三叉神经痛药物治疗的循证医学分析

原发性三叉神经痛是一种严重的颌面部神经疼痛,其病因未明,目前的主要治疗措施是通过各种药物进行控制,但很多药物存在副作用、长期使用疗效降低等问题.本文应用循证医学思想,通过检索和评价国内外文献,综合高质量的临床研究结论,为三叉神经痛的药物治疗提供循证医学证据.     

第八讲:循证医学与个体化治疗

医学发展至今的2千多年历史中,医护人员及科研工作者通过大量动物实验、临床研究及统计分析方法逐步总结出针对各类疾病的临床治疗标准、药物指南等.近年随着循证医学的发展,更是要求制定出符合循证医学原理的临床指南,以达到规范治疗的目的.     

第八讲：循证医学与个体化治疗

医学发展至今的2千多年历史中,医护人员及科研工作者通过大量动物实验、临床研究及统计分析方法逐步总结出针对各类疾病的临床治疗标准、药物指南等。近年随着循证医学的发展,更是要求制定出符合循证医学原理的临床指南,以达到规范治疗的目的。但因个体差异,同病同治异效甚至出     

循证医学与个体化治疗的共存和矛盾

从人体个体差异的绝对性出发,论述了个体化治疗与循证医学共存的必然性及两者之间的矛盾。循证医学的结论可通过对大量个体化治疗病例的循证研究而不断刷新,从而更好地指导个体化治疗,这是解决两者矛盾的途径。     

循证医学与个体化治疗的共存和矛盾

从人体个体差异的绝对性出发,论述了个体化治疗与循证医学共存的必然性及两者之间的矛盾.循证医学的结论可通过对大量个体化治疗病例的循证研究而不断刷新,从而更好地指导个体化治疗,这是解决两者矛盾的途径.     

如何正确处理循证医学与经验医学之间的关系

循证医学主张慎重和准确地应用当前所能获得的最好的研究依据。通过论述循证医学在临床实践中的重要性以及与经验医学的关系,证实循证医学是对经验医学的超越,临床医师应转变单一的经验医学,且有机地将二者结合,深刻理解指南的内容及意见,指导临床实践,达到最佳的治疗目的。     

肺癌治疗中辨证论治与循证医学的矛盾与统一

肺癌的个体化治疗是依托于循证医学和飞速发展的分子生物学技术开启的西医治疗的新篇章,但同时也面临着很多困境。而中医辨证论治思想在朴素哲学思想的启领下,早已体现了个体化治疗的灵魂。笔者融合辨证论治思想,现代循证医学证据,提出了肺癌中西医治疗新的概念,从个体差异的绝对性出发,论述了辨证思想与循证医学共存的必然性及两者之间的矛盾。循证医学的结论可通过对大量个体化辨证治疗的研究而不断更新,从而更好地指导辨证治疗,这是未来中西医临床肺癌诊疗的必经之路。     

循证医学指导下的真菌性角膜溃疡个体化综合治疗

真菌性角膜溃疡的诊治是眼科界的一大难题,在总结既往有效经验的基础上不断创新是FCU诊治取得突破的必然途径。本文通过综合分析循证医学与个体化综合治疗在FCU治疗中的不同作用,提出了FCU的诊治应是循证医学与个体化综合治疗辩证统一的观点。     

选择最佳证据 加强多学科协作

循证医学给医学带来了一次变革,极大地促进了医学的发展,使医生在对患者的诊治过程中有证可循,大大提高了临床诊治的准确性,也使各种诊治方法趋于规范化。循证医学首先强调的是应用当前所能获得的最好的研究证据,那么什么是最好的研究证据？如何获得最好的研究证据？又如何通过运用循证医学使患者得到最佳的治疗效果呢？本期“临床决策研究”栏目中陈懿等撰写的文章“循证医学与实事求是”对此进行了深入的探讨和评论。     

非小细胞肺癌分子靶向治疗中的循证医学和个体化治疗

肺癌是我国发病率和病死率最高的恶性肿瘤,分子靶向治疗是晚期非小细胞肺癌新的有前景的治疗方法。本文通过介绍以表皮生长因子受体酪氨酸激酶抑制剂为代表的非小细胞肺癌的分子靶向治疗历程,说明了循证医学和个体化治疗在临床肿瘤治疗中的相辅相成,只有将循证医学和个体化治疗结合起来才能不断地提高临床肿瘤治疗水平。     

原发性三叉神经痛两种治疗方法的比较

原发性三叉神经痛的治疗方法以神经毁损术最为常用。通过对经皮射频热凝毁损术和阿霉素化学毁损术的疗效、安全性、复发率、并发症及费用等方面的比较,揭示两种方法的利弊。用比较治疗学的理念及方法来指导三叉神经痛治疗的临床决策,以期能在目前条件下提高患者的治疗效果、降低医疗费用及提高生活质量。     

Counselling and Pain Relief

Health-care staff (e.g. doctors, nurses, physiotherapists, occupational therapists) frequently have to care for patients who suffer from conditions which cause crippling pain. Pain relief is part of such treatment. This article suggests how counselling, as a skill which every health care worker could acquire and use, may reduce the level of pain by helping the sufferer cope more effectively with it. Four principles of pain relief are considered: the therapeutic relationship; other sensory input; rest and relaxation; and the use of imagery. The discussion on pain relief centres on rest and relaxation and the use of imagery, based mainly on the work of Jung and Assagioli's model of psychosynthesis. Patients are encouraged to continue practising these pain-relieving techniques when counselling has ended. By so doing, they will acquire positive ways to escape from the world of nightmare in which sufferers from chronic pain are often held prisoners. An account is included of how a sufferer from trigeminal neuralgia benefited from one session in which imagery was used.     

Pursuing Peirce

Charles S. Peirce, polymath, philosopher, logician, lived a life of often wild extremes and, when he died in 1914, had earned a vile reputation as a debauched genius. Yet he created a unified, profound and brilliant work, both published and unpublished, a fact difficult to explain. In my 1993 biography, I proposed three hypotheses to account for his Jekyll-Hyde character: his obsession with the puzzle of meaning, two neurological pathologies, trigeminal neuralgia and left-handedness, and the powerful influence of his father. After publication, further research has led me to propose two additional hypotheses to explain his extraordinary life: manic-depressive illness and mystical experience, the last greatly influencing the development of his doctrine of semeiotic, of which his logic of science is a part.     

Effects of caffeine on the trigeminal blink reflex

The acoustic startle and trigeminal blink reflexes share the same motor output. Since caffeine has been shown to augment the startle reflex, it was proposed that caffeine would also increase the trigeminal blink reflex. In 6 humans, the effects of caffeine (100 mg) on the trigeminal blink reflex were investigated. Reflex blinks were elicited by stimulation of the supraorbital branch of the trigeminal nerve. Following ingestion of caffeinated coffee, reflex blinks increased in amplitude and duration and occurred at a shorter latency than reflex blinks following ingestion of decaffeinated coffee. Since the blink reflex is a brainstem reflex, these results suggest that the psychomotor effects of caffeine facilitate brainstem processing.     

Trigeminal nerve and eating in the pigeon (Columba livia): neurosensory control of the consummatory responses.

Electrophysiological, neurobehavioral, and cinematographic techniques were used to study the role of the trigeminal nerve in the neurosensory control of eating. Analaysis of single-unit data recorded in the pigeon's trigeminal ganglion indicates that the trigeminal nerve provides somatosensory inputs from the oral region that signal the location and movement of food and monitor the extent of mouth opening. Trigeminal deafferentation, although it does not affect pecking or swallowing, severly impairs the efficiency of eating. Cinematographic analysis shows that the impairment is due to disruption of the neurosensory control of mandibulation-the process by which grain is grasped at the beak tip and moved to the back of the mouth.     

Trigeminal sensitivity to contact chemical stimulation: A new method and some results

Acquisition of knowledge about the chemical senses might be hastened if chemicals or techniques that permitted stimulation of either the common chemical sense, mediated by the trigeminal nerve, or the sense of smell, mediated by the olfactory nerve without concomitant stimulation of the other sense, were used. Flowing the nonodorized output of an olfactometer into one naris of subjects while velopharyngeal closure was maintained produced effluent flow from the contralateral naris. To prevent odorous molecules from reaching the olfactory epithelium, the contralateral naris was stimulated by applying diluted and undiluted chemical solutions directly to the septal squamous epithelium downstream from the olfactory mucosa. A series of five geometric dilutions of three chemicals and one saturated solution of a fourth were used. The weakest dilution of each chemical was an adequate olfactory stimulus. Two were known trigeminal stimulants (acetic acid and butanol), and two were rated low in trigeminal stimulatory capacity (phenethyl alcohol and vanillin). The results showed that this method was useful in determining the trigeminal threshold for some chemicals. When this method was used, saturated aqueous solutions of vanillin and phenethyl alcohol were clearly not detectable by the trigeminal receptors. The application of the undiluted vanillin and phenethyl alcohol yielded a clear sensation. This result may imply that there are no pure olfactory stimuli.     

The link between glutamate and migraine

Migraine pain-relay centers, including the trigeminal ganglion, trigeminal nucleus caudalis, and thalamus, contain glutamate-positive neurons, and glutamate activates the trigeminal nucleus caudalis. Glutamate is implicated in cortical spreading depression, trigeminovascular activation, and central sensitization. Glutamate receptor-subtype antagonists are effective in preclinical models of migraine, and in the clinic. These preclinical and clinical observations argue for a strong link between migraine and the glutamatergic system, a link that is important to further characterize in an effort to better understand migraine mechanisms and deliver effective therapies.     

Pathophysiologic observations of facial neuralgia

The different etiology and pathogenesis of face-neuralgiae requires a spezific therapy of the respective illness. New aspects are formed in the last years in the so-called idiopathic neuralgia. She has good chances with the therapy through the Jannetta-operation. The evident mechanical lesion by compression, the ephaptic genesis and the special pain-characterization with trigger-attacks not support the "idiopathic". This is called "ictal neuralgia". The paper attempts pathophysiological to explain the specific pain. It shows aspects to the trigger mechanism, to the intensity of the pain and to the ictal pain-characterization.     

Nasal trigeminal chemosensitivity across the adult life span

Individuals can determine the side of the nose that receives an odorant during unilateral presentation (lateralize) if endings of the trigeminal nerve are stimulated. By using psychophysical methods, olfactory detection and trigeminal lateralization thresholds for 1-butanol were obtained from 142 individuals ranging in age from 20 to 89 year. Sensitivity in both chemosensory pathways declined with advancing age, especially in people older than 60 years.     

Trigeminal deafferentation and hunger in the pigeon (Columbia livia).

The location and distribution of the pigeon's trigeminal nerve permit deafferentation of the oral region without affecting motor functions. Although trigeminal deafferentation does not affect drinking, it reduces the efficiency of the consummatory response of eating and disrupts motivational processes underlying hunger and weight regulation. Although the two types of deficit may be experimentally dissociated, trigeminal deafferentation invariably affects both sensorimotor and motivational mechanisms. The deficits in food intake and weight regulation seen after trigeminal deafferentation in the pigeon resemble some components of the "lateral hypothalamic syndrome" in the rat. The results are related to recent studies of the contribution of peripheral and central oropharyngeal factors to the neural control of food intake in both rat and pigeon.