Guidelines for the use of allergen immunotherapy. Canadian Society of Allergy and Clinical Immunology.

OBJECTIVES: To recommend guidelines for the use of allergen immunotherapy to treat allergies in patients for whom allergen avoidance and drug therapy have not been sufficiently effective. OPTIONS: High-dose or low-dose allergen immunotherapy for the treatment of IgE-mediated allergy to insect stings, allergic rhinoconjunctivitis and asthma. OUTCOMES: Clinical evaluation of symptoms, objective measurement of reactions to nasal or bronchial allergen challenge, immunologic changes as a result of allergen immunotherapy and, among patients with anaphylactic reactions to stinging insects, clinical outcome of intentional sting challenge. EVIDENCE: A search of MEDLINE was conducted to identify articles that presented results of allergen immunotherapy. Proceedings of symposia held by international subcommittees and of consensus meetings, as well as references obtained from these sources, were reviewed. The articles were grouped according to their main subject: immunologic effects, specific allergies, the results of randomized placebo-controlled clinical trials, types of allergen extract and protocols for allergen immunotherapy, adverse effects and deficiencies of allergen immunotherapy. VALUES: Each member of the working group assessed the importance of such issues as basic immunologic effects, clinical efficacy, adverse effects and inappropriate use; the working group then arrived at a consensus. BENEFITS, HARMS AND COSTS: Implementation of these guidelines would lead to the appropriate use of allergen immunotherapy and control inappropriate treatment, which could result in adverse effects and increased costs of services for patients with allergies. RECOMMENDATIONS: Allergen immunotherapy with specific, standardized allergenic materials, administered in high-dose schedules, is effective in patients with an allergy to insect stings or allergic rhinoconjunctivitis, and in some patients with asthma, who have been correctly diagnosed through a meticulous history corroborated by positive results of skin tests and for whom avoidance of the allergen and drug therapy are not sufficiently effective. VALIDATION: These guidelines are similar to others being developed in the United States and recommended by the Joint Council of Allergy and Immunology and the American Academy of Allergy, Asthma and Immunology. SPONSOR: These guidelines were developed by a working group of the Canadian Society of Allergy and Clinical Immunology; no funding was received from any other source.     

儿童近视眼的临床特点与防治

目的 :针对儿童近视眼的临床特点 ,探讨有关防治措施。　方法 :收集门诊近视眼患儿 74 8例进行屈光状态检查分析。　结果 :近视眼按病变性质分类 ,以单纯性近视占绝大多数 ;按程度分类 ,以低度近视居多 ,中度近视次之 ;按形式分类 ,以复性近视散光为多。矫正效果以单纯性近视及中、低度近视为佳。 4～ 14岁儿童中以 12岁患病率最高。　结论 :重视儿童小学阶段近视的防治工作 ,对近视眼儿童适时准确地屈光矫正是延缓其发展的有效方法。     

临床免疫学教学的几点体会

临床免疫学课程的教学应体现免疫学的前沿性和应用性与临床医学的实践性相结合的特点,起到桥梁课程的作用,为医学生各门临床课程的学习打下良好的基础.     

Alcohol and cancer: a position statement from Cancer Council Australia

The Cancer Council Australia (CCA) Alcohol Working Group has prepared a position statement on alcohol use and cancer. The statement has been reviewed by external experts and endorsed by the CCA Board. Alcohol use is a cause of cancer. Any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption. It is estimated that 5070 cases of cancer (or 5% of all cancers) are attributable to long-term chronic use of alcohol each year in Australia. Together, smoking and alcohol have a synergistic effect on cancer risk, meaning the combined effects of use are significantly greater than the sum of individual risks. Alcohol use may contribute to weight (fat) gain, and greater body fatness is a convincing cause of cancers of the oesophagus, pancreas, bowel, endometrium, kidney and breast (in postmenopausal women). The existing evidence does not justify the promotion of alcohol use to prevent coronary heart disease, as the previously reported role of alcohol in reducing heart disease risk in light-to-moderate drinkers appears to have been overestimated. CCA recommends that to reduce their risk of cancer, people limit their consumption of alcohol, or better still avoid alcohol altogether. For individuals who choose to drink alcohol, CCA recommends that they drink only within the National Health and Medical Research Council guidelines for alcohol consumption.     

Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement

The publication of the Australasian Creatinine Consensus Working Group's position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010. The working group recommends that the method of calculating eGFR should be changed to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, and that all laboratories should report eGFR values as a precise figure to at least 90 mL/min/1.73 m(2). Age-related decision points for eGFR in adults are not recommended, as although an eGFR < 60 mL/min/1.73 m(2) is very common in older people, it is nevertheless predictive of significantly increased risks of adverse clinical outcomes, and should not be considered a normal part of ageing.If using eGFR for drug dosing, body size should be considered, in addition to referring to the approved product information. For drugs with a narrow therapeutic index, therapeutic drug monitoring or a valid marker of drug effect should be used to individualise dosing. The CKD-EPI formula has been validated as a tool to estimate GFR in some populations of non-European ancestry living in Western countries. Pending publication of validation studies, the working group also recommends that Australasian laboratories continue to automatically report eGFR in Aboriginal and Torres Strait Islander peoples. The working group concluded that routine calculation of eGFR is not recommended in children and youth, or in pregnant women. Serum creatinine concentration (preferably using an enzymatic assay for paediatric patients) should remain as the standard test for kidney function in these populations.     

Vitamin D and adult bone health in Australia and New Zealand: a position statement

A significant number of Australians are deficient in vitamin D--it is a fallacy that Australians receive adequate vitamin D from casual exposure to sunlight. People at high risk of vitamin D deficiency include elderly people (particularly those in residential care), people with skin conditions where avoidance of sunlight is advised, those with dark skin (particularly if veiled), and those with malabsorption. Exposure of hands, face and arms to one-third of a minimal erythemal dose (MED) of sunlight (the amount that produces a faint redness of skin) most days is recommended for adequate endogenous vitamin D synthesis. However, deliberate sun exposure between 10:00 and 14:00 in summer (11:00-15:00 daylight saving time) is not advised. If this sun exposure is not possible, then a vitamin D supplement of at least 400 IU (10 microg) per day is recommended. In vitamin D deficiency, supplementation with 3000-5000 IU ergocalciferol per day (Ostelin [Boots]; 3-5 capsules per day) for 6-12 weeks is recommended. Larger-dose preparations of ergocalciferol or cholecalciferol are available in New Zealand, Asia and the United States and would be useful in Australia to treat moderate to severe vitamin D deficiency states in the elderly and those with poor absorption; one or two annual intramuscular doses of 300 000 IU of cholecalciferol have been shown to reverse vitamin D deficiency states.     

The management of varicella-zoster virus exposure and infection in pregnancy and the newborn period. Australasian Subgroup in Paediatric Infectious Diseases of the Australasian Society for Infectious Diseases

Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection. Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease. Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy. Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox. ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery. Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG. Breastfeeding of babies infected with or exposed to VZV is encouraged. A mother with chickenpox or zoster does not need to be isolated from her own baby. If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative. The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG. After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation.     

短期预防小儿热性惊厥临床分析

目的:探讨短期应用地西泮及苯巴比妥预防热性惊厥的临床分析。方法:选取登记建档的热性惊厥患儿共300例,随机分为地西泮组、苯巴比妥组及观察组,三组患儿入院后均根据检查结果给予有效抗感染,T≥38.5℃立即给予物理降温配合药物口服降温等常规治疗。地西泮组在发热一开始立即给予地西泮片1 mg/(kg·d),分3次口服,疗程3 d;苯巴比妥组则在发热一开始立即给予苯巴比妥片5 mg/(kg·d),分2次口服;观察组则不给予药物预防。发病后2周、热退、感染症状完全消除前提下,完善视频脑电图检查。结果:本次研究结果表明,在感染性疾病发热早期,短期应用地西泮或苯巴比妥口服,有助于明显降低热性惊厥(FC)发生,减少发热极期24 h内发作次数,缩短单次惊厥发作持续时间,减少易感年龄发作次数,降低神经元放电、缺氧对大脑中枢神经组织的继发性损伤,治疗效果分别与观察组比较差异均有统计学意义(P<0.05);地西泮及苯巴比妥在本研究对热性惊厥发作次数、单次惊厥发作持续时间、复发次数、2周后视频脑电图改变等相比较差异无统计学意义(P>0.05)。结论:在发热早期短期应用地西泮与苯巴比妥有助于降低惊厥发生率,减少发作次数,缩短发作时间,控制复发率,减轻脑组织受损;地西泮及苯巴比妥发作次数、惊厥持续时间、复发次数及远期脑电图改变等比较无明显差异,故在临床工作中地西泮、苯巴比妥均可选用。     

Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis

For most warfarin indications, the target maintenance international normalised ratio (INR) is 2-3. Risk factors for bleeding complications with warfarin use include age, history of past bleeding and specific comorbid conditions. To reverse the effects of warfarin, vitamin K(1) can be given. Immediate reversal is achieved with a prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP). Vitamin K(1) is essential for sustaining the reversal achieved by PCC and FFP. When oral vitamin K(1) is used for warfarin reversal, the injectable formulation of vitamin K(1) is preferable to tablets because of its flexible dosing; this formulation can be given orally or injected. To temporarily reverse the effect of warfarin when there is a need to continue warfarin therapy, vitamin K(1) should be given in a dose that will quickly lower the INR to a safe, but not subtherapeutic, range and will not cause resistance once warfarin is reinstated. Prothrombinex-HT is the only PCC approved in Australia and New Zealand for warfarin reversal. It contains factors II, IX and X, and low levels of factor VII. FFP should be added to Prothrombinex-HT as a source of factor VII when used for warfarin reversal. Simple dental or dermatological procedures may not require interruption to warfarin therapy. If necessary, warfarin therapy can be withheld 5 days before elective surgery, when the INR usually falls to below 1.5 and surgery can be conducted safely. Bridging anticoagulation therapy for patients at high risk for thromboembolism should be undertaken in consultation with the relevant experts.     

人兽共患病预防控制概述

2007年上半年广东省云浮市发生由高致病性猪蓝耳病引起的猪“高热病”疫情^[1]。曾一度引起当地人们的恐慌，这是来自人们身边的威胁，为此并结合相关的人兽共患病疫情，卫生部发出相关的“关于做好人畜共患病防治工作的通知”^[2]，虽然高致病性猪蓝耳病目前属于动物疫病，仅是在动物中传播的疫病，但对动物疫病加强研究和关注，