超声引导下腹横肌平面阻滞复合瑞芬太尼靶控输注在胰管结石体外震波碎石术中的应用

目的 评价超声引导下腹横肌平面阻滞联合瑞芬太尼靶控输注应用于胰管结石体外震波碎石术(ESWL)中的效果。方法 随机选择60例首次接受ESWL治疗胰管结石的患者,分为R组和TR组(每组n=30)。R组患者仅接受瑞芬太尼靶控输注(TCI),TR组患者接受瑞芬太尼TCI前30min接受超声引导下腹横肌平面阻滞。采用Dixon序贯法计算两组患者的瑞芬太尼半数有效量(EC₅₀),记录患者围术期视觉模拟疼痛量表(VAS)、Ramsay镇静量表、血流动力学参数、呼吸参数和不良事件。结果 R组和TR组患者瑞芬太尼EC₅₀分别为3.448ng/ml(95%CI:1.636~3.946)和2.523ng/ml(95%CI:0.744~2.991),差异具有统计学意义(P＜0.05)。两组患者疼痛和镇静评分相当。两组患者血流动力学和呼吸参数均无明显差异。与R组相比,TR组不良事件发生率更低(10% vs 56.7%,P＜0.001),瘙痒发生率更低(6.7% vs 26.7%,P=0.038)。结论 腹横肌平面阻滞联合瑞芬太尼靶控输注可为胰管结石ESWL提供满意的镇痛和镇静,且不良事件发生率更低。     

Disparity of human immunodeficiency virus incidence and drug resistance in college student,non-student youth and older men who have sex with men: a cross-sectional study from seven major cities of China

Background:Human immunodeficiency virus (HIV) prevalence among student men who have sex with men (MSM) in college is more than 5.0% and keeps on increasing in China. This study aims to clarify the proportion of HIV recent infection, its propeller and the source among college student MSM.Methods:We conducted a multicenter cross-sectional study in seven major Chinese cities during 2012-2013. HIV recent infections (≤ 168 days) and incidence was measured and estimated by BED HIV-1 capture enzyme immunoassay (BED-CEIA) testing strategy. HIV-related behaviors and transmitted drug resistance (TDR) were investigated and compared between the college student MSM, <25-year-old non-student youth MSM (NSYM), and ≥25-year-old non-student non-youth MSM (NSNYM), using structured survey, and analyses of drug resistance.Results:Overall, 4,496 (4496/4526, 99.3%) were eligible for enrollment, comprising 565 college student MSM, 1,094 NSYM, and 2,837 NSNYM. The proportion of HIV recent infection were 70.3% (26/37), 50.8% (65/128) and 35.1% (95/271), the HIV incidence rate were 10.0 (95% CI: 6.2-13.9)/100PY, 12.9 (95% CI: 9.8-16.1)/100PY, 6.8 (95% CI: 5.4-8.2)/100PY, and TDR prevalence were 7.4% (2/27), 2.0%, (2/98) and 4.9% (11/226), among student MSM, NSYM, and NSNYM, respectively. Among HIV positive student MSM with age< 21-year-old, the proportion of HIV recent infection is 90.9% (10/11). Factors independently associated with HIV recent infection in student MSM was usage of recreational drug in the past 6 months (AOR: 2.5; 95% CI: 1.0–5.8).Conclusions:College student MSM had higher proportion of HIV recent infection and TDR than the youth and older MSM in China during 2012-2013. The HIV infections were more likely to happen during the early year of college life among student MSM.     

Anti-TNF dose escalation and drug sustainability in Crohn’s disease: Data from the nationwide administrative database in Hungary

BackgroundA significant percentage of patients receiving anti-tumor necrosis factor alpha (anti-TNFα) agents lose clinical response over time. This study aims to provide representative real-world data on anti-TNFα drug sustainability, prevalence and predictors of anti-TNFα dose escalation.MethodsIn this nationwide, retrospective study, patients receiving infliximab or adalimumab therapy between 2013 and 2016 were included using the administrative claims database of the Hungarian National Health Insurance Fund. Demographic characteristics, drug sustainability, dose escalation, use of parallel medications were analyzed.Results476 infliximab and 397 adalimumab patients were included. Dose escalation was observed in 7%, 9% and 22% of patients receiving originator/biosimilar infliximab and adalimumab during the complete follow-up, respectively. Dose escalation was associated with shorter disease duration (OR = 1.75, p = 0.026) and corticosteroid use. Drug retention rates were 62.7%, 72.3%, 75.4% after 1 year follow-up for Remicade®, Inflectra® and Humira®, which decreased to 38.3% and 52.1% for Remicade® and Humira® at 3 years. Drug sustainability was affected by steroid use prior biologic initiation in adalimumab treated patients (HR = 2.04, p < 0.001), while in infliximab treated patients dose escalation (HR = 0.51, p = 0.02) and gender (HR = 1.39, p = 0.033) were predictors of treatment discontinuation.ConclusionDose escalation rates were lower in this real-world administrative database study for both adalimumab and infliximab compared to published data. Drug retention rates were overall satisfactory, with no apparent difference between the legacy and biosimilar infliximab.     

哮喘治疗百年回顾:从经典辉煌到靶向选择

当前哮喘患病率在全球范围内仍呈逐年增加的趋势。在过去的一百年,伴随着吸入性糖皮质激素的问世、联合治疗尤其是吸入性糖皮质激素和长效支气管扩张剂联合治疗概念的提出、以哮喘总体控制为目标管理模式的建立,哮喘的治疗进入经典辉煌的抗炎药物治疗时期。我国哮喘的总体控制水平得到了一定程度的提高,但仍有部分重症哮喘患者依然达不到良好控制状态。重症哮喘造成了巨大的社会和经济负担。近年来,基于炎症表型和生物标志物的重症哮喘个体化治疗取得了诸多突破性进展,对未来哮喘治疗的方向产生了极其深远的影响,使更多哮喘患者从中获益。哮喘治疗正在从“经典”走向“精准”。     

Thiopurine-methyltransferase variants in inflammatory bowel disease:Prevalence and toxicity in Brazilian patients

AIM:To analyze the prevalence of thiopurine-methyltransferase(TPMT)genotypes and their associationwith drug toxicity in inflammatory bowel disease(IBD)patients from southeastern Brazil.METHODS:A total of 219 consecutive patients with IBD,of which 146 had Crohn’s disease and 73 had ulcerative colitis,regularly seen at the outpatient unit of the Division of Gastroenterology at the University Hospital Pedro Ernesto of the State University of Rio de Janeiro,a tertiary referral center,were enrolled in this study from February 2009 to January 2011.We analyzed the presence of major TPMT genetic variants(TPMT*2,*3A,*3C)in IBD patients by means of a specific allele and RFLP-PCR.Genomic DNA was isolated from peripheral blood leukocytes by proteinase-K/Sodium Dodecyl Sulfate digestion and phenol-chloroform extraction.TPMT*2(C238G),TPMT*3A(G460A/A719G),and TPMT*3C(A719G)genotypes were detected by real-time polymerase chain reaction followed by direct sequencing with specific primers.Clinical data were systematically recorded,and correlated with the genotype results.RESULTS:The distribution of the selected TPMT gene polymorphism TPMT*2(C238G),TPMT*3A(G460A/A719G),and TPMT*3C(A719G)genotypes was 3.6%,5.4%,and 7.7%of the patients,respectively.Among the side effects recorded from patients taking azathioprine,14 patients presented with pancreatitis and/or an elevation of pancreatic enzymes,while 6 patients had liver toxicity,and 2 patients exhibited myelosuppression/neutropenia.TPMT polymorphisms were detected in 37/219 patients(8 heterozygous for*2,11 heterozygous for*3A,and 18 heterozygous for*3C).No homozygotic polymorphisms were found.Despite the prevalence of the TPMT*3C genotype,no differences among the genotype frequencies were significant.Although no association was detected regarding myelotoxicity or hepatotoxicity,a trend towards the elevation of pancreatic enzymes was observed for TPMT*2 and TPMT*3C genotypes.CONCLUSION:The prevalence of TPMT genotypes was high among Brazilian patients.Variants genes*2and*3C may be associated with azathioprine pancreatic toxicity in a IBD southeastern Brazilian population.     

四川省二级综合医院耐碳青霉烯类鲍曼不动杆菌感染发生的相关危险因素分析

目的探讨四川省二级综合医疗机构耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant acinetobacter baumannii, CRAB)的耐药情况及相关临床危险因素。 方法采取回顾性病例-对照研究方法,调查2015年1月至2016年1月四川地区6家二级甲等综合医院鲍曼不动杆菌感染患者病例,根据药敏结果分为CRAB组和碳青霉烯敏感组(CSAB)。 结果共收集到非重复Ab菌株202株,其中CRAB 90株,耐药率40.1%。CRAB发生的4个独立危险因素为留置尿管(OR＝9.576,95%CI：4.964～18.474,P＝0.000)、中央静脉置管(OR＝2.707,95%CI：1.158～6.330,P＝0.022)、氟喹诺酮类(OR＝3.869,95%CI：1.603～9.377,P＝0.003)及碳青霉烯类抗菌药物(OR＝2.755,95%CI：1.164～6.521,P＝0.021)的使用。 结论二级综合医院CRAB感染的发生与侵袭性操作、氟喹诺酮类及碳青霉烯类等抗菌药物的选择压力有关。