去甲斑蝥素凝胶治疗尖锐湿疣58例报告

我们于1994～1996年12月应用0.5％去甲斑蝥素凝胶治疗尖锐湿疣58例,收到了较好的效果,现报告如下。1 临床资料 1.1 一般资料 58例均为门诊患者,男46例,女12例,年龄1～65岁。1岁1例,20～30岁30例,31～40岁18例,41～50岁8例,65岁1例。病史【1个月6例,1～3个月38例,4～6个月8例,半年以上6例。疣体主要发生于外生殖器及肛门周围。

顺铂化疗鼻咽癌94例疗效观察

顺铂是近年来广泛应用于临床的抗癌药物之一。本文总结了我科自1989年以来用顺铂化疗的94例鼻咽癌患者,就其疗效及主要副作用作一评价。

INDIGESTION OF FOOD RETENTION IN CHILDREN TREATED BY ACUPUNCTURE AND MASSAGE

Objective By acupuncture plus massage to treat poor appetite induced by indigestion of food retention in children to restore their normal appetite. Methods 476 cases of indigestion of food retention in children were treated by acupuncture plus massage. Results 385 of the 476 cases were cured, and 91 cases were improved by one treatment with a total effective rate of 100%. Conclusion Acupuncture plus massage provided remarkable therapeutic effects on indigestion of food retention in children.

Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer:A treatment planning comparison

AIM： To compare the volumetric-modulated arc ther- apy （VMAT） plans with conventional sliding window intensity-modulated radiotherapy （c-IMRT） plans in esophageal cancer （EC）. METHODS： Twenty patients with EC were selected, including 5 cases located in the cervical, the upper, the middle and the lower thorax, respectively. Five plans were generated with the eclipse planning sys- tem： three using c-IMRT with 5 fields （5F）, 7 fields （7F） and 9 fields （gF）, and two using VMAT with a single arc （1A） and double arcs （2A）. The treatment plans were designed to deliver a dose of 60 Gy to the plan-ning target volume （PTV） with the same constrains in a 2.0 Gy daily fraction, 5 d a week. Plans were normal- ized to 95% of the PTV that received 100% of the pre- scribed dose. We examined the dose-volume histogram parameters of PTV and the organs at risk （OAR） such as lungs, spinal cord and heart. Monitor units （MU） and normal tissue complication probability （NTCP） of OAR were also reported. RESULTS： Both c-IMRT and VMAT plans resulted in abundant dose coverage of PTV for EC of different Io- cations. The dose conformity to PTV was improved as the number of field in c-IMRT or rotating arc in VMAT was increased. The doses to PTV and OAR in VMAT plans were not statistically different in comparison with c-IMRT plans, with the following exceptions： in cervical and upper thoracic EC, the conformity index （CI） was higher in VMAT （1A 0.78 and 2A 0.8） than in c-IMRT （5F 0.62, 7F 0.66 and 9F 0.73） and homogeneity was slightly better in c-IMRT （7F 1.09 and 9F 1.07） than in VMAT （1A 1,1 and 2A 1.09）, Lung V30 was lower in VMAT （1A 12.52 and 2A 12.29） than in c-IMRT （7F 14.35 and 9F 14.81）. The humeral head doses were significantly increased in VMAT as against c-IMRT. In the middle and lower thoracic EC, CI in VMAT （1A 0.76 and 2A 0.74） was higher than in c-IMRT （5F 0.63 Gy and 7F 0.67 Gy）, and homogeneity was almost similar between VMAT and c-IMRT. V20 （2A 21.49 Gy vs 7F 24.59 Gy and 9F 24.16 Gy） and V30 （2A 9.73 Gy vs 5F 12.61 Gy, 7F 11.5 Gy and 9F 11.37 Gy） of lungs in VMAT were lower than in c-IMRT, but low doses to lungs （V5 and Vl0） were increased. V30 （1A 48.12 Gy vs 5F 59.2 Gy, 7F 58.59 Gy and 9F 57.2 Gy）, V40 and V50 of heart in VMAT was lower than in c-IMRT. MUs in VMAT plans were significantly reduced in comparison with c-IMRT, maximum doses to the spinal cord and mean doses of lungs were similar between the two techniques. NTCP of spinal cord was 0 for all cases. NTCP of lungs and heart in VMAT were lower than in c-IMRT. The advantage of VMAT plan was enhanced by doubling the arc. CONCLUSION： Compared with c-IMRT, VMAT, especial- ly the 2A, slightly improves the OAR dose sparing, such as lungs and heart, and reduces NTCP and MU with a better PTV coverage.

Clinical features and management of primary sclerosing cholangitis

Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts,resulting in cirrhosis and need for liver transplantation and reduced life expectancy.The majority of cases occur in young and middle-aged men,often in association with inflammatory bowel disease.The etiology of primary sclerosing cholangitis includes immune-mediated components and elements of undefined nature.No effective medical therapy has been identified.The multiple complications of primary sclerosing cholangitis include metabolic bone disease,dominant strictures,bacterial cholangitis,and malignancy,particularly cholangiocarcinoma,which is the most lethal complication of primary sclerosing cholangitis.Liver transplantation is currently the only life-extending therapeutic alternative for patients with end-stage disease,although recurrence in the allografted liver has been described.A PSC-like variant attracting attention is cholangitis marked by raised levels of the immunoglobulin G4 subclass,prominence of plasma cells within the lesions,and steroid responsiveness.

Inhalation treatment of lung cancer: the influence of composition, size and shape of nanocarriers on their lung accumulation and retention

Objective： Various nanoparticles have been designed and tested in order to select optimal carriers for the inhalation delivery ofanticancer drugs to the lungs. Methods： q-he following nanocarriers were studied： micelles, liposomes, mesoporous silica nanoparticles （MSNs）, poly propyleneimine （PPI） dendrimer-siRNA complexes nanoparticles, quantum dots （QDs）, and poly （ethylene glycol） polymers. All particles were characterized using the following methods： dynamic light scattering, zeta potential, atomic force microscopy, in vitro cyto- and genotoxicity. In vivo organ distribution of all nanopartides, retention in the lungs, and anticancer effects of liposomes loaded with doxorubicin were examined in nude mice after the pulmonary or intravenous delivery. Results： Significant differences in lung uptake were found after the inhalation delivery of lipid-based and non-lipid-based nanoparticles. The accumulation ofliposomes and miceUes in lungs remained relatively high even 24 h after inhalation when compared with MSNs, Q Ds, and PPI dendrimers. There were notable differences between nanoparticle accumulation in the lungs and other organs 1 and 3 h after inhalation or intravenous administrations, but 24 h after intravenous injection all nanoparticles were mainly accumulated in the liver, kidneys, and spleen. Inhalation delivery of doxorubicin by liposomes significantly enhanced its anticancer effect and prevented severe adverse side effects of the treatment in mice bearing the orthotopic model of lung cancer. Conclusion： The results of the study demonstrate that lipid-based nanocarriers had considerably higher accumulation and longer retention time in the lungs when compared with non-lipid-based carriers after the inhalation delivery. These particles are most suitable for effective inhalation treatment of lung cancer.

Medical treatment of cholestatic liver diseases:From pathobiology to pharmacological targets

Bile secretion is dependent on the coordinated functions of a number of hepatobiliary transport systems. Cholestasis may be caused by an impairment of bile secretion, an obstruction of bile flow or a combination of the two. The common consequence of all forms of cholestasis is retention of bile acids and other potentially toxic compounds in the hepatooltes leading to apoptosis or necrosis of hepatocytes and eventually to chronic cholestatic liver disease. In certain cholestatic disorders there is also leakage of bile acids into the peribiliary space causing portal inflammation and fibrosis. The following pharmacological targets for treatment of intrahepatic cholestasis can be identified： stimulation of orthograde biliary secretion and retrograde secretion of bile acids and other toxic cholephils into the systemic circulation for excretion via the kidneys to reduce their retention in the hepatocytes; stimulation of the metabolism of hydrophobic bile acids and other toxic compounds to more hydrophilic, less toxic metabolites; protection of injured cholangiocytes against toxic effects of bile; inhibition of apoptosis caused by elevated levels of cytotoxic bile acids; inhibition of fibrosis caused by leakage of bile acids into the peribiliary space. The clinical results of ursodeoxcholic acid therapy of primary biliary cirrhosis may be regarded as the first success of this strategy.

Study progression of recombinant human endostatin (Endostar) for the treatment of malignant serous effusion

Since recombinant human endostatin (rh-endostatin;Endostar) has been listed 5 years,clinicians have combined it with chemotherapy for the treatment of lung cancers and other malignant tumors,and proved its effect and safety.A number of scholars have explored the application of Endostar alone or in combination with chemotherapy for treatment of malignant serous effusion,finding its high efficiency and low toxicity;and that hydrops controlling is stronger,and that it can significantly improve patients' quality of life.It is worthy of conducting prospective,randomized and multi-center clinical studies and basic researches to clarify the mechanism.

Effects of Organic Enrichment on Sandy Beach Meiofauna:A Laboratory Microcosm Experiment

Meiofauna samples from intertidal sediments of Qingdao No.2 Bathing Beach, China, were collected for field study, and subjected to organic enrichment in a laboratory microcosm experiment for 21 d. There were three different treatments including non-organic addition as the control, low-organic enrichment (2 g DW green algae per 150 mL) and high-organic enrichment (10 g DW green algae per 150 mL). After 21 d, the meiofauna richness decreased in both organic enrichment treatments. Among the three treatments, total meiofauna abundance was significantly different, and the control groups had higher abundance than the other two treatment groups. However, the responses of the meiofauna abundance in the two organic enrichment treatments were non-significantly different. The relationship of meiofaunal abundance and nematode/copepod ratios to organic matter and oxygen level in the microcosm experiments were discussed.

Thiazolidinedione treatment inhibits bile duct proliferation and fibrosis in a rat model of chronic cholestasis

AIM： To investigate the effects of troglitazone （TGZ）, an anti-diabetic drug which activates peroxisome proliferatoractivated receptor-y （PPAR-y）, for liver tissue repair, and the development of ductular reaction, following common bile duct ligation （BDL） in rats. METHODS： Rats were supplemented with TGZ （0.2% w/w in the pelleted food） for i wk before BDL or sham operation. Animals were killed at 1, 2, or 4 wk after surgery. RESULTS： The development of liver fibrosis was reduced in rats receiving TGZ, as indicated by significant decreases of procollagen type I gene expression and liver hydroxyproline levels. Accumulation of a-smooth-muscle actin （SMA）-expressing cells surrounding newly formed bile ducts following BDL, as well as total hepatic levels of SMA were partially inhibited by TGZ treatment, indicating the presence of a reduced number and/or activation of hepatic stellate cells （HSC） and myofibroblasts. Development of the ductular reaction was inhibited by TGZ, as indicated by histochemical evaluation and hepatic activity of γ-glutamyltransferase （GGT）. CONCLUSION： Treatment with thiazolidinedione reduces ductular proliferation and fibrosis in a model of chronic cholestasis, and suggests that limiting cholangiocyte proliferation may contribute to the lower development of scarring in this system.

多模态影像融合在颅底肿瘤的诊断、治疗中的应用价值

目的探讨多模态影像融合在颅底肿瘤的诊断、治疗中的应用价值。方法 9例颅底肿瘤术前均行DynaCTA检查及MRI薄层(2 mm)增强扫描检查,将多组影像数据输入工作站,采用"双容积重建"技术进行脑血管及MRI的影像融合,通过静态及动态融合影像观察肿瘤与脑结构、血管及颅骨的毗邻关系,并对肿瘤的诊断、手术治疗及预防血管并发症进行分析。结果 9例均获得满意的影像融合、具有很好的空间一致性,在一张影像上可以清晰显示病变及其周围脑结构、血管及颅骨解剖关系,提高精准性诊断,并应用于指导治疗策略、设计手术划及预防并发症。9例均恢复满意出院。结论多模态影像融合对提高颅底肿瘤的诊断精准性、提高肿瘤全切除率、降低病死率和残疾率效果肯定,对血管损伤并发症治疗疗效肯定。

A Clinical observation of the therapy for malignant hydrothorax by intra-thoracic injection using IL-2 combining with Cisplatin

Objective: The aim of our study was to explore the short-term effects and complication of interleukin-2 (IL-2) combining with Cisplatin in the treatment of malignant hydrothorax.Methods: Sixty-two cases patients with malignant hydrothorax were randomly divided into two groups.Observation group was 31 examples,thoracic cavity injection IL-2 and Cisplatin;31 cases in control group using Cisplatin alone intra-thoracic injection.The regime of every week for 1–4 weeks was used to observe short term effects and complications.Results: The total response rate in observe group was higher than that in control group (90.3% vs.68.1%),which had statistically significant difference (P < 0.05).The complications included gastrointestinal tract reaction,bone marrow inhibition,chest pain and fever.The incidence rates of chest pain and fever in observe group was slightly higher than that in control group,but there was no statistically significant difference (P > 0.05).Conclusion: The IL-2 combining with Cisplatin intra-thoracic injection for malignant hydrothorax has the features of good therapeutic effects and slight poisonous side effects,which is worth to be used in clinic.

Complications and treatment of migrated biliary endoprostheses:A review of the literature

Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 too. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.

Primary angiosarcoma of the lung: a case report

A 40-year-old man with haemopbysis and serious spontaneous hemothorax. Chest computed tomography showed multiple flakes in his lungs, nodules shadow, right pleural effusion with right pulmonary atelectasis The pathological specimens obtained by thoracic surgery revealed pulmonary angiosarcoma. Primary pulmonary angiosarcoma is a rare malignant tumor and is lack of typical clinical symptoms and imaging features, diagnosis mainly depend on histopathologic features and immunohistochemical analysis. There is no effective therapy for pulmonary vascular sarcoma. Integrated treatment can may extend the survival time of patients.

Residual urinary output in high body mass index individuals on chronic hemodialysis:A disregarded life vest?

AIM： To assess residual diuresis and diverse variables according to body mass index （BMI）.METHODS： Cross-sectional study （n = 57）, with 3 groups. Group A： BMI 〈 25, n = 22; Group B： BMI 25-30, n = 15; Group C： BMI 〉 30, n = 20. Diuresis, hematocrit, albumin, C-reactive protein, Malnutrition infammatory score, Pro-BNP, Troponin T, leptin and in-sulin levels are expressed as median and ranges （r）. RESULTS： Albumin （g/dL）： GA vs GC, 3.70 （r2.20-4.90） vs 3.85 （r3.40-4.90）, P = 0.02. Diuresis （mL/d）： GA 690 （r0-1780）; GB 660 （r60-1800）; GC 840 （r40-2840）. Diuresis GA vs GC, P = 0.01. Leptin （ng/mL）： GA vs GC, 3.81 （r0.78-69.60） vs GC, 32.80 （r0.78-124.50）, P 〈 0.001. Insulin （μU/mL）： GA vs GB, 7 （r2-44） vs 11.50 （r4-38）, P = 0.02; GA vs GC, 7 （r2-44） vs 19.5 （r5-155）, P = 0.0001. Troponin T and Pro-BNP levels were not different. Significant correlations： GC, Insulin-UF： ρ= 0.53; P = 0.03; TroponinT-diuresis： ρ = -0.48, P 〈 0.05; Pro-BNP-diuresis： ρ = -0.39, P 〈 0.01; Troponin T-ProBNP： ρ = 0.77, P 〈 0.0001; albumin-Troponin T： ρ = -0.66, P 〈 0.0001; albumin-ProBNP： ρ = -0.44, P 〈 0.05.CONCLUSION： High BMI associated positively with higher diuresis and albuminemia, and negatively with TropT and Pro-BNP. High BMI-associated better survival may be explained by better urinary output, lowering cardiovascular stress.

Comparative study of induction chemotherapy and chemoradiotherapy in the treatment of limited-disease small cell lung cancer with ipsilateral pleural effusion

Objective:The aim of the study was to explore the effects and side effects of induction chemotherapy followed by chemoradiotherapy for limited-disease small cell lung cancer (LD-SCLC) patients with ipsilateral pleural effusion.Methods:From January 2005 to May 2009,52 LD-SCLC patients with ipsilateral pleural effusion were treated with induction chemotherapy first.The regimen was taken as follows:etoposide 100 mg iv,d1-d5,cisplatin 25 mg/m2 iv,d1-d3 or CBP AUC 4 iv,d1.Three-week therapy was a cycle.According to pleural effusion status after 2-4 cycles induction chemotherapy,patients got disappearance of pleural effusion after chemotherapy were underwent thoracic radiotherapy (TRT;50 Gy/25 fraction) or same chemotherapy regimen;patients without disappearance or with increasing of pleural effusion after chemotherapy were given same chemotherapy regimen.Therapeutic effect was evaluated every two cycles according to RECIST 1.0 and side-effects were evaluated every cycle according to NCI-CTC AE Grades.All patients were followed up,and the median follow-up time was 26 months.Results:The response rate of patients was 80.7% (42/52) after induction chemotherapy and 34 patients got disappearance of pleural effusion.The median survival time,1-and 2-year survival rates were 15.4 months,76.9% (40 /52) and 38.5% (20 /52) respectively.The median survival time,1-and 2-year survival rates of patients with pleural effusion remission received chest radiotherapy (A group,n=20),patients with pleural effusion remission received chemotherapy (B group,n=14) and patients without pleural effusion remission received chemotherapy (C group,n=18) were 21.5 months,14.4 months,12.5 months,80.0%,64.3%,55.6% and 35%,21.4%,11.1%,respectively.Main side effects were grades 1-2,including myelosuppression,fatigue,nausea and vomiting.No therapeutic related death was occurred.Conclusion:Induction chemotherapy plus chemoradiotherapy has shown better effect in prolonging survival of small cell lung cancer (SCLC) patients with ipsilateral pleural effusion than chemotherapy alone.The patients with decreased ipsilateral pleural effusion may receive benefit from subsequent TRT.

Study on Cytokines IL-2,IL-6,IL-10 in Patients of Chronic Allergic Rhinitis Treated with Acupuncture

OBJECTIVES: To observe the plasmatic concentration of IL-6, IL-10 and IL-2 in the patient of chronic allergic rhinitis before and after acupuncture therapy. METHODS: Cytokine levels were determined before and after treatment in 30 healthy volunteers (Group A) and 90 patients of chronic allergic rhinitis (Group B) with an increased plasma IL-10 level. Group B was then divided into 3 subgroups: 30 patients treated with real acupuncture (Group B1); 30 patients treated with sham acupuncture (Group B2); 30 non-treated patients (Group B3). RESULTS: The allergic subjects of group B1, compared with controls, showed a significant reduction of IL-10 after a specific treatment with acupuncture (P

Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

AIM： To determine the role of ciprofloxacin in reducing cholangitis in cholestatic patients with adequate biliary drainage after endoscopic retrograde cholangiopancreatogra phy （ERCP）. METHODS： A randomized, controlled trial was performed in 48 cholestatic patients at Rajavithi Hospital （Tertiary Referral Center for ERCP： 600 cases per year）. All the 48 patients received 200 mg ciprofloxacin intravenous injection for 30 min before starting any procedures, and then were randomly divided in two groups. Twenty-two patients in study group continually received dprofloxacin until 48 h after ERCP. Causes of biliary obstruction, bacteriology of bile and blood （in cholangitis） and dinical cholangitis were recorded. RESULTS： Forty-eight patients were enrolled and divided into continuous ciprofloxacin treatment group （/7 = 22） and discontinuous ciprofloxacin treatment group （n = 26）. During ERCP, stones were found in 22 patients, malignant diseases in 24 patients and other pathologic lesions in 5 patients. One （4.5%） of the 22 patients who received ciprofloxacin and 2 （6.3%） of the 26 patients who discontinued ciprofloxacin after ERCP developed cholangitis （relative risk = 0.71; 95% CI = 0.14-3.65; P = 0.88）. Bacterobilia was found in 27 （56.3%） out of 48 patients. E. coli and Streptococcus viridans were the most common organisms. CONCLUSION： Continual use of ciprofloxacin in patients with cholestasis after adequate biliary drainage procedures plays no role in reducing cholangitis.

Resolution of pleural effusion in a IgD multiple myeloma after chemotherapy based on liposomal doxorubicin

IgD myelomas account for only 2% of all myelomas. This kind of hematological malignancy is severe and carries a bleak prognosis. Pleural effusion is very rare in multiple myeloma. We reported a case in which pleural effusion appeared at the end of the illness of IgD myeloma and treated with liposomal doxorubicin.

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.