Ursodeoxycholic acid (UDCA) is a safe medical therapy for primary biliary cirr hosis (PBC), but its effect on liver histology remains uncertain. Budesonide is a glucocorticoid with high receptor activity and high firs...Ursodeoxycholic acid (UDCA) is a safe medical therapy for primary biliary cirr hosis (PBC), but its effect on liver histology remains uncertain. Budesonide is a glucocorticoid with high receptor activity and high first-pass metabolism in liver.We evaluated the combination of budesonide and UDCA on liver histology and compared this with UDCA alone in a 3 year prospective, randomized, open multice nter study. Patients with PBC (n = 77), at stages I to III, were randomized into 2 treatment arms, A (n = 41): budesonide 6 mg/d and UDCA 15 mg/kg/d and B (n = 36): UDCA 15mg/kg/d. Liver histology was assessed at the beginning and at the en d of the study. Liver function tests and glucose and cortisol values were determ ined every 4 months. Paired liver biopsy specimens were available from 69 patien ts (A = 37 and B = 32). Stage improved 22%in group A but deteriorated 20%in gr oup B (P = .009). Fibrosis decreased 25%in group A but increased 70%in group B (P = .000 9). S-PIIINP decreased significantly in group A.Inflammation decreas ed in both groups, 34%in group A(P=.02), but only 10%in group B (P = NS). Seru m liver enzymes decreased significantly in both treatment arms. Bilirubin values rose in group B but stayed stable in group A (A/B P = .002).A mild systemic glu cocorticoid effect from budesonide was evident after 2 years. In conclusion, bud esonide combined with UDCA improved liver histology, whereas the effect of UDCA alone was mainly on laboratory values. Studies with longer follow-up using a co mbination of budesonide and UDCA arewarranted to confirm safety and effects.展开更多
Background-Successful antitachycardia pacing(ATP) terminates ventricular tachycardia(VT) up to 250 bpm without the need for painful shocks in implantable cardioverter-defibrillator(ICD) patients. Fast VT(FVT) >200 ...Background-Successful antitachycardia pacing(ATP) terminates ventricular tachycardia(VT) up to 250 bpm without the need for painful shocks in implantable cardioverter-defibrillator(ICD) patients. Fast VT(FVT) >200 bpm is often treated by shock because of safety concerns, however. This prospective, randomized, multicenter trial compares the safety and utility of empirical ATP with shocks for FVT in a broad ICD population. Methods and Results-We randomized 634 ICD patients to 2 arms-standardized empirical ATP(n=313) or shock (n=321)-for initial therapy of spontaneous FVT. ICDs were programmed to detect FVT when 18 of 24 intervals were 188 to 250 bpm and 0 of the last 8 intervals were >250 bpm. Initial FVT therapy was ATP (8 pulses, 88%of FVT cycle length) or shock at 10 J above the defibrillation threshold. Syncope and arrhythmic symptoms were collected through patient diaries and interviews. In 11±3 months of follow-up, 431 episodes of FVT occurred in 98 patients, representing 32%of ventricular tachyarrhythmias and 76%of those that would be detected as ventricular fibrillation and shocked with traditional ICD programming. ATP was effective in 229 of 284 episodes in the ATP arm(81%, 72%adjusted). Acceleration, episode duration, syncope, and sudden death were similar between arms. Quality of life, measured with the SF-36, improved in patients with FVT in both arms but more so in the ATP arm. Conclusions-Compared with shocks, empirical ATP for FVT is highly effective, is equally safe, and improves quality of life. ATP may be the preferred FVT therapy in most ICD patients.展开更多
文摘近年来的研究发现,在ICU内进行机械通气的患者,早期进行深镇静可能是有害的,深镇静是拔管延迟的独立危险因素[1],亦是其6个月病死率增加的独立危险因素[1]。浅镇静的意识越来越深入人心,但是怎样的浅镇静策略是简单易行,具有可操作性,一直是困扰ICU医师的现实问题。2013年Shehabi等[2]在Critical Care
文摘Ursodeoxycholic acid (UDCA) is a safe medical therapy for primary biliary cirr hosis (PBC), but its effect on liver histology remains uncertain. Budesonide is a glucocorticoid with high receptor activity and high first-pass metabolism in liver.We evaluated the combination of budesonide and UDCA on liver histology and compared this with UDCA alone in a 3 year prospective, randomized, open multice nter study. Patients with PBC (n = 77), at stages I to III, were randomized into 2 treatment arms, A (n = 41): budesonide 6 mg/d and UDCA 15 mg/kg/d and B (n = 36): UDCA 15mg/kg/d. Liver histology was assessed at the beginning and at the en d of the study. Liver function tests and glucose and cortisol values were determ ined every 4 months. Paired liver biopsy specimens were available from 69 patien ts (A = 37 and B = 32). Stage improved 22%in group A but deteriorated 20%in gr oup B (P = .009). Fibrosis decreased 25%in group A but increased 70%in group B (P = .000 9). S-PIIINP decreased significantly in group A.Inflammation decreas ed in both groups, 34%in group A(P=.02), but only 10%in group B (P = NS). Seru m liver enzymes decreased significantly in both treatment arms. Bilirubin values rose in group B but stayed stable in group A (A/B P = .002).A mild systemic glu cocorticoid effect from budesonide was evident after 2 years. In conclusion, bud esonide combined with UDCA improved liver histology, whereas the effect of UDCA alone was mainly on laboratory values. Studies with longer follow-up using a co mbination of budesonide and UDCA arewarranted to confirm safety and effects.
文摘Background-Successful antitachycardia pacing(ATP) terminates ventricular tachycardia(VT) up to 250 bpm without the need for painful shocks in implantable cardioverter-defibrillator(ICD) patients. Fast VT(FVT) >200 bpm is often treated by shock because of safety concerns, however. This prospective, randomized, multicenter trial compares the safety and utility of empirical ATP with shocks for FVT in a broad ICD population. Methods and Results-We randomized 634 ICD patients to 2 arms-standardized empirical ATP(n=313) or shock (n=321)-for initial therapy of spontaneous FVT. ICDs were programmed to detect FVT when 18 of 24 intervals were 188 to 250 bpm and 0 of the last 8 intervals were >250 bpm. Initial FVT therapy was ATP (8 pulses, 88%of FVT cycle length) or shock at 10 J above the defibrillation threshold. Syncope and arrhythmic symptoms were collected through patient diaries and interviews. In 11±3 months of follow-up, 431 episodes of FVT occurred in 98 patients, representing 32%of ventricular tachyarrhythmias and 76%of those that would be detected as ventricular fibrillation and shocked with traditional ICD programming. ATP was effective in 229 of 284 episodes in the ATP arm(81%, 72%adjusted). Acceleration, episode duration, syncope, and sudden death were similar between arms. Quality of life, measured with the SF-36, improved in patients with FVT in both arms but more so in the ATP arm. Conclusions-Compared with shocks, empirical ATP for FVT is highly effective, is equally safe, and improves quality of life. ATP may be the preferred FVT therapy in most ICD patients.
