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Mazzaferri EL Gradinac S Sagic D Otasevic P Hasan AK Goff TL Sievert H Wunderlich N Nikolic SD Abraham WT 《American heart journal》2012,163(5):812-820.e1
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Celiac disease is an immune mediated disorder, the only one with a well-established origin, resulting from a permanent gluten intolerance. Although a gluten-free diet is currently the "safe" and appropriate therapy for celiac disease, this is not always an easy and simple option as "harmful" gluten may contaminate food during the processing and preparation phases. There are also further social pressures, which might be more pressing for young celiac patients, in following a strict gluten-free diet. Therefore, a new therapeutic approaches are sought which would permit celiacs to "peacefully" coexist with gluten. Presently, the most promising looks search for genetically modified wheat lacking toxic gluten peptides and the use of oral endopeptidases in attempt to curb gluten toxicity. Recently discovered role of anti-tissue transglutaminase antibodies in celiac pathogenesis has brought a prospect for a new hypothetical therapeutic approach, an oral immunization of celiacs with xenogeneic anti-tissue transglutaminase antibodies. 相似文献
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Pratali L Otasevic P Rigo F Gherardi S Neskovic A Picano E 《European journal of heart failure》2005,7(5):844-851
BACKGROUND: Diastolic dysfunction and lack of contractile reserve are unfavorable prognostic predictors in patients with dilated cardiomyopathy (DCM). AIMS: This study aims to assess whether diastolic dysfunction and lack of dipyridamole-induced contractile reserve were additive predictors of poor outcome in patients with DCM. METHODS: A total of 116 patients with DCM and ejection fraction (EF<35%) were studied by dipyridamole echo (0.84 mg/kg over 10 min). At rest, a restrictive filling pattern was defined as: E/A ratio >2 and an E-wave deceleration time of <140 ms on transmitral flow velocity profile. RESULTS: Rest wall motion score index (WMSI) was 2.2+/-0.3 and decreased to 1.9+/-0.41 after dipyridamole (p<0.001). During follow-up (median 26.5 months), 22 cardiac deaths occurred. At multivariate analysis, dipyridamole-induced contractile reserve yielded significant incremental prognostic value (RR=0.275, p<0.006) over NYHA class (RR=1.971, p<0.03), angiotensin-converting enzyme inhibitor therapy (RR=0.173, p<0.001), and left ventricular end-diastolic diameter (RR=1.131, p<0.001). The worst prognostic combination was the presence of restrictive pattern at rest and the absence of contractile reserve (deltaWMSI<0.15). CONCLUSION: In patients with DCM, the ominous combination of restrictive transmitral flow pattern and lack of contractile reserve during dipyridamole stress predicts an unfavourable outcome. 相似文献
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Opinion statement Anemia is a frequent extraintestinal manifestation of inflammatory bowel disease (IBD) that is commonly overlooked, despite
its significant impact on quality of life. Characteristic symptoms include chronic fatigue, headache, and subtle impairment
of cognitive function, although some less common symptoms include dyspnea, dizziness, pica, angular stomatitis, shortened
attention span, and esophageal webs. Several types of anemia are associated with IBD, but iron deficiency anemia (IDA) accounts
for the majority of cases and others include anemia of chronic disease, anemia associated with vitamin deficiency (vitamin
B12 and folate), autoimmune anemia, and anemia caused by medication used to treat IBD. The diagnosis of IDA relies on laboratory
blood tests. Therefore, these tests should be obtained on a regular basis because characteristic symptoms may be absent or
not readily recognized by patients and their clinicians. Complete blood count may suffice; however, iron studies and serum
vitamin levels may be necessary to differentiate between specific types of anemia. During the diagnostic process, it is important
to consider coexistence of different types of anemia, especially if no response to therapy is noted. The therapy for anemia
is directed towards treatment of the underlying inflammatory process and supplemental therapy, depending on the type of deficiency.
Iron deficiency anemia is treated with iron preparations, first orally, and if unresponsive or if associated with untoward
adverse events leading to decrease in adherence with the therapeutic regimen, with intravenous preparations. Intramuscular
therapy has been abandoned due to high rate of complications. Intravenous therapy may be administered as a multiple-dose regimen
(intravenous iron sucrose and gluconate) or as a single intravenous dose (iron dextran), which is associated with a higher
risk of allergic infusion reactions and requires obligatory test dose administration. Treatment with erythropoietin is reserved
for a select subgroup of patients with anemia of chronic disease. With appropriate treatment, the majority of patients with
IBD will have significant improvement or resolution of anemia, which can lead to a better quality of life. However, a high
index of suspicion should be maintained in order to identify the precise cause of anemia and to prescribe the appropriate
therapy. 相似文献