《2016年欧洲心脏病学会/欧洲动脉粥样硬化学会血脂异常管理指南》解读

<正>2016年8月,欧洲心脏病学会(European Society of Cardiology,ESC)和欧洲动脉粥样硬化学会(European Atherosclerosis Society,EAS)联合发布了欧洲血脂异常管理指南(以下简称《2016年指南》)[1]。《2016年指南》以《2011年ESC/EAS血脂异常管理指南》(以下简称《2011年指南》)[2]为基     

论长短而取舍,察异同以会通:欧美高血压新指南带给我们的启示

正继2017年美国高血压指南引起波澜之后,2018年6月9日,欧洲心脏病学会(European Society of Cardiology,ESC)和欧洲高血压学会(European Society of Hypertension,ESH)联合发布了新的欧洲高血压指南的要点[1]。欧洲新指南虽然仍坚持了原有高血压定义,但在内容上积极跟进、推荐了更强力的降压策略。深入探讨欧美指南的长短与异同,无疑更有益于确定     

2023年欧洲高血压学会新版高血压管理指南简评

<正>2023年6月24日,在意大利米兰召开的第33届欧洲高血压与心血管保护大会上,欧洲高血压学会(European Society of Hypertension,ESH)发布了新版高血压管理指南(新指南),并在线发表在ESH官方期刊Journal of Hypertension上^[1]。自2003年ESH制定欧洲首部高血压指南并取得欧洲心脏病学会(European Society of Cardiology,ESC)支持以来,两大学会于2007、2013及2018年联手制定三版指南,并在Journal of Hypertension^[2-4]及European Heart Journal^[3,5-6]杂志同时在线发表,在全世界范围内取得了较大影响,也成为ESH与ESC通力合作的典范之作。     

支气管内曲霉球3例并文献复习

正慢性肺曲霉病(chronic pulmonary aspergillosis,CPA)是一种相对不常见的难治性感染性疾病。除了美国感染病学会(IDSA)2000年的肺曲霉病(pulmonary aspergillosis,PA)治疗共识外~[1],缺乏更多的临床指南。2015年欧洲临床微生物学和感染性疾病联合会(ESCMID)与欧洲呼吸学会(ERS)联合发布了CPA临床指南~[2],对PA的疾病谱做了重新     

《2019年欧洲心脏病学会/欧洲动脉粥样硬化学会血脂异常管理指南》——老年人血脂管理解读

<正>2019年8月31日,欧洲心脏病学会(European Society of Cardiology,ESC)和欧洲动脉粥样硬化学会(European Atherosclerosis Society,EAS)联合发布了《2019年ESC/EAS血脂异常管理指南》(以下简称《2019年血脂指南》)[1],是对《2016年ESC/EAS血脂异常管理指南》(以下简称《2016年血脂指南》)[2]的更新。本文对老年人血脂管理的相关内容进行解读。1推荐老年人更积极使用他汀类药物《2019年血脂指南》扩大了高危及以上人群的范围(表1),建议不仅要考虑个体健康状况和药物相互作用,还应根据危险分层和基线低密度脂蛋白胆固醇     

心房颤动:目前的认识和治疗建议——2012

前言 自2010年中华医学会心电生理和起搏分会( China Society of Pacing and Electrophysiology,CSPE)制订并发表《心房颤动:目前的认识和治疗建议——2010》以来,欧洲心脏病学会(European Society of Cardiology,ESC),美国心脏协会( American Heart Association,AHA),加拿大心血管病学会(Canadian Cardiovascular Society,CCS),美国心律学会(Heart Rhythm Society,HRS)与欧洲心律学会(European Heart Rhythm Society,EHRS)、欧洲心血管学会(European Cardiovascular Society,ECAS)联合等又陆续发表了新的相关指南或建议,均提供了大量新的学术信息与专家共识;与此同时,国内学者在该领域亦有新的研究成果与临床经验问世.为此,CSPE为及时吸收国内外最新学术成果以丰富2010年版建议,故对2010年建议予以修订.     

高血压诊治的现代化观点:管理

<正>2013年6月在意大利米兰举行的第23届欧洲高血压学会(European Society of Hypertension,ESH)年会上,公布了《2013ESH/欧洲心脏病学会(European Society of Cardiology,ESC)动脉高血压管理指南》[1]。最近,美国高血压预防、检测、评估与治疗联合委员会(the joint national committee on prevention,detection,evaluation,and treatment of high blood pres-     

2014年与2015年欧洲肝病学会抗HCV治疗指南比较

<正>鉴于抗HCV药物研制进展非常迅速,针对抗HCV治疗的指南更新也非常及时。2014年美国感染病学会(Infectious Diseases Society of America,IDSA)及美国肝病学会(American Association for the Study of Liver Diseases,AASLD)联合发布了一部丙型肝炎诊治指南[1],同年世界卫生组织(WHO)发布了关于丙型肝炎管理及治疗的指南[2]。欧洲肝病学会(European Association for the Study of the Liver,EASL)在2014年发布了关     

2016年欧洲心脏病学会心力衰竭治疗指南解读——射血分数降低的心力衰竭非外科置入装置(埋藏式心律转复除颤器/心脏再同步化治疗)治疗

<正>本文重点介绍《2016年欧洲心脏病学会(European Society of Cardiology,ESC)急/慢性心力衰竭治疗指南》~[1](以下简称《2016年指南》)中关于射血分数降低的心力衰竭(heart failure with reduced ejection fraction,HFr EF)非外科置入装置治疗部分,主要包括埋藏式心律转复除颤器     

2022年《欧洲胃肠内镜学会与欧洲胃肠病和内镜护理学会联合立场声明：胃肠内镜安全核查表实施指南》解读

胃肠内镜是消化系统疾病的重要诊疗方式, 其持续质量改进和患者安全保障是内镜医师和护士的共同目标。2022年欧洲胃肠内镜学会(European Society of Gastrointestinal Endoscopy, ESGE)、欧洲胃肠病和内镜护理学会(European Society of Gastroenterology and Endoscopy Nurses and Associates, ESGENA)发布了《ESGE与ESGENA联合立场声明:胃肠内镜安全核查表实施指南》。本文围绕指南中安全核查表的制定、实施、潜在障碍进行解读, 为国内胃肠内镜安全核查工作提供参考和依据。     

Therapie von pulmonalen Infektionen durch nicht-tuberkul?se Mykobakterien

The indication to initiate treatment of pulmonary diseases caused by nontuberculous mycobacteria (NTM) depends on clinical, radiological, and microbiological criteria, the nature and severity of the disease, the overall condition of the patient, as well as the virulence and susceptibility of the mycobacteria to combination antibiotic therapy. The treatment of NTM diseases is guided by the statement of the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA). The species-specific combination antibiotic therapy of NTM diseases is long-lasting and often has to be altered or terminated due to the occurrence of adverse drug events. The treatment outcome is variable and depends on the causative NTM species. In suitable candidates the outcome can be improved by surgical interventions if the patient is not getting better on medical therapy alone and the disease is localized. Biomarkers that allow treatment success to be defined and therefore influence the individual duration of therapy have not been identified so far.     

特发性肺纤维化药物治疗推荐

特发性肺纤维化(IPF)是一种原因不明的纤维化性间质性肺炎,生存率及预后极差,临床上IPF治疗药物十分有限。2011年美国胸科学会、欧洲呼吸学会、日本呼吸学会和拉丁美洲胸科学会共同发表的《IPF诊治循证指南》为IPF药物治疗提供了建议。但随后的一些临床试验结果与2011年指南中治疗推荐相矛盾。2015年该机构又发表了一个补充指南。本文对2011年以来指南中治疗IPF的药物进行了回顾,同时综述了2015年补充指南对各药物的推荐情况。     

Practice guidelines for the management of patients with blastomycosis. Infectious Diseases Society of America.

Guidelines for the treatment of blastomycosis are presented; these guidelines are the consensus opinion of an expert panel representing the National Institute of Allergy and Infectious Diseases Mycoses Study Group and the Infectious Diseases Society of America. The clinical spectrum of blastomycosis is varied, including asymptomatic infection, acute or chronic pneumonia, and extrapulmonary disease. Most patients with blastomycosis will require therapy. Spontaneous cures may occur in some immunocompetent individuals with acute pulmonary blastomycosis. Thus, in a case of disease limited to the lungs, cure may have occurred before the diagnosis is made and without treatment; such a patient should be followed up closely for evidence of disease progression or dissemination. In contrast, all patients who are immunocompromised, have progressive pulmonary disease, or have extrapulmonary disease must be treated. Treatment options include amphotericin B, ketoconazole, itraconazole, and fluconazole. Amphotericin B is the treatment of choice for patients who are immunocompromised, have life-threatening or central nervous system (CNS) disease, or for whom azole treatment has failed. In addition, amphotericin B is the only drug approved for treating blastomycosis in pregnant women. The azoles are an equally effective and less toxic alternative to amphotericin B for treating immunocompetent patients with mild to moderate pulmonary or extrapulmonary disease, excluding CNS disease. Although there are no comparative trials, itraconazole appears more efficacious than either ketoconazole or fluconazole. Thus, itraconazole is the initial treatment of choice for nonlife-threatening non-CNS blastomycosis.     

Major Global Coronary Artery Calcium Guidelines

This review summarizes the framework behind global guidelines of coronary artery calcium (CAC) in atherosclerotic cardiovascular disease risk assessment, for applications in both the clinical setting and preventive therapy. By comparing similarities and differences in recommendations, this review identifies most notable common features for the application of CAC presented by different cardiovascular societies across the world. Guidelines included from North America are as follows: 1) the 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease; and 2) the 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for Prevention of Adult Cardiovascular Disease. The authors also included European guidelines: 1) the 2019 European Society for Cardiology/European Atherosclerosis Society Guidelines for the Management of Dyslipidemias; and 2) the 2016 National Institute for Health and Care Excellence Clinical Guidelines. In this comparison, the authors also discuss: 1) the Cardiac Society of Australia and New Zealand Guidelines on CAC; 2) the Chinese Society of Cardiology Guidelines; and 3) the Japanese Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases. Last, they include statements made by specialty societies including the National Lipid Association, Society of Cardiovascular Computed Tomography, and U.S. Preventive Services Task Force. Utilizing an in-depth review of clinical evidence, these guidelines emphasize the importance of CAC in the primary and secondary prevention of atherosclerotic cardiovascular disease. International guidelines all empower a dynamic clinician-patient relationship and advocate for individualized discussions regarding disease management and pharmacotherapy treatment. Some differences in precise coronary artery calcium score intervals, risk cut points, treatment thresholds, and stratifiers of specific patient subgroups do exist. However, international guidelines employ more similarities than differences from both a clinical and functional perspective. Understanding the parallels among international coronary artery calcium guidelines is essential for clinicians to correctly adjudicate personalized statin and aspirin therapy and further medical management.     

Kommentar zur Leitlinie (2011) der Europ?ischen Gesellschaft für Kardiologie zur Diagnose und Therapie der peripheren arteriellen Erkrankungen

The recently published European Society for Cardiology (ESC) guideline on the diagnosis and treatment of peripheral artery disease (PAD) is a great step forward for an improved and standardized handling of patients with peripheral artery disease which will enforce the standard of quality of care. Diseases of the aorta are not covered. The guideline is addressed to everybody involved in the treatment of patients with PAD and try to give support for the daily clinical routine and practice. The purpose of the guideline is concerned with the recognition, diagnosis, prevention and treatment. Methodological and diagnostic details can be found in the internet version of the European Heart Journal. All vascular territories from the carotid to the limb arteries are described. The medical and interventional as well as surgical treatment are presented in relation to evidence-based medicine class and level based on listed references. The tables and decision trees are most helpful as are discussions of multiside PAD and commonly occurring disease manifestation in various territories.     

Efficacy and safety of voriconazole in the treatment of chronic pulmonary aspergillosis: experience in Japan

Background

Though various clinical conditions of aspergillosis can occur, depending essentially on the host??s immunological status, the focus of research in North American and European countries has mainly been on invasive pulmonary aspergillosis in immunocompromised patients. There are, however, also many problems to overcome in chronic forms of aspergillosis. One of those problems is that there are no codified treatment guidelines for chronic pulmonary aspergillosis (CPA). Especially in Japan, this issue is more serious, because there are more cases with CPA due to the many aged people with past history of tuberculosis. Several clinical cases and case series have reported the usefulness of the various antifungal agents that are available. The new triazole, voriconazole, in particular, seems to be effective in the treatment of CPA. The aim of the present study is to evaluate the efficacy and safety of voriconazole in the treatment of CPA in non-immunocompromised patients.

Patients and methods

We conducted a prospective, open-label, non-comparative, multicenter study over a 2-year period. For inclusion in the study, patients with confirmed or probable CPA were recruited in 11 hospitals of the National Hospital Organization in Japan. Clinical, radiological, serological, and mycological data were collected at baseline and 12?weeks after treatment or at the end of treatment.

Results

Among 77 patients enrolled in the study, 71 patients (mean age 65.9?years, 56 males and 15 females) were eligible for the study. All of the eligible patients presented with underlying lung diseases, including sequelae of tuberculosis (n?=?35), non-tuberculous mycobacterial lung disease (n?=?8), chronic obstructive pulmonary disease (COPD) (n?=?8), interstitial pneumonia (n?=?7), cystic lung disease (n?=?4), pneumothorax (n?=?3), bronchial cancer (n?=?1), and others (n?=?5). Voriconazole was indicated in 48 cases (68?%) as the first-line treatment for CPA and 23 patients previously received other antifungal therapies. Based on a composite of clinical, radiologic, serological, and mycologic criteria, good response was seen in 43 patients (60.6?%), no response was observed in 19 patients (26.8?%), and 4 cases (5.6?%) got worse. Five patients (7.0?%) were unassessable for efficacy. The common adverse events were visual disturbances (17 patients, 23.9?%), abnormal liver function test results (12 patients, 16.9?%), adverse psychological effects (3 patients, 4.2?%), and others (10 patients, 14.0?%). Treatment with voriconazole had to be stopped in 2 cases (2.8?%) because of serious adverse events (abnormal liver function test results). There was no association between adverse effects and trough voriconazole levels in serum.

Conclusions

In Japan, voriconazole provides effective therapy of CPA in non-immunocompromised patients with an acceptable level of toxicity.     

Aspergillusinfektionen

Pulmonary aspergillosis remains a diagnostic and therapeutic challenge. Acute invasive aspergillosis (IPA) is increasingly seen in patients with respiratory diseases. Diagnosis is facilitated by the detection of mostly nodular infiltrates on high-resolution computed tomography and aspergillus galactomannan antigen testing of bronchoalveolar lavage fluid. A high grade of suspicion is needed to institute effective antimycotic treatment in time. Chronic pulmonary aspergillosis (CPA) is defined as progressive disease over a period of more than 3 months. The vast majority of CPA patients have underlying structural lung disease. Aspergillus-specific serum precipitins are frequently found. Antimycotic therapy is the mainstay of treatment, with a prolonged treatment duration.     

Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases.

In biology, classification systems are used to promote understanding and systematic discussion through the use of logical groups and hierarchies. In clinical medicine, similar principles are used to standardise the nomenclature of disease. For more than three decades, heart muscle diseases have been classified into primary or idiopathic myocardial diseases (cardiomyopathies) and secondary disorders that have similar morphological appearances, but which are caused by an identifiable pathology such as coronary artery disease or myocardial infiltration (specific heart muscle diseases). In this document, The European Society of Cardiology Working Group on Myocardial and Pericardial Diseases presents an update of the existing classification scheme. The aim is to help clinicians look beyond generic diagnostic labels in order to reach more specific diagnoses.     

The role of biomarkers in low respiratory tract infections

Low respiratory tract infections (LRTI) represent the leading infectious cause of death worldwide and account for substantial use of healthcare resources. Physicians must adopt practices focused on improving outcomes and serum biomarker can help them in the management of patients with LRTI. Several studies have been carried out or are currently ongoing to evaluate the role of various biomarkers for the differential diagnosis, definition of prognosis, treatment and duration of antibiotic therapy in respiratory infections. The objective of this position paper of the Italian Society of Respiratory Diseases (SIMER) is to provide evidence-based recommendations for the use of biomarkers in routine clinical practice in the management of adult patients with LRTI. These guidelines capture the use of biomarkers both outside and inside the hospital, focused on community-acquired pneumonia, acute exacerbations of chronic obstructive pulmonary disease, hospital-acquired and ventilator-acquired pneumonia.     

2009 ESC/ERS pulmonary hypertension guidelines and connective tissue disease

Pulmonary hypertension was defined as mean pulmonary artery pressure ≥ 25 mmHg at the 4th World Symposium on Pulmonary Hypertension. In 2009, the European Society of Cardiology and European Respiratory Society jointly created guidelines for practical pulmonary hypertension classifications and treatments based on the discussions at the 4th World Symposium. This classification is characterized by division into five groups: Pulmonary arterial hypertension (PAH); Pulmonary hypertension due to left heart disease; Pulmonary hypertension due to lung disease and/or hypoxia; Chronic thromboembolic pulmonary hypertension; and Pulmonary hypertension with unclear and/or multifactorial mechanisms. PAH is a common and fatal complication of connective tissue disease (CTD), but pulmonary hypertension in CTD consists of PAH, pulmonary hypertension caused by myocardial involvement, pulmonary veno-occlusive disorder, pulmonary hypertension due to interstitial lung disease. PAH has been studied widely in SSc and the estimated prevalence of 7-12%. Treatment of CTD associated PAH (CTD-PAH) consists of general therapeutic options and specific treatment. Specific treatment of CTD-PAH patients is targeted to produce vasodilatation. Calcium channel blockers (CCBs) are indicated in cases where a sufficient decrease in pulmonary arterial pressure is seen in vasoreactivity testing. If vasoreactivity is absent in CTD-PAH patients, the treatment consists of the endothelin receptor antagonists, the prostacyclin analogues and phosphodiesterase-type 5 inhibitors. Few data are available to support the use of immunosuppression in CTD-PAH. However, some case reports suggested that a minority of CTD-PAH patients could benefit from immunosuppressive therapy. The treatment of CTD-PAH patients may differ from the treatment of idiopathic PAH.