Background Infections of the central nervous system (CNS) are potentially life-threatening and can cause serious morbidity. We evaluated the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis of infectious encephalitis and meningitis and explored the factors affecting the results of mNGS.
Abstract Objective: To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis.Methods: Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the three drugs indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI).Results: In all, 17 RCTs were selected, including 51,496 patients. Finerenone reduced the risk of renal events and hospitalization for heart failure (HHF) (RR [95%CI]; 0.86 [0.79–0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of major adverse cardiovascular events (MACE) (RR [95%CI]; 0.84 [0.78–0.90]), renal events (RR [95%CI]; 0.67 [0.60–0.74], HHF (RR [95%CI]; 0.60 [0.53–0.68]), all-cause death (ACD) (RR [95%CI]; 0.89 [0.81–0.91]) and cardiovascular death (CVD) (RR [95%CI]; 0.86 [0.77–0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95%CI]; 0.88 [0.80–0.97]). As for renal outcomes and HHF, SGLT2i had significant effect in comparison to finerenone (RR [95%CI]; 1.29 [1.13–1.47], 1.31 [1.07–1.61], respectively) and GLP-1 RA (RR [95%CI]; 1.36 [1.16–1.59], 1.49 [1.18–1.89], respectively). Compared with placebo, there was a trend toward reduction in ACD with finerenone (RR [95%CI]; 0.90 [0.80–1.00]). GLP-1 RA did not reduce the risk of renal events, HHF, CVD and ACD, but the analysis based on chemical structure showed that a GLP-1 analogues, liraglutide (RR [95%CI]; 0.79 [0.67–0.92], 0.69 [0.52–0.90], 0.76 [0.62–0.93], respectively) showed significant effect in HHF, CVD and ACD, while an exendin-4 analogues, exenatide (RR [95%CI]; 1.10 [0.83–1.46], 1.19 [0.84–1.69], 1.10 [0.87–1.39], respectively), did not.Conclusions: In patients with T2DM and CKD, finerenone led to a risk reduction in renal events and HHF, SGLT2i were associated with a decreased risk of cardiovascular and renal events. GLP-1 RA were associated with a decreased risk of MACE. Among GLP-1 RA, GLP-1 analogues showed significantly reduced cardiovascular events compared with exendin-4 analogues.
Objective To investigate the effect on maternal neonatal hyperbilirubinemia by use of antibiotics in puerperant.Methods Two hundred twenty cases of cesarea section to antibiotic treatment were divided into 2 groups.The patients in research group were intravenously dripped with cefazolin 1.0 g dissolved in 0.9% sodium chloride injection 100 mL preoperative.The same dose drug was taken interval 8h,three times a day postoperative.The patients were intravenously dripped with cefazolin 2.0 g dissolved in 0.9% sodium chloride injection 250 mL twice a day for 3 d postoperative in control group which did not administrate drug.The neonatal hyperbilirubinemia and puerperal infection incidences were observed in two groups.Results The incidences of neonatal hyperbilirubinemia were significantly different in different times of the use of antibiotics in two group(P0.05).Conclusion Perioperative medication could reduce occurrence of neonatal hyperbilirubinemia and short medication time.
A first-line biologic treatment for metastatic colorectal cancer (mCRC) is still controversial. We, therefore, performed a meta-analysis to determine the efficacy of first-line cetuximab versus bevacizumab for RAS and BRAF wild-type mCRC. In March 2018, an electronic search of the following biomedical databases was performed: PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov and Web of Knowledge. Randomized controlled trials (RCTs) and prospective or observational cohort studies (OCSs) were included. Subgroup analyses of all RCTs were performed in all outcomes. All statistical analyses were performed using RevMan software 5.3. Two RCTs and three OCSs, involving a total 2576 patients, were included. The meta-analysis reported that cetuximab was associated with a longer overall survival (OS) [HR 0.89, 95% CI (0.81–0.98); p = 0.02], a higher ORR [RR 1.11, 95% CI (1.03–1.19); p = 0.006], higher complete response [RR 3.21, 95% CI (1.27–8.12); p = 0.01] and a greater median depth of response than bevacizumab. However, no significant difference was observed between cetuximab and bevacizumab groups for PFS, DCR, partial response, progressive disease, curative intent metastasectomy, EORR and incidence of grade 3 or higher adverse events. In the subgroup meta-analyses of the RCTs, inconsistent results compared to the main analysis, however, were found, in the ORR, DCR and curative intent metastasectomy. The current evidence indicates that compared to bevacizumab treatment, cetuximab provides a clinically relevant effect in first-line treatment against mCRC, at the cost of having lower stable disease.
Objective: To systematically evaluate the therapeutic efficacy of tongguan capsule (TGC) on the patients with coronary heart disease (CHD). Method: Literatures associated with randomized controlled trials (RCT) or quasi-RCT of TGC in treating patients with CHD was retrieved by computerized searching from related medicine database Quality assessment and data extraction were done by two reviewers independently. Statistical analysis was performed by Cochrane Collaboration's RevMan 5.1 software Result: Thirteen trials involving 877 patients were internalized in which 617 patients were treated by percutaneous coronary intervention (PCI). The results of meta-analysis showed that TGC improved the symptom of angina pectoris (AP)(RR=1.22, 95%CI[1.12, 1.33], P<;0. 00001), elevated the left ventricle ejection fraction(LVEF)(WMD=0.03, 95 %CI[0.01, 0.05], P=0.01), and depressed the level of fibrinogen (FIB) in CHD patients after PCI (WMD=-0.54, 95 %CI[-0.87, -0.20], P=0.002). Conclusion: TGC is beneficial to AP and heart function in patient with CHD, which could improve the hyper-coagulant status and adjust the balance of coagulant-fibrinolysis system of CHD patients after PCI.
Objective
To explore the knowledge, attitude and practice status quo of pulmonary rehabilitation among nurses in respiratory department, and to provide theoretical basis for clinical training and quality control.
Methods
From July to August 2018, a total of 134 respiratory nurses who participated in a continuing education training course in Sichuan Province were conveniently selected as the research objects. The questionnaire of knowledge, attitude and practice of lung rehabilitation of nursing staff was used to investigate them. The univariate analysis of knowledge, attitude and practice of lung rehabilitation of nursing staff were analyzed by t test and variance analysis.
Results
The total score of knowledge, attitude and practice in pulmonary rehabilitation among nurses was (101.63±19.58) . The average scores of the three dimensions from high to low were attitude (4.07±0.98) , practice (3.08±1.09) and knowledge (3.03±1.01) . There were statistical differences in the total score of knowledge, attitude and practice of nurses with different professional titles and whether they had received lung rehabilitation training or not (P<0.05) .
Conclusions
The knowledge, attitude and practice of pulmonary rehabilitation of nursing staff in respiratory department need to be improved. Nursing administrators should strengthen guidance and training of pulmonary rehabilitation and strengthen nurses' ability to implement pulmonary rehabilitation so as to ensure the effective implementation of pulmonary rehabilitation in clinical work.
Key words:
Nurses; Respiratory department; Pulmonary rehabilitation; Knowledge, attitude and practice
Abstract Objective: To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis.Methods: Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the three drugs indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI).Results: In all, 17 RCTs were selected, including 51,496 patients. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal events and hospitalization for heart failure (HHF) (RR [95%CI]; 0.88 [0.80-0.97], 0.86 [0.79–0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of MACE (RR [95%CI]; 0.84 [0.78–0.90]), renal events (RR [95%CI]; 0.67 [0.60–0.74], HHF (RR [95%CI]; 0.60 [0.53–0.68]), all-cause death (ACD) (RR [95%CI]; 0.89 [0.81–0.91]) and cardiovascular death (CVD) (RR [95%CI]; 0.86 [0.77–0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95%CI]; 0.88 [0.80–0.97]). As for renal outcomes and HHF, SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR [95%CI]; 1.29 [1.13–1.47], 1.31 [1.07–1.61], respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR [95%CI]; 1.36 [1.16–1.59], 1.49 [1.18–1.89], respectively). It can be concluded that all three kinds of drugs were comparable in MACE, ACD and CVD. When the risk of cardiovascular events arise in DM patients with CKD, SGLT2i，finerenone and GLP-1 analogues can be considered, as all three drugs share resemblance in the ability of lowering cardiovascular risks, but should renal events becomes a priority, then SGLT2i should be recommended. Compared with placebo, there was a trend toward reduction in ACD with finerenone (RR [95%CI]; 0.90 [0.80–1.00]). GLP-1 RA did not reduce the risk of renal events, HHF, CVD and ACD, but the analysis based on chemical structure showed that a GLP-1 analogues, liraglutide (RR [95%CI]; 0.79 [0.67–0.92], 0.69 [0.52–0.90], 0.76 [0.62–0.93], respectively) showed significant effect in HHF, CVD and ACD, while an exendin-4 analogues, exenatide (RR [95%CI]; 1.10 [0.83–1.46], 1.19 [0.84–1.69], 1.10 [0.87–1.39], respectively), did not.Conclusions: In patients with T2DM and CKD, finerenone led to a risk reduction in MACE, renal events and HHF, SGLT2i were associated with a decreased risk of cardiovascular and renal events. GLP-1 RA were associated with a decreased risk of MACE. And all three kinds of drugs were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significantly reduced cardiovascular events compared with exendin-4 analogues.
To provide a better surgical method for periampullary diverticulum, its teraninology and typing, and some experience in its diagnosis.In 11 cases of recurrent cholangitis or (and) pancreatitis resulting from periampullary diverticula juxta-ampullary diverticula was observed in 9, intra-ampullary diverticulum in 1, and ampullocele in 1. All patients underwent elective operation including combined diverticulo-sphincteroplasty (7 cases), diverticulectomy with sphincteroplasty (2), diverticulectomy (1), and papilloplasty (1).The perioperative and long-term results were excellent. There were no recurrence and morbidity.The combined diverticulo-sphincteroplasty is simpl, safe, effective for the treatment of juxta-ampullary diverticula.
Abstract Objective To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis. Methods Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the two drugs and finerenone indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). Results 18 RCTs involving 51,496 patients were included. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal outcome and hospitalization for heart failure (HHF) (RR [95% CI]; 0.88 [0.80–0.97], 0.86 [0.79–0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of MACE (RR [95% CI]; 0.84 [0.78–0.90]), renal outcome (RR [95% CI]; 0.67 [0.60–0.74], HHF (RR [95% CI]; 0.60 [0.53–0.68]), all-cause death (ACD) (RR [95% CI]; 0.89 [0.81–0.91]) and cardiovascular death (CVD) (RR [95% CI]; 0.86 [0.77–0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95% CI]; 0.86 [0.78–0.94]). SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR [95% CI]; 1.29 [1.13–1.47], 1.31 [1.07–1.61], respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR [95% CI]; 1.36 [1.16–1.59], 1.49 [1.18–1.89], respectively) in renal outcome and HHF. Conclusions In patients with T2DM and CKD, SGLT2i, GLP-1 RA and finerenone were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significant effect in reducing cardiovascular events compared with exendin-4 analogues.
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