Importance of vancomycin loading doses in intermittent infusion regimens

Purpose

Delayed achievement of target vancomycin serum concentrations may adversely affect clinical outcomes. The objective of this retrospective study was to explore the real frequency of loading dose use and to evaluate the impact of loading dose for the achievement of vancomycin PK/PD target in adult patients treated with intermittent vancomycin. As a secondary aim we determined optimal vancomycin loading dose based on individual pharmacokinetic calculations.

长链非编码RNA在肝细胞肝癌中的研究进展

肝细胞肝癌(HCC)是肝癌最常见的病理类型,患者病死率高。对HCC发生发展机制的认知局限是其不良预后的重要原因。长链非编码RNA(lncRNA)是基因调控的重要组成部分,在不同疾病患者和不同组织中的表达具有特异性。近年来,lncRNA在癌症发生发展中作用的研究逐渐深入,这为HCC早期诊断、病情控制和预后评估提供了新的方法和思路。本文就长链非编码RNA在HCC中的研究进展作一综述。     

左心声学造影诊断二尖瓣血囊肿一例

病例：患者男性,32岁,发现心脏杂音17年,间断胸痛气短1年。患者于17年前体检发现心脏杂音,未重视;1年前患者劳累后出现胸痛气短不适,伴恶心,胸痛呈绞痛样,持续约15分钟,休息后好转,后频繁发作晕厥不适,1年内发作3次,近来患者频发夜间阵发性呼吸困难。入院查体：体温：36.6℃,脉搏：60次/分,呼吸：18次/分,血压：110/67mmHg。心界向左下扩大,心尖部可闻及 3/6级收缩期吹风样杂音。     

Chronische myeloproliferative Erkrankungen

Zusammenfassung Die chronischen myeloproliferativen Erkrankungen (CMPE) sind neoplastische Erkrankungen der hämatopoetischen Stammzelle. Sie umfassen die chronische myeloische Leukämie (CML), die Polycythaemia vera, die essentielle Thrombozythämie, die primäre Osteomyelofibrose und Übergangsformen innerhalb dieser Erkrankungen sowie zwischen den CMPE und den Myelodysplasien. Hauptziele der Initialdiagnostik sind die genaue Klassifizierung der Erkrankung, die Erfassung von Risiko- und Prognosefaktoren sowie die Charakterisierung des malignen Klons mittels Zytogenetik und molekulargenetischer Methoden. Herkömmliche Therapeutika für alle CMPE sind Hydroxyurea und Interferon-. Bei der CML führt die gezielte Hemmung der BCR-ABL-Tyrosinkinase mit Imatinib klinisch zu hohen Ansprechraten. Die bisher einzige kurative Therapie für alle Entitäten ist die allogene Stammzelltransplantation. Bei der CML sollte die Indikation auf der Basis der neueren Risikoscores gestellt werden. Bei den BCR-ABL-negativen CMPE ist sie nur bei ungünstigem Krankheitsverlauf in Erwägung zu ziehen.

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Spontaneous remission in adult acute myeloid leukemia in association with systemic bacterial infection—case report and review of the literature

Spontaneous remission of acute myeloid leukemia in the adult is a rare event. We report on a 31-year-old male patient suffering from acute myeloid leukemia (AML) M5a according to the French-American-British (FAB) classification with biphenotypic features in flow cytometric examination and severe bacterial infection with group G streptococci at the time of diagnosis. Because of sepsis and stable clinical conditions, chemotherapy was delayed and antibiotics were administered intravenously. Within 6 weeks a spontaneous remission of AML occurred. Remission lasted for about 2 months. At the time of relapse, a change in phenotype of the leukemic blasts with a loss of B-lymphoid markers could be demonstrated by flow cytometry. The patient was treated with an induction therapy according to the multicentric German AMLCG 2000 schedule. To our knowledge, this is the first report of a spontaneous remission in an AML FAB M5a associated with coexpression of myeloid- and lymphoid-associated antigens on the leukemic blasts. Possible mechanisms of this phenomenon are discussed with a review of the literature.     

Fatigue failure load of immature anterior teeth: influence of different fiber post-core systems

Odontology - The aim was to explore the fracture-behavior, survival and marginal-microgaps within the root-canal of immature anterior teeth restored with different fiber-reinforced post-core...     

单泵输血辅助胸腹主动脉联合置换治疗马凡综合征Stanford B型主动脉夹层

目的：探讨采用改良单泵输血辅助胸腹主动脉联合置换治疗马凡综合征Stanford B型主动脉夹层的疗效。方法：回顾性分析自2011年1月至2018年12月在本院心脏大血管外科接受胸腹主动脉联合置换术的马凡综合征Stanford B型主动脉夹层患者19例,男性9例,女性10例,年龄32.6±9.8岁,手术经胸腹联合切口、腹膜后入路,采用单泵输血辅助、分段阻断的方法,重建肋间动脉及腹腔内脏血管。结果：全组患者手术均成功。无早期死亡,无截瘫发生,其中1例患者术后出现短暂性轻瘫并声音嘶哑,症状在出院前好转,术后呼吸功能不全4例（21.1%）,肾功能不全2例（10.5%）,但均未达到透析指标,肝功能不全3例（15.8%）。随访期间5年全因生存率94.6%,免于再手术率85.1%。其中3例患者术后再发升主动脉病变行二期手术治疗,1例三期行二尖瓣置换,一例患者死于脑血管意外。结论：改良单泵输血辅助胸腹主动脉联合置换术是治疗马凡综合征合并Stanford B型主动脉夹层有效安全途径,近远期效果满意。     

Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction

The authors prospectively analysed 50 patients with chronic anterior disc displacement without reduction, who underwent arthroscopic lysis and lavage of the temporomandibular joint (TMJ). Patients with symptoms lasting less than 1 year were assigned to Group A (n=28) and patients with symptoms lasting more than 1 year to Group B (n=22). The most common problems were inflammatory changes of synovial and retrodiscal tissue (Group A, 71%; Group B, 82%). Fibrous adhesions were present in 14% of Group A patients and 45% of Group B patients. Degenerative changes of the disc and articular surface were present in 4% of Group A patients and 32% of Group B patients. Mouth opening increased 123% from baseline in Group A, and 112% in Group B (P<0.05). Pain decreased significantly in both groups (Group A, 2.5 points; Group B, 1.68 points; P<0.05). In conclusion, almost all patients with chronic anterior disc displacement without reduction benefited from arthroscopic lysis and lavage of the TMJ. Patients with a shorter duration of symptoms problems benefited more than those with a longer duration. Arthroscopic lysis and lavage of the TMJ is safe and beneficial in chronic anterior disc displacement without reduction.     

Short pain-provoked head-up tilt test for the confirmation of vasovagal syncope

We investigated a short pain-provoked head-up tilt (PP-HUT) and the Calgary Syncope Symptom Score in a group of patients with clinically diagnosed vasovagal syncope and group of neurological patients without transient loss of consciousness. We included 127 consecutive patients who were investigated in our laboratory. The group 1 included 56 patients who after appropriate investigations were diagnosed with vasovagal syncope. The group 2 included 70 neurological patients without transient loss of consciousness. The subjects were tilted to 70° for a maximum period of 10 min or until symptoms occurred. If there were no symptoms after initial 10 min, a painful stimulus with the insertion of 0.7 mm needle into the dorsum of hand subcutaneously for 30 s was performed with the patient in the tilted for further 5 min. Calgary Syncope Symptom Score was calculated for all patients. In the group 1, significantly higher number of patients had positive results on PP-HUT (36 vs. 6 patients, respectively; p < 0,001). There was no difference in the presence of orthostatic hypotension (8 vs. 15 patients, respectively; p = 0.36) or postural orthostatic tachycardia syndrome (3 vs. 1 patient, respectively; p = 0.32) between groups. PP-HUT had sensitivity of 65.9 % (95 % CI 0.49–0.79) and specificity of 89.7 % (95 % CI 0.75–0.97). The CSSS had sensitivity of 58.5 % (95 % CI 0.42–0.73) and specificity of 46.1 % (95 % CI 0.30–0.63). PP-HUT has a higher diagnostic rate than the CSSS and provides a rapid alternative to conventional methods.