补肝强肾壮骨方联合烫熨治疗绝经后骨质疏松症疗效观察

目的:观察补肝强肾壮骨方联合烫熨治疗绝经后骨质疏松症临床疗效.方法:将126例绝经后骨质疏松症患者随机分为对照组和研究组各63例.对照组采用烫熨疗法治疗,研究组在对照组治疗的基础上口服补肝强肾壮骨方治疗,治疗3个月,比较两组患者治疗前后VAS评分、Oswestry功能障碍指数及骨密度.结果:两组患者治疗后VAS评分降低...     

益气通络熏洗方配合穴位按摩治疗糖尿病性周围神经病变的护理干预研究

目的 探讨益气通络熏洗方配合穴位按摩治疗糖尿病性周围神经病变(DPN)的效果及护理干预措施.方法 将68例DPN患者随机分为观察组和对照组各34例,对照组采用常规药物治疗,观察组在常规药物治疗的基础上,采用益气通络熏洗方配合穴位按摩治疗,4周后进行疗效比较.结果 观察组总有效率为94.1%,对照组总有效率为67.6%,2组比较差异明显.结论 益气通络熏洗方配合穴位按摩治疗糖尿病性周围神经病变康复效果优于单纯的西药治疗.     

强肝胶囊联合熊去氧胆酸治疗慢性乙型肝炎的疗效观察

目的观察强肝胶囊联合熊去氧胆酸胶囊治疗慢性乙型肝炎的疗效。方法113例慢性乙型肝炎患者均为抗病毒治疗失败或肝功能长期异常者,症状及体征为乏力、纳差、肝区不适、黄疸、肝脾肿大等。随机分为治疗组（55例）和对照组（58例）,分别给予强肝胶囊联合熊去氧胆酸胶囊和泛昔洛韦治疗,疗程均为10周。结果治疗组在肝功能、免疫功能改善方面优于对照组（P〈0．05）;治疗组与对照组总有效率分别为96．36％、74．14％（P〈0．01）。结论强肝胶囊联合熊去氧胆酸治疗抗病毒失败或肝功能长期异常的慢性乙型肝炎患者有效。熊去氧胆酸胶囊与强肝胶囊联合应用,比单用泛昔洛韦疗效更佳,值得临床推广应用。     

从燮理肝脾肾治疗绝经后骨质疏松症探讨

绝经后骨质疏松症(PMPO)是发生于女性绝经期的代谢性骨病,又称Ⅰ型原发性骨质疏松症,以腰背疼痛无力、脊柱驼背变形、易于跌倒骨折为主要临床表现。属中医“骨痿” “骨枯”范畴。从中医整体观出发分析本病的发生与肝脾肾失调相关,病理机制有:肾虚为本,先天亏虚; 脾虚失用,后天乏源; 肝郁血虚,枢机不利; 血瘀为标,瘀虚互生。其病机为本虚标实证,本虚在于肝脾肾精气亏虚、骨失濡养; 标实责之肝郁血瘀、骨络失和。治疗大法应当标本同治、扶正祛邪,燮理肝脾肾; 经验方补肾活血健骨方从“补肾填髓、健脾益气、疏肝理气、活血祛瘀”立法,契合PMOP病机,获得一定临床疗效。     

董克礼教授治疗原发性肝癌临床经验

原发性肝癌是病死率较高的恶性肿瘤之一,其发病率及病死率高。现代医学治疗肝癌的主要手段有肿瘤切除、化学治疗、放射治疗、介入治疗以及免疫治疗等,但肝癌恶性程度高,发展变化快,预后往往不理想。中医药治疗肝癌术后、放化疗后患者及中晚期肝癌患者,不良反应小,不容易产生耐药,能提高机体免疫力,明显改善患者生存质量、延长生存期。董克礼教授在原发性肝癌的中医辨证治疗上有独特的诊治思路和辨治方法,临床疗效突出,他认为本虚标实为原发性肝癌的根本病机,强调扶正祛邪原则,治疗上重视活血化瘀和清热解毒之法,善于辨证辨病治疗肝癌。本文总结了董教授治疗原发性肝癌的经验。     

Effects of bi-axial ankle strengthening on muscle co-contraction during gait in chronic stroke patients: A randomized controlled pilot study

IntroductionAnkle dysfunction in patients with stroke is a common but serious cause of balance and gait impairments. However, comprehensive paretic ankle training seldom exists. Thus, we investigated the effects of a bi-axial ankle muscle training program using visual feedback as a means to improve ankle strength and performance of functional activities in patients with stroke.MethodsThis study was a randomized controlled pilot trial with concealed allocation and assessor blinding and intention-to-treat analysis. Twenty-five patients with stroke and difficulty in walking (e.g., foot drop) or ankle muscle weakness receiving inpatient rehabilitation were included. The experimental group underwent ankle muscle training consisting of passive stretching, control of ankle muscles, and active-resistive strengthening using visual feedback for 40 min per day, 5 times per week for 4 weeks. The control group underwent ankle-related physical therapy, including ankle range-of-motion exercises. The amount of time for training was equal between the two groups. The outcome measurements were isometric ankle contraction force to assess the strength of ankle muscles, ankle proprioception, Fugl–Meyer lower extremity score, Berg balance scale score, walking speed, and ankle co-contraction index to assess muscle efficiency during gait.ResultsThe analysis revealed significant between-group differences in the ankle muscle strength in each direction (P < 0.05), Fugl–Meyer score (P < 0.01), and stance-phase co-contraction index (P < 0.05). After training, the experimental group displayed significant within-group differences in the strength of the ankle muscles in each direction (P < 0.01), ankle proprioception (P < 0.05), and walking speed (P < 0.05).ConclusionsOur findings demonstrate the significant short-term effects of ankle muscle training on strength, walking speed, and muscle efficiency in patients with chronic stroke.     

中医院700例住院病人医院感染回顾性调查报告

1990年我院对700例出院病人进行医院感染回顾性调查,初步探讨到中医院院内感染的特点:呼吸道部位感染率高;肿瘤病人易发生院内感染;女性感染率高于男性。并探讨了今后预防院内感染的要点,以达到降低医院感染的目的。     

固肾化浊汤联合替米沙坦治疗早期糖尿病肾病临床研究

目的:探讨固肾化浊汤联合替米沙坦治疗早期糖尿病肾病(气阴两虚证)的临床疗效及对肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)和超敏C-反应蛋白(hypersensitivity C-reactive protein,hs-CRP)的影响。方法:104例患者随机分为观察组和对照组各52例。对照组给予西医常规疗法,观察组在对照组治疗基础上给予固肾化浊汤,1剂·d-1,疗程12周。检测治疗前后糖化血红蛋白(glycosylated hemoglobin,Hb Alc)、尿素氮、血肌酐、尿微量白蛋白排泄率(urine albumer excretion rate,UAER)、尿微量白蛋白/肌酐、胆固醇、三酰甘油(triacylglycerol,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)和低密度脂蛋白胆固醇(low density lipoprotein cholesterin,LDL-C)检测、TNF-α、hs-CRP和IL-6水平;进行治疗前后气阴两虚证评分。结果:观察组患者有效率为76.92%,对照组有效率55.77%,两组比较,差异有统计学意义(χ2=5.210,P0.05);观察组中医证候有效率为86.54%,对照组为69.23%,观察组高于对照组(χ2=4.531,P0.05);治疗后观察组UAER、Hb Alc、24小时尿蛋白定量、尿素氮、血肌酐和尿微量白蛋白/肌酐水平低于对照组(P0.01);治疗后观察组HDL-C水平高于对照组,LDL-C水平低于对照组(P0.05);治疗后观察组TNF-α、hs-CRP和IL-6水平低于对照组(P0.01)。结论:固肾化浊汤联合替米沙坦治疗早期糖尿病肾病气阴两虚证患者临床疗效显著,能够减轻炎症反应,调节患者的糖脂代谢,减轻蛋白尿,改善肾功能,减轻中医证候,从而延缓肾功能损害的进展。     

Predictors of linkage to care for a nontargeted emergency department hepatitis C screening program

ObjectiveWe implemented a nontargeted, opt-out HCV testing and linkage to care (LTC) program in an academic tertiary care emergency department (ED). Despite research showing the critical role of ED-based HCV testing programs, predictors of LTC have not been defined for patients identified through the nontargeted ED testing strategy. In order to optimize health outcomes for patients with HCV, we sought to identify predictors of LTC failure.MethodsThis was a retrospective cohort study of adult patients who were tested for HCV in the ED between August 2015 and September 2018 and were confirmed to have chronic HCV infection through RNA testing. We used logistic regression to assess the relationship between candidate predictors and the primary outcome, LTC failure, which was defined as a patient not being seen by an HCV treating provider after discharge from the ED.ResultsOf 53,297 patients tested, 1,674 (3.1%) had HCV on confirmatory testing, and 355 (21%) linked to care. Predictors of LTC failure included younger age (OR 0.96, 95% CI 0.95–0.97), white race (OR 1.65, 95% CI 1.23–2.22), homelessness (OR 1.91, 95% CI 1.19–3.08), substance use (OR 1.77, 95% CI 1.34–2.34), and comorbid psychiatric illness (OR 2.16, 95% CI 1.59–2.94). Patients with significant medical comorbidities (OR 0.57, 95% CI 0.41–0.78) or HIV co-infection (OR 0.11, 95% CI 0.03–0.46) were less likely to experience LTC failure.ConclusionsOne in five HCV-infected patients identified by ED-based nontargeted testing successfully linked to an HCV treating provider. Predictors of LTC failure may guide the development of targeted interventions to improve LTC success.     

如何撰写高质量的流行病学研究论文第二讲分子流行病学研究报告规范--STROBE-ME介绍

背景/原理(ME-2)在“前言”中应明确该文献纳入的-种或多种特定生物标志物的选择过程。明确阐述选择特定生物标志的背景资料和理由, 以及该生物标志如何被引入研究设计(生物标志物的暴露、内部剂量、早期生物学变化和易感性), 例如某些多态性位点的选择是基于候选基因策略还是通路策略。此外，应澄清该生物标志是否被(某种物质/结构)替代, 如果是, 还应提示如何替代。