Fentanyl: A Review for Clinical and Analytical Toxicologists

Fentanyl is a highly potent, short acting synthetic analgesic indicated as a preanesthetic medication. It is available for intravenous injection, as a transdermal patch and a lozenge dosage form. Fentanyl displays a large apparent volume of distribution, short plasma half life and extensive biotransformation. It is a popular drug of abuse among health care professionals. Diversion of pharmaceutical fentanyl preparations, as well as the availability of illicitly synthesized potent and highly toxic fentanyl analogs have resulted in numerous overdose deaths. Analysis of fentanyl and fentanyl analogs requires highly selective and sensitive methodologies. This review is intended as a quick reference source for clinical and analytical toxicologists.     

推拿治疗肩关节周围炎264例临床观察

[目的]观察推拿治疗肩关节周围炎疗效。[方法]对264例住院患者根据病情，采取不同手法、部位和穴位，对症治疗。如患臂不能高举，应在三角肌、肱二头肌上端和肩谬穴点按，帮助患臂做抬肩运动，用力适当，逐步扩大范围，以患者忍受为宜。在肱二头肌上端触及至粘连、扭结、硬点，用拇指波动此处，接着分别牵拉每个手指，如患臂不能内收，用拇指在大圆肌和肩胛冈、天宗、肩贞穴进行揉、剥手法，另手拉上臂做运动，如患臂可能外展和后伸，用同法在肩俞、曲池穴和上臂内侧剥拿，同时向受限方向作外展、后伸运动，接着揉点大椎、合谷、后溪等穴。最后拍打推拿过的部位结束。1～2次／d，30min／次。连续治疗10d为1疗程。观测临床症状、不良反应。根据患者病情决定疗程，判定疗效。[结果]治愈189例，显效58例，1L~17例，但总有效率93．56％。[结论]推拿治疗肩关节周围炎效果显著，值得推广。     

Solution-Focused Supervision

Summary

This article discusses the use of solution-focused supervision questions and their perceived effect on a class of counseling practicum students. Rating scales have been used as a tool to evaluate therapist development since the 1960s. In this case study, questions were asked of student therapists from the perspective of the client. Student reports find that the questions were beneficial in helping direct future sessions toward client goals.     

2008-2011年产气肠杆菌的临床分布及耐药性分析

目的 分析产气肠杆菌临床分布特点及对常用抗菌药物的耐药性变化,以更好地指导临床的合理使用抗菌药物.方法 采用WHONET5软件统计分析2008年1月-2011年12月临床分离的产气肠杆菌临床分布和耐药率.结果 4年内共分离到产气肠杆菌459株,其中2008-2011年分别检出108、101、130、120株；病原菌主要来源于住院患者的痰液213株占46.4％、胆汁70株占15.3％、血液51株占11.1％、尿液50株占10.9％;4年耐药监测显示,亚胺培南和美罗培南的耐药率在2.0％～7.9％,呈明显的逐年上升趋势；头孢类抗菌药物除头孢唑林耐药率较高约90.0％外,其他如头孢替坦、头孢曲松、头孢他啶、头孢吡肟等耐药率由最高的55.5％下降至最低28.5％,氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦等复合制剂耐药率也由最高70.2％下降至最低21.1％,同时阿米卡星、庆大霉素等氨基糖苷类等药物的耐药率亦呈下降趋势,最高30.4％,最低为0,对喹诺酮类的耐药率约30.0％,保持相对稳定.结论 4年产气肠杆菌对头孢菌类、氨基糖苷类、复合制剂等药物的耐药率有所降低,而碳青霉烯类药物的耐药率呈上升趋势,说明细菌耐药性存在动态的变化,及时对细菌耐药性进行分析,依据药敏结果合理选用抗菌药物,严格掌握适应证,可减少或延缓耐药菌株的播散.     

肠道病毒71型和柯萨奇病毒A组致手足口病临床特点分析

目的探讨肠道病毒71型(EV71)和柯萨奇病毒A组16型(CA16)所致的手足口病在临床特征方面有无差异及对手足口病患儿的护理经验。方法回顾性分析我院感染科2010年6—9月收治的105例手足口病患儿的临床资料及预后。结果两组患儿呕吐、易惊或肢体抖动、抽搐、肺炎的发生率比较,差异均有统计学意义(P<0.01)。两组神经源性肺水肿和呼吸衰竭的发生率比较,差异均无统计学意义(P>0.05)。两组患儿最高体温、收缩压、舒张压及平静时最快心率、呼吸率的水平比较,差异均有统计学意义(P<0.01)。结论对于手足口病患儿,应根据所感染病原体不同,加强临床观察,早期识别危重病例,及时进行有效的治疗和护理。     

Missing Data in Noninferiority Trials

Missing data in clinical trials has been widely discussed in the literature, but issues specific to missing data in noninferiority trials have rarely been addressed. The goal of this article is to present missing data issues that are particularly important in noninferiority trials. Issues of assay sensitivity and the constancy assumption are affected by missing data. Importantly, these issues are not solved by per protocol analyses which remove patient data based on postrandomization criteria. We advocate collecting data to the extent possible for sensitivity analyses. We discuss some other issues that remain unresolved in assessing the impact of missing data in noninferiority trials. A simulation analysis of different strategies for assessing noninferiority in the presence of missing data is reported for a clinical trial comparing two treatments. Single imputation procedures and observed case analyses resulted in reduced power due to missing data and occasionally in inflation in Type I error rate or bias in estimates of treatment effect. The mixed-effect model repeated measures approach resulted in a method that controlled the Type I error rate when data are missing at random, and often with higher power than the other two methods. Further work on multiple imputation procedures is desired.     

磁疗开穴、按摩治疗乳腺增生70例临床观察

目的：观察磁疗法对乳腺增生的临床疗效。方法：招募70例乳腺增生患者，以子午流注开穴选择当日当时穴位磁疗，再结合乳房局部和循经磁疗按摩治疗，最后涌泉穴磁疗，30d为1个疗程，观察3个疗程后的临床疗效。结果：治疗后，乳腺增生患者疼痛、增生硬度、范围、直径及伴随症状得到显著改善。结论：磁疗对乳腺增生患者疗效明显，值得推广。