Efficacy and safety of rupatadine in Japanese adult and adolescent patients with chronic spontaneous urticaria: A double-blind,randomized, multicenter,placebo-controlled clinical trial

Background

Rupatadine, a novel nonsedating second-generation H1-antihistamine with antiplatelet-activating factor activity, has been used in the treatment of allergic rhinitis and urticaria in European countries since 2003. However, its efficacy and safety in Japanese patients with chronic spontaneous urticaria (CSU) are unknown.

Amino acid metabolism in parenteral nutrition: With special reference to the calorie: Nitrogen ratio and the blood urea nitrogen level

A clinical and experimental study was made on amino acid metabolism during parenteral nutrition with glucose and a synthetic amino acid solution. Good correlation was noted between the calorie: nitrogen ratio of the infusate and the blood urea nitrogen level, as well as between the calorie: nitrogen ratio and the amount of urinary excretion of urea nitrogen, nonprotein nitrogen, and amino nitrogen. Final results revealed that the extent to which amino acid is utilized for protein synthesis is directly proportional to the caloric supply, and for complete utilization of 1 g of nitrogen the required caloric intake is in the neighborhood of 450 total calories or 425 nonprotein calories. Blood urea nitrogen level can be used as a parameter of amino acid utilization during parenteral nutrition. Its level is influenced not only by renal function but also by calorie: nitrogen ratio of infusate.     

输卵管阻塞性不孕症宫腹腔镜术后应用欣可聆插管通液效果观察

[目的]观察输卵管阻塞性不孕症宫腹腔镜联合术后,用欣可聆注射液进行彩色超声引导下宫腔镜输卵管插管通液的临床效果。[方法]选择宫腹腔镜术后至少一侧输卵管通畅的不孕症患者160例,按入院先后依次编入观察组和对照组,每组80例,观察组术后第1次月经干净后3~7 d应用欣可聆注射液,行彩色超声引导下宫腔镜输卵管插管通液;对照组不给予任何药物,采取期待疗法。比较两组术后1年妊娠情况。术后1年未妊娠者,于月经干净后3~7 d行子宫输卵管碘佛醇造影检查,观察比较两组输卵管通畅情况。[结果]术后1年,观察组正常宫内妊娠率为68.75%高于对照组的51.25%,差异有统计学意义(χ2=5.104,P=0.024);两组异位妊娠率比较,差异无统计学意义(P0.05);观察组未妊娠者输卵管双侧通畅率为40.9%,显著高于对照组的14.2%(P0.05);双侧不通发生率为9.1%,非常显著低于对照组的42.8%(P0.01);两组总通畅率比较,差异无统计学意义(P0.05)。[结论]输卵管阻塞性不孕症宫腹腔镜联合术后第1次月经干净后3~7 d,用欣可聆注射液行彩色超声引导下宫腔镜输卵管插管通液,可以降低盆腔的再次粘连,维持输卵管的通畅,提高妊娠率,可以作为宫腹腔镜术后的后续治疗方法,值得临床推广应用。     

耳内镜下外耳道“锁孔”技术处理累及乳突的中耳胆脂瘤的初步实践

目的本文旨在探索耳内镜手术中的“锁孔”技术在中耳胆脂瘤手术中的临床应用价值。方法2017年1月至2018年12月间收治的65名单侧中耳胆脂瘤患者,27例患者术前的颞骨CT提示低密度影及骨质破坏局限于上鼓室,鼓窦和乳突区域未见异常;38例患者术前的颞骨CT显示上鼓室内形成的低密度影像,存在骨质破坏,而鼓窦及乳突内也存在类似的低密度影像,难以确定病变是否累及乳突腔。术中耳内镜下经耳道“锁孔”技术早期探查上鼓室、鼓窦和后方的乳突腔内的空间,确定胆脂瘤范围,修正手术方案、优化手术策略。结果术前通过颞骨薄层CT显示的胆脂瘤仅局限于上鼓室的27例患者中,其中17例患者的影像学病变范围与“锁孔”技术探查结果吻合;另外10例病变累及鼓窦及乳突。术前38例患者的影像学显示上鼓室胆脂瘤可能累及鼓窦和乳突,术中通过“锁孔”技术验证,29例为上鼓室胆脂瘤侵及乳突;9例为堵塞形成的黏膜增厚及肉芽组织等非胆脂瘤病变。患者术后随访时间均超过了2年,随访方式为耳内镜及颞骨CT,8例患者的鼓窦及乳突区存在可疑软组织影,进行了便捷的内镜下“锁孔”的探查,鼓窦及乳突区未见胆脂瘤复发,软组织影为增厚黏膜及肉芽。结论在耳内镜下经外耳道径路,可结合持续灌流模式,在耳道后上壁快速开放直径4-6mm的骨窗,通过“锁孔”可以早期明确和判断中耳胆脂瘤累及乳突、鼓窦、上鼓室的病变范围,有利于修正手术方式,减少不必要的骨质磨除,更利于微创的实现和便于手术中耳道重建。     

Meta-analysis of risk factors for the second hip fracture (SHF) in elderly patients

This study aims to quantitatively summarize the risk factors for the incidence of SHF. A meta-analysis was performed with the data obtained from 22 relevant papers published in Pubmed, Embase and Cochrane central database (all through January 2014) following strict selection. The pooled odds ratios (ORs) or standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated for potential risk factors associated with SHF. Our meta-analysis indicated the significant risk factors for SHF were female (OR, 1.46; 95%CI, 1.29–1.66), living in institutions (OR, 2.23; 95%CI, 1.29–3.83), osteoporosis (Singh index (SI) 1–3) (OR, 10.02; 95%CI, 5.41–18.57), low vision (OR, 2.09; 95%CI, 1.06–4.12), dementia (OR, 1.89; 95%CI, 1.47–2.43), Parkinson (OR, 2.90; 95%CI, 1.41–5.95), cardiac diseases (OR, 1.32; 95%CI, 1.02–1.70) and respiratory disease (OR, 1.97; 95%CI, 1.16–3.32). Related strategies must be implemented on those involved with above-mentioned medical conditions to effectively prevent a SHF.     

Inhibition of microRNA-17-5p reduces the inflammation and lipid accumulation,and up-regulates ATP-binding cassette transporterA1 in atherosclerosis

Atherosclerosis (AS) is a chronic inflammatory disease of the arterial wall. Macrophages are considered to be closely associated with the development and progression of AS. However, the precise mechanism of miR-17-5p in the macrophages under AS remains incompletely clarified. This study investigated the regulatory effect of miR-17-5p on the inflammation and lipid accumulation in mouse macrophages both in vivo and in vitro. It was found that miR-17-5p was highly expressed with lowered ATP-binding cassette transporterA1 (ABCA1) level in the peripheral blood leucocytes (PBLs) of AS patients. Moreover, the level of miR-17-5p was up-regulated in the macrophages of ApoE^?/? mice fed with a high-cholesterol diet. Furthermore, we injected miR-17-5p antagomir into AS mice or transfected miR-17-5p inhibitors into mouse macrophage RAW264.7 cells. Results showed that downregulation of miR-17-5p significantly reduced the production of inflammatory cytokines, inhibited the lipid accumulation and up-regulated ABCA1, and activated peroxisome proliferator-activated receptor (PPAR) γ/Liver X receptor (LXR) α signaling pathway. Additionally, ABCA1 was found to be a target of miR-17-5p by directly binding to 3′-untranslated region (3′-UTR) of its mRNA. Our study indicates a novel regulatory mechanism for miR-17-5p by interacting with ABCA1, which could be a therapy-target for the treatment of AS.     

Caring for women undergoing second-trimester medical termination of pregnancy

Objective

The objective was to explore the experiences and perceptions of nurses/midwives caring for women undergoing second-trimester medical termination of pregnancy (MTOP).

Study design

The study had a qualitative design using semistructured interviews. It took place in three wards at one gynecological clinic in a general hospital in Stockholm. Twenty-one nurses/midwives with experience in second-trimester abortion care were interviewed following a semistructured interview guide. The interviews were recorded, transcribed verbatim and then analyzed using qualitative content analysis to identify common themes.

Results

The analysis revealed two themes: “The professional self,” with six subthemes describing the experiences and perceptions described in terms of professional behavior, and “The personal self,” with four subthemes containing the experiences and perceptions described in terms of personal values.

Conclusions

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge, empathy and the ability to reflect on ethical attitudes and considerations. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. The feeling of supporting women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP. The findings of this study support the need for training, mentoring and support by experienced colleagues to help nurses/midwives feel secure in their professional role in difficult situations and feel confident in their personal life situation.

Implications statement

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge and empathy. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. Mentorship from experienced colleagues and structured opportunities for reflection on ethical issues enable the nurses/midwives to develop security in their professional roles and also feel confident in their personal life situation. The feeling of doing something good for women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP.     

“医闹”对护理人员的心理影响

目的：针对最近几年我国的医疗纠纷呈逐年上升趋势,殴打、辱骂、砍杀医护人员等事件,对护士的心理造成怎样的影响。方法;通过把2013年-2014年的医闹事件收集进行剖析、对比,设计调查表到每个科室去调查,结果：：护士的心理都有恐惧、害怕、惊慌等一系列负面影响。     

Second Solid Cancers after Allogeneic Hematopoietic Cell Transplantation Using Reduced-Intensity Conditioning

We examined risk of second solid cancers after allogeneic hematopoietic cell transplantation (AHCT) using reduced-intensity/nonmyeloablative conditioning (RIC/NMC). RIC/NMC recipients with leukemia/myelodysplastic syndrome (MDS) (n = 2833) and lymphoma (n = 1436) between 1995 and 2006 were included. In addition, RIC/NMC recipients 40 to 60 years of age (n = 2138) were compared with patients of the same age receiving myeloablative conditioning (MAC, n = 6428). The cumulative incidence of solid cancers was 3.35% at 10 years. There was no increase in overall cancer risk compared with the general population (leukemia/MDS: standardized incidence ratio [SIR] .99, P = 1.00; lymphoma: SIR .92, P = .75). However, risks were significantly increased in leukemia/MDS patients for cancers of lip (SIR 14.28), tonsil (SIR 8.66), oropharynx (SIR 46.70), bone (SIR 23.53), soft tissue (SIR 12.92), and vulva (SIR 18.55) and skin melanoma (SIR 3.04). Lymphoma patients had significantly higher risks of oropharyngeal cancer (SIR 67.35) and skin melanoma (SIR 3.52). Among RIC/NMC recipients, age >50 years was the only independent risk factor for solid cancers (hazard ratio [HR] 3.02, P < .001). Among patients ages 40 to 60 years, when adjusted for other factors, there was no difference in cancer risks between RIC/NMC and MAC in leukemia/MDS patients (HR .98, P = .905). In lymphoma patients, risks were lower after RIC/NMC (HR .51, P = .047). In conclusion, the overall risks of second solid cancers in RIC/NMC recipients are similar to the general population, although there is an increased risk of cancer at some sites. Studies with longer follow-up are needed to realize the complete risks of solid cancers after RIC/NMC AHCT.     

拔除下颌第二磨牙掩饰治疗成人轻度骨性Ⅲ类错殆畸形

目的研究成人轻度骨性Ⅲ类错[牙合]患者在拔除下颌第二磨牙矫治后软硬组织的变化。方法成人轻度骨性Ⅲ类错[牙合]患行6例,38、48发育良好,在拔除下颌第二磨牙后采用直丝弓矫治器进行掩饰治疗。对治疗前后x线头颅侧位片进行测量分析,结果与矫治前相比,矫治后H角平均增大2．8°,UM—PP平均增加1．47mm,LM—MP平均减小1．11mm,SN—OP平均减小1．5°,下颌磨牙平均远中移动2．87mm,前牙反[牙合]均得到纠正,后牙建说了正常的咬合关系、结论成人轻度骨性Ⅲ类错[牙合]病例通过拔除下颌第二磨牙的掩饰治疗可以取得较好的治疗效果。