European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.     

独活的临床应用及其用量探究

通过搜集古医籍及现代医家临床经验,总结出独活具有以下特点:首先,临床用量多为6~60 g。其次,独活临床用量应综合考虑病证及配伍等多种因素,随病施量、因证施量、因配伍施量。独活配伍羌活、防风等,治疗风寒湿引起的风湿免疫、骨科系统疾病,常用剂量9~60 g;配伍川芎、细辛、虫类药等,治疗神经官能症、阿尔兹海默症等多种神经系统疾病,常用剂量9~15 g;配伍黄芪、桂枝、女贞子等,治疗月经失调、产后身痛等妇产科疾病,临床常用9~12 g。     

Initial dosage optimization of tacrolimus in Chinese pediatric patients undergoing kidney transplantation based on population pharmacokinetics and pharmacogenetics

ABSTRACT

Background

The purpose of our research was to recommend the initial tacrolimus dosage for Chinese pediatric patients undergoing kidney transplantation based on population pharmacokinetics and pharmacogenetics.     

基于中医古籍文献的升降散应用溯源及探析

通过对中医古籍中有关升降散论述的文献梳理,全面探讨其内涵。本方是在大黄、僵蚕为雏形的基础上增加蝉蜕、姜黄而成方,几经易名,终在杨璿《伤寒瘟疫条辨》中为后人所熟知。本方广泛用于治疗瘟疫,以丸剂、散剂为主,方便携带,便于服用;重用大黄旨在祛邪、逐秽;应用时视人之体质强弱和量其毒之轻重而判断用药多寡,并辅以米酒、生蜜等以顾护正气。杨璿将其由治疗“热疫”的专方扩展为治疗“表里三焦大热”的通用方剂,扩大了本方治疗疾病范围。     

经典名方地黄饮子的古代文献考究

经典名方地黄饮子现代临床应用广泛,治疗多科疾病,尤其是内科病中的神经系统疾病较多,临床疗效确切,但目前尚未转化成中成药制剂。故笔者采用文献计量学的方法,搜集记载地黄饮子的中医古籍文献,筛选、整理出有效数据254条,涉及中医古籍144部,系统梳理和分析研究了地黄饮子的历史发展源流、主治病证、制方原理、用药剂量、制剂方法、煎服方法等,以期为经典名方的研发和临床应用提供古代文献证据支持。研究发现,地黄饮子出自金代医家刘河间所著《宣明论方》,由熟地黄、巴戟天、山茱萸、肉苁蓉、石斛、附子、五味子、官桂、白茯苓、麦门冬、藏菖蒲、远志12味药物组成,主治喑痱。后世记载的地黄饮子多遵从《宣明论方》中的方剂组成和主治,且临床应用有所扩展,在有主治病证记载的199条文献中,喑痱最多,约占总病证的一半;其次为中风,约占五分之二;亦用于暴喑、痿证、眩晕、遗尿等病证。地黄饮子治疗病证范围较广,但病机总属"肾中水火俱亏"。其制方独特,上下并治,标本兼顾,尤以治下治本为主。在有药物用量记载的56条文献中,约有三分之一继承了《宣明论方》的记载:"等分,上为末,每服3钱。"药物用量总体偏轻。制剂多为汤剂、煮散,在煎服方法上主张"浊药轻投""数滚即服""不计时候"。     

高渗盐水和甘露醇在动脉瘤性蛛网膜下腔出血患者降低颅内压中的应用

目的比较3%高渗盐水和20%甘露醇治疗重症动脉瘤性蛛网膜下腔出血所致颅内压增高的疗效.方法25例动脉瘤性蛛网膜下腔出血患者出现颅内压增高事件时, 随机交替接受等渗透剂量的160 mL 3%高渗盐水与150 mL 20%甘露醇进行降低颅内压治疗, 连续监测患者颅内压、平均动脉压、脑灌注压及中心静脉压.记录有效降低颅内压持续时间、颅内压最大降幅及其时间, 用药前及用药后1 h、3 h血钠水平及血浆渗透压.结果3%高渗盐水和20%甘露醇均可降低颅内压(均 P < 0.01), 两者的降低颅内压作用持续时间及颅内压降幅差异均无统计学意义(均 P >0.05).患者脑灌注压较用药前均上升(均 P < 0.01), 平均动脉压先上升后下降, 但差异无统计学意义( P >0.05).患者中心静脉压稍有波动, 但差异均无统计学意义(均 P >0.05).20%甘露醇治疗后患者血钠下降, 3%高渗盐水治疗后患者血钠值上升, 变化均有统计学意义(均 P < 0.05).20%甘露醇及3%高渗盐水治疗后患者血浆渗透压均先上升后下降, 变化均有统计学意义(均 P < 0.01). 结论3%高渗盐水可作为治疗动脉瘤性蛛网膜下腔出血所致颅内压增高患者的一线治疗药物.     

A Reminder of Methylene Blue's Effectiveness in Treating Vasoplegic Syndrome after On-Pump Cardiac Surgery

The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. Indeed the hypotension consequent to on-pump cardiac surgery often necessitates vasopressor and intravenous fluid support. Methylene blue counteracts vasoplegic syndrome by inhibiting the formation of nitric oxide.We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. After the administration of methylene blue, his hypotension improved to the extent that he could be weaned from vasopressors. The use of methylene blue should be considered in patients who develop hypotension refractory to standard treatment after cardiac surgery.