恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化临床研究

目的:探讨恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎(CHB)肝纤维化的疗效。方法:216例慢CHB肝纤维化患者按1:1随机分为采用恩替卡韦单药治疗的对照组和恩替卡韦联合复方鳖甲软肝片治疗的治疗组,各108例。疗程为48周,观察两组患者治疗前后的ALT、TBil、HBV DNA及肝硬度值(LSM)、APRI值,并进行比较。结果:治疗后两组患者ALT、TBil、HBV DNA水平均较治疗前明显降低,但两组比较,差异无显著性意义(P0.05);而治疗后两组患者的肝纤维化指标均有不同程度地下降,治疗组患者LSM值从(12.1±7.4)KPa降至(8.3±4.9)KPa、APRI值从(1.68±1.12)降至(0.76±0.87);对照组的LSM值从(13.1±7.8)KPa降至(9.8士5.5)KPa、APRI值从(1.76±1.23)降至(0.97±0.73),治疗组的降低幅度高于对照组(P0.05)。结论:恩替卡韦联合复方鳖甲软肝片治疗CHB肝纤维患者的疗效优于单用恩替卡韦。     

恩替卡韦联合复方鳖甲软肝片治疗早期乙型肝炎肝硬化临床观察

目的探索恩替卡韦联合复方鳖甲软肝片治疗早期乙型肝炎肝硬化的疗效。方法 43例乙型肝炎肝硬化患者接受恩替卡韦和复方鳖甲软肝片联合治疗,40例患者只给予恩替卡韦组治疗,观察1年。结果 12个月后联合治疗组及恩替卡韦组肝功能均明显恢复,两组比较差异无统计学意义;两组HBeAg阴转、HBeAg/HBeAb血清转换和HBV DNA阴转率无显著性相差（P〉0.05）;联合治疗组肝组织炎性活动度和纤维化程度改善更明显（t值分别为3.30和2.75,P均〈0.05）。结论恩替卡韦与复方鳖甲软肝片联合治疗早期乙型肝炎肝硬化有效。     

鳖甲煎丸联合恩替卡韦抗肝纤维化疗效观察

目的:本研究以慢性乙型肝炎肝纤维化患者为研究对象,通过Fibroscan测得的肝脏弹性测定值评估鳖甲煎丸抗肝纤维化的疗效。方法:选取本院感染科门诊乙型肝炎肝纤维化患者47例,随机分为鳖甲煎丸联合恩替卡韦研究组与单用恩替卡韦对照组,分别收集两组患者治疗前后肝功能及肝脏弹性测定值(LSM)等资料进行统计分析和比较。结果:两组患者治疗后肝功能总胆红素(TBil)、白蛋白(ALB)及丙氨酸氨基转移酶(ALT)均较治疗前改善(P0.05),治疗后两组患者肝功能比较,差异无统计学意义(P0.05);两组患者治疗后LSM与本组治疗前比较,差异有统计意义(P0.05),治疗后研究组患者LSM下降程度优于对照组,差异有统计学意义(P0.05)。结论:乙型肝炎肝纤维化患者应用鳖甲煎丸联合恩替卡韦,其抗肝纤维化作用优于单用恩替卡韦治疗。     

恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎患者疗效观察

目的 观察复方鳖甲软肝片联合恩替卡韦分散片（ETV）治疗慢性乙型肝炎（CHB）的临床疗效。方法 将138例慢性乙型肝炎患者随机分为复方鳖甲软肝片和恩替卡韦分散片联合治疗73例和恩替卡韦分散片单药治疗65例,观察两组患者肝功能、乙型肝炎病毒（HBV）血清学标志物、HBV DNA定量、肝纤维化指标、腹部彩超检查的变化及药物不良反应。结果 治疗48w后,两组患者肝功能与治疗前基线水平相比均显著改善[联合组治疗前后ALT为（118.7±70.9） U/L 对 （32.6±21.5） U/L,P＜0.01;ALB为（38.5±3.8） g/L 对 （43.2±4.5） g/L,P＜0.01];两组患者血清HBV DNA定量下降到检测水平以下的发生率分别为85.33％（64/73）和86.15％（56/65）,HBeAg血清学转换率分别为27.78%和15.15%（P>0.05）;在治疗48w时,联合治疗组血透明质酸（HA）和脾脏长径分别为（172.40±58.16） μg/L 和（10.15±0.12） cm,均较基线水平显著降低[（365.17±119.07） μg/L和（12.08±0.16） cm,P＜0.05],且联合治疗组疗效优于单药组[HA为（218.13±75.32） μg/L,脾脏长径（11.90±0.20）cm,P＜0.05]。结论 ETV 联合复方鳖甲软肝片治疗CHB患者疗效优于单用ETV,值得进一步验证。     

愈肝龙胶囊联合恩替卡韦治疗乙型肝炎肝纤维化临床观察

目的:研究愈肝龙胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化的临床疗效。方法:将符合纳入标准的116例慢性乙型肝炎肝纤维化患者随机分为观察组64例和对照组52例,两组患者均给予恩替卡韦抗病毒治疗,观察组加用愈肝龙胶囊。观察两组患者治疗前与治疗36个月后肝硬度值(LSM)、超声影像学指标(门静脉内径、脾脏厚度)、血清肝纤维化指标4项(HA、LN、C-Ⅳ、PC-Ⅲ)、肝功能(ALT、AST、PLT、Alb、TBil)、APRI指数的变化。结果:两组患者治疗36个月后,观察组的LSM值、肝纤维化指标(C-Ⅳ)、肝功能(ALT、AST、PLT、Alb、TBil)以及APRI指数优于治疗前(P<0.05),且与对照组比较差异有显著性意义(P<0.05)。结论:复方中成药愈肝龙胶囊联合恩替卡韦改善慢性乙型肝炎肝患者肝纤维化与肝功能的效果优于单用恩替卡韦。     

恩替卡韦联合复方鳖甲软肝片治疗乙型肝炎早期肝硬化疗效观察

目的：观察恩替卡韦联合复方鳖甲软肝片治疗早期乙型肝炎肝硬化的临床疗效。方法选择60例慢性乙型肝炎早期肝硬化患者,HBV-DNA 定量均≥105拷贝／mL,HBeAg 阳性,ALT 正常或轻微升高,肾功能正常,肝功能及Child-Pugh 分级均为 A、B 级,排除对其他抗病毒耐药株病例,随机分两组：治疗组30例采用恩替卡韦联合复方鳖甲软肝片治疗;对照组30例予单药恩替卡韦。用药总时间24个月,3个月、6个月、12个月、24个月分别评估 Child-pugh 分级并分别观察两组治疗前后肝功能、肝纤维化指标、HBeAg 及 HBV-DNA 转阴率的变化。结果两组患者肝功能复常率无显著性差异,但比较 Child-pugh 分级、肝纤维化指标等各项指标,治疗组均优于对照组,差异有统计学意义（P ＜0．05）。结论恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎早期肝硬化能显著抑制病毒进一步复制,降低血清 HA、LN、IV-C、PCⅢ指标,Child-Pugh 分级得以优化,肝功能得到明显改善及稳定疗效确切。     

复方鳖甲软肝片联合恩替卡韦治疗慢性乙型肝炎伴脾肿大患者疗效及相关影响因素分析

目的探讨复方鳖甲软肝片联合恩替卡韦治疗慢性乙型肝炎伴脾肿大患者疗效,分析影响疗效的因素。方法选取93例HBV DNA阳性慢性乙型肝炎伴脾肿大患者。采用随机数字表法分为对照组(n=46)和研究组(n=47)。对照组口服恩替卡韦,研究组口服恩替卡韦+复方鳖甲软肝片。收集并分析两组治疗前、后肝功能、肝纤维化指标、HBV DNA载量,脾脏弹性指数、脾脏大小及影响疗效的相关因素。结果两组治疗后肝硬化、肝纤维化、HBV DNA载量、脾脏大小及弹性指数均出现不同程度的改善。治疗后两组透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)、层黏蛋白(LN)水平均有下降,两组各指标治疗前后差异有统计学意义(P0.05);对照组Alb治疗前后差异无统计学意义(t=0.450,P0.05);治疗后,研究组脾脏弹性指数、脾脏大小和门静脉内径均显著改善(P0.05);对照组脾脏弹性指数和脾脏大小显著降低(P0.05),但门静脉内径无显著变化(t=0.496,P0.05)。研究组治疗有效率高于对照组(93.62%比73.91%,P0.05)、不良反应率低于对照组(2.13%比13.04%,P0.05)。多因素分析显示TBil(OR=3.016,P=0.001)、Ⅳ-C(OR=1.034,P=0.013)、复方鳖甲片治疗(OR=6.130,P=0.000)是影响慢性乙型肝炎伴脾肿大患者疗效的主要因素。结论复方鳖甲软肝片联合恩替卡韦治疗慢性乙型肝炎伴脾肿大可显著改善患者肝功能,降低肝硬化和脾脏肿胀程度,疗效显著。     

恩替卡韦联合扶正化瘀胶囊治疗慢性乙型肝炎肝纤维化73例疗效观察

目的观察恩替卡韦联合扶正化瘀胶囊治疗慢性乙型肝炎肝纤维化的临床疗效。方法选择73例慢性乙型肝炎肝纤维化患者,随机分为两组。联合组采用恩替卡韦联合扶正化瘀胶囊治疗,对照组采用单一恩替卡韦治疗,疗程12个月。观察两组患者治疗前后的症状体征、肝功能、HBV-M、HBV DNA、肝纤维化指标及肝脏影像学等变化。结果联合组患者治疗后乏力、纳差及肝区痛改善情况明显高于对照组(P<0.05);ALT下降及HBeAg转阴情况均优于对照组(P<0.05);但治疗后两组AST、TBIL、ALB、HBV DNA转阴率及腹胀情况比较差异无统计学意义(P>0.05);联合组肝纤维化指标降低较对照组明显(P<0.05);联合组门静脉内径及脾脏厚度缩小也优于对照组(P<0.05)。结论恩替卡韦联合扶正化瘀胶囊治疗慢性乙型肝炎肝纤维化具有较好的临床效果。     

复方中药阻断逆转肝纤维化：超越已知的前沿

肝纤维化是慢性乙型肝炎进展为肝硬化的必由之路，也是肝癌发生最重要的危险因素，因此阻断逆转肝纤维化是有效降低慢性乙型肝炎肝硬化和肝癌发生的重要策略。西医目前尚无治疗肝纤维化的有效药物和手段，在我国中药抗肝纤维化具有独特优势，但是由于缺乏严格规范的临床研究，导致缺少高质量循证医学证据支持。笔者团队在“十二·五”“十三·五”国家科技重大专项的资助下，开展了中药复方鳖甲软肝片联合恩替卡韦阻断逆转慢性乙型肝炎肝纤维化的多中心、随机、双盲、安慰剂对照临床研究，以肝活组织检查为标准，纳入1000例患者，确证复方鳖甲软肝片联合恩替卡韦阻断、逆转肝纤维化和肝硬化的确切疗效，并成为首个具有高质量循证医学证据支持的中医药抗肝纤维化研究成果，为全球慢性肝病患者带来巨大希望，助力中医药走向世界。本文重点就这一研究成果进行介绍并对中医药阻断逆转肝纤维化研究的现状和面临问题进行评述。     

恩替卡韦联合复方鳖甲软肝片治疗乙型肝炎肝硬化患者疗效观察

目的观察恩替卡韦联合复方鳖甲软肝片治疗HBVDNA阳性肝硬化的临床疗效。方法将59例乙型肝炎肝硬化患者随机分为治疗组30例和对照组29例,两组均应用恩替卡韦0.5mg/d治疗,治疗组在对照组基础上联合复方鳖甲软肝片治疗12个月。结果治疗12个月时,治疗组与对照组患者血清HBVDNA定量小于1000copies/ml者分别为96.7%(29/30)和96.6%(28/29),血清HBeAg阴转率分别为34.0%(5/16)和40.0%(6/15,P0.05);治疗组与对照组患者Child-Pugh计分分别由治疗前8.9±1.7和9.0±1.7降至治疗后5.2±1.1和7.2±1.3(P0.01);治疗后患者血清肝纤维化指标明显下降,而治疗组下降更显著。结论恩替卡韦联合复方鳖甲软肝片治疗HBVDNA阳性肝硬化有一定的协同作用,值得进一步验证。     

Effects of inspiratory muscle training in patients with heart failure

Aim

To investigate the effects of inspiratory muscle training (IMT) on functional capacity and balance, respiratory and peripheral muscle strength, pulmonary function, dyspnea, fatigue, depression, and quality of life in heart failure patients.

Methods

A prospective, randomized controlled, double-blinded study. Thirty patients with heart failure (NYHA II-III, LVEF<40%) were included. Sixteen patients received IMT at 40% of maximal inspiratory pressure (MIP), and 14 patients received sham therapy (15% of MIP) for 6 weeks. Functional capacity and balance, respiratory muscle strength, quadriceps femoris muscle strength, pulmonary function, dyspnea, fatigue, quality of life, and depression were evaluated.

Results

Functional capacity and balance, respiratory and peripheral muscle strength, dyspnea, depression were significantly improved in the treatment group compared with controls; quality of life and fatigue were similarly improved within groups (p < 0.05). Functional capacity (418.59 ± 123.32 to 478.56 ± 131.58 m, p < 0.001), respiratory (MIP = 62.00 ± 33.57 to 97.13 ± 32.63 cmH₂O, p < 0.001) and quadriceps femoris muscle strength (240.91 ± 106.08 to 301.82 ± 111.86 N, p < 0.001), FEV₁%, FVC% and PEF%, functional balance (52.73 ± 3.15 to 54.25 ± 2.34, p < 0.001), functional dyspnea (2.27 ± 0.88 to 1.07 ± 0.79, p < 0.001), depression (11.47 ± 7.50 to 3.20 ± 4.09, p < 0.001), quality of life, fatigue (42.73 ± 11.75 to 29.07 ± 13.96, p < 0.001) were significantly improved in the treatment group. Respiratory muscle strength (MIP = 78.64 ± 35.95 to 90.86 ± 30.23 cmH₂O, p = 0.001), FVC%, depression (14.36 ± 9.04 to 9.50 ± 10.42, p = 0.011), quality of life and fatigue (42.86 ± 12.67 to 32.93 ± 15.87, p = 0.008) were significantly improved in the control group.

Conclusion

The IMT improves functional capacity and balance, respiratory and peripheral muscle strength; decreases depression and dyspnea perception in patients with heart failure. IMT should be included effectively in pulmonary rehabilitation programs.     

Cardiac arrhythmias and sudden cardiac death in women

Zusammenfassung. Hintergrund: Geschlechtsspezifische Unterschiede bei Herzrhythmusstörungen sind seit Jahrzehnten bekannt. Einflüsse von Sexualsteroiden auf das autonome Nervensystem und die zelluläre Elektrophysiologie des Erregungsbildungs- und -leitungssystems werden ebenso diskutiert wie direkte genetische Dispositionen auf zellulärer, funktioneller oder metabolischer Ebene. Zudem gilt es, die alters- und geschlechtsspezifischen Unterschiede im Hinblick auf unterschiedliche kardiale Grunderkrankungen zu berücksichtigen, die ihrerseits Häufigkeit, Form und Schwere maßgeblich mitbestimmen. Herzrhythmusstörungen bei Frauen: Eine im Vergleich zu Männern höhere Ruhefrequenz und ein längeres QTc-Intervall, beginnend nach der Pubertät, sind die auffälligsten EKG-Veränderungen bei Frauen und weisen eine enge Beziehung zu konstitutionellen und hormonellen Einflüssen auf. Supraventrikuläre Herzrhythmusstörungen, bei Frauen prädestiniert Sinus- und AV-Knoten-Reentry-Tachykardien, seltener Wolff-Parkinson-White-Tachykardien, können zyklusabhängigen Häufigkeitsschwankungen unterliegen. Vorhofflimmern ist bei Frauen ebenfalls häufiger als bei Männern, meist typischerweise symptomatisch, und die Therapie erweist sich als problematischer. Ventrikuläre Herzrhythmusstörungen, in der gesunden Allgemeinbevölkerung gleich häufig, weisen bei Männern eine enge und prognostisch bedeutsame Beziehung zur KHK auf, während diese bei Frauen weniger ausgeprägt ist und arrhythmogene Kofaktoren eine größere Rolle spielen. Frauen leiden häufiger an erworbenem und kongenitalem Long-QT-Syndrom, in deren Folge häufiger Torsade de pointes-Tachykardien auftreten (u. a. durch ausgeprägtere medikamentös induzierte QT-Verlängerung, häufigere Kurz-Lang-Sequenzen, Unterschiede der Ikr-Sensitivität), die allerdings seltener als bei Männern in Kammerflimmern degenerieren. Frauen sind von einem plötzlichen Herztod etwa dreimal seltener betroffen. Er ereignet sich etwa zehn Jahre später; die zugrunde liegende Ursache ist deutlich heterogener als bei Männern, und die Prognose, ein solches Ereignis zu überleben, ist deutlich schlechter. Frauen sind in Studien zu Primär- und Sekundärprävention deutlich unterrepräsentiert, wenngleich der Nutzen dieser Therapie sogar den bei Männern zu übersteigen scheint. Schlussfolgerungen: Auch wenn die Genese der geschlechtsspezifischen Unterschiede von kardialen Arrhythmien in einer Reihe von Punkten noch offen ist, implizieren die dargestellten Befunde die besondere Notwendigkeit eines entsprechend ausgerichteten Forschungsansatzes, da sich nur so geschlechtsspezifische Risikostratifikations- und Therapieansätze für die Zukunft entwickeln lassen.     

Gut microbiota changes in patients with hypertension: A systematic review and meta-analysis

Hypertension is a major public health issue worldwide. The imbalance of gut microbiota is thought to play an important role in the pathogenesis of hypertension. The authors conducted the systematic review and meta-analysis to clarify the relationship between gut microbiota and hypertension through conducting an electronic search in six databases. Our meta-analysis included 19 studies and the results showed that compared with healthy controls, Shannon significantly decreased in hypertension [SMD = −0.13, 95%CI (−0.22, −0.04), p = .007]; however, Simpson [SMD = −0.01, 95%CI (−0.14, 0.12), p = .87], ACE [SMD = 0.18, 95%CI (−0.06, 0.43), p = .14], and Chao1 [SMD = 0.11, 95%CI (−0.01, 0.23), p = .08] did not differ significantly between hypertension and healthy controls. The F/B ratio significantly increased in hypertension [SMD = 0.84, 95%CI (0.10, 1.58), p = .03]. In addition, Shannon index was negatively correlated with hypertension [r = −0.12, 95%CI (−0.19, −0.05)], but had no significant correlation with SBP [r = 0.10, 95%CI (−0.19, 0.37)] and DBP [r = −0.39, 95%CI (−0.73, 0.12)]. At the phylum level, the relative abundance of Firmicutes [SMD = −0.01, 95%CI (−0.37, 0.34), p = .94], Bacteroidetes [SMD = −0.15, 95%CI (−0.44, 0.14), p = .30], Proteobacteria [SMD = 0.25, 95%CI (−0.01, 0.51), p = .06], and Actinobacteria [SMD = 0.21, 95%CI (−0.11, 0.53), p = .21] did not differ significantly between hypertension and healthy controls. At the genus level, compared with healthy controls, the relative abundance of Faecalibacterium decreased significantly [SMD = −0.16, 95%CI (−0.28, −0.04), p = .01], while the Streptococcus [SMD = 0.20, 95%CI (0.08, 0.32), p = .001] and Enterococcus [SMD = 0.20, 95%CI (0.08, 0.33), p = .002] significantly increased in hypertension. Available evidence suggests that hypertensive patients may have an imbalance of gut microbiota. However, it still needs further validation by large sample size studies of high quality.     

Clinical characteristics of non‐small cell lung cancer patients with EGFR mutations and ALK&ROS1 fusions

ObjectiveTo study the relationship between clinical characteristics and anaplastic lymphoma kinase (ALK) fusions, c‐ros oncogene 1, receptor tyrosine kinase (ROS1) gene fusions, and epidermic growth factor receptor (EGFR) mutations in non‐small cell lung cancer (NSCLC) patients to distinguish these different types.MethodsBoth ALK, ROS1 gene rearrangements and EGFR mutations testing were performed. The clinical characteristics and associated pulmonary abnormalities were investigated.ResultsFour hundred fifty‐three NSCLC patients were included for analysis. One hundred seventy (37.5%), 32 (7.1%), and 9 cases (2.0%) with EGFR mutations, ALK gene fusions, and ROS1 gene fusions were identified, respectively. The EGFR‐positive and ALK&ROS1‐positive were more common in female (χ ² = 61.934, P < 0.001 and χ ² = 28.152, P < 0.001), non‐smoking (χ ² = 59.315, P < 0.001 and χ ² = 11.080, P = 0.001), and adenocarcinoma (χ ² = 44.864, P < 0.001 and χ ² = 12.318, P = 0.002) patients; proportion of patients with emphysema was lower (χ ² = 35.494, P < 0.001 and χ ² = 15.770, P < 0.001) than the wild‐type patients. The results of logistic regression analysis indicated that female (adjusted odds ratio [OR] 1.834, 95% confidence interval [CI] 1.069–3.144, P = 0.028), non‐smoking (adjusted OR 2.504, 95% CI 1.456–4.306, P = 0.001), lung adenocarcinoma (adjusted OR 4.512, 95% CI 2.465–8.260, P < 0.001), stage III–IV (adjusted OR 2.232, 95% CI 1.066–4.676, P = 0.033), and no symptoms of emphysema (adjusted OR 2.139, 95% CI 1.221–3.747, P = 0.008) were independent variables associated with EGFR mutations. Young (adjusted OR 3.947, 95% CI 1.873–8.314, P < 0.001) and lung adenocarcinoma (adjusted OR 2.950, 95% CI 0.998–8.719, P = 0.050) were associated with ALK/ROS1 fusions.Conclusions EGFR mutations were more likely to occur in non‐smoking, stage III–IV, and female patients with lung adenocarcinoma, whereas ALK&ROS1 gene fusions were more likely to occur in young patients with lung adenocarcinoma. Emphysema was less common in patients with EGFR mutations.     

Arterial blood pressure and serum lipids in a population of children and adolescents from Southern Italy: The Calabrian Sierras Community Study (CSCS)

Background

Lipid standards in Italy are lacking in children and adolescents whereas those for blood pressure (BP) were derived from US surveys.

Methods

In a 14-town community in Southern Italy 1657 (64%) of 2594 children aged 6–14 years were enrolled and anthropometric, BP, lipid and glucose serum levels were obtained.

Results

Average systolic BP was 101 ± 11 (60–150) mm Hg and cholesterol (CholT) level was 156 ± 28 (57–264) mg/dl. There were positive (p < 0.00001) age-trends for systolic BP and body mass index (BMI) in both genders whereas age-trends for CholT and heart rate were negative (p < 0.00001). A negative age-trend in both genders was also seen for non-HDL cholesterol (p < 0.03). Based on 95% percentile gender and age distributions, there were 177 (10.68%) hypertensive (HT) and 82 (4.94%) hypercholesterolemic (HC) children or adolescents. Univariately, HT had higher (p < 0.00001) height, weight, BMI, arm circumference, hips, waist, diastolic BP and waist/height, whereas HC had higher LDL-, HDL and non-HDL-cholesterol and triglycerides (p < 0.01). Systolic BP was predicted (r² = 0.2810, p = 0.00001) by age (t = 2.319, p < 0.0205), male gender (t = 3.179, p < 0.0015), glucose (t = 2.357, p < 0.0186), height (t = 2.473, p < 0.0135), arm circumference (t = 3.313, p < 0.0009) and heart rate (t = 4.161, p < 0.00001). CholT was related inversely (r² = 0.1399, p = 0.00001) to height (t = − 3.928, p < 0.0001), weight (t = − 3.922, p < 0.0001) and waist/height (t = − 4.797, p < 0.00001) and directly to BMI (t = 3.064, p < 0.0022), waist (t = 5.149, p < 0.0000), triglycerides (t = 11.332, p < 0.00001) and female gender (t = − 2.041, p < 0.0414).

Conclusion

In these Southern Italian children and adolescents systolic BP and CholT are related with anthropometric and other variables, not confined to height. BP is lower than previously reported.     

Quality of life in young fibromyalgia patients and effect of depression

Aim: The purpose of this study was to compare the depression and quality of life (QOL) scores of fibromyalgia (FM) patients and control subjects. We also aimed to detect relationships between different QOL scales, depression and clinical symptoms. Method: Ninety‐eight fibromyalgia patients and 48 healthy volunteers were included in the study. Depression was evaluated by a psychiatrist according to the Hamilton Depression Rating Scale and Diagnostic and Statistical Manual for Mental Disorders Edition 4 (DSM‐IV) criteria. QOL of the FM patients was assessed according to the Nottingham Health Profile (NHP), Health Assessment Questionnaire (HAQ), and Fibromyalgia Impact Questionnaire (FIQ). Results: We found significantly higher scores of depression, NHP, FIQ and HAQ in FM patients compared with controls (P < 0.000). Pain, tender point count (TPC), pain intensity, skinfold tenderness, FIQ, HAQ, and NHP scores were higher in patients with depression than in those without depression. Depression scores correlated with FIQ (r = 0.39, P < 0.01), HAQ (r = 0.35, P < 0.01), NHP (r = 0.55, P < 0.01) scores, TPC (r = 0.34, P < 0.01) and duration of disease (r = 0.21, P < 0.05). Fibromyalgia Impact Questionnaire scores correlated with HAQ scores (r = 0.45, P < 0.01), NHP scores (r = 0.49, P < 0.01) and TPC (r = 0.21, P < 0.05). HAQ scores correlated with NHP scores (r = 0.40, P < 0.01) and TPC (r = 0.29, P < 0.05). Nottingham Health Profile scores correlated with TPC (r = 0.43, P < 0.01) and duration of disease (r = 0.22, P < 0.05). Conclusion: We found higher scores of TPC, pain intensity, skinfold tenderness, NHP, FIQ, and HAQ in depressive FM patients as compared with non‐depressive FM patients. Our study indicates that there is an important relationship between pain, depression and QOL scales in young FM patients. Therefore; these patients should be managed using a multidisciplinary approach including psychiatric support.     

Diabetes and pregnancy

Summary Pregnancy raises insulin requirement, lowers the renal threshold for glucose, increases the tendency to infection of the urinary tract and to renal insufficiency. Diabetic women are more prone to hydramnios, toxemia, stillbirths and neonatal deaths. Their infants, in contrast to their appearance (macrosomia), are immature and of low vitality. Congenital abnormalities, hyaline membrane disease, cardiac dilatation, hyperbilirubinemia, hypocalcemic tetany make their adaptation to extrauterine life difficult during the first few days. Good cooperation between internist, obstetrician, anesthesiologist and pediatrician considerably improves the prognosis of diabetic pregnancies.

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Zusammenfassung Schwangerschaft erhöht den Insulinbedarf, senkt die Nierenschwelle für Traubenzucker, steigert die Neigung zu Infektionen der Harnwege und zu Niereninsuffizienz. Diabetikerinnen neigen zu Hydramnion, Spättoxikose, Totgeburt und Neugeborenen-Todesfällen. Die Kinder zuckerkranker Mütter sind trotz ihrer Makrosomie unreif und lebensschwach. Missbildungen, hyaline Membranen, Herzerweiterung, Hyperbilirubinämie, hypokalzämische Tetanie erschweren während der ersten Tage die Anpassung an das extrauterine Leben. Gute Zusammenarbeit von Internist, Geburtshelfer, Narkosearzt und Pädiater verbessern die Prognose der Schwangerschaft bei zuckerkranken Frauen in wesentlichem Masse.

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Resumen El embarazo aumenta la necesidad de insulina, disminuye el dintel renal de la glucosa, aumenta la tendencia a las infecciones de las vias urinarias y a la insuficiencia renal. En las mujeres diabéticas son más frecuentes el hidramnios, la toxiemia, la natimortalidad y las muertes neonatales. Los recién nacidos de madre diabética, contrariamente a su aspecto (macrosomia), son inmaturos y escasamente vitales. Su adaptación a la vida extrauterina en los primeros días de vida se hace difícil a causa de anomalías congénitas, membranas hialinas, dilatación cardiaca, hiperbilirrubinemia y tetania hipocalcémica. Una buena collaboración entre internista, obstétrico, anestesista y pediatra mejora considerablemente el pronóstico de los embarazos diabéticos.

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Résumé La grossesse augmente le besoin en insuline, descend le seuil rénal pour glucose et agrandit la tendance à l'infection des voies urinaires et à l'insuffisance rénale. Chez les femmes diabétiques l'hydramnie est fréquente; elles sont disposées à la toxémie, aux mort-nés et à une mortalité exagérée des nouveau-nés. Les nouveau-nés des mères diabétiques sont immatures et de vitalité réduite malgré leur apparence macrosomique. Des malformations congénitales, des membranes hyalines, une dilatation aiguë du coeur, l'hyperbilirubinémie, une tétanie hypocalcémique rendent difficile l'adaptation à la vie extrautérine, surtout pendant les premiers jours. Une étroite coopération entre interniste, accoucheur, narcotiseur et pédiatre améliore considérablement le pronostic de la grossesse des diabétiques.

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Riassunto La gravidanza accresce il fabbisogno insulinico, abbassa la soglia renale per il glucosio, aumenta la disposizione alle infezioni delle vie urinarie e all'insufficienza renale. Nelle donne diabetiche sono più frequenti l'idramnios, la tossiemia, la natimortalità e le morti neonatali. I neonati di madre diabetica, contrariamente al loro aspetto (macrosomia), sono immaturi e scarsamente vitali. Il loro adattamento alla vita extrauterina nei primi giorni di vita è reso difficile da anomalie congenite, membrane ialine, dilatazione cardiaca, iperbilirubinemia e tetania ipocalcemica. Una buona cooperazione tra internista, ostetrico, anestesista e pediatra migliora considerevolmente la prognosi delle gravidanze diabetiche.

     

Predictive Factors of Severe Behçet's disease: A Longitudinal,Prospective Cohort Followed Between 1981–2020

IntroductionBehçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described.ObjectivesTo evaluate clinical factors associated with manifestations of severe disease in a single-center cohort.MethodsA longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points.ResultsWe included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N = 243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR = 2.004, p = 0.024), increasing with age (OR = 1.021 per year, p = 0.037), in the presence of skin manifestations (OR = 4.711, p < 0.001), specifically erythema nodosum (OR = 8.381, p < 0.001), and pseudofolliculitis (OR = 2.910, p < 0.001).In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR = 1.961, p = 0.047), erythema nodosum (Adjusted OR = 8.561, p < 0.001) and pseudofolliculitis (Adjusted OR = 2.372, p = 0.007).DiscussionMale gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.     

Doppler parameters of ophthalmic artery in women with preeclampsia: A meta-analysis

Preeclampsia is a progressive and severe cardiovascular disorder in pregnant women. To determine the potential significance of ophthalmic Doppler parameters in preeclamptic women and to provide evidence-based hints for clinical practice and scientific investigation. We searched PubMed, Embase, Web of Science, and the Cochrane Library till July 31, 2022. Pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random effects model. Heterogeneity across included studies was evaluated utilizing the Q test and I² statistic. We identified 8 observational studies that met the inclusion criteria. The pooled SMD for peak systolic velocities (PSV) was .12 (95% CI: −.82, 1.06, p = .8071; I² = 94%, p < .0001). The overall SMD for time-averaged mean peak velocities (MV) was 1.79 (95% CI: .87, 2.71, p = .0001; I² = 60%, p = .1152). Regarding the pulsatility index (PI), the pooled SMD was −2.05 (95% CI: −3.12, −.98, p = .0002; I² = 92%, p < .0001). Overall SMD for end-diastolic velocities (EDV) was 1.11 (95% CI: .23, 1.98, p = .0136; I² = 92%, p < .0001). The pooled SMDs for resistance index (RI) and peak ratio (PR) was −.18 (95% CI: −1.90, 1.53, p = .8333; I² = 96%, p < .0001) and 1.46 (95% CI: −1.30, 4.22, p = .2994; I² = 99%, p < .0001), respectively. Publication bias was not identified. MV, PI, and EDV showed significant differences between patients with preeclampsia and non-hypertensive pregnant participants. Studies on the predictive performance of ophthalmic artery Doppler parameters are warranted.     

Inpatientvs. outpatient bowel preparation for elective colorectal surgery

BACKGROUND: Recent pressures to decrease the cost of medical care have mandated preoperative outpatient bowel preparation (OBP) for elective colorectal surgery without any data documenting equivalent quality of care. This study examined the safety and efficacy of OBP compared with inpatient bowel preparation (IBP). METHODS: Records of all patients who underwent OBP for elective colorectal resection since the inception of the OBP program from July 1993 to June 1994 were compared with records of all patients who received IBP for elective procedures from January to June 1993. RESULTS: The two groups, 90 patients who underwent OBP and 98 patient who had IBP, were well matched for age, sex, diagnosis, and operations performed. The OBP group had a shorter length of hospital stay (median, 7 vs. 9 days; P < 0.0001; chi-squared analysis), whereas the complication rate was similar (19 percent in the OBP group vs. 18 percent in the IBP group), including infectious complications (10 percent in the OBP group vs. 7 percent in the IBP group). Although operating time was similar (mean, 199 vs. 213 minutes) and estimated blood loss (mean, 528 vs. 536 ml), the OBP group had significantly higher perioperative fluid requirements: intraoperative fluids (median, 4300 vs. 3700 ml; P < 0.05; Student's t-test), intraoperative colloid administration (48 vs. 29 percent; P < 0.0002; chi-squared), 24-hour postoperative fluids (3224 vs. 2700 ml; P < 0.0001; Student's t-test), and postoperative fluid challenges (50 vs. 20 percent; P <0.0001; chi-squared analysis). CONCLUSION: Outpatient bowel preparation for elective colorectal surgery is safe and effective. It offers shorter hospital stay, and, therefore, potentially reduces medical care cost. Patients with multiple medical problems may not tolerate extensive fluid shifts; therefore, other preoperative arrangements, such as inpatient or outpatient intravenous fluid therapy, need to be considered to minimize complications that may outweigh potential cost savings.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.