Patterns of abdominal relapse and role of sonography in Wilms tumor

This study characterizes the patterns of abdominal recurrence of Wilms tumor and describes the role of sonography in its detection. Twelve patients who had initial tumor recurrence in the abdomen were evaluated. Five patients had recurrence in the kidney; all had nephrogenic rests detected by computed tomography (CT) or magnetic resonance (MR) imaging but not by sonography. The remaining 7 patients had recurrence in the peritoneum (4), the nephrectomy site (2), or the regional lymph nodes (1); tumor spillage had occurred in five of these patients. Four recurrences were detected during therapy, and eight within 3 years after completion of therapy. Seven of the 12 recurrences were first detected by sonography. All 11 sonograms obtained at the time of relapse showed tumor recurrence. Nine patients died a median of 10 months after relapse. The results suggest that regular sonographic surveillance for 3 years after therapy is likely to reveal most abdominal recurrences. Supplementation with CT or MR imaging is indicated for detection of nephrogenic rests.     

胸腺五肽联合抗生素治疗复发性尿路感染疗效分析

 目的 观察胸腺五肽联合抗生素治疗复发性尿路感染的疗效.方法 将40例复发性尿路感染患者随机分为单纯抗生素治疗组和胸腺五肽联合抗生素治疗组,观察两组治疗前后患者症状、体征、尿常规、中段尿培养的改善情况以及尿路感染复发的情况.结果 与单纯抗生素治疗组相比,胸腺五肽联合抗生素治疗可以明显缩短复发性尿路感染的疗程,减少复发率(P＜0.05).结论 胸腺五肽联合抗生素可以有效治疗复发性尿路感染.     

Healthcare Utilization is High in Adult Patients Relapsing after Allogeneic Hematopoietic Cell Transplantation

Disease relapse is the leading cause of death for patients with acute leukemia (AL) and myelodysplastic syndrome (MDS) who undergo allogeneic hematopoietic cell transplantation (HCT). Relapse post-HCT is associated with poor prognosis; however, inpatient healthcare utilization of this population is unknown. Here we describe survival, intensity of healthcare utilization, and characteristics associated with high resource use at the end of life (EOL). Adult patients with AL/MDS who underwent HCT at a large regional referral center with subsequent relapse between 2005 and 2015 were included in this retrospective study. We compared the distribution of demographic and clinical characteristics of patients as well as healthcare utilization over 2 years postrelapse and at EOL by postrelapse disease-directed therapeutic interventions. We created a composite score for EOL healthcare utilization intensity by summing the presence of any of the following criteria: death in the hospital, use of chemotherapy, emergency department, hospitalization, intensive care unit, intubation, cardiopulmonary resuscitation, or hemodialysis in the last month of life. Higher scores indicate more intense healthcare use at EOL. Multivariable linear regression analysis was used to determine variables (demographic characteristics, postrelapse treatment group, advance directives documentation, palliative care referral, time to relapse) associated with EOL healthcare utilization intensity. One hundred fifty-four patients were included; median age at relapse was 56 years (interquartile range [IQR], 39 to 63), 55% were men, 79% had AL, and median time from HCT to relapse was 6 months (IQR, 3 to 10). After relapse, 28% received supportive care only, 50% received chemotherapy only, and 22% received chemotherapy plus cell therapy (either donor lymphocyte infusion, second HCT, or donor lymphocyte infusion plus second HCT). With the exception of time until relapse and Karnofsky Performance Status, baseline characteristics (gender, age, race, graft-versus-host disease, year of treatment) did not significantly differ by postrelapse treatment group. One hundred thirty-six patients (88%) died within 2 years of relapse; survival differed significantly by postrelapse treatment group, with those receiving disease-directed treatment showing lower risk of death. Healthcare use in AL/MDS patients after post-HCT relapse was high overall, with 44% visiting the emergency department at least once (22% at least 2 times), 93% hospitalized (55% at least 2 times, 16% at least 5 times), and 38% using the intensive care unit (median length of stay 5, days; IQR, 3 to 10). Use was high even among those receiving only supportive care. For those patients who died, the mean intensity score for EOL healthcare use was 1.8 (standard deviation, 1.8). Most patients (70%) had a marker of high-intensity healthcare utilization at the EOL or died in hospital. In multivariable analysis, an increase in age (estimate -.03 (95% CI, -.06 to -.003) and having AL versus MDS were significantly associated with a decreased EOL healthcare intensity score; no other variables were associated with intensity of EOL healthcare use. Healthcare utilization after post-HCT relapse is associated with receipt of disease-directed therapy but remains high across all groups despite known poor prognosis. Interventions are needed to minimize nonbeneficial treatments and promote goal-concordant EOL care in this seriously ill patient population.     

Hawley联合舌侧保持器和压膜式保持器的临床正畸保持效果比较

目的:比较Hawley联合舌侧固定保持器和压膜式保持器的临床效果,为选择合适的正畸保持方式提供参考。方法:选择正畸治疗刚结束的患者45例,随机给下颌戴用压膜式保持器(压膜式保持器组,25例)或联合保持器,即舌侧固定保持器配合夜间Hawley保持器(联合保持器组,20例)。每隔3个月复诊1次,记录矫治前、矫治结束时以及保持6个月和保持1年后的覆、覆盖及牙石指数。在模型上测量下颌牙扭转度、尖牙间和磨牙间宽度以及下前牙不齐指数。采用SAS 6.12软件包对数据进行方差分析、卡方检验和Fisher确切检验,比较2组之间的差异。结果:压膜式保持器组各测量项目在矫治后、保持6个月和保持1年后均无显著差异(P>0.05)。联合保持器组除牙石指数在保持6个月和1年后变化显著大于压膜式保持器组外(P<0.05),其余各项指标2组间均无显著差异。1年内的损坏率,压膜式保持器和联合保持器分别是24%和20%,即成功率76%和80%,两者无显著差异。结论:压膜式保持器保持和舌侧固定保持器配合夜间Hawley保持器保持的1年随访效果均良好,但综合考虑患者依从性和保持器的可靠性,后者是较好的保持方式。     

儿童自身免疫性溶血性贫血和Evans综合征复发及其相关因素分析

目的研究和探讨儿童自身免疫性溶血性贫血(AIHA)和Evans综合征复发率及其相关因素。方法采用同期病例对照法,比较不同因素与复发的相关性。结果40例患者中有7例复发,复发率为17·5%,Coombs阴性患者复发率为66·66%,Coombs阳性患者复发率为13·51%。复发发生在首次发病的2个月到2年7个月之间,4例在停药后,2例在激素减量中。复发诱因中感染因素占4例(57·14%),主要为呼吸道和消化道感染;无诱因者3例(42·86%)。复发组和未复发组患儿的性别、抗体的类型、是否存在其他自身免疫性疾病、患病时的血红蛋白水平和网织红细胞计数等均与复发无关(P>0·05)。细胞免疫功能的检查结果显示复发组CD3增高、CD8降低,经统计学分析两组存在显著差异(P<0·05)。结论儿童AIHA和Evans综合征的复发率远低于成人,复发患者免疫功能异常较未复发患者显著。     

室内公共场所禁烟前后经皮冠状动脉介入治疗患者复吸危险因素差异分析

目的探讨全国室内公共场所禁烟前后,接受经皮冠状动脉介入治疗(PCI)的患者的吸烟情况及复吸的独立危险因素的差异。方法对在中国医科大学附属第四医院接受PCI治疗的585例患者,进行病史采集及电话随访,比较在室内公共场所禁烟前后,患者吸烟情况及吸烟患者出院后复吸的危险因素的差异。结果禁烟令后,PCI患者吸烟率、术后复吸率、全因再入院率、每日被动吸烟时间等均无明显改善。禁烟令前后,吸烟的PCI患者出院后复吸的危险因素不完全相同;禁烟令前,复吸的独立危险因素为年龄(OR值为0.933,P<0.05);而禁烟令后,复吸的独立危险因素为年龄(OR值为0.869,P<0.05)、高血压(OR值为4.440,P<0.05);高龄患者复吸的风险更低。结论禁烟令前后,PCI患者术前吸烟率、术后戒烟率无差异;吸烟的PCI患者术后复吸的危险因素不相同。     

宫腔粘连治疗中应用雌激素联合氧化再生纤维素防粘连膜的疗效分析

目的 探讨雌激素联合氧化再生纤维素防粘连膜在宫腔粘连治疗中的临床效果.方法 收集2015年1月至2015年8月入院的80例宫腔粘连患者随机分为两组,对照组患者给予雌激素治疗,实验组患者则加施氧化再生纤维素防粘连膜干预,比较两组患者治疗前后月经量与子宫内膜厚度、宫腔粘连总体治疗效果、粘连复发率、药物不良反应与妊娠情况.结果 实验组患者治疗后3个月月经量为(52.82±8.50),子宫内膜厚度为(8.59±0.34),显著高于对照组的(34.33±7.27)、(8.03±0.45),差异具有统计学意义(均P＜ 0.01);实验组患者治疗总有效率(100.00％)明显高于对照组(87.50％),差异具有统计学意义(P＜0.05);实验组患者粘连复发率(10.00％)明显低于对照组(31.43％),差异具有统计学意义(P＜0.05);两组患者药物不良反应率(12.50％比7.50％)比较差异无统计学意义(P＞0.05).结论 雌激素联合氧化再生纤维素防粘连膜在宫腔粘连治疗中的临床效果显著,安全性较高,借鉴意义重大.     

Capital depreciation: The lack of recovery capital and post-release support for prisoners leaving the Drug Recovery Wings in England and Wales

BackgroundThis article draws on the evaluation of the pilot Drug Recovery Wings (DRWs), which were introduced ten prisons in England and Wales, with the intention of delivering abstinence-focused drug recovery services. The DRW pilots can be seen as representing the extension of the recovery paradigm – so prevalent elsewhere in UK drug policy – to the prison system. This study aimed to provide a detailed account of DRW prisoners’ expectations and experiences in the transition from prison to the community and explore the potential for ‘doing recovery’ in prison and on release.MethodsIn-depth, qualitative interviews were conducted in prison with 61 prisoners across six of the DRWs. Follow-up interviews six months after release were conducted with 21 prisoners and 26 ‘recovery supports’ (people identified as being close to the prisoners). Data from one, other or both sources was available for 36 prisoners. All interviews were fully transcribed and coded.ResultsThe majority of the 61 had long histories of alcohol and/or opiate dependence, childhood adversity, undiagnosed mental health problems and few educational qualifications. Nonetheless, many had long histories of employment – mostly in manual trades. The majority described themselves as being ‘in recovery’ at the time of the first interview in prison. While one of the main aims of the DRWs was to support prisoners’ recovery journeys into the community, this aspect of their work did not materialize. Professional support at release was largely absent or, where present, ineffectual. Many were released street-homeless or to disordered and threatening hostels and night-shelters. Only three of the 36 were fully abstinent from drink and drugs at time of re-interview, although some had moderated their use. A substantial number had returned to pre-imprisonment levels of use, often with deeply damaging impacts on those around them.Discussion and conclusionsThis research suggests a fundamental contradiction between recovery and imprisonment. In large part, imprisonment serves to erode recovery capital while, at the same time, making psychoactive substances readily available. Looking to the future, every effort should be made to divert substance users from imprisonment in the first place. Where that fails, the primary aim should be to reduce the erosion of recovery capital during imprisonment: through family support work, providing proper housing, training and education opportunities and ensuring a graduated reintroduction of prisoners into the community.     

外周血涂片镜检联合微小残留病检测在急性髓系白血病复发诊断中的应用

目的分析急性髓系白血病(AML)患者完全缓解(CR)后外周血涂片镜检情况和微小残留病(MRD)检测水平,探讨两者在判断AML复发中的应用价值。方法回顾性分析36例AML复发患者的外周血涂片原始细胞检出情况和MRD值,MRD<0.1%为阴性、MRD≥0.1%为阳性。结果 36例复发患者中,外周血涂片检出原始细胞31例,其中21例报告时间早于骨髓送检时间;原始细胞检出患者中最常见的复检类型是血小板计数降低、单核细胞百分比增高和白细胞计数降低。MRD检测阳性29例,阴性7例,阳性明显多于阴性;复发期与缓解期相比,MRD显著增高,差异有统计学意义(P<0.05)。外周血涂片镜检和MRD检测对AML复发的诊断符合率分别为86.11%和80.55%,2种方法联合检测的符合率为94.44%。结论外周血涂片镜检联合MRD检测对早期发现急性髓系白血病的复发具有临床意义。