Towards the definition of Institutional diagnostic reference levels in paediatric interventional cardiology procedures in Greece

This study aimed to evaluate paediatric radiation doses in a dedicated cardiology hospital, with the objective of characterising patterns in dose variation. The ultimate purpose was to define Local (Institutional) Diagnostic Reference Levels (LDRLs) for different types of paediatric cardiac interventional procedures (IC), according to patient age. From a total of 710 cases performed during three consecutive years, by operators with more than 15 years of experience, the age was noted in only 477 IC procedures. The median values obtained for Fluoroscopy Time (FT), Number of Frames (N) and Kerma Area Product (P_KA) by age range were 5.8 min, 1322 and 2.0 Gy.cm² for <1 y; 6.5 min, 1403 and 3.0 Gy.cm² for 1 to <5 y; 5.9 min, 950 and 7.0 Gy.cm² for 5 to <10 y; 5.7 min, 940 and 14.0 Gy.cm² for 10 to <16 y, respectively. A large range of patient dose data is observed, depending greatly on procedure type and patient age. In all age groups the range of median FT, N and P_KA values was 3.1–15.8 min, 579–1779 and 1.0–20.8 Gy.cm² respectively. Consequently, the definition of LDRLs presents challenges mainly due to the multiple clinical and technical factors affecting the outcome. On the other hand the lack of paediatric IC DRLs makes the identification of good practices more difficult. A consensus is needed on IC procedures nomenclature and grouping in order to allow a common assessment and comparison of doses.     

Specific anti‐integrase abzymes from HIV‐infected patients: a comparison of the cleavage sites of intact globular HIV integrase and two 20‐mer oligopeptides corresponding to its antigenic determinants

HIV‐infected patients possess anti‐integrase (IN) IgGs and IgMs that, after isolation by chromatography on IN‐Sepharose, unlike canonical proteases, specifically hydrolyze only IN but not many other tested proteins. Hydrolysis of intact globular IN first leads to formation of many long fragments of protein, while its long incubation with anti‐IN antibodies, especially in the case of abzymes (Abzs) with a high proteolytic activity, results in the formation of short and very short oligopeptides (OPs). To identify all sites of IgG‐mediated proteolysis corresponding to known AGDs of integrase, we have used a combination of reverse‐phase chromatography, matrix‐assisted laser desorption/ionization spectrometry, and thin‐layer chromatography to analyze the cleavage products of two 20‐mer OPs corresponding to these AGDs. Both OPs contained 9–10 mainly clustered major, medium, and minor sites of cleavage. The main superficial cleavage sites of the AGDs in the intact IN and sites of partial or deep hydrolysis of the peptides analyzed do not coincide. The active sites of anti‐IN Abzs are localized on their light chains, whereas the heavy chains are responsible for the affinity of protein substrates. Interactions of intact globular proteins with both light and heavy chains of Abzs provide high specificity of IN hydrolysis. The affinity of anti‐IN Abzs for intact integrase was ~1000‐fold higher than for the OPs. The data suggest that both OPs interact mainly with the light chains of different monoclonal Abzs of the total pool of IgGs, which possesses lower affinity for substrates; and therefore, depending on the oligopeptide sequences, their hydrolysis may be less specific and remarkably different in comparison with the cleavage of intact globular IN. Copyright © 2013 John Wiley & Sons, Ltd.     

Elevated serum lactate in emergency department patients predicts hospital admission unrelated to diagnosis – but not more

Purpose: The value of lactate as a screening biomarker in the emergency department is debated. We analysed all unselected patients in the emergency department with serum lactate measured with regard to different outcome parameters.

Material and Methods: In a retrospective single centre study, we analysed all digitalized patient data of a two-week period of all patients ≥18 where a serum lactate was measured. The lactate levels as well as demographic and other laboratory data were correlated in a logistic regression analysis, univariable as well as multivariable, with the outcome parameters.

Results: A total of 1157 patients contacted the emergency department of which 587 were included. The average lactate level was 2,08?mmol/l (SD ±1.51, median 1.73). A total of 313 patients were admitted to hospital, 274 treated as outpatients. Their median lactate levels were 2.0?mmol/l (min/max 0.6–18?mmol/l) and 1.5?mmol/l (min/max 0.5–7.4?mmol/l), respectively. Univariable regression analysis for hospital admission showed an odds ratio of 1756 (p?p?=?0.004). There was no correlation with admission to ICU, length of stay or a relation to a certain diagnostic group.

Conclusions: Screening lactate levels in unselected emergency department patients do not have a clinical relevance yet.     

老年气管插管患者下呼吸道感染细菌分布及 耐药性分析

目的研究老年气管插管患者下呼吸道感染的病原菌分布及耐药情况,为临床插管前预防性经验用药提供参考。方法回顾性分析2014-2016年上海市虹口区江湾医院老年气管插管患者的病原菌分布及耐药性情况。结果 560例标本中共检出177株致病菌,其中革兰阴性杆菌121株(68.36%),以肺炎克雷伯菌、铜绿假单胞菌为主;除鲍曼不动杆菌/溶血不动杆菌外,其他革兰阴性杆菌对亚胺培南、美罗培南敏感性均较高。革兰阳性球菌检出52株(29.38%),以金黄色葡萄球菌为主(其中MRSA 37株),对万古霉素敏感性较高。另外分离到真菌4株。结论气管插管患者下呼吸道感染致病菌以肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌为主。在临床应用中,应根据本地区、本医院的病原菌分布状况和细菌耐药情况,给予适当药物,预防感染。     

Medical societies,patient education initiatives,public debate and marketing of unproven stem cell interventions

Businesses marketing unproven stem cell interventions proliferate within the U.S. and in the larger global marketplace. There have been global efforts by scientists, patient advocacy groups, bioethicists, and public policy experts to counteract the uncontrolled and premature commercialization of stem cell interventions. In this commentary, we posit that medical societies and associations of health care professionals have a particular responsibility to be an active partner in such efforts. We review the role medical societies can and should play in this area through patient advocacy and awareness initiatives     

Plasma N-glycome composition associates with chronic low back pain

Background

Low back pain (LBP) is the symptom of a group of syndromes with heterogeneous underlying mechanisms and molecular pathologies, making treatment selection and patient prognosis very challenging. Moreover, symptoms and prognosis of LBP are influenced by age, gender, occupation, habits, and psychological factors. LBP may be characterized by an underlying inflammatory process. Previous studies indicated a connection between inflammatory response and total plasma N-glycosylation. We wanted to identify potential changes in total plasma N-glycosylation pattern connected with chronic low back pain (CLBP), which could give an insight into the pathogenic mechanisms of the disease.

Production of TNFα and IL-6 by Activated Whole Blood from HIV-1 Infected Patients Detected by a One-Stage Procedure: Relationship with the Phenotype of HIV-1 Isolates

Diluted whole blood (WB) culturing may be the most appropriate milieu in which to study cytokine production in vitro. We tested TNFα and IL-6 production using small volumes of WB (25 μl) from HIV-1 positive patients with a one-step procedure that combines WB stimulation with LPS, PHA and cytokine measurement. We studied 49 patients without secondary infection or at distance of secondary infection staged according to the 1993 classification of the CDC and 12 healthy seronegative subjects. Heparinized blood from 5 control subjects had been collected sequentially during a period of 5 months. The individual variations of TNFα and IL-6 production were limited for all these individuals. In 1 out of 20 CDC group A patients, 6 out of 17 CDC group B patients and 3 out of 12 CDC group C patients, we obtained higher values of TNFα than the mean + 2 S.D. of the control group. In 3 out of 20 CDC group A patients, 1 out of 17 CDC group B patients without AIDS and 5 out of 12 CDC group C patients, the TNFα values were lower than the mean ?2 S.D. of the control group. Low IL-6 values were obtained in 1 out of 20 CDC group A patients and 1 out of 17 CDC group B patients and 3 out of 12 CDC group C patients. There was no correlation between TNFα production in vitro and plasma level of TNFα. We found no correlation between the levels of cytokines and monocyte count or between the levels of cytokines and CD4 T-cell count in peripheral blood. Our data point out a disarray in TNFα and IL-6 production by WB from HIV-1 infected patients. The relationship between the disarray of cytokine production and cytopathogenicity of HIV-1 isolates in the P4 cell line was investigated in this study. We found a correlation between the high level of TNFα produced by WB and the phenotype of HIV-1 isolates isolated from patients. The one-stage procedure used in this work is of potential value to investigate the activation status of cells for monitoring HIV-1 positive individuals and predicting HIV-1 phenotype.     

某些内科系统疾病患者血浆游离氨基酸的变化及意义

为了解某些内科系统疾病的血氨基酸代谢特点。测定１７０例９种内科系统急慢性疾病患者血浆游离氨基酸浓度,并分别与５８例健康人血浆氨基酸浓度作对比分析。９种疾病的血浆胱氨基酸浓度不同程度升高,以尿毒症病人最为显著,炎症性病人血浆苯丙、蛋、赖氨酸和苯丙／酪比值显著升高,丙、组、精、脯氨酸和支／芳比值显著降低;糖尿病和甲亢病人血浆总游离氨基酸、谷、丙、酪、赖和支链氨酸显著升高;糠尿病病人支／芳比值显著升高,表明不同疾病的血氨基酸浓度有特征性变化,炎症是导致血氨基酸代谢紊乱的重要因素     

瑞芬太尼在全髋关节置换术中的麻醉效果观察

目的探讨瑞芬太尼在全髋关节置换术中的麻醉效果。方法将80例全髋关节置换术患者随机分为观察组和对照组各40例,观察组采用咪达唑仑、依托咪酯、舒芬太尼、罗库溴铵行全麻诱导,以丙泊酚、瑞芬太尼和阿曲库铵行麻醉维持;对照组采用咪达唑仑、依托咪酯、舒芬太尼、罗库溴铵行全麻诱导,以丙泊酚、芬太尼和阿曲库铵行麻醉维持。观察两组患者T0~T3各时点MAP和HR的变化情况以及手术时间、苏醒时间和语言恢复时间。结果观察组苏醒时间和语言恢复时间明显短于对照组,差异有统计学意义(P0.05)。结论瑞芬太尼用于全髋关节置换术中患者苏醒时间快,且手术过程血压、心率相对平稳,具有临床应用价值。