互动式头针结合镜像疗法对脑卒中软瘫期上肢功能障碍的康复疗效

目的：探索脑卒中患者促进上肢运动功能恢复中头针与镜像疗法联合应用的临床价值。方法：选取株洲市中心医院2021年8月至2022年11月期间收治的60例脑卒中后上肢功能障碍患者,以随机分组的方式分为两组,每组30例。其中常规康复训练联合镜像治疗纳入对照组,在对照组基础上增加头针治疗纳入观察组。在治疗4周后,比较两组患者临床治疗有效性、Fugl–meyer运动功能评定量表（FMA）上肢部分评分以及Brunnstrom分期。结果：两组患者治疗后FMA评分均高于治疗前,且观察组患者治疗后FMA评分高于对照组,差异具有统计学意义（P<0.05）。观察组患者治疗后上肢Brunnstrom运动功能分期结果优于对照组,差异具有统计学意义（Z=–2.101,P <0.05）。观察组患者治疗后手Brunnstrom运动功能分期结果优于对照组,差异具有统计学意义（Z=–2.152,P <0.05）。结论：在恢复早期,头针、镜像疗法与常规康复训练有效结合,对脑卒中患者软瘫期上肢运动功能恢复具有积极作用。     

结合家长参与的康复训练对功能性构音障碍的疗效分析

目的 分析家长参与的康复训练对功能性障碍患儿构音清晰度的疗效,为临床综合性治疗提供科学依据。 方法 选取2018年9月—2020年1月在株洲市中心医院康复治疗科治疗的67例功能性构音障碍患儿为研究对象,按随机数字表法随机分为家长参与组33例和常规组34例。两组均予以常规构音训练,家长参与组在常规组的基础上增加家长参与整个治疗过程、每周1次家长培训和每日微信打卡作业,共治疗12周。比较两组治疗前后采用构音清晰度评估和疗效评定。 结果 治疗12周后,两组构音清晰度均较治疗前明显提高(t＝22.38、25.50,P＜0.01),且家长参与组治疗后构音清晰度高于常规组,差异有统计学意义(t=5.10,P＜0.01);家长参与组每周平均家中练习天数与总有效率均显著高于常规组(t=16.08、χ²=19.90 ,P＜0.01)。 结论 结合家长参与的康复训练对功能性构音障碍患儿疗效明显。     

鹦鹉热衣原体肺炎患者临床特点分析

 目的 探讨分析鹦鹉热衣原体肺炎患者的临床表现及辅助检查结果特征,以提高对该病的认识。方法 回顾性分析某医院2019年6月- 2021年8月经宏基因组二代测序（mNGS）诊断鹦鹉热衣原体肺炎的9例患者临床资料。结果 9例患者中男性7例,女性2 例,包含1例妊娠36⁺²周孕妇;年龄25~70岁,中位年龄63岁;临床主要表现为高热（9例）、咳嗽（9例）、咳痰（7例）。白细胞计数正常8例,淋巴细胞计数降低9例,CRP升高9例,ESR升高9例,PCT正常4例,门冬氨酸氨基转移酶和丙氨酸氨基转移酶升高6例。9例患者胸部 CT均表现为斑片或斑片实变影。经血及肺泡灌洗液mNGS确诊后使用多西环素、莫西沙星、左氧氟沙星、阿奇霉素单药治疗方案,疗程14~21 d,均好转出院。结论 鹦鹉热衣原体肺炎临床表现多样、诊断困难,mNGS检测可以快速明确病原学诊断,有助于及时启动特异性抗感染治疗,可减少抗菌药物的使用,改善预后。     

512例胆管细胞癌的临床及预后特点

目的： 胆管细胞癌(cholangiocarcinoma，CCA)恶性程度较高，总体预后较差，初诊时分期较晚，治疗手 段有效率欠佳。本研究探索影响CCA发生、发展的临床特点及预后相关因素，以期为CCA的早期诊断及临床治疗提 供潜在的手段。方法： 回顾性分析中南大学湘雅二医院2002 年以来经病理确诊且临床资料完善的512 例CCA患者的 病历资料。利用Kaplan-Meier 法绘制生存曲线、log-rank 进行单因素分析，多元Cox回归法对有意义的变量进行多因 素分析。结果： CCA发病率≤60 岁者高于>60 岁者(61.13% vs 38.87%)，男性略高于女性(52.54% vs 47.46%)，糖类抗 原19-9(carbohydrate antigen 19-9，CA19-9)≥35 μg/L 者占66.21%，病理分期III 和IV 期患者居多(分别占49.22%和 17.58%)。单因素分析发现ALB，ALP，CA19-9 等因素与预后相关，多因素Cox 生存分析发现ALP，CA19-9，肿瘤 最大直径等是CCA预后独立影响因素。结论：CCA发病率≤60 岁人群较高，初诊时分期较晚，CA19-9 是较为敏感的 实验室指标。ALP，CA19-9，肿瘤最大直径，合并子瘤，肝硬化及TNM分期是影响CCA预后的独立因素。     

妊娠期体育锻炼干预对自然分娩影响的Meta分析

背景 自然分娩是人类繁衍的正常生理过程，中国剖宫产率超出了世界卫生组织（WHO）提出的警戒线2倍多，而体育锻炼作为一种非药物性的健康干预方式，应引起相关部门的重视。 目的 运用Meta分析方法检验妊娠期体育锻炼对自然分娩影响的干预效果，并提出最优的锻炼方案。 方法 检索中国知网（CNKI）、中国生物医学文献服务系统（CBM）、维普网中文数据库和PubMed、EMBase、Web of Science、Cochrane Library英文数据库中有关妊娠期体育锻炼干预影响自然分娩结果的随机对照试验（其中干预组以体育锻炼干预为唯一干预方式，对照组进行常规护理知识教育或不进行有规律的体育锻炼），同时追踪相关系统评价所引用的参考文献，检索时间为1990—2021年。提取纳入文献资料，并对纳入文献进行方法学质量评价，采用RevMan 5.2软件进行Meta分析，运用GRADE工具对结局指标进行质量评价。 结果 共纳入30篇文献。Meta分析结果显示，干预组自然分娩发生率高于对照组〔RR=1.34，95%CI（1.28，1.40），P<0.000 01〕。亚组分析结果显示，锻炼开始节点对自然分娩的干预效果从高到低依次为：>24周、13~24周、≤12周；锻炼内容对自然分娩的干预效果从高到低依次为：盆底肌训练、运动课、体操、有氧运动、分娩球、瑜伽；锻炼频率对自然分娩的干预效果从高到低依次为：≥12次/周、3~5次/周、6~8次/周、9~11次/周；中等强度的锻炼较低强度的锻炼对自然分娩具有更大的影响；锻炼时长对自然分娩的干预效果从高到低依次为：30~<50 min/次、<30 min/次、≥50 min/次；锻炼周期对自然分娩的干预效果从高到低依次为：≤8周、17~24周、9~16周、25~34周。绘制体育锻炼干预对孕妇自然分娩影响的漏斗图，结果显示，漏斗图左右两侧基本对称，发表偏倚较小。运用GRADE工具对结局指标进行质量评价，结果显示，妊娠期体育锻炼影响自然分娩的评级为中等级。 结论 孕妇在妊娠期进行一定的体育锻炼对自然分娩结果具有良好的干预效果，且从妊娠期>24周开始锻炼、≥12次/周、30~<50 min/次、持续进行≤8周的中等强度的盆底肌训练、运动课、体操、有氧运动、分娩球以及瑜伽均对孕妇自然分娩的选择具有积极的影响。     

High-dose vitamin C intravenous infusion in the treatment of patients with COVID-19: A protocol for systematic review and meta-analysis

Background:Patients infected with a virus usually lack vitamin C. High-dose vitamin C has an antiviral effect, and has been used by several researchers to treat COVID-19 by intravenous infusion, achieving good results. However, the efficacy and safety of vitamin C in the treatment of patients with COVID-19 remain unclear. Thus, the aim of the present study was to investigate the efficacy of high-dose vitamin C infusion in the treatment of patients with COVID-19.Methods:Electronic databases were searched, including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure database, Chinese Wanfang database, and Chinese Biomedical Literature database. The aim was to collect randomized controlled trials of high-dose vitamin C infusion in the treatment of patients with COVID-19, with the retrieval time being from the establishment of the database to March 2021. In accordance with the pre-designed inclusion/exclusion criteria, all data were extracted independently by 2 researchers. To assess the risk bias in the studies, the Cochrane collaboration''s tool for assessing risk of bias was used to assess the risk bias in the studies, while meta-analysis was performed using Revman 5.3 software.Results:In the present study, a high-quality comprehensive evaluation is provided of high-dose vitamin C infusion in the treatment of patients with COVID-19.Conclusion:Further convincing evidence for the clinical treatment of COVID-19 is provided, in addition to evidence-based guidance for clinical practice.PROSPERO Registration Number:CRD42021246342.     

Risk factors for post-traumatic stress disorder in acute trauma patients: A protocol for systematic review and meta-analysis

Background:Post-traumatic stress disorder (PTSD) is one of the most commonly reported mental health consequences, followed by disasters and traumatic events, either natural or man-made. At present, there are no unified results for the prevalence rate of PTSD in patients suffering from acute trauma and related influencing factors. Therefore, the purpose of this study is to systematically evaluate the existing literatures, thus obtaining a comprehensive estimation of the combined prevalence rate of PTSD and related factors in trauma patients, so as to provide evidence support for clinical disease prediction models and intervention strategies.Methods:Published articles will be retrieved from PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Research reports will be searched in March 2021. STATA 14.0 software will be applied for data analysis. Mantel–Haenszel fixed effect model or DerSimonian–Laird random effect model will be selected to estimate the pooled prevalence of PTSD in patients with acute trauma and associated factors.Results:We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Conclusions:The results of this analysis can be used to establish a risk prediction model of PTSD in patients experiencing acute trauma, so as to provide intervention strategies.OSF Registration Number:DOI 10.17605/OSF.IO/Z275U.     

Evaluation of adalimumab biosimilar candidate (HS016) in Chinese patients with active ankylosing spondylitis based on a health survey: sub-analysis of a phase 3 study

Clinical Rheumatology - The equivalence of the biosimilar HS016 to adalimumab (Humira) for the treatment of active ankylosing spondylitis (AS) patients has been previously validated. The aim was to...     

Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial

Purpose

To determine whether erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs) in critically ill patients.

Methods

A prospective, multicenter, open-label, parallel, and non-inferiority randomized controlled trial was conducted comparing erythromycin with metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients admitted to intensive care units (ICUs) of eight tertiary hospitals in China. The primary outcome was procedure success defined as post-pyloric placement (spiral NETs reached the first portion of the duodenum or beyond confirmed by abdominal radiography 24 h after tube insertion).

Results

A total of 5688 patients were admitted to the ICUs. Of these, in 355 patients there was a plan to insert a nasoenteric feeding tube, of whom 332 were randomized, with 167 patients assigned to the erythromycin group and 165 patients assigned to the metoclopramide group. The success rate of post-pyloric placement was 57.5% (96/167) in the erythromycin group, as compared with 50.3% (83/165) in the metoclopramide group (a difference of 7.2%, 95% CI ??3.5% to 17.9%), in the intention-to-treat analysis, not including the prespecified margin of ??10% for non-inferiority. The success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond), and proximal jejunum placement and the incidence of any adverse events were not significantly different between the groups.

Conclusions

Erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients. The success rates of post-D1, post-D2, post-D3, and proximal jejunum placement were not significantly different.

     

人感染H7N9禽流感26例临床特征与病毒基因分析研究

目的探讨人感染H7N9禽流感病毒患者的流行病学和临床特征,以及病毒分子生物学特征。方法收集湖南省2013、2014年确诊的26例人感染H7N9禽流感病毒患者的资料,对人和禽分离的H7N9病毒进行鉴定和测序分析。结果26例患者中,发热和咳嗽是最常见的起病症状,所有患者均存在肺炎;20例(76.92%)出现急性呼吸窘迫综合征(ARDS),25例(96.15%)初诊时白细胞下降或正常,发病至开始进行抗病毒治疗的平均时间为10 d。10例死亡,病死率达38.46%。患者分离的H7N9病毒株测序分析表明,发生了H7基因Gln226Leu和Gly186Val替换,PB2基因Asp701Asn突变。结论急性呼吸系统损害是人感染H7N9禽流感的主要临床表现,活禽暴露是人感染H7N9禽流感的重要危险因素,H7N9禽流感病毒基因发生了部分位点的适应性突变,更容易从禽类向人跨种传播引起人类严重疾病,需加强病原学监测。