Use of omalizumab in a severe asthma clinic

Abstract:   There is an urgent need to define new treatment strategies for severe persistent asthma. Using a severe asthma clinic model, it is possible to systematically assess diagnosis, self-management skills, and treatment efficacy. The addition of single-patient trials of therapy is useful to detect individual responders to drugs where use is limited because of access, cost, or toxicity. Omalizumab is effective in severe asthma, however access is restricted by cost and availability. We conducted single patient efficacy trials of omalizumab in 12 subjects with severe refractory asthman. There were 2 definite and 6 partial responders. Patients with difficult/therapy resistant or refractory asthma can respond to omalizumab, and this response can be detected in individual patients using a single patient controlled trial conducted in the setting of a severe asthma clinic.     

Diagnostic approach and treatment strategy in tachycardia-induced cardiomyopathy

BACKGROUND: Due to the absence of differential guidelines for heart failure with tachyarrhythmia, it is difficult to diagnose tachycardia-induced cardiomyopathy (TIC) at the initial visit. Furthermore, clinical outcomes of rate versus rhythm control in TIC are unclear. HYPOTHESIS: Because the etiology of TIC is different from dynamic cardiomyoplasty (DCMP), differential parameters may be present. METHODS: We assessed 21 patients with TIC (15 men; mean age, 50+/-14 years) and 21 control patients with idiopathic DCMP. We assessed clinical courses, echocardiographic parameters, as well as outcomes by treatment. RESULTS: In the TIC group, the related tachyarrhythmias were atrial fibrillation (n=12), atrial flutter (n=5), atrial tachycardia (n=3) and paroxysmal supraventricular tachycardia (n=1). After treatment, all patients became asymptomatic and the ejection fraction (EF) improvement (DeltaEF>or=15%) was observed in all patients (left ventricular ejection fraction [LVEF], 30+/-11%initial versus 58+/-6%last). In the idiopathic DCMP group, no patient showed EF improvement (EF increase相似文献   

Clinical features of hepatitis C virus-related hepatocellular carcinoma and their association with alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II.

PURPOSE: We investigated the differences in clinical features between alpha-fetoprotein (AFP)-predominant hepatocellular carcinoma (HCC) and protein induced by vitamin K absence or antagonist-II (PIVKA-II)-predominant HCC, especially regarding host factors thought to contribute to hepatocarcinogenesis in chronic hepatitis C virus (HCV) infection. METHODS: HCV-related HCC patients (n=306) were divided into four groups according to median AFP (48.1 ng/ml) and PIVKA-II (60 mAU/ml). Host factors, tumor factors, survival, and risk factors affecting survival were compared. RESULTS: Aspartate aminotransferase (AST; IU/L), alanine aminotransferase (ALT; IU/L), and platelet count (x 10(4)/ml) were, respectively, 81, 67, and 8.2 in AFP-predominant HCC (group A; n=66) vs. 50, 42, and 11.4 in PIVKA-II-predominant HCC (group P; n=52). Tumor sizes (mm) in groups A and P were 20 and 37, respectively. Significant differences were evident. Survival was identical between the two groups. Factors affecting survival were total bilirubin, portal tumor thrombus and number of nodule in group A, and albumin and tumor distribution in group P. CONCLUSIONS: PIVKA-II-predominant HCC had a milder hepatitis and a better-preserved platelet count compared with AFP-predominant HCC. Considering the strong relation between hepatocarcinogenesis and hepatic inflammation with chronic HCV infection, these differences indicate that hepatocarcinogenic mechanisms in PIVKA-II-predominant HCC may differ from those in AFP-predominant HCC.     

芬太尼不同给药速度复合丙泊酚静脉全麻用于人工流产551例观察

目的比较芬太尼与丙泊酚复合麻醉用于人工流产术时,不同给药速度对麻醉效果、不良反应及麻醉追加量的影响。方法回顾性分析2008～2009年4月无痛人流584例。其中观察组551例注入茂菲氏管静滴芬太尼,对照组33例静推芬太尼。结果观察组与对照组扩张宫口时的反应及追加剂量的例数比较,差异有统计学意义（P＜0.025）,呼吸暂停的发生例数比较,差异有统计学意义（P＜0.01）。结论静滴芬太尼比静推芬太尼复合丙泊酚麻醉效果好、不良反应少、麻醉追加量少,更加安全。     

Optimization of a murine immunization model for study of PF4/heparin antibodies

Summary.  Background:  Heparin-induced thrombocytopenia (HIT) is a life-threatening thrombotic illness caused by drug-dependent antibodies recognizing complexes of platelet factor 4 (PF4) and heparin. Little is known about the immune pathogenesis of HIT, in particular factors influencing PF4/heparin antibody formation. To gain insight into the biologic basis of heparin sensitization, we have recently developed an animal model using wild-type (WT) mice in which murine PF4/heparin antibodies (anti-mPF4/H) arise de novo after antigen challenge. Objectives and methods:  This report describes technical refinements to the murine model and describes additional biologic features of the immune response to mPF4/heparin. Results:  Our studies indicate that antibody responses to mPF4/heparin are dependent on murine strain, injection routes and doses of mPF4 and heparin. C57BL/6 mice are more immunologically responsive to mPF4/heparin antigen than BALB/c mice and robust immunization can be achieved with intravenous, but not intraperitoneal, administration of antigen. We also observe a direct relationship between initial concentrations of mPF4 and antibody levels. Additionally, we demonstrate that mPF4/H immune response in mice decays with time, is not associated with thrombocytopenia and displays characteristics of immune recall on re-exposure to antigen. Conclusions:  These studies describe and characterize a murine model for studying the immunologic basis of PF4/heparin sensitization.     

丙基硫氧嘧啶致以肺出血为主要表现的抗中性粒细胞胞浆抗体相关性血管炎1例报告并文献复习

目的：分析丙基硫氧嘧啶（PTU）诱发的抗中性粒细胞胞浆抗体相关性血管炎（AAV）的临床特点。方法：回顾分析我院收治的1例以肺出血为主要表现的PTU致AAV病例并复习相关文献。结果：患者女性,服用PTU5a,出现痰中带血、咯血,查尿潜血、蛋白、核周型ANCA（p—ANCA）、抗核抗体（ANA）均阳性。确诊后停用PTU,给予糖皮质激素冲击治疗,后期使用糖皮质激素维持治疗,临床症状缓解。结论：PTU可诱发AAV,及时停药及糖皮质激素治疗有效。     

心理护理在无痛人工流产术中的应用

目的观察心理护理综合措施用于无痛人工流产术的临床效果。方法将100例早孕妇女随机分为两组,每组50例。所有患者按常规过程进行术前准备和手术,试验组在进人手术室前根据患者所处状态和所提出的疑问有针对性地进行综合心理护理。结果进入手术室时试验组患者的焦虑程度明显小于对照组,且术后的主观感觉症状也明显优于对照组（P〈0．05）。同时,试验组患者较少发生不良反应。结论术前综合心理护理有利于无痛人工流产术者安全渡过围术期。     

202例猝死的法医病理学分析

目的分析猝死的死亡原因、年龄、性别差异、诱因、器官非特异性出血等特点。方法本教研室2000~2004年间所作563例法医病理检案中的202例猝死案例进行分析研究。结果①猝死者男性明显多于女性,年龄高峰为17~59岁。②导致猝死的疾病由高到低依次分布在心血管系统、呼吸系统、中枢神经系统、消化系统、泌尿生殖系统。③猝死诱因以死前有纠纷和/或轻外伤和夜间睡眠中死亡为多。④检出器官非特异性出血共80例,以胰腺、肾上腺和心外膜为多。结论猝死事件的法医学鉴定要根据其发生特征和变化规律,作出客观、全面、准确的鉴定结论。     

急性鱼胆中毒三种治疗方法的比较

目的:了解血液透析治疗对急性鱼胆中毒患者预后的影响。方法:将我院近十年收治的78例急性鱼胆中毒患者分为非透析治疗A组29例、血液透析治疗B组44例和提早行血液透析治疗C组5例(服用鱼胆到就诊时间≤12小时),A组患者单纯给予洗胃等常规治疗,B组在常规治疗基础上行血液透析治疗,C组则无论肾功如何,在就诊时立即给予血液透析治疗,分别比较三组患者少尿期时间、平均住院日及预后差异。结果:A、B、C三组患者少尿期时间分别为9·03±3·16、8·69±2·94及0天,平均住院日分别为17·8±8·42、17·33±7·86及7·12±1·66天,其中A、B两组少尿期时间和平均住院日无显著差异(P>0·05),C组与A、B两组比较则两项指标均显著降低(P<0·05);三组治愈率分别为62·1%、90·9%和100%,B组与A组相比、C组与B组相比,治愈率均显著提高。结论:对鱼胆中毒患者早期行血液透析治疗,尤其是在服用鱼胆后12小时内,尚未出现肾功损害时提早进行,是防治急性肾功能衰竭、改善预后的有效措施之一。