离子型造影剂在CT增强中预防毒副反应的研究

目的　探讨离子型造影剂加入地塞米松在CT增强中预防或减少过敏及毒副反应效果。方法　回顾性分析 2 480例患者中观察组 1860例用离子型造影剂加入地塞米松 ,两药混均后经肘静脉注入进行CT扫描。结果　 2组结果表明 ,过敏及毒副反应发生率轻度反应观察组比对照组降低 3 .1%,中度反应率对照组 1.4%,观察组 0 .5 %。结论　离子型造影加地塞米松在CT增强的应用中预防或减少过敏及毒副反应研究是切实可行的措施之一。     

CD39+ regulatory T cells modulate the immune response to carbamazepine in HLA-B*15:02 carriers

The HLA-B*15:02 allele is associated with an increased risk of developing carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Many studies, however, have demonstrated that a large majority of HLA-B*15:02 individuals are unlikely to develop the adverse drug reaction while on CBZ. This phenomenon suggests that other factors that modulate the allergic immune response, such as regulatory T cells (Tregs), might contribute to an uncontrolled immune response in SJS/TEN. Peripheral blood mononuclear cells (PBMCs) from 15 healthy HLA-B*15:02 carriers were isolated to investigate the role of Tregs in controlling the immune response towards CBZ. Recognition of CBZ was assessed using enzyme linked immunosorbent spot (ELISPOT) assay for IFN-γ, and the donor T-cell profiles were quantified by flow cytometry to differentiate CBZ responders from non-responders. As CD39 expression on Tregs promotes immune tolerance, we investigated the mechanisms of Treg suppression using inhibitors targeting the CD39/adenosinergic pathway. PBMCs from seven donors (responders) produced high levels of IFN-γ when re-exposed to CBZ, while eight donors (non-responders) did not. Flow cytometric analysis revealed that non-responders produced significantly higher frequencies of CD4⁺CD25⁺CD127^loCD39⁺FoxP3⁺ Tregs compared to responders. CD39 inhibition using POM-1 inhibitor converted five of the eight non-responders into responders (P < 0.05). Higher frequencies of CD4⁺CD25⁺CD127^loCD39⁺FoxP3⁺ Tregs was correlated with lower production of IFN-γ (P < 0.01). Our data suggest that CD4⁺CD25⁺CD127^loCD39⁺FoxP3⁺ Tregs may play a role in promoting CBZ tolerance in HLA-B*15:02 carriers. The CD39/adenosinergic axis can be a potential target to alleviate the uncontrolled immune response during this adverse drug event.     

他汀类与核苷类药物所致横纹肌溶解症及其防治

本文列举了他汀类和核苷类药物中可诱发药源性横纹肌溶解症的相关药物,介绍药源性横纹肌溶解症的防治措施.通过对横纹肌溶解症的发生机制及诱发该不良反应的药物应用进行分析,并结合临床诊断及治疗进行阐述.认为临床上应该慎用可能诱发药源性横纹肌溶解症的药物,观察到横纹肌溶解症出现的初始症状及时停用相关药物,避免横纹肌溶解症的发生,促进临床合理用药.     

Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials

BackgroundPeriprocedural intravenous hydration is suggested to decrease the risk of post-ERCP pancreatitis (PEP). However, quality of evidence supporting this suggestion remains poor. Here we hypothesized that aggressive hydration(AH) could be an effective preventive measure.MethodsPubmed, EMBASE, CINAHL, Google Scholar, Clinical Trials. gov, Clinical Key, International Standard Randomized Trial Number registry as well as secondary sources were searched through January 2019 to identify randomized controlled studies comparing AH to standard hydration (SH) for prevention of PEP. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the random-effects model. RevMan 5.3 was used for analysis.ResultsA total of 9 RCTs, with 2094 patients, were included in the meta-analysis. AH reduced incidence of PEP by 56% compared to SH (OR = 0.44, CI:0.28–0.69; p = 0.0004). The incidence of post-ERCP hyperamylasemia also decreased with AH compared to SH (OR = 0.51; p = 0.001). Length of stay decreased by 1 day with AH (Mean Difference (MD): −0.89 d; p = 0.00002). There was no significant difference in adverse events related to fluid overload between two groups (OR:1.29; p = 0.81) and post-ERCP abdominal pain (OR:0.35; p = 0.17). Numbers of patient to be treated with AH to prevent one episode of PEP was 17. Final results of the meta-analysis were not affected by alternative effect measures or statistical models of heterogeneity.ConclusionAggressive hydration is associated with a significantly lower incidence of PEP and it appears to be an effective and safe strategy for the prevention of Post ERCP pancreatitis.     

舒肝解郁胶囊治疗心血管神经症67例疗效观察

目的:观察舒肝解郁胶囊治疗心血管神经症的临床疗效.方法:选取我院2017年1月—2018年6月收治的心血管神经症患者132例,按治疗方法分为对照组(65例,口服谷维素、佐匹克隆平)和观察组(67例,口服舒肝解郁胶囊),对比两组治疗效果.结果:治疗6周后,观察组总有效率为97.01％,对照组总有效率为84.62％,组间差...     

Case studies putting the decision-making framework for the grouping and testing of nanomaterials (DF4nanoGrouping) into practice

Case studies covering carbonaceous nanomaterials, metal oxide and metal sulphate nanomaterials, amorphous silica and organic pigments were performed to assess the Decision-making framework for the grouping and testing of nanomaterials (DF4nanoGrouping). The usefulness of the DF4nanoGrouping for nanomaterial hazard assessment was confirmed. In two tiers that rely exclusively on non-animal test methods followed by a third tier, if necessary, in which data from rat short-term inhalation studies are evaluated, nanomaterials are assigned to one of four main groups (MGs). The DF4nanoGrouping proved efficient in sorting out nanomaterials that could undergo hazard assessment without further testing. These are soluble nanomaterials (MG1) whose further hazard assessment should rely on read-across to the dissolved materials, high aspect-ratio nanomaterials (MG2) which could be assessed according to their potential fibre toxicity and passive nanomaterials (MG3) that only elicit effects under pulmonary overload conditions. Thereby, the DF4nanoGrouping allows identifying active nanomaterials (MG4) that merit in-depth investigations, and it provides a solid rationale for their sub-grouping to specify the further information needs. Finally, the evaluated case study materials may be used as source nanomaterials in future read-across applications. Overall, the DF4nanoGrouping is a hazard assessment strategy that strictly uses animals as a last resort.     

泼尼松联合来氟米特治疗狼疮性肾炎的临床疗效及其安全性评价

目的 探讨与评价泼尼松联合来氟米特治疗狼疮性肾炎的临床疗效及其安全性。方法 2014年2月-2017年3月选择在安阳市人民医院诊治的狼疮性肾炎患者170例作为研究对象,根据入院顺序随机分为观察组与对照组各85例,对照组给予泼尼松治疗,观察组在对照组治疗的基础上给予来氟米特治疗,两组都治疗观察4周。比较两组治疗后的临床疗效、血白蛋白、24 h尿蛋白定量、肌酐清除率及不良反应情况。结果 所有患者都顺利完成治疗,观察组与对照组的治疗总有效率分别为97.6%和88.2%,观察组的治疗总有效率明显高于对照组,差异有统计学意义（P<0.05）。治疗后观察组的血白蛋白、24 h尿蛋白定量和肌酐清除率值分别（36.3±8.4） g/L、（1.9±0.8） g/24 h和（88.6±29.1） mL/min,对照组分别为（28.5±7.9） g/L、（2.8±1.7） g/24 h和（80.2±22.7） mL/min,各指标均较治疗前显著改善,组内差异有统计学意义（P<0.05）;同时治疗后观察组的血白蛋白和肌酐清除率显著高于对照组,24 h尿蛋白定量显著低于对照组,差异有统计学意义（P<0.05）。治疗期间观察组的肝功能损伤、消化道症状、肺部感染等不良反应发生率为5.9%,对照组为7.1%,两组对比差异无统计学意义。结论 泼尼松联合来氟米特治疗狼疮性肾炎能改善患者的肾功能,提高治疗效果,且不会增加不良反应的发生,有很好的应用价值。     

复方丹参注射液不良反应的回顾性分析

目的：探讨复方丹参注射液的不良反应是一般规律及有关特点。方法：对复方丹参注射液１０２例不良反应的临床报道进行文献计量学分析。结果：不良反应男性病例超过女性病例数１倍,与用药剂量无关。结论：复方丹参注射液的主要不良反应为变态反应（６４.１０％）,其中过敏性休克１８例（占２４.０％）且有１例死亡。     

茂名地区2007-2009年抗菌药物致不良反应报告分析

目的:了解茂名地区药品不良反应(ADR)发生的特点及规律。方法:对2007-2009年茂名市ADR监测中心收集的各医疗单位呈报的抗菌药物致ADR报告1495例进行统计、分析。结果:引起ADR的抗菌药物排序列前3位的分别是头孢菌素类、喹诺酮类、青霉素类;给药途径以静脉注射最高,有1380例(占92.31%);ADR累及器官或系统以皮肤及其附件损害最常见,有704例(占45.74%)。结论:抗菌药物ADR的发生与多种因素有关。临床上应进一步加强抗菌药物ADR的监测,以达到合理、安全、有效地使用抗菌药物,减少ADR的发生。     

我院93例头孢菌素类药物不良反应报告分析

目的:探讨药品不良反应(ADR)发生的特点及规律。方法:采用描述性研究方法,对我院2008年1月～2009年12月上报的93例头孢菌素类药物ADR报告进行统计、分析。结果:皮试液的选择有3种情况,分别为采用1种头孢菌素类药物皮试,采用拟用品种(原数)进行皮试、不作皮试或用其它药物皮试。涉及ADR的头孢菌素类药品共18个,发生频率排在前3位的是头孢哌酮/舒巴坦、头孢哌酮和头孢替安。ADR的主要临床表现以皮肤及其附件损害为主,有72例(77.42%)。结论:临床应规范皮试液的选择;重视ADR监测与报告、定期分析报告数据,为临床及时提供药品安全信息,以减少或避免ADR的重复发生。