主动脉瓣置换术后显著肥大左心室的逆转

目的 :探讨主动脉瓣置换术后显著肥大左心室的逆转和收缩功能的恢复趋势及其影响因素。方法 :分析 1991年 1月至 2 0 0 0年 12月间 3 2例左心室显著肥大患者施行主动脉瓣置换术后超声心动图随访资料。结果 :主动脉瓣置换术后左心室形态呈进行性缩小、心肌肥厚显著减轻。影响显著肥大左心室术后完全逆转的主要术前因素是左心室的收缩末内径≥ 6 0cm、舒张末容积指数≥ 2 10ml/m2 和重量指数≥ 15 0g/m2 (P <0 0 1)。术前射血分数≥ 0 40者术后射血分数和短轴内径缩短率的恢复显著优于术前射血分数 <0 40者 (P <0 0 5～ 0 0 1)。术后射血分数≥ 0 5 0或短轴内径缩短率≥ 2 5 %与术后恢复时间呈正相关 ,与术前左心室收缩末内径≥ 6 0cm呈负相关 (R2 =0 5 5 ,P <0 0 1)。　　结论 :在左心室的收缩末内径≥ 6 0cm或舒张末容积指数≥ 2 10ml/m2 、重量指数≥ 15 0 g/m2 和射血分数 <0 40前手术 ,有利于术后左心室逆转和左心室收缩功能恢复 ,术后 6个月～ 1年是恢复的关键期。     

Cyclosporin A combined with vincristine, doxorubicin and dexamethasone (VAD) compared with VAD alone in patients with advanced refractory multiple myeloma: an EORTC-HOVON randomized phase III study (06914)

Patients with multiple myeloma (MM) refractory to alkylating agents frequently express P-glycoprotein (Pgp), which is associated with the multidrug resistance (MDR) phenotype. We have conducted a randomized phase II/III study of the MDR reversal agent cyclosporin A combined with VAD (vincristine, doxorubicin, dexamethasone) compared with standard VAD in patients with MM stage IIA/IIIA who were refractory to or progressive after treatment with alkylating agents. Out of 81 patients who were randomized, 75 were eligible and evaluable: 34 in the VAD + cyclosporin A arm versus 41 in the VAD arm. Toxicities of grade 2-3 were observed more often with VAD + cyclosporin A than with VAD only: nausea (30% versus 8%, P = 0.015), mucositis (18% versus 5%, P = 0.13), infection (45% versus 35%, P = 0.50). The treatment results were similar in the two arms: 53% versus 49% responded [95% CI (-18.5%, 26.9%)]. The median progression-free survival (PFS) was 8.6 months (VAD + cyclosporin A) versus 5.8 months (VAD): [log rank P = 0.16, hazard ratio = 0.71, 95% CI (0.44, 1.15)], and median overall survival was 13 months versus 14.6 months [log rank P = 0.89, hazard ratio = 0.96, 95% CI (0.62, 1.72)]. The cause of death was progressive disease (85%), toxicity (10%) or other (5%). Bone marrow analysis performed in 23 patients showed that the response rate was 67% in Pgp-positive versus 55% in Pgp-negative patients. Cyclosporin A combined with VAD is relatively well tolerated. There is no effect of cyclosporin A on the overall response rate, PFS and overall survival with VAD.     

2例SRY阳性的46,XX男性综合征细胞和分子遗传学分析

目的通过对2例社会性别为男性的不育患者的细胞及分子遗传学分析,探讨性分化异常的机制,并分析染色体核型和SRY基因检测在性发育异常中的意义。方法外周血淋巴细胞染色体核型分析;提取外周血基因组DNA,进行SRY基因、Y染色体AZF区域微缺失检测。结果 2例患者染色体核型均为46,XX,Y染色体AZF区域微缺失检测提示AZFa、b、c区全部缺失,但SRY基因均存在。结论 SRY基因是参与性别决定和分化的关键基因,对其进行检测有利于明确性反转综合征的临床诊断,通过染色体核型分析结合分子遗传学检测,可为性发育异常患者的临床确诊和治疗提供依据。     

U型反转退镜法在无痛电子结肠镜检查中的应用体会

目的对U型反转退镜法在无痛电子结肠镜检查中的操作进行评价及操作技巧总结。方法分析总结邢台医学高等专科学校第二附属医院85例行无痛电子结肠镜检查中采用U型反转退镜法操作的临床应用情况,并与以往的清醒状态下＂U型反转退镜法＂比较。结果无痛状态下U型反转退镜法成功率100%,再次检查依从性100%。无痛状态下心率、血压无明显变化。清醒组心率、血压则呈上升趋势。无痛组退镜时间（10±1.8）min,清醒组（15±2.5）min。结论无痛状态下U型反转退镜法可提高安全性、缩短退镜时间,提高患者依从性。     

Nature cures nature: Hypericum perforatum attenuates physical withdrawal signs in opium dependent rats

Context: Hypericum perforatum Linn. (Hypericaceae) (St. John’s wort) attenuates opium withdrawal signs.

Aim: To explore the therapeutic potential of Hypericum perforatum in the management of opium-induced withdrawal syndrome.

Materials and methods: The effect of the Hypericum perforatum hydro-ethanol extract was investigated for potential to reverse naloxone (0.25?mg/kg)-induced opium withdrawal physical signs. Rats received opium extract (80–650?mg/kg) twice daily for 8 days along with Hypericum perforatum (20?mg/kg, orally) twice daily in chronic treatment and the same single dose 1?h before induction of withdrawal syndrome in the acute treated group.

Results: Hypericum perforatum reduced stereotype jumps and wet dog shake number in the chronic treatment compared to the saline control group (F(2, 24)?=?3.968, p?F(2, 24)?=?3.689, p?F(2, 24)?=?4.850, p?F(2, 24)?=?4.88, p?F(2, 240?=?5.364, p?F(2, 24)?=?4.907, p?Discussion and conclusion: This study reveals that the extract of Hypericum perforatum attenuates some physical signs of opium withdrawal syndrome possibly through direct or indirect interaction with opioid receptors. Further study is needed to clarify its mechanism.