他克莫司治疗口腔扁平苔癣的系统评价

目的系统评价他克莫司与糖皮质激素比较治疗口腔扁平苔癣(OLP)的疗效和安全性。方法采用Cochrane系统评价方法,计算机检索Cochrane Library、MEDLINE、EMbase、CBM、CNKI中从建库至2010年11月收录的关于比较他克莫司和糖皮质激素治疗OLP疗效的随机对照试验(RCT)。按照纳入与排除标准选择文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.0.25软件进行Meta分析。结果最终纳入4个RCT,共164例患者。2个研究结果显示,他克莫司能有效减少OLP患者的病损面积和疼痛。Meta分析发现:他克莫司治疗OLP的总有效率并不优于糖皮质激素[OR=4.38,95%CI(0.67,28.73)],其治疗期间的不良反应发生率亦与糖皮质激素无统计学差异[OR=3.49,95%CI(0.49,24.84)]。两组药物治疗OLP停药后的复发率差异无统计学意义[OR=0.82,95%CI(0.27,2.46)]。结论局部外用他克莫司在改善OLP患者体征(病损面积)和症状(疼痛)方面效果显著,与未纳入本系统评价的其他非RCT研究报告的结论一致。目前证据表明,他克莫司治疗OLP的总有效率、治疗期间局部不良反应发生率及停药后复发率均与糖皮质激素相当。由于本系统评价纳入试验对某些疗效评价指标的评估方法不尽相同,今后需要更多高质量、多中心、疗效评价指标及其相应评估方法均统一的RCT,以获得更可靠的证据。     

他克莫司软膏治疗特应性皮炎的经济性评价

目的比较国产与原研药物他克莫司软膏治疗特应性皮炎的经济性,为临床选用治疗特应性皮炎外用药提供参考依据。方法通过药物释放与经皮渗透性研究对两种药品疗效和安全性进行比较;采用最小成本法对两种药品进行经济性比较。结果国产仿制药与原研药两种药品在疗效及安全性方面均无统计学差异;0.03%和0.1%他克莫司软膏国产仿制药比原研药费用分别减少31.29%和27.87%。结论他克莫司软膏国产仿制药治疗特应性皮炎与原研药相比,具有更好的经济性。     

特应性皮炎的临床疗效分析

对应用他克莫司软膏治疗特应性皮炎的临床效果进行研究。抽取76例特应性皮炎患者,随机分为对照组和治疗组各38例。对照组采用醋酸氢氧化可的松治疗;治疗组采用他克莫司软膏治疗。治疗组疗效明显优于对照组;皮炎症状消失时间和临床治疗方案实施时间明显短于对照组。应用他克莫司软膏治疗特应性皮炎的临床效果非常明显。     

S-腺苷蛋氨酸改善妊娠肝内胆汁淤积症患者妊娠结局的评价

目的评价S-腺苷蛋氨酸改善妊娠肝内胆汁淤积症患者妊娠结局的作用.方法计算机检索MEDLINE、EMBASE、中国循证医学数据库/Cochrane中心数据库(CEBM/CCD)、Cochrane图书馆(2003年4期)、中国医院数字图书馆和中国数字化期刊万方数据库,手工检索有关S-腺苷蛋氨酸治疗妊娠肝内胆汁淤积症的中英文随机和半随机临床对照试验,检索截止时间为2003年12月.在严格质量评价的基础上,利用RevMan 4.2 软件进行Meta分析.结果共检索到符合纳入标准的文献8篇,包括随机对照试验2篇,半随机对照试验6篇,共有研究对象424例.所有纳入研究的方法学质量均不高.Meta分析结果显示,S-腺苷蛋氨酸改善妊娠肝内胆汁淤积症患者妊娠结局的作用如下:①降低剖宫产率:与安慰剂比较差异无统计学意义[OR=1.00, 95%CI (0.23, 4.33),P=1.00];与地塞米松组及强力宁比较差异有统计学意义,其OR(95%CI)和P值分别为0.44(0.23,0.85),P= 0.01; 0.28 (0.10, 0.75), P=0.01).②延长孕周:与安慰剂比较差异无统计学意义[WMD=0.70,95%CI(=-0.69, 2.10), P=0.32];而与地塞米松、强力宁、肝益灵相比差异有统计学意义,其WMD(95%CI)值和P值分别为1.10 (0.46,1.74), P=0.000 07; 2.50 (1.86,3.14), P≤ 0.000 01; 2.20(1.61,2.79), P≤0.000 01.③增加新生儿体重:与安慰剂比较差异无统计学意义[WMD=-26.27,95%CI(=-338.35,285.82), P=0.87];与地塞米松及苦黄注射液比较差异有统计学意义,其WMD(95%CI)和P值分别为386.86 (134.41,603.31), P=0.02;410.00(321.10,498.90), P≤0.000 01.④胎儿宫内窘迫:与地塞米松和苦黄注射液比较差异无统计学意义,其OR(95%CI)和P值分别为0.47(0.14,1.16),P =0.23;0.44,(0.10,1.97),P =0.29. ⑤降低羊水粪染的发生率:与地塞米松、熊去氧胆酸和苦黄注射液相比差异无统计学意义,其OR(95%CI)和P值分别为0.46(0.21,1.02),P=0.06;0.68(0.20,2.31),P=0.53;0.82(0.24,2.81),P=0.75.⑥新生儿窒息:与地塞米松、苦黄注射液比较差异无统计学意义,其OR(95%CI)和P值分别为0.19 (0.01,4.06),P=0.29和 0.31(0.08,1.13),P=0.08;而与强力宁比较则差异有统计学意义[OR=0.09, 95%CI(0.02,0.42),P=0.002].⑦新生儿Apgar评分:与安慰剂、地塞米松和熊去氧胆酸比较差异无统计学意义,其OR(95%CI)值分别为0.25(0.02,3.04),P=0.28; 2.09(0.70,6.27),P=0.19;1.22 (0.35,4.19),P=0.75.8篇文献中有 6篇文献提到了S-腺苷蛋氨酸治疗妊娠肝内胆汁淤积症是否有副作用,其中1篇报道有轻微的胃肠道反应.结论 S-腺苷蛋氨酸用于治疗妊娠肝内胆汁淤积症可以改善某些妊娠结局,如降低剖宫产率、延长孕周、增加新生儿体重等.但其确切的疗效和安全性尚不能肯定,还需要大样本、高质量的随机对照试验加以证实.     

他克莫司用于中国肾移植患者远期疗效的Meta分析

目的:他克莫司在器官移植方面已得到较为广泛的应用,但该药用于亚洲人特别是中国人肾移植远期疗效的报道较少,而且相关研究均为小样本、临床随机对照研究,缺乏有效的说服力.因此文章评估国内肾移植患者长期应用他克莫司进行免疫抑制治疗的有效性和安全性.资料来源:采用电子检索和手工检索进行文献初检,电子检索数据库有Medline database (1980/2008)、中国期刊全文数据库(CNKI:1980/2008)、中国循证医学ΠCochrane 中心数据库(CEBM/CCD)、Cochrane图书馆,检索无语种限制.手工检索主要专业期刊以免出现检索遗漏.资料选择:纳入国内外关于他克莫司用于国内肾移植后患者免疫抑制治疗的随机对照研究文献,要求对照组应用环孢素A,其余干预措施相同.排除非随机对照试验及多器官联合移植文章.对结果进行统计荟萃分析(Meta分析),统计学分析采用Stata软件,评价比较疗效及差异的指标采用优势比(OR)及95%可信区间(95%CI).结局评价指标:①肾移植后1年人/肾存活率.②肾移植后3 年人/肾存活率.③肾移植后3 年排斥反应发生率.④肾移植后3年感染发生率.⑤肾移植后3年肝功能异常发生率.⑥肾移植后3年血糖异常发生率.结果:共收集国内外3个随机对照研究,其中国内3篇,国外0篇.Meta分析结果显示,他克莫司用于国内肾移植患者移植后3年内排斥反应的发生率优于环孢素A对照组(OR值为0.40,95%CI为0.27～0.61,P < 0.000 1),他克莫司组患者肾移植后3年内肝功能异常的发生率低于环孢素A对照组(OR值为0.28,95%CI为0.15～0.52,P < 0.000 1);他克莫司组患者肾移植后1,3年人/肾存活率与环孢素A对照组比较差异无显著性意义;与环孢素A对照组相比,他克莫司组肾移植后3年的血糖异常发生率升高(OR值为2.39,95%CI为1.41～4.05,P=0.001).结论:选择近20年国内外重要期刊发表的他克莫司用于肾移植后排斥反应的随机对照文章,分析结果显示,国内肾移植患者应用他克莫司与环孢素A相比,移植后3年内排斥反应及肝功能异常的发生率明显降低,对患者移植后1,3年人/肾脏存活率无不良影响,但其不良反应主要表现为血糖升高.     

PUVA联合他克莫司软膏治疗白癜风的临床疗效观察及护理干预

目的:探讨运用他克莫司软膏外用联合PUVA局部照射治疗白癜风的疗效、安全性及护理对策。方法:将42例患者随机分为治疗组22例及对照组20例,治疗组予PUVA局部照射每周2次,外用0.1%他克莫司软膏(<12岁者用0.03%他克莫司软膏)每日2次,对照组采用常规药物治疗。比较两组的疗效及不良反应。结果:他克莫司软膏外用联合PUVA局部照射治疗白癜风与常规药物治疗组比较疗效无明显差异(P>0.05),但不良反应少(P<0.05)。联合治疗较单纯外用他克莫司软膏比较有统计学差异(P<0.05)。结论:他克莫司软膏外用联合PUVA局部照射治疗白癜风安全有效。     

他克莫司软膏联合二硫化硒洗剂治疗面部脂溢性皮炎的效果

目的观察他克莫司软膏外搽联合二硫化硒洗剂外敷用于治疗面部脂溢性皮炎的效果。方法选取门诊收治的91例面部脂溢性皮炎患者,按随机数字表法将其分为对照组(n=45)和观察组(n=46),对照组予他克莫司软膏外搽,观察组予他克莫司软膏外搽+二硫化硒洗剂外敷,2组均持续治疗30 d。比较2组治疗后皮损积分变化、人体蠕形螨驱除情况、临床疗效、复发率及不良反应发生率。结果观察组皮损积分低于对照组,总有效率及蠕形螨驱除率高于对照组(P<0.05)。完成治疗后随访30 d,观察组复发率低于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论他克莫司软膏联合二硫化硒洗剂能够有效提升面部脂溢性皮炎患者人体蠕形螨驱除率,进一步提升治疗效果,且复发率低、安全性高。     

乌司他丁治疗急性百草枯中毒的系统评价与meta分析

目的探讨乌司他丁治疗急性百草枯中毒的安全性和有效性,为临床治疗百草枯中毒提供决策依据。方法计算机检索Pub Med、Embase、The Cochrane library、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、万方数据库和维普数据库收录的有关乌司他丁治疗百草枯中毒的相关文献,依据Cochrane系统评价手册5.1.0版推荐的质量评价标准对临床随机对照试验(RCT)研究及Newcastle Ottawa Scale量表中质量评价标准对病例对照研究(CCS)进行评价,使用Rev Man5.2统计学软件进行数据分析并绘制森林图。结果本研究共纳入7篇CCS文献共计400例患者,无RCT文献,其中乌司他丁组202例,对照组198例。乌司他丁组与对照组比较,病死率差异有统计学意义[比值比(OR)=0.48,95%可信区间(CI)(0.32,0.71),P=0.0003];多脏器功能衰竭综合征(MODS)发生率差异无统计学意义[OR=0.56,95%CI(0.31,1.03),P=0.06];肺纤维化发生率差异有统计学意义[OR=0.44,95%CI(0.21,0.90),P=0.02];死亡病例存活时间差异无统计学意义[标准均数差(SMD)=0.49,95%CI(-0.08,1.05),P=0.09]。结论乌司他丁可降低百草枯中毒患者的病死率和肺纤维化发生率,但不能降低MODS发生率和延长死亡病例存活时间,相关数据证据等级较低,迫切需要多中心的RCT研究提供更有力的循证医学证据。     

肿瘤病人压力性损伤发生率及其影响因素的Meta分析

目的:对肿瘤病人压力性损伤发生率及其影响因素进行系统评价及Meta分析。方法:通过计算机检索CINAHL、Embase、PubMed、the Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库和维普中文期刊全文数据库,检索时限从建库至2023年6月30日,采用RevMan 5.3软件进行Meta分析。结果:纳入7篇文献,共计2 346例病人。Meta分析结果显示,肿瘤病人压力性损伤发生率为10%[95%CI(6%,13%)],压力性损伤发生的危险因素分别为血清白蛋白水平[OR=2.66,95%CI(1.60,4.43),P<0.001]、血红蛋白水平[OR=1.49,95%CI(1.22,1.82),P<0.001]、Braden评分[OR=1.52,95%CI(1.04,2.21),P=0.03]、失禁[OR=6.79,95%CI(3.22,14.33),P<0.001]、强迫体位[OR=3.68,95%CI(1.90,7.31),P<0.001]。结论:临床医护人员可早期识别肿瘤病人是否存在压力性损伤发生的危险因素,制定针对性的个...     

他克莫司软膏治疗幼儿中重度特应性皮炎疗效观察

[目的]评价0.03%他克莫司软膏治疗幼儿中重度特应性皮炎(AD)疗效、安全性及生活质量改善情况.[方法]27例年龄24~36个月的AD患者,给予为期3周的他克莫司软膏外用治疗,治疗前后行血常规、肝肾功能、总IgE及嗜酸性粒细胞计数检查,并在治疗前、治疗1周、治疗2周及治疗结束后进行生活质量量表的调查.[结果]27例患儿中23例完成疗程并获得明显疗效,生活质量明显改善( P ＜0.05).有8例患儿使用后有发红、瘙痒加重.[结论]0.03%他克莫司软膏治疗幼儿中重度特应性皮炎有效、安全,治疗后生活质量明显改善.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。