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麻醉与镇痛 2009年第1期5卷 63-67页

作者： Jeff E. Mandel Jonathan W. Tanner gary k lichtenstein David C. Metz David A. katzka Gregory G. Ginsberg Michael L. kochman 肖玮(译) 王天龙(校) Departments of Anesthesiology and Critical Care Departments of Medicine University of Pennsylvania School of Medicine Philadelphia Pennsylvania 不详

背景丙泊酚用于患者自控镇静（patient-controlled sedation，PCS）可解决中度镇静治疗窗窄的问题，但之前的研究存在方法学的不足。本研究中，我们使用瑞芬太尼＋丙泊酚经PCS给予，我们发现与芬太尼＋咪达唑仑相比，瑞芬太尼＋丙泊酚... 详细信息

背景丙泊酚用于患者自控镇静（patient-controlled sedation，PCS）可解决中度镇静治疗窗窄的问题，但之前的研究存在方法学的不足。本研究中，我们使用瑞芬太尼＋丙泊酚经PCS给予，我们发现与芬太尼＋咪达唑仑相比，瑞芬太尼＋丙泊酚更方便使用。方法将50例择期结肠镜检的患者随机（使用盲法）分为咪达唑仑＋芬太尼组（MF组）或丙泊酚＋瑞芬太尼组（PR组），药物均经PCS给予。研究中评估项目有：镇静起效时间、恢复时间、患者满意度、护士满意度、镜检医师满意度、是否需要麻醉医师干预。结果与MF组相比，PR组患者进入镇静状态与恢复明显较快（P〈0．0001）。在PR组中，恢复时间短于操作时间。两组间患者满意度、护士满意度、镜检医师满意度相同。PR组中，有2例患者因为动脉氧饱和度低于设置的安全终点而需要麻醉医师干预。结论在适当的监护条件下，丙泊酚＋瑞芬太尼用于PCS比咪达唑仑＋芬太尼更有优势。

关键词：患者自控镇静瑞芬太尼咪达唑仑结肠镜检随机对照丙泊酚双盲研究患者满意度

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Papillary thyroid cancer and inflammatory bowel disease:Is there a relationship?

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World Journal of Gastroenterology 2013年第7期19卷 1079-1084页

作者： Irene S Sonu Wojciech Blonski Ming Valerie Lin James Lewis Faten Aberra gary R lichtenstein Division of Internal Medicine Stanford University Hospital and ClinicsStanfordCA 94305United States Division of Internal Medicine UHS Wilson Medical CenterJohnson CityNY 13790United States Division of Digestive Diseases University of CincinnatiCincinnatiOH 45229United States Division of Gastroenterology Hospital of the University of PennsylvaniaUniversity of Pennsylvania School of MedicinePhiladelphiaPA 19103United States

AIM:To formally study age of diagnosis of papillary thyroid cancer(PTC) in inflammatory bowel disease(IBD) patients and evaluate the prevalence of PTC in IBD patients compared to a control *** that patients with IBD are more likely to be diagnosed with PTC than a control population.A retrospective cohort analysis was performed using the University of Pennsylvania Health System's electronic *** from 1998-2009 were included in the search,and patients in the cohort were selected based on ICD-9 *** criteria included the diagnosis of Crohn's disease(CD) or ulcerative colitis(UC) and the concurrent diagnosis of thyroid cancer in comparison to a control *** these methods 912 patients with CD and 1774 with UC were compared to 1638 diverticulitis and 19 447 asthma *** were performed using corrected chisquare *** primary outcome for this study was the diagnosis of *** to conduct this study was obtained by the Institutional Review Board at the University of ***:The mean age was 47.5 years(range:18-102 years) and 66% patients were *** analysis of variance model was used to compare the age of PTC diagnosis between the CD,UC,asthma and diverticulitis groups,and a statistically significant difference in age at PTC diagnosis was noted across all groups(F = 6.35,df = 3,P = 0.0006).The age of PTC diagnosis in CD patients was statistically significantly lower than UC,asthma,and diverticulitis patients(average PTC diagnosis age for CD 25,UC 49,asthma 45,diverticulitis 63).After covarying for sex and age in 2009,the difference in age at PTC diagnosis remained statistically significant(F = 4.13,df = 3,P = 0.0089).A total of 86 patients were diagnosed with *** patients(0.5%) with UC were diagnosed with *** with UC were not shown to be more likely to develop PTC [odds ratio(OR):1.544,95%CI 0.767-3.108] compared to asthma *** patients(0.4%) with CD were

关键词： Papillary thyroid cancer Inflammatory bowel disease Crohn disease Ulcerative colitis

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Tumor necrosis factor-α inhibitor therapy and fetal risk:A systematic literature review

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World Journal of Gastroenterology 2013年第17期19卷 2591-2602页

作者： Renée M Marchioni gary R lichtenstein Division of Gastroenterology and Hepatology University of Connecticut Health Center Division of Gastroenterology Hospital of the University of Pennsylvania

Tumor necrosis factor-α inhibitors (anti-TNFs) are effective in the treatment of inflammatory bowel disease (IBD) recalcitrant to conventional medical therapy. As the peak incidence of IBD overlaps with the prime reproductive years, it is crucial to establish pharmacologic regimens for women of childbearing age that achieve effective disease control without posing significant fetal harm. A systematic literature review was performed to identify all human studies with birth outcomes data after maternal exposure to infliximab, adalimumab, or certolizumab pegol within 3 mo of conception or during any trimester of pregnancy. Live births, spontaneous abortions or stillbirths, preterm or premature births, low birth weight or small for gestational age infants, and congenital abnormalities were recorded. Fifty selected references identified 472 pregnancy exposures. The subsequent review includes general information regarding anti-TNF therapy in pregnancy followed by a summary of our findings. The benefits of biologic modalities in optimizing disease control during pregnancy must be weighed against the potential toxicity of drug exposure on the developing fetus. Although promising overall, there is insufficient evidence to prove absolute safety for use of anti-TNFs during pregnancy given the limitations of available data and lack of controlled trials.

关键词： Tumor necrosis factor-α inhibitors Pregnancy Congenital abnormalities Safety Infliximab Adalimumab Certolizumab

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