中药周期治疗复发性外阴阴道假丝酵母菌病的临床研究

【目的】观察中药周期疗法对复发性外阴阴道假丝酵母菌病（RVVC）的远期疗效及对阴道局部免疫功能的影响。【方法】将100例RVVC患者随机分为中西医结合治疗组（治疗组）和对照组各50例。两组患者均根据敏感药物进行强化治疗及巩固治疗6个月,治疗组在巩固治疗初期加用中药周期疗法2个月,观察远期疗效及对阴道局部免疫功能的影响。【结果】100例中共有86例完成随访,其中治疗组42例、对照组44例,随访率为86％。随访时间13～32个月。治疗组和对照组复发率分别为35．7％（15／42）、65．9％（29／44）,两组比较差异有显著性意义（P〈0．05）。治疗组和对照组平均复发时间分别为（8．2±3．7）个月、（2．6±2．2）个月,两组比较差异有显著性意义（P〈0．05）。治疗组患者阴道灌洗液干扰素－γ（IFN－γ）水平显著降低（与治疗前比较,P〈0．05）,但对照组IFN－γ及两组白细胞介素4（IL-4）水平治疗前后比较差异无显著性意义（P〉0．05）。【结论】中药周期疗法能显著改善RVVC患者阴道局部的细胞免疫功能,降低复发率并延长复发时间,从而提高RVVC的远期疗效。     

Role and Evaluation of Palliative Home Care Services

Abstract

Evidence-based practice (EBP) first evolved within medicine in the early 1990s, and has since influenced nearly every clinical discipline. Despite differing definitions, its central tenet remains the appropriate integration of relevant best practice (usually based on published research findings when available) into clinical practice. EBP has also attracted criticisms; but, notwithstanding these, there are many reasons why healthcare professionals need to have an understanding of EBP as it now stands, ranging from its potential to contribute to improved clinical outcomes, through to participation in the further development and refinement of EBP. Minimally, clinicians should be aware of, understand, and be able to find EBP resources that provide access to research already appraised for both its quality and relevance. More extensive EBP skills remain highly desirable, and might be viewed as essential skills for life-long learning regardless of EBP.     

Amputees and Tightropes: A Pilot Study to Measure Postural Control Post-Amputation

Abstract

It is widely accepted that postural instability increases with age, making falls and subsequent injury likely. Amputees have been identified as having a higher risk of falling than comparable non-amputees. A few laboratory studies have examined postural changes post-amputation, but no clinical study has been identified. This pilot study tested whether clinical balance tools used with elderly populations could be used to measure postural changes in recent transtibial amputees. Seven subjects were tested during their initial rehabilitation, using the Berg balance scale, the 'timed up and go' (TUG) test and Tinetti's Falls Efficacy Scale (FES). Any falls or near misses were also recorded. The TUG test and FES showed changes over time. The Berg scale showed a possible floor and ceiling effect. Patients did experience falls during the study time. Larger studies are needed to determine whether these are appropriate clinical tools for use with amputees.     

Activation of the Canonical Wnt Signaling Pathway Induces Cementum Regeneration

Canonical Wnt signaling is important in tooth development but it is unclear whether it can induce cementogenesis and promote the regeneration of periodontal tissues lost because of disease. Therefore, the aim of this study is to investigate the influence of canonical Wnt signaling enhancers on human periodontal ligament cell (hPDLCs) cementogenic differentiation in vitro and cementum repair in a rat periodontal defect model. Canonical Wnt signaling was induced by (1) local injection of lithium chloride; (2) local injection of sclerostin antibody; and (3) local injection of a lentiviral construct overexpressing β‐catenin. The results showed that the local activation of canonical Wnt signaling resulted in significant new cellular cementum deposition and the formation of well‐organized periodontal ligament fibers, which was absent in the control group. In vitro experiments using hPDLCs showed that the Wnt signaling pathway activators significantly increased mineralization, alkaline phosphatase (ALP) activity, and gene and protein expression of the bone and cementum markers osteocalcin (OCN), osteopontin (OPN), cementum protein 1 (CEMP1), and cementum attachment protein (CAP). Our results show that the activation of the canonical Wnt signaling pathway can induce in vivo cementum regeneration and in vitro cementogenic differentiation of hPDLCs. © 2014 American Society for Bone and Mineral Research © 2015 American Society for Bone and Mineral Research     

酪酸梭茵、双歧杆菌二联活菌散联合蓝光照射治疗新生儿黄疸38例临床观察

目的观察酪酸梭菌、双歧杆菌二联活菌散（常乐康）联合蓝光照射治疗新生儿黄疸的临床效果。方法将114例新生儿黄疸患儿按随机数字表法分为单纯蓝光照射组（蓝光组）、单纯常乐康治疗组（常乐康组）和常乐康联合蓝光照射治疗组（联合组）,每组各38例,疗程5～7d。观察各组患）Ltl~床症状变化及血清总胆红素变化。结果治疗前各组间血清Tbil差异无统计学意义（均P〉0．05）;治疗后各组血清Tbil均呈下降趋势,治疗5d后蓝光组和常乐康组问Tbil无统计学差异f（182．45±18．56）VS（183．45±18．65）,仁一0．948,P〉0．05],而联合组与蓝光组和常乐康组相比有统计学差异『（156．34±14．78）VS（182．45±18．56）,（156．34±14．78）VS（183．45±18．65）,t值分别为6．324及7．226,均P〈0．05]。联合组（3．86±1．33）血清Thil降至正常所需天数较蓝光组（5．82±1．65）和常乐康组（5．78±1．62）明显缩短,差异有统计学意义（t值分别为9．107及8．924,均P〈0．05）。治疗后联合组总有效率明显高于蓝光组和常乐康组,差异有统计学意义（94．74％vs71．05％,94．74％VS73．68％,x‘=11．586,P=0．021）。结论酪酸梭菌、双歧杆菌二联活菌散联合蓝光照射治疗新生儿黄疸效果优于单用蓝光照射,值得推广应用。     

醒脑开窍针法治疗中风的Meta分析

【目的】运用循证医学的方法,对醒脑开窍针法治疗中风的临床疗效及安全性进行系统评价和Meta分析。【方法】全面收集醒脑开窍针法治疗中风的临床试验资料,在严格质量评价的基础上,利用RevMan4．1软件对多个研究结果的总体效应进行随机效应模型的Meta分析,并进行分层分析、异质性评价和敏感性分析;用漏斗图分析发表性偏倚。【结果】醒脑开窍针法治疗(痊显率)效应值伽=3．65,95％可信区间为[1．70,7．83];降低远期病死率效应值OR=0．21,95％可信区间为[0．08,0．52];分层分析结果显示,中风后遗症期治疗效应值OR=4．01,脑梗塞治疗效应值OR=4．45;漏斗图图形不对称;本研究所纳入的文献均未发现不良反应的报道。【结论】醒脑开窍针法治疗中风有一定疗效,对脑梗塞、尤其是脑梗塞急性期有较确切的疗效,并可降低中风患者的远期病死率。通过异质性评价与敏感性分析发现异质性的原因可能是试验设计类型不同和纳入标准不同。漏斗图提示存在发表性偏倚。现有的研究结论尚有一定局限性,欲得出公认的结论,还有待进行多中心、随机对照的临床试验。     

近代中医史述评(1840—1949年)

本文通过对近代医史文献资料的整理研究,综述评价了近代中医史发展历程。认为近代是中国医学发生重大变革的时期,中医沿着自《内经》以来建立的理论体系继续前进并取得一定成就。如提出中西汇通及中医科学化的口号,组织学会,出版刊物,创办学校,进行抗争,这是近代中医史有别于古代中医史的地方,为近百年来中医学发展的重要标志。     

《内经》直觉思维探析

《内经》直觉思维是以直观物象、提取意象为基础,推衍被研究对象属性及其规律的思维形式,有取象比类和运数比类两种模式。它不同于科学抽象,是从器物之象体道,超验地把握最高的宇宙真理,并推衍及于人体,因而是《内经》的主要认知形式。把握这一思维形式,对于探索《内经》教学规律、掌握中医理论研究的发展趋势、提高中医临床疗效都具有重要的指导意义。     

中医药治疗中风研究文献的质量评价

目的：对中风的中医药临床治疗性文献进行科研设计质量的分析。方法：按照临床流行病学／ＤＭＥ原则,制订《中风医药临床研究文献评价表》,经测试其重复性较好（主要条目Ｋａｐｐａ值为０．４６－０．４８,中度）;用其对１９９２－１９９６年的中风中医药临床临床治疗性文献进行评价。结果：２８．４％的研究采用了随机对照方法,但随机的质量和可信度较差;盲法极少被采用;     

Hospital Work and Pregnancy Outcomes: A Study in the Danish National Birth Cohort

Abstract

In hospitals, women of reproductive age do a range of work tasks, some of which are known to carry potential risks. Tasks such as working with radiation, chemicals, and infectious agents, as well as performing heavy lifting or tasks requiring erratic sleep patterns have been reported to increase the risk of reproductive failures. Our aim was to study pregnancy outcomes in female hospital workers in Denmark. We performed a cohort study of 5976 female hospital workers and used as a reference group 60,890 women employed outside of hospitals. The reproductive health of hospital workers working during pregnancy is comparable to those of non-hospital workers for the majority of reproductive failures studied. However, an increased prevalence of congenital abnormalities was noted in some subgroups of hospital workers, which may indicate that some hospital work still entails fetotoxic hazards.