银杏叶滴丸治疗冠心病不稳定型心绞痛的疗效观察

目的:探讨银杏叶滴丸治疗冠心病不稳定型心绞痛的疗效。方法:将冠心病不稳定型心绞痛患者90例随机分成2组,实验组和对照组各45例,对照组予以常规治疗,实验组在常规治疗的基础上加银杏叶滴丸,每次5粒,每日3次,疗程为4周。结果:实验组心绞痛症状改善总有效率为95.56%,心电图疗效总有效率为91.12%,均明显优于对照组(P<0.05)。结论:银杏叶滴丸治疗冠心病不稳定型心绞痛疗效可靠。     

老年性黄斑变性问题解答

问：什么是老年性黄斑变性？如何分类？     

老年性黄斑病变光动力疗法的新进展(综述)

老年性黄斑病变(AMD)是由于中央部脉络毛细血管硬化或闭塞所致。以往无特殊治疗,近年来采用光动力疗法进行治疗,极具发展前景。 一、历史 光动力疗法起始于1900年,现代光动力疗法始于20世纪70年代后期,自20世纪80年代中期开始应用于眼科临床。采用激光治疗老年性黄斑病变的主要问题是光凝热效应对黄斑部视网膜组织的损     

叶黄素与老年性黄斑变性的防治

老年性黄斑变性(AMD)是老年人的主要致盲性疾病之一。叶黄素作为高能量蓝光滤过器和抗氧化剂,能保护黄斑区和视网膜免受光损伤。通过食用各类水果、蔬菜和鱼类增加叶黄素摄入量可预防AMD。     

银杏叶滴丸治疗冠心病不稳定型心绞痛85例临床观察

目的 探讨银杏叶滴丸在治疗冠心病不稳定型心绞痛时的临床疗效.方法 选取2009年8月至2011年8月间于我院治疗的冠心病不稳定型心绞痛患者170例,随机平均分为实验组(85例)与对照组(85例).对照组予以西医常规治疗,实验组在对照组基础上另外口服银杏叶滴丸,1次5粒,1d3次.1个月后,通过对治疗前后的症状改善状况比较观察,统计2组治疗方案对临床有效率.结果 实验组的临床有效率高于对照组.结论 银杏叶滴丸治疗冠心病不稳定型心绞痛安全有效.     

叶黄素和玉米黄质与老年性黄斑变性

老年性黄斑变性是老年人的主要致盲眼病，其发病机制目前尚未明确。近年来提出叶黄素和玉米黄质是两种对视网膜有重要作用的黄斑色素。本文阐述了叶黄素和玉米黄质对视网膜的保护作用、与老年性黄斑变性的关系以及预防老年性黄斑变性的可能机制。     

中医药治疗老年性黄斑变性的临床体会

老年性黄斑变性，又称年龄相关性黄斑变性、衰老性黄斑变性，多见于45岁以上中老年人，且随年龄增长而患病率升高和病情加剧，严重影响着老年人的视力与生活质量。笔者应用中医药方法进行治疗，有一定康复效果，现报道如下。     

银杏叶提取物治疗糖尿病周围神经病变的疗效观察

目的 观察银杏叶提取物治疗糖尿病周围神经病变（DN）的临床疗效。方法 将65例患者随机分为两组，治疗组35例，对照组30，对照组采用常规治疗方法，治疗组在此基础上加用银杏叶提取物。在治疗9周后观察并记录患者的临床症状以及神经传导速度（NCV）的变化情况。结果 银杏叶治疗组能够明显改善DN患者的临床症状，有效率为71．4％，与对照组40.0％比较差异有显著性（P〈0．05）。治疗组治疗后NCV发生明显改变，与治疗前比较差异有统计学意义，对照组治疗前后NCV的改变不明显。治疗组治疗后NCV与对照组比较差异有显著性。结论 银杏叶提取物不仅能改善DN患者临床症状，而且能改善神经传导速度，可以作为DN治疗较理想的药物。     

老年性退行性骨关节病变中西医结合治疗

目的:研究中西医结合治疗方法对老年性退行性骨关节病变的临床疗效。方法:对我院60例老年性退行性骨关节病变患者进行随机分组,对照组患者进行常规的西医治疗,观察组患者则运用中西医结合的方式进行治疗,一疗程后,对比两组患者的临床疗效。结果:一疗程后,对照组患者的治疗总有效率为83.33%,不良反应发生率为10%,观察组患者的治疗总有效率为96.67%,不良反应发生率为3.33%,二者之间的差异具有显著性,即P<0.05。结论:中西医结合的治疗方法对老年性退行性骨关节病变效果显著,且不良反应小,值得在临床中进行推广和应用。     

065 叶黄素和玉米黄质与老年性黄斑变性

老年性黄斑变性是老年人的主要致盲眼病,其发病机制目前尚未明确.近年来提出叶黄素和玉米黄质是两种对视网膜有重要作用的黄斑色素.本文阐述了叶黄素和玉米黄质对视网膜的保护作用、与老年性黄斑变性的关系以及预防老年性黄斑变性的可能机制.     

Determinants of health related quality of life and health state utility in patients with age related macular degeneration: the association of contrast sensitivity and visual acuity

Background There has been increasing interest in the use of measures of health related quality of life (HRQoL) and health state utility values in Age Related Macular Degeneration (ARMD). Visual acuity has been found to be an important determinant of such measures in previous studies. More recently, another measure of visual impairment, contrast sensitivity has received considerable attention. We designed a study to examine whether the contribution of contrast sensitivity in explaining HRQoL and health utilities over and above that of visual acuity. Methods 209 patients with unilateral or bilateral ARMD were recruited into a cross-sectional study of patients from a large teaching hospital. Patients underwent visual tests (near and distant visual acuity, contrast sensitivity) and completed a vision function questionnaire, the VF-14, HUI3, and time trade-off. Results Using multivariate regression analysis, the study revealed that contrast sensitivity remained a statistically significant predictor of all outcome measures even when visual acuity was included. This result was supported by the correlation coefficients between measures. Conclusions The measurement of contrast sensitivity appears to be better related to a person’s HRQoL and health utility. Future studies should consider incorporating contrast sensitivity in addition to visual acuity. Studies, in particular economic evaluations, may underestimate the effect of treatment unless contrast sensitivity is considered.     

老年性急性上消化道出血56例的急救护理

目的 探讨积极有效的护理对老年性急性上消化道出血疗效的影响.方法 回顾性分析笔者所在医院2006～2009年共收治60岁以上老年性上消化道大出血56例进行有效的抢救及严密监测生命体征的护理体会.结果 经积极有效的急救护理,38例痊愈,12例好转,4例转外科进行手术治疗,2例抢救无效死亡.结论 熟练规范的操作技术和行之有效的护理是提高抢救成功率,降低病死率,减少并发症的关键因素之一.     

Obesity, lutein metabolism, and age-related macular degeneration: a web of connections

Age-related macular degeneration (AMD) is a major cause of visual impairment in the United States. Currently there is no effective cure for this disease. Risk factors include decreased lutein and zeaxanthin status and obesity. Obesity is also an increasing public health concern. The alarming increase in the prevalence of obesity further exacerbates the public health concern of AMD. The mechanism by which obesity increases the risk of AMD may be related to the physiologic changes that occur with this condition. These include increased oxidative stress, changes in the lipoprotein profile, and increased inflammation. These changes would also result in an increased destruction and a decreased circulatory delivery of lutein and zeaxanthin to the macula of the eye. Therefore, the mechanism by which obesity is related to AMD risk may be through indirect effects on changes in lutein and zeaxanthin status and metabolism.     

On the differences between mega- and meta-imputation and analysis exemplified on the genetics of age-related macular degeneration

While current genome-wide association analyses often rely on meta-analysis of study-specific summary statistics, individual participant data (IPD) from multiple studies increase options for modeling. When multistudy IPD is available, however, it is unclear whether this data is to be imputed and modeled across all participants (mega-imputation and mega-analysis) or study-specifically (meta-imputation and meta-analysis). Here, we investigated different approaches toward imputation and analysis using 52,189 subjects from 25 studies of the International Age-related Macular Degeneration (AMD) Genomics Consortium including, 16,144 AMD cases and 17,832 controls for association analysis. From 27,448,454 genetic variants after 1,000-Genomes-based imputation, mega-imputation yielded ~400,000 more variants with high imputation quality (mostly rare variants) compared to meta-imputation. For AMD signal detection (P < 5 × 10⁻⁸) in mega-imputed data, most loci were detected with mega-analysis without adjusting for study membership (40 loci, including 34 known); we considered these loci genuine, since genetic effects and P-values were comparable across analyses. In meta-imputed data, we found 31 additional signals, mostly near chromosome tails or reference panel gaps, which disappeared after accounting for interaction of whole-genome amplification (WGA) with study membership or after excluding studies with WGA-participants. For signal detection with multistudy IPD, we recommend mega-imputation and mega-analysis, with meta-imputation followed by meta-analysis being a computationally appealing alternative.     

Additional psychometric information and vision-specific questionnaires are available for age-related macular degeneration

Purpose  To present psychometric information and studies dealing with questionnaires for age-related macular degeneration (AMD) and visually impaired patients in addition to the study by Finger et al. “Quality of life in AMD: a review of available vision-specific psychometric tools”. We propose that their literature search should not have focused solely on the specific eye disease AMD. Methods  The literature search was partly replicated (PubMed) by using “visual impairment” instead of “macular degeneration” as free text words. Psychometric information was obtained from the additional studies. Preliminary results from a differential item functioning (DIF) analysis used to examine the relationship between item responses on the Vision-related quality of life Core Measure (VCM1) of AMD patients versus patients with other eye conditions are discussed. Results  Eight studies of visually impaired patient populations, including AMD patients, are discussed, with psychometric information from six vision-specific questionnaires. The VCM1 items did not present DIF, which means that the items were equally interpreted by all patients. Conclusions  The results on DIF and the additional studies presented here confirm that a specific eye disorder is of minor importance in the choice of a vision-specific questionnaire or, in this case, a literature search.     

口服硫辛酸对AMD患者血脂及抗氧化能力影响

目的 探讨硫辛酸对老年黄斑变性(AMD)患者血脂及抗氧化能力的影响,为预防和治疗AMD的发生和发展提供新方法。方法 对33名AMD患者进行为期3个月的硫辛酸干预研究,剂量为600mg,每天早晚口服,每次300mg。于干预前后分别测量眼视力,检测血清胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白(HLD)、低密度脂蛋白(LDL)、血清丙二醛(MDA)含量及过氧化物歧化酶(SOD)活性。结果 硫辛酸干预后有43%的AMD患者患眼视力有所改善;干预前后血清CHO、TG、HLD、LDL含量差异无统计学意义(P>0.05);与干预前比较,干预后AMD患者血清MDA含量平均降低5.4%(P>0.05),SOD活性平均升高10.9%(P<0.05),并且干预后AMD患者血清SOD活性均明显升高。结论 硫辛酸能提高AMD患者机体SOD活性,对预防AMD的病情进展有一定作用。     

长期小剂量红霉素口服治疗慢性支气管炎的疗效观察

目的观察长期小剂量应用红霉素类抗生素治疗慢性支气管炎的I晦床疗效,总结其临床价值。方法选取本院2008年12月～2010年12月140例慢性支气管炎患者,随机分为观察组和对照组各70例,对照组根据患者临床症状予抗感染及止咳、祛痰,解痉、平喘等对症治疗及增强免疫治疗,观察组在对照组的治疗基础上加用小剂量红霉素250mg／d,长期口服,两组均临床观察1年,对比两组治疗效果,记录相关数据并进行统计学分析。结果观察组显效56例,占80．00％,有效12例,占17．14％,无效2例,占2．86％,急性发作住院1次,总有效率97．14％;对照组显效37例,占52．86％,有效16例,占22．86％,无效17例,占24．29％,急性发作住院6次,总有效率75．71％,两组疗效比较差异有统计学意义（P〈0．05）。观察组发生不良反应3例,占4．29％,对照组发生不良反应2例,占2．86％,两组不良反应发生率比较差异无统计学意义（P〉0．05）。结论长期小剂量应用红霉素口服治疗慢性支气管炎的临床疗效明显优于常规抗感染及对症治疗,且明显减少急性发作住院次数,不良反应较少,值得在临床上推广应用。     

The epidemiology, economics and quality of life burden of age-related macular degeneration in France, Germany, Italy and the United Kingdom

Age-related macular degeneration (AMD) is a major public health issue, but little is known about the economics of the disease. This contribution describes the epidemiology and the economics of AMD in four European countries: France, Germany, Italy and the United Kingdom (UK). We reviewed published information on AMD, including guidelines, official statistics, and local literature and interviewed AMD experts. All available health-related quality of life studies (HRQoL) on AMD were also reviewed. Data collection focused on epidemiology, medical management and resource use (both medical and non-medical items). Prevalence of AMD among persons older than 65 years is 8% and increases with age. There are two forms of the disease: atrophic (80–85% of AMD cases) and exudative, which is characterised by choroidal neovascularisation (CNV; 15–20% of AMD cases). No treatment for the atrophic form is available. Laser photocoagulation is the mainstay of treatment for CNV, although less than 30% of persons with CNV can benefit from it. Photodynamic therapy (PDT), a new treatment for CNV, reduces the risk of vision loss in forms with predominantly visible lesions. Several other new procedures are also under development. Rehabilitation and low-vision aids are useful palliative interventions when there is a residual visual acuity. The yearly budget impact of AMD was found to be between 51.3 and 101.1 million euros in the four countries studied. Information on social services and resource use was scant and little is reported on the impact of AMD on HRQoL. Economic studies of AMD should be conducted in order to assist public health decision making.     

血清叶黄素水平与老年性黄斑变性关系的Meta分析

目的系统评价老年性黄斑变性(age-related macular degeneration,AMD)患者血清叶黄素水平与对照组相比差异有无统计学意义。方法以电子检索结合手工检索及索引检索的方式检索中外数据库中对AMD患者及其对照组进行血清叶黄素水平测定的病例对照研究、队列研究的中英文研究文献,按照纳入及排除标准从中选择符合标准的8篇文献,提取其数据信息,采用专用软件RevMan 5.0完成系统评价过程。结果共纳入8篇临床研究,固定效应模型合并的标准化均差(standard mean difference,SMD)和95%可信区间(95%CI)为-0.15(-0.28～-0.02),表明AMD患者血清叶黄素水平低于正常对照组,且差异有统计学意义。结论初步得出血清叶黄素水平低与AMD发生可能存在一定关联,但需要进行更广泛地研究,确定人体血清叶黄素水平的正常范围,从而为AMD高危人群的筛查和干预提供科学依据。     

Chances and challenges of machine learning-based disease classification in genetic association studies illustrated on age-related macular degeneration

Imaging technology and machine learning algorithms for disease classification set the stage for high-throughput phenotyping and promising new avenues for genome-wide association studies (GWAS). Despite emerging algorithms, there has been no successful application in GWAS so far. We establish machine learning-based phenotyping in genetic association analysis as misclassification problem. To evaluate chances and challenges, we performed a GWAS based on automatically classified age-related macular degeneration (AMD) in UK Biobank (images from 135,500 eyes; 68,400 persons). We quantified misclassification of automatically derived AMD in internal validation data (4,001 eyes; 2,013 persons) and developed a maximum likelihood approach (MLA) to account for it when estimating genetic association. We demonstrate that our MLA guards against bias and artifacts in simulation studies. By combining a GWAS on automatically derived AMD and our MLA in UK Biobank data, we were able to dissect true association (ARMS2/HTRA1, CFH) from artifacts (near HERC2) and identified eye color as associated with the misclassification. On this example, we provide a proof-of-concept that a GWAS using machine learning-derived disease classification yields relevant results and that misclassification needs to be considered in analysis. These findings generalize to other phenotypes and emphasize the utility of genetic data for understanding misclassification structure of machine learning algorithms.