高能体外冲击波治疗慢性足底筋膜炎

目的:观察高能体外冲击波对慢性足底筋膜炎的临床治疗效果。方法:选择2004-12/2005-12在深圳市第六人民医院疼痛科门诊就诊的足底筋膜炎患者167例,均自愿参加观察。按奇偶序列随机分为2组,治疗组84例,对照组83例。①治疗组采用HKSW-O冲击波治疗机进行标准治疗,工作电压7～10V,冲击波频率60次/min,治疗时间15min。②对照组除机器探头未与治疗部位充分有效接触外,定位及治疗参数设置同治疗组。两组患者均治疗3次,间隔5d治疗1次。①治疗前及治疗结束3个月后对两组患者进行简式McGill疼痛问卷测评:包括感觉类评分(0～33分)、情感类评分(0～12分)、疼痛总分(0～45分)、目测类比疼痛评分(0～10分)及现有疼痛强度评分(0～5分),以上各项分值越高,表示疼痛强度越大。②治疗后3个月对两组患者进行疗效评估:显效为疼痛明显减轻;好转为疼痛略减轻;无效为症状较治疗前无改变或加重。③患者治疗后第3天复诊时进行副作用观察,包括皮肤发红、疼痛、肿胀及其他(如恶心、眩晕、异感等)。结果:167例足底筋膜炎患者全部进入结果分析,无脱落。①两组患者治疗前及治疗3个月后简式McGill疼痛问卷评分比较:治疗3个月后,治疗组感觉类、情感类、疼痛总分、目测类比疼痛评分及现有疼痛强度评分均显著低于治疗前(t=2.639～3.416,P<0.01)。除现有疼痛强度评分外,治疗3个月后治疗组患者的感觉类、情感类、疼痛总分及目测类比疼痛评分均显著低于对照组(t=2.467～3.487,P<0.01)。②治疗3个月后两组患者的临床疗效比较:治疗组患者的显效率显著高于对照组(χ2=112.33,P<0.01)。③治疗后第3天复诊时治疗组患者的副作用发生情况:治疗组患者有少部分病例会出现皮肤发红和局部疼痛,而肿胀和其他副作用几乎不出现。结论:高能体外冲击波对慢性足底筋膜炎的临床治疗效果确切,具有安全、有效、简易和快速等特点。     

肝移植患者术后白蛋白的应用

目的:低白蛋白血症是肝移植患者的常见并发症,也是患者预后的重要影响因素。肝移植术后选择合理的白蛋白应用方案将有益于提高肝移植患者术后近远期疗效。方法:选择2000-10/2005-06于北京大学第三医院行肝移植并且随访时间大于6个月的患者80例,对治疗方案均知情同意。医院自2003年8月开始改变了肝移植术后白蛋白的输入方案:①方案改变之前患者即白蛋白输入方案未改变组(n=50),术后早期常规输入白蛋白剂量大于60g/d。②方案改变之后患者即白蛋白输入方案改变组(n=30),适当减少术后早期白蛋白输入的常规剂量至0￣20g/d。统计分析两组患者的一般情况、术后白蛋白使用情况、预后情况及住院费用。另外,对于两组中术后存在低白蛋白相关严重并发症的患者进行进一步的比较分析。结果:80例患者全部进入结果分析。①两组患者术前及术中一般情况差异无显著性意义(P>0.05)。②白蛋白输入方案改变组术后早期白蛋白的使用量及其费用/总住院费用比例显著低于白蛋白输入方案未改变组(P<0.01)。但两组患者术后第3天肝功能情况、白蛋白水平、早期并发症发生率、早期死亡率、半年生存率及呼吸机时间等情况差异均无显著性意义(P>0.05)。③两组中术后出现低白蛋白相关严重并发症患者术后第3天肝功能情况、白蛋白水平、早期死亡率、半年生存率及呼吸机应用时间等情况差异均无显著性意义(P>0.05)。结论:肝移植术后过多输入白蛋白不能改善患者预后;适当减少术后白蛋白的常规输入剂量,同时根据血白蛋白水平及并发症情况随时调整白蛋白的输入量能够减少白蛋白的用量,对患者预后因素亦无明显影响。     

Familial amyloidotic patients' experience of the disease and of liver transplantation

Liver transplantation is a new treatment for familial amyloidotic polyneuropathy (FAP). No qualitative study examining these patients' experiences of the disease and the treatment has been published. The purpose of this study was to explore and describe the experience of the disease and the liver transplantation from the FAP patient's perspective. In-depth interviews with 11 liver transplant FAP patients were performed. The process of the FAP disease and a liver transplantation was found to involve the following categories: going downhill, defence and denial, a chance of surviving, the decision — no choice, waiting powerless and uncertain, the first few steps after surgery, freed from the death sentence, still disabled, mastering up strength to recover, and the need for support and help.     

Lymphangiomyomatosis: CT, chest radiographic, and functional correlations

Eight patients with the diagnosis of lymphangiomyomatosis were evaluated with computed tomography (CT), chest radiography, and pulmonary function tests to determine the relationship between the extent of disease seen on imaging studies and functional status. Chest radiographic assessment included the subjective determination of disease extent and measurements of lung length and the arc of the right hemidiaphragm. Disease extent on CT scans was scored as a percentage of lung that was abnormal on the basis of visual assessment of the degree of cystic replacement of the lung parenchyma. Significant correlations were observed between CT scores and percentages of predicted forced expiratory volume in 1 second/forced vital capacity (r = -.92, P less than .002) and diffusing capacity of the lungs for carbon monoxide (r = -.80, P less than .017). No significant correlations were observed between subjective chest radiographic scores and pulmonary function tests, although measurements of lung length and percentage of predicted total lung capacity were correlated (r = .76, P less than .045). CT was more accurate than chest radiography in defining the presence and extent of parenchymal cysts and provided for greater morphologic-physiologic correlation. CT, particularly high-resolution CT, may be useful in the diagnosis and longitudinal evaluation of patients with this disease and may be more sensitive than pulmonary function tests in the early stages of lung damage.     

糖尿病与重症牙周病相关的证据

数据来源：检索MEDLINE数据库从1970年1月至2003年10月出版的所有文献．并手工检索参考文献中的相关文献。纳入标准：以人为对象的临床试验或观察性研究，且以英语发表的文献。数据提取和合成：由3位作者分别提取数据，意见不同则由讨论解决。记录一系列指标：菌斑指数（PI）、牙石指数、牙龈指数（GI）、探诊出血指数（BOP）、牙周探诊深度（PPD）、临床附着丧失（CAL）、牙龈退缩、牙周指数和骨丧失指数。用血液中糖化血红蛋白百分浓度显示糖尿病控制与否。评估各牙周参数的整体差异，并应用固定效应模型或随机效应模型计算相应的95％CI。用Q检验进行同质性检验。用漏斗图检测发表偏倚。结果：18个横断面对照研究、3个前瞻性队列研究和2个临床试验的基线资料入选。     

Low-Dose ATG/GCSF in Established Type 1 Diabetes: A Five-Year Follow-up Report

Previously, we demonstrated low-dose antithymocyte globulin (ATG) and granulocyte colony-stimulating factor (GCSF) immunotherapy preserved C-peptide for 2 years in a pilot study of patients with established type 1 diabetes (n = 25). Here, we evaluated the long-term outcomes of ATG/GCSF in study participants with 5 years of available follow-up data (n = 15). The primary end point was area under the curve (AUC) C-peptide during a 2-h mixed-meal tolerance test. After 5 years, there were no statistically significant differences in AUC C-peptide when comparing those who received ATG/GCSF versus placebo (P = 0.41). A modeling framework based on mean trajectories in C-peptide AUC over 5 years, accounting for differing trends between groups, was applied to recategorize responders (n = 9) and nonresponders (n = 7). ATG/GCSF reponders demonstrated nearly unchanged HbA_1c over 5 years (mean [95% CI] adjusted change 0.29% [–0.69%, 1.27%]), but the study was not powered for comparisons against nonresponders 1.75% (–0.57%, 4.06%) or placebo recipients 1.44% (0.21%, 2.66%). These data underscore the importance of long-term follow-up in previous and ongoing phase 2 trials of low-dose ATG in recent-onset type 1 diabetes.