静脉药物加药口消毒及使用医用输液瓶口贴的必要性研究

目的 研究静脉药物加药口消毒和使用医用输液瓶口贴的必要性。方法 在静脉药物配置中心的洁净操作环境下,向60个批次的静脉输液中加入10ml灭菌注射用水模拟配置加药过程,参照《中国药典》2010版二部附录Ⅺ J中细菌计数方法,对消毒组和未消毒组、使用密封消毒袋后医用输液瓶口贴组和未使用组的微生物污染情况进行统计分析。结果 消毒组和未消毒组在统计学意义上有显著差异（P>0.05）,在使用密封消毒袋后,贴医用输液瓶口贴组和未贴组在统计学意义上没有显著差异。结论 配制静脉药物时,加药口需要进行消毒以减少加药时微生物污染的风险,使用密封消毒袋后,30 min内静脉输液在病区使用不需要贴医用输液瓶口贴。     

How can we intervene to mitigate post-transplantation relapse in AML? Strategies to mitigate post-transplantation relapse in AML

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative approach for patients with acute myeloid leukemia (AML), relapse is a common occurrence. Several strategies, such as choice of conditioning regimen, donor lymphocyte infusions, pharmacologic agents, and cellular therapy approaches, are currently being developed to improve transplantation outcomes. This review outlines some important interventions and considerations to lower the burden of post-transplantation relapse in AML.     

Pharmacokinetics of continuous subcutaneous insulin infusion

Summary One of the reasons for the variability of blood glucose regulation in Type 1 (insulin-dependent) diabetic patients is the huge variation in subcutaneous absorption of intermediate-acting insulin. We have investigated the variation in insulin absorption during continuous subcutaneous insulin infusion in eight such patients. The content of insulin in the subcutaneous tissue was measured using ¹²⁵I-labelled insulin. The concentration of free serum insulin and blood glucose was followed from 1 h before and from 7 h after breakfast on two consecutive days. The amount of insulin absorbed during 24 h differed in all cases by less than 3% from the daily insulin dose given by the pumps. Mean insulin absorption rates and mean free insulin concentration showed peak values 30–90 min after meal bolus injections; this was sufficient to maintain near-normal blood glucose. Mean free serum insulin correlated strongly with disappearance of insulin from the subcutaneous tissue (r=0.98). From the insulin absorption rates and free insulin concentrations during basal constant insulin infusion, the half-time of serum insulin was calculated as 6 min. Compared with the known large variability in the absorption of intermediate-acting insulin, continuous subcutaneous insulin infusion offers a precise and reproducible way of insulin administration resulting in post-prandial serum insulin peaks sufficient to maintain near-normal blood glucose levels. The half-time of serum insulin during subcutaneous infusion corresponds to values for intravenous infusion given in the literature, indicating that local degradation of insulin in subcutaneous tissue is of minor importance.     

Radioiodinated anti-hepatocellular carcinoma (HCC) ferritin Targeting therapy,tumor imaging and anti-antibody response in HCC patients with hepatic arterial infusion

Summary Radioimmunoimaging and radioimmunotherapy with radioiodinated anti-(hepatocellular carcinoma ferritin) antibody (¹³¹I-or¹²⁵I-FtAb) have been applied in patients with primary liver cancer. A total of 41 patients with surgically unresectable hepatocellular carcinoma (HCC) and receiving hepatic artery ligation and cannulation during exploratory laparotomy were treated with this regimen by intrahepatic arterial infusion. Compared with the control group, a decline of serum -fetoprotein (65.7% versus 42.9%) and shrinkage of tumor (68.3% versus 33.9%) were observed in the treated group, and a higher second-look resection rate (31.7% versus 5.1%) and longer survival (1-year: 61.0% versus 37.3%, 3-year: 25.0% versus 6.9%) resulted. The administration of antibody through a hepatic arterial catheter (n=16) was compared with intravenous injection (n-17) in terms of the tumor-imaging sensitivity in 33 patients with liver cancer. The results indicated that hepatic arterial infusion was superior to intravenous injection. The sensitivity 7 days after the administration was 100% in the i.a. group and 76.5% in the i.v. group, the uptake ratio of tumor to liver being 1.74±0.57 in the former and 1.34±0.29 in the latter. Furthermore, intrahepatic arterial infusion revealed a lower anti-antibody detection rate than intravenous injection (0/14 versus 4/11).Abbreviations AFP -tetoprotein - FtAb ferritin antibody     

Relapse of Philadelphia chromosome positive acute lymphoblastic leukaemia after marrow transplantation: sustained molecular remission after early and dose-escalating infusion of donor leucocytes

We present a patient who underwent sibling allogeneic BMT because of refractory Ph+ve ALL and remained BCR-ABL-positive after marrow grafting. Haemopoietic precursor cells were predominantly BCR-ABL-negative and of donor origin. In T cells an exclusively donor genotype was demonstrated. Despite donor leucocyte infusion (DLI), 20 weeks after BMT BCR-ABL fusion mRNA increased in semiquantitative polymerase chain reaction and leukaemic infiltration of the patient's bone marrow was seen. After a second course of DLI the patient achieved sustained molecular remission but he developed severe graft-versus-host disease (GvHD) and died from bacterial sepsis 9 months after DLI.     

舒芬太尼靶控输注对非体外循环冠状动脉旁路移植术患者麻醉效果的影响

目的:比较不同效应室浓度的舒芬太尼靶控输注对非体外循环冠状动脉旁路移植术(OPCAB)患者麻醉效果的影响。方法:42例择期OPCAB的患者随机分为3组,分别在术中使用0.4ng/mL(组Ⅰ)、0.6ng/mL(组Ⅱ)和0.8ng/mL(组Ⅲ)固定效应室浓度的舒芬太尼靶控静脉麻醉。观察患者术中血流动力学及脑电双频普指数(BIS)值,记录术中舒芬太尼、丙泊酚、多巴胺用量,术后恢复时间及围手术期心肌酶谱[肌酸激酶(CK)与肌酸激酶同工酶(CK-MB)]。结果:3组患者术中都能维持满意的血流动力学。术中丙泊酚、多巴胺的用量,术后恢复时间和围手术期心肌酶谱差异无显著性(P>0.05)。但Ⅱ组与Ⅲ组患者舒芬太尼用量多于Ⅰ组(P<0.01),Ⅲ组患者心脏指数(CI)在手术开始时低于Ⅰ组(P<0.05),心率(HR)自搭桥开始后增快(与搭桥前比较P<0.01),Ⅰ组患者术中BIS值高于Ⅱ组与Ⅲ组(P<0.05)。结论:采用0.4ng/mL、0.6ng/mL或0.8ng/mL固定效应室浓度的舒芬太尼靶控静脉麻醉对OPCAB患者术中均可以维持满意的血流动力学,但0.6ng/mL为最合适的靶控浓度。     

The response to intravenous glucose infusion in normal and diabetic subjects

Summary Data from single injection studies on 23 normal subjects led to development of an intravenous primed — constant infusion test. The plasma glucose response to this test was determined in 48 normal and 24 diabetic subjects. Variation in plasma glucose concentration at equilibrium was minimal in normal and marked in diabetic subjects — assessed by the difference between maximum and minimum glucose concentration over the final 25 min of a 50 min infusion. This parameter was used successfully in predicting the course of 16 pregnant women with clinical suspicion of prediabetes unresolved by oral glucose tolerance tests.Submitted as part fulfillment of the requirements for Doctor of Medicine, Monash University, Melbourne, 1967.