分析探讨小脑血管畸形的临床特点及手术治疗方法与疗效

目的对小脑血管畸形的临床特点及手术治疗方法与临床疗效进行分析探讨。方法选取2012年9月至2014年3月在我院确诊为小脑血管畸形的患者100例作为研究对象,按照随机数字表法将患者分为对照组50例和观察组50例,对照组采用血管内栓塞治疗,观察组采用手术治疗,比较两组的临床疗效。结果观察组治疗后的总有效率(88.00%)明显好于对照组治疗后的总有效率(62.00%),观察组治疗后的不良反应等发生率(20.00%)明显低于对照组治疗后的不良反应的发生率(48.00%),两组比较具有统计学意义(P<0.05)。结论小脑血管畸形有不同的临床表现,采用手术治疗的疗效好于采用血管内栓塞治疗,患者的不良反应的发生率较低,值得在临床中推广应用。

花粉致变应性鼻炎免疫治疗方法及护理对策的分析

目的:探讨变应性鼻炎病人行特异性免疫治疗,观察其临床效果。方法:将吸入性变应原致AR的80例病人随机分为常规免疫治疗和加速免疫治疗两组,每组40人,采用皮下注射的方法,从低浓度向高浓度剂量逐渐递增。结果:接受常规免疫治疗的病人在3~4个月达到最高耐受点进入维持治疗期,接受加速免疫治疗者在10~14天即可进入维持治疗期。结论:两种免疫治疗疗效相似,均能提高机体对相应致敏原的耐受能力,减轻过敏症状。而疾病健康宣教能使病人消除恐惧心理,提高病人的治疗依从性。

乌贝止血散、大黄片联合治疗上消化道出血25例疗效观察

乌贝止血散、大黄片联合治疗上消化道出血２５例疗效观察徐国琴（上海市建工医院中医科上海２０００８３）我院中医科应用乌贝止血散、大黄片治疗急性上消化道出血，同时设立大黄片组２５例为对照，观察药物疗效，总结如下。１临床资料病例来源于１９８８年８月至１９８９...

中西医结合治疗71例支气管扩张合并急性感染疗效观察

目的:本文对比分析了常规西医抗感染治疗与中西医结合治疗支气管扩张合并急性感染的临床疗效。方法:对照组35例予常规抗感染治疗,治疗组36例在此基础上,配合中药汤剂加味苇茎汤口服,比较两组疗效。结果治疗组显效率91.6%,有效13.8%,总有效率100%;对照组显效率80%,有效14.3%,总有效率94.3%,两组显效率比较有显著性差异。结论:中西医结合治疗支气管扩张伴感染疗效优于西药抗感染治疗。

成人结节性胃炎32例临床分析

目的探索分析成人结节性胃炎的临床特点和治疗方法。方法：选择32例成人结节性胃炎患者，回顾分析患者的临床资料，总结成人结节性胃炎的临床特点和治疗方法。结果：患者的临床表现主要为上腹痛、消化不良症状、恶心、呕吐等，内镜特征以胃窦部为主，可见扩展到胃体部的均匀分布的颗粒样或者结节样颗粒改变，32例均为Hp感染阳性者，经过Hp根除治疗，截至目前，32例患者复查14E-呼气试验为阴性、胃镜见结节消失，黏膜恢复正常，经病理检查未见淋巴滤泡。结论：成人结节性胃炎是由于Hp感染造成的，根除Hp治疗是一种有效的治疗方法。

Genetic polymorphisms of ADH2 and ALDH2 association with esophageal cancer risk in southwest China

AIM＂ TO evaluate the impact of alcohol dehydrogenase 2 （ADH2） and aldehyde dehydrogenase 2 （ALDH2） polymorphisms on esophageal cancer risk. METHODS;One hundred and ninety-one esophageal cancer patients and 198 healthy controls from Yanting County were enrolled in this study. ADH2 and ALDH2 genotypes were examined by polymerase-chain-reaction with the confronting-two-pair-primer （PCR-CTPP） method. Unconditional logistic regression was used to calculate the odds ratios （OR） and 95% confidence interval （95% CI）. RESULTS; Both ADH2＊1 allele and ALDH2＊1/＊2 allele showed an increased risk of developing esophageal cancer. The adjusted OR （95% CI） for ADH2＊1 allele compared with ADH2＊2/＊2 was 1.65 （95% CI = 1.02-2.68） and 1.67 （95% CI = 1.02-2.72） for ALDH2＊1/＊2 compared with ALDH2＊1/＊1. A significant interaction between ALDH2 and drinking was detected regarding esophageal cancer risk, the OR was 1.83 （95% CI = 1.13-2.95）. Furthermore, when compared with ADH2＊2/＊2 and ALDH2＊1/＊1 carriers, ADH2＊1 and ALDH2＊2 carriers showed an elevated risk of developing esophageal cancer among non-alcohol drinkers

Meta-analysis of probiotics for the treatment of irritable bowel syndrome

Irritable bowel syndrome （IBS） is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics （beneficial microbes taken to improve health） may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded bials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. Pubr4ed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk （RRpooled） 0.77, 95% confidence interval （95% CI） 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RRpooled = 0.78 （0.69-0.88）]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.

剖宫产瘢痕妊娠治疗方法优劣的荟萃分析

目的比较剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)常用的几种治疗方法的疗效。方法检索中外数据库中治疗CSP的文献,将符合纳入标准的前瞻性临床对照试验进行荟萃分析。结果 72个试验纳入本研究,通过荟萃分析得到在治愈率、月经复潮时间、出血量等方面比较的数据。结论手术治疗优于子宫动脉栓塞术(uterine artery embolization,UAE)/子宫动脉化疗栓塞术(uterine arterial embolization chemotherapy,UAEC)后刮宫术(dilatation and curettage,D&C);腹腔镜病灶切除术优于经腹病灶切除术;阴式病灶切除术治疗外生型CSP优于腹腔镜病灶切除术;甲氨蝶呤(methotrexate,MTX)局部用药后D&C优于MTX全身用药后D&C;UAEC后D&C优于孕囊内MTX注射后D&C;UAE/UAEC后D&C优于直接D&C。

Hemosuccus pancreaticus: Problems and pitfalls in diagnosis and treatment

Hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Interventional radiology is the first modality for early diagnosis and possible treatment of hemosuccus pancreaticus. When angiography shows no abnormal findings or interventional radiological therapy can not be successful, surgery should be considered without delay. Our patients herein underwent surgery without recurrence or sequelae. Intraoperative ultrasonography and pancreatoscopy were helpful modalities for confirming the source of hemorrhage and determining the cutting line of the pancreas. When we encounter intermittent upper gastrointestinal bleeding with an obscure source, hemosuccus pancreaticus should be included in differential diagnoses especially in patients with chronic pancreatitis, which would lead to a prompt and proper treatment.

Antiviral efficacy of adefovir dipivoxil versus lamivudine in patients with chronic hepatitis B sequentially treated with lamivudine and adefovir due to lamivudine resistance

AIM： To compare the antiviral efficacy of adefovir （ADV） in lamivudine （LMV）-resistant patients with LMV treatment in nucleoside-naive patients, using serum samples collected sequentially during the course of treatment progressing from LMV to ADV.METHODS： Forty-four patients with chronic hepatitis B （CHB） were included. The patients were initially treated with LMV and then switched to ADV when LMV resistance developed. Antiviral efficacy was assessed by measuring the following： reduction in serum HBV DNA from baseline, HBV DNA negative conversion （defined as HBV DNA being undectable by the hybridization assay）, and HBV DNA response （either HBV DNA level ≤ 10^s copies/mL or a ≥ 2 log10 reduction from baseline HBV DNA level）.RESULTS： After two and six months of treatment, HBV DNA reduction was greater with LMV compared to ADV treatment （P = 0.021）. HBV DNA negative conversion rates were 64% and 27% after one month of LMV and ADV treatment respectively （P = 0.001）. Similarly, HBV DNA response rates were 74% and 51% after two months of LMV and ADV treatment respectively （P = 0.026）. The time taken to HBV DNA negative conversion and to HBV DNA response were both delayed in ADV treatment compared with LMV.CONCLUSION： The antiviral efficacy of ADV in LMV-resistant patients is slower and less potent than that with LMV in nucleoside-naive patients during the early course of treatment.

Screen p53 mutations in hepatocellular carcinoma by FASAY:A novel splicing mutation

Objective： To establish a routine procedure for the detection of p53 mutations in hepatocellular carcinoma （HCC） surgical resections using the FASAY （functional analysis of separated alleles of p53 on yeast） procedure. Methods： p53 status was analyzed by FASAY and cDNA sequencing in 50 cases of HCC. After the extraction of RNA from the frozen tumor and corresponding normal tissues, reverse transcription RT-PCR was carried out using these samples. The assay can detect mutations of p53 mRNA between codons 67 and 347 by the DNA-binding activity of the protein and reveal them as red colonies. Results： Of the 50 specimens, 29 （58%） were positive （mutan0 by FASAY. Sequencing analysis confirmed that all 29 FASAY positive tumors harbored mutations, and that no mutations were detectable in any FASAY negative tumors. In 29 p53 mutations, 22 mutations were point missense mutation, 5 were deletions and 2 were splicing mutations. A novel splice mutation on splice donor of intron 6 was reported, which could produce two different mRNAs, respectively using the nearest upstream and downstream recessive splice donor sites. Conclusion： FASAY is a sensitive method for detecting the various types of p53 mutations in HCC, suggesting that the yeast functional assay for the detection of p53 mutations may be essential for elucidating their clinical significance.

Undifferentiated connective tissue diseases-related hepatic injury

Hepatic injury is rarely associated with undifferentiated connective tissue diseases (UCTD). We report, here, a case of a middle-aged woman with UCTD-related hepatic injury, including its case history, clinical manifestations, laboratory findings, treatment and its short-term effect. The patient was admitted to the hospital with symptoms of fatigue, anorexia, low-grade fever and skin rashes. She had a past history of left knee joint replacement. Laboratory tests showed elevated levels of serum transaminase, IgG and globulin, accelerated erythrocyte sedimentation rate, eosinophilia and a high titer of antinuclear antibodies (1:320). Imaging studies showed interstitial pneumonitis and hydropericardium. Liver biopsy showed the features which were consistent with those of connective tissue diseases-related polyangitis. After treatment with a low-dose of oral prednisone, both symptoms and laboratory findings were significantly improved. UCTD-related hepatic injury should be considered in the differential diagnosis of connective tissue diseases with abnormal liver function tests. Low- dose prednisone may effectively improve both symptoms and laboratory tests.

Clinical study of docetaxel-vinorelbine as second-line chemotherapy in advanced non-small cell lung cancer

Objective： To evaluate the efficacy and toxicity of docetaxel and vinorelbine as second-line chemotherapy in the treatment of advanced non-small cell lung cancer （NSCLC）. Methods： 48 histologically or cytologically confirmed NSCLC patients with progressive or recurrent disease after first-line treatment were treated with docetaxel and vinoretbine. The chemotherapy included vinorelbine （25 mg/m^2） on days 1,5 and docetaxel （60 mg/m^2） on day 1. The treatment was repeated every 3 weeks. Patients receiving at least two cycles were evaluated for efficacy and toxicity. Results： Of 48 patients, 1 patient achieved complete response and 16 achieved partial response. Overall response rate for all 48 patients was 35.4% （17/48）. Main hematologic toxicities included neutropenia （60.4%） and febrile neutropenia （29.2%） and non-hematologic toxicities were mild. Conclusion： The combination of docetaxel-vinorelbine as second-line chemotherapy is an effective regimen with manageable toxicity for the treatment of advanced NSCLC. Further studies may confirm these results.

The value of radionuclide bone imaging on monitoring chemotherapeutic effects of multiple myeloma

Objective： To investigate the value of radionuclide whole-body bone imaging on monitoring chemotherapeutic ~ffects for multiple myeloma （MM）. Methods： Sixty patients were included. Twenty nine cases received CTD （thalidomide 100-200 rag/d; cyclophosphamide 200-300 mg/m2od, 1-4 days, every 4 weeks; and dexamethasone 20-40 rag/d, 1-4 days, every 4 weeks）; Thirty cases received VAD （vincristine 0.4 mg/d, 1-4 days, every 4 weeks; adriamycin 10 mg/d, 1-4 days, every 4 weeks; dexamethasone 40 rag/d, 1-4 days, every 4 weeks）. Radionuclide bone imagings were performed in all patients before chemotherapy, six months, twelve months and eighteen months after chemotherapy. The correlation of chemothera- peutic effects between CTD and VAD were analyzed. Results： One hundred and seventy nine bone lesions were visualized by bone scintigraphy before CTD treatment. Eighteen months after CTD chemotherapy, it was observed by bone scintigraphy that 39/179 （21.78%） lesions disappeared, 112/179 （62.57%） improved, and 281179 （15.64%） had no change. One hundred and ninety one bone lesions were showed by bone imaging before VAD treatment, 361191 （18.84%） lesions disappeared, eighteen months after chemotherapy, 103/191 （53.92%） improved, and 52/191 （27.22%） had no change. The significant dif- ference was observed in locations of MM induced bone lesions treated with CTD （H = 8.23, P 〈 0.05） and VAD （H = 11.18, P 〈 0.05）. A significant chemotherapeutic sensitivity in detecting MM induced lesions in ribs was found compared with other bone lesions. The chemotherapeutic effect of CTD was statistically significant than that of VAD （U = 2.17, P 〈 0.05）. Conclusion： Radionuclide whole-body bone imaging has great value in monitoring chemotherapeutic effects for MM.

Further Discussion on the Three Methods for the Stage-Treatment of Parkinson's Disease

Based on the long-term clinical practice and scientific researches on the three methods for the stage-treatment of Parkinson＇s disease put forward by the author in the early years, this essay further discusses the division of the three stages of Parkinson＇s disease. Early stage： Appearance of the early symptoms and signs of Parkinson＇s disease, but short in duration and mild in severity, which do not affect the social communications, daily life and work of the patient; and their modified Hoehn ＆ Yahr grading is 1,0-1.5. Mid stage： With the symptoms and signs of Parkinson＇s disease getting worse and affecting the social communications, daily life and work of the patient, those who have their modified Hoehn ＆ Yahr grading 2-3 need medical treatment. Late stage： The patients have severe clinical symptoms of Parkinson＇s disease, and Levodopa preparation is insufficient for them to maintain their daily life; and their modified Hoehn ＆ Yahr grading is 4-5. The three treating methods are： TCM medical treatment adopted at the early stage; the combined treatment of Chinese and western medicine at the mid stage; and comprehensive treatment with multi-theraoies at the late stage.

The therapeutics and prognosis of endometrial cancer

Objective: To investigate the relative factors in the prognosis of endometrial cancer. Methods: From 1991 to 1999, 125 patients with endometrial cancer were treated in our hospital. Among them, 96 cases were received operation. Their clinical and pathological data were analyzed retrospectively. Results: The overall survival rate at 5-year were 77.6%, stage I to stage IV were 85.9%, 68.8%, 53.8% and 0%, respectively. The survival rates at 5-year in histological grade 1, grade 2 and grade 3 were 100%, 77.1% and 38.1% respectively. There’s no significant difference between grade 1 and grade 2 (P > 0.05). As to grade 1 and grade 3, grade 2 and grade 3, there were significant differences (P < 0.05). The survival rate was 100% in patients with endometrium or superficial myometrial invasion and 35.3% in cases of deeper invasion (P < 0.01). Conclusion: Therapy based on operation is presently accepted as the first line management of endometrial cancer. Clinical stage, histo- logical grade, depth of myometrial invasion and lymph node metastasis are relative factors of prognosis.

Resection of Hilar Liver Cancer, Close to Major Vessels

Objective To study the surgical experience with resection of a hilar liver cancer close to major vessels and how to improve the therapeutic result.Methods From January 1990 to June 1997, 58 hilar liver tumors (segment I , IV , V , VI ) were resected. The tumors in these 58 patients were within a distance of 1 cm to major hepatic vessels (retrothepatic inferior vena cava, root of hepatic veins, and left or right trunk of portal vein) . The diameter of the tumors was > 5 cm in 42 cases and < 5 cm in 16 cases, respectively. The size of the largest tumor was 20 cm ×18 cm×18 cm. The surgical techniques are summarized, and the prevention and treatment of postoperative complications are discussed.Results All operations have been carried out successfully and had a regular follow-up until now with 1-, 3- and 5-year survival rate of 71%, 38% and 25%, respectively.Conclusion While hilar liver surgery is quite difficult and risky, the safety and therapeutic results of surgery could be improved by observing a meticulous surgical technique, and by preventing and treating postoperative complications by multimodal measures.

CLINICAL OBSERVATION ON TREATMENT OF 61 CASES OF INSOMNIA WITH AURICULAR PLASTER THERAPY

Objective: To observe the therapeutic effect of auricular plaster (otopoint-pressure) therapy in the treatment of insomnia. Methods: In this paper, 61 cases of insomnia patients including 16 males and 45 females were treated with Ershenmen (MA-TF 1), Zhen (MA-AT), Yuanzhong (MA-AT), Nao Dian and E (MA-AT), combined with other otopoints according to symptoms. The otopoint was stuck with a piece of plaster adhered with vaccaria seeds and pressured by the patient him- or her-self. The treatment was given twice a week, with 7 times being a therapeutic course. Results: After 1-2 courses of treatment, 19 (31.15%) cases were cured, 34 (55.74%) had improvement and 8 (13.11%) had no changes, with the total effective rate being 86.9%. Conclusion: Auricular plaster therapy works well in the treatment of insomnia patient.

Efficacy and nursing of stereotactic radiotherapy in lung cancer patients with brain metastases

Objective: To observe the efficacy of stereotactic radiotherapy (SRT) in lung cancer patients with brain metas-tases and explore the nursing for those patients. Methods: From June 2002 to December 2006, 43 patients of lung cancer with brain metastases were treated with SRT, 8 of them were treated with the association of whole-brain radiotherapy (WBRT) and 6 of them were treated with combination of chemotherapy. During the period of SRT, the patients were applied with active psychological nursing and diet nursing. We also tried to prevent patients from epicranium injury, and meanwhile, patients were asked to took active convalesce exercise. Results: All patients finished SRT without serious reaction and complication. Local control rate was 81.4%, nervous system symptoms relief rate was 76.7% and KPS score was raised significantly. Survival time ranged from 2 to 34 months, median survival time was 8.5 months, and 6-month, 1-and 2-year survival rates were 58.9%, 26.2%, and 6.0% respectively. Conclusion: SRT was one of the effective palliation treatments for the lung cancer patients with brain metastases, and with the assistance of effective nursing, which would prolong their survival time and improved quality of life.