原发性闭角型青光眼小梁切除术不同切口位置术后临床评效

目的:探讨原发性闭角型青光眼复合小梁切除术切口位置不同对患者术后治疗效果的比较,包括眼压的比较,术后舒适性的比较,及对于患者将来行白内障手术切口位置的选择的帮助。方法:对56例(62眼),原发性闭角性青光眼(pri-mary angle-clo-sure glaucoma,PACG)患者采用显微镜下1点位(42)和颞下方不同位置切口行复合小梁切除术(小梁切除口减小+丝裂霉素+前房穿刺),均为连续病例。其中1点位切口32例(36眼),颞下切口24例(26眼),术后3d、7d、2月分别观察眼压情况,术后1a滤过泡的情况及2月时患者自身舒适性感觉的情况。结果:1点位切口选择组术后平均眼压13.89±3.76mmHg,颞下切口选择组术后平均眼压13.91±3.25mmHg,无明显差异。1点位切口功能性滤过泡34眼(其中Ⅰ型15眼,Ⅱ型19眼),所占比例为:80.8%,颞下切口选择组功能性滤过泡16眼(其中Ⅰ型7眼,Ⅱ型9眼),所占比例为:80.0%,两组功能性滤过泡所占比例在统计学上差异无显著性。术后舒适性比较颞下切口选择组半月内明显优于1点位切口选择组,2月时舒适性比较无明显差异。但综合白内障医生习惯,颞下切口选择为白内障手术医生留出更多的可操作空间。结论:原发性闭角性青光眼复合小梁切除术两种切口位置的的选择对于术后眼压及远期舒适性的比较无明显差异性,对于将来白内障切口位置的选择有明显差异性。

METHODOLOGICAL EVALUATION ON CLINICAL RESEARCH LITERATURE OF ACUPUNCTURE TREATMENT OF FACIAL PARALYSIS

Objective: To try to give an objective evaluation on the clinical research situation about acupuncture treatment of facial paralysis in the past 50 years and try to provide a possible evidence for clinical practice. Methods: All papers are searched and assessed according to the international standards and clinical epidemiology. Results: There is no systematic review (SR) on acupuncture treatment of facial palsy in a total of 1021 articles enlisted in the present paper. Comparing with the quantity of the descriptive studies and expert opinions (constituting 84.84%), that of the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) is smaller (constituting 15.16%), besides, the quality of RCTs and CCTs is unsatisfactory. Conclusion: At present, the quantity and quality of studies with RCTs about acupuncture treatment of facial paralysis can’t meet the need of clinical practice, and in order to improve the therapeutic effect, a higher quality of RCTs and SR is required.

Value of whole body diffusion weighted imaging in diagnostic and therapeutic evaluation of malignant lymphoma

Objective:The aim was to evaluate the role of whole body diffusion weighted imaging(WB-DWI) of magnetic resonance in the diagnosis and efficacy evaluation of malignant lymphoma.Methods:The clinical manifestation of whole body diffusion weighted imaging of 47 patients with malignant lymphoma being pathologically proved were carried on by retrospective analysis and to compare with 10 healthy volunteers.There were 8 cases of Hodgkin's lymphoma(HD) patients,of which WB-DWI examination of 5 cases were carried out before and after treatment and 3 cases were done after treatment.There were 39 cases of non-Hodgkin's lymphoma(NHL) patients,of which WB-DWI examination in 19 cases were acted before treatment,11 cases were done before and after treatment and 9 cases done after treatment.In apparent diffusion coefficient(ADC) diagram the ADC values of lymph nodes in patients with malignant lymphoma and healthy volunteers were measured respectively,among 16 patients the ADC values of parts of lymph node being consistent with the initial inspection were determined again and compared the values before and after,and compared with healthy volunteers.Results:Whole body magnetic resonance diffusion weighted imaging(MR-DWI) showed more sensitive to lymphoma,and 372 lymph nodes greater than 1 cm were detected with MR-DWI.Before treatment,mean ADC value of 35 patients with malignant lymphoma was(0.86 ± 0.21) × 10-3 mm2/s,of which an average ADC values of 28 cases after treatment was(1.22 ± 0.31) × 10-3 mm2/s,before and after treatment difference of the average ADC values of patients was statistically significant(P < 0.05);the average ADC value of cervical lymph nodes of 10 healthy volunteers(1.29 ± 0.12) × 10-3 mm2/s and of 30 patients with malignant lymphoma before treatment was statistically significant(P < 0.05),and to compare with 28 patients after treatment difference of the ADC values was not statistically significant(P > 0.05).Conclusion:WB-DWI and ADC values being measured in the clinical diagnosis of malignant lymphoma,staging and evaluation of efficacy of monitoring is a fast and effective technology,with some clinical value.

Arthroscopic Debridement and Synovium Resection for Inflammatory Hip Arthritis

Objective To evaluate the efficacy of arthroscopic surgery in inflammatory hip arthritis.Methods A retrospective clinical study was conducted inspecting 40 hips in 36 patients of inflammatory arthritis.There were 17 cases of ankylosing spondylitis,11 cases of rheumatoid arthritis,and 8 cases of psoriatic arthritis.The joints were irrigated and the inflamed tissues were debrided with anthroscopy.The patients were followed up with Harris hip score,Oxford hip score,Visual Analog Scale(VAS),and magnetic resonance imaging(MRI).Statistical analysis was performed using Student t test.Results All of the 36 cases were followed up for 46-103 months,averaging 67.2±8.4 months.Harris and Oxford scores increased from 66.9±12.1 and 69.4±16.4 before operation to 78.4±19.3 and 80.2±18.8 after operation,respectively(P<0.05).VAS score decreased from pre-operative 8.5±2.5 to post-operative 7.2±2.5(P<0.05).All the patients showed improved joint range of motion.MRI revealed alleviation of hip synovitis.The results were classified as excellent in 8 patients,good in 17 patients,fair in 8 patient,and poor in 3 according to Harris hip score.Twenty-seven patients were satisfied with the operative outcomes as they regained normal daily activities.Conclusions Arthroscopy-assisted joint debridement and synovium resection is an effective procedure for hip lesion in inflammatory arthritis.The inflammatory lesion might be thereby controlled and the symptoms be relieved.

Evaluation of three-incision esophagectomy:Review of 1226 patients

Objective:The aim of our study was to evaluate the clinical effect and the prospect of the three-incision (right thoracotomy, midline laparotomy and left cervical incisions) esophagectomy for the treatment of esophageal carcinoma.Meth-ods:We reviewed our experience with 1226 patients undergoing three-incision esophagectomy for middle and upper esopha-geal carcinoma.Results:Anastomotic leak rates were determined for the entire group.The overall leak rate was 8.5% (104 patients).Overall hospital mortality was 0.24% (3 patients).No patient died as a result of anastomotic leakage.Conclusion:The three-incision technique can radically remove carcinoma and perform a complete lymphadenectomy.Although the cervical anastomotic leak rate is slightly high, the management of this complication is relatively easy and the satisfactory results can be achieved.

Clinical Analysis of 30 Cases of Deep Lamellar Keratoplasty for the Treatment of Corneal Disease

purpose： to analyze clinical therapeutic effect of deep lamellar keratoplasty on treatment of corneal disease. Method： select 30 cases of corneal disease patients with a total of sick eyes, from 2012 January to 2013 January; all patients underwent deep lamellar keratoplasty, then observe and analyze visual acuity, corneal and occurrence of complications, to comprehensively assess the clinical therapeutic effect. Result： after receiving treatment of deep lamellar keratoplasty, of the 30 patients and 40 eyes, 31 corneal grafts are transparent; 9 corneal grafts are translucent; postoperative visual acuity： I0 eyes are 0.01-0.04; 13 eyes are 0.05~0.1; 14 eyes are 0.1-0.4; 3 eyes are above 0.5; 10 eyes have descemet micro-perforation or small perforation; 7 eyes have complications; these conditions are all controlled after active treatment. Conclusion： for patients with corneal disease, deep lamellar keratoplasty can not only achieve the similar transparency and visual rehabilitation as penetrating keratoplasty, but also reduce the incidence of adverse reactions and reject reaction after operation, to achieve the purpose of treatment and vision improvement; it has significant clinical effect, and greatly improve the quality of patients＇ life, so it is worthy of clinical application.

The clinical effect and safety evaluation of Shugan Quzhi capsule in the treatment of adult simple obesity

Shugan Quzhi capsule is a hospital preparation of Xinhua Hospital affiliated to School of Medicine, Shanghai Jiaotong University. It has been used to treat adult patients with fatty liver caused by obesity, high cholesterol and other factors. In the present study, we investigated the clinical efficacy and safety of Shugan Quzhi capsule in adult simple obesity. The patients were randomly divided into the treatment group and control group. The whole treatment lasted 2 months under the same nutritional condition and diet intervention. Body weight, body mass index, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, urine and blood routine examination were recorded before and after treatment. Our data showed that the total effective rate of treatment group was 66.67%, and body weight and body mass index after treatment the body were significantly decreased （P〈0.01）. The levels of total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein after treatment were lower than before treatment, but there was no statistical difference （P〉0.05）. The total effective rate of control group was 39.13%, and the body weight and body mass index atter treatment were also significantly lower than before （P〈0.01）. There was no significant difference between the treatment group and control group （P〉0.05）. There were no significant changes in liver function, renal function, urine routine and blood routine examination data after treatment. The results suggested that Shugan Quzhi capsule had certain therapeutic efficacy and safety in adult simple obesity.

Clinical Research Progress of Acupuncture-moxibustion for Chronic Urticaria

To learn the current research status of acupuncture-moxibustion in treating chronic urticaria, the relevant clinical reports indexed by CNKI and VlP databases during 2000 and 2012 were retrieved, and then summarized and analyzed from the aspects of treatment method, acupoint selection, medicine, treatment frequency, and criteria of therapeutic efficacy, for guiding the treatment of chronic urticaria with acupuncture-moxibustion. The results show that acupuncture-moxibustion therapy has stable therapeutic efficacy in treating chronic urticaria with low adverse reaction rate, but the current evaluation criteria are too subiective to cluantifv.

Pharmacokinetic and pharmacodynamic comparison between Glucophage~? and a generic metformin in a rat model

In the present study, we aimed to compare the pharmacokinetics and pharmacodynamics between Glucophage~? and a generic metformin formulation in a diabetic rat model in order to assess the bioequivalence of the generic formulation. Adult male Zucker diabetes fatty rats received Glucophage~? or the generic metformin through gastric gavage at a dose of 180 mg/kg(n = 6 per condition). Both pharmacokinetic parameters(AUC0–t, AUC0–∞, Cmax) of metformin and plasma glucose levels were compared between the two groups. For pharmacodynamics, rats received Glucophage~? or the generic metformin at doses of 180 and 300 mg·kg–1·d–1 for 6 weeks. The measurements included body weight, fasting plasma glucose, glycosylated serum protein(GSP) and serum insulin. Data were analyzed with SPSS 22.0 and Prism 7. The level of statistical significance was set at P<0.05. In single dosing experiments, pharmacokinetic parameters(t1/2, AUC0–t and Cmax) did not differ between Glucophage~? and the generic metformin(P>0.05). However, plasma glucose was significantly higher in the generic metformin group at 2 h(P = 0.03) and 4 h(P = 0.04) after drug treatment. In repeated dosing experiments, fasting glucose, HOMA-IR and body weight in rats receiving high-dose Glucophage~? were significantly lower at the end of the 6-week treatment period than those in rats receiving high-dose generic metformin(P<0.05 for all). GSP and serum insulin did not differ significantly between the two groups. In rats receiving low-dose metformin, fasting glucose was lower in the Glucophage~? group. HOMA-IR and body weight did not differ between the two groups. Moreover, blood lipids did not differ significantly between the two groups. The generic metformin used in the current study did not differ significantly in pharmacokinetic characteristics with Glucophage~?. However, Glucophage~? was superior in terms of glucose control, body weight loss and insulin sensitivity in repeated administration.

Efficacy evaluation of summer acupoint application treatment on asthma patients: a two-year follow-up clinical study

OBJECTIVE: To evaluate the self-efficacy and satisfaction of asthma patients subjected to summer acupoint application treatment(SAAT).METHODS: A two-year follow-up clinical study was conducted. Patients with asthma were treated by applying a herbal paste onto the Feishu(BL 13) and Fengmen(BL 12) acupoints on the three hottest days of summer, according to the traditional Chinese calendar, from 2008 to 2010. During a two-year follow-up, these patients were asked tofill out a questionnaire evaluating asthma degree,exacerbation frequency, concomitant medications and self-satisfaction. The self-rate and doctor-report outcomes obtained in parallel were evaluated to assess the efficacy of SAAT.RESULTS: A total of 527 asthma patients were initially enrolled in this study, of which 97 elderly patients and those with more severe cases of asthma were lost to follow-up. Thus, a total of 430 patients were valid for analysis using self-rate data. Nevertheless, occasional negative returns were obtained;almost all of the outcomes were rated as "No change", "Moderate effective", or "Very effective". In addition, 80% of the patients were satisfied with this treatment. Moreover, 391(91.4%) patients were somewhat improved after SAAT in 2009, and further improvement was observed in 2010. After SAAT, the average asthma-degree score decreased from 5.3 in 2008 to 4 in 2009 and, subsequently to3.5 in 2010.CONCLUSION: With pronounced patient satisfaction, SAAT can reduce the exacerbation severity and frequency, concomitant medications and asthma degree. Prolonging the treatment course might enhance the efficacy of SAAT.

Modified Blair ankle fusion for ankle arthritis

Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvious foot varus deformity, and 17 were almost normal in appearance. There were 13 males and 15 females with an average age of 49.4 years （range, 23-67 years）. The main symptoms included swelling, pain, and a limited range of motion of the ankles. The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society （AOFAS） ankle and hindfoot score and visual analog scale （VAS） preoperatively and at I year follow-up. Results： Twenty-eight patients were followed up for 19.8 months on average （range, 1-2 years）. Superficial wound infection occurred in 3 cases, and was cured after debridement; the other incisions healed by first intention without complications. All ankles were fused at 1 year follow-up after operation. The symptom was relieved completely in all patients at last follow-up without complication of implant failure, or nonunion. The postoperative AOFAS ankle and hindfoot score was 83.13±3.76, showing significant difference when compared with the preoperative score （45.38±3.21, P〈0.01）. VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up （P〈0.05）. Conclusion： Modified Blair ankle fusion has the advantages of high feasiblity, less cost and rigid fixation. It shows high reliability in pain relief and may obtain a good clinical effectiveness.

Systematic evaluation on the clinical efficacy of acupoint stimulation therapy for treatment of premature ovarian insufficiency on the basis of network Meta-analysis

Objective To systematically evaluate the effectiveness and safety of acupoint stimulation therapy for treatment of premature ovarian insufficiency（POI）. Methods Computer retrieval was carried out in such databases as Pub Med, Embase, Cochrane Library, web of science, Chinese biomedicine database（CBM）, China National Knowledge Infrastructure（CNKI）, Wan Fang and VIP in order to collect the randomized controlled trials（RCT） concerning acupoint stimulation therapy for treatment of POI. Software R 3.40 and stata 14.0 were used for Meta-analysis and network Meta-analysis, and Rev Man 5.3 was used for plotting the risk bias diagrams. Results Fortythree RCTs were included in total, involving 3046 POI patients and 18 acupoint stimulation therapies and comprehensive therapies. Metaanalysis showed：（1） The curative effects of acupoint stimulation therapy（RR=1.25, 95%CI [1.07,1.45]）, acupoint stimulation therapy＋Chinese herbal medicine（RR=1.25, 95%CI [1.18,1.32]） and acupoint stimulation therapy＋ hormone replacement therapy（HRT）（RR=1.20, 95%CI [1.12,1.29]） were all superior to that of HRT, indicating that the differences were statistically significant（Z=2.90, P=0.04; Z=7.56, P〈0.000 01; Z=4.06, P〈0.000 01）.（2） Compared with HRT, the occurrence rate of adverse effect of acupoint stimulation therapy was lower, and the safety was superior to that of HRT（RR=0.18, 95%CI [0.08,0.41]）, indicating that the differences were statistically significant（Z=4.08, P〈0.000 1）. Forty-two direct comparisons and 110 indirect comparisons were generated according to network Meta-analysis, among which, 38 comparisons were statistically significant. Network Metaanalysis results with HRT as control showed： the therapeutic measures ranking top 3 according to the curative effect sequence were catgut embedment in acupoint, moxibustion and warming-needle moxibustion, successively, and all the 3 measures were monotherapies without reflecting the advantages of comprehensive therapy. HRT ranked 17 th among the 18 included therapeutic measures. Conclusion On the basis of current evidences, acupoint stimulation therapy has a better clinical efficacy and safety for treatment of POI when compared with HRT. The acupoint stimulation therapies ranking the top 3 have more significant curative effects, but the long-term efficacy and the effect on the ovarian function still need to be further explored. In addition, the conclusion of this study still needs to be verified through a large number of RCTs with reasonable designs and appropriate methods.

The Qi-regulating Massotherapy for Treatment of Tonic Headache in 150 Cases

Objective: To observe the therapeutic effects of the qi-regulating massotherapy (通脉调气推拿法) for treatment of tonic headache. Methods: According to different clinical types, 150 cases of tonic headache were treated by the qi-regulating massotherapy. Evaluations were done according to the scores for physiology, behavior, intensity of pain, and the therapeutic effects. Results: After treatment, the total score in the 150 cases significantly decreased as compared with that before treatment (P<0.01). The total effective rate was 93.3%, and the effective rates for all the types were over 90%. Conclusion: The qi-regulating massotherapy is indicated for all types of tonic headache with obvious therapeutic effects.