放疗在肝癌治疗中应用的研究进展

肝癌是临床上常见的恶性肿瘤，因早期症状不典型，至发现时往往已为中晚期，失去最佳手术治疗时机和机会。作为非手术治疗之一的放射治疗技术，其发展在近年来已有了较大的进步。放疗包括体外放疗和体内放疗，皆具有一定的治疗效果和相对可控的不良反应。本文就肝癌放射治疗的应用进展作一综述。     

Outcomes After Aortic Valve Replacement for Asymptomatic Severe Aortic Regurgitation and Normal Ejection Fraction

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Protection of White Leghorn chickens by recombinant fowlpox vector vaccine with an updated H5 insert against Mexican H5N2 avian influenza viruses

Despite decades of vaccination, surveillance, and biosecurity measures, H5N2 low pathogenicity avian influenza (LPAI) virus infections continue in Mexico and neighboring countries. One explanation for tenacity of H5N2 LPAI in Mexico is the antigenic divergence of circulating field viruses compared to licensed vaccines due to antigenic drift. Our phylogenetic analysis indicates that the H5N2 LPAI viruses circulating in Mexico and neighboring countries since 1994 have undergone antigenic drift away from vaccine seed strains. Here we evaluated the efficacy of a new recombinant fowlpox virus vector containing an updated H5 insert (rFPV-H5/2016), more relevant to the current strains circulating in Mexico. We tested the vaccine efficacy against a closely related subcluster 4 Mexican H5N2 LPAI (2010 H5/LP) virus and the historic H5N2 HPAI (1995 H5/HP) virus in White Leghorn chickens. The rFPV-H5/2016 vaccine provided hemagglutinin inhibition (HI) titers pre-challenge against viral antigens from both challenge viruses in almost 100% of the immunized birds, with no differences in number of birds seroconverting or HI titers among all tested doses (1.5, 2.0, and 3.1 log₁₀ mean tissue culture infectious doses/bird). The vaccine conferred 100% clinical protection and a significant decrease in oral and cloacal virus shedding from 1995 H5/HP virus challenged birds when compared to the sham controls at all tested doses. Virus shedding titers from vaccinated 2010 H5/LP virus challenged birds significantly decreased compared to sham birds especially at earlier time points. Our results confirm the efficacy of the new rFPV-H5/2016 against antigenic drift of LPAI virus in Mexico and suggest that this vaccine would be a good candidate, likely as a primer in a prime-boost vaccination program.     

脾胃病的中医治疗研究进展

在中医理论中,脾胃病主要是指脾胃消化功能受到严重影响的一种疾病。人体的气血是由脾胃消化食物转化而来,所以脾胃对人体健康具有非常重要的影响。随着中医治疗脾胃病的研究进展取得了非常大的突破,从基础理论实践逐步转变为临床实践阶段,有大量的研究文献提出了相应的观点。为了能够明确中医治疗脾胃病的研究发展方向,必须将中医辨证治疗理论与现代医学治疗相结合,促进脾胃病治疗的整体水平同步提升。本文综合近两年的主要文献资料对脾胃病的中医治疗研究进展进行详细论述,为脾胃病的中医治疗研究提供重要参考依据。     

Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve disease

BackgroundCT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.Methods44 consecutive patients (mean age: 73 ± 15 years, 57% male) undergoing CTA with subsequent SAPIEN 3 valve insertion for severe bicuspid aortic stenosis (AS) were included. AA was measured at the basal ring. SA was measured by generating a circle defined by the intercommisural distance. AA and SA were measured by 2 independent observers. Baseline characteristics, TAVR procedural data, and discharge echocardiography data were collected.ResultsThe SA was significantly larger than the AA (562 ± 146mm2 vs. 518 ± 112mm2,p = 0.013). Interobserver agreement was high using both techniques (ICC AA = 0.98,p < 0.001; SA = 0.80,p < 0.001), but with narrower limits of agreement with AA measurements (mean difference (limits of agreement): AA = −3mm2 (22; 19), SA = −16mm2 (−92; 76)). AA-based device sizing demonstrated substantial agreement with final valve inserted (κ = 0.72,p < 0.001), while SA demonstrated fair agreement (κ = 0.40,p < 0.001). There was no difference in post TAVR gradients, paravalvular leakage or valve success between patients with concordant sizing between AA and SA, and those in whom SA would have suggested an alternate valve size.ConclusionsSupra-annular sizing is less reproducible than annular sizing, with no difference in procedural complication rates in patients in whom supra-annular sizing would have altered the device size used. These results suggest no role for supra-annular sizing in current clinical practice.     

儿童舒缓治疗的意义和发展现状

儿童舒缓治疗是对患有危及生命疾病的儿童提供身体、心理和精神等全方面的照顾，同时给予家庭支持，旨在为儿童及其家庭提供最佳的生活质量。我国儿童人口基数庞大，不断增加的舒缓治疗服务需求与相关服务资源的发展不足是我国儿童舒缓治疗领域面临的两大现实问题。该文就儿童舒缓治疗的实施和发展现状等进行了综述，为国内开展儿童舒缓治疗相关工作及研究提供参考。