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.

A‐Fibers Mediate Cold Hyperalgesia in Patients with Oxaliplatin‐Induced Neuropathy

Cold hyperalgesia is a common side effect of oxaliplatin treatment; still, the pathophysiological and molecular mechanisms as well as the contribution of different primary afferent fiber systems are unclear. Therefore, patients with oxaliplatin‐induced acute neuropathy with (n = 6) and without (n = 7) cold hyperalgesia were tested by applying a preferential blockade of peripheral myelinated A‐fiber afferents in combination with quantitative sensory testing. Additionally, an interview‐based questionnaire assessed the severity of symptoms and the impact on daily activities. Results indicate a deficit of cold perception in patients without cold hyperalgesia compared to patients with cold hyperalgesia prior to A‐fiber blockade. In patients with cold hyperalgesia, a preferential blockade of A‐fibers abolished cold hyperalgesia. This suggests that oxaliplatin‐induced cold hyperalgesia is mediated by A‐fibers and that a deficit in A‐fiber function might prevent the development of cold hyperalgesia. The work supports findings in rodents and in human sural nerve biopsies indicating that oxaliplatin interferes with axonal ion conductance in intact A‐fibers by sensitizing potassium and/or sodium channels. Drugs that act on these molecular targets might be of potential value to treat oxaliplatin‐induced cold hyperalgesia.     

生理盐水联合甲硝唑注射液冲洗并湿敷在会阴侧切伤口中的应用研究

目的：探讨生理盐水联合甲硝唑注射液冲洗并湿敷在会阴侧切伤口中的应用效果。方法将282例经阴道分娩行会阴侧切术的初产妇,随机均分为研究组和对照组（n=141）。研究组缝合前先用生理盐水冲洗,常规缝合后产妇每天用1∶20碘伏溶液擦洗会阴切口,然后敷上甲硝唑注射液浸湿的无菌纱布。对照组常规缝合后每天仅用1∶20碘伏溶液擦洗。观察记录2组患者术后不良反应、拆线天数和切口愈合情况。结果研究组甲级愈合人数显著高于对照组,2组差异有统计学意义(P<0.05);研究组拆线天数为（4.5±0.65）d,显著低于对照组的（6.12±0.85）d,2组差异有统计学意义(P<0.05);研究组会阴切口有红肿、血肿、化脓等不良反应人数均低于对照组,2组差异有统计学意义(P<0.05)。结论生理盐水联合0.5%甲硝唑注射液冲洗并湿敷是较理想的护理方法,经济方便,值得在临床推广。     

陈宝田教授创小乌桂汤治疗顽固性痹证

小乌桂汤由陈宝田教授所创立,该方由《千金要方》的小续命汤、《金匮要略》的乌头汤和桂枝芍药知母汤三个经方的合方加减,主要用于治疗顽固性痹证,具有疏风通络,散寒除湿,益气养血的作用.陈宝田教授认为,顽固性痹证多因风寒湿邪阻滞经络肢体关节,且邪实甚重,非一般之剂能除之.临证治疗类风湿性关节炎及强直性脊柱炎,加全蝎以加强通络止痛之力;多发性动脉炎加黄连解毒汤,以增清热解毒之功;退行性骨关节病及年老病久、体质虚弱明显者,加独活寄生汤以补肝肾,强筋骨;寒盛者,加大辛温药量;化热者则减辛温药量,并加大黄芩、知母、白芍之用量.     

Eculizumab as a bridge to immunosuppressive therapy in severe cold agglutinin disease of anti‐Pr specificity

Severe cold agglutinin disease with hemodynamic compromise requires rapid stabilization of the autoimmune hemolytic anemia as a bridge to the immunosuppressive effect of rituximab. Herein, we describe eculizumab treatment of severe complement‐mediated hemolysis in a patient whose hemodynamic status deteriorated in spite of supportive blood transfusions and therapeutic plasma exchange.     

冷敷眼罩用于全激光角膜表层切削术后止痛的效果

目的：评价冷敷眼罩用于全激光角膜表层切削术后止痛、减轻术后反应的临床效果。
　　方法：选取行全激光角膜表层切削术的近视患者40例80眼,随机分成冷敷组和冲洗组两组,每组20例40眼：冷敷组术中不给予冰镇平衡盐溶液冲洗创面,术后给予冷敷眼罩配戴24 h;冲洗组术中以冰镇平衡盐溶液冲洗创面,术后不给予冷敷眼罩。分别记录两组术中、术后8,
　　16,24 h的疼痛分值,术后眼睑水肿、球结膜充血情况以及上皮愈合时间、Haze、术后裸眼视力、最佳矫正视力。结果：冷敷组和冲洗组在术中的疼痛分值无统计学差异,术后8,16,24 h冷敷组疼痛分值均低于冲洗组。冷敷组中术后眼睑水肿、球结膜充血程度均低于冲洗组。在使用止痛药物方面：术后24 h内,冷敷组使用表面麻醉剂点眼总次数和口服双氯芬酸钠胶囊总量均低于冲洗组。在上皮愈合时间、Haze、早期视力恢复方面,两组无统计学差异。
　　结论：全激光角膜表层切削术后应用冷敷眼罩可有效止痛并减轻术后反应,减少止痛药物用量,而且廉价易得、无化学药物的全身及局部副作用。     

温针灸治疗虚寒型膝骨关节炎临床疗效观察

目的探讨温针灸与毫针针刺治疗虚寒型膝骨关节炎的临床疗效。方法选取2012年3月~2014年3月所收治的虚寒型膝骨关节炎患者156例,分为温针灸组和毫针针刺组,每组各78例,均采取相同穴位,对比两组患者治疗依从性及临床疗效。结果温针灸组患者中,显效51例、有效24例、总有效率为96.2%,明显高于毫针针刺组的29例、24例及67.9%,温针灸组临床疗效更佳,结果具有统计学意义(P<0.05)。结论温针灸具有加强针感的作用,治疗虚寒型膝骨关节炎疗效显著优于单纯针刺治疗,且经济实惠,值得临床推广应用。     

妇科万应膏治疗宫寒血瘀型痛经的临床效果观察

目的：观察妇科万应膏治疗宫寒血瘀型痛经患者的疗效和安全性。方法根据纳入/排除标准,共筛选痛经患者223例,采用区组随机的方法,按照3：1的比例随机分为试验组167例与对照组56例。试验组使用妇科万应膏外用穴位贴敷,对照组使用痛经宝颗粒口服,共用药3个月经周期。治疗后比较2组的治疗效果与不良反应。结果治疗3个月经周期后,试验组总有效率为91.02%明显优于对照组的78.57,差异有统计学意义（P ＜0.05）。试验组发生不良反应5例,不良反应发生率2.89%;对照组无不良反应发生,组间比较差异无统计学意义（ P ＞0.05）。结论妇科万应膏治疗宫寒血瘀型月经不调和痛经安全有效,值得临床推广使用。