强的松联合霉酚酸酯与联合环磷酰胺治疗重症IgA肾病疗效比较

 目的比较强的松联合霉酚酸酯(mycophenolatemofetil,MMF)与强的松联合环磷酰胺(cyclophosphamide,CYC)治疗重症IgA肾病的临床疗效。方法84例重症IgA肾病患者分别给予强的松联合MMF治疗(MMF组,n=42),强的松联合CYC治疗(CYC组n=42)。强的松起始剂量40mg/d,MMF诱导期剂量1.5g/d,持续6个月;维持期剂量0.75~1.0g/d,持续12个月。CYC诱导期剂量为0.8~1.0g/月,静脉滴注,持续6个月;维持期剂量0.8~1.0g/3月,持续12个月。两组患者基础病情无差异,随访时间18个月,观察两组患者临床缓解率及相应实验室指标,如24h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂变化,并比较两组治疗的不良反应。结果(1)临床缓解率:治疗18个月时MMF组临床总有效率高于CYC组,分别为85.7%vs61.8%(P＜0.05);(2)观察期末,MMF组患者24h尿蛋白定量(0.6±0.3)明显低于CYC组(1.4±0.5)(P＜0.05),血浆白蛋白和总蛋白(43.2±4.3和70.2±8.1)均显著高于CYC组患者(36.9±3.6和60.3±7.6)(P＜0.05);(3)血脂变化:MMF组血脂较治疗前明显降低,而CYC组无变化(P＜0.05);(4)不良反应发生率:MMF组不良反应发生率(4.76%)明显低于CYC组(19.0%)。结论MMF组治疗重症IgA肾病,临床缓解率高于CYC组疗法,能更有效降低患者24h尿蛋白定量,改善患者血脂和血浆白蛋白水平,维持患者肾功能稳定,并且MMF组不良反应发生率显著低于CYC组疗法。     

他克莫司联合小剂量激素治疗北方IgA肾病临床研究

目的探讨他克莫司联合小剂量激素治疗北方IgA肾病患者的临床效果。方法选择自2008年1月至2010年12月于沈阳军区总医院肾内科住院的59例原发性IgA肾病患者,随机分为3组:单纯小剂量糖皮质激素治疗组(A组),小剂量糖皮质激素联合雷公藤多甙治疗组(B组),小剂量糖皮质激素联合他克莫司治疗组(C组)。观察24个月,对比3组患者治疗的有效性和安全性。结果治疗6个月后,A、B、C组完全缓解率分别为22.2%、5.6%、38.1%,3组间比较差异均有统计学意义(P<0.05);治疗12个月后,A、B、C组完全缓解率分别为27.8%、22.2%、68.4%,3组间比较差异均有统计学意义(P<0.05);治疗24个月后,A、B、C组完全缓解率分别为50%、50%、73.7%,3组间比较差异无统计学意义(P>0.05)。治疗结束时,3组患者尿蛋白水平较本组治疗前均有明显改善(P<0.05),组间比较差异无统计学意义(P>0.05)。与本组治疗前比较,A组和C组治疗后肾小球滤过率有显著改善(P<0.05),而B组治疗前后比较差异无统计学意义(P>0.05)。3组血肌酐、血糖、肝功等指标治疗前后变化无统计学意义(P>0.05)。在1、3、6、9、12、18、24个月时,他克莫司血药浓度分别为(1.75±1.81)μg/L、(1.82±1.54)μg/L、(1.97±2.48)μg/L、(1.81±1.81)μg/L、(1.69±1.38)μg/L、(1.10±1.31)μg/L、(1.34±1.47)μg/L。3组间不良事件发生率比较,差异无统计学意义(P>0.05)。结论 3种治疗方案对IgA肾病患者均有显著治疗效果,其中,激素联合他克莫司治疗组起效更快,总缓解率更高。而且,当他克莫司的血药浓度低于2.00μg/L时,其仍有良好的治疗效果。     

正清风痛宁片治疗 IgA肾病中等量蛋白尿的疗效

目的：研究正清风痛宁片治疗IgA肾病中等量蛋白尿的临床疗效。方法选择156例IgA肾病中等量蛋白尿患者（尿蛋白定量1～3 g/24 h）,按入院顺序号的奇偶数分组,正清风痛宁片联合缬沙坦治疗组（观察组）78例,缬沙坦治疗组（对照组）78例。治疗剂量：正清风痛宁片每次2片,3次/d,缬沙坦治疗80 mg,1次/d,服药并观察12个月,比较两组患者临床缓解率以及24 h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂等临床指标的变化,并观察临床不良反应。结果观察12个月,观察组临床缓解率高于对照组,分别为87．2％和56．4％（P＜0．01）;观察组24 h尿蛋白定量为（0．42±0．36）g/24 h,明显低于对照组[（1．59±0．66）g/24 h],两组相比差异有统计学意义（P＜0．05）;血浆白蛋白和总蛋白、血肌酐水平、血脂水平以及临床不良反应两组对比差异无统计学意义。结论正清风痛宁片联合缬沙坦治疗IgA肾病中等量蛋白尿,临床缓解率高于单纯缬沙坦治疗,能更有效降低24 h尿蛋白定量,无明显不良反应。     

来氟米特治疗30例难治性肾病的临床观察

目的 观察来氟米特联合激素治疗难治性肾病综合征的疗效和安全性.方法 我们选择30例难治性肾病综合征患者,给予来氟米特联合激素治疗12周(30例),观察指标为血常规、尿常规、24 h尿蛋白定量、肝功能、肾功能以及药物的副作用.结果 治疗12周后,治疗组:尿蛋白完全缓解及部分缓解27例,总有效率90%;对照组(30例):尿蛋白完全缓解及部分缓解15例,占50%.结论 来氟米特对大部分难治性肾病综合征的治疗安全可靠,值得临床推广.     

骁悉治疗难治性肾病8例

目的:总结8例难治性肾病使用骁悉即霉酚酸酯(mycophenolate mofetic,MMF)治疗的疗效及副作用,探讨扩大骁悉在肾脏病治疗范围的可能.方法:采用骁悉联合激素治疗方案.MMF初始剂量正1.5 g/d,3～6个月开始减量,疗程6～9个月.强的松1mg/kg/d,8～12周后将强的松逐渐减量.临床均表现为肾病综合症,均行肾穿检查.1例为激素加细胞毒药物正规治疗后复发轻度系膜增生性肾小球肾炎;1例为老年男性轻度系膜增生性肾小球肾炎合并急性肾功能不全;2例系老年Ⅰ期膜性肾病;1例系老年IgA肾病;1例为Ⅳ型狼疮性肾炎;1例为V型狼疮性肾炎.观察24h尿蛋白定量,血清蛋白,浮肿情况,肝肾功能等.监测血中抗核抗体(ANA),双链DNA抗体(dsDNA)效价,血沉;治疗中的不良反应.结果:均有明显的降尿蛋白效果,7例出现浮肿的病人经治疗均消肿,3例伴有轻中度肾功能不全病人均恢复正常,无1例用药后出现白细胞及其它血细胞下降,1例出现口周及四肢发麻;腹泻,一过性恶心、纳差各1例.结论:晓悉在治疗原发性难治性肾病及表现为肾病综合症的IgA肾病、狼疮型肾炎、乙肝病毒相关性肾炎等均有明显的降尿蛋白升高血清白蛋白作用,并改善肾功能,控制狼疮活动,在本文的剂量下,副作用比较小,使用安全.     

骁悉治疗难治性肾病8例

目的:总结8例难治性肾病使用骁悉即霉酚酸酯(mycophenolate mofetic,MMF)治疗的疗效及副作用,探讨扩大骁悉在肾脏病治疗范围的可能.方法:采用骁悉联合激素治疗方案.MMF初始剂量正1.5 g/d,3～6个月开始减量,疗程6～9个月.强的松1mg/kg/d,8～12周后将强的松逐渐减量.临床均表现为肾病综合症,均行肾穿检查.1例为激素加细胞毒药物正规治疗后复发轻度系膜增生性肾小球肾炎;1例为老年男性轻度系膜增生性肾小球肾炎合并急性肾功能不全;2例系老年Ⅰ期膜性肾病;1例系老年IgA肾病;1例为Ⅳ型狼疮性肾炎;1例为V型狼疮性肾炎.观察24h尿蛋白定量,血清蛋白,浮肿情况,肝肾功能等.监测血中抗核抗体(ANA),双链DNA抗体(dsDNA)效价,血沉;治疗中的不良反应.结果:均有明显的降尿蛋白效果,7例出现浮肿的病人经治疗均消肿,3例伴有轻中度肾功能不全病人均恢复正常,无1例用药后出现白细胞及其它血细胞下降,1例出现口周及四肢发麻;腹泻,一过性恶心、纳差各1例.结论:晓悉在治疗原发性难治性肾病及表现为肾病综合症的IgA肾病、狼疮型肾炎、乙肝病毒相关性肾炎等均有明显的降尿蛋白升高血清白蛋白作用,并改善肾功能,控制狼疮活动,在本文的剂量下,副作用比较小,使用安全.     

来氟米特联合科素亚与单纯应用科素亚治疗IgA肾病的对照研究

目的探讨来氟米特联合科素亚治疗IgA肾病的疗效。方法 40例IgA肾病患者按照就诊时间顺序分为单纯科素亚治疗组（科素亚组）及来氟米特联合科素亚治疗组（联合组）。分析两组治疗后1、3、6个月24 h尿蛋白定量、血浆白蛋白、肾功能变化及不良反应。结果治疗3个月时,与科素亚组[（1.28±0.49）g/d]比较,联合组[（0.92±0.53）g/d]能明显降低24 h尿蛋白定量,两组治疗前后差异有统计学意义（P〈0.05）。结论来氟米特联合科素亚治疗IgA肾病,较单纯应用科素亚能减少蛋白尿,延缓肾功能进展。     

正清风痛宁与雷公藤总苷治疗IgA肾病疗效比较

目的比较正清风痛宁与雷公藤总苷治疗IgA肾病的疗效。方法经肾穿刺活检并结合临床确诊为原发性IgA肾病53例,随机分成两组,对照组23例,服用雷公藤总苷;治疗组30例,服用正清风痛宁。结果对照组与治疗组在研究开始时各项指标间无统计学差异(P>0.05)。治疗3个月时,对照组与治疗组24h尿蛋白定量及尿RBC计数下降比值对比无统计学意义(P>0.05);但对照组副作用出现总频数为26%;而治疗组副作用出现总频数为10%。结论雷公藤总苷与正清风痛宁治疗IgAN,对于肾小球肾炎的蛋白尿及镜下血尿均有明显疗效,但正清风痛宁较雷公藤总苷副作用更少。     

米氟来特治疗难治性肾病的临床观察

目的：观察来氟米特联合激素治疗难治性肾病综合征的疗效和安全性。方法：我们选择30例难治性肾病综合征患者,给予来氟米特联合激素治疗12周,观察指标为血常规、尿常规、24尿蛋白定量、肝功能、肾功能、以及药物的副作用。结果：治疗12周后尿蛋白完全缓解：治疗组：12例,占40.0%,对照组：6例,占20.0%;部分缓解：治疗组：15例,占50.0%,总有效率为90%;对照组：9例,占30.0%,总有效率为50.0%。结论：来氟米特对大部分难治性肾病综合征的治疗安全可靠,值得临床推广。     

地黄叶总苷治疗特发性膜性肾病Ⅱ期患者疗效观察

目的探讨地黄叶总苷辅助治疗特发性膜性肾病Ⅱ期患者的临床疗效。方法选取临床诊断为原发性肾病综合征且病理类型为特发性膜性肾病Ⅱ期的患者30例,随机分为两组。A组15例患者接受常规的糖皮质激素与环磷酰胺治疗,B组15例患者在A组用药基础上加用地黄叶总苷。治疗6个月后,比较两组疗效。结果治疗6个月后,两组患者24 h尿蛋白定量均较治疗前降低,B组患者24 h尿蛋白定量低于A组,差异有统计学意义(P<0.05);两组患者血浆白蛋白水平均较治疗前升高,B组患者血浆白蛋白水平高于A组,差异有统计学意义(P<0.05);两组患者胆固醇、甘油三酯水平均较治疗前降低,B组患者胆固醇、甘油三酯水平低于A组,差异有统计学意义(P<0.05);A组不良反应发生率为53.3%(8/15),明显高于B组的20.0%(3/15),差异有统计学意义(P<0.05)。结论地黄叶总苷在治疗特发性膜性肾病Ⅱ期患者中发挥积极作用,可控制蛋白尿、升高血浆白蛋白、降低血脂。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.