目的 探讨保留括约肌虚挂线法治疗高位肛周脓肿的临床疗效。 方法 2009年10月－2010年10月采用随机对照试验，对52例高位肛周脓肿患者施行手术治疗，其中保留括约肌虚挂线法（治疗组）26例，切开挂线引流法（对照组）26例。对两组患者术后6个月肛瘘发生率、切口愈合时间、术后1～15 d每晚疼痛视觉模拟评分（VAS）和术后6个月痊愈患者肛门功能后遗症发生率进行比较。 结果 术后6个月，治疗组和对照组肛瘘发生率分别为4.0%和3.8%，差异无统计学意义（P＞0.05）。术后7～15 d治疗组VAS评分均低于对照组，差异有统计学意义（P＜0.05）。两组切口愈合时间分别为（19.05 ± 6.71）d和（21.42 ± 8.40）d，差异有统计学意义（P＜0.05）。术后6个月治疗组痊愈患者肛门功能全部正常，对照组后遗症发生率为12.0%，两组比较差异有统计学意义（P＜0.05）。 结论 保留括约肌虚挂线治疗在术后疼痛、切口愈合时间和保护肛门功能等方面明显优于切开挂线引流治疗，是一种治疗高位肛周脓肿较为理想的方法。
Objective To explore the mechanism of Liuhedan in promoting wound healing through applying Liuhedan to the infective wounds of New Zealand white rabbits. Methods A total of forty New Zealand white rabbit models of infective wounds were established after anesthesia. Five circular infective incisions were generated on the back of each rabbit, with a diameter of 2 cm. Five wounds of each rabbit were assigned respectively to the control group, model group, traditional Chinese medicine (TCM) group (Oleum Lithospermum), Western medicine group (calcium alginat), and treatment group (Liuhedan). Wound dressings were performed every day since postoperative day 1. Ten rabbits were selected randomly to be euthanized on postoperative day 3, 7, 14 and 21, respectively. Each specimen was divided into two parts. One was used for detecting interleukin-1β (IL-1β) by enzyme-linked immunosorbent assay, and the other was used for detecting tumor necrosis factor-α (TNF-α) by immunocytochemistry. Results On postoperative day 3 and 7, groups with the expression of IL-1β from low to high were respectively the control group, the treatment group, the Western medicine group, the TCM group, and the model group [postoperative day 3: (680.81±185.53), (1 028.67±205.57), (1 278.67±251.15), (1 449.86±230.74), (1 544.62±371.77) pg/mL; postoperative day 7: (1 024.43±239.94), (1 333.57±257.31), (1 635.14±222.40), (1 784.71±323.85), (1 953.29±324.78) pg/mL], and all the differences among the groups were significant (P<0.05); On postoperative day 14, groups with the expression of IL-1β from low to high were respectively the treatment group, the control group, the Western medicine group, the TCM group, and the model group [(908.71±108.61), (978.57±161.75), (1 120.43±265.39), (1 129.71±298.06), (1 191.14±234.92) pg/mL], and all the differences among groups were significant (P<0.05) except the difference between the Western medicine group and the TCM group (P>0.05); On postoperative day 21, the expression of IL-1β in the control group, the model group, the TCM group, and the Western medicine group was (487.19±121.80), (496.35±102.15), (500.31±139.34), (499.08±120.67) pg/mL, respectively, with no significant differences among the groups (P>0.05), which were all higher than that in the treatment group [(398.62±102.93) pg/mL] with significant difference (P<0.05). The expression of TNF-α in the model group was significantly greater than those in the other groups. The expression of TNF-α in the treatment group and Western medicine group was significantly lower compared with the model group. The expression of TNF-α in the TCM group was stronger compared with those in the treatment group and the Western medicine group. Conclusion Liuhedan can specifically suppress the expressions of IL-1β and TNF-α in the treatment of infective wounds, decrease the release of inflammatory factor and promote the healing.
Objectives To evaluate the clinical outcomes and identify its associated factors in patients with acute coronary syndromes (ACS) in Tianjin city. Methods Data were obtained from Tianjin urban employee basic medical insurance database. Adult patients who were discharged alive after the first ACS-related hospitalization (the index hospitalization) during January, 2012 to December, 2014 and without malignant tumor were included. Clinical outcomes were measured by subsequent major adverse cardiovascular events (MACE) including hospitalization for myocardial infarction (MI) or stroke, all-cause death, or their composite endpoint. Cox model was used to explore the factors associated with MACE. Results 22 041 patients were identified, in which 9.5% experienced MACE during follow-up with a mean number of 1.3 MACEs. 3.1% of patients had MI, 5.7% had stroke and 1.4% had all-cause death. Among patients who experienced MACEs, the average time from index discharge to the 1st MACE was 143.2 days. Patients being older, male or had higher Charlson Comorbidity Index (CCI) were more likely to experience MACE. Patients who had prior stroke and prior all-cause hospitalization were also more likely to experience MACE, whereas patients who had prior angina, prior β-blockers utilization and received percutaneous coronary intervention (PCI) during index event were less likely to experience MACE. Conclusion Stroke is the most common type of MACE among ACS patients in Tianjin, China. Almost half of the 1st MACE occur within the 3 months after ACS. Patients who are older, male, have higher CCI or have prior stroke are at higher risk of MACE.
Nuclear factor-erythroid 2-related factor 2 (Nrf2) is an important factor for cells to resist oxidative stress and electrophilic attack. It is involved in the formation and control of oxidative stress defense pathways. It is associated with oxidative stress-related diseases, including cancer, neurodegenerative diseases, cardiovascular diseases and aging, and is a potential pharmacological target for the treatment of chronic diseases. This article will review the important role of Nrf2 in the regulation of cell proliferation, including direct regulation of cell proliferation, regulation of reactive oxygen species, intracellular metabolism, regulation of mitochondrial function, cell lifespan and inflammatory response. The aim is to provide a theoretical basis for further research on how to use Nrf2 to regulate cell proliferation.
When there is a lack of head-to-head randomized controlled trials between two interventions of interest, indirect comparison methods can be employed to estimate their relative treatment effects. Matching-adjusted indirect comparison (MAIC) is a population-adjusted indirect comparison method that utilizes a weighting approach. Unanchored MAIC is particularly applicable in scenarios where a common control group between the two interventions is not available. This article introduces the background and mathematical theory of unanchored MAIC, along with a demonstration of the operational steps and interpretation of results through an application example.
Inflammatory bowel disease (IBD) is characterized by recurrent abdominal pain, diarrhea, and mucopurulent bloody stools as its main clinical manifestations. In recent years, its parenteral manifestations have received increasing attention. Fatigue, as one of the extraintestinal manifestations of IBD, affects the quality of life of patients, and results in considerable distress for patients. The influencing factors of fatigue symptoms in IBD patients include inflammation, psychological comorbidities, sleep disorders, anemia, micronutrient deficiency, changes in microbiota, and metabolomics. The pathogenesis is currently unclear and may be related to disorders in tryptophan metabolism. This article will review the influencing factors and pathogenesis of fatigue symptoms in IBD patients, aiming to provide a basis for the prevention and treatment of IBD fatigue.
Objective To assess the effectiveness and safety of Weifuchun for chronic atrophic gastritis. Methods Trials were located through electronic searches of The Cochrane Library (Issue 3, 2007), EMbase (1974 to June 2007), PubMed (1966 to June 2007), CBM (1978 to June 2007), CNKI (1994 to June 2007) and VIP (1989 to June 2007). Randomized controlled trials (RCTs) and quasi-RCTs of Weifuchun for chronic atrophic gastritis were included. A critical quality assessment and Meta-analysis were performed for the included studies. RevMan 4.2.2 was used for statistical analysis. Results A total of 8 trials involving 816 patients were included. Meta-analysis showed that compared with the control group, Weifuchun for the CAG treatment group had superiority in many aspects such as effective rate according to Gastroscopy (RR 1.54 and 95%CI 1.31 to 1.81), effective rate according to Patho-check (RR 1.99 and 95%CI 1.54 to 2.58), adverse events, remission rate based on clinical symptoms (RR 1.47 and 95%CI 1.30 to 156), remission rate based on a single symptom, curative effect with IM/ATP, HP darkening rate (RR 1.26 and 95%CI 1.02 to 1.56), situation of hemoglobin change and so on. No RCTs were found to describe the safety of Weifuchun for CAG. Conclusion Because of low quality and small samples, there is no enough evidence on Weifuchun for chronic atrophic gastritis. More largescale multi-center randomized trials are needed to investigate the role of Weifuchun for chronic atrophic gastritis.
Objective To investigate the clinical curative effect of divided excision and plastic combined with procedure for prolapse and hemorrhoids (PPH) in treatment for circular mixed hemorrhoids. Methods Clinical observation on 120 patients with circular mixed hemorrhoids between May 2007 and May 2008 treated by divided excision and plastic combined with PPH was carried out. Results The mean hospital stay after operation was 7.6 d. The wound healing average time was 11.9 d. The incidence rate of postoperative urinary retention was 5.8% (7/120). Average scores of pain in 3 d after operation: 5.3 points (1-8 points) on day 1, 3.6 points （2-9 points） on day 2, 2.2 points （1-8 points） on day 3. All patients were followed up for 12 months, there were 3 cases of hematochezia， 1 case of prolapse, and 1 case of remained abnormal outgrowth skin; the anus function was normal in all cases without anal stricture or tightening feeling. Conclusions Divided excision and plastic combined with PPH can better treat circular mixed hemorrhoids. This operation can not only completely clear the lesions, but also repair and reconstruct the anus and anal canal, protect its size and function. It is an ideal operation for treatment for circular mixed hemorrhoids.
ObjectiveTo develop an immune-related genes (IRGs) based prognostic signature and evaluate the value in predicting prognosis in patients with colon cancer.MethodsGene chip data sets of 452 colon cancer patients were collected from the TCGA database, and 2 498 IRGs data sets were obtained from the ImmPort database. After taking the intersection, univariate and multivariate Cox proportional hazards regression analysis were used to screen and construct the IRGs gene model. To evaluate the prognostic value of genetic models, Cox proportional hazards regression was used to analyze the correlation between IRGs model/clinicopathological features with prognosis of colon cancer. The relationship between risk score and immune cell infiltration was analyzed too.ResultsA total of 206 differentially expressed IRGs were identified in colon cancer tissues, and 11 kinds of IRGs were identified by univariate and multivariate Cox proportional hazards regression analysis: solute carrier family 10 member 2 (SLC10A2), C-X-C motif chemokine ligand 5 (CXCL5), C-C motif chemokine ligand 28 (CCL28), immunoglobulin kappa variable 1D-42 (IGKV1D-42), chromogranin A (CHGA), endothelial cell specific molecule 1 (ESM1), gastrin releasing peptide (GRP), stanniocalcin 2 (STC2), urocortin (UCN), oxytocin receptor (OXTR) and immunoglobulin heavy constant gamma 1 (IGHG1). Colon cancer patients were divided into high risk group and low risk group according to the median value of risk value of IRGs risk markers. Patients in the high risk group had shorter overall survival (OS) than that in the low risk group (P<0.001). The area of the time-dependent ROC curve (AUC) was 0.754, suggesting that IRGs model had a good ability to predict the prognosis of colon cancer patients. The higher the risk value of IRGs, the later T stage of colon cancer (T3–T4), the more lymph node metastasis (N1–N2) and the later clinical stage of colon cancer (Ⅲ–Ⅳ), P<0.05. Except for neutrophils, the infiltration density of B cells, CD4+ T cells, CD8+ T cells, dendritic cells and macrophages were significantly increased with the increased of the risk value (P<0.05).ConclusionThe risk values of the 11 kinds of IRGs gene models screened in this study can be used to predict the prognosis of colon cancer patients, and can be used as biomarkers to evaluate the prognosis of colon cancer patients.
ObjectiveTo analyze the limitations and challenges for the use of real-world data in the decision making of drug reimbursement through literature review and provide standard process and guideline for the real-world study supporting drug reimbursement. MethodsBy summarizing the relevant policies, regulations, and guiding principles of major drug regulatory agencies worldwide, the study analyzed the applicable conditions, framework, and reimbursement mode for using real-world evidence in the decision making of drug reimbursement. ResultsThe study found that the health technology assessment departments of major developed countries and Asian countries have used real -world evidence to evaluate the drug efficacy and safety. The application scope of real-world data for reimbursement decision included describing the treatment process of the disease, assessing economic burden, verifying economic models, and evaluating the efficacy and safety of drugs. Some developed countries including the United Kingdom and the United States had released guidelines or frameworks of the real-world study for reimbursement decision. The process and framework of using real-world data in reimbursement decision could be divided into three models: coverage with evidence development, outcome-based contract, and re-assessment. ConclusionReal-world data has been widely used in the process of health technology assessment. To adapt to the development of the pharmaceutical industry and to meet the needs of clinical patients, it is urgent to standardize the process of collecting real-world data and formulate the scope and process of using real-world data in the reimbursement process.