成人常复发性原发性肾病综合征的中西医结合治疗疗效观察

目的 :比较中西医结合疗法和单纯西医药疗法治疗成人常复发性原发性肾病综合征 (FRNS)的疗效。方法 :6 0例FRNS病人随机分为治疗组 (30例 ,采用中西医结合治疗 )和对照组 (30例 ,采用单纯西药治疗 ) ,比较二组患者临床疗效。结果 :治疗组完全缓解率为 76 .7% ,缓解后 6个月、1年、4年复发率分别为 0、4 .3%、17.4 % ,平均缓解期为 (33.7± 3.6 )月 ,激素不良反应发生率 2 6 .7% ;对照组缓解率为 4 0 % ,6个月、1年、4年复发率分别为 16 .7%、4 1.7%、5 8.3% ,平均缓解期为 (12 .5± 3.6 )月 ,激素不良反应发生率为 6 3.3%。治疗组均明显优于对照组 ,P <0 .0 1。结论 :中西医结合治疗FRNS疗效较为满意。     

Oral Squamous Cell Carcinomas Developing from Oral Lichen Planus: A 5–21 year Retrospective Study

Background and AimsThere is insufficient data regarding clinical characteristics, relapse rates, as well as lymph node metastasis of squamous cell carcinomas of the oral cavity (OSCC) developing from oral lichen planus (OLP-OSCC). The aim of this retrospective study was to evaluate clinical characteristics, as well as relapse, recurrence and survival rates of OLP-OSCC. MethodsIn a retrospective monocenter analysis, all consecutive patients with an OSCC treated in the time period 1st January 2000–December 31 2016 were reviewed. All patients with OSCC developing from OLP/OLL (oral lichenoid lesions) were identified and analyzed for epidemiological data, risk profile, location of primary tumor, pTNM classification, lymph node metastasis, primary therapy, recurrence, and outcome.ResultsA total of 103 patients (45%♂/ 55%♀) with an average age of 62 ± 14 year were included in this study. At the time of initial diagnosis, 17% (n = 18) of patients had cervical metastases (CM) whereas only 11% (11 patients) displayed advanced tumor sizes (T > 2). T-status (p = 0.003) and histopathological grading (p = 0.001) had an impact on the incidence of CM. 39.6% of the patients developed a relapse after an average of 24 months with a mean of two recurrences per patient. Advanced tumor size had a significant impact on the 5 year overall survival and was associated with disease-free survival of the patients (p < 0.001, respectively p = 0.004).ConclusionAlthough initial lymph node metastases were not more frequent, more aggressive recurrence patterns compared to OSCC were seen for OLP-OSCC. Therefore, based on the study results, a modified recall for these patients is suggested.     

Two-year remission and subsequent relapse in children with newly diagnosed epilepsy

PURPOSE: Although remission is the ultimate measure of seizure control in epilepsy, and epilepsy syndrome should largely determine this outcome, little is known about the relative importance of syndrome versus other factors traditionally examined as predictors of remission or of relapse after remission. The purpose of this study was to examine remission and relapse with respect to the epilepsy syndrome and other factors traditionally considered with respect to seizure outcome. METHODS: A prospectively identified cohort of 613 children with newly diagnosed epilepsy was assembled and is actively being followed to determine seizure outcomes. Epilepsy syndrome and etiology were classified at diagnosis and again 2 years later. Remission was defined as 2 years completely seizure-free, and relapse as the recurrence of seizures after remission. Multivariable analysis was performed with the Cox proportional hazards model. RESULTS: Five hundred ninety-four of the original 613 children were followed > or = 2 years (median follow-up, 5 years). Remission occurred in 442 (74%), of whom 107 (24%) relapsed. On multivariable analysis, idiopathic generalized syndromes and age at onset between 5 and 9 years were associated with a substantially increased remission rate, whereas remote symptomatic etiology, family history of epilepsy, seizure frequency, and slowing on the initial EEG were associated with a decreased likelihood of attaining remission. Young onset age (<1 year) and seizure type were not important after adjustment for these predictors. Relapses occurred more often in association with focal slowing on the initial EEG and with juvenile myoclonic epilepsy. Benign rolandic epilepsy and age at onset <1 year were associated with markedly lower risks of relapse. About one fourth of relapses were apparently spontaneous while the child was taking medication with good compliance, and more than half occurred in children who were tapering or had fully stopped medication. CONCLUSIONS: A large proportion of children with epilepsy remit. Symptomatic etiology, family history, EEG slowing, and initial seizure frequency negatively influence, and age 5-9 years and idiopathic generalized epilepsy positively influence the probability of entering remission. Factors that most influence relapse tend to be different from those that influence remission.     

尖锐湿疣复发的防治进展

尖锐湿疣是由人类乳头瘤病毒引起的增生性皮肤疾病,在我国性传播疾病中发病率已跃居第2位。经系统规范治疗后,其表面疣体可成功祛除,但临床上面临的难点是该病复发率过高,反复发作可引发鳞状细胞癌等严重后果。该文以近年来尖锐湿疣复发防治为基本点,从综合治疗的角度阐述预防尖锐湿疣复发的最新进展,并对该病复发的机制及相关因素进行探讨,期望为预防该病复发的研究提供新的思路。     

甘露聚糖肽注射液联合羟基喜树碱预防浅表性膀胱癌术后复发的临床疗效观察

目的:观察甘露聚糖肽注射液联合羟基喜树碱预防浅表性膀胱癌术后复发的临床疗效观察。方法:选取本院2012年4月至2014年2月收治的浅表性膀胱癌患者50名,随机分为羟基喜树碱组和羟基喜树碱+甘露聚糖肽组,每组25例,观察药物治疗后对患者一年、两年及三年内癌症复发率、不良反应,采用ELISA法检测对尿液中IL-8的影响,利用案例分析法、比较分析法及统计学方法分析结果。结果:灌注1、2、3、4、5次后羟基喜树碱组患者IL-8含量均高于甘露聚糖肽与羟基喜树碱联用组,且均有统计学意义(P<0.05),与联用组治疗前比较,灌注后IL-8水平也明显下降。结果预示甘露聚糖肽联合羟基喜树碱可显著降低患者IL-8水平从而有效预防膀胱癌复发,效果优于羟基喜树碱单用。结论:甘露聚糖肽注射液联合羟基喜树碱膀胱灌注能显著降低浅表性膀胱癌患者术后的复发率、不良反应,并且可以降低患者尿液中IL-8含量。     

Chronic daily ethanol and withdrawal: 2. Behavioral changes during prolonged abstinence

BACKGROUND: Our previous investigations have suggested that alcohol abuse may induce persistently compromised hypothalamo-pituitary-adrenal (HPA) function, which could increase risk for subsequent alcohol abuse. The apparent similarity of chronic alcohol abuse-induced HPA defects to the compromised HPA functions associated with posttraumatic stress disorder and atypical depression also suggest potential common mechanisms shared with varied neurobehavioral disorders. Accordingly, we have investigated persistent behavioral effects of previous repetitive daily ethanol consumption and withdrawal. METHODS: Male Sprague-Dawley rats received either daily ad libitum chow, ad libitum liquid diet containing ethanol, or pair-fed isocaloric control liquid diet. The ethanol was gradually introduced over 4 weeks, maintained at 5% w/v for four subsequent weeks, and then gradually removed over 1 week. RESULTS: Four weeks after removal of ethanol from the diet, the previously ethanol-consuming rats exhibited greater (p < 0.05) evidence of anxiety in the elevated plus-maze test and in the novel cork-gnawing test, as well as greater (p < 0.05) locomotor response to a novel environment, compared with controls. CONCLUSIONS: These results suggest that repetitive daily alcohol consumption and withdrawal can induce not only persistent defects in HPA function, but also persistent increases in anxiety and behavioral responsiveness to novelty, all consistent with characteristics of abstinent alcoholics as well as with rats that self-administer increased amounts of alcohol and other drugs of abuse. This suggests that alcohol abuse can induce persistent common or interacting changes in neuroendocrine and behavioral responses that may increase risk for subsequent abuse.     

AML1-ETO9a异构体在伴t(8；21)M2型急性髓系白血病中表达比例的监测及其意义

目的 研究AML1-ETO9a (AE9a)异构体在伴有t(8;21)的M2型急性髓系白血病( AML-M2)患者中表达比例的变化及其临床意义.方法 应用RT-PCR方法筛选了44例初诊AE9a与AML1-ETO(AE)融合基因共表达的伴有t(8;21)的AML-M2患者.应用实时定量PCR技术监测这44例多次随访标本中AE9a在AE9a与AE两者总和中百分比的变化.结果 伴有t(8;21)的44例初诊AML-M2患者中AE表达量高于AE9a(中位CT值分别为20.48和21.54),两者表达量呈正相关(r =0.900);44例初诊患者经首次标准方案化疗后AE与AE9a表达量均下降,但初治后AE9a在总体中百分比较初诊时上升(P＜0.05);患者经1个疗程标准方案化疗后,未达完全缓解(CR)组的AE9a百分比明显高于CR组(中位值分别为36.81％和7.93％,P＜0.05);复发患者缓解期间AE9a百分比高于未复发患者(中位值分别为22.89％和2.43％,P＜0.05);缓解期间,17例复发患者中11例AE9a百分比在AE表达低水平时即出现升高甚至异常升高.结论 AE9a与AE共表达于伴有t(8;21)的AML-M2患者中,并且AE表达量高于AE9a,两者呈正相关.AE9a异构体对标准化疗的敏感性较AE差.在缓解期监测AE9a在AE及AE9a两者总体中百分比的变化比单独监测AE融合基因能更早地预示疾病复发趋势,从而可提前进行临床干预,降低患者的复发率,提高患者的长期生存率.     

A comparative study on alcohol-preferring rat lines: effects of deprivation and stress phases on voluntary alcohol intake

BACKGROUND: Voluntary alcohol intake in rats can be influenced by alcohol deprivation phases and stress. We investigated the magnitude of the effects of both deprivation and stress (forced swimming in cold water and foot-shock had been chosen as stressors distinct in their physical and psychological features) on alcohol intake and the influence of these experiences on the time course of alcohol drinking behavior. For the alcohol drinking procedure, a long-term model of alcohol self-administration originally developed for heterogeneous Wistar rats was used and was compared with different alcohol-preferring rat lines. METHODS: Adult male Alko alcohol (AA), alcohol-preferring (P), high-alcohol-drinking (HAD), and unselected Wistar rats were given ad libitum access to water, 5%, and 20% alcohol solutions for 6 months. A deprivation phase of 14 days was performed after 8 weeks of access to alcohol. After 16 weeks and 22 weeks of alcohol access, all animals were subjected to forced swimming and foot-shock, respectively, for 3 consecutive days, while alcohol intake was still being measured. RESULTS: Alcohol deprivation led to a significant increase in alcohol intake in Wistar rats and P rats. No alcohol deprivation effect was observed in HAD and AA rats; after deprivation, however, their preference for the 20% alcohol solution increased, immediately in the HAD rats and gradually over time in the AA rats. Repeated swim stress caused an increase in alcohol intake in Wistar rats but no changes in the alcohol-preferring rat lines. Foot-shock stress increased alcohol consumption in all lines of rats, but the most pronounced effects were observed in HAD and P rats. CONCLUSIONS: Wistar, HAD, P, and AA rats differentially respond to alcohol deprivation and stress, showing that the genetic background of these different rat lines profoundly affects relapse-like drinking and stress-induced drinking.     

甲状腺球蛋白基因外显子33单核苷酸多态性与Graves病停药后复发的相关性分析

目的:探究甲状腺球蛋白基因外显子33单核苷酸多态性(E33SNP)与Graves病(GD)复发的相关性,为临床预测GD抗甲状腺药物(ATD)治疗后的复发提供合理性依据。方法:选取健康对照者232例以及GD治疗后停药的患者243例,且根据GD停药患者的复发情况将观察组分为A、B、C 3个亚组:77例治疗后1年内复发者为A组,86例治疗后1~2年内复发者为B组,80例治疗后2年内未复发者为C组。利用RT-PCR检测对照组和观察组的E33SNP进行分型,对比分析对照组和观察组不同基因型的比率及观察组不同甲状腺球蛋白基因型患者的游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)和促甲状腺激素受体抗体(TRAb)水平,以及眼征、甲状腺肿大程度等临床资料,且对观察组不同基因型患者在治疗后2年内的累积有效率进行对比分析。结果:观察组与对照组E33SNP的基因型差异无统计学显著性,但观察组各个亚组间E33SNP基因型差异具有统计学显著性(P0.05)。对观察组的A、B、C 3个亚组间不同基因型患者各项甲状腺功能相关指标进行对比分析表明,不同基因型患者的TSH、FT3、FT4水平及甲状腺肿大程度的差异无统计学显著性,而TRAb水平和眼征发生率的差异具有统计学显著性(P0.05)。此外,E33SNP T/T型GD患者ATD治疗后2年内的累积有效率为61.8%,E33SNP T/C型患者为42.6%,E33SNP C/C型患者为21.3%,差异具有统计学显著性(P0.05)。结论:E33SNP C/C型GD患者停药后的TRAb水平以及眼征发生率明显偏高,在ATD治疗后更加容易复发,E33SNP T/T型患者则呈现相反的趋势,复发率明显偏低,因此E33SNP C/C型GD患者采用其它治疗方式或者联合治疗方式可能更加合理。     

海洛因戒断与复吸对大鼠结肠5-羟色胺和 P物质表达的影响

目的 探讨海洛因戒断、脱毒和复吸期间5-羟色胺(5-HT)、P物质(SP)在大鼠结肠表达的变化.方法 将正常雄性SD大鼠35只,随机分为实验组15只、盐水对照组15只和正常对照组5只,实验组大鼠又分戒断组(HWG)、脱毒治疗组(MDG)和复吸组(HRG).取正常对照组、盐水对照组及实验组大鼠的结肠组织,采用免疫组织化学SABC法及图像分析方法进行研究.结果 戒断组和复吸组大鼠结肠内的5-HT-、SP-免疫反应(IR)细胞的平均灰度值低于正常及盐水对照组,免疫反应细胞计数增多,差异有统计学意义(P<0.05).脱毒治疗组与正常及盐水对照组比较,大鼠结肠内的5-HT-、SP-IR细胞的平均灰度值及细胞计数差异均无统计学意义(P>0.05).结论 在海洛因戒断、复吸期间,结肠分泌5-HT、SP增多;美沙酮脱毒治疗后,5-HT、SP的表达与正常组差异无显著性,提示结肠分泌的5-HT、SP参与了海洛因戒断、脱毒和复吸期间机体的调节.