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The core of diagnosing and treating diseases in traditional Chinese medicine lies in syndrome differentiation. The eight principles of syndrome differentiation serve as guidance for syndrome differentiation. As one of the eight principles of syndrome differentiation， the differentiation of deficiency and excess is the basic and critical method. Ischemic stroke is currently the leading cause harming the health of Chinese residents. Although the hypotheses about the cause of ischemic stroke have evolved from external wind to the later internal wind and to the modern theory of toxin damaging the brain collaterals， they all believe that this disease is rooted in internal deficiency and external excess. According to available studies， although stroke is characterized by complex pathogenesis and rapid progression of syndromes， the key cause evolution has a regularity， that is， from excess to deficiency. This article analyzes the historical evolution of the etiology， pathogenesis， and syndrome differentiation schemes of stroke. There are diverse schemes for the syndrome differentiation of stroke， which make it difficult to choose in clinical practice. In view of this problem， this paper puts forward a new approach of staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess according to the evolution law of the key cause of stroke. Furthermore， we conducted a randomized controlled study on 100 patients with ischemic stroke to evaluate this new approach. The results showed that the staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess demonstrated definite clinical efficacy. In addition， this article reviews the previous research results of our team and the research achievements of other teams to preliminarily explore the relationship between stroke syndromes and biomarkers， aiming to provide an objective basis for unveiling the pathogenesis of stroke. In summary， according to the key cause evolution （from excess to deficiency）， the treatment of ischemic stroke by stages based on differentiation of deficiency and excess can facilitate the rapid intervention and improve the clinical efficacy on ischemic stroke.
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Objective:To explore the efficacy of sequential and concurrent chemoradiotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) in the elderly, and to analyze the influencing factors of prognosis and outcome.Methods:The clinical data of 195 elderly patients with advanced NSCLC admitted to Beijing Shijingshan Hospitaland and Beijing Shijitan Hospital from March 2015 to March 2018 were retrospectively analyzed. They were divided into the concurrent chemoradiotherapy (100 cases) and the sequential chemoradiotherapy (95 cases) according to different chemoradiotherapy regiments. The short-term efficacy, 3-year survival, influencing factors of prognosis and toxic and adverse effects of the two groups were compared.Results:The objective response rate in the concurrent chemoradiotherapy group was significantly higher than that in the sequential chemoradiotherapy group: 61.00%(61/100) vs. 44.21%(42/95), there was statistically difference ( χ2 = 5.51, P<0.05). The 2-year and 3-year survival rate in the concurrent chemoradiotherapy group were 52.00% and 23.00%, which were significantly higher than those in the sequential chemoradiotherapy group: 32.60%, 11.60%, there were statistically differences ( P<0.05). Multivariate analysis results showed that smoking, Karnofsky score<70, TNM stage Ⅲb, short-term efficacy and treatment methods/sequential chemoradiotherapy were independent risk factors ( P<0.05). The incidence of radiation esophagitis, bone marrow suppression and lung function damage in the concurrent chemoradiotherapy group were higher than those in the sequential chemoradiotherapy group: 45.00%(45/100) vs. 27.37% (26/95), 36.00%(36/100) vs. 22.11%(21/95), 48.00%(48/100) vs. 26.32%(25/95), there were statistically differences ( χ2 = 6.54, 4.55, 9.78; P<0.05). Conclusions:Concurrent chemoradiotherapy can improve the short-term efficacy, and improve the 2-year and 3-year survival rates in advanced NSCLC in elderly patients, but the adverse effects are significantly enhanced.
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Objective@#Evaluate the effect of an integrated teaching model of oral preclinical practice based on endodontic-restorative sequential treatment to provide a reference for the exploration of the teaching mode of the stomatology specialty. @* Methods @#This retrospective study was reviewed and approved by the Ethics Committee. The study was divided into 2 groups. There were 450 2018-grade and 2019-grade students in the discipline integration teaching method (DIT) group, and a preclinical practice course (root canal therapy and fixed prosthetic treatments were integrated into an endodontic-restorative sequential treatment) using the DIT method was applied. There were 443 2016-grade and 2017-grade students in the traditional teaching method (TT) group, and a TT preclinical practice course (root canal therapy and fixed prosthetic treatments training courses were taught separately) was applied. Both groups were taught by the same two teachers. The scores of clinical skills examination and treatment planning were compared between the two groups. In addition, students in the two groups were asked to complete the questionnaires about the teaching methods, and students in Group DIT and their teachers were asked to complete the questionnaires on their degree of satisfaction with the DIT method in the preclinical course. @*Results @# Students in the DIT group had an average score of 90.2 ± 4.16 in the practical skill evaluation, which was higher than that of the TT group (86.3±3.57) (P = 0.001). In the case analysis, 91.8% (413/450) of the students in the DIT group successfully planned the treatment, compared to a significantly lower rate in the TT group of 74.7% (331/443) (P = 0.001). The questionnaire results showed that recognition degrees of cultivated clinical thinking, improved indication analysis ability, improved operational skills, stimulated enthusiasm for learning, and improved autonomous learning were higher in the DIT group than in the TT group, and both teachers (2/2) and 98.4% (443/450) of students recognized the DIT method. @*Conclusions@#The DIT method significantly improved students’ learning quality and ability, proved effective in the endodontic-restorative sequential treatment practice course and was more acceptable to teachers and students. The DIT method is more effective than the TT method in improving students’ clinical thinking and operation ability.
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Objective:To investigate the correlation between chronic renal insufficiency (CRF) and helicobacter pylori (HP) infection in elderly patients and the relative clinical treatment effects.Methods:In this study, 150 elderly patients with CRF were selected as the observation group and 40 health individuals who were confirmed in the physical examination were selected as the control group.All of them underwent examination of 14C-urea breath test (UBT) so as to diagnose the HP infection rate.100 patients with CRF combined with HP infection in 150 elderly patients with CRF were divided into sequential treatment group (50 cases) and triple treatment group (50 cases) according to the random number table method.The two groups were implement sequential treatment and routine triple treatment, respectively, and the clinical effects of the two methods were evaluated after they were continuously treated 10 d.The clearance rate of HP and symptom score of the two methods were compared, and the safeties of the two methods were evaluated by the examining functions of liver and kidney.Results:The results of 14C-UBT showed that the HP infection rate was 72％ (108cases) in observation group, which was significantly higher than that (32.50％) in control group (x2=28.324, P<0.05) .The clearance rate of HP in sequential treatment group was 98.00％, which was significantly higher than that (88.00％) in triple treatment group, and the clinically effective rate in sequential treatment group was 94.00％, which was significantly higher than that (84.00％) in triple treatment group, and the differences of them was statistically significant (x2=4.231, x2=5.576, P<0.05) .The scores of abdominal distension, abdominal pain, belching and anorexia of sequential treatment group were significantly lower than those of triple treatment group after treatment (t=12.432, t=1.223, t=10.276, t=9.326, P<0.05) .Besides, the differences of indicators of liver and kidney function between sequential treatment group and triple treatment group after treatment were no significant (t=12.432, t=1.223, t=10.276, t=9.326, P<0.05) .Conclusion:The incidence rate of HP infection in elderly patients with CRF is significantly higher than those of healthy people.For patients with CRF, routine HP detection should be carried out, moreover, compared with triple treatment, sequential treatment holds a more effective and safe therapeutic outcome.
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Objective To evaluate the efficacy of telbivudine in HBeAg-positive chronic hepatitis B (CHB) patients by comparing the efficacy of initial telbivudine therapy in treatment-naive patients with sequential telbivudine therapy in patients with poor response to adefovir.Methods A total of 90 HBeAg-positive CHB patients were assigned to receive sequential telbivudine therapy following poor response to adefovir dipivoxil (n=45),or initial telbivudine therapy in antiviral treatment-naive patients (n=45).All patients were treated with telbivudine 600 mg daily for 104 weeks.The efficacy was evaluated in terms of liver function tests,serum HBV markers,HBV DNA and antiviral drug resistance.Results Telbivudine showed good overall efficacy after treatment for 104 weeks in terms of alanine aminotransferase normalization rate (91.1％),HBV DNA negative conversion rate (80.0％),HBeAg loss rate (57.8％),and HBeAg/HBeAb seroconversion rate (30.0％).The HBV DNA negative conversion rate in initial treatment group was significantly higher than that in sequential treatment group (P＜0.05).However,among the patients with early response,the efficacy did not show significant difference between groups (P＞0.05).The patients with early response showed significantly better efficacy than those without early response,in terms of higher HBV DNA negative conversion rate,higher HBeAg loss rate and HBeAg/ HBeAb seroconversion rate (P＜0.000 1 or P＜0.05),but lower virological breakthrough rate (P＜0.05).Conclusions Telbivudine has shown reliable efficacy in CHB patients.Initial telbivudine therapy is better than sequential therapy in CHB patients with poor response to adefovir.However,for patients with early response to telbivudine,no statistical difference is found between initial and sequential therapy in long-term treatment efficacy (104 weeks).The patients receiving sequential telbivudine therapy should be monitored closely for early antiviral response to optimize treatment.
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Objective To evaluate the feasibility and effect of sequential treatment by the heated humidified high flow nasal cannula oxygen therapy (HFNC) in mechanically ventilated patients following endotracheal tube extubation.Methods A prospective randomized controlled trial was conducted. Forty-nine patients with the sequential treatment after tracheal intubation extraction admitted to Department of Critical Care Medicine of Shanghai Tenth People's Hospital from January 1st to December 31st 2016 were enrolled. The patients were randomly divided into HFNC group (n = 25) and non-invasive positive pressure ventilation (NPPV) group (n = 24) in accordance with the random numbertable. During the study, arterial blood gas and the sputum viscosity were assessed at 12, 24, and 48 hours after NPPV or HFNC treatment, and the nasal and facial pressure ulcers within 1 week was also recorded. Receiver operating characteristic curve (ROC) was plotted, and the effect of NPPV or HFNC on oxygenation was analyzed.Results Among the 25 patients in the HFNC group, 1 patient who was re-intubated and 2 patients who were changed to NPPV were excluded, and a total of 22 patients with complete data were enrolled in HFNC group. Among the 24 patients in the NPPV group, 1 patient who gave up the treatment and 1 patient who was re-intubated were excluded, and a total of 22 patients with complete data were enrolled in NPPV group. After the sequential treatment, most patients in NPPV group showed moderate viscous sputum (12, 12 and 10 cases at 12, 24 and 48 hours, respectively), whereas the patients in HFNC group showed thin sputum (15, 16 and 15 cases at 12, 24 and 48 hours, respectively). Sputum viscosity of patients in HFNC group at each time point was significantly lower than that in NPPV group (allP < 0.01). Arterial oxygen saturation (SaO2) and arterial partial pressure of oxygen (PaO2) at 12, 24 and 48 hours in the HFNC group were significantly higher than those in the NPPV group [SaO2: 0.978±0.009 vs. 0.906±0.139 at 12 hours, 0.976±0.019 vs. 0.924±0.103 at 24 hours, 0.973±0.019 vs. 0.935±0.079 at 48 hours; PaO2 (mmHg, 1 mmHg = 0.133 kPa): 97.85±22.99 vs. 79.24±25.86 at 12 hours, 108.10±43.87 vs. 84.44±29.24 at 24 hours, 102.31±39.02 vs. 79.04±27.46 at 48 hours, allP < 0.05], however, the difference in arterial partial pressure of carbon dioxide (PaCO2) at all of the time points between the two groups was not significant. In NPPV group, 4 patients with nasal and facial pressure ulcers was found, and all with Ⅰ phase of pressure ulcers, and no nasal and facial pressure ulcers was found in HFNC group, which was significantly decreased as compared with NPPV group (χ2 = 4.400,P = 0.036). A good effect of oxygen therapy was defined as PaO2 at 48 hours after the sequential treatment was increased by 20% as compared with that before the treatment. ROC curve analysis showed that the area under the ROC curve (AUC) of HFNC on improving oxygenation was higher than that of NPPV (0.917 vs. 0.830); when PaO2 at 48 hours after HFNC treatment was 76.25 mmHg, the sensitivity was 100%, and the specificity was 75.0%.Conclusions Compared with NPPV, adoption of HFNC as sequential treatment is a feasible manner in dealing with the mechanically ventilated patients after endotracheal tube extubation, which can improve the oxygenation as well as reducing the degree of sputum viscosity and incidence of nasal and facial pressure ulcers. HFNC is a promising therapy, which may be worthy to recommend broadly in such a clinical situation.
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Background: Patients with chronic hepatitis B virus (HBV) who are positive for e antigen (HBeAg) and have a high viral load are considered to be poor therapeutic responders to pegylated interferon (PEG-IFN). The aim of this study was to assess the therapeutic response of sequential therapy, lamivudine (LAM) followed by PEG-IFN, in these cases. Methods: Chronic HBV patients who were HBeAg positive, with HBV DNA over 107 IU/ml and ALT 2-10 times the upper normal limit, and who were treatment naive were included in our study. Those with concurrent hepatitis C or HIV infection, liver cirrhosis or decompensated cirrhosis, or pregnancy were excluded. The enrolled cases received therapy with PEG-IFN monotherapy for 48 weeks (PEG-IFN group) or sequential therapy with lamivudine (LAM) for 4 weeks followed by PEG-IFN therapy for 48 weeks (LAM/ PEG-IFN group). Results: There were 10 patients in each group, and there were no differences in age, gender, HBV genotype, pre-treatment ALT, and HBV DNA levels between the two groups. The biochemical, virological and serologic responses within 24 weeks after treatment were 40%-60%, 30-50%, and 40-50%, respectively, in the PEG-IFN group, compared with 70%, 20-40%, and 20-40%, respectively, in the LAM/PEG-IFN group. The rates of positive EOT were 30% and 10% in the PEG-IFN group and the LAM/PEG-IFN group, respectively, with rates of 40% and 10% in the SVR-12-week subgroup, and 30% and 20%, respectively, in the SVR-24-week subgroup. The therapeutic responses between the two groups showed no differences. Conclusion: In chronic HBV patients who were positive for HBeAg positive and with a high viral load at baseline, similar therapeutic responses were noted between the sequential LAM/PEG-IFN therapy group and the PEG-IFN monotherapy group. Further research with a higher number of patients and a prolonged LAM course are needed to confirm the efficacy of this approach.
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Objective To value the effect and safety of butyl phthalide sequential treatment in cerebral infarction of branch sclerosis of arterial congee appearance. Methods Sixty patients with acute cerebral infarction were randomly divided into treated group( n = 31)and control group( n = 29). According to the condition of illness,all patients were given aspirin,atorvastatin calcium,and the injection of ozagrel sodium intravenous;controlled the blood pressure,blood sugar,blood lipid,and treated complications posstively;take the early rehabilitation of nerve treatment afte the illness was in stable condition. Butyl phthalide was used in the patients of treated group(100 ml,twice per day,intravenous drip,during 14 days period therapy,and then 0. 2 g oral,third per day),besides the routine therapy. The degree of neural function defect score( NIHSS)and activities of daily living score(BI)between two groups were observed before and after treatment. Corresponding adverse consequences were recorded. Results Compared with pretreatment,the NIHSS of postreatment at the 14th day in treat and control groups were decreased(treated group:(4. 36 ± 3. 11)vs.(11. 42 ± 3. 20);control group:(6. 12 ± 2. 67)vs.(11. 64 ± 3. 43),P < 0. 05,and the treated group was significantly lower than control group(F inner groups = 2. 125,P < 0. 01;F between groups = 18. 63,P < 0. 01;F cross groups = 25. 34,P< 0. 01;P < 0. 05). The BI of postreatment in two group were increased(treated group:(86. 72 ± 8. 44)vs. (26. 54 ± 13. 36);control group:(75. 96 ± 9. 86)vs.(26. 38 ± 13. 02)),and the treated group was significantly lower than control group(F inner groups = 29. 27,P < 0. 01;F between groups = 32. 48,P < 0. 01;F cross groups= 42. 41,P < 0. 01;P < 0. 05). There was no the adverse reactions. Conclusion Butyl phthalide sequential treatment can improve the NIHSS and BI of cerebral infarction of branch sclerosis of arterial congee appearance and have a better therapy effect.
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With the improvement of the therapy and the drugs we known more results in a therapeutic ambitious goals of juvenile idiopathic arthritis.Selection of individualized sequential therapy is beneficial to the recovery of the disease.
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Introducción: La infección por Helicobacter pylori, está asociada a múltiples complicaciones: gastritis crónica, úlcera gástrica y duodenal, cáncer gástrico y linfoma tipo MALT. Los niveles de erradicación y adherencia con la terapia estándar han declinado progresivamente en los últimos años. La terapia secuencial modificada podría ser una alternativa para mejorar su eficacia y la adherencia al tratamiento en vista de la alta resistencia actual a la claritromicina. Objetivos: Comparar la eficacia de la terapia triple secuencial estándar y la terapia triple secuencial modificada con levofloxacina para la erradicación de Helicobacter pylori. Materiales y Métodos: Se estudiaron 140 pacientes con infección por Helicobacter pylori comprobada por biopsia gástrica que fueron asignados en forma aleatorizada en dos grupos de tratamiento: Grupo de terapia secuencial estándar con omeprazol y amoxicilina por 5 días, seguido de omeprazol, claritromicina y metronidazol por 5 días adicionales. Grupo de terapia secuencial modificada con omeprazol y amoxicilina por 5 días, seguido de omeprazol, levofloxacina y metronidazol por 5 días adicionales. La erradicación se confirmó por biopsia gástrica posterior al tratamiento. Se realizó un cuestionario dirigido para evaluar la adherencia y los efectos secundarios en cada grupo. Resultados: Se evaluaron 70 pacientes en cada grupo. La tasa de erradicación y de abandono de tratamiento fue de 80% y 5,71% respectivamente en el grupo de terapia secuencial modificada comparando con 65,71% y 11,42% en el grupo de terapia secuencial estándar, siendo estadísticamente significativas las diferencias en ambos casos (p<0,05). Conclusiones: La terapia secuencial modificada con levofloxacina logra mayores tasas de erradicación y de adherencia al tratamiento del Helicobacter pylori cuando se compara con la terapia secuencial estándar.
Introduction: The infection by Helicobacter pylori, is associate with multiple complications: chronic gastritis, gastric and duodenal ulcer, gastric cancer and lymphoma type MALT. The levels of eradication and adherence with the standard therapy have declined progressively in the last years. The sequential modified therapy could be an alternative to improve his efficiency and the adherence to the treatment in view of the high current resistance to the clarithromycin. Aims: To compare the efficiency of the triple sequential standard therapy and the triple sequential therapy modified with levofloxacin for the eradication of Helicobacter pylori. Materials and Methods: 140 patients were studied by infection by Helicobacter pylori verified by gastric biopsy that they were assigned in randomized form in two groups of treatment: Group of sequential standard therapy with omeprazole and amoxicillin for 5 days, followed by omeprazole, clarithromycin and metronidazole for 5 additional days. Group of sequential therapy modified with omeprazole and amoxicillin for 5 days, followed by omeprazole, levofloxacin and metronidazole for 5 additional days. The eradication was confirmed by gastric biopsy later to the treatment. Was realized a questionnaire to evaluate the adherence and the side effects in every group. Results: 70 patients were evaluated in every group. The rate of eradication and suspension of treatment was 80% and 5,71 % respectively in the group of sequential modified therapy comparing with 65,71% and 11,42% in the group of sequential standard therapy, being statistically significant the differences in both cases (p <0,05). Conclusions: The sequential therapy modified with levofloxacin achieves major rates of eradication and of adherence to the treatment of the Helicobacter pylori when it is compared with the sequential standard therapy.
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Humans , Male , Female , Helicobacter pylori/pathogenicity , Helicobacter Infections/diagnosis , Helicobacter Infections/therapy , Ofloxacin/therapeutic use , Treatment Outcome , GastroenterologyABSTRACT
Objective: To compare the eradication rates of H. pylori infection between a new sequential treatment regimen and conventional triple therapy in functional dyspepsia patients, and to assess the symptom improvement of functional dyspepsia. Methods: One hundred and thirty functional dyspeptic patients with H. pylori infection were randomly divided into 2 groups. Patients in sequential treatment group received 10-day sequential therapy: omeprazole (40 mg daily) plus amoxicillin (1 g twice daily) for the first 5 days, followed by omeprazole (20 mg), clarithromycin (500 mg) and tinidazole (500 mg) twice daily for the another 5 days; patients in triple therapy group received standard 7-day treatment: omeprazole (20 mg), clarithromycin (500 mg) and amoxicillin (1 g) twice daily for 7 days. H. pylori statuses were assessed by rapid urease test and 14C-urea breath test at base line level 4 weeks and one year after treatment, and symptom scores in various H. pylori statuses were evaluated. Results: The eradication rates of H. pylori in the sequential treatment group was 83.58% (56/67) by intention-to-treat(TTI) analysis and 91.80% (56/61) by per-protocol (PP) analysis, and the numbers in the triple therapy group were 65.08% (41/63) and 69.49% (41/59), respectively, which were significantly lower than those in the sequential treatment group (P<0.05). The symptom scores of patients with H. pylori eradicated after treatment were 4.88±1.76 before treatment and 2.18±0.83 one year after treatment (P<0.05); the scores of patients whose H. pylori was not eradicated after treatment was 4.99±1.66 before treatment and 3.89±1.56 one year later; there was no significant difference between the 2 numbers. Conclusion: Sequential treatment regimen has a better H. pylori eradication effect for functional dyspepsia patients positive of H. pylori than standard triple therapy; the symptom of dyspepsia can be greatly improved after H. pylori eradication.
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Objective:To:investigate the curative effects and cost of sequential treatment of children communityacquired pneumoni(CAP) with azithromycin. Method:118 cases of CAP from this hospital were divided into two groups: sequential azithromycin therapeutic group (Group A) and iv ceftazidime group (Group B). Their clinical effect was observed and cost minimization analysis was carried out. Result:The total costs were 612?7. 3 yuan and 819?8. 2 yuan(P 0.05) in Group A and Group B respectively. Conclusion: The sequential azithromycin scheme is a better one to treat CAP.
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OBJECTIVE: This study was designed to establish the treatment strategy on postoperative persistent pain of endometriosis. METHODS: During a 12-month period from March 2000 to February 2001, 62 patients had postoperative persistent pelvic pain. 62 patients of them were treated with GnRH analogue for 6 months. If they were not responsive to those treatment, It were recommended high dose progesterone treatment for 6 months after trigger point injection to differentiate from trigger point pain. and then for remained pain, Nonsteroidal antiinflammatory drugs (NSAIDs) and tricyclic antidepressants (TCAs) were supplied for 6 months. Finally, contineously remained pelvic pain was treated by mistletoe extract. RESULTS: 62 patients had a postoperative persistent pelvic pain. GnRH analogue were supplied to 62 patients, and then 23 patients had persistent pain. These 23 patients undertook lidocaine injection on trigger point to differentiate from trigger point pain. Two patients were responsive to injection. Remained 21 patients were treated with high dose progesterone for 6 months. Thereafter unresponded 14 patients were supplied with NSAIDs and TCAs. Finally, remained 5 patients that were uncontrolled with previous treatments were injected with mistletoe extract. Three patients were controlled with mistletoe extract. CONCLUSION: Most of persistent pain after laparoscopic operation of endometriosis were successfully controlled by sequential treatment of GnRH analogue, trigger point injection, high dose progesterone, NSAIDs and TCAs, and mistletoe extract injection.
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Female , Humans , Anti-Inflammatory Agents, Non-Steroidal , Antidepressive Agents, Tricyclic , Endometriosis , Gonadotropin-Releasing Hormone , Lidocaine , Mistletoe , Pelvic Pain , Progesterone , Trigger PointsABSTRACT
Objective To evaluate the efficacy of endoscopic injection hemostasis and sequential application of sandostatin in treatment of Dieulafoy's lesion. Methods After diagnosis of Dieulafoy's lesion confirmed, endoscopic injection hemostasis(EIH) together with mixture hypertonic saline and epinephrine(HSE) was performed, and then sandostatin was given consecutively for 7 days. The control group included the patients who were not given sandostatin or given just for 1 to 2 days. Results The rates of recurrent bleeding and transfer into surgery in sandostatin group were significantly lower than those in control group,(12.5% and 6.3% versus 53.8% and 46.2% respectively, P