Haemoglobin at time of referral prior to dialysis predicts survival: an association of haemoglobin with long-term outcomes

Haemoglobin (Hgb) levels are known to be associated with numerousadverse outcomes in both chronic kidney disease (CKD) and non-CKDpatients. This analysis evaluates the association of baseline haemoglobinlevels on survival in CKD patients, who are followed by nephrologists,irrespective of glomerular filtration rate (GFR), prior to initiationof renal replacement therapy (RRT) and erythropoietin hormonereplacement therapy. Analysis of data from the provincial database (PROMIS, PatientRegistration and Outcome Management Information System) in BritishColumbia, Canada, was undertaken. Records used for the analysisincluded all CKD patients at first registration: GFR <60ml/min/1.73 m², not yet on dialysis, starting from May 1998to October 2002, and who had complete data (defined as age andgender, diabetic status, eGFR and Hgb levels). The primary objective of this study was to determine the associationof Hgb and survival controlling for eGFR at first registrationvalue, age, gender and diabetic status. Multivariate Cox proportionalhazards analysis with time to death as outcome variable wasperformed. The cohort included 3028 patients: the mean age was 65 years,28% were diabetic, and the mean eGFR in the cohort was 21 ml/min/1.73m². The cohort is representative of the BC CKD and dialysispopulation regarding ethnicity: 64% Caucasian, 32% Asian. Medianfollow-up was 27 months, 1 year survival was 0.92, 2 year survivalwas 0.85. Hgb at initial registration is a statistically independentpredictor of survival (RR = 0.875 for every 10 g/l, 95% CI:0.835–0.917, P = 0.0001), after adjusting for age, gender,diabetic status and baseline eGFR. Further analysis, controllingfor RRT, demonstrated a similar association between Hgb andsurvival (RR = 0.853 for every 10 g/l, 95% CI: 0.799–0.910,P = 0.0001), after adjusting for above variables. Substantialvariation in Hgb values exists at all GFR levels. These findings underscore the importance of evaluating Hgb atall GFR levels, and the need to study the impact of modificationof Hgb at different GFR levels on survival.     

前列地尔注射液对慢性肝病血清透明质酸、IV型胶原、Ⅲ型前胶原的影响

目的　观察前列地尔注射液改善慢性肝病的炎症及抗肝纤维化的作用。方法　 42 5例慢性肝病随机分为治疗组 2 2 0例 ,对照组 2 0 5例 ,两组均采用相同的基础疗法。治疗组加用前列地尔 2 0ug加入 1 0 %葡萄糖 2 50ml,缓慢静脉滴注 ,每天 1次 ,1疗程结束复查透明质酸 (HA)、Ⅲ型前胶原 (PC -Ⅲ )、Ⅳ型胶原 (1V -C)、谷丙转氨酶(ALT) ,总胆红素 (TB) ,白蛋白 (A) ,球蛋白 (G)。结果　两组治疗前后比较P <0 .0 0 1 ,治疗组在降HA、PC -III、IV -C及改善肝功能方面明显优于对照组P <0 .0 0 1。结论　前列地尔对降低慢性肝病HA、PC -Ⅲ、IV -C有确切疗效     

老年精神分裂症合并肺炎临床分析

目的：通过对精神分裂症合并肺炎患者和老年肺炎患者进行对照观察分析，探索老年精神分裂症合并肺炎的临床特点，为临床诊治提供资料。方法：对35例CCMD-2-R精神分裂症合并肺部感染的患者及35例同期老年肺炎患者对照分析。结果：发现老年精神分裂症合并肺炎患者与老年肺炎患者在神经精神症状和消化系统症状方面差异有显著性。结论：对老年精神分裂症合并肺炎患者更要细致观察，精心护理，早发现、早诊断、早治疗，以降低其死亡率。     

老年心房颤动病人华法林抗凝治疗的有效性安全性评价

目的　评价华法林用于老年心房颤动病人抗凝治疗的有效性、安全性。方法　选择符合本研究抗凝标准的132例老年心房颤动病人随机分为两组 ,华法林治疗组 (治疗组 ) 5 8例 ,给予华法林 3mg/ d开始 ,监测凝血酶原时间(PT)及国际标准化比值 (INR) ,7～ 15 d使 INR达到 1.8～ 2 .5范围内 ,以后每月查 1次 INR。若病人增加或减少药物有出血倾向时随时再测 INR。阿司匹林对照组 (对照组 ) 74例 ,给予阿司匹林 30 0 mg/ d,分 2次口服 ,密切随访。结果　治疗组 7～ 15 d,平均 (9.1± 2 .8) d,INR达 1.8～ 3.0 (平均 2 .1± 0 .13) ,其中 INR在 1.8～ 2 .5 (平均 1.92±0 .2 3)之间者占 92 .7% ,治疗组有 1例心瓣膜病人出现脑梗死 ,而对照组有 7例发生脑梗死 ,差异显著 ,其余不良反应率两组差异无显著性。结论　老年心房颤动病人选择华法林 2～ 3mg/ d时 ,加强服药后监测及各药物间的相互作用 ,使 INR保持在 1.8～ 2 .5之间是有效、安全的     

Endothelial Apoptosis and Chronic Transplant Vasculopathy: Recent Results, Novel Mechanisms

Chronic transplant vasculopathy (CTV) is a progressive form of vascular obliteration affecting the arteries, arterioles and capillaries of solid organ transplants. It is characterized by intimal accumulation of mononuclear cells, vascular smooth muscle cells (VSMC), myofibroblasts and connective tissue. Mounting evidence, based on animal models and human biopsy results, suggests that acute and persistent rejection triggering apoptosis of endothelial cells (EC) plays a pivotal role in CTV. The precise mechanisms that underlie the induction of fibroproliferative changes in association with endothelial apoptosis have yet to be clearly delineated. Recent observations in the field of apoptosis research provide some important mechanistic clues. First, endothelial apoptosis creates a state of hyperadhesiveness for mononuclear cells, thus facilitating sustained leukocyte infiltration. Second, phosphatidylserine-dependent engulfment of apoptotic cells by infiltrating mononuclear leukocytes promotes transforming growth factor-beta1 production. Third, apoptosis of EC triggers extracellular matrix (ECM) proteolysis thus initiating the production of fibroproliferative/fibrogenic ECM fragments. The relative importance of these mechanisms in the pathophysiology of CTV will need to be addressed in vivo. Yet, these recent developments provide a new mechanistic framework that will help better define the importance of immune-mediated EC apoptosis in the regulation of vascular repair.     

A "grapple hook" technique using a deflectable tip catheter to facilitate complex proximal circumflex interventions.

We present two patients with angulated, proximal left circumflex lesions, one a chronic total occlusion and one an acute subtotal occlusion. In both cases, use of the deflectable tip Venture Catheter (Velocimed, Minneapolis, MN) facilitated guide wire passage and successful percutaneous coronary intervention (PCI) after prior attempts at guide wire passage with standard wires were unsuccessful.     

The severity of airways obstruction as a determinant of treatment response in COPD

Guidelines recommend that patients with COPD are stratified arbitrarily by baseline severity (FEV₁) to decide when to initiate combination treatment with a long-acting β₂-agonist and an inhaled corticosteroid. Assessment of baseline FEV₁ as a continuous variable may provide a more reliable prediction of treatment effects. Patients from a 1-year, parallel-group, randomized controlled trial comparing 50 μg salmeterol (Sal), 500 μg fluticasone propionate (FP), the combination (Sal/FP) and placebo, (bid), were categorized post hoc into FEV₁ <50% and FEV₁ ≥50% predicted subgroups (n=949/513 respectively). Treatment effects on clinical outcomes – lung function, exacerbations, health status, diary card symptoms, and adverse events – were investigated. Treatment responses based on a pre-specified analysis explored treatment differences by severity as a continuous variable. Lung function improved with active treatment irrespective of FEV₁; Sal/FP had greatest effect. This improvement appeared additive in milder disease; synergistic in severe disease. Active therapy significantly reduced exacerbation rate in patients with FEV₁ <50% predicted, not in milder disease. Health status and breathlessness improved with Sal/FP irrespective of baseline FEV₁; adverse events were similar across subgroups. The spirometric response to Sal/FP varied with baseline FEV₁, and clinical benefits were not restricted to patients with severe disease. These data have implications for COPD management decisions, suggesting that arbitrary stratifications of baseline severity are not necessarily indicative of treatment efficacy and that the benefits of assessing baseline severity as a continuous variable should be assessed in future trials.     

茴三硫治疗慢性肝损害北京地区多中心临床研究

目的：观察茴三硫对慢性病毒性肝炎、药物性肝病、酒精性肝病、瘀胆性肝病等的保肝、利胆和解毒的作用。方法：本研究是一项随机对照的多中心临床研究。按病例选择标准将人选病例随机分成两组，实验组(茴三硫组，70例)给予茴三硫25mg，tid；对照组(硫普罗宁组，36例)给予凯西来1片，tid；两组疗程均为8周。根据两组病人治疗后症状改善及肝功能恢复情况的判定标准，来评估两组药物的显效率、有效率和总有效率。结果：茴三硫组的显效率、有效率和总有效率分别为52．9％、27．1％和80％，硫普罗宁组的显效率、有效率和总有效率分别为55．6％、27．8％和83．3％，治疗前后两组的各症状及肝功能改善率基本相同，两组间无显没差异(P＞0．05)，两组均未发生明显不良反应。结论：茴三硫治疗慢性病毒性肝炎、药物性肝炎等馒性肝损害，可以明显减轻患症状，改善肝功能，其疗效与硫普罗宁效果相近，临床观察无明显不良反应。     

High incidence of and risk factors for metachronous bilateral upper tract urothelial carcinoma in Taiwan

AIM: Urothelial carcinoma (UC) can occur multifocally in the whole urothelium. A higher rate of bilateral metachronous upper tract (UT) UC was noted in Taiwan. The incidence and risk factors were largely unknown and hence were explored in the study. METHODS: From January 1977 through June 2003, 462 patients with unilateral UT-UC were studied retrospectively. The cumulative incidence of contralateral recurrence was analysed with the Kaplan-Meier analysis. Potential risk factors for contralateral recurrence including age, smoking, bladder cancer, renal function, diagnostic year etc. were evaluated with the log-rank test. Independent risk factors were identified by using the Cox regression analysis. RESULTS: The median follow-up time was 34 months (6-337). Among the 462 patients, 52 (11.3%) developed metachronous contralateral UC. The 2, 5, and 10-year contralateral disease-free survivals were 93.5%, 84.0%, and 75.7%, respectively. The median time to contralateral recurrence was 31.0 months. With the univariate analysis, only poor renal function (serum creatinine < or > OR =2.0 mg/dL, P < 0.001) and late diagnostic year (before or after 1990, P < 0.001) were risk factors for contralateral recurrence. In the multivariate analysis, poor renal function (hazard ratio: 2.98; 95% confidence interval: 1.67-5.33; P < 0.001) and late diagnostic year (hazard ratio: 4.27; 95% confidence interval: 1.71-10.65; P = 0.002) remained independent risk factors. CONCLUSIONS: The incidence of metachronous UT-UC is high in Taiwan. Patients who had either chronic renal insufficiency or a disease diagnosed after 1990 had a higher risk of contralateral recurrence.     

老年牙周组织疾病216例证候分析

目的 探讨老年牙周组织疾病的证候特点。方法 对 1998 年 1 月-2003 年 12 月门诊接诊的 216 例老年牙周组织疾病进行回顾性分析。结果 阴虚火旺型 124 例(57.4%),气血不足型 51 例(23.6%),胃火炽盛型 16 例(7.5%),气滞血瘀型 14 例(6.4%),痰湿阻络型 11 例(5.1%)。结论 老年牙周组织疾病证候表现以虚为主、虚中夹实,阴虚火旺型和气血不足型是其主要证候类型。