慢性泪囊炎泪道引流管置入术后导管留置最佳时机探讨

目的：探讨慢性泪囊炎行泪道引流管置入术后导管留置的最佳时机。

方法：回顾性选取2011-04/2016-10于我院行泪道引流管置入术的慢性泪囊炎患者143例143眼,根据术后导管留置时间进行分组,其中A组患者50例50眼术后导管留置6wk,B组患者57例57眼术后导管留置9wk,C组患者36例36眼术后导管留置12wk。比较三组患者术后临床疗效、视力、溢泪和复发情况及并发症发生情况。

结果：拔管当天,A组和B组患者临床疗效总有效率(94%和93%)优于C组(39%)(均P<0.0167),但拔管后3mo,三组患者临床疗效总有效率(56%、51%、36%)、视力、溢泪发生率(46%、53%、56%)均无明显差异。拔管后随访6mo,三组患者术后复发率(4%、7%、19%)无明显差异(P=0.056),但C组患者术后并发症发生率(25%)明显高于A组(4%)和B组(7%)(均P<0.0167)。

结论：慢性泪囊炎行泪道引流管置入术后导管留置6wk或9wk临床获益优于12wk,更具临床应用价值。     

基因诊断在儿童慢性腹泻中的应用

儿童慢性腹泻是临床常见的消化系统疾病,其疾病种类繁多,临床症状复杂,且各种慢性腹泻疾病之间症状常重叠,故临床病因诊断困难,基因检测是明确诊断的有效手段。近年来,分子诊断技术的不断进步,尤其是二代基因测序（NGS）技术的广泛应用,使基因检测成本降低、时间缩短,因此,基因诊断策略选择及报告解读对临床医师十分重要。     

他克莫司联合糖皮质激素治疗儿童IgA肾病的疗效观察

目的 观察他克莫司（TAC）和霉酚酸酯（MMF）分别联合糖皮质激素（GC）治疗儿童原发性IgA肾病（IgAN）的疗效及安全性。方法 回顾性分析2012年1月至2017年12月经肾脏病理证实为原发性IgAN患儿,根据治疗方案不同分为TAC组和MMF组。收集两组患儿治疗前及治疗1、3、6个月时的临床资料,比较研究期间IgAN的缓解情况和不良反应。结果 共纳入43例符合研究标准的患儿,TAC组15例,MMF组28例。治疗1月时两组患儿缓解情况差异无统计学意义（P > 0.05）;治疗3月及6月时TAC组缓解情况优于MMF组（P < 0.05）。治疗1月时TAC组血清白蛋白高于MMF组（P < 0.05）。两组在治疗后各时点的血清白蛋白均高于基线值,差异有统计学意义（P < 0.0083）;两组治疗3月及6月时肾小球滤过率（GFR）均高于基线值,差异有统计学意义（P < 0.0083）。研究期间两组患儿不良反应总发生率差异无统计学意义（P > 0.05）,但TAC组有1例发生真菌感染。结论 TAC联合GC治疗儿童原发性IgAN有良好的减低尿蛋白的作用,近期疗效优于MMF,且安全性良好。     

欲降先升理论治疗慢性便秘探讨

便秘在许多疾病的发生中起重要作用。其病位在大肠,与脾、胃、肝、肾、肺等脏腑的功能失调有关,基本病机为热结、气滞、寒凝、气血阴阳亏虚引起大肠传导功能失常。治疗时使用下法有一定效果,但易致诸多的不良反应。依据"肺降肝升,肺与大肠相表里"等整体观念提出"欲降先升"理论。强调胃肠气机不畅是便秘之本,肝气郁滞是便秘之因,肺气不宣是便秘之基;即欲使大便畅通下行,必先宣通肺气,疏肝解郁,在辨证论治的基础上,结合"上窍开则下窍自通"的理论,加用桔梗、杏仁、枳实、厚朴以起到"下病治上、腑病治脏"之功。     

Asthma and mental health among youth in high-risk service settings

Objective: To investigate the prevalence of asthma and mental health problems among representative samples of youth in high-risk service settings and the community, and to examine the relationship between asthma and mental health in these groups. Methods: Data were drawn from the Alternative Service Use Patterns of Youth with Serious Emotional Disturbance Study (SED) (n?=?1181), a combined representative, cross-sectional sample of youth in various clinical settings and the community. Multiple logistic regression analyses were used to examine the association between asthma and mental disorders. Demographic characteristics were investigated as potential confounders. Results: Asthma was common among 15.2% of youth in service settings and 18.8% of youth in the community. The prevalence of mental disorders was extremely high among youth with and without asthma in all service settings, and asthma was associated with increased prevalence of mental disorders among youth in the community, but not among youth in service settings. The relationship between asthma and internalizing disorders among youth in the community does not appear entirely attributable to confounding by demographics. Conclusions: Findings are consistent with and extend previous data by showing that both asthma and mental disorders are disproportionately common among youth in high-risk service settings. Almost half of youth with asthma in service settings meet diagnostic criteria for a mental disorder. Clinicians and policy makers who are responsible for the health care of youth in these high-risk groups should be aware that asthma is common, and that the prevalence of internalizing disorders are especially common among those with asthma.     

Rebasing the Medicare Payment for Dialysis: Rationale,Challenges, and Opportunities

After Medicare’s implementation of the bundled payment for dialysis in 2011, there has been a predictable decrease in the use of intravenous drugs included in the bundle. The change in use of erythropoiesis-stimulating agents, which decreased by 37% between 2007, when its allowance in the bundle was calculated, and 2012, was because of both changes in the Food and Drug Administration labeling for erythropoiesis-stimulating agents in 2011 and cost-containment efforts at the facility level. Legislation in 2012 required Medicare to decrease (rebase) the bundled payment for dialysis in 2014 to reflect this decrease in intravenous drug use, which amounted to a cut of 12% or $30 per treatment. Medicare subsequently decided to phase in this decrease in payment over several years to offset the increase in dialysis payment that would otherwise have occurred with inflation. A 3% reduction from the rebasing would offset an approximately 3% increase in the market basket that determines a facility’s costs for 2014 and 2015. Legislation in March of 2014 provides that the rebasing will result in a 1.25% decrease in the market basket adjustment in 2016 and 2017 and a 1% decrease in the market basket adjustment in 2018 for an aggregate rebasing of 9.5% spread over 5 years. Adjusting to this payment decrease in inflation-adjusted dollars will be challenging for many dialysis providers in an industry that operates at an average 3%–4% margin. Closure of facilities, decreases in services, and increased consolidation of the industry are possible scenarios. Newer models of reimbursement, such as ESRD seamless care organizations, offer dialysis providers the opportunity to align incentives between themselves, nephrologists, hospitals, and other health care providers, potentially improving outcomes and saving money, which will be shared between Medicare and the participating providers.     

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??Strong evidences exist to support that chronic periodontitis is closely related with systemic disease??the pathopoiesis is that endotoxin?? inflammatory mediators?? cytokines caused the disease through blood circulation. In the study of the causes of chronic kidney disease?? there are also inflammatory mediators?? cytokines and other pathogenic factors?? therefore?? there is same contact between chronic kidney disease and chronic periodontitis.     

基于网状Meta分析探索6种中成药治疗糖尿病肾病氧化应激反应的疗效＊

目的 基于网状Meta分析的方法对不同中成药治疗糖尿病肾病氧化应激反应的有效性及安全性进行评估。方法 计算机检索中国期刊全文数据库（CNKI）、万方数据库（WanFang）、维普数据库（VIP）、SinoMed数据库、PubMed数据库、Cochrane Library数据库等国内外数据库，检索时间均为建库至2020年2月。首先按预先制定的纳入与排除标准进行文献筛选和资料提取。然后采用Cochrane系统5.3推荐的偏倚风险评价工具对纳入的RCTs进行质量评估。紧接着采用Gemtc软件进行数据分析，采用STATA14.0软件进行绘图。结果 最终纳入关于中成药改善DN患者氧化应激水平的随机对照试验（RCT）共计30篇，涉及6种中成药，8种治疗方案，总计3354例患者，其中治疗组1693例，对照组1661例。网状Meta分析结果显示，SOD指标共产生7个直接比较和21个间接比较，其中，百令胶囊、黄葵胶囊、金水宝颗粒、糖脉康颗粒、益肾化湿颗粒联合常规治疗的疗效优于西医常规治疗，且差异具有统计学意义；中成药疗效排序结果为：益肾化湿颗粒 > 雷公藤多甙片联合黄葵胶囊 > 雷公藤多甙片 > 百令胶囊 > 黄葵胶囊 > 金水宝颗粒 > 糖脉康颗粒；MDA指标共产生7个直接比较和21个间接比较，百令胶囊、黄葵胶囊联合常规治疗的疗效较西医常规治疗更好，且差异具有统计学意义；8种治疗方案疗效排序结果为：雷公藤多甙片联合黄葵胶囊 > 雷公藤多甙片 > 黄葵胶囊 > 百令胶囊 > 益肾化湿颗粒 > 糖脉康颗粒 > 金水宝颗粒；UAER指标共产生5个直接比较和11个间接比较，其中黄葵胶囊联合西医常规治疗在减少UAER方面优于西医常规治疗，中成药之间排序为：黄葵胶囊 > 金水宝颗粒 > 百令胶囊 > 益肾化湿颗粒 > 糖脉康颗粒。结论 在西医常规基础上辅于中成药的治疗方案较单纯西医常规治疗方案，在提高血清SOD水平，降低血液中MDA含量方面明显优于后者。此外，由于涉及不同的中成药的RCTS中的研究数量及质量存在差异，本研究的中成药排序结果有待进一步RCT临床试验验证。