Comparison of PPIs and H2-receptor antagonists plus prokinetics for dysmotility-like dyspepsia

AIM: To compare efficacy of proton pump inhibitors (PPIs) with H₂-receptor antagonists (H₂RAs) plus prokinetics (Proks) for dysmotility-like symptoms in functional dyspepsia (FD).METHODS: Subjects were randomized to receive open-label treatment with either rabeprazole 10 mg od (n = 57) or famotidine 10 mg bid plus mosapride 5 mg tid (n = 57) for 4 wk. The primary efficacy endpoint was change (%) from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment.RESULTS: The improvement in dysmotility-like dyspepsia symptom score on day 28 was significantly greater in the rabeprazole group (22.5% ± 29.2% of baseline) than the famotidine + mosapride group (53.2% ± 58.6% of baseline, P < 0.0001). The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine + mosapride group (87.7% vs 59.6%, P = 0.0012). Rabeprazole therapy was the only significant predictor of treatment response (P < 0.0001), defined as a total symptom score improvement ≥ 50%.CONCLUSION: PPI monotherapy improves dysmotility-like symptoms significantly better than H₂RAs plus Proks, and should be the treatment of first choice for Japanese FD.     

Medication use and dry eye symptoms: A large,hypothesis-free,population-based study in the Netherlands

PurposeTo date, population-based studies reporting associations between dry eye disease and medications were hypothesis-driven, did not take into account underlying comorbidities, and did not investigate individual drugs. The purpose of this study was to clarify the association of dry eye symptoms with medication classes and individual drugs, using a hypothesis-free approach.Methods79,606 participants (age 20–97 years, 59.2% female) from the population-based Lifelines cohort in the Netherlands were cross-sectionally assessed for dry eye symptoms using the Womens’ Health Study dry eye questionnaire. All medications used were coded with the ATC classification system. Logistic regression was used to assess the risk of the 59 most-used therapeutic/pharmacological subgroups and the 99 most-used individual drugs (all n > 200) on dry eye symptoms, correcting for age, sex, body mass index, and 48 comorbidities associated with dry eye.ResultsThirty-eight (64%) medication subgroups and fifty-two (53%) individual drugs were associated with dry eye symptoms (P < 0.05), after correction for age and sex only. A multivariable model correcting for comorbidities revealed highly significant associations between dry eye symptoms and drugs for peptic ulcer (particularly proton pump inhibitors (PPIs)), antiglaucoma and anticholinergic medications.ConclusionsThis study underlines that medication use is highly informative of risk of dry eye symptoms. Correction for underlying comorbidities is critical to avoid confounding effects. This study confirms suggested associations between medications and dry eye symptoms at a population level and shows several new associations. The novel link between PPIs and dry eye symptoms deserves particular attention given how commonly they are prescribed.     

奥曲肽联合泮托拉唑预防内镜逆行胰胆管造影术后胰腺炎

目的：探讨内镜逆行胰胆管造影（ERCP）术后胰腺炎的预防措施。 方法：将2010年7月—2012年11月间行ERCP术后的患者100例,随机分为观察组和对照组,每组各50例患者。观察组术后给予联合应用生长抑素（奥曲肽0.1 mg/8 h皮下注射连用24 h）和质子泵抑制剂作预防治疗（泮托拉唑40 mg/d静脉滴注连用2 d）,对照组给予生理盐水静脉滴注。比较两组患者ERCP术后3,12,24 h的血清淀粉酶情况,及胰腺炎的发生情况。 结果：两组一般资料比较具有可比性;在术后3,12,24 h各时间点比较,观察组血清淀粉酶水平均明显低于对照组（均P<0.05）;观察组术后12,24 h高淀粉酶血症发生率及术后急性胰腺炎明显均低于对照组（18% vs. 42%;8% vs. 22%;2% vs. 16%）（均P<0.05）。 结论：联合应用生长抑素和质子泵抑制剂可减少ERCP术后高淀粉酶血症与胰腺炎的发生率,是一种安全且有效的ERCP术后胰腺炎预防措施。     

Proton MR spectroscopy in the breast: Technical innovations and clinical applications

Proton magnetic resonance spectroscopy (MRS) is a promising noninvasive diagnostic technique for investigation of breast cancer metabolism. Spectroscopic imaging data may be obtained following contrast‐enhanced MRI by applying the point‐resolved spectroscopy sequence (PRESS) or the stimulated echo acquisition mode (STEAM) sequence from the MR voxel encompassing the breast lesion. Total choline signal (tCho) measured in vivo using either a qualitative or quantitative approach has been used as a diagnostic test in the workup of malignant breast lesions. In addition to tCho metabolites, other relevant metabolites, including multiple lipids, can be detected and monitored. MRS has been heavily investigated as an adjunct to morphologic and dynamic MRI to improve diagnostic accuracy in breast cancer, obviating unnecessary benign biopsies. Besides its use in the staging of breast cancer, other promising applications have been recently investigated, including the assessment of treatment response and therapy monitoring. This review provides guidance on spectroscopic acquisition and quantification methods and highlights current and evolving clinical applications of proton MRS. Level of Evidence 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019.     

EBT3胶片和辐射荧光屏测量质子重离子放疗设备照射野剂量分布的对比研究

目的 对比离线分析的EBT3胶片和在线实时分析的辐射荧光屏对医用质子重离子加速器照射野剂量分布的质控测量差异,选择更适合的设备质控测量的探测器系统。方法 针对主动式点扫描医用质子重离子加速器,在布喇格峰展宽为3 cm,射程分别为7、16、29 cm条件下,通过放疗计划系统规划100 mm×100 mm的质子和碳离子照射野,分别利用EBT3胶片和辐射荧光屏探测器测量各种条件下的照射野大小,EBT3胶片图像获取在照射24小时后通过平板扫描仪获取,辐射荧光屏图像在束流照射过程中由相机实时拍照获取,通过照射野剂量分布曲线的半高宽进行对比分析。结果 三种质子和碳离子射程条件下,通过对比分析,不论物理意义方面还是统计学方面,两种探测器测量质子重离子照射野剂量分布,结果一致性好,精度相当,辐射荧光屏探测器在结果处理时间上更有效率。结论 两种探测器都满足质子重离子照射野剂量学参数测量要求,在照射野剂量分布的指标测量方面,能够在线实时测量分析的辐射荧光屏探测器比EBT3胶片更符合放疗质控发展要求。     

Pharmacological interventions for stress ulcer prophylaxis in critically ill patients: a mixed treatment comparison network meta-analysis and a recursive cumulative meta-analysis

Background: Proton pump inhibitors (PPI), histamine-2 receptor antagonists (H2RA), sucralfate and antacids are the commonly administered agents for stress ulcer prophylaxis (SUP) in critically ill patients. The authors of this paper have conducted a network meta-analysis to compare the efficacy of these agents in SUP.

Methods: Electronic databases were searched for randomized controlled trials, cohort studies and conference abstracts for studies comparing a SUP agent in critically ill patients to another active SUP agent or placebo. Overt, occult and clinically significant upper gastro-intestinal (UGI) bleeding, all-cause mortality, pneumonia, gastric colonization and ICU length of stay were considered as the outcome measures. A random effects model was used to generate pooled estimates.

Results: A total of 53 studies (4258 participants) were included. The pooled estimates were in favor of PPI and sucralfate for the overt UGI bleeding. PPI and H2RA bolus were associated with increased risk of gastric colonization and pneumonia.

Conclusions: SUP in critically ill patients was not associated with any benefit with regard to clinically significant bleeding episodes. However, PPI and sucralfate significantly reduces overt UGI bleeding. On the contrary, PPI and H2RA bolus are associated with an increased risk of gastric colonization and pneumonia.     

2010—2012 年解放军第二七二医院质子泵抑制剂应用分析

目的：了解我院质子泵抑制剂（PPI）的应用情况,为临床合理用药提供参考.方法：依托我院“医院药品库存管理系统”的原始数据,对2010-2012年我院PPI的品种、销售量、销售金额、用药频度（DDDs）、限定日剂量（DDC）等进行回顾性统计、分析.结果：我院PPI的总DDDs及总销售金额呈逐年增长趋势,DDDs及销售金额排序居前3位的药品分别为奥美拉唑、泮托拉唑、兰索拉唑;注射用PPI的销售金额构成比及DDDs构成比均逐年增加,且增幅较大;各药的DDC呈平稳趋势.结论：PPI在我院临床使用广泛,存在无适应证使用、盲目预防性应用、偏爱使用注射剂型等不合理现象,应加强PPI的合理应用管理.     

180例质子泵抑制剂预防应激性溃疡的用药分析

目的：了解扬州市第一人民医院临床使用质子泵抑制剂（PPIs）预防应激性溃疡（SU）的情况,评价该类药物的用药合理性.方法：抽查该院2008、2011年神经外科、神经内科、肝胆外科、胸外科和急诊科使用PPIs的患者病历共200份,对PPIs的预防应用指征、用法用量、溶媒及疗程的合理性进行评价.结果：共有180例患者预防使用PPIs,2008、2011年各90例.2008年69例患者具有SU风险因素,占76.67％;2011年63例患者具有SU风险因素,占70.00％.所有风险因素中,高龄、高血压、严重感染和严重创伤比例最高,分别占40.56％、31.67％、25.00％和20.00％.2008、2011年奥美拉唑注射剂用量不合理率分别为7.77％和22.22％;2008年泮托拉唑注射剂用量不合理率为14.44％,2011年全部合理.2008年溶媒不合理率为4.44％,2011年全部合理.2008、2011年疗程3日及以上分别占75.55％和77.78％.结论：该院使用PPIs预防SU在溶媒方面基本合理,但在应用指征、用法用量、疗程方面还需进一步优化.     

某“三甲”医院2010-2012年H2受体拮抗药和质子泵抑制剂应用分析

目的:评价某"三甲"医院抑酸药的应用情况。方法:对2010-2012年该院H2受体拮抗药和质子泵抑制剂这两类抑酸药的销售金额、用量、用药频度(DDDs)等进行统计、分析。结果:2010-2012年,该院质子泵抑制剂的销售金额始终占抑酸药的99%以上,且金额逐年上升;H2受体拮抗药的销售金额只占1%以下,且构成比逐年降低。泮托拉唑胶囊和奥美拉唑胶囊的用量3年来一直居第1、2位,两者的排序比均大于3;注射用泮托拉唑在静脉用药中的用量最大,排序比为0.33。结论:质子泵抑制剂在该院抑酸药的应用中占绝对主导地位,使用数量及金额逐年增加,但仍存在一些不合理的用药现象。     

注射用丙帕他莫单药及与β-内酰胺类药、质子泵抑制剂的配伍稳定性考察

目的:考察注射用丙帕他莫与β-内酰胺类药、质子泵抑制剂(PPI)的配伍稳定性。方法:采用高效液相色谱(HPLC)法测定丙帕他莫48 h内的含量变化,考察其p H值变化,并观察与β-内酰胺类药及PPI配伍后各溶液的外观变化。结果:丙帕他莫的水溶液不稳定,药物含量在7 h内可降解至90%以下,p H值在3 h内从5.37降至3.52,48 h后p H值降至1.87。丙帕他莫与β-内酰胺类药配伍3 h时肉眼可观察到液体乳光,配伍12 h时可观察到白色沉淀;与PPI配伍立即发生颜色的变化并逐渐形成深色沉淀。结论:丙帕他莫的水溶液稳定性差,与β-内酰胺类药物及PPI存在配伍禁忌。丙帕他莫临床上应现配现用,尽量在配伍1 h内用完且不与其他药物进行配伍,输液前后应冲管。