目的:探讨达比加群酯相关肾损伤的临床特点及其防治,为安全用药提供参考。方法:检索PubMed、Ovid、Web of Science、Embase、Springer-link、Wiley Oline Library、CNKI、万方数据库和维普数据库,收集达比加群酯相关肾损伤的文献,检索...目的:探讨达比加群酯相关肾损伤的临床特点及其防治,为安全用药提供参考。方法:检索PubMed、Ovid、Web of Science、Embase、Springer-link、Wiley Oline Library、CNKI、万方数据库和维普数据库,收集达比加群酯相关肾损伤的文献,检索时限均为建库截至2019年1月,提取相关数据进行分析。结果:初筛相关文献156篇,最终纳入符合标准的文献14篇,均来自国外期刊。14篇文献包括达比加群酯相关肾损伤患者14例,其中男9例,女5例;年龄59~89岁,中位年龄为80岁;临床表现主要为出血,其中以血尿为主;在达比加群酯相关肾损伤治疗后,4例肾功能恢复,4例肾功能改善,3例肾功能未恢复,3例肾功能恶化。结论:达比加群酯可能导致肾损伤,在肾损伤相关疾病的基础上也可能导致达比加群酯毒性增加,在出现危及生命的出血的紧急情况下血液透析不一定能达到很好疗效,可使用达比加群酯逆转剂——依达赛珠单抗(idarucizumab)解毒。临床在使用时,应权衡药物使用的利弊,以及时应对不良反应的防治、发生及处理。展开更多
Background Colonic polyps are frequently encountered in clinics. Computed tomographic colonography （CTC）, as a painless and quick detection, has high values in clinics. In this study, we evaluated the application va...Background Colonic polyps are frequently encountered in clinics. Computed tomographic colonography （CTC）, as a painless and quick detection, has high values in clinics. In this study, we evaluated the application value of computer-aided detection （CAD） in CTC detection of colonic polyps in the Chinese population.Methods CTC was performed with a GE 64-row multidetector computed tomography （MDCT） scanner. Data of 50 CTC patients （39 patients positive for at least one polyp of ≥0.5 cm in size and the other 11 patients negative by endoscopic detection） were retrospectively reviewed first without computer-aided detection （CAD） and then with CAD by four radiologists （two were experienced and another two inexperienced） blinded to colonoscopy findings. The sensitivity,specificity, positive predictive value, negative predictive value, and accuracy of detected colonic polyps, as well as the areas under the ROC curves （Az value） with and without CAD were calculated.Results CAD increased the overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the colonic polyps detected by experienced and inexperienced readers. The sensitivity in detecting small polyps （5-9 mm） with CAD in experienced and inexperienced readers increased from 82% and 44% to 93% and 82%,respectively （P 〉0.05 and P 〈0.001）. With the use of CAD, the overall false positive rate and false negative rate for the detection of polyps by experienced and inexperienced readers decreased in different degrees. Among 13 sessile polyps not detected by CAD, two were 〉1.0 cm, eleven were 5-9 mm in diameter, and nine were fiat-shaped lesions.Conclusions The application of CAD in combination with CTC can increase the ability to detect colonic polyps,particularly for inexperienced readers. However, CAD is of limited value for the detection of flat polyps.展开更多
文摘目的:探讨达比加群酯相关肾损伤的临床特点及其防治,为安全用药提供参考。方法:检索PubMed、Ovid、Web of Science、Embase、Springer-link、Wiley Oline Library、CNKI、万方数据库和维普数据库,收集达比加群酯相关肾损伤的文献,检索时限均为建库截至2019年1月,提取相关数据进行分析。结果:初筛相关文献156篇,最终纳入符合标准的文献14篇,均来自国外期刊。14篇文献包括达比加群酯相关肾损伤患者14例,其中男9例,女5例;年龄59~89岁,中位年龄为80岁;临床表现主要为出血,其中以血尿为主;在达比加群酯相关肾损伤治疗后,4例肾功能恢复,4例肾功能改善,3例肾功能未恢复,3例肾功能恶化。结论:达比加群酯可能导致肾损伤,在肾损伤相关疾病的基础上也可能导致达比加群酯毒性增加,在出现危及生命的出血的紧急情况下血液透析不一定能达到很好疗效,可使用达比加群酯逆转剂——依达赛珠单抗(idarucizumab)解毒。临床在使用时,应权衡药物使用的利弊,以及时应对不良反应的防治、发生及处理。
文摘Background Colonic polyps are frequently encountered in clinics. Computed tomographic colonography （CTC）, as a painless and quick detection, has high values in clinics. In this study, we evaluated the application value of computer-aided detection （CAD） in CTC detection of colonic polyps in the Chinese population.Methods CTC was performed with a GE 64-row multidetector computed tomography （MDCT） scanner. Data of 50 CTC patients （39 patients positive for at least one polyp of ≥0.5 cm in size and the other 11 patients negative by endoscopic detection） were retrospectively reviewed first without computer-aided detection （CAD） and then with CAD by four radiologists （two were experienced and another two inexperienced） blinded to colonoscopy findings. The sensitivity,specificity, positive predictive value, negative predictive value, and accuracy of detected colonic polyps, as well as the areas under the ROC curves （Az value） with and without CAD were calculated.Results CAD increased the overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the colonic polyps detected by experienced and inexperienced readers. The sensitivity in detecting small polyps （5-9 mm） with CAD in experienced and inexperienced readers increased from 82% and 44% to 93% and 82%,respectively （P 〉0.05 and P 〈0.001）. With the use of CAD, the overall false positive rate and false negative rate for the detection of polyps by experienced and inexperienced readers decreased in different degrees. Among 13 sessile polyps not detected by CAD, two were 〉1.0 cm, eleven were 5-9 mm in diameter, and nine were fiat-shaped lesions.Conclusions The application of CAD in combination with CTC can increase the ability to detect colonic polyps,particularly for inexperienced readers. However, CAD is of limited value for the detection of flat polyps.
