Comparison of microtransplantation,chemotherapy and allogeneic transplantation in post-remission therapy for Philadelphia chromosome-positive acute lymphoblastic leukemia

Patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL) have poor prognosis, and the efficacy of chemotherapy plus tyrosine kinase inhibitors (TKIs) followed by mismatched donor stem cell infusion (microtransplantation, MST) has not been determined. We retrospectively summarized 45 patients including 11 undergoing MST with TKIs, 17 receiving allogeneic transplant and 17 undergoing chemotherapy with TKIs. Improved 4-year overall survival rate was observed in the MST group (91%) compared with either transplant group (31%, P = .005) or chemotherapy group (36%, P = .013). The MST group also had higher 2-year and 4-year leukemia-free survival rates (91% and 72%, respectively) compared with either transplant group (33%, P = .005 and 33%, P = .021, respectively) or chemotherapy group (41%, P = .017 and 31%, P = .023, respectively). 2-year and 4-year cumulative incidences of hematologic relapse were lower in the MST group (9% and 28%, respectively) compared with those in the chemotherapy group (56%, P = .025 and 67%, P = .034, respectively). In patients undergoing MST, donor microchimerism was detected (1.07 × 10^-5 to 6.6 × 10^-4 copies from 9 to 1499 days) in 7 patients, and donor/patient-derived HLA*0201/2402⁺WT1⁺CD8⁺ T cells were found from 0.05% to 0.67% in 6 patients. MST may provide a favorable treatment for patients with Ph⁺ ALL.     

醛糖还原酶和晚期糖基化终末产物受体对糖尿病视网膜病变神经元凋亡的影响

目的　探究醛糖还原酶和晚期糖基化终末产物受体对糖尿病视网膜病变神经元凋亡的影响。方法　Wistar大鼠36只，随机分为对照组、模型组、转染组，后两组建立糖尿病大鼠模型。模型建立成功后，构建含有晚期糖基化终末产物受体siRNA的质粒并利用慢病毒转染入转染组大鼠体内。造模后4周、8周、12周，记录各组大鼠体质量及空腹血糖。造模后9周，禁食6 h，测定口服葡萄糖耐量。造模后12周，处死全部大鼠后，TUNEL法检测各组大鼠视网膜神经元凋亡情况，荧光分光光度计测定醛糖还原酶活性，Western blotting法测定晚期糖基化终末产物受体的表达，RT-PCR检测视网膜中Bcl-2和Bax mRNA相对表达量。结果　造模后4周、8周、12周，转染组和模型组的大鼠体质量均低于对照组（均为P<0.05）；造模后12周，转染组大鼠体质量高于模型组（P<0.05）。造模后4周、8周、12周，各组内大鼠空腹血糖水平均无明显变化（均为P>0.05），转染组和模型组大鼠的空腹血糖水平均高于对照组（均为P<0.05）。模型组和转染组大鼠在口服葡萄糖后30 min时，血糖水平均高于对照组（均为P<0.05）；在120 min时分别下降至最低，但仍高于对照组（均为P<0.05）。模型组和转染组的视网膜神经元凋亡指数、醛糖还原酶活性、晚期糖基化终末产物受体和Bax mRNA相对表达量均高于对照组（均为P<0.05），且转染组均高于模型组（均为P<0.05）。模型组和转染组的Bcl-2 mRNA相对表达量均低于对照组（均为P<0.05），转染组低于模型组（P<0.05）。结论　晚期糖基化终末产物结合受体后产生大量的氧自由基损伤，可能是导致糖尿病视网膜神经元凋亡，进而导致糖尿病视网膜病变发生的机制之一。     

Clinical Study on CT-guided Modified Akupotomye in the Treatment of Lumbar Nerve Posterior Branch Compression

Objective: To observe the clinical effect of modified akupotomye closed lysis under CT guidance on compression of posterior lumbar nerve branch.Methods: Patients were diagnosed by HRCT 3-D reconstruction combined with clinical symptoms and signs.After HRCT three-dimensional reconstruction combined with clinical symptoms and signs, the patients were confirmed as posterior lumbar nerve compression.After CT accurate surface positioning, CT-guided modified akupotomye was used for closed lysis of the posterior lumbar nerve branch.Oswestry Dysfunction Index Questionnaire(ODI) was used for quantitative scoring, 7 days before and after treatment and 6 months after treatment.Results: In 62 cases, 20 cases were cured, with 25 cases markedly effective, 11 cases effective, and 36 cases ineffective.The total effective rate was 90.3%.ODI score: Self-paired t test 7 days before after treatment, P < 0.01;Before treatment and 6 months after treatment, self-paired t test(P < 0.01);Self-paired t-test was performed 7 days after treatment and 6 months after treatment(P > 0.05).Conclusion: With CT precise positioning, the modified akupotomye can be used to do closed lysis, to relieve the adhesion and compression, so that the low back pain can be relieved, with good clinical.The akupotomye closed lysis, combined with modern imaging technology has not only achieved good clinical effect, but also can improve the accuracy, safety and scientificity of akupotomye treatment.     

儿童舒缓治疗的意义和发展现状

儿童舒缓治疗是对患有危及生命疾病的儿童提供身体、心理和精神等全方面的照顾，同时给予家庭支持，旨在为儿童及其家庭提供最佳的生活质量。我国儿童人口基数庞大，不断增加的舒缓治疗服务需求与相关服务资源的发展不足是我国儿童舒缓治疗领域面临的两大现实问题。该文就儿童舒缓治疗的实施和发展现状等进行了综述，为国内开展儿童舒缓治疗相关工作及研究提供参考。     

Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment

Abstract

Objective

Ras wild-type metastatic colorectal cancers (mCRC) may be treated with anti-vascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor (EGFR) agents. We aim to estimate patients’ preferences for mCRC treatment and relative importance of cost, efficacy improvement, avoidance of side effects and therapy convenience, and relative uptake between profiles that resemble Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), two commonly prescribed mCRC targeted therapies.     

广西防城港市2017年活禽市场环境样本禽流感监测

目的 了解防城港市活禽市场环境禽流感病毒监测情况,为科学评判疫情并采取适当的防控措施提供理论依据。方法 2017年3—4月在全市活禽市场外环境采集笼具擦物、冼禽污水、禽粪、砧板擦物、禽类饮用水等标本,用荧光定量PCR法检测禽流感病毒FluA、H5、H9、H7核酸,并进行统计学分析。结果 采集全市36个活禽市场外环境标本1 855份,阳性393份,阳性率为21.19%,其中H5阳性28份,H7阳性2份,H9阳性198份,H5和H9混合阳性37份,其他亚型（FluA阳性,H5、H7、H9 阴性）128份;不同地区标本阳性率差异有统计学意义（P<0.05）;城区和乡镇市场采集的标本的阳性率差异无统计学意义。5种类型的标本中,洗禽污水的阳性率最高,其次是砧板擦物, 再次是禽类饮用水和笼具擦物,禽粪的阳性率最低,差异有统计学意义（P<0.05）。结论 防城港市活禽市场环境普遍存在高致病性禽流感病毒的污染,H9亚型是主要的病原体,采取了综合防控措施后,防城港市没有发生人间禽流感疫情。     

Mixed Reality Combined with Three‐Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation

Three‐dimensional (3D) printing technology, virtual reality, and augmented reality technology have been used to help surgeons to complete complex total hip arthroplasty, while their respective shortcomings limit their further application. With the development of technology, mixed reality (MR) technology has been applied to improve the success rate of complicated hip arthroplasty because of its unique advantages. We presented a case of a 59‐year‐old man with an intertrochanteric fracture in the left femur, who had received a prior left hip fusion. After admission to our hospital, a left total hip arthroplasty was performed on the patient using a combination of MR technology and 3D printing technology. Before surgery, 3D reconstruction of a certain bony landmark exposed in the surgical area was first performed. Then a veneer part was designed according to the bony landmark and connected to a reference registration landmark outside the body through a connecting rod. After that, the series of parts were made into a holistic reference registration instrument using 3D printing technology, and the patient's data for bone and surrounding tissue, along with digital 3D information of the reference registration instrument, were imported into the head‐mounted display (HMD). During the operation, the disinfected reference registration instrument was installed on the selected bony landmark, and then the automatic real‐time registration was realized by HMD through recognizing the registration landmark on the reference registration instrument, whereby the patient's virtual bone and other anatomical structures were quickly and accurately superimposed on the real body of the patient. To the best of our knowledge, this is the first report to use MR combined with 3D printing technology in total hip arthroplasty.     

小儿腹股沟斜疝日间手术与专科住院手术的卫生经济学评价

目的对小儿日间手术模式和专科住院手术模式的卫生经济学进行评价,为小儿腹股沟斜疝手术的优选和决策提供参照依据。方法收集2016年6月至2017年7月间所有在重庆医科大学附属儿童医院治疗且符合纳入标准的单侧腹股沟斜疝患儿的临床资料,其中日间手术患儿324例(日间组),专科住院手术患儿65例(专科组)。比较两种手术模式下的患儿一般资料、治疗指标、容错情况、术后需要留院处理的并发症发生率、复发率、院内的感染等卫生效果指标;比较两种模式的HCAHPS优化星表满意度、住院时间、住院费用等卫生经济学指标。统计分析两种模式的成本-效果:治疗效果权重W、治疗效果指数(EI)、成本-效果比(CER)。结果日间外科组和专科组在性别、区域方面的差异无统计学意义,专科组年龄分布更广。日间组与专科组占用床位时间分别为(23.17±0.49)h和(112.06±19.75)h,差异具有统计学意义(P<0.01);两组的医疗费用分别为(3372±430)元和(6063±2104)元,差异具有统计学意义(P<0.01)。两组麻醉分级ASA比例的差异具有统计学意义,两组术后并发症发生率的差异无统计学意义(P>0.05)。日间组与专科组治疗EI分别为0.98和1.02,CER分别为3305和6184,日间组经济学效益较大。结论日间手术的成本-效果优于专科住院手术模式,患儿满意度和术后复发率与专科住院模式的差异无统计学意义,推荐符合日间手术指征的患儿采用该模式。