新生儿溶血病D-二聚体变化的临床研究

目的探讨新生儿溶血病D-二聚体水平变化及临床意义。方法选取新生儿溶血病患儿60例,按照胆红素水平分为非重度组（34例）和重度组（26例）。同期出生的40例正常足月儿为对照组。检测各组D-二聚体及纤维蛋白原(FIB)水平的变化。结果重度组、非重度组D-二聚体水平[分别为(9.29±11.34)、(0.84±0.77) mg/L]明显高于对照组[(0.45±0.06) mg/L](P＜ 0.01或＜0.05),重度组明显高于非重度组(P＜0.01)。各组FIB水平比较差异无统计学意义(P＞0.05)。结论重度新生儿溶血病患儿体内存在高凝状态,血浆D-二聚体水平测定对新生儿溶血病患儿的病情判断和治疗有一定的价值。     

Intracranial circulation: pulse-sequence considerations in three- dimensional (volume) MR angiography

The technique and feasibility of magnetic resonance (MR) angiography of intracranial vessels were studied in 35 healthy volunteers. Variations in image orientation, repetition time (TR), and flip angle were evaluated to determine their effects on flow-related enhancement. Gradient modifications--including echo time (TE), motion compensation, bandwidth, and field of view--were also studied in an effort to reduce motion-induced phase shifts. Results indicated that a FISP (fast imaging with steady precession) sequence with a TR of 50 msec, TE of 15 msec, velocity compensation in the read and section-select directions, acceleration compensation in the read direction, anisotropic volume, and a 1.25-mm partition thickness produced three-dimensional angiographic MR images that were accurate and reproducible in the depiction of the major intracranial vessels. Difficulties with field of view, persistent signal void secondary to higher-order motion, and spatial resolution remain major problems requiring additional study.     

A randomized study of high-dose cytarabine in induction in acute myeloid leukemia [see comments]

High-dose cytarabine (ara-c) may overcome cytarabine resistance in leukemic blasts. It has been used as a successful salvage and in postremission therapy but not as initial induction treatment. Patients aged 15 to 60 years, presenting with newly diagnosed acute myeloid leukemia (AML) were randomized to receive either high-dose cytarabine, 3 g/m2 12 hourly on days 1, 3, 5, and 7 for 8 doses, daunorubicin 50 mg/m2 days 1 to 3, etoposide 75 mg/m2 days 1 to 7, (HIDAC-3-7) or standard dose cytarabine 100 mg/m2 continuous intravenous infusion for 7 days with daunorubicin and etoposide at the same dose and schedule as above (7-3-7). Patients could receive a second or third induction course if complete remission (CR) was not achieved. All patients received the same postinduction consolidation therapy (5-2-5) for 2 courses. Eligible patients had no prior chemotherapy or myelodysplastic disease. Patients have been followed for a median of 4.5 years. Of 301 patients treated, complete response (CR) was achieved in 71% with HIDAC- 3-7 and 74% with 7-3-7. For patients in CR, the estimated median remission duration was 45 months with HIDAC-3-7 and 12 months with 7-3- 7 (P = .0005 univariate analysis, P = .0004 multivariate analysis). The estimated percentage of patients relapse free 5 years after achieving a CR was 49% on HIDAC-3-7 and 24% on 7-3-7. Patients in CR tended to survive longer with HIDAC-3-7 but there were no overall survival differences between the two arms. HIDAC-3-7 was associated with significantly more toxicity in induction with more leukopenia, thrombocytopenia, nausea, and vomiting and eye toxicity (all P < .001) but a similar incidence of severe central nervous system and cerebellar toxicity compared to 7-3-7. The consolidation treatment was the same in both arms but caused significantly more leukopenia and thrombocytopenia in patients previously treated with HIDAC-3-7 induction (P < .0001). We conclude that a dose-effect exists for cytarabine in AML and that HIDAC- 3-7 prolongs remission duration and disease-free survival and is tolerable when used as initial induction therapy in patients with de novo AML.     

脑卒中二级预防管理的最佳证据总结

目的 检索并获取脑卒中患者二级预防管理的相关证据,并对最佳证据进行总结。方法 系统检索15个数据库,涉及脑卒中二级预防管理的所有文献,包括指南、专家共识、证据总结、系统评价。检索时限为建库至2022年2月。由２名研究者独立对文献进行质量评价,并对符合标准的文献进行证据提取与总结。结果 共纳入15篇文献,包括指南5篇、专家共识2篇、证据总结2篇、系统评价6篇,最终总结出34条证据。结论 本研究通过总结脑卒中二级预防管理的最佳证据,旨在为临床实践提供循证依据,从而提高医务人员对脑卒中患者二级预防管理的关注度和管理的科学性。     

不同抗生素用药方案在预防腹膜透析置管术后腹膜炎中的比较

目的比较不同预防性用药方案在新置腹膜透析导管患者的使用情况,探讨抗生素用药在预防新置腹膜透析导管患者术后发生腹膜炎的重要性。方法回顾性分析2008年10月至2012年10月在北京大学深圳医院肾内科腹膜透析中心接受腹膜透析置管术开始行腹膜透析治疗的患者173例。按照预防性使用抗生素方法分为3组,A组:患者在腹膜透析置管术后3天内使用含有头孢唑啉0.25g/L的腹透液,共计101例次;B组:患者在腹膜透析置管术前3h静脉滴注头孢唑林0.5g,共计48例次;C组:患者术前及术后3天均未使用抗生素,共计24例次。比较3组患者术后14天内腹膜炎的发生率。结果 A组101例患者中1例出现腹膜炎,发生在术后第11天,占0.99%;B组48例患者中2例出现腹膜炎,均发生在术后第1天,占4.17%;C组24例患者中4例出现腹膜炎,3例发生在术后第1天,1例发生在术后第2天,占16.67%。对3组患者腹膜炎发生率进行两两比较,A组与C组比较,P=0.005,P<0.01,差异有统计学意义;B组与C组比较,P>0.05,差异无统计学意义;A组与B组比较,P>0.05,差异无统计学意义。结论腹膜透析置管术围手术期预防性抗生素用药十分有必要,术后腹腔内给药或术前一次静脉用药能有效预防术后腹膜炎发生。     

氟伐他汀防治大鼠放射性胸膜炎的实验研究

目的观察氟伐他汀对大鼠放射性胸膜炎的防治作用。方法采用随机数字表法,将80只健康雌性SD大鼠分为对照组（n=8）、单纯放射组（n=36）、氟伐他汀组（n=36）。氟伐他汀组于照射前1周,给予20mg／（kg·d）氟伐他汀灌胃,直至活杀,其他组灌服等量生理盐水。单纯放射组和氟伐他汀组采用直线加速器全胸部照射,单次剂量20Gy。照射后对大鼠进行x线透视扫描,并在第15d、30d、60d以3．5％水合氯醛麻醉大鼠,剪开胸腔,对有胸水者进行病理和生化检查。结果单纯放射组放射性胸膜炎发生率为41．7％（15／36）。氟伐他汀组放射性胸膜炎发生率为19．4％（7／36）。两组之间的差异有统计学意义（x2=4．19,P〈0．05）。经过对比发现氟伐他汀组病理学改变轻于同期的单纯放射组。结论放射性胸膜炎在放射性肺损伤的早期即可出现,氟伐他汀能有效防治大鼠放射性胸膜炎。     

Central drive and ventilatory failure in late-onset Pompe disease: At the gates of a new phenotype

Subjects with late-onset Pompe disease (LOPD) typically present as slowly progressive proximal muscle weakness. Respiratory muscle weakness and diaphragmatic paralysis are common features, and may be the initial manifestation of the disease. There is often a poor correlation between the severity of limb and respiratory muscle weakness. Early clinical observations about disproportionate hypercapnia to the respiratory muscular weakness in late-onset Pompe disease were recognized and will be discussed with special reference to blunted respiratory drive, and the connections between early clinical observations, respiratory functional studies and anatomical findings. According to new evidence about blunted respiratory drive in Pompe disease, it is necessary to rethink what is meant by “asymptomatic Pompe disease” and propose a new phenotype with its therapeutic implications. The conceptual model of the mechanisms leading to respiratory failure in this disease could be considered according to these new findings. It may broaden the diagnostic spectrum of the adult forms and warrants a closer interaction between neurologists and pulmonologists. The recognition of this new phenotype of predominant central alveolar hypoventilation in Pompe disease will improve the understanding of the underlying mechanisms of ventilatory failure and could lead to improved future therapeutic strategies.