2型糖尿病合并肺结核患者治疗方案的选择与评估

目的探讨2型糖尿病合并肺结核应用胰岛素加口服二甲双胍联合抗结核治疗的临床疗效。方法对216例2型糖尿病合并肺结核病人随机分成三组,三组患者均在有效控制血糖的基础上,规律抗结核治疗。A组单纯口服二甲双胍0.5/次,3次/d,B组单纯应用胰岛素。C组应用胰岛素加口服二甲双胍,胰岛素剂量12～60 U不等,根据FGB检测随时调整剂量。抗结核治疗方案为3HRZE(S)/9HR。结果肺结核疗效:治疗3月末、6月末及疗程结束病灶吸收率、空洞闭合率、痰菌阴转率:B组68.5%、83.6%、97.3%;C组78.1%、90%、98.6%。均高于A组41.1%、56.2%、68.5%;B、C组与A组比较均有显著差异(P<0.01)。结论应用胰岛素加口服降糖药疗效好于胰岛素组,胰岛素组好于口服降糖药组;控制血糖是治疗糖尿病合并肺结核的关键。     

Factor IX replacement to cover total knee replacement surgery in haemophilia B: a single‐centre experience, 2000–2010

Summary. Total knee replacement (TKR) is a well recognized treatment for haemophilic arthropathy. Successful haemostasis can be achieved by bolus doses or continuous infusion (CI) using either recombinant (r) or plasma‐derived (pd) factor IX (FIX). We retrospectively analysed our experience of factor replacement to cover TKR in haemophilia B patients and explored factors related to FIX use during surgery. Between 2000 and 2010, 13 primary TKRs were performed in 11 haemophilia B patients. Operations were performed by the same surgeon using standard techniques. Median age was 58 years (42–79). An adjusted CI protocol was used for 5 days followed by bolus doses. FIX:C was maintained at 100 IU dL^?1 in the immediate postoperative period. There was no excess haemorrhage. There was no evidence of thrombosis or infection. All patients received mechanical thromboprophylaxis and only one chemical. CI was used in seven cases. Ten patients received pdFIX. Median hospital stay was 14 days (8–17). Median factor usage was 999 IU kg^?1 (768–1248). During CI, factor consumption was 695 IU kg^?1, 691 IU kg^?1 and 495 IU kg^?1 for Bene Fix ®, Replenine® and Haemonine, respectively. Clearance of both pdFIX and rFIX reduced during CI. All operations were uncomplicated. The decreased clearance in the CI setting reduced the amount of FIX required to maintain a therapeutic level. This reduction was greater with pdFIX and may be related to pharmacokinetic differences between pdFIX and rFIX. Given the excellent safety profile of the pdFIX products, CI of FIX and particularly pdFIX is safe, efficacious and convenient.     

Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma and future treatments for the poor responders

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The most common problem associated with HCC is a high risk of intrahepatic recurrence despite radical treatment, and in many patients, this recurrence has fatal consequences. For patients with advanced-stage HCC according to the Barcelona Clinic Liver Cancer staging system, the multikinase inhibitor sorafenib is the current standard of care. In contrast, hepatic arterial infusion chemotherapy (HAIC) is the recommended treatment in Japan for patients with intermediate-stage or advanced-stage HCC. In this review, we describe the use of HAIC for advanced HCC. Furthermore, we demonstrate an alternative therapy for HCC, the iron chelator deferoxamine, and discuss future therapeutic possibilities.     

老年重症患者哌拉西林/他唑巴坦延长输注的药代/药效学参数

目的 研究老年重症患者哌拉西林/他唑巴坦延长输注的血药浓度-时间曲线,并计算哌拉西林/他唑巴坦的药代/药效学参数.方法 收集在重症医学科住院且满足入组条件的老年重症患者5例,给予哌拉西林/他唑巴坦(4.5 g/q8h)3 h延长输注治疗,于注射开始的0h、0.25 h、0.5h、1h、2h、3h、4h、5h、6h、8h采静脉血2 ml,3 500 r/min离心10 min,取上清液,置于-23℃冰箱中保存备检.用超高效液相色谱法-串联质谱法测定哌拉西林/他唑巴坦的血药浓度,应用noncompartmental模型估计哌拉西林/他唑巴坦的药代学参数,利用蒙特卡洛模拟10 000例患者的治疗·比较哌拉西林/他唑巴坦传统输注(0.5 h)与延长输注(3～4 h)下各MIC值(1～64 μg/ml)的达标概率(PTA),将％fT、MIC≥50％设置为有效药效学目标.结果 哌拉西林的血浆峰浓度、半衰期、分布容积、清除率分别为(97.64±27.16) mg/L、(2.32±0.81)h、(30.51±15.2)L、(9.27±2.69) L/h.在哌拉西林/他唑巴坦4.5 g/q8h.3h延长输注中,当MIC≤16 μg/ml时.PTA达到或接近100％;MIC=32 ug/ml时,PTA为42.54％.结论 本文描述了哌拉西林/他唑巴坦在老年重症患者的药代学参数,这与已发表文献的结果明显不同.蒙特卡洛模拟显示,老年重症患者采用哌拉西林/他唑巴坦4.5 g/q8h.3h输注可以获得较佳的药效学目标,尤其在MIC≤16μg/ml时.     

胰岛素瘤切除术围手术期血糖监测的临床意义

【摘要】 目的 探讨胰岛素瘤切除术的围术期管理。方法 回顾性分析本院5年来通过手术治疗胰岛素瘤患者的临床资料。结果 18例患者中男6例,女12例,均有典型的Whipple三联征。15例行开放性肿瘤切除术,3例行腹腔镜下肿瘤切除术。开腹手术采用硬膜外麻醉复合气管内全麻,腹腔镜手术采用单纯气管内全麻。根据术中不同的血糖管理方式将患者分为两组:持续泵注组(C组,n=10)术中静脉泵注50%葡萄糖溶液,根据血糖调节输注速度,维持血糖在3.0~6.0 mmol·L-1;非持续泵注组(NC组,n=8)未予持续泵注葡萄糖,仅在血糖低于2.8 mmol·L-1时才静脉推注50%葡萄糖50 mL。术中每隔15分钟监测一次血糖,肿瘤切除前30 min停止给糖。所有患者术中患者生命体征平稳。持续泵注葡萄糖组肿瘤切除前后血糖控制较非持续泵注稳定(P<0.05)。结论 胰岛素瘤手术时采用持续泵注葡萄糖能够稳定手术过程中血糖水平,肿瘤切除前静脉泵注50%葡萄糖可以避免肿瘤切除前后血糖急剧波动。     

Comparative effectiveness of water infusion vs air insufflation in colonoscopy: a meta‐analysis

Aim Colonoscopy with air insufflation is known to result in abdominal pain and discomfort. We aimed to determine the effectiveness of water infusion during colonoscopy through a meta‐analysis. Method Original papers and abstracts published up to October 2011 were searched in MEDLINE, EMBASE, Cochrane Library Database and important meeting abstracts. Clinical appraisal and data extraction were conducted by two reviewers independently. Statistical analysis was performed by meta‐analysis using a fixed effects model or a random effects model. Results Seven studies involving 872 patients were included. Meta‐analysis showed that the water infusion group had fewer patients requiring abdominal compression or position change [risk ratio (RR) 0.73, 95% CI 0.59, 0.91], a lower mean pain score (RR ?1.10, 95% CI ?1.26, ?0.95), lower maximum pain score (RR ?2.34, 95% CI ?2.92, ?1.76) and fewer patients requiring on‐demand sedation (RR 0.45, 95% CI 0.31, 0.66) than the air insufflation group during colonoscopy. There were no significant differences in caecal intubation rate, caecal intubation time, total procedure time and adenoma detection rate. Conclusion Water infusion significantly decreases patient discomfort and abdominal pain during colonoscopy without affecting operation time and intubation success rate.     

Intracranial pressure - volume response in dog subjected to repeated infusion tests: an experimental study

Several experimental studies have been made in the past to try to understand the nature of the fluid-induced changes in the intracranial pressures of the animals by infusing fluid into their craniospinal complex. The objective of the present investigation was to study the changes in the characteristics of the ventricular and epidural pressure-volume curves when a dog was subjected to repeated fluid infusion tests. The animals were subjected to three cycles of infusion tests with a time interval of either 10 min or 2 h between any two successive tests. An infusion test repeated 10 min after the preceding test exhibited a significant change in the characteristics of the ventricular fluid pressure (VFP) response but not in the epidural pressure (EDP) response. However, in the case of an infusion test which was repeated 2 h after the preceding test, it was observed that both the VFP and EDP responses remained the same as those found in the first infusion test.     

Feedback-controlled bolus plus infusion (FC-B/I) method for quantitative drug assessment in living brain with PET

We have developed a feedback-controlled bolus plus infusion (FC-B/I) method for monitoring the interaction between positron emission tomography (PET) ligands and their specific target molecules with PET. The usefulness of the FC-B/I method was evaluated by the direct interaction between [¹¹C]raclopride, a dopamine D₂ receptor (D₂R) ligand, and cold raclopride (10 and 100 μg/kg) in the brains of conscious monkeys. The present results demonstrated that the FC-B/I method could achieve the equilibrium state of [¹¹C]raclopride in the striatum of monkey brain, and also that the cold raclopride-induced reduction of [¹¹C]raclopride binding to D₂R was observed in a dose-dependent manner. Good correlations of distribution volume ratio of the striatum to cerebellum between the conventional bolus plus infusion (B/I) method and the FC-B/I method as well as between the conventional bolus injection method and the FC-B/I method were observed. These results indicated that the system could be a useful tool for the evaluation of interaction between drug candidates and their target molecules like enzymes, receptors, and transporters by using of their specific PET ligands.