主肺动脉窗合并重度肺动脉高压的诊疗

目的 通过本中心近年来主肺动脉窗(APW)的外科治疗经验,总结APW合并重度肺动脉高压的外科治疗及手术效果.方法 回顾性分析西京医院心血管外科2010～2018年收治的23例APW患者的临床症状、病理分型、合并畸形、诊断、治疗和预后资料.其中男9例、女14例,体重3.3～35.0(17.3±3.6)kg,年龄3个月至1...     

A systematic review on randomized control trials on rennin angiotensin aldosterone system inhibitors role in managing hypertension among hemodialysis patients

Randomized control trials (RCTs) are considered as most rigors way of determining the cause–effect relationship of a treatment and outcome. Activation of rennin angiotensin aldosterone system (RAAS) is an important contributor to hypertension in hemodialysis patients. The prevalence of hypertension in hemodialysis patients varies from 60% to 80% and hypertension management alone with conventional hemodialysis is insufficient. Hence, the current review was aimed to investigate the effect of RAAS inhibitors in managing hypertension among hemodialysis patients in a randomized control trial. Using PUBMED and EMBASE databases, randomized control trial with primary or secondary outcomes related to the effect of RAAS inhibitors on blood pressure among hemodialysis patients were included for analysis. The current review also assessed the quality of reporting of RCT. A total of eight RCT met inclusion criteria for current review. According to modified jaded scale, one (12.5%) study scored four points for quality reporting, whereas two (25%) studies scored one point that was the least score. The mean score for all included studies was 2.25. Six (75%) of the eight RCT included, involved ARB in hypertension management among hemodialysis patients, whereas two (25%) studies involved angiotensin-converting enzyme (ACE) inhibitors. Of the siz RCT involving ARB, two (33.3%) RCT also included ACE inhibitors comparison group. Altogether six (75%) studies report a reduction in blood pressure with the use of RAAS inhibitors compared to control group; however, of the six studies, two (33.3%) reported that the reduction in blood pressure was not significant. Whereas, two (25%) studies reported no reduction in blood pressure compared to the control group. The findings from current review do not indicate a clear pattern for a role of RAAS inhibitors for hypertension control among hemodialysis patients.     

Systematic literature review of clinical trials evaluating pharmacotherapy for overactive bladder in elderly patients: An assessment of trial quality

Aims

Overactive bladder (OAB) disproportionately affects older‐aged adults, yet most randomized controlled trials (RCTs) underrepresent patients ≥65. This systematic literature review (SLR) identified RCTs evaluating β‐3 adrenergic agonists or muscarinic antagonists in elderly patients with OAB, and compared study quality across trials.

Methods

MEDLINE^®, Embase^®, and Cochrane Collaboration Central Register of Clinical Trials databases were searched from inception through April 28, 2015 to identify published, peer‐reviewed RCT reports evaluating β‐3 adrenergic agonists or muscarinic antagonists in elderly OAB patients (either ≥65 years or study‐described as “elderly”). To assess study quality of RCT reports, we focused on internal/external validity, assessed via two scales: the validated Effective Public Health Practice Project [EPHPP]): Quality Assessment Tool for Quantitative Studies, and a tool commissioned by the Agency for Healthcare Research and Quality (AHRQ).

Results

Database searches yielded 1380 records that were then screened according to predefined inclusion/exclusion criteria. We included eight papers meeting study criteria. Despite scientific community efforts to improve RCT reporting standards, published reports still include incomplete and inconsistent reporting—of subject attrition, baseline patient characteristics, inclusion/exclusion criteria, and other important details. Only three of the eight OAB RCTs in this review received quality ratings of Strong (EPHPP) or Fair (AHRQ) and were multicenter with large samples.

Conclusions

Despite the prevalence of OAB among older age individuals, relatively few RCTs evaluate OAB treatments explicitly among elderly subjects. The findings from this quality assessment suggest some areas for improvement in both conduct and reporting of future RCTs assessing OAB treatment in elderly.     

西地那非治疗勃起功能障碍的有效性:中文文献的meta分析

目的评价西地那非治疗ED的有效性。方法通过中国生物医学文摘光盘(CBMdisc 2004新版)和清华同方数据库中CHKD期刊全文库检索公开发表的中文文献。凡摘要或方法中出现随机对照字样,无论有无盲法均予纳入。对纳入的试验设计特征用Jadad计分评价。以IIEF中Q3和Q4评分及IIEF总评分为疗效指标,采用RevMan4．1软件进行Meta分析。结果共有9个随机对照试验被纳入。其中6个为Jadad计分3分以上高质量试验。5个试验的IIEF Q3和Q4评分meta分析,OR=8．83,95％CI为(6．67,11．69),P<0．0001。4个高质量试验的IIEF总评分meta分析OR=13．76,95％CI为(9．50,19．92),P<0．0001。显示西地那非能够显著提高ED患者的疗效指标。结论西地那非能有效改善男性勃起功能,是一种有效治疗ED的口服药物。     

男性骨质疏松与冠心病相关性的Meta分析

目的运用Meta分析探究男性骨质疏松与冠心病之间的关系。方法检索中外文献数据库,包括Pubmed、Cochrane、Embase、CNKI、万方数据库、维普中文科技期刊全文数据库(VIP)和中国生物医学文献数据库(CBM)等,检索时间自建库至2020年6月,通过纳入、排除标准筛选合适的文献,根据Newcastle-Ottawa Scale (NOS)量表评价文献质量,应用Review Manager5.3软件进行数据分析。结果最终纳入11篇文献,共涉及1 962例患者,包括骨质疏松组603例,非骨质疏松组(骨量减少和骨量正常) 1 359例。Meta分析结果发现,男性骨质疏松组冠心病的发病率显著高于非骨质疏松组(OR=1.43,95%CI 1.14～1.79,P0.05);根据患者不同年龄段进行亚组分析,中年男性骨质疏松组冠心病的发病率与非骨质疏松组相比无统计学意义(OR=0.92,95%CI 0.23～3.69,P 0.05),但老年男性骨质疏松组冠心病的发病率显著增高(OR=1.86,95%CI1.12～3.08,P0.05);根据患者不同骨量减少程度进行亚组分析,中、老男性骨量减少组冠心病的发病率与骨量正常组相比均无统计学意义(中年男性OR=1.25,95%CI 0.66～2.36,P0.05;老年男性OR=1.11,95%CI 0.35～3.53,P0.05)。结论老年男性骨质疏松与冠心病的发病率密切相关,中年男性骨质疏松与冠心病的发病率无明显相关性,且中、老年男性骨量减少与冠心病的发病率无明显相关性。     

Efficacy of nifedipine or lisinopril in the treatment of hypertension after renal transplantation: a double-blind randomised comparative trial

Calcium channel blockers and angiotensin converting enzyme-inhibitors are commonly used in the treatment of hypertensive renal transplant recipients. The purpose of this study was to investigate if the response rate to treatment differs with these drugs in this setting. A single centre, prospective, randomised, double-blinded, comparative study to address the efficacy of controlled release nifedipine or lisinopril in the treatment of hypertension (diastolic blood pressure > or =95 mmHg) in cyclosporin (CsA)-treated renal transplant recipients was performed. Recipients were randomised to receive either lisinopril (10 mg once daily) or controlled release nifedipine (30 mg once daily). The dose was doubled on indication. The number of responders (diastolic blood pressure <90 mmHg on monotherapy) were addressed during the early post-transplant phase (first 3 months) and during a late post-transplant phase (from 3 to 12 months after renal transplantation) in the same patient population. One hundred and fifty-four patients (nifedipine=78, lisinopril=76) with untreated hypertension (diastolic blood pressure> or =95 mmHg) were randomised within 3 wk after renal transplantation. One hundred and twenty-three patients (nifedipine=69, lisinopril=54) completed the study. Fourteen (20%) nifedipine-treated recipients responded during the early, and 26 (38%) during the late post-operative phase (months 4-12 after renal transplantation). Eleven (20%) lisinopril-treated recipients responded during the early, and 18 (33%) during the late post-transplant phase. Non-responders were, on average, 8.5+/-1.5 kg heavier both in the early phase and after 1 yr of treatment (p<0.01), and 6.1+/-0.9 yr older than responders (p<0.05). In conclusion, these results indicate that both controlled release nifedipine and lisinopril are equally efficient in the treatment of post-transplant hypertension. As monotherapy, both drugs show a "response rate" of 20-38%, depending on time interval after transplantation.     

Effect of antihypertensive agents on plasma adiponectin levels in hypertensive patients with metabolic syndrome

AIM: Plasma adiponectin levels are well associated with metabolic syndrome. However, the relationship between hypertension and plasma adiponectin levels is not clear. Also, there is not enough data about the effects of different antihypertensive regimens on plasma adiponectin levels. METHODS: Ninety-six hypertensive patients (48 male, 48 female) who fulfil the diagnostic criteria of metabolic syndrome were enrolled. Patients were treated for 3 months with metoprolol (n = 18, 100 mg/day), amlodipine (n = 20, 10 mg/day), doxazosin (n = 18, 4 mg/day), ramipril (n = 20, 5 mg/day) and valsartan (n = 20, 80 mg/day). Blood biochemistry and plasma adiponectin concentrations were measured both before and after the study. Insulin resistance was measured by homeostasis assessment index (HOMA). RESULTS: Plasma adiponectin levels were correlated with the total cholesterol (r = -0.244, P = 0.017), triglyceride (r = -0.306, P = 0.002), high-density lipoprotein-cholesterol (r = 0.286, P = 0.005), body mass index (r = -374, P < 0.001), systolic (r = -502, P < 0.001) and diastolic blood pressures (r = -235, P = 0.021). The independent predictors of plasma adiponectin levels were HOMA (beta = -0.199, P = 0.02), body mass index (beta = -0.313, P < 0.001) and systolic blood pressures (beta = -0.483, P < 0.001). Ramipril and valsartan increased the plasma adiponectin levels significantly higher than the other regimens (P < 0.05 for both) while metoprolol did not make a significant effect. CONCLUSION: According to the results, plasma adiponectin levels are associated with the arterial blood pressures, body fat content and the lipid parameters in hypertensive patients with metabolic syndrome. The effects of antihypertensive drugs on plasma adiponectin levels are parallel to their effects on blood pressures and insulin sensitivities. The different effects of several regimens on plasma adiponectin levels and insulin sensitivities may account for the diversity of the cardiovascular outcomes in patients with hypertension.     

出院指导对预防老年心力衰竭复发的影响

目的：探讨护理干预对老年心力衰竭（心衰）病人复发再入院的影响。方法：将134例60－86岁心衰住院病人出院时随机分为观察组71例和对照组63例。观察组出院时由专职护士进行心衰相关知识健康教育、个别化用药指导、饮食指导及出院后定期护理随访指导；对照组则进行常规出院指导。观察90d内因心衰复发再入院率、两次以上再入院率和病死率。结果：90d内再入院率和两次以上再入院率，观察组分别为31．0％和9．9％，对照组为49．2％和22．2％（P＜0．05）；病死率，观察组5．6％，对照组9．5％（P＞0．05）。结论：加强心衰病人出院后的护理及健康教育有助于减少心衰复发率。     

Efficacy of uremic pruritus treatment in patients undergoing hemodialysis,a network meta-analysis for randomized clinical trials

IntroductionUremic pruritus is very common in hemodialysis or renal failure patients, there were lots of available treatments such as gabapentin, pregabalin, ondansetron, etc. However, there is no quantified study comparing these treatments together, it is impossible to conduct a clinical trial involving so many treatments, so we conduct a network meta-analysis to compare them.MethodWe collected mean difference and standard error of visual analogue scale data as outcome. In total we collected 15 articles, 15 articles, 1180 subjects and 6 treatments included to this study.ResultsIn these comparisons, gabapentin showed the largest effect MD: 5.19, 95% CI [3.77, 6.61], anti-histamine MD: 4.65, 95% CI [2.22, 7.07] and pregabalin MD: 4.62, 95%CI [2.71, 6.62] showed a similar effect. Opioid pathway related treatment also showed a significant but not so large effect MD: 2.45, 95% CI [0.41, 4.49]. Ondansetron and Doxepin didn’t show a significant improvement among placebo, the overall quantifying heterogeneity I² = 43.1%. There is no statically difference between gabapentin, pregabalin and anti-histamine treatments.ConclusionsSo we conclude that gabapentin, pregabalin and anti-histamine has a similar efficacy on pruritus control.     

Surgical Treatment for Ischemic Heart Failure (STICH) trial: A review of outcomes

Coronary artery disease (CAD) is a significant source of morbidity and mortality in developed countries. The landmark Surgical Treatment for Ischemic Heart Failure (STICH) trial has provided greatly needed evidence in the management of patients with severe left ventricle (LV) dysfunction (LVEF ≤ 35%) and CAD amenable to revascularization. The trial investigated two primary hypotheses: (i) that coronary artery bypass grafting (CABG) with optimal medical therapy (OMT) was superior to OMT alone, and (ii) that CABG with surgical ventricular reconstruction (SVR) would be superior to CABG alone. The results of the 10‐year follow‐up demonstrated significant long‐term benefits with the addition of CABG to OMT. However, the second hypothesis yielded controversial results as the study found no difference between CABG with SVR and SVR alone. The STICH trial, and the numerous subanalyses that followed have reinforced and challenged a number of widely held beliefs regarding the management of patients with severe LV dysfunction and ischemic heart failure. The purpose of this comprehensive review is to outline the published data from the STICH trial and its substudies while providing a balanced assessment of the evidence‐based conclusions and criticisms that have followed.     

胰源性左侧门静脉高压症的诊断和治疗(文献复习并附67例报告)

目的 探讨胰源性左侧门静脉高压症（PSPH）的诊断及治疗方法。方法 回顾性分析作者医院自2000年1月至2004年12月收治的15例PSPH及复习国内近10年报道的52例PSPH的临床资料。结果 诊断方法主要为超声、CT、MRA（磁共振三维重建血管造影）、胃镜及腹腔动脉造影。8例（8／67）行单纯脾切除术，23例（23／67）行单纯脾切除＋胰腺原发病治疗，13例（13／67）行脾切除＋贲门周围血管离断术，21例（21／67）行脾切除＋贲门周围血管离断＋胰腺原发病治疗，2例（2／67）行脾动脉栓塞＋曲张出血静脉硬化术。术后随访率89．6％（60／67），随访12—53个月，平均33．1个月。1例行单纯脾切除未断流者于术后13个月出现呕血，余59例病例术后均无再出血发生。结论 胰源性左侧门静脉高压症的治疗应遵循“个体化原则”。对于无上消化道出血病史者，可行单纯脾切除术；对于有出血病史者应根据具体情况，可采取脾切除＋贲门周围血管离断术、脾动脉栓塞术、内镜下曲张静脉硬化等方法，并且应同时重视对胰腺原发病的治疗。     

老年稳定性冠心病患者认知衰弱风险预测模型的建立

目的 建立老年稳定性冠心病患者认知衰弱风险的列线图模型,为临床早期识别和干预提供参考.方法 便利选取848例老年稳定性冠心病患者,采用 自制一般资料调查表、蒙特利尔认知评估量表、临床痴呆评定量表、衰弱表型量表进行评估;Logistic回归分析确定认知衰弱的独立危险因素,同时建立认知衰弱风险列线图预测模型并进行内部验证....     

Treatment of hypertension in renal disease

Experimental and clinical evidence are summarized that support the hypothesis that enhanced transmission of systemic hypertension to the adapted glomerulus in the setting of reduced nephron mass may be responsible for accelerated vascular and glomerular damage in the hypertensive stage of parenchymal renal disease in man. In experimental models of hypertension associated with reduced renal mass, the kidney appears to be damaged directly by transmission of pressure rather than primarily through vasoconstriction and ischemia. When hypertension is combined with models of glomerular disease, vascular and glomerular injury are aggravated. It is proposed that adaptive glomerular hemodynamic alterations which occur in parenchymal renal disease magnify the transmission of increased pressure and flows when hypertension supervenes. Accelerated vascular and glomerular damage and functional deterioration result. According to this hypothesis, control of systemic hypertension and minimization of hydraulic stress on the diseased glomerulus become critical to the management of chronic renal disease and the prevention of progressive renal insufficiency.     

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced neck of femur fracture

Displaced neck of femur fracture is a common clinical problem among the elderly population. Our aim is to review previously published randomized controlled trials to establish if total hip arthroplasty (THA) or hemiarthroplasty will offer a superior clinical outcome in this group of patients. We conducted literature search for relevant randomized controlled trials. A total of 407 patients from 3 trials were included in this meta-analysis. In the long-term follow-up, we found that THA patients were able to ambulate better, reported less pain compared with their hemiarthroplasty counterparts, and were less likely to undergo a repeated hip surgery. Considering the more favorable long-term outcomes in THA patients, we conclude that there may be a case to offer THA as the primary treatment of these patients.     

Personal reflections on the surgical treatment of portal hypertension

Reports, early in this century, on the treatment of portal hypertension by surgical diversion of the portal blood flow about the liver were largely ignored because of the anticipated high mortality. Whipple, Blakemore and Lord in the early 1940's described a technique of performing a splenorenal or portacaval shunt with an epithelial lined vitallium tube. Blalock, whom I assisted, was one of the first outside of the Whipple Group to successfully perform such an operation. Although he used the vitallium tube technique in his first cases he soon became convinced that the results were better with a direct suture anastomosis. Venous shunts, which seemed such a logical way to treat portal hypertension, were widely and quickly adopted. Little attention was paid to the problem of portal encephalopathy which had been described in experimental animals years before by Pavlov. As some of the follow up studies on these shunted patients began to appear it was evident that this was a common and at times a severe problem. Some of the earliest doubts about the shunt operation were expressed by surgeons in Japan. The most successful methods developed to date for the treatment of portal hypertension provided a shunt for blood from the esophageal variceal region while at the same time preserving portal blood flow through the liver. Two of these methods have been (1) the distal or selective splenorenal shunt proposed by Warren & Zeppa and (2) the coronary caval shunt first described by Inokuchi. These methods, although somewhat more difficult technically than end to side portacaval shunts, reduce portal hypertension and preserve blood flow through the liver thereby lowering significantly the incidence of encephalopathy. The vascular stapling instrument developed by Professor Inokuchi in the 1950's has allowed him to perform this and other types of difficult vascular surgery with excellent results.