克拉屈滨治疗多毛细胞白血病4例临床探讨

目的:探讨多毛细胞白血病(HCL)临床诊断及使用克拉屈滨治疗的效果.方法:回顾性分析4例初治HCL的临床资料.结果:4例患者的血常规均为二系或三系血细胞减少,单核细胞数减少,均有脾肿大,且外周血和骨髓中均可见典型的毛细胞.免疫表型发现毛细胞表达CD11c、CD19、CD20、CD22、CD25、FMC-7、CD103;不表达CD5及CD10.使用克拉屈滨治疗,3例患者1个疗程达到完全缓解(CR),1例患者2个疗程达CR;克拉屈滨主要毒副作用是骨髓抑制,易并发肺部感染.结论:HCL患者以血细胞减少、单核细胞数减少,脾肿大,外周血和骨髓发现多毛细胞为主要临床特征,结合免疫学分型,可诊断HCL;使用克拉屈滨治疗,可获得较好疗效.     

克拉屈滨治疗经典型毛细胞白血病致间质性肺炎一例报道并文献复习

毛细胞白血病（HCL）是一种以脾大、全血细胞减少、骨髓组织增生等为临床表现的罕见慢性B淋巴细胞增殖性疾病。克拉屈滨作为其一线药物，对HCL的完全缓解率很高。本文报道了2017-09-04绍兴市人民医院收治的1例经典型HCL患者在克拉屈滨治疗期间，出现严重粒细胞缺乏伴高热，合并全身皮疹及间质性肺炎，经大剂量激素等治疗后好转的诊疗过程。并结合文献回顾了HCL的诊断及治疗方法，简述了克拉屈滨治疗HCL致间质性肺炎这一少见并发症的诊疗思路，以提高临床医师对该毒副作用的认识，为临床工作提供帮助。     

DCAG治疗80岁以上的初诊急性髓系白血病疗效观察

目的：探讨地西他滨联合CAG（DCAG）治疗高龄初诊急性髓系白血病（AML）的疗效和安全性。方法：25例≥80岁初诊AML患者接受DCAG方案：地西他滨15mg/m2/d,d1-5,阿克拉霉素 10 mg/d,第3-6天;Ara-C 10 mg/m2,皮下注射,每12小时1次,第3-9天;G-CSF 300 μg/d, 皮下注射, d0-9。观察患者疗效和耐受性。结果：男12例,女13例,中位年龄82岁（80~87岁）,10例ECOG 1~2级,15例ECOG为3~4级。一个疗程后CR率为71%,PR率为9.5%。染色体核型分组,预后中等组完全缓解（CR）为 81.8%;预后差组CR率为62.5%。患者中位总生存率（OS） 10个月（1~61个月）,CR者的中位无病生存（DFS）达 14个月,血液学毒性为最主要的不良反应,中性粒细胞恢复至0.5×109/L的中位时间为14d,血小板恢复至20×109/L的中位时间为12d,3例（12.5%）早期死亡。但13例患者缺乏后续规范性治疗。结论：DCAG治疗≥80岁初诊AML患者,疗效好,毒副作用可耐受。     

VTD方案治疗多发性骨髓瘤

目的：观察VTD方案治疗初治及复发难治多发性骨髓瘤（MM）的疗效及不良反应。方法：21例患者均采用硼替佐米（1．3mg／m^2,第1、4、8、11d）联合沙利度胺（200mg／d）及地塞米松（20mg／d，d1-d4，d8-d11）治疗，21天为一疗程。每例患者分别接受了1-4个疗程的治疗。结果：总有效率（ORR）为76．2％，其中初治组ORR为100％，复发难治组ORR为58．3％。CR2例（9．5％）、nCR3例（14．3％）、PR8例（381％）、MCR3例（14．3％）。不良反应较轻，主要为乏力、血液学毒性、胃肠道反应、周围神经毒性，经对症治疗后缓解。结论：VTD方案治疗初治及复发难治MM患者具有有效率高，耐受性好，特别是在伴有肾功能不全患者中疗效可靠、安全。     

178例老年人消化性溃疡临床特征及埃索美拉唑疗效观察

目的：分析总结老年消化性溃疡（peptic ulcer,PU）的临床特征,观察埃索美拉唑治疗PU的效果。方法：调查我院2004年1月～2008年12月经胃镜确诊的178例老年PU患者的临床症状、溃疡发生部位、并发症及伴随疾病、治疗效果。治疗方案：Hp阴性患者：埃索美拉唑40mg,晨起口服（1次／d）。Hp阳性患者：埃索美拉唑40mg,晨起口服（1次／d）＋阿莫西林1g（2次／d）＋克拉霉素0．5g（2次／d）,疗程：胃溃疡6周,十二指肠球部溃疡4周,阿莫西林和克拉霉素疗程均为10d。结果：老年患者上腹痛多不典型;伴发病发生率高,高达52．81％。胃溃疡经埃索美拉唑或三联治疗6周后,愈合率86．11％,有效率94．44％。十二指肠溃疡经埃索美拉唑或三联治疗4周后,愈合率83．72％,有效率96．52％。复合性溃疡经治疗6周后,愈合率85．00％,有效率95．00％。所有患者3d后上腹痛缓解总有效率为100％。埃索美拉唑治疗不良反应发生率5．06％。结论：老年人消化性溃疡有临床表现不典型,并发症多等临床特点;埃索美拉唑应用于治疗老年PU具有治愈率高,起效快、作用持久稳定、不良反应较少的特点。     

利复星序贯疗法治疗急性下呼吸道细菌感染的研讨

目的：评价利复星序贯疗法治疗急性下呼吸道细菌性感染的疗效和安全性,方法：对102例急性下呼吸道细菌感染患者,采用利复星400mg/d,5－7d静脉滴注,继之以利复星400mg/d 4－7d口服,结果：痊愈30例（29．4％）,显效64例（62．7％）,有效率92．1％,细菌清除率88．9％,总疗程9－14d(平均11．8d),药物副作用发生较少（发生率3．92％）,结论：利复星序贯疗法治疗急性下呼吸道常见细菌性感染有效,安全,疗程短。     

克拉屈滨治疗复发毛细胞白血病 1 例并文献复习

目的通过1例经克拉屈滨治疗的复发毛细胞白血病的病例分析,进一步了解毛细胞白血病的治疗策略和方法。方法观察2012年4月我院收治的1例经克拉屈滨治疗的毛细胞白血病复发患者的治疗过程,分析毛细胞白血病的临床特点、治疗方法、治疗效果及不良反应,并复习有关文献。结果此例患者经1个疗程克拉屈滨治疗,3个月后达到部分缓解,随访5个月持续部分缓解。结论克拉屈滨是治疗毛细胞白血病的有效方法,不良反应小,耐受性好,适合在中国毛细胞白血病患者中应用。     

奥沙利铂联合亚叶酸钙与替加氟治疗晚期胃癌的临床观察

目的观察奥沙利铂联合亚叶酸钙及替加氟治疗晚期胃癌的临床疗效与毒副反应。方法25例患者均为晚期胃癌患者,均接受奥沙利铂130mg／m^2,静滴3h,第1天;亚叶酸钙（CF）200mg／（m^2·d）,第1～3天;替加氟500mg／（m^2·d）,第1—3天,每3周为1个疗程,每个患者至少接受2个疗程。结果25例患者均可行毒性及疗效评价,其中完全缓解1例,部分缓解12例,稳定8例,进展4例,总有效率为52％,中位缓解期5．6个月,中位生存期11个月。毒副反应主要为：神经毒性,胃肠道反应,均相对较轻,以Ⅰ～Ⅱ级为主。结论奥沙利铂联合替加氟化疗治疗晚期胃癌可获得较满意的临床疗效,毒副反应可耐受,为有效的治疗方案,值得进一步研究。     

改良序贯疗法与不同四联疗法根除幽门螺杆菌的疗效分析

目的：评价含呋喃唑酮的改良序贯疗法根除幽门螺杆菌（H ．pylori）的疗效和安全性。方法收集 H ．pylori 阳性的非萎缩性胃炎伴糜烂和消化性溃疡患者240例,均分为序贯疗法组（A 组）、伴同疗法组（B 组）、铋剂四联7 d 组（C 组）、铋剂四联10 d 组（D 组）。 A 组：先予雷贝拉唑10 mg ＋阿莫西林1000 mg ,每天2次,5 d ,再予雷贝拉唑10 mg ＋克拉霉素500 mg ＋呋喃唑酮100 mg ,每天2次,5 d ;B 组：雷贝拉唑10 mg ＋阿莫西林1000 mg ＋克拉霉素500 mg ＋呋喃唑酮100 mg ,每天2次,7 d ;C 组：雷贝拉唑10 mg ＋枸椽酸铋钾220 mg ＋阿莫西林1000 mg ＋克拉霉素500mg ,每天2次,7 d ;D 组：方案同 C 组,疗程10 d 。治疗结束停药至少4周后空腹行14C-尿素呼气试验,结果阴性者判为 H ．pylori 根除成功。结果224例患者完成治疗,A 、B 、C 、D 组H ．pylori 根除率按意向性（ITT ）分析分别为88．33％、83．33％、73．33％、81．67％,按方案（PP）分析分别为92．98％、90．90％、78．57％、87．50％。 A 组与 C 组 ITT 和 PP 分析比较差异均有统计学意义（χ2＝4．36、4．83,P＝0．037、0．028）。结论含呋喃唑酮的改良序贯疗法对 H ．pylori 根除率较高,是一种可供选择的一线治疗方案。     

沙利度胺联合DVD方案治疗老年难治性多发性骨髓瘤的疗效观察

目的探讨沙利度胺联合DVD方案（T-DVD）治疗老年难治性多发性骨髓瘤（MM）的临床疗效。方法 40例老年难治性MM给予DVD方案：长春新碱0.4 mg/d,静脉滴注,第1～4天;脂质体阿霉素40 mg/m2,静脉滴注,第1天;地塞米松30mg/d,静脉滴注,第1～4天、第9～12天和第17～20天。28d为1疗程,共3个疗程。沙利度胺起始剂量为100 mg/d,每周增加50 mg/d,最大剂量为200 mg/d,持续12周以上。结果完全缓解6例,部分缓解11例,微小反应4例,无反应14例,疾病进展5例,总有效率为52.50%。治疗相关不良反应为1～2级均可耐受。结论沙利度胺联合DVD方案对老年难治MM患者有效率高、耐受性好及不良反应少等特点,是老年难治性MM患者的理想选择。     

肱骨远端全骺分离

肱骨远端全骺分离在5岁以下儿童中是较常见的肘部损伤,且极易误诊为肱骨髁上骨折或肘关节脱位。本组25例肱骨远端全骺分离均为向内侧移位,年龄11个月至14岁,平均5.6岁,属Salter-HarrisⅠ型或Ⅱ型。对本症骨骺损伤的解剖学和组织学,诸骨(和骨化中心)之间的对应关系以及骨骺损伤的诊治进行了简短的讨论。     

食指背侧皮瓣的临床应用

通过对右手虎口挛缩以及左拇指皮肤剥脱损伤各一例应用直指背侧皮瓣修复的成功经验,提出该手术的适应症和优点,并重点介绍其应用解剖学和手术方法。     

Investigation of hypoglycemic,hypolipidemic and antioxidant activities of aqueous extract of Terminalia paniculata bark in diabetic rats

Objective

To investigate the hypoglycemic, hypolipidemic and antioxidant activities of aqueous extract of Terminalia paniculata bark (AETPB) in streptozotocin (STZ)-induced diabetic rats.

Methods

Acute toxicity was studied in rats after the oral administration of AETPB to determine the dose to assess hypoglycemic activity. In rats, diabetes was induced by injection of STZ (60 mg/kg, i.p.) and diabetes was confirmed 72 h after induction, and then allowed for 14 days to stabilize blood glucose level. In diabetic rats, AETPB was orally given for 28 days and its effect on blood glucose and body weight was determined on a weekly basis. At the end of the experimental day, fasting blood sample was collected to estimate the haemoglobin (Hb), glycosylated haemoglobin (HbA1c), serum creatinine, urea, serum glutamate-pyruvate transaminase (SGPT), serum glutamate-oxaloacetate transaminase (SGOT) and insulin levels. The liver and kidney were collected to determine antioxidants levels in diabetic rats.

Results

Oral administration of AETPB did not exhibit toxicity and death at a dose of 2 000 mg/kg. AETPB treated diabetic rats significantly (P<0.001, P<0.01 and P<0.05) reduced elevated blood glucose, HbA1c, creatinine, urea, SGPT and SGOT levels when compared with diabetic control rats. The body weight, Hb, insulin and total protein levels were significantly (P<0.001, P<0.01 and P<0.05) increased in diabetic rats treated with AETPB compared to diabetic control rats. In diabetic rats, AETPB treatment significantly reversed abnormal status of antioxidants and lipid profile levels towards near normal levels compared to diabetic control rats.

Conclusions

Present study results confirm that AETPB possesses significant hypoglycemic, hypolipidemic and antioxidant activities in diabetic condition.     

Association of smoking,alcohol and NSAIDs use with expression of cag A and cag T genes of Helicobacter pylori in salivary samples of asymptomatic subjects

Objective

To determine the association of smoking, alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs) use with presence and virulence of Helicobacter pylori (H. pylori) infection in a representative sample of a random adult population of asymptomatic subjects.

Methods

Non virulent 16S rRNA and virulent cag A and T genes from salivary samples of 854 asymptomatic subjects were determined using polymerase chain reaction. The presence and absence of virulent and non virulent infection was statistically compared with consumption of smoking, alcohol and NSAIDs.

Results

The prevalence of infection in male and female subjects was found to be 69.25% and 66.90%, respectively. The prevalence of infection in the population of asymptomatic subjects with respect to consumption of alcohol was as follows: current (31.22%), former (52.20%) and never (43.58%). The prevalence of infection in the population of asymptomatic subjects with respect to smoking of cigarettes was as follows: current (88.80%), former (57.14%) and never (33.33%). The prevalence of infection in the subject population consuming NSAIDs and not consuming NSAIDs frequently was found to be 82.75% and 21.16%, respectively. Virulence in male and female subjects was found to be 60.00% and 50.00%, respectively. The presence of virulent infection in the population of asymptomatic subjects with respect to consumption of alcohol was as follows: current (28.57%), former (40.15%) and never (50.00%). The prevalence of virulent infection in the population of asymptomatic subjects with respect to smoking of cigarettes was as follows: current (79.32%), former (75.00%) and never (50.00%). The prevalence of virulent infection in the subject population consuming NSAIDs and not consuming NSAIDs frequently was found to be 88.23% and 66.66%, respectively.

Conclusions

It can be concluded that smoking and NSAIDs consumption are aggravating factors for virulence of H. pylori and alcohol can inhibit H. pylori infection in asymptomatic subjects.     

大肠多发原发性癌:危险因素、诊治和预防(附8例报告)

综述分析1954～84年国内外文献,探讨了大肠多发原发性癌的诊断标准、发病情况、临床表现、发病危险因素、外科处理以及预防和诊断检测技术等问题,强调了大肠腺瘤,遗传基础、免疫缺陷、慢性溃疡性结肠炎等在发病上的作用,及高危险组患者应按方案进行常规检测监护之重要性。述介了大肠多发原发性癌系一种原发性大肠癌多中心发生的形式,在诊治上前者与后者有一致性,亦各有其独特性。报告宁夏医学院附属医院肿瘤科1977～84年收治的8例住院大肠多发原发性癌病例的临床资料,对诊治经过进行了初步总结。     

具有抗细菌黏附和杀菌双重功能的(HA/CHI-Van)5涂层的制备

目的：研究开发一种涂覆(HA/CHI-Van)5多层膜结构的骨科内植入物以用于预防骨内植入物感染。方法：将透明质酸（HA）和壳聚糖-万古霉素（CHI-Van）溶液进行层层自组装,制备得到(HA/CHI-Van)5多层膜结构;通过zeta电位检测组装过程,通过活细菌染色实验评价多层膜的抗细菌黏附效果,通过越狱实验和FE-SEM实验检测体外抗菌效果。SD大鼠随机分为空白组、(HA/CHI-Van)5组和假手术组,并以X线、Micro-CT、骨组织切片等方法检测该材料的体内动物实验效果。结果：每次组装不同的单层,zeta电位交替变化,证明多层膜组装成功。活细菌染色实验显示多层膜结构中的CHI具有一定的抗细菌黏附作用。越狱实验和FE-SEM实验证明(HA/CHI-Van)5多层膜结构在体外具有良好的抗菌作用。在体外实验中,(HA/CHI-Van)5组的X线评分为0.7,而空白组的评分为12.3,(HA/CHI-Van)5组在骨密度、骨小梁数量、骨体积分数、骨组织切片方面均优于空白组（均P＜0.05）,且非常接近假手术组（均P＞0.05）。结论：通过在骨科内植入物表面涂覆(HA/CHI-Van)5多层膜结构能够获得一定的抗细菌黏附功能和良好的抗菌作用,可以预防骨内植入物感染。     

Efficacy and side effects of praziquantel in the treatment of Schistosomiasis mansoni in schoolchildren in Shesha Kekele Elementary School,Wondo Genet,Southern Ethiopia

Objective

To evaluate the efficacy and side effects of praziquantel (PZQ) in the treatment of schistosomiasis in Ethiopia.

Methods

In a cross-sectional study, stool specimens were collected from randomly selected 299 school children in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia, in April 2010. Stool specimens were examined using a single Kato-Katz thick smear for Schistosoma mansoni (S. mansoni) ova. Children who were found positive for S. mansoni were treated with a single oral dose of PZQ at 40 mg/kg bw and interviewed for treatment-related symptoms 24 hours after drug administration. Four weeks post-treatment, stool specimens were collected from the same children and examined following the same procedure as in the pre-treatment. Drug efficacy was determined based on cure and egg reduction rates.

Results

Pre-treatment prevalence of S. mansoni infection was 74.9% with geometric mean egg count of 268. The evaluated generic PZQ produced an overall cure rate of 73.6% (P<0.000 1, OR: 8.33, CI: 5.3–13.1) and egg reduction rate of 68.2% (P=0.03, F=0.64). The cure rate showed significant association with age (χ²=11, P=0.004), the highest rate being observed in the 15–22 age group. 83% of S. mansoni infected children showed various treatment-related symptoms, the most frequent being headache, nausea, and abdominal pain. These symptoms were associated with age (P<0.001) and pre-treatment intensity of infection (P<0.05).

Conclusions

The present observations revealed relatively lower cure and egg reduction rates of the PZQ evaluated as compared to previous reports for other PZQ brands in Ethiopia. Hence, in depth studies are recommended to clarify whether the present relatively lower cure rate is the actual cure rate of the praziquantel evaluated, treatment failure, or reduced susceptibility of the parasite. Treatment-related side effects observed were transient and tolerable.     

NGR修饰唑来膦酸长循环脂质体制备及其表征研究

目的:制备具有肿瘤血管靶向的NGR修饰唑来膦酸长循环脂质体,并对其进行表征研究。方法：采用薄膜分散法制备NGR修饰唑来膦酸长循环脂质体,,并对其进行表征研究,并测定包封率。结果：制备得到的NGR-PEG-ZOL-LPs平均粒径为(271.43±9.23)nm,Zeta电位为-(36.20±0.20)mv,多分散系数(PDI)为(0.15±0.03),理化性质相对稳定;NGR-PEG-ZOL-LPs包封率为8.41%;电镜下显示NGR-PEG-ZOL-LPs呈类圆形,大小分布均匀,无明显聚集。结论：采用薄膜分散法制备的NGR修饰唑来膦酸长循环脂质体具有较高的稳定性,从而为体内药效学研究奠定基础。     

Control of Tetranychus urticae Koch by extracts of three essential oils of chamomile,marjoram and Eucalyptus

Objective

To evaluate the acaricidal activity of extracts of three essential oils of chamomile, marjoram and Eucalyptus against Tetranychus urticae (T. urticae) Koch.

Methods

Extracts of three essential oils of chamomile, marjoram and Eucalyptus with different concentrations (0.5%, 1.0%, 2.0%, 3.0% and 4.0%) were used to control T. urticae Koch.

Results

The results showed that chamomile (Chamomilla recutita) represented the most potent efficient acaricidal agent against Tetranychus followed by marjoram (Marjorana hortensis) and Eucalyptus. The LC₅₀ values of chamomile, marjoram and Eucalyptus for adults were 0.65, 1.84 and 2.18, respectively and for eggs 1.17, 6.26 and 7.33, respectively. Activities of enzymes including glutathione-S-transferase, esterase (α-esterase and β-esterase) and alkaline phosphatase in susceptible mites were determined and activities of enzymes involved in the resistance of acaricides were proved. Protease enzyme was significantly decreased at LC₅₀ of both chamomile and marjoram compared with positive control. Gas chromatography-mass spectrometer (GC-MS) proved that the major compositions of Chamomilla recutita are α-bisabolol oxide A (35.251%), and trans-β-farersene (7.758%), while the main components of Marjorana hortensis are terpinene-4-ol (23.860%), p-cymene (23.404%) and sabinene (10.904%).

Conclusions

It can be concluded that extracts of three essential oils of chamomile, marjoram and Eucalyptus possess acaricidal activity against T. urticae.