Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means to integrate individual clinical expertise with the best available external clinical evidence from systematic research. So evidence and its quality is the key issue of evidence-based medicine. The purpose of this article is to introduce to the healthcare professionals the sources of evidence and how to search for evidence for them.
Evidence has been retrieved through MEDLINE and Cochrane Libray about the treatment for patients with advanced Parkinson’s disease who suffered from on-off, dyskinesia and depression after chronic use of L-dopa. All of the evidence has been evaluated. Methods of evidence-based treatment were drawn up according to the evidence, clinciams’ experiences and patients’ preferences. All symptoms of the patient have been improved obviously.
【摘要】 目的 分析无面部血管瘤的Sturge-Weber综合征（SWS）的临床特点。 方法 2008年10月收治1例女性患儿，8岁，因发作性四肢强直入院，患儿无面部血管瘤及眼部异常，仅表现为癫痫。患儿接受丙戊酸钠抗癫痫治疗。 结果 患儿经头部CT、MRI确诊为无面部血管瘤的SWS。抗癫痫治疗后随访12个月，未再发癫痫，智力发育无减退，未出现瘫痪、蛛网膜下腔出血、脑出血、脑卒中样发作等。 结论 无面部血管瘤的SWS确诊依靠头部CT及MRI，治疗方法为药物抗癫痫治疗。复习文献得出无面部血管瘤的SWS患者临床表现不同于有面部血管瘤者，多仅表现出癫痫发作，且药物治疗有效，无需手术切除病灶，预后较好。【Abstract】 Objective To analyze the clinical features of Sturge-Weber syndrome without facial hemangioma. Methods One eight-year-old girl was admitted to the hospital for tonic seizure in October 2008. The physical examination results were normal with neither facial hemangioma nor ocular abnormalities. The only manifestation of the patient was epilepsy. The patient was treated with sodium valproate. Results According to cranial CT and MRI results, the patient was considered to have Sturge-Weber syndrome without facial hemangioma. The patient was treated with anticonvulsant drugs and experienced no recurrence of the seizures or any manifestations of mental retardation, hemiplegia, subarachnoid hemorrhage, cerebral hemorrhage, stroke-like episodes or migraine during the following 12 months of follow-up. Conclusion In the absence of facial hemangioma, the diagnosis can be based on cranial CT and MRI. Sturge-Weber syndrome patients without facial hemangioma are helped by anticonvulsant drugs. According to this case and the reports of literature, most patients without facial hemangioma only manifest epilepsy which can be treated effectively with antiepileptic drugs and such patients have a good prognosis without operation, which is different from those with facial hemangioma.
In 2014, the new concept of embolic stroke of undetermined source (ESUS) was first proposed by cryptogenic stroke/ESUS International Working Group. In the past 5 years, related clinical researches of ESUS have been deepened, and the results of many large clinical studies have been published. However, the guiding significance of this new concept to clinical practice is still controversial. By reviewing the background, diagnostic criteria, assessment, common emboli sources, anticoagulant therapy research advances and related limitations of ESUS, and analyzing the possible causes of negative anticoagulant therapy results, we explored the clinical value of this new classification.