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Mak Anselm Thornhill Susannah I Lee Hui Yin Lee Bernett Poidinger Michael Connolly John E Fairhurst Anna-Marie 《Clinical rheumatology》2018,37(3):811-816
Clinical Rheumatology - The signalling lymphocyte activation molecule (SLAM) family receptors play important roles in modulating immune responses. Previous studies in murine models and patients... 相似文献
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Pamela P. W. Lee Koon-Wing Chan Tong-Xin Chen Li-Ping Jiang Xiao-Chuan Wang Hua-Song Zeng Xiang-Yuan Chen Woei-Kang Liew Jing Chen Kit-Man Chu Lee-Lee Chan Lynette Pei-Chi Shek Anselm C. W. Lee Hsin-Hui Yu Qiang Li Chen-Guang Xu Geraldine Sultan-Ugdoracion Zarina Abdul Latiff Amir Hamzah Abdul Latiff Orathai Jirapongsananuruk Marco H. K. Ho Tsz-Leung Lee Xi-Qiang Yang Yu-Lung Lau 《Journal of clinical immunology》2013,33(7):1269-1270
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PURPOSE OF REVIEW: Hospitalization and mortality rates associated with heart failure are persistently high. This is due partly to aging of the population but mostly to delayed progress in the pharmacological treatment of decompensated heart failure. We will review the current recommendations and most recent advancement in the pharmacological treatment of acute decompensated heart failure while providing a systematic approach to the management of this prevalent condition. RECENT FINDINGS: Loop diuretics, nitrates and inotropes such as dobutamine and milrinone are the current mainstay of acute heart failure management although their associated morbidity and possible mortality have raised serious concerns. Recent vasoactive agents such as Nesiritide, Tolvaptan and more recently the inotropic agent Levosimedan could offer improved hemodynamics and congestive relief to patients in acute pulmonary edema. SUMMARY: Despite the promising results of these agents, further clinical trials are required prior to their international approval as first-line therapy. Although we can be optimistic that these vasoactive drugs might have favorable clinical outcomes and improve the intricate management of decompensated heart failure, their associated mortality benefit remains unclear and controversial. 相似文献
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Frilling B Schiele R Gitt AK Zahn R Schneider S Glunz HG Gieseler U Jagodzinski E Senges J;Maximal Individual Therapy in Acute Myocardial Infarction Study Group 《American heart journal》2004,148(2):306-311
Background
A meta-analysis of randomized trials has shown a significant reduction of mortality rate in patients receiving aspirin for secondary prevention after acute myocardial infarction (AMI). However, a significant number of patients do not receive aspirin after AMI. Little is known about why aspirin is withheld or the long-term outcome of these patients today.Methods
The Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) registry is a multicenter registry of patients with AMI in Germany.Results
Of 4902 patients, 509 (10%) did not receive aspirin at the time of discharge from the hospital. The mean follow-up period for these patients was 17 months. Relative contraindications to aspirin were significantly associated with the withholding of aspirin (in-hospital bleeding: odds ratio [OR], 3.56; 95% CI, 1.86-6.80; history of peptic ulcer: OR, 2.49; 95% CI, 1.62-3.83). Absolute contraindications to aspirin were rare (2.2%). Other medications of proven benefit were also given less often in these patients (β-blockers: 49.0% vs 61.9%, P <.001; angiotensin-converting enzyme inhibitors: 65.6% vs 70.2%, P = .06; statins: 12.2% vs 15.1%, P = .10). Patients who were not given aspirin were at high risk for vascular events. They were more likely to have a history of prior AMI (OR, 1.34; 95% CI, 1.02-1.79), were in critical clinical condition at admission more often (cardiogenic shock: OR, 1.98; 95% CI, 1.09-3.56; overt heart failure: OR, 1.6; 95% CI, 1.05-2.3), and received acute revascularization less often (OR, 1.32; 95% CI, 1.05-1.67). The 1-year mortality was 2-times higher in patients who did not receive aspirin than in patients who did receive aspirin (16.5% vs 8.3%, P <.001). A significant association of withheld aspirin at discharge with a higher long-term mortality rate was confirmed with multivariate analysis (OR, 1.62; 95% CI, 1.15-2.29).Conclusions
Ten percent of patients who sustained an AMI did not receive aspirin at the time of hospital discharge. Most of these patients were at high risk for cardiovascular events. Withheld aspirin was significantly associated with higher mortality rate during follow up. 相似文献19.
Anselm Wong Roger L. K. Tong Liam Ryan Tim Crozier Andis Graudins 《Clinical toxicology (Philadelphia, Pa.)》2018,56(3):229-231
Context: Massive paracetamol ingestion causing mitochondrial dysfunction is uncommon. Use of sustained low-efficiency dialysis (SLED) to improve acidaemia and enhance paracetamol elimination has not been previously described.Case details: A 44-year-old male presented to the emergency department 2.5?hours post overdose of 200?g (2.5?g/kg) of paracetamol. Examination revealed a BP 85/60?mmHg, pulse 112 bpm, temperature 33.9?°C and blood glucose of 13.9?mmol/l. Venous blood gas 5.5-hours post-ingestion showed a pH 6.9, pCO2 58?mmHg, HCO3 13?mmol/l and lactate 14?mmol/l. Fifty-grams of nasogastric activated charcoal and double-strength intravenous acetylcysteine were administered. Paracetamol concentration peaked at 4207 µmol/l six hours post-ingestion. SLED was commenced nine-hours post ingestion and acetylcysteine dose was doubled again during dialysis. Paracetamol extraction ratio was 47–52%. Plasma paracetamol clearance was steady throughout SLED (53–58?ml/min). Hepatotoxicity did not develop and the patient recovered.Discussions: Intermittent hemodialysis (IHD) is more efficient than SLED or continuous renal replacement therapy for enhancing paracetamol elimination and clearance. IHD plasma clearance is reported to range from 36 to 215?ml/min compared with endogenous clearance of 224?ml/70?kg/min.Conclusions: SLED improved acidaemia with only moderate overall increase in paracetamol plasma clearance. Lack of development of hepatotoxicity was likely the result of early administration of acetylcysteine rather than any effect of SLED on paracetamol elimination. 相似文献
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