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51.
Algra A van Gijn J Halkes PH Kappelle LJ Koudstaal PJ;ESPRIT Study Group 《Lancet neurology》2008,7(3):198-9; author reply 199
52.
Background Patients with aneurysmal subarachnoid hemorrhage (SAH) are at risk for circulatory volume depletion, which is a risk factor
for delayed cerebral ischemia (DCI). In a prospective observational study we assessed the effectiveness of fluid administration
based on regular evaluation of the fluid balance in maintaining normovolemia.
Methods A total of 50 patients with aneurysmal SAH were included and were treated according to a standard protocol aimed at maintaining
normovolemia. Fluid intake was adjusted on the basis of the fluid balance, which was calculated at 6-h intervals. Circulating
blood volume (CBV) was measured by means of pulse dye densitometry (PDD) on alternating days during the first 2 weeks after
SAH.
Results Of the 265 CBV measurements, 138 (52%) were in the normovolemic range of 60–80 ml/kg; 76 (29%) indicated hypovolemia with
CBV < 60 ml/kg; and 51 (19%) indicated hypervolemia with CBV > 80 ml/kg. There was no association between CBV and daily fluid
balance (regression coefficient β = −0.32; 95% CI: −1.81 to 1.17) or between CBV and a cumulative fluid balance, adjusted
for insensible loss through perspiration and respiration (β = 0.20; 95% CI: −0.31 to 0.72).
Conclusion Calculations of fluid balance do not provide adequate information on actual CBV after SAH, as measured by PDD. This raises
doubt whether fluid management guided by fluid balances is effective in maintaining normovolemia. 相似文献
53.
Freeman JB Garcia AM Coyne L Ale C Przeworski A Himle M Compton S Leonard HL 《Journal of the American Academy of Child and Adolescent Psychiatry》2008,47(5):593-602
ObjectiveTo examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment (RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD).MethodForty-two young children with primary OCD were randomized to receive 12 sessions of family-based CBT or family-based RT. Assessments were conducted before and after treatment by independent raters blind to treatment assignment. Primary outcomes included scores on the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-Improvement.ResultsFor the intent-to-treat sample, CBT was associated with a moderate treatment effect (d = 0.53), although there was not a significant difference between the groups at conventional levels. For the completer sample, CBT had a large effect (d = 0.85), and there was a significant group difference favoring CBT. In the intent-to-treat sample, 50% of children in the CBT group achieved remission as compared to 20% in the RT group. In the completer sample, 69% of children in the CBT group achieved a clinical remission compared to 20% in the RT group.ConclusionsResults indicate that children with early-onset OCD benefit from a treatment approach tailored to their developmental needs and family context. CBT was effective in reducing OCD symptoms and in helping a large number of children achieve a clinical remission. 相似文献
54.
Olutobi A. Sanuade MPHIL PhD Boni M. Ale MD MSc MPH Abigail S. Baldridge MS Ikechukwu A. Orji MBBS MPH PhD Gabriel L. Shedul MD MPH Tunde M. Ojo MD MSc Grace Shedul PharmD Eugenia N. Ugwuneji MSc FPCPharm Nonye Egenti MD MPH Kasarachi Omitiran MBBS FWACP Rosemary Okoli PhD Helen Eze MBBS Ada Nwankwo MBBCh Lisa R. Hirschhorn MD MPH Aashima Chopra MPH Jiancheng Ye MS Priya Tripathi MS Bolanle Banigbe MD MPH DrPH Namratha R. Kandula MD MPH Mark D. Huffman MD MPH Dike B. Ojji MD PhD the Hypertension Treatment in Nigeria Program Investigators 《Journal of clinical hypertension (Greenwich, Conn.)》2023,25(2):127-136
Fixed-dose combination (FDC) therapy is recommended for hypertension management in Nigeria based on randomized trials at the individual level. This cluster-randomized trial evaluates effectiveness and safety of a treatment protocol that used two-drug FDC therapy as the second and third steps for hypertension control compared with a protocol that used free pill combinations. From January 2021 to June 2021, 60 primary healthcare centers in the Federal Capital Territory of Nigeria were randomized to a protocol using FDC therapy as second and third steps compared with a protocol that used the same medications in free pill combination therapy for these steps. Eligible patients were adults (≥18 years) with hypertension. The primary outcome was the odds of a patient being controlled at their last visit between baseline to 6-month follow-up in the FDC group compared to the free pill group. 4427 patients (mean [SD] age: 49.0 [12.4] years, 70.5% female) were registered with mean (SD) baseline systolic/diastolic blood pressure 155 (20.6)/96 (13.1) mm Hg. Baseline characteristics of groups were similar. After 6-months, hypertension control rate improved in the two treatment protocols, but there were no differences between the groups after adjustment (FDC = 53.9% versus free pill combination = 47.9%, cluster-adjusted p = .29). Adverse events were similarly low (<1%) in both groups. Both protocols improved hypertension control rates at 6-months in comparison to baseline, though no differences were observed between groups. Further work is needed to determine if upfront FDC therapy is more effective and efficient to improve hypertension control rates. 相似文献
55.
The classification of ischemic stroke into different subtypes is supported in genetic association studies. While several gene variants have been identified as being associated with ischemia subtypes, most studies have not been powered to study subtypes separately. We investigated 887 patients with nondisabling cerebral ischemia of arterial origin and classified ischemia as being caused by large or small vessel disease (LVD or SVD), primarily based on neuroimaging findings. In total, 621 patients had LVD and 266 SVD. The coagulation factor XIII subunit B gene (F13B) His95Arg variant was more common in patients with LVD (mean prevalence difference 9.9%; 95% CI 4.7-15). None of 21 other prothrombotic gene variants was associated with LVD or SVD. Many gene variants may not be specific for one subtype. We could not replicate the genetic associations identified in previous smaller previous studies. Thus claims about genetic associations with specific subtypes of ischemia should be interpreted with caution. The association between F13B His95Arg and LVD requires replication. 相似文献
56.
57.
58.
Maurizio Pieroni James C. Moon Eloisa Arbustini Roberto Barriales-Villa Antonia Camporeale Andreja Cokan Vujkovac Perry M. Elliott Albert Hagege Johanna Kuusisto Aleš Linhart Peter Nordbeck Iacopo Olivotto Päivi Pietilä-Effati Mehdi Namdar 《Journal of the American College of Cardiology》2021,77(7):922-936
Fabry disease (FD) is a rare X-linked inherited lysosomal storage disorder caused by deficient α-galactosidase A activity that leads to an accumulation of globotriasylceramide (Gb3) in affected tissues, including the heart. Cardiovascular involvement usually manifests as left ventricular hypertrophy, myocardial fibrosis, heart failure, and arrhythmias, which limit quality of life and represent the most common causes of death. Following the introduction of enzyme replacement therapy, early diagnosis and treatment have become essential to slow disease progression and prevent major cardiac complications. Recent advances in the understanding of FD pathophysiology suggest that in addition to Gb3 accumulation, other mechanisms contribute to the development of Fabry cardiomyopathy. Progress in imaging techniques have improved diagnosis and staging of FD-related cardiac disease, suggesting a central role for myocardial inflammation and setting the stage for further research. In addition, with the recent approval of oral chaperone therapy and new treatment developments, the FD-specific treatment landscape is rapidly evolving. 相似文献
59.
Simone C. Oudshoorn Gabriel J. E. Rinkel Andrew J. Molyneux Richard S. Kerr Sanne M. Dorhout Mees Daan Backes Ale Algra Mervyn D. I. Vergouwen 《Neurocritical care》2014,21(1):4-13
Introduction
In patients with aneurysmal subarachnoid hemorrhage (aSAH), it is unclear whether aneurysm treatment <24 h after ictus results in better outcomes than treatment 24–72 h after aSAH. We studied whether aneurysm occlusion <24 h is associated with better outcomes than occlusion 24–72 h after aSAH.Methods
We used two cohorts of patients with aSAH: (1) the UMC Utrecht cohort with patients admitted between 2008 and 2012 and (2) the International Subarachnoid Aneurysm Trial cohort. Aneurysm treatment was categorized into <24 h and 24–72 h after ictus. We calculated adjusted risk ratios (aRRs) with 95 % confidence intervals (CIs) using Poisson regression analyses for poor functional outcome (death or dependency) for both cohorts separately, and performed a pooled analysis based on individual patient data. We also performed a worst-case scenario analysis wherein all patients with rebleeding >3 h after admission were re-categorized into the group with aneurysm treatment 24–72 h after aSAH.Results
We included 1,238 patients (UMC Utrecht cohort: n = 330; ISAT: n = 908). The aRR for poor outcome after treatment <24 h was in the UMC Utrecht cohort 1.84 (95 % CI: 1.25-2.70), in ISAT 1.14 (95 % CI 0.84–1.55), in the pooled analysis 1.37 (95 % CI 1.11–1.68), and in the worst-case scenario pooled analysis 1.24 (95 % CI 1.01–1.52).Conclusion
Our results suggest that aneurysm occlusion can be performed in day time within 72 h after ictus, instead of on an emergency basis. However, due to the retrospective, non-randomized design of our study, our results cannot be considered as definitive evidence. 相似文献60.
Acute pulmonary embolism (PE) bears a significant burden on health and survival. Rapid and accurate risk stratification and management are of paramount importance to ensure the highest quality of care. This present article summarizes currently available and emerging management strategies for the disease. The authors not only review current evidence regarding early therapy of acute PE, including supportive care, anticoagulation, thrombolysis, surgical and catheter-based treatment, but also the possible role of mechanical circulatory support in PE. The authors also discuss complications related to PE and its management. 相似文献