支氣管哮喘( 簡稱哮喘) 是一種以多種細胞特別是肥大細胞、嗜酸粒細胞和T 淋巴細胞等炎性細胞參與的氣道慢性炎性反應和以氣道高反應性為特征的疾病[1] 。目前全球大約有3.0 億哮喘患者, 占世界人口的1% ～3% , 我國大約有2 500 萬哮喘患者, 哮喘的發病率和死亡率在世界范圍內一直呈增高趨勢[2] 。2008 年在美國估計有210 萬人或1.1% 的人口在過去的12個月內尋求針刺治療, 4% 的美國人表示在他們的生活中曾使用過針刺療法[3] 。針刺治療哮喘在我國已有千年歷史, 且相當普遍。目前哮喘的治療仍以現代醫學為主, 但尚無根治方法, 針刺治療哮喘主要目標是控制哮喘復發, 提高患者的生命質量。
ObjectiveThe application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program. Methods The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized. ResultsAccording to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, etc., which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function. ConclusionReasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.
Medical ethics must be considered for protecting the fights and interests of patients in clinical trials. Now the fights of the subjects are more and more emphasised, but there are some problems. It is evidence-based medicine (EBM) and emphasis of evidence that need the high-quality clinical trials, yet it violates the principle of ethics in some degree. It will be helpful for the administrators to supervise the clinical trials on drugs well from the point of ethical views.
Objective To assess the quality of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) relevant to COPD besides chronic bronchitis and chronic pulmonary cor disease in strengthening immune published in Chinese medical journals to provide scientific basis of systematic review (SR) of regulating the immune function of COPD in Chinese herbs. Methods 54 articles with clinical controlled trials were obtained by electronic searching and handsearching, and the method for randomized allocation, blindness, multi-centres, sample sizes, diagnosis criteria, exclusion criteria, source of cases, immune markers (cellular immunity, humoral immunity, erythrocyte immunity, nonspecific immunity), the clinical outcome assessment, statistical management, course of treatment and the side effects or adverse drag reaction, follow-up were investigated and then methodologically evaluated. According to the investigation, literatures with the method for randomized allocation, correct controls, appropriate sample sizes (≥60), the nation-wide diagnosis criteria, the objective clinical outcome assessment distinct statistical method were stipulated as the high-quality ones relatively. Results Among the 54 trials, 70.4% had explicit diagnosis criteria, 18.5% with exclusion criteria, 20.4% with comparability of baseline, 37.0% with distinct statistical method. In the therapy, 63.0% were with Chinese herbs. Conclusion The selected 7 articles belong to the high quality and possibly are to be explored in Meta-analysis.
Assessment on adverse drug reactions (ADR) that directly affects the quality of life and mortality and an important part of the post-marketed reassessment are developing gradually in China. Many problems have been identified in clinical validity and safety for the authorized Chinese herbs. An effective and standardized system is needed in the post-marketed drug reassessment. Evidence-based drug evaluation, which mainly includes clinical epidemiology, systematic review and health technology, will be used to assess the clinical validity, safety and cost of post-marketed drug and play an important role in the process of modernization and internationalization of Chinese herbs.
Objective To investigate clinicopathologic features, pathogenesis, and diagnosis and treatment of hereditary pancreatitis (HP). Method The relevant literatures on HP research in recent years were searched and reviewed. Results The HP was similar to the pancreatitis caused by the cholelithiasis, excessive alcohol consumption, hyperlipidemia, etc. in the histomorphology, function, and clinical manifestations and it was difficult to be distinguished. However, HP was different from the other types of chronic pancreatitis due to its early onset, familial, and high risk of pancreatic cancer. The HP was mainly caused by the PRSS1 mutations, and its mutation types mainly included the R122H, N29I, A16V, K23R, etc., among which the R122H and N29I were the two most common types of mutations. There was no specific treatment for the HP. The principles of treatment of HP were similar to the pancreatitist caused by other etiologies, including the nutritional support, blood sugar control, analgesia, etc.. In addition to the medical treatment, the surgical intervention was also the important means for the treatment of HP, including the pancreatic partial resection, total pancreatectomy or total pancreatectomy combined with islet cell autografting. Conclusions HP is an autosomal dominant hereditary disease characterized by recurrent attacks of pancreatitis. Relevant gene tests could be performed for patient with highly suspected HP. It faces great challenges in treatment of HP. Pathogenesis of HP needs to be constantly explored and experimental study of multicenter and large sample needs to be further studied in order to determine its best treatment strategy.
ObjectiveTo systematically evaluate the factors affecting the curative effect of pulmonary rehabilitation in COPD patients,and to provide theoretical basis for the implementation of rehabilitation. MethodsLiterature on the influencing factors of pulmonary rehabilitation efficacy in COPD patients was systematically searched in PubMed,Web of Science,Medline,ProQuest,Embase,CNKI and Wanfang databases from August 30,2023. According to the inclusion and exclusion criteria of the literature,the factors influencing the pulmonary rehabilitation effect of COPD patients were analyzed based on the 5 dimensions of the new implementation comprehensive framework. ResultsA total of 2620 COPD patients with 18 literatures were included in this study. Based on the new CFIR framework,11 promoting factors and 10 hindering factors of pulmonary rehabilitation efficacy were extracted and coded into 5 fields:innovation field,external factor field,internal factor field,individual characteristics field and implementation process field. ConclusionBy applying the new implementation comprehensive framework to evaluate the factors affecting the pulmonary rehabilitation effect of COPD patients,it provides an important reference for the development of rehabilitation strategies for COPD patients. It is suggested to adopt the comprehensive rehabilitation strategy of interdisciplinary,wide field and multi-team in order to promote the best benefit of both individual and social medical system in the pulmonary rehabilitation process of COPD patients.
Objective To study effects of Helicobacter pylori on oncogenesis and progression of pancreatic cancer. Method The current literatures on the relationship between the Helicobacter pylori and the pancreatic cancer were collected and reviewed. Results The Helicobacter pylori infection might play a role in the development of the pancreatic cancer. The infection rate of the Helicobacter pylori in the patients with pancreatic cancer is higher than that of the healthy controls; furthermore, in the patients with Helicobacter pylori antibody positive, the infection rate of the Helicobacter pylori in the cytotoxin-associated gene A-negative strains of Helicobacter pylori is significantly higher than that of the healthy controls. Conclusions Helicobacter pylori infection is related to occurrence and development of pancreatic cancer. Specific mechanism is still not clarified and further research is need to study.
Objective To systematic investigate whether phase angle of bioelectrical impedance is associated with the functionality, severity, and prognosis of individuals afflicted with chronic obstructive pulmonary disease (COPD). Methods Relevant literature from the PubMed, Embase, Web of Science, Scopus, CNKI, and WanFang databases was retrieved, and literature screening and data extraction in accordance with standardized methods were conducted. Literature quality was assessed by utilizing Mixed Methods Appraisal Tool. Subsequently, data pertaining to the results was extracted for summarization and induction, and descriptive analyzed through qualitative synthesis. Results A total of 11 studies, encompassing 2189 subjects, were included in this review, and the overall quality of the literature was deemed relatively high. Of these studies, three examined the correlation between phase angle and the severity of COPD, eight studies examined the correlation between phase angle and pulmonary and physical function in COPD, and seven studies reported the association between phase angle and adverse outcomes such as hospitalization time, nutritional risk, acute exacerbation and mortality in COPD. The collective findings suggestted that reduced levels of phase angle are linked to severe illness, diminished function, and unfavorable prognosis among individuals with COPD. Phase angle emerged as an independent predictor of lung function, physical exercise endurance, acute exacerbation and mortality in COPD patients. Conclusion The phase angle level of COPD patients is associated with their disease severity, function, and prognosis, and is an potential available indicator for clinical management of COPD patients.
ObjectiveTo summarize the latest progress of parathyroid gland identification in thyroid surgery, and to provide some reference for improving the clinical efficacy.MethodThe literatures about the identification of parathyroid gland in thyroid surgery in recent years were collected to make an review.ResultsThere were many methods for identifying parathyroid gland in thyroid surgery, such as naked eye identification method, intraoperative frozen section, intraoperative staining identification method, intraoperative optical identification method, intraoperative parathyroid hormone assay, γ-detector, and histological identification, each method had its own advantages and disadvantages.ConclusionThe identification of parathyroid gland does not only depend on a certain method, but also require surgeons to enhance their ability to distinguish parathyroid gland.