ABSTRACT
Objective To investigate the target achievement of serum trough concentration of vancomycin in elderly patients routinely treated with vancomycin,and to analyze the influencing factors for vancomycin-associated acute kidney injury(VA-AKI).Methods A single-center retrospective study was conducted by collecting clinical data of elderly inpatients from January 2016 to July 2017 who received intravenous vancomycin therapy and serum vancomycin trough concentration test.Logistic regression was used to analyze the risk factors for VA-AKI.Results A total of 141 patients were enrolled,including 74 males (52.5 ％) and 67 females (47.5 ％).The median (interquartile range)age was 77.0(13.5) years old.Patients with serum vancomycin trough concentrations within 10～ 20 mg/L accounted for 48.9 ％ (69 cases),while those lower than the target value accounted for 23.4 ％ (33 cases),and those higher than the target value accounted for 27.7％ (39 cases).Patients were divided into three groups according to the vancomycin serum trough concentration:＜10 mg/L group,10～20 mg/L group,and ＞20 mg/L group.There were statistically significant differences among the three groups in median(interquartile range) age[74.0 (14.0) years old,76.0 (11.5) years old vs.80.0 (14.0) years old,H =9.506,P =0.009] and the median (interquartile range) vancomycin daily dose [1.5(0.5) g/d,1.5 (0.8) g/d vs.1.5 (0.5) g/d,H =6.131,P =0.047].VA-AKI occurred in 23 patients(16.3 ％).Logistic regression analysis showed that the baseline serum creatinine levels (OR =1.022,95 ％CI:1.001 ～ 1.042,P =0.035)and vancomycin trough concentration(OR =1.058,95 ％CI:1.011～1.106,P=0.015)were influencing factors for VA-AKI.Conclusions The elderly patients with infection who received clinical vancomycin therapy have a low target achievement rate of serum trough concentration.Baseline serum creatinine level and serum vancomycin trough concentration are influencing factors for VA-AKI.
ABSTRACT
The objective of this study was to evaluate parity as a risk factor for autoimmune thyroid disease ( AITD) by comparing features of thyroid autoantibodies of pregnant women with different parities. This prospective cohort study included 477 women of first trimester of pregnancy in Peking University International Hospital from October 2016 to April 2017. Subjects were categorized as never parturition group ( n=287) or previously parturition group(n=190). All pregnant women in this study voluntarily signed informed consents. Thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyrotropin (TSH), and free T4 were measured in the first trimester of pregnancy( from 7 to 12 weeks) . Meanwhile, height, weight, blood pressure, gestational weeks and pregnancy history were recorded. Data were statistically analyzed. The positive rates of thyroid autoantibodies including TPOAb and TGAb in previously parturition group were higher than those in no parturition group(10.0％vs 5.2％, P<0.05). The previously parturition group tended to be older and had lower TSH levels than the never pregnant group( P<0.05) . TSH 2.5 mIU/L and 4.0 mIU/L were used as upper reference limits respectively. The rate of abnormality of thyroid function was higher in the never parturition group than those in previously parturition ones ( 33. 33 by 29. 5％, 21. 2％ by 10. 8％) . In both previously parturition and never parturition groups, the commonest diseases of abnormal thyroidal function were SCH and subclinical thyrotoxicosis, and there was significant difference in disease of abnormal thyroidal function abnormal(χ2=15.704, P<0.05 and χ2=14.560, P<0.05). Parity was associated with AITD after adjustment for age, BMI, and gestational week [OR=2.346(1.075-5.121)]. Parity may affect AITD. Pregnant women should be monitored for thyroid function and thyroid autoantibodies even if they did not suffer from thyroid disease in the first pregnancy.
ABSTRACT
The metabolism of thyroid hormone changes during pregnancy. Subclinical hypothyroidism during pregnancy may adversely affect the pregnancy outcomes and neuropsychological development of child, controversially. The diagnostic criteria of subclinical hypothyroidism during pregnancy need to be specific. It is important to figure out when should pregnancy with subclinical hypothyroidism be treated and what is the specific goal of the treatment.
ABSTRACT
Objective To observe the clinical therapeutic effect of Qingxuan Jiangya decoction on patients with primary hypertension (PH) and its influence on their rennin-angiotensin-aldosterone system (RAAS). Methods A prospective study was conducted, including 178 patients with definite diagnosis of PH (Ⅰ-Ⅱ grade) who came from Guanggu district to the third Hospital of Wuhan City from April 2016 to March 2017, and they were divided into a control group and an observation group according to the method of taking medicine, each group 89 cases. The control group received 5 mg amlodipine besylate, orally once a day; the observation group on the basis of treatment in the control group, the Qingxuan Jiangya decoction (gastrodia rhizome 20 g, uncaria 20 g, ligusticum rhizome 15 g, salviae miltiorrhizae 10 g, puerarin 20 g, radix ophiopogonis 20 g, fructus lycii 25 g, chrysanthemum 10 g, root poria 15 g, poria cocos 10 g, radix glycyrrhizae 5 g) was added, a dose (400 mL) divided into two parts, one part taken twice daily, in the morning and in the evening after meals; the two groups took the treatment continuously for 4 weeks. The blood pressure dynamic changes and plasma levels of renin, angiotensin Ⅱ (Ang Ⅱ), aldosterone (ALD) and clinical efficacy were observed, and the safety of the drugs was evaluated by measuring the changes of liver and kidney functions. Results After treatment in the two groups, the daytime systolic pressure (D-SBP) and diastolic pressure (D-DBP) and nighttime SBP (N-SBP) and DBP (N-DBP), the mean of 24 hours-SBP and 24 hours-DBP were all lower than those before treatment, and the D-DBP, N-SBP and 24 hours-DBP of the observation group were significantly lower than those of control group [D-DBP (mmHg, 1 mmHg = 0.133 kPa): 78.24±5.35 vs. 81.56±6.23, N-SBP (mmHg):117.35±5.42 vs. 122.63±7.23, 24 hours-DBP (mmHg): 74.15±5.26 vs. 80.51±6.52, all P < 0.05]; after treatment, the levels of renin, Ang Ⅱ and ALD in two groups were also declined, and the degrees of decrease in the observation group were more significant than those in the control group [renin (ng/L): 5.46±0.41 vs. 7.82±0.36, ALD (ng/L):128.48±31.42 vs. 168.48±28.32, Ang Ⅱ (ng/L): 52.35±14.27 vs. 75.38±15.65, all P < 0.05]; there were no significant changes in the levels of alanine aminotransferase (ALT), aspartate transaminase (AST), urea and creatinine (Cr) before and after treatment in the two groups, showing that the treatment was safe. Conclusion Qingxuan Jiangya decoction can effectively and safely reduce the blood pressure in PH patients, and its mechanism is possibly related to its influence on RAAS.
ABSTRACT
Objective To observe the clinical therapeutic effect of Qingxuan Jiangya decoction on patients with primary hypertension (PH) and its influence on their rennin-angiotensin-aldosterone system (RAAS). Methods A prospective study was conducted, including 178 patients with definite diagnosis of PH (Ⅰ-Ⅱ grade) who came from Guanggu district to the third Hospital of Wuhan City from April 2016 to March 2017, and they were divided into a control group and an observation group according to the method of taking medicine, each group 89 cases. The control group received 5 mg amlodipine besylate, orally once a day; the observation group on the basis of treatment in the control group, the Qingxuan Jiangya decoction (gastrodia rhizome 20 g, uncaria 20 g, ligusticum rhizome 15 g, salviae miltiorrhizae 10 g, puerarin 20 g, radix ophiopogonis 20 g, fructus lycii 25 g, chrysanthemum 10 g, root poria 15 g, poria cocos 10 g, radix glycyrrhizae 5 g) was added, a dose (400 mL) divided into two parts, one part taken twice daily, in the morning and in the evening after meals; the two groups took the treatment continuously for 4 weeks. The blood pressure dynamic changes and plasma levels of renin, angiotensin Ⅱ (Ang Ⅱ), aldosterone (ALD) and clinical efficacy were observed, and the safety of the drugs was evaluated by measuring the changes of liver and kidney functions. Results After treatment in the two groups, the daytime systolic pressure (D-SBP) and diastolic pressure (D-DBP) and nighttime SBP (N-SBP) and DBP (N-DBP), the mean of 24 hours-SBP and 24 hours-DBP were all lower than those before treatment, and the D-DBP, N-SBP and 24 hours-DBP of the observation group were significantly lower than those of control group [D-DBP (mmHg, 1 mmHg = 0.133 kPa): 78.24±5.35 vs. 81.56±6.23, N-SBP (mmHg):117.35±5.42 vs. 122.63±7.23, 24 hours-DBP (mmHg): 74.15±5.26 vs. 80.51±6.52, all P < 0.05]; after treatment, the levels of renin, Ang Ⅱ and ALD in two groups were also declined, and the degrees of decrease in the observation group were more significant than those in the control group [renin (ng/L): 5.46±0.41 vs. 7.82±0.36, ALD (ng/L):128.48±31.42 vs. 168.48±28.32, Ang Ⅱ (ng/L): 52.35±14.27 vs. 75.38±15.65, all P < 0.05]; there were no significant changes in the levels of alanine aminotransferase (ALT), aspartate transaminase (AST), urea and creatinine (Cr) before and after treatment in the two groups, showing that the treatment was safe. Conclusion Qingxuan Jiangya decoction can effectively and safely reduce the blood pressure in PH patients, and its mechanism is possibly related to its influence on RAAS.
ABSTRACT
An HPLC method to determine six alkaloids of the Coptidis for Chinese Pharmacopoeia of 2015 Edition was established through C18 column. The mobile phase was CH3CN-0.25 mol·L-1 NH4Ac (36:64) (containing 8 mmol·L-1 SDS and adjusting pH 9.3 with ammonia) at the flow rate of 1 mL·min-1, the detective wavelength was 270 nm and the column temperature was 35 oC. The linear ranges of jatrorrhizine hydrochloride, columbamine hydrochloride, epiberberine hydrochloride, coptisine hydrochloride, palmatine hydrochloride and berberine hydrochloride were 0.006 96-0.233, 0.004 75-0.152, 0.003 30-0.528, 0.006 31-1.010, 0.004 71-0.753, 0.017 8-2.884 μg·mL-1, respectively. The average recoveries were 99.65%, 98.59%, 98.49%, 98.66%, 98.64%, 98.63% and RSD were 0.03%、0.15%、0.21%、0.12%、0.28%、0.23%, respectively. The method is simple and accurate, and can be used to determine the contents of jatrorrhizine, columbamine, epiberberine, coptisine, palmatine and berberine in the Coptidis.
ABSTRACT
Objective To investigate the clinical effectiveness of gamma knife and microsurgery operation for the treatment of bilateral parasagittal meningiomas.Methods Twenty-six patients with bilateral parasagittal meningiomas were operated by microscopy,and the most parts of the tumor was removed.The remains of the tumor were treated with gamma knife.Results All patients were followed up 5 years.The tumors disappeared in 8 cases,reduced in 11 cases,did not change in 5 cases,and recurred in 2 cases.No severe complications occurred after gamma knife treatment.Conclusion Combined treatment of gamma knife and micriosurgery operation are effective for bialateral parasagittal meningiomas.It not only greatly improves the effectiveness,but also reduces the complications and death rate in patients with bilateral parasagittal meningiomas.
ABSTRACT
OBJECTIVE To obtain primary knowledge of drug resistance to aztreonam(ATM) in commonly encounterd Gram-negative bacilli in our hospital thereby to bring the situation under control.METHODS A total of 3 928 strains of pathogenic bacteria were isolated from patients from 2001 to 2005,and drug resistance of these strains to ATM was examined.RESULTS Resistance of Pseudomonas aeruginosa,Klebsiella pneumoniae,Enterobacter cloacae and Acinetobacter spp to ATM was found to be tend increasing from 13%,14%,29% and 40% in 2001 to 28%,29%,40% and 77% in 2005.CONCLUSIONS The percentages of commonly encountered Gram-negative bacilli that are resistant to ATM have been considerably high and tend to increase further.ATM abuse needs to be given appropriate attention to.