复方甘草酸苷注射液改善慢性乙型肝炎肝损伤疗效和安全性的系统评价与Meta分析

为系统评价复方甘草酸苷注射液(Compound Glycyrrhizin Injection,CGI)改善慢性乙型肝炎(chronic hepatitis B,CHB)肝损伤的有效性和安全性。该研究系统检索了PubMed、Web of Science、CBM、CNKI、Wanfang和VIP数据库,检索时限为建库至2020年2月10日。纳入CGI治疗CHB的随机对照试验(randomized controlled trial,RCT),由2名作者独立对纳入研究进行资料提取,并采用Cochrane偏倚风险评价工具对纳入研究进行方法学质量评价。应用RevMan 5.3软件进行数据统计分析。最终纳入18项双臂RCT,1915例受试者。所有纳入研究的方法学质量总体不高。对于CGI vs甘草酸二铵,CGI在提高临床总有效率上优于对照组,而在提高ALT复常率、降低ALT及AST水平上2组无统计学差异;对于CGI vs甘草酸二铵+其他一般保肝药,CGI在降低AST水平上优于对照组,而在降低ALT水平和提高临床总有效率上2组无统计学差异;对于CGI+其他常用药(包括能量合剂、谷胱甘肽、维生素及门冬氨酸钾镁等)vs甘草酸二铵+其他常用药,CGI联合其他常用药在降低ALT及AST水平、提高临床总有效率上均优于对照组,而在提高ALT复常率上2组无统计学差异;对于CGI+其他常用药vs其他常用药,CGI联合其他常用药在降低ALT及AST水平、提高临床总有效率上均优于对照组;对于CGI+维生素vs甘草酸二铵+门冬氨酸钾镁+维生素,在降低AST水平上2组无统计学差异。少数纳入研究报告了CGI单独或联合其他药物使用过程中会引起轻度不良反应。研究结果表明,CGI对改善CHB肝损伤具有一定疗效,目前证据尚不足以证明CGI会引起较严重安全性问题。未来仍需更多严格设计、足够样本量并严格实施的RCT进一步评价CGI改善CHB肝损伤的效果。     

前列腺动脉栓塞术与经尿道前列腺电切术治疗前列腺增生的Meta分析

目的比较前列腺动脉栓塞术(PAE)与经尿道前列腺电切术(TURP)治疗良性前列腺增生的疗效与安全性,为前列腺增生症适宜治疗方案的选择提供理论依据。方法通过检索PubMed、EMBASE、Cochrane Library、CNKI、CBM、维普和万方等数据库,筛选出符合要求的PAE和TURP对比研究,并对所有纳入文献进行质量评价和资料提取,最后应用统计学软件Rev Man 5.3进行Meta分析,比较PAE与TURP治疗良性前列腺增生的优劣势。结果本研究最终共纳入9篇文献,共计675例患者。Meta分析结果显示:①临床疗效方面,术后3个月,TURP组优于PAE组,疗效指标IPSS、QOL、Qmax、PVR、PV的改善差异有统计学意义;术后12个月,TURP组改善情况优于PAE组,虽然指标IPSS、PVR的改善差异无统计学意义,但其余指标QOL、Qmax、PV的改善差异具有统计学意义;术后24个月,PAE组与TURP组治疗效果相近,指标IPSS、QOL、Qmax、PVR、PV的改善差异无统计学意义;PAE组失败率(4.4%)大于TURP组(0.5%);②安全性方面,PAE组比TURP组术中出血量少[MD=-98.25,95%CI:-105.51^-91.00,P<0.00001]、留置导尿时间短[MD=-1.61,95%CI:-2.31^-0.90,P<0.0006]、住院时间短[MD=-3.07,95%CI:-4.40^-1.74,P<0.00001];两组手术时间差异无统计学意义[MD=17.28,95%CI:-15.92~50.48,P=0.31];PAE组并发症(21.6%)少于TURP组(33.7%)。结论PAE治疗良性前列腺增生短期疗效(3个月)不及TURP;但中长期疗效(24个月)与TURP相近。总体来说,PAE较TUPR安全性高,具有术中出血量少,留置导尿时间短、住院时间短、并发症少的优点,对于不能耐受麻醉及TURP者可选择PAE治疗良性前列腺增生。但PAE手术失败率相对较高,其疗效的稳健性相对较差,目前尚没有足够的证据认定PAE优于TURP。未来随着更大样本、更多中心以及设计精良的随机对照试验出现,PAE用于治疗前列腺增生的疗效可以得到进一步的论证。     

Comparative analysis of functional and aesthetic outcomes of retroauricular full thickness versus plantar glabrous split thickness skin grafts in pediatric palmar hand burns

BackgroundOptimal management of palmar hand burns in children is controversial. We aimed to compare function and aesthetics of retroauricular full thickness skin grafts (FTSG) to plantar glabrous split thickness skin grafts (STSG).Methods32 palmar grafts in paediatric burn patients were analysed: 19 retroauricular FTSG (group 1) and 13 thick plantar glabrous STSG (group 2). The latter were harvested at a thickness of 0.5 mm. The resulting plantar donor defects were covered with a STSG from the scalp, a sequential surgical technique we termed the “Zurich move”. Clinical examination, Cutometer and Colorimeter assessment and validated patient and observer questionnaires were used. Donor site complications and subjective complaints were recorded.ResultsColorimeter results were superior in group 2 with an erythema score of 5.73 ± 2.64 (group 1) versus 2.33 ± 1.97 (group 2, p < 0.001) and a pigmentation score of 9.82 ± 5.42 (group 1) and 1.89 ± 1.92 (group 2, p < 0.001). Observers` scar evaluation using VSS and POSAS showed significantly superior results in group 2 for almost all items. Conversely, group 1 grafts were less stiff with mean normalized tissue extension R0 of 0.80 ± 0.21 versus 0.57 ± 0.24 in group 2 grafts (p < 0.05). In both groups donor sites complications were rare.ConclusionPlantar glabrous STSG showed superior functional and aesthetic results when compared to FTSG in pediatric palmar hand burns. In addition, the “Zurich Move” is safe and provides uncomplicated donor site healing on the scalp and the foot allowing rapid restoration of full function.     

肿瘤坏死因子相关凋亡诱导配体在再生障碍性贫血患者中的表达及意义

目的通过检测再生障碍性贫血(AA)患者骨髓单个核细胞表面肿瘤坏死因子相关凋亡诱导配体(TRAIL)的表达,探讨TRAIL在AA造血干细胞凋亡中的作用。方法采用流式细胞术对12例AA患者(AA组)、11例AA治疗后缓解患者(缓解组)、12例正常对照者(对照组)骨髓单个核细胞表面TRAIL的表达进行检测。结果 AA组、缓解组、对照组TRAIL均有表达;AA组TRAIL的阳性表达率(5.8±3.3)%高于缓解组(2.4±2.0)%和对照组(3.2±2.2)%(P<0.05);缓解组与对照组间差异无统计学意义(P>0.05)。结论 TRAIL在AA患者骨髓单个核细胞表面的表达阳性率增高,提示TRAIL介导的细胞凋亡可能在AA的发病机制中发挥一定的作用。     

Comparative effectiveness of different acupuncture courses in functional constipation: A Bayesian network meta-analysis of clinical trials

AimThe purpose of this study was to examine the comparative effectiveness of different acupuncture courses for functional constipation (FC).BackgroundThere is a need to optimize the treatment course of acupuncture for FC to improve efficacy and save health resources.MethodsWe performed a systematic electronic search of eight databases from inception to April 2021. Randomized controlled trials comparing acupuncture treatment with sham acupuncture were included. The main outcome indicators were complete spontaneous bowel movement (CSBM), spontaneous bowel movement, Bristol Stool Form Scale (BSFS), responder rate and safety evaluation (SE).ResultsIn this network meta-analysis, 19 studies with 1753 participants and 8 different acupuncture treatments were included. Using the consistency model via Monte Carlo simulation iterations, we found that the effect of acupuncture treatment at 3/4 weeks may be better in terms of CSBM and BSFS. The results of rank probability analysis showed that 6 weeks of treatment may be better for the responder rate, and 2 weeks of treatment may be better for SE. And, subgroup analysis found that, for patients with chronic severe functional constipation (CSFC), 8 weeks of acupuncture treatment may be the best for CSBM.ConclusionsBy indirect comparison, 3/4 weeks of acupuncture treatment may be the optimal course of treatment for FC in terms of improving bowel frequency and stool shape. And for CSFC, 8 weeks of acupuncture treatment may be the best. However, there is still a lack of direct comparison and publication bias that affects the accuracy of research results.     

Characterising tibialis posterior tendinopathy using the International Classification of Functioning,Disability and Health: a cross sectional study

BackgroundTibialis posterior tendinopathy (TPT) is characterised by pain around the medial foot/ankle and difficulties weightbearing.ObjectiveCompare individuals who have TPT with asymptomatic controls across the International Classification of Functioning, Disability and Health (ICF) domains of body structure and function, activity, participation and personal factors.MethodsTwenty-two individuals meeting the selection criteria for TPT (86% female, mean ± SD age:43 ± 13 years; body mass index [BMI]:28 ± 7 kg/m²) were compared to 27 controls (93% female, age:44 ± 16 years, BMI:23 ± 5 kg/m²). Standardised differences (and 95% confidence intervals [CIs]) between groups were estimated for outcomes under each ICF domain using Cliff's delta to allow for comparison of the magnitude of deficits across outcomes (>0.47 considered large).ResultsImpairments in body structure and function in individuals with TPT were accompanied by activity limitations including difficulties due to foot problems (-1.0 (-1.0, -1.0)) and with independent living (-0.8 (-1.0, -0.3)) and greater time to complete stair descent/ascent (-0.6 (-0.8, -0.3)). Considering participation, overall foot-related function (-1.0 (-1.0, -1.0)), ability to participate in activities (-0.7 (-0.08, -0.3)), social restrictions (-0.8 (-1.0, -0.4)) and quality of life (-0.7 (-0.9, -0.5)) were poorer in individuals with TPT.ConclusionIndividuals with TPT have large impairments in body structure and function, activity limitations and participation restrictions, particularly relating to independent living, mental health and pain. Personal factors appear to contribute to a lesser extent to the TPT presentation. Treatment plans should consider activity and participation limitations in addition to body structure and function.     

Effectiveness of intensive versus regular or no exercise in older adults after hip fracture surgery: A systematic review and meta-analysis

BackgroundIndividuals commonly experience age-related systemic decreases in skeletal muscle strength, physical function, and mobility, leading to falls and potential associated hip fractures.ObjectiveTo evaluate whether intensive exercise can improve physical function, mobility, and independence in activities of daily living (ADL) and shorten the length of hospital stay in older adults after hip fracture surgery.MethodsThis systematic review was conducted under the PRISMA guidelines. Searches were performed on January 5, 2022 in eight databases. Randomized controlled trials (RCTs) were included. The participants included older adults with hip fracture, and the intervention studied was intensive exercise. The outcomes were physical function, mobility, ADLs, and the length of hospital stay. Meta-analyses were conducted using RevMan 5.3.ResultsFifteen studies were included in this review. After hip fracture surgery, intensive exercise improved participants’ physical function to a greater extent than regular or no exercise (standardized mean difference [SMD] = 0.74; 95% CI: 0.25, 1.23). Intensive exercise was particularly more effective for gait speed (SMD = 0.15, 95% CI: 0.01, 0.30), the timed up-and-go test results (mean difference [MD] = -4.34, 95%CI: -6.74, -1.94), balance (SMD =0.42, 95% CI: 0.38, 0.89), and ADLs (SMD = 0.55, 95% CI: 0.24, 0.87). The quality of the evidence was low due to risk of bias, inconsistency, and imprecision.ConclusionsIntensive exercise early post-operation provides potential additional benefits compared to no or regular exercises on older adults after hip fracture surgery.     

Bariatric surgery decreased the serum level of an endotoxin-associated marker: lipopolysaccharide-binding protein

BackgroundRecent studies have shown serum lipopolysaccharide binding protein (LBP) is associated with obesity and related metabolic disorder. Bariatric surgery can significantly reduce weight, but reports about the change of LBP after bariatric surgery are limited. We investigated LBP concentration and its associations with clinical variables.MethodsWe enrolled 178 obese patients receiving different bariatric surgeries and 38 normal weight individuals. Fasting blood samples were collected at baseline in all and 1 year after surgery in obese individuals. The serum LBP concentration was measured.ResultsThe percentage of excess weight loss of mini-gastric bypass, Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric band were 72.0±20.0%, 65.5±23.0%, 67.2±18.4%, and 16.1±14.3%, respectively. Serum LBP levels were higher in the obese participants than in the normal weight participants (49.9±15.7 versus 25.2±7.5 μg/mL; P<.001) at baseline and significantly decreased to 35.1±22.6 μg/mL after bariatric surgery (P<.001) in the obese group. In the bariatric participants, after multivariate analyses, preoperative LBP and the change of LBP with surgery were independently associated only with high sensitive C-reactive protein (hs-CRP) (P<.001) and the change of hs-CRP (P = .012), respectively, while none of the postoperative variables was independently associated with LBP.ConclusionLBP is associated with body mass index and hs-CRP. Bariatric surgery significantly decreased the serum level of LBP. The relationship between LBP and hs-CRP disappeared after bariatric surgery. (Surg Obes Relat Dis 2014;0:000–000.) © 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.     

自噬相关基因Beclin1和MAP1LC3B在胆囊癌组织中的表达及其意义

目的 检测自噬基因Beclin1、MAP1LC3B在原发性胆囊癌组织中的表达情况,探讨细胞自噬在胆囊癌发生中的作用及其临床意义.方法 采用免疫组织化学SP方法,检测Beclin1、MAP1LC3B在胆囊癌组织中的表达情况,并以同期手术切除的胆囊炎性疾病组织为对照;统计Beclin1和MAP1LC3B的表达情况,并分析其与胆囊癌临床病理特征之间的关系.结果 胆囊癌组和慢性胆囊炎组Beclin1的阳性表达率分别为45.7％和78.3％,MAP1LC3B的阳性表达率分别为47.8％和71.7％,两组差异有统计学意义（P＜0.05）.Beclin1和MAP1LC3B在不同年龄、性别、癌组织分化程度患者中的表达水平差异无统计学意义（P＞0.05）,但与周围脏器侵犯情况、病理TNM分期有关（P＜0.05）.Beclin1和MAP1LC3B在胆囊癌组织中的表达水平呈正相关（r=0.538,P＜0.01）.结论 胆囊癌组织中Beclin1和MAP1LC3B表达水平明显低于胆囊炎性疾病组织;Beclin1和MAP1LC3B的表达水平与胆囊癌侵袭能力及TNM分期有关,且两者表达呈正相关;提示Beclin1和MAP1LC3B是反映胆囊癌生物学行为的重要指标,两者之间可能存在着某种共同通路.     

TAP、FOXJ1基因多态性与自身免疫性疾病相关性的研究进展

自身免疫性疾病（AD）是指机体对自身抗原发生免疫反应导致自身组织损害所引起的疾病.AD发病机制尚未明确,近年来国内外学者越来越多地将目光投在遗传背景上,欲从分子水平上探讨其病因,特别是TAP、FOXJ1基因多态性与自身免疫性疾病的研究备受关注.