新城疫病毒治疗乳腺癌的研究进展

乳腺癌是发病率最高的女性恶性肿瘤,是不容忽视的女性健康杀手.近年来,乳腺癌的发病率持续呈上升趋势和年轻化趋势.随着乳腺癌治疗的越来越多元化、细致化,乳腺癌患者的预后得到了显著的改善.当Csatary发现新城疫病毒能够抑制晚期胃癌转移的现象后,新城疫病毒便作为一种新型的抗肿瘤生物制剂得以广泛研究.新城疫病毒治疗乳腺癌也就成为一种较好的新的辅助治疗方法.本文简要地从新城疫病毒的概况、作用机制、研究意义等方面进行阐述.     

针刺抗炎研究进展

背景 创伤、烧伤、手术等容易导致机体发生全身炎性反应综合征、脓毒症、多器官功能不全综合征(multiple organ disfunction syndrome,MODS),甚至死亡.调控过度的炎症反应是防治脓毒症和MODS的重要手段之一. 目的 阐释针刺抗炎的作用及机制. 内容 针刺对多种炎性疾病有良好的治疗作用,对脓毒症和MODS亦有一定的防治作用.针刺可通过对免疫细胞、免疫球蛋白、神经递质和细胞因子等的调节,发挥抗炎作用.此外,下丘脑-垂体-肾上腺轴、胆碱能抗炎通路和内源性大麻素系统参与了针刺的抗炎机制. 趋向 针刺抗炎的确切机制尚不清楚,是否还有其他机制参与针刺的抗炎作用还有待阐明.     

The Parameters Affecting the Success of Irrigation and Debridement with Component Retention in the Treatment of Acutely Infected Total Knee Arthroplasty

BackgroundThe aims of our study were to evaluate the success rate of irrigation and debridement with component retention (IDCR) for acutely infected total knee arthroplasty (TKA) (< 4 weeks of symptom duration) and to analyze the factors affecting prognosis of IDCR.MethodsWe retrospectively reviewed 28 knees treated by IDCR for acutely infected TKA from 2003 to 2012. We evaluated the success rate of IDCR. All variables were compared between the success and failure groups. Multivariable logistic regression analysis was also used to examine the relative contribution of these parameters to the success of IDCR.ResultsSeventeen knees (60.7%) were successfully treated. Between the success and failure groups, there were significant differences in the time from primary TKA to IDCR (p = 0.021), the preoperative erythrocyte sedimentation rate (ESR; p = 0.021), microorganism (p = 0.006), and polyethylene liner exchange (p = 0.017). Multivariable logistic regression analysis of parameters affecting the success of IDCR demonstrated that preoperative ESR (odds ratio [OR], 1.02; p = 0.041), microorganism (OR, 12.4; p = 0.006), and polyethylene liner exchange (OR, 0.07; p = 0.021) were significant parameters.ConclusionsThe results show that 60.7% of the cases were successfully treated by IDCR for acutely infected TKA. The preoperative ESR, microorganism, and polyethylene liner exchange were factors that affected the success of IDCR in acutely infected TKA.     

Distribution of Major Pathogens from Sputum and Bronchoalveolar Lavage Fluid in Patients with Noncystic Fibrosis Bronchiectasis: A Systematic Review

Objective:

Noncystic fibrosis (non-CF) bronchiectasis remains as a common health problem in Asia. Pathogens’ distribution in airways of patients with non-CF bronchiectasis is important for doctors to make right decision.

Data Sources:

We performed this systematic review on the English language literatures from 1966 to July 2014, using various search terms included “pathogens” or “bacteria” or “microbiology” and “bronchiectasis” or “non-cystic fibrosis bronchiectasis” or “non-CF bronchiectasis” or “NCFB.”

Study Selection:

We included studies of patients with the confirmed non-CF bronchiectasis for which culture methods were required to sputum or bronchoalveolar lavage fluid (BALF). Weighted mean isolation rates for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Stapylococcus aureus, Moxarella catarrhails were compared according to different methodology.

Results:

The total mean bacterial culture positive rates were 63%. For studies using sputum samples, the mean positive culture rates were 74%. For studies using BALF alone or BALF and sputum, it was 48%. The distributions of main bacterial strains were 29% for H. influenzae, 28% for P. aeruginosa, 11% for S. pneumoniae, 12% for S. aureus, and 8% for M. catarrhails with methodology of sputum. Meanwhile, the bacterial distributions were 37% for H. influenzae, 8% for P. aeruginosa, 14% for S. pneumoniae, 5% for S. aureus, and 10% for M. catarrhails with methodology of BALF alone or BALF and sputum. Analysis of the effect of different methodology on the isolation rates revealed some statistically significant differences.

Conclusions:

H. influenzae accounted for the highest percentage in different methodology. Our results suggested that the total positive culture rates and the proportion of P. aeruginosa from sputum and BALF specimens had significant differences, which can be used in further appropriate recommendations for the treatment of non-CF bronchiectasis.     

CO2激光喉显微手术与电子喉镜手术治疗声带息肉效果比较

目的：比较支撑喉镜下CO2激光显微手术与电子喉镜下手术治疗声带息肉的临床疗效。方法选取2014年1月至2015年1月芜湖市第二人民医院收治的144例声带息肉行支撑喉镜下CO2激光显微手术患者(激光组)及同期门诊75例电子喉镜下手术的声带息肉患者(喉镜组),比较分析两组患者的临床治疗效果。结果激光组显效120例,有效19例,无效5例,总有效率为96．52%;喉镜组治愈60例,有效12例,无效3例,总有效率为96．00%。两组总有效率比较,差异无统计学意义( P>0．05)。结论声带息肉的手术方式应根据患者的自愿、声带息肉的基底部以及声门暴露情况选择不同的手术。     

榄香烯口服乳联合TP方案在食管癌中的疗效观察

目的：探讨榄香烯口服乳联合TP方案在食管癌的疗效和毒副作用。方法选择110例进展期食管癌患者,分为治疗组（榄香烯口服乳+TP方案）和对照组（TP方案）,21 d为1个化疗周期,榄香烯口服乳连服6周为1个疗程,化疗2个周期后进行疗效、生活质量和副作用的评价,并随访生存期。结果治疗组和对照组的有效率分别为90.9%和74.5%,差异具有统计学意义（P<0.05）;治疗组和对照组的中位生存期分别为9.7个月和7.3个月（P<0.05）;主要不良反应和Karnofsky评分的差异无统计学意义（P>0.05）。结论榄香烯口服乳联合TP方案对进展期食管癌具有较好疗效,且毒副作用较少。     

肺原发性浆细胞瘤1例报告并文献复习

目的 提高对原发性肺浆细胞瘤的认识。方法 对1例临床确诊为原发性肺浆细胞瘤患者的临床资料进行分析,通过Pubmed检索2000-2014年所发表相关文献,结合文献复习。结果 原发性肺浆细胞瘤是一种极为罕见的肺部肿瘤,属于髓外浆细胞瘤的范畴。患者多缺乏临床症状,影像学上表现为肺内单发或多发结节影,缺乏特异性,容易误诊。其诊断主要依赖肺部肿块的病理活检,并应排除骨髓原发病灶。对于局限性的病灶可采取手术治疗或放疗,多发病灶可采取化疗。结论 对于此类表现为肺部结节、肿块影的病例应当尽早进行穿刺活检以获取病理诊断,以免误诊误治。     

Effects of Moderate Hyperventilation on Jugular Bulb Gases under Propofol or Isoflurane Anesthesia during Supratentorial Craniotomy

Background:

The optimal ventilated status under total intravenous or inhalation anesthesia in neurosurgical patients with a supratentorial tumor has not been ascertained. The purpose of this study was to intraoperatively compare the effects of moderate hyperventilation on the jugular bulb oxygen saturation (SjO₂), cerebral oxygen extraction ratio (O₂ER), mean arterial blood pressure (MAP), and heart rate (HR) in patients with a supratentorial tumor under different anesthetic regimens.

Methods:

Twenty adult patients suffered from supratentorial tumors were randomly assigned to receive a propofol infusion followed by isoflurane anesthesia after a 30-min stabilization period or isoflurane followed by propofol. The patients were randomized to one of the following two treatment sequences: hyperventilation followed by normoventilation or normoventilation followed by hyperventilation during isoflurane or propofol anesthesia, respectively. The ventilation and end-tidal CO₂ tension were maintained at a constant level for 20 min. Radial arterial and jugular bulb catheters were inserted for the blood gas sampling. At the end of each study period, we measured the change in the arterial and jugular bulb blood gases.

Results:

The mean value of the jugular bulb oxygen saturation (SjO₂) significantly decreased, and the oxygen extraction ratio (O₂ER) significantly increased under isoflurane or propofol anesthesia during hyperventilation compared with those during normoventilation (SjO₂: t = −2.728, P = 0.011 or t = −3.504, P = 0.001; O₂ER: t = 2.484, P = 0.020 or t = 2.892, P = 0.009). The SjO₂ significantly decreased, and the O₂ER significantly increased under propofol anesthesia compared with those values under isoflurane anesthesia during moderate hyperventilation (SjO₂: t = −2.769, P = 0.012; O₂ER: t = 2.719, P = 0.013). In the study, no significant changes in the SjO₂ and the O₂ER were observed under propofol compared with those values under isoflurane during normoventilation.

Conclusions:

Our results suggest that the optimal ventilated status under propofol or isoflurane anesthesia in neurosurgical patients varies. Hyperventilation under propofol anesthesia should be cautiously performed in neurosurgery to maintain an improved balance between the cerebral oxygen supply and demand.     

Efficacy and Safety of Avandamet or Uptitrated Metformin Treatment in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Alone: A Multicenter,Randomized, Controlled Trial

Background:

At present, China has listed the compound tablet containing a fixed dose of rosiglitazone and metformin, Avandamet, which may improve patient compliance. The aim of this study was to evaluate the efficacy and safety of Avandamet or uptitrated metformin treatment in patients with type 2 diabetes inadequately controlled with metformin alone.

Methods:

This study was a 48-week, multicenter, randomized, open-labeled, active-controlled trial. Patients with inadequate glycaemic control (glycated hemoglobin [HbA1c] 7.5–9.5%) receiving a stable dose of metformin (≥1500 mg) were recruited from 21 centers in China (from 19 November, 2009 to 15 March, 2011). The primary objective was to compare the proportion of patients who reached the target of HbA1c ≤7% between Avandamet and metformin treatment.

Results:

At week 48, 83.33% of patients reached the target of HbA1c ≤7% in Avandamet treatment and 70.00% in uptitrated metformin treatment, with significantly difference between groups. The target of HbA1c ≤6.5% was reached in 66.03% of patients in Avandamet treatment and 46.88% in uptitrated metformin treatment. The target of fasting plasma glucose (FPG) ≤6.1 mmol/L was reached in 26.97% of patients in Avandamet treatment and 19.33% in uptitrated metformin treatment. The target of FPG ≤7.0 mmol/L was reached in 63.16% of patients in Avandamet treatment and 43.33% in uptitrated metformin treatment. Fasting insulin decreased 3.24 ± 0.98 μU/ml from baseline in Avandamet treatment and 0.72 ± 1.10 μU/ml in uptitrated metformin treatment. Overall adverse event (AE) rates and serious AE rates were similar between groups. Hypoglycaemia occurred rarely in both groups.

Conclusions:

Compared with uptitrated metformin, Avandamet treatment provided significant improvements in key parameters of glycemic control and was generally well tolerated. Registration number: ChiCTR-TRC-13003776.