奥美拉唑雷尼替丁预防颅脑损伤术后应激性胃出血比较

目的：探讨奥美拉唑,雷尼替丁预防颅脑损伤手术后应激性胃出血的效果。方法;将中,重型颅脑损伤（GCS12－4分）的手术后患者随机分为3组,各30例,奥美拉唑组,雷尼替丁组在对照组用药的基础上分别静脉滴注奥美拉唑40mg,qd,和雷尼替丁150mg,bid,观察临床出血程度,结果：奥美拉唑组,雷尼替丁组的预防效果分别为96．7％,93．3％,与对照组（76．7％）比较差异有统计学意义（P＜0．05）,在使用额外剂量后,奥美拉唑组的5例出血均停止,雷尼替丁组7例出血中仍有4例不能止血,结论：奥美拉唑,雷尼替丁均有预防颅脑损伤手术后应激性胃出血的作用,且预防效果几乎相等,但奥美拉唑较雷尼替丁的止血作用强。     

The effects of oral steroid duration on stricture prevention after extensive endoscopic submucosal dissection for superficial esophageal cancer

BackgroundEsophageal stricture is a major complication of endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer (SEC). Oral steroids have been used to prevent esophageal stricture in patients with more than 75% of the esophageal circumference resected. However, there are no established guidelines regarding the optimal duration of steroid use. This retrospective observational study aimed to compare the incidence of esophageal stricture according to the period of prophylactic oral steroid use and to identify the risk factors for esophageal stricture.MethodsEighty-one patients who were prescribed prophylactic steroid after undergoing ESD for SEC with more than 75% of esophageal circumference resected were enrolled. Patients were classified into the four-week steroid group (n=72) or eight-week steroid group (n=9) to compare the incidence of esophageal stricture. In addition, the patients were subdivided into those who developed esophageal stricture (n=24) and those who did not (n=57) to identify the risk factors for esophageal stricture.ResultsTwenty patients (27.8%) in the four-week oral steroid group and four patients (44.4%) in the eight-week oral steroid group developed esophageal stricture (P=0.44). The univariable analysis identified tumor size, longitudinal length of semi-circumferential resection, and proportion of circumferential resection as risk factors of esophageal stricture. The multivariable analysis identified the proportion of circumferential resection as an independent risk factor. After adjusting for the proportion of circumferential resection, the incidence of stricture was marginally higher in the eight-week steroid group [P=0.05; odds ratio (OR): 5.69; 95% confidence interval (CI): 1.01–32.15].ConclusionsEight weeks of oral steroid prophylaxis does not reduce the risk of stricture after extensive ESD more than four weeks of oral steroid prophylaxis. The proportion of circumferential resection is the strongest risk factor for stricture in patients with SEC undergoing ESD.     

Impact of G-CSF Prophylaxis on Chemotherapy Dose-Intensity,Link Between Dose-Intensity and Survival in Patients with Metastatic Pancreatic Adenocarcinoma

BackgroundIn metastatic pancreatic adenocarcinoma, few data are available on the use of granulocyte-colony stimulating factor (G-CSF) prophylaxis and its impact on dose-intensity (DI), or the link between DI and progression-free survival (PFS). This study assessed the impact of G-CSF prophylaxis on the DI received by patients and the relationship between full DI and PFS according to chemotherapy regimens.Patients and MethodsPatients from three first-line randomized phase II clinical trials were included in this retrospective cohort. G-CSF prophylaxis groups were identified and balanced according to baseline characteristics using a propensity score. Patients were classified into 2 treatment groups (FOLFIRINOX vs FOLFIRI/nab-paclitaxel (NAB)). DI was a binary variable (full/reduced). Adverse events were defined using NCI-CTCAE v4.0.ResultsOf the 498 patients, 154 (31%) were in “prophylaxis” group; 179 (36%) were treated by FOLFIRINOX and 319 (64%) by FOLFIRI/NAB. In FOLFIRINOX group, G-CSF prophylaxis was significantly associated with a higher rate of full DI (OR, 5.07; 95% CI, 1.52-16.90; P < .01) while in FOLFIRI/NAB group, it was significantly associated with a lower rate of full DI (OR, 0.23; 95% CI, 0.06-0.83; P = .03). Full DI was associated with a non-significant increase in PFS (FOLFIRINOX group: HR 0.83; 95% CI, 0.59-1.16; P = .27; FOLFIRI/NAB group: HR 0.84; 95% CI, 0.63-1.11; P = .22).ConclusionGranulocyte-colony stimulating factor prophylaxis was associated with a higher rate of full DI with FOLFIRINOX. Full DI was associated with a non-significant increase in PFS. These results need to be confirmed prospectively.     

氯喹和硫酸羟氯喹对SARS-CoV-2体外抗病毒活性的差异研究

目的 通过改变药物与病毒引入的先后顺序,探讨氯喹与硫酸羟氯喹对严重急性呼吸综合征冠状病毒2（SARSCoV-2）不同变体（Prototype、Beta、Delta、Omicron）的体外抗病毒活性。方法 预防研究：Vero E6细胞用氯喹或硫酸羟氯喹（200.00、150.00、100.00、50.00、16.70、5.55、1.85、0.62、0.21μmol·L^-1）孵育1h,加入病毒附着2h,去除病毒-药物混合物,用新鲜培养基培养细胞直到实验结束;治疗研究：Vero E6细胞中加入病毒吸附2h,去除病毒,用含氯喹或硫酸羟氯喹的培养基培养细胞直到实验结束;全时研究：Vero E6细胞用药物孵育1h,加入病毒附着2h,去除病毒-药物混合物,用含药物的培养基培养细胞直到实验结束。培养72h后显微镜下观察细胞是否变圆脱落判断细胞病变情况,计算半数效应浓度（EC₅₀）及药物选择指数（SI）。结果 2种药物对于SARS-CoV-2的预防效果较差;氯喹和硫酸羟氯喹在治疗和全时处理下均表现出良好的抗病毒活性,其中硫酸羟氯喹的EC₅₀小于氯喹,SI大于氯喹,抗病毒效果较氯喹更优越。在治疗和全时处理条件下,氯喹（EC₅₀＝0.904μmol·L^-1）和硫酸羟氯喹（EC₅₀＝0.143μmol·L^-1）对Omicron变异株抗病毒效果较其他变种更明显。结论 氯喹和硫酸羟氯喹在治疗和全时处理下均表现出良好的抗病毒活性,且2种药物对Omicron变异株的活性高于其他变种。     

Clinical validation of routine antenatal anti-D prophylaxis questions the modelling predictions adopted by NICE for Rhesus D sensitisation rates: results of a longitudinal study

OBJECTIVE: To compare the rates of Rh(D) sensitisations with a policy of restricted routine antenatal anti-D prophylaxis (first pregnancy only) with the rates predicted with universal routine antenatal anti-D prophylaxis (all pregnancies). STUDY DESIGN: A retrospective longitudinal observational study involving 15,500 confinements in Rhesus D negative (Rh(D)-ve) women between 1990 and 2003 in a single health district was conducted. All Rh(D) sensitised pregnancies were identified and evidence for routine antenatal anti-D prophylaxis administration during the first pregnancy was investigated. The rate of Rh(D) sensitisations following a policy of restricted prophylaxis was compared with that predicted with mathematical modelling following universal prophylaxis. RESULTS: There were 50 newly sensitised and 37 previously sensitised pregnancies among 15,596 Rh(D)-ve women. For the calculated 13,575 Rh(D)-ve women whose first confinement was in Oxford and who were eligible for restricted prophylaxis, there were 30 new and 26 previously sensitised pregnancies. Of these 30 new sensitisations, 10 were nulliparae, 12 parity 1, and eight parity 2 or greater (third or later continuing pregnancy); only one of these latter eight women had received routine prophylaxis, four had delivered their first baby before the programme was introduced, and in three documentary evidence could not be confirmed that prophylaxis had been given. There was no difference between a policy of restricted and universal routine antenatal anti-D prophylaxis in the sensitisation rates for women during their third or subsequent pregnancy. CONCLUSIONS: This study has shown that restricted routine antenatal prophylaxis provides continuing protection for subsequent pregnancies although the mechanism for this is unclear. These results challenge the wisdom and expense of a policy of universal prophylaxis and prompt a need for further similar analyses to test the appropriateness of the NICE guideline.     

No child should suffer from vitamin K deficiency‐induced bleeding disorders

We encountered an 11‐day‐old male neonate with vitamin K deficiency‐induced intracranial hemorrhage, despite receiving oral vitamin K₂ (menaquinone‐4) prophylaxis according to Japanese guidelines. This case suggests that the current vitamin K deficiency‐bleeding prophylaxis programs cannot prevent bleeding completely. Better prophylaxis programs using both intramuscular and oral administration should be considered.     

晚孕期孕妇生殖道B族链球菌感染对母儿结局的影响

目的 探讨晚孕期孕妇生殖道B族链球菌(GBS)感染的影响因素及其对母儿结局的影响.方法 选择2016年8月至2018年8月,在苏州高新区人民医院进行产前检查,并于35～37孕周时采取荧光定量PCR进行GBS DNA检测的1149例晚孕期孕妇为研究对象.采用回顾性分析方法,将其分为研究组(n=81,GBS DNA呈阳性)...     

圣脑康丸防治急性高原反应的现场观察

目的研究圣脑康丸对急性高原反应的即时防治效果。方法随机选择54名空运至拉萨(海拔3 700 m)的新兵,分为对照组(n=18)、红景天组(n=18)、圣脑康组(n=18),在进入高原前3 d开始分别服用空白胶囊、红景天胶囊、圣脑康丸,连续服用至进入高原的第7天止,定期测定血氧饱和度(SaO2)和心率(HR),以军用卫生标准GJB1098-91《急性高原反应的诊断和处理原则》随访记录受试者急性高原反应症状并评分。结果圣脑康组预防急性高原反应的效果明显优于对照组,圣脑康组急性高原反应评分以及进入高原第1,3,5天时的血氧饱和度(SaO2)和心率(HR)均显著优于对照组(P<0.05或0.01)。结论圣脑康丸能减轻缺氧症状的严重程度,降低急性高原反应的发生率,具有防治急性高原反应的功效。