国内外指南中甲状腺癌颈淋巴结清扫手术范围及指征变迁

颈淋巴结清扫术是治疗甲状腺癌颈淋巴结转移的主要手段，不规范的颈淋巴结清扫术会导致转移淋巴结残留，增加复发风险，降低存活率。随着越来越多具有高质量循证医学证据的文献发表，相关指南中颈淋巴结清扫部分也在不断更新。     

澳大利亚登记药品注册申报的概况研究

对澳大利亚政府卫生部治疗用品管理部门（TGA）的登记药品注册申报制度和证据要求进行梳理，阐述了澳大利亚补充药品的监管模式，并对《支持登记补充药品适应症所需证据的指南》《经评估登记药品的证据指南》的关键信息进行分析。TGA登记药品、经评估登记药品属于简化注册的申报程序，基于“许可成分清单”“许可适应症清单”进行申报。TGA将适应症按风险程度的高低划分为3个级别，其中低风险和中级风险适应症分别对应登记药品和经评估登记药品。对于经评估登记药品的仿制药L（A）1申请途径，可考虑借鉴该方式为中级风险适应症中药非处方药（OTC）品种的仿制提供支持。对于经评估登记药品的新药L（A）3申请途径，可考虑借鉴该方式为中级风险适应症中药新药的简化申请提供支持，此类申请路径有可能为无特定适应症的证候类中药或民族药提供支持。     

Editor's Choice: Medication-indication knowledge bases: a systematic review and critical appraisal

Objective Medication-indication information is a key part of the information needed for providing decision support for and promoting appropriate use of medications. However, this information is not readily available to end users, and a lot of the resources only contain this information in unstructured form (free text). A number of public knowledge bases (KBs) containing structured medication-indication information have been developed over the years, but a direct comparison of these resources has not yet been conducted.Material and Methods We conducted a systematic review of the literature to identify all medication-indication KBs and critically appraised these resources in terms of their scope as well as their support for complex indication information.Results We identified 7 KBs containing medication-indication data. They notably differed from each other in terms of their scope, coverage for on- or off-label indications, source of information, and choice of terminologies for representing the knowledge. The majority of KBs had issues with granularity of the indications as well as with representing duration of therapy, primary choice of treatment, and comedications or comorbidities.Discussion and Conclusion This is the first study directly comparing public KBs of medication indications. We identified several gaps in the existing resources, which can motivate future research.     

整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块43例

目的:观察整脊推拿结合中药化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块的的效果及安全性。方法:伴有颈动脉斑块的颈源性眩晕患者按随机数字表法分为两组,对照组45例采用基础治疗联合中药化痰祛瘀方,观察组43例在对照组基础上结合整脊推拿干预,治疗后统计比较两组眩晕指征和血脂改善情况。结果:治疗后两组患者眩晕、耳鸣、恶心欲呕、头痛、视力障碍、猝倒发作、颈项不适、反应迟钝等症状的恢复率比较,差异有统计学意义(P<0.01);治疗结束后观察组的总有效率为95.35%,明显优于对照组的77.78%,差异有统计学意义(P<0.05);疗程结束后两组患者血脂均较治疗前有所改善(P<0.05),观察组中的总胆固醇(TC)、低密度脂蛋白(LDL)明显低于对照组,高密度脂蛋白(HDL)明显高于对照组,差异均有统计学意义(P<0.05),但三酰甘油(TG)和对照组比较差异无统计学意义(P> 0.05)。结论:整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块,在改善眩晕相关指征和血脂方面疗效较好。     

The impact of cesarean section on neonatal outcome of infants born at 23 weeks of gestation

Objective

Determine the impact of cesarean section (CS) on neonatal outcome of infants born at 23 weeks of gestation.

Methods

A retrospective study was performed involving 34 infants born at 23 weeks and 91 infants born at 24–26 weeks. Indications necessitating delivery were severe pregnancy induced hypertension, non-reassuring fetal heart rate patterns (NRFHRs), or intrauterine infection (IUI). Obstetrical indication for CS included NRFHR and breech presentation. Poor outcome included neonatal death or cerebral palsy. Univariate and multiple logistic analyses were performed to determine the effect of CS for obstetrical indications on poor outcome.

Results

The incidence of poor outcome was significantly higher at 23 weeks (number of poor outcomes/total number: 22/34) compared to that (31/91) at 24–26 weeks (p < 0.01). The incidence of a poor outcome was significantly higher at 23 weeks for infants having NRFHR (11/16) compared to those at 24–26 weeks (15/43, p = 0.02). However, the incidence of a poor outcome was similar in infants with IUI (6/10 at 23 weeks versus 5/11 at 24–26 weeks, p = 0.41). Vaginal birth in cases of obstetrical indication for CS at 23 weeks was associated with higher risk of a poor outcome (odds ratio: 8.2). In contrast, the risk at 24–26 weeks was not higher (OR, 0.8). After adjustment using variables of vaginal birth and IUI, vaginal birth significantly affected poor outcome (OR, 13.0).

Conclusion

Poor neonatal outcome was closely related to the mode of delivery, suggesting that CS for obstetrical indication at 23 weeks may improve neonatal outcome.     

腹腔镜抗反流手术治疗胃食管反流病的总体疗效及手术指征选择

目的：探讨腹腔镜抗反流手术治疗胃食管反流病的疗效及手术指征选择。方法：总结2000年至2013年收治的185例胃食管反流病病人的临床资料和术后近期远期结果（生活质量、病人满意率、抗反流手术相关并发症及复发）,分析腹腔镜抗反流手术的安全性和有效性。结果：185例病人均顺利施行腹腔镜抗反流手术（食管裂孔修补＋胃底折叠）,手术用时50~200 min,术中失血10~100 mL,无中转开腹和手术死亡病例。20例病人发生围手术期并发症,经针对性处理后痊愈;术后并发慢性吞咽困难16例,多为轻、中度;163例GERD病人术后日常生活质量改善明显,手术满意率达88.1%;166例病人术前胃食管反流症状典型,术后152例症状明显改善（91.6%）,14例无缓解。随访见8例术后复发,其中2例合并食管裂孔疝复发。结论：腹腔镜手术治疗胃食管反流病安全可行、疗效可靠,但术前应严格把握手术适应证。     

麦默通在乳腺囊肿切除及活检中的价值初探

目的探讨麦默通（MMT）进行乳腺囊肿切除活检的手术指征及MMT对乳腺囊肿的辅助诊断价值。方法 2010年5月至2011年11月期间,根据笔者所在科室拟出的乳腺囊肿MMT手术指征（单发囊肿、内部回声不均且直径大于1cm者;多发囊肿伴有严重无规律疼痛或触诊局部腺体增厚并经3个月药物治疗无效者;有乳腺癌发生高风险者;囊肿与低回声结节、乳管扩张等病灶并存者;病变周围腺体组织彩超下回声杂乱或血供丰富者）,选择了78例患者进行MMT切除活检,将术后病理结果与术前彩超检查结果进行对照。结果 78例患者术前彩超检查发现双乳多发囊肿40例,多发囊肿＋触诊不可扪及的低回声结节38例。术中彩超示高风险病变42例,低风险病变36例。术后病理检查结果提示彩超高风险组病理诊断囊性增生症27例,非典型增生2例,乳腺癌1例;彩超低风险组诊断囊性增生症19例。术前彩超检查对乳腺囊肿诊断的敏感度为61.22%（30/49）,特异度为58.62%（17/29）,准确度为60.26%（47/78）。本组切除病灶（13.00±8.16）个,手术时间（74.25±22.68）min。术后平均住院1 d出院,出现局部血肿2例,无其他并发症发生。结论笔者所在科室根据乳腺囊肿患者的临床表现以及术前彩超的影像学改变所拟定的MMT手术指征简单实用。MMT多点切除手术美观、安全,MMT切除活检有助于医生了解高危囊肿患者的病理类型,发现癌前病变或早期癌,但仍需严格规范乳腺囊肿的MMT手术活检指征。