卒中溶栓绿色通道优化研究及实施效果分析

目的探讨卒中溶栓绿色通道的构建、整改对发病到实施溶栓的时间（onset to treatment time,OTT）、院内溶栓时间（door to needle time，DNT）、临床疗效及预后的影响。 方法收集通过绿色通道溶栓患者118例的临床资料，以时间为界分为对照组57例和观察组61例。比较2组OTT、DNT、DNT≤60 min比率、临床疗效、并发症发生情况、美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale,NIHSS）评分、Barthel指数（Barthel index，BI）评分、改良Rankin量表（Modified Rankin Scale,mRS）评分等。 结果观察组OTT、DNT短于对照组，DNT≤60 min比例高于对照组（P＜0.01）。经过溶栓治疗72 h后，观察组临床疗效优于对照组，总有效率高于对照组（P＜0.01）。2组总并发症发生率和病死率差异均无统计学意义（P＞0.05）。2组NIHSS评分均呈逐渐降低趋势，观察组NIHSS评分低于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。2组BI评分均呈逐渐升高趋势，观察组BI评分高于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。治疗3个月以后，观察组mRS评分明显低于对照组，≤2分比例高于对照组（P＜0.01）。 结论卒中溶栓绿色通道的建立，能够显著缩短OTT、DNT，提高临床疗效，减轻残障程度，取得良好的社会效益。     

脂蛋白肾病1例报道及文献复习

近期重庆市中医院肾病科收治脂蛋白肾病(Lipoprotein glomerulopathy,LPG)1例。现回顾分析病例资料、中西医诊疗及随访情况,并进行文献复习、中医传统理论阐述及讨论。以提高临床对中医药诊治该病的认识。     

The impact of current treatment modalities on the outcomes of patients with melanoma brain metastases: A systematic review

Patients with melanoma brain metastases (MBM) still have a very poor prognosis. Several treatment modalities have been investigated in an attempt to improve the management of MBM. This review aimed to evaluate the impact of current treatments for MBM on patient- and tumor-related outcomes, and to provide treatment recommendations for this patient population. A literature search in the databases PubMed, Embase, Web of Science and Cochrane was conducted up to January 8, 2019. Original articles published since 2010 describing patient- and tumor-related outcomes of adult MBM patients treated with clearly defined systemic therapy were included. Information on basic trial demographics, treatment under investigation and outcomes (overall and progression-free survival, local and distant control and toxicity) were extracted. We identified 96 eligible articles, comprising 95 studies. A large variety of treatment options for MBM were investigated, either used alone or as combined modality therapy. Combined modality therapy was investigated in 71% of the studies and resulted in increased survival and better distant/local control than monotherapy, especially with targeted therapy or immunotherapy. However, neurotoxic side-effects also occurred more frequently. Timing appeared to be an important determinant, with the best results when radiotherapy was given before or during systemic therapy. Improved tumor control and prolonged survival can be achieved by combining radiotherapy with immunotherapy or targeted therapy. However, more randomized controlled trials or prospective studies are warranted to generate proper evidence that can be used to change the standard of care for patients with MBM.     

气血同治法治疗胃息肉验案1则

胃息肉在消化道息肉中最常见,疾病早期多无明显症状,即使有临床症状也无特异性,主要表现为上腹疼痛和腹胀等症,极易造成漏治和误治,在很大程度上影响患者的生活质量。于春泉主任总结多年临床经验,在治疗胃息肉方面有独到的见解,以气血同治为治疗法则,通过补气、行气、活血和养血等治法扶正祛邪,恢复脏腑气血阴阳动态平衡,标本兼顾,临床效果可观。     

基于中医药防治新型冠状病毒肺炎的用药探析

武汉市爆发新型冠状病毒肺炎(COVID-19)疫情,传染性强,传播速度快,影响范围广,引起了国内外高度关注。WHO宣布将COVID-19疫情列为国际关注的突发公共卫生事件。面对重大疫情,河南省郑州市中医院开展中医药预防治疗COVID-19用药调查研究分析,总结中医药诊疗方向及抗病毒中药、经典名方、中成药用药要点,以期能为医疗机构COVID-19诊疗以及药物合理选择提供参考依据。     

蒋士卿治疗放射性口腔炎的临床经验

放射性口腔炎是口腔和头颈部肿瘤放疗过程中常见的并发症,西医目前尚无有效治疗手段。根据放射性口腔炎的临床表现,蒋士卿教授认为放射线属于“火毒”之邪,火毒蕴结、气阴两伤是放射性口腔炎的基本病机。随着射线剂量的累加,邪热渐盛,正气渐虚,脾气渐伤,久病及肾,疾病呈阶段性。发病初期热结上焦、火毒灼津,中期热伏中焦、脾虚热结,后期热伤下焦、虚火上炎,火邪贯穿于放射性口腔炎临床表现的始终,因此其根据放疗不同阶段口腔炎症特点标本兼顾,辨证诊治,分别运用泻火解毒法、泻火补土法、补土伏火法,临床治疗效果显著。     

DPD、MTHFR和TS表达水平与氟尿嘧啶类药物治疗消化道肿瘤疗效及预后关系的研究进展

消化道恶性肿瘤包括结直肠癌、胃癌和食管癌等。尽管使用了各种治疗方式，癌症患者仍然有复发和转移。绝大多数患者确诊时即为中晚期，因而化疗在癌症患者中发挥重要作用。作为5-FU抗癌活性中的三个关键酶，二氢嘧啶脱氢酶（DPD）、5,10-亚甲基四氢叶酸还原酶（MTHFR）、胸苷酸合成酶（TS）与消化道肿瘤的疗效、对化疗药物的敏感性及患者的预后有密切关系。     

谭新华从肝肾论治男科疾病临证经验

谭新华教授采用温肾补肝、益肾疏肝、填精消癥、养肾柔肝、补肾泻肝之法治疗男性不育症、勃起功能障碍、前列腺增生症、精索静脉曲张、慢性前列腺炎等男科疾病临床疗效显著。本文结合典型案例对谭教授从肝肾论治男科疾病经验进行总结。