120例海洛因依赖患者的临床分析

目的探讨海洛因依赖患者的临床特征。方法对自愿戒毒的120例海洛因依赖患者的临床资料进行回顾性分析。结果本文显示海洛因依赖患者以男性、文化程度较低、个体经商者居多;多数因好奇、贪图享乐、受人引诱或赶时髦而成瘾;吸毒方式以烫吸为主;临床疗效与吸毒方式、吸毒时间和治疗方法相关。结论单一替代疗法具成瘾性,不利于出院后康复,以替代疗法合并氟哌啶醇效果较好。

Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients

AIM： To identify prognostic factors of patients with hepatocellular carcinoma （HCC）, who were treated by orthotopic liver transplantation （OLT）. METHODS： From January 2000 to October 2006, 165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrencefree survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. RESULTS： The median follow-up was 13.0 mo （2.8-69.5 too）. Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively. One-, 2-, 3- and 5-year overall recurrencefree survival was 67.0%, 44.3%, 34.5% and 34.5%, respectively. In univariate analysis, number of tumors, total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria （97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively） compared with that of patients who met the Milan or University of California, San Francisco （UCSF） criteria. CONCLUSION： Macrovascular invasion and total tumor diameter are the strongest prognostic factors. The proposed criteria do not adversely affect the outcome of liver transplantation for HCC, compared with the Milan or UCSF criteria.

Pulmonary and cerebral lipiodol embolism after transcatheter arterial hemoembolization in hepatocellular carcinoma

Pulmonary and cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is rare. To our knowledge, only 7 cases have been reported in the literature. We present a case of pulmonary and cerebral lipiodol embolism, and analyzed retrospectively the imaging and clinical data of the patient and conclude the most probable mechanism of pulmonary and cerebral lipiodol embolism, which is different from that of the cases reported previously.

Investigation of quality of life in patients with lung cancer by the EORTC QLQ-C30(V3.0) Chinese version

Objective To explore quality of life(QOL) and its influencing factors in patients with lung cancer.Methods A QOL questionnaire(European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire-Core 30 [QLQ-C30] Chinese version) was used with 138 patients with lung cancer participating in the study. A statistical description of the general characteristics of the patients with lung cancer was performed. The patients' QLQ-C30 scores were compared with the reference value for each dimension. To analyze the influence of QOL in different genders, age groups, and cancer stages, ttests and rank sum tests were used to compare the differences in QOL using a 5% significance level. Results The QLQ-C30 function scores in PF(physical functioning), EF(emotional functioning), SF(social functioning), and GH(global functioning), and symptom scales in NV(nausea and vomiting), DY(dyspnea), SL(insomnia), and FI(financial difficulties) were significantly different(P < 0.05) in comparison to the reference values. Female patients were worse than males(P < 0.05) in EF, NV, and DI(diarrhea). The later the stage of lung cancer, the worse the quality of life became; the functional scales in RF(role functioning), EF, CF, SF, and GH, and symptom scales in PA(pain), AP(appetite), and SL differences were statistically significant(P < 0.05). Conclusion This study aids understanding of the status of the quality of life of Chinese patients with cancer and might be useful for clinical work, theory research, and health policymakers.

Acupuncture and the Elevation Manipulation of Massage for Treatment of Frozen Shoulder

The authors have treated 50 cases of frozen shoulder in recent years with electro-acupuncture and the elevation manipulation. The results were satisfactory and reported as follows.

Transarterial injection of H101 in combination with chemoembolization overcomes recurrent hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) has become the standard treatment modality for unresectable hepatocellular carcinoma (HCC). Nonetheless, the clinical outcomes in patients with unresectable HCC are often unsatisfactory, especially in those with recurrent HCC. H101, an E1B gene deleted adenovirus, is known to have a significant antitumor activity. In addition, local injection of H101 can enhance the effect of antitumor therapies (chemotherapy and radiotherapy). Transarterial H101 gene injection in combination with TACE may help to control refractory and recurrent HCC. In this study, we report a 55-year-old patient with recurrent HCC which was treated with transarterial injection of H101 in combination with TACE, leading to a good clinical prognosis of the patient.

Mycobacterium avium subspecies paratuberculosis and its relationship with Crohn's disease

The hypothesis postulating that Mycobacterium avium paratuberculosis(MAP) is the cause of Crohn's disease(CD) has been circulating for many years.Advances in molecular techniques,such as polymerase chain reaction and culture methods,have enabled researchers to demonstrate that there is an association between MAP and CD.Recently,genome-wide association studies have identified novel susceptibility genes for CD,which are critical for generation of an adaptive immune response that is protective against intracellular pathogens,including M.tuberculosis infection.However,the role of MAP as a cause of CD suffered a setback with the report that administration of antimycobacterial therapy failed to lead to a sustained response in CD patients.Accordingly,this review sought neither to confirm nor refute this,but instead to survey recent literature on the role of MAP in CD.

ANALYSIS OF EFFECT AND COMPLICATION ON SURGICAL TREATMENT OF CAROTID BODY TUMORS IN 46 CASES

Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT which were surgically treated with different kind of procedures.Resul t.All procedures performed successfully except that the CBT was not excised in 4cases.No operative mortality was observed.There were2postoperative hemiple gia,4hypoglossal nerve impairment ,2glossopharyngeal nerve impairment ,1va gus nerve impairment ,and1accessory nerve impairment.One patient presented p ostoperative cranial nerve impairment in glossopharyngeal,vagus and hypoglossa l nerves.Two patients developed local recurrence during the long-term follow-up.Conclusion.Complete surgical excision was possible in each patient if th e diagnosis had been cor-rectly made through selective preoperative angiography ,vessel ultrasound Doppler and other examinations.Reasonable surgical procedur e and Matas training were necessary to the successful surgical treatment and t hus decrease the complicative incidence rate of carotid chemodectomas.

Pioneering drugs for overactive bladder and detrusor overactivity: Ongoing research and future directions

The ongoing research on pioneering drug candidates for the overactive bladder （OAB） aimed to overcome the limitations of currently licensed pharmacotherapies, such as antimuscarinics, β3-adrenergic agents, and botulinum neurotoxin, has been reviewed performing a systematic literature review and web search. The review covers the exploratory agents alternative to available medications for OAB and that may ultimately prove to be therapeutically useful in the future mana-gement of OAB patients based on preclinical and early clinical data. It emerges that many alternative pharmacological strategies have been discovered or are under investigation in disease-oriented studies. Several potential therapeutics are known for years but still fnd obstacles to pass the clinical stages of development, while other completely novel compounds, targeting new pharmacological targets, have been recently discovered and show potential to translate into clinical therapeutic agents for idiopathic and neurogenic OAB syndrome. The global scenario of investigational drugs for OAB gives promise for the development of innovative thera-peutics that may ultimately prove effective as first, combined or second-line treatments within a realistic timescale of ten years.

Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids

AIM:To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids.METHODS:A total of 759 consecutive patients (415 males and 344 females) were enrolled.Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients).All patients received EHL at outpatient clinics.Hemorrhoid severity was classified by Goligher's grading.The mean follow-up period was 55.4 mo (range,45-92 mo).RESULTS:The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients.Bleeding was controlled in 587 (98.0%) patients,while prolapse was reduced in 137 (82.5%) patients.After treatment,93 patients experienced anal pain and 48 patients had mild bleeding.Patient subjective satisfaction was 93.6%.Repeat treatment or surgery was performed if symptoms were not relieved in the first session.In the bleeding group,the recurrence rate was 3.7% (22 patients) at 1 year,and 6.6%and 13.0% at 2 and 5 years.In the prolapsed group,the recurrence rate was 3.0%,9.6% and 16.9% at 1,2 and 5 years,respectively.CONCLUSION:EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids,with good long-term results.

Clinical Observation on 930 Child Epilepsy Cases Treated with Anti-epilepsy Capsules

1090 cases of child epilepsy were divided randomly into two groups: the treatment group (930 cases treated with anti-epilepsy capsules) and the control group (160 cases treated with luminal). The results showed that in the treatment group, 534 cases were markedly effective, 241 effective, 96 improved, 46 ineffective, and 13 aggravated, with a total effective rate of 83.33%; while in the control group, 64 cases were markedly effective, 19 effective, 38 improved, 29 ineffective, and 10 aggravated, with a total effective rate of 51.88%. The treatment group showed an obviously higher total effective rate than that in the control group (P<0.01). After treatment, cases in the two groups all had lower frequency of epilepsy attacks and shorter duration of each attack as compared with that before treatment (P<0.01), but the situation was obviously better in the treatment group. The anti-epilepsy capsules had very good effect on various types of epilepsy, especially on autonomic epilepsy and on epilepsies due to wind, phlegm, or terror as differentiated in TCM. After treatment, the recovery rate shown by EEG examination was 54.3% in the treatment group, while 38.4% in the control group, the former being obviously higher than the latter (P<0.01).

Expression and clinical significance of S100A2 and p63 in esophageal carcinoma

AIM： TO investigate the expression and clinical significance of S100A2 mRNA and protein, p63 protein in esophageal squamous cell carcinoma （ESCC） and their roles in carcinogenesis and progression of esophageal carcinoma （EC）. METHODS： Immunohistochemical staining （S-P method） for S100A2 and p63 protein were performed in 40 samples of ESCC and 40 samples of normal esophageal mucosa. In situ hybridization （ISH） was used to detect the expression of S100A2 mRNA. RESULTS： Expression of S100A2 mRNA in ESCC was positive in 77.5% of samples, which was lower than that in normal mucosa （100%） by ISH （P = 0.002）. The expression level of S100A2 mRNA was closely related to differentiation and and node-metastasis （P = 0.012, P = 0.008）. Expression of $100A2 protein was positive in 72.5% of ESCC samples and expression of p63 protein was positive in 37.5% of ESCC samples, and was lower than that in normal mucosa （100%） （P = 0.000）. The expression of S100A2 protein was correlated with the differentiation and node-metastasis （P = 0.007, P = 0.001）, but no relationship was observed between the expression of p63 protein and clinical pathological manifestations. S100A2 protein was positively correlated with the expression of S100A2 mRNA, and negatively associated with the expression of p63 protein （P = 0.000, P = 0.002）. CONCLUSION： S100A2 and p63 protein both play important roles in the carcinogenesis of ESCC. An investigation into the combined expression of S100A2 and p63 may be helpful in early diagnosis and in evaluating the prognosis of ESCC.

Clinical outcome following radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer

Objective： To estimate the impact of parametrial infiltration and lymph node metastasis on clinical outcome in women with early-stage cervical cancer following radical hysterectomy and pelvic lymphadenectomy. Methods： Clinical records and pathologic slides of 532 patients with early-stage cervical cancer （330 Ib and 202 Ila） treated with radical hysterectomy and pelvic lymphadenectomy were reviewed. The study group comprised 520 patients with squamous call carcinoma and 12 patients with adenocarcinoma of the cervix. Median follow-up time was 67 months. The association among the various histopathologic predictors of outcome was determined with analysis. The influence of the predictors on outcome was examined with log rank survival methods and the Cox regression model. Results： FIGO stage, histologic type, tumor size, depth of invasion, parametdal infiltration, lymph node metastasis, and remote metastasis were identified as significantly biologically relevant and therefore were included as candidate predictors in multivariate analysis. In particular, parametrial infiltration and lymph node metastasis were found to be simultaneous predictors of death on multivariate analysis （P 〈 0.05）. After controlling for these two factors, the other variables considered were not statistically significant up to a two-way interaction. Conclusion： Presence of parametdal infiltration and/or lymph node metastasis in women with early-stage cervical cancer is an independent poor prognostic factor. In addition, the relatively poor survival of women with more than one lymph nodes identified with cancer cells.

Seventy-two Cases of Antidiabetic-Induced Hepatopathy Treated by Huatan Yigan Decoction

In order to observe the therapeutic effects of Huatan Yigan Decoction (化痰益肝汤 Decoction for resolving phlegm and replenishing the liver) on antidiabetic-induced hepatopathy, 129 cases were divided into two groups, 72 cases in the treatment group were administrated with Huatan Yigan Decoction and 57 cases in the control group with the liver-protecting drugs. Their liver function, plasma prothrombin time (PT), blood urea nitrogen and symptoms of the patients before and after treatment were observed during the three therapeutic courses. Results: The total effective rate and cured rate of the treatment group manifested an obvious difference in comparison with those of the control group (P＜0.05 or P＜0.01). Even though the liver function, blood urea nitrogen (BUN) and symptoms in both groups were improved markedly, these indicators in the treatment group were improved more markedly than those in control group (P＜0.01). No adverse effect was found during the treatment. Conclusion: Huatan Yigan Decoction shows a repair action on hepatic injury.

METHODOLOGICAL EVALUATION ON CLINICAL RESEARCH LITERATURE OF ACUPUNCTURE TREATMENT OF FACIAL PARALYSIS

Objective: To try to give an objective evaluation on the clinical research situation about acupuncture treatment of facial paralysis in the past 50 years and try to provide a possible evidence for clinical practice. Methods: All papers are searched and assessed according to the international standards and clinical epidemiology. Results: There is no systematic review (SR) on acupuncture treatment of facial palsy in a total of 1021 articles enlisted in the present paper. Comparing with the quantity of the descriptive studies and expert opinions (constituting 84.84%), that of the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) is smaller (constituting 15.16%), besides, the quality of RCTs and CCTs is unsatisfactory. Conclusion: At present, the quantity and quality of studies with RCTs about acupuncture treatment of facial paralysis can’t meet the need of clinical practice, and in order to improve the therapeutic effect, a higher quality of RCTs and SR is required.

Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions

Objectives To evaluate the very long-term safety and effectiveness of drug-eluting stents （DES） compared to bare-metal stents （BMS） for patients with large coronary vessels. Methods From April 2004 to October 2006, 2407 consecutive patients undergoing de novo lesion percutaneous coronary intervention with reference vessel diameter greater than or equal to 3.5 mm at Fu Wai Hospital in Beijing, China, were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction （MI）, thrombosis, target lesion revascularization （TLR）, target vessel revascularization （TVR）, and major adverse cardiac events （MACE, the composite of death, MI, and TVR）. We performed Cox＇s proportional-hazards models to assess relative risks of all the outcome measures after propensity match. Results After propensity scoring, 514 DES-treated patients were matched to 514 BMS-treated patients. The patients treated with BMS were associated with higher risk ofTLR （HR： 2.55, 95%CI： 1.520-4.277, P = 0.0004） and TVR （HR： 1.889, 95%CI： 1.185-3.011, P = 0.0075）, but the rates of death/MI and MACE were not statistically different. All Academic Research Consortium definition stent thrombosis at 9-year were comparable in the two groups. Conclusions During long-term follow-up through nine years, use of DES in patients with large coronary arteries was still associated with significant reductions in the risks of TLR and TVR.

CLINICAL STUDY ON TREATMENT OF INFANTILE PRIMARY EPILEPSY WITH ACUPOINT CATGUT-IMPLANTATION THERAPY

Aim: To observe the therapeutic effect of acupoint catgut implantation therapy in the treatment of infantile primary epilepsy. Methods: A total of 63 cases of primary epilepsy children were randomly divided into medication group (n=32) and acupoint catgut implantation group (n=31) and treated respectively with Sodium Valproate 5-10 mg/kg/d and catgut implantation at Changqiang (GV 1), Jiuwei (CV 15), bilateral Xinshu (BL 15) and bilateral Zusanli (ST 36). Results: Following 60 days of treatment, the abnormal changes of electroencephlogram (EEG), the seizure frequency and duration and clinical symptoms were improved apparently in comparison with those of pre treatment, but no significant differences were found between the two groups (P>0.05). There was a significant difference between two groups in the cure rate of the short term effect (P<0.05), with the therapeutic effect of the treatment group being superior to that of medication group. Conclusion: Acupoint catgut implantation therapy has a good therapeutic effect in the treatment of primary infantile epilepsy.

Long-term efficacy of infliximab maintenance therapy for perianal Crohn’s disease

AIM:To assess the long-term efficacy of seton drainage with infliximab maintenance therapy in treatment of stricture for perianal Crohn’s disease(CD). METHODS:Sixty-two patients with perianal CD who required surgical treatment with or without infliximab between September 2000 and April 2010 were identified from our clinic’s database.The activities of the perianal lesions were evaluated using the modified perianal CD activity index(mPDAI)score.The primary endpoint was a clinical response at 12-15 wk after surgery as a shortterm efficacy.Secondary endpoints were recurrence as reflected in the mPDAI score,defined as increased points in every major element.The clinical responses were classified as completely healed(mPDAI=0),partially improved(mPDAI score decreased more than 4 points),and failure or recurrence(mPDAI score increased or decreased less than 3 points). RESULTS:There were 43 males and 19 females,of whom 26 were consecutively treated with infliximab after surgery as maintenance therapy.Complete healing was not seen.Failure was seen in 10/36(27.8%) patients without infliximab and 4/26(15.4%)patients with infliximab(P=0.25).Partial improvement was seen in 26/36(72.2%)patients without infliximab and 22/26(88.5%)patients with infliximab(P=0.25). Short-term improvement was achieved in 48/62(77.4%) patients.Although the mPDAI score improved significantly with surgery regardless of infliximab,it decreased more from baseline in patients with infliximab(50.0%) than in those without infliximab(28.6%),(P=0.003). In the long-term,recurrence rates were low regardless of infliximab in patients without anorectal stricture.In patients with anorectal stricture,cumulative recurrence incidences increased gradually and exceeded 40%at 5 years regardless of infliximab.No efficacy of infliximab treatment was found(P=0.97).Although the cumulative rate of ostomy creation was also low in patients without stricture and high in patients with stricture,no protective efficacy was found with infliximab treatment(P =0.6 without stricture,P=0.22 with stricture). CONCLUSION:Infliximab treatment was demonstrated to have short-term efficacy for perianal lesions.Longterm benefit with infliximab was not proven,at least in patients with anorectal stricture.

Treatment of Hyperlipemia by Acupoint Catgut-embedding in 34 Cases

With the therapeutic method of acupoint catgut embedding, the authors have in recent years treated hyperlipemia and achieved satisfactory therapeutic results. A report follows.

Clinical Observation in 46 Cases of Angina Pectoris Treated by the Catgut-embedding Therapy

With the catgut-embedding therapy, the author treated 46 cases of angina pectoris from October 1997 to February 2002, and achieved good therapeutic results. This is reported as follows.