伏立康唑一级预防急性白血病患者化疗期间并发真菌感染的临床疗效北大核心

目的:探讨初诊急性白血病患者化疗期间应用伏立康唑进行预防侵袭性真菌病(IFD)的临床疗效及安全性。方法:回顾性分析2016年02月至2018年03月期间我院血液科收治的初诊急性白血病行化疗的患者166例,按照是否使用抗真菌药进行预防性治疗分为观察组(应用伏立康唑进行预防治疗,n=103)和对照组(未应用抗真菌药物,n=63),比较两组患者IFD发生率差异,并分析抗真菌药物应用的不良反应。结果:观察组IFD发生率为10.7%,对照组为33.3%,两组患者的IFD发生率有明显差异(P<0.05);所有应用伏立康唑进行预防治疗的患者均未出现严重的不良反应。结论:伏立康唑可以有效减低急性白血病患者化疗期间IFD发生率,并且有着较好的安全性,值得在临床推广应用。     

健脾生血片治疗慢性心力衰竭伴贫血的临床效果

目的:探索健脾生血片治疗慢性心力衰竭伴贫血的疗效、安全性和作用机制。方法:选取2016年5月至2017年2月同济医院收治的慢性心力衰竭贫血患者144例,按照随机数字表法分为观察组和对照组,每组72例。观察组给予健脾生血片治疗,3片/次,3次/d,疗程3个月;对照组给予生血宝合剂治疗,15 m L/次,3次/d,3个月为1个疗程。比较2组患者治疗前与治疗后血红蛋白、红细胞计数、网织红细胞、血清铁、转铁蛋白饱和度、血清铁蛋白、血清铁调素(Hepcidin)、血清IL-1β、血清肿瘤坏死因子-α(TNF-α)、血清C反应蛋白(CRP)、左室射血分数(LVEF)、6 min步行距离、明尼苏达心力衰竭生命质量量表(MLHFQ)和不良事件。并随访2组心血管事件次数,住院次数与全因死亡率。结果:观察组72例患者完成了前3个月的治疗,随访期间脱失2例;对照组治疗期间1例患者退出研究,随访期间脱失4例。2组一般资料比较,差异无统计学意义(P 0. 05),具有可比性。观察组贫血有效率98. 6%,对照组有效率11. 3%,差异有统计学意义(P0. 05)。治疗后观察组红细胞计数和网织红细胞、均显著高于对照组(P 0. 05)。观察组血清铁、转铁蛋白饱和度水平均高于对照组,差异有统计学意义(P 0. 05),但血清铁调素水平显著低于对照组,差异有统计学意义(P 0. 05),血清铁蛋白水平2组差异无统计学意义(P 0. 05)。观察组IL-1β、血清TNF-α、血清CRP均显著低于对照组,差异有统计学意义(P 0. 05)。观察组LVEF、6 min步行距离、明尼苏达心力衰竭生命质量量表(MLHFQ)均显著高于对照组,差异有统计学意义(P 0. 05)。2组不良事件总发生率比较,差异无统计学意义(P 0. 05),但对照组4例患者出现血清肌酐、尿素氮水平异常,发生率高于观察组,差异有统计学意义(P 0. 05)。经1年随访,观察组心血管事件人均发生次数显著少于对照组(P 0. 05),但2组住院次数和全因死亡率比较,差异无统计学意义(P 0. 05)。结论:健脾生血片可有效治疗心力衰竭伴贫血,减少心血管发生次数,并且安全性良好,其作用机制与提供准确足量铁元素、抑制铁调素表达,抑制慢性炎性反应有关。     

Influences of simulated gastrointestinal environment on physicochemical properties of gold nanoparticles and their implications on intestinal epithelial permeability

Gold nanoparticles (Au NPs) hold great promise in food, industrial and biomedical applications due to their unique physicochemical properties. However, influences of the gastrointestinal tract (GIT), a likely route for Au NPs administration, on the physicochemical properties of Au NPs has been rarely evaluated. Here, we investigated the influence of GIT fluids on the physicochemical properties of Au NPs (5, 50, and 100?nm) and their implications on intestinal epithelial permeability in vitro. Au NPs aggregated in fasted gastric fluids and generated hydroxyl radicals in the presence of H₂O₂. Cell studies showed that GIT fluids incubation of Au NPs affected the cellular uptake of Au NPs but did not induce cytotoxicity or disturb the intestinal epithelial permeability.     

乳腺密度对浸润性小叶癌术前MRI评估的影响

目的:探讨MRI在浸润性小叶癌(ILC)术前诊断中的应用价值，并评估乳腺密度对其影响。方法:选取75例术前30天内行MRI检查的I-Ⅲ期ILC患者列入本项研究，根据腺体含量评估乳腺密度，在MRI下测量肿瘤大小，并对比其与病理大小的一致性。结果:75例入组患者中26例（34.7%）患者经MRI评估发现新的可疑病灶，20例（26.7%）患者改变了手术方式。高密度乳腺型患者额外病灶检出率明显高于低密度乳腺型患者（51.6% vs 22.7%，P=0.010）。MRI评估肿瘤大小在低密度乳腺型患者中容易被低估（36.4% vs 12.9%，P=0.024），在高密度乳腺型患者中容易被高估（6.8% vs 29.0%，P=0.010），但两组患者与病理大小一致性的比例无明显差异。结论:ILC患者术前乳腺MRI检查能够提高额外恶性肿瘤的检出率，而乳腺密度是影响MRI评估的重要因素。     

Simeprevir added to peginterferon and ribavirin lessens time with fatigue,depressive symptoms and functional limitations in patients with chronic hepatitis C compared with peginterferon and ribavirin: results from 1161 patients in the QUEST‐1, QUEST‐2 and PROMISE studies

The value of adding simeprevir (SMV) vs placebo (PBO) to peginterferon and ribavirin (PR) for treatment of chronic hepatitis C virus infection was examined using patient‐reported outcomes (PROs); further, concordance of PROs with virology endpoints and adverse events (AEs) was explored. Patients (n = 768 SMV/PR, n = 393 PBO/PR) rated fatigue (FSS), depressive symptoms (CES‐D) and functional impairment (WPAI: Hepatitis C Productivity, Daily Activity and Absenteeism) at baseline and throughout treatment in three randomised, double‐blind trials comparing the addition of SMV or PBO during initial 12 weeks of PR. PR was administered for 48 weeks (PBO group) and 24/48 weeks (SMV group) using a response‐guided therapy (RGT) approach. Mean PRO scores (except Absenteeism) worsened from baseline to Week 4 to the same extent in both groups but reverted after Week 24 for SMV/PR and only after Week 48 for PBO/PR. Accordingly, there was a significantly lower area under the curve (baseline–Week 60, AUC₆₀) and fewer weeks with clinically important worsening of scores in the SMV/PR group at any time point. Incidences of patients with fatigue and anaemia AEs were similar in both groups, but FSS scores showed that clinically important increases in fatigue lasted a mean of 6.9 weeks longer with PBO/PR (P < 0.001). PRO score subgroup analysis indicated better outcomes for patients who met the criteria for RGT or achieved sustained virological response 12 weeks post‐treatment (SVR12); differences in mean PRO scores associated with fibrosis level were only observed with PBO/PR. Greater efficacy of SMV/PR enabled reduced treatment duration and reduced time with PR‐related AEs without adding to AE severity.     

郭军教授治疗特发性男性不育症的经验

男性不育症中,精液分析多种参数异常且无法找到明确病因的称为特发性男性不育症,其发病率不断提高,给国内甚至全球范围内家庭带来精神及经济负担。由于病因不明确,目前现代医学尚无有效治疗方法。传统中医药通过辨证论治在治疗特发性男性不育症时具有优势,郭军教授认为该病以肾脾两虚为本,为体内湿热形成奠定基础,患者久病无子嗣,肝气不畅则郁结,气血津液运行不通则夹血瘀湿热等有形实邪,另外怪病多痰。故对于特发性男性不育症,治法注重补泻兼施,扶正祛邪,补益脾肾为主,对于湿热、痰湿、瘀血则清热祛湿化痰,活血化瘀等,并举验案1例。