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.     

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。     

Fingerprinting of Salmonella enterica subsp. enterica serovar Enteritidis by ribotyping

Objective: To carry out an epidemiologic evaluation of Salmonella enterica subsp. enterica serovar Enteritidis outbreaks in households and small communities by means of rRNA gene restriction pattern analysis (ribotyping).
Method: One hundred Enteritidis isolates dating from 1989 to 1994 which could be allocated epidemiologically to different sources or to small community outbreaks were investigated with ribotyping, a fingerprinting method in which bacterial DNA is hybridized with the biotin-labeled plasmid pKK 3535 containing a ribosomal RNA operon of Escherichia coli to determine the ribosomal RNA gene restriction patterns.
Results: Four different ribotyping patterns were found with the restriction endonuclease Sma I and nine with Sph I. Ribotypes of isolates which could be allocated epidemiologically to a common source usually corresponded. Almost 60% of the Enteritidis infections had the ribotyping pattern Sph I-A. In contrast, this pattern was not found in any of the five Enteritidis strains isolated in 1989. The suspicion that Enteritidis phage type 4 infections are caused by consumption of insufficiently heated eggs is supported by the fact that the ribotyping pattern Sph 1-A was found in isolates from eggs and from human specimens.
Conclusions: As patterns Sph I-A and Sma I-J appeared in 58% and 75% of the isolates, respectively, ribotyping cannot be used for the differentiation between various outbreaks with these two patterns. In cases where the Enteritidis strains showed less frequent patterns, ribotyping seems to be a practical tool for the identification of infection chains. In addition newly appearing ribotyping patterns can give information about the epidemiologic development of Enteritidis infection.     

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

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

长效驱避剂的初步筛选研究

目的　研究一种对人有效保护时间 >8h ,且安全经济的长效驱避剂配方。方法　采用实验室 (GB T173 2 2 .10 -1998)和现场的药效测试方法对所配制的驱避剂配方进行效果测试。结果　实验室试验表明 ,以 2 0 %IR3 5 3 5配制 10、12、13、14号驱避剂配方在实验室内对白纹伊蚊的有效防护时间可达 8h以上 ;现场试验表明 ,10、12、13、14号驱避剂配方对人有效防止丘陵地区伊蚊的叮咬时间达 9h ,有效防止稻田地区中华按蚊的叮咬时间达 8h。结论以 2 0 %IR3 5 3 5与纤维素配制的驱避剂对人的有效保护时间可达 8h。纤维素对IR3 5 3 5有一定延长有效保护时间的缓释作用。实验所用配方对人的皮肤无不良反应 ,可作为户外活动人群防止蚊虫刺叮的驱避剂。     

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.     

青叶胆Shan酮类化合物的成分研究

目的　分离鉴定青叶胆 Swertia mileensis全草的酮类成分。方法　 95 %乙醇浸提 ,经硅胶柱色谱分离纯化 ,UV,IR,MS,1 H和 1 3CNMR波谱方法确定化学结构。结果　分得 12个酮成分 ,分别为 1-羟基 - 2 ,3,4 ,5 -四甲氧基酮 (1- hydroxy- 2 ,3,4 ,5 - tetramethoxyxanthone, ) ;1-羟基 - 2 ,3,7-三甲氧基酮 (1- hydroxy- 2 ,3,7-trim ethoxyxanthone, ) ;1-羟基 - 2 ,3,5 ,7-四甲氧基酮 (1- hydroxy- 2 ,3,5 ,7- tetram ethoxyxanthone, ) ;1,5 -二羟基 - 2 ,3-二甲氧基酮 (1,5 - dihydroxy- 2 ,3- dimethoxyxanthone, ) ;1,5 -二羟基 - 2 ,3,7-三甲氧基酮 (1,5 - dihy-droxy- 2 ,3,7- trimethoxyxanthone, ) ;1-羟基 - 2 ,3,5 -三甲氧基酮 (1- hydroxy- 2 ,3,5 - trimethoxyxanthone, ) ;1,5 -二羟基 - 2 ,3,4 ,7-四甲氧基酮 (1,5 - dihydroxy- 2 ,3,4 ,7- tetramethoxyxanthone, ) ;1,8-二羟基 - 2 ,3,6 -三甲氧基酮 (1,8- dihydroxy- 2 ,3,6 - trimethoxyxanthone, ) ;1-羟基 - 2 ,3,4 ,7-四甲氧基酮 (1- hydroxy- 2 ,3,4 ,7- te-tramethoxyxanthone, ) ;1,2 ,3,5 -四甲氧基酮 (1,2 ,3,5 - tetromethoxyxanthone, ) ;1-羟基 - 2 ,3,4 ,6 -四甲氧基酮 (1- hydroxyl- 2 ,3,4 ,6     

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。     

Identification of GRASP-1 as a novel 97 kDa autoantigen localized to endosomes

We have identified an autoantigen that is recognized by antibodies from an 18-year-old female with a history of recurrent infections who later in her clinical course developed Raynaud's phenomenon and telangiectasias. By indirect immunofluorescence (IIF), the index serum produced a unique cytoplasmic discrete speckled (CDS) staining pattern that partially colocalized with early endosome antigen 1 (EEA1) but not Golgi complex or other cytoplasmic organelles in HEp-2 cells. When HEp-2 cells were treated with 0.1 N HCl, the cytoplasmic speckled staining of the index serum was markedly decreased, suggesting that the reactive antigen was soluble. Western blot analysis showed a reactive approximately 97 kDa protein in a saline soluble protein preparation from HeLa cells. Mass spectrometric analysis of the excised 97 kDa band that was immunoprecipitated from HeLa cell extracts identified GRASP-1 as a possible target. The index serum and anti-GRASP-1 antibodies colocalized to structures in the cytoplasm of HEp-2 cells. Synthetic peptides representing the full-length GRASP-1 protein were used to identify reactive epitopes. Like many other cytoplasmic autoantigens, GRASP-1 has numerous coiled-coil domains throughout the protein with the exception of short segments at the amino and carboxyl terminus.