Daptomycin serum levels in critical patients undergoing continuous renal replacement

Abstract

Background: Daptomycin pharmacokinetics has not been extensively studied in patients undergoing continuous renal replacement therapy (CRRT).

Methods: The aim of the study was to collect pharmacokinetics and clinical data of patients undergoing CRRT and receiving daptomycin therapy. Daptomycin was measured using an isocratic high-performance liquid chromatography technique.

Results: Three patients with bloodstream infection underwent CVVHD and three CVVHDF. CVVHDF patients had significantly lower mean AUC_0?24 and C_max values. A significant decrease in plasma levels was observed in a CVVHDF patient using ‘high cut-off’ hemofilters.

Conclusion: Increasing doses of daptomycin should be considered in critical patients, especially those undergoing CVVHDF.     

Treatment of a plunging ranula with fenestration and continuous pressure

We present a new method of fenestration and continuous pressure as a simple, effective and uninvasive procedure for the treatment of plunging ranulas. We have recently used in four female patients, aged 10-29 years old. After treatment, the patients remained symptom-free and assessment by magnetic resonance imaging (MRI) showed regression of the ranula in all cases. The procedure resulted in satisfactory healing and we advocate it as a simple and effective treatment that is better for patients than conventional treatment.     

中药熏洗联合功能锻炼对髌骨骨折术后功能恢复的影响

目的 探讨中药熏洗联合功能锻炼对髌骨骨折术后功能恢复的影响.方法 将符合纳入标准的80例髌骨骨折患者按随机数字表法分为2组,每组40例.对照组采用连续被动活动训练机(continuous passive motion,CPM)进行功能锻炼,治疗组在对照组基础上联合中药熏洗.2组均治疗8周.采用膝关节评分量表(Keen Society Score,KSS)评价膝关节功能,观察治疗前后膝关节活动范围变化,评价临床疗效.结果 治疗组优良率为87.5%(35/40)、对照组为65.0%(26/40),2组比较差异有统计学意义(χ2=5.591,P<0.01);治疗后8周,治疗组膝关节活动范围[(138.38±7.82)°比(120.29±7.83)°,t=10.338]、KSS评分[(88.38±9.52)分比(83.46±9.36)分,t=2.330]均高于对照组(P<0.01或P<0.05).结论 髌骨骨折术后采用中药熏洗联合CPM功能锻炼可促进膝关节功能恢复,减少骨折并发症.     

LISA技术治疗超低出生体质量儿呼吸窘迫综合征 28例

目的 探讨经鼻持续气道正压通气（nasal continuous positive airway pressure,nCPAP）下经微管气管内注入肺表面活性物质（less invasive surfactant administration,LISA）技术在超低出生体质量儿呼吸窘迫综合征（respiratory distress syndrome,RDS）治疗中的应用与疗效。方法 采取前瞻性研究方法,选取潍坊市妇幼保健院新生儿科重症监护病房（neonatalintensive careunit,NICU）2019年7月至2021年4月收治的超低出生体质量儿（58例）为研究对象。应用随机数字表法分为LISA组（28例）和气管插管-注入PS-拔管给予经鼻持续气道正压通气（intubation-surfactant-extubation,INSURE）组（30例）。LISA组采用LISA技术,在nCPAP下,气管内置入微管并注入肺表面活性物质（pulmonarysurfactant,PS）;INSURE组采用INSURE技术,拔管后给予nCPAP辅助通气。观察并比较两组病儿给药过程、给药前后...     

Shift from darbepoetin-α to continuous erythropoietin receptor activator decreases serum aluminium concentration in patients on hemodialysis

ObjectiveThe response of erythropoietic stimulating agents (ESA) in uremic patients may be associated with the changes of biochemical parameters, metal elements and inflammation status during the shift from one ESA to another.MethodWe compared changes in above mentioned factors after switching from darbepoetin-α (DPO) 20 μg weekly for 10 weeks to continuous erythropoietin receptor activator (CERA) 100 μg monthly for 10 weeks in uremic patients on hemodialysis. The haematocrit (Hct), metal elements and inflammation status are the primary outcome. Subjects included 54 patients without transfusion or bleeding or additional ESAs. Responders (IR, n = 36) were defined as patients with an increase in Hct after the swtich.ResultAlthough there was no significant difference in overall mean Hct after the switch (p = 0.135), there are significantly greater mean number of red blood cells (RBC) (p = 0.006), higher platelet numbers (p = 0.001), larger RBCs (p = 0.017) and higher creatinine (p = 0.04) and total cholesterol (T-CHOL) (p = 0.003) levels. Mean overall aluminium (Al) level decreased significantly (p = 0.001). C-reactive protein (CRP) also decreased (p = 0.016). The overall LDH increased (p = 0.049) and potassium decreased significantly (p = 0.036), which indicating active erythropoiesis. The calcium (Ca) level was significantly higher (p = 0.034) and phosphate was significantly lower (p = 0.028) after the shift. Although there was no significant increase in overall levels of parathyroid hormone (PTH) after the shift (p = 0.061), but the pre-shift and post-shift PTH level was significantly higher in IRs than in non-IRs (p = 0.003 and p = 0.027, respectively). IRs had a significantly lower initial T-CHOL (p = 0.03) and initial CRP (p = 0.012) than non-responders, which may be related to lower inflammation.ConclusionWe found the shift from DPO to CERA results in lower Al levels, a reduced inflammatory response, and an increase in RBC number and PTH level in uremic patients on hemodialysis.     

Impact on perceived postnatal support,maternal anxiety and symptoms of depression in new mothers in Nepal when their husbands provide continuous support during labour

Background

when a husband provides continuous support during his wife's labour, his presence is considered effective in reducing her dissatisfaction with the childbirth process. The impact of this on the postnatal well-being of a new mother, however, is not clear.

Objective

to examine the impact on postnatal support, maternal anxiety and symptoms of depression experienced by new mothers in Nepal when their husband supported them continuously during labour.

Method

the study involved 231 Nepali women, of whom 77 were supported continuously by their husbands, 75 by female friends, and 79 were not supported by any companion during childbirth. They were contacted at six to eight weeks post partum, when postpartum support questionnaires, a state-trait anxiety inventory and the Edinburgh postnatal depression scale were administered. Structural equation modelling was conducted.

Findings

observations showed that continuous support from a husband during his wife's labour was related to a greater degree of postnatal support than those who were not supported by their husband during labour (β=0.23, p<0.001). Similarly, the more the women considered they were being supported, the less likely they were to experience maternal anxiety (β=−0.52, p<0.001), which in turn was associated with a lower level of depression (β=0.43, p<0.001). These findings were consistent, even after adjustments for the effect of female support during the postnatal period.

Conclusion

the study suggests that continuous support from husbands during labour has a direct impact on the perceived postnatal support, and an indirect impact on anxiety and depression in new mothers in Nepal.     

智障儿童和健全儿童连续语音重复能力的比较研究

目的 从声母习得的5个阶段入手,比较智障儿童和健全儿童连续语音重复能力的差异.方法 采用自编的句子材料,对20名智龄为4岁左右的智障儿童和健全儿童进行测试,分析比较测试数据.结果 ①在声母习得的第三、第四阶段,智障儿童的连续语音重复能力显著落后于健全儿童;②智障儿童声母/d/、/f/、/j/、/q/、/z/、/r/的连续语音重复能力显著低于健全儿童;③智障儿童的连续语音重复能力在5个阶段内部表现出不平衡性.结论 在智障儿童连续语音重复能力训练中,需合理安排阶段训练重点、声母训练重点及各阶段内部训练顺序.     

改良悬雍垂腭咽成形术长期疗效的主观评价

目的 评价保留悬雍垂的改良悬雍垂腭咽成形术(Han-uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者术后5年的主观疗效改善程度.方法 回顾性队列研究.电话问卷随访2165例确诊5年及以上的OSAHS患者(呼吸暂停低通气指数≥5次/h),分为未治疗组、...     

OSAHS患者CPAP治疗前后MMP-9和FFA水平变化

目的探讨OSAHS治疗前后MMP-9、FFA的变化及呼吸紊乱指数、最低血氧饱和度及血脂的相关性,为研究OSAHS病情程度及与心血管疾病、内分泌疾病的关联提供相关依据。方法对50例符合纳入条件的重度OSAHS患者在进行CPAP治疗前及治疗后6个月PSG监测并抽取清晨空腹血清测定MMP-9、FFA及临床常规血脂四项(TG、TCH、HDL、LDL),并做相关比较。结果①OSAHS患者治疗后呼吸紊乱指数(AHI)下降,与术前比较有统计学意义(P<0.01),最低血氧饱和度(SO2)上升,与术前比较有统计学意义(P<0.05)。②OSAHS患者治疗后MMP-9水平较治疗前有统计学意义(P<0.01)。FFA水平较治疗前有统计学意义(P<0.01)。③OSAHS患者治疗后TG、TCH、LDL值下降,HDL值上升,较术前均有统计学意义(P<0.01)。结论应用持续正压通气(continuous positive airway pressure,CPAP)治疗OSAHS可以降低MMP-9与FFA的水平,有效降低OSAHS所致炎症反应及心血管疾病的发生。