FOLFOX4与替加氟替代方案对晚期胃癌疗效的对比研究

目的:对比观察FOLFOX4方案与替加氟替代方案治疗晚期胃癌的疗效和不良反应.方法:经病理或细胞学确诊的晚期胃癌患者75例,按收治的时间顺序交叉分入FOLFOX4组(A组)或替加氟替代组(B组),两方案均至少连用3周期评价疗效.A组:OXA 85mg/m2,静滴2h,第1天;LV 200mg/m2,静滴2h,第1、2天;5-FU 400mg/m2,静推,然后600mg/m2,22h静脉维持,第1、2天;2周重复,14天为1个周期.B组:OXA 130mg/m2,静滴2h,第1天;LV 200mg/m2,静滴2h,第1-5天;FT-207 800mg/m2,静滴3h,第1-5天;3周重复,21天为1个周期.结果:研究对象共75例.A组39例,总有效率(CR + PR)41.0%,其中初治患者总有效率55.6%;复治患者的总有效率28.6%.B组36例, 总有效率38.9%,其中初治患者总有效率 50.0%;复治患者的总有效率30.0%.两组总有效率比较均无统计学差异.不良反应主要是白细胞减少、恶心呕吐、神经感觉毒性等,A组白细胞下降发生率和消化系统不良反应发生率均明显高于B组(P均＜0.05).两组均无化疗相关死亡.结论:FOLFOX4方案与替加氟替代方案均为治疗晚期胃癌有效的方案,FOLFOX4方案总有效率稍高,不良反应较替加氟替代方案重,但可耐受.建议晚期胃癌初治可选用FOLFOX4方案,而其中年龄偏大,体质欠佳的患者宜选替加氟替代方案.     

李莹教授治疗肾病的经验

李莹教授毕业于长春中医学院，从事中医内科临床、科研、教学工作50余年，是吉林省首批名中医。她笔耕不辍，讲学传道，精通典籍，厚德载物，度人济世，尤其擅长治疗肾病，是吉林省中医药科学院肾病内科的创始人，并于1998年开始被国家中医药管理局指定为全国名老中医药专家学术经验继承工作指导老师。笔者有幸跟随李老师学习，成为第四批学术经验继承人之一。     

腮腺手术中耳大神经后支保留的临床意义

目的 探讨腮腺手术中耳大神经后支保留的可行性、方法及临床价值。方法 我们对48例腮腺肿瘤患者，按常规隐蔽切口腮腺手术方法进行治疗，保留或不保留耳大神经后支。分别于术后10d及1、6、12个月进行随访，检测耳廓上部、耳垂、耳下区、耳前区和耳后区的触觉、痛觉，并观察其感觉变化情况。结果 48例中35例耳大神经后支保留，耳廓上部及耳后区感觉无减退。术后早期耳前、耳垂及耳下区感觉有不同程度的减退，以耳前区最明显，随着时间延长症状逐步好转，6个月时感觉接近正常。另13例耳大神经切断患者感觉减退症状更加明显，恢复时间延长。结论 腮腺手术中耳大神经后支保留是可行的，所采用的方法可靠，可减轻局部麻木感，提高患者术后早期生活质量，降低神经切断后产生局部永久性麻木的可能性。     

Endoscopic pH monitoring for patients with suspected or refractory gastroesophageal reflux disease.

BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms. METHODS: Patients undergoing prolonged ambulatory pH studies for the evaluation of GERD-related symptoms were assessed. Patients with a known diagnosis of GERD were tested on medical therapy, while patients with suspected GERD were tested off therapy. The wireless pH capsules were placed during upper endoscopy 6 cm above the squamocolumnar junction. RESULTS: One hundred ninety-one patients underwent a total of 198 pH studies. Fifty ambulatory pH studies (25%) were excluded from the analysis: 27 patients (14%) had insufficient data capture (less than 18 h on at least one day of monitoring), 15 patients had premature capsule release (7%), seven were repeat studies (3.5%) and one had intolerable pain requiring capsule removal (0.5%). There were 115 patients undergoing pH studies who were off medication, and 33 patients were on therapy. For the two groups of patients, results were as follows: 32 (28%) and 22 (67%) patients with normal studies on both days; 58 (50%) and five (15%) patients with abnormal studies on both days; 18 (16%) and three (9%) patients with abnormal studies on day 1 only; and seven (6%) and three (9%) patients with abnormal studies on day 2 only, respectively. CONCLUSIONS: Prolonged 48 h pH monitoring can detect more abnormal esophageal acid exposure but is associated with a significant rate of incomplete studies.     

靶重建放大扫描对肺孤立性结节病变的诊断意义

目的：探讨靶重建放大扫描技术对肺孤立性结节病变的诊断价值。方法：对63例患者先行常规CT平扫，选定结节处为兴趣区，行薄层靶重建放大扫描，层厚、层距为2mm，FOV为160。结果：42例恶性病变中有37例表现为深分叶，占88．1％；21例良性病变中有15例表现为浅分叶，占71．4％。恶性结节中15例内部出现条状低密度支气管征；7例出现血管集中征；8例出现空泡征；病变内部出现液化坏死13例，其中恶性病变ll例。22例出现钙化，包括12例良性病变和10例恶性病变。2例错构瘤内均见小面积脂肪性低密度影。结论：靶重建放大扫描比普通CT扫描可提供更多的信息，对良恶性病变的鉴别诊断有一定价值。恶性病变大多数为深分叶，良性病变大多数为浅分叶或无分叶。     

Endoscopic T-tube placement in the management of lye-induced esophageal perforation: Case report of a safe treatment strategy

Esophageal perforation is associated with a significant risk of morbidity and mortality. We report herein a case of lye-induced esophageal perforation managed successfully by employing endoscopic T-tube placement with a successful outcome.     

环戊硫酮治疗干眼的临床疗效评价

Objective To investigate anethol trithione therapic efficiency on dry eye. Methods It was a prospective random double-blind controlled study. Eighty cases diagnosed dry eye in Ocular Surface Out-patient Clinic of Xiamen University Affiliated Xiamen Eye Center from 2006 to 2008 were divided into two groups: anethol trithione group and control group, 40 cases in each group. Every group was then divided into two subgroups: weak dry eye subgroup, middle and severe dry eye subgroup. All groups had been added with 0.05% refresh drops. All patients had been detected and evaluated by subjective symptoms of dry eye, visual acuity,corneal fluorescent staining(F1), break-up time(BUT) and Schirmer Ⅰ test (SⅠT) at pre-therapy and 3,7,28 d of post-therapy. All groups had been compared and analyzed by F test and sample mean difference (SMD) or median difference (MD) comparison between pre-therapy and post-therapy. Results Except of tear and red eye, the other subjective symptoms of dry eye, F1, BUT and SⅠT of weak dry eye subgroup of both groups had been improved at 7 d after therapy. Only those of middle and severe dry eye subgroup of anethol trithione group had been improved at 7 d after therapy compared with those of pre-therapy: SMD=0.96 (visual tiredness), 1.26 (dry and unsmooth sensation), 0.82 (foreign body sensation), 1.28 (burning sensation), 1.05 (photophobia), 1.48 ( pain ) ; MD=0.30 (visual acuity), 4.00 (F1) ,5.00 (BUT), 5.00 (SⅠT) [F=15.30 (visual tiredness), 15.68 (dry and unsmooth sensation ), 13.56 (foreign body sensation), 20. 91 ( burning sensation ), 18.90 (photophobia), 27.22 ( pain ), 10.54 (visual acuity), 188.21 (F1) ,261.76 (BUT) ,269.05 (SⅠT) ;P<0. 05]. Those of middle and severe dry eye subgroup of control group hadn't significantly been improved at 28 d after therapy: SMD=0.10 (visual tiredness) ,0.16 (dry and unsmooth sensation) ,0.09 (foreign body sensation) ,0.38 ( burning sensation ), 0.24(photophobia) ,0.36 (pain) ,0.23 (red eye) ; MD=0.10 (visual acuity) ,0.50(F1) ,0.50(BUT), 0.50(SⅠT) [F=1.76 (visual tiredness), 1.61 (dry and unsmooth sensation), 1.02 (foreign body sensation),2.39 (burning sensation), 2.42 (photophobia), 2.73 ( pain ), 2.55 ( red eye ), 1.46 ( visual acuity) ,2.35 (F1) ,2.90 (BUT) ,2.76 (SⅠT) ; P>0.05]. SⅠT of anethol trithione group had been improved more significantly after therapy (F=13.77, P<0.05). Conclusion Anethol trithione could significantly improve middle and severe dry eye patients' symptoms and signs whose lacrimal gland function survival and it has clinical application value.     

Liposome-mediated transfer of vascular endothelial growth factor cDNA augments survival of random-pattern skin flaps in the rat.

Tissue engineering is an application for gene therapy that is in its infancy. We show that simple liposomal-mediated gene transfer could result in a potentially useful biological effect in the field of wound healing. cDNA encoding the 165 amino acid form of vascular endothelial growth factor complexed to commercially available liposomes was injected into rat skin 1 week before raising a random pattern 3 x 10 cm flap. The flap survival was enhanced by 14 percent, and was accomplished without accessing the arterial inflow of the territory. These results were statistically significant (p<0.002) and reproducible. No adverse effects were seen. Histological analysis of the angiogenesis localized much of the new vessel formation to the area around the hair follicles. Polymerase chain reaction amplification of extracted flap tissue confirmed the presence of the transgene.     

2008年连云港市“手足口病”流行特征及病原学分型

目的分析连云港市2008年手足口病的流行特征及病原学分型情况。方法应用流行病学方法对2008年该市的手足口病流行资料进行分析。结果依据疫情报告,实验室诊断病例45例,其中CoxA1638例,EV71型7例,其他肠道病毒0例。2008年该市临床报告手足口病例1067例,报告发病率为23.19/10万,比2007年上升442.34%,男女发病比为3.1∶1。发病年龄最小的为0岁组,最大的为8岁;0～5岁组,共计发病976例,占总发数的91.47%。发病数的构成以散居儿童最多,占76.66%。地区分布:全市各个区县均有手足口病病例报告,但城区的总体发病率高于县。结论连云港市手足口病发病率有上升趋势;控制传染源是有效防止该病流行的关键。