双球囊导管促宫颈成熟在延期妊娠 引产中的应用效果及对妊娠结局的影响研究

目的 研究双球囊导管促宫颈成熟在延期妊娠引产中的应用效果及对妊娠结局的影响.方法 前瞻性选择2016年1月至2019年12月安徽医科大学附属宿州医院产科收治的80例延期妊娠产妇作为研究对象,采用随机数字表法将其分为2组:对照组40例采用传统的缩宫素引产,研究组40例采用双球囊导管引产.比较2组宫颈成熟度、引产效果、分娩...     

小儿喉蹼患者麻醉诱导期的管理

目的 探讨小儿喉蹼患者的最佳麻醉管理.方法 回顾性分析我院2009年12月至2013年3月经纤维喉镜、颈部X线或薄层CT确诊喉蹼的24例小儿患者的麻醉管理.结果 所有患儿在术前均有不同程度的呼吸困难,手术的目的是解决通气问题.气管切开13例,其中6例术前先局麻下行气管切开后全麻,7例全麻插管后行气管切开;未行气管切开11例,直接在全麻下行气管内插管.诱导方式:快诱导经气管切口插管6例,快诱导经口插管7例,保留自主呼吸浅全麻诱导10例,1例先采用保留自主呼吸浅全麻诱导,第1次经口喉镜明视下插管失败后,面罩通气良好的情况下,改用快诱导,换管第3次插管成功.插管成功率:5例一次插管成功,10例两次插管成功,3例三次插管成功,平均插管时间12 min.所有患儿均未出现诱导期缺氧,但有13例呼气末二氧化碳分压(PetCO2)明显偏高.所有患儿均安全完成麻醉诱导.结论 术前充分的气道评估、完善的麻醉前准备及良好的团队协作是先天性喉蹼患儿围术期麻醉管理的关键.小儿喉蹼作为已预料的困难气道推荐选用保留自主呼吸浅全麻比较安全.     

兔羊膜上皮细胞向兔软骨细胞诱导的研究

目的 观察兔羊膜上皮细胞(AECs)向兔软骨细胞诱导分化的特性.方法 获得兔新鲜羊膜组织,去除外膜组织,并剪碎,胶原酶消化法进行原代培养.经传代培养、细胞形态观察后,用软骨细胞诱导培养液使AECs向软骨细胞分化,并以组织化学和免疫组织化学染色进行鉴定,电镜观察细胞形态检测软骨细胞特征性表现、细胞活性噻唑蓝(MTT)比色法检测.结果 兔羊膜上皮细胞具有前期胚胎干细胞的多向分化潜能,采用酶消化法可快速分离培养原代细胞.MTT比色法显示第3代传代细胞活性、增殖能力较高,未进行软骨细胞诱导的细胞未显示出软骨细胞的特征性表现,经软骨细胞诱导分化后,组织化学和免疫组织化学检测表明其能较好的表现软骨细胞特征.结论 兔AECs无伦理学限制,且具有前期胚胎干细胞的多向分化潜能,有望成为软骨细胞组织工程学新型的种子细胞.     

Induction of hepatic cytochrome P450 enzymes: methods,mechanisms, recommendations,and in vitro–in vivo correlations

Induction of drug-clearance pathways (Phase 1 and 2 enzymes and transporters) can have important clinical consequences. Inducers can (1) increase the clearance of other drugs, resulting in a decreased therapeutic effect, (2) increase the activation of pro-drugs, causing an alteration in their efficacy and pharmacokinetics, and (3) increase the bioactivation of drugs that contribute to hepatotoxicity via reactive intermediates. Nuclear receptors are key mediators of drug-induced changes in the expression of drug-clearance pathways. However, species differences in nuclear receptor activation make the prediction of cytochrome P450 (CYP) induction in humans from data derived from animal models problematic. Thus, in vitro human-relevant model systems are increasingly used to evaluate enzyme induction. In this review, the authors’ current understanding of the mechanisms of enzyme induction and the in vitro methods for assessing the induction potential of new drugs will be discussed. Relevant issues and considerations surrounding proper study design and the interpretation of in vitro results will be discussed in light of the current US Food and Drug Administration (FDA) recommendations.     

应用维奈克拉桥接清髓性预处理方案的挽救性异基因造血干细胞移植治疗原发诱导治疗失败的急性髓系白血病一例

目的:探讨维奈克拉在难治急性髓系白血病（AML）患者移植中的应用。方法:回顾性分析2020年3月苏州大学附属第一医院收治的1例诱导治疗失败后使用维奈克拉和去甲基化药物桥接清髓性预处理方案后行异基因造血干细胞移植（allo-HSCT）的难治AML患者诊治过程。结果:患者，女性，28岁，诊断为难治AML。初始给予IA（去甲氧柔红霉素+阿糖胞苷）（3+7）方案诱导化疗未缓解，CLAG（克拉屈滨+阿糖胞苷+粒细胞集落刺激因子）方案再诱导化疗未缓解，使用维奈克拉与去甲基化药物桥接清髓性预处理方案化疗后，进行挽救性单倍体allo-HSCT。复查骨髓缓解，植入成功，随访100 d，持续缓解，无移植并发症发生。结论:对于原发诱导治疗失败的难治AML，使用维奈克拉与去甲基化药物桥接清髓性预处理可作为挽救性allo-HSCT的优选方案。     

Epidemiology,Risk Factors,and Outcome of Bloodstream Infection Within the First Year After Kidney Transplantation

BackgroundMulti-drug resistant organisms have been emerging among kidney transplant (KT) recipients with bloodstream infections (BSI). The investigation for epidemiology, risk factors and outcome of these infections following KT was initiated.Materials and MethodsA retrospective study of all adult KT recipients who developed a BSI within the first year after KT in 2016 at a single transplant center was conducted. The cumulative incidence of BSI was estimated with Kaplan-Meier methodology. Clinical characteristics and outcome were extracted. Risk factors were analyzed with Cox proportional hazards models.ResultsAmong 171 KT recipients, there were 26 (15.2%) episodes of BSI. Fifty-nine percent were men and the mean ± SD age was 43 ± 12 years. The cumulative incidence of BSIs was 10.1% at 1 month, 13.5% at 6 months, and 15.2% at 12 months. Gram-negative bacteria were responsible for 92% of BSIs, Escherichia coli was the most common pathogen (65%) followed by Klebsiella pneumoniae (11%). Among those, 71% were resistant to extended-spectrum cephalosporins. The genitourinary tracts were the predominant source of BSIs (85%). The second kidney transplantation (HR, 4.55; 95% CI, 1.24–16.79 [P = 0.02]) and receiving induction therapy (HR, 3.05; 95% CI, 1.15‐8.10 [P < 0.03]) were associated with BSI in a multivariate analysis. One patient (4%) developed allograft rejection, allograft failure and death from septic shock.ConclusionsOne out of six KT recipients could develop BSI from gram-negative bacteria within the first year after transplant, particularly in those that received the second transplantation or induction therapy.     

The current status of esophageal cancer treatment in North America

Cancer of the esophagus and gastroesophageal junction (GEJ) in North America remains a relatively small but challenging clinical problem. It is estimated that, in 2004, 21000 new esophageal cancers will be diagnosed (of which more than 75% will be in men) and 19600 deaths from esophageal cancer will occur. In contrast to the Asian experience, adenocarcinomas of the esophagus and GEJ comprise more than half of all esophageal malignancies. Other than surveillance endoscopy in patients with Barretts esophagus, there are currently no useful screening techniques for esophageal cancer. The lack of an early detection algorithm determines the distribution of stage at the time of diagnosis: stages 0, I 16%; IIA, IIB 26%; III 26%; IV 32%. Standard staging algorithms currently include computed tomography and sometimes a contrast esophagram. Fewer than 20% of patients undergo endoscopic ultrasonography (EUS), and an even lower incidence of positron emission tomography (PET) scanning is evident. Although data for the utility of neoadjuvant therapy before surgery for esophageal cancer are lacking, as many as 50% of resectable patients undergo such therapy. The choice of the method of resection has not changed for more than a decade, with only one-fourth of operations being performed using a transhiatal technique. Current surgical controversies include the extent of en bloc resection, the extent of nodal dissection, the utility of minimally invasive esophagectomy techniques, and hospital and surgeon case volume as a surrogate for quality outcomes. Unlike Asia and Europe, the free market philosophy of medical care in North America leads to widespread distribution and subsequent dilution of cancer care experience. However, it is likely that market forces will begin to encourage the development of centers of excellence for surgical therapy of esophageal cancer. There is a growing interest in treating localized cancers with chemoradiotherapy alone, and the use of EUS and PET for restaging these patients is being investigated. Some investigators believe that esophagectomy may soon be relegated to the role of a salvage operation. New biological agents are currently being evaluated as part of multimodality therapy for esophageal cancer, including radiation-induced release of TNF-alpha, statins, immunotoxins, and epithelial growth factor receptor (EGFR) tyrosine kinase inhibitors. Current free market forces may slow progress in standard cancer care but perhaps will provide opportunities for new and unique treatment methods that otherwise may not be explored in more traditional centers of excellence.This lecture was presented during the international session at the 58th Annual Meeting of the Japan Esophageal Society     

High-dose azathioprine pulse therapy as a new treatment option in patients with active Wegener’s granulomatosis and lupus nephritis refractory or intolerant to cyclophosphamide

The objective of this study was to evaluate the feasibility and safety of high-dose azathioprine pulse (HAP) therapy in the induction of remission in patients with active Wegeners granulomatosis (WG) or progressive lupus nephritis (LN) refractory to or intolerant of cyclophosphamide. Four patients with antineutrophil cytoplasmic antibody (ANCA)-associated WG and two patients with progressive LN were treated with HAP (1200–1800 mg) applied monthly as continuous intravenous infusions at 50 mg/h. Patients received a total of 50 courses of intravenous azathioprine (AZA) therapy. Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS) and the Systemic Lupus Erythematosus Activity Index (SLEDAI). As only partial remission was induced in patients with progressive LN on this regimen, an additional 18 cycles were applied in these patients in which oral AZA at 100 mg/day in weeks 2 and 3 was added between two intravenous courses. A hereditary defect in thiopurine methyltransferase activity was excluded before initiation of treatment. High-dose azathioprine pulse and the intensified HAP treatment were well tolerated. Complete remission was achieved in two patients with WG suffering from three relapses of disease on application of 2–6 courses of HAP. Remission was maintained for 16–24 months. The remaining two patients with WG were withdrawn after 2–3 courses due to unchanged disease activity. In two patients with LN, partial remission was noted on 6–9 courses of HAP; however, the patients relapsed despite therapy with methotrexate and mycophenolate mofetil. The intensified HAP regimen led to partial or complete remission in both LN patients which was confirmed by sequential renal biopsies. Our results suggest that HAP therapy represents a well-tolerated regimen in patients with active WG and LN intolerant of or refractory to cyclophosphamide. As partial or complete remission was observed in four of six patients, further studies seem warranted to assess clinical efficacy in these patients.     

急性髓系白血病患者诱导缓解治疗期症状群的纵向研究

目的 探讨急性髓系白血病（acute myeloid leukemia,AML）患者诱导缓解治疗（induction therapy,IT）期症状群的变化情况。方法 2018年1月—2020年6月,便利选取山东省某三级甲等医院血液内科首次确诊为AML并接受IT的130例患者,运用中文版记忆症状评估量表在IT开始前1 d（T1）、IT结束当天（T2）、IT结束后第7天（T3）对其进行评估,运用因子分析确立症状群的组成。 结果 T1存在4个症状群,为心理症状群、营养症状群、神经症状群和疼痛-出汗症状群。T2存在3个症状群,为胃肠道症状群、疲乏症状群和治疗相关症状群。T3存在4个症状群,为心理症状群、胃肠道症状群、疲乏症状群和形象改变症状群。其中心理症状群在T1和T3存在,疲乏症状群和胃肠道症状群在T2和T3持续存在。结论 AML患者在IT期经历的症状群呈动态变化。IT前的心理症状群、IT中的胃肠道症状群、IT结束后的疲乏症状群可作为优先干预的症状群。     

Origin of a malignant adenocarcinoma cell line induced by retrovirus-like particles from DMBA rat mammary tumors

Summary Intraperitoneal inoculation of neonate Sprague Dawley rats with cell-free extracts containing retrovirus-like particles from DMBA-induced rat mammary tumors resulted in a fivefold increase of benign mammary neoplasias in the survivor animals, in comparison to the spontaneous tumor incidence rate. In addition, four animals developed metastasizing abdominal adenocarcinomas. The ascitic cells of one of the abdominal tumors were established as a permanent tissue culture line (HH-1). After subsequent animal passage, cells of the permanent line HH-9 clone 14 showed increased malignancy manifested by the number of takes per animals injected, and by the number of remote metastases observed.Supported by the Deutsche Forschungsgemeinschaft, SFB 34