How Frequent Are Asthma Exacerbations in a Pediatric Primary Care Setting and Do Written Asthma Action Plans Help in Their Management?

Purpose. In the National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma, the expert panel recommends that a written asthma action plan be provided for all patients with asthma. Studies evaluating the usefulness of the asthma action plan in children are limited. We aim to determine exacerbation frequency and usefulness of the asthma action plan in managing exacerbations that occur in a pediatric primary care setting. Methods. Caretakers of asthmatic children attending the general pediatric clinic in an inner-city hospital completed a one-page questionnaire covering topics such as asthma severity, frequency of exacerbations, and possession/usefulness of an asthma action plan. Although controversy exists over the definition of yellow and red zone exacerbations, we defined the yellow zone as symptoms that require albuterol more than three times a day or more than two nights in succession. The red zone was defined as symptoms requiring systemic corticosteroids and/or an urgent physician visit. Results. Seventy of 75 subjects completed the survey. Almost 80% of respondents carried the diagnosis of persistent asthma, whereas the remainder had intermittent asthma. Exacerbation frequency over a 3-month period was determined. Approximately 80% of children experienced at least one yellow zone episode: 42% had one or two yellow zone episodes, and 39.6% had between three and five episodes. Sixty-three percent of patients did not experience a single red zone exacerbation. Almost 75% (44 of 59) of subjects possessed an asthma action plan. Ninety percent (37 of 41) of respondents with action plans found the plan to be useful in managing exacerbations. Conclusion. Approximately four of every five asthmatic children seen in this primary care setting experienced a yellow zone exacerbation at least once during a 3-month period. One third experienced at least one red zone episode. Nine of every 10 caretakers with an action plan reported the asthma action plan to be of value in managing exacerbations.     

Characteristics of Acute Asthma Patients Attended Frequently Compared with Those Attended Only Occasionally in an Emergency Department

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age ≥12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by ≥3 visits to the ED in the preceding year, and the occasional visitors (OV) by ≤2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 ± 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A$3000 and 66.3% had ≤8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled β-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.     

舒莱在肾移植免疫诱导治疗中有效性和安全性研究

目的 探讨在肾移植免疫诱导治疗中巴利昔单抗(舒莱)的有效性和安全性.方法随机选取69例肾移植受者,在常规三联免疫抑制方案的基础上,分别接受舒莱或ATG诱导治疗,对比观察两组的人/肾存活率、排斥反应以及包括感染在内的药物相关副作用的差异.结果接受舒莱的患者组药物相关副作用显著低于接受ATG的患者组(P＜0.05),两组患者的人/肾存活率、急性排斥反应和肺部感染的发生率均无显著差异(P＞0.05).移植物功能(移植后血肌酐水平及下降速度)在移植早期舒莱组优于ATG组,而长期随访结果显示两组之间无显著差异.结论 肾移植受者接受巴利昔单抗(舒莱)免疫诱导治疗是安全和有效的,与ATG诱导治疗方法比较具有更少的副作用.     

麻醉诱导前使用右美托咪啶的婴幼儿体外循环手术的护理配合

目的 探讨麻醉诱导前使用右美托咪啶的婴幼儿体外循环手术的护理配合.方法 选取60例先心病患儿行体外循环下心内直视手术治疗患儿为研究对象,数字法随机将其分为两组各30例,对照组给予常规手术治疗及护理,观察组在麻醉诱导前给予右美托嘧啶泵注及相应针对性护理配合,观察两组患者临床疗效和患儿家属对护理的满意度.结果 经过一定的护理配合治疗后,结果显示两组患儿术后心脏指数(CD、心搏指数(SI)、左心室射血分数(LVEF)、左室作功指数(LCWI)等心功能指标差异有统计学意义(P＜0.05);观察组患儿家属的满意度(96.7％)显著高于对照组(80.0％),差异有统计学意义(P＜0.05).结论 麻醉诱导前使用右美托咪啶的婴幼儿体外循环手术,加强术前充分护理准备,提高术中娴熟配合技巧,严密观察病情,能确保手术治疗效果,提高患儿家属的护理满意度.     

Induction of hepatic cytochrome P450 enzymes: methods,mechanisms, recommendations,and in vitro–in vivo correlations

Induction of drug-clearance pathways (Phase 1 and 2 enzymes and transporters) can have important clinical consequences. Inducers can (1) increase the clearance of other drugs, resulting in a decreased therapeutic effect, (2) increase the activation of pro-drugs, causing an alteration in their efficacy and pharmacokinetics, and (3) increase the bioactivation of drugs that contribute to hepatotoxicity via reactive intermediates. Nuclear receptors are key mediators of drug-induced changes in the expression of drug-clearance pathways. However, species differences in nuclear receptor activation make the prediction of cytochrome P450 (CYP) induction in humans from data derived from animal models problematic. Thus, in vitro human-relevant model systems are increasingly used to evaluate enzyme induction. In this review, the authors’ current understanding of the mechanisms of enzyme induction and the in vitro methods for assessing the induction potential of new drugs will be discussed. Relevant issues and considerations surrounding proper study design and the interpretation of in vitro results will be discussed in light of the current US Food and Drug Administration (FDA) recommendations.     

Feasibility of Induction Chemotherapy Using Bronchial Arterial Infusion for Locally Advanced Non-Small Cell Lung Cancer: A Pilot Study

Purpose: We examined the feasibility and effectiveness of bronchial arterial infusion (BAI) as induction chemotherapy before surgery for locally advanced non-small cell lung cancer (NSCLC). Methods: Eighteen patients with locally advanced NSCLC were given BAI consisting of cis-diamminedichloroplatinum (CDDP) (50–100 mg/m²) as induction chemotherapy before surgery (induction BAI). Six patients with clinical stage IIIA cancer had bulky N2 metastatic lymph nodes, and 12 patients with clinical stage IIIB cancer had T4 disease. Results: Of the 18 patients, 12 (67%) showed a partial response to the BAI therapy. Standard pulmonary resection was performed in 5 patients, pulmonary resection with the combined resection of adjacent organs was performed in 10 patients, and pulmonary resection with carinal resection and reconstruction was performed in 3 patients. Complete resection was possible in 14 patients (78%). There were no serious BAI therapy-related complications or postoperative deaths. The 5-year survival rate of the 18 patients was 35.7% and the median survival time (MST) was 19.4 months. Survival was better when complete resection was achieved after the induction BAI, especially in patients with stage IIIB (T4) disease. Conclusion: Based on our preliminary findings, BAI with CDDP as induction chemotherapy is feasible and may be an effective therapeutic modality for locally advanced NSCLC. Received: July 26, 2001 / Accepted: March 5, 2002     

体外诱导BMSCs向软骨分化的方法研究进展

目的全面了解目前体外诱导BMSCs向软骨分化的方法,为软骨组织工程研究提供参考。方法广泛查阅近年来有关软骨组织工程中诱导BMSCs向软骨分化的文献,并进行综合分析。结果目前BMSCs诱导成软骨方法主要是添加外源性生长因子,其中TGF-β家族被公认为最重要的诱导和调节因子。其他重要的诱导方法包括添加多种化学因子、物理因素、转基因技术和微环境诱导等方法,但这些方法仍存在诱导效率低、诱导效果不稳定的问题。结论诱导方法的进展促进了BMSCs在软骨组织工程中的应用,建立更高效、简便、安全的诱导方法仍是软骨组织工程领域重要研究课题之一。     

布地奈德雾化治疗中重度慢性阻塞性肺疾病急性加重期的随机临床试验

目的 评价布地奈德雾化治疗中重度慢性阻塞性肺疾病急性加重期病人的临床应用价值.方法 采用前瞻性设计,将200例病人(包括95例中度和105例重度病人)随机分组,分别予布地奈德混悬液2mg tid吸入、泼尼松片10mgtid口服和不使用激素治疗,疗程7d.记录各时段ls用力肺活量(FEV1)、血气分析、呼吸困难评分和不良反应.结果 与对照组相比,吸入布地奈德和口服泼尼松组在呼吸困难评分改善方面,各时间与对照组相比差异均有显著性(P＜0.05或P＜0.01).在FEV1升高方面,疗程早、中期(第24、72h)差异显著(P＜0.05或P＜0.01);疗程早、中期(第24、72h)PaCO2的下降差异有显著性(P＜0.05或P＜0.01),而PaO2的升高则差异无显著性.二治疗组间相比差异无显著性.布地奈德组的不良反应少于口服泼尼松组.结论 布地奈德雾化吸入治疗是COPD急性加重期糖皮质激素治疗的有效选择.     

白三烯受体基因mRNA在慢性阻塞性肺疾病患者中的不同表达

目的:评价慢性阻塞性肺疾病(COPD)患者的白三烯受体(LTs-R)基因的表达;对比LTs-R基因mRNA在COPD组和健康对照组之间表达水平的差异;研究COPD缓解期患者与急性发作期患者的LTs-R基因mRNA表达水平是否存在差异。方法:通过LT1-R和LT2-R特异性引物对59份试验者的血液标本,应用逆转录聚合酶链式反应(RT—PCR)技术检测LT1-R和LT2-R的表达。引入内参β-actin,应用电泳凝胶定位分析仪,1D凝胶分析软件,对比并定量分析LT1-R和LT2-R基因mRNA在COPD患者和对照健康者之间的表达差异,对所得数据进行统计学分析、处理和评价。结果:所有COPD患者的标本均检测到编码LT1-R和LT2-R基因的mRNA表达,且与正常组对比差异有显著性(P<0.05),但缓解期组与急性加重期组之间差异无显著性(P>0.05)。结论:LT1-R和LT2-R基因mRNA在COPD者外周血白细胞中表达水平显著增高;但缓解期组与急性加重期组患者的表达水平之间无明显差别。