tbuckley/cabot-search huggingface dataset:
Optimized management of nivolumab (Nivo) and ipilimumab (Ipi) in advanced renal cell carcinoma (RCC): A response-based phase II study (OMNIVORE).
Authors: Rana R. McKay, Wanling Xie, Bradley Alexander McGregor, David A. Braun, Xiao X. Wei, Christos Kyriakopoulos, Yousef Zakharia, Benjamin Louis Maughan, Tracy L Rose, Walter Michael Stadler, David F. McDermott, Lauren C Harshman, Toni K. Choueiri
Journal: Journal of Clinical Oncology (2020)

5005 Background: Nivo + Ipi is an established first-line treatment (tx) for advanced RCC. We hypothesized that the addition of CTLA-4 blockade may not be required for all patients (pts). Furthermore, the optimal duration of Nivo maintenance in responding pts is unknown. In this phase II response-adaptive trial, we investigate the sequential addition of 2 doses of Ipi to induce response in Nivo non-responders (NR) and duration of Nivo in responding pts (NCT03203473). Methods: We enrolled pts with advanced RCC with no prior checkpoint inhibitor exposure. All pts received Nivo alone with subsequent arm allocation based on RECISTv1.1 response within 6 months (mos) of tx. Pts with a confirmed partial response (PR) or complete response (CR) within 6 months (mos) discontinued Nivo and were observed (Arm A). Arm A pts reinitiated Nivo if they developed progressive disease (PD); Ipi was added to Nivo if PD persisted or recurred. Pts with stable disease (SD) or PD after no more than 6 mos of Nivo alone received 2 doses of Ipi (Arm B). The primary endpoints were the proportion with PR/CR at 1-year (yr) after Nivo discontinuation (Arm A) and proportion of Nivo NR who convert to PR/CR after adding Ipi (Arm B). Results: 83 pts initiated tx of whom 99% had ECOG 0-1, 96% clear cell RCC, 51% tx-naïve, and 69% IMDC intermediate/poor risk. Median follow-up was 17.0 mos. 15 pts were not allocated to an arm [7 withdrew for PD, 7 withdrew for toxicity, 1 still on tx with unconfirmed PR (uPR)]. At 6 mos, induction Nivo resulted in a confirmed PR in 11% of pts (n=9/83): 12% (n=5/42) tx-naïve, 10% (4/41) prior tx, 8% (n=1/13) favorable risk, 11% (n=8/70) intermediate/poor risk (Table). 11 pts (13%: 9 PR, 1 uPR, 1 SD) were allocated to Arm A, of whom 5 (45%, 90% CI 20-73%) remained off Nivo at ≥ 1 yr. Of 57 pts (69%) allocated to Arm B, 2 pts converted to a PR (4%, 90% CI 1-11%), both of whom had prior tx and PD as best response to Nivo alone. Grade 3-4 treatment related adverse events (TrAE) occurred in 7% (n=6/83) on induction Nivo and in 23% (n=13/57) on Arm B (Nivo + Ipi). Conclusions: We cannot currently recommend a strategy of Nivo followed by response-based addition of Ipi due to the absence of CR and low PR/CR conversion rate (4%). Though a subset of pts treated with Nivo alone can maintain durable responses off tx at 1-yr, early Nivo discontinuation in the absence of toxicity cannot currently be recommended. Investigation into biomarkers to guide tx is ongoing. Clinical trial information: NCT03203473 . [Table: see text]
Understanding the daily needs and challenges of caregivers of patients with lung cancer.
Authors: Yanyan Zhu, Fatima Scipione, Renee Anderson, Robin Y. DiPaolo, Ros Miller, Kristine Cherol, Chris Draft, Georgeta Lester, Jill Bell
Journal: Journal of Clinical Oncology (2020)

e24173 Background: Informal caregivers provide critical support in the management of all aspects of care for patients with cancer. Although caring for loved ones with cancer can be rewarding, it can also have a significant impact on caregivers’ quality of life. The aim of this study was to understand how caring for someone with advanced lung cancer affects caregivers’ lives. Methods: A targeted review of the caregiver literature (Medline, Embase, and Psych Info; year limits 2006-19) using a single search strategy, and qualitative focus group discussion among caregivers (N = 6) who have been or are currently caring for a loved one with advanced lung cancer was conducted. Results: The search identified 99 articles; however, few articles met eligibility criteria (N = 12). Impacts focused on: caring for patient, psycho-social well-being, ability to work, hopes for future, and physical well-being. Several gaps describing the caregiver experience remained based on the results from the literature review alone. Qualitative insights from caregivers included: (1) Caregivers must deal with all aspects of the patient’s experience, as well as the broader physical and emotional well-being of themselves and family members. (2) Disease-related symptoms and treatment-related side effects can result in physical and emotional distress for both caregivers and patients. (3) Caregivers feel hopeless, frustrated, and discouraged regarding side effects, particularly when they cannot perceive the benefits of treatment. (4) Caregivers are often compelled to mask or suppress their feelings to maintain a sense of (relative) normalcy. (5) Negative emotional states directly affect family relationships and dynamics, heightening stress and loneliness for caregivers. (6) Caregivers’ contributions to shared treatment decision-making relative to the patient’s role shift throughout the cancer journey based on their loved one’s ability to cope. Conclusions: These results provide valuable insights into the under-studied experience of caregivers of patients with lung cancer. Future quantitative research will improve understanding of the unique challenges associated with cancer caregiving, as well as facilitate development of personalized, evidence-based support programs and interventions for caregivers.
Depression status and related factors in patients with maintenance hemodialysis
Authors: Liping Dong, Yuanhong Shi, Ping Tong
Journal: BMJ (2018)

Objectives
To investigate the incidence of depression status and the related factors in patients with maintenance hemodialysis (MHD).


Methods
One hundred and forty three MHD patients were enrolled in the study. According to Hospital Anxiety and Depression Scale (HADS-D) score, 50 patients (35.0%) were classified in depression group and 93 were in non-depression group. The basic clinical information, demographic characteristics and laboratory parameters were collected. Univariate analysis, Pearson correlation and hierarchical regression analysis were used to assess the related factors of depression status.


Results
The average HADS-D score in 143 MHD patients was 6.22±2.35, and that in depression group and in non-depression group was 9.76±3.85 and 3.64±2.91, respectively. The prevalence of the symptoms in MHD patients varied from 15.9% to 98.4%, and the score of symptom burden was 12-136(72.54±34.86). Univariate analysis revealed that marital status(χ2=4.493, P=0.034), economic status(χ2=4.187, P=0.04), symptom burden(r=0.68, P<0.001), symptom severity(r=0.59, P<0.001)and social support(r=-0.38, P=0.002)were associated with the depression. Hierarchical regression analysis revealed that depression was associated significantly with symptom burden(β=0.546, P<0.001), symptom severity(β=0.428, P<0.001) and social support(β=0.205, P=0.032). Symptom burden and severity could explain 30.5% of the depression variance.


Conclusions
The prevalence of depression status is high in MHD patients, which is positively correlated with symptom burden. Among all influencing factors, symptom burden has the greatest impact on the depression status, and maybe an important predicting factor of depression.


Key words: 
Renal dialysis; Depression
上消化道出血少见病因四例分析
Authors: 敬长春, 陈冰, 朱玉森
Journal: BMJ (2004)

例1 男,44岁,因呕吐咖啡色液体800 ml急诊入当地医院,住院期间又呕血1 500 ml,伴心悸、出冷汗,经抢救后行胃镜检查未发现异常,转本院.5年前患十二指肠球部溃疡并上消化道出血曾在本院治愈出院.入院后行胃镜检查时患者又出现呕血,急测血压50/20 mm Hg(1 mm Hg=0.133 kPa),给予多巴胺、输血及静脉滴注奥美拉唑(洛赛克)等抢救后病情稳定.2 d后再经胃镜检查发现贲门黏膜撕裂并见胃底散在出血点.继续上述治疗1 d后患者再度排解暗红色血便1 500 ml,并出现昏迷、抽搐。
硝酸酯的规范化应用
Authors: 李俭春
Journal: BMJ (2012)

硝酸酯是广泛应用的扩血管药,但临床应用还有许多不规范之处.本文解读我国《硝酸酯在心血管疾病中规范化应用的专家共识》,重点介绍不同类型硝酸酯及其制剂的作用特点、主要适应证及临床应用方法和注意事项,以及如何预防产生耐药性。
BRD2 induces drug resistance through activation of the RasGRP1/Ras/ERK signaling pathway in adult T‐cell lymphoblastic lymphoma
Authors: Xiao‐Peng Tian, Jun Cai, Shu‐Yun Ma, Yu Fang, Hui‐Qiang Huang, Tong‐Yu Lin, Hui‐Lan Rao, Mei Li, Zhong‐Jun Xia, Tie‐Bang Kang, Dan Xie, Qing‐Qing Cai
Journal: Cancer Communications (2020)

Abstract Background Adult patients with T‐cell lymphoblastic lymphoma (T‐LBL) are treated with high‐intensity chemotherapy regimens, but the response rate is still unsatisfactory because of frequent drug resistance. We aimed to investigate the potential mechanisms of drug resistance in adults with T‐LBL. Methods Gene expression microarray was used to identify differential mRNA expression profiles between chemotherapy‐resistant and chemotherapy‐sensitive adult T‐LBL tissues. Real‐time PCR and immunohistochemistry were performed to detect the expression of bromodomain‐containing protein 2 (BRD2) and c‐Myc in fresh‐frozen T‐LBL tissues from 85 adult patients. The Ras pull‐down assay was performed to monitor Ras activation. Chromatin immunoprecipitation assays were used to analyze the binding of E2F transcription factor 1 (E2F1)/BRD2 to the RAS guanyl releasing protein 1 (RasGRP1) promoter region. The drug resistance effect and mechanism of BRD2 were determined by both in vivo and in vitro studies. Results A total of 86 chemotherapy resistance‐related genes in adult T‐LBL were identified by gene expression microarray. Among them, BRD2 was upregulated in chemotherapy‐resistant adult T‐LBL tissues and associated with worse progression‐free survival and overall survival of 85 adult T‐LBL patients. Furthermore, BRD2 suppressed doxorubicin (Dox)‐induced cell apoptosis both in vitro and in vivo . The activation of RasGRP1/Ras/ERK signaling might contribute to the Dox resistance effect of BRD2. Besides, OTX015, a bromodomain and extra‐terminal (BET) inhibitor, reversed the Dox resistance effect of BRD2. Patient‐derived tumor xenograft demonstrated that the sequential use of OTX015 after Dox showed superior therapeutic effects. Conclusions Our data showed that BRD2 promotes drug resistance in adult T‐LBL through the RasGRP1/Ras/ERK signaling pathway. Targeting BRD2 may be a novel strategy to improve the therapeutic efficacy and prolong survival of adults with T‐LBL.
Acquired immune deficiency of cancer: Evaluation of NK cell number as a predictor of overall survival in breast cancer.
Authors: R. Michael Williams, Edmond J Yunis
Journal: Journal of Clinical Oncology (2020)

e13003 Background: Cancer specialists, be they molecular geneticists or oncology clinicians, now accept the fact that a cancer results after a deleterious mutation in the apoptosis program AND failure of the immune system, innate (non-specific) and adaptive (specific), to eliminate the now abnormal transformed cell and it's progeny. Just as the acquired immune deficiency syndrome existed as a syndrome BEFORE the HIV virus was described, the disease AIDS/HIV was designated because the virus explained the syndrome and made HIV/AIDS a disease. We believe cancer works the same way. Cancer is a failure of surveillance by the immune system which leads to a disease, one we have described as AIDS/cancer (J Immunol May 1, 2019, 202, 1S, 182.79). Methods: Commercially available laboratory analysis of peripheral blood (Quest Diagnostics) and standard treatment protocols for breast cancer. Results: The immune system can be evaluated with samples of peripheral blood where cell subsets, antibody levels, etc. are measurable. Here we present results from over 200 unselected breast cancer patients, independent of Stage. All patients were treated with standard protocols. The initial number of NK cells in peripheral blood, but not other cell subsets or immunoglobulin levels, are a, and likely the, most significant predictor for survival. Kaplan Meier survival analysis, done when 20% of the entire population had died, showed that none of the patients in the upper quartile for NK cell number had died. Survival differences, comparing the top 50% vs. bottom 50% in initial NK number. were also highly significant (P &lt; 0.05). Conclusions: We conclude that the innate immune system, reflected as numbers of NK cells in the blood are the most significant predictor of survival.
手术治疗儿童颅咽管瘤79例
Authors: 陈治标, 郑必全, 陈谦学, 徐海涛, 叶应湖, 王国安, 陈坚
Journal: BMJ (2006)

自1993年7月至2004年8月我院手术治疗儿童颅咽管瘤79例,疗效满意,现报告如下. 1.对象与方法:男45例,女34例.年龄2～15岁,平均9岁;年龄分布:2～7岁17例,8～12岁33例,13～15岁29例.临床表现:头痛41例,呕吐37例,视力下降26例,视野障碍19例,头围增大35例,多饮多尿21例,肥胖8例,身材矮小39例;第二性征发育滞后34例,发育超前11例.内分泌检查: 生长激素(GH)缺乏41例,卵泡刺激素(FSH)缺乏21例,促黄体激素(LH)缺乏15例, 促甲状腺激素(TSH)缺乏13例,促肾上腺皮质激素(ACTH)缺乏11例.头颅CT和(或)MRI扫描:单纯囊性13例,单纯实性19例,囊实性47例.所有病例经术后病理学检查证实为颅咽管瘤.
Single-arm study of bimiralisib in head and neck squamous cell carcinoma (HNSCC) patients (pts) harboring <i>NOTCH1</i> loss of function (LOF) mutations.
Authors: Faye M. Johnson, Filip Janku, J. Jack Lee, Debora Schmitz, Henk Streefkerk, Mitchell Frederick
Journal: Journal of Clinical Oncology (2020)

TPS6590 Background: Effective targeted therapies are needed for HNSCC that is lethal despite recent advances with immunotherapy. A major challenge to personalize treatment is that most genomic alterations are in tumor suppressors, including NOTCH1 that is mutated in ~20% of HNSCC. We recently published that HNSCC cell lines harboring NOTCH1 LOF mutations undergo cell death in vivo and in vitro following PI3K inhibition, in contrast to PIK3CA mutant cell lines that merely undergo cell cycle arrest when exposed to the same drugs. Based on these results we initiated a novel genomic biomarker-driven phase II clinical trial treating NOTCH1 mutant HNSCC pts with the dual PI3K/mTOR inhibitor bimiralisib (PQR309). Methods: The primary objective is to determine the objective response rate (ORR) of recurrent/metastatic HNSCC harboring NOTCH1 LOF mutations to bimiralisib. Pts who have already received standard platinum chemotherapy and immunotherapy will receive bimiralisib orally twice per wk unless progression or intolerable toxicity occurs. Tumors will be evaluated using RECIST q 6 wks. A Simon’s optimal two-stage design is used. To have 80% power to detect an ORR of 30%, (one-sided α = 0.05, β = 0.20) 10 pts will be enrolled in the first stage. If ≤1 pts respond, the trial will be closed for futility. If ≥2 pts have an OR, the study will enroll an additional 19 pts in the second stage. The null hypothesis (ORR ≤ 10%) will be rejected if ≥ 6 in 29 pts have an OR. Seven pts have enrolled. The algorithm for determining NOTCH1 mutation function is based on the patterns of mutations in HNSCC vs. leukemia where mutations are activating. It may be difficult to determine whether NOTCH1 mutations are homo- or heterozygous due to normal cell contamination. Therefore, levels of activated NOTCH1 in pretreatment tumors may be assessed by IHC with an antibody against activated NOTCH1 (NICD). In parallel with the trial, to further confirm NOTCH1 LOF, we can use site-directed mutagenesis to re-create NOTCH1 mutations from trial pts that will then be introduced into NOTCH1-null cell lines to assay for NICD and growth inhibition with culture on NOTCH1 ligand. All pts will have serial collection of blood for pharmacokinetics and for ctDNA to examine clonal evolution associated with acquired resistance. Samples with high NOTCH1 mutation ctDNA VAF will be analyzed by WES and compared with pretreatment tissue. In the second stage, IHC and WES may be performed on pre- and post- treatment (day 15 and progression) tissue to examine pharmacodynamics and mechanisms of resistance. Clinical trial information: NCT03740100 .
Developmental stages of tertiary lymphoid tissue reflect local injury and inflammation in mouse and human kidneys
Authors: Yuki Sato, Peter Boor, Shingo Fukuma, Barbara M. Klinkhammer, Hironori Haga, Osamu Ogawa, Jürgen Floege, Motoko Yanagita
Journal: Kidney International (2020)

Tertiary lymphoid tissues (TLTs) are inducible ectopic lymphoid tissues in chronic inflammatory states and function as sites of priming local immune responses. We previously demonstrated that aged but not young mice exhibited multiple TLTs after acute kidney injury and that TLTs were also detected in human aged and diseased kidneys. However, the forms of progression and the implication for kidney injury remain unclear. To clarify this we analyzed surgically resected kidneys from aged patients with or without chronic kidney disease as well as kidneys resected for pyelonephritis, and classified TLTs into three distinct developmental stages based on the presence of follicular dendritic cells and germinal centers. In injury-induced murine TLT models, the stages advanced with the extent of kidney injury, and decreased with dexamethasone accompanied with improvement of renal function, fibrosis and inflammation. Kidneys from aged patients with chronic kidney disease consistently exhibited more frequent and advanced stages of TLTs than those without chronic kidney disease. Kidneys of patients with pyelonephritis exhibited more frequent TLTs with more advanced stages than aged kidneys. Additionally, TLTs in both cohorts shared similar locations and components, suggesting that TLT formation may not be a disease-specific phenomenon but rather a common pathological process. Thus, our findings provide the insights into biological features of TLT in the kidney and implicate TLT stage as a potential marker reflecting local injury and inflammation.
抗血栓治疗基础知识（一）——抗血栓治疗概论
Authors: AndrewDBlann, MartinJLandray, GregoryYHLip, 苏畅, 杨媛华
Journal: BMJ (2004)

患儿女,3岁.发现身材矮小近2年余,于2007年1月就诊.患儿系第2胎第2产,在当地卫生院足月顺产,出生体重不详,生后因母乳不足予混合喂养,食量比同龄儿小,2004年4月由外地迁入我辖区,按北京市儿童保健(儿保)常规进行系统管理。
Granzyme B is correlated with clinical outcome after PD-1 blockade in patients with stage IV non-small-cell lung cancer
Authors: Daan P. Hurkmans, Edwin A. Basak, Nina Schepers, Esther Oomen-De Hoop, Cor H. Van der Leest, Samira El Bouazzaoui, Sander Bins, Stijn L. W. Koolen, Stefan Sleijfer, Astrid A. M. Van der Veldt, Reno Debets, Ron H. N. Van Schaik, Joachim G. J. V. Aerts, Ron H. J. Mathijssen
Journal: Journal for ImmunoTherapy of Cancer (2020)

Background A minority of patients with advanced non-small-cell lung cancer (NSCLC) benefit from treatment with immune checkpoint inhibitors (ICIs). Ineffective effector function of activated T and NK cells may lead to reduced tumor cell death, even when these activated effector cells are released from their immune checkpoint brake. Hence, in this study we aimed to assess the association of baseline serum granzyme B, as well as germline variation of the GZMB gene, with clinical outcome to programmed cell death protein 1 (PD-1) blockade. Methods A total of 347 patients with stage IV NSCLC who started nivolumab treatment between June 2013 and June 2017 were prospectively included. Baseline serum and whole blood was available, allowing for protein quantification and targeted DNA sequencing. Clinical outcome was based on best overall response (BOR) according to Response Evaluation Criteria in Solid Tumors, V.1.1, progression-free survival (PFS), and overall survival (OS). Results Patients with low serum levels of granzyme B had worse PFS (HR: 1.96; 95% CI: 1.12 to 3.43; p=0.018) and worse OS (HR: 2.08; 95% CI: 1.12 to 3.87; p=0.021) than patients with high baseline serum levels. To validate the findings, germline variation of GZMB rs8192917 was assessed. Patients with homozygous and heterozygous variants of GZMB rs8192917 had worse BOR (OR: 1.60; 95% CI: 1.01 to 2.52; p=0.044) and worse PFS (HR: 1.38; 95% CI:1.02 to 1.87; p=0.036) than wild types. Conclusions A low baseline serum level of granzyme B and germline variation of GZMB was associated with worse clinical outcome in NSCLC, emphasizing the relevance and additional value of monitoring germline genetic variations which mirror cytotoxic functions of T cells in ICI therapy. Trail registration number Dutch Trial Registry (NL6828).
胰腺真性囊肿二例
Authors: 曹卫刚, 邱宝安
Journal: BMJ (2012)

回顾性分析2例胰腺真性囊肿患者的临床病理资料及手术治疗情况.胰腺真性囊肿定位主要以腹部CT或MRI,定性以组织病理学检查为准.手术切除是主要治疗方式,并应行术中快速病理检查,以决定手术方式。
Patterns in progression from early stage melanoma to late stage melanoma: Implications for survivorship follow up.
Authors: Benjamin Switzer, David James Savage, Jung Min Song, Carolyn Stanek, Pauline Funchain
Journal: Journal of Clinical Oncology (2020)

e24055 Background: Despite an encouraging 99% five-year survival in patients diagnosed with early-stage melanoma, a higher proportion of fatal melanomas initially present with thin ( &lt; 1mm) rather than thick ( &gt; 4mm) melanoma. 1 Therefore, early-stage melanoma survivorship remains a topic of high interest. We examined a cohort of early-stage melanomas which progressed to stage IV to inform survivorship and risk-stratification approaches in this large, understudied population. Methods: From a retrospective single-center study of 880 consecutive melanoma patients from 2016-2020, we identified new, non- de novo diagnoses of stage IV melanoma which progressed from an initial early-stage (IA-IIA) diagnosis. Descriptive data were collected via chart review on demographics, clinical features, presentation at time of progression, and follow up prior to progression. Results: A total of 50 patients met the inclusion criterion of an initial stage IA-IIA diagnosis with subsequent progression to stage IV melanoma. Primary early stage melanomas were diagnosed an average of 6.1 years prior to metastatic disease progression, with 46% (n = 23) diagnosed within 3 years, 22% (n = 11) between 4-6 years, 12% (n = 6) between 7-10 years, 8% (n = 4) between 10-12 years, and 12% (n = 6) beyond the 12 year mark from their initial early-stage diagnosis. Average age at time of diagnosis was 57.7 (median 60, range 21-68), and 62% (n = 31) were male. The two most common early-stage diagnostic sites were lower extremities (27.5%, n = 14) and back (23.5%, n = 12). The two most common sites of metastatic disease were lung (46%, n = 23) and brain (28%, n = 14). A total of 30% (n = 15) and 34% (n = 17) of this cohort maintained follow up with oncology and dermatology, respectively, prior to their stage IV diagnosis. Symptomatic disease lead to 80% (n = 40) of stage IV diagnoses, while 14% (n = 7) were diagnosed through routine oncologic or dermatologic follow up, and the final 6% were diagnosed incidentally. Conclusions: Early stage melanoma patients who develop stage IV disease exhibit wide ranges in onset of disease progression, thus survivorship plans for this group could include a combination of early provider screening and patient education for later presentations of metastatic disease. Due to relatively common metastatic involvement of the lung and brain, a high suspicion to screen for metastatic disease with symptoms involving these organs may be appropriate.
社区医生对危重症的识别与处置
Authors: 赵丽
Journal: BMJ (2009)

大多数社区医生在临床工作中,面对突发而至的急危重症都会感到恐惧和束手无策,这主要是由于社区医生对危重症的早期征象认识不足,并且不够重视问诊,轻视患者的疾病既往史.应该知道,无论患者就诊时表现出来的病情是轻是重,都不是临床意义上的轻或重,而且轻重之间是可以相互转化的.每一种疾病都有其发生和发展的过程,对于症状的认识是识别危重症的第一步,同一种疾病可以有不同的症状,同一种症状也可以出现在不同的疾病中.社区医生管理慢性病患者中,掌握出现危重症状况的早期信号和重点观察项目,是早期识别危重症和及时处置的重要方法。
对破伤风抗毒素皮试阳性患者拒脱敏注射的看法
Authors: 刘少青, 贺晓晶
Journal: BMJ (2006)

四五年来,我院对外伤患者破伤风抗毒素(TAT)皮试阳性者,护士拒做脱敏注射已成潜规则.究其原因,据说是某医院曾发生一例外伤患者接受TAT脱敏注射过敏死亡者,惹起医疗纠纷.为了保证医疗安全,避免医疗纠纷,征得护理部同意,对TAT皮试阳性患者一律不做脱敏注射.咨询几家兄弟医院,包括一家三甲医院,情况也是如此。
Management of chronic heart failure following evidance-based medicine
Authors: 胡大一
Journal: BMJ (2004)

一、慢性心力衰竭的传统治疗--强心、利尿、扩血管 在循证心血管医学以前的时代,慢性心力衰竭的治疗目标是控制肺和体循环淤血,改善临床症状.人们习惯于将这一水平的治疗概括为强心、利尿、扩血管.洋地黄类强心药物临床应用的历史最为悠久,它除有正性变力性作用以外,同时具有负性传导作用(增强房室交界区的隐匿传导,有益于减慢心房颤动的心室率)和负性频率作用(可在一定程度上使继发于心力衰竭的室性心率减慢)。