Pneumonia - pathogen-based or constellation-based therapy?

Community-acquired pneumonia is one of the most frequent infectious diseases with high morbidity and mortality. Early and sufficient antibiotic treatment is crucial for the prognosis of the patient. The underlying pathogens are mostly unknown at the onset of symptoms. The choice of antibiotic treatment depends on the suspected pathogens, derived from the typical germs and the typical resistances in a certain area. In addition, individual risk factors, such as age, severity of the diseases, comorbidities, and previous antibiotic treatment have a major impact on the probability of dying for an individual patient. These factors must be considered at the beginning of any treatment. Pathogen-based treatment has to be switched to constellation-based treatment.     

Gene therapy

2005147 CNHK200-hA-a gene-viral therapeutic system and its antitumor effect on lung cancer. WANG Wei-guo(王伟国),et al. Viral & Gene Ther Center, Eastern Hepatobilli Surg Instit 2nd Milit Univ, Shanghai 200438. Chin J Oncol,2005:27(2):69-72. Objective: To develop a novel vector system, which combines the advantages of the gene therapy,     

Observationson the therapeutic effects of γ - ray three dimensional conformal radiation therapy combined with inter ventional therapy or x- ray three dimensional conformal radiation therapy combined with interventional therapy in patients with primary hepatocellular carcinoma

目的 比较肝动脉介入栓塞化疗(TACE)联合伽玛刀治疗与TACE联合三维适形放射治疗原发性肝癌(HCC)的疗效.方法 将50例不能手术的Ⅱa或Ⅱb期HCC患者根据患者意愿和适应证分为TACE+伽玛刀治疗组(A组)25例与TACE+三维适形放射治疗组(B组)25例,两组一般情况无统计学差异.A组先行TACE(40％碘化油+CPDD+5- FU+ EADM)治疗2～3次后,再进行体部伽玛刀放射治疗.B组先行2～3次TACE治疗后,再行加速器适形放射治疗.结果 治疗后3个月评价疗效,A组RR率(CR+PR)为84％(21/25),1、2、3年生存率分别为76％,45.9％,20.44％.B组的RR率为56％ (14/25),与A组比较差异有统计学意义(P＜0.05),B组1、2、3年生存率分别为79.6％,30.2％,12.6％,与A组比较差异无统计学意义(P＞0.05).结论 与TACE联合适形放射治疗相比,TACE联合伽玛刀治疗HCC具有较高的近期有效率,而两种治疗的1、2、3年生存期差异无统计学意义.     

Effective lovastatin therapy in elderly hypercholesterolemic patients - an antioxidative impact?

The effect of 3 months lovastatin therapy on serum lipids, apolipoproteins, alpha-tocopherol and red cell membrane fatty acid pattern was assessed in twelve elderly ambulatory patients (mean age 70.9+/-8.0 years) with hypercholesterolemia type IIa according to Fredrickson. After a run-in period of 4 weeks without drug therapy, the patients were given a daily dose of 20 mg lovastatin. The treatment resulted in statistically significant decreases in mean serum low density lipoprotein cholesterol (LDL-CH, -34%), in the atherogenic index LDL-CH/HDL-CH (-35%) and in the concentration of apolipoprotein B (-26%). No change in the vitamin E status, as related to plasma total lipids, was observed during the 3 months of therapy. The fatty acid pattern of phospholipids from red cell membranes showed an increase in linoleic acid metabolites and a decrease in the precursor linoleic acid, indicating an induction of fatty acid desaturases by lovastatin. In addition, an increase in the plasmalogen portion of erythrocyte membrane phospholipids was exhibited by increases in the proportion of fatty aldehyde dimethyl acetals (DMA) in the fatty acid pattern. The plasmalogens increase may counteract the slow but consistent decrease in their concentration in red cell membranes and human aortas with increasing donor age and in arteriosclerosis. Since plasmalogens may function as physiological antioxidants, the observed increase in DMA concentration might reflect a previously unrecognized antioxidative principle of a lovastatin therapy.     

Mitochondrial DNA gene therapy: a gene therapy for aging?

Mutations in mitochondrial DNA cause a group of diverse diseases that affect an estimated half a million people worldwide. These disorders are remarkably resistant to conventional treatments, and thus several gene therapy approaches are being explored. As some of these approaches develop towards maturity, one can't help thinking that some day they may be used against a much more common health problem currently affecting about 6 billion people- aging, which also has been quite resistant to treatment. Unfortunately, we still do not know whether mtDNA mutations significantly contribute to the aging process or not. The prospect of success in mtDNA gene therapy makes getting the answer a high priority.     

Morphological and immunological changes of hairy cell leukemia during α-2-interferon therapy

Summary We describe a patient who presented with the clinical picture of hairy cell leukemia (HCL). Bone marrow and peripheral blood lymphoma cells showed morphological and immunological features of HCL. Under recombinant -2-interferon (-2-IF) therapy the characteristic morphology changed from HCL to prolymphocytic leukemia (PLL). At diagnosis the lymphoma cells expressed CD24 and FMC7 surface antigen, but stained negative for surface immunoglobulins, light chains and anti-CD5. During -2-IF treatment surface antigen expression changed to CD24, CD5 and FMC7. Surface IgD and lambda light chains became strongly positive. Southern Blot analysis of peripheral blood mononuclear cells showed two rearranged immunoglobulin bands at diagnosis but only one upon -2-IF therapy. These data suggest, that this patient suffered from a biclonal lymphoma, HCL and PLL. While undergoing -2-IF treatment the HCL came into remission, whereas the PLL clone proved to be poorly sensitive to -2-IF therapy.     

Drug therapy for ulcerative colitis

Ulcerative colitis (UC) is an inflammatory destructive diseaseof the large intestine occurred usually in the rectum andlower part of the colon as well as the entire colon.Drugtherapy is not the only choice for UC treatment and medicalmanagement should be as a comprehensive whole.Azulfidine,Asacol,Pentasa,Dipentum,and Rowasa allcontain 5-aminosalicylic acid (5-ASA),which is the topicalanti-inflammatory ingredient.Pentasa is more commonlyused in treating Crohn's ileitis because Pentasa capsulesrelease more 5-ASA into the small intestine than Asacoltablets.Pentasa can also be used for treating mild tomoderate UC.Rowasa enemas are safe and effective intreating ulcerative proctitis and proctosigmoiditis.The sulfa-free 5-ASA agents (Asacol,Pentasa,Dipentum andRowasa) have fewer side effects than sulfa-containingAzulfidine.In UC patients with moderate to severe diseaseand in patients who failed to respond to 5-ASA compounds,systemic (oral) corticosteroids should be used.Systemiccorticosteroids (prednisone,prednisolone,cortisone,etc.)are potent and fast-acting drugs for treating UC,Crohn'sileitis and ileocolitis.Systemic corticosteroids are noteffective in maintaining remission in patients with UC.Serious side effects can result from prolonged corticosteroidtreatment.To minimize side effects,corticosteroids shouldbe gradually reduced as soon as the disease remission isachieved.In patients with corticosteroid-dependent orunresponsive to corticosteroid treatment,surgery orirnmunomodulator is considered.Irnmunomodulatorsused for treating severe UC include azathioprine/6-MP,methotrexate,and cyclosporine.Integrated traditionalChinese and Western medicine is safe and effective inmaintaining remission in patients with UC.     

Cardiac resynchronization therapy in China

Congestive heart failure (HF) is a major and growing public health problem.The therapeutic approach includes non-pharmacological measures,pharmacological therapy, mechanical devices,and surgery.Despite the benefits of optimal pharmacologic therapy,the prognosis is still not ideal.At this time,cardiac resynchronization therapy (CRT) has gained wide acceptance as an alternative treatment for HF patients with conduction delay. As an innovative,pacemaker-based approach to the treatment of patients with HF,CRT uses a three-lead