坤泰胶囊联合激素替代治疗用于卵巢早衰疗效及安全性的系统评价

目的:基于荟萃分析(Meta分析)方法,系统评价坤泰胶囊联合激素替代治疗(hormone replacement therapy,HRT)用于卵巢早衰的疗效及安全性。方法:检索中国期刊全文数据库、维普数据库、万方数据库、中国生物医学文献数据库和PubMed数据库,检索时限为建库至2018年12月31日,收集坤泰胶囊联合HRT用于卵巢早衰的随机对照临床研究文献(研究组患者使用坤泰胶囊联合HRT;对照组患者单纯使用HRT),采用“偏倚风险评估工具”进行质量评价,运用RevMan 5.3软件对患者治疗前后的卵泡刺激素(FSH)、黄体生成素(LH)和雌二醇(E2)水平,症状积分,总有效率和不良反应发生情况进行Meta分析。结果:最终纳入15篇文献,涉及1343例患者。Meta分析结果显示,与单纯使用HRT比较,坤泰胶囊联合HRT能明显降低卵巢早衰患者的FSH水平(MD=-7.13,95%CI=-8.08^-6.19,P<0.00001)、LH水平(MD=-5.43,95%CI=-6.99^-3.88,P<0.00001),明显提高E2水平(SMD=1.14,95%CI=0.73~1.54,P<0.00001),明显降低症状积分(MD=-4.42,95%CI=-5.55^-3.28,P<0.00001),明显提高治疗总有效率(OR=3.53,95%CI=2.53~4.94,P<0.00001)和安全性(OR=0.56,95%CI=0.31~1.01,P=0.05),差异均有统计学意义。结论:坤泰胶囊联合HRT有明显优势,能在一定程度上改善卵巢早衰患者的临床症状,减少不良反应,提高安全性,可以作为较好的辅助搭配治疗。     

周围神经鞘瘤影像学表现及误诊分析

目的 探讨周围神经鞘瘤的影像学表现及诊断要点,以提高临床确诊率.方法 回顾性分析经病理学检查证实的周围神经鞘瘤6例的CT及磁共振成像（MRI）表现.结果 本组6例行CT平扫及增强扫描2例,行MRI平扫及增强扫描4例,其中病变位于舌根、胸壁、腹膜后各1例,病变位于下肢3例.经病理结果证实首次诊断正确者2例（小腿神经鞘瘤）,误诊4例,误诊为血管瘤、转移瘤、横纹肌肉瘤和卵巢肿瘤各1例.6例确诊后均予手术切除,其中左侧大腿神经鞘瘤1例因肿块未完全切除,术后3个月复发;余5例均完整切除,预后良好,未见复发.结论 CT、MRI检查对周围神经鞘瘤术前的定位、定性及鉴别诊断具有一定价值;对于发生于少见部位且影像学特征不典型的良性周围神经鞘瘤易误诊.     

肥胖对慢性阻塞性肺疾病稳定期病人无创机械通气治疗效果的影响

目的 探讨肥胖对进行无创机械通气的稳定期COPD病人疗效的影响.方法 纳入80例满足COPD全球倡议(GOLD)D组标准的病人,根据BMI分为对照组与肥胖组,每组40例.2组病人均按GOLD关于D组COPD的诊疗建议进行药物治疗,无创正压通气治疗每天至少6～8h.观察时间为3个月.治疗前后分别检测2组病人的动脉血气指标...     

新型冠状病毒肺炎疫情期间开展显微外科手术专家共识

目前,国内新型冠状病毒肺炎(简称新冠肺炎,COVID-19)疫情防控形势持续向好,各地生产、生活秩序加速恢复.然而,复工、复产带来的人员聚集和流动可能增加疫情反复的风险,境外疫情爆发带来的病例输入压力与日俱增.在“内防反弹,外防输入”的疫情防控要求下,如何开展显微外科手术,做到既满足患者日常诊治需求,又避免疫情扩散,亟待一份专家指导意见.中华医学会显微外科学分会和《中华显微外科杂志》编辑部组织部分显微外科专家,总结、讨论在新冠肺炎疫情期间进行疫情防控及开展显微外科手术的经验,形成专家共识:①根据患者新冠病毒感染风险的级别选择治疗方案,对于高风险患者,可选择非手术治疗或延迟手术,不影响预后者应暂缓进行手术,必须实施急诊手术者,应在Ⅲ级防护下进行手术;对于低风险患者,可在Ⅰ级防护下开展各类显微外科手术.院前急救或需进行紧急手术而未完成新冠肺炎排查,未能确定风险级别者,需在Ⅱ级以上(含Ⅱ级)防护条件下进行手术.②设置过渡病房(病区),集中收治中、高风险患者.③医务人员实施分级防护,正确使用防护用品.④中、高风险患者围术期处置应统一指挥,严格遵守疫情防控指引,有序落实人员、物品及环境准备.⑤需加强医护人员新冠肺炎知识及院感培训,以及手术人员在防护条件下进行显微外科操作的培训.     

Fatal disseminated adenovirus infection in a young adult with systemic lupus erythematosus

BackgroundThe use of corticosteroids and other immunosuppressive agents increases the risk of infection in patients with systemic lupus erythematosus (SLE). The role of human adenoviruses (HAdV) in the etiology of acute viral diseases in these patients is not known.ObjectivesDescribe a case of acute fatal disseminated adenovirus infection in an SLE patient receiving immunosuppressive therapy.Study designCase report and detailed viral diagnosis by real time PCR and molecular typing of virus isolates by sequencing of hexon and fiber genes and restriction enzyme analysis of viral DNA.ResultsHAdV was detected by real time PCR in multiple clinical specimens including respiratory, urine, plasma, synovial fluid, and cerebrospinal fluid. Amplification and sequence analysis of the hexon and fiber genes identified the virus as HAdV-7-like for both coding regions. Adenoviruses isolated from respiratory and urine specimens were identical and corresponded to genome type 7d2 by restriction enzyme analysis of viral DNA. The isolated strain encodes a unique fiber gene with a 6-nucleotide deletion corresponding to amino acid positions 250 and 251 in the knob region and not previously described for closely related genomic variants of HAdV-7.ConclusionsAdenovirus detection should be included in the diagnostic testing to determine the infectious etiology of fever and/or respiratory symptoms in SLE patients.     

微波热疗联合放化疗治疗鼻咽癌N2和N3期颈部淋巴结转移患者的疗效观察

目的探讨微波热疗联合放化疗治疗N2、N3期鼻咽癌颈部淋巴结转移患者的近期疗效。方法将95例N2^N3期、无放化疗及热疗禁忌证的鼻咽癌初治患者随机分为放化热疗组(42例)及放化疗组(53例)。两组均采用瑞典ELEKTA5933型直线加速器,8 MV X线行鼻咽、颈部调强适形放疗(IMRT)根治性外照射,设野及剂量基本相同;化疗采用DDP(20 mg/m2)、5-Fu(2200 mg/m2)和四氢叶酸(120mg/m2)24h灌注,诱导后单药顺铂(DDP方案)与放疗同一天开始,之后3周重复,共3个周期;热疗采用KJ-9000型微波肿瘤热疗仪行颈部淋巴结透热,45-60 min/次,2次/周,6N3期、无放化疗及热疗禁忌证的鼻咽癌初治患者随机分为放化热疗组(42例)及放化疗组(53例)。两组均采用瑞典ELEKTA5933型直线加速器,8 MV X线行鼻咽、颈部调强适形放疗(IMRT)根治性外照射,设野及剂量基本相同;化疗采用DDP(20 mg/m2)、5-Fu(2200 mg/m2)和四氢叶酸(120mg/m2)24h灌注,诱导后单药顺铂(DDP方案)与放疗同一天开始,之后3周重复,共3个周期;热疗采用KJ-9000型微波肿瘤热疗仪行颈部淋巴结透热,45-60 min/次,2次/周,6⁸次。结果放化热疗组和放化疗组的颈部淋巴结治愈成功率分别为100%和88.7%,差异有统计学意义(P<0.05)。分层分析显示,两组N3期患者的疗效差异有统计学意义,而N2期患者差异则无统计学意义(P>0.05)。结论临床治疗鼻咽癌N2、N3期颈部淋巴结转移患者中,微波热疗联合放化疗的治疗效果更显著,尤其对于N3期患者而言,效果更佳,应在临床治疗中推广使用。     

Efficacy and safety of sirolimus early conversion protocol in liver transplant patients with hepatocellular carcinoma: A single-arm,multicenter, prospective study

Mammalian target of rapamycin (mTOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant (LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival (RFS) in hepatocellular carcinoma (HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specific for the first 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefits for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data.Trial register: Trial registered at http://www.chictr.org.cn: ChiCTR2100042869.