Society of Family Planning clinical recommendations: contraception after surgical abortion

These recommendations present an evidence-based assessment of provision of contraceptives at the time of surgical abortion. Most methods of contraception, including the intrauterine devices (IUD), implant, depot medroxyprogesterone injection, oral contraceptive pill, contraceptive patch, monthly vaginal ring, barrier methods and some permanent methods, can be safely initiated immediately after first- or second-trimester surgical abortion. Provision of postabortion contraceptives, particularly IUDs and implants, substantially reduces subsequent unintended pregnancy. IUD insertion immediately following uterine aspiration is safe. While this may be associated with a higher risk of device expulsion than with interval placement, expulsion rates remain low, and this risk must be weighed against the fact that patients often do not receive their desired IUD at an interval insertion and therefore experience higher rates of subsequent unintended pregnancy. Many patients experience barriers that prevent access to the full spectrum of postabortion contraceptive options, particularly IUDs and implants. Advancements in health-systems-based point-of-care provision and policies are needed to improve comprehensive contraceptive availability following surgical abortion. These recommendations will address clinical considerations for postabortion contraceptive provision and recommend interventions to improve contraceptive access following uterine evacuation.     

重组人胰岛素类似物蛋白在大肠杆菌中克隆、表达与纯化

目的:设计合成编码Des30、B26 H、B28D和B26 H-B28D基因,用大肠杆菌BL21(DE3)表达上述4种速效人胰岛素原蛋白,为探知B26 H-B28D功能和用植物系统表达速效胰岛素原类似物研究做必要的准备。方法:基于人胰岛素氨基酸和小C肽(TYPGDVPK)序列,按植物(油菜)偏爱密码子设计合成了198 bp编码人速效胰岛素原基因Des30。随后以Des30为模板,用PCR突变技术扩增并创造了基因B26 H、B28D和B26 H-B28D,并构建了4个原核表达载体,转化大肠杆菌BL21(DE3)后,经IPTG诱导、用Ni-NTA亲和柱纯化、复性、胰岛素体外成熟(酶解)获得重组人胰岛素突变体蛋白。结果:4种人速效胰岛素原类似物在宿主菌中均以包涵体形式存在,IPTG诱导时间以8 h为佳。Western blot结果表明,带his-tag的速效人胰岛素原蛋白已成功在宿主菌中表达,用Ni-NTA亲和柱纯化获得了较纯的速效人胰岛素原蛋白。纯化的包涵体蛋白通过低温透析复性,然后用胰蛋白酶和羧肽酶B酶切,Western blot结果显示,释放出的单体胰岛素与阳性对照一样具有免疫活性,RP-HPLC和MALDI-TOF质谱检测表明,酶切产物分子量峰值分别与预测的人胰岛素类似物分子量一致。结论:该研究为B26 H-B28D功能研究和用植物系统表达人类胰岛素的研究奠定基础。     

Markers of abuse liability of short- vs long-acting opioids in chronic pain patients: A randomized cross-over trial

Background

Abuse liability is thought to possibly be lower in long- than in short-acting opioids because lower peak serum levels may be less likely to induce psychoactive effects.

Methods

We compared patient responses to extended-release morphine, hydrocodone plus acetaminophen, and placebo in a randomized, double-blind crossover study using markers of abuse liability. Patients indicated their craving for drugs on 5 visual analog scales (VASs), completed the Addiction Research Center Inventory, and underwent cue reactivity testing. To perform the latter, subjects watched a video intended to produce a positive or a negative affect, after which a vial of medication was or was not presented (the cue) and then indicated their craving for drugs on 5 different VASs (the reactivity).

Results

Differences in Addiction Research Inventory scores were statistically significant but clinically unimportant. Neuropsychological test results were mixed and unrelated to the medications studied. Cue reactivity did not differ among conditions but was uniformly high.

Conclusions

Using several markers of abuse liability, long-acting opioids do not have lower abuse potential than do short-acting opioids or placebo. Although cue reactivity did not differ among the conditions, uniformly high results in these patients suggest that it may have some value as a component of abuse liability testing.     

赖脯胰岛素与短效胰岛素强化治疗糖尿病的对比分析

目的对比赖脯胰岛素与短效胰岛素强化治疗糖尿病的有效性和安全性,以供临床借鉴和参考。方法以2009年6月—2012年5月在该院接受强化治疗的2型糖尿病患者140例为研究对象,进行随机分组。A组给予短效胰岛素,B组给予赖脯胰岛素,连续治疗12周。观察两组患者治疗前后FPG、2hPG、HbAlC水平的变化,并比较治疗期间低血糖反应的差异。结果与治疗前相比较,两组患者FPG、2hPG、HbAlC水平均有所下降;与A组相比较,B组FPG、HbAlC改善程度明显较好,差异有统计学意义（P〈0.05）。两组患者2hPG比较,差异无统计学意义（P〉0.05）。两组患者治疗期间低血糖发生率比较,差异无统计学意义（P〉0.05）。结论采用赖脯胰岛素强化治疗糖尿病临床疗效优于短效胰岛素,在患者经济条件许可的情况下可推广应用。     

Clinical characteristics of patients with not well-controlled severe asthma in Japan: Analysis of the Keio Severe Asthma Research Program in Japanese population (KEIO-SARP) registry

BackgroundMultiple phenotypes exist within the classification of severe asthma. However, characteristics of patients with not well-controlled severe asthma have not been well identified.MethodsJapanese patients with asthma (age ≥ 20 years) were enrolled at the Keio University Hospital and its affiliated hospitals in this observational study (Keio Severe Asthma Research Program). Among them, patients with severe asthma (those undergoing Global Initiative for Asthma [GINA] 2018 step 4 or 5 treatment) were included in this analysis and investigated clinical characteristics based on asthma control status.ResultsOf the 154 patients (men, 46.8%; age, 60.1 ± 14.9 years), 87 (56.5%) had not well-controlled (partly controlled and uncontrolled) asthma (GINA step 4, 42 patients; step 5, 45 patients). Overall, there were no significant differences in clinical characteristics between patients with well-controlled and not well-controlled asthma. However, cluster analysis revealed that distinct 5 clusters (cluster 1, well-controlled; cluster 2, eosinophilic; cluster 3, non–type 2 inflammation; cluster 4, high periostin; and cluster 5, late-onset type 2 inflammation), and clusters 2–5 were not well-controlled. Among them, cluster 3 was characterized by low eosinophil counts, low periostin levels, and less frequent olfactory disturbance, and this cluster had the worst asthma control.ConclusionsJapanese patients with severe asthma were divided into well-controlled and not-well controlled asthma, and we confirmed heterogeneity of not well-controlled severe asthma. These patients, especially non-type 2 phenotype, require a further therapeutic approach. (University Hospital Medical Information Network Clinical Trials Registry, UMIN000002980)     

人工流产术后即时口服避孕药优思明的有效性观察

[目的]探讨人工流产后应用复方短效避孕药优思明(含屈螺酮3mg+炔雌醇30μg)对减少阴道流血量,促进月经复潮及子宫内膜恢复的临床疗效。[方法]120例人工流产者分为两组。治疗组60例,于人工流产后服用优思明、抗生素及益母颗粒,对照组仅服用抗生素及益母颗粒。[结果]治疗组阴道流血时间与对照组相比较差异无统计学意义(P﹥0.05),但阴道流血量明显少于对照组(P﹤0.05),术后月经恢复正常比例及子宫内膜恢复情况均优于对照组(P﹤0.05)。[结论]人工流产术后即服用口服避孕药优思明除避孕外还能明显减少阴道流血量,促进月经恢复及子宫内膜修复,能减少人工流产的近期和远期并发症,应积极推广。     

小剂量艾司洛尔对丙泊酚麻醉诱导静脉注射疼痛的影响

目的 研究小剂量艾司洛尔对丙泊酚麻醉诱导静脉注射疼痛的影响.方法 选择2007年6月至2008年3月全身麻醉下行择期手术的患者80例,随机分为对照组(A组)和艾司洛尔组(B组),每组40例.A组进行常规麻醉诱导,B组先静脉注射艾司洛尔0.5 mg/kg,30 s后再进行常规麻醉诱导.采用4分制对两组的丙泊酚注射痛进行评分,比较麻醉前、诱导完毕、气管插管完成即刻、气管捅管后2、4、6、8与10 min的血压和心率变化及诱导期间注射痛的发生率.结果 两组麻醉前和诱导期间各时点血压和心率的变化差异无统计学意义(均P>0.05).诱导期间丙泊酚总的注射疼痛发生率A组为65%(26/40),B组为23%(9140)(P<0.01).其中重度疼痛发生率A组为20%(8/40),B组为3%(1/40)(P<0.05);而轻度和中度疼痛发生率两组间差异无统计学意义(P>0.05).结论 小剂量艾司洛尔可减轻丙泊酚麻醉诱导的静脉注射疼痛.     

Burden of preschool wheeze and progression to asthma in the UK: Population-based cohort 2007 to 2017

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