Objective To evaluate the safety and efficacy of venlafaxine and carbamazepine on painful peripheral diabetic neuropathy. Methods This was a randomized, parallel-group, double-blind, double-dummy clinical trial. 132 patients a venlafaxine group (n=66) and a carbamazepine group (n=66) with painful peripheral diabetic neuropathy were recruited from 3 clinical centers. The venlafaxine group took venlafaxine 25 mg plus one dummy carbamazepine tablet twice a day and the carbamazepine group took carbamazepine 0.1 g plus one dummy venlafaxine tablet twice a day both for 2 weeks. The primary efficacy measurement consisted of a numeric pain intensity scale and the secondary measurement assessed quality of life. Results One hundred and nineteen patients completed the trial. Venlafaxine was superior to carbamazepine in improving mean pain intensity scores at 5,7,10 and 14 days by per-protocol analysis (P=0.02, P=0.03, P=0.003 and P=0.001 respectively). The effects of venlafaxine on the improvement in the total quality of life scores were better than those of carbamazepine at 10 and 14 days (P=0.02 and P=0.01 respectively). Sleep interference and mood were improved by both venlafaxine and carbamazepine, but the efficacy of venlafaxine was superior to that of carbamazepine. The common adverse events of venlafaxine included mild gastrointestinal discomfort, dizziness and somnolence. The frequency of adverse events in the venlafaxine group was about 43.9% (4 patients withdrew because of adverse events) and in the carbamazepine group about 25.76% (2 patients withdrew because of adverse events) (P =0.06). Conclusions Venlafaxine and carbamazepine are effective in the treatment of painful diabetic neuropathy, venlafaxine is superior to carbamazepine in improving pain and quality of life. Both drugs may be safe and well tolerated.
Multi-disciplinary team (MDT) is increasingly applied in oncology and refractory diseases. In recent years, MDT has also been applied in diagnosis and treatment of pituitary adenoma and related diseases. This review summarizes the advantages and characteristics of the MDT diagnosis and treatment mode, and analyzes the application and effect of the MDT diagnosis and treatment mode in the Center of Pituitary Adenoma and Related Diseases, West China Hospital, Sichuan University. So far, it has shown that MDT has advantages such as it is professional, full of collaborative interaction, and efficient and optimized. It is a platform of multi-disciplinary cooperation and resources in the diagnosis and treatment of difficult diseases. Case discussion in MDT mode is conducive to timely selection of the best treatment options for patients with pituitary adenoma and related diseases, providing a good learning platform for doctors with different professional backgrounds, and promoting the improvement of professional diagnosis and treatment level of doctors in related departments. The development of MDT will help us to use limited medical resources efficiently, promote the medical team to be more specialized, optimize the diagnosis and treatment process, and improve the effectiveness of the treatment, for benefiting more patients with pituitary adenomas and related diseases.
