scholarly journals Hemostatic Efficacy and Safety of the Hemostatic Powder UI-EWD in Patients with Lower Gastrointestinal Bleeding

2021 ◽  
Author(s):  
Boram Cha ◽  
Dong Hyun Lee ◽  
Jongbeom Shin ◽  
Jin-Seok Park ◽  
Kye Sook Kwon ◽  
...  
Keyword(s):  
Treatment Group ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
South Korea ◽  
Conventional Treatment ◽  
Therapy Group ◽  
Lower Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
Conventional Treatment Group ◽  
Hemostatic Powder

Abstract Background and Aims: Acute lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. Recently, a novel endoscopic hemostatic powder (UI-EWD/NexpowderTM, Nextbiomedical, Incheon, South Korea) was developed and applied for the control of LGIB. The aim of this study was to evaluate the hemostatic efficacy and long-term safety of UI-EWD in LGIB. Patients and Methods: We conducted a retrospective cohort study of LGIB at a single tertiary center in south korea. One hundred and sixty-seven consecutive patients with LGIB who were initially successful in endoscopic hemostasis were included and divided into the conventional treatment group (n = 112) and the UI-EWD therapy group (n = 55; 38 patients with conventional treatment and 17 patients with UI-EWD alone). The success rate of hemostasis, adverse events related to UI-EWD, and re-bleeding rate were evaluated. Results: The incidence of endoscopic hemostasis applied to the hepatic flexure (7.3% vs. 0%, p = 0.011) and larger than 4 cm (25.5% vs. 8.0%, p = 0.002) were significantly higher in the UI-EWD group than in the conventional therapy group. The cumulative rebleeding rate within 28 days in the UI-EWD group was 5.5% (3/55), which was significantly lower than that in the conventional treatment group (17.0% [19/112]; p = 0.039). No UI-EWD-related adverse events were recorded.Conclusion: Based on our results, application of UI-EWD in LGIB showed promising results for the prevention of re-bleeding, especially in locations where it is difficult to approach or cases with more bleeding. There were no significant complications, such as perforation or embolism. In particular, UI-EWD should be considered first for anatomical or technical impediments to endoscopic access in LGIB.

scholarly journals Effect of regional arterial infusion combined with early enteral nutrition on severe acute pancreatitis

2019 ◽  
Vol 47 (12) ◽  
pp. 6235-6243
Author(s):  
Xiaojuan Wang ◽  
Jinbu Xu ◽  
Jiguang Li ◽  
Yajuan Cheng ◽  
Lu Liu ◽  
...  
Keyword(s):  
Treatment Group ◽  
Combination Therapy ◽  
Conventional Treatment ◽  
Therapy Group ◽  
Early Enteral Nutrition ◽  
Combination Therapy Group ◽  
Arterial Infusion ◽  
Conventional Treatment Group ◽  
Effectiveness Rate ◽  
Biochemical Indices

Objective To measure the therapeutic effects of regional arterial infusion (RAI) in combination with early enteral nutrition (EEN) in patients with severe acute pancreatitis (SAP). Methods A prospective randomized controlled study enrolled patients with SAP. They were randomly divided into a conventional treatment group that served as the control and a combination therapy group that received RAI combined with EEN. The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) scores, the levels of serum biochemical indices, functional recovery, the incidence of complications and total effectiveness rate were evaluated. Results A total of 100 patients were enrolled in the study. The APACHE II scores and the concentrations of blood glucose, serum amylase, white blood cell count, C-reactive protein, tumour necrosis factor-α, interleukin (IL)-6, IL-10 and IL-17 were significantly decreased, while albumin and serum calcium and total effectiveness rate in the combination therapy group were significantly higher than in the conventional treatment group. The combination therapy group had a significantly reduced time to abdominal pain relief, time of first defaecation, hospital stay and incidence of complications compared with the conventional treatment group. Conclusion The combination of RAI and EEN improved clinical biochemical indices, reduced the incidence of complications and promoted early recovery in patients with SAP.

Prevention of Progression to Severe Obesity in a Group of Obese Schoolchildren Treated With Family Therapy

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 880-884
Author(s):  
Carl-Erik Flodmark ◽  
Torsten Ohlsson ◽  
Olof Rydén ◽  
Tomas Sveger
Keyword(s):  
Family Therapy ◽  
Conventional Treatment ◽  
Severe Obesity ◽  
Therapy Group ◽  
Control Group ◽  
Obese Children ◽  
Treatment Groups ◽  
Conventional Treatment Group ◽  
The Family

Study objective. To evaluate the effect of family therapy on childhood obesity. Design. Clinical trial. One year follow-up. Setting. Referral from school after screening. Participants. Of 1774 children (aged 10 to 11), screened for obesity, 44 obese children were divided into two treatment groups. In an untreated control group of 50 obese children, screened in the same manner, body mass index (BMI) values were recorded twice, at 10 to 11 and at 14 years of age. Intervention. Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months, while one of the groups also received family therapy. Results. At the 1-year follow-up, when the children were 14 years of age, intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children. The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment, and less than in the control group (P = .04 and P = .02, respectively). Moreover, mean BMI was significantly lower in the family therapy group than in the control group (P < .05), and the family therapy group also had fewer children with BMI > 30 than the control group (P = .02). The reduction of triceps, subscapular, and suprailiac skinfold thicknesses, expressed as percentages of the initial values, was significantly greater in the family therapy group than in the conventional treatment group (P = .03, P = .005 and P = .002, respectively), and their physical fitness was significantly better (P < .05). Conclusions. Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age.

scholarly journals P121: Derivation of a clinical decision tool for predicting adverse outcomes among emergency department patients with lower gastrointestinal bleeding

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S99-S100
Author(s):  
R. Ramaekers ◽  
C. Leafloor ◽  
J. J. Perry ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Clinical Decision ◽  
Lower Gastrointestinal Bleeding ◽  
Bloody Stool ◽  
Decision Tool ◽  
Serious Adverse Events

Introduction: Lower gastrointestinal bleeding (LGIB) can result in serious adverse events, including recurrent bleeding, need for intervention and death. Endoscopy is important in the management of LGIB, however gastroenterologists have limited resources to safe endoscopy. Risk stratification of LGIB patients can aid physicians in disposition decisions. Objective: to develop a clinical decision tool to accurately identify LGIB patients presenting to the emergency department (ED) who are at risk for 30-day serious adverse events. Methods: We conducted a health records review and included 372 adult ED patients who presented with an acute LGIB. The outcome was a 30-day composite outcome consisting of all-cause death, recurrent LGIB, need for intervention to control the bleed and ICU admission. A second researcher confirmed data-collection of 10% of the data and we calculated a -value for inter-rater reliability. We analyzed the data using stepwise backwards selection and SELECTION=SCORE option and calculated the diagnostic accuracy of the final model. Results: Age 75 years, hemoglobin 100 g/L, INR 2.0, a bloody stool in the ED and a past medical history of colorectal polyps were significant predictors in the multivariable regression analysis. The AUC was 0.83 (95% CI 0.77-0.89), sensitivity 0.96 (0.90-1.00), specificity 0.53 (0.48-0.59), and negative likelihood ratio 0.08 (0.02-0.30) for a cut-off score of 1. Conclusion: This model showed good ability to identify LGIB patients at low risk for adverse events as evidenced by the high AUC, sensitivity and negative likelihood ratio. Future, large prospective studies should be done to confirm the data, after which it should be validated and implemented.

scholarly journals Adverse Events during Bowel Preparation and Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding Compared with Elective Non-Gastrointestinal Bleeding

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0138000 ◽  
Author(s):  
Ryota Niikura ◽  
Naoyoshi Nagata ◽  
Takuro Shimbo ◽  
Toshiyuki Sakurai ◽  
Tomonori Aoki ◽  
...  
Keyword(s):  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Bowel Preparation ◽  
Lower Gastrointestinal Bleeding

scholarly journals A Modified Hypothermic Circulatory Arrest Technique Improves Early and Near-Midterm Results in Patients with Acute Type A Aortic Dissection

2021 ◽  
Vol 24 (4) ◽  
pp. E675-E679
Author(s):  
Huadong Li ◽  
Hong Yu ◽  
Nianguo Dong ◽  
Long Wu
Keyword(s):  
Treatment Group ◽  
Aortic Dissection ◽  
Conventional Treatment ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Midterm Results ◽  
Type A Aortic Dissection ◽  
Conventional Treatment Group

Background: The hypothermic circulatory arrest (HCA) is an indispensable step in the surgical treatment of an acute type A aortic dissection (ATAAD), which could greatly affect the postoperative outcome. We modified the HCA technique and validated the feasibility and superiority of the new approach relative to the conventional method. Methods and results: Eighty-eight patients with ATAAD were enrolled in this study between May 2016 and April 2018. Of those, 36 patients in the Conventional treatment group had circulatory arrest at 25°C for about 16-28 minutes, while 52 patients in the Modification group underwent a circulatory arrest at 28°C for only 1-3 minutes. The preoperative clinical data and postoperative clinical outcomes were compared between the two groups. No intraoperative mortality occurred in any of the cases. No significant differences were observed in the aortic cross-clamp times during the cardiopulmonary bypass (CPB) between the two groups. In the Modification group, several indicators, such as mechanical ventilation time, postoperative 48-h drainage volume, blood transfusion volume, the ICU-stay time and postoperative hospital stay, were reduced significantly as compared with those in the Conventional group. Whereas three postoperative deaths in the hospital occurred in the Conventional treatment group, all the patients in the Modification group were cured. There is no difference in the incidence of postoperative complications between the two groups. The patients had a 100% follow up with a mean of 17 ± 6 months. Conclusions: A moderate hypothermia with a short circulatory arrest is a safe and effective HCA approach that provides satisfactory early and near-midterm results in the patients who received ATAAD treatment.

scholarly journals Pediatric Tuina in children with autism spectrum disorder: A study protocol for a randomized controlled trial

2021 ◽  
Author(s):  
Xiang Feng ◽  
Jun Yu ◽  
Wu Li ◽  
Tao Li ◽  
Quanrui Jiang ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Treatment Group ◽  
Conventional Treatment ◽  
Autism Spectrum ◽  
Clinical Treatment ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Pediatric Tuina ◽  
Conventional Treatment Group ◽  
Children With Asd

Abstract Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by repetitive stereotypical behaviour and communication disorders. Currently, it lacks a specific clinical treatment method. Pediatric Tuina is a recent therapy in traditional Chinese medicine; however, there have been studies on the treatment of children with ASD by Tuina. Nonetheless, it remains uncommon given the lack of large-scale evidence-based medical studies. This study aims to compare the efficacy of Tuina and conventional treatment in children with ASD. Methods Eligible children will be randomly divided into the pediatric Tuina plus conventional treatment group or conventional treatment group based on a random table at a ratio of 1:1. Effectiveness will be evaluated using a scale; moreover, the primary outcome will be the Childhood Autism Rating Scale. The secondary outcome will be the Autism Treatment Evaluation Checklist. All participants will be assessed on the scale by a third party not involved in the study. Baseline values of the participants will be determined at the registration time. Outcomes will be evaluated after the 30th treatment session. The follow-up period will last for 6 post-treatment months. Discussion This study will evaluate the effectiveness and safety of Tuina in ASD treatment, which could provide reliable evidence-based findings to improve clinical treatment. Trial registration: Chinese Clinical Trial Registry (CHICTR), ChiCTR2000040452. Registered on 28 November 2020

scholarly journals Efficacy of glucocorticoids for the treatment of macrolide refractory mycoplasma pneumonia in children: meta-analysis of randomized controlled trials

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hwan Soo Kim ◽  
In Suk Sol ◽  
Donghe Li ◽  
Miyoung Choi ◽  
Yun Jung Choi ◽  
...  
Keyword(s):  
Treatment Group ◽  
Hospital Stay ◽  
Randomized Controlled Trials ◽  
Conventional Treatment ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Glucocorticoid Treatment ◽  
Conventional Treatment Group ◽  
Randomized Controlled ◽  
The Mean

Abstract Background Mycoplasma pneumoniae is one of the most common pathogens causing community acquired pneumonia in children. Although the rate of macrolide-refractory Mycoplasma pneumoniae (MRMP) has increased, systemic glucocorticoids as a treatment option has not been validated yet. The purpose of this study was to assess the efficacy of glucocorticoids add-on in the treatment of MRMP in children through systematic review and meta-analysis. Methods Data sources A systematic literature search was conducted using ten electronic bibliographic databases including English, Korean, Chinese and Japanese languages, up to March 8, 2018. Study selection The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and selected randomized control trials which compared the efficacy of glucocorticoids add-on to macrolide in the treatment of MRMP in children. Data extraction Two independent reviewers extracted: primary outcomes as hospital days, fever duration, and change in C-reactive protein (CRP) and main analysis was performed through meta-analysis with random effects model. Results Twenty-four unique randomized controlled trials met the inclusion criteria. The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in conventional macrolide-treatment group (Weighted mean difference (WMD) = − 4.03 days). The mean length of fever duration was significantly shorter in the glucocorticoid treatment group in comparison with the conventional treatment group (WMD = -3.32 days). Level of CRP after treatment was significantly lower in the glucocorticoid treatment group than that in the conventional treatment group (WMD = -16.03). Sensitivity analysis and subgroup analysis showed no significant improvement in heterogeneity. As limitations of the study, most of the studies included were from a single country and we were unable to control for heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies. Conclusions Glucocorticoid add-on treatment for MRMP can significantly shorten the duration of fever and hospital stay and decrease the level of CRP. These results should be confirmed by adequately powered studies in the future.

scholarly journals Use of the Cardiovascular Polypill in Secondary Prevention of Cerebrovascular Disease: A Real-Life Tertiary Hospital Cohort Study of 104 Patients

2020 ◽  
Vol 10 (3) ◽  
pp. 166-173
Author(s):  
Victoria Ros-Castelló ◽  
Elena Natera-Villalba ◽  
Ana Gómez-López ◽  
Arantxa Sánchez-Sánchez ◽  
Juan Luis Chico-García ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Treatment Group ◽  
Secondary Prevention ◽  
Cerebrovascular Disease ◽  
Conventional Treatment ◽  
Real Life ◽  
Lipid Lowering ◽  
Conventional Treatment Group ◽  
Clinical Records

<b><i>Background:</i></b> The use of the cardiovascular polypill, a fixed-dose combination treatment, is conceived to improve adherence. However, randomized controlled trials (RCTs) may overestimate it. Studies focusing on cerebrovascular disease and real-life efficacy compared with conventional treatment are lacking. <b><i>Methods:</i></b> This is a retrospective, hospital-based cohort study of acute ischaemic stroke patients who were prescribed a polypill (aspirin 100 mg, atorvastatin 20/40 mg, ramipril 2.5/5/10 mg) versus conventional treatment (aspirin 100 mg and other blood pressure/lipid-lowering agents) in secondary prevention (2017–2018). Clinical records were reviewed 90 days after discharge for stroke recurrence, vascular risk factor control, and safety. Adherence was assessed using the adapted Morisky-Green scale. <b><i>Results:</i></b> A total of 104 patients were included (61% male; mean age 69.7 ± 13.9 years); 54 were treated with the polypill and 50 with conventional treatment. No baseline differences in clinical or demographic variables were detected. No recurrences were registered in the polypill group, compared to 1 recurrence in the conventional treatment group. A significant reduction of systolic blood pressure (SBP) was achieved in the polypill group (12.1 mm Hg) compared to the conventional treatment group (6.8 mm Hg) (<i>p</i> = 0.002). No significant differences were detected regarding the goal of LDL cholesterol ≤70 mg/dL (41 vs. 44%). The adverse events were mild and their frequency was similar in the two groups (9 vs. 2%, ns). Adherence was similarly good in the two groups (93 vs. 88%, ns). Polypill group adherence was similar to that reported in a previous meta-analysis of RCTs (93 vs. 84%, ns). <b><i>Conclusion:</i></b> In our experience, the cardiovascular polypill achieved a higher reduction in SBP levels and was well tolerated. Adherence was similar to that found in the previous literature, which is remarkable given the real-life setting of our study.

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