自杀基因联合中医药疗法治疗肿瘤的设想

自杀基因疗法是一种具有良好应用前景的肿瘤治疗新措施。但如何有效提高疗效是目前仍须解决的关键性问题。由于免疫机制在自杀基因疗法旁杀伤效应中的重要作用，激活荷瘤机体的免疫功能，改善自杀基因抗肿瘤作用的炎症免疫微环境，是提高肿瘤自杀基因疗法疗效的主要策略。中医中药在调节机体免疫状态方面具有肯定的作用，与其他方法比较具有明显优势。因而，将自杀基因疗法与中医中药联合应用，有可能起到提高肿瘤自杀基因疗法疗效，防止肿瘤复发的作用。提出了自杀基因联合中医药疗法治疗肿瘤的新设想，为肿瘤基因治疗提供了一种新的思路和模式。     

进展期胃癌根治术后的辅助治疗

目的 介绍进展期胃癌根治术后的辅助治疗进展动态。方法 复习相关文献,作综合性报道。结果与结论 对胃癌根治患者有必要行全身静脉化疗,但方案要个体化;腹腔内温热灌注化疗是肯定、副作用较小的局 疗方法;淋巴化疗及免疫化疗有一定的临床效果,主射化疗是效疗的发展趋势。     

The use of pursed lips breathing in stable chronic obstructive pulmonary disease: a systematic review of the evidence

Abstract

Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable chronic obstructive pulmonary disease (COPD). Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management.

Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means.

Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to the grading of recommendations assessments, development and evaluation (GRADE) system; the remaining studies were of low quality. Although no high quality evidence was identified, the direction of effect for PLB was consistently towards benefit, with the exception of one low quality study. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate at rest and reduces time taken to recover to pre-exercise breathlessness levels. One RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB: those with moderate to severe COPD are most likely to benefit.

Conclusion: High quality studies are required to identify PLB responders from non-responders and to determine whether short-term effects translate into clinically significant benefit.     

What instruments have been used to assess the mobility of community-dwelling older adults?

Abstract

Background: The primary aim of this review was to identify existing instruments that have been used to assess the mobility status of community-dwelling older adults. The secondary aims were to identify instruments that have face validity for measuring across the full mobility spectrum and to summarise and compare their clinimetric properties.

Methods: MEDLINE, CINAHL, PEDro, and EMBASE were searched until April 2007. The first stage included searching for papers that reported mobility outcome measures that had been applied to healthy community-dwelling older adults. The second stage identified these outcome measures and the third stage compared clinimetric properties of the instruments that had face validity for measuring across the full mobility spectrum (from bed-bound to high levels of independent mobility). Two independent reviewers extracted data from the included studies.

Results: From the 128 included papers, 14 outcome measures were identified, two of which, the Lower Extremity Functional Scale (LEFS) and the Elderly Mobility Scale (EMS), measured across the full spectrum of mobility. No clinimetric evidence was found for the LEFS amongst a community-dwelling older population and only evidence of known groups validity was identified for the EMS.

Discussion: An outcome measure that has face validity for measuring across the full mobility spectrum and has sufficient clinimetric evidence in a community dwelling population was not identified.

Conclusion: This review supports the need for the development of such an instrument.     

类固醇药物鼻腔局部应用的研究进展

目的 回顾近年来类固醇药物鼻腔局部应用的基础与临床研究进展。方法 分析近年有关的文献２６篇。结果 鼻腔局部用类固醇药物对参与变应性鼻炎和鼻息肉的多种细胞和细胞因子都有广泛的抑制作用,临床应用能有效地改善症状,治疗剂量下即使长期应用也几乎没有或无全身副作用,鼻腔局部副作用极轻微或无。结论 鼻腔局部用类固醇药物治疗鼻炎（变应性和非变应性）和鼻息肉等鼻腔疾病有广泛的应用前景。     

Chronic Musculoskeletal Conditions

Abstract

Neural mobilization is a treatment modality used in relation to pathologies of the nervous system. It has been suggested that neural mobilization is an effective treatment modality, although support of this suggestion is primarily anecdotal. The purpose of this paper was to provide a systematic review of the literature pertaining to the therapeutic efficacy of neural mobilization. A search to identify randomized controlled trials investigating neural mobilization was conducted using the keywords neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy. The titles and abstracts of the papers identified were reviewed to select papers specifically detailing neural mobilization as a treatment modality. The PEDro scale, a systematic tool used to critique RCTs and grade methodological quality, was used to assess these trials. Methodological assessment allowed an analysis of research investigating therapeutic efficacy of neural mobilization. Ten randomized clinical trials (discussed in 11 retrieved articles) were identified that discussed the therapeutic effect of neural mobilization. This review highlights the lack in quantity and quality of the available research. Qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilization. Future research need store-examine the application of neural mobilization with use of more homogeneous study designs and pathologies; in addition, it should standardize the neural mobilization interventions used in the study.     

Randomised Controlled Trials on the Efficacy Of Spinal Manipulation Therapy in The Treatment of Low Back Pain

Abstract

Low back pain presents a major challenge to health care professionals within both primary and secondary care. Spinal manipulation therapy is one option from a range of treatment techniques which until recently has lacked credibility, in part due to a dearth of published, plausible explanations of the mechanisms through which it works. Such explanations are starting to emerge but rigorous evaluations of spinal manipulation therapy over other treatment modalities remain few in number. This paper builds on the review by Mohseni-Bandpei et al. (Mohseni-Bandpei MA, Stephenson R, Richardson B. Spinal manipulation in the treatment of low back pain: a review of the literature with particular emphasis on randomised controlled trials. Phys Ther Rev 1998; 3:185–94), by reviewing literature in particular randomised controlled trials published in the field since that date. It is concluded that the efficacy of manipulation for patients with acute or chronic low back pain remains unconvincing and that the literature remains blighted by inconsistency of definitions of interventions and by methodological flaws.     

Cervical musculoskeletal impairments in cervicogenic headache: a systematic review and a meta-analysis

Abstract

The differential diagnosis of cervicogenic headache (CEH) requires the presence of a pattern of symptoms and cervical musculoskeletal signs that distinguishes it from other types of headaches. The investigation of cervical musculoskeletal impairments (CMI) can help in the diagnosis and treatment of the CEH. In order to assess the evidence concerning CMI in CEH subjects, a systematic review and a meta-analysis was performed. Several electronic databases were searched. A checklist was used to identify suitable articles and a methodological scale was used to analyse their quality. Ten articles met the inclusion criteria. Based on our meta-analysis, patients with CEH have altered range of motion in rotation, flexion-extension, cervical rotation with cervical flexion, altered cervical flexor strength, and altered cervical flexor endurance. More controlled studies investigating the cervical impairments in CEH, with a clear history of patients, and greater sample sizes, are necessary.     

Does transcutaneous electrical nerve stimulation (TENS) produce 'dose-responses'? A review of systematic reviews on chronic pain

Abstract

Background: This review aimed to examine existing systematic reviews regarding the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) in reducing pain in patients with chronic pain conditions.

Methods: Data concerning the methods and conclusions of the reviews and individual trials were extracted. The data from the individual trials were subcategorised according to the validity of outcome measures, methodological quality, sample size, and 'dose response' (if any) of TENS.

Results: Two of the six reviews concerning TENS and chronic pain reported that high intensity TENS applications were more effective compared to placebo than low intensity applications. However, the reviews and the authors' conclusions were based on a total of eight high quality trials which reported positive findings on a visual analogue scale or numeric rating scale which measured pain relief/intensity.

Discussion: Data from chronic pain trials that use these outcome measures show that any dose-related responses of TENS cannot be conclusively demonstrated as a result of the number of confounding variables (e.g. inadequate design, low statistical power and the many differences in TENS protocols such as repeated versus single treatments).

Conclusion: To address these issues, recommendations are made for future systematic reviews and randomised controlled trials. Such recommendations include the need for more comprehensive and rigorous tools in assessing substantive trials within systematic reviews.     

Physical Therapy Exercise Intervention Based on Classification Using the Patient Response Method: A Systematic Review of the Literature

Abstract

It has been suggested that inclusion into a study that categorizes patients in mutually exclusive, clinometric classifications should improve the outcome of an exercise based randomized clinical trial. This review examined the evidence regarding the effectiveness of physical therapist-directed therapeutic exercises when patients were classified using the patient response method. This systematic literature review restricted article inclusion to English-only articles that classified homogenous samples of low back pain patients using the patient response based method, demonstrated physical therapist-directed exercise interventions, and used specific outcome criteria for assessment of patient improvement. The PEDro scale was used to rate the methodological quality of the studies. Of 82 articles reviewed only 5 articles were accepted. All 5 met the PEDro standards for a high-quality study. Of the 5 articles, 4 demonstrated that physical therapy exercise intervention based on the patient response method of classification were significantly better than the pragmatic control comparisons; the remaining article indicated that exercise was less effective than manipulation. There appears to be a trend toward positive outcomes with physical therapy exercise intervention in trials restricted to the patient response method of classification; however, few studies have investigated this phenomenon.