儿童急性T淋巴细胞白血病微小残留病检测的临床价值分析

目的分析儿童急性T淋巴细胞白血病微小残留病检测的临床价值。方法选取2010年11月～2012年1月在我院接受治疗的急性T淋巴细胞白血病患儿72例作为研究对象,在患儿治疗的不同时间点,对其实施多参数流式细胞术跟踪监测,对不同微小残留病水平患儿的临床特征和预后进行观察、分析。结果在对72例患儿进行随访1个月～7年,其中存活51例(70.83%)、发生事件20例(27.78%)、死亡1例(1.38%),死亡患儿是由于在诱导治疗期间骨髓抑制感染性休克所导致;疾病复发15例(20.83%);随着对患儿的治疗,在最终存活的51例患儿中,通过对其监测,发现其微小残留病水平一直低于检测下限,且无事件发生。随着疾病治疗的持续,患儿微小残留病阳性率逐渐升高;患儿微小残留病水平中位数呈先降低后升高的现象;其中强化治疗前微小残留病阳性例数明显高于诱导治疗33 d、巩固治疗前和再诱导治疗前,微小残留病水平中位数明显高于诱导治疗33 d、巩固治疗前,而微小残留病中位数明显低于诱导治疗33 d、巩固治疗前,差异有统计学意义(P0.05)。在完全缓解的62例患儿中,有6例患儿的水平≥10~(-2),5例复发、1例死于感染;有12例患儿的水平在(1～10)10~(-3)之间,5例复发、且1例患儿由于并发症而出现死亡;微小残留病水平在(1～10)10~(-4)之间的患儿23例,有1例患儿出现病情复发现象。部分缓解患儿共5例,但有2例出现病情复发;在5例未缓解的患儿中,均诱导失败。微小残留病水平10~(-4)组和微小残留病水平10~(-4)～10~(-3)组完全缓解例数明显高于微小残留病水平≥10~(-2)组和微小残留病水平10~(-3)～10~(-2)组,差异有统计学意义(P0.05)。结论对急性T淋巴细胞白血病患儿进行微小残留病水平检测,可以评估患儿的早期治疗情况,对调整治疗策略、病情预后评估具有重要作用。     

从微小残留病角度看白血病诊疗

微小残留病（MRD）是评估白血病疗效的重要参数之一，与患者治疗后的复发和生存密切相关。文章结合第62届美国血液学会（ASH）年会MRD评估预后和指导治疗选择方面的代表性报道，从MRD角度总结了白血病的诊疗新进展。     

皮内缝扎法在动静脉内瘘术静脉属支及交通支结扎中的应用

目的 探索动静脉内瘘术中静脉属支及交通支结扎的最佳手术方法. 方法 本组98例,内瘘术式均采用前臂桡动脉和头静脉端端吻合的标准内瘘,术前常规进行桡动脉及头静脉B超检查,明确头静脉所有属支及伴行静脉交通支情况并做好标记,按所需结扎的静脉支数随机分为皮内缝扎组（观察组,n=52）和切开结扎组（对照组,n=46）,对比2组间手术用时、手术并发症、术后静脉结扎术区肿胀程度、术后静脉结扎术区疼痛程度、术后感染比例、术后3月静脉结扎有效率、术后3月静脉结扎术区硬结形成比例. 结果 观察组手术用时少于对照组,而且所需结扎支数越多,用时差异越明显（F=45.586,P=0.000）,术后静脉结扎术区疼痛程度轻于对照组（Z=2.289,P=0.022）,术后3月静脉结扎术区硬结比例及大小低于对照组（x2=4.176,P=0.041）;观察组与对照组术后静脉结扎术区肿胀程度差异虽未达统计学标准但极度接近（Z=1.904,P=0.057）;2组间手术并发症、术后感染比例、术后3月静脉结扎有效率无明显差异. 结论 皮内缝扎法具有手术时间短、术后疼痛及肿胀程度轻、硬结形成比例少等优点,而且结扎效果可靠、并发症少、不留瘢痕,在动静脉内瘘术静脉属支及交通支的结扎中优于切开结扎法.     

两种微创手术方式治疗功血的对比分析

目的探讨微创手术TCRE和RFAE治疗功血的最佳方案。方法回顾性研究TCRE组患者46例作为A组及RFAE组患者53例作为B组。对两组手术中情况、术后并发症及手术满意度调查进行对比分析。结果两组的手术疗效、术后并发症无明显的差异；而两组手术时间、术中出血、患者手术满意度具有显著性差异。结论RFAE可作为微创手术中治疗功能失调性子宫出血的首选方案。     

Ultrastructural Investigation of Pelvic Peritoneum in Patients With Chronic Pelvic Pain and Subtle Endometriosis in Association With Chromoendoscopy

Study ObjectiveTo evaluate the pelvic peritoneum under chromoendoscopy by scanning electron microscopy (SEM) as well as light microscopy with hematoxylin and eosin staining and immunohistochemistry (IHC) assays in patients with chronic pelvic pain (CPP) associated with subtle endometriosis.DesignCase series study (Canadian Task Force classification II).SettingA referral academic community tertiary medical center.PatientsThree women aged 29 to 37 years were referred to the obstetrics and gynecology clinic of the tertiary university hospital with CPP. They were suspicious for endometriosis, were not responding to medical treatments, and had undergone previous pelvic laparoscopy to determine the stage of endometriosis and preparation of peritoneal samples under the guidance of staining with methylene blue in 0.25% dilution.InterventionsComparison of stained and unstained pelvic peritoneal samples after the instillation of 0.25% methylene blue into the pelvic cavity.Measurements and Main ResultsIn 3 patients, laparoscopic examination showed minimal endometriosis. A total of 18 samples (9 stained and 9 unstained) from the 3 patients were prepared for SEM. Ten of the samples (55.6%) showed microstructural peritoneal destruction (7 of 9 stained [77.7%] and 3 of 9 [33.4%] unstained). Eighteen samples (9 stained and 9 unstained) from the 3 patients were also prepared for IHC. Six of these samples (33.3%) were S-100–positive, including 4 of 9 (44.4%) stained samples and 2 of 9 (22.2%) unstained samples.ConclusionsIn general, in the context of CPP and endometriosis, there is no established relationship between the severity of pain and stage of endometriosis. In the pathophysiology of CPP associated with endometriosis, ultrastructural changes can play a significant role. Under methylene blue staining, some destroyed areas were detected, but the stained areas do not necessarily correlate with increased microstructural peritoneal destruction.     

中西医治疗轻微型肝性脑病的研究进展

本文介绍了轻微型肝性脑病的流行病学、监测和诊断方法,分别从中医和西医的不同角度,论述了目前轻微型肝性脑病的治疗进展,并提出了轻微型肝性脑病的中西医结合治疗思路。     

Intraluminal magnetisation of bowel by ferromagnetic particles for retraction and manipulation by magnetic probes

Feasibility studies are needed to demonstrate that safe and effective manipulation of bowel during Minimal Access Surgery (MAS) can be obtained by use of magnetic force. This paper characterises two classes of magnetic particles: stainless steel microparticles (SS-μPs) and iron oxide nanoparticles (IO-nPs) in terms of their magnetisation, chemical composition, crystallinity, morphology and size distribution. Both magnetic particles were dispersed in a high viscosity biological liquid for intraluminal injection of bowel. Ex vivo porcine bowel segments were then retracted by permanent magnetic probes of 5.0 and 10 mm diameter. Strong retraction forces reaching 6 N maximum were obtained by magnetic fluid based on dispersion of SS-μPs. In contrast, the IO-nP-based magnetic liquid generated less attraction force, due to both lower magnetic and solution properties of the IO-nPs. The comparison of the two particles allowed the identification of the rules to engineer the next generation of particles. The results with SS-μPs provide proof on concept that intraluminal injection of magnetic fluid can generate sufficient force for efficient bowel retraction. Thereafter we shall carry out in vivo animal studies for efficacy and safety of both types of ferrofluids.     

Minimal Clinically Important Differences in COPD Lung Function

The FEV₁ is widely used by physicians in the diagnosis, staging, treatment, monitoring and establishing prognosis for patients with COPD. The MCID is the smallest difference which patients perceive as beneficial and which would mandate a change in patient management. A precise MCID for FEV₁ has not been established.

In attempt to establish a MCID for predose or trough FEV₁, several limitations need to be addressed. There are issues such as reproducibility, repeatability, acceptability, variability, placebo effect, and equipment effects. Patient factors, such as baseline level of FEV₁, albuterol reversibility, diurnal variation, influence the results.

Nonetheless, using anchoring techniques, a change in pre dose FEV₁ of about 100 mL can be perceived by patients, correlates with fewer relapses following exacerbations and is in the range usually achieved with bronchodilators approved for COPD.

In the future, consistent reporting of spirometric variables, such as a predose FEV₁ and other outcomes, can be incorporated into a more quantitative effort to establish the MCID. Also distributional/statistical methods may be useful in determining the MCID FEV₁.