External ventricular drains: is there a time limit in children?

Background/purpose The time limit for the use of external ventricular drains (EVDs) has always been controversial. The purpose of this study is to find out if there is a time limit with regard to infection of EVDs and their duration of use in children.Methods The records of 28 patients who had a total of 46 EVDs over a 4-year period at the Regional Paediatric Neurosurgical Centre at the Royal Liverpool Childrens Hospital, Alder Hey, Liverpool, UK, were retrieved. The cerebrospinal fluid (CSF) white cell counts, CSF Gram stains and the CSF culture results were analysed.Conclusion There is no time limit for EVDs in children. They can be left as long as clinically indicated provided strict protocols are followed in the handling of the set.There were no investments or financial interests in this work     

心血管介入诊疗致急性心包填塞原因分析

目的：分析介入手术中心包填塞的原因，并总结紧急处理经验，为以后的介入操作提供参考。方珐：总结我院开展介入手术以来发生的5例心包填塞特点、临床表现及术中紧急处理的经验和方法。结果：介入术中心包填塞可能由操作不当及患者自身心脏病变所致，经及时抢救可避免死亡。结论：心血管介入手术所致心包填塞发生迅速，其症状具有特征性，医师在手术过程中必须提高警惕，发现后及时做出处理。     

Effect of modern pacing algorithms on generator longevity: a predictive analysis

Pulse generator (PG) longevity is of major importance to the quality of care of pacemaker patients. A series of automatic algorithms affect PG longevity. This study investigated the individual and combined effects of three algorithms incorporated in the Medtronic Kappa 700 pacemaker series: Capture Management periodically measures the stimulation threshold and adjusts the PG output, Sinus Preference allows the sinus rate to prevail in a specified range below the sensor rate, and Search AV allows an extension of the AV interval if spontaneous conduction is observed. The effects of Capture Management, Sinus Preference, and Search AV on device longevity were studied in 21 consecutive patients treated in the VDD and DDDR modes. Patients were followed for 1 year. The data were analyzed using an equation provided by the manufacturer. Capture Management was activated in 20 patients. For 11 PGs at the basic settings, longevity was extended by 5.2%, whereas reprogrammed PGs had no gain. Sinus Preference was active in four DDDR patients, who gained 12.0 +/- 5.3%atrial sensing from it, with a resultant longevity gain of1.4 +/- 0.45 months(NS). Search AV was active in 19 patients and 8 responders gained 7.8 +/- 4.4 months PG longevity. The overall longevity in this study was 106.3 +/- 8.4 months with all features as programmed, whereas the longevity without Capture Management and Search AV algorithms would be 98.2 +/- 4.9 months, saving 8.1 +/- 5.8 months(range 0-18) of battery life. Thus, two algorithms: Capture Management and Search AV, have clinical relevance in the extension of PG longevity.     

Non-traumatic thoracic emergencies: imaging and treatment of thoracic fluid collections (including pneumothorax)

Cross-sectional imaging has revolutionised the radiological diagnosis of pleural collections. Not only can the precise location and volume of a pleural effusion be established, but also features specific for the aetiology of the effusion can be demonstrated. Increasingly, radiologists are called upon to perform image-guided biopsies, aspirations and small bore chest drain placement, all of which have been shown to be safe and efficacious. Pneumothoraces occurring due to acute trauma and in an intensive care setting can also benefit from radiological input, both in terms of diagnosis and image-guided treatment.     

Cerebrospinal fluid hemoglobin drives subarachnoid hemorrhage-related secondary brain injury

Secondary brain injury after aneurysmal subarachnoid hemorrhage (SAH-SBI) contributes to poor outcomes in patients after rupture of an intracranial aneurysm. The lack of diagnostic biomarkers and novel drug targets represent an unmet need. The aim of this study was to investigate the clinical and pathophysiological association between cerebrospinal fluid hemoglobin (CSF-Hb) and SAH-SBI. In a cohort of 47 patients, we collected daily CSF-samples within 14 days after aneurysm rupture. There was very strong evidence for a positive association between spectrophotometrically determined CSF-Hb and SAH-SBI. The accuracy of CSF-Hb to monitor for SAH-SBI markedly exceeded that of established methods (AUC: 0.89 [0.85-0.92]). Temporal proteome analysis revealed erythrolysis accompanied by an adaptive macrophage response as the two dominant biological processes in the CSF-space after aneurysm rupture. Ex-vivo experiments on the vasoconstrictive and oxidative potential of Hb revealed critical inflection points overlapping CSF-Hb thresholds in patients with SAH-SBI. Selective depletion and in-solution neutralization by haptoglobin or hemopexin efficiently attenuated the vasoconstrictive and lipid peroxidation activities of CSF-Hb. Collectively, the clinical association between high CSF-Hb levels and SAH-SBI, the underlying pathophysiological rationale, and the favorable effects of haptoglobin and hemopexin in ex-vivo experiments position CSF-Hb as a highly attractive biomarker and potential drug target.     

充血性心力衰竭的中医药治疗

充血性心力衰竭是指在有适量静脉回流的情况下,由于心脏收缩及/或舒张功能障碍,心排血量不足以维持组织代谢需要的一种病理状态。中医辨证心衰为本虚标实之证,心肺、气阴亏虚为其病本,气虚血瘀为基础病机。故治以益气温阳、活血化瘀、化气利水为基本治法。早期治疗宜以益气活血为主,中晚期治疗宜以温阳利水为主,阴虚明显者可合滋阴之法。     

慢性硬膜下棚中术后使用引流管有效吗

慢性硬膜下血肿会导致很高的致残率和死亡率。目前,慢性硬膜下血肿术后引流管的使用取决于医师的个人习惯。术后使用引流管对慢性硬膜下血肿患者预后的影响还没有明确的结论。针对这个问题,剑桥大学的一个研究小组进行了长达三年的研究。他们的研究结果提示,慢性硬膜下血肿术后使用引流管可以显著地降低复发率和六个月内的病死率。     

生活垃圾静态好氧堆肥鼓引风排渗系统技术探讨

结合工程设计,对生活垃圾好氧发酵鼓风、引风、排渗系统进行了研究,确定了合理的鼓风、引风、排渗系统的布置,选择了经济、可靠的鼓风排渗设备,改善了初级发酵仓的好氧发酵环境.     

Phospholipid impregnation of abdominal rubber drains: resistance to bacterial adherence but no effect on drain-induced bacterial translocation

In order to evaluate the effect of surface modification of biomaterials on bacterial adherence and bacterial translocation after intraperitoneal biomaterial implantation, phosphatidylcholine- or phosphatidylinositol-impregnated rubber drain pieces, which had been intraperitoneally implanted in the rat for 2 and 7 days, or unimplanted, were incubated in vitro with³H-labelledEscherichia coli andEnterobacter cloacae. As compared with unimpregnated pieces, the adherence of bacteria significantly decreased to phosphatidylcholine- and phosphatidylinositol-impregnated rubber drain pieces that were either unimplanted or implanted for 2 days, but not for 7 days. The supplementation of albumin in the medium reduced the adherence of bacteria to the unimplanted, unimpregnated drain pieces, but did not further decrease adherence of bacteria to the unimplanted, phospholipid-impregnated brain pieces. Bacterial growth was inhibited after incubation in nutrient broth supplemented with phospholipids. The incidence of enteric bacterial translocation induced by intraperitoneal drain implantation did not differ between phospholipid-impregnated and unimpregnated drain pieces. Scanning electron microscopy revealed a large amount of biofilm and fibrous deposition on the surface of the implanted, phospholipid-impregnated rubber drain pieces. Thus, phospholipid impregnation of rubber drains reduces bacterial adherence and inhibits bacterial growth, without influencing the incidence of bacterial translocation.     

Healthcare workers and the brain drain

The brain drain of health workers occurs mostly from low- and low/middle-income countries to resource-rich countries and from rural to urban areas. Shortage and uneven distribution of healthcare workers aggravated by the brain drain from Africa, Asia, and Pacific countries has contributed to impaired reproductive and sexual health services and the high rate of maternal and newborn mortality and morbidity in these counties. Brain drain impedes maternal, neonatal, and child health and the fight against HIV/AIDS, and translates into loss of potential employers, teachers, and role models. Source countries spend US$ 500 million each year to educate health workers who leave their home countries for North America, Western Europe, and South Asia. A code of practice on international recruitment of health personnel is needed. Improving the health workforce database, wages, health resources and working conditions, task shifting, pay-back from recipient countries and migrant health professionals, securing additional investment in the health workforce, and the development of locally relevant medical training and research are useful measures to combat this problem.