椎动脉发育不良的M RA 分型及临床意义

目的：研究椎动脉发育不良的磁共振血管造影分型及临床意义。方法对80例椎动脉发育不良患者的磁共振血管造影检查结果进行分型,分析不同分型与后循环短暂性脑缺血发作及脑梗死的相关性。结果椎动脉发育不良根据磁共振血管造影表现分为Ⅳ型,其中Ⅰ型后循环短暂性脑缺血发作发生率为81．8％、脑梗死发生率为9．1％,Ⅱ型分别为75．0％、17．9％,Ⅲ型分别为62．5％、29．2％,Ⅳ型分别为35．3％、58．8％;不同分型患者后循环短暂性脑缺血发作及脑梗死的发生率比较差异有显著或极显著性（χ2＝33．57、11．21,P＜0．05或0．01）。结论根据磁共振血管造影影像学表现,可将椎动脉发育不良分为Ⅳ型;椎动脉发育不良分型越高,发生脑梗死的概率越高。     

Serum Retinol and Xerophthalmia Among a Prison Population in Papua New Guinea

Purpose: To estimate the prevalence of vitamin A deficiency (VAD) and one of its clinical manifestations, xerophthalmia, and examine the predictive value of nyctalopia and ocular signs for serum retinol concentrations among a prison population in Papua New Guinea.

Methods: A cross-sectional study of 148 prisoners and 9 guards; all males aged ≥18 years. Interview-based questionnaire; ocular examination; serum retinol concentration determination.

Results: Two guards had marginal (retinol <1.05–≥0.70?µmol/L) VAD. For prisoners: mean retinol was 0.84?±?0.49?µmol/L; 43.9% (95% CI 35.9, 52.2) had VAD (retinol <0.70?µmol/L); 9.6% (95% CI 5.1, 17.0) self-reported nyctalopia prior to, and 36.1% (95% CI 27.7, 45.5) after incarceration; 10.9% (95% CI 6.7, 17.0) exhibited at least one sign of xerophthalmia (2 had fundus changes; all 4 with more than conjunctival xerosis alone had severe [<0.35 µmol/L] retinol deficiency). Prisoners with ocular signs were more likely than those without to have VAD (OR 10.4; 95% CI 2.5, 70.3; P?<?0.001) and severe retinol deficiency (OR 19.1; 95% CI 5.5, 77.2; P?<?0.001). Positive (PPV) and Negative (NPV) Predictive Values: of nyctalopia for any (PPV 62.9%; NPV 32.8%) and severe (PPV 25.7%; NPV 85.9%) retinol deficiency; of ocular signs for any (PPV 93.3%; NPV 38.2%) and severe (PPV 73.1%; NPV 87.8%) retinol deficiency, and VAD (PPV 86.5%, NPV 38.2%).

Conclusions: VAD and xerophthalmia were present in this prison population. There may be VAD in the wider community. The former needs remedy and the latter deserves investigation. Self-reported nyctalopia was not a useful indicator of retinol deficiency. Absence of ocular signs was unhelpful for ruling out VAD.     

Influence of the Compliance of the Pump Housing and Cannulas of a Paracorporeal Pneumatic Ventricular Assist Device on Transient Pressure Characteristics

Abstract: The dependence of transient pressure characteristics of a ventricular assist device (VAD) on the compliance of its housing and cannulas was investigated in a mock circulation. The peak rate of change of pressure ( dP/dt _max) values was greater in the cannulas than other compartments and was associated with valve closure-induced pressure oscillations. When cannula compliance was increased from 0.0057 to 0.0129 cm³/mm Hg, these values decreased by ˜20%, and outflow cannula pressure oscillation frequency decreased from 17.5 Hz by 35%. This trend was also apparent in the inflow. A VAD housing compliance increase from 0.0162 to 0.0483 cm³/mm Hg caused a dP/dt _max decrease of 30% in both the blood chamber and the outflow cannula. The effect of this change on the inflow was weaker implying that housing absorbs the energy associated with outflow deceleration more effectively than the inflow. These findings suggest that increasing VAD housing and cannulas compliance can improve hydrodynamic performance.     

沙利度胺联合改良VAD方案治疗多发性骨髓瘤临床疗效观察

目的:观察沙利度胺联合改良VAD方案治疗多发性骨髓瘤（MM）的临床疗效和不良反应。方法:MM患者79例,均给予沙利度胺联合改良VAD方案治疗。结果:第1疗程后79例患者中CR为12.66%（10/79）,总有效率为77.22%（61/79）;3疗程后79例患者中CR为40.51%（32/79）,总有效率为83.54%（66/79）。44例大于等于60岁患者中,CR为40.91%（18/44）,总有效率为84.09%（37/44）。35例小于60岁患者中CR为40%（14/35）,总有效率为85.71%（30/35）,两组患者经统计学检验临床疗效无显著性差异（P>0.05）。38例IgG型患者中CR为44.74%（17/38）,总有效率为92.11%（35/38）。23例IgA型患者中CR为39.13%（9/23）,总有效率为82.61%（19/23）。8例轻链型患者中CR为37.50%（3/8）,总有效率为75.00%（6/8）。10例不分泌型患者中CR为30.00%（3/10）,总有效率为70%（7/10）;各组患者经统计学检验临床疗效无显著性差异（P>0.05）。结论:沙利度胺联合改良VAD化疗方案治疗MM完全缓解率及总有效率高,对不同分型及年龄组患者疗效均显著,值得进一步临床观察和推广。     

VAD方案治疗多发性骨髓瘤疗效观察

 目的 评估VAD方案治疗多发性骨髓瘤（MM）的疗效。方法 24例Ⅲ期MM,采用VAD方案,即长春新碱0.5 mg／d（或长春地辛1 ~ 2 mg／d）缓慢静脉注射,第1～4天;多柔比星（或表柔比星）10 ~ 20 mg／d缓慢静脉注射,第1～4天;地塞米松40 mg／d口服,第1～4天,第9～12天,第17～20天,28 d为1疗程。连续应用2疗程以上评估疗效。观察项目包括：血清M蛋白、肝肾功能、尿蛋白、骨髓穿刺、血象等,记录毒副反应。MM疗效标准,分为完全缓解（CR）、部分缓解（PR）、未缓解（NR）。结果 CR8例（33.3 %）,PR12例（50 %）,NR4例（16.7 %）,总有效率为83.3 %。结论 VAD方案治疗Ⅲ期MM的临床疗效显著,临床症状改善明显。     

唑来膦酸联合化疗治疗多发性骨髓瘤骨病的疗效分析

目的:探讨唑来膦酸联合化疗治疗多发性骨髓瘤骨病的疗效及安全性。方法:50例多发性骨髓瘤患者,按治疗方案的不同随机分为联合组24例,即唑来膦酸联合VAD方案治疗组;化疗组26例,单用VAD方案化疗组。观察两组骨痛缓解的总有效率及不良反应发生率。结果:联合组与化疗组的骨痛缓解的总有效率分别为95.8%(23/24)与73.1%(19/26),差异有统计学意义（P<0.05）。联合组10例患者影像学检查显示骨质破坏范围有所缩小或新骨形成;化疗组影像学检查示骨质病变有不同程度进展。两组不良反应发生率分别为25%(6/24)与26.9%(7/26),差异无统计学意义（P>0.05）。结论:唑来膦酸联合化疗治疗多发性骨髓瘤骨病的疗效确切,不良反应发生率少,患者可耐受。     

硼替佐米联合VAD方案治疗初治多发性骨髓瘤的临床观察

目的:观察硼替佐米联合VAD方案治疗初治多发性骨髓瘤(MM)的初期疗效和安全性。方法:15例初治MM患者给予硼替佐米1.3mg.m-2,第1、4、8、11天静脉注射,每28天为1个疗程;每个疗程联合VAD方案化疗,每例患者至少接受2～8个疗程治疗。采用欧洲骨髓移植协作组(EBMT)标准评价其初步疗效,按美国国家癌症研究所不良事件常用名标准(NCI-CTCAE,version3.0)判断其毒副反应。结果:15例MM患者经过不同疗程的治疗,3例完全缓解,5例接近完全缓解,5例部分缓解,2例轻微缓解,总有效率达86.7%。最常见的毒副反应为胃肠道反应,有11例出现不同程度的胃肠道反应,其次为周围神经病变4例、乏力4例、肝功能损伤1例、带状疱疹1例,毒副反应分别经对症治疗后均获得一定程度的缓解。结论:硼替佐米联合VAD方案治疗初治MM疗效确切,患者可耐受。