Long‐term efficacy and safety of ranibizumab administered pro re nata in Japanese patients with neovascular age‐related macular degeneration in the EXTEND‐I study

Purpose: To evaluate the long‐term efficacy and safety of ranibizumab administered pro re nata (PRN) in Japanese patients with choroidal neovascularization secondary to age‐related macular degeneration during the extension phase of the EXTEND‐I study. Methods: EXTEND‐I, an open‐label, multicenter, Phase I/II study comprised: a single‐injection (Group A); a multiple‐injection (Groups A and B; the latter consisted of patients who did not participate in the single‐injection phase); and an extension phase. In the extension phase, a PRN regimen of ranibizumab (0.3 or 0.5 mg) guided by monthly best‐corrected visual acuity (BCVA) score and other ophthalmic examinations was employed. The efficacy variables included the mean BCVA change from Month 12 to the last visit in Group B. Safety was assessed in all patients. Results: In the extension phase, efficacy was assessed only in Group B patients. The number of ranibizumab injections per year in the 0.3 and 0.5 mg Group B patients was 4.19 and 4.27, respectively. The mean BCVA change (SD) from Month 12 to the last visit was ?3.6 (14.82) letters for 0.3 mg (n = 28) and ?2.2 (7.92) letters for 0.5 mg groups (n = 33) in Group B. Conjunctival haemorrhage and nasopharyngitis were the most commonly reported adverse events. Of the 13 serious adverse events reported, cerebral infarction (two incidences) was suspected to be study‐drug related. Conclusions: Pro re nata regimen of ranibizumab guided by monthly BCVA and other ophthalmic examinations appears effective in sustaining the BCVA gained with 12 monthly injections while reducing the number of injections during the extension phase. Ranibizumab was well tolerated during the extension phase.     

Early motor development of children with a congenital cytomegalovirus infection

BackgroundCongenital cytomegalovirus (cCMV) infection is the most important etiology of non-hereditary childhood hearing loss and an important cause of neurodevelopmental delay. The current study aimed to investigate the early motor development of symptomatic and asymptomatic cCMV infected children with and without sensorineural hearing loss (SNHL).MethodsSixty-four children with a cCMV infection, without cerebral palsy, were compared to a control group of 107 normal hearing children. They were assessed around the ages of 6, 12, and 24 months with the Peabody Developmental Motor Scales-2 (PDMS-2), Alberta Infant Motor Scales (AIMS), and Ghent Developmental Balance Test (GDBT). The cCMV infected children were subdivided into a symptomatic (n = 26) and asymptomatic cCMV group (n = 38) but also into a cCMV group with SNHL (n = 19) and without SNHL (n = 45).ResultsSymptomatic cCMV infected children and cCMV infected children with SNHL performed significantly weaker for all gross motor outcome measures.ConclusionA congenital CMV infection is a risk factor for a delay in the early motor development. Follow-up will be necessary to gain insight into the exact cause of this motor delay and to define the predictive value of early motor assessment of cCMV infected children.     

不同干燥方法对软式内镜的干燥效果

目的 探讨不同干燥方法对软式内镜及其带有管腔附件器械的干燥效果，为临床选择更好的干燥方法提供依据。方法 选择待干燥处理的胆道镜及其带有管腔的附件器械600件，随机分为三组，每组各200件器械，A组：用无絮纤维布蘸取95%乙醇擦拭器械表面，用注射器抽吸95%乙醇灌注两端有开口的管腔器械内腔，用压力气枪吹干器械表面及内腔水分：B组：用干燥无絮纤维布逐一擦拭器械表面水分，再用压力气枪吹管腔3~5 s，放入50℃低温真空干燥柜20~25 min：C组：用压力气枪吹管腔3~5 s，置于60~65℃高温干燥柜10~12 min，再置于50℃低温真空干燥柜20~25 min。通过目测+气枪吹拭+称重判定干燥效果，通过计量干燥时间评价工作效率。结果 A、B、C三组器械干燥合格率分别为86.00%、94.00%、98.00%，合格率比较差异有统计学意义（P<0.05），B组、C组干燥效果均优于A组（P<0.0175），B、C组合格率比较，差异无统计学意义（P=0.041）。A、B、C三组达到器械表面干燥所需时间分别为15、20、12 min：对于器械管腔内干燥，两端有开口的器械A、B、C三组所需干燥时间分别为1、20、20 min，A组无法处理有盲端的器械，B、C组均需25 min。结论 对不耐高温的软式内镜及其带有管腔的附件器械采用压力气枪吹管腔3~5 s，放入60~65℃高温干燥柜12 min，再置入50℃低温真空干燥柜20~25 min的干燥方法，干燥消毒效果最佳，工作效率最高。     

Combining informal care and work: supporting carers in the workplace

The UK Government is concerned that women and men who care for disabled or sick relatives, or elderly people, and who also wish to take part in paid work should have increased opportunities to do so. However, many informal carers find combining work and care difficult; some may 'choose' to give up paid employment completely. The present paper draws on the findings from two projects to explore the extent to which the needs of employees with caring responsibilities are supported in the workplace. The two projects examined evidence from a study of informal carers assessed under the 1995 Carers Act, identified the difficulties which they face in their workplace and observed the strategies which they developed to help sustain the two roles. From this, a model of support for working carers was developed which includes leave policies, carer-friendly working arrangements, access to a (private) telephone, and supportive line managers and co-workers. This support model was tested on the employment policies of 13 employers to see how 'carer-friendly' they were. Most of the organisations studied were able to provide appropriate support for carers identified in the model. Questions were then raised about different aspects of carer-friendly working arrangements, including whether carers should receive any special treatment that is not available to their colleagues, the role of line managers, and the relationship between seniority and opportunities to combine work and care.     

Ictal pattern of EEG and muscular activation in symptomatic infantile spasms: a videopolygraphic and computer analysis

PURPOSE: To investigate ictal muscular phenomena characterizing symptomatic infantile spasms (ISs) and their relation to ictal EEG. METHODS: Four children with severe encephalopathy, neurologic impairment, and refractory ISs related to different dysplastic lesions, underwent videopolygraphic recordings collecting surface electromyogram (EMG) activity from several cranial and limb muscles to evaluate the pattern of muscular recruitment, duration, and side-to-side asymmetry of ISs. Acquired data were stored for off-line analysis by a computerized polygraphic system. RESULTS: Spasms were characterized by a complex pattern of muscular activation. A constant or rostrocaudal propagation pattern was lacking in all patients. Intervals between the onset of EMG activity in different muscles in each spasm were very long: 相似文献   

南瓜提取物对Ⅱ型糖尿病降血糖作用研究

目的 观察南瓜提取物对Ⅱ型糖尿病患者的降糖作用。方法 采用双盲法，组间和自身两种对照设计，观察服用南瓜提取物30d后糖尿病患者的主要临床症状改善情况及空腹和餐后2h血糖水平。结果 南瓜提取物对糖尿病主要临床症状的总有效率为27．5％（对照组为11．8％），且空腹和餐后2h血糖平均下降率均超过10％。结论 南瓜提取物对Ⅱ型糖尿病患者具有一定的改善症状和降低血糖作用。     

双氯芬酸钠柔性脂质体的研究

目的 研究双氯芬酸钠柔性脂质体，为临床新制剂的开发提供参考。方法 以逆相蒸发－超声法制备双氯芬酸钠柔性脂质体，并对其性态、包封率、透过率、体外透皮以及抗炎药效学进行了试验。结果 双氯芬酸钠柔性脂质体平均粒径为81.5nm，平均包封率为73．12％；在0.3MPa外压作用下，柔性脂质体的透过速率平均达到水的90％；体外透皮实验中，24h累积透皮吸收百分率Q％为58．62％，优于普通脂质体和凝胶剂；对角叉菜胶所致的炎症有显著的抑制作用，比其凝胶剂作用持久。结论 双氯芬酸内柔性脂质体有望成为适于临床给药的一种新剂型。     

应用纤维胆道镜治疗术后残石的体会

本文报道纤维胆道镜治疗手术后残余结石42例,总有效率达到95.2％,结石取净率85.7％。评价了内镜取石的临床价值,认为是目前清除胆管残余结石最有效的方法,结果证明疗效良好。并分别介绍了肝外、肝内胆管结石、嵌顿性结石等的取石技术操作要领及难点,以及预防并发症的措施。     

What factors predetermine the risk of having a high-order multiple pregnancy with gamete intra-Fallopian transfer?

Limiting the number of oocytes transferred at gamete intra-Fallopiantransfer (GIFT) has limited the incidence of high-order pregnancybut at the same time compromised the fertility potential ofsome patients. A review of 300 patients who have undergone GIFTusing a flexible approach as to the number of oocytes transferredidentifies the patients at risk of high-order pregnancy as thoseaged under 30 years hi whom more than six oocytes are returnedand whose partner's spermatozoa have high progressive motUity.     

Fiberoptic techniques

Fiberoptic intubation of the spontaneously breathing patient is the gold standard and technique of choice for the elective management of a difficult airway. In the hands of the properly trained and experienced user, it is also an excellent 'plan B' alternative when direct laryngoscopy unexpectedly fails. Fiberscope-assisted intubation through an endoscopy face mask, laryngeal mask airway or intubating laryngeal mask airway secures ventilation and oxygenation, and permits endotracheal intubation in airway emergency situations. Portable fiberscopes can be used in remote settings, increasing patient safety. This review discusses current fiberoptic intubation techniques and their applications in the management of both the anticipated and unanticipated difficult airway.