ObjectiveTo summarize clinical application progress of stereotactic radiotherapy for primary hepatocellular carcinoma. MethodsThe literatures about the research progress of the stereotactic radiotherapy for primary hepatocellular carcinoma were reviewed. ResultsRadiotherapy for hepatocellular carcinoma is importantly based on the radiation biology of the liver and the radiophysics of the liver cancer. Stereotactic precision radiotherapy is an effective and low toxic treatment for early hepatocellular carcinoma, moreover, it alone or in combination with microwave ablation, hepatic artery chemoembolization for unresectable hepatocellular carcinoma is safe and effective method for the treatment. ConclusionsThe optimal dose model for hepatocellular carcinoma, hepatocellular carcinoma radical dose level are problems that need further exploration, and radiobiology, radiation physics research must be strengthened to explore it, stereotactic precision radiotherapy treatment modalities in the treatment of hepatocellular carcinoma position will become increasingly people attention.
Objective To evaluate the efficacy and safety of whole lung lavage in the treatment of pulmonary alveolar proteinosis ( PAP) .Methods Twelve patients who were diagnosed as PAP from September 2008 to October 2011 in Hunan Occupational Disease Hospital were recruited in the study. The changes of dyspnea symptom, lung-function, arterial blood gas, and chest image were compared before and after whole lung lavage treatment. Meanwhile, the safety of lung lavage was evaluated. Results All patients were relieved from dyspnea. The lung function, hypoxia, hyperventilation, and chest image were all obviously improved. The vital signs in the process of lung lavage were stable without serious complications. Conclusion Whole lung lavage is an effective and safe treatment for PAP.
截至2002年8月,有关妊娠子痫及高血压的临床证据如下:预防: ①抗血小板药物:1个系统评价发现,对可能发生先兆子痫的孕妇使用抗血小板药物(主要是阿司匹林)与使用安慰剂或不治疗相比,在降低发生先兆子痫的危险、减少胎儿死亡和早产方面有统计学意义,在其他重要结局上无统计学意义.随后的1个小样本随机对照试验(RCT)也得出相似的结论.该系统评价还发现,无证据表明使用阿司匹林会比安慰剂增加孕妇或胎儿出血的危险. ②补钙(用于高危孕妇或钙摄入不足的孕妇):1个系统评价发现,给孕妇补钙(2 g/d)与使用安慰剂相比,在降低先兆子痫的发病危险及减少胎儿出生时体重不足 2 500 g方面有统计学意义,但对降低死产、住院期间围产儿死亡、减少剖腹产或早产没有统计学意义. ③补镁 : 1个系统评价发现,尚无充足证据证明补镁对有发生先兆子痫或其并发症危险的孕妇有效. ④其它药物干预:两个RCT比较了使用阿替洛伟或硝酸甘油与安慰剂,但由于纳入的病例数太少不能得出可靠结论. ⑤限制盐的摄入: 1个系统评价的有限证据表明,低盐饮食与正常饮食相比,在降低孕妇先兆子痫的发生率方面无统计学差异. ⑥ Vit C和Vit E:在高危孕妇中进行的1个RCT中,有限的证据显示,使用Vit C和Vit E与安慰剂相比,前者可明显减少先兆子痫的发生率,但是,我们不能对其疗效得出可靠结论,也无足够证据证明Vit C和Vit E对其它临床指标有影响. ⑦夜间服用月见草油或鱼油:我们找到6个关于服用月见草油和鱼油的RCT,但其样本量都太小,不能得出可靠的结论.治疗: ①积极治疗与姑息疗法对首发严重先兆子痫孕妇的疗效比较:纳入两个小样本RCT的1篇系统评价发现,无证据表明积极治疗对严重先兆子痫孕妇比姑息疗法更能减少死产率或围产儿死亡率.相反,与姑息疗法相比,积极治疗增加了新生儿进入重症监护病房的比例和发生坏死性小肠结肠炎及呼吸窘迫的危险.与姑息疗法相比,无充足证据表明积极治疗对母亲有效. ②降压药用于治疗轻、中度高血压:两个系统评价发现,使用降压药与安慰剂、不用降压药或另外一种降压药比较,前者能明显减少发展为严重高血压的危险,但是对先兆子痫和围产儿死亡无明显效果.该系统评价发现,在妊娠期使用血管紧张素转换酶抑制剂与胎儿发生肾衰有关,还发现使用β受体阻滞剂会增加孕龄过小的危险. ③降压药用于治疗妊娠期重度高血压(尽管在药物的最佳选择方案上尚无足够的证据):在患有孕期重度高血压需要立即采取治疗的孕妇中做的1个系统评价和1个RCT中,无证据表明用不同的降压药控制血压在疗效上有差异.由于这些研究的样本量太小,尚不能得出关于不同药物之间相互关系的进一步结论. ④抗氧化剂用于治疗严重的先兆子痫:1个RCT发现,无足够证据表明,在治疗严重先兆子痫的疗效方面,Vit E、Vit C和别嘌呤醇联用与安慰剂相比有差异. ⑤卧床休息对出现蛋白尿的孕期高血压患者的作用:1个系统评价发现,无足够证据表明卧床休息与常规住院活动相比,前者对出现蛋白尿的孕期高血压患者更有效. ⑥卧床休息/住院治疗:我们没有找到关于住院、卧床休息或日间观察与门诊观察或住院但不限制活动相比较的充足证据. ⑦严重先兆子痫患者无痛分娩麻醉方式的选择:1个RCT发现,严重先兆子痫患者进行无痛分娩时,与静脉麻醉相比,硬膜外麻醉能明显降低平均疼痛指数,但这种差异的临床重要性不清楚. ⑧无蛋白尿的妊娠高血压患者的住院治疗:1个系统评价发现,住院治疗与门诊治疗相比,两者在主要临床结局上无统计学差异. ⑨硫酸镁用于治疗子痫(其疗效优于其它抗惊厥药):多个系统评价发现,对于子痫患者,硫酸镁比较苯妥英钠、地西泮或抗自主神经合剂(冬眠合剂)能明显减少子痫的进一步发作.所有系统评价都显示,使用硫酸镁有降低孕产妇死亡率的趋势,尽管其差异没有统计学意义. ⑩扩张血容量用于治疗严重先兆子痫:1个系统评价发现,无足够证据表明是否扩容治疗对严重先兆子痫患者在疗效上有差异.B11严重先兆子痫患者预防性使用硫酸镁:1个系统评价和1个大样本RCT发现,对于严重先兆子痫患者,与使用安慰剂相比,预防性给予硫酸镁可以使发生子痫的危险减半.但是这些试验中无证据表明,患有严重先兆子痫的孕妇使用硫酸镁和安慰剂,其胎儿在死产率或围产期死亡率方面有统计学差异.据报道,有1/4的孕妇会出现轻微的不良反应,主要是面部潮红. B12严重先兆子痫患者预防性使用地西泮:1个系统评价发现,无足够证据表明,在严重先兆子痫的孕妇中使用地西泮与不用抗惊厥药物治疗有差异.
目的:观察两种常用一线根除幽门螺杆菌(H.pylori)三联方案在本地区(成都市)的疗效。方法:纳入70例诊断为消化性溃疡、慢性糜烂性胃炎、慢性萎缩性胃炎伴H.pylori感染的患者。随机分为A、B两组。A组采用埃索美拉唑(E)20 mg bid+克拉霉素(C)500 mg bid+甲硝唑(M)400 mg bid,B组采用E 20 mg bid+ C 500 mg bid+阿莫西林(A)1.0g bid治疗,疗程7天。H.pylori根除失败者以1周四联方案:E 20 mg bid+胶体次枸櫞酸铋(B)220 mg bid+呋喃唑酮100 mg bid+ A1.0g bid治疗,观察疗效。结果:64例完成实验。三联方案H.pylori根除率:A组62.5%,B组84.4%,有显著差异(Plt;0.05)。二线四联方案根除率94.1%。结论:ECA方案H.pylori根除率明显高于ECM方案,可能更适合于本地区根除H.pylori的一线治疗,EBFA方案作为二线治疗具有较高疗效。
ObjectiveTo investigate the predicting effect of PIK3CA mutations for the efficacy and prognosis of hepatocellular carcinoma (HCC) patients received surgical resection. MethodsPCR and DNA sequencing were used to detect the PIK3CA mutation status of 79 HCC tissues, its impact on the short and long term effects of the patients were analyzed. ResultsIn this group of patients, mutation rate of PIK3CA gene exon 9 was 39.24% (31/79), PIK3CA mutation rate correlated with lymph node status and tumor differentiation (P < 0.05). The therapeutic effect of patients with PIK3CA mutation was significantly poor than that of the non-mutated group (P < 0.05). The three-year cumulative survival of patients with PIK3CA mutation (33.33%) was significantly lower than non-mutated group's (60.00%) by Kaplan-Meier (P < 0.05). ConclusionPIK3CA gene mutation in exon 9 could impact the efficiency of surgical resection in patients with HCC and could predict a poor survival prognosis.
目的探讨后天性直肠舟状窝瘘行经直肠修补术的治疗效果。 方法回顾性分析1992年1月至2013年1月期间笔者所在医院收治的18例行经直肠修补术的后天性直肠舟状窝瘘患者的临床资料。 结果18例患者的手术均顺利。手术时间75～120 min，平均94.6 min；术中出血量5～20 mL，平均10 mL；术后住院时间7～16 d、平均11 d；住院费用3 541～6 814元，平均5 966元。术后均留置导尿管，无尿潴留等发生。术后所有患者均治愈出院，切口均一期愈合，无一例发生感染。术后所有患者均获访1～11年，中位数为5年。随访期间无肛门狭窄及肛门失禁发生，无复发病例。 结论经直肠修补术治疗后天性直肠舟状窝瘘的效果较好，值得推广。
China is a country with a high incidence of esophageal cancer. Most patients are already in the locally advanced stage when first diagnosed. Preoperative neoadjuvant therapy followed by surgery has become the standard treatment mode for them. Closely related to prognosis, the evaluation of tumor response is essential. Response evaluation criteria in solid tumors is the gold standard to evaluate tumor response, but the lesions must meet the measurement standards. Tumor regression grading (TRG) systems are designed to classify regressive changes after neoadjuvant treatment based on histopathological results to reveal prognostic information. Concentrating on pathologic assessment of esophageal cancer following neoadjuvant therapy, this article reviews histopathological changes, commonly used TRG systems and current debate.