静脉血管滤器对严重创伤后肺栓塞发生影响的Meta分析

目的 系统评价创伤后肺栓塞成年患者使用静脉血管滤器的有效性和安全性。方法 检索PuMed、Embase、the Cochrane Library、中国知网、中国生物医学文献数据库、维普数据库、万方数据库建库至2022年3月关于创伤后肺栓塞患者使用静脉血栓滤器的随机对照实验(randomized controlled trials, RCT),由2名研究者对文献质量进行严格评价，按照纳入排除标准独立对文献进行筛选提取，采用RevMan5.3软件对数据进行Meta分析。结果 纳入RCT6篇，共810例患者，装有静脉血管滤器的创伤后肺栓塞患者为试验组，无静脉血管滤器的患者为对照组。Meta分析结果显示，两组深静脉血栓和肺栓塞(95%CI:0.29～0.77,P=0.003,MD=0.480)发生率比较差异有统计学意义，但病死率比较差异无统计学意义。通过安置静脉血管滤器，预防肺栓塞的发生率试验组优于对照组(95%CI:0.59～2.78,P=0.520,MD=1.290),深静脉血栓的发生率试验组高于对照组(95%CI:1.06～2.32,P=0.020,MD=1.570)。结论 综合文献分析...     

CT血管成像诊断下肢动脉硬化闭塞症的Meta分析

目的 探讨用Meta分析方法评价CTA对下肢动脉硬化闭塞症的诊断价值.方法 检索Pubmed、EBSCO、Springer、Ovid和中国期刊网(CNKI)以及Cochrane图书馆数据库,文献检索起止时间均从建库至2009年10月,同时检索纳入文献的参考文献.纳入探讨以DSA为诊断金标准的关于CTA诊断下肢动脉硬化闭塞症的文献,并逐个进行质量评价和资料提取.采用Meta Disc 1.4软件检验研究间的异质性、对诊断准确度指标进行Meta分析,绘制森林图,并进行综合受试者工作特征曲线(SROC)分析.结果 符合纳入标准的文献共24篇,各研究之间存在异质性,按照随机效应模型计算汇总敏感度、特异度与诊断优势比及其95%可信区间分别为95%(95%可信区间:94%～95%)、96%(95%可信区间:95%～96%)、471.13(95%可信区间:242.92～913.71).SROC下面积为为0.9888,Q指数为0.9555.亚组分析显示:CT层数所致诊断准确度之间的差异有统计学意义(P＜0.05).结论 对于下肢动脉硬化闭塞症患者,CTA是一项切实可行的影像检查方式,拥有较高的敏感度及特异度.然而对于下肢严重缺血的患者,尚需慎重对待CTA检查结果.     

磁共振波谱成像对颞叶癫痫定侧诊断价值的Meta分析

目的利用Meta分析的方法评价磁共振波谱成像(MRS)对颞叶癫痫(TLE)定侧的诊断价值。方法通过中国生物医学文献服务系统、中国知网、万方数据平台、维普网、Ovid检索平台、PubMed及Cochrane图书馆网进行检索,搜索关于MRS对颞叶癫痫定侧诊断价值的文献,应用Meta-Disc1.4软件进行Meta分析,合并计算敏感性、特异性、诊断比值比,绘制汇总受试者工作特征曲线。结果共纳入6篇文献(3篇中文,3篇英文),共计194例患者。Meta分析结果显示,MRS对颞叶癫痫定侧诊断的合并敏感性为0.84(95%CI:0.78~0.89)、合并特异性为0.87(95%CI:0.70~0.96)、诊断比值比为28.59(95%CI:9.47~86.33)、汇总受试者工作特征曲线下面积为0.9137。结论在诊断颞叶癫痫定侧方面,MRS具有较高的诊断准确性,可作为颞叶癫痫定侧有效可行的方法。     

原发性腹膜后肿瘤手术联合放射治疗患者预后的Meta分析

目的 系统评价手术联合放射治疗腹膜后肿瘤的预后情况.方法 检索Cochrane library、Medline、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、万方等数据库,学术会议资料和学位论文,以及一些图书馆纸质出版物,全面收集关于腹膜后肿瘤外科手术联合放射治疗的相关文献.制定相应的文献排除和纳入标准,并通过复习文献制定效应指标的评价标准.由两名研究者按照相应的文献评价标准分别对收集的文献进行评价,然后应用STATA软件进行Meta分析,计算治疗组和对照组的生存率、风险率(HR)及95％CI,对不能进行Meta分析的文献进行描述性分析,客观评价各种治疗方案的疗效.结果 最终共有9篇文献纳入本研究,其中中文文献l篇,英文文献8篇,累计治疗组573例,对照组1403例.Meta分析结果显示,腹膜后肿瘤手术联合放疗组患者的生存率明显高于单纯手术组(合并HR=0.57,95％CI 0.40～0.74),差异有统计学意义(P=0.000).结论 腹膜后肿瘤患者在严格完成手术的同时,可根据具体情况选择合适的方案进行放射治疗以改善预后,提高生存率.     

仅手术治疗卵巢未成熟畸胎瘤的Meta分析

目的 系统评价仅采用手术治疗卵巢未成熟畸胎瘤(immature terotoma, IT)患者的安全性。方法 检索Pubmed、The Cochrane Library、Web of Science、CNKI、Wangfang data数据库，搜集仅用手术治疗卵巢纯型IT患者的研究，检索时限1990-01-01至2022-02-16。由4名研究者独立筛选文献，提取资料并评价纳入研究的偏倚风险后，采用STATA软件进行Meta分析。结果 最终纳入5篇病例研究和3篇非随机队列研究，201例患者，15例复发。Meta分析结果显示，仅用手术治疗Ⅰ期卵巢纯型IT患者，复发率(95%可信区间)为5.2%(2.0%,9.4%);仅用手术治疗Ⅰ期G₂/G₃卵巢IT患者，复发率(95%可信区间)为6.1%(0.3%,16.0%)。3例死亡。结论 需要更多高质量的研究，明确是否能仅用手术治疗Ⅰ期G₂/G₃卵巢纯型IT患者。     

手术与非手术治疗无神经损伤胸腰椎爆裂骨折的Meta分析

目的 对无神经损伤胸腰椎爆裂骨折手术与非手术治疗进行Meta分析及疗效比较.方法 由2名研究者独立检索Pubmed Medline、荷兰医学文摘数据库(Embase)、Cochrane系统综述数据库和临床对照试验数据库、中国生物医学文献数据库(CBM)、万方数据库、中国知网(CNKI).根据纳入、排除标准筛选各数据库建库至2014年2月发表的文献,并遵循Cochrane指南进行文献质量评价及数据提取. 结果 最终纳入2篇随机对照研究,获取79例患者的临床资料(手术组41例,非手术组38例)进行Meta分析,随访期限最少2年.2篇研究的异质性较大,其中1篇认为随访结束时手术组在疼痛缓解、功能恢复及重返工作方面疗效较好;而另1篇的结果则相反.Meta结果显示,手术组并发症(RR =2.85,95％ CI 0.83 ～9.75)包括再次手术率(RR=8.39,95％CI 1.12 ～62.87)较高. 结论 对于无神经损伤的胸腰椎爆裂骨折,手术与非手术治疗在缓解疼痛、促进功能恢复及患者重返工作方面疗效相似,手术治疗往往带来较多的并发症.     

不同运动方式对帕金森病相关指标的作用——系统综述

目的:本文主要通过系统的文献检索与筛选,分析不同运动方式(太极拳、舞蹈、有氧跑步机锻炼、渐进式抗阻力锻炼)对帕金森病(Parkinson’s Disease,PD)患者相关指标产生的不同影响,评价不同运动方式在PD患者中的适用范围。方法:依据预先制定的文献检索、筛选、录入、评价方法,进行相关文献的检索和筛选。检索方法:1)在Pub Med、Web of Science、EBSCO外文数据库以关键词的检索方式检索不同运动方式对PD患者不同相关指标的应用研究文献。2)对相关文献的参考文献目录进行阅读和二次检索。筛选和录入标准:1)不同运动方式对帕金森病相关指标的随机干预研究;2)已在学术期刊出版的全文或摘要;3)只录入英文文献。结果:通过从Pub Med、Web of Science、EBSCO的检索与筛选,太极拳共纳入5篇文献,舞蹈共纳入2篇文献,有氧跑步机锻炼共纳入2篇文献,渐进式抗阻力锻炼共纳入2篇文献,进入最后的分析、评论和总结。结论:1)合理的运动锻炼会对PD患者相关指标产生一系列的积极作用;2)不同的运动方式会对PD患者相关指标产生不同的作用。     

DCE-MRI对孤立性肺结节良恶性诊断价值的Meta分析

目的 采用Meta分析方法评价动态增强磁共振成像(DCE-MRI)对孤立性肺结节(SPN)良恶性的鉴别诊断价值.方法 计算机检索PubMed、EBSCO、Cochrane Library、Ovid、CBM、VIP、万方和CNKI数据库,检索关于DCE-MRI用来诊断SPN的中英文文献.按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究文献的特征信息.文献评价采用诊断研究评价工具QUADAS-2.数据采用Stata 12.0和Meta-Disc 1.4软件进行Meta分析,检验异质性和发表偏倚,根据异质性的结果选择相应效应量,计算汇总敏感度、特异度、阳性似然比、阴性似然比以及诊断比值比,绘制汇总受试者工作特征(SROC)曲线并计算曲线下面积(AUC).结果 共纳入17篇文献,包含了1255个病灶,Meta分析结果显示:DCE-MRI对SPN良恶性的诊断价值的汇总灵敏度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.95、0.81、4.9、0.06、85.SROC曲线AUC为0.97.结论 DCE-MRI对SPN良恶性的鉴别诊断具有较高的灵敏度和特异度,是一种诊断效能较高的影像学检查方法.     

中国人群高脂血症与良性阵发性位置性眩晕复发风险的Meta分析

 目的 探讨中国人群高脂血症与良性阵发性位置性眩晕 (benign paroxysmal positional vertigo,BPPV) 复发的关系。方法 系统性检索国内外公开发表的有关中国人群高脂血症与BPPV复发关系的文献,检索数据库包括中国知网、万方数据知识服务平台、PubMed、Embase 和Google Scholar,时间范围从各数据库建库至2015年12月,共检索到16篇文献。采用Meta分析方法计算高脂血症与BPPV复发风险的合并OR(95%CI)值。结果 最终纳入文献6篇共计944例患者,Meta分析结果表明,高脂血症并不能增加BPPV复发的风险(OR=2.12,95%CI:0.77～5.89)。Begg秩相关法(Z=-0.98,P=0.383)和Egger 回归法(t=-0.44,P=0.680)结果均显示本次Meta分析不存在发表偏倚。结论 现有研究尚不能证明高脂血症是BPPV复发的独立危险因素。     

开窗减压髓核摘除术治疗腰椎间盘突出症的临床观察

目的 本文对国内外应用单纯髓核摘除术与间盘切除植骨内固定术治疗腰椎间盘突出症的对照试验进行荟萃分析(Meta分析).方法 检索相应中英文数据库.由2名评价人员独立阅读题目、摘要,按制定的纳入和排除标准进行筛选.使用Cochrane协作网提供的Revman 5.3软件对提取的评价指标做Meta分析.结果 纳入9篇国内外文献,随机6篇,非随机3篇,包括6 670例患者,质量等级均为C级.Meta分析结果显示:手术治疗腰椎间盘突出症的过程中髓核摘除组在手术时间及手术出血量方面明显优于融合内固定组;术后并发症方面髓核摘除组低于融合内固定组,但无统计学意义;再手术率及手术满意率方面融合内固定组优于髓核摘除组;术后疼痛评分(VAS)髓核摘除组优于融合内固定组;术后功能障碍指数(ODI)融合内固定组优于髓核摘除组.结论 腰椎间盘突出症手术治疗,无论是采用髓核摘除术,还是融合内固定术,近期均能获得较好的疗效.     

Effect of Vitamin C and E supplementation on biochemical and ultrastructural indices of muscle damage after a 21 km run.

This study investigated whether 4 weeks of daily supplementation with 500 or 1000 mg of Vitamin C and 500 or 1000 IU of Vitamin E could modify biochemical and ultrastructural indices of muscle damage following a 21 km run. Fifteen experienced male distance runners were divided into two groups (vitamin or placebo) and received supplementation for four weeks before completing the first 21 km run in as fast a time as possible. A four-week "washout" period followed before the subjects crossed over and received the alternate supplement for the next four weeks. They then completed a second 21 km run. Before, immediately after and 24 h after each run venous blood samples were taken and analysed for serum creatine kinase, myoglobin, malondialdehyde and vitamin C and E (before-samples only) concentrations. A subgroup of six subjects also had muscle biopsy (gastrocnemius) samples taken 24 h before and 24 h after each 21 km run, which were later analysed by electron microscopy. The two dosages of supplementation produced similar results, so a single vitamin group was formed for further analysis of results. Significant increases (p < 0.05) in creatine kinase and myoglobin, but not in malondialdehyde, were found post-run in both groups. However, no significant differences were found between the vitamin and placebo groups for creatine kinase, myoglobin and malondialdehyde concentrations recorded after the 21 km runs. A qualitative ultrastructural examination of pre-run muscle samples revealed changes consistent with endurance training, but little further change was seen after the 21 km run in either the vitamin or placebo groups. It was concluded that vitamin C and E supplementation (500 or 1000 mg or IU per day) for four weeks does not reduce either biochemical or ultrastructural indices of muscle damage in experienced runners after a half marathon.     

Vitamin C supplementation attenuates the increases in circulating cortisol, adrenaline and anti-inflammatory polypeptides following ultramarathon running

The effects of vitamin C supplementation on the alterations in the circulating concentrations of cortisol, adrenaline, interleukin-10 (IL-10) and interleukin-1 receptor antagonist (IL-1Ra) which accompany ultramarathon running were measured using immuno-chemiluminescence, radioimmunoassay and ELISA procedures. Forty-five participants in the 1999 Comrades 90 km marathon were divided into equal groups (n = 15) receiving 500 mg/day Vit C (VC-500), 1500 mg/day Vit C (VC-1500) or placebo (P) for 7 days before the race, on the day of the race, and for 2 days following completion. Runners recorded dietary intake before, during and after the race and provided 35 ml blood samples 15 - 18 hrs before the race, immediately post-race, 24 hrs post race and 48 hrs post-race. Twenty-nine runners (VC-1500, n = 12; VC-500, n = 10; P, n = 7) complied with all study requirements. All post-race concentrations were adjusted for plasma volume changes. Analyses of dietary intakes and blood glucose and anti-oxidant status on the day preceding the race and the day of the race did not reveal that carbohydrate intake or plasma vitamins E and A were significant confounders in the study. Mean pre-race concentrations of serum vitamin C in VC-500 and VC-1500 groups (128 +/- 31 and 153 +/- 34 micromol/l) were significantly higher than in the P group (83 +/- 39 micromol/l). Immediate post-race serum cortisol was significantly lower in the VC-1500 group (p < 0.05) than in P and VC-500 groups. When the data from VC-500 and P groups was combined (n = 17), immediate post-race plasma adrenaline, IL-10 and IL-1Ra concentrations were also significantly lower (p < 0.05) in the VC-1500 group. The study demonstrates an attenuation, albeit transient, of both the adrenal stress hormone and anti-inflammatory polypeptide response to prolonged exercise in runners who supplemented with 1500 mg vitamin C per day when compared to < or = 500 mg per day.     

Attenuation of increase in circulating cortisol and enhancement of the acute phase protein response in vitamin C-supplemented ultramarathoners

Supplementary vitamin C (2 x 500 mg tablets daily) or a matched placebo was administered to 10 and 6 ultramarathon athletes respectively for 7 days prior to participation in a 90 kilometer running event, as well as on the day of the race and for 2 days after its completion. Circulating concentrations of vitamins A, C and E, as well as those of leukocytes and platelets, myeloperoxidase, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF), cortisol, and creatine kinase were measured 16 hours before the race and at 30 min, 24 hours, and 48 hours after completion. Pre-race vitamin C concentrations in the supplemented group were unchanged after the race (118.2 +/- 15.9 and 115.9 +/- 11.9 micromol/l) while an increase was observed in the placebo group immediately post-race (85.8 +/- 11.9 to 107.4 +/- 18.8 micromol), with a return to pre-race values after 24 hours. Immediately on completion of the race transient elevations occurred in the concentrations of circulating neutrophils, monocytes and platelets, IL-6, cortisol, CRP, and creatine kinase in both groups. In the supplemented group the concentrations of CRP were significantly higher (p < 0.01) at each of the post-race time-points while those of cortisol were 30% lower immediately post-race. These observations provide evidence that supplementation with vitamin C may blunt the adaptive mobilization of this vitamin from the adrenals during exercise-induced oxidative stress and may be associated with an enhancement of the acute phase protein response and attenuation of the exercise-induced increase in serum cortisol.     

外伤后肢体动脉急性闭塞的介入溶栓治疗

目的探讨外伤后肢体动脉急性闭塞介入溶栓治疗的临床价值。方法对6例外伤后肢体动脉急性闭塞患者,行动脉内介入溶栓治疗,观察分析疗效。结果DSA造影清晰显示肢体动脉闭塞段部位、范围及程度。6例闭塞血管完全再通,溶栓成功率100%。4例术后出现再灌注损伤综合征,其中1例行肌筋膜室切开,3例药物治愈。术后肢体动脉远端搏动立刻恢复正常,疼痛明显减轻或消失,未出现肢体坏死,无出血等严重并发症。结论介入溶栓治疗外伤后肢体动脉急性闭塞,是安全、可靠的微创手段,疗效显著,并发症少,同时为置入内支架创造了条件。     

Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography

OBJECTIVE: The purpose of this study was to retrospectively assess the accuracy of MDCT angiography as the initial diagnostic technique to depict arterial injury in patients with extremity trauma. MATERIALS AND METHODS: Over 36 months, 87 patients (16 females and 71 males; age range, 16-87 years) with clinically suspected arterial injury after extremity trauma underwent 4-MDCT angiography and 67 ultimately underwent surgery. Eighty patients had blunt injuries, and seven had penetrating injuries. The presence of arterial involvement was investigated prospectively by the radiologist in charge and retrospectively by two independent radiologists. Each detected arterial lesion was then characterized as a spasm, stenosis, occlusion, or rupture. The standard of reference was surgery in 67 patients, angiography in two patients, and clinical and radiologic follow-up findings in 18 patients. MDCT angiography was assessed by means of receiver operating characteristic (ROC) curve analysis for lesion detection and Spearman's rank correlation test for lesion characterization. Image quality, lesion depiction, and artifacts were subjectively assessed. RESULTS: Sixty-two traumatic arterial lesions were confirmed at surgery in 55 patients. MDCT angiography yielded high accuracy in detection (area under the ROC curve [Az] = 0.96; p < 0.001) and characterization (r = 0.94; p < 0.001) of traumatic arterial injuries and in recognizing an underlying dissection (Az= 0.82; p < 0.001). Prospective sensitivity and specificity were 95% and 87%, respectively, and retrospective sensitivity and specificity were 99% and 87%, respectively. MDCT angiography was considered to be sufficient for a reliable diagnosis in 83 patients (p < 0.001). Image quality and lesion depiction on MDCT angiograms were considered to be good and artifacts were considered mild with substantial interobserver agreement (kappa, 0.62-0.69). CONCLUSION: MDCT angiography provides significant and reproducible technique for the detection and characterization of arterial injuries to the extremities with high image quality and vascular delineation.     

Management of unicompartmental arthritis in the anterior cruciate ligament-deficient knee

There exists a group of patients who are difficult to manage because they have both anterior knee instability secondary to anterior cruciate ligament deficiency and unilateral degenerative joint disease. A large majority of these patients report a history of previous meniscal injury or meniscectomy after knee trauma at a relatively young age. Active patients who report symptomatic knee instability or pain associated with athletics or activities of daily living after conservative treatment may be indicated for surgery. Current endoscopic methods of anterior cruciate ligament reconstruction result in low patient morbidity, the elimination of anterior knee instability, and a timely return of function. Osteotomies about the knee joint are an effective means of treating unicompartmental knee arthrosis. Long-term studies have demonstrated that knee osteotomy is a good surgical option for patients with unicompartmental arthritis who are considered too young for total knee arthroplasty. We describe a comprehensive treatment approach to the patient with anterior cruciate ligament deficiency and isolated medial or lateral osteoarthritis. An assessment of pain symptoms, instability symptoms, and lower extremity alignment is used to formulate a treatment plan.     

Rings and things on upper extremity radiographs of emergency patients

Rings, intravenous lines, and other objects on the injured upper extremities of trauma patients are frequently overlooked by radiology and emergency department (ED) personnel. This can impair proper radiologic evaluation of the injured extremity as well as negatively affect the quality of the patient's treatment. A 1-week sample of radiographs of injured upper extremities from the ED of University Medical Center (UMC), Tucson, Arizona, showed that 20% of the studies (19 of 95) contained at least one object on the injured upper extremity, but only one radiology report (1.1%) mentioned such an object. A review of 2489 upper extremity ED radiology reports from January to June 2002 showed only 47 reports (1.9%) that mentioned the presence of an overlying object. It is important to educate radiology department and ED personnel to remove upper extremity jewelry and place necessary medical devices on noninjured extremities. Electronic Publication     

A comparative study of flurbiprofen and aspirin in soft tissue trauma.

A double blind study using flurbiprofen (2-(2-fluoro-4-biphenylyl propionic acid) 150 mg daily and soluble aspirin (3.6 g daily) for 5 days immediately after injury, was carried out in 52 soft tissue injuries to the lower limb in professional sportsmen. Flurbiprofen was more effective than aspirin in producing analgesia (when daily pain scores were considered) after day 2 (p less than 0.02); and flurbiprofen produced a more effective resolution of soft tissue trauma when days to training and match play were considered (p less than 0.05). The inhibitory effects of flurbiprofen on prostaglandin biosynthesis and tissue action are mentioned and the use of anti-inflammatory agents given immediately after soft tissue injuries discussed.     

Extremity injuries remain a high surgical workload in a conflict zone: experiences of a British Field Hospital in Iraq, 2003

BACKGROUND: During this conflict 34 Field Hospital, the sole Coalition field hospital located in Iraq, received and treated casualties with a wide range of injuries. Located very close to the front line during the period of combat hostilities, it was potentially going to deal with relatively fewer battle-injured extremities. METHOD: A retrospective review of battle casualties admitted to the hospital was carried out based on casualty records and operating theatre logbooks. Data was collected for the period between the 26th March and the 8th May, focusing on casualties who had surgery for battle-injured extremities during the conflict. RESULTS: Sixty eight (55%) of the 124 casualties who underwent surgery did so for battle injuries to extremities. 139 (58%) of all operating theatre episodes and 189 (53%) of all surgical procedures undertaken were for battle-injured extremities. Fourteen major limb amputations were carried out from a total of 87 battle-injured limbs that had surgery, giving an amputation rate of sixteen percent (14/87). CONCLUSION: The experience at 34 Field Hospital confirms that extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma.     

Sonography and venography of the lower extremities for diagnosing deep vein thrombosis in symptomatic patients

The purpose of this study was to investigate the efficacy of sonography and the frequency of indeterminate sonographic examinations in the evaluation of patients with suspected lower extremity deep vein thrombosis (DVT). We prospectively evaluated 136 symptomatic patients (157 extremities) with suspected DVT using sonography and contrast-enhanced venography (n=106 patients, 115 extremities). Using venography as the reference standard for diagnosing DVT, the sensitivity and specificity of sonography was 92.8% and 98%, respectively, yielding an accuracy of 96.8%. The frequency of indeterminate examinations for calf DVT was 32.4%. One (0.7%) fatal pulmonary embolus occurred in our patients. The pulmonary embolism (PE) rate was 1.6% after lower extremity sonography with negative results. Sonography is highly accurate in detecting lower extremity DVT in symptomatic patients. Because of the high frequency of indeterminate studies in the calf and the associated possible risk of pulmonary emboli, we urge radiologists exercise additional caution when evaluating symptomatic patients with clinically suspected lower extremity DVT.