Eradication of Helicobacter pylori: therapies and clinical implications.

This review presents a critical evaluation of the role of Helicobacter pylori eradication in the management of peptic ulcer disease and non-ulcer dyspepsia. On current evidence, H. pylori eradication therapy seems likely to emerge as the most rational and cost-effective treatment for duodenal ulcer. The role of H. pylori eradication in the treatment of gastric ulcer and non-ulcer dyspepsia is unclear and requires further study. The emerging problem of antibiotic resistance in H. pylori is of major clinical importance and a prime cause of treatment failure. There is increasing evidence of a link between H. pylori and gastric cancer but it is premature to recommend large-scale eradication of H. pylori as a valid strategy for the primary prevention of gastric cancer. The search continues for the ideal H. pylori eradication regimen.     

癌症疼痛的规范化治疗

本文主要介绍癌症疼痛的规范化治疗方法:包括三阶梯治疗方法、非三阶梯治疗方法、手术治疗、放射治疗、化学治疗、激素治疗、心理治疗、物理治疗、神经阻滞治疗和介入治疗等。     

金属烤瓷牙修复96例临床观察

目的探讨金属烤瓷牙修复的临床疗效。方法对2010年6月-2011年3月本院96例共计178颗金属烤瓷牙的修复进行回顾性分析,对其临床修复效果进行评价。结果通过1～2年的随访,发现金属烤瓷牙修复体的美观性、牢固性均符合临床要求,有效率为91.67%(88/96)。8例失败病例中松动脱落5例,2例崩瓷,1例出现牙龈萎缩、基牙病变。结论对患者进行修复前,应严格选择基牙,对病变的基牙进行彻底处理,注意适应证的选择,可以最大限度地满足患者的需要。     

Immune reconstitution inflammatory syndrome: immune restoration disease 20 years on

Restoration of immune responses against opportunistic pathogens after commencing antiretroviral therapy (ART) may cause immune restoration disease (IRD) in about 10%-40% of HIV patients with low CD4(+) T-cell counts and usually presents clinically as a type of immune reconstitution inflammatory syndrome (IRIS). IRIS may be associated with many different opportunistic pathogens, but types associated with Mycobacterium tuberculosis, BCG, cryptococci, JC polyomavirus (the cause of progressive multifocal leukoencephalopathy [PML]), hepatitis C virus and hepatitis B virus infection are the most informative about disease pathogenesis and management. A CD4(+) T-cell count of < 50/μL and a high pathogen load are the most commonly identified risk factors for IRIS. Recovery of pathogen-specific T-cell responses and perturbations of innate immune responses before and after ART appear to cause immunopathological abnormality in tissues infected by the pathogen. Prevention of IRIS may be influenced by the timing of ART: The risk of tuberculosis (TB)-associated-IRIS can be reduced by commencing ART after 8 weeks of TB treatment, but rates of AIDS or death are lower if ART is commenced during the first 4 weeks of TB treatment. Outcomes for patients with HIV and treated cryptococcal or TB meningitis may be improved by deferring ART until the opportunistic infection is fully suppressed, but data are inadequate. As ART is currently the only effective treatment for PML in patients with HIV, PML-associated IRIS cannot be prevented by manipulating the timing of ART. A greater understanding of the immunopathogenesis of IRIS may lead to targeted therapies.     

糖尿病视网膜病变的系统性治疗多项研究为临床实践提供了新证据

糖尿病视网膜病变是成年人致盲的主要原因。自英国前瞻性糖尿病研究（UKPDS）和糖尿病控制与并发症试验（DCCT）公布以来，强化控制血糖和血压已成为糖尿病视网膜病变系统性治疗的关键。流行病学研究提示，血糖的升高程度与罹患糖尿病视网膜病变的危险呈直接连续性相关，因此血糖和血压的控制标准被认为是“越低越好”。     

颌面部缺损进行赝复体修复的研究进展

对近年有关颌面部缺损进行赝复体修复的临床研究结果进行综述分析,包括颌面部缺损的分类、颌面部缺损修复原则、赝复体修复应用的固位技术、颌面部缺损赝复体的材料以及赝复体的研究进展。     

精细制作树脂高嵌体修复磨牙大范围缺损——3年临床疗效观察

目的 研究精细制作的树脂高嵌体修复磨牙大范围缺损临床效果.方法 患者27例,患牙31颗,为牙冠大范围缺损的磨牙,已做完善根管治疗.选择松风光固化树脂和松风高温高压热聚合仪精细制作树脂高嵌体,严密黏接嘱患者按期随访(6个月复诊一次),采用USPHS标准进行临床效果评价,分别在修复后1周、0.5年、1年、1.5年、2年、2...     

Dyract flow流动复合体用于预防性树脂充填的疗效观察

目的观察Dyract flow流动复合体用于预防性树脂充填(PRR)的临床疗效。方法试验组应用Dyract flow流动复合体充填年轻恒牙窝沟龋损并封闭其余窝沟;对照组应用光固化复合树脂充填龋洞,其余窝沟用窝沟封闭剂封闭。结果试验组治疗后6个月和1年的封闭剂完全保留率分别为100.0%和94.8%,对照组分别为95.5%和87.7%,两组问差异均无统计学意义(P值均>0.05);2年后,试验组和对照组的封闭剂完全保留率分别为88.3%和77.2%,差异有统计学意义(P<0.05)。试验组和对照组在6个月、1年时的龋病发生率均为0;2年后试验组为0,对照组为1.98%;两组间的差异均无统计学意义(P值均>0.05)。结论Dyract flow流动复合体足一种良好的PRR材料,在PRR治疗中可作为传统充填方法的补充,值得推广应用。     

The quality of bioethics debate: implications for clinical ethics committees

Bioethicists have recently expressed concern over a lack of quality control within the field. This apprehension focuses on bioethics expanding in ways that obscure its distinctive ethical remit and the specialist reasoning skills it requires. This thesis about the quality and conduct of bioethics may have particular relevance for clinical ethics. As one of the youngest offshoots of bioethics, the field focuses on the ethical issues that arise specifically in a clinical context. However, non-ethics specialists are increasingly involved in this field. This means that clinical ethics could be especially vulnerable to the quality control concerns articulated within bioethics. The growing public profile of clinical ethics means that concerns over quality in this area warrant specific attention by those concerned with declining standards in bioethics and those working in clinical ethics.     

HIV/AIDS患者初始抗病毒治疗基线特点分析

目的：研究基线时人免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者的临床特点,为预防和控制艾滋病机会性感染提供依据。方法采集2013年1月至2014年1月在首都医科大学附属北京佑安医院感染中心随访并初次接受艾滋病抗逆转录病毒(ART)治疗的成年HIV/AIDS患者的基线资料并分析其临床特点。结果本研究共纳入1094例HIV/AIDS患者,其中男性1012例,女性82例,以30~44岁者居多,以性传播途径为主,主要临床表现为发热、咳嗽咳痰、乏力、消瘦等,其中呼吸系统机会性感染发生率达53.3%,其次为消化系统机会性感染(28.9%)。肺部感染、PCP、口腔真菌感染、带状疱疹、CMV视网膜炎和淋巴瘤的发生率在CD4<200个/μl组显著高于CD4≥200个/μl组,差异均有统计学意义(P<0.05)。结论艾滋病的临床表现复杂多样,机会性感染以呼吸系统最为常见,CD4细胞水平与机会性感染的发生密切相关。密切观察HIV/AIDS患者的临床症状,定期检测CD4细胞,有利于早期预防和控制机会性感染,提高HIV/AIDS患者的生活质量。     

慢性牙周炎患者种植修复后的临床疗效研究

目的 探讨慢性牙周炎对种植修复后临床疗效的影响及其与种植体周围炎症及局部氧化应激的关系。方法 80例牙列缺损并接受义齿种植的患者根据术前是否患有慢性牙周炎分为慢性牙周炎组40例和健康对照组40例,两组患者固定义齿修复完成后第1、3、6、12个月进行复诊,记录1年种植体的存留率。拍摄根尖片检测种植体边缘牙槽骨吸收量（MBL）,记录探诊深度（PD）、改良菌斑指数（mPLI）和改良龈沟出血指数（mSBI）。ELISA法检测龈沟液中白介素-1β（IL-1β）、白介素-6（IL-6）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化酶（GP-x）、丙二醛（MDA）水平。结果 两组种植修复后,随着时间的延长,mPLI、mSBI、PD、MBL均呈升高趋势,不同观察时间组间比较差异均有统计学意义（P＜0.01）。两组种植修复后,慢性牙周炎组mSBI、PD、MBL值均明显高于健康对照组（P＜0.01）。两组种植修复后,随着时间的延长,龈沟液中IL-1β、IL-6、MDA水平均逐渐增加,SOD、GP x水平逐渐降低,组间比较差异有统计学意义（P＜0.05或P＜0.01）。种植修复后各时间点,慢性牙周炎组龈沟液中IL-1β、IL-6、MDA水平均明显高于健康对照组,SOD、GP-x水平明显低于健康对照组,差异均有统计学意义（P＜0.01）。经种植修复1年,各组种植体存留率100%。结论 慢性牙周炎患者接受义齿种植短期内疗效可靠,但出现边缘骨吸收现象较为明显,种植体周围局部微环境存在炎症及氧化应激现象。     

Supratrochlear foramen of the humerus: An anatomico-radiological study with clinical implications

Background. The supratrochlear foramen (STF) of the humerus has been a neglected entity in standard anatomy and orthopaedics text-books. The knowledge of the presence of STF in a humerus may be important for preoperative planning for treatment of supracondylar fractures. The presence of STF may also result in erroneous interpretation of radiographs.

Methods. The STF was studied in detail in 384 (220 left side and 164 right side) human dried humeri of unknown sex and age. The topographical anatomy of the STF was studied in detail, morphometric measurements were taken, and the specimens were photographed. The humerus was also taken for radiological assessment of the STF and supratrochlear septum.

Results. Out of the 384 bones studied, 132 cases (34.3%) showed the presence of STF. The STF was oval, round, and triangular in shape in 123, 7, and 2 cases, respectively. The mean length of the transverse diameter for supratrochlear foramen was 6.55 mm and 5.99 mm on the left and right sides, respectively. The mean length of the vertical diameter for STF was 4.85 mm and 3.81 mm on the left and right sides, respectively. Most of the bones that had no STF showed a translucency of septum, in 56.7% of the bones.

Conclusions. The results of our study show that STF is more common on the right side, with the oval shape being more common. The respective sides did not exhibit any statistical significant differences. Presence of STF may be important for anthropological, clinical, and academic purpose.     

ALLHAT in perspective: implications to clinical practice and clinical trials

ALLHAT study is the biggest randomized clinical trial in hypertension ever conducted. Its objective was to ompare the efficacy of newer (calcium channel blocker amlodipine and angiotensin-converting enzyme inhibitor inopril) to the older (diuretic chlorthalidone) antihypertensive agents in the treatment of patients with hypertension. After enrolling 42,000 patients who were followed for an average of 4.9 years, ALLHAT did not find significant differences in the primary end-points between these antihypertenive agents. ALLHAT however found significant differences in the secondary end-points such as heart failure and strokes between chlorthalidone and amlodipine or lisinopril. Based on these and on economic reasons, the investigators unequivocally recommended diuretics as the first line therapy for hypertension. Since its publication, ALLHAT has been much discussed, debated A and opined. The choice of drugs for study, the study design, the conduct of the study and the conclusions drawn by the investigators had all been criticised or controversial. Yet ALLHAT has been widely quoted, commented upon or referred to and it has been instrumental in initiating the JNC VII Guidelines. Thus a thorough understanding of ALLHAT is necessary for clinical practice and in designing and evaluating clinical trials in the future. Moving Points: in Medicine will capture the essence of ALLHAT, discusses its implications to clinical trials and explores its possible impact on the practice of medicine in this country.