不同剂量沙利度胺联合化疗方案治疗老年多发性骨髓瘤的临床疗效

目的:探讨不同剂量沙利度胺联合化疗方案治疗老年多发性骨髓瘤的临床疗效。方法:选取老年多发性骨髓瘤患者共61例,随机分为A组(31例)和B组(30例)。A组给予沙利度胺(400 mg/d)+VAD化疗方案,B组给予沙利度胺(100 mg/d)+VAD化疗方案。比较2组临床疗效及不良反应。结果:A组与B组治疗有效率分别为83.9%和76.7%(P0.05)。治疗后2组患者血M蛋白、尿素氮、骨髓浆细胞计数均显著降低,血红蛋白及Kamofsky评分均显著提高(均P0.05);治疗后2组患者血M蛋白、血红蛋白、尿素氮、骨髓浆细胞计数及Kamofaky评分比较无统计学差异(P0.05)。B组便秘、口鼻黏膜干燥、乏力、头晕等不良反应发生率显著低于A组(P0.05或P0.01);2组腹胀、恶心、皮疹等发生率比较无统计学差异(P0.05)。治疗后B组股静脉血流峰速度和平均速度均显著提高(P0.05);治疗6个月后B组的肢端疼痛、感觉障碍、麻木感及不宁腿综合征等临床症状较A组改善明显(P0.05);B组各感觉神经传导速度改善明显优于A组(P0.05)。结论:100 mg/d沙利度胺或400 mg/d沙利度胺联合VAD方案治疗老年多发性骨髓瘤的临床疗效近似,100 mg/d沙利度胺联合VAD方案治疗多发性骨髓瘤的不良反应更轻。     

小剂量沙利度胺联合VAD方案治疗多发性骨髓瘤26例临床观察

目的观察小剂量沙利度胺联合VAD方案化疗治疗多发性骨髓瘤的临床疗效及毒副作用。方法对26例多发性骨髓瘤患者,给予沙利度胺100mg／d联合VAO方案化疗,在化疗疗程结束后继续给予沙利度胺100mg／d维持治疗6个月以上。结果部分缓解15例,进步6例,无效5例,有效率为80．8％,不良反应轻,均可耐受。结论小剂量沙利度胺联合VAD方案化疗治疗多发性骨髓瘤安全有效。     

小剂量沙利度胺联合含小剂量地塞米松的VAD方案治疗老年多发性骨髓瘤的研究

目的:观察小剂量沙利度胺联合含小剂量地塞米松的VAD方案治疗老年多发性骨髓瘤的疗效。方法:回顾性分析46例多发性骨髓瘤患者,分为治疗组及对照组。对照组采用标准剂量的VAD方案,治疗组应用小剂量沙利度胺及小剂量地塞米松(40mg.d-1,只应用4d)的VAD方案联合治疗,4周为1个疗程,3个疗程后观察疗效。结果:治疗组有效率为83.34%,略高于对照组(72.72%),但差异无统计学意义(P>0.05)。治疗后,治疗组血红蛋白高于对照组(P<0.05),肌酐低于对照组(P<0.05),卡氏评分高于对照组(P<0.05),骨痛评分明显低于对照组(P<0.05)。沙利度胺的主要不良反应为嗜睡、便秘及下肢深静脉血栓形成,但减低了剂量后未见严重上述不良反应。大剂量地塞米松的不良反应为血糖升高及增加感染的发生率,但本研究中减少了地塞米松的剂量,高血糖及感染的发生率明显降低,与对照组比较差异有统计学意义(P<0.05)。结论:小剂量沙利度胺联合含小剂量地塞米松的VAD方案与标准剂量的VAD方案治疗多发性骨髓瘤患者疗效相似,但在改善患者生活质量方面有较好的疗效。并且能减少严重并发症的发生,增加患者治疗的依从性。     

MM治疗中应用VAD方案联合沙利度胺的疗效观察

目的研究MM应用VAD方案联合沙利度胺的效果。方法选择2010年1月-2017年9月我院接诊的多发性骨髓瘤病患54例,将之采用奇偶数字分组法随机分成实验和对照两组(n=27)。实验组采取VAD方案联合沙利度胺的疗法,对照组应用VAD方案。分析2组不良反应的发生情况,比较疗效。结果实验组的不良反应发生率为37.04%,对照组的为29.63%,组间无明显差异(P0.05)。实验组的治疗总有效率为88.89%,明显比对照组的66.67%高,组间差异显著(P0.05)。结论 VAD方案积极联用沙利度胺对多发性骨髓瘤病患进行施治,不增加不良反应,用药方便,且有效率增高,建议采纳。     

沙利度胺联合VAD方案治疗多发性骨髓瘤的临床研究

目的 :探讨沙利度胺联合VAD方案治疗多发性骨髓瘤 (MM)的临床疗效及不良反应。方法 :5 3例MM患者 ,随机分为VAD方案对照组 :长春新碱加阿霉素加地塞米松 ;治疗组 :VAD方案加沙利度胺 ,沙利度胺起始剂量 2 0 0mg/d ,每 2周增加 5 0～ 2 0 0mg/d ,至患者不能耐受或最高剂量不超过每日 4 0 0mg ,维持该剂量半年。结果 :治疗组部分缓解 10例 (4 3.5 % ) ,进步 9例 (39.1% ) ,无效 4例 (17.4 % ) ,总有效率 82 .6 % (19/2 3) ,明显优于对照组 (总有效率的 5 3.3% ) (P <0 .0 5 ) ;能有效降低M蛋白 ,使骨髓瘤细胞下降 ,提升血红蛋白和改善生活自理状况 (P <0 .0 1) ;治疗后MM患者血清血管内皮细胞生长因子 (VEGF)水平明显下降 ,与对照组比较差异有统计学意义 (P <0 .0 1)。副反应程度均可耐受。结论 :沙利度胺联合VAD方案治疗MM具有副作用少、耐受性好、给药方便、疗效明显的优点 ,值得临床深入研究和推广应用。     

中西医结合方案治疗老年多发性骨髓瘤的应用价值

目的探讨中西医结合方案在治疗老年多发性骨髓瘤(MM)患者中的临床应用价值。方法 75例老年MM患者随机分成三组,每组25例,对照组釆用标准VAD方案治疗,观察1组釆用标准VAD方案+艾迪注射液治疗,观察2组釆用标准VAD方案+艾迪注射液+沙利度胺治疗。比较三组患者治疗结束时临床有效率、卡氏(KPS)评分情况、骨髓浆细胞比例及血清M蛋白水平。结果观察2组患者治疗后的有效率(88.0%)高于对照、观察1组(52.0%);观察2组患者治疗后体力状况改善率(84.0%)高于对照组(44.0%)(P<0.05)。观察2组患者治疗后骨髓浆细胞比例及血清M蛋白水平低于对照组、观察1组(P<0.05)。结论在VAD方案治疗MM的基础上联合应用艾迪注射液及沙利度胺可提高患者治疗的有效率,明显改善患者体力状况,并能有效降低患者治疗后骨髓浆细胞比例及血清M蛋白水平,是老年MM患者较为理想的一种治疗选择。     

沙利度胺联合蒽环类药物治疗复发和难治性多发性骨髓瘤近期临床疗效观察

目的 沙利度胺联合蒽环类药物治疗复发和难治性多发性骨髓瘤（MM）的临床疗效观察.方法 将16名复发难治的MM患者随机分为沙利度胺＋COAMP组和COAMP组,两组均采用蒽环类药物联合治疗,沙利度胺＋ COAMP组加用沙利度胺,开始剂量为100 mg/d,逐步加大至200～300 mg/d,治疗6个疗程.根据血清M蛋白、骨髓瘤细胞减少、乳酸脱氢酶（LDH）、β2-微球蛋白（β2-MG）等指标判断疗效.结果 总有效率：沙利度胺＋COAMP组为87.5%,COAMP组为50%,两组间比较差异有显著性（P＜0.05）.沙利度胺＋ COAMP组中出现便秘、腹胀、乏力和嗜睡,经过对症处理后较快消失,其他化疗不良反应与COAMP组相同.结论 沙利度胺联合蒽环类药物治疗复发和难治性多发性骨髓瘤疗效显著,病人耐受性好.     

硼替佐米及沙利度胺联合VAD方案治疗难治复发性多发性骨髓瘤疗效观察

目的:观察硼替佐米、沙利度胺联合VAD方案治疗难治复发性多发性骨髓瘤(MM)的临床疗效和不良反应。方法:9例难治复发性MM患者均采用硼替佐米、沙利度胺联合VAD方案治疗。其中,长春新碱0.4mg/d,d1～4;阿霉素10mg/d,d1～4;地塞米松40mg/次,d1～4,d9～12,d17～20;硼替佐米2mg/d,d1,4,8,11;沙利度胺,起始量100mg/d,根据患者情况,逐渐加量至200mg/d,每晚顿服,治疗2个周期。观察疗效,并按WHO不良反应分级标准判断不良反应。结果:9例患者,3例完全缓解/接近完全缓解(CR/nCR),4例部分缓解(PR),1例进步,1例无效,CR加PR率达77.8%,总有效率88.9%。不良反应主要有乏力、便秘、皮疹、胃肠道反应及末梢神经炎,均可耐受。结论:硼替佐米、沙利度胺联合VAD方案治疗难治复发性MM近期疗效显著,耐受性好,是一种新的治疗选择。     

沙利度胺对弥漫大B细胞淋巴瘤患者血清血管内皮生长因子水平的影响及临床意义

目的:观察沙利度胺联合CHOP方案治疗弥漫大B细胞淋巴瘤(DLBCL)患者前后血清血管内皮生长因子(VEGF)水平的变化及临床意义.方法:40例DLBCL患者随机分为2组,各20例,化疗组CHOP方案常规化疗;联合组CHOP方案常规化疗+沙利度胺治疗,沙利度胺50 mg/次,每天早晚各1次,第1～28天给药.4周1个疗程,治疗2个周期后比较疗效.采用酶联免疫法检测40例患者治疗前、后血清VEGF的水平.结果:联合组有效率(CR+ PR)为80％,化疗组有效率60％.差异有统计学意义(P＜0.05).2组治疗前血清VEGF水平比较差异无统计学意义(P＞0.05);化疗组化疗前后血清VEGF水平比较差异无统计学意义(P＞0.05),联合组治疗后血清VEGF水平较化疗前明显下降(P＜0.05).结论:沙利度胺联合CHOP化疗能改善DLBCL患者的有效率;沙利度胺能抑制肿瘤细胞VEGF的产生,从而降低血清VEGF的水平.     

VAD方案化疗联合血液净化治疗MMRN疗效及对血清Scr、BUA水平的影响

目的探究VAD方案化疗联合血液净化治疗多发性骨髓瘤肾病(MMRN)疗效及对血清肌酐(Scr)、血尿酸(BUA)水平的影响。方法 68例多发性骨髓瘤肾病患者依据建档顺序分组,各34例。两组均予以常规治疗,于此基础上对照组仅采用VAD方案化疗,观察组采用VAD方案化疗联合血液净化治疗,治疗3个月,对比两组治疗前后Scr、BUA、血钙水平,并统计临床疗效、不良反应发生情况。结果两组治疗前Scr、BUA、血钙水平无差异(P0.05);治疗后观察组Scr、BUA、血钙水平均低于对照组(P0.05);总有效率76.47%(26/34)高于对照组52.94%(18/34)(P0.05);两组不良反应发生率无差异(P0.05)。结论多发性骨髓瘤肾病患者联合应用VAD方案化疗与血液净化治疗效果显著,可有效降低Scr、BUA水平,改善肾功能,安全性较高。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.