麝香保心丸治疗心肌梗死的Meta分析

目的 系统评价麝香保心丸治疗心肌梗死的临床疗效及其临床应用价值.方法 计算机检索PubMed、EMBASE、SCI、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库及中华医学会数字化期刊,收集麝香保心丸治疗心肌梗死的随机对照试验(RCT),检索时间截至2010年4月.采用Cochrane系统评价手册文献质量评价标准评价纳入研究质量,用RevMan 5.0软件进行Meta分析.结果 共纳入6个RCT,各试验间基线均可比.Meta分析结果显示:麝香保心丸组在提高患者射血分数上优于常规组,而在左心室收缩末容积(LVESV),左心室舒张末容积(LVEDV),溶栓后再通率方面两组无明显差异,仅有1个研究报告显示服用麝香保心丸后患者有轻微不良反应.结论 当前研究显示:在常规治疗心肌梗死的基础上加用麝香保心丸可在一定程度上改善心脏功能,但还需要严格设计的、大样本的随机对照试验来进一步验证和支持.     

经导管干细胞移植治疗急性心肌梗死研究

目的应用多种影像学方法评价骨髓干细胞移植后左室功能、左室梗死面积等变化及其安全性。方法首次ST段抬高性急性心肌梗死患者271例入选本项前瞻性、随机、对照研究,随机分为自体骨髓干细胞移植组(BMC组,137例)和对照组(134例)。所有患者均在成功接受冠状动脉介入治疗(PCI)术后3 h内接受细胞移植或0．9%氯化钠溶液注射。结果所有患者随访12个月。与对照组相比,BMC组患者与细胞移植相关的恶性心律失常、再发心肌梗死、心力衰竭、晕厥等不良心脏事件的发生率均未见增加,肿瘤等其他不良事件的发生率亦未见增加。左室造影、磁共振成像(MRI)检查发现BMC组患者12个月时左室射血分数(LVEF)明显提高(P<0．01),INEF增加幅度为(7．7±6．9)％,显著高于对照组(P<0．01), MRI显示心肌梗死面积明显缩小,同时SPECT心肌显像发现心肌灌注缺损面积在移植后也明显缩小[(-7．0±7．5)％,P<0．01]。结论急诊经导管骨髓单个核细胞移植可以改善急性心肌梗死后左室功能,阻止心室重构。     

干细胞移植治疗扩张型心肌病疗效和安全性的系统评价

目的 系统评价干细胞移植治疗原发性扩张型心肌病的临床疗效和安全性.方法 检索中国生物医学文献光盘数据库、中国知网数据库、维普数据库、万方数据库、Cochrane图书馆临床对照试验数据库、OVID Medline和EMBASE.由2名研究人员独立阅读并交叉核对文献资料.主要疗效指标为病死率和心衰量表;次要疗效指标为左室射血分数(LVEF)、左室舒张末期内径(LVED)和6 min步行距离.安全性指标为不良反应事件发生率.采用RevMan 5.0.2软件进行Meta分析.结果 纳入7个随机对照临床试验(RCT),共263例患者.Meta分析结果显示:干细胞移植联合常规药物治疗的3年病死率与单用常规药物治疗相比无明显差别;于细胞移植联合常规药物治疗在提高术后3个月LVEF方面并不优于单用常规药物治疗;尚未发现与干细胞移植有关的不良反应.结论 干细胞移植联合常规药物治疗并不优于单用常规药物治疗;由于纳入的RCT数量较少且质量较低,结论有待更多大规模高质量的研究进一步论证.     

急诊经冠脉自体骨髓单个核细胞移植治疗急性下壁心肌梗死长期随访观察

目的采用前瞻性随机对照研究方法,评价经冠状动脉自体骨髓单个核细胞(BM-MNC)移植治疗急性下壁心肌梗死后6个月时患者心功能以及心肌缺血面积的变化。方法40例首次ST段抬高急性下壁心肌梗死患者,成功完成PCI术后,随机分为细胞移植组(n=20)和对照组(n=20),在急诊冠状动脉造影术同时,经微导管于梗死相关动脉内支架远端注入自体BM-MNC悬液或等量的肝素生理盐水。研究终点为术后6月时延迟增强核磁共振心肌灌注扫描(CMR)测定左室功能和心肌缺血面积。结果CMR记录左室射血分数(LVEF)、左室舒张末期容积(LVEDV)及心肌缺血面积的变化,结果显示与术前相比,两组患者LVEF均有显著提高(对照组47·9%±6·7%vs43·4%±6·7%,P=0·001;细胞移植组51·5%±5·2%vs44·5%±7·1%,P=0·001)。但细胞移植组患者LVEF升高程度(△LVEF)增加明显高于对照组LVEF改善程度(6·95%±3·33%vs4·05%±1·68%,P=0·047),且细胞移植组患者心肌缺血面积减少程度优于对照组,两组间左室舒张末容积变化未见明显差别。结论急性下壁心肌梗死患者经冠状动脉内自体骨髓单个核细胞移植,可显著长期改善患者左室收缩功能和心肌灌注,减少心肌缺血面积。     

冠状动脉内注射单核骨髓细胞治疗急性心肌梗死

背景:先前研究表明,心肌梗死急性期予冠状动脉内注射骨髓(BMC)源性自体细胞可改善患者的左室功能,故设计此随机对照试验以进一步探讨该治疗效果。     

糖代谢异常患者急性心肌梗死时的临床特征及左室收缩功能

目的:探讨糖代谢异常的患者发生急性心肌梗死时的临床特征及对心肌梗死后左室功能的影响。方法:选择以急性心肌梗死首次住院的患者147例,根据有无糖尿病病史及葡萄糖耐量试验结果分为正常血糖组、糖尿病前期组及糖尿病组。分析各组患者临床特征,检测各组患者BNP及LVEF值评价左室功能。结果:77.55%的急性心肌梗死患者合并糖代谢异常;糖尿病前期组和糖尿病组患者入院第2日BNP均高于正常血糖组(P<0.05),各组患者LVEF值无显著性差异(P>0.05)。结论:急性心肌梗死患者中合并糖代谢异常比例较高;合并糖代谢异常的急性心肌梗死患者左室收缩功能受损程度比糖代谢正常的急性心肌梗死患者严重。     

冠状动脉内注射骨髓源性祖细胞治疗急性心肌梗死

背景:初步试验提示,冠状动脉内给予自体祖细胞可改善急性心肌梗死后的左室功能。方法:在一项多中心试验中,204例急性心肌梗死患者被随机分配在成功再灌注治疗后3～7d针对梗死动脉予冠状动脉内注射骨髓(BMC)源性祖细胞或安慰剂。     

心肌梗死后经冠状动脉祖细胞移植

背景:初步研究提示,冠状动脉内移植骨髓(BMC)源性或循环血(CPC)源性祖细胞可改善急性心肌梗死后的左室功能。细胞移植对心肌梗死已治愈患者有何效果尚不知晓。方法:在包括17例患者的最初试验后,在一项对照交叉研究中随机分配75例有既往心肌梗死病史(至少已3个月)的稳定性缺血性心脏病患者接受无细胞注射治疗(23例患者)抑或CPC(24例患者)或BMC(28例患者)注射入供应左室运动障碍最严重区域的开放冠状动脉。     

别嘌呤醇治疗慢性心力衰竭随机对照研究的系统评价

目的：系统评价别嘌呤醇对慢性心力衰竭患者左室收缩功能的改善作用。方法：计算机检索PubMed、The Cochrane li－brary、ISI、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）和万方数据库（WanFang Data）,检索别嘌呤醇治疗慢性心力衰竭的随机对照试验（RCT）,检索时限均为各数据库建库至2014年8月。采用RevMan 5.3 软件进行Meta分析,计量资料采用均数差（mean difference,MD）或标准化均数差（standard mean difference,SMD）及其95％CI作为疗效分析统计量,计数资料采用相对危险度（relative risk,RR）及其95％可信区间（confidence interval,CI）作为疗效分析统计量。结果：共计21个随机对照研究（randomized controlled trials,RCTs）,1384例患者纳入分析。Meta分析结果显示：别嘌呤醇组较对照组能提高左室射血分数（left ventricular ejection fraction,LVEF）（MD=5.83,95%CI=4.65～7.01,P=0.000）,亚组分析显示别嘌呤醇对基线合并高尿酸和非高尿酸血症患者均能改善LVEF,分别为（MD=6.09,95%CI=4.73～7.45,P=0.000）,（MD=4.49,95%CI=2.99～5.99,P=0.000）。同时别嘌呤醇组还能明显降低血浆B型利钠肽（B-type natriuretic peptide,BNP）/N末端B型利钠肽原（N terminal pro-BNP,NT-proBNP）水平（SMD=-0.62,95%CI=-1.00～-0.24,P=0.001）。3篇文献报道了不良反应事件,两组间无差别无统计学意义。结论：别嘌呤醇能显著改善慢性心力衰竭患者的心功能。但受纳入研究质量限制,本系统评价结果尚需更多高质量、大样本、多中心随机对照试验验证。     

经皮冠状动脉介入术对急性心肌梗死患者合并二尖瓣反流的影响

目的:通过6个月以上随访观察,探讨经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)合并二尖瓣反流(MR)的影响.方法:213例AMI患者按治疗方法不同分为常规药物组(126例,服用常规药物)和PCI组(87例,PCI 常规药物),所有患者在住院期间及随访时行超声心动图检查,检测MR程度、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVEDs)、左室舒张末期容量(LVEDV)、左室收缩末期容量(LVESV)、左室射血分数(LVEF),将所得结果进行对比分析.结果:AMI患者住院期间MR的发生率为28.6%,下壁心梗MR发生率明显高于其他部位(34.5%vs 22.3%,P＜0.01).平均随访8.8个月后MR的总发生率为35.4%,PCI组MR发生率较住院期间无显著变化(26.4%vs 27.6%,P＞0.05),而常规药物组MR发生率较心梗急性期有明显增加(43.7%vs30.2%,P＜0.01),且明显高于PCI组(P＜0.01).PCI组LVEDd、LVEDV、LVESV低于常规药物组(P＜0.05),而LVEF高于常规药物组(P＜0.05).结论:急性下壁心肌梗死患者较其他部位心梗患者易出现MR;随着心肌梗死时间延长,MR发生率有增加趋势.PCI通过改善血流及左室重构,可降低或至少不增加MR的发生.     

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…     

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.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…