危重症患儿血栓栓塞的危险因素分析和干预

目的 分析危重症患儿静脉血栓栓塞（VTE）发病的主要危险因素,并探索有效的干预措施.方法 前瞻性研究321例PICU患儿,经影像确诊静脉血栓栓塞,分析各种因素对危重症患儿静脉血栓栓塞发病和预后的影响,针对性地制定干预措施.结果 30例患儿合并有症状性VTE,影响VTE的危险因素有：年龄、心脏疾病、手术情况、中心静脉导管、机械通气.有中心静脉置管（CVC）的患儿VTE发病率升高,VTE患儿病情重、死亡率升高.结论 PICU患儿VTE发病率较高,CVC的使用和机械通气是主要的危险因素,一定的干预可能减少VTE的发病和改善预后.     

Review of atypical antipsychotics in anxiety

Atypical antipsychotics are increasingly used for treatment of anxiety disorders, either in mono- or combination therapy. This is the first review reporting on the use of atypical antipsychotics in monotherapy or augmentation in patients with primary anxiety disorders or anxiety (disorders) comorbid to schizophrenia, bipolar disorder (BPD) and major depressive disorder (MDD). We included 49 open-label trials, 32 randomized, placebo-controlled trials (RCTpls) and five randomized controlled trials without placebo arm with almost 6000 patients (open-label: 1710, randomized: 4145). An increasing number of RCTpls show promising results in 27-71% of patients with primary or comorbid anxiety disorders who were treated with monotherapy atypical antipsychotics or augmentation therapy. However, methodological flaws of included studies may limit conclusions of this review and larger placebo-controlled trials are warranted comparing standard treatment with monotherapy and augmentation therapy of atypical antipsychotics and placebo. In addition, higher dropout rates and side effects from treatment with atypical antipsychotics may limit the use of atypical antipsychotics in patients with anxiety disorders.     

肺癌并静脉血栓栓塞症的危险因素分析

目的 总结我院38例肺癌合并静脉血栓患者的临床资料,探讨其发生的危险因素.方法 对2010年4月至2015年7月本院38例肺癌合并静脉血栓患者(血栓组)与同期76例不存在静脉血栓的肺癌患者(非血栓组)的临床资料进行回顾性病例-对照分析.单因素分析后,对有可能有意义的因素进行多因素Logistic回归分析,查找肺癌合并静脉血栓的危险因素.结果 单因素分析显示腺癌、ⅢB～Ⅳ期、D二聚体增高、中心静脉置管、CEA增高是发生静脉血栓的危险因素(P＜0.05).多因素回归分析显示腺癌、ⅢB～Ⅳ期、D二聚体增高是肺癌发生静脉血栓的独立危险因素(P＜0.05).结论 肺腺癌、肿瘤晚期、D二聚体增高是肺癌合并静脉血栓的高危因素.     

Statins and venous thromboembolism: a novel effect of statins?

ABSTRACT

Statins play a key role in the management of hypercholesterolemia and other dyslipidemias. However, statins exert several other actions, often referred to as ‘pleiotropic’. This Editorial looks at the JUPITER trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), examining, in particular, the occurrence of venous thromboembolism in the rosuvastatin and placebo groups, and discussing these findings in the context of the current literature. The authors conclude that statin use could perhaps be associated with reductions in the risk of venous thromboembolism, and call for further appropriately designed studies.     

冬眠灵与维思通对男性精神分裂症患者性生活满意度的比较调查研究

目的比较研究传统的抗精神病药物与非传统抗精神病药物对男性精神分裂症患者性生活质量的影响。方法对200例男性精神分裂症患者随机分为服用传统的抗精神病药物冬眠灵组和服用非传统抗精神病药物维思通组。服用后对患者进行性生活质量的问卷调查。结果冬眠灵组患者性生活质量降低明显,维思通组为无明显下降,差异有统计学意义(P<0.05).结论传统的抗精神病药物冬眠灵有降低性生活满意度。     

Comparison of the effects of antipsychotics on a delayed radial maze task in the rat

Rationale The cognitive impairments evident in many schizophrenics are related to the severity of their negative symptoms and ability to function in society. Drugs that alleviate cognitive impairments, in addition to other psychotic symptoms, may have an important influence on treatment outcome and the course of the illness. Objectives A delayed non-match to sample task conducted in an eight-arm radial maze was used to determine the influence of four atypical antipsychotics (olanzapine, ziprasidone, risperidone, and clozapine), as well as a typical neuroleptic (haloperidol) on consolidation processes in healthy rats. Method Well-trained rats were required to recall after a 7-h delay where they had received food pellets during an information phase (first four arm choices) in order to obtain the remaining food pellets during a retention phase (second four arm choices). Results The total number of errors that occurred during the retention session increased with increasing delay periods from 0 to 7 h. When administered orally immediately after the information phase, olanzapine (3 and 5 mg/kg) and risperidone (0.1 mg/kg) significantly reduced the number of errors made during the retention phase. Under the same conditions, clozapine, ziprasidone and haloperidol failed to affect the total number of retention phase errors. Conclusion Some atypical antipsychotics, such as olanzapine and risperidone, improve consolidation processes and may alleviate the cognitive impairments associated with schizophrenia.     

Risk of venous thromboembolism due to antipsychotic drug therapy

An increasing number of reports suggest a link between venous thromboembolism (VTE) and the use of antipsychotics. To better understand this association the available body of evidence has been critically scrutinised. Relevant articles were identified in the databases Scopus and PubMed. Several observational studies using different methodologies show an increased risk of VTE in psychiatric patients. This elevated risk seems to be related to the use of antipsychotic medication and in particular to the use of clozapine and low-potency first-generation drugs. Many studies investigating the association have, however, methodological limitations. The biological mechanisms involved in the pathogenesis of this possible adverse reaction are largely unknown but several hypotheses have been suggested such as drug-induced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinemia and hyperprolactinemia. The association may also be related to underlying risk factors present in psychotic patients. Physicians need to be aware of this possible adverse drug reaction. Although supporting evidence has not been published they should consider discontinuing or switching the antipsychotic treatment in patients experiencing VTE. In addition, although data is lacking, the threshold for considering prophylactic antithrombotic treatment should be low when risk situations for VTE arise, such as immobilisation, surgery and so on.     

One-year clinical and economic consequences of oral atypical antipsychotics in the treatment of schizophrenia

ABSTRACT

Objective: To assess the clinical and economic consequences of oral atypical antipsychotic treatment (aripiprazole, olanzapine, paliperidone ER, quetiapine, risperidone, and ziprasidone) in schizophrenia over one-year from a US healthcare system perspective.

Methods: The decision model captured rates of discontinuation, symptom response, frequency and duration of relapse, adverse events (extrapyramidal symptoms and weight gain), resource utilization, and unit costs. Published randomized, double-blind, placebo-controlled clinical trial data were used to obtain response rates for comparators. Published clinical trial data from long-term effectiveness trials reflective of typical clinical settings were used for time on therapy, rates of discontinuation, likelihood of switching, relapse rates, and adverse event rates. Drug costs were based on Wholesale Acquisition Cost weighted by Wolters Kluwer Retail and First Databank Pricing drug utilization data. PharMetrics Patient-Centric database was utilized for length of stay, frequency of relapse, and unit cost of healthcare resource data. A clinical expert panel provided resource-use information not available in published literature or healthcare databases. To test the robustness of the findings, sensitivity analyses were performed using plausible ranges of key model input parameters.

Results: The model estimated that, over 1 year, clinical outcomes of patients administered oral atypical antipsychotics would not vary considerably. This is partly due to differences ‘washing out’ because of frequent switching and discontinuation of medication. Economic outcomes did vary among pharmacotherapies: paliperidone ER was associated with cost savings in direct medical costs per patient per year compared to risperidone (cost savings using paliperidone ER vs. risperidone: $793), quetiapine ($1191), olanzapine ($1259), ziprasidone ($2159), and aripiprazole ($2204)). Limitations of this analysis include the absence of direct head-to-head long-term comparative data for antipsychotics. However, the results of the decision analysis held true when tested through a multitude of sensitivity analyses.

Conclusion: This modeling study showed that paliperidone ER had the most favorable clinical and economic outcomes compared to other oral atypical antipsychotics for patients with schizophrenia. The analysis supports the notion that frequent discontinuation of medication is a problem with all oral antipsychotic treatments for schizophrenia.     

Effects of atypical antipsychotics on vertebrate neuromuscular transmission

A study was made of the effects of the atypical antipsychotics clozapine, olanzapine, sulpiride and risperidone on nicotinic synaptic transmission at the frog neuromuscular junction. At concentrations higher than 10 microM, these atypical antipsychotics partially reduced the amplitude of miniature end-plate currents (mEPCs) in a dose-dependent and reversible manner. Atypical antipsychotics were, however, less effective than typical neuroleptics of the phenothiazine family at inhibiting mEPCs. In addition to decreasing mEPC amplitude, the atypical antipsychotics reduced the half-decay time of mEPCs. In the case of clozapine, the reduction in mEPC amplitude and duration was not markedly voltage-dependent. Beside their post-synaptic effects, all atypical neuroleptics, except sulpiride, increased the frequency of mEPCs in a concentration-dependent manner, with the strongest effect seen with clozapine. Altogether, these results raise the possibility that atypical neuroleptics could derive some of their therapeutic effects not only from their well-known inhibitory action on dopaminergic receptors, but also from their pre- and post-synaptic modulation of nicotinic neurotransmission.     

Medication patterns and costs associated with olanzapine and other atypical antipsychotics in the treatment of bipolar disorder

ABSTRACT

Objective: Atypical antipsychotics are playing an increasing role in the treatment of bipolar disorder. The objective of this study was to assess the medication treatment patterns and costs associated with different atypical antipsychotics.

Methods: PharMetrics Integrated Database for medical and pharmacy claims was used to assess medication patterns and healthcare costs associated with atypical antipsychotics in the treatment of bipolar disorder. Patients who initiated on olanzapine, risperidone, quetiapine or ziprasidone as monotherapy or in combination with other bipolar medications between 01/2003 and 01/2004 were followed for 1 year. Pair-wise group comparisons were made between olanzapine and other atypical antipsychotics using Wilcoxon without adjustment, log linear regression model with adjustment, and propensity score-adjusted bootstrapping methods.

Results: Among 1516 patients with bipolar disorder, olanzapine (n = 507, 51%) was significantly (?p < 0.01) more likely to be initiated as the mono-bipolar medication than risperidone (n = 424, 40%), quetiapine (n = 463, 36%) or ziprasidone (n = 122, 25%). Post-initiation, olanzapine was used as the mono-bipolar medication for significantly (?p < 0.01) more days (73.4) than risperidone (52.9), quetiapine (56.2) and ziprasidone (36.6). Annual healthcare costs incurred by patients with bipolar disorder varied from $14?216 for risperidone, $15?208 for olanzapine, $18?087 for quetiapine to $18?729 for ziprasidone treatments. No statistically significant differences in the annual healthcare costs were observed between olanzapine and risperidone treatments. Statistically significant differences between olanzapine and quetiapine were observed in two of the three models compared (?p < 0.01, Wilcoxon; p = 0.024, log linear; p = 0.390, propensity score-adjusted bootstrapping) and between olanzapine and ziprasidone in one of the three models (?p < 0.01, Wilcoxon; p = 0.068, log linear; p = 0.394, propensity score-adjusted bootstrapping).

Limitations: Those arising from the data source and nature of retrospective assessments. Potential bias may also exist due to the presence of confounding factors and unobserved conditions and characteristics. As such, results of this study need to be considered in the context of its limitations and generalizability should be reserved to similar patient populations.

Conclusions: Antipsychotic medication use patterns were statistically significantly different among atypical antipsychotics in the usual treatment of bipolar disorder. Olanzapine appears to be more likely used as a mono-bipolar medication compared with risperidone, quetiapine, and ziprasidone. The annual healthcare costs associated with the treatment of bipolar disorder by olanzapine and risperidone were similar, and the costs of these treatments were lower than with quetiapine or ziprasidone.     

基于Caprini血栓风险评估模型对妇科恶性肿瘤相关静脉血栓形成的风险预测

目的 探究Caprini血栓风险评估模型以及新建立的模型对妇科恶性肿瘤相关静脉血栓(VTE)形成的风险预测价值。方法 选取2015年1月—2020年6月湖南省肿瘤医院妇科恶性肿瘤并发VTE的患者161例,依据1∶2的比例抽取同期322例妇科恶性肿瘤患者为对照组。收集两组患者的临床资料,分析影响妇科恶性肿瘤相关VTE发生的危险因素,构建新的Caprini血栓风险评估模型,绘制受试者工作特征(ROC)曲线,与原Caprini血栓风险评估模型进行比较。结果 对照组患者的Caprini评分低于VTE组(P<0.001)。两组患者年龄、肿瘤分期、高血压、高脂血症、糖尿病、输血史、绝经状态、化疗、血小板计数和D-2聚体水平比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,合并高血压、高脂血症、糖尿病、有输血史、绝经、化疗、血小板计数≥300×109L^-1和D-2聚体≥0.55μm·mL^-1均为妇科恶性肿瘤患者发生VTE的独立危险因素(P<0.05)。与Caprini血栓风险评估模型相比较,新构建的Caprin...     

Use and tolerability of newer antipsychotics and antidepressants: a chart review in a paediatric setting

Objective To analyse the prescribing pattern and the safety profile of different atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) during the years 2002–2003 in paediatric setting. Setting Two Child Neurology and Psychiatry Divisions of Southern Italy (University of Messina and “Oasi Institute for Research on Mental Retardation and Brain Aging” of Troina). Methods A retrospective chart review of all children and adolescents starting an incident treatment with atypical antipsychotics or SSRIs was performed. Within the first 3 months of therapy, any potential adverse drug reaction (ADR) was identified and the clinical outcome of psychotropic drug treatment was assessed. Main Outcome Measure Rate of ADR in the first 3 months of therapy with atypical antipsychotics and SSRIs in children and adolescents. Results On a total of 97 patients’ charts being reviewed, 73 (75%) concerned atypical antipsychotics and 24 (25%) SSRIs. Risperidone (N = 45, 62%) was the most frequently prescribed antipsychotic drug, followed by olanzapine (24, 32%). Overall, 50 (68%) antipsychotic users reported a total of 108 ADRs during the first 3 months of therapy, leading to drug discontinuation in 23 patients (31%). Among 24 users of SSRI, 12 (50%) received paroxetine, 6 (25%) sertraline, 5 (21%) citalopram and 1 (4%) fluoxetine. Only paroxetine users (21%) reported at least one ADR, however, none of SSRI users withdrew drug treatment within first 3 months. Conclusions ADRs occurred frequently during first 3 months of treatment with atypical antipsychotics and, to a lesser extent, with SSRIs in children and adolescents. Further investigations are urgently needed to better define the benefit/risk ratio of psychotropic medications in paediatric setting.     

Tamoxifen and risk of idiopathic venous thromboembolism

Aims To evaluate a possible positive association between tamoxifen treatment and the risk of developing idiopathic venous thromboembolism (VTE) in women with breast cancer in the absence of clinical risk factors for venous thromboembolism other than breast cancer itself.
Methods Using information from the large UK-based General Practice Research Database, we identified, within a cohort of more than 10 000 women with breast cancer, all women who developed a first-time diagnosis of deep vein thrombosis or pulmonary embolism of uncertain cause between January 1, 1991 and December 31, 1996. In a case-control analysis, we compared their tamoxifen exposure experience prior to the thromboembolic event with that of a randomly selected group of control women with breast cancer who were matched to cases on age, year of the breast cancer diagnosis and calendar time.
Results We identified 25 cases of idiopathic VTE and 172 controls, all of whom had breast cancer, but were otherwise free from other risk factors for VTE. Past tamoxifen exposure was not materially associated with an elevated risk of developing VTE, and we therefore combined never and past users as reference group. The relative risk estimate of VTE for current tamoxifen exposure, as compared with never and past use combined, was 7.1 (95% CI 1.5–33), adjusted for body mass index, smoking status and hysterectomy status. High body mass index was an independent predictor of VTE itself.
Conclusions Our study provides evidence that current use of tamoxifen increases the risk of idiopathic venous thromboembolism.