A prospective multicentre study of mycophenolate mofetil combined with prednisolone as induction therapy in 213 patients with active lupus nephritis

Mycophenolate mofetil (MMF) with prednisolone has been associated with high remission rates when used as induction treatment for lupus nephritis. This prospective, multicentre, cohort study investigates the efficacy and safety of this regimen over 24 weeks in 213 Chinese patients with active lupus nephritis (Classes III, IV, V or combination). Baseline activity index (AI) was 6.91+/-3.33 and chronicity index (CI) was 1.9+/-1.2. The remission rate was 82.6% at 24 weeks (complete remission, 34.3%; partial remission, 48.4%). There were significant (P<0.01) improvements in kidney function shown by reductions in proteinuria, serum albumin, serum creatinine and creatinine clearance, as well as in systemic lupus erythematosus disease activity index (SLEDAI) scores. Independent risk factors influencing remission were pathological classification (including Class V and III or Class V and IV nephritis) and elevated serum creatinine at baseline (OR 2.967, 95% CI: 1.479-6.332, P=0.001 and OR 1.007, 95% CI: 1.002-1.011, P=0.001, respectively). Patients with concomitant membranous features on biopsy had a lower remission rate than those with Class III and IV nephritis (66.7% vs 87.3%, P=0.002). Renal biopsy was repeated in 25 patients following treatment. There was a transition to less severe pathological morphologies in majority of subjects. Infections were monitored throughout treatment: eight patients (3.8%) experienced bacterial infections, whereas herpes zoster occurred in seven patients. Nine patients (4.2%) suffered from gastrointestinal upset, which resolved without discontinuation of MMF. One patient became leucopenic, whereas another died from active disease unrelated to kidney symptoms. MMF combined with prednisolone is an effective and well-tolerated induction treatment for patients with active lupus nephritis and for controlling SLE systemic activity.     

Treatment of patients with chronic hepatitis B with adefovir dipivoxil

Adefovir dipivoxil, a nucleotide analog of adenosine monophosphate, is an antiviral agent that suppresses hepatitis B virus (HBV) replication through inhibition of DNA polymerase and by chain termination. To determine the effectiveness of adefovir, three populations of patients with chronic hepatitis B patients were studied: hepatitis B e antigen (HBeAg)-positive patients, HBeAg-negative patients, and patients with lamivudine-resistant tyrosine-methionine-asparate-aspartate (YMDD) mutants. All three groups of patients were treated for 48 weeks with adefovir 10 mg/d, and significant reduction in serum HBV DNA and normalization of serum alanine aminotransferase (ALT) were noted. Significant improvement in liver histology was noted in HBeAg-positive and in HBeAg-negative patients. Significant HBeAg loss and HBeAg seroconversion rates were noted in HBeAg-positive patients and in lamivudine-resistant patients. No major drug-related side effects were noted. Adefovir 10 mg/d orally is safe and effective for treatment of chronic hepatitis B.     

A statewide initiative to improve the care of hospitalized pneumonia patients: The Connecticut Pneumonia Pathway Project

PURPOSE: A statewide quality improvement initiative was conducted in Connecticut to improve process-of-care performance and to decrease length of stay for patients hospitalized with community-acquired pneumonia. SETTING AND METHODS: Data were collected on 1,242 elderly (> or =65 years) pneumonia patients hospitalized at 31 of 32 acute care hospitals between January 16, 1995, and March 15, 1996, and on 1,146 patients hospitalized between January 1, 1997, and June 30, 1997. Interventions included feedback of performance data (Qualidigm, the Connecticut Peer Review Organization), dissemination of an evidence-based pneumonia critical pathway (Connecticut Thoracic Society), and sharing of pathway implementation experiences (hospitals). Process and outcome measures included early antibiotic administration, blood culture collection, oxygenation assessment, length of stay, 30-day mortality, and 30-day readmission rates. Analyses were adjusted for severity of illness and hospital-specific practice patterns. RESULTS: After the statewide initiative, improvements were noted in antibiotic administration within 8 hours of hospital arrival (improvement from 83.4% to 88.8%, relative risk [RR] = 1.21; 95% confidence interval [CI]: 1.10 to 1.32), oxygenation assessment within 24 hours of hospital arrival (93.6% to 95.4%; RR = 1.23, 95% CI: 1.11 to 1.38), and length of stay (7 days to 5 days, P <0.001). There were no significant changes in blood culture collection within 24 hours of hospital arrival, blood culture collection before antibiotic administration, 30-day mortality, or 30-day readmission rates. CONCLUSIONS: Statewide improvements were demonstrated in the care of hospitalized pneumonia patients concurrent with a multifaceted quality improvement intervention. Further research is needed to separate the effects of the quality improvement interventions from secular trends.     

Clinical significance of liver biopsy in chronic hepatitis B patients with persistently normal transaminase

OBJECTIVE: The aim of this study was to study the clinical significance of liver biopsy for individuals who had chronic hepatitis B virus infection and persistently normal serum transaminases for more than 6 months. METHODS: A total of 452 patients with positive hepatitis B surface antigen for over 6 months underwent percutaneous liver biopsy. All liver biopsy specimens were assessed by experienced liver pathologists blinded to the liver biochemistry, and were scored according to the modified criteria of grade and stage of chronic hepatitis. Patients were divided into four groups: group A and group C patients had normal transaminases, and were hepatitis B e antigen (HBeAg) positive and HBeAg negative, respectively; group B and group D patients had elevated transaminases, and were HBeAg positive and HBeAg negative, respectively. RESULTS: All patients had necrosis and inflammation in the liver. Patients with increased serum transaminases had a significantly higher grade (G) of hepatic necrosis and inflammation and more severe (S) fibrosis compared with patients with normal transaminases (P < 0.05). However, in the latter patients, G3 was seen in 10 (5.5%) and 13 cases (9.1%), S3 in seven (3.8%) and 16 cases (11.1%), and S4 in three (1.6%) and seven cases (4.9%) in Group A and Group C, respectively. Moreover, in patients with normal transaminases, the HBeAg‐negative group had more severe fibrosis than the HBeAg‐positive group (P < 0.05). CONCLUSION: Although more severe pathological changes were more frequent in patients with elevated transaminases, significant hepatic pathology could still be found in cases with persistently normal transaminases. Liver biopsy in cases of chronic hepatitis B virus infection is helpful to accurately assess both the activity of the disease and the degree of fibrosis, and to estimate if antiviral therapy is justifiable. Patients with normal transaminases and serious hepatic necrosis, inflammation and fibrosis need proper management.     

晚期肝癌的一种新的有效治疗方法——反复暂时性肝动脉门静脉阻断并介入治疗

在反复暂时性肝动脉阻断治疗肝癌的基础上,作者设计了反复暂时性肝动脉、门静脉阻断并双介入治疗方法对12例晚期肝癌患者晚期患者进行了临床观察,发现患者经去血供等介入治疗后,临床症状改善,AFP 下降,生活质量提高,生存期明显延长。本方法既发挥反复暂时性肝动脉阻断治疗肝癌的优点,又可以阻断肿瘤内的门脉供血,同时配合双介入治疗,对门静脉癌栓有一定效果,因此不失为晚期肿癌的一种新的有效的辅助治疗方法。     

Effect of SstI polymorphism of the apolipoprotein CIII gene and environmental factors on risks of hypertriglyceridemia in Taiwan aborigines.

BACKGROUND: Hypertriglyceridemia (HTG) is a heterogeneous metabolic disorder. The aim of this study was to examine associations among genetic polymorphisms, SstI polymorphism of apolipoprotein CIII (ApoCIII) and Hind III polymorphism of lipoprotein lipase (LPL), environmental factors and risks of HTG. METHODS AND RESULTS: Two hundred and forty-nine southern Taiwanese aborigines were recruited for a cross-sectional study, which included 90 subjects with triglyceride (TG)>150 mg/dl (HTG) and 159 with TGor=25 (OR=2.22, 95% CI: 1.18-4.16), starchy food consumption>or=3 times/week (OR=1.89, 95% CI: 1.00-3.59) and ApoCIII S2S2 genotype (OR=3.35, 95% CI: 1.10-10.19) were independently (p<0.05) associated with HTG risks. Among ApoCIII S1S1, S1S2 and S2S2 genotypes, ApoCIII and TG concentrations increased (p<0.01) in a dose-responsive manner. CONCLUSIONS: The ApoCIII S2 variant and environmental factors, including education, tribal background, BMI and starchy food intake, modulate the risks of HTG in aboriginal Taiwanese. Interaction between genetic and environmental factors warrants further investigation.     

C—kit受体和CD34在急性髓系白血病中的表达与化疗疗效关系

目的：探讨ｃ－ｋｉｔ受体、ＣＤ３４的表现与化疗疗效的关系。方法：应用流式细胞仪，测定１０例正常人和８７例急性髓细胞白血病骨髓ｃ－ｋｉｔ受体和ＣＤ３４的表达。结果：正常人骨髓ｃ－ｋｉｔ受体和ＣＤ３４表达率分别为０．５％和１．７％。以〉２０％细胞表达为阳性，患者ｃ－ｋｉｔ受体和ＣＤ３４阳性率分别为５２％和３７％。结论：ｃ－ｋｉｔ受体和ＣＤ３４阳性病例缓解率较低，差异有显著性（Ｐ〈０．０１），ｃ－ｋｉｔ     

七氟醚旁路洗入对体外循环心脏瓣膜置换术患者脑损伤的影响

目的评价七氟醚旁路洗入对体外循环(CPB)下心脏瓣膜置换术患者脑损伤的影响。方法择期行CPB下心脏瓣膜置换术患者60例,性别不限,年龄24⁶7岁,体质指数16.767岁,体质指数16.7²7.3kg/m2,采用随机数字表法,分为两组(每组n=30):对照组(C组)和七氟醚组(S组)。S组于CPB期间通过体外循环机旁路洗入1.0%27.3kg/m2,采用随机数字表法,分为两组(每组n=30):对照组(C组)和七氟醚组(S组)。S组于CPB期间通过体外循环机旁路洗入1.0%³.0%七氟醚,C组不做任何处理。于CPB前(T0)、降温至28℃(T1)、复温至37℃(T2)、停CPB(T3)和术毕(T4)时采集颈内静脉球部和桡动脉血样,进行血气分析,测定颈内静脉球部血氧饱和度(SjvO2),计算动脉-静脉血氧含量差(Da-jvO2)和脑氧摄取率(CEO2),并测定颈内静脉球部血浆S-100β蛋白和8-异前列腺素-F2α(8-iso-PGF2α)浓度。结果与C组比较,S组T13.0%七氟醚,C组不做任何处理。于CPB前(T0)、降温至28℃(T1)、复温至37℃(T2)、停CPB(T3)和术毕(T4)时采集颈内静脉球部和桡动脉血样,进行血气分析,测定颈内静脉球部血氧饱和度(SjvO2),计算动脉-静脉血氧含量差(Da-jvO2)和脑氧摄取率(CEO2),并测定颈内静脉球部血浆S-100β蛋白和8-异前列腺素-F2α(8-iso-PGF2α)浓度。结果与C组比较,S组T1^T4时点颈内静脉球部血浆S-100β蛋白和8-iso-PGF2α浓度降低(P<0.05),T1T4时点颈内静脉球部血浆S-100β蛋白和8-iso-PGF2α浓度降低(P<0.05),T1^T3时点SjvO2升高,DajvO2和CEO2下降(P<0.05)。结论七氟醚旁路洗入可减轻CPB下心脏瓣膜置换术患者脑损伤,其机制与抑制脂质过氧化反应和降低脑氧代谢率有关。