Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis

BACKGROUND AND AIMS: Nocturnal gastric acid breakthrough (NAB) is defined as an intragastric pH < 4.0 lasting more than 1 h during the night in patients taking a proton pump inhibitor (PPI). Gastroesophageal reflux disease (GERD) patients with nocturnal gastroesophageal acid reflux accompanied by NAB are thought to be refractory to PPI treatment. The aim of this study was to endoscopically identify the patients with predominant nocturnal gastroesophageal acid reflux. METHODS: The subjects were 37 patients with erosive reflux esophagitis (Los Angeles classification (LA) grade A, 12; B, 10; C, eight; and D, seven cases) and a control group of 20 patients without esophagitis. The results of ambulatory 24 h gastric and esophageal pH monitoring were compared among different grades of esophagitis. RESULTS: Gastroesophageal reflux during 24 h in patients with high-grade esophagitis was more frequent than for patients with low-grade esophagitis or no esophagitis. Although the length of esophageal acid exposure (percentage time with pH < 4.0) in patients with grade A or without esophagitis was longer in the daytime, that in patients with grades C and D was longer during the night. The reason for the delayed nocturnal acid exposure was the longer nocturnal acid clearance in high-grade reflux esophagitis. CONCLUSIONS: Nocturnal exposure of the esophagus to acid occurs frequently in patients with LA grades C and D esophagitis. Thus, the existence of NAB with resulting nocturnal acid reflux should be considered when the patient with high-grade esophagitis shows resistance to PPI treatment.     

中温加压下镁基吸附剂CO2吸附和再生性能研究

以一种镁基前驱物和一种矿物黏结剂为原料,采用湿混法经煅烧及水合制备得到镁基吸附剂,考察了吸附温度和吸附压力对其CO2吸附性能的影响,并利用XRD、SEM和BET对其理化性质进行了表征。结果表明：镁基吸附剂经水合后的活性组分为Mg(OH)2,当吸附温度为300 ℃、吸附压力为2 MPa时其CO2穿透吸附量达3.93 mmol/g;吸附剂水合过程中生成叶蛇纹石,降低了Mg的利用率,吸附过程中在吸附剂表面生成的块状产物层阻碍了CO2内扩散的进行;在中温加压条件下此吸附剂能够达到稳定的18次吸附 再生循环,适用于整体煤气化联合循环发电(IGCC)系统中CO2的脱除。     

The Significance of the Patient/Family as a Unit of Care in Working with Terminally Ill Patients

This study investigates the concept of patient/family as a unit of care insofar as it affects the treatment of dying patients. One hundred social workers in three institutional settings were interviewed to determine if the patient/family concept is perceived to be more prevalent in hospitals, skilled nursing facilities, or hospices. The family’s allowable involvement in care was found to differ in these settings as were some aspects of health care provided by professionals to the family. The concept of patient/family as a unit of care was a salient one, and the concept was correlated across the three settings with job satisfaction and other characteristics of an optimal model of care.     

研究开发新药的进展与对策

本文介绍１９９０～１９９２年世界首次上市的新化学物体，美国ＦＤＡ批准的新分子实体以及１９８５～１９９２年世界最畅销药物的概况。探讨了创制合成新药的设计思路以及我国研究开发突破性新药的选题方向。     

空气中苯、甲苯和二甲苯的直接热解吸气相色谱测定法

本法特点是灵敏、快速、简便和不使用溶剂。用泵或注射器将含有待测物质的空气以3～5ml/s的速度通过Tenax GC吸附管。采好样后将Tenax GC管放入热解吸器中,在250℃下解吸,同时由氮气将释放以来的物质运送到色谱柱中,以氢水焰离子化检定器进行测     

Oral trasmucosal fentanyl citrate for breakthrough pain treatment in cancer patients

Resistance among pathogens causing the most common infections encountered in hospitalised patients is increasing. Due to this resistance, the clinical efficacy of current antimicrobial agents is decreasing against many pathogens, including Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Pseudomonas aeruginosa, extended-spectrum β-lactamases, and AmpC β-lactamase-producing organisms. Studies assessing the impact of these resistance mechanisms on clinical outcomes have been performed; however, studies determining the economic impact of resistance have been limited. Strategies to retain the clinical efficacy of currently available agents include the initiation of antimicrobials with efficacy against the suspected pathogen(s) based on data obtained from local antibiograms, the use of combination therapy, and pharmacodynamic optimisation. Once a broad-spectrum regimen has been initiated, de-escalation to narrow, targeted antimicrobial therapy based on susceptibility data is warranted. Despite these efforts, new antimicrobials with novel mechanisms of action are eagerly anticipated to extend the current armamentarium against the growing population of multi-drug-resistant pathogens.     

Envelope protein variability among HBV-Infected asymptomatic carriers and immunized children with breakthrough infections

A detailed study of hepatitis B virus (HBV) surface variants and their role in breakthrough infections has been conducted in The Gambia, West Africa. Samples from 1856 vaccinated subjects were tested for hepatitis B surface antigen (HBsAg). Evidence of infection was found in 11% (22/192) of subjects with breakthrough infections and 18 (81.8%) were also positive for HBV DNA following PCR analysis. A cohort of 58 unvaccinated carriers which also included 11 patients with hepatocellular carcinoma was also investigated in order to establish the prevalence of surface variants in the unvaccinated population. Analysis of the S gene from HBV PCR-positive subjects (n = 64) revealed little variation in the S gene of these subjects. Twenty-four S protein sequences (37.5%) were identical and a further 22 sequences differed by only a single amino acid. The K141E variant found in previous work was not detected and little variation was observed in the immunodominant "a" determinant; a single change was found in one vaccinated patient (Q129H) and nine changes detected among six unvaccinated carriers. This study showed that breakthrough HBV infection in vaccinated Gambians is mainly caused by the wild type genoytype E strain and that immune escape mutants are uncommon. However, HBV mutants may play a role in establishing infection later in life when anti-HBs antibodies have begun to decline. Further investigation is required to determine the cause of these breakthrough infections and whether they contribute to the establishment of the carrier state.     

Focal hole versus screw stimulation to prevent false negative results in detecting pedicle breaches during spinal instrumentation

ObjectiveWe describe a stimulus-evoked EMG approach to minimize false negative results in detecting pedicle breaches during lumbosacral spinal instrumentation.MethodsIn 36 patients receiving 176 lumbosacral pedicle screws, EMG threshold to nerve root activation was determined using a focal probe inserted into the pilot hole at a depth, customized to the individual patients, suitable to position the stimulating tip at the point closest to the tested nerve root. Threshold to screw stimulation was also determined.ResultsMean EMG thresholds in 161 correctly fashioned pedicle instrumentations were 7.5 mA ± 2.46 after focal hole stimulation and 21.8 mA ± 6.8 after screw stimulation. Direct comparison between both thresholds in individual pedicles showed that screw stimulation was always biased by an unpredictable leakage of the stimulating current ranging from 10 to 90%. False negative results were never observed with hole stimulation but this was not true with screw stimulation.ConclusionsFocal hole stimulation, unlike screw stimulation, approaches absolute EMG threshold as shown by the lower normal limit (2.6 mA; p < 0.05) that borders the upper limit of threshold to direct activation of the exposed root.SignificanceThe technique provides an early warning of a possible pedicle breakthrough before insertion of the more harmful, larger and threaded screw.