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Objective To establish the drug use evaluation ( DUE) of Dolasetron, evaluate the rationality of the clinical use of Dolasetron and provide a reference for the rationally clinical use of Dolasetron．Methods On the basis of Dolasetron DUE criteria, a retrospective analysis was made in 794 hospitalized patients from January 2021 to June 2021. Results The drug use evaluation criterion on Dolasetron consisted of drug indications, drug use process, the result of drug use and indication management. Conclusion There are some inappropriate medication problems in Dolasetron utilization in the hospital. The DUE criterion is very practical which could be used to standardize the clinical utilization of Dolasetron.
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Objective:To investigate the relationship between pre-delivery glycated hemoglobin A1c (HbA1c) level and pregnancy outcome in patients with gestational diabetes mellitus (GDM).Methods:A total of 200 GDM patients who received treatment in Zhuji Maternal and Child Health Hospital, China between April 2018 and April 2020 were included in this study. All patients were subjected to health education, medical nutrition therapy, exercise intervention and necessary drug treatment. These patients were divided into GDM-1 (HbA1c > 7.0%, n = 30), GDM-2 (HbA1c 5.5%-7.0%, n = 30) and GDM-3 (HbA1c < 5.5%, n = 106) groups according to HbA1c levels within pre-delivery 1-3 days. An additional 400 healthy pregnant women who concurrently received health examination were included in the healthy control group (NC group). HbA1c level was compared between GDM patients and healthy controls. Pregnancy outcome was compared among patients with different HbA1c levels. Results:The incidences of pregnancy-induced hypertension, pathologic excess of amniotic fluid volume, cesarean section, asphyxia, neonatal hyperbilirubinemia, neonatal hypoglycemia, giant infant and premature delivery were significantly higher than those in the NC group ( χ2 = 4.59, 8.11, 9.19, 7.42, 10.05, 11.52, 35.75, 21.12, all P < 0.05). The incidences of pregnancy-induced hypertension, pathologic excess of amniotic fluid volume, cesarean section, asphyxia, neonatal hyperbilirubinemia, neonatal hypoglycemia, giant infant and premature delivery in the GDM-1 group were 10.00% (3/30), 30.00% (9/30), 33.33% (10/30), 26.67% (8/30), 30.00% (9/30), 36.67% (11/30), 50.00% (15/30), 30.00% (9/30), respectively, and they were 4.69% (3/64), 14.06% (9/64), 28.13% (18/64), 14.06% (9/64), 18.75% (12/64), 18.75% (12/64), 39.06% (25/64), 15.63% (10/64), respectively in the GDM-2 group, and 0.94% (1/106), 6.60% (7/106), 14.15% (15/106), 9.43% (10/106), 4.72% (5/106), 4.72% (5/106), 18.87% (20/106), 9.43% (10/106), respectively in the GDM-3 group. There were significant differences in these indexes among the three groups ( χ2= 6.07, 11.91, 7.56, 5.97, 15.97, 21.59, 14.47, 8.07, all P < 0.05). Conclusion:Pre-delivery HbA1c level in GDM patients is related to pregnancy outcomes such as pregnancy-induced hypertension, pathologic excess of amniotic fluid volume, cesarean section, asphyxia, neonatal hyperbilirubinemia, neonatal hypoglycemia, giant infant and premature delivery. Strict control of blood glucose is of great significance to improve the outcomes of pregnant patients with GDM and their newborns.
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Objective@#To study the correlation of the degree of sleep apnea with arrhythmia, heart rate variability(HRV)and blood pressure variability(BPV)in elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS), and to investigate the intervention effects of home-based continuous positive airway pressure(CPAP)treatment.@*Methods@#A total of 122 elderly hypertension patients with OSAHS were recruited in the prospective study.Patients were divided into three groups according to the sleep apnea hypopnea index(apnea hypopnea index, AHI): the mild OSAHS group(5 times/h≤AHI≤15 times/h, n=42), moderate OSAHS group(15 times/h<AHI≤30 times/h, n=40)and severe OSAHS group(AHI>30 times/h, n=40). All patients took ambulatory electrocardiogram and ambulatory blood pressure examinations before and after three months of CPAP treatment.The incidences of arrhythmia, HRV and BPV indexes of each group before and after CPAP treatment were compared between the groups.@*Results@#The incidences of premature atrial contraction, atrial tachycardia and premature ventricular beats were higher in the moderate and severe OSAHS groups than in the mild OSAHS group(P<0.01). Compared with the mild OSAHS group, the RR interval standard deviation(SDNN), root mean square of successive differences(rMSSD), proportion of patients with consecutive RR-interval differences greater than 50 ms(PNN5), standard deviation of the averaged normal RR intervals for all 5 min segments and deceleration capacity of rate increased in the moderate and severe OSAHS groups(P<0.05), and the increases were more obvious in the severe group.Compared with the mild OSAHS group, the standard deviation of 24-h systolic blood pressure, standard deviation of 24-h diastolic blood pressure, standard deviation of daytime systolic blood pressure, standard deviation of nighttime systolic blood pressure and incidence of non-dipper hypertension increased in the moderate and severe OSAHS groups(P<0.05), with the increases were more obvious in the severe group, and the differences was significant between the moderate and severe OSAHS groups(P<0.05). HRV and BPV indicators improved except for high frequency(HF)/low frequency(LF)in all groups(P<0.05)after home treatment of CPAP, and the improvement was more obvious in the severe group.The incidence of non-dipper circadian rhythm of blood pressure improved more significantly in the severe OSAHS group than in the moderate OSAHS group.@*Conclusions@#With aggravated sleep apnea, the incidences of arrhythmias such as premature atrial contraction, atrial tachycardia, and premature ventricular contraction are increased and the HRV and BPV are enlarged in elderly hypertension patients complicated with OSAHS.The home treatment of CPAP can improve the above indicators, and it is an effective way to treat OSAHS complicated by hypertension in elderly patients.
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Objective To study the correlation of the degree of sleep apnea with arrhythmia,heart rate variability(HRV) and blood pressure variability(BPV)in elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and to investigate the intervention effects of home-based continuous positive airway pressure(CPAP)treatment.Methods A total of 122 elderly hypertension patients with OSAHS were recruited in the prospective study.Patients were divided into three groups according to the sleep apnea hypopnea index(apnea hypopnea index,AHI):the mild OSAHS group(5 times/h≤AHI≤15 times/h,n=42),moderate OSAHS group(15 times/h＜ AHI≤30 times/h,n=40) and severe OSAHS group (AHI＞30times/h,n=40).All patients took ambulatory electrocardiogram and ambulatory blood pressure examinations before and after three months of CPAP treatment.The incidences of arrhythmia,HRV and BPV indexes of each group before and after CPAP treatment were compared between the groups.Results The incidences of premature atrial contraction,atrial tachycardia and premature ventricular beats were higher in the moderate and severe OSAHS groups than in the mild OSAHS group(P＜0.01).Compared with the mild OSAHS group,the RR interval standard deviation(SDNN),root mean square of successive differences (rMSSD),proportion of patients with consecutive RR-interval differences greater than 50 ms (PNN5),standard deviation of the averaged normal RR intervals for all 5 min segments and deceleration capacity of rate increased in the moderate and severe OSAHS groups(P＜0.05),and the increases were more obvious in the severe group.Compared with the mild OSAHS group,the standard deviation of 24-h systolic blood pressure,standard deviation of 24-h diastolic blood pressure,standard deviation of daytime systolic blood pressure,standard deviation of nighttime systolic blood pressure and incidence of non-dipper hypertension increased in the moderate and severe OSAHS groups (P ＜ 0.05),with the increases were more obvious in the severe group,and the differences was significant between the moderate and severe OSAHS groups(P ＜0.05).HRV and BPV indicators improved except for high frequency(HF)/low frequency(LF) in all groups (P ＜ 0.05) after home treatment of CPAP,and the improvement was more obvious in the severe group.The incidence of non-dipper circadian rhythm of blood pressure improved more significantly in the severe OSAHS group than in the moderate OSAHS group.Conclusions With aggravated sleep apnea,the incidences of arrhythmias such as premature atrial contraction,atrial tachycardia,and premature ventricular contraction are increased and the HRV and BPV are enlarged in elderly hypertension patients complicated with OSAHS.The home treatment of CPAP can improve the above indicators,and it is an effective way to treat OSAHS complicated by hypertension in elderly patients.
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Bacterial liver abscess is a rare and life-threatening disease, and, clinically, its incidence has gradually increased in recent years. In terms of its treatment, percutaneous puncturing drainage combined with antibiotics has been the first-line therapeutic means, and surgical procedures are often used for patients in whom the interventional drainage is ineffective or in whom the liver abscess is complicated by abdominal disease that needs surgical management. Percutaneous catheter drainage and percutaneous fine needle aspiration, regarded as the two most commonly used interventional drainage methods, have been widely employed in the treatment of bacterial liver abscess; and percutaneous catheter drainage is more commonly adopted in clinical practice. Although the prognosis of bacterial liver abscess has been improved significantly, there is still a certain fatality rate. There is still no a well-accepted consensus on treatment guidelines. Moreover, there are still many controversies over the indications of percutaneous puncturing drainage. Based on a comprehensive review of the domestic and foreign literature, this paper aims to make a detailed introduction concerning percutaneous puncturing drainage for the treatment of bacterial liver abscess, focusing on its development history, curative effect and prognosis, and, in order to guide the clinical practice, the principles of the use of antibiotics, the comparison of clinical effect with surgery and the therapeutic indications will be also discussed.
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OBJECTIVE:To improve rational drug use and reduce potentially inappropriate medication (PIM). METHODS:PIM of 700 elderly inpatients in internal medicine department of our hospital was evaluated by Beers criteria(2012 edition)and STOPP/START criteria. RESULTS:700 inpatients whose mean ages were (76.3 ± 7.2) years old took (12.1 ± 4.9) kinds of drugs per patient. 144 cases involved PIM(20.6%). The number of PIM was 220 in total,among which there were 117 cases/times relat-ed to drugs and 22 cases/times related to disease in according to Beers criteria,9 cases/times of STOPP and 72 cases/times of START. Drug with most frequency of PIM in accordance with Beers was benzodiazepines and most frequency in STOPP was thia-zides that used by patients with gout histonry. The most omission frequency of START prescription were absence of metformin thera-py for type 2 diabetes and absence of antiplatelet therapy for diabetes complicated with cardiovascular risk. CONCLUSIONS:A high prevalence of PIM in elderly inpatients in our hospital requires various measures to prevent its occurrence.
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Objective: To explore the anti-proliferation and apoptosis-inducing effects of decitabine combined with paclitaxel on paclitaxel-resistant MCF-7 cells. Methods:Cell counting kit-8 (CCK-8) assays were used to determine the proliferation inhibition of drugs at different concentrations in 24, 48 and 72h. The group was treated with decitabine, paclitaxel and the combination of the two drugs, respectively. The cell apoptosis rate was determined by flow cytometry after the treatment with the drugs at different concentra-tions in 48h. Results:The results of CCK-8 showed the combination group significantly inhibited the cell proliferation when compared with the single drug use group(P<0. 05), and the anti-proliferation value was in a dose-dependent manner in all groups. The apopto-sis values after the treatment with decitabine, paclitaxel and the combination in 48h was(20. 4 ± 1. 98)%,(21. 8 ± 3. 34)% and(70. 8 ± 8. 23)%,respectively. Conclusion:The proliferation inhibition and apoptosis induction are both increased significantly in the com-bination group. Synergistic effect of decitabine and paclitaxel is found in multidrug resistant breast cancer cell line MCF-7 in vitro.
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Objective To summarize the clinical medicine treatment in elderly patients with renal dysfunction,in order to discover the existing problems and analyze the reasons.Methods One hundred and eighty cases of senile patients with renal insufficiency were randomly selected in the second half of 2012 to analyze medication states based on the medication standard.Results Medical advices prescribed by doctors showed that 7.5 ％ of drugs were forbidden used in patients with severe renal insufficiency,and 34.1％ of drugs should be used with caution or reduction requirements.Each department and system had irrational drug using.Conclusions There are a large problem in the clinical medication in patients with renal insufficiency,and a reasonable medication standard needs to be established to find out potential irrational drug using so as to reduce the possibility of adverse reactions.
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Objective To investigate the risk factors affecting prognosis in elderly patients with septic shock and explore the effective treatment. Methods A retrospective study of 147 patients with septic shock from the Affiliated Hospital of Hebei United University and Affiliated People's Hospital from Jan. 2011to Jan. 2013 was conducted. Early fluid loading was defined as the administration with an initial fluid bolus within 6 h in ICU. Conservative fluid management was defined as negative fluid balance measured in at least 1 d during the first 3 d as the case group,while the daily fluid balance and cumulative daily fluid balance of the first 3 d was as the control group. The effects of early fluid management on prognosis of elderly patients septic with shock combining the living index within 7 d in ICU were recorded. Results In the case group with 7 d ICU,21. 4%(15 / 70)patients were in progressed and 37. 1%(26 / 70)patients were dead,while 25. 9%(20 / 77)patients were in progressed and 59. 7%(46 / 77)patients were dead in control group(χ2 = 13. 17,P = 0. 00). Univariate analysis showed that APACHEⅡ scores,SIRS score,organ failure,patients with chronic diseases related were associated with 7 d survival rate in elderly patients with septic shock. Multivariate Logistic regression analysis showed that higher APACHEⅡ scores and SIRS score,organ failure,patients with chronic diseases related (have)were the risk factors(OR = 1. 88,5. 34,1. 96 and 4. 76;P < 0. 05). The restrictive fluid management strategy have related with the septic shock patients in elderly that the OR of death rate of fluid management in elderly patients with septic shock was 0. 657(P = 0. 032). Conclusion The prognosis in elderly patients septic with shock is associated with APACHE Ⅱ scores,SIRS score,organ failure,patients with chronic diseases related. Early fluid management can improve to the prognosis of elderly patients with septic shock.
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Objective To investigate the relationship between expression of Her-2 gene and the transfer number of axillary lymph node and its influence on prognosis.Methods A total of 351 cases with primary breast cancer from January 2008 to January 2011 were selected.The expression of Her-2 gene was detected by immunohistochemical method,and analyzed the relationship between it and the transfer number of axillary lymph node and its influence on prognosis.Results The expression of Her-2-,+,++ had no correlation with the transfer number of axillary lymph node (x2 =3.757,1.650,2.379,P ＞ 0.05),while the expression of Her-2 +++ had correlation with the transfer number of axillary lymph node (x2 =8.681,P ＜ 0.05).The 2 years survival rates in the expression of Her-2-,+,++,+++ were 77.01％ (201/261),85.00％ (34/40),29.17％(7/24),1 1.54％ (3/26),and which in the expression of Her-2--+ was significantly higher than that in the expression of Her-2 ++-+++ (x2 =61.605,P ＜ 0.01).The transfer number of axillary lymph node was 0 and 1-3,the 2 years survival rate in the expression of Her-2--+ was significantly higher than that in the expression of Her-2 ++-+++,and there was significant difference (x2 =61.605,14.747,P ＜ 0.05).The transfer number of axillary lymph node was 4-9 and ≥ 10,there was no significant difference in the 2 years survival rate between the expression of Her-2--+ and Her-2 ++-+++ (x2 =3.691,3.482,P ＞ 0.05).Conclusions The expression of Her-2-,+,++ has no correlation with axillary lymph node metastasis,and the 2 years survival rate in the expression of Her-2--+ is higher than that in the expression of Her-2 ++-+++,while Her-2-has no difference with Her-2 + in prognosis.While the transfer number of axillary lymph node ≤ 3,the expression of Her-2 gene may be an important prognostic factor.
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Objective To analyze and compare the fluorescence in situ hybridization(FISH) and immunohistochemical(IHC) for detecting HER-2 gene amplification and protein expression in breast cancer tissues .Methods 110 cases of breast cancer from Janu-ary 2008 to May 2012 receiving the modified radical mastectomy were selected .The resected breast cancer tissue was detected by FISH and IHC and the detected results were performed the comparative analysis .Results Among 110 cases of breast cancer tissue , 25 cases(22 .73% ) were the HER-2 protein expression(+ + + ) ,44 cases(40 .00% ) were(+ + ) ,26 cases(23 .64% ) were(+ ) and 15 cases(13 .64% ) were(-) .Among 110 cases ,the gene amplification was in 28 cases(25 .45% ) and no gene amplification was in 82 cases(74 .55% ) .The positive(+ + + ) of the IHC detection was coincident with that of FISH ,and the negative(+ /-) of the IHC detection was also coincident with that of FISH ,there was statistical difference between the suspicious positive of the IHC de-tection and the results of FISH (P<0 .05) .But the total coincidence of the IHC detection results and FISH test results was 89 .29%(25/28) ,and the two detection methods had the positive correlation (χ2 =84 .89 ,P<0 .01) .Conclusion The positive and negative expression of the IHC detection has better consistency with that of the FISH detection .However ,the coincidence of the IHC suspi-cious positive expression and the FISH results is poor ,indicating that the suspicious positive sample of the IHC detection needs to be detected by the FISH detection .
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Oral glucose tolerance test(OGTT)was performed in 419 first-degree relatives(FDRs)of type 1 diabetes mellitus. GADA, IA-2A, and IAA were determined by radioligand assay, and the positive rates were 7.16%, 1.43%, and 1.26%, respectively. Intravenous glucose tolerance test(IVGTT)and nateglinide-OGTT were performed in 39 controls, 11 first-degree relatives with positive autoantibody(Ab+group), 14 ones with negative autoantibody(Ab-group)during 5-7 days.The first-phase insulin release(FPIR), area under insulin release during 0-10 min [AUC0-10] of IVGTT and the value of(ΔI30/ΔG30)of nateglinide-OGTT in Ab+group were lower than those of control and(2.75±0.37 vs 3.61±1.05)mU/mmol, all P＜0.05]. The 1st min insulin release in Ab+group was lower than that of Ab-group [(3.80±0.30 vs 4.52±0.70)mU/L, P＜0.05]. The HOMA-IR was higher in Ab-group than that in control group(2.92±1.04 vs 1.96±1.22, P＜0.05). The results suggest that the positivity rates of autoantibodies in FDRs of type 1 diabetes mellitus are very close to those of Caucasian. There exist insulin secretion defects in FDRs with positive autoantibody while insulin resistance in FDRs with negative autoantibody.
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Objective To investigate PAX4 gene polymorphism and its association with islet autoantibody-negative patients with ketosis-prone diabetes in Chinese Han population. Methods We screened the variation of exon 3 and 9 within PAX4 gene by denaturing high performance liquid chromatography(DHPLC) in 112 non-diabetes control subjects (NC group) and 141 patients with ketosis-prone diabetes (KPD group), who were both negative for glutamic acid decarboxylase antibody (GAD-Ab) as well as protein tyrosine phosphatase antibody (IA-2Ab) . The sequences of abnormal peaks were analyzed by DNA-sequencing. The A1168C single nucleotide polymorphism in PAX4 gene was genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 308 non-diabetic control subjects and 141 KPD patients. Results No variation was discovered in PAX4 gene exon 3 both in the patients and in the controls. There was a single nucleotide polymorphism locus A1168C in the PAX4 gene exon 9, which induced mis-sence mutation P321H(rs712701). No significant difference was observed in the genotype and allele frequencies of A1168C polymorphism between KPD patients and control subjects (P=0.532, 0.426). The difference was detected in the CC genotype and C allele frequencies in the KPD group when patients were stratified by gender (P=0.009,0.028). According to age at diagnosis, the difference was observed in the CC genotype and C allele frequencies between <20 years old and ≥20 years old in the KPD group (P=0.034,0.032). The level of FCP in the CC genotype group was significantly higher than that of FCP in AA genotype group (P=0.005). Conclusion A1168C polymorphism in PAX4 gene may not play an essential role in the genetic susceptibility of the islet autoantibody-negative KPD in Chinese Han population. However, A1168C variation may contribute to the predisposition to the male or <20 years old patients with islet autoantibody-negative KPD.
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Objective To study the diagnostic significance of MR fat-suppression (FSEIR)in avascular necrosis of femoral head(ANFH).Methods MRI of 21 patients (12 men and 9 woman) with ANFH were reviewed . There were long-term steroid administration in 9 cases , long term alcoholic in 5 cases,fracture/dislocation of the hip in 4 cases and infection in 3 cases.General electric signa profile SYS#0.2 TMR unit and body coil were used for all examinations.Images in the axial plane and coronal plane,T_1-weighted images,T_2-weighted images and FSEIR were carried out.Results Totally 36 lesions in 21 patients,included 8 lesions of A type(fatlike),6 lesions of B type(bloodlike),10 lesions of C type(fluidike) and 12 lesions of D type(fibrouslike).On T_2WI,a rim of high signal intensity inside the low-signal margin (double line sign) was seen in 16 lesions.On FSEIR , A and D type exhibited low signal intensity , B and C type exhibited high signal intensity.Conclusion MR FSEIR is of important significance in showing the pathologic changes and guiding the clinical diagnosis and treatment of ANFH.