Comparison of mortality and its causes in patients with complicated systemic lupus erythematosus on hemodialysis versus peritoneal dialysis: A meta-analysis

Background:Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE). Ten percent to 20% of patients with SLE progress to end-stage renal disease and would require renal replacement therapy or renal transplantation. In this analysis, we aimed to systematically compare mortality and the causes of mortality in patients with complicated SLE who were treated on hemodialysis (HD) versus peritoneal dialysis (PD).Methods:Cochrane Central, Medical Literature Analysis and Retrieval System Online, Google Scholar, Web of Science, Excerpta Medica dataBASE, and http://www.ClinicalTrials.gov were searched for studies that compared HD versus PD in patients with SLE. The RevMan software version 5.4 (RevMan software, Cochrane Collaborations, United Kingdom) was used to analyze data. Heterogeneity was assessed using the Q and the I² statistical tests. In this analysis, a random effects model was used during data assessment. Risk ratios (RRs) with 95% confidence intervals (CIs) were used to represent the results following analysis.Results:A total number of 3405 SLE participants were included in this analysis, whereby 2841 were assigned to HD and 564 participants were assigned to PD. In patients with SLE who were on dialysis, our analysis showed that the risk of mortality was similar with HD and PD (RR, 0.69; 95% CI, 0.45–1.07; P = .10). When the cause of mortality was analyzed, cardiovascular death (RR, 0.63; 95% CI, 0.31–1.31; P = .22), death due to infection (RR, 0.74; 95% CI, 0.47–1.17; P = .20), death due to a respiratory cause (RR, 1.06; 95% CI, 0.18–6.21; P = .95), cause of death due to SLE flare up (RR, 2.54; 95% CI, 0.39–16.37; P = .33), and other causes of death (RR, 0.79; 95% CI, 0.35–1.77; P = .57) were not significantly different with HD and PD.Conclusion:This current analysis showed that in SLE patients who required dialysis, the risk of mortality between HD and PD was similar, and the causes of death including cardiovascular, infective, respiratory, SLE flare up, and other causes were not significantly different. Therefore, both dialysis methods were tolerable in these patients with SLE. Further studies with larger data would be required to confirm this hypothesis.     

有效成分组替代舒胸片原复方可行性的药效学探讨

目的:"在中药复方有效成分组"概念的指导下,比较舒胸片(三七、红花、川芎)及其有效成分组(SECG)在抗炎、镇痛、抗凝血、抗血栓和心肌保护方面的差异。方法:通过小鼠角叉菜胶足跖肿胀试验观察其抗炎作用,热水缩尾试验观察其镇痛作用,小鼠凝血试验观察其对凝血时间的影响,大鼠动静脉旁路血栓试验观察其抗血栓作用,垂体后叶素致大鼠心肌缺血试验观察其心肌保护作用。结果:舒胸片和SECG均能降低角叉菜胶导致的小鼠足跖的肿胀度,降低小鼠足局部炎症组织中前列腺素-2(PGE2)含量,增加超氧化物歧化酶(SOD)活性;提高痛阈;延长凝血时间;抑制血栓生成;抑制心肌缺血,使心肌组织中肌酸激酶(CK),乳酸脱氢酶(LDH),脂质过氧化产物丙二醛(MDA)含量明显降低,SOD活性明显升高。并且舒胸片、SECG两种组方作用一致。结论:舒胸片和SECG在抗炎、镇痛、抗凝血、抗血栓和心肌保护方面的作用效果一致,且量效关系也一致,说明SECG是舒胸片的起效成分,SECG可以替代舒胸片应用于研究及临床。     

破裂脑动脉瘤栓塞时机与术后蛛网膜下腔出血的治疗

目的 探讨破裂性颅内动脉瘤血管内栓塞的时间与术后蛛网膜下腔出血(subarachnoid hemorrhage,SAH)的治疗.方法 西安交通大学医学院第一附属医院神经外科对118例破裂性颅内动脉瘤患者在发病后7 d内用电解可脱性弹簧圈(guglielmi detachable coil,GDC)进行动脉瘤囊内栓塞.术后早期处理已经聚积在蛛网膜下腔的出血,以及由于SAH而导致的脑部及全身性并发症.治疗效果经χ2检验.结果 118个动脉瘤中101个瘤腔100%闭塞,12个95%闭塞,5个被90%闭塞.术后115例临床痊愈,其治疗结果根据Glasgow预后评分:Ⅰ级89例,Ⅱ级14例,Ⅲ级9例,Ⅳ级3例,Ⅴ级3例.全组死亡3例,死亡率2.5%.术中并发脑血管痉挛8例,动脉瘤破裂3例,GDC脱出2例,脑梗塞1例.术后74例随访6～72个月均无再出血,3例复发者经二次补充GDC栓塞治愈.结论 对破裂性动脉瘤应早期进行血管内栓塞.术后治疗的策略应着眼于早期处理SAH,防治脑血管痉挛及延迟性缺血性神经功能障碍,并妥善处理脑部与全身并发症.     

Evaluation of triage strategies for high-risk human papillomavirus-positive women in cervical cancer screening: A multicenter randomized controlled trial in different resource settings in China

ObjectiveWe aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus (hrHPV)-positive women in primary healthcare settings in China.MethodsThis study was undertaken in 11 rural and 9 urban sites. Women aged 35−64 years old were enrolled. HrHPV-positive women were randomly allocated to liquid-based cytology (LBC), visual inspection with acetic acid and Lugol’s iodine (VIA/VILI) (rural only) triage, or directly referred to colposcopy (direct COLP). At 24 months, hrHPV testing, LBC and VIA/VILI were conducted for combined screening.ResultsIn rural sites, 1,949 hrHPV-positive women were analyzed. A total of 852, 218 and 480 women were randomly assigned to direct COLP, LBC and VIA/VILI. At baseline, colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%−80%. LBC (n=3 and n=7) or VIA/VILI (n=8 and n=26) could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia (CIN) 2 or worse and CIN3+ compared with direct COLP (n=14 and n=23). For the 24-month cumulative detection rate of CIN2+, VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP. When stratified by age, baseline LBC triage+ performed best (P<0.001), peaking among women aged 35−44 years (P_trend=0.002). In urban sites, 1,728 women were hrHPV genotyping test positive. A total of 408, 571 and 568 women were randomly assigned to direct COLP for HPV16/18+, direct COLP for other hrHPV subtypes+, and LBC triage for other hrHPV subtypes+. LBC (n=12 and n=31) significantly decreased the number of colposcopies needed to detect one CIN2+ and CIN3+ compared with direct COLP (n=14 and n=44). HPV16/18+ increased the 24-month cumulative detection rate of CIN2+ (17.89%, P<0.001).ConclusionsLBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+ women and LBC triage for other hrHPV subtype+ women in urban settings might be feasible strategies.     

T1期结直肠癌淋巴结转移的危险因素分析及其列线图预测模型的应用价值

目的:探讨T1期结直肠癌淋巴结转移的危险因素及其列线图预测模型的应用价值。方法:采用回顾性病例对照研究方法。收集2008年6月至2019年12月复旦大学附属中山医院收治的914例行根治性切除术T1期结直肠癌病人的临床病理资料;男528例,女386例;中位年龄为63岁,年龄范围为25~87岁。观察指标：（1）T1期结直肠...     

STI在评价2型糖尿病患者右心功能的应用

目的 应用超声斑点追踪成像技术(speckle tracking imaging,STI)评价2型糖尿病患者右心室的收缩和舒张功能,为临床早期发现其功能异常并给予干预和指导用药;为延缓心力衰竭、改善预后提供参考价值.方法 对40例2型糖尿病患者及40例健康志愿者,取动态心尖四腔切面图常规测量:右心房横径(RADd),右...     

2014年度全国放射性核素γ能谱分析质量控制比对

目的 提高放射卫生技术服务机构检测人员的技术水平和分析能力,进一步促进全国γ能谱实验室放射性核素检测技术的发展。 方法 组织2014年度全国放射性核素γ能谱分析方法比对,比对基质为土壤样品,要求参加比对的单位分析测量样品中放射性核素40K、137Cs、208Tl和228Ac的比活度。 结果 提交结果报告的31家比对单位中,比对结果合格的有26家,不合格的有5家,有2家单位的比对结果获得优秀。所有参加比对的单位的整体合格率为84%（26/31）,优秀率为6%（2/31）。 结论 参加比对的多数单位具备较高的检测能力和水平,其出具的检测结果准确可靠。在日常工作中需加强对γ谱仪的维护保养,重视实验室间定期刻度,并注意采用正确的核衰变参数进行计算。     

新安“张一帖内科”痹病辨证思路探析

[目的] 总结“张一帖内科”治疗痹病的中医辨证思路。[方法] 通过跟诊学习,收集、整理、分析典型医案,查阅相关中医古籍及文献,结合新安医学“张一帖内科”主要传承人国医大师李济仁及李艳教授临证时所谈所述,从痹病病因病机、创新痹病新安理论、临证论治三个方面总结“张一帖内科”治疗痹病的辨证思路与经验,并附医案两则加以佐证。[结果] 新安“张一帖内科”创新新安医学理论,创立“平衡寒热、扶元培土”学说,以“寒热三期”疗法治疗痹病,临证注重平调寒热、扶元培土、调和气血、化痰散瘀。验案一中患者反复多关节疼痛,病程长,李艳教授自创“益肾清络活血方”合乌头汤加裁“化痰散瘀”,治疗痰瘀互阻型痹病;验案二中患者劳累过度,湿邪入络,多关节疼痛、肿胀、活动不利,局部有热感,神疲乏力,李艳教授辨证该患者为痹病湿热内阻兼气血亏虚证,以“清热解毒、益气活血通络”平调寒热。[结论] 新安“张一帖内科”在治疗痹病实践中形成了自身独特的临床特色,辨证灵活,效果甚佳,是新安医学的重要分支,为中医药治疗痹病拓展了新思路,值得借鉴。     

联动成像模式对提高结直肠息肉检出率的有效性研究

目的 评估联动成像模式（linked color imaging，LCI)提高结直肠息肉检出率，尤其是腺瘤检出率的有效性。方法 回顾性分析2018年5月—2019年3月入院接受LASEREO系统结肠镜LCI模式或普通白光（white light imaging，WLI）模式检查的患者，比较两种模式下结肠镜检查整体息肉检出率、腺瘤检出率、扁平息肉检出率、小息肉(≤5 mm)检出率及右半结肠息肉检出率的差异。用国际照明委员会（Commission Internationale de L""Eclairage，CIE）于1976年制定的L*a*b*颜色空间分析比较两种模式下腺瘤性息肉与周边黏膜的色差（ΔE）。结果 LCI组患者整体息肉检出率，尤其是腺瘤检出率高于WLI组，差异有统计学意义(45.53%比32.83%，P=0.038；53.65%比39.62%，P=0.009)。LCI组腺瘤性息肉与周边黏膜的色差（ΔE）明显高于WLI组，差异有统计学意义（27.24±8.67比15.28±6.68，P<0.001），且LCI组扁平息肉、小息肉及右半结肠息肉检出率均高于WLI组，差异有统计学意义（61.98%比47.17%，P=0.005；60.94%比42.77%，P=0.001；45.83%比32.70%，P=0.012）。结论 LCI能有效提高结直肠息肉检出率，尤其是腺瘤检出率，值得临床推广应用。