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.
Objective We intended to get a good understanding of the current role of alkylating agents in the treatment of idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched the Cochrane Library ( Issue 3, 2005), MEDLINE (1978 Jun., 2005) and CBM disc(1978-2005) to get the current best evidence of alkylating agents for treating IMN with NS and further critically appraised the available evidence. Results Alkylating agents showed a significant beneficial effect on complete remission of proteinuria. The treatment of glucocorticoid with cyclophosphamide (MP+CTX) was one of the best managements among the various regimens suggested for IMN, but it was not clear about its long-term effect on renal survival rate. Given the current best evidence together with our clinical experience and the attitudes of the patient and family members, the treatment of (MP+CTX) was administered. There was a significant remission of proteinuria after 6 months follow-up. Conclusions The treatment of (MP+CTX) can significantly improve the remission of proteinuria, however further observations on the long-term effect of alkylating agents on renal survival rate are required.
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.
Precision medicine is an individualized clinical research model established according to gene, environment, lifestyle and other information. As an innovative method of clinical trials, the main scheme design breaks the barriers of traditional randomized controlled trials to the evaluation of targeted therapies in precision medicine and improves the efficiency of clinical research. This paper will systematically introduce the types, concepts and principles of the main scheme design of the new method of precision medicine clinical trial design, and summarize the advantages and limitations of the main scheme design combined with classic cases, aiming at providing scientific and rigorous methodological guidance and clinical practice experience for precision medicine scientific research design.
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 evaluate correlation between –765G>C polymorphism of cyclooxygenase-2 (COX-2) gene and susceptibility to colorectal cancer. Methods The PubMed, Embase, The Cochrane Library, CNKI, CBM, VIP, and Wanfang databases were searched from inception to May 2016 to collect case-control studies about the –765G>C polymorphism of COX-2 gene and the susceptibility to colorectal cancer. Two reviewers independently screened the literatures and extracted data of included studies. The meta-analysis was performed using Stata 12.0 software. Results A total of 13 studies involving 4 998 cases and 7 750 controls were included in this meta-analysis. The overall meta-analysis showed that all the genotypes of the –765G>C polymorphism of COX-2 gene were not associated with the susceptibility to colorectal cancer 〔GGvs. GC: OR=0.98, 95% CI (0.89, 1.07), P=0.590; GC vs. CC: OR=0.85, 95% CI (0.65, 1.11), P=0.236; GG vs. CC: OR=0.86, 95% CI (0.66, 1.12), P=0.275; GG+GC vs. CC:OR=0.87, 95% CI (0.67, 1.13), P=0.288; GG vs. GC+CC:OR=0.97, 95% CI (0.89, 1.05), P=0.425〕. The stratification analysis by ethnicity showed that, the GG vs. GC and GG vs. GC+CC modes of COX-2 gene –765G>C polymorphism might be associated with the susceptibility to colorectal cancer in Asians 〔GGvs. GC: OR=0.70, 95%CI (0.58, 0.86), P=0.001; GG vs. GC+CC: OR=0.71, 95% CI (0.58, 0.87), P=0.001〕, but the other modes were not associated with it 〔GC vs. CC: OR=1.74, 95% CI (0.61, 5.00), P=0.301; GG vs. CC: OR=1.18, 95% CI (0.40, 3.45), P=0.762; GG+GC vs. CC: OR=1.50, 95% CI (0.53, 4.23), P=0.440〕. The genotypes of the –765G>C polymorphism of COX-2 gene were not associated with the susceptibility to colorectal cancer in Caucasians 〔GGvs. GC: OR=1.05, 95% CI (0.95, 1.16), P=0.321; GC vs. CC: OR=0.80, 95% CI (0.61, 1.01), P=0.129; GG vs. CC: OR=0.85, 95% CI (0.64, 1.11), P=0.228; GG+GC vs. CC: OR=0.83, 95% CI (0.64, 1.09), P=0.198; GG vs. GC+CC: OR=1.03, 95% CI (0.94, 1.13), P=0.526〕. Conclusion Current evidence shows that –765G>C polymorphism of COX-2 gene might be a genetic risk factor for colorectal cancer in Asians, but not in Caucasians.