心力衰竭治疗药物的新变革

心力衰竭是一项极其重要的危害人类健康的全球性公共卫生问题,是心血管疾病发展的终末阶段,其发病率、再住院率及病死率在逐年不断的增长,这使得进一步开发更为有效的新型心力衰竭治疗药物迫在眉睫,而具有血管紧张素受体脑啡肽酶抑制剂双重作用机制的沙库巴曲缬沙坦的上市为心力衰竭患者的治疗带来了新的变革.     

少量蛋白尿IgA肾病临床研究现状

少量蛋白尿IgA肾病(24 h尿蛋白<1 g)的患者既往认为长期预后良好,且肾活检比例低,普遍未予积极有效的治疗。近年来陆续有研究表明,少量蛋白尿IgA肾病患者长期预后并不乐观,因此需提高对少量蛋白尿IgA肾病临床、病理、治疗及预后的认识及理解。本文将对少量蛋白尿IgA肾病临床表现、肾脏病理、治疗及预后4个方面予以综述。     

心脑血管疾病与肾素血管紧张素醛固酮系统

肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosterone system,RAAS）的激活不但和多种心血管疾病如高血压、心肌肥厚、动脉粥样硬化、动脉中层硬化及心力衰竭等的发生发展关系极为密切,还可引起脑水肿的发生,加重缺血性脑组织的损害[1].     

Sedation and delirium in the intensive care unit

Sedation is a widely used technique in critical care, and delirium is a common and serious complication of hospital stay. An understanding of drug choice and administration for safe use of sedation is important. Equally, an understanding of the mechanisms of delirium, along with preventative factors and treatments is an essential part of caring for many patients admitted to hospital. This article will cover these aspects of the subject.     

When is it safe to exercise mechanically ventilated patients in the intensive care unit? An evaluation of consensus recommendations in a cardiothoracic setting

Rationale

Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.

Effect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery

Objective

The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery.

Predicting hospital mortality and length of stay: A prospective cohort study comparing the Intensive Care Delirium Screening Checklist versus Confusion Assessment Method for the Intensive Care Unit

ObjectiveThe objective of this study was to compare two tools, the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the intensive care unit (ICU) (CAM-ICU), for their predictive validity for outcomes related to delirium, hospital mortality, and length of stay (LOS).MethodsThe prospective study conducted in six medical ICUs at a tertiary care hospital in Taiwan enrolled consecutive patients (≥20 years) without delirium at ICU admission. Delirium was screened daily using the ICDSC and CAM-ICU in random order. Arousal was assessed by the Richmond Agitation–Sedation Scale (RASS). Participants with any one positive result were classified as ICDSC- or CAM-ICU-delirium groups.ResultsDelirium incidence evaluated by the ICDSC and CAM-ICU were 69.1% (67/97) and 50.5% (49/97), respectively. Although the ICDSC identified 18 more cases as delirious, substantial concordance (κ = 0.63; p < 0.001) was found between tools. Independent of age, Acute Physiology and Chronic Health Evaluation II score, and Charlson Comorbidity Index, both ICDSC- and CAM-ICU-rated delirium significantly predicted hospital mortality (adjusted odds ratio: 4.93; 95% confidence interval [CI]:1.56 to 15.63 vs. 2.79; 95% CI: 1.12 to 6.97, respectively), and only the ICDSC significantly predicted hospital LOS with a mean of 17.59 additional days compared with the no-delirium group. Irrespective of delirium status, a sensitivity analysis of normal-to-increased arousal (RASS≥0) test results did not alter the predictive ability of ICDSC- or CAM-ICU-delirium for hospital mortality (adjusted odds ratio: 2.97; 95% CI: 1.06 to 8.37 vs. 3.82; 95% CI: 1.35 to 10.82, respectively). With reduced arousal (RASS<0), neither tool significantly predicted mortality or LOS.ConclusionsThe ICDSC identified more delirium cases and may have higher predictive validity for mortality and LOS than the CAM-ICU. However, arousal substantially affected performance. Future studies may want to consider patients’ arousal when deciding which tool to use to maximise the effects of delirium identification on patient mortality.     

Brain renin-angiotensin--a new look at an old system

The classic renin-angiotensin system (RAS) is described as a circulating hormone system focused on cardiovascular and body water regulation, with angiotensin II as its major effector. Detlef Ganten's discovery some years ago of an independent local brain RAS composed of the necessary functional components (angiotensinogen, peptidases, angiotensins and specific receptor proteins) significantly expanded the possible physiological and pharmacological functions of this system. This review first describes the enzymatic pathways resulting in active angiotensin ligands and their interaction with AT(1), AT(2) and AT(4) receptor proteins. We discuss the characterization and distribution of the AT(1) and AT(2) receptor subtypes and the current controversy over the identity of the AT(4) receptor subtype. Research findings favoring the candidates insulin-regulated aminopeptidase (IRAP) and the type 1 tyrosine kinase receptor c-Met, are presented. Next, we summarize current research efforts directed at the use of angiotensin analogues in the treatment of clinical disorders such as memory dysfunction, cerebral blood flow and cerebroprotection, stress, depression, alcohol consumption, seizure, Alzheimer's and Parkinson's diseases, and diabetes. The use of ACE inhibitors, and AT(1) and/or AT(2) receptor blockers, has shown promise in the treatment of several of these pathologies. The development of blood-brain barrier penetrant AT(4) receptor agonists and antagonists is of major importance regarding the continuing evaluation of the efficacy of new treatment approaches.