Network Meta-Analysis of Randomized Controlled Trials: Efficacy and Safety of UDCA-Based Therapies in Primary Biliary Cirrhosis

Major ursodeoxycholic acid (UDCA)-based therapies for primary biliary cirrhosis (PBC) include UDCA only, or combined with either methotrexate (MTX), corticosteroids (COT), colchicine (COC), or bezafibrate (BEF). As the optimum treatment regimen is unclear and warrants exploration, we aimed to compare these therapies in terms of patient mortality or liver transplantation (MOLT) and adverse events (AE).PubMed, the Cochrane Library, and Scopus were searched for randomized controlled trials up to August 31, 2014. We estimated the hazard ratios (HRs) for MOLT and odds ratios (ORs) for AE. A sensitivity analysis based on the dose of UDCA was also executed.Thirty-one eligible articles were included. Compared with COT plus UDCA, UDCA (HR 0.38, 95% confidence interval [CI] 0.09–1.39), BEF plus UDCA (HR 0.29, 95% CI 0.02–4.83), COC plus UDCA (HR 0.39, 95% CI 0.07–2.25), MTX plus UDCA (HR 0.28, 95% CI 0.05–1.63), or OBS (HR 0.49, 95% CI 0.11–2.01) all provided an increased risk of MOLT. With respect to drug AE profile, although not differing appreciably, BEF plus UDCA was associated with more AEs compared with UDCA (OR 3.16, 95% CI 0.59–20.67), COT plus UDCA (OR 2.27, 95% CI 0.15–33.36), COC plus UDCA (OR 1.00, 95% CI 0.09–12.16), MTX plus UDCA (OR 2.03, 95% CI 0.23–17.82), or OBS (OR 3.00, 95% CI 0.53–20.75). The results of sensitivity analyses were highly consistent with previous analyses.COT plus UDCA was the optimal UDCA-based regimen for both MOLT and AEs. BEF plus UDCA was most likely to cause AEs, whereas monotherapy with UDCA and coadministriation of COT plus UDCA appeared to be associated with the fewest AEs for PBC treatment.     

我国类鼻疽病的流行病学特征及诊疗的研究进展

类鼻疽病是由类鼻疽伯克霍尔德菌(Burkholderia pseudomallei)感染引起的一类人畜共患病,主要流行于全球热带及亚热带地区。在我国主要流行于南部地区,疫源地为海南、广东、广西、台湾等。伴随着旅游业和贸易业的发展,我国其他非疫区出现了输入性病例。类鼻疽病的感染途径主要为经伤口、粘膜、呼吸道、消化道等,其病变可涉及机体所有器官,易造成较高的误诊率和病死率。然而我国目前类鼻疽病的流行病筛查技术存在一定的局限性,在防控方面未实行有效的疾病监测和疾病报告制度,对基层医师和民众疾病知识普及的力度不够。因此,本文旨在提高我国医务工作者对类鼻疽病的重视程度,从类鼻疽病的病原学特征、流行病学特征、临床特征、诊断与治疗、防控措施这五个方面进行详细综述。     

术前预后营养指数对肺癌术后并发症风险的预测价值

目的:探讨术前预后营养指数（prognostic nutritional index，PNI）对肺癌术后并发症风险的预测价值。方法:回顾分析2015年12月至2018年3月于我院行手术治疗的非小细胞肺癌患者180例，收集患者的临床资料以及术后并发症的发生情况，采用Logistic回归分析患者术后并发症的影响因素。结果:多因素Logistic回归分析表明，术前低PNI值是术后并发症Clavien-Dindo评分≥II级的独立危险因素（OR:1.10，95%CI:1.02~1.17，P=0.023）；根据术前PNI值将患者分为三组，分别为PNI≥50组（n=113）、45≤PNI<50组（n=47）、PNI<45组（n=20），各组术后并发症Clavien-Dindo评分≥II级以及Clavien-Dindo评分≥III级发生的比例分别为22.1%、40.4%、40.0%和6.2%、17.0%、25.0%，不同PNI值术后并发症发生率存在显著差异；PNI值可作为术后并发症发生风险及气胸、肺外感染的独立危险因素。结论:PNI值可作为肺癌患者术后并发症风险的有效预测因子。     

Infantile spasms. A retrospective study of 105 cases.

This paper is a summary of our observations on 105 cases of infantile spasms. The age of onset was around six months after birth, but the patients came for treatment mainly about one year after onset. Fever of unknown cause, asphyxia, birth injury, infection of the central nervous system, tuberous sclerosis, phenylketonuria and recent immunization etc. were complained. Clinically, it is characterized by head nodding, mental retardation, myoclonic jerks and various neurologic deficits. EEG findings showed classical or modified arrythmia or other epileptiform patterns. About one third of 22 cases examined had abnormal brain stem auditory evoked potentials. Among 42 patients who underwent CT scanning before ACTH treatment, 18 were normal and 7 abnormal; during ACTH treatment 3 normal and 4 abnormal; after completion of treatment, 4 normal and 6 abnormal, suggesting no further atrophy of the brain. Examination of trace elements of the hair by particle-induced X-ray emission (PIXE) method in 23 patients revealed a significant difference in lead, calcium and zinc contents between patients and 101 controls, but no statistical difference in iron and copper contents between the two groups. Sodium valproate, prednisone and ACTH appear to be effective in the treatment of infantile spasms. Eight patients fully recovered, and they can go to school without difficulty. Many patients derived various degrees of improvement to the satisfaction of their parents. Two patients were still amented and often attacked by myoclonus. The effects, side effects of these drugs, and the possible pathogenesis were discussed.

     

小切口股骨近端解剖钢板治疗股骨转子间骨折

目的 探讨股骨转子间骨折的治疗方法和疗效。方法小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折17例。结果 随访时间8个月～3年，平均1.6年，优良16例，占94%（16/17）。结论 小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折具有切口小、出血少等优点，是一种微创手术。     

联合培养的成纤维细胞对平滑肌细胞增殖和形态的影响

目的:观察体外联合培养的成纤维细胞对平滑肌细胞形态和增殖的影响,为研究成纤维细胞和平滑肌细胞生物学特性和相互关系以及体外构建含此两种细胞的组织工程皮肤提供理论和实践基础。方法:在体外分别分离培养成纤维细胞和平滑肌细胞并常规传代培养。模拟组织工程皮肤的结构及成纤维细胞和平滑肌细胞间的相互影响途径,按照不同比例(平滑肌细胞:成纤维细胞=1:1,1:2,1:3)建立以胶原凝胶为基质的成纤维细胞与平滑肌细胞联合培养模型。应用荧光标记、组织学观察和MTT法对平滑肌细胞的形态和代谢进行研究。结果:联合培养模型法可以有效地建立起成纤维细胞和平滑肌细胞的相互影响模式。1:1组的成纤维细胞对联合培养的平滑肌细胞增殖有促进作用,1:3组的促增殖作用则不明显。结论:1:1联合培养的成纤维细胞对平滑肌细胞增殖有促进作用,对它们体外培养和扩增以及相互关系的研究对阐明这两种细胞组合作为真皮替代物种子细胞具有重要的意义。     

人卵巢癌中肿瘤转移抑制基因nm23-H1编码蛋白的表达

目的：探讨人卵巢癌标本中，肿瘤转移抑制基因ｎｍ２３－Ｈ１编码蛋白ＮＤＰＫ－Ａ表达的临床意义及其与预后的关系。方法：应用免疫组织化学抗生蛋白链菌素－过氧化酶结合（Ｓ－Ｐ）法，检测５８例人卵巢癌标本中ｎｍ２３－Ｈ１蛋白水平。结果：ｎｍ２３－Ｈ１蛋白的表达与患者手术时是否有淋巴结及大网膜转移相关（Ｐ〈０．０５），但原发灶与转移灶间的阳性表达率相差不显著；与患者术后生存时间密切相关（Ｐ〈０．０１），术后生     

脊髓手术中体感诱发电位监测的临床研究

报告３０例脊髓手术中体感诱发电位（ＳＥＰ）连续监测的临床研究结果。ＳＥＰ记录包括脊髓ＳＥＰ（ＳＳＥＰ）和皮层ＳＥＰ（ＳＣＥＰ）。麻醉药物对ＳＥＰ有一定程度影响，ＳＣＥＰ相对较大。认为，至少术中ＳＥＰ潜伏期延长不超过８％和波幅降低不超过５０％，不会引起术后并发症，超过该范围由于病例较少，尚不能肯定与预后的关系，需进一步探讨。     

磷脂酶C与生殖

磷脂酶C(PLC)是磷脂酰肌醇信号转导途径中一个关键酶。目前确认的哺乳类PLC共有PLC β、PLC γ、PLC δ、PLC ε和最近新发现的PLC ζ 5种亚型 ,12种同工酶。不同亚型的结构、调控和组织分布各有差异。PLC在调控信号转导通路中的特性使其在顶体反应、卵子激活中发挥了巨大的作用。本文综述了PLC家族 5种亚型的结构、调控机制及PLC在男性生殖领域的相关内容 ,包括PLC引起卵子发生Ca2 + 振荡、激活卵子、促进胚胎发育等 ,并进一步探讨了PLC在临床上可能的应用前景。