ObjectiveTo investigate the clinical characteristics and prognosis of cerebral hemorrhage in young and elderly patients, to provide evidences for individual clinical diagnosis and treatment, and lay a foundation for building a predictive model of prognosis in cerebral hemorrhage.MethodsPatients with spontaneous cerebral hemorrhage in the Third People’s Hospital of Chengdu were recruited prospectively and continuously from January 2014 to January 2019. They were divided into the youth group (≤50 years old) and the elderly group (>50 years old), and their risk factors, disease characteristics, etiology, and prognosis were analyzed.ResultsA total of 757 patients were recruited. There were 160 cases (21.1%) in the youth group, including 120 males and 40 females, aged from 17 to 50 years, with an average age of (42.06±7.62) years old; 597 cases (78.9%) in the elderly group, including 361 males and 236 females, aged from 51 to 96 years, with an average age of (69.34±10.56) years old. The incidences of hypertension (74.2% vs. 51.2%), diabetes (15.1% vs. 4.4%), coronary heart disease (12.1% vs. 1.3%), and the level of blood glucose at admission [7.1 (5.8, 8.4) vs. 6.3 (5.3, 8.1) mmol/L] in the elderly group were higher than those in the youth group (P<0.05), respectively. However, the proportions of males (60.5% vs. 75.0%), smoking (24.5% vs. 36.9%), and the diastolic blood pressure at admission [(92.37±18.50) vs. (100.95±25.25) mm Hg (1 mm Hg=0.133 kPa)] in the elderly group were lower than those in the youth group (P<0.05), respectively. There was no significant difference between the two groups in systolic blood pressure at admission, Glasgow Coma Score, National Institutes of Health Stroke Scale score, initial hematoma volume, hematoma enlargement, brain hernia, location of hemorrhage, midline shift, hydrocephalus, combined subarachnoid hemorrhage, or intraventricular extension (P>0.05). Hypertension was the most common etiology in the two groups. There was a significant difference in the etiology of cerebral hemorrhage between the two groups (P<0.05), the difference was mainly reflected in cerebral amyloid angiopathy, cavernous hemangioma, and arteriovenous malformation. The fatality rate during hospitalization (9.4% vs. 20.9%), 3 months after discharge (10.3% vs. 26.3%), and at 1 year follow-up (19.0% vs. 37.6%) in the youth group was lower than that in the elderly group (P<0.05), respectively. The disability rate 3 months after discharge and at 1 year follow-up in the youth group was lower than that in the elderly group (32.1% vs. 44.2%, 16.9% vs. 34.4%; P<0.05), respectively.ConclusionsThe education of healthy lifestyles should be strengthened to reduce the adverse effects of smoking in young patients. Young patients should choose antihypertensives that can control diastolic blood pressure better. There are more structural abnormalities in young patients, so routine vascular examination is reasonable. It is necessary to focus on whether the original underlying diseases are stable in elderly patients. Cerebral amyloid angiopathy is an important cause of cerebral hemorrhage in elderly patients, and is a risk factor of recurrence. Anticoagulation or antiplatelet therapy should be cautious.
ObjectiveTo explore the clinical and video EEG features of patients with post-stroke epilepsy (PSE).MethodsThe clinical data of 68 patients with epilepsy after cerebral infarction and 33 patients with epilepsy after cerebral hemorrhage were analyzed retrospectively from January 2015 to June 2018 in the Affilated Hospital of Jining Medical University. There were 5 cases of early-onset epilepsy, and the rest were late-onset epilepsy. There were 68 cases of cerebral infarction (1 case showed post-infarction hemorrhagic transformation), 33 cases of cerebral hemorrhage; 51 females, 50 males (f∶m = 1.02∶1); the onset age was 45 ~ 101 years, with an average of (68.10 ± 10.26) years.ResultsThe time from seizure to stroke in 101 cases was (28.92 ± 35.61) months, 60 cases (59.40%) ≤ 1 year, 26 cases (25.74%) 1 ~ 5 years, and 15 cases (14.85%) 5 ~ 10 years. Post-stroke epilepsy had no relation to gender (P>0.05). The age of onset is mostly in 60 to 75 years old (62.38%). Seizure often happen within 1 year after stroke (59.4%). The type of attack is focal seizure (77.23%). Cortical infarction (77.94%), cerebral artery stenosis (83.82%), hypertension, diabetes, and atrial fibrillation are risk factors for epilepsy after infarction. The abnormal rate of EEG for PSE is 90.1%, which was manifested as slow wave in the lesion side, epileptic wave in the lesion side or contralateral side.ConclusionsThe location, duration, age and severity of cerebral artery stenosis in patients with PSE are closely related to the occurrence of seizure. VEEG plays an important role in the diagnosis, treatment and prognosis of epilepsy.
Objective To explore the shortcomings of the traditional clinical probation teaching mode, propose and implement the interactive teaching mode, so as to stimulate the students’ interest in knowledge and achieve better teaching effects. Methods The students of Grade 2017 who had clinical probation in the Orthopaedic Trauma Center of West China Hospital of Sichuan University from September 2020 to December 2021 were selected. Students were randomly divided into traditional clinical probation teaching mode group and interactive teaching mode group according to random number table method. Wechat mini program anonymous questionnaire survey was used to evaluate students’ satisfaction with the interactive teaching model of orthopaedic trauma and the teaching effect. Results A total of 110 students were enrolled, 55 in the traditional clinical probation teaching mode group and 55 in the interactive teaching mode group. There was no significant difference in gender or age between the two groups (P>0.05). The students in the interactive teaching mode group were better than those in the traditional clinical probation teaching mode group in orthopedic theory test (90.13±3.65 vs. 88.39±3.74; t=2.469, P=0.015) in the orthopedic theory test, teacher evaluation (89.15±2.94 vs. 87.56±3.12; t=2.751, P=0.007) and student self-evaluation (89.07±3.18 vs. 87.41±2.89; t=2.865, P=0.005). The teaching satisfaction of the interactive teaching group was higher than that of the traditional teaching group (96.36% vs. 87.27%; Z=−2.159, P=0.031). Conclusion Interactive teaching mode can effectively stimulate students’ interest in knowledge seeking, improve the enthusiasm and interaction of clinical probation, and effectively improve the satisfaction of undergraduate orthopaedic trauma clinical probation teaching.
Objective To analyze the significance of operation date in clinical path designing of cleft lip-palate. Methods The case records of cleft lip-palate patients from 8 hospitals in Gansu province were collected from 2005 to 2008. By means of comprehensive analysis of case records and frequencies of hospitalization duration, analyzed the influence of operation date selection on hospitalization duration in clinical path designing. Result In Gansu province, the average hospitalization duration of cleft lip-palate was 11 days, and the operation was usually done at the sixth day. The main preparations for operation were kinds of examinations. Within five days after operation, most treatments were postoperative care, diet and antibiotic therapy. Conclusion The strategy of operation date selection is much important to ascertain the real hospitalization duration in clinical path designing.
Objective To investigate the clinical typing and their relevant surgical treatment principle and method of pressure sore. Methods From January 1983 to April 2006, 122 patients with 179 pressure sores were treated. There were 93 males and29 females, aging 1568 years. The pressure sores were located at sacrococcygeus (54 lesions), petrochanteric region (37 lesions), ischial tuberosity (30 lesions), heel (17 lesions), olecranon (15 lesions), scapula (9 lesions), lateral malleolar (7 lesions), caput fibulace (4 lesions), pretibial (3 lesions), and lumbar region (3 lesims)respectivly. The disease course was from 2 months to 11 years. The areas of pressure sores were from 1.5 cm× 1.0 cm to 20.0 cm×18.0 cm. According to the wound characteristics, the pressure sores were divided into three types：sinus type（12/179）, ulcer type （74/179） and mixed type（93/179）.Aimed at different types of pressure sore, skin grafting, skin flap and myocutaneous flap were employed to repair wound. The areas of flaps were from 5.0 cm×3.5 cm to 26.0 cm×14.5 cm. The areas of skin grafting were from 7 cm×5 cm to 23 cm×12 cm. Results All wounds of sinus type healed by firstintention except one; and all flaps survived. All wounds of uler type healed byfirst intention; and the flaps survived completely except two which had a partial necrosis. All flaps which harvested to repair 93 pressure sores of mixed typewere survived. But one or two sinus occurred in 8 cases. Two healed by operation, and the others healed by dressing exchange. The wounds healed by first intention. The donor sites healed by first intention. The routine followup in 73 patients after 6 months showed that the recurrence appeared in 4 mixed type. The recurrence rate was 55% and the other patients had good outcome. Conclusion Clinical typing of pressure sore is helpful to select the suitable operation method and improve the rate of success.
目的 探讨运用心脏临时起搏器抢救严重心律失常、更换永久性心脏起搏器及心动过缓的外科手术患者围手术期需用临时起搏器保护的临床效果及护理经验。 方法 2008年8月－2011年7月，共对30例缓慢型心律失常者实施临时心脏起搏术。术前做好患者的心理护理，做好器材及药品准备；术中抢救器械、抢救药品处于备用状态，作好术中配合及病情观察；术后护理，观察生命体征及相关症状变化。 结果 安置心脏临时起搏器患者共30例，除1例因合并下壁心肌梗死、严重心力衰竭抢救无效死亡外，其余均取得满意的治疗效果，术中、术后无并发症发生，术后恢复良好，病情稳定出院。 结论 心脏临时起博器运用于抢救严重心律失常患者、赢得进一步抢救时间，更换永久性心脏起博器患者的临时保护，以及心动过缓的外科手术患者围手术期保护，均是一种安全有效的治疗方法。做好术前、术中及术后的护理是必要保证。Objective To investigate the clinical effects and nursing experiences of using temporary cardiac pacemaker in emergency rescue for patients with severe arrhythmia, in renewal of permanent cardiac pacemaker, or in peri-operative patients with bradycardia. Methods From August 2008 to July 2011, 30 patients with bradycardia arrhythmia underwent temporary cardiac pacemaker implantation surgery. We applied psychological nursing to the patients and made a good preparation of necessary equipments and medicine before operation. During the surgery, all required apparatuses and materials were ready at hand, and careful observation of conditions of the patients was carried out. After operation, the vital signs as well as the development of related symptoms in the patients were closely observed. Results There were 30 patients who had temporary cardiac pacemakers implanted. All got satisfying treatment effects except one who died from severe heart failure combined with inferior-wall myocardial infarction. No intraoperative or postoperative complications occurred, and the patients attained good postoperative recuperation before leaving hospital. Conclusion Temporary cardiac pacemaker is safe and effective in the emergency rescue of patients with severe arrhythmia, in temporary heart protection for patients undergoing renewal of permanent cardiac pacemaker, and in perioperative protection for patients with bradycardia. Good nursing before, during, and after the operation should be guaranteed.
①抗抑郁药 我们没有找到研究抗抑郁药治疗绝经期症状疗效的随机对照试验(RCT). ②可乐定 1个RCT发现,疗程8周的经皮可乐定较安慰剂能明显减少发生潮热的妇女人数,增加潮热发生频率减少的妇女人数. ③雌激素 1篇系统评价和2个随后的RCT发现,雌激素较安慰剂能明显改善血管舒缩症状.两篇系统评价和3个随后的RCT发现,雌激素能预防尿路感染,改善泌尿生殖系统症状.1篇系统评价发现,雌激素能减轻抑郁情绪.4个RCT发现,雌激素在短期内能改善生活质量.重要的不良反应包括静脉血栓性疾病、乳腺癌和子宫内膜癌. ④植物雌激素 1个RCT发现,治疗6周时,大豆蛋白与非植物雌激素相比能减轻血管舒缩症状的严重程度,但不能减少其发生频率.1个RCT发现,治疗12周后,黄酮和安慰剂在改善血管舒缩症状方面无显著差异.另1个RCT发现,疗程gt;12周,异黄酮与安慰剂相比能减轻血管舒缩症状.1个RCT发现,治疗12周后,大豆粉与安慰剂相比能明显减少每周潮热的平均发生次数.但另1个RCT发现,大豆蛋白和安慰剂相比在改善血管舒缩症状方面无显著差异.1个RCT发现,疗程gt;12周,大豆粉和小麦粉在改善血管舒缩症状方面无显著差异.1个RCT(94例妇女)发现,治疗3个月时,大豆蛋白和安慰剂在缓解心理、肌肉关节、泌尿生殖系统症状方面无显著差异. ⑤孕激素 1篇系统评价和另6个RCT发现,孕激素能减轻血管舒缩症状.对于其它结局(包括生活质量),我们没有发现高质量的证据. ⑥睾酮 1个RCT比较了甲基睾酮 + 雌激素与单独使用雌激素,结果 发现甲基睾酮能明显减轻潮热症状;但另1个RCT发现,治疗6个月后两者没有明显差异.1个交叉设计的RCT发现,有限的证据显示睾酮能提高性快感和性欲,但另1个RCT发现治疗6个月时两组间没有明显差异.我们未找到单用甲基睾酮在改善更年期其他常见症状方面的RCT. ⑦替勃龙 1个RCT发现,替勃龙与安慰剂比较能明显改善血管舒缩症状.第2个RCT发现,替勃龙改善血管舒缩症状效果不如雌、孕激素替代治疗.第3个RCT发现,在改善血管舒缩症状方面,替勃龙和雌激素替代治疗无明显差异.1个RCT发现,治疗48周后,在改善阴道干燥症状方面,替勃龙和持续性激素替代治疗无明显差异,但前者能明显改善性满足感.1个RCT发现,与安慰剂比较,治疗3个月后,替勃龙能明显降低性唤起阈和提高性高潮.1个RCT发现,替勃龙与结合雌激素相比能明显提高性欲和增加性交频率.
ObjectiveTo compare drug clinical trials between China, the United States, Europe and Japan in terms of study type, design, completion and results publication.MethodsWe randomly selected 190 clinical trials that were registered in ClinicalTrials.gov from 2009 to 2014, and followed up to December 31st, 2019. Comparisons were made for the type of sponsor, phase, design, and completion status by the sponsor’s country.ResultsAmong all included clinical trials, trials from the United States, Europe, Japan and China accounted for 50.5%, 34.2%, 9.0% and 6.3%, respectively. Among these trials, 71.1% had been completed and 69.5% disclosed results had been published publicly prior to the end of follow-up, and differences between countries were statistically significant (P<0.05). Two-thirds of the trials in China were phase Ⅲ/Ⅳ trials; in contrast, most of the clinical trials in the United States and Europe were phase Ⅰ/Ⅱ trials. The proportion of using double-blind, randomized controlled trial design was the highest in the United States (46.9%) and the lowest in China (8.3%). Chinese sponsors were mostly hospitals/universities (58.3%), while in other countries drug trials were mostly sponsored by the industry and in Japan the proportion was as high as 94.0%.ConclusionsThe number of drug trials registered in ClinicalTrials.gov from China is small and these trials are less likely to be completed and have results published/disclosed. Pharmaceutical companies in China should pay more attention to the public registration of their clinical trials, particularly those in early phases, and improve trial design and management.