自发性细菌性腹膜炎的二级预防:利福昔明vs诺氟沙星

<正>【据《Eur J Gastroen Hepat》2016年10月报道】题:随机比较利福昔明与诺氟沙星用于自发性细菌性腹膜炎二级预防的疗效(作者Elfert A等)自发性细菌性腹膜炎(SBP)是肝硬化的严重并发症,其复发率和病死率均较高。诺氟沙星已广泛用于SBP的二级预防,但其长期大量应用可导致喹诺酮耐药率和革兰阳性菌所致的SBP发病率显著增高。利福昔明是一种不可吸收的广谱抗菌药物,几乎无耐药发生。本研究旨在比较利福昔明与诺氟沙星用于肝硬化腹水患者SBP二级预防的疗     

利福昔明治疗肠易激综合征疗效与安全性的Meta分析

目的系统评价利福昔明治疗肠易激综合征(irritable bowel disease,IBS)的疗效与安全性。方法计算机检索Pub Med、EMBASE、Web of Science、The Cochrane Central Register of Controlled Trials等外文数据库(1966年9月-2014年9月)及中国期刊全文数据库(CNKI)、中国生物医学文献数据库、万方学位论文数据库等中文数据库(1978年9月-2014年9月)中关于利福昔明用于IBS治疗的随机对照试验(RCT),由2位研究者按照Cochrane系统评价手册5.0.1标准独立评价文献质量、提取资料并交叉核对,采用Rev Man 5.20软件对数据进行Meta分析。结果共纳入6项RCT,包括2 415例患者。Meta分析结果显示:(1)IBS总体症状缓解率:利福昔明组疗效优于对照组(OR=1.53,95%CI:1.30~1.81,P0.01);(2)IBS相关腹胀缓解率:利福昔明组疗效优于安慰剂组(OR=1.56,95%CI:1.32~1.85,P0.01);(3)IBS相关腹痛及大便性状改变缓解率:利福昔明组疗效优于安慰剂组(OR=1.44,95%CI:1.20~1.74,P0.01);(4)不良事件发生率:利福昔明组与安慰剂组在不良事件发生率方面差异无统计学意义(P0.05)。结论利福昔明能有效改善IBS总体症状、IBS相关腹胀、IBS相关腹痛及大便性状改变等一系列症状,且有较好的安全性。     

利福昔明治疗肠易激综合征疗效的系统评价和Meta分析

目的探讨利福昔明对肠易激综合征(irritable bowel syndrome,IBS)患者的临床疗效。方法计算机检索中国生物医学文献数据库(CBM)(2001年1月-2013年10月)及外文数据库Pub Med(2001年1月-2013年10月),收集利福昔明治疗IBS的所有随机对照试验(RCT),并对所有资料进行Meta分析。结果共纳入5个RCT,2 124例患者。Meta分析结果显示:利福昔明实验组总体疗效优于对照组,能够有效缓解IBS患者全部症状(OR=1.61,95%CI:1.35~1.93),且无明显异质性(P=0.32,I2=14%)。对于次要结局指标腹胀缓解,仅3个RCT收集该有效数据,表明利福昔明实验组相对于对照组能有效缓解患者腹胀(OR=1.62,95%CI:1.35~1.96),且无明显异质性(P=0.39,I2=1%)。发生药物不良反应较少,利福昔明实验组和对照组副反应发生率相比,差异无统计学意义(P0.05)。结论利福昔明在提高IBS的总体疗效及缓解腹胀症状等方面疗效显著,且副作用发生率低。     

利福昔明治疗肠易激综合征疗效与不良反应Meta分析

目的评价利福昔明治疗肠易激综合征(irritable bowel syndrome,IBS)患者的疗效与不良反应。方法检索Pubmed、Web of Science、Google scholor、Medline及The Cochrane Library数据库及中国期刊全文数据库、中国维普全文数据库、万方医学全文数据库中1950年1月1日-2014年5月29日发表的关于利福昔明治疗IBS的临床随机对照试验的研究。评价的主要终点事件为IBS患者全身症状改善情况(global symptom improvement,GLSI),次要终点事件为腹胀改善情况及治疗过程、随访期间的不良反应事件。结果与安慰剂组比较,利福昔明可明显改善IBS患者全身症状(OR=1.55,95%CI:1.32~1.84,I2=17%);IBS相关腹胀缓解现象显著(OR=1.56,95%CI:1.32~1.85,I2=0%);短期不良反应事件发生率较低(OR=0.81,95%CI:0.66~0.99,I2=0%)。结论 Meta分析结果显示利福昔明可能较安慰剂组明显改善患者全身症状及腹胀情况,有较低的不良反应发生率,值得进一步研究。     

他汀对预防冠状动脉旁路移植术后心房纤颤的Meta分析

目的系统评价他汀(statin)对冠状动脉旁路移植术(CABG)后心房颤动(房颤)发生及术后重症监护室(ICU)监护时间、房颤开始及持续时间的影响。方法计算机检索Pub Med、EMbase、Cochrane图书馆、中国知网、万方数据库、维普数据库,查找所有关于他汀对CABG术后房颤发生情况的随机对照试验(RCT),按排除标准及纳入标准独立筛选文献、提取资料、评价纳入研究的质量后,用Revman5.3及Stata12.0软件进行Meta分析。结果纳入11篇RCT,共1062例患者,Meta分析显示:(1)他汀组较对照组其CABG后房颤发病率低(OR=0.36,95%CI:0.27~0.50,P0.001);(2)他汀组术后ICU住院日较对照组短(SMD=-0.36,95%CI:-0.70~-0.02,P=0.04);(3)他汀组发生CABG后房颤患者其房颤持续时间短于对照组(SMD=-2.17,95%CI:-2.52~1.81,P0.001);他汀组及对照组发生CABG后房颤患者其房颤开始时间无差异(SMD=-0.0009,95%CI:-0.14~0.15,P=0.96)。结论CABG术前服用他汀对术后房颤有预防作用,也可缩短患者术后ICU监护时间及房颤持续时间。     

慢加急性肝衰竭合并自发性细菌性腹膜炎的危险因素分析

目的探讨慢加急性肝衰竭(ACLF)患者出现自发性细菌性腹膜炎(SBP)的相关影响因素,为临床诊断及预后判断提供参考。方法回顾分析2009年1月-2014年12月于福州市传染病医院住院治疗的667例ACLF患者的临床资料,根据是否合并SBP分为ACLF组(n=232)和ACLF合并SBP组(n=435)。比较分析2组患者的一般资料、实验室指标以及相关并发症发生情况。服从正态分布的计量资料2组间比较采用t检验,不服从正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ~2检验,ACLF合并SBP的独立危险因素采用logistic回归分析。结果 2组患者的实验室指标和并发症比较结果显示,在Alb(t=-4.110,P0.001)、ALT(U=-6.653、P0.001)、AST(t=-8.045,P0.001、血钠(t=-2.879,P=0.006)、PTA(t=-2.140,P=0.037)、INR(t=1.453,P=0.042)、Hb(t=-3.446,P=0.001)以及上消化道出血、肝肾综合征、肺部感染(χ~2值分别为48.252、16.244、13.564,P值分别为0.002、0.031、0.001)等方面的差异均有统计学意义。进一步行多因素logistic回归分析结果显示,Alb[比值比(OR)=1.119,95%可信区间(95%CI):1.052~1.189]、PLT(OR=1.035,95%CI:0.755~1.084)以及上消化道出血(OR=1.117,95%CI:0.072~1.135)、肺部感染(OR=2.275,95%CI:0.978~5.292)等方面的差异均有统计学意义(P值分别为0.002、0.038、0.022、0.036)。结论在治疗ACLF患者的过程中,应注意预防低Alb、低PLT、上消化道出血以及肺部感染等危险因素发生,及早诊断和干预,有助于预防SBP的发生。     

中性粒细胞百分比/白蛋白联合白细胞/红细胞比容对急性ST段抬高型心肌梗死后心脏破裂的预测价值

目的 探究中性粒细胞百分比/白蛋白(NPAR)联合白细胞/红细胞比容(WBCHR)对急性ST段抬高型心肌梗死(STEMI)后发生心脏破裂(CR)的预测价值。方法 回顾性收集STEMI患者,最终筛选纳入CR患者(CR组)126例和非CR患者(非CR组)331例。通过Logistic回归分析研究NPAR、WBCHR及其他因素对STEMI后发生CR风险影响,并绘制受试者工作特征(ROC)曲线评估NPAR、WBCHR及两者联合对CR的预测价值。结果 根据多因素Logistic回归分析结果,年龄(OR=1.04,95%CI:1.00～1.08,P=0.033)、收缩压(OR=0.98,95%CI:0.97～1.00,P=0.032)、红细胞(OR=0.50,95%CI:0.26～0.95,P=0.033)、急诊经皮冠状动脉介入(PCI)(OR=0.36,95%CI:0.18～0.75,P=0.006)、NPAR(OR=2.44,95%CI:1.13～5.30,P=0.024)和WBCHR(OR=1.08,95%CI:1.04～1.12,P<0.001)是CR的独立影响因素。在ROC曲线分析...     

药物洗脱支架2年内再狭窄危险因素分析和Nomogram构建

目的探讨冠心病合并2型糖尿病患者药物洗脱支架(DES)植入后2年内再狭窄(ISR)危险因素并构建Nomogram模型。方法回顾性分析2010年1月—2020年2月在中国医学科学院阜外医院深圳医院植入DES的冠心病合并2型糖尿病患者临床资料。PASS估计模型产生队列样本量,根据冠状动脉造影结果分为支架内再狭窄组(DES-ISR)及非狭窄组(non-DES-ISR),对两组之间差异有统计学意义的参数进行单因素和条件性多因素Logistic回归分析构建Nomogram并在验证队列中验证其检验效能。结果模型产生队列共1741例,233例(13.4%)在植入DES后2年内确诊ISR,条件性多因素Logistic回归分析显示,DES-ISR的预测因素为肾小球滤过率(eGFR)<60 mL/(min·1.73 m²)(OR=2.77,95%CI:1.41~5.47,P=0.003)、血脂异常(OR=1.90,95%CI:1.30~2.78,P=0.001)、空腹血糖(FPG)≥6.5 mmol/L(OR=5.50,95%CI:3.05~9.92,P<0.001)、冠状动脉多支病变(OR=7.26,95%CI:3.27~16.11,P<0.001)、冠状动脉弥漫病变(OR=1.80,95%CI:1.13~2.88,P=0.014)、首次PCI操作时间≥60 min(OR=2.62,95%CI:1.13~6.05,P=0.024)和首次PCI为急诊(OR=2.20,95%CI:1.48~3.28,P<0.001)。模型验证队列102例,DES-ISR发生风险随Nomogram评分增高而增加,Nomogram模型受试者工作特征(ROC)曲线下面积为0.791(95%CI:0.753~0.829,P=0.019)。结论冠状动脉病变特征以及PCI操作程序是DES-ISR的重要预测因素,Nomogram能够较好地识别DES-ISR高危人群,能够为高危人群的随访干预提供有效的决策信息。     

十二指肠乳头括约肌切开后球囊扩张术和乳头括约肌切开术治疗巨大胆总管结石效果比较的Meta分析

目的评价两种手术方式十二指肠乳头括约肌切开术(EST)和十二指肠乳头括约肌切开后球囊扩张术(ESBD)处理巨大胆总管结石的疗效差异。方法计算机检索至2019年7月8日的Pubmed、Cochrane Central、Embase等外文数据库及中国知网、万方等中文数据库中的文献,同时检索相关会议论文等,纳入ESBD vs EST治疗巨大胆总管结石的随机对照试验(RCT),提取相关数据,采用RevMan5.3软件进行分析。结果共纳入13项RCT,共计1926例患者,其中ESBD组973例,EST组953例。Meta分析结果显示:ESBD组和EST组结石清除率[比值比(OR)=1.53,95%可信区间(95%CI):1.03~2.29,P=0.04]、一次清除率(OR=1.77,95%CI:1.06~2.93,P=0.03)、机械碎石率(OR=0.40,95%CI:0.25~0.63,P<0.0001)、出血率(OR=0.23,95%CI:0.11~0.50,P<0.001)、胆管炎发生率(OR=0.31,95%CI:0.12~0.78,P=0.01)、早期并发症(OR=0.59,95%CI:0.42~0.84,P=0.003)、手术时间(MD=-8.89,95%CI:-17.56^-0.22,P=0.04)比较,差异均有统计学意义;但在穿孔(OR=0.27,95%CI:0.05~1.30,P=0.10)、内镜后胰腺炎(OR=1.03,95%CI:0.66~1.61,P=0.91)方面二者结果相似。结论在内镜下处理巨大胆总管结石中,ESBD在结石清除率、机械碎石率、出血率、胆管炎发生率、手术时间方面比EST更有优势。     

经导管与外科手术治疗继发孔型房间隔缺损的Meta分析

目的系统评价经导管与外科手术治疗继发孔型房间隔缺损的临床研究数据。方法计算机检索Pub Med、EMbase、MEDLINE、Cochrane图书馆、CBM、万方数据库及CNKI,纳入经导管与外科手术治疗继发孔型房间隔缺损的随机对照研究(RCT)和队列研究。由两名评价员按照纳入与排除标准筛选文献,提取资料和评价质量后,采用Cochrane协作网提供的Rev Man5.3统计软件进行Meta分析。结果共纳入28篇队列研究(共计14 741例患者)。导管组全因死亡率、并发症发生率、住院时间均低于外科手术组,差异均有统计学意义(OR 0.36,95%CI 0.21~0.59,P0.0001;OR 0.37,95%CI 0.25~0.55,P0.0001;WMD–3.77,95%CI–4.36~–3.18 P0.00001)。导管组残余分流发生率、再次干预率高于外科手术组,差异均有统计学意义(OR 3.55,95%CI 1.79~7.05,P=0.0003)、(OR 2.19,95%CI 1.31~3.65,P=0.003)。结论两种手术方式都是有效的,与外科手术封堵相比,经导管介入封堵治疗继发孔型房间隔缺损具有低死亡率、低并发症发生率以及低住院时间等优势,而外科手术组在残余分流发生率及再次干预率方面有一定优势。     

Effect of poorly absorbable antibiotics on hepatic venous pressure gradient in cirrhosis: A systematic review and meta-analysis

BackgroundThe effects of poorly/non-absorbable antibiotics on hepatic venous pressure gradient (HVPG) are debated.AimTo analyze the effects of rifaximin or norfloxacin on HVPG and on markers of bacterial translocation and proinflammatory cytokines.MethodsWe performed a systematic search of randomized clinical trials (RCTs) involving patients with cirrhosis and portal hypertension, assessing the effect of rifaximin or norfloxacin vs control on HVPG. Pooled analyses were based on random-effects models, heterogeneity was assessed by Cochran's Q, I² statistic and subgroup analyses.ResultsFive studies (215 patients) were included. Risk of bias was high in three. We found no significant differences using antibiotics versus control. The summary mean difference in HVPG was of -0.55 mmHg (95%CI:-1.52, 0.42; P = 0.27), with moderate heterogeneity (P = 0.15; I² = 40%). RCTs with longer therapy (60–90 days) used non-selective-beta-blockers (NSBB) in both antibiotics and control arms. Subgroup analysis showed a significantly greater reduction in HVPG in the combination arm over controls (mean difference -1.46 mmHg [95%CI: −2.63, −0.28; P = 0.01]) with no heterogeneity (P = 0.46; I² = 0%). Serum lipopolysaccharide-binding protein (LBP) significantly decreased with antibiotics, but with high heterogeneity (P < 0.001; I² = 92%).ConclusionsRifaximin or norfloxacin did not significantly reduce HVPG in patients with cirrhosis and portal hypertension. Studies using antibiotic for longer periods on top of NSBB showed a significant decrease in HVPG.     

Effectiveness of 5-flurouracil-based neoadjuvant chemotherapy in locally-advanced gastric/gastroesophageal cancer: A meta-analysis

AIM:To investigate the effectiveness of 5-flurouracilbased neoadjuvant chemotherapy(NAC) for gastroesophageal and gastric cancer by meta-analysis.METHODS:MEDLINE and manual searches were performed to identify all published randomized controlled trials(RCTs) investigating the efficacy of the flurouracilbased NAC for gastroesophageal and gastric cancer,and RCTs of NAC for advanced gastroesophageal and gastric cancer vs no therapy before surgery.Studies that included patients with metastases at enrollment were excluded.Primary endpoint was the odds ratio(OR) for improving overall survival rate of patients with gastroesophageal and gastric cancer.Secondary endpoints were the OR of efficiency for down-staging tumor and increasing R0 resection in patients with gas-troesophageal and gastric cancer.Safety analyses were also performed.The OR was the principal measurement of effect,which was calculated as the treatment group(NAC plus surgery) vs control group(surgery alone) and was presented as a point estimate with 95% confidence intervals(CI).All calculations and statistical tests were performed using RevMan 5.1 software.RESULTS:Seven RCTs were included for the analysis.A total of 1249 patients with advanced gastroesophageal and gastric cancer enrolled in the seven trials were divided into treatment group(n = 620) and control group(n = 629).The quality scores of the RCTs were assessed according to the method of Jadad.The RCT quality scores ranged from 2 to 7(5-point scale),with a mean of 3.75.The median follow-up time in these studies was over 3 years.The meta-analysis showed that NAC improved the overall survival rate(OR 1.40,95%CI 1.11-1.76;P = 0.005),which was statistically significant.The 3-year progression-free survival rate was significantly higher in treatment group than in control group(37.7% vs 27.3%)(OR 1.62,95%CI 1.21-2.15;P = 0.001).The tumor down-stage rate was higher in treatment group than in control group(55.76% vs 41.38%)(OR 1.77,95%CI 1.27-2.49;P = 0.0009) and the R0 resection rate of the gastroesophageal and gastric cancer was higher in treatment group than in control group(75.11% vs 68.56%)(OR 1.38,95%CI 1.03-1.85;P = 0.03),with significant differences.No obvious safety concerns about mortality and complications were raised in these trials.There were no statistically significant differences in perioperative mortality(5.08% vs 4.86%)(OR 1.05,95%CI 0.57-1.94;P = 0.87 fixed-effect model) and in the complication rate between the two groups(13.25% vs 9.66%)(OR 1.40,95%CI 0.91-2.14;P = 0.12 fixed-effect model).Trials showed that patients from Western countries favored NAC compared with those from Asian countries(OR 1.40,95%CI 1.07-1.83).Monotherapy was inferior tomultiple chemotherapy(OR 1.40,95%CI 1.07-1.83).Intravenous administration of NAC was more advantageous than oral route(OR 1.41,95%CI 1.09-1.81).CONCLUSION:Flurouracil-based NAC can safely improve overall survival rate of patients with gastroesophageal/gastric cancer.Additionally,NAC can down the tumor stage and improve R0 resection.     

Anterior vs conventional approach right hepatic resection for large hepatocellular carcinoma: A systematic review and meta-analysis

AIM To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach.METHODS We comprehensively performed an electronic search of Pub Med, EMBASE, and the Cochrane Library for randomized controlled trials(RCTs) or controlled clinical trials(CCTs) published between January 2000 and May 2017 concerning the anterior approach(AA) and the conventional approach(CA) to right hepatectomy. Studies that met the inclusion criteria were included, and their outcome analyses were further assessed using a fixed or random effects model.RESULTS This analysis included 2297 patients enrolled in 16 studies(3 RCTs and 13 CTTs). Intraoperative blood loss [weighted mean difference =-255.21; 95% confidence interval(95%CI):-371.3 to-139.12; P 0.0001], intraoperative blood transfusion [odds ratio(OR) = 0.42; 95%CI: 0.29-0.61; P 0.0001], mortality(OR = 0.59; 95%CI: 0.38-0.92; P = 0.02), morbidity(OR = 0.77; 95%CI: 0.62-0.95; P = 0.01), and recurrencerate(OR = 0.62; 95%CI: 0.47-0.83; P = 0.001) were significantly reduced in the AA group. Patients in the AA group had better overall survival(hazard ratio [HR] = 0.71; 95%CI: 0.50-1.00; P = 0.05) and disease-free survival(HR = 0.67; 95%CI: 0.58-0.79; P 0.0001) than those in the CA group.CONCLUSION The AA is safe and effective for right hepatectomy for large hepatocellular carcinoma and could accelerate postoperative recovery and achieve better survival outcomes than the CA.     

射频消融在心房颤动伴射血分数降低心力衰竭患者中的治疗价值的荟萃分析

目的 评估导管射频消融对心房颤动合并射血分数降低心力衰竭(HFrEF)患者的心功能改善方面是否优于药物治疗.方法 系统检索了PubMed、Embase、Cochrane图书馆中对比导管射频消融和药物治疗心房颤动合并HFrEF患者的随机对照试验,并比较两者对心功能的改善作用.结果 纳入8项随机对照试验的1166例患者.相...     

Hypertension is associated with a high risk of cancer.

To investigate the possible relationship between hypertension and cancer, a retrospective analysis was carried out using a database including 1225 cases, of which 552 were hypertensives and 673 normotensives. Seventy cases of cancers with different origins were found during a 17-year follow-up. Odds ratio (OR) for occurrence of cancer was calculated. It was shown that an age over 40 years, male sex, alcohol-taking, systolic and diastolic blood pressures (SBP/DBP) were the five risk factors for the occurrence of cancers, while occupation, smoking, body mass index, left ventricular hypertrophy, and antihypertensive medication had no effect on cancer incidence. Hypertensives were at a high risk of overall cancer incidence with OR 2.2 (P < 0.01). After stratification of age, OR for hypertensives aged 40-49 years old with SBP > or =140 mm Hg or DBP > or =90mm Hg was 3.18 and 2.98 (P < 0.01 respectively). The OR of cancer for non-alcohol taking male hypertensives with SBP < or =140 mm Hg or DBP > or =90 mm Hg were 3.6 (95%CI 1.37-9.68, P = 0.003) and 5.67 (95%CI 2.01-16.75, P < 0.001), 7.55 (95%CI 2.10-33.19, P < 0.001) and 7.80 (95%CI 2.14-33.79, P < 0.001) for non-alcohol taking female hypertensives with SBP > or =140 mm Hg or DBP > or =90 mm Hg. After adjustment of age, sex and alcohol taking, the OR of the cancer incidence was 3.45 (95%CI 1.30-9.01, P < 0.01) for male and 5.0 (95%CI 1.56-16.67, P < 0.01) for female hypertensives aged 40-49 years. Multiple logistic regression analysis shows that age over 40 years, male sex, alcohol-taking, and DBP were the four independent risk factors for cancers. It is concluded that hypertension is associated with a high risk of cancer.     

幕上皮质下梗死后进展性运动功能缺损的预测因素

目的探讨幕上皮质下梗死后进展性运动功能缺损（PMD）的相关预测因素。方法前瞻性纳入142例幕上皮质下梗死患者,根据病情特点及美国国立卫生研究院卒中量表（NIHSS）中运动项目评分,将患者分为PMD组（39例）与稳定组（103例）。比较两组一般临床资料、实验室指标、神经功能评分及影像学特点,采用多因素Logistic回归分析,分析幕上皮质下梗死后PMD的独立危险因素。结果①PMD组患者进展时间平均为（31±11）h,33例（84.6%）病情进展出现在夜间。②单因素分析显示,PMD组中女性（P=0.045）、基线收缩压≥180mm Hg（P=0.000）、放射冠部位梗死（P=0.000）、梗死灶直径15～30 mm（P=0.003）、不稳定性斑块（P=0.001）及大脑中动脉狭窄或闭塞（P=0.015）患者所占的比例明显高于稳定组。而稳定组基底核部位梗死（P=0.000）、梗死直径〈15 mm（P=0.000）比例显著高于PMD组。③多因素Logistic回归分析显示,女性（OR=2.837,95%CI：1.076～7.485;P=0.035）、基线收缩压≥180 mm Hg（OR=3.509,95%CI：1.349-9.124;P=0.010）、放射冠部位梗死（OR=6.807,95%CI：2.446～18.944;P=0.000）、不稳定性斑块（OR=3.137,95%CI：1.019～9.657;P=0.046）、大脑中动脉病变（OR=4.027,95%CI：1.160～13.976;P=0.028）是发生PMD的独立危险因素。结论幕上皮质下梗死后PMD的发病率较高,女性、基线收缩压≥180mmHg以及放射冠部位梗死、不稳定性斑块和大脑中动脉病变均为PMD重要的预测因素。     

Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study

BACKGROUND Rifaximin has been shown to reduce the incidence of hepatic encephalopathy and other complications in patients with cirrhosis.However,few studies have investigated the effect of rifaximin in cirrhotic patients with refractory ascites.AIM To evaluate the effects of rifaximin in the treatment of refractory ascites and to preliminarily explore its possible mechanism.METHODS A total of 75 cirrhotic patients with refractory ascites were enrolled in the study(50 in a rifaximin and 25 in a control group).Patients in the rifaximin group were divided into two subgroups according to the presence of spontaneous bacterial peritonitis and treatment with or without other antibiotics(19 patients treated with rifaximin and 31 patients treated with rifaximin plus intravenous antibiotics).All patients received conventional treatment for refractory ascites,while patients in the rifaximin group received oral rifaximin-α200 mg four times daily for at least 2 wk.The ascites grade,fasting weight,liver and kidney function,and inflammatory factors in the plasma were evaluated before and after treatment.In addition,the gut microbiota was determined by metagenomics sequencing to analyse the changes in the characteristics of the gut microbiota before and after rifaximin treatment.The patients were followed for 6 mo.RESULTS Compared with the control group,the fasting weight of patients significantly decreased and the ascites significantly subsided after treatment with rifaximin(P=0.011 and 0.009,respectively).The 6-mo survival rate of patients in the rifaximin group was significantly higher than that in the control group(P=0.048).The concentration of interferon-inducible protein 10 decreased significantly in the rifaximin group compared with that in the control group(P=0.024).The abundance of Roseburia,Haemophilus,and Prevotella was significantly reduced after rifaximin treatment,while the abundance of Lachnospiraceae_noname,Subdoligranulum,and Dorea decreased and the abundance of Coprobacillus increased after treatment with rifaximin plus intravenous antibiotics.The gene expression of virulence factors was significantly reduced after treatment in both subgroups treated with rifaximin or rifaximin plus intravenous antibiotics.CONCLUSION Rifaximin mitigates ascites and improves survival of cirrhotic patients with refractory ascites.A possible mechanism is that rifaximin regulates the structure and function of intestinal bacteria,thus improving the systemic inflammatory state.     

阿替普酶初始溶栓序贯抗凝治疗老年急性次大面积肺栓塞疗效与安全性的meta分析

目的:系统评价阿替普酶初始溶栓序贯抗凝治疗老年急性次大面积肺栓塞(ASPE)的疗效与安全性。方法:检索中国知网、维普数据、中国生物医学文献数据库、万方数据、Medline、Embase、PubMed、The Cochrane Library、Clinical Trials,收集阿替普酶溶栓序贯抗凝对比单纯抗凝治疗ASP...     

达比加群酯对非瓣膜性房颤导管消融围术期抗凝疗效和安全性的 Meta 分析

目的：系统评价达比加群酯对非瓣膜性房颤导管消融围术期的抗凝疗效和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library（2016年第2期）、CMB、知网、万方和维普数据库,搜集有关房颤导管消融围术期使用达比加群酯和华法林抗凝治疗的随机对照及非随机对照的研究文献,由两位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5．3软件进行 Meta 分析。结果最终纳入23个研究、共7673例患者。Meta 分析结果显示：达比加群酯组脑卒中或短暂性脑缺血发生率与华法林组无明显区别[OR ＝1．0,95％CI：0．60～1．68,P ＝0．99],大出血事件发生率无明显区别[OR ＝0．79,95％CI：0．52～1．19, P ＝0．25],小出血事件发生率显著降低[OR ＝0．71,95％CI：0．57～0．87,P ＝0．001]。结论达比加群酯在房颤导管消融围术期抗凝疗效及大出血并发症的发生率上与华法林无明显区别,小出血并发症的发生率较华法林降低。