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Gerald Chi Adeel Jamil Umer Jamil Muhammad A. Balouch Jolanta Marszalek Farima Kahe 《Clinical and experimental hypertension (New York, N.Y. : 1993)》2019,41(2):160-167
Background: Intensive blood pressure (BP) lowering may offer protective effects against major adverse cardiac event (MACE) but is also associated with a greater risk of a serious adverse event (SAE). The risk-benefit profile of intensive versus standard BP control has not been comprehensively assessed. Methods: Four studies were identified from a systematic literature search for randomized controlled trials comparing intensive versus standard BP lowering that reported both MACE and SAE endpoints. A previously described statistical approach was applied to characterize the efficacy-safety tradeoff of BP control. The bivariate outcome was computed to quantitatively assess the net clinical benefit (NCB) of intensive BP lowering as compared to standard treatment, with positive values indicating increased risks and negative values indicating decreased risks. Results: Data from the SPRINT trial demonstrated that intensive strategy was superior in MACE but inferior in SAE, thereby eroding the NCB (bivariate outcome: 0.33% [?0.50% to 1.21%]). Intensive strategy from the SPS3 trial fulfilled non-inferiority in both MACE and SAE but did not reach a favorable NCB (?1.31% [?2.25% to 0.01%]). The ACCORD trial suggested that intensive strategy was non-inferior in MACE but inferior in SAE (?0.19% [?0.79% to 1.37%]). Results from the VALISH trial were inconclusive for SAE but suggested non-inferiority in MACE (?1.19% [?3.24% to 0.68%]). Conclusions: Compared to the standard blood pressure target, pooled data from randomized controlled trials suggest that intensive strategy did not achieve a net clinical benefit when weighing the benefit of MACE reduction against the risk of SAE under the bivariate framework.Abbreviations: Blood pressure (BP), diastolic blood pressure (DBP), major adverse cardiac event (MACE), net clinical benefit (NCB), serious adverse event (SAE), systolic blood pressure (SBP). 相似文献
105.
Emergency cricothyroidotomy: an observational study to estimate optimal incision position and length
P. Fennessy T. Drew V. Husarova M. Duggan C.L. McCaul 《British journal of anaesthesia》2019,122(2):263-268
Background
A vertical incision is recommended for cricothyroidotomy when the anatomy is impalpable, but no evidence-based guideline exists regarding optimum site or length. The Difficult Airway Society guidelines, which are based on expert opinion, recommend an 80–100 mm vertical caudad to cephalad incision in the extended neck position. However, the guidelines do not advise the incision commencement point. We sought to determine the minimum incision length and commencement point above the suprasternal notch required to ensure that the cricothyroid membrane would be accessible within its margins.Methods
We measured using ultrasound, in 80 subjects (40 males and 40 females) without airway pathology, the distance between the suprasternal notch and the cricothyroid membrane, in the neutral and extended neck positions. We assessed the inclusion of the cricothyroid membrane within theoretical incisions of 0–100 mm in length made at 10 mm intervals above the suprasternal notch.Results
In the 80 subjects, the distance ranged from 27 to 105 mm. Movement of the cricothyroid membrane on transition from the neutral to extended neck position varied from 15 mm caudad to 27 mm cephalad. The minimum incision required in the extended position was 70 mm in males and 80 mm in females, commencing 30 mm above the suprasternal notch.Conclusions
An 80 mm incision commencing 30 mm above the suprasternal notch would include all cricothyroid membrane locations in the extended position in patients without airway pathology, which is in keeping with the Difficult Airway Society guidelines recommended incision length. 相似文献106.
Alexander Becker Kobi Peleg Joseph Dubose Yaakov Daskal Adi Givon Boris Kessel 《Journal of pediatric surgery》2019,54(4):780-782
Background
Penetrating stab wounds in children are relatively rare and no clear recommendations for the optimal evaluation have been devised. An acceptable traditional approach to the patient with an abdominal stab wound who does not require urgent surgery is selective nonoperative management and serial exams. The use of routine computed tomography remains an actively utilized investigation for these patients at many institutions.Purpose
We hypothesize that the approach to pediatric stab wound victims should be distinctly different than that of adult counterparts in order to minimize radiation exposure.Methods
A retrospective cohort study involving abdominal stab wounds among pediatric trauma patients (age < 14) compared with adults between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry.Results
A total of 92 children and 4444 adults were identified from the registry for inclusion. Among the children 20 (21.7%) patients had intraabdominal injury compared to 1730 (38.9%) among adult counterparts. Four children were hemodynamically unstable, two of them were referred directly to operating room and two others were treated without surgery. Among the remaining 88 children there was no observed mortality.Conclusions
The majority of pediatric stab wounds trauma victims have minor abdominal injuries. We do not recommend the routine utilization of abdominal CT scan in the evaluation of abdominal stab wounds. Observation with serial exams and minimization of radiation exposure from CT are warranted in this unique population.Type of study
Retrospective comparative study.Level of evidence
3. 相似文献107.
108.
Hitoshi Kohsaka Tsuneyo Mimori Takashi Kanda Jun Shimizu Yoshihide Sunada Manabu Fujimoto Yasushi Kawaguchi Masatoshi Jinnin Yoshinao Muro Shoichiro Ishihara Hiroyuki Tomimitsu Akiko Ohta Takayuki Sumida 《The Journal of dermatology》2019,46(1):e1-e18
Although rheumatologists, neurologists and dermatologists see patients with polymyositis (PM) and dermatomyositis (DM), their management appears to vary depending on the physician's specialty. The aim of the present study was to establish the treatment consensus among specialists of the three fields to standardize the patient care. We formed a research team supported by a grant from the Ministry of Health, Labor and Welfare, Japan. Clinical questions (CQ) on the management of PM and DM were raised. A published work search on CQ was performed primarily using PubMed. Using the nominal group technique, qualified studies and results in the published work were evaluated and discussed to reach consensus recommendations. They were sent out to the Japan College of Rheumatology, Japanese Society of Neurology and Japanese Dermatological Association for their approval. We reached a consensus in 23 CQ and made recommendations and a decision tree for management was proposed. They were officially approved by the three scientific societies. In conclusion, a multidisciplinary treatment consensus for the management of PM and DM was established for the first time. 相似文献
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110.
小儿急性咳嗽作为儿科常见病,因小儿脏腑娇嫩、形气未充,具有发病急骤、传变迅速的病理特点,故易出现各种变证,建立完善的小儿急性咳嗽诊治体系就显得尤为重要。因咳嗽病程不同,病邪部位有异,辨证论治之法亦有不同,唐方教授通过多年临床实践归纳和总结出小儿咳嗽从"肺胃肝三脏"治疗理论。该理论以脏腑辨证为基础,具有紧抓主症、用药考究、灵活加减的特点。临床用药加减则依据肺主宣发肃降,故多予炙麻黄、桔梗开宣肺气,予桑白皮、葶苈子降气止咳,且小儿生理特点为"脾常不足",故而过量进食之后,损伤脾胃,造成肺胃热盛同病,胃多气多血之腑,故予红景天、地龙、牡丹皮活血凉血清热。通过对临床医案的分析,进一步阐释从"肺胃肝三脏"治疗理论,从而为小儿咳嗽的临床诊治工作提供有益借鉴。 相似文献