Differential Improvement in Angina and Health-Related Quality of Life After PCI in Focal and Diffuse Coronary Artery Disease

BackgroundAn increase in fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is associated with improvement in angina. Coronary artery disease (CAD) patterns (focal vs diffuse) influence the FFR change after stenting and may predict angina relief.ObjectivesThe aim of this study was to investigate the differential improvement in patient-reported outcomes after PCI in focal and diffuse CAD as defined by the pullback pressure gradient (PPG).MethodsThis is a subanalysis of the TARGET-FFR (Trial of Angiography vs. pressure-Ratio-Guided Enhancement Techniques–Fractional Flow Reserve) randomized clinical trial. The 7-item Seattle Angina Questionnaire (SAQ-7) was administered at baseline and 3 months after PCI. The PPG index was calculated from manual pre-PCI FFR pullbacks. The median PPG value was used to define focal and diffuse CAD. Residual angina was defined as an SAQ-7 score <100.ResultsA total of 103 patients were analyzed. There were no differences in the baseline characteristics between patients with focal and diffuse CAD. Focal disease had larger increases in FFR after PCI than patients with diffuse disease (0.30 ± 0.14 vs 0.19 ± 0.12; P < 0.001). Patients with focal disease who underwent PCI for focal CAD had significantly higher SAQ-7 summary scores at follow-up than those with diffuse CAD (87.1 ± 20.3 vs 75.6 ± 24.4; mean difference = 11.5 [95% CI: 2.8-20.3]; P = 0.01). After PCI, residual angina was present in 39.8% but was significantly less in those with treated focal CAD (27.5% vs 51.9%; P = 0.020).ConclusionsResidual angina after PCI was almost twice as common in patients with a low PPG (diffuse disease), whereas patients with a high PPG (focal disease) reported greater improvement in angina and quality of life. The baseline pattern of CAD can predict the likelihood of angina relief. (Trial of Angiography vs. pressure-Ratio-Guided Enhancement Techniques–Fractional Flow Reserve [TARGET-FFR]; NCT03259815)     

Acute myeloid leukemia in the elderly: conventional and novel treatment approaches

Acute Myeloid Leukemia (AML) is a disorder affecting primarily elderly individuals and poses significant treatment challenges. Much has been learned about the underlying immunologic, cytogenetic and molecular features of AML in recent years, and many features have been identified that portend a poor prognosis for elderly patients with newly diagnosed AML. Despite this, treatment outcomes for elderly patients remain poor for both newly diagnosed and relapsed disease. While conventional treatment approaches may be appropriate for some elderly patients, the vast majority do not tolerate intensive chemotherapy well, thus alternative strategies have been investigated. Here we review both conventional and novel treatment approaches for elderly patients with AML, including agents in early clinical trials. Treatment options have been divided into several discussions, including conventional treatments, agents complementary to conventional treatments, alternatives to conventional induction therapies, post-induction treatment, and relapsed disease. Current and developing research focuses upon identifying subgroups of patients that benefit more from specific chemotherapeutic agents. Treating elderly patients with AML requires an organized, multidisciplinary approach, taking into account individual patient characteristics, preferences, and comorbidities when formulating treatment plans.     

Diltiazem reverses tissue Doppler velocity abnormalities in pre-clinical hypertrophic cardiomyopathy

BACKGROUND: Abnormalities in systolic and diastolic function shown by tissue Doppler imaging have been shown to be present in patients with hypertrophic cardiomyopathy who do not yet show clinical or echocardiographic evidence of the disease. These become more marked as left ventricular hypertrophy develops. We attempted to show that these abnormalities could be reversed by treatment with diltiazem. METHODS AND RESULTS: Six adults, who were carriers of a mutation involving the cardiac myosin binding, protein-C gene and who did not show clinical electrocardiographic or echocardiographic evidence of the disease were given a dose of 240mg of diltiazem daily. Tissue Doppler peak systolic and early diastolic velocities at the lateral mitral annulus were examined before treatment and at a mean of 8 weeks after starting treatment. Improvement in both parameters occurred with early diastolic velocities returning to normal and most systolic velocities also becoming normal. CONCLUSION: Diltiazem may have a role in helping to prevent abnormalities of function and perhaps the development of left ventricular hypertrophy in patients with pre-clinical hypertrophic cardiomyopathy.     

Plasma Exchange Versus Double Filtration Plasmapheresis in the Treatment of Guillain‐Barré Syndrome

Abstract: Previous studies have shown that both plasma exchange (PE) and double filtration plasmapheresis (DFPP) are effective treatments in Guillain‐Barré syndrome (GBS). Whether PE and DFPP have similar effects in GBS is not clear. This report compares the therapeutic effectiveness of PE and DFPP in GBS patients treated in 3 major hospitals in northern Taiwan. A total of 102 patients were included in this survey, including 39 with PE (hereafter PE group) and 63 with DFPP (hereafter DFPP group). Both groups showed significant improvement of disability scores after treatment. However, time to onset of effect was shorter (5.6 ± 3.5 versus 7 ± 3.4 days, p < 0.05), and changes of disability scores were more prominent (1.3 ± 0.8 versus 0.8 ± 0.8, p < 0.05) in the PE group than the DFPP group. Mortality and outcome after 6 months were not different between the 2 groups. In conclusion, both PE and DFPP are effective treatments in GBS. PE was superior to DFPP in short‐term effectiveness. The long‐term effectiveness was not different.     

Pure red cell aplasia: Clinical features and treatment results in 16 cases

 Pure red cell aplasia (PRCA) is a rare hematological disease characterized by selective marrow erythroid aplasia. We report the clinical features and treatment results of 16 Chinese patients with PRCA. Nine (56%) cases were not associated with any underlying disorders and were considered idiopathic, while seven patients (44%) had associated diseases, three involving the thymus, two with T large granular lymphocyte leukemia (T-LGLL), and one each with Stevens-Johnson syndrome and acute hepatitis A. Conventional-dose corticosteroid therapy resulted in complete remission in three of 13 patients. Cyclosporin A was used in six patients. There were three complete and one partial remissions. High-dose methylprednisolone was ineffective in four patients who failed conventional-dose corticosteroids but achieved complete remission in one patient with thymoma who did not respond to thymectomy. Antithymocyte globulin was used in four patients, resulting in partial remission in only one patient with concomitant T-LGLL. Intravenous gamma globulin and danazol were ineffective in three patients. Thymectomy was performed in two patients, with one patient remitting. This is the largest series of PRCA reported in an oriental population. Our results indicate that treatment of PRCA may still be problematic and better therapeutic strategy will have to be defined. Received: 11 September 1995 / Accepted: 1 January 1996     

内镜下氩离子凝固术治疗Barrett食管的临床研究

目的探讨内镜下氩离子凝固术（APC）联合抑酸治疗对Barrett食管的临床疗效。方法对32例病理证实伴有肠上皮化生的Barrett食管，在内镜下以APC完全毁损化生黏膜，并予以口服奥美拉唑40mg／d抑酸治疗。从末次治疗开始进行为期12个月的内镜随访监测，每次内镜检查时对再生的鳞状上皮进行间隔1cm的四象限活检，对可疑病灶进行针对性的活检。结果32例患者共接受61次APC治疗，31例（96．9％）达到完全的鳞状上皮再生，1例（3．1％）在再生的鳞状上皮间混有岛状的柱状上皮；除1例出现食管轻度狭窄外，无其他并发症的出现。12个月后，共有4例出现内镜下可见的复发，另活检发现d例内镜下无异常患者的再生鳞状上皮下有柱状上皮残留。结论BE的内镜下APC联合抑酸治疗安全有效，能使鳞状上皮替代BE黏膜，但仍有一定比例的复发和残留。     

COPD合并慢性呼吸衰竭患者院内肺部真菌感染30例临床分析

目的探讨慢性阻塞性肺病(COPD)合并慢性呼吸衰竭患者院内肺部真菌感染的危险因素、临床特点及防治对策。方法回顾性分析我院收治30例COPD合并慢性呼吸衰竭继发肺部真菌感染患者的临床资料,并与同期30例无院内真菌感染的COPD合并慢性呼吸衰竭患者对比分析。结果COPD合并慢性呼吸衰竭患者肺部真菌感染除与患者年龄、并发症有关外,还与长期住院、广谱抗生素和糖皮质激素的应用、各种侵入性操作等有密切关系,临床表现无特异性。结论合理使用抗生素和糖皮质激素,减少不必要的侵入性操作,尽快脱机,加强全身营养支持,警惕真菌感染,及早治疗,可以有效防治COPD合并慢性呼吸衰竭患者发生肺部真菌感染,改善其预后。     

Spontaneous Spondylodiscitis Caused by Klebsiella pneumoniae

Summary A rare case of spontaneous spondylodiscitis caused by Klebsiella pneumoniae in a 55-year-old man who presented with thoracolumbar pain is described. Increased erythrocyte sedimentation rate and C-reactive protein level were pertinent laboratory findings. Computed tomography revealed a paravertebral mass and destruction of the 10th and 11th vertebrae. Magnetic resonance imaging (MRI) showed spondylodiscitis in the same area. Culture of a biopsy sample from the mass grew Klebsiella pneumoniae, while histological examination confirmed the inflammation. A combination of ceftazidime, amikacin and ciprofloxacin resulted in disappearance of the pain. Two months later, MRI showed substantial improvement of the lesions. Received: March 19, 1999 · Accepted: September 19, 1999     

慢性阻塞性肺疾病治疗的循证医学研究

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）的治疗必须依据循证医学的研究证据，作者就COPD稳定期和急性加重期的治疗查询了国际Cochrane协作网Cochrane图书馆中的系统评估（SR）资料库（2006年第3期），并将结果进行汇总。     

浅谈糖尿病肾病的研究进展

糖尿病肾病(Diabetic nephropathy,DN)是糖尿病的主要并发症,在我国,该病的发病率逐年增加,目前已成为终末期肾脏病的第2位原因,仅次于各种肾小球肾炎,该疾病已严重影响患者的生命健康及生活质量。该文从糖尿病肾病的发病机制出发,对其发病相关因素进行分析与概括,并结合现有临床诊断方法对糖尿病肾病五期诊断提供指标参考依据,同时对该病治疗手段做综述分析,进一步了解近期糖尿病肾病的研究动向。