Efficacy and safety of noninvasive high-frequency oscillatory ventilation in the treatment of respiratory distress syndrome in premature infants : a Meta-analysis / 中国新生儿科杂志

Objective:To evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (nHFOV) as the initial ventilation mode for respiratory distress syndrome (RDS) in premature infants.Methods:From the establishment of the databases [(PubMed, Embase, Cochrane Library, CNKI, Wanfang database, CQVIP and CBM (SinoMed)] to March 1, 2022, literature on randomized controlled trials (RCTs) using nHFOV and nasal continuous positive airway pressure(NCPAP) as the initial ventilation modes for RDS in premature infants were searched. The qualities of the included literature were evaluated according to Cochrane Evaluation Manual. RevMan 5.4 software was used for Meta-analysis.Results:Seven RCTs involving 786 children were included for the final Meta-analysis, with 395 cases in the nHFOV group and 391 cases in the NCPAP group. The results showed that the nHFOV group had lower intubation rates than the NCPAP group ( OR=0.34, 95% CI 0.22~0.51, P<0.001). No significant differences existed in mortality rates and complication rates between the two groups ( P>0.05). Conclusions:nHFOV as the initial treatment for RDS in premature infants may reduce the incidence of early treatment failure without increasing complications.

Korean Guidelines for the Pharmacological Treatment of Social Anxiety Disorder: Initial Treatment Strategies

OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Efficacy of a new therapeutic approach as initial treatment for tuberculous pleuritis / 中国感染控制杂志

Objective To explore the therapeutic efficacy of levofloxacin combined with anti-tuberculosis drugs and thoracic catheterization for the treatment of tuberculous pleuritis.Methods Patients who were admitted to Departments of Infectious Diseases of Hanzhong Central Hospital and Ankang Central Hospital between February 2014 and August 2016 for initial treatment of tuberculous pleuritis were included in the study,they were divided into groups A,B,C and D.Group A received 2HRZE + 7HR regimen combined with conventional drainage;group B received 2HRZE+ 7HR regimen combined with thoracic catheterization;group C received 2HRZEV + 7HR regimen combined with thoracic catheterization;group D received 2HRZEV + 10HR regimen combined with thoracic catheterization.groups B,C and D received thoracic catheterization,normal saline 20mL and urokinase 100,000U were given through the drainage tube.Results A total of 172 patients with newly diagnosed tuberctlous pleurisy were received for treatment.There were 45,53,38,and 36 cases in group A,B,C,and D respectively.The total effective rate of therapy for pleural effusion in group A was lower than that in group B(64.44％ vs 90.57％,x2 =9.863,P＜ 0.05);after two month therapy,total effective rate of therapy for pleural effusion in group B was lower than that in group C (18.87％ vs 39.47％,x2 =4.716,P＜0.05);at the end of therapy,total effective rate in group C was lower than that in group D (60.53 ％ vs 83.33 ％,x2 =4.731,P＜0.05).Conclusion For initial treatment of patients with tuberculous pleuritis,2HRZEV + 10HR antituberculosis regimen combined with thoracic catheterization and urokinase infusion can significantly improve the clinical symptoms and recovery rate of tuberculous pleuritis,facilitate drainage of pleural effusion and prevent pleural thickening,adhesion and encapsulation.

Study progress in early recognition and initial treatment before referral of childhood malignant solid tumors / 中华实用儿科临床杂志

Childhood malignant solid tumors exhibit a wide variety of vagueness signs and symptoms in the early stage,which are usually nonspecific,therefore the diagnosis of childhood malignant solid tumor can be challenging when the disease is in the early stage.As a result,the delay of diagnosis causes mistreatment,and which makes childhood malignant solid tumors become a leading cause of death in children.Physicians should recognize the early warning signs of childhood cancer,and a good clinical history and careful physical examination can help physicians determine whether the children have cancer and make referrals in time.Some children with possible cancers require immediate initial treatment before referral to be stabilized in order to make the referrals possible and increase the chance of receiving appropriate treatment in time and the possibility of being cured,saving more children with malignant solid tumors to the maximum extent.

A cross-sectional study on application of glucocorticoid in systemic lupus erythematosus patients / 中华内科杂志

Objective To explore the status of glucocorticoid application in patients with systemic lupus erythematosus (SLE) in China.Methods Epidemiological survey was used.The SLE patients who met the 1997 classification criteria of American College of Rheumatology were enrolled.The usage of glucocorticoid and related adverse reactions were recorded and analyzed.Results A total of 400 SLE patients were enrolled,including 35 men and 365 women.The average age was (37.4 ± 14.0) years old,and the average duration of disease was (6.7 ± 5.8) years.There were 310 patients using glucocorticoid as maintenance.Sixty-one percent (n =244) patients started using medium dose (prednisone 30-＜ 60 mg/d) as the initial treatment of glucocorticoid,which lasted for (37 ± 11) days.The time of drug duration in patients with low dose prednisone (7.5-＜30 mg/d)and high dose (60-100 mg/d) was(92 ± 20)and (17 ± 3) days respectively (P ＜ 0.05 between 3 groups).However,patients receiving different initial dosage were of no discrepancy in the maintenance therapy.During maintenance,even though 51.0％ (n =158) patients were on prednisone 2.5-5 mg/d,the duration of drug use in ＞ 5-10 mg/d groupwas longer [(29.9 ± 3.3) months].Patients with involvement of internal organs had a higher tendency to use 60-100 mg/d prednisone or pulse-dose therapy in the initial treatment,nevertheless these two groups had no difference of maintenance dosage.Among all 400 patients,62 patients withdrew glucocorticoid,including 17 patients with disease remission (4.3％),44 by self-withdrawal and one with adverse reaction.Conclusion In China,the medium dosage of glucocorticoid is the most common initial treatment in patients with SLE.Prednisone 2.5-5 mg/d was the most common choicefor maintenance therapy.Currently,the proportion of glucocorticoid withdrawal remains low in SLE patients achieving remission.

Analysis of Effect of Powder for Ascending and Descending on Treated or Initial Treatment Patient with Cough / 浙江中医药大学学报

Objective] To analyze the effect of powder for ascending and descending on patients with different cough. [Method] The treatment group patients had still cough with conventional western medicine for two weeks, and initial treatment group patients had not any treatment after cough. All these patients were treated with powder for ascending and descending according to different Chinese traditional medicine syndromes cough. [Results] There were 49 patients, and 17 cases were the initial diagnosed group and 32 patients were the after treatment group. Patients with the improvement of the symptoms of cough and throat were effective in 15 cases(88.2%), while in patients with the improvement for sputum symptoms in initial group were 16 cases(94.1%), and 27 case(84.4%) in treatment group. It had no statistically significant difference between the two groups(χ2=0.006, P=0.940). Cough concrete improvement between the two groups showed no significant difference(χ2 =0.006, P =0.465). Between the two groups cough, throat and sputum symptoms overall improvement rate was 87.8%(43/49), no significant difference between the two groups(P>0.05). [Conclusion] Regardless of the treatment patients or untreated patients, treatment with powder for ascending and descending had good effect in improvement of the symptoms of cough, and the improvement of throat and sputum was effective, too.

A Four-year Review of Delayed Initial Treatment of Patients with Congenital Talipes equinovarus in a General Hospital

Congenital Talipes Equinovarus (CTEV), or club foot, is a common congenital orthopaedic abnormality of the foot. , which is easily diagnosed but difficult to treat perfectly. Controversy in terms of its etiology, classification and management continues to exist. Delayed initial treatment in patients with clubfoot has a strong correlation with a poor outcome. The purpose of this study was to review the factors that influence the outcome in patients who get delayed initial treatment at Hasan Sadikin General Hospital so that poor outcome can be prevented. We reviewed the medical records of 15 patients (23 feet) during the period from January 2009 to December 2013 and analysed various factors including gender, age at time of first treatment, type of disorder, the level of success of non-surgical therapy, parent education level, family income and accessibility to health care centre. CTEV was more common in girls in our patients who were in the 6-12 months age group. The most common type of CTEV was the flexible type. Treatment with serial casting produced good results in most patients. The majority of parents’ educational level was junior high school and had 2-5 million/month income. The accessibility of patients to health care centre was difficult.

Effect Comparison of Oxycodone Hydrochloride Prolonged-release Tablets and Tramadol Hydrochloride Sustained-release Tablets in the Treatment of Cancer Pain / 中国药师

Objective: To investigate the efficacy and safety of oxycodone hydrochloride prolonged-release tablets and tramadol hydrochloride sustained-release tablets in the treatment of moderate cancer pain. Methods:Totally 290 cases of the patients with mod-erate pain were divided into the observation group with 148 cases and the control group with 142 cases. The observation group received oxycodone hydrochloride prolonged-release tablets, while the control group was given tramadol hydrochloride sustained-release tablets. The treatment course was 2 weeks, and the total efficiency and the incidence of adverse drug reactions( ADR) in the two groups were calculated and compared. Results:The total efficiency in the observation group and the control group was 92. 6% and 81. 7%, respec-tively, and the difference was statistically significant (P0.05). Conclusion: The effect of oxycodone hydrochloride prolonged-release tablets in the treatment of moderate cancer pain is better than that of tramadol hydrochloride sustained-release tablets.

Clinical efficacy of pegaspargase plus GEMOX regimen for initial treatment of nasal NK/T-cell lymphoma / 中国肿瘤临床

Objective:To evaluate the efficacy and safety of pegaspargase plus GEMOX (pegaspargase, gemcitabine, oxaliplatin) regimen in the initial treatment of nasal NK/T-cell lymphoma. Methods: Twelve preliminarily diagnosed nasal NK/T-cell lymphoma patients in Tianjin Medical University Cancer Institute and Hospital from June 2011 to March 2012 were analyzed. All patients took the pegaspargase plus GEMOX regimen (gemcitabine 800-1 000 mg/m2 on days 1 and 8, oxaliplatin 130 mg/m2 on day 1, and pegaspargase 2 500 IU/m2 on day 2), every three weeks for one cycle. The efficacy and toxicity of the regimen were evaluated in the follow-up treat-ment. Results:After two cycle treatments, 1 patient dropped out of treatment because of acute pancreatitis;the remaining 11 patients had response, in which 1 achieved complete response , 7 had partial response, 2 had stable disease, and 1 had progressive disease. The objective response rate was 72.7%, and the disease control rate was 90.9%. The 2-year overall survival rate was 90.9%. With median 6-cycle P-GEMOX regimen treatment, 81.8% of 11 patients presented side effects, primarily myelosuppression and hepatic dysfunc-tion. Conclusion:Pegaspargase plus GEMOX regimen showed high efficacy on the initial treatment of nasal NK/T-cell lymphoma pa-tients, but the incidence of adverse effect was still high.

Perspective research of preliminarily diagnosed angioimmunoblastic T-cell lymphoma with dose-adjusted EPOCH regimen / 中国肿瘤临床

Objective:The effect and side effect of the dose-adjusted EPOCH regimen were evaluated perspectively for the pre-liminarily diagnosed angioimmunoblastic T-cell lymphoma. Methods: Nine cases of untreated angioimmunoblastic T-cell lymphoma were diagnosed and enrolled in our department from September 2008 to September 2012. All patients received dose-adjusted EPOCH regimen as first-line chemotherapy. Results: The median age of 9 patients was 54 years. The male-to-female ratio was 2∶1. About 88.9%of all patients were at Ann Arbor stageⅢ/Ⅳ, and 77.8%presented with B symptoms. Anemia was found in 66.7%of 9 patients, and lactate dehydrogenase elevated in 55.6%of patients. After an average of 4.7 cycles of chemotherapy of dose-adjusted EPOCH regi-men, the complete remission rate was 22.2%, and the total response rate was 66.7%. With a median follow-up of 20 months, the 4-year progression-free survival rate was 11.1%, and the overall survival rate was 33.3%. The median survival time was 19 months. The most common adverse events of EPOCH chemotherapy were hematologic toxicity. Grades 3-4 neutropenia and thrombocytopenia were re-ported in 77.8%and 33.3%of patients. Febrile neutropenia was observed in 44.4%of patients. Non-treatment-related mortality was al-so noted. Conclusion: The results of our research showed no clear benefit of treating preliminarily diagnosed angioimmunoblastic T-cell lymphoma with dose-adjusted EPOCH regimen. The main adverse events were hematologic toxicity and could be tolerated.

Therapeutic Effect and Safety of Integrated Therapy of Chinese Medicine and Chemical Drugs on Initial Treatment of Pulmonary Tuberculosis / 中国中医药信息杂志

Objective To observe the effect of integrated therapy of Chinese medicine and chemical drugs on adverse reaction and curative effect of initial treatment of secondary pulmonary tuberculosis. Methods Totally 1404 patients with secondary pulmonary tuberculosis and TCM lung consumption diagnostic criteria (syndrome of lung yin deficiency, qi-yin deficiency, yin-deficiency caused excessive fire) were chosen for single blind, randomized, controlled, multicenter clinical trials. Trial group was given 2HRZE/4HR, 1 time/day with Chinese medicine 2 or 3 times/day, and control group was given 2HRZE/4HR only for six months. The adverse reactions and clinical symptoms were observed to evaluate clinical efficacy and safety. Results In terms of reducing liver damage and other adverse reactions, the ratio of trial group had statistical difference with that of control group (P<0.001). In symptom scores of lung yin deficiency syndrome treated for 2, 4, 6 months, yin-deficiency caused excessive fire syndrome treated for 6 months, qi-yin deficiency syndrome treated for 4, 6 months, the differences between the two groups were significant (P<0.001). TCM syndrome curative effect between the two groups was statistical different (P<0.001). Safety evaluation result between the two groups was statistical different by tratified analysis (P<0.001). Conclusion Integrated therapy of Chinese medicine and chemical drugs can improve the symptoms and reduce adverse reactions caused by chemical drugs. It can enhance the curative effect and safety.

Cooling Effect of Biocellulose Sheet (Bestian M(R) Pack) in Burn Patients

PURPOSE: The optimal initial treatment for burn wound is generally applying cold running tap water of temperature 12~18degrees C for approximately 20 minutes. But most of the patients are not susceptible to this initial treatment because they are likely to get embarrassed in such situation. According to statistics of our hospital, 92.2% of patients who visited ER (emergency room) had less than 10 minutes of water cooling. In this study, our aim was to find out the clinical effect of biocellulose sheet (Bestian M(R) pack) as an emergent treatment. METHODS: Between November 2010 and October 2011, 93 patients with burn wound showing first or superficial second degree at first inspection were evaluated in our study. Biocellulose sheet (Bestian M(R) pack) was applied at the wound as soon as possible for 25 minutes and second inspection was done. Routine moisture dressing was done thereafter and patients were followed as outpatient. RESULTS: Among 93 patients, 28 were male and 65 were female. Scalding burn, contact burn, flame burn and other causes were 78, 6, 4 and 5 patients respectively. Average complete healing time was 7.99 days and average follow-up time was 5.49. CONCLUSION: Biocellulose sheet has the effect of cooling down the skin temperature up to 6~8degrees C after 10 minutes of its application. Recent studies reported that appropriate cooling in burn wound improves the zone of stasis and zone of erythema histologically eventually reducing the chance of skin graft. Therefore, biocellulose sheet has the effect of improving initial pain, histologic status, healing time and cost in patients with burn wound whose depth is not deep. Furthermore it reduces the risk of scar formation.

Korean Medication Algorithm Project for Generalized Anxiety Disorder 2009 (I) : Initial Treatment Strategy / 신경정신의학

OBJECTIVES: This study investigated the consensus about treatment strategies for the initial treatment of generalized anxiety disorder (GAD). This issue represents one of the subjects addressed by the Korean Medication Algorithm Project for GAD in Korea. METHODS: The executive committee of the Korean Medication Algorithm Project for GAD, supported by The Korean Association of Anxiety Disorders, developed questionnaires about treatment strategies for patients with GAD, based on guidelines or algorithms and clinical trial studies previously published in foreign countries, especially by the International Psychopharmacology Algorithm Project, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association. Fifty-five (64%) of 86 experts on a committee reviewing GAD in Korea responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a Chi-square test and a 95% confidence interval. RESULTS: For the initial treatment of GAD, antidepressant monotherapy and the combination of antidepressants and benzodiazepines as anxiolytics were recommended as the first line strategies. Escitalopram, paroxetine CR and venlafaxine XR were selected as first-line antidepressant treatments, and alprazolam, clonazepam and lorazepam were the preferred benzodiazepines. The mean starting doses and mean maximum doses of the drugs were 7.55+/-3.09 mg and 24.91+/-8.14 mg for escitalopram, 12.57+/-2.83 mg and 44.76+/-15.00 mg for paroxetine CR, and 46.81+/-16.74 mg and 223.32+/-60.64 mg for venlafaxine XR. CONCLUSION: These results, which reflect recent studies and clinical experiences, may provide guidelines for the initial.

Korean Medication Algorithm for Panic Disorder 2008: Initial Treatment Strategies / 대한정신약물학회지

OBJECTIVE: The Korean Association of Anxiety Disorders developed a Korean treatment algorithm for panic disorder to help clinicians make treatment decisions. This study investigated a consensus about initial treatment strategies as part of developing a medication algorithm for panic disorders in Korea. METHODS: Based on current treatment algorithms published by the American Psychiatric Association, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association, we developed questionnaires about initial treatment strategies for patients with panic disorder. Fifty-four experts in panic disorder answered the questionnaires. We classified expert opinions into three categories (first-, second-, and third-line treatment strategies) by chi-square tests. RESULTS: Antidepressants and anxiolytics were recommended as first-line strategies for the initial treatment of panic disorder. A combination of medical treatment and cognitive-behavioral therapy was also recommended for more severe cases. Paroxetine, escitalopram, alprazolam, and clonazepam were preferred from among many anti-panic drugs. The mean starting dose of anti-panic drugs in the initial treatment for panic disorder was relatively lower than that for such other psychiatric illnesses as major depressive disorder. CONCLUSION: These results, reflecting recent studies and clinical experiences, may provide guidelines about initial treatment strategies for panic disorder.

Effects of 20% Aluminum Chloride in Axillary Hyperhidrosis not Accompanying Osmidrosis

OBJECTIVE: Surgical treatment of focal axillary hyperhidrosis is often unsatisfactory because of compensatory hyperhidrosis. The purpose of this study is to evalute the effect of decreased sweating production using 20% aluminum chloride on axillary hyperhidrosis. METHODS: From February to December, 2002, 10 patients(mean age 25.2 male 2, female 8) with clinical diagnosis of axillary hyperhidrosis were treated by 20% aluminum chloride solution. Until the desired degree of symptom relief was obtained, they were educated to apply every day and thereafter, the agent would be applied as often as is necessary. We analyzed patient's satisfaction and application time at onset of desired dryness, application interval to maintain the relief of symptom and side effects. RESULTS: Aluminum chloride solution was effective in treatment of axillary hyperhidrosis showing excellent result in 60% of patients and good in 40%. Application time at onset of desired dryness ranged from 1 to 6 days(mean 3 days). Application interval to maintain the relief of symptom ranged from 5 to 45 days(mean 12 days). There were no significant complications but just mild irritation and miliaria in seven patients. CONCLUSION: 20% aluminum chloride solution is the simple, safe and less expensive method for initial treatment for axillary hyperhidrosis not accompanying osmidrosis.

The Precipitating Factors of Amputation as Initial Treatment in Diabetic Foot / 대한족부족관절학회지

PURPOSE: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. MATERIALS AND METHODS: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). RESULTS: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. CONCLUSION: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.

The Precipitating Factors of Amputation as Initial Treatment in Diabetic Foot / 대한족부족관절학회지

PURPOSE: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. MATERIALS AND METHODS: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). RESULTS: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. CONCLUSION: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.