寻常型银屑病主症量表反应度测评研究

[目的]通过中医药干预治疗银屑病的临床研究以评价前期构建的寻常型银屑病主症量表的反应度,从而进一步完善对量表的应用评价.[方法]选择应用中医药治疗的寻常型银屑病患者115例,对治疗前后相隔12周的寻常型银屑病主症量表进行纵向重测、变化率、标准化效应值(ES)和标准化反应均数(SRM)的计算以评价量表反应度.[结果](1...     

艾滋病疗效评价标准的现状及展望

目前艾滋病西医抗病毒药物疗效评价的金指标是人类免疫缺陷病毒(human immunodeficiency virus,HIV)核酸定量(病毒载量)检测和CD4+T淋巴细胞计数,但两者均存在较大的局限性。生存质量评价是一种较为适合中医药疗效评价的手段,但相关量表需要反复修订、长期完善。因此,建立一套突出中医特色、综合的艾滋病中医疗效评价指标体系是迫切需要解决的问题。中医药治疗艾滋病的临床疗效评价标准需要综合各方面的研究成果,如:症状体征、实验室指标(生化指标、病毒载量、CD4+T淋巴细胞计数为主的免疫功能)、生存质量、机会性感染发生率、生存期、治疗不良反应发生率、服药依从性、心理状态等,以便更好地开展中医药防治艾滋病的研究。     

天津市社区开展中医药适宜技术的做法与体会

目的 总结天津市社区开展中医药适宜技术的做法及取得的经验,以期为我国中医药适宜技术在社区卫生服务机构中推广应用的可持续发展提供参考.方法 采用回顾性调查、现况调查、文献研究和小组访谈的方法,对中医药适宜技术在社区卫生服务机构中的应用情况进行了研究.结果 天津市在社区开展中医药适宜技术服务是以创建全国中医药特色示范区的活动为契机,点面结合,分步实施,整体推进.结论 提出天津市推广应用中医药适宜技术的政策建议:(1)应尽快建立中医药适宜技术研究开发体系;(2)努力完善中医药适宜技术筛选评价体系;(3)创新中医药适宜技术推广应用的管理模式;(4)探索建立中医药适宜技术推广应用的长效机制;(5)制定或修订中医药适宜技术推广应用的配套政策.     

单病例随机对照试验在中医药临床疗效评价中的应用与思考

目的对比单病例随机对照试验(N-of-1)、随机对照试验(RCT)、真实世界研究(RWS) 3种临床研究方法在中医药领域的优劣,并寻找出更适用于中医药临床疗效评价的研究方法。方法查阅国内外相关文献和最新版指南,对3种研究方法进行比较。结果中医学临床研究强调个体化,N-of-1能够科学合理地与中医自身规律有机结合,核心思想与中医临床诊疗模式相同。结论通过N-of-1是对中医诊疗个案研究的科学提炼与完善,通过对所得数据的系统评价,不仅能够获得对中医诊疗的疗效、治则等的科学评价,更能够为中医个体化诊疗提供有效的验证方式,在中医药临床研究中有极好的应用前景。     

生存质量与冠心病中医临床疗效评价

论述了生存质量(QOL)的定义和冠心病心绞痛中医药疗效评价现状,以及QOL量表在冠心病评价中的应用,针对中西医学理论体系差异和应用QOL的现状,提出评价冠心病心绞痛中医药疗效不仅要引入QOL的定义,在借鉴公认的通用QOL量表的基础上,还要在中医药理论的指导下,加快体现中医学特点的通用QOL量表的研究和开发,使疗效评价体系立足于中医药的优势,与国际规范接轨,有利于中医药走向世界.     

基于德尔菲法的基层中医药服务评价体系研究

目的构建客观、科学的基层中医药服务评价体系,为评价基层医疗机构的中医药服务能力在分级诊疗制度中所起作用提供参考依据。方法通过文献分析法及实地调研法,初步拟定基层中医药服务评价体系咨询表,采用德尔菲法经2轮专家咨询调整各级指标,最终形成基层中医药服务评价体系。结果构建的基层中医药服务评价指标包括一级指标5项、二级指标35项,涵盖了基层中医药服务的主要环节:服务保障、服务设施、服务人员、服务能力、服务绩效,具有较高的可靠性和科学性。结论建立合理的基层中医药考核评价体系,对于基层中医药发展有着重要意义。本研究构建的基层中医药服务评价指标体系,能够对基层开展中医药服务进行综合考评,能从服务保障、服务设施、服务人员、服务能力和服务绩效等5个方面科学客观地反映基层中医药服务开展情况,具有较好的导向性。通过建立基层中医药服务评价指标,能够有针对性地促进基层中医药服务能力提升,充分调动基层医务人员开展中医药服务的积极性,更好地促进中医药服务在基层的推广,进而增强城乡居民对中医药服务的获得感。     

生命质量与中医药治疗恶性肿瘤临床疗效评价标准探讨

中医药治疗肿瘤疗效确切,在综合治疗中有独特的地位和优势.中医药治疗肿瘤是一种多途径、多层次、多渠道及多靶点的整体综合治疗,"带瘤生存"和生命质量提高是其显著特点.中医治疗肿瘤的理想疗效应是在满意的生命质量和较长的生存时间基础上的一定程度的肿瘤的反应性.因此,应当把生命质量、证候(症状体征量化)及证候标准化引入到中医药治疗恶性肿瘤领域中,使其疗效评价能够客观化、定量化、标准化.要全面客观地评价中医药治疗肿瘤的疗效,必须制定一个既能体现中医治疗肿瘤的特色及优势,又能适应现代医学肿瘤临床疗效评价的要求及发展趋势的标准.我们认为,疗效＝质量调整生命年(生命质量×生存时间)十证候缓解率十肿瘤缓解率.但质量调整生命年、证候缓解率、肿瘤缓解率三者在疗效评价中各自所占的比重(权重)与不同的肿瘤分期及治疗方法密切相关.     

中医药治疗脂溢性皮炎随机对照试验报告的质量评价

[目的]评价中医药治疗脂溢性皮炎随机对照试验(RCT)的文献质量,了解其临床随机对照试验的现状,以提高其临床研究质量.[方法]检索中国知网(CNKI)、维普(VIP)中文科技期刊数据库、万方(Wanfang)数据库、中国生物医学文献服务系统(SinoMed)中公开发表的关于中医药治疗脂溢性皮炎的RCT,由2名研究人员根...     

中医药治疗痛风性肾病文献质量评价与分析

目的对中医药治疗痛风性肾病(gouty nephropathy,GN)的临床随机对照试验(randomizedcontrolledtrials,RCT)进行文献质量评价与分析。方法以中医药/中药(包括各剂型)治疗、痛风肾/痛风性肾病为检索词,检索了中国知网数据库。对纳入研究的报告质量,包括研究设计的方法学质量、诊断与纳入/排除标准、中医药/对照组干预措施、疗效评价标准及观察时间点、不良反应报告、中医药内容等方面进行评价。结果共纳入31文献,2408例患者,改良后的Jadad量表评分1篇属高质量研究(4～7分),余均属于低质量研究。文献质量评价结果显示,目前国内关于中医药治疗GN高质量临床研究报道较少,诊断标准、中医证候诊断标准及疗效标准尚未得到统一,随机、对照设置欠合理。结论从目前的临床报道来看,中医药治疗痛风性肾病具有一定疗效,但文献质量尚不可观,仍需要进行进一步高质量的临床研究。     

积五十年成果 铸新世纪辉煌

《浙江中医药大学学报》由浙江中医药大学主办,浙江科技出版社出版,国内外公开发行学术期刊,是我国最早创办的中医药高校学报之一。近年来,《学报》以开辟并巩固特色栏目为龙头、组约重点论著为主的办刊方式,侧重从中医药学科发展前沿和多学科综合研究的角度精心组稿,精编刊物。力求为中医药学术的发展起推陈致新的作用,营造清新的学术氛围,从而体现并保持自己的风格和特色,发行至20多个国家及地区,是一份在国内外享有较高声誉、很有学术品味和影响的中医药学术期刊。我们将秉承:继承发扬祖国中医药学传统,促进国内外中医药学术交流,传播中医药信息,反应最新研究动态,培养中医药人才,促进中医药事业的繁荣与发展的办刊宗旨。以高品位、高质量快速传递信息为特点,积极促进中医药学学术交流和学术发展。国内外收录美国《化学文摘》(CA)波兰《哥白尼索引》(IC)俄罗斯《文摘杂志》(AJ)世界卫生组织(WHO)西太平洋地区医学索引(WPRIM)中国科学引文数据库(CSCD)中国科学论文统计源期刊(中国科技核心期刊)中国学术期刊综合评价数据库(CAJCED)CNKI中国期刊全文数据库(CJFD)万方数据——数字化期刊群维普中文科技期刊数据库中国生物医学期刊...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.