Analysis on Common Compatibility Contraindications of Breviscapine for Injection

[Objectives]To analyze the common compatibility contraindications of breviscapine for injection,and to provide references for clinical rational drug use.[Methods]The pH distribution of the combined drugs in the report on the compatibility contraindications of breviscapine for injection and was analyzed.[Results]Breviscapine for injection may become turbid or precipitated when mixed with drugs whose pH are lower;it can make the liquid discoloration in a strong alkaline solution.[Conclusions]Breviscapine for injection should not be combined with drugs whose pH are lower,especially drugs with pH lower than 4.2.Breviscapine for injection should not be used with drugs with strong alkaline.It is recommended to use Breviscapine for injection separately.

Liver transplantation for Wilson disease

The aim of this paper is to review the current status of liver transplantation (LT) for Wilson disease (WD), focusing on indications and controversies, especially in patients with neuropsychiatric disease, and on identification of acute liver failure (ALF) cases related to WD. LT remains the treatment of choice for patients with ALF, as initial presentation of WD or when anti-copper agents are stopped, and for patients with chronic liver disease progressed to cirrhosis, unresponsive to chelating medications or not timely treated with copper chelating agents. The indication for LT in WD remains highly debated in patients with progressive neurological deterioration and failure to improve with appropriate medical treatment. In case of Wilsonian ALF, early identification is key as mortality is 100% without emergency LT. As many of the copper metabolism parameters are believed to be less reliable in ALF, simple biochemical tests have been proposed for diagnosis of acute WD with good sensitivity and specificity. LT corrects copper metabolism and complications resulting from WD with excellent 1 and 5 year survival. Living related liver transplantation represents an alternative to deceased donor LT with excellent long-term survival, without disease recurrence. Future options mayinclude hepatocyte transplantation and gene therapy. Although both of these have shown promising results in animal models of WD, prospective human studies are much needed to demonstrate their long-term beneficial effects and their potential to replace the need for medical therapy and LT in patients with WD.

Neoadjuvant treatment strategies for hepatocellular carcinoma

The incidence of hepatocellular carcinoma(HCC)remains high globally.Surgical treatment is the best treatment for improving the prognosis of patients with HCC.Neoadjuvant therapy plays a key role in preventing tumor progression and even downstaging HCC.The liver transplantation rate and resectability rate have increased for neoadjuvant therapy.Neoadjuvant therapy is effective in different stages of HCC.In this review,we summarized the definition,methods,effects,indications and contraindications of neoadjuvant therapy in HCC,which have significance for guiding treatment.

Liver transplantation in adults:Choosing the appropriate timing

Liver transplantation is indicated in patients with acute liver failure,decompensated cirrhosis,hepatocellular carcinoma and rare liver-based genetic defects that trigger damage of other organs.Early referral to a transplant center is crucial in acute liver failure due to the high mortality with medical therapy and its unpredictable evolution.Referral to a transplant center should be considered when at least one complication of cirrhosis occurs during its natural history.However,because of the shortage of organ donors and the short-term mortality after liver transplantation on one hand and the possibility of managing the complications of cirrhosis with other treatments on the other,patients are carefully selected by the transplant center to ensure that transplantation is indicated and that there are no medical,surgical and psychological contraindications.Patients approved for transplantation are placed on the transplant waiting list and prioritized according to disease severity.Thus,the appropriate timing of transplantation depends on recipient disease severity and,although this is still a matter of debate,also on donor quality.These two variables are known to determine the "transplant benefit"(i.e.,when the expected patient survival is better with,than without,transplantation) and should guide donor allocation.

不合理静脉用药医嘱分析与药学干预研究

目的通过对不合理静脉用药医嘱的分析及药学干预,促进临床合理用药。方法选取2019年7月―2019年12月我院静配中心调剂的消化内科、神经内科和胃肠外科等病区的静脉用药医嘱进行逐一分析并统计分类。结果药师共计审核医嘱216043条,发现不合理医嘱603条。不合理用药的类型主要为溶媒选择、药物浓度、给药途径、配伍禁忌及其他,同时分别举例加以阐述。结论针对静脉用药不合理使用问题采取有效干预措施,药师借助合理用药软件进行医嘱审核,以保障患者用药安全。

Try Analyzing the Usage of Monkshood in Gynecology

This paper centers on the usage of monkshood in gynecology and tries to analyze why monkshood is rarely mentioned in nowa days' teaching

Colonoscopy a True Therapeutic Icon

Colonic polypectomy remained the first colonoscopic therapeutic intervention which was successfully accomplished with the help of an early snare. This therapeutic procedure was executed by Dehyle in Europe and Shinya in USA in 1971 [1]. Thus, these two colonoscopists acquired the pioneer’s position of therapeutic colonoscopy. Now the colonoscopy has achieved a special status in treating colorectal diseases because of its unique therapeutic aspect. The common uses of therapeutic colonoscopy are broadly classified in to the four major categories because of its unique therapeutic properties. These uses include resection and ablation, hemostasis, decompression with or without recanalization and foreign body extraction. Colonic perforation remained an absolute contraindication to therapeutic colonoscopy which is analogous to diagnostic colonoscopy. Good Communication plays a vital role in accomplishment of successful therapy with the help of colonoscopy. Consent process remained a complex process which should be well organized and tailored as per patient’s needs. There are lot of advancements in colonoscopy in recent years and many new procedures and treatment modalities have become available to treat colorectal diseases with the help of colonoscope. The recent advancement in colonoscopy has led to having many novel techniques. This therapeutic colonoscopy has made a significant change in current colorectal cancer management as polyps can be treated in the early stage, thus reducing the incidence of colorectal cancer. This is the basis of the United Kingdom existing bowel screening program, which is only feasible because of colonoscopy-induced interventions. The successful uses of these techniques obviate the need for a major surgical operation and colorectal disease can be treated with minimally invasive colonoscopic methods. These attributes make colonoscopy a true therapeutic icon.

Obesity Management-Bariatric Surgery vs Lifestyle Modification

Role of Bariatric surgery for obesity is briefly outlined. Selection criteria, contraindications, evaluations of patients before surgery, types of bariatric surgery with their merits and demerits are discussed. Results of lifestyle modifications is compared with that of bariatric surgery.

Colonoscopy a Real Diagnostic Paragon

Diagnostic colonoscopy acquires the status of gold standard investigation for evaluation of colonic problems. Formally, colonoscopy was first initiated in June 1969 in America. Colonoscopic history can be traced back to 1958. Matsunaga from Japan was the pioneer as he used a gastrocamera which was the start of colonoscopic era. Flexible sigmoidoscopy was later introduced in 1963. Existing colonic perforation and refusal of a fully compos mentis patient, remain absolute contraindications to diagnostic colonoscopy. Bowel Perforation, although less common, is a disastrous complication of colonoscopy. It is a basic right of any patient who has been offered a colonoscopic procedure to have appropriate, clear and concise information about colonoscopy. Consent literally means permission or an agreement which is granted by a patient to a health care individual to receive examination, test, treatment or intervention. Colonoscopic consent process should be valid and has voluntary, fully informed and capacity aspects as its integral components. There were a lot of oppositions against colonoscopy at that time. It was believed to be dangerous and unnecessary exercise by many surgeons. Time has proved that to be a wrong perception. It is now believed to be an extremely useful diagnostic modality. It is safe procedure in experienced hands and provides valuable clinical information. Colonoscopy is not a pleasant investigation as it is usually related with pain and discomfort by patients;fortunately, good analgesia and safe conscious sedation make this hostile but worthwhile procedure tolerable to patients.Today colonoscopy has kept its status of the gold standard investigation in diagnosing bowel cancer and has prime role in the assessment of majority of large bowel symptoms. Colonoscopy also retains the status of being an investigation with highest sensitivity and specificity, out of all available diagnostic modalities, for identifying adenomatous polyps and now it has acquired a unique status of being a diagnostic paragon.

Ayurveda perspective and global scenario of Wet cupping therapy-a comprehensive review

Wet cupping is a simple and minor procedure practiced in Ayurveda and various traditional medicine system worldwide.In Ayurveda wet cupping therapy is practiced under the scope of Raktamo Kshana(therapeutic bloodletting)which is adopted to remove vitiated Rakta(blood).The present work is aimed to explore the wet cupping therapy from Ayurveda perspective along with global scenario.In this review,classical Ayurveda text and PubMed,Cochrane library,science direct,Google scholar and DHARA database were scrutinized for worldwide work on wet cupping therapy.The Ayurveda science can utilize these researches in completing its lost knowledge and also provide integrative effort in re-validation and enrichment of WCT which are required at large for greater benefit of the mankind.The method of WCT application,principles,indications,contraindications,complications and probable mode of action from Ayurveda perspective and global scenario were introduced and summarized.

Garlic:Medicinal Plant and Natural Aromatic Condiment

Objective:To relate the presence of active metabolites with therapeutic effects of the Allium sativum L whose common name is Garlic,as well as its contraindications and adverse reactions and its use as condiment.Methods:Searching about the topic in the last 5 years and present a general view of the Allium sativum L whose common name is Garlic.Conclusions:Technological prevision was based on the search of articles in the Virtual Library in Health(BVS)and using the key words“medicinal plants”/“spice”/Allium sativum L/garlic/adverse reactions and contraindications,and the association among them.

Traditional Chinese Medicine and Traditional Indonesian Medicine:A Comparative Review of Herbal Medicines Restricted in Pregnancy

The decline in birth rates has become a very serious problem in various parts of the world.Many countries have implemented national programs for increasing birth rates,one of which involves the use of traditional medicine as an alternative solution.Among the fast-growing traditional medicines,traditional Chinese medicine(TCM)and traditional Indonesian medicine(TIM)have attracted a lot of demand globally.Here,we analyzed and compared the herbal medicines from TCM and TIM that must be avoided by pregnant women for preventing miscarriage and maintaining safety during pregnancy and the postpartum period.This review uses data from official reports from the respective government and national and international electronic databases for analysis.Although TCM and TIM have their own characteristics of treatment,they also have some similarities in concept and treatment,especially those related to herbal medicines.This review can be used as a reference base to help pregnant women consume herbal medicines at appropriate conditions and doses.

Debranching thoracic endovascular aortic repair combined with ascending aortic aortoplasty

Surgical treatment of aortic arch lesions is a challenge for cardiac surgeons because of the complexity of the technique.For high-risk patients who are not suitable to undergo traditional open arch replacement,debranching thoracic endovascular aortic repair (d-TEVAR) is often a good choice.Retrograde type A aortic dissection (RTAD) is a common and fatal complication after d-TEVAR,[1] and thus d-TEVAR is contraindicated in low-risk patients.Herein,we describe a modification of d-TEVAR with an aortoplasty of the ascending aorta using artificial blood vessels and the subsequent use as an anchoring zone to minimize the occurrence of RTAD.

Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation

Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P<0.001).At discharge,the prescription rate of OAC was 45.2%(16,757/37,087)in eligible patients with high stroke risk and 60.7%(2778/4578)in eligible patients with low stroke risk.OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time(all P<0.001).Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies,including catheter ablation(adjusted odds ratio[OR]11.63,95%confidence interval[CI]10.04-13.47;P<0.001),electronic cardioversion(adjusted OR 2.41,95%CI 1.65-3.51;P<0.001),and anti-arrhythmic drug use(adjusted OR 1.45,95%CI 1.38-1.53;P<0.001).Conclusions:In hospitals participated in the CCC-AF project,>70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.