新生儿呼吸窘迫综合征的管理——欧洲共识指南2010版

一、简介 2010版指南包含了2007年后循证医学的最新证据,如现在有更多的证据支持以前推荐的早期使用肺表面活性物质及持续气道正压通气(CPAP);对产房稳定进行了扩充,并有一些新的推荐,如延迟脐带结扎;增加了避免和减少使用机械通气及通气时间,以及咖啡因、鼻腔通气、允许性高碳酸血症、新式呼吸机通气模式的使用等内容;还增加了其他情况下发生的新生儿呼吸窘迫综合征(RDS)的管理.该指南得到欧洲围产医学会的认同.     

Tuberculosis in rheumatic patients treated with tumour necrosis factor alpha antagonists: the Portuguese experience

In Portugal, 13 cases of tuberculosis (TB) were reported, in the period between 1999 and 2005, in 960 patients exposed to anti-TNFalpha treatment (1.35%), 8 females and 5 males. Mean age was 46.7 +/- 13.8 years. 9 patients had rheumatoid arthritis (RA), in 639 exposed patients (1.4%), 3 had ankylosing spondylitis (AS), in 200 exposed patients (1.5%) and 1 had psoriatic arthritis (PA), in 101 exposed patients (1%). The anti-TNFa used was in 8 cases infliximab (in 456 patients exposed, 1.5%), in 4 adalimumab (in 171 patients exposed, 2.3%) and in 1 etanercept (in 333 exposed, 0.3%). Treatment with a biological agent was started 11.1 +/- 8.7 months (min 3 and max 50) before TB onset. Tuberculin skin test (TST) was performed in 9 out of the 13 patients (the other 4 had started biological therapy before 2002). In 3 cases the TST response was 0 mm, in 3 less than 10 mm, in one was 14 mm and in two 20 mm. In the 3 cases with a TST response superior to 10 mm, isoniazid treatment 300 mg/d was prescribed, during 9 months. The time between first symptoms and TB diagnosis was 2.6 +/- 2.9 months. TB involvement was pulmonary in 6 patients, lymph node disease in 2, peritoneal and pulmonary in 2, osteoarticular in one case, lymph node disease and splenic in another and miliar TB in the last case. One death was reported; all of the other cases had a good outcome after anti-TB treatment. In two cases (one treated with adalimumab and the other with infliximab), paradoxical response to treatment occurred. None of the patients has restarted biological therapy after TB treatment.     

Staplerh?morrhoidopexie im Vergleich zur Milligan-Morgan- und Ferguson-H?morrhoidektomie: ein systematisches Review

Zusammenfassung Fragestellung:   Ziel dieser Studie war, ein systematisches Review und eine Metaanalyse der Kurz- und Langzeitergebnisse der Staplerh?morrhoidopexie durchzuführen. Patienten und Methodik:   Mit einer Literatursuche wurden randomisierte, kontrollierte Studien zum Vergleich von Staplerh?morrhoidopexie und Milligan-Morgan-/Ferguson-H?morrhoidektomie abgefragt. Die Daten wurden für jede Studie einzeln entnommen und die Unterschiede mit Fixed- und Random-Effects-Modellen analysiert. Ergebnisse:   Es wurden 34 randomisierte Studien und zwei systematische Reviews gefunden; hiervon wurden 29 Studien eingeschlossen. Die Staplerh?morrhoidopexie erwies sich in Bezug auf den Klinikaufenthalt (p < 0,001) als statistisch signifikant überlegen und hinsichtlich der postoperativen Schmerzen (perioperativ und früh-postoperativ), der Operationsdauer sowie der Blutungen (postoperativ und sp?t-postoperativ) als numerisch überlegen. Nach der Staplerh?morrhoidopexie waren Prolapsrezidive und wiederholte Eingriffe aufgrund von Rezidiven h?ufiger. Bei den Komplikationsraten wurden keine Unterschiede beobachtet. Schlussfolgerung:   Die Staplerh?morrhoidopexie reduziert die Dauer des Krankenhausaufenthalts und k?nnte einen Vorteil im Sinne einer kürzeren Operationsdauer, weniger postoperativer Schmerzen und geringerer Blutungen bieten, ist jedoch mit einer erh?hten Rate von Prolapsrezidiven assoziiert. übersetzter Nachdruck aus Int J Colorectal Dis 2009;24:335–44; DOI 10.1007/s00384-008-0611-0.     

Acceptability and accessibility of a Shigellosis vaccine in Nha Trang city of Viet Nam

The acceptability and accessibility of a hypothetical Shigella vaccination campaign was explored. A household survey was conducted with 539 randomly-selected residents of six communes in Nha Trang city of Viet Nam. Four categories of acceptability, such as refusers, low acceptors, acceptors, and high acceptors, were established, Refusers were significantly more likely to be elderly women and were less likely to know the purpose of vaccinations. Low acceptors tended to be male, elderly, and live in urban areas. Low acceptors perceived the disease as less serious and themselves as less vulnerable than acceptors and high acceptors. In terms of accessing vaccination, the commune health centre workers and commune leaders were the preferred sources of information and commune health centres the preferred location for vaccination. Direct verbal information from healthcare providers and audio-visual media were preferred to written information. The respondents expressed a desire for knowledge about the side-effects and efficacy of the vaccine. These findings are significant for targeting specific messages about shigellosis and vaccination to different populations and maximizing informed participation in public-health campaigns.     

Endoxin antagonist lessens myocardial ischemia reperfusion injury

Endoxin antagonist lessens myocardial ischemia reperfusion injury@柯永胜$Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001 China @王德国$Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001 C     

Investigations into the safety and immunogenicity of a killed oral cholera vaccine developed in Viet Nam

OBJECTIVE: To evaluate a killed oral cholera vaccine produced in Viet Nam, and to compare the Vietnamese vaccine with one that is licensed internationally. METHOD: Two-dose regimens of a locally produced, bivalent, anti-O1, anti-O139 killed oral whole-cell cholera vaccine (biv-WC) and of a commercially available, monovalent (anti-O1) oral recombinant B subunit-killed whole-cell cholera vaccine (rBS-WC) were compared in two trials in Viet Nam. In the first trial, 144 adults were randomized to biv-WC with or without buffer, rBS-WC with buffer, or placebo without buffer. In the second, 103 children aged 1-12 years were randomized to biv-WC without buffer, rBS-WC with buffer, or placebo without buffer. FINDINGS: No regimen was associated with significant side-effects. In adults, ca 60% of recipients of either vaccine exhibited at least fourfold serum anti-O1 vibriocidal antibody responses and ca 40% of recipients of biv-WC demonstrated anti-O139 vibriocidal responses. Both anti-O1 (ca 90% in each vaccine groupand anti-O139 (68% in the biv-WC group) vibriocidal responses occurred more frequently in children. The responses to biv-WC were unaffected by the receipt of buffer. CONCLUSION: It was concluded that biv-WC was safe and immunogenic, that it could be administered without buffer, and that it could elicit robust immune responses even in children, for whom the risk of endemic cholera is highest.     

Phase II protocol for the evaluation of new treatments in patients with advanced gastric carcinoma: results of ECOG 5282

The study was a Phase II randomized study to evaluate the efficacy of new agents for the treatment of advanced gastric carcinoma. Patients were randomized to receive single agent chemotherapy with mitoxantrone, etoposide, aclacinomycin-A or spirogermanium. The patients were stratified by prior use of chemotherapy, prior doxorubicin use and ECOG performance status. Patients with a history of cardiac disease or prior doxorubicin exceeding a dose of 400 mg/m2 were restrictively randomized to sopirogermanium or etoposide only. One hundred and fourteen patients were registered for the study. Among 98 evaluable patients there were only two partial responses (both in the etoposide arm), and one complete response in the mitoxantrone arm. The median survival on the study was 3.3 months. One hundred and six patients were analyzable for toxicity. There were four treatment-related deaths and four life-threatening toxicities. Because of low response rates and relatively high toxicities the studied compounds were not deemed worth further investigation for advanced gastric cancer.     

The predetermination of embryonic sex using flow cytometrically separated X and Y spermatozoa

A review is given of the predetermination of sex in variousdomestic animals and in the human using sperm samples enrichedfor X- and Y-chromosome bearing spermatozoa obtained by flowcytometry and cell sorting. A comparison of other putative methodsof sperm separation is made. In separating human X and Y spermatozoa,measurements of the DNA content in each individual gamete usingthe Hoechst fluorochrome 33342 remains the only validated method.The difference in DNA content between human X and Y spermatozoais 2.8%, and cell sorters have been adapted to take accountof this and the asymmetrical nature of the sperm head. DNA analysesand PCR have been used to validate the method for animal spermatozoa.In the human, fluorescence in-situ hybridization (FISH) hasconfirmed sorting accuracy. Many correctly-diagnosed normaloffspring have been born in various animal species and any potentialmutagenic or cytotoxic effects are being closely monitored asare the cost and efficiency of the technology.     

Human chorionic gonadotrophin-beta gene sequences in women with disorders of HCG production

Women with recurrent abortion, primary unexplained infertility, and gestational trophoblastic neoplasia (GTN) manifest disordered human chorionic gonadotrophin (HCG) secretion. Mutations in the HCG beta/luteinizing hormone (LH) beta gene complex could cause aberrant HCG production in these disorders. The purpose of this study was to determine whether HCG beta gene deletions occur in women with recurrent abortion or primary unexplained infertility, and whether HCG beta gene duplications are present in women with GTN. DNA was extracted from 10 patients with unexplained recurrent abortion, 10 patients with unexplained primary infertility, 12 patients with GTN, three partners of women with GTN, and 30 controls. Southern blots were constructed and hybridized with DNA probes for HCG beta-5 and the LH beta gene. No gene deletions were identified in patients with recurrent abortion or primary unexplained infertility. Likewise, no gene duplications were identified in women with GTN. A previously described Mbol restriction fragment length polymorphism (RFLP) was identified in both patients and controls. A new Pstl RFLP was also characterized, but was present in patients and controls. Deletion/duplication mutations in the HCG beta/LH beta gene complex do not appear to be common causes of aberrant HCG production in humans with these disorders.