耳鸣耳聋中医诊疗进展

耳鸣不是外来的声音,而是自身发出的声音,它可发生于单侧,也可发生于双侧,分为客观性耳鸣和主观性耳鸣。耳聋指不同程度的听力减退。耳鸣耳聋是生活中常见、难治的一种疾病,目前发病机理不明。中医学早在《黄帝内经》中就有耳鸣耳聋的记载及病因病机的论述,此后历代医家亦从不同角度探讨其病因病机及治疗方法。近年来,临床工作者在继承中医传统理论基础上试图从脏腑、经络、气血等方面阐明耳鸣耳聋病因病机,探索应用方剂、针灸、按摩导引等方法治疗耳鸣耳聋,取得了一定的疗效。本文详细归纳近年来耳鸣耳聋的病因病机及治疗方法等方面的文献,以期为临床提供一定的参考依据。     

Overview of transcatheter patent ductus arteriosus closure in preterm infants

Clinically significant patent ductus arteriosus (PDA) has been associated with significant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a comprehensive review of this emerging procedure.     

Phase 1 trial of ADI-PEG20 plus cisplatin in patients with pretreated metastatic melanoma or other advanced solid malignancies

Background Arginine depletion interferes with pyrimidine metabolism and DNA damage-repair pathways, and pairing arginine deiminase pegylated with 20,000-molecular-weight polyethylene glycol (ADI-PEG20) with platinum enhances cytotoxicity in vitro and in vivo in arginine auxotrophs.Methods This single-centre, Phase 1 trial was conducted using a 3 + 3 dose escalation designed to assess safety, tolerability and determine the recommended Phase 2 dose (RP2D) of ADI-PEG20.Results We enrolled 99 patients with metastatic argininosuccinate synthetase 1 (ASS1) deficient malignancies. We observed no dose-limiting toxic effects or treatment-related mortality. Three percent of patients discontinued treatment because of toxicity. After treatment, 5% (5/99) of patients had partial responses, and 41% had stable disease. The median progression-free and overall survival durations were 3.62 and 8.06 months, respectively. Substantial arginine depletion and citrulline escalation persisted in most patients through weeks 24 and 8, respectively. Tumour responses were associated with anti-ADI-PEG20 antibody levels at weeks 8 and 16 (p = 0.031 and p = 0.0357, respectively).Conclusion Concurrently administered ADI-PEG20 and cisplatin had an acceptable safety profile and had shown antitumour activity against metastatic ASS1-deficient solid tumours. Further evaluation of this treatment combination is warranted.Subject terms: Cancer, Cancer therapy     

Treatment and outcome of adult‐onset neuroblastoma

Adult‐onset neuroblastoma is rare and little is known about its biology and clinical course. There is no established therapy for adult‐onset neuroblastoma. Anti‐GD2 immunotherapy is now standard therapy in children with high‐risk neuroblastoma; however, its use has not been reported in adults. Forty‐four adults (18–71 years old) diagnosed with neuroblastoma between 1979 and 2015 were treated at Memorial Sloan Kettering Cancer Center. Five, 1, 5 and 33 patients had INSS stage 1, 2, 3 and 4 diseases, respectively. Genetic abnormalities included somatic ATRX (58%) and ALK mutations (42%) but not MYCN‐amplification. In the 11 patients with locoregional disease, 10‐year progression‐free (PFS) and overall survival (OS) was 35.4 ± 16.1% and 61.4 ± 15.3%, respectively. Among 33 adults with stage 4 neuroblastoma, 7 (21%) achieved complete response (CR) after induction chemotherapy and/or surgery. Seven patients with primary refractory neuroblastoma (all with osteomedullary but no soft tissue disease) received anti‐GD2 antibodies, mouse or humanized 3F8. Antibody‐related adverse events were similar to those in children, response rate being 71.4%. In patients with stage 4 disease at diagnosis, 5‐year PFS was 9.7± 5.3% and most patients who were alive with disease at 5 years died of neuroblastoma over the next 5 years, 10‐year OS being only 19.0 ± 8.2%. Patients who achieved CR after induction had superior PFS and OS (p = 0.006, p = 0.031, respectively). Adult‐onset neuroblastoma appeared to have different biology from pediatric or adolescent NB, and poorer outcome. Complete disease control appeared to improve long‐term survival. Anti‐GD2 immunotherapy was well tolerated and might be beneficial.     

大鼠海马与前皮质N4 mRNA神经元的发育--原位杂交与RT-PCR研究

目的 研究大鼠N4 mRNA神经元在前皮质与海马的时空表达模式。方法 地高辛标记的cRNA探针原位杂交组织化学和逆转录PCR技术。结果 E13-E16：原位杂交方法最早检测到N4 mRNA神经元，在海马与前皮质呈强阳性信号。P0～P2：N4 mRNA阳性信号在海马开始减弱，在前皮质仍维持较高的水平。P7：N4 mRNA阳性信号在海马明显减弱，仅在海马的齿状回见部分阳性神经元，在前皮质的水平轻度减低。P14：N4 mRNA神经元数目增多，主要位于海马齿状回的颗粒细胞层；P21-P28：N4 mRNA在海马的齿回呈强阳性信号，在CA3区呈中等程度的阳性信号，CA1区、CA2区及下托可见部分阳性神经元，前皮质可见Ⅱ／Ⅲ层的锥体细胞层呈强阳性信号。P90～P150：在海马的齿状回、CA3区，CA1区、CA2区及下托见中等强度的N4 mRNA阳性信号。P300：N4 mRNA神经元在海马与皮层的表达明显减少，仅见部分散在的阳性神经元。逆转录PCR检测结果与原位杂交所得结果基本相符，在胚胎期N4 mRNA表达最强，生后减弱，P7降至最低，P21～P28为生后的表达高峰，随之下降，P300表达弱。N4基因在不同发育时期皮层的表达，在胚胎期信号最强，生后略微减弱，组间差异不明显。结论 N4基因特异的表达于海马，并在海马的形成期表达最高，可能对海马的传入通路的发育有重要作用。     

一种基于FUZZYSET的尘肺治疗效果综合评价方法

本文提出的模型与方法，是基于ＦＵＺＺＹＳＥＴ构造一个多元函数，以此函数来判定、评价疗效。实践证明，该法对尘肺病疗效，有十分好的评价效果。该模型与方法可推广到其它医学领域的判定、评价中。