孟鲁司特钠联合甲泼尼龙琥珀酸钠治疗支气管哮喘急性发作的疗效观察

目的观察孟鲁司特钠联合甲泼尼龙琥珀酸钠治疗支气管哮喘急性发作的临床疗效。方法选择2010年1月—2013年6月在我科住院的支气管哮喘急性发作患者48例,将其随机分为对照组和试验组,各24例。在常规治疗的基础上对照组患者给予甲泼尼龙琥珀酸钠治疗,试验组患者给予甲泼尼龙琥珀酸钠联合孟鲁司特钠治疗。观察治疗后第3天、第6天两组患者临床疗效及治疗期间不良反应情况。结果治疗后第3天试验组总缓解率为95.8%,高于对照组的75.0%(χ2=2.676,P0.05);治疗后第6天试验组总缓解率为100.0%,高于对照组的83.3%(χ2=3.572,P0.05)。两组患者均未出现严重不良反应。结论孟鲁司特钠联合甲泼尼龙琥珀酸钠能有效控制支气管哮喘急性发作,减轻患者痛苦,且不良反应轻微。     

氯沙坦与氨氯地平的降压疗效及其对左心室肥厚逆转作用的效果对比

目的比较氯沙坦与氨氯地平的降压疗效及其对左心室肥厚逆转作用的效果。方法选取2010年5月—2013年4月我社区收治的高血压患者120例,采用随机数字表法将其分为A组和B组,各60例。A组口服氯沙坦钾片治疗,B组口服苯磺酸氨氯地平片治疗,均连续治疗12周。比较两组患者血压和超声心动图指标,包括左心室舒张末内径(LVDd)、舒张期室间隔厚度(LVSd)、左心室后壁厚度(LVPWd)、左心室重量指数(LVMI)。结果治疗后两组收缩压和舒张压比较,差异均无统计学意义(P0.05);A组LVDd、LVSd、LVPWd、LVMI均低于B组(P0.05)。两组不良反应发生率比较,差异无统计学意义(P0.05)。结论氯沙坦与氨氯地平治疗原发性高血压均可获得满意的降压疗效,其中氯沙坦可有效逆转左心室肥厚,疗效具有一定的优越性。     

Evaluation of Chinese updated guideline for acute pancreatitis on management of moderately severe and severe acute pancreatitis

Background/Objectives: The management of acute pancreatitis (AP) in China has undergone major changes since the launch of the updated guideline in 2013. This study aimed to evaluate the impact of this guideline on clinical practice and patient outcome.MethodsModerately severe and severe adult AP patients, who were admitted to Peking Union Medical College Hospital from January 1, 2001 to December 31, 2016, were retrospectively included in the study. All enrolled patients were divided into two groups based on the publication date of the updated guideline, as the pre-guideline (Pre) group and post-guideline (Post) group. In-hospital case-fatality rates were compared between two groups after adjusting baseline features, including gender, age, etiology and disease severity. In addition, the associations between specific therapeutic approaches recommended in the updated guideline and in-hospital case-fatality rates were explored.ResultsA total of 475 patients were enrolled in this study, including 273 (57%) in the Pre group and 202 (43%) in the Post group. The adjusted in-hospital case-fatality rate significantly decreased in the Post group (14.3% vs. 5.9%, OR 0.39, 95%CI 0.19–0.82). In the post-hoc analysis, the use of enteral nutrition was a protective factor against in-hospital death (OR: 0.08, 95%CI: 0.03–0.18), while open surgery showed an opposite effect (OR: 3.81, 95%CI: 1.06–13.74). Prophylactic antibiotics was not significantly associated with in-hospital death (OR: 1.00, 95%CI: 0.39–2.60).ConclusionsThere was a prominent transition in the management of moderately severe and severe AP after the release of the guideline in China in 2013, which made the prognosis better.     

诱导痰细胞分类在嗜酸细胞性支气管炎诊断和治疗中的应用

目的探索诱导痰细胞分类在嗜酸细胞性支气管炎(EB)诊断和治疗中的作用。 方法回顾性分析我院门诊239例慢性咳嗽患者,依据慢性咳嗽中诊断标准,分为非EB组和EB组,分析两组诱导痰中细胞分类情况;同时给予EB患者进行8周治疗,观察经治疗后诱导痰中各细胞分类的改变情况。 结果239例慢性咳嗽患者中,非EB患者216例,占90.7%,EB患者23例,占9.3%,两组中共有121例(50.6%)患者诱导痰中嗜酸细胞百分比升高;非EB患者组细胞总计数为(4.83±2.61)×10⁶个/g、嗜酸细胞比例为(4.56±10.07)%、中性粒细胞比例为(50.32±26.12)%、淋巴细胞比例为(5.14±7.27)%、单核巨噬细胞比例为(40.30±16.70)%,EB患者组痰中细胞总计数为(5.46±3.07)×10⁶个/g、嗜酸细胞比例为(13.85±1 2.23)、中性粒细胞比例为(46.16±16.89)、淋巴细胞比例为(4.83±2.98)、单核巨噬细胞比例为(35.91±16.35),两组间EB组嗜酸细胞比例有显著的增多(P<0.05),在性别、年龄以及其余细胞成分差异无统计学意义(P>0.05);EB患者组经治疗后,痰中细胞总计数为(4.07±3.89)×10⁶个/g、嗜酸细胞比例为(2.52±3.80)%、中性粒细胞比例为(54.18±17.97)%、淋巴细胞比例为(5.59±4.33)%、单核巨噬细胞比例为(38.32±17.23)%,嗜酸细胞较治疗前有显著减少(P<0.05),其余细胞改变无显著差异(P>0.05)。 结论诱导痰细胞分类检查是诊断EB的重要方法,在其诊断和治疗过程中有着重要的指导作用,可作为EB治疗过程的监测指标。     

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

BackgroundIn recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation.AimsTo perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics.MethodsA survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n = 318).ResultsIn total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%).ConclusionsEveryday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.     

Does the etiology affect the outcome and satisfaction rates of penile prosthesis implantation surgery?

Our aim was to compare the outcomes and satisfaction rates of men undergoing penile prostheses implantation (PPI) secondary to radical prostatectomy (RP) and other causes of vasculogenic erectile dysfunction (ED). A total of 142 patients, of whom 60 underwent PPI due to ED following RP (Group 1) and 82 underwent PPI due to ED with other vasculogenic causes (Group 2) were included in this study. The preoperative erectile status was evaluated with the International Index of Erectile Function (IIEF). The satisfaction of patients and partners were evaluated by a telephone interview using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire and Erectile Dysfunction Inventory of Treatment Satisfaction Partner Survey. Preoperative mean IIEF scores were significantly lower in Group 1 (17.5 ± 6.4 vs. 24.2 ± 5.1, p = 0.01). For Groups 1 and 2, the mean EDITS scores of the patients were 58 ± 10 and 71 ± 8, respectively, and that for the partners were 46 ± 8 and 65 ± 7, respectively. Group 1 had significantly lower scores both for the EDITS and the EDITS Partner Survey (p = 0.03, p = 0.01, respectively). Patients who had undergone RP and their partners were found to have lower satisfaction rates compared to patients with other causes of vasculogenic ED who had penile implant surgery. From this point of view, it is important to know the patient's expectations about the treatment outcomes and a preoperative psychological and sexual counseling should be managed for possible treatment alternatives after RP.