集落刺激因子在血液恶性疾病中的应用指南

血液恶性疾病本身或用来治疗这些疾病的强化疗方案常引起中性粒细胞减少,由此所导致的感染的发病率和死亡率均很高,尤其在老年患者。中性粒细胞减少和感染实际上已成为化疗剂量受限的主要原因。中     

Upper Cervical Facet Joint and Spinal Rami Blocks for the Treatment of Cervicogenic Headache

(Headache 2010;50:657‐663) Objective.— To evaluate the efficacy of upper cervical facet joint injections and spinal rami blocks in the treatment of cervicogenic headache. Background.— Cervicogenic headache has been recognized as a common and often disabling disorder. The treatment of this headache type remains challenging. Methods.— We conducted a retrospective chart review of 31 patients with refractory cervicogenic headache who underwent fluoroscopically guided C_1/2, C_2/3 facet joint injections and C₂, C₃ spinal rami blocks using a mixture of 0.25% bupivacaine and 3 mg betamehtasone. The outcome measures were the change in headache severity, assessed using an 11‐point numerical pain scale, after treatment, and the duration of head pain relief. Results.— Twenty‐eight (90.3%) patients experienced >50% headache relief after treatment, with an average duration of 21.7 (1‐90) days. Mean (±SD) head pain intensity decreased from 7.5 ± 1.3 before treatment to 2.7 ± 1.9 immediately after it (P < .0001). The procedures were well tolerated. Conclusions.— C_1/2, C_2/3 facet joint injections and C₂, C₃ spinal rami blocks were effective and well tolerated for the treatment of cervicogenic headache in this study. The procedures provided significant and prolonged pain relief in the majority of patients. Larger controlled studies are needed to further evaluate the efficacy of this treatment modality in cervicogenic headache.     

Improving outcomes with recent advances in chemotherapy for castrate-resistant prostate cancer

The FDA's approval of docetaxel in 2004 created a clear mandate for clinical researchers to create new therapies effective for metastatic castrate-resistant prostate cancer (mCRPC) patients with progression post-docetaxel. In 2010, the first trial to prolong survival in this setting was announced using a cabazitaxel, a novel taxane. This therapeutic agent was specifically designed to have activity in model systems resistant to conventional taxanes. After phase I testing, with observation of clinically significant activity in patients with advanced cancers, cabazitaxel/prednisone was tested in a large phase III trial enrolling patients with mCRPC who had disease progression despite prior docetaxel therapy. This phase III trial TROPIC (Treatment of Hormone-Refractory Metastatic Prostate Cancer Previously Treated With a Taxotere-Containing Regimen), using mitoxantrone/prednisone as a control arm, demonstrated a significant improvement in survival (the primary endpoint). Both subset analyses and secondary endpoints (response rates and time to progression) were supportive of the survival findings. This trial was pivotal for the FDA's approval of the new drug application for cabazitaxel. This review focuses on both the pre-clinical and clinical development of cabazitaxel.     

新疆农村2 129例学生血红蛋白水平及相关因素分析

目的 了解新疆农村中小学生血红蛋白水平并分析其主要影响因素,为干预措施提供科学依据。方法 随机抽取国家营养改善计划重点监测县新疆莎车县和阿合县农村共6所小学和6所中学,抽取一年级到初三年级的中小学生,每个年级抽取40人,男女生各半作为调查对象,进行体格测量、血红蛋白检测和问卷调查,并采末梢静脉血检测血红蛋血,应用多因素Logistic回归分析筛选影响低血红蛋血的主要因素。结果 共调查中小学生2 129名,其中男生1 024名,女生1 105名,低血红蛋白检出率为3.1%。单因素结果显示:中小学男生、小学低年级学生、学校开设健康教育课、近一周摄入豆类食物较多、营养知识得分高以及学校提供食物摄入情况好等学生贫血检出率较低。多因素logistic回归结果显示,女学生(OR＝2.164)是高危人群;位于县城学校(OR＝0.078)、由学校食堂供餐(OR＝0.338)、学校性质为中心小学和普通中学的学校(OR＝0.505)是降低中小学生贫血的保护因素。结论 应着重加强学校营养改善计划有效实施及宣传教育,针对当地较为落后的乡镇学校,积极推进学校食堂建设和配餐指导,开展形式多样的健康教育活动,提倡合理营养,开展食育教育,树立平衡膳食的理念,是降低农村学生缺铁性贫血率的根本措施。     

Real world MRI experience with nonconditional and conditional cardiac rhythm devices after MagnaSafe

1 Introduction

The recent MagnaSafe Registry demonstrated safety of nonthoracic magnetic resonance imaging (MRI) with nonconditional cardiac implantable electronic devices (CIEDs). However, independent validation and extension to thoracic MRIs are needed.

2 Methods and results

We prospectively examined 178 consecutive patients with CIEDs who underwent 212 MRI scans (62 with implantable cardioverter/defibrillators) for clinical reasons between February 2014 and August 2016. Scans were done in standard modes with a limit of 2 W/kg. Pacing modes were ODO or OVO for intrinsic rates > 40 and DOO or VOO for rates ≤ 40. Patients were cleared prescan by both radiology and cardiology, and pre‐ and postscan CIED interrogations were performed. Primary outcome events were death and generator or lead failure. Secondary events included battery voltage loss > 0.04 V, decrease in P wave voltage > 50% or R wave voltage > 25%, threshold increase of > 0.5 V, and impedance change > 50 Ω. Scan sites were 87 (41%) C‐spine/head/neck, 28 (13%) T‐spine/cardiac/shoulder (thoracic), 69 (33%) L‐spine/abdomen/pelvis, and 28 (13%) lower extremity. No primary or secondary outcome events occurred, and no periscan disruption of pacing was noted.

3 Conclusion

In a real‐world MRI experience in patients with CIEDs representing a broad range of models, types, and scan sites (including thoracic scans), no adverse safety signals were noted. This experience validates and extends that of the large but inclusion‐restricted MagnaSafe Registry, profiles MRI scanning in CIED patients in general clinical practice, and argues against replacing nonconditional with conditional devices when MRI is performed in a carefully controlled environment.     

Chromosome imbalances in syndromic hearing loss

The cause of hearing impairment has not been elucidated in a large proportion of patients. We screened by 1-Mb array-based comparative genomic hybridization (aCGH) 29 individuals with syndromic hearing impairment whose clinical features were not typical of known disorders. Rare chromosomal copy number changes were detected in eight patients, four de novo imbalances and four inherited from a normal parent. The de novo alterations define candidate chromosome segments likely to harbor dosage-sensitive genes related to hearing impairment, namely 1q23.3–q25.2, 2q22q23, 6p25.3 and 11q13.2–q13.4. The rare imbalances also present in normal parents might be casually associated with hearing impairment, but its role as a predisposition gene remains a possibility. Our results show that syndromic deafness is frequently associated with chromosome microimbalances (14–27%), and the use of aCGH for defining disease etiology is recommended.     

Altered brain activation during response inhibition in obstructive sleep apnea

This study examined response inhibition during a Go–NoGo task in individuals with obstructive sleep apnea (OSA). Fourteen OSA patients and 14 controls were studied with functional magnetic resonance imaging. Compared to controls, the OSA group showed more false positives (error of commission) during the NoGo trials with decreased brain activation in the left postcentral gyrus, cingulate gyrus and inferior parietal lobe, as well as right insula and putamen. This is consistent with previous findings of impaired performance and decreased brain activation in OSA patients during a working memory task, suggesting that compromised brain function in response to cognitive challenges may underlie some of the cognitive deficits seen in patients with OSA.