子宫动脉栓塞加中药治疗子宫肌瘤疗效分析

目的 :研究子宫动脉栓塞加中药治疗子宫肌瘤的疗效。方法 :40例子宫肌瘤患者 ,采用Seldinger技术 ,穿刺股动脉成功后 ,行双侧子宫动脉超选择插管 ,分别注入 3 5 5～ 70 0 μmPVA颗粒栓塞子宫动脉 ;术后配合中药治疗。分别于术后 3个月、6个月、1年观察疗效。结果 :治疗成功率为 10 0 % ,临床症状逐渐改善、消失。 3个月复查肌瘤平均缩小 3 8 48% ,6个月平均缩小 5 7 40 % ,1年后复查无再增大者。结论 :子宫动脉栓塞加中药治疗子宫肌瘤有很好的临床应用价值     

p53和VEGF蛋白表达与胆囊癌的关系

目的探讨抑癌基因p53和血管内皮生长因子(vascular endothelial growth factor,VEGF)与胆囊癌的关系。方法采用免疫组化方法分别检测50例胆囊癌、35例胆囊腺瘤和26例慢性胆囊炎组织中p53和VEGF蛋白表达。结果胆囊癌组织中p53和VEGF的阳性表达率分别为64.0%和72.0%,明显高于胆囊腺瘤的17.1%和22.9%及慢性胆囊炎的19.2%和23.1%,χ2=4.25,P=0.006,根据Nevin分期,胆囊癌S1、S2、S3期的p53阳性表达率为63.2%,明显高于S4、S5期的35.5%,χ2=7.29,P=0.009,而VEGF在胆囊癌S4、S5期的阳性表达率为87.1%,明显高于S1、S2、S3期的47.4%,χ2=4.29,P=0.007,胆囊癌中p53和VEGF的阳性表达明显相关,r=0.87,P=0.009。它们与胆囊癌病理分级均未发现明显相关性。结论p53和VEGF的过度表达可能对胆囊癌的发生、发展及预后判断有一定作用。     

干扰素基因刺激蛋白相关婴儿期发病血管病变1例并文献复习

目的 探讨干扰素基因刺激蛋白(STING)相关婴儿期发病血管病变(SAVI)的临床特点、诊断和治疗。方法 对1例SAVI患儿的临床表型及基因型进行分析,并通过复习相关文献,分析和总结有关国内外SAVI的文献报道,总结SAVI的临床特征及遗传学特点。结果 男,11岁4个月,为反复呼吸道感染、咳嗽、活动耐力下降,查体可见杵状指(趾),实验室检查提示ESR异常升高、ANA及抗心磷脂抗体阳性,肺部高分辨CT提示间质性病变。全外显子测序提示患儿TMEM173基因新生杂合突变:c.463G>A,p.V155M。予托法替尼(每次5 mg,每天2次)治疗有效。文献复习目前国内外已报道SAVI病例31例(包括本文1例),SAVI男性多发,以婴幼儿为主。首发症状以皮疹(58.0%)、呼吸急促(41.9%)及活动受限(48.3%)为主。实验室检查64.5%伴有ESR增快或CRP升高,64.5%出现自身抗体阳性。70.9%患儿肺部影像学提示为间质性肺炎改变。基因检查可明确诊断,SAVI相关的基因突变位于第5号染色体上的TMEM173基因,74.1%为新发突变。Janus激酶抑制剂治疗有效。结论 SAVI为一种罕见的自身炎症性疾病,为TMEM173基因变异,临床上以活动耐力下降、生长受限及间质性肺疾病为主要表现。Janus激酶抑制剂对该病治疗有效。     

Brief report: Longitudinal associations between sedentary behaviours and depressive symptoms in adolescent girls

The purpose of this study was to examine longitudinal associations between sedentary behaviours (SB) and depressive symptoms in adolescent girls. Participants (n = 341) completed the self-report ecological momentary assessments diary for the measurement of sedentary behaviours and completed the Center for Epidemiological Studies Depression scale (CES-D) at three time points during a 4-year period. The association between SB and depressive symptoms over time was examined with latent growth models. Both depressive symptoms and SB increased over time. Baseline levels of depressive symptoms were predictive of change in SB, but initial levels of SB did not predict changes in depressive symptoms. These prospective associations remained controlling for age, home electronic equipment and socioeconomic status.     

Breakthrough invasive fungal disease in patients receiving posaconazole primary prophylaxis: a 4-year study

Posaconazole (PSC) is currently recommended as primary prophylaxis in neutropenic patients with acute myeloid leukaemia (AML) and in allogenic haematopoietic stem cell transplantation (AHSCT) recipients with graft-versus-host disease (GVHD). Studies focusing on breakthrough invasive fungal disease (IFD) upon PSC prophylaxis show disparate results. In order to evaluate the incidence of IFD in patients on PSC prophylaxis and identify IFD risk factors, we carried out a retrospective study of all consecutive patients on PP from January 2007 to December 2010 in our hospital. Breakthrough IFDs were identified from the database of the central pharmacy and the French administrative database (PMSI), registering final medical diagnoses of hospitalized patients. Medical data were reviewed to study proven or probable IFD, according to EORTC/MSG definition. PSC plasma concentrations (PPC) were also retrieved. Poisson models were used for statistical analysis. Two hundred and seventy-nine patients received PSC prophylaxis for a median duration of 1.4 months (range 0.2–17.9). Proven (n = 6) or probable (n = 3) IFDs were diagnosed in nine cases (3.2%). IFD incidence rate per 100 person-month was 1.65 (95% CI, 0.79–2.97). IFDs were candidaemia (Candida glabrata, n = 2), pulmonary invasive aspergillosis (n = 3), disseminated fusariosis (n = 2) and pulmonary mucormycosis (n = 2). Seven deaths were reported, directly related to IFD in three patients (33.3%). First dosage of PPC under 0.3 mg/L was the single significant risk factor for IFD (RR, 7.77; 95% CI, 1.30–46.5; p 0.025). Breakthrough IFD in patients receiving PSC prophylaxis is rare but associated with a poor outcome. Low PSC plasma concentrations are associated with an increased risk of IFD.     

Radiofrequency hyperthermia-enhanced herpes simplex virus-thymidine kinase/ganciclovir direct intratumoral gene therapy of hepatocellular carcinoma

Purpose: To determine the feasibility of using radiofrequency hyperthermia (RFH) and to enhance the therapeutic effect of herpes simplex virus-thymidine kinase/ganciclovir (HSV-TK/GCV) for the treatment of hepatocellular carcinoma (HCC).

Materials and methods: Human HCC cells (HepG2) were first transfected with lentivirus/luciferase. For both in vitro confirmation and in vivo validation, luciferase-labeled HCC cells and HCC tumour xenografts on mice received different treatments: (i) combination therapy of intratumoral HSV-TK/GCV-mediated gene therapy plus magnetic resonance imaging heating guidewire (MRIHG)-mediated RFH; (ii) gene therapy only; (iii) RFH only; and (iv) phosphate-buffered saline (PBS) as control. Cell proliferation was quantified. Tumour changes were monitored by ultrasound imaging and bioluminescence optical imaging before and at days 7 and 14 after treatments, which were correlated with subsequent histology.

Results: In vitro, the lowest cell proliferation was seen in the combination therapy group compared with control groups (29?±?6% vs. 56?±?9%, 93?±?4%, and 100?±?5%, p?p?p?Conclusion: RFH can enhance HSV-TK/GCV-mediated gene therapy of HepG2 cell line and mice human HCC xenografts, which may open new avenues for effective management of HCC using MR/RFH integrated interventional gene therapy.     

The role of tenofovir in preventing and treating hepatitis B virus (HBV) reactivation in immunosuppressed patients. A real life experience from a tertiary center

Introduction/aimPatients who present HBV reactivation during immunosuppressive treatment are prone to develop life threatening decompensation of the liver function, therefore prophylaxis and treatment are strongly recommended. So far there are no data regarding the role of tenofovir in this context. Therefore, the aim of our study was to describe our “real life” experience with the use of tenofovir (TDF) in patients who underwent immunosuppressive treatment.Results38 patients with immunosuppression received antiviral treatment with tenofovir (25 patients as prophylaxis and 13 patients as treatment of HBV reactivation). In all 25 patients in whom prophylactic treatment with tenofovir was administered no HBV flare occurred during immunosuppression and the levels of serum HBV-DNA became or remained undetectable during the follow up period (mean follow up 17.2 months, range 6–54). One patient experienced HBsAg seroconversion. In the 13 patients who exhibited HBV reactivation TDF treatment resulted in complete biochemical and virological response within 6 months except two patients with high pretreatment HBV-DNA levels who became HBV-DNA negative at 9 months. No exacerbation of liver disease or liver related death has been observed. One patient who presented with decompensated cirrhosis during HBV reactivation returned into a compensated state after treatment. No side effects of tenofovir have been documented.ConclusionTenofovir seems to be highly effective and safe in the prophylaxis and rescue treatment of HBV reactivation in patients who receive immunosuppression therapy.