引入GRADE体系制定中医药国际标准的思考与实践探析

推荐等级的评估、制定与评价(GRADE)是国际统一的证据质量分级和推荐强度标准,它综合考虑研究设计、研究质量、研究结果的一致性和证据的直接性、利弊平衡、资源配置、结局指标的重要性,并认为观察性研究也是重要的证据来源,它是循证医学发展的里程碑。介绍了GRADE的来源及其理论框架,阐明了建立亚健康国际标准的必要性和步骤、方法,提倡采用GRADE制定亚健康的国际标准。同时,主张将GRADE引入中医药临床评价,进一步发展中医药临床评价体系,推动中医药的现代化、国际化。     

实时三维超声成像诊断胎儿畸形的临床应用效果评价

目的探析实时三维超声成像诊断胎儿畸形的临床应用效果。方法选取我院2013年2月~2015年2月行常规检查的750例孕妇为观察对象,先给予孕妇常规二维超声检查,记录检查结果,之后给予实时三维超声成像诊断,记录诊断结果,对2次检查结果予以观察对比。结果经引产及足月分娩确诊畸形30例,二维超声检查结果相符率为60.0%,实时三维超声成像诊断结果相符率为96.7%,2次检查结果对比差异具有统计学意义(P0.05)。结论在胎儿畸形诊断中,实时三维超声成像诊断准确率高于二维超声检查,临床应用价值更高。     

Repeatability and agreement of CCT measurement in myopia using entacam and ultrasound pachymetry

AIM: To evaluate the repeatability of central corneal thickness (CCT) measurement by entacam, and agreement of CCT measured by Pentacam and ultrasound pachymetry (USP) in Chinese myopia. Thereby investigate the possibility of Pentacam as a substitute for USP in CCT measurement before refractive surgery. The effects of corneal curvature measured by Pentacam on CCT were also evaluated. METHODS: One hundred and forty-eight right eyes of 148 individual with myopia were included in this study. Three successive Pentacam CCT measurements followed by 10 successive ultrasound pachymetry were carried out in the 148 eyes. Mean of CCT taken by each device was calculated for comparison. According to the CCT measured by USP, all the 148 eyes were divided into 3 groups: <520μm, 520-560μm, >560μm. For all eyes and each group the CCT obtained by Pentacam and USP were compared. Anterior corneal curvature of the 148 eyes was also adopted for correlation analysis with CCT obtained by ultrasound pachymetry. In addition, CCT measurement using 60 random selected Scheimpflug images was performed by 3 skilled investigators at different time, and this was repeated for 3 times by a forth investigator to assess repeatability of Pentacam CCT measurement using Scheimpflug images. RESULTS: Intraclass correlation coefficient (ICC) analysis revealed high intraobserver repeatability (ICC=0.994, F=158.60, P<0.001) for CCT measurement by Pentacam. The interobserver (ICC=0.998, F=494.73, P<0.001) and intraobserver (ICC=0.997, F=383.98, P<0.001) repeatability for Pentacam CCT measurements using Scheimpflug images were also excellent. There was high positive correlation between the CCT values measured by Pentacam and ultrasound pachymetry (r=0.963, P<0.001). Bland-altman plots showed that the Pentacam underestimate the CCT by 8.02μm compared with ultrasouond pachymetry. The differences between Pentacam and USP increased as the CCT readings by USP increased (Pentacam vs USP: slope=-0.04, P<0.05). The 95% upper and lower limits of agreement between CCT values obtained from the two devices were +9.33μm and -25.37μm. No significant association could be found between CCT and anterior corneal curvature. CONCLUSION: Inter- and intraobserver variability for CCT measurements by Pentacam was considerably below clinically significant levels. CCT of myopia obtained by Scheimpflug camera, Pentacam, were highly correlated to that by ultrasound pachymetry. However, the values obtained are not directly interchangeable between Pentacam and ultrasound pachymetry as the 95% limits of agreement are relatively wide. Pentacam can be a useful instrument for measuring CCT in candidates to refractive surgery in clinic.     

利胆胶囊治疗急性胆道感染临床研究

目的：观察利胆胶囊治疗急性胆道感染的临床疗效。方法：治疗组采用利胆胶囊每次4粒、每日3次治疗106例;对照组应用西药氨苄青霉素600万u和氨基糖甙类联合应用治疗40例。结果：治疗组总有效率94．34％,对照组总有效率为905,2组疗效经统计学处理无显著性差异（P＞0．05）;退热时间治疗组平均2．8d,对照组平均4．8d,2组退热时间经统计学处理有显著性差异（P＜0．05）;腹痛消失时间治疗组平均为4．21d,对照组平均为7．21d,2组腹痛消失时间经统计学处理有显著差异（P＜0．05）。结论利胆胶囊治疗急性胆道感染具有确切疗效。     

应变率成像定量评价孤立性房颤患者局部左房功能的研究

目的:探讨应变率成像技术定量评估孤立性房颤患者左房局部功能的临床应用价值。材料与方法:随机选取来我院就诊的孤立性房颤患者50例,行常规超声心动图检查,在超声组织速度成像状态下获取心尖四腔、两腔、左室长轴切面动态图像,将左房间隔壁、侧壁、前壁、下壁、前间隔和后壁分别按照基底段、中间段和心尖段划分为18个节段。观察左房各壁的基底段和中间段,测量收缩期峰值应变率(SR-LAs)和舒张期应变率(SR-LAe和SR-LAa),并与40例健康人相应节段心肌比较。结果:正常对照组40例480个被研究心肌节段,470个节段的应变率-时间曲线的形态整体有一定的规律性,SR-LAs、SR-LAe和SR-LAa值随个体变化不大。孤立性房颤患者组被研究600个心肌节段,应变率-时间曲线显示523个节段失去正常形态,轮廓杂乱,波峰低小、消失甚至倒置,峰值较正常心肌节段明显降低(P0.05)。结论:用应变率成像技术能够无创的定量评价孤立性房颤所致的左房功能异常。     

老年股骨转子间骨折股骨头置换与内固定的比较与分析

目的 通过临床的一些客观指标,观察与分析比较老年股骨转子间骨折内固定与人工股骨头置换术适应证和效果.方法 2002年3月～2004年11月治疗老年股骨转子间骨折84例.改良Evans-Jensen分型：Ⅰ型骨折30例,Ⅱ型骨折25例,Ⅲ型骨折19例,Ⅳ型骨折7例,V型骨折3例.年龄65～94岁,平均74.6岁.A组：人工股骨头置换术置换21例.B组：内固定63例.结果 术后随访1～51个月,平均11.5个月.A组与B组的年龄、住院时间、术中出血和术中输血等比较有差异.A组：手术创伤大,手术时间短,术后卧床时间短,住院时间短,部分病人需输血,平均年龄稍大.B组：手术创伤小,手术时间长.术中出血少,不需输血,住院时间长,平均年龄小.疗效按生活自理程度分为：生活完全自理54例,部分自理23例,卧床不能自理6例,死亡1例.结论 二种手术方法各有优势,只要根据不同的适应证及术者的经验,人工股骨头置换术也适用于老年股骨转子间骨折的治疗.     

利多卡因和输液部位对丙泊酚注射痛的影响

目的 观察利多卡因和不同输液部位对丙泊酚注射痛的影响.方法 120例妇产科日间手术患者随机分为二组,每组60例,每组内再根据患者的输液部位分成手背静脉和桡静脉两组.1组推注2ml乳酸林格液后和2组推注40mg利多卡因后缓慢推注丙泊酚.观察推注丙泊酚时患者的疼痛情况.结果 1组的桡静脉的注射痛优于手背静脉(P<0.05),2组的桡静脉和手背静脉的注射痛没有明显区别(P>0.05);2组注射痛的发生率45%,1组注射痛的发生率是78%(P<0.05),药物对注射痛的影响因子大于输液部位对静脉痛的影响因子.结论 利多卡因可以缓解丙泊酚的注射痛,在不复合利多卡因的情况下,选择桡静脉要优于选择手背静脉.     

Poly(vinyl alcohol)/poly(acrylic acid) hydrogel coatings for improving electrode–neural tissue interface

A major problem which hinders the applications of neural prostheses is the inconsistent performance caused by tissue responses during long-term implantation. The study investigated a new approach for improving the electrode–neural tissue interface. Hydrogel poly(vinyl alcohol)/poly(acrylic acid) interpenetrating polymer networks (PVA/PAA IPNs) were synthesized and tailored as coatings for poly(dimethylsiloxane) (PDMS) based neural electrodes with the aid of plasma pretreatment. Changes in the electrochemical impedance and maximum charge injection (Q_inj) limits of the coated iridium oxide microelectrodes were negligible. Protein adsorption on PDMS was reduced by ～85% after coating. In the presence of nerve growth factor (NGF), neurite extension of rat pheochromocytoma (PC12) cells was clearly greater on PVA/PAA IPN films than on PDMS substrates. Furthermore, the tissue responses of PDMS implants coated with PVA/PAA IPN films were studied by 6-week implantation in the cortex of rats, which found that the glial fibrillary acidic protein (GFAP) immunoreactivity in animals (n = 8) receiving coated implants was significantly lower (p < 0.05) compared to that of uncoated implants (n = 7) along the entire distance of 150 μm from the outer skirt to the implant interface. The coated film remained on the surface of the explanted implants, confirmed by scanning electron microscopy (SEM). All of these suggest the hydrogel coating is feasible and favorable to neural electrode applications.     

高曝光剂量CT辐射致家兔肝组织发生病理变化的初步探讨

目的探讨腹部模式常规和非常规扫描次数。高曝光剂量的CT扫描对家兔肝组织病理变化的影响。方法将46只大白兔随机分成3组：(1)高曝光剂量CT扫描组36只：分两大亚组,每组18只,进一步分6个小组,每小组3只。采用高曝光剂量(约为常规2倍曝光剂量)的腹部CT扫描模式．对大白兔进行全身扫描。①腹部模式一次性扫描组(以下简称一次性扫描组)：CT以2．5mm层厚分别连续扫描3、6、9、12、15、18次,48h后剖杀;②腹部模式重复扫描组(以下简称重复扫描组)：CT以5mm层厚分别连续扫描2、4、6、8、10、12次,24h后重复上述扫描,24h后剖杀。(2)常规CT扫描组：5只,采用常规次数和曝光剂量对大白兔进行全身扫描,48h后剖杀。(3)正常对照组：5只。所有实验动物取肝组织作病理检查和凋亡相关基因Cpp32、Bax蛋白的免疫组化分析。结果(1)高曝光剂量CT扫描组光镜病理结果：①一次性扫描组连续扫描6次时出现轻微肝损伤;连续6～18次扫描后,肝细胞逐渐由轻微或局限性浊肿变为弥漫性浊肿、水样变性或脂肪变性、肝窦狭窄或闭塞、点状肝细胞坏死和局部肝出血。②重复扫描组共8次扫描时出现轻微肝损伤;8～24次扫描后,肝细胞逐渐由轻微到弥漫性浊肿、水样变性,近中央静脉周围肝细胞散在性核固缩改变。免疫组化结果：①一次性扫描组部分肝组织对Bax、Cpp32呈阳性表达,而且随着扫描次数的增加,其阳性表达也多更高,肝细胞的凋亡程度也随之加重。②重复扫描组各小组扫描肝组织Bax和cpp32均出现阳性表达,其阳性表达程度与扫描次数无明显相关性。(2)常规CT扫描组：实验肝组织光镜下无发生明显的病理变化。Bax、Cpp32呈阴性表达。结论常规肝脏CT扫描是非常安全的：但在非常规扫描次数和高曝光剂量下,CT辐射可能会引起家兔急性肝组织的异常病理变化。