The incidence of chronic kidney disease is increasing worldwide, which greatly increases the risk of end-stage renal disease. It is particularly important to find out the risk factors for the development and progression of chronic kidney disease. Whether gender is a risk factor for the progression of kidney disease remains controversial with inconsistent results in human cohort studies with diabetic or non-diabetic kidney disease. In most of the studies, women seem to exhibit certain gender advantages. Sex hormones, renal hemodynamics and lifestyle differences may play an important role. The underlying mechanism of gender affecting the progression of kidney disease deserves further exploration. This article reviews the gender differences and possible mechanisms in diabetic and non-diabetic chronic kidney disease, in order to provide reference for future research.
ObjectiveTo summarize the epidemiology of nonalcoholic fatty liver disease (NAFLD) and the epidemiological and economic burdens of NAFLD, so as to provide a reference for hospital management decision-making. MethodThe domestic and foreign guidelines relevant to NAFLD and the literatures relevant to epidemiological investigation and disease burden researches were summarized and its research progress was reviewed. ResultsThe global prevalence of NAFLD was increasing over years. The incidence, mortality, and disability adjusted life years of liver cirrhosis and liver cancer caused by NAFLD had increased year by year. The patients relevant to NAFLD of inpatients and outpatients had increased obviously, and the overall medical expenses had also shown a rising trend. The possible reasons were health care awareness, new drug research, population aging, and excessive medical consumption. In addition, children and adolescents with NAFLD had a obviously increased risk of liver or extrahepatic diseases. ConclusionsBy understanding the epidemiological trend of NAFLD, it is a certain understanding of the disease burden of NAFLD and the related factors affecting the increase of its treatment cost. It is believed that it is necessary to further pay attention to and strengthen the genetic characteristics, pathogenesis, drug research and development, and early diagnosis of cirrhosis and liver cancer relevant to NAFLD in the future. At the same time, the NAFLD group of children and adolescents should not be ignored.
Anti-vascular endothelial growth factor (VEGF) drugs have been widely used in clinic by inhibiting angiogenesis to treat ocular diseases such as malignant tumors and diabetic retinopathy. However, recent studies have shown that intravitreal injection of anti-VEGF drugs may have significant systemic absorption, leading to a series of renal damages such as worsening hypertension, proteinuria, new glomerular disease, and thrombotic microangiopathy. This article reviews the renal toxicity of intravitreal injection of anti-VEGF drugs in the treatment of diabetic retinopathy and other ocular diseases, aiming to provide recommendations for clinicians.
ObjectivesTo systematically review the application of evidence-based medicine (EBM) combined with problem-based learning (PBL) method in clinical teaching.MethodsDatabases including WanFang Data, CNKI, VIP, CBM, PubMed and EMbase were searched to identify eligible randomized controlled trials that compared EBM plus PBL with traditional lecture based learning (LBL) method in clinical teaching from inception to March 28th, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Statistical analysis was performed using Stata 14.0 software.ResultsA total of 33 randomized controlled trials with 2 855 students were included. The results showed that students in EBM combined with PBL group obtained better scores of specialized theory (WMD=6.87, 95%CI 5.08 to 8.66, P<0.001), skills examination (WMD=10.57, 95%CI 8.98 to 12.16, P<0.001) and case analysis (WMD=9.79, 95%CI 4.71 to 14.88, P<0.001), comparing with those in LBL group. Besides, EBM combined with PBL method improved students’ overall ability including independent learning capability, clinical thinking ability, problem-solving capability, literature exploring capacity, communication and presentation skills and team-work ability.ConclusionsApplication of EBM combined with PBL method can improve clinical teaching quality.
【摘要】 目的 總結急性腎功能衰竭（acute renal failure， ARF）的病因特點、治療情況與預后的關系。 方法 回顧性分析2007年8月-2008年4月77例ARF的臨床資料，總結各種因素與患者預后的關系。 結果 腎性因素是最主要的致病病因，占77.92%，其中以藥物和中毒居多。老年患者、少尿型患者或合并多臟器功能衰竭患者病死率較高，分別為25.93%，29.55%，83.33%。 結論 ARF應早期診斷，積極給予綜合治療，包括腎臟替代治療，老年ARF患者易出現多臟器功能衰竭、合并感染等，應放寬透析指征，并注意去除高危因素以提高存活率。【Abstract】 Objective To explore the clinical features, treatment, and prognosis of acute renal failure (ARF). Methods The clinical data of 77 patients with ARF from Auguest 2007 to April 2008 were retrospectively analyzed. Results Renal factor was the most important cause of ARF, accounting for 77.92%. The mortalities of elderly patients, oliguric patients and with multiple organ failure were 25.93%, 29.55%, and 83.33%, respectively. Conclusion Patients with ARF should be diagnosed as early as possible and given comprehensive treatments, including renal replacement therapy; the elderly patients with multiple organ failure and infection should be relaxed dialysis indications. We should pay attention to the removal of risk factors to improve the survival rate.
Objective To introduce the evidence-based evaluation on off-label uses at home and abroad, so as to investigate a systematic method of evidence-based evaluation on off-label uses. Methods In combination with the domestic and international research literature, a systematic method of evidence-based evaluation on off-label uses was discussed from the following three aspects: sources of evidence, levels of evidence, and recommendation strength. Results Sources of evidence included Clinical Pharmacology, DRUGDEX? System, NCCN Drugs amp; Biologics Compendium and handsearched literature. Levels of evidence and recommendation strength could refer to the 2009 grade system of Oxford Centre for Evidence-Based Medicine, and the strength of recommendations and scientific support of DRUGDEX? System. Conclusion A systematic method of evidence-based evaluation on off-label uses is initially established.
Objective To evaluate the effectiveness of Xingnaojing (XNJ) injection in the treatment of acute alcohol intoxication. Methods The Cochrane library (Issue 4, 2008), MEDLINE (1989 to 2008), WANFANG database (1991 to 2008), CBM (1991 to 2008), and CNKI (1991 to 2008) were searched. The quality of included studies was assessed according to the criteria recommended Cochrane Collaboration.Meta-analyses were performed using RevMan 4.2.2 software. Results Twenty seven trials, all published in China were included. The quality of these studies was low. Meta-analyses showed that normal treatment plus XNJ could significantly shorten action time [WMD= – 90.62 min, 95%CI (– 121.12, – 60.11)] and effective time [WMD= – 124.97 min, 95%CI (– 183.54, – 66.40)]. Normal treatment plus XNJ was similar with normal treatment plus naloxone in action time. No significant differences were observed in effective time between naloxone and XNJ. Conclusions It shows that XNJ injection plus western medical therapy is superior to western medical therapy. The curative efficacy of XNJ and Naloxone was similar.
Objective To explore the application effects of innovative health education on patients undergoing ambulatory laparoscopic cholecystectomy (LC). Methods A total of 139 patients undergoing ambulatory LC from November to December 2016 were selected as the control group, receiving the traditional health education; and other 141 patients undergoing ambulatory LC from February to March 2017 were selected as the observation group, receiving the innovative health education. The two groups were followed up and observed 1 day, 2, and 28 days after the discharge, and the incidence rates of adverse reactions such as postoperative pain, bleeding and incision infection were measured, and the disease knowledge mastery, self-care skills, medication compliance and satisfaction to nursing and hospital were evaluated. Results The total incidence rate of adverse reactions was 7.8% in the observation group and 25.2% in the control group (P<0.001). Medication compliance from high to low was 90, 46 and 5 cases in the observation group and 59, 64 and 16 cases in the control group (P<0.001). In the observation group, the scores of disease knowledge mastery, self-care cognition, nursing satisfaction and hospital satisfaction were 93.4±5.5, 91.4±4.5, 96.4±3.7 and 98.1±3.7, respectively, which were higher than those in the control group (83.8±8.7, 83.2±9.1, 91.5±9.2 and 94.8±7.3, respectively) with statistical significance (P<0.001). Conclusion Innovative health education has certain application effects on ambulatory LC, and it can significantly improve disease knowledge mastery and self-care cognition, and help to ensure the medical quality and safety during perioperative period, and improve the patients’ satisfaction.
Objective To assess the efficacy and safety of fructose-1,6 diphosphate (FDP) in the treatment of cerebral infarction. Methods We searched MEDLINE, EMbase, Cochrane CENTRAL Register of Controlled Trials, CBM and CNKI in 2006. Randomized controlled trials(RCTs) or quasi-randomized controlled trials involving FDP for cerebral infarction were collected. We assessed the quality of the studies and conducted meta-analyse with The Cochrane Collaboration’s RevMan 4.2. Results Ten RCTs were included, 9 of which were of low quality and only one was graded as high quality. None of the trials reported the number of patients who had died or were dependent at the end of long term follow-up. After 7 to 30 days of treatment, improvement of neurological deficiency was associated with FDP compared with placebo or control [OR 2.45, 95%CI (1.91,3.15)]. There was no statistical difference in the death rate between the FDP and control groups at the end of the treatment [RD –0.01, 95%CI (–0.03,0.01)]. One study found that FDP had a similar safety profile [OR 1.24, 95%CI (0.32,4.75)] to the control group. None of the trials compared the costs in the treatment groups. Conclusions The quality of the published clinical trials on FDP in the treatment of cerebral infarction is poor. FDP may improve short-term neurological deficits, but seems unlikely to decrease mortality. Moreover, we found no evidence to support the long-term efficacy of FDP on mortality, dependency and neurological deficit. Large-scale and high quality clinical trials with sufficient follow-ups are needed to evaluate the role of FDP in the treatment of cerebral infarction.
Objective To assess the response rate, improvement in neurological function and safety of cinepazide maleate injection for patients with cerebral infarction. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane Central Register of Controlled Trials (Issue 1, 2010), PubMed (1948 to March 2010), EMbase (1966 to March 2010) and Chinese Bio-Medicine Database (1978 to March 2010). We also hand searched relevant literatures and obtained unpublished trials from pharmaceutical companies. The Cochrane Collaboration’s software RevMan5.0 was used for meta-analysis. Results Fifteen randomized controlled trials involving 1 456 patients were included. The results of meta-analyses indicated that: 1) Neurological deficits: We identified 11 trials involved 978 patients. Cinepazide maleate injection group compared with the control groups (placebo, Xuesaitong, Dansen and Nimodipine) could significantly improve the neurological deficits. The difference was statistically significant with WMD= – 4.64, 95%CI – 6.43 to – 2.85, WMD= – 2.39, 95%CI – 4.37 to – 0.42, WMD= – 3.67, 95%CI – 5.26 to – 2.07 and WMD= – 6.14, 95%CI – 8.39 to – 3.89, respectively. 2) Response rate: A total of 14 trials involved 1 349 patients were identified. Compared with control groups (placebo, Xuesaitong, Dansen and Nimodipine), cinepazide maleate injection group were more efficient, the difference was statistically significant with RR=1.33, 95%CI 1.16 to 1.54; RR=1.24, 95%CI 1.04 to 1.50; RR=1.33, 95%CI 1.23 to 1.43 and RR=1.29, 95%CI 1.12 to 1.49, respectively. 3) Adverse events: No serious adverse events were observed. But the difference of adverse events reports of headache and skin itching in cinepazide maleate injection group was statistically significant compared with the control groups. Conclusion Current evidence shows that cinepazide maleate injection can reduce neurological deficits in patients with acute cerebral infarction, improve the clinical treatment efficacy without serious adverse events. Due to limited quality of included studies, high-quality, large sample randomized controlled trials are required.