不同剂量辛伐他汀对老年早期糖尿病肾病患者炎症因子和肾功能的影响观察

摘 要 目的： 观察不同剂量辛伐他汀对老年早期糖尿病肾病患者炎症因子和肾功能的影响。方法: 160例老年早期糖尿病肾病患者随机分为对照组、低剂量组、常规剂量组和大量组。各组均给予基础治疗,低剂量组、常规剂量组、大量组分别在基础治疗同时加用辛伐他汀10,20,40 mg·d^-1。4周后观察比较各组患者治疗前后炎症因子（CRP、ICAM-1、IL-1β）和肾功能指标（BUN、Cr、UAER、24hUpro、Uβ₂-MG）变化及药品不良反应。结果: 治疗后大量组CRP水平较治疗前显著降低,且明显低于对照组治疗后（P<0.05）;治疗后低量组、常量组和大量组ICAM-1水平均较治疗前显著降低,且明显低于对照组治疗后（P<0.05）;治疗后4组IL-1β水平均无明显变化（P>0.05）。治疗后4组BUN水平均无明显变化（P>0.05）;Cr、UAER水平均较治疗前显著降低（P<0.05）,且辛伐他汀各剂量组均低于对照组治疗后（P<0.05）,常量组和大量组低于低量组（P<0.05）;治疗后辛伐他汀各剂量组24 h Upro、Uβ₂-MG水平均较治疗前显著降低,且低于对照组治疗后（P<0.05）;且常量组和大量组Uβ₂ MG水平低于低量组治疗后（P<0.05）,大量组低于常量组治疗后（P<0.05）。四组不良反应发生率比较,差异无统计学意义（P>0.05)。结论:辛伐他汀治疗从炎症因子和肾功能指标两个方面可以改善糖尿病肾病的病情,大剂量辛伐他汀表现出一定的优势。     

放射性核素131I在甲亢治疗中的应用现状和进展

以Graves病为代表,探讨放射性核素131I在甲亢治疗学中的应用,归纳、总结和讨论131I在甲亢治疗中的适应症、剂量、联合治疗、疗效和转归.与传统治疗方法相比,131I治疗甲亢具有快速简便、不良反应少、治疗效果好、费用低等优点,逐渐成为甲亢治疗的主流方法,但治疗时需注意向甲减的转归.     

Effectiveness of Reinduction and/or Dose Escalation of Ustekinumab in Crohn’s Disease: A Systematic Review and Meta-analysis

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人类平衡型核苷转运蛋白1高表达晚期非小细胞肺癌患者术后应用不同剂量吉西他滨治疗的临床效果观察

目的 观察晚期非小细胞肺癌(NSCLC)中人类平衡型核苷转运蛋白1(hENT1)高表达患者应用不同剂量吉西他滨治疗的临床效果.方法 选取2008年7月至2013年12月于浙江金华广福医院行晚期NSCLC手术后,病理确诊晚期NSCLC患者,采用免疫组织化学SP法检测肺癌组织中hENT1抗体的表达水平.62例hENT1高表达患者入组,按随机数字表分组法分为对照组(30例)和观察组(32例).对照组采用常规剂量吉西他滨(1 000 mg/m2)联合顺铂进行化疗,观察组用低剂量吉西他滨(250 mg/m2)联合顺铂进行化疗,观察2组近期疗效、化疗不良反应.采用生活质量调查核心量表QLQ-C30和肺癌专用量表QLQ-LCl3比较2组化疗后生活质量.结果 对照组和观察组近期有效率和疾病控制率差异无统计学意义[43.3％ (13/30)比46.9％ (15/32),76.9％ (23/30)比81.2％(26/32)](x2 =0.08,x2 =0.20,P＞0.05).观察组Ⅲ、Ⅳ度白细胞减少、血小板减少及恶心、呕吐发生率低于对照组,差异有统计学意义(P＜0.05);除角色功能外,观察组化疗后总体生活评分及躯体功能、情绪功能、认知功能、社会功能、经济状况各项评分均优于对照组[(54±20)分比(54±16)分,(72±25)分比(62 ±20)分、(85 ±20)比(72±19)分、(76±28)分比(62±25)分、(61 ±24)分比(49 ±30)分、(36±24)分比(56±21)分],差异均有统计学意义(均P＜0.05).观察组除乏力症状外其他症状评分均优于对照组(P＜0.05).结论 对于晚期NSCLC术后hENT1高表达患者,在保证化疗效果的同时,相对于常规剂量吉西他滨,低剂量用药可有效降低化疗过程中不良反应,提高患者的生活质量.     

Febrile neutropenic events in cancer patients Treatment for fever and neutropenia in young adult patients during intensive chemotherapy for solid tumours

Summary Febrile neutropenic events (FNE) were studied in 90 patients on chemotherapy protocols for solid tumours, from 1986 to 1990. All patients received intensive chemotherapy with a high dose intensity. There were 51 FNE admissions in 31 patients, with an average event rate of 1.6/patient. The average periods of granulocytopenia, fever and admission were 3.5, 2.7 and 5.4 days respectively. The management of FNE consisted of accurate clinical observation and antibiotic treatment if indicated by symptoms of infection or by bacteriological cultures. Only 25 of 51 patients admitted received empiric broad-spectrum antibiotics, while 7 were treated after the results of bacteriological cultures were known. One patient died during granulocytopenia, of interstitial pneumonitis for which no bacteriological source was established. Recurrences of infection after discharge from the hospital were not seen. We conclude that in this group of young adult patients, FNE runs a favourable course. Only a short period of admission and a limited form of antibiotic treatment are needed, minimizing the load on the patient and the costs of their care.Abbreviation FNE febrile neutropenic events     

Methadone-related death in detention

Oral methadone may be prescribed to detainees with the aim of minimising the risk of fatal opioid poisoning on release. To study the circumstances under which methadone-related deaths can occur in detention, we audited reports of 17 [14 male, 3 female; median (range) age 34 (22–52) years] such deaths, July 2010–December 2011. The median (range) methadone dose was 40 (10–110) mg/d (N = 16). The median (range) post-mortem blood methadone concentration was 0.42 (0.16–1.40) mg/L. Those who died within 7 days of the commencement of methadone treatment were significantly younger (Mann-Whitney U 102.5, p < 0.05), were prescribed a significantly lower dose (U = 80.0, p < 0.05) and had significantly lower blood methadone concentrations at death (U = 106.5, p < 0.02) than in those given methadone long-term. In 8 reports the prisoner had been recorded as either ‘sleepy’ (N = 7), or ‘unwell’ in the hours before death. In 13 deaths, the prisoner was either found dead first thing in the morning, or in one instance could not be roused (‘snoring heavily’). Pneumonia, tracheobronchitis, end-stage cirrhosis, and ischaemic heart disease/coronary artery atherosclerosis were cited as associated factors in four patients, all of whom were on long term stable methadone treatment. Attention to warning signs of likely methadone toxicity (daytime or excessive drowsiness, snoring, nausea/vomiting) and associated risk factors (use of drugs such as benzodiazepines and gabapentinoids, the presence of respiratory infection, liver or renal disease) could help minimise the risk of unexpected death in patients given methadone.     

Alcohol Acceptance, Preference, and Sensitivity in Mice. II. Quantitative Trait Loci Mapping Analysis Using BXD Recombinant Inbred Strains

Quantitative trait loci (QTL) mapping of complex phenotypes has emerged as an important feature of the recombinant inbred (Rl) strain methodology. In this second study of our series on alcohol-related behaviors in mice, we examine alcohol acceptance, preference, and hypnotic dose sensitivity (HDS) to a standard dose of alcohol measured in BXD RI strains to identify candidate QTL regions responsible for their heritability. We detected highly significant marker associations for acceptance on chromosome 12 (Eif4e) , for preference on chromosome 1 (D1Rti2) and chromosome 7 (D7Mit7) , and for HDS on chromosome 7 (Mpmv1). These are the strongest QTL associations that we detected, but several other candidate QTL regions are reported. Given the limited number of BXD RI strains available, the large number of markers used herein, and the consequent chance of identifying false marker associations, these RI QTL mapping results must be seen as tentative, but an important first step toward identifying QTL for alcohol-related behaviors.     

Dose fusion and efficacy evaluation of different radical radiotherapy doses for cervical cancer

BackgroundThe recommended external beam radiotherapy (EBRT) dose for cervical cancer is 40–50 Gy, but there is no consensus. In this study, 45-Gy and 50.4-Gy treatment groups were compared for fused doses to target tumor areas and organs at risk (OARs), clinical efficacy, and quality of life.MethodsSeventy-nine cases receiving radical radiotherapy within the past 3 years were retrospectively analyzed. EBRT and three-dimensional brachytherapy dose fusion values were calculated for target areas and OARs using Elastix V5.0. Clinical efficacy was assessed using Response Evaluation Criteria in Solid Tumors (RECIST), adverse events using Common Terminology Criteria for Adverse Events v4.03 (CTCAE4.03), and quality of life using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30).ResultsMinimum fused dose delivered to 90% of the high-risk clinical target volume (HRCTV D90) did not differ significantly between 45-Gy and 50.4-Gy groups, whereas D2cc values of rectum and bladder (OARs) were significantly lower in the 45-Gy group (both p < 0.05). Further analysis showed that these D2cc differences resulted primarily from EBRT. No grade III–IV adverse events were observed in either group during follow up. Short-term clinical efficacy, adverse events, and EORTC QLQ-C30 functional and symptom scales also did not differ significantly between groups (all p > 0.05). However, quality of life was markedly higher in the 45-Gy group (p < 0.05).ConclusionAppropriate EBRT dose reduction can reduce OAR irradiation without compromising total target area dose or clinical efficacy. Dose fusion can facilitate the judicious choice of EBRT to limit OAR exposure, reduce adverse events, and enhance the quality of life.     

Multi-institution assessment of the use and risk of cardiovascular computed tomography in pediatric patients with congenital heart disease

BackgroundCardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known.MethodsFour centers prospectively enrolled consecutive pediatric CHD patients <18 years of age undergoing cardiac CT from January 6, 2017 to 1/30/2020. Patient characteristics, cardiac CT data and comprehensive diagnostic risk were compared by age and institutions. Risk categories included sedation and anesthesia use, vascular access, contrast exposure, cardiovascular medication, adverse events (AEs), and estimated radiation dose.ResultsCardiac CT was performed in 1045 pediatric patients at a median (interquartile range, IQR) age of 1.7 years (0.3, 11.0). The most common indications were arterial abnormalities, suspected coronary artery anomalies, functionally single ventricle heart disease, and tetralogy of Fallot/pulmonary atresia. Sedation was used in 8% and anesthesia in 11% of patients. Peripheral vascular access was utilized for 93%. Median contrast volume was 2 ​ml/kg. Beta blockers were administered in 11% of cases and nitroglycerin in 2% of cases. The median (IQR) total procedural dose length product (DLP) was 20 ​mGy1cm (10, 50). Sedation, vascular access, contrast exposure, use of cardiovascular medications and radiation dose estimates varied significantly by institution and age (p ​< ​0.001). Seven minor adverse events (0.7%) and no major adverse events were reported.ConclusionCardiac CT for CHD is safe in pediatric patients when appropriate CT technology and expertise are available. Scans can be acquired at relatively low radiation exposure with few minor adverse events.     

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.