Application of immunosuppressant facilitates the therapy of optic neuritis combined with Sjögren’s syndrome

Keywords:optic neuritis; Sjögren’s syndrome; magnetic resonance imaging; immunosuppressant; remedy

Background Optic neuritis (ON) is often the first symptom of multiple sclerosis (MS) and neuromyelitis optica (NMO) while there has been very little research reported on ON combined with Sjögren’s syndrome (SS). The aim of this study is to provide different treatments and services for and NMO patients combined with SS.

Methods Twenty-seven patients with ON combined SS were divided into two groups: corticosteroid group (C group, methylprednisolone sodium succinate, 14 patients) and corticosteroid+ immunosuppressant group (C+I group, leflunomide, 13 patients). ON relapse times in 1 year after treatment, number of patients who relapsed to NMO/MS in 1 years, visual acuity and retina nerve fiber layer (RNFL) thickness were measured. Mann Whitney-Wilcoxon test was used to compare continuous variables and Chi-square test or Fisher’s exact test was to compare proportions.

Results ON combined with SS patients had higher incidence rates in middle-aged women who have binocular damage and heavier visual function damage or when there is an easy relapse, and the patients are often hormone dependent. The patients are more likely anti-aquaporin-4 IgG seropositive (70.4%). They are liable to form a centrocecal scotoma and tubular vision. The times of relapse decreased in patients who used immunosuppressant, and a significant difference was found between immunosuppressant and non-immunosuppressant groups in visual acuity recovery during 6-month follow-up period (P <0.05); however, the RNFL thickness at the four quadrants was not significantly different.

Conclusions The effect of immunosuppressant plus corticosteroid on the early onset of ON combined with SS was to provide ON remedy and to prevent recurrence in clinics. This study provides a significant reference for the prevention and treatment of ON on the basis of immunosuppressant and corticosteroid.

     

Dan Zhi Xiao Yao Yin Combined With Auricular-Point-Pressing for Treatment of Optic Atrophy-A Clinical Observation of 51 Cases

To evaluate the therapeutic effect of Dan Zhi Xiao Yao Yin (丹栀消遥饮 Decoction of Moutan Bark and Capejasmine) combined with auricular-point- pressing therapy for treatment of optic atrophy. The visual acuity and visual field was observed in the 51 cases (58 eyes) from the treatment group that were treated with Dan Zhi Xiao Yao Yin combined with auricular-point-pressing therapy and the 43 cases (49 eyes)from the control group that were treated with routine western drugs at the end of the trial (60 days). The effective rates of increase in visual acuity obtained in the treatment and the control groups were 79.3% and 44.89% respectively and enlargement in visual field were 61.9% and 22.6% respectively. Statistical analysis showed that there were significant differences between two groups (P＜0.05). The therapeutic effect of Dan Zhi Xiao Yao Yin combined with auricular-point -pressing therapy in increasing the visual acuity and enlarging the visual field was superior to that of the routine western drugs.     

视神经炎患者血清胆红素水平

Background Bilirubin is the end product of heme catabolism and has strong antioxidant properties. Serum bilirubin levels are reported to be reduced in patients with multiple sclerosis （MS） and neuromyelitis optica （NMO）. The pathophysiology of optic neuritis （ON） resembles that of MS; however, the role of endogenous bilirubin in ON is unclear. The aim of this study is to measure serum bilirubin levels in patients with ON, and to investigate the correlation between ON and serum antioxidant status of bilirubin. Methods Serum levels of bilirubin were measured in 42 patients with ON, 50 patients with multiple sclerosis （MS）, 48 patients with neuromyelitis optica （NMO） and 48 healthy control subjects. Results Serum total bilirubin （Tbil）, direct bilirubin （Dbil） and indirect bilirubin （Ibil） levels in patients with ON were significantly lower than those in the healthy controls. However, no statistical significance was found between levels in the ON and MS, ON and NMO, and MS and NMO groups. In patients with ON, serum Tbil, Dbil, and Ibil levels were lower in those with recurrence or those with ON for a longer duration （〉1 year）. Moreover, Tbil, Dbil, and Ibil concentrations were lower in patients with papillitis than in those with retrobulbar type ON, but the differences were not statistically significant. Conclusions Low antioxidant status may exist in patients with ON. But serum levels of Tbil, Dbil, and Ibil did not correlate with clinical presentations, such as recurrence, duration of disease and subtypes of ON. Low antioxidant status already existed in MS or NMO patients before systemic symptoms appeared.     

Clinical observation on the efficacy of Xiaoshui decoction (消水方) combined with intrapleural perfusion of cisplatin in treating malignant pleural effusion

Objective： To observe the clinical efficacy of Xiaoshui decoction （XSD,消水方） combined with intrapleural perfusion of cisplatin in the treatment of malignant pleural effusion. Methods： Fifty-one patients with malignant pleural effusion were randomly assigned to two groups. The treated group patients） received oral administration of XSD combined with intrapleural perfusion of cisplatin, and control group （25 patients） was only treated with intrapleural perfusion of cisplatin. The effects of 26 he he short-term efficacy, quality of life scores and clinical symptom scores of malignant pleural effusion were evaluated. Results： The short-term efficacy in the treated group and the control group was 72.0% and 58.3%, respectively, and no significant difference was found （P〉0.05）. In contrast, the quality of life in the treated group was significantly improved compared to that of the control group （P〈0.05）, and so was the symptom remission （P〈0.05）. Conclusions： The combined therapy of XSD and intrapleural perfusion of cisplatin did not show obvious improvement in short-term efficacy, but the therapy remarkably alleviated the symptoms and improved the quality of life of patients.     

Analysis on Reverse of Atypical Endometrial Hyperplasia by Drugs in Patients with Polycystic Ovary Syndrome

Objective To analyze the efficacy and safety of drugs on reverse of atypical endometrial hyperplasia in patients with polycystic ovary syndrome （PCOS）. Methods Seventeen patients with PCOS complicated by atypical endometrial hyperplasia （9 patients who were treated with progestin but not reversed were considered as group A; 8 patients who were untreated were considered as group B） were retrospectively analyzed Both groups received oral glucose tolerance test （OGTT） and insulin release test, to check whether the patients had insulin resistance （IR） or hyperinsulinemia. The 17 patients were treated with oral contraceptives combined with metformin. Results After the 17 patients with PCOS complicated by IR and hyperinsulinemia received drug treatment for 3 -6 cycles, atypical endometrial hyperplasia was success- fully reversed Conclusion Oral contraceptives combined with metformin is a clinically practical and effective method for treatment of PCOS complicated by atypical insulin-resistant endometrial hyperplasia.     

Comparison of higher-order aberrations and contrast sensitivity between Tecnis Z9001 and CeeOn 911A intraocular lenses: a prospective randomized study

Background The advent of wavefront technology in the past five years has provided some insight into the optical outcomes of cataract surgery. The Tecnis Z9001 intraocular lens （Tecnis IOL, AMO） with a modified prolate anterior surface was claimed to reduce or even eliminate ocular spherical aberration to improve the visual quality. The purpose of this study was to determine whether Tecnis IOLs can improve the quality of vision as evaluated by measuring visual acuity, wavefront aberration, and contrast sensitivity. Methods In an intraindividual prospective study, 20 patients with bilateral cataract were randomly assigned to receive a modified prolate anterior surface IOL （Tecnis Z9001, AMO） in one eye and a biconvex spherical surface IOL （CeeOn 911A, AMO） in the other. After 3 months, the following were investigated： best corrected visual acuity, pupil diameter, photopic and mesopic contrast sensitivity, and wavefront aberration of the whole eye （ocular）, cornea, and internal plane. Results The differences in the best corrected visual acuity and pupil diameter between the two groups were not statistically significant. Negative 4th-order spherical aberration （Z4^0） was found in the Tecnis group, whereas positive Z4^0 found in the CeeOn group for the internal and ocular plane. Statistically significant differences were found at the ocular higher-aberrations between the two IOLs. Contrast sensitivity testing showed significantly better results in the Tecnis group at visual angles higher than 1.0 degree under photopic conditions and at visual angles higher than 1.6 degree under mesopic conditions both without glare and with glare in comparison with the CeeOn group. Conclusions The Tecnis Z9001 IOL with a modified prolate anterior surface produces negative spherical aberration and consequently reduces the higher-order aberrations in pseudophakic eyes. This leads to enhanced contrast sensitivity and improved functional vision compared to conventional spherical IOLs.     

Fcγ receptor IIIA polymorphisms and efficacy of rituximab therapy on Chinese diffuse large B-cell lymphoma

Background Rituximab is used extensively in combination with chemotherapy to cure non-Hodgkin＇s lymphoma （NHL）, and not only accelerates short-term improvement, but also prolongs patient survival and decreases relapse. The aim of this study was to evaluate the impact of Fcγ receptor IliA （FcyRIIIA） gene polymorphisms on the response to rituximab therapy for newly diagnosed B-cell lymphomas. Methods Patients with newly diagnosed histologically-proven CD20-positive B-cell lymphoma were eligible for the study. All of the patients received rituximab combined with chemotherapy （CHOP）. The FcyRIIIA type was analyzed by PCR. The initial efficacy was assessed after 6 cycles and the long-term survival was determined. Results Thirty-four patients were recruited between October 2005 and April 2006. The FcyRIIIA distribution was as follows： 11 patients were VV, 5 were FF, and 18 were VE After a median of 6 cycles （range 4-8） of rituximab combined chemotherapy, the overall response rate was 79% （82% in the VV group, 83% in the VF group, and 60% in the FF group; P=0.04）. After a median follow-up time of 37 months （range 34-41）, there were 12 relapses among 27 responders （44%）; 5 of 9 patients （5/9） in the VV group, 5 of 15 patients （33%） in the VF group, and 2 of 3 patients （2/3） in the FF group （P=0.21）. The 1-year overall survival in the VV, FF, and VF groups was 80%, 60%, and 80%, respectively, and the 3-year overall survival was 58%, 40%, and 69%, respectively （P=0.08）. After analysis by COX regression, only the international prognosis index and response to initial treatment were significantly related to overall survival. Conclusions The distribution of FcyRIIIA polymorphisms in this B-cell lymphoma population shows that VF is most frequently expressed, followed by VV and FE Patients with the FcyRIIIA VV and VF types are more sensitive to the initial treatment of rituximab combined with chemotherapy and have superior long-term survival compared with those with FF. Nevertheless, FcyRIIIA polymorphisms do not predict prognosis independently.     

Evaluation of Effectiveness of Integrated Intervention Program in Improving Drug Addicts＇ Psychological Health

Objective To investigate the social mental state of drug addicts in a compulsive drug abuse treatment center; evaluate the effectiveness of integrated program for the prevention of abuse relapse and improvement of drug addicts＇ psychological health. Methods The study subjects were addicts from the Wuhan Compulsive Drug Abuse Treatment Center between October 2003 and June 2004, who satisfied the inclusion criteria. A non-randomized control-intervention study design was adopted. Volunteers willing to take part in intervention were put into the intervention group with their full awareness and willingness to prevent drug abuse relapse. The control group was composed of the addicts who were willing to prevent relapse and to be followed up after their discharge. Results The effectiveness of the integrated intervention program in promoting addicts＇ psychological health： before the intervention, the scores of Self-Rating Anxiety Scale （SAS）, the positive and negative dimensionalities of Simple Coping Style Questionnaire （SCSQ） and Chinese Perceived Stress Scales （CPSS） had no significant differences between the intervention group and the control group. After the intervention, except that the SCSQ＇s positive dimensionality in the intervention group was significantly higher than that in the control group, other indices in the intervention group were lower. Before and after the intervention, the psychological health level in both the groups was lower than that in the normal population; there were significant differences between addicts and normal subjects in regards with all of the indices above. Conclusion Drug abuse was associated closely with addicts＇ social mental factors. The integrated intervention program can alleviate anxiety and stress, reduce co-morbid mental disorders and effectively improve their coping style. In conclusion, the program can promote addicts＇ psychological health significantly.     

A Comparative Assessment of the Efficacy of Carbomer Gel and Carboxymethyl Cellulose Containing Artificial Tears in Dry Eyes

The present study aimed to compare the clinical efficacy of a 0.4% carbomer gel and 1% carboxymethyl cellulose （CMC） containing artificial tears in treatment of dry eye patients. Sixty subjects with mean age of 45.89 years who had symptoms and signs of dry eye were enrolled in this prospective, investigator-masked and stratified random sampling study. The subjects were divided into two parallel groups with 30 subjects （60 eyes） in each group. One group received carbomer gel, and the other group received 1% CMC containing artificial tears. Subjects received the drops 3 to 4 times or more per day for 3 months. At the first visit time, the precorneal residence time of these two drops was measured. The efficacy was assessed by comparing the subjective symptoms （ocular dry- ness, foreign body sensation, burning sensation and pain）, and the objective test results of tears breakup time, Schirmer＇s test and corneal fluorescein staining prior to the study and after the treat- ment. As a result, the ocular residence time of carbomer gel was significantly longer than that of 1% CMC （P〈0.001）. Most of the primary subjective symptoms and objective test results were improved after treatment in both carbomer gel group and 1% CMC group. As to the improvement of each symptom and objective test result, carbomer gel was more effective than 1% CMC group （P〈0.01）. In conclusion, carbomer gel had longer precorneal residence time and was more effective than 1% CMC in the treatment of patients with dry eyes.     

Immediate or delayed repair of pelvic fracture urethral disruption defects in young boys: twenty years of comparative experience

Background The treatment of the patient with pelvic fracture urethral disruption defects （PFUDD） remains controversial especially in pediatric urology. Debate continues in regarding the advisability of immediate repair versus delayed repair. The aim of this study was to analyze our experience in the outcomes of immediate and delayed repair of pelvic fracture urethral distraction defects in young boys. Methods We retrospectively reviewed the records of 210 boys with posterior urethral disruption after pelvic injury between 1992 and 2012. Exclude partial urethral injury, a total of 177 cases acquired follow-up. All patients were evaluated by plain radiography, ultrasonography, or a computed tomography scan to assess the conditions of the upper urinary tract and to exclude other severe injuries. Data on 35 patients who underwent immediate repair were compared to those on 142 treated with delayed urethroplasty. After the diagnosis of a complete urethral injury, the immediate repair group underwent urethroplasty via the perineal approach if the patient＇s condition was stable, and serious complications were treated. The delayed repair group patients with the delayed urethroplasty average 6 months after injury. All patients were evaluated postoperatively for urethral strictures, incontinence and impotence. The patients were assessed by uroflowmetry and renal ultrasonography with evaluation of the postmictional residue every 3 months during the first year of follow-up. We assessed incontinence and erectile function by questioning the parents or the children themselves. Statistical analysis with the chi-square test was performed using SPSS software. Results One hundred and seventy-seven patients were followed up with an average 58 months （range 6 to 192 months）. Strictures developed in 3 （9%） patients in immediate repair group; two recluired direct visual internal urethrotomy （DVIU）, the other patient required dilatation. Strictures developed in 11.9% of the delayed repair group, 17 patients need visual     

Cohort Study on the Effect of a Combined Treatment of Traditional Chinese Medicine and Western Medicine on the Relapse and Metastasis of 222 Patients with Stage Ⅱ and Ⅲ Colorectal Cancer after Radical Operation

Objective:To evaluate the effectiveness of a comprehensive therapy of traditional Chinese medicine(TCM)in reducing the relapse and metastasis of stageⅡandⅢcolorectal cancer based on conventional Western medicine(WM)therapy.Methods:Two hundred and twenty-two patients in total, diagnosed as stageⅡandⅢcolorectal cancer from February 2000 to March 2006,were recruited from Xiyuan Hospital,China Academy of Chinese Medical Sciences and the General Hospital of Beijing Military Area.They were followed-up once every 3-6 months.Twenty cases dropped out from the cohort.The remaining 202 patients were all treated with routine WM treatment [including R0 radical operation,or chemotherapy or/and radiotherapy according to national comprehensive cancer network(NCCN)clinical guidelines].These patients were assigned to two groups based on whether or not they were additionally treated with TCM comprehensive therapy(orally administered with a decoction according to syndrome differentiation,combined with a traditional patent drug over one year).Ninety-eight patients from Xiyuan Hospital were treated with WM and TCM(combined group),and 104 patients from the General Hospital of Beijing Military Area were treated with WM alone(WM group).The demographic data at baseline were comparable,including the operation times,age,sex,TNM staging,and pathological types.The patients were followed-up for one to five years.Up to now,there are 98,98,77,64,and 47 patients with 1,2,3, 4,and 5 years of follow-up in the combined group,respectively;and 104,104,97,81,and 55 patients in the WM group,respectively.The results of the 5-year follow-up of all the patients will be available in 2011. Results:The relapse/metastasis rate of 1-,2-,3-,4-,and 5-year were 0(0/98),2.04%(2/98),11.69% (9/77),14.06%(9/64),and 21.28%,(10/47)in the combined group,and were 4.80%(5/104),16.35% (17/104),21.65%(21/97),25.93%(21/81),and 38.18%(21/55)in the WM group,respectively.A significant difference was found in the second year between the two groups(χ~2=12.117,P = 0.000).Median relapse/ metastasis time was 26.5 months in the combined group and 16.0 months in the WM group.Conclusion: The combined therapy of TCM and WM may have great clinical value and a potential for decreasing the relapse or metastasis rate in stageⅡandⅢcolorectal cancer after conventional WM therapy.     

Cohort Study on the Effect of a Combined Treatment of Traditional Chinese Medicine and Western Medicine on the Relapse and Metastasis of 222 Patients with Stage Ⅱ and Ⅲ Colorectal Cancer after Radical Operation

Objective： To evaluate the effectiveness of a comprehensive therapy of traditional Chinese medicine （TCM） in reducing the relapse and metastasis of stage Ⅱ and Ⅲ colorectal cancer based on conventional Western medicine （WM） therapy. Methods： Two hundred and twenty-two patients in total, diagnosed as stage Ⅱ and Ⅲ colorectal cancer from February 2000 to March 2006, were recruited from Xiyuan Hospital, China Academy of Chinese Medical Sciences and the General Hospital of Beijing Military Area. They were followed-up once every 3-6 months. Twenty cases dropped out from the cohort. The remaining 202 patients were all treated with routine WM treatment [including R0 radical operation, or chemotherapy or/and radiotherapy according to national comprehensive cancer network （NCCN） clinical guidelines]. These patients were assigned to two groups based on whether or not they were additionally treated with TCM comprehensive therapy （orally administered with a decoction according to syndrome differentiation, combined with a traditional patent drug over one year）. Ninety-eight patients from Xiyuan Hospital were treated with WM and TCM （combined group）, and 104 patients from the General Hospital of Beijing Military Area were treated with WM alone （WM group）. The demographic data at baseline were comparable, including the operation times, age, sex, TNM staging, and pathological types. The patients were followed-up for one to five years. Up to now, there are 98, 98, 77, 64, and 47 patients with 1, 2, 3, 4, and 5 years of follow-up in the combined group, respectively; and 104, 104, 97, 81, and 55 patients in the WM group, respectively. The results of the 5-year follow-up of all the patients will be available in 2011. Results： The relapse/metastasis rate of 1-, 2-, 3-, 4-, and 5-year were 0 （0/98）, 2.04% （2/98）, 11.69% （9/77）, 14.06% （9/64）, and 21.28% （10/47） in the combined group, and were 4.80%（5/104）, 16.35% （17/104）, 21.65% （21/97）, 25.93% （21/81）, and 38.     

Long-term efficacy of excimer laser in situ keratomileusis in the management of children with high anisometropic amblyopia

Background Children with anisometropic amblyopia are often noncompliant with traditional treatment including spectacules and contact lenses. This study was to evaluate the long-term efficacy of excimer laser in situ keratomileusis （LASIK） for children with high anisometropic amblyopia.
Methods A retrospective analysis of 24 children with high unilateral anisometropic amblyopia, who underwent LASIK during the period between August 2000 and September 2005 in our hospital, was conducted. The mean age of these children was （7.4±1.9） years （range 5-14 years） and the mean follow-up period was （33.3±14.2） months （range 18.5-74.2 months）. After LASIK, visual acuity, refraction and far or near stereoacuity were analyzed. Near stereoacuity was measured by the random-dot butterfly stereogram and the pre-school random-dot stereogram, while far stereoacuity was measured by the synoptophore with Yan＇s random-dot stereogram. Results Mean preoperative uncorrected visual acuity was 0.06±0.05, while mean postoperative uncorrected visual acuity was elevated to 0.43±0.33. Mean preoperative best-corrected visual acuity was 0.26±0.22, while mean postoperative best-corrected visual acuity was elevated to 0.67±0.40. For patients with myopic anisometropia, preoperative mean spherical equivalent refraction was （-8.01±2.70） D while postoperative value significantly reduced to （-1.32±2.47） D. For patients with hyperopic anisometropia, preoperative mean spherical equivalent refraction was （ 7.35±1.55） D while postoperative value significantly reduced to （3.30±0.86） D. These results demonstrated that there was statistical difference in these parameters between preoperative and postoperative tests. At the last follow-up, 20 patients had near stereoacuity, and the mean near stereoacuities measured by the random-dot butterfly stereogram and the preschool random-dot stereogram were （149.00±152.93）＂ and （201.05±235.94）＂, respectively. In contrast, 11 patients had far stereoacuity, and the mean far stereoacuity measured by the synoptophore was （210.91±217.51）. Three cases of patients developed mild corneal complications.
Conclusion LASIK for the correction of high anisometropia in children with monocular amblyopia may be safe and effective, and this can help effectively conduct postoperative amblyopia training and improve the cure rate.     

Management of intracranial invasive olfactory neuroblastoma

Background Olfactory neuroblastoma （ONB） is a rare tumor that often arise from the nasal cavity. The aim of this study was to investigate the clinical characteristics and treatments of intracranial invasive ONB. Methods Between July 2001 and August 2005, 5 patients with intracranial invasive ONB were treated in our department. Their clinical features, radiological and pathological characteristics, and surgical treatments were analyzed. Among the 5 patients, 1 received transnasal biopsy, and 4 were operated through the transfrontal or extended bifrontal approaches to reconstruct the skull base. After the operation, all the patients received radiotherapy, and one received chemotherapy. They were followed up for 6 to 45 months. Results The ONB was resected totally in the 4 patients. In all the patients, nasal obstruction was alleviated without cerebrospinal fluid leakage. The visual acuity was improved in 3 patients, who had a decreased visual acuity before the operation. Two patients had metastasis into the lumbosacral spinal canal 6 and 8 months after the operation, one of them received a second operation and the other died. Conclusion ONB has no specific symptoms. Intracranial ONB should be resected as far as possible, and treated by radiotherapy after the operation.     

Treatment of advanced non-small cell lung cancer with extracorporeal high frequency thermotherapy combined with Chinese medicine

Objective： To observe the clinical efficacy and benefit response of extracorporeal high frequency thermotherapy （EHFT） combined with Chinese medicine （CM） in the treatment of patients with advanced non-small cell lung cancer. Methods： The study adopted a prospective, small sample and randomized controlled method, and the advanced non-small cell lung cancer patients were assigned to two groups according to the table of random digits, one having the treatment of EHFT combined with CM （the treatment group）, the other only with CM （the control group）. The patients in the treatment group were treated with EHFT one hour once per day, together with CM differentiation decoction, 250 mL orally taken, twice daily for 14 days as one cycle, and 3-4 cycles was performed. The patients in the control group were treated only with CM differentiation decoction using the same dose as the treatment group. The efficacies were evaluated after three to four cycles of treatment. Primary endpoints were disease control rate （DCR） and time to progression （TTP）. Secondary endpoints were overall survival time and 1-year survival rate. Results： Sixty-six patients accomplished the study. After the patients underwent different treatments, none of the patients got a complete response or partial response in both groups. In the treatment group, DCR was 72.2%, and 10 had progression of disease （28.8%）, while the DCR of the control group was 63.3%, and 11 had progression of disease （36.7%）; there was a significant statistical difference （P0.05）, suggesting that the combined regimen had superiority on the DCR. As for long-term efficacy, the median survival time （MST） of the treatment group was 7.5 months, TTP was 5.5 months, and 1-year survival rate was 21.4 %; in the control group, the results were 6.8 months, 4.5 months and 16.6% respectively. There was significant statistical difference on TTP （P0.05）, but no difference on MST or 1-year survival rate. Conclusion： EHFT combined with CM differentiation has better tolerance and short-term efficacy in the treatment of patients with advanced NSCLC.     

Efficacy of radical cystectomy plus adjuvant intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced bladder cancer

Background Bladder cancer is the ninth most common cancer in the world; fewer than 15％ of transitional-cell carcinoma patients survive 2 years if left untreated.Although radical cystectomy is the standard treatment of choice,much of them relapse and the necessity of adjuvant chemotherapy is still under debate.The aim of the study was to evaluate the efficacy of adjuvant intraarterial chemotherapy （IAC） with gemcitabine and cisplatin （GC） on locally advanced bladder cancer.Methods This is a retrospective study on 60 patients with locally advanced bladder carcinoma who underwent radical cystectomy between May 2000 and June 2011.Patients were studied in two groups based on IAC and followed up for up to 5 years.Results Among 60 patients,there were 25 patients who underwent IAC （GC） after radical cystectomy （the IAC group） and 35 patients who underwent radical cystectomy alone （the control group）.Although not significant,the relapse rates were slightly reduced in the IAC group than in the control group.Patients with IAC had a reduction in mortality compared with patients without IAC over 5 years.Specifically,IAC significantly reduced about 82％ of mortality within the first year （hazard ratio=0.18,95％ Cl 0.03-0.97,P=-0.04）.Additionally,IAC was well tolerated and safe.The most common adverse effect was transient myelosuppression （10/25,40％）,which was resolved by various medical treatments.Conclusions Compared with radical cystectomy alone,radical cystectomy in combination with adjuvant IAC moderately but significantly reduces 1-year mortality.Our preliminary data showed only marginal benefit for the early survival.However,a randomized clinical study is needed to determine the long-term survival benefit.     

Neoadjuvant chemotherapy of cisplatin and fluorouracil regimen in head and neck squamous cell carcinoma: a meta-analysis

Background The benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas （HNSCC） still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil （PF） regimen in enhancing the overall survival of and decreasing Iocoregional relapse and distant metastasis in HNSCC patients. Methods Medline and manual searches were performed to identify all published randomized controlled trials （RCTs） investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included Iocoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group （chemotherapy plus Iocoregional treatment） versus the control group （Iocoregional treatment alone） and was presented as a point estimate with 95% confidence intervals （CI）. Results Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the Jocoregional relapse was 0.92 （0.70-1.22, 95%CI）, which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 （0.33-0.68, 95% CI） and 1.28 （1.01-1.62, 95% CI） respectively, which were both statistically significant. Conclusions Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on Iocoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.     

Summary of 32 patients with cardiac syndrome X treated by TCM therapy of regulating qi relieving chest stuffiness and promoting blood circulation

Objective： To evaluate the clinical effect of Liqi Kuanxiong Huoxue method （宽胸活血,LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circulation） in treating patients with cardiac syndrome X （CSX）. Methods： The prospective, non-randomized controlled study was conducted on 51 selected patients with CSX, who were non-randomly assigned to 2 groups, the treated group treated with LKH in addition to the conventional treatment （32 patients）, and the control group treated with conventional treatment （19 patients） like nitrate, diltiazem hydrochloride, etc. The treatment course was 14 days. The changes of such symptoms as angina pectoris, TCM syndrome and indexes of treadmill exercise test before and after treatment were observed. Results： After treatment, such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group （P〈0.05）; the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group （P〈0.05）. The treadmill exercise test showed that the maximal metabolic equivalent （Max MET）, the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups, but the improvement in the treated group was better than that in the control group respectively （P〈0.05）. Conclusion： The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX.     

Effect of Jieze No.1 (洁泽 号) on cervicitis caused by ureaplasma urealyticum and on ureaplasma urealyticum in vitro

Objective： To observe the clinical therapeutic effect of Jieze No. 1 （洁泽Ⅰ号） on cervicitis caused by ureaplasma urealyticum and its inhibitory effect on ureaplasma urealyticum （Uu） in vitro. Methods： A total of 393 patients suffering from cervicitis induced by ureaplasma urealyticum without other complications were randomly assigned to 3 groups, the combined treatment group： 140 patients treated with Chinese herbs Jieze No.1 by vaginal lavage, 30 min each time, once a clay for 10 consecutive clays and oral administration of Azithromycin, 1.0 g once every 72 h for three times; Jieze group： 115 patients were treated with Jieze No.1 alone by vaginal lavage, 30 min each time, once a day for 10 consecutive days; and the Azithromycin group： 138 patients were treated with oral administration of Azithromycin, 1.0 g once in 72 h for three times. All the patients were treated for 1 therapeutic course and condom were used for contraception during the treatment course. The Uu patients were examined again after 21 clays of treatment. The therapeutic effect on cervicitis was observed. The experimental study of Jieze No. 1 on the Uu strain separated from the secretion of the urogenital tract was also observed. The minimum inhibitory concentration （MIC） and minimum bactericidal concentration （MBC） of the Uu were investigated. Results： The total effective rate of the combined group was 85.3%, showing a significant difference compared with the Jieze group （67.8%） and the Azithromycin group （60.3%, both P〈0.01）. There was no statistical significance between the latter two groups （P〉0.05）. The clearing rate of Uu in the combined group was 78.4%, that of the Jieze group was 60.9% and the Azithromycin group was 47.9%. The combined group also showed a significant difference in comparison with the other two groups （all P〈0.01）. Especially for the drugresistant strain, the clearing rate of Uu reached 48.1% in the combined group, 42.1% in the Jieze group, and 16.1% in the Azithromyc     

Clinical and serological characterization of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation

Background Autoimmune hemolytic anemia （AIHA） is an uncommon complication of allogeneic hematopoietic stem cell transplantation （allo-HSCT） which has only been reported in a few cases.We here aimed to explore its mechanism.Methods We retrospectively analyzed 296 patients who underwent allo-HSCT in our center from July 2010 to July 2012.Clinical manifestations were carefully reviewed and the response to currently available treatment approaches were evaluated.The survival and risk factors of AIHA patients after allo-HSCT were further analyzed.Results Twelve patients were diagnosed with AIHA at a median time of 100 days （15-720 days） after allo-HSCT.The incidence of AIHA after allo-HSCT was 4.1％.IgG antibody were detected in ten patients and IgM antibody in two patients.The two cold antibody AIHA patients had a better response to steroid corticoid only treatment and the ten warm antibody AIHA patients responded to corticosteroid treatment and adjustment of immunosuppressant therapy.Rituximab was shown to be effective for AIHA patients who failed conventional therapy.Survival analysis showed that the combination of AIHA in allo-HSCT patients hinted at poor survival.Cytomegalovirus （CMV） infection,graft-versus-host disease （GVHD） and histocompatibility leukocyte antigen （HLA） mismatch seemed to increase the risk of developing AIHA.Conclusions Patients who develop AIHA after allo-HSCT have poor survival compared to non-AIHA patients.Possible risk factors of AIHA are CMV infection,GVHD,and HLA mismatch.Rituximab is likely to be the effective treatment choice for the refractory patients.