通滞苏润江胶囊联合塞来昔布治疗类风湿性关节炎的临床研究

目的 探讨通滞苏润江胶囊联合塞来昔布治疗类风湿性关节炎的临床疗效。方法 选取2018年2月-2020年2月在河南省洛阳正骨医院（河南省骨科医院）就诊的86例类风湿性关节炎患者,随机分为对照组和治疗组,每组各43例。对照组口服塞来昔布胶囊,0.2 g/次,2次/d;治疗组在对照组治疗基础上口服通滞苏润江胶囊,7粒/次,2次/d。两组均经8周治疗。观察两组的临床疗效,比较两组临床症状缓解时间、相关评分和血清学因子的情况。结果 经治疗,治疗组的总有效率是97.67%明显高于对照组81.40%（P<0.05）。经治疗,治疗组晨僵、关节压痛、屈伸不利、关节肿胀、关节发热症状缓解时间均显著短于对照组（P<0.05）。经治疗,两组HAQ指数、DAS28评分、VAS评分均较治疗前显著降低（P<0.05）;治疗后,治疗组HAQ指数、DAS28评分、VAS评分显著低于对照组（P<0.05）。经治疗,两组血清类风湿因子（RF）、抗环瓜氨酸抗体（ACCP）、白细胞介素-1β（IL-1β）、白细胞介素-17（IL-17）、白细胞介素-37（IL-37）水平均显著降低,但骨保护素（OPG）显著升高（P<0.05）;治疗后,治疗组RF、ACCP、IL-1β、IL-17、IL-37水平显著低于对照组,而OPG高于对照组（P<0.05）。结论 通滞苏润江胶囊联合塞来昔布治疗类风湿性关节炎具有较好的临床疗效,可显著改善患者相关症状和细胞因子水平,具有一定的临床推广应用价值。     

Overuse of Compression Ultrasound for Patients with Lower Extremity Cellulitis

Background

Compression ultrasound (CUS) is often ordered in hospitalized patients with cellulitis to assess for deep vein thrombosis (DVT). Despite this common practice, the rate of use and utility of CUS has not been well described.

Methods

We conducted a retrospective cohort study of adult patients with lower extremity cellulitis hospitalized between October 1, 2008 and September 30, 2013 at an academic medical center. Cases meeting inclusion criteria were reviewed for the use of CUS, the indication for CUS, the occurrence of DVT, and the 3 month follow-up occurrence of DVT after discharge.

Results

A total of 239 patients were identified using ICD-9 coding data with a discharge diagnosis of cellulitis or abscess of leg. Of these, 183 met criteria for inclusion in the study, 133 of whom had CUS to assess for DVT (73%). Of the 133 who received CUS, 11 studies found DVTs (8%). Of the 11 DVTs, 8 had been previously diagnosed, and 3 were new. Of the new DVTs, only one was ipsilateral to the leg with cellulitis.

Conclusion

Most patients admitted with lower extremity cellulitis received CUS to assess for DVT. Despite this common practice, the rate of acute ipsilateral DVT was low and matched the rate of acute contralateral DVT. Previously diagnosed DVTs were commonly re-imaged. Overall the use of CUS had minimal impact on patient management and the routine use of CUS to assess for DVT in hospitalized patients with cellulitis appears to be unnecessary.     

The Top 10 Pulmonary Pearls for Primary Care Physicians

Pulmonary diseases are commonly encountered by primary care physicians in the outpatient setting. Despite their prevalence, many physicians may be unfamiliar with the diagnosis and appropriate management of these disorders. The evidence-based pearls in this article will help primary care physicians navigate important topics in pulmonary medicine and guide their decision to refer their patients to a pulmonary specialist.     

Systematic Analysis Underlying the Quality of the Scientific Evidence and Conflicts of Interest in Interventional Medicine Subspecialty Guidelines

ObjectiveTo determine the validity of guidelines published by interventional medical societies.MethodsWe reviewed the interventional medicine subspecialty society websites of the American Association for Bronchology and Interventional Pulmonology (AABIP), American Society of Diagnostic and Interventional Nephrology (ASDIN), American Society for Gastrointestinal Endoscopy (ASGE), and Society for Cardiovascular Angiography and Interventions (SCAI) as of November 15, 2012, for published interventional guidelines. The study was performed between November 15, 2012, and January 1, 2013. The AABIP did not publish guidelines, so American Thoracic Society and American College of Chest Physicians guidelines were reviewed. All the guidelines were reviewed for graded levels of evidence, methods used to grade the evidence, and disclosures of conflicts of interest (COIs).ResultsOf 153 interventional guidelines evaluated, 4 were duplicates. Forty-six percent of guidelines (69 of 149) graded the quality of evidence using 7 different methods. The ASGE graded 71% of guidelines (46 of 65) compared with 29% (23 of 78) by the SCAI and 0 by the ASDIN (n=4) and the pulmonary societies (n=2). Of the 3425 recommendations reviewed, 11% (n=364) were supported by level A, 42% (n=1432) by level B, and 48% (n=1629) by level C. The mean age of the guidelines was 5.2 years. Additionally, 62% of the guidelines (92 of 149) failed to comment on COIs; when disclosed, 91% of guidelines (52 of 57) reported COIs. In total, 1827 COIs were reported by 45% of the authors (317 of 697), averaging 5.8 COIs per author.ConclusionMost of the interventional guidelines failed to grade the evidence. When present, most guidelines used lower-quality evidence. Furthermore, most guidelines failed to disclose COIs. When commented on, numerous COIs were present. Future guidelines should clearly state the quality of evidence, use a standard grading system, be transparent regarding potential biases, and provide frequent updates.     

天津市和平区小白楼街人口老龄化及危险因素改变对心脑血管病死亡率的影响

目的对影响小白楼街心脑血管病死亡率的人口老龄化及危险因素进行定量分析。正确评价危险因素对心脑血管死亡率变化的影响。方法对该街2000—2005年的心脑血管病死亡率变化进行分析,定量计算人口老龄化及危险因素对心脑血管病死亡率变化的作用。结果2005年心脑血管病死亡率(46.32/万)较2000年(42.28/万)上升了9.56%,其中归因于人口老龄化的因素占236.63%,危险因素效应使死亡率下降了13.06%。结论人口老龄化与危险因素对心脑血管病死亡率的影响作用是不一样的,人口老龄化的影响大于危险因素。     

Chronic cough: Stepwise application in primary care practice of the ACCP guidelines for diagnosis and management of cough

Purpose: To illustrate decision points encountered when using evidence-based guidelines for diagnosis and management of chronic cough by means of a composite case study based on primary care practice.
Data source: The American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines for Diagnosis and Management of Cough, and review of the scientific literature on cough and related topics.
Conclusions: The ACCP guidelines offer a systematic approach that uses trials of empirical therapies to diagnose and resolve the very common, often perplexing complaint of chronic cough. The major diagnoses reached are upper airway cough syndrome, cough-variant asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis.
Implications for practice: Cough is the most common reason that patients seek an office visit. Many coughs resolve spontaneously, but coughs that persist significantly impair the quality of life. Use of the ACCP guidelines allows a stepwise empirical approach to the problem of unexplained chronic cough. This approach greatly increases the percentage of chronic coughs that are accurately diagnosed and effectively treated, and avoids unnecessary diagnostic testing.     

Increased circulating Wnt5a protein in patients with rheumatoid arthritis-associated interstitial pneumonia (RA-ILD)

An early diagnosis of interstitial lung disease (ILD) is important for guiding treatments of rheumatoid arthritis (RA)-associated ILD (RA-ILD) in clinical settings. The non-canonical Wnt signaling representative ligand Wnt5a was recently found to involve in idiopathic pulmonary fibrosis (IPF) and pathogenesis of RA. The goal of this study was to examine the clinical relevance of Wnt5a in RA-ILD. In this report, the clinical relevance of plasma Wnt5a protein was evaluated in 40 RA-ILD patients and 41 non-ILD RA cohorts. The results showed an elevated Wnt5a protein in plasmas of RA-ILD patients compared with non-ILD RA patients (p < 0.01), which was positively correlated with the plasma level of rheumatoid factor (RF). Of note, more abundant Wnt5a was also found in patients with usual interstitial pneumonia (UIP) than those with nonspecific interstitial pneumonia (NSIP) and other ILD patterns. More importantly, the disease severity was correlated with the circulating Wnt5a as ascertained by high-resolution computed tomography (HRCT)-UIP scores. The multiple-factor non-conditional logistic regression analysis further revealed that the age, RA duration, smoking and plasma Wnt5a were risk factors with clinical significance for RA-ILD. Interestingly, more Wnt5a-positive patients were identified in RA-ILD smokers relative to RA-ILD never-smokers, and longer smoking duration was strongly correlated with Wnt5a in RA-ILD patients. In consistence, ROC curve also suggested that the Wnt5a was a potential candidate biomarker for identifying patients with RA-UIP. These results demonstrate that the circulating Wnt5a may be a risk factor and potential biomarker for identifying UIP and accessing the severity and progression of ILD in RA patients.