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21.
Leonardo Jönck Staub Roberta Rodolfo Mazzali Biscaro Erikson Kaszubowski Rosemeri Maurici 《The Journal of emergency medicine》2019,56(1):53-69
Background
Lung ultrasound can accelerate the diagnosis of life-threatening diseases in adults with respiratory symptoms.Objective
Systematically review the accuracy of lung ultrasonography (LUS) for emergency diagnosis of pneumonia, acute heart failure, and exacerbation of chronic obstructive pulmonary disease (COPD)/asthma in adults.Methods
PubMed, Embase, Scopus, Web of Science, and LILACS (Literatura Latino Americana e do Caribe em Ciências da Saúde; until 2016) were searched for prospective diagnostic accuracy studies. Rutter-Gatsonis hierarchical summary receiver operating characteristic method was used to measure the overall accuracy of LUS and Reitsma bivariate model to measure the accuracy of the different sonographic signs. This review was previously registered in PROSPERO (Centre for Reviews and Dissemination, University of York, York, UK; CRD42016048085).Results
Twenty-five studies were included: 14 assessing pneumonia, 14 assessing acute heart failure, and four assessing exacerbations of COPD/asthma. The area under the summary receiver operating characteristic curve of LUS was 0.948 for pneumonia, 0.914 for acute heart failure, and 0.906 for exacerbations of COPD/asthma. In patients suspected to have pneumonia, consolidation had sensitivity of 0.82 (95% confidence interval [CI] 0.74–0.88) and specificity of 0.94 (95% CI 0.85–0.98) for this disease. In acutely dyspneic patients, modified diffuse interstitial syndrome had sensitivity of 0.90 (95% CI 0.87–0.93) and specificity of 0.93 (95% CI 0.91–0.95) for acute heart failure, whereas B-profile had sensitivity of 0.93 (95% CI 0.72–0.98) and specificity of 0.92 (95% CI 0.79–0.97) for this disease in patients with respiratory failure. In patients with acute dyspnea or respiratory failure, the A-profile without PLAPS (posterior-lateral alveolar pleural syndrome) had sensitivity of 0.78 (95% CI 0.67–0.86) and specificity of 0.94 (95% CI 0.89–0.97) for exacerbations of COPD/asthma.Conclusion
Lung ultrasound is an accurate tool for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of COPD/asthma. 相似文献22.
Chronic transplant dysfunction is a complex dynamic pathogenic process. Clinically, a decrease in glomerular filtration rate (GFR) becomes apparent leading to chronic renal insufficiency and dialysis or death from cardiovascular events. Chronic transplant dysfunction can develop into a chronic alIograft nephropathy (CAN) as a specific entity with dynamic progression. CAN includes a collection of immunologic and non-immunologic factors, rejection, ischemia time, donor and recipient characteristics and toxicity of calcineurin inhibitors. Despite improvements in immunosuppression, the long-range prognosis of renal allografts has not improved. Whether modern immunosuppressive concepts with reduction or avoidance of calcineurin inhibitors and a therapy based on antimetabolites, such as mycophenolate or mTOR-inhibitors could lead to a prolongation of transplant survival, remains to be seen. 相似文献
23.
24.
D B Irving J L Cook H B Menz 《Journal of Science and Medicine in Sport》2006,9(1-2):11-22; discussion 23-4
25.
A-C Koschker M Fassnacht S Hahner D Weismann B Allolio 《Experimental and clinical endocrinology & diabetes》2006,114(2):45-51
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare and highly malignant tumour with a poor prognosis. Patients present with signs of steroid hormone excess (e.g., Cushing's syndrome) or symptoms due to an abdominal mass. DIAGNOSIS: In case of an adrenal mass, hormonal workup before surgery is required for differential diagnosis, perioperative management, and for follow-up. The imaging of choice is CT or MRI with MRI being of additional use when invasion of big vessels is suspected. Apart from that, the use of 18-FDG-PET is becoming increasingly established. TREATMENT: Surgical resection is the therapeutic option of choice in stages 1 - 3. In stage 4, the adrenolytic compound mitotane is part of the first-line treatment, but often needs to be combined with cytotoxic chemotherapy. Most patients will eventually have a recurrence, so adjuvant treatment (mitotane/tumour bed radiation) has to be considered in high risk patients, even if randomized controlled trials on adjuvant treatment are still lacking. STRUCTURAL PROGRESS: Several national and European structures have recently been established in order to increase our knowledge of ACC, improve therapeutic options and diagnostic procedures, and promote research. GANIMED, as a Germany-wide network of experts on adrenal diseases, has been founded allowing for improved gathering of data and joint studies. ENSAT (European Network for the Study of Adrenal Tumours) has been brought to life, aiming at European standards for therapy, diagnosis and tumour banking. Since 2003, patients can be enrolled in the German ACC Registry. France and Italy have also developed a central registry to collect nationwide data from patients with ACC. For the first time, patients with metastatic/unresectable ACC can participate in a prospective controlled randomized trial comparing two different cytotoxic chemotherapy regimes (FIRM-ACT). 相似文献
26.
B Dederichs M Dietlein B Jenniches-Kloth M Schmidt P Theissen D Moka H Schicha 《Experimental and clinical endocrinology & diabetes》2006,114(7):366-370
BACKGROUND: Radioiodine therapy (RIT) combined with glucocorticoids is an effective therapy for Graves' disease, but it is debatable whether glucocorticoids should be applied in patients without Graves' ophthalmopathy (GO). METHODS: The effect of 0.4 - 0.5 mg prednisone every second day over a period of 5 weeks after RIT was monitored over a follow-up period of at least 12 months after RIT. A questionnaire was sent to 186 consecutive patients without GO concerning eye symptoms after RIT. 148 patients (80 %) answered. If eye symptoms had occurred after RIT, additional clinical examination was carried out at our outpatient clinic. The primary endpoint was the absence or onset of GO within the first year after RIT. RESULTS: Within 12 months after RIT the examination confirmed GO in 5 out of 148 patients (3.4 %). In all cases the symptoms were transient. No adverse reaction to the use of prednisone after RIT was noted. CONCLUSIONS: The risk of new GO in the first year after RIT was low and the clinical course of GO was mild when RIT was combined with a low-dose glucocorticoid regimen. Preventive administration of glucocorticoids can therefore be recommended in patients with Graves' disease even without evident GO. 相似文献
27.
M Vitacca M Paneroni L Bianchi E Clini A Vianello P Ceriana L Barbano B Balbi S Nava 《The European respiratory journal》2006,27(2):343-349
The present study compared four different sites and conditions for the measurement of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in 38 spontaneous breathing tracheotomised patients. Of the patients, 28 had chronic obstructive pulmonary disease (COPD). The four different conditions were: 1) through a cuff inflated cannula (condition A); 2) through the mouth with a deflated cannula (condition B); 3) through the mouth with a phonetic uncuffed cannula (condition C); and 4) through the mouth after stoma closure (condition D). Five trials in each condition were performed using a standardised method. The measurement of both MIP and MEP differed significantly depending on the condition of measurement. MIP taken in condition A was significantly higher when compared with conditions B, C and D. MEP in condition A was significantly higher when compared with condition B and D. In condition A the highest frequency of the best measurement of MIP and MEP was observed at the fourth and fifth effort, respectively. The same results were obtained after the selection of only COPD patients. In conclusion, respiratory muscle assessment differs significantly depending on measurement condition. Measurement through inflated cannula tracheotomy yields higher values of both maximal inspiratory and maximal expiratory pressure. 相似文献
28.
Deng H. Le W. - D. Hunter C. B. 《世界核心医学期刊文摘》2006,2(6):17-18
背景:Parkin基因(PRKN)突变可导致常染色体隐性遗传性早发帕金森病(EOPD)。目的:探讨EOPD白人家族PRKN突变的表现和基因型-表型关系。设计:对EOPD家族的3代20例成员进行基因分析,该家族有4例患者。应用直接基因组DNA测序、半定量聚合酶链反应、实时定量聚合酶链反应以及逆转录酶聚合酶链反应分析以确定PRKN突变。结果:4例早发患者(年龄30—38岁)被确定有PRKN复合杂合突变(T240M和EX5_6缺失),虽然PRKN的杂合T240M和纯合EX5_6缺失突变已有描述,但是据悉,本文为上述复合杂合突变的首次报道。患者的表型为典型常染色体隐性遗传性EOPD的表现,其特征是对左旋多巴治疗有效、相对缓慢的进展和运动障碍。所有杂合突变的基因携带者(T240M或EX5_6缺失)和1例56岁的复合杂合突变女性携带者(T240M和EX5_6缺失)无任何神经系统症状。结论:研究发现,PRKN基因复合杂合突变(T240M和EX5_6缺失)导致一个大的白人家族中4例成员发生常染色体隐性遗传性EOPD。另外1例成员具有相同的突变,比4例患者的平均发病年龄大10岁,并且无本病的临床表现。不完全的外显率对遗传咨询具有暗示作用,并且提示复杂的基因一环境交互作用在PRKN相关EOPD的发病机制中发挥作用。 相似文献
29.
30.
背景:对于脊椎以外的骨折而言,补充口服维生素D的预防作用和用量仍无定论。
目的:评估补充维生素D在预防老年髋骨骨折和非脊椎骨折方面的效果。
数据来源:使用MEDLINE、Cochrance对照试验记录(1960~2005年)以及EMBASE(1991-2005年),对英文和非英文文章进行系统回顾。通过与临床专家接触,通过检索美国社会骨和骨矿研究协会提供的参考文献和摘要(1995~2004年).进一步寻找更多的研究。检索词包括随机对照试验(randomized controlled trial,RCT)、临床对照试验、随机分配、双盲法、维生素D3、维生素D2;25-羟基维生素D、骨折、人类、老年、摔倒和骨密度。
研究选取:纳入的研究仅限于口服补充维生素D(维生素D3、维生素D2、补钙或不补钙)与补钙或安慰剂比较的双盲RCTs。试验于检查髋部骨折或非脊椎骨折的老年人(年龄≥60岁)中进行。数据提取:两位作者根据预先规定独立提取相关数据,其中包括研究质量指标。
数据综合:所有的汇总分析均以随机效应模型为基础。5项有关髋部骨折的RCTs(n=9294)和7项有关非脊椎骨折危险的RCTs(n=9820)符合我们的纳入标准。所有试验均使用了维生素D3。对髋部和非脊椎骨折预防研究的异质性亦进行观察,用低剂量(400IU/d)和高剂量(700~800IU/d)分别合并RCTs后异质性消失。与补钙或安慰剂相比,每天服700~800IU的维生素D可使髋部骨折的相对危险(relative risk,aa)下降26%(3项RCTs共计5572人;RR,0.74;95%可信区间[confidence interval,CI],0.61~0.88),使非脊椎骨折的相对危险下降23%(5项RCTs共计6098人;RR,0.77;95%CI,0.68~0.87)。每天服400IU的维生素D(2项RCTs共计3722人;髋部骨折RR,1.15;95%CI,0.88~1.50;非脊椎骨折RR,1.03;95%CI,0.86—1.24)未见明显获益。
结论:口服补充维生素D(700~800IU/d)可以降低尚能活动的老人或慈善机构收容的老年人发生髋部骨折和脊椎以外骨折的危险,每天口服400IU维生素D并不足以预防骨折。 相似文献