中西医结合治疗失眠症临床疗效的Meta分析

目的 分析中西医结合治疗失眠症的疗效优势和不良反应发生率.方法 在维普资讯中文科技期刊数据库及中国期刊全文数据库中检索,纳入以失眠患者为研究对象,比较中医药、西药与单用西医治疗效果和不良反应发生的临床随机对照试验或半随机对照试验.采用Jadad量表记分法评价纳入研究的质量,并用RevMan 4.2.10软件进行Meta分析.结果 Meta分析结果,中西医结合治疗组与西药对照组总有效率比较:OR=4.45,95％ CI[3.30～6.00],P＜0.001;中西医结合治疗组与西药对照组不良反应发生率比较:OR=0.20,95％ CI[0.13～0.30],P＜0.01.结论 中西医结合治疗失眠症患者总体疗效优于西药,且可大大降低不良反应发生率,但尚需更多高质量研究进一步证实.     

东亚地区非瓣膜性心房颤动患者低强度华法林抗凝治疗有效性与安全性的Meta分析

目的:探索低强度华法林抗凝治疗对东亚地区非瓣膜性心房颤动(房颤)患者的有效性与安全性。方法:检索Cochrane、Pubmed、Embase和CBM数据库,收集东亚地区非瓣膜性房颤患者使用不同强度华法林抗凝治疗的相关研究,用RevMan5.3软件进行统计分析。结果:共纳入文献12篇。比较INR 1.50~1.99组(低强度组)和2.0~2.5组的栓塞与出血事件发生率,结果发现,低强度组栓塞事件发生率并未增加[OR=1.12,95%CI:0.84~1.49,P=0.43],但出血事件发生率明显降低[OR=0.72,95%CI:0.56~0.93,P=0.01];进一步比较低强度组与标准强度组(INR 2.0~3.0),结果显示,低强度组的栓塞事件仍未增加[OR=1.30,95%CI:0.97~1.75,P=0.08],而出血事件[OR=0.62,95%CI:0.48~0.80,P0.01],甚至致命性出血事件发生率[OR=0.58,95%CI:0.38~0.88,P=0.01]显著降低。另外INR 2.6~3.0组的出血事件发生率高于2.0~2.5组[OR=0.67,95%CI:0.46~0.97,P=0.04]。结论:低强度(INR 1.50~1.99)是华法林治疗的有效范围,且比较安全,而INR 2.6~3.0时出血风险较大,故东亚地区非瓣膜性房颤患者使用华法林治疗时,其INR维持在1.5~2.5是较理想的范畴。     

替格瑞洛与氯吡格雷在急性ST段抬高型心肌梗死急诊PCI中的疗效及安全性探讨

目的探讨替格瑞洛与氯吡格雷在急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入术(PCI)中的疗效及安全性。方法选择2015-01~2015-08酒泉市医院心内科接诊的STEMI行PCI治疗的100例患者作为研究对象。根据随机数字表法将患者分为两组,每组50例。在进行PCI术前,对照组给予口服硫酸氢氯吡格雷8片治疗,观察组则口服替格瑞洛2片治疗。以冠脉造影中梗死相关血管血流分级(thrombolysis in myocardial infarction,TIMI)3级比例、支架内血栓发生率、靶向血管再狭窄发生率、心血管不良事件发生率、术后出血发生率与药物不良反应发生率为评价指标。结果术前两组TIMI 3级患者比例相当(P0.05),术后两组TIMI 3级比例均大幅上升(P0.05),但观察组上升幅度更为明显(P0.05)。对照组支架内血栓发生率为6.00%,与观察组的4.00%差异无统计学意义(P0.05),观察组靶向血管再狭窄发生率为2.00%,与对照组的6.0%差异无统计学意义(P0.05)。两组心血管不良事件、术后出血及药物不良反应发生率差异均无统计学意义(P0.05)。结论替格瑞洛与氯吡格雷相比急性STEMI急诊PCI中可更加迅速地抑制血小板聚集,降低靶向血管再狭窄发生率,不增加心血管不良事件发生率、术后出血发生率及药物不良反应发生率。     

激素联合高压氧治疗肝细胞癌放疗后并发放射性胃炎1例报告

放射性胃炎是较少见的一类肿瘤放疗后并发症,随着放射治疗在肝癌、食管癌、胰腺癌、胆管癌等上腹部肿瘤中的应用,作为相邻器官的胃、十二指肠也会受到一定剂量的照射,胃肠组织的耐受剂量为45~55 Gy[1],当大于这个剂量时会造成胃肠黏膜放射性损伤,引起一系列的消化道症状,如厌食、恶心、呕吐、腹胀等,重者可引起消化道出血[2]。     

氯吡格雷强化剂量治疗冠脉介入术后氯吡格雷抵抗患者的安全性及有效性比较的Meta分析

目的系统评价强化剂量氯吡格雷治疗冠脉介入术后氯吡格雷抵抗患者的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI和WanFang Data,收集有关强化剂量氯吡格雷治疗冠脉介入术后氯吡格雷抵抗患者的随机对照研究,检索时限均为从建库至2016年8月。提取有效数据,评价纳入研究的方法学质量,采用RevMan 5.3软件进行Meta分析。结果最终纳入12个随机对照研究,共计4748例患者,Meta分析结果显示:与常规剂量组相比,强化剂量组再发非致死性心肌梗死(RR=0.59,95%CI[0.39,0.91],P=0.02)、心源性死亡(RR=0.46,95%CI[0.26,0.83],P=0.009)、支架内血栓形成(RR=0.39,95%CI[0.24,0.63],P=0.0001)及复合终点事件(RR=0.48,95%CI[0.36,0.63],P0.00001)的发生率明显减低,而大出血(RR=0.78,95%CI[0.47,1.31],P=0.35)及小出血事件(RR=1.21,95%CI[0.98,1.51],P=0.08)的发生率方面,两组差异无统计学意义。结论强化剂量氯吡格雷可降低冠脉介入术后氯吡格雷抵抗患者的缺血事件且不增加出血事件的发生。     

两种不同方式治疗视网膜分支静脉阻塞继发黄斑水肿的meta分析

目的系统评价激光联合玻璃体腔注射雷珠单抗与单独玻璃体腔注射雷珠单抗治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿的疗效及安全性。方法通过检索PubMed、CNKI、万方等数据库收集有关治疗BRVO继发黄斑水肿的随机对照试验研究(RCT)。检索时间为建库至2019年5月。采用RevMan 5.3软件对纳入文献进行meta分析。结果共纳入12篇文献,包括1081例患者。meta分析结果显示:与单纯注药组相比,联合治疗组黄斑中心凹厚度(CMT)在随访1、3、6个月时均降低,差异有统计学意义[95%CI(-135.44^-15.54),P<0.001];但对于最佳矫正视力(BCVA)的提高,2组间无统计学差异[95%CI(-1.75~0.80),P>0.05];2组不良反应的发生率无统计学差异[OR=1.50,95%CI(0.97~2.30),P=0.07]。结论激光联合玻璃体腔注射雷珠单抗能够显著降低BRVO继发黄斑水肿患者的CMT,早期疗效优于单纯注药组。但两种方式对于治疗后BCVA的影响及不良反应的发生尚需要大样本的随机对照双盲研究加以验证。     

英夫利昔治疗克罗恩病疗效与安全性的meta分析

[目的]通过运用meta分析,系统评价英夫利昔单抗治疗克罗恩病(CD)的疗效和安全性。[方法]通过检索中国期刊全文数据库、中国生物医学文献数据库、cochrane图书馆、Pubmed和西文生物医学数据库(EMCC)获取文献,纳入所有应用英夫利昔治疗CD的随机对照试验(randomized controlled trials,RCTs)。根据Jadad评分评价纳入文献的质量。2位作者独立提取资料并进行质量评价。对纳入文献采用固定效应模型进行meta分析,通过固定效应模型和随机效应模型分析比较的方法进行敏感性分析。[结果]共5个RCTs试验符合纳入标准,用于此次meta分析。Meta分析显示:①临床缓解:英夫利息单抗治疗CD的缓解率较安慰剂高;②临床应答:英夫利息单抗治疗CD的临床应答率高于安慰剂;③不良反应:英夫利西单抗治疗CD不良反应的发生率与安慰剂相比无明显差异;④复发率:英夫利息单抗治疗存在瘘管CD的复发率与安慰剂相比无明显差异。[结论]英夫利西单抗治疗CD具有一定疗效。     

冠状动脉旁路移植术前口服他汀类对术后疗效的 meta分析

目的 通过系统性评价来探讨冠状动脉旁路移植(CABG)术前口服他汀类对术后的疗效。方法 计算机检索Pubmed、the coherence library、EMbase、CNK和wanfang Data数据库,搜集CABG术前口服安慰剂与口服他汀类来对比术后发生不良事件的随机对照试验（RCT）,检索时限均为建库至2017年5月。由2位研究员独立筛选文献、提取资料和评价纳入研究的偏倚风险,采用Revman5.3软件进行Meta分析。 结果 共包括895例患者的9项RCT被纳入研究,其中他汀组464例、安慰剂组431例。Meta分析结果显示,他汀类组较安慰剂组可降低CABG术后房颤发生率[OR=0.43,95%CI(0.30,0.62),P<0.0001],缩短机械通气时间[MD=-1.64,95%CI(-2.90,-0.38),P=0.01]和术后住院天数[MD=-0.59,95%CI(-0.82,-0.35),P<0.0001]并降低心脑血管事件发生率[MD=0.35,95%CI(0.17,-0.70),P=0.003]、但重症监护时间[MD=-2.26,95%CI(-4.78,0.27),P=0.08]方面,差异无统计学意义。结论 CABG术前口服他汀类可降低术后房颤及心脑血管事件发生率的同时缩短术后机械通气时间和住院天数。     

托伐普坦治疗充血性心力衰竭的疗效和安全性评价——meta分析

目的:评价托伐普坦对充血性心力衰竭的治疗效果及安全性。方法:通过检索Pubmed、中国生物医学文献等数据库,手工检索已纳入的相关文献,对符合随机对照条件的研究经质量评估、数据提取,进行meta分析。结果:纳入10项随机、双盲、安慰剂对照研究。共计5 086例病例,4 958例完成研究设计随访。Meta分析结果显示,治疗组体质量(单位:0.1 kg)减轻[加权均数差(WMD)=-8.29,95%CI:-9.38~-7.20,P0.001],尿量(单位:100 mL)增加(WMD=14.58,95%CI:8.22~20.95,P0.001),血钠(单位:mmol/L)增加(WMD=2.83,95%CI:1.66~4.01,P0.01);与安慰剂比较,长期治疗的主要不良反应为口渴、口干和尿频;亚组分析显示,短期(1周)治疗,不良事件发生率无明显增加(WMD=1.35,95%CI:0.61~2.97,P=0.46)。托伐普坦对死亡率和再住院率无明显影响。结论:充血性心力衰竭患者选择性使用托伐普坦(30 mg/d)可以减轻体液潴留、纠正低钠血症,长期用药可能出现口渴、口干和尿频。     

益生菌联合奥替溴铵治疗腹泻型肠易激综合征有效性与安全性的meta分析

目的系统评价益生菌联合奥替溴铵治疗腹泻型肠易激综合征有效性与安全性,为临床治疗提供循证参考。方法本研究通过计算机检索EMBASE、Pubmed、Cochrane Library、万方、中国生物医学文献数据库、维普及中国知网,收集益生菌联合奥替溴铵治疗腹泻型肠易激综合征的随机对照试验,检索时间均为数据库建库时间至2020年11月。纳入符合条件的文献后提取数据并对文献质量进行评价,并使用REVman5.3软件进行meta分析。结果共纳入10项随机对照试验,共计956例。Meta分析结果显示,试验组总有效率[RR=1.25,95%CI:1.16~1.34,P<0.00001]显著高于对照组。治疗后肿瘤坏死因子-α浓度[SMD=-2.28,95%CI:-3.47~-1.10,P=0.0002]、治疗后白细胞介素-8水平[SMD=-2.16,95%CI:-3.14~-1.17,P<0.0001]、腹泻改善时间[SMD=-1.29,95%CI:-1.66~-0.92,P<0.00001]和腹部不适改善时间[SMD=-1.79,95%CI:-2.01~-1.56,P<0.00001]均显著低于对照组。在安全性上,试验组不良反应发生率与对照组比较,差异无统计学意义[RR=0.48,95%CI:0.18~1.29,P=0.14]。结论益生菌联合奥替溴铵能显著提高腹泻型肠易激综合征的疗效,且不增加不良反应的发生。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.