他克莫司联合小剂量激素治疗北方IgA肾病临床研究

目的探讨他克莫司联合小剂量激素治疗北方IgA肾病患者的临床效果。方法选择自2008年1月至2010年12月于沈阳军区总医院肾内科住院的59例原发性IgA肾病患者,随机分为3组:单纯小剂量糖皮质激素治疗组(A组),小剂量糖皮质激素联合雷公藤多甙治疗组(B组),小剂量糖皮质激素联合他克莫司治疗组(C组)。观察24个月,对比3组患者治疗的有效性和安全性。结果治疗6个月后,A、B、C组完全缓解率分别为22.2%、5.6%、38.1%,3组间比较差异均有统计学意义(P<0.05);治疗12个月后,A、B、C组完全缓解率分别为27.8%、22.2%、68.4%,3组间比较差异均有统计学意义(P<0.05);治疗24个月后,A、B、C组完全缓解率分别为50%、50%、73.7%,3组间比较差异无统计学意义(P>0.05)。治疗结束时,3组患者尿蛋白水平较本组治疗前均有明显改善(P<0.05),组间比较差异无统计学意义(P>0.05)。与本组治疗前比较,A组和C组治疗后肾小球滤过率有显著改善(P<0.05),而B组治疗前后比较差异无统计学意义(P>0.05)。3组血肌酐、血糖、肝功等指标治疗前后变化无统计学意义(P>0.05)。在1、3、6、9、12、18、24个月时,他克莫司血药浓度分别为(1.75±1.81)μg/L、(1.82±1.54)μg/L、(1.97±2.48)μg/L、(1.81±1.81)μg/L、(1.69±1.38)μg/L、(1.10±1.31)μg/L、(1.34±1.47)μg/L。3组间不良事件发生率比较,差异无统计学意义(P>0.05)。结论 3种治疗方案对IgA肾病患者均有显著治疗效果,其中,激素联合他克莫司治疗组起效更快,总缓解率更高。而且,当他克莫司的血药浓度低于2.00μg/L时,其仍有良好的治疗效果。     

肾移植术后肝肾功能损害患者应用他克莫司切换环孢素的临床观察

目的观察他克莫司切换环孢素A治疗肾移植术后肝、肾功能损害患者的安全性及临床疗效。方法将33例肾移植术后肝、肾功能异常的患者分为4组：术后直接使用他克莫司组（Ⅰ组,8例）;术后1年内切换他克莫司组（Ⅱ组,9例）;术后2～4年切换他克莫司组（Ⅲ组,9例）;术后5年以上切换他克莫司组（Ⅳ组,7例）。观察用他克莫司替换环孢素A12、24个月后各组患者肝、肾功能的变化情况。结果肾移植术后1年内切换他克莫司的患者,切换12个月时血肌酐由切换前的（133.21±40.92）μmol·L-1降至（116.86±35.41）μmol·L-1,呈明显下降趋势,但差异无统计学意义;移植术后2～4年切换他克莫司的患者,切换24个月时,患者的血肌酐由（138.00±15.72）μmol·L-1降至（109.76±9.68）μmol·L-1,下降较显著（P〈0.05）,差异有统计学意义;术后5年以上切换他克莫司患者,切换12个月时,血肌酐变化不大,差异无统计学意义。结论用他克莫司替换环孢素A治疗肾移植术后肝、肾功能损害是一种安全而有效的措施。     

瑞格列奈治疗肾移植后糖尿病的疗效和安全性

 目的 探讨瑞格列奈治疗肾移植后糖尿病(post-transplantation diabetes mellitus, PTDM)的疗效和安全性。方法 收集2012-01至2014-06在我院确诊为肾PTDM并接受瑞格列奈治疗6个月的患者,观察治疗前和治疗后 1、3、6个月空腹血糖、餐后2 h血糖、糖化血红蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、总胆红素、直接胆红素、白蛋白、总蛋白、肌酐、尿素氮、尿酸水平和他克莫司浓度。结果 共纳入病例32例,22例单用瑞格列奈即能达到满意疗效,剩余10例单用瑞格列奈血糖控制欠佳,采用瑞格列奈加甘精胰岛素血糖控制满意。治疗后 1、3、6个月时的空腹血糖,餐后2 h血糖较治疗前均明显降低,差异有统计学意义(P＜0.05);治疗6个月时糖化血红蛋白(6.20%±0.3%)水平较治疗前(7.50%±0.63%)明显降低(P＜0.05);治疗前后肝肾功能各项指标和他克莫司浓度变化无统计学意义;治疗过程中发生6人次低血糖反应,最低血糖为3.7 mmol/L,无严重低血糖发生。结论 瑞格列奈可作为肾PTDM患者一种安全有效的降糖药物。     

对他克莫司软膏联合308nm准分子激光治疗白癜风护理干预的疗效研究

目的探讨对他克莫司软膏联合308 nm准分子激光治疗白癜风患者进行护理干预的疗效。方法选取2012年9月至2014年9月,白癜风患者100例,随机分为观察组和对照组各50例,对照组采用他克莫司软膏联合308 nm准分子激光的照射治疗;观察组在对照组的基础上加以护理干预。治疗6个月后通过随访收集患者的恢复情况,通过统一的疗效评定标准进行疗效的评估和患者对治疗的满意度的比较。结果观察组总有效率(98.0%)明显高于对照组(86.0%),差异具有统计学意义(P0.05);观察组患者对治疗效果的满意度(96.0%)明显优于对照组(82.%),差异具有统计学意义(P0.05)。结论应用他克莫司软膏联合308 nm准分子激光并加以适当的护理干预对促进白癜风患者的康复具有重要作用,明显提高康复率和患者对治疗的满意度,值得临床借鉴和推广应用。     

他克莫司与环孢霉素治疗单纯性V型狼疮性肾炎的疗效比较

目的比较他克莫司(Tacrolimus,TL)与环孢霉素(Cyclosporine,CsA)联合激素治疗单纯性V型狼疮性肾炎的疗效及安全性。方法选择本院确诊为V型狼疮性肾炎的35例患者,比较同期激素联合TL[0.07～0.08mg/(kg.d),n=17例]与激素联合CsA[3～5mg/(kg.d),n=18例]治疗6个月的疗效。主要观察治疗前后SLE-DAI、尿蛋白、血清白蛋白、血清补体C3、anti-dsDNA和ANA阳性率的变化,以及治疗前后的完全缓解率、部分缓解率。结果CsA或TL治疗后,治疗指标均出现明显的改善,其中,6个月治疗效果更为明显。治疗3个月TL组与CsA组有效率分别为77.7%和58.8%,经比较两组差异无统计学意义(P>0.05),但是,3个月TL治疗组在降低SLE-DAI、24h蛋白尿和增加血清白蛋白方面疗效比CsA组更明显(P<0.05)。治疗6个月TL组有效率及治疗指标的改善均较好于CsA组,但差异无统计学意义(P>0.05)。TL组无严重副作用出现。结论TL联合激素治疗单纯性V型狼疮性肾炎是有效和安全的。与CsA相比,TL可迅速缓解单纯性V型狼疮性肾炎患者蛋白尿和LN狼疮的活动。     

自体骨髓干细胞联合脐血单个核细胞移植治疗胸段慢性脊损伤27例报告

目的观察自体骨髓干细胞联合脐血单个核细胞移植治疗胸段慢性脊髓损伤的效果。方法选择接受自体骨髓干细胞联合脐血单个核细胞移植治疗的胸段慢性脊髓损伤患者27例,每位患者均接受4次干细胞悬液注射治疗,每周1次。收集患者治疗前(基线)及治疗后6周、6个月时的最低正常功能平面,ASIA残损分级,ASIA运动感觉评分,ASIA模拟视觉评分,Ashworth评分等资料并进行比较,评价治疗效果。结果治疗后6个月,6例患者左、右侧感觉最低正常功能平面出现下降(1或2个平面),5例患者两侧运动最低正常功能平面出现下降(下降1个平面2例,2个平面1例,10个平面1例,11个平面1例)。治疗后6周,ASIA残损分级由A级变为B级4例,由A级变为C级1例,由B级变为C级1例,ASIA残损分级变化率为22.2%(6/27);治疗后6个月随访时,ASIA残损分级由A级变为B级1例,ASIA分级总的变化率为25.9%(7/27)。治疗后6周、6个月时ASIA下肢运动评分分别为1.7±2.9、3.1±3.6,明显高于治疗前(0.5±1.5,P<0.05)。治疗后6周、6个月时ASIA感觉(轻触)评分分别为68.8±14.4、70.5±14.4,ASIA感觉(针刺)评分分别为68.4±14.7、70.2±14.4,均明显高于治疗前(分别为66.6±13.7、67.0±13.6,P<0.05)。治疗前改良Ashworth量表评分为1.8±1.5,与治疗后6周(1.6±1.2)比较无明显差异,但明显高于治疗后6个月(1.1±0.8,P<0.05)。结论自体骨髓干细胞联合脐血单个核细胞移植能从一定程度上改善胸段慢性脊髓损伤患者ASIA残损分级和运动感觉功能,并可部分促进慢性脊髓损伤的恢复。     

玉屏风颗粒联合他克莫司胶囊治疗原发性肾病综合征患儿的临床效果和对免疫功能的影响分析

目的 分析玉屏风颗粒联合他克莫司胶囊在原发性肾病综合征患儿的价值。方法 于2020年06月～2022年08月在我院采集病例展开研究,以严格按照纳排标准筛选后的86例门诊原发性肾病综合征患儿为研究对象,将入组的年龄4～15岁、病程3～14个月、肝肾阴虚型的86例患儿按随机数字表法分为联合组与单一组,各43例。单一组采用他克莫司胶囊,联合组采用玉屏风颗粒联合他克莫司胶囊。对比2组疗效、体液免疫功能[免疫球蛋白G(Immunoglobulin G,IgG)、免疫球蛋白A(Immunoglobulin A,IgA)]、T淋巴细胞亚群(CD3⁺、CD4⁺、CD8⁺)、炎症因子水平[白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-10(Interleukin-10,IL-10)]、不良反应发生率、复发率。结果 联合组总有效率93.02%(40/43)较单一组72.09%(31/43)高(P<0.05)。治疗后,联合组IgG、IgA较单一组高(P<0.05)。治疗后,联合组CD3⁺...     

他克莫司致药物不良反应发生影响因素分析及风险预测列线图模型构建

目的 分析他克莫司致药物不良反应(ADR)发生的影响因素,并构建风险预测列线图模型。方法 回顾性分析阜阳市人民医院自2017年1月至2021年6月收治的移植术后服用他克莫司的288例患者的临床资料。患者均随访12个月,以发生ADR为随访结局,以是否发生ADR将患者分为ADR组和非ADR组。分析患者的临床资料,采用Logistic回归分析探讨他克莫司发生ADR的影响因素,再根据影响因素建立列线图模型并进行拟合优度检验。结果 288例患者中,58例(20.14%)发生ADR(ADR组),230例(79.86%)未发生ADR(非ADR组)。男性、年龄>60岁、血药浓度>15 ng/ml、联合用药>3种、有过敏史、空腹血糖>7 mmol/L、总胆红素>20μmol/L、血肌酐>133μmol/L是他克莫司致ADR发生的影响因素(P<0.05)。列线图模型验证C-index为0.851,校正曲线与理想曲线走势基本一致;受试者工作特征曲线下面积为0.824;决策曲线显示阈值概率在3%～62%范围内时模型净获益值较高。结论 男性、年龄>60岁、血药浓度...     

经皮椎体成形术联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤北大核心CSCD

目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤的安全性和有效性。方法回顾性分析2019年6月至2021年6月在河南科技大学第一附属医院介入科接受治疗的55例患者75节病变椎体。采用随机数字化法将患者分为两组,25例患者40节病变椎体接受PVP联合^(125)I粒子组织间置入术(联合组),30例患者35节病变椎体接受PVP(单一组)。使用视觉模拟量表(visual analogue scale,VAS)、卡氏评分(Karnofsky performance score,KPS)评估疼痛程度及体力状况。CT评估骨水泥分布及渗漏,MRI评估肿瘤控制情况,记录两组骨水泥数量及^(125)I粒子数目,Kaplan-Meier法分析两组患者生存情况。结果手术成功率是100%,联合组VAS评分由术前(8.25±0.31)分降至术后12个月(3.27±0.83)分,单一组VAS评分由术前(8.53±0.21)分降至术后12个月(3.98±0.69)分,联合组与单一组术后1、3、6、12个月VAS评分比较差异均有统计学意义(均P<0.05)。联合组KPS由(43.46±9.66)分升至术后12个月(90.05±2.06)分,单一组KPS由(41.15±8.36)分升至术后12个月(84.05±1.56)分。联合组与单一组术后1个月KPS差异无统计学意义(P=0.983),术后3、6、12个月KPS比较差异有统计学意义(均P<0.05)。联合组每个椎体骨水泥注射量为(2.8±0.6)mL,粒子植入量为(15±2)粒,单一组骨水泥注射量为(3.1±0.3)mL。联合组和单一组骨水泥渗漏发生率为42.5%和53.5%,单一组骨水泥漏入椎管1例,无相应症状发生。术后随访联合组肿瘤控制有效率与单一组比较差异有统计学意义(均P<0.05)。两组生存方面差异无统计学意义(P=0.324)。结论PVP联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤安全可靠,较单纯PVP更能明显缓解疼痛、控制肿瘤生长。在延长生存时间方面无明显区别。     

射频热凝术和球囊压迫术治疗眼支三叉神经痛的疗效对比

目的 探讨射频热凝术(PRT)和球囊压迫术(PBC)治疗眼支三叉神经痛(TN)的疗效和安全性。方法 回顾性分析2017年11月至2021年7月收治的46例原发性眼支TN患者的临床资料，接受PRT治疗26例(射频组),接受PBC治疗20例(球囊组)。比较两组患者术前、术后3天、3个月疼痛数字评分(NRS)变化并评估安全性。结果 射频组术前、术后3天、3个月NRS评分分别为(6.96±0.66)分、(0.54±0.51)分、(1.58±1.64)分，球囊组术前、术后3天、3个月NRS评分分别为(6.85±0.59)分、(0.15±0.37)分、(0.65±0.75)分。两组患者术后3天、3个月NRS评分均较术前明显下降(P<0.001),射频组术后NRS评分均显著高于球囊组(3天，P=0.006;3个月，P<0.001)。射频组术后出现角膜麻痹2例，余无严重并发症发生。结论 对于眼支TN患者，PBC较PRT疗效更为显著、安全性更高。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.