内镜切除术与腹腔镜切除术治疗非微小胃间质瘤的对比研究

目的 对比分析内镜下切除和腹腔镜手术切除非微小胃间质瘤（直径大于1 cm且小于5 cm）的疗效及安全性。方法 回顾性分析2012年1月－2017年12月在苏州大学附属第一医院和苏州大学附属张家港医院行内镜下切除和外科腹腔镜手术治疗、并经术后病理及免疫组化确诊为非微小胃间质瘤患者的临床资料。根据手术方式将患者分为内镜切除组和腹腔镜手术组,比较两组患者术后住院时间、并发症、治愈性切除率等。结果 内镜切除组术后进食时间、术后排气时间、住院时间较腹腔镜手术组短,住院费用较腹腔镜手术组少,两组患者比较,差异有统计学意义（均P < 0.05）。术后对所有患者进行随访,内镜切除组平均随访时间为32个月,有1例出现复发;腹腔镜手术组平均随访时间为35个月,有1例出现复发,1例出现转移,两组患者比较,差异无统计学意义（P > 0.05）。结论 内镜下切除直径大于1 cm且小于5 cm的非微小胃间质瘤,具有肿瘤切除率高、术后恢复快、并发症少等优势,且与腹腔镜手术相比,复发率无明显差异。     

Decline in attentional inhibition among migraine patients: an event‐related potential study using the Stroop task

BackgroundAs a disorder of brain dysfunction, migraine has been associated with cognitive decline. However, no consistent results with respect to the attention function in migraineurs have been found, and the relationship between attentional inhibition and migraine is also unclear. In this study, the attentional inhibition function was evaluated using event-related potentials (ERPs) while migraine patients and healthy controls were performing the color–word Stroop task.MethodsIn this study, 75 migraine patients and 41 age-, gender-, and education-matched healthy controls were enrolled. The Stroop task was performed, and both behavioral and ERP data were analyzed.ResultsAs to the behavioral data, the migraine group had a longer reaction time compared to the control group, but no difference in Stroop effect was observed. With respect to ERP components, the amplitudes of both early and late medial frontal negativity (MFN) were decreased in the migraine group. Additionally, obvious differences in the early MFN and sustained potential (SP) amplitudes were found between patients with and without allodynia.ConclusionsAt the behavioral level, migraine patients exhibited decreased executive ability but no obvious decline in inhibition. By contrast, a decline in attentional inhibition during the migraine interictal phase was confirmed by the analysis of ERP components, mainly those associated with changes in the conflict-monitoring stage, independent of confounding factors such as age, education, medication and mood disorders. Migraine patients with allodynia exhibited some significant differences in early MFN and SP compared to those without, supporting the hypothesis that migraine chronification aggravates the decline in attentional inhibition.     

A retrospective analysis of clinical efficacy of ribavirin in adults hospitalized with severe COVID-19

IntroductionCoronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swept rapidly throughout the world. So far, no therapeutics have yet proven to be effective. Ribavirin was recommended for the treatment of COVID-19 in China because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking.MethodsA total of 208 confirmed severe COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and the length of hospital stay.Results68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except for coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.01). Treatment with ribavirin was not associated with a difference in the time to clinical improvement (P = 0.48, HR = 0.88, 95% CI = 0.63–1.25). There were also no significant differences between-group in SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and the length of hospital stay.ConclusionsIn hospitalized adult patients with severe COVID-19, no significant benefit was observed with ribavirin treatment.     

ICU患者影响万古霉素血药浓度的相关因素分析

目的 通过分析影响重症监护病房(ICU)患者万古霉素血药浓度的相关因素,探讨优化ICU患者万古霉素给药方案。方法 采用回顾性研究方法,收集东莞市人民医院ICU2016年1月至2018年9月使用并监测万古霉素血药浓度的出院患者。统计ICU患者万古霉素血药浓度分布情况,根据肌酐清除率(CrCl)将患者分为CrCl>90mL/min、CrCl 50~90mL/min、CrCl 10~50mL/min及CrCl<10mL/min 4组,分析不同肌酐清除率组对万古霉素血药浓度水平和达标率的影响以及比较指南推荐剂量与实际剂量的差别,并利用多重线性回归分析进一步探讨影响万古霉素血药浓度的相关因素。结果 99例ICU患者监测万古霉素血药浓度共230例次,45例次(19.57%)达到目标浓度(15~20mg/L),72例次(31.30%)未达标(<15mg/L),113例次(49.13%)超标(>20mg/L)。 CrCl 50~90mL/min和CrCl 10~50mL/min组平均血药浓度[(20.16±7.51)mg/L, (23.12±9.37)mg/L]、血药浓度超标比例(45.45%,62.79%)显著高于CrCl>90mL/min组[(14.65±9.07)mg/L, 19.15%]。CrCl>90mL/min、CrCl 50~90mL/min组实际剂量显著低于推荐剂量,而CrCl 10~50mL/min、CrCl<10mL/min组实际剂量显著高于推荐剂量。多重线性回归分析显示,给药剂量(B=11.631,95%CI=7.030~16.232,P<0.001)、肌酐清除率(B=-0.064,95%CI=-0.097~-0.032,P<0.001)、白蛋白水平(B=-0.334,95%CI= -0.634~-0.035,P=0.029)是影响ICU患者万古霉素血药浓度的主要相关因素。结论 ICU患者万古霉素血药浓度达标率较低,在优化ICU患者万古霉素给药方案时应考虑给药剂量、肌酐清除率和白蛋白水平因素的影响。     

药品检验机构运行的政府采购管理体系建立

目的：为增强政府采购管理在药品检验行业应用的规范性与适用性,在药品检验这一特殊专业背景下,探讨如何提高政府采购管理的效率。方法：分析药品检验业务中政府采购管理的现状和存在的问题,将国家政府采购的宏观要求与药品检验业务特殊性相结合,建立一种药品检验业务背景下的政府采购管理体系。结论：药品检验机构运行的政府采购管理体系的建立,使药品检验专业性与政府采购管理规范性更有效地结合,对做好药品检验机构政府采购管理具有重要的现实意义。     

Dopamine increases the anti-cancer efficacy of sunitinib in the treatment of pancreatic cancer

Sunitinib (SUN) is a multi-targeted receptor tyrosine kinase inhibitor (TKI) that may lead to drug resistance and metastasis because of increased cancer stem-like cells (CSCs) due to the induction of hypoxia. Our group has proved that dopamine (DA) can specifically reduce CSC frequency and enhance the response of SUN in drug-resistant breast cancerand non-small cell lung cancer (NSCLC). In this study, DA and SUN combination therapy was investigated in the treatment of pancreatic cancer, a malignant tumor with high mortality rate and very limited therapies. The cytotoxicity assay, clone formation assay and wound healing assay in two pancreatic cancer cell line PANC-1 and SW1990 showed that DA could significantly increase the effect of SUN on cell survival, clone formation ability and migration ability. Besides, SW1990 cell-derived xenograft model and a pancreatic cancer patient-derived xenograft (PDX) model were constructed, further proving that DA could increase the in vivo anti-tumor efficacy of SUN, and could be reversed by SCH23390, a D1 dopamine receptor (D1DR) antagonist. Moreover, the CSC frequency of the combination groups was lower than the control groups or SUN monotherapy groups. In addition, the body weight, H&E staining and blood routine test results showed that the combination therapy was safe. In summary, DA and SUN combination therapy could be a promising strategy for the treatment of pancreatic cancer.