| 2 | 接受替罗非班和阿斯匹林治疗的非ST段抬高急性冠脉综合征患者应用依诺肝素或普通肝素的疗效及安全性:随机对照试验显示文摘背景: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(合并了两种独立的出血判定策略)表明,采用依诺肝素每治疗200例患者就会发生一次TIMI严重出血。结论:对于接受替罗非班和阿斯匹林治疗的非ST段抬高ACS患者而言,依诺肝素是除普通普通肝素之外的另一种适当选择。依诺肝素可使一级终点相对减少12%,绝对减少1%,符合非劣势标准。该结果与以往未联用糖蛋白Ⅱb/Ⅲa受体拮抗剂的试验一致。 | Michael A.Blazing James A. de Lemos Harvey D. White Keith A. A. Fox Freek W. A. Verheugt Diego Ardissino Peter M. DiBattiste Joarme Palmisano David W. Bilheimer Steven M. Snapinn Karen E. Ramsey Laura H. Gardner Vic Hasselblad Marc A. Pfeffer Eldrin F. Lewis Eugene Braunwald Robert M. Califf 王淑敏(译) 胡大一(校) | 2005 | 美国医学会杂志(中文版)2005，24，4： | 1 |
| 3 | Effect of pelvic fixation on ambulation in children with neuromuscular scoliosis显示文摘BACKGROUND The effect of posterior spinal fusion(PSF)incorporating the pelvis on an ambulatory patient’s ability to mobilize after the fusion is not well understood.AIM To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis(NMS)patients influences postoperative ambulatory ability.METHODS A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1,2012 and February 29,2019.A total of 118 patients were eligible,including 11 ambulatory patients.The primary outcome was the maintenance of ambulatory status postoperatively.Secondary outcomes included postoperative curve magnitude,pelvic obliquity,and complications,comprising infections,instrumentation failure,and any unplanned returns to the operative room.RESULTS The ambulatory function was maintained in all 11 ambulatory NMS patients.One patient had an improvement in functional status with equipment-free ambulation postoperatively.An average postoperative follow-up was 19 mo.The overall complication rate was 19.4%(n=23)with no significant differences between the groups in infection(P=0.365),hardware failure(P=0.505),and reoperation rate(P=1.0).Ambulatory status did not affect complication rate(P=0.967).CONCLUSION Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities. | Luke Drake Hamdi Sukkarieh Tyler McDonald Eldrin Bhanat Elisa Quince Myles Atkins Patrick Wright Jaysson Brooks | 2022 | World Journal of Orthopedics2022，13，8： | 0 |
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