| 1 | Tenofovir vs lamivudine plus adefovir in chronic hepatitis B:TENOSIMP-B study显示文摘AIM To demonstrate the non-inferiority(15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate(TDF) vs the combination of lamivudine(LAM) plus adefovir dipivoxil(ADV) in the maintenance of virologic response in patients with chronic hepatitis B(CHB) and prior failure with LAM.METHODS This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups(TDF and LAM+ADV) of adult patients with hepatitis B e antigen(HBe Ag)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were analysed.RESULTS Forty-six patients were evaluated [median age: 55.4 years(30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA(HBV-DNA) remained undetectable, all patients remained HBe Ag negative, and hepatitis B surface antigen(HBs Ag) positive. Alanine aminotransferase(ALT) values at the end of the study were similar in the 2 groups(25.1± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects(AEs)(53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively(P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment(€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001).CONCLUSION TDF monotherapy proved to be safe and not inferior to the LAM+ADV combination therapy in maintaining virologic response in patients with CHB and previous LAM failure. In addition, the use of TDF generated a significant savings in hospital costs. | Manuel Rodríguez Juan Manuel Pascasio Enrique Fraga Javier Fuentes Martín Prieto Gloria Sánchez-Antolín Jose Luis Calleja Esther Molina María Luisa García-Buey María Angeles Blanco Javier Salmerón María Lucía Bonet Jose Antonio Pons Jose Manuel González Miguel Angel Casado Francisco Jorquera 无 | 2017 | World Journal of Gastroenterology2017，23，41： | 16 |
| 3 | Arrhythmogenic cardiomyopathy with left ventricular involvement versus ischemic heart disease: lessons learned from the family study and the reviewed autopsy of a young male显示文摘Ischemic heart disease (IHD) is the leading cause of sudden cardiac death (SCD) and often non-thrombosed severe coronary stenoses with or without myocardial scars are detected.Left dominant arrhythmogenic cardiomyopathy (LDAC) is a life-threating rare disease which has been more thoroughly studied in the last 10years.The macroscopic study of an SCD victim was conducted and re-evaluated 9years later.The cardiological work-up in his firstdegree relatives initially comprised an electrocardiogram (ECG) and an echocardiogram.When they were re-evaluted 9years later,a cardiac magnetic resonance,an ECG-monitoring,an exercise testing and a genetic study were performed and the pedigree was extended accordingly.In 2008,an IHD was suspected in the sports-triggered SCD of a 37-year-old man upon the postmortem (75% stenosis of the left main and circumflex coronary arteries;the subepicardial left ventricular fibrofatty infiltration with mild myocardial degeneration was assumed to be a past myocardial infarction).No cardiomyopathy was identified in any of the two proband's sisters.Nine years thereafter,distant relatives were diagnosed with LDAC due to a pathogenic desmoplakin mutation.The reanalysis of the two sisters showed ventricular arrhythmias in one of them without structural heart involvement and the reviewed postmortem of the proband was reclassified as LDAC based on the fibrofatty infiltration;both were mutation carriers.The completion of the family study on 19 family members yielded one SCD due to LDAC (the proband),three living patients diagnosed with LDAC (two with a defibrillator),one mutation carrier without structural ventricular involvement,and 14 healthy relatives (who were discharged) with a very good co-segregation of the mutation.Although rare,LDAC exists and sometimes its differential diagnosis with iHD has to be faced.Modifying previous postmortem misdiagnoses can help family screening to further prevent SCDs. | Pilar Molina Jorge Sanz-Sánchez Manuel Fenollosa Marina Martínez-Matilla Juan Giner Esther Zorio | 2019 | Forensic Sciences Research2019，4，3： | 1 |
| 4 | 门诊成人社区获得性肺炎的危险因素:生活方式和共病条件(NEUMO-ES-RISK项目)显示文摘背景社区获得性肺炎(CAP)风险在初级保健中的信息是有限的。我们评估了不同生活方式和共病条件作为初级保健成人CAP的危险因素。方法一项回顾性观察对照研究。使用国家初级保健数据监测系统检索了2009至2013年在西班牙初级保健部门诊断的成人CAP病例。匹配年龄和匹配性别的对照组采用发病率密度抽样(比例2∶1)。以百分比和比值比来表示关联分析。为了避免偏倚效应,建立二项回归模型。结果51 139例患者和102 372例对照组做比较。平均年龄为61.4(19.9)岁。危险因素与CAP的显著相关性如下:艾滋病[比值比(95%可信区间)5.21(4.35~6.27)]、慢性阻塞性肺病(COPD)[2.97(2.84~3.12)]、哮喘[2.16(2.07~2.26)]、吸烟[1.96(1.91~2.02)]和口腔卫生问题[1.45(1.41~1.49)]。患者组中有危险因素存在的平均患病率为82.2%,对照组为69.2%。CAP患病率的增加与危险因素和年龄的累积有关:1个危险因素时,在18~60岁老人中的风险相关性是1.42,在>60岁人中是1.57;2个危险因素时,是1.88和2.35;≥3个危险因素时,是3.11和4.34。结论成人CAP初级保健中的危险因素普遍较高。主要与危险因素相关的是艾滋病、COPD、哮喘、吸烟、口腔卫生问题。我们的风险叠加结果可以帮助临床医生确定肺炎风险较高的患者。 | Irene Rivero-Calle Miriam Cebey-López Jacobo Pardo-Seco José Yuste Esther Redondo Diego A Vargas Enrique Mascarós Jose Luis Díaz-Maroto Manuel Linares-Rufo Isabel Jimeno Angel Gil Jesus Molina Daniel Ocana Federico Martinón-Torres 崔晓霞(译) | 2019 | 英国医学杂志中文版2019，22，8： | 1 |
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