不同治疗方案对多发性骨髓瘤患者骨病的影响

Objective To explore the difference of effects of two regimens (bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD) on bone disease in multiple myeloma(MM).Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen (5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P ＜ 0.05), and so did for serum DKK-1 concentration in patients responded to BD regimen (35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P ＜0.05) ;for serum concentration of sRANKL in patients responded to BD regimen (1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P ＜ 0. 05); and for serum concentration of TRACP-5b in responders to BD regimen (5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P ＜0.05). Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.     

不同治疗方案对多发性骨髓瘤患者骨病的影响

目的 探讨不同的治疗方案[BD(硼替佐米+地塞米松)、TID(沙利度胺+地塞米松)]对多发性骨髓瘤(MM)骨病的影响.方法 2006年11月至2008年9月,分别应用硼替佐米和沙利度胺联合地塞米松治疗的初治及难治复发MM患者共40例.在2种不同化疗方案前后,对患者进行骨痛评分、X线检查,同时采用ELISA法检测血清成骨细胞抑制因子DKK-1、可溶性细胞核因子κB受体活化因子配体(sRANKL)和抗酒石酸酸性磷酸酶(TRACP)-5b等骨代谢因子的水平.结果 TD组治疗前后中位血清TRACP-5b水平分别为5.94 U/L和4.84 U/L(P＜0.05).BD组有效患者治疗前后中位血清DKK-1浓度分别为35.11 μg/L和32.03 μg/L(P＜0.05);血清sRANKL浓度分别为1.05 pmol/L和0.67 pmol/L(P＜0.05);血清TRACP-5b浓度分别为5.57 U/L和4.90U/L(P＜0.05).结论 硼替佐米治疗有效的患者通过下调血清DKK-1、sRANKL和TRACP-5b水平从而可能显著增加骨形成活动,减少骨吸收活动;沙利度胺治疗的患者骨吸收活动显著减少.

Abstract：

Objective To explore the difference of effects of two regimens (bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD) on bone disease in multiple myeloma(MM).Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen (5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P ＜ 0.05), and so did for serum DKK-1 concentration in patients responded to BD regimen (35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P ＜0.05) ;for serum concentration of sRANKL in patients responded to BD regimen (1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P ＜ 0. 05); and for serum concentration of TRACP-5b in responders to BD regimen (5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P ＜0.05). Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.     

The influence of modified electrocomulsive therapy on serum interleukin—6 in schizophrenic patients

AIM：To explore the influence of modified electroconvulsive therapy on serum interleukin-6 in schizophrenic patients.METHOD:Testing change of serum IL-6 in 60 cases treated with MECT and 60 control cases treated with clozapine therapy by ELISA method. RESULTS:Serum IL-6 level before treatment of both groups was positive related to SAPS; serum IL-6 level wasn′t related to BPRS total score, factor score and SANS total fractions. IL-6 level of clozapine therapy group decrease apparently after treatment, and IL-6 level was apparently positive related to anxious depressed factor of BPRS; but there was no apparent difference in IL-6 level of MECT group between before and after treatment.CONCLUSION:To schizophrenic patients, clozapine can take effects of immune inhibit through inhibiting serum IL-6; MECT may have different mechanism.     

Anti-virus efficacy of cyclosporine in renal transplant recipients with hepatitis C virus-RNA positive

BACKGROUND:The selection of immunosuppressants and anti-hepatitis C virus drug is currently the focus for the hepatitis C virus-positive patients after receiving renal transplantation. OBJECTIVE:To investigate the anti-virus replication effect of cyclosporine in hepatitis C virus-RNA positive renal transplant recipients in addition to its anti-rejection effect. METHODS:Eleven hepatitis C virus-RNA positive renal transplant recipients were enrol ed and treated with cyclosporine, prednisone and mizoribine. Hepatitis C virus-RNA level, hemoglobin, liver functions and renal functions were evaluated before treatment and at 6 and 12 months after treatment. RESULTS AND CONCLUSION:The median of hepatitis C virus-RNA in 11 patients before treatment, and at 6 and 12 months after treatment were 1.22×107 copies/mL,1.11×104 copies/mL and 4.19×106 copies/mL respectively. At 6 months after treatment,8 cases of hepatitis C virus-RNA were negative (hepatitis C virus-RNA<500 copies/mL), and the total response of hepatitis C virus-RNA was 73%, and the sustained virological response was 55%(6/11) at the final fol ow-up. There was no significant difference of alanine transaminase, serum creatinine and serum uric acid levels before and after treatment (P>0.05), and the hemoglobin level was increased after treatment. During the fol ow-up, acute rejection only occurred in one patient and was control ed within 3 days after methylprednisolone pulse therapy. Cyclosporine-based treatment would be a better choice for renal transplant recipients combined with hepatitis C virus infection for both the anti-virus replication and anti-rejection effect.     

Improvement of hyperlipemia by hemodilution therapy

Background:Hemodilution therapy changes cellular ultrastructure and decreased serum concentration of various constitutes of patients with hyperlipemia through self－ blood transfusion under ultraviolet radiation and infusion of oxgen. Objective:To investigate influence of hemodilution on hyperlipemia. Design:Level of Blood lipid before and after hemodilution was measured in 48 patients with hyperlipemia. Unit:Out－ patient department, 251th Hospital of China People's Liberation Army. Subje…     

血液稀释疗法改善高脂血症患者血脂血粘度观察

Background:Hemodilution therapy changes cellular ultrastructure and decreased serum concentration of various constitutes of patients with hyperlipemia through self-blood transfusion under ultraviolet radiation and infusion of oxgen. Objective:To investigate influence of hemodilution on hyperlipemia. Design:Level of Blood lipid before and after hemodilution was measured in 48 patients with hyperlipemia. Unit:Out-patient department, 251th Hospital of China People's Liberation Army. Subject:48 patients with hyperlipemia during 1999-2000,36 male,12 female(mean age:50.4± 5.9).Diagnostic creteria was as followed:(1)serum lipoprotein[(s)]≥ 300mg/L or (2)TG>=3.6mmol/L or (3)cholesterol≥ 6.28mmol/L.Patients with liver or renal disease were excluded from the study.     

阿托伐他汀对老年脑梗死伴高血脂患者颈动脉粥样硬化斑块的影响

Objective To investigate the effect of atorvastatin on arteriosclerosis plaque of carotid artery in elder patients with cerebral infarction and hypercholesterolemia. Methods With self-comparsion of before and after treatment,50 subjects with arteriosclerosis plaque of carotid artery were given atorvastatin 10 mg,qn for 12 months. After treatment 6 and 12 months, arteriosclerosis plaque of carotid artery、 intima-media thickness and peak index were measured in all patients. Results After 6 and 12 months adminstration of atorvastatin, TC、TG、LDL-C were all reduced (P<0.05), and HDL-C was elevated (P<0.01) in all patients.The initial diameter of carotid was significantly enlarged in 12 months (P<0.01). The size of plaque decreased (P<0.01) in 12 months after atorvastatin therapy than before(P<0.01). Conclusion The effect of atorvastatin is certain and it can stabilize the plaque of carotid artery.     

Effect of selective and non-selective <Emphasis Type="Italic">β</Emphasis>-blockers on body weight,insulin resistance and leptin concentration in chronic heart failure

Background Chronic heart failure (CHF) is characterized by increased insulin resistance and hyperleptinaemia. We aimed to study effects of selective and non-selective β-blockers on body weight, insulin resistance, plasma concentrations of leptin and resistin in patients with CHF. Methods Twenty-six non-cachectic β-blocker-naive patients with CHF were randomized and treated with either carvedilol or bisoprolol. Body weight, plasma concentrations of leptin, resistin, fasting glucose and insulin were measured at baseline and after 6 months of therapy. Insulin resistance was estimated by homeostasis model assessment- estimated insulin resistance (HOMA-IR). Results Body weight increased significantly in the carvedilol group (mean change + 2.30 kg, p = 0.023) while it did not change in the bisoprolol group (mean change –0.30 kg, p = 0.623) (ns between groups). Plasma leptin concentration increased only in the carvedilol group (mean change + 4.20 ng/ml, p = 0.019) (ns between groups). Fasting glucose and resistin remained unchanged in both groups. After 6 months, mean plasma insulin concentration changed significantly differently (p = 0.015) in the bisoprolol (mean change +3.1 μU/ml) compared to the carvedilol group (mean change –6.3 μU/ml) and HOMA-IR was consequently higher in the bisoprolol compared to the carvedilol group (5.2 ± 4.2 vs 2.8 ± 1.6, p = 0.046). Conclusion This study found different metabolic effects of carvedilol and bisoprolol in non-cachectic patients with CHF. With unchanged fasting plasma glucose concentration after 6 months of treatment, carvedilol significantly decreased plasma insulin concentration and insulin resistance compared to bisoprolol.     

阿托伐他汀对老年脑梗死伴高血脂患者颈动脉粥样硬化斑块的影响

Objective To investigate the effect of atorvastatin on arteriosclerosis plaque of carotid artery in elder patients with cerebral infarction and hypercholesterolemia. Methods With self-comparsion of before and after treatment,50 subjects with arteriosclerosis plaque of carotid artery were given atorvastatin 10 mg,qn for 12 months. After treatment 6 and 12 months, arteriosclerosis plaque of carotid artery、 intima-media thickness and peak index were measured in all patients. Results After 6 and 12 months adminstration of atorvastatin, TC、TG、LDL-C were all reduced (P<0.05), and HDL-C was elevated (P<0.01) in all patients.The initial diameter of carotid was significantly enlarged in 12 months (P<0.01). The size of plaque decreased (P<0.01) in 12 months after atorvastatin therapy than before(P<0.01). Conclusion The effect of atorvastatin is certain and it can stabilize the plaque of carotid artery.     

慢性特发性血小板减少性紫癜患者血清转化生长因子β1测定的意义

Objective To investigate clinical significance of transforming growth factor-beta 1 ( TGF-β1 ) in patients with chronic idiopathic thrombocytopenic purpura(CITP). Methods The serum level of TGF-β1 in 38 pa-tients with initial CITP were detected using enzyme-linked immunosorbent assay(ELISA). Results The serum level of TGF-β1 in initial patients with CITP was significantly higher than that of the controls [( 132.57±5.17) μg/L vs ( 76.81±4.42) μ/L] ( P <0.01 ). The serum level of TGF-β1 in those having good response after therapy was sig-nificantly lower than before treatment[(81.26±3.78)μg/L] (P <0.01 ). There was no difference in TGF-β1 be-tween nonremission [(123.49 ± 4.31 ) μg/L] and initial patients (P > 0.05 ). There was negative correlation between TGF-β1 and platelet count(r = -0. 342 ,P < 0.05 ) ,there was positive correlation between TGF-β1 and megakaryo-cyte count (r = 0.409, P < 0.01 ). Conclusions TGF-β1 partakes in the pathogenesis of CITP, the determination of which in patients with CITP is useful to judge the state of illness, which can be regarded as an assistant index of cur-ative effect.     

韶关市农村留守儿童孤独感状况调查

目的了解广东省韶关市农村地区留守儿童孤独感现状及其影响因素。方法对韶关市某地区两所农村小学3～6年级学生中的489名留守儿童采用儿童孤独量表和自编调查表进行问卷调查。结果17．6％留守儿童存在孤独感，不同性别孤独感发生率无差异性，不同年龄及不同年级间孤独感发生率差异均有极显著性（P〈0.01）；随年级增加，孤独感发生率呈下降趋势（X^2趋势=5．970，P〈0.05）。留守儿童孤独感与健康状况、学习成绩、学习困难程度、父母教育方式、父母间关系和老师教育方式等因素显著相关（P〈0.01～0．05）。结论农村地区留守儿童中存在一定程度的孤独感问题，老师和家长应以正确的态度和方法对待留守儿童，以减少其孤独感的发生。     

产科新生儿不同部位经皮测黄报警预值的可靠性观察

目的对比观察产科新生儿不同部位经皮胆红素（TCB）报警预值的可靠性。方法132例产科新生儿采取随机数字分组法分为正常产组和剖宫产组各66例,新生儿均于产后第4天同一时间点应用KJ8000经皮测黄仪分别测量额、胸、腹、额胸、额胸腹TCB值,TCB〉12．9mg／dl者,取得亲属同意抽取静脉血检测血清胆红素（SB）,对比分析不同部位TCB及其与sB值的差异。结果两组分别有17例或21例达到TCB报警预值。两组TCB或sB相同方法及相同部位比较,差异无统计学意义（P〉0．05）;两组TCB不同部位对比,额部值最低、胸部值最高,且与其他部位同组对比差异均有统计学意义（P〈0．01）;两组sB值对比差异无统计学意义（t=1．53,P〉0．05）,与不同部位TCB对比均以胸部数值差异无统计学意义（P〉0．05）,而与其他部位TCB两组差异均有统计学意义（P〈0．01）。结论正常产与剖宫产新生儿术后sB对比差异无意义;TCB动态监测以胸部结果更接近SB。     

Determination of loss of quality of life

Physiatrists are a valuable resource in legal settings, where assessment of functional capacity to perform work and of future medical needs must be determined. Physiatrists help determine what future medical care is needed to restore and maintain an individual at the maximum level of life function. This article focuses on the use of a quality of life (QOL) rehabilitation model, rather than a medical model, for enhancing functional performance, modifying environments, and facilitating patient coping. We discuss use of the QOL model to describe and influence a patient's physical, psychological, cognitive, vocational/economic, and social/leisure domains.     

护士选择性应用静脉留置针现状分析

[目的]了解护士选择性应用留置针的现状以及主要影响因素,为指导临床留置针合理应用提供理论依据。[方法]采用自设问卷对138名护士留置针选择性使用情况及其影响因素进行调查。[结果]约1／4的护士并不知道应选择性使用留置针,近60％的护士在实际工作中选择留置针的意识较差;护士选择性应用留置针的决策受多因素影响;不同科室、职称及是否具有带教资格选择性应用留置针的影响因素不尽相同;绝大部分护士希望参加选择性应用留置针相关内容的培训。[结论]临床护士操作前考虑留置针选择的意识有待加强。建议实施有针对性的培训以提高护士选择性应用留置针的能力。     

血液透析患者家庭护理提供者的生活质量调查

目的:了解江汉油田血液透析(血液透析)患者家庭护理提供者(护理者)的生活质量。方法:对60例血液透析患者的家庭护理提供者进行一般情况和生活质量综合评定问卷(QOLI-74)调查,并进行相关性和多因素回归分析。结果:家庭护理提供者各维度的主观生活满意度与其客观指标相关,但也与其需求、年龄、文化程度、与患者的关系有关。结论:客观状态是影响主观生活满意度的重要因素,同时应考虑护理者的需求、年龄、文化程度、与患者的关系对护理者主观生活满意度的影响。