Objective To report an evidence-based treatment of Mycophenolate Mofetil for idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched The Cochrane Library (Issue 3, 2005), MEDLINE (1978 to 2006) and CNKI (1978 to 2006), and critically appraised the available evidence. Results The available Level C (low quality) evidence showed that Mycophenolate Mofetil was effective for the remission of proteinuria, and effective in patients who were resistant to steroid or cytotoxic agents. However, there was no evidence on its long-term effect on renal survival. Given the current evidence, together with our clinical experience and the patient’s preference, Mycophenolate Mofetil and glucocorticoid were administered to the patient. After 3 months of treatment, proteinuria was relieved. The patient is still can followed up. Conclusions We only find Level C evidence to support the short-term efficacy of Mycophenolate Mofetil on the remission of proteinuria. Further studies on its long-term effects on renal survival, and a health economics evaluation are needed.
Objective We intended to get a good understanding of the current role of alkylating agents in the treatment of idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched the Cochrane Library ( Issue 3, 2005), MEDLINE (1978 Jun., 2005) and CBM disc(1978-2005) to get the current best evidence of alkylating agents for treating IMN with NS and further critically appraised the available evidence. Results Alkylating agents showed a significant beneficial effect on complete remission of proteinuria. The treatment of glucocorticoid with cyclophosphamide (MP+CTX) was one of the best managements among the various regimens suggested for IMN, but it was not clear about its long-term effect on renal survival rate. Given the current best evidence together with our clinical experience and the attitudes of the patient and family members, the treatment of (MP+CTX) was administered. There was a significant remission of proteinuria after 6 months follow-up. Conclusions The treatment of (MP+CTX) can significantly improve the remission of proteinuria, however further observations on the long-term effect of alkylating agents on renal survival rate are required.
After comparative interpretation of the essentials and highlights of the expert recommendations based on European experience published in 2019 and the expert recommendations based on Asia Pacific experience published in 2021, this article summarizes the core principles of adsorptive hemofiltration for sepsis in following aspects, including patient selection, laboratory index, and key factors in the implementation of treatment (covering initiation timing and duration, choice of anticoagulant mode, discontinuation, etc) combined with the experience in West China Hospital of Sichuan University as well, to provide references for sepsis management with adsorptive hemofiltration in clinical practice.
Hypophosphatemia is a common and potentially serious complication during continuous renal replacement therapy (CRRT), which is often underestimated and ignored. This article systematically searched and reviewed the relevant literature on previous CRRT and hypophosphatemia, and summarized the risk factors affecting hypophosphatemia during CRRT, the impact on the body, and the existing phosphorus supplement scheme during CRRT, so as to attract everyone’s attention to hypophosphatemia during CRRT in clinical work.
Precision medicine is an individualized clinical research model established according to gene, environment, lifestyle and other information. As an innovative method of clinical trials, the main scheme design breaks the barriers of traditional randomized controlled trials to the evaluation of targeted therapies in precision medicine and improves the efficiency of clinical research. This paper will systematically introduce the types, concepts and principles of the main scheme design of the new method of precision medicine clinical trial design, and summarize the advantages and limitations of the main scheme design combined with classic cases, aiming at providing scientific and rigorous methodological guidance and clinical practice experience for precision medicine scientific research design.
Immunoadsorption with Staphylococcus protein A column is a blood purification therapy that eliminates pathogenic antibodies on the principle that Staphylococcus protein A can specifically bind to human immunoglobin G efficiently. At present, it has been safely applied to a variety of autoimmune diseases and organ transplantation rejection and other fields. It has been reported to have efficacy for a variety of immune diseases, comparable to traditional plasma exchange. This article provides a review of the application progress of this technology in different systemic diseases, providing a reference for selecting blood purification treatment modes for clinical treatment of related diseases.
In recent years, Regional citrate anticoagulation (RCA) technology has been widely used not only in adult blood purification, but also in children’s blood purification, and its advantages in patients with high bleeding risk, active bleeding and heparin-induced thrombocytopenia have been repeatedly confirmed. Therefore, this article reviews and analyzes the application of RCA in different blood purification modes at home and abroad in recent years. It is found that its anticoagulation is not only safe and effective, but also can prolong the life of filter and reduce bleeding complications, which is suitable for the practice of blood purification.
Hemodialysis, serving as a crucial renal replacement therapy for patients with end-stage kidney disease, has consistently prioritized the optimization of dialysate composition in clinical practice. The application of glucose-containing dialysate has undergone a conceptual evolution from its initial role in osmotic regulation to its current recognition as a multifunctional systemic modulator. Accumulating evidence demonstrates that glucose-containing dialysate exhibits distinctive clinical advantages in maintaining glycemic and hemodynamic stability while reducing heart rate variability among hemodialysis patients. Nevertheless, existing studies present certain limitations, including relatively small sample sizes and insufficient evaluation of long-term prognostic indicators. Consequently, future investigations should emphasize large-scale, multicenter clinical trials with extended follow-up periods to further substantiate the therapeutic benefits of glucose-containing dialysate in clinical practice.
Peritoneal dialysis (PD) represents an essential renal replacement therapy for end-stage renal disease patients. However, conventional glucose-based dialysis solutions limit the clinical adoption of PD due to complications including peritoneal fibrosis and metabolic disturbances. This review systematically elaborates on advances in novel biocompatible osmotic agents: L-carnitine improves peritoneal metabolic homeostasis, while hyperbranched polyglycerol enables sustained ultrafiltration with dual peritoneal/renal protection. These innovations delineate the future direction for osmotic agent development: integrating multifunctional properties (anti-fibrotic, pro-repair, and metabolic regulation) beyond foundational osmotic efficacy.
Objective We sought a good understanding of the current role of computed tomography (CT) in the diagnosis of small bowel obstruction (SBO).Methods We looked for the best evidence on computed tomography for diagnosing small bowel obstruction by searching MEDLINE/PubMed (1978-April, 2006), SUMsearch (1978-April, 2006), CNKI (1978-April, 2006) and critically appraised the evidence. Results There was powerful evidence supporting the efficacy of computed tomography in the diagnosis of small bowel obstruction. Given the current evidence together with our clinical experience and considering the patient and his family members, values and preferences, computed tomography was done. We confirmed the diagnosis of strangulating small bowel obstruction, which needed immediate operation. Conclusions Computed tomography is a very useful tool for the diagnosis of small bowel obstruction with high sensibility and specificity.