BACKGROUND: The level of the inactive N-terminal fragment of pro-brain(B-type) natriuretic peptide(BNP)-is a strong predictor of mortality among patients with acute coronary syndromes and may be a strong prognostic ma...BACKGROUND: The level of the inactive N-terminal fragment of pro-brain(B-type) natriuretic peptide(BNP)-is a strong predictor of mortality among patients with acute coronary syndromes and may be a strong prognostic marker in patients with chronic coronary heart disease as well. We assessed the relationship between N-terminal pro-BNP(NT-pro-BNP) levels and long-term mortality from all causes in a large cohort of patients with stable coronary heart disease. METHODS: NT-pro-BNP was measured in baseline serum samples from 1034 patients referred for angiography because of symptoms or signs of coronary heart disease. The rate of death from all causes was determined after a median follow-up of nine years. RESULTS: At follow-up, 288 patients had died. The median NT-pro-BNP level was significantly lower among patients who survived than among those who died(120 pg per milliliter[interquartile range, 50 to 318] vs. 386 pg per milliliter[interquartile range, 146 to 897], P< 0.001). Patients with NT-pro-BNP levels in the highest quartile were older, had a lower left ventricular ejection fraction(LVEF) and a lower creatinine clearance rate, and were more likely to have a history of myocardial infarction, clinically significant coronary artery disease, and diabetes than patients with NT-pro-BNP levels in the lowest quartile. In a multivariable Cox regression model, the hazard ratio for death from any cause for the patients with NT-pro-BNP levels in the fourth quartile as compared with those in the first quartile was 2.4(95 percent confidence interval, 1.5 to 4.0; P< 0.001); the NT-pro-BNP level added prognostic information beyond that provided by conventional risk factors, including the patients age; sex; family history with respect to ischemic heart disease; the presence or absence of a history of myocardial infarction, angina, hypertension, diabetes, or chronic heart failure; creatinine clearance rate; body-mass index; smoking status; plasma lipid levels; LVEF; and the presence or absence of clinically significant coronary展开更多
背景与目的:Epstein-Barr病毒VCA/IgA抗体(serum immunoglobulin A against Epstein-Barrvirus capsid antigen,EBV-VCA/IgA)是目前应用最广泛的鼻咽癌诊断指标之一,但它对鼻咽癌预后判断的意义尚不明确。本研究探讨VCA/IgA抗体水平与...背景与目的:Epstein-Barr病毒VCA/IgA抗体(serum immunoglobulin A against Epstein-Barrvirus capsid antigen,EBV-VCA/IgA)是目前应用最广泛的鼻咽癌诊断指标之一,但它对鼻咽癌预后判断的意义尚不明确。本研究探讨VCA/IgA抗体水平与鼻咽癌患者长期生存的关系,为确立VCA/IgA能否作为鼻咽癌独立的预后指标提供依据。方法:根据广东省四会市肿瘤发病与死亡登记资料,选择1990至2003年在中山大学肿瘤防治中心治疗的全部317例四会籍初诊鼻咽癌患者,收集患者的临床与病理资料,分析患者治疗前血清VCA/IgA抗体不同水平与生存期的关系。结果:在临床分期中Ⅲ、Ⅳ期的抗体水平率较Ⅰ、Ⅱ期为高,P=0.01。抗体滴度越高的患者生存时间越短,低水平组(<1∶160)的患者(n=170)与高水平组(≥1∶160)患者(n=147)的5年生存率分别为65.0%和43.0%,P=0.01。多因素分析显示患者的临床分期、性别、治疗年代和EBV-VCA/IgA水平是影响生存期的独立因素。结论:鼻咽癌患者治疗前VCA/IgA抗体水平可能是影响患者生存的独立预后指标。展开更多
Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD t...Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD trials consist of thre e pragmatic multicentre randomized controlled trials, two of which included dysp hagic stroke patients. In one trial, patients enrolled within 7 days of admissio n were randomly allocated to early enteral tube feeding or no tube feeding for m ore than 7 days (early versus avoid). In the other, patients were allocated perc utaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcom e was death or poor outcome at 6 months. Analysis was by intention to treat.Find ings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 ho spitals in 15 countries into the early versus avoid trial. Early tube feeding wa s associated with an absolute reduction in risk of death of 5.8%(95%CI -0.8 t o 12.5, p=0.09) and a reduction in death or poor outcome of 1.2%(-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increa se in risk of death of 1.0%(-10.0 to 11.9, p=0.9) and an increased risk of dea th or poor outcome of 7.8%(0.0 to 15.5, p=0.05). Interpretation Early tube feed ing might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiatio n of PEG feeding in dysphagic stroke patients.展开更多
文摘BACKGROUND: The level of the inactive N-terminal fragment of pro-brain(B-type) natriuretic peptide(BNP)-is a strong predictor of mortality among patients with acute coronary syndromes and may be a strong prognostic marker in patients with chronic coronary heart disease as well. We assessed the relationship between N-terminal pro-BNP(NT-pro-BNP) levels and long-term mortality from all causes in a large cohort of patients with stable coronary heart disease. METHODS: NT-pro-BNP was measured in baseline serum samples from 1034 patients referred for angiography because of symptoms or signs of coronary heart disease. The rate of death from all causes was determined after a median follow-up of nine years. RESULTS: At follow-up, 288 patients had died. The median NT-pro-BNP level was significantly lower among patients who survived than among those who died(120 pg per milliliter[interquartile range, 50 to 318] vs. 386 pg per milliliter[interquartile range, 146 to 897], P< 0.001). Patients with NT-pro-BNP levels in the highest quartile were older, had a lower left ventricular ejection fraction(LVEF) and a lower creatinine clearance rate, and were more likely to have a history of myocardial infarction, clinically significant coronary artery disease, and diabetes than patients with NT-pro-BNP levels in the lowest quartile. In a multivariable Cox regression model, the hazard ratio for death from any cause for the patients with NT-pro-BNP levels in the fourth quartile as compared with those in the first quartile was 2.4(95 percent confidence interval, 1.5 to 4.0; P< 0.001); the NT-pro-BNP level added prognostic information beyond that provided by conventional risk factors, including the patients age; sex; family history with respect to ischemic heart disease; the presence or absence of a history of myocardial infarction, angina, hypertension, diabetes, or chronic heart failure; creatinine clearance rate; body-mass index; smoking status; plasma lipid levels; LVEF; and the presence or absence of clinically significant coronary
文摘背景与目的:Epstein-Barr病毒VCA/IgA抗体(serum immunoglobulin A against Epstein-Barrvirus capsid antigen,EBV-VCA/IgA)是目前应用最广泛的鼻咽癌诊断指标之一,但它对鼻咽癌预后判断的意义尚不明确。本研究探讨VCA/IgA抗体水平与鼻咽癌患者长期生存的关系,为确立VCA/IgA能否作为鼻咽癌独立的预后指标提供依据。方法:根据广东省四会市肿瘤发病与死亡登记资料,选择1990至2003年在中山大学肿瘤防治中心治疗的全部317例四会籍初诊鼻咽癌患者,收集患者的临床与病理资料,分析患者治疗前血清VCA/IgA抗体不同水平与生存期的关系。结果:在临床分期中Ⅲ、Ⅳ期的抗体水平率较Ⅰ、Ⅱ期为高,P=0.01。抗体滴度越高的患者生存时间越短,低水平组(<1∶160)的患者(n=170)与高水平组(≥1∶160)患者(n=147)的5年生存率分别为65.0%和43.0%,P=0.01。多因素分析显示患者的临床分期、性别、治疗年代和EBV-VCA/IgA水平是影响生存期的独立因素。结论:鼻咽癌患者治疗前VCA/IgA抗体水平可能是影响患者生存的独立预后指标。
文摘Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD trials consist of thre e pragmatic multicentre randomized controlled trials, two of which included dysp hagic stroke patients. In one trial, patients enrolled within 7 days of admissio n were randomly allocated to early enteral tube feeding or no tube feeding for m ore than 7 days (early versus avoid). In the other, patients were allocated perc utaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcom e was death or poor outcome at 6 months. Analysis was by intention to treat.Find ings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 ho spitals in 15 countries into the early versus avoid trial. Early tube feeding wa s associated with an absolute reduction in risk of death of 5.8%(95%CI -0.8 t o 12.5, p=0.09) and a reduction in death or poor outcome of 1.2%(-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increa se in risk of death of 1.0%(-10.0 to 11.9, p=0.9) and an increased risk of dea th or poor outcome of 7.8%(0.0 to 15.5, p=0.05). Interpretation Early tube feed ing might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiatio n of PEG feeding in dysphagic stroke patients.
