中草药治疗慢性乙型肝炎随机对照试验的系统评价

目的 评价中草药治疗慢性乙型肝炎的疗效与安全性。设计Cochrane系统评价。研究的鉴定 检索Cochrane肝胆疾病组、Cochrane图书馆、Cochrane另证医学领域试验注册数据库,MEDLINE、EMBASE以及BIOSIS数据库。手工检索发表与未发表的中献。纳入标准 收集比较中草药与安慰剂、未治疗、非特异性治疗或干扰素治疗慢性乙型肝炎并随访达3个月以上的随机与半随机对照试验。中草药联用干扰素与单用干扰素比较的试验也予以纳入。试验无论是否使用盲法或发表语种均不受纳入限制。资料提取与统计方法 两名评价人员独立提取资料。纳入试验的方法学质量采用Jadad评分标准与随机分配隐藏。数据采用Cochrane协作网专用软件RevMan4．1版进行统计分析。结果 九篇随机对照试验共治疗936名病人满足纳入标准。其中仅一篇属于高质量的试验,双盲试验有二篇。回归分析表明存在发表偏倚,“倒漏斗”图（funel plot)显示不对称图形（P＝0．047）。与非特异性治疗或安慰剂比较,扶正解毒汤显示有清除乙型肝炎病毒血清表面抗原（HBsAg)、e抗原（HBeAg)及乙型肝炎病毒（HBV）DNA的疗效;猪苓多糖对清除血清HBsAg与HBV DNA有效;草药叶下珠对清除血清HBeAg有效。复方叶下珠和苦参碱对清除血清HBeAg及HBV DNA及恢复肝功能的效果与干扰素相当。试验未发现严重的副作用。结论 由于存在发表偏倚及普遍低质量的随机对照试验,中草药治疗慢性乙型肝炎目前尚无充分的证据。潜在的疗效亟待设计严格的随机双盲安慰剂对照试验予以证实。     

中草药治疗乙型肝炎病毒无症状携带者的系统评价

目的评价中草药治疗乙型肝炎病毒无症状携带者的疗效与安全性.设计Cochrane系统评价.研究的鉴定检索Cochrane肝胆疾病组、Cochrane图书馆、Cochrane另证医学领域试验注册数据库,MEDLINE、EMBASE以及BIOSIS数据库.手工检索发表与未发表之中文文献.纳入标准收集比较中草药与安慰剂、未治疗、非特异性治疗或干扰素治疗乙型肝炎病毒无症状携带者并随访达3个月以上的随机临床试验.试验无论是否使用盲法或发表语种均不受纳入限制.资料提取与统计方法两名评价人员独立提取资料.纳入试验的方法学质量采用Jadad评分标准与随机分配隐藏.数据采用Cochrane协作网专用软件RevMan4.1版进行统计分析.结果3篇共涉及307名病人随访达3个月及以上的随机临床试验符合纳入标准.均为低质量试验.健脾温肾方与干扰素比较对清除乙型肝炎病毒具有显著效果清除乙型肝炎病毒血清表面抗原(HBsAg)相对危险度为2.40(95%可信区间1.01～5.72),血清e抗原(HBeAg)转化为e抗体的效应为2.54(1.13～5.70).草药叶下珠和黄芪与安慰剂比较未见显著的抗病毒效果.对8个随访少于3个月的随机临床试验的分析表明中草药对病毒标志物无显著疗效.试验未发现严重的副作用.结论由于小样本及低质量的随机对照试验,中草药治疗乙型肝炎病毒携带者的证据无够充分.需要进一步的随机双盲安慰剂对照试验.     

中草药治疗乙型肝炎病毒无症状携带者的系统评价

目的 评价中草药治疗乙型肝炎病毒无症状携带的疗效与安全性。设计 Cochrane系统评价。研究的鉴定检索Cochrane肝胆疾病组、Cochrane图书馆、Cochrane另证医学领域试验注册数据,MEDLINE、EMBASE以及BIOSIS数据库。手工检索发表与未发表之中献。纳入标准 收集比较中草药与安慰剂、未治疗、非特异性治疗或干扰素治疗乙型肝炎病毒无症状携带并随访达3个月以上的随机临床试验。试验无论是否使用盲法或发表语种均不受纳入限制。资料提取与统计方法 两名评价人员独立提取资料。 纳入试验的方法学质量采用Jadad评分标准与随机分配隐藏。数据采用Cochrane协作网专用软件RevMan4．1版进行统计分析。结果 3篇共涉及307名病人随访达3个月及以上的随机临床试验符合纳入标准。均为低质量试验。健脾温肾方与干扰素比较对清除乙型肝炎病毒具有显效果：清除乙型肝炎病毒血清表面抗原（HBsAg）相对危险度为2．40（95％可信区间1．01－5．72）,血清e抗原（HBeAg)转化为e抗体的效应为2．54（1．13－5．70）。草药叶下珠和黄芪与安慰剂比较未见显的抗病毒效果。对8个随访少于3个月的随机临床试验的分析表明中草药对病毒标志物无显疗效。试验未发现严重的副作用。结论 由于小样本及低质量的随机对照试验,中草药治疗乙型肝炎病毒携带的证据无够充分。需要进一步的随机双盲安慰剂对照试验。     

草药叶下珠治疗慢性乙型肝炎病毒感染的系统评价

目的评价叶下珠属治疗慢性乙型肝炎病毒感染的疗效和安全性.设计随机临床试验的系统评价.方法用电子和手工检索鉴定比较叶下珠与安慰剂、不治疗、非特异性治疗、其他草药治疗、或干扰素治疗慢性乙型肝炎病毒感染者的随机临床试验.叶下珠合用干扰素与单用干扰素比较的随机试验也予以纳入.无论使用盲法与否或以何种语言发表均无限制.纳入试验的质量用Jadad记分量表加随机隐藏评价.结果22篇试验包含1947名患者符合纳入标准.5篇双盲试验被评为高质量试验,其余均为低质量试验.合并的结果表明,与安慰剂或不治疗比较,叶下珠属对于血清HBsAg转阴有积极效果(相对危险度5.64,95%可信区间1.85～17.21).叶下珠与干扰素比较,在血清HBsAg、HBeAg和HBVDNA转阴效果方面没有显著差异.在血清HBsAg、HBeAg、HBVDNA转阴以及转氨酶复常方面,叶下珠优于非特异性治疗或其他草药治疗.分析表明叶下珠与干扰素联合用药比单用干扰素效果更好,HBeg转阴相对危险度1.56,95%可信区间1.06～2.32,HBVDNA转阴的相对危险度1.52,95%可信区间1.05～2.21.这些试验没有报告发生严重的副性事件.结论根据本系统评价,某些叶下珠属可能具有抗乙型肝炎病毒和改善肝功能的作用.然而,由于试验的方法学质量普遍较低以及该草药使用的变异性大,目前尚无足够的证据支持它的治疗应用,需要进一步的大样本试验.     

草药叶下珠治疗慢性乙型肝炎病毒感染的系统评价

目的 评价叶下珠属治疗慢性乙型肝炎病毒感染的疗效和安全性。设计 随机临床试验的系统评价。方法 用电子和手工检索鉴定比较叶下珠与安慰剂、不治疗、非特异性治疗、其他草药治疗、或干扰素治疗慢性乙型肝炎病毒感染的随机临床试验。叶下珠合用干扰素与单用干扰素比较的随机试验也予以纳入。无论使用盲法与否或以何种语言发表均无限制。纳入试验的质量用Jadad记分量表加随机隐藏评价。结果 22篇试验包含1947名患符合纳入标准。5篇双盲试验被评为高质量试验,其余均为低质量试验。合并的结果表明,与安慰剂或不治疗比较,叶下珠属对于血清HBsAg转阴有积极效果（相对危险度5．64,95％可信区间1．85－17．21）。叶下珠与干扰素比较,在血清HBsAg、HBeAg和HBV DNA转阴效果方面没有显差异。在血清HBsAg、HBeAg、HBVDNA转阴以及转氨酶复常方面,叶下株优于非特异性治疗或其他草药治疗。分析表明叶下珠与干扰素联合用药比单用干扰素效果更好,HBeAg转阴相对危险度1．56,95％可信区间1．06－2．32,HBV DNA转阴的相对危险度1．52,95％可信区间1．05－2．21。这些试验没有报告发生严重的副性事件。结论 根据本系统评价,某些叶下珠属可能具有抗乙型肝炎病毒和改善肝功能的作用。然而,由于试验的方法学质量普遍较低以及该草药使用的变异性大,目前尚无足够的证据支持它的治疗应用,需要进一步的大样本试验。     

两种药物联合应用治疗慢性乙型肝炎60例

目的评价门冬氨酸鸟氨酸颗粒剂和干扰素α-2β联合应用治疗慢性乙型肝炎的疗效和安全性。方法将60例慢性乙型肝炎住院患者随机分为两组,对照组采用综合治疗,治疗组在综合治疗的基础上接受干扰素α-2β抗病毒治疗,300万单位隔日肌肉注射1次,并同时应用门冬氨酸鸟氨酸颗粒剂,3克/次,3次/天,两组均治疗24周,观察患者治疗前后症状体征、肝功能(包括丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、γ-谷氨酰转移酶)、乙型肝炎病毒血清标志物[包括乙型肝炎病毒表面抗原(HBsAg)、乙型肝炎病毒表面抗体、乙型肝炎病毒e抗原(HBeAg)、乙型肝炎病毒e抗体、乙型肝炎病毒核心抗体及HBV DNA]。结果干扰素α-2β与门冬氨酸鸟氨酸颗粒剂联合应用,对肝功能改善作用明显优于对照组,对血清HBsAg、HBeAg、HBV DNA阴转的效果优于对照组,并且治疗慢性乙型肝炎的临床总有效率高于对照组,两组相比较差异有统计学意义(P<0.01)。结论干扰素α-2β与门冬氨酸鸟氨酸颗粒剂联合应用治疗慢性乙型肝炎能促进肝功能恢复、清除HBV标志物和HBVDNA,并且临床应用安全。     

荧光定量检测血清HBV—DNA与HBeAg、临床类型的关系

目的 了解乙型肝炎病毒携带、慢性乙型肝炎患病毒含量与血清HBeAg、临床类型的关系。方法 采用荧光定量聚合酶链反应检测乙型肝炎病毒携带和慢性乙型肝炎病人血清HBV－DNA含量。结果 乙型肝炎病毒携带HBeAg阳性组HBV－DNA含量明显高于HBeAg阴性组；乙型肝炎病毒携带HBeAg阴性组中有25％HBV－DNA呈阳性，少数病例HBV－DNA水平还很高；乙型肝炎病毒携带HBV－DNA含量明显视于慢性乙型肝炎。结论 血清HBeAg是反映乙型肝炎病毒复制的良好指标，阳性乙型肝炎携带HBV－DNA含量低于乙型肝炎病毒携带。     

乙型肝炎病毒YMDD变异及C区1896A变异的临床意义

乙型肝炎病毒 (HBV)免疫学标志物 (HBVM)和乙型肝炎病毒脱氧核糖核酸 (HBVDNA)是临床诊断HBV感染和判断治疗效果的指标。在拉米夫定治疗慢性乙型肝炎的过程中 ,一部分患者出现e抗原血清转换 (HBeAg阳性转移为抗HBe阳性 )后HBVDNA仍是阳性。本文对此类患者的HBVYMDD变异及C区 18     

乙型肝炎患者血清中HBeAg与乙型肝炎病毒DNA关系的探讨

目的探讨乙型肝炎患者血清乙型肝炎e抗原(HBeAg)和乙型肝炎病毒脱氧核糖核酸(HBVDNA)定量之间的关系。方法用化学发光法和荧光定量聚合酶链反应(PCR)法同时检测103例乙型肝炎患者血清HBeAg和HBVDNA水平,进行统计学分析。结果 103例乙型肝炎患者血清HBeAg和HBVDNA阳性率分别为40.78和61.17,差异具有统计学意义(χ2=7.473,P0.05);HBeAg和HBVDNA反映乙型肝炎病毒复制的敏感性差异有统计学意义(χ2=19.047,P0.05);经相关性分析,HBeAg和HBVDNA之间具有较好的相关性(r=0.738)。结论与HBeAg相比,HBVDNA能够更加敏感地反映乙型肝炎病毒的复制,但仍需二者有机结合、综合分析,以指导临床合理用药。     

乙肝病毒YMDD区变异后不同抗病毒疗法效果的系统评价

目的系统评价与拉米夫定相关的乙型肝炎病毒YMDD区变异后不同抗病毒治疗方法的疗效和安全性.方法计算机检索MEDLINE (1989～2004.4)、EMBASE (1989～2004.4)和中国生物医学文献数据库(1989～2004.4);手工检索未发表的中文学术会议文献.收集与拉米夫定相关的乙型肝炎病毒YMDD区变异后不同抗病毒疗法的临床随机与半随机对照试验,由两名评价者独立评价和提取资料,并采用Cochrane协作网专用软件RevMan 4.2进行统计分析.结果共纳入5篇随机和半随机对照研究,包括6个试验组284例病人.Meta分析结果显示,拉米夫定 阿德福韦治疗对HBVDNA、HBeAg转阴率及ALT复常率的效果明显优于单独应用拉米夫定,其RR和95%CI分别为16.61(2.29,120.71),6.66(1.23,35.88)和6.26(2.29,17.12).氧化苦参碱 胸腺肽对HBVDNA、HBeAg转阴率明显优于单独应用拉米夫定,其RR和95%CI分别为2.96(1.26,6.93),2.51(1.05,5.98).试验组单独使用阿德福韦与拉米夫定比较,两者在HBVDNA及HBeAg转阴率方面差异无统计学意义[RR 11.00,95%CI(0.65,186.02);RR 7.00,95%CI(0.39,126.92)];干扰素 拉米夫定对HBVDNA转阴率、HBeAg转阴率、ALT复常率优于单独应用拉米夫定,其RR和95%CI分别为3.50(0.90,13.58),4.90(0.70,35.10)和2.80(0.91,8.12);拉米夫定 中药与拉米夫定比较,其HBVDNA转阴率的差异无统计学意义[RR 1.16,95%CI(0.89,1.51)].在治疗过程中出现的副作用主要有:干扰素组产生流感样症状,阿德福韦组有轻度肾脏损伤,拉米夫定组有少数病例出现一过性病情加重.结论乙肝病毒YMDD变异后,阿德福韦 拉米夫定、氧化苦参碱联合胸腺肽等疗法的抗病毒作用及生化指标改善均优于继续单独使用拉米夫定.但由于样本量偏少,随机对照试验的质量普遍较低,对此尚不能得出肯定性的结论,有待扩大样本进一步研究.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."