共查询到20条相似文献，搜索用时 46 毫秒
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Renato D. Lopes Roberto Rordorf Gaetano M. De Ferrari Sergio Leonardi Laine Thomas Daniel M. Wojdyla Peter Ridefelt John H. Lawrence Raffaele De Caterina Dragos Vinereanu Michael Hanna Greg Flaker Sana M. Al-Khatib Stefan H. Hohnloser John H. Alexander Christopher B. Granger Lars Wallentin 《Journal of the American College of Cardiology》2018,71(10):1063-1074
Background
Digoxin is widely used in patients with atrial fibrillation (AF).Objectives
The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration.Methods
The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score–adjusted analysis and in new digoxin users during the trial versus propensity score–matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment.Results
At baseline, 5,824 (32.5%) patients were receiving digoxin. Baseline digoxin use was not associated with an increased risk of death (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 0.96 to 1.23; p = 0.19). However, patients with a serum digoxin concentration ≥1.2 ng/ml had a 56% increased hazard of mortality (adjusted HR: 1.56; 95% CI: 1.20 to 2.04) compared with those not on digoxin. When analyzed as a continuous variable, serum digoxin concentration was associated with a 19% higher adjusted hazard of death for each 0.5-ng/ml increase (p = 0.0010); these results were similar for patients with and without heart failure. Compared with propensity score–matched control participants, the risk of death (adjusted HR: 1.78; 95% CI: 1.37 to 2.31) and sudden death (adjusted HR: 2.14; 95% CI: 1.11 to 4.12) was significantly higher in new digoxin users.Conclusions
In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure. 相似文献3.
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Kenji Watanabe Takayuki Matsumoto Tadakazu Hisamatsu Hiroshi Nakase Satoshi Motoya Naoki Yoshimura Tetsuya Ishida Shingo Kato Tomoo Nakagawa Motohiro Esaki Masakazu Nagahori Toshiyuki Matsui Yuji Naito Takanori Kanai Yasuo Suzuki Masanori Nojima Mamoru Watanabe Toshifumi Hibi 《Clinical gastroenterology and hepatology》2018,16(4):542-549.e1
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Ecker KW Stallmach A Löffler J Greinwald R Achenbach U 《Diseases of the colon and rectum》2005,48(2):237-242
PURPOSE In a previous, controlled study, it was shown that orally administered budesonide increases the absorptive capacity of the intestinal mucosa in patients with ileostomies caused by Crohn’s disease. This open, nonrandomized study was designed to analyze this functional, not inflammation-dependent steroid-effect in the long-term course comparing exposure, withdrawal, and reexposure.METHODS Phase 1: 23 patients without inflammatory activity of the disease received oral budesonide (3 mg t.i.d.) for at least four weeks (36.7 weeks; standard deviation, 45.3 weeks) because of high intestinal output syndrome. Phase 2: Medication was stopped for four weeks. Phase 3: Medication as in Phase 1. In each phase the weight of the ileostomy bags was measured with a spring balance before emptying and documented in a diary. Mean values per day and per week were calculated and the differences statistically evaluated by the Wilcoxon-(Pratt)-test.RESULTS Comparing the last week of Phase 1 to first week of Phase 2, a significant (P < 0.0001) increase of the intestinal output (295 g; standard deviation, 313 g) was observed after omitting budesonide. In contrast, comparing the last week of Phase 2 to Phase 3, a significant (P < 0.0001) decrease of the intestinal output by 323.7 g (standard deviation, 322.2 g) was noticed reaching the same level as in Phase 1.CONCLUSIONS These data show that the functional, inflammation-independent effect of budesonide on the intestinal mucosa is strongly correlated to the administration of the drug and may be maintained long-term. These results should be confirmed by a larger number of patients.Published online: 28 January 2005Supported by Dr. Falk Pharma GmbH, Freiburg, Germany.Presented in part at the Falk Workshop “New Findings on Pathogenesis and Progress in Management of Inflammatory Bowel Diseases, Part III,” Berlin, Germany, June 14, 2003.An erratum to this article can be found at . 相似文献
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William L. Hasler Laura A. Wilson Linda A. Nguyen William J. Snape Thomas L. Abell Kenneth L. Koch Richard W. McCallum Pankaj J. Pasricha Irene Sarosiek Gianrico Farrugia Madhusudan Grover Linda A. Lee Laura Miriel James Tonascia Frank A. Hamilton Henry P. Parkman 《Clinical gastroenterology and hepatology》2019,17(7):1285-1294.e1
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Jack D. Sobel Chitra Subramanian Betsy Foxman Marilyn Fairfax Scott E. Gygax 《Current infectious disease reports》2013,15(2):104-108
Mixed vaginitis is due to the simultaneous presence of at least two vaginal pathogens, both contributing to an abnormal vaginal milieu and, hence, symptoms and signs of vaginitis. In mixed vaginitis, both pathogens require specific therapy for complete eradication of concurrent manifestations. In coinfection, although two pathogens are identified, a potential pathogen may be present but may not be a cause of existing vaginal symptoms. Although data remain sparse, mixed vaginitis occurs rarely (<5 %). By contrast, pathogen coinfection occurs frequently in women with vaginitis. Approximately 20 %–30 % of women with bacterial vaginosis (BV) are coinfected with Candida species. Coexistence of BV pathogens and T. vaginalis is even more common, with coinfection rates of 60 %–80 %. Both coinfection and mixed vaginitis have significant clinical and therapeutic implications and are worthy of further investigation. 相似文献
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Cristina Gluhovschi Silvia Velciov Roxana Buzas Ligia Petrica Gheorghe Bozdog Florica Gadalean Adrian Gluhovschi Cristian Balgradean Corina Vernic Ioan Sporea 《Hepatitis monthly》2013,13(4)
Background
Renal dysfunction is a major determinant of the Model of End-stage Liver Disease (MELD) score. The implementation of the MELD score has shifted allocation of livers to patients with renal dysfunction.Objectives
The aim of our study was the assessment of estimated Glomerular Filtration Rate (eGFR) by the Modification of Diet in Renal Disease 4 (MDRD4) method in patients with HBV chronic hepatitis, HCV chronic hepatitis, and cirrhosis (CH) caused by these viruses to detect any differences in renal function among these diseases.Patients and Methods
We performed a cross-sectional analysis of all consecutive patients with HBV chronic hepatitis, HCV chronic hepatitis, and cirrhosis caused by these viruses hospitalized during a 4 year period in the Gastroenterology and Hepatology department of the Emergency County Hospital Timisoara, Romania. The eGFR was assessed by the MDRD4 method. Statistical analysis (unpaired t-test, ANOVA, Chi Square test) was performed using OpenEpi 2.3.1.Results
HBV chronic hepatitis, HCV chronic hepatitis, and cirrhosis secondary to these viruses were associated with a reduction of the GFR. The eGFR was higher in patients with HBV chronic hepatitis than in patients with HCV chronic hepatitis (P < 0.001). Patients with cirrhosis secondary to HBV infection had a higher eGFR than patients with cirrhosis secondary to HCV (P = 0.01). The eGFR of patients with HCV chronic hepatitis was higher than the eGFR of patients with cirrhosis due to this virus (P < 0.001).Conclusions
Functional renal impairment in diseases caused by HCV was more important than in diseases caused by HBV. The eGFR was statistically lower in cirrhosis secondary to HCV than in HCV chronic hepatitis. 相似文献11.
Michelle K. York Deepak K. Gupta Cassandra F. Reynolds Eric Farber-Eger Quinn S. Wells Katherine N. Bachmann Meng Xu Frank E. Harrell Thomas J. Wang 《Journal of the American College of Cardiology》2018,71(19):2079-2088
Background
Circulating B-type natriuretic peptide (BNP) concentrations strongly predict mortality in patients with heart failure (HF). Both cardiac and extracardiac stimuli influence BNP levels, suggesting that BNP might have similar prognostic value in patients without HF.Objectives
The aim of this study was to compare the prognostic value of BNP between patients with and those without HF.Methods
Using the Vanderbilt University Medical Center electronic health record, 30,487 patients (median age 63 years, 50% men, 17% black, 38% with HF) who had a first plasma BNP measurement between 2002 and 2013, with follow-up through 2015, were studied. The risk for death according to BNP level was quantified using multivariate Cox proportional hazards models.Results
BNP levels were lower in patients without HF (median 89 pg/ml; interquartile range: 34 to 238 pg/ml) compared with those with HF (median 388 pg/ml; interquartile range: 150 to 940 pg/ml) (p < 0.0001). Over 90,898 person-years of follow-up, 5,903 patients without HF (31%) and 6,181 patients with HF (53%) died. In multivariate models including demographic and clinical characteristics, BNP and age were the strongest predictors of death in both patients with and those without HF. In acute care settings and even among outpatients with modestly elevated BNP, the risk for death according to BNP was similar between patients with and those without HF. For instance, a BNP level of 400 pg/ml was associated with a 3-year risk for death of 21% (95% confidence interval: 20% to 23%) and 19% (95% confidence interval: 17% to 20%) in patients with and those without HF, respectively.Conclusions
Among patients without HF, plasma BNP level is a stronger predictor of death than traditional risk factors. The risk for death associated with any given BNP level is similar between patients with and those without HF, particularly in the acute care setting. 相似文献12.
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Gianluigi Savarese Nicola Orsini Camilla Hage Ulf Dahlström Ola Vedin Giuseppe M.C. Rosano Lars H. Lund 《Journal of cardiac failure》2018,24(6):365-374
Background
The aim of this study was to characterize N-terminal pro–B-type natriuretic peptide (NT-proBNP) in terms of determinants of levels and of its prognostic and discriminatory role in heart failure with mid-range (HFmrEF) versus preserved (HFpEF) and reduced (HFrEF) ejection fraction.Methods and Results
In 9847 outpatients with HFpEF (n?=?1811; 18%), HFmrEF (n?=?2122; 22%) and HFrEF (n?=?5914; 60%) enrolled in the Swedish Heart Failure Registry, median NT-proBNP levels were 1428, 1540, and 2288?pg/mL, respectively. Many determinants of NT-proBNP differed by ejection fraction, with atrial fibrillation (AF) more important in HFmrEF and HFpEF, diabetes and hypertension in HFmrEF, and age and body mass index in HFrEF and HFmrEF, whereas renal function, New York Heart Association functional class, heart rate, and anemia were similar. Hazard ratios for death and death/HF hospitalization for NT-proBNP above the median ranged from 1.48 to 2.00 and were greatest for HFmrEF and HFpEF. Areas under the receiver operating characteristic curve for death and death/HF hospitalization were greater in HFmrEF than in HFpEF and HFrEF and were reduced by AF in HFpEF and HFmrEF but not in HFrEF.Conclusions
In HFpEF and especially HFmrEF, NT-proBNP was more prognostic and discriminatory, but also more affected by confounders such as AF. These data support the use of NT-proBNP for eligibility, enrichment, and surrogate end points in HFpEF and HFmrEF trials, and suggest that cutoff levels for eligibility should be carefully tailored to comorbidity. 相似文献15.
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Background
Although β blockade (BB) in patients with chronic obstructive pulmonary disease (COPD) does not show signs of worsening pulmonary function or respiratory symptoms, the effects on cardiopulmonary exercise testing (CPET) remain unclear. The aim of this study was to determine whether BB affects exercise capacity, gas exchange, and hemodynamic responses in patients with COPD.Methods
Twenty-four COPD subjects on BB were matched to 24 COPD subjects without BB according to age, gender, body mass index, and severity of COPD. All subjects underwent resting pulmonary function and symptom-limited CPET.Results
Comparing COPD patients with and without BB revealed that percent peak oxygen consumption and VE/VCO2 nadir were not significantly different (45 ± 16 vs. 51 ± 23 %, p = 0.30, and 35.1 ± 8.5 vs. 36.2 ± 11.6 %, p = 0.69). Systolic blood pressure and heart rate at peak exercise were significantly decreased in COPD patients with BB (168 ± 16 vs. 185 ± 20 mmHg, and 109 ± 16 vs. 122 ± 14 bpm, respectively, p < 0.05).Conclusion
Exercise capacity and gas exchange remain unaffected in patients with COPD in the presence of BB, although heart rate and blood pressure are lower. These findings imply that BB does not adversely affect functional capacity in patients with COPD. 相似文献17.
MA Weber J Basile M Stapff B Khan D Zhou 《Journal of clinical hypertension (Greenwich, Conn.)》2012,14(9):588-592
J Clin Hypertens (Greenwich). 2012; 14:588–592. © 2012 Wiley Periodicals, Inc. Blood pressure (BP) reductions when combining blockers of the renin‐angiotensin system (RAS) and β‐blockers have generally not been shown to be greater than for individual agents, possibly because of overlapping mechanisms of action. The authors tested the additivity of the β‐blocker nebivolol, which has vasodilating activity, with the angiotensin‐converting enzyme inhibitor lisinopril in patients with stage 2 diastolic hypertension. The BP effects of placebo (n=93), nebivolol 5 mg to 20 mg daily (n=185), lisinopril 10 mg to 40 mg daily (n=189), and nebivolol 5 mg to 20 mg + lisinopril 10 mg to 40 mg (n=189) during 6 weeks of treatment were compared. The primary end point was change in diastolic BP (DBP). For the full cohort, baseline BP was 163.8/104.4 mm Hg, mean age was 49.2 years, 58% were men, 62% were white, and 34% were black. DBP fell by 17.2±10.2 mm Hg with the combination, greater than placebo (8.0±9.2, P<.0001), nebivolol (13.3±8.9, P=.0010), and lisinopril (12.0±9.8, P<.0001). For systolic BP, corresponding reductions were 19.2±19.8 mm Hg, 9.9±16.4 (P<.0001 vs combination), 14.4±14.1 (P=.0470), and 16.1±17.2 (P=.0704). Adverse event rates were similar in all groups. This study demonstrated the potential antihypertensive benefits of combining nebivolol with a RAS blocker. 相似文献
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M. Cecilia Gonzalez Corcia Juan Sieira Gudrun Pappaert Carlo de Asmundis Gian Battista Chierchia Mark La Meir Andrea Sarkozy Pedro Brugada 《Journal of the American College of Cardiology》2018,71(2):148-157
Background
Young patients presenting with symptomatic Brugada syndrome have very high risks for ventricular arrhythmias and should be carefully considered for implantable cardioverter-defibrillator (ICD) placement. However, this therapy is associated with high rates of inappropriate shocks and device-related complications.Objectives
This study investigated clinical features, management, and long-term follow-up of young patients with Brugada syndrome and ICD.Methods
Patients diagnosed with Brugada syndrome, who underwent implantation of an ICD at an age of ≤20 years, were studied.Results
The study included 35 consecutive patients. The mean age at ICD placement was 13.9 ± 6.2 years. Ninety-two percent were symptomatic; 29% presented with aborted sudden cardiac death and 63% with syncope. During a mean follow-up period of 88 months, sustained ventricular arrhythmias were treated by the ICD in 9 patients (26%), including shocks in 8 patients (23%) and antitachycardia pacing in 1 patient (3%). Three patients (9%) died in an electrical storm. Seven patients (20%) experienced inappropriate shocks, and 5 patients (14%) had device-related complications. Aborted sudden cardiac death and spontaneous type I electrocardiogram were identified as independent predictors of appropriate shock occurrence.Conclusions
ICD therapy is an effective strategy in young patients with symptomatic Brugada syndrome, treating potentially lethal arrhythmias in >25% of patients during follow-up. Appropriate shocks were significantly associated with previously aborted sudden cardiac death and spontaneous type I electrocardiograms. However, ICDs are frequently associated with complications and inappropriate shocks, both of which remain high regardless of careful device implantation and programming. 相似文献19.
《The American journal of the medical sciences》2020,359(4):206-211
BackgroundLower gastrointestinal bleeding (LGIB) is a common clinical problem, and may be more prevalent among patients with cirrhosis, especially in the setting of portal hypertension and coagulopathy. However, there is extremely little data available on the subject of LGIB in patients with cirrhosis. Therefore, the primary objective of this study was to better understand the etiology and outcomes of cirrhotic patients hospitalized with LGIB.Materials and MethodsWe analyzed 3,735 cirrhotic patients admitted to the Medical University of South Carolina between January 2011 and September 2018, and identified patients admitted with a primary diagnosis of hematochezia or bright red blood per rectum.ResultsThirty patients with cirrhosis and LGIB were included in the cohort. The mean age was 56 ± 13 years, with 30% women. The mean model of end stage liver disease score was 22, and Child-Pugh (CP) scores were C: 41%, B: 33% and A: 26%. The mean Charlson Comorbidity Index was 5.6. Twenty-four (80%) patients had a clinical decompensating event (hepatic encephalopathy, ascites, esophageal varices); the mean hepatic venous pressure gradient was 14.1 mm Hg (n = 8). In 33% of patients, LGIB was considered significant bleeding that necessitated blood transfusion. The most common cause of LGIB was hemorrhoids (11 patients, 37%), followed by portal hypertensive enteropathy or colopathy (7 patients, 23%). Hemoglobin levels on admission were lower in patients with CP B/C cirrhosis than in those with CP A (P < 0.001). The length of stay was 9 ± 10 days, and 5 patients died (mortality, 17%).ConclusionsDespite being uncommon, LGIB in cirrhotic patients is associated with a high mortality rate. 相似文献
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Ersilia M. DeFilippis Avinainder Singh Sanjay Divakaran Ankur Gupta Bradley L. Collins David Biery Arman Qamar Amber Fatima Mattheus Ramsis Daniel Pipilas Roxanna Rajabi Monica Eng Jon Hainer Josh Klein James L. Januzzi Khurram Nasir Marcelo F. Di Carli Deepak L. Bhatt Ron Blankstein 《Journal of the American College of Cardiology》2018,71(22):2540-2551