中医医院膝关节骨关节炎住院患者的治疗情况--附892份病历分析

为了解中医医院膝关节骨关节炎住院患者的治疗现状,对湖南省12家中医医院5年膝关节骨关节炎住院患者治疗情况进行调查,摘录其相关治疗资料,并进行统计学分析处理.结果显示892例中,78.8%者内服中药汤剂,19.4%外用中药,所用中药性味多为辛温,内服药以祛风湿、补虚类药物居多,外用药以祛风湿、活血化瘀类药物为主.25.1%采用针灸治疗,常用穴位有膝眼、足三里、阳陵泉、阴陵泉、血海、梁丘等.13.1%接受推拿按摩治疗,但大多数病案未记载具体手法.46.2%内服NSAIDs,19.5%使用抗生素,15.4%使用激素类药物.表明中医医院对膝关节骨关节炎住院患者常采用中西医结合方法治疗,中医治疗多为各种方法组合的综合疗法,中药多选择性味辛温之品,祛风湿药、补虚药和活血化瘀类药物为临床常用中药.     

临床试验数据采集与报告文件设计制作的技术规程

临床试验数据采集与报告文件的设计和制作对保证试验数据的质量与完整性至关重要。参照临床试验数据管理规范 (GCP)并结合具体实践经验制订本规程。设计规程包括与方案设计同步、文件格式、问题和提示、冗余数据、数据记录指南、标准化、版本管理与培训 ;印制规程包括审批、印制说明书以及厂商选择。     

Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform: Challenges and Strategies in Data Reuse

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management. It is a common requirement to reuse the data for clinical research. However, we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform. In this paper, we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology. We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform. Secondly, we built special disease case repositories (i.e., heart failure repository) that utilize the graph to search the related patients and to normalize the data. Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure, we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository. After the propensity score matching, the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired. Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients. This paper presents the workflow and application example of big data mining based on regional EHR data.     

Challenging surgical treatment of giant retroperitoneal liposarcoma: A case report

Liposarcoma is a rare malignant tumor type and surgical resection is the gold standard treatment. The present study reported on the case of a 51-year-old woman who presented with a mass in the left upper abdomen. Computed tomography revealed a 32-cm giant retroperitoneal liposarcoma. Complete tumor resection was performed without the removal of other organs. Postoperative pathological examination indicated retroperitoneal well-differentiated liposarcoma and immunohistochemistry revealed S-100(−), MDM2(+), vimentin(+), CDK4(+), p16(+) and STAT6(+) results. The patient recovered well after the surgery. Complete tumor resection during the first surgery is key to cure liposarcoma. The present case report will be helpful for clinical oncologists to fully understand giant retroperitoneal liposarcoma and treat it accordingly.     

Peripheral polyneuropathy and acute psychosis from chronic nitrous oxide poisoning: A case report with literature review

Rationale:Nitrous oxide (NO) is a commonly used drug in medical practice, restoration, and the automobile industry. Recreational abuse is an emerging public health problem owing to its accessibility and drug properties.Patient concerns:A 25-year-old male was hospitalized with acute psychosis and lower-extremity sensorimotor proprioceptive ataxia due to nitrous oxide abuse.Diagnosis:Laboratory studies confirmed a vitamin B12 deficiency. Magnetic resonance imaging of the spinal cord showed normal findings. Electrophysiological testing confirmed length-dependent sensorimotor polyneuropathy, with a predominant motor component and axonal degeneration.Intervention and outcomes:Abstinence from toxic substances was suggested, and vitamin B12 substitution was introduced. The patient was lost to follow up.Lessons:Nitrous oxide toxicity is multisystemic and is thought to result from vitamin B12 inactivation. Recent case reports postulated direct paranodal lesions resulting from nitrous oxide consumption. Neurological, neuropsychiatric, and hematological toxicities are among those explored in this case report. Correction of the functional vitamin B12 status and nitrous oxide abstinence are essential in the treatment process.     

夜间营养护理对肝衰竭病人营养状况的影响

目的:探讨肝衰竭病人营养支持中实施夜间营养护理干预的效果。方法:选取2019年3月—2020年7月在我院治疗的82例肝衰竭病人为研究对象,通过随机数字表法分为日间组(41例)及夜间组(41例)。日间组在内科综合治疗基础上给予日间营养干预,夜间组在日间组的基础上加强夜间营养护理。比较两组相关营养指标、Child-Pugh评分、营养风险筛查表2002(NRS-2002)评分、生活质量变化情况。结果:经夜间营养护理干预后,夜间组血清总蛋白(TP)、白蛋白(ALB)、转铁蛋白(TF)、前白蛋白(PA)水平高于日间组,差异均有统计学意义(P<0.001);干预2周、4周后夜间组Child-Pugh评分均低于日间组,NRS-2002评分明显低于日间组,差异均有统计学意义(P<0.001);夜间组营养护理干预4周后生活质量GQOL-74量表评分高于日间组,差异有统计学意义(P<0.001)。结论:肝衰竭病人住院期间加强实施夜间营养护理干预,可明显改善病人营养状况,降低营养不良发生风险,改善病人生活质量。     

Acute appendicitis after colorectal endoscopic mucosal resection: a case report

Endoscopic mucosal resection (EMR) was originally described in 1973 and is currently a popular practice used in treating polyps, small adenomas, and early cancers. Although the safety of EMR has been proven in numerous studies, complications occur occasionally. We report a case in which the patient complained of severe upper abdominal pain and who was diagnosed with acute appendicitis after colorectal EMR. The patient recovered well after surgery. Cautious observation is necessary when resuming oral intake in patients who undergo colorectal EMR and who complain of postoperative abdominal pain. Observation is especially important for patients with a fecalith that may have originally existed in the appendix or in the colon near the appendix.     

张家港市社区健康教育防控境外输入性疟疾再传播效果

目的 评价张家港市社区健康教育用于提高出归国人员疟疾防控意识的效果,为制定防控境外输入性疟疾再传播措施提供参考依据.方法 2018-2019年,在张家港市各社区实施出归国人员疟疾健康教育干预,比较目标人群干预前后疟疾防治知识和就医行为变化.结果 2018年7月至2019年12月,张家港市共有赴境外疟疾流行区的出归国人员...     

L-Serine Treatment is Associated with Improvements in Behavior,EEG, and Seizure Frequency in Individuals with GRIN-Related Disorders Due to Null Variants

Pathogenic missense variants in GRIN2A and GRIN2B may result in gain or loss of function (GoF/LoF) of the N-methyl-D-aspartate receptor (NMDAR). This observation gave rise to the hypothesis of successfully treating GRIN-related disorders due to LoF variants with co-agonists of the NMDAR. In this respect, we describe a retrospectively collected series of ten individuals with GRIN2A- or GRIN2B-related disorders who were treated with L-serine, each within an independent n-of-1 trial. Our cohort comprises one individual with a LoF missense variant with clinical improvements confirming the above hypothesis and replicating a previous n-of-1 trial. A second individual with a GoF missense variant was erroneously treated with L-serine and experienced immediate temporary behavioral deterioration further supporting the supposed functional pathomechanism. Eight additional individuals with null variants (that had been interpreted as loss-of-function variants despite not being missense) again showed clinical improvements. Among all nine individuals with LoF missense or null variants, L-serine treatment was associated with improvements in behavior in eight (89%), in development in four (44%), and/or in EEG or seizure frequency in four (44%). None of these nine individuals experienced side effects or adverse findings in the context of L-serine treatment. In summary, we describe the first evidence that L-serine treatment may not only be associated with clinical improvements in GRIN-related disorders due to LoF missense but particularly also null variants.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-021-01173-9.     

下颌覆盖义齿短微型种植体与标准长度微型种植体效果比较

目的:比较下颌覆盖义齿短微型种植体(mini dental implant,MDI)与标准长度MDI修复牙槽嵴重度萎缩无牙颌患者的效果,为临床应用提供参考.方法:选择进行下颌覆盖义齿短MDI和标准长度MDI修复的无牙颌患者60例,分为短MDI组(30例)和标准MDI组(30例),比较2组基线、术后1周和1年种植体周围组...