Cold snare polypectomy: Indications,devices, techniques,outcomes and future

Colonoscopy has been shown to reduce the risk of colon cancer by enabling the removal of precancerous lesions. Although cold snare and hot snare polypectomy have similar retrieval rates and complete resection rates, rates of delayed bleeding tend to be lower with cold snare polypectomy than with hot snare polypectomy, especially for patients taking antithrombotic agents. However, among cold snares there may be differences in terms of the completeness of polyp excision, as complete removal appears more likely with thin‐wire dedicated cold snares compared to the traditional, thick‐wire cold snares. Cold snare polypectomy may be especially well suited for use in patients taking antithrombotic agents, due to its minimal risk of delayed bleeding. Histological analyses suggest that cold snare polypectomy causes less damage to blood vessels in the submucosal layers, which results in a reduced incidence of hemorrhage compared to hot snare polypectomy. However, cold snare removal of small polyps may result in fragmentation of small specimens during collection and concerns as to whether the resection is complete. An endoscopy biomarker of effective cold snare polypectomy technique is needed to ensure complete removal of non‐pedunculated colorectal polyps ≤10 mm. Future uses of cold snare polypectomy may include piecemeal removal of sessile serrated adenoma/polyp lesions >10 mm. Currently, cold snare polypectomy should be considered a primary method for colorectal polyps of less than 10 mm, especially those in the 4‐ to 10‐mm range.     

悟透寒热说辨证——医案连载(十)

病案33 素常畏冷 感冒身麻 寒气窜动案 刘某某. 女,65岁. 2012年1月10日初诊:感冒一周,周身发麻,觉得有寒气在身上窜动, 喉咙有锁紧感, 微咳,无痰,畏冷,胃不适,吃东西好像梗在喉中. 素常畏冷.脉沉细,舌极浅淡胖嫩,润,少苔. 处麻黄附子细辛汤加味:黄芪20 g,麻黄6 g,附子6 g,细辛3 g,防风10 g,杏仁10 g,炒白术 20 g,桂枝10 g,白芍10 g,紫苑10 g,桔梗10 g,甘草10 g.     

Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials

ObjectiveThe aim of this review and meta-analysis was to evaluate the effect of heat and cold therapy on the treatment of delayed onset muscle soreness (DOMS).MethodsWe followed our protocol that was registered in PROSPERO with ID CRD42020170632. A systematic review and meta-analysis of randomized controlled trials (RCT) was conducted. Nine databases were searched up to December 2020. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis.ResultsA total of 32 RCTs involving 1098 patients were included. Meta-analysis showed that, the application of cold therapy within 1 h after exercise could reduce the pain of DOMS patients within 24 h (≤24 h) after exercise (SMD -0.57,95%CI -0.89 to −0.25, P = 0.0005) and had no obvious effect within more than 24 h (>24 h) (P = 0.05). In cold therapies, cold water immersion (SMD -0.48, 95%CI -0.84 to −0.13, P = 0.008) and other cold therapies (SMD -0.68, 95%CI -1.28 to −0.08, P = 0.03) had the significant effects within 24 h. Heat treatment could reduce the pain of patients. It had obvious effects on the pain within 24 h (SMD -1.17, 95%CI -2.62 to −0.09, P = 0.03) and over 24 h (SMD -0.82, 95%CI -1.38 to −0.26, P = 0.004). Hot pack effect was the most obvious, which reduced the pain within 24 h (SMD -2.31, 95%CI -4.33 to −0.29, P = 0.03) and over 24 h (SMD -1.78, 95%CI -2.97 to −0.59, P = 0.003). Other thermal therapies were not statistically significant (P > 0.05). Both cold and heat showed effect in reducing pain of patients, however there was no significant difference between cold and heat group (P = 0.16).ConclusionsThe current evidence indicated that the application of cold and heat therapy within 1 h after exercise could effectively reduce the pain degree of DOMS patients for 24 h cold water immersion and hot pack therapy, which had the best effect, could promote the recovery of DOMS patients. But more high-quality studies are needed to confirm whether cold or heat therapy work better.     

加减肾附丸治疗腰椎间盘突出症肾虚寒凝证的疗效观察

目的 观察加减肾附丸治疗腰椎间盘突出症肾虚寒凝证的近远期疗效。方法 100例患者被随机分为对照组和观察组，各50例。对照组口服美洛昔康片，每次7.5 mg，每日1次；观察组口服加减肾附丸，每次300 mL，每日2次，疗程均为3个月。治疗前后分别观察两组简化McGill疼痛积分量表（SF-MPQ），Oswestry腰背及下肢功能障碍指数（ODI），中医证候评分；检测全血黏度（高切、中切、低切），血清炎性因子［肿瘤坏死因子-α（TNF-α），白细胞介素-1β（IL-1β），白细胞介素-6（IL-6）］，疼痛介质［内皮素-1（ET-1），前列腺素E₂（PGE₂），环氧化酶-2（COX-2）］。观察两组临床疗效，随访12，24个月的复发率。记录研究期间两组患者出现的不良反应类型及时间。结果 治疗后，观察组患者总有效率98.0%（49/50），高于对照组的82.0%（41/50）（P<0.05）。随访12个月，观察组复发率23.9%（11/46）低于对照组的52.5%（21/40）（χ²＝5.193，P<0.05）。随访24个月，观察组复发率43.9%（18/41），低于对照组的80.6%（29/36）（P<0.05）。与对照组治疗后比较，观察组SF-MPQ，ODI，中医证候，全血黏度，IL-6，TNF-α，IL-1β，ET-1，PGE₂，COX-2明显降低（P<0.05）。观察组不良反应发生率2.0%（1/50），低于对照组的52.0%（26/50）（χ²＝6.264，P<0.05）。结论 加减肾附丸可明显改善腰椎间盘突出症肾虚寒凝证的患者的近远期临床疗效，不良反应发生率低。     

早期卧位踏车训练对下肢重度烧伤患者的效果

目的探讨早期卧位踏车训练在下肢重度烧伤患者功能康复中的临床效果。方法2016年10月至2017年12月,下肢重度烧伤患者30例分为对照组和观察组,各15例。对照组采用常规综合康复,观察组此基础上增加早期卧位踏车训练。入院时和住院治疗6周后,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、疼痛数字评分法(NRS)、Berg平衡量表(BBS)和6分钟步行测试进行评定。结果治疗后,两组SAS、SDS、NRS评分均明显降低(t>3.636,P<0.01),观察组低于对照组(t>2.319,P<0.05);观察组BBS评分和6分钟步行距离高于对照组(t>2.541,P<0.05)。结论早期卧位踏车训练对下肢重度烧伤患者功能恢复有一定促进作用。     

黄芪建中汤加减联合针刺治疗消化性溃疡

目的探究黄芪建中汤加减方联合针刺治疗消化性溃疡(脾胃虚寒型)的疗效。方法选取2016年6月-2019年6月本院门诊收治的消化性溃疡(脾胃虚寒型)患者96例作为研究对象,年龄在26~68周岁。根据门诊单双号分为治疗治疗组和对照组,每组48例。对照给予常规口服埃索美拉唑镁肠溶片、阿莫西林胶囊、克拉霉素缓释片、胶体果胶铋胶囊等,治疗组则给予黄芪建中汤加减联合针刺治疗,疗程6周。观察两组患者治疗有效率及不良反应,并采用专业量表调查患者治疗前后中医症候积分、简式McGill疼痛问卷结果。结果两组疗效对比显示,治疗组总有效率明显高于对照组,差异对比有统计学意义(P <0.05);两组患者在中医症候积分、简式McGill疼痛问卷各项积分方面均有显著降低,提示两组均有明显治疗效果。治疗组简式McGill疼痛问卷表中VAS、PPI及PRI(感觉项总分、情感项总分)、差异有统计学意义(P <0.05)。两组不良反应发生情况差异无统计学意义(P> 0.05)。结论黄芪建中汤联合针刺治疗可有效缓解消化性溃疡(脾胃虚寒型)患者中医症候及降低简式McGill疼痛问卷各项积分,疗效可靠,值得临床应用。     

某师范院校大学生普通感冒发病及就诊行为分析

目的 了解大学生人群对普通感冒的认知和就诊行为情况。方法 自制关于普通感冒的调查问卷,并随机向安庆师范大学大学生发放问卷,要求匿名的方式回答问卷并回收。结果 本次调查有效问卷共197份。 37.06%的大学生对于感冒的病原体没有很好的认知;绝大多数大学生对感冒基本症状的了解比较片面;在大学生普通感冒的就诊行为方面,41.62% 的人大多数情况下不考虑到医院就诊,甚至有17.77%的人基本不考虑就诊;在选择就诊或用药的时机方面,30.46%的人在病情严重后才会选择,44.67%的人会在病程的 2~4 d 选择,有9.14%的人不论何时不会去就诊或用药。结论 该校大学生存在着普通感冒的认知误区和感冒治疗行为的偏差。学校相关部门应加强相关健康教育。     

不同介入方案治疗急性下肢静脉血栓的临床效果与安全性比较

目的 探讨不同介入方案治疗急性下肢静脉血栓(DVT)的临床效果与安全性。方法 选取我院2015年1月～2019年12月介入科收治的急性DVT患者54例作为研究对象,按照治疗方式的不同分为研究组27例和对照组27例。研究组采用血管腔内综合治疗,对照组采用导管介导溶栓治疗,比较两组患者疗效评价、治疗前后膝上、下15 cm与患肢周径差、治疗前后皮肤肿胀张力、静脉通畅率、住院时间和并发症发生情况。结果 经治疗后研究组患者膝上、下15 cm与患肢周径差均短于对照组(P0.05);经治疗后研究组患者皮肤肿胀张力恢复程度显著优于对照组(P0.05);经治疗后研究组患者静脉通畅率显著高于对照组(P0.05);研究组治疗有效率显著高于对照组(P0.05);研究组患者住院时间明显少于对照组,且其并发症发生率显著低于对照组(P0.05)。结论 血管腔内综合介入治疗能够有效改善患者下肢症状,提高DVT恢复情况,降低并发症的发生,从而有效提高患者生活质量,为临床治疗DVT提供重要参考。