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Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.
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Humans , Child , Voice Disorders/diagnosis , Voice , Voice Quality , Acoustics , Speech Acoustics , Vocal Cords/surgeryABSTRACT
The main clinical manifestation of dyslipidemia is hyperlipidemia， which is an important risk factor leading to the occurrence of cardiovascular and cerebrovascular diseases such as atherosclerosis， coronary heart disease and stroke. In clinical practice， lipid-lowering drugs are mainly used for treatment， but there are issues such as individual differences and genetic effects. Therefore， it is necessary to perform gene detection on patients， so as to guide individualized application of lipid-lowering drugs. This review mainly previews the definition of gene detection and the individualized treatment of lipid-lowering drugs， and introduces the application of gene detection in the individualized treatment of lipid-lowering drugs （statins， fibrates， nicotinic acid and ezetimibe）. Among them， the gene polymorphisms of APOE， SLCO1B1 and CYP450 family play a key role in the efficacy and safety of statins； the gene polymorphisms of APOA/B/C family have a significant impact on the efficacy of fenofibrate； the gene polymorphisms of HCAR2 and DGAT2 have an important impact on the efficacy of niacin； the gene polymorphisms of NPC1L1 have a significant impact on the efficacy of ezetimibe. It is suggested to conduct genotype detection for patients with dyslipidemia to select appropriate treatment strategies， so as to provide individualized medication guidance.
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Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to chronic airway inflammation. Individualized assessment and treatment for COPD has become significantly important. This paper describes the current status regarding individualized assessment and treatment for patients with COPD, in order to improve the understanding of the different characteristics between COPD individuals for physicians.
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Objective To investigate the predictive and diagnostic value of absolute value and function of different lymphocyte subsets in evaluating the risk of early viral infection after kidney transplantation. Methods Ninety-five kidney transplant recipients were enrolled in this prospective observational cohort study, and divided into the stable group (n=77) and infection group (n=18) according to postoperative immune status. Peripheral blood samples were collected for flow cytometry before operation, and 2 weeks, 1 month, 2 months and 6 months after operation. The dynamic changes of the absolute values of CD4+T cells, CD8+T cells and natural killer (NK) cells were compared between two groups. The function of lymphocyte subsets in two groups was evaluated by detecting the proportion of interferon (IFN)-γ+CD4+T cells, IFN-γ+CD8+T cells and IFN-γ+NK cells. The value of the absolute values and function of lymphocyte subsets in predicting and diagnosing viral infection in the early stage after kidney transplantation was evaluated. Results During viral infection, the absolute values of CD4+T cells, CD8+T cells and NK cells in the infection group were at a relatively low level. At 2 months after operation, the absolute values of CD4+T cells and NK cells in the infection group were lower than those in the stable group. At 6 months after operation, the absolute values of CD4+T cells and CD8+T cells in the infection group were significantly lower compared with those in the stable group (all P < 0.05). During viral infection, the proportion of IFN-γ+CD4+T cells, IFN-γ+CD8+T cells and IFN-γ+NK cells in the infection group were all at a relatively low level, especially that of IFN-γ+CD8+T cells decreased most significantly. At postoperative 2 months, the proportion of IFN-γ+CD8+T cells and IFN-γ+NK cells in the infection group was significantly higher than those in the stable group. At 6 months after operation, the proportion of IFN-γ+CD4+T cells and IFN-γ+CD8+T cells in the infection group was significantly higher than those in the stable group (all P < 0.05). Logistic regression analysis showed that the increasing proportion of IFN-γ+CD8+T cells and IFN-γ+NK cells was correlated with the increasing risk of viral infection at 2 months after operation (both P < 0.05). The receiver operating characteristic (ROC) curve demonstrated that the diagnostic value of absolute values of lymphocyte subsets combined with IFN-γ secretion function for viral infection in the immunocompromised recipients was significantly higher than that of absolute values of lymphocyte subsets alone (P < 0.05). Conclusions Dynamic monitoring of the changes of absolute values and function of lymphocyte subsets provides critical reference value for the prediction, diagnosis and medication guidance of viral infection.
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@#Abstract: Objective By analyzing the frequency distribution of antihypertensive drug-related genotypes in hypertensionpatients treated in our hospital, so as to provide a clinical basis for individualized treatment of hypertension patients. Methods A total of 72 hypertensive patients treated in Hainan Hospital of PLA General Hospital from June 2021 to April 2022 were collected. PCR-melting curve method was used to detect CYP2D6*10 (c.100 C>T), CYP2C9*3 (c.1075 A>C), ADRB1 (c.1165 G>C), AGTR1 (c.1166 A>C), ACE (I/D), NPPA (T2238C) and CYP3A5*3 (A6986G), and the relationship between different genotypes and biochemical indexes was analyzed. Results According to the statistics of the gene and genotype frequency of each point in 72 patients, the gene frequencies of 7 sites all conformed to Hardy Weinberg equilibrium. There were gender differences in ADRB1 genotypes (χ2 = 5.878, P<0.05). There were statistical differences in triglycerides [AA: 1.4 (1.0, 2.0)mmol/L; AC: 2.2 (1.5, 2.5)mmol/L; P=0.038], total cholesterol [AA: 4.0 (3.1, 4.9) mmol/L; AC: 4.8 (4.0, 5.3) mmol/L; P=0.040] and low-density lipoprotein cholesterol [(AA: 2.4 (1.8, 3.3) mmol/L; AC: 3.2 (2.5, 3.5) mmol/L; P=0.035] among patients with different genotypes of AGTR1 locus. The patients with different genotypes of CYP2C9 locus had significant differences in their alanine transferase (ALT) [AA:16.9 (11.4,30.2) mmol/L; AC:10.4 (9.4, 18.2) mmol/L; P=0.040]. Aftergene-directed individualized therapy, different genotypes of CYP3A5 andAGTR1 affected the heart rate [CYP3A5: AA: (79.3±7.0) beats/min; AG： (69.8±6.8) beats/min; GG： (68.8±7.3) beats/min; P=0.010], systolic blood pressure [AGTR1: AA: (131.3±16.7) mmHg; AC: (140.6±11.8) mmHg; P=0.014] and diastolic blood pressure [CYP3A5: AA: (90.0±8.3) mmHg; AG: (78.7±10.8) mmHg; GG: (74.9±10.7) mmHg; P=0.025; AGTR1: AA: (75.3±10.2) mmHg; AC: (86.3±10.6) mmHg; P=0.001] of patients. Conclusions The related gene loci of antihypertensive drugs are an important basis for guiding the diversification and individualization of clinical medication. Clinicians need to consider the impact of related genes on drug efficacy and adverse reactions when prescribing.
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Multiple myeloma(MM)is a common hematological malignancy of the elderly.It is characterized by the involvement of multiple organs and its treatment becomes more difficult when aging and frailty exert their influence.In elderly MM patients, frailty is associated with poor tolerance to treatment and poor outcomes.Individualized therapy based on frailty assessment can minimize treatment-related adverse effects and reduce the rate of treatment interruptions, thereby improving the survival in elderly patients.In this review, we aim to provide an overview of the frailty assessment systems for MM patients.We also discuss their clinical applications, issues to be addressed, and future directions for optimizing MM-specific frailty assessment to guide MM treatment in frail elderly patients.
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Parkinson′s disease (PD) is a common neurodegenerative disorder, which has a highly effective pharmacological symptomatic treatment. Levodopa is the most effective drug available for the symptomatic treatment of PD and is the gold standard with which other therapies must be compared. There are significant individual differences in clinical features, disease course, and response to pharmacological treatment in PD patients, not only attributed to disease process and environmental factors, but also genetic factors. Pharmacogenomics, also known as personalized medicine, is the study of how genetic variations in a person′s genome affect their response to drug therapies, which contribute to apply the patient with the best treatment plan, including the timing of dosing, the dose administered, and the most appropriate drugs. Pharmacogenomics accounts for 60%-90% variability in drug pharmacokinetics and pharmacodynamics. Major determinants of the pharmacogenomic outcome include pathogenic, mechanistic, metabolic, transporter and pleiotropic genes. This article will summarize the impact of polymorphisms in genes encoding dopamine signaling pathway on drug response, and the impact of genetic polymorphisms on complications and prognosis associated with dopaminergic drug therapy.
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Treatment sequencing in early-stage breast cancer has significantly changed in recent years. Instead of surgery-adjuvant chemotherapy mode, several clinical trials showed benefits using administering systemic chemotherapy (and human epidermal growth factor receptor 2 targeted therapies) prior to surgery. Neoadjuvant therapy (NAT) could frequently downstage the primary tumor and lymph nodes, allowing conversion of the planned surgery form inoperable to operable one, from a mastectomy to a lumpectomy, and potentially allowing omission of axillary lymph node dissection. These benefits also include providing the opportunity to monitor the individual drug response and more accurate prognostic estimates based on the extent of residual cancer that can guide additional adjuvant treatment. This allows escalation or de-escalation of NAT: patients who achieved pathologic complete response could be spared further chemotherapy or de-escalation of locoregional therapies, while those with residual cancer could receive additional systemic therapy postoperatively. NAT is not an option anymore but a platform for personalized breast cancer therapy.
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ObjectiveTo investigate the efficacy and safety of venlafaxine in the treatment of depression under the guidance of pharmacogenomics testing， and to provide references for individualized medication. MethodsA total of 66 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for depressive episode were included in the study. Patients who were recommended to be treated with venlafaxine in the pharmacogenomics testing report were divided into study group （n=32）， and those who were decided to be treated with venlafaxine by doctors after consultation with patients were divided into control group （n=34）. At the baseline and the end of the 2nd， 4th， 6th and 8th weekend of treatment， Hamilton Depression Scale-24 item （HAMD-24） was adopted to evaluate the clinical efficacy. Meanwhile， Sheehan Disability Scale （SDS） was applied to measure the social function of patients at the baseline and the end of the 8th weekend of treatment. After treatment， Treatment Emergent Symptom Scale （TESS） was used to assess the incidence of adverse reactions. ResultsAt the end of the 4th， 6th and 8th weekend of treatment， HAMD-24 scores in the study group were all lower than those in the control group， with statistical differences （t=2.344， 4.316， 5.760， P<0.05 or 0.01）. At the end of the 8th weekend of treatment， SDS score of the study group was lower than that of the control group， with statistical difference （t=2.173， P<0.05）. The adverse reaction rate in the study group was lower than that in the control group， with statistical difference （χ2=5.720， P<0.05）. ConclusionTreatment of depression with venlafaxine based on pharmacogenetic testing is an effective and safe way to alleviate the depression symptoms in patients.
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Objective:The clinical heterogeneity of non-metastatic castration-resistant prostate cancer is high, and precise and individualized treatment is required for different patients to achieve maximum benefits. Three cases of non-metastatic castration-resistant prostate cancer were reported in this paper. One case received apalutamide + leproprillin treatment, one received radical prostatectomy, and one received radiotherapy + abiraterone treatment. After a period of follow-up, the three patients all benefited to varying degrees.
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BACKGROUND: Breast cancer is one of the most common malignant tumors in women. Its incidence rate is increasing year by year and tends to be younger. It seriously threatens women’s health. Therefore, it is particularly important to establish an ideal breast cancer model that can accurately simulate the tumor in vivo. Organoid is a new three-dimensional cultural model in vitro, which recapitulates key aspects of in vivo tissue or organ. In recent years, researches based on organoids have covered many kinds of tumors. OBJECTIVE: To review the research progress and application of breast cancer organoids, in order to provide a new research way for personalized treatment of breast cancer. METHODS: Using the key words of “organoid, breast cancer organoids, cancer organoids, mammosphere, three-dimensional culture” in English and Chinese, respectively, the first author retrieved relevant articles published from January 1980 to February 2020 in CNKI, Wanfang, and PubMed databases. The type of the article was not limited. After removal of the articles that were not related to the purpose of the study or repetitive, 66 articles were finally analyzed. RESULTS AND CONCLUSION: This review introduced organoid technology briefly and retraced the process of exploring suitable culture conditions to establish breast-cancer-origin organoids. Also, we concluded latest development of its applications and research progress. Breast cancer organoids have a wide range of application prospects in disease modeling, tumor pathogenesis, drug screening and other aspects, which provide a reliable model for breast cancer research and treatment, and in particular, open up a new perspective for personalized treatment of breast cancer.
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Objective To provide reference for anti-infection treatment and individual pharmaceutical care in patient on peritoneal dialysis. Methods The plasma concentration of vancomycin in patient on peritoneal dialysis was monitored by clinical pharmacists. The anti-infection treatment plan was evaluated and adjusted according to the bacterial culture and drug sensitivity results of the abdominal dialysis fluid. The adverse reactions of pancytopenia induced by vancomycin were documented. Results Infection in the patient on peritoneal dialysis was effectively controlled. The related indicators of pancytopenia were improved. Conclusion A case of pancytopenia induced by vancomycin in the patient on peritoneal dialysis was analyzed to get clinical staff's attention to this adverse reaction and improve the safety of vancomycin administration.
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Abstract Introduction The types of allergic rhinitis are roughly classified based on the causative antigens, disease types, predilection time, and symptom severity. Objective To examine the clinical typing and individualized treatment approach for allergic rhinitis and to determine the optimal treatment method for this disease using various drug combination therapies. Methods A total of 108 participants with allergic rhinitis were divided into three groups based on symptoms. Subsequently, each group was further categorized into four subgroups based on the medications received. The efficacy of the treatments was evaluated using the visual analog scale VAS scores of the total and individual nasal symptoms, decline index of the symptom score, histamine and leukotriene levels, and mRNA and protein expression levels of histamine 1 and cysteinyl leukotriene 1 receptors. Results Loratadine + mometasone furoate and loratadine + mometasone furoate + montelukast significantly improved the sneezing symptom and reduced the histamine levels compared with the other combination therapies (p < 0.05). Meanwhile, montelukast + mometasone furoate and montelukast + mometasone furoate + loratadine considerably improved the nasal obstruction symptom and decreased the leukotriene D4 levels compared with the other combination therapies (p < 0.05). Conclusion Clinical symptom evaluation combined with experimental detection of histamine and leukotriene levels can be an objective and accurate method to clinically classify the allergic rhinitis types. Furthermore, individualized treatment based on allergic rhinitis classification can result in a good treatment efficacy.
Resumo Introdução A rinite alérgica é basicamente classificada de acordo com os antígenos causadores, tipos de doença, peridiocidade e gravidade dos sintomas. Objetivo Avaliar os tipos clínicos e a abordagem terapêutica individualizada para cada tipo de rinite alérgica e determinar o método de tratamento ideal utilizando várias terapias de combinação de fármacos. Método Um total de 108 participantes com rinite alérgica foram divididos em três grupos com base nos sintomas. Posteriormente, cada grupo foi subsequentemente categorizado em quatro subgrupos com base nos medicamentos recebidos. A eficácia dos tratamentos foi avaliada utilizando os escores da escala visual analógica EVA dos sintomas nasais totais e individualmente, índice de declínio do escore de sintomas, níveis de histamina e leucotrienos e níveis de expressão de mRNA e proteína dos receptores de histamina 1 e cisteinil-leucotrieno 1. Resultados As associações entre loratadina + furoato de mometasona, assim como a de loratadina + furoato de mometasona + montelucaste melhoraram significativamente o sintoma de espirros e reduziram os níveis de histamina em comparação às outras terapias combinadas (p < 0,05). Por outro lado, a associação montelucaste + furoato de mometasona, assim como a associação montelucaste + furoato de mometasone + loratadina melhoraram consideravelmente o sintoma de obstrução nasal e diminuíram os níveis de leucotrieno D4 em comparação com as outras combinações (p < 0,05). Conclusão A avaliação clínica dos sintomas combinada com a detecção experimental dos níveis de histamina e leucotrieno pode ser um método objetivo e preciso para classificar clinicamente os tipos de rinite alérgica. Além disso, o tratamento individualizado baseado na classificação da rinite alérgica pode resultar no aumento da eficácia do tratamento.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Histamine/blood , Leukotriene D4/blood , Drug Therapy, Combination/methods , Precision Medicine/methods , Rhinitis, Allergic/blood , Quinolines/therapeutic use , Sneezing , RNA, Messenger/genetics , Receptors, Histamine H1/genetics , Nasal Obstruction/drug therapy , Treatment Outcome , Loratadine/therapeutic use , Receptors, Leukotriene/genetics , Anti-Allergic Agents/therapeutic use , Rhinitis, Allergic/diagnosis , Rhinitis, Allergic/drug therapy , Mometasone Furoate/therapeutic use , Acetates/therapeutic use , Nasal MucosaABSTRACT
The morbidity and mortality of lung cancer are the highest in China, and the non-small cell lung cancer(NSCLC) is the first one, accounting for about 80% of lung cancer.NSCLC includes squamous cell carcinoma, adenocarcinoma, etc.Because of the slow growth of lung cancer cells and the late diffusion and metastasis, most of the patients were in late stage and lost the best period of surgical treatment.In recent years, molecular targeted therapy for specific genes has become an important strategy for the treatment of NSCLC.Multiple target genes, such as EGFR, KRAS, BRAF and EML4-ALK have been identified.This article reviews the related driving genes and molecular targeted therapy of NSCLC, expecting to be helpful to the individualized treatment of advanced NSCLC patients.
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In order to achieve the overall victory of the 2019 novel coronavirus disease epidemic in this 'war’, especially to prevent the disease recurrence from rebounding during the resumption of labor, the government has not loosened any control of personnel mobility, which has obviously affected the normal examination and treatment of lung cancer patients under the influence of this epidemic. During the epidemic period, cancer patients with low immunity levels face the double ordeals of disease and epidemic situation. Compared with the general population, they are more likely to be infected with the new coronavirus. Among the infected cancer patients, lung cancer is the most common type. It is necessary to provide more appropriate individualized treatment recommendations for patients with lung cancer based on the epidemic situation of the patient's location and in combination with the patient's own condition. Through active prevention of infection, timely conversion of treatment strategies, online and offline joint control, and positive psychological counseling, we significantly hope to help patients with lung cancer to survive this difficult period.
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In order to achieve the overall victory of the 2019 novel coronavirus disease epidemic in this 'war’, especially to prevent the disease recurrence from rebounding during the resumption of labor, the government has not loosened any control of personnel mobility, which has obviously affected the normal examination and treatment of lung cancer patients under the influence of this epidemic. During the epidemic period, cancer patients with low immunity levels face the double ordeals of disease and epidemic situation. Compared with the general population, they are more likely to be infected with the new coronavirus. Among the infected cancer patients, lung cancer is the most common type. It is necessary to provide more appropriate individualized treatment recommendations for patients with lung cancer based on the epidemic situation of the patient's location and in combination with the patient's own condition. Through active prevention of infection, timely conversion of treatment strategies, online and offline joint control, and positive psychological counseling, we significantly hope to help patients with lung cancer to survive this difficult period.
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Congenital ovarian dysplasia syndrome is a feminine genetic disease which is rarely seen.Its clinical manifestations include short stature and primary ovarian insufficiency, in addition of which could cause multi-systema-tic complications.According to its therapeutic methods, recombinant human growth hormone and Estrogen are normally used to improve stature and the development of gonad.However, these methods are long-lasting and with great expense, which may result in economic and emotional burdens on patients and their family.On the contrary, individual therapies has a rather precise pharmacogenetical evaluation on patients and their disease, which could effectively decrease iatrogenic loss while enhancing the curative effect.
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Objective@#To investigate the clinical effect of modified Graeb criteria score and Glasgow coma score (GCS) in individualized treatment of intraventricular hemorrhage.@*Methods@#113 patients with intraventricular hemorrhage admitted to the department of neurosurgery of Second Affiliated Hospital of Guangxi Medical University from June 2014 to February 2018 were enrolled, and they were divided into 13-15, 9-12, and 3-8 groups according to GCS score at admission, and modified Graeb criteria score was classified as grade Ⅰ, Ⅱ and Ⅲ at the same time. In GCS 9-12 and 3-8 groups, patients with modified Graeb criteria score grade Ⅲ were treated with bilateral extra ventricular drainage, patients with modified Graeb criteria score grade Ⅱ were treated with bilateral extra ventricular drainage or lumbar cistern drainage (GCS 9-12 group was more prior to lumbar cistern drainage, 3-8 group was given priority to extra ventricular drainage), and patients with modified Graeb criteria score grade Ⅰ were treated conservatively. In GCS 13-15 group, bilateral extra ventricular cerebral drainage or lumbar cistern drainage was performed if the modified Graeb criteria score grade was Ⅲ, lumbar cistern drainage or conservative treatment was performed if the modified Graeb criteria score grade was Ⅱ, and conservative treatment was performed if the modified Graeb criteria score grade was Ⅰ. The changes in GCS score at 1 month after individualized treatment and the favourable prognosis rate at 6 months after treatment were observed [favourable prognosis was defined as Glasgow outcome score (GOS) Ⅳ-Ⅴ] as well as the basic clearance time of intraventricular hematomas, and the occurrence of complications such as intracranial infection, pulmonary infection and hydrocephalus were recorded.@*Results@#113 patients with intraventricular hemorrhage were enrolled in the final analysis, including 39 patients in GCS 13-15 group, 27 in 9-12 group, and 47 in 3-8 group; 21 patients with the first grade of modified Graeb criteria score, 42 with the second grade and 50 with the third grade. At 1 month after individualized treatment, the GCS scores in GCS 13-15 and 9-12 groups were significantly higher than those at admission (14.8±0.2 vs. 13.7±0.8, 13.1±1.7 vs. 10.7±1.1, both P < 0.05). When comparing the GCS score of the same patient at admission with that of 1 month after treatment, the GCS scores of the three groups were significantly improved, indicating that the consciousness of patients with different coma levels at admission had been significantly improved after individualized treatment. The basic clearance time of intracerebroventricular hematomas in patients with the second grade of modified Graeb criteria score was (7.0±2.8) days, in patients with the third grade was (6.1±2.0) days. At 6 months after individualized treatment, among 113 patients, GOS score was grade Ⅰ in 7 patients (6.2%), grade Ⅱ in 13 patients (11.5%), grade Ⅲ in 28 patients (24.8%), grade Ⅳ in 27 patients (23.9%), and grade Ⅴ in 38 patients (33.6%), with the favourable prognosis rate of 57.5% (65/113). Among 113 patients, intracranial infection occurred in 5 patients (4.4%), pulmonary infection in 22 patients (19.5%), hydrocephalus in 2 patients (1.8%) and rebleeding in 4 patients (3.5%). In 83 patients with lumbar cistern drainage, 1 patient had post-drainage infection (1.2%), 3 patients had plugging (3.6%), 6 patients had accidental drop of drainage tube (7.2%), and none of them had occipital macroforamen hernia after drainage. Seven of the 113 patients died including 2 patients died of cerebral hernia caused by rebleeding, 5 patients died of severe pneumonia or automatic discharge from hospital.@*Conclusion@#The combination of modified Graeb criteria score and GCS score can individualize treatment for patients with intraventricular hemorrhage and effectively improve the prognosis of patients with intraventricular hemorrhage.
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Necrotizing pancreatitis is a complicated disease with multiple clinical outcomes. Although it's hard to select appropriate treatment strategies, it's still an important branch in improving the curative effect. The pathology and outcome of local complications of necrotizing pancreatitis show great diversity and individualized differences in different patients and stages of pathogenesis. Currently, a variety of treatment strategies for local complications of necrotizing pancreatitis, including minimally invasive treatment and laparotomy, can be selected. Removal of infected and necrotic tissues and adequate drainage of peripancreatic effusion are the basic principles. In clinical practice, minimally invasive and laparotomy strategies should be dialectically implemented according to the specific conditions and indications of patients. And we should avoid unilaterally emphasizing one method over the other or invariably using one method to deal with all patients' conditions. Clinical practice has proved that the choice of operation time is more decisive than the selection of debridement method to the success of treatment for local complications of necrotizing pancreatitis. As long as the operation time is appropriate, any debridement method can achieve good results. Therefore, we should avoid the overemphasis on debridement method, and ignore the significance of operation time for patients. In clinical practice, we are supposed to attach importance to the timing of intervention and selection of intervention methods according to the specific conditions of patients.
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To investigate the clinical effect of modified Graeb criteria score and Glasgow coma score (GCS) in individualized treatment of intraventricular hemorrhage. Methods 113 patients with intraventricular hemorrhage admitted to the department of neurosurgery of Second Affiliated Hospital of Guangxi Medical University from June 2014 to February 2018 were enrolled, and they were divided into 13-15, 9-12, and 3-8 groups according to GCS score at admission, and modified Graeb criteria score was classified as grade Ⅰ, Ⅱ and Ⅲ at the same time. In GCS 9-12 and 3-8 groups, patients with modified Graeb criteria score grade Ⅲ were treated with bilateral extra ventricular drainage, patients with modified Graeb criteria score grade Ⅱ were treated with bilateral extra ventricular drainage or lumbar cistern drainage (GCS 9-12 group was more prior to lumbar cistern drainage, 3-8 group was given priority to extra ventricular drainage), and patients with modified Graeb criteria score grade Ⅰ were treated conservatively. In GCS 13-15 group, bilateral extra ventricular cerebral drainage or lumbar cistern drainage was performed if the modified Graeb criteria score grade was Ⅲ, lumbar cistern drainage or conservative treatment was performed if the modified Graeb criteria score grade was Ⅱ, and conservative treatment was performed if the modified Graeb criteria score grade was Ⅰ. The changes in GCS score at 1 month after individualized treatment and the favourable prognosis rate at 6 months after treatment were observed [favourable prognosis was defined as Glasgow outcome score (GOS) Ⅳ-Ⅴ] as well as the basic clearance time of intraventricular hematomas, and the occurrence of complications such as intracranial infection, pulmonary infection and hydrocephalus were recorded. Results 113 patients with intraventricular hemorrhage were enrolled in the final analysis, including 39 patients in GCS 13-15 group, 27 in 9-12 group, and 47 in 3-8 group;21 patients with the first grade of modified Graeb criteria score, 42 with the second grade and 50 with the third grade. At 1 month after individualized treatment, the GCS scores in GCS 13-15 and 9-12 groups were significantly higher than those at admission (14.8±0.2 vs. 13.7±0.8, 13.1±1.7 vs. 10.7±1.1, both P < 0.05). When comparing the GCS score of the same patient at admission with that of 1 month after treatment, the GCS scores of the three groups were significantly improved, indicating that the consciousness of patients with different coma levels at admission had been significantly improved after individualized treatment. The basic clearance time of intracerebroventricular hematomas in patients with the second grade of modified Graeb criteria score was (7.0±2.8) days, in patients with the third grade was (6.1±2.0) days. At 6 months after individualized treatment, among 113 patients, GOS score was grade Ⅰ in 7 patients (6.2%), grade Ⅱin 13 patients (11.5%), grade Ⅲ in 28 patients (24.8%), grade Ⅳ in 27 patients (23.9%), and grade Ⅴ in 38 patients (33.6%), with the favourable prognosis rate of 57.5% (65/113). Among 113 patients, intracranial infection occurred in 5 patients (4.4%), pulmonary infection in 22 patients (19.5%), hydrocephalus in 2 patients (1.8%) and rebleeding in 4 patients (3.5%). In 83 patients with lumbar cistern drainage, 1 patient had post-drainage infection (1.2%), 3 patients had plugging (3.6%), 6 patients had accidental drop of drainage tube (7.2%), and none of them had occipital macroforamen hernia after drainage. Seven of the 113 patients died including 2 patients died of cerebral hernia caused by rebleeding, 5 patients died of severe pneumonia or automatic discharge from hospital. Conclusion The combination of modified Graeb criteria score and GCS score can individualize treatment for patients with intraventricular hemorrhage and effectively improve the prognosis of patients with intraventricular hemorrhage.