Consenso de expertos sobre el uso de alemtuzumab en la práctica clínica diaria en España

IntroductionAlemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis.ObjectiveA consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain.DevelopmentA group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group.ConclusionThe present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.     

《本草纲目》引用书名核准之研究报告

核准李时珍所引用的医药文献,不仅对《本草纲目》整理研究具有重要意义,还可能作为一个范例,探索古代医家文献引用的普遍规律。研究发现,《本草纲目》引用书名标注方式存在规律性,一般包括:书名、简称、别名、作者姓名(姓氏、名、字、号)、修订增补者姓名(姓氏、名、字、号)等。其引据文献有重要的文献学意义,如可用以考证元代吴瑞的重要本草学著作《日用本草》各版之真伪,可证实明代《食物本草》的作者与版本真伪。《本草纲目》增引的276家医书中,有64种未见于此前其他书目记载。同时,《本草纲目》引书也存在两书混一、一书重出、误引书名、误写作者、存目未引等问题,需引起读者的注意。     

A pilot randomised controlled comparison of continuous veno–venous haemofiltration and extended daily dialysis with filtration: effect on small solutes and acid–base balance

Background and aims Continuous veno–venous haemofiltration (CVVH) is an established treatment for acute renal failure (ARF). Recently, extended intermittent dialytic techniques have been proposed for the treatment of ARF. The aim of this study was to compare these two approaches. Setting Intensive care unit of tertiary hospital. Subjects Sixteen critically ill patients with ARF. Design Randomised controlled trial. Intervention We randomised sixteen patients to three consecutive days of treatment with either CVVH (8) or extended daily dialysis with filtration (EDDf) (8) and compared small-solute, electrolyte and acid–base control. Results There was no significant difference between the two therapies for urea or creatinine levels over 3 days. Of 80 electrolyte measurements taken before treatment, 19 were abnormal. All values were corrected as a result of treatment, except for one patient in the CVVH group who developed hypophosphataemia (0.54 mmol/l) at 72 h. After 3 days of treatment, there was a mild but persistent metabolic acidosis in the EDDf group compared to the CVVH group (median bicarbonate: 20 mmol/l vs. 29 mmol/l: p = 0.039; median base deficit: –4 mEq/l vs. –2.1 mEq/l, p = 0.033). Conclusions CVVH and EDDf as prescribed achieved similar control of urea, creatinine and electrolytes. Acidosis was better controlled with CVVH. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

行为护理在老年脑梗死患者康复过程中的应用价值

【目的】探讨行为护理在老年脑梗死（ACI）患者康复过程中的应用价值。【方法】选择2014年6月至2015年10月本院神经内科收治的105例老年ACI患者为研究对象,采用随机数字表法将其分为对照组和观察组。对照组给予常规护理,观察组在对照组的基础上给予行为护理。干预4周后,比较两组患者干预前后日常生活能力、运动功能和生活质量的差别。【结果】干预前两组患者的日常生活功能评定量表（BI）各维度得分和总分、运动功能评定量表（FMA）评分以及生活质量评分均无明显差别;干预后,两组患者的各项指标均有所提高,且观察组均高于对照组,差异有统计学意义（P〈0．05）。【结论】行为护理在老年ACI患者康复过程中的应用可明显提高患者的运动能力,提高其生活质量。     

Locust bean gum safety in neonates and young infants: An integrated review of the toxicological database and clinical evidence

Locust bean gum (LBG) is a galactomannan polysaccharide used as thickener in infant formulas with the therapeutic aim to treat uncomplicated gastroesophageal reflux (GER). Since its use in young infants below 12 weeks of age is not explicitly covered by the current scientific concept of the derivation of health based guidance values, the present integrated safety review aimed to compile all the relevant preclinical toxicological studies and to combine them with substantial evidence gathered from the clinical paediatric use as part of the weight of evidence supporting the safety in young infants below 12 weeks of age. LBG was demonstrated to have very low toxicity in preclinical studies mainly resulting from its indigestible nature leading to negligible systemic bioavailability and only possibly influencing tolerance. A standard therapeutic level of 0.5 g/100 mL in thickened infant formula is shown to confer a sufficiently protective Margin of Safety. LBG was not associated with any adverse toxic or nutritional effects in healthy term infants, while there are limited case-reports of possible adverse effects in preterms receiving the thickener inappropriately. Altogether, it can be concluded that LBG is safe for its intended therapeutic use in term-born infants to treat uncomplicated regurgitation from birth onwards.     

Individual patterns of alcohol use

Aims

We present methodology to identify statistically distinct patterns of daily alcohol use and classify them into categories that could be further used in monitoring of transitions between patterns such as transitions from regular to problem use.

Data

The study analyzed individual patterns of adult alcohol consumption from two datasets containing short (< 6 month) and long (up to 2 years) daily records of drinking. These data were collected over the period between 1999 and 2003.

Results

By using a non-parametric (Kolmogorov–Smirnov) test we have identified distinct drinking patterns and classified them into 8 types according to their means, percentages of non-drinking days and variances of consumed amount during drinking days. For each studied individual we calculated a transition chart that characterizes transitions between the types.

Conclusions

Individual daily consumption patterns can be identified, and classified into distinct patterns. Changes between the patterns could be related to life events or environmental trends, and thus provide insights into pathways towards either heavier use or recovery.     

Effects of Coffee Intake on Incident Chronic Kidney Disease: A Community-Based Prospective Cohort Study

Background

Drinking coffee can raise public health problems, but the association between coffee and kidney disease is unknown. We studied whether coffee intake can affect the development of chronic kidney disease in the general population.

Effect of photoperiod manipulation on the daily rhythms of melatonin and reproductive hormones in caged European sea bass (Dicentrarchus labrax)

Reproduction in fish is cyclical and timed to guarantee the survival of the offspring. Seasonal variations in reproductive hormones of fish have been deeply investigated in fish over the last years. However, there are few studies regarding the daily changes in reproductive hormone profiles in teleosts. The aim of the present research was to investigate the effects of photoperiod manipulation on melatonin and reproductive hormones (pituitary sbGnRH, pituitary LH and plasma LH, testosterone [T], and 11-ketotestosterone [11KT]) daily rhythms in male sea bass, kept in net cages under farming conditions in winter (9L:15D). Fish were distributed in two groups, one under constant long photoperiod (18L:6D) and the other under natural photoperiod. The photoperiod strongly influenced the daily melatonin profile, so that the duration of the nocturnal melatonin rise was longer in the control group than in the group exposed to the artificial photoperiod (18L:6D). A daily rhythm was observed in the pituitary sbGnRH profile in both groups, showing the lowest levels during the dark period. A daily rhythm of pituitary LH was detected in the control group, which was suppressed in the group under long photoperiod. Daily variations in plasma LH were observed, the highest levels being found in the dark phase in both groups, although this profile was significantly altered by artificial light, maintaining a fixed relationship between the first nocturnal rise of melatonin and the nocturnal peaks of plasma LH in both groups. Plasma T levels showed significant fluctuations in their daily cycle following a sinusoidal pattern with an acrophase around sunrise in both groups, without any influence of light regime. No significant daily variations in plasma levels of 11-KT were observed in none of the groups. Our results provide the first evidence of the presence of daily variations in pituitary sbGnRH content, pituitary and plasma LH, and plasma T in sea bass. Artificial lights suppressed the circulating melatonin and significantly affected the daily rhythm of LH storage and release.     

某日用化工企业职业病危害检测与分析

目的识别、评价和分析某日用化工企业建设项目可能存在的职业病危害因素及危害程度,确定危害类别,分析其对劳动者健康的危害程度;对采取的职业病危害防护设施进行分析与评价,制定相应职业病危害防护措施,为卫生行政部门审批建设项目提供可行的技术依据。方法选择对该建设项目进行职业卫生调查,采用职业卫生检测、经验法、检查表分析法进行评价。结果该建设项目属于职业病危害一般的项目。本项目在选址、总体布局及生产工艺及设备布局、采取的职业病防护设施设计,基本符合国家有关规定。个人职业病防护用品、辅助用室的卫生设施配置等方面仍有待改善。本项目可能产生的主要职业病危害因素有：化学因素（瓜尔胶、硫醚硫酸铵、十二烷基硫酸铵、硅脂、单甘酯、香精、防腐剂、中药提取成分、乙醇等）和物理因素（高温、噪声等）。其中噪声合格率为75%,高温合格率为0%。该建设项目采取的职业病防护措施基本符合国家有关规定。结论该项目执行了国家的有关规定,针对主要职业病危害因素采取了相应的防护措施,但职业病危害控制还有待改善。