Safety of total dose iron dextran infusion in geriatric patients with chronic kidney disease and iron deficiency anemia

There are limited data on total dose infusion (TDI) using iron dextran in geriatric chronic kidney disease (CKD) patients with iron-deficiency anemia (IDA). Our goal was to evaluate the safety of TDI in this setting. We conducted a retrospective chart review spanning a 5 year period (2002–2007), including all patients with CKD and IDA who were treated with iron dextran TDI. Patient demographics were noted, and laboratory values for creatinine, hemoglobin and iron stores were recorded pre- and post-dose. TDI diluted in normal saline was administered intravenously over 4-6 hours after an initial test dose. One hundred fifty-three patients received a total of 250 doses of TDI (mean?±?SD?=?971?±?175?mg); age was 69?±?12 years and creatinine 3.3?±?1.9?mg/dL. All stages of CKD were represented (stage 4 commonest). Hemoglobin and iron stores improved post-TDI (P?P?=?0.1433 by Fishers Exact Test). Iron dextran TDI is relatively safe and effective in correcting IDA in geriatric CKD patients. Fewer AEs were noted with the LMW compared to the HMW product. LMW iron dextran given as TDI can save both cost and time, helping to alleviate issues of non-compliance and patient scheduling.     

Utilisation of primary and secondary G-CSF prophylaxis enables maintenance of optimal dose delivery of standard adjuvant chemotherapy for early breast cancer: An analysis of 1655 patients

Optimal outcome for early breast cancer patients receiving adjuvant chemotherapy requires adequate dose delivery, commonly defined as >85% of planned dose of chemotherapy agents. Outside the clinical trial setting, reports from community oncology centres have demonstrated that a significant proportion of patients fail to receive this dose intensity, with neutropenia being the most commonly cited reason for sub-optimal treatment. Data collected prospectively on 1655 patient treated in a single breast cancer centre demonstrates that patients at risk of sub-optimal dose delivery can be identified by routine assessment of neutropenic events during the first cycle. The uniform administration of secondary G-CSF for all subsequent cycles enables dose delivery ≥85%, which was shown to lead to improved survival outcomes when compared with those patients who received <85%.     

Single dose spinal analgesia: Is it a good alternative to epidural analgesia in controlling labour pain?

ObjectivesRegional anaesthesia is considered the optimal technique for obstetric patients; nevertheless, the optimal method of regional anaesthesia for delivery remains to be determined. In our study we investigate the safety, efficacy and cost benefits of single-dose spinal analgesia in comparison with epidural analgesia during labour.Study designIn our study women in advanced labour were randomly allocated into two equal groups using a computer-generated randomization table, one group (spinal group = S group) were given 3.75 mg hyperbaric bupivacaine +25 μg fentanyl with 0.75 ml saline, the other group (Epidural group = E group) were given 4 ml bupivacaine with 4 ml saline and 1 ml (50 μg) fentanyl pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, Pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded, Apgar score were noted, and all the results were compared in the two groups.ResultsOnset of sensory block (detected by pin-prick test) was early (4.4 ± 1.5 min vs 12.5 ± 2.3 min, p < 0.001) and duration of sensory block was longer (120.4 ± 15.6 vs 103.2 ± 18.3 min, p < 0.001) in S group compared to E group, time to reach maximum dermatome level of sensory block (T₁₀) was shorter in S than E group (8.3 ± 2.4 min vs 22.4 ± 5.7 min, p < 0.001), two segment regression occur late in S group compared to E group(75.6 ± 12.5 min vs 66.3 ± 9.4 min, p < 0.001). Visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were lower in S group compared to E group, all the previous result is statically significant (p < 0.001). 88% of the parturients in S group vs 60% in E group scored the analgesic quality as excellent, the mean duration of analgesia (Mean ± SD) was longer in S group compared to E group. 8% of parturients in S group vs 14% of parturients in E group had hypotension. Motor block, sedation and nausea were 2–6% in both groups. Pruritus was seen in 60% in E group vs 25% in spinal one. No caesarean section was performed. Vacuum extraction was done in 15% vs 25% among S group and E group respectively. Oxytocin augmentation was needed in 48% vs 62% of the parturients among S group and E group respectively. Faetal heart rate disturbances following the spinal block were seen in 2 cases. Apgar score were high and no neonate had Apgar score <7 in both group. The overall cost was lower in S group compared to E group.ConclusionsBased on the results of our study we concluded that single dose spinal analgesia is a good alternative to epidural analgesia in controlling labour pain i.e. spinal compared to epidural is more easy performed, faster, less expensive, and provide effective analgesia.     

Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis

In standard care, hemodialysis patients are often treated with a center‐specific fixed dialysate sodium concentration, potentially resulting in diffusive sodium changes for patients with plasma sodium concentrations below or above this level. While diffusive sodium load may be associated with thirst and higher interdialytic weight gain, excessive diffusive sodium removal may cause intradialytic symptoms. In contrast, the new hemodialysis machine option “Na control” provides automated individualization of dialysate sodium during treatment with the aim to reduce such intradialytic sodium changes without the need to determine the plasma sodium concentration. This proof‐of‐principle study on sodium control was designed as a monocentric randomized controlled crossover trial: 32 patients with residual diuresis of ≤1000 mL/day were enrolled to be treated by high‐volume post‐dilution hemodiafiltration (HDF) for 2 weeks each with “Na control” (individually and automatically adjusted dialysate sodium concentration) versus “standard fixed Na” (fixed dialysate sodium 138 mmol/L), in randomized order. Pre‐ and post‐dialytic plasma sodium concentrations were determined at bedside by direct potentiometry. The study hypothesis consisted of 2 components: the mean plasma sodium change between the start and end of the treatment being within ±1.0 mmol/L for sodium‐controlled treatments, and a lower variability of the plasma sodium changes for “Na control” than for “standard fixed Na” treatments. Three hundred seventy‐two treatments of 31 adult chronic hemodialysis patients (intention‐to‐treat population) were analyzed. The estimate for the mean plasma sodium change was ?0.53 mmol/L (95% confidence interval: [?1.04; ?0.02] mmol/L) for “Na control” treatments and ?0.95 mmol/L (95% CI: [?1.76; ?0.15] mmol/L) for “standard fixed Na” treatments. The standard deviation of the plasma sodium changes was 1.39 mmol/L for “Na control” versus 2.19 mmol/L for “standard fixed Na” treatments (P = 0.0004). Whereas the 95% CI for the estimate for the mean plasma sodium change during “Na control” treatments marginally overlapped the lower border of the predefined margin ±1.0 mmol/L, the variability of intradialytic plasma sodium changes was lower during “Na control” versus “standard fixed Na” treatments. Thus, automated dialysate sodium individualization by “Na control” approaches isonatremic dialysis in the clinical setting.     

不同厚度铜附加滤过在骨骼数字化X线摄影中的应用

［摘要］ 目的探讨不同厚度铜附加滤过在骨骼数字化X线摄影（digital radiograph,DR）中的应用价值。 方法对人体等效体模进行头颅、脊柱、骨盆、四肢等部位的DR检查,其中头颅、脊柱、骨盆等厚部位应用电离室自动曝光控制（automatic exposure control,AEC）系统为AEC组,四肢、关节等不使用AEC的薄部位检查为非AEC组。选择无附加滤过、0.1 mm、0.2 mm、0.3 mm不同厚度铜附加滤过进行曝光。比较不同厚度铜附加滤过检查的表面入射剂量值、图像质量评分值以及管电流量值。 结果非AEC组4种不同厚度铜附加滤过表面入射剂量差异有统计学意义,经两两比较,无附加滤过时表面入射剂量大于0.1 mm、0.2 mm、0.3 mm铜附加滤过时,0.1 mm铜附加滤过时表面入射剂量大于0.3 mm铜附加滤过时,差异有统计学意义（P＜0.05）;非AEC组4种不同厚度铜附加滤过的图像质量评分值、管电流量差异无统计学意义（P＞0.05）。AEC组4种不同厚度铜附加滤过时表面入射剂量和管电流量差异有统计学意义,经两两比较,无附加滤过时表面入射剂量大于0.3 mm铜附加滤过时,管电流量小于0.3 mm铜附加滤过时,差异有统计学意义（P＜0.05）。AEC组4种不同厚度铜附加滤过的图像质量评分值差异无统计学意义（P＞0.05）。 结论铜附加滤过可以在保证诊断质量的前提下有效降低骨骼系统DR的检查剂量,实现骨骼系统DR的低剂量检查。     

大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮的疗效

目的探讨大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮的疗效。方法选取2015年12月～2018年12月在我院收治的系统性红斑狼疮患者100例,将其随机分为对照组与观察组,每组50例,对照组采用环磷酰胺静脉滴注、强的松口服、甲基强的松龙冲击治疗。观察组在对照组治疗的基础上,使用大剂量静脉滴注免疫球蛋白治疗。比较两组患者的治疗效果。结果观察组患者血小板达高峰平均时间,明显短于对照组,差异有统计学意义(P0.05)。治疗前,两组患者系统性红斑狼疮疾病活动度评分(SLEDAI)、系统性红斑狼疮生活质量量表(SLEQOL)评分比较,差异无统计学意义(P0.05)。治疗后,观察组患者的SLE-QOL评分、SLEDAI评分明显低于对照组,差异有统计学意义(P0.05)。观察组患者4周内血小板上50%以上的为100%,明显高于对照组的76%,差异有统计学意义(P0.05)。两组不良反应发生情况比较无明显差异(P0.05)。结论大剂量静脉滴注免疫球蛋白对系统性红斑狼疮的治疗有积极的作用,能够控制疾病活动度,提高患者的生活质量,不会增加不良反应。     

低剂量佐匹克隆延迟控释片治疗早醒性失眠的疗效研究

背景　失眠可分为入睡困难、睡眠维持障碍和早醒等,目前药物治疗失眠存在局限性,尚缺乏对不同类型失眠的针对性治疗,对失眠分型治疗的研究鲜见报道。目的　探讨低剂量佐匹克隆延迟控释片治疗早醒性失眠的疗效。方法　本研究时间为2016年10月—2018年1月。将40只清洁级雄性SD大鼠随机分为对照1组、低剂量（2.5 mg/kg佐匹克隆）组、高剂量（5.0 mg/kg佐匹克隆）30 min组、高剂量60 min组,每组10只大鼠。采用戊巴比妥钠延长实验,观察并记录各组大鼠的睡眠潜伏期及睡眠时间,为佐匹克隆延迟控释片的制备奠定基础。将佐匹克隆与羧甲基淀粉钠、乳糖、5%聚维酮K30（PVPK30）、硬脂酸镁混匀后压片;将山嵛酸甘油酯、乳糖、5%PVPK30、硬脂酸镁混匀后得到包衣颗粒,将片芯置于包衣颗粒中央,压片制得佐匹克隆延迟控释片。将60只清洁级雄性SD大鼠随机分为对照2组、佐匹克隆延迟控释片组（2.5 mg/kg佐匹克隆）、佐匹克隆溶液组（5.0 mg/kg佐匹克隆）,每组20只大鼠,观察并记录各组大鼠的睡眠潜伏期和睡眠时间。结果　对照1组〔（126.3±18.6）min〕、低剂量组〔（175.3±18.1） min〕、 高剂量30 min组〔（151.8±19.2）min〕和高剂量60 min组〔（181.5±15.6） min〕睡眠时间比较,差异有统计学意义（F=19.651,P<0.01）;其中,低剂量组与高剂量30 min组、60 min组大鼠睡眠时间长于对照1组,高剂量30 min组大鼠睡眠时间短于低剂量组,高剂量60 min组大鼠睡眠时间长于高剂量30 min组（P<0.05）。佐匹克隆延迟控释片组〔（188.3±25.0） min〕、佐匹克隆溶液组〔（194.0±28.1） min〕与对照2组〔（130.2±25.6） min〕睡眠时间比较,差异有统计学意义（F=30.400,P<0.05）,佐匹克隆延迟控释片组、佐匹克隆溶液组睡眠时间长于对照2组（P<0.05）。结论　通过制备低剂量（2.5 mg/kg）佐匹克隆延迟控释片喂食实验大鼠,使之在大鼠入睡后释药,能达到高剂量（5.0 mg/kg）佐匹克隆睡前60 min灌胃延长大鼠睡眠时间的效果,显现了以低剂量佐匹克隆延迟控释片针对性治疗成人早醒性失眠的前景。     

中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿的疗效及安全性

【摘要】目的 探讨中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性急性髓系白血病（AML）患儿的疗效及安全性。方法 选取2008年12月～2012年12月我院收治的行阿糖胞苷联合米托蒽醌、依托泊甙巩固治疗的难治复发性AML患儿96例作为研究对象,采用回顾性分析法分析所有患儿的临床及随访资料,根据阿糖胞苷使用剂量的不同将其分为低剂量组、中剂量组和高剂量组3组,每组各32例,治疗结束后分析并比较3组患儿近期和远期临床疗效,并记录3组患儿治疗过程中不良反应的发生情况。结果 近期临床总有效率3组相比较差异均无统计学意义（P＞0.05）,且所有部分缓解的患儿中8例患儿进行骨髓移植治疗后治愈,余42例继续采用药物进行治疗;3组患儿5年总生存率（OS）比较差异有统计学意义（P＞0.05）,中剂量组和高剂量组患儿5年OS均高于低剂量组（P＞0.05）,但中剂量和高剂量组5年OS比较差异无统计学意义（P＞0.05）,3组患儿其5年无事件生存年率（EFS）比较差异均无统计学意义（P＞0.05）;3组患儿在骨髓抑制和心脏毒性的不良反应方面比较差异无统计学意义（P＞0.05）,但中剂量组和高剂量组患儿其感染、胃肠道反应以及肝肾功能损伤的不良反应发生率均显著高于低剂量组,且高剂量组患儿胃肠道和肝肾功能损伤的不良反应发生率均高于中剂量组患儿,组间比较差异均有统计学意（P＞0.05）。结论 中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿具有较好的临床疗效和较低的毒副反应,存在一定的安全性,可作为临床上治疗AML患儿的首选治疗方案。     

王耀光教授治疗小儿免疫性血小板减少症经验采撷

免疫性血小板减少症（ITP）是小儿常见出血性疾病,王耀光教授认为本病为虚实交杂之证,本虚者脾肾亏虚、阴虚血燥,标实者热毒内蕴、血脉瘀阻,在临床上将其分为急性期、迁延期和慢性期三个阶段,相应地提出祛邪解毒兼止血、补气健脾兼养血、调护脾肾兼活血的治疗法则,尤重视黄芪剂量的应用。并在辨病的基础上强调病证结合,综合辨证施治。     

多剂量复方苦参注射液对吉西他滨在大鼠体内药物代谢动力学参数的影响

目的 探讨多剂量复方苦参注射液与盐酸吉西他滨联合使用后对吉西他滨在大鼠体内药物代谢动力学参数的影响。方法 选取24只健康雄性SD大鼠,随机分为对照组和实验组（复方苦参高、中、低3个剂量组）,实验组大鼠连续10 d尾静脉给予不同剂量的复方苦参注射液,对照组大鼠连续10 d尾静脉给予等量的生理盐水,于最后一天给药5 min后注射吉西他滨,分别于13个时间点眼底静脉丛采血,通过高效液相色谱法测定血样中吉西他滨的浓度,并采用DAS 2.0软件处理,得出吉西他滨药物代谢动力学参数。结果 各组大鼠体内吉西他滨药物代谢动力学过程符合二室模型拟合;与对照组比较,复方苦参高剂量组可以增加吉西他滨的药-时曲线下面积（P<0.05）,并延长平均滞留时间（P<0.05）。结论 多剂量复方苦参注射液对大鼠体内吉西他滨的药物代谢动力学行为有明显影响,在临床上应根据病情需要联合使用复方苦参注射液与吉西他滨。