地西他滨联合芦可替尼治疗老年不典型慢性粒细胞白血病：1例报道并文献复习

目的 报道1例经地西他滨联合芦可替尼方案治疗的老年不典型慢性粒细胞白血病(aCML)的诊治经过并复习文献，以提高对aCML的认识。方法 报告1例伴CSF3R T618I突变的老年aCML患者的病例资料及应用地西他滨联合芦可替尼方案治疗的临床过程。检索中国知网、万方数据知识服务平台、PubMed数据库(截至2021年12月)，结合文献报道总结aCML的临床特点及应用地西他滨方案联合芦可替尼治疗的有效性和安全性。结果 本病例系72岁男性，因“乏力、头晕1个月余”入院。血常规提示白细胞计数明显增高，骨髓细胞形态学提示粒系明显增生伴粒系发育异常，原始细胞<20%，二代测序显示CSF3R T618I突变，诊断为aCML。给予地西他滨治疗4个周期，并联合芦可替尼靶向治疗后，患者达到形态学完全缓解(CR)，且分子应答良好，长期口服芦可替尼维持治疗病情稳定。国内外报道采用去甲基化药物地西他滨或阿扎胞苷治疗aCML的患者共11例，其中8例采用单药地西他滨治疗[总体CR率为87.5%(7/8)],2例采用单药阿扎胞苷治疗[有效率为50.0%(1/2)],1例采用地西他滨联合CAG方案(重组人粒细胞集...     

呋喹替尼联合程序死亡受体-1抑制剂治疗微卫星稳定型或错配修复正常型转移性结直肠癌临床效果及安全性观察

目的观察呋喹替尼联合程序死亡受体-1(PD-1)抑制剂治疗微卫星稳定(MSS)型或错配修复正常(pMMR)型转移性结直肠癌(mCRC)的临床效果及安全性。方法回顾性分析安徽医科大学第一附属医院自2020年5月至2023年5月收治的41例MSS型或pMMR型mCRC患者的临床资料。患者接受三线或三线以上呋喹替尼单药治疗(呋喹替尼单药治疗组,简称单药组,n=23)或呋喹替尼+PD-1抑制剂联合治疗(呋喹替尼+PD-1抑制剂联合治疗组,简称联合组,n=18)。比较两组患者的基线资料、治疗效果及不良事件发生率,分析无进展生存期的影响因素。结果两组患者基线资料比较,差异无统计学意义(P>0.05)。联合组的疾病控制率高于单药组,但差异无统计学意义(P>0.05)。在单因素分析中,东部肿瘤合作组评分、治疗方案均与MSS型或pMMR型mCRC患者的无进展生存期相关(P<0.05);在多因素分析中,治疗方案是影响MSS型或pMMR型mCRC患者无进展生存期的独立预后因素(P<0.05)。联合组患者的中位无进展生存期长于单药组患者,差异有统计学意义(P<0.05)。两组患者不良事件发生率比较,差异无统计学意义(P>0.05)。结论与呋喹替尼单药治疗比较,呋喹替尼+PD-1抑制剂联合治疗对MSS型或pMMR型mCRC的临床效果更优,且联合用药未明显增加毒性。     

骨髓纤维化与巨核细胞数的关系

骨髓纤维化(MF)可在多种血液病中发生,其原因尚不清楚。虽有人发现MF局部有巨核细胞聚集现象,继发性骨髓纤维化亦有巨核细胞增多;但也有相反的报道。本文就此作了观察。1 材料与方法 1.1 对象为1989年9月以来我院住院的血液病患者及有骨髓转移的癌症患者,可供分析者136例,男92例,女44例,年龄范围15～78岁。 1.2 方法 采用上海产环钻骨髓活检针于髂后或髂前上嵴取骨髓组织约7mm     

仑伐替尼治疗中晚期肝癌的研究进展北大核心CSCD

仑伐替尼是晚期肝癌的一线分子靶向治疗药物,国内外已有很多关于仑伐替尼疗效相关研究报道,但其影响因素尚不清楚。免疫检查点抑制剂是一类新型抗肿瘤药物,在多种晚期肿瘤治疗中有较好的疗效。本文就仑伐替尼治疗晚肝癌的疗效及其影响因素、联合免疫检查点抑制剂治疗晚期肝癌的研究进展、与中期肝癌标准治疗TACE之间的关系、治疗期间病情进展的治疗方法以及对于REFLECT试验排除患者仑伐替尼的有效性和安全性等方面分别进行介绍,以期对指导肝癌的临床治疗有所帮助。     

伊马替尼治疗慢性期慢性髓细胞白血病早期分子反应39例临床分析

目的评估伊马替尼治疗慢性期慢性髓细胞白血病(CML)的早期分子反应(EMR)。方法回顾性分析我院自2011年4月至2014年3月应用伊马替尼治疗的39例CML慢性期EMR的患者,并分析影响EMR的因素。结果 39例CML患者可评估38例,EMR率61%。其中,低、中危组EMR率70%(19/27),高危组EMR率36%(4/11)。高危组与中、低组比较,EMR率明显减低(P<0.05)。EMR患者和EMR失败患者,例数分别为23例和15例;初诊时肋缘下脾脏大小分别为4.0(QR=1.5)cm,11.3(QR=1.6)cm(P<0.05);白细胞计数分别为23(QR=4.0)×10~9/L,35(QR=8.9)×10~9/L(P<0.05)。结论初诊时脾脏大、白细胞计数高、Sokal评分高危可能与伊马替尼治疗CML的EMR失败相关。     

小剂量阿帕替尼治疗晚期肿瘤的疗效观察

目的观察小剂量阿帕替尼在治疗失败的晚期恶性肿瘤的临床疗效。方法 9例经行阿帕替尼治疗的晚期恶性肿瘤患者的临床资料,通过对其无进展生存期(PFS),疾病控制率(DCR)进行分析,评价其疗效和不良反应。结果 9例患者中,患者的中位PFS为5.5个月(3.2-12个月),治疗后完全缓解0例,部分缓解2例,疾病稳定3例,疾病进展4例,疾病控制率55.5%,不良反应主要是乏力、骨髓抑制、高血压、手足综合征、腹泻、一过性转氨酶升高、出血、恶心呕吐、口腔炎、蛋白尿、声嘶等。结论阿帕替尼在晚期恶性肿瘤有一定疗效,不良反应可控,罕见心脏毒性,是晚期肿瘤患者的一个选择。     

舒尼替尼治疗伊马替尼耐药晚期胃间质瘤9例

目的观察舒尼替尼治疗伊马替尼耐药晚期胃间质瘤的疗效及副作用。方法本组采用自身治疗前后对照,选择经胃镜、手术及病理证实为晚期胃间质瘤的患者9例,CT检查:7例肝转移、2例胰腺转移,9例均行姑息切除,术后使用伊马替尼400 mg/d口服,治疗6个月无效;而后改为舒尼替尼连续治疗37.5 mg1次/d,口服,每阶段治疗4周,停药2周;每阶段结束后复查血常规,肝肾功能,甲状腺功能,心电图,腹部CT,评价疗效及副作用。结果 9例患者舒尼替尼中位治疗时间为166周。按Choi标准进行疗效评估,获CR0例(0%),PR2例(22.2%),SD4例(44.4%),PD 3例(33.3%);客观有效率22.2%,疾病控制率为66.7%;治疗期间的主要不良反应有:恶心3例(33.3%)、疲乏4例(44.4%)、中性粒细胞减少2例(22.2%)。结论舒尼替尼治疗伊马替尼耐药胃间质瘤有较好疗效,副作用较少。     

非直系亲属半相合异基因造血干细胞移植治疗慢性粒细胞性白血病-急淋变1例

1 资料与方法 1.1 病例资料女性患者,22岁,未婚.2006年4月出现腰骶部疼痛,白细胞计数增加,于解放军总医院第一附属医院血液科就诊,根据骨髓形态、染色体融合基因诊断为慢性粒细胞性白血病-急淋变,TOAP(吡喃阿霉素 阿糖胞苷 长春新碱 泼尼松)方案化疗后骨髓部分缓解(PR),给予伊马替尼300mg/d口服,1个月后骨髓完全缓解(CR).此后给予MOAP(米托蒽醌 阿糖胞苷 长春新碱 泼尼松)方案、VPMM(米托蒽醌 甲氨蝶呤 长春新碱 泼尼松) 伊马替尼方案化疗.11月27日骨髓中原始淋巴细胞占40.5%,提示病情复发.     

伊马替尼联合化疗治疗成人费城染色体阳性急性淋巴细胞白血病46例临床分析

目的探讨伊马替尼联合化疗治疗费城染色体阳性(Ph+)急性淋巴细胞白血病(ALL)的疗效。方法 Ph+ALL患者46例,分别应用VDCP、VDCLP方案联合伊马替尼诱导治疗,完全缓解(CR)后继续伊马替尼联合化疗进行巩固及强化治疗,有合适供者的患者行异基因造血干细胞移植。结果 46例Ph+ALL CR率为67.4%(31/46),无治疗相关死亡。16例患者CR后行造血干细胞移植,10例目前仍无病生存;3例复发;3例死于慢性移植物抗宿主病(GVHD)合并感染。CR后持续巩固及强化治疗的15例患者中位缓解期为13(9～19)个月。结论伊马替尼联合化疗治疗Ph+ALL,CR率较常规化疗诱导治疗明显提高。伊马替尼联合化疗进行巩固治疗,中位缓解时间及生存时间较长,较单用化疗明显延长。     

TACE联合低剂量阿帕替尼治疗中晚期肝癌的疗效及生存预后分析北大核心CSCD

目的探讨并分析TACE联合低剂量阿帕替尼治疗中晚期肝细胞癌的临床疗效及影响预后的独立因素。方法回顾性分析2016年6月至2019年6月接受TACE联合低剂量阿帕替尼治疗的61例中晚期肝癌患者的临床资料。采用寿命表法进行生存分析,同时采用Kaplan-Meier法和Cox风险回归模型分析生存率,最后利用Cox比例风险回归模型进行多因素分析,筛选出独立影响生存期的预后因素。结果61例患者的1、2和3年累积生存率分别为64%、33%和16%,中位生存期(m OS)为17.3个月,中位无疾病进展生存期(mPFS)为10.3个月。Cox风险回归模型多因素分析得出ECOG评分、肝外转移、TACE次数、阿帕替尼相关高血压、阿帕替尼相关手足综合征及阿帕替尼疗程为生存期的独立影响因素。结论TACE联合低剂量阿帕替尼治疗中晚期肝癌临床疗效令人满意,独立影响生存期的预后因素为ECOG评分、肝外转移、TACE次数、阿帕替尼相关高血压、阿帕替尼相关手足综合征及阿帕替尼疗程。     

Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

Objective

Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma.

Materials and Methods

We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage.

Results

The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection.

Conclusion

Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.     

再程立体定向放射治疗的应用

肿瘤经放射治疗或者多种方法联合治疗后,局部复发经常出现,但局部再程放疗仅适用于少数病人,因其会引起潜在的严重并发症,特别是对大体积的肿瘤进行再程放疗时。采用立体定向放射治疗(SBRT)对复发的椎体转移瘤、头颈部肿瘤、盆腔肿瘤进行再程放疗,不仅能够提高局部控制率并减轻症状,同时还能够减少正常组织不良反应。SBRT在临床上是一种安全有效的方法,建议将SBRT作为控制局部症状的重要治疗手段。     

50-Hz magnetic field induces EGF-receptor clustering and activates RAS

PURPOSE: In a previous study, we found that exposure to a 50 Hz magnetic field (MF) could activate stress-activated protein kinase (SAPK) and P38 mitogen-activated protein (MAP) kinase (P38 MAPK) in Chinese hamster lung (CHL) fibroblast cells, and simultaneous exposure to a 'noise' MF of the same intensity inhibited these effects. In order to explore the possible target sites and upstream signal transduction molecules of SAPK and P38 MAPK, and further validate the interference effects of 'noise' MF on 50 Hz MF, the effects of MF exposure on clustering of epidermal growth factor (EGF) receptors and Ras protein activation were investigated. MATERIALS AND METHODS: CHL cells were exposed to a 50 Hz sinusoidal MF at 0.4 mT for different durations, and clustering of EGF receptors on cellular membrane and Ras protein activation were analyzed using immunofluorescence confocal microscopy and co-precipitation technology. EGF treatment served as the positive control. RESULTS: The results showed that, compared with sham-exposed cells, exposure to a 50 Hz MF at 0.4 mT for 5 min slightly induced EGF receptor clustering, whereas exposure for 15 min enhanced receptor clustering significantly. Corresponding to receptor clustering, Ras protein was also activated after exposure to the 50 Hz MF. Exposure to a 'noise' MF (with frequency ranges from 30 - 90 Hz) at the same intensity and durations, did not significantly affect EGF receptor clustering and Ras protein. However, by superimposing the 'noise' MF, receptor clustering and Ras activation induced by 50 Hz MF were inhibited. CONCLUSION: The results suggested that membrane receptors could be one of the most important targets where extremely low frequency (ELF) MF interacts with cells, and Ras may participate in the signal transduction process of 50 Hz MF. Furthermore, a 'noise' MF could inhibit these effects caused by ELF-MF.     

天麻素联合丁咯地尔注射液治疗椎-基底动脉供血不足性眩晕的临床观察

目的观察天麻素联合丁咯地尔治疗椎-基底动脉供血不足(IBV)的临床疗效。方法治疗组50例采用天麻素联合丁咯地尔注射液治疗,对照组50例采用天麻素联合舒血宁注射液治疗,治疗7 d后观察两组的临床疗效、血流动力学及脑血流速度的变化。结果治疗组总有效率92%,对照组总有效率76%。两组治疗后症状、血流动力学变化、脑血流速度均有改善,但治疗组的疗效、血流动力学、脑血流速度改善更为明显,两组相比差异有统计学意义(P<0.05)。结论天麻素联合丁咯地尔治疗IBV能更好的扩张脑血管,增加脑血流量,降低血液黏稠度,改善椎-基底动脉供血不足及临床症状。     

"Motion-frozen" display and quantification of myocardial perfusion.

Gated myocadial perfusion SPECT (MPS) incorporates functional and perfusion information of the left ventricle (LV). To improve the image quality and accuracy of gated MPS we propose to eliminate the influence of cardiac LV motion in the display and quantification by a novel "motion-frozen" (MF) technique. METHODS: Three-dimensional LV contours were identified on images of the individual time phases. Three-dimensional phase-to-phase motion vectors were derived by sampling of the epi- and endocardial surfaces. A nonlinear image warping (thin-plate spline) was applied to warp all image phases to fit the end-diastolic (ED) phase. Warped images were created to provide the LV image in the ED phase but containing counts from an arbitrary number of time intervals. MF quantification has been performed using the same phase-to-phase motion vectors. MF normal perfusion limits were created from (99m)Tc sestamibi gated MPS studies of 40 females and 40 males with low likelihood (<5%) of coronary artery disease. All MF processing was completely automated. In the initial evaluation, we assessed the display quality and quantification of stress images using MF processing in 51 consecutive patients with 16-frame electrocardiographic gating and available coronary angiography. RESULTS: The display quality was significantly better for MF images as assessed visually. The MF images had the appearance of ED frames but were less noisy and of higher resolution than the summed images. MF images had higher maximum count values in the LV (116% +/- 6%) and higher contrast (12.5 +/- 7.7 vs. 9.5 +/- 3.2) than the corresponding summed images. The area under the receiver operator characteristic curve for prediction of stenoses > or = 70% by the MF method was 0.92 +/- 0.04 versus 0.89 +/- 0.04 by standard quantification (P = not significant). The computation time for automated MF quantification and warping was <25 s for each case. CONCLUSION: We have developed a novel technique for display and quantification of gated myocardial perfusion images, which retrospectively eliminates blur due to cardiac motion. Such processing of gated MPS appears to improve the effective resolution of images. Initial evaluation indicates that it may improve the accuracy of gated MPS in detection of coronary artery disease.     

多模式生物反馈治疗慢性特发性便秘的临床观察

目的探讨多模式生物反馈疗法治疗慢性特发性便秘(C IC)的疗效及作用机制。方法采用多模式生物反馈疗法,对90例C IC患者进行生物反馈治疗,包括盆底肌放松训练、肛门直肠协调性训练,直肠敏感性反馈训练。观察治疗前后C IC病人临床症状、肛门直肠压力、直肠敏感性、心理测试的变化。结果生物反馈治疗后临床症状评分明显降低(P<0.05);肛管静息压、肛门括约肌最大缩榨压较治疗前明显增高,模拟排便动作时肛门括约肌的剩余压明显降低(P<0.05;P<0.001;P<0.001);直肠的初始感觉阈值、排便感阈值较治疗前明显降低(P<0.001);治疗后抑郁、焦虑分值较治疗前明显降低(P<0.001)。结论生物反馈治疗可以改变肛门直肠动力学参数及心理异常,恢复排便的生理功能,是治疗特发性功能性便秘的有效方法。     

放射治疗联合免疫检查点抑制剂的不良反应

放射治疗与免疫检查点抑制剂（immune-checkpoint inhibitors,ICI）在抗肿瘤方面具有协同作用,这种作用涉及与免疫系统间的复杂效应机制,并可能改善肿瘤患者的临床结果。然而,放疗联合ICI协同调节免疫应答的同时也可能引发治疗相关不良反应。鉴于联合治疗的临床研究与实践日益增加,需要关注放疗和ICI联合研究中不良反应事件的发生风险,进而评估联合治疗的安全性。     

50-Hz magnetic field induces EGF-receptor clustering and activates RAS

Purpose: In a previous study, we found that exposure to a 50 Hz magnetic field (MF) could activate stress-activated protein kinase (SAPK) and P38 mitogen-activated protein (MAP) kinase (P38 MAPK) in Chinese hamster lung (CHL) fibroblast cells, and simultaneous exposure to a ‘noise’ MF of the same intensity inhibited these effects. In order to explore the possible target sites and upstream signal transduction molecules of SAPK and P38 MAPK, and further validate the interference effects of ‘noise’ MF on 50 Hz MF, the effects of MF exposure on clustering of epidermal growth factor (EGF) receptors and Ras protein activation were investigated.

Materials and methods: CHL cells were exposed to a 50 Hz sinusoidal MF at 0.4 mT for different durations, and clustering of EGF receptors on cellular membrane and Ras protein activation were analyzed using immunofluorescence confocal microscopy and co-precipitation technology. EGF treatment served as the positive control.

Results: The results showed that, compared with sham-exposed cells, exposure to a 50 Hz MF at 0.4 mT for 5 min slightly induced EGF receptor clustering, whereas exposure for 15 min enhanced receptor clustering significantly. Corresponding to receptor clustering, Ras protein was also activated after exposure to the 50 Hz MF. Exposure to a ‘noise’ MF (with frequency ranges from 30 – 90 Hz) at the same intensity and durations, did not significantly affect EGF receptor clustering and Ras protein. However, by superimposing the ‘noise’ MF, receptor clustering and Ras activation induced by 50 Hz MF were inhibited.

Conclusion: The results suggested that membrane receptors could be one of the most important targets where extremely low frequency (ELF) MF interacts with cells, and Ras may participate in the signal transduction process of 50 Hz MF. Furthermore, a ‘noise’ MF could inhibit these effects caused by ELF-MF.     

中西医结合介入治疗下肢深静脉血栓形成

目的:探讨中西医结合介入治疗下肢深静脉血栓形成的应用价值。方法:收集有明确临床症状、体征,并经血管造影证实的下肢深静脉血栓形成患者56例,施行介入插管、双向溶栓,并联合应用中西药内服外敷。26例安放下腔静脉滤器,24例行球囊导管扩张成形,3例安放血管内支架。采用自行设计的治疗效果量化测量表进行量化判定。结果:治疗后显效32例(57.1%),有效18例(32.2%),无效6例(10.7%)。1月后复查,显效40例(71.4%),有效13例(23.2%),无效3例(5.4%)。未出现严重并发症。结论:中西医结合介入治疗方法对下肢深静脉血栓形成有良效,结合中医辨证论治综合治疗,可以增强疗效。