揿针治疗老年膝关节骨性关节炎疗效观察：随机对照试验

ObjectiveTo observe the effects of the thumb-tack needling therapy on knee joint pain and joint function in the elderly patients with knee osteoarthritis (KOA) and compared with medication.MethodsA total of 60 patients were randomized into a thumb-tack needling group and a medication group, 30 cases in each one. In the thumb-tack needling group, the therapy with the thumb-tack needle retaining and waiting for qi was adopted. The acupoints were Hèdĭng (EX-LE2鹤顶), Nèixīyăn (内膝眼EX-LE4), Dúbí (犊鼻ST35), Xuèhăi (血海SP10), Liángqiū (梁丘ST34) and Ashi points on the affected side. The needles were retained for 24 h. This therapy was given once every two days, 3 times a week. The treatment for 2 weeks was as one course and consecutive 2 courses of treatment were required. In the medication group, diclofenac sodium sustained release tablets were taken orally, 75 mg each time, once daily, consecutively for 4 weeks. Successively, the score of visual analogue scale (VAS) at the affected knee before treatment, after treatment and 3 months after treatment as well as Lequesne indicator before and after treatment were evaluated. The clinical therapeutic effect was observed in the patients of the two groups after treatment.Results(1) After treatment, VAS scores were reduced as compared with those before treatment in the patients of the two groups (both P < 0.05). After treatment, VAS score in the thumb-tack needling group was lower than that in the medication group (P < 0.05). (2) After treatment, the scores of all the items of Lequesne indices reduced as compared with those before treatment in the patients of the both groups, indicating significance differences (all P < 0.05). After treatment, compared with the medication group, the score of pain, morning stiffness and walking ability as well as the total score were all lower in the thumb-tack needling group, indicating significant differences (all P < 0.05). (3) The curative and remarkably effective rate and the total effective rate were 66.7% and 93.3% in the thumb-tack needling group, higher than 56.7% and 86.7% in the medication group respectively (both P < 0.05).ConclusionThe thumb-tack needling therapy effectively relieves knee joint pain and improves joint function in the patients and the therapeutic effect is better than medication group. Hence, this therapy deserves to be promoted in clinical practice.     

Prognostic Value of NRAS Gene for Survival of Colorectal Cancer Patients: A Systematic Review and Meta-Analysis

Introduction: NRAS gene is associated with malignant proliferation and metastasis of colorectal cancer (CRC).But its prognostic value on CRC is still unknown. The objective of this study is to perform a meta-analysis to obtainits prognostic value on survival of CRC patients. Methods: The systematic review and meta-analysis was designed,undertaken and reported using items from the PRISMA statement. Relevant articles were identified through PubMed(containing Medline), Embase, Web of Science databases and Google scholar search engines from their inception up toOctober 3, 2016. The articles about NRAS on prognosis of CRC patients were enrolled. The association between NRASand CRC survival time (including overall survival [OS], progression-free survival [PFS], and disease-free survival[DFS]) was evaluated using hazard ratio (HR) with its corresponding 95% confidence interval (CI). Results: A totalof fifteen articles were included. High-expression of NRAS was significantly associated with poor OS (HR: 1.36, 95%CI: 1.15–1.61), and poor PFS (HR: 1.75, 95% CI: 1.04–2.94). The combined HR of NRAS on DFS was 0.87 (95% CI:0.37–2.03). Subgroup analysis showed that NRAS was significantly associated with poor OS for patients from Westerncountries (HR: 1.38, 95% CI: 1.09–1.73), but not for those from Asian countries. Conclusions: This meta-analysisdemonstrate that NRAS gene could predict the poor prognosis for the CRC patients. More large-sample cohort studiesare needed to further confirm this conclusion.     

人参固本口服液联合泼尼松治疗成人肾病综合征的疗效观察

目的:探讨人参固本口服液联合泼尼松治疗成人肾病综合征的疗效,为临床治疗提供参考。方法:选取2017年3月至2018年2月西南医科大学附属医院肾病内科收治的肾病综合征患者108例作为研究对象,随机分为对照组、观察组A(低剂量组)和观察组B(高剂量组),每组36例。对照组患者给予泼尼松治疗,初始剂量1. 0 mg/(kg·d),最大剂量60 mg/d,尿蛋白转阴或每日最大剂量服用4周后减量,每周减少10%剂量,直至调至20 mg/d,并在2个月后减量至10 mg/d,以10 mg/d维持至疗程结束。观察组A在对照组基础上,给予口服人参固本口服液治疗,每次餐前口服10 mL,2次/d,1周后减量至1次/d,继续服用1周后减量,口服5 mL/次,隔日顿服,并以此剂量维持至疗程结束。观察组B在对照组基础上,给予口服人参固本口服液治疗,每次餐前口服10 mL,2次/d,1周后减量至1次/d,并以此剂量维持至疗程结束。观察组A和观察组B的疗程均为1个月。比较3组的治疗效果。结果:3组患者在疗程结束后总治愈率有明显差别,观察组A和观察组B的总有效率分别为94. 44%、97. 22%,均优于对照组的总有效率77. 22%,差异有统计学意义(P 0. 05)。但观察组A和观察组B总有效率比较,差异无统计学意义(P 0. 05)。观察组A和观察组B患者的尿液蛋白指标和血脂水平均低于对照组,差异有统计学意义(P 0. 05)。但观察组A、观察组B的尿液蛋白指标和血脂水平比较,差异无统计学意义(P 0. 05)。观察组A不良反应发生率比观察组B低,差异无统计学意义(P 0. 05)。结论:人参固本口服液联合泼尼松治疗肾病综合征的疗效显著,明显优于泼尼松单独治疗。但临床建议使用低剂量的人参固本口服液联合泼尼松治疗肾病综合征。     

通腑泄浊法治疗危重病病人胃肠功能障碍 60例临床观察

目的 观察通腑泄浊法治疗危重病病人胃肠功能障碍临床疗效.方法 2015年1月至2018年1月于辽宁中医药大学附属医院住院并发生胃肠功能障碍的120例病人,按住院的先后顺序,按照事先由随机数确定的随机分组方法,进入观察组和对照组.观察组在西药治疗原发病基础上,加用通腑泄浊中药治疗.比较两组有效率、死亡率、APACHEⅡ评分、C反应蛋白水平.结果 观察组有效率为86.67％(52/60),对照组为71.67％(43/60),观察组较对照组高(P<0.05);而观察组死亡率为18.33％(11/60),对照组为35.00％(21/60),观察组死亡率低于对照组(P<0.05).观察组治疗前APACHEⅡ评分(23.08±7.64),治疗后为(11.79±4.13),对照组治疗前APACHEⅡ评分(22.15±8.36),治疗后为(14.76±4.81),两组APACHEⅡ评分治疗后均明显下降(P<0.05),观察组较对照组下降更明显(P<0.05).观察组治疗前C反应蛋白水平(102.87±37.06),治疗后(41.79±14.07),对照组治疗前C反应蛋白水平(105.64±38.35),治疗后C反应蛋白水平(72.86±13.74),两组C反应蛋白水平治疗后均明显下降(P<0.05),观察组较对照组下降更明显(P<0.05).结论 应用通腑泄浊法治疗危重病人胃肠功能障碍有效.     

临床教学中PBL教学模式与传统教学模式的应用

目的分析临床医学教学中采用PBL教学模式与传统教学模式的效果。方法选择本院2018年5月-2019年5月期间临床医学专业学生200名,采用数字随机分配方式,将学生分为对照组与观察组,每组各100名学生。其中对照组学生接受传统教学模式,观察组学生采用PBL教学模式,对比两组学生理论知识掌握能力、实际操作能力以及合作意识,并对比两组学生考试成绩合格率。结果观察组学生理论知识掌握能力、实际操作能力以及合作意识明显优于对照组学生。同时观察组学生理论考试成绩高于对照组,两组学生对比差异具有统计学意义(P<0.05)。结论采用PBL教学方式应用于临床医学教学效果明显优于传统教学方法,可有效提高学生学习效果,培养新型思维方式,提高团队合作能力。     

胃食管反流病的中西医结合诊疗体会

刘万里教授主张诊疗胃食管反流病应重视中西医结合思维。在明确诊断的基础上,对胃食管反流病治疗采取分期疗法,发作期以快速愈合炎症、缓解控制症状为治疗目标,此阶段以西药为主、中药为辅;缓解期主要是巩固疗效、减少复发,中药为主、西药为辅。针对难治性胃食管反流病,刘万里教授强调优化诊疗方案的重要性,找到中医干预胃食管反流病的切入点,发挥中医药"治病求本""辨证论治"等特色优势,可提高胃食管反流病的临床疗效,显著减少复发率。     

免疫增强型肠内营养对感染性休克老年患者炎症反应和免疫功能的影响

目的:探讨免疫增强型肠内营养对严重感染休克老年患者炎症反应和免疫功能的影响。方法:选取58例严重感染休克老年患者为研究对象。根据患者所使用的营养支持方法,随机分为两组,每组29例。观察组给予肠内营养乳剂,对照组给予肠内营养混悬液。观察并比较两组入院当日、1周、2周的免疫指标以及炎症指标的变化情况。结果:随着入院时间的增加,两组的CD4、CD4/CD8水平逐渐升高,CD8水平逐渐降低;入院1周及2周时观察组的CD4以及CD4/CD8水平高于对照组(P<0.05),CD8水平低于对照组(P<0.05)。两组受试者的各项免疫球蛋白指标均随着入院时间的增加而升高;两组受试者入院2周时观察组IgG以及IgM水平高于对照组(P<0.05);入院1周及2周时观察组IgA水平高于对照组(P<0.05)。随着入院时间的增加,两组C-反应蛋白浓度逐渐下降(P<0.05);入院1周后,观察组C-反应蛋白与对照组比较,差异无统计学意义(P>0.05);入院2周时观察组C-反应蛋白高于对照组(P<0.05)。随着入院时间的增加,两组血浆组织二胺氧化酶(DAO)浓度逐渐下降,每组内不同时间点的DAO比较,差异均有统计学意义(P<0.05);入院1周后,观察组DAO与对照组比较,差异无统计学意义(P>0.05);入院2周时观察组受试者DAO高于对照组,差异有统计学意义(P<0.05)。结论:使用免疫增强型肠内营养时能有效抑制严重感染休克老年患者体内的炎症反应,并可增加患者的免疫功能。     

Effect of Banxiaxiexin Tang on treatment of functional dyspepsia： a Meta-analysis of randomized controlled trials

OBJECTIVE： To evaluate the efficacy of Banxiaxiex- in Tang compared with Western Medicine in the treatment of functional dyspepsia （FD） through Meta-analysis. METHODS： Literature was searched in the following databases： MEDLINE, Excerpta Medica Database, Chinese Medical Current Contents, China Science and Technology Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. Randomized controlled trials evaluating the efficacy of Banxiaxiexin Tang for the treatment of FD were selected according to certain standards including clear general situation of pa- tients, specific diagnostic criteria, definite clinical outcomes, etc. Articles were evaluated with quality assessment standards in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted with RevMan 5.0.23 software. RESULTS： Ten articles with a total of 972 patients were included. The comparison of efficacy between Banxiaxiexin Tang and Western Medicine showed a combined effect size [OR=2.75, 95% CI （1.86-4.07）] and combined effect of value ofZ=5.07 （P〈0.000 01 ）, suggesting a significant difference between the groups. CONCLUSION： Banxiaxiexin Tang was more effec- tive than Western Medicine in treating FD.     

多发性硬化后阴痛1例

A female patient with vaginal pain induced by multiple sclerosis was treated by acupuncture. Her chief complaint: pricking vaginal pain during intercourse for 1 year. Electroacupuncture was applied to Shènshū (肾俞 BL23), Huìyáng (会阳 BL35), Cìliáo (次髎 BL32) and Zhōngliáo (中髎 BL33) on lumbosacral region. The disperse wave was adopted firstly, followed by the dense wave in stimulation. The stimulation intensity was determined by the patient's tolerance. The needles were retained for 50 min totally. After 2-month treatment, the sexual function of the patient was recovered to be normal. The sexual activity was normal in 1-year follow-up and vaginal pain was not recurred.     

利伐沙班用于股腘动脉粥样硬化闭塞支架植入术后的临床观察

  目的  研究利伐沙班在股腘动脉粥样硬化闭塞支架植入术后的疗效及安全性。  方法  将满足标准的87患者随机分为试验组45例和对照组42例，两组患者一般资料差异无统计学意义。试验组予利伐沙班片每次10 mg，po，qd和阿司匹林肠溶片每次100 mg，po，qd；对照组予阿司匹林肠溶片每次100 mg，po，qd，两组患者均予阿托伐他汀10 mg，po，qd和贝前列素钠40 μg，po，tid，嘱所有患者戒烟。观察随访术后当天、治疗后3个月和6个月两组患者ABI、跛行距离、支架再狭窄、支架附壁血栓形成以及二次干预率等相关疗效指标，并统计药物不良反应、不良心脑血管事件、轻度和严重出血情况等安全性指标，对随访观察的结果进行统计学分析。  结果  6个月时两组患者附壁血栓形成、ABI和跛行距离差异有统计学意义（P < 0.05），支架再狭窄差异无统计学意义（P > 0.05），两组患者二次干预率的Log-rank检验差异无统计学意义（P > 0.05），两组患者安全性对比无统计学意义（P > 0.05）。  结论  利伐沙班联合阿司匹林治疗明显的减少了支架内附壁血栓形成并延缓了术后ABI和跛行距离的下降趋势，可能对患者的长期预后有益。