Inappropriate Antibiotic Prescribing for Acute Bronchiolitis in US Emergency Departments, 2007-2015.

One-fourth of patients with bronchiolitis seen in US emergency departments between 2007 and 2015 received antibiotics; 70% of them had no documented bacterial coinfection. Macrolides were prescribed in 38% of the cases. Antibiotic use did not decrease after national recommendations against routine prescribing. Efforts are needed to reduce unnecessary and inappropriate antibiotic use for bronchiolitis.

Effect of eletroacupuncture on DU-14 (Dazhui), DU-2 (Yaoshu), and Liv-13 (Zhangmen) on the survival of Wistar rats' dorsal skin flaps.

The survival of skin flaps has great interest in many areas of Medicine. In practice, one of the most important complications in the use of skin flaps is the tissue ischemia, which frequently results in widespread necrosis and failure of the proposed treatments. The objective of this study was to evaluate the possible benefits of eletroacupuncture stimulation of the points DU-14 (Dazhui), DU-2 (Yaoshu), and Liv-13 (Zhangmen) over the skin flap survival of Wistar rats after 8 days of treatment. Forty male Wistar rats were allocated into four groups with 10 animals each. They were submitted to a surgical procedure in which a dorsal skin flap measuring 10 x 4 cm was elevated and then sutured back with a plastic barrier between the flap and the donor site. During the following 8 days, one group received electro stimulation in two "nonaccupoints" whereas the other one had the accupoints DU-14 (Dazhui), DU-2 (Yaoshu), and Liv-13 (Zhangmen) stimulated. After this period, the rats were killed and flaps were appraised qualitative and quantitatively. Data were evaluated with analysis of variance and to establish significance Fisher's PLSD test was used when analysis of variance showed P < .05. It was observed that electroacupuncture group presented a skin flap survival index remarkably larger than the others. It has also shown a better evolution during the 8 days PO, confirmed by the lowest rate of necrosis and absent area. In this experimental model, eletroacupuncture was an efficient method to preserve vitality and decrease dorsal skin flap necrosis on Wistar rats.

Sympathetic and renin-angiotensin systems contribute to increased blood pressure in sucrose-fed rats.

BACKGROUND: This study evaluated the effect of chronic sucrose feeding on hemodynamic parameters and renal sympathetic nervous activity. In addition, angiotensin I, II, and 1-7 levels were determined in plasma, heart, kidney, and the epididymal adipose tissue. METHODS: Male Wistar rats were treated for 30 days with 20% sucrose solution (n = 21) or tap water (n = 19) and food ad libitum. Blood pressure, cardiac output, and total peripheral resistance were recorded at the end of the 30-day treatment period. Sympathetic and angiotensinergic systems were evaluated by acute hexamethonium and captopril administration; plasma and tissue (heart, kidney, and epididymal adipose tissue) angiotensins were measured by high-performance liquid chromatography; and angiotensin-converting enzyme activity was determined by continuous fluorescent assay. Plasma renin activity and plasma levels of insulin and leptin were evaluated by radioimmunoassay. RESULTS: Chronic sucrose feeding was associated with increased blood pressure (BP) (129 +/- 1 v 102 +/- 3 mm Hg) and circulating insulin (171%) and leptin (356%) levels when compared with the control group. The sucrose group also showed a 27% higher renal sympathetic nervous activity. The depressor response to hexamethonium was similar in both groups, whereas captopril caused a more pronounced decrease in BP in the sucrose group than in controls (-40 +/- 2 v -11 +/- 2 mm Hg), possibly reflecting the higher plasma renin activity and plasma content of angiotensin II and renal angiotensin II in sucrose rats. CONCLUSIONS: These findings suggest a specific renal renin-angiotensin-sympathetic activation as a potential mechanism for the cardiovascular changes in response to chronic sucrose feeding.