来氟米特的作用机制及临床应用进展

来氟米特是一种新型的免疫抑制剂，主要用于类风湿性关节炎的治疗。近年的一些临床研究提示，该药物对其他自身免疫性疾病也有一定的疗效。本文综述来氟米特的作用机制和临床研究进展，阐述其最新研究动态和发展趋向。     

PRIMARY INTRACRANIAL GERM CELL TUMORS: Clinicopathologic Review of 32 Cases

Primary intracranial germ cell neoplasms are rare tumors and constitute a heterogeneous group. We have reviewed 32 cases, over a 21-year period, from the University of Florida. The cases include 22 germinomas, 6 mixed germ cell tumors, and 4 teratomas. The clinical presentations in these cases were more closely related to the location of the tumor, that is, pineal or suprasellar, rather than the histologic subtype. Neuroimaging evaluation was useful in distinguishing between germinomas, teratomas, and other mixed germ cell tumors (MGCTs), primarily by evaluation of cystic versus solid lesions (teratoma versus germinoma), contents of cysts (teratoma versus MGCT), and infiltrative nature of the tumors (MGCT), although cytologic-histopathologic confirmation remains necessary. Germinomas responded favorably to radiation therapy with survival periods of over 16 years; MGCTs were treated with combination chemotherapy and radiation, with a markedly poorer prognosis. This study underlines the critical significance of histopathologic evaluation of the tumor in determining therapeutic interventions as well as prognosis.     

An obstetric and gynecologic clerkship''s influence on a medical community: The Washington, Alaska, Montana, and Idaho Anchorage obstetric and gynecologic clerkship

OBJECTIVES: Our purpose was to explore the influences of an obstetric and gynecologic medical student clerkship on a remote medical community. Return of physicians to Alaska and faculty perceptions of their experience were central foci.STUDY DESIGN: Data were obtained on former clerks to determine choice of speciality and location of practice. Data regarding all physicians new to Alaska was correlated with the University of Washington Medical School graduate data. Additionally, a questionnaire with a Likert-type scale evaluated the 10 clinical faculty members participating in the clerkship.RESULTS: Between 1978 and 1991 we trained 266 clerks. A total of 77 of 374 (21%) new physicians in Alaska (1978 to 1991) were graduates of the University of Washington; 26 of those 77 (34%) were our former Anchorage obstetrics and gynecology clerks. The clinical faculty reported both positive and negative effects of their participation in the clerkship.CONCLUSION: The desired benefit, the return of new physicians to Alaska, seemed supported. Questionnaire results hinted at additional benefits for the supervising faculty physicians in this isolated community. The formal affiliation effected by the clerkship seemed to have a positive impact on patient care, communication, consultation, and shared action among the participating physicians. (Am J Obstet Gynecol 1997;176:1363-7.)     

重组人绒毛膜促性腺激素β-亚基对C57BL小鼠免疫应答反应及抗血清特征的研究

采用福氏性剂，对C57BL小鼠进行重组hCGβ和天然hCGβ免疫应签反应的比较研究，结果表明：两者引发的抗血清性质相似，与hCG有较高的亲和力（K（γβ）≈5．86×108／mol／L，Kaβ≈8．18×108／mol／L）；抗血清能有效地抑制（125）I－hCG与睾丸受体的结合，结果提示重组hCGβ抗血清与天然hCGβ抗血清相似，具有中和hCG的生物活性能力，重组hCGβ可作为免疫避孕疫苗的抗原。     

洛美沙星片剂随机对照治疗急性细菌性感染的临床评价

 目的：评价国产洛美沙星（lomefloxacin）治疗细菌性感染的有效性和安全性。方法：随机对照开放试验。结果：随机对照组76例，用氧氟沙星（ofloxacin）对照，其中两组痊愈率和有效率分别是66．7％，64．9％和89．7％，89．2％；细菌阳性率是82．1％与86．5％；细菌清除率是90．6％和93．8％；不良反应发生率是5．1％和5．4％。以上结果经统计学处理，无显著差异（P＞0．05）。开放试验组80例，其痊愈率和有效率分别是67．5％与86．3％；细菌阳性率是85％；细菌清除率88．2％。不良反应发生率5．0％。全部临床分离菌株纸片法药敏试验及MIC结果表明两药作用相似，但明显优于氨苄青霉素、头孢拉定和庆大霉素。结论：洛美沙星可作为临床上常见致病菌所致感染的选择用药。     

Radiation therapy for intracranial germ cell tumors: Predictive value of tumor response as evaluated by computed tomography

Background This retrospective study analyzed the outcome in patients with intracranial germ-cell tumors to determine whether tumor response during radiation therapy can predict achievement of primary local control with radiation therapy alone. Methods Between 1983 and 1993, 22 patients with untreated primary intracranial germ cell tumors received a total whole brain radiation dose of between 18 Gy and 45 Gy (mean 31.3 Gy) with or without a localized field of 10 to 36.4 Gy (mean, 22.4 Gy), or local irradiation only (1 patient). In 10 patients with pineal tumor only, who were treated first with radiation therapy, tumor response to radiation therapy was evaluated using computed tomography (CT) (at baseline, and approximately 20 Gy and 50 Gy). Areas of calcification in the tumor were subtracted from total tumor volume. Follow-up time ranged from 2 to 12 years. Results Five-year actuarial survival rates for patients with germinoma were 71%, 100% for patients with a teratoma component, and 100% for patients without histologic verification. Patients with germinomas or tumors suspected of being germinomas who were given more than 50 Gy had no local relapse. There was no correlation between primary local control by radiation therapy alone and initial tumor volume. The rate of tumor volume response to irradiation assesed by CT was significantly different in those patients who relapsed compared to those who did not relapse Conclusion Tumor response during radiation therapy using CT was considered to be predictive of primary local control with radiation therapy alone.     

纵断体层摄影在膝关节前后十字韧带胫骨止点撕脱骨折诊断中的应用

对膝关节前后十字韧带胫骨止点骨折，常因关节周围骨骼影像重叠使其显影不清而影响诊断。通过11例该类损伤患者的X线平片及纵断作层片的分析比较，认为纵断体层摄影可清晰显示关节内骨折的形状、大小、范围，获得完整的骨折分层像，从而有利于临床分型，对骨折的诊断及指导治疗有较大的应用价值。     

Teaching medical undergraduates basic clinical skills in hospice—is it practical?

AIM—Basic clinical skills teaching to medical undergraduates was a new departure for the hospice stimulated by the changing philosophies and organisation of students'' training. This study was undertaken to assess the practicalities of the venture.
METHOD—Questionnaires were designed for each of the three major groups of people involved, namely the students, the patients, and the hospice nurses. Involved patients completed theirs after teaching sessions, while the students and nurses were given two different questionnaires each, one at the start and another at the end of the academic year.
RESULTS—All students completed both questionnaires. Overall they had acquired adequate skills to pass their end of year assessments and considered themselves more comfortable with difficult situations than may otherwise have been the case. The majority of patients had enjoyed the experience and found it personally educational and a change to hospice routines. The nurses'' response rates were very poor, limiting any conclusions that could be drawn.
CONCLUSION—The venture was successful, stimulating, and practical for patients and students. Its impact on the nurses remains uncertain but, by their unusual lack of opinion expression, it can be inferred tentatively that this was minimal.


     

益肾生血片为主治疗再生障碍性贫血的临床研究

研究益肾生血片治疗再竽障碍性贫血的临床疗效。方法：治疗组１０６例用益肾生血片治疗，对照组３６例用人参归脾丸治疗，并观察两组治疗前后末梢血象和骨髓象的变化及益肾生血片的毒副作用。结果：治疗组及对照组的基本治愈率，缓解率，总有效率分别为２３．６％，３６．８％，８２．１％及１１．１％，２２．２％，５８．３％，经统计学处理有显著性差异，治疗组的疗效明显优于对照组。     

升降理论在心血管病中的临床应用

本文从升降学说的理论基础来论证升降理论，体现于脏腑的各种机能活动和各种物质代谢运动中，升降功能的失调是心血管疾病发生发展的主要原因，因此，临床心血管病的治疗亦离不开升降理论作指导，遣方用药注重升中有降，降中寓升，升降相宜