药师参与1例重症肺部感染患者用药方案的调整

本文报告临床药师参与的1例入住呼吸内科重症监护病房治疗的感染性休克合并急性肾功能不全的慢性阻塞性肺疾病急性加重患者的抗感染治疗及药学监护过程,探讨严重肾功能不全情况下抗菌药物的选择及其用法用量的调整以及嗜麦芽窄食单胞菌的合理治疗方案,体现了临床药师能在促进合理用药、降低药物不良反应,保证临床安全、有效地用药方面发挥积极作用。     

参芪扶正注射液对慢性肾功能不全贫血的影响

目的：探讨参芪扶正注射液对慢性肾功能不全贫血的影响。方法整群选取2013年11月-2015年1月医院收治的慢性肾功能不全贫血患者138例随机分成两组各69例,对照组给予蔗糖铁注射液,观察组给予参芪扶正注射液,比较两组的治疗效果,RBC、WBC及Hb和不良反应。结果观察组治疗有效率为85.5%,对照组治疗有效率为65.2%(P<0.05﹚;两组患者治疗后RBC,WBC及Hb均高于治疗前,但观察组明显高于对照组(P<0.05﹚;两组不良反应发生率差异无统计学意义(P>0.05﹚。结论参芪扶正注射液治疗慢性肾功能不全贫血疗效满意,不良反应少,值得应用。     

Accommodative Anomalies in a Sample of Black High School Students in South Africa

Purpose: Accommodative anomalies cause asthenopia and affect student reading efficiency and academic performance. The aim of conducting this study was to determine the prevalence and distribution of accommodative anomalies (insufficiency, excess and infacility) in relation to demographic variables (sex, age, school grade level and study location).

Methods: Study participants comprised 1,211 children (481 male and 730 female), with age range 13-19 years. Visual functions evaluated included refractive error, accommodative amplitude, accuracy, facility and relative accommodation.

Results: A total of 242 participants (20.2%) had accommodative anomalies. Prevalence estimates were; accommodative infacility 12.9% (95% confidence interval, CI, 10.9-14.7%), accommodative insufficiency 4.5% (95% CI 3.4-5.8%) and accommodative excess 2.8% (95% CI 1.9-3.8%). There were no significant differences based on sex, school grade level or study site, except in the prevalence of accommodative infacility, which was significantly higher in the younger grade level than the older (P=0.027).

Conclusion: The study fills a gap in the literature in providing data on predominantly black South African students. The prevalence estimates for accommodative insufficiency and excess found in the sample studied are relatively low, while that of accommodative infacility is high. Accommodative anomalies were not markedly associated with demographic variables except for the prevalence of accommodative infacility, which was significantly higher in the younger grade level than the older. Identification and referral are important steps towards diagnosis and treatment of accommodative anomalies. Future studies on differences in prevalence of accommodative anomalies among different racial populations will be relevant.     

Bisphosphonates for Osteoporosis in Patients with Renal Insufficiency: Pharmacists’ Practices and Beliefs

Background:Clinicians often face challenges in deciding how to treat osteoporosis in patients with chronic kidney disease. As background to offering guidance to health care providers, it is important to understand their practices and beliefs.Objectives:To describe the practices and beliefs of pharmacists regarding use of bisphosphonates for patients with osteoporosis and chronic kidney disease.Methods:A cross-sectional survey of pharmacists working in hospitals and related health care settings was conducted. A 34-item online questionnaire was developed consisting of 4 sections: demographic characteristics, practices, beliefs, and comfort level with making decisions about osteoporosis treatment. An e-mail invitation was sent to members of the Canadian Society of Hospital Pharmacists (n = 2499) in November 2012.Results:A total of 367 pharmacists completed the survey. Most of the respondents were women (258 [70%]), had more than 10 years in practice (213 [58%]), and were providing care to 1 or more osteoporosis patients per week (212 [58%]). Over one-third (150 [41%]) stated that they would use a bisphosphonate for patients with creatinine clearance (CrCl) of 15–30 mL/min, but more than half (207 [56%]) stated that they would avoid a bisphosphonate (and recommend another medication) for patients with CrCl below 15 mL/min. Forty-eight percent (176/363) agreed that oral bisphosphonates could be used for patients with renal failure (defined as CrCl < 30 mL/min), so long as dosage adjustments are made. More than half (206/363 [57%]) believed that the adverse effects of oral bisphosphonates increase for patients with renal failure. Respondents expressed a low level of comfort in assessing and initiating osteoporosis treatment for patients with renal failure.Conclusions:Pharmacists had varying beliefs about managing osteoporosis in patients with chronic kidney disease. This study highlights the need for practice tools and targeted education addressing the use of bisphosphonates for these patients.     

Palatal evaluation and treatment in 22q11.2 deletion syndrome

Palatal involvement occurs commonly in patients with 22q11.2 Deletion Syndrome (22qDS), and includes palatal clefting and velopharyngeal dysfunction in the absence of overt or submucous clefts. The reported incidence and distribution of palatal abnormalities vary in the literature. The aim of this article is to revisit the incidence and presenting features of palatal abnormalities in a large cohort of patients with 22qDS, summarize the surgical treatments performed in this cohort, and provide an overview of surgical treatment protocols and management guidelines for palatal abnormalities in this syndrome. Charts of 1,121 patients seen through the 22q and You Center at the Children's Hospital of Philadelphia were reviewed for palatal status, demographic factors, deletion size, and corrective surgical procedures. Statistical analysis was performed using Pearson's chi‐squared test to identify differences between gender, deletion size, and palatal abnormality. Of the patients with complete evaluations, 67% were found to have a palatal abnormality. The most common finding was velopharyngeal dysfunction in 55.2% of patients, and in 33.3% of patients, this occurred in the absence of palatal clefting. There was no significant difference in the incidence of palatal abnormalities by gender; however, a difference was noted among race (p < 0.01) and deletion sizes (p < 0.01). For example, Caucasian and Asian patients presented with a much higher prevalence of palatal abnormalities, and conversely those with nested deletions presented with a much lower rate of palatal defects. Overall, 26.9% of patients underwent palatal surgery, and the most common indication was velopharyngeal dysfunction. Palatal abnormalities are a hallmark feature of 22q11.2 Deletion Syndrome; understanding the incidence, presenting features, and treatment protocols are essential for practitioners counseling and treating families affected with this disorder.     

右心瓣膜感染性心内膜炎的外科治疗

目的：总结右心系统瓣膜心内膜炎的特点和手术处理经验。方法：回顾性分析右心系统瓣膜感染性心内膜炎１７例,其侵犯三尖瓣６例、肺动脉瓣４例,同时侵犯三尖瓣＋肺动脉瓣３例,肺动脉瓣＋主动脉瓣３例,主动脉瓣、二尖瓣、三尖瓣与肺动脉瓣同时受累１例。合并心脏畸形１４例,室间隔缺损修补术后、主动脉窦瘤破裂修补术后、起博器安置术后各１例。施行三尖瓣瓣膜游离缘或瓣膜赘生物切除直接缝合５例、三尖瓣瓣膜赘生物切除用自体心包片修补２例、部分瓣叶和瓣下结构切除缝合瓣叶并行人工腱索成形术１例,施行三尖瓣置换术２例;单纯行肺动脉瓣瓣叶赘生物切除４例,部分肺动脉瓣切除用自体心包片瓣叶成形术６例,切除肺动脉瓣用自体心包瓣置换１例。结果：术后早期死亡２例,病死率为１２％,术后早期并发急性肾功能不全３例,肝功能不全１例。术后随访５个月～１８年,平均随     

老年慢性呼吸衰竭患者血小板活化因子及血小板功能改变

目的 探讨老年慢性呼吸衰竭患者血小板活化因子（ＰＡＦ）及血小板粘附、聚集、释放功能的改变及与老年慢笥肺心病和呼吸衰竭发展的关系。方法 生物定量法观察老年慢性呼吸衰竭组患者（５５例）、老年健康人组（４０组）及非老年健康人组（３５例）血以激活因子（ＰＡＦ）的改变,放免法观察血以膜ＧＭＰ１４０、血小板释放功能、血小板粘附功能（ＰＡＤＴ）和血小板聚集功能（ＰＡｇＴ）的变化。结果 老年慢性呼吸衰竭组ＰＡＦ为     

补中益气法学术源流、传承及当代应用

补中益气法是临床常用的治法之一。《黄帝内经》《难经》阐述了中气不足的主要临床表现,并总结出"劳者温之""损者益之"的治疗原则。《伤寒杂病论》《医学启源》为补中益气法的用药提供了依据。后世医家传承应用本法,多有创新。如李东垣用补中益气常兼顾升阳、理气、泻火、除湿、和血、养阴等加减变法,罗天益擅用灸法,王好古用以治疗外阳内阴证,薛己、孙一奎强调脾肾双补而各有特色,张景岳明确补中益气汤七禁,陈实功将本法应用于外科、补中益气、托毒外出,傅青主用以治疗妇科难证、用药剂量特色鲜明。当代医家还将本法应用于心、肝、肺、肾等各脏病证的治疗,其作用机理也逐渐被现代研究阐明。研究补中益气法的古今传承应用及作用机制,具有重要意义。     

获得性主动脉瓣瓣膜病变的整形手术

目的为了恢复主动脉瓣的功能,总结４０例获得性主动脉瓣整形术的经验。方法对４０例获得性主动脉瓣病变进行整形手术,包括主动脉瓣边缘楔形削除、交界切开、钙化灶清除、穿孔修补及自体心包加宽瓣叶等整形手术。结果手术死亡率５％。单纯主动脉瓣关闭不全组术后反流面积明显减少;单纯主动脉瓣狭窄组或狭窄合并关闭不全组术后跨瓣压差明显下降,而后者反流加重。结论在获得性主动脉瓣病变中,瓣膜条件尚好的单纯关闭不全或狭窄可行整形矫正,而狭窄合并关闭不全者行整形难以恢复正常瓣膜功能