Transperineal Magnetic Resonance Imaging–Targeted Biopsy May Perform Better Than Transrectal Route in the Detection of Clinically Significant Prostate Cancer: Systematic Review and Meta-analysis

The diagnostic accuracy of magnetic resonance imaging (MRI)-targeted biopsy by using the transperineal (TP) versus transrectal (TR) route in the detection of clinically significant prostate cancer (csPCa) remains to be revealed. A systematic search of PubMed, Embase, Ovid, and the Cochrane Library up to April 2019 was conducted. We pooled odds ratios with 95% confidence intervals (CIs) for csPCa detected by TP and TR MRI-targeted biopsy. The relative sensitivity (or risk ratio) between TP and TR route was synthesized. We also pooled the diagnostic sensitivity of either approach using the combined biopsy results as the reference standard. A total of 328 patients with positive multiparametric MRI underwent TP MRI-targeted biopsy, and 315 patients underwent TR MRI-targeted biopsy. The TP route detected more csPCa, with a detection rate of 62.2% (204/328) compared to 41.3% (130/315) for the TR route (odds ratio = 2.37; 95% CI, 1.71-3.26). After adjusting for differences in cancer prevalence, TP MRI-targeted biopsy detected 91.3% (105/115) of csPCa compared to 72.2% (83/115) by the TR route (risk ratio = 1.26; 95% CI, 1.02-1.54). The pooled diagnostic sensitivity of the TP route (86%; 95% CI, 77-96) was better than the TR route (73%, 62-88%). The TR approach missed more csPCa located at the anterior zone of the prostate (20 vs. 3). The TP route performed better than the TR route in MRI-targeted biopsy, especially in detecting csPCa located at the anterior prostate. More large prospective randomized or head-to-head comparison studies comparing the two approaches are warranted.     

针刺长强穴治疗精神发育迟滞患儿57例多中心临床研究报告

目的:观察针刺长强穴治疗精神发育迟滞(MR)的临床疗效。方法:将符合纳入标准的115例MR患儿随机分为长强组59例与头针组56例,两组患者每周治疗2次,持续治疗3个月进行治疗前后婴儿-初中生生活能力及韦氏智力量表评定。结果:韦氏智力评定与婴儿-初中生生活能力评定:两组患儿评分治疗前与治疗后组间比较,经统计学处理均未见明显差异;两组治疗后与治疗前组内比较,数据均有明显差异(P<0.05)。Pearson相关分析:患儿年龄与韦氏智力、婴儿-初中生生活能力的改善情况成负相关(P<0.001)。结论:针刺治疗可以有效提高精神发育迟滞儿童智力与社会适应能力,而且越早干预智力与社会适应能力的改善越明显;治疗精神发育迟滞除选用局部传统头针外,还可以依据腧穴"远道调节"的作用选取远端穴位,比如长强穴。     

痛泻要方治疗腹部术后患者胃肠运动功能紊乱症30例

目的 探讨用痛泻要方调节腹部术后患者胃肠运动功能紊乱的作用.方法 治疗组30例服用痛泻要方,对照组30例仅对症治疗.结果 治疗组服药2～3剂(2～3d)后症状缓解,而对照组需对症治疗5～7d.结论 痛泻要方对腹部术后患者胃肠运动功能紊乱具有较好的调剂作用.具有临床推广应用价值.     

解建国治疗疑难杂症验案3则

导师解建国教授出身于医学世家,深谙岐黄之术,博览群书,勤求古训,学验俱丰;其用药思维敏捷,辨证细腻,处方圆活,对诊治疑难杂症见解独到。笔者有幸侍诊,受益匪浅,今择其疑难杂症临床验案3则介绍如下,以飨同道。     

Gentiana scabra Bunge. Formula for Herpes Zoster: Biological Actions of Key Herbs and Systematic Review of Efficacy and Safety

This study reviewed the biological action of key herbs and evaluated systematically the efficacy and safety of oral Gentiana formula for herpes zoster (HZ). Experimental studies relevant to HZ were identified in PubMed. Randomized controlled trials using Gentiana formula for HZ were identified from nine English and Chinese databases. The primary outcome was evaluation of pain. Potential risk of bias was assessed. Meta‐analysis was conducted using mean difference or risk ratio with 95% confidence intervals. Key herbs Gentiana scabra Bunge, Gentiana triflora Pall, Scutellaria baicalensis Georgi, and Gardenia jasminoides Ellis have shown antiinflammatory actions through inhibition of inflammatory cytokines and pro‐inflammatory enzymes. Twenty‐six clinical studies, involving 2955 participants, were included. Modified Gentiana formula resolved pain earlier than pharmacotherapy when used alone or combined with topical Chinese herbal medicine. Incidence of postherpetic neuralgia was lower (risk ratio 0.14, 95% confidence interval 0.03 to 0.74) with modified Gentiana formula plus topical Chinese herbal medicine. Mild adverse events were reported. Antiinflammatory actions of key herbs of Gentiana formula may explain clinical benefit in hastening pain relief and decreasing postherpetic neuralgia. Few adverse events were reported. Findings were limited by study quality and diversity in intervention and comparator dosage. Copyright © 2017 John Wiley & Sons, Ltd.     

The Role of Endoplasmic Reticulum Stress-related Apoptosis in Vascular Endothelium Pathogenesis

正Vascular endothelium refers to a single layer of endothelial cells that line the inner surface of blood vessels,serving as barriers and transducers between the circulating blood in the lumen and the rest of the vessel wall.Endothelial cells play essential roles in many aspects of vascular biology,such as barrier functions,thrombosis/fibrinolysis,inflammation,angiogenesis,vasoconstriction and vasodilation,and     

龙胆泻肝汤联合克林霉素治疗男性免疫性不育

目的观察龙胆泻肝汤联合克林霉素治疗男性免疫性不育的临床疗效。方法筛选出100例精子表面AsAb阳性的免疫性不育患者。双盲随机分成观察组与对照组各50例。观察组采用龙胆泻肝汤＋克林霉素治疗;对照组采用强的松小剂量维持疗法。比较两组治疗前后精液常规、AsAb及精液中的白细胞含量的改变。结果两种疗法均可降低精子表面AsAb阳性率及精液白细胞含量,但观察组精液白细胞含量下降更显著（P〈0、05）;治疗后患者的精子密度、活动力、妊娠率两组均有所提高,经统计学分析两组疗效无显著性差异（P〉0、05）;结论龙胆泻肝汤联合克林霉素对男性免疫性不育具有治疗作用。