药物洗脱支架与裸支架置入治疗冠心病的安全性及生物相容性比较

药物洗脱支架与裸金属支架相比，最大的改进就是在原有的裸金属支架平台上，增加了药物载体和药物。药物洗脱支架的药物载体主要是多聚物涂层，其目的是用于承载足够的药量，并在药物洗脱支架置入人体后能有效控制药物的分解、扩散和释放。在临床治疗中，聚合物载体的生物相容性及完整性会影响到药物洗脱支架的安全性，而聚合物载体对药物的控释性则影响到药物洗脱支架有效性。从目前的发展趋势来看，涂层药物要具备保护内皮的功能，在最大程度上保持支架表面的光滑度，从而提高支架的生物相容性，使支架平台和多聚载体可吸收、药物释放体系更科学,将是未来药物洗脱支架的发展方向。     

药物洗脱支架与裸支架临床应用的安全性比较

目的：评价药物洗脱支架与裸支架临床应用中的安全性，观察药物洗脱支架与裸支架在冠状动脉粥样硬化性心脏病治疗中的应用。 方法：以计算机检索方法在检索中国期刊全文数据库中(CNKI：2004/2008)检索关于药物洗脱支架与裸支架的临床研究与实验研究的随机对照实验，检索词为“洗脱支架、裸支架”。检索后对每项研究的资料结果进行提取、分析。 结果：共有19项实验2 731例血管内支架置入患者符合纳入标准，药物洗脱支架与裸支架置入后比较，应用药物洗脱支架血管再狭窄率均较术前降低，随访结果显示药物洗脱支架较金属裸支架能明显减低再狭窄率，靶病变血管重建率等，但其远期在体内对血流动力学的影响尚有待进一步随访观察。 结论：与金属裸支架相比, 药物洗脱支架在小血管复杂病变中置入是有效的,且能明显减少术后再狭窄和靶病变血运重建率。但由于纳入试验少，证据的强度不足，其他有效性指标和安全性，有待更多证据加以评价。     

药物洗脱支架临床应用安全性的影响因素

目的：介绍药物洗脱支架在临床应用中的相关问题，从支架本身、涂层物质以及生物活性成分进行分析,探讨药物洗脱支架在临床应用中的安全性和有效性。 方法：以 “药物洗脱支架，金属裸支架，血管再狭窄”为中文关键词；以“Drug-eluting stent, Bare metal stent, Restenosis ” 为英文关键词，采用计算机检索1990-01/2008-10相关文章。纳入与药物洗脱支架与裸支架临床应用的安全性比较研究相关文章；排除重复研究或Meta分析类文章。以17篇文献为主重点探讨药物洗脱支架在临床应用中的安全性和有效性。 结果：目前临床上所用的药物洗脱支架均存在值得进一步改进的可能，未来药物洗脱支架的发展方向是研发适合小血管、分叉部位的支架和扩展PCI适应证；寻求新的涂层、生物材料支架；研发支架药物的选择和洗脱技术，以及在维持DES作用、改善安全性的同时，寻找促进支架植入部位血管内膜愈合的方法。 结论：改良支架平台及研发新型支架仍将是热点，注重远期疗效成为药物洗脱支架发展趋势。 关键词：药物洗脱支架；心肌梗死；金属裸支架；安全性；血管再狭窄 doi:10.3969/j.issn.1673-8225.2010.25.042     

国产雷帕霉素药物洗脱支架置入治疗急性ST段抬高心肌梗死：与进口药物支架比较其安全性和有效性

目的：比较国产雷帕霉素洗脱支架（Firebird支架）和进口雷帕霉素洗脱支架（CypherTM支架）置入治疗急性ST段抬高心肌梗死的安全性和有效性。 方法：选择2005-03/2007-02就诊于赣州市立医院心内科及深圳市孙逸仙心血管医院的急性ST段抬高心肌梗死患者121例，经患者及家属知情同意后进行临床观察，治疗过程经医院医学伦理委员会批准。其中CypherTM支架组59例，Firebird支架组62例。比较两组支架置入后冠状动脉造影结果、住院期间的临床结果；随访2~12个月，记录死亡率、靶血管重建率及主要心血管事件发生率。 结果：①121例患者支架置入均获得成功。62例梗死相关血管的62处病变置入64枚Firebird支架；另59支梗死相关血管的59处病变置入61枚CypherTM支架。②Firebird支架组1例术后第5天出现支架内亚急性血栓形成，再次行冠状动脉介入术获得成功。CypherTM支架组1例术后64 d发生急性左心衰竭而死亡，1例术后5个月在院外猝死。③两组比较支架置入后造影结果和临床结果差异无显著性意义。④对117例患者进行随访，CypherTM支架组死亡率、靶血管重建率和主要心血管事件发生率分别为3.4%、0%和3.4%；Firebird支架组死亡率、靶血管重建率和主要心血管事件发生率分别为3.2%、1.6%和4.8%，差异无显著性意义（P > 0.05）。 结论：国产雷帕霉素药物洗脱支架置入治疗急性ST段抬高心肌梗死患者是安全的,随访未发现管腔内出现血液及组织细胞的变化，无特殊生物相容性和安全性问题，与进口雷帕霉素药物涂层支架相比较各项指标差异不明显。     

心血管药物洗脱支架置入安全性与血管再狭窄的关系

目前国外有几种类型的心血管支架获得了相当满意的临床效果,国内学者也进行了临床试验,均肯定了血管内支架置入的临床意义。但进口血管内支架价格昂贵,难以广泛应用。近年来国产血管内支架已开始用于心血管疾病,但由此产生的并发症也日益显露出来。药物洗脱支架在降低再狭窄率方面取得了良好效果,但何种材料、何种药物涂层的血管内支架更适于心血管疾病的治疗目前尚无定论。目前开发新的涂层药物,并寻找更加合理有效的药物组合,以提高抑制新生内膜增生效果是当务之急。随着科技的进步,有理由相信在不久的将来一种新型合成材料且具有多效能的药物涂层支架将问世。     

急性心肌梗死置入药物洗脱支架与裸金属支架的安全性及即时效应比较

背景：药物洗脱支架越来越多应用于冠状动脉狭窄患者,效果良好。但急诊应用于急性心肌梗死患者的研究报道较少。 目的：对比观察Firebird支架(雷帕霉素洗脱支架)与普通金属裸支架在急性ST段抬高型心肌梗死急诊经皮腔内冠状动脉介入治疗中应用的安全性和临床疗效。 设计、时间及地点：回顾性分析,病例来自2006-01/2008-09洛阳150医院心内科。 对象：选择洛阳150医院心内科收治的ST段抬高型急性心肌梗死行直接经皮腔内冠状动脉介入治疗患者94例,男71例,女23例,年龄47~76岁。 方法：94例患者随机分为2组,Firebird支架组：均在靶病变置入Firebird支架1或2枚;普通支架组：在靶病变置入金属裸支架1或2枚。 主要观察指标：两组患者的安全性、临床疗效及随访情况。 结果：①94例患者介入治疗均获得成功。Firebird支架组52例,共置入68枚药物涂层支架;普通支架组42例,共置入56枚普通支架。两组平均置入支架个数、手术成功率、支架置入并发症发生率、置入前置入后平均狭窄程度及操作时间等差异均无显著性意义(P > 0.05);两组选用的支架内径相比,Firebird支架明显偏小(P < 0.01);两组支架长度相比,Firebird支架显著偏长(P < 0.05)。②住院期间观察两组患者心肌酶峰值,TnI峰值,血管开通后2 h ST段下降幅度,左室功能差异均无显著性意义(P > 0.05)。两组靶血管重建Firebird支架组1例,普通支架组2例,差异亦无显著性意义(P > 0.05)。两组各有2例患者死亡,住院期间心脏事件发生率差异无显著性意义(P > 0.05)。Firebird支架组和普通支架组平均住院时间差异无显著性意义[(11.3±4.2),(12.4±4.6)d,P > 0.05]。③出院后随访1~10个月,平均(6.5±2.4)个月,两组患者无心源性死亡、再梗死。普通支架组心绞痛发生率35.5%较Firebird支架组21.0%显著增高(P < 0.01)。Firebird支架组无心脏事件生存率95%;显著高于普通支架组78%(P < 0.01)。 结论：雷帕霉素药物洗脱支架与普通支架一样在ST段抬高型急性心肌梗死急诊经皮腔内冠状动脉介入中是安全有效的。     

雷帕霉素药物洗脱支架置入后发生血管再狭窄的相关因素及其安全性

目的：评价雷帕霉素药物洗脱支架置入的安全性,分析雷帕霉素药物洗脱支架支架血栓发生率和特征,探讨雷帕霉素药物洗脱支架治疗的患者中造影证实的支架血栓事件风险。 方法：以计算机检索方法在检索中国期刊全文数据库中(CNKI：1997/2009)检索关于雷帕霉素药物洗脱支架血栓形成原因分析及安全性的自身前后对照实验,检索词为“雷帕霉素、药物洗脱支架、金属裸支架、支架内血栓”。检索后对每项研究的资料结果进行提取、分析。 结果：共有12项实验3 839例雷帕霉素药物洗脱支架置入患者符合纳入标准,雷帕霉素药物洗脱支架置入后血管脉狭窄率均较术前降低,随访结果显示国产雷帕霉素洗脱支架与金属裸支架内血栓的发生率均较低,两者无显著性差异,再狭窄率国产雷帕霉素洗脱支架支架明显低于金属裸支架。远期临床随访结果表明,延长联合抗血小板治疗时间很有必要。 结论：雷帕霉素洗脱支架置入后的安全性尤其是晚期血栓问题的确值得关注,但发生率很低,临床实践中需要对雷帕霉素洗脱支架安全性以及危险与获益的相关性进行合理的判断。治疗多支血管病变时全部采用雷帕霉素洗脱支架优于金属裸支架,可获得较高的收益与风险比。     

vip70001/药物支架置入后再内皮化及晚期血栓形成评价

药物支架置入后再内皮化及晚期血栓形成评价     

Risperidone treatment in children and adolescents with autism: short- and long-term safety and effectiveness

OBJECTIVE: Atypical neuroleptics, including risperidone, are used to treat children with autism, despite limited efficacy and safety data. Many clinicians believe that risperidone will not induce dyskinesias in children. The authors investigated open risperidone treatment in children with autism and included findings on dyskinesias. METHOD: The sample included 22 outpatients (mean age = 7.1 years) diagnosed with autism (DSM-IV). Treatment consisted of a 1-month short-term phase followed by a 6-month long-term phase. At the end of the long-term phase, drug was discontinued, and the need for further drug treatment and the occurrence of withdrawal dyskinesias were assessed. Measures included the Clinical Global Impressions (CGI), Children's Psychiatric Rating Scale (CPRS), and the Abnormal Involuntary Movement Scale. RESULTS: The mean risperidone dosage was 1.2 mg/day. Overall, the children had significant clinical improvement as assessed by the CPRS and CGI. Untoward effects included sedation, increased appetite, and weight gain. Two of 13 (15.4%) children treated long-term developed mild, reversible withdrawal dyskinesias when risperidone was discontinued. No child developed dyskinesias on risperidone. CONCLUSIONS: Risperidone shows promise as a treatment in autism. However, withdrawal dyskinesias were noted. Further assessment of the risk of risperidone-related dyskinesias is indicated.     

Giant craniopharyngiomas in children: short- and long-term implications

Object

Craniopharyngiomas (CPs) are histologically benign tumors, yet they may carry an unfavorable prognosis. ”Giant” tumors are associated with worse prognosis. Our aim was to evaluate the impact of tumor’s size on different short- and long-term clinical factors.

Methods

Between 2002 and 2012, a total of 36 consecutive CP patients less than 18 years of age and with at least 12 months of post-operative follow-up (FU) underwent a total of 54 operations for excision of CPs. Gross total resection (GTR) was the goal for all the first surgical resections. Twenty-seven patients were identified as eligible for inclusion in this study. Data were retrospectively collected by reviewing pertinent clinic/office notes and inpatient records as well as pre- and post-operative imaging. Long-term neurosurgical, ophthalmological, and endocrinological outcomes were obtained from records of the most recent FU office visit. Statistical analysis was performed to compare data from patients with tumors greater than or equal to 4.5 cm (nine patients) to those with smaller ones (<4.5 cm; 18 patients).

Results

Mean age at the time of surgery was 5.4 years (median 5 years, range 1.3–15.3 years) for patients in the large-tumor group (LTG) and 8.9 years (median 9.6 years, range 2.1–17.1 years) for the small-tumor group (STG). Average duration of follow-up was 82.1 and 105.4 months for LTG and STG patients, respectively. There was a noticeable difference in the rate of emergent surgeries between the two groups (33.3 vs. 5.5 % in the LTG and STG, respectively; p?=?0.055) as well as in recurrent surgeries (RR?=?3.76; CI?=?95 %, 1.793–7.877) and radiotherapy (RR?=?2, 95 % CI 0.775–5.154). Rates of residual tumor on both initial post-operative imaging and last FU imaging were significantly increased in LTG patients (44.5 vs. 27.7 % and 66.6 vs. 16.6 %; respectively). Progression-free survivals (PFS) assessed at 2 and 5 years were 33.3 vs. 73.3 % (RR?=?2.2, 95 % CI?=?0.171–1.202) and 33.3 vs. 53.3 % (RR?=?1.6, 95 % CI 0.221–1.765) in favor of smaller tumors. No difference in 2-, 5-, and 10-year overall survival was found. We found no significant difference in mean BMI at last follow-up between the two groups (23.83?±?4.86 and 27.33?±?8.09, respectively; p?=?0.27), although significantly more patients in the LTG had shorter stature (mean height SDS ?1.72?±?1.88 and ?0.17?±?1.08 in LTG and STG patients, respectively; p?=?0.027).

Conclusion

Tumor’s size has significant impact on the management of CP in children. It affects both short-term factors (initial symptoms, urgency of surgical resection, extent of resection, and perioperative morbidity) as well as long-term parameters (PFS, rate of adjuvant treatments/recurrent surgeries, and metabolic/endocrinal/ophthalmological and functional outcomes). We think that a proper, world-wide accepted definition of what is “large,” “giant,” or even “monstrous” CP should be established. This will enable carrying multi-institutional studies on a larger group of patients, allowing further determining the importance of tumor’s size in the management and outcome of craniopharyngiomas in children.

     

Ketogenic diets: Evidence for short- and long-term efficacy

The use of dietary treatments for epilepsy (ketogenic, modified Atkins, and low glycemic index diets) has been in continuous use since 1921. These treatments have been well studied in the short term, with approximately half of children having at least a 50% reduction in seizures after 6 months. Approximately one third will attain >90% reduction in their seizures. Animal studies confirm these findings, with broad evidence demonstrating acute anticonvulsant effects of the diet. Furthermore, the diet appears to maintain its efficacy in humans when provided continuously for several years. Interestingly, benefits may be seen long term even when the diet is discontinued after only a few months of use, suggesting neuroprotective effects. This potential antiepileptogenic activity has been recently demonstrated in some animal studies as well. This review discusses the animal and human evidence for both short- and long-term benefits of dietary therapies.     

The short- and long-term effects of vasectomy

Vasectomy is commonly perceived as a quick, simple and permanent method of contraception. There are recognized side effects, both short- and long-term, many of which are the norm following a vasectomy operation. It is imperative that patients are fully counselled on the likely and possible outcomes before undergoing surgery.     

Therapist-assisted, self-administered bibliotherapy to enhance parental competence: short- and long-term effects

The efficacy of bibliotherapy has primarily been investigated in anxiety disorders, depression, or substance dependence. The efficacy of self-help books to increase parenting competence was only investigated in a few studies despite their broad dissemination in public. The aims of the study were to investigate the short- and long-term efficacy of a therapist assisted version of the Triple P self-help booklet (Sanders, Markie-Dadds, & Turner, 2003) for families with preschool-age children in Germany. Sixty-nine families were randomly assigned to either a therapist-assisted self-administered parent training (SDPT+T) or to a waitlist control group (WL). Parents in the SDPT+T received the 10 chapter self-help book and an accompanying video. A Triple P facilitator offered seven telephone consultations which aimed to support parents in skill implementation. After the post test, the WL parents were also offered the intervention. A follow-up assessment was conducted six months after post. Compared to waitlist controls, SDPT+T mothers reported significant short- and long-term reductions in child behavior problems as well as in dysfunctional parenting practices. Fathers reported only marginal changes. The study adds further empirical support of parenting self-help materials.     

Drug-eluting stent for the treatment of symptomatic vertebral origin stenosis: Long-term results

Atherosclerotic stenosis originating from the vertebral artery (VA) is a well-known cause of stroke in the posterior circulation. Stent-assisted angioplasty using a bare metal stent is safe but used in a limited number of patients due to high rates of in-stent restenosis (ISR). A drug-eluting stent (DES) is an alternative for reducing ISR after stenting for atherosclerotic stenosis. We report the technical feasibility and mid to long-term clinical and angiographic outcomes after stenting with a DES in vertebral origin stenosis. This retrospective study included 47 consecutive patients treated with DES for vertebral origin stenosis. The demographics, indications for treatment, procedural technique, clinical and radiographical follow-up results were reviewed. The technical success rate was 100% without any complications. Postprocedure residual stenosis was 8.6% (range = 0-12%). All patients were followed up clinically for a mean of 28.3 months (range = 12-68 months), and two patients (4.2%) had recurrent stroke in stented-vessel territories at 5 and 17 months after the procedure, respectively. Digital subtraction angiography was performed at follow-up in 38 patients (80.9%) at a mean of 16.3 months (range = 6-48 months) and showed two patients with ISR (5.3%) and four stent fractures (10.5%). One asymptomatic ISR was related to stent fracture. DES for vertebral origin stenosis are safe and effective with an acceptable lower ISR rate. However, stent fracture may be a potential complication and requires long-term follow-up.     

药物洗脱支架治疗椎动脉起始段狭窄

目的 评价药物洗脱支架治疗椎动脉起始段狭窄的安全性及中、长期疗效.方法 回顾分析47例采用药物洗脱支架成形术治疗椎动脉起始段狭窄病例资料、术后临床和影像学随访结果.结果 47例患者椎动脉单侧狭窄41例,双侧狭窄6例;同侧椎动脉串联狭窄2例,BX支架术后再狭窄1例,并存其他部位动脉狭窄17例.先后共治疗椎动脉起始段狭窄49处.椎动脉起始段术前、术后平均狭窄程度分别为72%和9%.无手术并发症.术后临床症状消失11例,症状改善30例,症状无变化6例.所有病例术后临床随访2-48个月,平均28.3个月,2例患者再发后循环缺血性事件.28例(59%)血管造影随访3-34个月,平均12.2个月,2例发生支架内再狭窄.其中1例为症状性;4例无症状性支架断裂.结论 中长期随访结果显示药物洗脱支架治疗椎动脉起始段狭窄是安全有效的,支架内再狭窄率明显低于裸支架.     

The interlude between short- and long-term psychotherapy

The interlude between short- and long-term psychotherapy is a critical period, fraught with possible pitfalls as well as therapeutic opportunities. During this transitional phase certain discernible shifts may take place in the therapeutic process. Among these changes are: (1) an increasing vagueness with respect to formerly circumscribed goals and outcomes, (2) the assumption on the part of the therapist of a less active role in the treatment process, and (3) the growing centrality and significance of the transference relationship to the therapeutic process. Each of these shifts will very likely evoke strong and sometimes frightening reactions in the patient. These reactions can often be effectively broached and resolved through discussion and interpretation of their earlier origins. An effective auxiliary approach, however, is the willingness of the therapist to impart to the confused or frightened patient his rationales for being less definitive regarding therapeutic goals, less active in pursuing those goals, and more explicitly interested in the patient's attitudes towards him.