曲美他嗪治疗酒精性心肌病的Meta分析

【目的】采用Meta分析评价联用曲美他嗪（TMZ）治疗酒精性心肌病（ACM ）的有效性。【方法】检索PubMed、MedLine、Clinical Trials、Cochrane临床对照试验中心数据库、CNKI全文数据库、万方医学数据库、维普全文数据库建库至今公开发表的与TMZ治疗ACM 相关的临床试验文献。按照纳入和排除原则进行文献筛选及进行方法学质量评估。采用RevM an 5．2软件进行M eta分析。【结果】共纳入5项研究,288例患者。Meta分析显示：与β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）、利尿剂、维生素等常规治疗相比,联用TMZ治疗可明显增加6分钟步行距离（WMD＝74．53,95％ CI 25．55～123．50）,明显提高左室射血分数（W M D＝5．15,95％ C I 2．82～7．49）,具有更好的治疗有效性（O R＝8．94,95％ C I 2．44～32．80）。【结论】联用TMZ可明显改善ACM患者的心功能指标,改善患者生活质量。     

母牛分枝杆菌辅助治疗结核性胸膜炎的Meta分析

目的评价母牛分枝杆菌菌苗辅助治疗结核性胸膜炎的疗效与安全性。方法检索中国生物医学文献数据库中文科技期刊全文数据库、万方数据库、Pubmed、Embase、Biosis,纳入比较母牛分枝杆菌辅助治疗组与对照组的随机对照临床试验,采用Stata 12.0进行Meta分析。结果最终纳入9个随机对照临床试验。 Meta分析结果显示,微卡辅助治疗组与对照组相比,胸水吸收情况[ RR＝1.12,95％ CI （1.07.1．17）,P＜0.001],胸膜增厚情况[RR＝0.28,95％ CI（0.18,0.43）,P＜0.001]1年期复发率[RR＝1.12,95％CI（1.05,1.19）,P＜0.001]的差异均有统计学意义。未报道与微卡临床应用相关的严重系统性不良反应。结论母牛分枝杆菌用于辅助治疗结核胸膜炎,是一种安全有效的药物。为获得更佳的循证医学证据,建议开展更多大样本、多中心、长期随访的高质量临床随机对照试验。     

益生菌干预方案改善肥胖人群血脂水平的Meta分析

目的:系统评价益生菌对肥胖人群脂质代谢的影响。方法:计算机检索中文科技期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库、PubMed,检索益生菌改善肥胖人群脂质代谢的随机对照试验和观察研究,检索时限自建库至2022年8月31日。对纳入研究进行资料提取以及偏倚风险评价,使用RevMan 5.3软件对肥胖人群的总胆固醇、低密度脂蛋白、高密度脂蛋白、三酰甘油、体重、腰围、体质指数等进行Meta分析。结果:经文献筛选后共纳入13项研究,其中5项研究显示益生菌组与对照组人群总胆固醇的变化差异有统计学意义（P<0.05）;8项研究显示益生菌组与对照组人群三酰甘油变化差异有统计学意义（P<0.05）;6项研究显示益生菌组与对照组人群高密度脂蛋白的变化差异有统计学意义（P<0.05）;9项研究显示益生菌组与对照组腰围的变化差异有统计学意义（P<0.05）;11项研究显示益生菌组与对照组人群体质指数的变化差异有统计学意义（P<0.05）。结论:现有证据表明,益生菌在改善肥胖人群血脂异常方面具有显著效果。     

透明质酸用于急性伤口的系统评价

目的对透明质酸用于急性伤口的临床疗效进行系统评价。方法全面检索有关透明质酸治疗急性伤口的临床试验,由3位研究人员按照系统评价的要求,制定纳入和排除标准,然后对纳入的文献进行严格的质量评价和Meta分析。结果共纳入5个临床试验,受试对象185人。平均愈合时间：植皮亚组结果没有统计学意义（P＝0.12）,外伤或术后亚组（P＝0.0007）及牙种植术亚组（P＝0.03）差异均具有统计学意义;合并分析：试验组和对照组的差异没有统计学意义（ Meta分析P＝0.14,敏感性分析P＝0.24）。伤口愈合情况：试验组和对照组的差异具有统计学意义（ P＝0.007）。疼痛反应降低值：试验组和对照组的差异具有统计学意义（ P＜0.00001）。结论现有证据说明透明质酸可减少急性伤口愈合过程中的色素沉着及瘢痕生成,同时可降低疼痛反应。但现有证据尚不能说明透明质酸能缩短急性伤口的愈合时间,需要更多严格的随机对照临床试验加以证实。     

胺碘酮联合美托洛尔治疗慢性心力衰竭并室性心律失常疗效和安全性的Meta分析

目的：评价胺碘酮联合美托洛尔治疗慢性心力衰竭合并室性心律失常的疗效和安全性。方法计算机检索PubMed、中国生物医学文献数据库（网络版）、中国期刊全文数据库、万方数据库、重庆维普中文科技期刊全文数据库中有关美托洛尔和胺碘酮治疗慢性心力衰竭并室性心律失常疗效的随机对照试验（RCT）,检索时限为建库至2013年10月。客观评价文献质量后,采用Revman 5.1软件对纳入的试验结果进行Meta分析。结果共纳入10篇RCT文献。Meta分析结果显示：心律失常总有效率（OR＝4.01,95%CI：2.49～6.47,P＜0.00001）,心功能总有效率（OR＝3.96,95%CI：2.56～6.12,P＜0.00001）,治疗前后左心室射血分数变化（WMD＝7.70,95%CI：5.25～10.14,P＜0.00001）,心脏不良事件发生率（OR＝0.13,95%CI：0.05～0.37,P＝0.0001）,再住院发生率（OR＝0.26,95%CI：0.15～0.44,P＜0.00001）五项指标比较,两组差异均有统计学意义。不良反应发生率（OR＝1.55,95%CI：0.89～2.70,P＝0.13）两组差异无统计学意义。结论胺碘酮联合美托洛尔治疗慢性心力衰竭并室性心律失常的疗效优于单用胺碘酮,不增加药物不良反应发生率,且降低心脏不良事件和再住院发生率。因纳入研究较少,样本量小,且质量不高,故仍需开展大样本、多中心、高质量的随机对照试验加以验证。     

ICU患者创伤后应激障碍危险因素的Meta分析

目的 通过 Meta 分析明确 ICU 治疗后生存者创伤后应激障碍（ posttraumatic stress disorder , PTSD ）的危险因素。 方法 检索中英文数据库及纳入文献的参考文献,由 2 名评价人员按照标准独立筛选文献、提取资料、评价文献质量。 采用 RevMan 5.3 分析软件对资料进行Meta 分析。 结果 从 864 篇文献中筛选 29 篇（样本量为 5125 例）,纳入危险因素 115 个,仅女性、受教育水平、 Charlson 共病指数、氢化可的松的使用、镇静剂的使用、精神疾病史的合并效应量具有统计学意义, OR/RR 及 95%CI 分别为 1.39 （ 1.17 , 1.66 ）; 0.88 （ 0.80 , 0.97 ）; 1.31 （ 1.03 , 1.65 ）;0.13 （ 0.04 , 0.39 ）; 3.70 （ 1.7 , 8.05 ）; 3.75 （ 1.96 , 7.18 ）,是 ICU 治疗后 PTSD 的预测因素。 结论 目前 ICU 治疗后 PTSD 危险因素的研究证据尚不足,且 PTSD 评价标准和随访时间差异较大,尚需更多设计严谨、评价标准和随访时间统一的原始研究。     

益生菌对婴儿湿疹及特应性湿疹预防作用的系统评价

目的系统评价益生菌对婴儿湿疹及特应性湿疹的预防作用。方法计算机检索PubMed、EMbase、MEDLINE(Ovid)、CENTRAL、CBM和CNKI数据库,收集益生菌预防婴儿湿疹及特应性湿疹的随机对照试验(RCT),检索时限均从建库至2012年2月。由2位评价员根据纳入和排除标准独立筛选文献、提取资料、评价质量和交叉核对后,采用RevMan 5.0软件进行Meta分析。结果最终纳入15个研究,共3 179例患儿。仅纳入8个质量较高的研究进行Meta分析,结果显示:益生菌组婴儿湿疹发生率低于安慰剂组,两组差异有统计学意义[RD=–0.06,95%CI(–0.10,–0.03),P<0.05];益生菌对婴儿特应性湿疹无预防作用[RD=–0.02,95%CI(–0.08,0.03),P>0.05)];益生菌对高危人群[RD=–0.09,95%CI(–0.15,–0.03),P<0.05]和普通人群[RD=–0.05,95%CI(–0.10,0.00),P<0.05]婴儿湿疹均有预防作用。结论益生菌对于婴儿湿疹有一定预防作用,但由于益生菌菌种、剂量、疗程等诸多方面的差异,其对婴儿湿疹及特应性湿疹的具体效应尚需进一步研究加以验证。     

雄激素对改善卵巢低反应患者中体外受精妊娠结局的Meta分析

目的系统评价雄激素在卵巢低反应患者体外受精治疗周期妊娠结局中的作用。方法电子检索Cochrane Library、CENTRAL、PUBMED、MEDLINE、EMBASE、中国知网、万方及维普等中外文数据库，收集已公开发表的比较联合应用雄激素与不联合应用雄激素对卵巢低反应患者体外受精治疗周期妊娠结局影响的临床随机对照研究。由两名独立研究员按照Cochrane系统评价员手册对纳入文献进行筛选、数据提取及文献质量评价，并通过RevMan 5.1软件对提取的数据进行Meta分析。结果本研究共纳入5项符合标准的随机对照试验，共计393例患者，其中6例中途退出。3项随机对照试验是控制性超促排卵前使用经皮肤吸收的睾酮，共227例患者；2项随机对照试验是控制性超促排卵前服用脱氢表雄酮（ dehydroepiandros-terone，DHEA），共166例患者。 Meta分析结果显示：对卵巢反应不良患者体外受精术前联用雄激素，与对照组相比在临床妊娠率[OR＝2.1，95％CI（1.21，3.65）]、活产率[OR＝2.57，95％ CI（1.09，6.06）]、促性腺激素总量[ MD ＝-529.69，95％ CI （-663.86，-395.53）]及促性腺激素刺激天数[ MD ＝-0.6，95％CI（-0.94，-0.27）]等方面，差异均具有统计学意义（P＜0.05）；但在HCG日E2水平及内膜厚度，周期取消率，MⅡ获卵数、可移植胚胎数、生化妊娠率等方面比较，差异均无统计学意义（ P＞0.05）。结论本研究结果显示，联合应用雄激素能有效改善卵巢对促性腺激素反应性，减少促性腺激素用量及天数，同时可提高临床妊娠率及活产率。由于各试验纳入人群不完全一致，雄激素的使用剂量、给药方法和持续时间不同，且患者对促性腺激素的反应性存在个体差异性等，因此，对雄激素辅助超促排卵改善低反应患者体外受精妊娠结局的作用有待更多大样本、高质量的多中心随机双盲对照试验加以证实。     

马术治疗对脑性瘫痪儿童粗大运动功能疗效的系统评价与Meta分析

目的：系统评价马术治疗（EAT）对脑性瘫痪（CP）儿童粗大运动功能的疗效。方法：计算机检索Medline、EmBase、Cochrance、SciVerse ScienceDirect、Web of science、Pubmed、Pedro、万方医学、知网医学、中国生物医学文献服务系统数据库检索时限为建库至2019年8月,由２位评价员对符合纳入标准的文献采用PEDro量表进行质量评估。对纳入的文献进行系统评价,并提取粗大运动功能评估量表(GMFM-66;GMFM-88)的标准分以及GMFM-88中的B（坐）、D(站)、E（走、跑、跳）维度分数等数据,采用Revman5.3软件进行Meta分析。结果：共纳入7篇文献进行系统评价,其中5篇数据纳入Meta分析,共288例。Meta分析显示GMFM-66［SMD =0.52,95％CI（0.28~0.76）,P<0.0001］、GMFM-88［SMD =0.56 ,95％CI(0.25~0.86), P=0.0003］和B维度［SMD=0.31,95％CI（0.02~0.61）,P=0.04］、D维度［SMD=0.61,95％CI（0.28~0.95,P=0.0004］、E维度［SMD=0.55,95％CI（0.25~0.85）,P=0.0004］。结果表明,实验组与对照组结果差异具有统计学意义,即EAT可以显著改善CP儿童粗大运动功能。结论：基于系统评价及Meta分析结果,EAT可以显著改善CP儿童粗大运动功能,可以作为CP儿童物理治疗的参考治疗方法。     

认知疗法辅助治疗双相情感障碍系统评价

目的系统评价认知疗法辅助治疗双相情感障碍的临床疗效,为临床有效干预提供依据。方法检索Cochrane图书馆临床对照试验资料库（1980-2008）,MEDLINE（1950-2008）,PubMed（1980-2008）、CBMdise（1979-2008）及同方数据库（1979-2008）,手工检索中、英文已发表的资料,收集所有认知疗法辅助治疗双相情感障碍的随机对照试验,根据纳入和排除标准筛选文献、提取资料,并进行质量评价、结果描述;采用RevMan5．0软件对数据进行Meta分析。结果共纳入有效文献6篇;经文献质量评估,5项研究为A级,1项为B级;3项研究对比了认知疗法与未干预的疗效差异,Meta分析显示认知疗法与未干预相比在减少复发率方面无差异性[RR=0．94,95％CI（0．79,1．12）,P=0．491;另3项研究对比了认知疗法与协同照护,结果不完全一致。结论由于纳入研究数量少,样本量小,数据间异质性高,难以证实认知疗法治疗双相障碍的有效性,因此,有待设计良好的随机对照研究进一步验证。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Calcified primary tumors of the gastrointestinal tract

The dominant pattern and location of calcifications occurring within 23 primary gastrointestinal tumors have been analysed and correlated with the data from the literature. The provided guidelines for radiologic diagnosis of such calcified tumors include: (1) a retrocardiac mass containing amorphous calcifications is typical of leiomyoma of the esophagus; (2) calcific deposits similar to that in uterine fibroids may be the feature of gastric leiomyoma or intestinal leiomyosarcoma; (3) sand-like deposits within the wall of the stomach or colon are characteristic of a mucinous adenocarcinoma; (4) clusters of phleboliths in the gastrointestinal wall suggest a hemangioma particularly if recurrent intestinal bleeding and cutaneous hemangiomas are associated; (5) sunburst type of calcification in the pancreas indicates a cystadenoma or cystadenocarcinoma of that organ; and (6) aggregates of granular calcifications in the liver are diagnostic for metastatic adenocarcinoma of the colon but may rarely be seen in a primary malignancy of the liver.     

康养人才培养产教融合生态圈的构建研究

近年来,我国人口老龄化程度加快,高龄化、空巢化对于康养需求激增,职业教育通过产教融合打造康养人才培养生态圈,对于整合各方资源、提高提高行业适应性具有积极意义。基于康养行业的发展趋势,打造康养人才培养产教融合生态圈需要具有有拓展性、现代化和先进性,要服务国家发展战略规划找准产教融合生态圈的出发点,明确人才培养问题导向确立产教融合生态圈的支撑点,明确产教融合生态圈的结合点。由此,提出通过建立基本架构、做优专业链条、深化三教改革、聚焦创新链条、拓宽培训渠道等方面打造康养人才培养产教融合生态圈。     

他汀时代对高甘油三酯血症再认识

近年来,越来越多的证据表明降低低密度脂蛋白胆固醇可以减少心血管事件的发生,降低死亡率,但不容忽视的是,即使经标准治疗后低密度脂蛋白胆固醇达标,仍然存在发生大血管和微血管事件的风险（即心血管剩留风险）。我国成人高甘油三酯血症患病率高,与心血管疾病剩留风险关系密切,应该引起足够的重视。     

Preoperative diagnosis of angiomyolipoma of the liver

We experienced a case of surgically proven hepatic angiomyolipoma, a rare primary benign lipomatous tumor, which was preoperatively diagnosed by defining of its characteristic histologic components and benign radiologic nature with various imaging modalities. It was the first case that full radiologic evaluation was taken and internal vascular proliferation was defined by using dynamic bolus computed tomography (CT) prior to angiography.An invited commentary on this article follows on pp. 552–553.     

医学生职业选择量表的汉化及信效度检验

目的：引进、汉化医学生职业选择量表,并在医学生中进行信度和效度检验。方法：对医学生职业选择量表进行翻译、回译和跨文化调试,形成中文版医学生职业选择量表;方便抽取某医学院校医学生280例,使用该量表进行调查,评价量表的信度和效度。 结果：中文版医学生职业选择量表内容效度指数为0.971;共提取6个公因子,累积方差贡献率为60.996%;量表总的Cronbach’s α系数为0.869,根据奇偶数折半,奇数条目18条折半信度为0.805,偶数条目17条为0.824。结论：中文版医学生职业选择量表具有良好的信效度,可作为医学生职业选择的测量工具。     

Ultrasound examination of the liver: Variations in the vascular anatomy

The hepatic vasculature is highly complex. The hepatic artery (a branch of the celiac tripod) and the portal vein (formed by the confluence of the splenic and superior mesenteric veins) provide a dual blood supply while venous drainage is guaranteed by the hepatic veins. There are also numerous anatomic variants that can involve one or more of the system’s three components.Hepatic artery variants are the least common. Ten types have been identified, including several that are fairly frequent and others that are quite rare, and the variation generally involves the extrahepatic portion of the vessel. Portal vein variants are found in around 20% of the population. They can involve the main portal trunk or segmental branches. Variants of the hepatic veins are the most common. They involve the number and course (supernumerary veins) or the number, course, and openings (accessory veins).Knowledge of portal vein and hepatic vein variants, which are extremely common, is of prime importance for precise localization of lesions. Hepatic artery variants are equally important for surgical treatment of hepatic disease, especially liver transplantation, where it is essential for preoperative workup and postoperative follow-up of the recipient as well as for assessment of potential donors.     

Management of acute and chronic vascular conditions of the hand

Management of acute and chronic vascular disorders of the hand in patients with vasospastic and vaso-occlusive disorders is a complex problem and requires a multidisciplinary approach. The ischemia-related pain, skin ulcerations, and ultimately the threat of digital gangrene require a concerted effort to improve perfusion using a combination of medications and surgery. The purpose of this work is to review our experience over the past 2 decades with this cohort of patients including the variability of the clinical presentation, a method of classification, and a practical treatment philosophy.     

Sonography of subacute thyroiditis: changes in the findings during the course of the disease

Fifteen patients with subacute thyroiditis were studied with thyroid sonography. There were local hypoechoic areas in all patients during the active phase of the disease. Among 6 patients who underwent follow-up studies during the course of treatment, 3 had recurrence or aggravation of clinical symptoms such as painful swelling of the thyroid region, which was associated with, and sometimes preceded by, spread or reappearance of the sonographic abnormality. All 6 patients showed complete disappearance of the hypoechoic area when they were in remission. The thyroid sonography is useful not only for the initial diagnosis but also for the follow-up of these patients during the course of the disease.     

护理本科实习生毕业论文回顾分析

目的了解我院2003—2007年本科实习生毕业论文情况,改善科研带教的方法。方法对2003—2007年178篇毕业论文的选题范围、研究方法、统计学方法等进行分析。结果论文选题范围广,模仿偏多;调查研究篇数多,试验研究需要加强数量和质量;加强统计学的学习;应多参考近期核心期刊。结论护理本科生具有基础的科研能力,但应避免一味模仿,加强科研学习。