狄诺塞麦(Denosumab)在骨质疏松症治疗中的研究进展

骨质疏松症(osteoporosis,OP)是困扰中老年人的代谢性骨病,药物治疗骨质疏松是目前研究的重点。狄诺塞麦是一种通过抑制破骨细胞的分化、激活从而抑制骨吸收的单克隆抗体类药物,国外临床试验中已明确证实其对改善骨密度、降低相关骨折发生率的良好作用,但目前国内尚未就此在临床展开应用。本文从狄诺塞麦的药物机制、临床疗效和不良反应等方面,综述了国外近年高质量研究,探讨其在治疗骨质疏松症方面的临床应用及最新进展。狄诺塞麦对原发性骨质疏松症具有较好的治疗效果且总体不良反应温和,尽管现存在用药策略方面争议及停药后骨折风险亟待进一步研究,总体上仍具有良好的应用前景。     

胃肠癌前哨淋巴结定位和检测的应用评价

尽管前哨淋巴结的定位和检测迅速应用到临床研究,但仍存在大量争议。本文旨在综合评价前哨淋巴结在胃肠肿瘤方面应用的可行性和价值。对近年来前哨淋巴结在胃肠外科治疗临床应用方面的国外文献作一综述。对前哨淋巴结的定义、历史发展过程、现状与争议,并着重对其在胃肠癌方面的应用价值进行了概述。前哨淋巴结的定位和检测技术应用在T1／T2期胃肠肿瘤,具有较高的成功率和较低的假阴性率。胃肠癌前哨淋巴结定位和检测具有重要的研究价值,对胃肠癌综合治疗具有指导意义。     

MRI在乳腺癌综合治疗中的应用价值及评价

随着乳腺癌个体化、规范化综合治疗理念的推广,乳腺MRI在综合治疗中的作用日益受到重视。伴随乳腺MRI临床应用开展和研究的深入,其在乳腺癌的诊断、保乳治疗、新辅助化疗(NAC)以及随访监测中的应用价值得到评估。乳腺MRI对肿瘤范围的精确显示为多种治疗方式的合理应用、评估及监测治疗效果等方面具有重要价值,对乳腺癌综合治疗起着不可替代的作用。     

生长因子在肌腱愈合中的作用

研究了近年来有关生长因子与肌腱愈合方面的部分文献。认为生长因子在肌腱损伤后的修复中发挥重要作用，应用生长因子的转基因治疗有望成为一种肌腱损伤的全新的治疗方法，基因治疗在肌腱损伤的治疗方面具有很强的应用价值。     

3D打印用于骨缺损治疗的研究进展

骨缺损是临床上常见的一类疾病,具有手术难度大、治疗周期长、并发症多等特点,如何快速有效促进骨缺损修复是临床医师面临的巨大难题。对于骨缺损,目前的治疗手段主要以手术治疗为主,包括牵引成骨、骨移植技术等。近年来,3D打印在医疗领域应用越来越广泛。本文对3D打印在骨缺损治疗方面的应用进行综述,并对具有研究前景的3D打印组织工程支架做重点介绍。     

脂肪来源干细胞的过去、现在和未来

20世纪末以干细胞为基础的治疗技术被引入再造外科.在目前研究的各种治疗方法中,基于脂肪来源干细胞的治疗技术是近几年应用最为广泛,也是最具有应用前景的.当前应用的脂肪组织来源干细胞技术操作简便,主要具有以下三方面特点:①脂肪来源干细胞是侵袭性最低的自体移植物.     

骨骼疾病的干细胞临床试验安全性及伦理问题分析

间充质干细胞具有良好的向软骨细胞、骨细胞等间叶组织分化的能力,在促进骨及软骨组织的再生及病变修复方面有着巨大应用前景.应用间充质干细胞治疗骨骼疾病的研究已成为近年来骨科领域研究的热点.但由于干细胞还在诸多方面存在着不确定的风险,需对干细胞临床试验安全性及伦理问题高度重视,采取相应措施,防患于未然.本文对干细胞在治疗骨骼...     

骨髓干细胞向上皮细胞分化的研究进展

骨髓于细胞具有多向分化潜能,可以向肺、肝、皮肤等组织的上皮细胞分化,因此在细胞移植治疗、基因治疗和组织工程种子细胞方面具有潜在的应用价值。文中对骨髓干细胞向上皮细胞分化的研究现状和分化机制的讨论进行介绍,并分析存在的问题和今后的临床应用前景。     

磁场治疗骨折的实验研究、作用机理及临床应用

采用脉冲电磁场和静磁场治疗骨折是一种非侵入性方法,对机体无创伤,具有许多方面的优点。其实验研究及临床应用自Bassett 1974年首先报道以来,国内、国外已有许多学者在这方面相继做了研究,无论在动物实验及临床应用,其促进骨折愈合的作用已得到肯定。但所应用磁场的技术参数则不尽相同,其作用机理也尚无定论。为此,在这方面尚有许多问题需进一步研究。     

音乐疗法在儿童烧伤疼痛管理中的应用研究进展

儿童烧伤后的疼痛是十分常见的问题。严重的疼痛不仅会妨碍治疗, 处理不及时还会损害儿童心理健康, 因此疼痛管理在烧伤儿童的治疗中至关重要。音乐疗法作为一种安全、有效和方便的非药物治疗方法, 在缓解疼痛方面具有巨大的优势, 被广泛应用于各种临床领域。该文重点围绕音乐疗法及其疼痛缓解机制、儿童烧伤疼痛管理的研究现状、音乐疗法在儿童烧伤疼痛管理中的应用与前景等方面进行综述, 为临床应用提供参考。     

从雷帕霉素与肝癌的关系浅谈转化医学的研究思路

Translational medicine is a new concept in China.It sets up a bridge between basic research and clinical work,and aims to transfer the basic study results to clinical practice as soon as possible.It is...     

Research methods for the clinical surgeon

Research methods describe the tools, processes and techniques used to answer a research question. It is vitally important for the clinical surgeon to understand research methods and methodology to effectively appraise and design research studies. This article outlines some of the different research methods commonly used in clinical research, highlighting the basic features, appropriateness, benefits and limitations of each method.     

Laboratory models for neuropharmacologic studies

Summary Biological research historically has been separated into either basic research or clinical research. A third category which combines elements of both basic and clinical research can be called applied basic research in which basic research techniques are utilized in the study of specific clinically encountered problems with the goal to either develop novel therapies or improve existing ones. In Urology there has been a significant increase in interest in applied basic research. This increased interest of clinical urologists in basic science is reflected also by the increase in the number of basic scientists working on urologically related topics in conjunction with academic urologists. It is the purpose of this article to present information on basic research techniques and animal models which are presently utilized for neuromuscular research of the lower urinary tract. It is hoped that this information will be useful to the academic urologist who has an interest in developing an animal research program in this area.     

基因组护理学：现代护理学发展的动力

基因研究已经取得重大进展,基因组学相关的卫生保健研究也正在迅速发展。护理研究正处于共享基因组学研究前景以实现临床结局最优化的重要时机,本文结合对国外基因组护理学研究方向、研究实例、临床实例的分析,探讨如何将基因组学融入护理研究与实践中。     

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??Standard and rule of clinical research of surgery YANG Zhen.Department of Surgery, Tongji Hospital, Tongji Medical College,Huazhong University of Science and Technology,Wuhan430030,China
Abstract In order to enhance the level and quality of clinical research of chinese surgery,the design, implementation, supervision and reporting of clinical research should follow the international standard and rule. It is included that (1) Chinese medical journals should adopt the checklist and the flow diagram of reporting statements, ensuring the quality of reporting of studies of surgical literature. (2) Assessment of the level of evidences and grades of recommendation of reporting of clinical research according to the Oxford and GRADE system in order to improve the quality of clinical research results and reporting of systematic reviews and meta-analyses.(3) Applications with database management system provides a very useful framework for clinical research of surgery. (4)Implementation of clinical research methodologically should follow the standard operation procedure.(5) Medical statistic are very important during the whole course of clinical research, including the research design, data collection and analysis of results, etc.(6)The precision medicine conducted in China need improvement and collaboration with evidence-based medicine in order to meet the need of clinical research of surgery.     

Translational ethics: a perspective for the new millennium

Modern medical care is increasingly dependent on the application of science to clinical practice, which occurs through clinical or translational research. We propose the concept of translational ethics, which incorporates the contributions of research codes of ethics that involve the protection of human subjects into the ethics of clinical practice. The modern research environment, which has contributed the scientific tools of modern medicine, has also framed the ethical environment in which medicine is practiced. The single most important contribution of research codes for protection of human research subjects to clinical practice is the doctrine of informed consent. Translational ethics, based on autonomy and informed consent, progresses beyond the narrow interpretation of those 2 concepts. It requires consensual understanding of a spectrum of clinical interventions that are increasingly complicated. Translational ethics helps navigate the ethical ramifications of technological and scientific advances that will increasingly challenge the corporate-oriented health system in the new millennium.     

外科临床研究的规范与准则

为了提高我国外科临床研究的水平和质量,临床研究的设计、实施、评价与报道应遵循国际规范与准则。包括：（1）中国医学期刊应采纳“报告声明”的清单和流程图,以确保外科文献的报告质量。（2）根据牛津和GRADE分级标准来评价外科临床研究文献的证据级别和推荐等级,以提升临床研究结果和系统综述及Meta分析的报告质量。（3）数据库的建立为外科临床研究提供了十分有用的联网数据录入系统。（4）外科临床研究的实施在方法学上应遵循标准作业程序。（5）统计学对外科临床研究的实施具有重要作用,包括研究设计、资料收集和结果分析等。（6）精准医学已引进中国,但需完善并与循证医学合作,共同应对临床研究的需求。     

外科临床研究中常用的统计分析方法

选择临床研究中统计分析方法时择,必须了解研究的目的、研究的设计、资料的类型、资料的分布和样本量的大小。否则常会造成统计分析方法的误用,严重影响科研的质量。应根据实验设计类型和目的,结合应变量和自变量的数据类型、数据分布来选定适当的统计分析方法。外科医生应了解如何合理实验设计,选择合适的统计方法来回答临床问题。     

Reliability and validity of the Braden Scale for predicting pressure ulcer risk.

Multiple tools have been developed to assist nurses and other care providers to identify and quantify pressure ulcer risk. One of the most widely used tools is the Braden Scale for Predicting Pressure Ulcer Risk. It has been in use for 2 decades and multiple studies have individually reported on its reliability and validity. This article summarizes the reliability and validity of the instrument, and discusses implications for its use in clinical and research settings. The Braden Scale for Predicting Pressure Ulcer Risk has generally performed well in the clinical setting. It has demonstrated reliability and validity in multiple clinical settings, and its parsimonious format enhances incorporation into routine clinical practice. Expanding the instrument may further increase its reliability and validity in the research setting.     

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转化医学是近年来在国内外科研领域兴起的一个新概念,也是医学研究的一个重要分支,其倡导实验室基础研究与临床医疗实践之间建立更直接的联系,实现二者的双向快速转化。转化医学体现的正是永无止境并且不断循环向上的研究过程。临床肠内和肠外营养科学作为国际医学研究发展活跃的领域之一,其转化研究为实验室科学和临床医疗架起了一座桥梁,并取得了重要的进步,诸如全胃肠外营养的建立和应用、胃肠屏障功能的保护、免疫营养素的开发运用以及快速康复外科的实践与发展等。若能进一步围绕肠内、外营养支持中的关键性问题开展转化医学研究,将有利于改善病人的预后,而完成临床营养支持转化研究的每一次循环都将推动着这门科学不断进步。