Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients

Background/AimsThe utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients.MethodscACLD patients were stratified into three categories (CSPH excluded, grey zone, and CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and hepatocellular carcinoma as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using non-selective beta-blocker (NSBB) was compared against other strategies in decision curve analysis.ResultsOne thousand one hundred fifty-nine cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients (subdistribution hazard ratio, 5.5; 95% confidence interval, 4.0–7.4). “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB.ConclusionsNon-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients.     

Nitrogen-Containing Bisphosphonates Are Associated With Reduced Risk of Pneumonia in Patients With Hip Fracture

The objective of this work was to study the risk of pneumonia and pneumonia mortality among patients receiving nitrogen-containing bisphosphonates (N-BPs), non-N-BP anti-osteoporosis medications, and no anti-osteoporosis medications after hip fracture. We studied a historical cohort using a population-wide database. Patients with first hip fracture during 2005–2015 were identified and matched by time-dependent propensity score. The cohort was followed until December 31, 2016, to capture any pneumonia and pneumonia mortality. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox-proportional hazards regression. Absolute risk difference (ARD) and number needed to treat (NNT) were calculated. We identified 54,047 patients with hip fracture. Of these, 4041 patients who received N-BPs and 11,802 without anti-osteoporosis medication were propensity score–matched. N-BPs were associated with a significantly lower risk of pneumonia compared with no treatment (6.9 versus 9.0 per 100 person-years; HR 0.76; 95% CI, 0.70 to 0.83), resulting in an ARD of 0.02 and NNT of 46. A similar association was observed with pneumonia mortality (HR 0.65; 95% CI, 0.56 to 0.75). When N-BPs were compared with non-N-BP anti-osteoporosis medications, the association remained significant. N-BPs were associated with lower risks of pneumonia and pneumonia mortality. Randomized controlled trials are now required to determine whether N-BPs, non–vaccine-based medications, can reduce pneumonia incidence in high risk groups. © 2020 American Society for Bone and Mineral Research.     

样品固相净化及反相高效液相色谱法测定血浆中茶碱

本文用氧化铝固相净化血样以消除血中杂质及某些合并用药的干扰,用Zorbax-C18柱及甲醇-(0.05 mol/L)醋酸钠缓冲液(50:50)为流动相,254 nm波长检测,咖啡因为内标测定了茶碱人体血浆浓度的变化。该法样品处理简便、快速,净化回收率好(80～86%)茶碱的检测限为0.2ng(信噪比3),在血浆中的最低检测浓度为20 ng/ml。标准曲线r为0.9995,日内变异系数1.89%,日间变异系数为2.41%,方法平均回收率为98.44±0.89%。     

对青少年特发性脊柱侧弯患者的体感诱发电位检查

本体感觉神经传导异常被认为与青少年特发性脊柱侧弯有关。用体感诱发电位检查在青少年特发性脊柱侧弯患者中是否合并存在本体感觉传导通道的功能异常。研究包括147例青少年特发性脊柱侧弯患者及31位同年龄分布正常对照。对每一位受试者检查胜后神经体感皮质诱发电位，电信号缺失、传导时间延长或双侧传导时间不对称为本体感觉传导通道结构性异常诊断指标。在脊柱侧弯患者中有7人电信号单或双侧缺失，其余140例脊柱侧弯患者中10例传导时间延长，其中4例双侧延长，6例单侧延长。结果证实，部分青少年特发性脊柱侧弯患者同时有本体感觉传导异常，提示青少年特发性脊柱侧弯可进一步分为有本体感觉传导异常及无异常两组。     

N-(4-乙氧羰基-4-取代丁酰基)-N-取代甘氨酸的合成

本文报道9个估计具有血管紧张素转化酶抑制活性的N-(4-乙氧羰基-4-取代丁酰基)-N-取代甘氨酸及其相应叔丁酯的合成和鉴定。药理初试结果,化合物Ⅶ₇和Ⅶ₉显示明显降压活性。     

Rp－HPLC法测定血清中的抗生育甾体药物利洛司酮

以ＲＵ４８６为内标，建立了血清样品中新型抗孕激素甾体药物利洛司酮（ｌｉｌｏｐｒｉｓｔｏｎｅ）的反相高效液相色谱法。色谱分析条件为μＢｏｎｄａｐａｋＣ１８柱１０μｍ，３００ｍｍ×３．９ｍｍＩＤ；流动相为甲醇－二氯甲烷－１０ｍｍｏｌ·Ｌ－１磷酸盐缓冲液（ｐＨ４．０）（６７：５：２８ｖ／ｖ）；紫外检测波长为３０２ｎｍ。利洛司酮的检测限为１ｎｇ（Ｓ／Ｎ≥４：１）。血清样品经二次液一液超声振荡萃取后，得到了较好的净化。血清样品中利洛司酮的方法回收率为１０３．３％，日内精密度及日间精密度平均ＲＳＤ为３．５１％及２．９２％。在浓度为１０～１０００ｎｇ·ｍｌ－１血清范围内呈线性关系。