高强度聚焦超声治疗肝癌的疗效观察

目的探讨高强度聚焦超声(HIFU)对不能手术切除的肝癌患者的疗效、安全性及对肿瘤标志物的影响。方法15例肝癌患者采用平均接受3次高强度聚焦超声(HIFU)治疗,对其进行疗效评价,观察患者的临床受益反应、化学免疫分析法检测CA19-9和AFP浓度。结果15例患者血液检查CA19-9、AFP均有不同程度下降,且有统计学差异(P<0.05或P<0.01)。其中CR3例,PR9例,CR+PR80%,肝脏急性不良反应1级3例,2级1例,无3、4级不良反应。结论高强度聚焦超声能控制肝癌肿瘤进展、改善生活质量、对肿瘤标志CA19-9、AFP有明显下调作用,无明显不良反应。     

高强度聚焦超声通过TRIF介导的ERK通路增强乳腺癌的顺铂化疗敏感性

目的　探究高强度聚焦超声（HIFU）通过β干扰素TIR结构域衔接蛋白（TRIF）介导的细胞外调节蛋白激酶（ERK）通路增强乳腺癌顺铂（DDP）化疗敏感性的作用机制。方法　依次增加DDP浓度间歇作用的方法诱导乳腺癌细胞（MDA-MB-231、MCF-7）/DDP耐药细胞;将MDA-MB-231/DDP、MCF-7/DDP细胞分为control组、HIFU组、HIFU+二甲基亚砜（DMSO）组、HIFU+漆黄素（fisetin）组。CCK-8检测细胞活力;集落形成实验检测细胞增殖情况;流式细胞术检测细胞周期及凋亡情况;Western blot检测细胞TRIF蛋白、耐药相关蛋白及ERK通路蛋白表达;体内成瘤实验检测肿瘤生长情况;免疫组化染色法检测肿瘤组织Ki-67的表达。结果　与亲本MDA-MB-231及MCF-7细胞相比,在相同浓度DDP处理下MDA-MB-231/DDP及MCF-7/DDP细胞活力更高,且半数抑制浓度（IC50）显著增加（P＜0.05）,成功建立了稳定的DPP耐药细胞系;与control组相比,HIFU组MDA-MB-231/DDP及MCF-7/DDP细胞IC50、OD450值、克隆细胞数、S期细胞百分比、B淋巴细胞瘤-2基因（Bcl-2）、TRIF、p-糖蛋白（p-gp）、多药耐药基因1（MDR1）、p-ERK1/2/ERK1/2表达水平显著降低,G0/G1期细胞百分比、细胞凋亡率、Bcl-2关联X蛋白（Bax）表达水平显著增加（P＜0.05）;与HIFU组相比,HIFU+fisetin组细胞IC50、OD450值、克隆细胞数、S期细胞百分比、Bcl-2、TRIF、p-gp、MDR1、p-ERK1/2/ERK1/2表达水平显著增加,G0/G1期细胞百分比、细胞凋亡率、Bax表达水平显著降低（P＜0.05）。与control组相比,HIFU组肿瘤体积、肿瘤质量、TRIF及p-ERK1/2/ERK1/2表达水平、Ki-67阳性表达显著降低（P＜0.05）;与HIFU组相比,HIFU+fisetin组肿瘤体积、肿瘤质量、TRIF及p-ERK1/2/ERK1/2表达水平、Ki-67阳性表达显著增加（P＜0.05）。结论　HIFU通过抑制TRIF表达来抑制其介导的ERK通路,从而增强乳腺癌DDP化疗敏感性。     

1例心理护理高强度聚焦超声治疗妇科肿瘤患者的体会

目的消除患者和家属对高强度超声聚焦刀治疗的疑虑,获得患者和家属的认同,配合治疗。方法运用心理护理技巧建立良好的护患关系,协助建立良好的社会支持系统;详细介绍HIFU治疗的原理、优势及治疗注意事项,介绍成功病例,增加患者和家属对治疗的信心。结果患者和家属充分了解HIFU治疗的知识,消除对新治疗方式的顾虑,使患者积极配合治疗。结论 HIFU治疗是一种新的治疗方法,患者和家属需要一个认知和接受的过程,建立良好的护患关系有助于护理人员开展HIFU治疗的卫生宣教,及时消除患者和家属的怀疑、恐惧、焦虑的心理,通过心理护理,可以获得患者的认同、家属的支持,患者积极配合治疗。     

Spontaneous pneumomediastinum: ten years of our experience in diagnosis and outcome

Spontaneous pneumomediastinum (SPM) is a rare clinical condition that may be mild but also dramatic with sudden onset of chest pain and dyspnea accompanied by swelling and subcutaneous crepitations. The objective of this study was to analyze the clinical presentation and outcome of SPM in a specialized pulmonary tertiary care centre over a 10 years year period. In subsequent followup, we received information related to recurrence episodes of SPM by patients or their GPs physicians. Eighteen patients, 15 (83%) men, mean age 24 years (SD ±7.86) were diagnosed with SPM. Predominant symptoms were chest pain and cough (n=11) then dyspnea (n=9). Asthma was the most common predisposing condition (n=12). Pneumomediastinum was present on chest radiograph in 17 cases (94%), and in one case it was detected only by computed tomography. The mean length of hospital stay was 7 days (SD ±4.4 days). All our patients recovered and there were no complications. Recurrent event occurred in one asthma patient, 2 years after the first episode. Although, SPM is usually a self-limiting and benign condition, close monitoring is necessary. Recurrence is rare, but possible, with no evidence that routine monitoring of those patients is needed.     

Findings of ten years of clinical drug screening

During the years from 1977 to 1986, 21,410 specimens were collected for clinical drug screening from 13,589 patients. The specimens included 9,530 blood samples, 9,184 urine samples and 2,717 samples of gastric contents. One or more drugs/drug metabolites were detected in 74% of the specimens. Gastric contents were positive most often (85%) followed by urine (79%) and blood (66%). Although the 5 most frequently detected drugs did not change (caffeine, ethanol, nicotine, salicylates and acetaminophen), the presence of cocaine, phenylpropanolamine, diphenhydramine and the group of cyclic antidepressants steadily increased over the time period. Over 200 different drugs/drug metabolites were detected in the drug screens, contributing a significant amount of information for the appropriate diagnosis and treatment of the patients for which the testing was requested.     

高强度聚焦超声消融治疗子宫肌瘤的影像学评估进展

评估高强度聚焦超声(HIFU)消融治疗子宫肌瘤疗效的影像方法括超声、CT和MRI,本文对各种影像学评估方法进行综述,特别是超声、MRI对高强度聚焦超声消融治疗子宫肌瘤的影像评估进展.     

Dobutamine: ten years later

Dobutamine is a commonly used positive inotrope for the short-term management of heart failure. It is commercially available as a 50:50 mixture of two isomers with unique effects on alpha- and beta adrenergic receptors. In dosages of 2-15 micrograms/kg/minute, dobutamine has been shown to increase cardiac output (mainly through stroke volume), reduce systemic vascular resistance, lower central venous and pulmonary artery wedge pressures, improve renal blood flow, and relieve signs and symptoms of congestive heart failure. At higher dosages it can increase heart rate and induce arrhythmias. Recent evidence indicates that effects of dobutamine last long after the drug has been eliminated from the plasma, and some work has been done on ambulatory use of this agent. Dobutamine has been used successfully in several circumstances, such as after cardiac surgery, in patients with myocardial infarction, and in various shock states. An understanding of the pathophysiology of the underlying disorder is important in deciding which catecholamine to use. With this in mind, monotherapy or combination therapy with inodilators such as dobutamine, or inopressors like dopamine will follow logically.     

高强度聚焦超声消融治疗结合超声引导下清除子宫壁妊娠1例

目的　探讨高强度聚集超声（HFIU）消融治疗结合宫腔镜检查及超声引导下清除子宫壁妊娠的效果。方法　对广州市越秀区妇幼保健院2021年收治的1例子宫壁妊娠患者进行HFIU消融治疗结合宫腔镜检查及超声引导下清除。结果　总共治疗时间仅需要2 d,手术出血仅10 ml;术后阴道流血持续5 d干净;血β人绒毛促性腺激素（β-hCG）术后第1天即明显下降,3周左右血降至正常;术后6周左右恢复正常月经,治疗效果满意。结论　子宫壁妊娠HIFU消融治疗+超声引导下病灶清除术治疗时间短、损伤小、恢复快且治疗效果满意,可以作为子宫壁妊娠治疗方案的一种好的选择。     

高强度聚焦超声治疗盆腹腔中晚期恶性肿瘤疗效观察

目的 观察高强聚焦超声治疗盆腹腔中晚期恶性肿瘤的近期疗效.方法 采用高强聚焦超声治疗盆腹腔恶性肿瘤共46例,观察其影像学、肿瘤标志物变化及疼痛的改善,了解治疗过程中并发症.结果 根据彩超影像变化,采用高强聚焦超声治疗后有效率达89%;治疗前肿瘤标志物呈阳性,对晚期恶性肿瘤合并疼痛者,治疗有效率达80%.46例患者治疗中仅有1例发生皮肤浅度烧伤,无其它并发症及不良反应.结论 高强聚焦超声治疗盆腹腔中晚期恶性肿瘤具有无创伤,疗效确切、并发症少等优点,是治疗中晚期腹腔、盆腔恶性实体肿瘤的一种新的有效的局部治疗方法.     

A pattern of acute poisoning in children in urban Zimbabwe: ten years experience.

1. A retrospective analysis was performed to evaluate the epidemiology of poisoning in children based on admissions to six of Zimbabwe's main urban hospitals over a 10-year period from 1980 to 1989 inclusive. 2. A total of 2873 cases were children aged between 0-15 years. This constituted 47.8% of poisoning cases from all age groups (6018) recorded during the study period. 3. All of the children (0-15 years) had signs and symptoms of poisoning on admission and, depending on their severity, were admitted to a ward or to an intensive care unit. A total of 4.9% (141) died. Most of those who died were suicide cases among the 11-15 year age group and accidental poisonings among the 0-15 year old group. 4. The under 0-5 age group constituted the majority of cases (75.4%) in the 0-15 age group, and most were between 1 and 3 years old. The 6-10 and 11-15 age groups formed 12.6% and 12% of the cases, respectively. The sex distribution showed that 53.1% were male. 5. Most incidences were accidental (93.2%). Suicides and parasuicides accounted for 1.9% and there were only two homicides. 6. The commonest toxic agents were: household products (27.2%), traditional medicines (23.%), venoms from snake bites and insect stings (16%) and therapeutic agents (12.4%). Of the therapeutic agents the most frequently implicated were antipsychotics 18.9%, analgesics 16.8%, anti-infectives 11.7%, anticonvulsants (8.2%) and benzodiazepines (7.7%).(ABSTRACT TRUNCATED AT 250 WORDS)     

The smoking habits of New Zealand doctors: a review after ten years.

A second survey of New Zealand doctors' smoking habits in 1972 elicited an 83 percent response from 3113 doctors. 38.5 percent had never smoked compared with 23.8 percent in a 1963 survey; 29.2 had given up smoking, and 33.3 percent still smoked. Only 21.3 percent smoked cigarettes compared with 35.3 percent in 1963. There has been a sustantial increase in non-smokers among recent graduates. Both sexes now smoke cigarettes less frequently but pipe and cigar smoking by male doctors has risen sharply. Obstetricians smoke cigarettes more often than other groups of doctors, while pathologists, medical administrators and academics smoke the least. Giving up smoking was not difficult for most former smokers except for the heavy smokers who now make up most of the persistent smoker group.     

Eptastigmine: ten years of pharmacology, toxicology, pharmacokinetic, and clinical studies

Eptastigmine (heptyl-physostigmine tartrate) is a carbamate derivative of physostigmine in which the carbamoylmethyl group in position 5 of the side chain has been substituted with a carbamoylheptyl group. In vitro and ex vivo results suggest that eptastigmine has a long-lasting reversible brain cholinesterase (i.e., acetylcholinesterase and butyryl-cholinesterase) inhibitory effect. When administered in vivo to rodents by various routes, eptastigmine inhibits cerebral acetylcholinesterases (AChE) and increases acetylcholine (Ach) brain levels by 2500-3000%, depending on the dose. This effect leads to an improvement in the cerebral blood flow in the ischemic brain, excitatory and inhibitory effects on the gastrointestinal tract and to a protection from acute soman and diisopropylfluorophosphate intoxication. Eptastigmine, by either acute or chronic administration, has been found to have memory enhancing effects in different species of normal, aged and lesioned animals. It also restored to normal the age-related increase of EEG power without affecting spontaneous motor activity. Clinical investigations on more than 1500 patients with Alzheimer's disease demonstrated that eptastigmine significantly improved cognitive performance (as assessed by the cognitive subscale of the Alzheimer's Disease Assessment Scale) as compared with placebo. This improvement was most evident in patients with more severe cognitive impairment at the baseline. The relationship between patient performance and average steady-state AChE inhibition was described by an inverted U-shaped dose-response curve. Pharmacokinetic studies have revealed that after oral administration eptastigmine is rapidly distributed to the tissues and readily enters the CNS, where it can be expected to inhibit AChE for a prolonged period. Eptastigmine is generally well tolerated and the majority of adverse events (cholinergic) were mild to moderate in intensity. However, the adverse hematologic (granulocytopenia) effects reported in two studies have resulted in the suspension of further clinical trials.     

急性胰腺炎410例住院患者临床分析

目的　探讨急性胰腺炎的临床特点、诊断和治疗的若干问题。方法　对 1993年 1月至 2 0 0 3年 1月期间住院的急性胰腺炎患者 4 10例作回顾性分析 ,总结其临床特点 ;并对不同的诊断方法进行评价。对急性胰腺炎的诊断标准提出意见。结果　腹痛为急性胰腺炎的必有症状 ,呕吐后腹痛不缓解可与急性胃炎相区别。症状、血清酶学及影像检查三者结合可对急性胰腺炎作出正确诊断。腹部 CT对诊断有重要价值。每个急性胰腺炎患者均须给予严密监测 ,以防止其病情发展为急性重症胰腺炎。凡腹痛严重伴有 1个以上的脏器功能障碍表现者 ,即应考虑为急性重症胰腺炎并及时治疗。结论　急性胰腺炎为常见病 ,近年来有增多趋势。重症胰腺炎预后凶险 ,须提高警惕早期诊断 ,并予以有效治疗。     

近十年国内外药物依赖的脑功能成像研究概况

药物滥用已成为当今世界上严重的公共卫生及社会问题,其特征为反复大量地使用与医疗目的无关的、具有依赖性潜力的物质,以追求药物所致的欣快效应.滥用者个体尽管明白使用成瘾物质会带来明显的危害,但还在继续使用,自我用药的结果导致耐受性增加、戒断症状和冲动性觅药行为[1].近年来,通过不断的研究分析,药物依赖被绝大多数学者归类为精神与行为异常,被认为是一种顽固的反复发作的慢性脑病,大脑被锁定为成瘾的主要"战区".多年来对脑的研究采用了形态学、生理学、电生理学、生化、脑的结构和功能成像等方法,各自在一定程度上阐述了药物依赖的脑中枢机制.在诸多以大脑为对象的成瘾研究方法中,脑功能成像因其具有能够活体、无创伤及动态地进行脑研究的独到优势而得到了日益广泛的应用,在药物依赖的研究中发挥着越来越重要的作用.     

聚焦超声治疗慢性宫颈炎临床疗效分析

目的探讨聚焦超声治疗慢性宫颈炎的临床疗效，评价聚焦超声治疗的有效性、安全性及可行性。方法对2006年7月至2007年1月，采用聚焦超声治疗的300例慢性宫颈炎患者的临床资料进行回顾性分析。患者年龄21～52岁，平均35．6岁。平均病程2年（3个月～5年），于治疗后3个月评价其疗效（分为痊愈，显效，有效，无效，以治愈及有效例数计算有效率）。结果300例患者随访资料完整，治疗后3个月，痊愈247例（占82．3％），显效24例（占8％），有效15例（占5％），无效14例（占5％）。结论聚焦超声是当前治疗慢性子宫颈炎行之有效的新方法，值得在临床上进一步推广应用。     

Migraine, ten years of progress

In the past ten years, migraine has really entered the field of science, with a number of major advances Despite theses advances, a lot has still to be done to understand what migraine really is and to improve the management of migraine sufferers.