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H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.
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Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.
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Objective:To evaluate the degree of left atrial fibrosis in patients with persistent atrial fibrillation(AF) using four-dimensional automic left atrial quantitation(4D Auto LAQ).Methods:A total of 60 patients with persistent AF who underwent transcatheter radiofrequency ablation in the Second Hospital of Hebei Medical University from March 2022 to March 2023 were included. Patients were grouped according to the low-voltage area (mild<5%, moderate 5%-20%, severe>20%). General clinical data, conventional echocardiogram parameters, left atrial strain and related parameters of each group were compared. The relevant factors were obtained by Logistic regression analysis. The factor with the highest accuracy and its cut-off value was obtained by the ROC curve.Results:Sixty patients with persistent atrial fibrillation, were divided into mild low-voltage group(22 cases), moderate low-voltage group(20 cases), and severe low-voltage group(18 cases). There were statistical differences in gender, CHA2DS2-VASc score, peak value of early diastolic velocity of mitral inflow/average peak value of early diastolic tissue Doppler velocity of mitral annulus (E/e′), left atrial diameter (LAD), left atrial volume index (LAVI), left atrial maximal volume (LAVmax), left atrial minimal volume (LAVmin), left atrial total emptying fraction (LAEF), left atrial reservoir longitudinal strain (LASr), left atrial reservoir circumferential strain (LASr-c), left atrial myocardial work (LA MW, LA MW-c), left atrial stiffness (LA stiffness, LA stiffness-c) among the 3 groups(all P<0.05). The LASr had the highest correlation with low voltage area ( rs=-0.814, P<0.001). Logistic regression analysis showed that CHA2DS2-VASc, LAD, LAVI, LAVmax, LAVmin, LAEF, LASr, LASr-C, LA MW, LA MW-C, LA stiffness and LA stiffness-c could all predict the low voltage area(all P<0.05). The LA stiffness had the highest AUC (0.952). The cut-off value of severe low voltage was 1.15, the sensitivity was 94.4%, and the specificity was 83.3%. Conclusions:4D Auto LAQ can be used to evaluate the degree of left atrial fibrosis. The correlation between LA stiffness and substrate voltage mapping is the highest.
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Objective:To investigate the diagnostic value of CT-guided puncture biopsy combined with serum gamma-glutamyltransferase (GGT) and abnormal prothrombin (PIVKA-Ⅱ) in serum alpha-fetoprotein(AFP) negative primary liver cancer (PHC).Methods:Eighty patients with AFP negative PHC treatment in Fuyang Women and Children′s Hospital from January 2018 to March 2021 were selected as AFP negative PHC group, and another 85 patients diagnosed with benign liver tumor during the same period were selected as the control group retrospectively. The patients of the two groups underwent CT-guided biopsy and the levels of GGT and PIVKA-Ⅱ were detected. The single diagnostic value and combined diagnostic value of AFP negative PHC were analyzed by receiver operating characteristic (ROC) curve.Results:Seventy-five of the 80 patients in the AFP negative PHC group were confirmed as liver malignant lesions by biopsy, with a coincidence of 93.75%, and 84 of the 85 patients in the control group were confirmed as liver benign lesions by biopsy, with a coincidence of 98.82%. The levels of AFP, GGT and PIVKA-Ⅱ in AFP negative PHC group were significantly higher than those in the control group: (175.67 ± 39.58) μg/L vs. (18.74 ± 7.42) μg/L, (1 245.37 ± 255.41) U/L vs. (486.63 ± 89.05) U/L, (385.49 ± 30.27) AU/L vs. (25.84 ± 7.66) AU/L, there were statistical differences ( P<0.05). Spearman correlation analysis showed that serum AFP was positively correlated with GGT and PIVKA-Ⅱ ( r = 0.858 and 0.429, P<0.05). The results of ROC curve showed that the area under curve of CT-guided biopsy combined with GGT and PIVKA-Ⅱ in the diagnosis of AFP negative PHC was 0.877, the sensitivity was 91.19%, the specificity was 87.34%. Conclusions:CT-guided biopsy combined with GGT and PIVKA-Ⅱ detection of AFP negative PHC can effectively improve the diagnostic value.
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Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.
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Objective@#To explore the application of endoscopy and clinical effect of endoscopic resection of benign tumor in infratemporal fossa.@*Methods@#The clinical data of 11 patients with benign tumors in infratemporal fossa admitted to the Department of Otorhinolaryngology Head and Neck Surgery and Skull Base Surgery of the Affiliated Hospital of Qingdao University from January 2016 to September 2018 were retrospectively analyzed. There were 6 males and 5 females, with the age ranging from 11 to 63 years old. The main clinical manifestations were pharyngeal foreign body sensation, submaxillary pain, maxillofacial numbness and tongue numbness. Imaging examination showed that the tumor was round and had a clear boundary with the surrounding tissue. All the patients underwent endoscopic surgery. Appropriate surgical approach was selected according to the location of the tumor and its relationship with the internal carotid artery. The endoscopic surgical approaches included trans-oropharyngeal approach in 7 cases, trans-lateral pterygomandibular raphe approach in 1 case and trans-medial pterygomandibular raphe approach in 3 cases. The pathological results, prognosis, complications and relapse of patients were summarized through descriptive statistics.@*Results@#The tumors were completely resected under endoscope in all patients, and there was no significant complication occurred after surgery. The average pain VAS score was 3.1 after surgery and average hospital stay was 5.9 d. The postoperative pathological diagnoses consisted of 6 cases of pleomorphic adenoma, 4 cases of neurilemmoma and 1 case of basal cell adenoma. All patients were followed up regularly from 6 to 39 months without recurrence of tumor.@*Conclusion@#Endoscopic resection of benign tumors in infratemporal fossa has the advantages of minimal damage, rapid recovery, few complications, and definite curative effect, which can be used as an important alternative for surgical treatment of benign tumors.
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Objective: To investigate the effect of modified fecal drainage device on avoiding the occupational exposure infection of the medical staffs in the treatment of corona virus disease 2019 (COVID-19), and to provide the reference for the clinical treatment of COVID-19 and avoiding the occupational exposure infection of the medical staffs. Methods: The clinical data of a critical COVID-19 patient with diarrhea as the main symptom were collected. The modified fecal drainage device of F18 silicone gastric tube connected with disposable negative pressure drainage device was uesd to treat the fecal excrement of the patient. The general data of the medical staffs, containing 16 doctors and 48 nurses∗ were collected. The COVID-19 serological antibodies and pharyngeal swabs of the medical staffs were tested every 2 weeks. Results: The 78-year-old woman patient was admitted to hospital due to diarrhea∗ cough and expectoration for 15 d, chest distress and shortness of breath for 10 d» and fever for 1 d. The test result of COVID-19 pharyngeal swabs of the patient was positive. After the feces were collected with the modified fecal drainage device, the average operation time of medical staffs was reduced from 20 min to 10 min, the patient's perianal skin flushing subsided, and no incontinence-associated dermatitis ( IAD ) occurred. The patient was cured but remained in hospital for the other underlying diseases. The test results of COVID-19 serological antibodies and pharyngeal swabs of 64 medical staffs were all negative, all the medical staffs had no infection. Conclusion: The modified fecal drainage device has better stability, which can effectively prevent IAD and the spread of COVID-19 and reduce the risk of occupational exposure infection of medical staffs, and it is suitable for clinical promotion application.
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T cells play an important role in atherosclerosis (AS) besides monocytes and macrophages .The T helper cell type 1 (Th1) affect AS via strong apoptotic effect ,other T cell subgroups are also involved in occurrence and development of AS ,such as Th2 and Th17. The interaction between regulatory T cells (Tregs) and Th2 related cy—tokines can inhibit AS development .However ,mechanism of T cells in AS is still not clear .The present article made a review on role of T cells in AS and their possible guidance for research and treatment of AS .
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Objective@#To analyze the clinical features of respiratory epithelial adenomatoid hamartoma (REAH) in the nasal cavity.@*Methods@#Clinical datas of 23 patients, who were hospitalized in Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, from February 2016 to February 2018 with histopathologically proved REAH in the nasal cavity were reviewed. There were 18 males and 5 females, with the age range from 16 to 71 years old. The most common area, main symptoms, surgical methods and follow-up results were analyzed.@*Results@#The most common area was olfactory cleft (21 cases), and the mainly symptom was nasal congestion (18 cases). All the patients received transnasal endoscopic surgery and had no recurrence during following-up from three months to one year.@*Conclusions@#The most common area of REAH in the nasal cavity is the olfactory cleft. Histopathological result is needed to make a definite diagnosis. Complete surgical resection is the main treatment.
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Five general practitioners were trained for application of the enhancing CalgaryCambridge guide in consultation.The consultation time in 50 patients were recorded before and after training and the satisfaction degree of patients was investigated by questionnaire survey.Results showed that the length of consultation time after training was longer than that before training (490 s vs 277 s,P ＜ 0.05) and also longer than that of specialists (490 s vs 268 s,P ＜0.05).The overall satisfaction rate of patients was increased after training (72％ vs 88％,P ＜0.05).The results indicate that training of Calgary-Cambridge guide for doctor-patient communication can improve the communication skills of general practitioners.
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Proteolytic processing of viral polyproteins is indispensible for the lifecycle of coronaviruses. The main protease (M(pro)) of SARS-CoV is an attractive target for anti-SARS drug development as it is essential for the polyprotein processing. M(pro) is initially produced as part of viral polyproteins and it is matured by autocleavage. Here, we report that, with the addition of an N-terminal extension peptide, M(pro) can form a domain-swapped dimer. After complete removal of the extension peptide from the dimer, the mature M(pro) self-assembles into a novel super-active octamer (AO-M(pro)). The crystal structure of AO-M(pro) adopts a novel fold with four domain-swapped dimers packing into four active units with nearly identical conformation to that of the previously reported M(pro) active dimer, and 3D domain swapping serves as a mechanism to lock the active conformation due to entanglement of polypeptide chains. Compared with the previously well characterized form of M(pro), in equilibrium between inactive monomer and active dimer, the stable AO-M(pro) exhibits much higher proteolytic activity at low concentration. As all eight active sites are bound with inhibitors, the polyvalent nature of the interaction between AO-M(pro) and its polyprotein substrates with multiple cleavage sites, would make AO-M(pro) functionally much more superior than the M(pro) active dimer for polyprotein processing. Thus, during the initial period of SARS-CoV infection, this novel active form AOM(pro) should play a major role in cleaving polyproteins as the protein level is extremely low. The discovery of AOM(pro) provides new insights about the functional mechanism of M(pro) and its maturation process.