静脉药物配置中心在防范用药失误中的作用

目的 探讨静脉药物配置中心（PIVAS）在防范用药失误中的作用。方法 医院成立质控小组，对PIVAS记录在案的用药失误进行记录、总结和分类。结果 PIVAS自成立以来，接受科室所提交的处方983876份，涉及用药失误的处方2096份，其中医师处方错误1617份；处方信息传递错误9份；PIVAS内部调配错误470份。提出用药安全问题反映医院管理水平，用药失误的防范，需要医生、护士、药师三方面共同配合。需对各阶段的错误进行分析，对错误频率高发过程加以管理和控制。结论 建立规范的操作规程．加强医护人员岗位培训，制定严格的考核、报告、奖惩制度是确保用药安全的关键。     

Sigmoid resection for diverticulitis is more difficult than for malignancies

Purpose

Sigmoid resection for diverticulitis is usually the first procedure performed when starting the learning process for laparoscopic colorectal surgery. The aim of this study is to evaluate the difficulty of laparoscopic sigmoid resection for diverticulitis in comparison to sigmoid malignancy in order to assess its role in the residents training program.

Methods

A cohort of patients was selected who suffered either from malignancy or recurrent diverticulitis in the sigmoid colon. Laparoscopic sigmoid resection was performed. The degree of difficulty was assessed by intraoperative complications and intraoperative technical challenges. Furthermore, take-overs from assistant to surgeon, surgeon to surgeon, and conversion were reported.

Results

A total of 224 patients were included, 119 (53.1%) men and 105 (46.9%) women.Patients suffering from diverticulitis had significantly less co-morbidities than those with malignancies. In the diverticulitis group, there were significantly more technical challenges. There was a higher rate in take-overs from residents (p = 0.02) as well as surgeon to surgeon (p = 0.04). The rate of conversions was also significantly higher in the diverticulitis group (p = 0.03) when compared to the malignancy group.

Conclusions

The outcomes of our study show that diverticulitis may not be the ideal condition to start the learning process for laparoscopic colorectal surgery.

     

Polypharmacy in the Geriatric Oncology Population

Purpose of Review

This review explores the multiple definitions, epidemiology, and impact of polypharmacy in geriatric oncology patients. Risk factors and clinical implications of polypharmacy are delineated and potential clinical approaches to reduce polypharmacy are reviewed.

Recent Findings

Most sources currently define polypharmacy as the administration of multiple medications that are non-essential, unnecessary, duplicative, or ineffective. Possible risk factors associated with polypharmacy in geriatric cancer patients include comorbid conditions, prescribing cascades, and hospitalization. Consequences of polypharmacy in this population include adverse drug events, drug-drug interactions, reduced adherence, frailty, and increased morbidity. Clinical approaches to the reduction of polypharmacy include thorough medication histories and an interprofessional team approach to care.

Summary

Polypharmacy is common and has a direct clinical impact on geriatric oncology patients.There is a clear deficit in our understanding of the scope and impact of polypharmacy in this population and only limited evaluation of various interventions exist. The paucity of information is at least partially linked to the consistent exclusion of older adults in cancer studies and the complex interaction between polypharmacy and potential morbidities/mortality.

     

中耳胆脂瘤和慢性化脓性中耳炎手术临床分析

目的　探讨中耳胆脂瘤和慢性化脓性中耳炎术式选择及临床效果。方法　对110例中耳乳突病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据范围显微镜下实施完壁式或开放式乳突根治,部分同时鼓室成形术,随访术后干耳状况、并发症、复发情况以及术后听力改善程度等。结果　110例患者中66例中耳胆脂瘤、44例慢性化脓性中耳炎,出现颅内外并发症者7例。手术方式：51例（46.36%）行完壁式乳突根治术,46例（41.81%）同时行鼓室成形术,59例（53.64%）行开放式乳突根治术。完壁式乳突根治术后听 力提高＞25 dB 37例（33.64%）,＞15 dB 14例（12.72%）;开放式乳突根治术后听力提高＞15 dB 5例（4.55%）,听力减退4例（3.64%）,比较手术前后言语频率区平均听阈,差异有统计学意义（P＜0.05）。术后随访1年发现开放式和完壁式两组胆脂瘤复发共4例。结论　中耳胆脂瘤与慢性化脓性中耳炎通过选择恰当手术方式可获得较好的临床疗效。     

mTOR抑制剂雷帕霉素对早期肝硬化门静脉高压症大鼠的治疗作用

目的:研究雷帕霉素阻断mTOR信号通路在早期肝硬化门静脉高压症中的治疗作用,并探讨其可能机制。方法:雄性SD大鼠30只,随机分为假手术组、模型组和模型干预组。采用胆道结扎离断3周制备早期肝硬化门静脉高压症模型,模型干预组于术后1周给予雷帕霉素[2 mg/(kg·d)]腹腔注射2周。通过组织病理学、形态学和血流动力学评估肝纤维化和门静脉压力。应用RT-PCR测定肝纤维化基因PC-α_1、α-SMA、TGFβ_1和PDGF的转录,采用Western印迹法测定mTOR信号通路标志物P70S6K和磷酸化P70S6K(p-P70S6K)的表达。结果:模型组大鼠肝内胆管细胞和α-rSMA阳性细胞活化增殖显著,肝脾明显增大,门静脉压力也显著增高;肝脏促纤维化基因明显上调,prP70S6K蛋白表达量明显增高;而雷帕霉素通过阻断mTOR信号通路显著改善了肝功能、肝纤维化、门静脉压力及脾肿大。结论:mTOR信号通路是早期肝硬化门静脉高压症形成的重要调控机制,阻断该通路可能成为早期肝硬化门静脉高压症治疗的新靶点。     

Durable responses with the metronomic rituximab and thalidomide plus prednisone,etoposide, procarbazine,and cyclophosphamide regimen in elderly patients with recurrent mantle cell lymphoma

BACKGROUND:

Targeting the tumor microenvironment and angiogenesis is a novel lymphoma therapeutic strategy. The authors report safety, activity, and angiogenic profiling results with the rituximab and thalidomide plus prednisone, etoposide, procarbazine, and cyclophosphamide (RT‐PEPC) regimen in patients with recurrent mantle cell lymphoma (MCL).

METHODS:

RT‐PEPC included induction (Months 1‐3) of rituximab 4 times weekly, daily thalidomide (50 mg), and PEPC followed by maintenance thalidomide (100 mg), oral PEPC titrated to the neutrophil count, and rituximab every 4 months. Endpoints included safety, efficacy, quality of life (QoL), and translational studies, including tumor angiogenic phenotyping, plasma vascular endothelial growth factor (VEGF), and circulating endothelial cells.

RESULTS:

Twenty‐five patients were enrolled, and 22 were evaluable. The median age was 68 years (range, 52‐81 years), 24 patients (96%) had stage III or IV disease, 18 patients (72%) had an International Prognostic Index (IPI) score of 3 to 5, and 20 patients (80%) had high‐risk Mantle Cell International Prognostic Index (MIPI) scores. Patients had received a median of 2 previous therapies (range, 1‐7 previous therapies), and 15 patients (60%) had progressed on bortezomib. At a median follow‐up of 38 months, the overall response rate was 73% (complete response [CR]/unconfirmed CR rate, 32%; partial response [PR] rate, 41%; n = 22 patients), and the median progression‐free survival was 10 months. Four CRs were ongoing (≥6 months, ≥31 months, ≥48 months, and ≥50 months). Toxicities included grade 1 and 2 fatigue, rash, neuropathy, and cytopenias, including grade 1 and 2 thrombocytopenia (64%) and grade 3 and 4 neutropenia (64%). Two thromboses and 5 episodes of grade 3 or 4 infections occurred. QoL was maintained or improved. Correlative studies demonstrated tumor autocrine angiogenic loop (expression of VEGF A and VEGF receptor 1) and heightened angiogenesis and lymphangiogenesis in stroma. Plasma VEGF levels and circulating endothelial cells trended down with treatment.

CONCLUSIONS:

RT‐PEPC had significant and durable activity in MCL with manageable toxicity and maintained QoL. Novel, low‐intensity approaches warrant further evaluation, potentially as initial therapy in elderly patients. Cancer 2010. © 2010 American Cancer Society.     

Pentacam 系统角膜后表面参数在临床前期圆锥角膜筛查中的作用

目的 探讨Pentacam测量所得的们膜后表面参数对于筛查临床前期圆锥角膜的作用.设计前瞻性病例对照研究.研究对象正常对照组45例73眼,临床期圆锥角膜组14例20眼,临床前期圆锥角膜组43例58眼.方法 经TOPOLYZER角膜地形图仪和裂隙灯显微镜检查确诊的临床前期、临床期圆锥角膜组,用Pentacam测量获得角膜后表面参数水平,分别与正常对照组所得的相应参数进行对比.主要指标角膜后表面的高度最大值、高度最小值、高度差、最小矢状曲率、角膜中央3 mm平均散光度.结果 正常对照组和临床期、临床前期圆锥角膜组间有统计学显著性差异的角膜后表面参数为:角膜后表面的高度最大值(P均<0.001)、高度最小值(P均<0.001)、高度差(P均<0.001)、最小欠状曲率(P<0.001、P=0.014)、角膜中央3mm平均散光度(P<0.001、P=0.008),它们均与圆锥角膜的发展相关,并依照ROC曲线,计算出角膜后表面高度最大值、高度差、角膜中央3mm平均散光度在区分正常角膜和临床期、临床前期圆锥角膜时的切点、敏感度及特异度.结论 Pentacam测量的角膜后表面参数可以有效地筛查临床前期圆锥角膜及确诊临床期圆锥角膜.     

Annexin II: a mediator of the plasmin/plasminogen activator system

The annexins constitute a family of calcium-dependent membrane binding proteins. Recently, annexin II has been shown to accelerate the activation of the clot-dissolving protease plasmin by complexing with the plasmin precursor plasminogen and with tissue plasminogen activator. Binding of plasminogen to annexin II is inhibited by the atherogenic lipoprotein, lipoprotein(a), while binding of tissue plasminogen activator to annexin II is blocked by the thiol amino acid homocysteine. Formation of the plasminogen/tissue plasminogen activator/annexin II complex may represent a key regulatory mechanism in fibrinolytic surveillance.