Brain metastasis in children with stage 4 neuroblastoma after multidisciplinary treatment

Introduction: Brain metastasis is common in relapsed neuroblastoma patients, but the characteristics of brain metastasis remain largely unknown. This study aimed to investigate the status of brain metastasis with neuroblastoma in South China.Methods: In this retrospective case?based study, 106 patients with stage 4 neuroblastoma from the Department of Pediatric Oncology in Sun Yat?sen University Cancer Center between January 2004 and May 2013 were included. The incidence, risk factors, and survival status of these patients were reviewed and analyzed.Results: Of the 106 patients, 11(10.4%) developed brain metastasis, accounting for 20.0% of 55 patients with relapse or progression. The age at initial diagnosis of the 11 patients ranged from 2 to 10 years(median 4 years), which was younger than that of the patients without brain metastasis(median 5 years, range 1–10 years, P = 0.073). The male to female ratio of the 11 patients was 8:3, which was not signiicantly diferent from that of the patients with?out brain metastasis(P = 0.86). Patients with brain metastasis had higher lactate dehydrogenase levels than those without brain metastasis, but the diferences were not signiicant(P initial diagnosis to the develo= 0.076). Eight patients died, and 3 patients survived. The median interval from thepment of brain metastasis was 18 months(range 6–32 months). The median survival was 4 months(range 1 day to 29 months) after the diagnosis of brain metastasis. The median interval from the manifestation of brain metastasis to death was 3 months(range 1 day to 11 months).Conclusions: High?risk factors for brain metastasis in cases of neuroblastoma include bone marrow involvement and a younger age at initial diagnosis. Nevertheless, multiple treatment modalities can improve disease?free survival.

TCM Stage Differentiation Treatment of Diabetic Gangrene——An Observation on Microcirculatory Changes

Microcirculatory changes and therapeutic effects in 39 non-insulin dependent diabetes mellitus (NIDDM) cases were evaluated. Under the same basic treatment in both groups, the treatment group (21 cases) was treated with TCM drugs according to its stages and compared with the control group (18 cases, treated with 654-2). The results showed that the microcirculatory cumulative scores were significantly decreased in both groups (P<0.05), but the decrease in the treatment group was more marked (P<0.05). In the treatment group, 15 cases were cured, 3 markedly effective, 2 effective and 1 ineffective; while in the control group, 13 cases were cured, 1 markedly effective and 4 ineffective. Statistically, there is no significant difference between the 2 groups (P>0.05) in therapeutic effects.

Two-stage treatment of an unusual haemobilia caused by intrahepatic pseudoaneurysm

A 84-year-old man with a surgical history of subtotal gastrectomy for gastric cancer was transferred to our department because of a disorder of consciousness. Septic shock due to obstructive suppurative cholangitis secondary to choledocholithiasis was diagnosed. Anemia was also present,and upper gastrointestinal tract endoscopy revealed blood emerging from the Papilla of Vater.The cause of the anemia was identified as haemobilia.Angiography showed a small aneurysm over the artery on segment 3(A3) .The cause of the haemobilia was suspected to be the bleeding into the biliary tree from this aneurysm.Because the patient's general condition was poor,minimally invasive therapy was needed.Transcatheter arterial embolization(TAE) was selected initally.Later,lateral sectionectomy was performed in order to remove the aneurysm on A3. No surgical complication occurred and,after surgery,no haemobilia was identified.In conclusion,a twostage treatment,namely,surgery following TAE,is recommended for patients in a physically poor condition who have haemobilia due to intrahepatic aneurysm.

Terephthalic acid wastewater treatment by using two-stage aerobic process

Based on the tests between anoxic and aerobic process, the two stage aerobic process with a biological selector was chosen to treat terephthalic acid wastewater (PTA). By adopting the two stage aerobic process, the COD Cr in PTA wastewater could be reduced from 4000—6000 mg/L to below 100 mg/L; the COD loading in the first aerobic tank could reach 7 0 to 8 0 kgCOD Cr /(m 3·d) and that of the second stage was from 0 2 to 0 4 kgCOD Cr /(m 3·d). Further researches on the kinetics of substrate degradation were carried out.

Two-stage treatment with hepatectomy and carbon-ion radiotherapy for multiple hepatic epithelioid hemangioendotheliomas

Hepatic epithelioid hemangioendothelioma(HEH)is a rare neoplasm of vascular origin with variable malignant potential.Because most patients with this condition have multiple bilobar lesions,liver transplantation is the standard treatment,and hepatectomy is much less frequently indicated.We describe a case of a 35-yearold woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy.This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.

Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support

AIM: To investigate the feasibility of treatment for upper gastrointestinal fistula and leakage with personal stage nutrition support. METHODS: Forty-three patients with upper gastrointestinal fistula and leakage were randomly divided into two groups. Patients in group A were treated with personal stage nutrition support and patients in group B were treated with total parental nutrition (TPN) in combination with operation. Nutritional states of the candidates were evaluated by detecting albumin (Alb) and pre-Alb. The balance between nutrition and hepatic function was evaluated by measurement of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (Tbill) before and after operation. At the same time their complications and hospitalized time were surveyed. RESULTS: Personal stage nutrition support improved upper gastrointestinal fistula and leakage. The nutrition state and hepatic function were better in patients who received personal stage nutrition support than in those who did not receive TPN. There was no significant difference in the complication and hospitalized time in the two groups of patients. CONCLUSION: Upper gastrointestinal fistula and leakage can be treated with personal stage nutrition support which is more beneficial for the post-operation recovery and more economic than surgical operation.

Effect of intervention treatment from different stages on prognosis in children with central coordination disturbance

BACKGROUND： Central coordination disturbance is regarded as the early-stage symptom of brain injury-induced cerebral palsy. This disease manifests itself as motor disorder, abnormal attitudinal reflex and muscular tension. Early intervention may improve its prognosis. OBJECTIVE： To observe the effects of intervention treatment from different stages on the prognosis of central coordination disturbance following brain injury in children patients. DESIGN： A contrast observation experiment SETTING： Department of Neurology and Rehabilitation, Urumqi Children＇s Hospital PARTICIPANTS ： Totally 151 children who were diagnosed as central coordination disturbance from January 2002 to December 2003 in the Department of Neurology and Rehabilitation of Urumqi Children＇s Hospital were recruited. All the children patients, including 101 male and 50 female, aged from 3 months to 1 year old, met the diagnosis criteria of central coordination disturbance from Vojta. They were divided into slight, moderate and severe abnormity according to Vojta attitudinal reflex. All 151 patients were divided into 2 groups according to their age at diagnosis： 3-6 months old group （n=74）, 62 severe, 10 moderate and 2 slight; 7-12 months old group （n=77）, 66 severe, 7 moderate and 4 slight. All the relatives of children patients were informed of the experiment. METHODS： ① Both groups received physical training （PT） as the main treatment; Hand training was given if necessary. All of the patients received additional hyperbaric oxygen therapy, bioelectric therapy, scalp acupuncture, drug treatment and family training. The importance of integration of hospital and family based rehabilitation was stressed. Those who did not catch up with the normal development or had abnormal reflexes continued to receive treatment. ② Around the age of 2 years old, all children did a final evaluation using Bayley Scales of Infant Development （BSID）. Mental development index （MDI） and physical development index （PDI） were taken as evaluative criteria. Children with scores 80 and above on MDI and PDI were considered to have normal motor and mental development; 79 and below were considered delayers. The Diagnostic Criteria of Cerebral Palsy and Infantecondary School Social Adaptation Scale were used in the final evaluation[scores ≤5 was extremely severe （extremely severe cerebral palsy）, 6 was severe（severe cerebral palsy）, 7 was moderate（moderate cerebral palsy）, 8 was slight（slight cerebral palsy）, 9 was borderline（slight cerebral palsy）, 10 was normal, 11 was above average, 12 was excellent and ≥13 was extremely excellent]. ③ Final evaluative results of 2 groups were compared. And u test was used for the comparison of Bayley development index and Chi-square test for the comparison of normalization rate. MAIN OUTCOME MEASURES： BSID MDI and PDI as well as the normalization rate of motor function and mental behavior of children patients at 2 years old. RESULTS： Totally 151 children patients entered the stage of result analysis. ①Two groups of children patients were given integrated rehabilitation therapy , and evaluated at 2 years old . The 3-6 months old group had higher MDI and PDI than the 7-12 months old group （91.81＋19.99 vs 71.93＋18.98;91.55＋23.61 vs 68.95＋23.51, u=6.265,5.894,P 〈 0.01 ）.②After being given integrated rehabilitation therapy, children patients of 3-6 months old group had significantly higher normalization rate of motor function and mental behavior than 7-12 months old group （73% ,27%,X2=29.723 9,P 〈 0.01 ）. ③Six slight and 17 moderate central coordination disturbance children of 2 groups all completely recovered; After intervention treatment, among 128 severe central coordination disturbance children, 52 recovered and 76 were still abnormal, in which, 43 slight cerebral palsy, 18 moderate cerebral palsy, 5 severe cerebral palsy and 10 extremely severe cerebral palsy. CONCLUSION： To perform integrated intervention treatment before 6 months old can better improve and promote mental and physical development levels of children patients with central coordination disturbance after brain injury than 6 months later.

Stem cell transplantation for the treatment of end-stage liver disease

The past two decades have witnessed an explosion of research and clinical application of stem cells, transforming the field of regenerative medicine. Stem cell transplantation has already been performed to treat patients with cancer,liver diseases, and various types of chronic diseases. Indeed, stem cell-based therapies are effective in many diseases, and provide novel insights into the treatment of end-stage liver disease. Several clinical trials have indicated the efficacy profiles of stem cell transplantation in patients with end-stage liver disease, including liver cirrhosis, liver failure, and liver tumors. Animal models of acute liver failure have also provided important insights into the safety,mechanisms, and efficacy of stem cell therapies. Nevertheless, excitement due to this promising field must be tempered with careful and calculated research. In particular, studies on the quality, safety, and efficacy of stem cell transplantation are needed to ensure that qualified products are tested in well-designed clinical trials and approved by governments. Therefore, further investigations are required to effectively balance the safety with the innovation of stem cell transplantation research toward the effective treatment of end-stage liver disease.

中医药防治儿童变应性鼻炎策略

变应性鼻炎是儿童常见过敏性疾病,其发病机制复杂,难以实现根治或有效且稳定的远期治疗目标。中医药防治儿童变应性鼻炎靶点广泛、作用持久且不良反应少,优势明显。提出变应性鼻炎发病多由肺脾肾三脏功能失调,外风引动伏风,两风相合而致。应采取发作期疏外风、抑伏风、宣肺利窍治其标,缓解期防外风、平伏风,调补肺脾肾治其本的中医药分期论治策略;同时应注重未病先防,包括避免先天禀赋因素的不良影响、避免后天环境因素的诱导发病、扶正御邪避其贼风,既病防变以及瘥后防复的全阶段预防。

Qualitative and Quantitative Analysis of the Inorganic Materials Changes with Time in the Stages of the Wastewater Treatment Plant

Due to the importance of the inorganic materials removal from wastewater, experimental and analytical study to the concentration change with time of these materials became essential. In this work, experimental analyses were performed to investigate the concentration changes of inorganic compounds during stages of activated sludge wastewater treatment plants at different sites in Jordan. The aim of this research is to examine the performance of the plants in treating pollutants and inorganic materials, and verify the quantitative and qualitative changes with time. Samples from the treatment stages were monthly taken and analyzed in the laboratory along a period of one year. The concentration changes of the inorganic solids in wastewater passing through treatment stages and aeration tank were recorded. Results show that the conventional treatment of the wastewater within different conditions in the year is not effective to decrease the concentrations of the inorganic compounds. Based on these results, we recommend adding tertiary advanced treatment unit in order to get acceptable water quality allowable to be reused for different purposes.

CLINICAL OBSERVATION ON STAGE-AIDED TREATMENT OF 62 CASES OF PERIPHERAL FACIAL PARALYSIS WITH ACUPUNCTURE,MOXIBUSTION AND CUPPING

Objective: To probe the best therapy for peripheral facial paralysis. Methods: A total of 122 cases of facial paralysis patients were randomized into treatment group (n=62, treating the disease by stages) and control group (n=60). For patients at the acute stage in treatment group, main point Yifeng (TE 17) was pricked first, followed by performing cupping and moxibustion, for patients at the resting stage, main point Hegu (LI 4) was punctured with reducing needling method, combined with other acupoints in the light of the concrete situations. For patients at the restoration stage, main point Zusanli (ST 36) was punctured with reinforcing method in combination with seven-star-needle tapping at the local affected region. Patients of control group were treated with routine method by puncturing Fengchi (GB 20), Yifeng (TE 17), Jiache (ST 6), Hegu (LI 4), Taichong (LR 3), etc.. The treatment was conducted once daily, with 10 days being a therapeutic course. Results: Following 3 courses of treatment, of the 62 cases in treatment group, 44 (70.9%) were cured, 12 (19.4%) had remarkable improvement in their symptoms and signs, 6 (9.7%) had amelioration, with the cure plus markedly effective rate being 90.3%; of the 60 cases in control group, 30 (50.0%) were cured, 12 (20.0%) had apparent improvement, 16 (26.7%) had amelioration, and the rest 2 (3.3%) failed in the treatment, with the cure plus markedly effective rate being 70.0%. Ridit analysis showed that the cure rate and cure plus markedly effective rate of treatment group were significantly higher than those of control group (P<0.05). Conclusion: Stage-aided acupuncture treatment is superior to routine treatment for facial palsy.

Diagnosis and one stage surgical treatment of lower thoracic ossification of ligamentum flavum combined with lumbar spinal stenosis

Objective To study the diagnosis and treatment of lower thoracic ossification of ligamentum flavum(OLF) combined with lumbar spinal stenosis.Methods Retrospective analysis was carried out on 11 cases of lower thoracic OLF combined with

Selection of staged or synchronous percutaneous nephrolithotomy for treatment of bilateral upper urinary tract calculi

Objective To evaluate the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy ( PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indication for bilateral PCNL were enrolled in the study

汪受传教授分期论治小儿睾丸鞘膜积液经验

睾丸鞘膜积液为小儿常见的泌尿系统疾患。汪受传教授认为本病病位主要在肝,与肺、脾、肾密切相关,主要由水湿不化,湿痰凝聚,留滞肝经,郁结不消所致,治疗当以调理脏腑、利水消肿为基本原则,擅用分期论治。病程初期重在化气利水,病程后期重在培元固本,疏肝理气贯穿始终。临床收效良好,值得推广应用。

杨国旺教授辨病分期论治肿瘤相关肾脏病经验

肿瘤相关肾脏病是指一类继发于全身各个器官的由肿瘤导致的肾脏损害性疾病,包括实体肿瘤导致的肾脏损伤和血液系统肿瘤引起的肾脏损伤,另外尚有肿瘤治疗(手术、化疗、分子靶向、免疫调节)过程中导致的急性和慢性肾损伤。临床表现以蛋白尿或肾病综合征或肾功能衰竭为主。肿瘤相关肾脏病的预后主要取决于肿瘤的类型、部位以及疾病分期等。根据肿瘤相关肾损害发病特点可将其归属于中医“癥瘕”“积聚”“虚劳”“关格”等范畴。中医治疗肿瘤相关肾脏病,首先要辨别肾脏损伤的原发病,再进行论治。杨国旺教授倡导辨病论治与分期论治相结合治疗肿瘤相关肾脏病。辨病论治强调首先要辨别引起肾脏损伤的原发病,再进行论治。如肺癌辨病以气阴两虚、痰浊瘀毒阻肺为核心病机,治宜以益气养阴、化痰散结、祛瘀解毒为法;淋巴瘤辨病以“痰”为根本病理因素,“寒”“虚”“瘀”“毒”共同构成其核心病机,治宜以化痰散结、散寒解毒、扶正逐瘀为法。分期论治基于虚损期、虚劳期、虚衰期,在中西医结合综合治疗基础上强调益肺健脾、补肾固精、抗癌解毒、通腑泄浊、攻补兼施、标本兼顾等治疗思路。文章分析杨国旺教授辨病分期论治肿瘤相关肾脏病经验,并附病案1例,以期为临床相关治疗提供参考。

城市污水处理厂的“水-能-碳”协调调度模型

城市污水处理厂面临能量密集、碳排量大、运行成本高的突出问题。污水厂优化调度是实现“节能降碳增效”的重要途径,但现有调度方法还存在对处理设备控制特性利用不足、对处理过程的温室气体排放缺乏全面管控等局限。为此,该文提出一种面向污水厂“水-能-碳”协调调度的新模型。所提模型利用鼓风机启停/沼气池温度控制来挖掘节能空间、计入碳排放成本来提升低碳水平、引入污水分级处理与回用来促进资源回收利用,在满足污水处理工艺流程和各种设备运行约束及水质处理要求的条件下,实现污水厂的低碳经济运行。以某中小型城市污水厂为算例,验证了所提调度模型的有效性以及各调度要素对污水厂“节能降碳增效”的积极作用。

许芝银教授从中焦气机论治非哺乳期乳腺炎经验

总结许芝银教授从中焦气机论治非哺乳期乳腺炎经验,认为非哺乳期乳腺炎病变脏腑在肝脾胃,与中焦气机失调关系密切,根据临床表现分为肿块期、脓肿期和瘘管期,主要病机为肝郁脾虚,痰阻乳络;日久郁热,热盛肉腐;气虚邪滞,缠绵阻遏。治疗上应根据疾病不同时期明辨病机,药随机转,以调畅中焦气机为关键分期化裁论治,肿块期辛开苦降,抑木扶土;脓肿期降浊升清,泻火平木;瘘管期运转中州,培土荣木,从而获得满意疗效。

One stage anterior release and posterior fusion for the treatment of irreducible atlantoaxial dislocation secondary to os odontoideum

Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secondary

安罗替尼联合一线化疗治疗晚期非小细胞肺癌的效果

目的研究安罗替尼联合化疗一线治疗晚期非小细胞肺癌(NSCLC)的价值。方法回顾分析2018年3月至2022年5月郑州大学第五附属医院收治的90例晚期NSCLC患者资料,其中45例接受单纯一线化疗的患者纳入对照组,45例联合安罗替尼治疗的患者纳入观察组。两组均连续治疗4个化疗周期。记录两组治疗效果、肿瘤标志物水平[细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)和神经元特异性烯醇化酶(NSE)]、生存情况、不良反应发生情况。结果治疗后,观察组治疗总有效率高于对照组(P<0.05)。治疗前,两组CYFRA21-1、NSE、CEA差异无统计学意义(P>0.05);治疗后,两组CYFRA21-1、NSE、CEA均降低,且观察组低于对照组,差异有统计学上的意义(P<0.05)。观察组生存时间长于对照组,生存率高于对照组,差异有统计学上的意义(P<0.05)。治疗期间,两组不良反应发生率差异无统计学意义(P>0.05)。结论安罗替尼联合化疗一线治疗晚期NSCLC可以进一步提高效果,降低肿瘤标志物水平,有助于延长患者生存时间,且不会增加不良反应,安全性较好。

乙型肝炎不确定期与灰区的再认识

慢性乙型肝炎病毒(hepatitis B virus,HBV)感染的防治依然任重而道远.即使我国新版指南扩大了抗病毒治疗适应证,依然有一定比例的HBV感染者不符合抗病毒治疗适应证,称之为不确定期或灰区(grey zone,GZ).但当前关于不确定期或GZ的解读与判断标准较为混乱,两者之间的联系与区别还不甚清晰,不同研究所指向的对象不尽相同.但无论如何认定不确定期或GZ,其目的是为了及时、准确判断慢性HBV感染的疾病进展与是否需要及时治疗.基于GZ对应于“治疗的适应证分类”和不确定期对应于“自然史分期”的理解,本文结合国内外的研究进展阐述对慢性HBV感染不确定期与GZ的再认识.GZ即为不治疗对象(不符合抗病毒治疗适应证),而不确定期仅为难以明确归于自然史分期(不符合自然史分期)的患者,GZ应包括不确定期,而不是等同关系.对应我国新版指南标准,属于GZ的不确定期患者,建议抗病毒治疗;对应欧洲肝病学会2017年指南标准,免疫控制期与属于GZ的不确定期患者,建议抗病毒治疗.