引用第6楼guodon于2006-07-17 22:56发表的“”:据说南方医大的侯凡凡因为洛汀新的那篇文章已经当选院士了？不一般啊。。。。不过现在临床上遇到Cr>3的病人还是不敢用洛汀新。。。毕竟没入指南
侯凡凡过了2轮，没有上院士。。
中国所发NEJM所有文章。
1: N Engl J Med. 2006 Jun 29;354(26):2783-93.
Comment in:
N Engl J Med. 2006 Jun 29;354(26):2819-21.
Effect of iodine intake on thyroid diseases in China.
Teng W, Shan Z, Teng X, Guan H, Li Y, Teng D, Jin Y, Yu X, Fan C, Chong W, Yang
F, Dai H, Yu Y, Li J, Chen Y, Zhao D, Shi X, Hu F, Mao J, Gu X, Yang R, Tong Y,
Wang W, Gao T, Li C.
Department of Endocrinology and Metabolism, First Affiliated Hospital, China
Medical University, Shengyang, China.
twpendocrine@yahoo.com.cnBACKGROUND: Iodine is an essential component of thyroid hormones; either low or
high intake may lead to thyroid disease. We observed an increase in the
prevalence of overt hypothyroidism, subclinical hypothyroidism, and autoimmune
thyroiditis with increasing iodine intake in China in cohorts from three regions
with different levels of iodine intake: mildly deficient (median urinary iodine
excretion, 84 microg per liter), more than adequate (median, 243 microg per
liter), and excessive (median, 651 microg per liter). Participants enrolled in a
baseline study in 1999, and during the five-year follow-up through 2004, we
examined the effect of regional differences in iodine intake on the incidence of
thyroid disease. METHODS: Of the 3761 unselected subjects who were enrolled at
baseline, 3018 (80.2 percent) participated in this follow-up study. Levels of
thyroid hormones and thyroid autoantibodies in serum, and iodine in urine, were
measured and B-mode ultrasonography of the thyroid was performed at baseline and
follow-up. RESULTS: Among subjects with mildly deficient iodine intake, those
with more than adequate intake, and those with excessive intake, the cumulative
incidence of overt hypothyroidism was 0.2 percent, 0.5 percent, and 0.3 percent,
respectively; that of subclinical hypothyroidism, 0.2 percent, 2.6 percent, and
2.9 percent, respectively; and that of autoimmune thyroiditis, 0.2 percent, 1.0
percent, and 1.3 percent, respectively. Among subjects with euthyroidism and
antithyroid antibodies at baseline, the five-year incidence of elevated serum
thyrotropin levels was greater among those with more than adequate or excessive
iodine intake than among those with mildly deficient iodine intake. A baseline
serum thyrotropin level of 1.0 to 1.9 mIU per liter was associated with the
lowest subsequent incidence of abnormal thyroid function. CONCLUSIONS: More than
adequate or excessive iodine intake may lead to hypothyroidism and autoimmune
thyroiditis. Copyright 2006 Massachusetts Medical Society.
PMID: 16807415 [PubMed - indexed for MEDLINE]
2: N Engl J Med. 2006 Apr 20;354(16):1728.
Images in clinical medicine. Bird-mite infestation.
Kong TK, To WK.
Princess Margaret Hospital, Hong Kong, SAR, China.
Publication Types:
Case Reports
PMID: 16625011 [PubMed - indexed for MEDLINE]
3: N Engl J Med. 2006 Mar 9;354(10):1011-20.
Erratum in:
N Engl J Med. 2006 Apr 27;354(17):1863.
Comment in:
N Engl J Med. 2006 Mar 9;354(10):1074-6.
Rev Gastroenterol Disord. 2006 Spring;6(2):112-6.
Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis
B.
Lai CL, Shouval D, Lok AS, Chang TT, Cheinquer H, Goodman Z, DeHertogh D, Wilber
R, Zink RC, Cross A, Colonno R, Fernandes L; BEHoLD AI463027 Study Group.
Queen Mary Hospital, Hong Kong, China.
hrmelcl@hkucc.hku.hkBACKGROUND: Entecavir is a potent and selective antiviral agent that has
demonstrated efficacy in phase 2 studies in patients with hepatitis B e antigen
(HBeAg)-negative chronic hepatitis B. METHODS: In this phase 3, double-blind
trial, we randomly assigned 648 patients with HBeAg-negative chronic hepatitis B
who had not previously been treated with a nucleoside analogue to receive 0.5 mg
of entecavir or 100 mg of lamivudine once daily for a minimum of 52 weeks. The
primary efficacy end point was histologic improvement (a decrease by at least
two points in the Knodell necroinflammatory score, without worsening of
fibrosis). RESULTS: Histologic improvement after 48 weeks of treatment occurred
in 208 of 296 patients in the entecavir group who had adequate baseline
liver-biopsy specimens that could be evaluated (70 percent), as compared with
174 of 287 such patients in the lamivudine group (61 percent, P=0.01). More
patients in the entecavir group than in the lamivudine group had undetectable
serum hepatitis B virus (HBV) DNA levels according to a
polymerase-chain-reaction assay (90 percent vs. 72 percent, P<0.001) and
normalization of alanine aminotransferase levels (78 percent vs. 71 percent,
P=0.045). The mean reduction in serum HBV DNA levels from baseline to week 48
was greater with entecavir than with lamivudine (5.0 vs. 4.5 log [on a base-10
scale] copies per milliliter, P<0.001). There was no evidence of resistance to
entecavir. Safety and adverse-event profiles were similar in the two groups.
CONCLUSIONS: Among patients with HBeAg-negative chronic hepatitis B who had not
previously been treated with a nucleoside analogue, the rates of histologic
improvement, virologic response, and normalization of alanine aminotransferase
levels were significantly higher at 48 weeks with entecavir than with
lamivudine. The safety profile of the two agents was similar, and there was no
evidence of viral resistance to entecavir. (ClinicalTrials.gov number,
NCT00035789.). Copyright 2006 Massachusetts Medical Society.
Publication Types:
Clinical Trial, Phase III
Multicenter Study
Randomized Controlled Trial
PMID: 16525138 [PubMed - indexed for MEDLINE]
4: N Engl J Med. 2006 Jan 12;354(2):131-40.
Comment in:
N Engl J Med. 2006 Apr 6;354(14):1530-1; author reply 1530-1.
N Engl J Med. 2006 Apr 6;354(14):1530-1; author reply 1530-1.
N Engl J Med. 2006 Jan 12;354(2):189-91.
Efficacy and safety of benazepril for advanced chronic renal insufficiency.
Hou FF, Zhang X, Zhang GH, Xie D, Chen PY, Zhang WR, Jiang JP, Liang M, Wang GB,
Liu ZR, Geng RW.
Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China.
ffhou@public.guangzhou.gd.cnBACKGROUND: Angiotensin-converting-enzyme inhibitors provide renal protection in
patients with mild-to-moderate renal insufficiency (serum creatinine level, 3.0
mg per deciliter or less). We assessed the efficacy and safety of benazepril in
patients without diabetes who had advanced renal insufficiency. METHODS: We
enrolled 422 patients in a randomized, double-blind study. After an eight-week
run-in period, 104 patients with serum creatinine levels of 1.5 to 3.0 mg per
deciliter (group 1) received 20 mg of benazepril per day, whereas 224 patients
with serum creatinine levels of 3.1 to 5.0 mg per deciliter (group 2) were
randomly assigned to receive 20 mg of benazepril per day (112 patients) or
placebo (112 patients) and then followed for a mean of 3.4 years. All patients
received conventional antihypertensive therapy. The primary outcome was the
composite of a doubling of the serum creatinine level, end-stage renal disease,
or death. Secondary end points included changes in the level of proteinuria and
the rate of progression of renal disease. RESULTS: Of 102 patients in group 1,
22 (22 percent) reached the primary end point, as compared with 44 of 108
patients given benazepril in group 2 (41 percent) and 65 of 107 patients given
placebo in group 2 (60 percent). As compared with placebo, benazepril was
associated with a 43 percent reduction in the risk of the primary end point in
group 2 (P=0.005). This benefit did not appear to be attributable to
blood-pressure control. Benazepril therapy was associated with a 52 percent
reduction in the level of proteinuria and a reduction of 23 percent in the rate
of decline in renal function. The overall incidence of major adverse events in
the benazepril and placebo subgroups of group 2 was similar. CONCLUSIONS:
Benazepril conferred substantial renal benefits in patients without diabetes who
had advanced renal insufficiency. (ClinicalTrials.gov number, NCT00270426.)
Copyright 2006 Massachusetts Medical Society.
Publication Types:
Randomized Controlled Trial
PMID: 16407508 [PubMed - indexed for MEDLINE]
5: N Engl J Med. 2005 Jun 30;352(26):2682-95.
Comment in:
ACP J Club. 2006 Jan-Feb;144(1):5.
N Engl J Med. 2005 Jun 30;352(26):2743-6.
N Engl J Med. 2005 Oct 13;353(15):1630-1; author reply 1630-1.
N Engl J Med. 2005 Oct 13;353(15):1630-1; author reply 1630-1.
Rev Gastroenterol Disord. 2005 Fall;5(4):223-7.
Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive
chronic hepatitis B.
Lau GK, Piratvisuth T, Luo KX, Marcellin P, Thongsawat S, Cooksley G, Gane E,
Fried MW, Chow WC, Paik SW, Chang WY, Berg T, Flisiak R, McCloud P, Pluck N;
Peginterferon Alfa-2a HBeAg-Positive Chronic Hepatitis B Study Group.
Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
SAR, China.
gkklau@netvigator.comBACKGROUND: Current treatments for chronic hepatitis B are suboptimal. In the
search for improved therapies, we compared the efficacy and safety of pegylated
interferon alfa plus lamivudine, pegylated interferon alfa without lamivudine,
and lamivudine alone for the treatment of hepatitis B e antigen (HBeAg)-positive
chronic hepatitis B. METHODS: A total of 814 patients with HBeAg-positive
chronic hepatitis B received either peginterferon alfa-2a (180 microg once
weekly) plus oral placebo, peginterferon alfa-2a plus lamivudine (100 mg daily),
or lamivudine alone. The majority of patients in the study were Asian (87
percent). Most patients were infected with hepatitis B virus (HBV) genotype B or
C. Patients were treated for 48 weeks and followed for an additional 24 weeks.
RESULTS: After 24 weeks of follow-up, significantly more patients who received
peginterferon alfa-2a monotherapy or peginterferon alfa-2a plus lamivudine than
those who received lamivudine monotherapy had HBeAg seroconversion (32 percent
vs. 19 percent [P<0.001] and 27 percent vs. 19 percent [P=0.02], respectively)
or HBV DNA levels below 100,000 copies per milliliter (32 percent vs. 22 percent
[P=0.01] and 34 percent vs. 22 percent [P=0.003], respectively). Sixteen
patients receiving peginterferon alfa-2a (alone or in combination) had hepatitis
B surface antigen (HBsAg) seroconversion, as compared with 0 in the group
receiving lamivudine alone (P=0.001). The most common adverse events were those
known to occur with therapies based on interferon alfa. Serious adverse events
occurred in 4 percent, 6 percent, and 2 percent of patients receiving
peginterferon alfa-2a monotherapy, combination therapy, and lamivudine
monotherapy, respectively. Two patients receiving lamivudine monotherapy had
irreversible liver failure after the cessation of treatment--one underwent liver
transplantation, and the other died. CONCLUSIONS: In patients with
HBeAg-positive chronic hepatitis B, peginterferon alfa-2a offers superior
efficacy over lamivudine, on the basis of HBeAg seroconversion, HBV DNA
suppression, and HBsAg seroconversion.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 15987917 [PubMed - indexed for MEDLINE]
6: N Engl J Med. 2005 Jan 20;352(3):238-44.
Comment in:
ACP J Club. 2005 Jul-Aug;143(1):9.
Gastroenterology. 2005 Jul;129(1):386-8.
J Fam Pract. 2005 Apr;54(4):308-9.
N Engl J Med. 2005 Apr 21;352(16):1716-8; author reply 1716-8.
N Engl J Med. 2005 Apr 21;352(16):1716-8; author reply 1716-8.
N Engl J Med. 2005 Apr 21;352(16):1716-8; author reply 1716-8.
N Engl J Med. 2005 Jan 20;352(3):287-9.
Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding.
Chan FK, Ching JY, Hung LC, Wong VW, Leung VK, Kung NN, Hui AJ, Wu JC, Leung WK,
Lee VW, Lee KK, Lee YT, Lau JY, To KF, Chan HL, Chung SC, Sung JJ.
Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese
University of Hong Kong, Shatin, Hong Kong, China.
fklchan@cuhk.edu.hkBACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard
treatment for patients receiving aspirin who are at risk for ulcer. Current U.S.
guidelines also recommend clopidrogel for patients who have major
gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin
plus esomeprazole for the prevention of recurrent bleeding from ulcers in
high-risk patients. METHODS: We studied patients who took aspirin to prevent
vascular diseases and who presented with ulcer bleeding. After the ulcers had
healed, we randomly assigned patients who were negative for Helicobacter pylori
to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice
daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12
months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320
patients (161 patients assigned to receive clopidogrel and 159 to receive
aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients
receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative
incidence of recurrent bleeding during the 12-month period was 8.6 percent (95
percent confidence interval, 4.1 to 13.1 percent) among patients who received
clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent)
among those who received aspirin plus esomeprazole (difference, 7.9 percentage
points; 95 percent confidence interval for the difference, 3.4 to 12.4;
P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer
bleeding whose ulcers had healed before they received the study treatment,
aspirin plus esomeprazole was superior to clopidogrel in the prevention of
recurrent ulcer bleeding. Our finding does not support the current
recommendation that patients with major gastrointestinal intolerance of aspirin
be given clopidogrel. Copyright 2005 Massachusetts Medical Society.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 15659723 [PubMed - indexed for MEDLINE]
7: N Engl J Med. 2004 Apr 22;350(17):1731-9.
Comment in:
N Engl J Med. 2004 Apr 22;350(17):1710-2.
N Engl J Med. 2004 Aug 5;351(6):609-11; author reply 609-11.
N Engl J Med. 2004 Aug 5;351(6):609-11; author reply 609-11.
N Engl J Med. 2004 Aug 5;351(6):609-11; author reply 609-11.
Evidence of airborne transmission of the severe acute respiratory syndrome
virus.
Yu IT, Li Y, Wong TW, Tam W, Chan AT, Lee JH, Leung DY, Ho T.
Department of Community and Family Medicine, Chinese University of Hong Kong,
Hong Kong, China.
iyu@cuhk.edu.hk.
BACKGROUND: There is uncertainty about the mode of transmission of the severe
acute respiratory syndrome (SARS) virus. We analyzed the temporal and spatial
distributions of cases in a large community outbreak of SARS in Hong Kong and
examined the correlation of these data with the three-dimensional spread of a
virus-laden aerosol plume that was modeled using studies of airflow dynamics.
METHODS: We determined the distribution of the initial 187 cases of SARS in the
Amoy Gardens housing complex in 2003 according to the date of onset and location
of residence. We then studied the association between the location (building,
floor, and direction the apartment unit faced) and the probability of infection
using logistic regression. The spread of the airborne, virus-laden aerosols
generated by the index patient was modeled with the use of airflow-dynamics
studies, including studies performed with the use of computational
fluid-dynamics and multizone modeling. RESULTS: The curves of the epidemic
suggested a common source of the outbreak. All but 5 patients lived in seven
buildings (A to G), and the index patient and more than half the other patients
with SARS (99 patients) lived in building E. Residents of the floors at the
middle and upper levels in building E were at a significantly higher risk than
residents on lower floors; this finding is consistent with a rising plume of
contaminated warm air in the air shaft generated from a middle-level apartment
unit. The risks for the different units matched the virus concentrations
predicted with the use of multizone modeling. The distribution of risk in
buildings B, C, and D corresponded well with the three-dimensional spread of
virus-laden aerosols predicted with the use of computational fluid-dynamics
modeling. CONCLUSIONS: Airborne spread of the virus appears to explain this
large community outbreak of SARS, and future efforts at prevention and control
must take into consideration the potential for airborne spread of this virus.
Copyright 2004 Massachusetts Medical Society
PMID: 15102999 [PubMed - indexed for MEDLINE]
8: N Engl J Med. 2004 Mar 25;350(13):1304-13.
Comment in:
N Engl J Med. 2004 Jun 24;350(26):2715-8; author reply 2715-8.
N Engl J Med. 2004 Jun 24;350(26):2715-8; author reply 2715-8.
N Engl J Med. 2004 Mar 25;350(13):1349-51.
Outcomes at school age after postnatal dexamethasone therapy for lung disease of
prematurity.
Yeh TF, Lin YJ, Lin HC, Huang CC, Hsieh WS, Lin CH, Tsai CH.
Department of Pediatrics, College of Medicine, China Medical University,
Taichung, Taiwan.
master@mail.cmu.edu.twBACKGROUND: We studied the outcomes at school age in children who had
participated in a double-blind, placebo-controlled trial of early postnatal
dexamethasone therapy (initiated within 12 hours after birth) for the prevention
of chronic lung disease of prematurity. METHODS: Of the 262 children included in
the initial study, 159 lived to school age. Of these children, 146 (72 in the
dexamethasone group and 74 in the control group) were included in our study. All
the infants had had severe respiratory distress syndrome requiring mechanical
ventilation shortly after birth. In the dexamethasone group, 0.25 mg of
dexamethasone per kilogram of body weight was given intravenously every 12 hours
for one week, and then the dose was tapered. We evaluated the children's growth,
neurologic and motor function, cognition, and school performance. RESULTS:
Children in the dexamethasone group were significantly shorter than the controls
(P=0.03 for boys, P=0.01 for girls, and P=0.03 for all children) and had a
significantly smaller head circumference (P=0.04). Children in the dexamethasone
group had significantly poorer motor skills (P<0.001), motor coordination
(P<0.001), and visual-motor integration (P=0.02). As compared with the controls,
children in the dexamethasone group also had significantly lower full IQ scores
(mean [+/-SD], 78.2+/-15.0 vs. 84.4+/-12.6; P=0.008), verbal IQ scores
(84.1+/-13.2 vs. 88.4+/-11.8, P=0.04), and performance IQ scores (76.5+/-14.6
vs. 84.5+/-12.7, P=0.001). The frequency of clinically significant disabilities
was higher among children in the dexamethasone group than among controls (28 of
72 [39 percent] vs. 16 of 74 [22 percent], P=0.04). CONCLUSIONS: Early postnatal
dexamethasone therapy should not be recommended for the routine prevention or
treatment of chronic lung disease, because it leads to substantial adverse
effects on neuromotor and cognitive function at school age. Copyright 2004
Massachusetts Medical Society
Publication Types:
Clinical Trial
Controlled Clinical Trial
PMID: 15044641 [PubMed - indexed for MEDLINE]
9: N Engl J Med. 2004 Feb 19;350(8):e7.
Images in clinical medicine. Meckel's diverticulum in action.
Chan SC, Lo CY.
University of Hong Kong Medical Center, Hong Kong, China.
Publication Types:
Case Reports
PMID: 14973202 [PubMed - indexed for MEDLINE]
10: N Engl J Med. 2003 May 15;348(20):1986-94. Epub 2003 Apr 7.
Comment in:
N Engl J Med. 2003 Aug 14;349(7):708-9.
N Engl J Med. 2003 May 15;348(20):1947-8.
N Engl J Med. 2003 May 15;348(20):1948-51.
N Engl J Med. 2003 May 15;348(20):2034-5; author reply 2034-5.
A major outbreak of severe acute respiratory syndrome in Hong Kong.
Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, Ahuja A, Yung MY, Leung CB, To
KF, Lui SF, Szeto CC, Chung S, Sung JJ.
Department of Medicine, Chinese University of Hong Kong, Hong Kong, China.
BACKGROUND: There has been an outbreak of the severe acute respiratory syndrome
(SARS) worldwide. We report the clinical, laboratory, and radiologic features of
138 cases of suspected SARS during a hospital outbreak in Hong Kong. METHODS:
From March 11 to 25, 2003, all patients with suspected SARS after exposure to an
index patient or ward were admitted to the isolation wards of the Prince of
Wales Hospital. Their demographic, clinical, laboratory, and radiologic
characteristics were analyzed. Clinical end points included the need for
intensive care and death. Univariate and multivariate analyses were performed.
RESULTS: There were 66 male patients and 72 female patients in this cohort, 69
of whom were health care workers. The most common symptoms included fever (in
100 percent of the patients); chills, rigors, or both (73.2 percent); and
myalgia (60.9 percent). Cough and headache were also reported in more than 50
percent of the patients. Other common findings were lymphopenia (in 69.6
percent), thrombocytopenia (44.8 percent), and elevated lactate dehydrogenase
and creatine kinase levels (71.0 percent and 32.1 percent, respectively).
Peripheral air-space consolidation was commonly observed on thoracic computed
tomographic scanning. A total of 32 patients (23.2 percent) were admitted to the
intensive care unit; 5 patients died, all of whom had coexisting conditions. In
a multivariate analysis, the independent predictors of an adverse outcome were
advanced age (odds ratio per decade of life, 1.80; 95 percent confidence
interval, 1.16 to 2.81; P=0.009), a high peak lactate dehydrogenase level (odds
ratio per 100 U per liter, 2.09; 95 percent confidence interval, 1.28 to 3.42;
P=0.003), and an absolute neutrophil count that exceeded the upper limit of the
normal range on presentation (odds ratio, 1.60; 95 percent confidence interval,
1.03 to 2.50; P=0.04). CONCLUSIONS: SARS is a serious respiratory illness that
led to significant morbidity and mortality in our cohort. Copyright 2003
Massachusetts Medical Society
PMID: 12682352 [PubMed - indexed for MEDLINE]
11: N Engl J Med. 2003 May 15;348(20):1977-85. Epub 2003 Mar 31.
Comment in:
N Engl J Med. 2003 Aug 14;349(7):709-11; author reply 709-11.
N Engl J Med. 2003 May 15;348(20):1948-51.
A cluster of cases of severe acute respiratory syndrome in Hong Kong.
Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, Lam WK, Seto WH, Yam LY,
Cheung TM, Wong PC, Lam B, Ip MS, Chan J, Yuen KY, Lai KN.
University Department of Medicine, University of Hong Kong, Pokfulam, China.
BACKGROUND: Information on the clinical features of the severe acute respiratory
syndrome (SARS) will be of value to physicians caring for patients suspected of
having this disorder. METHODS: We abstracted data on the clinical presentation
and course of disease in 10 epidemiologically linked Chinese patients (5 men and
5 women 38 to 72 years old) in whom SARS was diagnosed between February 22,
2003, and March 22, 2003, at our hospitals in Hong Kong, China. RESULTS:
Exposure between the source patient and subsequent patients ranged from minimal
to that between patient and health care provider. The incubation period ranged
from 2 to 11 days. All patients presented with fever (temperature, >38 degrees C
for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise,
headache, and hypoxemia. Physical examination of the chest revealed crackles and
percussion dullness. Lymphopenia was observed in nine patients, and most
patients had mildly elevated aminotransferase levels but normal serum creatinine
levels. Serial chest radiographs showed progressive air-space disease. Two
patients died of progressive respiratory failure; histologic analysis of their
lungs showed diffuse alveolar damage. There was no evidence of infection by
Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All
patients received corticosteroid and ribavirin therapy a mean (+/-SD) of
9.6+/-5.42 days after the onset of symptoms, and eight were treated earlier with
a combination of beta-lactams and macrolide for 4+/-1.9 days, with no clinical
or radiologic efficacy. CONCLUSIONS: SARS appears to be infectious in origin.
Fever followed by rapidly progressive respiratory compromise is the key complex
of signs and symptoms from which the syndrome derives its name. The
microbiologic origins of SARS remain unclear. Copyright 2003 Massachusetts
Medical Society
PMID: 12671062 [PubMed - indexed for MEDLINE]
12: N Engl J Med. 2002 Dec 26;347(26):2104-10.
Comment in:
ACP J Club. 2003 Jul-Aug;139(1):12.
J Fam Pract. 2003 May;52(5):363-4.
N Engl J Med. 2002 Dec 26;347(26):2162-4.
N Engl J Med. 2003 Jun 12;348(24):2464-6; author reply 2464-6.
N Engl J Med. 2003 Jun 12;348(24):2464-6; author reply 2464-6.
Z Gastroenterol. 2003 Aug;41(8):883-4.
Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent
ulcer bleeding in patients with arthritis.
Chan FK, Hung LC, Suen BY, Wu JC, Lee KC, Leung VK, Hui AJ, To KF, Leung WK,
Wong VW, Chung SC, Sung JJ.
Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese
University of Hong Kong, Hong Kong, China.
fklchan@cuhk.edu.hkBACKGROUND: Current guidelines recommend that patients at risk for ulcer disease
who require treatment for arthritis receive nonsteroidal antiinflammatory drugs
(NSAIDs) that are selective for cyclooxygenase-2 or the combination of a
nonselective NSAID with a proton-pump inhibitor. We assessed whether celecoxib
would be similar to diclofenac plus omeprazole in reducing the risk of recurrent
ulcer bleeding in patients at high risk for bleeding. METHODS: We studied
patients who used NSAIDs for arthritis and who presented with ulcer bleeding.
After their ulcers had healed, we randomly assigned patients who were negative
for Helicobacter pylori to receive either 200 mg of celecoxib twice daily plus
daily placebo or 75 mg of diclofenac twice daily plus 20 mg of omeprazole daily
for six months. The end point was recurrent ulcer bleeding. RESULTS: In the
intention-to-treat analysis, which included 287 patients (144 receiving
celecoxib and 143 receiving diclofenac plus omeprazole), recurrent ulcer
bleeding occurred in 7 patients receiving celecoxib and 9 receiving diclofenac
plus omeprazole. The probability of recurrent bleeding during the six-month
period was 4.9 percent (95 percent confidence interval, 3.1 to 6.7) for patients
who received celecoxib and 6.4 percent (95 percent confidence interval, 4.3 to
8.4) for patients who received diclofenac plus omeprazole (difference, -1.5
percentage points; 95 percent confidence interval for the difference, -6.8 to
3.8). Renal adverse events, including hypertension, peripheral edema, and renal
failure, occurred in 24.3 percent of the patients receiving celecoxib and 30.8
percent of those receiving diclofenac plus omeprazole. CONCLUSIONS: Among
patients with a recent history of ulcer bleeding, treatment with celecoxib was
as effective as treatment with diclofenac plus omeprazole, with respect to the
prevention of recurrent bleeding. Renal toxic effects are common in high-risk
patients receiving celecoxib or diclofenac plus omeprazole. Copyright 2002
Massachusetts Medical Society
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12501222 [PubMed - indexed for MEDLINE]
13: N Engl J Med. 2002 Dec 26;347(26):2097-103.
Comment in:
N Engl J Med. 2002 Dec 26;347(26):2159-62.
Thorax. 2003 Mar;58(3):251.
Influenza-related hospitalizations among children in Hong Kong.
Chiu SS, Lau YL, Chan KH, Wong WH, Peiris JS.
Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Hong
Kong, China.
BACKGROUND: It has been difficult to define the burden of influenza in children
because of confounding by the cocirculation of respiratory syncytial virus
(RSV). In Hong Kong, China, the influenza and RSV infection seasons sometimes do
not overlap, thus providing an opportunity to estimate the rate of
influenza-related hospitalization in a defined population, free from the effects
of RSV. METHODS: In a retrospective, population-based study, we estimated the
influenza-associated excess rate of hospitalization among children 15 years old
or younger in the Hong Kong Special Administrative Region from 1997 to 1999.
Data from a single hospital with intensive use of virologic analyses for
diagnosis were obtained to define and adjust for underestimation of the model.
RESULTS: Peaks of influenza and RSV infection activity were well separated in
1998 and 1999 but overlapped in 1997. The adjusted rates of excess
hospitalization for acute respiratory disease that were attributable to
influenza were 278.5 and 288.2 per 10,000 children less than 1 year of age in
1998 and 1999, respectively; 218.4 and 209.3 per 10,000 children 1 to less than
2 years of age; 125.6 and 77.3 per 10,000 children 2 to less than 5 years of
age; 57.3 and 20.9 per 10,000 children 5 to less than 10 years of age; and 16.4
and 8.1 per 10,000 children 10 to 15 years of age. CONCLUSIONS: In the
subtropics, influenza is an important cause of hospitalization among children,
with rates exceeding those reported for temperate regions. Copyright 2002
Massachusetts Medical Society
PMID: 12501221 [PubMed - indexed for MEDLINE]
14: N Engl J Med. 2002 Jun 27;346(26):2033-8.
Comment in:
ACP J Club. 2003 Jan-Feb;138(1):11.
N Engl J Med. 2002 Nov 14;347(20):1623-4; author reply 1623-4.
Lansoprazole for the prevention of recurrences of ulcer complications from
long-term low-dose aspirin use.
Lai KC, Lam SK, Chu KM, Wong BC, Hui WM, Hu WH, Lau GK, Wong WM, Yuen MF, Chan
AO, Lai CL, Wong J.
Departments of Medicine, University of Hong Kong, Queen Mary Hospital, Hong
Kong, China.
kclai@hku.hkBACKGROUND: The role of gastric acid suppression in preventing the recurrence of
ulcer complications after the eradication of Helicobacter pylori infection in
patients taking long-term low-dose aspirin is uncertain. METHODS: We enrolled
123 patients who had ulcer complications after using low-dose aspirin
continuously for more than one month and who had H. pylori infection. After the
ulcers had healed and the H. pylori infection was eradicated, the patients were
randomly assigned to treatment with 30 mg of lansoprazole daily or placebo, in
addition to 100 mg of aspirin daily, for 12 months. The primary end point was
the recurrence of ulcer complications. RESULTS: During a median follow-up of 12
months, 9 of the 61 patients in the placebo group (14.8 percent), as compared
with 1 of the 62 patients in the lansoprazole group (1.6 percent), had a
recurrence of ulcer complications (adjusted hazard ratio, 9.6; 95 percent
confidence interval, 1.2 to 76.1). Of these 10 patients, 4 had evidence of a
recurrence of H. pylori infection and 2 had taken nonsteroidal antiinflammatory
drugs before the onset of complications. Patients in the lansoprazole group were
significantly less likely to have a recurrence of ulcer complications than
patients in the placebo group (P=0.008). There was no significant difference in
mortality between the two groups. CONCLUSIONS: In patients who had ulcer
complications related to the long-term use of low-dose aspirin, treatment with
lansoprazole in addition to the eradication of H. pylori infection significantly
reduced the rate of recurrence of ulcer complications.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12087138 [PubMed - indexed for MEDLINE]
15: N Engl J Med. 2000 Oct 19;343(16):1156-62.
Comment in:
Clin Exp Rheumatol. 2002 Jul-Aug;20(4):443-4.
N Engl J Med. 2000 Oct 19;343(16):1182-3.
N Engl J Med. 2001 Feb 1;344(5):382-3.
Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus
nephritis. Hong Kong-Guangzhou Nephrology Study Group.
Chan TM, Li FK, Tang CS, Wong RW, Fang GX, Ji YL, Lau CS, Wong AK, Tong MK, Chan
KW, Lai KN.
Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong
Kong, China.
dtmchan@hku.hkBACKGROUND: The combination of cyclophosphamide and prednisolone is effective
for the treatment of severe lupus nephritis but has serious adverse effects.
Whether mycophenolate mofetil can be substituted for cyclophosphamide is not
known. METHODS: In 42 patients with diffuse proliferative lupus nephritis we
compared the efficacy and side effects of a regimen of prednisolone and
mycophenolate mofetil given for 12 months with those of a regimen of
prednisolone and cyclophosphamide given for 6 months, followed by prednisolone
and azathioprine for 6 months. Complete remission was defined as a value for
urinary protein excretion that was less than 0.3 g per 24 hours, with normal
urinary sediment, a normal serum albumin concentration, and values for serum
creatinine and creatinine clearance that were no more than 15 percent above the
base-line values. Partial remission was defined as a value for urinary protein
excretion that was between 0.3 and 2.9 g per 24 hours, with a serum albumin
concentration of at least 30 g per liter. RESULTS: Eighty-one percent of the 21
patients treated with mycophenolate mofetil and prednisolone (group 1) had a
complete remission, and 14 percent had a partial remission, as compared with 76
percent and 14 percent, respectively, of the 21 patients treated with
cyclophosphamide and prednisolone followed by azathioprine and prednisolone
(group 2). The improvements in the degree of proteinuria and the serum albumin
and creatinine concentrations were similar in the two groups. One patient in
each group discontinued treatment because of side effects. Infections were noted
in 19 percent of the patients in group 1 and in 33 percent of those in group 2
(P = 0.29). Other adverse effects occurred only in group 2; they included
amenorrhea (in 23 percent of the patients), hair loss (19 percent), leukopenia
(10 percent), and death (10 percent). The rates of relapse were 15 percent and
11 percent, respectively. CONCLUSIONS: For the treatment of diffuse
proliferative lupus nephritis, the combination of mycophenolate mofetil and
prednisolone is as effective as a regimen of cyclophosphamide and prednisolone
followed by azathioprine and prednisolone but is less toxic.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11036121 [PubMed - indexed for MEDLINE]
16: N Engl J Med. 2000 Aug 24;343(8):544-50.
Comment in:
N Engl J Med. 2000 Nov 30;343(22):1656; author reply 1657.
Genetic and clinical features of hemoglobin H disease in Chinese patients.
Chen FE, Ooi C, Ha SY, Cheung BM, Todd D, Liang R, Chan TK, Chan V.
Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong
Kong, China.
BACKGROUND: Normally, one pair of each of the two alpha-globin genes, alpha1 and
alpha2, resides on each copy of chromosome 16. In hemoglobin H disease, three of
these four alpha-globin genes are affected by a deletion, a mutation, or both.
We studied the alpha1-globin gene abnormalities and the clinical and hematologic
features of Chinese patients with hemoglobin H disease in Hong Kong. METHODS: We
assessed the clinical features, hematologic values, serum ferritin levels, and
liver function of 114 patients with hemoglobin H disease. We also performed
echocardiography and magnetic resonance imaging of the liver and examined the
two pairs of alpha-globin genes. RESULTS: Hemoglobin H disease in 87 of the 114
patients (76 percent) was due to the deletion of three of the four alpha-globin
genes (--/-alpha), a combination termed the deletional type of hemoglobin H. The
remaining 27 patients (24 percent) had the nondeletional type of hemoglobin H
disease, in which two alpha-globin genes are deleted and a third is mutated
(--/alphaalphaT). All 87 patients with the deletional type of hemoglobin H were
double heterozygotes in whom there was a deletion of both alpha-globin genes
from one chromosome, plus a deletion of the alpha1 or alpha2 gene from the other
chromosome (--/alpha- or --/-alpha). A variety of mutated alpha-globin genes was
found in the patients with nondeletional type of hemoglobin H disease. Patients
with the nondeletional type of the H disease had more symptoms at a younger age,
more severe hemolytic anemia, and larger spleens and were more likely to require
transfusions than patients with deletional hemoglobin H disease. The severity of
iron overload was not related to the genotype. CONCLUSIONS: Chinese patients in
Hong Kong with the nondeletional type of hemoglobin H disease have more severe
disease than those with the deletional type of the disease. Iron overload is a
major cause of disability in both forms of the disease.
PMID: 10954762 [PubMed - indexed for MEDLINE]
17: N Engl J Med. 1999 Mar 11;340(10):751-6.
Comment in:
ACP J Club. 1999 Nov-Dec;131(3):64.
N Engl J Med. 1999 Aug 5;341(6):455-6.
N Engl J Med. 1999 Mar 11;340(10):799-801.
Endoscopic retreatment compared with surgery in patients with recurrent bleeding
after initial endoscopic control of bleeding ulcers.
Lau JY, Sung JJ, Lam YH, Chan AC, Ng EK, Lee DW, Chan FK, Suen RC, Chung SC.
Department of Surgery, Prince of Wales Hospital and Chinese University of Hong
Kong, Shatin, China.
BACKGROUND AND METHODS: After endoscopic treatment to control bleeding of peptic
ulcers, bleeding recurs in 15 to 20 percent of patients. In a prospective,
randomized study, we compared endoscopic retreatment with surgery after initial
endoscopy. Over a 40-month period, 1169 of 3473 adults who were admitted to our
hospital with bleeding peptic ulcers underwent endoscopy to reestablish
hemostasis. Of 100 patients with recurrent bleeding, 7 patients with cancer and
1 patient with cardiac arrest were excluded from the study; 48 patients were
randomly assigned to undergo immediate endoscopic retreatment and 44 were
assigned to undergo surgery. The type of operation used was left to the surgeon.
Bleeding was considered to have recurred in the event of any one of the
following: vomiting of fresh blood, hypotension and melena, or a requirement for
more than four units of blood in the 72-hour period after endoscopic treatment.
RESULTS: Of the 48 patients who were assigned to endoscopic retreatment, 35 had
long-term control of bleeding. Thirteen underwent salvage surgery, 11 because
retreatment failed and 2 because of perforations resulting from
thermocoagulation. Five patients in the endoscopy group died within 30 days, as
compared with eight patients in the surgery group (P=0.37). Seven patients in
the endoscopy group (including 6 who underwent salvage surgery) had
complications, as compared with 16 in the surgery group (P=0.03). The duration
of hospitalization, the need for hospitalization in the intensive care unit and
the resultant duration of that stay, and the number of blood transfusions were
similar in the two groups. In multivariate analysis, hypotension at
randomization (P=0.01) and an ulcer size of at least 2 cm (P=0.03) were
independent factors predictive of the failure of endoscopic retreatment.
CONCLUSIONS: In patients with peptic ulcers and recurrent bleeding after initial
endoscopic control of bleeding, endoscopic retreatment reduces the need for
surgery without increasing the risk of death and is associated with fewer
complications than is surgery.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10072409 [PubMed - indexed for MEDLINE]
18: N Engl J Med. 1998 Jul 9;339(2):61-8.
Comment in:
N Engl J Med. 1998 Dec 10;339(24):1786-7.
N Engl J Med. 1998 Jul 9;339(2):114-5.
N Engl J Med. 2000 Oct 12;343(15):1123-4.
A one-year trial of lamivudine for chronic hepatitis B. Asia Hepatitis
Lamivudine Study Group.
Lai CL, Chien RN, Leung NW, Chang TT, Guan R, Tai DI, Ng KY, Wu PC, Dent JC,
Barber J, Stephenson SL, Gray DF.
Department of Medicine, Queen Mary Hospital, Hong Kong, China.
BACKGROUND AND METHODS: In preliminary trials, lamivudine, an oral nucleoside
analogue, has shown promise for the treatment of chronic hepatitis B. We
conducted a one-year, double-blind trial of lamivudine in 358 Chinese patients
with chronic hepatitis B. The patients were randomly assigned to receive 25 mg
of lamivudine (142 patients), 100 mg of lamivudine (143), or placebo (73) orally
once daily. The patients underwent liver biopsies before entering the study and
after completing the assigned treatment regimen. The primary end point was a
reduction of at least two points in the Knodell necroinflammatory score.
RESULTS: Hepatic necroinflammatory activity improved by two points or more in 56
percent of the patients receiving 100 mg of lamivudine, 49 percent of those
receiving 25 mg of lamivudine, and 25 percent of those receiving placebo
(P<0.001 and P=0.001, respectively, for the comparisons of lamivudine treatment
with placebo). Necroinflammatory activity worsened in 7 percent of the patients
receiving 100 mg of lamivudine, 8 percent of those receiving 25 mg, and 26
percent of those receiving placebo. The 100-mg dose of lamivudine was associated
with a reduced progression of fibrosis (P=0.01 for the comparison with placebo)
and with the highest rate of hepatitis B e antigen (HBeAg) seroconversion (loss
of HBeAg, development of antibody to HBeAg, and undetectable HBV DNA) (16
percent), the greatest suppression of HBV DNA (98 percent reduction at week 52
as compared with the base-line value), and the highest rate of sustained
normalization of alanine aminotransferase levels (72 percent). Ninety-six
percent of the patients completed the study. The incidence of adverse events was
similar in all groups, and there were few serious events. CONCLUSIONS: In a
one-year study, lamivudine was associated with substantial histologic
improvement in many patients with chronic hepatitis B. A daily dose of 100 mg
was more effective than a daily dose of 25 mg.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 9654535 [PubMed - indexed for MEDLINE]
19: N Engl J Med. 1996 Aug 8;335(6):400-6.
Comment in:
N Engl J Med. 1996 Aug 8;335(6):430-2.
N Engl J Med. 1997 Jan 16;336(3):228; author reply 228-9.
N Engl J Med. 1997 Jan 16;336(3):228; author reply 228-9.
N Engl J Med. 1997 Jan 16;336(3):228; author reply 228-9.
Effect of economic reforms on child growth in urban and rural areas of China.
Shen T, Habicht JP, Chang Y.
Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine,
Bejing, China.
BACKGROUND: Beginning in 1978, China implemented economic reforms to transform
the economy to a free-market system. We compared the effect of the reforms on
the growth of children in urban and rural areas. METHODS: Using data from five
large cross-sectional surveys conducted between 1975 and 1992, we examined the
trends in height for age of children two to five years of age in urban and rural
areas. Mean height for age was expressed as the height in centimeters adjusted
to a reference value of 99.1 cm for a 42-month-old boy. RESULTS: Height
increased before and during the economic reforms. In 1975, the average height of
children in periurban rural areas was about 3.5 cm less than that of children in
urban areas. Between 1975 and 1985, the average height of children in periurban
rural areas increased by 2.0 cm, as compared with 1.3 cm in urban children.
Between 1987 and 1992, the average height of both urban and rural children
increased, but the net increase for rural children was only one fifth that for
urban children (0.5 vs. 2.5 cm). In a 1990 survey of seven provinces, the rural
mean height was 92.5 cm, as compared with the urban mean of 96.9 cm and the
reference value of 99.1 cm; 38 percent of rural children had moderate stunting
of growth and 15 percent had severe stunting, as compared with 10 percent and 3
percent of urban children, respectively. Differences in height between rural and
urban children were greater in provinces in which the average height of children
was lower. CONCLUSIONS: Despite an overall improvement in child growth during
the economic reforms in China, the improvement has not been equitable, as judged
by increased differences in height between rural and urban children and
increased disparities within rural area.
PMID: 8663882 [PubMed - indexed for MEDLINE]
20: N Engl J Med. 1996 Jul 4;335(1):21-5.
Comment in:
N Engl J Med. 1996 Nov 28;335(22):1688-9.
Percutaneous balloon valvuloplasty for pulmonic stenosis in adolescents and
adults.
Chen CR, Cheng TO, Huang T, Zhou YL, Chen JY, Huang YG, Li HJ.
Department of Cardiology, Guangdong Cardiovascular Institute, China.
BACKGROUND: Percutaneous balloon valvuloplasty has been the accepted first-line
treatment for congenital pulmonic stenosis in children. Its efficacy in
adolescents and adults is less well defined. METHODS: Between December 1985 and
July 1995 we performed percutaneous pulmonic valvuloplasty with a single Inoue
balloon catheter in 53 adolescent or adult patients 13 to 55 years of age (mean
[+/- SD], 26 +/- 11). Follow-up studies were performed 0.2 to 9.8 years after
the procedure (mean, 6.9 +/- 3.1) by Doppler echocardiography (in all the
patients) and by cardiac catheterization and angiography (in nine patients).
RESULTS: After balloon valvuloplasty, the systolic pressure gradient across the
pulmonic valve decreased from 91 +/- 46 mm Hg to 38 +/- 32 mm Hg (P < 0.001),
and the diameter of the pulmonic-valve orifice increased from 8.9 +/- 3.6 mm to
17.4 +/- 4.6 mm (P < 0.001). In the nine patients catheterized at follow-up, the
systolic gradient decreased from 107 +/- 48 mm Hg before valvuloplasty to 50 +/-
29 mm Hg after valvuloplasty and to 30 +/- 16 mm Hg at follow-up (P < 0.001 for
the comparison of the gradient before and after valvuloplasty; P < 0.001 for the
comparison before valvuloplasty and at follow-up; and P < 0.05 for the
comparison after valvuloplasty and at follow-up). In the same nine patients, the
diameter of the pulmonic valve, as measured by right ventricular angiography,
increased from 8.3 +/- 1.4 mm before valvuloplasty to 17.2 +/- 2.0 mm after
valvuloplasty (P < 0.001) and to 18.4 +/- 1.4 mm at follow-up (P = 0.08).
Incompetence of the pulmonic valve was noted in 7 of the 53 patients (13
percent) after balloon valvuloplasty, but it had disappeared at follow-up in all
of them. CONCLUSIONS: Patients with congenital pulmonic stenosis who present in
late adolescence or adult life can be treated with percutaneous balloon
valvuloplasty with excellent short-term and long-term results that are similar
to those in young children.
PMID: 8637537 [PubMed - indexed for MEDLINE]
