Improvements in overactive bladder syndrome after polypropylene mesh surgery for cystocele

Background: The International Continence Society has defined overactive bladder syndrome (OABS) by the following set of symptoms: 'urgency, with or without urge incontinence, usually with urinary frequency and nocturia'. OABS and cystocele often coexist.
Aim: This study aimed to analyse the changes in the overactive bladder symptom score (OABSS) of women followed up for one year after anterior repair surgery performed using a polypropylene mesh. In this surgery, a tape with four straps designed for optimum tissue holding capacity was fixed to the obturator foramen.
Material and methods: Thirty-four women were operated using the abovementioned mesh. The OABSS, maximal urinary flow rate (Qmax) and postvoid residual (PVR) volume were evaluated pre- and post-surgery.
Results: We observed significant improvements in the OABSS and quality of life scores before and after one year of surgery. The surgery was significantly effective in improving urgency, daytime frequency, incontinence, the Qmax and the PVR volume. No significant change in nocturia was observed post-surgery.
Conclusions: Our study confirmed the efficacy of the propylene mesh introduction surgery for cystocele for the improvement of OABS symptoms.     

Gelatinase B C(‐1562)T polymorphism in relation to ischaemic heart disease

Objective. Matrix metalloproteinases, such as gelatinase B, are important in connective tissue remodelling processes associated with atherogenesis and plaque rupture. The T allele of the gelatinase B C_(‐1562) T polymorphism has been reported to be associated with an almost 2‐fold increase in promoter activity and with the extent of coronary artery disease (CAD). The aim of this study was to analyse the relation of this gene variation to the risk and severity of CAD and the risk of myocardial infarction (MI). Material and methods. This case‐control study comprised 535 healthy controls and 2731 participants who had undergone coronary angiography. Results. In the total sample, the gelatinase B promoter polymorphism was not associated with the risk of CAD and MI or with the extent of CAD defined either by the number of diseased coronary arteries or – in patients with coronary angiography – by a score for coronary heart disease (CHD) according to the Gensini score. However, patients with TT genotype had higher CHD scores than the other genotypes in subgroups of individuals with high apolipoprotein B levels, high lipoprotein (a) plasma concentrations and high fibrinogen levels, or with combinations of increased levels of these coronary risk factors. These observations were made in the entire sample of individuals with coronary angiography and in the population of patients with documented CHD. Conclusions. Obviously, the gelatinase B C_(‐1562)T gene polymorphism is not a risk indicator for CAD and MI. With respect to the extent of CHD, the impact of this gene variation may be restricted to individuals with high apolipoprotein B, lipoprotein (a) and/or fibrinogen levels.     

Impact of renal dysfunction and glucometabolic status on one month mortality after acute myocardial infarction

Patients with impaired glucometabolic status or renal function have a higher mortality after acute myocardial infarction. It is unclear whether this higher risk is independent or related to the quality of care. In a prospective registry, stress hyperglycaemia (SH) was defined as glucose level>140?mg/dl. Renal function was assessed by the glomerular filtration rate (GFR): normal (?60), mild (30–60) and severe dysfunction (<30?ml/min/1.72?m²). The level of risk was assessed by the TIMI risk index and the quality of care by the rate of use of five guidelines‐recommended treatments. Among the 1388 patients included, 23% had diabetes, 16% had SH, renal function was normal in 55%, mildly impaired in 35% and severely impaired in 9.5%. At one month, the mortality rate was higher in patients with SH (18%) as compared with diabetics (9%) or those with normal glucometabolic status (5%). Similarly, the mortality rate was higher in those with impaired renal function. Multivariable analysis identified SH, GFR group, TIMI risk index, ST segment elevation MI and quality of care as independent predictors of one‐month mortality. In patients with acute MI, SH and GFR<30?ml/min/m² are independent predictors of mortality after adjustment for the level of risk and acute care.     

妈富隆治疗原发性痛经的初步研究

目的评价妈富隆治疗原发性痛经的有效性和安全性。方法采用随机,对照,双盲方法将原发性痛经患者分为对照组和实验组各30例。对照组服用安慰剂,实验组服用妈富隆各3个周期。采用总的痛经评分(Total Dysmenorrhea Score,TDS)和视觉模拟评分法(Visual Analog Scale,VAS)来评价药物的疗效,对比治疗前后痛经的改善情况和药物的副作用。结果治疗后实验组TDS和VAS较对照组明显降低(P<0.05)。实验组TDS和VAS在第2,3周期下降明显。实验组药物副作用发生率明显增高,但随时间的发展而下降,而在对照组无变化,无严重副作用发生。结论妈富隆治疗原发性痛经效果明显,比较安全,值得临床推广应用。     

基于真实世界的脉络舒通丸对肝功能指标影响的研究

目的 应用医院信息医疗系统电子数据开展真实世界脉络舒通丸对肝功能指标影响的安全性临床研究。方法 基于全国14家大型三级甲等医院的医疗电子数据库，将服用脉络舒通丸患者作为脉络舒通丸组，未服用脉络舒通丸者作为对照组，以性别相同、年龄±5岁为匹配条件，按照1∶1比例分组后2组均为2387例，以用药后肝功能指标[碱性磷酸酶（alkaline phosphatase,ALP）、丙氨酸氨基转移酶（alanine transaminase,ALT）、天冬氨酸氨基转移酶（aspartate transaminase,AST）、谷氨酞转移酶（gamma-glutamyl transferase,GGT）、总胆红素（total bilirubin,TBIL）]作为结局评价指标，通过倾向性评分方法控制研究中存在的混杂因素，采用3种统计学方法进行安全性分析。结果 筛选出12个影响程度较高的混杂因素，加权平衡了全部的混杂因素，3种统计学方法得到的结果均为P>0.05，两组差异不具有统计学意义。结论 不能认为脉络舒通丸导致肝功能指标异常变化，但鉴于倾向性评分法仅能控制已知潜在混杂因素，无法实现对未知混杂因素...     

Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching

Cross‐country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro‐level data from hospitals in different health care systems. To do so, we developed a multi‐level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi‐level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi‐level models are recommendable to consider the clustered structure of the data when patient‐level data from different hospitals and health care systems are compared. The results provide an important justification for exploring new ways in performing health system comparisons. Copyright © 2010 John Wiley & Sons, Ltd.     

Long‐term efficacy and safety of ranibizumab administered pro re nata in Japanese patients with neovascular age‐related macular degeneration in the EXTEND‐I study

Purpose: To evaluate the long‐term efficacy and safety of ranibizumab administered pro re nata (PRN) in Japanese patients with choroidal neovascularization secondary to age‐related macular degeneration during the extension phase of the EXTEND‐I study. Methods: EXTEND‐I, an open‐label, multicenter, Phase I/II study comprised: a single‐injection (Group A); a multiple‐injection (Groups A and B; the latter consisted of patients who did not participate in the single‐injection phase); and an extension phase. In the extension phase, a PRN regimen of ranibizumab (0.3 or 0.5 mg) guided by monthly best‐corrected visual acuity (BCVA) score and other ophthalmic examinations was employed. The efficacy variables included the mean BCVA change from Month 12 to the last visit in Group B. Safety was assessed in all patients. Results: In the extension phase, efficacy was assessed only in Group B patients. The number of ranibizumab injections per year in the 0.3 and 0.5 mg Group B patients was 4.19 and 4.27, respectively. The mean BCVA change (SD) from Month 12 to the last visit was ?3.6 (14.82) letters for 0.3 mg (n = 28) and ?2.2 (7.92) letters for 0.5 mg groups (n = 33) in Group B. Conjunctival haemorrhage and nasopharyngitis were the most commonly reported adverse events. Of the 13 serious adverse events reported, cerebral infarction (two incidences) was suspected to be study‐drug related. Conclusions: Pro re nata regimen of ranibizumab guided by monthly BCVA and other ophthalmic examinations appears effective in sustaining the BCVA gained with 12 monthly injections while reducing the number of injections during the extension phase. Ranibizumab was well tolerated during the extension phase.