The recent reduction in mortality from bleeding oesophageal varices is primarily observed from Days 1 to 5

Background: Several new treatments of bleeding oesophageal varices (BOV) have been introduced during the last 25 years; among these are vasoactive drugs, improved endoscopic techniques and prophylactic antibiotics. Aims: The aim was to compare clinical outcomes based on Baveno IV criteria in two patient‐cohorts (1983–1987, n=56 and 2000–2007, n=111) with respect to control of bleeding, rebleeding and mortality after a first episode of BOV. Further, we wanted to assess whether an eventual reduction in bleeding‐related mortality occurred within the first 5 days or between Days 6 and 42 after the bleeding episode. Methods: Data from medical records were collected, according to the Baveno IV criteria, on key events: type of treatment, failure to control bleeding, failure to prevent rebleeding, 5‐day and 6‐week mortality. Results: Six‐week mortality decreased from 30.4 to 17.1% [odds ratio (OR) 0.44; 0.21–0.95] with a reduction in 5‐day mortality from 17.9 to 6.3% (OR 0.31; 0.11–0.86). A non‐significant reduction was seen in the 5‐day failure rate to control bleeding from 35.7 to 26.1%. Mortality and failure to prevent rebleeding Days 6–42 decreased from 15.2 to 11.5% (NS) and 22.2 to 10.7% (NS) respectively. Mean length of hospital stay decreased from 14.6 ± 12.5 to 9.1 ± 9.0 days (P<0.01) and mean number of cumulated blood transfusions within the first 5 days decreased from 5.0 ± 4.8 to 3.6 ± 3.9 (P=0.05). Conclusions: In this retrospective study on individual patient records, we observed a decrease in mortality from BOV over the last 20 years, which seems mainly owing to a reduction in 5‐day mortality; mortality at Days 6–42 remained unaffected.     

Oral or intravenous proton pump inhibitor in patients with peptic ulcer bleeding after successful endoscopic epinephrine injection

AIMS

We aimed to assess the clinical effectiveness of oral vs. intravenous (i.v.) regular-dose proton pump inhibitor (PPI) after endoscopic injection of epinephrine in patients with peptic ulcer bleeding.

METHODS

Peptic ulcer patients with active bleeding, nonbleeding visible vessels, or adherent clots were enrolled after successful endoscopic haemostasis achieved by epinephrine injection. They were randomized to receive either oral rabeprazole (RAB group, 20 mg twice daily for 3 days) or i.v. omeprazole (OME group, 40 mg i.v. infusion every 12 h for 3 days). Subsequently, the enrolled patients receive oral PPI for 2 months (rabeprazole 20 mg or esomeprazole 40 mg once daily). The primary end-point was recurrent bleeding up to 14 days. The hospital stay, blood transfusion, surgery and mortality within 14 days were compared as well.

RESULTS

A total of 156 patients were enrolled, with 78 patients randomly allocated in each group. The two groups were well matched for factors affecting the clinical outcomes. Primary end-points (recurrent bleeding up to 14 days) were reached in 12 patients (15.4%) in the OME group and 13 patients (16.7%) in the RAB group [95% confidence interval (CI) of difference −12.82, 10.22]. All the rebleeding events occurred within 3 days of enrolment. The two groups were not different in hospital stay, volume of blood transfusion, surgery or mortality rate (1.3% of the OME group and 2.6% of the RAB group died, 95% CI of difference −5.6, 3.0).

CONCLUSIONS

Oral rabeprazole and i.v. regular-dose omeprazole are equally effective in preventing rebleeding in patients with high-risk bleeding peptic ulcers after successful endoscopic injection with epinephrine.     

Spiral-shaped Metallic Implant in the Treatment of Achilles Tendon Ruptures: An Experimental Study on the Achilles Tendon of Sheep

There are 2 main factors contributing to the strength of tendon repair: the tensile strength of the material used in repair and the tendon-holding capacity of the suture configuration. In the current study, we aimed to find a technique with high repair strength by increasing both the tensile strength of the material and the tendon-holding capacity of the configuration. We developed metal implants (models 1 and 2) made from stainless-steel wire with 2 different spiral-shaped configurations. We measured tendon-holding capacities of these alternative implants biomechanically and compared them with frequently used suture techniques, the Bunnell and locking loop, which were achieved with 5 Ticron sutures. Sixty-four sheep Achilles' tendons were used in the study as 16 tendons in each group. Model 2 was more resistant to deformation under loading when compared with model 1. The results demonstrated that model 2 was superior to model 1 and both suture techniques. This study could be accepted as a step for reaching a strong tendon repair technique. It should be emphasized that the technique needs to be improved technically to make it convenient for clinical use.     

内镜下套扎术联合β-受体阻滞剂预防肝硬化食管静脉曲张再出血的Meta分析

目的评价食管静脉曲张套扎术(EVL)联合β-受体阻滞剂与单独套扎术对肝硬化食管静脉破裂再出血二级预防的疗效。方法计算机检索Cochrane library、Pubmed、Ovid、Embase,中国生物医学文献数据库(CBM)及中国期刊全文数据库(CNKI),检索时间从建库至2014年8月,并辅以手工检索有关EVL和β-受体阻滞剂预防食管静脉曲张破裂再出血的随机对照临床试验(RCT),按Cochrane协作网推荐的方法 ,采用Revman 5.2.5版软件进行Meta分析。结果共纳入7篇文献,共计600例患者,其中试验组301例,对照组299例。试验组使用EVL联合β-受体阻滞剂治疗,对照组单独使用EVL治疗。Meta分析结果显示,试验组与对照组比较,试验组可明显降低肝硬化食管静脉曲张破裂再出血的发生率[OR=0.29,95%CI(0.16,0.54),P<0.0001];随访期内两组总病死率比较差异无统计学意义[OR=0.67,95%CI:(0.43,1.06),P=0.09]。同时,再出血发生率及总病死率的漏斗图均比较对称,说明存在发生偏倚的可能性较小。结论 EVL联合β-受体阻滞剂预防肝硬化食管静脉曲张再出血疗效优于单独采用EVL治疗。     

颅内破裂动脉瘤栓塞后再出血分析

目的分析颅内破裂动脉瘤栓塞后再出血的发生率及其可能的影响因素。方法随访285例破裂动脉瘤病人，随访时间2-72个月，平均28.1个月，通过书信，电信以及门诊的方式进行随访，内容以询问病人症状，体征为主，重点在于动脉 瘤栓塞后是否再出血。结果4例病人发生动脉瘤再次破裂出血，再出血率为1.4%，其中不全栓塞3例，大动脉瘤2例。结论颅内破裂动脉瘤应用弹簧圈栓塞后再出血发生率大大降低，再出血主要发生于不全栓塞的动脉瘤和何种较大的动脉瘤。     

替吉奥联合奥沙利铂治疗晚期胃癌近期疗效观察分析

目的：探究替吉奥与奥沙利铂联合治疗晚期胃癌的近期疗效。方法方便选取该院晚期胃癌患者70例,时间为2012年12月—2015年12月。动态随机化法分为2组,分别给予晚期胃癌患者替吉奥与奥沙利铂联合治疗以及奥沙利铂与5-氟尿嘧啶/亚叶酸钙联合治疗。结果实验组治疗疗效（45.71%)优于对照组（14.29%),且不良反应几率低于对照组差异有统计学意义（P﹤0.05)。结论替吉奥与奥沙利铂联合治疗晚期胃癌的近期疗效较好,且毒副作用小,安全有效。     

Variceal rebleeding: use of drug therapy and endoscopic band ligation

Patients surviving a variceal bleed are at high risk of re-bleeding with a mortality of 25–50% during a 1–2 year follow-up. Several studies and meta-analyses have demonstrated reduced rates of oesophageal variceal rebleeding with the use of β-blockers. However, their use can be limited by contraindications or intolerance to therapy. Other trials have shown that addition of nitrates may improve the efficacy of β-blockers in prevention of variceal re-bleeding. Endoscopic variceal band ligation (VBL) has been shown in meta-analyses to decrease the rates of rebleeding and mortality compared with endoscopic sclerotherapy. Studies comparing combined drug therapy with VBL have shown similar rebleeding rates although there is a suggestion that survival may be higher in those given drug therapy. Recent data suggest that combined VBL and drug therapy reduces the risk of rebleeding from oesophageal varices compared with either therapy alone; however there appears to be no reduction in overall mortality.     

福建省婚前保健的现状与对策

本文回顾我省１９８５年开展婚前保健工作以来的现状及存在的难点，提出相应的对策，探讨提高婚前保健质量的措施。为贯彻落实《母婴保健法》做努力。