醒脑静注射液治疗缺血性中风急性期随机对照试验的系统评价

目的 系统评价醒脑静注射液治疗缺血性中风急性期的疗效及安全性。方法 集醒脑静注射液治疗缺血性中风急性期随机对照试验文献，筛选合格研究，应用Jadad评分法进行质量评价，运用异质性检验、Meta-分析、漏斗图分析、敏感性分析等方法统计相关数据。结果 项研究符合纳入标准，Jadad评分所有研究得分均低于3分，属低质量文献。Meta-分析结果显示，总有效率比较的相对危险度（RR值）=1．04，99％的可信区间（CI值）为（0．88，1．23）。结论 前尚无充分证据证实醒脑静注射液治疗缺血性中风急性期的疗效及安全性。要进一步验证醒脑静注射液治疗缺血性中风急性期的疗效及安全性，尚需进行设计合理、执行严格、多中心大样本且随访时间足够的随机对照试验。     

变应性鼻炎、哮喘患者血白细胞介素的循证医学研究

目的 评价变应性鼻炎、哮喘患者血清中白细胞介素IL-4、IL-6、IL-8检测指标的意义。方法 检索策略:通过中国生物医学文献数据库(CBMdisc)、中文全文数据库全面检索国内已发表的相关文献。选择标准:中国成人变应性鼻炎、哮喘患者与对照组血清白细胞介素IL-4、IL-6、IL-8水平检测。资料收集和分析:由2位评价者按照上述检索策略收集文献。排除那些不符合选择标准要求的试验。结果 经Meta分析,发作期、缓解期变应性鼻炎患者血清中IL-4水平分别较对照组上升129.45 ng/mL(95％CI 124.95～133.96)、35.00 ng/mL(95％CI 32.01～39.78),有显著统计学意义(P<0.000 01):缓解期IL-6水平较对照组上升21.87 ng/mL(95％CI 19.83～23.91),有显著统计学意义(P<0.000 01);发作期、缓解期IL-8水平分别较对照组上升41.75 ng/mL(95％CI 29.14-54.36)、98.94 ng/mL(95％CI 96.48-101.41),有显著统计学意义(P<0.000 01);发作期IL-4水平较缓解期上升129.99 ng/mL(95％CI 125.00～134.99),有显著统计学意义(P<0.000 01)。结论 IL-4、IL-6和IL-8参与了变应性鼻炎、哮喘的发生和促进了变态反应性疾病的发展,有必要开展更广泛研究和更深层的原因探索。     

Symptoms, diagnosis and endoscopic management of common bile duct stones

Symptomatic BDS commonly cause significant morbidity and attempt at stone removal should be attempted if possible. Complications of CBDS include biliary colic, jaundice, cholangitis and pancreatitis. Investigations aimed to predict the presence of stones within the bile duct include serum bilirubin, AST, ALP, common bile duct diameter and age as independent predictors of choledocholithiasis. TUS is a sensitive test in detecting bile duct dilatation but the sensitivity is reduced in its ability to detect choledocholithiasis. A NIH consensus statement found that ERC, MRC and EUS were comparable in their sensitivities, specificities and accuracy rates for detection of choledocholithiasis. ERC and stone removal using a balloon or basket is often performed following EST. EBD may be performed if patients have uncorrected coagulopathies but the risk of pancreatitis is higher than for EST (although the risk of bleeding complications is lower for EBD). ML is often required in difficult to remove CBDS and using this device, CBDS can be removed in 90–95% of cases. Other forms of lithotripsy including laser lithotripsy and EHL are confined to specialised centres and the evidence for their use is based on small studies. ESWL may clear stones from the bile duct in up to 93% of patients but frequently ERC and stone fragment removal is required post ESWL. The role of medical therapy in difficult to remove CBDS (or in CBDS in patients with severe co-morbid illness preventing ERC + stone removal) is still currently uncertain due to a lack of large randomised control trials.     

Radiofrequency Procedures

Abstract:   Radiofrequency is a minimally invasive, target-selective technique that has been in clinical use for more than 25 years and has demonstrated success at reducing pain in several chronic pain conditions, including trigeminal neuralgia, chronic low back pain, postherpetic neuralgia, and complex regional pain syndrome. However, the success of radiofrequency in chronic pain has not been adequately reproduced in good-quality, randomized controlled trials, and its use in the management of neuropathic pain is under some debate. In addition, conventional radiofrequency occasionally leads to worsening and even new onset of neuropathic pain. Nevertheless, clinical experience suggests that radiofrequency may be a useful tool in the overall management of refractory neuropathic pain. Pulsed radiofrequency in particular is a minimally destructive procedure that may offer new opportunities and a broader perspective for therapy with radiofrequency.     

CD4+CD25+ regulatory T cells: I. Phenotype and physiology

The immune system protects us against foreign pathogens. However, if fine discrimination between self and non-self is not carried out properly, immunological attacks against self may be launched leading to autoimmune diseases, estimated to afflict up to 5% of the population. During the last decade it has become increasingly clear that regulatory CD4⁺CD25⁺ T cells (T_reg cells) play an important role in the maintenance of immunological self-tolerance, and that this cell subset exerts its function by suppressing the proliferation or function of autoreactive T cells. Based on human and murine observations, this review presents a characterization of the phenotype and functions of the Treg cells in vitro and in vivo . An overview of the surface molecules associated with and the cytokines produced by the Treg cells is given and the origin, activation requirements and mode of action of the Treg cells are discussed. Finally, we address the possibility that Treg cells may play a central role in immune homeostasis, regulating not only autoimmune responses, but also immune responses toward foreign antigens.     

Polydrug use (the use of drugs in combination): A brief review

This brief review provides an overview of this topic; it is not a critical review. Polydrug use is a poorly defined concept; it is taken here to mean the simultaneous use of more than one drug. Data on polydrug use is seldom systematically collected, and the use of alcohol and tobacco in combination with illegal drugs is frequently overlooked. If alcohol and tobacco are included, most users are polydrug users, since these drugs are used by most users of illegal drugs, and many people with alcohol problems also use illegal drugs. Polydrug use has increased; drug availability, cultural context and the 'normalization' of drug use are important factors. Gender and racial differences are observed in the prevalence of polydrug use. Implications for drug prevention include the importance of targeting multiple substance use rather than single substances. Aiming prevention campaigns at younger people and focusing on 'gateway' drugs might be more effective. But polydrug users are diverse, and a variety of strategies (aimed at different types of polydrug users) are necessary. Implications for treatment include the evidence of the greater difficulty that polydrug users have in quitting; they may therefore require additional help. A fuller, systematic, review is required; it is expected that this would recommend the commissioning of additional research on this poorly understood phenomenon.     

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence Part 2: Long-term outcome

OBJECTIVE: We reviewed recent literature to assess the impact of hospital caseload, surgeon's caseload and education on long-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant literature starting from 1992. We selected hospital caseload, surgeon's caseload and surgeon's education, type of hospital, and surgeon's experience as variables of interest. Measures of outcome were recurrence-free survival and overall survival, and for rectal cancer frequency of permanent stoma. We reviewed the 34 studies according to tumour location: colonic cancer, rectal cancer, or colorectal cancer. We described the studies individually and performed a meta-analysis whenever it was considered appropriate. RESULTS: For colonic cancer, overall survival improved with increasing hospital caseload, odds ratio (OR) 1.22 [95% confidence interval (CI) 1.16-1.28], and surgeon's education. For rectal cancer, overall survival improved with increasing hospital caseload, OR 1.38 (95% CI 1.19-1.60), and, possibly by surgeon' education and experience. Cancer-free survival was strongly influenced by surgeon's education. The colostomy rate was less in high caseload hospitals, OR 0.76 (95% CI 0.68-0.85). For colorectal cancer, overall survival improved with surgeon's education. CONCLUSION: The data have provided evidence that long-term survival following colorectal cancer surgery in general improved significantly with increasing hospital caseload and surgeon's education.     

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome

OBJECTIVE: An association between caseload and outcome has been reported for complex surgical procedures. We systematically reviewed recent literature to determine whether caseload and surgical speciality are associated with short-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant publications starting in 1992. We selected hospital caseload and type, and surgeon's caseload, education and experience as variables of interest. Measures of outcome were postoperative morbidity, in-hospital and 30-day mortality, and for rectal cancer anastomotic leak. We stratified the 35 reviewed studies by tumor location: colonic cancer, rectal cancer, or colorectal cancer and described the studies individually. A meta-analysis was performed only when it was considered appropriate. RESULTS: For colonic cancer, postoperative morbidity was associated with surgeon's caseload and education. Postoperative mortality was strongly associated with hospital caseload (OR 0.64, 95% CI 0.55-0.73), and surgeon's caseload (OR 0.50, 95% CI 0.39-0.64). It was also influenced by surgeon's education and experience. For rectal cancer, we found no evidence of an association between the selected variables and short-term outcome, including frequency of anastomotic leak. For colorectal cancer, there was evidence for an association between postoperative morbidity and hospital caseload. CONCLUSION: Our review offers evidence for a positive association between high hospital caseload, surgeon's caseload, sub-speciality and experience and improved short-term outcome in colonic cancer surgery. We failed to find evidence of a relationship for rectal cancer surgery, possibly owing to methodological artifacts. No study reported an inverse relation.