Objective Making an individualized pharmacological treatment plan for a patient of acute respiratory distress syndrome after operation. Methods First, six clinical problems were put forward after assessing the patient’ s health state. Then we searched OVID versions of the ACP Journal Club (1991~2009), CENTRAL (1st Quarter 2009), CDSR (1st Quarter 2009), and MEDLINE (1991~2009) databases. Systematic reviews, meta-analyses, and randomized clinical trials about treatment of acute respiratory distress syndrome were included. The pharmacological treatment plan was made accordingly.Results After evaluation, 13 studies were eligible. The evidence indicated that the restrictive strategy of fluid management, corrected hypoproteinaemia, diuresis, and low-dose corticosteroids given in the early phase could improve oxygenation and prognosis; inhaled nitric oxide, exogenous surfactant supplement, other pharmacological drugs were associated with limited improvement in oxygenation in patients with ARDS but confer no mortality benefit and may cause harm, so we did not recommend their routine use in ARDS patients. The individual treatment plan was made based on the evidence found. After 8 days of treatment, the patient was out the ICU. He recovered and was discharged after 1 month. Conclusions The individual treatment plan, which was made based on high quality evidence and patient’s condition, improved treatment efficacy, shortened the stay in ICU, reduced mortality, and decreased adverse reactions.
Atrial fibrillation, as the most common arrhythmia currently, can lead to secondary post-stroke cognitive dysfunction and chronic brain damage through various pathways, increasing the risk of cognitive dysfunction and affecting patient prognosis. The prevention and treatment drugs for cognitive dysfunction associated with atrial fibrillation mainly include anticoagulants, heart rhythm and heart rate control drugs, statins, and antihypertensive drugs. At present, there is still some controversy over the medication for cognitive dysfunction associated with atrial fibrillation, lacking guidelines and expert consensus. It is urgent and necessary to find safe, economical, and effective drugs to improve the cognitive function of atrial fibrillation patients. This article summarizes the recent advances in drug therapy for cognitive dysfunction associated with atrial fibrillation, in order to provide a reference for the treatment of cognitive dysfunction associated with atrial fibrillation in clinical practice.
ObjectiveTo summarize the therapeutic effect and clinical significance of reduced volume lesion resection combined with drug therapy for end-stage alveolar hepatic echinococcosis.MethodClinical data of 46 patients with end-stage alveolar hepatic echinococcosis who received treatment of reduced volume lesion resection combined with drug therapy at Department of General Surgery of Qinghai Provincial People’s Hospital from March 2013 to October 2019 were retrospectively analyzed.ResultsAmong the 46 patients, 3 patients were lost to follow-up and 43 patients received follow-up. The follow-up time ranged from 3 to 79 months, with the median of 40 months. Fifteen patients died during the follow-up period, of which 5 patients with cerebral hydatid disease died during 16–36 months due to acute seizures and cerebral edema, 4 patients with multiple systemic metastases died during 9–36 months due to multiple organ failure, 2 patients with pulmonary echinococcosis died due to acute pulmonary embolism, 4 patients died in 2 years after operation due to recurrent biliary tract infection, other patients survived during follow-up period without distant organ metastasis.ConclusionReduced volume lesion resection combined with drug therapy in treatment of end-stage alveolar hepatic echinococcosis can improve the patient’s quality of life, reduce the hospital cost, reduce the occurrence of postoperative complications, and shorten the length of hospital stay.
目的:观察比较胃镜下硬化剂注射联合药物治疗和单纯硬化剂注射治疗、药物治疗食管静脉曲张出血的疗效。方法:95例肝硬化并食管静脉曲张出血患者,分成三组。32例患者给予硬化剂注射联合药物治疗,31例患者给予硬化剂治疗,32例患者给予药物治疗。观察三组患者急诊止血率,近期出血率、远期再出血率、曲张静脉消失率、曲张静脉复发率。 结果: 联合组、硬化剂组、药物组急诊止血率分别为93.8%.90.3%、68.8%;联合组、硬化剂组、药物组近期出血率分别为6.3%、9.7%、46.9%;联合组、硬化剂组、药物组曲张静脉消失率分别为90.6%、83.9%、1.9%;联合组、硬化组与药物组急诊止血率、近期出血率、曲张静脉消失率有显著差异。联合组、硬化剂组、药物组远期出血率分别为9.4%、59.4%、31.3%; 联合组、硬化剂组、药物组曲张静脉复发率分别为18.8%、45.2%、87.5%;联合组与硬化组、药物组远期出血率、曲张静脉复发率有显著差异。结论:胃镜下硬化剂注射联合药物治疗食管静脉曲张出血可显著提高疗效。
Heart failure is a global problem that occurs in 38 million patients worldwide, and the number is dramatically increasing in elderly society. Meanwhile, heart dysfunction is also the most common disease among hospitalized patients more than 65 years, especially in high-income countries. Approximately, one million patients are hospitalized because of heart failure in the world every year. Drug therapy is currently the most popular treatment for heart failure in clinic, however, the effects are limited. Therefore, exploring novel treatment strategies gradually becomes a focus not only in basic but also in clinical research.
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) published the first clinical practice guideline for sudden sensorineural hearing loss in 2012 and updated it in 2019. The guideline, which includes 13 expert consensus recommendations and treatment protocols, advocates medication (glucocorticoids are the sole optional medicine) and hyperbaric oxygen therapy. In order to provide references for the formulation of the guidelines for sudden sensorineural hearing loss that are more suitable for our national conditions, this article interprets the treatment regimens of the guideline.
ObjectiveTo investigate the relation between mammographic density (MD) and the efficacy of neoadjuvant chemotherapy (NACT) for patients with breast cancer. MethodsThe clinicopathologic data of patients diagnosed with breast cancer in the Affiliated Hospital of Southwest Medical University from January 2019 to December 2021 and met the inclusion and exclusion criteria of this study were collected. According to the 5th edition of the Breast Imaging-Reporting and Data System, the MD was classified into 4 categories: a, b, c, and d. Based on the pathological evaluation systems of Miller-Payne and Residual Cancer Burden, the new and improved pathological criteria was structured including the residual cancer cell and lymph node statuses to evaluate the pathological changes of breast cancer after NACT. After adjusting the factors affecting MD, the original model (only including MD categories as independent variables), the minimum adjustment model (adding age, body mass index, and menopausal status as independent variables), and the fully adjusted model (further including estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, axillary lymph node status at the initial diagnosis, and NACT regimen) were used to analyze the relation between MD and NACT effect. In the 3 models, the MD category a was used as the reference. ResultsA total of 287 patients with breast cancer were enrolled in this study. Thirty-eight, 76, 114, and 59 of whom with MD category a, b, c, and d respectively, and 14, 74, 117, and 82 of whom with grade L1, L2, L3, and L4 of NACT effect respectively. No matter in integrated patients or premenopausal patients, the results of the fully adjusted model showed that, the regression coefficient of MD classification was negative, and with the increase of MD classification, the odds ratio was <1 and showed a decreasing trend. ConclusionsFrom the results of this study, the increase of MD classification may have a negative impact on the effect of NACT. Namely, effect of NACT is poor in integrated patients or premenopausal patients of whom with higher MD. MD can be used as a predictor of NACT effect, so as to guide doctors in the selection and individual management of neoadjuvant therapy, and improve the prognosis of patients with breast cancer.
目的:分析腹腔镜手术联合药物治疗子宫内膜异位症的疗效。方法:回顾性分析2002年至2005年四川大学华西第二医院收治的830例子宫内膜异位症患者腹腔镜手术治疗后的随访资料。比较手术后加用丹那唑、孕三烯酮(内美通)、诺雷得以及中药治疗3个月后的轻、重度子宫内膜异位症的复发率、合并不孕患者的受孕率。结果:术后两年,各药物组在各类中受孕率及在轻度中复发率无明显差异,在重度中,中药组复发率显著高于其他各药物组。结论:子宫内膜异位症腹腔镜手术后联合用药可降低复发率,提高受孕率。中药组的复发率在重度子宫内膜异位症中要高于其他组。各药物组在受孕率上无显著差异。
Epilepsy (EP) is one of the most common chronic nervous system disease in childhood and adolescence, with a prevalence rate of 7.6‰. About 3/4 of epilepsy patients begin to get sick in childhood. At present, there are many ways to treat epilepsy, such as oral anti-seizure medications (ASMs), surgical treatment, ketogenic diet, etc. However, ASMs are the preferred treatment for most epilepsy patients and the most important and basic treatment. Oxcarbazepine (OXC) and Lacosamide (LCM) are both sodium channel blockers. The former is a second-generation ASMs, a fast sodium channel blocker, while the latter is a third-generation ASMs, a slow sodium channel blocker. The rapid inactivation of sodium channel is mediated by the inner pore ball chain mechanism in milliseconds, which is helpful to the termination of action potential and the regulation of refractory period. It is the main inactivation mode under normal physiological conditions. Different from the rapid inactivation of sodium channels, the slow inactivation is in seconds per minute, which may involve the rearrangement of the inner pore structure and increase the excitability of the action potential threshold regulating membrane. Generally, under pathological conditions, sodium channels are more likely to enter the slow inactivation state. Now, OXC and LCM have been approved by the US Food and Drug Administration, the European Union Drug Administration, and the National Drug Administration of China for monotherapy or additive therapy of focal origin (with or without secondary generalized seizures) in epilepsy patients aged 4 years and above. This article will focus on the pharmacokinetics, efficacy, and safety of LCM and OXC in the treatment of childhood epilepsy.