Antioxidant therapy for chronic hepatitis C after failure of interferon： Results of phase Ⅱ randomized,double-blind placebo controlled clinical trial

AIM： TO assess the safety and efficacy of antioxidant therapy for patients with chronic hepatitis C virus （HCV） infection.
METHODS： One hundred chronic HCV infection patients failed in interferon treatment were enrolled and randomly assigned to receive combined intravenous and oral antioxidants or placebo, or oral treatment alone, Primary end points were liver enzymes, HCV-RNA levels and histology.
RESULTS： Combined oral and intravenous antioxidant therapy was associated with a significant decline in ALT levels in 52% of patients who received antioxidant therapy vs 20% of patients who received placebo （P = 0.05）. Histology activity index （HAI） score at the end of treatment was reduced in 48% of patients who received antioxidant therapy vs 26% of patients who received placebo （P = 0.21）. HCV-RNA levels decreased by l-log or more in 28% of patients who received antioxidant therapy vs 12% who received placebo （P = NS）. In part 11 of the trial, oral administration of antioxidants was not associated with significant alterations in any of the end points.
CONCLUSION： Antioxidant therapy has a mild beneficial effect on the inflammatory response of chronic HCV infection patients who are non-responders to interferon. Combined antiviral and antioxidant therapy may be beneficial for these patients.     

Effect of artificial liver support system on patients with severe vira hepatitis:A study of four hundred cases

AIM:To assess the effect of artificial liver support system(ALSS)on patients with severe viral hepatitis,who weredivided into treatment group and control group.METHODS:Four hundred in-hospital patients enrolledduring 1995-2003 who received ALSS therapy were studiedas the treatment group.Four hundred in-hospital patientsenrolled during 1986-1994 who received other medicaltherapies served as the control group.The methods ofALSS used included plasma exchange,hemoperfusion,hemofiltration,continuous hemodiafiltration(CHDF).Theeffect of ALSS treatment was studied in patients at differentstages of the disease.RESULTS:The cure rate of acute and subacute severehepatitis in the treatment group was 78.9%(30/38),andwas 11.9%(5/42)in the control group.The improved rateof chronic severe hepatitis in the treatment group was 43.4%(157/362),and was 15.4%(55/358)in the control group.We found that patients treated with ALSS in the early ormiddle stage of the disease had much higher survival ratesthan patients in the end stage of the disease.CONCLUSION:ALSS is an effective and safe therapy forsevere viral hepatitis.     

Prevention of hepatotoxicity due to anti tuberculosis treatment： A novel integrative approach

AIM： To evaluate the ability of Curcuma Ionga （CL） and Tinospora cordifolia （TC） formulation to prevent anti-tuberculosis （TB） treatment （ATT） induced hepatotoxicity. METHODS： Patients with active TB diagnosis were randomized to a drug control group and a trial group on drugs plus an herbal formulation. Isoniazid, rifampicin, pyrazinamide and ethambutol for first 2 mo followed by continuation phase therapy excluding Pyrazinamide for 4 mo comprised the anti-tuberculous treatment. Curcumin enriched （25%） CL and a hydro-ethanolic extract enriched （50%） TC 1 g each divided in two doses comprised the herbal adjuvant. Hemogram, bilirubin and liver enzymes were tested initially and monthly till the end of study to evaluate the result. RESULTS： Incidence and severity of hepatotoxicity was significantly lower in trial group （incidence： 27/192 vs 2/316, P 〈 0.0001）. Mean aspartate transaminase （AST） （195.93 ± 108.74 vs 85 ± 4.24, P 〈 0.0001）, alanine transaminase （ALT） （75.74 ± 26.54 vs 41 ± 1.41, P 〈 0.0001） and serum bilirubin （5.4 ±3.38 vs 1.5 ±0.42, P 〈 0.0001）. A lesser sputum positivity ratio at the end of 4 wk （10/67 vs 4/137, P = 0.0068） and decreased incidence of poorly resolved parenchymal lesion at the end of the treatment （9/152 vs 2/278, P = 0.0037） was observed. Improved patient compliance was indicated by nil drop-out in trial vs 10/192 in control group （P 〈 0.0001）. CONCLUSION： The herbal formulation prevented hepatotoxicity significantly and improved the disease outcome as well as patient compliance without any toxicity or side effects.     

Efficacy and safety of pegylated-interferon α-2a in hemodialysis patients with chronic hepatitis C

AIM： To evaluate the efficacy and safety of pegylated- interferon alpha-2a in hemodialysis patients with chronic hepatitis C. METHODS： Thirty-six hemodialysis patients with chronic hepatitis C were enrolled in a controlled and prospective study. All patients were treatment naive, positive tested for anti-HCV antibodies, and positive tested for serum HCV-RNA. Twenty-two patients received 135 μg peglyated-interferon α-2a weekly for 48 wk （group A）. The remaining patients were left untreated, eleven refused therapy, and three were not candidates for kidney transplantation and were allocated to the control group （group B）. At the end of the treatment biochemical and virological response was evaluated, and 24 wk after completetion of therapy sustained virological response （SVR） was assessed. Side effects were monitored.
RESULTS： Of 22 hemodialysis patients, 12 were male and 10 female, with a mean age of 35.2 ± 12.1 years. Virological end-of-treatment response was observed in 14 patients （82.4%） in group A and in one patient （7.1%） in group B （P = 0.001）. Sustained virological response was observed in 11 patients （64.7%） in group A and in one patient in group B （7.1%）. Biochemical response parameters normalized in 10/14 patients （71.4%） at the end of the treatment. ALT levels in group B were initially high in six patients and normalized in one of them （25%） at the end of the 48 wk. In five patients （22.7%） therapy had to be stopped at mo 4 due to complications of weakness, anemia, and bleeding.
CONCLUSION： SVR could be achieved in 64.7% of patients on hemodialysis with chronic hepatitis C by a treatment with peglyated-interferon α-2a. Group A had a significantly better efficacy compared to the control group B, but the side effects need to be concerned.     

Inhibitory effects of saikosaponin-d on CCl4-induced hepatic fibrogenesis in rats

AIM： To investigate the suppressive effect of saikosaponin-d （SSd） on hepatic fibrosis in rats induced by CCh injections in combination with alcohol and high fat, low protein feeding and its relationship with the expression of nuclear factor-κB （NF-κB）, tumor necrosis factor-alpha （TNF-α） and interleukins-6 （IL-6）. METHODS： Hepatic fibrosis models were induced by subcutaneous injection of CCh at a dosage of 3 mL/kg in rats. At the same time, rats in treatment groups were injected intraperitoneally with SSd at different doses （1.0, 1.5 and 2.0 mg/kg） once daily for 6 wk in combination with CCh, while the control group received olive oil instead of CCh. At the end of the experiment, rats were anesthetized and killed （except for 8 rats which died during the experiment; 2 from the model group, 3 in high-dose group, 1 in medium-dose group and 2 in lowdose group）. Hernatoxylin and eosin （HE） staining and Van Gieson staining were used to examine the changes in liver pathology. The levels of alanine aminotransferase （ALT）, triglyeride （TG）, albumin （ALB）, globulin （GLB）, hyaluronic acid （HA） and larninin （LN） in serum and the content of hydroxyproline （HYP） in liver were measured by biochemical examinations and radioimmuneoassay, respectively. In addition, the expression of TNF-α and IL-6 in liver homogenate was evaluated by enzymelinked immunosorbent assay （ELISA） and the levels of NF-κBp65 and I-κBa in liver tissue were analyzed by Western blotting. RESULTS： Both histological examination and Van Gieson staining demonstrated that SSd could attenuate the area and extent of necrosis and reduce the scores of liver fibrosis. Similarly, the levels of ALT, TG, GLB, HA, and LN in serum, and the contents of HYP, TNF-α and IL-6 in liver were all significantly increased in model group in comparison with those in control group. Whereas, the treatment with SScl markedly reduced all the above parameters compared with the model group, especially in the medium gr     

Fecal markers of inflammation used as surrogate markers for treatment outcome in relapsing inflammatory bowel disease

AIM： To evaluate fecal calprotectin （FC） as a surrogate marker of treatment outcome of relapse of inflammatory bowel disease （IBD） and, to compare FC with fecal myeloperoxidase （MPO） and fecal eosinophil protein X （EPX）.
METHODS： Thirty eight patients with IBD, comprising of 27 with ulcerative colitis （UC） and 11 with Crohn＇s disease （CD） were investigated before treatment （inclusion）, and after 4 and 8 wk of treatment. Treatment outcomes were evaluated by clinical features of disease activity and endoscopy in UC patients, and disease activity in CD patients. In addition, fecal samples were analyzed for FC by enzyme-linked immunosorbent assay （ELISA）, and for MPO and EPX with radioimmunoassay （RIA）.
RESULTS： At inclusion 37 of 38 （97%） patients had elevated FC levels （〉 94.7 μg/g）. At the end of the study, 31 of 38 （82%） patients fulfilled predefined criteria of a complete response IUC 21/27 （78%）; CD 10/11 （91%）]. Overall, a normalised FC level at the end of the study predicted a complete response in 100% patients, whereas elevated FC level predicted incomplete response in 30%. Normalised MPO or EPX levels predicted a complete response in 100% and 90% of the patients, respectively. However, elevated MPO or EPX levels predicted incomplete response in 23% and 22%, respectively.
CONCLUSION： A normalised FC level has the potential to be used as a surrogate marker for successful treatment outcome in IBD patients. However, patients with persistent elevation of FC levels need further evaluation. FC and MPO provide superior discrimination than EPX in IBD treatment outcome.     

Detection and treatment of synchronous lesions in colorectal cancer： The clinical implication of perioperative colonoscopy

AIM： To evaluate the clinical significance of preand intra-operative colonoscopy for the detection of synchronous lesions in colon cancer.
METHODS： Two hundred and sixty-five pre-operative and 51 intra-operative colonoscopic evaluations were performed in 316 colorectal cancer patients who underwent curative resection from January 2001 to June 2006. The incidence and characteristics of synchronous lesions and their influence on surgery were evaluated.
RESULTS： Two hundred and eighty-two synchronous lesions were detected in 124 （39.2%） of 316 patients including all lesions regardless of their histologic type. True adenomatous polyps were found in 91 （28.8%） of 326 patients, and 27 （5.4% of all patients） patients had synchronous colon cancers. The preoperative identification of synchronous lesions altered the planned surgery in 37 （14.0%） of 265 patients. In 18 patients among the surgically removed cases, the lesions were removed by extending the resection range. Further segmental resection or polypectomy through enterotomy was necessary in 29 patients. Nineteen （37.2%） of 52 intraoperative colonoscopy cases had synchronous lesions. Additional surgical procedures including segmental bowel resection and polypectomy with enterotomy were necessary in 7 （23.7%） of 52 intraoperative colonoscopy cases to remove the lesions.
CONCLUSION： Synchronous colorectal polyps or cancer are frequent and their preoperative detection is important for optimal surgical planning and treatment. Intraoperative colonoscopy is a useful option in cases where a preoperative colonoscopy is not feasible.     

广州地区老年科良性前列腺增生的诊断治疗现状

Objective To evaluate the diagnostic and therapeutic status of lower urinary tract symptoms (LUTS) in the elderly outpatients with benign prostatic hyperplasia (BPH) in Guangzhou.Methods The investigation was conducted in outpatient departments for elderly patients in 3 hospitals of Guangzhou. The eligible male patients with LUTS/BPH were chosen from patients who came to the clinic in the process of investigation. Results The 29.7% (1824/6140) of them had history of LUTS/BPH previously or presently. In 134 patients received medical questionnaire, the proportion of LUTS/BPH patients with mild, middle and severe degree based on international prostate symptom score (IPSS) was 24.5%, 72.5% and 3.0% respectively. The abnormal percentage of PSA was 37. 3 %. The most common examinations that patients received were directeral rectun examination (96.8%), PSA (88. 7%) and transabdominal ultrasonography (84.8%). The 44.7% of cases were given the treatment of 5α-reductase inhibitor, and 24.7% of cases received a combination therapy of 5α-reductase inhibitor plus α receptor blocker. The 16.7% of cases were given a combination treatment of 5α-reductase inhibitor plus herbs. The proportion of therapy with α receptor blocker and herbs was similar (6.8% and 7.1% respectively). Conclusions LUTS/BPH is one of the most common diseases in elderly male patients. The examinations conducted by doctors are unreasonable.The doctors are easy to ignore inquirement of patient's history and IPSS. The drugs conducted by doctors are reasonable basically.     

Inborn Errors of Metabolism

2007164 Diagnosis, treatment and long-term following up of 223 patients with hyperphenylalaninemia detected by neonatal screening programs. YE Jun(叶军), et al. Xinhua Hosp, Shanghai Jiaotong Univ Med Sch, Shanghai Instit Pediatr Res, Shanghai 200092. Chin J Prev Med 2007;41(3);189-192. Objective To investigate the incidence of hyperphenylalaninemia (HPA) caused by different etiologic factors in China and the relationship between the phenylalanine and mental development of patients with HPAs who were diagnosed by neonatal screening and early treated. Methods Two hundred and twenty-three patients with HPA detected by neonatal screening programs were refered to us at the age of (41±27) days after birth. The differential diagnosis was performed by BH4 (20 mg/kg) loading test, urinary pterin analysis and dihydropteridine reductase (DHPR) activity determination respectively. The control of phenylalanine (Phe) metabolism, growth and mental development were evaluated in all treated patients. Related gene mutation analysis was performed in some patients. Results One hundred and twenty nine of 223 patients (57.8%) were diagnosed as phenylalanine hydroxylase deficiency (PAHD), 64 patients (28.7%) as BH4 responsive PAHD, 30 patients (13.5%) as 6-pyruvoyl tetrahydropterin synthase deficiency (PTSD). One hundred and forty-nine patients were followed at age of 4 m-22 y in our clinic. The 136 of 149 patients were treated according to different etiology at the age of 1.6 m(0.5~3.5 m) after birth. Thirteen patients were followed up without the need for treatment. All patients had normal growth development. One hundred and eight (79.4%) of 136 treated patients had normal mental development. The negative correlation(r=-0.439, P<0.01) between IQ and average Phe levels were observed in 58 patients. Twenty-eight patients were able to go to primary school or even university. Nine kinds of PTS gene mutations were found in 9 cases with PTSD, among which 286G→A and 259C→T were most commonly seen, accounting for 45%. Seven kinds of PAH gene mutations were found in 13 cases with BH4 responsive PAHD with the R2A1C (43.8%) mutation being the most frequent one. Conclusion The differential diagnosis should be quickly made in all HPA patients detected by neonatal screening. Near 80% patients early treated had normal mental development. The good control of blood Phe level is a key factor for mental development.     

14C-urea breath test in patients undergoing anti-tuberculosis therapy

AIM: Urea breath test (UBT) is a non-invasive diagnostic test for detecting the presence of Helicobacterpylori(H pylori). In this study we evaluated the effect of anti-tuberculosis therapy on the results of 14C-UBT. METHODS: Patients, with the diagnosis of tuberculosis (TB) who had a positive UBT at the point of starting anti-TB therapy, were included. None had a history of peptic ulcer disease or had taken antibiotics, bismuth compounds and/or PPI in the previous month. 14C-UBT was repeated at the end of the second month and the end of treatment period and one month after completion of treatment course. RESULTS: Thirty-five patients (23 males) were enrolled. 14C-UBT was negative in all 35 patients (100%) at the end of the second month and remained negative in 30 cases (85.7%) at the end of the treatment course. One month after completion of treatment course, UBT remained negative in 13 patients (37.1%). CONCLUSION: Our report underscores the need for caution while interpreting urea breath test results in patients undergoing anti-TB therapy. Furthermore, the combination of drugs used in this study resulted in H pylori eradication in a minority of patients.     

多重耐药铜绿假单胞菌耐药状况分析

目的 了解医院铜绿假单胞菌对常用抗菌药物的耐药谱动态变化,为临床合理选用抗菌药物提供依据.方法 应用回顾性调查方法,对本院从2005年1月至2009年6月间临床样本分离的铜绿假单胞菌的药敏试验进行对比统计分析.结果 所分离出的1125株铜绿假单胞菌对常用抗菌药物的耐药率总体呈上升趋势.耐药率最低的是美罗培南（33%）.铜绿假单胞菌对常见抗菌药物的耐药性均有显著性变化.结论 本地区铜绿假单胞菌耐药率有显著性变化,多重耐药现象严重,动态监测其耐药谱变化是防止铜绿假单胞菌的感染率攀升的重要措施.     

冠心病运动处方的最新研究进展

冠心病是目前中国成人心脏病住院和死亡第一位原因,其发病率和病死率呈逐年上升趋势。随着医疗条件的发展,心脏康复知识的普及,冠心病患者康复意识逐渐提高,人们也越来越重视运动锻炼。     

重视对认知功能障碍的临床研究

随着社会经济的发展和医学的进步,人口寿命明显延长。按照世界卫生组织的统计,我国65岁以上人口在1997年约为8000万,预计2020年将达到2亿。人口老龄化使得老年疾病成为重要的社会和医学问题,其中认知功能障碍尤为突出,表现为发病和患病率高、社会家庭负担重和患者生命质量差。欧洲2000年的流行病学统计表明认知功能障碍的发病率是脑卒中的1．5-3．0倍,患病率分别是脑卒中和帕金森病的2-4倍及4-6倍。我国最新的流行病学调查结果显示我国痴呆的患病率与欧美发达国家相当,65岁以上人群的痴呆患病率为7．5％,     

Impact on physical fitness on cognitive aging

Cognitive vitality is one of the determining factors of autonomy in the elderly. Aging is often accompanied by important changes in the central nervous system, which may lead to cognitive decline. Several factors seem however to modulate the effect of aging on cognition. For instance, older adults who engage in regular physical activity have better performances in tests implying decision-making process, memory and problems solving. This article draws up a portrait of normal aging while being interested in the impact of the physical fitness on cognition in the elderly. Although further researches are needed to elucidate the mechanisms by which physical fitness enhance cognition in old age, recent studies have shown that improving physical fitness leads to better performances in tasks assessing a diversity of cognitive domains. Moreover, the impact of physical fitness appears to be heterogeneous, being of greater amplitude in tasks that tap executive functions. It thus seems that physical training could serve to enhance and maintain cognitive vitality in older adults.