光动力三阶段疗法治疗肛周尖锐湿疣的临床观察

目的:采用光动力三阶段疗法治疗肛周尖锐湿疣,观察疗效及复发率.方法:将我科门诊肛周尖锐湿疣患者随机分成治疗组(45例)、对照组(35例),分别采用冷冻、光动力疗法及局部免疫调节剂分三个阶段治疗和单纯采用冷冻治疗.比较两组患者的疗效和复发率.结果:治疗组治愈率97.78%,对照组治愈率65.72%;两组患者治疗结束后第4,8和12周时的复发率差异和治愈率均有统计学意义(P均<0.05).结论:肛周尖锐湿疣进行三阶段治疗,能明显降低复发率,疗效优于单一疗法.     

Anal cancer – What is the optimum chemoradiotherapy?

Radical concurrent chemoradiotherapy with 5FU and Mitomycin C is the standard-of-care for squamous-cell carcinoma of the anus (SCCA). Phase III trials combined radiation doses of 50–60 Gy with concurrent Fluoropyrimidines, Mitomycin C and Cisplatin in various doses and schedules. CRT is highly successful for early T1/T2 cancers, but results in appreciable late morbidities and still fails to control larger and node-positive tumours.Compliance to chemotherapy is important for local control. Modern radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), rotational IMRT, image-guided radiotherapy (IGRT) have enabled smaller margins and highly conformal plans, resulting in decreased radiation doses to the organs at risk and ensuring a shorter overall treatment time. These advances offer the potential for integrating higher doses of radiation, escalation of the currently used drugs and the safe use of other more novel agents with acceptable toxicity. In this chapter potential novel approaches are discussed in the context of SCCA.     

注射用依那西普联合骨痹汤治疗幼年脊柱关节病的临床观察

目的观察注射用依那西普联合骨痹汤治疗幼年脊柱关节病(JSp A)的临床疗效。方法将77例JSp A患者随机分为2组,治疗组40例应用注射用依那西普联合骨痹汤治疗,对照组37例单纯应用柳氮磺吡啶肠溶片治疗。2组均治疗12周,观察2组治疗前、治疗2周后及治疗12周后红细胞沉降率(ESR)、C反应蛋白(CRP)、血小板计数(PLT)及视觉模拟评分(VAS)变化,比较2组疗效。结果 2组治疗过程中ESR、CRP、PLT及VAS评分均逐步降低,治疗2周后比较差异无统计学意义(P0.05),但治疗12周后,2组均较本组治疗前降低(P0.05),且治疗组各项观察指标较对照组降低更明显(P0.05)。治疗组缓解率55.0%、总有效率97.5%,对照组缓解率27.0%、总有效率81.1%,2组缓解率、总有效率比较差异均有统计学意义(P0.05),治疗组疗效优于对照组。结论注射用依那西普联合骨痹汤治疗JSp A,疗效显著,安全性好。     

Fibrosis with emphysema

Wright J L, Tazelaar H D & Churg A (2011) Histopathology  58 , 517–524
Fibrosis with emphysema The concept of fibrosis with emphysema is confused by the existence of two very different clinical/pathological scenarios: first, cases in which a diffuse fibrosing interstitial pneumonia, most commonly usual interstitial pneumonia (UIP), occurs in a patient with emphysema. This combination is largely of clinical interest because of its effects on pulmonary function and pulmonary hypertension, but can produce unusual appearances in surgical lung biopsies when the fibrotic areas are wrapped around emphysematous spaces. However, the underlying morphology of emphysema and UIP or other interstitial lung disease remains unchanged. Radiological consultation is often helpful to show that the patient has both lesions; secondly, cases in which there is localized fibrosis that is part of emphysema, or related to respiratory bronchiolitis, or both. These lesions have been called ‘respiratory bronchiolitis’ (RB), ‘respiratory bronchiolitis–interstitial lung disease’ (RB‐ILD), ‘airspace enlargement with fibrosis’, ‘RB‐ILD with fibrosis’ and ‘clinically occult interstitial fibrosis in smokers’, but are probably all the same entity. Such changes are associated only rarely with the physiological or radiological features of an interstitial lung disease. Care should be taken when describing these lesions in biopsies so as not to give the impression that a diffuse interstitial lung disease is present.     

疏血通联合银杏达莫治疗急性脑梗死疗效分析

目的观察疏血通联合银杏达莫治疗急性脑梗死患者的临床疗效。方法按标准选择急性脑梗死患者84例,随机分为治疗组和对照组,每组各42例。治疗组给予疏血通联合银杏达莫治疗,对照组给予银杏达莫治疗,疗程均为14 d.观察2组临床疗效及血脂、凝血指标等的变化。结果治疗组临床疗效优于对照组（P〈0.05）,血脂、凝血指标均有明显改善（P〈0.05）。结论疏血通联合银杏达莫治疗急性脑梗死疗效确切,且安全性好。     

枯草杆菌二联活菌颗粒对厌食症患儿血清神经肽Y和肿瘤坏死因子-α水平影响及疗效

目的探讨枯草杆菌二联活菌颗粒对厌食症患儿血清神经肽Y(NPY)和肿瘤坏死因子-α(TNF-α)水平影响及疗效。方法选取2012年6月~2014年6月在浙江省嘉兴市妇幼保健院儿童厌食症患者86例,采用随机数字表将其分为观察组(43例)和对照组(43例)。两组患儿均予以纠正患儿不良饮食习惯、健胃消食药和葡萄糖酸锌等常规治疗。观察组患儿加用枯草杆菌二联活菌颗粒1.0 g/次,2次/d,温开水冲服。疗程为6周。对照组患儿除不使用枯草杆菌二联活菌颗粒外余治疗基本同观察组。观察并记录两组患儿治疗前和治疗6周后血清NPY和TNF-α水平的变化,并比较其治疗后的临床效果及药物不良反应。结果治疗6周后,两组患儿血清NPY和TNF-α水平[观察组:(45.53±7.82)pg/m L,(10.24±2.74)mmol/L;对照组:(37.39±7.53)pg/m L,(8.19±2.13)mmol/L]较治疗前[观察组:(32.17±5.18)pg/m L,(6.82±1.76)mmol/L;对照组:(32.79±4.23)pg/m L,(7.03±1.54)mmol/L]明显上升(t=2.89、3.12、2.31、2.45,P<0.05或P<0.01),且观察组上升程度较对照组更明显(t=2.19、2.24,P<0.05);同时观察组患儿临床总有效率(93.02%)较对照组(76.74%)更佳(χ2=4.44,P<0.05)。两组患儿治疗中无明显的药物不良反应发生。结论枯草杆菌二联活菌颗粒治疗儿童厌食症的效果较确切,且安全性较好,其作用机制可能与其升高血清NPY和TNF-α水平,提高患儿的食欲密切相关。     

联合术式治疗直肠脱垂102例疗效分析

目的：探讨联合术式治疗直肠脱垂的临床效果,并对其治疗作用进行分析及评价。方法回顾性分析2014年1-8月该院收治直肠脱垂患者共102例,随机分为观察组和对照组,各51例,对照组采用经腹直肠悬吊固定术治疗,观察组采用经腹、肛门联合术式方法治疗,比较两组患者的治疗效果并分析评价。结果对照组的治疗有效率为80.3%,观察组的治疗有效率为94.1%,两组比较差异有统计学意义(P<0.05);观察组患者的住院天数为(11.57±3.54)d,对照组患者的住院天数为(21.61±6.23)d,两组比较差异有统计学意义(P<0.05);对照组患者术后并发症的发生率为33.3%,过程组患者术后并发症的发生率为13.7%,两组比较差异有统计学意义(P<0.05)。结论经腹、肛门联合术式治疗直肠脱垂有效提高治愈率,缩短患者住院时间,减少患者的住院花销,同时也有利于减少患者术后并发症的发生,是值得临床推广的治疗直肠脱垂的手术的方法。     

Optimization of azathioprine dose in combined treatment with anti-TNF-alpha in inflammatory bowel disease

IntroductionThe dose of thiopurine drugs in combined treatments with anti-TNF in inflammatory bowel disease (IBD) has not been clearly established. The purpose of this study is to assess whether the dose of azathioprine influences clinical and biochemical response/remission rates, and anti-TNF drug levels/antibody formation.Material and methodsPatients with IBD on combined maintenance treatment with azathioprine and infliximab or adalimumab were selected. Based on the dose of azathioprine, two groups were defined (standard: 2–2.5 mg/kg/day; and decreased: less than 2 mg/kg/day).ResultsIn the IFX group, there were no statistically significant differences (p = 0.204) in the rates of remission (39% vs 41.3%), response (10% vs 21.7%) or failure (51.5% vs 37%) depending on the dose of thiopurine drugs. No differences were found between AZA-dose dependent IFX levels (2.46 vs 3.21 μg/mL; p = 0.211). In the adalimumab group, there were no statistically significant differences (p = 0.83) in the rates of remission (66% vs 56%), response without remission (15.38% vs 25%) or failure (18% vs 18%) depending on the dose of thiopurines. With respect to ADA-levels, no differences were found in both groups (7.69 vs 8.23 μg/mL; p = 0.37).ConclusionIn our experience, no statistically significant differences were found in either anti-TNF levels or clinical-biological response/remission rates based on doses of azathioprine.     

The Steroid-Sparing Effect of Long-Term Plasmapheresis in Pemphigus: An Update

Abstract: Glucocorticoids and immunosuppressive agents can induce remission in most pemphigus patients, but mortality remains at 5 to 15% as a result of side effects. We reviewed the adjunctive effect of long-term plasmapheresis in 8 pemphigus patients. Four cases had been resistant to conventional therapy. One or 2 large-volume plasmapheresis treatments were given monthly over 5 to 141 months. All patients, were in clinical remission within 2 months. Relapses seldom occurred: the patients stayed in remission 90% (40–94) (median, ranges) of the period. In all cases the daily dose of glucocorticoid was reduced. The prednisone level could be decreased from 38 (15–80) mg/day to 7.5 (2.5–35) mg/day (p = 0.002). The overall level of other immunosuppressive agents remained unchanged, except in 1 patient for whom cyclosporine was introduced. This indicates that long-term plasmapheresis could have a steroid-sparing effect and clinical efficacy in pemphigus.—