CLASI(皮肤红斑狼疮病面积和严重度指数):一种皮肤红斑狼疮的输出工具

We developed and validated a measurement instrument (CLASI-Cutaneous Lupus Erythematosus Disease Area and Severity Index) for lupus erythematosus that could be used in clinical trials. The instrument has separate scores for damage and activity. A group of seven American Dermato-Rheumatologists and the “ American College of Rheumatology Response Criteria Committee on SLE (systemic lupus erythematosus)” assessed content validity. After a preliminary session, we conducted standardized interviews with the raters and made slight changes to the instrument. The final instrument was evaluated by five dermatologists and six residents who scored nine patients to estimate inter- and intra-rater reliability in two sessions. Consultation with experts has established content validity of the instrument. Reliability studies demonstrated an intra-class correlation coefficient (ICC) for inter-rater reliability of 0.86 for the activity score (95% confidence interval (CI) = 0.73- 0.99)- and of 0.92 for the damage score (95% CI = 0.85- 1.00). The Spearman’ s ρ (Sp) for intra-rater reliability for the activity score was 0.96 (95% CI = 0.89 to 1.00) and for the damage score Sp was 0.99 (95% CI = 0.97- 1.00). Clinical responsiveness needs to be evaluated in a prospective clinical trial, which is ongoing.

非致命性心肌梗死时应用罗非昔布和塞来昔布的优势比不同

Background: Studies have postulated that cyclooxygenase-2(COX-2) selective inhibitors affect cardiovascular risk through various mechanisms. Some of these mechanisms could increase risk(for example, inhibition of prostacyclin production), and some could decrease risk(for example, inhibition of inflammation). Objective: To determine the effect of COX-2 inhibitors on risk for nonfatal myocardial infarction(MI). Design: Case-control study. Setting: 36 hospitals in a 5-county area. Participants: 1718 case-pa-tients with a first, nonfatal MI admitted to these hospitals and 6800 controls randomly selected from the same counties. Measurements: Self-reported medication use assessed through telephone interviews. Results: The adjusted odds ratio for MI among celecoxib users, relative to persons who did not use nonaspirin nonsteroidal anti-inflammatory drugs(NSAIDs), was 0.43(95%CI, 0.23 to 0.79) compared with 1.16(CI, 0.70 to 1.93) among rofecoxib users. The use of rofecoxib was associated with a statistically significant higher odds of MI compared with the use of celecoxib(adjusted odds ratio for rofecoxib vs. celecoxib, 2.72[CI, 1.24 to 5.95]; P=0.01). Nonselective NSAIDs were associated with a reduced odds of nonfatal MI relative to nonusers. Comparisons of COX-2 inhibitors with nonselective NSAIDs were the following: rofecoxib versus naproxen(odds ratio,3.39[CI, 1.37 to 8.40]) and celecoxib versus ibuprofen or diclofenac(odds ratio, 0.77[CI, 0.40 to 1.48]). Limitations: The possibility of recall bias and uncontrolled confounding in this observational study limit the ability to make definitive conclusions. The association of celecoxib with a lower odds of MI could have occurred by chance. Only about 50%of eligible participants completed telephone interviews. Conclusion: Celecoxib and rofecoxib were associated with different odds of MI. Cardiovascular effects among the COX-2 inhibitors seem different, but further studies, preferably randomized trials, are needed to fully understand the spectrum of effects of COX-2 inhibitors and potential differences among them.

应用抗生素治疗痤疮可能并发上呼吸道感染

Objective: To determine if the long- term use of antibiotics for the treatment of acne results in an increase in either of 2 common infectious illnesses: upper respiratory tract infections (URTIs)or urinary tract infections. Design: Retrospective cohort study. Setting: General Practice Research Database of the United Kingdom, London, England, from 1987 to 2002. Patients: Patients with a diagnosis of acne. Main Outcome Measure: The onset of either a URTI or a urinary tract infection. Results: Of 118 496 individuals with acne (age range, 15- 35 years) who were identified in the General Practice Research Database, 84977 (71.7% ) received a topical or oral antibiotic (tetracyclines, erythromycin, or clindamycin) for treatment of their acne and 33 519 (28.3% ) did not. Within the first year of observation, 18281 (15.4% ) of the patients with acne had at least 1 URTI, and within that year, the odds of a URTI developing among those receiving antibiotic treatment were 2.15 (95% confidence interval, 2.05- 2.23; P<.001) times greater than among those who were not receiving antibiotic treatment. Multiple additional analyses, which were conducted to show that this effect was not an artifact of increased health care- seeking behavior among our cohorts, included comparing the cohorts of patients with acne with a cohort of patients with hypertension and the likelihood of developing a urinary tract infection. Conclusions: Patients with acne who were receiving antibiotic treatment for acne were more likely to develop a URTI than those with acne who were not receiving such treatment. The true clinical importance of our findings will require further investigation.

血管紧张素转换酶抑制剂在预防心肌梗死时的作用分级

Angiotensin-converting enzyme(ACE) inhibitors differ in their affinity for tissue-boundACE. It has been hypothesized that tissue ACE affinity might be responsible for some of the beneficial cardiovascular properties of ACE inhibitors. The present study examined this question and found no correlation between tissue ACE affinity and risk of first nonfatal myocardial infarction in patients who have hypertension.