免疫抑制剂对百草枯中毒预后的meta分析

目的:探讨免疫抑制剂对百草枯的治疗效果。方法:检索国内外公开发表免疫抑制剂治疗百草枯中毒的中英文文献,通过Stata软件进行Meta分析。结果:根据纳人和剔除标准筛选出10篇文献,其中8篇为历史对照的观察性研究,2篇为随机对照试验研究。Meta分析表明免疫抑制剂对百草枯中毒的预后有显著改善。历史对照的观察性研究RR=0.54,95%CI:0.44~0.66,RCT研究RR=0.76,95%CI:0.62~0.94。结论:免疫抑制剂治疗对百草枯中毒的生存率改善明显。但目前的文献存在异质性,证据尚不够充分。需要进行更多的RCT试验以进一步明确。     

Effect of ambulance 12-lead ECG recording on times to hospital reperfusion in acute myocardial infarction

OBJECTIVE: To review the evidence that recording a prehospital 12-lead electrocardiogram (ECG) reduces time from hospital arrival to initiation of reperfusion therapy for acute myocardial infarction (AMI). DATA SOURCES: Medline search from 1966 to the present (articles in all languages) and examination of bibliographies. STUDY SELECTION: Published studies of prehospital 12-lead ECG recording that included control groups and reported time intervals from hospital arrival to start of reperfusion therapy. DATA EXTRACTION: Eight articles satisfied selection criteria (two randomised controlled trials, four non-randomised interventional studies and two prospective observational studies). DATA SYNTHESIS: Widely varying study methodologies precluded meta-analysis. All studies had methodological problems, but hospital delays were consistently reduced. Such improvements appear to be small in hospitals where delays are already minimal. CONCLUSIONS: Little evidence is available to support routine prehospital 12-lead ECG recording if the median hospital time to reperfusion is already less than 30 minutes. Improvement of in-hospital treatment times may be a better initial strategy than prehospital 12-lead ECG recording, as this will benefit more patients and allow ambulance services to better allocate their available resources.     

Thrombolytic failure with streptokinase in acute myocardial infarction using electrocardiogram criteria

INTRODUCTION: This study was primarily aimed to determine the failure rate of thrombolysis with streptokinase in acute myocardial infarction using electrocardiogram criteria and its association between various independent variables and outcome parameters. METHODS: A total of 192 subjects were recruited into this retrospective observational study. Thrombolysis failure with streptokinase was defined using electrocardiogram criteria of less than 50 percent reduction in ST elevation in the worst infarct lead. Multivariate analysis was used to test association with study outcome. RESULTS: A total of 109 patients (56.8 percent) failed thrombolysis using streptokinase. The failures were associated with five variables in multiple logistic regression analysis (backward stepwise method) including anterior location of myocardial infarct (odds-ratio [OR] 0.07, 95 percent confidence interval [CI] 0.03-0.16; p-value is less than 0.001), longer door-to-needle time (OR 1.01, 95 percent CI 1.00-1.02; p-value is 0.02), diabetes mellitus (OR 3.13, 95 percent CI 1.13-8.69; p-value is 0.03), hypertension (OR 2.06, 95 percent CI 0.92-4.60; p-value is 0.08) and high total white cell count (OR 1.12, 95 percent CI 1.01-1.24; p-value is 0.03). Thrombolysis failure with streptokinase was associated with recurrent acute coronary syndrome (crude OR 2.49, 95 percent CI 1.16-5.32; p-value is 0.02) and death after one year (crude OR 7.61, 95 percent CI 0.95-61.24; p-value is 0.04). CONCLUSION: This study showed that streptokinase had a failure rate of 56.8 percent. History of diabetes mellitus, history of hypertension, anterior location of myocardial infarction, longer door-to-needle time and high total white cell count were highly predictive of thrombolysis failure using streptokinase. This group of patients may benefit from other early reperfusion strategy.     

Triple antithrombotic therapy versus double antiplatelet therapy after percutaneous coronary intervention with stent implantation in patients requiring chronic oral anticoagulation: a meta-analysis

Background Whether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated.This...     

急性百草枯中毒的救治体会

目的探讨急性百草枯（paraquat,PQ）中毒的治疗方法。方法对12例急性百草枯中毒住院患者的治疗效果与转归进行回顾性分析。结果 5例患者存活,占41.2%;4例自动出院,占33.3%;3例患者临床死亡,占25.0%。结论急性百草枯农药中毒可以导致多脏器损害;早期积极治疗可以降低患者死亡率。     

Automatic external defibrillators: changing the way we manage ventricular fibrillation

OBJECTIVE: To discuss recent developments in automatic defibrillation and to review the evidence that first-responders equipped with automatic external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest. DATA SOURCES: MEDLINE search from 1966 to 1999 (articles in English only) and examination of bibliographies. STUDY SELECTION: Published studies of out-of-hospital cardiac arrest and first-responders equipped with AEDs. Studies had to have a control group and to report survival to hospital discharge from ventricular fibrillation (VF). DATA EXTRACTION: Six studies met the selection criteria (two prospective randomised trials, two prospective controlled trials, and one cohort study and one retrospective study, both with historical controls). DATA SYNTHESIS: A random effects meta-analysis of odds ratios for survival from VF. CONCLUSIONS: Meta-analysis suggests that equipping first-responders with AEDs increases the probability of survival to hospital discharge after out-of-hospital cardiac arrest (odds ratio, 1.74; 95% CI, 1.27-2.38; P < 0.001). However, most of the studies lacked sufficient power to draw definitive conclusions. Until the impact of wide deployment of AEDs is fully understood, first-responder defibrillation in Australia should only occur as part of coordinated multicentre research studies.     

Role of foods in sporadic listeriosis. I. Case-control study of dietary risk factors. The Listeria Study Group.

OBJECTIVE--To identify dietary risk factors for sporadic listeriosis. DESIGN--Case-control study with blinded telephone interviews. SETTING--Multistate population of 18 million persons, November 1988 through December 1990. PARTICIPANTS--One hundred sixty-five patients with culture-confirmed listeriosis and 376 control subjects matched for age, health care provider, and immunosuppressive condition. RESULTS--The annual incidence of invasive listeriosis was 7.4 cases per million population; 23% of the infections were fatal. Cases were more likely than matched controls to have eaten soft cheeses (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4 to 4.8; P = .002) or food purchased from store delicatessen counters (OR, 1.6; 95% CI, 1.0 to 2.5; P = .04); 32% of sporadic disease could be attributed to eating these foods. Sixty-nine percent of cases in men and nonpregnant women occurred in cancer patients, persons with the acquired immunodeficiency syndrome, organ transplant recipients, or those receiving corticosteroid therapy. Among these immunosuppressed patients, eating undercooked chicken also increased the risk of listeriosis (OR, 3.3; 95% CI, 1.2 to 9.2; P = .02). CONCLUSIONS--Foodborne transmission may account for a substantial portion of sporadic listeriosis. Prevention efforts should include dietary counseling of high-risk patients and continued monitoring of food production.     

百草枯中毒患者脑脊液中NSE和S-100β的变化及意义

目的:探讨急性百草枯中毒患者脑脊液中神经元特异性烯醇化酶(NSE)和S-100β蛋白(S-1O0β)水平变化及其临床意义。方法:检测36例急性百草枯中毒患者脑脊液中NSE和S-100β水平的变化,与20例对照组比较分析。结果:中毒组脑脊液中NSE和S-l00β的水平均显著高于对照组(均P<0.01);死亡组脑脊液中NSE和S-l00β的含量均明显高于存活组(P<0.01或P<0.05)。结论:脑脊液中NSE和S-100β水平的变化,可作为评估急性百草枯中毒患者脑组织损伤及其严重程度的临床指标。     

中药治疗结核病临床评价的Meta分析

目的 采用Meta分析综合评价基于随机对照临床试验中药治疗结核病临床疗效,研究中药治疗与结核病治疗结局的相关性。方法 在中国期刊全文数据库（CNKI）、万方数据库（Wanfang Data）、PubMed、EMBASE、The Cochrane Library数据库中,采用主题词检索的方式检索有关中药治疗结核病的随机对照临床试验（randomized controlled clinical trials, RCTs）检索时间为建库截至2022年1月30日。采用改良Jadad评分对纳入文献的质量进行评价,以比值比（odds ratio, OR）及95%可信区间（confidential interval, CI）比较试验组和对照组治疗效果,采用漏斗图和Begg检验评价发表偏倚。应用Revman5.4和Stata12.0软件统计分析。结果 对10项RCTs文献进行定性分析,其中, 4篇RCT报道芩部丹治疗,样本量共517例,试验组261例,对照组256例。4篇RCT报道芪甲利肺治疗,样本量共473例,试验组239例,对照组234例。2篇RCT报道益肺通络辅助治疗,样本量共有325例,试验组...     

Efficacy and safety of induction therapy with alemtuzumab in kidney transplantation: a meta-analysis

Background Alemtuzumab, a humanized CD52 monoclonal antibody, with its profound lymphocyte depletion property, was expected to be a promising induction therapy agent for kidney transplantation （KTx）. However, currently no consensus is available about its efficacy and safety. The aim of this meta-analysis was to make a profound review and an objective appraisal of this issue. Methods Relevant papers were searched, essentially in the PubMed database and the Cochrane library. After a thorough review, randomized controlled trials （RCTs） comparing the outcome of KTx using alemtuzumab induction therapy （test group） with a control group were collected according to the inclusion criteria. Data of general characteristic of studies and major outcomes of Ktx were extracted and meta-analyses were performed with RevMan 4.2 software. The odds ratio （OR） with a 95% confidence intervals （Co was the principle measurement of effect. Results Five RCTs were included. The chi square test showed no significant between-study heterogeneity, thus fixed effect model was employed. Sub-group analysis with studies including alemtuzumab induction followed by a tacrolimus-based immunosuppressive regimen showed that the acute rejection rate （ARR） was lower relative to the control （OR=0.59, 95% CI 0.34-1.01, P=0.05）. However, meta-analysis with all included studies revealed that neither ARR nor patient/graff survival rates differ significantly between the test and the control group, but the cytomegalovirus （CMV） infection rate was higher in the test group （OR 2.50, 95% CI 1.22-5.12, P=0.01）. A great number of the test group recipients safely remained on a regimen that was steroid-free and with a reduced dose of conventional immunosuppressive drugs. Conclusions Alemtuzumab induction therapy for KTx was an effective and safe protocol in the tested follow-up period. Steroid avoidance and a dose reduction of conventional immunosuppressive drugs after alemtuzumab induction therapy may have clinical importance. However, high quality RCTs with larger population and longer follow-up are needed for a more accurate and objective appraisal of this novel protocol.     

社区高血压非药物治疗措施的执行情况分析

目的 通过开展社区高血压规范化管理项目,评估基层社区医生对高血压非药物治疗措施的执行情况和效果.方法 2005年至2008年,以我国现行高血压防治指南为依据制定了基层高血压规范化管理方案,根据此方案对全国基层医务人员逐步进行规范化培训,并要求受训人员按照方案要求管理高血压患者.在项目实施社区选择符合入选标准且管理满1年的患者为分析对象,分析管理期间患者危险因素变化情况,药物和非药物治疗情况,不同治疗方式的降压效果及不同行为危险因素的干预情况.结果 到2008年12月,规范化管理满1年的患者共29411例,其中资料齐全用于本文分析者共20 077例,其中男性47.1%,平均年龄（61±11）岁.经过1年的规范化管理,患者的吸烟率、饮酒率、饮食偏成者所占比例分别由17.7%、18.1%和32.8%降至8.9%、8.7%和15.8%（均P＜0.01）;单纯非药物治疗、单纯药物治疗、兼有药物及非药物治疗者收缩压分别下降11.6mm Hg（1 mm Hg=0.133 kPa,95%CI10.8～12.4）、13.7 mm Hg（95%CI 13.3～14.1）和15.2 mm Hg（95%CI14.8～15.6）,舒张压分别下降7.5 mm Hg（95%CI6.9～8.1）、8.3 mm Hg（95%CI8.1～8.5）和8.0 mm Hg（95%CI7.8-8.2）.为期1年的随访管理期间,研究对象接受针对性非药物治疗措施的患者比例均持续增加;管理满1年时分别有59.5%的吸烟者被要求戒烟,55.5%的饮酒者被要求限酒,52.3%的超重肥胖者被要求限制体重,47.3%的每周体育锻炼不足3次的患者被要求规律运动.但仍有相当比例的具有行为危险因素的患者未接受针对性的非药物治疗措施.结论 高血压规范化管理推动了非药物措施的使用,然而全部落实需要一个过程.     

中国心肌梗死患者血管紧张素Ⅰ转换酶基因插入/缺失多态性Meta分析

目的对中国人血管紧张素Ⅰ转换酶(ACE)基因内含子16插入(I)/缺失(D)多态性与心肌梗死的关联性进行Meta分析.方法以心肌梗死组和健康对照组基因型分布的比值比(OR)为统计量.全面检索到相关文献,剔除不符合要求的文献,排除发表偏倚的影响,应用REVMAN3.1软件对各研究结果进行一致性检验和采用相应的数学模型进行数据合并.结果相关文献未发现显著发表偏倚,数据合并结果心肌梗死组和健康对照组DD/(ID+II)OR 2.33,95%可信区间(CI)1.65～3.29,(P＜0.01),II/(ID+DD)OR 0.59,95%CI 0.47～0.73,(P＜0.01).结论中国人ACE I/D多态性与心肌梗死有关联,心肌梗死组DD基因型增多,II基因型减少.     

Survival of zidovudine-treated patients with AIDS compared with that of contemporary untreated patients. Italian Zidovudine Evaluation Group.

OBJECTIVE--To assess the long-term effectiveness of zidovudine (AZT) in patients with acquired immunodeficiency syndrome (AIDS). This assessment has never been adequately done because controlled clinical trials were stopped early and survival comparisons were made with historical controls. DESIGN--Nonrandomized contemporary observational study of patients treated and not treated with zidovudine. SETTING--Twenty-three AIDS treatment centers throughout Italy that reported cases to the National Registry of AIDS Cases between July 1987 and March 1988. PATIENTS--One hundred fifty-nine zidovudine-treated and 112 untreated patients with AIDS, the majority of whom had acquired human immunodeficiency virus (HIV) infection through intravenous drug use. OUTCOME MEASURES--Median survival and 1- and 2-year survival for treated and untreated groups, as estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was also used to identify independent predictors of survival among the variables studied. RESULTS--Patients were similar with respect to CD4/CD8 ratio, age, sex, clinical and immunological status at diagnosis, and source of HIV infection. After 24 months, survival was 45.9% (95% confidence interval [CI], 36.1% to 55.7%) in the treated group and 20.5% (95% CI, 12.6% to 28.3%) in the untreated group, with median survival of 21.2 and 9.6 months, respectively. CONCLUSIONS--Possible biases of this study include imperfect matching for clinical status and better overall medical care of treated patients. Nevertheless, we believe that the observed differences in survival were primarily due to zidovudine treatment.     

血液灌流联合环磷酰胺和甲基强的松龙治疗百草枯中毒的疗效与安全性

目的观察血液灌注联合环磷酰胺和甲基强的松龙治疗百草枯中毒患者的近期疗效。方法回顾性分析运城市中心医院2003—01～2008-01收治的百草枯中毒患者72例,其中血液灌流联合环磷酰胺和甲基强的松龙治疗患者（联合治疗组）38例,血液灌流不联合环磷酰胺和甲基强的松龙治疗患者（常规治疗组）34例。比较2组间患者的临床特征,30d死亡率、肺纤维化发生率、多脏器功能衰竭发生率及肺纤维化发生时间。结果两组患者临床特征差异无统计学意义（P〉0．05）;联合治疗组较常规治疗组死亡率显著降低（10．52％船38．23％,P=0．013）,肺纤维化发生率（2．60％惦18．91％,P=0．041）和多器官衰竭发生率也显著下降（0vs14．70％,P=0．047）,肺纤维化发生时间的差异无统计学意义（P=0．483）,同时总的严重并发症发生率差异也无统计学意义（2．60％∞0,P=0．955）。结论血液灌注联合环磷酰胺和甲基强的松龙治疗百草枯中毒早期疗效是确切的。     

乌司他丁对急性百草枯中毒的疗效观察

目的探讨乌司他丁对急性百草枯中毒的治疗效果。方法选择2010年9月-2012年2月收治的急性百草枯中毒患者53例为研究对象,分为常规治疗组和乌司他丁组。乌司他丁组在常规治疗基础上加用乌司他丁注射液治疗。比较两组患者发生肺纤维化、多器官功能障碍综合征(MODS)及病死率之间的差异。结果与常规治疗组相比,乌司他丁组发生肺纤维化、MODS的人数少,差异有统计学意义(P<0.05);乌司他丁组病死率低于常规治疗组,差异有统计学意义(P<0.05)。结论乌司他丁在治疗急性百草枯中毒时能够有效改善脏器功能、降低肺纤维化及MODS的发生率,改善预后,降低病死率,是临床上急性百草枯中毒的有效治疗方法之一。     

急性百草枯中毒的临床救治分析

目的探讨急性百草枯（PQ）中毒的临床特点及治疗方法,以降低死亡率。方法对12例口服PQ中毒患者的临床资料进行回顾性分析。结果12例中2例存活,10例死亡,病死率为80．33％。结论急性PQ中毒病人的生存机会主要取决于服药量与就诊时间,及早洗胃、有效导泻、适时血液灌流、早期应用抗氧化损伤药物和肾上腺皮质激素,给予器官功能支持、控制感染等综合治疗措施可降低病死率。     

PTEN蛋白表达与乳腺癌患者临床病理学特征相关性的 Meta分析

目的：评价PTEN蛋白表达与乳腺癌患者临床病理学特征的关联性。方法通过PubMed、Embase、Cochrane Li‐brary、中国知网（CNKI）及万方数据库检索所有已发表的关于乳腺癌患者组织中PTEN蛋白表达与临床病理学参数的相关性研究。应用RevMan 5．2软件进行分析,计算表达比值比（OR）和95％可信区间（CI）,并对研究文献进行异质性检验和偏倚评估。结果共28篇研究文献（3172例患者）纳入Meta分析。PTEN在乳腺癌组织中的表达与患者的雌激素受体（OR＝3．16,95％CI：2．01～4．97,P＜0．01）、孕激素受体（OR＝2．27,95％ CI：1．70～3．04,P＜0．01）、淋巴转移（OR＝0．36,95％ CI：0．27～0．49, P＜0．01）、临床分期（OR＝2．59,95％ CI：2．04～3．30,P＜0．01）和组织学分级（OR＝2．19,95％ CI：1．74～2．75,P＜0．01）均有显著相关性。结论 PTEN异常表达可能在乳腺癌的发生、进展、浸润及预后中起重要作用,是乳腺癌早期诊断和内分泌治疗中较有价值的分子标志物。     

针刺治疗神经根型颈椎病系统评价

目的系统评价针刺与牵引相比较治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的疗效和安全性。方法广泛检索国内外各数据库中针刺与牵引治疗CSR的随机对照试验。严格按最新版Cochrane系统评价员手册5.1进行方法学质量评价并计算其效应量,进行Meta分析或描述性分析。结果 14个研究包括1 542例病例被纳入,结果显示针刺治疗CSR是安全的;针刺治疗CSR总体疗效较牵引治疗具有优效性(RR:1.20;95%CI:1.13～1.27 vs RR:1.14;95%CI:1.09～1.20)。针刺较牵引对CSR患者更具镇痛效果,且能减少复发。结论针刺较牵引治疗CSR具有优越性,但证据等级较低,结论并不可靠。