Deceased Donor Intervention Research: A Survey of Transplant Surgeons,Organ Procurement Professionals,and Institutional Review Board Members

Innovative deceased donor intervention strategies have the potential to increase the number and quality of transplantable organs. Yet there is confusion over regulatory and legal requirements, as well as ethical considerations. We surveyed transplant surgeons (n = 294), organ procurement organization (OPO) professionals (n = 83), and institutional review board (IRB) members (n = 317) and found wide variations in their perceptions about research classification, risk assessment for donors and organ transplant recipients, regulatory oversight requirements, and informed consent in the context of deceased donor intervention research. For instance, when presented with different research scenarios, IRB members were more likely than transplant surgeons and OPO professionals to feel that study review and oversight were necessary by the IRBs at the investigator, donor, and transplant center hospitals. Survey findings underscore the need to clarify ethical, legal, and regulatory requirements and their application to deceased donor intervention research to accelerate the pace of scientific discovery and facilitate more transplants.     

不同剂量丙种球蛋白治疗儿童免疫性血小板减少性紫癜的疗效分析

目的：分析不同剂量丙种球蛋白（IVIg）治疗儿童免疫性血小板减少性紫癜（ITP）的疗效,探讨有效、安全、经济的IVIg用量。方法回顾分析某院儿科自2005年2月至2014年2月收治的经不同剂量IVIg治疗的新诊断儿童ITP的临床资料。根据所用IVIg剂量的不同分为三组：小剂量（1.0g／kg）组、中剂量（1.5 g／kg）组、传统剂量（2.0 g／kg）组,分5 d应用。结果共入组病人98例,小、中、传统剂量组分别为30、35、33例。三组总反应率分别为96.67％、97.14％、100％（ P＝0.996）,血小板（PLT ）升至30×109／L的中位时间分别为2.5、2.3、2.9 d（P＝0.355）,组间差异均无统计学意义。三组患者的完全反应率分别为86.67％、88.57％、87.88％,差异无统计学意义（ P＝1.000）。结论减低剂量（1.0 g／kg或1.5 g／kg ）IV Ig与传统剂量（2.0 g／kg）IVIg比较,疗效相当、不增加慢性转化的风险,且更为经济节约,可被用来治疗新诊断儿童免疫性血小板减少性紫癜。     

抗生素降阶梯治疗重症肺炎的临床疗效及安全性

目的：比较抗生素降阶梯方案与传统抗生素方案治疗重症肺炎的临床疗效及安全性。方法将2013年1月至2015年1月在本院呼吸科住院的100例重症肺炎患者按照随机数表法分为观察组和对照组各50例,观察组患者给予抗生素降阶梯治疗方案,对照组给予传统抗生素方案。治疗7d后,比较两组患者的临床疗效,治疗前后C反应蛋白(CRP)、D-二聚体(D-D)、降钙素原(PCT)的变化,以及抗生素静脉用药时间、感染控制时间、病死率、肺部啰音消失时间、平均住院时间、痰细菌培养结果。结果观察组患者的治疗总有效率为88.00%(44/50),二次感染率为8.00%(4/50),总有效率明显高于对照组的72.00%(36/50),二次感染率明显低于对照组的28.00%(14/50),且差异均有统计学意义(P<0.01);两组患者治疗前的CRP、D-D、PCT水平比较差异均无统计学意义(P>0.05);治疗后,两组患者CRP、D-D、PCT均有所下降,且观察组下降明显低于对照组,差异有统计学意义(P<0.05);与对照组比较,观察组患者的抗生素静脉用药时间、感染控制时间、肺部啰音消失时间、平均住院时间明显低于对照组,病死率明显低于对照组,两组比较差异均有统计学意义(P<0.05);观察组患者的细菌清除率为87.04%(47/54),明显高于对照组的52.17%(24/46),差异有统计学意义(P<0.05)。结论抗生素降阶梯治疗方案治疗重症肺炎临床疗效优于传统方案,且安全性较高,值得临床推广使用。     

健脾益肾清热利湿方辅助治疗急性肾盂肾炎的疗效观察

目的：观察健脾益肾清热利湿方辅助治疗急性肾盂肾炎的临床疗效。方法将52例急性肾盂肾炎患者随机分为治疗组和对照组各26例。对照组给予抗生素治疗,治疗组在对照组的基础上给予健脾益肾清热利湿方辅助治疗,两组疗程均为2周。观察两组治疗前后主要临床症状、体征的变化。结果在疗效方面,治疗组总有效率为96.2%,对照组总有效率为80.8%,治疗组疗效优于对照组（P<0.05）;在发热、腰痛、尿路刺激征消除时间方面治疗组明显快于对照组（P<0.01）。结论健脾益肾清热利湿方辅助治疗急性肾盂肾炎效果显著,可明显改善患者的临床症状,并可缩短临床症状的消除时间,能提高治疗的有效率。     

单侧多功能外固定支架与钢板内固定治疗开放性胫腓骨骨折的疗效比较

目的：对比单侧多功能外固定支架与钢板内固定治疗开放性胫腓骨骨折的疗效。方法选择2015年5月至2016年3月期间我院骨科收治的80例开放性胫腓骨骨折患者为研究对象,根据随机数表法随机分为观察组与对照组,每组40例。对照组予钢板内固定治疗,观察组予单侧多功能外固定支架治疗,比较两组患者的临床疗效、骨折愈合时间及术后并发症发生情况。结果观察组患者骨折愈合时间为(6.27±1.44)个月,明显短于对照组的(7.95±1.89)个月,差异有统计学意义(P<0.05);观察组患者疗效优良率为95.00%,明显高于对照组的80.00%,差异有统计学意义(P<0.05);观察组患者发生伤口感染率为2.50%,并发症发生率为10.00%,均明显低于对照组的17.50%和32.50%,差异均有统计学意义(P<0.05)。结论单侧多功能外固定架治疗开放性胫腓骨骨折的疗效优于钢板内固定,且具有骨折愈合快、愈合质量高及并发症少等优点。     

药物联合康复训练治疗首发精神分裂症的疗效及其对患者认知功能的影响

目的 探讨在药物治疗基础上进行康复训练对首次发作的精神分裂症患者的治疗效果及其对患者认知功能的影响.方法 选取于2014年1月1日至2014年12月1日在我院精神卫生中心住院治疗的60例首发精神分裂症患者.利用SAS随机数字软件将其随机分为观察组和对照组各30例,均用非典型抗精神病药物(单一药物)对两组患者进行治疗.观察组在此基础上进行认知康复训练,采用阳性与阴性症状评定量表(PANSS)和威斯康星卡片分类测验-改良版(M-WCST)在治疗前和治疗第3个月对两组患者治疗效果进行评定.结果 治疗结束后,观察组PANSS总评分及阴性症状因子分低于对照组,差异均有统计学意义(P<0.05),观察组M-WCST评分错误应答数较对照组低,M-WCST评分总正确应答数和正确分类数高于对照组,WMS短时记忆、瞬时记忆得分高于对照组,差异均有统计学意义(P<0.05).结论 药物治疗联合康复训练对改善首发精神分裂症患者的治疗效果和认知功能优于单一使用药物治疗.     

老年慢性肾衰竭患者持续性血液透析治疗的临床疗效分析

目的:观察维持性血液透析(continuous blood purification,CBP)治疗老年慢性肾衰竭(chronic renal failure,CRF)患者的临床疗效。方法:选取2015年1月至2016年1月在本院采用CBP治疗的90名CRF患者,根据年龄分为老年组56例和非老年组34例,并观察两组患者治疗前后肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)、血红蛋白(hemoglobin,Hb)、甘油三脂(triglycerides,TG)、C反应蛋白(C-reaction protein,CRP)等指标变化以及相关并发症发生率。结果:两组患者经治疗后,Scr、BUN、Hb、TC、CRP等指标均较治疗前明显改善;老年组并发症发生率明显高于非老年组。结论:血液透析治疗对老年CRF患者显著有效。     

Survey on practice of venom immunotherapy in France

Introduction

Venom immunotherapy (VIT) is the only efficient prevention for sting-induced anaphylaxis, but its application is not without risks and needs precautions and standardization. European guidelines were proposed in 2005, but recent practice surveys and more recent knowledge raise the need for an update. The aim of this study was to analyze VIT practices in France, based on previous surveys in Europe but also extended to outcome event management.

Material and methods

A paper questionnaire was sent widely to persons involved in venom treatment.

Results

Eighty-six responses could be included from physicians actively involved in VIT induction evenly distributed in France. The survey shows that VIT was engaged from grade III down to grade I reactions, starting preferentially with the ultra-rush protocol. Premedication was used by 42% only and risks induced by co-treatment with β-blockers were well known but not with angiotensin-converting enzyme inhibitors. However, side effects were very variably managed from arrest to enhancement in doses, time-delay or duration. Similarly, we observed a large discrepancy in treatment evaluation (skin tests, biology, timing and interpretation), decision making for treatment termination (when and how long to be prolonged) and post-treatment follow-up (adrenaline kit, event record) as well as procedures in case of late relapse (new induction, different doses).

Conclusions

Our study shows that most recommendations were fully or partially followed and may need reminding, but many points need to be completed or updated with new tools and knowledge acquired during the last 10 years.     

Efficacy and safety of sublingual immunotherapy in children

Allergen immunotherapy (AIT) is currently the only available disease-modifying and aetiological treatment of IgE-mediated diseases. Sublingual allergen immunotherapy (SLIT) constitutes the preferred route of administration of AIT for respiratory allergies in Europe. Recently it has also been approved in the US. Further applications are currently under evaluation, such as IgE-mediated food allergy and IgE-mediated atopic dermatitis. The SLIT safety profile is overall favourable, although local adverse events, usually mild, are described. Most of the meta-analyses confirmed the efficacy of SLIT in reducing symptoms and medication intake in children with allergic diseases. AIT, as an immune-modulating treatment, can modify the natural history of the allergic diseases: reduction of the risk of development of asthma and bronchial hyperreactivity in patients with allergic rhinitis, and reduction of the onset of new sensitizations. A great interest is now devoted to the preventive effects of AIT and, consequently, to the optimal time of initiation.