Infectious endocarditis: degree of discordance between clinical guidelines recommendations and clinical practice

INTRODUCTION AND OBJECTIVES: The present study was made to investigate the degree of discordance between the recommendations of clinical guidelines and actual practice in the care of patients with infectious endocarditis. MATERIAL AND METHODS: Data was gathered on 34 patients that were admitted to our hospital for native valve infection over a 4-year period. The degree of discordance (%) was obtained by comparing each clinical history with a catalog of 15 specific actions recommended in the clinical guidelines for four consecutive phases: pre-diagnosis, hospital diagnosis, antibiotic treatment, and surgical treatment. A system was constructed, scoring each phase with the greatest detected error (on a severity scale of 0 to 8 points) and adding together the scores for the four phases. RESULTS: The mean degree of discordance was 30.5% (range, 0-66%). Scores of more than six points were clearly associated with an unfavourable evolution. CONCLUSIONS: The recommendations of clinical guidelines for infectious endocarditis are inadequately followed in practice, which can affect the course of the disease. It is necessary to increase adherence to clinical guidelines in practice, in order to improve the care of patients with this serious disease.     

转化医学:基础研究与临床应用间的纽带

转化医学(translational medicine)是欧美生物医学界于上世纪末提出的一个新概念,其目的主要是促进基础研究成果向临床应用的转化。后来其概念进一步演变,内涵和外延不断加深和拓展,目前转化医学通常泛指以解决疾病预防、诊断和治疗等实际问题为导向的医学科研活动,既包括从基础研究成果转化为临床应用的科研活动,也包括从临床问题出发凝练出科学问题、在实验室研究出解决问题的方法再应用于临床的过程。     

Loose stools during auranofin treatment: clinical study and some pathogenetic possibilities

Loose stools, one of the most frequent adverse reactions ascribed to the orally absorbed gold compound auranofin (AF), was studied during a longterm trial. At some time during the study 44% of 25 patients reported the occurrence of loose stools. No infection or signs of malabsorption were found; nor were loose stools caused by the presence of osmotically active substances in the gut lumen. Arguments for a direct effect of AF on the ion and water absorption in the intestine are given. Although no morphological studies on biopsy material are available, the known side effects of the drug do not seem to warrant its discontinuation in suitable patients.     

Unexpected connections between Burnside groups and knot theory

In classical knot theory and the theory of quantum invariants substantial effort was directed toward the search for unknotting moves on links. We solve, in this article, several classical problems concerning unknotting moves. Our approach uses a concept, Burnside groups of links, that establishes an unexpected relationship between knot theory and group theory. Our method has the potential to be used in computational biology in the analysis of DNA via tangle embedding theory, as developed by D. W. Sumners [Sumners, D. W., ed. (1992) New Scientific Applications of Geometry and Topology (Am Math. Soc., Washington, DC) and Ernst, C. & Sumners, D. W. (1999) Math. Proc. Cambridge Philos. Soc. 126, 23-36].     

The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD

BACKGROUND/AIMS: The National Kidney Foundation (NKF) recently published new guidelines and clinical practice recommendations for the diagnosis and management of patients with diabetes and chronic kidney disease (CKD). METHODS: Guidelines were developed using an evidence-based approach. When sufficient evidence was lacking, recommendations were developed that reflect expert opinion. RESULTS: Guidelines describe the process for screening and diagnosis of kidney disease in the setting of diabetes and the management of hyperglycemia, hypertension, dyslipidemia, and nutrition. Recommendations describe the management of albuminuria in the normotensive diabetic patient and the potential value of albuminuria as a marker of treatment efficacy; the impact of diabetes and CKD in special populations; the importance of behavioral self-management; and the value of intensive multifaceted intervention in these high risk patients. CONCLUSIONS: The new guidelines and recommendations update and extend the scope of the NKF's Kidney Disease Outcomes Quality Initiative (KDOQI(TM)).     

Drug interactions between antineoplastic and antiretroviral therapies: Implications and management for clinical practice

Despite the impact of combined antiretroviral therapy (cART) on human immunodeficiency virus (HIV)-related mortality, malignancies remain the second most common cause of death in HIV infection in developed countries. In addition to the AIDS-defining malignancies, other cancers such as Hodgkin's lymphoma and anal cancer, are more frequent in HIV-infected patients who survive longer even though they do not have complete immune restoration The use of concomitant antineoplastic chemotherapy and cART have been demonstrated to be feasible and effective in patients with HIV-related malignancies; however, many drugs used in cART regimens have the potential for causing drug interactions as a result of their ability to either inhibit or induce the cytochrome P450 (CYP) enzyme system. Since many antineoplastic drugs are also metabolised by the CYP system, co-administration with cART could result in either drug accumulation and possible toxicity, or rapid drug metabolism and decreased efficacy. Unfortunately, very limited prospective interaction data are available to safely guide the combined use of cART and chemotherapy. This paper reviews the potential drug interactions and therapeutic considerations of the antiretroviral agents used to treat HIV and the most common anticancer agents used in the treatment of malignancies found in patients with HIV infection.     

氮氧化钛生物有效性支架与雷帕霉素药物洗脱支架临床应用的比较

目的:对比氮氧化钛生物有效性支架(Titan2-BAS)与雷帕霉素药物洗脱支架(sirolimus-eluting stent,SES)在冠状动脉血运重建方面的临床疗效。方法:冠心病患者141例,根据植入的支架不同分为A组(Titan2-BAS)87例,B组(SES)54例,A组病变内径(3.1±0.4)mm,长度(24±3)mm,B组病变内径(3.0±0.5)mm,长度(22±4)mm,两组无显著差异。均采用经桡动脉或尺动脉途径冠脉血运重建。A组阿司匹林与氯吡格雷治疗1~3月,B组至少12月。计算A,B两组支架病变的通过率、早期支架内血栓发生率及随访MACE发生率(指死亡、急性心肌梗死、靶血管重建等)。结果:A组146处75%狭窄病变共植入Titan2-BAS 168枚,1枚支架未能通过病变(RCA),通过率99.3%;B组86处病变共植入SES94枚,通过率100%,两组无显著差异。随访1~17(平均5.8)月。两组均无死亡病例;A组无急、晚期血栓。B组1例术后2 d出现支架内血栓;A组1例术后3月行靶血管重建,B组无靶血管重建;两组MACE发生率无显著差异。结论:Titan2-BAS与SES在冠脉血运重建方面的近期及远期疗效相近,Titan2不增加MACE发生率。     

Sleep, health, and aging. Bridging the gap between science and clinical practice

Problems with sleep are common with advancing years and occur in over half of adults age 65 and older. It has been estimated that insomnia affects about a third of the older population in this country. This inability to have restful sleep at night results in excessive daytime sleepiness, attention and memory problems, depressed mood, falls, and lowered quality of life. Other factors associated with aging, such as disease, changes in environment, or concurrent age-related processes also may contribute to problems of sleep. Data indicate that age by itself does not predict incident complaints of insomnia, even in the presence of lowered sleep efficiency and decreased proportion of slow-wave sleep. Rather, the prevalence of insomnia and other sleep disorders is high in the geriatric population due to the associated comorbidities common in late life. It is now evident that disturbance in sleep can also lead to adverse changes in functioning of a number of body systems.