首荟通便胶囊预防肝胆胰恶性肿瘤化疗后便秘的疗效观察

目的:探讨首荟通便胶囊预防肝胆胰恶性肿瘤化疗后便秘的临床疗效。方法:选取2016年8月至2018年8月河北医科大学第二医院肝胆外科收治的老年肝胆胰恶性肿瘤化疗患者80例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组40例。对照组口服乳果糖口服液,观察组在对照组基础上加服首荟通便胶囊。治疗14 d后,比较2组的临床疗效。结果:中医病症临床疗效观察,对照组总有效率达到75%;观察组,总有效率达到90%,2组比较差异有统计学意义(P<0.05)。临床症状评分观察,对照组总有效率达到77.5%;观察组总有效率达到92.5%,2组比较差异有统计学意义(P<0.05)。排便评分(VAS评分)观察,治疗后对照组排便间隔时间和每次排便时间均长于观察组,2组VAS评分比较,差异均有统计学意义(P<0.05)。结论:首荟通便胶囊可以有效预防肝胆胰恶性肿瘤化疗后的便秘,有效缓解患者排便疼痛程度,减少排便时间,效果显著,值得临床推广。     

Controversial conclusions from two randomized controlled trials for acupuncture’s effects on polycystic ovary syndrome or in vitro fertilization support

Two reports of trials investigating the potential effect of acupuncture in increasing live birth rate (LBR) in women with polycystic ovary syndrome (PCOS) or those undergoing in vitro fertilization (IVF) were published by Journal of American Medical Association in 2017 and 2018 respectively. The trial investigators did not recommend acupuncture for the women with PCOS or IVF based on their findings. This paper raises the concern that the findings that acupuncture did not increase LBR for women with PCOS or undergoing IVF may be the result of methodological flaws in the studies and unintended bias such as use of an invalid control intervention and underestimation of the true acupuncture effect. Therefore, their findings may not be a valid reflection of acupuncture’s effect in improving LBR in women with these clinical conditions.     

妇炎舒胶囊联合抗生素治疗慢性盆腔炎疗效分析

目的观察中药妇炎舒胶囊联合盐酸左氧氟沙星片和甲硝唑片治疗慢性盆腔炎患者的疗效和相关炎性因子的影响。方法收取118例湿热瘀结型慢性盆腔炎的患者,随机分为实验组(A组)和对照组(B组)各59例。A组给予妇炎舒胶囊56 d,B组妇炎舒胶囊模拟剂56 d,两组均服用盐酸左氧氟沙星片+甲硝唑片用药14 d。患者服药56 d后观察临床有效率及治疗前后血清中肿瘤坏死因子-α(Tumor necrosis factor,TNF-α),干扰素-γ(Interferon,IFN-γ)因子含量的变化;随访1个月经周期后观察者复发率及慢性盆腔痛情况。结果(1)A组中医证候积分有效率明显高于B组,且差异有统计学意义(P<0.01)。(2)治疗后A组患者外周血中TNF-α和IFN-γ的含量明显低于B组,具有显著统计学差异(P<0.01)。(3)A组随访复发率(10.17%vs 96.61%)和后遗盆腔痛(18.64%vs 86.44%)均显著低于B组(P<0.01)。结论中药妇炎舒胶囊联合抗生素治疗湿热瘀结型慢性盆腔炎疗效显著,并能够降低慢性盆腔炎的复发率和慢性盆腔痛,并能通过适当降低外周血中TNF-α、IFN-γ等炎性因子的形成,起到治疗作用。     

盐酸氨溴索联合排痰仪与大剂量盐酸氨溴索联合支气管镜对老年重症肺炎疗效的Meta分析

目的比较正常剂量盐酸氨溴索联合排痰仪与大剂量盐酸氨溴索联合支气管镜在治疗老年重症肺炎中的临床疗效。方法通过计算机检索PubMed、The Cochrane Library、Web of Science、CNKI、万方数据库、维普数据库和中国生物医学文献服务系统,搜索国内外公开发表的有关盐酸氨溴索联合排痰仪与大剂量盐酸氨溴索联合支气管镜治疗老年重症肺炎的相关文章,检索时限从建库起到2019年5月。分别由两名作者根据文献纳入和排除标准对文献进行筛选以及数据提取,使用RevMan 5.3软件进行Meta分析。结果经筛选后共有27篇文献最终被纳入分析。Meta分析结果表明,大剂量盐酸氨溴索联合支气管镜治疗能减少患者ICU住院时间(MD=-1.84,95%CI:-2.21～-1.48)、呼吸机使用时间(MD=-3.93,95%CI:-4.17～-3.69)、治疗期间死亡率(O^R=0.42,95%CI:0.33～0.53)、急性生理学与慢性健康状况(APACHEⅡ)评分(MD=-0.67,95%CI:-1.05～-0.29)、多器官功能衰竭(MOF)发生率(O^R=0.41,95%CI:0.32～0.53)、C反应蛋白(CRP)浓度(MD=-10.35,95%CI:-11.29～-9.41)以及血清降钙素原(PCT)浓度(MD=-0.37,95%CI:-0.40～-0.33),增加患者动脉血氧分压(PaO_2)(MD=4.85,95%CI:3.83～5.86)、经皮动脉血氧饱和度(SpO_2)(MD=6.47,95%CI:5.65～7.29)和氧合指数(OI)(PaO_2/FiO_2)(MD=31.88,95%CI:29.21～34.54)。结论大剂量使用盐酸氨溴索联合支气管镜治疗老年重症肺炎是安全可行的,且与常规治疗方法相比,在所测指标中均具有一定的优势,有望成为治疗老年重症肺炎的优先选择。     

中成药治疗缓慢性心律失常临床随机对照试验的网状Meta分析

采用网状Meta分析方法比较治疗缓慢性心律失常中成药的有效性和安全性。计算机检索中国期刊全文数据库(CNKI)、万方数据库(WanFang)、维普数据库(VIP)、SinoMed数据库、PubMed、Cochrane Library,检索时间均为建库至2019年2月。按预先制定的纳入与排除标准进行文献筛选和资料提取。Cochrane系统评价员手册5.3推荐的偏倚风险评估工具对纳入的RCTs进行质量评价。采用WinBUGS软件进行数据分析,STATA软件进行绘图。最终纳入46个中成药治疗缓慢性心律失常的随机对照试验(RCT),涉及4种中成药,3306例患者。网状Meta分析结果显示,心律失常症状改善总有效率共产生7个直接比较和3个间接比较,其中,参仙升脉口服液、参松养心胶囊、心宝丸、宁心宝胶囊联合常规治疗的临床疗效均优于单纯常规治疗,且差异具有统计学意义;中成药疗效排序依次为:参仙升脉口服液>参松养心胶囊>心宝丸>宁心宝胶囊。平均心率监测共产生7个直接比较和3个间接比较,参仙升脉口服液、参松养心胶囊联合常规治疗的疗效均优于单纯常规治疗,且差异具有统计学意义;中成药疗效排序依次为:参仙升脉口服液>参松养心胶囊>心宝丸>宁心宝胶囊。在常规治疗基础上,联用中成药可提高缓慢性心律失常的临床治疗效果。不同的中成药由于纳入的研究数量及质量存在差异,中成药排序结果有待进一步验证。     

Formulation and characterization of lornoxicam-loaded cellulosic-microsponge gel for possible applications in arthritis

Rheumatoid arthritis (RA) is an autoimmune disease associated with severe joint pain. Herein, we report lornoxicam loaded cellulosic microsponge gel formulation with sustained anti-inflammatory effects that are required to manage arthritic pain. The microsponges were formulated using quasi emulsion-solvent diffusion method employing four different surfactant systems, namely polyvinyl alcohol (PVA), Tween80, Gelucire 48/16 and Gelucire 50/13. All the lornoxicam loaded microsponge formulations were extensively characterized with a variety of analytical tools. The optimized microsponge formulation was then converted into gel formulation. The lornoxicam loaded microsponge gel formulation had adequate viscosity and sufficient pharmaceutical properties as confirmed by the texture analysis and the drug release followed Super case II transport. It is noteworthy that we described the preparation of a new cellulosic polymers based microsponge system for delivery of lornoxicam to provide quick as well as lasting (sustained) anti-inflammatory effects in rats using carrageenan induced rat paw edema model. We were able to demonstrate a 72% reduction in inflammation within 4 h using the optimize transdermal gel formulation utilizing Transcutol P as permeation enhancer and with the aid of skin micro-piercing by microneedles, hence, demonstrating the potential of this microsponge gel formulation in arthritis management.     

复方甘草酸苷联合盐酸左西替利嗪治疗皮炎湿疹的效果及对Th1/Th2型细胞因子的影响

目的 分析复方甘草酸苷联合盐酸左西替利嗪治疗皮炎湿疹的效果及对Th1/Th2 型细胞因子的影响。方法 选取2018 年10 月～2019 年10 月于我院接受治疗的皮炎湿疹患者80 例，分为对照组（40 例）和观察组（40 例）。两组采取不同的方法进行治疗，其中对照组采取盐酸左西替利嗪治疗，观察组采取复方甘草酸苷联合盐酸左西替利嗪治疗。治疗后比较两组患者的Th1/Th2 型细胞因子水平指标及临床疗效。结果 治疗后，观察组的Th1 型细胞因子中的IFN-γ 及IL-2 明显高于对照组，差异有统计学意义（P＜0.05）。观察组的Th2 型细胞因子中的IL-4、IgE 与对照组比较，差异有统计学意义（P＜0.05）。治疗后，观察组的瘙痒症状分数及糜烂症状分数与对照组比较，差异有统计学意义（P＜0.05）。观察组的总有效率明显高于对照组（P＜0.05）。结论 对皮炎湿疹患者进行治疗的过程中，使用复方甘草酸苷联合盐酸左西替利嗪进行治疗能够有效改善患者Th1、Th2 型细胞炎症因子，疗效确切，值得推广和应用。     

氯氮平片辅助治疗PD合并精神障碍患者的有效性及不良反应研究

目的:对氯氮平片在帕金森病(Parkinson’s disease,PD)合并精神障碍辅助治疗中的应用价值予以探讨。方法:选取50例我院2013年1月1日—2019年6月30日接诊的PD合并精神障碍患者进行研究,按照随机数表法分为对照组和观察组。对照组用多巴丝肼,观察组联合氯氮平片,对比治疗效果。结果:观察组疾病治疗总有效率96.00%(24/25)高于对照组68.00%(17/25),差异有统计学意义(P<0.05),不良反应发生率8.00%(2/25)与对照组20.00%(5/25)差异无统计学意义(P>0.05);观察组UPDRD评分、VGI-S评分和BPRS评分明显低于对照组,差异有统计学意义(P<0.05)。结论:氯氮平片辅助治疗PD合并精神障碍患者,既可提高临床疗效,也不会增加用药后不良反应,安全性高,值得推广。     

越鞠丸联合盐酸氟西汀胶囊治疗抑郁症临床研究

目的:观察越鞠丸联合盐酸氟西汀胶囊治疗抑郁症的临床效果及对血清脑源性神经营养因子(BDNF)水平的影响。方法:纳入因抑郁症就诊的64例患者,随机分为对照组与治疗组各32例。对照组给予盐酸氟西汀胶囊抗5-羟色胺(5-HT)治疗,治疗组在对照组基础上联合越鞠丸治疗。比较2组治疗前后汉密尔顿抑郁量表(HAMD-24)评分、抑郁症状学快速自评量表(QIDS-SR16)、血清BDNF水平及总体疗效。结果:治疗前后比较,2组HAMD-24评分、QIDS-SR16评分均下降,血清BDNF水平升高(P<0.05),组间比较,治疗组2项评分下降更多,血清BDNF水平升高更多(P<0.05)。治疗后,治疗组总体疗效为90.63%,优于对照组的68.75%,差异有统计学意义(P<0.05)。结论:越鞠丸联合盐酸氟西汀胶囊治疗抑郁症,可更加有效减缓患者抑郁症状,升高血清BDNF水平,增加临床疗效,有效保护患者脑功能,值得临床推广。     

Indwelling catheter increases the risk of urinary tract infection in total knee arthroplasty: A meta-analysis of randomized controlled trials

Background:The purpose of this meta-analysis was to assess whether a urinary catheter is necessary for all patients in primary total knee arthroplasty (TKA).Methods:PubMed, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs). All RCTs were compared with receive either an indwelling urinary catheter or no urinary catheter in TKA. Primary outcomes were urinary retention and urinary tract infection. Secondary outcomes were the length of stay, duration of the surgery, and the first urination time.Results:A total of 6 RCTs involving 1334 patients were included in the meta-analysis. No significant difference between the 2 groups was found in urinary retention (P = .52), length of stay (P = .38), duration of the surgery (P = .55). However, patients with an indwelling catheter were associated with a higher risk of urinary tract infections and longer time for the first urination than patients without indwelling catheters (P = .009 and P = .004).Conclusion:The available evidence indicates that patients without using the indwelling catheters could reduce urinary tract infections and the time for the first urination, without increase in the incidence of urinary retention in primary TKA.Level of Evidence:Level I, therapeutic study.