Clinical characteristics and medical management of Iranian patients with ankylosing spondylitis

Abstract

Objectives. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease with variable clinical expression. Ethnic, racial and geographical factors have been associated with disease occurrence and expression. We intended to describe the clinical characteristics and assess the disease severity and treatment status in Iranian AS patients.

Methods. A total of 320 AS patients were assessed for demographic variables, clinical manifestations, human leukocyte antigen (HLA) status, disease severity, functional capacities, quality of life and treatment status.

Results. A gender ratio of 3.8:1, an average age onset of 27 ± 7.3 and a mean diagnostic delay of 8 years were observed. Eleven percent had juvenile onset AS. Positive family history was higher than that observed in most other countries. Enthesitis was a very common finding involving more than two-thirds of our patients. Uveitis was the leading extra-articular manifestation. We found an HLA-B27 prevalence of 73% and four HLA-B27 subtypes. Disease activity was high and the functional status was poor as indicated by mean Bath AS Disease Activity, Functional and Metrology indices. Quality of life was considerably impaired in our patients. We found a low percentage of patients on biological medications and a relatively higher percentage on disease modifying anti-rheumatic drugs and corticosteroids.

Conclusions. Our results demonstrate a broad characterization of Iranian AS patients providing a better understanding of this disease. A national multicenter registry would enable larger- scale prospective studies to be carried out further evaluating the disease burden on patients and society.     

风湿免疫贴敷疗法治疗类骨性关节炎的临床研究

目的 探究对类骨性关节炎患者应用风湿免疫贴敷疗法的治疗效果.方法 临床纳入2015年7月至2016年6月间在本院进行治疗的类骨性关节炎患者66例,按随机投掷法给予分组,对照组33例给予常规药物治疗,研究组33例在药物治疗基础上增加免疫贴敷法,对比两组疼痛程度及疗效.结果 治疗后研究组疼痛评分为(3.32±0.42)分,明显低于对照组的(6.01±0.52)分,P＜0.05.治疗后研究组有效率为96.97％,优于对照组的78.79％,P＜0.05.结论 通过敷贴的使用增加了患者的后期疗效,缓解了疼痛程度.     

人结直肠锯齿状腺癌的研究现状

结直肠锯齿状腺癌（serrated adenocarcinoma，SAC）作为大肠癌的一种特殊临床类型，因其癌变途径的特殊性，检测以及较差的治疗反应和预后逐渐引起众多研究者的兴趣。其产生的途径主要为“锯齿状通路”途径，锯齿状通路途径以BRAF突变、微卫星体不稳定（microsatellite instability，MSI））和CpG岛的甲基化（CpG island methylator phenotype，CIMP）为特征。由于特殊的形态和内镜特征及特殊的发生部位，在结肠镜检查时很容易漏诊，甚至病理评估时也极易被忽视，临床确诊时往往已处于进展期，患者预后差，生存率低。本文针对锯齿状结直肠腺癌流行病学、危险因素、临床特征、病理学特征、分子特征等作一综述。     

Hermeneutic application research – finding a common understanding and consensus on care and caring

To clinically and contextually implement the theoretical and factual knowledge of care and caring that has been developed in the last 30 years is seen as a great challenge in caring science research. Emphasis has been put on problem‐solving research methodologies and action research in hopes of narrowing the divide between caring theory and clinical practice. Thus, the intention is now to further action research towards a hermeneutic approach and to put emphasis on hermeneutic application where theory and praxis become one through human dialogue. This article highlights hermeneutic application research as an alternative methodology within participatory‐oriented research which presents a new opportunity to unite clinical practice and caring theory. The aim is to contribute to the development of the hermeneutical application research design in its epistemological, ontological and ethical perspective, by articulating and clarifying the central foundations in the application. On the basis of Gadamer's hermeneutical thinking and Levinas ethical thinking, the central foundations in the application research are ethics, creation of a hermeneutical room, dialogue and common understanding and appropriation and action. When theoretical understanding turns into praxis, knowledge also becomes activity and theory and practice become one. Application thus realises the basic idea that praxis and theory are one, and thus, theory of caring can only become evident and implemented in a clinical practice through moments when the participants find a common understanding and consensus on the knowledge of care and caring.     

观察降压丸治疗高血压的临床疗效

目的：探讨降压心丸治疗高血压的临床疗效。方法：选取我院2007年6～2011年6月60例原发性患者，随机分为研究组和对照组．研究组患者30例使用降压丸进行治疗，对照组30例患者使用西药联合治疗，对比分析两组患者的治疗效果。结果：降压丸治疗原发性高血压效果更明显，总有效率达到93．33％。结论：降压丸对于治疗脑梗死、高血压等疾病的并发症治疗效果也非常明显，有较好的临床推广价值。     

抗血小板聚集治疗在大面积脑梗塞中的应用分析

目的探讨抗血小板聚集对大面积脑梗塞进行治疗的临床效果。方法选取100例大面积脑梗塞患者作为研究对象,并将其随机列入观察组和对照组,各50例。观察组应用抗血小板聚集进行治疗,对照组行常规治疗。对比分析两组的疗效。结果观察组的总有效率、神经功能的缺损积分以及日常生活能力的恢复情况均显著优于对照组(P0.05)。结论应用抗血小板聚集对大面积脑梗塞患者进行治疗,疗效确切,安全性强。     

分析三维重建及3D打印技术在腹部外科临床教学中的应用

目的分析在腹部外科的临床教学中应用三维重建技术与3D打印技术的临床效果。方法选择2016年1月—2017年12月我院接收的腹部外科实习生60例作为研究对象,2016年1—12月抽取30例设置为对照组,2017年1—12月抽取30例设置为观察组,对照组实习生采用常规临床教学方法学习腹部外科相关知识,观察组实习生则在常规临床教学基础上应用三维重建技术与3D打印技术。经带教后对比分析两组实习生的培训反馈结果以及理论知识考核、实践操作考核成绩。结果经带教后,观察组实习生对临床带教的学习兴趣、理论理解、知识点掌握、记忆效果以及操作技能均明显高于常规组,组间数据差异有统计学意义(P<0.05);经考核,其结果显示观察组实习生的理论知识成绩与实践操作成绩均明显高于常规组,组间差异有统计学意义(P<0.05)。结论在腹部外科实习生的临床教学中,除了常规教学方法之外,将三维重建技术与3D打印技术加入其中可获得良好的应用效果,能够显著提升实习生对临床教学的学习兴趣与记忆效果等,提升实习生理论知识成绩与实践操作能力,临床应用效果显著,值得推广。     

内扎外剥保留齿状线加内痔注射术治疗混合痔的临床观察

为观察内扎外剥保留齿状线加内痔注射术治疗混合痔的疗效，将600例混合痔患者随机分为A、B两组，每组各300例。A组采用内扎外剥保留齿状线加内痔注射术治疗，B组采用传统的外剥内扎术治疗。观察两组术后创口愈合时间、痔核结扎线脱落时间、疼痛程度、创缘水肿、肛周皮赘、肛门溢液、肛门舒适度及疗效。结果显示，两组各项指标均有显著性差异（P均〈0．05）。A组治愈率明显高于B组（93．3％vs 83．3％，P〈0．05）。结果表明，混合痔内扎外剥保留齿状线加内痔注射术疗效确切，创伤小，并发症少，操作简单，值得推广。