Objective To investigate the efficacy and safety of nebulized budesonide for acute exacerbation of chronic obstructive pulmonary disease, and to formulate an evidence-based treatment protocol for a patient with acute exacerbation of chronic obstructive pulmonary disease. Methods We searched The Cochrane Library (Issue 4, 2009), MEDLINE (1990 to February 2010), ACP Journal Club (1991 to February 2010) and Chinese Journal Full-text Database (1979 to February 2010), and critically appraised the available evidence. Results Four randomized controlled trials were included, and all were of relatively high quality. Evidence showed that nebulized budesonide could alleviate symptoms, improve pulmonary function without any serious side effects. Given the current evidence, we used nebulized budesonide which helped the control of symptoms with no adverse effects. Conclusion Nebulised budesonide may be an effective and safe alternative to systemic corticosteroids in the treatment of acute exacerbation of chronic obstructive pulmonary disease.
Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.
Acute kidney injury is a common complication in the critically ill patients with high morbidity and mortality. Continuous renal replacement therapy (CRRT) is one of the most important treatments for the disease. The timing of starting and stopping of CRRT is often a matter of choice for clinicians. Early stopping of CRRT may lead to inadequate treatment, recurrent disease and poor prognosis, while excessive treatment of CRRT may prolong the hospital stay, increase medical costs and increase the risk of CRRT-related complications. In order to illustrate the proper stopping time of CRRT, this paper summarizes the research progress of the clinical indicators and biomarkers by reviewing relevant domestic and foreign data.
Objective To systematically review the clinical effectiveness and safety of Lianhuaqingwen capsule in the treatment of influenza. Methods Databases including MEDLINE, The Cochrane Library, PubMed, VIP, WanFang Data, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) on Lianhuaqingwen capsule treating influenza published from 2000 to 2011. The studies were screened according to the inclusion and exclusion criteria, the data were extracted, the quality of the included RCTs was assessed, and meta-analysis was performed using RevMan 5.0 software. Results Among 12 RCTs included, 11 were in Chinese and 1 was in English. The results of meta-analyses based on stratified therapeutic strategies showed that: a) Lianhuaqingwen caspule vs. other traditional Chinese medicinals (TCM): A total of 5 RCTs were included. Compared with the Lingyangganmao capsule, significant differences were found in the clinically marked effective rate (RR=1.32, 95%CI 1.15 to 1.52), the marked effective rate of temperature (RR=1.31, 95%CI 1.10 to 1.55), and the time of defervescence (RR=3.98, 95%CI –4.81 to –3.15); compared with the Kugan granules, significant differences were found in the clinically marked effective rate (RR=1.33, 95%CI 1.08 to 1.64) and the marked effective rate of temperature (RR=1.58, 95%CI 1.20 to 2.09); compared with the TCM decoction, the time of defervescence was significantly different (WMD=5.52, 95%CI 0.32 to 10.72); and b) Lianhuaqingwen capsule vs. western drugs: A total of 9 RCTs were included. Compared with ribavirin, the clinically marked effective rate was significantly different (RR=1.52, 95%CI 1.15 to 2.02); compared with Phosphate oseltamivir, the clinically marked effective rate was not significantly different (RR=0.96, 95%CI 0.77 to 1.18), and the WMDs (95%CI) of such indexes as the time of defervescence, the duration of cough, sore throat, myalgia, expectoration and headache, and the time of viral shedding were –4.50 (–8.83, –0.17), –10.38 (–13.89, –6.87), –13.92 (–19.81, –8.04), –16.44 (–26.50, –6.39), –10.80 (–18.98, –2.63), –9.24 (–17.92, –0.57), and 1.39 (–7.24, 10.02), respectively. Except for the time of viral shedding, all the other indexes showed significant differences between the two groups. No obvious adverse reactions related to Lianhuaqingwen capsule were reported. Conclusion Current evidence shows that Lianhuaqingwen capsule is more effective than other Chinese medicinals and western drugs in alleviating flu-like symptoms when treating influenza. Due to the low methodological quality of the included RCTs, more high-quality large-scale RCTs need to be conducted to verify this conclusion.
Objective To systematically assess the effectiveness of traditional Chinese medicines (TCM) in treating upper airway cough syndrome (UACS) or postnasal drip syndrome (PNDS). Methods Such databases as MEDLINE (1950 to 2011), PubMed (1996 to 2011), VIP (1989 to 2011), WanFang Data (1998 to 2011), CNKI (1979 to 2011) and CBM (1978 to 2011) were searched for collecting the randomized controlled trials (RCT) or quasi-RCTs about TCM treating UACS/PNDS. The trials were screened according to the inclusive and exclusive criteria, and then after the quality assessment and data extraction were conducted, the statistical analysis was conducted by using RevMan 5.0 software. Results A total of 10 RCTs and quasi-RCTs in Chinese were identified. The results of analysis showed that: a) The integrated Chinese and western medicine was superior to western medicine alone, either for adults and children with UACS, or for adults with PNDS. However the effectiveness had to be further assessed due to lack of high-quality literatures; b) TCM alone was probably more effective than western medicine alone for adults with PNDS, but not for adults and children with UACS. No obvious adverse reaction related to TCM was reported. Conclusion The recent research outcomes show that the integrated Chinese and western medicine is superior to western medicine alone, either for adults and children with UACS, or for adults with PNDS, but no definite evidence is found to support the superiority of TCM in treating UACS/PNDS. More high-quality RCTs with large scale need to be conducted in future to verify this conclusion due to the overall low methodological quality and significantly different intervention of the included trials.
Objective To evaluate the efficacy and safety of traditional Chinese medicine (TCM) in treatingchronic obstructive pulmonary disease (COPD) in a stable stage. Methods We searched MEDLINE (1950 to July 2008), PubMed (1996 to July 2008), VIP (1989 to July 2008), WanFang (1998 to July 2008), CNKI (1979 to July 2008), and CBM (1978 to July 2008)for randomized control trials about TCM to treat stable COPD. Trial screening, quality assessment of included trials, and data extract were conducted. Statistical analysis was conducted by using RevMan 4.2.7 software. Results A total of 30 randomized controlled trials (RCTs) in the Chinese language were identified. No pooled analysis was performed because of the significant heterogeneity among the included trials. (1) For TCM alone versus blank therapy or placebo: 3 RCTs reported the clinical effective rate and only 1 indicated TCM was more effective; 5 RCTs reported forced expiratory volume in one second (FEV1)% after treatment and 2 indicated TCM alone as more effective in improving lung function; 4 RCTs reported quality of life after therapy and 2 indicated TCM alone was more effective in improving quality of life after therapy. (2) For integrated tradtional and western medicine versus western medicine alone: 11 RCTs included the clinical effective rate, 3 RCTs showed that integrated traditional and western medicine was more effective. Of 8 RCTs reporting FEV1%, 2 RCTs suggested that integrated traditional and western medicine was more effective. There were 3 RCTs studying 6 minute walking distance and 4 RCTs about quality of life, which also showed that integrated traditional and western medicine was more effective. No obvious adverse reaction to TCM was reported.Conclusions The current evidence shows TCM tends to relieve the symptoms and improve quality of life for patients with stable COPD without obvious adverse reaction. Due to the low methodological quality of trials included, more RCTsof high quality and large scale are required.
Objective To evaluate the efficacy and safety of traditional Chinese medicine(TCM) paste in treating chronic obstructive pulmonary disease (COPD) in stable stage. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2016), VIP, WanFang Data, CNKI and CBM to collect randomized controlled trials (RCTs) regarding TCM paste in combination with conventional Western therapy versus Western therapy alone in treating stable COPD from inception to December 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The meta-analysis was conducted by RevMan 5.3 software. Results A total of 9 RCTs involving 605 Chinese patients were included. The results of meta-analysis showed that: when compared with conventional Western medicine alone, TCM paste combined with the conventional Western medicine significantly improved clinical effective rate (RR=1.20, 95% CI 1.10 to 1.31,P<0.000 1), decreased SGRQ score (MD=–4.53, 95% CI –5.41 to –3.65,P<0.000 01) and CAT score (MD=–2.45, 95% CI –3.38 to –1.51,P<0.000 01), increased FEV1% (MD=3.80, 95% CI 0.40 to 7.20,P=0.03), and reduced the frequency of acute exacerbation (P<0.05). No serious adverse reaction occurred in both groups. Conclusion The current evidence shows that combination of TCM paste and conventional Western medicine may improve clinical effective rate, quality of life, increase FEV1%, and reduce the frequency of acute exacerbation in patients with stable COPD. Due to the limited quality and quantity of included studies, the above results are needed to verify by more studies.
Objective To study the efficacy and safety of Yi Huo Hua Tan granule in the treatment of stable chronic obstructive pulmonary disease (COPD) patients with a traditional Chinese medicine (TCM) syndrome of Qi deficiency with phlegm and blood stagnation. Methods The stable COPD patients with a TCM syndrome of Qi deficiency with phlegm and blood stagnation who visited the outpatient in the Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University between August 2016 and March 2017 were selected. The patients were randomly divided into an experimental group and a control group using a random number table method. Patients in both groups received conventional western medicine, with Yi Huo Hua Tan granule being additionally prescribed in patients in the experimental group. The treatment during was 60 days. The TCM effective rate, TCM syndrome score, COPD Assessment Test (CAT) score, modified Medical Research Council Dyspnea Scale, six minutes walking distance, long-term prognostic indicators, lung function indicators, inflammatory cytokines in serum and induced sputum supernatant were compared between groups. The safety of Yi Huo Hua Tan granule was also observed. Results A total of 69 patients were included, including 34 patients in the experimental group and 35 patients in the control group. After treatment of Yi Huo Hua Tan granule for 2 months , the total effective rate of TCM syndrome was 44.1% and 8.6% in the experimental group and the control group, respectively (P=0.001). There were statistically significant differences at 2 months and 4 months of follow-up visits between groups (P<0.05). After 2 months treatment, TCM syndrome score, CAT score, modified Medical Research Council score, number of acute exacerbations per year, hospitalization per year, and total length of hospital stay per year in the experimental group were lower than those in the control group (P<0.05). The six minutes walking distance, forced vital capacity, forced expiratory volume in one second, forced expiratory volume in one second /predicted value, serum, and the concentrations of interleukin (IL)-6, IL-1β, and IL-10 in induced sputum supernatant between the two groups showed no statistically significant difference (P>0.05). There was no significant change in blood routine, liver and kidney function, electrocardiogram, or urine and urine routine of the patients in the two groups. Conclusion Yi Huo Hua Tan granule improves the clinical symptoms and quality of life in patients with stable COPD, with a good safety.
Objective To explore the relationship between thrombocytosis and all-cause in-hospital mortality in patients with chronic obstructive pulmonary disease (COPD) and low-risk pulmonary embolism (PE). Methods In a multicenter retrospective study on clinical characteristics, COPD patients with proven acute PE between October 2005 and February 2017 were enrolled. The patients in risk classes III-V on the basis of the PESI score were excluded. The patients with COPD and low-risk PE were divided into two groups of those with thrombocytosis and without thrombocytosis after extracting platelet count on admission. The clinical characteristics and prognosis of the two groups were compared. Multivariate logistic regression was performed to reveal an association between thrombocytosis and all-cause in-hospital mortality after confounding variables were adjusted. Results A total of 874 consecutive patients with COPD and PE at low risk were enrolled in which 191 (21.9%) with thrombocytosis. Compared with those without thrombocytosis, the thrombocytopenic group had significantly lower body mass index [(20.9±3.3) kg/m2 vs. (25.1±3.8) kg/m2, P=0.01], lower levels of forced expiratory volume in one second (FEV1) [(0.9±0.4) L vs. (1.3±0.3) L, P=0.001] and lower partial pressure of oxygen in the arterial blood (PaO2) [(7.8±1.2) kPa vs. (9.7±2.3) kPa, P=0.003]. The COPD patients with thrombocytosis had a higher proportion of cardiovascular complications as well as higher level of systolic pulmonary arterial pressure (sPAP) [(46.5±20.6) mm Hg vs. (34.1±12.6) mm Hg, P=0.001]. Multivariate logistic regression analysis after adjustment for confounders revealed that thrombocytosis was associated with all-cause mortality in hospitalized patients with COPD and low-risk PE (adjusted OR=1.53, 95%CI 1.03–2.29), and oral antiplatelet treatment was a protective factor (adjusted OR=0.71, 95%CI 0.31–0.84). Conclusions Thrombocytosis is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. Antiplatelet therapy may play a protective role in the high-risk cohort.
Objective To evaluate the efficacy and safety of Huo Xiang Zhengqi dropping pill in treating wind cold and dampness stagnation pattern of common cold. Methods A multicenter, randomlyized, double blind, double dummy, controlled trial was conducted. A total of 480 patients with common cold were randomly divided into two groups: a trial group (360 patients) were treated with Huo Xiang Zhengqi Dropping Pill and Huo Xiang Summer-heat Eliminating Soft Capsule analogue, while a control group (120 patients) were treated with Huo Xiang Summer-heat Eliminating Soft Capsule and Huo Xiang Zhengqi Dropping Pill analogue. The therapeutic course of both groups was 3 days. Results The therapeutic effectiveness of diarrhea as the main symptom: the marked effective rate and total effective rate of the trial group were 86.1% and 96.1%, respectively, while those of the control group were 69.2% and 84.6%, respectively; the therapeutic effectiveness of traditional Chinese medicine (TCM) pattern: the marked effective rate and total effective rate of the trial group were 87.5% and 98.5%, respectively, while those of the control group were 69.2% and 91.5%, respectively. There were significant differences between the two groups in terms of the above two indicators (Plt;0.05), which indicated Huo Xiang Zhengqi Dropping Pill was superior to Huo Xiang Summer-heat Eliminating Soft Capsule in treating wind cold and dampness stagnation pattern of common cold. No adverse effects were found in the trial group. Conclusion Huo Xiang Zhengqi Dropping Pill is effective and safe in treating wind cold and dampness stagnation pattern of common cold.