双时相门冬胰岛素30对2型糖尿病患者血糖的影响

目的分析2型糖尿病患者口服降糖药控制不满意时加用双时相门冬胰岛素30治疗前后血糖水平的变化,探讨其降糖作用。方法 40例2型糖尿病患者口服降糖药控制不满意时加用双时相门冬胰岛素30治疗24周,观察治疗前后血糖等指标的变化。结果双时相门冬胰岛素30治疗后空腹血糖(FPG)、餐后2 h血糖(PPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)水平较治疗前显著降低,患者加用双时相门冬胰岛素30治疗后,HbA1c水平<7%及≤6.5%者所占比例较治疗前显著增加。结论双时相门冬胰岛素30可改善口服降糖药控制不满意时2型糖尿病患者的血糖控制及血脂代谢,有助于降低2型糖尿病患者并发症,改善预后。     

Donor interleukin 6 gene polymorphisms predict the recurrence of hepatocellular carcinoma after liver transplantation

Background

Application of the Milan criteria is an effective strategy to select patients with hepatocellular carcinoma (HCC) for liver transplantation, but HCC recurrence is still a major concern. The aim of this study was to determine whether interleukin 6 (IL6) polymorphisms and clinical variables are potential predictors for HCC recurrence and prognosis after transplantation.

Methods

A total of 110 consecutive patients with HCC undergoing liver transplantation were enrolled in the study. Six tag single nucleotide polymorphisms in IL6 were genotyped in both the donors and recipients. Demographic characteristics, HCC features, and IL6 polymorphisms were assessed against HCC recurrence.

Results

Pretransplant hepatitis B virus DNA (P = 0.014), pretransplant serum alpha-fetoprotein (P = 0.035), number of nodules (P = 0.011), diameter of main nodule (P = 0.001), macrovascular invasion (P = 0.001), microvascular invasion (P = 0.001), HCC exceeding the Milan criteria (P < 0.001), and donor rs2069852 AA genotype (P = 0.010) were associated with HCC recurrence. Recurrence-free survival rate and overall survival rate were significantly lower (P = 0.011 and P = 0.026, respectively) in patients whose donor had the rs2069852 AA genotype than in those whose donor had the AG and GG genotypes. Independent risk factors for recurrence-free survival and overall survival were microvascular invasion (P = 0.003; P = 0.002), HCC exceeding the Milan criteria (P < 0.001; P = 0.001), and donor rs2069852 AA genotype (P = 0.002; P = 0.010).

Conclusions

Our data suggest that donor IL6 rs2069852 polymorphisms may be a potential genetic marker for HCC recurrence after liver transplantation in the Han Chinese population.

     

乳腺不可触及病灶的放射导向定位与传统导丝定位对比的Meta分析

目的比较放射导向定位技术,包括导向放射隐匿性病灶定位(ROLL)和放射性粒子定位(RSL)技术与导丝定位(WGL)的临床效果,评估放射导向定位技术在不可触及的乳腺病灶(NPBL)检测中的应用价值。 方法检索PubMed、Embase、Cochrane、万方、中国知网、维普数据库,收集截至2017年4月关于放射导向定位与WGL对比的随机对照临床试验。由2名研究者独立完成文献筛选、数据提取,运用Cochrane协作网系统评价手册推荐的偏倚风险评价工具进行文献质量评价。采用风险比(RR)和95%置信区间(CI)评价二分类数据的差异,采用均数差(MD)和95%CI评价连续性数据的差异,使用RevMan 5.3软件进行Meta分析。 结果共纳入14项随机对照研究,纳入患者2 311例,其中,ROLL组562例,RSL组614例,WGL组1 135例。ROLL组与WGL组的定位并发症发生率(RR＝0.53,95%CI：0.24～1.18,P＝0.120)、病灶成功切除率(RR＝1.01,95%CI：0.99～1.02,P＝0.240)、切缘阳性率(RR＝0.88,95%CI：0.68～1.13,P＝0.310)、术中再切除率(RR＝1.07,95%CI：0.71～1.61,P＝0.750)、再次手术率(RR＝0.54,95%CI：0.23～1.25,P＝0.150),术后并发症发生率(RR＝0.88,95%CI：0.56～1.40,P＝0.590)及切除标本体积(MD＝－2.11,95%CI：－8.39～4.16, P＝0.510)比较,差异均无统计学意义。RSL组与WGL组的定位并发症发生率(RR＝1.02,95%CI：0.21～5.08,P＝0.980)、切缘阳性率(RR＝0.84,95%CI：0.65～1.09,P＝0.190)、再次手术率(RR＝0.78,95%CI：0.55～1.11, P＝0.170)及术后并发症发生率(RR＝1.34, 95%CI：0.81～2.22, P＝0.260)比较,差异也均无统计学意义。 结论在NPBL的定位技术中,放射导向定位技术具有与传统导丝定位技术相似的定位效果及广泛的临床应用前景。     

参附注射液对大鼠心肌缺血再灌注损伤PTEN和PI3K表达的影响

目的探讨参附注射液(SFI)对大鼠心肌缺血再灌注时第10染色体同源丢失性磷酸酶-张力蛋白酶基因(PTEN)及磷脂酰肌醇-3激酶(PI3K)表达的影响。方法健康雄性SD大鼠30只,随机分为三组:假手术组(Sham组)、缺血再灌注组(I/R组)和SFI治疗组。Sham组丝线穿过冠状动脉前降支但不结扎;I/R、SFI组通过结扎冠状动脉左前降支30min,再灌注120min的方式制备心肌缺血再灌注损伤模型。缺血前30min,SFI组经腹腔注射参附注射液10ml/kg,Sham组和I/R组均腹腔注射等量生理盐水。于再灌注120min时处死大鼠,取左心室心肌组织,计算心肌梗死面积。以缺口末端标记(TUNEL)法检测心肌细胞凋亡情况,计算细胞凋亡指数。免疫组织化学法测定心肌组织PTEN和PI3K表达水平,并计算其比值(PTEN/PI3K)。观察心肌组织病理学损伤程度。细胞凋亡指数与PTEN/PI3K行直线相关分析。结果与Sham组比较,I/R组和SFI组心肌梗死面积增加,细胞凋亡指数升高,PTEN和PI3K表达均上调(P<0.05),SFI组PTEN/PI3K降低(P<0.05);与I/R组比较,SFI组心肌梗死面积减小,细胞凋亡指数降低,PTEN表达下调,PI3K表达上调,PTEN/PI3K降低(P<0.05);SFI组心肌损伤程度较I/R组减轻。I/R组及SFI组细胞凋亡指数与PTEN/PI3K均呈正相关(分别为r=0.788、P=0.007和r=0.829、P=0.003)。结论 SFI能够抑制心肌细胞凋亡,减轻大鼠心肌缺血再灌注损伤,其作用机制与下调心肌组织PTEN表达,上调PI3K表达有关。     

黄煌经方内科医案(八)——肌肉痉挛治验2则

肌肉痉挛指肌肉突然、不自主的强直收缩,常引起肌肉僵硬及疼痛不适。根据发作持续时间,本病可分为阵挛性肌痉挛与强直性肌痉挛两类,前者如面肌痉挛、三叉神经痛性面肌痉挛,后者如手足搐搦症、破伤风、狂犬病、药物中毒、职业性肌痉挛、痛经、膈肌痉挛以及高热惊厥、自主神经性癫痫等。肌肉痉挛在临床     

黄煌经方内科医案(九)——精神分裂症医案2则

精神分裂症是以基本个性、思维、情感、行为的分裂,精神活动以及行为与环境的不协调为主要特征的一种精神疾病。本病多于青壮年时期发病,给患者本人及家庭、社会造成极大的痛苦和危害。黄煌老师运用经方诊治本病,疗效良好,兹举验案2则,以供参考。     

黄煌经方内科医案(三)——糖尿病治验2则

1糖尿病合并周围神经病变案1.1病案记录殷某,女,67岁。初诊日期:2011年8月9日。体貌:肤白、体胖而壮实,面红、面斑,唇暗红。主诉:头昏、乏力13年,加重伴唇麻、腿麻3年。患者有糖尿病史10年,一直服用降糖药(具体不详)治疗,但血糖控制不理想,空腹血糖在7.2～9.6 mmol/L之间;近3年来出现唇麻、腿麻。否认高血压病史,13年前曾有腔隙性脑梗死病史,常服肠溶阿司匹林、丹     

Phase II study of carboplatin combined with weekly docetaxel in patients with advanced non-small cell lung cancer

Purpose

This phase II study is performed to evaluate the safety, efficacy and tolerability of carboplatin combined with weekly docetaxel in patients with advanced non-small cell lung cancer (NSCLC).

Patients and methods

All patients were treated with the combination of docetaxel 35 mg/m² by IV infusion over 30–60 min weekly, on days 1, 8, and 15, for 3 weeks followed by 1 week of rest, with intravenous carboplatin (AUC 6) administered immediately afterward on day 1. Cycles were repeated every 28 days.

Results

Forty-seven (95.9%) of the 49 patients were assessable for response, one case of complete response and 17 cases of partial response were confirmed, giving an overall response rate of 36.7% (95% CI 23.2–50.2%). The median time to progression and overall survival (OS) for all patients were 5.2 months (95% CI 4.1–6.3 months) and 10.4 months (95% CI 7.3–13.5 months), respectively. The estimate of OS at 12 months was 37.6% (95% CI 24.0–51.2%). The most severe hematologic adverse event was anemia, which occurred with grade 3/4 intensity in 7 (14.9%) patients. Neutropenia occurred with grade 3 intensity in 4 (8.5%) patients. However, no grade 4 neutropenia was observed. Grade 3 nausea/vomiting, diarrhea, asthenia, nail changes, and skin reaction were observed in 6 (12.8%), 3 (6.4%), 2 (4.3%), 2 (4.3%) and 1 (2.1%) patients. Yet, no grade 4 non-hematologic toxicity was observed.

Conclusions

The combination of carboplatin with weekly docetaxel is a tolerated treatment modality with encouraging activity and survival outcome in previously untreated patients with advanced NSCLC.     

共焦激光眼底造影在糖尿病性视网膜病变诊断和治疗中的应用

目的:评价眼底荧光血管造影(FFA)在糖尿病视网膜病变(DR)诊断和治疗中的应用价值。方法:采用FFA检查对88例176眼糖尿病患者进行筛查,对DR临床分期进行修正,并根据FFA检查结果指导治疗。结果:其中11眼眼底检查未发现视网膜病变的糖尿病患者FFA检查出现早期微血管瘤病变。眼底镜下Ⅰ～Ⅱ期DR患者中有15眼FFA检查出比检眼镜更多的微血管瘤。眼底镜下Ⅲ期DR患者中有11眼FFA检查出现新生血管改变。结论:FFA检查是DR诊断和分期的金标准,且为指导眼底激光和评价激光疗效的指标。     

Therapeutic observation on acupuncture plus auricular point sticking for melasma

Objective： To observe the clinical efficacy and safety of acupuncture plus auricular point sticking in treating melasma. Methods： Forty-three eligible subjects with melasma were intervened by acupuncture plus auricular point sticking, 10 times as a treatment course, with an interval of 3-5 d between each two courses. The therapeutic efficacy was analyzed after 1, 2 and 3 treatment courses respectively. Results： With the increase of treatment course, the markedly effective rate and total effective rate were also increasing. Of the 43 subjects after 3 treatment courses, the epidermal type had the highest markedly effective rate and total effective rate, then it＇s the subtype IV of the mixed type and dermal type, and the subtype III of the mixed type had the lowest markedly effective rate and total effective rate. Conclusion： Acupuncture plus auricular point sticking is effective and safe in treating melasma, but different types have different therapeutic efficacies.