药物联合高压氧治疗突发性聋132例

 目的 探讨药物联合高压氧治疗(hyperbaric oxygen treatment,HBOT)突发性聋的效果.方法 连续就诊的261例突发性聋患者随机分为药物治疗组(对照组)和HBOT结合药物治疗组(CHBOT),对照组采用常规药物治疗,HBOT组除上述药物治疗外,在舱内压力达0.20 MPa下,吸纯氧30 min 2次(中间吸空气10 min),1/d.在治疗后第30天或其间结束治疗的时间点按预定疗效指标评价.结果 与对照组相比,CHBOT 组听力显著改善(P＜0.01);耳鸣显著减轻,有效率为 76.8%, 对照组为56.63%(P＜0.01).在有眩晕的患者中,CHBOT组98.11% 的患者消失,而对照组仅 83.3%消失(P＜0.05).CHBOT组疗程明显短于对照组(P＜0.01).分析显示,无论采用何种治疗方法,入院前病程长、听力丧失(PTA＞55 dB)明显以及伴随眩晕的患者预后差.结论 CHBOT治疗突发性聋的疗效明显优于单纯药物治疗.尽早启动HBOT结合药物治疗是提高突发性聋治愈率的重要途径.     

梅花针刺络拔罐治疗带状疱疹疗效观察

目的观察刺络拔罐与肌注干扰素治疗带状疱疹的疗效差异。方法将120例患者随机分为2组,观察组60例,采用梅花针叩刺拔罐。对照组60例,采用肌注干扰素治疗,观察并对比疗效。结果观察组治愈率85％,对照组治愈率为50％,两组疗效对比差异有显著意义（P〈0．05）。观察组的止痛、止疱、结痂时间均明显短于对照组。结论梅花针刺络拔罐治疗带状疱疹的临床效果,好于干扰素。     

激光光凝综合微创治疗静脉骨肥大综合征的初步探讨

目的探讨激光光凝综合微创治疗静脉骨肥大综合征的方法,总结临床治疗体会。方法选择2003年2月至2013年12月收治的42例静脉骨肥大综合征患者,利用激光光凝技术联合血管内介入以及局部硬化剂注射等综合治疗,分析总结临床治疗经过和治疗结果。结果本组42例患者病情明显好转,血管瘤硬化,下肢曲张静脉消失、动静脉瘘消失,下肢溃疡愈合,治疗后无瘢痕。随访1～10年无曲张静脉或血管瘤复发现象,下肢增粗无加重现象。结论激光光凝技术联合血管内介入以及局部硬化注射等综合治疗,是一种较好的微创治疗静脉骨肥大综合征的方法,创伤小、恢复快、元手术瘢痕。     

Evaluation of bolus electron conformal therapy compared with conventional techniques for the treatment of left chest wall postmastectomy in patients with breast cancer

Postmastectomy radiation (PMRT) lowers local-regional recurrence risk and improves survival in selected patients with breast cancer. The chest wall and lower axilla are technically challenging areas to treat with homogenous doses and normal tissue sparing. This study compares several techniques for PMRT to provide data to guide selection of optimal treatment techniques. Twenty-five consecutive left-sided patients treated postmastectomy were contoured using Radiation Therapy Oncology Group (RTOG) atlas guidelines then planned using 4 different PMRT techniques: opposed tangents with wedges (3-dimensional [3D] wedges), opposed tangents with field-in-field (FiF) modulation, 8-field intensity modulation radiotherapy (IMRT), and custom bolus electron conformal therapy (BolusECT, .decimal, Inc., Sanford, FL). Required planning target volume (PTV) coverage was held constant, and then dose homogeneity and normal tissue dose parameters were compared among the 4 techniques. BolusECT achieved clincally acceptable PTV coverage for 22 out of 25 cases. Compared with either tangential technique, IMRT and BolusECT provided the lowest heart V₂₅ doses (3.3% ± 0.9% and 6.6% ± 3.2%, respectively with p < 0.0001). FiF had the lowest mean total lung dose (7.3 ± 1.1 Gy, with p = 0.0013), IMRT had the lowest total lung V₂₀ (10.3% ± 1.6%, p < 0.0001), and BolusECT had the lowest mean heart dose (7.3 ± 2.0 Gy, p = 0.0002). IMRT provided the optimal dose homogeneity and normal tissue sparing compared with all other techniques for the cases in which BolusECT could not achieve acceptable PTV coverage. IMRT generally exposes contralateral breast and lung to slightly higher doses. Optimal PMRT technique depends upon patient anatomy. Patients whose maximal target volume depth is about 5.7 cm or less can be treated with BolusECT-assisted 12 or 15 MeV electron beams. At these energies, BolusECT has comparable dose-volume statistics as IMRT and lower heart V₂₅ than opposed tangential beams. Patients with larger depths are best treated with IMRT, which provides significant advantages in both dose homogeneity and normal tissue sparing compared with all other techniques.     

MRI-compatible manipulator with remote-center-of-motion control

Purpose

To develop and assess a needle‐guiding manipulator for MRI‐guided therapy that allows a physician to freely select the needle insertion path while maintaining remote center of motion (RCM) at the tumor site.

Materials and Methods

The manipulator consists of a three‐degrees‐of‐freedom (DOF) base stage and passive needle holder with unconstrained two‐DOF rotation. The synergistic control keeps the Virtual RCM at the preplanned target using encoder outputs from the needle holder as input to motorize the base stage.

Results

The manipulator assists in searching for an optimal needle insertion path which is a complex and time‐consuming task in MRI‐guided ablation therapy for liver tumors. The assessment study showed that accuracy of keeping the virtual RCM to predefined position is 3.0 mm. In a phantom test, the physicians found the needle insertion path faster with than without the manipulator (number of physicians = 3, P = 0.001). However, the alignment time with the virtual RCM was not shorter when imaging time for planning were considered.

Conclusion

The study indicated that the robot holds promise as a tool for accurately and interactively selecting the optimal needle insertion path in liver ablation therapy guided by open‐configuration MRI. J. Magn. Reson. Imaging 2008. © 2008 Wiley‐Liss, Inc.     

老年高血压并糖尿病患者血压控制调查

目的 了解驻蓉军队干休所高血压并糖尿病患者血压控制现况.方法 用问卷调查、查阅健康档案和体检相结合的方法对960例驻蓉老干部进行高血压并糖尿病发病与治疗情况调查.结果 （1）调查了960名老干部,高血压并糖尿病201例（占21.0%）,其中单纯收缩期高血压179例（88.6%）.（2）控制血压〈130/80mmHg 94例（46.5%）,在130-159/80～90mmHg98例（48.5%）,≥160/90mmHg 10例（5.0%）.（3）降压药使用情况,使用最广泛的为钙拮抗剂（CCB）159例（78.7%）,其余依次为血管紧张素转换酶抑制剂（ACEI）66例（32.7%）,血管紧张素Ⅱ受体拮抗剂（ARB）49例（24.3%）.（4）联合用药情况,单药治疗86例（42.6%）,其中CCB 51例（59.3%）,ACEI/ARB 17例（19.8%） 二联治疗88例（43.6%）,其中CCB＋ACEI/ARB为59例（67.0%） 三联以上治疗27例（13.4%）,其中CCB＋ARB/ACEI＋β阻滞剂联用最多,为16例（57.1%）.（5）不同联合用药组间、不同高血压病程组间、合并/并发疾病的数量不同组闻血压控制标率均相似.结论 驻蓉军队干休所高血压并糖尿病患者血压控制总体情况较好,降压药使用规范,但有待进一步提高.     

放疗联合光动力疗法治疗肿瘤的研究进展

放疗联合光动力疗法(PDT)在治疗肿瘤方面日益受到人们的关注,从细胞水平、动物水平及临床应用等方面的研究进展来看,放疗联合传统PDT可以提高肿瘤治疗效果,降低放疗剂量,减少不良反应的发生。尤其近年发展起来的自发光光动力疗法可以不再需要额外的光源,与放疗的联合应用在降低辐射剂量的同时,亦有效解决了外部光源穿透力弱、诱发PDT效应差的弊端。自发光光动力疗法比放疗与传统PDT的简单联合应用更具优势,是目前研究的热点。就放疗联合光动力疗法治疗肿瘤的研究进展予以综述。     

The photodynamic/photothermal synergistic therapeutic effect of BODIPY-I-35 liposomes with urea

Photodynamic therapy (PDT) has a successful track record in cancer. . Urea is a naturally occurring metabolite in the human body. Some studies have shown that it can inhibit the proliferation of tumor cells and cause oxidative stress. In order to explore the application of urea in enhancing the PDT effect, we synthesized a new photosensitizer (BODIPY-I-35) with good phototherapeutic effect and encapsulated it in liposomes. Compared with free BODIPY-I-35, water-soluble nanoliposomes (LipoBOD) produced a huge redshift (> 122 nm) of fluorescence emission in solution. When LipoBOD was irradiated with 808 nm laser (1 W/cm²) for 10 min, the temperature contrast increased by 20 °C, which was 4 times higher than free BODIPY-I-35. Confocal microscopy showed appreciable accumulation of LipoBOD in HeLa cells. In addition, when LipoBOD was incubated with urea in HeLa cells, we found that urea not only obviously enhanced the production of ROS, but also increased the apoptosis of HeLa cells. The synergistic effect of LipoBOD (20 μg/mL, at BODIPY-I-35-eq) with urea (250 mM) showed significantly higher phototoxicity than LipoBOD alone. Low dose can reduce the cell viability to 10%. Therefore, we have obtained an effective method of using urea to enhance the PDT effect.     

光量子血疗治疗神经症190例

目的　研究光量子血疗对神经症的治疗作用。方法　将 380例神经症随机分为对照组和观察组 ,每组 190例 ,观察组治疗方法除与对照组相同外 ,另加光量子血疗。结果　观察组有效率 94 7% ,治愈率 85 % ,比对照组有效率82 6 %、治愈率 74 6 %明显提高 ,P <0 .0 5 ,尤其是癔症观察组的治愈率达 10 0 %。结论　光量子血疗治疗神经症 ,尤其是癔症疗效高 ,安全简便。     

立体定向放射治疗配合靶向药物索拉非尼治疗复发

 目的 探讨γ-体部立体定向放射治疗（stereotactic body radiation therapy with γ-knife,γ-SBRT)配合靶向药物索拉非尼 (sorafenib)治疗复发及转移性肾癌的效果。 方法 2007-05至2009-05收治的肾癌术后复发及转移患者45例中 ,26例单纯行γ-SBRT,19例行γ-SBRT配合Sorafenib治疗,比较两组的有效率、局部控制率、生存率及生存质量改善情况。 结果 治疗后3个月总有效率为80.0%(36/45)。单纯γ-SBRT组的1年、2年局部控制率分别为42.3%(11/26)、 19.2% (5/26);中位生存12个月;1年、2年生存率分别为46.2％、19.2％。γ-SBRT+Sorafenib组的1年、2年局部控制率分 别为47.3%(18/19)、21.1%(4/19),中位生存18个月;1年、2年生存率分别为57.9％、26.3％。 结论 采用γ- 体部立体定向放疗结合靶向药物索拉非尼对复发及转移性肾癌进行治疗效果较好,不良反应轻微,多数患者能耐受治疗。     

RHEpo联合三维适形放疗对食管癌的近期疗效观察

目的观察RHEpo联合三维适形放疗对Ⅲ期食管癌的近期疗效及毒副反应。方法将62例欲接受根治性放疗的Ⅲ期食管癌患者随机分为试验组和对照组。试验组：在放疗前1周给予RHEpo3万U,皮下注射,每周1次,至放疗结束。放疗用6MVX射线进行三维适形照射,DT1.8～2.0Gy/次,每周5次,中位剂量为DT64Gy。对照组行单纯三维适形照射,照射野和剂量同试验组,中位剂量为DT65Gy。结果放疗DT20Gy时,试验组完全消退率（CRR）6.7%（2/30）,对照组CRR6.7%（2/30）（χ2=0.2679,P=0.6048）;放疗DT40Gy时,试验组CRR33.3%（10/30）,对照组CRR16.7%（5/30）（χ2=2.2222,P=0.1360）;放疗结束时,试验组CRR50.0%（15/30）,对照组CRR26.7%（8/30）（χ2=3.4548,P=0.0631）;放疗后1个月,试验组CRR63.3%（19/30）,对照组CRR36.7%（11/30）（χ2=4.2667,P=0.0389）;放疗后6个月,试验组CRR66.7%（20/30）,对照组CRR40.0%（12/30）（χ2=4.2857,P=0.0384）。两组在血液学毒性方面有统计学差异（χ2=8.1481,P=0.0043）。结论RHEpo联合三维适形放疗能明显提高Ⅲ期食管癌的近期疗效,血液学毒性轻微,并可预见能延长患者的远期生存,值得临床上试用推广。     

电解可脱性铂弹簧圈栓塞治疗颅内动脉瘤

目的:探讨电解可脱性铂弹簧圈（GDC）栓塞治疗颅内动脉瘤应用效果。方法:在局麻或神经安定镇痛麻和肝素抗凝下,使用Seldingers技术,经Tracker微导管放置GDC栓塞颅内动脉瘤。结果:成功栓塞18例患者的20个颅内动脉瘤,其中18个为100％栓塞,1个为95％,另1个为90％ 95％栓塞者为宽颈动脉瘤。而90％栓塞者为 Hunt分级Ⅳ级,存在严重脑血管痉挛,经解痉治疗效果不好,而放弃继续栓塞。无并发症及死亡。结论:GDC是栓塞颅内动脉瘤较理想材料,具有安全可靠,效果确切,适合颅内动脉瘤的治疗,尤其适合栓塞危险性较大的动脉瘤。     

高压氧结合电针治疗对颅脑损伤后认知功能恢复的影响

目的探讨高压氧结合电针治疗对颅脑损伤后认知功能恢复的治疗效果。方法将102例颅脑损伤后认知功能障碍患者随机分为治疗组和对照组。对照组进行常规治疗,治疗组在常规治疗的基础上进行高压氧结合电针治疗。治疗前后分别采用NCSE量表、Barthel指数评定法评定两组患者的认知功能、日常生活活动能力。结果两组患者治疗前后和组间的NCSE和Barthel指数评定法评分比较有显著性差异(P>0.05),且评分的变化均数比较显示治疗组的ADL和认知功能恢复显著优于对照组(P<0.05)。结论高压氧结合针刺治疗不仅能改善颅脑损伤后认知功能障碍,而且能促经患者日常生活活动能力的恢复。     

5-氨基酮戊酸-光动力疗法联合微波治疗尖锐湿疣的临床疗效

目的比较5-氨基酮戊酸-光动力疗法（5-aminolevulinic acid-mediated photodynamic therapy,ALA-PDT）和微波治疗尖锐湿疣的临床疗效。方法尖锐湿疣患者90例,分为3组,A组为特殊部位（尿道口、系带或宫颈部位）的疣体患者20例,采用5-ALA-PDT治疗,每周治疗一次,3次为一疗程。其余70例患者随机分为两组,每组35例,B组为采用ALA-PDT联合微波治疗组,根据疣体大小一次或分次清除疣体;C组为单纯微波治疗组。ALA-PDT微波治疗。末次治疗后7 d进行疗效评价,术后3个月随访评价复发率。结果 A组患者治疗后7 d的清除率为95.2%,总复发率为10.0%。B组和C组末次治疗后7 d的清除率均为100%,术后总的复发率分别为8.6%,28.6%,三组比较差异有显著意义（P〈0.05）。结论 ALA-PDT联合微波治疗尖锐湿疣疗效确切,复发率低。ALA-PDT可有效治疗特殊部位疣体,临床使用范围广。     

负压封闭引流技术联合局部氧疗对创面愈合的影响

目的：探讨负压封闭引流技术联合局部氧疗对创面愈合的影响,为临床应用提供实验依据。方法以新西兰大白兔为研究对象,建立皮肤切除伤口动物模型,并随机分为4组,分别对创面施加负压封闭引流治疗（负压值－60mmHg）、局部氧疗（氧流量1L／min）、负压封闭引流技术＋局部氧疗（负压值－60mmHg,氧流量1L／min）3种治疗,而对照组采用常规包扎治疗。观察创面愈合情况28d,记录各组伤口愈合数目和愈合天数并计算平均愈合时间。结果结合治疗组（即负压封闭＋局部氧疗组）中10个创面全部愈合,平均愈合天数为（18.6±2.4）d,分别与负压封闭治疗组、局部氧疗组、对照组存在显著性差异。结论负压封闭引流技术与局部氧疗相结合能促进创面愈合,是一种新的治疗创面的方式。     

经肝动脉介入治疗肝癌并发症分析

目的 探讨肝癌介入治疗并发症以及对疗效的影响。方法 回顾性分析75例经介入治疗的肝癌患者资料。对其并发症的发生率，以及预防、处理进行讨论。结果 穿刺、插管并发症发生率13％，灌注化疗后综合症发生率89％，栓塞后综合症发生率97％，胃肠粘膜损害发生率7．7％，肝功能损害发生率81％，急性肝衰竭死亡发生率8％。1例肝癌破裂死亡，发生率1．3％。结论 介入治疗是中晚期肝癌的最佳姑息治疗手段，防止或减少并发症是提高其疗效重要的一环。     

Efficacy of surgical periodontal treatment with and without photobiomodulation in the treatment of severe periodontitis: An evaluation of periodontal,microbiological, and cytokine levels

AimTo compare the efficacy of surgical periodontal treatment (SPT) alone and PDT-assisted surgery in participants with severe periodontitis.Material and methodsThe present clinical trial was completed by 64 participants (n = 32 each). The selection was made according to predefined inclusion and exclusion criteria. Patients in group A were treated with SPT only and participants in group B were treated with SPT adjunct to PDT. Microbiological assessment of P.Gingivalis; T. Forsythia and T.Denticola were evaluated using cultural analysis and periodontal parameters plaque score (PSc), bleeding on probing (BoP) periodontal depth (PD), and clinical attachment loss (CAL) at baseline and post-treatment at 6 months and 12 months were performed. The gingival crevicular fluid (GCF) was collected for the estimation of IL-1β and tumor necrosis factor-alpha (TNF-α) using an enzyme-linked immunosorbent assay (ELISA). For intra-group comparison and post hoc correction, Student's t-test along with Bonferroni was used. For the difference between follow-ups, an analysis of variance (ANOVA) multiple rank tests were incorporated.ResultsThe mean age of participants in the SPT group was 55.25±4.6yrs. Whereas, participants treated with PDT adjunct to SPT were 54.88±3.6yrs. Periodontal parameters (BoP, PD, PSc, CAL) showed no significant difference at baseline. At 6 months and 12 months follow-up, a significant difference in all parameters (BoP, PD, PSc, and CAL) was found in participants treated with SPT alone and PDT adjunct to SPT (p<0.05). Inflammatory biomarkers at 6-month and 12-month follow-ups, a statistically significant difference in the level of biomarkers (IL-1β and TNF-α) were observed in both groups from baseline (p<0.05). However, at baseline, no significant difference was noted in both groups (p> 0.05). The microbiological assessment showed a significant drop in the bacterial count in participants treated with both regimes i.e., SPT alone and PDT adjunct to SPT.ConclusionPhotodynamic therapy (PDT) adjunct to surgical periodontal treatment (SPT) in severe periodontitis improves microbiological and periodontal parameters and lowers the level of proinflammatory cytokines.     

Endodontic treatment associated with photodynamic therapy: Case report

Background dataThe complete elimination of bacteria inside the root canal is a difficult task, and inconsistent removal of the innermost layer of contaminated dentin leaves bacteria behind. PDT is an adjunct to conventional endodontic treatment due to its potential to reduce bacteria and its biocompatibility.ObjectiveReport a case of endodontic treatment associated with Photodynamic Therapy (PDT).Study Design/Patient and methodsA patient with chronic dentoalveolar abscess with radiolucent lesion next to the apexes of teeth 11 and 21 was submitted to conventional endodontic treatment associated with PDT. The canals were filled after two PDT sessions with an interval of 15 days between applications.ResultsAfter six months, total regression of apical periodontitis and no fistula or associated symptoms were observed.ConclusionsThe treatment proposed is a viable option for the clinician as it is easy to perform, has relatively low-cost and allows the improvement of symptoms in a short period of time.     

The in vitro effect of antimicrobial photodynamic therapy with toluidine blue and indocyanine green on microleakage of class V cavities

IntroductionConsidering the importance of disinfecting dentin and enamel after cavity preparation and the possible effect of disinfection methods on induction of various reactions in the tooth structure the aim of the present study was to evaluate microleakage of composite resin restoration after disinfecting the prepared dentin and enamel surface with antimicrobial photodynamic therapy (aPDT) with toluidine blue (TBO) and indocyanine green (ICG).Materials and methodsStandard class V cavities were prepared on buccal surface of 71 human premolar teeth. The samples were randomly divided into 3 groups based on disinfection method: Group 1: conventional disinfection method with Phosphoric acid 37% as the control; Group 2: aPDT with TBO and diode laser with wavelength of 635 nm; Group 3: aPDT with ICG and diode laser with wavelength of 808 nm. All the cavities were restored with composite resin (3M™ Filtek™ Z250). After thermocycling and immersing in 0.5% basic fuchsin, the samples were prepared for microleakage evaluation under a stereomicroscope. Data was analyzed with Kruskal-Wallis and Wilcoxon signed-rank tests at P < 0.05.ResultsThere were no significant differences in the microleakage of occlusal and gingival margins between the TBO and control groups (P > 0.05). Also, the microleackage of occlusal margins between groups was not significantly different (P > 0.05) but microleackage of gingival margins of ICG group was lower than two other groups in a meaningful way (P < 0.05).ConclusionPhotodynamic therapy with ICG as disinfecting agent in cavity preparations before composite resin restorations decreases the microleackage of gingival margins.