利妥昔单抗鞘注联合静脉化疗治疗脾边缘区淋巴瘤中枢神经系统复发一例并文献复习

目的 分析脾边缘区淋巴瘤中枢神经系统复发患者的临床、影像学、病理学特征,评估利妥昔单抗鞘注联合静脉化疗的安全性及疗效.方法 回顾性分析苏州大学附属第一医院血液科收治的1例脾边缘区淋巴瘤中枢神经系统复发患者的临床、影像学、病理学及治疗资料,并复习相关文献.结果 根据骨髓细胞形态学、免疫学、细胞遗传学和分子遗传学(MICM)分型、脾脏病理、PET-CT及实验室检查(乳酸脱氢酶)等,患者明确诊断为脾边缘区淋巴瘤Ⅳ期B组,国际预后指数(IPI)和年龄调整的国际预后指数(aaIPI)均为中高危组.经过一线治疗,患者达到完全缓解.但随后出现中枢神经系统复发,予利妥昔单抗鞘注联合静脉化疗治疗后,中枢病灶消失.结论 脾边缘区淋巴瘤属于低度恶性淋巴瘤,合并中枢神经系统复发十分罕见.利妥昔单抗鞘注联合静脉化疗对本例患者是安全的,且获得很好的临床疗效.     

角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉

翼状胬肉治疗方法多、术后复发率高，有报导达30％～69％。为减少其术后的复发率，我们采用角膜缘于细胞移植联合丝裂霉素C（MMC）治疗，取得良好效果，现报告如下：     

多层羊膜移植治疗难治性角膜溃疡的临床价值分析

目的探讨多层羊膜移植治疗难治性角膜溃疡的临床价值。方法选取2011年1-12月来本院就医的17例难治性角膜溃疡患者为观察对象，共17只患眼，所有患者均接受多层羊膜移植治疗，回顾分析患者的临床治疗效果。结果17例患者的难治性角膜溃疡症状均显著改善。视力明显提高．且所有患者均未发生明显的术后并发症。结论多层羊膜移植治疗难治性角膜溃疡．具有较为理想的临床治疗效果，且操作简单、取材方便，临床应用价值较高。     

硬脑膜补丁修补法与普通硬脑膜缝合在关于后颅窝手术术后并发症的比较

目的探讨硬脑膜补丁修补法与普通硬脑膜缝合在预防后颅窝手术术后皮下积液、脑脊液漏中的优势。方法对2016年10月至2019年4月采用硬脑膜补丁修补法修补缺损硬脑膜40例,同期常规修补方式修补缺损硬脑膜60例患者资料进行分析。结果硬脑膜补丁修补的40例中,术后2例(5%)出现皮下积液,1(2.5%)例出现脑脊液漏,1例(2.5%)出现颅内感染。普通硬脑膜缝合的60例中,15例(25%)出现皮下积液,7例(11.6%)出现脑脊液漏,4例(6.6%)出现颅内感染。结论硬脑膜补丁法修补法在预防后颅窝手术术后皮下积液明显优于常规修补法。     

亚砷酸对人骨髓间充质干细胞增殖及凋亡的影响

目的：研究亚砷酸（ATO）对人骨髓间充质干细胞（MSC）增殖及凋亡的影响。方法：通过正常志愿者髂后上棘穿刺获得MSC,体外培养传代,取第3代细胞鉴定后进行实验。纯化的MSC与1、5、10μmol/L的ATO共孵育,分别在24、48、72h时采用HE染色观察细胞形态学变化,MTT法检测细胞增殖抑制率,流式细胞术（FCM）分析细胞凋亡情况。结果：ATO可引起MSC形态明显改变;抑制MSC增殖,不同浓度（1、5、10μmol/L）ATO对MSC作用72h时的细胞增殖抑制率分别为（66.3±2.2）%、（81.1±1.7）%、（90.0±2.2）%;FCM检测表明ATO可诱导MSC凋亡,10μmol/L的ATO处理72h时引起（68.37±2.93）%的凋亡率。这3种作用均随ATO浓度及作用时间的增加而增强。结论：ATO可在体外抑制MSC增殖,并促进其凋亡。     

含利妥昔单抗化疗方案治疗套细胞淋巴瘤效果分析

目的探讨含利妥昔单抗化疗方案治疗套细胞淋巴瘤(MCL)患者效果及预后影响因素。方法回顾性分析2007年6月至2018年11月苏州大学附属第一医院血液科收治的56例≤65岁MCL患者临床资料,化疗方案中均包括利妥昔单抗,观察临床特征、治疗方案及生物学指标对总生存(OS)和无进展生存(PFS)的影响。结果56例患者中位发病年龄57岁,男性43例,女性13例。24例接受R-CHOP方案化疗;29例接受含阿糖胞苷方案化疗,其中15例接受R-hyper CVAD/R-MA方案化疗,14例接受R-CHOP/R-DAHP交替治疗;3例接受其他方案化疗。19例接受自体造血干细胞移植(ASCT)巩固治疗。56例患者中位OS时间74个月,2年OS率83.8%,3年OS率70.9%,2年PFS率72.0%,3年PFS率49.7%。国际预后指数(IPI)评分和治疗中是否接受ASCT是MCL患者OS和PFS的独立影响因素。含阿糖胞苷治疗组总有效率(ORR)93.1%,优于R-CHOP方案组(83.3%),差异无统计学意义(χ²=0.465,P=0.495);两组间OS及PFS差异均无统计学意义(OS:χ²=0.291,P=0.590;PFS:χ²=0.912,P=0.339)。诱导化疗达缓解的MCL患者中,ASCT巩固治疗可延长中位OS时间(72个月比124个月,χ²=3.973,P=0.040)及中位PFS时间(34个月比90个月,χ²=3.984,P=0.046)。简化MCL国际预后指数(sMIPI)评分中高危组患者中接受ASCT巩固治疗患者OS和PFS优于未接受ASCT治疗者(OS:χ²=5.037,P=0.025;PFS:χ²=6.787,P=0.009),而sMIPI评分低危组患者中,是否接受ASCT组间OS、PFS差异均无统计学意义(均P>0.05)。结论含阿糖胞苷的化疗方案对改善MCL患者的预后和生存并不理想。对于诱导化疗达缓解及sMIPI评分中高危组的MCL患者,ASCT巩固治疗可改善其预后,可作为年轻患者的一线巩固治疗方案。     

食管癌放疗敏感性与个体化治疗

放射治疗是目前食管癌主的、有效的、安全的治疗手段,是食管癌综合治疗的重手段之一.然而多项临床研究表明局部控制失败仍然是治疗失败的首原因.因此,提高食管癌细胞放射敏感性是治疗的关键.放射增敏剂可有效提高肿瘤细胞的放射敏感性,一直是放射肿瘤治疗学中的一个研究热点.使用放射增敏剂是改善相当一部分患不能够耐受同期放化疗的不良反应这一现状,提高放疗效果.本文从凋亡、乏氧、血管生成三个角度介绍食管癌放疗增敏的转化医学及临床研究,力求为食管癌综合治疗提供新思路.针对不同靶点通过不同药物增加其敏感性是未来食管癌个体化医疗的发展方向.     

荆门市长期护理保险60岁以上受益人支出的影响因素分析

目的:分析湖北省荆门市长期护理保险60岁以上受益人支出的影响因素,以期为我国长期护理保险政策的运行提供建议。方法:采用描述性统计、线性对数回归模型分析荆门市长期护理保险60岁以上受益人长期护理服务支出的影响因素。结果:性别、参保天数、失能评分、医保类型、长期护理服务类型、重选长期护理服务类型、亲属照顾情况、患有阿尔茨海默病或肿瘤是长期护理支出的影响因素,60岁以上受益人长期护理支出的主要影响因素在城市和乡镇存在差异。结论:城乡长期护理支出存在差异,应加强慢性病防治工作,推进城乡护理资源均等化,健全重度失能老人护理保障网络。     

EMILIN1基因多态性与蒙古族原发性高血压相关性研究

Objective To explore the relationship between genetic polyrnorphisms of 3 single nucleotide polymorphisms (SNPs) in the elastin microfibril interfacer 1 (EMILIN1)gene and essential hypertension. Methods A case-control study was conducted in which 201 hypertensive patients and 202 healthy controls in Mongolian population were enrolled, and the genotypes of rs3754734, rs2011616 and rs2304682 loci were analyzed using polymerase chain reaction-restriction fragment length polyrnorphism (PCR-RFLP) and direct sequencing techniques. Results There were significant differences in the frequencies of alleles and genotypes for the rs2304682 between the hypertensives and normotensives in the population(P＜0. 05). The frequency of the G-G haplotype established by rs3754734 and rs2304682 was significantly higher in the hypertensive patients (P＜0. 05). The frequencies of alleles and genotypes for the rs2304682 also had significant differences between the group with high diastolic blood pressure and normal diastolic blood pressure (P＜0.05). There were no significant differences in the frequencies of alleles and genotypes for the 3 SNPs between the group with high systolic blood pressure and normal systolic blood pressure (P＞0.05). Conclusion The rs2304682 locus in the EMILIN1 gene, as well as the haplotypes G-G constructed using rs3754734 and rs2304682, may associate with the susceptibility of essential hypertension in the Mongolian population. Also, rs2304682 may associate with the level of the diastolic blood pressure.     

EMILIN1基因多态性与蒙古族原发性高血压相关性研究

Objective To explore the relationship between genetic polyrnorphisms of 3 single nucleotide polymorphisms (SNPs) in the elastin microfibril interfacer 1 (EMILIN1)gene and essential hypertension. Methods A case-control study was conducted in which 201 hypertensive patients and 202 healthy controls in Mongolian population were enrolled, and the genotypes of rs3754734, rs2011616 and rs2304682 loci were analyzed using polymerase chain reaction-restriction fragment length polyrnorphism (PCR-RFLP) and direct sequencing techniques. Results There were significant differences in the frequencies of alleles and genotypes for the rs2304682 between the hypertensives and normotensives in the population(P＜0. 05). The frequency of the G-G haplotype established by rs3754734 and rs2304682 was significantly higher in the hypertensive patients (P＜0. 05). The frequencies of alleles and genotypes for the rs2304682 also had significant differences between the group with high diastolic blood pressure and normal diastolic blood pressure (P＜0.05). There were no significant differences in the frequencies of alleles and genotypes for the 3 SNPs between the group with high systolic blood pressure and normal systolic blood pressure (P＞0.05). Conclusion The rs2304682 locus in the EMILIN1 gene, as well as the haplotypes G-G constructed using rs3754734 and rs2304682, may associate with the susceptibility of essential hypertension in the Mongolian population. Also, rs2304682 may associate with the level of the diastolic blood pressure.