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991.
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993.
Carlo Fucci Pompilio Faggiano Matilde Nardi Antonio D'Aloia Giuseppe Coletti Giuseppe De Cicco Leonardo Latini Enrico Vizzardi Roberto Lorusso 《International journal of cardiology》2013
Objectives
Barlow disease represents a surgical challenge for mitral valve repair (MR) in the presence of mitral insufficiency (MI) with multiple regurgitant jets. We hereby present our mid-term experience using a modified edge-to-edge technique to address this peculiar MI.Methods
From March 2003 till December 2010, 25 consecutive patients (mean age 54 ± 7 years, 14 males) affected by severe Barlow disease with multiple regurgitant jets were submitted to MR. Preoperative transesophageal echo (TEE) in all the cases showed at least 2 regurgitant jets, involving one or both leaflets in more than one segment. In all the patients, a triple orifice valve (TOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the TOV repair.Results
There was no in-hospital death and one late death (non-cardiac related). At intra-operative TEE, the three orifices showed a mean total valve area of 2.9 ± 0.1 cm2 (range 2.5–3.3 cm2) with no residual regurgitation (2 cases of trivial MI) and no sign of valve stenosis (mean transvalvular gradient 4.6 ± 1.5 mm Hg). At follow up (mean 38 ± 22 months), TTE showed favourable MR and no recurrence of significant MI (6 cases of trivial and 1 of mild MI). Stress TTE was performed in 5 cases showing persistent effective valve function (2 cases of trivial MI at peak exercise). All the patients showed significant NYHA functional class improvement.Conclusions
This report indicates that the TOV technique is effective in correcting complex Barlow mitral valves with multiple jets. Further studies are required to confirm long-term applicability and durability in more numerous clinical cases. 相似文献994.
TW Mahungu CJ Smith F Turner D Egan M Youle MA Johnson S Khoo DJ Back A Owen 《HIV medicine》2009,10(5):310-317
Objectives
The aim of the study was to characterize the impact of the cytochrome P450 2B6 (CYP2B6), CYP3A4, CYP3A5 and ATP‐binding cassette sub‐family B member 1 (ABCB1) polymorphisms on nevirapine plasma concentrations.Methods
A total of 104 patients (82% male; 26% non‐Caucasian) were genotyped for eight single nucleotide polymorphisms at four loci (CYP2B6, CYP3A4, CYP3A5 and MDR1). Nevirapine plasma concentrations were determined using high‐performance liquid chromatography.Results
Non‐Caucasian ethnicity [5609 ng/mL (n=27) for non‐Caucasians vs. 3771 ng/mL (n=77) for Caucasians; P<0.0001] and CYP2B6 516G→T [GG, 3574 ng/mL (n=50); GT, 4634 ng/mL (n=50); TT, 8170 ng/mL (n=4); Panalysis of variance (anova) =0.001] were significantly associated with a higher nevirapine trough concentration (Ctrough). The latter association was maintained with both 200 mg twice daily (bid) and 400 mg once daily (qd) dosing [GG, 3527 ng/mL (n=30); GT, 4525 ng/mL (n=32); TT, 7020 ng/mL (n=2); Panova =0.05 and GG, 3645 ng/mL (n=20); GT, 4861 ng/mL (n=17); TT, 9508 ng/mL (n=2); Panova =0.01, respectively]. In a multivariable analysis, CYP2B6 516G→T and non‐Caucasian ethnicity remained significant predictors of nevirapine Ctrough but CYP2B6 516G→T homozygosity had the greatest effect (108% higher, 46% higher). No associations were found between nevirapine Ctrough and the remaining polymorphisms.Conclusion
In this population, both non‐Caucasian ethnicity and carriage of the variant allele of CYP2B6 516G→T were significant predictors of nevirapine Ctrough. The association between CYP2B6 516G→T and higher plasma nevirapine exposure was maintained at both bid and qd dosing. 相似文献995.
V Jackson J Breiden S Gibbons L Dickinson DJ Back M Brennan EO Connor N Boyle C Fleming S Coulter‐Smith SH Khoo 《HIV medicine》2011,12(3):166-173
Objectives
The aim of the study was to determine total and unbound lopinavir (LPV) plasma concentrations in HIV‐infected pregnant women receiving lopinavir/ritonavir (LPV/r tablet) undergoing therapeutic drug monitoring (TDM) during pregnancy and postpartum.Methods
Women were enrolled in the study who were receiving the LPV/r tablet as part of their routine prenatal care. Demographic and clinical data were collected and LPV plasma (total) and ultrafiltrate (unbound) concentrations were determined in the first, second and third trimesters using high‐performance liquid chromatography–tandem mass spectrometry (HPLC‐MS/MS). Postpartum sampling was performed where applicable. Antepartum and postpartum trough concentrations (Ctrough) were compared independently [using analysis of variance (anova )] and on a longitudinal basis (using a paired t‐test).Results
Forty‐six women were enrolled in the study (38 Black African). Forty women initiated LPV/r treatment in pregnancy. Median (range) gestation at initiation was 25 (15–36) weeks and median (range) baseline CD4 count and viral load were 346 (14–836) cells/μL and 8724 (<50–267408) HIV‐1 RNA copies/mL, respectively. Forty women (87%) had LPV concentrations above the accepted minimum effective concentration for wild‐type virus (MEC; 1000 ng/mL). Geometric mean (95% confidence interval [CI]) total LPV concentrations in the first/second [3525 (2823–4227) ng/mL; n=16] and third [3346 (2813–3880) ng/mL; n=43] trimesters were significantly lower relative to postpartum [5136 (3693–6579) ng/mL; n=12] (P=0.006). In a paired analysis (n=12), LPV concentrations were reduced in the third trimester [3657 (2851–4463) ng/mL] vs. postpartum (P=0.021). No significant differences were observed in the LPV fraction unbound (fu%). Conclusions The above target concentrations achieved in the majority of women and similarities in the fu% suggest standard dosing of the LPV/r tablet is appropriate during pregnancy. However, reduced LPV concentrations in the second/third trimesters and potentially compromised adherence highlight the need for TDM‐guided dose adjustment in certain cases. 相似文献996.
997.
Rizza V Coletti G Grimaldi A Clemente K Di Cocco P D'Angelo M Delreno F Famulari A Pisani F 《Transplantation proceedings》2011,43(4):1210-1212
Introduction
We report a rare case of herpes simplex virus (HSV) type 1B in patient with kidney transplant as a possible cause of patient death.Case Report
A 32-year-old renal transplanted Caucasian man was referred for asthenia, fever, anemia, chest pain, cough, dyspnea, myalgias, peripheral edema, acute renal failure, diffuse cutaneus and mucous vesicles, and acute weight gain. The home therapy consisted of tacrolimus, sodic mycophenolate, and steroids. Laboratory data, bronchoscopy, and bronchial mucosal biopsy revealed HSV1B. We administered antiviral and antibiotic agents and reduced tacrolimus with clinical resolution. But after 10 days from discharge, the patient was admitted for acute cardiomegaly. So using ex adiuvantibus criteria we administered antiviral therapy with complete clinical improvement.Conclusion
According to the literature, posttransplant HSV1B infection is a rare but severe complication of kidney transplantation associated with poor graft survival and a high mortality. Only an early, accurate diagnosis with efficient treatment permitted resolution of the problem. Our report stresses the difficulty of HSV2B clinical diagnosis and treatment. 相似文献998.
011 PCI应用药物洗脱支架与CABG术后生活质量改善的比较[Cohen DJ,van Hout B,Serruys PW,et al.N Engl J Med,2011,364(11):1016-1026(英文)]经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)都可选择用于治疗多支血管冠状动脉病变;以往研究显示:多支血管冠状动脉病变实施CABG或PCI实施气囊血管成形术或金属裸支架后,心绞痛发作频率和生活质量均明显改 相似文献
999.
1000.
A multinational study of the factorial structure and other characteristics of the Dartmouth COOP Functional Health Assessment Charts/WONCA 总被引:4,自引:0,他引:4
Westbury RC; Rogers TB; Briggs TE; Allison DJ; Gervas J; Shigemoto H; Elford W 《Family practice》1997,14(6):478-485
BACKGROUND: The 'Dartmouth COOP Functional Health Assessment Charts/WONCA'
constitute a relatively new derived instrument for assessing health status
that is specifically intended for use in primary care on a world-wide
basis. It needs further validation in its special area of use. OBJECTIVES:
Over a range of countries, social backgrounds and case mixes, our aim was
(i) to examine the factorial structure of the instrument; (ii) to explore
how well it was understood; (iii) to check its acceptability; and (iv) to
assess the value of the pictures on the charts. METHODS: The charts
themselves, accompanied by a short questionnaire about the charts, were
administered to 1719 patients at eight varied types of treatment centre in
Canada, Japan, Nepal and Spain. The responses to the instrument were
subjected to standard factor analysis and a special Q-type principal
components analysis. The responses to direct questions about the charts
were compared with the answers to open-ended questions. RESULTS: Factor
analysis suggested a shared factorial pattern for all sites, with the first
two factors accounting for 88.5% of the variability in correlations between
the charts across the sites. The individual questions were understood by
most patients, but a substantial minority did not appear to grasp the
underlying purpose of the instrument. The instrument was well accepted. The
pictures were considered to be helpful by most respondents, especially
those at the Nepal sites. The variability in the scores for the individual
charts across sites was less than expected and not always in the expected
direction. CONCLUSIONS: The COOP/WONCA system continues to show promise,
but needs more validation.
相似文献