应当重视对冠心病的二级预防

应当重视对冠心病的二级预防陈在嘉根据流行病学调查，近年来我国冠心病发病和死亡有升高趋势。临床冠心病患者显著增加，占住院心脏病患者的首位，患心肌梗塞和心绞痛年青人为数不少。虽然对急性心肌梗塞和心绞痛的治疗有所进步，但我们还应当更重视二级预防，改善患者生...     

强化冠心病二级预防对改善患者危险因素及预后的作用

冠心病（ACS）是目前中国成人心脏病住院和死亡的主要原因，其发病率和死亡率依然呈上升趋势。如何加强冠心病二级预防工作，有效改善冠心病预后，我们对67例冠心病患者进行对照研究，观察冠心病二级预防的作用。     

肾素-血管紧张素系统阻断剂与脑卒中二级预防的研究进展

综述降压治疗对脑卒中二级预防的重要性、紧素-血管紧张素系统及其阻断剂的作用机制,以及其在脑卒中二级预防中的临床应用现状,为脑卒中的二级预防提供参考依据。     

我对PROGRESS试验的看法

读了王文志的《科学的研究证据是临床工作的指南》和罗传铭等的译文《PROGRESS和HOPE—卒中预防的新视野》后感受很深，降压治疗是目前卒中一、二级预防最有效的手段，但不同的降压药效果有一定差别，笔者愿与同道共同探讨预防卒中降压药物的选择。     

依普沙坦对高血压患者的卒中二级预防作用优于尼群地平

高血压不仅是首次卒中的重要危险因素，而且也能增高既往卒中患者的心血管病死率和残疾率以及复发性卒中的风险。尽管高血压在卒中二级预防中极其重要，但到目前为止在有高血压的卒中患者中仅进行了少数几项比较不同类型降压药效果的研究。继PROGRESS研究之后，卒中后病死率和残疾率、依普沙坦和尼群地平的二级预防比较（Morbidity and Mortality After Stroke，Eprosartan Compared With Nitrendipine for Secondary Prevention，MOSES）研究再次对2种降压药在卒中二级预防中的作用进行了比较，其结果发表在最近出版的Stroke上。     

冠心病二级预防的抗血小板治疗

抗血小板治疗作为冠心病二级预防的基石,与生活方式干预、控制冠心病危险因素起着同等重要的作用。抗血小板药物对冠心病二级预防拥有大量的临床循证医学证据,其主要包括环氧化酶-1抑制剂阿司匹林和二磷酸腺苷依赖的P2Y12拮抗剂、氯吡格雷、普拉格雷、替格瑞洛。现拟对目前临床上常用的抗血小板药物在冠心病二级预防中的应用做一综述。     

他汀类药物预防缺血性脑血管病的研究进展

他汀类药物（以下简称他汀类）因具有降脂作用，早在20世纪80年代就被应用于临床。它是3-羟基-3-甲基戊二酸单酰辅酶A（HMG—CoA）还原酶的抑制剂，主要通过竞争性抑制HMG—CoA还原酶而减少甲羟戊酸和其他甲羟戊酸通路的中间产物生成。以往用于临床的主要目的是降低血脂，尤其是降低胆固醇。迄今为止，很多基础研究和临床试验证实，他汀类在心血管病事件一级和二级预防中有显著作用。其中，大样本多中心随机对照试验4S试验和胆固醇与复发性血管事件研究（CARE）试验证实，他汀类对心血管疾病有预防作用的同时，对卒中也有积极的预防作用。     

血脂康调整血脂对冠心病二级预防研究协作会在京召开

国家"九·五"攻关课题"血脂康调整血脂对冠心病二级预防的研究"第二次协作会于１９９８年１１月１９日在北京商务会馆召开，出席会议的有来自全国６６家协作医院的代表和课题组各专业委员会的委员共计１１０人。课题指导委员会主任委员、心血管病专家陶寿淇教授及委员方圻、陈在嘉教授都在会上发表了重要讲话，一致认为用国产调脂药对中国人冠心病二级预防的研究是对国内外都有重大意义的课题，其结果将会填补在血脂水平偏低的东方人群中进行冠心病二级预防研究的空白，同时也强调了进行如此大规模研究所面临的困难。课题负责人陆宗良、寇文…     

维生素在胃癌发生中的作用

胃癌是常见的恶性肿瘤，其二级预防之一是增加维生素的摄入。本文从流行病学调查、实验研究及机理研究方面简述维生素在胃癌发生中的作用，为维生素临床防治胃癌的应用提供一定的理论基础。     

规范化二级预防对冠心病患者预后结局的影响

目的:探讨规范二级预防对冠心病患者预后结局的影响。方法:128例冠心病患者被随机分为二级预防组和常规治疗组,各64例。常规治疗组住院期间给予常规冠心病治疗,并作常规出院指导,半年随访1次。二级预防组住院过程中由专门医师负责,给予二级预防干预,出院后每月随访1次;对冠心病患者进行问卷调查,了解其对冠心病危险因素的掌握情况、出院后二级预防药物服用依从情况,评估各组危险因素控制、冠心病复发率等。结果:随访1年后,与常规治疗组比较,二级预防组危险因素知晓率(34.38%比78.18%)、危险因素(血压、血脂、吸烟、饮食、运动等)控制、出院后二级预防药物服用率(18.75%比87.50%)明显提高,临床事件[心力衰竭(18.75%比4.69%)、心绞痛(28.13%比6.25%)、再入院(21.89%比3.13%)、再发心肌梗死(15.63%比4.69%)]明显降低(P0.05或0.01)。结论:对冠心病患者实施规范化二级预防行之有效,值得在临床上推广。     

When research becomes practice: the concept of the therapeutic misconception and challenges to consent in clinical trials

Many factors influence patients' decisions to participate in clinical trials. For many, the primary motivation is the possibility that they might derive some benefit from participation. This is particularly true for patients with limited treatment options, such as patients with advanced cancer. While this is not surprising, it is potentially problematic if patients fail to recognise the distinction between research and clinical care (a phenomenon known as the ‘therapeutic misconception’). This is becoming increasingly problematic as clinical trial designs become more complex, as clinical trials become more embedded in routine clinical care, and as trials are increasingly used by patients and clinicians to access new diagnostic platforms and therapies. We outline some of these recent trends, focusing on the cancer clinical trials landscape as this provides a good case study of the phenomenon. We conclude by making preliminary suggestions that changes to the consent process, perhaps using ‘dynamic consent’ platforms, might help to mitigate the therapeutic misconception and note the need for further research to guide strategies for improving communication and decision-making.     

Horizons on the Therapy of Biliary Tract Cancers: A State-of-the-art Review

Biliary tract cancers (BTCs) comprise a group of heterogeneous poor prognosis cancers with increasing incidence recent years. The combination chemotherapy with cisplatin and gemcitabine is the first-line therapy for advanced BTC. There remains no accepted standard treatment in the second-line setting. Nowadays, more and more novel treatment strategies have entered development, with some encouraging results being seen. Here, we review the current treatment status and clinical characteristics of BTC, the role of immunotherapy in BTC as well as the design of clinical trials for oncology drugs for BTC which aim to focus on the future profiles of clinical care and resolution of BTC.     

血嗜酸粒细胞作为糖皮质激素治疗慢性阻塞性肺疾病疗效的生物标志物研究

有研究证实部分 COPD急性加重期痰液嗜酸粒细胞(eosinophils,EOS)增加,对此类患者应用糖皮质激素治疗,能促进肺功能恢复、缩短病程并降低治疗失败率。然而,在日常临床实践中,诱导痰项目存在技术要求高、检测有效性低、部分患者不能耐受等情况。所以,探讨血 EOS和痰 EOS之间的相关性,选择血 EOS计数作为一种标志物,评估 COPD患者的激素治疗反应,可能更实用。本文就这些方面作一综述。     

Hypersensitivity to members of the botanical order Fabales (legumes).

Legumes are an important source of proteins and their consumption is very frequent in the Mediterranean region and in some Asian and African countries. In some of these regions, lentils and chickpeas are one of the main food allergens. Legumes are also used as food additives due to their emulsifying properties and can be present in many manufactured foods. These hidden food allergens have the potential of causing adverse reactions in legume-sensitive subjects. The allergenic composition of various legumes has been investigated. They have been found to contain multiple allergens, a few of which have been cloned and sequenced. Legumes contain acid-resistant and thermostable allergens. There is a significant degree of cross-reactivity among legumes, the clinical relevance of which seems to be dependent on the dietary habits in different communities. In Spain, the consumption of several legumes is frequent and, therefore, clinical allergy to more than one species in children is common. Clinical manifestations include cutaneous, digestive and respiratory symptoms. Legumes can cause life-threatening reactions in sensitized individuals. Inhalation of steam, powder or flour from some legumes may cause respiratory diseases such as rhinitis, asthma and hypersensitivity pneumonitis. Soybean allergy is generally transitory, but clinical allergy to peanuts is rarely outgrown. The natural history of other legume allergies is less known and more studies are necessary to reach definite conclusions.     

慢性便秘的流行病学研究现状

慢性便秘是临床常见病症,老年人是其高危高发人群。慢性便秘不仅危害患者的身心健康、降低患者的生活质量,而且产生的直接医疗费用不菲,加重了患者和社会的经济负担。深入开展便秘的流行病学的研究,掌握慢性便秘的流行病学特点,尤其是危险因素及高危人群,对于制订慢性便秘的干预策略和干预措施以及开展慢性便秘的社区综合干预,都具有极其重要的意义。本文主要就慢性功能性便秘的流行病学研究现状做一简要综述,供同道参考。     

The Impact of the Nursing Home Clinical on Attitudes Toward Working With the Elderly

This article describes the impact of the nursing home clinical on attitudes of 70 second year nursing students. A 25 item scale was developed to measure attitudes toward the elderly as persons and toward working with elderly persons. While the attitudes became more positive for some students, the overall impact was a negative one. The findings suggest that some revisions must be made in the manner in which we prepare nursing students.     

Ventricular ectopic beats: an overview of management considerations

Ventricular ectopic beats are commonly seen in daily clinical practice. Majority of them being asymptomatic, some can cause symptoms. In a normal heart, their occurrence is of no clinical significance. However, in the presence of an underlying heart disease, they signify a susceptibility toward more sinister arrhythmias. In some patients, they are triggered by the same mechanism as ventricular tachycardia and these can be cured by catheter ablation. Recent reports on the use of catheter ablation in cases where focal ventricular ectopics are found to trigger ventricular fibrillation. Clinical evaluation and investigations are important in assessing patients with ventricular ectopic beats so that appropriate treatment can be targeted when necessary. This article discusses the current knowledge and practice in this commonly encountered clinical problem.     

The Brugada syndrome revisited

The Brugada syndrome is a rare but well-defined cause of sudden cardiac death. The key underlying abnormality is a decrease in net depolarising current due to a genetic defect, though recent evidence also implicates structural abnormalities in some patients. Diagnosis requires a Brugada-type ECG as well as typical clinical features: such clinical considerations are currently key in guiding risk stratification and hence management. Whilst pharmacological therapies are under investigation, the only intervention with a robust evidence base remains insertion of an implantable cardioverter defibrillator. Further research will be required to allow more effective risk stratification and hence more rational therapy.     

Certain practical problems of recognition and treatment of cardiac rhythm disorders]

Having briefly touched upon the problem of terminology and classification of arrhythmias the authors consider the diagnosis and clinical evaluation of some disorders, including the extrasystole (the significance of the extrasystolic interval), ectopic arrhythmias from the region of the atrio-ventricular junction (with simultaneous consistent or transent disruption of the intraventricular conduction), isolated atrial tachycardia, some variants of auricular fibrillation, flutter paroxysms, paroxysms of ventricular tachycardia, with continued auricular fibrillation in particular, and also the earlier described electrocardiographic phenomenon tentatively interpreted as sinistroatrial fibrillation with dextraatrial tachycardia, as well as major types of disrupted condution. The authors give a brief exposure of their views as to the principles of the treatment. Emphasis is placed on the importance of a comprehensive clinical approach to the diagnostic matters and to the evaluation of arrhythmias, as well as to the fundamental need to define more precisely the pathogenesis of the disturbed rhythm in a concrete patient so as to adopt an effective treatment.     

Adverse effects of bisphosphonates

Aminobisphosphonates are drugs that have been used successfully in the treatment of osteoporosis for more than 20 years. Although main registry studies found a scarcity of relevant adverse events, in recent years and as a result of pharmacovigilance, different complications have been reported, some potentially serious. This has raised questions on the safety of these drugs, especially in high doses, like those used in oncology and long-term treatment, as needed in patients with osteoporosis. In this review, based on the analysis of relevant scientific evidence from clinical trials, case series, cohort studies and databases published to date, we summarize the clinical and epidemiological characteristics of the adverse effects of these drugs.