Hepatitis D: advances and challenges

Hepatitis D virus (HDV) infection causes the most severe form of viral hepatitis with rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Although discovered > 40 years ago, little attention has been paid to this pathogen from both scientific and public communities. However, effectively combating hepatitis D requires advanced scientific knowledge and joint efforts from multi-stakeholders. In this review, we emphasized the recent advances in HDV virology, epid...     

经皮椎体成形术治疗15例骨质疏松性椎体压缩性骨折体会

近年来,国内外文献报导经皮椎体成形术治疗骨质疏松性椎体压缩性骨折由于创伤小、效果好、并发症少而大量应用于临床。2009-2010年我们采用该手术治疗骨质疏松性骨折15例,疗效满意,现报告如下。     

辨证论治与变量颈椎牵引及手法联合西药治疗颈性眩晕随机平行对照研究

[目的]观察辨证论治与变量颈椎牵引及手法联合西药治疗颈性眩晕疗效。[方法]使用随机平行对照方法,将60例门诊患者按抽签法分为两组。对照组30例①5%葡萄糖氯化钠注射250mL加脉络宁20mL静滴,1次/d;尼莫地平40mg,3次/d,口服。②枕颌带坐位变量牵引,牵引质量2～10kg,(按患者体位和自我感觉有所增减)先由轻至重牵引,逐渐增至患者最大耐受限度,10～14d牵引质量再由重减轻,至病程完成。牵引时间每次10～30min,以患者能耐受为限,1次/d,14d为1疗程。③手法点、按、揉风池、百会、天柱、合谷、内关、大椎、肩贞、肩井等穴位。治疗组30例辨证论治。①肝阳上亢型,方以天麻沟藤饮加减。②气血亏虚型,方以归脾汤加减。③痰浊中阻型,方以半夏白术天麻汤加减。④肾精不足型,方以偏阳虚用右归丸加减,偏肾阴虚用左归丸加减。西医、牵引、手法治疗同对照组。连续治疗14d为1疗程。观测临床症状、不良反应。连续治疗疗程,判定疗效。[结果]治疗组临床治愈6例,显效14例,有效7例,无效3例,总有效率90.00%。对照组临床治愈2例,显效13例,有效7例,无效8例,总有效率73.33%。临床疗效治疗组优于对照组(P<0.05)。[结论]辨证论治、变量颈椎牵引及手法联合西药治疗颈性眩晕疗效满意,值得临床应用。     

肩痛颗粒治疗肩周炎的临床观察

目的:初步观察和评价肩痛颗粒治疗肩痹(肩周炎)属风寒湿痹证者的疗效和安全性。方法:采用随机双盲、双模拟、平行阳性药对照的临床试验方法,将72例肩周炎(风寒湿痹证)患者,随机分为试验组(肩痛颗粒组)和对照组(祛痹肩安丸组),两组每次服用颗粒剂和丸剂各1袋,一日3次,疗程为4周。按照症状、体征分级量化标准,对治疗前及用药后每周进行疗效评价;并对患者进行用药前后的三大常规、心、肝、肾功能等安全性检查,观察以上安全性指标的变化。结果:疗效性结果:肩痛颗粒组的愈显率为29.63%,总有效率为92.59%;而祛痹肩安丸组分别为16.67%和83.33%。两组差别无统计学。每周证候总积分:试验组患者用药后21、28d中医证候总积分下降值和下降率均高于对照组,但差别无统计学意义。安全性结果:治疗前后患者的指标差异值无临床意义,未观察到药物引起的不良反应和不良事件。结论:肩痛颗粒在目前的口服剂量疗程范围内,治疗证属风寒湿痹的肩周炎疗效确切,安全,无毒副作用,是一种治疗肩周炎安全、有效的中药新药。     

淋巴水肿治疗的研究进展

淋巴水肿是淋巴系统的一种慢性疾病。随着我国恶性肿瘤发病人数和发病率的增加,癌症治疗后的淋巴水肿已经成为继发性淋巴水肿的主要病因。正确、合理的治疗对淋巴水肿预后十分重要。近年来,淋巴领域的治疗进展给患者带来了新的希望。本文就淋巴水肿治疗的研究进展进行综述。     

Composition of treatment alliance in bipolar disorder: A cross-sectional study of patients’ perspectives

BACKGROUNDTreatment alliance has an impact on several key patient outcomes in all psychiatric disorders, including bipolar disorder (BD). It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings. However, research on the composition of treatment alliance in psychiatric disorders, such as BD, is relatively limited.AIMTo determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.METHODSThis is a cross-sectional study, conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (September 2018 to September 2019). A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected. The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version (WAI-Client). Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians (TRIP) scale, perceived support from clinicians assessed by the Psychosocial Care by Physicians (PCP) scale, and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire (PSQ). Associations between scores on all scales were determined by correlational and multiple regression analyses. Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.RESULTSScores on all the three WAI-Client subscales were significantly correlated with each other (r = 0.66-0.81; P < 0.0001). The total TRIP scores were associated with the total WAI-Client scores (r = 0.28; P < 0.01). The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale (r = 0.28-0.29; P < 0.01). The total TRIP scores were significantly associated with the total PSQ scores (r = 0.45; P < 0.0001). Factor analysis yielded two independent and coherent factors, which explained 69% of the variance in data. Factor-1 (“alliance and support”), which explained about 41% of the variance, was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items. Factor-2 (“trust and satisfaction”), which explained about 28% of the variance, consisted of all the TRIP trust and the PSQ treatment satisfaction items.CONCLUSIONA broader construct of treatment alliance in BD was found. Apart from collaborative components, this construct included patients’ perceptions regarding trust in clinicians, support from clinicians, and treatment satisfaction.     

分化好的胃肠胰神经内分泌瘤G3的诊治新进展

神经内分泌肿瘤属于少见肿瘤,发病率低,异质性强,可发生于全身多个器官.在中国,胃肠胰是神经内分泌肿瘤发病率最高的部位,自2017年世界卫生组织(World Health Organization,WHO)消化系统肿瘤病理学分类关于胃肠胰神经内分泌肿瘤提出分化好的神经内分泌瘤G3(neuroendocrine tumor...     

腹腔镜诊治结直肠肿瘤的临床应用

目的：探讨腹腔镜诊治结直肠肿瘤的临床疗效与可行性及肿瘤切除的彻底性。方法：回顾性分析我院2004年1月至2007年12月应用腹腔镜诊治43例结直肠肿瘤患者的临床资料,并与同期52例开腹结直肠肿瘤手术进行对比。结果：腹腔镜组手术成功39例,中转开腹4例。手术时间（160-340min）稍长于开腹手术（120-270min）,术后住院时间短,康复快,排气快,两组出血量、并发症发生率、淋巴结清扫数、近期临床效果等无显著性差异。结论：腹腔镜诊治结直肠肿瘤安全可行,切除范围与开腹手术相同,但患者康复快,创伤小,术后住院时间短,值得临床推广应用。     

居家治疗的患者家庭中医疗废弃物处理问题的探讨与研究

目的 了解目前居家治疗的患者对医疗废弃物的认识及医疗废弃物的处理情况,并通过正确的指导和鼓励进一步规范居家治疗的患者家庭中医疗废弃物的管理.方法 发放问卷对居家治疗的120名糖尿病患者进行调查,调查他们对医疗废弃物的认识,目前所采取的处理方法,有无被废弃物损伤的经历等.通过知识讲解,电话回访,并和社区、当地基层医院建立联系,借助社区医院、基层医院为载体,在广泛宣传的基础上,按照就近、方便的原则,利用废弃的广口硬质塑料瓶,将居家治疗中产生的医疗垃圾有效收集并集中处理.为患者提供恰当的容器和地点进行医疗废弃物回收,对按要求回收者给予一定的奖励.结果 通过12个月的跟踪调查指导,居家治疗的患者对医疗废弃物的危害、正确处理的途径的认识有了较大提高;针刺伤发生率明显下降(P<0.01).结论 通过正确的指导和鼓励,能够提高人们对医疗废弃物认识,逐步做到规范处理.