[Cephalic artery peak velocity variation during passive leg raising can predict fluid responsiveness in mechanically ventilated severe sepsis patients with spontaneous breathing].

Objective: To explore whether cephalic artery peak velocity variation during passive leg raising (ΔVpeak(CA)-PLR) could effectively predict fluid responsiveness in mechanically ventilated severe sepsis patients with spontaneous breathing. Methods: Total of 38 patients on mechanical ventilation with spontaneous breathing admitted to the Fourth Departments of Intensive Care Unit (ICU) of Fujian Provincial Hospital from January to December in 2017 were enrolled.The patients were diagnosed with severe sepsis or sepsis shock.The peak velocity in cephalic artery (Vpeak(CA)) during PLR was measured by bedside portable ultrasonic, and then ΔVpeak(CA)-PLR was calculated.All patients received volume expansion (VE) test and the changes of stroke volume during VE test (ΔSV-VE) were measured.Patients were classified as responsive group or non-responsive group according to the ΔSV-VE increased ≥15% or not after VE test.Furthermore, the sensitivity and specificity of ΔVpeak(CA)-PLR for predicting fluid responsiveness were evaluated by receiver operating characteristic (ROC) curve.The comparisons between groups were performed with Student's unpaired two-tailed t test, and Pearson's test was used for the correlation analysis. Results: Among the patients, 22 cases responded to VE test and the rest 16 cases did not.There were no significantly differences in age, gender, body mass index, infection site, sepsis-related organ failure assessment score, acute physiology and chronic health evaluation Ⅱ score, ventilator parameters and dose of vasoactive agent between the two groups.The ΔVpeak(CA)-PLR in responsive group was markedly higher than that in non-responsive group (15.7%±4.2% vs 6.9%±4.3%, t=6.240, P<0.05), and the ΔVpeak(CA)-PLR in the responsive group was positively related to the ΔSV-VE (r=0.723, P<0.05). Furthermore, the area of ΔVpeak(CA)-PLR under ROC curve was 0.912.The sensitivity and specificity of ΔVpeak(CA)-PLR≥12.2% to predict fluid responsiveness in the patients with sepsis were 81.8% and 87.5%, respectively. Conclusion: ΔVpeak(CA)-PLR measured by bedside portable ultrasonic can predict the fluid responsiveness in mechanically ventilated severe sepsis patients with spontaneous breathing, and it can be used to guide further fluid resuscitation.

The prevalence of Parkinson's disease in British Columbia, Canada, estimated by using drug tracer methodology.

OBJECTIVE: To estimate the prevalence of Parkinson's disease (PD) in British Columbia utilizing the prescription database of the College of Pharmacists. METHODS: Patients receiving anti-parkinsonian drug (anti-PD) prescriptions between 1996 and 1998 were stratified by year, age, gender, drug use category, and geographic location. The numbers of patients on levodopa alone, or levodopa and/or other anti-PD drugs were adjusted using published data which gave estimates of the proportion of undiagnosed patients with PD, the proportion of those treated for parkinsonism with definite PD, the proportion of patients with PD not being treated with anti-PD medications, and the proportion of patients treated with anti-PD medications who have PD. Use of the anti-PD drug bromocriptine for other purposes in women under 50 years of age was also considered. RESULTS: The estimated prevalences of PD based on all anti-PD medications used were 109, 121, and 125 per 100,000 population in 1996, 1997, and 1998, respectively. Estimated prevalences of PD based on levodopa use were 126, 134, and 144, respectively. The prevalence in both prescription groups increased with age. The male to female ratio of prevalence ranged from 1.16 to 1.21. CONCLUSIONS: Using a large, accurate database, it is possible to estimate the prevalence of PD in a large population, though the assumptions built into the estimate remain to be validated in the subject population.

Occupational and environmental risk factors for Parkinson's disease.

The etiology of Parkinson's disease (PD) remains obscure. Current research suggests that a variety of occupational and environmental risk factors may be linked to PD. This paper provides an overview of major occupational and environmental factors that have been associated with the development of PD and tries to assess current thinking about these factors and their possible mechanisms of operation. While clear links to rural living, dietary factors, exposure to metals, head injury, and exposure to infectious diseases during childhood have not been established, there is general agreement that smoking and exposure to pesticides affect the probability of developing PD.

Molecular characterizations of an intraacrosomal antigen defined by HS-33 monoclonal antibody.

Among the numerous anti-sperm monoclonal antibodies generated in our laboratory, HS-33 was shown to react with a conserved antigen on the acrosome of spermatozoa from human and mouse. By using indirect immunofluorescent assay, it was demonstrated that HS-33 did not bind to live human sperm. However, this antibody was found to react with the methanol-fixed acrosome-intact, but not with acrosome-reacted sperm. The human sperm antigen recognized by this antibody was purified from human sperm extract by immunoaffinity chromatography. The purified cognate human sperm antigen designated as HSAg-33 was found to be a protein with a molecular weight of approximately 72 kDa on sodium dodecyl sulfate polyacrylamide gel electrophoresis under reducing conditions. The tissue-specificity and the developmental expression of this sperm antigen were examined using frozen sections of various human and mouse tissues. The antigen was shown to be expressed specifically in the testicular sperm at the postmeiotic stages of spermatogenesis but not in any other somatic tissues. "Spontaneous" acrosome reaction was determined following 18 hours of incubation in Biggers, Whitten, and Whittingham (BWW) medium by using HS-33 monoclonal antibody and Pisum sativum agglutinin (PSA) as probes. The number of sperm stained positively with this antibody decreased significantly following overnight incubation, indicating the occurrence of an acrosome reaction. The results of this study suggest that HSAg-33 is a potentially useful sperm-specific acrosome marker for studies of sperm capacitation and acrosome reaction.

Continuous arteriovenous hemoperfusion in meprobamate poisoning.

A patient with severe meprobamate poisoning presented within 4 h after suicidal ingestion of an unknown amount of the drug. The patient was unconscious, unresponsive, and hypotensive. Continuous arteriovenous hemoperfusion with coated activated charcoal resulted in a clearance of 198.8 +/- 15.6 mL/min with an extraction ratio of 0.66 +/- 0.05 (n = 3). There was almost complete elimination of the drug from the blood by 16 h. Continuous arteriovenous hemoperfusion, which can be performed in areas where dialysis facilities are not available, may be an effective adjunct to the treatment of acute meprobamate intoxication, particularly in patients with profound hypotension.