吡柔比星为主联合化疗方案治疗老年非霍奇金淋巴瘤

目的观察含吡柔比里（THP）的CTOP方案治疗非霍奇金淋巴瘤的临床疗效及毒副作用。方法将45例初治的非霍奇金淋巴瘤（NHL）患者分为两组：治疗组采用含THP的CTOP方案化疗,对照组采用含阿霉索（ADM）的CTOP方案化疗。观察两组的临床疗效和不良反应。结果治疗组完全缓解（CR）率52．2％,总有效率78．3％;对照组CR率50．0％,总有效率77．3％。两组总有效率比较,差异无显著性（P〉0．05）。两组消化道反应（恶心、呕吐）、血液学毒副反应（白细胞下降、血小板减少）及肝功能异常的发生率均无显著性差异（P〉0．05）;脱发及心电图异常的发生率有显著性差异（P〈0.05）。结论以THP为主的CTOP化疗方案治疗老年非霍奇金淋巴瘤疗效确切,毒副作用小,安全可靠。     

THP为主联合化疗方案治疗老年非霍奇金淋巴瘤的临床疗效观察

目的探讨以THP为主联合化疗方案治疗老年非霍奇金淋巴瘤的临床疗效观察。方法回顾分析70例患者的临床资料。结果治疗组35例，CR20例（54％），PR9例（26％），NR6例（20％），总有效率80％；对照组35例中，CR19例（52％），PR9例（27％），NR7例（21％），总有效率78％。两组总有效率比较，差异无统计学意义（P〉0．05）。结论含THP联合CTOP化疗方案治疗NHL疗效与CHOP相当，但前者心脏毒副作用轻，脱发发生率低，适合老年人及合并心脏病的患者。     

以吡柔比星为主的化疗方案治疗非霍奇金淋巴瘤疗效分析

目的观察以吡柔比星(THP)为主的化疗方案(CTOP方案)治疗非霍奇金淋巴瘤(NHL)的临床疗效和不良反应。方法59例接受CTOP方案化疗的NHL患者,低剂量组26例,THP用量23~35 mg/m2(40~60 mg);高剂量组33例,THP用量40~75 mg/m2(60~120 mg),其余用药相同。重复使用2~8疗程(平均4疗程),评价疗效及不良反应。结果低剂量组完全缓解13例,部分缓解3例,总有效率61.5%;高剂量组完全缓解20例,部分缓解6例,总有效率78.8%;骨髓抑制、Ⅲ~IV度中性粒细胞减少的发生率分别为30.8%和27.3%;近期无患者出现心脏毒性,两组各有2例发生药物性肝功能损伤。结论CTOP方案治疗非霍奇金淋巴瘤不良反应发生率低,在条件许可的情况下尽可能采用标准剂量化疗。     

吡柔比星与阿霉素为主的方案治疗非霍奇金淋巴瘤30例疗效比较

【目的】分析比较吡柔比星（吡喃阿霉素,THP）与盐酸阿霉素（ADM）治疗非霍奇金淋巴瘤（NHL）的疗效与不良反应。【方法】将58例NHL患者随机分成两组,A组30例,选用THP联合化疗;B组28例,选用ADM联合化疗,4个疗程后比较两组疗效及不良反应。【结果】A组与B组比较,总有效率分别为76．66％和71．43％,A组高于B组,但差异无显著性（P〉0．05）。两组心脏毒性发生率分别为6．25％和17．66％,胃肠道反应分别为50％和67．66％,两者比较有显著性差异（P〈0．05）,脱发分别为37．5％和82．14％,两者比较有非常显著性差异（P〈0．01）,骨髓抑制两者比较无明显差异。【结论】THP相对于ADM联合化疗患者不良反应发生率低,尤其消化道反应、脱发率及心脏毒性较低,且程度上也较轻,故THP较适合用于NHL患者。     

沙利度胺联合MINE方案治疗难治性侵袭性非霍奇金淋巴瘤的临床疗效研究

目的观察沙利度胺联合MINE方案（美斯钠／异环磷酰胺、米托蒽醌、依托泊苷）治疗难治性侵袭性非霍奇金淋巴瘤（NHL）的疗效和不良反应。方法回顾性分析2005年6月至2009年5月我院收治25例难治性侵袭性NHL患者的临床资料,所有患者均接受过至少1个化疗方案的治疗,所有患者均采用沙利度胺联合MINE方案化疗2～6个疗程（中位疗程数为4个）。结果25例NHL患者者均可评价疗效和不良反应,其中16例（64．0％）达到完全缓解（CR）,4例（16．0）部分缓解（PR）。总有效率为80．0％。不良反应主要为消化道症状,轻度肝功能异常以及神经症状。少有骨髓抑制伴感染。结论沙利度胺联合MINE方案为难治性侵袭性NHL的经济、有效挽救治疗方案之一,总有效率明显高于单纯化疗。其不良反应可以耐受,值得临床进一步推广。     

IDBP方案治疗难治性非霍奇金淋巴瘤

目的 评价IDBP方案治疗难治性非霍奇金淋巴瘤的疗效及毒副作用。方法 42例难治性非霍奇金淋巴瘤患者接受IDBP方案（异环磷酰胺1．2g／耐加入生理盐水1000ml中，第1～5天静脉点滴；顺铂30mg／耐加入生理盐水300ml中，第1～3天静脉点滴，卡氮芥125rag／耐加入生理盐水300ml中，第1～3天静脉点滴；强的松40mg／耐，第1～10天口服。）化疗，21天为一周期。结果有效率为54．8％（23／42），其中CR10例（23．8％），PR13例（31．0％），SD12例（28．6％），PD7例（16．7％）。中位生存时间9．5（2～51）个月。有效患者中位缓解时间5．5（1．5～51）个月。1年生存率为46．4％，2年生存率为25．0％。主要不良反应为骨髓抑制和消化道反应：Ⅲ～Ⅳ度白细胞下降44．4％（18／42），Ⅲ～Ⅳ度血小板下降31．0％（13／42），Ⅲ～Ⅳ度恶心呕吐14．3％（6／42）。结论 IDBP是治疗难治性非霍奇金淋巴瘤的有效方案，但仍存在缓解时间较短，不良反应较大等缺点。     

54例高危侵袭性T细胞非霍奇金淋巴瘤的回顾性分析

目的 探讨高危侵袭性T细胞非霍奇金淋巴瘤（T—NHL）的临床特征、治疗与预后。方法 对国际预后指数（IPI）评分为中高危或高危的54例侵袭性T-NHL患者，按WHO分类标准分型，对其进行回顾性分析。结果 T淋巴母细胞淋巴瘤（TLBL）12例（22．2％），非特殊型外周T细胞淋巴瘤（PTCL—U）31例（57．4％），肝脾T细胞淋巴瘤（HSTCL）11例（20．4％）。IPI评分中高危12例（22．2％），高危42例（77．8％）；其中侵犯骨髓49例（90．7％），侵犯脑膜7例（13．0％）。治疗总体反应率为86．5％，完全缓解率为67．3％，3年总生存（OS）率为16．0％；采取造血干细胞移植治疗的患者3年OS率为44．4％，明显高于化疗组（8．3％）。多因素分析显示治疗方案的选择、能否达缓解是影响预后的重要因素。结论 T—NHL是一组高度异质性肿瘤。中高危、高危T—NHL，尤其是PTCL—U和TLBL，虽然化疗反应率较高，但远期疗效很差，需要探索新的治疗方案，自体造血干细胞移植可能是较好的选择。     

MIME的改良方案IEMAD治疗难治和复发性非霍奇金淋巴瘤

为了探讨MIME的改良方案——IEMAD（异环磷酰胺、VM26或VP16、甲氨喋呤，阿糖胞苷、地塞米松或甲基强的松龙）治疗难治性和（或）复发性非霍奇金淋巴瘤（NHL）的疗效，用该方案治疗了25例难治性和（或）复发性NHL患者，其中难治性NHL11例，复发性NHL14例。结果表明：6例难治性和（或）复发性NHL患者达到完全缓解（CR率为24．0％），7例达到部分缓解（PR率为28．0％），总有效率为52．0％，中位生存期13个月。中位疾病无进展时间8个月；IEMAD方案治疗的毒副作用较轻，不良反应主要有消化道不适及骨髓抑制，未发生治疗相关死亡。结论：MIME的改良方案IEMAD对于部分难治性和（或）复发性非霍奇金淋巴瘤（NHL）有疗效。且毒副作用较轻，病人耐受良好。可用于其他治疗方案无效的难治性和（或）复发性非霍奇金淋巴瘤（NHL）患者的治疗。     

NP方案与TP方案对初治晚期非小细胞肺癌疗效的对比观察

目的探讨NP方案与TP方案对初治晚期非小细胞肺癌（NSCLC）的疗效和毒性。方法120例晚期NSCLC患者（Ⅲ期75例，占62．5％；IV期45例，占37．5％）按所接受的化疗方案分成NP组和TP组，每例患者至少接受2个周期以上的同一方案治疗，比较两组方案治疗的效果和不良反应。结果NP组和TP组的总有效率分别为43％和46％：1年生存率分别为23％和25％；2年生存率分别为8．5％和7．0％；NP组和TP组患者的中位生存期分别为8．5个月和8．7个月，两组间比较差异无统计学意义（P〉0．05）。NP组和TP组的不良反应均在可耐受范围。结论NP方案与TP方案对初治晚期非小细胞肺癌疗效确切，可作为晚期初治NSCLC的一线化疗方案。     

卡铂和足叶乙甙治疗96例肺癌的临床分析

用卡铂和足叶乙甙方案（CE）治疗96例肺癌结果表明：小细胞肺癌的疗效较好，总有效率为72．2％（39／54），初治者总有效率为92．3％（36／39），复治者总有效率为20％（3／15）；非小细胞肺癌疗效较差，总有效率为35．7％（15／42）。CE方案主要表现在血液毒性，小细胞肺癌对化疗敏感的同时骨髓抑制也明显重于非小细胞肺癌；如小细胞肺癌血色素下降的发生率达55．5％（2～4度者占28％），非小细胞肺癌为28．6％（2—3度者占14％）白细胞下降的发生率小细胞肺癌达66．6％（3～4度占28％）非小细胞肺癌为35．7％（3～4度占7．1％）；血小板下降的发生率小细胞肺癌为55．5％（3～4度者占44．4％）非小细胞肺癌为21．4％（3—4度者占7．1％）。本组病例骨髓抑制均在用药后的第十天出现，约需20天恢复。CE方案可作为小细胞肺癌化疗的最佳方案之一，对非小细胞肺癌疗效较差。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.