双环醇联合拉米夫定治疗慢性乙型肝炎临床观察

目的观察双环醇联合拉米夫定治疗慢性乙型肝炎的治疗效果。方法180例慢性乙型肝炎患者随机分为三组。双环醇组用双环醇(北京协和药厂)口服25mg/次,3次/d,疗程6个月;拉米夫定组用拉米夫定100mg口服,每日1次,疗程6个月,联合组双环醇和拉米夫定同时应用。结果治疗结束时,联合组肝功复常率与双环醇组相近,高于拉米夫定组;HBVDNA阴转率联合组76.7%与拉米夫定组70.0%相近,高于双环醇组28.3%;HBeAg阴转率联合组43.3%高于双环醇组25.0%及拉米夫定组11.7%。结论双环醇联合拉米夫定治疗慢性乙型肝炎有协同作用,优于单一用药。     

子宫瘢痕部位异位妊娠药物治疗护理方法

目的 探讨子宫瘢痕部位异位妊娠药物治疗护理方法.方法 选择62例患者,随机分为两组,各31例,其中观察组实施本研究护理干预方法,如:加强心理护理和患者病情的观察,针对药物治疗不良反应进行护理,对照组则实施常规护理,如入院宣教、病情观察、出院指导等,比较两组患者月经恢复症状时间以及治疗期间发生的不良反应.结果 观察组患者月经恢复正常时间显著短于对照组(P < 0.05),观察组发生恶心呕吐和口腔溃疡的比率显著低于对照组(P < 0.05).结论 对于子宫瘢痕部妊娠患者,实施有效的护理干预能减少治疗期间不良反应,提高患者依从性,从而提高治疗效果.     

胃镜下金属夹联合黏膜内注射治疗Dieulafoy病38例临床疗效分析

目的：探讨胃镜下金属夹止血联合肾上腺素液局部黏膜注射治疗Dieulafoy病所致上消化道出血的临床效果。方法：均采用PANTAX3500电子胃镜、一次性注射针和Olympus金属夹（HX-600-090）及推送器（HX-5LR-1型）对38例Dieulafoy病患者止血。结果：36例在胃镜下止血成功,成功率为95％（36／38）,未发生穿孔等严重并发症,2例转外科手术治疗。结论：金属夹钳夹止血联合肾上腺素液局部黏膜注射治疗Dieulafoy病出血是安全、有效、微创的治疗方法。     

Soy Foods Might Weaken the Sensitivity of Tamoxifen in Premenopausal Patients With Lumina A Subtype of Breast Cancer

Background

Based on estrogen active substances, many women consume soy foods in the belief that it could prevent breast cancer (BC). Women with different molecular subtypes would be likely to have diverse reactions to soy foods, especially those with the estrogen-receptor-positive (ER⁺) subtype. The aim of the current study is to identify the differentially expressed genes (DEGs) on soy foods in premenopausal patients with Lumina A subtype of BC (LABC) after soy food treatment, and to further investigate the critical molecule change.

乳腺癌改良根治术后皮下积液产生的高危因素及预防措施

目的探讨乳腺癌改良根治术后皮下积液产生的高危因素及预防措施。方法回顾性分析395例乳腺癌改良根治术患者的临床资料,分为传统手术组237例及改进手术组158例。统计分析传统手术组中患者临床因素与皮下积液的关系,确定术后积液的高危因素;对比2组患者术后积液发生率,分析改进手术方法在预防皮下积液中的作用。结果 2组积液发生率(41.77%vs 8.86%)差异具有统计学意义(P<0.01)。对传统手术组行统计分析发现,皮下积液发生率在腋窝淋巴结阳性者与腋窝淋巴结阴性者(48.85%vs 22.22%)、体重指数(body mass index,BMI)≥25与BMI<25者(53.85%vs 35.85%)、合并糖尿病与无病者(56.10%vs 38.78%)之间差异明显(P<0.05)。结论腋窝淋巴结阳性、BMI≥25及合并糖尿病为术后皮下积液产生的高危因素;改进手术方式可以明显减少积液的发生。     

Toxicity profile characteristics of novel androgen-deprivation therapy agents in patients with prostate cancer: a meta-analysis

Background: To investigate the toxicity profile characteristics of abiraterone acetate and enzalutamide to see if they are of critical clinical value.

Methods: Prospective studies were identified by searching the PubMed, EMBASE, Cochrane Library, and American Society of Clinical Oncology Meeting abstracts. Randomized clinical trials that evaluate abiraterone acetate or enzalutamide in patients with prostate cancer were included. The risk ratio (RR) of adverse events (AEs) was calculated for each trial along with appropriate 95% CI using fixed- or random-effects methods.

Results: Ten studies (5 abiraterone acetate, and 5 enzalutamide studies) were included in the meta-analysis. Use of abiraterone acetate was associated with an increased risk of all-grade adverse effects (RR = 1.01, 95% CI: 1.01–1.02) and high-grade adverse effects (RR = 1.29, 95% CI: 1.15–1.45). Also, there was a significantly higher incidence of some individual adverse effects (e.g. liver-function test abnormalities, arthralgia, cardiac adverse effects, diarrhea, oedema, hypertension and hypokalemia). Treatment with enzalutamide did not increase the risk of all-grade adverse effects and high-grade adverse effects, but there was a significantly higher incidence of some individual adverse effects (e.g. back pain, fatigue, hot flush and hypertension).

Conclusions: Both abiraterone acetate and enzalutamide have toxicity profile characteristics that need to be recognized. Understanding the toxicity profile characteristics of both drugs could promote decision making in clinical use.     

髋部骨折术后对侧髋部再骨折的相关因素分析

目的 探讨髋部骨折患者术后出现对侧髋部再次骨折的相关危险因素.方法 对261例接受手术治疗的髋部骨折患者行回顾性研究及临床随访,根据术后是否出现对侧髋部骨折分组,对两组间的相关因素(性别、年龄、BMI、患侧、首次骨折部位、手术方式、围术期实际失血量、术后短期瞻望、术后卧床时间、内科合并症、Charlson合并症指数、术后抗骨质疏松治疗、术后6个月随访时Harris髋关节功能评分及FIM功能独立性评定)进行单因素分析及多因素Logistic回归分析.结果 平均随访时间28.3个月,15例出现对侧髋部骨折;两组间单因素分析及多因素回归分析均显示年龄、术后短期谵妄、合并高血压病、合并脑血管病、术后抗骨质疏松治疗、术后Harris评分、术后FIM评分是术后对侧髋部再骨折的相关危险因素(P＜0.05).结论 髋部骨折术后出现对侧髋部再骨折的危险因素包括年龄、术后谵妄、内科合并症等被动因素,以及术后抗骨质疏松治疗、术后关节功能康复情况等主动因素.术后患者需积极接受内科疾病的治疗,并增强抗骨质疏松的治疗和髋关节功能康复锻炼的主观能动性,以预防再骨折的发生.     

庞国明教授反治法治疗2型糖尿病消谷善饥临证心得

庞国明教授,第六批全国老中医药专家学术继承工作指导老师,享受国务院特殊津贴专家,从医40余载,专长内科,主攻糖尿病的纯中药治疗,学验俱丰,善用中医思维方法解决临床疑难问题.对2型糖尿病消谷善饥甚则饥饱无度等久治不愈者,悟道探理,善用"反治法"治疗,即运用"消食导滞"法以"消治消",此文总结了庞教授在2型糖尿病辨证论治基...     

Pulmonary hypertension associated with combined fibrosing mediastinitis and bronchial anthracofibrosis: A retrospective analysis in a single Chinese hospital

Introduction

Both fibrosing mediastinitis (FM) and bronchial anthracofibrosis (BAF) are unique diseases. The combined appearance of FM and BAF is extremely rare.

Objectives

The aim of this study was to investigate the clinical features of patients with coexisting FM and BAF.

Method

Between January 2003 and December 2015, a total of eight patients were diagnosed at the Peking Union Medical College Hospital as having combined FM and BAF. The clinical presentations, radiographic features and bronchoscopic findings of the eight patients were reviewed.

Results

The patients were five women and three men with a median age of 64 years (range 56‐86 years). Symptoms included dyspnea (eight patients), cough (seven patients), chest pain (two patients), hemoptysis (two patients) and so on. Chest CT of all eight patients showed mediastinal soft‐tissue lesions, with multiple narrowed or obliterated lobar or segmental bronchi and arteries. Bronchoscopy showed that all of the patients had multiple stenoses of lobar or segmental bronchi with anthracotic pigmentation on the mucosa. Echocardiography showed that all of the patients had elevated pulmonary arterial systolic pressure (median 81 mm Hg, range 51‐107 mm Hg). Each of the eight patients had a history of exposure to, or infection with, tuberculosis, although there was no evidence of active disease. All of the eight patients had long‐term exposure to indoor coal or biomass fuel smoke.

Conclusions

FM can coexist with BAF, characterized by prominent pulmonary hypertension. The possible etiological factors are tuberculosis and coal or biomass fuel exposure.     

临床药师对乙肝后肝硬化腹水合并肌脓肿患者的药学监护

【摘要】〓临床药师参与1例乙肝后肝硬化腹水合并肌脓肿患者的药学监护,提出抗乙肝病毒采用强效和低耐药的恩替卡韦单药长期治疗;患者凝血功能不好,抗感染治疗上将利奈唑胺更换为万古霉素,并监测万古霉素的血药谷浓度,调整给药剂量和频次等用药建议,提高疗效和减少药品不良反应的发生率。