对慢性鼻窦炎药物治疗和手术治疗疗效比较

目的:探讨功能性鼻窦内镜手术(FESS)及药物治疗慢性鼻-鼻窦炎的疗效比较.方法:对2008年1月～2009年1月行功能性鼻窦内镜手术治疗慢性鼻-鼻窦炎患者78例(鼻窦炎症主要在上颌窦和前组筛窦.不伴有鼻息肉.鼻中隔明显偏曲者),患者术后6个月按时复查并有完整资料记录.及对2008年10月～2009年10月药物治疗有完整资料的慢性前组鼻窦炎患者(不伴有鼻息肉.鼻中隔明显偏曲者)82例,对疗效进行回顾性分析.(若患者有急性上呼吸道感染,就将评估时间推迟至症状完全消失2周以后进行).结果:慢性鼻-鼻窦炎患者药物治疗和手术治疗疗效相当.结论:对慢性鼻-鼻窦炎(前组鼻窦炎)应首选药物治疗.     

Gene therapy: future therapy for erectile dysfunction

Advances in molecular biological techniques, completion of the Human Genome Project, and the ensuing age of molecular medicine, in conjuction with the sum of a decades-long accumulation of knowledge of the physiology of erection and the pathophysiology of erectile dysfunction have converged to make gene therapy for erectile dysfunc-tion a distinct possibility. In short, both the intrinsic complexities of mechanisms responsible for ensuring normal erection and the multifactorial nature of erectile dysfunction ensure that there is a relatively vast number of physiologically relevant molecular targets for gene therapy. As such, perhaps it is not surprising that virtually every preclinical gene therapy strategy/target examined thus far has been largely successful in ameliorating conditions associated with compromised erectile function in vivo and/or in vitro. This report highlights the goals and strategies of gene therapy for erectile dysfunction and reviews the strategies that initially have been employed. In short, the preclinical data, while still quite preliminary in many regards, are nonetheless quite impressive and encouraging. If similar success is obtained in clinical trials, gene therapy for erectile dysfunction may provide the first concrete “proof of concept” for using gene therapy in the treatment of human smooth muscle disorders.     

Photodynamic therapy

Photodynamic therapy (PDT) is a new modality of cancer treatment. It is based on the use of photosensitizing agents and laser light which interact and produce singlet oxygen. This toxic compound destroys malignant tumours while healthy tissue remains intact. The present paper reviews the method of PDT and its possible clinical applications.     

定制你的音乐处方——记录音乐养生疗法

在生活中我们常说,喜欢唱歌的人大多心情开朗,不轻易生病。在科学上,这其实是有依据的。不同的人,不同的心情,都有相应适合的音乐,在科学家眼中,从古典音乐到现代流派,从轻音乐到嘻哈和摇滚,任何不同类型的乐曲都有着不同的“治疗功用”。这就是我们通常所说的,也是目前最新流行的“音乐养生疗法”。     

Immunosuppressive therapy

Although several new immunosuppressive medications have been developed in the past decade, many possible avenues are yet to be explored. Although the newer agents have not reflected any clear benefit in patient or graft survival over CsA or tacrolimus, they have been useful in reducing the incidence and severity of rejection, reducing the concomitant use of steroids, and decreasing the doses of CsA or tacrolimus to minimize their toxicity profile. The appearance of these new agents has given more options to clinicians, who can select the one with the least toxicity and most efficacy for individual patients. In the future, combinations of these agents, in conjunction with a strategy to induce tolerance of the donor organ without drug toxicity, will be the goal.     

Diuretic-based therapy

Diuretics are pharmacological agents that increase natriuresis through inhibition of tubular re-absorption of sodium. The mechanisms and site of this inhibition differ with each drug class, accounting for their additive effects on natriuresis increase and their hydroelectrolytic side effects. The response to a given diuretic dose depends on the diuretic concentration on the urine at its action site. This concentration may be decreased by pharmacokinetic factors such as encountered in renal insufficiency or in nephrotic syndrome. These resistance mechanisms of diuretics may be corrected by dose increase, previous diuretic fixation on albumin or warfarin administration. Once these mechanisms are opposed, the diuretic concentration for maximal efficacy is reached at is action site and the natriuresis obtained as the normal maximal plateau. This is not the case when an oedematous systemic disease with effective hypovolemia is present, like in heart failure or cirrhosis, or when chronic use of loop diuretics has induced a hypertrophy of the more distant part of the tubule. In theses cases, a pharmacodynamic resistance exists, resulting in a lower maximal natriuresis plateau in spite of adequate concentration of the diuretic at its action site, even in the absence of pharmacokinetic resistance factors. The main indications of diuretics are systemic oedematous disease and hypertension. In the oedematous diseases, diuretics indication is both straightforward and sufficient only if effective hypervolemia is present. The therapeutic approach is discussed according to the various clinical conditions and pathophysiological background. In uncomplicated hypertension, diuretics are the cornerstone of the therapy. The most suitable diuretic treatment for hypertension is an association of low doses thiazide (12.5-50 mg/day) with potassium sparing diuretics. Rare indications of diuretics are also reviewed.     

Gene therapy

We selected bone-metastatic prostate cancer as the target form of recurrent prostate cancer and developed a suicide-gene therapy based on an adenovirus vector with an organ-specific osteocalcin promoter. Related clinical studies have already been conducted in the United States at the University of Virginia, where results so far have established the safety of this therapy. In the present paper, in addition to presenting the results of these gene-therapy studies from the basic research to the clinical stage, we discuss the clinical studies begun by our group in August 2003. In the 21st century, therapeutic systems in use are undergoing major changes. Gene therapy is likely to become an important therapeutic option in recurrent prostate cancer. In terms of theory and technology however, this form of treatment is still at a very immature stage of development. We look forward to evolution in this field to provide an established treatment for recurrent prostate cancer and are committed to actively continuing with the development of gene therapy through translational research.     

Fluid therapy

Peri-operative fluid therapy is a fundamental part of the management of the high-risk surgical patient. Knowledge of the physicochemical and pharmacological effects of the available crystalloid and colloid solutions should guide their use. In addition to differences in tissue distribution and plasma volume expansion many of these solutions have significant effects on haemorrheology, haemostasis, vascular integrity and inflammatory cell function. When considering colloid solutions differentiation between the properties of the carrier solution and the dissolved colloid is important. Pre-operative risk assessment leading to institution of appropriate monitoring to guide fluid therapy is essential. Fluid therapy should be titrated to specific endpoints. Use of techniques which allow optimization of stroke volume, cardiac output and oxygen delivery have been shown to be beneficial. Monitoring of tissue perfusion as an endpoint will become increasingly important.