结合CARC、CARE病例报告标准探究“和法”治疗乳腺癌

乳腺癌是世界范围内女性发病率第一的恶性肿瘤。中医药特有的辨证论治体系及整体治疗方式在乳腺癌的治疗中起到至关重要的作用。从古至今中医医案一直是中医理论基础及经验传承的重要载体，但其病例报告格式的不规范影响了中医药的继承和规范化。本文中我们试图采纳规范的CARC和CARE中医病例报告形式报告1例“和法”论治乳腺癌的有效病例，以为乳腺癌临床治疗和中医病案报告提供新的思路。     

和胃利胆汤治疗麻醉微创保胆取石术后并发症临床研究

目的:观察和胃利胆汤联合西药治疗微创保胆取石术后相关并发症的临床疗效。方法:将96例行全身麻醉下微创保胆取石术后患者96例随机分为对照组和观察组各48例。对照组患者术后给予西药镇痛、抗感染、补液、止吐、保护胃黏膜等西药对症处理;观察组患者在对照组治疗的基础上给予和胃利胆汤治疗,两组均以15 d为1个疗程,连续治疗4个疗程,观察两组临床疗效。结果:两组患者术后经治疗胆囊壁厚度有所减少,胆囊功能有所增强,以观察组的改善尤为明显(P0.05);术后服药治疗过程中观察组患者均未出现明显胃肠不适症状;观察组患者结石复发率为6.25%,对照组患者结石复发率为31.25%,观察组的结石复发率明显低于对照组,差异有统计学意义(P0.05)。结论:和胃利胆汤联合西药能有效防治麻醉微创保胆取石术后患者的不良反应,提高胃肠功能,减小患者的胆囊壁厚度,提高患者的胆囊功能,降低复发率,效果满意。     

利胆和胃方辅治慢性胆囊炎疗效观察

目的:观察利胆和胃方治疗慢性胆囊炎(CC)的疗效。方法:74例随机数字表法分为两组各37例。两组均用西药治疗,观察组加用利胆和胃方治疗。结果:治疗6个月,两组中医证候各项积分及总分低于治疗前,且观察组低于对照组,两组比较差异有统计学意义(P<0.05);治疗6个月,观察组胆壁厚度、胆囊容积小于对照组,胆囊收缩率高于对照组,两组比较差异有统计学意义(P<0.05)。结论:利胆和胃方辅治CC疗效较好。     

Low serum albumin levels and in-hospital outcomes in patients with ST segment elevation myocardial infarction

Background and aimsLow serum albumin (SA) is associated with an increased risk of long-term adverse events (AEs) among patients with chronic coronary syndromes. Its prognostic role in patients with ST-elevation myocardial infarction (STEMI) is less clear. To investigate the association between low SA and in-hospital AEs in STEMI patients.Methods and resultsMulticenter retrospective cohort study of 220 STEMI patients undergoing primary percutaneous coronary intervention within 12 h from the onset of symptoms. Hypoalbuminemia was defined by serum SA <35 g/L. SA. In-hospital AEs were defined as cardiogenic shock, resuscitated cardiac arrest and death. Median SA was 38 (IQR 35.4–41.0) g/L and 37 (16.8%) patients showed hypoalbuminemia (<35 g/L) on admission. Patients with hypoalbuminemia were older, more frequently women and diabetics, prior CAD and HF. Furthermore, they showed lower hemoglobin levels and impaired renal function. At multivariable logistic regression analysis, diabetes (odds ratio [OR]:4.59, 95% confidence interval [CI] 1.71–12.28, p = 0.002) and haemoglobin (OR:0.52, 95%CI 0.37–0.72, p < 0.001) were associated with low SA. In a subgroup of 132 patients, SA inversely correlated with D-Dimer (rS −0.308, p < 0.001). Globally, twenty-eight (14.6%) AEs were recorded. Hypoalbuminemia (OR:3.43, 95%CI 1.30–9.07, p = 0.013), high-sensitive (HS)-Troponin peak above median (OR:5.41, 95%CI 1.99–14.7, p = 0.001), C-reactive protein (CRP) peak above median (OR:6.03, 95%CI 2.02–18.00, p = 0.001), and in-hospital infection (OR:3.61, 95%CI 1.21–10.80, p = 0.022) were associated with AEs.ConclusionLow SA levels are associated with worse in-hospital AEs in STEMI patients, irrespective of HS-troponin and CRP plasma levels. Our findings suggest that low SA may contribute to the pro-thrombotic phenotype of these patients.     

Comparison of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing an invasive strategy: A meta-analysis of randomized clinical trials

Objective

This meta-analysis was performed to assess the efficacy and safety of bivalirudin compared with unfractionated heparin or enoxaparin plus glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention (PCI).

Background

Pharmacotherapy for patients undergoing PCI includes bivalirudin, heparin, and GP IIb/IIIa inhibitors. We sought to compare ischemic and bleeding outcomes with bivalirudin versus heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI.

Methods

A literature search was conducted to identify fully published randomized trials that compared bivalirudin with heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI.

Results

A total of 19,772 patients in 5 clinical trials were included in the analysis (9785 patients received bivalirudin and 9987 patients received heparin plus GP IIb/IIIa inhibitors during PCI). Anticoagulation with bivalirudin, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in no difference in major adverse cardiovascular events (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.96 to 1.19), death (OR 0.93, 95% CI 0.72 to 1.21), or urgent revascularization (OR 1.06, 95% CI 0.86 to 1.30). There is a trend towards a higher risk of myocardial infarction (OR 1.12, 95% CI 0.99 to 1.28) but a significantly lower risk of TIMI major bleeding with bivalirudin (OR 0.55, 95% CI 0.44 to 0.69).

Conclusion

In patients who undergo PCI, anticoagulation with bivalirudin as compared with unfractionated heparin or enoxaparin plus GP IIb/IIIa inhibitors results in similar ischemic adverse events but a reduction in major bleeding.     

“少阳枢机”的原理及其临床意义初探

＂少阳枢机＂是伤寒六经中的重要概念。本文从多个层面对其进行综合阐述,分析其在人体代谢中生理病理的表现,明确其内在含义,并初步探讨了临床上针对少阳的治法和组方策略。     

500例慢性肾小球肾炎患者少阳病流行病学调查

目的对慢性肾小球肾炎患者中少阳病的患病情况及少阳病可能相关因素进行调查，为和解少阳法治疗本病提供参考依据。方法采用流行病学现场调查的方法，对2007年10-11月收集的500例慢性肾小球肾炎患者的人口学、中医证候学及实验室检查资料，运用SPSS软件进行统计分析。结果两家医院500例患者中咽于、耳鸣耳聋、目眩、口苦、胸胁苦闷等少阳病常见症状出现频数均〉20％，少阳病患病率为19．8％；近期有外感者患病率为42．6％，无外感者为13．0％，二者差异有统计学意义（P〈0．01）。各证型的慢性肾小球肾炎患者少阳病的患病率差异有统计学意义（P〈0．01），脾肾气虚患者更易患病（患病率35．5％）。女性患病率更高（22．9％）．与男性少阳病患病率（11．7％）差异有统计学意义（P〈0．05）。不同肾功能状况、病程及年龄段的患者少阳病患病率差异无统计学意义（P〉0．05）。结论慢性肾小球肾炎患者少阳病患病率外感后较高；少阳病患病率与肾功能状况、病程及年龄未见明显相关性，脾肾气虚型患者及女性更易患病；和解少阳法可以参考用于慢性肾小球肾炎的辨证治疗。     

The use of Deauville criteria in follow-up assessment of response to therapy in extra-nodal Non-Hodgkin's lymphoma

Objective

Our aim was evaluate the role the PET/CT in the assessment of response to therapy in patients with Non-Hodgkin extra-nodal lymphoma: in particular, a five-point scale (Deauville criteria), which can be employed for early- and late-therapeutic response assessment.

Effects of Bushenyiqihexue formula on the endometrial gland apoptosis in mice with blastocyst implantation dysfunction

Objective: To observe the effects of Bushenyiqihexue Formula (补肾益气和血方 Formula for Tonifying the Kidney, Replenishing qi and Harmonizing Blood, FTKRQHB) on the endometrial gland apoptosis in the mice with blastocyst implantation dysfunction. Methods: The mice with the first-day pregnancy were divided into the control, model and treatment groups, with 30 in each group, and blastocyst implantation dysfunction was induced by subcutaneous injection of mifepristone in the mice of the model and treatment groups. The pregnancy rate and implantation number of blastocysts were measured and the expressions of proliferating cell nuclear antigen (PCNA), Bax, Bcl-2, and activated caspase-3 were detected in all the three groups. Results: The model group had significantly depressed pregnancy rate, implantation number of blastocysts and apoptosis index, and elevated proliferation index of endometrial gland as compared with the control group (P0.05 or P0.01). Administration of FTKRQHB (the treatment group) resulted in significant increases in pregnancy rate, implantation number of blastocysts and apoptosis index of the endometrial gland, and a significant decrease in the proliferation index of the endometrial gland as compared with the model group (P0.05 or P0.01). The differences in the four indexes between the treatment group and control group were not significant statistically. The Bax and activated caspase-3 expressions in endometrial gland in the model group became significantly lower than that of the control group (P0.01), whereas those in the treatment group were significant higher than that of the model group (P0.01). However, the Bax and activated caspase-3 expressions in endometrial gland were similar in both treatment and control groups. Conclusion: Promoting the increases in Bax and activated caspase-3 expressions in the endometrial gland and bringing into balance between apoptosis and proliferation of the glandular cells at the implantation window phase by FTKRQHB may contribute to the effects of promoting the establishment of endometrial receptivity and improving blastocyst implantation dysfunction.     

调理脾胃针法治疗糖尿病视网膜病变对照研究

目的:探讨针刺治疗糖尿病视网膜病变的临床疗效及取效机理。方法:将120例糖尿病视网膜病变患者随机分为观察组和对照组,每组60例,在常规糖尿病治疗的基础上,观察组取穴以调理脾胃为目的,对照组以眼周穴位为主治疗。以眼底状况、血糖、血脂、一氧化氮(NO)、内皮素(ET)水平进行临床疗效评定。结果:调理脾胃针法不仅能改善患者的眼底状况,而且对患者的糖、脂代谢和NO、ET水平都有良性的调节作用,与对照组比较差异有显著性或非常显著性意义(P<0·05,P<0·01)。结论:调理脾胃针法是治疗糖尿病视网膜病变的有效方法,其取效机制可能与调节了血管活性物质NO、ET水平有关。