中药熏洗(浴)疗法临床外用技术规范(草案)

熏洗(浴)疗法临床应用广泛,但方法各异。基于对熏洗(浴)疗法已有临床应用的数据挖掘与分析,结合临床应用实际和相关现代研究,经相关领域专家多次论证,形成中药熏洗(浴)疗法临床应用技术规范(草案)。该规范(草案)包括适应症、禁忌症、用药前评估、用药前准备、药液制备、熏洗温度、熏洗时间、熏洗频率、熏洗疗程、操作方法、用药后处理及评估、注意事项、常见不良反应及应对措施等,以期规范中药熏洗(浴)疗法的临床应用,提高临床疗效,减少不良反应。     

Patient Functional Status as an Indication for Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundThe number of total hip arthroplasties performed per year is increasing for reasons not fully explained by a growing and aging population. The purpose of this study was to determine the role of patient functional status as an indication for surgery and determine if patients are undergoing surgery at a better functional status than in the past.MethodsA systematic review and meta-analysis of the MEDLINE, EMBASE, and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Functional status was assessed using the 36-Item Short-Form Health Survey’s Physical Component Summary score. Only primary procedures were included; revisions were excluded. Articles were screened by 2 independent reviewers with conflicts resolved with a third reviewer. Meta-regression analysis was performed to determine the effect of time, patient age, and gender. Subgroup analysis was performed to compare geographic regions.ResultsA total of 1504 articles were identified. Data from 172 groups representing 18,644 patients recruited from 1990 to 2013 and identified from 107 articles were included. The mean preoperative Physical Component Summary score was 31.2 (95% confidence interval 30.5-31.9) with a 95% prediction interval of 22.6-39.8. The variance across studies was statistically significant (P = .000) with 97.25% true variance. Year of enrollment, age, and the percentage of females were not found to have any significant effect. There were no differences between countries.ConclusionPatients are undergoing total hip arthroplasty at a similar preoperative physical functional status as in the past. Patient age, gender, and location do not influence the functional status at which patients are indicated for surgery.     

Changing trends in penetrating keratoplasty indications at a tertiary eye care center in Budapest, Hungary between 2006 and 2017

AIM: To analyse the changing trends in penetrating keratoplasty (PKP) indications. METHODS: This retrospective study included all patients with PKP between 2006 and 2017. Patients were classified using histological diagnoses. Our groups were more than 10 various keratopathies. Additionally, two different time-periods (2006-2012 and 2013-2017) were analysed. Results: Totally 1721 histological analyses of 1214 patients were available for review. The diagnoses were pseudophakic or aphakic bullous keratopathy in 487 (28.3%), regraft in 443 (25.7%), acute necrotizing and ulcerative keratitis in 313 (18.2%), corneal scar in 153 (8.9%), keratoconus in 140 (8.1%). Fuchs’ dystrophy in 61 (3.5%), corneal dystrophy other than Fuchs’ in 46 (2.7%), other diagnoses in 44 (2.6%) and failed endothelial keratoplasty graft in 34 (2.0%) cases. From the first to the second analysed time-period, incidence of acute necrotizing and ulcerative keratitis, corneal scar, Fuchs’ dystrophy increased (P≤0.032 for all) and incidence of keratoconus significantly decreased (P=0.015). Conclusion: Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP, followed by regraft and acute necrotizing and ulcerative keratitis.     

奈达铂同步放化疗治疗无手术指征食管癌的增敏疗效及临床观察

目的:研究奈达铂同步放化疗治疗无手术指征食管癌的增敏疗效及临床观察。方法:收治2011年1月至2013年12月中晚期食管癌患者47例，经病理证实且失去手术指征的食管癌患者，随机分成两组，其中实验组23例，予奈达铂同步放化疗，对照组24例，予单纯放疗。结果:实验组有效率为69.57%，对照组为54.17%，两组差异无统计学意义（P＞0.05)；放射性肺炎、放射性食管炎、血小板下降、血红蛋白下降两组差异无统计学意义（P＞0.05)；胃肠道反应、白细胞下降两组差异有统计学意义（P＜0.05），实验组明显高于对照组；实验组1、2、3年生存率分别为82.6%、65.2%、21.7%，对照组分别为75.0%、33.3%、12.5%,1、3年生存率差异无统计学意义（P＞0.05），2年生存率差异有统计学意义（P＜0.05），两组生存率随时间递增而递减，实验组生存率高于对照组。结论:奈达铂同步放化疗治疗无手术指征食管癌可以提高疗效，可能延长生存期，但毒副反应相对明显。     

黄葵胶囊适应证的文献计量分析

目的 为黄葵胶囊在临床上的超说明书应用和说明书修改提供参考依据。方法 利用文献计量学方法分析黄葵胶囊的临床应用情况。以“黄葵胶囊”“黄蜀葵”“Huangkui capsule”“Abelmoschus manihot”为关键词,检索Pubmed、Ovid、Web of Science、CNKI数据库、维普数据库和万方数据库的文献。采用EndNote X7软件对检索到的文献进行去重、分类,利用Excel 2007软件对纳入文献的发表时间、适应证、联合用药进行分析。结果 共纳入文献444篇,其中临床研究432篇,综述11篇,病例报道1篇,其中英文文献有3篇。说明书记载黄葵胶囊的功能主治为：清利湿热,解毒消肿,用于慢性肾炎之湿热证。文献报道黄葵胶囊在临床上不仅被用于治疗慢性肾炎、糖尿病肾病、IgA肾病、高血压肾病、肾病综合征、紫癜性肾炎、肾移植术后蛋白尿、造影剂肾病、狼疮肾炎等肾脏疾病,还被用于治疗绝经后女性复发性尿路感染、原发性痛经和慢性盆腔炎等非肾脏疾病。结论 该研究为黄葵胶囊的说明书修改和二次开发提供了参考。     

Temporomandibular joint surgery: what does it mean to the dental practitioner?

A poor appreciation of the role of surgery in the management of temporomandibular disorders (TMD) may result in some patients being denied access to appropriate care. While surgery is often considered as an option of last resort, there are instances where surgery is the definitive and sometimes the only treatment option. The aim of this paper was to review the role of temporomandibular joint (TMJ) surgery and its place in the treatment armamentarium of temporomandibular disorders. Indications, rationale for surgery, risks vs. benefits are discussed and complemented with examples of clinical cases treated by the author. All dental practitioners should be aware of the benefits of TMJ surgery so that patients do not suffer unnecessarily from ongoing non-surgical treatments that ultimately prove to be ineffective in the management of their condition.     

俯卧位通气在急性呼吸窘迫综合征治疗中的研究进展

俯卧位通气(prone position ventilation,PPV)是急性呼吸窘迫综合征(acute respiratory distress syn-drome,ARDS)肺保护性通气的有效治疗措施之一,具有改善氧合、减少呼吸机相关性肺损伤等优点,但由于临床医师对PPV认识不足及顾虑其并发症,目前在临床上并未得到广泛的应用.本文针对PPV在ARDS治疗中的作用机制、适宜患者的选择、可能出现的并发症及注意事项进行综述.希望能提高临床医师在ARDS治疗中PPV的应用,降低ARDS患者的死亡率.