幽门螺杆菌阳性胃溃疡除菌治疗的临床研究

目的研究根除幽门螺杆菌（Hp）治疗对Hp阳性的胃溃疡愈合率、愈合质量及复发的影响。方法将68例Hp阳性的胃溃疡患者随机分为除菌组和非除菌组，除菌组给予奥美拉唑20mg＋阿莫西林0．5g＋呋喃唑酮0．1g口服，2次／d，1周后奥美拉唑改为20mg，1次／d，共治疗4周。非除菌组单独给予奥美拉唑，剂量方法同上。分别于4周及1年后复查胃镜。结果除菌组和非除菌组比较，4周后溃疡愈合率差异无统计学意义（分别为97．4％和90％，P〉0．05），但两组溃疡愈合质量比较差异有统计学意义。1年后两组溃疡复发率比较，除菌组低于非除菌组，差异有统计学意义（分别为6．7％和59．3％，P〈0．01），Hp根除率除菌组高于非除菌组，差异有统计学意义（分别为86．7％和3．7％，P〈0．01）。结论Hp感染与胃溃疡存在相关性，根除Hp治疗不仅可以提高溃疡的愈合质量，而且还可以减少溃疡的复发。     

Combined Efficacy of Acamprosate and Disulfiram in the Treatment of Alcoholism: A Controlled Study

This study presents the results of a multicenter investigation of the efficacy of acamprosate in the treatment of patients with chronic or episodic alcohol dependence. One hundred eighteen patients were randomly assigned to either placebo or acamprosate, and both groups were stratified for concomitant voluntary use of disulfiram. Treatment lasted for 380 days, with an additional 360-day follow-up period. The primary efficacy parameters evaluated were: relapse rate and cumulative abstinence duration (CAD). Results were analyzed according to Intention-To-Treat principles using χ², t , and multiple regression analyses where appropriate. After 30 days on study medication, 40 of 55 (73%) acamprosate-treated patients were abstinent, compared with 26 of 55 (43%) placebo-treated patients ( p = 0.019). The treatment advantage remained throughout the study medication period and was statistically significant until day 270 ( p = 0.028). Twenty-seven percent of patients on acamprosate and 53% of patients on placebo had a first drink within the first 30 days of the study. The mean CAD was 137 days (40% abstinent days) for the patients treated with acamprosate and 75 days (21% abstinent days) for the placebo group ( p = 0.013). No adverse interaction between acamprosate and disulfiram occurred, and the subgroup who received both medications had a better outcome on CAD than the those on only one or no medication. Acamprosate was well tolerated. Diarrhea was the only significant treatment-induced effect. It was concluded that acamprosate was a useful and safe pharmacotherapy in the long-term treatment of alcoholism. Concomitant administration of disulfiram improved the effectiveness of acamprosate.     

家庭访视对肾病综合征患儿遵医行为的影响

目的：探讨家庭访视对肾病综合征患儿遵医行为的影响,以期对家庭访视进行评价。方法随机选取40例肾病综合征患儿为研究对象且按随机数字表法和1：1的比例将其随机分为观察组和对照组,每组各20例。两组患儿均建立随访档案,其中对照组采取出院常规指导、接受电话询问、定期复诊,观察组采取家庭访视,同时对两组患儿的遵医行为和肾病综合征复发率进行观察与对比。结果观察组患儿按时按量服药、合理饮食、按时复诊、定期检查等遵医行为优于对照组,差异具有统计学意义（ P＜0．05）;观察组复发率低于对照组,差异具有统计学意义（ P＜0．05）。结论家庭访视能显著提高肾病综合征患儿的遵医行为,降低其复发率,值得临床推广运用。     

Impact of ribavirin dose on retreatment of chronic hepatitis C patients

AIM: To study the efficacy and factors associated with a sustained virological response (SVR) in chronic hepatitis C (CHC) relapsing patients.METHODS: Out of 1228 CHC patients treated with pegylated interferon (PEG-IFN) and ribavirin (RBV), 165 (13%) had a relapse. Among these, 62 patients were retreated with PEG-IFN-α2a or -α2b and RBV. Clinical, biological, virological and histological data were collected. Initial doses and treatment modifications were recorded. The efficacy of retreatment and predictive factors for SVR were analyzed.RESULTS: An SVR was achieved in 42% of patients. SVR was higher in young (< 50 years) (61%) than old patients (27%) (P = 0.007), and in genotype 2 or 3 (57%) than in genotype 1 or 4 (28%) patients (P = 0.023). Prolonging therapy for at least 24 wk more than the previous course was associated with higher SVR rates (53% vs 28%, P = 0.04). Also, a better SVR rate was observed with RBV dose/body weight > 15.2 mg/kg per day (70% vs 35%, P = 0.04). In logistic regression, predictors of a response were age (P = 0.018), genotype (P = 0.048) and initial RBV dose/body weight (P = 0.022). None of the patients without a complete early virological response achieved an SVR (negative predictive value = 100%).CONCLUSION: Retreatment with PEG-IFN/RBV is eff-ective in genotype 2 or 3 relapsers, especially in young patients. A high dose of RBV seems to be important for the retreatment response.     

Introduction of the "Rotterdam mandibular distractor" and a biomechanical skull analysis of mandibular midline distraction

The Rotterdam mandibular distractor (RMD) is a slim, rigid, boneborne distractor for use in midline distraction of the mandible. We did a biomechanical study to compare the RMD with the Trans Mandibular Distractor-flex (TMD-flex). This included an anatomical biomechanical study that was conducted on 9 dentate human cadaveric heads using both the RMD and the TMD-flex. In the vertical plane less tipping was measured in the RMD group than in the TMD-flex group. Significantly less skeletal tipping was found in the horizontal plane in the RMD group (P=0.021). There was minimal difference in the intercondylar distance between the groups. As the amount of lateral displacement of the condyle was similar in both groups and there was less rotational movement in the RMD group, the TMD-flex would be expected to increase stress on the temporomandibular joint. As a result of the increased parallel widening in the vertical plane, more basal bone is being created and less relapse is expected using the RMD. The study design involves an in vitro anatomical model and conclusions must be drawn with care. At present clinical studies are under way and results will follow.     

复发儿童急性淋巴细胞白血病58例临床分析

目的探讨复发儿童急性淋巴细胞白血病(ALL)的临床特点及预后。方法 2010年10月-2015年4月郑州大学第一附属医院儿童血液中心共收治ALL患儿487例,回顾性分析其中58例复发ALL的临床表现、实验室检查、治疗及预后。结果(1)58例复发患儿中,极早期复发42例(72.4%),早期复发12例(20.7%),晚期复发4例(6.9%);单纯骨髓复发36例(62.1%),单纯中枢神经系统白血病(CNSL)复发12例(20.7%),联合复发共10例(17.2%)。(2)临床表现:骨髓复发患儿主要有发热、贫血、出血、肝脾淋巴结肿大、骨痛等;单纯CNSL复发患儿主要有严重的头痛、呕吐、颈项强直等神经系统症状及失明等非典型症状;睾丸复发,出现睾丸白血病(TL),主要表现为睾丸肿胀;部分患儿可无任何临床症状。实验室检查:复发患儿乳酸脱氢酶(LDH)较完全缓解期显著升高(P0.05)。(3)随访至2015年10月31日,复发ALL患儿总体中位存活时间为24个月,极早期复发、早期复发及晚期复发ALL患儿的中位生存时间分别为13个月、32个月及41个月(P=0.006);单纯骨髓复发、单纯髓外复发及联合复发ALL患儿3年生存率分别为14.1%、78.6%及40.0%(P=0.018)。结论儿童ALL复发以极早期复发及早期复发为主,复发的主要部位为骨髓,复发时临床表现无特异性,单纯骨髓复发预后最差,单纯髓外复发预后较好;LDH在儿童ALL的疗效观察及疾病监测中有一定作用。     

Effect of hydroxychloroquine on treatment and recurrence of acute brucellosis: a single-blind,randomized clinical trial

Brucellosis is associated with a high recurrence rate and requires more than one course of standard treatment; therefore, more research is required to find more effective treatments that lead to prompt recovery, and reduce the relapse of disease. This single-blind, randomized study was designed to evaluate the effect of the standard treatment for brucellosis in combination with hydroxychloroquine.A total of 177 patients with acute brucellosis were randomly assigned to one of two treatment groups: doxycycline-streptomycin (DS) and doxycycline-streptomycin-hydroxychloroquine (DSH). Clinical symptoms and signs, serological tests, and side effects of therapy were compared between the two groups during the treatment course and at three and six months after the end of drug therapy. Of the 177 patients, with a mean age of 40.5?±?16.9 years, 66.1% were males. The mean duration of clinical signs prior to admission was 43.4?±?41.1 days. Appropriate clinical responses, relapse, treatment failure, and adverse drug reactions were seen in 98.9%, 1.2%, 0.0%, and 12.6% of patients, respectively, in the DSH group vs. 86.7%, 11.6%, 2.3%, and 19.8% of patients, respectively, in the DS group. There were significant differences in clinical response and relapse rates between the two groups. The addition of hydroxychloroquine to a doxycycline-streptomycin regimen appears to increase the efficacy of treatment, accelerate improvement of clinical symptoms, and significantly reduce the rate of relapse of brucellosis.     

复发性大肠癌再次手术指征问题探讨：附36例临床分析

从1974,1,～1990,12,在我院402例大肠癌病人中,我们对36例大肠癌术后复发的病人进行了再次手术(占8.98％),切除23例,(切除率为63.88％),较其他报道略高。因此,研究大肠癌术后复发的再手术,在临床上具有较大意义。现结合文献资料,对此问题进行初步分析。