我国儿童基本药物政策框架设计

目的:为促进我国儿童基本药物相关工作提供参考。方法:比较四版《世界卫生组织(WHO)儿童基本药物示范目录》、《母亲和儿童的重点药物目录》和我国《国家基本药物目录》中收录的儿童基本药物的情况,提出构建我国儿童基本药物的政策框架的设计思路。结果与结论:我国儿童基本药物和有儿童用药信息的基本药物品种、数量都较少,现状堪忧。我国可借鉴WHO的经验,根据我国儿童疾病谱制定儿童基本药物目录和配套的标准处方集,并统一儿童基本药物的包装标志,落实配套政策,以推动我国儿童基本药物的发展。     

肝细胞癌肝移植供肝选择策略

供肝数量不足是制约肝移植发展的主要因素,更是制约肝细胞癌肝移植治疗的突出因素。既往对肝细胞癌肝移植的研究多集中在受者选择标准、降期治疗、免疫抑制方案等方面,近年来研究发现供肝的选择对肝细胞癌肝移植术后肿瘤复发也有显著影响。笔者从临床供肝的主要类型、肝细胞癌肝移植适应证的把握、适应证内肝细胞癌肝移植和超适应证肝细胞癌肝移植的供肝选择以及供肝选择对肝细胞癌肝移植预后的影响进行深入探讨。     

Pregnancy is not a risk factor for gallstone disease： Results of a randomly selected population sample

AIM: To investigate the prevalence, risk factors, and selection of the study population for cholecystolithiasis in an urban population in Germany, in relation to our own findings and to the results in the international literature. METHODS: A total of 2 147 persons (1 111 females, age 42.8±12.7 years; 1 036 males, age 42.3±13.1 years) participating in an investigation on the prevalence of Echinococcus multilocularis were studied for risk factors and prevalence of gallbladder stone disease. Risk factors were assessed by means of a standardized interview and calculation of body mass index (BMI). A diagnostic ultrasound examination of the gallbladder was performed. Data were analyzed by multiple logistic regression, using the SAS statistical software package. RESULTS: Gallbladder stones were detected in 171 study participants (8.0%, n = 2 147). Risk factors for the development of gallbladder stone disease included age, sex, BMI, and positive family history. In a separate analysis of female study participants, pregnancy (yes/no) and number of pregnancies did not exert any influence. CONCLUSION: Findings of the present study confirm that age, female sex, BMI, and positive family history are risk factors for the development of gallbladder stone disease. Pregnancy and the number of pregnancies, however, could not be shown to be risk factors. There seem to be no differences in the respective prevalence for gallbladder stone disease in urban and rural populations.     

Effect of forward and reverse selection for ethanol-induced locomotor response on other measures of ethanol sensitivity

BACKGROUND: Ethanol sensitivity may be a predictor of genetic predisposition to ethanol abuse. To examine ethanol sensitivity in rodents, two lines of mice were bred in replicate for high (FAST-1 and -2) and low (SLOW-1 and -2) locomotor stimulant responses to ethanol. After large differences between the lines developed and further response to selection seemed to have arrested, reverse selection was initiated by breeding the slowest FAST mice with each other and the fastest SLOW mice with each other. The reverse-selected lines, named r-FAST and r-SLOW, were virtually equally sensitive to the stimulant effects of the selection dose of ethanol after 16 generations of reverse selection. METHODS: These experiments used this unique genetic model to examine two responses, putatively genetically correlated with sensitivity to ethanol stimulation: handling-induced convulsions during chronic ethanol withdrawal, and ethanol-induced hypothermia. Ethanol clearance, for which a small difference was previously found between the FAST and SLOW lines, was also examined. RESULTS: Handling-induced convulsions during chronic ethanol withdrawal were significantly greater in both FAST lines compared with both SLOW lines. Reverse selection eliminated the difference between the replicate 1 lines but did not alter the difference between the replicate 2 lines. Ethanol-induced hypothermia was greater in both SLOW lines compared with the FAST lines. This difference was significantly reduced by reverse selection in r-SLOW mice only. Ethanol clearance rates were similar among all lines and replicates. CONCLUSIONS: These data demonstrate the usefulness of reverse-selected lines for examining putatively genetically correlated traits. Changes in the correlated traits demonstrated the existence of persistent trait-relevant genetic heterogeneity and some genetic overlap between the correlated traits and the selection trait. Absence of a change after reverse selection suggests that trait-relevant genetic heterogeneity was eliminated by forward selection or, alternatively, that the trait was not influenced by genes associated with successful reverse selection.     

麻醉后导尿管的选择在术后拔除尿管时对患者的影响

目的 改变传统留置导尿管在拔除尿管时给成年患者带来的不适反应.方法 将100例需留置导尿的成年患者随机分成2组各50例,麻醉后用16Fr气囊导尿管导尿者为对照组,麻醉后用12Fr气囊导尿管导尿者为观察组.观察2组患者在拔除尿管时出现的尿道刺激反应和排尿困难的程度及留置尿管后有无尿管自行脱出及管周漏尿情况.结果 观察组患者在拔除尿管时出现的尿道刺激反应以及排尿困难程度明显低于对照组,2组患者留置尿管后均无尿管自行脱出及管周漏尿现象.结论 成年患者应用12Fr气囊导尿管留置导尿能明显减轻拔除尿管时的尿道刺激反应以及排尿困难的程度,且不会增加管周漏尿及尿管脱出的发生.     

Systematic review: Predictors of students’ success in baccalaureate nursing programs

Nursing schools strive to select a diverse student population who are likely to succeed by ensuring timely student progression through the program and effective use of educational sources. The purpose of this systematic literature review is to explore the preadmission variables and selection criteria that predict student success in 4-year baccalaureate nursing programs in the U.S. Sixteen articles met the eligibility criteria, and six measures were used to define student success: (a) early academic success, particularly during the first and second year; (b) attrition; (c) timely completion of the program; (d) graduation; (e) performance in nursing courses; and (f) academic performance in other science courses. Typically, the core set of cognitive predictors used in the admission process in nursing schools were pre-nursing GPA, pre-nursing collegiate science GPA, and scores on standardized aptitude exams. This review suggests that it is challenging to isolate one single variable as the best predictor of student success; however, using a combination of variables can offer a reliable prediction method. More researchers should consider using a theoretical basis to guide their inquiry on this topic. Additionally, researchers should examine admission variables that are most relevant across programs.     

Candidate selection, timing of listing, and choice of procedure for lung transplantation

Decisions about patient selection, timing of listing, and choice of procedure are important steps in optimizing the outcome of lung transplantation. Selection of candidates for lung transplantation requires an appreciation of the effect of pretransplant patient characteristics on posttransplant outcomes. Familiarity with the natural history of the underlying disease and of disease-specific prognostic factors is essential in making decisions about when to list candidates. Decisions about transplanting 1?or 2 lungs are principally determined by the underlying disease, but in cases in which both procedures are acceptable, factors such as survival benefit, patient's age, and center-specific preferences come into play.     

Clinical outcome in patients with hepatocellular carcinoma after living-donor liver transplantation

AIM: To investigate risk factors for hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT) and efficacy of various criteria. METHODS: From October 2000 to November 2011, 233 adult patients underwent LDLT for HCC at our institution. After excluding nine postoperative mortality cases, we analyzed retrospectively 224 patients. To identify risk factors for recurrence, we evaluated recurrence, disease-free survival (DFS) rate, survival rate, and various other factors which are based on the characteristics of both the patient and tumor. Additionally, we developed our own criteria based on our data. Next, we compared our selection criteria with various tumor-grading scales, such as the Milan criteria, University of California, San Francisco (UCSF) criteria, TNM stage, Barcelona Clinic Liver Cancer (BCLC) stage and Cancer of the Liver Italian Program (CLIP) scoring system. The median follow up was 68 (6-139) mo.RESULTS: In 224 patients who received LDLT for HCC, 37 (16.5%) experienced tumor recurrence during the follow-up period. The 5-year DFS and overall survival rates after LDLT in all patients with HCC were 80.9% and 76.4%, respectively. On multivariate analysis, the tumor diameter {5 cm; P < 0.001; exponentiation of the B coefficient [Exp(B)], 11.89; 95%CI: 3.784-37.368} and alpha fetoprotein level [AFP, 100 ng/mL; P = 0.021; Exp(B), 2.892; 95%CI: 1.172-7.132] had significant influences on HCC recurrence after LDLT. Therefore, these two factors were included in our criteria. Based on these data, we set our selection criteria as a tumor diameter ≤ 5 cm and AFP ≤ 100 ng/mL. Within our new criteria (140/214, 65.4%), the 5-year DFS and overall survival rates were 88.6% and 81.8%, respectively. Our criteria (P = 0.001), Milan criteria (P = 0.009), and UCSF criteria (P = 0.001) showed a significant difference in DFS rate. And our criteria (P = 0.006) and UCSF criteria (P = 0.009) showed a significant difference in overall survival rate. But Milan criteria did not show significan