A predictive model to estimate the risk of serious bacterial infections in febrile infants

Low risk criteria have been defined to identify febrile infants unlikely to have serious bacterial infection (SBI). Using these criteria approximately 40% of all febrile infants can be defined as being at low risk. Of the remaining infants (60%) only 10%–20% have an SBI. No adequate criteria exist to identify these infants. All infants aged 2 weeks-1 year, presenting during a 1-year-period with rectal temperature 38.0°C to the Sophia Children's Hospital were included in a prospective study. Infants with a history of prematurity, perinatal complications, known underlying disease, antibiotic treatment or vaccination during the preceding 48 h were excluded. Clinical and laboratory variables at presentation were evaluated by a multivariate logistic regression model using SBI as the dependent variable. By using likelihood ratios a predictive model was derived, providing a post test probability of SBI for every individual patient. Of the 138 infants included in the study, 33 (24%) had SBI. Logistic regression analysis defined C-reactive protein (CRP), duration of fever, a standardized clinical impression score, a history of diarrhoea and focal signs of infection as independent predictors of SBI.Conclusion CRP, duration of fever, the standardized clinical impression score, a history of diarrhoea and focal signs of infection were the independent, most powerful predictors of SBI in febrile infants, identified by logistic regression analysis. Although the predictive model is not validated for direct clinical use, it illustrates the clinical potential of the used technique. This technique offers the advantage to assess the probability of SBI in every individual infant. This probability will form the best basis for well-founded decisions in the management of the individual febrile infant.     

Steady-state kinetics of imipramine in patients

Steady-state plasma level kinetics were studied in 76 patients given imipramine (IP) 150 to 225 mg/day for 2–5 weeks. IP was given in three divided doses at 8.00 a.m., 1.00 p.m. and 5.00 p.m. Plasma concentrations of IP and its active metabolite desipramine (DMI) were determined by quantitative in situ thin-layer chromatography. The plasma levels of IP and DMI showed pronounced flucutations throughout the day with a ratio of about 2 between highest and lowest level. Patients with steady-state levels of IP and/or DMI below 50 g/l reached this within 1 week of treatment. Patients with higher steady-state levels reached steady-state concentrations within 2–3 weeks. There were some intraindividual fluctuations in plasma levels from week to week after steady state had been reached (coefficient of variation: 10–20%). Interindividually, the steady-state levels corrected to a dose of 3.5 mg/kg per day varied considerably: IP: 6–356 g/l, DMI: 24–659 g/l and IP+DMI: 58–809 g/l. The steady-state plasma levels showed a skew distribution that became normal by logarithmic transformation. The IP/DMI ratio ranged from 0.07 to 5.5 with a median value of 0.47. Compared to data from amitriptyline treated patients the IP/DMI ratios had significantly lower median value and larger variation than the corresponding plasma level ratios of amitriptyline/nortriptyline. Several statistically significant differences in steady-state levels between age groups were found. For IP: Women aged 30–39 had lower levels than women aged 20–29, 40–49, and 50–59, and men aged 50–59 and 60–65; men aged 30–39 had lower levels than men aged 60–65. For DMI: Women aged 30–39 had lower levels than women aged 50–59.     

葡萄胎p53、p21~(CIP1)及p185蛋白表达与恶变的关系

目的 :探讨葡萄胎p5 3、p2 1CIP1及p185蛋白表达与恶变的关系及其临床特点。方法 :免疫组化法检测葡萄胎标本中p5 3、p2 1CIP1及p185蛋白的表达 ,以侵蚀性葡萄胎及绒癌为对照 ,并回顾性分析其临床资料。结果 :葡萄胎组p5 3、p2 1CIP1、p185蛋白阳性表达率分别为 35 % (35 / 10 0 ) ,71% (71/ 10 0 )及 36 % (36 / 10 0 ) ,与恶性对照组相比均有显著性差异 (P <0 .0 5 ) ;而完全性与部分性葡萄胎 ,完全性葡萄胎恶变组与非恶变组之间差异均无显著性 (P >0 .0 5 ) ,但恶变组p2 1CIP1表达有降低趋势。结论 :p5 3、p2 1CIP1及p185蛋白表达改变与葡萄胎恶变无确定关系 ,但可作为晚期现象出现于恶性滋养细胞肿瘤中 ,其中p2 1CIP1蛋白表达降低提示滋养细胞有向恶性转化的倾向     

鼻内翻性乳头状瘤及其癌变与p53蛋白异常表达

目的：探讨鼻内翻性乳头状瘤及其癌变与ｐ５３基因的关系。方法：采用免疫组化方法（ＡＢＣ法）对３６例鼻内翻性乳头状瘤（ＩＰ）组织和１６例鼻内翻性乳头状瘤癌变（ＩＰ＋ＳＣＣ）组织进行了ｐ５３蛋白检测。结果：３６例ＩＰ均为ｐ５３蛋白阴性，而在１６例ＩＰ＋ＳＣＣ组织中有５例为ｐ５３蛋白阳性，阳性率为３１．３％（５／１６），经统计学处理，二者差异显著（Ｐ〈０．００１）。结论：ｐ５３蛋白异常表达可能与ＩＰ的发生     

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.     

Is normal β-hCG regression curve helpful in the diagnosis of persistent trophoblastic disease?

OBJECTIVE: The aim of this study was to evaluate the probable usefulness of normal beta-human chorionic gonadotropin (beta-hCG) regression curve in the diagnosis of persistent trophoblastic disease (PTD). METHODS: A log-value regression curve was developed from the means and 95% confidence limits of serial weekly serum beta-hCG titers of 43 patients with uneventful complete hydatidiform moles and 14 patients, who were previously confirmed as PTD. RESULTS: All 14 PTD patients (100%) had abnormal values, beyond normal range, within 4 weeks. beta-hCG was in its upper values, compared to normal regression curve at 2.29 +/- 0.19 weeks. This was earlier than plateau or rise detection at 4.21 +/- 0.33 weeks (P < 0.001). Within 3 weeks of evacuation, 13 of 14 (92.86%) PTD patients' beta-hCG values exceeded the normal range, whereas only six of 14 (42%) showed a rise or plateau. CONCLUSION: Our finding indicates that the normal beta-hCG regression curve may be useful for quicker detection of PTD than the plateau or rise of level.     

基于谱效关系的款冬花祛痰活性成分研究

目的：研究款冬花提取物的高效液相色谱指纹图谱与祛痰作用的谱效关系,筛选款冬花的祛痰活性成分。方法：采用高效液相色谱法建立款冬花提取物的指纹图谱并获得其化学成分含量信息,采用小鼠酚红排泌模型获得款冬花提取物的祛痰药效指标信息,采用偏最小二乘回归法对款冬花提取物的化学成分含量信息与祛痰药效指标信息进行谱效相关分析。结果：初步判断芦丁、异槲皮苷、绿原酸、新绿原酸、隐绿原酸、异绿原酸A、异绿原酸B、异绿原酸C及峰3成分、峰17成分构成款冬花的祛痰活性成分群。结论：款冬花的祛痰作用是多成分共同作用的结果。本研究结果可为关联药效的款冬花质量标准的建立提供参考。     

基于QSPR 研究绿原酸类化合物与血清白蛋白的结合

本文选取32个小分子化学成分和9个天然产物化学成分为训练集,利用Dragon软件计算分子描述符,应用WEKA软件中CfsSubsetEval评价方法和BestFirst-D1-N5搜索方法进一步筛选描述符,利用Linear Regression方法建立了分子结构与其血清蛋白结合常数值logK的定量结构-性质相关性模型(相关系数为0.9557)。应用该模型对10个绿原酸类化合物的logK进行预测,结果显示绿原酸的logK预测值为4.51,与文献报道的logK值在4~7范围内基本相符。研究结果为进一步探讨绿原酸与血清蛋白的结合情况提供指导,为研究药物与血清蛋白的结合提供思路。     

基于肿瘤能量代谢失衡探讨扶正解毒法在慢性结肠炎“炎癌转化”分期干预中的应用

慢性结肠炎在一定情况下可发生癌转化。慢性结肠炎“炎癌转化”是在线粒体能量代谢损伤、有氧糖酵解代谢上调的机制下,肠道上皮细胞代谢失衡,促使炎症微环境向肿瘤微环境转化的过程。认为由正气虚损而致太阴经、阳明经的寒热分离是结肠炎癌转化的触发机制,由邪毒鸱张诱发的气机升降失调是打破促瘤抑瘤平衡,进而邪聚成瘤的关键。临床治疗上应在中医恒动观理论指导下分清慢性结肠炎炎癌转化的不同阶段,灵活把握扶正与解毒的主次,改善肠道炎性环境,调节异常能量代谢,以延缓恶化时间,截断炎癌转化的进程。     

Moorfields回归分析及多变量区别分析诊断开角型青光眼

目的研究Moorfields回归分析(MRA)及多变量区别分析(MDA)的2个指标FSM和RB诊断开角型青光眼的能力,及MRA在视盘整体和视盘分区间的差异。方法对23例正常人(26眼)、26例可疑开角型青光眼患者(32眼)和21例开角型青光眼患者(21眼)进行HRT-Ⅱ和OCTOPUS视野计G2-TOP程序两项检查。结果视盘整体MRA、FSM、RB与视野缺损指数间相关系数分别为0.537、-0.565、-0.716(P<0.01),且3个组间差异均有统计学意义(P<0.01),随着视盘面积增大,MRA、FSM和RB特异性均下降。可疑组中视盘分区MRA与视野检查一致率均高于整体,一致率最高分区为颞下(78.13%)。各分区中MRA敏感性、特异性最高的分区为颞上和颞下。结论MRA和MDA检测开角型青光眼能力较强,且与视野检查间存在较好的相关性,但应用于大视盘分析时须谨慎下结论。