Objective To assess the quality of randomized controlled trials (RCTs) on acupuncture for treating acute migraine attacks. Methods With the searching terms of acupuncture and migraine, the Cochrane Controlled Trials Register (CCTR), PubMed, MEDLINE, EMbase, CBM, CMCC, CNKI and VIP were searched. The reports quality of the included trials, including the quality of methodology, diagnostic criteria, inclusion/exclusion criteria, acupuncture/control interventions, outcome measures, observing time, and adverse effects reports, was evaluated. Results A total 23 RCTs involving 2645 patients were included, of which only 3 RCTs were of high quality with Jadad scores equal to or more than 4. At present, only a few high quality trials on treating acute attacks of migraine with acupuncture had been reported at home and abroad. The international recognized diagnostic criteria and common evaluation methods had not been used generally, and the design of control was kind of irrational. Conclusion Based on current clinical reports, acupuncture may be effective in the management of acute migraine attacks, but some relevant proof is still required. The further domestic studies should be designed strictly following the international recommended diagnosis and evaluation criteria of migraine, and rational control methods as well.
目的 探讨诱导痰、痰、血清中的白介素(IL)-4、-6、-8在慢性支气管炎急性期的浓度阈值，确定其诊断意义，了解三种白介素在三种标本中的不同浓度对诊断慢性支气管炎急性期的意义。 方法 2001年1月-8月对77例慢性反复咳嗽患者按全国慢性支气管炎诊断标准确诊慢性支气管炎急性期48例，非慢性支气管炎29例，进行IL-4、-6、-8的诱导痰、痰、血清检测。采用受试者工作特征曲线(ROC曲线)鉴定三种白介素对三种标本的诊断价值。 结果 ①三种标本的三种白介素的诊断比值比(DOR)均＞3，95%可信区间的下限均＞1。②ROC曲线下面积显示：诱导痰及痰中IL-4、-8之间无差别(P＞0.05)，IL-4和IL-8分别与IL-6之间有统计学意义(P＜0.05)；血清中IL-4、-6、-8检测结果无差异(P＞0.05)。IL-4、-8的诱导痰及痰与血清有统计学意义(P＜0.05)，IL-6的诱导痰、痰、血清之间无差异(P＞0.05)。 结论 诱导痰及痰中的IL-4、-8诊断价值较好，可用于慢性支气管炎急性期的诊断。
Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD， 8 patients died during perioperatively， received endovascular repair in 1-5 days after admission （mean 2.4 d）， and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation， among them 2 cases occurred in 1 h after operation， the other 1 case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection， 2 cases died of cerebral infarction， 1 case died of multiple organ failure， and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.
ObjectiveTo observe the dynamic changes of the concentrations of serum matrix metalloproteinase (MMP)-2 and MMP-9, and to discuss its clinical significance. MethodsFrom January to May 2014, 50 cases of clinically diagnosed cerebral infarction patients were included in the study as the cerebral infarction group, and we randomly selected 30 healthy volunteers at the same time in the same age group as the control group. The serum MMP-2 and MMP-9 of patients with acute cerebral infarction were detected in the onset of 24 hours, 7th day and 14th day respectively, which were compared with the control group accordingly. The patients with cerebral infarction were divided into small infarction group (1.5-3.0 cm), middle infarction group (3.1-5.0 cm) and large infarction group (>5.0 cm) according to the infraction volume. According to neurological functional deficit score they were divided into mild (0-15 points), moderate (16-30 points) and severe group (31-45 points). Changes of the level of MMP-9 and MMP-2 were compared in patients with different cerebral infarction volume and different impairment degree. ResultsFor the cerebral infarction group, the serum MMP-2 and MMP-9 levels were significantly higher in the onset of 24 hours, 7th day and 14th day[MMP-2:(2.36±0.76), (2.86±0.87), and (2.20±0.79) ng/mL; MMP-9:(238.8±99.6), (360.4±141.8), and (152.2±80.4) ng/mL] than the control group[MMP-2:(1.20±0.27) ng/mL; MMP-9:(124.8±28.2) ng/mL] (P<0.05). The larger the infarction volume was in the patients with acute ischemic stroke, the higher the levels of serum MMP-9 and MMP-2. The severer the neurologic impairment degree was in the patients with acute ischemic stroke, the higher the levels of serum MMP-9 and MMP-2 were. ConclusionFor patients with acute cerebral infarction, the levels of serum MMP-2 and MMP-9 are closely related to time of onset, infarct volume and neurological deficits, which can be used as an important basis to estimate the condition and assess the prognosis.
ObjectiveTo observe systemic inflammatory response (SIR)of patients in different stages after the onset of aortic dissection (AD), and preliminarily explore a new staging system of AD based on SIR. MethodsFrom September 2011 to February 2012, 46 AD patients were admitted to the Department of Cardiovascular Surgery, West China Hospital of Sichuan University. There were 33 male and 13 female patients with their age ranging from 22 to 77 years (53.2±13.6 years). Blood samples were collected in 9 different periods after the onset of AD (0-12 hours (T1), 12-24 hours (T2), 24-48 hours (T3, 1-2 days), 48-96 hours (T4, 2-4 days), 96-168 hours (T5, 4-7 days), 168-336 hours (T6, 7-14 days), 336-720 hours (T7, 14-30 days), 720-1440 hours (T8, 30-60 days) and > 1 440 hours (T9, > days))to measure blood concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), endotoxin (ET), white blood cell (WBC)and neutrophils (Neut). SIR changes after the onset of AD were summarized. ResultsBlood concentrations of different inflammatory mediators were all significantly elevated within 14 days (T1-T6), significantly decreased in 14-60 days (T7-T8), and returned to normal range 60 days (T9)after the onset of AD. Peak levels of ET and TNF-α appeared in T1 with 263.42±29.98 pg/ml and 86.75±18.83 pg/ml respectively. Peak level of IL-6 appeared in T2 with 95.70±22.64 pg/ml. Peak level of CRP appeared in T5 with 123.74±54.78 mg/L. There was no obvious peak level of WBC or Neut. ConclusionDisease progression of AD can be divided into 3 stages including acute stage (within 14 days), subacute stage (14-60 days)and chronic stage ( > 60 days)based on the degree of SIR.
Objective To study the risk factors of urinary incontinence in acute stroke patients and provide scientific evidence for preventing and managing such complication. Methods A computerized literature search was performed on both English and Chinese databases including Embase, Medline, Wanfang Data, VIP, and CNKI from January 1990 to January 2017 based on such search strategies as literature review and manual retrieval. In addition, we tracked down the related reference lists. The RevMan 5.3 software was used for Meta-analysis. Categorical data were calculated by the pooled odds ratio (OR) values and 95% confidence intervals (CI), and numerical data were calculated by pooled mean difference (MD) and 95%CI. Results A total of 17 articles of controlled studies with 2 428 cases and 3 725 controls were included. According to the results of Meta-analysis, factors associated with urinary incontinence following acute stroke were age [MD=2.80, 95%CI (0.29, 5.30),P=0.03], female gender [OR=1.29, 95%CI (1.16, 1.45),P<0.000 01], diabetes [OR=1.40, 95%CI (1.13, 1.73),P=0.002], heart disease [OR=1.65, 95%CI (1.29, 2.13),P<0.000 1), former cerebrovascular disease [OR=1.43, 95%CI (1.21, 1.69),P<0.000 1), speech disorder [OR=4.20, 95%CI (3.45, 5.10),P<0.000 01], smoking [OR=0.68, 95%CI (0.50, 0.92),P=0.01]. Hypertension [OR=1.25, 95%CI (0.99, 1.58),P=0.06], left hemisphere involvement [OR=1.29, 95%CI (0.81, 2.06),P=0.29], and hemorrhagic stroke [OR=1.26, 95%CI (0.79, 2.03),P=0.33] were not correlated with urinary incontinence following acute stroke. Conclusions Older age, female gender, diabetes, heart disease, former cerebrovascular disease and speech disorder are risk factors associated with post-stroke urinary incontinence, while smoking lowers the potential risk. However, hypertension, hemorrhagic stroke and left hemisphere involvement do not significantly increase the risk of urinary incontinence following stroke.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on the treatment for acute gout.MethodsPubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating drug interventions therapy in acute gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs by the AMSTAR tool, and assessed the quality of the body of evidence for each outcome by the GRADE approach.ResultsA total of seven relevant SRs were included, which contains three main outcome measures. Four SRs contained non-steroidal anti-inflammatory drugs (NSAIDS), three SRs contained colchicine and two SRs contained glucocorticoids. All SRs assessed risk of bias of included original studies. Two used the Jadad scale or modified Jadad scale in this assessment while others used the " assessing risk of bias” tool recommended by Cochrane Collaboration. The assessment results of AMSTAR tool suggested that: three SRs were considered high quality (scores≥9), and the other four were considered moderate quality. GRADE results showed: the quality of the evidence of 11 outcomes was low or very low, and five outcomes was moderate.ConclusionsThe current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute gout, however, the priority of these drugs is still unclear. We suggest conducting new SRs and updating relevant SRs, to systematically compare different drug interventions therapy in acute gout with the latest evidence. In addition, we still expect to put more efforts in conducting high-quality original studies, in order to fill the gap of relevant fields and improve the level of evidence quality.
Patients with acute human immunodeficiency virus (HIV) infection are the critical source of infection due to high viral load and strong transmission ability. The vast majority of patients in the acute infection stage have no or only mild clinical symptoms, and their screening and diagnosis often rely on laboratory tests. However, there are still some difficulties in early screening and detection for HIV infection due to the detection window period. In recent years, laboratory testing for acute HIV infection has made great progress. This article reviews the progress in laboratory testing of acute HIV infection, in order to provide a reference for follow-up related research.