证据质量升级的最常见原因是效应量大。当方法学严谨的观察性研究表明风险至少降低或增加2倍时，GRADE建议考虑将证据质量升高1级；当风险至少降低或增加5倍时，考虑将证据质量升高2级。当存在剂量-反应关系，或所有合理的混杂、偏倚会降低明显的治疗效应，或混杂、偏倚使得结果无效为假效应时，系统评价作者和指南制定者也可考虑升高证据质量。其他考虑因素包括起效迅速、潜在的疾病（状态）趋势以及间接证据。
目的:观察帕罗西汀治疗非便秘型肠易激综合征的临床疗效。方法:符合罗马Ⅲ诊断标准的非便秘型肠易激综合征患者107例,随机分为2组,治疗组57例,给予帕罗西汀20 mg,每日晨起顿服,匹维溴铵50 mg,3次/d,口服;对照组50例,给予谷维素30 mg, 3次/d,口服,匹维溴铵50 mg,3次/d,口服,疗程4周。观察患者腹痛、腹泻、腹部不适、排便次数、大便性状,以及焦虑、抑郁等改善情况。结果:治疗组总有效率为930%,对照组总有效率为760%,两组比较差异有统计学意义(Plt;001)。结论:帕罗西汀治疗非便秘型肠易激综合征有明确的临床意义。
目的：慢性肾脏疾病中肾性高血压常见，危害大且不易控制，本文就临床护理实践进行总结。方法：肾性高血压患者男性82例，女性74例，予限水盐摄入,饮食疗法,休息与心理护理,以及合理的降压药治疗，加强观察等。结论：肾性高血压控制不佳者，在降压药使用基础上注意休息，控制水钠入量，并加强其心理治疗，解除心理负担，有利于控制血压。
目的：探讨射频配合药物治疗疣状胃炎的疗效。方法:将胃镜诊断为疣状胃炎患者68例随机分为两组，射频配合药物治疗组用射频波25～40W对病灶行一次性“ 烧灼”，术后口服奥美拉唑胶囊4周；药物治疗组使用奥美拉唑治疗4周组作为对照组。两组若幽门螺杆菌(HP)阳性者均给予根除HP治疗。结果：射频配合药物治疗组症状缓解/消失率及疣状病灶消退率明显优于药物治疗组（P＜0.01）。结论：射频配合药物治疗疣状胃炎是一种较理想的、值得推广的有效方法，具有治疗彻底，操作技术简单,使用安全,病灶愈合快,治愈时间短,价格便宜,病人痛苦小等优点。
目的 探讨嵌顿环状混合痔的手术治疗方法。 方法 回顾性总结我院1998年1月至2002年1月采用小切口外剥内扎硬注术治疗嵌顿环状混合痔30例临床经验。 结果 30例患者手术过程顺利，手术时间平均50 min，平均住院时间10 d，术后并发肛门Ⅰ度水肿4例，术后当天排尿困难1例，经对症治疗后痊愈出院。本组病例术后随访1年均无复发。 结论 该术式能迅速减轻患者痛苦，且疗效满意。
Objective To gain accurate imaging information of biliary tract after surgery. MethodsThe biliary tract of 170 cases after surgery had been observed dynamically from different directions for longer time. The results of data on biliary tract change were stored in disc, or picture. ResultsOf 170 cases, 120 cases were cured without any abnormal change on cholangiography, and then the Ttube was removed. Of another 50 cases, 30 cases revealed remnant stone on cholangiography, 9 cases showed inflammatory stricture of biliary tract, 4 cases displayed common bile duct tumor, and 7 cases had false fillingdefect. Then, the results were further confirmed by sonography, CT, choledochoscopy, and operation. Conclusion The dynamic observation of biliary tract by Ttube cholangiography after surgery is usual way that is handy, practical, painless, and economic.
Objective To summarize the clinical application of esophagogastrostomy with layered anastomosis and to observe the healing quality of anastomotic stoma in animal experiments. Methods One thousand and twenty-four patients suffered from carcinoma of esophagus or carcinoma of gastric cardia had undergone esophagogastrostomy by layered anastomosis with absorbable suture. Twenty-four experimental dogs (adult male healthy hybrid dogs) were divided into two groups: the experimental group and the control group. The former (experimental group) underwent the layered anastomosis, the diameter of esophagogastric stoma and the length and depth of stomal scar were measured under anesthesia in both groups on 5th,8th,14th,and 42th postoperative day, respectively. So were done the histological measurement, such as the count infiltrating inflammatory cells, the proliferation of blood capillary and other cells. And the cytokines related to wound healing (LsAB technique) such as epidermal growth factor(EGF), transforming growth factor-beta 1 (TGF-beta 1) were detected, either. Results One thousand and twenty-four patients had no anastomotic leakage. There were only 6 patients suffered from mild anastomotic stricture, and they got well after one dilatation. The results of the measurement of 24 experimental dogs revealed that, in the experimental group, the mucosa was in good connecting condition, had a soften anastomotic stoma and a thin scar. The counts of inflammatory cells and fibroblast showed more in number at the early time after operation (Plt;0.05), while showed less in number at the advanced time of operation (Plt;0.05). In the control group, however, the mucosa were in a bad connecting condition, the scar was thicker, and the muscle layer was frequently exposed. The counts of inflammatory cells and fibroblast were fewer at the early time after operation, however, they had a clearly tendency of increasing at the anaphase after the operation. On the cytokines related to the healing of wound in the experimental group, there was a high expression and activity at the early period. There were a little expression up to postoperative 42 d. Whereas, in the control group, there had a low expression level,increased clearly on postoperative 8 d, and still a higher expression up to postoperative 42 d. Conclusions The esophagogastrostomy by layered anastomosis has a high healing quality with a thin scar. The proliferation of cells and the expression of growth factors benefits the normal healing of wound by first intention.
Objective The tendon-bone heal ing is the key point to ensure the success of the anterior cruciate l igament (ACL) reconstruction. To observe the histological change in the tendon-bone heal ing after ACL reconstruction by different concentrations of platelet-rich plasma (PRP) combined with deproteinized bone (DPB) of calf as bone tunnel infill ing and to investigate the active effect of the complex on tendon-bone heal ing and to define the optimal concentration of PRP. Methods Eight mL blood was drawn from central artery of New Zealand rabbit ears; PRP was prepared by Landesbergmethod, and l iquid supernatant was used as thinner to prepare different concentrations of PRP (30%, 60%, and 100%). Fresh osteoepiphysis spongy bone was harvested from lower end of femur of newborn calf to prepare DPB by way of 30% H2O2 and ether alternating soaking for 24 hours continuous 6 times. DPB was soaked in different concentrations of PRP and mixed with activator to prepare the PRP/DPB complex. A total of 54 New Zealand white rabbits, aging 8-12 months, weighing (2.5 ± 0.4) kg, were divided randomly into 3 groups: group A (30%PRP/DPB complex, n=18), group B (60%PRP/DPB complex, n=18), and group C (100%PRP/DPB complex, n=18). The legs of the rabbits were randomly divided into experimental side and the control side; ACL was reconstructed by semitendinosus and PRP/DPB complex in bone tunnel in the experimental side, and only by semitendinosus in the control side. The general conditions of the rabbits were observed postoperatively and HE staining was used to observe the tendon-bone heal ing, then I-IV levels of semi-quantitative analysis of the tendon-bone heal ing were evaluated according to Demirag standard at 3, 6, and 12 weeks. Results General observation: Synovial fluid sl ightly increased in the specimens and no bony tissue was found in inner of femoral tunnel at 3 weeks; there was no synovial fluid in all the specimens and scar tissue was discovered in inner of femoral tunnel at 6 weeks; and there was no synovial fluid and the tendons became tighter with fibrous tissue at 12 weeks. Histological observation: New granulation tissue formed in the tendon-bone interface of group A experimental sides at 3 weeks; there was various widths of Sharpey type textile fiber in the tendon-bone interface at 6 weeks; Sharpey type textile fiber arranged regularly, which formed an irregular and blur “tidal l ine” at 12 weeks. Group B experimental sides were better than any other group at 3, 6, and 12 weeks; chondrocyte-l ike arranged regularly in the tendonboneinterface at 3 weeks; the number of chondrocyte-l ike per unit area was more than that of the other groups at 6 weeks;and chondrocyte-l ike prol iferated and matured in the tendon-bone interface, Sharpey type textile fiber became tighter andordered. Group C experimental sides were similar to both sides of group A at 3 weeks, however, the prol iferation of relatively mature dense connective tissue was worse than that of other groups at 6 and 12 weeks. According to Demirag grading, there were significant differences in tendon-bone heal ing between the experimental sides and the control sides of group B at 3 and 6 weeks, and between group B experimental sides and group C experimental sides at 12 weeks (P lt; 0.05). Conclusion The mixture of PRP/PRP has good biocompatibil ity and bone induction, so it can enhance tendon-bone heal ing after ACL reconstruction when the concentration of PRP is 60%.
Objective To repair the defects in articular cartilage with collagen complex gradient TCP in vivo andto study the regenerated cartilage histomorphologically. Methods The models of defects in articular cartilage were madeartificially in both condylus lateral is femoris of mature rabbits, male or female, with the weight of 2.0-2.5 kg. The right defects were implanted with the material of Col/TCP as the experimental group and the left defects were untreated as the control group. The rabbits were killed at 4, 6, 8, 12 and 24 weeks after operation, respectively, with 6 ones at each time, and the macroscopic, histological, ultrastructural examinations and semi-quantity cartilage scoring employing Wakitanifa repaired cartilage value system were performed. Results Four weeks after operation, the defects in the experimental group were partly filled with hyal ine cartilage. Twelve weeks after operation, the defects in the experimental group were completely filled with mature hyal ine cartilage. Twenty-four weeks after operation, regenerated cartilage had no ataplasia. However, fibrous tissues were seen in the control group all the time. At 4, 6, 8, 12 and 24 weeks ostoperatively, the Wakitanifa cartilage scores were 7.60 ± 0.98, 5.69 ± 0.58, 4.46 ± 0.85, 4.35 ± 0.12 and 4.41 ± 0.58, respectively, in the experimental group and 10.25 ± 1.05, 9.04 ± 0.96, 8.96 ± 0.88, 8.88 ± 0.68 and 8.66 ± 0.54, respectively, in the control group. At 4, 6, 8, 12 and 24 weeks postoperatively, the collagen II contents were 0.28% ± 0.01%, 0.59% ± 0.03%, 0.68% ± 0.02%, 0.89% ± 0.02% and 0.90% ± 0.01%, respectively, in the experimental group, while 0.08% ± 0.02%, 0.09% ± 0.04%, 0.11% ± 0.03%, 0.25% ± 0.03% and 0.29% ± 0.01%, respectively, in the control group. Differences between the control group and the experimental group were significant (P lt; 0.05). By then, typical chondrocyte was observed by transmission electron microscope in the experimental group and much fiber with less fibrocyte was observed in the control group. Conclusion Three-dimensional scaffold collagen complex gradient TCP may induce cartilage regeneration to repair the defects of articular cartilage in vivo.