妈富隆治疗原发性痛经的初步研究

目的评价妈富隆治疗原发性痛经的有效性和安全性。方法采用随机,对照,双盲方法将原发性痛经患者分为对照组和实验组各30例。对照组服用安慰剂,实验组服用妈富隆各3个周期。采用总的痛经评分(Total Dysmenorrhea Score,TDS)和视觉模拟评分法(Visual Analog Scale,VAS)来评价药物的疗效,对比治疗前后痛经的改善情况和药物的副作用。结果治疗后实验组TDS和VAS较对照组明显降低(P<0.05)。实验组TDS和VAS在第2,3周期下降明显。实验组药物副作用发生率明显增高,但随时间的发展而下降,而在对照组无变化,无严重副作用发生。结论妈富隆治疗原发性痛经效果明显,比较安全,值得临床推广应用。     

Current Clinical Practice DIC 2002: A Review of Disseminated Intravascular Coagulation

The turn of the millennium has seen clear advances in the understanding and management of Disseminated Intravascular Coagulation (DIC). The recognition that its pathogenesis stems from sustained thrombin generation in fuelling the cycle between inflammation and coagulation has seen the first successful treatment in severe sepsis through targeting this activity. An advance in treatment brings heightened relevance to laboratory testing, which now emphasises earlier detection and better monitoring to facilitate improved risk-identification and assessment of therapeutic efficacy. This review article also provides insights into future strategies that might build on the foundation of improving prognosis for the patient with DIC.     

基于真实世界的脉络舒通丸对肝功能指标影响的研究

目的 应用医院信息医疗系统电子数据开展真实世界脉络舒通丸对肝功能指标影响的安全性临床研究。方法 基于全国14家大型三级甲等医院的医疗电子数据库，将服用脉络舒通丸患者作为脉络舒通丸组，未服用脉络舒通丸者作为对照组，以性别相同、年龄±5岁为匹配条件，按照1∶1比例分组后2组均为2387例，以用药后肝功能指标[碱性磷酸酶（alkaline phosphatase,ALP）、丙氨酸氨基转移酶（alanine transaminase,ALT）、天冬氨酸氨基转移酶（aspartate transaminase,AST）、谷氨酞转移酶（gamma-glutamyl transferase,GGT）、总胆红素（total bilirubin,TBIL）]作为结局评价指标，通过倾向性评分方法控制研究中存在的混杂因素，采用3种统计学方法进行安全性分析。结果 筛选出12个影响程度较高的混杂因素，加权平衡了全部的混杂因素，3种统计学方法得到的结果均为P>0.05，两组差异不具有统计学意义。结论 不能认为脉络舒通丸导致肝功能指标异常变化，但鉴于倾向性评分法仅能控制已知潜在混杂因素，无法实现对未知混杂因素...     

Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching

Cross‐country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro‐level data from hospitals in different health care systems. To do so, we developed a multi‐level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi‐level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi‐level models are recommendable to consider the clustered structure of the data when patient‐level data from different hospitals and health care systems are compared. The results provide an important justification for exploring new ways in performing health system comparisons. Copyright © 2010 John Wiley & Sons, Ltd.     

Long‐term efficacy and safety of ranibizumab administered pro re nata in Japanese patients with neovascular age‐related macular degeneration in the EXTEND‐I study

Purpose: To evaluate the long‐term efficacy and safety of ranibizumab administered pro re nata (PRN) in Japanese patients with choroidal neovascularization secondary to age‐related macular degeneration during the extension phase of the EXTEND‐I study. Methods: EXTEND‐I, an open‐label, multicenter, Phase I/II study comprised: a single‐injection (Group A); a multiple‐injection (Groups A and B; the latter consisted of patients who did not participate in the single‐injection phase); and an extension phase. In the extension phase, a PRN regimen of ranibizumab (0.3 or 0.5 mg) guided by monthly best‐corrected visual acuity (BCVA) score and other ophthalmic examinations was employed. The efficacy variables included the mean BCVA change from Month 12 to the last visit in Group B. Safety was assessed in all patients. Results: In the extension phase, efficacy was assessed only in Group B patients. The number of ranibizumab injections per year in the 0.3 and 0.5 mg Group B patients was 4.19 and 4.27, respectively. The mean BCVA change (SD) from Month 12 to the last visit was ?3.6 (14.82) letters for 0.3 mg (n = 28) and ?2.2 (7.92) letters for 0.5 mg groups (n = 33) in Group B. Conjunctival haemorrhage and nasopharyngitis were the most commonly reported adverse events. Of the 13 serious adverse events reported, cerebral infarction (two incidences) was suspected to be study‐drug related. Conclusions: Pro re nata regimen of ranibizumab guided by monthly BCVA and other ophthalmic examinations appears effective in sustaining the BCVA gained with 12 monthly injections while reducing the number of injections during the extension phase. Ranibizumab was well tolerated during the extension phase.     

Improvements in Extracorporeal Membrane Oxygenation for Primary Graft Failure After Heart Transplant

BackgroundSevere primary graft failure is a life-threatening complication of heart transplantation that may require venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Surgical practices and management strategies regarding VA-ECMO vary between and within centers.MethodsWe performed a single-center retrospective cohort study on adult patients who received VA-ECMO for primary graft failure between 2013 and 2020. Clinical data were obtained from chart review and national databases. Patients were stratified by transplantation before or after 2017, when our center adopted additional objective criteria for VA-ECMO, adopted partial-flow support, and changed from central cannulation to chimney graft arterial cannulation of brachiocephalic, axillary, or aorta. The primary outcome was survival to device weaning. Secondary outcomes were survival to discharge, survival to 1 year, complications on support, and time to sedation weaning and extubation.ResultsFrom 276 heart transplant recipients, 39 severe primary graft failure patients requiring VA-ECMO were identified. Incidence of graft failure was 13% (n = 18 of 135) pre-2017 and 15% (n = 21 of 141) post-2017. Survival at all time points improved significantly after 2017, with greatest difference in survival to device weaning (61% pre-2017 vs 100% post-2017). After controlling for other factors in multivariable Cox regression modeling, transplantation after 2017 was a predictor of reduced mortality (hazard ratio, 0.209; 95% CI, 0.06-0.71; P = .01). Significant differences were not observed in other secondary outcomes of recovery.ConclusionsThe new VA-ECMO strategy displayed reasonable survival and a remarkable improvement from the prior system.