全膝关节置换后应用自体血回输器是否必要：一项Meta分析

BACKGROUND: Total knee arthroplasty is a procedure for treatment of knee osteoarthritisa with standardized, mature technology and affirmative efficacy. Total knee arthroplasty can result in overt excessive bleeding, decreased hemoglobin levels, patient mouth infection and other complications. As a new technology, autologous blood transfusion device can effectively reduce the rate of blood transfusion through reinfusing the unwashed and filterable drainage blood after operation. Up to now, no systematic reviews incorporating meta-analyses have found directly sufficient evidence to compare autologous blood transfusion drainage and no drainage after primary total knee arthroplasty.OBJECTIVE: To study the clinical efficacy, safety and potential advantages of the application of autologous blood transfusion device/no drainage based on the meta-analysis.METHODS: PubMed, Embase, the Cochrane Library, CBMdisc, China HowNet, VIP, Wanfang database were searched comprehensively by computer. The search strategies were developed by the way of MeSH terms combining with free words: “total knee replacement” OR “total knee arthroplasty” OR “total knee prosthesis” OR “unicompartmental” OR “unicondylar” OR “unicompartmenta” OR “arthroplasty, replacement, knee” [MeSH terms] AND “autologous blood transfusion” OR “Autotransfusion” OR “blood transfusion, autologous” [MeSH Terms] OR “Intraoperative Blood Salvage” OR “Intraoperative Blood” OR “Postoperative Blood Salvage” OR “Intraoperative Blood Cell Salvage” OR “Operative Blood Salvage” [MeSH Terms]. Data included in the final literature were analyzed using RevMan 5.3.5 software recommended by Cochrane. The main outcome measure was the rate of transfusion. The secondary outcome measures were the average change in hemoglobin, hemoglobin levels at the 3^rd day, hospitalization time and intraoperative mouth infection rate.RESULTS AND CONCLUSION: Five randomized controlled trials, a total of 667 patients were enrolled. Meta-analysis results showed that there were no significant differences in the transfusion rate (OR=0.73, 95%CI: 0.47-1.13; Z=1.41, P=0.16), average change in hemoglobin (WMD=0.20, 95%CI: -0.28-0.68; Z=0.82, P=0.41), the hemoglobin levels at the 3^rd day (WMD=0.41, 95%CI: -0.26-1.09; Z=1.20, P=0.23), hospitalization time (OR=1.01, 95%CI: 0.06-16.27; Z= 0.01, P=1.00), intraoperative mouth infection rate (OR=1.01, 95%CI: 0.06-16.27; Z=0.01, P=1.00) between the postoperative use of autologous blood transfusion and no drainage. These results suggest that the meta-analysis of outcome measures has not provided the evidence-based medical support for the clinical efficacy of autologous blood transfusion device (including blood transfusion rate, the average change in hemoglobin, average hemoglobin change at the 3^rd day, hospitalization time). Given the inherent limitations of the quality of the included studies and the publication bias, future high-quality, large-volume, multi-center randomized controlled trials are awaited to confirm and update the findings of this analysis.  中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Smoking and Glioma Risk: Evidence From a Meta-Analysis of 25 Observational Studies

To systematically assess the relationship between smoking and glioma risk.A dose–response meta-analysis of case–control and cohort studies was performed. Pertinent studies were identified by searching database and reference lists. Random-effects model was employed to pool the estimates of the relative risks (RRs) with corresponding 95% confidence intervals (CIs).A total of 19 case–control and 6 cohort studies were included. Overall, compared with those who never smoked, the pooled RR and 95% CI was 0.98 (0.92–1.05) for ever smoker. The subgroups were not significantly different regarding risk of glioma except the group of age at start smoking (RR = 1.17, 95% CI: 0.93–1.48 for age < 20; RR = 1.25, 95% CI: 1.02–1.52 for age ≥ 20). Dose–response analysis also suggested no significant association between smoking and the risk of glioma, although some evidence for a linear relationship between smoking and glioma risk was observed.In conclusion, this meta-analysis provides little support for a causal relationship between smoking and risk of glioma.     

EB病毒相关性肿瘤疾病

EB病毒（EBV）是一种能诱发肿瘤的疱疹病毒。近年来,有关EBV在人体内生存的机制、感染后的免疫调控、相关疾病的发病机制等方面均有了新的认识。现就近年来EBV相关性肿瘤的研究进展情况进行介绍。     

机器学习在急性缺血性卒中并发症中的应用进展

机器学习在脑血管疾病诊疗中的应用是目前研究的热点.作者从急性缺血性卒中并发症的角度,总结不同机器学习模型在急性缺血性卒中并发症的发生、危险因素预测、影像图像分割及发病机制应用中的研究进展,以期为国内研究者提供参考.     

亚临床甲状腺功能减退对颈动脉粥样硬化和心功能的影响

目的 探讨亚临床甲状腺功能减退对颈动脉粥样硬化和心功能的影响。方法 随机选取2016年5月~2017年8月西安医学院第二附属医院内分泌科收治的286例患者,根据甲状腺紊乱诊断标准随机选取甲状腺功能减退患者50例为研究组,选择甲状腺功能正常患者50例为对照组。比较两组患者的一般临床资料、血脂、血糖、血中同型半胱氨酸,两组心功能检测指标（LVEF、E/E'、NT-proBNP）、斑块积分、脉搏波速度。将血浆促甲状腺激素水平与心功能检测指标、动脉彩色多普勒超声及脉搏速度检测结果进行Pearson线性相关分析。结果 研究组血压高于对照组,差异具有统计学意义（P＜0.05）;血脂各项检测指标及Hcy水平高于对照组,统计学意义显著（P＜0.01）。研究组E/E'值、血浆NT-proBNP水平均高于对照组[（9.85±1.56）vs（11.42±2.34）],[（90.46±10.36）pg/mlvs（145.32±16.61）pg/ml],统计学意义显著（P＜0.01）。血浆TSH水平与E/E'值、血浆NT-proBNP水平呈显著正相关（P＜0.01）。研究组斑块平均积分、PWV均高于对照组,统计学意义显著（P＜0.01）。血浆TSH水平与斑块积分、PWV均呈显著正相关（P＜0.01）。结论 TSH与颈动脉粥样硬化形成、心功能受损明显相关,可能通过引起血脂、血压异常,进一步加大颈动脉粥样硬化及心功能损害的风险。     

升阶梯法治疗重症急性胰腺炎

重症急性胰腺炎是一种具有潜在致命性的疾病。近年来,随着对重症急性胰腺炎研究的不断深入以及微创外科等相关学科的迅速发展,重症急性胰腺炎的治疗理念也发生了巨大的变革。强调多学科、分阶段、微创的升阶梯法打破了传统外科手术的模式,成为重症急性胰腺炎治疗的新理念,其显著的临床疗效也受到国内外学者的广泛认可。     

CT联合IVU预定位超声实时修正定位在经皮肾镜通道建立中的应用

目的探讨经皮肾镜碎石取石术（PCNL）初学者采用CT联合静脉/排泄性尿路造影（IVU）预定位超声术中实时修正定位在经皮肾镜通道建立中的应用价值。 方法选取2016年1月至2016年11月我科住院的肾结石或输尿管上段结石拟行PCNL术的成人患者共128例,分为预定位组和常规组。预定位组患者术前预设穿刺路径,对照组采用常规术中实时定位。术前预定位组68例患者,术前根据CT和IVU设计穿刺路径、预定穿刺点。术中超声监视下对预定穿刺点进行修正,建立工作通道。常规组60例患者术前不进行预定位,术中实时超声定位。比较两组患者的皮肾通道建立时间、手术时间、血红蛋白损失情况,一次结石清除率等及其他并发症发生率,并进行统计分析。 结果两组患者术前性别比例、年龄、结石大小、结石表面积和体质量指数比较差异无统计学意义。术后一次结石清除率、血红蛋白丢失和介入治疗比较差异无统计学意义。术前预定位组通道建立时间明显少于对照组（P<0.05）。常规手术组术后介入治疗止血1例。预定位组手术时间较常规组少,但差异无统计学意义。 结论采用CT联合IVU预定位超声术中实时修正定位在经皮肾镜通道建立中能够更好选择最佳穿刺路径,提高穿刺准确性,缩短通道建立时间,值得在基层医院和PCNL初学者中推广应用。     

中耳手术后并发颈性眩晕的临床分析

目的：总结中耳手术后并发颈性眩晕的诊治经验。方法：回顾分析4例中耳手术后并发颈性眩晕患者的临床资料。结果：4例患者均在全身麻醉清醒后出现与头位转动密切相关的眩晕,并伴颈枕及颈侧肿痛,颈部旋转诱发试验阳性,4例患者经口服地芬尼多片及静滴丹参、能量合剂等治疗,眩晕均在5～7d内治愈。结论：眩晕发作与头位转动密切相关并伴颈痛是诊断颈性眩晕的关键,术中头位过度偏曲是造成中耳术后颈性眩晕的原因,抗眩晕及扩管治疗是有效的治疗方法,本病预后好,与迷路损伤所致眩晕相鉴别有重要的临床意义。