从脾论治慢性肾脏病的生物学基础探讨

脾为后天之源,肾为先天之本,以后天滋先天,使从脾论治成为中医临床治疗慢性肾脏病(CKD)的经典方法。现代医学研究发现人体内最庞大的“器官”——肠道菌群与“脾”的功能非常密切。目前研究发现肠道菌群紊乱是加速CKD进展的重要环节,基于脾肾互根互用的中医原理,收集、整理肠道菌群与CKD代谢功能、免疫应答及肾脏损伤关联的文献,从肠道菌群与机体功能代谢和内环境稳态的角度进行探讨,认识到运用中医药可通过干预肠道菌群的丰度、结构和代谢功能,维持肠道微生态的平衡,从而达到调节肾脏代谢和免疫应答的作用,提出肠道菌群是从脾论治慢性肾脏病的重要生物学基础。     

临床护理路径（CNP）在腹部CT增强扫描检查中的应用研究

目的 探究临床护理路径在行腹部CT增强扫描检查患者中的应用效果。方法 收集本院2017年7月～2018年6月收治的120例行腹部CT增强扫描检查患者的临床资料,依据不同的干预方法归纳为对照组和实验组,各60例。前者采取常规护理方法,后者采取临床护理路径。对照并分析两组患者的检查配合度、不良反应发生率、护理满意度及护理差错数。结果 实验组患者的检查配合度为93.3%,明显优于对照组的73.3%(P0.05);实验组患者的不良反应发生率为5.0%,明显低于对照组的18.3%(P0.05);实验组患者的满意度评分为(4.37±0.40)分,明显优于对照组患者的(3.26±0.73)分(P0.05);实验组护理差错共1次,明显少于对照组的8次(P0.05)。结论 临床护理路径在腹部CT增强扫描检查中应用效果较好,能够明显提升患者的依从性,进而更好地配合检查,提高患者的满意度,具有较高的临床实用性。     

针刺治疗PTSD神经生物学研究进展

近年来，随着经济社会的快速发展与社会关系的复杂化和多元化，诸如自然灾害、暴力犯罪、性侵害等创伤性事件频频发生，创伤后应激障碍（PTSD）的关注度正在逐年上升，如何防治PTSD成为重要的研究课题。针灸作为我国传统医学的瑰宝，在精神疾病的预防和治疗方面有着丰富的经验和独特的优势，临床研究证实，针刺能有效改善PTSD的相关症状，然而其神经生物学机制到底为何，至今仍无定论。基于此，本文综述了近些年发表的相关研究，企图初步揭示针刺治疗PTSD内在的神经生物学机制，为临床治疗提供参考。     

Electrochemotherapy for the palliative management of cutaneous metastases: A systematic review and meta-analysis

BackgroundElectrochemotherapy combines electroporation in conjunction with chemotherapeutic agents and is used to treat tumours in many localisations, including cutaneous metastases. The symptoms associated with cutaneous malignant wounds can be distressing for patients and their management is a challenge in healthcare.AimThe purpose of this systematic review was to investigate the effectiveness of electrochemotherapy in the context of palliative care.DesignAll aspects of the systematic review were followed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data sourcesThe following databases were searched for English-language reviews; Medline, Embase, CINAHL, British Nursing Index and the Cochrane Library. The search was conducted between the publication of Standard Operating Procedures in 2006 and the third week of October 2017. Studies involving oral cancers and studies with fewer than 10 patients were excluded. The selected studies were assessed for risk of bias and sub-group data were synthesised in a random-effects meta-analysis.ResultsFrom 425 studies, 29 studies were included involving 1503 patients, the pooled results were 46.6% for complete response and 82.2% for objective response according to the Response Evaluation Criteria in Solid Tumours. The meta-analysis indicated that small tumours were over twice as likely (2.25) to have a complete response than large.ConclusionsElectrochemotherapy is an effective, repeatable and minimally invasive intervention within the palliative population that can reduce symptom burden. This review is an update of previous systematic reviews by Mali et al. [1,2] and highlights the need for tailored treatment depending on each individual case.     

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.     

原发性骨淋巴瘤诊疗现状及进展

原发性骨淋巴瘤是一种罕见的结外淋巴瘤，缺少特征性的临床症状和影像学表现。化疗、放疗或联合治疗是原发性骨淋巴瘤患者常用的治疗方法。原发性骨淋巴瘤预后优于其他结外淋巴瘤。文章就原发性骨淋巴瘤的临床表现、病理诊断、治疗方法进行综述，以加深对原发性骨淋巴瘤的理解。     

Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease

Objective

The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.