通瘀注射液盆腔给药法治疗外在型子宫内膜异位症的临床研究

目的　运用通瘀注射液在非直视下经输卵管盆腔给药对子宫内膜异位症 (EEMs)的治疗作用 ,探讨活血化瘀法对EEMs的作用机理及此给药法的优势。方法　将临床治疗的EEMs患者 60例随机分为治疗组 (通瘀注射液组 )和对照组 (丹那唑组 ) ,疗程各为 3个月。用药前后测定下列指标 :临床症状与体征、内分泌激素、血液流变学、癌抗原 12 5 (CA12 5)和子宫内膜抗体 (EMAb)的阳性率变化。结果　治疗组的临床症状与体征、血液粘滞度和红细胞压积、CA12 5和EMAb的阳性率均降低 ,卵泡刺激素 (FSH)、黄体生成素 (LH)、雌二醇 (E2 )和孕激素 (P)的含量均受到调节 ,与对照组相比 ,差异有显著性。而治疗组对内分泌的调节能力弱于对照组 ,但作用柔和、均衡。结论　通瘀注射液对EEMs的作用是通过清除月经时异位内膜的瘀血、水肿、改善微循环及组织供氧、调节免疫功能和内分泌紊乱而实现的 ,与丹那唑相比其副作用小、并以治本为主。盆腔给药法则可使药物直达病灶 ,见效快     

避免鼻内窥镜手术并发症的临床解剖

目的：为避免鼻内窥镜手术并发症提供解剖学基础。方法：在３０侧成人头部正中矢状剖面标本上,观察了泪囊的毗邻、在鼻腔外侧壁上的投影及筛窦的毗邻。结果：泪囊与中鼻道前房相邻,其在鼻腔外侧壁上投影的前界为“骨梭”,后界为钩突基部,上界为中鼻甲附着处前部的下缘,下界为下鼻甲附着处前部的上缘。筛顶壁为一前窄后宽的骨板,筛前、后动脉在筛窦内均靠筛顶下方并与筛板同水平走行。结论：鼻内窥镜手术者若熟悉手术区的解剖可减少或避免并发症。     

胆石症合伴腹腔肿瘤的诊治：附36例报告

目的探讨胆石症合伴腹腔肿瘤患者漏诊原因及诊断治疗经验。方法回顾性分析诊治的胆石症合伴腹腔肿瘤36例的临床资料,男24例,女12例,年龄48～82岁。门诊均以胆石症诊断入院。结果 36例术前明确合并腹腔肿瘤诊断的18例,术中明确诊断12例,术后5 d至3个月明确诊断6例,并再次手术,均获肿瘤病理学诊断。36例中包括胆囊癌5例(13.9%),胆管癌4例(11.1%),肝癌3例(8.3%),十二指肠乳头癌3例(8.3%),胰腺癌6例(16.7%),胃癌6例(16.7%),结肠癌7例(19.4%),直肠癌2例(5.5%)。2例放弃手术治疗,2例行介入治疗,32例手术治疗,其中18例行肿瘤根治性切除术+胆囊切除术和/或胆道探查取石术,4例行肿瘤姑息性切除及胆囊切除术和/或胆道探查取石,4例行剖腹探查术;另6例行腹腔镜下胆囊切除术和/或胆道探查取石术中误诊者,术后5 d至3个月再次手术行肿瘤根治性切除4例,姑息性切除1例,介入治疗1例。结论胆石症可能合并腹腔肿瘤,特别是合并消化道肿瘤,但其漏诊几率较大。胆石症术前应仔细病史采集,对症状体征不典型者和老年患者术前进行系统全面检查,术中详细探查腹腔脏器,及时发现可能存在的腹腔肿瘤,术后对"胆囊切除术后综合征"患者应严密随访,以避免漏诊及延误治疗。     

Shaving effects on percutaneous penetration: clinical implications

Context: Human/animal shaving biology.

Objective: To assess the effect of shaving on percutaneous penetration and skin function.

Methods: We screened 500+publications in Pub Med, Scopus, Cochrane Library and pertinent journals out of which only 17 were deemed relevant. Terms for searches included shaving and skin, percutaneous penetration and shaving, skin absorption and shaving, absorption of dyes and shaving, skin penetration, effects of shaving and absorption, shave and dyes, axillary shaving and stratum corneum, shaving and breast cancer, shaving and infections, etc.

Result: Shaving appears to have an exaggerated effect on percutaneous absorption; however, some studies do not support this evidence.

Conclusion: Shaving enhances percutaneous penetration of some chemicals; however this effect is species and chemical specific. Further investigations of chemicals of varying physio-chemical properties are mandated before a generalized theory can be promulgated.     

肺部癌性空洞与其他空洞的CT诊断及鉴别诊断

目的 探讨肺部癌性空洞和其他空洞的CT表现特点及其鉴别要点,提高各种疾病空洞的诊断率.方法 选取本院就诊的81例伴有空洞的肺疾病患者,采用回顾性研究分析空洞发生的部位、大小、内容物、壁厚度等指标进行统计分析.结果 该81例患者中,肺癌、肺结核、肺脓肿、干酪性肺结核、肺霉菌感染和肺囊肿的空洞位于病灶中心的比例分别为23.8%(10/42)、73.6%(14/19)、25%(2/8)、20%(1/5)、100%(5/5)和50%(1/2);肺癌和肺结核空洞位置偏心的比率分别为76.2%和26.4%,差异具有统计学意义(P<0.05);出现空洞部位上叶以干酪性肺炎为最高,为80%,肺癌和肺脓肿部位下叶的比率分别为69.0%和12.5%,两者比较差异具有统计学意义(P<0.05).空洞平均直径的测量结果:肺癌和干酪性肺炎两者数值差异有统计学意义(P<0.05),肺癌与其他类型两两比较差异均无统计学意义(P>0.05).壁CT强化幅度结果:肺癌与肺脓肿、肺癌与肺霉菌感染CT幅度比较差异具有统计学意义(P<0.05),肺癌与其他类型两两比较差异均无统计学意义(P>0.05).壁平均厚度结果:肺癌、肺结核和肺脓肿的空洞壁平均厚度均比较高.肺癌与肺结核、肺脓肿进行两两比较差异均无统计学意义(P>0.05).结论 肺部空洞性病变的发生部位、空洞壁的厚度及形态对鉴别伴肺癌空洞与其他肺疾病空洞具有诊断意义.     

Toxicity and efficacy of chemotherapy for non-small cell lung cancer with cavitary lesions

BackgroundConcurrent chemoradiation in stage III non-small cell lung cancer (NSCLC) patients with cavitary lesions is reported to cause serious lung complications and is a predictor of poor survival. However, the efficacy and toxicity associated with chemotherapy for advanced NSCLC patients with cavitary lesions is not clear. We investigated the toxicities, particularly hemoptysis and cavity infection, and efficacy associated with chemotherapy for NSCLC patients with cavitary lesions.MethodsWe retrospectively reviewed consecutive patients who received first-line chemotherapy, including platinum-based chemotherapy, single-agent chemotherapy, or epidermal growth factor receptor-tyrosine kinase inhibitors, at our institution between January 2008 and December 2010.ResultsWe found tumor cavitation prior to treatment in 23 of 415 NSCLC patients (5.5%). The response rate of all the patients was 30%, and the median survival time (MST) was 8.9 months. The MST of the 15 patients treated with platinum-based chemotherapy was 11 months. Grade 1 bronchopulmonary hemorrhage occurred in 2 patients. Grade 3 cavitary infection occurred in 2 patients, resulting in the discontinuation of chemotherapy.ConclusionsThis study indicates that the toxicity of chemotherapy for NSCLC patients with cavitary lesions is tolerable; however, the development of cavitary infection should be carefully considered. In addition, this study suggests that the efficacy of chemotherapy for NSCLC patients with cavitary lesions is similar to the response rates reported in the literature; however, the survival of these patients may be worse than that for general NSCLC patients.     

Er:YAG激光备洞对牙髓P物质表达的影响

目的探讨Er:YAG激光备洞对牙髓的生物学效应。方法雄性SD大鼠66只随机分为实验组与对照组,实验组大鼠左上第一磨牙用高速牙钻备洞,右上第一磨牙用Er:YAG激光备洞,对照组大鼠磨牙不作任何处理。于不同时段分批处死大鼠,取标本做HE染色进行牙髓组织病理学观察,免疫组化法观察P物质(substance P,SP)的表达情况。结果 Er:YAG激光备洞后牙髓组织病理学改变及P物质的表达改变恢复正常要快于高速牙钻备洞。结论 Er:YAG激光备洞对牙髓的刺激小。     

醋酸泼尼松片在结核性多浆膜腔积液患者中的临床疗效及安全性研究

目的：研究醋酸泼尼松片在结核性多浆膜腔积液患者中的临床治疗效果。方法选取2014年4月-2016年4月医院诊治的结核性多浆膜腔积液患者60例,根据患者治疗措施将患者分为对照组30例和观察组30例,对照组采用3HREZ/15HRE方案抗结核治疗,观察组在对照组基础上联合醋酸泼尼松片治疗。比较两组临床疗效。结果观察组治疗疗效率为93.3%,高于对照组的80.0%(P<0.05);观察组不良反应发生率为13.33%,显著低于对照组的30.00%(P<0.05)。结论与单一抗结核方案治疗相比,结核性多浆膜腔积液患者联合醋酸泼尼松片治疗效果理想值得推广应用。     

Mechanisms of killing by anti-CD20 monoclonal antibodies

CD20 is a cell-surface marker expressed on mature B cells and most malignant B cells, but not stem or plasma cells. It is an ideal target for monoclonal antibodies (mAb), such as rituximab and ofatumumab, as it is expressed at high levels on most B-cell malignancies, but does not become internalized or shed from the plasma membrane following mAb treatment. This allows mAb to persist on the cell surface for extended periods and deliver sustained immunological attack from complement and FcR-expressing innate effectors, particularly macrophages. CD20 can also generate transmembrane signals when engaged by certain mAb which, although unproven, might provide an important element of the therapeutic success of anti-CD20 mAb. These favourable characteristics have led to anti-CD20 mAb being developed and exploited for use in immunotherapy, where they have proven remarkably efficacious in both the treatment of malignant disease and autoimmune disorders by deleting malignant or normal B cells, respectively. In this review, we discuss how these mAb have driven research in the immunotherapy field over the last decade, detail their likely modes of action and their limitations in terms of effector exhaustion, and explore ways in which they might be enhanced and further exploited in the future.