Homeopathic Agents or Vitamins in Reducing Ecchymosis after Oculofacial Surgery: A Report by the American Academy of Ophthalmology

PurposeTo review the published literature to determine the efficacy and safety of homeopathic agents or vitamins in reducing ecchymosis after oculofacial surgery or laser surgery.MethodsA literature search was conducted in the PubMed database initially in December 2019 and updated in March 2020 to identify all studies in the English language literature on the use of homeopathic agents or vitamins in oculofacial procedures, including laser surgery. The search yielded 124 citations, and 11 articles met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Eleven studies met inclusion criteria; 9 were rated level I, and 2 were rated level III.ResultsThe agents studied in the articles identified included oral or topical Arnica montana (AM), oral Melilotus extract, topical vitamin K oxide, and topical AM combined with Rhododendron tomentosum. Metrics to describe ecchymosis varied. In 7 controlled studies, perioperative AM provided no or negligible benefit versus placebo. In 2 studies, vitamin K cream was equivalent to placebo. One study of oral Melilotus extract had less ecchymosis compared with controls in paranasal and eyelid ecchymosis at postoperative day (POD) 7, but not at PODs 1 and 4. A lone cohort study of combined topical AM and R. tomentosum lacked objective metrics and adequate controls. No serious side effects from administration of homeopathic agents or vitamins were identified.ConclusionsThe current literature does not support the use of AM, vitamin K oxide, R. tomentosum, or Melilotus extract for reducing ecchymosis after oculofacial surgery or pulsed dye laser surgery.     

玉树地震高原医疗救援——特殊性及其对策

目的 2010年4月10日发生在玉树的里氏7.1级地震是世界最高海拔(4000m)青藏高原腹地藏区的大地震,由于救援行动面临高寒缺氧、气候恶劣、地处偏远、交通受阻、伤员高度分散等挑战,故总结高原医疗救援所遇的特殊问题及应采取的对策。方法对玉树地震的伤情特点及死亡原因加以分析,并与汶川地震的伤情分类、严重度、死亡原因及死亡时间分布相比较。分析高原地震创伤学的特殊问题。结果玉树地震与平原地震相比,在创伤学与死亡原因上有很大不同。由于藏区居民房屋的土木沙石结构,地震使90%以上房屋倒塌,形成玉树地震以压埋伤为主和以窒息为主的死因,必须在第一时间采取紧急救援措施。在高原低氧的复合损伤下,各型创伤均易于并发急性呼吸窘迫综合征及多脏器功能障碍综合征,必须紧急救治。为此针对玉树地震高原医疗救援的特殊性,提出了一系列防护措施。结论根据伤亡特点,震后48h进入死亡高峰期,为此强调高原地震"黄金48h"的急救概念。快速有组织向低海拔转运伤病员及转运中供氧是急救成功的两个关键。青藏高原是地震频发区,医疗救援必须加强。     

西藏拉萨市1351例患者幽门螺杆菌感染情况分析

幽门螺杆菌(Helicobacter pylori,HP)是人类上消化道疾病的重要致病菌[1-3].HP的感染与社会经济状况、卫生习惯、饮食习惯有关,且有家庭聚集性,不同国家、地区、人群感染率有明显差异.为了解拉萨市居民HP的感染情况及与相关疾病的关系,对西藏军区总医院1351例随机就诊患者进行了调查分析.     

高原心肌低氧症患者血浆肾素系统和心钠素的变化

为研究高原心肌低氧症患者血浆肾素系统和心钠素的变化，对３０例高原心肌低氧症（ＨＡＭＨ）患者用放免法测定了血浆肾素活性（ＰＲＡ）、血管紧张素ＩＩ（ＡＩＩ）、醛固酮和心钠素（ＡＮＦ）含量，结果发现ＨＡＭＨ患者血浆ＡＩＩ与ＡＮＦ间浓度比例与慢性高原心脏病、长期移居高原健康成人明显不同。并讨论了这些生物活性物质紊乱可能在ＨＡＭＨ发生发展中的作用。     

Predictive Risk Factors of Cardiorespiratory Abnormality for Upper Gastrointestinal Endoscopy in Tibet

Background

To explore the predictive factors of cardiorespiratory abnormality in nonsedated patients at high altitude (HA) during upper gastrointestinal endoscopy (UGIE).

Methods

The pulse and saturated oxygen (SaO₂) levels of 993 patients undergoing nonsedated UGIE in Tibet were monitored. Bivariate correlation and logistic regression were used to identify predictive risk factors for hypoxemia.

Results

The basal and minimum SaO₂ levels during UGIE of the Tibetan group were significantly higher than those of the non-Tibetan group. The minimum SaO₂ and maximum pulse in the HA transient residents groups were significantly higher than those in the HA usual residents groups. The incidences of hypoxemia and severe hypoxemia in the Tibetan groups were significantly lower than those of the non-Tibetan groups. Bivariate correlation and logistic regression showed that race, age (≥40 years), residence time in HA (<10 years), and basal SaO₂ (<89 %) were sufficiently effective to predict hypoxemia. High-risk hypoxemic patients whose residence time in HA was <2 years were more prone to severe hypoxemia. The combination of the four variables showed superior performance in hypoxemia prognosis (AUC-ROC, 0.941; sensitivity, 83.7 %; specificity, 92.5 %) and severe hypoxemia prognosis (AUC-ROC, 0.968; sensitivity, 90.3 %; specificity, 98.0 %).

Conclusions

Race, age, residence time in HA, and basal SaO₂ of patients in HA were predictive variables for hypoxemia during UGIE. Non-Tibetan patients with age ≥40 years, residence time in HA <10 years, and basal SaO₂ <89 % were prone to hypoxemia. Among those groups, patients whose residence time was <2 years were at higher risk for severe hypoxemia.     

常驻拉萨官兵3091人血压调查分析

目的了解高海拔环境对移居人群血压的影响。方法收集2008年为拉萨部队体检的血压测量数据,回顾调查同批人员在内地入伍时的血压测量数据,对两者进行对比分析。结果与内地入伍时相比,常驻拉萨海拔3658m高原部队青年官兵平均动脉收缩压为107mmHg,下降8mmHg,平均动脉舒张压为71mmHg,下降3mmHg,平均脉压为36mmHg,下降5mmHg。结论高海拔环境可导致移居人群血压的显著改变。     

麻黄汤的发汗作用与M受体的关系研究

目的:探讨麻黄汤的发汗作用机制与M受体的关系。方法:将70只小鼠随机分为麻黄汤+硫酸阿托品注射液0·1mg/kg组、麻黄汤+硫酸阿托品注射液0·4mg/kg组、硫酸阿托品注射液0·1mg/kg+麻黄汤组、硫酸阿托品注射液0·4mg/kg+麻黄汤组、麻黄汤组、硫酸阿托品注射液0·1mg/kg组、空白对照(生理盐水)组,给药后30min,采用组织形态学方法观察小鼠腋窝部皮肤汗腺组织,以判断其发汗作用强弱。结果:麻黄汤具有发汗作用,阿托品对麻黄汤的发汗作用有抑制作用,但不能完全阻滞,随着阿托品剂量增加,发汗作用减弱;麻黄汤+阿托品组的发汗作用强于阿托品+麻黄汤组。结论:麻黄汤发汗作用与激动M受体有关,但并非唯一途径。     

全反式维甲酸诱导分化治疗对胃癌患者免疫功能的影响

目的 观察全反式维甲酸（all trans retinoic acid,ATRA)诱导分化治疗对胃癌患者免疫功能的影响。方法 对56例胃癌患者进行诱导分化测定，测定外周血T淋巴细胞亚群（T－Ls)和血清白细胞介素Ⅱ受体（sIL-2R)水平。结果 根治性手术组；CD3、CD4细胞数及CD4／CD8比值较对照组明显增高，sIL-2R水平明显降低；经ATRA治疗后，上述指标接近正常对照组；未手术或未根治性手术组：经ATRA治疗后，CD3、CD4细胞数及CD4／CD8比值也明显增高，sIL-2R水平明显降低。结论 ATRA诱导分化治疗有效提高胃癌患者的免疫功能。     

高原环境下高原病再发的流行病学研究

目的了解在高原环境下住院高原病患者的预后。方法以医院(海拔3658m)40年间收治、并符合筛选标准的19118例住院病历为样本,随访1～15年,样本中以高原病首次住院为病例组,以非高原病首次住院者为对照组。随访两组高原病的发病情况,并进行临床流行病学的分析。结果(1)对照组的急性高原病发病率、总体发病率随观察年限延长而增加且呈正相关(r急=08259,P<001,r总=06815,P<005);急性高原病组和慢性高原病组的慢性高原病发病率随观察年限延长而减低,且呈负相关(r急1～7=08993,P<001;r慢1～9=09068,P<0001)。(2)病例组总体高原病逐年发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001),RR=1129。(3)各型高原病发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001)。急性高原病组以急性轻型高原病和高原肺水肿发病率最高,达1712%和2766%,RR=759;慢性高原病组以急性轻型高原病和Monges病发病率最高,达1284%和1119%,RR=531。结论高原病患者再发生高原病的风险显著增加,不适宜长期滞留高原地区。     

高原人附红细胞体的感染与防治

目的了解高原环境条件人附红细胞体的感染状况及人附红细胞体病的治疗效果。方法用末梢血或静脉血、骨髓常规涂片、固定、染色、镜检方法检测了西藏7地(市)不同人群、不同年龄、不同民族的血样3214份及住院附红细胞体病患者9例血样或者骨髓标本中的附红细胞体。结果3214份标本人附红细胞体总感染率为3·2%,男性、女性附红细胞体感染率分别为3·3%(58/1768)和3·1%(45/1446),男性高于女性,但差异无显著性(P>0·05)。9例附红细胞体病患者均有进行性贫血、发热、黄疸、疲劳、出汗等临床症状。实验检查红细胞、血红蛋白降低,网织红细胞升高,白细胞正常或轻度升高,血小板正常或降低,谷丙转氨酶轻度升高。经用四环素、甲硝唑、庆大霉素等治疗效果明显。结论高原环境条件人附红细胞体的感染多数呈潜伏状态,严格消毒隔离制度,搞好附红细胞体病知识的宣传教育,对降低人附红细胞体的感染率及人附红细胞体病的发病率具有积极的作用。