Impact of Eighth Joint National Committee guidelines on achievement of target blood pressure among hypertensive patients attending tertiary care hospital in South Kerala

Background: Hypertension is a major non-communicable disease and a large proportion of patients are not treated adequately even though several antihypertensive drugs and various guidelines are available. Aims and Objectives: The aim of the study was to study the treatment pattern and effectiveness of the antihypertensive drugs by estimating the blood pressure (BP) control achieved based on Joint National Committee (JNC) 8 guidelines for the treatment of hypertension. Materials and Methods: In this observational study, 92 patients with primary hypertension diagnosed since 1 1/2 years were included in the study. BP at the time of diagnosis and on subsequent follow-up visits and details of antihypertensive drugs prescribed during each visit were recorded, until target BP was achieved or till the end of the study period. Wilcoxon Signed Rank test and Mann–Whitney U test were used for analyzing the dependent and independent groups, respectively. Results: Mean age of patients was 57.50 years and 54.3% of them were females. Majority received single drug (80.43%) compared to combination therapy (19.57%). Most frequently prescribed antihypertensive drug group was angiotensin receptor blockers (47.75%) followed by calcium channel blockers (41.44%) and most commonly prescribed individual drugs were losartan and amlodipine (both 25.22%). Seventy-three (79.30%) patients attained their target BP and the average time taken for the adequate control of BP was 5.67 (S.D ± 2.674) weeks. Conclusion: JNC 8 guidelines were found to be effective in this study population.

Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai Integration Model (SIM) / 医学前沿

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43 ± 8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95 ± 5.53 (SD) years. The percentage of patients who achieved the target level for HbA1c (< 7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP) < 130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c) < 2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (< 140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.

Integrative medicine in the era of cancer immunotherapy: Challenges and opportunities / 中西医结合学报

Cancer immunotherapy has led to a new era of cancer treatment strategies, and transforming healthcare for cancer patients. Meanwhile, reports of immune-related adverse events have been increasing, greatly hindering the use of cancer immunotherapy. Traditional Chinese medicine (TCM), which has been widely used in Asian countries for thousands of years, is known to play a complementary role in the treatment of cancer. Taken in combined with conventional modern therapies, such as resection, ablation and radiotherapy, TCM exerts its main anti-cancer effects in two ways: health-strengthening (Fu-Zheng) and pathogen-eliminating (Qu-Xie). Theoretically, pathogen-eliminating TCM can promote the release of tumor-related antigens and should be able to increase the effect of immunotherapy, while health-strengthening TCM may have immune-enhancing mechanisms that overlap with immunotherapy. In the era of cancer immunotherapy, it is important to balance the use of TCM and immunotherapy, with the goal of enhancing immune efficacy and antagonizing immune toxicity. In this article, we discuss this issue by considering the mechanism of tumor immunotherapy, alongside the theoretical basis of TCM treatment of tumors, with the aim of bringing new insights to future research in this field.

New diagnosis and treatment pattern for cataract based on artificial intelligence / 中华实验眼科杂志

With the increase in the aging of the global population, the prevalence of cataract has increased gradually, and cataract has become a significant cause of blindness and visual impairment in China and even in the whole world.In recent years, artificial intelligence (AI) technology has developed rapidly, and has been applied widely in medical fields, especially in ophthalmology.AI is expected to become a vital method to alleviate the lack of medical resources, improve the efficiency of diagnosis and treatment and reduce medical costs.For cataract, AI is mainly applied in cataract screening and diagnosis, preoperative evaluation, the calculation of intraocular lens power and the analysis of cataract surgery procedure.In this article, the researches on the applications of AI technology in the diagnosis and classification of cataract based on the slit-lamp/fundus photograph, ultrasound image, cataract surgery video and health record data, the grading of opacity, the calculation of intraocular lens power as well as the recognization of cataract surgery and the management of cataract patients at home and abroad were summarized and reviewed in order to provide more references for the application and promotion of AI in ophthalmology.

Dilated cardiomyopathy: a pharmacotherapeutic research

Background: AHA defines cardiomyopathies as a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes that frequently are genetic.Methods: This is a prospective observational study conducted in the year 2017 at an OPD of Cardiology of a private hospital located in Telangana state, India. Data has been collected after diagnosis is made and treatment regimen is given by an Interventional Cardiologist.Results: Data has been collected from 78 cardiac patients, out of which 17.9% patients had Dilated Cardiomyopathy (DCM) among them 57.14% were male. In the present study DCM was reported more in the age group of 61-70 years (42.85%). Treatment pattern in most of the prescriptions include Diuretics, Beta blockers, Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor Blockers (ARBs), Cardiac Glycosides, Antiplatelet and Antihyperlipidaemics.Conclusions: To conclude, lack of awareness among people about this disease is leading it to progress to advanced stages and prognosis of which is poor. Conducting community awareness programs can play a key component in improving the prognosis of this disease.

Characteristics and Treatment Patterns of Patients with Advanced Soft Tissue Sarcoma in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: A soft tissue sarcoma (STS) is a rare type of cancer, accounting for 1% of adult solid cancers. The aim of the present study is to determine the incidence of localized and advanced STS in Korean patients, their treatment patterns, and the survival of patients by disease status. MATERIALS AND METHODS: The STS patient cohort was defined using National Health Insurance Service medical data from 2002 to 2015. Incidence, distribution, anatomical location of tumors, survival rates (Kaplan-Meyer survival function) and treatment patterns were analyzed by applying different algorithms to the STS cohort containing localized and advanced STS cases. RESULTS: A total of 7,813 patients were diagnosed with STS from 2007 to 2014, 4,307 were localized STS and 3,506 advanced STS cases. The total incidence of STS was 2.49 per 100,000 person- years: 1.37 per 100,000 person-years for localized STS and 1.12 per 100,000 person-years for advanced STS. The 5-year survival rate after diagnosis was 56.4% for all STS, 82.4% for localized, and 27.2% for advanced STS. Half of the advanced STS patients (49.98%) received anthracycline-containing chemotherapy as initial treatment after diagnosis. CONCLUSION: This study provides insights into localized and advanced STS epidemiology, treatment patterns and outcomes in Korea, which could be used as fundamental data in improving clinical outcomes of STS patients in the future.

Analysis of the factors influencing adjuvant chemotherapy decisions for triple negative breast cancer / 中华肿瘤杂志

Objective@#To analyze adjuvant chemotherapy decisions for triple negative breast cancer (TNBC), and explore the influencing factors in the multidisciplinary treatment (MDT) modality.@*Methods@#A retrospective analysis was performed. The cases with invasive TNBC who underwent surgery and MDT discussion for adjuvant treatment in Ruijin Hospital, from April 2013 to June 2015, were recruited. The patients′ clinicopathological characteristics were analyzed and adjuvant treatment suggestions from MDT were obtained. Here the chemotherapy decision alteration was defined as a disagreement in chemotherapy or not, or inconsistence in regimens between the attending doctor and the multidisciplinary team.@*Results@#A total of 194 patients aged ≤70 years old were enrolled in the multidisciplinary discussion, and 187 patients (96.4%) were suggested to receive chemotherapy. When compared the opinions of the attending doctor to suggestions of the multidisciplinary team, we found that the percentage of chemotherapy decision alteration reached 22.7% (39/172), of which 94.9% (37/39) were inconsistence in chemotherapy regimens. There were 119 patients who were recommended to receive epirubicin plus cyclophosphamide (EC) followed by docetaxel (T) or weekly paclitaxel (wP) regimens. Before the announcement of results for the E1199 trial, EC-T accounted for 62.5% (55/88), and EC-wP accounted for 37.5% (33/88) for this group of patients. After that, the proportion of EC-T was decreased to 22.6% (7/31) and proportion of EC-wP increased to 77.4%(24/31) (P<0.001). In addition, a total of 20 patients were suggested to receive platinum based chemotherapy. The proportions were 9.3% in cases with invasive ductal carcinoma, and 33.3% in cases with metaplastic carcinoma, respectively (P=0.016).@*Conclusions@#The adjuvant chemotherapy decision for TNBC patients is altered in 22.7% of the patients after MDT discussion. After the announcement of SABCS E1199 results, more patients are suggested to receive EC followed by weekly paclitaxel. There is a lack of detailed evidence for platinum based adjuvant chemotherapy for TNBC, and more patients with metaplastic carcinoma receive platinum based adjuvant chemotherapy.

Risk-Treatment Paradox in Acute Coronary Syndrome / 昆明医科大学学报

Objective This study aimed to assess the adherence to guideline-recommended therapies according to risk stratification in the management of acute coronary syndrome(ACS). Methods We analyzed 1,001 consecutive patients admitted with ACS. Patients were stratified using the GRACE risk score into low- and high-predicted risk of mortality at 6 months. We evaluated the use of hospital angiography,revascularization,and guideline-recommended medications between high and low-risk patients. Results High-risk compared to low-risk patients were less likely to underwent coronary angiography and/or revascularization during the hospitalization. The use of hospital-initiated pharmacotherapies was also lower in high-risk patients(P<0.05). Advanced age, increased creatinine level and higher GRACE score were independent predictors for failure to administer evidence-based therapies. Conclusion Patients with ACS at high risk of mortality were paradoxically less likely to undergo revascularization or receive medications according to guidelines. Better adherence to evidence-based therapies in high-risk patients may improve clinical outcome and quality of health care.

Research on Discovery and Application of Regular Syndrome-Treatment Pattern of Classical Chinese Medicinal Formulae for Emotional Diseases Based on Formal Concept Analysis / 世界科学技术-中医药现代化

This study was aimed to analyze the regulation of syndrome-treatment pattern of classical Chinese medici-nal formulae for emotional diseases based on formal concept analysis. First, we dealt with the decision formal context of 51 prescriptions about emotional symptom in the Treatise on Febrile and Miscellaneous Diseases and the Es-sentials from the Golden Cabinet based on the principle of optimization. Then, we generated a new partial-order at-tribute diagram in order to present the specific character. Finally, we explained properties of partial-order structure graph from traditional Chinese medicine (TCM) experts' point of view based on knowledge discovery. The results indi-cated the relationship between prescription and syndrome of emotional diseases. It was concluded that method pro-posed in this paper worked well in treatment of description of syndrome differentiation and discovery of new knowl-edge from the known data in the clinical diagnosis.

Investigation of the clinical characteristics of benign prostatic hyperplasia patients with enlarged prostate in China / 中华泌尿外科杂志

Objective　To evaluate the real-life clinical characteristics of benign prostatic hyperplasia (BPH) patients with moderate and severe enlarged prostate.　Methods　From February 2009 to January 2011,a prospective,non-interventional,multi-center study was conducted on 2 758 BPH patients recruited from 32 hospitals in 10 cities nationwide with the following criteria:prostate volume (PV) larger ≥30 ml and international prostate symptom score (IPSS) ≥ 8. Patient age,PV,IPSS,Qmax medical treatment patterns and physician prescription practice were recorded. The demographic information and clinic characteristics were evaluated as well.　Results　The mean patient age,PV,IPSS score and Qmax of 2 786eligible patients were 69.2 ±8.5 years (50 to 97 years),47.8 ±16.6 ml (30 to 165 ml),17.5 ±5.4 (8to 35 ) and 11.6 ± 3.6 ml/s (2 to 36 ml/s),respectively.Age subgroup analysis pointed that the mean PV and Qmax in 50 -55 years group were 42.8 ml and 13.3 ml/s compared to 49.0 ml and 11.1 ml/s in the group beyond 71 years.Both parameters had statistical significances (P ＜ 0.05 ). For 56.1％ of the patients,it was their first time coming to clinic seeking for medical advice. Of whom,22.8％ patients had taken BPH prescription medication regularly beyond two weeks.Only 31.3％ of the patients had a history of BPH shorter than one year.22.9％ and 18.3％ of the patients had a history of BPH for 1 -2 and 3 -4 years.And 27.5％　of the patients had a history of BPH related symptoms longer than five years. Only 52.6％ patients were treated with α adrenoceptor antagonists + 5-α reductase inhibitor by urologists according to the recommendation in Chinese guideline of BPH.　Conclusions　The symptoms and key parameters of moderate and severe benign prostatic hyperplasia (BPH) patients become worse and more with increased age in China.It is quite late for most patients coming to clinic seeking for their first medical advice.Furthermore,there is a huge gap between urologist prescription and the recommendation of the Chinese guideline on BPH.