基于互联网医疗的中医医疗资源信息集成模式应用研究

医疗资源信息化及信息集成是互联网医疗发展的先决条件,其后才是以此为基础的互联网医疗的业务开展。中医参与互联网医疗是必然趋势,也有其先天优势。基于中医行业的行医模式和诊疗方式的特点,中医参与互联网医疗的重要环节是医疗资源的信息集成。信息的合理集成可以解决凸显医生临证特色和患者诊前精准择医两大问题。目前中医医疗资源信息集成还处于非个性化的阶段,为实现上述目的,应加强广度和深度方面延展。而基于网络中医工作室为依托的平台建设,一方面可以凸显医生的临证特色,另一方面可以满足大众互联网医疗时代精准择医的需求,从而推动中医在线咨询诊疗业务的发展,是基于互联网医疗的中医医疗资源信息集成模式应用化平台的较好形式。     

中药熏洗联合功能锻炼对髌骨骨折术后功能恢复的影响

目的 探讨中药熏洗联合功能锻炼对髌骨骨折术后功能恢复的影响.方法 将符合纳入标准的80例髌骨骨折患者按随机数字表法分为2组,每组40例.对照组采用连续被动活动训练机(continuous passive motion,CPM)进行功能锻炼,治疗组在对照组基础上联合中药熏洗.2组均治疗8周.采用膝关节评分量表(Keen Society Score,KSS)评价膝关节功能,观察治疗前后膝关节活动范围变化,评价临床疗效.结果 治疗组优良率为87.5%(35/40)、对照组为65.0%(26/40),2组比较差异有统计学意义(χ2=5.591,P<0.01);治疗后8周,治疗组膝关节活动范围[(138.38±7.82)°比(120.29±7.83)°,t=10.338]、KSS评分[(88.38±9.52)分比(83.46±9.36)分,t=2.330]均高于对照组(P<0.01或P<0.05).结论 髌骨骨折术后采用中药熏洗联合CPM功能锻炼可促进膝关节功能恢复,减少骨折并发症.     

The Clearance of High-Risk Human Papillomavirus is Sooner After Thin Loop Electrosurgical Excision Procedure (t-LEEP)

Abstract

Purpose/aim of the study: To investigate high-risk human papillomavirus (HPV) infection clearance following thin loop electrosurgical excision procedure (t-LEEP) among patients with cervical benign lesion. Materials and Methods: This retrospective study analyzed clinical data from patients with cervical benign lesion and HPV infection, who had undergone t-LEEP (T-Group), compared with patients with HPV infection undergone no treatment (NT-Group). Both groups attended regular follow-up between January 2008 and January 2012. Kaplan–Meier analysis was used to compare the HPV clearance time. Results: The average clearance time was 7.7?months (M) (95% confidence interval [CI]: 6.5–8.9 M) in T-Group, and 10.4?M (95%CI: 9.4–11.3 M) in NT-Group, with significant difference between groups (p?=?0.003). Among patients with low viral load, the HPV clearance times were 7.6?M (95%CI: 6.3–9.0 M) in T-Group and 9.7?M (95%CI: 8.6–10.8 M) in NT-Group (p?=?0.042). Among patients with high viral load, the HPV clearance times were 8.0?M (95%CI: 5.3–10.6 M) in T-Group and 11.4?M (95%CI: 9.7–13.1 M) in NT-Group (p?=?0.041). The average time of HPV clearance in T-Group was shorter than NT-Group in all age groups, with significant differences in ≤29Y-group (p?=?0.008) and 30–39Y-group (p?=?0.005). The accumulated clearance rate of HPV infection at sixth month and 12th month were 24.5% and 67.9% in T-Group, 7.8% and 43.1% in NT-Group, with significant differences (p?=?0.001 at 6th month, p?=?0.032 at 12th month). Conclusions: T-LEEP accelerates the clearance of high-risk HPV infection and make the HPV infection rates dropped rapidly in the first year.     

原发性气管肿瘤的X线诊断（附22例分析）

本文复习了气管原发性肿瘤22例,其中鳞癌9例、腺癌1例、腺样囊性癌10例、平滑肌肉瘤1例、纤维瘤1例。肿瘤的位置分布:气管20例、隆突2例,有些病例的X线所见在乎片上可以表现为阴性,而在断层或支气管造影片则可以得到显示。笔者分析了误诊的原因,讨论了良、恶性肿瘤的诊断与鉴别诊断。     

Effects of an acetone extract of Boswellia carterii Birdw. (Burseraceae) gum resin on rats with persistent inflammation

OBJECTIVE: Ruxiang, or Gummi olibanum, an herbal medicine derived from the gum resin of Boswellia carterii Birdw. (BC) of the family Burseraceae, has been used traditionally in China to alleviate pain and reduce inflammation. The present study is an investigation of the effects of a BC extract on persistent hyperalgesia and edema in rats with peripheral inflammation. DESIGN: In this randomized, blinded study, the antihyperalgesic and antiedema effects of 3 dosages of BC were compared to a vehicle control. Inflammation was induced in rats by injecting complete Freund's adjuvant (CFA) into one hind paw. A single oral dose of the BC extract was administered daily for 7 days, beginning one day before CFA. Hyperalgesia was assessed using a paw withdrawal latency (PWL) test pre-CFA and 2 hours, 5 hours, 1 day, and 5 days post-CFA. Edema was determined by measuring paw thickness at the same time points. Spinal Fos protein expression was analyzed 2 hours post-CFA. Adverse effects of the extract were monitored by observing the animals closely for unusual behavioral changes. RESULTS: Compared to control, a dosage of 0.45 g/kg BC significantly lengthened PWL and reduced paw edema on day 5 post-CFA. At 0.90 g/kg, BC significantly lengthened PWL at 5 hours, 1 day, and 5 days, and reduced paw edema at 2 hours, 5 hours, 1 day, and 5 days. This dosage also significantly suppressed spinal Fos expression in the medial half of laminae I-II. At 1.80 g/kg, BC significantly lengthened PWL and reduced paw edema at all time points. No noticeable adverse effects were observed in animals given the lower dosages of BC, but adverse effects in some animals were observed at 1.80 g/kg per day. In the acute toxicity study, the maximal single dose of 2.50 g/kg produced no adverse effects in the treated rats during the 14 days of observation. CONCLUSIONS: The data suggest that BC produces significant antihyperalgesia and anti-inflammation effects and that the antihyperalgesia may be mediated by suppressed inflammation-induced Fos expression in the spinal dorsal horn neurons.     

锁定加压钢板治疗复杂胫骨平台骨折82例临床研究

目的探讨锁定加压钢板治疗复杂胫骨平台骨折的临床效果。方法选择我院2008年1月至2011年1月复杂胫骨平台骨折患者82例,其中男49例,女33例,平均年龄为33.8±6.8岁,均行手术治疗,实施锁定加压钢板内固定治疗。结果本组患者随访时间为10～36个月,3例失访,79例患者骨折均愈合,术后没有出现骨筋膜室综合症,没有患者出现下肢深静脉血栓形成。骨折骨性愈合平均时间为5个月;术后没有患者出现断钉、钢板断裂等;其中1例患者出现小范围皮肤坏死,经游离植皮等处理后愈合。2例伤口出现轻度感染,经抗感染治疗后控制并治愈。无患者出现明显膝关节僵硬,无患者合并排总神经损伤。按Rasmussen评分标准,优良率为82.9%。结论锁定加压钢板治疗复杂性胫骨平台骨折膝关节功能恢复效果显著,临床效果显著。     

蒙脱石散保留灌肠治疗婴幼儿轮状病毒肠炎系统评价

目的:系统评价蒙脱石散保留灌肠治疗婴幼儿轮状病毒肠炎的临床疗效和安全性。方法:计算机检索Cochrane Library、Pub Med、中国生物医学数据库、万方数据库、中国学术期刊网络出版总库和维普数据库,收集应用蒙脱石散保留灌肠治疗婴幼儿轮状病毒肠炎的随机对照研究文献,检索年限均截至2014年1月。由2名评价员独立筛选合格文献并提取相关信息,应用Rev Man5.2软件进行统计学分析。结果:纳入随机对照试验研究20项,共2 484例轮状病毒肠炎患儿。对纳入的研究进行Meta分析结果显示,各独立研究间无统计学异质性,合并分析后效应值RR=1.20,95%CI(1.17,1.24),蒙脱石散保留灌肠组的临床疗效优于对照组,差异有统计学意义(P<0.05)。发表偏倚分析提示纳入研究的文献存在发表偏倚可能。结论:蒙脱石散保留灌肠在治疗轮状病毒肠炎上具有提高临床愈显率的优势。     

Poor prognosis in carcinoma is associated with a gene expression signature of aberrant PTEN tumor suppressor pathway activity

Pathway-specific therapy is the future of cancer management. The oncogenic phosphatidylinositol 3-kinase (PI3K) pathway is frequently activated in solid tumors; however, currently, no reliable test for PI3K pathway activation exists for human tumors. Taking advantage of the observation that loss of PTEN, the negative regulator of PI3K, results in robust activation of this pathway, we developed and validated a microarray gene expression signature for immunohistochemistry (IHC)-detectable PTEN loss in breast cancer (BC). The most significant signature gene was PTEN itself, indicating that PTEN mRNA levels are the primary determinant of PTEN protein levels in BC. Some PTEN IHC-positive BCs exhibited the signature of PTEN loss, which was associated to moderately reduced PTEN mRNA levels cooperating with specific types of PIK3CA mutations and/or amplification of HER2. This demonstrates that the signature is more sensitive than PTEN IHC for identifying tumors with pathway activation. In independent data sets of breast, prostate, and bladder carcinoma, prediction of pathway activity by the signature correlated significantly to poor patient outcome. Stathmin, encoded by the signature gene STMN1, was an accurate IHC marker of the signature and had prognostic significance in BC. Stathmin was also pathway-pharmacodynamic in vitro and in vivo. Thus, the signature or its components such as stathmin may be clinically useful tests for stratification of patients for anti-PI3K pathway therapy and monitoring therapeutic efficacy. This study indicates that aberrant PI3K pathway signaling is strongly associated with metastasis and poor survival across carcinoma types, highlighting the enormous potential impact on patient survival that pathway inhibition could achieve.