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961.
962.
963.
R.J. van de Peppel M.T. van der Beek L.G. Visser M.G.J. de Boer J. Wallinga 《International journal of antimicrobial agents》2019,53(3):284-293
Objectives
Triazole resistance in Aspergillus spp. is emerging and complicates prophylaxis and treatment of invasive aspergillosis (IA) worldwide. New polymerase chain reaction (PCR) tests on broncho-alveolar lavage (BAL) fluid allow for detection of triazole resistance at a genetic level, which has opened up new possibilities for targeted therapy. In the absence of clinical trials, a modelling study delivers estimates of the added value of resistance detection with PCR, and which empiric therapy would be optimal when local resistance rates are known.Design
A decision-analytic modelling study was performed based on epidemiological data of IA, extended with estimated dynamics of resistance rates and treatment effectiveness. Six clinical strategies were compared that differ in use of PCR diagnostics (used vs not used) and in empiric therapeutic choice in case of unknown triazole susceptibility: voriconazole, liposomal amphotericin B (LAmB) or both. Outcome measures were proportion of correct treatment, survival and serious adverse events.Results
Implementing aspergillus PCR tests was projected to result in residual treatment-susceptibility mismatches of <5% for a triazole resistance rate up to 20% (using voriconazole). Empiric LAmB outperformed voriconazole at resistance rates >5–20%, depending on PCR use and estimated survival benefits of voriconazole over LAmB. Combination therapy of voriconazole and LAmB performed best at all resistance rates, but the advantage over the other strategies should be weighed against the expected increased number of drug-related serious adverse events. The advantage of combination therapy over LAmB monotherapy became smaller at higher triazole resistance rates.Conclusions
Introduction of current aspergillus PCR tests on BAL fluid is an effective way to increase the proportion of patients that receive targeted therapy for IA. The results indicate that close monitoring of background resistance rates and adverse drug events are important to attain the potential benefits of LAmB. The choice of strategy ultimately depends on the probability of triazole resistance, the availability of PCR and individual patient characteristics. 相似文献964.
Yoav Michowitz Anat Milman Antoine Andorin Georgia Sarquella-Brugada M. Cecilia Gonzalez Corcia Jean-Baptiste Gourraud Giulio Conte Frederic Sacher Jimmy J.M. Juang Sung-Hwan Kim Eran Leshem Philippe Mabo Pieter G. Postema Aviram Hochstadt Yanushi D. Wijeyeratne Isabelle Denjoy Carla Giustetto Yuka Mizusawa Bernard Belhassen 《Journal of the American College of Cardiology》2019,73(14):1756-1765
Background
Information on young patients with Brugada syndrome (BrS) and arrhythmic events (AEs) is limited.Objectives
The purpose of this study was to describe their characteristics and management as well as risk factors for AE recurrence.Methods
A total of 57 patients (age ≤20 years), all with BrS and AEs, were divided into pediatric (age ≤12 years; n = 26) and adolescents (age 13 to 20 years; n = 31).Results
Patients’ median age at time of first AE was 14 years, with a majority of males (74%), Caucasians (70%), and probands (79%) who presented as aborted cardiac arrest (84%). A significant proportion of patients (28%) exhibited fever-related AE. Family history of sudden cardiac death (SCD), prior syncope, spontaneous type 1 Brugada electrocardiogram (ECG), inducible ventricular fibrillation at electrophysiological study, and SCN5A mutations were present in 26%, 49%, 65%, 28%, and 58% of patients, respectively. The pediatric group differed from the adolescents, with a greater proportion of females, Caucasians, fever-related AEs, and spontaneous type-1 ECG. During follow-up, 68% of pediatric and 64% of adolescents had recurrent AE, with median time of 9.9 and 27.0 months, respectively. Approximately one-third of recurrent AEs occurred on quinidine therapy, and among the pediatric group, 60% of recurrent AEs were fever-related. Risk factors for recurrent AE included sinus node dysfunction, atrial arrhythmias, intraventricular conduction delay, or large S-wave on ECG lead I in the pediatric group and the presence of SCN5A mutation among adolescents.Conclusions
Young BrS patients with AE represent a very arrhythmogenic group. Current management after first arrhythmia episode is associated with high recurrence rate. Alternative therapies, besides defibrillator implantation, should be considered. 相似文献965.
B. Kowall N. Lehmann A.A. Mahabadi S. Moebus R. Erbel K.H. Jöckel A. Stang 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2019,29(3):228-235
Background and aims
There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population.Methods and results
In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. For cross-sectional and longitudinal analyses, we included 1585 participants free of coronary heart disease at baseline, with CAC measurements at baseline and at follow-up, and with either normal weight (BMI 18.5–24.9 kg/m2) or obesity (BMI ≥30.0 kg/m2) at baseline. We used four definitions of MHO. In our main analysis, we defined obese persons as metabolically healthy if they met ≤1 of the NCEP ATP III criteria for the definition of the metabolic syndrome – waist circumference was not taken into account because of collinearity with BMI.Persons with MHO had a higher prevalence of CAC than metabolically healthy normal weight (MHNW) persons (prevalence ratio = 1.59 (95% confidence interval 1.38–1.84) for the main analysis). Persons with MHO had slightly larger odds of CAC progression than persons with MHNW (odds ratios ranged from 1.17 (0.69–1.99) to 1.48 (1.02–2.13) depending on MHO definition and statistical approach).Conclusion
Our analyses on MHO CAC associations add to the evidence that MHO is not a purely benign health condition. 相似文献966.
967.
目的 探讨济南市手足口病重症病例发病的危险因素,为早期识别重症病例,降低手足口病重症病例的发生提供科学依据。 方法 采用病例对照研究方法,病例组为86例手足口病重症病例,对照组为86例手足口病轻症病例,用问卷调查收集病例组和对照组的社会人口学特征、接触史、就诊史、临床症状、实验室诊断等信息,对重症病例危险因素分析采用单因素和多因素非条件logistic回归分析。 结果 单因素结果显示发病到就诊日期、初诊单位类型为村级、患儿出现发热、足部皮疹、口腔疱疹、臀部皮疹、咳嗽、呕吐、有病例接触史、EV71阳性在两组间差异有统计学意义。多因素非条件Logistic回归分析结果显示,患儿出现发热(OR=89.38)、口腔疱疹(OR=22.28)、臀部皮疹(OR=234.81)、呕吐(OR=23.90)、有病例接触史(OR=31.48)和EV71阳性(OR=71.65)是手足口病重症病例发病的危险因素。 结论 早期识别发热、口腔疱疹、臀部皮疹、呕吐等症状的患儿,对降低手足口病重症病例的发生具有一定的参考意义。提高EV71手足口病疫苗的接种率,可降低由EV71导致的重症手足口病病例的发生率。 相似文献
968.
目的探讨国产氨磺必利治疗迟滞性抑郁症的疗效和安全性。方法将162例迟滞性抑郁患者随机分为观察组(国产氨磺必利)和对照组(丙咪嗪),治疗12周后对疗效、不良反应发生率、治疗依从性及随访1年复发率等数据进行组间比较及统计学分析。结果观察组研究对象的痊愈率和总有效率分别为39.0%和91.4%与对照组的38.3%和88.9%进行组间比较,观察组具有一定优势,但差异无统计学意义(P>0.05);随访1年复发率的比较中,观察组优于对照组,且差异有统计学意义(P<0.05);观察组研究对象的不良发应率为14.8%,低于对照组的23.5%,且差异有统计学意义(P<0.05);在治疗依从性的比较中,观察组显著高于对照组,且差异有统计学意义(P<0.05)。结论国产氨磺必利在迟滞性抑郁症的治疗中具有疗效显著,安全性高,复发率低,治疗依从性高等优势,具有重要的临床价值,适于临床推广使用。 相似文献
969.
Raquel P. F. Guiné Patrícia Ferreira Ana Rita Roque Helena Pinto Andreia Tomás 《Journal of Culinary Science & Technology》2014,12(4):294-305
The aim of this work was to develop a new product, port wine “caviar,” consisting of products based on red and white port wines used in different concentrations. Sample R+ consisted of red port wine at a concentration of 90%, sample R- was red port at 75%, sample W+ was white port at 90%, and sample W- was white port at 75%, all (m/m). The use of two types of port is related to different colors and the two concentrations related to the intensity. The results from the sensory analysis showed that the red port “caviar” at 90% was the best among the products tested, either in the preference test or in the evaluation of the individual characteristics. Furthermore, the market study revealed that this product can be successfully commercialized, particularly for the gourmet kitchen, which is one the main usages identified by the respondents. 相似文献
970.