Extracorporeal membrane oxygenation for the treatment of postcardiotomy shock

Use of extracorporeal membrane oxygenation (ECMO), one of an increasing variety of mechanical circulatory support strategies, was first used close to 50 years ago. For decades, it was mostly applied to the pediatric population. However, during the past several years, its use has dramatically increased as therapy for pulmonary and cardiac failure in the adult. In particular, ECMO is being used more and more for postcardiotomy shock. Unfortunately, despite its increased application in this setting, improved outcomes have been hard to come by. Improved results must be grounded on an approach that honors the tenets of myocardial recovery, minimizing the work done by the heart during the recovery period. Left ventricular decompression should be a tenet of ECMO support in the setting of postcardiotomy shock, universally applied if we are to see any significant improvement in our results. Furthermore, the point is made that surgeons should play a leadership role in the immediate counseling of patients' families to assure realistic expectations on their part. To address the need for family support during this very difficult time, ECMO centers should design a programmatic approach to care for patients and their families so as to provide them with education, guidance, and emotional support.     

The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain

BackgroundPsychological variables, including catastrophic thoughts and kinesiophobia, are common in people with chronic musculoskeletal pain and are associated with pain and function. However, the role of each factor has not been evaluated in people with plantar heel pain (plantar fasciitis).MethodsThirty-six participants diagnosed with plantar heel pain were recruited. Main outcome measures included the Pain Catastrophising Scale, Tampa Scale of Kinesiophobia, the Foot Health Status Questionnaire and a Visual Analogue Scale. Hierarchical regression models were developed to evaluate the association between each psychological variable with variations in foot pain, first step pain and foot function.ResultsIn a full model with age, sex and BMI, kinesiophobia contributed to 21% of the variability in foot function and was a significant predictor in this model (Beta = −0.49, P = 0.006). In a separate model, catastrophising explained 39% of the variability in foot function and was a significant predictor in this model (Beta = −0.65, P < 0.001). Finally, pain catastrophising accounted for 18% of the variability in first step pain and was a significant predictor in a model that also included age, sex and BMI (Beta = 0.44, P = 0.008).ConclusionsAfter controlling for age, sex and BMI, kinesiophobia and catastrophising were significantly associated with foot function, while catastrophising was associated with first step pain in people with plantar heel pain. In addition to addressing biological factors in the management of plantar heel pain, clinicians should consider the potential role of pain catastrophising and kinesiophobia in this population.     

Prediction of colloidal stability of high concentration protein formulations

Abstract

A major aspect determining the colloidal properties of proteins in solution is the interaction between them and with surrounding molecules. These interactions can be described by the concentration dependency of the protein diffusivity (k_D), as derived by dynamic light scattering and was determined for different solutions of monoclonal antibodies varying in pH, ionic strength and presence/absence of co-solute(s). Concerning colloidal stability, protein solutions of different k_D values are evaluated, based on their initial solution opalescence, to assess protein association. The current investigation shows that solution conditions with large k_D values, indicating high repulsive protein–protein interactions, show lower initial opalescence, compared to solution conditions with low k_D values. Upon applying stirring stress, to assess colloidal stability, the trend is such that, the higher k_D values are, the more stable the protein solutions are, as long as the thermodynamic and conformational stability is not impaired. Besides, k_D allows ranking of solution conditions for highly concentrated immunoglobulin solutions up to concentrations of ～200?mg?mL^?1 with regard to protein self-association and thus opalescent properties. The present study shows that the protein interaction parameter k_D can be used as a surrogate parameter for a qualitative prediction of protein association and, thus, colloidal protein stability.     

病人分类系统在优质护理服务病区护理人力资源配置中的应用

[目的]应用病人分类系统探索专科医院优质护理服务病区护理人力资源配置,为专科医院优质护理服务病区护理人力资源配置提供科学依据。[方法]2013年9月选择我院开展优质护理服务的肝病内科、肝胆外科、肝病产科、感染病科、肿瘤科5个病区的住院病人护理需求量及各班次护理人员每日护理时数作为研究对象。采用改良的罗斯麦迪可斯量表(RMT-PCS)调查,辅以工作参与法,计算出各病区病人24h的平均工作量指数、各病区病人疾病平均严重度,按照改良RMT-PCS量表护理人力分配比率计算出各病区所需护理人员数量。[结果]各病区由于病种不同,病人类别所占比例不同,病人严重度、每日平均工作量指数、每日所需护理时间均有不同。[结论]运用改良RMT-PCS量表对病人分类,建立专科医院的病人分类系统,为专科医院优质护理服务病区的护理人员配置提供科学依据,更加有利于护理管理,有利于为病人提供优质护理服务。     

Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Cardiac Surgery in the Randomized PARTNER 2A Trial

Objectives

The aim of this study was to further evaluate clinical outcomes in patients with and without PCS.

十二指肠乳头旁憩室与胆总管结石及胆囊切除术后综合征的关系

目的探讨十二指肠乳头旁憩室（JPD）与胆总管结石及胆囊切除术后综合征（PCS）的关系。方法回顾分析313例患者经内镜逆行胰胆管造影（ERCP）资料，计算JPD的检出率；比较两组（憩室组和非憩室组）胆总管结石的发生率及60岁以上患者占有比例；分析114例胆囊切除术后患者ERCP造影结果。结果全组JPD检出率26．5％；憩室组胆总管结石的发生率显著高于非憩室组（82.9％vs56，1％，P〈0.01），憩室组60岁以上者比例高于非憩室组（61．4％vs43，9％，P〈0.05）；114例胆囊切除术后患者ERCP造影显示胆总管结石的发生率80.4％，JPD合并发生率31.5％。结论随着年龄的增长，十二指肠乳头旁憩室的发生率增加，十二指肠乳头旁憩室是胆总管结石形成的重要危险因素，胆总管结石和十二指肠乳头旁憩室是胆囊切除术后综合征的两大主要原因。     

Changes in respiratory symptoms and health-related quality of life

BACKGROUND: For a number of chronic diseases, health-related quality of life (HRQoL) has become an important outcome measure. Little data are available on how incidence, remission, or persistence of respiratory symptoms affect HRQoL. METHODS: The Hordaland County Cohort Study was conducted between 1985 and 1997, and comprised 3,786 subjects, randomly selected, and aged 15 to 70 years in 1985. Respiratory symptoms were assessed both in 1985 and 1996/1997, and HRQoL was measured by the Short-Form 12 questionnaire in 1996/1997. Robust linear regression analysis was used to examine the relationship between changes in six respiratory symptoms and the physical component score (PCS) and mental component score (MCS). RESULTS: Among subjects with incidence or persistence of any of the six examined respiratory symptoms, PCS and MCS were significantly lower than among subjects without symptoms. The PCS was more reduced than the MCS in symptomatic subjects; however, this trend was reduced after adjustment for the confounder's gender, age, educational level, body mass index, and smoking status. Dyspnea attacks and dyspnea grade 2 had the largest negative impact on both PCS and MCS. CONCLUSIONS: This is the first longitudinal population study to show the negative impact of incidence and persistence of respiratory symptoms on HRQoL.     

The vasodepressor function of the kidney: prostaglandin E2 is not the principal vasodepressor lipid of the renal medulla

Aim: Whereas prostaglandin E2 has been characterized as the principal vasodepressor lipid, medullipin remains a hypothetical vasodepressor principle of the renal medulla. Representing the first step towards the isolation of medullipin as a pure compound, the aim of the present study was to determine whether or not the known vasodilator and antihypertensive action of prostaglandins play a role in the antihypertensive activity of renal medulla. Methods: A chloroform extract of porcine kidney medulla was fractionated by gradient vacuum liquid chromatography (VLC) and analysed by capillary GC‐MS for the presence of prostaglandins (detection limit: 2.2 ppm). The biological activity was determined in spontaneously hypertensive Wistar rats. The particle size of injectable colloids prepared from extract and fractions was controlled by photon correlation spectroscopy. Results: The extract caused a pronounced blood pressure decline (29.6 ± 6.3/24.9± 5.5 mmHg; P = 0.0078; 10 mg kg^?1 body weight; particle size of 143 ± 18 nm; n = 7) lasting for more than 1 h. The heart rate remained stable, showing only a slightly decrease. All fractions were shown to be devoid of vasodilator prostanoid substances. The VLC procedure allowed the successful separation of endogenous emulsifiers from the active principle. An extract from the renal cortex did not exhibit a similar vasodepressor effect. Conclusion: Prostaglandins are excluded as the blood pressure‐lowering active principle of a total lipid kidney medulla extract. The vasodepressor principle is contained in the kidney medulla, but not in the cortex. It can be separated from endogenous emulsifying substances, is chromatographically stable, and is amenable to purification and chemical characterization.