ABSTRACT
Objective To investigate the effect of valsartan combined with amlodipine in treatment of elderly patients with essential hypertension and diabetes,and to provide a reference for the development of clinical treatment. Methods 339 patients with essential hypertension complicated with diabetes in our hospital were randomly divided into 3 groups:A group,B group and C group,each group in 113 cases.A group was treated with amlodipine tablets,B group was treated with valsartan capsules,and C group was treated with amlodipine tablets combined with valsartan capsules.After 3 months of continuous treatment,blood pressure,blood glucose,blood lipids and uric acid were com-pared among the three groups before and after treatment.Results The three groups of patients before treatment, systolic blood pressure and diastolic blood pressure had no significant difference;The three groups of patients after treatment,systolic blood pressure and diastolic blood pressure were significantly lower than before treatment;After treatment in C group,the systolic blood pressure was (135.70 ±8.17)mmHg,which was significantly lower than (139.42 ±8.29)mmHg in A group and (139.52 ±7.48)mmHg in B group,the difference was statistically significant (t =3.77,3.81,all P <0.05);The three groups of patients after treatment of diastolic blood pressure had no significant difference,and there were no statistical significance among the three groups before treatment in the fasting blood glucose,fasting insulin,ISI level difference;Of A group after treatment,the fasting blood glucose,fasting insulin,ISI levels were (7.63 ±0.89)mmol/L,(16.11 ±2.39)mIU,(-4.26 ±0.35),there were no significant difference before and after treatment;Of B group and C group after treatment,fasting blood glucose,fasting insulin and ISI were significantly lower than before treatment (t =4.45,4.83,6.74,6.61,4.48,4.93,all P <0.05)and A group after treatment(t =4.23,448,5.24,515,409,3.95,all P <0.05),and the differences were statistically significant,and before and after treatment the total cholesterol,triglyceride,high density lipoprotein cholesterol and low density lipo-protein cholesterol levels among the three groups had no statistical significance;the level of uric acid of C group after treatment(282.04 ±81.31)μmol/L was significantly lower than that in A group and B group(t =4.94,4.68,all P <0.05).Conclusion Valsartan combined with amlodipine can effectively reduce the community elderly patients with primary hypertension in patients with diabetes mellitus blood pressure levels,promote the stability of blood glucose level,improve the uric acid metabolism and on renal function have protective effect.
ABSTRACT
Objective To analyze the related factors that influence the stone free rate ( SFR) in flexible ureteroscopic lithotripsy ( FURL ) and develop a stone free index ( SFI ) model to estimate and predict the outcome of FURL.Methods A total of 393 patients receiving FURL were included in this study from May 2013 to August 2014.All patients′and calculous characteristics were recorded.It was evaluated the correlation of one-stage SFR with body mass index, the degree of hydronephrosis, the sterile urine, the renal insufficiency, the stone location, the stone number, the cumulative stone diameter ( CSD) , the stone density, the average of CT values, the minimum angle of pelvis ureter long axis with lamp long axis, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.Multivariate regression analysis was used to analyze the relationship between preoperative characteristics and the SFR.Results The one-stage postoperative SFR in our study was 92.4% ( 363/393).We found that the staghorn stone, bacteriuria, CSD, average of CT values, the average length of stone located calyx-neck, the minimum ratio of stone located calyx-neck′width with calyx′width were significantly correlated with the postoperative SFR ( P 7.5 meant a relatively high SFR ( SFR>85%) of FURL.Conclusions A SFI model using preclinical data was developed to predict the postoperative outcome of FURL, as well as the one-stage SFR.This model needs further prospective studies in the future.
ABSTRACT
OBJECTIVE To explore clinic effect of antibiotics intervention during perioperative period guided by rational usage of antibiotics.METHODS Selected all the discharged patients of Oct 2003 and Apr 2004 as group without intervention and that of Oct 2004,Apr and Oct 2005,and Apr and Oct 2006 as group with intervention,to analyze their antibiotics usage data.RESULTS After continuous intervention,antibiotics utilization ratio promoted,especially the antibiotics half an hour pre-operation utilization ratio of clean-contaminated incision and contaminated incision improved from 48.9% and 14.3% in pre-intervention group to 88.2% and 50.0% in post-intervention group,respectively,antibiotics cost to total drug fee ratio decreased from 30.51% to 24.06%.CONCLUSIONS Effective and feasible intervention can promote antibiotics prophylaxis utilization during perioperative period and decrease incision infection and medical expense.
ABSTRACT
<p><b>OBJECTIVE</b>With the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety.</p><p><b>METHODS</b>Between October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed.</p><p><b>RESULTS</b>Six polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared.</p><p><b>CONCLUSION</b>Mechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.</p>