椎间盘镜与传统开放术治疗腰椎间盘突出症疗效和安全性比较的Meta分析

目的:比较椎间盘镜与传统开放椎间盘摘除术治疗腰椎间盘突出症的疗效与安全性。方法:在中国生物医药数据库,CNKI数据库,重庆VIP数据库和万方数据库进行系统文献检索。Meta统计分析使用RevMan4.2软件完成。对两种手术方法的优良率、手术时间、术中失血量、术后卧床休息时间、恢复日常活动时间、住院或手术后住院天数,以及并发症进行比较。结果:总共纳入了20篇文献,其中2957例患者行椎间盘镜术,而2130例患者行传统开放椎间盘摘除术。有12篇报道比较了两种治疗方法的手术时间,11篇比较了术中失血量,7篇比较了术后卧床休息时间,5篇进行了术后恢复日常活动所需时间的比较,另外分别有4篇比较了住院日及术后住院天数。其中有10篇文献提到了手术并发症。与开放手术比较,椎间盘镜治疗的患者有较高的优良率[OR=1.29,95%CI(1.03,1.62)],术中出血量少[OR=-63.67,95%CI(-86.78,-40.55)],更少的卧床休息时间[OR=-15.33,95%CI(-17.76,-12.90)],恢复日常活动所需时间更短[OR=-24.41,95%CI(-36.86,-11.96)],更少住院日[OR=-5.00,95%CI(-6.94,-3.06)]或手术后住院天数[OR=-7.47,95%CI(-9.17,-5.77)]。但是在手术并发症发生率和手术时间方面,两者之间差异无统计学意义。结论:椎间盘镜与传统开放术治疗腰椎间盘突出症均是安全有效的,手术并发症发生率相当。与传统手术比较,椎间盘镜治疗出血量少,术后卧床休息天数及住院日短,并且能更快地恢复日常生活。选择哪种手术方式主要根据患者的适应证,在相同适应证的情况下椎间盘镜手术应该被推荐。     

昆明山海棠化学成分研究

目的 研究昆明山海棠Tripterygium hypoglaucum根中的化学成分。方法 利用硅胶、Sephadex LH-20柱色谱及半制备HPLC进行分离纯化,采用¹H-NMR、¹³C-NMR、ESI-MS等多种波谱技术鉴定获得的化合物结构。结果 从昆明山海棠根乙醇提取物的二氯甲烷部位分离得到6个化合物,分别鉴定为2-（5'',7''-二甲氧基-2'',2''-二甲基-2H-苯骈吡喃-6''-）-3-甲酰基-5,6-二甲氧基-苯骈呋喃（1）、3（R）-（4'',5''-二羟基）-2'',5,7-三甲氧基-6-（3-甲基-2-丁烯基）-异黄酮（2）、3''-香叶草基-5,7,2'',5''-四羟基异黄酮（3）、β-谷甾醇棕榈酸酯（4）、甘油山嵛酸酯（5）、β-谷甾醇（6）。结论 化合物1为新化合物,命名为毛秔子梢素C;化合物2~5为首次从该植物中分离得到。     

肌少-骨质疏松症专家共识

肌少-骨质疏松症已成为全球性的公共健康问题和前沿研究难题。目前仍存在对肌少-骨质疏松症的临床知晓率低、重视不够、诊断治疗方法单一、管理不完善等实际问题。中国健康促进基金会组织专家编写《肌少-骨质疏松症专家共识》,为肌少-骨质疏松症的临床诊疗和科学研究提供参考。共识论述了肌少-骨质疏松症是肌少症和骨质疏松症并存的退行性代谢综合征,有共同的发病基础,诊断标准应是骨质疏松症与肌少症并存,预防比治疗更重要。肌少-骨质疏松症的治疗目标是改善肌量、肌力、身体平衡、骨量和骨质量,避免出现跌倒和骨折。肌少-骨质疏松症的管理应肌骨并重,综合诊断、规范治疗,医患合作,建立科学评估、定期随访机制。     

妇科疑难杂症的中医诊治思路

[目的]结合本人40余年的临床经验,总结妇科疑难杂症的中医诊治思路。[方法]分析妇科疑难杂症的临床特点,总结中医药的诊治特色和思路,分享临床典型案例。[结果]妇科疑难杂症患者常常在妇科疾病的基础上兼有复杂的内科疾病,病情错综复杂,需辨证明确,应详察四诊、首重问诊;要重视抓主症、寻兼症、明辨证;临床上要重视辨证和辨病相结合;治疗注意扶正祛邪、调和阴阳。[结论]中医药治疗妇科疑难杂症具有良好的疗效,对妇科疑难杂症只有理清思路,方能药病中的。     

范炳华教授追本溯源法诊治下腰痛学术经验探析

[目的]探析范炳华教授诊治下腰痛的学术经验。[方法]通过跟随范炳华教授临床实践,复习验案,总结范炳华教授诊治下腰痛的临证经验,并附典型病例以佐证范炳华教授诊治下腰痛的思维和方法。[结果]范炳华教授基于“症因相关”理论,主张“有症必有因,症因要相关,治因应为先”的学术思想,临证注重以临床症状为起点,结合病史,运用专科检查方法,探寻下腰痛的内在病因之源,并将其归纳为三源,胸腰椎源性下腰痛治则为定点纠偏,骶髂关节源性下腰痛则行理筋整复,尾椎源性下腰痛则施捋顺解痉,分门别类进行相应精准治疗,临床疗效显著。[结论]范炳华教授“追本溯源”学术思想对临床诊疗下腰痛有很好的指导意义,临床实用性强,值得推广和借鉴。     

Successful treatment of ankylosing spondylitis with alternative and complementary medicine withdrawal of adalimumab treatment

Background and purposeCurrent treatment strategies for ankylosing spondylitis (AS) include adalimumab and other biological drugs. However, treatment failures and side effects are commonly observed. This report documents the successful use of supplements and dietary changes to treat a patient with AS after cessation of adalimumab therapy.Patient presentationA 38-year-old human leukocyte antigen B27 positive female patient with AS showed no improvement when treated with a non-steroidal anti-inflammatory drug. The patient then began adalimumab therapy with some success; however, after nine months, she developed a disseminated and refractory Molluscum contagiosum infection. Adalimumab was withdrawn, and the patient started taking supplements, while adopting an anti-inflammatory diet (dairy-free, gluten-free, and sugar-free). Normalization of inflammatory markers was achieved after two months, and magnetic resonance imaging of the sacroiliac revealed a notable physical improvement.     

Baduanjin exercise ameliorates motor function in patients with post-stroke cognitive impairment: A randomized controlled trial

Background and purposeAs a traditional Chinese mind-body exercise, Baduanjin has been documented to have a positive effect on cognitive and physical function in a wide range of populations, but it is unclear whether it helps improve motor function in patients with post-stroke cognitive impairment (PSCI). The aim of this two-arm, randomized, parallel controlled study was to explore the rehabilitation effect of Baduanjin exercise on motor function in patients with PSCI.Materials and methodsForty-eight patients with PSCI were randomly assigned to control and intervention groups. The control group received health education sessions on stroke prevention and rehabilitation. The intervention group received Baduanjin training in addition to the health education intervention. Before and after the 24-week intervention, both groups completed the Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Manual Muscle Test (MMT), Modified Ashworth Scale (MAS), and Three-Dimensional Gait Analysis (3DGA).ResultsAfter the 24-week intervention, both groups showed significant improvements in the FMA, BBS, MMT and MAS test results, but the Baduanjin group exhibited significantly better FMA, BBS and MMT test results than the control group (all P < 0.05). Furthermore, the Baduanjin exercise group showed significant improvements in spatial gait parameters, including the step length, walking speed and cadence, which were significantly better than the control group (all P < 0.05). No adverse events were reported during the study period.ConclusionThe 24-week Baduanjin exercise training may improve the limb motor function, balance, muscle strength and gait function of individuals with PSCI.     

骨质疏松症(骨痿)的中医临床路径研究

骨质疏松症(骨痿)是老年性骨代谢疾病,国内尚未制定出较为完整的骨质疏松症(骨痿)专业中医临床路径,为适应现代中医学发展的需要,广州中医药大学第三附属医院联合浙江中医药大学附属第二医院、上海中医药大学附属曙光医院、广西骨伤医院、常德市第一中医院等中医医疗单位在《临床路径管理指导原则》下,结合就诊中医医院患者的诊断标准、证候诊断,制定进入路径标准,优化门诊及住院治疗时间、规范中医证候学及检查项目,依据证候诊断脾肾阳虚型、肝肾阴虚型、气滞血瘀型三种证型,辨证给予治疗方案,并配合外治及物理等疗法,观察患者临床疼痛改善情况,最后进行安全性指标评价,以完成路径标准。希望通过临床试用,对中医的临床路径实用性、可行性进行探讨,并对其进行完善。     

急性心肌梗死QT离散度与恶性室性心律失常关系的探讨

目的 探讨发生急性心肌梗死时QT离散度（Q-Td）与发生恶性室性心律失常的关系.方法 测量45例患者急性心肌梗死时的Q-Td,计算校正的QT离散度（Q-TdC）.分析Q-Td、Q-TdC与恶性室性心律失常之间的关系.根据有无室性心律失常分为观察组（n=28）与对照组（n=17）.根据Q-TdC水平（分别以60ms、80ms为分界）分析其与室性心律失常和恶性室性心律失常发生的关系.结果 观察组Q-Td、Q-TdC[（70.84±29.87）ms、（79.21±33.58）ms]与对照组[（46.19±17.03）ms、（51.64±17.71）ms]相比,差异均有统计学意义（均P＜0.05）.Q-TdC≥60ms者室性心律失常发生概率（92.30%）高于Q-TdC＜60ms者（21.05%）（P＜0.05）.Q-TdC≥80ms者恶性室性心律失常发生概率（100.00%）高于Q-TdC＜80ms者（10.34%）（P＜0.05）.结论 急性心肌梗死随着Q-Td或Q-TdC值的增大,发生恶性室性心律失常的概率增高.