系统性红斑狼疮合并溶血性贫血患者病情活动度脏器损害程度及相关实验室检查的特点

目的探讨系统性红斑狼疮(SLE)患者合并溶血性贫血(hemolytic anemia,HA)发生率与SLE病情活动指数(DAI)、脏器损伤指数(SDI)、抗心磷脂(aCL)抗体阳性率、抗双链DNA(ds-DNA)抗体阳性率及肾脏、神经精神系统受累率的关系。方法分析453例SLE患者的临床资料及相关实验室指标,应用χ2检验进行统计学分析。结果 453例SLE患者中,213例(占47%)无贫血,193例(占42%)合并非溶血性贫血,合并溶血性贫血者47例(占10.3%)。溶血性贫血组DAI(17.6分±6.1分)、SDI(1.83分±1.8分)、aCL抗体阳性率(33.8%)、肾脏、神经精神系统受累率(81.7%和32.6%)高于非贫血组(上述指标,分别为10.6分±5.3分、1.1分±1.3分、24.7%、43.9%和18.0%)及非溶血性贫血组(上述指标分别为13.7分±4.2分、1.2分±1.0分、24.1%、57.6%和19.1),且具有统计学意义(P<0.05)。溶血性贫血组抗dsD-NA抗体阳性率为73.4%高于非贫血组(55.7%)及非溶血性贫血组(61.2%),且与非贫血组的差异具有统计学意义(P<0.05)。结论 SLE发生HA者有更高的病情活动度、损伤指数、肾脏、神经精神系统受累率及抗ds-DNA抗体和aCL抗体阳性率。     

发病3～6h应用rt-PA静脉溶栓治疗急性脑梗死的有效性与安全性分析

目的探讨重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗扩大时间窗至6 h的疗效与安全性。方法试验组选择发病3 h内的患者(A组)16例,3～6 h的患者(B组)10例做为观察对象,分别给予rt-PA(0.7 mg/kg)静脉溶栓治疗;另选择发病在0～6 h内未选择溶栓治疗的患者为对照组(16例)。试验组与对照组均给予奥扎格雷钠80 mg,1次/d,静点;舒雪宁20 mL,1次/d,静点;阿司匹林0.1 g,1次/d,口服治疗。评定患者治疗前、治疗后2 h、24 h、7 d、30 d的NIHSS评分及治疗后90 d的Barthel指数评分。治疗前、治疗后1 d查头部CT,判定是否出血(根据影像学判定是梗死后还是实质出血)并记录各组出血和死亡例数。结果试验组与对照组各自NIHSS评分治疗前无差别(P>0.05),治疗后各时间点比较有统计学意义(P<0.05),试验A组与B组治疗前后各时间点差别无统计学意义(P>0.05);试验组与对照组B I指数治疗前与治疗后90d比较差异有统计学意义。A组出血2例,1例为梗死后出血,1例为脑实质出血,死亡1例;B组出血1例,为梗死后出血,死亡0例;对照组出血1例,1例为梗死后出血,死亡1例。结论用rt-PA溶栓治疗,扩大时间窗至6 h,疗效确切,未增加出血几率。因此,将溶栓时间窗扩大至6 h可行。     

静脉系统与脑小血管病白质高信号相关性研究

脑白质高信号是脑小血管病主要影像学标记物之一,普遍存在于老年人群中。目前其发病机制尚不清楚,以往的研究大多集中在动脉系统上,但静脉系统在脑白质高信号中的作用也越来越受到关注,小静脉胶原增生、下游颅内静脉扩张以及颈内静脉的返流或许都参与脑白质高信号的形成与发展。     

Formation of microchimerism in rat small bowel transplantation by splenocyte infusion

AIM: To investigate the effect of donor splenocyte infusion combined with cyclosporine A (CsA) on rejection of rat small bowel transplantation (SBT). METHODS: Male Sprague-Dawley (SD) rats and female Wistar rats weighing 230-270 g were used as donors and recipients respectively in the study. Heterotopic small bowel transplantation was performed. The rats were divided into three groups: group one receiving allotransplantation (SD rarr Wistar), group two receiving allotransplantation (SD rarr Wistar) + donor splenocyte infusion, group three receiving allotransplantation (SD rarr Wistar) + donor splenocyte infusion + CsA followed by CsA 10 mg/kg per day after transplantation, in which recipient Wistar rats were injected with 2 x 10(8) SD splenocytes 28 d before transplantation, and treated with CsA after transplantation. Finally, the specific DNA fragment of donor Y chromosome was detected in recipient peripheral blood and skin by PCR. The survival time after small bowel transplantation was observed. Gross and histopathological examinations were performed. RESULTS: The survival time after small bowel trans-plantation was 7.1 +/- 1.2 d in group 1, 18.4 +/- 3.6 d in group 2 and 31.5 +/- 3.1 d in group 3. The survival time was significant longer (P < 0.01) in group 3 than in groups 1 and 2. The gross and histopathological examination showed that the rejection degree in group 3 was lower than that in groups 1 and 2. CONCLUSION: Donor splenocyte infusion combined with CsA decreases remarkably the rejection and prolongs the survival time after rat small bowel transplantation.     

进展期胃癌应用FOLFOX4治疗方案的临床研究

目的观察FOLFOX4方案治疗进展期胃癌的临床疗效和毒性。方法采用FOLFOX4方案治疗我科2003年6月-2008年7月确诊的221例老年晚期胃癌患者,4个周期后评定疗效。结果总有效率（CR＋PR）为40.27%（89/221）,完全缓解（CR）24例,部分缓解（PR）65例,最常见的毒性反应为骨髓抑制、神经毒性及胃肠道反应。结论FOLFOX4方案治疗进展期胃癌疗效可靠,毒性反应可以耐受。     

Repeat hepatectomy for patients with early and late recurrence of hepatocellular carcinoma: A multicenter propensity score matching analysis

BackgroundRepeat hepatectomy is a feasible treatment modality for intrahepatic recurrence after hepatectomy of hepatocellular carcinoma, yet the survival benefit remains ill-defined. The objective of the current study was to define long-term, oncologic outcomes after repeat hepatectomy among patients with early and late recurrence.MethodsPatients undergoing curative-intent repeat hepatectomy for recurrent hepatocellular carcinoma were identified using a multi-intuitional database. Early and late recurrence was defined by setting 1 year after initial hepatectomy as the cutoff value. Patient clinical characteristics, overall survival, and disease-free survival were compared among patients with early and late recurrence before and after propensity score matching.ResultsAmong all the patients, 81 had early recurrence and 129 had late recurrence from which 74 matched pairs were included in the propensity score matching analytic cohort. Before propensity score matching, 5-year overall survival and disease-free survival after resection of an early recurrence were 41.7% and 17.9%, respectively, which were worse compared with patients who had resection of a late recurrence (57.0% and 39.4%, both P < .01). After propensity score matching, 5-year overall survival and disease-free survival among patients with early recurrence were worse compared with patients with late recurrence (41.0% and 19.2% vs 64.3% and 43.2%, both P < .01). After adjustment for other confounding factors on multivariable Cox-regression analysis, early recurrence remained independently associated with decreased overall survival and disease-free survival (hazard ratio 2.22, 95% confidence interval 1.35–3.34, P = .001; hazard ratio 1.86, 95% confidence 1.26–2.74, P = .002).ConclusionRepeat hepatectomy for early recurrence was associated with worse overall survival and disease-free survival compared with late recurrence. These data may help inform patients and selection of patients being considered for repeat hepatectomy of recurrent hepatocellular carcinoma.     

Quantitative three-dimensional computed tomography analysis of sinus tympani volume in temporal bones with petrous apex pneumatization

ObjectiveTo investigate the association between sinus tympani volume and petrous apex pneumatization in this retrospective-archival temporal bone computed tomography study.MethodsWe included 46 temporal bones with pneumatized petrous apex from 26 patients and 52 temporal bones without petrous apex pneumatization from 26 other patients. Using OsiriX software for MacOS (version 3.8.1, Pixmeo), we measured the volumes from three-dimensional sinus tympani models and compared the sinus tympani volumes and depths between the temporal bones with and without pneumatized petrous apex.ResultsAmong 150 patients totally reviewed, 26 (17.3%) had petrous apex pneumatization. The median sinus tympani volume was 16.05 (5.6–59.7) mm³ in temporal bones with pneumatized petrous apex and 8.7 (1.76–59.7) mm³in temporal bones without. The sinus tympani volume was significantly greater in temporal bones with pneumatized petrous apex compared to those without (p < 0.001). Additionally, temporal bones with pneumatized petrous apex had a significantly deeper sinus tympani [median depth = 2.17 (0–3.04) mm] compared to the temporal bones without [median depth = 1.69 (0–3.73) mm] (p = 0.045). We found that petrous apex pneumatization was associated with deeper and larger sinus tympani.ConclusionPatients with pneumatized petrous apex had a greater sinus tympani volume associated with the increased risk of residual cholesteatoma.