24-hour Blood Research Articles

Association Between Nondipper Behavior and Serum Calcium in Hypertensive Patients with Mild-to-Moderate Chronic Renal Dysfunction

A nondipping BP pattern has been shown to be predictive of end-organ damage, cardiovascular events, and mortality. The mechanisms of blunted nocturnal BP fall are multifactorial. We assessed whether total corrected serum calcium and ionic calcium (iCa) are associated with a blunted nocturnal BP fall in both treated and untreated hypertensive patients with stages 1–3 of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI). Clinical data and 24-hour ambulatory blood pressure monitoring were obtained in a cohort of 231 essential hypertensive patients. Among the entire cohort, 107 were nondippers and 124 were dippers. Only in nondippers, we found significant correlations between iCa and 24-hour systolic blood pressure (SBP; r = 0.21, P < .03), diurnal SBP (r = 0.21, P < .03), and 24-hour pulse pressure (PP; r = 0.23, P < .02). The ambulatory arterial stiffness index (AASI) was significantly related with 24-hour PP in both dippers and nondippers after adjusting for age. Both AASI and 24-hour PP were higher in nondippers than in dippers. In addition, in nondippers, the prevalence of estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73 m2 was higher than in dippers (50% vs. 33.7%, P < .02). Logistic regression showed that patients with eGFR ≥60 mL/minute/1.73 m2 had lower risk of nondipper status than patients with eGFR <60 mL/minute/1.73 m2 (odds ratio = 2.445; 95% confidence interval = 1.398–4.277, P < .002). In conclusion, serum iCa could participate in the pathogenesis of nondipping pattern. Increased large artery stiffness may be a mechanism of the deleterious influence of nondipping on cardiovascular outcome. Hypertensive subjects with stage 3 of NKF KDOQI had a greater loss of circadian BP rhythm than those in stages 1 and 2.

Influences of Dry Weight Adjustment Based on Bioimpedance Analysis on Ambulatory Blood Pressure in Hemodialysis Patients

❙ABSTRACT❙ Background: Hypertension is a common problem for hemodialysis patients and is associated with an increased cardiovascular mortality. We analyzed ambulatory blood pressure (ABP) in hemodialysis patients and investigated if an adjustment of dry weight can be used to control blood pressure. Methods: ABP was measured for twenty-four hours after hemodialysis. A bioimpedance Analysis (BIA) was conducted. Patients were divided into two groups by the edema index. A normohydration (NH) group included patients with the edema index less than 0.40, and an overhydration (OH) group included patients with the edema index 0.40 or more. We accordingly adjusted the dry weight based on BIA results. Results: Thirty-six patients were recruited, comprising twenty-two men and fourteen women. In regard to the ABP, 24-hour systolic and diastolic blood pressures were 140.2 ± 19.7 mm Hg and 79.0 ± 10.6 mm Hg, respectively. There was a significant association between 24-hour systolic blood pressure and the edema index (r = 0.501, p = 0.002). Twenty four-hour systolic blood pressure was significantly different between the NH and OH groups (median value, 132.0 vs. 150.5 mm Hg; p = 0.008). In OH group, after adjustment of the dry weight, the edema index was decreased from 0.411 ± 0.009 to 0.389 ± 0.047 and office systolic blood pressure was also decreased from 144.7 ± 32.7 mm Hg to 125.3 ± 15.4 mm Hg in OH group (p = 0.028 and p = 0.018, respectively). Conclusions: The edema index obtained by the bioimpedance analysis is significantly correlated with 24-hour systolic blood pressure in hemodialysis patients. Also, an adjustment of dry weight can be used to control blood pressure in hemodialysis patients. (J Korean Soc Hypertens 2012;18(4):166-175)

Ambulatory Arterial Stiffness Index Is Higher in Hypertensive Patients with Chronic Kidney Disease

Ambulatory arterial stiffness index (AASI) is a parameter obtained from ambulatory blood pressure monitoring (ABPM) that correlates with clinical endpoints. The aim of this study was to compare AASI in nondiabetic hypertensive patients with and without chronic kidney disease (CKD). Subjects with systemic arterial hypertension (SAH, n = 30) with normal renal function, aged 40 to 75 years, were compared to hypertensive patients with CKD (n = 30) presenting estimated glomerular filtration rate (eGFR) <60 mL/min by MDRD formula. ABPM was carried out in all patients. In CKD group, eGFR was 35.3 ± 2.8 ml/min. The mean 24-hour systolic and diastolic blood pressure (BP) was similar in both groups. AASI was significantly higher in CKD group (0.45 ± 0.03 versus 0.37 ± 0.02, P < 0.05), positively correlated to age (r = 0.38, P < 0.01) and pulse pressure (r = 0.43, P < 0.01) and negatively correlated to nocturnal BP fall (r = -0.28, P = 0.03). These findings indicate the presence of stiffer vessels in CKD hypertensive patients.

Effects of combination therapy with amlodipine and fosinopril administered at different times on blood pressure and circadian blood pressure pattern in patients with essential hypertension

Objective— The objective of our study was to compare the effects of a combination therapy with amlodipine and fosinopril administered concomitantly or at different times on blood pressure and circadian blood pressure pattern in subjects with essential hypertension.Methods— 40 subjects with grade 1-2 essential hypertension and uncontrolled blood pressure after amlodipine or fosinopril monotherapy were randomized to combination therapy with amlodipine and fosinopril given in the morning and at bedtime (group A), or given concomitantly in the morning (group B). Clinic blood pressure values and 24-hour ambulatory blood pressure measurements were obtained before and after 4 weeks of treatment.Results— After treatment, a reduction of 24-hour mean systolic and diastolic blood pressure was found in both groups. Subjects in group A showed a significant reduction in mean nocturnal systolic and diastolic blood pressure compared with group B (22.38/17.39 mmHg vs. 7.61/6.32 mmHg; P < 0.001). In group A a significant increase (5.68% and 4.57%, respectively; P < 0.05) was found in the diurnal/nocturnal blood pressure ratios of systolic and diastolic blood pressure and a slight reduction in the prevalence of non-dipping (< 10% decline in mean nocturnal vs. diurnal BP) from 53.85% to 30.77% (P= 0.428). Group B showed a significant reduction (5.68% and 5.76%; P < 0.01) in the diurnal/nocturnal systolic and diastolic blood pressure ratios and a slight increase in the prevalence of non-dipping from 38.46% to 53.85% (P= 0.428).Conclusion— Compared to concomitant administration of amlodipine and fosinopril in the morning, administration of the drugs at different times significantly decreased nocturnal blood pressure, increased the diurnal/nocturnal blood pressure ratio, and normalized the circadian blood pressure pattern. These findings indicate that chronotherapy may be an important strategy for optimizing blood pressure control and restoring the circadian blood pressure pattern.

Statins lower 24-hour systolic blood pressure and fibrates shift circadian blood pressure variation in the elderly

Statins lower 24-hour systolic blood pressure and fibrates shift circadian blood pressure variation in the elderly

Fixed-dose manidipine/delapril versus losartan/hydrochlorothiazide in hypertensive patients with type 2 diabetes and microalbuminuria

Patients with diabetes complicated by hypertension and microalbuminuria have elevated cardiovascular risk, and controlling blood pressure in these patients is an urgent clinical priority. The present study aimed to examine the effects of a fixed-dose combination of antihypertensives on blood pressure and microalbuminuria. Patients with type 2 diabetes, mild-to-moderate hypertension (diastolic blood pressure 85-105 mmHg, systolic blood pressure <160 mmHg, and 24-hour mean systolic blood pressure >130 mmHg), and microalbuminuria were randomized to 1 year of doubleblind treatment with fixed-dose manidipine/delapril (n=54) or losartan/hydrochlorothiazide (HCTZ) (n=56). Blood pressure was significantly reduced at 1 year in both groups (-22.2/-14.6 mmHg and -19.5/-14.3 mmHg, for systolic and diastolic blood pressure respectively, P<0.001 for each), with no significant between-group difference. Reductions in microalbuminuria occurred in both groups, with mean changes at 1 year of -3.9 mg/mmol creatinine (95% CI -5.3, -2.5) for manidipine/delapril (P<0.001 vs. baseline) and -2.7 mg/mmol creatinine (95% CI -4.0, -1.3) for losartan/HCTZ (P<0.001 vs. baseline and P=0.199 between groups). Glycemia over the 1-year study was largely unaffected; the blood glucose concentration was reduced from baseline with manidipine/delapril, although not statistically significant (mean change -0.2 mmol/L, P=0.064). Both treatments were well tolerated, with discontinuation for adverse events for one (1.9%) patient in the manidipine/delapril group and two (3.6%) in the losartan/HCTZ group. A fixed-dose manidipine/delapril combination represents a useful addition to the treatment options available to control hypertension complicated by diabetes and microalbuminuria.

Effects of Angiotensin II Receptor Blockers on Relationships Between 24-Hour Blood Pressure, Autonomic Function, and Health-Related QOL

We report the relationship between 24-hour (24-h) blood pressure, autonomic function, and health-related quality of life (HRQOL) in normotensives and hypertensives. The aim of this study was to determine whether there is a relationship between 24-h blood pressure, autonomic function, and HRQOL during treatment with an angiotensin receptor blocker (ARB) in patients with hypertension. Thirteen patients with hypertension were randomly treated with losartan (25–50 mg, n = 5), candesartan (4–8 mg, n = 4), valsartan (80 mg, n = 1), telmisartan (40 mg, n = 2), and olmesartan (10 mg, n = 1), daily. 24-h ambulatory blood pressure (BP) was measured before treatment and 3 months after treatment. Sympathetic nervous activity (the ratio of low frequency to high frequency component (LF/HF)) and parasympathetic nervous activity (high frequency component (HF)) were calculated by analyzing heart rate variability. HRQOL was assessed using a medical outcome study short-form 36-item health survey (SF-36) questionnaire. All of the participants completed the study. Angiotensin receptor blocker treatment reduced 24-h mean BP (MBP) from 107 ± 9 to 100 ± 9 mmHg. 24-h MBP positively correlated with 24-h LF/HF in all subjects who received ARB (R = 0.568, p < 0.04). There were no differences in heart rate, serum albumin level, BUN level, creatinine level, potassium level, or HRQOL score. These findings indicated that ARB reduced BP; however, treatment with ARB did not affect the scores of HRQOL and the relationship between 24-h blood pressure and autonomic function.

233: Do the second trimester ambulatory 24-hour, awake and sleep blood pressure measurements correlate with infant birth weight in women at risk for hypertension in pregnancy?

233: Do the second trimester ambulatory 24-hour, awake and sleep blood pressure measurements correlate with infant birth weight in women at risk for hypertension in pregnancy?

Daily Rhythm of Arterial Pressure in Patients with Autoimmune Thyroidite in a Phase Subclinical Hypothyroidism

The purpose of research was studying of a condition circadian rhythms and parameters of a daily structure according to 24-hour monitoring blood pressure at sick with the verified diagnosis of autoimmune thyroidite in a phase of subclinical hypothyroidism. 23 patients (22 women and 1 man) in the age of from 18 till 58 years are surveyed. The control group was made by practically healthy 25 persons without pathology of a thyroid gland and normal values of blood pressure of similar age. It is revealed, that at patients with autoimmune thyroidite in a phase of subclinical hypothyroidism higher levels of systolic blood pressure and diastolic blood pressure in day time and night hours, also infringement circadian a rhythm of systolic blood pressure “non-dipper” at 39,2% of patients are defined. It is received, that according to 24-hour monitoring blood pressure these patients have features of dynamics of the diastolic blood pressure, described increase of diastolic blood pressure in the afternoon and excessive decrease at night in 30,4% of cases.

Kidney and Circadian Blood Pressure Rhythm

Association between nondipper pattern of circadian rhythm of blood pressure (BP) and impaired renal capacity to excrete sodium into urine was confirmed by Bankir et al1 in this issue of Hypertension based on a large number of subjects. Although this association has been observed in small studies,2,3 their study1 is the first to show it in a large-scale setting, and, therefore, is highly welcomed. Because there is a tight link between kidney and hypertension, renal dysfunction causes hypertension, whereas hypertension accelerates renal damage. It is well appreciated that the kidneys play an important role in the long-term regulation of BP. Usually it takes almost 1 week for kidneys to achieve a new steady-state balance of sodium, when sodium intake is altered. Therefore, renal participation in the short-term BP regulation, such as circadian rhythm, has been overlooked. However, the findings of Bankir et al1 strongly suggest that nocturnal hypertension and nondipper pattern of circadian BP rhythm are because of impaired renal capacity to excrete sodium, and circadian BP rhythm is at least in part regulated by kidneys. Sodium sensitivity of BP is also determined by renal capacity to excrete sodium and is regulated by glomerulotubular balance between glomerular ultrafiltration capability and rate of tubular sodium reabsorption.4 Thus, sodium sensitivity is increased in chronic kidney disease (CKD) where glomerular filtration rate (GFR) is reduced and also in disorders with enhanced tubular sodium reabsorption, including primary aldosteronism, diabetes mellitus, and metabolic syndrome, where GFR is augmented. When sodium sensitivity is increased, glomerular capillary pressure is usually elevated, resulting in albuminuria and renal damage. It becomes evident that, in patients with high-sodium sensitivity, the nocturnal dip in …

Ambulatory Blood Pressure and Endothelial Dysfunction in Patients with Autosomal Dominant Polycystic Kidney Disease

Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Endothelial dysfunction (ED), which is an early manifestation of vascular injury, has been shown in patients with ADPKD. However, the association between ambulatory blood pressure and ED has not been investigated in these patients. Forty-one patients with ADPKD having well-preserved renal function were included in the study. Ambulatory blood pressure monitoring was performed in all patients. Patients were divided into dipper and non-dipper groups. Endothelial function of the brachial artery was evaluated by using high-resolution vascular ultrasound. Endothelial-dependent dilatation was expressed as the percentage change in the brachial artery diameter from baseline to reactive hyperemia. The mean 24-hour systolic blood pressure was similar in both groups (125.5 ± 10.7 mmHg in dippers and 121.2 ± 14.3 in non-dippers, p > 0.05). There was also no significant difference between the mean 24-hour diastolic blood pressures in both groups (82.3 ± 9.6 mmHg in dippers and 77.1 ± 8.6 mmHg in non-dippers, p > 0.05). The nocturnal fall rate in systolic blood pressure was 11.1 ± 1.2% in dippers and 0.98 ± 0.9% in non-dippers (p = 0.001). The nocturnal fall rate in diastolic blood pressure was 14.0 ± 0.9% in dippers and 3.8 ± 0.8% in non-dippers (p = 0.001). Endothelial-dependent dilatation was significantly higher in dippers compared to non-dippers (6.22 ± 4.14% versus 3.57 ± 2.52%, p = 0.025). Non-dipper patients with ADPKD show significant ED, which has an important impact on cardiovascular morbidity and mortality.

Monitoring Maternity Mortality in Botswana

This paper describes the maternity monitoring system in Botswana, developed in 1998, and the main methods used: maternal death and morbidity reviews at service delivery level, analysis by the National Maternal Mortality Audit Committee of data from the reviews as reported on two forms, perinatal reviews and surveys using process indicators. We carried out a study of these findings to examine whether the system was working well. Surveys using process indicators in 2001 and 2006 were analysed. Other data examined were from 2004–2006 and early 2007. The Maternal Death Notification Form was found to be comprehensive but not all health facilities were submitting them and some gave incomplete information. In 2001, 70% of pregnant women attended antenatal care but access to emergency obstetric care was uneven. In 2006, 28 facilities with maternity services surveyed were providing 24-hour delivery care, but laboratory, theatre and blood supplies were more limited, and only 50% of doctors and 67% of midwives had life-saving skills. Antibiotics were widely available, but there were shortages of magnesium sulphate, diazepam, oxytocics and manual vacuum aspiration kits. Recommendations for improvements have been made, training for skilled attendants is ongoing and a medical school has just opened at the University of Botswana.RésuméLe Botswana a instauré un système de surveillance de la maternité en 1998. Il utilise les analyses de la mortalité et de la morbidité maternelles au niveau de la prestation des services, l’étude par le Comité national de contrôle de la mortalité maternelle des données des analyses, telles que notifiées dans deux formulaires, les enquêtes périnatales à l’aide d’indicateurs de processus. On a étudié ces conclusions pour déterminer si le système fonctionne bien et on a analysé des enquêtes utilisant les indicateurs de processus en 2001 et 2006. D’autres données dataient de 2004–2006 et début 2007. Le formulaire de notification des décès maternels est complet, mais n’est pas envoyé par tous les centres de santé et donne parfois des informations fragmentaires. En 2001, 70% des femmes enceintes bénéficiaient de soins prénatals, mais l’accès aux soins obstétricaux d’urgence était inégal. En 2006, 28 maternités visées par l’enquête assuraient des accouchements 24 heures sur 24, mais l’accès aux laboratoires, aux salles d’opération et aux produits sanguins était plus limité, et seulement 50% des médecins et 67% des sages-femmes possédaient des compétences capables de sauver la vie. Les antibiotiques étaient largement disponibles, mais des pénuries de sulfate de magnésium, de diazépam, d’ocytociques et de trousses d’aspiration manuelle se produisaient. Des recommandations ont été formulées pour améliorer les services, la formation des agents qualifiés est en cours et une école de médecine vient d’ouvrir à l’Université du Botswana.ResumenEn este artículo se describe el sistema de monitoreo de maternidad en Botsuana, creado en 1998, y los principales métodos utilizados: revisiones de morbimortalidad materna en los puntos de entrega de servicios, análisis por el Comité Nacional de Auditoría de Mortalidad Materna de los datos de las revisiones, conforme informados en dos formularios, revisiones y encuestas perinatales utilizando indicadores de proceso. Realizamos un estudio de estos hallazgos para examinar si el sistema funcionaba bien. Se analizaron las encuestas utilizando los indicadores de proceso en 2001 y 2006. Otros datos examinados fueron de 2004–2006 y principios de 2007. Se encontró que el Formulario de Notificación de Muerte Materna era completo, pero no todos los establecimientos de salud lo estaban llenando y algunos daban información incompleta. En 2001, el 70% de las mujeres embarazadas recibieron atención antenatal, pero no todas tenían acceso a los cuidados obstétricos de emergencia. En 2006, se estaba brindando atención a partos las 24 horas, en 28 establecimientos con servicios de maternidad encuestados, pero los suministros de laboratorio, quirófano y sangre estaban más limitados y sólo el 50% de los médicos y el 67% de las parteras contaban con habilidades para salvar vidas. Los antibióticos se conseguían con facilidad, pero había escasez de sulfato de magnesio, diazepán, oxitócicos e instrumental de aspiración manual endouterina. Se han hecho recomendaciones para mejoramientos, se continúa capacitando a parteras calificadas y se acaba de inaugurar la Facultad de Medicina de la Universidad de Botsuana.

A Pharmacokinetic & Pharmacodynamic Study of Oral Lenalidomide in Patients with Low- or Intermediate-1-Risk Myelodysplastic Syndromes.

Twelve patients diagnosed with low- or intermediate-1-risk myelodysplastic syndromes (MDS) were administered a single, 10 mg dose of lenalidomide followed by 24-hour blood and urine sampling on one occasion, and again at Day 14 of multiple dosing, followed by 5-hours of blood and urine sampling. Patients then continued into a combined treatment phase in which recombinant EPO was administered with lenalidomide. Table 1 describes the pharmacokinetic profiles of lenalidomide found for the first 12 MDS patients.Following the single oral 10 mg dose, lenalidomide had an average renal clearance of 7.48 ± 1.74 L/hr. Greater than half of the dose (65.6% ± 6.9%) was excreted unchanged in the urine over 24 hours.Conclusions: Among these MDS patients, the single and multiple dose pharmacokinetics of lenalidomide were similar, suggesting no accumulation of lenalidomide with multiple dosing. After 24 hours, 65.6% of the dose is eliminated in the urine as the parent compound. No relationship was apparent between the total number of adverse events normalized per day or Grade's 3+4 adverse events and the drug exposure.Table 1Pharmacokinetics (Mean ± SD) in MDS Patients After a Single and Multiple 10 mg Oral Dose of LenalidomideParameterSingle DoseMultiple DoseCmax1188 ± 59.5168 ± 55.4AUCt852.3 ± 272NAAUCss,0–5NA553.1 ± 205.6T½,z3.72 ± 0.75NAtmax1,21.00 (0.5, 2.00)0.75 (0.75, 2.50)1Cmax and tmax are presented on Day 142median (min, max); NA = Not Applicable

Adolescent Obesity: Some Bad News, and Maybe Some Good News

Investigators in Greece compared ambulatory blood pressure and carotid artery intimal-medial thickness (IMT, an early marker of atherosclerosis in adults) in 93 consecutive adolescents (age range, 11–18) who were referred for possible hypertension; 22 were obese (body-mass index, >95%), and 71 were not. Obese adolescents had significantly higher mean 24-hour systolic blood pressure than nonobese adolescents (129 vs. 118 mm Hg). Ultimately, 64% of obese vs. 23% of nonobese adolescents had confirmed hypertension. Mean IMT was significantly higher in obese adolescents (0.53 vs. 0.36 mm). IMT did not correlate …

Association of betaxolol therapy with the clinical and functional parameters in patients with essential hypertension

The association of clinical and functional parameters was studied in patients with mild and moderate arterial hypertension (All) during therapy with betaxolol (Lokren), Twenty six patients (19 males and 7 females) aged 28 to 56 (mean 40.5 ± 1.4) years who had grade 1-2 AH were examined. The patients received monotherapy with betaxolol in a single dose of 10 mg/day. 24-hour ECG and blood pressure monitoring, stress-echocardiography during the arithmetic test estimating cognitive functions and life quality by the SP-36 scale were performed at the baseline and following 8 weeks of therapy. It has been found that betaxolol (Lokren) used In a single dose of 10 mg/day for 8 weeks has a high antihypertensive efficacy, stabilizes the autonomic balance of cardiac rhythm regulation, by simultaneously showing antiarrhythmic properties, reduces the degree of stress responsiveness, and enhances the inhibition of the central nervous system, by ultimately improving the quality of life in the patients.

Potential Substitution of Cord Blood for Infant Blood in the Neonatal Sepsis Evaluation

Background: Evaluation of sepsis accounts for one third of all nursery triage admissions. If umbilical cord blood could be accurately substituted for infant blood, it would spare infants the discomfort of an invasive procedure and save both time and resources. While awaiting 48-hour blood culture results, we decide on clinical management based on whether the white blood cell (WBC) immature to total (I:T) granulocyte ratio is ≧0.2. Objectives: Our goal was to assess the correlation of complete blood count (CBC), I:T ratio and blood culture results between umbilical cord and infant blood. Methods: We conducted a prospective cohort study comparing CBC/differential and blood culture results of paired samples of umbilical cord and infant blood from term newborns. Results: We sent 113 paired samples of cord and infant venous blood for CBC/differential and blood culture. All 113 umbilical cord and infant blood cultures were negative, yielding a false-positive blood culture rate of zero. For 92% of babies, both the cord and infant blood I:T ratio were <0.2 or both were ≧0.2. Cord and infant WBC, hematocrit and platelet counts were moderately to highly correlated. Conclusion: We conclude that cord blood can be safely substituted for infant blood in routine sepsis evaluations of asymptomatic, term infants based on both the low false-positive cord blood culture rate and the significant association between high I:T ratios in cord and infant blood.

W03-P-013 Peak level of 24-hour mean blood pressure and endothelial dysfunction

W03-P-013 Peak level of 24-hour mean blood pressure and endothelial dysfunction

The Correlation Between Renal Function and Systolic or Diastolic Blood Pressure in Severe Preeclamptic Women

Objective. To evaluate the correlation between renal function and systolic or diastolic blood pressure in preeclamptic mothers. Methods. In this prospective study from August 1998 to September 2002, 28 women ≥ 28 weeks gestation with severe preeclampsia were selected. Meanwhile, 56 normotensive pregnant women without proteinuria or edema served as the control group. Urine was collected for 24 hours for all subjects. The concentration of uric acid, blood urea nitrogen, creatinine, sodium, calcium, and albumin in the 24-hour urine and blood of both groups were examined. Neonatal outcome also was evaluated. Results. The serum and 24-hour urine concentration of blood urea nitrogen, creatinine, and albumin were significantly higher in severe preeclamptic women. Serum uric acid and urinary albumin/creatinine ratio was significantly higher in severe preeclamptic women compared with that in normotensive mothers and showed positive correlation with systolic or diastolic blood pressure. On the other hand, serum calcium/creatinine ratio was significantly lower in the severe preeclamptic group and negatively correlated to blood pressure. In multiple regressions, systolic or diastolic blood pressure was dependent on serum uric acid, albumin/creatinine, and calcium/creatinine ratios. Fetal birth weight was significantly lower in women with severe preeclampsia and with a lower Apgar score < 7 at 1 minute and 5 minutes and more preterm delivery compared with that in normotensive women. Conclusion. Renal function in women with severe preeclampsia was significantly impaired and highly correlated with systolic or diastolic blood pressure.

The changes in blood sugar and CRP in infantile pneumonia associated with SIRS

目的 探讨血糖、C反应蛋白(CRP)在肺炎并全身炎症反应综合征(SIRS)患儿中的改变及其意义.方法选择62例肺炎并SIRS患儿,动态测定血糖及CRP,同时选择非SIRS的肺炎患儿和正常儿童作对照.结果非SIRS组血糖与正常对照组比较差异无显著意义(P＞0.05),而CRP显著高于正常对照组(P＜0.01);SIRS组血糖和CRP均显著高于非SIRS组(P＜0.01);具有SIRS诊断标准3项以上的患儿48 h血糖和第5 d CRP持续不降,发生多器官功能不全综合征(MODS)率明显增高(P＜0.01).结论肺炎时血糖和CRP联合检测有助于准确评估病情的危重度,血糖和CRP持续性升高,预示着MODS的可能发生。

Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax in Emphysematous Patients

Objectives. Video-assisted thoracoscopic surgery (VATS) is a useful modality for the management of spontaneous pneumothorax (SP). We report our experience using VATS for SP in emphysematous patients with regards to efficacy, morbidity, and mortality. Methods. We retrospectively studied 25emphysematous patients with SP who were treated primarily by VATS. This series included 23 male and 2 female patients with a median age of 75 years (range, 62 to 86 years). All 25patients presented with persistent pneumothorax (air leakage for more than 4 days), and 15(60%) of them had recurrent ipsilateral pneumothorax (first ipsilateral recurrence in 13, and second in 2). The mean preoperative chest drainage was 8 days (range, 4 to 14 days). Preoperatively, ventilator support was mandatory for three patients with respiratory failure. A limited thoracotomy was necessary for three patients because of. massive adhesion, and for one patient because of persistent postoperative air leak. Routine bullectomy with staple cartridges and strip reinforcement of suture line, subsequent mechenical pleurodesis with scouring pads, and talc powder instillation were performed for all 25 patients. Results. One patient died of pneumonia two months after operation. Postoperative complications with prolonged air leak (＞ 7 days) occurred in 3 patients. At a mean follow-up of 12 months (range, 6 to 43 months), no pneumothorax had recurred in 23 patients. In comparison with our experience using this technique to treat primary SP in 72 patients, there was no significant difference in the operating time, number of staples used, 24-hour postoperative blood loss, or 24-hour postoperative morphine dosages; however, the duration of both preoperative and postoperative chest drainage was longer, and there were more primary treatment failures with prolonged air leak (＞ 7 days). Conclusions. As a minimally invasive method, VATS is an adequate initial treatment procedure for emphysematous patients with SP.