Objective: to compare the effect of VSD negative pressure drainage and traditional drug replacement in the satisfaction of patients with refractory pressure ulcers. Methods: We enrolled 88 patients with refractory pre...Objective: to compare the effect of VSD negative pressure drainage and traditional drug replacement in the satisfaction of patients with refractory pressure ulcers. Methods: We enrolled 88 patients with refractory pressure ulcer wound from March 2019 to December 2020, using randomized table method 1:1. Control group (n=44): routine treatment + routine care;observation group (n=44): VSD negative pressure drainage + routine care. Patient pressure ulcer wound healing index, clinical efficiency, satisfaction, wound infection rate, and MVD detection values were counted. Results: (1) the wound granulation growth time, wound healing time, local antibiotic medication time and hospitalization time were shorter during the treatment of the observation group (P <0.05);(2) the treatment efficiency (95.45%), care satisfaction (97.73%) were higher than the control group, and the incidence of wound infection (0.00%) was lower than the control group, with significant differences (P <0.05).There was no significant difference in MVD detection values (P> 0.05) before and 1d after treatment, and both showed at 3d and 7d after treatment (P <0.05).Conclusion: the application of VSD negative pressure drainage and traditional drug replacement in the treatment of patients with refractory pressure ulcers significantly promotes wound granulation growth and wound healing, and reduces the risk of wound infection.展开更多
BACKGROUND Despite advances in the treatment of ulcerative colitis(UC),some patients remain refractory to the currently available treatments.Dual biologic therapy(DBT)has emerged as a promising strategy for these pati...BACKGROUND Despite advances in the treatment of ulcerative colitis(UC),some patients remain refractory to the currently available treatments.Dual biologic therapy(DBT)has emerged as a promising strategy for these patients.CASE SUMMARY A patient with extensive UC presented with steroid dependence and contraindications(past medical history included breast cancer and previous myocardial infarction)to treatment with tumor necrosis factor and Janus kinase inhibitors.DBT ofα4β7 integrin antagonist(vedolizumab)and interleukin 23p19 inhibitor(mirikizumab)resulted in a sustained clinical and biochemical remission.No adverse events were recorded during the follow-up.CONCLUSION This case highlighted the challenge of managing refractory UC,especially in frail patients.展开更多
BACKGROUND Many patients with ulcerative colitis(UC)do not respond well to,or tolerate conventional and biological therapies.There is currently no consensus on the treatment of refractory UC.Studies have demonstrated ...BACKGROUND Many patients with ulcerative colitis(UC)do not respond well to,or tolerate conventional and biological therapies.There is currently no consensus on the treatment of refractory UC.Studies have demonstrated that the selective Janus kinase 1 inhibitor upadacitinib,a small-molecule drug,is effective and safe for treating UC.However,no studies have revealed that upadacitinib is effective in treating refractory UC with primary nonresponse to infliximab and vedolizumab.CASE SUMMARY We report the case of a 44-year-old male patient with a chief complaint of bloody diarrhoea with mucus and pus,in addition to dizziness.The patient had recurrent disease after receiving mesalazine,prednisone,azathioprine,infliximab and vedolizumab over four years.Based on the endoscopic findings and pathological biopsy,the patient was diagnosed with refractory UC.In particular,the patient showed primary nonresponse to infliximab and vedolizumab.Based on the patient’s history and recurrent disease,we decided to administer upadacitinib.During hospitalisation,the patient was received upadacitinib under our guidance.Eight weeks after the initiation of upadacitinib treatment,the patient’s symptoms and endoscopic findings improved significantly.No notable adverse reactions have been reported to date.CONCLUSION Our case report suggests that upadacitinib may represent a valuable strategy for treating refractory UC with primary nonresponse.展开更多
It has been reported that a 92-year-old female had got a bruise superficial wound on her right leg one and a half years ago,developing into refractory skin ulcer due to improper management before.A prepared cream,mixe...It has been reported that a 92-year-old female had got a bruise superficial wound on her right leg one and a half years ago,developing into refractory skin ulcer due to improper management before.A prepared cream,mixed royal jelly with berberine for dressing change,was made on the scene through the crush of berberine tablets,working with fresh royal jelly.Topical dressing change with the cream was done every 3 days,and two months later,such the ulcer became clean and was covered fully with fresh granulation tissue.This kind of cream consists of the ingredients of TCM purely,free of antibiotic,and being quite effective clinically,also helpful for proper use of antibiotic.展开更多
A small subset of patients with active ulcerative colitis is non-responsive to major known non-biological therapies. We reported 5 patients with positive serum proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANC...A small subset of patients with active ulcerative colitis is non-responsive to major known non-biological therapies. We reported 5 patients with positive serum proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) and tried to (1) identify the common clinical features of these patients; (2) investigate the efficacy of a novel therapy using a Chinese medicine compound; and (3) attract more gastroenterologists to be engaged in further study of this subset of patients. The common manifestations of disease in these 5 patients included recurrent bloody diarrhea and inflammatory lesions involving the entire colorectal mucosa. Initial treatment with intravenous methylprednisolone successfully induced remission. Four of these 5 patients were steroid-dependence, and immunosuppressants, such as azathioprine and cyclophosphamide, were in effective. In 3 patients, only the particular Chinese medicine compound could induce and maintain remission. One patient underwent colectomy. No vascular inflammatory lesions were found by histopathological examination. Although more cases are needed for confirmation, our study indicates thatulcerative colitis with positive PR3-ANCA may belong to a subtype of refractory ulcerative colitis. The particular Chinese medicine compound used in our study is by far the most effective in the management of these patients, with additional advantages of having no noticeable side-effects and less financial burden.展开更多
文摘Objective: to compare the effect of VSD negative pressure drainage and traditional drug replacement in the satisfaction of patients with refractory pressure ulcers. Methods: We enrolled 88 patients with refractory pressure ulcer wound from March 2019 to December 2020, using randomized table method 1:1. Control group (n=44): routine treatment + routine care;observation group (n=44): VSD negative pressure drainage + routine care. Patient pressure ulcer wound healing index, clinical efficiency, satisfaction, wound infection rate, and MVD detection values were counted. Results: (1) the wound granulation growth time, wound healing time, local antibiotic medication time and hospitalization time were shorter during the treatment of the observation group (P <0.05);(2) the treatment efficiency (95.45%), care satisfaction (97.73%) were higher than the control group, and the incidence of wound infection (0.00%) was lower than the control group, with significant differences (P <0.05).There was no significant difference in MVD detection values (P> 0.05) before and 1d after treatment, and both showed at 3d and 7d after treatment (P <0.05).Conclusion: the application of VSD negative pressure drainage and traditional drug replacement in the treatment of patients with refractory pressure ulcers significantly promotes wound granulation growth and wound healing, and reduces the risk of wound infection.
文摘BACKGROUND Despite advances in the treatment of ulcerative colitis(UC),some patients remain refractory to the currently available treatments.Dual biologic therapy(DBT)has emerged as a promising strategy for these patients.CASE SUMMARY A patient with extensive UC presented with steroid dependence and contraindications(past medical history included breast cancer and previous myocardial infarction)to treatment with tumor necrosis factor and Janus kinase inhibitors.DBT ofα4β7 integrin antagonist(vedolizumab)and interleukin 23p19 inhibitor(mirikizumab)resulted in a sustained clinical and biochemical remission.No adverse events were recorded during the follow-up.CONCLUSION This case highlighted the challenge of managing refractory UC,especially in frail patients.
基金Supported by Shenzhen Science and Technology Program,No.JCYJ20220530154013031Guangdong Province Health and Health Appropriate Technology Promotion Project,No.2023385Guangdong Province Grassroots Science Popularization Action Plan,No.20240205.
文摘BACKGROUND Many patients with ulcerative colitis(UC)do not respond well to,or tolerate conventional and biological therapies.There is currently no consensus on the treatment of refractory UC.Studies have demonstrated that the selective Janus kinase 1 inhibitor upadacitinib,a small-molecule drug,is effective and safe for treating UC.However,no studies have revealed that upadacitinib is effective in treating refractory UC with primary nonresponse to infliximab and vedolizumab.CASE SUMMARY We report the case of a 44-year-old male patient with a chief complaint of bloody diarrhoea with mucus and pus,in addition to dizziness.The patient had recurrent disease after receiving mesalazine,prednisone,azathioprine,infliximab and vedolizumab over four years.Based on the endoscopic findings and pathological biopsy,the patient was diagnosed with refractory UC.In particular,the patient showed primary nonresponse to infliximab and vedolizumab.Based on the patient’s history and recurrent disease,we decided to administer upadacitinib.During hospitalisation,the patient was received upadacitinib under our guidance.Eight weeks after the initiation of upadacitinib treatment,the patient’s symptoms and endoscopic findings improved significantly.No notable adverse reactions have been reported to date.CONCLUSION Our case report suggests that upadacitinib may represent a valuable strategy for treating refractory UC with primary nonresponse.
文摘It has been reported that a 92-year-old female had got a bruise superficial wound on her right leg one and a half years ago,developing into refractory skin ulcer due to improper management before.A prepared cream,mixed royal jelly with berberine for dressing change,was made on the scene through the crush of berberine tablets,working with fresh royal jelly.Topical dressing change with the cream was done every 3 days,and two months later,such the ulcer became clean and was covered fully with fresh granulation tissue.This kind of cream consists of the ingredients of TCM purely,free of antibiotic,and being quite effective clinically,also helpful for proper use of antibiotic.
基金Supported by National Natural Science Foundation of China, No. 30570829
文摘A small subset of patients with active ulcerative colitis is non-responsive to major known non-biological therapies. We reported 5 patients with positive serum proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) and tried to (1) identify the common clinical features of these patients; (2) investigate the efficacy of a novel therapy using a Chinese medicine compound; and (3) attract more gastroenterologists to be engaged in further study of this subset of patients. The common manifestations of disease in these 5 patients included recurrent bloody diarrhea and inflammatory lesions involving the entire colorectal mucosa. Initial treatment with intravenous methylprednisolone successfully induced remission. Four of these 5 patients were steroid-dependence, and immunosuppressants, such as azathioprine and cyclophosphamide, were in effective. In 3 patients, only the particular Chinese medicine compound could induce and maintain remission. One patient underwent colectomy. No vascular inflammatory lesions were found by histopathological examination. Although more cases are needed for confirmation, our study indicates thatulcerative colitis with positive PR3-ANCA may belong to a subtype of refractory ulcerative colitis. The particular Chinese medicine compound used in our study is by far the most effective in the management of these patients, with additional advantages of having no noticeable side-effects and less financial burden.
