone formation are present more frequently in patients with ureteropelvic junction obstruction who have associated stones compared to those who do not. As such, urinary stasis alone does not explain stone formation in these cases. Rather, the local physiological environment of urine likely has a predisposing role. In addition to restoring unobstructed urinary flow, consideration should be given to metabolic evaluation and prophylactic treatment for affected patients.     

男性参与计划生育状况及其影响因素分析

目的:分析男性参与计划生育状况及其影响因素。方法:对全国31个省16 994名已婚育龄妇女进行问卷调查。结果:近10年来,有48.05%的男性与妻子讨论过避孕,25.75%的男性参加过计划生育/生殖健康培训,14.90%的男性参与避孕方法决策,27.59%的男性曾经使用过避孕套,5.10%的男性采用男性绝育术。多因素分析结果提示:男性参与与居住地(城镇/农村)、本人或妻子的文化程度等有较大关联。结论:我国男性尤其是农村男性参与计划生育程度有待提高。建议加大男性参与宣传教育的力度,扩展男用避孕方法种类以及全面推进避孕方法知情选择。     

雌激素和血管内皮细胞生长因子促进血管瘤增殖的体外实验研究

目的：研究雌二醇(E2)和血管内皮细胞生长因子(VEGF)在促进血管瘤血管内皮细胞(HVEC)增殖中的作用和相互关系，以及4羟基他莫昔芬(4OH—TAM)对该促进作用的影响。方法：取2例雌激素受体阳性的皮肤增生期草莓状血管瘤标本，采用组织块培养法培养HVEC。HVEC原代及传代培养在M199培养液中进行，传至第三代时改用无雌激素培养液IMEM进行干预实验，实验分5组：组1(无干预，为对照组)、组2(加E2)、组3(加VEGF)、组4(加E2和VEGF)、组5(加E，、VEGF和4OH—TAM)。分别在0、3、6、9d进行细胞计数(CC)和流式细胞仪DNA增殖指数(PI)检测。结果例1在第9d时，组2示HVEC轻微增殖，CC和PI分别为组1的1．38倍和1．61倍；组3示CC及PI明显增加，分别为组2的2．10倍和1．61倍；组4示OC及PI的增加更加显著，分别是组3的1．62倍和1．40倍；组5的OC和PI与组1相仿。例2的实验结果与例1相似。结论：体外实验显示雌激素能够轻微促进HVEC增殖；VEGF可明显促进HVEC增殖；而雌激素和VEGF同时存在时，对HVEC的促增殖作用更加显著，二者存在协同作用；他莫昔芬能抑制这种协同促增殖作用。     

干休所代谢综合征流行病学调查及生活方式强化干预

目的:调查北京136个军队老年集聚社区居民代谢综合征(m etabolic syndrom e,MS)的患病率及危险因素;探讨生活方式强化干预对MS患者早期治疗及降低危险因素的效果。方法:于2004年5~6月对北京136个以离退休干部为主体的军队社区、2 335名医疗体系属于我院的常住居民通过健康体检后进行MS的筛查和评价;对明确诊断MS患者实施健康教育、饮食和运动等生活方式强化干预。结果:在被调查的2 335人中MS患病率为28.7%,具有4个危险因素者占6.9%。饮食、运动干预后饮食结构趋于合理,中、老年组平均体重指数下降2~4 kg。结论:对MS高危人群进行常规筛查和评价,可促进MS的早期临床诊断;生活方式强化干预可增强老年人维护健康的意识,积极的防治有利于MS的转归及防止并发症的发生及发展。     

儿童Ⅰ型糖尿病发病相关危险因素分析

[目的]探讨Ⅰ型糖尿病可能的相关因素.[方法]采用1：2配对原则应用单因素和多因素回归分析对新乡市中心医院儿科住院和门诊患者1999年1月～2004年1月50名患者.100名对照者进行研究.[结果]单因素分析表明窒息、体重过大或过轻、易患感冒、胃肠道感染、腮腺炎、不明原因发热、药物中毒为主要因素.多因素回归分析示窒息,体重过大或过小、感冒、胃肠道感染、呼吸道感染为高危因素.[结论]窒息、体重过大或过轻、发热、感冒、胃肠道感染、药物中毒是高危因素,增强儿童预防保健是关健.     

影响药物流产效果的相关因素分析

目的:分析影响药物流产成功的相关因素,指导药物流产的临床使用。方法:对1311例早孕药物流产患者的年龄、孕产次、子宫位置及人流史与药流不全的关系进行分析。结果:总的药流不全率为40.3%。不同年龄组药流不全比例没有显著性差异;子宫位置中,后屈者药流不全率高达62.5%,前倾位者药流不全率为4.6%;初孕者药流成功率高达82.0%;随着人流次数的增多,药流不全率明显增高。结论:影响药物流产成功的因素有子宫屈位、既往分娩史及人流史。