药物洗脱支架治疗完全闭塞病变的疗效观察

目的:评估在冠心病患者,不同药物洗脱支架对于治疗冠状动脉完全闭塞病变的远期疗效。方法:122例完全闭塞病变[冠状动脉溶栓治疗临床试验(TIMI)0级血流,且闭塞时间>3个月]并成功置入Firebird支架(Firebird组,n=58)、Cypher支架(Cypher组,n=40)和Taxus支架(Taxus组,n=24)的患者入选本研究。术后12个月随访时进行定量冠状动脉造影分析,并观察住院期间,30天和12个月时不良心脏事件的发生和靶病变重复血管重建。结果:3组的基本临床特征和基础冠状动脉造影结果相似,支架置入成功率均为100。术后支架内最小管腔直径,3组间差异无统计学意义(P>0.05)。住院期间3组均无靶病变重复血管重建和死亡发生。在30天时,3组均无支架内血栓形成。12个月随访期间,严重不良心脏事件发生率和靶病变重复血管重建率,在Firebird组为5.2和3.4;Cy-pher组为10.0和5.0,其中死亡1例(2.5);Taxus组为12.5和12.5,均无显著性差异(P>0.05)。12个月定量冠状动脉造影分析显示:支架内最小管腔直径和管腔狭窄直经,在Firebird组和Cypher组无显著差...     

Therapeutic Ultrasound as a Treatment Modality for Chronic Rhinosinusitis

West Nile virus, a flavivirus identified in Africa in the 1930s, appeared in the Western Hemisphere in 1999. Since its appearance, West Nile virus has caused nearly 40,000 cases of human disease in the US and more than 1,500 deaths, mostly among elderly persons with neuroinvasive disease. This review summarizes recent information regarding the clinical manifestations and prevention of West Nile virus infections in children, and emphasizes that although West Nile virus fever and neuroinvasive disease primarily affect adults, infants and children remain at risk of serious complications, including death, from this disorder.     

Long-Term Efficacy of Interferon-alpha and Ursodeoxycholic Acid in Treatment of Chronic Type C Hepatitis

Interferon-alpha (IFN) and ursodeoxycholic acid(UDCA) combined have a controversial role in thetreatment of chronic type C hepatitis. We studied thelong-term efficacy of both drugs alone or incombination. In a three-year period, 108 patients wererandomized into three treatment arms: (1) IFN alone 3 MUthree times a week (N = 49), (2) IFN 3 MU three times aweek + UDCA 250 mg twice a day (N = 45), and (3) UDCA alone 250 mg twice a day (N = 14). Response wasdefined as complete normalization of serum ALT. For theresponders at the end of six months, the treatment wasrun to 12 months. Nonresponders (NRs) of the first group were crossed over to combinationand NRs of the combination received 6 MU three times aweek IFN + UDCA for the next six months. The enrollmentto the UDCA alone arm was stopped early, since only 1/14 normalized serum ALT at the end of thirdmonth. However, 12/14 completed six months and 11 NRsreceived IFN 3 MU three times a week alone for the nextsix months. Twelve discontinued treatment due to side effects. Responders were followed-upuntreated for 18 months. Sustained response (SR) wasdefined as persistence of normal serum ALT levels inthis period. At the end of six months, 22/45 (48%) from the IFN-alone and 23/39 (58%) from thecombination group responded. Twenty NRs from former and15 of latter group were crossed over. While none of the20 from the IFN-alone group responded to thecombination, 1/15 NRs of the combination group responded todose escalation. SR was achieved in 9/45 (20%) of theIFN alone and 7/39 (18%) of the combination group. Themean time form the end of the treatment to the relapse was not different between the groups.Five of 11 UDCA NRs responded to IFN with SR in 2. Itwas concluded that UDCA as a single agent is ineffectivein achieving response in the treatment of chronic type C hepatitis. Combined with IFN, itincreases response rate insignificantly although this isnot sustained.     

Long-Term Safety of Pulsed Irrigation Evacuation (PIE) Use with Chronic Bowel Conditions

We wanted to determine the long-term effects ofpulsed irrigation evacuation on the colon.Sigmoidoscopy/colonoscopy was performed on four patientswith spinal cord injuries who have used this procedure an average of 3.5 times weekly, for an averageof 6.7 years. No gross or microscopic abnormalities wereidentified in any of these individuals. Impactions aswell as other complaints were markedly diminished or absent following the initiation of thistherapy. Pulsed irrigation evacuation is a safe andeffective method for long-term treatment of chronicneurogenic bowel.     

Long-Term Efficacy and Safety of Somatropin for Adult Growth Hormone Deficiency

The beneficial effects of somatropin (growth hormone [GH] replacement therapy) in adults are now established. Long-term somatropin administration in GH-deficient adults improves body composition, muscle strength, quality of life, bone mass and density, and lipoprotein pattern. The extent to which somatropin therapy can also reduce cardiovascular morbidity and mortality in GH-deficient adults remains to be determined. By starting with a low dose of somatropin, which is gradually increased based on clinical response (body composition, well-being, and serum insulin-like growth factor-1 concentration), effective treatment can be achieved with a minimum of fluid-related adverse effects. Thorough long-term monitoring of glucose metabolism, cardiovascular measurements, and underlying pituitary disease, is, however, mandatory.     

EXCEL可降解涂层雷帕霉素洗脱支架长期临床应用的安全性和有效性

目的:评估EXCEL可降解涂层雷帕霉素洗脱支架置入3年后的安全性和有效性。方法:连续入选我院100例冠心病住院患者,均单一置入EXCEL支架。术后接受双联抗血小板治疗(氯吡格雷和阿司匹林)6个月,随后单用阿司匹林。术后平均8个月实施造影随访及冠状动脉内超声检测。观察术后3年主要不良心脏事件(MACE)、全因死亡和血栓事件发生率。结果:100例患者均完成3年临床随访。1年时发生4例(4.0%)靶病变血运重建,无死亡和非致死性心肌梗死发生,1年MACE发生率为4.0%。3年随访时共6例(6.0%)MACE发生,包括靶病变血运重建4例(4.0%)和心性死亡2例(2.0%)。3年累计全因死亡率4%,包括心性死亡2例(2.0%),脑卒中和肺癌导致的非心性死亡各1例(2.0%),术后3年共发生支架内血栓事件2例(2.0%),其中很可能的支架内血栓事件仅1例(1.0%)。造影随访支架内再狭窄率3.6%(4/112),支架内晚期管腔丢失(0.12±0.34)mm。冠状动脉内超声检查共发现4处晚期支架贴壁不良(发生率6.3%,4/64),但随访期间无任何临床事件发生。结论:EXCEL支架置入术后患者的靶病变血运重建及MACE发生率一直处于较低水平,提示其早期临床获益可持续至术后3年。这一结论有待大规模、随机对照及随访期更长的临床研究证实。     

Efficacy and Safety of Tenofovir-Based Rescue Therapy for Chronic Hepatitis B Patients with Previous Nucleo(s/t)ide Treatment Failure

Background/Aims

We investigated the efficacy and safety of tenofovir disoproxil fumarate (TDF)-based treatment in chronic hepatitis B (CHB) patients who failed previous antiviral therapies.

Methods

Seventeen patients who failed to achieve virological responses during sequential antiviral treatments were included. The patients were treated with TDF monotherapy (four patients) or a combination of TDF and lamivudine (13 patients) for a median of 42 months. Hepatitis B virus (HBV) DNA and hepatitis B e antigen (HBeAg) were measured, and renal function was also monitored.

Results

Prior to TDF therapy, 180 M, 204 I/V/S, 181 T/V, 236 T, and 184 L mutations were detected. After TDF therapy, the median HBV DNA level decreased from 4.6 log₁₀ IU/mL to 2.0 log₁₀ IU/mL and to 1.6 log₁₀ IU/mL at 12 and 24 months, respectively. HBV DNA became undetectable (≤20 IU/mL) in 14.3%, 41.7%, and 100% of patients after 12, 24, and 48 months of treatment, respectively. HBeAg loss was observed in two patients. Viral breakthrough occurred in five patients who had skipped their medication. No significant changes in renal function were observed.

Conclusions

TDF-based rescue treatment is effective in reducing HBV DNA levels and is safe for patients with CHB who failed prior antiviral treatments. Patients'' adherence to medication is related to viral rebound.     

Efficacy and Safety of Long-Term Treatment With the Combination of Amlodipine Besylate and Olmesartan Medoxomil in Patients With Hypertension

The authors report on the 44-week open-label extension of the 8-week, double-blind Combination of Olmesartan Medoxomil and Amlodipine Besylate in Controlling High Blood Pressure (COACH) trial in 1684 patients. Initial therapy was amlodipine (AML) plus olmesartan medoxomil (OM) 5+40 mg/d, up-titrated to AML+OM 10+40 mg/d plus hydrochlorothiazide (HCTZ) 12.5 mg then 25 mg if patients did not achieve blood pressure (BP) goal (<140/90 mm Hg or <130/80 mm Hg in patients with diabetes). Baseline mean BP decreased from 164/102 mm Hg to 131/82 mm Hg at end of study, with an overall 66.7% of patients, including those with diabetes, achieving BP goal. The BP goal achievement was 80% for AML+OM 5+40 mg/d, 70.6% for AML+OM 10+40 mg/d, 66.6% for AML+OM+HCTZ 10+40+12.5 mg/d, and 46.3% for AML+OM+HCTZ 10+40+25 mg/d. Study medication was safe and well tolerated. Combination antihypertensive therapy with AML+OM±HTCZ, up-titrated as necessary, allowed a majority of patients to achieve BP goal.     

Rituximab (Anti-cd20 Monoclonal Antibody) in Children with Chronic Refractory Symptomatic Immune Thrombocytopenic Purpura: Efficacy and Safety of Treatment

This retrospective study investigated the effects of rituximab in 19 pediatric patients (15 girls and 4 boys) with chronic refractory symptomatic immune thrombocytopenic purpura (ITP). Patients received from 2 to 5 weekly infusions of rituximab (375 mg/m(2)); 15 patients were younger than 12 years when treated. The median follow-up time was 30 months (range, 9-43 months). The overall response rate was 68% (13/19 patients). Six responders relapsed at a median of 4.5 months (range, 3-8 months). Seven patients still displayed a platelet count >150,000/microL at a median of 33 months (range, 14-43 months) after rituximab treatment. Six of 15 patients treated with 4 or 5 weekly infusions and 1 of 4 patients treated with 2 or 3 infusions are still in remission. No difference was detected between splenectomized and nonsplenectomized patients. The duration of ITP disease at the time of treatment did not influence the response rate. Patients still in remission showed significantly lower levels of CD19+ cells after 4 and 6 months than nonresponding or relapsed patients (P < .05). No major infections were reported during follow-up. Our data show the efficacy and tolerability of rituximab in young children with refractory symptomatic ITP. Nonrelapsed patients showed a more prolonged B-cell depletion.     

Nasal Saline Irrigations for the Symptoms of Acute and Chronic Rhinosinusitis

The use of saline nasal irrigation (SNI) in the treatment of nasal and sinus disorders has its roots in the yoga tradition and homeopathic medicine. In recent years, SNI has been increasingly observed as concomitant therapy for acute (ARS) and chronic rhinosinusitis (CRS). Various devices are employed, such as nasal douches, neti pots or sprays. The saline solutions used vary in composition and concentration. This article gives a current overview of literature on the clinical efficacy of SNI in the treatment of ARS and CRS. It then answers frequent questions that arise in daily clinical routine (nasal spray vs. nasal irrigation, saline solution composition and concentration, possible risks for patients). SNI has been an established option in CRS treatment for many years. All large medical associations and the authors of systematic reviews consistently conclude that SNI is a useful addition for treating CRS symptoms. SNI use in ARS therapy, however, is controversial. The results of systematic reviews and medical associations’ recommendations show the existing but limited efficacy of SNI in ARS. For clinical practice, nasal douches are recommended—whatever the form of rhinosinusitis—along with isotonic and hypertonic saline solutions in CRS (in ARS to a limited extent). To prevent infections, it is essential to clean the nasal douche thoroughly and use the proper salt concentration (2?3.5 %). Conclusive proof of the efficacy of SNI in the treatment of ARS is still pending. In CRS, SNI is one of the cornerstones of treatment.     

拉米夫定治疗重型乙型病毒性肝炎的临床研究

目的 :探讨拉米夫定治疗慢性乙型重型病毒性肝炎的疗效和安全性。方法 :86例慢性乙型重型病毒性肝炎分为两组。对照组 3 8例 ,给予常规内科综合治疗 ;拉米夫定组 48例 ,在综合治疗的基础上 ,加用拉米夫定。统计两组的病死率、存活者肝功能恢复情况及平均住院时间。结果 :治疗组患者病死率为 41 7% ,对照组为 68 4% ,两组患者病死率经统计学处理差异有显著性意义 (P <0 0 5 ) ;治疗组存活者达到显效出院平均住院时间为 (74 6±2 2 7)天 ,明显短于对照组的 (114 3± 2 6 2 )天 (P <0 0 5 )。拉米夫定治疗期间未见明显副反应 ,显示良好的安全性。结论 :拉米夫定治疗慢性乙型重型病毒性肝炎是有效和安全的 ,可作为抢救重型乙型肝炎的治疗药物之一。     

沙库巴曲缬沙坦治疗慢性心力衰竭的有效性及安全性研究

目的探讨沙库巴曲缬沙坦治疗慢性心力衰竭的疗效和安全性,并观察其对1年生存率的影响。方法入选2017年5月至2019年4月在我院连续住院的慢性心力衰竭患者96例,分成两组,对照组应用常规抗心衰治疗,研究组在常规抗心衰治疗基础上联合沙库巴曲缬沙坦治疗。主要观察终点:治疗3个月时患者的临床疗效变化,次要观察终点:(1)治疗3个月时超声心动图相关指标的变化:左心射血分数(LVEF)、左心舒张末径(LVEDD)、左房内径(LA)、舒张早期与晚期间血流最大峰值的比值(E/A)及舒张早期最大峰值(E/e’);(2)血清生物标志物包括血清β-内啡肽(β-EP)、心肌营养素-1(CT-1)及N-末端B型利钠肽(NT-pro BNP)变化;(3)治疗一年后比较两组生存率的差异。结果治疗3个月后,沙库巴曲缬沙坦研究组有效性明显优于对照组(95.8%vs 83.3%,P<0.05);研究组的次要观察终点LVEF改善程度及E/A水平升高幅度显著优于对照组(P<0.05),LVEDD、LA及E/e’水平降低幅度显著优于对照组(P<0.05),血清β-EP及CT-1水平降低幅度显著大于对照组(P<0.05),研究组的NT-pro BNP降低幅度显著大于对照组(P<0.05)。平均随访时间1年,研究组1年生存率显著高于对照组(83.7%vs 65.9%,P=0.03)。结论沙库巴曲缬沙坦可明显改善慢性心力衰竭患者的近期疗效,并且可显著提高1年生存率。     

白芍总苷联合氯雷他定治疗慢性荨麻疹的疗效

目的探讨白芍总苷治疗慢性荨麻疹的疗效和安全性。方法将48例慢性荨麻疹患者分为试验组和对照组,试验组采用白芍总苷联合氯雷他定治疗,对照组单用氯雷他定。两组患者均于治疗开始前及治疗后2、4、8周对病情进行评价,比较两组的疗效。结果试验组2、4、8周的疗效均高于对照组,治疗8周时,试验组与对照组的症状积分下降指数(symptomscore reducing index,SSRI)比较差异具有显著性意义(P0.05)。结论白芍总苷联合氯雷他定治疗慢性荨麻疹较单纯用氯雷他定疗效更好,且疗效随用药时间延长而更加显著。     

Sinus Imaging for Diagnosis of Chronic Rhinosinusitis in Children

Chronic rhinosinusitis (CRS) is a relatively common disease in children but is often overlooked because at times the clinical symptoms are subtle and nonspecific. This makes imaging very important in the diagnosis. Among the different techniques, plain radiography has limited utility, whereas CT scan and MRI have a major role in evaluating the modifications caused by the disease. In particular, a CT scan provides higher resolution of bone and soft tissue and removes the overlapping structures that are present in conventional radiography. CT is recommended in isolated sphenoid sinusitis, is essential in diagnosing fungal sinusitis, and is the technique of choice when orbital complications are suspected. MRI allows investigation of not only the morphology of structures, but their intrinsic biophysical and biochemical properties, such as water content, cellular density, lipid or blood product deposits, and fibrosis. MRI allows better soft tissue differentiation and high spatial resolution images depicting fine details. When indicated, MRI with contrast gadolinium-based agents may better characterize the local disease extension or its diffusion beyond paranasal and nasal cavities and has excellent contrast resolution. A combination of CT and MRI is useful in cases of diagnostic difficulties, especially when complications are involved.     

前列地尔治疗高龄糖尿病并慢性肾脏病患者的临床效果和安全性探讨

目的探究前列地尔治疗高龄糖尿病并慢性肾脏病患者的临床效果与安全性。方法选取该院2013年5月—2014年10月收治的高龄糖尿病合并慢性肾脏病患者60例作为该次的研究对象,按照随机分组法分为Ⅰ组和Ⅱ组,每组患者各30例。Ⅰ组患者进行基础治疗;Ⅱ组患者先采取基础治疗14 d后再给予10μg的前列地尔注射液静推,观察用药期间药物的安全性,观察指标包括:肾功能与尿蛋白、凝血功能、血脂、血糖、肝功能、血压等指标。结果两组患者使用前列地尔治疗后,其中UAER、ACR、LDL-c、CHOL等血脂指标与治疗前相比均明显下降,两组比较差异有统计学意义(P0.05);凝血功能指标(PLT、PT、FIB、APTT)、FBG、D-DI、Hb Alc等指标水平与治疗前相比无明显差异,差异无统计学意义(P0.05);治疗后的临床效果分析:与基础治疗相比,采用基础治疗联合前列地尔注射液治疗的临床效果更佳,两组比较差异有统计学意义(P0.05)。结论对高龄糖尿病并慢性肾脏病患者采用前列地尔治疗的临床效果显著,药物安全性高,无明显不良反应,值得进一步推广并应用。