异位甲状腺癌的诊断和治疗

目的　探讨异位甲状腺癌的发病特点、诊断和治疗方法。方法　对 2 9例异位甲状腺癌的临床及病理资料进行回顾性分析。结果　 2 9例均行手术治疗 ,术后辅以放、化疗。术后随访 ,5年存活率为 5 2 .0 % ,最长 1例已存活 2 4年。结论　早期发现并及时手术治疗是提高异位甲状腺癌患者生存率的关键 ,术后给予辅助性放、化疗有助于提高生存率。     

Efficacy Of Balneotherapy For Rheumatoid Arthritis: A Meta-analysis

Abstract

Balneotherapy is an accepted therapeutic approach in Europe. However, its efficacy for treating rheumatoid arthritis (RA) remains controversial in North America. This is a meta-analysis of randomized (RCT ) and controlled clinical trials (CCT ), case-control and cohort studies of balneotherapy compared to control (no treatment) or active therapy (head to head studies). All the included studies (n =7) in this review were identified as RCTs. This meta-analysis examines different balneotherapy modalities: Radon-carbon dioxide baths, mud packs, hot sulphur baths, Dead Sea baths, Red Sea baths, and grey sand. Several types of balneotherapy, including radon-carbon dioxide baths, mud packs, hot sulphur baths, combination of hot sulphur baths and mud packs, Dead Sea baths, combination of Dead Sea baths and sulphur baths, and Grey sand and Red Sea baths compared to control were found to be beneficial for RA. These modalities were found to be especially beneficial for pain, grip strength, tender/swollen joints, patient and physician, and global function. These improvements ranged from 5-93% greater improvement relative to the control group. However, methodological considerations including the poor quality of trials impact the conclusions of this review.     

Creation and Critique of Studies of Diagnostic Accuracy: Use of the STARD and QUADAS Methodological Quality Assessment Tools

Abstract

Clinical special tests are a mainstay of orthopaedic diagnosis. Within the context of the evidence-based practice paradigm, data on the diagnostic accuracy of these special tests are frequently used in the decision-making process when determining the diagnosis, prognosis, and selection of appropriate intervention strategies. However, the reported diagnostic utility of these tests is significantly affected by study methodology of diagnostic accuracy studies. Methodological shortcomings can influence the outcome of such studies, and this in turn will affect the clinician's interpretation of diagnostic findings. The methodological issues associated with studies investigating the diagnostic utility of clinical tests have mandated the development of the STARD (Standards for Reporting of Diagnostic Accuracy) and QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criterion lists. The purpose of this paper is to outline the STARD and QUADAS criterion lists and to discuss how these methodological quality assessment tools can assist the clinician in ascertaining clinically useful information from a diagnostic accuracy study.     

Assessment of Hepatic Functional Reserve in Cirrhotic Patients by Computed Tomography of the Caudate Lobe

In order to investigate whether the size of thecaudate lobe of the cirrhotic liver is related to thehepatic functional reserve, the morphometric analysis ofthe caudate lobe was preformed retrospectively using computed tomography in 106 consecutivepatients of whom 67 had compensated (group 1), and 39uncompensated (group 2) liver cirrhosis. In 51 patients,hepatic measurements were repeated in follow-up. Age- and gender-matched controls were studied.The size of the caudate lobe and the ratio of thecaudate to right lobe were correlated with liverfunction. The caudate lobe was larger in the studypatients than in the controls, and larger in group 1than in group 2 (P < 0.01). The caudate to right loberatios were also greater in the study patientsespecially in group 1 (P < 0.01). In follow-up, the regression coefficient for the caudate to rightlobe ratio was positive in group 1 and negative in group2 (P < 0.05). Even though the caudate lobe ofpatients with uncompensated liver cirrhosis was larger than that of the controls, patients withcompensated liver cirrhosis had a larger caudate lobeand higher caudate to right lobe ratio compared to thepatients with uncompensated liver cirrhosis. The caudate lobe may have played an importantrole in maintaining proper liver function in thesepatients.     

Femoral Strength Changes Faster With Age Than BMD in Both Women and Men: A Biomechanical Study

Although a large number of studies have addressed the age‐related changes in bone mineral density (BMD), there is a paucity of data for the assessment of femoral strength loss with age in both genders. We determined the variation of strength with age in femurs of women and men by mechanical tests on a cohort of 100 cadaveric femurs. In addition, the age‐related neck BMD loss in our cadaveric cohort was found to be similar with BMD loss of four published population‐based studies. Given the strong correlation found in our cadaveric study between BMD and femoral strength, we also estimated the femoral strength of the four populations based on their reported neck BMDs. Our study showed that men's femurs in our cadaveric cohort were stronger than women's femurs by about 800 N at the same BMD level, and by 1750 N at the same age. The strength differences were not explained satisfactorily by the size difference between men's and women's bones. Similar to the findings of clinical studies, the BMD values of men at all ages were larger than that of women. The age‐related loss rates in BMD and strength were not statistically different between the two genders of our cadaveric cohort. After normalization, strength decreased more than 40% faster than BMD. On average, men reached a certain BMD value about 16 years later than women, and for strength about 23 years later, which may explain the higher rate of hip fracture in postmenopausal women. In patient population cohorts men reached a similar BMD value about 16 to 25 years later than women, whereas for estimated strength, sometimes more than 40 years later. © 2015 American Society for Bone and Mineral Research.     

Degree of biological apatite c‐axis orientation rather than bone mineral density controls mechanical function in bone regenerated using recombinant bone morphogenetic protein‐2

The aim of the present study was to assess the bone regeneration process in defects introduced into rabbit long bones, which were regenerated with controlled release of recombinant bone morphogenetic protein‐2 (rBMP‐2). The orientation of the biological apatite (BAp) c‐axis and bone mineral density (BMD) were compared as predictors of bone mechanical function. A 20‐mm‐long defect was introduced in rabbit ulnas, and 17 µg of rBMP‐2 was controlled‐released into the defect using a biodegradable gelatin hydrogel as the carrier. In the bone regeneration process, two characteristic phases may have been governed by different factors. First, new bone formation actively occurred, filling the bone defect with newly formed bone tissue and increasing the BMD. This process was regulated by the strong osteoinductive capacity of rBMP‐2. Second, after filling of the defect and moderate BMD restoration, preferential BAp c‐axis orientation began to increase, coincident with initiation of remodeling. In addition, the BAp c‐axis orientation, rather than BMD, was strongly correlated with Young's modulus, an important index of bone mechanical function, particularly in the later stage of bone regeneration. Thus, preferential BAp c‐axis orientation is a strong determinant and predictor of the mechanical function of tissue‐engineered bone. Therefore, analysis of BAp preferential c‐axis orientation in addition to measurement of BMD is crucial in assessment of bone mechanical function. © 2013 American Society for Bone and Mineral Research © 2013 American Society for Bone and Mineral Research     

清热利湿、凉血利胆法治疗重度黄疸型肝炎的临床研究

【目的】根据肝为血脏,湿热蕴于血分和肝气热则胆泻,胆泻则发黄的中医理论,观察在清热利湿基础上加用凉血利胆法治疗重度黄疸型肝炎肝胆湿热证的降黄效果。【方法】71例患者随机分为2组,治疗组38例,对照组33例,2组均采用基础治疗和对症处理。治疗组加用清热利湿和凉血利胆中药治疗,对照组加用小剂量654-2注射液静滴。观察2组总胆红素、直接胆红素、丙氨酸转氨酶、凝血酶原活动度的变化及黄疸持续时间以判定降黄疗效,比较治疗前后胆囊声像图的变化。【结果】治疗后2组均能降低血中总胆红素及丙氨酸转氨酶水平(P<0.05或P<0.01),且在降低总胆红素水平方面,治疗组优于对照组(P<0.01);治疗组的黄疸持续时间较对照组短(P<0.05),降黄疗效优于对照组(P<0.05);胆囊声像图的改善两组比较无显著性差异(P>0.05),但治疗组显效率高于对照组(P<0.05)。【结论】清热利湿、凉血利胆法治疗重度黄疸型肝炎肝胆湿热证降黄效果显著,黄疸持续时间缩短。     

桥本病及其共存病的诊断和处理

目的 探讨桥本病及与其共存病的诊断和外科处理原则。方法 回顾性分析５４例桥本病患者的临床资料。结果 甲组２５例经临床检查、小针穿刺细胞学检查及免疫抗体测定拟诊桥本病,采用药物诊断性治疗,２４例治愈,１例后发现共存癌中转手术;乙组２９例因非典型表现误诊为外科病施行甲状腺切除术,术后均经病理切片明确诊断,并发现１４例与甲状腺其它良、恶性疾病共存（甲亢３例,甲状腺癌４例,恶性淋巴瘤２例,甲状腺腺瘤５例）     

活血化瘀中药对原发性青光眼患者视力的影响

【目的】探讨活血化瘀中药对原发性青光眼患者视力的影响。【方法】回顾性总结原发性青光眼 32例6 0眼治疗前后的视力变化。根据用药方法不同分为常规治疗组 (33眼 )和活血化瘀组 (2 7眼 ) ,常规治疗组按病情常规给予降眼压药物及手术治疗。活血化瘀组在常规治疗的基础上加用活血化瘀药物。【结果】常规治疗组治疗后 8眼 (2 4 .2 4 % )视力提高 ,活血化瘀组治疗后 16眼 (5 9.2 6 % )视力提高 ,两组疗效差异有显著性 (P<0 .0 5 )。活血化瘀组中采用复方丹参注射液者 15眼 ,治疗后 8眼 (5 3.33% )视力提高 ,采用脉络宁注射液者 8眼 ,治疗后 6眼 (75 % )视力提高 ,差异无显著性 (P>0 .0 5 )。【结论】在常规治疗的基础上 ,加用活血化瘀中药治疗有助于提高原发性青光眼患者的视力。