Efficacy and safety of cilostazol, a novel phosphodiesterase inhibitor in patients with intermittent claudication

Pharmacotherapy is limited for the relief of intermittent claudication (IC), a common manifestation of peripheral arterial disease (PAD). Pentoxyfylline, the only current pharmacological therapy for IC, has been shown to have similar efficacy as placebo. Cilostazol, a new phosphodiesterase III (PDE III) inhibitor, is a potent inhibitor of platelet aggregation with vasodilatory, antithrombotic, antiproliferative and positive lipid-altering effects. To evaluate the efficacy and safety of cilostazol for the treatment of IC in Indian patients, 123 patients were selected from 6 centres in India. The patients, aged 58-73 years, with the diagnosis of stable moderate-to-severe IC received cilostazol 100/50 mg twice daily for a period of 12 weeks. Primary efficacy measures included initial claudication distance (ICD) and absolute walking distance (ACD) by treadmill testing and ankle-brachial index (ABI) using Doppler ultrasonography-measured systolic pressures. Secondary efficacy outcomes included subjective assessment of symptom improvement by patient and investigator and estimation of lipid values. Adverse events were monitored throughout the study. Laboratory investigations were carried out at baseline and end of study. At the end of week 12 of cilostazol therapy, there was a significant improvement in the raw walking distances (ICD and ACD). Percentage change in ICD and ACD was 46.77% and 64.5%, respectively, at the end of study. There was a significant increase (32.7%) in the ABI by the end of study period. According to patient and investigator assessment of symptoms, 58-60% of the subjects showed significant improvement to complete resolution of claudication symptoms by the end of 12 weeks of therapy. In addition, there was a significant increase of 20.24% in the mean plasma HDL-cholesterol levels and a decrease of 29.55% in the mean plasma triglyceride concentrations by the end of study period. Headache, diarrhoea, palpitation and dizziness were the commonly reported adverse effects during the study. No adverse effect led to discontinuation of therapy. The present study suggests that cilostazol is an effective therapeutic option with an acceptable tolerability profile for the treatment of IC in patients with PAD.     

Six minute walking test for assessing exercise capacity in chronic heart failure

Twenty six patients, mean age 58 years (range 36-68), with stable chronic heart failure, New York Heart Association class II-III, and 10 normal subjects of a similar age range were studied. Exercise capacity was assessed by determining oxygen consumption reached during a maximal treadmill exercise test and by measuring the distance each patient walked in six minutes. There were significant differences in the distance walked in six minutes between normal subjects, patients with heart failure, class II, and those with class III heart failure (683 m, 558 m, and 402 m, respectively (p less than 0.003)). The relation between maximal oxygen consumption and the distance walked in six minutes was curvilinear; thus the distance walked varied considerably in those with a low maximal oxygen consumption but varied little in patients and normal subjects with a high maximal oxygen consumption. All subjects preferred performing the six minute walking test to the treadmill exercise test, considering it to be more closely related to their daily physical activity. The six minute test is a simple objective guide to disability in patients with chronic heart failure and could be of particular value in assessing patients with severe heart failure but less useful in assessing patients with mild heart failure.     

糖尿病膝下动脉病变经皮腔内血管成形术的短期疗效

目的 评价糖尿病膝下动脉病变经皮腔内血管成形术(PTA)的临床短期疗效.方法 本组35例糖尿病合并缺血性下肢动脉病变患者,男20例,女15例,年龄50～81岁,中位年龄为69岁.Rutherford-Becker分级Ⅰ级6例,临床表现为中度以上间歇性跛行;Ⅱ级10例,临床表现为缺血性静息痛;Ⅲ级19例,为不同程度的溃疡和坏疽.所有患者术前均行患肢CT三维重建(CTA)及数字减影血管造影(DSA)检查,术后定期门诊随访,观察记录临床症状和体征变化,并测定1、3、6和12个月患肢踝肱指数(ABI).结果 35例患者53侧肢体共60支膝下动脉存在狭窄或闭塞,其中51支动脉通过球囊扩张得以开通,PTA成功率为85.0%.所有患者的疼痛症状均明显缓解,32例患者单位时间步行距离和固定距离步行时间均恢复正常.术后12个月ABI为0.65,与术前(0.49)的差异无统计学意义(P0.05).结论 PTA是治疗糖尿病膝下动脉病变安全有效的方法.     

Transcutaneous oxygen tension during exercise in patients with claudication

Transcutaneous oxygen tension (TcPO2) was monitored during maximal exercise in 10 patients with stable moderate to severe claudication. The TcPO2 fell by 16% at the onset of claudication and 32% at the maximum walking distance. On resting this decrease reached a maximum of 66% roughly four minutes after exercise. This was followed by a steady recovery. The percentage changes were reproducible in each patient and were appreciably different from the TcPO2 exercise profiles of normal healthy volunteers. TcPO2 monitoring during exercise is a simple, reproducible, cheap, and useful technique for assessing claudication and compares favourably with other techniques used to quantify this condition.     

骨髓动员外周血干细胞移植治疗严重肢体缺血的临床应用

目的:探讨外周血干细胞移植改善严重缺血肢体的作用。方法:15例下肢严重缺血的患者,经骨髓动员后,CS-3000Plus机器采集外周血干细胞,直接移植入缺血肢体中,共移植17人次。结果:采用骨髓动员外周血干细胞分离并移植治疗临床上严重肢体缺血的患者,术后一年,疼痛指数由术前5.0降到术后0,踝肱指数(ABI)由术前0.30提高到术后0.46;6例溃疡5例愈合;无痛行走距离由术前0.15 km提高到术后0.72 km;最大行走距离由术前0.96 km提高到术后2.13 km。结论:骨髓动员外周血干细胞移植能促进缺血肢体新生血管形成,有效改善缺血肢体的疼痛和步行距离,并促进溃疡愈合。     

运动训练对老年下肢动脉硬化闭塞症非介入术患者的疗效观察

目的 通过6MWT、CPET、ABI等评估方法,对老年下肢动脉硬化闭塞症行非介入治疗术患者进行有氧运动等治疗干预,观察其疗效。 方法 入选下肢动脉硬化闭塞症非介入治疗术患者65例,随机分为对照组和研究组,2组观察前后均行6MWT、CPET评估和ABI值检测,测得6MWD,跛行距离、VO_2peak、无氧阈、METs、ABI等值。对照组行常规治疗无规范运动训练干预,研究组在常规治疗基础上,根据CPET结果制定个体化运动处方,指导运动训练3个月,3个月后复查6MWT、CPET和ABI等值。 结果 研究组运动训练3个月后,6MWT结果显示,步行距离较干预前增加75.75 m,跛行距离增加71.4 m。CPET结果显示,与干预前比较VO_2peak增加169.2 ml/min,峰值kgVO₂增加,2.46 ml/(kg·min),AT值增加2.19 ml/(kg·min),代谢当量增加0.5 METs,ABI值增加0.08,上述各项值与干预前比较差异均有统计学意义(P＜0.05)。研究组运动训练3个月后与对照组同期比较,各项指标差异均有统计学意义(P＜0.05)。 结论 个体化运动处方指导下的有氧运动训练能有效改善老年下肢动脉硬化闭塞症非介入术患者症状和步行距离、提高运动耐力和ABI值。      

腰椎椎管狭窄与椎间盘突出症关系的探讨

腰椎管狭窄常合并椎间盘突出较常见。根据临床特点将本组68例分为三种类型:(1)间歇性跛行型21例;(2)根性疼痛型42例;(3)间歇跛行-根性疼痛型5例。全部施行手术治疗,随访58例,平均访程22个月。优41例,良14例,无变化3例。本文对腰椎管狭窄与椎间盘并存者之病理、临床特征及诊治作了讨论。     

自体外周血干细胞移植联合介入治疗下肢动脉缺血性疾病的效果评价

目的:探讨运用自体外周血干细胞移植与介入联合治疗下肢动脉缺血性疾病,并对其疗效进行临床观察.方法:本研究共入组38例下肢动脉缺血性疾病患者,依自愿原则分组,仅采用介入治疗的19例患者为单独介入组,采用自体外周血进行干细胞移植与介入联合治疗的19例患者为联合治疗组.常规治疗方案两组相同,对两组患者的疼痛感、冷感、间歇跛行、踝肱指数(ankle brachial index,ABI)、侧支血管生成数量等方面的指标进行比较,从而判断两组患者的疗效差异.结果: 在疼痛感、冷感、间歇跛行3方面两组患者均明显降低,差异具有统计学意义(P＜0. 05),ABI评分与侧支血管生成数评分方面,两组均升高,差异具有统计学意义(P＜0. 05).与单独介入组比较,联合治疗组在疼痛感、冷感、间歇跛行方面、ABI评分与侧支血管生成数评分改善更为明显(P＜0. 05).联合治疗组的有效率是89. 5% ,单独介入组的有效率是78. 9% ,联合治疗组效果显著优于单独介入组(P＜0. 05).结论: 自体外周血干细胞移植与介入结合是治疗下肢动脉缺血性疾病安全而有效的方法.     

西地那非治疗肺动脉高压的临床疗效观察

目的探讨西地那非在肺动脉高压治疗中的临床应用价值。方法将我院近年来收治的COPD伴肺动脉高压患者71例随机分为观察组36例,对照组35例;对照组予以常规治疗,观察组在常规治疗的基础上加用西地那非。3个月为1个疗程。比较两组患者血氧饱和度、肺动脉收缩压、6rain步行距离变化。结果观察组治疗后3个月血氧饱和度、肺动脉收缩压、6min步行距离分别为（87．8±4．0）％、（79．9±6．3）mmHg、（292．8±18,8）m,与对照组的（80．8±4．1）％、（83．4±7．9）mmHg、（285．8±20．6）m比较,差异有统计学意义（均P〈0．05）。治疗后6个月观察组分别为（91．7±4.2）％、（75．5±5．9）mmHg、（365．1±17．5）m,与对照组的（86．8±3．7）％、（79．7±6．9）mmHg、（294．9±22．3）m比较,差异有统计学意义（P〈0．05或P〈0．01）。结论西地那非降低肺动脉高压效果显著,可在临床广泛推广应用。     

Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment

CONTEXT: Persons with lower-extremity peripheral arterial disease (PAD) are often asymptomatic or have leg symptoms other than intermittent claudication (IC). OBJECTIVE: To identify clinical characteristics and functional limitations associated with a broad range of leg symptoms identified among patients with PAD. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 460 men and women with PAD and 130 without PAD, who were identified consecutively, conducted between October 1998 and January 2000 at 3 Chicago-area medical centers. MAIN OUTCOME MEASURES: Ankle-brachial index score of less than 0.90; scores from 6-minute walk, accelerometer-measured physical activity over 7 days, repeated chair raises, standing balance (full tandem stand), 4-m walking velocity, San Diego claudication questionnaire, Geriatric Depression Score Short-Form, and the Walking Impairment Questionnaire. RESULTS: All groups with PAD had poorer functioning than participants without PAD. The following values are for patients without IC vs those with IC. Participants in the group with leg pain on exertion and rest (n = 88) had a higher (poorer) score for neuropathy (5.6 vs 3.5; P<.001), prevalence of diabetes mellitus (48.9% vs 26.7%; P<.001), and spinal stenosis (20.8% vs 7.2%; P =.002). The atypical exertional leg pain/carry on group (exertional leg pain other than IC associated with walking through leg pain [n = 41]) and the atypical exertional leg pain/stop group (exertional leg pain other than IC that causes one to stop walking [n = 90]) had better functioning than the IC group. The group without exertional leg pain/inactive (no exertional leg pain in individual who walks 相似文献   

脂肪间充质干细胞治疗下肢缺血患者疗效分析及人成骨细胞特异因子-2基因表达

目的探讨分析人脂肪间充质干细胞(ADSC)治疗下肢缺血患者疗效分析及人成骨细胞特异因子-2(periostin,POSTN)基因表达状况。方法选取2015年1月至12月收治住院的下肢缺血患者56例,常规治疗的基础上给予ADSC治疗,对比治疗前后的各项临床症状、体征、检测指标的变化及人成骨细胞特异因子-2的表达。结果患者静息痛、冷感与间歇性跛行状况经治疗后均显著由于治疗前,治疗后需要止疼药物或保温措施干预的患者显著减少,行走有疼痛的患者也显著减少,差异有统计学意义(P<0.05);患者经治疗后皮温、踝臂指数、经皮氧分压显著优于治疗前,POSTN表达显著低于治疗前,差异有统计学意义(P<0.05);患者经治疗后生理职能、生理机能、一般健康状况、躯体疼痛、社会功能、精力、精神健康和情感职能8个不同的方面的SF-36评分显著优于治疗前,差异有统计学意义(P<0.05)。结论 ADSC治疗下肢缺血疗效较佳,POSTN在ADSC治疗前的下肢缺血患者血浆中呈现为高表达,治疗后显著降低,POSTN表达或可用于评价下肢缺血患者临床疗效。     

自体骨髓干细胞移植联合经皮腔内血管成形术治疗糖尿病足的效果评价

目的: 探讨自体骨髓干细胞移植与经皮腔内血管成形术相结合方法治疗糖尿病足的优点,阐明该方法独特的临床疗效。 方法: 将糖尿病足且下肢血管重度狭窄或闭塞40例患者,按患者意愿分为2组,其中采用自体骨髓干细胞移植联合经皮腔内血管成形术治疗的20例患者为联合治疗组,行自体骨髓干细胞移植治疗的20例患者为单独移植组。2组患者均进行常规治疗,观察2组患者治疗前后患侧肢体疼痛、冷感、间歇性跛行、踝肱指数(ABI)和侧支血管生成数量的变化,比较2组患者疗效。 结果: 与治疗前比较,联合治疗组和单独移植组患者治疗后肢体疼痛评分、冷感评分和间歇性跛行评分均明显降低(P<0.01),ABI和侧支血管生成数量评分均明显升高(P<0.01)。与单独移植组比较,联合治疗组患者肢体总疼痛评分、总冷感评分和总间歇性跛行评分明显减低(P<0.05),ABI和侧支血管生成数量评分明显升高(P<0.05)。以患者溃疡面的变化情况为疗效判定标准,联合治疗组患者临床治愈率较单独移植组高,有效率较单独移植组低。 结论: 自体骨髓干细胞移植与经皮腔内血管成形术结合是治疗糖尿病足的安全而有效方法。     

超声消融联合球囊扩张和支架置入对下肢动脉长段闭塞的临床研究

目的：通过与单独球囊扩张和支架植入比较,评价超声消融联合球囊扩张和支架植入治疗下肢动脉长段闭塞的疗效及安全性。方法筛选我院2010年1月～2013年9月下肢动脉闭塞症患者,选取满足条件的40例存在长段动脉闭塞患者。随机分为2组,治疗组采用超声消融联合球囊扩张和支架植入治疗,对照组采用单纯球囊扩张和支架植入治疗。观察治疗组与对照组两组术前、术后2周患者跛行距离、足部皮温及ABI变化。结果 A组与B组中共11例患者下肢溃烂,术后经局部换药后2周内全部愈合。 A组成功率为97．0％,而B组成功率为87．1％．A组和B组术后2周与术前相比,足部皮温、ABI及间歇性跛行距离均得到明显改善,具有统计学意义（P＜0．05）。术后2周A组与B组比较,足部皮温、ABI及间歇性跛行距离改善无统计学意义（P＞0．05）。术后造影A组较B组有更丰富的侧枝循环。手术并发症：A组并发症发生率6．1％,B组并发症发生率19．3％．结论血管内超声消融联合球囊扩张成形和支架植入治疗下肢动脉完全闭塞比单纯球囊扩张和支架植入的成功率高、并发症少。血管内超声消融联合球囊扩张成形和支架植入治疗下肢动脉完全闭塞的长期疗效有待进一步观察。     

长期家庭氧疗联合呼吸操训练在慢性阻塞性肺疾病稳定期中的临床应用

目的观察长期家庭氧疗(LTDOT)联合呼吸操训练对中重度慢性阻塞性肺疾病稳定期患者生活质量的影响。方法选择2009年11月-2010年11月62例中重度COPD稳定期患者,随机分为LTDOT组(19例)、呼吸操组(21例)和LTDOT+呼吸操组(22例)。3组患者分别于治疗前、治疗12个月后进行血气分析、生活质量CAT评估、6min步行距离(6MWD)、肺动脉压检测。结果 3组患者治疗前血气分析、生活质量CAT评估、6MWD、肺动脉压检测各项指标比较差异均无统计学意义(P>0.05);LTDOT组及LTDOT+呼吸操组患者12月后血气分析、生活质量CAT评估、肺动脉压、6MWD较治疗前差异均有统计学意义(P<0.05),且以LTDOT+呼吸操组更显著。呼吸操组在改善生活质量CAT评估、6MWD及血气分析方面差异有统计学意义(P<0.05),但在降低肺动脉压方面差异无统计学意义(P>0.05)。结论家庭氧疗联合呼吸操训练治疗,较单纯长期家庭氧疗及单纯呼吸操训练能更好地改善COPD患者的运动能力和生活质量。     

Pentoxifylline as an adjuvant to surgery and antibiotics in the treatment of perforation peritonitis: a prospective, randomised placebo-controlled study

INTRODUCTION: In animal models and human trials, pentoxifylline has shown beneficial pharmacological effects in the treatment of septic shock. We evaluated the role of pentoxifylline in the treatment of perforation peritonitis, as an adjuvant to surgery and standard antibiotic treatment. METHODS: A prospective, randomised placebo-controlled trial was conducted on 50 patients with perforation peritonitis. 25 patients were randomised to the test group and 25 patients to the control group. In addition to standard treatment, the test group of patients received pentoxifylline 200 mg per day as an adjuvant for three days. The endpoints of the study were to evaluate the condition of the wound in the postoperative period, APACHE II score and total duration of hospital stay. RESULTS: Both groups were comparable in all aspects. There were 23 male and two female patients in the test group, and 20 male and five female patients in the control group (p-value is 0.021). Mean age was 37.9 +/- 10.5 years in the test group and 33.8 +/- 11.0 years in the control group (p-value is 0.186). The APACHE II score in the test group and in the control group was statistically not significant (p-value is 0.661). In the test group, seven (28 percent) patients had wound infection and in the control group, 13 (52 percent) patients had wound infection (p-value is 0.083). The mean postoperative hospital stay in the test group was 6.8 +/- 2.1 days and in the control group, it was 11.2 +/- 5.2 days (p-value is 0.001). CONCLUSION: Pentoxifylline improved the outcome by significantly decreasing the length of the hospital stay and the rate of wound infection.     

运动疗法改善慢性阻塞性肺疾病患者的生活质量和肺功能

目的:探讨运动疗法对中重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者生活质量和肺功能的影响.方法:选取中重度COPD稳定期住院患者122例,随机分为试验组62人和对照组60人,2组在进行常规治疗基础上,试验组进行呼吸肌运动疗法和有氧运动疗法1年,对照组未...     

Effectiveness of physician-based interventions with problem drinkers: a review.

OBJECTIVE: To review the results of randomized controlled trials on the effectiveness of brief physician interventions with problem drinkers. DATA SOURCES: The MEDLINE and EMBASE databases were searched for articles published from 1966 and 1972 respectively, with the terms "problem/controlled/responsible/moderate/risk/drink"; "advice/drink"; "physician, nurse, general practitioner"; and "random." Forty-three articles were identified in the EMBASE search and 112 articles in the MEDLINE search. STUDY SELECTION: All trials examining the effectiveness of interventions by physicians in reducing alcohol consumption among problem drinkers attending a health-care facility were reviewed. Trials involving subjects attending an alcohol treatment clinic and those involving interventions delivered solely by nonphysicians were excluded. Eleven trials met the final selection criteria. DATA EXTRACTION: For each article, two of the authors independently assigned a score from 0 to 2 on a number of criteria for validity and generalizability. DATA SYNTHESIS: The four trials with the highest validity scores showed that men in the intervention groups reduced their weekly alcohol consumption by five to seven standard drinks more than the men in the control groups. Results for women were inconsistent. No convincing evidence of declines in alcohol-related morbidity among men or women was found. CONCLUSIONS: The trials support the use of brief interventions by physicians for patients with drinking problems. Although further studies are needed to determine their effect on morbidity and mortality, the public health impact of such interventions is potentially enormous. Further research is needed to determine which patients are best suited for brief interventions, the optimal intensity of treatment and which components of brief interventions are most effective. Research is also needed to establish which strategies are effective in inducing physicians to use brief interventions.     

综合康复疗法治疗高龄退行性腰椎管狭窄症的观察

目的：探讨康复疗法治疗高龄退行性腰椎管狭窄症的有效性及其特点。方法：研究组100例患者。采用综合保守方法进行治疗，对短期疗效进行随访观察。设立对照组对治疗效果进行比较分析，对照组选取本院同期内因腰椎管狭窄症施行手术的患者56例。结果：研究组随访1年，治疗前JOA点数7～24点，治疗后12～29点，平均好转率为56．5％；治疗前出现间歇性跛行的距离为10～500m，治疗后为350～1000m，平均RIC为46．5％；治疗前平均VAS6．5，治疗后为2．4，随访1年后为1．9。对照组手术前JOA点数7～18点，手术后10～29点，平均好转率59．7％；手术前出现间歇性跛行的距离为0～500m，手术后为400～1000m，平均RIC为47．2％，两组比较差异无统计学意义。结论：综合康复治疗可作为治疗腰椎管狭窄症的方法之一，对不能接受手术的高龄患者的短期疗效是可靠的。     

间歇性外斜视术后立体视觉的重建

目的:探讨间歇性外斜视手术后立体视觉的重建及其影响因素.方法:56例间歇性外斜视手术前和术后6个月用《颜少明立体视觉检查图》检测近立体视锐度,用同视机检查远距离双眼视觉.结果:间歇性外斜视患者术前远距离立体视丧失比例高于近距离立体视.术后近距离立体视改善不明显,远距离立体视改善明显.术前有无融合功能对术后双眼视功能恢复非常重要.≤9岁组术后立体视觉恢复率明显高于＞9岁组.结论:间歇性外斜视手术可明显提高远距离立体视.应早期手术治疗,以利于双眼视功能的恢复,达到功能性治愈.