预混胰岛素类似物——更模拟生理,疗效更突出

与注射后30min才起效的预混人胰岛素相比,预混胰岛素类似物有更优越的药代动力学特点,其注射后立即进餐,起效更快,峰值回落迅速,增加疗效的同时减少低血糖发生,特别是重度和夜间低血糖.在体重影响和患者满意度方面,预混胰岛素类似物也表现出色.     

Post-adolescent acne in women: more common and more clinical considerations

Current evidence suggests that post-adolescent acne in women is on the rise. Acne in this subgroup of patients commonly follows a specific pattern that can often be treatment resistant and/or prone to relapse, including after oral isotretinoin therapy. With a plethora of medications to choose from for acne treatment, many of which have been used in the past by patients without success, dermatology practitioners often find oral contraceptives and spironolactone to be of benefit in otherwise healthy adult females. Also, some of these patients may have concurrent hormonal anomalies such as polycystic ovarian syndrome or other underlying endocrine disorders, which should also be appropriately worked up by the clinician and managed accordingly. This article reviews some of the underlying pathophysiological factors, available treatment options, and screening guidelines to assist clinicians in the management of acne in adult females.     

The long-term efficacy and safety of immunosuppressive therapy on the progression of IgA nephropathy: a meta-analysis of controlled clinical trials with more than 5-year follow-up

Objective: To evaluate the long-term efficacy of immunosuppressive therapy on Immunoglobulin A nephropathy (IgAN).

Methods: Trials with at least 5-year follow-up investigating immunosuppressive therapy were selected.

Main outcome measures: Primary outcome was end-stage renal disease (ESRD). Secondary outcome was deterioration in renal function defined as doubled serum creatinine or 50% reduction of eGFR.

Results: Seven studies were enrolled. Immunosuppression lowered the risk for ESRD risk ratio (RR = 0.30, 95% CI 0.19 – 0.48, p < 0.00001) and deterioration in renal function (RR = 0.19, 95% CI 0.07 – 0.54, p = 0.002). As for pooled RRs of ESRD, there were four studies with < 7-year follow-up, three followed for > 7 years, four adopted corticosteroids, two used corticosteroids plus other immunosuppressive agents, four were from Asia, and three from Europe. Pooled RRs were 0.32 (95% CI, 0.18 – 0.58, p = 0.0001), 0.28 (95% CI, 0.13 – 0.59, p = 0.0009), 0.34 (95% CI, 0.17 – 0.67, p = 0.002), 0.29 (95% CI, 0.15 – 0.58, p = 0.0005), 0.37 (95% CI, 0.20 – 0.68, p = 0.001) and 0.23 (95% CI, 0.11 – 0.47, p < 0.0001), respectively. Immunosuppression was associated with an increased risk for adverse events (RR = 2.13, 95% CI 1.17 – 3.86, p = 0.01).

Conclusions: Immunosuppressive therapy for IgAN might reduce long-term risk of ESRD and deterioration in renal function but increase risk of adverse events, and the efficacy on patients from Europe and Asia might be similar. Addition of other immunosuppressive agents did not provide additional benefit.     

Status hearings in drug court: when more is less and less is more

We examined the effects of increasing the number of times misdemeanor drug court clients appeared before a judge for judicial status hearings. Our previous findings showed no main effect of increased hearings during the first 14 weeks of the program. The present study examined participants' discharge status in the program, and also explored potential interactions between client characteristics and the frequency of judicial status hearings on outcomes. Results revealed no main effects for hearing frequency on graduation status. Drug offenders who satisfied DSM-IV criteria for antisocial personality disorder (APD) achieved more weeks of urinalysis-confirmed drug abstinence when assigned to more frequent judicial status hearings, whereas subjects without APD achieved more abstinence and were more likely to graduate successfully from the program when assigned to less frequent hearings. Additionally, clients with a history of substance abuse treatment achieved more weeks of abstinence when assigned to more frequent hearings. These findings lend useful guidance to drug courts. Status hearings are expensive and time consuming and should be targeted to clients who would benefit most from them.