中药消癌平、金龙胶囊联合奥宁治疗老年巨块型原发性肝细胞性肝癌的前瞻性研究

目的:探索中药消癌平、金龙胶囊联合奥宁治疗老年巨块型原发性肝细胞性肝癌的疗效和应用价值.方法:2位老年原发性肝细胞性肝癌患者,第一例采用消癌平60 ml+5%葡萄糖液250 ml,静脉滴注16天,奥宁15-18 μg/h,Civ(连续静脉泵入),16天;第二例在前一例基础上加用金龙胶囊4粒,3次/日,连续口服14天.每次治疗结束休息一周进行AFP、影像学评价和QOL评分.结果:第一例患者治疗2个周期AFP降至162.8 μg/L,肿块7.910.2 cm,增大约18%,QOL评分48分,疗效评价SD,该患者治疗两周期后,自行转其他医院行超声聚焦刀治疗后死亡.第二例患者治疗3周期后,AFP降至1107μg/L,B超示肿瘤缩小至4.514.33 cm,缩小约70%,QOL评分53分,疗效评价PR,目前患者无症状.结论:消癌平、奥宁联合奥宁治疗巨块型原发性肝细胞性肝癌是一种有效的方法.     

EBV与非霍奇金淋巴瘤的相关性研究

目的探讨EBV与非霍奇金淋巴瘤的相关性。方法采用免疫荧光法检测62例非霍奇金淋巴瘤患者外周血血清中EBV-VCA-IGA,进而探讨EBV感染与非霍奇金淋巴瘤的相关性。结果92例非霍奇金淋巴瘤患者EBV-VCA-IGA阳性率为36%,B细胞来源非霍奇金淋巴瘤患者EBV-VCA-IGA阳性率为34%,T细胞来源非霍奇金淋巴瘤患者EBV-VCA-IGA阳性率为38%。结论EBV与非霍奇金淋巴瘤关系密切,监测EBV感染状况,对非霍奇金淋巴瘤的早期诊断及预后判断具有重要意义。     

利妥昔单抗联合化疗治疗非霍奇金淋巴瘤的药物经济学评价

目的：系统评价利妥昔单抗联合化疗治疗非霍奇金淋巴瘤的药物经济学价值。方法：用计算机检索PubMed、ScienceDirect、Springer Link、Elsevier 等英文数据库以及CNKI、维普、万方等中文数据库1998—2013 年间公开发表的利妥昔单抗联合化疗治疗非霍奇金淋巴瘤的药物经济学评价文献,对文献质量、研究结果进行系统评价。结果：所有英文文献的 ICER 值均在各国的意愿支付范围内;国内外利妥昔单抗药物经济学评价在数据来源、研究方法等方面存在差异。结论：利妥昔单抗联合化疗治疗非霍奇金淋巴瘤在国外具有成本-效果;需开展高质量的研究来探索利妥昔单抗联合化疗治疗非霍奇金淋巴瘤在我国的经济性。     

氟达拉滨联合化疗方案对复发性非霍奇金淋巴瘤的疗效研究

目的：探讨氟达拉滨为主联合化疗方案对复发性非霍奇金淋巴瘤的临床疗效。方法：用氟达拉滨为主的方案（FMD）化疗复发性非霍奇金淋巴瘤17例,以EPOCH方案化疗14例患者,比较两组疗效。结果：FMD方案化疗有效率为70．6％,高于EPOCH方案的50．0％,但是差异无统计学意义（P〉0．05）。FMD化疗方案在对低度恶性组疗效最佳,优于高度恶性组和中度恶性组（P〈0．05）;对不同临床分期（I、II、III、Ⅳ期）患者和不同免疫细胞分型患者,其有效率无统计学差异（P〉0．05）。在各种不良反应中,FMD组白细胞减少率、转氨酶升高率低于EPOCH组（P〈0．05）。结论：以氟达拉滨为主联合化疗方案对复发性非霍奇金淋巴瘤的临床疗效好,毒副反应轻,预后良好。     

TK1与LDH联合检测对非霍奇金淋巴瘤鉴别诊断及疗效评估的作用

目的:探讨联合检测血清胸苷激酶1(TK1)与乳酸脱氢酶(LDH)水平在非霍奇金淋巴瘤(NHL)患者鉴别诊断及疗效监测中的临床意义。方法:收集2016年1月至2018年6月我院诊治的111例非霍奇金淋巴瘤的初诊患者血清标本,并选择50例正常人血清标本作为对照,采用免疫印迹增强发光法检测TK1浓度,比色法检测LDH浓度。所有患者随访至少1年,分析和比较惰性NHL与侵袭性NHL及各自四类分期之间血清TK1和LDH水平的差异,化疗后完全缓解、部分缓解与未缓解组LDH水平以及NHL患者中血清TK1和LDH的阳性率。结果:高度侵袭性NHL患者和侵袭性NHL患者血清TKI和LDH水平与惰性NHL患者相比显著增高(P0.05),但惰性NHL患者血清TK1和LDH水平与正常组之间差异无统计学意义(P0.05);Ⅲ、Ⅳ期侵袭性NHL患者血清TK1和LDH水平与Ⅰ、Ⅱ期患者相比显著增高(P0.05)。与化疗前相比,四次化疗后,完全缓解组NHL患者血清LDH水平下降21.05%,部分缓解组为16.66%,病情稳定组血清LDH水平升高至11.54%,三组NHL患者血清LDH水平比较差异具有统计学意义(P0.008),两组之间的差异均有统计学意义(P0.05)。结论:联合检测血清TK1和LDH水平对于NHL患者的鉴别诊断、疗效评估均具有重要参考价值。     

ICE方案治疗复发难治性非霍奇金弥漫大B细胞淋巴瘤临床观察

目的:观察ICE方案(异环磷酰胺IFO,卡铂CBP,依托泊苷VP-16)治疗复发/难治性非霍奇金弥漫大B细胞淋巴瘤(Non-hodgkin's lymphoma,NHL)的疗效及安全性。方法:20例经系统化疗后复发或进展的非霍奇金弥漫大B细胞淋巴瘤(DLBCL)患者,采用ICE方案化疗至少2周期,IFO 5 g/m2,第2天,持续24小时静脉输注,CBP按AUC=5,max 800 mg,第2天,静脉输注,VP-16.100 mg/m2,第1-3天,静脉输注。结果:完全缓解(complete response,CR)5例,部分缓解(partial response,PR)8例,疾病稳定(stable disease,SD)4例,疾病进展(progress disease,PD)3例,总有效率(overall response rate,ORR,CR+PR)65%,化疗副作用主要为骨髓抑制(Ⅰ、Ⅱ度6例,Ⅲ、Ⅳ度14例),其他不良反应包括胃肠道反应、粘膜损伤、肝肾毒性及脱发等均可耐受。结论:ICE方案可用于非霍奇金弥漫大B细胞淋巴瘤的二线化疗方案。     

利妥昔单抗注射液联合化疗治疗B细胞非霍奇金淋巴瘤的疗效观察

目的:观察利妥昔单抗注射液联合化疗治疗B细胞非霍奇金淋巴瘤(B-NHL)的疗效。方法:将2013年1月至2014年12月我院收治的71例B-NHL患者分为对照组(n=35例)和观察组(n=36例)。对照组给予常规化疗方案进行治疗,观察组在此基础上加用利妥昔单抗进行治疗,3个周期后评价其疗效及安全性。结果:观察组总有效率为91.67%,明显高于对照组的68.57%,对比差异有统计学意义(x2=5.979,P0.05);观察组不良反应总发生率为41.67%,略低于对照组的45.71%,但无统计学差异(x2=0.118,P0.05)。结论:利妥昔单抗注射液联合化疗治疗B-NHL中期疗效显著,且无严重不良反应,值得临床推广。     

nm23-H1与白血病和淋巴瘤的预后关系

肿瘤转移相关蛋白nm23-H1/NDPK-A在某些癌症中与肿瘤转移潜能呈负相关,另一方面它又是多种血液肿瘤的分化抑制因子。大量临床病例的研究表明nm23-H1在急性髓性白血病和非霍奇金淋巴瘤中具有预后作用。本文主要就nm23-H1/NDPK-A蛋白在急性髓性白血病和非霍奇金淋巴瘤与邓后的相关性以及潜在的预后价值进行了综述。     

乙肝病毒感染与B 细胞型非霍奇金淋巴瘤的相关性研究

目的：探讨乙肝病毒（HepatitisB virus, HBV）感染与B细胞型非霍奇金淋巴瘤（B-cell Non-Hodgkin''s Lymphoma,B-cell NHL） 的相关性。方法：回顾性分析2008 年1 月至2014 年1 月我院232 例NHL患者作为研究组,另选取经病理学、影像学等诊断为其 他类型肿瘤的患者230 例作为对照组。比较两组研究对象HAV、HBV及HCV 的感染情况。结果：研究组患者HBsAg阳性率高于 对照组,差异具有统计学意义（P<0.05）;但两组患者Anti-HAV和Anti-HCV 阳性率无明显差异（P>0.05）。B-cell NHL患者HBsAg 阳性率高于对照组和T-cell NHL患者,差异具有统计学意义（P<0.05）。T-cell NHL患者HBsAg阳性率与对照组无显著差异（P>0. 05）。B-cell NHL 年轻患者HBsAg 阳性率高于T-cell NHL患者,差异具有统计学意义（P<0.05）。B-cell NHL 患者Anti-HBs、 HBeAg、Anti-HBe及Anti-HBc阳性率与对照组存在明显差异（P<0.05）;而T-cellNHL患者与对照组无显著差异（P>0.05）。结论：B-cell NHL感染HBV 的几率较高,HBV 感染与B-cell NHL早期发病有明显的关联性。     

甲磺酸多沙唑嗪控释片联合中药坐浴治疗老年非细菌性前列腺炎的临床疗效

目的:探讨甲磺酸多沙唑嗪控释片联合中药坐浴治疗老年非细菌性前列腺炎的临床疗效。方法:选取我院泌尿男科收治的老年非细菌性前列腺炎患者60例,随机分配为实验组和对照组,每组各30例,对照组患者使用甲磺酸多沙唑嗪控释片进行治疗,实验组患者在对照组的治疗基础上加用中药坐浴进行治疗,两组患者均治疗1个月。治疗结束后对患者前列腺液中的WBC水平进行检测,并应用美国国家卫生研究院慢性前列腺炎症状指数(NIH-CPSI)表对患者的前列腺功能进行评分,同时比较治疗结束后两组患者临床总有效率。结果:与治疗前相比,两组患者WBC计数及NIH-CPSI评分均有所降低(P0.05);与对照组相比,实验组患者治疗后WBC计数及NIH-CPSI评分较低(P0.05);临床总有效率较高(P0.05)。结论:甲磺酸多沙唑嗪控释片联合中药坐浴能够提高老年非细菌性前列腺炎患者的前列腺功能,降低炎症反应,临床疗效更好。     

骨髓增生异常综合征合并非霍奇金淋巴瘤一例病例报道并文献复习

目的:探讨骨髓增生异常综合征合并非霍奇金淋巴瘤的发病机制、诊断及治疗,并判断其预后情况。方法:回顾我院收治的一例骨髓增生异常综合征(MDS)患者同时诊断间变大细胞淋巴瘤(ALCL)患者的临床资料,总结其诊断及治疗经过,对其预后进行评价。结果:该患者诊断间变大细胞淋巴瘤后,经化疗对症治疗病情无显著改善,且患者ALK阳性,考虑预后较差,建议造血干细胞移植。结论:骨髓增生异常综合征合并非霍奇金淋巴瘤的病例在国内外十分罕见,治疗方法目前尚需进一步研究。     

Clinical Application of RT-Nested PCR Integrated with RFLP in Hantavirus Detection and Genotyping: A Prospective Study in Shandong Province, PR China

The aim of the present study was to evaluate the clinical usefulness of applying RT-nested PCR along with RFLP as a method for diagnosis and genotypic differentiation of Hantavirus in the acute-stage sera of HFRS patients as compared to the ELISA technique. A prospective study of patients with suspected HFRS patients was carried out. Sera were collected for serological evaluation by ELISA and RT-nested PCR testing. Primers were selected from the published sequence of the S segment of HTNV strain 76-118 and SEOV strain SR-11, which made it possible to obtain an amplicon of 403 bp by RT-nested PCR. The genotypic differentiations of the RT-nested PCR amplicons were carried out by RFLP. Sequence analyses of the amplicons were used to confirm the accuracy of the results obtained by RFLP. Of the 48 acute-stage sera from suspected HFRS patients, 35 were ELISA-positive while 41 were positive by RT-nested PCR. With Hind III and Hinf I, RFLP profiles of the RT-nested PCR amplicons of the 41 positive sera exhibited two patterns. 33 had RFLP profiles similar to the reference strain R22, and thus belonged to the SEOV type. The other 8 samples which were collected during October–December had RFLP profiles similar to the reference strain 76-118, and thus belonged to the HTNV type. Sequence phylogenetic analysis of RT-nested PCR amplicons revealed sdp1, sdp2 YXL-2008, and sdp3 as close relatives of HTNV strain 76-118, while sdp22 and sdp37 as close relatives of SEOV strain Z37 and strain R22 located in two separate clusters in the phylogenetic tree. These results were identical to those acquired by RFLP. RT-nested PCR integrated with RFLP was a rapid, simple, accurate method for detecting and differentiating the genotypes of Hantavirus in the acute-stage sera of suspected HFRS patients. In Shandong province, the main genotypes of Hantavirus belonged to the SEOV types, while the HTNV types were observed during the autumn–winter season.     

A Prospective,Observational Study on the Application of Ultra-Wide-Field Angiography in the Evaluation and Management of Patients with Anterior Uveitis

Purpose

Evaluation of peripheral retinal vascular changes in anterior uveitis using ultra-wide-field fluorescein angiography.

Design

A prospective, observational study of a case series of patients diagnosed with anterior uveitis.

Methods

Setting: Clinical observation at an academic medical center. Patient or Study Population: A total of 65 eyes of 33 patients corresponded with the research criteria of anterior uveitis in the opinion of specialists of Peking University First Hospital. Observation Procedures: Patients were diagnosed primarily through clinical examinations and conventional fluorescein angiography. Subsequently, ultra-wide-field fluorescein angiograms were obtained for each patient. Main Outcome Measures: The main outcome was the detection of peripheral retinal changes by ultra-wide-field fluorescein angiography, and how these changes influenced the evaluation and management of the disease.

Results

Peripheral vessel leakage was detected in 27 eyes (42%) with anterior uveitis, of which 15 eyes displayed active inflammation and 12 eyes displayed inactive inflammation. Peripheral vessel leakage was found in seven of eight eyes with cystoid macular edema. Cystoid macular edema was detected in 7 of 27 eyes (26%) with peripheral vessel leakage, whereas 1 of 38 eyes (3%) did not display peripheral vessel leakage (p<0.01). 44.4% of the patients with peripheral vessel leakage had a specific etiology. The relevant treatment strategies were modified based on the results of the ultra-wide-field fluorescein angiography. 12 patients with peripheral vessel leakage and a quiescent anterior segment were added to those receiving topical glucocorticoids, while 3 patients with serious peripheral vessel leakage and an active anterior segment received a sub-Tenon injection of triamcinolone acetonide.

Conclusions

Ultra-wide-field fluorescein angiography was very effective in detecting peripheral retinal vascular pathology in anterior uveitis. The changes found in the periphery were important in the evaluation and management of anterior uveitis.     

A Multicenter,Randomized Clinical Trial Comparing the Three-Weekly Docetaxel Regimen plus Prednisone versus Mitoxantone plus Prednisone for Chinese Patients with Metastatic Castration Refractory Prostate Cancer

Purpose

To explore the feasibility and efficacy of docetaxel plus prednisone for Chinese population with metastatic castration refractory prostate cancer (mCRPC).

Patients and methods

A total of 228 patients recruited from 15 centers were randomized to receive 10 cycles of D3P arm (docetaxel: 75 mg/m², intravenous infusion, every three weeks; Prednisone 10mg orally given daily) or M3P arm (mitoxantrone: 12 mg/m², intravenous infusion, every three weeks; Prednisone 10mg orally given daily). Primary end point was overall survival, and secondary end points were events progression-free survival (PFS), response rate, response duration. Quality of life (QoL) was also assessed in both treatment groups.

Results

The median overall survival was 21.88 months in D3P arm and 13.67 months in M3P arm (P = 0.0011, hazard ratio = 0.63, 95% confidence interval, 0.46–0.86). Subgroup analysis was consistent with the results of overall analysis. Events progression-free survival (pain, PSA, tumor and disease) were significantly improved in D3P arm compared with M3P arm. PSA response rate was 35.11% for patients treated by D3P arm and 19.39% for M3P arm (P = 0.0155). Pain response rate was higher in D3P arm (61.11%, P = 0.0011) than in M3P (23.08%) arm. No statistical differences were found between D3P arm and M3P arm for QoL, tumor response rate and response duration of PSA and pain. The tolerability and overall safety of D3P arm were generally comparable to that of M3P arm.

Conclusions

Compared with M3P arm, D3P arm significantly prolonged overall survival for the Chinese patients with mCRPC and improved the response rate for PSA and pain.

Trial Registration

clinicaltrials.gov NCT00436839     

超声造影在肝癌分级应用中的前瞻性研究

目的：利用超声造影研究高分化和低分化肝癌患者的肿瘤血流灌注情况,探讨超声造影在肝癌分级的诊断价值。方法：选择我院原发性肝癌（HCC）患者65例并根据活检肝细胞癌病变和肿瘤分级不同分为A组37例（高分化组）和B组28例（低分化组）,对两组患者行超声造影检查,分析超声造影的血流灌注状态。结果：A组与B组病灶的到达时间（AT）、峰值时间（TTP）和峰值强度（PI）均存在显著的差异性（tAT=7．266,PAT=0．000;tTTP=5．966,PTTP=0．000;tPI=8．219,PPI=0．000）。A组与B组间的病灶增强时间（1）、增强斜率（2）、清除时间（3）、清除斜率（4）具有差异,并且差异具有统计学意义（t1=7．266,PI=0．000;t2=317,P2=0．000;t3=8．880,P3=0．000;t4=6．178,P4=0．000）。结论：超声造影可作为一种新型的肝癌分级方法,对于早期诊断肝癌和获得肿瘤分级具有很大的临床价值。     

Depressive Symptoms,HIV Medication Adherence,and HIV Clinical Outcomes in Tanzania: A Prospective,Observational Study

Depressive symptoms have been shown to independently affect both antiretroviral therapy (ART) adherence and HIV clinical outcomes in high-income countries. We examined the prospective relationship between depressive symptoms and adherence, virologic failure, and suppressed immune function in people living with HIV/AIDS in Tanzania. Data from 403 study participants who were on stable ART and engaged in HIV clinical care were analyzed. We assessed crude and adjusted associations of depressive symptoms and ART adherence, both at baseline and at 12 months, using logistic regression. We used logistic generalized estimating equations to assess the association and 95% confidence intervals (CI) between depressive symptoms and both virologic failure and suppressed immune function. Ten percent of participants reported moderate or severe depressive symptoms at baseline and 31% of participants experienced virologic failure (>150 copies/ml) over two years. Depressive symptoms were associated with greater odds of reported medication nonadherence at both baseline (Odds Ratio [OR] per 1-unit increase  = 1.18, 95% CI [1.12, 1.24]) and 12 months (OR  = 1.08, 95% CI [1.03, 1.14]). By contrast, increases in depressive symptom score were inversely related to both virologic failure (OR = 0.93, 95% CI [0.87, 1.00]) and immune system suppression (OR = 0.88, 95% CI [0.79, 0.99]), though the association between depressive symptoms and clinical outcomes was less precise than for the association with nonadherence. Findings indicate a positive association between depressive symptoms and nonadherence, and also an inverse relationship between depressive symptoms and clinical outcomes, possibly due to informative loss to follow-up.     

缬沙坦胶囊联合醋酸泼尼松片治疗原发性肾病综合征患儿的疗效及对肾功能及炎性因子的影响

目的:探讨原发性肾病综合征(NS)患儿在醋酸泼尼松片治疗的基础上联合缬沙坦胶囊治疗的临床疗效及对肾功能和炎性因子的影响.方法:选取2017年2月～2019年4月期间我院收治的NS患儿107例,根据随机数字表法分为对照组(n=53,醋酸泼尼松片治疗)和研究组(n=54,对照组的基础上联合缬沙坦胶囊治疗),比较两组患儿的临...     

比阿培南治疗淋巴瘤患者合并中重度感染的临床疗效观察

目的:评价化疗期间,出现中重度感染后应用比阿培南抗感染的疗效.方法:回顾性分析我科104例应用比阿培南的淋巴瘤合并中重度感染患者,予以比阿培南0.3-0.6g/次,静脉滴注,1/8小时或1/12小时,治疗5-16天,观察其应用比阿培南后的临床疗效及不良反应.结果:治疗中度发热的患者31例,其中痊愈+显效28例,有效率为90.3％(28/31)；治疗高热以上的患者73例,其中痊愈+显效56例,有效率为76.7％(56/73).总有效率为80.8％.其中感染发生在Ⅳ度骨髓抑制期的有52例,痊愈+显效44例,有效率为84.6％.且104例患者中,仅l例发生皮肤过敏反应,其余未观察到明确的不良反应.结论:比阿培南在治疗淋巴瘤患者合并中重度感染的应用中,为安全有效的碳青霉烯类药物.