Objective To assess the growth station, the upper respiratory infection frequency and consultation frequency of the geographically defined high risk neonatal population at 1-year-old based on both birthweight and gestational age. Methods All infants admitted in our hospital from May in 2008 to May in 2009 were divided into three groups according to gestational age and birth weight, that were, group 1: born lt;32 completed gestational weeks and weighing ≥1 500 g; group 2: born after 32 completed gestational weeks and weighing lt;1 500 g; and group 3: born lt;32 completed gestational weeks and weighing lt;1 500 g. Information at 12 months corrected age about growth, the upper respiratory infection frequency and consultation frequency was collected. Results The growth rate of weight and head circumference in group 3 were lower than that in group 1, and the length growth rate was lower than that in group 1 and group 2. Infants in group 3 suffered from more airway infections (median: 15.5) than in group 1 (12.5) and group 2 (8.5). Infants in group 3 needed more medical consultations (median: 27.5) than those in group 1(17.5) and group 2 (15.5). Conclusions This study gives estimates for growth outcome, airway infection and consultation frequency at 12 months corrected age for very low birthweight infants (lt;1 500 g) and for very preterm infants (lt;32 completed gestational weeks). Gestational age and birth weight are the same important for predicting infants’ outcome and should therefore be integrated into clinical statistics.
Objective To investigate the role of low-dose heparin added to total nutrient admixture (TNA) solutions in the prevention of catheter related infections (CRIs). Methods One-hundred three newborn infants with periph-erally inserted central catheter (PICC) were divided into heparin group (n=63) and control group (n=40). The patients in the heparin group received TNA with 0.5 U/ ml heparin. The patients in the control group received TNA without heparin. We retrospectively analyzed the incidence of CRTs in the two groups. Results We found that the incidence of CRIs was 0 in the heparin group and 12.5% (5/40) in the control group. The incidence of catheter obstruction was 6.3% (4/63) in the heparin group and 20% (8/40) in the control group. The incidence of catheter-tip colonization was 1.58% (1/40) in the heparin group and 17.5% (7/40) in the control group. The incidences of CRIs, catheter obstruction, and catheter-tip colonization were signiicantly lower in the heparin group than those in the control group (Plt;0.05). Conclusion TNA solutions with 0.5U/ml heparin have decreased catheter obstruction and CRIs.
Objective Use the method of Cochrane systematic review to evaluate the difference of two fixation methods of femoral component in hip arthroplasty in order to choose the most appropriate fixation method. Methods Searches was applied to the following electronic databases: Chinese Bimedical Database (CBM) (1979 to Dec. 2004), MEDLINE (1966 to Feb. 2005), EMBASE (1984 to 2004) and The Cochrane Library (Issue 4, 2004). We handsearched Chinese Journal of Orthopaedy, the Journal of Bone and Joint Injury and Orthopaedic Journal of China (from establishment to Feb. 2005). Randomized controlled trials (RCT) were indentified and we applied RevMan 4.2 for statistical analysis. Results Nine RCTs involving 1 075 hips were included. The combined results of meta-analysis showed that the embolization occurred more commonly in the first and second generation cemented group (OR 0.02, 95%CI 0 to 0.11, P＜0.000 01), but this difference was not seen between the third generation cemented group and uncemented group (OR 0.80, 95%CI 0.36 to 1.78, P=0.58); The subsidence of femoral component (OR 12.20, 95%CI 3.58 to 41.54, P＜0.000 1) and the cortical hypertrophy (OR 69.97, 95%CI 27.88 to 175.57, P＜0.000 01) were more commonly found in uncemented group; the thigh pain occurrence, the revision for the femoral component’s cause and heterotopic ossification were found no significant difference in the two groups. Conclusions Compared with noncemented group, we found that cemented fixation may be more associated with embolism in the first and second generation cemented technique and less with femoral subsidence and cortical hypertrophy. There was no significant difference in embolization between the third generation cemented technique group and noncemented group. However, more randomized controlled trials to evaluate the occurrence of the postoperative thigh pain, revision and heterotopic ossification are needed.
Objective To investigate present status of health care in peri-brain-death and analyze its effectiveness and health economic characteristics. Method Retrospective analysis of case series was conducted and a total of 940 patients from surgical intensive care unit (SICU) were reviewed on treatment and part of direct medical expenditure. The patients admitted from Jun. 1999 to Dec. 2000 and Nov. 2001 to Jun. 2002 were included in this study. Data were processed by SPSS 10.0. Results Patients were included if they had two of the three symptoms for at least one hour: deep coma, pupillar light reflex disappear, and no autonomic respiratory. Ultimately 115 patients were included, with a total cost of ￥2 515.9 per day for each case, whereas mortality was 99.10%. Mortality increased with the state of peri-brain-death prolonged. Eighty percent of patients included were dead within 72 hours after admission. Conclusions Attempts to resuscitate patients of peri-brain-death have been the most widely applied in China, however, it resulted in great unnecessary consumption of health resources. It is of great importance to promote legislation of brain death in China.
Objective To improve the retrograde rotative-type interlocking intramedullary nail based on humeral bone dissection and cl inical appl ication, and investigate the cl inical values of modified retrograde rotative-type interlocking intramedullary nail for humeral shaft fracture. Methods Between March 2006 and March 2010, 146 patients with humeral shaft fractures were treated and fractures were fixed with the modified retrograde rotative-type interlocking intramedullary nail (the modified group, n=73) and with the retrograde rotative-type interlocking intramedullary nail (the original group, n=73). In the original group, there were 40 males and 33 females with an average age of 41 years; 41 cases were classified as transversefracture, 18 as obl ique fracture, 8 as spiral fracure, and 6 as comminuted fracture; the median disease duration was 11 days (range, 3 hours to 2 months); and close reduction fixation was performed in 27 cases and open reduction fixation in 46 cases. In the modified group, there were 39 males and 34 females with an average age of 40 years; 43 cases were classified as transverse fracture, 16 as obl ique fracture, 10 as spiral fracure, and 4 as comminuted fracture; the median disease duration was 13 days (range, 3 hours to 3 months); and close reduction fixation was performed in 31 cases and open reduction fixation in 42 cases. There was no significant difference in sex, age, fracture type, and disease duration between 2 groups (P gt; 0.05). The fracture heal ing and functional recovery of affected l imbs were compared between 2 groups after operation. Results The operation time and intraoperative blood loss in the modified group were significantly less than those in the original group (P lt; 0.05). Iatrogenic fracture occurred in 3 cases of the original group, which were cleavage fracture of supracondylar. No iatrogenic fracture occurred in the modified group. All incisions of 2 groups healed by first intention without compl ications of postoperative infections, metal fracture, and loosening of internal fixation, etc. A total of 116 patients were followed up more than 12 months in 2 groups with 58 patients in each group. The fracture heal ing time was (15 ± 3) weeks (fresh fracture) and (30 ± 12) weeks (old fracture and nonunion) in the modified group, and was (16 ± 4) weeks (fresh fracture) and (35 ± 14) weeks (old fracture) in the original group, showing significant differences between 2 groups (P lt; 0.05). The results of Neer shoulder score were excellent in 65 cases and good in 8 cases, and the results of Aitken and Rorabeck elbow function score were excellent in 61 cases and good in 12 casesin the original group; the results of Neer shoulder score were excellent in 67 cases and good in 6 cases, and the results of Aitken and Rorabeck elbow function score were excellent in 63 cases and good in 10 cases; and the excellent and good rates were 100% in 2 groups. Conclusion The modified retrograde rotative-type interlocking intramedullary nail has the advantages of easy operation and less compl ication, which is an effective and rel iable internal fixator.
目的 探讨不同剂量和不同疗程米非司酮对大鼠子宫异位内膜基质金属蛋白酶-9（MMP-9）及其组织特异性抑制物-1（TIMP-1）表达的影响。 方法 65只子宫内膜异位症大鼠随机分为低剂量组、高剂量组、对照组。各个剂量组分别灌胃20、30、40 d后取异位子宫内膜组织用免疫组织化学法检测MMP-9及TIMP-1的表达，并计算MMP-9/TIMP-1比值。 结果 低剂量组和高剂量组均能使异位内膜MMP-9表达下降（P＜0.05）,TIMP-1表达升高（P＜0.05）,高剂量组的作用更加明显，与低剂量组差异有统计学意义（P＜0.05）；用药30 d低剂量组TIMP-1表达最高，与用药20 d和40 d相比差异有统计学意义（P＜0.05）,同样高剂量组用药30d TIMP-1的表达也最高，与用药20 d和用药40 d比较差异有统计学意义（P＜0.05）。与用药20、40 d比较差异有统计学意义（P＜0.05）。 结论 米非司酮能够降低大鼠异位子宫内膜的侵袭能力，高剂量米非司酮抑制效果更明显；用药30 d米非司酮对大鼠异位内膜的侵袭能力抑制最强，延长用药时间不能使异位内膜侵袭能力继续下降。
ObjectiveTo systematically review the renal adverse reactions of tyrosine kinase inhibitors (TKI). MethodsPubMed, EMbase, Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the incidence of renal adverse reactions of TKI from inception to March 30, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 19 RCTs involving 10 141 patients were included. The results of meta-analysis showed that compared with placebo or blank control, gefitinib, ranvartinib, cabotinib, vandetanib, pazopanib, arotinib, apatinib, and acitinib could lead to an increased risk of proteinuria events, while sildenib did not increase the risk of proteinuria in patients. Anlotinib could increase the risk of hematuria. Vandetanil increased the risk of acute kidney injury. Gefitinib, ranvartinib and apatinib could increase the risk of grade 3-4 renal adverse reactions. ConclusionCurrent evidence shows that TKI drugs may cause renal damage in patients, and proteinuria is the most common. Vandetanil can cause acute kidney injury, gefitinib, ranvartinib and apatinib are more nephrotoxic. The renal adverse reactions of neratinib, ibutinib and sildenib are relatively few.
Objective To assess the therapeutic effect of sulodexide for diabetic patients with early nephropathy. Methods A total of 60 patients with early diabetic nephropathy (albuminuria: 30 to 300 mg/24 h, male/female: 30/30, mean age: 51.23 years, mean course of disease: 12.9 years) were randomized equally into three groups: the routine treatment group, cozaar group (50 mg qd, po for 12 weeks) and sulodexid group (600 LSU qd, iv or im for 4 weeks, 250 LSU bid, po for 8 weeks). The levels of urinary albumin excretion rate (UAER), urea nitrogen and creatinine were determined. Results After three months of treatment, the level of UAER was decreased significantly in both the sulodexide group and cozaar group (Plt;0.01), but not in the routine treatment group (Pgt;0.05). The level of UAER was reduced by 34.04% and 33.62% in the cozaar group and the sulodexide group, respectively. Significant difference was noted in the level of UAER between the cozaar/sulodexide groups and the routine treatment group (Plt;0.01), but no significant difference was observed between cozaar group and sulodexide group (Pgt;0.05). Conclusion Sulodexide could decrease the level of UAER in patients with early diabetic nephropathy. It has similar efficacy to cozaar.
Objective To evaluate the effectiveness of terazosin, tamsulosin and finasteride for benign prostatic hyperplasia (BPH). Methods We searched the related original studies all over the world, and only included randomized controlled trials (RCT) and quasi-randomized controlled trials (CCT). MEDLINE (1966 to Dec. 2004), EMBASE (1984 to Dec. 2004), The Cochrane Library (Issue 4, 2004) and four Chinese databases were electronically searched and 10 related journals were handsearched. The studies included in the references of eligible studies were additionally searched. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinion were consulted by a third party. Meta-analysis was performed by using RevMan 4.2 software. Results Twelve original studies involving 2 471 participants met inclusion criteria. Compared with terazosin, tamsulosin could improve international prostatic symptom score, with WMD 0.75, 95% confidence interval (CI) 0.03 to 1.46, P=0.04. There was no statistical difference between terazosin and tamsulosin in improving the average rate of urine flow (WMD 0.23, 95%CI -0.39 to 0.85, P=0.46), the residual urine volume (WMD 0.82, 95%CI -2.92 to 4.57, P=0.67) and in diminishing the volume of prostate (WMD 2.20, 95%CI -3.99 to 8.39, P=0.49). There was no statistical difference between finasteride and tamsulosin in improving the international prostatic symptom score (WMD 0.65, 95%CI -0.45 to 1.75, P=0.25) or the max rate of urine flow (WMD 0.39, 95%CI -0.72 to 1.51, P=0.49). Only two studies compared finasteride with terazosin and had different conclusions. Only one study compared finasteride or terazosin with a combination of these drugs suggested that the combination had higher effective power than finasteride alone but no difference with terazosin alone. Conclusions Although the effectiveness in some aspects is higher in the tamsulosin group, there is not enough evidence to show which one is the best among these three drugs. The combination of finasteride and terazosin does not show more effectiveness than terazosin alone. This review suggests that tamsulosin alone should be used for the treatment of BPH and the combination needs to be identified by better evidence. It is important to improve the quality of original studies.
Objective To investigate the adverse drug reactions (ADRs) of patients with SARS in Xiao Tang Shan Hospital. Methods We developed and distributed Drug Use Handbook and established ADRs monitoring group to guide resaonable drug use. We followed up the process and collected clinical report on ADRs. We retrospectively analyzed the data on ADRs by the classification and grade of ADRs according to WHO and Hospital Information Sysytem (HIS) of Chinese PLA General Hospital. Results We collected 193 (87 males and 106 females) patients with ADRs among 680 SARS patients with incidence rate of ADRs of 28.38%. The ADRs incidence rate was higher in females and elders. Critical SARS patients and SARS patients with diabetes were more susceptible to ADRs. Large dosage and combination of drugs may induce ADRs. Steroids may be a main cause of ADRs. The ADRs incidence rate induced by injection was higher than that induced by all kinds of oral drugs. ADRs mainly happened in hematological, endocrine and digestive systems. Conclusion SARS patients are prescribed many kinds of medications. Large dosage of so many medications may lend to high incidence rate of ADRs. Steroid should be cautiously used in the treatment of SARS.