VD方案和VAD方案治疗多发性骨髓瘤的疗效观察和比较

目的 探讨VD方案和VAD方案治疗多发性骨髓瘤的临床疗效和安全性.方法 回顾性分析了2008年6月到2011年6月我院收治的59例多发性骨髓瘤患者的临床资料,根据治疗方案将患者分为VD组(38例)和VAD组(21例),VD组接受硼替佐米联合地塞米松治疗,3周为一个疗程,治疗2个疗程;VAD组接受长春新碱、阿霉素联合地塞米松治疗,4周为一疗程,治疗2个疗程.分别对两组疗效和不良反应进行分析.结果 VD组和VAD组治疗缓解率分别为83.78％和59.09％,VD方案优于VAD方案,差异具有统计学意义(P＜0.05).VD组主要不良反应为血液毒性和周围神经病变,症状较轻微,在停药和对症处理后症状消失或缓解.VAD组主要不良反应为感染、脱发和血液毒性等,其中感染多以3～4度为主.结论 VD方案治疗多发性骨髓瘤疗效优于VAD方案,不良反应轻微,患者可耐受,值得临床推广使用.     

Resultados a largo plazo de la valvuloplastia transluminal percutánea en la estenosis valvular pulmonar en población pediátrica

Introduction and objectives

Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population.

Methods

The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up.

Results

Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients.

Conclusions

Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results.Full English text available from:www.revespcardiol.org/en     

枸地氯雷他定联合维生素D滴剂治疗慢性自发性荨麻疹的疗效观察

 目的 观察枸地氯雷他定联合维生素D滴剂治疗血清25-(OH)维生素D含量缺乏的慢性自发性荨麻疹患者的临床疗效。方法 选取2018-10至2019-09就诊于山西医科大学第一医院皮肤科门诊的血清25-(OH)维生素D含量缺乏的慢性自发性荨麻疹患者108例,按随机数字表法分为两组,每组54例。对照组予口服枸地氯雷他定片,治疗组予口服枸地氯雷他定片联合维生素D滴剂,疗程均为6周,比较两组患者的总有效率及治疗前后的每天发作次数评分、每天发作时间评分、皮肤病生活质量指数评分、血清25-(OH)维生素D含量的差异。结果 治疗后治疗组总有效率83.33%,高于对照组的64.81%,差异有统计学意义(P＜0.05);治疗前两组各项指标差异均无统计学意义,治疗后两组各项指标均较治疗前有改善,差异有统计学意义(P＜0.05);治疗后治疗组每天发作次数评分、每天发作时间评分及DLQI评分均低于对照组,差异均有统计学意义(P＜0.05);治疗组25-(OH)维生素D含量明显高于对照组,差异有统计学意义;治疗后治疗组平均血清25-(OH)维生素D含量[(59.43±10.08)nmol/L]与对照组血清25-(OH)维生素D含量[(30.19±9.60)nmol/L]相比差异有统计学意义(P＜0.05)。结论 血清25-(OH)维生素D含量缺乏的慢性自发性荨麻疹患者口服枸地氯雷他定片联合维生素D滴剂疗效显著,能够改善患者的生活质量,值得推广使用。     

Neuroimaging in dementia

Over the last few years, advances in neuroimaging have generated biomarkers, which increase diagnostic certainty, provide valuable information about prognosis, and suggest a particular pathology underlying the clinical dementia syndrome. We aim to review the evidence for use of already established imaging modalities, along with selected techniques that have a great potential to guide clinical decisions in the future. We discuss structural, functional and molecular imaging, focusing on the most common dementias: Alzheimer's disease, fronto-temporal dementia, dementia with Lewy bodies and vascular dementia. Finally, we stress the importance of conducting research using representative cohorts and in a naturalistic set up, in order to build a strong evidence base for translating imaging methods for a National Health Service. If we assess a broad range of patients referred to memory clinic with a variety of imaging modalities, we will make a step towards accumulating robust evidence and ultimately closing the gap between the dramatic advances in neurosciences and meaningful clinical applications for the maximum benefit of our patients.     

针刺对血管性痴呆大鼠行为及脑内神经递质的影响

目的:观察针刺治疗对于血管性痴呆大鼠学习记忆行为及脑内神经递质的影响。方法:制备120只VD大鼠模型,随机分组后给予药物和/或针刺治疗,针刺取主穴肾俞、肝俞、脾俞、百会、四神聪、神庭、水沟、内关、风池,每日1次,每次30min,10d为1个疗程,共进行3个疗程,疗程间休息1d。治疗前后采用迷宫实验与跳台实验进行行为学观测,行为学观测后将大鼠处死,检测脑组织中神经递质的含量。结果:各治疗组VD大鼠的学习与记忆能力较治疗前有明显提高,VD大鼠脑组织中相关递质含量较正常对照组降低,经过30d治疗后递质有不同程度的提高,针药组的行为改善与递质升高均优于针刺组与药物组,而针刺组又优于药物组。结论:针刺治疗能明显改善VD大鼠的认知功能,而且能够改善Ach、5-HT、CAs等神经递质的功能状态;针刺治疗较抗痴呆药物单一应用有一定优势,不但效果较好,且与传统抗痴呆药物有协同作用,能够加强药物的疗效。     

Structural airway abnormalities in infants and young children with cystic fibrosis

OBJECTIVES: To determine whether the airway structure of infants and young children with cystic fibrosis (CF) differs from that of normal children by using high-resolution computed tomography (HRCT) imaging. Study design Full-inflation, controlled ventilation HRCT images of the lungs were obtained at four anatomic levels in 34 infants with CF (age, 2.4+/-1.4 years) and 20 control infants (age, 1.8+/-1.4 years). Short axis diameters of all clearly identifiable, round airway/vessel pairs were measured to obtain airway wall thickness (AWT), airway lumen diameter (ALD), and vessel diameter (VD). RESULTS: In infants with CF, mean AWT (+/-SD) was 0.58+/-0.13 mm, ALD was 1.31+/-0.56 mm, and VD was 1.62+/-0.58 mm. In control infants, mean AWT was 0.49+/-0.13 mm, ALD was 1.07+/-0.42 mm, and VD was 1.86+/-0.64 mm. Mean AWT and ALD were greater in children with CF than in normal subjects (P<.001). ALD:VD ratios increased with age in patients with CF compared with control subjects (P=.026). CONCLUSIONS: The airways of infants and young children with CF have thicker walls and are more dilated than those of normal infants.     

Myocardial infarction associated with stroke revealing a thrombus of the ascending aorta

Mobile thrombus of the ascending thoracic aorta is an uncommon source of embolism. We report the case of a 40-year-old woman, without coronary risk factors, who was admitted for an acute myocardial infarction associated with stroke. Transesophageal echocardiography showed the presence of a pedunculated highly mobile thrombus attached to the aortic wall near the right coronary ostium. With appropriate anticoagulation, the thrombus resolved after 2 weeks and no recurrence occurred over the next 18 months. Coronary angiography was normal.     

维生素D3对大鼠卵巢切碎组织性激素分泌影响

目的研究维生素D3（VD3）在动情周期不同阶段对大鼠卵巢切碎组织分泌雌二醇（E2）,孕酮（P4）的影响。方法采用正交表L16（4^5）设计实验,研究VD3（10^-4,10^-7,10^-10mol/L在动情周期的4个阶段（动情前期、动情期、动情后期、动情间期）对卵巢切碎组织分泌E2和P4的影响。结果VD3可影响卵巢切碎组织体外分泌E2（P〈0.001）,但不会影响分泌P4（P〉0.05）,卵巢切碎组织体外分泌E2和P4与所处的动情周期有关（P〈0.001,P〈0.05）。结论VD3对卵巢类固醇激素生成和分泌有直接影响。     

铝与血管性痴呆发病机制的相关性探讨

目的对缺血性脑卒中(不论有无痴呆)患者进行脑脊液(CSF)中铝含量进行测定,探索老年性痴呆的发病机制。方法观察组为缺血性脑卒中患者,对照组为整形外科患者。取两组患者的CSF,用原子吸收光谱进行CSF的铝含量测定,然后用韦氏智力量表及长谷川简易量表对患者智能进行测定。结果第1次检测结果:观察组铝含量为(81.6±8.9)ng/L,对照组为(35.6±2.2)ng/L(t=35.17,P<0.001)。第2次检测结果:观察组铝含量为(76.8±6.7)ng/L,韦氏成人智力量表均值低于75分,智力水平低于平常水平。对照组25例,铝含量为(14.0±1.2)ng/L(t=34.55,P<0.001)。第3次检测结果:观察组铝含量为(100.6±7.8)ng/L,长谷川简易量表均值为10.48分,为中等以下痴呆。对照组铝含量为(32.3±0.1)ng/L(t=14.92,P<0.001)。3次检测结果中观察组患者的铝含量均较对照组增加。结论VD及AD可能有相同的致病原因,中枢神经系统铝中毒。