Knowledge Graph Construction of Coronary Heart Disease Based on Traditional Chinese Medicine Diagnosis and Treatment Guidelines / 中国实验方剂学杂志

ObjectiveTo construct the syndrome differentiation and treatment process in the diagnosis and treatment guideline into a visual knowledge graph using knowledge graph technology， and visualize the process from the input of clinical manifestations to the output of corresponding traditional Chinese medicine （TCM） diagnosis and prescriptions through programs， to visually display the diagnosis and treatment process as well as the data relationship for TCM practitioners. This paper facilitated the standardized and normalized TCM diagnosis and treatment of coronary heart disease， and provided technical support for the inheritance and promotion of TCM diagnosis and treatment. MethodNeo4j and py2neo were used to construct a knowledge graph based on the Guideline for Diagnosis and Treatment of Coronary Heart Disease with Stable Angina Pectoris published by China Association of Chinese Medicine Cardiovascular Disease Branch. A knowledge graph regarding the input of clinical manifestations was built through programs， visually displaying the standardized TCM diagnosis and treatment process of coronary heart disease with stable angina pectoris. ResultThe structured data were extracted from the guideline by py2neo connecting to Neo4j and imported into Neo4j to construct the knowledge graph of TCM diagnosis and treatment of coronary heart disease with stable angina pectoris， which had graph database query function. ConclusionAiming at the problems existing in the inheritance of TCM diagnosis and treatment， this paper proposed a diagnosis and treatment guideline integrating the experience of TCM experts and evidence-based evidence for coronary heart disease with stable angina pectoris， and realized the visualization process of knowledge graph based on TCM diagnosis and treatment guideline and the experience of TCM experts. It is helpful to intuitively display the whole TCM diagnosis and treatment process from symptom input to prescriptions and inherit TCM experience， providing a new paradigm for standardized and normalized TCM diagnosis and treatment.

The interpretation of the American Academy of Orthopaedic Surgeons "management of anterior cruciate ligament injuries evidence-based clinical practice guideline (2022)" / 中华骨科杂志

The anterior cruciate ligament (ACL) injury is a common sports injury, which can lead to the knee unstable, make it difficult for the patient to return to sports, and cause post-traumatic osteoarthritis. The difficulty of its clinical diagnosis and treatment has always been the focus of sports medicine research. In August 2022, the American Association of Orthopaedic Surgeons updated and published "evidence-based clinical practice guideline on management of ACL injuries (2022 version)" based on the "evidence-based clinical practice guideline on management of ACL injuries (2014 version)". In the prevention, diagnosis and treatment of ACL injuries, the new guideline offers 8 recommendations and 7 options according to different evidence strength. To assist clinicians in the diagnosis and treatment of ACL injuries, this article provides an interpretation of the new guideline. In comparison to the 2014 version, the new guideline does not recommend allografts any more, shortens the time for reconstruction after ACL injury from 5 months to 3 months, adds advice that ACL reconstruction can be combined with anterolateral ligament reconstruction or lateral extra-articular tenodesis, and does not recommend ACL repair. The new guideline also shares many similarities with the domestic "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)", both of which advocate history and physical examination at diagnosis, early reconstruction, the use of autologous bone-patellar tendon-bone or hamstring tendon, and either single-bundle or double-bundle ACL reconstruction. The new ACL guidelines of the American Association of Orthopaedic Surgeons lack specific recommendations on artificial ligaments, techniques for bone tunnel creation, and rehabilitation programs, all of which are of concern to domestic physicians because they are based on evidence-based research from abroad. Therefore, in order to improve the diagnosis and treatment of ACL injuries in China, clinicians should not only follow the new ACL guidelines of the American Association of Orthopaedic Surgeons, but also combine the characteristics of Chinese patients, clinical practice, and pertinent domestic guidelines when diagnosing and treating ACL injuries.

Interpret of Clinical Practice Guidelines by the Infectious Diseases Society of America: Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza / 中国医师杂志

The update of the clinical practice guide on seasonal influenza issued by the American Society of Infectious Diseases (IDSA) is mainly based on the content of the seasonal influenza guide issued by IDSA before the H1N1 influenza pandemic in 2009, combined with the latest literature. This guide covers the diagnosis, treatment, drug prevention and other aspects of seasonal influenza and emergency response suggestions for outbreaks in public institutions. Based on the full study of the guide and the actual situation of our country, this article interprets and discusses the diagnosis and treatment of seasonal influenza.

Illustration of the updated recommendations and evidence for China neonatal resuscitation guideline ( revised in 2021) / 中华围产医学杂志

This article elaborates the key points of the updated recommendations and the latest evidence of the important steps in China neonatal resuscitation guideline (revised in 2021), aiming to help clinicians better understand the guideline and guide training to achieve a standardized and efficient resuscitation and further to improve neonatal outcomes.

Antimicrobial prescribing patterns in surgical inpatient of tertiary care hospital in Eastern India

Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.

Korean Medication Algorithm for Bipolar Disorder 2018: Comparisons with Other Treatment Guidelines

The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018) with other recently published guidelines for treating bipolar disorder. We reviewed a total of five recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2018 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy for mania. However, the KMAP-BP 2018 did not prefer monotherapy with MS or AAP for psychotic mania. Quetiapine, olanzapine and aripiprazole were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Most guidelines advocated newer AAPs as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs (such as asenapine, cariprazine, paliperidone, lurasidine, long-acting injectable risperidone and aripiprazole once monthly) became prominent. KMAP-BP 2018 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2018, predominantly in the treatment of psychotic mania and severe depression. Further studies were needed to address several issues identified in our review.

Pharmacological Treatment Strategies for Acute Bipolar Depression / 신경정신의학

Of the different phases of bipolar disorder, bipolar depression is more prevailing and is more difficult to treat. However, there is a deficit in systemic research on the pharmacological treatment of acute bipolar depression. Therefore, consensuses on the pharmacological treatment strategies of acute bipolar depression has yet to be made. Currently, there are only three drugs approved by the Food and Drug Administration for acute bipolar depression : quetiapine, olanzapine-fluoxetine complex, and lurasidone. In clinical practice, other drugs such as mood stabilizers (lamotrigine, lithium, valproate) and/or the other atypical antipsychotics (aripiprazole, risperidone, ziprasidone) are frequently prescribed. There remains controversy on the use of antidepressants in bipolar depression. Here, we summarized the evidence of current pharmacological treatment options and reviewed treatment guidelines of acute bipolar depression from recently published studies.

An Updated Overview of Low Back Pain Management in Primary Care

Currently, guidelines for lower back pain (LBP) treatment are needed. We reviewed the current guidelines and high-quality articles to confirm the LBP guidelines for the Korean Society of Spine Surgery. We searched available databases for high-quality articles in English on LBP published from 2000 to the present year. Literature searches using these guidelines included studies from MEDLINE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Embase. We analyzed a total of 132 randomized clinical trials, 116 systematic reviews, 9 meta-analyses, and 4 clinical guideline reviews. We adopted the SIGN checklist for the assessment of article quality. Data were subsequently abstracted by a reviewer and verified. Many treatment options exist for LBP, with a variety of recommendation grades. We assessed the recommendation grade for general behavior, pharmacological therapy, psychological therapy, and specific exercises. This information should be helpful to physicians in the treatment of LBP patients.

Clinical Practice Guideline 2015: Oral Hypoglycemic Agents for Patients with Type 2 Diabetes / 임상당뇨병

The revised Clinical Practice Guideline (5th edition) for patients with diabetes was released in November 2015 by the Korean Diabetes Association. Strict glycemic control is emphasized for the prevention and progression of diabetes-related vascular complications. The recommended target goal of HbA1c is less than 6.5%, especially for patients with recently diagnosed type 2 diabetes. To achieve this target goal, various classes of oral hypoglycemic agents and insulin should be initiated promptly, according to the patient's clinical situation. Accurate and up-to-date information about the available oral hypoglycemic agents will help increase glycemic control and diabetes management.

Management of Hypertension in Diabetic Patients / 임상당뇨병

Diabetes mellitus is a major chronic disease worldwide, and its prevalence is expected to increase in the near future. Because cardiovascular disease continues to be the leading cause of morbidity and mortality in diabetic patients, it is important to detect and address other risk factors of cardiovascular disease such as hypertension and dyslipidemia. Moreover, presence of diabetes increases the risk of developing hypertension. Despite significant advances in the understanding of the pathophysiology and treatment of hypertension, there are still many debates regarding the management of hypertension, especially in patients with diabetes. The most important unresolved questions are at what blood pressure to initiate drug therapy and the target blood pressure. Recently, the Korean Diabetes Association published "Treatment Guideline for Diabetes 2015." This review will compare major guidelines from other countries and discuss how to determine the target goal for blood pressure control in Korean diabetic patients.

19-1 A pioneer in development of aquatic therapy in Taiwan - Cheng Hsin General Hospital / 日本温泉気候物理医学会雑誌

Original missions: Aquatic therapy in Cheng Hsin General Hospital was founded specifically for patients with poliomyelitis in 1960s. At that time, Taiwan was shrouded in darkness due to the outbreak of polio. Many children were paralyzed overnight and thousands of families broke down. Desperate as they were, they had caught a glimmer of hope when the First Lady, Madam Chiang, decided to run a national shelter for children with polio. Cheng Hsin Children’s Home was built and involved in educational and medical systems to provide full time care for free. Aquatic therapy was also included at that time. Following Missions: After poliomyelitis being eradicated in Taiwan in 1983, our team was dedicated in aquatic rehabilitation for people with all kinds of disabilities. Since Taiwan National Health Insurance System being established in 1995, the population receiving rehabilitation kept on rising. As a pioneer in the field of aquatic therapy, we delivered our experience to assist in construction of aquatic rehabilitation nationwide. Learning from the numerous cases, we have accumulated much experience, especially neurological deficits. Thus, physical therapists in Cheng Hsin General Hospital have designed some treatment guidelines for neurological patients. These guidelines, though not standardized, provide therapists various aspects to evaluate clinical problems and to design programs (See Table). Further missions: From the polio to all kinds of special needs, aquatic therapy in Cheng Hsin General Hospital has prosperously developed. In order to broaden our horizon, our team is eager to joining international society of medical hydrology and adopting professional advices and collaboration.

Korean Medication Algorithm for Depressive Disorder: Comparisons with Other Treatment Guidelines

We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review.

INAPPROPRIATE PRESCRIBING PATTERN AMONG ELDERLY PATIENTS TREATED IN THE TERTIARY LEVEL HOSPITAlS / Монголын эм зүй, эм судлал

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce the health care costs.Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system.Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct a retrospective study on inappropriate prescribing pattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals of Ulaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 – 2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.Results: The mean age of the participants was 67.38±0.24 and 54.6% of participants were male and 44.4% were female.The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total use drug per patients were from standard therapeutic guideline.The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital), dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medical conditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used to elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.

The result of study on medications used for in-patients with ischemic heart disease of tertiary level hospitals / Монголын Анагаах Ухаан

IntroductionThe main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce drug cost. Ischemic heart disease is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.GoalAim of study was to conduct retrospective study on medications used for in-patients with Ischemic heart disease of tertiary level hospitals of Ulaanbaatar.Materials and MethodTotal of 438 patient’s records was collected randomly from 3 state hospitals, which were treated with diagnosis of ICD. Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.ResultThe trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I national hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. In second state hospital, anticoagulant and anti-platelet agents were chosen less than first and third state hospitals. In order to decrease cardiac oxygen demand and improve cardiac microcirculation, nitrates were chosen mostly in second and third state hospitals but, beta blockers were chosen mostly in first state hospital.ConclusionThe study results shown the treatment pattern and trends of rational use of drugs in in patients with ischemic heart disease have been different in tertiary level hospitals of Ulaanbaatar.

Korean Guidelines for Tailored Management of Gout

Gout is a chronic systemic metabolic disease characterized by recurrent attacks of inflammatory arthritis resulting from precipitation of monosodium urate crystals, presenting various clinical and pathologic manifestations. The disease is associated with multiple comorbidity, impaired quality of life, life threatening, and heavy economic burden. The incidence and prevalence of gout is increasing in many developed and developing countries as well as in Korea. However, the current state of gout and hyperuricemia management in Korea is not sufficient because the therapeutic goal has been achieved in less than half of patients with gout. Thus, education in gout management for people and primary care physicians appears important for proper treatment of gout. In the United States, Japan, and Europe, guidelines for management of gout and hyperuricemia have already been published. In this review, Korean guidelines for tailored management of gout will be suggested.

Head and neck cancer in India: Need to formulate uniform national treatment guideline.

Background: In a large and diverse country like India, there is a wide variation in the availability of infrastructure and expertise to treat head-neck cancer patients. Lack of consistent adherence to evidence-based management is the biggest problem. Aims: There is an unmet need to evaluate the existing treatment practices to form the basis for development of effective and uniform treatment policies. Settings and Designs: Prospective case series. Materials and Methods: A group of previously treated, potentially curable patients presenting to our institution (from April 2009 to March 2011) were evaluated for appropriateness of initial treatment based on National Comprehensive Cancer Network or Tata Memorial Hospital guidelines. Data regarding treatment center, protocol and accuracy of delivered treatment and their eventual outcome were analyzed. Statistical Analysis: Descriptive. Results: Amongst 450 newly registered patients, 77(17%) were previously treated with curative intent and 69(89%) of them were inappropriately treated. Seventeen (25%) patients were treated in clinics while 12(17%) in cancer centers and 34(50%) in corporate hospitals. Fourteen (20%) patients received chemotherapy, 22(32%) received radiotherapy and 14(20%) underwent surgery while 19(28%) patients received multimodality treatment. Disease stage changed to more advanced stage in 40(58%) patients and curative intent treatment could be offered only to 33(48%) patients. Amongst 56 patients available for outcome review, 18(32%) patients were alive disease-free, 20(36%) had died and 18(32%) were alive with disease. Conclusion: Large numbers of potentially curable patients are inappropriately treated and their outcome is significantly affected. Many initiatives have been taken in the existing National Cancer Control Program but formulation of a uniform national treatment guideline should be prioritized.

Guía clínica: lupus eritematoso sistémico (LES) / Systemic lupus erythematosus: a clinical guide

El Lupus Eritematoso Sistémico (LES) es una enfermedad inflamatoria, sistémica, crónica, de patogenia autoinmune. Sus manifestaciones varían desde afecciones leves a graves o fatales. En más común en mujeres y su prevalencia varía entre 40 a 200 casos/100.000 habitantes. El diagnóstico y reconocimiento precoz de sus manifestaciones sistémicas son críticos para una adecuada derivación, tratamiento y pronóstico de los pacientes. A petición del MINSAL, la Sociedad Chilena de Reumatología designó un grupo de trabajo para la elaboración de una guía clínica de LES. Objetivos: Definir niveles de atención, criterios de derivación según gravedad y elaborar recomendaciones para el diagnóstico, tratamiento y seguimiento de los principales compromisos del LES siguiendo la metodología de realización de guías clínicas. Metodología: Se siguieron las indicaciones para realización de guías clínicas basadas en criterios de evaluación (AGREE) y una combinación de criterios de medicina basada en la evidencia y consenso de expertos. La pesquisa bibliográfica se centró en la búsqueda de respuesta para 13 preguntas seleccionadas, respecto a: niveles de atención y criterios de derivación; abordaje general; principales compromisos graves del LES y situaciones especiales. Para cada pregunta se hizo una recomendación. La evidencia se estableció usando una escala tradicional. Además, se midió el grado de acuerdo (GdA) con las recomendaciones efectuadas, mediante una escala de 0 a 10 puntos, por los reumatólogos integrantes del grupo de trabajo y por cinco pares independientes. Resultados: Se desarrollaron 13 recomendaciones respecto a: 1) Rol del médico no especialista y criterios de derivación. 2) Rol del reumatólogo. 3) Sospecha y diagnóstico precoz del LES. 4) Pronóstico y gravedad. 5) Evaluación de actividad y daño en el LES. 6) Patología asociada al LES. 7) Fármacos utilizados en el LES y su toxicidad. 8) Bases diagnósticas de nefropatía lúpica. 9) Tratamiento de nefropatía lúpica...

Systemic lupus erythematosus (SLE) is an inflammatory, systemic and chronic disease of autoimmune pathogenesis. Manifestations vary from mild to serious or fatal conditions. It is most common among women and its prevalence varies between 40 to 200 cases/100.000 inhabitants. Early diagnosis as well as identification of systemic manifestations are critical for adequate referral, treatment and prognosis. At the request of Chile's health ministry, the Chilean Society of Rheumatology designated a work group to elaborate clinical guidelines for SLE. Objectives: Define levels of attention, criteria for referral according to seriousness, and elaborate recommendations for diagnosis, treatment and follow-up of the main disorders of SLE following the clinical guideline execution methodology. Methodology: Indications for the creation of clinical guidelines based on the AGREE evaluation criteria and a combination of medical criteria based on expert evidence and consensus were followed. Bibliographical investigation was centered on responding 13 selected questions with respect to: level of attention and referral criteria; general approach; main critical SLE compromises, and special situations. A recommendation was given for each question. Evidence was established using a traditional scale. Moreover, the degree of agreement was measured (GdA) with the recommendations carried out, by means of a scale from 0 to 10 by the rheumatologists who made up the work group and by five independent peers. Results: 13 recommendations were developed with respect to: 1) Role played by non-specialized physicians and referral criteria; 2) Role played by rheumatologist; 3) Suspicion and early diagnosis of SLE; 4) Prognosis and seriousness; 5) evaluation of SLE activity and damage; 6) Pathology associated to SLE; 7) Drugs used for SLE and their toxicity; 8) Diagnostic basis for lupus nephritis; 9) Treatment for lupus nephritis; 10) Neuropsychiatric manifestations of SLE; 11) SLE and...

A Treatment Guideline for Neuropathic Pain

STUDY DESIGN: A review of literature including definition, diagnosis and treatment of neuropathic pain. OBJECTIVES: To review and discuss the treatment guideline for neuropathic pain. SUMMARY OF LITERATURE REVIEW: Neuropathic pains are characterized by partial or complete somatosensory change caused by various disorders affecting central and peripheral nervous system, and are especially problematic because of their severity, chronicity and resistance to simple analgesics. MATERIALS AND METHODS: Review of literature. RESULTS: Tricyclic antidepressants and the anticonvulsants gabapentin and pregablin were recommended as first-line treatments for neuropathic pain. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications such as dual reuptake inhibitors of both serotonin and norepinephrine would be used in severe cases. More invasive interventions (e.g., spinal cord stimulation) may sometimes be helpful. CONCLUSIONS: Treatment must be individualized for each patient and aggressive, combinatory pharmacotherapy and multidisciplinary approach are recommended for the treatment of neuropathic pain.

Korean Medication Algorithm for Bipolar Disorder 2010: Comparisons with Other Treatment Guidelines / 대한정신약물학회지

The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002 and thereafter revised in 2006. It was secondly revised in 2010 (KMAP-BP 2010). The aim of this study was to compare KMAP-BP 2010 with other recently published treatment algorithm and guidelines for bipolar disorder. The authors reviewed the 4 recently published guidelines and treatment algorithms for bipolar disorder [The British Association for Psychopharmacology Guideline for Treatment of Bipolar Disorder, Canadian Network for Mood and Anxiety Treatments Guidelines for the Management of Patients with Bipolar Disorder, The World Federation Society of Biological Psychiatry Guideline for Biological Treatment of Bipolar Disorder and National Institute for Health and Clinical Experience (NICE) Clinical Guideline] to compare the similarities and discrepancies between KMAP-BP 2010 and the others. In aspects of treatment options, most treatment guidelines had some similarities. But there were notable discrepancies between the recommendations of other guidelines and those of KMAP-BP in which combination or adjunctive treatments were favored. Most guidelines advocated new atypical antipsychotics as first-line treatment option in nearly all phases of bipolar disorder and lamotrigine in depressive phase and maintenance phase. Lithium and valproic acid were still commonly used as mood stabilizers in manic phase and strongly recommended valproic acid in mixed or psychotic mania. Mood stabilizers or atypical antipsychotics were selected as first-line treatment option in maintenance treatment. As the more evidences were accumulated, more use of atypical antipsychotics such as quetiapine, aripiprazole and ziprasidone were prominent. This review suggests that the medication strategies of bipolar disorder have been reflected the recent studies and clinical experiences, and the consultation of treatment guidelines may provide clinicians with useful information and a rationale for making sequential treatment decisions. It also has been consistently stressed that treatment algorithm or guidelines are not a substitute for clinical judgment; they may serve as a critical reference to complement of individual clinical judgment.

Isolated Dissection of Superior Mesenteric Artery: Study on the Treatment Guidelines

PURPOSE: Isolated superior mesenteric artery (SMA) dissection is a rare, but increasing vascular disorder. However, optimal treatment guidelines are not well established. The purpose of this study is to review a single institutional experience in the management of isolated SMA dissections and establish optimal treatment guidelines. METHODS: Between November 2004 and August 2009, 26 patients were diagnosed with isolated SMA dissection at Eulji University Hospital. Diagnosis was confirmed with CT scans in all patients. We retrospectively reviewed the medical records, imaging studies, and the early outcomes of the patients. RESULTS: There were 22 (84.5%) men and 4 women. The mean age was 55.4 (39~74) years. The mean follow-up was 39.1 (4.1~53.3) months. In 15 patients, CT scans were performed for abdominal pain, and in the other 11 patients, the isolated SMA dissections were detected incidentally during workup for other causes. The radiographic findings included an intimal flap with a patent false lumen in 16 and intramural hematoma in 10. The dissection started at a mean of 22.3 (5~46) mm from the origin of the SMA with a mean length was 47.7 (10~150) mm. Treatments included expectant management in 13, anticoagulation in 6, stenting in 6 patients, and surgery in one case of bowel infarction. None required additional intervention. All patients remained asymptomatic during follow-up. CONCLUSION: Most patients with isolated SMA dissection were successfully managed medically. Surgical or percutaneous intervention should be reserved for those with evidence of bowel necrosis or mesenteric ischemia and failed cases to initial medical treatment.