射频消融治疗肝肿瘤的现状及其临床地位的评价

射频消融（radiofrequency ablation，RFA）作为治疗肿瘤的新方法，在得到临床医生重视的同时，尽早界定RFA的评价和地位是临床应用的迫切需要，但其界定义不得不等待相当长的一段时间。国内外对肝肿瘤射频消融的基础研究和临床应用已经有13年的经验，相关的研究越来越多。本文纵览近年文献，概括与归纳射频治疗肝肿瘤技术的发展，适应证，临床疗效、预后、影响因素以及并发症，并对RFA与其它治疗方法进行比较。对其在肝肿瘤治疗领域中的地位，做出初步的评价。     

软骨组织工程的研究进展

目前，软骨组织工程已在基础研究方面取得了令人瞩目的成果，并在临床应用方面进行了初步尝试，为I临床软骨缺损的修复提供了新的思路与途径，已经成为该领域主要的研究方向，但其大规模临床应用尚存在诸多困难。现结合近年的研究成果，就组织工程化软骨的种子细胞、生物支架材料、体内外构建以及临床应用等方面进行综述。     

国产新型喷雾胶粘合脾断面的动物实验与临床应用

国产新型喷雾胶粘合脾断面的动物实验与临床应用邓谭养，徐志意，田霞，卢永顺作者在涂布胶的实验研究和临床应用的基础上，于１９９１年９月开始采用新型喷雾胶（简称ＰＷ胶）粘合大鼠鼠脾脏手术断面，研究其止血粘合效果、吸收情况、毒性反应，并经临床应用，取得满意效...     

2010广州“转化医学与人才培养”院士论坛会议报名通知

转化研究是把生物基础研究的最新成果快速有效地转化为临床医学技术、同时把临床问题及时转化为基础研究方向的过程，简称为“B—to—B”。其核心在于紧密连接基础与临床，在从事基础科学研究的研究工作者和了解临床需求的医生之间建立起沟通桥梁，特别关注如何将研究成果最有效地向疾病诊断、治疗和预防模式进行转化。     

外科实验研究的选题和设计

外科实验研究相对于临床研究而言，泛指课题的研究工作主要在实验室中进行，但和基础医学的理论研究有所不同，一般均立足于临床，从临床实际出发，通过实验研究的直接观察或模拟观察来解释某些临床现象，探索某些疾病的发病原因、发病机制，验证某些手术的可行性，提高某些手术的安全性，评估某些外科治疗的效果和预后等等。实验研究的优势在于其不受限制的前瞻性、设置条件的随意性、观察项目和指标的可比性、操作进度的计划性。     

2010广州“转化医学与人才培养”院士论坛会议报名通知

转化研究是把生物基础研究的最新成果快速有效地转化为临床医学技术、同时把临床问题及时转化为基础研究方向的过程，简称为“B—to—B”。其核心在于紧密连接基础与临床，在从事基础科学研究的研究工作者和了解临床需求的医生之间建立起沟通桥梁，特别关注如何将研究成果最有效地向疾病诊断、治疗和预防模式进行转化。     

氨哮素对失神经支配肌萎缩的作用

β２－肾上腺受体激动剂氨哮素对失神经支配肌萎缩的作用是近来年研究的一个新发现，对临床上维持失神经支配的健康状态、防治其萎缩、提高功能恢复具有重要意义。本文综述氨哮素逆转去神经肌萎缩的研究现状，讨论其作用的表现、机理以及临床应用的潜力，并分析临床应用尚待进一步研究的方向。     

脊柱内固定对椎间盘影响的研究

脊柱内固定对椎间盘影响的研究李永刚综述侯筱魁审校⒇我国脊柱内固定物的临床应用已广泛开展，积累了一定的经验，但其并发症也在不断增加。临床医生往往从固定效果及固定物植入技术进行研究，但对内固定后椎间盘生化、组织学及超微结构等基础研究较少，本文就国内外在这...     

复合人工骨治疗感染性骨缺损的初步报告

对于感染性骨缺损，是临床常见问题，处理比较棘手。作者研制的复合珊瑚羟基磷灰石人工骨，经动物实验、临床试验，初步证实具有骨传导、骨诱导作用，本研究旨在对其在感染性骨缺损应用中临床效果评价。     

ACEI／ARB在肾脏病中的合理应用

血管紧张素转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体阻断剂（ARB）已在临床使用数十年，关于其作用机制、临床疗效已有众多研究，可以说，没有哪一位临床医生不知道 ACEI／ARB；但随着对 ACEI／ARB 的研究不断增多、认识不断加深、困惑并未减少，从另一个层面也可以说，没有哪一位临床医生完全精通了解ACEI／ARB。本文就 ACEI／ ARB 的发展历程及其在肾脏病中的合理应用，结合文献资料和自己的临床应用体会作一简述。     

Calcium intake and bone mass: A quantitative review of the evidence

Summary The relationship between calcium intake and bone mass remains controversial. In this paper, the published research on this association is reviewed using the quantitative technique of meta-analysis. Selection of studies was based on defined eligibility criteria, and information relating to study design was recorded. Study results were converted, where necessary, to similar outcome measures so that direct comparison among studies was possible. A total of 37 eligible papers, representing 49 separate studies or parts of studies, were identified in the literature. Calcium had a consistent prevention effect on the rate of bone loss in the 12 studies of calcium supplements in postmenopausal women. This effect was greatest in studies in which the baseline calcium was low, supporting the idea of a threshold beyond which the effect of calcium is reduced. Cross-sectional studies showed a small but consistent positive correlation between calcium intake and bone mass. This association was greater in studies of premenopausal women. Some caution is needed in interpreting the results of this meta-analysis because of the poor quality of many of the studies reviewed. Nevertheless, the consistency of findings suggests that women in their early postmenopausal years will benefit from a high calcium intake.     

A systematic review of intervention studies demonstrates the need to develop a minimum set of indicators to report the presence of burn wound infection

IntroductionBurn wound infections result in delayed healing and increased pain, scarring, sepsis risk and healthcare costs. Clinical decision making about burn wound infection should be supported by evidence syntheses. Validity of evidence from systematic reviews may be reduced if definitions of burn wound infectionvary between trials. This review aimed to determine whether burn wound infectionis defined, and whether there is variation in the indicators used to define burn wound infectionacross studies testing interventions for patients with burns.MethodSearches were carried out in four databases (Ovid Medline, Ovid Embase, Cinahl, Cochrane Register of Trials) to identify studies evaluating interventions for patients with burns and reporting a burn wound infection outcome. Pre-defined inclusion and exclusion criteria were systematically applied to select relevant studies. Data were systematically extracted and reported narratively.Results2056 studies were identified, of which 72 met the inclusion criteria, comprising 71 unique datasets. 52.1% of studies were randomised controlled trials. Twenty-eight (38.0%) studies reporting a burn wound infection outcome did not report how they had defined it. In the methods of included studies, 59 studies (83.1%) reported that they planned to measure burn wound infection as an outcome. Of these, 44 studies (74.6%) described how they had defined burn wound infection; 6 studies (13.6%) reported use of a previously developed consensus-informed definition of burn wound infection, and 41 studies (69.5%) described the specific indicators used to define it. Studies used between one (11 studies; 26.8%) and nine indicators (2 studies; 4.9%) to define burn wound infection (median = 3, inter-quartile range = 2). The most commonly used indicator was presence of bacteria in the wound (61.0% of studies). Only 13 studies (31.7%) defined burn wound infection using the same indicators as at least one other study.Discussion and conclusionsWithin intervention studies reporting burn wound infection outcomes, a definition of this outcome is commonly not provided, or it varies between studies. This will prevent evidence synthesis to identify effective treatments for patients with burn injuries. Since there is no objective method for assessing burn wound infection, expert consensus is needed to agree a minimum set of indicators (Core Indicator Set) reported in all trials reporting burn wound infection as an outcome.     

Diet and blood pressure in children and adolescents

Identifying dietary factors associated with blood pressure (BP) in children and adolescents would help guide recommendations for prevention of elevated BP, which is a major public health problem. This paper reviews 46 reports of studies examining relationships between dietary nutrients and BP in children and adolescents, many of which studied more than one nutrient. Sodium is the most extensively studied nutrient, with 25 observational and 12 intervention studies identified. Although many studies suffer from methodological problems, the results suggest that higher sodium intake is related to higher BP in children and adolescents. The results of 13 observational and 2 intervention studies of potassium and BP do not provide a clear picture of a relationship. The results of 8 observational and 1 intervention study of calcium and BP are inconclusive. Five observational studies of magnesium and BP provide evidence of an inverse relationship, but no intervention studies were identified. Nine studies of macronutrients and food groups or dietary patterns are inconclusive. Additional research is needed to provide more information about the relationships between dietary nutrients and BP in children and adolescents. Recommendations are provided for methodological features of additional research on diet and BP in children and adolescents. Received August 23, 1996; received in revised form and accepted September 30, 1996     

Clinical and Radiological Outcomes in Robotic-Assisted Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundThe aim of this systematic review is to determine if robotic-assisted total knee arthroplasty (RATKA) results in improved clinical and radiological outcomes, and to elucidate the breadth and depth of studies conducted on this topic.MethodsA Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review was conducted using 4 databases (MEDLINE, EMBASE, Cochrane, and Web of Science) to identify all clinical studies that investigate clinical or radiological outcomes using RATKA. The Critical Appraisal Skills Program checklist for cohort studies was employed for critical appraisal and evaluation of all 22 studies that met the inclusion criteria.ResultsAll studies reviewed determined that knee arthroplasty improved clinical outcomes. Twelve studies found statistically better clinical outcomes with RATKA compared with conventional TKA, whereas 9 studies found no difference. One study did not assess clinical outcomes. When assessing radiological outcomes, 14 studies reported that RATKA resulted in more consistent and accurate postoperative mechanical alignment, whereas 2 studies reported no difference. Six studies did not assess radiological outcomes.ConclusionAlthough knee arthroplasty is one of the most commonly performed orthopedic operations, the level of patient satisfaction varies. The meta-analyses conducted in our systematic review shows that RATKA results in greater improvements in postoperative Hospital for Special Surgery score and Western Ontario and McMaster Universities scores compared to conventional TKA. Furthermore, it shows that RATKA results in more accurate postoperative alignment of prostheses. These together can explain the improved postoperative outcomes. More randomized controlled trials must be conducted before this technique is integrated into routine clinical practice.     

Fewer adhesions induced by laparoscopic surgery?

Background Laparoscopic surgery has potential theoretical advantages over open surgery in reducing the rate of adhesion formation, but very few comparative studies are available to prove this.Methods A literature search was performed within Medline and Cochrane databases using the key words: adhesion*, adhesiolysis, laparoscop*, laparotomy, open surgery. Further articles were identified from the reference lists of retrieved literature. Both clinical and experimental studies comparing laparoscopy and laparotomy with regard to adhesion formation were retained. In each article, the rates of adhesion formation were identified or deduced for the operative site, access wound site, and distant sites.Results Fifteen studies from 1987 to 2001 were identified. Most studies assessed the operative site. Thus, three clinical studies and six experimental ones found fewer adhesions following laparoscopy than laparotomy, while other five experimental studies found similar adhesion rates for the two surgical methods. There were fewer adhesions to trocar wounds than to the laparotomy wounds in seven studies and equal rates of adhesion in one study. The problem of distant adhesions is poorly represented in literature; three studies favored laparoscopy as being followed by fewer adhesions. Because of the important differences between studies with regard to the design, end points, and statistical calculations, a metaanalysis could not be achieved. The conclusion is based on the prevalence of evidence.Conclusions All clinical studies and most of the experimental studies found a reduction of adhesion formation after laparoscopic surgery compared to open surgery.     

Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review

Purpose

Cervical radiculopathy (CR) is a common diagnosis. It is unclear if intervention studies use uniform definitions and criteria for patient selection. Our objective was to assess the uniformity of diagnostic criteria and definitions used in intervention studies to select patients with CR.

Methods

We electronically searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL. Studies were included when evaluating conservative interventions in randomised clinical trials (RCTs) in patients with CR. Selection criteria and definitions for patients with CR were extracted and evaluated on their uniformity.

Results

Thirteen RCTs were included. Pain was used as an inclusion criterion in 11 studies. Inclusion based on the duration and location of pain varied between studies. Five studies used sensory symptoms in the arm as inclusion criterion. Four studies used cervical range of motion and motor disturbances as inclusion criteria, while reflex changes were used in two studies. Three studies included patients with a positive Spurling’s test and two studies used it within a cluster of provocation tests.

Conclusions

Criteria used to select patients with CR vary widely between different intervention studies. Selection criteria and test methods used are poorly described. There is consensus on the presence of pain, but not on the exact location of pain.     

Lumbar Spine Imaging: Role in Clinical Decision Making

Imaging studies are an integral component of the evaluation of the lumbar spine. For each study there is a specific role, an appropriate indication, and a correct time for utilization during the course of a patient's illness. The physician must know the specificity and sensitivity of each test, as well as the prevalence of abnormal findings in asymptomatic persons, to properly order and interpret the results of the studies. Many errors in decision making arise, not from misinterpretation of what is seen on imaging studies, but rather from misuse of imaging information in the clinical decision making process. Because all neurodiagnostic imaging modalities reveal abnormalities in at least a third of asymptomatic persons, the use of these tests for general screening is dangerous. The challenge for the future is to be able to better correlate what is seen on imaging studies with the patient's symptoms. Obtaining these expensive studies too early in the treatment of self-limited disorders is costly and often misleading for both the physician and the patient. The authors outline an approach to the judicious timing of imaging studies and discuss pitfalls in their interpretation in the evaluation of degenerative diseases of the lumbar spine.     

Balancing the Evidence: How to Reconcile the Results of Observational Studies vs. Randomized Clinical Trials in Dialysis

Because large randomized clinical trials (RCTs) in dialysis have been relatively scarce, evidence‐based dialysis care has depended heavily on the results of observational studies. However, when results from RCTs appear to contradict the findings of observational studies, nephrologists are left to wonder which type of study they should believe. In this editorial, we explore the key differences between observational studies and RCTs in the context of such seemingly conflicting studies in dialysis. Confounding is the major limitation of observational studies, whereas low statistical power and problems with external validity are more likely to limit the findings of RCTs. Differences in the specification of the population, exposure, and outcomes can also contribute to different results among RCTs and observational studies. Rigorous methods are required regardless of what type of study is conducted, and readers should not automatically assume that one type of study design is superior to the other. Ultimately, dialysis care requires both well‐designed, well‐conducted observational studies and RCTs to move the field forward.     

Biochemical bone turnover markers in diabetes mellitus — A systematic review

BackgroundDiabetes mellitus is associated with an increased risk of fractures, which is not explained by bone mineral density. Other markers as bone turnover markers (BTMs) may be useful.AimTo assess the relationship between BTMs, diabetes, and fractures.MethodsA systematic literature search was conducted in August 2014. The databases searched were Medline at Pubmed and Embase. Medline at Pubmed was searched by “Diabetes Mellitus” (MESH) and “bone turnover markers” and Embase was searched using the Emtree by “Diabetes Mellitus” and “bone turnover”, resulting in 611 studies. The eligibility criteria for the studies were to assess BTM in either type 1 diabetes (T1D) or type 2 diabetes (T2D) patients.ResultsOf the 611 eligible studies, removal of duplicates and screening by title and abstract lead to 114 potential studies for full-text review. All these studies were full-text screened for eligibility and 45 studies were included. Two additional studies were added from other sources. Among the 47 studies included there were 1 meta-analysis, 29 cross-sectional studies, 13 randomized controlled trials, and 4 longitudinal studies. Both T1D and T2D were studied. Most studies reported fasting BTM and excluded renal disease.ConclusionMarkers of bone resorption and formation seem to be lower in diabetes patients. Bone specific alkaline phosphatase is normal or increased, which suggests that the matrix becomes hypermineralized in diabetes patients. The BTMs: C-terminal cross-link of collagen, insulin-like growth factor-1, and sclerostin may potentially predict fractures, but longitudinal trials are needed. This article is part of a Special Issue entitled Bone and diabetes.