抗骨质疏松药物对骨质疏松症患者糖代谢、脂代谢的影响

骨质疏松症与心血管疾病已成为影响中老年人健康与生活质量的重要原因。研究发现糖代谢、脂代谢可以与骨代谢相互影响,而糖脂代谢异常可致心血管风险增高。目前现有研究发现抗骨质疏松药物可以影响心血管事件的发生,但关于其风险因素的研究却较少。因此,本文拟通过综述抗骨质疏松药物对患者糖代谢、脂代谢的影响,探讨抗骨质疏松药物非骨骼方面的益处和危害,使患者在控制骨折风险的同时,对心血管疾病进行管理,从而改善患者的整体状况。     

Rates and Outcomes of Periprosthetic Joint Infection in Persons Who Inject Drugs

BackgroundThe risk of periprosthetic joint infection (PJI) is higher in persons who inject drugs (PWID) after total joint arthroplasty (TJA), though reported rates vary widely. This study was designed to assess outcomes of TJA in PWID and to describe factors associated with improved PJI outcomes among PWID.MethodsA retrospective matched cohort study was performed using a 1:4 match among those with and those without a history of injection drug use (IDU) undergoing TJA. Demographic, surgical, and outcome variables were compared in multivariate logistic regressions to determine PJI predictors. Kaplan-Meier analyses were constructed to characterize the difference in survival of patients who did not have PJI or undergo joint explantation between PWID and the matching cohort.ResultsPWID had a 9-fold increased risk of PJI compared to the matched cohort (odds ratio 9.605, 95% CI 2.781-33.175, P < .001). Ten of 17 PWID whose last use was within 6 months (active use) of primary TJA had a PJI, while 7 of 41 PWID who did not have active use developed a PJI. Of PWID with PJI, treatment failure was seen in 15 of 17, while in patients who did not have an IDU history, 5 of 8 with PJI had treatment failure.ConclusionIDU is a significant risk factor for PJI following TJA. Future work investigating the effect of a multidisciplinary support team to assist in cessation of IDU and to provide social support may improve outcomes and reduce morbidity in this vulnerable population.     

Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.     

Effects of prophylactic or therapeutic application of bovine haemoglobin HBOC-200 on ischaemia-reperfusion injury following acute coronary ligature in rats

Background. Haemoglobin-based oxygen carriers (HBOCs) are assessedas blood substitutes in patients with perioperative anaemiaincluding patients at risk for perioperative cardiac ischaemia.There is controversy as to whether HBOCs are beneficial or deleteriousduring ischaemia–reperfusion (I–R). Therefore theeffects of HBOC-200 on I–R injury were evaluated in arandomized placebo-controlled animal trial. Methods. Animals were randomized to receive either placebo i.v.without I–R (sham group, n=9), placebo i.v. with I–R(control group, n=10), HBOC-200 0.4 g kg^–1 i.v. priorto I–R (prophylaxis group, n=12) or HBOC-200 0.4 g kg^–1i.v. during I–R (therapy group, n=15). I–R consistedof 25 min of acute ligature of the left coronary artery followedby 120 min of reperfusion. Measurements included assessmentof the area at risk and infarct size using triphenyl tetrazoliumchloride (TTC) stain, DNA single-strand breaks (in situ nicktranslation with autoradiography/densitometry) and cardiac arrhythmias. Results. Infarct size within the area at risk was 62 (SD 15)%(control), 46 (10)% (prophylaxis, P<0.025 vs control) and61 (9)% (therapy, P<0.85 vs control). The frequency of DNAsingle-strand breaks was reduced vs control in the sham (P<0.01)and prophylaxis (P<0.04) groups and was almost the same inthe therapy group (P<0.75). The severity of cardiac arrhythmiasduring ischaemia was lower compared with control in the sham(P<0.001) and prophylaxis (P<0.039) groups, but therewas no difference in the therapy group. Conclusion. This study demonstrates that neither prophylacticnor therapeutic application of the cell-free haemoglobin solutionHBOC-200 aggravates cardiac I–R injury. Furthermore, theprophylactic approach may offer a new opportunity for pretreatmentof patients at risk for perioperative ischaemic cardiac events. The results were presented in part at the Congress of the EuropeanSociety of Anaesthesia, Glasgow, UK, June 2003 (‘BestAbstract Award’), and at the Annual Meeting of the AmericanSociety of Anesthesiologists, San Francisco, CA, USA, October2003. Declaration of interest. T. G. Standl has received lecture honorariaand travel fees from Biopure Corporation, Boston, MA, the manufacturerof HBOC. The Department of Anaesthesiology, University Hospital,Hamburg-Eppendorf, received restricted grants from Biopure Corporation,Boston, MA, between 1994 and 1998 for animal and clinical phaseII and III trials. M.A. Burmeister is Vice President Researchand Development, Hospital Care Division, B. Braun MelsungenAG, Melsungen, Germany. B. Braun, a global health care supplier,cooperated with Biopure Corporation, Boston, MA, on HBOC developmentuntil 1996. The work presented in this paper was done independentlyof and without any support from B. Braun.     

细胞周期蛋白D1和P21WAF1在胃癌中的表达及其与化疗药物敏感性的关系

目的检测细胞周期蛋白（cyclin）D1、P21WAF1在胃癌组织中的表达,并探讨其与化疗药物敏感性的关系。方法采用MTT比色法观察80例胃癌原代培养细胞在体外对化疗药物羟基喜树碱（HCPT）、顺铂（DDP）、阿霉素（ADM）、氟尿嘧啶（5-Fu）及丝裂霉素（MMC）的敏感性;免疫组织化学染色检测cyclin D1和P21WAF1蛋白在胃癌组织中的表达情况。结果胃癌细胞对不同化疗药物敏感性不同：5-FU、MMC和DDP对胃癌细胞的抑制率显著高于ADM和HCPT（P〈0．05）。胃癌组织中cvclin D1和P21WAF1蛋白的阳性率分别为70．0％和47．5％。cyclin D1阳性表达者对5-Fu和HCPT的敏感性显著高于阴性表达者（P〈0．05）,而P21WAF1阴性表达者对MMC、5-FU和DDP的敏感性显著高于阳性表达者（P〈0．05）。结论cyclin D1和P21WAF1蛋白与胃癌对化疗药物敏感性有关．检测其表达对于化疗药物的选择具有一定的参考价值。     

注射毒品所致假性股动脉瘤治疗体会(附34例)

目的探讨注射毒品所致假性股动脉瘤的外科疗法。方法对34例注射毒品所致假性股动脉瘤病人的临床资料进行回顾分析。结果13例直接采用ePTFE人造血管行旁路髂外动脉和股浅动脉端侧吻合术,3例采用自体大隐静脉原位移植术,其中1例术后吻合口破裂出血改行ePTFE人造血管行旁路髂外动脉动脉和股浅端侧吻合术,18例股动脉结扎术。全部病例保肢成功。血管移植者术后复查彩色多普勒显示移植血管通畅。结论在患者不能采用合适的自体大隐静脉移植及人造血管移植时,运用结扎股动脉术是治疗注射毒品所致假性股动脉瘤的有效方法。     

环孢素A及FK506对人肝癌细胞株增殖的影响

目的:探讨免疫抑制剂环孢素(CsA)及他克莫司(FK506)对肝癌细胞增殖的影响及可能机制。方法:采用噻唑蓝(MTT)比色法观察CsA及FK506对QGY鄄7701、QGY鄄7703、SMMC鄄7721和BEL鄄7402等4株肝癌细胞增殖的影响。还应用Hoechst33258荧光染料涂片,在荧光显微镜下观察用药组细胞的形态学改变。结果:随着作用时间延长,10μM的CsA对4株肝癌细胞均呈现明显的生长抑制效应(P<0.01),而0.5μM的FK506与对照组相比,其生长抑制作用不明显(P>0.05)。荧光显微镜下CsA用药组肝癌细胞呈现凋亡改变;而FK506用药组与对照组无显著差异。结论:免疫抑制剂CsA非但未促进体外肝癌细胞生长,相反呈明显的抑制效应。FK506尽管未呈现对肝癌细胞增殖的抑制效应,也未显示有生长促进作用。CsA对肝癌细胞的增殖抑制作用与诱导癌细胞发生凋亡有关。     

感染性心内膜炎致病菌分布与临床特征

目的 分析感染性心内膜炎患者致病菌分布情况与临床特征。方法 选择2016年10月~2019年9月我院收治的80例感染性心内膜炎患者作为研究对象,收集其临床资料,观察患者致病菌分布情况及临床特征。结果 80例患者血样共检出病原菌株36株,检出病原菌株中革兰阳性菌占比8889%,真菌占比1111%。革兰阳性菌中占比最高的为酿脓链球菌（3889%）,其次为金黄色葡萄球菌（1944%）、D链球菌（1111%）和表皮葡萄球菌（1111%）。感染性心内膜炎患者中最常见临床表现为发热（9250%）,其次为心脏杂音（8875%）、疲乏（8375%）、盗汗（8125%）。9750%的患者超声心动图检查可见心脏赘生物。80例患者中有6例死亡,死亡率为750%。死亡组先天性心脏病、人工瓣膜、Hb＜90g/L、ALB＜30g/L和栓塞所占比例均高于存活组（P＜0.05）,外科手术治疗占比低于存活组（P＜0.05）。多因素Logistic回归分析显示,先天性心脏病、人工瓣膜、Hb＜90g/L、脑栓塞是感染性心内膜炎患者预后的危险因素（P＜0.05）,手术治疗是其保护因素（P＜0.05）。结论 感染性心内膜炎患者血样病原菌中革兰阳性菌占比最高,绝大多数患者超声心动图可见心脏赘生物,部分伴有基础心脏疾病,及早诊断并合理使用抗菌药物,警惕预后危险因素,及时给予外科手术治疗,对改善患者预后具有重要价值。     

国家谈判药品门诊医保待遇现状、问题及完善措施

2017-2019年国家医保目录准入谈判有效缓解了高值创新药品的"看病贵"难题。但"重住院、轻门诊"医保现状使得谈判药品门诊实际报销水平较低,进而影响患者的健康福利。本文以97个谈判药品、337个统筹市为统计样本,实证分析门诊用药的医保报销情况,结果显示有40个品种在大部分统筹市(统筹市占比超过70%)的实际报销水平低于50%。进一步探究门诊待遇低的原因发现未纳入门诊特殊政策、或门诊特殊政策不完善是其主要原因。最后,本文基于国内各统筹市门诊补偿政策经验提出提高门诊保障待遇的建议与方案,认为各统筹市可通过实现门诊统筹、完善门诊特殊政策、探索创新支付等手段提高谈判药品门诊保障待遇,确保医保目录准入谈判结果落地工作的顺利实施。