The most immature infants: Is evidence-based practice possible?

IntroductionAt extremely low gestational ages, preterm infants are markedly physiologically immature, thus their responses to common clinical interventions may differ from more mature preterm babies. This study was performed to describe the evidence base which is available to make care decisions for such infants.MethodsA literature search of recent large neonatal randomized controlled trials (RCTs) was performed to determine the representation of infants <25 weeks of gestation, and whether it is clear if the overall results applied to the most immature infants.ResultsAmong 30 multi-centre RCTs in neonatology from the last 5 years, many excluded the most immature infants, and those that included them rarely presented the impacts of the intervention on the most at-risk group. Over 25,000 infants of under 32 weeks gestational age (GA) were included in these trials. Eight trials presented results of the primary outcome for infants of <26 weeks GA (n = 2,152) and a further four trials for infants <25 weeks, n = 711.ConclusionThe evidence base for treatment decisions for the highest risk infants in the NICU is severely limited. RCTs in extremely preterm infants should not exclude the highest risk group, and lower limits of gestational age (or body weight) should be avoided, any infant receiving intensive care should be eligible regardless of how immature. The results among the most immature infants should be presented separately, or be easily available, in order to build a database of effective treatments among infants of 22,23, and 24 weeks GA.     

玻璃离子水门汀氟离子的释放和再吸收及重量减少

观察缺氧及再给氧对体外培养星形胶质细胞存活能力及谷氨酸摄取功能的影响。方法：取生后１～２ｄ新生昆明小鼠大脑皮层进行星形胶质细胞原代培养,培养 １周左右予以缺氧。缺氧时间分别为 １２、２４、４８ ｈ,并取缺氧２４ ｈ后再给氧０、１２、２４、４８ ｈ的细胞观察其形态、死亡细胞数目、乳酸脱氢酶活性及谷氨酸摄取能力的变化。结果：缺氧组及再给氧组星形胶质细胞死亡数较对照组无明显变化,缺氧前、后乳酸脱氢酶活性亦无明显改变,缺氧组谷氨酸摄取功能较对照组下降３０％～６０％,并随缺氧时间延长而明显下降（与对照组相比,Ｐ＜０．０１）,再给氧２４ ｈ内谷氨酸摄取能力有所恢复,但未达正常水平。结论：星形胶质细胞与神经元相比,对缺氧培养液较为耐受,缺氧对星形胶质细胞存活能力无明显影响,但细胞摄取谷氨酸能力有所改变。     

Release of endogenous catecholamines in two different regions of the nucleus of the solitary tract as influenced by carotid occlusion

Summary The effects of carotid occlusion on the release of catecholamines in the nucleus of the solitary tract (NTS) were investigated in anaesthetized cats. Two aspects of the nucleus (rostral or intermediate NTS) were superfused bilaterally through push-pull cannulae with artificial CSF and the release of the endogenous dopamine, noradrenaline and adrenaline was determined in the superfusate radioenzymatically. The superfusion rate was 150 l/min or 800 l/min. In some experiments, superfusion of the intermediate NTS was carried out after denervation of the aortic arch.In the rostral NTS superfused at a rate of 150 l/min, bilateral carotid occlusion led to a rise in blood pressure and decreased the release rate of dopamine. These changes continued after occlusion termination. The release rate of noradrenaline was transiently diminished during occlusion. The release of this amine was also decreased after occlusion termination. The release rate of adrenaline was not influenced during carotid occlusion, but it was found to be diminished after termination of the occlusion. Superfusion of the rostral NTS at a rate of 800 l/min also reduced the release rate of adrenaline after termination of carotid artery occlusion. In the intermediate NTS (superfusion rate 150 l/min) similar effects of the carotid occlusion on the release rates of dopamine and noradrenaline were observed. In this aspect of the NTS, denervation of the aortic arch abolished the decrease in the noradrenaline release during carotic occlusion, while the release rates of dopamine and adrenaline were decreased during and after termination of the carotid occlusion.The results suggest that (a) the rise in blood pressure in the carotid sinus after termination of a carotid occlusion decreases the release rates of noradrenaline and adrenaline in the NTS, (b) the decrease in the release of noradrenaline during carotid occlusion is due to impulses originating from the baroreceptors of the aortic arch.Thus, impulses from carotid sinus and aortic arch modify the release rates of noradrenaline in the NTS so as to counteract blood pressure changes.Supported by the Fonds zur Förderung der wissenschaftlichen Forschung Send offprint requests to A. Philippu at the above address     

国产长效皮下埋植剂和Norplant的药物体外释放比较

本文研究了国产18-甲基炔诺酮硅橡胶长效皮下埋植剂的药物体外释放,并与进口Norplant进行了比较。释放试验采用水平振荡法,实验条件符合“漏槽”状态的要求。用紫外分光光度法在240 nm波长处测定18-甲基炔诺酮每天的体外释放量。二年多体外释放试验的实验结果表明:国产埋植剂的药物体外释放无爆破效应,释药速度稳定,为零级速度。平均每天释放量为85μg。体外释放的重现性好。进口Norplant则有明显的爆破效应,经10天释放,才趋于稳定,平均每天释药量为68μg。     

Treatment of mesangiocapillary glomerulonephritis with alternate-day prednisone —a report of The International Study of Kidney Disease in Children

It has been claimed that long-term prednisone treatment ameliorates the course of children with mesangiocapillary glomerulonephritis (MCGN). The International Study of Kidney Disease in Children conducted a randomized, double-blinded, placebo-controlled clinical trial in 80 children with idiopathic MCGN, including 42 patients with type I disease, 14 with type II disease, 17 with type III disease, and 7 with nontypable disease. Criteria for admission included heavy proteinuria and a glomerular filtration rate of greater than or equal to 70 ml/min per 1.73 m². Prednisone or lactose, 40 mg/m², was given every other day as a single morning dose. The mean duration of treatment was 41 months, renal failure being the most common reason for termination of therapy. Treatment failure was defined as an increase from baseline of 30% or more in serum creatinine, or more than 35 mol/l. Overall, treatment failure occurred in 55% of patients treated with lactose, compared with 40% in the prednisone group. Life-table analysis showed a renal survival rate (i.e., stable renal function) at 130 months of 61% among patients receiving prednisone and 12% among patients receiving lactose (P=0.07). Of patients with type I or III MCGN, 33% treated with prednisone were treatment failures, compared with 58% in the lactose group. Long-term treatment with prednisone appears to improve the outcome of children with MCGN.     

丙戊酸钠缓释片的制备及其释放度的测定

目的 研制丙戊酸钠缓释片并进行体外释放度测定。方法 采用喷雾干燥法制备丙戊酸钠微囊，通过电镜和X-射线衍射等检测方法对微囊进行质量评价。采用永停滴定法测定丙戊酸钠微囊含量及缓释片的体外释放度。结果 喷雾干燥法制备的丙戊酸钠微囊质量较好，所制缓释片体外释放符合一级动力学过程。结论 运用丙戊酸钠微囊制备缓释片的工艺简便、可靠，体外释放证明有明显的缓释作用。     

Treatment of Acute Lumbar Sprain with Single Acupoint： A RCT

目的:评价单一穴位治疗急性腰扭伤的治疗效果.方法:根据统一的诊断标准,在多个临床中心进行随机对照研究.全部病例320例经随机数字表法分为针刺后溪穴观察组和针刺腰痛点对照组.对患者的疼痛程度分别由医师和患者进行评分.结果:治疗2个疗程后,观察组和对照组近期有效率分别为89.4%和82.5%,远期有效率分别为95.6%和93.5%.经Ridit分析,近期疗效差异有统计意义(P<0.05),远期疗效差异无统计意义(P>0.05).结论:针刺单一穴位治疗急性腰扭伤疗效确切,取穴简便,后溪穴疗效好于腰痛点.     

十八甲基炔诺酮透皮控释传递系统在人体不同部位皮肤的药物动力学

6名健康妇女分别于上臂、臀部和腹部三部位经皮给予合LNG的透皮控释传递系统（TCDS）后，用放射免疫法测定LNG血清浓度，计算其主要药物动力学参数。结果表明：在TCDS用药期间，三部位的C（max）、T（max）及AUC（0～168h）基本接近，部位间无显著性差异（P＞0．05）；TCDS揭除后，AUC（168～204h）及消除相半衰期T（1／2）（Ke）均以腹部最大，臀部次之，上臂最小，在腹部与上臂间有显著性差异（P＜0．05）。上述结果可归因于TCDS对LNG的控释和人体皮下脂肪的“贮库效应”。     

破伤风类毒素在卡波普凝胶中的释放研究

目的研究破伤风类毒素在卡波普凝胶中的释放。方法采用絮状沉淀法。将25Lf/mL破伤风类毒素分别溶于磷酸缓冲液和蒸馏水中,然后加入等量的0.25%、0.125%、0.625%三种浓度的卡波普,充分混匀,用NaCl沉淀法分离卡波普,然后取上清和卡波普沉淀分别做絮状反应。结果破伤风类毒素在上清中含量很高,呈典型絮状沉淀,而卡波普沉淀中不含任何破伤风类毒素,絮状反应均为阴性。结论通过对破伤风类毒素在卡波普凝胶中的释放条件与方法的研究,初步建立了该种制品在卡波普凝胶中的生物学检测手段及其在卡波普中溶解的条件。确定了这种释放研究的卡波普浓度不应高于0.25%。     

Evaluation of combined fibroblast growth factor-2 and moderate hypothermia therapy in traumatically brain injured rats

Both the exogenous administration of fibroblast growth factor-2 (FGF-2) or the induction of moderate hypothermia have been shown to attenuate histopathology and improve functional outcome after traumatic brain injury (TBI). Since combined therapeutic strategies may be more beneficial than single therapies, we examined the potential synergistic effect of FGF-2 combined with moderate hypothermia treatment induced 10 min after TBI on functional and histological outcome following controlled cortical impact (CCI) injury. Fifty male Sprague-Dawley rats were randomized to one sham and four CCI treatment groups: Sham+vehicle (VEH); FGF-2 (45 microg/kg/h for 3 h i.v.)+Normothermia (37+/-0.5 degrees C); FGF-2+Hypothermia (32+/-0.5 degrees C for 3 h); VEH+Norm; VEH+Hypo. Vestibulomotor performance on the beam balance and beam-walk (BW) tasks on post-operative days 1-5 and spatial memory acquisition in the Morris water maze (MWM) on days 14-18 were assessed. After 4 weeks survival, histological evaluations (CA(1) and CA(3) cell counts and lesion volume) were performed. MWM performance improved in all treatment groups, but combined treatment was not more efficacious than either alone. The FGF-2+Hypo group performed significantly better than the other injured treatment groups in the BW task. Lastly, no significant group differences in beam balance or histological outcome were observed. These data suggest a suboptimal and incomplete synergy of combined FGF-2 and hypothermia treatment. These data may indicate that either our dose of FGF-2 or combination therapy was not optimized in our model.