中成药说明书内容分析与药学服务

目的根据中成药说明书内容思考用药安全性及药学服务的开展,促进中成药的合理使用。方法收集我院应用的具有国药准字Z的324份中成药说明书(包括16份注射剂),以国家法律法规为标准,逐一核对其中的项目是否完整,每一项下的内容是否具体。结果 324份说明书中,63份有不良反应内容(19.44%),118份有禁忌内容(36.42%),239份有注意事项内容(73.17%),3份有相互作用内容(0.93%),2份有临床试验(0.62%),45份有药理毒理(13.89%)。结论中成药说明书项目不够完整,内容不够规范。为提高临床用药安全性和药学服务,应加强管理力度,不断完善中成药说明书的内容。     

改良阴式全子宫切除及前后壁修补术的临床探讨

目的：探讨改良阴式全子宫切除及前后壁修补术的术式及其在盆腔器官脱垂中的临床应用价值。方法：选取2008年1月-2013年1月在本院妇科行手术治疗的235例子宫脱垂及前后壁膨出的患者作为研究对象,按照随机数字表法将其分为传统组125例和改良组110例,传统组采用传统阴式全子宫切除及前后壁修补术进行治疗,改良组采用阴式全子宫切除及阴道前后壁修补术进行治疗,观察比较两组的治疗效果、手术时间、住院时间、复发率及并发症发生情况的差异。结果：改良组的手术时间和住院时间均明显短于传统组,并发症发生率和复发率均明显低于传统组,且术后改良组的治愈率、总有效率均明显高于传统组,差异均有统计学意义（P＜0.05）。结论：改良阴式全子宫切除及阴道前后壁修补术治疗盆腔脏器脱垂疗效较满意,具有微创、安全、术后恢复快的特点,复发率及术后并发症的发生率较低,值得在临床上进一步推广。     

Performance of the Steno type 1 risk engine for cardiovascular disease prediction in Italian patients with type 1 diabetes

Background and aimsPremature cardiovascular disease cause excess mortality in type 1 diabetes (T1D). The Steno T1D Risk Engine was developed and validated in northern European countries but its validity in other populations is unknown. We evaluated the performance of the Steno T1D Risk Engine in Italian patients with T1D.Materials and methodsWe included patients with T1D with a baseline visit between July 2013 and April 2014, who were free of cardiovascular disease and had complete information to estimate risk. The estimated cardiovascular risk score was compared with the 5-year rate of cardiovascular events by means of logistic regression.ResultsAmong 223 patients (mean age 43 ± 13 years, 34.5% male, mean duration of diabetes 22 ± 12 years) the mean estimated cardiovascular risk at 5 years was 5.9% (95% C.I. 5.2–6.5%). At baseline, high estimated risk discriminated the presence of asymptomatic atherosclerosis better than microangiopathy, and was not associated with markers of inflammation or endothelial activation. After a mean follow-up of 4.7 ± 0.5 years, only 3 cardiovascular events were observed and nonetheless the risk score was significantly associated with their incidence (OR 1.22; 95% C.I. 1.08–1.39, p = 0.001). However, the observed event rate was significantly lower than the estimated one (3 vs 13; 95% C.I. 12–14; p < 0.001).ConclusionThe Steno T1D Risk Score identified subjects with subclinical atherosclerosis and high cardiovascular risk in an Italian T1D population. However, the absolute risk was significantly overestimated. Further studies in larger population are needed to confirm these results.     

支气管哮喘患儿吸入丙酸氟替卡松疗效观察

目的:观察哮喘患儿吸入丙酸氟替卡松(FP)治疗的疗效及评估哮喘控制水平.方法:(1)采用回顾性研究和临床随访的方法,选取在我院哮喘门诊就诊的哮喘患儿200例,按照哮喘控制简易方案(easyasthma management)进行病情严重程度分级,采取半随机自愿的形式(愿意接受激素治疗与拒绝激素治疗)分为两组,治疗组100例,根据病情程度给予FP治疗,非治疗组100例给予相关的对症治疗,疗程4周.治疗组在治疗2、4周后进行重新评估,比较治疗组在治疗前后日间及夜间症状评分改善情况,且以非治疗组同期观察哮喘控制情况作对比.(2)对200例哮喘患儿中≥4岁的98例检测峰流速(PEFR)值,对比治疗组在治疗前后此值变化情况及两组间该值对比情况.结果:(1)治疗组与非治疗组在年龄、性别、治疗前病情严重程度、日间及夜间症状评分均差异无统计学意义(P＞0.05);治疗组在吸入FP治疗2、4周后各项症状评分均明显改善(P＜0.001);治疗组与非治疗组2、4周后日间、夜间症状评分比较差异有统计学意义(P ＜0.001).(2)治疗组在吸入FP 4周后PEFR值比治疗前明显改善(P＜0.001),与非治疗组比较差异亦有统计学意义(P ＜0.001).结论:吸入FP疗效明显,是目前较佳的支气管哮喘的治疗方法.     

上海地区人乳中脂肪酸成分的研究

目的对上海地区人乳脂肪酸成分再次进行调查,以获得上海地区人乳脂肪酸成分的最新数据。方法选择健康产妇31例,平均年龄(27±4)岁,平均孕期(39±1)周,婴儿平均出生体质量为(3 405±375)g。采集每位产妇产后1～7 d的初乳、14 d和28 d的过渡乳以及42 d的成熟乳,采用气相色谱法对人乳中的脂肪酸成分进行测定。结果人乳中的总脂肪酸含量从初乳、过渡乳到成熟乳逐渐增加;饱和脂肪酸的含量在1～7 d的初乳中逐渐增加,至过渡乳和成熟乳逐渐下降;单不饱和脂肪酸含量在1～7 d的初乳中逐渐降低,到过渡乳和成熟乳又逐渐升高;长链多不饱和脂肪酸、花生四烯酸(AA)和二十二碳六烯酸(DHA)的含量在初乳中很高,到成熟乳后明显降低,而必需脂肪酸、亚油酸(LA)和α-亚麻酸(ALA)则随哺乳期的延长逐渐增加。与10年前的上海人乳资料相比较,DHA含量有所增加,而ALA含量却有下降。结论人乳中的脂肪酸含量随哺乳期的延长不断发生变化。中国上海地区人乳中必需脂肪酸、LA的含量显著高于国外报道。     

腹腔镜下子宫内膜异位症术后不同处理方法的临床疗效比较

目的观察不同方法治疗子宫内膜异位症的临床疗效以及复发情况,并评价患者的生存质量。方法将210例子宫内膜异位症患者按数字表法随机分为A、B、C 3组,每组70例。A组为单纯腹腔镜手术治疗组,B组为腹腔镜手术后加用米非司酮治疗组,C组为腹腔镜手术后加用孕三烯酮组,所有病例随访1～2年,比较3组患者的症状缓解情况、复发率及不良反应发生率,并比较3组治疗前1周、治疗后3个月、治疗后6个月患者的生存质量评分。结果 B组、C组临床疗效优于A组,且术后1年内复发率低于A组,差异均有统计学意义(P<0.05),而B组与C组之间比较差异无统计学意义(P>0.05),且2组均无再次手术者。A组不同领域生存质量得分均显著低于B、C组,差异均有统计学意义(P<0.05),随着随访时间的延长、症状复发,A组患者的生存质量呈明显下降趋势。B、C组患者短期生存质量、远期生存质量比较差异均无统计学意义(P>0.05),B、C 2组内患者随着随访时间延长,生存质量呈明显升高趋势,但差异无统计学意义(P>0.05)。与C组比较B组不良反应更轻,差异有统计学意义(P<0.05)。结论腹腔镜术后加用米非司酮或孕三烯酮治疗子宫内膜异位症疗效好,且复发率较低,能明显改善患者的生存质量,而米非司酮不良反应更轻,更宜于临床推广。     

宫外孕汤剂治疗子宫外孕64例临床观察

目的探讨宫外孕汤剂在子宫外孕患者中的临床应用价值。方法选取我院2011年11月～2012年11月期间收治的子宫外孕患者128例,随机将其分为研究组和对照组,每组患者各64例。两组子宫外孕患者经相关检查和明确诊断后,研究组患者给予宫外孕中药汤剂临床治疗,对照组患者则给予西药临床治疗,分别比较和分析两组子宫外孕患者的临床疗效和毒副反应。结果研究组患者的显效率和总有效率分别为51.56%、95.31%,均明显高于对照组患者,两组比较差异有统计学意义(P<0.05);研究组患者胃肠道刺激和肝功能损害的毒副反应发生率较对照组患者均有所降低,但两组间比较,差异无统计学意义(P>0.05)。结论宫外孕中药汤剂对于子宫外孕患者临床疗效的改善和毒副反应的减少均具有积极的临床价值。     

Obesity,self-reported symptom severity,and quality of life in people with atrial fibrillation: A community-based cross-sectional survey

Background and aimsIntentional weight loss may reduce symptom severity of atrial fibrillation (AF) in relatively young AF patients with overweight. We examined whether symptom severity and quality of life (QoL) are associated with weight status in the general population with AF.Methods and resultsPatients with electrocardiogram-confirmed AF completed validated questionnaires: the EuroQol 5 Dimensions QoL questionnaire and the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS assessed the AF burden scoring on AF-related symptoms and the total AF burden measured as a combination of duration, frequency, and severity of an irregular heartbeat. Generalized liner models examined the association of body mass index (BMI) with AF severity and QoL adjusting for confounders. Between 2018 and 2019, 882 of 1901 (46%) mailed questionnaires were returned completed. Participants had a mean (SD) age of 74 (10) years old and a BMI of 27.4 (5.6) kg/m². Sixteen percent reported having never experienced an irregular heartbeat. A 5 kg/m² higher BMI was associated with a 0.65 (95%CI: 0.25 to 1.06) higher symptom score, where 3 points represent a clinically relevant change in state. A 5 kg/m² higher BMI was associated with a −1.61 (95%CI: −2.72 to −0.50) lower QoL score. The coefficient of the total AF burden for a 5 kg/m² higher BMI was 0.17 (95% CI: −0.01 to 0.68).ConclusionBMI was positively associated with symptoms and negatively associated with one of the two measures of QoL, but not with the total AF burden. However, the strength of association was small and not clinically meaningful.     

Serum folate modified the association between low-density lipoprotein cholesterol and carotid intima-media thickness in Chinese hypertensive adults

Background and aimsWhile folate is known for its importance in cardiovascular health, it is unknown whether folate status can modify the association between low-density lipoprotein cholesterol (LDL-C) and carotid intima-media thickness (CIMT). We aimed to investigate this question in a Chinese hypertensive population, who are at high-risk of low folate and atherosclerosis.Methods and resultsThis report included 14,970 hypertensive adults (mean age 64.5 years; 40.3% male) from the China Stroke Primary Prevention Trial (CSPPT) and analyzed the fasting serum LDL-C and folate, and CIMT data obtained at the last follow-up visit. LDL-C was calculated using the Friedewald equation. Serum folate levels were measured by chemiluminescent immunoassay. CIMT was measured by ultrasound. Non-parametric smoothing plots, multivariate linear regression analysis, subgroup analyses and interaction testing were performed to examine the LDL-C–CIMI relationship and effect modification by folate. Consistent with graphic plots, multivariate linear regression showed that LDL-C levels were independently and positively associated with CIMT (β = 7.69, 95%CI: 5.76–9.62). More importantly, the relationship between LDL-C and CIMT was significantly attenuated with increasing serum folate levels (1st tertile: β = 10.06, 95%CI: 6.67–13.46; 2nd tertile: β = 6.81, 95%CI: 3.55–10.07; 3rd tertile: β = 5.96, 95%CI: 2.55–9.36; P-interaction = 0.045). Subgroup analyses showed the association between LDL-C and CIMT across serum folate tertiles was robust among various strata (all P-interaction >0.05).ConclusionsAmong Chinese hypertensive adults, the serum folate levels could modify the association between LDL-C and CIMT. Our findings, if further confirmed, have important clinical implications.     

The individual and joint effects of maternal 25(OH)D deficiency and gestational diabetes on infant birth size

Background and aimsTo examine the independent effect of maternal serum 25-hydroxyvitamin D [25(OH)D] deficiency and its joint effect with gestational diabetes mellitus (GDM) on infant birth size.Methods and resultsThis retrospective cohort study was conducted in 15,724 mother-offspring dyads in Beijing, China between 2016 and 2017. Outcomes included infant birth weight Z-score (adjusted for gestational age and sex) and large for gestational age (LGA). Exposures were maternal 25(OH)D concentrations. Linear and logistic regression models were used to assess the associations of exposures with continuous and binary outcomes, respectively. Exposure-outcome associations were not observed when analyzing 25(OH)D concentrations continuously or in quartiles (P > 0.05); however, mothers with severely deficient 25(OH)D concentrations (n = 307) had a decreased risk of LGA compared with those with sufficient 25(OH)D concentrations (≥30.0 ng/mL; n = 5400) (adjusted odds ratio (OR): 0.63; 95% confidence interval (CI): 0.42, 0.93). Compared to mothers with no 25(OH)D deficiency (≥20.0 ng/mL) and no GDM (n = 7975), those with both 25(OH)D deficiency and GDM (n = 1090) had 0.15 (95% CI: 0.09, 0.21) higher infant birth weight Z-score and a higher risk of LGA (OR: 1.29; 95% CI: 1.09, 1.52). Maternal 25(OH)D deficiency and GDM had additive interaction on the risk of LGA (relative risk due to interaction: 0.18).ConclusionMothers with severely deficient 25(OH)D might have a decreased risk of LGA. However, the joint effect of maternal 25(OH)D deficiency and GDM might increase the risk of LGA. Our findings have clinical and public health implications and provide potential directions for future studies.