Experience of Interstitial Permanent I125 Brachytherapy for Extremity Soft Tissue Sarcomas

AimsSoft tissue sarcomas are uncommon, but relatively aggressive tumours. Although surgical resection remains the primary therapeutic modality for all localised tumours, brachytherapy combined with function-preserving excision is a popular treatment for extremity soft tissue sarcomas. The objective of this study was to evaluate the effect of interstitial permanent brachytherapy using I¹²⁵ seeds in patients undergoing the combined modality in the management of soft tissue sarcomas at our institution.Materials and methodsBetween January 2007 and January 2012, 110 adult patients aged 18–86 years (median = 44 years) with extremity soft tissue sarcomas and who underwent interstitial permanent brachytherapy as part of the local treatment were included in this study. Treatment included wide local excision of the tumour and brachytherapy using a permanent I¹²⁵ implantation. Complications were assessed in terms of wound complication and peripheral nerve damage.ResultsAfter a median follow-up of 43.7 months, the local control, disease-free survival and overall survival for the entire cohort studied were 74, 54 and 77%, respectively. The actual rates of wound complications requiring reoperation and nerve damage were 4.5 and 1.8%, respectively.ConclusionsWe conclude that interstitial permanent brachytherapy with I¹²⁵ after function-preserving surgery results in a satisfactory outcome in patients with extremity soft tissue sarcomas and the complication rate is low.     

自发性高血压大鼠肾脏血管紧张素转换酶2 mRNA转录及其蛋白表达

目的 观察不同月龄自发性高血压大鼠(SHR)肾脏血管紧张素转换酶2(ACE2)mRNA转录及其蛋白表达,初步探讨ACE2在高血压发生、发展过程中的可能作用.方法 雄性SHR 1月龄组(S1)、2月龄组(S2)、3月龄组(S3)、6月龄组(S6)和9月龄组(S9)共5组,每组各6只,各组均有相应月龄匹配的Wistar-Kyoto(WKY)大鼠作对照.采用RBP-Ⅰ型大鼠血压心率测定仪测量大鼠尾动脉收缩压(SBP);逆转录聚合酶链式反应(RT-PCR)法检测肾脏ACE2 mRNA的转录水平;免疫组化染色结合计算机图像分析方法 测定肾脏ACE2蛋白的表达水平.结果 1)SHR的SBP随着月龄的增加而上升,6月龄后趋于稳定.2)SHR和WKY肾脏ACE2蛋白和mRNA水平均随着月份的增加而增加,3月龄时达高峰,6月龄后趋于稳定;且SHR肾脏ACE2蛋白和mRNA水平均低于同龄的WKY.S1肾脏髓质内侧部ACE2免疫染色阳性面积百分比较皮质和髓质外侧部高,与1月后的分布相反.结论 1)SHR肾脏ACE2 mRNA和蛋白的表达水平比WKY大鼠低.2)大鼠肾脏ACE2 mRNA和蛋白的表达具有时间和部位分布上的差异.     

福建省闽西地区维持性血液透析患者病因及贫血状况的多中心调查

目的 了解福建省闽西地区终末期肾病(ESRD)患者的病因构成及其贫血状况。 方法 回顾性分析闽西地区11家医院2014年1-12月因ESRD行维持性血液透析的858例患者的临床资料,比较患者的血红蛋白水平与铁缺乏、营养状况、甲状旁腺激素、透析充分性、促红细胞生成素(EPO)治疗之间的关系。 结果 ESRD的病因中,前3位分别为慢性肾小球肾炎(458例,52.79%)、糖尿病肾病(143例,16.67%)和高血压肾病(128例,14.92%)。使用EPO治疗775例,治疗率90.33%,贫血治疗达标率42.87%。血红蛋白越低,EPO治疗的比例越高,用量也越大。与贫血治疗达标患者比较,贫血治疗不达标患者血清铁蛋白、转铁蛋白饱和度、血清白蛋白水平明显低下(均为P<0.05),血甲状旁腺素、肌酐、尿素氮水平明显升高(均为P<0.05),每周3次透析的患者所占比例明显下降(P<0.05)。 结论 闽西地区ESRD的病因主要是原发性肾小球肾炎、糖尿病肾病和高血压肾损害; 维持性血液透析患者贫血治疗率高,但达标率仍偏低,主要影响因素是铁缺乏、营养不良、继发性甲状旁腺功能亢进和透析不充分。     

单极与双极切割系统经尿道前列腺剜除术的比较

目的 探讨并比较单极与双极切割系统在经尿道前列腺解剖性剜除术(TUAEP)中的安全性和疗效。 方法 分别采用2种切割系统对良性前列腺增生(BPH)患者行TUAEP,单极98例,双极83例,比较2组的手术时间、前列腺切除质量、血红蛋白下降值、血Na⁺浓度、最大尿流率(Qmax)、残余尿(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等围手术期安全及疗效指标。 结果 采用2种切割系统均能将增生的前列腺腺体完整剜除,未发生输血、前列腺包膜穿孔和电切综合征等严重并发症。单极组及双极组的手术时间分别为(55.1±6.1)和(58.3±5.4)min,前列腺切除质量分别为(35.2±5.8)和(36.5±7.4)g,术后4 h血Na⁺浓度分别为(139.96±3.59)和(140.52±4.31)mmol/L,血红蛋白分别为(129.46±12.58)和(128.79±0.5)g/L,2组比较差别均无统计学意义(P>0.05)。术后6月,2组的前列腺特异抗原(PSA)、前列腺体积、Qmax、IPSS、QOL差别均无统计学意义(P>0.05),但与同组术前比较,PSA、前列腺体积、残余尿、Qmax、IPSS、QOL均较术前明显改善,差别有统计学意义(P<0.01)。 结论 采用单极或双极切割系统均可安全有效实施TUAEP,疗效满意,单极切割系统并不增加风险。     

CXCL10对βTC6细胞TLR4表达及细胞凋亡的影响

目的探讨CXC趋化因子配体10(CXCL10)对βTC6细胞Toll样受体4(TLR4)表达及细胞凋亡的影响。方法体外培养βTC6细胞,0.1~10.0ng/mL CXCL10分别干预βTC6细胞12,24,48h后,应用Westernblot检测TLR4表达情况,流式细胞术和DNA Ladder检测细胞凋亡情况。结果与对照组比较,CXCL10干预12h,10.0ng/mL干预组开始出现TLR4蛋白的表达水平上调(0.840±0.049,P<0.05);干预24h,1.0和10.0ng/mL干预组TLR4的表达水平上调[分别为(0.851±0.052)和(0.893±0.030),P<0.05];干预48h,1.0和10.0ng/mL干预组TLR4的表达进一步上调[分别为(0.876±0.046)和(0.923±0.027),P<0.05],且各干预浓度两两比较,差别均有统计学意义(P<0.05)。CXCL10干预βTC6细胞24h,仅10.0ng/mL干预组细胞出现DNA梯状条带;干预时间延长至48h,1.0和10.0ng/mL干预组均出现DNA梯状条带。流式细胞术显示,CXCL10诱导细胞凋亡呈浓度依赖性。结论长时间高浓度的CXCL10作用将导致TLR4表达显著上调,并诱导β细胞凋亡。     

Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre,randomised, double-blinded trial

Purpose

Recent clinical data suggest that terlipressin, a vasopressin analogue, may be more beneficial in septic shock patients than catecholamines. However, terlipressin’s effect on mortality is unknown. We set out to ascertain the efficacy and safety of continuous terlipressin infusion compared with norepinephrine (NE) in patients with septic shock.

Methods

In this multicentre, randomised, double-blinded trial, patients with septic shock recruited from 21 intensive care units in 11 provinces of China were randomised (1:1) to receive either terlipressin (20–160 µg/h with maximum infusion rate of 4 mg/day) or NE (4–30 µg/min) before open-label vasopressors. The primary endpoint was mortality 28 days after the start of infusion. Primary efficacy endpoint analysis and safety analysis were performed on the data from a modified intention-to-treat population.

Results

Between 1 January 2013 and 28 February 2016, 617 patients were randomised (312 to the terlipressin group, 305 to the NE group). The modified intention-to-treat population comprised 526 (85.3%) patients (260 in the terlipressin group and 266 in the NE group). There was no significant difference in 28-day mortality rate between the terlipressin group (40%) and the NE group (38%) (odds ratio 0.93 [95% CI 0.55–1.56]; p?=?0.80). Change in SOFA score on day 7 was similar between the two groups: ??7 (IQR ??11 to 3) in the terlipressin group and ??6 (IQR ??10 to 5) in the NE group. There was no difference between the groups in the number of days alive and free of vasopressors. Overall, serious adverse events were more common in the terlipressin group than in the NE group (30% vs 12%; p?<?0.001).

Conclusions

In this multicentre, randomised, double-blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of serious adverse events.

Trial registration

This trial is registered at ClinicalTrials.gov: ID NCT01697410.

     

缬沙坦联合阿托伐他汀治疗早期糖尿病肾病的临床研究

目的评价缬沙坦联合阿托伐他汀治疗早期糖尿病肾病(DN)的临床疗效及安全性。方法 63例DN患者随机分为试验组(30例)和对照组(33例),对照组患者口服缬沙坦80 mg·d-1;试验组在对照组的基础上加用阿托伐他汀20mg·d-1,2组疗程均为4个月。疗程结束后,分析比较2组患者血清肌酸酐(Scr)、尿蛋白排泄率(UAER)、肾小球滤过率(GRF)、β2微球蛋白(β2-MG)及咳嗽、头痛头晕等不良反应发生率。结果治疗后,2组患者血清Scr、UAER及β2-MG较治疗前均降低(P<0.05),且试验组降低更为显著(P<0.05);2组患者药品不良反应发生率差异无统计学意义(P>0.05)。结论缬沙坦联合阿托伐他汀治疗DN可显著降低患者血清Scr、UAER及β2-MG水平,且不增加药品不良反应发生率。