摘要：目的：探讨晚期产后大出血的发生原因，提出防治措施。方法：对我院1992年1月至2000年1月收治的晚期产后大出血36例病例进行回顾性分析。结果：晚期产后出血的原因依次为胎盘残留、子宫复旧不全、切口裂开。结论：重视第三产程的处理，特别是对产时出血米索前列醇的应用，可有效预防大出血的发生。采用宫缩素及抗感染、清宫术等对症治疗可获得满意的治疗效果，对严重急性出血者可行子宫切除术。
Objective To assess reduction of adverse drug reaction incidence in patients with colorectal cancer receiving Jianpi herbs combined with chemotherapy. Methods The randomized controlled trials (RCTs) comparing Jianpi herbs combined with chemotherapy were searched through CBMdisc, CJFD, Wangfang Data and PubMed. The search was updated to September 2007. Software RevMan5, provided by Cochrane Library, was used to perform meta-analysis. Results Six RCTs were identified in this systematic review. All the methodology quality of the enrolled RCTs was gaded C. The pooled analysis showed that Jianpi herbs combined chemotherapy significantly reduced the incidences of grade I and grade II leucopenia [grade I with RR= 0.50 and 95%CI (0.31 to 0.80); grade II with RR= 0.37 and 95%CI (0.21 to 0.66)], grade II nausea and vomiting [RR= 0.51, 95%CI (0.31 to 0.84)] compared with routine chemotherapy. There was no statistical difference in reduction of neurotoxicity between the two groups. Conclusion The methodological quality of the RCTs using Jianpi herbs combined with chemotherapy on treating colorectal cancer should be improved. Based on this systematic review, Jianpi herbs combined with chemotherapy may reduce the incidence of mild to moderate adverse drug reaction, such as leucopenia and nausea and vomiting, in patients with colorectal cancer. Well-designed RCTs are needed in the future.
Chronic kidney disease (CKD) has been highlighted as one of the most important public health problems due to sharply climbing incidence and prevalence. To efficiently attenuate the disease burden and improve the disease management, not only active and effective treatment should be administrated, but also comprehensive follow-up nursing management with innovative and evolving spirits should be implemented. Thus dynamic changes of diseases could be acquired in time and patients are under appropriate medical instruction as soon as possible. This editorial is based on quickly developing medical big data resources and advanced internet techniques, from both aspects of patients and health care providers, briefly talking about integrated management strategy of CKD and its future development in China.
目的 探讨在丙泊酚诱导麻醉的改良电休克治疗中脑双频谱指数(BIS)与动作发作时间的关系，以及其他因素对电休克动作发作时间的影响。 方法 2012年4月－5月，记录28名患者的107次治疗中的不同时刻脑双频谱指数（BIS）值诱导前、睫毛反射消失时、治疗前即刻、动作发作结束即刻、动作发作结束后60 s）、麻醉药物剂量、动作发作时间及治疗不良反应，并根据动作发作时间将治疗分为A组（治疗无效组，动作发作时间＜17 s）和B组（治疗有效组，动作发作时间≥17 s）。探讨不同时刻BIS值与癫痫发作时间的关系并比较A、B组之间BIS值、麻醉药物剂量差异。 结果 两组间睫毛反射消失时及治疗前即刻BIS值差异有统计学意义（P＜0.05）。动作发作时间与治疗前即刻BIS值呈正相关（r=0.245，P=0.012），与治疗次数呈负相关（r=−0.283，P=0.004）。 结论 治疗前即刻BIS值与动作发作时间呈正相关，因此，此时的BIS值也许可以作为预测动作发作时间长短的指标。
Objective To explore the prevention and control effect of carbapenem resistant Gram-negative bacillus (CRO) in geriatric ward based on transparent supervision model. Methods Patients admitted to the geriatric ward in the First People’s Hospital of Lianyungang between January 2018 and December 2022 were selected. A transparent regulatory model for CRO was established and implemented in 2019, including the establishment of a regulatory group, the development of cluster prevention and control measures, the implementation of transparent reminder, publicity, supervision and assessment and other management measures. We evaluated the effectiveness by comparing the detection rate and infection rate of CRO before and after the intervention. Results A total of 15015 patients were monitored, and a total of 418 strains of CRO were detected. The incidence rate of noso-comial infection was decreasing year by year（χ2=26.666, P<0.001), and the etiological submission rate of hospitalized patients before antimicrobial treatment had been increasing year by year（χ2=280.320, P<0.001). The detection rate of CRO infection had been decreasing year by year, but the difference was not statistically significant (P>0.05), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia infection (P=0.030). The detection rate of CRO had been decreasing year by year (χ2=33.593, P<0.001), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia (χ2=23.663, P<0.001) and carbapenem resistant Pseudomonas aeruginosa (χ2=14.527, P=0.006).Conclusions By establishing and promoting transparent supervision mode in the geriatric ward, the detection rate and infection rate of drug-resistant bacteria can be significantly reduced, and the prevention and control effect of CRO in the elderly patients in the ward can be effectively improved to ensure the safety of elderly patients.
ObjectiveTo systematically review the diagnostic value of miRNAs for Alzheimer’s disease (AD).MethodsPubMed, Web of Science, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect diagnostic tests of miRNAs for AD from inception to October 31, 2020. Two researchers independently screened literature, extracted data, and assessed the risk of bias of the included studies. RevMan 5.3 and Stata 14.0 software were used for meta-analysis. ResultsA total of 22 studies involving 4 006 subjects were included. The meta-analysis results showed that the pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and the areas under the working characteristic curve of miRNA in AD diagnosis were 0.83 (95%CI 0.79 to 0.87), 0.80 (95%CI 0.76 to 0.83), 4.07 (95%CI 3.37 to 4.92), 0.21 (95%CI 0.17 to 0.27), 19.20 (95%CI 12.96 to 28.48) and 0.88 (95%CI 0.85 to 0.90), respectively. ConclusionThe current evidence shows that miRNAs have a high diagnostic value for AD. However, because of the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
ObjectiveTo summarize the latest research progress in active surveillance of low-risk papillary thyroid microcarcinoma at home and abroad, and provide some reference for future clinical work. MethodRetrieved and reviewed relevant literatures about prospective studies on active surveillance of papillary thyroid microcarcinoma.ResultsIn recent years, the incidence of papillary thyroid microcarcinoma had increased sharply, but most of the biological activities were inert, tumor-specific mortality was very low, and only a few had progressed. For patients with papillary thyroid microcarcinoma, surgery was a safe and effective treatment method, but due to changes in the epidemiological characteristics of the disease, people were reconsidering whether there was overtreatment in patients without high-risk characteristics. Expert consensus and guidelines no matter at home or abroad mentioned that active monitoring can be considered as an alternative to surgery. For suitable patients, active monitoring might be a better choice.ConclusionsActive surveillance for low-risk papillary thyroid microcarcinoma is basically considered to be a safe and feasible treatment option, but large numbers of clinical trials are still needed to provide evidence for the conversion of conventional clinical treatment models. In the future, by more accurately assessing the tumor progression of patients with low-risk papillary thyroid microcarcinoma, active surveillance is promising to alternate surgical treatments.
Objective To detect characteristics and the pathogenesis of rhodopsin (RHO) gene mutation in an inbreeding family with autosomal recessive retinitis pigmentosa (ARRP). Methods Peripheral venous blood 5-8 ml was abstracted from 8 members in the inbreeding ARRP family and 10 control individuals. DNA gene group was picked. Extron 1-5 of RHO gene was amplified by polymerase chain reaction (PCR)，and the mutation of RHO gene was screened by direct DNA sequence measurement. Results The Gln-344-Arg mutation in the RHO gene was detected in 3 patients with ARRP and homozygotes of the mutation in 3 patients were found. Heterozygous of the mutation was detected in the parent of patients and 1 healthy family member. No mutation of RHO gene was found in 2 healthy family members and 10 control individuals. Conclusions The Gln-344-Arg mutation in the RHO gene may be the pathogenic factor of the ARRP family; the frequency of the mutation of RHO gene may increase in the in breeding ARRP family.(Chin J Ocul Fundus Dis，2004，20：145-148)
ObjectiveTo establish a prediction model for ipsilateral cervical lateral lymph node metastasis (LLNM) in stages T1–T2 unilateral papillary thyroid carcinoma (PTC) and to verify its efficacy. MethodsA retrospective case-control study was conducted to analyze the clinical information of 280 patients with unilateral PTC at stages T1–T2 who underwent ipsilateral cervical lateral lymph node dissection and were diagnosed postoperatively via pathological examination in the Department of Thyroid Surgery (General Surgery) at the First Hospital of Shanxi Medical University from February 2019 to February 2024. The patients were randomly allocated into a training set and a test set in a 7∶3 ratio. The general, clinical, laboratory, and imaging data were collected for all patients. The univariate and multivariate logistic regression analyses were used to compare the differences in data of the patients between with and without LLNM in the training set. Then the risk factors affecting on the LLNM were used to construct a nomogram prediction model. The receiver operating characteristic (ROC) curve was generated for both the training and test sets, and the area under the ROC curve (AUC) was calculated to evaluate model discrimination. The calibration curve was used to assess model calibration, and decision curve analysis (DCA) was conducted to evaluate the clinical utility of the nomogram prediction model. ResultsA total of 280 patients were included, including 196 in the training set and 84 in the testing set. There were no statistically significant differences in the clinical and pathological data between the training set and the testing set (P>0.05). There were 147 cases of LLNM in the training set and 63 cases of LLNM in the testing set. The results of multivariate logistic regression analysis showed that the patients with T1–T2 stage unilateral PTC who were male in gender, had cancer lesions located in the upper pole, had central lymph node metastasis, had larger cancer lesions, and higher serum thyroid stimulating hormone level had a higher probability of developing ipsilateral cervical LLNM (P<0.05). The AUC (95%CI) of the nomogram prediction model constructed based on these risk factors in the training and testing sets were 0.822 (0.747, 0.897) and 0.838 (0.743, 0.933), respectively. The calibration curves of the training and testing sets roughly overlapped with the reference curve. The DCA results indicated that the net benefit for patients was positive when the threshold probabilities were within the ranges of 15% to 92% for the training set and 10% to 100% for the test set. ConclusionsThe results of this study suggest that gender, maximum cancer lesion diameter, cancer lesion location, central lymph node metastasis, and serum thyroid stimulating hormone are risk factors affecting the occurrence of ipsilateral cervical LLNM in T1–T2 stages unilateral PTC. The nomogram prediction model developed based on these risk factors demonstrates good discrimination, accuracy, and clinical applicability for its prediction.
Objective To evaluate the effect of PNS on Idiopathic facial palsy. Methods A total of 86 cases of acute idiopathic facial paralysis were randomly divided into the treatment group (PNS group, 44 cases), and the control group (42 cases). The basis of the two groups included hormone therapy, B vitamins, anti-viral treatment, as well as acupuncture and physical therapy, both in the incidence of 7 days to give the treatment. House-Brackmann facial nerve function classification and evaluation were used to determine clinical efficacy; ENoG line was tested before and after treatment. Results Before H-B classification of facial nerve function, EnoG side of the latency and amplitude in the two groups were comparable. At 28 days after treatment, H-B scores for the treatment group and the control group were (2.33 ± 1.21) and (3.08 ± 1.35), respectively, and the two groups had significant differences (Plt;0.05); ENoG incubation period (2.46 ± 0.34) and amplitude (189 ± 67) of the treatment group were more than those of the control group; the incubation period (3.37 ± 0.49) and amplitude (131 ± 52) improved, and there were significant differences between the two groups (Plt;0.05). Comparison of efficacy of the two groups showed the total effective rate: 95.45% in the treatment group, 80.95% in the control group, and the efficacy of the treatment group was better than that of the control group (Plt;0.05). Conclusion Sanqi tongshu, B vitamins, anti-virus, such as the acupuncture and physical therapy for the treatment of acute idiopathic facial paralysis have significant effect.