膳食干预对围绝经期妇女围绝经期症状的影响

目的探讨围绝经期妇女增加膳食中的大豆及其大豆制品含量对改善围绝经期症状的效果。方法对2008年1至2月来本院进行健康查体的30～45岁女性,由医疗确诊已存在围绝经期症状的156例妇女,随机分为膳食干预组、结合雌激素组和对照组,对膳食干预组给予量化进食大豆或大豆制品,结合雌激素组给予结合雌激素口服,对照组保持原饮食习惯不变。经一年干预,采用Kuppennun评分观察各组症状改善情况。结果对照组干预后Kuppermun评分为（20．54±7．94）分,膳食干预组为（15．10±6．20）分,雌激素组为（15．31±6．62）分;对照组与膳食干预组比较差异有统计学意义（P〈0．05）;结合雌激素组与膳食干预组比较,差异无统计学意义（P〉0．05）。结论围绝经期妇女经增加膳食中的大豆或大豆制品的含量可以替代激素作用,能有效地改善围绝经期症状。     

Primary invasive cancer of the vagina: Outcome and complications of therapy

The aim of the present study was to review the characteristics of cases of vaginal cancer, results of treatment and complications occurring at Westmead Hospital over the period 1979–96. International Federation of Gynaecology and Obstetrics (FIGO) staging and Eastern Cooperative Oncology Group (ECOG) status had been recorded prospectively, while other information was obtained retrospectively, including complications using the Franco-Italian Glossary. There were 37 eligible patients, 34 of whom were treated radically. Five-year survival for stage I was 90%, for stage II it was 50%, and for stage III it was 40%. There was only one stage-IV patient. The majority of patients who relapsed did so locally (63%). Using the Franco-Italian Glossary 10.8% of patients had, at worst, G0 toxicity, 21.6% had G1 toxicity, 29.7% had G2 toxicity, 37.8% had G3 toxicity, and no patients had G4 toxicity. Seven patients (18.9%) had a laparotomy for a complication of therapy. Excluding the three palliative patients and controlling for disease stage, it was found that there was a trend to improved survival in patients who had brachytherapy and those who suffered worse complications. While results for treatment of early stage vaginal cancer appear good, new techniques, particularly those that improve local control, are required for higher stage disease.     

Implementation of a multidisciplinary guideline‐driven approach to the care of the extremely premature infant improved hospital outcomes

Aim: To test the hypothesis that implementing guidelines for the standardized care of the extremely premature infant (<27 weeks) in the first week of life would improve patient outcomes in an all referral NICU. Methods: Data were collected on all infants <27 weeks gestational age and <7 days of age on admission cared for using these small baby guidelines (SBG), as well as on all age‐matched infants admitted the year prior (comparison). Results: Thirty‐seven patients were cared for utilizing the SBG and 40 patients were in the comparison group. There were no differences between the groups in gestational age, birthweight or age on admission. There was no difference in survival to discharge (73% SBG, 70% comparison). The mean length of stay for survivors was 112 ± 38 days SBG and 145 ± 76 days (p < 0.05) comparison group. Survival without BPD was greater in the SBG group (24%) than in the comparison group (9%; p < 0.05), and survival without severe IVH was greater in the SBG group (65%) than in the comparison group (38%; p < 0.01). Conclusions: These data demonstrate that applying a unified approach to the care of the extremely premature infant in the first week of life resulted in a decrease in the length of hospitalization and improved patient outcomes.     

Immunopathology of inflammatory bowel disease

Inflammatory bowel disease(IBD)results from a complex series of interactions between susceptibility genes,the environment,and the immune system.The host microbiome,as well as viruses and fungi,play important roles in the development of IBD either by causing inflammation directly or indirectly through an altered immune system.New technologies have allowed researchers to be able to quantify the various components of the microbiome,which will allow for future developments in the etiology of IBD.Various components of the mucosal immune system are implicated in the pathogenesis of IBD and include intestinal epithelial cells,innate lymphoid cells,cells of the innate(macrophages/monocytes,neutrophils,and dendritic cells)and adaptive(T-cells and B-cells)immune system,and their secreted mediators(cytokines and chemokines).Either a mucosal susceptibility or defect in sampling of gut luminal antigen,possibly through the process of autophagy,leads to activation of innate immune response that may be mediated by enhanced toll-like receptor activity.The antigen presenting cells then mediate the differentiation of na?ve T-cells into effector T helper(Th)cells,including Th1,Th2,and Th17,which alter gut homeostasis and lead to IBD.In this review,the effects of these components in the immunopathogenesis of IBD will be discussed.     

单纯球囊扩张治疗输尿管结石术后输尿管狭窄的临床效果分析

目的探讨单纯球囊扩张治疗输尿管结石术后输尿管狭窄的临床疗效。方法回顾性分析我院2010年6月至2014年1月收治的输尿管结石术后出现输尿管狭窄的28例患者的临床资料。结果 28例手术均顺利完成。手术时间26⁷5 min,平均47 min;术后住院时间275 min,平均47 min;术后住院时间2⁷ d,平均4 d;术中未出现输尿管撕脱、大出血等严重并发症;随访复查提示28例患者中22例肾积水程度减轻或未加重,有效率为78.6%。6例患者拔除双J管后肾积水持续加重,肾小球滤过率下降,或再次出现泌尿道感染、发热等。结论单纯球囊扩张治疗输尿管狭窄收效满意,与其他治疗方法相比,其创伤更小,恢复更快,且减轻了患者对取石术后再次手术的心理负担。     

Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy

BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. Echinocandins are novel antifungal molecules with in vitro and in vivo activity against Aspergillus species. METHODS: We investigated the efficacy and safety of caspofungin in the treatment of IA. Ninety patients with IA who were refractory to or intolerant of amphotericin B, lipid formulations of amphotericin B, or triazoles were enrolled to receive caspofungin. RESULTS: Efficacy was assessed for 83 patients who had infection consistent with definitions of IA and who received >or=1 dose of study drug. Common underlying conditions included hematologic malignancy (48% of patients), allogeneic blood and marrow transplantation (25% of patients), and solid-organ transplantation (11% of patients). Seventy-one patients (86%) were refractory to and 12 patients (14%) were intolerant of previous therapy. A favorable response to caspofungin therapy was observed in 37 (45%) of 83 patients, including 32 (50%) of 64 with pulmonary aspergillosis and 3 (23%) of 13 with disseminated aspergillosis. Two patients discontinued caspofungin therapy because of drug-related adverse events. Drug-related nephrotoxicity and hepatotoxicity occurred infrequently. CONCLUSION: Caspofungin demonstrated usefulness in the salvage treatment of IA.