Clinical comprehensive treatment protocol for managing diabetic foot ulcers:A retrospective cohort study

BACKGROUND Diabetic foot ulcers(DFUs)are a common complication of diabetes,often leading to severe infections,amputations,and reduced quality of life.The current standard treatment protocols for DFUs have limitations in promoting efficient wound healing and preventing complications.A comprehensive treatment approach targeting multiple aspects of wound care may offer improved outcomes for patients with DFUs.The hypothesis of this study is that a comprehensive treatment protocol for DFUs will result in faster wound healing,reduced amputation rates,and improved overall patient outcomes compared to standard treatment protocols.AIM To compare the efficacy and safety of a comprehensive treatment protocol for DFUs with those of the standard treatment protocol.METHODS This retrospective study included 62 patients with DFUs,enrolled between January 2022 and January 2024,randomly assigned to the experimental(n=32)or control(n=30)group.The experimental group received a comprehensive treatment comprising blood circulation improvement,debridement,vacuum sealing drainage,recombinant human epidermal growth factor and anti-inflammatory dressing,and skin grafting.The control group received standard treatment,which included wound cleaning and dressing,antibiotics administration,and surgical debridement or amputation,if necessary.Time taken to reduce the white blood cell count,number of dressing changes,wound healing rate and time,and amputation rate were assessed.RESULTS The experimental group exhibited significantly better outcomes than those of the control group in terms of the wound healing rate,wound healing time,and amputation rate.Additionally,the comprehensive treatment protocol was safe and well tolerated by the patients.CONCLUSION Comprehensive treatment for DFUs is more effective than standard treatment,promoting granulation tissue growth,shortening hospitalization time,reducing pain and amputation rate,improving wound healing,and enhancing quality of life.

Research on the Effect of Comprehensive Intervention in the Clinical Treatment of Patients with Type 2 Diabetes Mellitus

Objective:This study aims to explore the value of comprehensive intervention in the clinical treatment of patients with type 2 diabetes mellitus complicated with hypertension.Methods:90 patients with type 2 diabetes and hypertension were selected and divided into a control group and an intervention group according to the random number table method,with 45 cases in each group.The control group received conventional treatment,and the intervention group received comprehensive intervention on the basis of the control group,including a diet plan,an exercise program,scientific treatment,regular monitoring,and psychological counseling.The blood sugar,blood pressure,and other indicators of the two groups were compared.Results:After 5 months of intervention,the fasting blood glucose,postprandial 2 h blood glucose,glycosylated blood glucose protein,diastolic blood pressure,systolic blood pressure,mean arterial pressure,and other indicators of the intervention group were significantly lower than the control group(P<0.05),and the rate of decrease was significantly greater than that of the control group(P<0.05).Conclusion:Comprehensive intervention for patients with type 2 diabetes mellitus and hypertension helps in controlling blood sugar and lowering blood pressure,with clinical significance.

Guidelines and standards for comprehensive clinical diagnosis and interventional treatment for diabetic foot in China(Issue 7.0)

Diabetic foot(DF)is one of the most common complications of diabetes and is associated with high morbidity,disability,lethality and low cure-rate.The clinical diagnosis and treatment of DF need to be standardized.The Chinese Diabetic Foot Cell and Interventional Therapy Technology Alliance has released six editions of guidelines and standards for clinical diagnosis and interventional treatment of DF,which filled the gap in the domestic DF treatment standard and played an important role in improving the level of diagnosis and treatment in China.In line with the latest developments in diagnosis and treatment,the Alliance,along with other 89 institutions,developed and issued the new edition based on the sixth edition to help standardize the clinical diagnosis and treatment of DF in China.

Clinical Effect of Comprehensive Rehabilitation Treatment for Deep Burns in Different Functional Joint Areas

Objective:To analyse the clinical effect of comprehensive rehabilitation therapy in patients with deep burns at different functional joint areas.Methods:Eighty-one patients with deep burns with different functional joint areas from April 2018 to April 2019 were divided into the conventional and rehabilitation groupings.The conventional group(n=40)received routine treatment and rehabilitation while the rehabilitation group(n=41)was given comprehensive rehabilitation treatment.Thereafter,the recovery of joint function in patients with deep burns in different areas,the combined value of clinical long-term treatment,the recovery of joint function and the score of daily living ability were calculated.Results:The total long-term effective rate of treatment,the recovery of the joint function,and the score of daily living ability of the patients with deep burns in the rehabilitation group were more favourable than those of the conventional group as demonstrated by P<0.05,the index data indicating statistical significance.Conclusion:Comprehensive rehabilitation therapy can reduce complications and improve the quality of life in patients with deep burns in different functional joint areas.

Clinical analysis of valvuloplasty on treatment of infective endocarditis

Objective To investigate the clinical effect of valvuloplasty on infective endocarditis ( IE) . Methods antimicrobial susceptibility was tested by K - B paper disk method. All the cases were treated with valvuloplasty. Results Totally 28 cases ( 43. 8% ) showed positive results by blood culture,and the main pathogens

Research progress in rehabilitation treatment of stroke patients A bibliometric analysis

BACKGROUND： Stroke presents as a transient or chronic brain dysfunction and is associated with high morbidity and high mortality. The doctors and scientists would like to argue how to enhance the validity of the rehabilitation treatment and how to further improve the level of treatment on stroke. OBJECTIVE： The aim of this study was to quantitatively analyze the current worldwide progress in research on stroke rehabilitation treatment based on Web of Science database and CiinicalTrial.gov in the past 10 years. METHODS： We conducted a quantitative analysis of clinical trial articles regarding stroke rehabilitation published in English from 2003 to 2013 and indexed in the National Institutes of Health Clinical Trials registry and Web of Science databases. Data were downloaded on March 15, 2013. RESULTS： （1） From 2003 to 2013, 2 654 clinical trials investigating stroke were indexed in ClinicalTrials.gov. There were only 58 clinical trials registered in 2003, and there was a marked increase from 2005. A total of 605 clinical trials on the rehabilitation of stroke were conducted in the past 10 years. （2） The analysis showed that most of the trials in the field were registered by North American institutions. With respect to the Asian countries, China and Taiwan Region of China also published a reasonable proportion of the trials, but comparatively speaking, the number of trials is really rare. Most of the interventions were drugs, followed by the devices, and behavioral interventions were ranked third. （3） In the past 10 years, there were 4 052 studies on stroke indexed by Web of Science database. CONCLUSION： From perspective of research progress, we found that the number of clinical trials and papers on stroke rehabilitation has increased significantly in the past 10 years, between them a remarkable positive correlation exists.

Clinical Analysis of 73 Cases of Intraspinal Nerve Sheath Tumor

Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.0 months. Out of the 73 cases enrolled, 69 had gradual recovery of sensation, motor and sphincter functions 1 week to 3 months after operation. Forty-six cases had incomplete paralysis, whose American Spinal Injury Association （ASIA） grades, however, were gradually increased during the follow-up period, 4 cases had no significant improvement of the clinical symptoms and no change in ASIA grades during the follow-up period. Two cases had postoperative recurrence of the tumor. There were no deaths, no spinal instability, and no kyphotic malformations fotmd in any cases. Our study indicated that complete removal of the tumor is important for good recovery, and an ideal surgical method may reduce the recurrence of the tumor or the occurrence of complications.

Clinical Effect of Integrated Traditional Chinese and Western Medicine on Diabetic Peripheral Neuropathy

Objective:Patients with diabetic peripheral neuropathy were treated with integrated traditional Chinese and western medicine,and the final results were observed.Methods:70 patients with such symptoms were randomly divided into two groups.The number of people is the same,and the treatment methods are different.The control group uses western medicine,while the observation group uses traditional Chinese medicine to evaluate the treatment effect.Results:After treatment,the effective rate of the observation group was(P<0.05),indicating that the treatment effect was significantly better.Conclusion:Patients with clinical diabetic peripheral neuropathy treated with routine nutrition and nerve repair,and with Chinese medicine,the effect is more satisfactory,and the effect is positive,so as to promote the optimization of their health.

Mini-CEX联合MDT在急诊科住院医师规范化培训中的应用效果

目的探讨迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)联合多学科综合治疗协作组(multidisciplinary team,MDT)在急诊科住院医师规范化培训中的运用效果。方法选择于医院急诊科进行规范化培训的住院医师,2022年6—8月进行规范化培训者为传统培训组,2022年9—11月进行规范化培训者为Mini-CEX联合MDT组。传统培训组35名,给予常规教学方式教学,Mini-CEX联合MDT组35名,给予Mini-CEX联合MDT教学,教学完成后评估规范化培训住院医师的理论成绩及实际操作技能,教学前、后通过Mini-CEX考核规范化培训住院医师的问诊能力、临床诊断、操作能力、查体能力、治疗方案、沟通能力,给予评判性思维能力量表-中文版(critical thinking disposition inventory—Chinese version,CTDI-CV)、学生自主学习能力评价量表评价,比较2组教学满意度。结果Mini-CEX联合MDT组理论知识、实际操作技能评分较传统培训组高,差异有统计学意义(P<0.001);Mini-CEX联合MDT组问诊能力、临床诊断、操作能力、查体能力、治疗方案、沟通能力评分较传统培训组高,差异有统计学意义(P<0.001);Mini-CEX联合MDT组CTDI-CV评分较传统培训组低,自主学习能力评分、教学满意度较传统培训组高,差异有统计学意义(P<0.001)。Mini-CEX联合MDT组教学满意度(97.14%)较传统培训组高(85.71%),差异有统计学意义(P<0.05)。结论在急诊科住院医师规范化培训中运用Mini-CEX联合MDT教学,可提升规范化培训住院医师理论及实践操作成绩,提升其综合临床能力、评判性思维能力、自学能力及教学满意度。

基于审美分析的口腔美容修复分类诊疗方案(一):基本概念、决策树及临床路径

当前美容修复临床方案多基于欧美国家提出的口腔美感指标(简称欧美审美)制定,但机械地照搬欧美口腔美容修复方案,忽视了其与中国人口腔美感指标(简称中式审美)的差别,是无法有效支撑国人个性化口腔美容修复诊治的。另外,近年发展迅猛的美容修复新技术、新方案层出不穷,但不少热门概念的内涵混淆不清,也缺乏应有的分级诊疗规范,急需讨论明晰。本文从服务好口腔美容修复临床运用出发,探讨了中译词“美学”的不足与误用,美学与美容的区别与联系,美容修复与固定修复的相关关系,还讨论了前牙区、美学区与暴露区的差别、口腔审美分析的诊疗价值,以及脱敏、暗示等疗法在口腔疑难美容修复病例中的运用方法。进一步介绍了审美分析引导的暴露区牙位修复重建的决策树及临床路径,并案析介绍了审美分析评估临床流程、口腔美容修复临床三分类及相应的临床分类诊疗要点。

外阴良性肿瘤的病理特征及临床分析

目的 探讨外阴良性肿瘤的临床特点、病理特征及治疗预后,总结相关的临床诊治经验。方法 收集2018年1月至2022年12月因外阴肿物收入首都医科大学附属北京妇产医院妇科微创中心住院治疗的24例经病理检查证实为外阴良性肿瘤患者的临床及病理资料进行回顾性分析。探讨发病年龄、临床症状体征、肿物性状特点、病理类型、治疗及转归情况。结果 24例患者中仅2例(8.3%)为多发病灶,其余患者均为单发。发病年龄为14~78岁,中位发病年龄为38岁,围绝经期患者2例(8.3%)。所有患者表现为自触和/或在妇科检查时发现外阴肿物,有2例伴异味及破溃;病程为2周~70年;3例表现为外阴囊性肿物,21例表现为外阴实性肿物(包括8例外阴皮赘),包块大小为0.5~8 cm。术后病理诊断为外阴软纤维瘤者8例,平滑肌瘤4例,外阴皮内痣、纤维瘤、乳头状汗腺腺瘤、血管肌纤维母细胞瘤各2例,多发鳞状细胞乳头状瘤、脂肪瘤、细胞性血管纤维瘤、孤立性纤维性肿瘤各1例。除1例外阴多发鳞状细胞乳头状瘤患者行单纯外阴切除术,其余患者均采用局部病灶切除术。术后随访3个月~5年,均未见复发。结论 外阴良性肿瘤多为单发,实性肿物多见,常无明显自觉症状,病理类型呈多样性,预后较好,建议尽早手术切除,术后加强随访。

中医针推治疗腰椎间盘突出症的临床疗效分析

目的分析中医针推治疗腰椎间盘突出症的临床疗效。方法选取100例腰椎间盘突出症患者作为研究对象,收治时间为2022年2月—2023年2月。采用随机数字表法将患者分为两组:对照组和观察组,每组均为50例。观察组患者接受中医针推治疗;对照组患者接受常规药物治疗。对比两组临床疗效。结果经过治疗,观察组治疗总有效率、VAS评分、JOA评分、TNF-α、hsCRP、-6(IL-6)均显著优于对照组,组间差异显著(P<0.05)。结论中医针推治疗腰椎间盘突出症具有显著的疗效,优于常规药物治疗。它能够快速缓解疼痛,改善患者的症状和体征,提高生活质量。因此,中医针推治疗应作为腰椎间盘突出症的首选治疗方法之一。

Design and analysis of high-risk medical device clinical trials for diabetes monitoring and treatment: a review

Class III medical devices are those devices that support or sustain human life or prevent impairment of human health but,when used,pose high risks to the patients.There were 15 class III medical devices that were approved by the US Food and Drug Administration from September 1,2005 to December 31,2018 for glucose monitoring and diabetes treatment.In this article,we reviewed the study design and statistical analysis in clinical trials that were conducted to provide evidences for safety and effectiveness of these medical devices.Two exemplars of clinical trials for"Eversense continuous glucose monitoring system"and"t:slim X2 Insulin Pump with Basal-IQ Technology"are discussed in details.

状态论治急危重症病例分析方法在博士研究生临床教学中的应用

姜良铎教授提出的“状态论治”是中医精准辨治各种疑难复杂、危重病证的有效方法。实践证明状态论治能够提升临床疗效,特别是对急危重症的救治起到重要的指导作用。将现代医学症状、体征、辅助检查等诊断依据纳入中医学辨证论治体系中,用中医理论辨证分析急危重症的临床信息和中医四诊资料,最终辨证为包含当前病机、基本病机、演变病机3个层次的状态病机,根据此状态病机从整体上、综合性地立法遣方用药,施救急危重症,能够截断病势,扭转病情。将状态论治的诊疗思维方法贯穿在北京中医药大学专业学位博士研究生的临床教学中,能帮助学生将书本知识转变成临床知识,并能提高博士研究生融会贯通中西医理论的思维能力,最终有利于提升专业学位博士研究生处理急危重症的综合能力。

美国国立综合癌症网络肿瘤学临床实践指南指导下的口腔癌规范化治疗

口腔癌在全球范围内发病率较高,是影响口腔与全身的重要公共健康问题。不同专业学科对于口腔癌的治疗手段不一,并且医生个人经验具有一定的局限性,临床工作指南能够使不同专业的医生根据实际情况确定一个对于患者最适合的、一致化的治疗方案。美国国立综合癌症网络(NCCN)制定的NCCN肿瘤学临床实践指南已经成为全球肿瘤临床实践中应用最广泛的指南。本文就2024年第3版的《NCCN头颈癌指南》,结合具体病例,探讨不同分期口腔癌规范化治疗方案的选择。

糖尿病足介入综合诊治临床指南(第九版)

糖尿病足作为糖尿病血管病常见并发症之一,具有高发病率、高致残率、高致死率和治愈率低的特点,严重影响糖尿病患者的身心健康和生活品质,却一直缺少统一的规范性治疗方法。中国糖尿病足细胞与介入治疗技术联盟曾于2015年制定了糖尿病足介入综合诊治临床指南(第一版),在一定程度上填补了国内糖尿病足规范性治疗的空白,对于提高我国糖尿病足治疗水平起到了支撑作用。近10年来,随着诊断标准和治疗方式的更新,以及国内外相关研究的不断深入,联盟组织国内89家单位在第八版的基础上进行新的修订,并颁布第九版指南,以期进一步规范我国糖尿病足临床诊治工作。本指南较第八版主要增加了糖尿病足下肢动脉狭窄或闭塞的腔内治疗原则,强调血管重建优先重建直线血流的原则,至少建立1支能够从股浅动脉起始端到达足部病变部位的直接供血动脉,对于膝下动脉多支病变治疗时建议遵循“先易后难”的重建原则,先处理容易开通的病变动脉,保证至少有1支血管能够供应到足部。同时本版指南介绍了同济大学“五点法皮温”设备在糖尿病足诊治中的巨大应用价值。

慢性肾脏病围透析期的中医一体化治疗

慢性肾脏病(CKD)围透析期病情进展迅速,各系统症状突出,且并发症多,患者生存率及生命质量下降明显。以中药经方、现代医家经验方、中成药及中药制剂等为主的中医内治法,结合中药灌肠、耳穴压豆、中药熏洗、穴位贴敷等常见中医外治法的中医一体化治疗模式,可以缓解临床症状,保护残余肾功能,防治并发症,降低死亡率,对围透析期患者的综合管理具有显著作用。

Mycobacterium gordoniasis of the cervical lymph nodes:A case report

BACKGROUND Owing to the advancement in bacterial identification techniques,the detection rate of non-tuberculous mycobacterium(NTM)has been on the rise.Different from Mycobacterium tuberculosis,the clinical symptoms of NTM are not easily detected,and the clinical efficacy and prognosis are somewhat heterogeneous.To report a case of Mycobacterium gordoniasis of cervical lymph node diagnosed in Anhui Chest Hospital in July 2022.CASE SUMMARY Upon examination,the patient who weighed 67.5 kg,was human immunodeficiency virus negative,healthy,without hypertension,diabetes,heart disease and other basic diseases microscopic analysis revealed granulomatous inflammation with coagulation necrosis in the lymphocyte,and tuberculosis was not ruled out.Plain computed tomography scans of the neck and chest indicated the presence of a single grayish-yellow and grayish-brown tissue,the dimensions of which was top of form 10.5 cm×3.0 cm×1.5 cm.After pathological consultation in our hospital,the diagnosis was confirmed as NTM infection.CONCLUSION This case report and the clinical epidemiological research on improving NTM have important guiding significance for improving decision-making in clinical treatments.

真武汤合血府逐瘀汤联合西医治疗慢性心力衰竭疗效的Meta分析

目的 观察真武汤合血府逐瘀汤联合西医治疗慢性心力衰竭(CHF)的临床疗效。方法 将中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、Web of Knowledge数据库中收录的有关真武汤合血府逐瘀汤联合西医治疗CHF临床疗效的临床随机对照试验(RCT),按照纳入和排除标准选取文献,并提取文中的数据,用Revman5.3软件进行Meta分析。结果 共纳入了12篇文献,包括1006例患者,其中试验组和对照组各503例。对照组采用常规西医治疗,试验组采用真武汤合血府逐瘀汤联合西医治疗。根据Cochrane手册的评价标准,所纳入的文献均为中低质量文献。(1)临床疗效的Meta分析:采用固定效应(FE)模型进行分析,结果显示加权均数差(WMD)=1.24, 95%置信区间(CI)=(1.17, 1.31), P<0.01,说明采用真武汤合血府逐瘀汤联合西医治疗较常规西医治疗可以提高CHF患者的临床有效率。(2) N末端B型利钠肽前体(NT-proBNP)的Meta分析:采用FE模型进行分析,结果显示WMD=-144.35, 95%CI=(-164.97,-123.74), P<0.01,说明西医加用真武汤合血府逐瘀汤相对于常规西医治疗,可以更好地降低CHF患者的NT-proBNP水平。(3)左心室射血分数的Meta分析:采用随机效应(RE)模型进行分析,结果显示WMD=9.37, 95%CI=(6.47, 12.26), P<0.01,说明西医加用真武汤合血府逐瘀汤治疗较常规西医治疗可以提高CHF患者的左心室射血分数。(4)左心室舒张末期内径的Meta分析:采用FE模型进行分析,结果显示WMD=-3.85, 95%CI=(-4.91,-2.79), P<0.01,说明西医加用真武汤合血府逐瘀汤较常规西医治疗可以降低CHF患者的左心室舒张末期内径。(5)不良反应分析:西医联合真武汤合血府逐瘀汤治疗CHF能够减少不良反应的发生。以临床有效率的Meta分析结果进行发表偏倚的分析,漏斗图结果显示各项研究平均地分布在中线两侧,但是图形缺乏对称性,考虑可能存在发表偏倚。结论 真武汤合血府逐瘀汤联合西医治疗可显著提高CHF患者的临床疗效。

妊娠糖尿病实施临床综合治疗方法的效果分析

目的 分析妊娠糖尿病采用临床综合治疗方法的疗效。方法 随机选取2020年4月—2022年12月漳州市第二中医院收治的222例妊娠糖尿病患者为研究对象,以随机数表法将患者分成参照组与观察组,各111例。参照组实施常规的药物治疗,观察组实施胰岛素注射治疗同时给予饮食治疗、运动治疗等综合治疗,比较两组患者的血糖指标改善情况、产妇分娩妊娠结局、新生儿妊娠结局。结果 观察组空腹血糖(Fasting Plasma Glucose, FPG)、餐后2 h血糖(Postprandial Plasma Glucose at 2 Hours, 2 hPG)和糖化血红蛋白(Glycosylated Hemoglobin A1c, HbA1c)比治疗前有明显改善,其下降幅度优于参照组,差异有统计学意义(P均<0.05)。观察组的自然分娩率(82.88%)高于参照组(61.26%),产后出血发生率(1.80%)低于参照组(8.11%),差异有统计学意义(P均<0.05)。观察组的不良新生儿妊娠结局发生率低于参照组,差异有统计学意义(P<0.05)。结论 妊娠糖尿病患者开展综合治疗,能有效改善患者的妊娠结局,疗效明显,血糖得到良好控制,保障母婴健康与安全。