万古霉素血药谷浓度和临床结局相关性的系统评价和meta分析

目的:研究万古霉素血药谷浓度与死亡率、治疗失败率和肾毒性之间的关系。方法:系统检索Pub Med、Embase、Cochrane图书馆和三个中文数据库（CNKI、CBM和万方数据）,检索时间范围均为建库到2014年1月16日。纳入所有研究万古霉素谷浓度与临床结局相关性的文章,由两位研究者独立提取数据,并采用Newcastle-Ottawa评分评价观察性研究的质量,二分类变量结果选用相对危险比（RRs）和95%可信区间（95%CI）表示,如无统计学异质性则采用固定效应模型。主要终点结局是死亡率和治疗失败率,次要终点结局是肾毒性。结果:共纳入40个队列研究。与万古霉素谷浓度<15 mg·L^-1的患者相比,谷浓度≥15 mg·L^-1的患者的治疗失败率更低（RR=0.83,95%CI:0.70⁰.97,P=0.02）,肾毒性发生率更高（RR=1.99,95%CI:1.56².53,P<0.000 01）;与万古霉素谷浓度<10 mg·L^-1或<20 mg·L^-1相比,万古霉素谷浓度≥10 mg·L^-1或≥20 mg·L^-1与肾毒性发生率增加明显相关;万古霉素谷浓度与死亡率不相关。结论:与万古霉素谷浓度<15 mg·L^-1相比,万古霉素谷浓度≥15 mg·L^-1与降低治疗失败率和肾毒性发生率增加明显相关。当患者的万古霉素谷浓度≥15 mg·L^-1时,应注意患者增加的肾毒性发生风险。     

Adding cetuximab to paclitaxel and carboplatin for first-line treatment of carcinoma of unknown primary (CUP): results of the Phase 2 AIO trial PACET-CUP

Background Patients with carcinoma of unknown primary (CUP) have a dismal prognosis, even when treated with multi-agent chemotherapy. We hypothesised that adding the epidermal growth-factor receptor (EGFR) inhibitor cetuximab to standard first-line chemotherapy with paclitaxel and carboplatin would improve PFS and RR in unfavourable CUP.Methods This open-labelled, multicentre Phase 2 study included patients with unfavourable, untreated adeno- or undifferentiated CUP. Patients were randomised to receive either paclitaxel/carboplatin (group A) or paclitaxel/carboplatin plus cetuximab (group B) every 3 weeks for a maximum of 6 cycles followed by cetuximab maintenance in group B. The primary endpoint was PFS in the two groups. Secondary endpoints were RR, toxicity and overall survival (OS).Results One-hundred-and-fifty patients were randomised (group A = 72, group B = 78). The median PFS and OS for all patients were 3.8 and 8.1 months (95% confidence interval (CI): 2.9–4.8 and 6.8–9.5). There was no significant difference in PFS (3.7 vs 4.6 months, HR 0.98) or OS (8.1 vs 7.4, HR 1.1) between the two treatment groups. Response rate tended to be better for chemotherapy plus cetuximab compared to chemotherapy alone (22% vs 15%). Adverse events grade ≥3 were comparable between the two groups, except for significantly increased skin toxicity in the cetuximab arm.Conclusions Cetuximab plus paclitaxel/carboplatin did not improve PFS, OS and RR in metastatic CUP compared to paclitaxel/carboplatin alone. Addition of cetuximab resulted in additional skin toxicity.Clinical trial registration The study was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00894569","term_id":"NCT00894569"}}NCT00894569.Subject terms: Cancer therapy, Cancer     

Proportional unterstützende Beatmungsformen: Automatische Tubuskompensation (ATC) und Proportional assistierende Beatmung (PAV)

Kontrollierte mechanische überdruckbeatmung hat eine Reihe von unerwünschten Nebenwirkungen, die durch den Einsatz unterstützender Spontanatmungsverfahren teilweise vermieden werden k?nnen. Deshalb werden heute assistierende Verfahren zur Beatmung eingesetzt, und zwar nicht nur in der Phase der Entw?hnung von der Beatmung, sondern bereits im akuten Krankheitsverlauf. Ziel assistierender Beatmungsformen ist es m?glichst eine optimale Synchronisation zwischen Patient und Maschine und eine Reduzierung der Atemarbeit zu erreichen. Zur Optimierung der bekannten Verfahren wird einerseits eine Technik beschrieben, die den durch den Tubus bedingt erh?hten Atemwiderstand ausgleicht bzw. kompensiert (automatische Tubuskompensation (ATC)). Darüber hinaus stellt die proportional assistierende Beatmung (PAV) eine Beatmungsform dar, bei der nicht nur der Atemwiderstand durch die Beatmungsmaschine in variablem Ausma? kompensiert wird, sondern auch elastische Widerstandkomponenten der Atemarbeit kompensiert werden.     

EsKiMo – Das Ernährungsmodul im Kinder- und Jugendgesundheitssurvey (KiGGS)

In a module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the dietary behaviour of 6-17-year-olds was assessed from January to December 2006. The study, named EsKiMo (Eating Study as a KiGGS Module), was performed by the Robert Koch Institute together with the division of nutrition and consumer education at the University of Paderborn. It was funded by the Federal Ministry of Food, Agriculture and Consumer Protection. Parents of participants younger than 12 years were asked to conduct a 3-day dietary record. Participants of 12 years and older were personally interviewed about their eating behaviour during the last four weeks using DISHES (Dietary Interview Software for Health Examination Studies). In addition, they were asked to fill in the KiGGS food frequency questionnaire a second time. Furthermore, all participants were asked about their socio-demographic background, leisure time activities, supplement use, meals at school, body weight and height. The study will provide up-to-date, representative data on the nutrition of children and adolescents in Germany. The analyses will include the amounts of foods and food groups consumed as well as the nutrient intake. By connecting these nutrition data with other health data from KiGGS, comprehensive analyses of relationships between nutrition and health are possible.     

Assessing emerging technologies--the case of organ replacement technologies: volume, durability, cost

OBJECTIVES: The aim of this study was to estimate thresholds for production volume, durability, and cost of care for the cost-effective adoption of liver organ replacement technologies (ORTs). METHODS: We constructed a discrete-event simulation model of the liver allocation system in the United States. The model was calibrated against UNOS data (1994-2000). Into this model, we introduced ORTs with varying durability (time to failure), cost of care, and production volume. Primary outputs of interest were time to 5 percent reduction in the waiting list and time to 5 percent increase in expected transplant volume. RESULTS: Model output for both calibration and validation phases closely matched published data: waiting list length (+/-2 percent), number of transplants (+/-2 percent), deaths while waiting (+/-5 percent), and time to transplant (+/-11 percent). Reducing the waiting list was dependent on both ORT durability and production volume. The longer the durability, the less production volume needed to reduce the waiting list and vice versa. However, below 250 ORT/year, durability needed to be >2 years for any significant change to be seen in the waiting list. For base-case costs, all ORT production volume and durability scenarios result in more transplants per year at less total cost of care/patient than the current system. ORTs remain cost saving until manufacturing costs are >5 times base-case costs, production is less 500 ORT/year, and durability <6 months. CONCLUSIONS: Although there remain many technical challenges to overcome, as long as ORTs can meet these threshold criteria, they have the potential of transforming the world of end-stage liver disease.     

Relation between hydration status in children and their dietary profile - results from the DONALD study

OBJECTIVE: To describe associations between hydration status and dietary behaviour in children, as current research indicates that hydration status is influenced by nutrition vice versa, hydration status may influence dietary behaviour. DESIGN: Cross-sectional analyses of data from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, (DONALD) using 24-h urine samples to determine the hydration status and 3-day weighed food records to describe the dietary profile of the children. SETTING: Secondary analyses of data from an observational study. SUBJECTS: A group of 4-11 year old children living in Dortmund, Germany; N=717. METHODS: Hydration status was determined by calculating the 'free water reserve', using analyses of the 24-h urine samples. Nutrient intake per day was calculated from the 3-day weighed food records. Children were categorized into groups of hydration status and analysed for significant differences in their dietary profile. RESULTS: Children in the highest group of the hydration status had significant higher total water intake, lower energy density of the diet and a lower proportion of metabolic water compared to children in the lowest group of the hydration status. In addition, analyses showed - although not significant in all subgroups - that better hydrated children consumed more water from beverages and water-supplying foods and less energy from fat. CONCLUSIONS: Euhydrated children, that are children in the highest group of hydration status, had a more preferable dietary profile than children at risk of insufficient hydration. SPONSORSHIP: Funding for the DONALD Study and its analyses is provided by the Ministry of Innovation, Science, Research and Technology of the State of North Rhine-Westphalia, Germany.