双J管拔除困难12例临床分析

目的 探讨双J管拔除困难的常见原因及相应的预防措施及处理方法.方法 回顾性分析12例双J管拔除困难患者的临床资料.结果 7例双J管结石形成,3例放置不到位或上移,1例双J管上端被可吸收线误缝,1例术后遗忘拔管2年致双J管断裂.12例均经微创治疗方式成功拔除双J管.结论 双J管拔除困难有多种原因,针对原因进行预防是减少双J管拔除困难发生的关键,应联合多种手段,以达微创处理的目的.     

正常变异J波与异常J波的诊断讨论

目的:探讨心电图正常变异与异常J波的鉴别.方法:均行常规12导联心电图检查,观察J波的振幅、时限,及其各导联出现的频度.结果:J波呈尖型,时限<0.02秒,振幅<0.2mv,常伴发早期复极综合征,多属于正常变异J波;若为顿挫或驼峰型,J波时限>0.03秒,J波振幅>0.2mv,且伴发器质性心脏疾患,多属于异常J波.结论:心电图出现异常J波时应警惕恶性心律失常,特别是心室颤动的发生.     

ST段抬高型急性心肌梗死合并J波综合征患者的心电图特征

目的 总结ST段抬高型急性心肌梗死合并J波综合征患者的心电图特征.方法 分析入选的69例ST段抬高型急性心肌梗死合并J波综合征患者的心电图,观察J波的形态,出现最明显的部位,出现的时间和消失的时间,所出现的心律失常类型.结果 ST段抬高型急性心肌梗死合并J波综合征患者有明显J波的4例,占总J波综合征人数的5.8%;JT部分融合J波尚可分辨的11例,占总J波综合征人数的15.9%;JT完全融合,J波不可分辨的54例,占总J波综合征人数的78.3%.下壁受累的患者共有57例(82.6%),所有前壁受累(除去含下壁)的患者共12例(17.4%).无J波伴病理性Q波及J波伴T波倒置的病例.发病后(3.9±2.5)h出现J波,(26.7±17.8)h后消失.结论 ST段抬高型急性心肌梗死合并J波综合征可能仅出现在心肌梗死的超急期,J波形态多变,下壁多受累,且容易出现室性心律失常.     

小细胞肺癌预防性全脑照射的决策分析

1 文献来源 Lee J J, analysis for patients with Bekele BN, Zhou X, et al. Decision prophylactic cranial irradiation for small-cell lung cancer [J]. J Clin Oncol, 2006,24：3597-3603.     

紫杉醇药物洗脱支架与金属裸支架对急性心肌梗死疗效的比较

1 文献来源 Stone GW, Lansky A J, Pocock S J, et al. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction [J]. N Engl J Med, 2009,360（19） ： 1946-1959.     

冠心病心电图检查的缺血性J波分析及临床价值

目的 通过对冠心病(CHD)心电图(ECG)缺血性J波的分析,探讨缺血性J波在冠心病的临床应用价值.方法 选取冠状动脉造影(CAG)检查诊断为冠心病患者164例.根据冠心病患者冠状动脉管腔狭窄程度分成2组,分别分析缺血性J波的发生率.根据有无缺血性J波又分为J波组与非J波组,分析缺血性J波预测冠心病恶性室性心律失常的临床价值.结果 发生缺血性J波115例,总体发生率70.12％.其中冠状动脉管腔狭窄≥50％但＜75％的103例中发生缺血性J波61例(59.22％);狭窄≥75％的61例中发生缺血性J波54例(88.52％),差异有统计学意义(P＜0.05).缺血性J波组发生恶性室性心律失常的人数明显多于无缺血性J波人数(64.35％ vs 14.29％,P＜0.05).结论 缺血性J波发生率与冠心病患者冠状动脉管腔狭窄程度有关,缺血性J波在预测冠心病患者发生恶性室性心律失常中具有临床应用价值.     

男性冠心病患者心电图J波发生的临床意义

目的 探讨男性冠心痛患者心电图J波发生的临床特点及与心律失常的关系.方法 收集1034例男性冠心病患者,根据心电图结果分为J波组和非J波组,分析J波发生的临床特征,并比较二组患者心律失常发生情况.结果 共95例患者心电图出现J波,J波发生率为9.19％,J波组与非J波组室性心动过速、室颤及恶性心律失常发生率分别为9.5％比3.8％、3.2％比0.5％和10.5％比4.2％,各组比较差异有统计学意义(P＜0.05).结论男性冠心病患者心电图J波发生率较高,伴有J波的男性冠心痛患者更秀发生恶性心律失常.     

更上一层楼——奥希替尼辅助治疗完全切除的EGFR基因突变阳性非小细胞肺癌患者：ADAURA

1文献来源Wu YL,Tsuboi M,He J,et al.Osimertinib in resected EGFR-mutated non-small-cell lung cancer[J].N Engl J Med,2020,383(18):1711-1723.Wu YL,John T,Grohe C,et al.Postoperative chemotherapy use and outcomes from ADAURA:Osimertinib as adjuvant therapy for resected EGFR-mutated NSCLC[J].J Thorac Oncol,2021,S1556-0864(21)03285-8.Online ahead of print.2证据水平1b。     

A review on pharmacological significance of genus Jatropha (Euphorbiaceae)

<正>A number of herbs belonging to the genus Jatropha of Euphorbiaceae family are noted for their medicinal benefits.The genus Jatropha is one of the prospective biodiesel yielding crops.The plants which have been so far explored include J.curcas,J.gossypifolia,J.glandulifera,J.multifida and J.podagrica.Although, the plants of this genus are widely distributed,there is an exiguity of scientific literature proclaiming the medicinal benefits of the plants belonging to genus Jatropha.The present paper is a pragmatic approach to accrue the findings on this very significant genus.     

51例右侧胸导联大J波的预后与临床意义

目的研究右侧胸导联明显J波或大J波的预后及临床意义.方法通过临床随访观察患者的预后,并结合临床资料进行回顾性分析.结果 51例患者住院及随访期间共死亡6例(11.7%),直接死因均与J波及其相关特征无关.结论右侧胸导联大J波本身并无明显的临床意义,这些患者的预后好坏主要决定于原发疾病.但应与急性前间壁心肌梗死、右束支传导阻滞相鉴别,特别是J波后ST段明显抬高及J波明显宽大者.     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

Hypercalcemic crisis due to a mediastinal parathyroid cyst diagnosed by ultrasound-guided fine needle aspiration

Hypercalcemic crisis, generally accepted as serum calcium concentration greater than 3.5 mmol/L,constitues a life-threatening endocrinologic emergency,and is most frequently caused by either primary hyperparathyroidism （PHPT） or malignant diseases.Parathyroid cysts are uncommon lesions, most of that are located in the low part of the neck. By routine neck ultrasound scan investigation in a large series of 6621 patients, only 5 parathyroid cysts were detected, yielding a prevalence of 0.075% in setting of unselected patients.The parathyroid cysts in the mediastinum are much less frequently encountered, with only 106 cases reported in English literature.2,3 Moreover, less than half of these cases presented as functional with elevated serum calcium and parathyroid hormone, and only 10 cases were associated with hypercalcemic crisis.3 Herein, we present a rare case of mediastinal parathyroid cyst associated with recurrent hypercalcemic crisis, which diagnosed by ultrasound-guided fine needle aspiration （FNA）.     

Saffron （Crocus sativus L.） and major depressive disorder： a meta-analysis of randomized clinical trials

Due to safety concerns and side effects of many antidepressant medications, herbal psychopharmacology research has increased, and herbal remedies are becoming increasingly popular as alternatives to prescribed medications for the treatment of major depressive disorder （MDD）. Of these, accumulating trials reveal positive effects of the spice saffron （Crocus sativus L.） for the treatment of depression. A comprehensive and statistical review of the clinical trials examining the effects of saffron for treatment of MDD is warranted. OBJECTIVE： The purpose of this study was to conduct a meta-analysis of published randomized controlled trials examining the effects of saffron supplementation on symptoms of depression among participants with MDD. SEARCH STRATEGY： We conducted electronic and non-electronic searches to identify all relevant randomized, double-blind controlled trials. Reference lists of all retrieved articles were searched for relevant studies. INCLUSION CRITERIA： The criteria for study selection included the following： （1） adults （aged 18 and older） with symptoms of depression, （2） randomized controlled trial, （3） effects of saffron supplementation on depressive symptoms examined, and （4） study had either a placebo control or antidepressant comparison group. DATA EXTRACTION AND ANALYSIS： Using random effects modeling procedures, we calculated weighted mean effect sizes separately for the saffron supplementation vs placebo control groups, and for the saffron supplementation vs antidepressant groups. The methodological quality of all studies was assessed using the Jadad score. The computer software Comprehensive Meta- analysis 2 was used to analyze the data. RESULTS： Based on our pre-specified criteria, five randomized controlled trials （n = 2 placebo controlled trials, n = 3 antidepressant controlled trials） were included in our review. A large effect size was found for saffron supplementation vs placebo control in treating depressive symptoms （M ES = 1.62, P 〈 0.001）, revealing that saffron supplementation significantly reduced depression symptoms compared to the placebo control. A null effect size was evidenced between saffron supplementation and the antidepressant groups （M ES = -0.15） indicating that both treatments were similarly effective in reducing depression symptoms. The mean Jadad score was 5 indicating high quality of trials. CONCLUSION： Findings from clinical trials conducted to date indicate that saffron supplementation can improve symptoms of depression in adults with MDD. Larger clinical trials, conducted by research teams outside of Iran, with long-term follow-ups are needed before firm conclusions can be made regarding saffron＇s efficacy and safety for treating depressive symptoms.     

细针穿刺活检在WHO分类基础上的非霍奇金淋巴瘤诊断价值

1文献来源Mourad WA,Tulbah A,Shoukri M,et al.Primary diagnosis and REAL/WHO classification of non-Hodgkin＇s lymphoma by fine-needle aspiration：     

Association between intervertebral disc degeneration and disturbances of blood supply to the vertebrae

Low back pain is a common public health problem in western industrialized societies and the world as well.Studies indicate that the prevalence rate ranges to 35%, with around 10% of patients from 12% becoming chronically disabled. It also places an enormous economic burden on society. Although the exact cause of low back pain has yet to be defined, intervertebral disc degeneration is considered a major source of it. Since patients with degenerative discs are often asymptomatic, the mechanisms of it are still unclear.     

Relevance of muscle biopsy for diagnosing multifocal motor neuropathy

Multifocal motor neuropathy （MMN） is a rare,.focal,inflammatory,demyelinating disease of the peripheral nerves with pure motor involvementJ MMN is clinically characterized by slowly progressive,asymmetric,distal,upper limb predominant weakness,in the absence of sensory disturbances） Weakness is usually multifocal and connected to a distinct motor nerve,such as the musculocutaneous nerve resulting in biceps weakness,the posterior interosseus nerve resulting in finger drop,the median,ulnar,or radial nerve resulting in dexterity problems or grip weakness,or the peroneal nerve resulting in a foot drop.Onset of clinical manifestations is between 20 and 50 years of age.The prevalence of MMN is reported as 1-2 per 100 000.2 MMN is three times more frequent in men as compared to women.     

Modulating Effects of Chlorogenic Acid on Lipids and Glucose Metabolism and Expression of Hepatic Peroxisome Proliferator-activated Receptor-α in Golden Hamsters Fed on High Fat Diet

Objective To examine the effects of chlorogenic acid （CGA） on lipid and glucose metabolism under a high dietary fat burden and to explore the possible role of peroxisome proliferator-activated receptor-α （PPAR-α） in these effects. Methods Twenty male golden hamsters were randomly divided into CGA treatment group （n=10, given peritoneal injection of CGA solution prepared with PBS, 80 mg CGA/kg body weight daily）, and control group （n=10, given PBS i.p. at the average volume of the treatment group）. Animals in both groups were given 15% high fat diet. Eight weeks after treatment with CGA, the level of biochemical parameters in fasting serum and tissues and the expression of hepatic mRNA and protein PPAR-α were determined. Results Eight weeks after treatment with CGA, the levels of fasting serum triglyceride （TG）, free fatty acid （FFA）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, glucose （FSG）, and insulin （FSI） were significantly lower in the GGA treatment group than in the control group. CGA also led to higher activity of hepatic lipase （HL） lower contents of TG and FFA in liver, and lower activity of lipoprotein lipase （LPL） in skeletal muscle. Furthermore, CGA significantly elevated significantly elevated the expression level of mRNA and protein expression in hepatic PPAR-α. Conclusion CGA can modify lipids and glucose metabolism, which may be attributed to PPAR-α facilitated lipid clearance in liver and improved insulin sensitivity.