AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received...AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day. RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to ≤ 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05). CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.展开更多
Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute ill...Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.展开更多
AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients...AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years;previously received surgical treatment or endoscopic therapy for variceal bleeding;and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS(TIPS group) while 62 patients received endoscopic therapy(ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rateand cost of treatment were compared between the two groups.RESULTS:During the follow-up period(median,20.7 and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group(Kaplan-Meier analysis and log-rank test,P = 0.000).Rebleeding rates at any time point(6 wk,1 year and 2 year) in the TIPS group were lower than in the ET group(Bonferroni correction α' = α/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test c2 = 4.864,P = 0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates(Bonferroni correction α' = α/3).However,significant differences were observed between the two groups in the 1-year survival rates(92% and 79%) and the 2-year survival rates(89% and 64.9%)(Bonferroni correction α' = α/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy(12 patients in TIPS group and 5 in ET group,KaplanMeier analysis and log-rank test,c2 = 3.103,P = 0.08).The average total cost for the TIPS group was higher than for ET group(Wilcxon-Mann Whitney test,52 678 RMB vs 38 844 RMB,P < 0.05),but hospitalization frequency and hospital stay during follow-up period were lower(Wilcxon-Mann Whitney test,0.4 d vs 1.3 d,P = 0.01;5 d vs 19 d,P < 0.05).CONCLUSION:Early use of TIPS is more effective than endoscopic treatment in preventing variceal rebleeding and improving survival rate,and does not increase occurrence of hepatic encephalopathy.展开更多
Bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. Antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile ...Bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. Antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile infection (CDI). We argue against the conclusion of the authors and consider that this result may be simply due to concurrent use of metronidazole, a therapeutic agent against CDI.展开更多
Objective： This study is a prospective randomized, double-blind, placebo-controlled study to evaluate the effect of calcium and magnesium （Ca/Mg） infusion on amelioration of oxaliplatin neuropathy, the dose-limitin...Objective： This study is a prospective randomized, double-blind, placebo-controlled study to evaluate the effect of calcium and magnesium （Ca/Mg） infusion on amelioration of oxaliplatin neuropathy, the dose-limiting toxicity. Methods： Sixty patients with resected colorectal carcinoma （CRC） planned to receive adjuvant oxaliplatin-containing regimen were randomly assigned to two arms; Arm A： patients received Ca/Mg were given as 1 gm Ca gluconate and 1 gm MgSO4 in 250 mL of intravenous （IV） solution over 30 rain pre and post oxaliplatin infusion, and Arm B： patients received 250 mL of IV solution without Ca/Mg over 30 min pre and post oxaliplatin infusion. Primary outcome was to assess percentage of patients with oxaliplatin-induced neurotoxicity. Neurotoxicity was assessed according to the National Cancer Institute Common Terminology Criteria forAdverse Events （NCI-CTCAE） version 3.0. Results： Sixty patients in both arms were assessed, 30 with Ca/Mg infusion and 30 without. Patients developed neurotoxicity in arm A were significantly lower than that in arm B after the end of treatment; 7 （23.3%） and 14 （46.6%） respectively （P 〈 0.05）, and significantly lower duration of neuropathy in months （8 ± 2.5 vs 18 ±3） respectively （P 〈 0.001）. Conclusion： Use of IV Ca/Mg showed a statistically significant reduction of peripheral neuropathy （PN） in patients with CRC receiving oxaliplatin in the adjuvant settings.展开更多
Deep venous thrombosis （DVT） is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who r...Deep venous thrombosis （DVT） is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.展开更多
Complications arising from tendon injury include tendon sheath infection and peritendinous adhesion, in which tendon adhesion often leads to serious motor dysfunction. In this work, the electrospun membranes of poly(L...Complications arising from tendon injury include tendon sheath infection and peritendinous adhesion, in which tendon adhesion often leads to serious motor dysfunction. In this work, the electrospun membranes of poly(L-lactide)(PLA) and poly(ε-caprolactone)(PCL) with different degradation kinetics were used to investigate their efficacy for anti-adhesion toward Achilles tendon repair. Compared with the PCL membrane, the PLA sample showed a faster rate of degradation in 42 d, and all the degradation media(i.e., phosphate-buffered saline) maintained at a constant p H of around 7.4. Meanwhile, the superior biocompatibility of both the PLA and PCL membranes were proved by the in vitro cellular adhesion tests and in vivo histopathological assays. Simultaneously, the PLA membrane was more effective than the PCL sample in decreasing adhesion and promoting functional recovery. Furthermore, the experiment result was further confirmed by hematoxylin-eosin and Masson's trichrome staining, and type I collagen immunohistochemical analysis. All results revealed that the model treated with the electrospun PLA membrane was obviously better with regard to both anti-adhesion and tendon repair than that in the PCL membrane group. Considering the results of degradation and adhesion prevention efficacy, the electrospun polyester membranes, especially the PLA one, would be applied with fascinating potential in clinical prevention of postoperative tendon adhesion.展开更多
Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients.It represents a medical emergency and is associated with a hig...Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients.It represents a medical emergency and is associated with a high morbidity and mortality.In those who survive the initial bleeding event,the risks of further bleeding and other decompensated events remain high.The past 30 years have seen a slow evolution of management strategies that have greatly improved the chances of surviving a variceal haemorrhage.Liver cirrhosis is a multi-staged pathological process and we are moving away from a one-size-fits-all therapeutic approach.Instead there is an increasing recognition that a more nuanced approach will yield optimal survival for patients.This approach seeks to risk stratify patients according to their disease stage.The exact type and timing of treatment offered can then be varied to suit individual patients.At the same time,the toolbox of available therapy is expanding and there is a continual stream of emerging evidence to support the use of endoscopic and pharmacological therapies.In this review,we present a summary of the treatment options for a variety of different clinical scenarios and for when there is failure to control bleeding.We have conducted a detailed literature review and presented up-to-date evidence from either primary randomized-controlled trials or meta-analyses that support current treatment algorithms.展开更多
文摘AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day. RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to ≤ 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05). CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.
文摘Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.
文摘AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years;previously received surgical treatment or endoscopic therapy for variceal bleeding;and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS(TIPS group) while 62 patients received endoscopic therapy(ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rateand cost of treatment were compared between the two groups.RESULTS:During the follow-up period(median,20.7 and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group(Kaplan-Meier analysis and log-rank test,P = 0.000).Rebleeding rates at any time point(6 wk,1 year and 2 year) in the TIPS group were lower than in the ET group(Bonferroni correction α' = α/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test c2 = 4.864,P = 0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates(Bonferroni correction α' = α/3).However,significant differences were observed between the two groups in the 1-year survival rates(92% and 79%) and the 2-year survival rates(89% and 64.9%)(Bonferroni correction α' = α/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy(12 patients in TIPS group and 5 in ET group,KaplanMeier analysis and log-rank test,c2 = 3.103,P = 0.08).The average total cost for the TIPS group was higher than for ET group(Wilcxon-Mann Whitney test,52 678 RMB vs 38 844 RMB,P < 0.05),but hospitalization frequency and hospital stay during follow-up period were lower(Wilcxon-Mann Whitney test,0.4 d vs 1.3 d,P = 0.01;5 d vs 19 d,P < 0.05).CONCLUSION:Early use of TIPS is more effective than endoscopic treatment in preventing variceal rebleeding and improving survival rate,and does not increase occurrence of hepatic encephalopathy.
文摘Bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. Antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile infection (CDI). We argue against the conclusion of the authors and consider that this result may be simply due to concurrent use of metronidazole, a therapeutic agent against CDI.
文摘Objective： This study is a prospective randomized, double-blind, placebo-controlled study to evaluate the effect of calcium and magnesium （Ca/Mg） infusion on amelioration of oxaliplatin neuropathy, the dose-limiting toxicity. Methods： Sixty patients with resected colorectal carcinoma （CRC） planned to receive adjuvant oxaliplatin-containing regimen were randomly assigned to two arms; Arm A： patients received Ca/Mg were given as 1 gm Ca gluconate and 1 gm MgSO4 in 250 mL of intravenous （IV） solution over 30 rain pre and post oxaliplatin infusion, and Arm B： patients received 250 mL of IV solution without Ca/Mg over 30 min pre and post oxaliplatin infusion. Primary outcome was to assess percentage of patients with oxaliplatin-induced neurotoxicity. Neurotoxicity was assessed according to the National Cancer Institute Common Terminology Criteria forAdverse Events （NCI-CTCAE） version 3.0. Results： Sixty patients in both arms were assessed, 30 with Ca/Mg infusion and 30 without. Patients developed neurotoxicity in arm A were significantly lower than that in arm B after the end of treatment; 7 （23.3%） and 14 （46.6%） respectively （P 〈 0.05）, and significantly lower duration of neuropathy in months （8 ± 2.5 vs 18 ±3） respectively （P 〈 0.001）. Conclusion： Use of IV Ca/Mg showed a statistically significant reduction of peripheral neuropathy （PN） in patients with CRC receiving oxaliplatin in the adjuvant settings.
文摘Deep venous thrombosis （DVT） is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.
基金financially supported by the National Natural Science Foundation of China(51303174,51473165,51233004,51390484,51273196,51321062,51203153)the Scientific Development Program of Jilin Province(20140520050JH)
文摘Complications arising from tendon injury include tendon sheath infection and peritendinous adhesion, in which tendon adhesion often leads to serious motor dysfunction. In this work, the electrospun membranes of poly(L-lactide)(PLA) and poly(ε-caprolactone)(PCL) with different degradation kinetics were used to investigate their efficacy for anti-adhesion toward Achilles tendon repair. Compared with the PCL membrane, the PLA sample showed a faster rate of degradation in 42 d, and all the degradation media(i.e., phosphate-buffered saline) maintained at a constant p H of around 7.4. Meanwhile, the superior biocompatibility of both the PLA and PCL membranes were proved by the in vitro cellular adhesion tests and in vivo histopathological assays. Simultaneously, the PLA membrane was more effective than the PCL sample in decreasing adhesion and promoting functional recovery. Furthermore, the experiment result was further confirmed by hematoxylin-eosin and Masson's trichrome staining, and type I collagen immunohistochemical analysis. All results revealed that the model treated with the electrospun PLA membrane was obviously better with regard to both anti-adhesion and tendon repair than that in the PCL membrane group. Considering the results of degradation and adhesion prevention efficacy, the electrospun polyester membranes, especially the PLA one, would be applied with fascinating potential in clinical prevention of postoperative tendon adhesion.
文摘Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients.It represents a medical emergency and is associated with a high morbidity and mortality.In those who survive the initial bleeding event,the risks of further bleeding and other decompensated events remain high.The past 30 years have seen a slow evolution of management strategies that have greatly improved the chances of surviving a variceal haemorrhage.Liver cirrhosis is a multi-staged pathological process and we are moving away from a one-size-fits-all therapeutic approach.Instead there is an increasing recognition that a more nuanced approach will yield optimal survival for patients.This approach seeks to risk stratify patients according to their disease stage.The exact type and timing of treatment offered can then be varied to suit individual patients.At the same time,the toolbox of available therapy is expanding and there is a continual stream of emerging evidence to support the use of endoscopic and pharmacological therapies.In this review,we present a summary of the treatment options for a variety of different clinical scenarios and for when there is failure to control bleeding.We have conducted a detailed literature review and presented up-to-date evidence from either primary randomized-controlled trials or meta-analyses that support current treatment algorithms.
