Background: Pulmonary arterial hypertension (PAH) is a deadly disease with limited treatment options.Objectives: The objectives of this study were to assess the effects of bosentan, an orally active dual endothelin receptor antagonist, on exercise capacity and cardiopulmonary hemodynamics, as well as to assess its safety and tolerability in patients with severe PAH.Methods: In this double-blind, placebo-controlled, multicenter study, 32 patients with PAH (primary or associated with scleroderma) were randomized to receive bosentan for a minimum of 12 weeks (62.5 mg BID for 4 weeks, then 125 mg BID) or placebo. The primary end point was the change in exercise capacity. Secondary end points included changes in cardiopulmonary hemodynamics, Borg dyspnea index, and modified New York Heart Association (NYHA) functional class, as well as withdrawal due to clinical worsening.Results: Patients treated with bosentan improved their 6-minute walking distance. Fifteen bosentan-treated patients (71%) improved their walking distance from baseline to week 12 by >30 m, which is considered a clinically relevant improvement. The difference between treatment groups in the mean (±SEM) change at week 12 was 76 ± 31 m in favor of bosentan (95% CI, 12 to 139; P = 0.021). The improvement was maintained for at least 20 weeks. For cardiac index, the difference was 1.0 ± 0.2 L/min/m2 in favor of bosentan (95% CI, 0.6 to 1.4; P < 0.001). Bosentan significantly decreased pulmonary vascular resistance, whereas it was increased with placebo (P ≤ 0.001). Bosentan improved both the Borg dyspnea index and the NYHA functional class. All 3 withdrawals due to clinical worsening were in the placebo group (P = 0.033). The number and nature of adverse events were similar in the 2 groups.Conclusions: In these patients with PAH, bosentan increased exercise capacity and improved hemodynamics. These results, which have been summarized previously in a brief report, include all data up to 28 weeks of treatment and support the potential clinical value of endothelin receptor antagonists in the treatment of patients with PAH. 相似文献
Introduction: Interstitial lung disease (ILD) is the most serious complication of systemic sclerosis (SSc). There is no accepted guidance as to which clinical, radiological or physiological thresholds should prompt initiation or changes in treatment. Furthermore, some patients with extensive disease remain stable without the need for intervention whilst others with limited disease at the outset, experience a precipitous decline.
Areas covered: In this article, evidence for the integration of a number of disease-specific and patient-related domains are discussed and proposed. Introduction and maintenance of therapy requires a nuanced understanding of these factors and is crucial when weighing up the risks and benefits of immunomodulation. The evidence for the existing treatment modalities is discussed and the future directions for management of patients with SSc-ILD, which may include antifibrotic or biologic therapy, are explored.
Expert commentary: In the management of SSc-ILD, a multidisciplinary team approach which integrates physiology and radiology with the patient at the centre of the process is crucial for effective management and provision of the best outcomes. 相似文献
To explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP).
Methods
Multicenter study in a scenario of prostate-specific antigen (PSA) ≤ 20 ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4 mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study.
Results
In the intention-to-treat population (n = 81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%, 83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%, 88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported.
Conclusions
Results support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa. 相似文献
Purpose: The objectives were to identify reasons why patients attend scleroderma support groups and to ascertain preferences for how meetings are best organized.
Methods: The survey included 30-items on reasons for attending and nine items on organizational preferences. Patients were recruited through European patient organizations. Exploratory factor analysis was used to group reasons for attendance thematically.
Results: About 213 scleroderma patients (192 women) completed the survey. A three-factor model best described reasons for attending [χ2(348)?=?586.1, p?<?0.001; Comparative Fit Index?=?0.98; Tucker Lewis Index?=?0.97; Root Mean Square Error of Approximation?=?0.06] with themes that included: (1) obtaining interpersonal and social support, (2) learning about treatment and symptom management strategies, and (3) discussing other aspects of scleroderma. Among organizational preferences, respondents emphasized that meetings should include educational aspects and the opportunity to share information and support.
Conclusion: People with scleroderma attend support groups to give and obtain social support and for education about managing their disease and other aspects of living with scleroderma. Support groups should be structured to facilitate both educational and informational aspects and to provide opportunities for sharing and support between members.
Implications for rehabilitation
Local peer-led support groups are an important support and informational resource for patients living with scleroderma.
People with scleroderma attend support groups in order to: (1) obtain interpersonal and social support, (2) learn about disease treatment and symptom management strategies, and (3) discuss other aspects of living with scleroderma outside of symptom management.
Most support group members prefer groups with a trained facilitator, that include family members or loved ones in the groups, that include between 11and 20 members, that last between 1 and 2?h, and that meet once every 1–3 months.
Rehabilitation professionals can support the formation and management of local support groups or can refer patients to national scleroderma patient organizations for information on support groups that they may be able to access.
Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small... 相似文献
Background: Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) represent the leading causes of death in systemic sclerosis (SSc). Screening for these complications has assumed greater importance, but is not universal. The aim of this study is to determine the self‐reported screening, diagnosis and treatment practices of rheumatologists and respiratory physicians for SSc‐related lung disease. Methods: Email survey of 270 rheumatologists and 600 respiratory physicians. Results: Responses were received from 42 (16%) rheumatologists and 68 (11%) respiratory physicians. Of SSc patients seen by rheumatologists, 17% had ILD and 7.5% had a diagnosis of PAH compared with 31% and 21% for respiratory physicians. Forty per cent of all physicians screened asymptomatic SSc patients without a known diagnosis of ILD or PAH less than annually or not at all. The most commonly used screening investigations were pulmonary function tests (PFT) (95%) and transthoracic echocardiogram (TTE) (78%). In suspected ILD, both groups used high‐resolution computed tomography scans and PFT in >90% of patients. In suspected PAH, both used TTE and PFT (>90%); right heart catheterisation was used by only 50% of physicians. In treatment of ILD, rheumatologists used intravenous (IV) cyclophosphamide more often (CYC) (59% vs 28%, P= 0.003) and more respiratory physicians used oral CYC (44% vs 28%, P= 0.012). In PAH, more respiratory physicians used warfarin (68% vs 40%, P= 0.006). Only approximately 65% of physicians had used specific PAH therapy, which may reflect lack of access to a designated PAH treatment centre. Conclusion: The heterogeneity of responses revealed in this study raises the importance of screening, diagnosis and treatment algorithms in the management of this potentially life‐threatening disease. 相似文献