1.Clinical Treatment Ideas and Methods of Diabetes from the Perspective of Improving Symptoms
Yi ZHOU ; Shuyu YANG ; Hongfei KE ; Bo LI ; Sisi MA
Journal of Traditional Chinese Medicine 2024;65(5):464-468
This paper discussed the clinical ideas and methods of treating diabetes by improving symptoms. Diabetes-related symptoms can affect the control of blood glucose and other metabolic indicators to varying degrees, and affect the quality of life of patients. In the clinical diagnosis and treatment of diabetes, “equal emphasis on both indicators” is suggested, meaning that quality of life indicators is as important as metabolic indicators. The patient's symptoms should be paied attention to, and the diagnosis and treatment should start from “symptom differentiation”, and emphasize the “key symptoms”. When there are many symptoms, it is advised to adopt the combined treatment mode of “syndrome cluster”, and take the principle of “treating both the root and accompanying symptoms in mild cases with multiple symptoms, and prescribing multiple formulas daily”. At the same time, the model of co-management of three disciplines of diabetes consisting of diabetes specialists, traditional Chinese medicine doctors, and health managers can help the management of diabetes symptoms.
2.Safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia
Dongjuan XU ; Huan ZHOU ; Mengmeng HU ; Yilei SHEN ; Hongfei LI ; Lianyan WEI ; Jing XU ; Zhuangzhuang JIANG ; Xiaoli SHAO ; Zhenhua XI ; Songbin HE ; Min LOU ; Shaofa KE
Journal of Zhejiang University. Medical sciences 2024;53(2):175-183
Objective:To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.Methods:Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale(NIHSS)score≤3 and a platelet count<100×109/L were obtained from a multicenter register.Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded.Short-term safety outcomes were in-hospital bleeding events,while the long-term safety outcome was a 1-year all-cause death.The short-term neurological outcomes were evaluated by modified Rankin scale(mRS)score at discharge.Results:A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled.Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge(OR=1.657,95%CI:1.253-2.192,P<0.01)and did not increase the risk of intracranial hemorrhage(OR=2.359,95%CI:0.301-18.503,P>0.05),compared with those without antiplatelet therapy.However,dual-antiplatelet therapy did not bring more neurological benefits(OR=0.923,95%CI:0.690-1.234,P>0.05),but increased the risk of gastrointestinal bleeding(OR= 2.837,95%CI:1.311-6.136,P<0.01)compared with those with mono-antiplatelet therapy.For patients with platelet counts≤75×109/L and>90×109/L,antiplatelet therapy significantly improved neurological functional outcomes(both P<0.05).For those with platelet counts(>75-90)×109/L,antiplatelet therapy resulted in a significant improvement of 1-year survival(P<0.05).For patients even with concurrent coagulation abnormalities,mono-antiplatelet therapy did not increase the risk of various types of bleeding(all P>0.05)but improved neurological functional outcomes(all P<0.01).There was no significant difference in the occurrence of bleeding events,1-year all-cause mortality risk,and neurological functional outcomes between aspirin and clopidogrel(all P>0.05).Conclusions:For non-cardioembolic mild stroke patients with thrombocytopenia,antiplatelet therapy remains a reasonable choice.Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.