ObjectiveThe application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program. Methods The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized. ResultsAccording to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, etc., which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function. ConclusionReasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.
支气管哮喘( 简称哮喘) 是一种以多种细胞特别是肥大细胞、嗜酸粒细胞和T 淋巴细胞等炎性细胞参与的气道慢性炎性反应和以气道高反应性为特征的疾病[1] 。目前全球大约有3.0 亿哮喘患者, 占世界人口的1% ～3% , 我国大约有2 500 万哮喘患者, 哮喘的发病率和死亡率在世界范围内一直呈增高趋势[2] 。2008 年在美国估计有210 万人或1.1% 的人口在过去的12个月内寻求针刺治疗, 4% 的美国人表示在他们的生活中曾使用过针刺疗法[3] 。针刺治疗哮喘在我国已有千年历史, 且相当普遍。目前哮喘的治疗仍以现代医学为主, 但尚无根治方法, 针刺治疗哮喘主要目标是控制哮喘复发, 提高患者的生命质量。
The modernization and internationalization of traditional Chinese medicine (TCM) are the key issues we must face up to. The development of TCM needs to depend on the breakthrough of methods and the innovation of ideology, and the international standardization of scientific research evaluation. The clinical evidence from randomized comtrolled trials (RCT) is valuable and reliable. It has shown that the proportion of RCT identified in TCM journals was less than 30%, and the score of RCT’s quality was less than 3 using Jadad scale. However, the number of systematic reviews on TCM is increasing rapidly after the evidence-based medicine (EBM) was introduced and practiced in China. Until 2004, 43 systematic reviews of TCM were published in China, and the quality of RCT included in those reviews was elevated. It has shown that the efficacy and safety of TCM indicated some advances in treatment of certain kind of diseases. It has been realized that RCT are important in TCM, and improving the quality of RCT is the key step for modernization and internationalization of TCM.
In the clinical trials, the rights and interests of participants must be considered. Ethical principles including the Declaration of Helsinki for clinical research have been established, and the institutional review board (IRB) and informed consent are important for protecting the rights and interests of participants. Whether a clinical trial is in accordence with the ethics depends on if the available clinical evidence is valuable and credible. The better candomize controlled trial (RCT) is one of the best evidence which will make different results equal between the treatment group and the controlled group. Thus benefits and risks of participants are allocated equitably and useless treatment is prohibited when the effective treatment affirmed at the same time. Economic health evaluation and outcome measurements are emphasized in EBM, and the clinical evidence is updated regularly. It is EBM and its emphasis of evidence that need the high-quality clinical trials, therefore the problems of ethics involved in clinical trials is important.
ObjectiveTo systematically evaluate the factors affecting the curative effect of pulmonary rehabilitation in COPD patients,and to provide theoretical basis for the implementation of rehabilitation. MethodsLiterature on the influencing factors of pulmonary rehabilitation efficacy in COPD patients was systematically searched in PubMed,Web of Science,Medline,ProQuest,Embase,CNKI and Wanfang databases from August 30,2023. According to the inclusion and exclusion criteria of the literature,the factors influencing the pulmonary rehabilitation effect of COPD patients were analyzed based on the 5 dimensions of the new implementation comprehensive framework. ResultsA total of 2620 COPD patients with 18 literatures were included in this study. Based on the new CFIR framework,11 promoting factors and 10 hindering factors of pulmonary rehabilitation efficacy were extracted and coded into 5 fields:innovation field,external factor field,internal factor field,individual characteristics field and implementation process field. ConclusionBy applying the new implementation comprehensive framework to evaluate the factors affecting the pulmonary rehabilitation effect of COPD patients,it provides an important reference for the development of rehabilitation strategies for COPD patients. It is suggested to adopt the comprehensive rehabilitation strategy of interdisciplinary,wide field and multi-team in order to promote the best benefit of both individual and social medical system in the pulmonary rehabilitation process of COPD patients.
Objective To assess the quality of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) relevant to COPD besides chronic bronchitis and chronic pulmonary cor disease in strengthening immune published in Chinese medical journals to provide scientific basis of systematic review (SR) of regulating the immune function of COPD in Chinese herbs. Methods 54 articles with clinical controlled trials were obtained by electronic searching and handsearching, and the method for randomized allocation, blindness, multi-centres, sample sizes, diagnosis criteria, exclusion criteria, source of cases, immune markers (cellular immunity, humoral immunity, erythrocyte immunity, nonspecific immunity), the clinical outcome assessment, statistical management, course of treatment and the side effects or adverse drag reaction, follow-up were investigated and then methodologically evaluated. According to the investigation, literatures with the method for randomized allocation, correct controls, appropriate sample sizes (≥60), the nation-wide diagnosis criteria, the objective clinical outcome assessment distinct statistical method were stipulated as the high-quality ones relatively. Results Among the 54 trials, 70.4% had explicit diagnosis criteria, 18.5% with exclusion criteria, 20.4% with comparability of baseline, 37.0% with distinct statistical method. In the therapy, 63.0% were with Chinese herbs. Conclusion The selected 7 articles belong to the high quality and possibly are to be explored in Meta-analysis.
ObjectiveTo summarize the latest progress of parathyroid gland identification in thyroid surgery, and to provide some reference for improving the clinical efficacy.MethodThe literatures about the identification of parathyroid gland in thyroid surgery in recent years were collected to make an review.ResultsThere were many methods for identifying parathyroid gland in thyroid surgery, such as naked eye identification method, intraoperative frozen section, intraoperative staining identification method, intraoperative optical identification method, intraoperative parathyroid hormone assay, γ-detector, and histological identification, each method had its own advantages and disadvantages.ConclusionThe identification of parathyroid gland does not only depend on a certain method, but also require surgeons to enhance their ability to distinguish parathyroid gland.
Objective To study effects of Helicobacter pylori on oncogenesis and progression of pancreatic cancer. Method The current literatures on the relationship between the Helicobacter pylori and the pancreatic cancer were collected and reviewed. Results The Helicobacter pylori infection might play a role in the development of the pancreatic cancer. The infection rate of the Helicobacter pylori in the patients with pancreatic cancer is higher than that of the healthy controls; furthermore, in the patients with Helicobacter pylori antibody positive, the infection rate of the Helicobacter pylori in the cytotoxin-associated gene A-negative strains of Helicobacter pylori is significantly higher than that of the healthy controls. Conclusions Helicobacter pylori infection is related to occurrence and development of pancreatic cancer. Specific mechanism is still not clarified and further research is need to study.
ObjectiveTo understand advances in the timing and surgical mode selection of gastrointestinal endoscopy and surgical intervention for acute biliary pancreatitis (ABP).MethodThe recent literatures on the timing and choice of gastrointestinal endoscopy and surgical treatments aimed at ABP were reviewed.ResultsFor ABP patients with early cholangitis or biliary obstruction, no matter how serious, endoscopic treatment should be used to relieve obstruction and relieve symptoms. For patients only with ABP, if non-surgical treatment was not effective and patients showed symptoms such as biliary obstruction or biliary tract infection, endoscopic intervention should be considered. Most ABP patients had milder symptoms and could undergo cholecystectomy during the same hospitalization to prevent ABP recurrence after symptoms relief. Patients with severe ABP could be treated with cholecystectomy along with pancreatic necrotic tissue removal, and surgery should be performed after the disease was controlled. If the preoperative imaging examination highly suspected that there were stones in the biliary tract, biliary exploration should be performed at the same time. Laparoscopic surgery should be selected as far as possible to facilitate the postoperative recovery of the patient.ConclusionsFor patients with ABP, whether endoscopic or surgical treatment, the timing and surgical mode selection should follow the specific clinical situation with the “individualization” principle of the treatment. We should make the reasonable and effective policy at diagnosis and treatment according to different conditions.
ObjectiveTo investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture.MethodsBetween February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O’Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS).ResultsAll cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case.ConclusionThe treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.