Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors

The purpose of this study is to determine the incidence, clinical characteristics and risk factors of postradiation pelvic insufficiency fracture (PIF) in women with uterine cervical cancer. We reviewed the medical records of 126 patients who received definitive radiotherapy (RT) for uterine cervical cancer between 2003 and 2009 at our institution. Among them, 99 patients who underwent at least one computed tomography (CT) or magnetic resonance imaging of the pelvis during their follow-up at more than 6 months were included in this analysis. The relationship between the incidence of PIF and several patient- and treatment-related factors was analyzed. The median follow-up period was 21 months. Of the 126 patients, 33 (with a total of 50 lesions) were diagnosed with PIF. The 2-year cumulative incidence was 32%. Univariate analysis showed that age ≥70 years (P= 0.0010), postmenopausal state (P = 0.0013), and lower CT density of bone and bone marrow (P= 0.020) significantly related to PIF. In a multivariate analysis, of the 59 patients whose CT densities were evaluable, lower CT density was the only significant factor associated with PIF (P = 0.0026). In conclusion, postradiation PIFs were detected in a considerable number of patients after definitive RT for cervical cancer. Predisposing factors were older age, postmenopausal state, and decreased density of bone and bone marrow on CT.     

Enzyme-replacement therapy in perinatal hypophosphatasia: Case report and review of the literature

Hypophosphatasia (HPP) is a rare disease resulting from alterations of the ALPL gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). Perinatal HPP is mainly characterized by bone hypomineralization and severe respiratory insufficiency. We describe a full-term boy diagnosed with perinatal HPP after birth, showing dramatic improvement after treatment with Asfotase Alfa, an enzyme-replacement therapy (ERT) prescribed in HPP cases. He initially presented with respiratory insufficiency due to bone hypomineralization, and severe pulmonary hypoplasia that required tracheostomy and invasive ventilation for 8 months. He was taken off ventilation at 41 weeks of age. He also presented complications including hypercalcemia, craniosynostosis, nephrocalcinosis, hypotonia, and a severe feeding disorder. He is still alive at 30 months of age, and his respiratory status and tonus is steadily improving. This case reflects the progression of HPP patients with specific therapy added to symptomatic management. Some aspects of the disease are now well known, such as nephrocalcinosis and craniosynostosis, related to the natural course of the disease, which persisted despite the ERT. The long-term prognosis and outcome for this newborn child remain unknown.     

骨化三醇治疗慢性肾功能不全患者肾性骨病的效果观察

目的研究慢性肾功能不全患者肾性骨病应用骨化三醇治疗的临床疗效,并分析其安全性。方法选择2014年7月~2016年11月期间所收治的68例肾性骨病患者作为本次研究病例,对患者进行分组治疗,采用随机数字表法进行分组,对照组和研究组各34例,对照组患者应用常规治疗方法,研究组在此基础上加用骨化三醇治疗,对比分析两组患者的临床各项指标,并分析其不良反应发生情况。结果治疗前,两组临床指标无明显统计学意义(P0.05),经治疗后,研究组患者的血清钙水平为(2.31±0.15)mmol/L,血清无机磷水平为(1.89±0.14)mmol/L,甲状旁腺激素为(202.01±35.87)pg/m L,碱性磷酸酶为(80.46±2.85)U/L,其中血清钙、血清无机磷与甲状旁腺激素水平与对照组比较具有统计学意义(t=4.1607、3.1260、5.7254,P0.05),碱性磷酸酶与治疗前比较无统计学意义(t=1.3055,P0.05);研究组患者不良反应发生率为8.82%(3例),对照组患者不良反应发生率为14.71%(5例),两组患者不良反应比较无统计学意义(χ~2=0.5667,P0.05)。结论慢性肾功能不全患者肾性骨病中应用骨化三醇治疗的效果明显,能够有效改善患者的临床症状,改善钙磷紊乱情况,并且不良反应少,可以在临床中推广使用。     

葛根素联合纳洛酮治疗椎基底动脉供血不足随机平行对照研究

[目的]观察葛根素联合纳洛酮治疗椎基底动脉供血不足疗效。[方法]使用随机平行对照方法,将40例住院患者按随机数字表法随机分为两组。对照组20例口服阿司匹林,0.4mg/次,3次/d。治疗组20例葛根素,0.4mg/次,1次/d,静滴;纳洛酮,0.8mg/次,1次/d,静滴。均连续治疗20d为1疗程。观测临床症状、体征、不良反应。连续治疗2疗程,判定疗效。[结果]治疗后,治疗组痊愈10例,显效5例,有效2例,无效1例,总有效率95.00%。对照组痊愈8例,显效4例,有效1例,无效7例,总有效率65.0%。治疗组疗效优于对照组(P0.05)。[结论]葛根素联合纳洛酮治疗椎基底动脉供血不足效果显著,值得推广。