背景使用行政管理数据时,确立清晰、适当的慢性病洗脱期时长是正确确定反复就医的慢性病患者发病时点、确定新发病例的基础。目的通过系统文献回顾,综述确定洗脱期时长的方法,以期为我国研究者后续使用行政管理数据识别慢性病新发病例...背景使用行政管理数据时,确立清晰、适当的慢性病洗脱期时长是正确确定反复就医的慢性病患者发病时点、确定新发病例的基础。目的通过系统文献回顾,综述确定洗脱期时长的方法,以期为我国研究者后续使用行政管理数据识别慢性病新发病例时确认洗脱期长短、正确识别新发病例提供思路。方法于2021年10月,系统检索PubMed、Web of Science、EmBase、中国知网、维普中文科技期刊全文数据库、万方知识服务平台,获取有关利用行政管理数据探究慢性病发病、患病情况的文献,检索时限均为建库至2022-10-01。由两名研究者独立筛选文献并提取相关信息,并采用定性研究报告评价标准(SRQR)评价文献方法学质量后,使用描述性分析法总结洗脱期时长的确定方法。结果共纳入26篇文献,纳入文献的SRQR评分均≥15分,方法学质量较好。文献所使用的数据主要来自加拿大、美国、澳大利亚等行政管理数据完整、丰富的国家(地区),聚焦的疾病包括糖尿病、肿瘤、精神分裂症等多种慢性病。研究指出,设定合适的洗脱期时长是准确识别发病病例的基础。目前,文献中确定洗脱期时长的方法主要包括直接限定法、一致性检验法和逆向生存函数法三大类,其中最常用的方法是直接限定法,逆向生存曲线法的使用率相对较低。结论直接限定法、一致性检验法和逆向生存函数法均有相应的优势和局限性,方法的选择标准、判断标准和稳定性有待进一步探究。展开更多
Study objectives: Pharmacological therapy can reduce diagnostic and prognostic accuracy of exercise stress testing. However, the risk of withdrawing drugs ear ly after myocardial infarction (MI) has not been establish...Study objectives: Pharmacological therapy can reduce diagnostic and prognostic accuracy of exercise stress testing. However, the risk of withdrawing drugs ear ly after myocardial infarction (MI) has not been established. We assessed safety and clinical implications of drug withdrawal in patients undergoing stress test ing after uncomplicated MI. Methods: A total of 362 MI patients underwent ECG Ho lter recording before and after withdrawing beta blockers, calcium antagonists and nitrates. QRS(QRS/h) and ventricular premature beats(VPB/h) count per hour, repetitive ventricular arrhythmias, ST segment changes and patient complaints w ere evaluated for reproducibility using kappa statistics and Bland Altman metho d. Results: No major complications occurred. Forty three patients complained of >1 symptom on and 37 off therapy. QRS/h and VPB/h count were significantly(p< 0 .0001) higher off therapy but correlated with the corresponding values on therap y. A mean heart rate increase of 8 beats/min (agreement range -8 to +14 beats/ min) and a fivefold increase in VPB/h(agreement range -141 to +151) were obser ved after withdrawing therapy. Repetitive ventricular arrhythmias and ST changes were also more frequent off therapy but intra patient reproducibility was poor : kappa 0.12(95%confidence interval(CI)-0.01 to 0.25) for arrhythmias, -0.02( 95%CI-0.46 to 0.39) for ST depression and -0.01(95%CI-0.66 to 0.64) for ST elevation. Conclusions: The withdrawal of therapy is well tolerated soon after u ncomplicated MI; however, a generic but not individual risk of ventricular arrhy thmias and/or transient myocardial ischemia has to be taken into account.展开更多
The protective role of xanthophyll cycle in resurrection angiosperm Boea hygrometrica (Bunge) R.Br. was investigated by analysis of the changes of chlorophyll fluorescence and xanthophyll cycle components in response ...The protective role of xanthophyll cycle in resurrection angiosperm Boea hygrometrica (Bunge) R.Br. was investigated by analysis of the changes of chlorophyll fluorescence and xanthophyll cycle components in response to dehydration and rehydration in detached leaves under very weak light condition (3 mumol photons.m(-2).s(-1)) and in the dark. With declines in the values of PSII photochemical efficiency (Fv/Fm), PSII actual quantum yield (Phi(PSII)), photochemical quenching (qP) and non-photochemical quenching (NPQ) during dehydration, zeaxanthin significantly increased in control Boea leaves under very weak light condition, while no zeaxanthin accumulation was detected in Boea leaves treated with dithiothreitol (DTT) and Boea leaves in the dark, and after 3 d rehydration, the parameters Fv/Fm, Phi(PSII), qP and NPQ showed full recovery in control Boea leaves under very weak light condition, but the parameters only underwent partial recovery in Boea leaves treated with DTT and Boea leaves in the dark, suggesting that the recovery of photosystem II (PSII) photochemical activities in Boea leaves was obviously affected by treatments with DTT and darkness, therefore, zeaxanthin may play an important protective role in desiccated Boea leaves even under very weak light conditions.展开更多
Purpose: To evaluate the effectiveness of the autologous serum eyedrops in the treatment of severe dry eye patients. Design: Prospective randomized case- control study. Methods: Thirty- seven eyes of twenty severe dry...Purpose: To evaluate the effectiveness of the autologous serum eyedrops in the treatment of severe dry eye patients. Design: Prospective randomized case- control study. Methods: Thirty- seven eyes of twenty severe dry eye patients without punctal occlusion were enrolled in this study. After 2 weeks of washout, they were randomly assigned to two groups. Group A patients used only preservative- free artificial tears, and group S patients used only autologous serum eyedrops. We evaluated the results of Schirmer test, fluorescein and rose bengal staining scores, tear film breakup time (BUT), and subjective symptom scores before and 2 weeks after treatment. Results: Mean BUT and fluorescein and rose bengal staining scores, as well as subjective symptom scores, showed significant improvement in the patients assigned to autologous serum eyedrops compared with subjects assigned to preservative- free artificial tears after 2 weeks of treatment. Conclusions: Autologous serum eyedrops were found effective in the treatment of severe dry eye disease, as evidenced by improvement of tear stability and ocular surface vital staining scores.展开更多
Background:There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis.On the contrary,we can hardly find studies that compare each oth...Background:There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis.On the contrary,we can hardly find studies that compare each other.Objective:To evaluate and compare the effectiveness and toxicity of mycophenolate mofetil and cyclosporin in chronic plaque psoriasis through a prospective,sequential,cross-over,non-randomized,two phase,open-label study.Patients/Methods:Eight patients(five women and three men;mean age 57,range 35-78)with moderate-to-severe chronic plaque psoriasis were included in the study.They were treated with oral mycophenolate mofetil(30 mg/kg/day)over a period of 16 weeks.Following a variable wash out period and after a new outbreak of the disease,oral cyclosporinwas introduced at a dose of 4 mg/kg/day.During both treatment regimens,follow-up visits were performed at 3,8 and 16 weeks.Results:In both groups,the PASI started to decrease once treatment was begun.Cyclosporin was faster and statistically a lot more effective than mycophenolate mofetil,reaching a higher number of complete remissions and better percentages of PASI improvement from baseline(45.7%,60.2%and 60.5%at 3,8 and 16 weeks respectively for mycophenolate mofetil,and 89.7%,95.3%and 95.3%respectively at the same intervals for cyclosporin).Cyclosporin was also more predictable in its action as the percentage of improvement along the follow up visits had a much wider range for mycophenolate mofetil.Overall,the tolerability of both drugs was good.None of the patients had to discontinue treatment because of an adverse event.Two patients treated with cyclosporin showed increased plasma levels of creatinine.Conclusions:Cyclosporin is more effective,fast,and predictable in its effect than mycophenolatemofetil to control moderate-to-severe chronic plaque psoriasis.Both drugs are well tolerated in short courses of treatment.展开更多
Objective: To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD). Design: Double-blind, crossover, placebo-contro-lled study. Setting: Gynecological diabetic...Objective: To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD). Design: Double-blind, crossover, placebo-contro-lled study. Setting: Gynecological diabetic outpatient clinic and sexual clinic. Patient(s): Thirty-six type 1 premenopausal diabetic women affected by SAD. Intervention(s): Two 8-week periods of sildenafil 100 mg, washout, and placebo, by two possible sequences. Main Outcomes Measure(s): Each woman submitted blood samples to measure HbA 1c, and T, free T (FT), and PRL. Efficacy was assessed [1] subjectively by the Personal Experiences Questionnaire based on the 5- point Likert scale, quantifying arousal, desire, orgasm, enjoyment of sexual activities, and frequency of sexual relationships; and [2] objectively by translabial color Doppler ultrasound to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity of clitoral arteries. Result(s): Thirty-two women completed the study. The mean HbA 1c value was 8.0% ± 1.8% , and plasma concentrations of T, FT, and PRL were normal. Sildenafil seems to improve arousal, orgasm and sexual enjoyment, and dyspareunia in women affected by type 1 diabetes. However, by flowmetric measurements, the mean RI was significantly lower and both the mean PI and PSV of the clitoral arteries were significantly higher compared with baseline and placebo. Conclusion(s): Sildenafil seems to improve subjective sexual aspects and can be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes.展开更多
Objective: To assess the impact of long-term treatment with topical timolol on bronchial reactivity in healthy individuals. Methods: Twenty-one other wise healthy individuals with high-pressure primary open-angle glau...Objective: To assess the impact of long-term treatment with topical timolol on bronchial reactivity in healthy individuals. Methods: Twenty-one other wise healthy individuals with high-pressure primary open-angle glaucoma were enrolled in a randomized controlled clinical trial. Eleven patients underwent 3 years of topical 0.5% timolol treatment followed by a 1- year washout period; 10 patients underwent primary argon laser trabeculoplasty. Functional variables and bronchial reactivity (forced expiratory volume in 1 second and metacholine challenge test results) were assessed in both groups at enrollment and after 3 and 4 years of follow-up. Results: After 3 years, a measurable response to metacholine challenge was recorded in 6 of 11 otherwise symptom-free individuals treated with 0.5% timolol twice daily. A detectable response to metacholine challenge was still present in half of these individuals (3 of 6) when further washed out for 1 year from the topical β-blocker. No significant variation in bronchial reactivity was measured in the laser-treated group during 4 years of follow-up. Conclusions: Healthy individuals who undergo long-term topical application of a nonselective β-blocker (0.5% timolol) can develop a subclinical increase in bronchial reactivity. This phenomenon may not be completely reversible on withdrawal of the β-blocker.展开更多
To evaluate the ocular surface inflammatory response to the presence of preservatives in nonselective beta-blocker eyedrops. Prospective, crossover, single-masked, randomized clinical study. study population: Twenty p...To evaluate the ocular surface inflammatory response to the presence of preservatives in nonselective beta-blocker eyedrops. Prospective, crossover, single-masked, randomized clinical study. study population: Twenty primary open-an-gle glaucoma or ocular hypertensive patients were divided in two groups, one treated with preservative-free timolol 0.5% (group 1) and the other with preserved timolol 0.5% (group 2) eyedrops. After 60 days of therapy and 3 more weeks of washout, the two groups switched to the other therapy. procedure: At each visit, basal tear samples were collected from the inferior conjunctival fornix for the determination of interleukin (IL)-1β tear concentrations by an enzyme-linked immunosorbent assay. Intraocular pressure measurement, conjunctival hyperemia, superficial punctate keratitis, and tear film breakup time were evaluated. main outcome measure: IL-1β concentration in tears following the use of preserved eyedrops. IL-1β tear concentrations increased significantly in both groups,compared with baseline values, during preserved timolol therapy. There were no statistically significant changes in hyperemia and superficial punctate keratitis throughout the study in either group. A statistically significant breakup time reduction was observed in both groups after 30 days and after 60 days of preserved therapy. The use of preservatives in timolol 0.5% eyedrops leads to tear film instability and ocular surface inflammatory changes documented by a reduction of breakup time and an increase of IL-1β tear concentrations. Preservative-free betablockers are preferable for long-term hypotensive therapy to prevent ocular surface inflammation.展开更多
文摘背景使用行政管理数据时,确立清晰、适当的慢性病洗脱期时长是正确确定反复就医的慢性病患者发病时点、确定新发病例的基础。目的通过系统文献回顾,综述确定洗脱期时长的方法,以期为我国研究者后续使用行政管理数据识别慢性病新发病例时确认洗脱期长短、正确识别新发病例提供思路。方法于2021年10月,系统检索PubMed、Web of Science、EmBase、中国知网、维普中文科技期刊全文数据库、万方知识服务平台,获取有关利用行政管理数据探究慢性病发病、患病情况的文献,检索时限均为建库至2022-10-01。由两名研究者独立筛选文献并提取相关信息,并采用定性研究报告评价标准(SRQR)评价文献方法学质量后,使用描述性分析法总结洗脱期时长的确定方法。结果共纳入26篇文献,纳入文献的SRQR评分均≥15分,方法学质量较好。文献所使用的数据主要来自加拿大、美国、澳大利亚等行政管理数据完整、丰富的国家(地区),聚焦的疾病包括糖尿病、肿瘤、精神分裂症等多种慢性病。研究指出,设定合适的洗脱期时长是准确识别发病病例的基础。目前,文献中确定洗脱期时长的方法主要包括直接限定法、一致性检验法和逆向生存函数法三大类,其中最常用的方法是直接限定法,逆向生存曲线法的使用率相对较低。结论直接限定法、一致性检验法和逆向生存函数法均有相应的优势和局限性,方法的选择标准、判断标准和稳定性有待进一步探究。
文摘Study objectives: Pharmacological therapy can reduce diagnostic and prognostic accuracy of exercise stress testing. However, the risk of withdrawing drugs ear ly after myocardial infarction (MI) has not been established. We assessed safety and clinical implications of drug withdrawal in patients undergoing stress test ing after uncomplicated MI. Methods: A total of 362 MI patients underwent ECG Ho lter recording before and after withdrawing beta blockers, calcium antagonists and nitrates. QRS(QRS/h) and ventricular premature beats(VPB/h) count per hour, repetitive ventricular arrhythmias, ST segment changes and patient complaints w ere evaluated for reproducibility using kappa statistics and Bland Altman metho d. Results: No major complications occurred. Forty three patients complained of >1 symptom on and 37 off therapy. QRS/h and VPB/h count were significantly(p< 0 .0001) higher off therapy but correlated with the corresponding values on therap y. A mean heart rate increase of 8 beats/min (agreement range -8 to +14 beats/ min) and a fivefold increase in VPB/h(agreement range -141 to +151) were obser ved after withdrawing therapy. Repetitive ventricular arrhythmias and ST changes were also more frequent off therapy but intra patient reproducibility was poor : kappa 0.12(95%confidence interval(CI)-0.01 to 0.25) for arrhythmias, -0.02( 95%CI-0.46 to 0.39) for ST depression and -0.01(95%CI-0.66 to 0.64) for ST elevation. Conclusions: The withdrawal of therapy is well tolerated soon after u ncomplicated MI; however, a generic but not individual risk of ventricular arrhy thmias and/or transient myocardial ischemia has to be taken into account.
文摘The protective role of xanthophyll cycle in resurrection angiosperm Boea hygrometrica (Bunge) R.Br. was investigated by analysis of the changes of chlorophyll fluorescence and xanthophyll cycle components in response to dehydration and rehydration in detached leaves under very weak light condition (3 mumol photons.m(-2).s(-1)) and in the dark. With declines in the values of PSII photochemical efficiency (Fv/Fm), PSII actual quantum yield (Phi(PSII)), photochemical quenching (qP) and non-photochemical quenching (NPQ) during dehydration, zeaxanthin significantly increased in control Boea leaves under very weak light condition, while no zeaxanthin accumulation was detected in Boea leaves treated with dithiothreitol (DTT) and Boea leaves in the dark, and after 3 d rehydration, the parameters Fv/Fm, Phi(PSII), qP and NPQ showed full recovery in control Boea leaves under very weak light condition, but the parameters only underwent partial recovery in Boea leaves treated with DTT and Boea leaves in the dark, suggesting that the recovery of photosystem II (PSII) photochemical activities in Boea leaves was obviously affected by treatments with DTT and darkness, therefore, zeaxanthin may play an important protective role in desiccated Boea leaves even under very weak light conditions.
文摘Purpose: To evaluate the effectiveness of the autologous serum eyedrops in the treatment of severe dry eye patients. Design: Prospective randomized case- control study. Methods: Thirty- seven eyes of twenty severe dry eye patients without punctal occlusion were enrolled in this study. After 2 weeks of washout, they were randomly assigned to two groups. Group A patients used only preservative- free artificial tears, and group S patients used only autologous serum eyedrops. We evaluated the results of Schirmer test, fluorescein and rose bengal staining scores, tear film breakup time (BUT), and subjective symptom scores before and 2 weeks after treatment. Results: Mean BUT and fluorescein and rose bengal staining scores, as well as subjective symptom scores, showed significant improvement in the patients assigned to autologous serum eyedrops compared with subjects assigned to preservative- free artificial tears after 2 weeks of treatment. Conclusions: Autologous serum eyedrops were found effective in the treatment of severe dry eye disease, as evidenced by improvement of tear stability and ocular surface vital staining scores.
文摘Background:There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis.On the contrary,we can hardly find studies that compare each other.Objective:To evaluate and compare the effectiveness and toxicity of mycophenolate mofetil and cyclosporin in chronic plaque psoriasis through a prospective,sequential,cross-over,non-randomized,two phase,open-label study.Patients/Methods:Eight patients(five women and three men;mean age 57,range 35-78)with moderate-to-severe chronic plaque psoriasis were included in the study.They were treated with oral mycophenolate mofetil(30 mg/kg/day)over a period of 16 weeks.Following a variable wash out period and after a new outbreak of the disease,oral cyclosporinwas introduced at a dose of 4 mg/kg/day.During both treatment regimens,follow-up visits were performed at 3,8 and 16 weeks.Results:In both groups,the PASI started to decrease once treatment was begun.Cyclosporin was faster and statistically a lot more effective than mycophenolate mofetil,reaching a higher number of complete remissions and better percentages of PASI improvement from baseline(45.7%,60.2%and 60.5%at 3,8 and 16 weeks respectively for mycophenolate mofetil,and 89.7%,95.3%and 95.3%respectively at the same intervals for cyclosporin).Cyclosporin was also more predictable in its action as the percentage of improvement along the follow up visits had a much wider range for mycophenolate mofetil.Overall,the tolerability of both drugs was good.None of the patients had to discontinue treatment because of an adverse event.Two patients treated with cyclosporin showed increased plasma levels of creatinine.Conclusions:Cyclosporin is more effective,fast,and predictable in its effect than mycophenolatemofetil to control moderate-to-severe chronic plaque psoriasis.Both drugs are well tolerated in short courses of treatment.
文摘Objective: To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD). Design: Double-blind, crossover, placebo-contro-lled study. Setting: Gynecological diabetic outpatient clinic and sexual clinic. Patient(s): Thirty-six type 1 premenopausal diabetic women affected by SAD. Intervention(s): Two 8-week periods of sildenafil 100 mg, washout, and placebo, by two possible sequences. Main Outcomes Measure(s): Each woman submitted blood samples to measure HbA 1c, and T, free T (FT), and PRL. Efficacy was assessed [1] subjectively by the Personal Experiences Questionnaire based on the 5- point Likert scale, quantifying arousal, desire, orgasm, enjoyment of sexual activities, and frequency of sexual relationships; and [2] objectively by translabial color Doppler ultrasound to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity of clitoral arteries. Result(s): Thirty-two women completed the study. The mean HbA 1c value was 8.0% ± 1.8% , and plasma concentrations of T, FT, and PRL were normal. Sildenafil seems to improve arousal, orgasm and sexual enjoyment, and dyspareunia in women affected by type 1 diabetes. However, by flowmetric measurements, the mean RI was significantly lower and both the mean PI and PSV of the clitoral arteries were significantly higher compared with baseline and placebo. Conclusion(s): Sildenafil seems to improve subjective sexual aspects and can be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes.
文摘Objective: To assess the impact of long-term treatment with topical timolol on bronchial reactivity in healthy individuals. Methods: Twenty-one other wise healthy individuals with high-pressure primary open-angle glaucoma were enrolled in a randomized controlled clinical trial. Eleven patients underwent 3 years of topical 0.5% timolol treatment followed by a 1- year washout period; 10 patients underwent primary argon laser trabeculoplasty. Functional variables and bronchial reactivity (forced expiratory volume in 1 second and metacholine challenge test results) were assessed in both groups at enrollment and after 3 and 4 years of follow-up. Results: After 3 years, a measurable response to metacholine challenge was recorded in 6 of 11 otherwise symptom-free individuals treated with 0.5% timolol twice daily. A detectable response to metacholine challenge was still present in half of these individuals (3 of 6) when further washed out for 1 year from the topical β-blocker. No significant variation in bronchial reactivity was measured in the laser-treated group during 4 years of follow-up. Conclusions: Healthy individuals who undergo long-term topical application of a nonselective β-blocker (0.5% timolol) can develop a subclinical increase in bronchial reactivity. This phenomenon may not be completely reversible on withdrawal of the β-blocker.
文摘To evaluate the ocular surface inflammatory response to the presence of preservatives in nonselective beta-blocker eyedrops. Prospective, crossover, single-masked, randomized clinical study. study population: Twenty primary open-an-gle glaucoma or ocular hypertensive patients were divided in two groups, one treated with preservative-free timolol 0.5% (group 1) and the other with preserved timolol 0.5% (group 2) eyedrops. After 60 days of therapy and 3 more weeks of washout, the two groups switched to the other therapy. procedure: At each visit, basal tear samples were collected from the inferior conjunctival fornix for the determination of interleukin (IL)-1β tear concentrations by an enzyme-linked immunosorbent assay. Intraocular pressure measurement, conjunctival hyperemia, superficial punctate keratitis, and tear film breakup time were evaluated. main outcome measure: IL-1β concentration in tears following the use of preserved eyedrops. IL-1β tear concentrations increased significantly in both groups,compared with baseline values, during preserved timolol therapy. There were no statistically significant changes in hyperemia and superficial punctate keratitis throughout the study in either group. A statistically significant breakup time reduction was observed in both groups after 30 days and after 60 days of preserved therapy. The use of preservatives in timolol 0.5% eyedrops leads to tear film instability and ocular surface inflammatory changes documented by a reduction of breakup time and an increase of IL-1β tear concentrations. Preservative-free betablockers are preferable for long-term hypotensive therapy to prevent ocular surface inflammation.
