脑干多发性海绵状血管畸形11例临床分析及文献复习

目的探讨脑干多发性海绵状血管畸形的临床特征和治疗策略。方法回顾性分析11例脑干多发性海绵状血管畸形病人的临床资料。病灶共32个,其中位于脑桥29个,中脑2个,延髓1个。手术组包括手术治疗3例,非手术组包括保守观察7例和γ-刀治疗1例。结果随访11例,时间6～77个月。首次发病时平均KPS评分为(64.5±15.7),随访平均KPS评分为(71.8±15.4),两者无显著差异(P=0.07)。非手术组再次出血4例,手术组无再次出血,2组出血情况无显著性差异(P=0.236)。结论脑干多发性海绵状血管畸形病灶较大和症状较重病人,可采用手术治疗,首选切除主要病灶。无显著症状和病灶较小且深在者可保守观察。     

儿童脑干胶质瘤生存时间的相关因素分析

目的探讨影响儿童脑干胶质瘤生存时间的相关因素。方法回顾性分析33例儿童脑干胶质瘤病人的临床资料。应用Kaplan-Meier法进行单因素分析,分析临床、影像和病理组织学因素对生存时间的影响。差异的显著性检验应用Log-rank法,对单因素分析中P<0.05者进行COX回归多因素模型分析。结果单因素分析显示影响生存时间的因素包括:发病年龄、发病到就诊时间、入院时KPS评分、肿瘤部位、病理级别、肿瘤生长类型以及治疗方法(均P<0.05)。多因素分析显示:病人的发病到就诊时间(P=0.034)及肿瘤生长类型(P=0.046)对生存时间的影响更为显著。结论儿童脑干胶质瘤的生存时间与多种因素有关,手术切除可延长生存时间。     

Kawase's入路对岩斜区暴露范围的量化研究

目的 量化研究Kawase's入路对岩斜区的暴露面积,明确Kawase’s入路适用范围,为临床手术入路的选择提供解剖学基础.方法 成人头颅湿标本8例,采用Kawase's入路进行手术模拟操作,观察神经、血管走行关系,并测量重要结构,采用CT三维重建测量岩斜区暴露范围.结果 Kawase's三角磨除深度为(1.16±0.14) cm,岩斜区暴露面积为(5.48±0.71) cm2,暴露范围下限距鞍背(2.26±0.22) cm.该入路可暴露中上斜坡、蝶岩裂部和海绵窦后部.结论 Kawase's入路适用于位于内听道内侧中上斜坡、蝶岩裂部及颅中窝底肿瘤,伴或不伴海绵窦侵袭.     

醋酸泼尼松与布地奈德结合鼻内镜手术治疗鼻息肉的临床疗效观察

目的观察醋酸泼尼松与布地奈德结合鼻内镜手术对鼻息肉的治疗作用。方法随机将在笔者所在医院接受治疗的74例鼻息肉患者分为对照组和联合治疗组,每组各37例。对照组采用单纯鼻内镜手术治疗,联合治疗组在对照组的治疗基础上加用醋酸泼尼松与布地奈德进行联合治疗,以两组患者的术中出血量、术后复发率及总有效率作为临床药效的评价指标。结果联合治疗组术中出血量、术后复发率及临床总有效率分别为(41.5±6.9)mL、21.4%及88.9%,对照组分别为(69.2±7.1)mL、32.5%及75.9%,两组比较差异有统计学意义(P<0.05或P<0.01)。结论使用糖皮质激素联合鼻内镜手术对于鼻息肉具有显著的临床疗效,其效果优于单纯手术治疗,此法值得在临床进行推广。     

Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer

Objectives

The aim of this study was to assess the diagnostic performance of pre-treatment 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI) for predicting Gleason score (GS) downgrading after radical prostatectomy (RP) in patients with GS 3?+?4 prostate cancer (PCa) on biopsy.

Methods

We retrospectively reviewed 304 patients with biopsy-proven GS 3?+?4 PCa who underwent mpMRI before RP. On T2-weighted imaging and three mpMRI combinations (T2-weighted imaging + diffusion-weighted imaging [DWI], T2-weighted imaging + dynamic contrast-enhanced-MRI [DCE-MRI], and T2-weighted imaging + DWI + DCE-MRI), two radiologists (R1/R2) scored the presence of a dominant tumour using a 5-point Likert scale (1 = definitely absent to 5 = definitely present). Diagnostic performance in identifying downgrading was evaluated via areas under the curves (AUCs). Predictive accuracies of multivariate models were calculated.

Results

In predicting downgrading, T2-weighted imaging + DWI (AUC?=?0.89/0.85 for R1/R2) performed significantly better than T2-weighted imaging alone (AUC?=?0.72/0.73; p?DCE-MRI (AUC?=?0.89/0.84 for R1/R2) performed no better than T2-weighted imaging + DWI (p?=?0.48/p?>?0.99 for R1/R2). On multivariate analysis, the clinical + mpMRI model incorporating T2-weighted imaging + DWI (AUC?=?0.92/0.88 for R1/R2) predicted downgrading significantly better than the clinical model (AUC?=?0.73; p?Conclusion mpMRI improves the ability to identify a subgroup of patients with Gleason 3?+?4 PCa on biopsy who are candidates for active surveillance. DCE-MRI (compared to T2 + DWI) offered no additional benefit to the prediction of downgrading.

Key Points

? Diagnostic performance of T2-weighted-imaging + DWI was better than T2-weighted-imaging alone. ? Diagnostic performance of T2-weighted-imaging + DWI was similar to T2-weighted-imaging + DWI + DCE-MRI. ? Combining clinical and T2-weighted-imaging + DWI features best predicted GS downgrading. ? mpMRI might prevent overtreatment by increasing eligibility for PCa active surveillance.     

Identification, structural properties and chelating capacity of miltipolone as a broad-spectrum inhibitor to cancer cells

Miltipolone (1) was discovered as a good and broad-spectrum inhibitor against the growth of cancer cells from “Danshen” based on the activity-driven screening of TCMs. The structural features make 1 easily tautomerize between different forms and 1 is linked and stabilized by intermolecular O-H?O hydrogen bonds in the crystal structure. The interaction of 1 in ddH₂O solution with Co²⁺, Mn²⁺, Zn²⁺, Fe²⁺ or Fe³⁺ changed UV absorption values; the chelation of 1 with Fe²⁺ or Fe³⁺ also altered the characteristic UV absorption peaks. However, only did Fe²⁺ reverse 1’s inhibition against the growth of cancer cells; therefore, we concluded that 1 possibly acts as a Fe²⁺ chelator to conduct its inhibitory activity.     

Evaluation of pharmacokinetic and pharmacodynamic relationship for oral sustained-release atenolol pellets in rats

This study was designed to evaluate the in vitro release, pharmacokinetics (PK), pharmacodynamics (PD) and PK-PD relationships of atenolol sustained-release pellets (AT-SRPs), compared with those of atenolol immediate-release pellets (AT-IRPs). Blood sampling for AT plasma concentration was performed in normal rats and blood pressure-lowering effects were recorded continuously in hypertensive rats (HRs) before and at 1, 4, 8, 12, 16 and 24 h after drug administration. The parameters were calculated using DAS1.0 program and WinNonlin software. The release profile of SRPs was steadier and more sustained than that of IRPs. The mean Cmax and area under concentration-time curve from 0 to 24 h after administration (AUC0-24 h) of SRPs were significantly lower than that of IRPs (p<0.05), while area under concentration-time curve from 0 to infinity (AUC0-∞) was almost equivalent between the two formulations. The mean half life time (t1/2) of AT-SRPs was almost 2 times longer compared to that of AT-IRPs. The SRPs approximately achieved half of peak drug effect (Emax) of IRPs, while there were no significant differences in the area under effect-time curve from 0 to 24 h after administration (AUEC0-24 h) and the area under effect-time curve from 0 to infinity (AUEC0-∞). The value of the rate constant of equilibration between plasma and the effect-site (ke0) for SRPs was about 4 times higher than IRPs. The effect-concentration-time course for AT-SRPs was represented by the clockwise hysteresis loop, while the counter-clockwise hysteresis loop well showed that for AT-IRPs. The more favorable characteristics of SRPs would make it more appropriate as a potential dosage form for the treatment of hypertension.     

中西医结合治疗带状疱疹20例疗效观察

目的探讨中西医结合治疗老年带状疱疹的临床疗效。方法将20例患者分为两组,治疗组11例,以中药汤剂、中医针刺配合西药联合治疗,并设对照组9例单纯给予西药治疗及其他对症治疗。结果治疗组:1周内治愈8例,显效2例,总有效率为90.9%;对照组:1周内治愈6例,显效1例,总有效率为77.8%。两组比较,差异有统计学意义(P0.05)。结论中西医结合治疗比单用西药常规治疗效果好,可明显缩短病程,提高疗效,减轻病患痛苦,且无明显毒副作用,具有一定的临床推广意义。     

产科病房护理中断事件的干预性管理研究

目的探讨产科病房护理中断事件干预性管理的效果,降低护理中断事件的发生。方法观察16名护理人员高峰工作时段临床工作中护理中断事件的发生情况,并针对护理中断事件来源进行干预。比较干预前、后护理中断事件的发生次数、中断持续时间及中断的结局。结果干预后护理中断事件明显减少,中断时间较干预前显著缩短,因中断导致的消极型结局和不良护理事件显著减少(均P0.01)。结论护理中断事件干预性管理可以降低护理中断事件的发生,减少中断护理不良事件。