糖皮质激素长疗程间歇疗法治疗神经性皮炎的临床疗效观察

目的探讨外用糖皮质激素长疗程间歇疗法治疗神经性皮炎的疗效、安全性及复发情况,为指导临床用药提供依据。方法采用随机对照开放试验,选取门诊神经性皮炎患者,外用复方氟米松软膏常规疗法短期治疗。将已短期治愈入选的120例患者随机分为2组,试验组外用复方氟米松软膏进行长疗程间歇治疗,2次/d;对照组外用尿素霜（成分：尿素,羊毛脂,白蜡,凡士林）进行治疗,2次/d。2组每周用药2 d,每次间隔3 d用药,疗程8周。在长疗程治疗4周、8周及停药12周时各随访1次,分别比较2组患者的复发率。结果长疗程治疗8周及停药12周时,试验组SCORAD评分均显著低于对照组（P均〈0.05）。长疗程治疗4周、8周及停药12周时,试验组复发率均显著低于对照组（P均〈0.05）。治疗期间不良反应发生率1.67%,无严重不良事件。结论外用糖皮质激素长疗程间歇治疗神经性皮炎,效果好,不良反应少,有预防症状加重、延缓复发的作用。     

A novel use of a split sheath to maintain vessel access when guidewire exchange is not possible

After inserting a catheter into a vessel, guidewire exchange technique must be used to maintain vascular access. If the lumen of the catheter is blocked and the guidewire exchange cannot be used, the catheter can only be removed, vascular access is lost, and an alternate vascular approach attempted. We describe a technique to remove the blocked catheter and still maintain vascular access. © 2008 Wiley‐Liss, Inc.     

主动固定电极在右室流出道间隔部起搏中的应用研究

目的评价主动固定电极在右室流出道间隔部起搏应用中的可行性和稳定性。方法160例起搏适应证患者随机分为两组,每组80例,一组采用主动固定电极行右室流出道间隔部起搏(简称主动固定电极组),另一组应用被动固定电极行右室心尖起搏(简称被动固定电极组),观察电极置入时间和心电图QRS波宽度,电极置入后随访观察起搏阈值、感知、阻抗,电极脱位及相关并发症。结果主动固定电极组的置入时间和X线曝光时间均长于被动固定电极(26.34±6.54minvs20.86±4.32min,16.78±5.38minvs8.67±4.52min;P均<0.01)。主动固定电极组电极置入15min时较置入即刻的起搏阈值明显下降(0.76±0.21mVvs1.12±0.25mV,P<0.01)。主动固定电极组起搏的QRS波时限较被动固定电极组短(0.14±0.04msvs0.16±0.03ms,P<0.01)。术后随访1,3,6个月,两组的起搏阈值、感知、阻抗均无差异,未见电极脱位等并发症。结论主动固定电极在右室流出道间隔部起搏中的应用是可行和稳定的。     

Comparison of the efficacy and safety of the adalimumab biosimilar TQ-Z2301 and adalimumab for the treatment of Chinese patients with active ankylosing spondylitis: a multi-center,randomized, double-blind,phase III clinical trial

Clinical Rheumatology - To assess the clinical equivalence of TQ-Z2301, a biosimilar of adalimumab, to the reference adalimumab in the treatment of Chinese patients with active ankylosing...     

Psychological Comfort of Paramedics with Field Death Pronouncement: A National Asian Study to Prepare Paramedics for Field Termination of Resuscitation

Objectives: Paramedics' decision to terminate field resuscitation without a physician present may depend on personal and external factors. This study investigates factors associated with paramedic psychological comfort with termination of resuscitation (TOR) to inform future training. Methods: We administered an anonymous survey to all practicing paramedics in a large urban Asian Emergency Medical Services system where formal TOR training had not yet been conducted and field TOR was not routinely applied. The survey assessed psychological comfort using the validated Psychological Comfort Total (PCT) scale (summed score of 28 items, with higher scores representing greater comfort). We examined scores associated with four personal (prior resolution of personal loss, knowledge of survival probability, religious affiliation and experience with death pronouncements) and two external (location of patient and perceived trust of family) factors. Data were entered into Excel and analyzed by t-tests and ANOVA. Results: Response rate was 73.6% (254/345). Respondents were 30.3 years (mean, SD 7.1) with 7.2 years (mean, SD 5.54) of practice experience. Over 60% had been involved in 6 or more field death pronouncements in the prior 12 months. Higher PCT scores were associated with prior resolution of personal loss and knowledge of survival probability. Lower PCT scores were associated with patient location in a public place and perceived family lack of trust. PCT scores were not associated with paramedic religious affiliation or number of prior death pronouncements. Conclusions: Paramedic psychological comfort with field death pronouncement is associated with personal and external factors. Since paramedic comfort is important for protocol adoption, TOR education should target not only knowledge, but also public arena management, communication skills for engaging with families, and help paramedics resolve prior personal loss.     

Prognostic significance of N-terminal pro-atrial natriuretic factor (1-98) in acute myocardial infarction: comparison with atrial natriuretic factor (99-126) and clinical evaluation.

OBJECTIVE--To evaluate the prognostic significance of plasma N-terminal pro-atrial natriuretic factor (1-98) concentrations measured in the subacute phase after acute myocardial infarction, and to compare the predictive value of measurement of N-terminal pro-atrial natriuretic factor (1-98) with the measurement of atrial natriuretic factor (99-126) and with clinical assessment of the degree of heart failure. DESIGN--Prospective observational. SETTING--Norwegian central hospital. PATIENTS--139 patients (mean (SD) age 66.9 (11.1) years, 71.2% males) with acute myocardial infarction. Patients in cardiogenic shock or with severe heart failure (New York Heart Association class IV) were excluded. MAIN OUTCOME MEASURE--Cardiovascular death within 12 months. RESULTS--During the follow up period 15 patients died. In a univariate Cox proportional hazards model N-terminal pro-atrial natriuretic factor (1-98) was significantly related to mortality (p = 0.0003). In a multivariate model the prognostic value of N-terminal pro-atrial natriuretic factor (1-98) was better than that of atrial natriuretic factor (99-126) and clinical assessment of heart failure (N-terminal pro-atrial natriuretic factor (1-98), p = 0.0003; atrial natriuretic factor (99-126), p = 0.4513; heart failure, p = 0.0719). The odds ratio estimate of patients in whom plasma concentrations of N-terminal pro-atrial natriuretic factor (1-98) were greater than 2000 pmol/l was 25 (95% confidence interval 2.8-225.0) compared with patients with plasma concentrations less than 1000 pmol/l. CONCLUSIONS--These results suggest that determination of plasma N-terminal pro-atrial natriuretic factor (1-98) in the subacute phase of myocardial infarction may provide clinically relevant prognostic information that is superior to that obtained from atrial natriuretic factor (99-126) measurements and clinical evaluation.     

Modification of ventricular fibrillation latency following coronary artery occlusion in the conscious pig.

Abrupt occlusion of the left anterior descending coronary artery was performed on 45 unanesthetized farm pigs in order to evaluate the relative effects on the latency to ventricular fibrillation (VFL) of 1) adaptation of the animals to the laboratory, and 2) beta-receptor blockade by propranolol. Compared to control values, VFL was greatly lengthened (i.e., VF delayed or prevented) by adaptation (P smaller than 0.01), was shortened by large (2 MG/KG) doses of racemic propranolol in unadapted animals (P smaller than 0.02), and was again increased while under the influence of the drug, by adaptation (P smaller than 0.051). Neither a lower (0.02 mg/kg) dose of racemic propranolol, 2 mg/kg of dextropropranolol, nor ventricular pacing to a higher heart rate had an effect on VFL. The results suggest that reduced psychological stress was very effective in retarding or preventing the onset of VF, that low doses of propranolol were ineffective, and that higher doses were deleterious in unadapted animals.