曲马多治疗慢性腰背部疼痛的疗效

目的：评价曲马多治疗慢性腰背部疼痛的疗效和安全性。方法：3阶段临床试验：（1）清洗期：（2）为时3周的标记开放试行期；（3）为时4周的随机，安慰剂对照的双盲治疗期。380名年龄在21至79岁之间的，患有慢性腰背部疼痛，没有或很早以前背部手术史的门诊病人入选标记开放期，并用曲马多400mg/天治疗。标记开放期末，可以接受曲马多且治疗有效的病人进行双盲期，被随机分配继续用曲马多治疗或转为使用安慰剂。退出标记和期的原因包括不良事件（78人，20．5％）、药物无效（23人，6．1％）或其他原因（25人，6．6％）。254名病人进入双盲期，期间每日药量控制在200－400mg曲马多或等量的安慰剂。双盲期结果变量的评价指标为患者因疼痛不能充分缓解而退出的时间。结果：曲马多组和安慰剂相比较，因治疗失败而退出的时间分布有显著性差异（P≤0.0001)。Kaplan-Meier分析曲马多组由于治疗失败造成的累计退出率为20．7％，安慰剂组为51．3％。在双盲期的末次随访时，曲马多组病人的平均视觉模拟疼痛评分（10cm级）为3．5cm，显著低于安慰剂组病人（5．1cm)(P≤0.0001)。在McGill疼痛问卷（P＝0．0007）和Roland失能问卷（P＝0．0001）上曲马多组病人的评分显著优于安装剂且。127名曲马多组病人中的5人和127名安慰剂组病人中的6人由于不良事件而退出双盲期治疗。曲马多组的常见不良事件有恶心、头晕、嗜睡和头痛。结论：对曲马多接受程度良好的病人来说，曲马多可以有效治疗患者的慢性腰痛部疼痛。     

The efficacy and safety of fluticasone propionate in very young children with persistent asthma symptoms

We aimed to evaluate the efficacy and safety of fluticasone propionate (FP) in children aged 12-47 months with recurrent/persistent asthma symptoms. One hundred and sixty children (12-47 months) were randomised into this multicentre, double-blind, placebo-controlled, parallel-group study, and treated with either FP (100 microg bd) or placebo (2 puffs bd), both administered by metered-dose-inhaler and Babyhaler for 12 weeks. The primary endpoint was percentage of symptom-free 24h periods. Over weeks 1-12, FP-treated patients had significantly more percentage symptom-free 24-h periods compared with placebo (odds ratio 0.53; 95% CI 0.29-0.95; P = 0.035). Relative to baseline, where all patients were symptomatic for at least 21/28 days of the run-in, the improvement equated to one additional symptom-free 24 h period per week. FP patients also had a significantly higher percentage of 24 h periods with no wheeze or cough, the odds ratio for treatment difference corresponding to two additional wheeze-free and one additional cough-free periods per week. FP was well-tolerated, with similar reported adverse events in both groups. Urinary cortisol-creatinine ratio was slightly decreased among FP patients after 12 weeks, but with no clinical correlates. FP is effective for the treatment of chronic persistent asthma symptoms in very young children.     

The Psychosocial Functioning of HIV+ and HIV− African American Recent Mothers

African American HIV+ and HIV– recent mothers were compared on levels of psychosocial functioning. Participants included 82 HIV+ and 122 HIV– women. HIV risk behaviors, stressors, coping resources, close relationships, coping responses, and psychological distress were examined. There were fewer statistically significant differences than expected, indicating that psychosocial functioning was relatively well preserved for the HIV+ women. There were no statistically significant differences in social support, close relationships or psychological distress. Statistically significant differences indicated that HIV– women perceived greater control over present health and sexual behaviors than HIV+ women, although HIV+ women used more sexual protection than did the HIV– women. HIV+ women also used avoidant as well as support coping more than their HIV– counterparts. These differences were also apparent in a discriminant function analysis, implying that they are independent of each other. Implications of the findings for future efforts to address HIV/AIDS in this community are discussed.     

Effects of thoracic epidural anaesthesia on intestinal microvascular perfusion in a rodent model of normotensive endotoxaemia

Objective To investigate whether sympathetic blockade by means of thoracic epidural anaesthesia (TEA) increases intestinal perfusion during normotensive endotoxaemia.Design A prospective, randomised and controlled animal study.Setting Animal laboratory in a university hospital.Subjects Sprague-Dawley male rats.Interventions The rats were anaesthetised with urethane and ketamine, mechanically ventilated and haemodynamically monitored. Lidocaine or saline were infused continuously via thoracic epidural catheters followed by a continuous intravenous infusion of Escherichia coli lipopolysaccharide (1.5 mg/kg per h). Densities of perfused and non-perfused capillaries (i.e., with and without erythrocyte perfusion, respectively) as well as erythrocyte velocity in both the mucosa and the muscularis of the terminal ileum were determined using intravital microscopy.Measurements and results Measurements were performed at baseline, after 30 min of epidural infusion as well as after 60 and 120 min of lipopolysaccharide infusion. In animals receiving TEA, mean arterial pressure and heart rate were significantly reduced throughout the experiment. In the muscularis the endotoxaemia-induced increase in non-perfused capillaries was absent with epidural lidocaine (0 [0/0] versus 39 [36/137] cm^-1, median [25^th/75^th percentile]), whereas in the mucosa perfused capillary density declined to a greater extent than in controls (–47 [–53/–23]%) versus –19 [–34/+10]%, p<0.05). Erythrocyte velocity decreased with endotoxaemia and was not influenced by epidural lidocaine.Conclusions Microvascular perfusion data during endotoxaemia show a redistribution of blood flow towards the mucosa. TEA seems to impede this redistribution resulting in improved muscularis and worsened mucosal microvascular perfusion.