人纤维蛋白胶对大鼠肝损伤的止血护创作用

目的探讨局部应用人纤维蛋白胶 (FS)对实验性肝损伤的止血和护创作用。方法采用大鼠肝表面裂伤 (Ⅰ型 )和部分肝切除断面伤 (Ⅱ型 )模型 ,以自然止血法为阴性对照 ,缝合止血法和凝血酶止血法为阳性对照 ,比较各组间创面止血时间和术后d 1、4、7、14及 5 0光镜下创面愈合情况。结果与自然止血组相比 ,FS组对Ⅰ型肝损伤模型止血时间平均缩短 86 .0 % (P <0 .0 1) ,对Ⅱ型肝损伤模型缩短 79.0 % (P <0 .0 1) ;与凝血酶止血法相比 ,FS组止血时间分别缩短 45 .0 %和 84.0 % (P <0 .0 1和P <0 .0 5 )。肉眼和镜下观察 ,FS组创面愈合较快 ,局部组织损伤较轻 ,术后 5 0d腹腔粘连基本消失。结论FS对大鼠肝损伤有明显止血作用 ,并能促进创伤的愈合。     

Systematic review and meta-analysis of budesonide/formoterol in a single inhaler

ABSTRACT

Objective: To compare the effectiveness of budesonide/formoterol using fixed dosing (BUD/FORM) with inhaled corticosteroid (ICS) alone or alternative ICS and long-acting β₂-agonist (LABA) regimens for adults with moderate/severe asthma.

Methods: BIOSIS, CENTRAL, EMBASE and MEDLINE were searched for abstracts and papers. All searching was completed in July 2006. No restriction was placed on language. Meta-analysis of randomised controlled trials (RCTs) using a fixed effects model. RCTs were included if the comparator with BUD/FORM had an equivalent daily dose of ICS at the start of the trial. The primary outcome measure was, ‘treatment failure’, defined as: asthma-related serious adverse event, oral glucocorticosteroid treatment, A&E visit and/or admission to hospital, withdrawal due to a need for additional asthma therapy.

Results: Of the 330 papers identified in the literature search, 15 met the inclusion criteria. The following alternative treatments were found: ICS alone (BUD), BUD/FORM adjustable maintenance dose (BUD/FORM-AMD), and salmeterol/fluticasone in a single inhaler (SALM/FP). Meta-analysis of treatment failure demonstrated a 50% increase with BUD versus BUD/FORM (Relative Risk [RR] 1.50, 95% confidence interval [95% CI]: 1.12–2.02, p = 0.007; 2 RCTs); a trend in favour of a reduction with BUD/FORM-AMD versus BUD/FORM (RR 0.88, 95% CI: 0.77–1.02, p = 0.09; 11 RCTs); and no evidence of a difference with SALM/FP versus BUD/FORM (RR 0.99, 95% CI: 0.83–1.16, p = 0.86; 3 RCTs). Significant heterogeneity was not detected in the primary analyses. Secondary analyses demonstrated the following significant differences: hospitalisations/A&E visits (49% increased risk with SALM/FP vs. BUD/FORM, RR 1.49, 95% CI: 1.07–2.08, p = 0.02, and 28% reduced risk with BUD/FORM-AMD vs. BUD/FORM, RR 0.72, 95% CI: 0.52–0.99, p = 0.04); and use of oral steroids (51% increase in risk with BUD vs. BUD/FORM, RR 1.51, 95% CI: 1.10–2.09, p = 0.01, and 19% reduced risk with BUD/FORM-AMD vs. BUD/FORM, RR 0.81, 95% CI: 0.70–0.95, p = 0.01).

Conclusions: Fixed-dose BUD/FORM is an effective treatment option for adult patients with moderate/severe asthma when compared to BUD and SALM/FP, with adjustable maintenance dosing demonstrating important advantages over fixed dosing in relation to exacerbation prevention and reduced treatment load.     

纤维蛋白封闭剂在治疗胎膜早破中的应用研究

目的探讨纤维蛋白封闭剂在治疗胎膜早破中的临床应用价值,为未足月胎膜早破患者提供一种新的、切实有效的治疗方法。方法随机选择我院妇产科住院的孕20～35周胎膜早破或伴先兆早产的病人56例,排除明显宫腔感染,将接受纤维蛋白封闭剂治疗的28例病人为治疗组,未采用者28例设为对照组。结果28例纤维蛋白封闭剂治疗后23例妊娠持续时间〉3周,3例妊娠持续10天至2周,治疗有效率为92．86％;而28例对照组巾仅有3例妊娠持续1至3周,25例1周内自然临产,有效率为10．71％。治疗组较对照组孕剧明显延长,且新生儿出生情况良好。结论未足月胎膜早破应用纤维蛋白封闭剂治疗能显著延长孕周,安全有效,而宫颈管的消退是影响疗效的原因之一,应慎重选择合适的病例。     

甲状腺功能亢进手术中纤维蛋白胶的应用与观察

目的 总结甲状腺功能亢进(甲亢)手术使用纤维蛋白胶不放置引流的临床经验.方法 对392例甲状腺Ⅲ度及以下肿大的甲亢手术创面喷洒纤维蛋白胶不放置引流(下称蛋白胶组)与386例甲亢手术切口放置胶管引流(下称引流组)进行比较.结果 蛋白胶组切口术后无出血,无切口积液,无切口感染,切口甲级愈合,无不良反应,术后平均住院(4.6...     

Safety of ivabradine,a heart rate lowering drug: a systematic review and meta-analysis

As a novel heart rate lowing agent, ivabradine can reduce the heart rate by inhibiting the I_f (pacemaker) current in the sinoatrial node without affecting blood pressure or left ventricular systolic function. However, the safety of ivabradine remains controversial. In the present work, we aimed to assess any risk of cardiovascular mortality, bradycardia, phosphenes and atrial fibrillation associated with the ivabradine administration by meta-analysis. Studies were retrieved from PubMed, EMBASE, MEDLINE, Web of Science, Cochrane, www.clinicaltrials.gov web site and related conferences. Randomized controlled trials comparing ivabradine with comparators were identified and analyzed. Two reviewers independently extracted relevant informationfrom the eligible trials and processed the data. This meta-analysis was performed by using Review Manager (5.3) and Stata (14.1) software. Moreover, sensitivity analysis and publication bias of the included studies were evaluated. A total of 12 randomized controlled trials meeting the inclusion criteria were included. Results of the meta-analysis revealed that there was no significant difference between ivabradine group and control groups in cardiovascular mortality (RR = 0.97, 95% CI: 0.89-1.06, P= 0.49). While the administration of ivabradine was associated with a significant increase in the incidence of bradycardia (RR = 3.90, 95% CI: 2.47-6.17, P<0.00001) and phosphenes (RR = 4.95, 95% CI: 3.24-7.55, P<0.00001) as well as atrial fibrillation (RR = 1.24,95% CI: 1.07-1.43, P = 0.003). High quality of the included studies was confirmed by quality assessment. No publication bias was observed, and sensitivity analysis confirmed that the obtained results were stable. In conclusion, the meta-analysis proved that the use of ivabradine was associated with a significant increase in the risk of bradycardia, phosphenes and atrial fibrillation. Therefore, clinicians need to take these risks into account when using ivabradine in treatment.     

Clinician reported ease of use for a novel fibrin sealant patch for hemostasis: results from four randomized controlled trials

Background:

In addition to rapid and sustained efficacy, ease of use is also an important characteristic of topical hemostats.

Objectives:

To evaluate clinician-reported ease of use for the Evarrest fibrin sealant patch across various surgical bleeding situations.

Methods:

An ease of use questionnaire (EUQ) was validated and administered in four randomized studies comparing the fibrin sealant patch to standard of care (SoC) in soft tissue and hepatic surgical bleeding. Three of these randomized studies have been previously published and all have been registered (NCT00658723; NCT00977925; NCT01166243; NCT01993888). The EUQ is a 19 item instrument evaluating clinician’s preferences on five subscales: product ease of use, satisfaction with product properties and efficiency, confidence in product efficacy, global confidence, and global satisfaction. A pair-wise meta-analysis using a random effects model was conducted on EUQ scores for trials that reported data for both treatment arms. Individual scores are presented for each trial.

Results:

The fibrin sealant patch demonstrated numerically greater scores than SoC in all EUQ subscales. The meta-analysis demonstrated that fibrin sealant patch scores improved for all subscales compared with SoC: satisfaction with product properties (mean difference [MD]?=?0.38, 95% CI: 0.04 to 0.73; P?=?0.03), confidence in efficacy (MD?=?1.10, 95% CI: 0.47 to 1.74; P?=?0.0007), global confidence (MD?=?0.57, 95% CI: 0.05 to 1.10, P?=?0.03), global satisfaction (MD?=?0.79, 95% CI: 0.32 to 1.26, P?=?0.001), and ease of use (MD?=?0.33, 95% CI: -0.29 to 0.94; P?=?0.23). Fibrin sealant patch single arm trial results aligned with these findings.

Conclusions:

Physicians consistently reported high EUQ scores for the fibrin sealant patch across surgical bleeding populations. An important limitation of this study was that the composition of SoC varied across studies and EUQ data were only available for the SoC in two of four trials. Future studies should evaluate ease of use for other hemostats and across other surgical subspecialties, as data are currently limited.     

Anticonvulsant drugs in cocaine dependence: A systematic review and meta-analysis

A systematic review and meta-analysis according to the methodology developed by the Cochrane Collaboration and the Quality of Reporting of Meta-Analyses statement based on randomized controlled trials to evaluate the efficacy of anticonvulsants in subjects with cocaine dependence were performed. Fifteen randomized, double-blind, placebo-controlled clinical trials involving 1,236 patients were included. Two outcome measures were evaluated: retention in the anticonvulsant treatment (compared to the placebo treatment) and the subsequent cocaine use, measured by urinalysis results. The efficacy of the seven anticonvulsant drugs analyzed was not homogenous. On average, 50% of the enrolled participants were lost to follow-up. Treatments did not show an improvement in subject retention compared to placebo. Overall, the number of cocaine-positive urine samples was close to statistical significance (95% confidence interval = 0.85–1.06) compared to placebo. Available clinical trials indicate that there is insufficient evidence to justify the use of anticonvulsant drugs in treating cocaine dependence.     

Systematic review comparing meropenem with imipenem plus cilastatin in the treatment of severe infections

ABSTRACT

Objective: To compare the effectiveness of meropenem with imipenem plus cilastatin in the treatment of severe infections.

Data sources: CENTRAL, EMBASE and MEDLINE were searched for abstracts and papers. All searching was completed in March 2004. No restriction was placed on language.

Study selection: Randomized controlled trials of adult patients with severe infections treated with meropenem or imipenem plus cilastatin at an equal dose, on a gram-for-gram basis, and with the same dosing regimen.

Data extraction: Two reviewers independently assessed papers against the inclusion/exclusion criteria and for methodological quality with differences in opinion adjudicated by a third party. Data were extracted on clinical response, bacteriologic response, mortality and adverse events.

Data synthesis: A total of 27 trials met the inclusion criteria. Meta-analyses were carried out using a Fixed Effects model. Results demonstrated that when compared to imipenem plus cilastatin, meropenem is associated with a significantly greater clinical response (Relative Risk 1.04; 95% Confidence Interval: 1.01–1.06), a significantly greater bacteriologic response (RR 1.05; 95% CI: 1.01–1.08), a non-significant reduction in mortality (RR 0.98; 95% CI: 0.71–1.35), and a significantly lower adverse event rate (RR 0.87; 95% CI: 0.77–0.97).

Conclusions: This systematic review demonstrates that meropenem compared to imipenem plus cilastatin has a significantly greater clinical and bacteriologic response with a significant reduction in adverse events. There was no evidence of heterogeneity or publication bias and the analyses were robust to changes in the inclusion/exclusion criteria and use of a Random Effects model.     

Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis

Background

Timeline Follow-Back (TLFB) is a widely used, calendar-based measure of self-reported use of (among other things) illicit substances. We examined agreement between TLFB and biological measures for illicit substances.

Methods

PubMed, PsycINFO, Cochrane CENTRAL, and EMBASE were searched in December 2010. 16,633 papers screened to identify those that measured illicit substance use by both TLFB and biological measures. We extracted data on agreement between TLFB and biological measures, sample size, study type, inclusion criteria of participants, and length of recall of TLFB.

Results

Twenty-nine papers were included, almost exclusively in substance-use-disorder populations. Some studies reported several overall agreement rates, e.g. over time. Lowest and highest weighted average agreement rates were: for cannabis, 87.3% (95% confidence interval 86.9% to 87.7%) and 90.9% (90.5% to 91.4%); for cocaine, 79.3% (79.1% to 79.6%) and 84.1% (83.9% to 84.2%); for opiates 94.0% (93.5% to 94.5%) for both weighted averages; and for studies not distinguishing between substances, 88.5% (88.4 to 88.7%) and 91.0% (90.7% to 91.2%). Higher agreement was found in populations without psychiatric comorbidity, and lower agreement in randomized controlled trials. Publication bias or selective outcome reporting bias was not detected.

Conclusions

TLFB validly detects use of illicit substances in populations with substance use disorders. Using TLFB may limit the need for biological samples, making information on illicit substance use easier and less costly to obtain and analyze.     

A systematic review and meta-analysis of oxaceprol in the management of osteoarthritis: An evidence from randomized parallel-group controlled trials

Oxaceprol, a derivative of l-proline, is an established drug for managing osteoarthritis (OA) with better safety profile than non-steroidal anti-inflammatory drugs (NSAIDs). This systematic review and meta-analysis, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, evaluated the efficacy, safety and tolerability of oxaceprol in OA. Electronic databases for published and grey (unpublished) literature were searched to identify parallel-group randomized controlled trials (RCTs) evaluating the impact of oxaceprol in patients with OA. Risk of bias was assessed using the Cochrane collaboration's tool. A total of seven parallel-group RCTs involving 1087 participants were included in the systematic review. Meta-analysis, in Review Manager, demonstrated numerically greater/significant improvements compared to active control [diclofenac/ibuprofen]/placebo in pain and function of joint; similar improvement vs. active control in global treatment efficacy; no difference/significant difference vs. active control/placebo in NSAIDs as rescue medication. Treatment with oxaceprol showed numerically less adverse events (AEs) than active control (diclofenac: risk ratio [RR], 0.71; 95% confidence interval [CI], 0.45 to 1.11; p = 0.14: ibuprofen: RR, 0.73; 95% CI, 0.30 to 1.78; p = 0.49) and significantly fewer AEs compared to placebo (RR, 0.76; 95% CI, 0.63 to 0.92; p = 0.004). Given the nature of small-to-moderate sample size and short duration of eligible studies, the available clinical evidence of oxaceprol in the management of OA is modest – though looks promising. New and better RCTs with larger sample size and longer follow-up are warranted to strengthen the use of oxaceprol in clinical setting for managing OA.     

Pharmacist services provided in general practice clinics: A systematic review and meta-analysis

BackgroundIntegration of pharmacists into primary care general practice clinics has the potential to improve interdisciplinary teamwork and patient care; however this practice is not widespread.ObjectiveThe aim of this study was to review the effectiveness of clinical pharmacist services delivered in primary care general practice clinics.MethodsA systematic review of English language randomized controlled trials cited in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and International Pharmaceutical Abstracts was conducted. Studies were included if pharmacists had a regular and ongoing relationship with the clinic; delivered an intervention aimed at optimizing prescribing for, and/or medication use by, clinic patients; and were physically present within the clinic for all or part of the intervention, or for communication with staff. The search generated 1484 articles. After removal of duplicates and screening of titles and abstracts against inclusion criteria, 131 articles remained. A total of 38 studies were included in the review and assessed for quality. Seventeen studies had common endpoints (blood pressure, glycosylated hemoglobin, cholesterol and/or Framingham risk score) and were included in meta-analyses.ResultsTwenty-nine of the 38 studies recruited patients with specific medical conditions, most commonly cardiovascular disease (15 studies) and/or diabetes (9 studies). The remaining 9 studies recruited patients at general risk of medication misadventure. Pharmacist interventions usually involved medication review (86.8%), with or without other activities delivered collaboratively with the general practitioner (family physician). Positive effects on primary outcomes related to medication use or clinical outcomes were reported in 19 studies, mixed effects in six studies, and no effect in 13 studies. The results of meta-analyses favored the pharmacist intervention, with significant improvements in blood pressure, glycosylated hemoglobin, cholesterol and Framingham risk score in intervention patients compared to control patients.ConclusionsPharmacists co-located in general practice clinics delivered a range of interventions, with favorable results in various areas of chronic disease management and quality use of medicines.     

乌司他丁对急诊肝切除术后肝肾功能的影响

目的：分析乌司他丁对急诊切除术后肝肾功能造成的影响。方法：30例研究对象均为我院于2008年3月～2015年6月收治的原发性肝癌自发破裂出血患者,所有患者进行急诊肝切除术,并按照患者入院治疗的顺序划分为观察组以及对照组,对照组只进行手术,观察组在此基础上应用乌司他丁20万U。对比两组手术前、手术d4以及d7的相关指标。结果：观察组和对照组经过不同方法治疗,手术前的肝功能相关指标以及肾功能指标,差异并不显著,无统计学意义,手术后d4以及d7的肝功能相关指标以及肾功能指标经比较,差异显著加强,有统计学意义。结论：对于原发性肝癌自发破裂出血在围手术期时采用乌司他丁对肝肾功能具有一定的保护效果。     

Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: meta-analysis

Rationale A number of reviews have claimed that the selective serotonin and noradrenalin re-uptake inhibitor venlafaxine is more effective than selective serotonin re-uptake inhibitors (SSRIs) in achieving remission and symptom reduction in major depression. Objectives The aim of this study was to systematically review studies on the efficacy of venlafaxine vs SSRI and to evaluate the influence of methodological issues on the effect sizes. Materials and methods Following a systematic literature search, we pooled data on depression scores, response, remission and dropout rates. We also performed sub-group analyses. Results Seventeen studies were included. We found no significant superiority in remission rates (risk ratio [RR] = 1.07, 95% confidence intervals [95%CI] = 0.99 to 1.15, numbers needed to treat [NNT] = 34) and a small superiority in response rates (RR = 1.06, 95%CI = 1.01 to 1.12, NNT = 27) over SSRIs. There was a small advantage to venlafaxine in change scores (effect size = −0.09, 95%CI = −0.16 to −0.02, p = 0.013), which did not reach significance when post-treatment scores were used (effect size = −0.06, 95%CI = −0.13 to 0.00). Discontinuation rates due to adverse events were 45% higher in the venlafaxine group. The main reasons for the differences between this analysis and previous reviews were the exclusion of studies with methodological limitations, avoiding to pool selectively reported study results and exclusion of studies available as abstracts only. Conclusions Our analysis does not support a clinically significant superiority of venlafaxine over SSRIs. Differences between our study and previous reviews were not accounted for by technical aspects of data synthesis, but rather by study selection and choice of outcome parameters. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

冻干人纤维蛋白胶在心血管外科手术中的应用

目的:评价冻干人纤维蛋白胶在心外科手术应用中的止血效果及安全性.方法:选取年龄为18～60岁,体外循环下行心脏直视手术,并有主动脉或右心室切口的病人共60例,随机分为试验组和对照组各30例,选择主动脉或右心室缝合后有渗血的切口为试验创面,局部使用试验药或对照药.以止血时间及出血量为主要疗效评价指标,比较试验药和对照药的临床疗效.试验组患者随机抽取7例进行3个月安全性随访.结果:用药前后生命体征变化及实验室检查结果的变化,两组之间无明显差异;试验组止血时间(14.67±6.18s)和渗血量(0.81±0.54g)等指标均明显优于对照组(分别为250.45±37.02s和15.39±2.69g);7例试验组病例术后3个月的安全性随访结果均为阴性.结论:冻干人纤维蛋白胶对心脏外科手术后的切口及创面渗血具有良好的止血和组织粘合作用,且具有可靠的病毒安全性.     

头孢哌酮/舒巴坦治疗临床感染的有效性和安全性：系统综述和荟萃分析

目的 系统评价注射用头孢哌酮钠/舒巴坦钠(商品名：舒普深)在中国治疗临床感染的有效性和安全性。方法 系统检索万方、中国知网、维普、SinoMed、PubMed和Cochrane Library数据库,收集1978年至2019年7月4日公开发表的关于头孢哌酮/舒巴坦在中国治疗临床感染方面的文献,按照纳入排除标准进行筛选,使用Stata 15.0和SAS 9.4软件进行荟萃(Meta)分析。主要结局指标包括临床有效率与痊愈率,次要结局指标包括细菌清除率(株)与不良事件发生率。结果 最终纳入110篇文献,其中有82篇、87篇分别纳入有效率和痊愈率的Meta分析。结果显示,头孢哌酮/舒巴坦治疗临床感染的总有效率为80.3%[95%置信区间(CI):77.4%～83.0%],痊愈率为50.1%(95%CI:45.1%～55.1%)。共38项研究报告了细菌清除率,结果显示细菌清除率为81.1%(95%CI:76.9%～84.9%)。62篇文献报告治疗中发生的不良事件例数,合计不良事件的发生率为7.4%(95%CI:6.1%～8.9%),包括血液系统不良事件、胃肠道不良事件、肝肾功能损害及皮肤不良事...     

Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis

BackgroundPharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined.ObjectiveTo systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness.MethodsThe protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched.Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate.ResultsEighteen RCTs and 7 economic studies were included. The RCTs were from USA (n = 3), Sweden (n = 2), Belgium (n = 2), China (n = 2), Australia (n = 2), Denmark (n = 2), Northern Ireland, Norway, Canada, UK and Netherlands. The economic studies were from UK (n = 2), Sweden (n = 2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean = −1.74 days [95% CI: 2.76, −0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) = 1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) = £632/QALY-gained). No evidence was found for 7-day pharmacist presence.ConclusionsPharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective.     

左旋肉碱用于减肥的系统评价

目的:系统评价左旋肉碱在减肥方面的作用。方法:按照系统评价的要求,全面检索左旋肉碱用于减肥的随机对照试验,对纳入的文献进行严格的质量评价和Meta分析。结果:2组在体重减轻量[WMD=2.35,95%C(I0.35,4.36),P=0.02]、体重指数降低量[WMD=1.75,95%CI(0.28,3.22),P=0.02]、腰臀比减小量[WMD=0.04,95%CI(0.03,0.05),P<0.00001]、体脂减少量方面[WMD=1.36,95%CI(0.31,2.41),P=0.01]的差异均有统计学意义,在皮褶厚度减小量[WMD=0.36,95%CI(-0.64,1.35),P=0.48]及总不良反应发生率方面[RR=2.00,95%C(I0.81,4.91),P=0.13]的差异无统计学意义。结论:左旋肉碱用于减肥安全、有效,需适当配合运动才能更好地发挥作用。     

Guanfacine for attention deficit and hyperactivity disorder in pediatrics: A systematic review and meta-analysis

To review the evidence from randomized controlled trials (RCTs) on the safety and efficacy of guanfacine in pediatric attention deficit hyperactivity disorder (ADHD), a bibliographic search up to May 2014 was performed using the Cochrane Library׳s Central Register of Controlled Trials, the Embase, PsycINFO, and Medline databases, and clinical trials registers. The search terms used were: [“guanfacine”] and [“child” or “adolescent” or “pediatrics”] and [“randomized controlled trial”] and [“Attention Deficit Disorder with Hyperactivity” or “Attention Deficit Disorder” or “Attention Hyperactivity Disorder” or “Hyperactivity” or “ADHD”]. A meta-analysis was performed using response, defined as a score≤2 on the Clinical Global Impression Improvement score, as the outcome measure. In all, 7 out of 48 studies were included, for a total of 1752 participants. All studies compared guanfacine versus placebo, with a duration ranging from 6 to 16 weeks. In all, the Clinical Global Impression Improvement score was reported as a secondary measure. Overall, 694/1177 (59.0%) participants in the guanfacine group benefited from the treatment compared to 192/575 (33.3%) in the placebo group (pooled OR 3.2; 95%CI 2.4–4.1). The participants with at least one adverse event were 948 (82.4%) in the guanfacine and 376 (67.9%) in the placebo group (OR 2.6; 95%CI 1.6–4.4). Somnolence (OR 4.9), sedation (OR 2.8), and fatigue (OR 2.2), were the adverse events with the greatest risk of occurrence in the guanfacine versus the placebo group. On the basis of seven randomized, placebo controlled trials guanfacine resulted safe and effective in treating children and adolescents with ADHD     

肝组织切除术治疗肝胆管结石的临床疗效

目的观察肝组织切除术治疗肝胆管结石的临床疗效。方法我科47例肝胆管结石患者,均采用肝组织切除术治疗,术后随访6～24个月。结果治疗效果良好,术后有2例患者发生胆漏,均在术后2～3d腹腔引流管引出胆汁延期7～10d拔管,自行愈合。1例术后5d切口感染,经引流冲洗换药、抗炎,术后20d好转。47例患者均获得随访,其中临床疗效优为40例,良6例,1例患者术后12个月发生肝胆管结石复发进行再手术,无死亡病例。结论肝组织切除术治疗肝胆管结石,有可靠的临床疗效,术后复发率小,值得临床推广。