Safety of a 90-min duration of intravenous infusion of obinutuzumab in patients with B-cell non-Hodgkin's lymphoma in a tertiary hospital in China: a prospective, open-label, exploratory clinical trial

This study aimed to analyze the safety and applicability of a 90-min duration of infusion (SDI) of obinutuzumab in patients with B-cell non-Hodgkin's lymphoma (NHL) in a tertiary hospital in China. This exploratory clinical trial was performed at Jiangsu Province Hospital. All patients were treated with the standard infusion regimen for the first infusion. If no grade ≥3 infusion-related reactions (IRRs) occurred, the subsequent infusions were given as SDI. The primary endpoint was the incidence of IRR during the standard infusion (3-4 h) and 90-min SDI regimens. This study enrolled 208 patients and all completed cycle 1. Forty-one patients (19.71%) had IRRs: five (2.40%) with grade 1, twenty-eight (13.46%) with grade 2, and eight (3.85%) with grade 3. The 41 patients had 71 IRRs, mainly fever (40.85%), chest pain/tightness (12.68%), and dyspnea (9.86%). The occurrence of IRRs in the first infusion was significantly lower in patients who received oral acetaminophen prophylaxis than those who did not (10.72% vs 30.21%, P<0.001). For the subsequent cycles with 90-min SDI, only two (0.25%) IRRs occurred among 814 infusions (one grade 1 hand numbness and one grade 2 chill/fever). The 90-min obinutuzumab SDI might be safe and feasible in patients with B-cell NHL in China.

Lidocaína para el alivio del dolor en pacientes de cuidados paliativos, una serie de casos / Lidocaine for pain relief in palliative care patients, a case series

Introducción. El dolor neuropático afecta al 2 % de la población y 15 de cada 100 pacientes que acuden a consulta médica, sufren de dolor neuropático. Este tipo de dolor es muy común en pacientes con cáncer. Objetivo. Determinar si el uso de lidocaína en infusión endovenosa disminuye el dolor neuropático en los cuidados paliativos con tratamiento opioide. Metodología. Serie de casos de tres pacientes en cuidados paliativos que presentaron dolor neuropático y se les administraron múltiples infusiones de lidocaína intravenosa como coadyuvante para el manejo del dolor, se describieron las dosis utilizadas, el número de infusiones, se evaluó la mejoría del dolor a través de la escala visual análoga y se monitorizaron los posibles efectos secundarios. Resultados. Caso 1: escala visual análoga al ingreso 9/10; 24 horas posinfusión de lidocaína: 4/10. Caso 2: escala visual análoga al ingreso 6/10; 24 horas posinfusión de lidocaína 2/10. Caso 3: escala visual análoga al ingreso 8/10; 24 horas posinfusión 2/10. Conclusión. La infusión intravenosa de lidocaína al 2 % disminuyó el dolor neuropático en los tres pacientes del estudio, sin embargo, el alivio fue transitorio y el efecto positivo se perdió con el paso del tiempo

Introduction. Neuropathic pain affects 2 % of the population and 15 out of 100 patients who go to a physician suffer from neuropathic pain. This type of pain is common in cancer patients. Objective. To determine if the use of lidocaine in intravenous infusion reduces neuropathic pain in palliative care with opioid treatment. Methodology. Case series of three patients in palliative care who presented neuropathic pain and underwent multiple infusions of intravenous lidocaine as an adjuvant for pain management; the doses used and the number of infusions were described, pain improvement was evaluated through the visual analog scale and possible side effects were monitored. Results. Case 1: visual analogue scale on admission 9/10; 24 hours post lidocaine infusion: 4/10. Case 2: visual analogue scale on admission 6/10; 24 hours post lidocaine infusion 2/10. Case 3: visual analogue scale on admission 8/10; 24 hours post-infusion 2/10. Conclusion.Intravenous infusion of 2 % lidocaine reduced neuropathic pain in the three patients of the study, however, the relief is transitory, and the positive effect is lost over time.

Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Abstract Background Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. Objective We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. Methods Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1.h-1 infusion for the first 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1.h-1 and Mg sulfate 8 mg.kg-1.h-1 infusions for the first 24 hours postoperative. The primary outcome was the morphine consumption in the first 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. Results Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. Conclusion Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Síndrome de infusión de propofol y COVID-19. Reporte de caso / Propofol and COVID-19 infusion syndrome. Case report

Resumen: La forma grave de neumonía por SARS-CoV-2 (COVID-19) cursa en la mayoría de los casos con un síndrome de dificultad respiratoria aguda (SDRA). Es necesario emplear sedación durante su ventilación mecánica, el propofol es el que más de utiliza por su farmacocinética y farmacodinamia. El propofol es un anestésico que se usa ampliamente en las unidades de cuidados intensivos. Su empleo puede provocar un efecto adverso poco frecuente, pero en extremo grave, conocido como síndrome por infusión de propofol (SIP), el cual se encuentra estrechamente asociado a la velocidad de infusión aunado a factores de riesgos propios del paciente. Se caracteriza principalmente por inestabilidad hemodinámica, acidosis láctica y por progresión a disfunción multiorgánica. Se presenta un caso de SIP en paciente con síndrome de dificultad respiratoria aguda (SDRA) secundario a SARS-CoV-2 que desarrolla esta complicación asociada a la sedación. Se discute fisiopatológica clínica y consideraciones que deberán tomarse en cuenta al momento de su utilización en infusión continua.

Abstract: The severe form of SARS-CoV-2 pneumonia (COVID-19) occurs in most cases with acute respiratory distress syndrome (ARDS), requiring the use of sedation during mechanical ventilation, with propofol being the most widely used for its pharmacokinetics and pharmacodynamics. Propofol is a widely used anesthetic in intensive care units (ICU). Its use can cause an infrequent but extremely serious adverse effect, known as propofol infusion syndrome (PRIS), which is closely associated with the speed of infusion coupled with risk factors specific to the patient, the clinical features of PRIS are hemodynamic instability, lactic acidosis and with progression to multi-organ dysfunction. We present a case of SIP in a patient with acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 who develops this complication associated with sedation, discusses clinical pathophysiology and considerations that should be taken into account when using it in continuous infusion.

Adherence and Cost Effectivity of Home-Based Prophylaxis Over Institutionalized Prophylaxis in Patients with Hemophilia

Purpose: Home-based prophylaxis in hemophilia facilitates the treatment of patients with hemophilia (PwH) at home resulting in an improved quality of life, experiencing less pain and greater flexibility in daily activities. This literature studies the cost effectivity and adherence to prophylaxis treatment after the implementation of home-based prophylaxis therapy in PwH registered under the Hemophilia Treatment Centre (HTC) of Assam Medical College and Hospital. Materials and Methods:?PwH and their parents were advised for self/home infusion after being trained by a medical professional for 6 months. Data were collected on the skip in prophylaxis treatment by PwH and their traveling cost to access the prophylaxis treatment before and after the implementation of home infusion, through questionnaire and telephonic interview. Results:?The mean number of days of skip in prophylaxis was significantly reduced from 25 (±11) to 4 (±2) days after implementation of home infusion. The mean transportation cost was also found to be significantly decreased from Rs. 3297 (±2251) to 440 (±279). Before home/self-infusion, 77% of the registered PwH were found to skip prophylaxis doses more than 12 times a year but after home infusion, no PwH were found to skip more than 12 doses a year. Conclusion:?Home therapy facilitates the PwH to strictly adhere to the prophylaxis regime significantly reducing the skipping of doses to be administered to the PwH. The risks of regular traveling and the burden of transportation expenditure to avail the prophylaxis treatment was also found to be reduced significantly.

Advances in neoadjuvant therapy for hepatocellular carcinoma / 中华消化外科杂志

In recent years, the rapid development of systematic therapy and local therapy, represented by targeted therapy, immunotherapy and vascular interventional therapy, has signifi-cantly improved the therapeutic effects of advanced hepatocellular carcinoma (HCC), and also greatly promoted the development of neoadjuvant therapy of HCC. The main purpose of neoadjuvant therapy is to decrease the size of tumor and the difficulty of surgery, and to reduce the postoperative recurrence rate. But meanwhile it also brings potential risks such as tumor progression and loss of surgical opportunity. At present, most experts recommend that patients with Ⅱb stage and Ⅲa stage HCC according to China Liver Cancer staging system are the preferred target population for neoadjuvant therapy. However, due to the lack of high-quality medical evidence, it is recommended to be cautiously carried out after multidisciplinary discussion. Moreover, it is suggested that neoadjuvant therapy with rapid onset of effect, less and mild side effects, high objective response rate and low probability of disease progression should be carried out. The author expects that neoadjuvant therapy can further improve the prognosis of HCC, and provide more options for clinical practice.

Disposable disinfection cap for preventing catheter-related blood stream infections: a Meta-analysis / 中国实用护理杂志

Objective:To evaluate the efficacy of disposable disinfection cap in preventing catheter-related blood stream infections (CRBSIs).Methods:Literature on the prevention of CRBSIs by disposable disinfection caps were retrieved from CNKI, Wanfang Database, VIP database, Chinese Biomedical Literature Database, PubMed, Cochrane Library, Embase and Web of Science databases. The retrieval period was from the database construction to June 30, 2022. After literature screening, data extraction and quality evaluation were independently carried out by 2 researchers, RevMan5.4 software was used for analysis.Results:A total of 12 articles were included, including 9 832 patients. Meta-analysis results showed that compared with conventional manual disinfection, disposable disinfection cap could reduce the incidence of CRBSIs, and the difference was statistically significant ( RR = 0.58, 95% CI 0.43-0.79, P<0.01). Disposable disinfection cap could reduce the incidence of CRBSIs in adults, but there was no significant difference in the incidence of CRBSIs in children ( P>0.05). It could reduce the incidence of CRBSIs in patients with indwelling vascular catheters in ICU ( RR = 0.58, 95% CI 0.38-0.89, P<0.05), but there was no statistical difference in the incidence of CRBSIs in patients without indwelling vascular catheters in ICU ( P>0.05). In addition, the compliance of the use of disinfection caps by nursing staff was improved by 80% - 90% and the treatment cost was saved by about 282 - 464 dollars. Conclusions:Disposable disinfection caps can reduce the occurrence of CRBSIs, improve the disinfection compliance of nursing staff, and save the hospitalization cost of patients. It is suggested to be popularized in clinical practice.

A study of continuous subcutaneous insulin infusion in children with type 1 diabetes mellitus / 国际儿科学杂志

Objective:To study the effect of continuous subcutaneous insulin infusion(CSII)on the emotional disorder of children and adolescents with type 1 diabetes mellitus(T1DM)and their parents.Methods:A total of 72 children and adolescents with T1DM were divided into CSII group( n=40)and multiple daily injection(MDI)group( n=32).There were 58 healthy children and adolescents with their parents selected as control group.The emotional condition of children and adolescents in T1DM group and control group was evaluated by Depression Self-rating Scale for Children(DSRS)and the Screen for Child Anxiety Related Emotional Disorders(SCARED)respectively, and Symptom Checklist-90(SCL-90)was used for evaluating the mental health of all parents. Results:The average glycated hemoglobin A1c(HbA1c)of T1DM group was at the optimal level(7.406±1.294)%.The average HbA1c of CSII group was significantly lower than that of MDI group[(7.040±1.082)% vs(7.863±1.404)%, t=2.728, P=0.008].The depression rate of children and adolescents in T1DM group increased significantly than that of control group(31.9% vs 15.5%, χ2 =4.671, P=0.031).There were statistically significant differences among CSII group, MDI group and control group(20.0% vs 46.9% vs 15.5%, χ2 =11.591, P=0.003).The depression rate of children and adolescents in MDI group increased significantly than that of CSII group and control group(all P<0.05).CSII group showed similar results as compared with control group( P>0.05).Concerning the anxiety in children and adolescents, there was no significant difference between T1DM group and control group(19.4% vs 13.8%, χ2=0.730, P=0.393), and there were no significant differences among CSII group, MDI group and control group(15.0% vs 25.0% vs 13.8%, χ2=1.994, P=0.369).The emotional disorder prevalence of parents in T1DM group was remarkably higher than that of the control group(31.9% vs 5.2%, χ2=52.927, P<0.01).The factor scores of obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, paranoia and psychotic symptoms in T1DM group were higher than that of control group( P<0.05).There were statistically significant differences among CSII group, MDI group and control group(17.5% vs 50.0% vs 5.2%, χ2=26.126, P<0.01).The emotional disorder prevalence of parents in MDI group increased significantly than that of CSII group and control group(all P<0.05).But CSII group was same as that of control group( P>0.05). Conclusion:The children and adolescents with T1DM and their parents were high-risk population of emotional disorder.CSII can reduce not only the depression in the children and adolescents with T1DM, but also emotional disorder of their parents, thus CSII can improve the mental health in families suffering from T1DM.

Comparison of clinical efficacy of intravitreal injection of Conbercept and Aflibercept in the treatment of wet age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the clinical efficacy of conbercept and aflibercept in the treatment of wet age-related macular degeneration(wARMD)based on 4 consecutive intravitreal injections.METHODS: The clinical data of 108 patients(108 eyes)who were diagnosed as wARMD and treated with intravitreal injection at our hospital from January 2019 to January 2021 were retrospectively analyzed. They were divided into conbercept group(54 cases, 54 eyes)and aflibercept group(54 cases, 54 eyes)according to the different injectable drugs. All patients received intravitreal injection once a month, with four consecutive injections. Follow up for 12mo to observe best corrected visual acuity(BCVA), central macular thickness(CMT), complications and recurrence before and after injection.RESULTS: BCVA and CMT of patients in the two groups at 1, 2, 5 and 8mo after injection had no between-group differences(P&#x0026;#x003E;0.05), but both were significantly improved compared with those before injection(P&#x0026;#x003C;0.05). By the end of follow-up, conjunctival hemorrhage occurred in 2 eyes of the conbercept group at the early stage, and increased intraocular pressure and conjunctival hemorrhage occurred respectively in 2 eyes of the aflibercept group. There were no serious complications related to drug injection such as retinal detachment, complicated cataract, endophthalmitis and retinal pigment epithelial tear in the two groups, and there was no difference in the recurrence rate between the two groups(7% vs. 6%, P=1.000).CONCLUSION: On the basis of continuous 4 times of intravitreal injection, both conbercept and aflibercept are safe and effective in the treatment of wARMD, and the efficacy is even.

Literature analysis of compatible stability of commonly used intravenous drugs in ICU / 中国药房

OBJECTIVE To analyze the compatible stability of commonly used intravenous drugs in the intensive care units （ICU）， and to provide a reference for improving medication safety in clinic. METHODS The commonly used intravenous drugs in the ICU of Hebei General Hospital were investigated and confirmed in April 1-30， 2022， and used as keywords to retrieve the relevant literature about compatible stability from PubMed， CNKI， Wanfang Data and other databases， and manually filtered with Micromedex database at the same time. Then， the compatible stability results of the included literature were analyzed descriptively. RESULTS Totally 32 commonly used intravenous drugs and 39 mixed infusion combinations were collected from ICU of this hospital. A total of 40 studies were included， only 2 studies followed all quality requirements； 18 studies validated their methods to guarantee correct reproducibility； 33 studies evaluated physical stability， including precipitate formation and pH changes； 32 studies evaluated chemical compatibility， mainly content/concentration changes. A total of 666 possible two-drug combinations were obtained from the included literature， of which 254 combinations of stability data were available， including 176 were stable， 68 were unstable， and 10 were contradictory. Totally 412 combinations had no stability results. Among two-drug combinations in ICU of this hospital， 42 combinations were stable， 14 combinations were unstable， and 2 combinations were contradictory. CONCLUSIONS The pH， solvent， excipients and preparation concentration are the factors that affect the stability. There are drug combinations with unstable compatibility of commonly used intravenous drugs in ICU of this hospital. The stability study methods are limited， and the stability data cannot meet the actual clinical needs.

Atribuição do enfermeiro no processo de hemotransfusao: uma revisão integrativa dos últimos 4 anos / Attribution of the nurse in the blood transfusion process: an integrative review of the last 4 years / Atribución de la enfermera en el proceso de transfusión sanguínea: una revisión integradora de los últimos 4 años

A transfusão de sangue é considerada uma tecnologia de grande importância na terapia moderna. Quando usada corretamente, pode salvar vidas e melhorar o quadro clínico dos pacientes. Todavia, esse procedimento pode apresentar riscos tanto aguda quanto tardia. Para tanto, o conhecimento da enfermagem é de grande relevância a fim de evitar complicações e fornecer um procedimento assertivo ao paciente. Objetivo: Demonstrar, a partir de uma revisão integrativa dos últimos quatro anos, a atribuição do enfermeiro no processo de hemotransfusão, descrevendo seu papel desde o acolhimento até a infusão dos hemoderivados. Métodos: Trata-se de uma revisão integrativa da literatura. Resultados e discussão: Para a seleção, 10 artigos científicos foram inclusos na revisão. As análises em nível de grupo mostraram que é de suma importância do conhecimento técnico e científico para a segurança do paciente. Considerações finais: O processo de hemotransfusão é de responsabilidade da enfermagem, incluindo cuidados minuciosos e atenção clínica por parte do enfermeiro, devendo ser amplamente divulgado e discutido para garantir atualização de conhecimento entre os profissionais que atuam em hemoterapia, para que possam realizar as práticas com segurança e prevenir a ocorrência de eventos adversos.

Blood transfusion is considered a technology of great importance in modern therapy. When used correctly, it can save lives and improve the condition of patients. However, this procedure may present both acute and late requirements. Therefore, nursing knowledge is of great encouragement in order to avoid complications and provide an assertive procedure to the patient. Objective: To demonstrate, based on an integrative review of the last four years, the attribution of nurses in the blood transfusion process, describing their role from reception to the infusion of blood products. Methods: This is an integrative literature review. Results and discussion: For the selection, 10 scientific articles were included in the review. The group-level analyzes appreciated that technical and scientific knowledge is of paramount importance for patient safety. Final considerations: The blood transfusion process is the responsibility of nursing, including meticulous care and clinical attention by the nurse, and should be widely publicized and discussed to ensure updating of knowledge among professionals who perform hemotherapy, so that they can carry out the practices safely and preventing the occurrence of adverse events.

La transfusión de sangre se considera una tecnología de gran importancia en la terapia moderna. Cuando se utiliza correctamente, puede salvar vidas y mejorar el estado de los pacientes. Sin embargo, este procedimiento puede presentar requisitos agudos y tardíos. Por lo tanto, los conocimientos de enfermería son de gran estímulo para evitar complicaciones y proporcionar un procedimiento asertivo al paciente. Objetivo: Demostrar, a partir de una revisión integradora de los últimos cuatro años, la atribución de enfermería en el proceso de transfusión sanguínea, describiendo su papel desde la recepción hasta la infusión de hemoderivados. Métodos: Se trata de una revisión bibliográfica integradora. Resultados y discusión: Para la selección se incluyeron en la revisión 10 artículos científicos. Los análisis a nivel de grupo apreciaron que el conocimiento técnico y científico es de suma importancia para la seguridad del paciente. Consideraciones finales: El proceso de transfusión sanguínea es responsabilidad de enfermería, incluyendo el cuidado meticuloso y la atención clínica por parte de la enfermera, y debe ser ampliamente divulgado y discutido para garantizar la actualización de conocimientos entre los profesionales que realizan hemoterapia, para que puedan llevar a cabo las prácticas con seguridad y previniendo la ocurrencia de eventos adversos. PALABRAS CLAVE: Hemoterapia; Transfusión Sanguínea; Infusión de Hemoderivados; Cuidados de Enfermería; Asignación de Enfermería.

Maternal-fetal outcomes of pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion or multiple daily injections during pregnancy - A Brazilian health care referral center cohort study

ABSTRACT Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 vs. 75.4%, p = 0.017], but there was no significant difference in the frequency of other complications, such as miscarriage, premature delivery and preeclampsia. The mean birth weight and occurrence of neonatal complications were also similar, except for the proportion of congenital malformations, which was significantly lower in the CSII group [2.9 vs. 15.6%, p = 0.048]. In regression analysis, the association of CSII with cesarean section and malformations lost significance after adjusting for HbA1c and other covariates of interest. Conclusion: In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control.

Construction and application of total quality management system in pharmacy intravenous admixture service / 中国药房

OBJECTIVE To establish a total quality management system for pharmacy intravenous admixture services （PIVAS）， in order to promote the standardization， accuracy and rationalization of clinical intravenous infusion. METHODS Based on information system in PIVAS， the management system and quality monitoring items of the whole process before， during and after PIVAS infusion preparation were formulated. The quality control and quality improvement were carried out regularly with quality management tools and methods such as PDCA （plan， do， check， process） cycle， quality control circle， and root cause analysis. The main quality control indexes of PIVAS were retrospectively analyzed before （in 2019） and after PDCA cycle management （in 2020 and 2021）. RESULTS The indexes of quality monitoring in the whole process of PIVAS infusion preparation， such as the score of drug quality management， the drug residue qualification rate and the qualified rate of drug content in infusion， were increased from 92 points， 79%， 86.4% in 2019 to 99 points， 92%， 99.8% in 2021， respectively. The indexes of safe and rational drug use， such as the ratio of intravenous irrational medical orders， the rate of drug repercussion， the rate of antibiotics use， and the rate of TCM injection use decreased from 0.98%， 6.1%， 40.55%， 39.70% to 0.23%， 3.2%， 37.18%， 26.00%， respectively. CONCLUSIONS The established total quality management system for PIVAS can improve the quality management level in the infusion preparation process， improve the quality of infusion preparation and promote clinical safe and rational drug use.

Exploration of “six-step”management mode to reduce the utilization rate of intravenous infusion in inpatients / 中国药房

OBJECTIVE To explore and establish a long-term mechanism for rational control of intravenous fluids in hospitals. METHODS On the basis of the establishment of rules and regulations， through the exploration and implementation of the core technical strategy of “six-step method”， a new mode of intravenous infusion control was established. The contents of the “six-step method” were as follows： the first step was to sort out the diseases that did not require intravenous infusion； the second step was to sort out the alternative drugs/dosage forms； the third step was to sort out the alternative routes of infusion； the fourth step was to develop drug specifications； the fifth step was to explore the personalized medication needs of clinical departments； the sixth step was to develop a department-specific integrated infusion regimen. The utilization rate of intravenous fluids in inpatients and the average daily amount of intravenous fluids per bed in inpatients were used as the main indicators to evaluate the control effect. RESULTS The comparison of the average values of three months before and after the implementation of the “six-step” management mode in the department of thoracic surgery of our hospital showed that after management and control， the average utilization rate of intravenous fluids in inpatients decreased by 1.74%， the average daily use of intravenous fluids in inpatients per bed decreased by 0.30 bags/bottle， and the per capita use of infusion drugs under key control gradually decreased. CONCLUSIONS The “six-step” management mode can reduce the utilization rate of intravenous fluids in inpatients， and this management mode is practical and feasible.

Efficacy and safety of continuous pump versus intermittent infusion of amphotericin B in the treatment of invasive fungal infection：a meta-analysis / 中国药房

OBJECTIVE To compare efficacy and safety of continuous pump versus intermittent infusion of amphotericin B in the treatment of invasive fungal infection， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， the Cochrane Library， Web of Science， Embase， Wanfang， CNKI， CBM and VIP database， randomized controlled trial （RCT） and cohort study about 24 h continuous pump （trial group） versus intermittent infusion （control group） of amphotericin B were collected from the inception to Jan. 2023. After literature screening and data extraction， the quality of RCT was evaluated with modified Jadad scale， and the quality of cohort study was evaluated with Newcastle-Ottawa scale. Meta-analysis and sensitivity analysis were performed by using RevMan 5.4 software. RESULTS A total of 7 literature were included， involving 1 RCT and 6 cohort studies with a total of 767 patients. The results of meta-analysis showed that the clinical effective rate [RR＝1.44， 95%CI （1.13，1.83）， P＝0.003] of trial group was significantly higher than that of control group， and all-cause mortality rate [RR＝0.37， 95%CI（0.19，0.72），P＝0.003] and the incidence rate of infusion reaction [RR＝0.28，95%CI（0.18，0.43）， P＜0.000 01] were significantly lower than control group； there was no statistical significance in the incidence rate of renal impairment between 2 groups [RR＝0.71，95%CI（0.45，1.11），P＝0.13] . The sensitivity analysis results showed that the results obtained in this study were robust. CONCLUSIONS The efficacy and safety of 24 h continuous pump of amphotericin B are better than those of intermittent infusion in the treatment of invasive fungal infection.

Advances in Hormone Replacement Therapy for Adult Adrenal Insufficiency / 罕见病研究

Adrenal insufficiency is a disease characterized by insufficient secretion of adrenocortical hormones, usually treated with glucocorticoid replacement therapy. The routine drugs have two forms-short-acting and long-acting. The shorter one should be taken 2-3 times a day resulting hormone level of patients fluctuating greatly within a day. Although long-acting drugs reduce the frequency of administration, it is easy to lead to excessive replacement, resulting in adverse effects on metabolism. New alternative treatments for adult patients have emerged, including modified-release hydrocortisone and hydrocortisone subcutaneous infusion pumps. In this review, we briefly introduce these new therapies, emphasizing the pharmacodynamics and pharmacokinetics of the replacement, the effects on metabolism and drug safety, aiming at contributing to the future clinical practice.

Animalexperiment on regulating effect of stored red blood cells transfusion on BMDMs in inflammatory conditions / 中国输血杂志

【Objective】 To discuss the regulating effect of stored red blood cells (RBCs) transfusion on BMDMs in inflammatory conditions, and the relationship between stored RBCs transfusion and inflammatory response induced by bacterial infection. 【Methods】 Forty C57BL/6 male mice of 6-8 weeks (18-22 g/mouse) were randomly divided into experimental group and control group. Each mouse was infected with 200 µL Pseudomonas aeruginosa injecting into the tail vein, and 400 µL fresh (storage >14 d) and stored RBCs (storage 0.05). F4/80 of experimental group and control group 2, 4 and 8 hours after RBCs infused were 1.83±0.11 vs 0.75±0.06, 0.46±0.06 vs 0.33±0.06 (P0.05), respectively. iNOS, TNF-α, MCP1 of M1 in liver of experimental group and control group 2, 4 and 8 hours after RBCs infused were respectively: iNOS 3.44±0.20 vs 2.46±0.08, 9.25±0.55 vs 2.67±0.12, 2.80±0.08 vs 2.39 ±0.01; TNF-α 1.69±0.22 vs 1.13±0.03, 1.44±0.24 vs 0.96±0.09, 1.31±0.05 vs 0.96±0.06; MCP1 4.96±0.08 vs 4.28±0.27, 4.63±0.04 vs 2.07±0.09, 2.28±0.19 vs 1.33±0.03 (P0.05). 【Conclusion】 Stored RBCs infusion can greatly promote the M1 polarization of BMDMs in liver.

Study on infusion misdirection syndrome during phacoemulsification cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Infusion misdirection syndrome(IMS)is a rare and troublesome intraoperative complication during phacoemulsification cataract surgery, which usually occurs in hydrodissection, phacoemulsification or irrigation/aspiration(I/A). Under the factors of lax zonular fibers, lens dislocation, posterior capsular rupture, the anterior segment crowding, high perfusion pressure, the infusion fluid accumulates in the vitreous cavity or behind the vitreous, leading to intraocular hypertension, shallowness or even disappearance of the anterior chamber and eventually causing the suspension of surgery. It needs to be differentiated from suprachoroidal hemorrhage(SCH), capsular block syndrome(CBS), etc. After intraoperative emergency treatments, such as rest combined with intravenous drip of mannitol, pars plana needle aspiration or vitrectomy, a favorable prognosis can be obtained. This review discusses the pathogenesis, diagnosis, emergency management, prevention and prognosis of IMS during phacoemulsification cataract surgery, with the aim of providing clinical guidance for ophthalmologists.

Safety and efficacy analysis of hepatic artery infusion chemotherapy combined with immune targeted therapy for single CNLC Ⅰb hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To investigate the safety and efficacy of FOLFOX (5-fluorouracil + calcium folinate + oxaliplatin) hepatic arterial infusion chemotherapy (FOLFOX-HAIC) combined with immune and targeted therapy as triple combination therapy for patients with single China Liver Cancer Staging (CNLC) Ⅰb hepatocellular carcinoma.Methods:A total of 20 patients with single CNLC Ⅰb hepatocellular carcinoma who received FOLFOX-HAIC combined with immune and targeted therapy as triple combination therapy in the First Affiliated Hospital of Guangxi Medical University from October 2021 to August 2022 were included. The clinical data of all patients was retrospectively analyzed. There were 18 males and 2 females, with the age of (55.1±9.9) years. Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and Modified Response Evaluation Criteria in Solid Tumors (mRECIST) were used to evaluate the efficacy of FOLFOX-HAIC combined with immune and targeted therapy, and the clinical safety of triple combination therapy was evaluated by common terminology criteria for adverse events 4.0.Results:According to RECIST 1.1, objective response rate of 20 patients was 70.0% (14/20) and disease control rate was 100.0% (20/20) after 2 cycles of treatment (one cycle of FOLFOX-HAIC plus programmed death-1 antibody). According to mRECIST, objective response rate was 90.0% (18/20) and the disease control rate was 100.0% (20/20) after 2 cycles of treatment. Following the treatment, 12 patients (60.0%) received liver tumor resection, and all of them achieved R 0 resection, 2 patients (10.0%) received radiotherapy, 3 patients (15.0%) stopped drug treatment for surgery, 2 patients (10.0%) refused surgery, and 1 patient (5.0%) died of multiple organ failure caused by immune hepatitis. According to pathological results, 3 patients (25.0%, 3/12) achieved pathological complete response, and 4 patients (33.3%, 4/12) achieved major pathological response. In the safety evaluation, the overall incidence of adverse events was 100.0% (20/20). Seven patients (35.0%) had grade 3 adverse events and 1 patient (5.0%) died of multiple organ failure due to immune hepatitis (grade 5). Grade 1-3 adverse events could be relieved after symptomatic treatment. Conclusion:The triple combination therapy of FOLFOX-HAIC combined with immune and targeted therapy is safe and has high objective response rate and disease control rate, which could be a new strategy for the neoadjuvant treatment of hepatocellular carcinoma.

Analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids / 中国基层医药

Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.