十全大补汤/CTX抑瘤作用及对生活质量影响的比较研究

目的:比较十全大补汤/CTX抑瘤作用及对肿瘤小鼠生活质量的影响。方法:50只C57小鼠复制Lewis肺癌模型后,分别给予低、中、高剂量十全大补汤及CTX处理,比较各组小鼠的生活质量及各组药物的抑瘤率。结果:CTX抑瘤率明显高于十全大补汤组,但十全大补汤在改善小鼠生活质量方面有明显的优势。结论:中西医结合治疗肿瘤,将使患者在生存期及生活质量方面受益。     

晚期上皮性卵巢癌术后顺铂腹腔灌注联合化疗疗效观

目的探讨顺铂（Cisplatin,DDP）腹腔灌注联合环磷酰胺（Cyclophosphamide,CTX）化疗治疗卵巢癌患者术后的疗效及预后因素。方法对2000年6月至2005年6月间入住我院的晚期卵巢癌患者术后43例进行回顾性分析,所有患者都经初次手术,化疗方案为PC（CTX iv＋DDP腹腔灌注）,分别为1-~12个疗程不等,分析他们的药物反应以及预后情况。结果Ⅲ期患者中CR10例,PR 14例,SD6例,PD1例,总有效率（overall response rate,ORR）为77.4%。Ⅳ期患者CR3例,PR5例,SD3例,PD1例,PR5例,SD3例,PD1例,ORR为66.7%,两组无显著差异。但Ⅲ期同Ⅳ期患者3年生存率及5年生存率均有显著性差异。43例无进展生存PFS（progression-free survival,PFS）为21.5个月,平均生存时间为37.5个月。结论顺铂腹腔灌注联合CTX化疗治疗卵巢癌是有效而且安全的,预后与病理类型、组织分级、术后残留癌大小及化疗疗程相关。     

The evaluation of serial measurements of the NK cell activity in man

Studies on the NK cell activity require extensive controls because it is known that a series of variables can influence both the quality of effector cells and of target cells. This known variation of the susceptibility to lysis in one target cell line or even in sublines requires "standards", if separately performed experiments should be compared. In some laboratories, the experiments have been controlled for the variation of the target cell's susceptibility to lysis; others control for the differences of NK cell activities among subjects or for the variation of the NK cell activity in individuals from day to day. Each of these methods concentrates the main point of control to a particular variable. To demonstrate the power of several variables in relation to an induced and expected variation of the NK cell activity, we describe in this paper the results of a factorial analysis of variance testing PB-MNC from healthy donors against two target cells. The in vitro treatment of PB-MNC by IFN was chosen as induced variation of NK cell activity. As variables of the system, we defined subjects, days, target cells, and the effect of IFN. It is shown that the induced variable (IFN-treatment) counts for the most powerful variance component (32% of the total variance). Other large variance components are the differences of NK cell activities among subjects (20%), the day to day variation of the subjects' NK cell activities (13%), and the day to day variation of the susceptibility of target cells to lysis (13%). Since it is almost impossible to control for all variables in an experiment, some variables have to be selected which should be controlled for. The quantification of the variables, which is possible by a factorial analysis of variance, is useful for that purpose. This method of data analysis allows to estimate further the relevance of a particular expected effect if several variables, as in NK cell tests, influence the result of the experiment.     

The Relevance of Osteoclastic and Osteoblastic Activity Markers Follow-Up in Patients on Antiresorptive Osteoporosis Treatment

In general, markers of bone formation and markers of bone resorption are changing synergistically, so the monitoring of any osteoclastic and any osteoblastic marker should reflect the rate of bone transformation. The aim of the study is to monitor the bone metabolism markers in postmenopausal women with osteoporosis and osteopenia along with the variations caused by the effects of bisphosphonate therapy. The study involved 55 women of average age of 57.95 years, with osteopenia or osteoporosis. The patients with osteoporosis were treated with bisphosphonates (75?mg once a week); the laboratory tests were performed before the treatment and 6 months later. Patients with osteopenia were evaluated at the first assessment and 6 months later. The tests included bone densitometry, dual-energy X-ray absorptiometry, osteocalcin, alkaline phosphatase, collagen 1 N-terminal pro-peptide (P1NP), and beta C telopeptide of type I collagen (CTX). The mean T-score was ?2.80?±?0.63 before therapy and ?2.64?±?0.45 6 months later (p?<?0.001). Women with osteoporosis had elevated levels of osteocalcin and P1NP at the first assessment, whereas the alkaline phosphatase level did not change with the treatment. After the introduction of antiresorptive therapy, the levels of osteocalcin and P1NP significantly decreased (p?<?0.001). In the group with osteopenia, the biochemical markers activity were increased in both assessments. In patients with osteoporosis, Beta-CTX was increased in the first evaluation, and decreased after treatment (p = 0.001). The results indicate that the assessment of biochemical markers of bone metabolism show excellent results in the assessment of prognosis, monitoring the course and the response to various treatment regimens of osteoporosis and evince strong correlation with standard densitometry and dual-energy X-ray absorptiometry procedures. P1NP and CTX show better diagnostic applicability compared with osteocalcin and alkaline phosphatase. The analysis of the activity of biochemical markers may obtain early information on the therapeutic response, before definitive assessment by bone density measurements.     

产ESBLs的大肠埃希菌和肺炎克雷伯菌的药敏分析及其CTX-M基因型的研究

[目的]通过对产ESBLs大肠埃希菌和克雷伯菌的表型、基因型检测和耐药性分析，了解产ESBLs的大肠埃希菌和克雷伯菌的基因分布及耐药特性，为临床抗感染治疗提供有力证据。[方法]用NCCLS推荐的纸片确认试验检测产ESBLs大肠埃希菌和克雷伯菌，用PCR方法对ESBLs阳性菌进行CTX-M基因型检测；用K-B法对其进行药物敏感性试验，并进行耐药性分析。[结果]产ESBLs的大肠埃希菌和肺炎克雷伯菌大部分同时以CTX和CAZ为底物，单用CAZ-CAZ／CLA作底物会造成30．3％的漏检。ESBLs阳性菌对头孢菌素及广谱青霉素的耐药率高，对亚胺培南则均为敏感。对其基因型分析显示CTX-M型在肺炎克雷伯菌中占71．4％，而大肠埃希菌仅为15．8％。[结论]ESBLs是大肠埃希菌和肺炎克雷伯菌对头孢菌素产生耐药的主要原因，ESBLs菌耐药性强且多重耐药，ESBLs表型检测应同时选择2种以上底物，CTX-M基因型检出率为39．4％。     

Responsiveness of gynecologic tumors to chemotherapeutic agents in the 6-day subrenal capsule assay

Various gynecologic malignancies have been tested in the 6-day subrenal capsule assay, which is an in vivo test of human tumor responsiveness to drug therapy. Fresh surgical explants of ovarian, endometrial, and cervical tumors were implanted as 1-mm³ fragments under the renal capsule of normal mice and tested against a spectrum of clinically active agents. Regardless of the site of origin, human tumors showed variations in growth rate when implanted under the renal capsule that appeared to reflect both the growth potential characteristic of each tumor as well as the heterogeneity of the cell populations comprising each tumor. An average of 60% of tumors showed positive growth and 11% demonstrated no measurable change in size. The response rates of 18 ovarian, 28 endometrial, and 20 cervical carcinomas to clinically active chemotherapeutic agents were determined. A range of responses, in terms of drugs indicated to be active and of the degree of responsiveness to active agents, was obtained with each histologic type. Response rates varied from 6% to tamoxifen in cervical carcinomas to 80% to 5-fluorouracil in ovarian carcinomas. The results of this study support the variability in chemotherapy responsiveness observed clinically with gynecologic tumors and suggest the feasibility of using the subrenal capsule assay as a predictive test.     

小剂量环磷酰胺在类风湿关节炎的临床应用

目的：探讨小剂量环磷酰胺治疗类风湿关节炎（RA）的可行性、有效性及安全性。方法：40例患者分为小剂量环磷酰胺组与甲氨蝶呤组,评价药物疗效及不良反应。结果：小剂量环磷酰胺治疗组患者耐受良好,临床指标有所改善,关节压痛数、肿胀数、晨僵时间、ESR和CRP明显降低P〈0．05．差异有显著性。治疗前后肝肾功能、血、尿常规比较均未见明显异常改变。结论：小剂量环磷酰胺治疗类风湿关节炎是一种简单、有效、安全的治疗方案。     

“五脏六腑皆令人咳, 非独肺也”新识

笔者近来随师重温<素问@咳论>,对"五脏六腑皆令人咳,非独肺也"一语颇有体会,今不揣谫陋,草就成篇,意欲祈正于医林长者.     

Outbreak of CTX‐M‐15‐producing Klebsiella pneumoniae of sequence type 199 in a Latvian teaching hospital

Dumpis U, Iversen A, Balode A, Saule M, Mikla?evi?s E, Giske CG. Outbreak of CTX‐M‐15‐producing Klebsiella pneumoniae of sequence type 199 in a Latvian teaching hospital. APMIS 2010; 118: 713–6. Previous studies on the epidemiology of extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae in Latvia are lacking. ESBL‐producing Klebsiella pneumoniae (n = 32) were subjected to pulsed‐field gel electrophoresis (PFGE) and selected isolates to multi‐locus sequence typing (MLST). Species identification and susceptibility testing were performed using VITEK2, and sequencing of bla_CTX‐M was performed in selected isolates. PFGE revealed one major clone (n = 23), with most of the isolates derived from the ICU. The clone harboured bla_CTX‐M‐15, was sequence type 199 and comprised two ertapenem non‐susceptible isolates. This is the first report of an ESBL outbreak in Latvia, and calls for increased epidemiological typing of ESBL‐producing Enterobacteriaceae, as well as improved infection control routines.