Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
【摘要】 目的 探讨高原地区桡神经损伤的治疗效果，并总结影响疗效的因素。 方法 回顾性分析2005年6月-2010年6月收治的桡神经损伤并有完整随访资料的54例患者，其中男40例，女14例；年龄8～69岁，平均32.6岁。开放性损伤5例，闭合性损伤49例；左侧26例，右侧28例。受伤原因:刀伤5例，医源性损伤（手术牵拉伤、被钢板挤压伤）10例，肱骨干骨折合并桡神经损伤39例。神经损伤类型:桡神经完全断裂12例；大部分断裂15例；挫伤27例，挫伤长度1.5~4.5 cm。所有患者均有典型的感觉及运动功能障。采用神经吻合修复27 例，神经松解减压27例。骨折均用钢板内固定。 结果 所有患者手术均顺利，术后切口均I期愈合，无手术相关并发症发生。54例均获随访16~24个月，平均18个月。骨折于术后8～14个月达临床愈合。末次随访时根据中华医学会手外科上肢周围神经功能评定标准，神经吻合的27例中，获优14例，良8例，差5例；神经松解减压术治疗的27例均获优。总优良率为91%。 结论 上臂桡神经损伤宜早期手术修复，神经吻合的疗效较神经松解减压术差。【Abstract】 Objective To explore the therapeutic effect on radial nerve injuries in plateau area, and to analyze the influencing factors. Methods The clinical data of 54 patients with radial nerve injuries who were treated between June 2005 and June 2010 were retrospectively analyzed. The patients included 40 males and 14 females and aged 8-69 years (averaged 32.6 years old). Of these 54 patients, 5 were open injuries, 49 were closed injuries; 26 were on the left side, and 28 were on the right sides. Causes of injuries included: 5 direct cut injuries, 10 iatrogenic injuries (including traction injuries and crush injuries by steel plates), and 39 humeral shaft fracture and radial nerve injuries. Types of nerve injuries included: 12 complete radial neurotmesis, 15 partial radial neurotmesis, and 27 radial contusions (with contusion length ranged 1.5-4.5 cm). All patients had radial nerve injuries experienced significant motor dysfunctions. Among these patients, 27 underwent nerve anastomosis, the remaining 27 were treated by nerve decompression; all fractures were treated with internal fixation with steel plates. Results During the average follow-up of 18 months (16-24 months), all 54 patients completely recovered from radial nerve injuries without any complications. The time for fracture healing ranged 8-14 months. According to the evaluation standards for radial nerve functional recovery, developed by the Chinese Medical Association, among the 27 cases treated by nerve anastomosis, 14 were “optimal”, 8 were “fair”, and 5 were “bad”; and all 27 cases treated by nerve decompression were “optimal”. Conclusion It is suggested to have early surgical treatment for the upper arm radical nerve injuries. The nerve decompression had better curative effects than the nerve anastomosis does.
While proposing evidence-based medical decision, we analyzed the existing problems in laboratory medicine, discussed the necessity and probability and explored the practicing way of evidence-based laboratory medicine, in order to follow the latest developing of clinical medicine and provide the best clinical laboratory technique and clinical laboratory service for good patient care.
Backgroud Iodine deficiency is the main cause for potentially preventable mental retardation in childhood and is still prevalent in large parts of the world. Objectives To assess the effects of iodised salt in comparison with other forms of iodine supplementation or placebo in the prevention of iodine deficiency disorders.Search strategy We searched the Cochrane Library, Medline, the Register of Chinese trials developed by the Chinese Cochrane Centre, and the Chinese Med Database. We performed handsearching of a number of journals (Chinese Journal of Control of Endemic Diseases, Chinese Journal of Epidemiology, Chinese Journal of Preventive Medicine, and Studies of Trace Elements and Health up to February 2001), and searched reference lists, databases of ongoing trials and the Internet. Date of latest search: November 2001. Selection Criteria We included prospective controlled studies of iodised salt versus other forms of iodine supplementation or placebo in people living in areas of iodine deficiency. Studies reported mainly goitre rates and urinary iodine excretion as outcome measures. Data collection amp; analysis As the studies identified were not sufficiently similar and not of sufficient quality, we did not do a meta-analysis but summarised the data in a narrative format. Main results We found six prospective controlled trials relating to our question. Four of these were described as randomised controlled trials, one was a prospective trial that did not specify allocation to comparison groups, and one was a large population-based study comparing different interventions. Comparison interventions included non-iodised salt, iodised water, iodised oil, iodation with potassium iodide versus potassium iodate. Numbers of participants in the trials ranged from 35 to 334; over 20 000 people were included in the population-based study. There was a tendency towards goitre reduction with iodised salt, although this was not significant in all studies. There was aim an improved iodine status in most studies (except in small children in one of the studies), although urinary iodine excretion did not always reach the levels recommended by the WHO. Reviewers’ conclusions The results suggest that iodised salt is an effective and safe means of improving iodine status. However, high quality controlled studies are needed to address questions of dosage and best means of iodine supplementation in different population groups.
Objective To systematically assess the effectiveness and safety of streamlined liner of the pharynx airway (SLIPA) compared with endotracheal tube (TT) for airway management in patients undergoing laparoscopic cholecystectomy surgery. Methods Databases such as PubMed (1992 to February 2012), EMbase (1984 to February 2012), MEDLINE (Ovid, 1964 to February 2012), SCI (1992 to February 2012), CNKI (1992 to February 2012), CBM (2002 to 2012) as well as WanFang Data (1992 to February 2012) were searched for relevant literature. The references of the included articles were also manually traced. Two reviewers independently screened the trials according to inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Meta-analyses were performed using RevMan 5.0 software. Results Ten randomized controlled trials (RCTs) involving 664 patients were included. Results of meta-analysis showed that: a) as for side effects, none of the patients experienced regurgitation or hypoventilation during operation; b) as for extubation response, SLIPA was proved fewer than TT during extubation with a significant difference (RR=0.14, 95%CI 0.05 to 0.36, Plt;0.000 1); c) SLIPA was superior to TT with regard to reducing postoperative sore throat (RR=0.15, 95%CI 0.06 to 0.38, Plt;0.000 1); d) SLIPA was similar to TT with regard to Ppeak after peritoneal insufflations (WMD=–0.07, 95%CI –0.73 to 0.59, P=0.83); e) as for PETCO2, the SLIPA group was lower than the TT group obviously after peritoneal insufflations (WMD=–1.09, 95%CI –1.70 to –0.49, P=0.000 4); f) as for hemodynamic change, the SLIPA group was more stable than the TT group during the operation with significant differences (Plt;0.05). Conclusion Current studies suggest that it is safe and effective to apply SLIPA for ventilation in laparoscopic cholecystectomy surgery. However, due to the limited quantity and quality of the included studies, more high-quality studies are need.
Objective To assess the effectiveness and safety of Chinese medicinal herbs for female immune-caused subfertility. Methods Databases included: MEDLINE (1966-2002.2), EMBASE (1984-2002.2), CBM (1978-2002.2) and Cochrane Controlled Trial Register, CCTR (Issue 1, 2002). Reference lists of trials were handsearched. Published randomized controlled trials (RCTs) whether blind or unblind, any languages and length of follow up were included. Treatments included Chinese medicinal herbs (single or compound). Controls were placebo and western medicine, or no intervention. Data were extracted independently by two reviewers and analyzed with Revman 4.2. Results Six RCTs were included, all of which were poor in methodological quality. Because of different therapies in the treatment and control groups, we did not perform meta-analysis. The No.1 anti-immune tablet was more effective than corticosteroid plus condom during intercourse both in the pregnancy rate (RR 3.75, 95%CI 1.61 to 8.75, P=0.002) and AsAb negative rate (RR 1.66, 95%CI 1.23 to 2.22, P=0.000 8). Bushen Xiezhuo Soup was more effective than antibiotic in the pregnancy rate (RR 2.97, 95%CI 1.60 to 5.50, P=0.000 6) and antisperm antibody (AsAb) negative rate (RR 2.33, 95%CI 1.54 to 3.54, Plt;0.000 1)。Zhenqi Zhuanyin Soup was as effective as IUI in pregnancy rate (RR 1.80, 95%CI 0.58 to 5.60, P＝0.31) but more effective than IUI in AsAb negative conversion rate (RR 9.61, 95%CI 3.22 to 28.67, Plt;0.000 1), Zhenqi Zhuanyin Soup combined with IUI was more effective than IUI in pregnancy rate (RR 3.60, 95%CI 1.32 to 9.85,P=0.01) and AsAb negative rate (RR 8.92, 95%CI 2.98 to 26.75, Plt;0.000 1). Conclusions Some Chinese medicinal herbs may work well in subfertility treatment. However, the evidence is too weak to draw a conclusion for there are deficiencies in strict randomization, blinding and follow-up.More strictly designed, randomized, double-blind, placebo-controlled trials are required.
目的 研究人喉表皮癌细胞系Hep-2中乳腺癌易感基因1（BRCAl）、P53结合蛋白1（53BP1）和DNA损伤检测点介质1（MDC1）的表达及临床意义。 方法 采用逆转录聚合酶链式反应检测BRCA1、53BP1、MDC1在喉癌细胞系Hep-2中mRNA的表达，同时用免疫印迹法检测蛋白的表达。 结果 在所检测的人喉癌细胞系Hep-2中BACR1、53BP1、MDC1在基因与蛋白两个水平均有表达。 结论 BRCA1、53BP1、MDC1可能在喉癌的发生发展中有一定作用。
This paper focuses on whether masking signal with natural sounds is an effective way for mitigating annoyance caused by monotone-like tinnitus. Four natural sounds, pink noise, and narrow bandwidth noise were applied as maskers in the present study shown in this paper. Two monotones were applied as maskees. As a basis for research, natural sounds do not necessarily mask monotones entirely. According to the results, spring water and rain noise can be selected as effective noise for masking monotones. In the case of monotones with different frequency, the same masker performed a little differently on masking. We preliminarily demonstrated the feasibility of natural sounds for masking monotone-like tinnitus, which is of great use for improving maskers in tinnitus masking therapy.
ObjectiveTo explore the relationship between the proportion of hospitalization expenses and the rationality of expense structure in patients with chronic heart failure (CHF), providing reference for early warning of unreasonable hospitalization expense structure and reasonable control of patients’ hospitalization expenses.MethodsPatients with CHF between 2020 and 2023 in Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine were used as the study data. Percentile algorithm was used to judge the rationality of the hospitalization expense structure. Multivariate logistic regression model was used to analyze the correlation between the proportion and rationality of expense structure. Restricted cubic spline model was to analyze the threshold response relationship. ResultsA total of 762 patients were included. The medicine expenses remained the primary component of hospitalization expenses for patients with CHF, and combined expenses of examination and laboratory tests exceeded 80% of the total hospitalization expenses. The incidence of unreasonable hospitalization expense structure in patients with CHF was about 10%. The proportion of traditional Chinese medicine, western medicine, examination and laboratory tests, age, admission mode and clinical pathway were the influencing factors of unreasonable hospitalization expense structure in patients with CHF. After coordinating the relevant variables, when the proportion of examination and laboratory tests was <35%, the risk of unreasonable hospitalization expense structure decreased with the increase of the proportion [odds ratio=0.887, 95% confidence interval (0.805, 0.977), P<0.01]. While the proportion of western medicine expenses was >30%, the proportion of traditional Chinese medicine expenses was >13%, and the proportion of examination and laboratory tests was>35%, the risk of unreasonable hospitalization expense structure increased with the increase of proportion (P<0.01). ConclusionsThere is a correlation between the expense proportion of medicine, examination and laboratory tests and unreasonable hospitalization expense structure. The consumptive expenses should be reasonably controlled.
Objective To evaluate the efficacy and side effect of non-conventional fractionated radiotherapy for head and neck cancer.Methods Trials were identified by searching CENTRAL, MEDLINE, EMBASE, Chinese Biological Medicine Database (CBMdisc) and Chinese VIP Database. We handresearched the data from 10 kinds of important Chinese journals. Two reviewers assessed and extracted the studies. The following primary outcomes were assessed: complete relief (CR), overall survival (OS), acute side effect and late side effect. Results Twenty-three trials involving 8 411 patients were included. Thirteen trials were of good quality, and the rest were of poor quality. Meta-analysis of these trials showed that: (1) non-conventional fractionated radiotherapy vs conventional fractionated radiotherapy: ① Only S-HART and CAIR resulted in higher CR, RR=1.21 (95%CI 1.02 to 1.44), 3.31 (95%CI 1.16 to 9.42), respectively; ② Only HRT could improve 2-year OS (RR=1.32, 95%CI 1.13 to 1.54), but this difference wasn’t found in 5-year follow up; ③ Most of the non-conventional fractionated radiotherapy could increase acute side effects, but not the late ones; (2) non-conventional fractionated radiotherapy combined with concurrent chemotherapy vs non-conventional fractionated radiotherapy: ① Only C-HRT resulted in higher CR (RR=1.58, 95%CI 1.18 to 2.11); ② Higher 2-year OS could be gained when combined with chemotherapy (RR=1.35, 95%CI 1.18 to 1.54), and only C-HRT resulted in higher 5-year OS (RR=1.57, 95%CI 1.19 to 2.07). ③ Acute and late side effects of radiotherapy would not increase when combined with chemotherapy. Conclusion It can not be concluded that non-conventional fractionated radiotherapy can improve the CR and OS of head and neck cancer, for a small number of patients, but it will get effect when combined with concurrent chemotherapy, and would not increase acute or late side effects. The effects of HRT and C-HRT should be cared specially.