硫酸镁联合地塞米松治疗爆震性耳聋的临床观察

目的观察硫酸镁联合地塞米松治疗爆震性耳聋的临床疗效。方法选择已确诊为爆震性耳聋患者35例,随机分为联合治疗组20例和糖皮质激素组15例。联合治疗组给予硫酸镁加地塞米松治疗;糖皮质激素组给予地塞米松治疗。两组治疗前、后均行纯音测听、听性脑干反应测听(ABR)检查。对检查结果进行统计学分析。结果治疗后两组患者听力水平都有显著改善,且两组之间对比存在非常显著性差异(P<0.01)。结论硫酸镁联合地塞米松可有效治疗爆震性耳聋,疗效明显优于单纯使用地塞米松。     

Development of quality metrics for ambulatory pediatric cardiology: Transposition of the great arteries after arterial switch operation

Objective

To develop quality metrics (QMs) for the ambulatory care of patients with transposition of the great arteries following arterial switch operation (TGA/ASO).

Design

Under the auspices of the American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Steering committee, the TGA/ASO team generated candidate QMs related to TGA/ASO ambulatory care. Candidate QMs were submitted to the ACPC Steering Committee and were reviewed for validity and feasibility using individual expert panel member scoring according to the RAND‐UCLA methodology. QMs were then made available for review by the entire ACC ACPC during an “open comment period.” Final approval of each QM was provided by a vote of the ACC ACPC Council.

Patients

Patients with TGA who had undergone an ASO were included. Patients with complex transposition were excluded.

Results

Twelve candidate QMs were generated. Seven metrics passed the RAND‐UCLA process. Four passed the “open comment period” and were ultimately approved by the Council. These included: (1) at least 1 echocardiogram performed during the first year of life reporting on the function, aortic dimension, degree of neoaortic valve insufficiency, the patency of the systemic and pulmonary outflows, the patency of the branch pulmonary arteries and coronary arteries, (2) neurodevelopmental (ND) assessment after ASO; (3) lipid profile by age 11 years; and (4) documentation of a transition of care plan to an adult congenital heart disease (CHD) provider by 18 years of age.

Conclusions

Application of the RAND‐UCLA methodology and linkage of this methodology to the ACPC approval process led to successful generation of 4 QMs relevant to the care of TGA/ASO pediatric patients in the ambulatory setting. These metrics have now been incorporated into the ACPC Quality Network providing guidance for the care of TGA/ASO patients across 30 CHD centers.     

Lymphocyte subpopulations in long-term dialysis patients: a case- controlled study of the effects of blood transfusion

Lymphocyte subsets in a group of intensely transfused (greater than 10 units/year) patients on long-term hemodialysis were compared with those in a carefully controlled population of lightly transfused (1-10 units/year, no units during study period) long-term dialysis patients. The data confirm previous reports of lymphopenia and a symmetrical reduction of both T- and B-cell subpopulations in patients on long-term dialysis. Eleven (36.7%) of 30 intensely transfused dialysis (ITD) patients had a low T8 population when expressed as a percentage value, while 0 of 25 lightly transfused dialysis (LTD) control patients exhibited a low percentage of T8 cells. There were no significant absolute differences between the lymphocyte subsets in the ITD and LTD patients. These data contrast with previous reports of other groups of ITD patients in whom there was an observed increase in T8 cytotoxic suppressor cells. Our findings suggest that the immunologic effects of renal failure and long-term dialysis largely override the increase in T8 lymphocyte subsets observed in other groups of transfused patients. There is little difference between ITD and LTD patients, but both groups are significantly different from nontransfused controls. Further longitudinal studies are needed in completely untransfused patients to resolve the contribution of minimal transfusion therapy to the immunologic deficits observed in long-term dialysis patients.     

PHARMACOTHERAPY OF THE DEPRESSED PATIENT WITH CARDIOVASCULAR AND/OR CEREBROVASCULAR ILLNESS

SUMMARY Cardiovascular and cerebrovascular disease are associated with a high incidence of depressive disorder. Despite this high level of co-morbidity, depressive disorders appear to go largely unrecognised and remain untreated. This may have serious consequences, as concomitant depression worsens the prognosis in patients with cardiovascular or cerebrovascular disease, increases medical costs, and delays return to work. Treatment with traditional tricyclic antidepressants is difficult in these patients because of the known cardiac effects. The favourable side-effect profiles of the 5-HT reuptake inhibitors suggest that they may offer therapeutic advantages, as they have little or no effect on cardiac conduction, do not cause orthostatic hypotension, and lack serious sequelae in overdose. The pharmacological profiles and the reduced potential of these newer antidepressant drugs to cause drug interaction show important differences that may be of clinical relevance in this patient population.