剖宫产瘢痕妊娠的临床特点及不同临床类型治疗结果的作用探讨

目的评价剖宫产瘢痕妊娠的临床特点及不同临床类型治疗结果的作用。方法选入2015年1月至2018年1月我院收治的剖宫产瘢痕妊娠患者40例,采用抽签法的分组形式将其平均划分成为两个组别,即实验组与对照组,每组各为20例,对照组为内生类型的瘢痕妊娠采用常规的手术治疗法,实验组为外生类型的瘢痕妊娠采用腹腔镜电切除手术法,分析治疗效果、手术与住院时间、并发症。结果实验组的治疗效果、手术与住院时间、并发症远远优于对照组,数据之间的对比存在统计学差异性,P<0.05。结论在剖宫产瘢痕妊娠实际治疗的过程中,结合不同类型的病症进行治疗,有助于提升治疗效果。

不同类型音乐辅助治疗阿尔茨海默病患者对促进患者认知能力恢复的作用对比

针对阿尔茨海默病患者,评价不同类型音乐辅助治疗对促进其认知能力恢复的效果。方法 将我院2018年8月~2020年8月收录的68例患者进行研究,分别实施摇滚音乐辅助治疗以及莫扎特音乐辅助治疗,评价临床疗效。结果 观察组治疗后的ADAS-Cog评分较对照组更低,而ADL评分更高,对比有统计学差异(P<0.05)。观察组治疗后的情绪状态以及睡眠质量评分较对照组更高,对比有统计学差异(P<0.05)。结论 莫扎特音乐辅助治疗能调节阿尔茨海默病患者的认知功能,改善生活质量,值得地方推广。

放射治疗技术

放射治疗学已有百余年历史，对成年人的癌症来说，放射治疗目前仍是仅次于手术的治愈性手段。放射治疗学家的目的是给肿瘤组织致死性剂量的电离辐射；辐射对DNA的损伤将导致细胞死亡，尤其是当细胞进行有丝分裂时。辐射对正常组织和肿瘤组织影响的差异决定于以下几方面：

草鱼出血病的类型与防治

由“草鱼呼肠孤病毒”引起的草鱼出血病,是对草鱼危害最大的传染性疾病,草鱼鱼种最易发生,发病率与死亡率都很高,对渔业生产造成很大损失。 草鱼出血病流行于水温较高的6—10月,水温27℃以上最为流行,8月份为高峰期。根据病鱼所表现的症状及病理变化,大致可将症状区分为三种类型:

Primary Lymphoma of Respiratory System (A Report of 11 Cases)

Objective: To analyze the clinical and pathologic features and the treatmentoutcomes of primary lymphoma of respiratory system (PLRS). Methods: The clinical manifestation,imaging changes, pathologic subtypes, treatment and overall survival of 11 patients with PLRS wereanalyzed retrospectively. Results: Of the 11 patients diagnosed with PLRS by histopathology, thetumor of 2 patients occurred in trachea and the other 9 in lung. Cough, dyspnea and fever were themost frequent symptoms. Mass or infiltrative changes could be found on the chest X-ray and/or CTscan. Two patients were diagnosed as having Hodgkin's Lymphoma (HL) and 9 having non-Hodgkin'sLymphoma (NHL), including 7 patients with low degree NHL [5 of them (55.6%) were mucosa-associatedlymphoid tissue (MALT) lymphoma] and 2 with intermediate degree NHL. Of 10 patients undergoingexploratory thoracotomy and surgical treatment, 8 received adjuvant chemotherapy and 2 adjuvant ofradiotherapy. The remaining patient was subjected to combined chemotherapy. Both of HL patientssurvived more than 5 years without clinical disease. The median survival of MALT lymphoma and othertype of NHL was 39 months and 34 months respectively. Conclusion: Both the clinical manifestationand imaging changes are non-specific. The diagnosis was made through exploratory thoracotomy (10cases) and fiber-optical bronchoscopy (1 case). MALT lymphoma is the most frequent pathologicsubtype. Majority of patients are diagnosed and treated by surgical resection. The prognosis isacceptable.

Protocol of Interventional Treatment for Hepatocellular Carcinoma

To establish a reasonable protocol for interventional treatment ofhcpatocellular carcinoma (HCC). Methods: The data of 1000 HCC patients treated by different kinds ofinterventional treatments were reviewed with their results of biochemistry, imaging, pathology andsurvival rate evaluated. The values as well as the pros and cons of these various kinds ofinterventional treatments were compared in order to find an optimal protocol. Results:Segmental-transcatheter oil chemoembolization (S-TOCE) could more effectively eradicate the tumoryet inflicting less damage on the noncancerous hepatic tissue and giving much higher survival ratethan the conventional transcatheter oil chemoembolization (C-TOCE). Precutaneous ethanol injection(PEI) in combination with chemoembolization could eliminate the residual tumor and significantlyincrease the survival rate without damaging the noncancerous hepatic tissue. The living quality orsurvival rate could be improved by choosing different ways of interventional treatments to cut downthe complications. Conclusion: The selection of different interventional treatments should bo doneaccording to the size and type of HCC. Active management is indicated for different complicationspresenting along with HCC.

Dosimetric evaluation of VMAT radiation therapy technique for breast cancer after conservative surgery based on three different types of multileaf collimators

Objective Radiotherapy combined with conservative surgery plays an important role in the treatment of early-stage breast cancer. Volumetric modulated arc therapy(VMAT) has been introduced into clinical practice. The purpose of this study was to investigate the dosimetric effects of different multileaf collimators(MLC) on VMAT radiotherapy plans for treating breast cancer.Methods Fifteen breast cancer patients who were treated using a conventional technique in our department were selected to participate in this retrospective analysis. VMAT plans based on three types of Elekta MLCs [Beam Modulator(BM) with 4-mm leaf width, Agility with 5-mm leaf width and MLCi2 with 10-mm leaf width] were independently generated for each patient. Plan comparisons were performed based on dose-volume histogram(DVH) analysis including dosimetric parameters such as the homogeneity index(HI), conformity index(CI), Dmax, Dmin, and Dmean for the planning treatment volume(PTV), in addition to dose-volume parameters for the organs at risk(OARs). The delivery efficiency of the three types of MLCs was compared in terms of the beam delivery time and the monitor units(MUs) per fraction for each plan. Results Both target uniformity and conformity were improved in plans for Agility and BM MLC compared with the plan using MLCi2. The mean HI decreased from 1.14 for MLCi2 to 1.13 for BM and 1.10 for Agility, while the mean CI increased from 0.68 for MLCi2 to 0.73 for BM and 0.75 for Agility. Furthermore, at both low and high dose levels, smaller volumes of ipsilateral lung, heart, contralateral lung, and breast were irradiated with Agility MLC than with the other two types of MLCs. The delivery time with Agility MLC was reduced by 10.8% and 32.1%, respectively, compared with that for MLCi2 and BM.Conclusion Our results indicate that the Agility MLC exhibits a dosimetric advantage and a significant improvement in delivery efficiency for the treatment of breast cancer using VMAT.

Clinical characteristics and type of antithrombotic treatment in a Spanish cohort of elderly patients with atrial fibrillation according to dependency, frailty and cognitive impairment

Background Available data regarding clinical profile and management of elderly patients with atrial fibrillation （AF） according to dependency, fragility and cognitive impairment are scarce. The objective of the study was to analyze the biodemographic data, clinical profile and antithrombotic treatment according to dependency, fragility and cognitive impairment in elderly AF patients. Methods Cross- sectional and multi-center study performed in consecutive AF patients ≥ 75 years treated with oral anticoagulants ≥ 3 months attended in Internal Medicine Departments in Spain. Results A total of 837 patients （83.0 ± 5.0 years; CHA2DS2-VASc： 5.0 ± 1.4; HAS-BLED： 2.1 ± 0.9） were included. 44.4% of patients had some degree of dependency, 43.3% were fragile, and 32.3% had cognitive impairment. Patients with any of these conditions were older, had a worse clinical profile, with more comorbidities and higher risks of thromboembolic and bleeding events. All these conditions were independently associated among them. Overall, 70.8% of patients were taking vitamin K antagonists, the remaining 29.2% direct oral anticoagulants and 9.7% oral antiplatelets. This distribution was independent of the presence of dependency or fragility, but there was a trend to a higher prescription of vitamin K antagonists in those patients with cognitive impairment （75.2% vs. 68.8%; P = 0.05）. Conclusions Approximately 32%-44% of elderly anticoagulated AF patients attended have some degree of dependency, fragility and/or cognitive impairment. Patients with any of these conditions are older and have a worse clinical profile. Ap？proximately 71% of patients are taking vitamin K antagonists, regardless dependency or frailty, but with a trend to higher prescription in patients with cognitive impairment.

Pancreatic cancer–Neoadjuvant therapy

In spite of the high mortality in pancreatic cancer, significant progress is being made. This review discusses multimodality therapy for patients with pancreatic cancer. Surgical therapy currently offers the only potential monomodal cure for pancreatic adenocarcinoma. However only 10%–20% of patients present with tumors that are amenable to resection, and even after resection of localized cancers, long term survival is rare. The addition of chemoradiation therapy significantly increases median survival. To achieve long-term success in treating this disease it is therefore increasingly important to identify effective neoadjuvant/adjuvant multimodality therapies. Preoperative chemoradiation for potentially resectable pancreatic cancer has the following advantages: (1) neoadjuvant treatment would eliminate the delay of adjuvant treatment due to postoperative complications; (2) neoadjuvant treatment could avoid unnecessary surgery for patients with metastatic disease evident on restaging after neoadjuvant therapy; (3) downstaging after neoadjuvant therapy may increase the likelihood for negative surgical margins; and (4) neoadjuvant treatment could prevent peritoneal tumor cell implantation and dissemination caused during surgery. This review systematically summarizes the current status, controversies, and prospects of neoadjuvant treatment of pancreatic cancer.

Evaluation of Cladribine treatment in refractory celiac disease type Ⅱ

AIM: To evaluate cladribine [2-chlorodeoxyadenosine (2-CdA)] therapy in refractory celiac disease (RCD) Ⅱ. METHODS: An open-label cohort-study of RCD Ⅱ patients treated with 2-CdA was performed between 2000 and 2010. Survival rate, enteropathy associated T-cell lymphoma (EATL) occurrence, clinical course, and histological and immunological response rates were evaluated. RESULTS: Overall, 32 patients were included with a median follow-up of 31 mo. Eighteen patients responded well to 2-CdA. Patients responsive to 2-CdA had a statistically significant increased survival compared to those who were unresponsive. The overall 3- and 5-year survival was 83% in the responder and 63% and 22% in the non-responder group, respectively. The overall 2-year clinical, histological and immunological response rates were 81%, 47% and 41%, respectively. Progression into EATL was reported in 16%, all of these patients died. CONCLUSION: Treatment of RCD Ⅱ with 2-CdA holds promise, showing excellent clinical and histological response rates, and probably less frequent transition into EATL.

Effect of the Type of Vitis vinifera Cultivation in the Cenophenoresistome and Metabolic Profiling （CLPP） of Edaphic Bacterial Communities

In the present work, bacterial soil communities of different grapevine exploitation samples are studied in order to elucidate the possible influence of different agrarian management techniques （use of fertilizers, irrigation with river water） may have on the rhizospheric microbiome of Vitis vinifera plants. Therefore, it is postulated the Cenophenoresistome as a novel methodology to evaluate complex communities＇ global resistance against different antibiotics, by using and adjusting a serial of techniques traditionally applied to evaluate a monospecific population＇s resistance against antibiotics （Vitek, ATB and disk diffusion methods）. Likewise, the metabolic profile （CLPP： comunity level physiological profile） of bacterial communities is studied by Biolog ECO. In relation to the functional structure of the bacterial communities, it is observed that the metabolic profile （diversity, kinetics and CLPP） of unexploited soils differs from soils under anthropic influence. It is discussed the causes of resistance in the human clinic antibiotic treatment based on the agrarian management, especially with the contamination transmitted by irrigation water, which could be associated with changes in edaphic communities. The results obtained in the present study through two different approaches （Cenophenoresistome and metabolic profiles） are consistent with each other, suggesting that both methods can be good bioindicators of the state of humankind-altered soils that host natural ecosystems. Likewise, the concept of Cenophenoresistome is proposed as a bioindicator of soil response to alteration processes, as well as a possible predictor of its evolution in edaphic remediation processes.

Dosimetric evaluation of CR, 3DCRT and two types of IMRT for breast cancer after conservative surgery

Objective: The purpose of this study was to compare the dose distribution and dose volume histogram (DVH) of the planning target volume (PTV) and organs at risk (OARs) among conventional radiation therapy (CR), three-dimensional conformal radiation therapy (3DCRT), two-step intensity-modulated radiation therapy (TS-IMRT) and direct machine parameter optimization intensity-modulated radiation therapy (DMPO-IMRT) after breast-conserving surgery. Methods: For each of 20 randomly chosen patients, 4 plans were designed using 4 irradiation techniques. The prescribed dose was 50 Gy/2 Gy/25 f, 95% of the planning target volume received this dose. The cumulated DVHs and 3D dose distributions of CR, 3DCRT, TS-IMRT and DMPO-IMRT plans were compared. Results: For the homogeneity indices, no statistically significant difference was observed among CR, 3DCRT, TS-IMRT and DMPO-IMRT while the difference of the conformality indices were statistically significant. With regard to the organs at risk, IMRT and 3DCRT showed a significantly fewer exposure dose to the ipsilateral lung than CR in the high-dose area while in the low-dose area, IMRT demonstrated a significant increase of exposure dose to ipsilateral lung, heart and contralateral breast compared with 3DCRT and CR. In addition, the monitor units (MUs) for DMPO-IMRT were approximately 26% more than those of TS-IMRT and the segments of the former were approximately 24% less than those of the latter. Conclusion: Compared with CR, 3DCRT and IMRT improved the homogeneity and conformity of PTV, reduced the irradiated volume of OARs in high dose area but IMRT increased the irradiated volume of OARs in low dose area. DMPO-IMRT plan has fewer delivery time but more MUs than TS-IMRT.

Lamivudine treatment enabling right hepatectomy for hepatocellular carcinoma in decompensated cirrhosis

A 69-year-old man was admitted to our hospital in October 2003,for further examination of two liver tumors.He was diagnosed with hepatocellular carcinoma(HCC) arising from decompensated hepatitis B virus(HBV)-related cirrhosis.Long-term lamivudine administration improved liver function dramatically despite repeated treatment for HCC.His Child-Pugh score was 9 points at start of lamivudine treatment,improving to 5 points after 1 year.His indocyanine green at 15 min after injection test score was 48%before lamivudine treat-ment,improving to 22%after 2 years and to 5%after 4 years.Radiofrequency ablation controlled the HCC foci and maintained his liver function.In April 2009,abdominal computed tomography revealed a tumor thrombus in the right portal vein.Since his indocyanine green test results had improved to less than 10%,we performed a right hepatectomy,which was successful.To our knowledge,there have been no documented reports of patients undergoing successful right hepatectomy for HCC arising from decompensated cirrhosis.The findings observed in our patient indicate the importance of nucleoside analogs for treating HBV-related HCC.

Safety of lamivudine treatment for chronic hepatitis B in early pregnancy

AIM:To evaluate the safety of lamivudine(LAM) treatment for chronic hepatitis B in early pregnancy.METHODS:A total of 92 pregnant women who received LAM treatment either before pregnancy or in early pregnancy were enrolled in this study.All of the pregnant women volunteered to take lamivudine during pregnancy and were not co-infected with hepatitis C virus,human immunodeficiency virus,cytomegalovirus,or other viruses.All infants received passiveactive immunoprophylaxis with 200 IU hepatitis B immunoglobulin and three doses of 10 μg hepatitis B vaccines(0-1-6 mo) according to the guidelines for the prevention and treatment of chronic hepatitis B.Adverse events were observed throughout the entire pregnancy and perinatal period,and the effectiveness of lamivudine treatment for blocking mother-to-infant transmission of hepatitis B virus(HBV) was evaluated.All adverse events in mothers and infants during pregnancy and the perinatal period and the HBV motherto-infant transmission blocking rate were compared with the literature.RESULTS:Among the 92 pregnant women,spontaneous abortions occurred in 11 cases,while 3 mothers had a second pregnancy after the initial abortion;72 mothers delivered 73 live infants,of whom 68 infants were followed up for no less than 6 mo,and 12 mothers were still pregnant.During pregnancy,the main maternal adverse events were vaginitis(12/72,16.7%),spontaneous abortion(11/95,11.6%),and gestational diabetes(6/72,8.3%);only one case had 1-2 degree elevation of the creatine kinase level(195 U/L).During the perinatal period,the main maternal adverse events were premature rupture of the membranes(8/72,11.1%),preterm delivery(5/72,6.9%),and meconium staining of the amniotic fluid(4/72,5.6%).In addition,2 infants were found to have congenital abnormalities;1 had a scalp hemangioma that did not change in size until 7 mo,and the other had early cerebral palsy,but with rehabilitation training,the infant's motor functions became totally normal at 2 years of age.The incidence of adverse events among the mothers or abnormalities in the infants was not higher than that of normal mothers or HBV-infected mothers who did not receive lamivudine treatment.In only 2 cases,mother-to-infant transmission blocking failed;the blocking rate was 97.1%(66/68),which was higher than has been previously reported.CONCLUSION:Lamivudine treatment is safe for chronic HBV-infected pregnant mothers and their fetuses with a gestational age of less than 12 wk or throughout the entire pregnancy.

Does it make sense evaluating cardiac resynchronization therapy in the elderly regardless of the type of the device？

We read the research article entitled Is cardiac resyn- chronisation therapy feasible, safe and beneficial in the very elderly？ with great interest. The authors emphasized that despite the average age of heart failure was 77 years in the general population of UK,patients receiving cardiac re- synchronisation therapy [with pacemaker alone （CRT-P） or with additional defibrillator capabilities （CRT-D）] were on younger ages at 72 and 67 years respectively. In the lights of this data, we agree with the authors that CRT seems to be undemtilized in the elderly patients with heart failure.

Use of agents stimulating erythropoiesis in digestive diseases

Anemia is the most common complication of inflammatory bowel disease (IBD). Control and inadequate treatment leads to a worse quality of life and increased morbidity and hospitalization. Blood loss, and to a lesser extent, malabsorption of iron are the main causes of iron def iciency in IBD. There is also a variable component of anemia related to chronic inflammation. The anemia of chronic renal failure has been treated for many years with recombinant human erythropoietin (rHuEPO), which significantly improves quality of life and survival. Subsequently, rHuEPO has been used progressively in other conditions that occur with anemia of chronic processes such as cancer, rheumatoid arthritis or IBD, and anemia associated with the treatment of hepatitis C virus. Erythropoietic agents complete the range of available therapeutic options for treatment of anemia associated with IBD, which begins by treating the basis of the inflammatory disease, along with intravenous iron therapy as f irst choice. In cases of resistance to treatment with iron, combined therapy with erythropoietic agents aims to achieve near-normal levels of hemoglobin/hematocrit (11-12 g/dL). New formulations of intravenous iron (iron carboxymaltose) and the new generation of erythropoietic agents (darbepoetin and continuous erythropoietin receptor activator) will allow better dosing with the same eff icacy and safety.

应用SPSS逐步判别分析建立晚期血吸虫病治疗分类模型的研究

目的运用SPSS逐步判别分析方法建立晚期血吸虫病治疗分类函数方程,探讨相关指标临床价值。方法收集晚期血吸虫住院病人资料80例,其中外科治疗病人38例,内科治疗病人42例,并同时收集病人的相关临床指标,并利用SPSS采用逐步判别分析法建立分类函数方程。结果进入分类函数方程的临床指标分别红细胞X1、谷草转氨酶X8(自然对数值)及腹水X10,所建立Fisher判别方程Y=-4.893-0.521X1+1.727X8+2.295X10,其标准化函数系数分别是-0.358、0.460、0.771;所建立Bayes判别方程为Y外科治疗=-41.639+8.601X1+20.093X8+12.765X10;Y内科治疗=-53.591+7.313X1+24.366X8+18.442X10;其函数方程的回顾性检验正确率与误判率分别为87.5%、12.5%;刀切法检验正确率及误判率分别为87.5%、12.5%。结论临床指标红细胞、谷草转氨酶及腹水对判断晚血住院治疗类型具有重要的临床意义,利用逐步判别分析所建立方程对晚期血吸虫病住院治疗类型判断具有参考性价值。

脑出血,来势凶猛的“杀手”

脑出血是指脑实质内的出血,是第二大常见的脑卒中类型,发病率在15%~30%。它是潜伏在我们生命中的危险杀手,发病后死亡率可达50%。是脑血管病中致死、致残率最高的病种,所以也被人们称为来势最凶猛的＂杀手＂。脑出血的病因瑞士的Johan Wepfer（1620~1695）最早在尸检中发现了脑出血,当时认为问题出在血液中的＂元气＂问题。