Morbidity associated with heroin overdose presentations to an emergency department: A 10‐year record linkage study

Introduction: To examine hospitalizations in a cohort of 224 patients who presented with non‐fatal heroin overdose to an ED. Methods: A record linkage study, using the morbidity, mental health and mortality databases in the Data Linkage Unit of the Department of Health, Western Australia. The main outcome measures were hospital separations 5 years before and after entry into the cohort. Results: Before entry into the cohort, 199 (89%) patients had an admission to mental health services. These 199 had a combined total of 1367 separations, most commonly for a mental health condition, injury or poisoning. Women had more than twice the relative risk (RR) of men for all separations (RR 2.35, 95% confidence interval [CI] 1.96–2.82, P < 0.001) and for injury and poisoning separations (RR 2.04, 95% CI 1.56–2.66, P < 0.001). The highest concentrations of separations occurred within 1 year before and 1 year after entry into the cohort. There were 12 (5.4%, 95% CI 2.9–9.4%) deaths, most commonly from overdose. Conclusion: Non‐fatal heroin overdose ED presentations are associated with a cluster of hospitalizations around that episode, likely to be related to heroin availability. Presentation to hospital by heroin users represents an opportunity to counsel less risky behaviour.     

Risk factors for colorectal neoplasia in inflammatory bowel disease: a nested case-control study from Copenhagen county, Denmark and Olmsted county, Minnesota

OBJECTIVES: Population-based data on risk factors and protective factors for colorectal dysplasia and cancer in patients with inflammatory bowel disease (IBD) are sparse. We conducted a nested case-control study of such factors in two well-described IBD cohorts from Copenhagen County, Denmark and Olmsted County, Minnesota. METHODS: Forty-three neoplasia cases were matched on six criteria to 1-3 controls (N = 102). Medical records were scrutinized for demographic and clinical data. For each variable, the odds of neoplasia were estimated using conditional logistic regression. RESULTS: Primary sclerosing cholangitis (PSC) (odds ratio [OR] 6.9, 95% confidence interval [CI] 1.2-40), percentage of disease course with clinically active disease (OR [per 5% increase] 1.2, 95% CI 0.996-1.4), and >or=1 yr of continuous symptoms (OR 3.2, 95% CI 1.2-8.6) were associated with neoplasia, whereas a borderline association with median number of small-bowel x-rays (OR 1.3, 95% CI 0.96-1.6) was observed. We did not observe a protective effect of frequency of physician visits (OR 1.4, 95% CI 0.96-2.0), number of colonoscopies (OR 1.4, 95% CI 1.0-2.1), cumulative dose of sulfasalazine (OR [per 1,000 g] 1.1, 95% CI 1.0-1.3) and mesalamine (OR [per 1,000 g] 1.3, 95% CI 0.9-1.9), or partial intestinal resections (OR 1.5, 95% CI 0.3-7.1). CONCLUSIONS: Subgroups of IBD patients-those with PSC, severe long-standing disease, and exposure to x-ray-were at greater risk of colorectal neoplasia. The protective effect of close follow-up, colonoscopy, and treatment with 5-aminosalicylates was questionable.     

肾移植术后肾功能延迟恢复原因及术后血液净化的干预作用

目的：分析肾移植术后常见并发症肾功能延迟恢复的诱因，并观察术后血液净化干预所发挥的临床效应。方法：选择1996—12/2006—12在解放军第三军医大学大坪医院野战外科研究所泌尿外科明确诊断为肾移植术后肾功能延迟恢复的患者193例，其中接受尸肾移植192例，活体肾移植1例，均知情同意。根据患者的临床资料，分析术后肾功能延迟恢复的主要原因。除5例因术前安置腹膜透析管继续采用腹膜透析外，其余均选择血液透析治疗，其中35例穿插接受过连续性肾脏替代治疗或血液透析滤过，8例血浆置换2-5次。终止透析的标准为每日尿量〉1500mL，血肌酐〈300μmol／L。分析术后肾功能延迟恢复的原因，观察接受透析治疗后肾功能延迟恢复患者的临床疗效。结果：193例患者全部进入结果分析。①术后肾功能延迟恢复的病因：急性肾小管坏死89例（46．1％），术后早期低血压42例（21．8％），排斥反应37例（19．2％），动静脉吻合口狭窄9例（4-7％），尿路梗阻8例（4．1％），动脉过长扭曲5例（2．6％），环孢素A肾毒性2例（1．0％），髂内动脉粥样硬化斑块阻塞1例（0．5％）。（④术后肾功能转归：移植肾功能恢复正常者145例（75．1％）；术后3个月血肌酐135-300μmol／L29例（15．3％）；〉300μmol/L15例（7．8％）；因超急性排斥反应切除移植肾2例（1％），肺部重症感染死亡2例（1％）。③术后接受血液透析次数：术后接受血液透析189例，透析1—5次移植肾功能恢复正常20例（13．8％）；6-10次41例（28．3％）；11-20次82例（56．6％）；21-25次2例（1．4％）；〉25次44例，仅1例恢复正常（0．7％），其余43例患者带肾存活。结论：急性肾小管坏死、术后早期低血压和排斥反应是引起肾移植术后肾功能延迟恢复的主要原因。在肾功能延迟恢复患者确定以血液净化为主的方案后，绝大多数移植肾功能可以恢复。     

薄层扫描法测定熊胆引流物中胆汁酸含量

熊胆向以贵重药材闻名,被称之为稀有药品,为开发熊胆资源,解决熊胆奇缺问题,我校解剖教研室已成功地完成了人工引流熊胆汁技术,可随时进行人工引流获取熊胆汁。为了确定胆汁的质量指标,了解其主要成分,我们进行了引流胆汁与天然熊胆的分析。文献报道,熊胆中主要含熊去氧胆酸(ursodesoxycholic acid,UDCA)、鹅去氧胆酸(cheno desoxycholic acid,CDCA)、胆酸(cholic acid,CA)、去氧胆酸(deoxycholic,acid DCA)等。     

Prolonged breastfeeding in Bangladesh: indicators of inadequate feeding practices or mothers'' response to children''s poor health?

The association between breastfeeding and diarrhoeal morbidity was examined in a prevalence study of 5502 children aged 6-71 months from rural and urban Bangladesh. Breastfeeding was found to be associated with reduced prevalence of diarrhoea. This association was most pronounced at the age of six months and declined linearly to zero at approximately 30 months of age; thereafter, breastfeeding was increasingly associated with diarrhoeal illness. The linear association was found only among those children who have no access to modern health services and information, when controlling for urban and rural differences. The literature provides two opposing explanations for the positive association of prolonged breastfeeding with diarrhoeal illness. The first explanation suggests that breastfeeding can be seen as mothers' response to children's poor health. The second explanation incriminates sub-optimal child feeding practices, characterised by prolonged breastfeeding and inadequate quality and quantity of complementary foods, as the cause of malnutrition and diarrhoea. Further studies are needed to identify which explanation is correct, given the public health implications in terms of children's survival, growth and development.     

慢性移植肾失功356例危险因素分析

目的:慢性移植肾失功是导致后期移植肾丧失的重要原因之一,文章拟探讨慢性移植肾失功的相关因素及防治措施。方法:①选择1993-12/2006-12于解放军第三军医大学大坪医院行肾移植术后发生慢性移植肾失功患者356例,回顾性分析其临床资料。②调整免疫抑制剂方案,停服硫唑嘌呤、环孢素A或减少环孢素A30%￣50%剂量,改用他克莫司0.5￣1mg/(kg·d)、霉酚酸酯1￣2g/d、西罗莫司1￣2mL/d等药;控制血糖、血脂、血压,抗凝及补充鱼肝油丸;服用雷公藤、百令胶囊或尿毒清等中药,给予低蛋白、低磷及高维生素、氨基酸饮食;必要时手术切除移植肾。③分析肾移植术后发生慢性移植肾失功的危险因素并观察其治疗结果。结果:①慢性移植肾失功的危险因素:急性排斥反应254例(71.35%),巨细胞病毒感染65例(18.26%),移植肾肾小球肾炎21例(5.9%),药物中毒(环孢素A/他克莫司)9例(2.53%),高血压/高血脂/高血糖5例(1.41%),肾单位减少(高龄供肾/性别差异)2例(0.56%)。②治疗结果:切除移植肾194例(54.49%),带肾存活、恢复血液透析87例(24.44%),经治疗血肌酐维持在200￣300μmol/L63例(17.70%),死亡12例(3.37%)。结论:急性排斥反应是引起肾移植术后慢性移植肾失功的主要因素。提高供肾质量,严格组织配型,减少移植肾功能延迟恢复的发生,制定个体化免疫方案,定期监测药物浓度及肝肾功能,预防巨细胞病毒感染,可减少慢性移植肾失功的发生。