Phenotype classification using the combination of lung sound analysis and fractional exhaled nitric oxide for evaluating asthma treatment

Background

We report the utility of combining lung sound analysis and fractional exhaled nitric oxide (FeNO) for phenotype classification of airway inflammation in patients with bronchial asthma.We investigated the usefulness of the combination of the expiration-to-inspiration sound power ratio in the mid-frequency range (E/I MF) of 200–400 Hz and FeNO for comprehensively classifying disease type and evaluating asthma treatment.

结直肠癌患者血清肿瘤标志物联合检测的临床意义

目的探讨血清肿瘤标志物联合检测在结直肠癌(CRC)患者病情监测中的临床意义。方法 116例CRC患者根据不同肿瘤分期分为Ⅰ~Ⅱ期组50例和Ⅲ~Ⅳ期组66例,比较2组血清肿瘤标志物水平。同时比较化疗后12个月和24个月时复发转移与未复发转移者血清肿瘤标志物水平差异。结果Ⅰ~Ⅱ期组患者血清癌胚抗原(CEA)、糖链抗原19-9(CA19-9)和CA242水平均显著低于Ⅲ~Ⅳ期组,差异有统计学意义(P0.05);2组血清甲胎蛋白(AFP)、CA724水平比较,差异无统计学意义(P0.05);化疗后12个月,复发转移与无复发转移患者血清CEA、CA199、CA242、CA724水平比较,差异有统计学意义(P0.05);2组血清AFP水平比较,差异无统计学意义(P0.05);化疗后24个月,复发转移与无复发转移患者血清CEA、CA199、CA242、AFP、CA724水平比较,差异有统计学意义(P0.05)。结论血清肿瘤标志物联合检测在评估CRC患者病情、监测化疗后是否复发转移上具有一定临床价值。     

Infection of donor lymphocytes with human T lymphotrophic virus type 1 (HTLV-I) following allogeneic bone marrow transplantation for HTLV-I positive adult T-cell leukaemia

Summary. Human T lymphotrophic virus type 1 (HTLV-I) associated leukaemia has a poor prognosis even with chemotherapy. We describe a patient with adult T-cell leukaemia treated with allogeneic bone marrow transplantation from an HTLV-I negative identical sibling donor. During follow-up after bone marrow transplantation, HTLV-I could be repeatedly isolated inspite of anti-viral prophylaxis. The patient died of an acute encephalitis and HTLV-I could be detected in autopsy material from the brain. By a PCR-based technique using short tandem repeats (STRs) it was shown that the patient's haemopoiesis was of donor origin. This shows the infection of donor cells in vivo by an aetiological agent which has been implicated in the leukaemogenic process for adult T-cell leukaemia.     

Guidelines for avoiding risks resulting from discontinuation of nucleoside/nucleotide analogs in patients with chronic hepatitis B

Nucleoside/nucleotide analogs (NUC) can lead to rapid reduction in hepatitis B virus (HBV) DNA levels in blood and normalization of alanine aminotransferase levels in many patients. They also provide histological improvement which results in a reduction in liver carcinogenesis. However, it is difficult to completely remove viruses even by NUC and there are some problems such as emergence of resistant strains and hepatitis relapse resulting from discontinuation of treatment. One of the reasons for this is that NUC reduce the HBV DNA level in blood but have almost no effects on the HBV cccDNA level in hepatocyte nuclei, which are the origins of HBV replication, and HBV cccDNA remains for a long period. For treatment with NUC in patients with hepatitis B, it is considered that NUC should not be easily discontinued because discontinuation often results in hepatitis relapse. However, it has not been clearly revealed when and how hepatitis relapses after discontinuation. Although some patients do not experience hepatitis relapse after discontinuation of NUC, or experience only mild relapse and finally achieve a stable condition, it has not been established how to identify such patients efficiently. We performed research to investigate characteristics of the course after discontinuation of treatment and definition of hepatitis relapse and estimate the relapse rate. “Guidelines for avoiding risks resulting from discontinuation of NUCs 2012” is summarized based on the study results. Because the guidelines are written in Japanese, we explain them in English as a review article.     

艾司西酞普兰合并托吡酯治疗男性酒依赖伴焦虑抑郁及复饮

目的 探讨艾司西酞普兰合并托吡酯对男性酒依赖患者伴有焦虑抑郁的临床疗效、安全性及对复饮的影响。方法 采用了随机、对照的临床试验设计,把入组的患者分成艾司西酞普兰合并托吡酯治疗组(协同用药组)和单用艾司西酞普兰治疗组(单一用药组)。共治疗了12周,治疗前后分别采用了汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、用药后出现的不良反应量表(TESS)、可视渴求量表(VAS)等评估患者的临床效果及安全性。结果 2组HAMA、HAMD评分在治疗后4周末、8周末与治疗前比较差异有统计学意义(P<0.05)。随着治疗时间的延长2组VAS评分均逐渐下降,协同用药组渴求程度下降更为明显(P<0.05);协同用药组在随访6个月时复饮率低于单一用药组,差异有统计学意义(χ²=11.009,P=0.001<0.05);2组用药后不良反应发生率的差异无统计学意义(P>0.05)。结论 对伴焦虑抑郁症状的酒依赖患者,艾司西酞普兰合并托吡酯治疗焦虑、抑郁症状的疗效与单用艾司西酞普兰相当,但减少对酒的渴求优于单用艾司西酞普兰,且患者有更低的复饮率。2种治疗方案的不良反应相当。     

伤寒差后更发热及选方辨证探析

各医家对伤寒差后更发热原因的认识主要有:余热未尽、劳复、邪在少阳、重感于邪。对脉浮和脉沉实选用方剂的观点主要有:脉浮用枳实栀子豉汤,脉沉实者加大黄;脉浮用麻桂剂,脉沉实用承气剂;脉浮用柴胡桂枝汤,脉沉实用大柴胡汤。本文认为,伤寒差后更发热应为劳复使然,无明显表里症状者,用小柴胡汤和解之;如脉浮,为病后正气尚虚,重感于寒,可用柴胡桂枝汤微发汗解之;如脉沉实,为饮食失节,里有宿食,可用大柴胡汤下之。     

Craving predicts opioid use in opioid-dependent patients initiating buprenorphine treatment: A longitudinal study

Background: Few studies have assessed associations between craving and subsequent opioid use. We prospectively evaluated the relative utility of two craving questionnaires to predict opioid use among opioid-dependent patients in outpatient treatment. Method: Opioid-dependent patients (n?=?147) initiating buprenorphine treatment were assessed every two weeks for 3 months. Craving was measured using the: (1) Desires for Drug Questionnaire (DDQ) and (2) Penn Alcohol-Craving Scale adapted for opioid craving (PCS). Multi-level logistic regression models estimated the effects of craving on the likelihood of opioid use. Craving assessed at time t was entered as a time-varying predictor of opioid use at time t?+?1. Results: Craving scores plateaued at approximately 2 weeks after initiation of buprenorphine. In adjusted regression models, a 1-point increase in PCS scores (on a 7-point scale) was associated with a significant increase in the odds of opioid use at the subsequent assessment (OR?=?1.27, 95% CI 1.08; 1.49, p?p?p?>?0.05) or DDQ control (OR?=?0.97, 95%CI 0.85; 1.11, p?>?0.05) scores. Conclusion: Self-reported craving for opioids was modestly associated with subsequent relapse to opioid use among a cohort of patients treated with buprenorphine. Assessment of craving may provide clinical utility in predicting relapse among treated opioid-dependent patients.