加味地黄汤治疗男性乳房肥大症临床研究

目的:观察加味地黄汤治疗男性乳房肥大症的临床疗效。方法:60例男性乳房肥大症患者随机分为对照组和观察组,每组30例。观察组给予中药加味地黄汤治疗,对照组给予他莫昔芬片治疗。结果:治疗后观察组中医证候积分、乳房肿块、硬度、缓解疼痛方面均优于对照组(P0.05或P0.01);1个疗程后,观察组愈显率为40.00%,有效率为88.33%,停药2个月后复发率13.33%;对照组愈显率23.07%,有效率为66.67%,停药2个月后复发率34.61%;观察组均优于对照组(P0.05)。治疗后观察组雌二醇、睾酮、泌乳素水平显著低于对照组(P0.05)。结论:加味地黄汤治疗男性乳房肥大症临床疗效显著。     

深部真菌在儿童消化道的定植与感染

目的 了解儿童消化道深部真菌感染的临床特点,避免临床误诊及漏诊.方法 回顾性分析总结自2005年1月至2016年5月在广州市妇女儿童医疗中心消化科住院治疗,确诊为儿童消化道深部真菌感染患儿的临床特征及治疗效果.结果 总计确诊为消化道深部真菌感染6例,所有患儿均出现真菌性食管炎,其中合并真菌性胃肠病2例.主要临床表现为呕吐、喂养或进食困难.其中2例患儿伴有间歇性胸痛、腹痛.病程4~12周.起病前应用广谱抗生素1例;诊断先天性免疫缺陷1例;因先天性食管闭锁经历手术治疗3例.食管造影均提示食管狭窄.胃镜检查均出现食管黏膜损伤,散在成簇的灰白色斑点或豆腐渣样附着物3例,食管全周被灰白色豆腐渣样物覆盖,范围1/3~1/2食管全长,伴有食管腔堵塞3例.多发巨大的浅表溃疡2例.病变累及胃、十二指肠2例,其中1例累及范围自口腔至肛门整个消化道.6例患儿经黏膜病理检查或分泌物涂片检查确定为白色念珠菌感染.3例轻症患儿选择制霉素片口服,疗程2~3周.3例重症患儿予伊曲康唑口服,疗程3~4周.胃镜复查见食管、胃、十二指肠黏膜光滑,食管溃疡表面未见附着物.1例患儿结肠及末端回肠黏膜豆腐渣样附着物及溃疡明显减少.4例临床痊愈,1例确诊免疫缺陷病,因肺部感染死亡;1例全消化道感染者,3月后复发,目前仍在随诊中.结论 儿童消化道深部真菌感染主要表现为反复呕吐,进食困难及腹痛,病变范围可累及食管以至全消化道.食管黏膜损伤可能是诱因之一,同时应注意排除先天性免疫缺陷.确诊依赖于消化内镜检查、黏膜活检.抗真菌治疗有效.     

降钙素原和C-反应蛋白水平在指导慢性阻塞性肺疾病急性加重期患者抗生素使用中的应用价值

目的 探讨血清降钙素原(PCT)在指导慢性阻塞性肺疾病急性加重期(AECOPD)患者抗生素使用中的应用价值.方法 选取收治的120例AECOPD患者,随机分为PCT组(n=40)、C-反应蛋白(CRP)组(n=40)和对照组(n=40).PCT组、CRP组分别根据血清PCT、CRP水平指导使用抗生素,对照组根据临床症状、体征等决定抗生素的使用.观察三组患者临床有效率、抗生素应用情况、住院时间、住院费用、二重感染等指标.结果 PCT组、CRP组、对照组治疗有效率分别为90.0％ 、87.5％ 、92.5％,差异无统计学意义(P>0.05);PCT组、CRP组在抗生素使用率、使用强度、使用时间及费用方面均较对照组低(P<0.05);在住院时间、住院费用方面,PCT组、CRP组均较对照组低(P<0.05).PCT组较CRP组抗生素使用率及使用强度更低(P<0.05).PCT组较对照组二重感染降低(P<0.05).PCT组与CRP组在抗生素使用时间、住院时间、住院费用方面差异无统计学意义(P>0.05).结论 血清PCT、CRP的水平在指导AECOPD患者抗生素使用中均有良好效果,对减少抗生素暴露有重要意义,但PCT的敏感性更高.     

Clinical outcome of cycles with oocyte degeneration after intracytoplasmic sperm injection

There are variant rates of oocyte degeneration after intracytoplasmic sperm injection (ICSI) among different patients. Oocyte degeneration after ICSI may reflect the cohort of oocyte quality and subsequent embryo development capacity and clinical outcome. This retrospective study analyzed 255 cycles with at least one degenerated oocyte after ICSI (degeneration group) and 243 cycles with no degenerated oocytes after ICSI (control group). Basic characteristics like female age, body mass index, duration of infertility, hormone (FSH, LH, E₂) levels on day 3 of menses, and primary infertility patient rate were similar between the two groups (p > 0.05). Total dose of gonadotropin and length of stimulation were also similar between the two groups (p > 0.05), but the degeneration group exhibited a more exuberant response to ovarian stimulation as reflected by more oocytes retrieved (p < 0.05). The number of 2PN embryos available and high quality embryos were similar between the two groups (p > 0.05), but the high quality embryo rate, early cleavage embryo rate, and available embryo rate were all statistically lower than the control group (p < 0.05). Embryo developmental kinetics seemed to be disturbed and embryo fragmentation rate increased in the degeneration group (p < 0.05). However, there was no statistical difference in the distribution of graded embryos transferred, and there were no statistical differences in the pregnancy rate, implantation rate, and abortion rate between the two groups (p > 0.05). We deduce that the presence of oocyte degeneration after ICSI may be associated with decreased embryo quality with embryo development kinetics disturbed. However, the clinical outcomes may not be affected if the premise that sufficient high quality degeneration group embryos are available for transfer.     

Circulating Tumor Cells Versus Circulating Tumor DNA in Colorectal Cancer: Pros and Cons

Circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) are emerging noninvasive multifunctional biomarkers in liquid biopsy allowing for early diagnosis, accurate prognosis, therapeutic target selection, spatiotemporal monitoring of metastasis, as well as monitoring response and resistance to treatment. CTCs and ctDNA are released from different tumor types at different stages and contribute complementary information for clinical decision. Although big strides have been taken in technology development for detection, isolation and characterization of CTCs and sensitive and specific detection of ctDNA, CTC-, and ctDNA-based liquid biopsies may not be widely adopted for routine cancer patient care until the suitability, accuracy, and reliability of these tests are validated and more standardized protocols are corroborated in large, independent, prospectively designed trials. This review covers CTC- and ctDNA-related technologies and their application in colorectal cancer. The promise of CTC- and ctDNA-based liquid biopsies is envisioned.     

升麻鳖甲汤治疗急性髓性白血病的疗效及部分机制

目的:观察升麻鳖甲汤辅助治疗急性髓性白血病的临床疗效,并评估其对患者T淋巴细胞亚群的影响。方法:选取2012年4月至2015年4月兖矿集团有限公司总医院收治的急性髓性白血病患者70例作为研究对象,按照随机数字表法分为对照组和观察组,每组35例。将同期健康体检的志愿者35例作为健康对照组。2组患者均接受常规治疗,包括保肝、止吐、营养支持等。对照组在常规治疗基础上予DA、HA或是EA方案诱导治疗,观察组在对照组方案基础上加用升麻鳖甲汤,每日1剂,200 m L煎服,早晚分服温服,连续服用60剂。观察治疗前后2组患者SF-36生命质量量表、造血恢复时间、复发时间及并发症发生情况、白细胞介素-2(IL-2)、白细胞介素-4(IL-4)、白细胞介素-10(IL-10)以及干扰素(IFN-γ)水平以及CD3+、CD4+、CD8+水平的变化。结果:2组患者治疗后SF-36生命质量量表评分均较治疗前增加,差异有统计学意义(P 0. 05),其中观察组增加幅度优于西药对照组,差异有统计学意义(P 0. 05);察组患者骨髓有核细胞(ANC) 0. 5×109/L恢复时间、血小板 20. 0×109/L恢复时间较对照组明显缩短,差异有统计学意义(P 0. 05),复发时间较对照组明显延长,差异有统计学意义(P 0. 05)。治疗后2组患者的CD3+、CD4+、CD4+/CD8+均较治疗前升高,CD8+较治疗前降低,其中观察组改善较对照组明显,差异有统计学意义(P 0. 05),治疗后2组患者与健康对照组比较,差异有统计学意义(P 0. 05)。治疗后2组患者的IL-2、IFN-γ均较治疗前升高,IL-4、IL-10均较治疗前下降,其中观察组改善较优于对照组,差异有统计学意义(P 0. 05),治疗后2组患者与健康对照组比较,差异有统计学意义(P 0. 05)。2组治疗过程中出现不良反应主要是咽部感染、尿血、口腔感染及胃肠道反应,观察组不良反应的发生率低于对照组,差异有统计学意义(P 0. 05)。结论:升麻鳖甲汤可有效辅助治疗急性髓性白血病,降低不良反应的发生率,其作用机制可能与纠正患者T细胞亚群紊乱有关。     

某市青霉素及头孢类抗菌药物皮肤过敏试验现状调查研究

目的调查某市部分医疗机构青霉素类和头孢类抗菌药物皮肤过敏试验(简称皮试)的执行现状,为规范皮试的执行提供参考。方法分层随机抽取10家某市二级以上医疗机构医院,发放调查问卷180份,了解各医疗机构青霉素类和头孢类抗菌药物皮试的执行情况。结果口服剂型是否需皮试、皮试液的配制流程等方面在不同医院、科室和护士间均存在较大差异。结论为了保证患者用药安全,青霉素类和头孢类的皮试相关问题亟待规范。     

银杏叶提取物改善反复脑缺血再灌注小鼠血液流变学的作用

目的：研究银杏叶提取物（ＥＧＢ）改善反复脑缺血再灌注小鼠血液流这的作用。方法：采用反复脑缺血再注模型鼠,应用毛细管微量热沉法和毛细管微量法分别检测血纤维蛋白原含量和红细胞压积数值,并将结果输入全自动血液流变仪得出血浆粘度、血液粘度、血细胞聚集系数,血栓形成系数及微循环滞留时间（ＭＳＴ）。结果：ＥＢＧ２５￣１００ｍｇ／ｋｇ均可不同程度地降低Ｆｉｂ、ＨＣＴ、降低ηｂ、ηｐ、ηｈ,缩小ＶＡＬ及ＴＷＥＬ,     

牛奶蛋白过敏致婴儿食物诱导性小肠结肠炎综合征1例报告

目的探讨牛奶蛋白过敏及牛奶蛋白过敏导致的食物诱导性小肠结肠炎综合征的临床诊断和治疗。方法回顾性分析1例牛奶蛋白过敏导致婴儿食物诱导性小肠结肠炎综合征的临床资料。结果出生67 d女性患儿,出生起即混合喂养,出生后2周起反复腹泻、腹胀、呕吐、黏液血便、喂养困难、贫血和生长发育迟缓。实验室检查见贫血、白细胞总数和C反应蛋白升高、嗜酸性粒细胞比例增高,牛奶特异性Ig E阴性。4次住院及入院时均诊断为"坏死性小肠结肠炎"。经回避牛奶蛋白4周后,症状消失,牛奶蛋白激发试验阳性,符合牛奶蛋白过敏以及牛奶蛋白过敏导致婴儿食物诱导性小肠结肠炎特征。结论牛奶蛋白过敏及牛奶蛋白过敏导致婴儿食物诱导性小肠结肠炎的临床表现非特异性,症状体征多样,临床需注意辨别。     

Evaluation of the Effect of Inactivated Transmissible Gastroenteritis Virus Vaccine with Nano Silicon on the Phenotype and Function of Porcine Dendritic Cells

A transmissible gastroenteritis virus (TGEV) is a porcine enteropathogenic coronavirus, causing acute swine enteric disease especially in suckling piglets. Mesoporous silica nanoparticles (MSNs) are safe vaccine adjuvant, which could enhance immune responses. Our previous research confirmed that nano silicon had immune-enhancing effects with inactivated TGEV vaccine. In this study, we further clarified the immune-enhancing mechanism of the inactivated TGEV vaccine with MSNs on porcine dendritic cells (DCs). Our results indicated that the inactivated TGEV vaccine with MSNs strongly enhanced the activation of the DCs. Expressions of TLR3, TLR5, TLR7, TLR9, and TLR10, cytokines IFN-α, IL-1β, IL-6, IL-12, and TNF-α, cytokine receptor CCR-7 of immature DCs were characterized and showed themselves to be significantly higher in the inactivated TGEV vaccine with the MSN group. In summary, the inactivated TGEV vaccine with MSNs has effects on the phenotype and function of porcine DCs, which helps to better understand the immune-enhancing mechanism.