Absence of respiratory effects with ivabradine in patients with asthma

AIM

β-Blockers are commonly prescribed for stable angina and are recommended as initial therapy. However, β-blockers are contraindicated in patients with obstructive airway disease because of a risk of bronchoconstriction. Ivabradine is a specific heart rate-lowering agent that acts via I_f pacemaker channels in the sinoatrial node with no β-adrenoreceptor activity. Ivabradine has been recently approved for the treatment of stable angina. This study assessed the effects of repeated administration of ivabradine on lung function in patients with asthma.

METHODS

In this double-blind, placebo-controlled, crossover study, 20 subjects with asthma received either oral ivabradine 10 mg b.i.d. or placebo for 4.5 days. Forced expiratory volume in 1 s (FEV₁) and peak expiratory flow rate (PEFR) were designated as the main outcome variable. Diary cards were used to monitor asthma symptoms on a five-point scale, rescue medication usage, and adverse events.

RESULTS

There were no significant differences in mean variation of FEV₁ (ivabradine P = 0.664; placebo P = 0.652) or PEFR (ivabradine P = 0.153; placebo P = 0.356) from baseline following administration of ivabradine. There was also no significant difference in maximum percent variation in FEV₁ or PEF between treatment groups (P = 0.994; FEV₁ and P = 0.704; PEF). On a similar note, there was no significant difference in asthma symptoms or rescue medication usage reported between the two groups. Adverse events were generally mild-to-moderate in intensity and no cardiovascular or serious adverse events were recorded.

CONCLUSIONS

This study confirms that ivabradine does not affect respiratory function or symptoms in patients with asthma and therefore represents a valuable therapeutic alternative to β-blockers for treating patients with stable angina and asthma.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Ivabradine is a new heart rate-lowering agent that acts specifically on the sinoatrial node via the I_f pacemaker channels.
• Ivabradine has demonstrated similar efficacy to β-blockers.
• As β-blockers are contraindicated in patients with obstructive airway disease, this study was conducted to assess the safety of ivabradine in patients with asthma.

WHAT THIS STUDY ADDS

• This study demonstrates that ivabradine has no effect on the pulmonary functions in patients with asthma and can be safely used a heart rate-lowering agent in patients with angina and coexistent airflow obstruction.

     

拉氧头孢联合罗红霉素治疗支气管扩张症继发肺部感染疗效观察

目的观察拉氧头孢联合罗红霉素治疗支气管扩张症继发肺部感染的疗效和不良反应。方法选取38例支气管扩张症继发肺部感染的患者,对比拉氧头孢联合罗红霉素治疗前后的临床情况、炎症指标、肺通气功能参数、细菌学评价,分析其疗效和观察不良反应。结果在全部38例病人中,痊愈18例,显效8例,进步6例,无效6例,总有效率84.2%（32/38）,细菌清除率为82.4%,没有发现严重不良反应。结论拉氧头孢联合罗红霉素可以作为支气管扩张症继发肺部感染的治疗方案之一。     

Improvement in quality of life with omalizumab in patients with severe allergic asthma

ABSTRACT

Background: Patients with severe persistent asthma experience daily symptoms and frequent serious exacerbations that contribute to a significant impairment of health-related quality of life (QoL).

Methods: A pooled analysis was completed of six controlled clinical trials that evaluated the effect of add-on omalizumab on asthma-related QoL in patients with severe persistent allergic (IgE-mediated) asthma. Asthma-related QoL was assessed at baseline and treatment endpoint using the well-validated Juniper Asthma Quality of Life Questionnaire (AQLQ). Change from baseline in AQLQ total score was compared between treatments using analysis of covariance methods. The percentage of patients who achieved a clinically meaningful (≥ 0.5-point) improvement in AQLQ total score was compared using the Mantel–Haenszel Chi-square test.

Results: The pooled patient population comprised 2548 patients (omalizumab, n = 1342; control, n = 1206), of whom 96% had severe persistent asthma according to the GINA 2002 classification. Omalizumab produced significantly greater improvements in AQLQ total score vs the control group (mean increases of 1.01 and 0.61 points, respectively; p < 0.001). In addition, significantly more omalizumab-treated patients achieved a clinically meaningful improvement in AQLQ total score than patients in the control group (66.3% vs 52.4%; p < 0.001).

Conclusions: Add-on therapy with omalizumab improves QoL to a significant and clinically meaningful level in patients with severe persistent allergic asthma.     

重症胰腺炎血小板计数的动态变化与预后的关系

目的探讨血小板计数变化对重症急性胰腺炎(SAP)并发腹膜后出血、多脏器功能衰竭及死亡率的的影响。方法将该院2009年10月～2011年8月收治的73例SAP患者,按血小板计数的动态变化,分成血小板降低组(100×109.L-1)和血小板正常组(≥100×109.L-1)。分析两组血小板计数动态变化对胰腺炎并发腹膜后出血、多脏器功能衰竭及死亡率的影响。结果血小板计数降低组47例,占64.4%;血小板计数正常组26例,占35.6%。两组在并发腹膜后出血、多脏器功能衰竭发生率及死亡率上均有统计学意义(P0.05)。结论血小板计数动态变化对提示重症胰腺炎的预后有一定的临床指导意义。     

氟比洛芬酯脂微球注射液用于子宫切除术后PCIA的临床研究(附120例分析)

目的比较观察氟比洛芬酯脂微球注射液用于子宫切除术后病人自控静脉镇痛(PCIA)的镇痛效果和安全性。方法选择在腰、硬膜外联合麻醉下行子宫切除术、术毕行PCIA的120例患者随机分成四组,每组30例。A组应用氟比洛芬酯脂微球注射液150 mg;B组氟比洛芬酯脂微球注射液150 mg 芬太尼0.4 mg;C组氯诺昔康40 mg;D组芬太尼20μg.kg-1。镇痛时间48 h。观察PCIA开始和开始后2、4、8、12、16、24、36、48h的镇痛效果、镇静程度、不良反应和术前、PCIA结束时的肝肾功能、凝血功能变化。结果镇痛效果A组与其他三组相似,B组镇痛质量明显提高。不良反应A组与C组相似,明显少于D组,B组不良反应相对小。术后肠功能恢复时间A组与C组相似,明显短于D组,B组未见明显延长。病人镇痛质量评价为B组>A组>C组>D组。结论氟比洛芬酯脂微球注射液用于子宫切除术后PCIA镇痛效果良好、副反应少、安全性高,若复合小剂量芬太尼可提高病人的镇痛效果和镇痛质量。     

原发胃癌恶性表型与患者自发淋巴细胞微核形成的关系

目的 探讨淋巴细胞微核形成与胃癌恶性度的关系.方法 术前取外周血采用体内微核实验方法检测130例胃癌患者(胃癌组)、13例良性胃肠病变(良性病变组)及59例正常人(对照组)淋巴细胞微核率(MNF).结果 胃癌组淋巴细胞MNF为(1.93±0.93)‰,明显高于良性病变组的(0.62士0.49)‰和对照组的(0.51±0.45)‰(P＜0.01);MNF随着胃癌组分化度降低及淋巴结转移率的增加而逐渐上升(P＜0.01).结论 淋巴细胞微核形成与胃癌恶性度密切相关,为胃癌患者的术前恶性度的判断和高危人群筛查提供了一个有用的生物学标志物.     

Facilitation of shuttle-box avoidance behaviour in mice treated with nifedipine in combination with amphetamine

The dihydropyridine calcium channel antagonist nifedipine, tested in mice of CD-1, C57BL/6 and DBA/2 strains, at doses of 2.5, 5 and 10 mg/kg IP, had no significant effect on shuttle-box avoidance acquisition. Nifedipine also failed to affect performance retention in CD-1 mice subjected to a one-trial passive avoidance task (step-through). While ineffective alone, nifedipine strongly enhanced the shuttle-box avoidance facilitating action of amphetamine (1 and 2 mg/kg IP) in low performing CD-1 mice. The results indicate that although calcium channel blockers do not affect learning in avoidance paradigms in normal animals, they can interfere with the effects of other centrally acting drugs. Calcium antagonists might interfere with neuronal changes induced by amphetamine, but at present it is difficult to explain the strong avoidance facilitation produced by combinations of nifedipine and amphetamine. A possibility that the action of nifedipine on cerebral circulation is involved in the amphetamine-nifedipine interaction cannot be excluded.     

Pharmacokinetics of Platinum in Cancer Patients Treated with Carboplatin in Combination with High-Dose Methotrexate

The pharmacokinetics of platinum was investigated in 10 cancer patients treated with a 1-hr infusion of 300 mg/m² of carboplatin which was given 2–4 days after the administration of 100 mg/kg (20-mg/kg bolus and 80-mg/kg intravenous infusion) of methotrexate. Platinum was analyzed in the samples by flameless atomic absorption spectrophotometry. The concentration vs time data for total platinum in plasma followed a two-compartment model and the mean (and SE) values for , TBC, V _c, and RC were 0.0827 (0.22) hr^–1, 2.355 (0.252) liters/hr · m², 10.74 (0.62) liters/m², and 2.405 (0.228) liters/hr · m², respectively. There was no significant change in the creatinine clearance or TBC with repeated treatment. The ultrafilterable platinum which was measured in the plasma of two patients constituted 82 and 11.3% of the total platinum at 1 and 24 hr, respectively, and the data conformed to the one-compartment model. The mean (SE) values for t , TBC, and V _d for free platinum were 1.844 (0.208) hr, 4.583 (1.059) liters/hr · m², and 11.88 (1.45) liters/m², respectively. The above data are in good agreement with those reported earlier for platinum following the administration of carboplatin as a single agent. These results suggest that high-dose methotrexate therapy, when administered 2–4 days before carboplatin, does not affect the pharmacokinetics of platinum in the plasma.     

老年慢性心力衰竭患者应用辛伐他汀、曲美他嗪联合治疗的疗效分析

目的 探讨辛伐他汀、曲美他嗪联合治疗老年慢性心力衰竭患者的临床效果.方法 收集我院2013年1月至2015年6月收治的老年慢性心力衰竭患者80例,随机分为对照组和实验组.对照组临床常规治疗,实验组在以上基础上加服辛伐他汀与曲美他嗪,比较两组超声心动图、生化指标变化与心功能分级情况.结果 两组治疗后左室射血分数、左室收缩末期内径、左室舒张末期内径、血胆固醇、低密度脂蛋白胆与高敏C-反应蛋白水平分别与治疗前组内比较,差异有统计学意义(P＜0.01);两组治疗后左室射血分数、左室收缩末期内径、左室舒张末期内径、血胆固醇、低密度脂蛋白胆与高敏C-反应蛋白水平组间比较,差异有统计学意义(P＜0.01);实验组治疗后心功能分级情况显著优于对照组,差异有统计学意义(P＜0.01).结论 辛伐他汀、曲美他嗪联合治疗老年慢性心力衰竭患者临床效果显著,具有借鉴性.     

西咪替丁联合阿昔洛韦治疗小儿水痘的临床分析

目的 探讨西咪替丁联合阿昔洛韦治疗小儿水痘的临床疗效。方法 选取80例水痘患儿,随机数字表法分为两组,对照组患儿（40例）静脉滴注阿昔洛韦注射液15 mg/（kg·d）,观察组患儿（40例）静脉滴注西咪替丁注射液和阿昔洛韦注射液各15 mg/（kg·d）,两组均治疗7 d。观察并记录两组患儿临床疗效,治疗后患儿退热时间、皮疹结痂时间、瘙痒消失时间,治疗前后HAMA评分及治疗期间不良反应情况,评价西咪替丁联合阿昔洛韦治疗小儿水痘的临床疗效。结果 观察组治疗有效率87.5%,对照组治疗有效率65.0%,观察组治疗有效率高于对照组,差异有统计学意义（P<0.05）。治疗后观察组患儿退热时间、皮疹结痂时间、瘙痒消失时间均短于对照组,差异有统计学意义（P<0.05）。治疗前,两组患儿HAMA评分相比,无统计学差异;治疗后,两组患儿HAMA评分均明显降低,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组明显低于对照组,差异有统计学意义（P<0.05）。治疗期间,两组不良反应率无明显差异。结论 西咪替丁联合阿昔洛韦治疗小儿水痘效果良好,能较快改善水痘临床症状,减轻小儿焦虑情绪,治疗方案安全性高,值得临床推广使用。     

Disposcope无线传输气管插管内视镜在困难气管插管中的应用

目的 观察Disposcope内视镜在困难气道气管插管的应用效果.方法 困难气管插管成人患者40例随机均分为Disposcope内视镜(A)组和McCoy喉镜(B)组.记录麻醉诱导前(T0)、诱导后(T1)、插管后即刻(T2)、插管后1 min(T3)的平均动脉压(MAP)、心率(HR)及气管插管时间、次数和并发症.结果 与T1时比较,两组T2、T3时的MAP明显增高(P＜0.05);A组T2时的MAP和HR明显低于B组(P＜0.05).A组插管时间较B组明显缩短[(43.9±14.5)s vs.(90,4±26.6)s](P＜0.01)、一次插管成功率明显高于B组(85.0％ vs.60.0％) (P＜0.05).结论 与McCoy喉镜比较,Disposcope内视镜用于困难气道气管插管一次插管成功率高、插管时间短、应激反应轻.     

肺癌椎体转移的磁共振成像表现对患者预后评价

目的评价磁共振成像(MRI)技术在肺癌椎体转移诊断中的作用,研究肺癌转移灶的病理征象能否预测患者的预后。方法收集病理及临床证实的肺癌椎体转移患者60例(椎体病灶病理活检证实20例,核素扫描及临床证实40例),60例患者病理均证实有原发肺腺癌,行脊柱MR扫描。均采用常规自旋回波(SE)T1WI、脂肪抑制序列(SPIR)序列、增强T1WI行矢状及横断面扫描。结果60例肺腺癌患者,MRI下均可见椎体信号异常。单发灶与多发灶组在椎体转移灶出现后患者的生存时间差异有统计学意义(t=10·63,P<0·01);无椎体附件受累与有椎体附件受累组间的患者生存时间差异有统计学意义(t=12·23,P<0·01);无椎旁软组织肿块与有椎旁软组织肿块组间的患者生存时间差异有统计学意义(t=12·50,P<0·01);无脊髓受压与有脊髓受压组间的患者生存时间差异有统计学意义(t=14·36,P<0·01)。结论MRI能够显示肺癌椎体转移的病理改变,MRI表现可以前瞻性地预测肺癌患者的病程。     

丙泊酚联合芬太尼在ICU机械通气患者中的应用研究

目的探讨丙泊酚联合芬太尼在ICU机械通气患者中的应用及护理效果,为临床治疗呼吸衰竭疾病提供依据。方法选择我院ICU 2014年6月至2016年6月接受治疗的ICU机械通气患者104例作为观察对象,按数字表法分为丙泊酚联合芬太尼组(观察组)和丙泊酚组(对照组),每组52例,并对两组患者的临床疗效、药物镇静效果及并发症等情况进行分析。结果两组患者不同时间点的镇静效果比较差异无统计学意义(P>0.05)。观察组患者停药后的苏醒时间与SAS评分达3~4分时间较对照组缩短(P<0.01),丙泊酚总用药量明显少于对照组(P<0.05),高血压、低血压、恶心呕吐、心动过快及心动过缓等预后并发症的发生率低于对照组(P<0.05或P<0.01)。结论应用丙泊酚联合芬太尼对于ICU机械通气患者具有较好的疗效,能促进镇静,降低疼痛,平稳血压,减少预后并发症,具有较高的临床价值。     

依那普利和氯沙坦治疗中重度高血压的疗效观察

目的：评价依那普利和氯沙坦联用对中度重度高血压患者的降压效果和左心室肥厚的逆转作用。方法：对36例中重度高血压患者给予口服依那普利5－10mg/日和氯沙坦25－50mg/日,监测血压、心率及行超声心动图检查。结果：经治疗患者血压、心率明显下降,IVST、LVPWT和LVMI明显减少（P＜0．01）。结论：依那普利和氯沙坦联用能有效降低血压及逆转心室肥厚,且两药单独用量少,副作用少。     

类风湿关节炎合并肺间质纤维化的临床特征研究

目的 对类风湿关节炎合并肺间质纤维化患者的临床特征进行分析,为今后的临床诊治工作提供可靠的参考依据.方法 选取2010年1月-2013年3月我院收治的类风湿性关节炎患者102例,按照是否合并肺间质纤维化分成合并组和单纯组,而后对这两组的临床观察指标进行对比分析.结果 合并组患者的男性所占比例、吸烟者比例、患者年龄、发病年龄、抗环瓜氨酸抗体、类风湿因子、C反应蛋白水平以及骨破坏发生率均较单纯组高.结论 类风湿关节炎患者合并肺间质纤维化可能与诸多临床指标均存在较大的相关性,临床应给予关注,采取有效措施进行预防和治疗.