Use of red blood cell transfusions in surgery

Background: Limited blood supplies necessitate the rational use of blood products. The aim of the present study was to provide a basis for audits of red cell usage in surgery by benchmarking common practice. Application of the data to the construction of a maximum surgical blood order schedule may be relevant for centres that perform a serological crossmatch or who collect autologous units. Methods: Data on surgical procedures identified by Commonwealth Medical Benefits Schedule item numbers, were collected retro­spectively from theatre and blood bank records at the Royal Melbourne and Melbourne Private hospitals from May 1997 to April 1998. The percentage of procedures for which red cells were transfused, and the mean, median and range of units transfused for procedures with ≥ 30% transfusion likelihood were identified. Results: Over 12 months, 266 surgical procedure codes were itemized ≥ 10 times each, contributing 12 300 data entries. Only 38 procedures demonstrated an incidence of transfusion of at least 30%. Most frequently transfused procedures included spinal fusion, total hip replacement, mandible/maxilla resection, prostatectomy and bladder excision. Conclusion: The number of common surgical procedures in which there is a 30% or greater likelihood that red cell transfusions will be given is limited. This benchmarking of common red cell usage is a first step in the process of determination of transfusion appropriateness.     

把Delphi开发的排课表导出到Excel文件

本文介绍了Delphi开发的排课系统中把课表导出到Excel文件的方法.在课表导出前,先制定一个Excel电子表格类型的课程表模板.使用排课系统把课表排好以后,把课表导出到Excel电子表格文件.课表导出时,排课系统所用的Access数据根据日期与课程表模板中相应的单元格一一对应,系统自动完成.     

HCPT联合5-Fu加CF双周疗法治疗胃癌临床观察

目的探讨羟基喜树碱（HCPT）联合5-氟脲嘧啶（5-Fu）＋醛氢叶酸（CF）双周疗法治疗晚期胃癌的疗效及毒副反应。方法32例晚期、复发胃癌患者。采用静脉滴入CF200mg／m^2后经中心静脉留置导管48h持续灌注高浓度5-Fu3g／m^2，HCPT8mg／（m^2．d）静脉滴入d1-5，每2周重复，3周期以上评价疗效。结果完全缓解1例（3．1％），部分缓解12例（37．5％），有效率为40．6％，中位生存期10个月，1年生存率为31．3％，KPS评分增高23例（71．9％）。毒副反应以骨髓毒性及消化道反应为主，程度较轻。结论HCPT联合5-Fu＋CF双周疗法化疗对晚期胃癌有效率较高，毒副反应轻，生存质量得到改善。     

Irinotecan combined with bolus 5-fluorouracil and folinic acid Nordic schedule as first-line therapy in advanced colorectal cancer.

BACKGROUND: This multicentre phase II study evaluated the efficacy and safety of irinotecan combined with the Nordic schedule of 5-fluorouracil (5-FU) and folinic acid (FA) as first-line therapy in patients with advanced colorectal cancer. PATIENTS AND METHODS: Seventy-four patients with measurable disease and a WHO performance status of 2 or less were treated with irinotecan 210 mg/m(2) as a 30-90 min intravenous infusion on day 1, followed by 5-FU 500 mg/m(2) and FA 60 mg/m(2) bolus on days 1 and 2, every 2 weeks, until disease progression or unacceptable toxicity. The primary end point was the objective response rate. RESULTS: Twenty-nine out of 68 evaluable patients achieved a complete (n = 7) or partial (n = 22) response, leading to an overall response rate of 43% [95% confidence interval (CI) 31% to 55%]. The median duration of response was 10 months. The estimated median time to progression and survival were 6.4 months (95% CI 5.4-9.0) and 15.6 months (95% CI 13.3-19.0), respectively, in the intention-to-treat population. A total of 860 cycles were administered to 74 patients. Neutropenia was the main adverse event with grade 3-4 toxicity in 66% of patients and 17.5% of cycles. Grade 3-4 non-haematological toxicities were infrequent and included diarrhoea in 16% of patients and 2% of cycles and nausea/vomiting in 10% of patients and 1% of cycles. CONCLUSIONS: Irinotecan combined with the bolus Nordic schedule of 5-FU/FA is active in advanced colorectal cancer with an easily managed safety profile which ensures good schedule compliance. The low incidence of grade 3-4 non-haematological toxicity justifies the further evaluation of this combination in the context of randomised clinical trials.     

Monte Carlo法用于新生儿阿米卡星的群体药动学分析和认证(英文)

目的:用Monte Carlo算法编制群体药动学分析程序并认证该方法估计药动学参数和预测血药浓度的能力.方法:用阿米卡星作为模型药物,对来自42名新生儿共142对血药浓度时间数据进行分析;根据Sheiner等提出的群体药动学思想,我们编制了估计群体参数和个体参数的程序,目标函数最小值以Monte Carlo算法求得,方法的认证采用经典药动学 程序3p87作为对照,预测能力通过计算预测血药浓度的均方根误差(RMSD)和偏性(BIAS)来考察.结果:我们自编的程序运行稳定;本法提取的群体参数与3p87得到的一致,学习样本与认证样本的预测浓度与实测浓度显著相关(相关系数分别为0.995和0.990),预测误差大多数小于1 mg/L,认证样本RMSD和BIAS分别为0.58和-0.07 mg/L.结论:本法估计参数准确,预测血药浓度能力令人满意.     

Antibiotic treatment for animals: effect on bacterial population and dosage regimen optimisation

Concern regarding antimicrobial resistance has led to proposals for the prudent use of antimicrobial agents. Whilst this is appropriate, it is not sufficient. This article proposes that dosage schedules should be developed to provide a basis for the rational use of antimicrobial drugs. This requires knowledge of resistance mechanisms and transfer, the biochemistry and structure of microorganisms and both the pharmacodynamics and pharmacokinetics of antimicrobial drugs. Dosage schedules should maintain concentrations at the site of infection in excess of MIC₉₀ for bacteriostatic drugs and bactericidal drugs acting primarily by time-dependent mechanisms whilst they should provide high AUIC and C_max/minimum inhibitory concentration (MIC) values for agents acting mainly by concentration-dependent mechanisms. It is proposed that pharmacodynamic and population pharmacokinetic data should be integrated through use of the sigmoidal E_max equation, together with mathematical modelling and appropriate statistical analyses, to take account of the natural variation in drug pharmacodynamics and pharmacokinetics.     

甲泼尼龙冲击疗法治疗杰杨-巴勒综合征

杰杨-巴勒综合征患者23例(男14,女9;平均年龄24±19a;病程9±12mo,)用甲泼尼龙冲击疗法治疗。甲泼尼龙1g或20mg/(kg·d)溶于5％葡萄糖溶液500mL中静滴,qd×3d,1mo后根据病情重复第2、3疗程,冲击间歇期口服泼尼松20-40mg/d维持。结果12例(52％)痊愈,9例(39％)显效,2例无效。值得临床试用。     

Subjective and behavioural evaluation of cigarette cravings

Cigarette cravings were evaluated in a sample of moderately heavy smokers, using the Questionnaire on Smoking Urges (QSU: Tiffany and Drobes 1991), which produces scores on two factors, related to the positive (factor I) and negative (factor II)-reinforcing properties of smoking, respectively. Smoking motivation was also assessed behaviourally using a progressive-ratio operant procedure, in which responding on a computer keyboard was reinforced by puffs on a cigarette, under a progressively increasing work requirement. Abstinence (4–14 h) increased scores on both subjective and behavioural measures. In non-deprived subjects, behavioural measures and cigarette liking correlated more strongly with factor I of the QSU than with factor II, while in abstinent subjects, correlations with factor II were stronger than with factor I. The significant relationships between the QSU and cigarette-reinforced progressiveratio operant performance support the validity of both of these procedures as measures of cigarette craving.     

Rapid acquisition of oral phencyclidine self-administration in food-deprived and food-satiated rhesus monkeys: Concurrent phencyclidine and water choice

Eight rhesus monkeys were trained to self-administer orally-delivered phencyclidine, with water concurrently available, under a fixed ratio (FR) schedule during daily 3-hr sessions. Liquid deliveries (0.55 ml) were contingent upon lip-contact responses on solenoid-operated drinking spouts. During the sessions, phencyclidine and water were available under FRs ranging from 1 to 16. Water was always available between sessions (FR 1), and food initially was available 24 hr/day. In Experiment 1 the monkeys initially were given access to water (FR 1) during the 3-hr sessions. Subsequently, phencyclidine (0.25 mg/ml) was substituted for water, and the monkeys were reduced to 85 percent of their free-feeding weights. The FR value was then increased from 1 to 8. Next, the monkeys received concurrent access to water from one spout and phencyclidine from the other (each under the FR 8 schedule), then the FR value was increased to 16 for both drug and water. Orally-delivered phencyclidine was rapidly demonstrated to function as a reinforcer (37.2 sessions) without using food to induce drinking. In Experiment 2 a similar procedure was used for another group of monkeys, except the monkeys remained food satiated throughout the acquisition phase. Phencyclidine was rapidly demonstrated to function as a reinforcer (25.9 sessions), although intakes were lower than in Experiment 1. After concurrent phencyclidine- and water-maintained performance stabilized at FR 16, the monkeys were food deprived, and phencyclidine intake increased to the levels reported in Experiment 1. Food deprivation greatly enhanced the reinforcing effect of phencyclidine and changed the temporal pattern of responding, but neither food deprivation nor food-induced drinking were necessary conditions to demonstrate the drug's reinforcing effects.     

Disruption and habituation of stable fixed-interval behavior in younger and older monkeys

Reactivity to novel and irrelevant stimuli has been shown to vary as a function of age. Since differential responsivity to irrelevant events may account for purported age differences on other tasks, the present experiment studied the extent to which these age differences may be reduced with repeated exposure, i.e., habituation. Young (2 to 3 years) and old (15+ years) squirrel monkeys were trained and their performance stabilized over months on a fixed-interval operant task. This behavior was then disrupted by periodic presentations of an auditory stimulus of moderate intensity. Disruption of stable behavior and habituation to the tone stimulus were evaluated across several measures including overall response rates between and within the daily sessions; recovery of baseline response rates during the tone stimulus; and the curvature of the fixed interval "scallop." Old monkeys responded for sweet fruit juice more frequently, but less efficiently, than young monkeys. Their responding was more severely disrupted by intermittent novel auditory stimuli, to which they were slower to habituate.