第二届海峡两岸消化论坛获得圆满成功

秉承海峡两岸学术交流, 促进医学进步, 为民谋福祉的宗旨, 第二届海峡两岸消化论坛在美丽的海上花园城市-厦门拉开帷幕.     

开胸手术前指导患者进行肺功能锻炼的意义

1 临床资料挑选均能配合指导的肺功能异常的患者66(男38,女28)例,年龄43～80岁,其中限制性通气功能障碍32例,阻塞性通气功能障碍20例;有40 a以上吸烟史25例;伴有糖尿病3例.术前心电图检查提示异常21例,按肺功能测定分类[1]分为高度危险17例,中度危险31例,低度危险18例.进行手术前肺功能锻炼的指导.     

青霉胺联合硫酸锌治疗肝豆状核变性42例

1 临床资料肝豆状核变性(Wilson disease,WD)[1].42(男20,女22)例,年龄5～13(平均8)岁,其中27例以乏力、纳差、黄疸为首发症状,检查发现肝脏肿大,血清胆红素及ALT升高,4例以关节痛、手足不自主运动为首发症状,检查发现脑电图异常,3例首发症状类似佝偻病,血钙、血磷无变化,X线检查可见骨质疏松、关节间隙变窄;2例首发症状为血尿,尿常规检查发现红细胞及蛋白,6例首发症状为精神障碍,表情呆板,颅脑CT显示基底节低密度灶,脑脊液检查未见异常.入院时23例诊断明确,19例出现误诊[2],所有患儿诊断明确后,随机用青霉胺治疗9例,常用量: 600～1500 mg/d,分3次于饭前长期po[2],其临床症状消失,各项检查正常的平均时间为62 d,其中1例已出现肾病综合征症状;用硫酸锌治疗14例,常用量: 50 g/L硫酸锌2～4 mL,每天3次于饭前1 h服用.     

Health-Care Providers' Perspectives towards Childhood Cancer Treatment in Kenya

Background: This study explored perspectives of health-care providers on childhood cancer treatment in Kenya. Materials and Methods: A self-administered questionnaire was completed by 104 health-care providers in January and February 2013. Results: Seventy six percent of the health-care providers believed cancer to be curable. More doctors than other health-care providers had this positive opinion (p=0.037). The majority of health-care providers (92%) believed that most children with cancer will not be able to finish their treatment due to financial difficulties. They considered that prosperous highly-educated parents adhere better with treatment (88%) and that doctors adhere better with treatment for prosperous highly-educated parents (79%). According to 74% of health-care providers, quality of care is better for prosperous highly-educated parents (74%). Most health-care providers reported giving more explanation (71%), work with greater accuracy (70%) and use less difficult vocabulary (55%) to prosperous more educated families. Only 34% of health-care providers reported they feel more empathy towards patients from prosperous families. Reasons for non-adherence with the protocol according to health-care providers are: family refuses drugs (85%), inadequate supply of drugs at pharmacy (79%), child looks ill (75%), and financial difficulties of parents (69%). Conclusions: Health-care providers' health beliefs and attitudes differ for patients with families having high versus low socio-economic backgrounds.     

Phosphorylation of the oestrogen receptor alpha at serine 305 and prediction of tamoxifen resistance in breast cancer

Phosphorylation of oestrogen receptor alpha at serine 305 (ERalphaS305-P) induces tamoxifen resistance in experimental studies, but does not influence response to other endocrine agents, such as fulvestrant. We evaluated ERalphaS305-P using immunohistochemistry in 377 breast carcinomas from premenopausal participants of a randomized trial (n=248) and patients with advanced disease (n=129). Among the premenopausal patients, adjuvant tamoxifen improved recurrence-free survival (RFS) for ERalphaS305-P-negative tumours (multivariate HR=0.53, 95% CI 0.32-0.86, p=0.010), but not for ERalphaS305-P-positive tumours (multivariate HR=1.01, 95% CI 0.33-3.05, p=0.99) (interaction p=0.131). Notably, ERalphaS305-P was not significantly associated with RFS in patients not treated with tamoxifen (multivariate HR=0.64, 95% CI 0.30-1.37, p=0.248), indicating that ERalphaS305-P is a marker for treatment outcome rather than tumour progression. Given the direct experimental link between ERalphaS305-P and tamoxifen resistance and these first clinical data suggesting that premenopausal patients with ERalphaS305-P-positive breast cancer are resistant to adjuvant tamoxifen, further research is encouraged to study whether alternative endocrine treatment should be considered for this subgroup.     

Ixodes scapularis ticks collected by passive surveillance in Canada: analysis of geographic distribution and infection with Lyme borreliosis agent Borrelia burgdorferi

Passive surveillance for the occurrence of the tick Ixodes scapularis Say (1821) and their infection with the Lyme borreliosis spirochaetes Borrelia burgdorferi s.l. has taken place in Canada since early 1990. Ticks have been submitted from members of the public, veterinarians, and medical practitioners to provincial, federal, and university laboratories for identification, and the data have been collated and B. burgdorferi detected at the National Microbiology Laboratory. The locations of collection of 2,319 submitted I. scapularis were mapped, and we investigated potential risk factors for I. scapularis occurrence (in Quebec as a case study) by using regression analysis and spatial statistics. Ticks were submitted from all provinces east of Alberta, most from areas where resident I. scapularis populations are unknown. Most were adult ticks and were collected in spring and autumn. In southern Québec, risk factors for tick occurrence were lower latitude and remote-sensed indices for land cover with woodland. B. burgdorferi infection, identified by conventional and molecular methods, was detected in 12.5% of 1,816 ticks, including 10.1% of the 256 ticks that were collected from humans and tested. Our study suggests that B. burgdorferi-infected I. scapularis can be found over a wide geographic range in Canada, although most may be adventitious ticks carried from endemic areas in the United States and Canada by migrating birds. The risk of Lyme borreliosis in Canada may therefore be mostly low but more geographically widespread than previously suspected.     

Care of patients with the most severe and persistent mental illness in an area without a psychiatric hospital

OBJECTIVE: With standard community resources, managing some patients with long-term mental illness can prove difficult, given the high level of care required. How many beds do such patients require? The study examined the prevalence, diagnostic and behavioral characteristics, and residential arrangements of a cohort of these patients in a semirural area of Canada (population of 291,500). The area has always functioned without a psychiatric hospital. METHODS: A cross-sectional inquiry was made of all relevant institutions and residential facilities (including the local jail and shelters). Key stakeholders were interviewed and provincial databases were accessed in an effort to identify all adults aged 18 to 65 originating from the catchment area who displayed both a psychotic illness and severe behavioral disturbance necessitating ongoing close supervision. The Riverview Psychiatric Inventory was used to describe and quantify behavioral problems. RESULTS: Thirty-six patients met the study criteria, for a prevalence of 12.4 per 100,000 in the general population. Most resided in a publicly funded nursing home or a well-staffed rural group home. Four (prevalence of 1.4 per 100,000) had a forensic profile, needed secure settings, and were long-term residents on acute care wards. Only one patient had transferred to a psychiatric hospital outside the catchment area. CONCLUSIONS: Care for this population can be provided outside conventional psychiatric institutions but requires highly supervised long-term residential services in the range of ten to 40 per 100,000 in the population, depending on area characteristics, with urban, socially deprived areas likely having higher needs.     

Spa therapy for knee osteoarthritis – a fair test?

Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C, Rolland C, Roques CF, Bosson JL. Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis 2010; 69: 660–5.     

Cyclophosphamide and prednisone induction followed by cyclophosphamide mobilization effectively decreases the incidence of engraftment syndrome in patients with POEMS syndrome who undergo stem cell transplantation

High-dose chemotherapy with autologous stem cell transplantation (ASCT) can achieve excellent clinical responses in patients with POEMS syndrome (Jimenez Zepeda et al., Blood 2010;116:2403; Gertz et al., Am J Hematol 2005;79:319-328; Gherardi et al., Ann Neurol 1994;35:501-505; Gattinoni et al., Nat Rev Immunol 2006;6:383-393; Salem et al., J Immunol 2009;182:2030-2040; Salem et al., Cancer Immunol Immunother 2010;59:341-353; Salem et al., Cell Immunol 2010;261:134-143). However, High-dose melphalan with ASCT should be considered carefully due to its treatment-related morbidity (Vuckovic et al., Blood 2003;101:2314-2317), especially in patients with poor performance status owing to polyneuropathy and multiorgan involvement, such as cardiac, respiratory, and renal failure. Significant increases in the concentration of circulating macrophage colony-stimulating factor, erythropoietin, IL-6, and TNF-α, reach near maximal values at approximately day +12, predating neutrophil engraftment, and clinically manifest with fever, rash and edema (Dispenzieri et al., Eur J Haematol 2008;80:397-406). Depending on the definition used, approximately 50% of patients satisfied criteria for engraftment syndrome (ES) (Vuckovic et al., Blood 2003;101:2314-2317). ES occurs in 27-47% of patients who undergo ASCT; mortality rate is reported from 8% to 18% (Gattinoni et al., Nat Rev Immunol 2006;6:383-393; Vuckovic et al., Blood 2003;101:2314-2317). We have therefore reviewed our experience with ASCT in patients with POEMS syndrome who were treated with cyclophosphamide and prednisone as induction therapy followed by cyclophosphamide mobilization with an emphasis on treatment-related morbidity and frequency of ES. Our study confirms that ASCT is a feasible and efficacious treatment for patients with POEMS syndrome. In addition, the use of CP followed by cyclophosphamide mobilization decreases the incidence of PES leading to less morbidity and mortality rates.