中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿的疗效及安全性

【摘要】目的 探讨中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性急性髓系白血病（AML）患儿的疗效及安全性。方法 选取2008年12月～2012年12月我院收治的行阿糖胞苷联合米托蒽醌、依托泊甙巩固治疗的难治复发性AML患儿96例作为研究对象,采用回顾性分析法分析所有患儿的临床及随访资料,根据阿糖胞苷使用剂量的不同将其分为低剂量组、中剂量组和高剂量组3组,每组各32例,治疗结束后分析并比较3组患儿近期和远期临床疗效,并记录3组患儿治疗过程中不良反应的发生情况。结果 近期临床总有效率3组相比较差异均无统计学意义（P＞0.05）,且所有部分缓解的患儿中8例患儿进行骨髓移植治疗后治愈,余42例继续采用药物进行治疗;3组患儿5年总生存率（OS）比较差异有统计学意义（P＞0.05）,中剂量组和高剂量组患儿5年OS均高于低剂量组（P＞0.05）,但中剂量和高剂量组5年OS比较差异无统计学意义（P＞0.05）,3组患儿其5年无事件生存年率（EFS）比较差异均无统计学意义（P＞0.05）;3组患儿在骨髓抑制和心脏毒性的不良反应方面比较差异无统计学意义（P＞0.05）,但中剂量组和高剂量组患儿其感染、胃肠道反应以及肝肾功能损伤的不良反应发生率均显著高于低剂量组,且高剂量组患儿胃肠道和肝肾功能损伤的不良反应发生率均高于中剂量组患儿,组间比较差异均有统计学意（P＞0.05）。结论 中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿具有较好的临床疗效和较低的毒副反应,存在一定的安全性,可作为临床上治疗AML患儿的首选治疗方案。     

Hepatitis C immune globulin (human) for the prevention of viral recurrence after liver transplantation

Immunoglobulin therapy has been used extensively in the treatment of infectious diseases. Hepatitis B immunoglobulin (HBIg) reduces the onset of infection in post-percutaneous exposure to Hepatitis B virus (HBV) and in infants of hepatitis B surface antigen (HBsAg)-positive mothers; it also significantly reduces the risk of recurrent HBV infection in liver transplant recipients, thus increasing the survival rate of this population. Prior to 1990, when plasma donors were not screened for the hepatitis C virus (HCV) antibody, the prevalence of HCV viremia after a liver transplant was found to be lower in those patients receiving HBIg containing anti-HCV antibodies. Phase I trials with chimpanzees demonstrated the ability of hepatitis C immune globulin (human) to decrease hepatic inflammation and to neutralize the HCV antibody, but this effect was not sustained over time. Phase I/II human studies have currently been unable to replicate the animal studies, but further trials are planned.     

Laparoscopic treatment of recurrent ectopic pregnancy in the ipsilateral salpinx after ovulation induction and intrauterine insemination

ObjectiveTo report a case of recurrent ectopic pregnancy in the ipsilateral salpinx after and intrauterine insemination treated by laparoscopy.Case reportA 33-year-old woman with unexplained infertility sought evaluation at our hospital due to pelvic pain after ovulation induction and intrauterine insemination. She had a history of a right salpingectomy. Transvaginal ultrasonography did not reveal an intrauterine pregnancy, but showed a suspected extrauterine gestational sac on the operated adnexal area with free fluid in the pouch of Douglas. The patient was diagnosed with a recurrent ruptured ectopic pregnancy and an emergency laparoscopy was performed.ConclusionRecurrent ectopic pregnancy in the ipsilateral fallopian tube is rare, but it is important to be suspicious of the diagnosis to prevent serious morbidity. This case also demonstrates transtubal or transperitoneal migration of the gametes because ovulation and ectopic pregnancy occurred on opposite sides.     

Recurrent Urinary Tract Infections in Women: How Promising is the Use of Probiotics?

Urinary tract infections (UTIs) currently rank amongst the most prevalent bacterial infections, representing a major health hazard. UTIs in females usually start as vaginal infections and ascend to the urethra and bladder. Recurrent UTIs (rUTIs) can be defined as at least three episodes of UTI in 1 year or two episodes in 6 months. Various antibiotics have been the mainstay of therapy in ameliorating the incidence of UTIs, but recurrent infections continue to afflict many women. It necessitates the exploitation of alternative antimicrobial therapy. Probiotics have been shown to be effective in varied clinical trials for long-term preventions of rUTI. Because Escherichia coli is the primary pathogen involved in UTIs which spreads from the rectum to vagina and then ascends up the sterile urinary tract, improving the gut or vaginal flora will thus impact the urinary tract. Since a healthy vaginal microbiota is mainly dominated by Lactobacillus species, in this context, exogenously administered probiotics containing Lactobacilli play a pivotal role in reducing the risk of rUTI. The concept of artificially boosting the Lactobacilli numbers through probiotic administration has long been conceived but has been recently shown to be possible. Lactobacilli may especially be useful for women with a history of recurrent, complicated UTIs or on prolonged antibiotic use. Probiotics do not cause antibiotic resistance and may offer other health benefits due to vaginal re-colonisation with Lactobacilli. However, more comprehensive research is still needed, to recommend for probiotics as an alternative to antibiotics.     

Fetal rejection: infertility and immunity

Defective reaction toward fetal alloantigens could result in both recurrent spontaneous abortions (RSAs) and recurrent early pregnancy failures (REPFs), the latter existing in couples with unexplained infertility and multiple failures of implantation after in vitro fertilization embryo transfer. Immunological mechanisms leading to RSA and REPF seem to be different, although both syndromes probably have a genetic background that has not been identified so far. Despite the fact that antiphospholipid syndrome is a well-established cause of repeated pregnancy loss, the role of different autoantibodies existing in RSA and REPF patients needs to be elucidated. Immunotherapy is believed to correct the detrimental immune reactions; however, its real effectiveness and safety for the treatment of distinct forms of pregnancy loss need to be reconsidered.     

清胃散加味治疗复发性口腔溃疡53例

目的:观察清胃散加味治疗复发性口腔溃疡的临床疗效.方法:选取复发性口腔溃疡患者53例,均给予清胃散加味治疗.结果:53例患者中,治愈49例,好转3例,未愈1例,有效率为98.11％.结论:清胃散加味治疗复发性口腔溃疡疗效显著.     

Eroded Valves,Recurrent Pleural Effusions,and Ultimately Heart–Liver Transplant

A patient with eroded tricuspid and pulmonic valves, who eventually developed elevated right atrial and systemic venous pressure that led to hepatic cirrhosis and recurrent pleural effusion, is presented. The complex issues involved over a long period in this patient, who ultimately required combined heart and liver transplant, are discussed.     

Clinical outcome after 36 months of treatment with injections of autologous blood for recurrent dislocation of the temporomandibular joint

We investigated the prognosis after three years of treatment for recurrent dislocation of the temporomandibular joint with autologous blood given intravenously in 21 patients with a mean (range) age 64 (17-92) years of whom 16 had coexisting systemic disease. The mean (range) follow up from the first injection was 64 (41-99) months. Eighteen patients had no recurrence during the first 36 months after their first injection, which showed that this minimally-invasive treatment was effective, particularly for those who had conditions that made a mouthpiece or operation unsuitable.