Abstract： Objective To investigate the methods of diagnosis and treatment for early and late cheobronchial rupture, in order to improve the understanding of this disease. Methods We retrospectively analyzed the records of 19 patients treated for traumatic tracheobronchial rupture in our hospital between October 1988 and August 2010. There were 9 males and 10 females with a median age of 28 years (ranged from 8 to 48 years). We analyzed the clinical characteristics of the disease, including clinical presentation, and the results of chest Xrays, computed tomography（CT）, and fibrobronchoscopy. There were 2 cases of tracheal repair, 1 case of tracheostomy, 8 cases of bronchial reconstruction, 7 cases of bronchial repair, and 1 case of pneumonectomy. Results Seventeen patients were cured by operation and 2 patients died of multiple organ failure. Blood oxygen saturation resumed normal in most patients after operation (9680%±159% vs. 8840%±390%，Plt;0.01). Postoperative followup time was ranged from 3 to 24 months, and no tracheobronchial stenosis was observed and no patients needed stent or dilatation for treatment. Conclusion The diagnosis of tracheobronchial rupture depends on history of trauma, chest Xray, CT and fibrobronchoscopy results. Surgical treatments should be based on the tracheobronchial reconstruction or repair, and the clinical outcome is satisfying.
【摘要】 目的 探讨高血压危象评估和处理原则及对高血压危象急诊处理的指导意义。 方法 依据高血压危象评估和处理原则对2008年1月-2009年12月期间收治的160例高血压危象患者进行诊断和治疗。结果 160例高血压危象患者中,高血压急症134例,高血压亚急症26例。高血压急症中,以心脑血管病变为主,包括脑卒中、急性冠脉综合征和急性左侧心力衰竭。依据高血压危象评估和处理原则进行急诊处理,能够对高血压危象进行准确评估和有效处理,减少诊治失误,降低死亡率并改善预后。结论 有关高血压危象的评估和处理原则能够指导高血压危象的急诊处理,取得良好的预后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
目前哮喘的治疗已经取得了显著的进步, 大多数哮喘按全球哮喘防治创议( GINA) 推荐的治疗方案进行规范治疗都可以获得良好的临床控制, 但仍有部分中重度患者难以获得良好的临床控制, 所以仍有必要探索针对这一部分哮喘人群的更好的干预措施。
Heart failure with preserved ejection fraction (HFpEF) is the main type of heart failure (HF), accounting for more than half of the incidence of HF. However, the etiology, pathogenesis, treatment and prognosis of HFpEF are still not fully understood. Recommendations for HFpEF are in different chapters in the 2022 AHA/ACC/HFSA guideline for the management of heart failure. This paper interpreted the definition, stage, diagnosis, epidemiology, clinical evaluation, stage treatment, acute attack stage, comorbidity management, vulnerable population and research prospect of HFpEF, which aimed to provide the latest thinking in terms of the management of HFpEF for clinicians.
With the increasing number of chronic kidney disease (CKD) population globally, establishing an optimal model of CKD care has become an important issue. The major contents of CKD care include patient education, control of CKD risk factors (such as increased blood pressure and glucose), management of CKD complications, and preparation process of renal replacement therapy in pre-dialysis patients. Compared with other non-communicable diseases management, evidence-based evidence related to CKD care is limited. Based on the related studies worldwide, combined with the characteristics of CKD population and previous experiences in China, this paper discusses the management mode of non-dialysis CKD population.
Epilepsy and epileptic seizures have a long history of stigmatization. In the 20th century, epilepsy patients were treated as usual as patients with mental disorders and neurodegenerative diseases. More than 30 years ago, scholars still believed that most patients with a first unprovoked seizure would have more seizures unless they were treated. It was not taken place until Hauser's research reported that landmark changed. However, there is still controversy about workup and treatment for a first unprovoked seizure. No consensus was reached. This article is to review the changes and challenges in the workup, treatment and management of a first unprovoked seizure in children in the past 30 years in order to provide available data and standardized management process.
ObjectivesTo evaluate the quality of evidence-based guidelines for the treatment of female stress urinary incontinence, so as to provide evidence for clinical stress urinary incontinence management research.MethodsWebsite of the professional society, clinical practice guide website, Yimaitong website, PubMed, CNKI, WanFang Data and VIP databases were electronically searched to collect stress urinary incontinence management related guidelines from January 1st, 2014 to January 1st, 2019. Two reviewers independently screened literature, extracted data and evaluated the quality of included guidelines using Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the characteristics of each guidelines were analyzed.ResultsWe identified totally 8 relevant evidence-based guidelines in this field. The average standardized scores in the 6 domains of AGREE II were 90.74% (scope and purpose), 78.71% (stakeholder involvement), 74.60% (rigor of development), 93.52% (clarity of presentations), 61.81% (applicability), and 91.67% (independence). The overall standardized scores of 8 guidelines were 77.70%, and the total scores were 5.31 (out of 7). For overall quality, 4 of them were grade A and 4 of them were grade B.ConclusionsThe overall quality of evidence-based guidelines for stress urinary incontinence is high, and scores in different fields are vary large. Fields of " stakeholder involvement”, " rigor of development” and " applicability” with lower scores still requires strengthening. The current guidelines for female stress urinary incontinence in China still fails to meet the standards of evidence-based guidelines, so the quality of the guidelines should be improved to improve guide clinical practice.
ObjectiveTo investigate the status of quality of life and influencing factors among newly diagnosed epilepsy patients with co-morbid anxiety and depression. MethodsA total of 180 newly diagnosed epilepsy patients from June 2022 to December 2022 in a district of Shanghai were selected as the study subjects. The Quality of Life in Epilepsy-31 (QOLIE-31), Hamilton Depression Rating Scale (HAMD-24), Hamilton Anxiety Rating Scale (HAMA), and Epilepsy Self-Management Scale (ESMS) were used to assess patients' quality of life, depression levels, anxiety levels, and self-management abilities, respectively. Patients were divided into the co-morbid depression group (HAMA≥14 and HAMD>17) and the control group (HAMA<14 and HAMD≤17), and their general characteristics and scale scores were compared. Spearman correlation, Pearson correlation, and multiple linear regression analysis were used to identify influencing factors of quality of life in epilepsy patients with co-morbid depression. ResultsCompared to the control group, the anxiety comorbid with depression group of older adults had a higher proportion, higher unemployment rate, lower personal and family annual income in the past year, higher frequency of epileptic seizures, and lower medication adherence (P<0.05). The correlational analysis revealed a negative correlation between the quality of life abilities of epilepsy patients with comorbid anxiety and depression and the severity of anxiety and depression. (r=−0.589, −0.620, P<0.05). The results of multiple linear regression analysis showed that the frequency of seizures in the past year (β=−1.379, P<0.05), severity of anxiety (β=−0.279, P<0.05), and severity of depression (β=−0.361, P<0.05) have an impact on the ability to quality of life in epilepsy patients with co-morbid anxiety and depression. These factors account for 44.1% of the total variability in quality of life (R2=0.4411, P<0.05). ConclusionThe frequency of seizures in the past year, as well as the severity of anxiety and depression, are important factors that influence the ability to quality of life in epilepsy patients with comorbid anxiety and depression. For these patients, it is crucial to take into account these factors and provide appropriate support and interventions.
Since the appearance of the concept of evidence-based medicine in 1992, its advanced conception and scientific method has been widely applied in various social science fields, and several sub-disciplines were formed such as evidence-based management, evidence-based education, and evidence-based social work and so on. However, there has been no studies to review its history and condition until now. The purpose of this study was to introduce the evidence-based social science in terms of its origin, development conditions, challenges and strategies. We hope it can serve as reference for research and policy makings in the fields of social science in China.
The Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease is produced based on important studies published in last five years and published online. So far it is the most influential evidence-based strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease to guide clinical professionals.