晚期非小细胞肺癌的化放疗序贯治疗

目的探讨吉西他滨联合顺铂治疗晚期非小细胞肺癌3周方案并序贯化放疗的疗效和不良反应。方法经病理和细胞学证实的晚期非小细胞肺癌患者，既往未进行化疗和放疗，临床上有可测量病灶（根据WHO标准），美国东部肿瘤协作组（ECOG）评分为0—2分，肝、肾功能基本正常。均给予吉西他滨和顺铂的联合化疗并序贯化放疗方案治疗。按照WHO的标准评价疗效和不良反应，并随访生存期。结果共入组43例患者，其中39例可评价疗效：19例（48．72％）部分缓解、13例（33．33％）病情稳定和7例（17．95％）疾病进展。生存期为3．7—21．4个月，中位生存期为10．1个月。主要的不良反应为血液毒性，表现为白细胞、中性粒细胞、血小板和血红蛋白下降；其次为消化道症状。结论吉西他滨联合顺铂治疗晚期非小细胞肺癌3周方案并序贯化放疗是晚期非小细胞肺癌的标准一线化疗方案之一，患者可较好耐受。     

Preschoolers’ mathematical play and colour preferences: a new window into the development of gendered beliefs about math

In play, children often explore mathematical ideas that are vital for future learning. Children’s play also reveals gender differences in both colour and toy preferences. The authors examined how gender-related colour preferences of 5-year-olds are related to preferences for math-specific games/toys and gendered beliefs about math. Spanish preschoolers (N?=?143) completed a self-report measure of gendered beliefs about math. Children then indicated their favourite colour and were given five math-specific games/toys in that colour. Play times for each game/toy were recorded. Three findings emerged. First, girls preferred games/toys of particular colours (pink/purple) that differed from boys’ preferences (blue/red). Second, play time with math games/toys did not differ between girls and boys. Third, 5-year-olds of both genders thought that girls liked math more than boys did. This is the youngest age at which these gendered beliefs about math have been shown, and suggests new theorizing about stereotypes, gender, and math.     

实验性松质骨缺损修复过程中血管内皮生长因子与转化生长因子β1的表达

目的 观察实验性松质骨缺损修复过程中血管内皮生长因子(VEGF)和转化生长因子β1(TGF-β1)的表达情况,探讨实验性松质骨缺损愈合的分子生物学机制.方法 选用中国家兔60只,在其双侧股骨髁造成一直径6.0mm、深12.0 mm之孔洞状骨缺损.将左侧作为实验侧,右侧作为对照侧.4周后,对实验侧采用自制微型剥离器插入骨缺损处做反复切割,以造成二次创伤模型.于经皮骨折端二次创伤术后1 d(总4周+1 d)、1周、2周、4周、8周各处死6只实验兔,行X线片检查后,于双侧骨缺损区取材.使用免疫组化染色技术对标本进行检测和观察.结果 实验侧松质骨缺损多在12周时得以修复.而未经二次创伤处理的对照侧松质骨缺损则不能自行修复;VEGF和TGF-βl的局部表达贯穿于松质骨修复的全过程,但经二次创伤处理,实验侧的表达强度明显高于对照侧,且VEGF和TGF-B1的表达呈正相关关系.结论 二次创伤可以促进松质骨缺损的修复和内源性VEGF和TGF-β1在骨缺损局部的表达,而VEGF和TGF-β1表达增强可能是其促进松质骨缺损修复的重要因素.     

Relationship of C-reactive protein levels with angiographic findings and markers of necrosis in non-ST-segment elevation acute coronary syndrome

INTRODUCTION AND OBJECTIVES: The mechanism responsible for elevated C-reactive protein levels (inflammation of the ruptured atherosclerotic plaque or myocardial necrosis) in acute coronary syndromes is controversial. The aim of this study was to investigate the relationship between C-reactive protein levels and angiographic complexity of the culprit lesion and troponin elevation in patients with non-ST elevation acute coronary syndromes. PATIENTS AND METHOD: The study group consisted of 125 patients with single-vessel disease. Troponin-I and C-reactive protein were measured, and the complexity of the culprit lesion was analyzed (TIMI flow and thrombus). Information on age, sex, smoking habit, hypertension, hypercholesterolemia and diabetes was obtained from the medical record. RESULTS: The quartile distribution of C-reactive protein showed more patients with TIMI flow < 3 (31%, 28%, 18%, and 55%; P=.02), thrombus (3%, 6%, 7%, and 28%; P=.007) and troponin-I elevation (19%, 44%, 50%, and 66%; P=.003) in the fourth quartile. Multivariate analysis showed both thrombus (OR = 4.1; 95% CI, 1.2-14.3; P=.03) and troponin elevation (OR = 2.6; 95% CI, 1.1-6.3; P=.03) to be associated with C-reactive protein > 18 mg/L (fourth quartile cut-off). When treated as a continuous variable, higher levels of C-reactive protein were also associated with thrombus (P=.02) and troponin elevation (P=.003). No other clinical variables were related with C-reactive protein levels. CONCLUSIONS: Both angiographic complexity of the culprit lesion and elevated troponin level are related with increased C-reactive protein levels in non-ST elevation acute coronary syndromes.     

Assessment of the living renal donor. Analysis of extra-renal pathology as a limitation for donation

The goal of the donor evaluation is to ensure the suitability, safety and well being of the donor. In order to avoid important omissions, the evaluation of potential living kidney donors should be carried according to a protocol that includes a logical sequence of complementary explorations. Old age alone is not an absolute contraindication to donation but the evaluation should be more rigorous, because increased age may be associated with more post-operative complications after nephrectomy and renal function and long term graft survival could be shorter than the ones obtained from younger living donors. A body mass index of more than 35 kg/m2 should be an absolute contraindication to renal donation. Between 30 and 35 kg/m2 the donor evaluation should be more rigorous and it should be recommended to lose weight before nephrectomy. Hypertension is one of the most common reasons to declare a potential kidney donor unsuitable. Evidence of organ damage is an absolute contraindication to kidney donation. The donation is only reasonable when hypertension is well controlled with less than two drugs. To excluded diabetes mellitus all donors should have a fasting plasma glucose measurement. Diabetes mellitus is an absolute contraindication to living donation such as an impaired glucose tolerance or impaired fasting glucose with a family history of type 2 diabetes mellitus. Another contraindication to living donation is malignant disease, and the same standards should be adopted for cadaveric donors. The exceptions are low-grade non-melanoma skin cancer and carcinoma in situ of the uterine cervix. The presence of active infection usually precludes donation. It is very important to perform a routine test for viral infections. HIV, hepatitis B and C infection of the donor are usually a contraindication to living donor. CMV donor and recipient status should be taken into account before transplantation, and the recipients at risk for CMV disease should recieve prophylactic treatment according to the transplant unit policy.     

Usefulness of C-reactive protein and left ventricular function for risk assessment in survivors of acute myocardial infarction

The additional prognostic information provided by C-reactive protein (CRP) to parameters of left ventricular function in survivors of acute myocardial infarction (AMI) was investigated in 665 patients (326 with ST elevation and 339 with non-ST elevation). Cox multivariable analysis identified the following predictors of 6-month cardiac death: age (per 5 years hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.1 to 1.4, p = 0.004), Killip class >I at presentation (HR 2.4, 95% CI 1.3 to 4.5, p = 0.0001), a reduced ejection fraction (per 5% HR 1.3, 95% CI 1.2 to 1.4, p = 0.0001), and greater CRP (per 5 mg/L HR 1.02, 95% CI 1.01 to 1.04, p = 0.02); the C-index of the model was 0.77 without and 0.78 with CRP. CRP is associated with mortality in addition to age and parameters of ventricular function (Killip class and ejection fraction) in survivors of AMI, although the relevance of its additive predictive role seems marginal.     

颞叶癫(癎)的临床特征和脑电图分析

目的分析和总结颞叶癫癎的临床、脑电图特征。方法对2004年6月至2006年1月于首都医科大学北京天坛医院癫癎中心门诊和病房确诊为颞叶癫癎的145例患者的临床、脑电图和神经影像学资料进行分析。结果患者的发作类型包括简单和复杂部分性发作以及全面强直阵挛发作,以复杂部分性发作最常见。病因分析显示,45例病灶性颞叶癫癎的病因依次为脑血管病、颅内感染、脑外伤等,100例非病灶性颞叶癫癎中,海马硬化29例。脑电图显示颞区癫癎样放电。结论颞叶癫癎是一组临床常见、病因复杂、表现多样的癫癎综合征。正确诊断、规范化治疗是提高其疗效的关键。     

Gastric cancer susceptibility is not linked to pro-and anti-inflammatory cytokine gene polymorphisms in whites: a Nationwide Multicenter Study in Spain

BACKGROUND AND AIMS: Recent studies have reported an association between cytokine gene polymorphisms and GC risk. However, results are inconsistent among studies from different geographic regions and ethnic groups. Our goal was to evaluate the influence of Helicobacter pylori (H. pylori) infection and host genetic factors on GC susceptibility in a population of Spanish white GC patients. METHODS: DNA from 404 unrelated patients with GC and 404 sex- and age-matched healthy controls was typed for several functional polymorphisms in pro- (IL-1B, TNFA, LTA, IL-12p40) and anti-inflammatory (IL-4, IL-1RN, IL-10, TGFB1) genes by PCR, RFLP, and TaqMan assays. H. pylori infection and CagA/VacA antibody status were also determined by western blot serology. RESULTS: Logistic regression analysis identified H. pylori infection with cagA strains (OR 2.54, 95% CI 1.77-3.66), smoking habit (OR 1.91, 95% CI 1.25-2.93), and positive family history of GC (OR 3.67, 95% CI 2.01-6.71) as independent risk factors for GC. None of the cytokine gene polymorphisms analyzed in this study were associated with susceptibility to GC development, whether GC patients were analyzed as a group or categorized according to anatomic location or histological subtype. Some simultaneous combinations of proinflammatory genotypes reportedly associated with greater GC risk yielded no significant differences between patients and controls. CONCLUSIONS: Our results show that, at least in some white populations, the contribution of the cytokine gene polymorphisms evaluated in this study (IL-1B, IL-1RN, IL-12p40, LTA, IL-10, IL-4, and TGF-B1) to GC susceptibility may be less relevant than previously reported.     

精神病患者院前自杀行为的调查及护理对策

目的了解精神病患者院前自杀行为的特点,提出针对性的预防措施。方法采用问卷调查法对51例院前自杀的精神病患者及家属进行有关自杀的地点、方法及原因的调查。结果精神病患者在院前自杀有一定的特征性,自杀时间在下午最多,自杀方法以过量服药为多,疾病种类不同采用的方法和自杀的原因也不同,41例有自杀先兆。结论精神病患者需要家庭、社会的关心理解和支持,重视家庭护理和社会支持,以预防和减少精神病患者自杀的发生。     

Prognostic value of serum creatinine in non-ST-elevation acute coronary syndrome

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is the main cause of death in patients with kidney failure. Moreover, the presence of impaired renal function is an important prognostic factor in patients with heart disease, and is a determinant of outcome during follow-up. The main aim was to investigate the relationship between kidney failure at admission and one-year mortality in patients with non-ST-elevation acute coronary syndrome. PATIENTS AND METHOD: We studied 1029 consecutive patients admitted to our institution. The serum creatinine level and glomerular filtration rate were determined at admission, and classical risk factors and biochemical markers were assessed. The primary endpoint was all-cause mortality at one year. RESULTS: Patients who died were older, more frequently had a history of diabetes or coronary artery disease, were more likely to have heart failure at admission, had higher troponin-I, myoglobin and creatinine levels, and were less likely to have dyslipidemia or to be a smoker. Multivariate analysis showed that the independent predictors of all-cause mortality at one year were age, diabetes, troponin-I level, Killip class > 1, male gender, creatinine level, and glomerular filtration rate. There was a linear correlation between increased risk and creatinine level. CONCLUSIONS: Creatinine level at admission is one of the most important covariates in early prognostic stratification in these patients. A high serum creatinine level (or a low glomerular filtration rate) increases the probability of death due to all causes. The serum creatinine level is, moreover, an inexpensive, easy-to-use, and widely available prognostic marker.