甲真菌病治疗现状

甲真菌病是较常见的甲疾病,致病菌有皮肤癣菌、酵母菌和非皮肤癣菌性丝状真菌.常用治疗方法包括局部外用药治疗、系统口服药治疗,近来新型口服抗真菌药的研发以及局部治疗新技术的应用都将成为甲真菌病治疗的补充以及新的发展方向.该文就近年来甲真菌病的治疗现状进行综述.     

胃食管反流病的治疗进展

胃食管反流病(gastroesophaeal reflux disease,GERD)是医疗实践中的最常见的疾病之一,其发病率在世界范围内呈逐年上升趋势,且随年龄增长而增加,40-60岁为高发年龄[1]。GERD是一种由胃、十二指肠内容物反流入食管引起不适症状和(或)并发症的疾病,GERD在临床上大致可分为:糜烂性食管炎(EE)(反流性食管炎(RE))和非糜烂性食管炎(NERD)。其中NERD最多见,约占60%。GERD远期危害较小,但其病情漫长且极易复发,严重影响了生活质量。主要表现为食管症状(包括典型的烧心和反流)和食管外症状(包括咽部异物感、咳嗽、声嘶、哮喘、咽喉炎等表现),还有增加发展为Barrett食管及食管癌的危险[2,3]。GERD的治疗目的是愈合食管炎,快速缓解症状、减少复发、提高生活质量,治疗方法主要包括以下4个方面:一般治疗,药物治疗,内镜下治疗和外科治疗。近年来已成为国内外研究的热点,本文就近年来对GERD的治疗进展做一综述。     

Estimating the distribution of heterogeneous treatment effects from treatment responses and from a predictive biomarker in a parallel-group RCT: A structural model approach

When the objective is to administer the best of two treatments to an individual, it is necessary to know his or her individual treatment effects (ITEs) and the correlation between the potential responses (PRs) and under treatments 1 and 0. Data that are generated in a parallel-group design RCT does not allow the ITE to be determined because only two samples from the marginal distributions of these PRs are observed and not the corresponding joint distribution. This is due to the “fundamental problem of causal inference.” Here, we present a counterfactual approach for estimating the joint distribution of two normally distributed responses to two treatments. This joint distribution of the PRs and can be estimated by assuming a bivariate normal distribution for the PRs and by using a normally distributed baseline biomarker functionally related to the sum . Such a functional relationship is plausible since a biomarker and the sum encode for the same information in an RCT, namely the variation between subjects. The estimation of the joint trivariate distribution is subjected to some constraints. These constraints can be framed in the context of linear regressions with regard to the proportions of variances in the responses explained and with regard to the residual variation. This presents new insights on the presence of treatment–biomarker interactions. We applied our approach to example data on exercise and heart rate and extended the approach to survival data.     

48 例卵巢子宫内膜异位囊肿患者中药辅以超声介入治疗观察

目的:探讨中药辅以超声介入法对卵巢子宫内膜异位囊肿的治疗效果.方法:选取2007年至2008年来我院就诊的卵巢子宫内膜异位囊肿患者48例,采用中药辅以超声介入治疗方法进行治疗,作为实验组;选取同期在我院接受手术治疗的45例卵巢子宫内膜异位囊肿患者45例作为对照组,比较两组患者治疗后的情况.结果:两组患者治疗后在妊娠率及排卵率方面比较无显著差异P＞0.05;在复发率上,实验组复发率为6.3％,对照组高达33.3％,实验组2例患者进行再手术,而对照组14例患者进行再手术,两组间对比差异均显著P＜0.01.结论:对卵巢子宫内膜异位囊肿患者采用中药辅以超声介入治疗方法进行治疗,复发率较低,有利于患者的术后恢复.     

龙岩市急诊蛇伤流行病学特征与综合救治

目的探讨龙岩市急诊蛇伤流行病学特征和综合救治措施。方法回顾性分析我院2006-2011年资料完整的458例蛇伤住院患者的临床资料。结果458例急诊蛇伤患者中,死亡6例,病死率1．3％,致伤蛇种以竹叶青蛇、烙铁头、眼镜蛇、银环蛇、眼镜王蛇为主,近年来还发现一些罕见蛇类如白头蝰蛇、红脖颈槽蛇咬伤病例;掌握了我市蛇伤的发病季节、致伤人群、致伤部位及转归。结论初步掌握了龙岩市急诊蛇伤流行病学特征,并提出了有效的综合救治措施,为今后开展蛇伤的防治、教学、科研提供了科学依据。     

A Review of Thermotherapy to Free Plant Materials from Pathogens,Especially Seeds from Bacteria

Treating planting materials with heat is a one-century-old method of disease control that has proved to be efficient against various pathogenic microorganisms. Thermotherapy, simple in principle, consists in heat treatment of plant parts at temperature/time regimes that kill the conserved pathogen and that are only slightly injurious to the host. Heat is applied mainly by water, air, or vapor.

A large variety of plant parts can be heat treated: Whole tree, scions, vitroplants, seedlings, stalks, cuttings, sprouts, cut flowers, seeds, bulbs, tubers, corms, or fruit and vegetables in storage. The target pathogenic microorganisms are mainly fungi, viruses, and bacteria. Many studies show the success of reducing diseases by heat. Thermotherapy also is the main means, associated with meristem and tip culture, of producing virus-free explants from infected mother-plants.

Most bacterial diseases of annual plants are seed-borne. Seed-transmission provides numerous foci of primary infection in the field and only a relatively small amount of infested seeds is sufficient to promote serious disease outbreaks. To disinfect seeds, authors mainly use hot water and hot air treatments. Satisfactory control has been obtained for several bacterial diseases (on tomato, tobacco, rice, barley, cucumber, Crucifers, pumpkin, guar, and cotton), mostly caused by the genera Xanthomonas and Pseudomonas. Thermotherapy is more difficult to use with large seeds of legumes, such as pea, bean, or soybean, because a significant decrease of germination is often obtained before the bacteria have been totally killed. The success of thermotherapy may be improved by combination with chemicals at the seed stage, by sprays during plant growth, or by replacing water with nonaqueous fluids.

When no efficient chemicals are known to control a disease, treating seeds by heat may be of great interest. However, the method requires studies to determine the most appropriate kind of heat for a particular plant part, and the optimal combination of time and temperature of exposure to use for the best efficiency with the least damage to the host.     

Treatment of disseminated histoplasmosis in hamsters

A comparative study between itraconazole, ketoconazole and amphotericin B in the treatment of experimental histoplasmosis in hamsters was carried out.Seventy five animals were inoculated intracardiacally with the yeast-phase of Histoplasma capsulatum. They were divided in 5 groups: 1) treated with itraconazole by gavage (g) at a daily dose of 16 mg/kg; 2) treated with ketoconazole by (g) at a daily dose of 80 mg/kg; 3) treated with amphotericin B intraperitoneally (i.p.) at 6 mg/kg every other day; 4) control animals receiving distilled water i.p. and 5) control animals receiving P.E.G. 200 by (g). All the treatments were started one week after the challenge inoculation and they were given for 21 days. The results were evaluated by autopsy of all the animals one week after the end of the treatments. The following determinations were taken into account: microscopic examinations of spleen, liver and lungs and cultures of the spleen with determination of colony forming units/g.All the antifungal drugs used in this study were able to cause negative microscopic examinations of the liver, spleen and lungs; but only amphotericin B produced culture negative results. Itraconazole and ketoconazole presented 66% and 86% of positive cultures respectively, nevertheless the C.F.U. were lower than those obtained in control groups.In these experimental conditions amphotericin B seems to be more active than the azolic compounds and itraconazole is slightly superior to ketoconazole at a lower dose.     

Sustainable intensive livestock production demands manure and exhaust air treatment technologies

Intensive livestock production is connected with a number of environmental effects, including discharges to soils and surface waters and emissions to the atmosphere. In areas with a high livestock density the low availability of nearby arable land, together with the preferred use of chemical fertilizer by arable farmers, results in high off-farm disposal costs for manure. Furthermore, ammonia abatement technologies, such as treatment of exhaust air, are important as ammonia emissions may account up to a quarter of the total nitrogen flux.     

中医药治疗疲劳的研究进展

摘要：疲劳是当代社会人类亚健康状态的最常见表现形式之一。它不易引起患者自身的关注，是严重影响人类生命质量的"隐形杀手"。防治疲劳与人类的生命质量和工作效率密切相关，已引起医学界的广泛关注。中国早在东汉时期就有关于疲劳的中医学疗法记载，而中医疗法在不断的实践中得到了丰富与发展。本文以中医药治疗疲劳为切入点，对疲劳的中医发病特点、辨证分型进行考察，并搜集、梳理中医药治疗疲劳的内外治法，以期为中医药治疗疲劳方面的研究提供思路。     

A preliminary assessment of intra-oral lubricating systems for dry mouth patients

Objective: To provide extended intra-oral delivery of a saliva substitute. Intervention: Three different types of prostheses containing saliva substitute were designed and assessed: a two-part device resembling a mandibular complete denture sealed by cobalt-samerium magnets, a one-part clear resin device for the edentate patients and a flexible mouth guard type of appliance containing a lubricant releasing bubble for the dentate patients. Setting: A teaching hospital Oral Medicine and Rheumatology Clinic. Subjects: 8 edentate and 3 dentate Sjogren Syndrome sufferers. Outcome measures: Subjective dryness after a week of wearing the lubricating appliance. Results: The majority of the subjects wore the appliances for 6–12 hours during each 24 hours. The initial dryness severity diminished after wearing the lubricating prosthesis. The patients preferred to wear the appliance at night. Conclusion: All criteria were fulfilled on designing a saliva substitute lubricating appliance and some of the subjects have worn this prosthesis successfully for up to 3 years. Particular benefit was obtained by night-time wear.     

菊科几种入侵和非入侵植物种子需光发芽特性差异

对入侵菊科植物(假苍耳、薇甘菊、紫茎泽兰、飞机草)以及非入侵菊科植物(扫帚梅、天人菊、金鸡菊、麦秆菊、翠菊、黑心菊)对比研究发现,入侵组种子往往是需光发芽,即有光条件下平均高出无光条件发芽率40%(P0.01),而非入侵组的需光发芽特性不明显,即有光和无光条件下种子发芽率差异不显著(P0.05)。以入侵植物假苍耳为例对其种子需光发芽的特性研究发现:红光有利于提高种子的萌发率(萌发率为62%),而蓝光起到相反的作用(萌发率37%);当以全光的25%照射种子时,最能够促进种子的萌发(萌发率59%),更高的光强抑制种子萌发(100%光强时,发芽率为21%)。适宜浓度水杨酸SA处理(0.01mmol/L)可以起到与光照类似的效果而促进种子萌发(提高30%发芽率),而PEG和低温处理对其不存在显著影响,说明这种需光发芽的机理可能与SA处理影响种子萌发存在一定的联系。研究证实了入侵和非入侵菊科植物之间确实存在需光发芽的差异,其生理生化差异及是否有利于入侵植物的快速入侵需深入研究。     

Cognitive behavioral therapy and fluoxetine for binge eating disorder: two-year follow-up

Objective: This study assessed the long‐term effects of group behavioral treatment plus individual cognitive behavioral therapy (CBT) and/or fluoxetine in binge eating disorder (BED) patients. Research Methods and Procedures: A total of 116 individuals were randomized to an initial five‐month trial and were followed up over two years. Assessments, including binge frequency, weight, and self‐report measures, were administered at pre‐treatment, post‐treatment, and ～6, 12, 18, and 24 months after initial treatment. Results: Across treatment groups, there was overall improvement over 29 months in binge frequency and in binge abstinence. The odds of binge abstinence 2 years post‐treatment were 1.373 times the odds of binge abstinence immediately post‐treatment. There was no significant change in weight over the two‐year period. Subjects who received individual CBT evidenced lower binge frequency over the two‐year follow‐up period than patients who had not received individual CBT. Similarly, CBT was associated with increased rates of binge abstinence. There were no main effects of treatment assignment on weight over the two‐year follow‐up period. There was a significant advantage for fluoxetine assignment over the two‐year follow‐up period on depressive symptoms. Discussion: The major significance of the study rests in its examination of the long‐term effects of standardized interventions for BED. Our findings provide support for the ideas that short‐term treatment may confer long‐term benefit and that not all treatments are equivalent in the benefits they confer.     

痔治疗的临床进展研究

痔是肛肠外科最常见的疾病之一,其治疗方式多种多样,尚无统一治疗标准。虽然,痔在临床上以保守治疗为主,但是对于II度以上有症状的痔,手术仍是目前最主要的治疗方式。关于有症状痔最佳治疗方式的争论仍在继续,无论是非手术治疗、传统的痔切除术还是痔的微创手术,都处于不断的改进和探索之中。临床医生总希望能够找到一项理想的具有复发率低、安全可靠、可早期恢复正常活动、术后疼痛轻微甚至无痛的手术方式。随着手术方式的改进和医疗技术的进步,痔的治疗效果也取得了很大的进步。本文就痔的非手术治疗、有创手术治疗以及微创手术治疗作一综述,为痔的临床治疗提供一定的理论依据。     

32例脑动静脉畸形未手术治疗患者的随访与观察

目的:探讨非手术治疗脑动静脉畸形患者的临床预后。方法:选择129例脑动脉畸形患者并根据治疗方法将其分为非手术治疗组、手术治疗组、血管内栓塞治疗组、血管内栓塞治疗+手术治疗组,对各组的患者进行随访,将随访结果分为无症状、好转、脑出血以及死亡,分析和比较不同治疗方法治疗患者的随访结果。结果:手术组愈后无症状13例,好转29例,死亡1例;血管内栓塞组愈后无症状22例,好转21例,死亡1例;血管内栓塞联合手术治疗组愈后无症状5例,好转4例,死亡1例;非手术治疗组愈后无症状11例,好转20例,新发脑出血1例,无死亡。各治疗组之间的愈后比较差异无统计学意义(P0.05)。结论:本研究中32例未手术治疗患者在随访期内,愈后与其他治疗组结果未见明显差异。脑动静脉畸形的发病机制及疾病自然转归,值得深入研究探讨。     

城市污水土地处理专家系统研究

在进行污水土地处理适宜性调查和研究基础上,应用ＴｕｒｂｏＰｒｏｌｏｇ和Ｃ程序语言建立了污水土地处理专家系统（ＬＴＥＳ）．通过测试表明,该系统能对土地处理系统的进水水质、场地适宜性、出水目标等指标进行快速准确的判断和预测,解决了污水土地处理的选址、处理工艺类型选择等问题,是科学设置污水生态工程的重要工具．     

基于诊疗规范的慢性髓细胞白血病治疗单元费用研究

依据《血液病诊疗规范》中慢性髓细胞白血病(CML)诊疗规范,结合专家咨询,将CML慢性期临床治疗中多种情况分成不同治疗单元组,按组计算费用;再依据实际病历数据,采用回顾性分析法进行实际费用分组测算。比较两种分组费用确定合理标准,为内科疾病按病种付费测算方式提供思路,为医保部门合理制定基金预算提供理论依据。     

工程纳米材料对污水生物处理影响的研究进展

工程纳米材料因其独特的物理化学性质被广泛应用于生产和生活中,但其潜在的风险正逐渐引起越来越多研究者的关注。目前国内外的研究主要探讨了工程纳米材料对模式微生物的毒性效应,但是对污水处理微生物的潜在影响尚缺乏系统和完整的报道。因此,本文综述了常见纳米材料对污水生物处理的影响,如碳、氮、磷的去除、甲烷化以及功能微生物种群结构演变等;同时还探讨了两种削减纳米银颗粒毒性的途径。综述内容为深入研究纳米材料对污水生物处理的潜在影响奠定了重要的理论基础。     

Cost-effective G-CSF therapy strategies for cyclical neutropenia: mathematical modelling based hypotheses

Using computer simulations of a mathematical model for the regulation of stem cell and neutrophil production in dogs, we have studied the efficacy of four different treatment protocols for cyclical neutropenia involving granulocyte colony stimulating factor (G-CSF). The first treatment scheme is based on the bifurcation analysis of the mathematical model and proposes a daily, phase-dependent, protocol. The second involves alternate day administration of G-CSF. The third triggers G-CSF administration whenever neutrophil levels fall below a predetermined level, and the fourth one follows a random administration protocol. The computer simulations predict that clinically desirable results can be achieved with the three last methods, using far less G-CSF than would be needed with the standard daily treatment. If the results of this modelling are borne out clinically, they will entail a considerable financial savings for patients.