Clinical application of the trifoliated flap from the dorsal foot

Objective To summerize clinical application of the trifoliated flap from the dorsal foot. Methods The flaps, which were made of the first dorsal metatarsal flap,medial foot flap and lateral foot flap, were designed on the basis of the anatomy of flap whose common pedicle was anterior tibial artery or dorsal foot artery and whose other branches was medial trasal artery or medial anterior, melleolar artery and lateral tarsal artery respectively, the single flaps were harvested to repair multi-finger skin defect. The flaps from both feet were repaired digit degloving injuries. Results Thirty-one patients were treated by trifoliated flap from the dorsal foot. 29 of 31 flaps survived completely. Two flaps in patient necrosised. One flap in two patients necrosised. Conclusion The trifoliated flap from the dorsal foot is a good procedure for coverage problems in multiple-finger avulsion and digit degloving injuries. 4 refs.     

Repair of the finger pulp loss

Objective To investigate the results of flap for repair of the finger pulp defects. Methods The volar digital advancement flap, the lateral digital neurovascular island flap, the lateral digital reverse island flap and the dorsal digital flap had been undergone for 78 patients. The size of the pulp defect varied from 1.0 cm±1.0 cm to 3. 0 cm ± 3. 5 cm. Results All flaps were survived. The follow-up was 1 to 3 years. The appearance of the pulp was satisfactory with good sensory recovery. Conclusion The digital flap is an ideal method for repair of pulp loss, which is a simple and efficient procedure with minimal donor site morbidity. 2 refs.China Medical Abstracts(Surgery)     

The application of island myocutaneous flap for challenging wounds on cervico-thoracic region

Objective: To introduce the experiences in the application of island myoculaneous flap for challenging wound on cervico-thoracic region. Methods: Different myocutaneous flaps were selected according to the location, peculiarity and etiological factor of wound. There were 28 cases of island pectoralis major island myocutanuous flaps, 34 cases of latissimus dorsi island myocutaneous flaps. 19 cases of trapizius island myocutaneous flaps and 17 cases of rectus abdominis island myocutaneous flaps in this report. Results: All 98 patients with challenging wound on cervico-thoracic region were successfully treated with this method without complications, and obtained functional and cosmetic effectiveness. Conclusion : Challenging wounds in cervico-nuchal region can be repaired with pertoralis major island myoculaneous flap, latissimus dorst island myocutaneous flap and trapizius island myocutancous flap, while challenging wounds in thoracic region can be repaired with latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. Satisfactory functional and cosmetic results can be obtained.     

ORTHOPEDIC SURGERY Extremity and extremital replantation

206382Emergency repair of soft tissue defect at thmnbusing miniature flaps/Zhang Guangzheng(张光正,DeptHand Surg,Humen Hosp,Dongguan 523900)…∥Chin JMicrosurg.-2006 ,29(2) .-89 ~91ObjectiveTo report the treatment outcomes andrepair methods for soft tissue defects at thumb usingminiature flaps.MethodsSix different kinds of surgicalflaps were usedfor the repair on different thumbinjuries.They were radial lateral thumb reverse island flap,dorsalulnar thumb revers flap,first metacarpal dorsa…     

Subcutaneous island pedicle flap for aesthetic reconstruction of the face

Objective：To investigate the outcomes of subcutaneous island pedicle flap for reconstruction of the medium-sized facial skin defects. Methods： Eighty nine cases of facial defects within one cosmetic unit following removal of skin tumors or scars were reconstructed with advancement or transposition island pedicle flaps. Patient records and postoperative photographs were reviewed retrospectively. Both patients and other surgeons were asked to assess outcome variables. Results ： All flaps survived with primary healing postoperatively. Patients and surgeons judged excellent or good overall outcomes in 95.5% and 92.7% of all evaluated cases, respectively. Conclusion ： The subcutaneous island pedicle flap may be an extremely versatile and reliable method for aesthetic reconstruction of medium-sized facial defects in the patients of all time of life.     

Versatility of reverse sural fasciocutaneous flap for reconstruction of distal lower limb soft tissue defects

Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years （14-83 years） and with a medium followp period of 18 months （12-24 months）. Of all the cases of acute trauma, there were 10 eases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes （2 cases）, advanced age （〉65 years, 3 cases） and ciga- rette smoking （6 cases）. The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.     

Reverse flap based on the end dorsal branches of the digital artery

Objective To introduce the treatment outcome of the reverse flap of the end dorsal branches of the digital artery for coverage of fingertip soft tissue loss and exposed digital bone. Methods The reverse flap from the dorsal of the middle phalanx was harvested for coverage of the distal phalanx for 5 cases. Results All cases survived completely and had a satisfactory appearance. Conclusion The procedure was one of the pedicled flaps named with the finest vascular branches presently. It can avoid injury of the digital proper artery with simple procedure. 8 refs.     

Y-V vascular pedicle elongation technique in island flap transplantation

Objective To introduce a new technique for vascular pedicle elongation in island flap transplantation, and evaluate its clinical results. Methods From February 1994 to October 2001,16 cases were treated with island flap transplantation with Y-V vascular pedicle elongation technique. There were 10 males and 6 females with the age ranging from 19 to 45 years (average 26. 8 years). The locations of the primary injury were as follows: the fingers in 6 cases, the great toe in 2 cases, the other toes in 2 cases, the knee joint in 3 cases and the proximal tibia in 1 case. The flaps vascularized by a branch of "Y" pattern bifurcation were used. Both branches of "Y" shaped vascular pedicle arising form the same main vessel trink were dissected, then the main vessel trunk was severed at the division of the branches, the arc of "Y" bifurcations was then turned into "V" pattern, the length of pedicle was significantly elongated than the original pedicle. Results The operative procedures were smooth in the patients,     

Clinical application of dorsal carpometacarpal reversed island flap with dorsal metacarpal nerve to reconstruct finger

Clinical application of dorsal carpometacarpal reversed island flap with dorsal metacarpal nerve to reconstruct finger@左中男$Dept Hand,Foot Plast Surg,1st Hosp Foshan,Foshan 528000     

Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm

Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap. Methods Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm × 7 cm to 24 cm × 10 cm in size in hand and forearm after injured by motor vehicle accidents （2 cases） or crushed by machine （8 cases）. Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial （or ulnar） artery and the peroneal veins to one of the radial （or ulnar） veins and the cephalic vein respectively. The flap sizes ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months＇ follow-up. Conclusions Peroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.     

股骨远端骨折的手术治疗

目的 观察各种内固定方法治疗股骨远端骨折的临床疗效.方法 对285例股骨远端骨折患者采用股骨髁钢板、逆行髓内钉、动力髁螺钉和单独拉力螺钉内固定治疗.结果 术后随访时间8～14个月,按Hohl评分标准判定膝关节功能活动情况.术后膝关节活动度基本恢复,无明显内外翻畸形,行走基本不受限,活动时无明显疼痛.结论 手术治疗股骨远端骨折可使骨折得到解剖复位、加强内固定,有利于关节早期活动,从而使膝关节功能得以改善,且各种内固定方法各有利弊,要根据骨折具体类型选择合适的内固定方法. Abstract： Objective To explore the value of internal fixations in the clinical treatment of distal femoral fractures.Methods Two hundred and eighty-five cases of distal femoral fractures were treated with of femoral condylar plate, retrograde intramedullary nail, dynamic condylar screw and single lag screw fixation.Results The patients were followed up for 8 to 14 months. Using Hohl scoring criteria to determine knee function activities, we found all cases regained knee activity, and there was no significant internal or external varus deformity and walking was not basically limited and there was no significant pain. Conclusions Surgical treatment can make the fractures of distal femur fractures anatomic reset and rigid fixated, so it is conducive for early ambulant of the joint and to improve the function of the knee. Each internal fixation method has its advantages and disadvantages, so we must select suitable fixation according to the type of fracture.     

骨髓干细胞和伞状支撑骨移植治疗股骨头坏死的动物实验研究报告

目的 探讨骨髓干细胞移植和伞状支撑骨移植治疗股骨头坏死的效果.方法 取6只健康山羊,采用液氮冷冻法制作单侧股骨头坏死动物模型,8周后在坏死侧行骨髓干细胞移植和伞状支撑骨移植术.分别于术后3、6个月做放射学检查,观察股骨头内骨质变化.结果 实验动物一般状况良好.液氮冷冻法8周后达成股骨头坏死模型,模型侧后肢出现跛行.骨髓干细胞移植和伞状支撑骨移植术后3个月X线显示,股骨头外形恢复,股骨头内囊性低密度区消失,可见骨柱影,股骨头内骨质愈合状况良好,原塌陷已修复,股骨头无再塌陷.6个月时,治疗侧股骨头外形正常,骨密度基本均匀,骨柱影已模糊,植骨已融合,股骨头无再塌陷.正常对照侧股骨头无异常变化.结论 骨髓干细胞移植和伞状支撑骨移植术可以有效治疗骨坏死,防治股骨头塌陷,效果良好. Abstract： Objective To study the usefulness to treat the osteonecrosis of the femoral head (ONFH) with bone marrow mesenchymal stem cell transplantation and umbrella strut bone grafting. Methods Six goats were established of osteonecrosis of the femoral head models on one side by method of liquid nitrogen frozen, and then they were taken into bone marrow mesenchymal stem cell transplantation and umbrella strut bone grafting after 8 weeks. The radiological examination was made at 3 and 6 months after the bong grafting, and observed changes of bone union in the femoral head. Results The general state of the experimental animal was fine after the operation. The model of ONFH was reached on 8 weeks after liquid nitrogen frozen, and limping. After 3 months of bone marrow mesenchymal stem cell transplantation and umbrella strut bone grafting, X-ray film showed that low bone density disappeared, the shape of the femoral heads, grafting strut bone and initial bone union were fine in the head, and no repeated collapse of the head. The X-ray film showed that the shape of the femoral heads was normal, grafting strut bone was union in the head, and no repeated collapse of the head after 6 months. There was normal on the control side. Conclusions The ONFH can be treated effectively by bone marrow mesenchymal stem cell transplantation and umbrella strut bone grafting, and the collapse of the femoral head is prevented.     

复合富含血小板血浆联合牛骨形态发生蛋白组织工程骨修复兔桡骨缺损

目的 研究自体富含血小板血浆(PRP)和牛骨形态发生蛋白(bBMP)对兔桡骨缺损区骨组织代谢的影响和促进骨缺损修复的能力.方法 成年新西兰白兔36只,随机分为A、B、C三组,每组12只.A组取右侧桡骨中段2.0 cm节段性骨缺损处植入复合型组织工程骨(PRP+FG+bBMP);B、C两组右侧桡骨缺损处分别植入复合材料(PRP+FG)和复合材料(bBMP+FG).分别于术后4、8、12周各取4只兔子进行计算机图像分析、X线片和组织学切片检查.结果 A组动物实验侧新生骨在骨缺损区所占的面积百分比在4、8、12周时明显高于B、C两组(P＜0.05);B组动物新生骨在骨缺损区所占的面积百分比在术后8周、12周均多于C组(P＜0.05).结论 PRP与bBMP单独或复合应用均能促进桡骨骨缺损处新骨的生长,但三者联合应用促进骨缺损处新骨的形成效果更明显. Abstract： Objective An animal study was carried out to investigate the influence of platelet-rich plasma(PRP) and bovine bone morphogenetic proteins( bBMP)on the bone regeneration of radius defects in rabbits. Methods Thirty-six New Zealand white rabbits were divided randomly into 3 groups: A,B and C. All animals underwent general anesthesia and a 20 mm defects were made in the right radius bone. Implantation of bBMP and PRP with fibrin glue was done in group A,PRP with fibrin glue in group B,bBMP with fibrin glue in group C respectively. The animals were killed after 4,8 and 12 weeks. The specimens were observed by computer graphic analysis, X-ray and histological examination. The results were compared between the three groups. Results At 4,8 and 12 weeks after surgery, area ratio of newly-formed bone on the surface area of radius defects in group A was significantly higher than that group B and C. Area ratio of newly-formed bone on the radius in group B was significantly higher than that on the radius in group C at 8 to 12 weeks after surgery. Conclusions This study shows that the PRP and bBMP being used respectively or being combined with eath other can also improve the generation of radius defects in rabbits. But three ingredients conbined with eath other have a better effect on the generation and maturity of radius defects in rabbits than the other two groups which only contains PRP and bBMP.     

带蒂深筋膜瓣促大段组织工程骨成骨效果的观察

目的 研究带蒂筋膜瓣包裹大段组织工程骨的长期成骨效果.方法 新西兰大白兔36只,每只兔双侧桡骨制作1.5 cm骨缺损,将组织工程骨植入骨缺损处,左侧用带蒂筋膜瓣将之包裹作为实验组,右侧不用带蒂筋膜瓣包裹作为对照组.术后早期2、4、6、8、12周行X线、ECT、组织学等手段检测;远期在术后6、12个月行X线及组织学检查,评价骨缺损修复情况.结果 术后早期标本的大体观察和组织学观察看,在各个时间段,实验组的骨痂生成和血管化成度均优于对照组,从X线片和ECT可以看出,术后2周实验组和对照组比较差异无统计学意义,以后的各个时间段,实验组的骨修复效果均明显优于对照组;远期X线和组织学显示组织工程骨与兔桡骨牢固愈合,并开始塑形且出现髓腔再通,β-TCP在体内逐渐被吸收,自身架构消失.结论 早期采用筋膜瓣包裹的方法能够显著提高组织工程骨修复大段骨缺损的能力,远期组织工程骨可以完全修复兔大段骨缺损,形成正常骨组织并发挥功能. Abstract： Objective To investigate the long-term osteogenesis effects of large tissue engineered bone wraped up by blood supplied fascia. Methods Thirety -six New Zealand rabbits were subjected to operations to induce a 1.5 cm defect in rabbit' s two radiuses, which was filled subsequently with tissue engineered bone. The tissue engineering bone were wraped up by blood supplied fascia in rabbit's left radius, as the experimental group, the treatment wasn' t done to right radius, as the control group. At 2,4,6,8and 12 weeks after operation, X-ray examination, radionuclide bone scan and histological examination, were carried out to judge the osteogenesis effects. The repaired defects were evaluated by X-ray and histological examination at 6th , 12th month postoperation. Results In the early stage, gross observation and histology showed batter osteotylus generation and revascularization within 12 weeks postop-eratively experimental group than that in control group. Postoperative 2 weeks, X-ray and ECT displayed experiment group and control group do not have obvious difference, in each time later, the osteogenesis effects of the experiment group repairs was obviously superior to the control group. Longterm follow -up were performed by X -ray examination and histology at 6th, 12th month postoperatively revealed moulding of the new bones and medullary cavity recanalization, and the structure of β- TCP disappeared and gradually integrated into the new bones. Conclusions Early observation showed blood supplied fascia flap can accelerate the osteanagenesis process of tissue engineered bone. Long-term observation displayed tissue engineered bone is capable of total repair of large bone defect in rabbits by forming normal functional new bones.     

Pdx-1真核表达载体构建及其在大鼠骨髓间充质干细胞中的表达

目的 构建含有胰腺-十二指肠同源盒-1(Pdx-1)的真核表达载体,并研究其在大鼠骨髓间充质干细胞(MSCs)中的表达情况.方法 克隆Pdx-1基因,构建含Pdx-1的真核表达载体pEGFP-Pdx-1及pcDNA3.1-Pdx-1,转染MSCs,倒置荧光显微镜及逆转录聚合酶链反应(RT-PCR)检测MSCs中Pdx-1的表达.结果 测序结果 表明克隆的Pdx-1基因序列正确,构建的含Pdx-1的真核表达载体能有效的转染MSCs,并检测到该基因mRNA的表达.结论 完成Pdx-1基因克隆,成功构建含有Pdx-1基因真核表达载体,并在转化株中检测到该基因的表达,为糖尿病的细胞替代及基因治疗提供基础. Abstract： Objective To construct eukaryotic expression vector containing the pancreatic-duodenum homeobox-1(Pdx-1)and to study the expression in rat bone marrow-derived mesenchymal stem cells (MSCs). Methods Cloned Pdx-1 gene and constructed containing Pdx-1 eukaryotic expression vector pEGFP-Pdx-1 and pcDNA3.1-Pdx-1, transfected MSCs, detected the Pdx-1 expression in MSCs by invert fluorescence microscope and RT-PCR.Results Sequencing results showed that the cloned Pdx-1 gene sequence was correct, the eukaryotic expression vector containing Pdx-1 could effectively transfected MSCs and detected the gene expression at mRNA level.Conclusions The completion of Pdx-1 gene is cloned successfully and constructed containing Pdx-1 gene eukaryotic expression vector, detected the expression of the gene in the stable transfected MSCs,making preparations for the cell replacement and gene therapy of diabetes.     

骨髓间充质干细胞移植对肺气肿大鼠血浆TNF-α的作用

目的 研究移植骨髓间充质干细胞(MSCs)对肺气肿大鼠血浆肿瘤坏死因子-α(TNF-α)水平的影响.方法 将30只Wistar大鼠随机分为对照组、肺气肿组、肺气肿+MSCs治疗组,每组30只.在气管内注入脂多糖(LPS)并烟雾暴露,建立肺气肿大鼠模型,然后将培养的MSCs经尾静脉注入到肺气肿大鼠体内.观察移植后大鼠肺组织的变化,酶联免疫吸附测定(ELISA)法检测血浆TNF-α含量.结果 肺气肿组、肺气肿+MSCs移植组均出现肺气肿样病理改变,但后者较前者明显减轻.与肺气肿组比较,肺气肿+MSCs组TNF-α含量显著降低.结论 MSCs移植对肺气肿大鼠有保护作用. Abstract： Objective To investigate the effect of bone marrow mesenchymal stem cell (MSCs) transplantation on plasma TNF-α levels in rats of pulmonary emphysema. Methods Thirty wistar rats were randomized into three groupes:normal control group, pulmonary emphysema group, pulmonary emphysema +MSCs transplantation groupe. The pulmonary emphysema model of rats were established by intratracheal instillation of lipopolysaccharide twice and daily exposure to smog. Bone marrow MSCs were infused through tail vein. Morphologic changes of the lung tissues were observed. The level of plasma TNF-α were dectected using enzyme-linked immunosorbent assay. Results Destruction of alveolar walls was observed in rat lungs from pulmonary emphysema group and pulmonary emphysema +MSCs transplantation group. MSCs transplantation group significantly ameliorated the emphysematous changes. Significant differences in the levels of TNF-α between pulmonary emphysema group and pulmonary emphysema +MSCs transplantation group were observed. Conclusions MSCs therapy shows protective effects against pulmonary emphysema.     

人骨髓间充质干细胞向血管内皮细胞诱导的研究

目的 研究人骨髓间充质干细胞(HBMCs)的体外培养和向血管内皮细胞的诱导分化.方法 利用密度梯度离心法将HBMCs从人骨髓中分离出来,体外扩增.将第三代的细胞以含VEGF,bFGF的培养基定向诱导,使其向内皮细胞方向分化.利用免疫细胞化学和流式细胞学检测诱导后的细胞表型.结果 原代未经诱导的骨髓干细胞,培养3周后细胞形态呈梭形,诱导后第7天的细胞呈椭圆形或不规则形,第14天细胞大致呈铺路石样改变.免疫细胞化学显示CD31、CD34、vWF因子呈阳性,流式细胞仪测定CD31、vWF因子阳性率分别为87.5%、82.6%,双阳性率为71.2%.结论 骨髓间充质干细胞在内皮细胞生长因子和碱性成纤维细胞因子的诱导下向血管内皮细胞方向分化. Abstract： Objective To study the culture methods of human bone marrow mesenchymal stem cells(MSCs) and differentiation into vascular endothelial cells in vitro. Methods Bone marrow mesenchymal stem cells were isolated and cultivated by density gradient centrifugation method. Induce the third generation to vascular endothelial cells with vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Immunophenotypes of cells were detected by flow cytometry techniques and immunocyte chemistry after the transfection. Results After three weeks of primary culture of MSCs, the cell showed on fusiform shape. After 7 days induction, the cell showed on ellipse and irregular shape. After two weeks transfection, the cell exhibited a Cobblestone-like morphology. The cell expressed CD34,CD31,vWF after transfection by immunocyte chemistry. The positive rates of CD31 vWF were 87.5% and 82.6%, and the double positive rate was 71.2%. Conclusions Bone marrow mesenchymal stem cells can differentiate into vascular endothelial cells by treating with vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF).     

叶酸联合塞来昔布对食管癌的化学预防作用

目的 探讨选择性环氧合酶-2(COX-2)抑制剂塞来昔布联合叶酸预防食管癌的有效性.方法 将84例食管上皮轻、中重度不典型增生患者随机分为叶酸组(28例)、塞来昔布联合叶酸组(28例)以及安慰剂组(28例),连续服用12个月后,再行胃镜及病理复查.终点指标定义为食管上皮不典型增生的组织学分级有严重程度的改变,记录其逆转、稳定、进展变化,比较各治疗组疗效.结果 塞来昔布联合叶酸组的不典型增生的好转率为60.7%(17/28),显著高于对照组(P＜0.05).叶酸组对食管上皮各级不典型增生并未有显著影响.结论 塞来昔布和叶酸联合应用可能降低食管癌发病的危险,尚需进一步扩大样本量的研究. Abstract： Objective To determine the validity of celecoxib combined with folate for the prevention of esophageal carcinoma.Methods Eighty four subjects completed the trial. Subjects had histologically confirmed mild or moderate esophageal dysplasia at baseline. And they were randomly divided into three groups: folate group,celecoxib plus folate group and control group.Esophagogastroduodenoscopy was performed before and after a 12-month intervention. Per-subject change (regression, stable or progression) in the worst dysplasia grade was defined as the primary end point. Results were compared by agent group.Results The relative reverse rate of celecoxib plus folate group was 60.7%(17/28), significantly higher than that in placebo group (P＜0.05). Folate alone did not influence changes in dysplasia grade by baseline histology subgroup(P＞0.05).Conclusions Celecoxib and folate have better effects than celecoxib alone in the chemoprevention of esophageal carcinoma for high risk subjects. Further trials with larger numbers are needed to confirm these results.     

利维爱联合盐酸米多君治疗绝经后女性尿失禁的临床研究

目的 探讨利维爱联合盐酸米多君治疗绝经后女性尿失禁的有效性和可行性.方法 采用随机、双盲、安慰剂平行对照的方法对120例绝经期女性尿失禁患者进行利维爱联合盐酸米多君与安慰剂对照组的对比研究.试验组60例,利维爱2.5 mg/次,1次/d,同时加用盐酸米多君2.5 mg/次,3次/d,疗程3个月;对照组60例,给予安慰剂.均分别在给药4周和3个月时观察疗效.结果 120例均未失访,治疗组症状改善率达56.1%,恶化率达26.7%;对照组改善率达22.6%,恶化率达33.8%.治疗组症状改善率明显高于对照组,两组比较差异有统计学意义(uc≈59.9658,P＜0.01),但治疗时间的长短对疗效无明显影响(χ2≈0.6265,P＞0.05).结论 利维爱联合盐酸米多君可以改善绝经后女性尿失禁的症状,是治疗绝经后妇女尿失禁的一种有效方法. Abstract： Objective To investigate the efficacy and feasibility of liviral plus midodrine in postmenopause women with incontinence. Methods A randomized,double-blind,parallel,placebo-controlled study was carried out.One hundred and twenty postmenopause women with incontinence were involved in. Sixty cases in study group received liviral(2.5 mg/d) and midodrine (2.5 mg,thrice daily)for three months.Sixty cases in control group received placebo in the same way. Results One hundred and twenty cases completed the treatment. Incontinence improved in 22.6% of the women assigned to placebo compared with 56.1% assigned to liviral and midorine, while 33.8% of the placebo group worsened compared with 26.7% of the liviral and midorine group (P＜0.01). This difference was evident by 4 weeks of treatment,but there was no obvious greater improvement for three months of treatment (P＞0.05). Conclusions Liviral combined with midodrine hydrocholoride therapy is associated with improving urinary incontinence in older postmenopausal women with incontinence. We believe this therapy will be effective for the treatment of incontinence in postmenopause women.     

诺维本联合顺铂二线治疗晚期乳腺癌

目的 探讨诺维本(长春瑞滨)联合顺铂方案治疗蒽环类和(或)紫杉类耐药晚期乳腺癌的疗效与安全性.方法 73例蒽环类和(或)紫杉类耐药晚期乳腺癌患者接受诺维本联合顺铂方案化疗.诺维本(法国Pierre Fabre公司产品)25 mg/m2,第1天和第8天,静脉滴注;顺铂75～80 mg/m2,静脉滴注, 分割为2～5 d.3周为1个周期,每2个周期治疗结束2周后评价疗效.结果 71例均可评价近期疗效和不良反应,总有效率为63.4%(45/71),完全缓解4.2%(3/71),部分缓解59.2%(42/71),稳定32.4%(23/71),进展4.2%(3/71).既往放疗者疗效优于未放疗者(P=0.029),转移部位为单个者疗效优于多个者(P=0.005).主要不良反应为骨髓抑制和胃肠道反应.结论 诺维本联合顺铂方案是治疗蒽环类和(或)紫杉类耐药晚期乳腺癌安全有效的方案. Abstract： Objective To investigate the efficacy and security of vinorelbine combined with cisplatin in the treatment of advanced breast cancer patients resistant to antracyclines and/or taxanes.Methods Seventy-three patients with advanced breast cancer resistant to anthracyclines and/or taxanes received NP regimen:Vinorelbine(NVB 25 mg/m2,intravenous infusion, day 1,8) plus cisplatin(DDP 75-85 mg/m2,intravenous infusion in 2-5 days).Three weeks as one period of treatment.The evaluation was performed two weeks after every two periods of treatment. Results Seventy-one patients were evaluated for efficacy and toxicity of the therapy, the overall response was 63.4%(45/71),3 cases (4.2%) had complete response,42 cases(59.2%)had partial response,while 23 cases(32.4%) had stable disease and progressive disease were 3 cases(4.2%).The efficacy in patients who had received radiotherapy were more effective than those without radiotherapy(P=0.029).The efficacy in patients with single metastatic organ were more effective than those with multiple organs(P=0.005). The common toxicities were myelosuppression and gastrointestinal reactions.Conclusions Vinorelbine combined with cisplatin are tolerable and effective in the treatment of advanced breast cancer with anthracycine and/or taxanes resistance.