Influence of progressive renal dysfunction in chronic heart failure

Chronic heart failure (CHF) is often associated with impaired renal function due to hypoperfusion. Such patients are very sensitive to changes in renal perfusion pressure, and may develop acute tubular necrosis if the pressure falls too far. The situation is complicated by the use of diuretics, ACE inhibitors and spironolactone, all of which may affect renal function and potassium balance. Chronic renal failure (CRF) may also be associated with fluid overload. Anaemia and hypertension in CRF contribute to the development of left ventricular hypertrophy (LVH), which carries a poor prognosis, so correction of these factors is important.     

单硝酸异山梨酯注射液治疗慢性支气管炎合并慢性肺源性心脏病160例疗效分析

目的　探讨单硝酸异山梨酯注射液 (鲁南欣康注射液 )在治疗慢性支气管炎 (简称慢支 )并慢性肺源性心脏病 (简称慢性肺心病 )的临床效果。方法　 10 0例慢支合并慢性肺心病患者使用抗炎、解痉、化痰、强心利尿等常规治疗作对照组 ;另一组 16 0例为治疗组 ,即在此基础上加用鲁南欣康注射液 ,观察两组心功能改善、动脉血Pa O2 增加、Pa CO2 减少、Sa O2 增加情况。结果　治疗组总有效率明显优于对照组 ,其疗效有非常显著差异 (P<0 .0 1)。结论　鲁南欣康注射液在治疗慢支并慢性肺心病的过程中可以有效改善心功能 ,并且影响整个病情的预后 ,副作用小 ,价格便宜 ,值得推广。     

Absence of anti-LKM-1 antibody in hepatitis C viral infection in the United States of America

Summary. Several studies from Europe have observed a relationship between hepatitis C virus infection and anti-liver/kidney microsome-1 (anti-LKM-1) positive chronic hepatitis. It has been suggested that hepatitis C may induce an autoimmune phenomenon that leads to the development of a specific type (type II anti-LKM-1 positive) autoimmune chronic hepatitis. We evaluated 204 sera from patients with well-documented hepatitis C infection from two centres in the United States of America and compared them with sera from 428 French patients from three centres. We evaluated the serological prevalence of anti-smooth muscle antibodies, anti-nuclear antibodies, anti-liver cytosol antibodies, and anti-mitochondrial antibodies subtype anti-M₂ in patients with chronic hepatitis C. The two groups were matched in their ages, gender, mode of transmission of hepatitis C infection and severity of liver disease. Anti-LKM-1 was not observed in the patients from the USA at a time when it was noted in 3.7% of French patients. There were no differences, however, in the expression of other auto-antibodies, which were often in low titres. Absence of anti-LKM-1 in USA sera in comparison with French sera suggests that there may be differences in induction of anti-LKM-1 related to environmental and/or host genetic factors, and/or genomic variation in the hepatitis C virus.     

慢性肾功能不全患者血栓调节蛋白与心脑血管并发症关系的探讨

目的探讨慢性肾功能不全患者血栓调节蛋白（Tm）与心脑血管并发症的关系。方法北京朝阳医院肾内科2005-2006年期间住院的86例慢性肾脏病患者，按照CKD分期标准划分为肾功能正常组（GFR≥90ml／min）42例和肾功能不全组（GFR〈89ml／min）44例。合并心、脑血管疾病的诊断均根据其临床表现、生化指标和冠脉造影或CT、MRI等影像学改变。清晨空腹采静脉血分别测定血肌酐、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白及血栓调节蛋白。结果慢性肾脏病肾功能不全组Tm水平明显高于肾功能正常组和对照组（P〈0．05），伴心脑血管并发症患者Tm水平较不伴并发症患者明显升高（P〈0．05）。将86例患者作为一个整体，进行多元逐步回归分析，结果显示：血栓调节蛋白、低密度脂蛋白、收缩压和血肌酐分别与慢性肾脏病合并心脑血管并发症密切相关。结论慢性肾脏病功能不全患者血栓调节蛋白升高，血栓调节蛋白与慢性肾脏病合并心脑血管并发症密切相关。     

Readmission patterns in patients with chronic obstructive pulmonary disease, chronic heart failure and diabetes mellitus: an administrative dataset analysis

Comprehensive disease management programmes for chronic disease aim to improve patient outcomes and reduce health-care utilization. Readmission rates are often used as an outcome measure of effectiveness. This study aimed to document readmission rates, and risk for early and late readmission, for patients discharged from the Royal Melbourne Hospital with a disease diagnosis of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus compared to those with other general medical conditions. Eighty five (8.6%) of patients were readmitted within 28 days and 183 (20.8%) were readmitted between 29 and 180 days. No risk factors for early readmission were identified. Patients with a primary disease diagnosis of CHF and COPD are at increased risk of late readmissions (29-180 days).     

Silymarin treatment of viral hepatitis: a systematic review

Silymarin from the milk thistle herb (Silybum marianum) is used by many patients with chronic viral hepatitis, but its efficacy remains unknown. We performed a systematic review of silymarin for the treatment of chronic viral hepatitis B and C. An exhaustive search strategy identified 148 papers that studied silymarin compounds in liver disease. Of these, four trials included patients with hepatitis C, one included hepatitis B patients, and two, unspecified chronic viral hepatitis. However, only one trial exclusively studied patients with hepatitis C, and none involved patients with only hepatitis B. Silymarin treatment resulted in a decrease in serum transaminases compared with baseline in four studies, and compared with placebo in only one study. There is no evidence that silymarin affects viral load or improves liver histology in hepatitis B or C. No studies were found that investigated the use of silymarin concomitantly with interferon, nucleoside analogues, or other conventional treatments for hepatitis B or C. In conclusion, silymarin compounds likely decrease serum transaminases in patients with chronic viral hepatitis, but do not appear to affect viral load or liver histology. Nevertheless it may be worthwhile to determine its effects in conjunction with standard antiviral treatment.     

Psychological factors to predict chronic diarrhea and constipation in Korean high school students

Chronic diarrhea and constipation are common in adolescents and are associated with depression and anxiety. However, the association was not reported in adolescents adjusted for other psychological factors (resilience, personality traits, perceived stress, and suicidal ideation). Therefore, we investigated the significant psychological factors predicting chronic diarrhea and constipation in adjusted individuals for co-variables.A total of 819 Korean high school students who completed bowel health and psychological questionnaires were enrolled in this study. Depression and anxiety were assessed using validated questionnaires. We used multivariate analyses, controlling for demographic, dietary, lifestyle, and psychological variables to predict chronic diarrhea and constipation.Chronic diarrhea and constipation were more common in individuals with depression (22.3% and 18.6%, respectively) than in individuals with no depression (7.0% and 10.9%, respectively). In addition, they were more prevalent in individuals with anxiety (24.5% and 18.6%, respectively) than in individuals with no anxiety (9.1% and 12.7%, respectively). Multivariate analyses showed that resilience (adjusted risk ratio [aRR] = 0.98, adjusted 95% confidence interval [CI] = 0.97–0.99), moderate (aRR = 6.77, adjusted 95% CI = 3.55–12.91), and severe depression (aRR = 7.42, adjusted 95% CI = 3.61–15.27) were associated with chronic diarrhea. Only mild depression was associated with chronic constipation (aRR = 2.14, adjusted 95% CI = 1.36–3.38). However, anxiety was not significantly associated with chronic diarrhea or constipation.Among the psychological factors predicting disordered bowel habits, resilience and moderate and severe depression were significant predictors of chronic diarrhea, but not anxiety. Furthermore, only mild depression was an independent predictor of chronic constipation.     

慢加急性肝衰竭101例临床分析

目的探讨不同发病基础上的慢加急性肝衰竭在临床表现、实验室指标、预后是否存在差异。方法回顾分析慢加急性肝衰竭101例,按发病基础分为慢性HBV携带者、慢性肝炎、肝硬化3组,比较它们临床及实验室指标,并发症发生率及预后。结果（1）3组患者的ALT、ALB、CHE差异有统计学意义（P〈0．001）,慢性HBV携带者组中的ALT、ALB、CHE明显高于其它两组。（2）3组并发肝性脑病、腹水、自发性腹膜炎及感染并发症的发生率有统计学差异（P〈0．05）。（3）3组患者发病年龄以慢性HBV携带者组最小,肝硬化组年龄最大。3组预后,以慢性HBV携带者组最好,肝硬化组最差。结论慢性HBV携带者、慢性肝炎、肝硬化基础上发病的急性肝衰竭,在生化指标、合并症、预后均有差异。肝硬化组预后最差,应尽早进性肝移植。     

比索洛尔在慢性心力衰竭合并慢性阻塞性肺病患者中的应用观察

目的 观察比索洛尔对慢性心力衰竭（CHF）合并COPD患者的疗效及安全性.方法 将43例CHF合并COPD患者随机分成两组,对照组给予常规治疗,治疗组在对照组的基础上加用比索洛尔.比较两组治疗前及治疗6个月后的血压、心率、血气分析、心功能和肺功能的变化情况.结果 治疗组治疗后的心率、血压、LVEF、LVED、LVSD、6MWT和NYHA心功能分级指标与对照组有显著性差异（P〈0.05）,而两组的血气分析和肺功能（FEV1%、FEV1/FVC）差异无统计学意义（P〉0.05）.结论 比索洛尔用于治疗CHF合并COPD患者安全有效.     

Chronic disease management: a primer for physicians

Approximately one in three Australians or 6.8 million individuals suffer from one or more chronic diseases, the most prevalent being ischaemic heart disease, congestive heart failure, chronic obstructive lung disease, diabetes and renal disease. Potentially avoidable hospitalizations related to chronic disease comprise 5.5% of all admissions nationally and cluster in older age groups and socioeconomically disadvantaged regions. In an effort to reduce mortality and morbidity, programmes of chronic disease management have evolved with the aim of achieving formalized, population-wide implementation of elements of the chronic care model developed by Wagner et al . Results of rigorous evaluations of such programmes suggest improved survival and/or disease control with reductions in hospitalizations and adverse clinical events. This paper aims to provide an overview of available evidence for chronic disease management programmes for practising physicians who will be increasingly invited to take an active leadership role in designing and operationalizing such programmes.     

Immunological aspects of chronic hepatitis

Chronic active hepatitis (CAH) is a clinically and histologically defined syndrome which is aetiologically heterogeneous. Immune reactions are involved in almost all types of chronic inflammatory liver diseases. The host's immune system is thought to contribute significantly to the degree of liver cell destruction in chronic hepatitis B—HBcAg is regarded as a major target antigen. Auto-immune type CAH is a syndrome of unknown aetiology, a loss of tolerance against self antigens is thought to be a principal pathogenetic mechanism. At least three different subgroups of auto-immune type CAH can be distinguished by circulating auto-antibodies: antinuclear antibodies (ANA), smooth muscle antibodies (SMA), liver membrane auto-antibodies (LMA); liver-kidney-microsomal antibodies (LKM); and antibodies to a soluble liver antigen (SLA). The identification of auto-immune type CAH has clinical relevance since only auto-immune type CAH seems to profit from immunosuppressive therapy. A suppressor T cell defect was demonstrated in chronic hepatitis B and auto-immune type CAH. However, this defect could only be reversed by the addition of prednisone in vitro in auto-immune type CAH. Present research concentrates on the evaluation of the precise cellular mechanisms leading to liver cell destruction. In vitro cytotoxicity assays including autologous target cell systems have several drawbacks due to the use of peripheral blood lymphocytes and the questionable viability of the hepatocytes isolated from liver biopsies. Immunohistological studies using monoclonal antibodies revealed that T₈ positive T lymphocytes account for the majority of the inflammatory cell infiltrate. In addition, T cell clones derived from liver biopsies are mainly T₈ positive and show cytotoxic function in vitro. At present, little is known about the antigen specificity of these liver-derived T cell clones.     

The Impact of Pulmonary Rehabilitation on Chronic Pain in People with COPD

Abstract

Chronic pain affects up to 88% of people with chronic obstructive pulmonary disease (COPD) and has been associated with comorbidities. However, with pain not evaluated during pulmonary rehabilitation (PR) assessments, it is unclear whether PR impacts pain intensity and coping ability. This study aimed to 1) determine the effect of PR on pain qualities, coping behavior and psychological symptoms in those with COPD and chronic pain; and 2) assess the impact of PR on exercise capacity and quality of life in individuals with COPD and chronic pain compared to those without pain. Patients with COPD and comorbidities enrolling in outpatient PR were assessed for chronic pain. Those with chronic pain completed the Brief Pain Inventory, Coping Strategies Questionnaire-24, Fear Avoidance Behavior Questionnaire and measures of anxiety and depression. Changes in HRQOL and 6-minute walk distance (6MWD) following PR were compared between participants with and without chronic pain. Thirty-four participants with chronic pain and 34 participants without pain were included (mean?±?SD, FEV₁ 47?±?19% predicted). In those with chronic pain, PR did not affect pain intensity (median[IQR] pre/post PR 3[2–5] vs. 4[2–6] points, p?=?0.21), anxiety (7[2–9] vs. 5[3–8] points, p?=?0.82) or depression (4[2–8] vs. 3[1–6] points, p?=?0.38) and did not change pain coping strategies. Both groups improved in 6MWD (mean difference [95% CI] 17[?39 to 72] m), and those without pain had greater improvement in mastery (p?=?0.013). PR was effective in patients with moderate to severe COPD whether or not they reported chronic pain at the time of their initial assessment.     

运动诱导的肌肉因子与久坐慢性病群

运动有助于预防和治疗心血管疾病、癌症、糖尿病等久坐慢性病群疾病。这可能是由于骨骼肌具有内分泌和旁分泌功能,收缩肌肉能够释放白细胞介素-6(IL-6)、IL-15、脑源性神经营养因子(BDNF)等具有激素样作用的肌肉因子,交互调节身体各器官、肌肉和脂肪。一些肌肉因子具有内分泌作用,调节内脏脂肪氧化或介导抗炎反应;另一些肌肉因子则经旁分泌机制在肌肉局部和脂肪氧化有关的信号途径中发挥作用。     

Chronic Renal Insufficiency Cohort Study (CRIC): Overview and Summary of Selected Findings

The Chronic Renal Insufficiency Cohort (CRIC) Study is a United States multicenter, prospective study of racially and ethnically diverse patients with CKD. Although the original aims of the study were to identify novel predictors of CKD progression and to elucidate the risk and manifestations of cardiovascular disease among nearly 4000 individuals with CKD, the CRIC Study has evolved into a national resource for investigation of a broad spectrum of CKD-related topics. The study has produced >90 published scientific articles, promoted many young investigative careers in nephrology, and fostered international collaborations focused on understanding the global burden of CKD. The third phase of the CRIC Study will complete enrollment of 1500 additional study participants in 2015 and is designed to answer questions regarding morbidity and mortality in mild-to-moderate CKD and to assess the burden of CKD in older persons. This review highlights some of the salient findings of the CRIC Study in the areas of race and ethnicity, CKD progression, CKD and cognition, and cardiovascular disease outcomes; it also outlines the ongoing and forthcoming opportunities for the global nephrology community to enhance its understanding of CKD and related complications through the study.