HLH患儿血清GDF15表达水平与高铁蛋白血症发生的相关性

目的探讨噬血性淋巴组织细胞增生症(HLH)患儿血清细胞生长分化因子15(GDF15)表达水平及其与高铁蛋白血症发生的相关性。方法回顾性分析2012年1月至2014年1月舞阳县中心医院收治的25例HLH患儿的临床资料。结果观察组GDF15和铁转出蛋白(Fpn)mRNA表达水平呈正相关(r=0.54,P=0.0210.05),GDF15和铁蛋白重链(Fn-H)mRNA表达水平呈正相关(r=0.57,P=0.0130.05),铁调节蛋白2(IRP2)和Fpn表达呈正相关(r=0.50,P=0.0340.05)。结论 HLH患儿血清GDF15、Fpn和Fn-H表达水平均明显上调,GDF15和Fpn、Fn-H表达水平呈正相关,可能是HLH患儿高铁蛋白血症发生的两个关键机制。     

Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review

The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL^?1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.     

一线应用兔源抗胸腺细胞球蛋白联合环孢素治疗成人重型再生障碍性贫血疗效分析

目的 研究成人重型再生障碍性贫血(SAA)一线应用兔源抗胸腺细胞球蛋白(r-ATG)联合环孢素(CsA)免疫抑制治疗(IST)的疗效及不良反应.方法 回顾性分析我院2003年至2008年贫血诊疗中心收治的79例成人初始SAA或极重型再生障碍性贫血(VSAA)患者临床资料,评价IST疗效及分析相关因素.结果 6例患者早期死亡,73例患者可进行疗效评价,60例(82.2%)获得治疗反应,获得治疗反应的患者脱离输注血制品的中位时间为60 d.32例SAA患者均获治疗反应,治疗反应率(100%)高于41例VSAA组患者的68.3%(P=0.001).获得G-CSF治疗反应的患者较无反应者IST疗效明显增高(100%对67.5%,P=0.001).共61例(77.2%)患者出现血清病反应.获得治疗反应的患者3例复发,2例发生克隆性血液学异常.应用该方法治疗,患者预计3年总生存率为88.9%.结论 一线应用r-ATG联合CsA治疗成人SAA疗效高,不良反应轻微.

Abstract：

Objective To analyze the efficacy and side-effects of combination of rabbit antithymocyte globulin (ATG) and cyclosporine A(CsA) as the first-line immunosuppressive therapy (IST) for adult severe aplastic anemia ( SAA ) patients. Methods Adult SAA or very severe aplastic anemia ( VSAA ) patients treated with rabbit ATG + CsA as first line therapy in our hospital from 2003 to 2008 were retrospectively analysed and the therapeutic response relevant factors were analysed. Results Seventy-nine patients were enrolled. Of all these patients, 6 died within 3 months after IST. The overall response rate was 82.2% and the median time to transfusion independent was 60 days. The therapeutic response rate in 32 SAA patients ( 100% ) was significantly higher than that in 41 VSAA cases (68.3%) ( P = 0.001 ). Patients with neutrophil response to G-CSF treatment had a higher IST response rate than those without response to G-CSF ( 100% vs 67.5%, P=0.001 ). Sixty-one patients (77.2%) occurred serum sickness reaction. Three patients relapsed and two developed clonal hematological abnormdities after IST. The 3-year overall survival for all the patients was 88.9%. Conclusions Rabbit ATG in combination with CsA as first-line IST for adult SAA can lead to excellent treatment outcomes with minor adverse effects.     

TPF方案诱导化疗加同期调强放化疗治疗局部晚期鼻咽癌近期疗效观察

目的探讨TPF方案诱导化疗加同期调强放化疗治疗局部晚期鼻咽癌的近期疗效。方法本研究对46例经病理确诊的局部晚期鼻咽癌患者采用TPF方案诱导加化疗同期调强放化疗治疗,观察并记录近期疗效以及1、2年生存率,1、2年无局部复发生存率,1、2年无区域进展生存率等指标。结果治疗的总有效率为82.61%;1、2年总体生存率分别为91.30%、84.78%;1、2年无局部复发生存率分别为86.96%、80.43%;1、2年无区域进展生存率分别为91.30%、82.61%;主要毒副作用为骨髓抑制、脱发及消化道反应。结论 TPF方案诱导化疗加同期调强放化疗治疗局部晚期鼻咽癌的近期疗效良好,毒副反应小,容易被患者接受,可以临床广泛应用。     

UV therapy: Physiotherapists' perception of therapeutic efficacy and barriers to usage

This study was conducted to assess the perception of efficacy of ultraviolet (UV) light therapy and barriers to its use among physiotherapists. A purpose-designed questionnaire containing 29 items, seeking information on perception of efficacy of UV therapy and perceived barriers to its use, was administered to physiotherapists in Northwestern Nigeria. With a response rate of 97%, it was demonstrated that almost 70% of the respondents perceived UV therapy to be effective and only 59.3% of them had ever used UV therapy for treatment purposes. In general, the major barrier to the use of the modality was nonavailability of UV therapy machine (66.1%) followed by availability of a substitute treatment modality (13.5%). Lack of referral of patients with indications for possible use of UV therapy accounted for 10.2%. The study also found significant association between the use of UV therapy by the respondents and the perception of its therapeutic efficacy (p < 0.05), and perception of the modality as being abandoned by physiotherapists (p < 0.05). It was concluded that despite the low level of use of UV therapy mainly due to its unavailability, physiotherapists in Northwestern Nigeria perceived the modality as being efficacious.     

不同诱导方案对成人急性髓系白血病的应用效果及安全性研究

目的探讨不同诱导方案对成人急性髓系白血病的应用效果及安全性。方法选取2014年1月至2018年12月于该院就诊的82例急性髓系白血病患者作为研究对象,将患者按不同诱导方案分为观察组与对照组,观察组(n=42)采用去甲氧柔红霉素联合阿糖胞苷治疗,对照组(n=40)采用柔红霉素联合阿糖胞苷治疗,分析两组患者的缓解率、总有效率和不良反应情况。结果观察组总有效率为83.33%,对照组总有效率为62.50%,观察组总有效率明显高于对照组,差异有统计学意义(P<0.05);两组治疗后血小板计数、血红蛋白4级患者均稍少于2~3级患者,中性粒细胞4级患者均稍低于2~3级患者,但观察组与对照组比较,血液学不良反应率差异无统计学意义(P>0.05);观察组心律失常、肝肾功能损伤、感染及发热、出血发生率稍低于对照组,但两组非血液学不良反应率差异无统计学意义(P>0.05)。结论去甲氧柔红霉素联合阿糖胞苷对成人急性髓系白血病患者,与柔红霉素联合阿糖胞苷治疗相比疗效更好,治疗后并无明显血液、非血液不良反应增加,安全性较好。     

血清C反应蛋白、铁蛋白与糖尿病视网膜病变严重程度关系的研究

目的探讨血清C反应蛋白（CRP）、血清铁蛋白（sF）水平和糖尿病视网膜病变（DR）严重程度的关系。方法随机选取住院的2型糖尿病患者60例,根据眼底检查结果分为无糖尿病视网膜病变组（M）R）21例、非增值期糖尿病视网膜病变组（NPDR）20例、增值期糖尿病视网膜病变组（PDR）19例。比较3组患者CRP、SF水平的关系。结果CRP、SF水平在NDR组、NPDR组、PDR组中逐渐升高,3者问比较差异有统计学意义（P〈0．05）。多因素有序logistic回归分析显示CRPSF是DR严重程度的独立危险因素。结论血清CRP、SF水平和DR严重程度密切相关,应重视早期监测血清CRP和SF。     

Outpatient parenteral antimicrobial therapy (OPAT) for the treatment of osteomyelitis: evaluation of efficacy, tolerance and cost

OBJECTIVES: To evaluate the feasibility, efficacy, and cost of outpatient parenteral antimicrobial therapy (OPAT) in the treatment of osteomyelitis. SUBJECTS: 39 patients with an osteomyelitis requiring parenterally administered antibiotics for more than 4 weeks, and able to receive antibiotics at home. METHODS: All patients had a totally implanted catheter. Antibiotics were administered by continuous infusion using a portable elastomeric infusion system, which was changed every day by the patient or by the home-care nurse. Laboratory monitoring and surveillance were performed weekly. Clinical efficacy, adverse effects and quality of life were recorded. RESULTS: The most commonly used antibiotics were vancomycin (51%) and beta-lactam (44%) antibiotics. Thirty patients were available for follow-up for a minimum of 12 months after completion of therapy. Twenty-eight (93%) were considered cured of their infection with a mean of 24 +/- 4 months after completion of antibiotic therapy. Adverse effects among the study patients were rare. The 39 patients in our OPAT programme resulted in a potential saving of US $1 873 885 relative to conventional therapy. CONCLUSION: OPAT is practicable and effective and may be the best alternative treatment for patients suffering from osteomyelitis requiring intravenous therapy.     

序贯疗法、四联疗法及标准三联疗法根除幽门螺杆菌的疗效对比分析

目的对比序贯疗法、四联疗法及标准三联疗法根除幽门螺杆菌(Hp)的疗效。方法选取本院门诊Hp阳性病例105例,随机分为3组,A组采用序贯疗法;B组采用四联疗法;C组采用标准三联疗法。停药4周后复查胃镜、快速尿素酶试验及14C呼气试验,观察慢性胃炎改善、溃疡愈合及Hp根除情况。结果四联疗法与序贯疗法,对Hp阳性的慢性胃炎及消化性溃疡患者的Hp根除率、慢性胃炎改善及溃疡愈合,以及Hp感染复发率方面均显示出良好的疗效,而标准三联疗法显著劣于其他2种方案。3种方案的不良反应发率均较低,且程度轻。结论含泌剂四联疗法与序贯疗法在根除Hp、改善慢性胃炎、促进溃疡愈合以及降低复发率的疗效优于标准三联疗法,且不增加不良反应发生率及程度,可作为Hp感染初治患者的首选方案。     

128例手术治疗小儿先天性马蹄内翻足的临床效果观察

目的观察手术治疗小儿先天性马蹄内翻足的临床效果。方法纳入2005年1月~2011年12月在本院进行手术治疗的先天性马蹄内翻足患儿128例,采用腱延长+跖筋膜切断以及胫前肌外置的手术方法进行治疗,并观察手术效果和患者满意度。结果患者手术的成功率及满意率均为100%,术后随访无感染、复发及并发症发生。结论采用腱延长+跖筋膜切断以及胫前肌外置的手术方法治疗小儿先天性马蹄内翻足,只要手术操作过程准确得当,术后矫形处置得当,可以获得令患者满意的疗效。     

Investigating the effects of myofascial induction therapy techniques on pain,function and quality of life in patients with chronic low back pain

IntroductionLow back pain (LBP) is well documented as a common health problem; it is the leading cause of activity limitation and work absence throughout much of the world, and it causes an enormous economic burden on individuals, families, communities, industry, and governments. The aim of this study was to comparatively investigate the effects of myofascial induction therapy (MIT) against pain neuroscience education (PNE) on pain and function in patients with chronic low back pain (CLBP).MethodForty patients with CLBP were included and randomly divided into two groups according to the treatment program (40 min/session, 2 sessions/week during 8-week), as follows: the MIT and the PNE groups. The outcome measures were the fear-avoidance beliefs questionnaire (FABQ), Roland Morris disability questionnaire, McGill pain questionnaire, finger floor test, SF-36 quality-of-life questionnaire, and thoracolumbar fascia ultrasound imaging results. Patients were evaluated before and after treatment.ResultsWithin both groups, all outcome scores showed a significant improvement (p < 0.05). After 8-week, SF-36 physical function, physical role and mental health scores significantly improved in MIT group compared with PNE group, finger floor test score significantly decreased in MIT group compared with PNE group, and FABQ score significantly decreased in PNE group compared with MIT group (p < 0.05).ConclusionsAlthough both MIT and PNE were found to be effective on pain and function in patients with CLBP, MIT techniques were substantially better in improving the mobility of trunk flexion and quality of life in these patients.     

急性髓细胞白血病诱导治疗的进展及展望

近十年来,急性髓细胞白血病(AML)诱导治疗的进展主要体现在3个方面,①治疗强度提高;②新的治疗药物的引入;③早期治疗相关死亡率的降低.展望AML诱导治疗未来可能的发展方向也主要体现在3个方面,①靶向治疗药物的应用;②诱导治疗的个体化分层;③诱导治疗期间的支持治疗和抗感染治疗方案的优化及细化.笔者拟就AML诱导治疗的进展及展望进行阐述如下.     

CRP和SF检测在急性胰腺炎临床分型及严重程度评估中的意义

目的研究C反应蛋白(CRP)、铁蛋白(SF)的表达水平在急性胰腺炎(AP)临床分型及严重程度评估中的意义。方法收集该院2014年2月至2015年10月收治的AP患者120例,进行回顾性分析,其中重症急性胰腺炎(SAP)32例,轻型急性胰腺炎(MAP)88例,另选取30例健康体检者作为健康对照组。测定健康对照组和AP患者入院初的血清SF、CRP、淀粉酶(AMY)及脂肪酶(LPS)水平。结果与健康对照组比较,早期SAP组、MAP组的SF、CRP、AMY、LPS水平均明显升高(P0.05);SAP组的SF、CRP水平均高于MAP组(P0.05),而AMY、LPS水平与MAP组比较差异无统计学意义(P0.05);SAP组SF阳性率水平明显高于MAP组(P0.05);早期AP患者血清SF和CRP呈正相关(r=0.227,P=0.013)。结论 SF和CRP均能够作为急性胰腺炎患者分型的重要标志物,SF在判断患者严重程度上优于CRP,具有重要的临床应用价值。     

能谱CT预测同步放化疗用于中晚期食管癌效果

目的 观察能谱CT预测同步放化疗(CRT)用于中晚期食管癌效果的价值。方法 回顾性分析于CRT前后均接受能谱CT增强扫描的89例中晚期食管癌患者,根据疗效分为有效组(完全缓解+部分缓解)和无效组(疾病进展+疾病稳定)。在GE AW4.7后处理工作站于碘图中勾画病灶ROI,获得CRT前(pre-)、后(post-)病灶动脉期标准化碘值(SAI)及静脉期标准化碘值(SVI),计算CRT前后标准化碘值变化率(△SAI%、△SVI%);再于单能量图像上勾画病灶ROI,获得病灶动脉期(k_A)及静脉期(k_V)能谱曲线斜率,计算CRT前后能谱曲线斜率变化量(△k_A、△k_V)。采用受试者工作特征(ROC)曲线评价各参数评估CRT疗效的效能。结果 CRT后完全缓解5例,部分缓解51例,疾病进展31例,疾病稳定2例,即有效组56例、无效组33例;组间pre-SAI、post-SVI、△SAI%、△SVI%、post-k_A、post-k_V、△k_A及△k     

脑电生物反馈治疗失眠症疗效观察

目的观察脑电生物反馈治疗失眠症的临床疗效。方法将70例失眠症患者随机分为研究组和对照组各35例,研究组给予脑电生物反馈治疗,对照组给予药物治疗。于治疗前后采用匹茨堡睡眠质量指数量表评定睡眠质量。结果治疗后两组匹茨堡睡眠质量指数量表总分及各因子分较治疗前均有显著降低（P〈0．05或0．01）;与对照组比较,研究组匹茨堡睡眠质量指数量表总分、睡眠潜伏期、睡眠持续性、功能紊乱因子得分下降更显著（P〈0．05）,使用睡眠药物更少（P〈0．01）。结论脑电生物反馈治疗可以明显改善失眠症患者症状,提高睡眠质量。     

基线磁共振T2WI纹理预测晚期直肠癌转化治疗原发灶疗效的应用研究

目的 探讨基线磁共振成像(magnetic resonance imaging,MRI)T2WI图像纹理分析在晚期直肠癌转化治疗原发灶疗效的预测价值.材料与方法 回顾性分析临床及病理证实为晚期直肠癌的患者66例,基线行盆腔MRI平扫、增强及扩散加权成像(diffusion weighted imaging,DWI)检查...     

Short-term efficacy of exercise therapy for temporomandibular disorders: a case control study

[Purpose] This study compared the short-term outcomes of manual therapy performed by a dentist and home exercises performed by patients as a single exercise therapy program for temporomandibular joint anterior disc displacement without reduction. [Participants and Methods] In this study we included seventeen patients with temporomandibular joint anterior disc displacement without reduction, moderate or greater temporomandibular joint functional impairment, and no treatment interventions. Patients receiving treatment underwent exercise therapy at the time of their first visit, whereas those in the non-treatment group received only an explanation of the condition. We evaluated the clinical symptoms (maximum painless opening distance, pain on motion and mastication, and degree of difficulty in daily life) at the first visit and at the two-week follow-up visit. [Results] For both groups, maximum painless opening distance and degree of difficulty in daily life improved significantly. For the treatment group, the pain on motion and mastication values significantly improved throughout the assessment period. [Conclusion] An exercise therapy program may be useful for the early treatment of temporomandibular joint anterior disc displacement without disc reduction.     

A cluster randomised controlled trial on the efficacy of client-centred occupational therapy in multiple sclerosis: good process,poor outcome

Abstract

Purpose: To assess the efficacy of client-centred occupational therapy (OT) according to a client-centred process framework, as compared to usual care OT, in patients with multiple sclerosis (MS). Method: A multicentre cluster randomised controlled trial with the institution (i.e. hospital or rehabilitation centre) as the unit of randomisation was performed. A total of 269 outpatients with MS, 13 hospitals and rehabilitation centres and 29 occupational therapists participated. Primary outcomes included measures of disability, participation and autonomy. Secondary outcomes included fatigue, generic health-related quality of life, quality and evaluation of therapy, therapy compliance and therapy frequency. Measurements were taken at baseline, four months and at eight months follow-up. Results: Primary outcome measures did not show significant differences between the two interventions. Secondary outcomes revealed significant differences in favour of the usual care OT on fatigue (physical scale and total scale) and health-related quality of life (bodily pain and vitality) at four months. After eight months only significant differences on mental health were found. Process outcomes (i.e. the information scale of therapy quality and the client-centredness of the organisation) were in favour of the client-centred intervention. Conclusion: Because the client-centred intervention resulted in no effects on the primary outcomes and small but negative effects on the secondary functional outcomes, we should seriously reconsider the application of client-centred practice.

• Implications for Rehabilitation

• An increasing number of interventions claim to incorporate client-centred practice. Client-centred practice is associated with improved satisfaction but the effects on functional health-related outcomes have not been fully evaluated.

• The findings of this study show that the process outcomes of therapy were in favour of the client-centred intervention, but no effects were found on the primary outcomes and negative effects on the secondary functional health outcomes.

• It is suggested that the implementation of client-centred practice should be adjusted in order to achieve optimal health outcomes.