Clinical Efficacy
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2021 ◽  
Vol 66 (7-8) ◽  
pp. 67-82
Author(s):  
S. V. Yakovlev

The wide spread of carbapenemases among gram-negative bacteria of the Enterobacterales order in hospitals around the world, including Russia, creates great difficulties in the effective use of antibiotics for these infections in the ICU. Ceftazidime-avibactam is the first antibiotic developed and studied for the treatment of infections caused by carbapenem-resistant enterobacteria. Ceftazidime-avibactam shows high activity against producers of class A and D serine carbapenemases (KPC and OXA-48). In combination with aztreonam it is effective in infections caused by producers of class B metallo-beta-lactamases (NDM and VIM). The review analyzes the results of 19 non-comparative and 10 comparative studies of ceftazidime-avibactam in infections caused by carbapenem-resistant Enterobacterales, as well as case reports. According to the data of non- comparative studies, the clinical efficacy of ceftazidime-avibactam ranged from 45.0 to 87.2%, on average 71.7±11.3%, and the eradication rate of KPC or OXA-48 carbapenemase producers ranged from 40.0 to 100%, on average 65.5±18.6%. The effectiveness of ceftazidime-avibactam in comparative studies was 67.9±17.3%, which was significantly higher compared to other antibiotics (44.3±14.4%, P=0.012). Treatment with ceftazidime-avibactam was accompanied by a significantly lower 30-day mortality in contrast to other antibiotics – 23.8±13.5% and 41.0±13.6%, respectively, P=0.001. The development of resistance in Enterobacterales species to ceftazidime-avibactam during therapy is rarely observed, on average 5.4±4.4%, which characterizes a rather low potential of the antibiotic in resistance selection. Early administration of ceftazidime-avibactam is accompanied by better treatment results as opposed to delayed therapy. Treatment of infections caused by carbapenem-resistant enterobacteria with ceftazidime-avibactam is associated with a significantly higher recovery rate and a lower mortality compared to other regimens of antibacterial therapy.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Weiwei Gao ◽  
Xueli Qiao ◽  
Jinxin Zhu ◽  
Xin Jin ◽  
Yuegang Wei

Objective. To unearth the clinical efficacy of tacrolimus ointment + 3 % boric acid lotion joint Chinese angelica decoction in chronic perianal eczema. Methods. Patients with chronic perianal eczema admitted to hospital from June 2018 and June 2019 were retrospectively analyzed. Patients in the control group ( n = 38 ) underwent basic therapy with tacrolimus ointment + 3 % boric acid lotion, whereas those in the observation group ( n = 38 ) were given oral Chinese angelica decoction on the basis of the above therapy. Patient’s baseline information before therapy and clinical symptoms after therapy were observed and compared, including pruritus ani score, anus drainage and damp score, skin lesion score, skin lesion area score, life quality index score, and IL-2, IL-4, and IgE levels in serum. Overall efficacy in the two groups was also evaluated. Results. No significant differences were found in the baseline information between the observation group and control group before therapy. After therapy, pruritus ani score ( P = 0.023 ), anus drainage and damp score ( P = 0.041 ), skin lesion score ( P = 0.025 ), and skin lesion area score ( P = 0.035 ) of patients in the observation group were remarkably lower than those in the control group. Significantly higher release levels of clinical symptoms of patients in the observation group were indicated. With respect to the control group, the life quality score ( P = 0.020 ) and IgE level in serum ( P = 0.003 ) of patients in the observation group were significantly lower, while IL-4 level in serum was significantly higher ( P = 0.129 ). The therapy in the observation group achieved better clinical efficacy. Overall efficacy in the observation group was markedly favorable with respect to the control group. Conclusion. With respect to tacrolimus ointment + 3 % boric acid lotion, patients with chronic perianal eczema displayed better clinical efficacy after jointly being treated by Chinese angelica decoction.


2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yan Jin ◽  
Yanzheng Wang ◽  
Sai Wang ◽  
Qiongqiong Zhao ◽  
Donghua Zhang ◽  
...  

Objective. This study aimed to explore the clinical efficacy and relevant mechanism of Tripterygium glycosides combined with low molecular weight heparin calcium (LMWH) in the treatment of Henoch–Schönlein purpura nephritis (HSPN) in children. Methods. 64 cases of children patients with HSPN treated at Qilu Hospital (Qingdao) from January 2015 to May 2020 were selected and randomly divided into the control group and the observation group and 32 cases in each group. Conventional medical treatment was applied in the two groups, besides which the control group was given LMWH while the observation group was given Tripterygium glycosides based on the control group. The clinical efficacy and the indexes of clinical symptoms of the two groups were compared. Immune globulin level, fibrinogen content (FIB), prothrombin time (PT), platelet level (PLT), and activated partial thromboplastin time (APTT) level of the two groups were compared before and after the treatment. Results. The total effective rate in the observation group was significantly higher than that of the control group, and the recurrence rate in the observation group was lower than that in the control group. After treatment, urine red blood cell count and 24 h urine protein were obviously better than those of the control group. There was no statistically significant difference in PT between the two groups of children before and after treatment. The levels of PLT and FIB in the two groups of patients after treatment were significantly lower than before treatment, and the PLT levels in the observation group were lower than those in the control group. Conclusion. The combination of Tripterygium glycosides and LMWH had good clinical effects in the treatment of children with HSPN, and it could improve the clinical symptoms, the mechanism of which might be related to the increase of PT, a decrease of PLT, and the improvement of coagulation function.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Chunyu Cao ◽  
Lihua Chen ◽  
Shu Li ◽  
Lili Yuan ◽  
Yishan Wang

’Purpose. To observe the clinical efficacy and safety of carbon dioxide laser combined with ALA photodynamics in the treatment of condyloma acuminatum. Method. A total of 211 patients with condyloma acuminatum admitted to our hospital from April 2018 to June 2021 were selected as the observation object. They were divided into the intervention group (CO2 laser combined with ALA photodynamic therapy, 125 cases) and conventional group (CO2 laser treatment, 86 cases), and the efficacy and incidence of adverse reactions between the two groups were compared. Result. The total effective rate of the intervention group (96.00%) was significantly higher than that of the conventional group (84.88%) ( P < 0.05 ). The total incidence of adverse reactions in the intervention group (8.00%) was lower than that in the conventional group (32.56%) ( P < 0.05 ). Univariate analysis showed that the patient’s smoking history, drinking history, course of disease, wart area, and number of sexual partners were related to the short-term prognosis ( P < 0.05 ). Multivariate logistic regression analysis showed that the patient’s course of disease, the area of the wart body, and the number of sexual partners were independent factors affecting the prognosis of patients with condyloma acuminatum ( P < 0.05 ). Conclusion. Carbon dioxide laser combined with ALA dynamics treatment of condyloma acuminatum significantly improves the clinical efficacy, does not increase the incidence of adverse reactions, and has important clinical therapeutic value. The course of the disease, the area of the wart, and the number of sexual partners are independent factors affecting the prognosis of patients with condyloma acuminatum.


2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Ryo Torii ◽  
Magdi H Yacoub

Computations of fractional flow reserve, based on CT coronary angiography and computational fluid dynamics (CT-based FFR) to assess the severity of coronary artery stenosis, was introduced around a decade ago and is now one of the most successful applications of computational fluid dynamic modelling in clinical practice. Although the mathematical modelling framework behind this approach and the clinical operational model vary, its clinical efficacy has been demonstrated well in general. In this review, technical elements behind CT-based FFR computation are summarised with some key assumptions and challenges. Examples of these challenges include the complexity of the model (such as blood viscosity and vessel wall compliance modelling), whose impact has been debated in the research. Efforts made to address the practical challenge of processing time are also reviewed. Then, further application areas – myocardial bridge, renal stenosis and lower limb stenosis – are discussed along with specific challenges expected in these areas.


2021 ◽  
Vol 6 (4) ◽  
pp. 146-159
Author(s):  
A. V. Chetveryakov ◽  
V. L. Tsepelev

The identification of the PD-1 receptor by Tasuku Honjo and CTLA-4 by James Ellison marked the beginning of the study of new regulatory pathways activating the immune response. The term “immune checkpoints” was introduced to denote the system of inhibitory mechanisms that include these proteins. The review presents the literature data on the molecular characteristics of the membrane protein PD-1 (programmed cell death 1 receptor) and its role in the regulation of immunity. We consider the PD-1 pathways used of by tumor cells to escape the immune response. The discovery of immune checkpoints made it possible to develop a new type of targeting therapy for cancer. The review presents the results of clinical trials of drugs that block the interaction between the PD-1 and its ligands in various types of cancer. These drugs include nivolumab, pembrolizumab, and avelumab. Studies of these drugs efficacy in patients with various types of cancer localization were conducted within the CheckMate, KEYNOTE and JAVELIN Solid Tumor programs, with some research being in progress. We analyze the results of studying the clinical efficacy of the drugs in patients with melanoma, lung cancer, renal cell cancer, colorectal cancer, classical Hodgkin’s lymphoma, Merkel carcinoma and stomach cancer. Both positive and inconclusive results in the treatment of patients are noted. These data made it possible to identify promising directions for the use of the drugs in certain localizations of the malignant process, as well as to determine the dose and time of their use to obtain an objective positive response to treatment.


Author(s):  
Samuel Baek ◽  
Seok Kim ◽  
Myung Ho Shin ◽  
Tae Min Kim ◽  
Seoung-Joon Lee ◽  
...  

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.Methods: Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.Results: NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.Conclusion: Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.


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