BACKGROUND: Evidence for the effectiveness of topical treatments, in providing symptomatic relief from ocular allergy, remains uncertain. AIMS: To assess the effectiveness and relative efficacy of topical treatments for the management of seasonal allergic conjunctivitis. DESIGN OF STUDY: A systematic review and meta-analysis. SETTING: A literature search of the Cochrane Library, Medline, and EMBASE bibliographic databases. METHOD: Double-masked randomised controlled trials were identified, that compared the use of topical mast cell stabilisers (sodium cromoglycate, nedocromil, lodoxamide) with placebo, topical antihistamines with placebo, and topical mast cell stabilisers with topical antihistamines. RESULTS: A meta-analysis of six trials showed that patients using sodium cromoglycate were 17 times (95% confidence interval [CI] = 4 to 78) more likely to perceive benefit compared with those using a placebo, although this estimate may be partially influenced by publication bias. Five trials indicated that those patients using nedocromil were 1.8 times (95% CI = 1.3 to 2.6) more likely to perceive their allergy to be moderately or totally controlled than those using a placebo. Four trials showed that those using antihistamines were 1.3 times (95% CI = 0.8 to 2.2) more likely to perceive a 'good' treatment effect than those using mast cell stabilisers, although this beneficial effect was not statistically significant. Limited evidence suggests that antihistamines might have a faster therapeutic effect compared to mast cell stabilisers. CONCLUSION: Overall, these findings confirm the benefit of topical mast cell stabilisers and antihistamines over placebo for the treatment of allergic conjunctivitis. There is, however, insufficient evidence to recommend the use of one type of medication over another. Treatment preferences should therefore be based on convenience of use (with reduced frequency of instillation for some preparations), patient preference, and costs, especially as important side effects were not reported with any medication. 相似文献
It has been suggested that cellular immune responses to the hepatitis B virus are of importance in the production of liver cell damage in both acute and chronic hepatitis. An assay has now been developed which detects lymphocytes cytotoxic for target cells coated with the hepatitis B surface antigen (HBsAg). The reaction could be blocked by prolonged pre-incubation of lymphocytes with highly purified HBsAg and studies with lymphocyte subpopulations have shown that T lymphocytes were the principle effector cells.
When lymphocytes from twenty-three patients with acute hepatitis were used, cytotoxic T cells were demonstrable during the recovery phase, but not in the first 3 weeks of the illness. However, when these same lymphocytes were extensively washed, cytotoxicity was then detected in all the patients, even at the time of presentation. In patients with HBsAg-positive chronic liver disease the results with the standard assay were largely within the normal range, but again with extensive lymphocyte washing cytotoxicity was detected in all of the patients with untreated chronic active hepatitis and in five out of six with more minor histological lesions. The results in five carriers with normal liver histology were completely different, cytotoxicity remaining undetectable even after the extensive washing procedure.
The results suggest that blocking factors, possibly antigen or antigen–antibody complexes, could be interfering with the detection of sensitized T cells in patients with acute and chronic hepatitis, but that there is a true absence of sensitization to HBsAg in healthy carriers with normal liver histology.
The stability, accuracy, reproducibility, and predictive value of Sensititre MIC panels containing meropenem (Merrem) were evaluated by using National Committee for Clinical Laboratory Standards (NCCLS)-recommended American Type Culture Collection (ATCC) strains and 110 selected strains of rapidly growing and fastidious aerobes and anaerobes with various degrees of susceptibility to meropenem. The NCCLS-recommended agar dilution method was used as a standard reference method. Meropenem-containing Sensititre MIC panels were monitored for their stabilities at room temperature and reproducibilities over 24 months by using six ATCC strains. Ninety-nine percent of the MICs of both meropenem and imipenem obtained for NCCLS-recommended ATCC strains were within the established ranges after 2 years. The overall agreement (+/- 1 twofold dilution) between the Sensititre and the agar dilution meropenem MICs was greater than 93%. The predictive value of meropenem MICs for indicating suspeptibility or resistance obtained by the Sensititre method was greater than 90%. No major or very major interpretive errors were observed, and only 5% of meropenem MICs were associated with minor interpretive errors. Problematic organisms were not observed. The Sensititre MIC panels containing meropenem offer a convenient and valid alternative to the NCCLS reference method for the susceptibility testing of potential pathogens likely to be recovered from mixed infections. 相似文献