Factors influencing choice of medical vs. surgical treatment of pediatric appendicitis

PurposeTo examine what proportion of caregivers, if given a choice, would choose medical versus surgical treatment of appendicitis and what factors would be important in their decision.MethodsA survey was devised and given to the caregivers of children presenting to the pediatrician for a routine visit in community and academic pediatric clinics. The survey presented a summary of outcomes after medical (non-operative) and surgical treatment of uncomplicated appendicitis. Participants were then asked to choose medical versus surgical treatment if their child were to develop appendicitis. They were also asked to rate the importance of certain factors in their decision ? 1 being “not important” and 5 being “very important”.ResultsFour hundred surveys were distributed with an 86.2% (345/400) response rate. Six percent (21/342) of respondents reported a history of appendicitis and 49.4% (168/340) reported having known someone who had appendicitis. The majority of respondents, 85.3% (284/333), were mothers. A minority of respondents, 41.7% (95% CI: 36.7, 47.0), chose medical treatment over surgery for appendicitis. There was no statistical difference in the proportion of mothers (41.6%) versus fathers who chose medical treatment (41.3%). Caregivers who chose medical treatment were more likely to rate time in hospital (p = .008) and time out of school (p = 05) as important in decision making when compared with those who chose surgery. Those who chose surgical treatment were more likely to rate risk of recurrent appendicitis (p < .001) as important to decision making. In the multivariate analysis, those who rated time in hospital as very important had more than twice the odds of choosing medical therapy (OR 2.20, p = 0.02) when compared with those who rated it as less important. Not knowing someone who has had appendicitis was significantly associated with choosing medical therapy when compared with those who do know someone who has had appendicitis, OR 2.3, p = .002. Rating pain as very important was also significantly associated with choosing medical therapy, when compared to those rating pain 1–3, OR 3.38, p = .03.ConclusionsIn this survey of caregivers of children presenting for routine care, 41.7% would choose medical, or non-operative, therapy for their children with acute appendicitis. The risk of recurrence, time in hospital, and time out of school, pain, and knowing someone who has had appendicitis were all important factors that families may consider when making a decision. These data may be useful for surgeons counseling patients on which treatment to pursue.     

石家庄地区汉族人群DIS80(pMCT118)位点VNTR基因频率分布调查

本文采用ＰＣＲ技术对石家庄地区２１６名无关个体ＤＩＳ８０（ｐＭＣＴ１１８）位点扩增片段长度多态性的等位基因频率进行调查。ＰＣＲ扩增产物采用聚丙烯酰胺凝胶电泳分型及溴化乙锭染色，共检出７０种基因型，２５个等位基因，其中以１８、２４、３０三个等位基因频率最高。将本文结果与日本人群在ＤＩＳ８０（ｐＭＣＴ１１８）位点多态性结果进行比较，石家庄地区汉族人群ＤＩＳ８０（ｐＭＣＴ１１８）位点基因频率分布符合ＨａｒｄｙＷｅｉｎｂｅｒｇ平衡定律，该位点非父排除率为０．７１，个体识别率为０．９，杂合度为０．８５。     

高活性的人白细胞介素-3突变体的构建与表达

目的:在大肠杆菌中构建表达高活性的人白细胞介素-3(hIL-3)突变体。方法:通过定点突变的方法构建hIL-3突变体K116V和K116W的表达载体,并实现hIL-3突变体在大肠杆菌中的表达。对所得包涵体蛋白依次溶解、纯化、透析复性。用Westernblot检测hIL-3突变体的特异性。单溶液细胞增殖(MTS)测定hIL-3突变体的生物学活性。结果:hIL-3在大肠杆菌中高效表达,表达量占菌体总蛋白的40%以上,主要以包涵体的形式存在。将包涵体溶解在8mol/L脲中,经Ni-NTA-Sepharose柱纯化后纯度达90%以上。MTS法测定hIL-3突变体K116V的活性为野生型的5倍,K116W的生物学活性也有所增加。结论:获得了高活性的hIL-3突变体K116V,有望成为hIL-3的替代品,也证明了hIL-3第116位的赖氨酸残基对于hIL-3的生物学活性很重要。     

Acute cardiac and pulmonary arrest after infusion of vancomycin with subsequent desensitization

J Allergy Clin Immunol 1997;100:853-4.     

Acute polymyositis associated with W. bancrofti

Two cases of acute polymyosotis associated with W. bancrofti , presented with generalised painful swelling and weakness of the muscles. These patients had elevated muscle enzymes, a myopathic EMG pattern, inflammatory myopathy on biopsy and W. bancrofti in the peripheral blood smear. The clinical, improvement of the disorder and total clearance of microfilariae was obtained with the combination therapy of steroid and diethyl-carbamazine in comparison with steroid alone.     

食管穿孔和破裂的诊断与治疗

目的 提高对食管穿孔和破裂的诊断及处理水平。方法 回顾性分析经外科处理的45例食管穿孔或破裂患的临床资料。结果 本组患经胸部平片、胸腔穿刺、上消化道造影及胃镜确诊。15例为自发性食管破裂，6例为医源性穿孔，5例为创伤性穿孔，10例为食管癌并食管支气管瘘，9例为食管憩室并食管支气管瘘。治疗予以食管修补9例；胸腔引流、空肠造瘘9例(其中1例为食管修补失败后改行此手术)；食管切除胃食管吻合术12例(其中3例为食管修补失败)；胃造瘘术4例；置入食管支架4例；食管支气管瘘切除修补3例；食管瘘口修补并肺叶切除2例；食管胃弓上短路1例，颈部引流2例；放弃治疗3例。治愈25例，好转11例，死亡6例。结论 详细了解病史和进行胸腔穿刺、上消化道造影等检查可帮助诊断。尽早手术闭合瘘口和治疗食管原发病变是治疗的关键。     

健康教育项目设计PRECEDE诊断评价模式

美国著名健康教育专家Lawrence W.Green 提出的健康教育项目设计PRECEDE 诊断评价模式,站在社会健康的宏观高度,全面规划健康教育内容、方式与作用环节,并从项目设计开始就将监测评价纳入项目内容。由于设计思维的缜密与方法的科学性,保证了健康教育项目能够紧紧抓住重点健康问题,做到有的放矢。因此,在模式的引进和使用过程中,应结合我国妇幼卫生的现状和当地的实际情况,设计出适合我国国情的妇幼卫生健康教育项目规划,为发展我国妇幼卫生事业服务。     

Measurement of Perceived Disruption During Rebuilding Following Hurricane Andrew

The purpose of this study was to develop and evaluate a measure of perceived disruption during rebuilding following a disaster. Two eight-item scales, which measured intensity of disruption during the entire repair phase (Intensity-RP) and intensity of disruption during the past month (Intensity-PM) were developed and administered to 135 survivors of Hurricane Andrew. At 9 to 12 months postdisaster, Intensity-RP and Intensity-PM were both significantly associated with scores on the Global Severity Index of the SCL-90-R, and with scores on the Impact of Event-Intrusion Scale; Intensity-PM alone was significantly associated with PTSD scores. Regression analyses indicated that each scale contributed significant unique variance in predicting mental health symptoms, even after controlling for relevant demographic and initial disaster exposure variables.