目的:觀察膠原酶治療腰椎間盤突出的療效。方法:對1218例不同程度的腰椎間盤突出患者進行椎旁穿刺,注入膠原酶1200u進行溶解治療。結果:91%的患者取得較好療效,9%的患者療效欠佳。結論:膠原酶是治療腰椎間盤突出的一種有效方法。
ObjectiveTo systematically review the efficacy and safety of JAK inhibitor in the treatment of axial spondyloarthritis (axSpA). MethodsThe PubMed, Cochrane Library, Embase, CNKI, WanFang Data, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of JAK inhibitors in patients with axSpA from inception to December, 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 7 RCTs involving 1 602 patients were included, including 852 patients in the experimental group and 750 patients in the placebo group. The results of meta-analysis showed that in terms of clinical efficacy, ASAS20 (RR=1.67, 95%CI 1.50 to 1.86, P<0.01), ASAS40 (RR=2.30, 95%CI 1.93 to 2.73, P<0.01), ΔBASFI (MD=?1.04, 95%CI ?1.21 to ?0.87, P<0.01), and ΔBASMI (MD=?0.30, 95%CI ?0.41 to ?0.19, P<0.01) of JAK inhibitors in the treatment of axSpA patients were significantly higher than those in the placebo group. In terms of safety, adverse event (RR=1.09, 95%CI 0.97 to 1.21, P=0.14) and major adverse events, such as diarrhea (RR=1.18, 95%CI 0.55 to 2.51, P=0.67), nasopharyngitis (RR=0.98, 95%CI 0.55 to 1.75, P=0.96), liver enzyme abnormalities (RR=1.83, 95%CI 0.84 to 3.99, P=0.13), and headache (RR=1.94, 95%CI 0.77 to 4.87, P=0.16) were statistically insignificant. ConclusionCurrent evidence shows that JAK inhibitors can improve the clinical efficacy in the axSpA patients, and the safety is high. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
目的 研究C-C亞族趨化因子單核細胞趨化蛋白-4（MCP-4/CCL13）在系統性紅斑狼瘡（SLE）患者外周血的表達水平，并分析MCP-4的水平與狼瘡腎炎的關系，以探討MCP-4在SLE發病機制中可能起的作用。 方法 選取2007年9月－2010年8月在四川大學華西醫院和宜賓市第一人民醫院診斷明確的SLE及類風濕關節炎（RA）患者各40例。另收入正常健康對照組（20例），應用酶聯免疫吸附試驗定量方法測定SLE組、RA患者和正常健康對照者血清中MCP-4的水平，SLE患者根據有無腎臟受累分為非狼瘡腎炎組和狼瘡腎炎組，其中非狼瘡腎炎組20例，狼瘡腎炎組20例，并分析SLE組血清MCP-4水平是否與抗核抗體、補體C3、C4等指標及SLE疾病活動指數SLEDAI評分相關性，血清MCP-4水平采用方差分析、LSD-t檢驗和Spearman相關進行統計分析。 結果 血清MCP-4水平SLE組為（216.32 ± 12.65）pg/mL，RA組為（203.79 ± 18.64）pg/mL，正常健康對照組為（125.13 ± 11.08）pg/mL。SLE組、RA組血清MCP-4水平與正常健康對照組相比均有統計學意義（P＜0.05），SLE組與RA組比較血清MCP-4水平無統計學意義（P＞0.05）；SLE患者中狼瘡腎炎組與非狼瘡腎炎組比較血清MCP-4水平無統計學意義（P＞0.05）。SLE組血清MCP-4水平與抗核抗體、補體C3、C4等指標及SLEDAI評分無相關性。 結論 MCP-4在SLE組患者血清中表達增高，MCP-4可能參與了SLE的發病過程，可能成為SLE新的血清學有用指標并作為治療的靶點。
Objective To investigate the benefits and drawbacks of breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap for breast cancer and treatment experience of postoperative operation-related complications. Methods A retrospective analysis was performed on clinical data of 26 female patients with breast cancer who met the selection criteria between September 2021 and March 2023 aging 48.7 years (range, 26-69 years). All tumors were unilateral, with 17 on the left side and 9 on the right side. The tumor size ranged from 1.0 to 7.0 cm, with an average of 2.7 cm. The pathological staging included T1 in 11 cases, T2 in 14 cases, and T3 in 1 case; N0 in 10 cases, N1 in 11 cases, N2 in 2 cases, and N3 in 3 cases; no distant metastasis (M0) occurred when first diagnosed. Among them, 10 cases underwent breast conserving surgery, and 16 cases underwent nipple-sparing mastectomy. All patients underwent breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap. The operation time, incision length, and postoperative drainage volume in 3 days were recorded. Breast-Q “Satisfaction with back” scale was conducted to evaluate patients’ satisfaction with back at 6 months after operation. Results The operation time was 280-480 minutes (mean, 376.7 minutes), the incision length was 10-15 cm (mean, 12.2 cm), the postoperative drainage volume in 3 days was 500-1 600 mL (mean, 930.2 mL). There were 4 cases of postoperative seroma, 1 case of incision rupture, 1 case of paresthesia of the thoracic wall, and 1 case of edema of the ipsilateral upper limb. All patients were followed up 12-30 months (mean, 20.1 months). No latissimus dorsi muscle flap necrosis, latissimus dorsi muscle atrophy, or shoulder joint dysfunction occurred during follow-up; 2 patients had recurrence of lymph nodes in the ipsilateral axilla after operation, but no distant metastasis occurred. Breast-Q score at 6 months after operation was 64-100 (mean, 79.5). The average score was 78.6 (range, 64-100) in patients underwent nipple-sparing mastectomy and 81.0 (range, 78-100) in patients underwent breast conserving surgery. Conclusion Breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap for breast cancer is proven to be a surgical approach with safety and cosmetic effects with mild postoperative operation-related complications and considerable patient satisfaction.