无创呼吸机在重症支气管哮喘的早期临床治疗中的应用研究

通过进行无创呼吸机在重症支气管哮喘早期临床治疗中的应用研究,以期找出治疗效果的科学证据。方法 采用随机对照试验的方法,选取48例重症支气管哮喘患者作为研究对象,分为观察组与对照组各24例。对照组采取常规药物治疗,观察组在常规药物治疗基础上配合无创呼吸机治疗,对两组患者的相关肺功能指标、临床症状积分以及血气功能指标进行对比分析。结果 观察组患者的FEV1(L)、FEV1/FVC(%)与PEF(L/s)明显优于对照组,住院时间较对照组明显缩短,临床症状积分的六项指标以及治疗后的血氧分压(kPa)均显著好于对照组(p<0.05)。结论 无创呼吸机在重症支气管哮喘早期的临床治疗中能够有效改善患者的肺功能指标、临床症状积分以及血气功能指标,缩短住院时间,对改善患者的临床病情、提高患者的生活质量提供了新的临床治疗思路。

PPH加外剥内扎术治疗环状混合痔临床观察

目的：探讨PPH加外剥内扎术治疗环状混合痔临床效果。方法：选取我院自2010年4月～2012年4月收治的96例Ⅲ～Ⅳ期环状混合痔患者。根据手术方法分为对照组及观察组各48例，对照组采用传统外剥内扎术治疗，观察组采用PPH加外剥内扎术治疗，比较两组的手术效果。结果：观察组临床总有效率为91．67％，明显高于对照组的70．83％，差异具有统计学意义（P〈O．05）；观察组复发率低于对照组，差异具有统计学意义（P〈0．05）。结论：PPH加外剥内扎术治疗环状混合痔疗效显著，能够弥补单一术式的不足，术后并发症少，恢复快，值得临床推广应用。

澳特斯治疗小儿慢性咳嗽疗效分析

目的探索治疗小儿慢性咳嗽的临床疗效。方法患者随机分成2组,治疗组与对照组各50例。治疗组采用澳特斯,7d为一疗程;对照组采用止咳合剂。结果统计学处理P<0.01,两组差异有统计学意义。治疗组咳嗽的临床症状改善快。结论小儿慢性咳嗽,用澳特斯是有效的,临床使用安全,更适合基层医疗机构使用。

Clinical outcomes of elderly South-East Asian patients in primary percutaneous coronary intervention for ST- elevation myocardial infarction

Objective To evaluate the clinical characteristics and in-hospital outcomes of elderly South-East Asian patients undergoing primary pereutaneous coronary intervention （PPCI）. Methods From January 2009 to December 2012, 1268 patients （86.4% male, mean age of 58,4 ± 12.2 years） presented to our hospital for ST-elevation myocardial infarction （STEMI） and underwent PPCI. They were divided into two groups： elderly group defined as age _〉 70 years and non-elderly group defined as age 〈 70 years. Data were collected retrospectively on baseline clinical characteristics, door-to-balloon （D2B） time, angiographic findings, therapeutic modality and hospital course. Results The elderly group constituted 19% of the study population with mean age 76.6 ± 5.0 years. There was a higher proportion of female gender and ethnic Chinese patients in the elderly group when compared with the non-elderly group. The former was less likely to be smokers and have a significantly higher prevalence of hypertension. The mean D2B time was significantly longer in the elderly group. They also had a significantly higher incidence of triple vessel disease and obstructive left main disease. The use of radial artery access, glyeoprotein 2b/3a inhibitors and drug-eluting stents during PPCI were also significantly lower. In-hospital mortality was significantly higher in the elderly group. The rate of cardiogenic shock and inhospital complications were also significantly higher. Conclusions Our registry showed that in-hospital mortality rate in elderly South-East Asian patients undergoing PPCI for STEMI was high. Further studies into the optimal STEMI management strat- egy for these elderly patients are warranted.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Abstract： Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

Clinico-pathological study and treatment results of 1009 operable breast cancer cases:Experience of NCI Cairo University,Egypt

Objective： This retrospective study was designed to evaluate ciinico-pathological data including stage, results of treatment, and prognostic factors which affect the overall survival ＆ disease free survival. Methods： This was a retrospective study carried out at the Radiotherapy Department, National Cancer Institute, Cairo University, Egypt on 1009 patients treated for primary breast cancer between 1999-2003. Results： The median follow-up was 68 months. Loco regional relapse occurred in 23 patients （2.3%） and distant relapse occurred in 203 patients （20.1%）. Both Ioco regional and distant relapse were reported in 32 patients （3.2%）. The disease free survival （DFS） at 3 and 5 years were 87% and 78% respectively, while OAS at 3 and 5 years were 96.4% and 91.4% respectively. Multivariate analysis of different prognostic factors showed that the independent bad prognostic factors in the study for disease relapse were positive lymph nodes （LNs, more than 10）, tumor size T3, T4 with significance of 0.0001 for each, and pathologic grade with significance of 0.003. Conclusion： The most important independent bad prognostic factors for relapse are positive LNs more than 10, tumor size T3, T4 and pathologic grade. The timing of radiotherapy affects the disease free survival significantly also it is recommended to analyze the group of patients with LNs negative using well designed randomized trials.

The clinical effects of DC-CIK cells combined with chemotherapy in the treatment of advanced NSCLC

Objective: The aim of the study was to evaluate the safety and therapeutic effects of autologous dendritic cells co-cultured with cytokine-induced killer cells (DC-CIK) combined with chemotherapy in advanced non-small cell lung cancer (NSCLC) patients. Methods: Fifty patients with advanced NSCLC (stages III to IV), who had received therapies in our Center (Department of Biotherapy, Affiliated to Cancer Hospital of Shanxi Medical University, Taiyuan, China) from August 2008 to January 2010, were treated by DC-CIK + chemotherapy as the combined treatment group; fifty advanced NSCLC patients treated with chemotherapy at the same time served as controls. The immunologic function, short-term therapeutic effects, the 1-year survival rate, the life quality, the chemotherapy side effects were compared between the two groups, the safety and therapeutic effects of DC-CIK cells therapy were observed too. Results: There was no obvious change of subsets of T cells in peripheral blood before and after therapy in DC-CIK + chemotherapy group, and IFN-γ was improved after therapy in this group (P < 0.05); in chemotherapy alone group, the ratios of CD3+CD4+, CD3+CD8+, CD3-CD56+ cells and the secretion of IL-2, TNF-α decreased significantly after therapy (P < 0.05); the ratios of CD3+CD8+, CD3+CD56+ were improved after cell culture (P < 0.05). The disease control rate (DCR) of DC-CIK + chemotherapy group was higher than that in the chemotherapy alone group (78.0% vs 56.0%, P < 0.05); the 1-year survival rates of DC-CIK + chemotherapy group and chemotherapy alone group were 50% and 44% respectively, had no significant difference. Compared with chemotherapy alone group, the occurrence of chemotherapy side effects (including bone marrow suppression, nausea and vomiting, peripheral nerve toxicity) was less in the DC-CIK + chemotherapy group (P < 0.05). The physical and appetite were better in DC-CIK + chemotherapy group after therapy. Conclusion: To compare with simple chemotherapy, DC-CIK + chemotherapy for advanced NSCLC is safe and effective, and it can improve patients' life quality and remission rate, and prolong their survival time.

Safety and efficacy of oral HD-03/ES given for six months in patients with chronic hepatitis B virus infection

AIM： To investigate the safety and efficacy of the formulation HD-03/ES capsules in the management of patients with chronic hepatitis B infection.METHODS： A total of 25 patients were recruited to the study and were given HD-03/ES, two capsules twice daily for six months. Clinical assessment of symptoms and signs were done using the ＂clinical observation table＂ once a month before and after the treatment. Biochemical investigations of total bilirubin, ALT, AST, serum protein for liver function tests were done every month after initiating treatment. Serum was analyzed for HBV markers for HBsAg, HBeAg and HBV DNA at baseline, 4 and 6 mo alter therapy using ELISA kits from Roche.RESULTS： After 6 mo of therapy with HD-03/ES, a significant reduction of ALT values from 66.5 ± 11.1 to 39.1 ± 5.2 （P 〈 0.01） and a significant HBsAg loss （52%, P 〈 0.001）, HBeAg loss （60%, P 〈 0.05） and HBV DNA loss （60%, P 〈 0.05） was observed. Adverse effects were mild and never warranted withdrawal of the drug.CONCLUSION： The results of this pilot study indicate that HD-03/ES might be a safe and effective treatment for chronic hepatitis B infection and a long-term multicentric comparator trial is warranted and under way.

A clinical trial of cytokine induced killer cells treating patients with malignant tumor after radiochemotherapy

Objective: Our study investigated the immunity changes and life quality changes after the treatment of cytokine induced killer (CIK) cells for patients with malignant tumor after radiochemotherapy, and explored the therapeutic effects of CIK cells on these patients. Methods: Thirty-one patients with malignant tumor after radiochemotherapy were treated with CIK cells. Before and after CIK cells being transfused back, the immunity indexes of the peripheral blood of these cases were detected and the changes of life quality of these cases were compared. Results: After radiochemotherapy, the percentage of CD3+, CD4+ cells declined, the percentage of CD8+ cells rose; the ratio of CD4+/CD8+ declined, and the percentage of CD16+, CD56+ cells declined. As all the above indexes compared with that of normal people, the difference was significant (P < 0.05). After CIK cells therapy, the above indexes improved (P < 0.05). Life quality improved significantly after CIK cells therapy (P < 0.05). Conclusion: Radiochemotherapy can inhibit the immunity in patients with malignant tumor. CIK cells therapy is safe and effective. It may improve the recent immunity and life quality of the patients, which suggesting that it may be an alternative maintenance treatment for patients with malignant tumor after radiochemotherapy.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

Clinical Analysis of 30 Cases of Deep Lamellar Keratoplasty for the Treatment of Corneal Disease

purpose： to analyze clinical therapeutic effect of deep lamellar keratoplasty on treatment of corneal disease. Method： select 30 cases of corneal disease patients with a total of sick eyes, from 2012 January to 2013 January; all patients underwent deep lamellar keratoplasty, then observe and analyze visual acuity, corneal and occurrence of complications, to comprehensively assess the clinical therapeutic effect. Result： after receiving treatment of deep lamellar keratoplasty, of the 30 patients and 40 eyes, 31 corneal grafts are transparent; 9 corneal grafts are translucent; postoperative visual acuity： I0 eyes are 0.01-0.04; 13 eyes are 0.05~0.1; 14 eyes are 0.1-0.4; 3 eyes are above 0.5; 10 eyes have descemet micro-perforation or small perforation; 7 eyes have complications; these conditions are all controlled after active treatment. Conclusion： for patients with corneal disease, deep lamellar keratoplasty can not only achieve the similar transparency and visual rehabilitation as penetrating keratoplasty, but also reduce the incidence of adverse reactions and reject reaction after operation, to achieve the purpose of treatment and vision improvement; it has significant clinical effect, and greatly improve the quality of patients＇ life, so it is worthy of clinical application.

A clinical comparative study of GP and TP 1st-line chemotherapies for advanced non-small cell lung cancer

Objective： The aim of the study was to evaluate the efficacies of initial gemcitabine plus cisplatin （GP） and paclitaxel plus cisplatin （TP） 1st-line chemotherapies for advanced non-small cell lung cancer （NSCLC） and observe their side effects. Methods： Eighty-one cases were randomly divided into two groups： GP group and TP group. In GP group, adminis- tered gemcitabine （GEM） 1000 mg/m2 on days 1 and 8; i.v. cisplatin （DDP） 30 mg/m2 from days 2 to 4 on a 28-day cycle. In TP group, administered paclitaxel （PTX） 175 mg/m2 on day 1, i.v. DDP 30 mg/m2 from days 2 to 4 on a 28-day cycle. Results： GP group had an overall response rate （ORR; CR＋PR） of 45.0% （18/40）. TP had an overall response rate of 43.2% （16/37）. Short-term ORR had no significant difference between two groups （x2 = 0.527, P = 0.957）. GP had median survival time of 11 months and 37.7% of one-year survival rate, while TP showed 11 months of median survival time and 31.7% of one-year survival rate. Survival had no significant difference between two groups （x2 = 0.140, P = 0.708）. However, main side effects varied. Thrombocytopenia of GP group was significantly more than that of TP group, while peripheral neuritis, nausea/vomiting and myalgia of TP group were significantly more than those of GP group. Conclusion： Both GP and TP regimens had no significant difference in short-term treatment effect and survival rate for initial treatment of advanced NSCLC. However, side effects related to GP regimen treatment were slighter. Therefore, it was considered as the preferred initial first-line treatment for NSCLC.

Microsurgical Resection of Pituitary Adenoma via Single-Nostril Transsphenoidal Approach

OBJECTIVE To explore the methods and experience of thesingle-nostril transsphenoidal approach for treating pituitaryadenomas.METHODS We retrospectively analyzed 46 patients whohad pituitary tumors and received surgery via the singlenostriltranssphenoidal approach and observed the effects andcomplications of surgery. The specific surgical methods are: a nasalspeculum is inserted slowly through the right nostril towards theanterior wall of the sphenoid sinus. A 1.5 cm incision is made intothe nasal mucosa in the right nasal cavity at the level of the middlenasal turbinate. By fracturing the bony septum, a space is formedbetween the bilateral nasal mucosa and the bony septum of thesphenoid sinus. Then, the inside of the sphenoid sinus is exposed.The remaining part of the bony septum, the anterior sphenoidsinus wall, and the sphenoid mucosa are gradually removed. Theanterior sphenoidotomy is less than 1.5 cm wide. After confirmingthe tumor by dural puncture, a cross incision of the dura is made,and the tumor is slowly removed by curette. The sella is usuallycollapsed and visible after the total tumor removal. When thetumor is resected satisfactorily, gelatin sponges are placed into theoperative cavity to stop bleeding.RESULTS Postoperative MRI scans revealed that among the 46cases, total resection of the tumor was achieved in 34 cases andsubtotal in 12. No deaths or disability occurred, and the hormonelevels of almost all patients improved. Signs of diabetes insipidusoccurred in 17, electrolyte disturbances in 5, and there were noreports of postoperative cerebrospinal fluid rhinorrhea.CONCLUSION The direct single nostril transsphenoidalapproach of continuous improvement has the advantages ofa convenient approach, simplified operation, safety and highefficiency.

Clinical analysis of 45 cases of surgical treatment for inner thigh primary soft tissue sarcoma

Objective: We aimed to study the relationship between clinical effect and surgical methods of inner thigh primary soft tissue sarcomas. Methods: Wide or radical resection were performed in 45 cases of soft tissue sarcomas, including 20 cases of postoperative recurrence after radiation therapy, 7 cases of first treatment. Thirty-six cases received 4–6 cycles of postoperative chemotherapy. Results: Thirty-eight of 45 cases were followed up for 1–5 years, with 5 case of recurrence and 6 cases of distant metastasis. Conclusion: The inner thigh primary soft tissue sarcoma can be effectively treated with wide or radical resection.

Clinical observation of Fufangchangtai decoction combined with FOLFOX4 regimen for postoperative colorectal cancers

Objective:The aim of the study was to observe the therapeutic effect of FOLFOX4 regimen plus Fufangchangtai decoction on postoperative colorectal cancers.Methods:Thirty postoperative colorectal cancer patients were allocated into control and experiment groups respectively.Patients in experiment group were given Fufangchangtai decoction combined with FOLFOX4 regimen.Patients in control group were given FOLFOX4 regimen alone.Efficacy was evaluated after 2 periods of treatment.Results:The improvement rate of symptoms were 86.6% in experiment group compared to 53.3% in control group.KPS was stable in experiment group,and decreased in control group.QOL was increased in experiment group,and stable in control group after the treatment.For impact of immunity parameters,there were enhancements of CD3+ and CD4+ in experiment group,while they did not change in control group.In experiment group,WBC reduction was slighter than that of control group.The differences were not remarkable in PLT reduction,alimentary response,and toxicity of liver and kidney and nervous system.Conclusion:The clinical observation showed that Fufangchangtai decoction plus FOLFOX4 regimen could effectively enhance KPS,improve the symptoms,the quality of life and the immunity state,and down-regulate the side effects.In conclusion,Fufangchangtai decoction can decrease the toxicity so as to increase the treatment effect.

FDG-PET AS A ROUTINE SURVEILLANCE TOOL IN HEAD AND NECK CARCINOMA SIX MONTHS AFTER TREATMENT

Objective To evaluate prospectively the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the detection of recurrence, second primary cancers, and distant metastases in head and neck squamous cell carcinoma (HNSCC) 6 months after treatment. Methods A total of 41 patients without any clinical element for recurrence, second primary cancer, or distant metastases received a whole-body FDG-PET as a routine surveillance tool 6 months after initial combined curative therapy for HNSCC. Results There were 35 negative PET results and 6 positive. One patient with abnormal FDG-PET did not have recurrent HNSCC (false positive). Five had true positive results: proven recurrence in 2 patients, second primary cancer in 2, and distant metastasis in 1. The sensitivity and specificity of FDG-PET for the diagnosis of HNSCC recurrence, second tumor, and distant metastases were 100% (5/5) and 97.2% (35/36), respectively. The positive predictive value was 83.3% (5/6). The negative predictive value was 100% (35/35). The overall accuracy was 97.6% (40/41). FDG-PET had a therapeutic impact in 5 of 41 patients (12.2%). There was no impact of FDG-PET on management in other 36 patients. Conclusion FDG-PET is useful as primary method for detecting nodal recurrence and distant metastases in HNSCC as well as second cancer in subclinical patients as it had a high effectiveness. But systematic FDG-PET performed at 6 months in patients without any clinical suspicion of local recurrence was scarcely useful.

Regression Model to Analyze Differential Response to Treatment in Randomized Controlled Clinical Trial

The primary aim of clinical trials is to investigate whether a treatment is effective for a particular disease or condition. Randomized controlled clinical trials are considered to be the gold standard for evaluating the effect of a certain intervention. However, in clinical trials, even after randomization, there are situations where the patients differ substantially with respect to the baseline value of the outcome variable. Many a times the response to interventions depends on the baseline values of the outcome variable. When there are baseline-dependent treatment effects, differences among treatments vary as a function of baseline level. Although variation in outcome associated with baseline value is accounted for in ANCOVA, analysis of individual differences in treatment effect is precluded by the homogeneity of regression assumption. This assumption requires that expected differences in outcome among treatments be constant across all baseline levels. To overcome this difficulty, Weigel and Narvaez [7] proposed a regression model for two treatment groups to analyze individual response to treatments in randomized controlled clinical trials. The authors reviewed the model suggested by Weigel and Narvaez and extended further for three or more treatment groups. The utility of the model was demonstrated with real life data from a randomized controlled clinical trial of bronchial asthma.

Clinical Effects of Acupuncture Combined with Nimodipine for Treatment of Vascular Dementia in 30 Cases

To study the therapeutic effects of acupuncture combined with nimodipine for vascular dementia. Methods： Acupuncture was applied at Baihui （GV 20）, Shenshu （BL 23）, Geshu （BL 17）, and the points selected according to the midnight-noon, ebb-flow eight methods of the intelligent turtle, combined with the drug nimodipine. The treatment was continued for 8 consecutive weeks. Results： Of the 30 cases treated, 6 cases were cured, 21 cases improved, and 3 cases failed, with a total effective rate of 90%. Conclusion： Acupuncture at Baihui （GV 20）, Shenshu （BL 23）, Geshu （BL 17）, and the points selected according to the midnight-noon, ebb-flow eight methods of the intelligent turtle combined with the drug nimodipine can yield definite therapeutic effects for vascular dementia.

Clinical Research Progress of Acupuncture-moxibustion for Chronic Urticaria

To learn the current research status of acupuncture-moxibustion in treating chronic urticaria, the relevant clinical reports indexed by CNKI and VlP databases during 2000 and 2012 were retrieved, and then summarized and analyzed from the aspects of treatment method, acupoint selection, medicine, treatment frequency, and criteria of therapeutic efficacy, for guiding the treatment of chronic urticaria with acupuncture-moxibustion. The results show that acupuncture-moxibustion therapy has stable therapeutic efficacy in treating chronic urticaria with low adverse reaction rate, but the current evaluation criteria are too subiective to cluantifv.

Using acupoint-to-acupoint penetrative needling to treat poststroke spastic paralysis:a clinical progress review

OBJECTIVE: To determine the characteristics and advantages of acupoint-to-acupoint penetrative needling(AAPN) treatment for post-stroke spastic paralysis(PSSP) to improve the clinical outcomes of this disease in the future.METHODS: Randomized, controlled trials of PSSP patients receiving AAPN treatment were searched from MEDLINE, EMBASE, and China National Knowledge Infrastructure Database between January 2006 and June 2013. Key words included: clinic or clinical, acupuncture, needling, acupoint-to-acupoint, penetrative or penetration or penetrating,stroke or apoplexy or cerebral infarction or cerebral hemorrhage, spastic paralysis or spasticity or palsy,and hypermyotonia. Language was limited to English and Chinese. Case series reports, review articles, and animal studies were excluded.RESULTS: AAPN showed better clinical results on PSSP than other acupuncture treatments, especially when combined with adjunct therapies such as electroacupuncture, bloodletting, and rehabilitation. The greatest benefit was achieved with rehabilitation combined with penetration from Yang-channel acupoints to Yin-channel acupoints in the upper limbs, and from Yin-channel acupoints to Yang-channel acupoints in the lower limbs with a reinforcing maneuver.CONCLUSION: AAPN is an effective treatment for PSSP, and it can accelerate and enhance functional repair of PSSP patients.