从“湿疫”论治新型冠状病毒肺炎的思考

本文基于中医经典文献及临床实践思考,立足于"湿疫"理论阐释新型冠状病毒肺炎(简称"新冠肺炎")的病因、病机、传变规律及治疗方药。认为新冠肺炎乃湿毒疫邪所致,其病机特点为内外病邪相引,合而致病;本病除遵循卫、气、营、血传变规律外,同时也表现出三焦传变的过程。同时,通过归纳梳理相关中医经典著作中关于湿疫的证治方药,为新冠肺炎的中医诊治提供临床思路。     

A systematic review of the complications of high-risk third molar removal and coronectomy: development of a decision tree model and preliminary health economic analysis to assist in treatment planning

Coronectomy is an alternative surgical technique for the management of high-risk third molars. It involves the removal of the crown of a tooth and the deliberate retention of the roots, thereby avoiding injury to the inferior alveolar nerve (IAN). Previous studies have suggested that it reduces the risk of nerve injury when compared with surgical extraction. The purpose of this study was to systematically review the incidence of complications following coronectomy such as IAN injury, pain, dry socket, infection, root migration, and need for re-operation. A comparative cost analysis of coronectomy and surgical extraction was done based on the results of the review. This provides an insight into the economic implications of the two procedures. A search through the MEDLINE database via Ovid, PubMed, Scopus, EMBASE via Ovid, and Web of Science, was carried out to extract randomised and non-randomised controlled trials. Four studies fulfilled the inclusion criteria. A meta-analysis was conducted to measure the overall effect of each outcome. The pooled odds ratio (OR) for IAN injury was 0.16 (95% CI 0.01 to 0.39). Coronectomy reduced this risk by 84%. Dry socket may occur less frequently following coronectomy whereas infection did not show a higher incidence with either intervention. Root migration was found to occur in 13%–85% of cases and the average incidence of re-operation was 2.2%. The ratio of the average costs was 1.12 favouring coronectomy if cone-beam computed tomography (CBCT) was not done prior to the procedure. If a scan was taken routinely for coronectomy, the cost ratio marginally favoured extraction. Coronectomy reduced the risk of nerve injury in high-risk third molars. Definitive conclusions, however, cannot be made for outcomes such as the need for re-operation, which may alter the cost ratio of coronectomy:extraction, as higher quality studies with longer follow-up are needed.     

正念疗法对乳腺癌病人睡眠质量影响的系统评价

[目的]系统评价正念疗法在癌症病人中应用的效果。[方法]计算机检索Medline、Cochrane Library、CINAHL、PubMed、Web of science、CBM、中国知网、维普和万方数据库中有关正念疗法对癌症病人研究的随机对照试验(RCTs)。此外,采用百度、谷歌学术等搜索引擎查找有关文献,并追查已纳入文献的参考文献,以获取未检索到的文献,检索截至2018年6月。2位评价员按纳入与排除标准独立筛选文献,提取资料并进行质量评价后,如有歧义与第3人进行协商。[结果]据纳入原始研究设计的类型,共纳入6个随机对照试验,合计有818例病人。[结论]现有证据表明,正念减压疗法能够改善乳腺癌病人睡眠,但仍需大样本、高质量的RCTs进行验证。     

药品审评检查机构质量管理体系建设实践探索

目的:贯彻国务院强化质量管理、落实全国药监部门完善自身质量管理体系工作部署,梳理山东省药品审评检查机构质量管理体系建设情况,总结经验、查找不足,加强审评检查质量管理。方法:调研药品审评检查机构导入质量管理体系的现实意义,剖析山东省药品审评检查机构质量管理体系建设的实践经验,思考存在的问题。结果:行之有效的质量管理体系对药品审评检查机构规范化建设和药品审评检查发展起到了积极的推动作用。结论:药品审评检查机构推进质量管理体系建设,对规范自身建设、提高工作质量、降低业务风险、服务医药产业发展具有重要作用,也是必然要求,药品审评检查机构质量管理体系需要持续改进,逐渐与国际接轨。