Population Pharmacokinetics of Oxycodone in Patients With Cancer-Related Pain

ABSTRACT

Oxycodone is an opioid widely prescribed to cancer patients for pain relief. However, the pharmacokinetics of oxycodone has not been sufficiently examined. Therefore the aim of this work was to study population pharmacokinetics of oxycodone in patients with cancer pain. The authors analyzed 108 serum oxycodone samples of 33 individuals with nonlinear mixed-effects model (NONMEM). Population pharmacokinetics was calculated using the one-compartment model of clearance, volume of distribution, bioavailability, absorption constant rate, and lag time. An exponential error model was used to determine interindividual variability and a relative error model was applied to assess residual variability. Population pharmacokinetics of oxycodone at the end point were as follows: CL(L/h) = 10.7 × [1 + (2 ? Child-Pugh Classification)] (Class: A = 0, B = 1, C = 2); V_d (L) = 193; k_a (h^?1) = 0.336; T_lag (h) = 0.859; F (%) = 63.9. Interindividual variability was CL: 30.5%, V_d: 44.6%, and F: 37.0%, and residual variability was 16.2%. As the total clearance in patients with liver dysfunction (Child-Pugh class B) was reduced to 33.3%, serum concentration of oxycodone increased by 1.5. Therefore, it became clear that dose adjustments are essential when treating patients with liver dysfunction. These findings suggest that population parameters are useful for evaluating pharmacokinetics of oxycodone in patients with cancer pain.     

急性脊柱创伤诊断及治疗的临床研究

目的研究急性脊柱创伤诊断及急性脊柱创伤手术治疗方法。方法回顾34例脊柱创伤的患者的临床及影像学资料,均采用短节段椎弓根钉固定治疗。术后1月复诊,观察骨折的恢复情况,神经功能恢复按Frankel评分。结果患者术后恢复情况良好,Frankel评分有显著改变。结论手术方法的选择应参考患者骨折类型,内固定器的特点,适合的手术方法,对患者的恢复及术后并发症的减少是很有意义的。     

Pharmacoepidemiologic study of acute exacerbations of COPD: challenges and opportunities

Evaluation of: Rothberg MB, Pekow PS, Lahti M, Brody O, Skiest DJ, Lindenauer PK. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA 303(20), 2035–2042 (2010).

Guideline recommendations for the treatment of acute exacerbations of chronic obstructive pulmonary disease are derived from randomized clinical trials; they usually have a small sample size and are unrepresentative of patient populations. By contrast, observation data represent real-world patient population with large sample sizes and greater generalizability; however, appropriate methodologies are needed to analyze the data and make sound inference. This article reviews the study by Rothberg et al., summarizes the key findings, and extends the discussion to the challenges and opportunities of pharmacoepidemiologic studies in acute exacerbations of chronic obstructive pulmonary disease.     

Predicting ICU admission in community-acquired pneumonia: clinical scores and biomarkers

Community-acquired pneumonia (CAP) remains a common and serious worldwide health problem. Despite all the advances in therapy, significant interest has focused on the identification of patients with CAP who require intensive care unit admission to improve their outcomes. The severity assessment of CAP provides an important guide to clinicians in deciding the site of care and the use of empiric antibiotics and adjuvant therapy. For years, several clinical assessment scores have been suggested and validated to achieve this goal. The recent introduction of biomarkers as prognostic indicators of severe CAP, whether used alone or in conjunction with other clinical severity of illness scores, has been investigated. An objective scoring system with a high level of sensitivity and specificity to predict the severity of CAP and the need for high levels of care do not exist. Today, the addition of clinical scores and biomarkers to clinical judgment is the best approach to optimize the care of severe CAP. Future research will allow validation of these and newer tools to improve the prognosis of patients with CAP.     

The association between gender difference with metabolic syndrome,metabolic syndrome score and serum vitamin D levels in Korean adults

This study assessed the association between gender difference with metabolic syndrome (MetS), metabolic syndrome score (MSS) and serum vitamin D levels in Korean adults. Analyses were restricted to 5147 adults (2162 men; 2985 women) aged 20 and older, using the 2012 Korean National Health and Nutrition Examination Survey (KNHANES) data. In the non-adjusted model, serum 25-hydroxyvitamin D [25(OH)D] levels were inversely associated with MetS (p?=?.001) and MSS (p?=?.009) in men, but positively associated with MetS (p?=?.002) and MSS (p?001) in women. However, when adjusted for related variables (including age), serum 25(OH)D levels were inversely associated with MetS (p?001) and MSS (p?001) in men, but were not associated with MetS (p?=?.200) and MSS (p?=?.541) in women. In conclusion, increases in MetS and its components were inversely associated with the serum vitamin D concentration in men.     

The healthy Nordic diet and incidence of Type 2 Diabetes — 10-year follow-up

Studies have shown that a diet of healthy foods typical of Nordic countries has a beneficial effect on risk factors for Type 2 Diabetes (T2D), such as obesity and low-grade inflammation. However, longitudinal epidemiological studies examining the association between the healthy Nordic diet and T2D are lacking.     

Gain in real-world cardiac resynchronization therapy efficacy with SyncAV dynamic optimization: Heart failure hospitalizations and costs

1. Download : Download high-res image (150KB)
2. Download : Download full-size image

     

Evaluation of POSSUM for Patients Undergoing Pancreatoduodenectomy

ABSTRACT

Background: The POSSUM score is a predictive scoring system for postoperative morbidity. Although numerous studies have validated its application in major abdominal surgery, few have exclusively considered pancreatic resections, which have unique complications that are costly and problematic. We examined whether POSSUM could accurately reflect the clinical outcomes in pancreatic resection. Methods: A total of 694 consecutive resections of the pancreatic head were performed between 1993 and 2010 at the Department of General, Thoracic, and Vascular Surgery at the University Hospital Dresden. The POSSUM score calculated for each case was compared with the observed morbidity. Relevance and predictive performance of the score were assessed; in particular, because of the poor calibration of the POSSUM predictions on the Dresden data, a new score was created that was externally validated on patient cohorts from two different centers for pancreatic surgery. Results: The goodness-of-fit analysis revealed that the POSSUM score was not well calibrated because the POSSUM-predicted morbidity rate was 58.9% on average whereas the observed morbidity rate was 43.4%. Discrepancies occurred particularly among the predicted high-risk patients, for whom the score actually overestimated the morbidity risk. Therefore, we adapted the score and complemented it with additional prognostic parameters. The new score was validated in a patient cohort from two other German centers and fitted better to the data. Conclusion: The new score, named PS-POSSUM (POSSUM in pancreatic surgery), fits the data better. However, the prediction ability remains rather poor. PS-POSSUM may still be helpful, as it draws attention to additional risk and protective factors in addition to those in the original POSSUM score.     

C臂机透视下骨盆骨折经皮空心螺钉内固定的临床应用研究

目的 探讨C 臂机透视下骨盆骨折经皮空心螺钉内固定的临床应用价值。方法 选取2015 年7 月至2016年12 月九江市第一人民医院80 例骨盆骨折患者作为研究对象，按照随机数字表法分为观察组（C 臂机透视下经皮空心螺钉内固定治疗）与对照组（传统切开复位内固定手术治疗）两组，每组各40 例。比较两组患者手术指标、治疗前后VAS 评分、majeed 评分，随访术后并发症发生率。结果 观察组患者手术时间、术后下床活动时间及住院时间均短于对照组，术中出血量少于对照组，差异有统计学意义（P＜0.05）；两组患者治疗前VAS 评分、majeed评分比较，差异无统计学意义（P＞0.05），治疗后观察组VAS 评分和majeed 评分均优于对照组，差异有统计学意义（P＜0.05）；观察组患者并发症发生率为5.0%（2/40），低于对照组的22.5%（9/40），差异有统计学意义（P＜0.05）。结论C 臂机透视下经皮空心螺钉内固定应用于Tile B 型、C 型骨盆骨折患者，创伤小、术后恢复快，在缓解疼痛、提升术后骨盆功能方面有突出效果，并发症少，应掌握其适应证，发挥该术式的优势。