疼痛全程管理对癌痛患者服药依从性及爆发痛的影响

目的降低癌痛患者爆发痛发生率。方法将200例癌痛患者根据入院时间分组,2014年1~12月收治的癌痛患者100例分为对照组,2015年1~12月收治的癌痛患者100例分为干预组,两组均按癌痛规范化治疗,对照组行常规护理及健康指导,干预组实施疼痛全程管理模式干预,比较两组服药依从性及爆发痛发生率。结果干预后干预组服药依从性显著高于对照组(P0.01),而爆发痛发生率显著低于对照组(P0.01)。结论全程护理管理模式是一种全程化、专业化、人性化的护理模式,用于癌症晚期患者的疼痛管理,能有效提高患者服药依从性,减少癌性爆发痛的发生,提高癌痛患者生活质量。     

Non-invasive methods for PCA in pain management

Patient controlled analgesia (PCA) with an intravenous opioid has become one of the most effective techniques in the management of acute postoperative pain. In order to increase patient convenience non-invasive patient controlled analgesia by different routes of drug administration has been developed. This article gives a short review of transdermal, nasal, and oral PCA which are currently under extensive investigation.     

洪涝灾害后疟疾流行早期预测的探讨

通过对 1989～ 1997年湖北省汉川市和老河口市的疟疾疫情资料分析 ,求出逐月及年疟疾病例之总合 ,并分别计算出逐月发病均数和标准差 ,以均数加标准差为标准绘出曲线 ,以此双曲线作为标准曲线与既往各年逐月的实际发病曲线相比较 ,找出各月疟疾上升的突破点。结果显示 ,平均数加两个标准差是疟疾上升的预警指标 ,此指标的准确性为 95 %。一般而言 ,湖北省回升预警点出现在每年的 4～ 5月 ,出现突破预警后需立即进行流行病学分析 ,并制定出针对性的防治对策 ,将疟疾控制在回升之初     

睡前服用法替莫丁和奥美拉唑对十二指肠溃疡患者日间和夜间酸突破影响的对照研究

目的比较十二指肠溃疡患者晨服奥美拉唑,睡前加服法莫替丁和加服奥美拉唑后日间酸突破（DAB）和夜间酸突破（NAB）的情况.方法将20例十二指肠溃疡患者随机分成两组,日间服用奥美拉唑20 mg后,一组睡前加服奥美拉唑20 mg,一组睡前加服法莫替丁40 mg,疗程1周.治疗前后行夜间胃酸pH监测.结果治疗后奥美拉唑组夜间pH＜4的中位时间百分比减少62.4%,法莫替丁组减少83.95%,两组之间比较P＜0.05.奥美拉唑组NAB发生率为70%,法莫替丁组NAB发生率为30%,两组之间比较P＜0.001.两组日间pH＜4的中位时间百分比、DAB的发生率差异无显著性（P＞0.05）.结论睡前服用法莫替丁比睡前服用奥美拉唑对夜间胃酸分泌和酸突破的控制更为有效.     

Defining breakthrough invasive fungal infection–Position paper of the mycoses study group education and research consortium and the European Confederation of Medical Mycology

Breakthrough invasive fungal infections (IFIs) have emerged as a significant problem in patients receiving systemic antifungals; however, consensus criteria for defining breakthrough IFI are missing. This position paper establishes broadly applicable definitions of breakthrough IFI for clinical research. Representatives of the Mycoses Study Group Education and Research Consortium (MSG‐ERC) and the European Confederation of Medical Mycology (ECMM) reviewed the relevant English literature for definitions applied and published through 2018. A draft proposal for definitions was developed and circulated to all members of the two organisations for comment and suggestions. The authors addressed comments received and circulated the updated document for approval. Breakthrough IFI was defined as any IFI occurring during exposure to an antifungal drug, including fungi outside the spectrum of activity of an antifungal. The time of breakthrough IFI was defined as the first attributable clinical sign or symptom, mycological finding or radiological feature. The period defining breakthrough IFI depends on pharmacokinetic properties and extends at least until one dosing interval after drug discontinuation. Persistent IFI describes IFI that is unchanged/stable since treatment initiation with ongoing need for antifungal therapy. It is distinct from refractory IFI, defined as progression of disease and therefore similar to non‐response to treatment. Relapsed IFI occurs after treatment and is caused by the same pathogen at the same site, although dissemination can occur. These proposed definitions are intended to support the design of future clinical trials and epidemiological research in clinical mycology, with the ultimate goal of increasing the comparability of clinical trial results.     

Natural YMDD-motif mutants affect clinical course of lamivudine in chronic hepatitis B

AIM:To investigate the prevalence of nature tyrosinemethionine-aspartic acid-aspartic acid motif mutations in chronic hepatitis B(CHB)patients and to evaluate the efficacy of lamivudine.METHODS:A total of 1268 CHB patients were recruited from the outpatient and inpatient departments of six centers.Tyrosine-methionine-aspartic acid-aspartic acid(YMDD)mutations were analyzed using the hepatitis B virus(HBV)drug resistance line probe assay.Forty voluntary patients were selected from those with positive or negative natural YMDD mutations to undergo treatment with lamivudine.RESULTS:YMDD mutations were detected in 288(22.71%)of the 1268 CHB patients.Multivariate analysis revealed that the patients’HBV DNA level(P=0.0282)and hepatitis B e antigen status(P=0.0133)were also associated with natural YMDD mutations.The rates of normalization of alanine aminotransferase levels and HBV DNA nondetection at 6,24,36,and 48 wk were compared between the patients with natural YMDD mutations and those without,and the differences were not significant.However,there was a significant difference in the cumulative emergence rates of virological breakthrough at 48 wk in the patients with natural YMDD mutations and those without(32.5%vs 12.5%,P=0.032).CONCLUSION:Naturally occurring YMDD mutationsare detectable in a large proportion of CHB patients;breakthrough hepatitis tended to occur in patients with natural YMDD mutations.     

Fentanyl buccal tablets for breakthrough pain in highly tolerant cancer patients: preliminary data on the proportionality between breakthrough pain dose and background dose

Context

Cancer patients receiving high doses of opioids as background medication are challenging, and it would be useful clinically to know whether a rapid-onset opioid (ROO) for breakthrough cancer pain (BTcP) may be started at a dose proportional to the background opioid dose.

Objectives

The aim of this study was to assess the efficacy and safety of the fentanyl buccal tablet (FBT) in doses proportional to the opioid dose administered for background analgesia in a sample of patients with BTcP who were receiving high doses of opioids.

Methods

Twelve patients who were receiving opioids for background analgesia at doses equivalent to more than 500 mg of oral morphine and had adequately controlled pain were prospectively recruited. BTcP was treated with proportional doses of FBT: patients receiving 600 mg of oral morphine equivalents were administered 1000 μg of FBT, patients receiving 900 mg of oral morphine equivalents were administered 1500 μg of FBT, and so on. For each episode of BTcP, trained nurses collected pain intensity (on a 0–10 numerical rating scale) and emerging problems when called for increases in pain considered to be severe in intensity by patients (T0) and 15 minutes after FBT administration (T15).

Results

Patients were receiving mean doses of oral morphine equivalents of 1340 mg (±585; range 720–2400). Seventy-nine events were treated with FBT (6.6 ± 4.9 for each patient). The median pain intensity of BTcP events was 8 (range 7–10), and the mean dose of FBT administered was 2233 μg (±975; range 1200–4000). In most events, a decrease in pain intensity >33% and >50% was observed (n = 14 and n = 48, respectively) 15 minutes after the administration of FBT. Data on 11 episodes were missed. Only six events were unsuccessfully treated. In all the patients, the level of adverse effects after FBT administration was mild and indistinguishable from that associated with the background opioid analgesia.

Conclusion

FBT in doses proportional to the high doses of opioids used for background analgesia was efficacious and well tolerated when administered for BTcP. Controlled studies with a specific design and a large number of patients should confirm such preliminary results.     

手术治疗颅内蛛网膜囊肿及其正常灌注压突破的防治

目的 分析不同手术方式治疗颅内蛛网膜囊肿(IAC)37例的疗效,探讨手术治疗IAC时正常灌注压突破(NPPB)的预防措施及治疗方法.方法 24例行囊肿切除及脑池交通术,3例行囊肿切除术,10例行神经内镜下造瘘术.结果 术后平均随访7月,34例症状或体征有不同程度改善,2例无明显改善,1例死亡.2例发生NPPB(1例治愈,1例死亡),头颅CT或MRI提示囊肿较大,占位效应明显,有小脑幕上抬或颅骨变形、受压征象.内镜手术病例中未发生NPPB.结论 显微手术疗效确切,是大多数IAC的首选治疗方法;如预计发牛NPPB可能性较高,可行神经内镜下造瘘术;头颅CT或MRI可为选择手术方式提供参考;大剂量脱水、激素治疗对NPPB有效.