Objective: To investigate the clinical effect of comprehensive management of vascular access in chronic renal failure.Methods: A total of 206 patients with chronic renal failure who received the first dialysis treatment in our hospital from March 2015 to December 2021 were selected and divided into group A (patients were dialysis with autologous arteriovenous fistula, n=100), group B (patients were converted to autologous arteriovenous fistula from temporary or long-term hemodialysis catheter, n=76 and group C (patients receiving temporary or long-term hemodialysis catheter dialysis, n=30) according to the different vascular access of the patients during dialysis treatment. The dialysis adequacy, renal function, inflammation, anemia indexes and the incidence of complications were compared among the three groups.Results: The decrease rate of urea nitrogen, blood flow in vascular access and urea clearance fraction in groups A and B were significantly higher than those in group C (P<0.05). After treatment, the levels of BUN and Cr in group A were strikingly lower than those before treatment and those in group C; the levels of BUN and Cr in group B were markedly lower than those before treatment and those in group C (P<0.05); the levels of BUN and Cr in group C were obviously lower than those before treatment (P<0.05). After treatment, the levels of IL-6, CRP and TNF-alpha in group A were remarkably lower than those before treatment and those in groups B and C, and the levels of IL-6, CRP and TNF-alpha in group B were dramatically lower than those before treatment and those in group C (P<0.05). After treatment, the level of EPO in group A was significantly lower than that before treatment and that in group C, and the level of Hb was markedly higher than that before treatment, and that in group B and group C (P<0.05); the level of EPO in group B was obviously lower than that before treatment and that in group C, and the level of Hb was significantly higher than that before treatment and that in group C (P<0.05). The total incidence of complications in group A was significantly lower than that in groups B and C (P<0.05).Conclusion: The use of autologous arteriovenous fistula as the vascular access for hemodialysis in patients with chronic renal failure has a good dialysis effect, and is beneficial to reduce the micro-inflammatory state of the body, improve the anemia state, and reduce the incidence of complications. Clinically, patients with chronic renal failure should be encouraged to avoid the use of central venous catheters and establish autologous arteriovenous fistulas as early as possible.
Introduction: To summarize the clinical characteristics of patients with ankylosing spondylitis (AS) combined with fibromyalgia (FM), in order to provide clues and a basis for early diagnosis and standard treatment. Materials and methods: A total of 26 patients with AS complicated with FM who were treated in Jiangsu Province Hospital of Traditional Chinese Medicine from January 1, 2017 to December 31, 2021, were collected. The clinical data of the patients were retrospectively analyzed, including epidemiological characteristics, clinical manifestations, diagnostic characteristics, drug conditionsResults: The onset age of AS combined with FM was concentrated between 19 and 40 years old (73%), and the ratio of male to female was close to 1:1 (54% vs 46%). When FM was diagnosed, all patients did not show typical inflammatory low back pain, and most of the patients could not relieve the pain after activity (88%), but no patient (0%) recorded waking up with pain at night. All patients (100%) had dorsoaxial pain, most patients also had shoulder girdle pain (69%) and buttock pain (54%). A small number of patients had chest pain (31%), upper limb pain (46%), and lower limb pain (35%). Most patients had sleep disorders (62%), fatigue (69%), neuropsychiatric symptoms (54%), and self-reported paresthesia (81%). Prior to diagnosis, most patients had used 1-2 NSAIDs (81%) and most had used biologics (74%). After the diagnosis of FM, the symptoms of most patients (77%) were improved after adding the indicated drugs (pregabalin and duloxetine).Conclusion: In patients with AS who present with diffuse pain, especially diffuse pain that does not show a clear tendency to improve with rest after activity, nor does it show a tendency to wake up with pain and difficulty turning over at night (especially 3-5 am). In cases where there is no improvement with multiple NSAIDs, biologics, the possibility of comorbid FM needs to be considered with emphasis. In patients with AS combined with FM, anti-FM drugs are required to improve the patient's symptoms.
Objective: To explore the differences of clinical efficacy and safety between transjugular intrahepatic portosystemic shunt (TIPS) assisted by gastric coronary embolization and TIPS alone in the treatment of upper gastrointestinal bleeding secondary to portal hypertension in liver cirrhosis.Methods: 78 patients with upper gastrointestinal bleeding secondary to portal hypertension in liver cirrhosis admitted to our hospital from January 2019 to June 2021 were retrospectively included. Among them, 35 cases were treated with TIPS alone (control group) and 43 cases were treated with TIPS assisted by gastric coronary embolization (observation group). The incidence of postoperative rebleeding, preoperative and postoperative portal hemodynmic indexes, liver function indexes, coagulation function indexes and the incidence of complications were compared between two groups.Results: The incidence of rebleeding in the observation group 6 and 12 months after surgery was significantly lower than that in the control group (P<0.05). The levels of albumin, total bilirubin and prothrombin time in the observation group 12 months after surgery were significantly better than those in the control group and before surgery (P<0.05). There was no significant difference between two groups in the incidence of fever and abdominal pain (P>0.05). The incidence of hepatic encephalopathy in the observation group was significantly lower than that in the control group (P<0.05).Conclusion: Compared with TIPS surgery alone, TIPS assisted by gastric coronary embolization can effectively reduce the risk of rebleeding, improve liver function and blood coagulation, without affecting portal haemodynamics, and help prevent the occurrence of hepatic encephalopathy in the treatment of upper gastrointestinal bleeding secondary to portal hypertension in liver cirrhosis.
Objective: To investigate the clinical efficacy and safety of dose-escalation of icotinib hydrochloride in targeted therapy of epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma patients after progression. Methods: A total of 80 patients with EGFR-mutated lung adenocarcinoma who were diagnosed and treated in our hospital from January 2018 to January 2021 were selected and divided into the control group and the observation group according to the random number table method, with 40 cases in each group. The control group was given docetaxel combined with a conventional dose of icotinib hydrochloride targeted therapy, and the observation group was given an additional dose of icotinib hydrochloride after treatment resistance on the basis of the control group. The clinical efficacy, health status, cancer-related fatigue status, serological indicators, and toxic and side effects were compared between the two groups. Results: The disease control rate (DCR) in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the levels of CD4+, CD4+/CD8+ in the two groups were significantly lower than those before treatment, and the levels of CD4+/CD8+ and CD4+ were significantly higher than those before treatment (P<0.05). The difference was not statistically significant (P>0.05). After treatment, the Piper fatigue scale (RPFS) score in the observation group was significantly lower than that before treatment and the control group, and the KPS score was significantly higher than that before treatment and the control group (P<0.05). The survival of the observation group was better than that of the control group (chi 2=4.240, Lon RankP=0.039). There was no significant difference in the total incidence of toxic and side effects between the two groups (P>0.05). After treatment, the levels of cytokeratin 19 fragment (CYFRA21-1), carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125) in observation group were significantly lower than those before treatment and control group (P<0.05). Conclusions: EGFR-mutated lung adenocarcinoma patients who are resistant to icotinib hydrochloride targeted therapy and then given icotinib hydrochloride plus dose therapy have good clinical efficacy. It is not only beneficial to inhibit the proliferation of tumor cells, reduce the tumor volume, improve the prognosis of patients, but also has no obvious malignant effect on the immune function of the body, the treatment effect is relatively safe and effective.
Objective: To explore the correlation between the levels of interleukin-6 (IL-6), soluble P-selectin (sP-selectin), D-dimer (D-D) and platelet (PLT) and the severity of severe pneumonia with sepsis pneumonia.Methods: A total of 125 patients with severe pneumonia complicated with sepsis who were treated in our hospital from January 2018 to May 2019 were randomly selected as the study group. According to the PCIS score, the patients were divided into non-critical group (65 cases), critical group (53 cases) and extremely critical group (7 cases). The basic clinical data such as gender, central venous pressure (CVP), respiratory rate, heart rate and PCIS score were compared. The levels of IL-6 and sP-selectin were measured by enzyme-linked immunosorbent assay. The PLT level of each group was determined by automatic hematology analyzer. The levels of D-D in each group were measured by latex immunoturbidimetry assay. The correlation between IL-6, sP-selectin, D-D and PLT levels and PCIS score was analyzed by multiple linear stepwise regression analysis.Results: There was no significant difference in age, gender, CVP, respiratory rate, memory, heart rate and other basic clinical data among the three groups (P>0.05), but with the increase of the severity of the disease, the PCIS score was significantly decreased (P<0.05). Compared with the non-critical group, the levels of serum IL-6, sP-selectin and D-D in the critical and extremely critical groups were dramatically increased, and the level of PLT was remarkably decreased (P < 0.05). Moreover, the serum IL-6, sP-selectin and D-D levels in the extremely critical group were notedly higher than those in the critical group, and the PLT level was markedly lower than that in the critical group (P<0.05). Multiple linear stepwise regression analysis showed that IL-6, sP-selectin and D-D levels were positively correlated with PCIS score, while PLT level was negatively correlated with PCIS score (P<0.01).Conclusion: The serum levels of IL-6, sP-selectin and D-D in patients with severe pneumonia complicated with sepsis were significantly increased, and the PLT level was enormously reduced, which were significantly correlated with the PCIS score, and could be used as important indicators to evaluate the severity of severe pneumonia complicated with sepsis pneumonia.
