Low dose oral haloperidol does not prolong QTc interval in older acutely hospitalised adults： a subanalysis of a randomised double-blind placebo-controlled study

BackgroundHaloperidol 是经常规定的大多数为谵妄症状抑制精神。 QTc 延伸的风险经常提起担心，尽管 QTc 间隔上的 haloperidol 的效果还没在 randomised 被调查了一个 randomised 双窗帘的控制安慰剂的改正剂量 study.MethodsA subanalysis 控制安慰剂的学习被进行评估预防 haloperidol 的效果 1 mg 或安慰剂 1 mg 口头上地两次每日( 14 剂量的最大值)在 QTc 上，在病人的间隔变老 70 年并且在上。床边， 12 铅 ECG 被记录在前，在期间并且在一个星期干预时期以后。自动 QTc 大小除了 QT 和 RR 间隔的用手的大小被获得，为治疗使失明地位。用手的大小被改正(QTc ) 使用 Bazett (QTc-B ) ， Framingham (QTc-Fa ) ， Fridericia (QTc-Fi ) 和霍奇斯(QTc-H ) 方法。混合模型分析在在收到 haloperidol 和 72 个病人的 placebo.ResultsECG 记录的病人之间的 QTc 的纵的路线为差别习惯于测试(haloperidol n = 38 ) 被分析， 45.8% 男性。中部(范围)白天 4 上的 haloperidol 浆液集中是 0.71 ( 0.32-1.82 )溜????????????????????????????????????????????????

Cytomegalovirus in inflammatory bowel disease： Asystematic review

AIM: To identify definitions of cytomegalovirus(CMV) infection and intestinal disease, in inflammatory bowel disease(IBD), to determine the prevalence associated with these definitions.METHODS: We conducted a systematic review and interrogated Pub Med, EMBASE and Cochrane for literature on prevalence and diagnostics of CMV infection and intestinal disease in IBD patients. As medical headings we used "cytomegalovirus" OR "CMV" OR "cytomegalo virus" AND "inflammatory bowel disease" OR "IBD" OR "ulcerative colitis" OR "colitis ulcerosa" OR "Crohn's disease". Both Me SH-terms and free searches were performed. We included all types of English-language(clinical) trials concerning diagnostics and prevalence of CMV in IBD.RESULTS: The search strategy identified 924 citations, and 52 articles were eligible for inclusion. We identified 21 different definitions for CMV infection, 8 definitions for CMV intestinal disease and 3 definitions for CMV reactivation. Prevalence numbers depend on used definition, studied population and region. The highest prevalence for CMV infection was found when using positive serum PCR as a definition, whereas for CMV intestinal disease this applies to the use of tissue PCR > 10 copies/mg tissue. Most patients with CMV infection and intestinal disease had steroid refractory disease and came from East Asia.CONCLUSION: We detected multiple different definitions used for CMV infection and intestinal disease in IBD patients, which has an effect on prevalence numbers and eventually on outcome in different trials.

Melanoma of the rectum: A rare entity

A 41-year-old man presented with a 6-mo history of changed defecation and rectal bleeding. A 3-cm polypoid tumor of the lower rectum was found at rectosigmoidos- copy, which proved to be a leiomyosarcoma upon biopsy. Dissemination studies did not show any metastases. He was underwent to an abdomino-perineal resection (APR). Histopathology of the specimen showed a melanoma (S-100 stain positive). Two years after the resection, me- tastases in the abdomen and right lung were found. He died one and half years later. Primary anorectal melano- ma is a rare and very aggressive disorder. According to current data, one should always perform a S-100 stain when anorectal sarcoma is suspected. A positive S-100 stain suggests the tumour to be most likely a melanoma. Subsequently, thorough dissemination studies need to be performed. Depending on the outcome of the dissemina- tion studies, a surgical resection has to be performed. Nowadays, a sphincter-saving local excision combined with adjuvant loco-regional radiotherapy should be pre- ferred in case of small tumors. The same loco-regional control is achieved with less "loss of function" compared to non-sphincter saving surgery. Only in the case of large and obstructing tumors an abdomino-perineal resection is the treatment of choice.

Single-port laparoscopic cholecystectomy vs standard laparoscopic cholecystectomy:A non-randomized,agematched single center trial

AIM: To compare the safety of single-port laparoscopic cholecystectomies with standard four-port cholecystectomies.METHODS: Between January 2011 and December 2012 datas were gathered from 100 consecutive patients who received a single-port cholecystectomy. Patient baseline characteristics of all 100 single-port cholecystectomies were collected(body mass index, age, etc.) in a database. This group was compared with 100 age-matched patients who underwent a conventional laparoscopic cholecystectomy in the same period. Retrospectively, per- and postoperative data were added. The two groups were compared to each other using independent t-tests and χ2-tests, P values below 0.05 were considered significantly different.RESULTS: No differences were found between both groups regarding baseline characteristics. Operating time was significantly shorter in the total single-port group(42 min vs 62 min, P < 0.05); in procedures performed by surgeons the same trend was seen(45 min vs 59 min, P < 0.05). Peroperative complications between both groups were equal(3 in the single-port group vs 5 in the multiport group; P = 0.42). Although not significant less postoperative complications were seen in the single-port group compared with the multiport group(3 vs 9; P = 0.07). No statistically significant differences were found between both groupswith regard to length of hospital stay, readmissions and mortality. CONCLUSION: Single-port laparoscopic cholecystectomy has the potential to be a safe technique with a low complication rate, short in-hospital stay and comparable operating time. Single-port cholecystectomy provides the patient an almost non-visible scar while preserving optimal quality of surgery. Further prospective studies are needed to prove the safety of the single-port technique.

Phase Ⅱ study of docetaxel,cisplatin and capecitabine as preoperative chemotherapy in resectable gastric cancer

AIM To investigate the feasibility of preoperative docetaxel,cisplatin and capecitabine(DCC) in patients with resectable gastric cancer.METHODS Patients with resectable gastric cancer fulfilling the inclusion criteria,were treated with 4 cycles of docetaxel(60 mg/m2),cisplatin(60 mg/m2) and capecitabine(1.875 mg/m2 orally on day 1-14,two daily doses) repeated every three weeks,followed by surgery.Primary end point was the feasibility and toxicity/safety profile of DCC,secondary endpoints were pathological complete resection rate and pathological complete response(p CR) rate.RESULTS All of the patients(51) were assessable for the feasibility and safety of the regimen.The entire preoperative regimen was completed by 68.6% of the patients.Grade Ⅲ/Ⅳ febrile neutropenia occurred in 10% of all courses.Three patients died due to treatment related toxicity(5.9%),one of them(also) because of refusing further treatment for toxicity.Of the 45 patients who were evaluable for secondary endpoints,four developed metastatic disease and 76.5% received a curative resection.In 3 patients a p CR was seen(5.9%),two patients underwent a R1 resection(3.9%).CONCLUSION Four courses of DCC as a preoperative regimen for patients with primarily resectable gastric cancer is highly demanding.The high occurrence of febrile neutropenia is of concern.To decrease the occurrence of febrile neutropenia the prophylactic use of granulocyte colonystimulating factor(G-CSF) should be explored.A curative resection rate of 76.5% is acceptable.The use of DCC without G-CSF support as preoperative regimen in resectable gastric cancer is debatable.

Hepatosplenic T-cell lymphoma in a 47-year-old Crohn's disease patient on thiopurine monotherapy

Hepatosplenic T-cell lymphoma(HSTCL) is a rare nonHodgkin lymphoma with a high mortality rate. Higher incidence is reported in patients with inflammatory bowel disease, specifically in male patients that are younger than 35 years, and have been treated with thiopurine and tumor necrosis factor(TNF)-α inhibitor combination therapy for over 2 years. In this case report we describe a 47-year-old patient with Crohn's disease(CD) who developed HSTCL after having been treated with thiopurine monotherapy for 14 years. To our best knowledge, only eleven cases exist of patients with CD who developed HSTCL while on thiopurine monotherapy. We report the first patient with CD, older than 35 years, who developed HSTCL while on thiopurine monotherapy. This emphasizes that HSTCL risk is not limited to young men receiving both thiopurines and TNF-α inhibitors.

Pelvic sepsis after stapled hemorrhoidopexy

Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade Ⅲ and Ⅳ hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons.

Tuf m RNA rather than 16S r RNA is associated with culturable Staphylococcus aureus

AIM: To study the presence of various nucleic acids targets of Staphylococcus aureus(S. aureus) during bacterial growth and antibiotic induced killing in relation to viability.METHODS: S. aureus was cultured to log phase and spiked in Todd Hewitt(TH) broth and whole blood of healthy human volunteers. Viability of S. aureus after flucloxacillin treatment(0, 1, 3 and 6 d) was assessed by culture on bloodagar plates. DNA and RNA were isolated from 200 μL. c DNA synthesis was performed by using random primers. The presence of S. aureus DNA, r RNA, and m RNA were determined by real-time polymerase chain reaction of the 16 S r DNA and tuf gene(elongation factor Tu).RESULTS: S. aureus spiked in TH broth without antibiotics grew from day 0-6 and DNA(tuf and 16S), and 16 S r RNA remained detectable during this whole period. During flucloxacillin treatment S. aureus lost viability from day 3 onwards, while the 16 S r RNA-gene and its RNA transcripts remained detectable. DNA andr RNA can be detected in flucloxacillin treated S. aureus cultures that do not further contain culturable bacteria.However, tuf m RNA became undetectable from day 3onwards. Tuf m RNA can only be detected from samples with culturable bacteria. When spiking S. aureus in whole blood instead of broth no bacterial growth was seen, neither in the absence nor in the presence of flucloxacillin. Accordingly, no increase in DNA and RNA levels of both 16 S r DNA and the tuf gene were detected. CONCLUSION: Tuf m RNA expression is associated with culturable S. aureus and might be used to monitor antibiotic effects.

唐氏综合征儿童淋巴细胞计数的内在异常

Objective: Down syndrome (DS) is associated with an increased frequency of infections, hematologic malignancies, and autoimmune diseases, suggesting that immunodeficiency is an integral part of DS that contributes significantly to the observed increased morbidity and mortality. We determined the absolute counts of the main lymphocyte populations in a large group of DS children to gain further insight into this immunodeficiency. Study design: In a large group of children with DS (n = 96), the absolute numbers of the main lymphocyte subpopulations were determined with 3-color immunophenotyping using the lysed whole-blood method. The results were compared with previously published data in healthy children without DS. Results: In healthy children with DS, the primary expansion of T and B lymphocytes seen in healthy children without DS in the first years of life was severely abrogated. The T-lymphocyte subpopulation counts gradually reached more normal levels with time, whereas the B-lymphocyte population remained severely decreased, with 88%of values falling below the 10th percentile and 61%below the 5th percentile of normal. Conclusions: The diminished expansion of T and B lymphocytes strongly suggests that a disturbance in the adaptive immune system is intrinsically present in DS and is not a reflection of precocious aging. Thymic alterations have been described in DS that could explain the decreased numbers of T lymphocytes, but not the striking B lymphocytopenia, seen in these children.

麻醉技术对结肠癌患者术后生存期的影响:文献综述

对于潜在可根治的结肠癌,手术切除是核心治疗方式。尽管肉眼看不见,但大多数患者术中都会残留一些癌细胞。而手术本身所引起的免疫抑制也会影响到肿瘤复发和术后生存。相较于阿片类麻醉剂,区域阻滞麻醉或椎管内麻醉(如硬膜外麻醉)或可通过减少应激和降低阿片类麻醉剂的用量,减轻对免疫功能的抑制作用。研究显示,区域阻滞麻醉可降低乳腺癌和前列腺癌的复发率,从而印证了这一假设。然而对于结肠癌,相关研究结果却不尽一致。本文对所有探讨硬膜外麻醉与结肠癌手术患者生存相关性的研究进行了综述。