T4N (+)Ⅲ期食管胸中下段癌3DRT长期生存分析

目的 观察T₄N (+)Ⅲ期食管胸中下段癌IMRT长期生存情况及不良反应。方法 2004-2010年间300例T₄N (+)Ⅲ期食管中下段癌患者采用3DCRT 202例、IMRT 98例,常规分割照射剂量60 Gy。比较两种不同治疗方式的长期生存情况及不良反应。Kaplan Meier法计算生存率并Logrank法检验。结果 5、7年样本量分别为239、120例。3DCRT和IMRT组1、3、5、7年LC率分别为64.4%、40.6%、38.3%、34.2%和68.3%、55.3%、51.9%、51.9%(P=0.048),OS率分别为54.5%、19.8%、14.7%、10.9%和63.3%、34.7%、24.4%、20.3%(P=0.013)。分层分析显示年龄>65岁、放疗前食管造影长度>8.0 cm、CT最大横径>4.6 cm、GTV>60 cm³、邻近组织或器官受累、非手术 N₂期、未行化疗者,IMRT组OS率高于3DCRT组(P=0.022、0.003、0.022、0.034、0.016、0.044、0.047)。IMRT组GTVD_min、GTVD₁₀₀高于3DCRT组(P=0.000、0.000),脊髓D_max低于3DCRT组(P=0.000)。IMRT组急性放射性食管炎发生率明显高于3DCRT组,以轻度(1-2级)食管炎为著(P=0.000)。3DCRT组死于肿瘤局部因素的比率明显高于IMRT组(P=0.039)。结论 局部晚期食管胸中下段癌IMRT安全有效,LC率明显提高,正常组织保护良好,长期生存获益显著。基于回顾分析结果还有待前瞻性随机对照研究的证实。     

Hyperbaric oxygen therapy combined with Schwann cell transplantation promotes spinal cord injury recovery

Schwann cell transplantation and hyperbaric oxygen therapy each promote recovery from spinal cord injury, but it remains unclear whether their combination improves therapeutic results more than monotherapy. To investigate this, we used Schwann cell transplantation via the tail vein, hyperbaric oxygen therapy, or their combination, in rat models of spinal cord contusion injury. The combined treatment was more effective in improving hindlimb motor function than either treatment alone; injured spinal tissue showed a greater number of neurite-like structures in the injured spinal tissue, somatosensory and motor evoked potential latencies were notably shorter, and their amplitudes greater, after combination therapy than after monotherapy. These findings indicate that Schwann cell transplantation combined with hyperbaric oxygen therapy is more effective than either treatment alone in promoting the recovery of spinal cord in rats after injury.     

扶正解毒通络法治疗糖尿病足

目的观察扶正解毒通络法治疗糖尿病足(气血亏虚、湿毒内蕴证)患者的临床疗效。方法将90例糖尿病足(WagnerⅡ级或Ⅲ级),中医辨证属气血亏虚、湿毒内蕴证的患者随机均分成3组。其中治疗组A 30例,治疗组B 30例,对照组 30例。对照组予以西医内科常规治疗和蚕食清创,治疗组A在对照组基础上联用扶正解毒、通络生肌膏外用,治疗组B在治疗组A基础上内服中药汤剂。对比3组患者治疗前后中医证候积分、ABI、TcPO2、CRP、ALB、感觉阈值、创面面积等变化。4周为1个疗程,共治疗3个疗程。结果单纯西医内科常规治疗和蚕食清创的对照组临床总有效率为66.7%,加用中药膏外用的治疗组A临床总有效率83.3%;而内服汤药联合外用膏药治疗组B临床总有效率为90.0%,治疗组疗效明显优于对照组。3组治疗前后中医证候积分、ABI、CRP、ALB、感觉阈值、创面面积变化均有明显差异,治疗组明显优于对照组。治疗组均未出现不良反应。结论中药内外联用治疗糖尿病足(WagnerⅡ级或Ⅲ级)气血亏虚、湿毒内蕴证者疗效显著,在改善患者临床症状、创面面积及下肢循环、神经损伤等方面较单纯中医外治和单纯西医常规治疗疗效确切。     

Hepatic epithelioid hemangioendothelioma: Update on diagnosis and therapy

With an estimated incidence of only 1-2 cases in every 1 million people, hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular endothelial cell tumor occurring in the liver and consisting of epithelioid and histiocyte-like vascular endothelial cells in mucus or a fibrotic matrix. HEHE is characterized as a low-to-moderate grade malignant tumor and is classified into three types: solitary, multiple, and diffuse. Both the etiology and characteristic clinical manifestations of HEHE are unclear. However, HEHE has a characteristic appearance on imaging including ultrasound, magnetic resonance imaging, and positron emission tomography/computerized tomography. Still, its diagnosis depends mainly on pathological findings, with immunohistochemical detection of endothelial markers cluster of differentiation 31 (CD31), CD34, CD10, vimentin, and factor VIII antigen as the basis of diagnosis. Hepatectomy and/or liver transplantation are the first choice for treatment, but various chemotherapeutic drugs are reportedly effective, providing a promising treatment option. In this review, we summarize the literature related to the diagnosis and treatment of HEHE, which provides future perspectives for the clinical management of HEHE.     

OEC9900中型C型臂X射线机电源故障维修一例

1故障现象OEC9900中型C型臂X射线机在曝光时突然报错,无法工作。再次开机,在工作站右侧显示屏上报"WORK STATION UPS COMMUNICATION FAILURE"。下面两行说明是让关闭工作站,等待10 s再开机,如果还是报此信息,联系维修服务。C型臂端控制面板点阵显示屏上出现了"PRECHARGE VOLTAGE ERROR"的报错信息。由于此C型臂X射线机安装至今工作良好,没有出现过问题,所以过了保修期也没有向厂家购买过保修服务。联系厂家答复说工程师上门维修费1.6万元,还要等工程师安排时间。近期天气原因,患者增多,时间宝贵。     

中药熏蒸与人工泪液联用及综合护理对干眼症的治疗效果

【摘要】 目的 探讨中药熏蒸结合西医人工泪液及综合护理对干眼症的治疗效果。方法 选取干眼症患者120例为研究对象，随机分为西医人工泪液治疗37例（A组）、中药熏蒸治疗39例（B组）、中药熏蒸结合人工泪液治疗44例（C组），三组均行综合护理，连续治疗20天，并随访1个月，用分泌泪液指数、人工泪液使用频率、眼睛不适症状总数及VAS舒适度评价各组治疗后第20天和随访1个月的临床效果。结果 与治疗前相比，治疗第20天，A、B、C三组在泪液分泌指数、眼睛不适症状总数及VAS舒适度均显著改善（P＜0.05）。随访1个月，C组与A组相比，上述指标显著更优（均P＜0.05）；与B组相比，C组眼睛不适症状总数显著减少（P＜0.05），两眼泪液指数显著增加（P＜0.05）；C组有效率显著高于A及B组（P＜0.05）。结论 在综合护理下，中药熏蒸结合西医人工泪液治疗干眼症效果明显优于单独中医和西医治疗效果，可有效提升患者生活质量。     

A Novel Method for Three-Dimensional Analysis of Endoscopic Spatial Relationships of Pterygopalatine Fossa Structures and Associated Regions

Background: The spatial orientation rules of the important skull base structures are essential for performing endoscopic surgery. However, there is no satisfactory three-dimensional (3-D) anatomy study available to the surgeon at present. The aims of this study are to construct a new method to learn the spatial orientation of anatomical features under endoscopy and to help the surgeon establish a 3-D image of skull base structures in his mind. Methods: A modified MicronTracker navigation system was used to measure the pitch angle, direction angle and distance from the reference points to various anatomical landmarks of the pterygopalatine fossa and related structures (PPFRS) at the skull base in 10 fresh cadavers (20 sides). Results: The location data of the positions of the major landmarks were acquired and a digital model of the anatomical structures of the PPFRS was built, which can be moved, whirled or demonstrated easily. Conclusion: It is practical to measure the positions of the anatomical structures of the PPFRS with a modified binocular vision-based MicronTracker navigation system. It is a valuable exploration tool to help the surgeon establish the orientation of surgical landmarks in his mind by the 3-D parameters and model.