• 【老年恶性胶质瘤患者短程放疗的前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.1023/a:1005750111883 复制DOI
    作者列表:Hoegler DB,Davey P
    BACKGROUND & AIMS: Elderly patients with malignant glioma have a poor prognosis and the benefit of standard radical radiotherapy is equivocal. Twenty-two percent of the adult referral base with malignant glioma at our centre is of age 70 years or greater. A phase II study was undertaken to determine if a shorter course of therapy yields a comparable median survival to radical radiotherapy and thus constitutes an appropriate investigational palliative regimen. 25 patients were accrued between 1988-1995, all of whom had histologically proven malignant glioma, 23 glioblastoma multiforme and 2 anaplastic astrocytoma. The median age was 73 (range 70-78) and median Karnofsky Performance Status (KPS) was 70.40% had a stereotactic biopsy only for diagnosis. Radiotherapy was delivered to limited fields to a dose of 37.5 Gy in 15 daily fractions over 3 weeks. An intention-to-treat analysis was undertaken with survival determined from date of initial consultation. The median survival of the whole group was 8.0 months (95% CI 4.8-9.6). Patients with good performance status (KPS > 70) had a median survival of 10.4 months (95% CI 9.6-14.7). 37.5 Gy in 15 daily fractions appears to yield comparable median survival to that of other series of radical radiotherapy. A phase III study of this regimen is recommended in investigating optimal palliation of elderly malignant glioma patients.

    背景与目标: 老年恶性神经胶质瘤患者的预后较差,标准的根治性放疗的益处是模棱两可的。在我们中心,患有恶性神经胶质瘤的成人转诊基地中有22% 的年龄在70岁或以上。进行了一项II期研究,以确定较短的疗程是否可以产生与根治性放疗相当的中位生存期,从而构成适当的研究性姑息治疗方案。在1988-1995之间累积了25例患者,所有这些患者均经组织学证实为恶性神经胶质瘤,23例多形性胶质母细胞瘤和2例间变性星形细胞瘤。中位年龄为73岁 (范围70-78),中位Karnofsky表现状态 (KPS) 70.40% 仅用于诊断的立体定向活检。在3周内,将放射疗法递送到有限的区域,剂量为37.5 Gy,每天15次。进行了意向性治疗分析,从初次咨询之日起确定生存率。全组的中位生存期为8.0个月 (95% CI 4.8-9.6)。表现良好的患者 (KPS > 70) 的中位生存期为10.4个月 (95% CI 9.6-14.7)。在15个每日分数中37.5 Gy似乎产生与其他系列的根治性放疗相当的中位生存期。建议对该方案进行III期研究,以研究老年恶性神经胶质瘤患者的最佳姑息治疗。
  • 【停药后跌倒风险增加药物的风险: 一项前瞻性队列研究。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2125.2006.02736.x 复制DOI
    作者列表:van der Velde N,Stricker BH,Pols HA,van der Cammen TJ
    BACKGROUND & AIMS: AIMS:Falling in older persons is a frequent and serious clinical problem. Several drugs have been associated with increased fall risk. The objective of this study was to identify differences in the incidence of falls after withdrawal (discontinuation or dose reduction) of fall-risk-increasing drugs as a single intervention in older fallers. METHODS:In a prospective cohort study of geriatric outpatients, we included 139 patients presenting with one or more falls during the previous year. Fall-risk-increasing drugs were withdrawn, if possible. The incidence of falls was assessed within 2 months of follow-up after a set 1 month period of drug withdrawal. Multivariate adjustment for potential confounders was performed with a Cox proportional hazards model. RESULTS:In 67 patients, we were able to discontinue a fall-risk-increasing drug, and in eight patients to reduce its dose. The total number of fall incidents during follow-up was significantly lower in these 75 patients, than in those who continued treatment (mean number of falls: 0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during follow-up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug withdrawal, 0.35 (95% CI 0.15, 0.82) for cardiovascular drug withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug withdrawal, after adjustment for age, gender, use of fall-risk-increasing drugs, baseline falls frequency, comorbidity, Mini-Mental State Examination score, and reason for referral. CONCLUSIONS:Withdrawal of fall-risk-increasing drugs appears to be effective as a single intervention for falls prevention in a geriatric outpatient setting. The effect was greatest for withdrawal of cardiovascular drugs.
    背景与目标:
  • 【GABA在胎儿,产后和成人视网膜中的表达: 一项免疫组织化学研究。】 复制标题 收藏 收藏
    DOI:10.1017/s0952523800012104 复制DOI
    作者列表:Nag TC,Wadhwa S
    BACKGROUND & AIMS: The expression of GABA in the human fetal (12-25 weeks of gestation), postnatal (five-month-old), and adult (35-year-old) retinas was investigated by immunohistochemistry. GABA expression was seen as early as 12 weeks in the undifferentiated cells of the inner neuroblast zone; a few optic nerve fiber layer axons were clearly labeled, suggesting that some of the stained cell bodies were prospective ganglion cells, others could be displaced amacrine cells. From 16-17 to 24-25 weeks, intense labeling was found in the amacrine, displaced amacrine, and some ganglion cells. During this time period, horizontal cells (identified by calbindin immunohistochemistry), undergoing migration (periphery) and differentiation (center), expressed GABA prominently. In the postnatal retina, some horizontal cells were moderately labeled, but very weakly in a few cells, in the adult. The Müller cells developed immunoreactivity first weakly at 12 weeks and then moderately from 16-17 weeks onward. The staining was also evident in the postnatal and adult retinas, showing labeled processes of these glial cells. Virtually no axons in the adult optic nerve and nerve fiber layer were stained; the staining was restricted to a few, large ganglion cells and displaced amacrine cellsSome amacrines were also labeled. The possibility that GABA might play a role in horizontal cell differentiation and maturation is highlighted. Other evidences suggest that GABA might play a role in metabolism during retinal development.

    背景与目标: 通过免疫组织化学研究了GABA在人类胎儿 (妊娠12-25周),产后 (5个月大) 和成人 (35岁) 视网膜中的表达。早在12周内在神经母细胞区的未分化细胞中就看到了GABA的表达; 清晰地标记了一些视神经纤维层轴突,这表明一些染色的细胞体是潜在的神经节细胞,另一些可能是置换的无长突细胞。从16-17到24-25周,在无长突,移位的无长突和一些神经节细胞中发现了强烈的标记。在此期间,水平细胞 (通过钙结合蛋白免疫组织化学鉴定) 经历了迁移 (外围) 和分化 (中心),显着表达GABA。在成年后的视网膜中,一些水平细胞被适度标记,但在少数细胞中却非常弱。M ü ller细胞首先在12周时出现免疫反应性,然后从16-17周开始适度发展。在产后和成年视网膜中,染色也很明显,显示了这些神经胶质细胞的标记过程。成人视神经和神经纤维层中几乎没有轴突被染色; 染色仅限于少数大神经节细胞和移位的无长突细胞,还标记了一些无长突。强调了GABA可能在水平细胞分化和成熟中起作用的可能性。其他证据表明,GABA可能在视网膜发育过程中发挥代谢作用。
  • 【表面上健康的男性和女性的组织因子血清水平和未来冠状动脉疾病的风险: EPIC-Norfolk前瞻性人群研究。】 复制标题 收藏 收藏
    DOI:10.1111/j.1538-7836.2006.02190.x 复制DOI
    作者列表:Keller TT,Choi D,Nagel C,Te Velthuis H,Gerdes VE,Wareham NJ,Bingham SA,Luben R,Hack CE,Reitsma PH,Levi M,Khaw KT,Boekholdt SM
    BACKGROUND & AIMS: INTRODUCTION:Tissue factor (TF) has been implicated in coronary artery disease (CAD). High levels of circulating TF are found in patients with acute atherothrombotic events. Whether high serum TF levels predict risk of future CAD independent of known risk factors remains unknown. METHODS:We conducted a prospective case-control study nested in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population study. Cases (n=1037) were apparently healthy men and women, aged 45-79 years, who developed fatal or non-fatal CAD during follow-up. Controls (n=2005) were matched by age, sex, and enrolment time. Serum TF levels were measured using high-affinity antibodies. RESULTS:In men, median TF levels were not significant higher in cases than in controls (59.0 pg mL-1, range: 16.7-370.4 vs. 54.9 pg mL-1, range: 16.2-452.4). In women, median TF levels were not significant higher in controls than in cases (73.4 pg mL-1, range: 16.7-492.3 vs. 50.5 pg mL-1, range: 16.5-376.7). The incidence of smoking was about double in the lowest compared with the highest TF quartile. Correcting for sex, age, body mass index, smoking, diabetes, systolic blood pressure, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and C-reactive protein levels, the risk of future CAD was 1.05 (95% CI: 0.81-1.36) for people in the highest TF quartile, compared with those in the lowest (P-value for linearity=0.8). CONCLUSION:High levels of serum TF were not independently associated with an increased risk of future CAD in apparently healthy individuals.
    背景与目标:
  • 【神经性贪食症的危险因素。基于社区的病例对照研究。】 复制标题 收藏 收藏
    DOI:10.1001/archpsyc.1997.01830180015003 复制DOI
    作者列表:Fairburn CG,Welch SL,Doll HA,Davies BA,O'Connor ME
    BACKGROUND & AIMS: BACKGROUND:Many apparently disparate risk factors have been implicated as causes of eating disorders. This study was designed to test the hypothesis that 2 broad classes of risk factors exist for bulimia nervosa: those that increase the risk for development of a psychiatric disorder in general and those that increase the risk of dieting. It was predicted that the latter are especially common among persons with bulimia nervosa.

    METHODS:A case-control design was used involving 2 integrated comparisons. First, 102 subjects with bulimia nervosa were compared with 204 healthy control subjects without an eating disorder. Second, the same 102 subjects with bulimia nervosa were compared with 102 subjects with other psychiatric disorders. To reduce sampling bias, the subjects were recruited directly from the community. A broad range of putative risk factors was assessed.

    RESULTS:The subjects with bulimia nervosa and the healthy control subjects differed in their rates of exposure to most of the putative risk factors. Far fewer differences were evident between the subjects with bulimia nervosa and the control subjects with other psychiatric disorders, although exposure to factors that were likely to increase the risk of dieting and to negative self-evaluation and certain parental problems (including alcohol use disorder) were substantially more common among those with bulimia nervosa.

    CONCLUSIONS:The findings support the hypothesis that bulimia nervosa is the result of exposure to general risk factors for psychiatric disorder and risk factors for dieting. An unexpected finding was the particularly high rates of premorbid negative self-evaluation and certain parental problems among those with bulimia nervosa.

    背景与目标: 背景 : 许多明显不同的危险因素被认为是饮食失调的原因。这项研究旨在检验以下假设: 神经性贪食症存在两大类危险因素: 通常增加精神疾病发展风险的因素和增加节食风险的因素。据预测,后者在神经性贪食症患者中尤其常见。
    方法 : 使用了涉及2个综合比较的病例对照设计。首先,将102名患有神经性贪食症的受试者与204名没有进食障碍的健康对照受试者进行比较。其次,将患有暴食症的相同102受试者与患有其他精神疾病的102受试者进行比较。为了减少抽样偏差,直接从社区招募了受试者。评估了广泛的推定危险因素。
    结果 : 患有神经性贪食症的受试者和健康对照受试者在暴露于大多数推定危险因素的比率上有所不同。神经性贪食症的受试者与其他精神疾病的对照受试者之间的差异要少得多,尽管暴露于可能增加节食风险的因素以及负面的自我评估和某些父母问题 (包括酒精使用障碍) 在神经性贪食症患者中更为普遍。
    结论 : 研究结果支持以下假设: 神经性贪食症是暴露于精神疾病的一般危险因素和节食的危险因素的结果。一个意想不到的发现是,在神经性贪食症患者中,病前负面自我评估和某些父母问题的发生率特别高。
  • 【土耳其绝经后骨质疏松症妇女中骨化三醇与依替膦酸盐-骨化三醇和降钙素-骨化三醇联合治疗的比较: 一项前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.1007/s002239900291 复制DOI
    作者列表:Gürlek A,Bayraktar M,Gedik O
    BACKGROUND & AIMS: Calcitriol has been widely used in the management of osteoporosis, but its efficiency is a matter of controversy. It is not known whether combinations of calcitriol and antiresorptive agents such as etidronate and calcitonin are superior to calcitriol alone in the treatment of postmenopausal osteoporosis. To make this determination, 30 Turkish women with postmenopausal osteoporosis between 45 and 68 years of age were randomized to receive either intermittent cyclical etidronate (400 mg/day, for 14 days) followed by 60 days of cyclical calcitriol therapy 0.25 microg twice daily (group 1; n = 10), or calcitriol 0.25 microg twice daily (group 2; n = 10), or calcitriol 0.25 microg/day in combination with 100 IU intranasal salmon calcitonin taken every other day (group 3; n = 10) through a 1-year period. Bone mineral density (BMD) of lumbar spine (L2 to L4) was determined for each patient by dual-photon absorptiometry (153Gd) at baseline, after 6 months, and at the end of the study. There was no significant difference among groups with respect to mean spinal BMD at baseline, after 6, and after 12 months. No significant spinal BMD changes occurred in any group from baseline, after 6 months, and after 12 months. Four patients in groups 1 and 2 and five patients in group 3 developed hypercalcemia at least once during therapy. Hypercalciuria occurred at least once in 9, 10, and 7 patients in groups 1, 2, and 3, respectively. One patient in group 2 developed a renal stone at the end of the study. Mean urine hydroxyproline levels did not change significantly in any group with respect to baseline. The data suggest that one-year treatment with calcitriol, given either alone or in combination with antiresorptive agents, does not improve spinal BMD in Turkish women with postmenopausal osteoporosis, and is associated with a high rate of adverse events.

    背景与目标: 骨化三醇已广泛用于骨质疏松症的治疗,但其效率仍存在争议。尚不清楚骨化三醇和抗吸收剂 (如依替膦酸盐和降钙素) 的组合在绝经后骨质疏松症的治疗中是否优于单独的骨化三醇。为了做出这一决定,30名年龄在45至68岁之间的绝经后骨质疏松症土耳其妇女被随机分配接受间歇性周期性依替膦酸盐 (400毫克/天,持续14天),然后接受60天的周期性骨化三醇治疗,0.25每天两次 (组1; n = 10),或骨化三醇0.25 microg每天两次 (组2; n = 10),或骨化三醇0.25 microg/天与100 IU鼻内鲑鱼降钙素组合,每隔一天服用 (组3; n = 10),持续1年。在基线,6个月后和研究结束时,通过双光子吸收法 (153Gd) 测定每位患者的腰椎 (L2至L4) 的骨矿物质密度 (BMD)。在基线,6个月后和12个月后,各组之间的平均脊柱BMD没有显着差异。从基线,6个月后和12个月后,任何组均未发生明显的脊柱BMD变化。第1组和第2组中的4名患者和第3组中的5名患者在治疗期间至少出现一次高钙血症。高钙尿症分别在第1、2和3组的9、10和7名患者中至少发生一次。第2组中的一名患者在研究结束时出现了肾结石。任何组的平均尿羟脯氨酸水平相对于基线没有明显变化。数据表明,单独或与抗吸收剂联合使用骨化三醇治疗一年不会改善土耳其绝经后骨质疏松症妇女的脊柱BMD,并且与不良事件的发生率很高有关。
  • 【美国黑人和尼日利亚儿童的恶性肿瘤: 一项比较研究。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Olisa EG,Chandra R,Jackson MA,Kennedy J,Williams AO
    BACKGROUND & AIMS: :Results of a study on the relative frequencies of tumors in American black and Nigerian children were compared with data from the Childhood Cancer Registries in Manchester, United Kingdom, and Kampala, Uganda. The American black child living in Washington, D.C. and the Caucasian child living in Manchester had similar high frequencies for leukemia and glioma, whereas the incidence of lymphoma and retinoblastoma was low. African children living in Nigeria or Uganda had the opposite frequency patterns. These differences in frequencies of tumors between two ethnologically related population groups, American black and Nigerian, suggested the influence of environmental factors in the etiology of these tumors, even though exposure to environmental carcinogens was short. The rarity of Ewing's sarcoma and testicular tumors in American black and Nigerian children suggested a genetic influence.
    背景与目标: : 将美国黑人和尼日利亚儿童肿瘤相对频率的研究结果与英国曼彻斯特和乌干达坎帕拉的儿童癌症登记处的数据进行了比较。居住在华盛顿特区的美国黑人儿童和居住在曼彻斯特的高加索儿童患白血病和神经胶质瘤的频率相似,而淋巴瘤和视网膜母细胞瘤的发生率较低。生活在尼日利亚或乌干达的非洲儿童的频率模式相反。尽管暴露于环境致癌物的时间很短,但两个与种族相关的人群 (美国黑人和尼日利亚人) 之间的肿瘤频率差异表明环境因素对这些肿瘤的病因的影响。美国黑人和尼日利亚儿童尤因肉瘤和睾丸肿瘤的稀有性表明了遗传影响。
  • 【脊髓小脑共济失调3型和6型脊髓灰质和白质减少的解离: 基于体素的形态计量学研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.neulet.2006.09.007 复制DOI
    作者列表:Lukas C,Schöls L,Bellenberg B,Rüb U,Przuntek H,Schmid G,Köster O,Suchan B
    BACKGROUND & AIMS: :The aim of this study was to examine the different patterns of cerebellar and/or brainstem atrophy in spinocerebellar ataxia (SCA) type 3 and 6. Eighteen patients (SCA3 n=9, SCA6 n=9) and 15 healthy volunteers were studied. Voxel-based morphometry (VBM) was applied to segmented grey matter (GM) and white matter (WM) of high-resolution T1-weighted brain volumes of each group. We found reduction of grey matter in the pons as well as in the vermis in SCA3 as compared to control subjects. In SCA6 significant grey matter loss was found in hemispheric lobules bilaterally as well as in the vermis. White matter analysis revealed significant changes in SCA3, especially in the pons, in the white matter surrounding the dentate nucleus (DN) and in the cerebellar peduncles, whereas no significant white matter reduction was found in SCA6 patients. Our results demonstrate different patterns of grey and white matter affection detected by magnetic resonance imaging (MRI) in SCA3 and SCA6 patients, confirming the pathological concept of cortical cerebellar atrophy in SCA6. In contrast, SCA3 represents a form of ponto-cerebellar atrophy with predominant affection of pontine nuclei and fibre tracts.
    背景与目标: : 这项研究的目的是检查3型和6型脊髓小脑共济失调 (SCA) 的小脑和/或脑干萎缩的不同模式。研究了18名患者 (SCA3 n = 9,SCA6 n = 9) 和15名健康志愿者。将基于体素的形态计量学 (VBM) 应用于每组高分辨率T1-weighted脑体积的分段灰质 (GM) 和白质 (WM)。与对照组相比,我们发现SCA3中的脑桥和ver中的灰质减少。在SCA6中,双侧半球小叶以及ver骨中都发现了明显的灰质损失。白质分析显示SCA3发生了显着变化,尤其是在脑桥,齿状核 (DN) 周围的白质和小脑梗中,而在SCA6患者中未发现明显的白质减少。我们的结果表明,通过磁共振成像 (MRI) 在SCA3和SCA6患者中检测到的灰质和白质的不同模式,证实了SCA6中皮质小脑萎缩的病理概念。相反,SCA3代表一种桥小脑萎缩的形式,主要影响桥脑核和纤维束。
  • 【医护人员对患者痛苦的看法有多准确?一项试点研究。】 复制标题 收藏 收藏
    DOI:10.7205/milmed.171.8.774 复制DOI
    作者列表:Lesho EP,Udvari-Nagy S,László R,Saullo L,Rink T
    BACKGROUND & AIMS: :Health care workers' perceptions of patient suffering have not been well studied. Patients and health care workers were invited to answer a single, open-ended question. To develop a survey tool that could be validated and used for future research, what health care workers thought causes or caused the most suffering for patients was compared with what patients actually identified as the cause of their worst suffering. Health care workers underestimated loss and significantly underestimated physical nonpainful symptoms as causes of maximal suffering. Communication, emotional, and systems issues were often overestimated by health care workers. Health care workers may not accurately perceive what causes the worst suffering for patients. More studies are needed.
    背景与目标: : 医护人员对病人痛苦的看法没有得到很好的研究。邀请患者和医护人员回答一个开放式的问题。为了开发一种可以验证并用于未来研究的调查工具,将医护人员认为导致或导致患者最痛苦的原因与患者实际确定的最痛苦原因进行了比较。医护人员低估了损失,并大大低估了身体上的无痛苦症状,这是造成最大痛苦的原因。医护人员经常高估沟通,情感和系统问题。医护人员可能无法准确理解是什么导致了患者最严重的痛苦。需要更多的研究。
  • 【CO中毒后基底神经节体积: 一项前瞻性纵向研究。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Pulsipher DT,Hopkins RO,Weaver LK
    BACKGROUND & AIMS: :Carbon monoxide (CO) poisoning may result in focal and diffuse neuropathological changes, including basal ganglia lesions. The effect of CO poisoning on basal ganglia volumes over time is unclear. We assessed basal ganglia volumes longitudinally following CO poisoning. We prospectively enrolled 73 CO poisoned patients who underwent brain MR imaging on day 1 (baseline), 2 weeks, and 6 months post-CO poisoning. Basal ganglia volumes were obtained. One patient had bilateral globus pallidus lesions at two weeks and 6 months. Of the CO-poisoned patients 28% had volume reduction in at least one basal ganglia structure by 6 months, of which 21% had putamen, 15% had caudate, 15% had globus pallidus, and 16% had total basal ganglia volume reduction. Putamen volumes were significantly smaller from baseline to six months (p = 0.02). Verbal memory and mental processing speed correlated with smaller putamen and globus pallidus volumes. Carbon monoxide poisoning results in basal ganglia volume reduction 6 months post CO poisoning. Slow mental processing speed and impaired memory correlated with smaller putamen and globus pallidus volumes. Clinicians need to be aware of basal ganglia neuropathologic changes in the absence of observable lesions following CO poisoning.
    背景与目标: 一氧化碳 (CO) 中毒可能导致局灶性和弥漫性神经病理变化,包括基底节病变。CO中毒对基底神经节体积随时间的影响尚不清楚。我们在CO中毒后纵向评估了基底神经节的体积。我们前瞻性地招募了73名CO中毒患者,他们在CO中毒后第1天 (基线),2周和6个月接受了脑MR成像。获得基底神经节体积。一名患者在两周和6个月时出现双侧苍白球病变。在共中毒的患者中,28% 在6个月前至少有一个基底神经节结构的体积减少,其中21% 有壳核,15% 有尾状核,15% 有苍白球,16% 有总基底神经节体积减少。从基线到6个月,壳核体积明显较小 (p = 0.02)。言语记忆和心理处理速度与较小的壳核和苍白球体积相关。一氧化碳中毒导致CO中毒后6个月基底神经节体积减少。缓慢的心理处理速度和记忆受损与较小的壳核和苍白球体积有关。在CO中毒后没有可观察到的病变的情况下,临床医生需要意识到基底神经节的神经病理学变化。
  • 【特发性血小板减少性紫癜: 克罗地亚里耶卡儿童医院的15年自然史研究。】 复制标题 收藏 收藏
    DOI:10.1002/pbc.20995 复制DOI
    作者列表:Roganovic J,Letica-Crepulja M
    BACKGROUND & AIMS: :We review a 15-year experience with childhood idiopathic thrombocytopenic purpura (ITP) at a tertiary-care pediatric hospital in Croatia. Data confirm that ITP is typically a self-limited bleeding disorder that usually presents with mild symptoms in children between 1 and 10 years of age and affects both sexes equally. At presentation, more than half of the children had platelet counts of <10x10(9)/L. The absence of preceding viral infection and insidious onset of symptoms were significantly associated with development of chronic ITP. In our experience, observation without specific therapy seems to be the optimal approach to a child with ITP.
    背景与目标: : 我们回顾了克罗地亚一家三级儿科医院对儿童特发性血小板减少性紫癜 (ITP) 的15年经验。数据证实,ITP通常是一种自限性出血性疾病,通常在1至10岁的儿童中表现为轻度症状,并且对男女影响均等。在演讲中,超过一半的儿童的血小板计数 <10x10(9)/L。先前没有病毒感染和症状的隐匿性发作与慢性ITP的发展显着相关。根据我们的经验,没有特定疗法的观察似乎是治疗ITP儿童的最佳方法。
  • 【升主动脉的外科病理: 513例临床病理研究。】 复制标题 收藏 收藏
    DOI:10.1097/01.pas.0000213270.38091.69 复制DOI
    作者列表:Homme JL,Aubry MC,Edwards WD,Bagniewski SM,Shane Pankratz V,Kral CA,Tazelaar HD
    BACKGROUND & AIMS: :Only 2 comprehensive surgical series, published in 1977 and 1983, have evaluated clinicopathologic features of the ascending aorta. Retrospective review of medical records and microscopic slides was performed on 513 consecutive patients with surgical resection of ascending aortic tissue (1985 to 1999). Patients were 2 to 89 years old (mean 59 y), and 303 (59%) were men. Aneurysm or dissection was the indication for surgery in 479. Aortic valves were also excised in 360. Systemic hypertension was present in 279, inherited connective tissue disease (ICTD) in 67, arteritis in 33, and acquired connective tissue disease in 16. Microscopy showed cystic medial degeneration (CMD) in 209, aortic dissection (AD) in 109 (with CMD in 56), normal media in 90, aortitis in 57 (with CMD in 14), and other findings in 48. The most significant, independent risk factor of CMD and AD was ICTD (confidence interval=7.61 and 2.26, respectively). Systemic hypertension was more common in patients with AD than without (P=0.0202). Normal media was the most common histologic finding associated with bicuspid aortic valve (P<0.0001). Among 57 patients with aortitis (giant cell in 39), ages ranged from 16 to 85 years (mean 64 y), and 42 (74%) were women; only 8 had Takayasu arteritis, and 11 had temporal or systemic arteritis. In surgically resected ascending aorta, the 3 most common histologic findings were CMD, AD, and normal media. ICTD, systemic hypertension, and bicuspid aortic valve were common comorbid findings. Giant cell aortitis occured predominantly in women, usually without systemic disease.
    背景与目标: : 只有2个全面的外科系列,发表于1977年和1983,评估了升主动脉的临床病理特征。对连续513例手术切除升主动脉组织的患者 (1985例1999年) 进行了病历和显微镜切片的回顾性回顾。患者为2至89岁 (平均59岁),303 (59%) 为男性。动脉瘤或夹层是479手术的指征。主动脉瓣也在360中切除。279存在全身性高血压,遗传性结缔组织病 (ICTD) 67例,动脉炎33例,获得性结缔组织病16例。显微镜检查显示209的囊性内侧变性 (CMD),109的主动脉夹层 (AD) (CMD为56),正常介质为90,主动脉炎为57 (CMD为14),其他发现为48。CMD和AD最重要的独立危险因素是ICTD (置信区间分别为7.61和2.26)。全身性高血压在AD患者中比没有AD患者更常见 (P = 0.0202)。正常介质是与二叶主动脉瓣相关的最常见组织学发现 (P<0.0001)。在57例主动脉炎患者 (巨细胞39例) 中,年龄从16岁到85岁 (平均64岁),女性42例 (74% 例); 只有8例患有大动脉炎,11例患有颞动脉炎或全身性动脉炎。在手术切除的升主动脉中,最常见的3种组织学发现是CMD,AD和正常介质。ICTD,全身性高血压和二叶主动脉瓣是常见的合并症。巨细胞主动脉炎主要发生在女性,通常没有全身性疾病。
  • 【一项通用实践研究,旨在比较喷雾剂 (“otomize”) 与标准滴剂制剂 (“sofradex”) 治疗外耳道炎患者的疗效和耐受性。】 复制标题 收藏 收藏
    DOI:10.1185/03007999009111486 复制DOI
    作者列表:Smith RB,Moodie J
    BACKGROUND & AIMS: :In an open, multi-centre study in general practice, a comparison was made of the efficacy, tolerability and acceptability of a neomycin/dexamethasone preparation administered by metered-dose spray ('Otomize') and a framycetin/gramicidin/dexamethasone preparation ('Sofradex') administered as drops in 60 patients with otitis externa. Patients were allocated at random to receive one or other preparations 3-times daily for 10 days and were followed-up again 14 days after cessation of therapy. Clinical assessments were carried out under observer blind conditions on entry (Day 0) and on Days 10 and 24 of the severity of erythema, swelling and debris in the affected ear(s). A global assessment of clinical outcome was made by the doctor on Day 10. There were no significant differences in the two groups at the start of treatment. Significant improvement occurred in both groups from Day 0 to Day 10 and from Day 10 to Day 24 in all symptoms, with the proportion symptom-free in the 'Otomize' group significantly greater than in the 'Sofradex' group at 24 days, and approaching significance at 10 days. Significantly more patients in the 'Otomize' group were rated as having a good clinical outcome by the physician, and fewer patients experienced discomfort on application. Few side-effects were reported by either treatment group, none necessitating discontinuation of therapy.
    背景与目标: : 在一项常规的开放,多中心研究中,比较了通过定量喷雾 ('Otomize') 和framycetin/gramicidin/地塞米松制剂的疗效,耐受性和可接受性。地塞米松制剂 ('Sofradex') 以滴剂形式在60例外耳道炎患者中使用。患者被随机分配接受一种或其他制剂,每天3次,持续10天,并在停止治疗后14天再次随访。在进入 (第0天) 以及受影响的耳朵中红斑,肿胀和碎屑的严重程度的第10天和第24天,在观察者盲条件下进行临床评估。医生在第10天对临床结果进行了全面评估。治疗开始时两组无显著差异。在所有症状中,从第0天到第10天和从第10天到第24天,两组均发生了显着改善,“otomize” 组无症状的比例在24天显着高于 “sofradex” 组,并在10天接近显着性。医生将 “otomize” 组中的更多患者评为具有良好的临床结果,并且更少的患者在应用中出现不适。任何治疗组都很少报告副作用,没有必要停止治疗。
  • 【口腔护理对老年患者手术恢复影响的初步研究。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2842.2006.01634.x 复制DOI
    作者列表:Sato M,Yoshihara A,Miyazaki H
    BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.
    背景与目标: : 本研究旨在阐明消化道手术后口腔护理的有效性,包括刷牙,义齿清洁和舌头清洁。受试者包括30名60-98岁 (74.9 +/- 7.8岁) 接受消化道手术的老年患者。受试者随机分为干预组和对照组。在干预组中,从基线 (手术当天) 开始,在早晨的5分钟内每天提供以下口腔护理,并持续5天: 用聚维酮碘漱口,刷牙,使用特殊刷子清洁义齿和使用舌头刷子清洁舌头。在对照组中,受试者仅用聚维酮碘漱液。我们在基线和5天后比较了两组之间的以下变量: 口干感,口内气体浓度,肺音,体温和细菌菌群。肺音异常 (干或湿啰音) 的患者数量在干预组从1增加到2,在对照组从0增加到4 (P <0.05)。对照组每个受试者的平均细菌种类数术前为3.64 +/- 1.34,术后为3.50 +/- 1.74,而干预组的平均细菌种类数术前为3.08 +/- 0.95,术后为2.62 +/- 0.65。干预组细菌种类显著减少 (P <0.05)。这些发现表明,接受消化道手术的老年患者的术后口腔护理降低了口腔中发现的细菌种类的数量。反过来,这种作用可能会改善呼吸功能。
  • 【持续静脉和皮下吗啡治疗慢性癌症疼痛的前瞻性,患者内交叉研究。】 复制标题 收藏 收藏
    DOI:10.1016/s0885-3924(96)00329-6 复制DOI
    作者列表:Nelson KA,Glare PA,Walsh D,Groh ES
    BACKGROUND & AIMS: The dose, efficacy, and side effects of continuous intravenous infusion (CIVI) of morphine were compared with continuous subcutaneous infusion (CSCI) of morphine in patients with chronic cancer pain. Eligible patients were referred to the Palliative Care Program and were receiving a stable dose of CIVI of morphine. The design was a within-patient, one-way crossover; in which each patient provided data before and after a switch from CIVI to CSCI of morphine. "Rescue" doses were 50% of the hourly dose given every 2 hours as needed. Morphine was infused intravenously (i.v.) and subcutaneously (s.c.) via a McGaw/AccuPro Volumetric Infusion Pump. After baseline data, including side effects and pain assessment, were obtained, patients were evaluated twice daily for toxicity and analgesic efficacy. Those who had a stable CIVI dose for 48 consecutive hr were crossed over to the CSCI at the same dose as the intravenous (i.v.) phase. A stable dose was defined as no dose change, four or less rescue doses in the previous 24 hr, and a pain rating of none or mild. CIVI was considered equal to CSCI if these criteria were maintained for 96 consecutive hr. Fifty-seven patients were entered, and 40 were evaluable (15 women and 25 men). The median age was 67 (range 30-83 years). All 40 participants, after maintaining a stable dose throughout the i.v. phase, crossed to the s.c. phase and remained on s.c. for at least 48 hr. Thirty-two patients maintained a stable dose throughout the i.v. and s.c. phases. The mean stable i.v. dose (day 2) was 5.05 mg/hr, and the mean stable s.c. dose (day 4) was 5.7 mg/hr (P = 0.01). The mean number of rescue doses on day 2 was 0.83 per 24 hr versus 0.80 per 24 hours on day 4 (P = 0.6). The mean categorical pain score on day 2 was 0.83, and on day 4, 0.85 (P = 0.7). The mean visual analogue scale (VAS) on day 2 was 22.9 mm versus 17.6 mm on day 4 (P = 0.1). The mean incidence of side effects on day 2 was 1.7, and on day 4, 2.0 (P = 0.2). No patient was withdrawn or had a dose reduction due to unacceptable toxicity. There were two reports of local toxicity (mild erythema) at the SC needle insertion point, which required a site change. All of our 40 patients had adequate pain control with CIVI and CSCI morphine. Of the eight participants who were not maintained on the same i.v. and s.c. dose, all had adequate pain control and a similar side-effect profile on a higher s.c. morphine dose. These data suggest that the i.v. and s.c. routes are equianalgesic for most patients when administered as a continuous infusion. Pain control and side-effect profiles are quite similar and acceptable. s.c. morphine is an excellent alternative to i.v. morphine in both inpatients and outpatients requiring parenteral morphine for pain.

    背景与目标: 比较了慢性癌痛患者持续静脉输注 (CIVI) 吗啡与持续皮下输注 (CSCI) 吗啡的剂量,疗效和副作用。符合条件的患者被转诊到姑息治疗计划,并正在接受稳定剂量的CIVI吗啡。该设计是患者内部的单向交叉; 其中每个患者在吗啡从CIVI切换到CSCI之前和之后提供数据。“抢救” 剂量是根据需要每2小时给予的每小时剂量的50%。通过McGaw/AccuPro容积输液泵静脉内 (i.v.) 和皮下 (s.c.) 注入吗啡。获得包括副作用和疼痛评估在内的基线数据后,每天两次评估患者的毒性和镇痛效果。那些连续48小时稳定的CIVI剂量的人以与静脉 (i.v.) 阶段相同的剂量交叉到CSCI。稳定剂量定义为无剂量变化,在之前的24小时内有四个或更少的抢救剂量,并且疼痛等级为无或轻度。如果连续96个小时保持这些标准,CIVI被认为等于CSCI。进入了57名患者,其中40名可评估 (15名女性和25名男性)。中位年龄为67岁 (范围30-83岁)。所有40名参与者在整个静脉内保持稳定剂量后。阶段,越过s.C.阶段并保留在s.c.至少48小时。32名患者在整个静脉内保持稳定剂量。和南卡罗来纳州阶段。平均稳定的静脉注射。剂量 (第2天) 为5.05 mg/hr,平均稳定s.c.剂量 (第4天) 为5.7 mg/hr (P = 0.01)。第2天的平均抢救剂量为每24小时0.83次,而第4天的平均抢救剂量为每24小时0.80次 (P = 0.6)。第2天和第4天的平均分类疼痛评分为0.83,0.85 (P = 0.7)。第2天的平均视觉模拟量表 (VAS) 为22.9毫米,第4天为17.6毫米 (P = 0.1)。第2天和第4天的平均副作用发生率为1.7,2.0 (P = 0.2)。没有患者因不可接受的毒性而退出或剂量减少。有两份关于SC针插入点局部毒性 (轻度红斑) 的报告,需要改变部位。我们的40名患者均使用CIVI和CSCI吗啡进行了足够的疼痛控制。在没有保持相同i.v.的八名参与者中。和南卡罗来纳州剂量,都有足够的疼痛控制,并且在较高的s.C.上有相似的副作用。吗啡剂量。这些数据表明,静脉注射和南卡罗来纳州当作为连续输注给药时,大多数患者的途径是等镇痛。疼痛控制和副作用特征非常相似且可以接受。吗啡是静脉注射的绝佳替代品需要胃肠外吗啡治疗疼痛的住院患者和门诊患者的吗啡。

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