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Nephroprotective effect of SGLT2 inhibitors in elderly patients with type 2 diabetes mellitus and hypertension: a real-world population-based cohort study. SGLT2 抑制剂对老年 2 型糖尿病和高血压患者的肾脏保护作用:一项基于真实世界人群的队列研究。
Pub Date : 2024-11-01 Epub Date: 2024-11-13 DOI: 10.1080/00325481.2024.2426442
Shasha Geng, Yang Li, Jianli Ge, Yue Liu, Qingqing Li, Xin Chen, Yingqian Zhu, Xiaotong Guo, Huixiao Yuan, Xiaoli Wang, Hua Jiang

Objectives: This study aimed to investigate the nephroprotective effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in elderly patients with type 2 diabetes mellitus (T2DM) and hypertension based on real-world clinical data. The study aimed to provide a theoretical basis for evidence-based pharmacological treatment of chronic kidney disease in this population.

Methods: The 'Health Cloud' platform of the Shanghai Municipal Health Commission was employed to identify and screen elderly patients with T2DM and hypertension. The propensity score matching cohort was further constructed to estimate the effect of SGLT2i on the risk of rapid decline in renal function (∆eGFR≤-5 mL/min/1.73 m2 or ∆eGFR%≤-5%). Multiple sensitivity analyses were conducted to assess the robustness of the results.

Results: After propensity score matching, no significant differences of covariates were identified between the SGLT2i and non-SGLT2i groups. The results of multivariate logistic models demonstrated a consistent and inverse correlation between SGLT2i use and the risk of rapid eGFR decline, whether defined as ∆eGFR≤-5 mL/min/1.73 m2 (OR = 0.60, 95% CI:0.38-0.96) or ∆eGFR%≤-5% (OR = 0.57, 95% CI:0.37-0.89). In the stratification of renin-angiotensin system inhibitor (RASi) treatment, SGLT2i was associated with a lower risk of rapid eGFR decline in the RASi group (all ORs < 1, p < 0.05), with no interaction between SGLT2i and RASi (all P for interaction > 0.05) detected.

Conclusions: SGLT2i significantly reduced the risk of rapid eGFR decline in elderly patients with T2DM and hypertension, but the synergistic effect with RASi remains unclear.

研究目的本研究旨在基于真实世界的临床数据,探讨钠-葡萄糖共转运体 2 抑制剂(SGLT2i)对老年 2 型糖尿病(T2DM)和高血压患者的肾保护作用。该研究旨在为该人群慢性肾病的循证药物治疗提供理论依据:方法:利用上海市卫计委的 "健康云 "平台,对患有 T2DM 和高血压的老年患者进行识别和筛查。进一步构建倾向得分匹配队列,以估计 SGLT2i 对肾功能快速下降(∆eGFR≤-5 ml/min/1.73 m2 或 ∆eGFR%≤-5%)风险的影响。为评估结果的稳健性,进行了多项敏感性分析:结果:经过倾向评分匹配后,SGLT2i 组和非 SGLT2i 组之间的协变量无明显差异。多变量逻辑模型的结果表明,无论是定义为∆eGFR≤-5 ml/min/1.73 m2(OR = 0.60,95% CI:0.38-0.96)还是∆eGFR%≤-5%(OR = 0.57,95% CI:0.37-0.89),使用SGLT2i与eGFR快速下降的风险之间存在一致的反相关性。在肾素-血管紧张素系统抑制剂(RASi)治疗分层中,SGLT2i与RASi组eGFR快速下降风险较低相关(所有ORs p 0.05):结论:SGLT2i 能明显降低 T2DM 和高血压老年患者 eGFR 快速下降的风险,但与 RASi 的协同作用尚不明确。
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引用次数: 0
Pentoxifylline improves anemia through its novel effect on hypoxia-inducible factor-2 alpha in hemodialysis patients: a randomized, double-blind, placebo-controlled clinical trial. 通过对缺氧诱导因子-2α的新作用,五氧嘧啶可改善血液透析患者的贫血状况:一项随机、双盲、安慰剂对照临床试验。
Pub Date : 2024-11-01 Epub Date: 2024-11-10 DOI: 10.1080/00325481.2024.2426448
Hadeer Zakaria, Noha Alaa Hamdy, Nagy Ah Sayed-Ahmed, Ahmed El-Mallah

Objectives: This randomized, double-blind, placebo-controlled clinical trial aimed to prospectively examine the effect of pentoxifylline (PTX) on hypoxia-inducible factor-2 alpha (HIF-2α) and its role in controlling anemia in hemodialysis (HD) patients.

Methods: Eighty patients on HD were randomized to receive 400 mg of PTX or placebo twice daily for 6 months. The hemoglobin (Hb) and other hematologic parameters, the weekly erythropoiesis-stimulating agents (ESAs), and the ESA resistance index (ERI) were assessed monthly during the study. The HIF-2α, transforming growth factor-β1 (TGF-β1), and high-sensitivity C-reactive protein (hs.CRP) were measured before and after the intervention.

Results: In the pentoxifylline group, an appreciable increase in Hb from 9.7 (9.3, 10.3) g/dl to 10.5 (9.3, 11.4) g/dl and hematocrit (Hct) from 31.3 (29.6, 32.4)% to 33.2 (29.4, 35.9)% was observed after one month of PTX administration, and this effect was maintained over the study time (p < 0.001). This was along with a decrease in the ESA doses required from 8000 (8000, 11500) IU/wk to 4000 (2000, 8000) IU/wk (p < 0.001), and an improvement in the ERI from 11.6 (8.07, 16.97) IU/kg/wk/g/dl to 5.79 (2.01, 10.09) IU/kg/wk/g/dl (p < 0.001). Additionally, the HIF-2α increased significantly at the end of the intervention in patients who received PTX from 3245.35 (2886.8, 4691.56) pg/ml to 7208.75 (5382, 9182.7) pg/ml, while TGF-β1 and hs.CRP decreased significantly from 657.78 (539.78, 1146.62) pg/ml and 88.08 (39.93, 100.4) mg/l to 329.94 (228.67, 793.18) pg/ml and 48.65 (34.44, 84.61) mg/l, respectively. The percent changes in HIF-2α, TGF-β1, and hs.CRP levels in the pentoxifylline group were also statistically significant in comparison with the placebo group.

Conclusions: PTX could be a promising agent for correcting anemia in HD patients via increasing HIF-2α levels.

Clinical trial registration: Clinicaltrials.gov, February 2023, registry number: NCT05708248.

研究目的这项随机、双盲、安慰剂对照临床试验旨在前瞻性地研究五氧去氧肾上腺素(PTX)对低氧诱导因子-2α(HIF-2α)的影响及其在控制血液透析(HD)患者贫血中的作用:80名接受血液透析治疗的患者随机接受400毫克PTX或安慰剂治疗,每天两次,为期6个月。研究期间,每月评估血红蛋白(Hb)和其他血液学参数、每周使用的促红细胞生成药物(ESAs)和ESAs抵抗指数(ERI)。干预前后测量了 HIF-2α、转化生长因子-β1(TGF-β1)和高敏 C 反应蛋白(hs.CRP):结果:服用喷托非利辛一个月后,Hb 从 9.7 (9.3, 10.3) g/dl 显著升高至 10.5 (9.3, 11.4) g/dl,血细胞比容(Hct)从 31.3 (29.6, 32.4) %升高至 33.2 (29.4, 35.9)%:PTX是通过提高HIF-2α水平纠正HD患者贫血的一种有效药物:临床试验注册:Clinicaltrials.gov,2023 年 2 月,注册号:NCT05708248:NCT05708248。
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引用次数: 0
Calcific aortic valve disease and cardiometabolic triggers: an explanation behind progression of aortic valvular disease and failure of medical therapy interventions. 钙化性主动脉瓣疾病和心脏代谢诱因:主动脉瓣疾病进展和医疗干预失败背后的解释。
Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1080/00325481.2024.2406740
Akruti Patel Prabhakar, Angel Lopez-Candales

Calcific aortic valve disease (CAVD), a nonrheumatic stenosis of the trileaflet aortic valve, is a complex, multifaceted cardiovascular condition involving a widespread inflammatory process and an analogous atheromatous process affecting the arteries. It is currently the most encountered valvular abnormality in cardiology. Although distinctive abnormal mechanical forces are at the core propelling a responsive mechanosensitive feedback cascade, implicated in both initiation and perpetuation of CAVD; we propose a conundrum of metabolic abnormalities including hypertension, elevated fasting blood sugar, decreased high-density lipoprotein, hypertriglyceridemia, and abdominal obesity as perpetuators of this process. Furthermore, we suggest CAVD as a cardio metabolic disorder. New perspectives as well as which pathways we believe are critically involved and ideas for early intervention are discussed.

主动脉瓣钙化病(CAVD)是主动脉三叶瓣的一种非风湿性狭窄,是一种复杂的、多方面的心血管疾病,涉及广泛的炎症过程和影响动脉的类似动脉粥样硬化过程。它是目前心脏病学中最常见的瓣膜异常。虽然独特的异常机械力是推动机械敏感性反馈级联反应的核心,与 CAVD 的启动和延续都有关联;但我们提出了代谢异常的难题,包括高血压、空腹血糖升高、高密度脂蛋白减少、高甘油三酯血症和腹型肥胖,它们是这一过程的延续因素。此外,我们还认为 CAVD 是一种心血管代谢紊乱。我们还讨论了新的视角以及我们认为关键的参与途径和早期干预的想法。
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引用次数: 0
Juvenile idiopathic arthritis management: insights into the utilization of intra-articular corticosteroid injections. 幼年特发性关节炎的治疗:对使用关节内皮质类固醇注射的见解。
Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1080/00325481.2024.2412969
Çisem Yıldız, Batuhan Küçükali, Merve Kutlar, Nuran Belder, Nihal Karaçayır, Pelin Esmeray Şenol, Emine Nur Sunar Yayla, Deniz Gezgin Yildirim, Sevcan A Bakkaloğlu

Background: Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children, requiring careful management to reduce both short- and long-term morbidity. In this study, our objective was to assess the clinical features of patients diagnosed with JIA who received intra-articular corticosteroid injections (IACI).

Methods: In this retrospective study, we evaluated the clinical and laboratory characteristics of 225 JIA patients monitored from January 2012 to October 2023 at a tertiary care center. We focused on patients who underwent intra-articular corticosteroid injections (IACI) as part of their treatment. Triamcinolone hexacetonide (TH) was used due to its demonstrated safety and efficacy.

Results: Our analysis revealed that IACI, particularly utilizing TH, was a widely employed and effective adjunct therapy, contributing to rapid symptom relief and local disease control. Patients receiving IACI exhibited earlier symptom onset, younger age at diagnosis, longer follow-up durations, and higher cumulative treatment burden (p < 0.001, p < 0.001, p < 0.01, p < 0.001 respectively). Despite inconclusive acute-phase reactants, a higher frequency of ANA positivity and elevated initial lymphocyte counts were associated with increased IACI use (p < 0.001, p < 0.001 respectively). Importantly, on a joint basis, a high percentage of arthritis remission following IACI underscores its efficacy and favorable safety profile.

Conclusions: Notably, the high percentage of arthritis remission achieved with intra-articular corticosteroid injections (IACI) on a joint-specific basis highlights its efficacy and favorable safety profile. A lymphocyte count exceeding 5000/mm3 at the time of diagnosis may serve as an early indicator for considering intra-articular steroid administration. These findings emphasize the need for nuanced and individualized treatment strategies in JIA management to optimize outcomes for affected children.

背景:幼年特发性关节炎(JIA)是儿童常见的慢性风湿病,需要精心治疗以降低短期和长期发病率。在这项研究中,我们的目的是评估确诊为 JIA 并接受了关节内皮质类固醇注射(IACI)的患者的临床特征:在这项回顾性研究中,我们评估了从 2012 年 1 月至 2023 年 10 月在一家三级医疗中心接受监测的 225 名 JIA 患者的临床和实验室特征。我们关注的重点是接受关节内皮质类固醇注射(IACI)治疗的患者。由于曲安奈德(TH)的安全性和有效性已得到证实,因此我们使用了曲安奈德:我们的分析表明,IACI,尤其是使用TH,是一种广泛使用且有效的辅助疗法,有助于快速缓解症状和控制局部疾病。接受 IACI 治疗的患者症状出现较早、确诊年龄较小、随访时间较长、累积治疗负担较重(P P P P P P 结论):值得注意的是,关节内皮质类固醇注射(IACI)在关节特异性基础上实现了高比例的关节炎缓解,这凸显了其疗效和良好的安全性。诊断时淋巴细胞计数超过 5000/mm3 可作为考虑关节内注射类固醇的早期指标。这些研究结果表明,JIA 的治疗需要细致入微的个体化治疗策略,以优化患儿的预后。
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引用次数: 0
Giant cell arteritis (GCA) as a risk factor for seizures: a cohort study. 巨细胞动脉炎(GCA)是癫痫发作的危险因素:一项队列研究。
Pub Date : 2024-11-01 Epub Date: 2024-10-07 DOI: 10.1080/00325481.2024.2413355
Paula David, Esther Houri Levi, Ariel Feifel, Yonatan Shneor Patt, Abdulla Watad, Omer Gendelman, Arnon D Cohen, Howard Amital, Avishai M Tsur

Objectives: The objective of this study was to assess the risk of seizures in Giant Cell Arteritis (GCA) patients in a large cohort of Israeli subjects, in comparison to matched controls.

Methods: Patients diagnosed with GCA between 2002 and 2017 were included. Controls were matched based on sex, age, socioeconomic status, country of birth, diabetes mellitus, and hypertension in a 4:1 ratio. Patients with seizure records prior to the study period were excluded. Hazard ratios for seizures was obtained by cox regression models.

Results: The study cohort was composed by 8,103 GCA patients and 32,412 matched controls. The GCA group included 5,535 women (68%), 2,644 patients born in Israel (33%), and 2,888 patients with low socioeconomic status (36%). The median age of this group was 71. During the followed cumulative person-years of 54,641 and 222,537 in the GCA and control group, respectively, 15.92 cases per 10,000 person-years was found in the GCA group, compared to 9.62 per 10,000 person-years in the controls. GCA was associated with seizures in the unadjusted (HR = 1.66, 95% CI [1.29 to 2.13]) and adjusted (HR = 1.67, 95% CI [1.3 to 2.14]) models. GCA was also associated with seizures after controlling for strokes (HR = 1.55, 95% CI [1.16 to 2.07]).

Conclusion: According to this study, individuals with GCA are at a higher risk of developing seizures when compared to the general population. This increased risk is independent of their predisposition for stroke. One proposed mechanism is that the GCA pro-inflammatory state may decrease the neuronal threshold for depolarization.

研究目的本研究的目的是评估一大批以色列受试者中巨细胞动脉炎(GCA)患者的癫痫发作风险,并与匹配的对照组进行比较:方法:纳入 2002 年至 2017 年期间确诊为 GCA 的患者。对照组根据性别、年龄、社会经济地位、出生国、糖尿病和高血压按 4:1 的比例进行匹配。研究期间之前有癫痫发作记录的患者被排除在外。癫痫发作的危险比通过 Cox 回归模型得出:研究队列由 8,103 名 GCA 患者和 32,412 名匹配对照组成。GCA 组中有 5535 名女性(占 68%),2644 名患者出生于以色列(占 33%),2888 名患者社会经济地位较低(占 36%)。该组患者的年龄中位数为 71 岁。GCA组和对照组的累计跟踪年数分别为54,641年和222,537年,GCA组每万人年中有15.92例,而对照组每万人年中只有9.62例。在未调整模型(HR = 1.66,95%CI [1.29-2.13])和调整模型(HR = 1.67,95%CI [1.3-2.14])中,GCA 与癫痫发作有关。在控制中风后,GCA 也与癫痫发作有关(HR = 1.55,95%CI [1.16-2.07]):根据这项研究,与普通人群相比,GCA 患者出现癫痫发作的风险更高。这种风险的增加与中风的易感性无关。一种可能的机制是 GCA 促炎状态可能会降低神经元去极化的阈值。
{"title":"Giant cell arteritis (GCA) as a risk factor for seizures: a cohort study.","authors":"Paula David, Esther Houri Levi, Ariel Feifel, Yonatan Shneor Patt, Abdulla Watad, Omer Gendelman, Arnon D Cohen, Howard Amital, Avishai M Tsur","doi":"10.1080/00325481.2024.2413355","DOIUrl":"10.1080/00325481.2024.2413355","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to assess the risk of seizures in Giant Cell Arteritis (GCA) patients in a large cohort of Israeli subjects, in comparison to matched controls.</p><p><strong>Methods: </strong>Patients diagnosed with GCA between 2002 and 2017 were included. Controls were matched based on sex, age, socioeconomic status, country of birth, diabetes mellitus, and hypertension in a 4:1 ratio. Patients with seizure records prior to the study period were excluded. Hazard ratios for seizures was obtained by cox regression models.</p><p><strong>Results: </strong>The study cohort was composed by 8,103 GCA patients and 32,412 matched controls. The GCA group included 5,535 women (68%), 2,644 patients born in Israel (33%), and 2,888 patients with low socioeconomic status (36%). The median age of this group was 71. During the followed cumulative person-years of 54,641 and 222,537 in the GCA and control group, respectively, 15.92 cases per 10,000 person-years was found in the GCA group, compared to 9.62 per 10,000 person-years in the controls. GCA was associated with seizures in the unadjusted (HR = 1.66, 95% CI [1.29 to 2.13]) and adjusted (HR = 1.67, 95% CI [1.3 to 2.14]) models. GCA was also associated with seizures after controlling for strokes (HR = 1.55, 95% CI [1.16 to 2.07]).</p><p><strong>Conclusion: </strong>According to this study, individuals with GCA are at a higher risk of developing seizures when compared to the general population. This increased risk is independent of their predisposition for stroke. One proposed mechanism is that the GCA pro-inflammatory state may decrease the neuronal threshold for depolarization.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"875-882"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unmasking bocavirus: is it a co-infectious agent or an actual respiratory pathogen? 揭开球状病毒的神秘面纱:它是一种共感染病原体还是真正的呼吸道病原体?
Pub Date : 2024-11-01 Epub Date: 2024-10-15 DOI: 10.1080/00325481.2024.2412972
Damla Hanalioglu, Selin Cetin, Meltem Cetin, Bedia Dinc, Leman Akcan Yildiz, Mustafa Oguz Kaynak, Funda Kurt, Halise Akca, Saliha Senel, Can Demir Karacan

Objectives: Although human bocavirus (HBoV) is primarily linked to respiratory tract infections, its exact role as a respiratory pathogen remains unclear. This study aims to investigate HBoV detection rates, as well as clinical, laboratory, microbiological, and radiological characteristics, length of stay in the emergency department (ED), rate of hospitalization, and severity of illness in cases where HBoV is detected in respiratory secretions.

Methods: We conducted a retrospective analysis of all consecutive patients under 18 years who visited a large-volume tertiary pediatric ED from January to December 2023 and tested positive for HBoV in their respiratory viral panel (RVP).

Results: Among the 14,315 patients who underwent RVP testing during the study period, 591 (4%) tested positive for HBoV. After excluding those with incomplete data, 528 patients (57% male) were included in the analyses. The median age was 2.8 [1.2-4.9] years. The most common symptoms were cough (67%), fever (58%), runny nose/nasal congestion/sore throat (34%), and respiratory distress (24%). Thirty percent of the patients had a history of antibiotic use before admission. Thirteen percent of the patients had at least one chronic illness. Co-infection with HBoV occurred in 37% of the patients, with respiratory syncytial virus (RSV) being the most frequently co-detected virus (45%). Lymphopenia was documented in 12% of patients, and 36% had elevated C-reactive protein levels (median 21 [12-38] g/dl). Abnormal chest X-rays were noted in 85% of patients. The management approach included outpatient care for more than half of the patients (69%). Clinical severity was classified as high in 11% of patients (n = 60), necessitating ICU admission.

Conclusion: Although typically mild, HBoV infections can escalate to severe respiratory illnesses, requiring respiratory support and intensive care.

目的:尽管人类博卡病毒(HBoV)主要与呼吸道感染有关,但其作为呼吸道病原体的确切作用仍不清楚。本研究旨在调查在呼吸道分泌物中检测到 HBoV 的病例中,HBoV 的检出率以及临床、实验室、微生物学和放射学特征、急诊科(ED)住院时间、住院率和病情严重程度:我们对 2023 年 1 月至 12 月期间在一家大型三级儿科急诊室就诊并在呼吸道病毒检测(RVP)中检测出 HBoV 阳性的所有 18 岁以下连续患者进行了回顾性分析:在研究期间接受 RVP 检测的 14,315 名患者中,有 591 人(4%)检测出 HBoV 阳性。在排除数据不完整的患者后,528 名患者(57% 为男性)被纳入分析。中位年龄为 2.8 [1.2 - 4.9] 岁。最常见的症状是咳嗽(67%)、发烧(58%)、流鼻涕/鼻塞/喉咙痛(34%)和呼吸困难(24%)。30%的患者在入院前曾使用过抗生素。13%的患者至少患有一种慢性疾病。37%的患者合并有乙型肝炎病毒感染,呼吸道合胞病毒(RSV)是最常合并检测到的病毒(45%)。12%的患者出现淋巴细胞减少症,36%的患者C反应蛋白水平升高(中位数为21 [12- 38] g/dl)。85%的患者胸部X光片异常。半数以上的患者(69%)接受了门诊治疗。11% 的患者(n = 60)的临床严重程度被归类为高度严重,需要入住重症监护病房:结论:虽然乙型肝炎病毒感染的症状通常较轻,但也可能发展为严重的呼吸系统疾病,需要呼吸支持和重症监护。
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引用次数: 0
The masters athlete and use of antihypertensive medications. 大师级运动员和降压药的使用。
Pub Date : 2024-11-01 Epub Date: 2024-11-13 DOI: 10.1080/00325481.2024.2426449
Audrey H Wu, Riley Patzsch, Andrew Cornett

Hypertension is the most common cardiovascular condition in recreational athletes, especially older (masters) athletes. The interacting effects of hypertension, cardiac adaptation to endurance training, and antihypertensive medications on exercise performance are complex and of relevance to athletes, trainers, and health care providers. Cardiac adaptations occur in response to aging and endurance training, and findings may overlap with pathologic cardiac remodeling. This review summarizes the influence of antihypertensive medications on exercise performance, which can include both hemodynamic and metabolic effects, and includes practical considerations in choice of antihypertensive agent for the masters endurance athlete. Whereas the overriding priority for choice of antihypertensive is control of hypertension and improving clinical outcomes, other considerations regarding effects on exercise performance may also influence the choice of agent.

高血压是休闲运动员,尤其是老年(大师级)运动员最常见的心血管疾病。高血压、心脏对耐力训练的适应以及降压药物对运动表现的交互影响非常复杂,与运动员、教练员和医疗保健提供者息息相关。心脏适应性会随着年龄增长和耐力训练而发生变化,其结果可能与病理性心脏重塑重叠。本综述总结了降压药物对运动表现的影响,其中包括血液动力学和新陈代谢的影响,还包括耐力大师级运动员在选择降压药物时的实际考虑因素。虽然选择降压药的首要任务是控制高血压和改善临床疗效,但有关对运动表现影响的其他考虑因素也会影响药物的选择。
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引用次数: 0
Evaluating cardiac electrophysiological markers for predicting arrhythmic risk in hypothyroid patients. 评估用于预测甲状腺功能减退症患者心律失常风险的心脏电生理标记物。
Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI: 10.1080/00325481.2024.2419358
Sibel Tunç Karaman, Abdullah Ozan Polat, Okcan Basat

Objectives: This study aimed to evaluate the impact of hypothyroidism and levothyroxine (LT4) treatment on arrhythmic risk by concurrently analyzing multiple electrocardiogram (ECG) parameters such as the Index of Cardio-Electrophysiological Balance (iCEB), frontal QRS-T angle, Tpeak-Tend (Tp-e) interval/QT interval ratio, and QT dispersion (QTd).

Methods: This cross-sectional study included 132 adult patients with primary hypothyroidism who had been receiving LT4 treatment, and 132 demographically matched healthy controls. The hypothyroid group was also stratified by thyroid-stimulating hormone (TSH) levels (subclinical <4.5 and overt ≥ 4.5). Participants underwent a series of thyroid function and ECG measurements.

Results: The hypothyroid and healthy control groups were matched for age and gender (p = 0.080; p = 0.176). Participants with hypothyroidism had higher Tp-e/QT ratios, iCEB, median frontal QRS-T angle, and corrected QT dispersion (cQTd) than healthy controls (p = 0.004; p = 0.025; p = 0.004; p = 0.004, respectively). In the overt group, the Tp-e/QT ratio, iCEB, and median frontal QRS-T angles were all higher (p = 0.012, p = 0.037, and p = 0.016, respectively). Logistic regression analysis indicated that a higher iCEB score (β = 0.60, p = 0.003) was significant for the detection of arrhythmia risk. ROC analysis showed that iCEB had the highest sensitivity (0.80), moderate specificity (0.60), and AUC 0.70.

Conclusion: Patients with hypothyroidism have a higher risk of arrhythmia. To assess this risk, it is important to analyze the Tp-e interval, iCEB, frontal QRS-T angle, and QTd. Differentiating between patients with subclinical and overt hypothyroidism can help minimize the risk of arrhythmia. iCEB is the most effective method for identifying arrhythmic risk. Using all these parameters can improve the accuracy of arrhythmic risk detection in patients with hypothyroidism.

研究目的本研究旨在通过同时分析多种心电图(ECG)参数,如心电生理平衡指数(iCEB)、额叶QRS-T角、Tpeak-Tend(Tp-e)间期/QT间期比值和QT频散(QTd),评估甲状腺功能减退症和左旋甲状腺素(LT4)治疗对心律失常风险的影响:这项横断面研究包括132名接受LT4治疗的原发性甲状腺功能减退症成年患者和132名人口统计学匹配的健康对照组。甲状腺功能减退组还根据促甲状腺激素(TSH)水平(亚临床结果)进行了分层:甲状腺功能减退组和健康对照组在年龄和性别上相匹配(p = 0.080;p = 0.176)。甲减患者的 Tp-e/QT 比值、iCEB、额叶 QRS-T 角中位数和校正 QT 离散度(cQTd)均高于健康对照组(分别为 p = 0.004;p = 0.025;p = 0.004;p = 0.004)。在显性组中,Tp-e/QT 比值、iCEB 和额叶 QRS-T 角中位数均较高(分别为 p = 0.012、p = 0.037 和 p = 0.016)。逻辑回归分析表明,iCEB 分数越高(β = 0.60,p = 0.003),对检测心律失常风险越有意义。ROC分析显示,iCEB的灵敏度最高(0.80),特异性适中(0.60),AUC为0.70:结论:甲状腺功能减退症患者发生心律失常的风险较高。要评估这种风险,分析 Tp-e 间期、iCEB、额叶 QRS-T 角和 QTd 非常重要。区分亚临床甲减和显性甲减患者有助于将心律失常的风险降至最低。使用所有这些参数可以提高甲减患者心律失常风险检测的准确性。
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引用次数: 0
Advances in insulin: a review of icodec as a novel once-weekly treatment for type 2 diabetes. 胰岛素的进步:综述作为 2 型糖尿病每周一次新型疗法的 icodec。
Pub Date : 2024-11-01 Epub Date: 2024-10-06 DOI: 10.1080/00325481.2024.2410694
Javier Morales, Aaron King, Sean Oser, Sherwin D'Souza

Type 2 diabetes (T2D) is a chronic condition that requires not only a team-based approach but also substantial self-management by those affected. Patient-clinician barriers such as lack of educational resources, hesitancy in initiation of therapy, concerns over treatment-related side effects, frequency of dosing, and the establishment of treatment goals, can prevent a patient from achieving optimal glycemic management. Recently, advances in diabetes technology and insulin formulations have helped to address some of these concerns. Insulin icodec, the first once-weekly basal insulin analog, has demonstrated efficacy and safety comparable to traditional basal insulin formulations. Since clinicians and patients may benefit from a once-weekly therapy, this review sought to evaluate the potential clinical implications of insulin icodec. A literature search was performed using PubMed, Google Scholar, and ClinicalTrials.gov up to 31 January 2024. Key search terms such as once-weekly basal insulin, icodec, and ONWARDS were utilized to compile relevant publications. Further, studies involving patients living with T2D on once-weekly insulin icodec compared with once-daily basal insulin were considered for this review. Findings from this review suggest insulin icodec can offer a reduced dosing frequency that may improve medication adherence, provide effective glycemic management, and a comparable safety profile to existing basal insulins. In summary, insulin icodec may help to remove patient-clinician barriers associated with suboptimal glycemic management with its once-weekly dosing schedule. Clinicians can further support a patient's ability to self-manage the disease through continued monitoring and guidance on the use of icodec.

2 型糖尿病(T2D)是一种慢性病,不仅需要团队合作,还需要患者进行大量的自我管理。患者与医生之间存在的障碍,如缺乏教育资源、在开始治疗时犹豫不决、对治疗相关副作用的担忧、用药频率以及治疗目标的确定,都会阻碍患者实现最佳血糖管理。最近,糖尿病技术和胰岛素配方的进步有助于解决其中一些问题。胰岛素 icodec 是首款每周一次的基础胰岛素类似物,其疗效和安全性与传统的基础胰岛素制剂不相上下。由于临床医生和患者可能会从一周一次的治疗中获益,本综述试图评估胰岛素 icodec 的潜在临床意义。我们使用 PubMed、Google Scholar 和 ClinicalTrials.gov 对截至 2024 年 1 月 31 日的文献进行了检索。利用每周一次基础胰岛素、icodec 和 ONWARDS 等关键检索词汇编了相关出版物。此外,本综述还考虑了涉及使用每周一次胰岛素 icodec 和每日一次基础胰岛素的 T2D 患者的研究。本综述的研究结果表明,伊科达克胰岛素可减少给药频率,从而改善用药依从性,提供有效的血糖管理,并具有与现有基础胰岛素相当的安全性。总之,胰岛素 icodec 每周一次的给药计划有助于消除患者与临床医生之间因血糖管理不理想而产生的障碍。临床医生可以通过对 icodec 使用情况的持续监测和指导,进一步提高患者自我管理疾病的能力。
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引用次数: 0
Thiazide diuretics versus loop diuretics in stage 3-5 CKD: impact on cardiorenal outcomes. 噻嗪类利尿剂与襻利尿剂在 3-5 期慢性肾脏病中的应用:对心肾功能预后的影响。
Pub Date : 2024-09-01 Epub Date: 2024-08-27 DOI: 10.1080/00325481.2024.2396796
Li-Chin Sung, Hui-Wen Chiu, Samuel Mon-Wei Yu, Liam Li-An Tsou, Yung-Ho Hsu, Mai-Szu Wu, Cheng-Li Lin, Fuu-Jen Tsai, Chu-Lin Chou

Objectives: The association between diuretic use and cardiorenal outcomes remains limited in patients with stage 3-5 chronic kidney disease (CKD) and hypertension. To address this gap, we aim to investigate the long-term clinical impact of diuretic use with its pharmacological classification in Taiwanese patients with stage 3-5 CKD and hypertension who were concurrently received angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs).

Methods: Using data from the National Health Insurance Research Database (January 2008 to December 2019), we focused on individuals with stage 3-5 CKD receiving ACEIs/ARBs between 2010 and 2018. We categorized the cohort into non-diuretic, loop diuretic (furosemide), thiazide diuretic, and combination diuretic groups. We used a Cox proportional hazards regression model with propensity score matching to analyze the influence of diuretics on all-cause mortality, cardiovascular (CV) death, and cardiorenal adverse outcomes.

Results: The study included 59,719 patients, with 17,585 in the non-diuretic group and 42,134 in the diuretic group. Diuretics including furosemide use was significantly associated the risks of hospitalization for decompensated congestive heart failure (CHF), acute renal failure (ARF), end-stage renal disease (ESRD) requiring dialysis, CV mortality, and all-cause mortality (p-value <0.001). Thiazide diuretics showed no such adverse outcomes associations. The group receiving both thiazide and furosemide was more associated with all-cause mortality than the nondiuretic, thiazide, and furosemide monotherapy groups (all p-value <0.001).

Conclusion: Among stage 3-5 CKD patients on ACEIs/ARBs, loop diuretics exposure was associated with increased mortality and hospitalization for cardiorenal events, while thiazide diuretics exposure in isolation had no such associations. In the present data, we cannot evaluate the relationship between furosemide-associated adverse outcomes and worse renal function. These findings highlight the need for randomized controlled trials to assess the safety of loop diuretics in this population, urging caution in their prescription without a clear clinical indication.

目的:在 3-5 期慢性肾脏病(CKD)和高血压患者中,利尿剂的使用与心衰结果之间的关系仍然有限。为了填补这一空白,我们旨在研究同时接受血管紧张素转换酶抑制剂(ACEIs)或血管紧张素II受体阻滞剂(ARBs)治疗的台湾3-5期慢性肾脏病和高血压患者使用利尿剂的长期临床影响及其药理分类:利用全国健康保险研究数据库(2008 年 1 月至 2019 年 12 月)的数据,我们重点研究了 2010 年至 2018 年期间接受 ACEIs/ARBs 治疗的 3-5 期 CKD 患者。我们将队列分为非利尿剂组、襻利尿剂组(呋塞米)、噻嗪类利尿剂组和联合利尿剂组。我们使用倾向得分匹配的 Cox 比例危险回归模型分析了利尿剂对全因死亡率、心血管(CV)死亡和心肾不良结局的影响:研究共纳入 59719 名患者,其中非利尿剂组 17585 人,利尿剂组 42134 人。包括呋塞米在内的利尿剂的使用与失代偿性充血性心力衰竭(CHF)、急性肾功能衰竭(ARF)、需要透析的终末期肾病(ESRD)住院风险、心血管疾病死亡率和全因死亡率显著相关(p-value p-value 结论):在使用 ACEIs/ARBs 的 3-5 期 CKD 患者中,襻利尿剂暴露与死亡率和心肾事件住院率增加有关,而单独使用噻嗪类利尿剂则没有这种关联。根据目前的数据,我们无法评估呋塞米相关不良后果与肾功能恶化之间的关系。这些发现突出表明,有必要进行随机对照试验,以评估襻利尿剂在这一人群中的安全性,并敦促在没有明确临床指征的情况下谨慎处方襻利尿剂。
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引用次数: 0
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Postgraduate medicine
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