目的:探讨并强调电子病历系统在医院信息化建设中的应用及前景。方法:了解目前国内电子病历系统现状,并结合本科室已建立的结构化电子病历系统应用经验,分析电子病历系统的利弊及在我国发展的需求前景。结果:电子病历系统的运行大大提高了医疗质量和工作效率。结论:以电子病历系统为中心的医院信息化建设势在必行。
The necessity and methods of systematic review or Meta-analysis of observational studies were introduced. The difference between the systematic review or Meta-analysis of observational studies and randomized controlled trials was also described.
In this study, loop-mediated isothermal amplification (LAMP) assay in conjunction with calcein for visualized detection of Mycobacterium tuberculosis (MTB) was established. Firstly, four LAMP primers were designed according to the region of 16S rDNA sequences of MTB. Secondly, clinical sputum samples were collected, decontaminated and their DNA was extracted. Thirdly, standard MTB strains were used to evaluate the specificity and sensitivity of LAMP. At the same time, electrophoresis was used for products detection and calcein was used for visualized verification. At last, Chi-squared test function in SPSS 17.0 software was used for consistency evaluation of LAMP assay as compared with the gold standard (culture method). Results showed that there was no nonspecific amplification appeared in the specificity assay and the detection limit was 10 copies/tube in the sensitivity assay. In addition, visualized method by calcein had a comparable sensitivity with that of electrophoresis method. After evaluation of clinical practicability, the sensitivity of LAMP was calculated as 94.74% and the specificity was 90%, respectively. And Chi-squared test showed that LAMP and culture method had no statistic difference, and the two methods were in good consistency (P>0.05). In conclusion, LAMP assay introduced in our study has the characteristics of high efficiency and visualized detection so that this technique has great application prospects in the resource-limited environment, such as work field and primary care hospitals.
Objective To discuss the feasibility and clinical outcomes of fast-track (FT) surgery for elderly patients (≥70 years) with colorectal carcinoma. Methods Between November 2007 and January 2009, 103 elderly patients were analyzed prospectively, who were divided into FT group and traditional group randomly. All 103 patients had completed the entire study. Postoperative complications and early rehabilitations were studied and compared. In addition, completion of FT courses was recorded. Results ① In early rehabilitation, the time of first ambulation was (1.96±0.89) d and (2.92±1.43) d, oral intaking was (2.41±0.92) d and (3.62±1.40) d, and first flatus was (3.88±1.05) d and (4.52±1.29) d in the FT group and the traditional group, respectively. The early rehabilitation indexes in the FT group were significantly earlier than those in the traditional group (Plt;0.05). ② Postoperative hospital stay was (9.27±1.87) d and (12.75±7.05) d in the FT group and the traditional group, respectively, in the FT group which was shorter than that in the traditional group (Plt;0.05). ③ The mortality rate and readmission rate was 0 on 2 weeks after operation in two groups. ④ The total morbidity rate was 11.76% (6/51) in the FT group, in the traditional group was 28.85% (15/52), there was significant difference between two groups (Plt;0.05), while there was no significant difference in general complications and surgical complications between two groups (Pgt;0.05).Conclusions FT surgery for elderly patients with colorectal carcinoma is feasible and could enhance recovery, cut down morbidity rate and shorten postoperative hospital stay. If the FT courses are more completed, the clinical outcomes could be better.
Objective To evaluate the efficacy and safety of prophylactic octreotide for preventing complications after pancreas transplantation. Methods We searched The Cochrane Library (Issue 1, 2008), PubMed (1970 to January 2008), EMbase (1974 to January 2008) and CBM (1978 to January 2008). Six studies concerning prophylactic octreotide in preventing complications after pancreas transplantation were retrieved. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently. Meta-analyses were done using The Cochrane Collaboration’s RevMan 4.2.10 software. Results Three RCTs, involving a total of 82 patients were included in the review. On the fifth postoperative day, the urinary amylase was significantly lower in patients in the octreotide group compared to the control group (SMD=–784.86, 95%CI –1464.24 to –105.49, P=0.02), and no significant difference was observed between the two groups in serum amylase (SMD=–12.26, 95%CI –56.53 to 32.06, P=0.59). No significant difference in the incidence of complications was noted between the two groups. The differences between the two groups in graft survival rate (90 days after operation) and patients’ 6-month survival rate were not statistically significant (RR=0.96, 95%CI 0.83 to 1.11, P=0.56; RR=1.17, 95%CI 0.86 to 1.58, P=0.32, respectively). As for safety, there were no reports of adverse effects of octreotide on CsA or FK506 absorption and no reports of other adverse reactions. Conclusion The evidence currently available shows that prophylactic octreotide is not capable of reducing dramatically the occurrence of pancreatitis, fistula, thrombosis and rejection after pancreas transplantation. And there is no obvious influence on graft survival rate and patient survival rate. Because the RCTs available for this systematic review are too small, further high-quality large-scale RCTs with long-term follow up are required to provide more reliable evidence.
Objective To evaluate the impact of portal or systemic venous pancreas graft drainage on patient and graft outcomes following simultaneous pancreas kidney transplantation (SPK). Methods We searched The Cochrane Library (2008, Issue 1), PubMed (1970 to Feb 2008) and EMBASE (1974 to Feb 2008) to find studies concerning the effect of systemic versus portal venous pancreas graft drainage on patient and graft outcomes. Meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2 software. Results Three RCTs involving 401 simultaneous pancreas kidney transplants were included in our meta-analysis. Statistically significant differences were only observed in 3- and 5-year pancreas graft survival rates (P=0.03 and P=0.05). No significant difference was noted in patient or kidney graft survival rates. Conclusion Currently available evidences from RCTs does not support the effectiveness of portal drainage in preventing thrombosis, rejection or infection after SPK. Large-scale, long-term and appropriately designed RCTs are required to conclude whether portal and systemic drainage in pancreas transplantation are equivalent in terms of patient and graft survival.
Objective To investigate the research base and current understanding of the mechanism of ischemia-reperfusion injury (IR) to intrahepatic cholangiocytes after l iver transplantation, so as to identify the key points of the mechanism and provide references for cl inical practice. Methods We searched PubMed (1970 to 2007) and CBM(1979 to 2007). Qual ity assessment and data collection were performed by two reviewers independently. Since the baseline supplied and the measure were very different, we decided to provide a descriptive summary only. Results The earliest study on liver IR was publ ished in 1970. A total of 65 papers were included. There were 13 on cl inical studies, 35 on basic research studies; and 17 review articles. Most basic studies focus on injury mechanism: ① The physiology of bile ducts and Intrahepatic Bil iary Duct Cells(IBDC); ②the IR caused injury mechanism of IBDC during or after liver transplantation; ③ the basic injury mechanisms include: cold ischemia, warm ischemia, reperfusion, injury of bile and bile salts. Most clinical studies focused on preventive measures, including surgical and non-surgical approaches. Based on the evidence from basic research, changing the composition and perfusion methods of perfusate and protecting the specific blood supply to biliary ducts and cholangiocytes during the operation were important in preventing or reducing such an injury. Conclusion ① The heterogeneity of morphology, function, status and the special blood supply in large and small IBDC are important material base. ② Our own study indicated that simple IR or H/R was able to change the expression of MHC, MIC, DR4, DR5 and other adhesion molecules. ③ Compared to hepatic cells, hIBDC can’ t resist cold ischemia and even worse in tolerating reperfusion injury. ④ Hydrophobic bile salts will could increase the harm to bile ducts during organ preservation. ⑤ Due to the low quantity and limited quantities of clinical researches, the power of evidence was low. The evaluation indexes and baseline conditions are not unified. So the conclusions are for reference only.
Objective To evaluate the safety and efficacy of steroid withdrawal in modern triple immunosuppressant (Cycloproine/Tacrolimus, Mycophenolate Mofetil and Steroid) on renal transplantation recipients. Methods We searched MEDLINE (1966-Sep. 2005), OVID (1966-2004), EMBASE (1984-2004), The Cochrane Library (Issue 4, 2005), CBMdisc (1994-2005), and handsearched 7 Chinese Journals. Randomized controlled trials (RCTs) adopting modern triple immunosuppressant, and comparing steroid withdrawal (SW), group and steroid continuing group (SC) were selected. The quality of included studies was evaluated and graded according to Cochrane Reviewer’s Handbook 4.2.5, and meta-analysis was performed by using RevMan 4.2.7 software. Results Nine RCTs including 1 681 patients (845 in SW and 836 in SC) were identified. The average follow-up time was 6-12 months. No significant difference was found in using CsA or Tac in modern triple immunosuppressant. The results of our meta-analysis showed: ① the risk of acute rejection was two times higher in SW than SC (RR 2.05, 95% CI 1.54 to 2.72, P lt;0.000 01), mainly Banff grade I (mild) (RR 1.92, 95% CI 1.16 to 3.17, P =0.01); but no significant differences were found on Banff grade II and III between the two groups. ② the rate of graft and patient survival and chronic rejection were the same between two groups. ③ Steroid withdrawal decreased the incidence of opportunistic infection (mainly caused by simplex herpes virus and Candida) and urinary tract infection. While the incidence of CMV and sepsis infection has no significant difference between two groups. Conclusion Steroid withdrawal within 3 months in modern immunosuppressive regimen ① increases the risk of Banff Grade I rejection reaction, but the moderate and severe rejection are similar between the two groups; ② doesn’t affect the rate of graft, patient survival, and chronic rejection; ③ decreases the incidence of opportunistic and urinary tract infection, but doesn’t improve the CMV infection and sepsis. To prophylaxis serious infection, steroid withdrawal is worth considering under sufficient immunosuppressive regimen. The key point is to balance the benefit and harm for individual recipients.
Objective To assess the effect of integrated traditional Chinese medicine with western medicine (ICWM) in the treatment of SARS. Methods We searched MEDLINE, EMBASE, and Chinese BioMed Database ( CBM ) , and the Intemet performed handsearching in Chinese journals and reference lists. We included randomised controlled trials and prospective controlled studies of integrated Chinese medicine with western medicine versus western medicine alone in people with SARS. Three independent reviewers collected details of study population, interventions, and outcomes using a data extraction form. We conducted meta-analysis for similar data of studies.Results Nine studies (n =812) were included, all with the possibility of containing serious bias. ICWM in the treatment of SARS was associated with the following reductions: case fatality [ OR 0.32, 95% CI (0.14,0.71 ) ] , fever clearance time [ WMD -1.17, 95% CI ( -1.83, -0.50 ) , symptom remission time [ WMD-1.47, 95% CI ( - 1.96, - 0. 98) ] and the number of inflammation absorption cases [ MD 1.63, 95% CI(0.95, 2.80 ) ], having no significant difference in symptom scores of convalescents [ WMD -1.25, 95% CI ( -2.71, 0.21 ) ], cumulative dose of corticosteroids [ WMD - 236.96, 95% CI ( - 490.64, 16.73) ] and inflammation absorption mean time [ WMD 0.63, 95% CI ( - 1.33, 2.59) ] .Conclusions Due to the methodological limitations of the studies, the effect of ICWM for SARS is unclear. The apparent improvements in cases fatality, fever clearance time, syndromes remission time and numbers of inflammation absorption cases warrant further evaluation with high quality and large scale trials to be expected.
Objective To observe the effect of bone marrow mesenchymal stem cells (BMSCs) conditioned medium on microglia (MGs) and its secretion of arginase 1 (Arg1). Methods The BMSCs separated through differential adhesion method from the femur and tibia marrow of 4-week-old Sprague Dawley (SD) rats were cultured and identified by Vimentin immunofluorescence staining; whereas MGs separated through trypsin digestion method from the brain of 3-day-old SD rats were cultured and identified by Iba1 immunofluorescence staining. The primary MGs were cultured with DMEM/F12 medium containing BMSCs conditioned medium (experimental group) and with single DMEM/F12 medium (control group), respectively. After 48 hours of culture, the morphology of MGs was observed by inverted phase contrast microscope, the activated state of MGs was detected by using Iba1 immunofluorescence staining, and Arg1 expression of MGs was assessed by Iba1-Arg1 double-labelling immunofluorescence staining and Western blot method. Results Inverted phase contrast microscope observation showed that BMSCs entered logarithmic growth phase at 14 days after culture, and more than 98% cells were positive to Vimentin immunofluorescence staining; whereas MGs entered logarithmic growth phase at 21 days after culture, and around 80% cells were positive to Iba1 immunofluorescence staining. Inverted phase contrast microscope observation displayed that in the experimental group, MGs were activated with increased size of soma, shortened process, and amoeba change. Immunofluorescence staining displayed that the Iba1 positive cells number in the experimental group was significantly higher than that in the control group (t=0.007, P=0.000); double-labelling immunofluorescence staining revealed that the Iba1-Arg1 positive cells number in the experimental group was significantly higher than that in the control group (t=0.007, P=0.000); and Western blot results elucidated that the relative expression of Arg1 protein in the experimental group was significantly higher than that in the control group (t=0.001, P=0.000). Conclusion BMSCs conditioned medium can activate MGs and induce MGs to express Arg1.