医学要问

admin Post in 2015.04, 医学新闻
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  1. In the December 24 and 31, 2014 issue of JAMA, a systemic review of addresses safety issues associated with metformin therapy in diabetic patients with chronic kidney disease. The review found that in patients with mild to moderate chronic kidney disease, use was associated with slight elevation of lactic acid but these were not clinically worrisome.
  1. In a retrospective study in the December 2014 issue of JAMA Surgery, researchers compared outcomes after lobectomy, sublobar resection, or stereotactic ablative radiotherapy for management of none-small-cell lung cancer in older adults. They found  that unadjusted three-year mortality with highest after stereotactic ablative therapy;  after adjusting for baseline differences between groups, the three-year mortality after ablative radiotherapy was similar to that after lobectomy and 3- month motility was lower in patients who received stereotactic ablative therapy than in those who underwent surgery.
  1. In a meta-analysis on the website of The BMJ, researchers evaluating the association between blood glucose concentration and the risk for pancreatic cancer show a strong linear dose-response relationship.
  1. In a double-blind trial in the January 2015 Annals of the Rheumatic Diseases, patients with early rheumatoid arthritis were randomized to receive either low-dose or high-dose fish oil therapy in addition to their standard triple-therapy disease-modifying regimen. Compared with the low-dose fish oil therapy, height-dose therapy was associated with lower rate of failure of the disease-modifying regimen and shorter time to first remission.
  1. In a study in the January 2015 Annals of the Rheumatic Diseases, researchers evaluated the utility of IgG4 levels in diagnosing IgG4-related disease. They found that an elevated level of IgG 4 is insufficient to diagnose IgG4-related disease.
  1. The relationship between nerve impairment in the lower limbs and subsequent development of mobility problems was investigated in a prospective study in the December 2014 Journal of the American Geriatric Society. The findings suggest that peripheral nerve impairment at baseline he is directly associated with risk for incident disability in all-comers.
  1. In a study in the January 6, 2015 Annals of Internal Medicin, researchers sought to determine whether anticoagulation therapy can be safely discontinued 3-7 months after first unprovoked venous thromboembolism in patients whose D-dimer test is negative. Their findings support  continuation of anticoagulation therapy despite negative D-dimer test unless risk for bleeding is unacceptably high.
  2. In a study in the January 1, 2015 Journal of Infectious Diseases, researchers used a rat model to study the effects of antiplatelet drugs and anticoagulants on the development of endocarditis. The incidence of endocarditis was significantly decreased with Abciximab (anti-glycoprotein IIb/III monoclonal antibody) and aspirin plus ticlopidine.
  1. In a trial on the website of the BMJ, woman more than 55 years of age with mild prolapse of the pelvic organs were randomized to either pelvic floor training or watchful waiting. Pelvic floor training was associated with decrease in urinary and overall symptom scores.
  1. In a meta-analysis on the website of the Annals of Internal Medicine, researchers evaluated the effects of antihypertensive therapy in patients with mild (stage I) hypertension. They show that, in this population of patients, blood pressure-lowering therapy is associated with significant reductions in stroke, cardiovascular-related death,  and overall death.

 

  1. 2014年12月24日JAMA,就二甲双胍治疗合并慢性肾脏病的糖尿病相关的安全问题进行了系统性审查。审查发现,轻中度慢性肾脏疾病的病人,使用二甲双胍与乳酸轻度升高有关,但无临床意义 (JAMA 2014 Dec 24: 312:2668)。
  1. 在2014年12月JAMA外科杂志上, 一项回顾性研究比较了肺叶切除术,部分肺叶切除术,或立体定向消融放疗 (sterotactic ablative radiotherapy)老年非小细胞肺癌的结果。他们发现,立体定向消融治疗未经调整的3年死亡率最高;调整群体间的基线差异后,立体定向消融治疗与肺叶切除三年死亡率相似,但3个月死亡率明显低于手术患者 (JAMA Surg 2014 Dec; 149:1244)。
  1. BMJ网站上一项荟萃分析发现, 血糖浓度和胰腺癌风险之间有强烈的线性剂量 – 反应关系 (BMJ 2015 Jan 2; 349:g7371)。
  1. 在2015年1月风湿性病杂志的一项双盲试验中,接受标准三联疗法的早期类风湿关节炎患者被随机分配接受低剂量或高剂量的鱼油治疗。与低剂量鱼油治疗相比,高剂量鱼油治疗患者三联疗法成功率较高,达到第一次缓解较快 (Ann Rheum Dis 2015 Jan; 74:89)。
  1. 2015年1月风湿性病杂志的一项研究评估了IgG4水平诊断IgG4相关疾病的效用。他们发现,IgG 4升高不足以诊断IgG4相关的疾病 (Ann Rheum Dis 2015 Jan 74:14)。
  1. 2014年12月美国老年病学协会杂志就下肢神经损害和下肢运动功能之间的关系进行了前瞻性研究。调查结果显示,周围神经损伤直接与残疾有关 (J Am Geriatr Soc 2014 Dec; 62:2273)。
  1. 在2015年1月6内科年鉴的研究中,研究人员试图确定第一次无诱因静脉血栓栓塞患者的抗凝治疗是否可以在3-7个月后, D-二聚体检测阴性的前提下,安全地停止。他们的研究结果支持继续抗凝治疗,除非出血风险不可接受 (Ann Intern Med 2015 Jan 6; 162:27)。
  1. 在2015年1月1日传染病杂志上,研究人员利用大鼠模型来研究抗血小板药物和抗凝药物对性心内膜炎发病的影响。心内膜炎的发病率在用阿昔单抗(抗糖蛋白Ⅱb/ III单克隆抗体)和阿司匹林加噻氯匹定 (ticlopidine) 治疗时显著下降 (J Infect Dis 2015 Jan 1; 211:72)。
  1. 在BMJ的网站上的一项研究中,超过55岁的盆腔器官轻微脱垂的女患者被随机分配到盆底训练或观察等待组。盆底训练组尿濒和总体症状均减少 (BMJ 2014 Dec 22; 349:g7378)。
  1. 内科医学年鉴网站上一项荟萃分析评估了轻度(Ⅰ期)高血压患者降压治疗的效果。结果表明, 降血压治疗与显著降低中风,降低心血管相关的死亡,和整体死亡相关联 (Ann Intern Med 2014 Dec 23; (e-pub ahead of print))。
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