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991.
992.
The etiology of system lupus erythematosus (SLE) still remains unclear, and vitamin D is associated with immune response. Although a few studies are conducted to investigate the association between polymorphism in vitamin D receptor (VDR) genes and SLE risk, their results are conflicting. Following the guideline of PRISMA, we conducted a systematic search and meta-analysis of the BsmI polymorphism rs1544410 and the risk of SLE. The pooled odds ratios (OR) and its 95 % confidential interval (CI) were calculated by using Stata Version 10 with dominant and recessive model and allele analyses. Nine studies were included in our meta-analysis with a total of 1247 SLE cases and 1687 controls. No significant association was found in both models in the overall population. Only Bb?+?BB genotypes showed a significantly elevated SLE risk in Asian subgroup with an OR of 3.26 (95 % CI?=?1.30–8.17) while no significance was observed in Caucasian population. Notably, B allele significantly increased the SLE risk among Asian population with an OR of 2.29 (95 % CI?=?1.14–4.61). No positive findings were reported in Caucasian population and in the overall analysis. In Asian population, Bb?+?BB genotype and B allele can significantly increase the SLE risk. 相似文献
993.
Tess Petersen Kerry Townsend Lori A. Gordon Sreetha Sidharthan Rachel Silk Amy Nelson Chloe Gross Monica Calderón Michael Proschan Anu Osinusi Michael A. Polis Henry Masur Shyam Kottilil Anita Kohli 《Hepatology International》2016,10(2):310-319
Background
As treatment for chronic hepatitis C (HCV) virus has evolved to all-oral, interferon-free directly acting antiviral (DAA) therapy, the impact of these improvements on patient adherence has not been described.Methods
Medication adherence was measured in 60 HCV, genotype-1, treatment-naïve participants enrolled in a phase 2a clinical trial at the National Institutes of Health and community clinics. Participants received either ledipasvir/sofosbuvir (LDV/SOF) (90 mg/400 mg) (one pill) daily for 12 weeks, LDV/SOF + GS-9451 (80 mg/day) (two pills) daily for 6 weeks, or LDV/SOF + GS-9669 (500 mg twice daily; three pills, two in the morning, one in the evening) for 6 weeks. Adherence was measured using medication event monitoring system (MEMS) caps, pill counts and patient report.Results
Overall adherence to DAAs was high. Adherence declined over the course of the 12-week treatment (p = 0.04). While controlled psychiatric disease or symptoms of depression did not influence adherence, recent drug use was a risk factor for non-adherence to 12-week (p = 0.01), but not 6-week regimens. Adherence as measured by MEMS was lower than by patient report.Conclusions
Adherence to short courses of DAA therapy with 1–3 pills a day was excellent in an urban population with multiple risk factors for non-adherence.994.
Abstract Currently available anticoagulants are effective in reducing the recurrence rate of venous thromboembolism (VTE). However,
anticoagulant treatment is associated with an increased risk for bleeding complications. Thus, anticoagulation has to be discontinued
when benefit of treatment no longer clearly outweigh its risks. The duration of anticoagulant treatment is currently framed
based on the estimated individual risk for recurrent VTE. The incidence of recurrent VTE can be estimated through a two-step
decision algorithm. Firstly, the features of the patient (gender), of the initial event (proximal or distal deep vein thrombosis
or pulmonary embolism), and the associated conditions (cancer, surgery, etc) provide essential information on the risk for
recurrence after anticoagulant treatment discontinuation. Secondly, at time of anticoagulant treatment discontinuation, d-dimer levels and residual thrombosis have been indicated as predictors of recurrent VTE. Current evidence suggests that the
risk of recurrence after stopping therapy is largely determined by whether the acute episode of VTE has been effectively treated
and by the patient’s intrinsic risk of having a new episode of VTE. All patients with acute VTE should receive oral anticoagulant
treatment for three months. At the end of this treatment period, physicians should decide for withdrawal or indefinite anticoagulation.
Based on intrinsic patient’s risk for recurrent VTE and for bleeding complications and on patient preference, selected patients
could be allocated to indefinite treatment with VKA with scheduled periodic re-assessment of the benefit from extending anticoagulation.
Alternative strategies for secondary prevention of VTE to be used after conventional anticoagulation are currently under evaluation.
Cancer patients should receive low molecular-weight heparin over warfarin in the long-term treatment of VTE. These patients
should be considered for extended anticoagulation at least until resolution of underlying disease.
Abbreviated abstract The risk for recurrent venous thromboembolism can be estimated through a two-step algorithm. Firstly, the features of the
patient (gender), of the initial event (proximal or distal deep vein thrombosis or pulmonary embolism), and the associated
conditions (cancer, surgery, etc) are essential to estimate the risk for recurrence after anticoagulant treatment discontinuation.
Secondly, a correlation has been shown between d-dimer levels and residual thrombosis at time of anticoagulant treatment discontinuation and the risk of recurrence. Currently
available anticoagulants are effective in reducing the incidence of recurrent venous thromboembolism, but they are associated
with an increased risk for bleeding complications. All patients with acute venous thromboembolism should receive oral anticoagulant
treatment for three months. At the end of this treatment period physicians should decide for definitive withdrawal or indefinite
anticoagulation with scheduled periodic re-assessment of the benefit from extending anticoagulation. 相似文献
995.
Impact of an Evidence-Based Medicine Curriculum on Resident Use of Electronic Resources: A Randomized Controlled Study 下载免费PDF全文
Kim S Willett LR Murphy DJ O'Rourke K Sharma R Shea JA 《Journal of general internal medicine》2008,23(11):1804-1808
Background Evidence-based medicine (EBM) is widely taught in residency, but evidence for effectiveness of EBM teaching on changing residents’
behavior is limited.
Objective To investigate the impact of an EBM curriculum on residents’ use of evidence-based resources in a simulated clinical experience.
Design/Participants Fifty medicine residents randomized to an EBM teaching or control group.
Measurements A validated test of EBM knowledge (Fresno test) was administered before and after intervention. Post intervention, residents
twice completed a Web-based, multiple-choice instrument (15 items) comprised of clinical vignettes, first without then with
access to electronic resources. Use of electronic resources was tracked using ProxyPlus software. Within group pre–post differences
and between group post-test differences were examined.
Results There was more improvement in EBM knowledge (100-point scale) for the intervention group compared to the control group (mean
score increase 22 vs. 12, p = 0.012). In the simulated clinical experience, the most commonly accessed resources were Ovid (71% of residents accessed)
and InfoPOEMs (62%) for the EBM group and UptoDate (67%) and MDConsult (58%) for the control group. Residents in the EBM group
were more likely to use evidence-based resources than the control group. Performance on clinical vignettes was similar between
the groups both at baseline (p = 0.19) and with access to information resources (p = 0.89).
Conclusions EBM teaching improved EBM knowledge and increased use of evidence-based resources by residents, but did not improve performance
on Web-based clinical vignettes. Future studies will need to examine impact of EBM teaching on clinical outcomes. 相似文献
996.
Jérôme Fichet Axel de Labriolle Bruno Giraudeau Philippe Arbeille Bernard Charbonnier 《Heart and vessels》2008,23(6):397-402
Stroke is a rare but severe event after acute coronary syndrome. Relations between both arterial territories are still discussed
but prevalence of asymptomatic carotid stenosis potentially implicated in the mechanism of stroke is under-investigated. This
study aimed to determine the prevalence of asymptomatic carotid stenosis in that population and review the value of screening
in a view to potential surgical correction or other preventive therapies. Systematic carotid Doppler ultrasound screening
was implemented on 152 consecutive patients admitted to the intensive care unit due to acute coronary syndrome. Fifty-two
percent of patients had at least one carotid artery stenosis determined using the NASCET method. Forty-three percent had at
least one carotid stenosis <30%, 6% had mild (30–60%) stenosis, and 2.6% had high-grade (>60%) stenosis. Existence of carotid
stenosis was associated with age, diabetes mellitus, hypertension, and with the extent of the coronary atherosclerosis (left
main artery stenosis). In multivariate analysis, age and diabetes were independently associated with existence of a carotid
stenosis. When ultrasound screening was restricted to patients identified by multivariate analysis, the prevalence of carotid
stenosis potentially requiring surgical treatment rose to 4.6%. The frequency of asymptomatic carotid atherosclerosis was
high in this population but lesions were mild. While the small number of high-grade lesions indicates that systematic screening
is not to be recommended, screening of patients aged >65 years or with diabetes, or both, with a view to surgery may be envisaged,
since the role of mild stenosis in the occurrence of stroke remains debatable. 相似文献
997.
Marcus Bahra Dietmar Jacob Jan M. Langrehr Ulf P. Neumann Peter Neuhaus 《Journal of hepato-biliary-pancreatic sciences》2008,15(5):501-507
Background/Purpose
Carcinoma of the distal bile duct is associated with poor prognosis. Surgical resection remains the only potentially curative treatment. We conducted a retrospective study to identify prognostic factors determining longterm survival.Methods
From 1990 to 2006, 95 patients with distal and/or middle bile duct carcinoma had resections. Fifty-four patients underwent pylorus-preserving pancreaticoduodenectomy (57%) and 41 patients underwent standard Kausch-Whipple pancreaticoduodenectomy (43%). Nine patients underwent pancreaticoduodenectomy including portal vein resection (9%).Results
Overall 1-, 3-, and 5-year survival rates were 60%, 36%, and 29%, respectively. Five-year survival after R0 resection was 34%, and after R1 resection it was 0%. Four patients died during their hospital stay (4%). Multivariate analysis showed negative resection margins (P = 0.040), lymphatic vessel invasion (P = 0.036), and portal vein infiltration (P = 0.027) as strong predictors for survival, whereas the location of the tumor (distal bile duct vs middle bile duct) and lymph node status were not identified as independent prognostic factors.Conclusions
Five-year survival depends strongly on negative resection margins, independent of nodal status. Portal vein resections in patients with portal vein involvement fail to ameliorate long-term survival. Primary tumor site — middle bile duct or distal bile duct — did not determine prognosis.998.
Richard Ofori-Asenso Jenni Ilomäki Ella Zomer Andrea J. Curtis Sophia Zoungas Danny Liew 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2018,32(3):265-272
Background
Statins have become standard of care in the prevention and treatment of atherosclerotic cardiovascular disease. The objective of this study was to examine the trends in statin use among Australians aged ≥?65 years for the period 2007–2016.Methods
Data from the Pharmaceutical Benefits Scheme covering a 10% random sample of the Australian population were analysed. The 1-year prevalence and incidence of statin use were determined for each year, as were the percentage of statin dispensations according to statin type or intensity and the percentage of new users prescribed each statin type or intensity. To describe relative changes, age-sex adjusted rate ratios (RRs) and 95% confidence intervals (CIs) were determined via Poisson regression modelling using 2007 as the reference year.Results
The 1-year prevalence of statin use increased consistently each year from 34.2% in 2007 to 44.1% in 2016 (RR 1.29, 95% CI 1.28–1.31). The 1-year incidence was 68.5 per 1000 in 2007 and 59.0 per 1000 in 2016 (RR 0.87, 95% CI 0.84–0.90). Women were 18% (age-adjusted rate ratio [aRR] 0.82, 95% CI 0.79–0.83) less likely than men to initiate statins across all years. The incidence of statin use was also highest among individuals aged 65–74 years, who were about 15% (sex-adjusted rate ratio [sRR] 1.15, 95% CI 1.13–1.16) and 45% (sRR 1.45, 95% CI 1.44–1.47) more likely to initiate statins than those aged 75–84 and ≥ 85 years, respectively. Atorvastatin was the most commonly dispensed statin across all years. The proportion of new users dispensed high-intensity statins increased year-on-year from 23.6% in 2007 to 30.5% in 2016 (RR 1.26, 95% CI 1.21–1.31).Conclusion
The proportion of older adults in Australia using statins has increased over the last decade, although the incidence has declined. Atorvastatin is the most commonly dispensed statin and the use of high intensity statin has increased.999.
Purpose of Review
The development of food allergies is increasingly being recognized as a post-solid organ transplant complication. In this article, we review the spectrum of post-transplant food allergy development and the proposed mechanisms for de novo food allergies and the clinical significance they pose.Recent Findings
The development of new food allergies is disproportionately associated with pediatric liver transplants, where it occurs in up to 38% of select populations. The mechanism of food allergy development is not completely understood; however, it is likely promoted by unbalanced immune suppression.Summary
De novo food allergy development is a common complication of solid organ transplants with the highest risk occurring in pediatric liver transplant recipients. There are likely multiple mechanisms for food allergy development including passive transfer of membrane-bound IgE and lymphocytes from donor to recipient, as well as loss of food tolerance and active development of new food allergies. The optimal management of food allergies following organ transplants has not been well researched but may include changing the immune suppression regimen if the food allergy does not resolve without intervention.1000.
David L. Leverenz Christopher Henderson Ankoor Shah 《Current allergy and asthma reports》2018,18(8):40