从系统科学到教育的科学发展观

本文从系统科学的基本原则出发,探讨我国高等教育的主要问题,指出教育的关键是质量。并指出,目前教育改革的关键之一是高教制度的改革。但改革要找到根本解,否则将是表面问题改善,新的问题随之发生,而且老问题还会再次不定期出现。文中指出目前教育的两大症结问题:平等竞争机制和人的创造性张力的产生。这两个问题将涉及到目前与高等教育相关的绝大多数问题的根源。

Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection

AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori ) infection. METHODS:This open randomized trial recruited 234 H. pylori positive gastritis patients from seven local centers. The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid , clarithromycin 500 mg bid , and amoxicillin 1000 mg bid ; OCA group, n = 79); two weeks of pre-treatment with probiotics, containing 3 × 107 Lactobacillus acidophilus per day, prior to one week of triple therapy (POCA group, n = 78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group, n = 77). Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy. Patients were asked to report associated symptoms at baseline and during follow-up, and side effects related to therapy were recorded. Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods. RESULTS:PP analysis involved 228 patients, 78 in the OCA, 76 in the POCA and 74 in the OCAP group. Successful eradication was observed in 171 patients; by PP analysis, the eradication rates were significantly higher (P = 0.007 each) in the POCA (62/76; 81.6%, 95% CI 72.8%-90.4%) and OCAP (61/74; 82.4%, 95% CI 73.6%-91.2%) groups than in the OCA group (48/78; 61.5%, 95% CI 50.6%-72.4%). ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5%, 95% CI 70.4%-88.6%) and OCAP (61/77; 79.2%, 95% CI 70%-88.4%) groups than in the OCA group (48/79; 60.8%, 95% CI 49.9%-71.7%), (P = 0.014 and P = 0.015). The symptom relieving rates in the POCA, OCAP and OCA groups were 85.5%, 89.2% and 87.2%, respectively. Only one of the 228 patients experienced an adverse reaction. CONCLUSION:Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates.

Improvement of clinical parameters in patients with gastroesophageal reflux disease after radiofrequency energy delivery

AIM:To evaluate the efficacy of Stretta procedure with gastroesophageal reflux disease(GERD)based on symptom control,medication changes and oesophagitis grade.METHODS:Ninety patients with a history of GERD underwent Stretta procedure from June 2007 to March 2010.All patients with GERD diagnosed by the pres-ence of endoscopically evidenced oesophagitis or abnormal esophageal pH testing.We evaluated GERD-health-related quality of life,satisfaction,medication use and endoscopy at baseline,6,12 mo after treatment.Complications of the procedure were analyzed.RESULTS:We found that patients experienced significant changes in symptoms of GERD after Stretta proce-dure.The onset of GERD symptom relief was less than 2 mo(70.0%)or 2 to 6 mo(16.7%).The mean GERD-HRQL score was 25.6(baseline),7.3(6 mo,P<0.01),and 8.1(12 mo,P<0.01).The mean heartburn scorewas 3.3(baseline),and 1.2(12 mo,P<0.05).The percentage of patients with satisfactory GERD control improved from 31.1%at baseline to 86.7%after treat-ment,and patient satisfaction improved from 1.4 at baseline to 4.0 at 12 mo(P<0.01).Medication usage decreased significantly from 100%of patients on pro-ton pump inhibitors therapy at baseline to 76.7%of patients showing elimination of medications or only as needed use of antacids/H2-RA at 12 mo.An improvement in endoscopic grade of oesophagitis was seen in 33 of the 41 patients.All patients had either no erosions or only mild erosive disease(grade A)at 6 mo.CONCLUSION:The experience with Stretta procedure confirms that it is well tolerated,safe,effective and durable in the treatment of GERD.The Stretta procedure provides the drug-refractory patients with a new mini-mally invasive method.

Treatment of functional dyspepsia with sertraline:A double-blind randomized placebo-controlled pilot study

AIM:To evaluate sertraline,a selective serotonin reuptake inhibitor in the treatment of patients with functional dyspepsia.METHODS:Consecutive tertiary hospital patients with a clinical diagnosis of functional dyspepsia(FD) according to the Rome Ⅱ criteria with a Hong Kong dyspepsia index(HKDI) of greater than 16 were recruited.Patients commenced enrolment prior to the inception of the Rome Ⅲ criteria for functional dyspepsia.All patients were ethnic Chinese,had a normal upper endoscopy and were Helicobacter pylori negative prior to enrolment.Study patients were randomized to receive sertraline 50 mg or placebo daily for 8 wk.HKDI symptom scores,quality of life,hospital anxiety and depression(HAD) scale and global symptom relief were evaluated before,during and after treatment.Adverse effects were monitored during and after treatment.RESULTS:A total of 193 patients were randomized in the intention to treat(ITT),and 150 patients were included in the per protocol(PP) analysis.In both the ITT and PP,there was no difference in the primary outcome of global dyspepsia symptoms between the sertraline and placebo groups at week 8.In the ITT analysis,98 and 95 patients were randomized to the sertraline and placebo groups respectively.A total of 43 patients withdrew from the study(22.3%) by week 8,with 23 of the 24 drop-outs in the sertraline group occurring prior to week 4(95.8%).In contrast,in the placebo arm,11 of 19 patients dropped out by week 4(57.9%).Utilizing the last response carried forward to account for the drop-outs,there were no differences between the sertraline and placebo groups at baseline in terms of the HKDI,HKDI 26.08 ± 6.19 vs 26.70 ± 5.89,P = 0.433;and at week 8,HKDI 22.41 ± 6.36 vs 23.25 ± 7.30,P = 0.352 respectively.In the PP analysis,74 and 76 patients were randomized to the sertraline and placebo groups respectively.At baseline,there were no statistically significant differences between the sertraline and placebo groups,HKDI 25.83 ± 6.313 vs 27.19 ± 5.929 respectively,P = 0.233;however by week 8,patients in the sertraline group demonstrated a statistically significant difference in their Hong Kong Dyspepsia Index compared to placebo,HKDI 20.53 ± 6.917 vs 23.34 ± 7.199,P = 0.02,respectively).There was also no statistically significant difference in overall quality of life measures or the HAD scale related to treatment in either the ITT or PP analysis at week 8.CONCLUSION:This pilot study,the first to examine sertraline,a selective serotonin reuptake inhibitor,for the management of FD,did not find that it was superior to placebo.

Clinical trial:Lactobacillus plantarum 299v(DSM 9843)improves symptoms of irritable bowel syndrome

AIM:To assess the symptomatic efficacy of Lactobacillus plantarum 299v(L.plantarum 299v)(DSM 9843) for the relief of abdominal symptoms in a large subset of irritable bowel syndrome(IBS) patients fulfilling the Rome Ⅲ criteria.METHODS:In this double blind,placebo-controlled,parallel-designed study,subjects were randomized to daily receive either one capsule of L.plantarum 299v(DSM 9843) or placebo for 4 wk.Frequency and intensity of abdominal pain,bloating and feeling of incomplete rectal emptying were assessed weekly on a visual analogue scale while stool frequency was calculated.RESULTS:Two hundred and fourteen IBS patients were recruited.After 4 wk,both pain severity(0.68 + 0.53 vs 0.92 + 0.57,P < 0.05) and daily frequency(1.01 + 0.77 vs 1.71 + 0.93,P < 0.05) were lower with L.plantarum 299v(DSM 9843) than with placebo.Similar results were obtained for bloating.At week 4,78.1 % of the patients scored the L.plantarum 299v(DSM 9843) symptomatic effect as excellent or good vs only 8.1 % for placebo(P < 0.01).CONCLUSION:A 4-wk treatment with L.plantarum 299v(DSM 9843) provided effective symptom relief,particularly of abdominal pain and bloating,in IBS patients fulfilling the Rome Ⅲ criteria.

How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

AIM:To investigate the prevalence of gastroesophageal reflux disease(GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux(LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms(LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors(PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires(GERD impact scale,GIS;visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score(RFS) and reflux symptom index(RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH(MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis(ERD),pathological acid exposure time(AET) in the absence of esophageal erosions(NERD),and a positive correlation between symptoms and refluxes(hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52(14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m 2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms(heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia(38/41),linear indentation in the medial edge of the vocal fold(31/41),vocal fold nodules(6/41) and diffuse infraglottic oedema(25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy(P < 0.05);conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy(P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients,and ineffective esophageal motility was found in 3/41 patients.The MII-pH analysis showed an abnormal AET in 5/41 patients(2 ERD and 3 NERD);11/41 patients had a normal AET and a positive association between symptoms and refluxes(HE),and 25/41 patients had a normal AET and a negative association between symptoms and refluxes(no GERD patients).It is noteworthy that HE patients had a positive association with typical GERD-related symptoms.Gas refluxes were found more frequently in patients with globus(29.7 ± 3.6) and hoarseness(21.5 ± 7.4) than in patients with heartburn or regurgitation(7.8 ± 6.2).Gas refluxes were positively associated with extraesophageal symptoms(P < 0.05).Overall,no differences were found among the three groups of patients in terms of the frequency of laryngeal signs.The proximal reflux was abnormal in patients with ERD/NERD only.The differences observed by means of MII-pH analysis among the three subgroups of patients(ERD/NERD,HE,no GERD) were not demonstrated with the RSI and RFS.Moreover,only the number of gas refluxes was found to have a significant association with the RFS(P = 0.028 andP = 0.026,nominal and numerical correlation,respectively).CONCLUSION:MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR,most likely because of the low specificity of the laryngoscopic findings.

Effectiveness of Mesotherapy on Temporomandibular Joint Disorders

TMJDs （Temporomandibular joint disorders） are a common pathology but best treatment remains unclear. The goal of this study was to evaluate the effectiveness of mesotherapy on TMJD. We conducted a case review of all TMJD patients treated since 2006 with mesotherapy procedures only and using a cocktail of drugs composing of lidocaine, piroxicam and pentoxifylline. Patients were treated every 15 days until symptomatic relief was achieved and thereafter every two months. Main outcome was complete symptomatic relief, and associated factors were analysed. 27 patients were included. Complete pain relief was achieved in 26. The necessary number of procedures to get pain relief ranged from 1 to 6 （median of 1） and the total number of treatments from 1 to 40 （median of 11）. 19 patients had other painful complains mainly related with anxiety disorders. A weak correlation （r = 0.357; p = 0.05） between anxiety disorders and the required months of treatments was found. Mesotherapy is a valuable option on pain relief in a temporomandibular pain syndrome with none of the systemic effects of oral medication. Anxiety may have a role on the aetiology and therapeutic success highlights the holistic approach of these patients. Future comparative studies are necessary.

Biliary cystadenoma

The diagnosis of cystadenoma is rare, even more so when located in the extrahepatic bile duct. Unspecific clinical signs may lead this pathology to be misdiagnosed. The need for pathological anatomy in order to distinguish cystadenomas from simple biliary cysts is crucial. The most usual treatment nowadays is resection of the bile duct, together with cholecystectomy and Roux-en-Y reconstruction.

卡马西平所致皮肤反应分析

报告了服用卡马西平124例的各类患者，出现皮肤反应17例，发生率为17.3%，发生率与性别、年龄、病种无大相关。反应仅在服药6周内、总剂量30g以下，且均剂量1g以下时发生。发生率与出现反应的服药时间、剂量无统计学差异。反应类型以全身充血性弥慢丘疹型为最多，占47.1%，次为出血性大疱表皮坏死松解型，占23.5%，值得提起高度重视，若及时发现，妥善处理多无严重后果。

Clinical Observation on Curative Effect of Dissolving Phlegm-Stasis on 50 Cases of Knee Osteoarthritis

Objective： To observe the curative effect of dissolving phlegm-stasis on knee osteoarthritis. Methods： The 100 patients with knee osteoarthritis were randomly divided into two groups. The 50 patients in the treatment group orally took Chinese medicine while the other 50 patients in the control groups orally took Votalin and Vitamin C for one week as a course of treatment. At the end of 2-week treatment, analytic comparison was carried in evaluate the curative effect and the changes in total score of symptoms before and after treatment between the two groups. Results： The total score of symptoms after treatment was significantly lower than that before treatment in both groups （P〈0.01, P〈0.05）. The total score after treatment of patients with X-ray grade I and II in the treatment group was more obviously reduced as compared to the control group （P〈0.05）. The remarkably effective rate after treatment of patients with X-ray grade I and It in the treatment group was also higher than that in the control group （P〈0.05）. Conclusion： The treatment of knee osteoarthritis with dissolving phlegm-stasis can effectively improve the clinical symptoms.