半导体激光联合药物治疗带状疱疹

目的观察半导体激光联合药物治疗带状疱疹的疗效。方法将97例带状疱疹患者随机分成2组。对照组45例单纯药物治疗(静脉注射5%葡萄糖注射液250 ml加入阿昔洛韦0.5 g,每日2次;本院自制中药冷湿敷患处,每次15 min,每日2次)。治疗组在上述药物治疗基础上加用半导体激光照射受损的神经根部和皮损部位。疗程7 d。结果治疗组与对照组治疗后病情积分均有所下降(P<0.01),治疗组的病情积分下降明显大于对照组(P<0.01);治疗组的疼痛积分明显下降(P<0.01);对照组的疼痛积分无明显下降,治疗组有效率大于对照组,后遗神经痛发生率低于对照组。结论半导体激光联合药物治疗带状疱疹疗效优于单纯药物治疗,且可明显减轻疼痛症状,降低后遗神经痛发生率。     

Durable efficacy of early postoperative radiation therapy for high-risk pT3N0 prostate cancer: the importance of radiation dose

Objectives. To determine the durable efficacy of early postoperative radiation therapy (RT) in patients with pT3N0 prostate cancer who were at an increased risk of biochemical failure. We also evaluated the long-term benefit derived from using higher RT doses.Methods. Seventy-nine patients with pathologic Stage T3N0 prostate cancer and high-risk postoperative features underwent RT within 6 months after surgery. No patient received prior hormonal therapy. Fifty-nine patients had positive surgical margin, 29 had pathologic seminal vesicle invasion, and 27 had persistently elevated postoperative prostate-specific antigen (PSA) levels. Freedom from biochemical relapse (bNED) was defined as an undetectable (less than 0.2 ng/mL) PSA level. Median follow-up time was 39 months, and the median radiation dose was 64.8 Gy. All patients were followed for at least 2 years to be considered biochemically controlled.Results. Patients receiving adjuvant RT for an undetectable pre-RT PSA level had a 3-year bNED rate of 90%, compared with 44% for those receiving salvage RT for a detectable level (P < 0.0001). In the group of adjuvant patients, RT doses more than 61.2 Gy resulted in a 3-year bNED rate of 90% compared with 64% for those receiving a lower dose (P = 0.015). The salvage patients irradiated with a dose of 64.8 Gy or greater had a 3-year bNED rate of 52% compared with 18% for those irradiated with lower doses (P = 0.048). Severe late RT-related complications were infrequent and did not correlate with dose.Conclusions. In patients with high-risk pT3N0 prostate cancer, an RT dose response may exist. Although some studies suggest limited durable efficacy for early postoperative RT, our data suggest that RT doses of 64.8 Gy or more appear superior to prevent future biochemical failures. A prospective randomized study evaluating a postoperative RT dose response is warranted.     

Cystic fibrosis and the phenotypic expression of autosomal dominant polycystic kidney disease

Recent experiments in cultured cyst epithelial cells from kidneys of patients with autosomal dominant polycystic kidney disease (ADPKD) have shown that the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) is present in the apical surface of these cells and mediates chloride (Cl-) and fluid secretion in vitro. To determine whether the presence of CF with the expression of mutated CFTR proteins modifies cyst formation in ADPKD, we studied a large family with both inherited diseases. ADPKD in this family is linked to PKD1. The family is composed of 26 members; 11 members with ADPKD, 4 members with CF, and 2 members with both diseases. Renal volumes measured by computerized tomography (CT), calculated creatinine clearances, and other clinical parameters in the family members with ADPKD and CF were compared with those in the family members with ADPKD alone, as well as to a large population of patients with ADPKD. The patients with CF and ADPKD, but not the CF heterozygote carriers with ADPKD, had less severe polycystic kidney and liver disease, as indicated by normal renal function; smaller renal volume, even when corrected for height and body surface area; and the absence of hypertension and liver cysts. These observations suggest that the coexistence of CF may reduce the severity of ADPKD.     

Charcot-Marie-Tooth病患者血清PMP22抗体、IL-6和TNF-α水平的研究

目的检测Charcot-Marie-Tooth(CMT)病患者血清周围髓鞘蛋白22(PMP22)抗体、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,以探讨是否有免疫学机制参与CMT的病理生理过程。方法以人工合成PMP22胞外片段作为多肽抗原,用双抗体酶标法检测9名CMT1A患者和7名CMTX1患者血清PMP22抗体,同时检测IL-6和TNF-α水平;11名吉兰-巴雷综合征(GBS)患者和20名性别、年龄相匹配的正常人作对照。结果55.6%CMT1A患者和57.1%CMTX1患者PMP22抗体阳性,63.6%GBS患者和10%正常对照PMP22抗体阳性。正常对照组和CMT患者血清IL-6和TNF-α水平差异无统计学意义(P>0.05)。结论CMT1A患者PMP22抗体阳性与性别、年龄和病程均无关,但在CMTX1家系中,该抗体与性别相关(男性患者阳性),这可能是导致CMTX1家系中男性患者临床症状明显重于女性患者的原因之一。在CMT1A中,PMP22抗体的存在可能是对神经损伤的继发性反应而不是原发性病理过程,在CMTX1家系中存在继发性的免疫过程。此症可能不存在细胞因子介导的免疫损害。     

Lithium usage and renal function testing in a large UK community population; a case–control study

Objective

This study investigates the prevalence of lithium use, monitoring practice and associated effects on renal function in a large UK community sample.

Method

A large population-based renal function database was cross-referenced with a general practitioner database of 404,673 patients. The renal function of patients prescribed lithium during the 2-year period was compared with that of matched controls. The renal monitoring patterns of these cases were investigated in a naturalistic observational study. Data underwent parametric testing — continuous variables by analysis of variance, with appropriate adjustment, and categorical outcomes by χ² testing. Block analysis of variance was undertaken on case–control data.

Results

A total of 422 patients in the database were prescribed lithium. Renal function monitoring in accordance with published guidelines occurred in 69% of patients. Patients taking lithium had a significantly higher serum creatinine (5.8 μmol/L, P< .001) and lower glomerular filtration rate (5.9 ml/min, P< .001) when compared to matched controls.

Conclusions

This is the first study carried out in a large community sample. Lithium remains widely prescribed in the community setting. The study confirms that lithium has a statistically and clinically significant negative effect on renal function. Despite published guidelines and recognition of the importance of serial measurements, monitoring of renal function is inconsistent.     

武警某机动部队幽门螺杆菌感染情况的调查分析

  目的 了解武警某机动部队官兵幽门螺杆菌(helicobacter pylori,Hp)感染情况及其影响因素。 方法 随机抽取武警某总队机动部队官兵912名,填写一般情况问卷调查表,采用¹³C呼气试验进行Hp检测,对感染者相关因素进行统计学分析。 结果 912名受检官兵Hp感染率为56.5%,其中<20、20~30、≥30年龄组Hp感染率分别为53.2%,56.1%和64.5%,三组比较差异无统计学意义(P>0.05)。大学及大学以上文化程度Hp感染率为30.4%,明显低于高中及以下文化程度的62.4%,差异有统计学意义(P<0.001)。40.7%的干部感染了幽门螺杆菌,明显低于战士的58.1%,差异有统计学意义(P=0.002)。入伍前居住城市者与居住农村者感染率差异有统计学意义(P<0.001)。 结论 武警机动部队Hp感染率高于国内平均水平,文化程度、职务因素及其入伍前居住环境对Hp感染有明显的影响。     

造血干细胞移植研究进展

造血干细胞移植(hematopoietic stem cell transplantation,HSCT)是通过化学药物及放射治疗清除患者的骨髓,再将健康供者的造血干细胞植入患者体内,建立新的造血系统及免疫系统,从而达到治愈血液系统恶性肿瘤及骨髓衰竭的目的.自从1981年我国开始第一例异基因造血干细胞移植(allo-HSCT)以来,经过20余年的努力,HSCT技术已取得很大进步,根据北京市道培医院移植中心统计结果,白血病标危组同胞人类组织相容性抗原(HLA)配型相合组5年生存率为80%,HLA半相合(单倍体)及非血缘造血干细胞移植组5年生存率为70%-75%,白血病高危组长期生存率为35%-40%.