针刀松解法改善膝骨关节炎疼痛症状的随机对照临床研究

[目的]评价针刀松解法缓解膝骨关节炎疼痛症状的疗效和安全性。[方法]180例膝骨关节炎患者随机分入针刀组和电针组,每组各90例,分别给予针刀松解法和电针干预,共3周。采用日常生活活动能力（ADL）评分法评价两组治疗前、治疗后及治疗后6月随访时行走疼痛和上下楼梯疼痛的疗效,同时评价治疗期间的安全性。[结果]两组治疗后和随访时行走疼痛和上下楼梯疼痛评分均较治疗前升高,差异有统计学意义（P〈0.01）;组间比较治疗后和随访时ADL评分与治疗前的差值,针刀组在两个时间点的行走疼痛和上下楼梯疼痛评分差值均大于电针组,差异有统计学意义（P〈0.01）;组间比较治疗后及随访时疗效等级分布,差异有统计学意义（P〈0.01）,针刀组的疗效优于电针组。[结论]针刀松解法对缓解膝骨关节炎疼痛症状安全有效。     

2014年淄博市中心医院中药注射剂超说明书用药情况分析

目的：对淄博市中心医院中药注射剂超说明书用药情况进行调查分析,为临床合理用药提供参考。方法随机抽取2014年淄博市中心医院使用中药注射剂的住院患者病历200份,对中药注射剂的溶媒选择、用药剂量或浓度、用药疗程、超适应症用药等进行分析评价。结果中药注射剂临床使用广泛。中药注射剂存在一定程度溶媒选择不当、超剂量、超浓度或超疗程用药等超说明书用药的情况,超说明书用药处方占42%。结论加强处方点评与反馈,对超说明书用药进行有效干预,促进中药注射剂的合理使用。     

肺癌患者因严重不良反应致表皮生长因子受体酪氨酸激酶抑制剂换药治疗的临床分析

目的 探讨表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)药物治疗肺癌患者致不良反应是否可以换用另外一种EGFR-TKI药物治疗,从而使患者能够继续从中获益.方法 回顾性总结接受过EGFR-TKI治疗的病例,筛选出因严重不良反应而换用另外一种EGFR-TKI药物的病例,分析疗效和安全性.从Pubmed中检索相关文献,进行文献总结分析.结果 共有4例患者因严重不良反应而换用另一种EGFR-TKI,其中男性4例,女性0例,中位年龄55岁(45~78岁).严重的不良反应包括肝毒性3例(4级2例、3级1例)、皮疹(过敏性紫癜)1例.药物转换从厄洛替尼换为埃克替尼1例,埃克替尼换为厄洛替尼2例,吉非替尼换为埃克替尼1例.更换药物后,未再出现类似严重不良反应.检索文献,共有13篇文献报道了54例因不良反应换用另一种EGFR-TKI治疗的病例,其中多数因肝毒性从吉非替尼换为厄洛替尼.结论 使用EGFR-TKI出现严重不良反应的肺癌患者,需要权衡换用另外一种EGFR-TKI的获益与风险.如获益大于风险,在严密的监测下,换用另外一种EGFR-TKI可能是一种可以选择的策略.但因病例数较少,尚需进一步收集病例,并研究其机制.     

霉酚酸对白蛋白刺激肾小管上皮细胞表达趋化因子的影响

目的:探讨霉酚酸对白蛋白刺激肾小管上皮细胞趋化因子RANTES表达的影响。方法:培养大鼠肾小管上皮细胞(NRK-52E),分别加入白蛋白或/和霉酚酸。应用RT-PCR方法测定RANTES mRNA表达,应用Western blot测定RANTES蛋白的表达。结果:白蛋白呈时间依赖性上调肾小管上皮细胞RANTES mRNA和蛋白表达增加。霉酚酸可抑制肾小管上皮细胞RANTES的表达。结论:霉酚酸可抑制白蛋白引起的肾小管上皮细胞分泌RANTES而发挥其抗炎作用。     

A Phase II study of neoadjuvant axitinib for reducing the extent of venous tumour thrombus in clear cell renal cell cancer with venous invasion (NAXIVA)

Background Surgery for renal cell carcinoma (RCC) with venous tumour thrombus (VTT) extension into the renal vein (RV) and/or inferior vena cava (IVC) has high peri-surgical morbidity/mortality. NAXIVA assessed the response of VTT to axitinib, a potent tyrosine kinase inhibitor.Methods NAXIVA was a single-arm, multi-centre, Phase 2 study. In total, 20 patients with resectable clear cell RCC and VTT received upto 8 weeks of pre-surgical axitinib. The primary endpoint was percentage of evaluable patients with VTT improvement by Mayo level on MRI. Secondary endpoints were percentage change in surgical approach and VTT length, response rate (RECISTv1.1) and surgical morbidity.Results In all, 35% (7/20) patients with VTT had a reduction in Mayo level with axitinib: 37.5% (6/16) with IVC VTT and 25% (1/4) with RV-only VTT. No patients had an increase in Mayo level. In total, 75% (15/20) of patients had a reduction in VTT length. Overall, 41.2% (7/17) of patients who underwent surgery had less invasive surgery than originally planned. Non-responders exhibited lower baseline microvessel density (CD31), higher Ki67 and exhausted or regulatory T-cell phenotype.Conclusions NAXIVA provides the first Level II evidence that axitinib downstages VTT in a significant proportion of patients leading to reduction in the extent of surgery.Clinical trial registration {"type":"clinical-trial","attrs":{"text":"NCT03494816","term_id":"NCT03494816"}}NCT03494816.Subject terms: Surgical oncology, Renal cell carcinoma, Predictive markers     

不同药物麻醉下行肝肿瘤切除患者术后血浆miR-92a水平与肝损伤指标的关系

目的 分析不同药物麻醉下行肝脏肿瘤切除患者术后血浆miR-92a水平与肝损伤指标的相关性,探讨血浆miR-92a表达水平对肝脏肿瘤切除术后肝损伤的诊断价值.方法 将择期行肝脏肿瘤切除手术的93例患者按照麻醉药物不同分为七氟醚组48例和丙泊酚组45例.检测两组患者术后12 h血浆丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(A...     

启膈散的研究

启膈散出自《医学心悟》一书,该方组方严谨,配伍得当,多用于治疗食管类疾病且疗效确切.近年来,围绕此方的研究不断深化,临床和药理研究都取得了新进展.根据搜集的文献可以看出,启膈散的临床研究多与治疗食管相关疾病为主,尤其是对于食管癌的治疗应用相对成熟.对其他疗效确切疾病的治疗也多是与"噎膈"症状或病机相近的疾病,这对启膈散...     

淫羊藿素在大鼠体内的药动学研究

 目的 研究淫羊藿素灌胃或静脉注射给药后原型药物及结合型药物在大鼠体内的血浆药动学和排泄特征,为新药开发提供参考依据。方法 采用高效液相色谱-串联质谱法测定生物样品经酶水解前后淫羊藿素浓度。结果 大鼠灌胃给予不同剂量淫羊藿素（20、40和80 mg·kg-1）后,ρ_max和AUC_0-∞与给药剂量呈正相关,生物利用度分别为17.29%、13.80%和10.70%。灌胃给予80 mg·kg-1淫羊藿素后,大鼠血浆中游离淫羊藿素的ρmax和AUC_0-∞分别为13.26 ng·mL-1,495.67 ng·h·mL-1;游离与结合形式总和的药动学参数分别为597.50 ng·mL-1,12 038 ng·h·mL-1。静脉给药20 mg·kg-1后,大鼠血浆中游离淫羊藿素的ρmax和AUC_0-∞分别为5 896 ng·mL-1,2 470 ng·h·mL-1;游离与结合形式总和的药动学参数分别为11 598 ng·mL-1,23 303 ng·h·mL-1。大鼠灌胃给予80 mg·kg-1淫羊藿素72 h后,尿、粪样品中游离淫羊藿素的排泄量分别占给药量的0.04%和25.09%,游离与结合形式总和的排泄量分别占给药量的0.14%和32.46%;大鼠静脉注射给予20 mg·kg-1淫羊藿素72 h后,尿、粪样品中游离淫羊藿素的排泄量分别占给药量的0.58%和8.76%,游离与结合形式总和的排泄量分别占给药量的2.48%和10.82%。结论 淫羊藿素给药后在体内主要以结合形式存在,生物利用度较低,主要通过粪便排泄。     

Recurrent Metastatic Chordoma to the Liver: A Case Report and Review of the Literature

Chordoma is a rare malignant neoplasm derived from notochordal tissue that primarily affects the axial skeleton. Almost 40% of patients have non-cranial chordoma metastases. The most common metastatic sites are the lungs, bones, lymph nodes, and subcutaneous tissue. We present a 52-year female with a history of sacral chordoma presenting with abdominal fullness, early satiety, and a palpable abdominal mass. Abdominal magnetic resonance imaging (MRI) revealed an isolated, highly vascularized, and multilobed liver mass in the left lateral segment. The mass was surgically removed using a clean surgical margin. A histological examination and immunohistochemical staining were consistent with a metastatic chordoma. Two years later, follow-up imaging studies showed a 6.5 × 4.0 × 2.0 cm right liver lesion with multiple lungs, chest wall, pleural, and diaphragmatic lesions. Microscopic- and immunohistochemical staining revealed a recurrent metastatic chordoma. Herein, we present a unique case of metastatic recurrent chordoma in the liver with the involvement of other sites. To the best of our knowledge, no other case of recurrent liver metastasis has been reported.