Objective To report an evidence-based treatment of Mycophenolate Mofetil for idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched The Cochrane Library (Issue 3, 2005), MEDLINE (1978 to 2006) and CNKI (1978 to 2006), and critically appraised the available evidence. Results The available Level C (low quality) evidence showed that Mycophenolate Mofetil was effective for the remission of proteinuria, and effective in patients who were resistant to steroid or cytotoxic agents. However, there was no evidence on its long-term effect on renal survival. Given the current evidence, together with our clinical experience and the patient’s preference, Mycophenolate Mofetil and glucocorticoid were administered to the patient. After 3 months of treatment, proteinuria was relieved. The patient is still can followed up. Conclusions We only find Level C evidence to support the short-term efficacy of Mycophenolate Mofetil on the remission of proteinuria. Further studies on its long-term effects on renal survival, and a health economics evaluation are needed.
After comparative interpretation of the essentials and highlights of the expert recommendations based on European experience published in 2019 and the expert recommendations based on Asia Pacific experience published in 2021, this article summarizes the core principles of adsorptive hemofiltration for sepsis in following aspects, including patient selection, laboratory index, and key factors in the implementation of treatment (covering initiation timing and duration, choice of anticoagulant mode, discontinuation, etc) combined with the experience in West China Hospital of Sichuan University as well, to provide references for sepsis management with adsorptive hemofiltration in clinical practice.
Hypophosphatemia is a common and potentially serious complication during continuous renal replacement therapy (CRRT), which is often underestimated and ignored. This article systematically searched and reviewed the relevant literature on previous CRRT and hypophosphatemia, and summarized the risk factors affecting hypophosphatemia during CRRT, the impact on the body, and the existing phosphorus supplement scheme during CRRT, so as to attract everyone’s attention to hypophosphatemia during CRRT in clinical work.
Immunoadsorption with Staphylococcus protein A column is a blood purification therapy that eliminates pathogenic antibodies on the principle that Staphylococcus protein A can specifically bind to human immunoglobin G efficiently. At present, it has been safely applied to a variety of autoimmune diseases and organ transplantation rejection and other fields. It has been reported to have efficacy for a variety of immune diseases, comparable to traditional plasma exchange. This article provides a review of the application progress of this technology in different systemic diseases, providing a reference for selecting blood purification treatment modes for clinical treatment of related diseases.
In recent years, Regional citrate anticoagulation (RCA) technology has been widely used not only in adult blood purification, but also in children’s blood purification, and its advantages in patients with high bleeding risk, active bleeding and heparin-induced thrombocytopenia have been repeatedly confirmed. Therefore, this article reviews and analyzes the application of RCA in different blood purification modes at home and abroad in recent years. It is found that its anticoagulation is not only safe and effective, but also can prolong the life of filter and reduce bleeding complications, which is suitable for the practice of blood purification.
Objective We sought a good understanding of the current role of computed tomography (CT) in the diagnosis of small bowel obstruction (SBO).Methods We looked for the best evidence on computed tomography for diagnosing small bowel obstruction by searching MEDLINE/PubMed (1978-April, 2006), SUMsearch (1978-April, 2006), CNKI (1978-April, 2006) and critically appraised the evidence. Results There was powerful evidence supporting the efficacy of computed tomography in the diagnosis of small bowel obstruction. Given the current evidence together with our clinical experience and considering the patient and his family members, values and preferences, computed tomography was done. We confirmed the diagnosis of strangulating small bowel obstruction, which needed immediate operation. Conclusions Computed tomography is a very useful tool for the diagnosis of small bowel obstruction with high sensibility and specificity.
【摘要】 目的 总结急性肾功能衰竭（acute renal failure， ARF）的病因特点、治疗情况与预后的关系。 方法 回顾性分析2007年8月-2008年4月77例ARF的临床资料，总结各种因素与患者预后的关系。 结果 肾性因素是最主要的致病病因，占77.92%，其中以药物和中毒居多。老年患者、少尿型患者或合并多脏器功能衰竭患者病死率较高，分别为25.93%，29.55%，83.33%。 结论 ARF应早期诊断，积极给予综合治疗，包括肾脏替代治疗，老年ARF患者易出现多脏器功能衰竭、合并感染等，应放宽透析指征，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 summarize the risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis. Methods A retrospective review was conducted of 347 patients underwent necrosectomy for severe acute pancreatitis between January 2011 and December 2015 at West China Hospital of Sichuan University. Results Of the 347 patients, thirty-eight patients had intra-abdominal bleeding after surgeries, including 5 patients who had twice bleeding. The bleeding positions including splenic vein (n=7), splenic artery (n=2), pancreatic and peripancreatic vessels (n=8), colonic mesangial vessels (n=6), other vessels (n=12), and extensive osmotic bleeding in abdominal cavity (n=7). Hemostatic modes: suture (n=20), compression hemostasis (n=18), transcatheteranerial embolism (n=2), suture and compression hemostasis (n=4), and conservative treatment (n=1). There were 19 dead patients of 38 bleeding patients. There were statistically significant differences between the hemorrhage group and the non-hemorrhage group on gender, acute physiology and chronic health evaluation (APACHEⅡ) scores and modified Marshall scores at admission, interval onset to surgery, surgical approaches, and morbidity (P<0.05). Compared with the non-hemorrhage group, there were more males, higher APACHE Ⅱ scores and modified Marshall scores, longer interval onset to surgery, and higher mortality in the hemorrhage group. Multivariable logistic regression analysis showed that male patients had higher risk of intra-abdominal bleeding (OR=3.980, P=0.004), as the grow of APACHEⅡ scores, the risk of intra-abdominal bleeding increased (OR=1.487, P<0.001). Conclusions We should pay more attention on the male SAP patients as well as patients with multiple organ dysfunction.