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OBJECTIVE：To systematically evaluat e the efficacy and safety of different regimens in the treatment of refractory Kawasaki disease ，and to provide evidence-based reference for clinical treatment. METHODS ：Retrieved from PubMed ，Embase， Cochrane Library ， CNKI， VIP， Wanfang database ，randomized controlled trials （RCTs）and cohort studies about different therapeutic regimens in the treatment of refractory 84206032。E-mail：liuyingzryy@163.com Kawasaki disease were collected during the inception to March 2021. After selecting the literature and extracting the data ，the quality of RCT was evaluated by modified Jadad scale ，and the quality of cohort st udy was evaluated by NOS scale. Network Meta-analysis was performed by using Stata 16.0 software. RESULTS ：A total of 29 literatures were included ，involving 15 RCTs and 14 cohort studies. A total of 3 112 patients and 12 therapeutic regimens were involved ，including twice IVIG ，twice IVIG+hormone，twice IVIG+ulinastatin ，first IVIG ，first time IVIG+hormone ，first time IVIG+cyclosporine ，first time IVIG+ etanercept，hormone，hormone+ulinastatin，ulinastatin，infliximab and placebo. The results of network Meta-analysis showed that in terms of the incidence of coronary artery injury （CAL），twice IVIG+hormone was significant lower than hormone ，and first time IVIG +etanercept was significant lower than first time IVIG （P＜0.05）. The sorting results of network Meta-analysis showed that area under cumulative ranking curve of CAL incidence in ascending order was hormone ＜ulinastatin＜twice IVIG ＜first time IVIG＜first IVIG+hormone ＜twice IVIG+hormone ＜infliximab＜first time IVIG+cyclosporin ＜first time IVIG+etanercept. In terms of the incidence of ADR ，compared with twice IVIG+ hormone and hormone ，twice IVIG and first time IVIG+etanercept were decreased significantly ；infliximab was significantly lower than hormone （P＜0.05）. The sorting results of network Meta-analysis showed that area under cumulative ranking curve of ADR incidence in ascending order was hormone ＜twice IVIG+hormone ＜first time IVIG+hormone ＜first time IVIG+cyclosporin ＜first time IVIG ＜twice IVIG ＜first time IVIG+etanercept ＜infliximab. In terms of the serum level of CRP ，compared with twice IVIG ，twice IVIG+hormone ，twice IVIG+ulinastatin and hormone were decreased significantly；twice IVIG+hormone was significantly lower than first time IVIG ；twice IVIG+ulinastatin were all significantly lower than twice IVIG+hormone ，hormone，hormone+ulinastatin，first time IVIG ，first time IVIG+hormone and ulinastatin （P＜0.05）. The sorting results of network Meta-analysis showed that area under cumulative ranking curve of serum CRP level in ascending order was first time IVIG ＜first time IVIG+hormone ＜twice IVIG ＜hormone+ulinastatin＜ulinastatin＜infliximab＜hormone＜twice IVIG+hormone＜twice IVIG+ulinastatin. In terms of improving persistent fever duration ，there was no statistical difference between pairwise treatment measures （P＞0.05）. The sorting results of network Meta-analysis showed area under cumulative ranking curve of persistent fever time in ascending order was first time IVIG ＜placebo＜first time IVIG+cyclosporine ＜hormone＜twice IVIG+ hormone＜twice IVIG ＜ulinastatin＜infamliximab. CONCLUSIONS ：The first time IVIG+etanercept has the best effect in reducing the incidence of CAL. Infliximab possesses a relatively low incidence of ADR and the best antipyretic effect. Twice IVIG + ulinastatin has the best anti-inflammatory effect.
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OBJECTIVE： To provide reference for improving the economics evaluation studies for pediatric therapeutic regime in China. METHODS： By searching the literature published in domestic journals from Jan. 1st， 2009 to Dec. 31th， 2018， the current situation of the measurement of cost （including time range， cost calculation） and health output （including outcome indicators and measurement scales） were explored. Combined with relevant literature at home and abroad， the deficiencies of economics evaluation for pediatric therapeutic regime in terms of cost measurement and health outcome measurement were summarized in China， and the corresponding research prospects were put forward. RESULTS & CONCLUSIONS： Totally 140 related literatures were finally included. In terms of cost measurement， short-term （≤1 year） research accounted for the highest proportion （109 literatures， 77.86％）. Cost calculation mostly had no clear research perspective （125 literatures， 89.29％）. It did not involve the cost of child productivity. The main shortcomings were unclear time range， incomplete cost calculation （lack of productivity， hidden cost） and so on. In terms of health output measurement， 103 （73.57％） used cost-effectiveness analysis， 23 （16.43％） used cost-benefit analysis， and only 4 （2.86％） related to the use of measurement scales. Main shortcomings included that the difficulty in obtaining outcome indicators， lack of child health output measurement scale and so on. Based on this， it is suggested that related demands should be complied before conducting economics evaluation research， we should clarify the research angle， formulate unified and standardized cost measurement methods， rationally select technical analysis methods and health outflow indicators according to research purposes and disease characteristics， and develop appropriate measurement scales according to the physiological and psychological characteristics of children in different age groups. At the same time， future studies can report on the status of family members when reporting on children's related conditions， and conduct an economic evaluation of therapeutic regimen in the family unit.
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@#AIM: To retrospectively analyze the clinical change of retinal vein occlusion inpatients of the Second People's Hospital of Foshan in the nearby five years.<p>METHODS: The data of inpatients in the Second People's Hospital of Foshan were collected by the term “retinal vein occlusion”from 2013-01-01 to 2017-12-31. Retrospective analysis of the details for the disease.<p>RESULTS: Totally 351 patients with retinal vein occlusion were admitted and treated for 473 times in five years. Elder with systemic disease(hypertension, diabetes and renal inadequacy)was more common. The hospital days were significantly statistical difference among five years with the shortest days in 2017. The prevalence of RVO was growing year by year, especially for BRVO, with statistical difference between 2017 and the other four years(<i>P</i><0.005). Treatments for RVO were mainly including retinal laser, intravitreal injection or both combined. There was significantly statistical difference about the rate of intravitreal injection among five years(<i>P</i><0.05)with the lowest one in 2013.“1+PRN” therapeutic regimen was more tolerable for patients than “3+PRN”.<p>CONCLUSION: BRVO is growing more sharply than CRVO in the nearby five years. Retinal laser combined with“1+PRN”intravitreal injection is the main therapeutic regimen for RVO in our hospital.
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Adjuvant temozolomide-based chemotherapy has become the standard of care for most postoperative glioma patients. However, a large proportion of these patients do not respond to temozolomide. DNA repair enzyme O6-methylguanine-DNA methyl-transferase (MGMT) promoter methylation has emerged as an important molecular marker in patients with gliomas. It is associated with prognosis and resistance to alkylated drugs such as temozolomide. MGMT promoter methylation is the key mechanism of MGMT gene silencing, thereby inhibiting DNA repair and increasing the sensitivity of chemotherapy. We reviewed current data on the prog-nostic and predictive relevance of MGMT testing and clinical trials, summarized the clinical application of MGMT promoter methyla-tion, in order to provide reference for the individualized treatment of glioma patients.
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Objective: To investigate the clinical characteristics, treatment regimens, and outcomes of patients with primary breast dif-fuse large B-cell lymphoma (PB-DLBCL). Methods: Between January 2010 and January 2018, 21 patients with PB-DLBCL were diag-nosed, treated, and followed up at the First Affiliated Hospital of Zhengzhou University. All patients were female, with a median age of 49 years (ranging from 21 to 77 years) at presentation. All patients received chemotherapy, of which 17 patients received the CHOP regimen and 4 received the EPOCH regimen. Eight patients received chemotherapy followed by radiotherapy, and 13 received chemo-therapy alone. Six patients received prophylactic intrathecal injections. The incidences of refractory and progressive disease between patients who received different regimens were analyzed using the Chi-square test. The overall survival (OS) and progression-free sur-vival (PFS) rates were calculated using the Kaplan-Meier method, and differences in survival were compared using the Log-rank test. Multivariate analysis was performed with the Cox-regression model for those factors that were confirmed as significant in the univari-ate analysis. Results: The most common presentation was a painless mass. The 5-year OS and PFS rates were 74% and 66%, respective-ly. There was no significant difference in the incidence of refractory or progressive disease between the EPOCH and CHOP groups (P=0.603). Six of those who received prophylactic intrathecal injections had no central nervous system recurrence, and 2 patients who did not receive prophylactic intrathecal injections had central nervous system recurrence. Univariate and multivariate analyses showed that both the level of serum β2 microglobulin [P=0.044, hazard ratio (HR)=0.431, 95% confidence interval (CI): 0.432-0.967] and radio-therapy (P=0.002, HR=0.495, 95% CI: 1.073-2.508) were related to the OS of PB-DLBCL. Conclusions: PB-DLBCL often occurs in women, mostly involving the unilateral breast, which manifests mainly as a painless mass. The level of serum β2 microglobulin is a factor of poor prognosis in PB-DLBCL. The treatment modality of chemotherapy combined with radiotherapy can significantly improve the OS of PB-DLBCL. Prophylactic intrathecal injections may be useful to reduce the incidence of refractory disease or recurrence in the central nervous system.
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AIM:To compare the efficacy of one initial intravitreal Conbercept injection(IVR) followed by pro re nata(PRN) dosing with that of three initial monthly IVR followed by PRN dosing in patients with macular edema (ME) after branch retinal vein occlusion (BRVO). METHODS: The clinical data of 35 cases were retrospectively analyzed; 20 received one initial IVR injection (1+PRN group) and 15 cases received 3-monthly IVRs (3+PRN). Both groups were followed monthly for 12mo. The best-corrected visual acuity (BCVA) and the macular central retinal thickness (CMT) on optical coherence tomography were evaluated before and after treatment, and the BCVA results were converted to the LogMAR visual acuity. RESULTS: The mean LogMAR BCVA and CMT, respectively,improved from 0.58士0.21 to 0.34士0.18 and from 561士65μ m to 252士69μ m in the"1+PRN冶 group (P<0 05) and from 0.64士0.21 to 0.29士0.13 and from 585士87μ m to 242士56μ m in the"3+PRN冶 group (P>0.05). During the study period, the mean total number of injections was significantly smaller in the"1+PRN冶 group than in the"3+PRN冶 group (2. 3士1. 2 and 4. 1士1. 1, respectively,P<0.05). No serious complications related to the IVB injections developed in either group. CONCLUSION: The two methods are both safe and effective for the treatment of BRVO combined with ME.
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OBJECTIVE: To analyze the adjustment of therapeutic regimen and pharmaceutical care for a patient with AIDS accompanied by a variety of opportunistic infection, and to explore the work pattern of pharmacists in the clinical practice. METHODS: According to the patient's condition and clinical guidelines to disease, reasonable suggestions for rational drug use were put forward, and adverse drug reactions were also monitored by the pharmacists during the treatment. RESULTS: With adjustment of therapeutic regimen and pharmaceutical care, clinical pharmacists optimized the treatment program and solved clinical programs. CONCLUSION: Through participating clinical practice, pharmacists improve the safety and effectives.
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Actualmente, el nacimiento pretérmino es uno de los problemas básicos en la atención perinatal, pues constituye causa de morbilidad, mortalidad y alteraciones del desarrollo en estos infantes. El objetivo del presente artículo es proporcionar una revisión bibliográfica sobre el uso de los corticosteroides en la reducción de complicaciones en los recién nacidos pretérmino. Se exponen los regímenes terapéuticos de dosis múltiple, única y de rescate, en busca del esquema que permita lograr mejor efectividad, reducir los efectos secundarios y que facilite la toma de decisiones. Se concluye que el régimen de dosis única ofrece mayores ventajas terapéuticas y menos efectos adversos.
Preterm birth is one of the basic problems in perinatal care nowadays, because it constitutes a cause of morbidity, mortality, and changes in the development in these infants. The objective of the present work is to provide a literature review on the use of the corticosteroids in the reduction of complications in the preterm newborns. The therapeutic courses of multiple, unique and rescue doses are exposed, trying to find the regimen which allows to achieve better effectiveness, to reduce the secondary effects and to facilitate the decision-making. It is concluded that the regimen of unique dose offers greater therapeutic advantages and less adverse effects.
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PURPOSE: This study was done to investigate correlations between compliance and physiological parameters of hemodialysis patients. METHOD: The subjects were 102 patients on hemodialysis at 3 hospitals in B city. Data was collected using Shon(1986)'s questionnaire and measuring physiological parameters (serum urea nitrogen, creatinine, hemoglobin, albumin, potassium, phosphorus, interdialytic weight gain). RESULT: Mean scores of compliance with the therapeutic regimen was 4.00+/-0.55 on a 5 point scale. The area of visiting hospitals and taking medicines were shown to have high compliance with therapeutic regimens; on the other hand, the areas concerning diet and symptoms were shown to be low. Interdialytic weight gain and phosphorus were significantly related to the compliance with therapeutic regimens. CONCLUSION: Hemodialysis patients' therapeutic compliance was related to the physiological parameters(potassium, phosphorus, interdialytic weight gain). Therefore, these findings give hemodialysis patients useful information for raising their therapeutic compliance.
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Middle Aged , Male , Humans , Female , Adult , Weight Gain , Serum Albumin/analysis , Renal Dialysis , Potassium/blood , Phosphorus/blood , Patient Compliance , Kidney Failure, Chronic/blood , Hemoglobins/analysis , Creatinine/blood , Blood Urea NitrogenABSTRACT
PURPOSE: This study was done to investigate correlations between compliance and physiological parameters of hemodialysis patients. METHOD: The subjects were 102 patients on hemodialysis at 3 hospitals in B city. Data was collected using Shon(1986)'s questionnaire and measuring physiological parameters (serum urea nitrogen, creatinine, hemoglobin, albumin, potassium, phosphorus, interdialytic weight gain). RESULT: Mean scores of compliance with the therapeutic regimen was 4.00+/-0.55 on a 5 point scale. The area of visiting hospitals and taking medicines were shown to have high compliance with therapeutic regimens; on the other hand, the areas concerning diet and symptoms were shown to be low. Interdialytic weight gain and phosphorus were significantly related to the compliance with therapeutic regimens. CONCLUSION: Hemodialysis patients' therapeutic compliance was related to the physiological parameters(potassium, phosphorus, interdialytic weight gain). Therefore, these findings give hemodialysis patients useful information for raising their therapeutic compliance.
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Middle Aged , Male , Humans , Female , Adult , Weight Gain , Serum Albumin/analysis , Renal Dialysis , Potassium/blood , Phosphorus/blood , Patient Compliance , Kidney Failure, Chronic/blood , Hemoglobins/analysis , Creatinine/blood , Blood Urea NitrogenABSTRACT
Optimization of Traditional Chinese Medicine (TCM) clinical trials as philosophy, process and method, is extremely necessary and can be applied in different levels. Optimization of TCM clinical trials should follow some principles and procedures, and be executed in two ways. Optimization of treatment plan should be supported by the research basis and literature experience, and be perfected by research group and experts argumentation. Optimization of design plan is modified and accomplished by expert discussion and repeated consulting multi-disciplinary experts. Specific research objective, exact target population definition, proper design plan selection, valid calculation of sample size, precise and appropriate main outcome measures, data management system, medical ethics and statistical analysis are the focuses.
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OBJECTIVE: To analyze the cost-effectiveness of 3 different therapeutic regimens for chronic urticaria.METHODS: 3 oral therapeutic regimens including regimen A(triprolidinen plus ranitidine),regimen B(levocetirizine),and regimen C(levocetirizine plus antipruritic) were analyzed using cost-effectiveness analysis.RESULTS: The total costs of regimen A,B,and C were 91.96 yuan,54.16 yuan and 356.56 yuan,respectively;The effective rates were 76.09%,74.00% and 91.84%,respectively;The cost-effectiveness ratios were 120.86,73.19 and 388.24,respectively.As compared with regimen B,the incremental cost-effectiveness ratios for regimen A and C were 1 808.61 and 1 695.07,respectively.CONCLUSION: Regimen C is the preferable one in terms of the cost-effectiveness.
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OBJECTIVE:To evaluate the therapeutic effects and cost-effectiveness of 3 therapeutic regimens in the treatment of vertebrobasilar ischemia. METHODS: 90 cases with vertebrobasilar ischemia were randomly divided into 3 groups: Group A were assigned to receive buflomedil+Flunarizine, Group B to receive Shuxuening + Flunarizine and Group C to receive compound Compound Danshen + Flunarizine. The curative effects and the cost-effectiveness of the 3 Groups after 14-day treatment were analyzed comparatively. RESULTS: The total costs for Group A, B and C were 1 705.06 yuan,2 876.30 yuan and 1 117.34 yuan, respectively; the effective rates were 93.75%, 92.86% and 70.00%, respectively; the cost-effectiveness ratios were 1 818.73, 3 097.46 and 1 596.20, respectively. As compared with Group C, the incremental costs-effectiveness ratios for Group A and Group B were 2 474.61 and 7 694.49, respectively. CONCLUSION: Group A is more preferable among the 3 therapeutic regimens in terms of cost-effectiveness.
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0.05).The costs of the 3 groups were 5.21,293.16 and 430.08yuan,respectively,showing significant differences among groups(P
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OBJECTIVE: To evaluate the therapeutic effects and cost-effectiveness of 3 therapeutic regimens in the treatment of gonarthritis. METHODS: The cost-effectiveness analyses were conducted among 3 therapeutic regimens: regimen A(sodium hyaluronate), regimen B(sodium hyaluronate plus compound betamethasone) and regimen C(sodium hyaluron_ate plus triamcinolone acetonide acetate). RESULTS: The total costs for Group A, B and C were 956.5 yuan, 1 206 yuan and 998.5 yuan, respectively. The effective rates were 79.2%, 91.3% and 96.4%, respectively. The cost-effectiveness ratios were 12.08, 13.21 and 10.36 respectively. As compared with regimen A, the incremental cost-effectiveness ratios for regimen B and C were 20.62 and 2.44 respectively. CONCLUSION: Regimen C is more preferable among the three therapeutic regimens.
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OBJECTIVE:To compare the therapeutic effects and cost-effectiveness among 3 therapeutic regimens. METHODS:85 cases with sudden deafness were divided into 3 groups:Group A (n=30) were ascribed to receive buflomedil, Group B (n=28) to receive compound Danshen and Group C (n=27) to receive Herba Erigerontis. The curative effects of the 3 were observed and the cost-effectiveness of which were analyzed. RESULTS:The costs of the 3(A, B and C) were 1 908.20yuan, 1 102.68yuan and 1 825.64yuan, respectively. The effective rates of the 3 were 93.33%, 60.71% and 70.37%, respectively. The cost-effectiveness ratios were 20.45yuan, 18.16yuan and 25.94yuan, respectively. As compared with Group B, the incremental costs for Group A and C were 24.73yuan and 74.84yuan, respectively with every one-unit effectiveness increase. CONCLUSION:Group C is the superior one among the 3 therapeutic regimens.
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OBJECTIVE:To evaluate the cost-effectiveness of 4 different therapeutic regimens for cervicitis of chlamydia trachomatis.METHODS:4therapeutic regimens including regimen A(azithromycin by oral administration),regimen B(azithromycin by intravenous injection),regimen C(minocycline by oral administration),regimen D(levofloxacin and de?oxycycline by oral administration)were analyzed using cost-effectiveness analysis.RESULTS:The total costs of A,B,C,D4regimens were(645.20?109.56)yuan,(933.10?249.90)yuan,(413.14?38.04)yuan,and(489.00?83.60)yuan respective?ly;The effective rate were96.2%,98.6%,93.4%and94.1%respectively;The ratios of cost to effectiveness were6.71,9.46,4.42,and5.19respectively;As compared with regimen C,the incremental cost effectiveness ratios for regimen A,B and D were82.88,99.99,and108.37respectively.CONCLUSION:Regimen C is the preferable one.
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PURPOSE: This study was to identify the influencing factors of the compliance level to a therapeutic regimen after a bone mineral densitometry test. METHOD: The sample for the study was 95 people who took the bone mineral densitometry test from March, 2002 to July, 2002. Data was collected by mail using aself reporting questionnaire on the selected variables such as the compliance level, self efficacy, health locus of control, susceptibility, severity, usefulness, barrier, and self esteem. RESULT: The average compliance level was 63.93. Through multiple regression, three independent variables including chance health locus of control on personality, the result of bone mineral density and self-efficacy were entered in the model as the significant determinants of the compliance level after a bone mineral densitometry test. The coefficients of determination of each variable were 10.9%, 8.3% and 8.1% respectively. CONCLUSION: The identification of the determinants of the compliance level to the therapeutic regimen after bone mineral densitometry is expected to contribute to the development of an intervention program to improve the compliance level to the therapeutic regimen in osteoporosis patients.
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Aged , Female , Humans , Male , Middle Aged , Bone Density , Osteoporosis/diagnosis , Patient ComplianceABSTRACT
BACKGROUND: The purpose of this study is to recommend the initial therapeutic regimen for adult patients with acute pyelonephritis (APN) according to the changes of antimicrobial susceptibility patterns of causative microorganisms isolated from patients with APN. METHODS: We reviewed medical charts of 229 APN patients, who had been treated at Korea University Guro Hospital from 1st of January, 1999 to 31st of December, 2001. We investigated the demographic data, clinical findings, durations of hospital treatment, antimicrobial susceptibility patterns of the causative microorganisms and initial antibiotic regimens in patients with APN. RESULTS: In this study, 229 adult patients with APN were classified into simple APN patients (118 patients, 51.5%) and complicated APN patients (111 patients, 48.4%). Mean age of patients with simple APN was 38.2+/-14.1 years old and that of patients with complicated APN was 56.1+/-14.9 years old. Mean age of patients with complicated APN was significantly higher than that of simple APN patients (P<0.0001). Escherichia coli was the most common microorganism both in simple APN (96.7%) group and in complicated APN (90.6%) group. Antimicrobial susceptibility of E. coli was at the low level of ampicillin (31%/20%) and trimethoprim-sulfamethoxazole (42.6%/34.2%) in each group. In contrast, ciprofloxacin (11.5%/22.7%), gentamicin (16.4%/22%) and cefotaxime (0%/8.2%) resistance remained at relatively lower level. In comparison of simple APN with complicated APN, ciprofloxacin and gentamicin resistances were higher in complicted APN group. Average duration of hospitalization (5.9+/-2.3 days/8.2+/-4.6 days) and duration of antibiotic use (12.1+/-3.9 days/15.3+/-10.0 days) were significantly longer in complicated APN. CONCLUSIONS: The results of this study suggests that 3rd cephalosporin, aminoglycoside or quinolone antibiotic would considered as one of the initial therapeutic regimen for patients with simple APN in southwestern Seoul.
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Adult , Humans , Ampicillin , Cefotaxime , Ciprofloxacin , Escherichia coli , Gentamicins , Hospitalization , Korea , Pyelonephritis , Seoul , Trimethoprim, Sulfamethoxazole Drug CombinationABSTRACT
BACKGROUND: The purpose of this study is to recommend the initial therapeutic regimen for adult patients with acute pyelonephritis (APN) according to the changes of antimicrobial susceptibility patterns of causative microorganisms isolated from patients with APN. METHODS: We reviewed medical charts of 229 APN patients, who had been treated at Korea University Guro Hospital from 1st of January, 1999 to 31st of December, 2001. We investigated the demographic data, clinical findings, durations of hospital treatment, antimicrobial susceptibility patterns of the causative microorganisms and initial antibiotic regimens in patients with APN. RESULTS: In this study, 229 adult patients with APN were classified into simple APN patients (118 patients, 51.5%) and complicated APN patients (111 patients, 48.4%). Mean age of patients with simple APN was 38.2+/-14.1 years old and that of patients with complicated APN was 56.1+/-14.9 years old. Mean age of patients with complicated APN was significantly higher than that of simple APN patients (P<0.0001). Escherichia coli was the most common microorganism both in simple APN (96.7%) group and in complicated APN (90.6%) group. Antimicrobial susceptibility of E. coli was at the low level of ampicillin (31%/20%) and trimethoprim-sulfamethoxazole (42.6%/34.2%) in each group. In contrast, ciprofloxacin (11.5%/22.7%), gentamicin (16.4%/22%) and cefotaxime (0%/8.2%) resistance remained at relatively lower level. In comparison of simple APN with complicated APN, ciprofloxacin and gentamicin resistances were higher in complicted APN group. Average duration of hospitalization (5.9+/-2.3 days/8.2+/-4.6 days) and duration of antibiotic use (12.1+/-3.9 days/15.3+/-10.0 days) were significantly longer in complicated APN. CONCLUSIONS: The results of this study suggests that 3rd cephalosporin, aminoglycoside or quinolone antibiotic would considered as one of the initial therapeutic regimen for patients with simple APN in southwestern Seoul.