苦碟子注射液治疗缺血性中风急性期上市后再评价

目的:评价苦碟子注射液对缺血性中风急性期患者影响的有效性和安全性。方法:采用实用性随机对照试验,通过中央随机系统,将700例缺血性中风患者随机分为试验组346例、对照组354例。试验组给予苦碟子注射液的基础上加用西医内科基础治疗和中医康复技术,对照组给予西医内科基础治疗加用现代康复技术,疗程为10～21 d,在第7,14,21天3个时间点上观察患者的神经功能缺损(NIHSS评分)和肢体运动功能(FMI评分)。同时观察2组不良事件发生率及治疗前后实验室检查指标。结果:应用广义估计方程模型,发现随着治疗时间的延长,2组NIHSS评分及FMI评分均呈改善趋势,且治疗第14天和第21天NIHSS和FMI评分试验组较对照组相比,具有显著统计学差异(P<0.05)。试验组未发生与苦碟子注射液相关的不良事件。结论:苦碟子注射液对缺血性中风患者的神经功能缺损及肢体运动功能有一定的改善作用。苦碟子注射液在治疗缺血性中风早期康复方面是安全有效的。     

Does follicular flushing increase oocyte number in poor responders? An update of a systematic review

Research questionDoes flushing of the follicles at ovum retrieval increase the number of retrieved oocytes in poor-response IVF patients?DesignAn update of an electronic literature search was performed to identify randomized controlled trials (RCT) investigating follicular flushing versus no flushing in women with a poor response to IVF treatment. No exclusion criteria for type of needle, stimulation or protocol were applied. A meta-analysis was conducted using the software RevMan 5.4.ResultsSix RCT were identified that had the primary objective of testing for an increase in mean number of cumulus–oocyte complexes or/and metaphase II oocytes between flushing and no flushing. A double-lumen needle was used in five trials, one study investigated a pseudo-double-lumen needle, and a conventional single-lumen needle was used in all the control groups. The main risk of bias in all the included studies is a lack of blinding of the physicians performing the puncture and incomplete data in four trials. A heterogeneity of direction and size of effect of follicular flushing on mean oocyte number retrieved was detected (I² = 80, P = 0.0001), which precludes a synthesis of the data. Two studies showed a decrease or tendency towards a decrease in oocyte numbers, one study showed similar oocyte numbers, and one study showed a strong tendency towards increased oocyte numbers with flushing. A similar picture was seen for metaphase II oocytes (I² = 73, P = 0.002).ConclusionsIt is uncertain whether follicular flushing in poor-response IVF patients affects the number of retrieved oocytes. Larger pragmatic trials are warranted to clarify the effect of flushing on oocyte numbers and clinical outcomes in poor responders and monofollicular patients.     

胰腺部分切除术所致高血糖对肠道菌群的影响及可能机制探讨

背景　随着近年来肠道菌群测序技术的迅速发展,越来越多的疾病被发现与肠道菌群存在密切关系。糖尿病作为威胁人类健康的一大疾病,其与肠道菌群的关系受到广泛关注。目的　探讨血糖升高后肠道菌群的变化及可能机制。方法　将40只雄性SD大鼠采用简单随机化分组法分为正常组（n=10,A组）、假手术组（n=10,B组,只开腹切除脾脏）、实验组（n=10,C组,开腹切除脾脏及部分胰腺）和实验+干预组〔n=10,D组,在C组基础上,术后1周开始给予胰岛素干预（甘精胰岛素注射液,0.1 U/kg,1次/d）〕。术后1、4周四组大鼠行口服葡萄糖耐量试验（OGTT）,观察各组大鼠血糖变化。术后4周处死大鼠,留取回肠组织,观察肠道组织形态变化并行免疫组化测定各组核因子（NF）-κB p65表达变化〔以平均光密度值（AOD值）表示〕;留取粪便并使用测序平台Illumina MiSeq PE300对肠道菌群的16S rRNA V3~V4可变区进行测序,并分析四组大鼠肠道菌群的变化。结果　胰腺部分切除术成功复制较为稳定的高血糖大鼠模型。显微镜下C组回肠肠道黏膜层、黏膜下层、肌层均可见棕色深染,C组AOD值高于A、B组（P<0.001）。各组肠道菌群在门水平的相对分布情况存在差异,与A、B组比较,C组和D组厚壁菌门丰度降低,而拟杆菌数目和变形杆菌丰度增加。α多样性稀释曲线显示,按物种丰富程度从低到高排序依次为：A组相似文献   

Dural plasmacytoma as the initial presentation of multiple myeloma: A case report and review of the literature

Dural plasmacytoma is a type of multiple myeloma of the central nervous system. Our patient presented with symptoms of headache. Imaging findings suspected glioblastoma, whereas pathological findings revealed mucosa-associated lymphoid tissue lymphoma associating with plasma cell differentiation. Further in-depth studies confirmed a diagnosis of dural plasmacytoma. This case indicates that morphological variations may occur in the extramedullary involvement of CD20-positive multiple myeloma. The multidisciplinary team contributes to the diagnosis of hematological diseases.     

Development of patient versions of guidelines in Chinese mainland: A systematic survey of current practices and methods

ObjectivesTo review current practices and methods underlying the development of patient versions of guidelines (PVGs) in Chinese mainland.MethodsWe systematically searched for PVGs created or published between January 2010 and February 2022. We conducted a framework analysis for the development process and assessed the compliance of PVGs using the Reporting Checklist for Public Versions of Guidelines (RIGHT-PVG).ResultsWe identified 26 PVGs developed by 16 PVG-working teams. In accordance with the Guidelines International Network (GIN), only two PVGs were translated using one clinical practice guideline (CPG) provided by the CPG-working group source. Several CPGs and other information sources were integrated and translated into a single PVG by other PVG teams. Moreover, we identified various practices described by different PVG teams that could be structured into six steps. Out of the 17 RIGHT-PVG items, five items were fully reported in all PVGs, while two items (“Provide a summary of the PVG” and “Provide a list of terms and abbreviations”) were not reported in any of the PVGs.Conclusions and practical implicationsA relatively small number of PVGs were developed in Chinese mainland. The development of a PVG requires comprehensive methodological guidance based on several CPGs and other sources of information as opposed to only using one.     

DNA甲基化在肺癌诊疗中的应用价值

DNA甲基化是基因遗传信息改变的最重要因素,是表观遗传学的主要内容之一。DNA甲基化被认为是肿瘤形成的重要分子机制,是近年来肿瘤分子病因学的研究热点。研究发现DNA甲基化与肺癌的发生、发展密切相关。深入研究甲基化在肺癌进程中的作用机制,将为肺癌的诊断、治疗及预后提供新依据、新策略。该文就目前DNA甲基化在肺癌中的研究及应用进展予以综述。     

关于大学生处理校园突发事件以及人身安全预防知识的调查

目的：根据调查分析的结果,了解大学生应对校园突发事件的现状以及人身安全预防知识的掌握程度,对大学生采取切实可行的培养方案,提高其应对突发事件的能力。方法：采取调查问卷形式,在山西大学、太原理工大学、中北大学、山西医科大学四所高校进行随机调查并记录所得数据;再以地震及预防意外事件为例,将四所高校的数据用EXCEL绘制成柱状图,判断当代大学生处理突发事件以及对人身安全预防知识的掌握程度是否属于普遍性;然后将四所高校所得数据进行比较,得出其中应对突发事件表现最佳的高校,并分析其优势原因;最后进行数据归纳整理,分析当代大学生应对校园突发事件的现状以及人身安全预防知识的掌握程度。结果：分析发现,四所高校大学生整体应对突发事件的能力岌岌可危,对人身安全预防知识的掌握程度更是令人担忧,其中山西医科大学的学生在应对突发事件以及对人身安全预防知识掌握的程度最佳。结论：当代大学生处理校园突发事件的能力以及对安全知识的理解程度欠佳,安全教育程度与其学校学生处理突发事件以及对人身安全预防知识的掌握程度成正比。     

青壮年股骨颈骨折治疗后的临床观察

目的探索青壮年股骨颈骨折的有效治疗方法。方法对本院60例股骨颈骨折患者进行随访,其中空心加压螺纹钉25例;加压空心钉固定加肌蒂髂骨瓣移植35例,术后均进行康复训练。结果 44例完全康复,12恢复良好,1例再次手术。结论青壮年股骨颈骨折手术方式的选择及术后的康复措施极为重要。     

非杓型心率与心脑血管疾病

由于心率是一项易于监测的生命体征,通过对心率节律变化的规律性以及该变化过程中的各种影响因素的提取和分析,提出了杓型、非杓型和反杓型心率的分类。该分类可以更深入了解心律的变化与心脑血管疾病发生以及预后的相关性,从而对进一步指导临床工作者更好地预防心脑血管疾病,以及帮助进一步制订合理的诊疗方案有一定的意义。