Imaging in neonatal respiratory disease

The purpose of this review is to describe the current state of the art in clinical imaging for NICU patients, divided into major areas that correspond to likely phenotypes of neonatal respiratory disease: airway abnormalities, parenchymal disease, and pulmonary vascular disease. All common imaging modalities (ultrasound, X-ray, CT, and MRI) are discussed, with an emphasis on modalities that are most relevant to the individual underlying aspects of disease. Some promising aspects of dynamic and functional imaging are included, where there may be future clinical applicability.     

基于CiteSpace可视化分析代谢组学在中医药领域的研究现状及趋势＊

目的 应用可视化方法分析代谢组学在中医药领域的现状及趋势。方法 检索中国知网数据库（CNKI）和Web of Science 核心合集数据库2021年3月15日之前收录的中医药领域代谢组学研究的相关文献，应用CiteSpace软件对纳入的文献进行关键词、作者、研究机构等内容进行可视化分析。结果 共纳入中文文献247篇，英文文献350篇。文献数量在波动中迅速上升。中、英文文献作者合作网络显示，张爱华是中医药领域代谢组学研究发文量最多的作者，并形成了核心研究团队。发文机构显示，中国医学科学院是该领域的重要研究机构，机构间合作紧密。中、英文文献关键词分析显示，研究内容主要集中在核磁共振、代谢标记物、冠心病、质谱技术、代谢通路等相关领域。结论 中医药领域代谢组学研究的热点主要为中医药治疗代谢性疾病的机制研究。研究趋势为卵泡代谢组学研究及中药有效成分的研究。     

Dose Rate Simulation of the Urine Collection Bag of Patients Undergoing Bone Scintigraphy

ObjectiveThe objective of the study was to estimate the determined dose rate in the urine collection bag of patients undergoing bone scintigraphy.MethodThe ^99m Tc-methylene diphosphonate accumulated activity eliminatedin urine was estimated and calculated by the Committee on Medical Internal Radiation Dose 14 method. This allowed the calculation of the dose rate emitted at distances of 10, 50, and 100 cm and the creation of a simulation collection bag to validate the calculations by means of measurements carried out with a Geiger Müller counter in the same situations. A linear regression test was performed to verify the significant difference between the measurements and validate the dose rate estimate.ResultsThe calculated and measured dose rates showed the highest values at a distance of 10 cm up to 3 hours after administering the radiopharmaceutical to the patient. After this period, as the collection bag was emptied for image acquisition, the dose rate was close to the background radiation.ConclusionThe maximum accumulated activity in the urine collection bag, and consequently, the maximum dose rate, occurs at the time of emptying the bag for image acquisition. Therefore, in addition to exposure to radiation, there is a considerable risk of contamination by ionizing radiation for the professional who performs the procedure. To minimize this risk and the exposure, the recommendation is to use personal protective equipment and to consider radiological protection factors, which are shorter exposure time, longer distance, and greater barrier between the professional and the radioactive source.     

The effect of massage therapy on pain after surgery: A comprehensive meta-analysis

BackgroundFindings on the usefulness of massage therapy (MT) in postoperative pain management are often inconsistent among studies.ObjectivesThis study’s aim is to conduct a meta-analysis of randomized controlled trials (RCT) to clarify the effects of massage therapy in the treatment of postoperative pain.MethodsThree databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for RCTs published from database inception through January 26, 2021. The primary outcome was pain relief. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The random-effect model was used to calculate the effect sizes and standardized mean difference (SMD) with 95 % confidential intervals (CIs) as a summary effect. The heterogeneity test was conducted through I². Subgroup and sensitivity analyses were used to explore the source of heterogeneity. Possible publication bias was assessed using visual inspection of funnel plot asymmetry.ResultsThe analysis included 33 RCTs and showed that MT is effective in reducing postoperative pain (SMD, −1.32; 95 % CI, −2.01 to −0.63; p = 0.0002; I² = 98.67 %). A similar significant effect was found for both short (immediate assessment) and long terms (assessment performed 4–6 weeks after the MT). Remarkably, we found neither the duration per session nor the dose had an impact on the effect of MT and there seemed to be no difference in the effects of different MT types. In addition, MT seemed to be more effective for adults. Furthermore, MT had better analgesic effects on cesarean section and heart surgery than orthopedic surgery.LimitationsPublication bias is possible due to the inclusion of studies in English only. Additionally, the included studies were extremely heterogeneous. Double-blind research on MT is difficult to implement, and none of the included studies is double-blind. There was some heterogeneity and publication bias in the included studies. In addition, there is no uniform evaluation standard for the operation level of massage practitioners, which may lead to research implementation bias.ConclusionsMT is effective in reducing postoperative pain in both short and long terms.     

To what degree could clinical trials in evidence based medicine reflect reality in the treatment of candidemia?

IntroductionEvidenced based medicine (EBM) is necessary to standardize or treatment for infection since EBM is established based on the results of clinical trials. Entry criteria for clinical trials are very strict, and many patients have difficulties in being enrolled in any clinical trials regarding candidemia. It is questionable if the results of clinical trials reflect the real world of general medicine in this case.Patients and methodsFor the purpose of examining how many patients could join any randomized clinical trials for the treatment of candidemia, we reviewed all the candidemia patients in our institute during 2014–2018. The patients were divided into two groups: patients who were eligible for clinical trials (participation possible group), and those who were not (participation impossible group). Exclusion criteria for clinical trials were set based on previous clinical trials.ResultsA total of 70 patients was enrolled in this study. The median age was 73 years (range 36–93 years). Of these, 41 patients (59%) were male. As for site of infections, catheter related blood stream infection was most frequently seen in 37 (53%). Seventeen patients (24%) were classified as participation possible group and 53 patients (76%) were participation impossible group. Comparing the two groups, participation possible group patients have much better performance status, have less comorbidities and have longer overall survival times than participation impossible group patients.ConclusionOnly 24% of candidemia patients were eligible for the clinical trials. Thus, we can see that clinical trials might not correctly reflect the real world among candidemia patients.     

日本汉方药企业近十年申请专利的分析及思考——以津村制药和Kracie为例＊

目的 对日本医疗用汉方医药品和一般用汉方医药品市场占有率最大的企业日本津村制药公司和Kracie制药公司2008-2020年间申请的专利内容进行综述，为国内中药经典名方和保健食品研发、知识产权保护提供参考。方法 通过日本专利局的官方检索渠道J-PlatPat平台，检索日本津村制药公司和Kracie制药公司在2008年至2020年间申请的专利，并进行专利布局和技术内容分析。结果 共收集43项日本津村制药公司特许和实用新案专利，其围绕汉方制剂产品全过程质量控制构建了坚实的专利技术体系；共收集52项Kracie制药公司特许和实用新案专利，其致力于功能性制剂和组合物的开发，重点在生活改善、老龄化和癌症等领域进行专利布局，还创建了多种产品功效和功能的客观评价方法。结论 津村制药近十年专利布局提示在中药现代化制造和走向国际的过程中，应把提高品质作为主攻方向，树立持续质量改进理念，完善产品有效性证据链。Kracie制药公司践行的以人为中心的汉方药设计理念，以及精准满足消费者健康需求的研发模式值得借鉴。     

基于免疫机制从“脾虚生痰湿”论治多发性抽动症的研究＊

多发性抽动症的发病率逐年升高，严重影响儿童生长发育及心理健康。中医治疗多发性抽动症（脾虚痰湿型）取得显著效果，但作用机制仍不明确。近年来，诸多研究表明“脾虚生痰湿”和免疫系统之间存在密切关系，还揭示了免疫机制在抽动症发病中起重要作用。本文通过概述多发性抽动症（脾虚痰湿型）的病机与免疫之间的关系，发现多发性抽动症（脾虚痰湿型）患者免疫状态与大脑皮质-基底节-丘脑-皮层回路异常密切相关，细胞免疫损伤参与了多发性抽动症的发生和发展。并分析了健脾化痰祛湿中药治疗多发性抽动症的潜在机制，为从“脾虚生痰湿”论治多发性抽动症提供相关科学依据。     

“医信融合”视域下复合型医学人才培养目标及效果评价

培养“医信融合”复合型医学人才是医学高等教育在新时代信息技术发展背景下的历史使命。在引入“医信融合”教育理念的基础上，提出“医信融合”教育的人才培养目标及其内容体系，并据此构建了“医信融合”人才培养质量评价指标，提出了培养效果评价方法。介绍“医信融合”教育人才培养效果的评价方法，对山西医科大学“医信融合”教学效果进行实证分析，从而为“医信融合”教育实践提供借鉴。