醒脑静注射液治疗脑梗塞临床疗效及安全性随机对照试验的系统评价

目的系统评价醒脑静与丹参等不同药物比较,治疗脑梗塞的临床疗效和安全性.方法计算机检索MEDLINE (1996～2005.4) 、EMBASE (1984～2005.4) 、Cochrane临床对照试验资料库 (2005年第2期) 、中国Cochrane中心临床对照试验资料数据库、中国生物医学文献数据库 (1978～2005.4),手工检索纳入试验的所有中文及外文文献及相关文献,并逐个进行方法学质量评价,采用RevMan 4.2.7 软件进行Meta 分析.结果共纳入13个随机对照试验 (1 203例患者).Meta 分析结果显示, ①病死率:2个研究比较了醒脑静与丹参的病死率,结果显示,差异有统计学意义 [RR0.31, 95%CI (0.14,0.70)]; 1个研究比较了醒脑静与丹参的病死率,结果显示,其差异无统计学意义 [RR0.92, 95%CI (0.14,6.27)]. ②总有效率:与丹参比较的4个研究,其差异有统计学意义 [RR1.26, 95%CI (1.12,1.42)]; ③治愈率:醒脑静与各种对照措施比较,其差异均无统计学意义; ④不良反应:极少发生且表现轻微,使用相对安全; ⑤神经功能缺损评分:3个研究比较了醒脑静与丹参的治愈率,结果显示,评分前后变化值差异有统计学意义 [WMD3.78, 95%CI (2.30, 5.26)].结论现有的有限证据表明,醒脑静与丹参等药物比较,可以部分降低脑梗塞患者的病死率、提高总有效率; 需要更多设计良好的随机、双盲、安慰剂对照试验加以证实.     

疏血通注射液治疗缺血性脑卒中急性期随机对照试验的系统评价

目的系统评价疏血通注射液治疗缺血性脑卒中急性期的疗效及安全性。方法检索疏血通注射液治疗缺血性脑卒中急性期随机对照试验文献,筛选合格研究,应用Jadad评分法进行质量评价,运用异质性检验、Meta分析、漏斗图分析、敏感性分析等方法统计相关数据。结果4项研究符合纳入标准,Jadad评分所有研究得分均低于3分,属低质量文献。Meta分析结果显示,总有效率比较的相对危险度(RR)为1.13,99%的可信区间(99%CI)为(1.02,1.24);神经功能缺损评分比较的合并加权均数差(WMD)为-5.20,99%CI为(-7.89,-2.51);不良反应皮下瘀斑发生率比较的RR及99%CI均为6.66(0.14,313.35)。结论Meta分析结果显示疏血通注射液具有改善缺血性脑卒中急性期患者神经功能缺损状况的作用,且安全性较高。由于纳入研究质量普遍较低等因素影响,降低了该系统评价结论的可靠性。要进一步验证疏血通注射液治疗缺血性脑卒中急性期的疗效及安全性,尚需进行设计合理、执行严格、多中心大样本且随访时间足够的随机对照试验。     

纳洛酮注射液治疗急性脑梗死随机对照试验系统评价

目的再次评价纳洛酮注射液治疗急性脑梗死随机对照试验临床疗效及安全性。方法制定严格的纳入与排除标准,通过计算机检索Pub Med、Embase、Cochrane图书馆临床对照试验数据库、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库及中国期刊网全文数据库,手工检索及向药厂索取资料,全面收集纳洛酮注射液治疗急性脑梗死的随机或半随机对照试验,检索时间均为从建库至2015年7月,按Cochrane协作网推荐的方法进行再次系统评价。结果共纳入14篇文献,共计1 098例受试者。Meta分析结果表明:纳洛酮治疗组患者治疗后ADL评分、NIHSS评分、ESS评分及总有效率均优于对照组,差异有统计学意义(P<0.05)。且纳洛酮注射液仅有少量轻微不良反应。结论现有临床证据表明纳洛酮注射液能提高急性脑梗死患者的生活质量,促进神经功能恢复,改善预后,安全性好,但由于所纳入的研究质量及数量有限,仍需更多大规模、高质量的研究进一步证实。     

干扰素治疗蕈样霉菌病的系统评价

目的 采用系统评价方法,评估干扰素(IFN)治疗蕈样霉菌病(MF)的疗效及安全性.方法 计算机检索截止2010年5月的Cochrane协作网系统评价方法,纳入所有比较IFN与其他方法治疗MF的随机对照试验及临床对照试验进行质量评价,采用RevMan 5.0.24软件进行Meta分析.结果 共纳入6篇符合标准的已发表文献...     

马来酸桂哌齐特治疗急性脑梗塞的系统评价

目的系统评价马来酸桂哌齐特对于急性脑梗塞患者的疗效、神经功能缺损的改善情况及安全性。方法计算机检索Cochrane图书馆临床对照试验数据库（2010年第1期）、PubMed（1948～2010.3）、EMbase（1966～2010.3）、中国生物医学文献数据库（1978～2010.3）,手工检索相关文献并向药厂索取资料等。按Cochrane系统评价方法筛选试验、评价质量、提取资料,并用RevMan5.0软件进行Meta分析。结果共纳入15个随机对照试验（RCT）（1456例患者）,但均为低质量研究。纳入的试验均未在试验结束后随访患者的死亡/依赖情况。Meta分析结果显示：①神经功能缺损改善情况：11个研究（978例患者）在治疗末进行了神经功能缺损程度的评价。马来酸桂哌齐特组与对照组（空白对照、血塞通注射液、复方丹参注射液、尼莫地平注射液）比较,能显著改善神经功能缺损,差异有统计学意义,其WMD（95%CI）分别为-4.64（-6.43,-2.85）、-2.39（-4.37,-0.42）、-3.67（-5.26,-2.07）和-6.14（-8.39,-3.89）。②有效率：14个研究（1349例患者）报告了临床疗效。马来酸桂哌齐特治疗组与对照组（空白对照、血塞通注射液、复方丹参注射液、尼莫地平注射液）比较临床治疗有效率更高,差异有统计学意义,其RR（95%CI）分别为1.33（1.16,1.54）、1.24（1.04,1.50）、1.33（1.23,1.43）和1.29（1.12,1.49）。③不良反应：所有试验均未未观察到严重不良反应,但马来酸桂哌齐特治疗组头痛、皮肤瘙痒的不良反应发生率与对照组的差异有统计学意义。结论现有的临床研究证据显示,与对照组比较,马来酸桂哌齐特能够减少急性脑梗塞患者的神经功能缺损,提高临床治疗有效率,且无严重不良反应。但因研究质量及研究样本的局限性,尚需进行高质量、大样本的随机对照试验予以进一步证实。     

霉酚酸酯与环磷酰胺比较治疗狼疮性肾炎的系统评价

目的系统评价霉酚酸酯和环磷酰胺诱导缓解治疗狼疮性肾炎的疗效和安全性。方法计算机检索MEDLINE、EMbase、SCIE、Cochrane Library、Cochrane临床对照试验注册资料库、CBM和CNKI等数据库,查找霉酚酸酯与环磷酰胺比较治疗狼疮性肾炎的随机对照试验(检索时间均从建库至2010年8月),按纳入排除标准选择文献、评价质量和提取有效数据后,采用RevMan 5.0软件进行Meta分析。结果共纳入8个随机对照试验,共773例患者。Meta分析结果显示,霉酚酸酯组总缓解率、完全缓解率高于环磷酰胺组[OR=1.49,95%CI(1.10,2.02);OR=1.67,95%CI(1.08,2.57)],但两组在部分缓解率、完成诱导治疗比例方面差异无统计学意义。两组在药物不耐受比例、感染和白细胞减少发生率方面差异无统计学意义,但霉酚酸酯组腹泻的发生率高于环磷酰胺组,差异有统计学意义[OR=2.99,95%CI(1.87,4.78)]。Ⅳ型狼疮性肾炎患者的Meta分析结果也显示了相似的结果。结论霉酚酸酯治疗狼疮性肾炎患者(Ⅲ型、Ⅳ型、Ⅴ型)的总诱导缓解疗效优于环磷酰胺,但腹泻发生率高于环磷酰胺。     

两种丹参类中药注射剂治疗冠心病心绞痛的系统评价及其药物经济学分析

目的系统评价注射用丹参多酚酸盐与丹参注射液治疗冠心病心绞痛的有效性和安全性,并分析其药物经济性。方法计算机检索PubMed、CENTRAL(2013年第4期)、CNKI、VIP和WanFang Data,查找有关注射用丹参多酚酸盐与丹参注射液比较治疗冠心病心绞痛的随机对照试验(RCT),检索时限均为2004年1月~2013年5月。同时手检相关期刊与会议论文。由2位评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果共纳入10个RCT,包括患者1 196例。Meta分析结果显示:注射用丹参多酚酸在治疗冠心病心绞痛方面的有效性[OR=3.79,95%CI(2.78,5.17),P<0.00001]和安全性[OR=0.24,95%CI(0.09,0.64),P=0.004]明显优于丹参注射液,但缺乏经济学优势。结论现有证据表明,注射用丹参多酚酸盐为治疗冠心病心绞痛的安全、有效方案,丹参注射液为较经济方案。受限于纳入研究的数量和质量,上述结论尚需今后开展更多大样本、高质量的RCT加以验证。     

腹腔镜切除术治疗胃间质瘤疗效与安全性的系统评价

目的系统评价腹腔镜切除术治疗胃间质瘤的疗效和安全性。方法按Cochrane系统评价方法,计算机检索PubMed、EMbase、Wiley Online Library、MEDLINE、CNKI、VIP、CBM数据库,检索时间从建库截止2010年12月,并手工检索相关文献,查找腹腔镜与开腹术比较治疗胃间质瘤的随机和非随机对照试验。由2位研究者按照纳入排除标准筛选文献、评价质量并提取资料后,采用RevMan 5.0软件进行Meta分析。结果纳入4个半随机对照试验和8个同期的临床对照试验,共496例患者。Meta分析结果显示:与开腹术相比,腹腔镜手术住院时间短[MD=–2.81,95%CI(–4.51,–1.11)],术后复发及转移发生率低[OR=0.36,95%CI(0.13,1.01)]。但两组在手术时间、出血量、首次排气和进食时间、并发症方面,其差异均无统计学意义(P>0.05)。结论现有研究显示,腹腔镜手术治疗胃间质瘤在减少住院时间、降低复发和转移发生率方面优于传统开腹手术。由于纳入研究方法学质量较低且数量少,期待更多高质量的随机对照试验以提供更高质量的证据。     

丹参川芎嗪注射液联合前列地尔治疗糖尿病肾病的Meta分析

目的:系统评价丹参川芎嗪注射液联合前列地尔治疗糖尿病肾病的有效性和安全性。方法:计算机检索Pub Med、EM-Base、The Cochrane Library、中国知网(CNKI)、万方资源数据库和维普中文科技期刊数据库从建库至2019年8月丹参川芎嗪注射液联合前列地尔治疗糖尿病肾病的随机对照试验研究,根据纳入与排除标准对文献进行筛选,并应用Review Manager5.3统计学软件进行数据分析。结果:最终纳入13篇文献,合计882例患者,其中治疗组(丹参川芎嗪注射液联合前列地尔)和对照组(单用丹参川芎嗪注射液或前列地尔)各441例,Meta分析结果显示,治疗组在提高总有效率[RR=1.21,95%CI(1.10,1.32),P0.0001],降低尿微量白蛋白[MD=-10.03,95%CI (-11.82,-8.24) P0.00001]、24h尿微量白蛋白定量[MD=-49,95%CI (-60.60,-37.39) P0.00001]、血肌酐[MD=-18.22,95%CI (-29.51,-6.949) P=0.002]、尿素氮[MD=-2.98,95%CI (-5.11,-0.84) P=0.006]方面优于对照组,不良反应发生率[RR=1.60,95%CI(0.76,3.39),P=0.22]比较无统计学意义。结论:丹参川芎嗪注射液联合前列地尔治疗糖尿病肾病疗效显著,两者联合应用的临床疗效优于单独用药,但因本研究纳入的质量偏低、样本量少,尚需更多高质量、大样本的临床研究加以验证。     

黄芪注射液治疗再生障碍性贫血疗效和安全性的系统评价

目的系统评价黄芪注射液+雄激素与雄激素单用比较治疗再生障碍性贫血(再障)的疗效和安全性。方法计算机检索Cochrane Library(2011年第3期)、PubMed(1966～2011.3)、EMbase(1974～2011.3)、CNKI(1994～2011.3)、VIP(1989～2011.3)和万方(1997～2011.3)数据库等,按照纳入排除标准选择文献、提取资料和进行质量评价后,采用RevMan 5.0.24软件进行Meta分析。结果共纳入7个随机对照试验,合计518例患者。Meta分析结果显示:黄芪注射液+雄激素治疗组的总有效率优于单用雄激素组,其差异有统计学意义[OR=3.12,95%CI(2.09,4.66),P<0.00001];治疗组与对照组的骨髓增生升级程度相当,其差异无统计学意义[OR=1.93,95%CI(0.85,4.38),P=0.11];治疗组的不良反应明显少于对照组,其差异亦有统计学意义[OR=0.30,95%CI(0.12,0.76),P=0.01]。结论黄芪注射液+雄激素治疗再障的有效率高于单用雄激素,且不良反应少。但由于纳入研究样本量小且质量较低,上述结论尚需更多高质量的研究来加以证实。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.