中医外治法治疗过敏性鼻炎的临床研究近况

参照近10年相关文献,对治疗过敏性鼻炎的中医外治法进行了梳理分析,总结了临床常用的外治法有针刺疗法、灸法、穴位贴敷、穴位注射、穴位埋线、推拿疗法、特色疗法、局部给药及综合疗法,并分析了各自的优势及有效性,以期为临床治疗过敏性鼻炎提供借鉴。     

Endovascular management of multiple intracranial dural arteriovenous fistulas

Background and purposeMultiply occurring intracranial dural arteriovenous fistulas (dAVFs) have been documented but rarely occur, and neither pathogenesis nor prognosis is clearly understood. This study was conducted to analyze angiographic characteristics of multiple dAVFs and to chronicle our treatment experience.MethodsBetween April, 2002 and January, 2018, data prospectively collected from 310 patients with intracranial dAVFs were systematically reviewed, assessing clinical and anatomic outcomes of endovascular treatment in 32 patients with multiple dAVFs (≥ 2 fistulas each). Lesions were categorized as multifocal or diffuse type, depending on presentation, and further characterized as progressive or non-progressive disease.ResultsOverall, 18 patients (56.3%) experienced aggressive presentations, including intracerebral hemorrhage or venous infarction. Cortical venous reflux (CVR) was observed in 26 patients (81.3%), and sinus thrombosis or occlusion was seen in 24 (75.0%). Clinical outcomes in patients with multifocal fistulas (n = 11) were excellent (100%), marked by a moderately high rate of complete occlusion (54.5%). Those with progressive disease (n = 10) regularly displayed certain angiographic findings, namely diffuse configuration (100%), sinus thrombosis (100%), and CVR (100%). Complete anatomic obliteration was achieved in 12 patients (37.5%), and in 26 patients (81.3%), clinical outcomes were favorable.ConclusionMultiple dAVFs are typically aggressive at presentation, given strong associations with CVR and sinus thrombosis. In diffuse-type fistulas, the potential to recur or progress is high. Although definitive treatment poses a challenge, outcomes of endovascular therapeutics may be still optimized in this setting through strategic procedural modifications and careful follow-up monitoring.     

手法整复可调式外固定支具治疗第5掌骨颈骨折临床研究

目的:探讨可调式外固定支具治疗第5掌骨颈骨折的可行性及有效性。方法:选取2014年1月～2017年6月我院收治的54例第5掌骨颈骨折患者作为研究对象,随机分为A组和B组,每组27例。A组行闭合复位交叉克氏针固定,B组行手法整复可调式外固定支具固定,比较两组末次随访第5掌指关节活动度和主观满意度。结果:随访4～10个月,两组患者第5掌指关节活动度(ROM)值相比较,差异无统计学意义,P0.05;两组的主观满意度相比较,差异无统计学意义,P0.05。结论:手法整复可调式外固定支具固定可为第5掌骨颈骨折提供可靠、有效的固定,有助于患者的早期功能恢复,是一种有效的治疗方法。     

Fluorescence ureteral navigation during laparoscopic surgery for clinically suspected stage T4 colorectal cancer: A cohort study

BackgroundApproximately 15% of patients with colorectal cancer present with locally advanced tumors (T4 stage). Laparoscopic surgery for stage T4 disease has not yet been established.The near-infrared ray catheter fluorescent ureteral catheter (NIRFUC) is a new device that uses near-infrared fluorescence resin.We examined the utility of fluorescence ureteral navigation (FUN) with the NIRFUC during laparoscopic surgery for stage T4 colorectal cancer.Materials and methodsPatients with stage T4 colorectal cancer (n = 143, from January 2017 to March 2021) were divided into a T4FUN + group, in which the NIRFUC was used (n = 21), and a T4FUN- group, in which the NIRFUC was not used (n = 122). Short-term outcomes were compared between the groups.Next, the laparoscopic surgery rate and incidence of ureteral injury from January 2017 to March 2021 were compared between the T4FUN- group and the non-stage T4FUN- group (n = 434, from January 2017 to March 2021), in which fluorescence ureter navigation was not used.ResultsRectal cancer, stage T4b disease, and invasion into the urinary tract were observed more often in the T4FUN + group than in the T4FUN- group.In the comparisons of the T4FUN + versus T4FUN- groups, the operative time was 398 (161–1090) vs. 256 (93–839) minutes, the blood loss was 10 (1–710) vs. 25 (0–1360) ml, and the ratio of laparoscopic surgery to open surgery was 21:0 vs. 79:43. Postoperative complications (Clavien-Dindo grade ≥ III) were present in 2 (10%; 0 ureteral injury) patients in the T4FUN + group and 13 (11%; 2 ureteral injury) patients in the T4FUN- group.In the T4FUN + group, the operative time was longer (p < 0.0001), but the laparoscopic ratio was higher (p = 0.0002), and the blood loss volume and incidence of ureteral injury tended to be lower.In the comparisons of the T4FUN- versus non-stage T4FUN- groups, the ratio of laparoscopic surgery to open surgery was 79:43 vs. 384:50, the incidence of open conversion was 8 (6.6%) vs. 15 (3.5%), and the incidence of ureteral injury was 2 (1.6%) vs. 0 (0%). In the T4FUN- group, the open surgery rate (<0.0001), open conversion rate (p = 0.0205) and incidence of ureteral injury (p = 0.0478) were high, with a significant difference observed between the groups.ConclusionPatients with stage T4 disease have an increased risk of ureteral injury and are more likely to be converted to open surgery.FUN can help to safely increase the laparoscopic surgery rate while safely visualizing the ureter. FUN is recommended for laparoscopic surgery in patients with stage T4 colorectal cancer.Clinical trial registrationExamination of fluorescence navigation for laparoscopic colorectal cancer surgery; Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinical research-r02.pdf;     

Tratamiento endourológico de la litiasis ureteral lumbar. ¿Qué aporta la ureterorrenoscopia flexible?

Introduction and objectivesCurrently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope.Material and methodsRetrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated.ResultsMean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8 mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (P = 0.001) of more than 11 mm (P = 0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; P = 0.004] in multivariate analysis.ConclusionsEndourological treatment obtained a high success rate in our sample. Size greater than 11 mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.     

中医外治法治疗膝关节骨性关节炎研究概况

膝关节骨性关节炎(KOA)是一种以膝关节疼痛、肿胀、变形及活动受限为主要特征的一类疾病。中医外治法在膝骨关节炎的治疗中具有显著疗效。整理近5年来中医治疗膝关节骨性关节炎相关文献,从推拿疗法、中药外用、艾灸疗法、针刺疗法、针刀疗法5个方面进行概述,探究中医外治法在治疗膝关节骨性关节炎的研究进展,为临床提供参考。     

《世医得效方》之洗方荆叶散特色及医案分析

从方药特色研究危亦林《世医得效方》之洗方荆叶散药物组成、方剂配伍及使用方法特色,从典型病案探讨荆叶散临床特色功效,得出洗方荆叶散能够活血化瘀,行气止痛,消肿利水,主治一切骨折筋伤导致的瘀血疼痛。提示洗方荆叶散疗效确切、使用简便、安全无不良反应,具有很好的推广应用价值。