脾大部切除术与脾完全切除术比较治疗肝硬化门脉高压症的系统评价

目的系统评价脾大部切除联合断流术和脾完全切除联合断流术治疗肝硬化门脉高压症的疗效。方法计算机检索Cochrane图书馆（2008年第2期）;MEDLINE（1966．1-2008．8）;EMbase（1966．1-2008．8）;CBM（1978．1—2008．8）;VIP（1989．1-2008．8）;CNKI（1994．1—2008．8）。手工检索相关杂志及会议论文集中未发表的文献。结果纳入3个随机对照试验,共136例患者,试验组68例,对照组68例。2个研究的合并分析结果表明,脾大部切除术后患者外周血小板水平提高更低[WMD=-39．27,95％CI（-62．57,-15．97）]。另2个研究的合并分析结果表明,脾大部切除术后患者血清Tuftsin水平更高[WMD=165．28,95％CI（159．36,171．21）102个研究的合并结果显示,两组患者血清IgM水平差异无统计学意义[WMD=0．52,95％CI（-0．17,1．21）]。1个研究发现脾大部切除术可提高外周白细胞水平[WMD=-0．93,95％CI（-1．52,-0．34）101个研究显示两组血清IgA水平差异无统计学意义[WMD=0．05,95％CI（-0．02,0．12）]。另1个研究表明脾完全切除组患者术后均发热天数长于脾大部切除组,两组5年生存率差异有统计学意义（P〈0．05）。结论脾大部分切除术后患者能维持免疫系统的储备功能,有助于保持抗感染能力。鉴于本系统评价纳入的研究太少,质量均不高,每个研究纳入病例不多,测量指标不全面,随访时间不长,影响了本系统评价的论证强度及全面性。因此尚需开展更多高质量研究。     

绝经早期妇女龈沟液白细胞介素-6 与牙周炎的关系

目的探讨白细胞介素-6(IL-6)与绝经早期妇女牙周炎的关系.方法选择30例非牙周炎和49例患慢性中、重度牙周炎的维吾尔族(维族)妇女,所有妇女绝经年限均≤5年.采集30颗牙周健康牙和49颗牙周炎患牙的龈沟液(GCF)样本,随后记录牙周临床观察指标.应用放射免疫分析法检测GCF中IL-6的含量. 结果牙周健康组GCF中IL-6的含量为(1 088.10±102.33) pg/ml,慢性牙周炎组GCF中IL-6的含量为(2 961.22±224.80) pg/ml, 慢性牙周炎组明显高于牙周健康组(P<0.005);经相关分析,慢性牙周炎患牙GCF中IL-6的含量与GI、PPD、CAL均呈正相关(r=0.564, P<0.005; r=0.335, P<0.05; r=0.324, P<0.05).结论绝经早期的妇女健康牙GCF中含有少量IL-6.GCF中IL-6的产生增加可能与牙周炎的发生、发展有关,同时IL-6的水平反映了牙周炎症的严重程度,可以尝试作为判断牙周病变程度的一个指标.     

Hypermetabolism in the left thalamus and right inferior temporal area on positron emission tomography-statistical parametric mapping (PET-SPM) in a patient with Charles Bonnet syndrome resolving after treatment with valproic acid

Charles Bonnet syndrome (CBS) is characterized by the occurrence of complex visual hallucinations in visually impaired patients who understand that what they see is unreal. The pathophysiologic mechanism of CBS is poorly understood. However, hypermetabolism of the thalamocortical pathway as a result of deafferentation was recently proposed as a possible mechanism. A 69-year-old patient with CBS presented with a 5-year history of visual hallucinations after bilateral visual impairment, which had progressed to troublesome images of many unreal people and animals. Positron emission tomography-statistical parametric mapping (PET-SPM) imaging studies initially revealed hypermetabolism in the right inferior temporal area and left thalamus, which disappeared after treatment with valproic acid. This case, using PET-SPM analysis, supports the thalamic hypermetabolism theory of CBS.     

肝泡型包虫病的手术治疗:附43例病例分析

目的 探讨肝泡型包虫病手术治疗的方式和疗效.方法 对我院2000年至2008年收治的43例肝泡型包虫病患者分成两组回顾性分析.根治性手术组19例、姑息性手术组24例.结果 姑息性手术组围手术期病死1例,2例术后出现远处转移,2例术后出现肝内播散,4例因术后再次出现黄疸、3例因术后反复发作胆管炎而入院治疗.根治性手术组3例术后出现胆瘘,1例出现胆管炎,3例出现消瘦.术后30例获得随访(≤3年至≤8年).随访期间,姑息性手术组有10例患者病死,长期生存率为28.5%(4/14);根治性手术组中有1例患者因贲门癌病死,长期生存率为93.7%(15/16).结论 根治性手术是治疗肝泡型包虫病的首选方法.可使患者获得临床治愈并长期存活.而姑息性手术多用于解决梗阻性黄疸或并发症,以便为进一步治疗争取时间.

Abstract：

Objective To study the operative techniques and the surgical results of hepatic alveolar echinococcosis. Methods Forty three patients with hepatic alveolar echinococcosis treated in our Hospital from 2000 to 2008 were studied retrospectively. They were divided into two groups: radical resection group (19 cases) and palliative resection group (24 cases). Results There were 1 surgeryrelated death, 2 patients with remote metastases, 2 patients with intrahepatic dissemination, 4 patients with recurrent jaundice and 3 patients with cholangitis in the palliative resection group. There were 3 patients with biliary fistula, 1 patient with cholangitis and 3 patients with emaciation in the radical resection group. Among the 30 patients followed-up for ≤3-≤8 years, 10 patients died in the palliative resection group and the long-term survival rate was 28.5% (4/14). One patient died from gastric cancer in the cardiac in the radical resection group and the long survival rate was 93. 7%(15/16). Conclusions The first choice of treatment for hepatic alveolar echinococcosis is radical resection. Patients could be cured by radical resection. Palliative surgery is an option for patients not manageable otherwise.     

阿苯达唑脂质体和阿苯达唑片治疗囊型包虫病的临床疗效及安全性

目的 观察阿苯达唑脂质体(L-ABZ)和阿苯达唑片(T-ABZ)治疗囊型包虫病的临床疗效及安伞性.方法 收集1998-2008年我院门诊收治及下乡现场普查发现的囊型包虫病患者269例,采用回顾性病例对照方法,纳入符合病例218例,其中经L-ABZ治疗的患者110例,经T-ABZ治疗的患者108例.依据随访的临床症状及影像和血清学化验结果对比分析药物的疗效及不良反应.短期为服药3个月,长期为服药6个月.囊型包虫病患者分为单囊型(CE1)、多子囊型(CE2)和内囊塌陷坏死型并囊内可见活性子囊(CE3).用χ2检验分析计量资料、计数资料;用Wilcoxon秩和检验分析等级资料;统计学检验均为双侧检验,统计数据均用SPSS13.0及PEMS3.1医学统计软件分析完成.结果 短期疗效评价中,L-ABZ组与T-ABZ组总有效率及治愈率分别为77.9%和49.1%,28.4%和13.9%,两组比较,χ2值分别为19.581、6.877,P值均<0.05,差异有统计学意义.长期疗效评价中,L-ABZ组与T-ABZ组总有效率及治愈率分别为81.7%和49.0%,47.6%和20.6%,两组比较,χ2值分别为20.977、15.049,P值均<0.05,差异有统计学意义.T-ABZ组不同类型包虫囊肿疗效比较:对于短期治愈率、短期总有效率、长期治愈率、长期总有效率,CE1组分别为50.0%(15/30)、56.7%(17/30)、58.3%(7/12)、75.0%(9/12);CE2组分别为8.8%(8/91)、35.2%(32/91)、28.6%(12/42)、69.0%(29/42);CE3组分别为33.3%(7/21)、61.9%(13/21)、70.0%(7/10)、100.0%(10/10).CE1组、CE3组分别与CE2组的短期疗效(治愈率和总有效率)比较,χ2值分别为24.887、4.329、8.860、5.076,P值均<0.05,差异有统计学意义;L-ABZ组不同类型包虫囊肿疗效比较:对于短期治愈率、短期总有效率、长期治愈率、长期总有效率,CE1组分别为47.4%(18/38)、92.1%(35/38)、79.3%(23/29)、96.6%(28/29).CE2组分别为12.2%(12/98)、65.3%(64/98)、35.9%(23/64)、84.40/0(54/64).CE3组分别为61.5%(8/13)、92.3%(12/13)、50.0%(3/6)、100%(6/6).CE1组、CE3组分别与CE2组的短期疗效(治愈率、总有效率)比较,χ2值分别为19.648、9.930、18.880、3.876,P值均<0.05,差异有统计学意义;在安全性评价中,T-ABZ组和L-ABZ组药物相关的不良反应发生率分别为11.1%(12/108)、12.7%(14/110),两组比较,χ2=0.155,P>0.05,差异无统计学意义.结论 L-ABZ及T-ABZ均是有效的抗包虫药物,但L-ABZ临床疗效更佳.

Abstract：

Objective To explore and compare the clinical effect and safety of liposomal albendazole (L-ABZ) and tablet-albendazole (T-ABZ) in the treatment of cystic echinococcosis (CE1, CE2, and CE3). Methods A total of 269 cases treated with cystic echinococcosis (CE) in Xinjiang Medical University the First Affilicated Hospital from 1998 to 2008 were reviewed. 51 cases were excluded and 218 cases were enrolled in this research by retrospective case-control method. Among 110 cases were treated with L-ABZ and 108 cases were treated with T-ABZ for short-term (3 months) and long-term courses (6 months) respectively. The effects and safety of the two medicines were compared by analyzing the clinical symptoms, imaging check and serologic test results. Results In short-term effect evaluation, the total effective rates and curative rates of L-ABZ group and T-ABZ group were 77.9% and 49.1% vs 28.4% and 13.9%, respectively. The effects of L-ABZ group was better than that of T-ABZ group, with remarkable difference in total effective rates and curative rates ( χ2 value was 19.581, 6.877, respectively, P < 0.05). In long-term effect evaluation, the total effective rates and curative rates of L-ABZ and T-ABZ group were 81.7% and 49.0% vs 47.6% and 20.6%, respectively. There was significant difference between L-ABZ group and T-ABZ group in total effective rates and curative rates (χ2 value was 20.977, 15.049, respectively, P < 0.05). In T-ABZ group the short-term curative rates were 50.0% (15/30), 8.8% (8/91) and 33.3% (7/21) respectively in CE1, CE2, and CE3, the short-term total effctive rates were 56.7% (17/30), 35.2% (32/91) and 61.9% (13/21) respectively in CE1, CE2, and CE3. The long-term curative rates were 58.3% (7/12), 28.6% (12/42) and 70.0% (7/10) respectively in CE1, CE2 and CE3, the long-term total effctvie rates were 75.0% (9/12), 69.0% (29/42) and 100.0% (10/10) respectively in CE1, CE2, and CE3. When compared with CE2, differences existed in CE1 ( χ2 = 24.887,4.329; P < 0.05) and CE3 groups ( x 2 = 8.860, 5.076; P < 0.05) in terms of short-term effects. In L-ABZ group, the short-term curative rates were 47.4% (18/38), 12.2% (12/98) and 61.5% (8/13) respectively in CE1, CE2 and CE3, the short-term total effctive rates were 92.1% (35/38), 65.3% (64/98) and 92.3% (12/13) respectively in CE1, CE2 and CE3, the long-term curative rates were 79.3% (23/29), 35.9% (23/64) and 50.0% (3/6) respectively in CE1, CE2 and CE3, the long-term total effective rates were 96.6% (28/29),84.4% (54/64) and 100% (6/6) respectively in CE1, CE2 and CE3. When compared with CE2, there were significant differences in CE1 (χ2 = 19.648, 9.930; P < 0.05) and CE3 groups ( χ2 = 18.880, 3.876; P < 0.05) in terms of short-term effect. In L-ABZ and T-ABZ groups, the durg-related adverse effects were 11.1% (12/108) and 12.7% (14/110) respectively without significant difference ( χ2 = 0.155, P > 0.05). Conclusion L-ABZ and T-ABZ were both effective anti-echinococcosis drugs without dominant sideeffects. The clinical effect of L-ABZ was better than that of T-ABZ.     

经皮无水酒精治疗直径≤3cm肝癌的系统评价

目的系统评价经皮无水酒精（PEI）治疗直径≤3cm肝癌的疗效和安全性。方法计算机检索Cochrane图书馆临床对照试验数据库（2008年第2期）、PubMed（1978～2008）、EMbase（1966—2008）、Ovid（2000-2008）、中国生物医学文献数据库（1978-2008）和中国期刊全文数据库（1979～2008）,手工检索中、英文已发表和未发表的资料以及查阅文后参考文献,文献检索无语种限制。按Cochrane系统评价方法筛选试验、评价纳入研究的方法学质量、提取资料,并用RevMan4．2．10版软件进行Meta分析。结果本系统评价纳共入7个随机对照试验,包括891例患者。按测量指标和干预措施进行亚组分析。结果显示,直径≤3cm肝癌治疗后1、3年生存率与局部复发率,PEI与经皮射频消融（RFA）治疗比较差异均有统计学意义[RR=0．95,95％CI（0．91,1．00）;RR=0．80,95％CI（0．71,0．91）;RR=2,18,95％CI（1．11,4．30）;RR=2．59,95％CI（1．55,4．32）];PEI与经RFA治疗比较,直径2-3cm的肝癌治疗后3年无瘤生存率差异有统计学意义[RR=0．47,95％CI（0．24,0．93）];两种治疗方式在其余指标方面的差异均无统计学意义。结论现有有限证据表明,对于直径≤3cm的肝癌,PEI与经皮醋酸注射（PAl）治疗、手术切除的疗效相当;PEI注射十RFA与RFA治疗的疗效无差异;治疗直径≤2cm肝癌,PEI的疗效与RFA无差别,但RFA治疗直径2～3cm肝癌的疗效优于PEI。由于本系统评价纳入RCT数量及样本量较少,质量偏低,一些主要测量指标报道过少,缺乏足够信息进行分析,尚需开展更多更高质量RCT进一步验证其疗效和安全性。     

Enhancement of Arsenic Trioxide (As2O3)- Mediated Apoptosis Using Berberine in Human Neuroblastoma SH-SY5Y Cells

Objective

Arsenic trioxide (As₂O₃) has been used as an anticancer agent in traditional Chinese medicine for thousand years and berberine is an isoquinoline alkaloid present that has indicated significant antimicrobial activity. We have examined the combined anticancer effects of As₂O₃ and berberine against the human neuroblastoma (HNB) SH-SY5Y cells in vitro, and to elucidate underlying molecular mechanism.

Methods

HNB SH-SY5Y cells were treated with 2 µM As₂O₃ and 75 µg/ml berberine, and their survival, cell death mechanism as well as synergistic cytotoxic effects were estimated by using MTT assay, DAPI staining, agarose gel electrophoresis, flow cytometric analysis, and western blot analysis.

Results

The combined treatment of two drugs also markedly decreased cell viability. The cytotoxic effects of two drugs were revealed as apoptosis characterized by chromatin condensation, DNA fragmentation, and the loss of mitochondrial membrane potential. The apoptotic cytotoxicity was accompanied by activation of caspase-3 protease as well as decreased the expression of Bcl-2, Bid, and Bcl-x/L. In addition, the cells treated with combination of two drugs also showed significantly increased intracellular reactive oxygen species levels and lipid peroxidation compared to cells As₂O₃ or berberine only.

Conclusion

Combined treatment of As₂O₃ with berberine induced activation of apoptotic signaling pathways in HNB SH-SY5Y cells. These results suggest that the possibility of the combined treatment of two chemotherapeutic agents with low concentration improving cytotoxic effect for cancer cells with minimal side effects.     

Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver: A case report

BACKGROUNDPyogenic liver abscess (PLA) due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly. We report a case of PLA caused by a fishbone puncture.CASE SUMMARYThis report describes the clinical features, diagnosis and treatment of a 56-year-old male patient who presented with severe pneumonia, acute respiratory failure and septic shock. The main clinical manifestation was a nonspecific recurrent infection. Based on the findings of abdominal computed tomography examination and the detailed medical history, the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver. After active anti-inflammatory treatment, the patient''s general condition had improved. The laparoscopic drainage of the liver abscess and the foreign body removal was performed. There was no recurrence of abscess at discharge or during follow-up and the patient’s general condition was satisfactory. CONCLUSIONPLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics. Our case confirms that a laparoscopic approach is safe and feasible for such cases.     

Pharmacokinetics of 11-hydroxyaclacinomycin X (ID-6105), a novel anthracycline, after i.v. bolus multiple administration in rats

We investigated the pharmacokinetics of 11-hydroxyaclacinomycin X (ID-6105), a novel anthracycline, after intravenous (i.v.) bolus administration at a multiple dose every 24 h for 5 days in rats. To analyze ID-6105 levels in biological samples, we used an HPLC-based method which was validated in a pharmacokinetic study by suitable criteria. The concentrations of ID-6105 after the multiple administration for 5 days were not significantly different from the results after the single administration. The t1/2alpha, t1/2beta, Vdss, and CLt after the multiple administration were not significantly different from the values after the single administration. Moreover, the concentrations of ID-6105 1 min at day 1-5 after i.v. bolus multiple administration did not show the significant difference. Of the various tissues, ID-6105 mainly distributed to the kidney, lung, spleen, adrenal gland, and liver after i.v. bolus multiple administration. ID-6105 concentrations in the kidney or lung 2 h after i.v. bolus administration were comparable to the plasma concentration shortly after i.v. bolus administration. However, the ID-6105 concentrations in various tissues 48 h after i.v. bolus administration decreased to low levels. ID-6105 was excreted largely in the bile after i.v. bolus multiple administration at the dose of 3 mg/kg. The amounts of ID-6105 found in the bile by 12 h or in the urine by 48 h after the administration were calculated to be 14.1% or 4.55% of the initial dose, respectively, indicating that ID-6105 is mostly excreted in the bile. In conclusion, ID-6105 was rapidly cleared from the blood and transferred to tissues, suggesting that ID-6105 might not be accumulated in the blood following i.v. bolus multiple dosages of 3 mg/kg every 24 h for 5 days. By 48 h after i.v. bolus administration, ID-6105 concentrations in various tissues had decreased to very low levels. The majority of ID-6105 appears to be excreted in the bile.