6年随访1例伴染色体1,11核型异常演变的骨髓增生异常综合征

本研究探讨骨髓增生异常综合症-原始细胞增多型(MDS-RAEB)患者的染色体核型演变与疾病进展的关系。通过对1例MDS-RAEB-II患者长达6年的随访,动态检测染色体核型、骨髓以及血常规,并采用荧光原位杂交技术(FISH)对患者的异常核型进行验证。结果表明,随访72个月中发现急性髓系白血病型化疗对患者无效,而全反式维甲酸、6-巯基嘌呤的诱导及支持治疗对患者有效。在初诊时为正常男性核型,病程第48月出现核型演变46,XY,2q+[1]/46,XY[19],第56月演变为46,XY,dup(1q)[3]/46,XY[7],第68月出现以dup(1)和der(11)为主的复杂染色体异常,并有血小板进行性下降。结论:染色体核型的演变与骨髓增生异常综合症疾病的进展可能有相关性。     

血管紧张素ⅡⅠ型受体拮抗剂和血管紧张素转换酶抑制剂的肾保护作用及其对肾内肾素-血管紧张素系统的影响

目的:比较血管紧张素受体拮抗剂(AT₁RA)和血管紧张素转换酶抑制剂(ACEI)的肾脏保护作用,观察这两类药物对肾脏局部肾素-血管紧张素系统的影响。方法:肾病综合征模型由反复给SD大鼠腹腔注射嘌呤霉素诱导而成。28只大鼠随机分为4组:正常对照组、肾病对照组、AT₁RA治疗组和ACEI治疗组。12周后收集血、尿和肾组织标本进行检测。结果:两治疗组尿蛋白明显少于肾病对照组,且到实验期末,肾功能仍在正常范围,肾小球和肾间质损伤指数也低于肾病对照组,但两治疗组间无明显差异(P＞0.05)。肾病对照组的肾组织ACE活性、血管紧张素Ⅱ浓度显著高于正常对照组(P＜0.01)。在ACEI和AT₁RA治疗组,肾组织ACE活性和ANGⅡ浓度显著低于肾病对照组(P＜0.01)。结论:AT₁RA和ACEI在肾病综合征进行性肾损伤中,具有相似的肾脏保护作用,这种作用可能与抑制肾脏局部的ANGⅡ有关。     

单核细胞趋化蛋白-1在颅内动脉瘤壁的表达

目的 研究内皮细胞单核细胞趋化蛋白-1（monocyte chemotactic protein 1,MCP-1）在颅内动脉瘤壁的表达及其在炎症反应过程中的作用。方法 天坛医院2006年10月至2007年9月术中随机取得9例颅内动脉瘤,以同期5例脑肿瘤患者的颞浅动脉为对照,通过苏木素-伊红（hematoxylin and eosin,HE）染色及Western-blot方法研究MCP-1在颅内动脉瘤发生中所起的作用。结果 HE染色显示,相对于正常动脉壁,动脉瘤其内层、外层网架结构均有破坏;Western-blot显示,MCP-1在动脉瘤中的蛋白表达明显增高。结论 MCP-1在囊性动脉瘤壁中的高表达与动脉瘤的发展有相关性。通过某些途径阻断炎性反应的过程可能防止囊性动脉瘤的形成。     

Capecitabine monotherapy for recurrent and metastatic nasopharyngeal cancer

Background: Capecitabine monotherapy had activity in recurrent/metastaticnasopharyngeal carcinoma (NPC) as demonstrated previously ina small pilot study. We conducted a retrospective review ofpatients who received capecitabine for recurrent and metastaticNPC to further evaluate its clinical benefits. Methods: Forty-nine patients with recurrent and metastatic NPC receivedcapecitabine at a dose of 1–1.25 G/m² twice daily for14 days in 3-week cycles. Disease sites were locoregional in29%, distant in 45% and locoregional plus distant in 26%. Allexcept one had prior platinum-based chemotherapy for relapseor as adjunctive treatment. Median follow-up was 10 months (range:3–41). Results: Treatment was generally well tolerated. Hand-foot syndrome wascommon and occurred in 86% (25% Grade 3). Grade 3 hematologicaltoxicity occurred in 6%. Partial response rate was 31% (95%CI: 18%, 44%) and complete response rate was 6% (95% CI: 0%,13%), for an overall response rate of 37% (95% CI: 23%, 50%).Median time-to-progression was 5 months and median survivalwas 14 months. One- and two-year survival rates were 54 and26%, respectively. Significantly better survival was observedin patients treated for locoregional recurrence and those withsevere hand-foot syndrome. Conclusions: Capecitabine has single agent activity in NPC and severe hand-footsyndrome predicts favorable outcome. Based on our experience,capecitabine monotherapy should be considered in patients withrecurrent/metastatic NPC.     

Short-term prognosis of depression in adults with Down's syndrome: association with thyroid status and effects on adaptive behaviour

Findings for Down's syndrome adults with depression were compared to those for non–depressed Down's syndrome controls. Mean age of onset of depression was 30.1 years, the majority of subjects were female and biological more so than psychotic symptoms were presenting features. No statistically significant association between depression and thyroid dysfunction was found. For the depressed group, scores for level of adaptive functioning were significantly lower and those for maladaptive behaviour significantly higher. At one–year follow–up, although some improvement was found, the majority of depressed subjects were still symptomatic. The short-term prognosis for depression in adults with Down's syndrome appears to be poor but possibly better the earlier the age of onset.     

78例A—V综合征手术治疗的临床观察

Ａ－Ｖ综合征７８例手术治疗，其中６６例有斜肌功能异常者行亢进斜肌减弱术，１２例无斜肌功能异常者行水平肌垂直移位法，均矫正了Ａ－Ｖ现象。故认为：对Ａ－Ｖ综合征应合理选择术式。     

大剂量丹参辅助治疗难治性肾病综合征20例

目的 :观察大剂量丹参对治疗难治性肾病综合征 (RNS)的有效性和安全性。方法 :将 40例患儿随机分为治疗组 2 0例和对照组 2 0例。治疗组应用丹参注射液静滴。设立常规药物治疗作为对照组。比较两组的临床疗效。结果 :治疗组疗效明显优于对照组 ,未见明显副作用。结论 :丹参注射液治疗效果好而且安全     

证本质研究应树立功能结构观

根据中医“证”的特质,结合现代科学和哲学的新观点,分析了目前证本质研究陷入困境的原因,指出证的本质是功能性的,不是实物粒子的。因此,证本质研究应树立功能结构观,从寻找证的特异性粒子转到证的功能结构变化的研究上来。     

Hand-foot skin reaction is a beneficial indicator of sorafenib therapy for patients with hepatocellular carcinoma: a systemic review and meta-analysis

Background: Sorafenib remains the only standard first-line drug for advanced hepatocellular carcinoma (HCC). Hand-foot skin reaction (HFSR) is a very common side-effect in patients treated with sorafenib, and also affects the treatment schedule and quality of life. However, the association of HFSR and response of HCC to sorafenib remain unclear.

Methods: Databases including PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials were searched up to May 7^th, 2017. Review Manager 5.3 software was adopted for performing meta-analyses, Newcastle-Ottawa Scale for assessing the bias of cohort studies, and GRADEprofler software for further assessing outcomes obtained from meta-analyses.

Results: 1478 articles were reviewed, and 12 cohort studies with 1017 participants were included in the analyses. The pooled hazard ratio (HR) of overall survival is 0.45 (95% confidence interval (CI) 0.36, 0.55; P < 0.00001; I² = 35%). The pooled HR of time to progression is 0.41 (95% CI 0.28, 0.60; P < 0.00001; I² = 0%). Patients suffering HFSR had significantly better outcomes from sorafenib therapy than those without HFSR.

Conclusions: The results indicate that HFSR is a beneficial indicator for HCC patients receiving sorafenib therapy. However, molecular mechanisms accounting for sorafenib-induced HFSR in HCC patients remain.     

抗肿瘤药物所致手足综合征中医外治法

梳理抗肿瘤药物所致手足综合征的中医外治法,单味中药可以采用紫草油外涂,金银花液浸泡,自拟方外用选芪归通络汤、通络活血颗粒、四妙活血散、加味桂枝汤外洗,炎敌油、京万红软膏、湿润烧伤膏外涂等。外治法使药效直达病所,能有效缓解症状,保证抗肿瘤方案的实施。