HBeAg阴性慢性乙型肝炎干扰素治疗的疗效观察

目的 了解IFN治疗HBeAg阴性慢性乙型肝炎的疗效.方法 选择HBeAg阴性慢性乙型肝炎患者50例为治疗组,HBeAg阳性慢性乙型肝炎患者52例为对照组,治疗组及对照组均采用6 MU WN-α隔日一次肌肉注射,疗程48周,观察2组患者治疗前及疗程完成时及之后24周的ALT、HBeAg、HBV DNA、纤维化四项定量指标.结果 疗程完成后24周,治疗组36人有效,有效率72%,高于对照组(X2=5.43,P<0.05),对照组26人有效,有效率50%;治疗组及对照组肝纤维化四项定量指标治疗前后均下降明显(t=2.365,P<0.05).结论 6 MU IFN-α治疗HBeAg阴性慢性乙型肝炎效果好,较HBeAg阳性慢性乙型肝炎的疗效明显;IFN有显著阻断或延缓慢性乙型肝炎肝纤维化的作用.     

慢性乙型肝炎病毒感染患者自然杀伤细胞IFNγ的表达与病情的关系

目的探讨自然杀伤细胞IFNγ的表达与慢性乙型肝炎(CHB)患者病情变化的关系。方法采用流式细胞术胞内细胞因子染色法,检测慢性乙型肝炎患者外周血中自然杀伤细胞分泌IFNγ的水平。结果慢性乙型肝炎活动组NK细胞的水平为(4.08±2.75)%;显著高于慢性乙型肝炎稳定组(2.37±1.13)%及对照组(1.27±0.39)%;慢性乙型肝炎稳定组与对照组比较,NK细胞差异有统计学意义;治疗后,未缓解组NK细胞分泌IFNγ的水平为(4.89±2.66)%,显著高于缓解组(2.24±1.47)%。结论慢性乙型肝炎的炎症与自然杀伤细胞的IFNγ高表达存在一定的关系。     

基因多态性和慢性乙型肝炎干扰素疗效的相关性

影响慢性乙型肝炎(CHB)IFN疗效的因素很多,宿主免疫遗传背景的差异是重要原因之一.最近关于基因多态性和CHB患者IFN疗效的相关性研究越来越多,此文就相关的研究进展进行了简要综述.     

基因多态性和慢性乙型肝炎干扰素疗效的相关性

影响慢性乙型肝炎(CHB)IFN疗效的因素很多,宿主免疫遗传背景的差异是重要原因之一.最近关于基因多态性和CHB患者IFN疗效的相关性研究越来越多,此文就相关的研究进展进行了简要综述.     

基因多态性和慢性乙型肝炎干扰素疗效的相关性

影响慢性乙型肝炎(CHB)IFN疗效的因素很多,宿主免疫遗传背景的差异是重要原因之一.最近关于基因多态性和CHB患者IFN疗效的相关性研究越来越多,此文就相关的研究进展进行了简要综述.     

α—干扰素联合复方益肝灵、甘利欣治疗慢性乙型肝炎的疗效分析

本文将60例慢性乙型肝炎患者随机分为治疗组和对照组,治疗结束后两组谷丙酶(ALT)复常率分别为80％和53.3％,HBV、DNA阴性率分别为86.7％和46.7％,随访1年,两组ALT正常率分别为100％、60％,HBV、NDA阴性率分别为86.7％和40％。本研究表明,IFN—α联合复方益肝灵、甘利欣治疗慢性乙型肝炎效果优于单用IFN—α。     

趋化因子及其共同受体在慢性乙型肝炎发病机制中的作用

趋化因子通过与其受体的相互作用,招募外周血中的淋巴细胞到达肝脏炎症部位,介导HBV感染后的病毒清除与免疫损伤的过程.此文就趋化因子IFN诱导蛋白10(IP-10)、LFN-γ诱生单核因子(MIG)、IFN诱导T细胞趋化因子(I-TAC)及其共同受体CXCR3在慢性乙型肝炎发病中的作用进行综述.     

重组α-干扰素治疗慢性乙型肝炎诱导自身免疫性慢性肝炎非特异性的自身抗体

α-干扰素(IFN-α)治疗慢性乙型肝炎(CHB)是很有希望的治疗方法,但有许多副作用,最常见的是引起流感样症状。近来已有IFN治疗后产生自身抗体的报道,这些抗体不是与慢性活动性肝炎(CAH)有关的抗体,但IFN治疗CHB也许能诱导加重肝病的自身免疫反应。作者分析了接受IFN治疗的慢性乙型肝炎病人的自身抗体,着重分析了那些典型地出现在慢性肝脏疾病,如自身免疫型CAH的各种亚型和原发性胆汁性肝硬变的自身抗体。研究对象为经活检证实的HBsAg阳性CAH病人31例(男27、女4)。他们的HBsAg、     

IFN-α引起慢性乙型肝炎致死性恶化

临床研究已证实α-干扰素(IFN-α)可致约1/3慢性乙型肝炎患者的乙型肝炎病毒(HBV)复制完全抑制以及HBe血清转化、HBeAg消失及抗-HBe出现。也有人报道IFN治疗肝硬变有效。于HBe血清转化前通常可见与淋巴细胞引起肝细胞溶解加重有关的血清转氨酶中度升高。本文报道1例用IFN引起慢性乙型肝炎致死性恶化。患者男性,62岁,因慢性乙型肝炎而用IFN-α治疗,患者无任何肝硬变并发症。治疗前血清丙氨酸转氨酶(ALT)持续性升高,凝血酶原时间15.5S,胆红质8μmol/L。血清HBsAg、HBeAg及HBV DNA均阳性,抗-HIV、抗-HCV及抗δ因子均阴性。肝活检为慢性乙型肝炎伴肝硬变,免疫化学检测证实约20％的肝细胞核中有HBcAg。用IFN     

HBV DNA及HBeAg定量在乙型肝炎患者抗病毒治疗方案选择中的指导作用

目的 根据慢性乙型肝炎患者HBV DNA及HBeAg定量高低的不同组合,观察其对IFN、阿德福韦酯(ADV)的治疗效果,寻求抗病毒药物的最佳治疗方案.方法 选择HBeAg阳性患者165例,根据所测HBV DNA及HBeAg定量高低的不同,将其分为A、B、C、D组.每组患者再随机分为IFN治疗组及ADV治疗组,48周时观察不同药物在各组患者治疗效果中的各项指标.结果 IFN治疗组对HBV DNA抑制率、HBV DNA水平下降(≥2lg拷贝/ml)的患者比例、HBV DNA阴转率及ALT复常率与ADV治疗组比较差异均无统计学意义,但在HBeAg定量下降≥500.00 COL/ml的患者比例、HBeAg阴转率、HBeAg血清转换率等项指标比较差异有统计学意义(P<0.05).并提示随着HBV DNA及HBeAg定量的增高,IFN和ADV的疗效依次下降,表现在ADV治疗组更为明显,显示在HBeAg血清转换率方面,IFN疗效明显优于ADV.结论 根据HBV DNA及HBeAg定量的高低,对选择不同的抗病毒治疗方案具有指导作用.     

论医疗事故,“伪医疗事故”,医疗责任事故罪的甄辨

由于对“医疗事故”特征的把握不当,致许多犯罪行为被误定为医疗事故,形成“伪医疗事故”,使其行为人逃避应有的刑事处罚。有的伪医疗事故今后可能会被误定为医疗责任事故罪,影响法律条文的正确运用。产生严重危害公民“生命、健康权利”后果的伪医疗事故,实属《中华人民共和国刑法》中的“过失致死罪”与“过失重伤罪”,应予以相应惩处。医疗责任事故弄不全是医疗责任事故罪。     

The co-evolution of therapeutic landscape and health tourism in bama longevity villages,China: An actor-network perspective

Many locales featuring therapeutic landscapes have seen a rise in health tourism recent years. This study introduces an actor-network perspective to examine the co-evolution of therapeutic landscapes and health tourism, and its inherent dynamism. We argue that therapeutic landscapes and health tourism are emerging out of an integrated actor-network, and thus are in continuous processes of (re)ordering and co-evolution. We also propose a typology of dynamics for the study of such an actor-network, substantiated with an empirical study of the Bama longevity villages in China, in which four interrelated and cascaded dynamics are closely scrutinized: tourists as part of the therapeutic landscape; tourism's impact on the landscape; the heterogeneous therapeutic perceptions of tourists; and the extension of the therapeutic network by health tourism. This study contributes to the relational thinking of therapeutic landscapes and health tourism, and enriches the understanding of their interlacing dynamics from the vantage point of the tourismscape.     

A comparison of new drug availability in Canada and the United States and potential therapeutic implications of differences

BACKGROUND: Claims are made that new valuable drugs are not available in Canada at the time that they are marketed in the United States. This study uses a convenience sample of new drugs marketed in the United States and determines how many of these products are initially unavailable in Canada and their therapeutic value. METHODS: Issues of the Canadian edition of The Medical Letter from May 12, 2003 to June 21, 2004 were hand searched for evaluations of new drugs and the following information was recorded: indication, availability in Canada and conclusions about therapeutic value. For drugs not available in Canada two clinical pharmacologists rated the therapeutic value of the products and the type of FDA review (standard or priority) was recorded. A database from the Therapeutic Products Directorate was searched to see if any of the drugs initially unavailable were subsequently marketed. RESULTS: Thirty-two of 37 drugs were not available in Canada. Between 9 and 11 of these products were rated as offering moderate to significant therapeutic gains. Twelve of the 32 drugs eventually were marketed in Canada. INTERPRETATION: Although the majority of new drugs marketed in the United States but not available in Canada do not offer any therapeutic advantage, between about a quarter and a third of may offer moderate to significant therapeutic gains. The reasons why these drugs are unavailable and how much their absence affects the treatment Canadians receive should be the subject of future research.     

Walking together: The embodied and mobile production of a therapeutic landscape

This paper draws on a case study of led group walks in the South-East of England to explore the affective potency of shared movement for producing therapeutic landscapes (landscapes that through placed practices become associated with health and healing). The paper addresses the lack of attention to embodiment and movement in work on therapeutic landscapes through an exploration of how shared movement can produce supportive social spaces that are experienced as restorative. Drawing on an expansive conception of mobility inspired by the ‘mobilities turn’ in the social sciences in the last decade, the paper explores how the therapeutic landscape concept can be enriched by being approached through the lens of the body in movement. A complimentary concern in the paper is the ways in which supportive socialities and group dynamics are integral to many therapeutic landscape experiences. Walking together is found to have a significant impact on social interaction and together embodied mobilities and supportive socialities transform the countryside walkscape into a mobile therapeutic landscape and a site for shared therapeutic body work.     

Contributions to the therapeutic milieu: Integrating key theoretical constructs

The concept of a therapeutic milieu is central to numerous theories of institutional treatment of youth. Yet, the therapeutic milieu is evasive and frequently difficult to conceptualize. The constructs of social climate, therapeutic discipline, and the Social Order are discussed as components of an integrated strategy for institutional program development. The implications of this approach call for the therapeutic milieu to become the hallmark measure of the quality of care provided to institutionalized youth.     

老年子宫内膜癌患者治疗方式探讨

目的 分析老年子宫内膜癌患者的临床特征、预后相关因素,探讨其最佳治疗方式.方法 对268例老年子宫内膜癌患者的临床病理资料、生存情况进行回顾性分析,评价影响其预后的因素.结果 单因素方差分析显示治疗方式、手术-病理分期、病理分级与老年子宫内膜癌患者预后有显著相关性(P<0.01).COX多元逐步回归分析显示手术-病理分期、病理分级为预测老年子宫内膜癌患者预后的独立因素(P值分别为0.002、0.000).结论 手术-病理分期、治疗方式及病理分级与老年子宫内膜癌预后密切相关;手术-病理分期及病理分级为预后独立因素.老年子宫内膜癌患者的治疗应结合其高危因素,采取个体化、综合化的治疗方式.     

Special considerations in generic substitution of immunosuppressive drugs in transplantation

Long-term success in solid organ transplantation strongly depends on the optimal use of maintenance immunosuppressive treatment. Cyclosporin and tacrolimus are the most frequently administered immunosuppressants and they are designed to narrow therapeutic index drugs. The substitution of the branded formulation by their generic counterparts may lead to economic benefit only if equivalent clinical outcomes can be achieved. There is no published evidence to date on the guarantee of their long-term therapeutic equivalence and cases of therapeutic failures have been reported due to inadvertent drug conversion. The disadvantageous clinical consequences of a non medical, mechanistic forced switch from the original to generic formulation of tacrolimus and the estimated loss of the payer's presumed savings are presented in a kidney transplant recipient population. Special problems related to pediatric patients, drug interactions with concurrent medications and the burden of additional therapeutic drug monitoring and follow up visits are also discussed. The authors are convinced that the implementation of the European Society of Organ Transplantation guidelines on generic substitution may provide a safe way for patients and healthcare payers.     

A users' guide to understanding therapeutic substitutions

Therapeutic substitutions are common at the level of ministries of health, clinicians, and pharmacy dispensaries. Guidance in determining whether drugs offer similar risk–benefit profiles is limited. Those making decisions on therapeutic substitutions should be aware of potential biases that make differentiating therapeutic agents difficult. Readers should consider whether the biological mechanisms and doses are similar across agents, whether the evidence is sufficiently valid across agents, and whether the safety and therapeutic effects of each drug are similar. This article uses a problem-based format to address the biological mechanism, validity, and results of a scenario in which therapeutic substitutions may be considered.     

A comparison of new drug availability in Canada and the United States and potential therapeutic implications of differences

BackgroundClaims are made that new valuable drugs are not available in Canada at the time that they are marketed in the United States. This study uses a convenience sample of new drugs marketed in the United States and determines how many of these products are initially unavailable in Canada and their therapeutic value.MethodsIssues of the Canadian edition of The Medical Letter from May 12, 2003 to June 21, 2004 were hand searched for evaluations of new drugs and the following information was recorded: indication, availability in Canada and conclusions about therapeutic value. For drugs not available in Canada two clinical pharmacologists rated the therapeutic value of the products and the type of FDA review (standard or priority) was recorded. A database from the Therapeutic Products Directorate was searched to see if any of the drugs initially unavailable were subsequently marketed.ResultsThirty-two of 37 drugs were not available in Canada. Between 9 and 11 of these products were rated as offering moderate to significant therapeutic gains. Twelve of the 32 drugs eventually were marketed in Canada.InterpretationAlthough the majority of new drugs marketed in the United States but not available in Canada do not offer any therapeutic advantage, between about a quarter and a third of may offer moderate to significant therapeutic gains. The reasons why these drugs are unavailable and how much their absence affects the treatment Canadians receive should be the subject of future research.     

Methods of control for hospital quality assurance systems.

The major failure of hospital quality assurance systems is the failure to influence physicians' therapeutic decision making in a way that will ensure their ordering necessary and only necessary services. The primary reason for this is insufficient recognition of the "intensive" technology used to treat acute patients, a technology characterized by the interdependence of therapeutic services and the patient's response to these services. In such situations, the appropriate method of achieving quality control is to provide performance feedback to the physician on a regular basis. To the extent that there is uncertainty about the impact of therapeutic services on the patient's response, the physician should be allowed discretion over the therapeutic process. In contrast, when process-outcome relations in the therapeutic process are relatively certain, feedback should be reinforced with sanctions.