While the incidence of toddlers’ diabetes is soaring,their mainstay insulins were withdrawn,namely the weak 10% or 20% insulin mixtures (WIM),which were injected only once or twice daily.Consequently,toddlers are coe...While the incidence of toddlers’ diabetes is soaring,their mainstay insulins were withdrawn,namely the weak 10% or 20% insulin mixtures (WIM),which were injected only once or twice daily.Consequently,toddlers are coerced to use an insulin pump,multi-dose insulin regime (MuDIR),mix or dilute insulins.This paper highlights the difficulties and proposes a simple solution.While an insulin pump is the best available option,it is not readily available for everyone.Mixing insulins is not sufficiently precise in small doses.Although diluting insulin would allow precise dosing and reduce the dose variability secondary to dribbling after injections,it,like insulin mixing,deprives children from using the pen and related child-friendly accessories.In MuDIR,we inject 4-5 small doses of insulin instead of 1-2 daily larger doses of WIM.Thus,on using a half unit (unit) insulin pen,a dose of 0.5,1,1.5 and 2 units are adjusted in steps of 100%,50%,33% or 25%;unlike the advisable 5%-20%.This does not easily match the tiny erratic meals of grazing toddlers.Maternal anxiety peaks on watching yo-yoing glycemia.Carers have to accept either persistently high sugar or wild fluctuation.The risks of such poor glycemic pattern are increasingly recognized.Using insulin U20 in a unit disposable pen allows deci-unit dosing,with 5%-20% dose-tuning,greater accuracy on delivering small doses and reduction of dose variability from dribbling.Deci-unit dosing may help avoid wide glycemic swings and provide the affordable alternative to insulin pumps for toddlers.Deci-unit pen materializes the Human Rights of Children,a safer and effective treatment.展开更多
目的评估CYP3A4*1G多态性对行腹腔镜结肠癌根治术患者芬太尼剂量的影响。方法选取2018年7月—2020年4月复旦大学附属中山医院行芬太尼麻醉腹腔镜结肠癌根治术的患者101例,检测其CYP3A4*1G基因型。采用多重线性回归分析探讨CYP3A4*1G多...目的评估CYP3A4*1G多态性对行腹腔镜结肠癌根治术患者芬太尼剂量的影响。方法选取2018年7月—2020年4月复旦大学附属中山医院行芬太尼麻醉腹腔镜结肠癌根治术的患者101例,检测其CYP3A4*1G基因型。采用多重线性回归分析探讨CYP3A4*1G多态性与芬太尼剂量之间的关系。结果多重线性回归分析结果显示,年龄、术中芬太尼剂量和CYP3A4*1G、CYP3A5*3、OPRM1 A118G多态性是麻醉后复苏观察室(PACU)芬太尼剂量的影响因素(P<0.05)。校正年龄、性别、体重、身高、术中芬太尼用量、手术时间和OPRM1 A118G、CYP3A5*3、COMT V158M多态性后,CYP3A4*1G野生型(*1*1型)患者PACU芬太尼剂量较CYP3A4*1G突变型[*1*1G型(杂合型)和*1G*1G(纯合型)]患者增加13.99μg[β=-13.99,95%可信区间(CI)为-6.78~-1.20,P=0.035],CYP3A4*1G多态性与术后24 h镇痛泵自控静脉镇痛(PCIA)芬太尼剂量无关(β=-7.79,95%CI为-33.70~-18.11,P=0.557),与术后48 h PCIA芬太尼剂量也无关(β=-10.28,95%CI为-22.70~2.15,P=0.108)。与CYP3A4*1G野生型(*1*1型)患者比较,CYP3A4*1G突变型[*1*1G型(杂合型)和*1G*1G(纯合型)]患者PACU和术后24 h PCIA芬太尼剂量显著降低(P<0.05)。结论CYP3A4*1G多态性是PACU芬太尼剂量的独立影响因素。相对于野生型患者,突变型患者消耗较少剂量芬太尼即可获得相似的麻醉效果。展开更多
文摘While the incidence of toddlers’ diabetes is soaring,their mainstay insulins were withdrawn,namely the weak 10% or 20% insulin mixtures (WIM),which were injected only once or twice daily.Consequently,toddlers are coerced to use an insulin pump,multi-dose insulin regime (MuDIR),mix or dilute insulins.This paper highlights the difficulties and proposes a simple solution.While an insulin pump is the best available option,it is not readily available for everyone.Mixing insulins is not sufficiently precise in small doses.Although diluting insulin would allow precise dosing and reduce the dose variability secondary to dribbling after injections,it,like insulin mixing,deprives children from using the pen and related child-friendly accessories.In MuDIR,we inject 4-5 small doses of insulin instead of 1-2 daily larger doses of WIM.Thus,on using a half unit (unit) insulin pen,a dose of 0.5,1,1.5 and 2 units are adjusted in steps of 100%,50%,33% or 25%;unlike the advisable 5%-20%.This does not easily match the tiny erratic meals of grazing toddlers.Maternal anxiety peaks on watching yo-yoing glycemia.Carers have to accept either persistently high sugar or wild fluctuation.The risks of such poor glycemic pattern are increasingly recognized.Using insulin U20 in a unit disposable pen allows deci-unit dosing,with 5%-20% dose-tuning,greater accuracy on delivering small doses and reduction of dose variability from dribbling.Deci-unit dosing may help avoid wide glycemic swings and provide the affordable alternative to insulin pumps for toddlers.Deci-unit pen materializes the Human Rights of Children,a safer and effective treatment.
文摘目的评估CYP3A4*1G多态性对行腹腔镜结肠癌根治术患者芬太尼剂量的影响。方法选取2018年7月—2020年4月复旦大学附属中山医院行芬太尼麻醉腹腔镜结肠癌根治术的患者101例,检测其CYP3A4*1G基因型。采用多重线性回归分析探讨CYP3A4*1G多态性与芬太尼剂量之间的关系。结果多重线性回归分析结果显示,年龄、术中芬太尼剂量和CYP3A4*1G、CYP3A5*3、OPRM1 A118G多态性是麻醉后复苏观察室(PACU)芬太尼剂量的影响因素(P<0.05)。校正年龄、性别、体重、身高、术中芬太尼用量、手术时间和OPRM1 A118G、CYP3A5*3、COMT V158M多态性后,CYP3A4*1G野生型(*1*1型)患者PACU芬太尼剂量较CYP3A4*1G突变型[*1*1G型(杂合型)和*1G*1G(纯合型)]患者增加13.99μg[β=-13.99,95%可信区间(CI)为-6.78~-1.20,P=0.035],CYP3A4*1G多态性与术后24 h镇痛泵自控静脉镇痛(PCIA)芬太尼剂量无关(β=-7.79,95%CI为-33.70~-18.11,P=0.557),与术后48 h PCIA芬太尼剂量也无关(β=-10.28,95%CI为-22.70~2.15,P=0.108)。与CYP3A4*1G野生型(*1*1型)患者比较,CYP3A4*1G突变型[*1*1G型(杂合型)和*1G*1G(纯合型)]患者PACU和术后24 h PCIA芬太尼剂量显著降低(P<0.05)。结论CYP3A4*1G多态性是PACU芬太尼剂量的独立影响因素。相对于野生型患者,突变型患者消耗较少剂量芬太尼即可获得相似的麻醉效果。
