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Objective@#To explore the effect of valproic acid with different loading doses in treatment of children with status epilepticus.@*Methods@#The data of children who were hospitalized in the intensive care unit of the Children′s Hospital Affiliated to Zhejiang University because of status epilepticus from January 1, 2013 to December 31, 2017 were collected.All the patients were divided into different groups according to loading dose of valproic acid.The effect were analyzed in different groups.@*Results@#(1)There were 66 children with status epilepticus were admitted, including 35 males and 31 females.Among all children with status epilepticus, the etiology included epilepsy(n=36, 54.5%), intracranial infection(n=16, 24.2%), hypoxic asphyxia (n=3, 4.5%), intracranial tumor(n=2, 3.0%), abnormal brain development(n=2, 3.0%), intracranial hemorrhage(n=2, 3.0%), and etiology was not clear(n=5, 7.6%). (2)All children with status epilepticus were divided into four groups according to different valproic acid loading dose(0 mg/kg, 10-15 mg/kg, 16-39 mg/kg, 40 mg/kg). There are no significant differences in gender and age among groups.There were no significant differences in duration of status epilepticus and epileptic treatment efficiency(P=0.402, 0.034). (3)All children were monitored for liver function after the treatment of sodium valproate, and no patient had been found increased alanine aminotransferase.@*Conclusion@#There are no significant differences in the effect of different valproic acid loading doses in children with status epilepticus, and no adverse side effects are observed in children with status epilepticus who received a dose of 40 mg/kg.
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Objective@#To observe the use of clopidogrel and related factors for patients with acute coronary syndrome (ACS) in terms of early use, loading dose, dual antiplatelet therapy (DAPT) and maintenance dose hospitalized in non-PCI country hospitals in China.@*Methods@#Patients hospitalized for ACS from 101 non-PCI country hospitals across China were recruited prospectively from October 2011 to November 2014. In-hospital clopidogrel use rate, the proportions of early use (within 24 hours), loading dose use (≥300 mg), DAPT (early use combined with aspirin) and maintenance dose use (following dose≥75 mg/d) were analyzed. Generalized estimated equation (GEE) model was used to explore factors associated to in-hospital clopidogrel use and loading dose use in both univariate and multivariate analyses, adjusting for cluster effect.@*Results@#A total of 14 809 ACS patients were included, with an average age of (64.1±11.6) years and 60% (8 888/14 809) were male. The in-hospital clopidogrel use rate was 66.4% (9 828/14 809), which varied across different regions, years and sub-types of ACS (all P<0.05). Among users, the proportions of patients with early use, DAPT and maintenance dose use were 91.3% (8 734/9 562), 89.2% (8 526/9 562) and 95.1% (9 094/9 562), respectively, but the proportion of patients received loading dose was only 41.8% (3 995/9 562). Multivariate analyses showed that patients who admitted to hospital in earlier years and with non-ST elevation ACS, ≥75 years old, female, non-smoking, illiterate, heart rate≥100 beats per minute, atrial fibrillation, not on ECG monitoring, and not using other anti-ACS drugs were less likely to receive clopidogrel (all P<0.05). And those clopidogrel users who with non-ST elevation ACS, ≥75 years old, non-smoking, illiterate, not using other anti-ACS drugs were less likely to receive loading dose (all P<0.05).@*Conclusion@#The use rate of clopidogrel and the loading dose among in-hospital ACS patients are both low and remain to be improved in non-PCI county hospitals in China. Special attention should be paid on non-ST elevation ACS, ≥75 years old, female, and illiterate patients to increase the rational use of clopidogrel and the loading dose.
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Objective To understand serum trough concentrations (Cmin) of teicoplanin and target concentration achieved in severely infected patients after three days treatment with different loading doses of teicoplanin,and find out optimal loading dose.Methods Severely infected patients who admitted to the intensive care unit(ICU) of a hospital from February 1,2016 to February 28,2017 were enrolled in the study.According to different drug loading doses (teicoplanin standard dose:6mg/kg;high dose:10mg/kg) and different creatinine clearance rates (Ccr:50mL/min as standard value),patients were divided into four subgroups:group of standard dose and normal Ccr (GsD1),group of standard dose and low Ccr (GSD2),group of high dose and normal Ccr (GHD1),group of high dose and low Ccr(GHD2).Serum Cmin,percentage of achieving target concentration,and adverse reactions of teicoplanin in different groups were compared.Results A total of 49 patients were enrolled in the study,17 patients were in GSD group,Cmin on 4th day before administration was (5.98 ± 2.67)mg/L;32 patients were in GHD group,Cmin on 4th day before administration was (9.05 ± 4.25)mg/L;Cmin in GHD group was higher than that in GsD group,and there was statistical difference between two groups(t=3.10,P=0.003).Values of Cmin in GSD1,GSD2,GHD1,and GHD2 groups were (5.78±2.72),(6.34±2.78),(8.21 ±3.77),and (12.07±4.81) mg/L respectively,differences among four groups were statistically significant(F =4.766,P =0.006).The Cmin in GHD2 group was higher than those in GHD1,GSD2,and GsD1 groups,percentage of achieving the target concentration were 9.09％ (1/11),16.67％ (1/6),28.00％(7/25),and 71.43％ (5/7) respectively,differences were statistically significant(x2=8.766,P=0.033).Complications associated with teicoplanin such as rash,damage to hepatic and renal function were not observed in all patients during the treatment course.Conclusion Whether the Ccr is normal or not,target Cmin can not be achieved early in patients given teicoplanin with standard loading dose;in patients with low Ccr,given high loading dose,target Cmin can be achieved early;while in patients with normal Ccr,higher loading dose may be needed.
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Objectives@#The primary goal of this study is to determine if a single loading dose of Magnesium sulfate (MgSO4) is comparable to standard 24 hour therapy in preventing seizures with severe preeclampsia and eclampsia@*Study Design@#Metaanalysis and Systematic review of six randomized controlled trials @*Patients/Subject Selection@#Patients diagnosed with severe preeclampsia and eclampsia Intervention: Giving of single loading dose only (study group) versus 24-hour MgSO4 therapy (control) in patients with severe preeclampsia and eclampsia @*Outcome Measures@#(1) Anti-convulsant effects (2) Maternal: loss of deep tendon reflex and oliguria, incidences of caesarean section, Hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, post partum hemorrhage and intensive care unit admissions and (3) Neonatal complications: incidences of neonatal intensive care unit (NICU) admission, APGAR score at 5 minutes and death@*Results@#Occurrence of seizures was similar in both groups. The risk difference of -0.00 (95% Confidence interval (CI): -0.04 to 0.03; p=0.84) showed no significant difference and the combined studies were found to be homogenous with an I2 of 0.0. @*Conclusion@#A single loading dose of MgSO4 is comparable in preventing seizures of preeclamptic and eclamptic patients with similar maternal and neonatal complications except for a lesser occurrence of decreased patellar reflex in the study group (p=<000001).
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Pre-Eclampsia , EclampsiaABSTRACT
OBJECTIVE:To explore loading dose simvastatin on related indicators in PCI perioperative period of patients with acute myocardial infarction. METHODS:Data of 203 acute myocardial infarction patients undergoing emergency PCI were retro-spectively collected and divided into observation group (102 cases) and control group (101 cases) by different regimens. Control group received conventional treatment for 3 d before PCI,including orally taking Aspirin enteric-coated tablet 300 mg/d,qd + Sim-vastatin tablet 40 mg/d,qd,simvastatin 40 mg/d after surgery,qd,for 4 weeks. Observation group received Simvastatin tablet 80mg 2 h before PCI,the other treatment was the same with control group. Total cholesterol(TC),triglyceride(TG),low-density li-poprotein cholesterol (LDL-C),high-density lipoprotein cholesterol(HDL-C),IL-6,IL-10,TFN-α,plasma super-sensitive tropo-nin(TNT-HSST)level,creatine kinase isoenzyme(CKMB)level,high sensitive C-reactive protein(hs-CRP)level and transami-nase level before and 24 h after treatment were observed and the incidence of adverse reactions was recorded. Meanwhile,the inci-dence of postoperative 30 d of MACE and CIN was followed-up. RESULTS:There was no significant difference in TG,TC, LDL-C,HDL-C before and after treatment(P>0.05). Before treatment,there was no significant difference in TNF-α,IL-6,IL-10, hs-CRP,CKMB,TNT-HSST levels in 2 groups (P>0.05);after treatment,TNF-α,IL-6,hs-CRP,CKMB,TNT-HSST levels were significantly higher than before(P<0.05),and TNF-α,IL-6,hs-CRP levels in observation group was significantly lower than control group,CKMB,TNT-HSST levels were significantly higher than control group;IL-10 was significantly lower than before in 2 groups,and observation group was higher than control group,with statistical significance (P<0.05). The MACE rate and CIN rate in observation were lower than control group with statistical significance(P<0.05). And no obvious adverse reaction was found in 2 groups. CONCLUSIONS:Loading dose simvastatin in PCI perioperative period can significantly reduce patients' PCI, TNF-α,hs-CRP,CKMB,TNT-HSST levels and the incidence of cardiovascular and renal adverse reactions.
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OBJECTIVE:To evaluate the effects of loading-dose rosuvastatin on vascular endothelial function in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) after early interventional therapy. METHODS:Totally of 128 NSTE-ACS patients underwent early interventional therapy were randomly divided into conventional dose group (63 cases) and loading dose group(65 cases). Before operation,all patients were given Clopidogrel sulfate tablets 300 mg and Aspirin enteric-coat-ed tablets 100 mg;on this basis,conventional dose group was given Rosuvastatin calcium tablets 10 mg orally;loading dose group was given Rosuvastatin calcium tablets 20 mg orally. After PCI,both groups were given Rosuvastatin calcium tablets 10 mg orally, qd,and Aspirin enteric-coated tablets(100 mg/d)and Clopidogrel sulfate tablets(75 mg/d),for consecutive 3 months. The blood samples were collected before surgery,8 h and 24 h after surgery. The serum levels of CK-MB,cTn T,hs-CRP,ET and NO were detected. The occurrence of major adverse cardiovascular events was recorded within 3 months after surgery. RESULTS:Compared with before surgery,the serum levels of CK-MB,cTn T,hs-CRP and ET were increased significantly 8 h and 24 h after surgery, while the level of NO was decreased,with statistical significance (P0.05). CONCLUSIONS:For NSTE-ACS patients underwent ear-ly interventional therapy,loading dose of rosuvastatin can protect the patients and inhibit the injury of vascular endothelial cell in-duced by the surgery.
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Objective To investigate the prevention effect of Ezetimibe with loaded dose on hematologic parameters and re-infarction in patients undergoing PCI.Methods 240 cases of patients with non ST segment elevation myocardial infarction performed PCI from October 2012 to October 2014 were selected and randomly divided into two groups,the control group received conventional dose Ezetimibe 10 mg every time,qd,the study group received loading dose ezetimibe 20 mg every time, qd, both two groups treatment 30 days.The inflammatory factors, myocardial injury and vascular endothelial function were compared before, 24 h and 30 d after the operation, and patients were followed up for two years,record adverse reactions. Results Compared with before treatment,levels of serum inflammatory factor,myocardial injury and vascular endothelial function index in different time points had differences by single factor analysis of variance(P<0.05),and compared with the control group, levels of serum hs-CRP,TNF-α,IFN-γand IL-6 in the study group were lower, levels of serum CK-MB,cTnI and BNP were lower,the contents of ET in serum were lower,and the contents of NO were higher(P<0.05).The improvement degree in the study group of myocardial microcirculation perfusion after treatment was higher(P<0.05).No case shedding phenomenon occurred during the two year follow-up, and there was no statistical significance in the incidence of cardiovascular events between two groups.Conclusion Loading dose of ezetimibe can protect myocardium,and it can inhibit the inflammatory reaction and vascular endothelial injury caused by operation,it also can improve myocardial microcirculation.
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Objective To evaluate the medium-and long-term efficacy of loading statins after coronary artery bypass grafting surgery by comparing patients undergoing coronary artery bypass grafting surgery(CABG) using a loading dose statins or a regular dose of statins.Methods Cochrane Library, WanFang database etc database web were searched for the efficacy of a loading dose of statins after CABG in randomized controlled trials(RCTs).The quality of included studies was evaluated according to the Newcastle-Ottawa Scale(NOS).The statistical results of treatment were represented by weighted mean difference (WMD) , the odds ratio(OR) and 95％ confidence intervals(CI).Revman 5.2 software was used for data processing and analysis.Results There are eight studies including 8 676 cases, 4 352 cases are in group using a loading dose of statins, 4 324 cases are in group using a regular dose of statins.Meta-analysis showed the level of low-density lipoprotein(LDL-C) in patients who took a loading dose of statins after CABG(WMD =-42.15,95％ CI:-44.45～-39.84, P ＜0.00001);the number of death caused by myocardial infarction (OR =0.74, 95 ％ CI: 0.60～ 0.91, P =0.005);the number of patients occurred myocardial infarction (OR =0.78, 95 ％ CI: 0.66～ 0.92, P =0.004);the number of patients undergoing secondary CABG (OR =0.72, 95％ CI: 0.63～ 0.82, P ＜ 0.00001);the number of patients occurred drug side effects(OR =1.43, 95％ CI: 1.06～ 1.93, P =0.02);the number of patients occurred grafts restenosis by intravascular ultrasound(IVUS) (OR =0.59, 95％ CI: 0.50～0.70, P ＜0.0001).The data above reached statistically significant difference.Conclusion Comparing patients who used a loading dose of statins and those who used a regular dose of statins after CABG.The medium-and long-term efficacy of a loading dose of statins showed significantly reduction of LDL-C;reduction of the occurrence to cardiac events, such as death caused by myocardial infarction, myocardial infarction and secondary CABG;reduction of grafts restenosis.The incidence of drug side effects was a little higher in a loading dose of statin group.But the majority of patients did not show serious drug side effects after using a loading dose of statins.In summary, the medium-and long-term efficacy of a loading dose of statins after CABG is better than that of a regular dose of statins.
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Objective To explore the effect of different doses of tirofiban for PCI, myocardial injury and arterial flow conditions.Methods 70 patients undergoing PCI elevation acute myocardial infarction, were randomly and equally divided into the observation group and the control group.The control group of patients before PCI given haplotype character loading dose of tirofiban, the observation group were given a double load before PCI tirofiban.Recording and analyzing two groups of patients cTnI (cardiac troponin I), 90 minST section down percentage circumstances.Results The patients after 6h, 12h, 24hcTnI contents were (2.11 ±0.50,3.50 ±1.64,3.28 ±1.15) ng/mL was significantly lower than the control group (4.09 ± 1.13,9.48 ±2.61,5.79 ±1.26) ng/mL, and the difference was significant(P<0.05); the observation group were CTFC, 90 min fall within ST respectively was significantly better than the control group ( P<0.05 ) .Conclusion Preoperative use of double loading dose of tirofiban can effectively improve the blood flow after PCI,, and reduce the incidence of myocardial injury and postoperative cardiovascular events.
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BACKGROUND: Teicoplanin is a glycopeptide antibiotic that is widely used in clinical practice for the treatment of infections caused by drug-resistant Gram-positive bacteria. The aim of this study was to analyze plasma teicoplanin concentrations to determine the percentage of patients in whom therapeutic concentrations of teicoplanin were achieved in clinical practice. MATERIALS AND METHODS: The plasma teicoplanin concentrations of hospitalized patients receiving treatment at a teaching hospital were retrospectively analyzed. The target level was defined as a plasma teicoplanin concentration of 10 mg/L or greater, since this was generally regarded as the lower limit of the optimal concentration range required for the effective treatment of a majority of infections. RESULTS: Patients with sub-optimal (< 10 mg/L) plasma teicoplanin concentrations constituted nearly half of the total study population. The majority of these patients received the recommended loading dose, which were three 400 mg doses administered every 12 hours. Sub-group analysis showed a trend that the group receiving loading dose was more likely to reach the optimal teicoplanin concentration. CONCLUSIONS: The data revealed that a significant proportion of patients in clinical practice achieved only sub-optimal teicoplanin concentrations, which emphasizes the importance of the mandatory use of loading dose and routine therapeutic drug monitoring. Treatment reassessment and simulation of individual dose regimens may also be necessary to achieve optimal drug concentrations.
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Humans , Drug Monitoring , Gram-Positive Bacteria , Hospitals, Teaching , Plasma , Retrospective Studies , TeicoplaninABSTRACT
ObjectiveTo observe the effects and safety of early high-loading-dose clopidogrel in treatment of patients with acute coronary syndrome.Methods178 patients with STEMI were divided into two groups randomly.96patients were treated with clopidogrel 600 mg immediately when they came to the hospital, and then were treated with clopidogrel 75mg daily for 1 year;82 patients were treated with clopidogrel 300mg immediately when they came to the hospital,and then were treated with clopidogrel 75mg daily for 1 year.The attacks of postinfarction angina pectoris,events of heart failure and the composite of death,reinfarction or stroke were observed.ResultsCompared with control group, the high-loading-dose group had obvious reduction in the attacks of postinfarction angina pectoris and the composite of death, reinfarction or stroke (all p ＜ O.05).There were no major and minor bleeding events in the two groups.ConclusionEarly treatment with high-loading-dose of clopidogrel in ACS could significantly improve its prognosis,and was safe and well tolerated.
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Objective To explore the effect of high loading dose of clopidogrel on myocardial microcirculation in patients with ST segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI). Methods Sixty-four STEMI patients were divided into 300 mg clopidogrel group(n =32)and 600 mg clopidogrel group(n = 32)randomly. Myocardial blush grades,sum-ST-segment resolution (sumSTR%),placental growth factor(PIGF),soluble CD40 ligand(sCD40L)and left ventricular ejection fraction (LVEF%)were compared after PCI. Results There was no significant difference between the two groups in basic clinical or angiographic characteristics before PCI(P＞0. 05). Compared with the 300 mg clopidogrel group,patients in the 600 mg clopidogrel group had higher percentage of blush grade 3 of infarct related arteris(21.88%vs. 50. 00% ,P ＜0.05)and higher sumSTR%((70. 90 ±9. 51)% vs.(60. 70 ± 15.06)% ,P ＜0. 05). There were lower serum PIGF levels(14.37 ± 1.32)ng/L vs.(15. 85 ± 1.71)ng/L,P ＜ 0. 05)and sCD40L levels(4. 93 ±0. 71)μg/L vs.(5.68 ± 0. 77)μg/L,P ＜ 0.05)in patients in the 600 mg clopidogrel group after PCI. Seven days after PCI,the LVEF was significantly increased in the 600 mg clopidogrel group(70.96 ± 9. 51)% vs.(65. 27 ±9. 85)% ,P ＜ 0.05). Conclusions High loading dose of clopidogrel before primary PCI can improve myocardium microcirculation in patients with STEMI.
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BACKGROUND: Sedation with propofol during esophagogastroduodenoscopy (EGD) has been increased. However, the use of propofol during EGD may have significant side effects such as hypoxemia and hypotension. We studied the dose of propofol for adequate sedation without side effects during EGD. METHODS: From June to August 2003, 46 healthy persons who visited St. Carollo hospital health management center for diagnostic EGD were enrolled for this study. Twenty four persons (Group A) were given a initial loading dose of propofol 60 mg (in person below 60 kg by body weight) and 80 mg (in person above 60 kg by body weight). Twenty two persons (Group B) were given a initial loading dose of propofol 80 mg and 100 mg at the same way. Additional dose of propofol which was injected once a minute until adequate sedation by 20 mg and maintenance dose during EGD were compared between two groups. Respiration rate, pulse rate, blood pressure, arterial oxygen saturation and ejection fraction of left ventricle were monitored. RESULTS: There were no significant differences between two groups in monitored parameters. Persons in group B were given significantly lower additional dose (p<0.001) and maintenance dose (p<0.05) of propofol. However total amount of propofol during EGD was not significantly different between two groups. CONCLUSION: In relatively young (under 60 years of age) and healthy persons without significant medical problem, 80 mg and 100 mg of propofol (in person below 60 kg and above 60 kg by body weight) as initial loading dose of propofol during EGD are more clinically relevant than 60 mg and 80 mg of propofol (in person below 60 kg and above 60 kg by body weight).