近7年中医药治疗特发性面神经麻痹随机对照试验结局指标的现状分析

目的：评价中医药治疗特发性面神经麻痹（IFP）随机对照试验（RCT）的结局指标应用现状。方法：全面检索7个数据库、2个临床试验注册中心,按预先制定的遴选标准筛选出相关的RCT,根据Cochrane风险偏倚评估工具对纳入文献进行偏倚风险评估,对结局指标、测量时间点、研究时间、结局指标等级情况进行统计描述。结果：初步检索出相关文献13 489篇,最终纳入45篇RCT（中文文献44篇,英文文献1篇）,报告95个结局指标,使用频次233次。研究发现中医药治疗IFP的RCT总体偏倚不明确,临床研究中结局指标存在参考标准、命名、测量时间点杂乱,选用类别不均,主次不明确的问题。结论：中医药治疗IFP的RCT结局指标集研究尚处于起步阶段,参考国际经验,结合中医药特点制定实用的研究流程,仍需要精确的临床及统计工作来构建规范、统一、公认的核心指标集。     

Comparison of manual mycobacteria growth indicator tube and epsilometer test with agar proportion method for susceptibility testing of Mycobacterium tuberculosis

Background and Objectives: Antimycobacterial susceptibility tests take weeks, and delayed therapy can lead to spread of Mycobacterium tuberculosis. Therefore, rapid, accurate and cost-effective methods are required for proper therapy selection. In this study, the Mycobacteria growth indicator tube (MGIT) and epsilometer test (Etest) methods were compared to the agar proportion method for susceptibility testing of Mycobacterium tuberculosis. Materials and Methods: The susceptibility tests against isoniazid (INH), rifampin (RIF), streptomycin (STM) and ethambutol (ETM) of 51 M. tuberculosis complex isolates were analyzed by the MGIT, Etest and agar proportion methods. Results: The concordance between MGIT/Etest and agar proportion methods was 98% for INH and 100% for RIF, STM, ETM. There were not statistically significant differences in results of the susceptibility tests between MGIT/Etest and the reference agar proportion method. Conclusion: The results have shown that MGIT and Etest methods can be used instead of the agar proportion method, because these two methods are more rapid and easier than the agar proportion method.     

腹腔镜下全子宫加双附件切除术治疗早期子宫内膜癌患者的效果

目的:观察腹腔镜下全子宫加双附件切除术治疗早期子宫内膜癌患者的效果。方法:选取78例早期子宫内膜癌患者为研究对象,按照随机数字表法分为观察组与对照组各39例。对照组行腹腔镜广泛子宫切除术治疗,观察组行腹腔镜下全子宫加双附件切除术治疗,比较两组手术相关指标(手术时间、术中出血量、术后首次排气时间、住院时间)水平、住院期间并发症发生率和术后2年生存率。结果:观察组手术时间、术后首次排气时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.13%(2/39),低于对照组的25.64%(10/39),差异有统计学意义(P<0.05);观察组术后2年生存率为97.44%(38/39),高于对照组的76.92%(30/39),差异有统计学意义(P<0.05)。结论:腹腔镜下全子宫加双附件切除术治疗早期子宫内膜癌患者可缩短手术时间、术后首次排气时间、住院时间,降低术中出血量和并发症发生率,以及提高术后2年生存率,效果优于腹腔镜下广泛全子宫切除术。     

供应室消毒指示带粘贴架的制作

随着供应室新规范的出台,每家医院都在取消无菌包的包扎绳,但无菌包的名称必须写在消毒指示带上。为了节省时间,每天必须预先将带有无菌包名称的消毒指示带写好,粘贴于架子上,便于操作时取用方便。为此,我科自行设计制作了消毒指示带粘贴架,通过使用效果良好,现介绍如下。     

妇炎舒胶囊联合头孢噻肟钠治疗慢性盆腔炎的临床研究

目的探讨妇炎舒胶囊联合头孢噻肟钠治疗慢性盆腔炎的临床效果。方法选择2020年2月—2020年10月在河南大学淮河医院治疗的74例慢性盆腔炎患者,随机分成对照组和治疗组,每组各37例。对照组静脉滴注注射用头孢噻肟钠,每次2 g加入生理盐水100 mL,2次/d;治疗组在对照组的基础上口服妇炎舒胶囊,5粒/次,3次/d。两组患者均治疗3周。观察两组患者临床疗效,比较治疗前后两组患者临床症候积分,血清血红素氧合酶1(HO-1)、细胞间黏附分子-1(ICAM-1)、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、白细胞介素-26(IL-26)和基质金属蛋白酶-2(MMP-2)水平,Smad-3、miRNA-224-3P和Smad-7水平,子宫血流动力学指标子宫血流搏动指数(PI)、血流最大峰值流速(Vs)和血流阻力指数(RI)。结果治疗后,治疗组总有效率为97.30%,明显高于对照组的81.08%(P0.05)。治疗后,两组中医症候评分均显著降低(P0.05),且治疗组降低更明显(P0.05)。治疗后,两组血清HO-1、ICAM-1、GM-CSF、IL-26、MMP-2水平均明显下降(P0.05),且治疗组下降更明显(P0.05)。治疗后,两组血清Smad-3水平明显降低,而miRNA-224-3P和Smad-7明显升高(P0.05),且治疗组改善更明显(P0.05)。治疗后,两组PI、RI均下降,而Vs均显著增高(P0.05),且治疗组改善更明显(P0.05)。结论妇炎舒胶囊联合注射用头孢噻肟钠治疗慢性盆腔炎可有效改善患者临床症状,降低机体炎症反应,改善血流动力学,其抗炎作用与调节miRNA-224-3P、Smad信号通路有关。     

脉波指示剂连续心排血量(PiCCO)中的胸内血容量(ITBV)测定

在新近推向临床的脉波指示剂连续心排血量(PiCCO)监测中,用单一温度稀释法所测定的胸内血容量(IT-BV),已被许多学者证明是一项可重复、又敏感,而且比肺动脉阻塞压(PAOP)、右心室舒张末期压(RVEDP)、中心静脉压(CVP)更能准确反映心脏前负荷变化的实用指标.本文从心脏生理学、病理生理学及临床应用等方面,系统阐述了前负荷的定义及其影响因素,列举了上述压力监测数据不能准确反映心脏前负荷的机理及临床报道.详细讲述了单一温度稀释法测定ITBV的原理、计算方法、修正公式、测定中注意事项、正常范围值.列举了ITBV作为心脏前负荷的具有代表性的实验与临床统计分析资料.有鉴于左心功能减退伴有中度容量不足病人.恒速补液过程中显示充盈压比ITBV更敏感的报道,笔者建议:临床工作者在应用PiCCO新技术、确认ITBV作为前负荷指标的同时,仍然不应该忽略相关心血管腔的传统压力监测.     

¿Es el intervalo libre de docetaxel un factor predictivo para el cáncer de próstata resistente a la castración?

ObjectiveProstate cancer (PCa) is the second most common solid tumor in men and the fifth leading cause of cancer-related death. In advanced stage, palliative treatments are used instead of curative therapies. Therefore, finding predictive indicators seems crucial. Patients with castration-resistant prostate cancer (CRPC) that received Dx chemotherapy have been retrospectively reviewed. The aim of this study was to investigate whether docetaxel (Dx)-free interval could have a predictive value for PCa and influence other sequential therapies.Material and methodsThis clinical trial study was performed on 104 patients at Medeniyet University Oncology Clinic in 2018-2020. All CRPC patients had metastases, received Dx as first-line treatment and underwent androgen receptor axis targeted (ARAT) therapy after disease progression. We analyzed patients’ progression time after Dx therapy and the effects on sequential treatment.ResultsAfter Dx therapy, all patients received ARAT (abiraterone (ABI) n: 49 (47.1%) and enzalutamide (ENZ) n: 54 (51.9%)) as a second-line treatment, except for one patient who received cabazitaxel. There was a statistically significant relationship between the Dx-free interval and duration of response to ARAT (P<.001). The response time of ARAT treatment was <10.5 months in all patients whose Dx-free interval period was <9 months.ConclusionsOur findings support the theory that Dx-free interval can be a predictive factor for CRPC. CRPC disease can be classified as Dx-sensitive disease or Dx-resistance disease, based on the Dx-free interval. Decision on subsequent treatments could be made considering this information.     

Moment-Based Multi-Resolution HWENO Scheme for Hyperbolic Conservation Laws

In this paper, a high-order moment-based multi-resolution Hermiteweighted essentially non-oscillatory (HWENO) scheme is designed for hyperbolic conservation laws. The main idea of this scheme is derived from our previous work [J.Comput. Phys., 446 (2021) 110653], in which the integral averages of the function andits first order derivative are used to reconstruct both the function and its first orderderivative values at the boundaries. However, in this paper, only the function values atthe Gauss-Lobatto points in the one or two dimensional case need to be reconstructedby using the information of the zeroth and first order moments. In addition, an extramodification procedure is used to modify those first order moments in the troubled-cells, which leads to an improvement of stability and an enhancement of resolutionnear discontinuities. To obtain the same order of accuracy, the size of the stencil required by this moment-based multi-resolution HWENO scheme is still the same as thegeneral HWENO scheme and is more compact than the general WENO scheme. Moreover, the linear weights are not unique and are independent of the node position, andthe CFL number can still be 0.6 whether for the one or two dimensional case, which hasto be 0.2 in the two dimensional case for other HWENO schemes. Extensive numericalexamples are given to demonstrate the stability and resolution of such moment-basedmulti-resolution HWENO scheme.     

基于马斯洛需求层次理论农村留守老年人社会支持需求评估体系的构建

目的 构建农村留守老年人社会支持需求评估体系,为科学评估留守老年人的社会支持需求现状提供依据。方法 基于马斯洛需求层次理论,采用文献研究、焦点小组、德尔菲法建立农村留守老年人社会支持需求评估体系,于2020年3—7月对14名专家进行2轮专家咨询,应用SPSS 23.0计算专家积极系数、权威系数与协调系数,经小组讨论后对条目进行修改,应用Yaahp 确定各级指标权重与组合权重。结果 2轮专家函询的有效回收率分别为100%和93%,专家权威系数分别为0.797和0.810,2轮专家Kendall's W系数为0.236~0.529（均P<0.001）。最终形成的农村留守老年人社会支持需求评估指标包括5个一级指标、11个二级指标、56个三级指标。5个一级指标的权重分别为0.315、0.315、0.118、0.192和0.060。结论 本研究构建的农村留守老年人社会支持需求评估体系具有科学性和可靠性,可用于判断农村地区留守老年人的社会支持需求,以构建有针对性的社会支持体系,为养老服务的建设提供参考。     

Defining Textbook Outcome in liver surgery and assessment of hospital variation: A nationwide population-based study

IntroductionTextbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery.MethodsThis was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment.Results2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51–0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44–0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34–0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54–0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36–0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed.ConclusionTO differs between indications for liver resection and can be used to assess between hospital and network differences.