BACKGROUND: Selective cyclooxygenase-2 (COX-2) in hibitors have come under s crutiny because of reports su- ggesting an increased cardiovascular risk associated with their use. Experimen tal research suggesting that t...BACKGROUND: Selective cyclooxygenase-2 (COX-2) in hibitors have come under s crutiny because of reports su- ggesting an increased cardiovascular risk associated with their use. Experimen tal research suggesting that these drugs may contribute to a prothrombotic state providessupport for this concern . METHODS: We reviewed all potentially serious cardiovascular events among 2035 patients with a history of colorectal neoplasia who were enrolled in a trial com paring two doses of celecoxib (200 mg or 400 mg twice daily) with placebo for th e prevention of colorectal adenomas. All deaths were categorized as cardiovascul ar or noncardiovascular, and nonfatal cardiovascular events were categorized in a blinded fashion according to a prespecified scheme. RESULTS: For all patients except those who died, 2.8 to 3.1 years of follow-up data were available. A com posite cardiovascular end point of death from cardiovascular causes, myocardial infarction, stroke, or heart failure was reached in 7 of 679 patients in the pla cebo group (1.0 percent), as compared with 16 of 685 patients receiving 200 mg o f celecoxib twice daily (2.3 percent; hazard ratio, 2.3; 95 percent confidence i nterval, 0.9 to 5.5) and with 23 of 671 patients receiving 400 mg of celecoxib t wice daily (3.4 percent; hazard ratio, 3.4; 95 percent confidence interval,1.4 t o 7.8). Similar trends were observed for other composite end points. On the basi s of these observations,the data and safety monitoring board recommended early d iscontinuation of the study drug. CONCLUSIONS: Celecoxib use was associated with a dose-related increase in the composite end point of death from cardiovascula r causes, myocardial infarction, stroke, or heart failure. In light of recent re ports of cardiovascular harm associated with treatment with other agents in this class, these data provide further evidence that the use of COX-2 inhibitors ma y increase the risk of serious cardiovascular events.展开更多
Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training thro...Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training through practical exercises on abstracted and reduced models.Methods The authors strive for a portable,easy to use and cost-effective Virtual Reality-based(VR)laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens.Current VR controllers are limited regarding haptic feedback.Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training,the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback,a commercially available head-mounted display,a VR environment for simulating a laparoscopic surgery,and a training concept.Results To take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training,the system shall not require a tissue sample for haptic feedback.It is currently calculated and visually displayed to the user in the VR environment.On the prototype controller,a first axis was provided with perceptible feedback for test purposes.Two of the prototype VR controllers can be combined to simulate a typical both-handed use case,e.g.,laparoscopic suturing.A Unity based VR prototype allows the execution of simple standard pre-trainings.Conclusions The first prototype enables full operation of a virtual laparoscopic instrument in VR.In addition,the simulation can compute simple interaction forces.Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback.Mechanical weaknesses were identified in the first hardware prototype,which will be improved in subsequent versions.All degrees of freedom of the controller are to be provided with haptic feedback.To make forces tangible in the simulation,characteristic values 展开更多
美国心脏学会（American College of Cardiology，ACC）与美国心脏病协会（American Heart Association．AHA）关于二级预防的共识声明自2001年更新以来，许多临床试验提供了重要证据．进一步支持和拓展了对冠心病和其他动脉粥样硬化性...美国心脏学会（American College of Cardiology，ACC）与美国心脏病协会（American Heart Association．AHA）关于二级预防的共识声明自2001年更新以来，许多临床试验提供了重要证据．进一步支持和拓展了对冠心病和其他动脉粥样硬化性血管疾病（包括外周动脉疾病、动脉粥样硬化性主动脉疾病和颈动脉疾病）进行积极控制危险因素治疗的重要性。证据不断涌现，证实对这些患者进行积极而全面的危险因素干预治疗能够改善生存率，减少事件复发以及对介入治疗的需要．并提高生活质量。展开更多
Recent guidelines restricted aspirin(ASA)in primary prevention of cardiovascular disease(CVD)to patients<70 years old and more recent guidance to<60.In the most comprehensive prior meta-analysis,the Antithrombot...Recent guidelines restricted aspirin(ASA)in primary prevention of cardiovascular disease(CVD)to patients<70 years old and more recent guidance to<60.In the most comprehensive prior meta-analysis,the Antithrombotic Trialists Collaboration reported a significant 12%reduction in CVD with similar benefit−risk ratios at older ages.Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,four trials were added to an updated meta-analysis.ASA produced a statistically significant 13%reduction in CVD with 95%confidence limits(0.83 to 0.92)with similar benefits at older ages in each of the trials.Primary care providers should make individual decisions whether to prescribe ASA based on benefit−risk ratio,not simply age.When the absolute risk of CVD is>10%,benefits of ASA will generally outweigh risks of significant bleeding.ASA should be considered only after implementation of therapeutic lifestyle changes and other drugs of proven benefit such as statins,which are,at the very least,additive to ASA.Our perspective is that individual clinical judgements by primary care providers about prescription of ASA in primary prevention of CVD should be based on our evidence-based solution of weighing all the absolute benefits and risks rather than age.This strategy would do far more good for far more patients as well as far more good than harm in both developed and developing countries.This new and novel strategy for primary care providers to consider in prescribing ASA in primary prevention of CVD is the same as the general approach suggested by Professor Geoffrey Rose decades ago.展开更多
The human brain is built to process complex visual impressions within milliseconds. In comparison with sequentially coded spoken language and written texts, we are capable of consuming graphical information at a high ...The human brain is built to process complex visual impressions within milliseconds. In comparison with sequentially coded spoken language and written texts, we are capable of consuming graphical information at a high bandwidth in a parallel fashion, producing a picture worth more than a thousand words. Effective information visualization can be a powerful tool to capture people's attention and quickly communicate large amounts of data and complex information. This is particularly important in the context of communication data, which often describes entities (people, organizations) and their connections through communication. Visual analytics approaches can optimize the user-computer interaction to gain insights into communication networks and learn about their structures. Network visualization is a perfect instrument to better communicate the results of analysis. The precondition for effective information visualization and successful visual reasoning is the capability to draw "good" pictures. Even though communication networks are often large, including thousands or even millions of people, underlying visualization principles are identical to those used for visualizing smaller networks. In this article, you will learn about these principles, giving you the ability to assess the quality of network visualizations and to draw better network pictures by yourself.展开更多
背景：血管紧张素转换酶（angiotensin-converting enzyme，ACE）抑制剂可降低心肌梗死（myocardial infarction，MI）的危险，但是还不清楚血管紧张素受体拮抗剂是否具有同样的效果。
目的：评价血管紧张素受体拮抗剂坎地沙坦对心力...背景：血管紧张素转换酶（angiotensin-converting enzyme，ACE）抑制剂可降低心肌梗死（myocardial infarction，MI）的危险，但是还不清楚血管紧张素受体拮抗剂是否具有同样的效果。
目的：评价血管紧张素受体拮抗剂坎地沙坦对心力衰竭患者MI和其他冠脉事件的影响。
设计、地点和参试者：“坎地沙坦治疗心力衰竭：降低病死率和发病率评价”（Candesartan in Heart Failure：Assessment of Reduction in Mortality and Morbidity，CHARM）计划是一项随机、安慰剂对照研究。研究入选有纽约心脏病协会分级Ⅱ至Ⅳ级症状的患者（平均年龄，66[SD，11]岁）。在心力衰竭最佳治疗的基础上，随机接受坎地沙坦（目标剂量，32mg每天一次）或匹配的安慰剂。患者入选期为1999年3月至2001年3月。分组的7599例患者中，4004例（53％）有MI病史，1808例（24％）患有心绞痛。基线时，服用ACE抑制剂3125例（41％）；服用β-阻滞剂4203（55％）例；降脂药物3153例（42％）；阿斯匹林4246例（56％）；利尿药6286例（83％）。
主要观测指标：该分析的主要终点为坎地沙坦或安慰剂组心力衰竭患者心血管死亡和非致死性MI复合发生率。
结果：在37．7个月的中位随访期间，坎地沙坦组（775例患者[20．4％]）心血管死亡和非致死性MI主要终点的发生率明显低于安慰剂组（868[22．9％]）（风险比[hazard ratio，HR]，0．87；95％可信区间[confidence interval，CI]，0．79-0．96；P=0．004；所需治疗例数[numbe rneeded to treat，NNT]，40）。与安慰剂组（522[13．8％]）比较，坎地沙坦组（459[12．1％]）单纯非致死性MI也明显降低（HR，0．86；95％CI，0．75-0．97；P=0．02；NNT，59）。在CHARM试验预先设定的不同亚组和分析间，心血管死亡和非致死性MI危险的降低相似。坎地沙坦对不稳定心绞痛或冠脉血运重建导致的住院没有影响。结�展开更多
BACKGROUND: The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. Renal failure is associated with one of the highest risks, but the influence of milder degrees ...BACKGROUND: The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. Renal failure is associated with one of the highest risks, but the influence of milder degrees of renal impairment i s less well defined. METHODS: As part of the Valsartan in Acute Myocardial Infar ction Trial (VALIANT), we identified 14,527 patients with acute myocardial infar ction complicated by clinical or radiologic signs of heart failure, left ventric ular dysfunction, or both, and a documented serum creatinine measurement. Patien ts were randomly assigned to receive captopril, valsartan, or both. The glomerul ar filtration rate (GFR) was estimated by means of the four component Modificat ion of Diet in Renal Disease equation, and the patients were grouped according t o their estimated GFR. We used a 70-candidate variable model to adjust and comp are overall mortality and composite cardiovascular events among four GFR groups. RESULTS: The distribution of estimated GFR was wide and normally shaped, with a mean (±SD) value of 70±21 ml per minute per 1.73 m2 of bodysurface area. The prevalence of co existing risk factors, prior cardiovascular disease, and a Kil lip class of more than I was greatest among patients with a reduced estimated GF R (less than 45.0 ml per minute per 1.73 m2), and the use of aspirin, beta bloc kers, statins, or coronary revascularization procedures was lowest in this group . The risk of death or the composite end point of death from cardiovascular caus es, reinfarction, congestive heart failure, stroke, or resuscitation after cardi ac arrest increased with declining estimated GFRs. Although the rate of renal ev ents increased with declining estimated GFRs, the adverse outcomes were predomin antly cardiovascular. Below 81.0 ml per minute per 1.73 m2, each reduction of th e estimated GFR by 10 units was associated with a hazard ratio for death and non fatal cardiovascular outcomes of 1.10(95 percent confidence interval, 1.08 to 1. 12), which was independent of the 展开更多
背景：他汀治疗的时机和强度会对急性冠脉综合征(acute coronary syndrome，ACS)的临床结局产生何种影响?目前尚缺乏相关评估资料。目的：在ACS患者中比较早期强化他汀治疗与迟发低强度他汀治疗的疗效与安全性。设计、地点和参试者：国...背景：他汀治疗的时机和强度会对急性冠脉综合征(acute coronary syndrome，ACS)的临床结局产生何种影响?目前尚缺乏相关评估资料。目的：在ACS患者中比较早期强化他汀治疗与迟发低强度他汀治疗的疗效与安全性。设计、地点和参试者：国际化随机双盲试验。于1999年12月29日～2003年1月6日参与A to Z试验Z阶段研究的ACS患者中，2265例接受辛伐他汀40mg／d，1个月后剂量增至80mg／d；另2232例接受安慰剂，4个月后服用辛伐他汀20mg／d。二者进行比较。主要观察指标：一级研究终点包括心血管死亡、非致死性心肌梗死、ACS再入院以及卒中。随访6～24个月。结果：安慰剂+辛伐他汀组患者服用安慰剂1个月后低密度脂蛋白(low-density lipoprotein．LDL)胆固醇中值水平为122mg／dL(3．16mmol／L)，服用辛伐他汀20mg／d8个月后LDL胆固醇中值水平为77mg／dL(1．99mmol／L)。单用辛伐他汀组患者服用辛伐他汀40mg／d1个月后LDL胆固醇平均水平为68mg／dL(1．76mmol／L)，服用辛伐他汀80mg／d8个月后LDL胆固醇平均水平为63mg／dL(1．63mmol／L)。安慰剂+辛伐他汀组共有343例患者(占16．7％)出现一级终点事件，而单用辛伐他汀组(40mg／80mg)有309例患者(占14．4％)出现一级终点事件(风险比[HR]，0．89；95％可信区间[CI]，0．76～1．04；P=0．14)。两组中分别有109例(占5．4％)和83例(占4．1％)患者出现心血管死亡(HR，0．75；95％ CI 0．57～1．00；P=0．05)。其他各一级终点事件无差异。前4个月，两组一级终点事件无显著差异(HR，1．01；95％CI，0.83～1.25；P=0．89)，从第4个月起至研究结束，单用辛伐他汀组一级终点事件明显减少(HR，0．75；95％CI，0．60～0．95；P=0．02)。9例(占0．4％)接受辛伐他汀80mg／d治疗的患者发生肌病(肌酸激酶高于正常值上限10倍，同时伴有肌肉症状)，服用低剂量辛伐他汀的患者未出现肌�展开更多
文摘BACKGROUND: Selective cyclooxygenase-2 (COX-2) in hibitors have come under s crutiny because of reports su- ggesting an increased cardiovascular risk associated with their use. Experimen tal research suggesting that these drugs may contribute to a prothrombotic state providessupport for this concern . METHODS: We reviewed all potentially serious cardiovascular events among 2035 patients with a history of colorectal neoplasia who were enrolled in a trial com paring two doses of celecoxib (200 mg or 400 mg twice daily) with placebo for th e prevention of colorectal adenomas. All deaths were categorized as cardiovascul ar or noncardiovascular, and nonfatal cardiovascular events were categorized in a blinded fashion according to a prespecified scheme. RESULTS: For all patients except those who died, 2.8 to 3.1 years of follow-up data were available. A com posite cardiovascular end point of death from cardiovascular causes, myocardial infarction, stroke, or heart failure was reached in 7 of 679 patients in the pla cebo group (1.0 percent), as compared with 16 of 685 patients receiving 200 mg o f celecoxib twice daily (2.3 percent; hazard ratio, 2.3; 95 percent confidence i nterval, 0.9 to 5.5) and with 23 of 671 patients receiving 400 mg of celecoxib t wice daily (3.4 percent; hazard ratio, 3.4; 95 percent confidence interval,1.4 t o 7.8). Similar trends were observed for other composite end points. On the basi s of these observations,the data and safety monitoring board recommended early d iscontinuation of the study drug. CONCLUSIONS: Celecoxib use was associated with a dose-related increase in the composite end point of death from cardiovascula r causes, myocardial infarction, stroke, or heart failure. In light of recent re ports of cardiovascular harm associated with treatment with other agents in this class, these data provide further evidence that the use of COX-2 inhibitors ma y increase the risk of serious cardiovascular events.
文摘Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training through practical exercises on abstracted and reduced models.Methods The authors strive for a portable,easy to use and cost-effective Virtual Reality-based(VR)laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens.Current VR controllers are limited regarding haptic feedback.Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training,the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback,a commercially available head-mounted display,a VR environment for simulating a laparoscopic surgery,and a training concept.Results To take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training,the system shall not require a tissue sample for haptic feedback.It is currently calculated and visually displayed to the user in the VR environment.On the prototype controller,a first axis was provided with perceptible feedback for test purposes.Two of the prototype VR controllers can be combined to simulate a typical both-handed use case,e.g.,laparoscopic suturing.A Unity based VR prototype allows the execution of simple standard pre-trainings.Conclusions The first prototype enables full operation of a virtual laparoscopic instrument in VR.In addition,the simulation can compute simple interaction forces.Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback.Mechanical weaknesses were identified in the first hardware prototype,which will be improved in subsequent versions.All degrees of freedom of the controller are to be provided with haptic feedback.To make forces tangible in the simulation,characteristic values
文摘美国心脏学会（American College of Cardiology，ACC）与美国心脏病协会（American Heart Association．AHA）关于二级预防的共识声明自2001年更新以来，许多临床试验提供了重要证据．进一步支持和拓展了对冠心病和其他动脉粥样硬化性血管疾病（包括外周动脉疾病、动脉粥样硬化性主动脉疾病和颈动脉疾病）进行积极控制危险因素治疗的重要性。证据不断涌现，证实对这些患者进行积极而全面的危险因素干预治疗能够改善生存率，减少事件复发以及对介入治疗的需要．并提高生活质量。
文摘背景：对于非ST段抬高急性冠脉综合征（acute coronary syndromes，ACS）患者而言，与单独应用普通肝素相比，依诺肝素或者血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂替罗非班与普通肝素联合应用都显示出较好的疗效。目前，尚不清楚依诺肝素和替罗非班联合应用是否像普通肝素和替罗非班标准联合方案一样安全有效。目的：在非ST段抬高的ACS患者中评价依诺肝素和替罗非班联合疗法与普通肝素和替罗非班联合方案的疗效及安全性。设计、地点及参试者：国际前瞻性、开标（open—label）、随机、非劣势（noninferiority）试验。在接受替罗非班和阿斯匹林治疗的非ST段抬高ACS患者中分别给予依诺肝素1mg／kg（n=2026）每12小时一次或经体重校正的静脉普通肝素（n=1961），然后进行比较。这项A to Z试验的A阶段试验是于1999年12月至2002年5月进行的。主要观察指标：意向治疗人群7天时死亡、再发心肌梗死和难治性缺血的发生情况，该意向治疗人群是根据优效性和非劣势原则确定的。应用“心肌梗死溶栓治疗试验”（Thrombolysis in Myocardial Infarction，TIMI）中之出血分级系统，通过监测出血发生率判定用药安全性。结果：在治疗第7天时，随机分配至依诺肝素组的2018例患者中有169例（8．4％）发生死亡、心肌梗死或者难治性缺血，而普通肝素组的1952例患者中有184例（9．4％）发生上述事件（风险比[hazard ratio，HR]为0．88，95％可信区间[confidence interval，CI]为0．71～1．08）。该结果符合预先设定的非劣势标准。除死亡外，所有一级和二级复合终点事件分析结果均提示，依诺肝素更为有益。死亡仅见于1％的患者（依诺肝素组23例，普通肝素组17例）。任何TIMI分级的出血发生率都很低（依诺肝素组为3．0％，普通肝素组为2．2％；P=0．13）。最差情况分析（合并了两种独立的
文摘Recent guidelines restricted aspirin(ASA)in primary prevention of cardiovascular disease(CVD)to patients<70 years old and more recent guidance to<60.In the most comprehensive prior meta-analysis,the Antithrombotic Trialists Collaboration reported a significant 12%reduction in CVD with similar benefit−risk ratios at older ages.Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,four trials were added to an updated meta-analysis.ASA produced a statistically significant 13%reduction in CVD with 95%confidence limits(0.83 to 0.92)with similar benefits at older ages in each of the trials.Primary care providers should make individual decisions whether to prescribe ASA based on benefit−risk ratio,not simply age.When the absolute risk of CVD is>10%,benefits of ASA will generally outweigh risks of significant bleeding.ASA should be considered only after implementation of therapeutic lifestyle changes and other drugs of proven benefit such as statins,which are,at the very least,additive to ASA.Our perspective is that individual clinical judgements by primary care providers about prescription of ASA in primary prevention of CVD should be based on our evidence-based solution of weighing all the absolute benefits and risks rather than age.This strategy would do far more good for far more patients as well as far more good than harm in both developed and developing countries.This new and novel strategy for primary care providers to consider in prescribing ASA in primary prevention of CVD is the same as the general approach suggested by Professor Geoffrey Rose decades ago.
基金The research project on the fragments of the Giant Budd has of Bamiyan has been supported by international,Afghan and German institutions. ICOMOS and the UNESCO provided the financing of research and conservation work on site.
文摘The human brain is built to process complex visual impressions within milliseconds. In comparison with sequentially coded spoken language and written texts, we are capable of consuming graphical information at a high bandwidth in a parallel fashion, producing a picture worth more than a thousand words. Effective information visualization can be a powerful tool to capture people's attention and quickly communicate large amounts of data and complex information. This is particularly important in the context of communication data, which often describes entities (people, organizations) and their connections through communication. Visual analytics approaches can optimize the user-computer interaction to gain insights into communication networks and learn about their structures. Network visualization is a perfect instrument to better communicate the results of analysis. The precondition for effective information visualization and successful visual reasoning is the capability to draw "good" pictures. Even though communication networks are often large, including thousands or even millions of people, underlying visualization principles are identical to those used for visualizing smaller networks. In this article, you will learn about these principles, giving you the ability to assess the quality of network visualizations and to draw better network pictures by yourself.
文摘背景：血管紧张素转换酶（angiotensin-converting enzyme，ACE）抑制剂可降低心肌梗死（myocardial infarction，MI）的危险，但是还不清楚血管紧张素受体拮抗剂是否具有同样的效果。
目的：评价血管紧张素受体拮抗剂坎地沙坦对心力衰竭患者MI和其他冠脉事件的影响。
设计、地点和参试者：“坎地沙坦治疗心力衰竭：降低病死率和发病率评价”（Candesartan in Heart Failure：Assessment of Reduction in Mortality and Morbidity，CHARM）计划是一项随机、安慰剂对照研究。研究入选有纽约心脏病协会分级Ⅱ至Ⅳ级症状的患者（平均年龄，66[SD，11]岁）。在心力衰竭最佳治疗的基础上，随机接受坎地沙坦（目标剂量，32mg每天一次）或匹配的安慰剂。患者入选期为1999年3月至2001年3月。分组的7599例患者中，4004例（53％）有MI病史，1808例（24％）患有心绞痛。基线时，服用ACE抑制剂3125例（41％）；服用β-阻滞剂4203（55％）例；降脂药物3153例（42％）；阿斯匹林4246例（56％）；利尿药6286例（83％）。
主要观测指标：该分析的主要终点为坎地沙坦或安慰剂组心力衰竭患者心血管死亡和非致死性MI复合发生率。
结果：在37．7个月的中位随访期间，坎地沙坦组（775例患者[20．4％]）心血管死亡和非致死性MI主要终点的发生率明显低于安慰剂组（868[22．9％]）（风险比[hazard ratio，HR]，0．87；95％可信区间[confidence interval，CI]，0．79-0．96；P=0．004；所需治疗例数[numbe rneeded to treat，NNT]，40）。与安慰剂组（522[13．8％]）比较，坎地沙坦组（459[12．1％]）单纯非致死性MI也明显降低（HR，0．86；95％CI，0．75-0．97；P=0．02；NNT，59）。在CHARM试验预先设定的不同亚组和分析间，心血管死亡和非致死性MI危险的降低相似。坎地沙坦对不稳定心绞痛或冠脉血运重建导致的住院没有影响。结�
文摘BACKGROUND: The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. Renal failure is associated with one of the highest risks, but the influence of milder degrees of renal impairment i s less well defined. METHODS: As part of the Valsartan in Acute Myocardial Infar ction Trial (VALIANT), we identified 14,527 patients with acute myocardial infar ction complicated by clinical or radiologic signs of heart failure, left ventric ular dysfunction, or both, and a documented serum creatinine measurement. Patien ts were randomly assigned to receive captopril, valsartan, or both. The glomerul ar filtration rate (GFR) was estimated by means of the four component Modificat ion of Diet in Renal Disease equation, and the patients were grouped according t o their estimated GFR. We used a 70-candidate variable model to adjust and comp are overall mortality and composite cardiovascular events among four GFR groups. RESULTS: The distribution of estimated GFR was wide and normally shaped, with a mean (±SD) value of 70±21 ml per minute per 1.73 m2 of bodysurface area. The prevalence of co existing risk factors, prior cardiovascular disease, and a Kil lip class of more than I was greatest among patients with a reduced estimated GF R (less than 45.0 ml per minute per 1.73 m2), and the use of aspirin, beta bloc kers, statins, or coronary revascularization procedures was lowest in this group . The risk of death or the composite end point of death from cardiovascular caus es, reinfarction, congestive heart failure, stroke, or resuscitation after cardi ac arrest increased with declining estimated GFRs. Although the rate of renal ev ents increased with declining estimated GFRs, the adverse outcomes were predomin antly cardiovascular. Below 81.0 ml per minute per 1.73 m2, each reduction of th e estimated GFR by 10 units was associated with a hazard ratio for death and non fatal cardiovascular outcomes of 1.10(95 percent confidence interval, 1.08 to 1. 12), which was independent of the
文摘背景：他汀治疗的时机和强度会对急性冠脉综合征(acute coronary syndrome，ACS)的临床结局产生何种影响?目前尚缺乏相关评估资料。目的：在ACS患者中比较早期强化他汀治疗与迟发低强度他汀治疗的疗效与安全性。设计、地点和参试者：国际化随机双盲试验。于1999年12月29日～2003年1月6日参与A to Z试验Z阶段研究的ACS患者中，2265例接受辛伐他汀40mg／d，1个月后剂量增至80mg／d；另2232例接受安慰剂，4个月后服用辛伐他汀20mg／d。二者进行比较。主要观察指标：一级研究终点包括心血管死亡、非致死性心肌梗死、ACS再入院以及卒中。随访6～24个月。结果：安慰剂+辛伐他汀组患者服用安慰剂1个月后低密度脂蛋白(low-density lipoprotein．LDL)胆固醇中值水平为122mg／dL(3．16mmol／L)，服用辛伐他汀20mg／d8个月后LDL胆固醇中值水平为77mg／dL(1．99mmol／L)。单用辛伐他汀组患者服用辛伐他汀40mg／d1个月后LDL胆固醇平均水平为68mg／dL(1．76mmol／L)，服用辛伐他汀80mg／d8个月后LDL胆固醇平均水平为63mg／dL(1．63mmol／L)。安慰剂+辛伐他汀组共有343例患者(占16．7％)出现一级终点事件，而单用辛伐他汀组(40mg／80mg)有309例患者(占14．4％)出现一级终点事件(风险比[HR]，0．89；95％可信区间[CI]，0．76～1．04；P=0．14)。两组中分别有109例(占5．4％)和83例(占4．1％)患者出现心血管死亡(HR，0．75；95％ CI 0．57～1．00；P=0．05)。其他各一级终点事件无差异。前4个月，两组一级终点事件无显著差异(HR，1．01；95％CI，0.83～1.25；P=0．89)，从第4个月起至研究结束，单用辛伐他汀组一级终点事件明显减少(HR，0．75；95％CI，0．60～0．95；P=0．02)。9例(占0．4％)接受辛伐他汀80mg／d治疗的患者发生肌病(肌酸激酶高于正常值上限10倍，同时伴有肌肉症状)，服用低剂量辛伐他汀的患者未出现肌�
