目的:探讨聚焦超声治疗慢性宫颈炎的安全性和有效性。方法:回顾性分析2003年1月至2006年12月我院门诊诊断治疗的慢性宫颈炎患者,行聚焦超声治疗后并于3月内随访的574例患者,分析其安全性及有效性。结果:574例中,痊愈 378例(65.9%),显效155例(27.0%),总有效率96.7%。治愈率与糜烂面积及深浅程度有关(Plt;0.05)。超声治疗后部分患者出现阴道少量流液及血性分泌物。结论:聚焦超声应用于慢性宫颈炎的治疗安全有效,疗效确切,不良反应及并发症小,值得推广。
Tuberculosis remains a major public health problem. Genetic epidemiological studies have shown that the differences in host genes partly determine the susceptibility to tuberculosis. The occurrence of tuberculosis is the result of the joint action of Mycobacterium tuberculosis and host gene regulation immune response. The study of susceptibility candidate genes has differences in race, population and region, and the study of susceptibility gene polymorphism still has a long way to go in clinical precision diagnosis and treatment. The study and clinical application of mendelian susceptibility to mycobacterial disease can be used as a classic application of precision medical treatment in tuberculosis; although it is a rare case, this model is worthy of reference.
Objective To observe the clinical and pathological characteristics of choroidal metastatic carcinoma from lung carcinoma.Methods The clinical and pathological data of 6 patients with choroidal metastatic carcinoma from lung carcinima were analysed retrospectively.Results All the 6 patients had severe visual impairment, including 3 with severe ophthalmalgia. Flat neoplasm were seen in the posterior pole of the eyes in all the 6 patients and retinal detachment were found in 5 patients. Fundus fluorescein angiography (FFA) examination had been performed on 1 patient and blocked fluorescence and hyperfluorescence were seen in the lesion with pinpoint fluorescein leakage loop around it. CT examination had been performed on 3 patients and the shadow of flat homogenous tumor was seen. MRI examination had been performed on 1 patient and high signal intensit ies on T1W and low signal intensities on T2W were found. In all the 6 patients with primary lung carcinoma, 5 were diagnosed with adenocarcinoma and 1 with cellule carcinoma through pathological examination, and 5 patients were diagnosed with choroidal metastatic carcinoma from adenocarcinoma and 1 with choroidal metastatic carcinoma from cellule carcinoma through pathological examination.Conclusion Rapid visual acuity decrease, severe ophthalmalgia, flat neoplasm in ocular fundus and secondary retinal detachment are the main clinical characteristics of the choroidal metastatic carcinoma from lung carcinoma. Most histopathologica l manifestations of the metastatic carcinoma like that of the primary focus, and adenocarninoma is the most common histoclassification. (Chin J Ocul Fundus Dis，2003，19：333-404)
目的 初步测试中文版情绪障碍快速筛查量表K6、SCL-8AD及其分量表（SCL-8、SCL-ANX4及SCL-DEP6）在综合医院内科和精神科住院患者中的适用性。 方法 2011年11月－12月对四川大学华西医院内科（心脏内科、消化内科、风湿免疫科、内分泌科、神经内科）和精神科的住院患者共373例应用由K6和SCL-8AD量表构成的问卷进行自评，分析总问卷、各量表及分量表的信度及相互之间的相关性；在各科患者间进行评分结果差异性比较，并分别将内科及精神科评分结果与住院日进行相关分析。 结果 各量表及全问卷的Cronbach’s α系数和分半系数＞0.75（内科：0.802～0.952，精神科：0.774～0.944）；其中，K6及SCL-8的Cronbach’s α系数和分半系数在内科及精神科均≥0.817。总问卷、各量表及分量表相互之间均存在较高相关性（r≥0.676）；其中，K6及SCL-8与问卷总分均有极高相关性（r≥0.959）。问卷总分、各量表及分量表评分内科组均低于精神科组。 结论 条目少、操作简便的中文版K6和SCL-8量表内部一致性高、其评定结果能较全面反应综合医院内科及精神科住院患者中不同程度的焦虑及抑郁情绪，值得对其进行更深入研究，以便推广应用于非精神科患者情绪障碍的快速筛查。
Objective To evaluate the effectiveness, safety, cost and optimal dosing regimen of bone morphogenetic protein (BMP) used in the lumbar spine arthrodesis. Methods We formulated the clinical questions according to the PICO principle. We searched the ACP Journal Club (1991 to February 2008), The Cochrane Library (Issue 4, 2007) and PubMed (1990 to February 2008) as well as other relevant databases. The evidence retrieved was critically appraised. Results Current evidence showed that BMP was a satisfactory and safe behavior in lumbar arthrodesis. Its cost was equal to that of autogenous iliac bone graft. The types of BMP currently used in clinical practice are BMP-2 and BMP-7. Finished product of fixed composition ratio was recommended in anterior lumbar inter-body fusion, while in posterolateral fusion, 20mg of BMP-2 or 3.5mg of BMP-7 for each side was recommended, with proper carrier according to the place where it was used. Conclusion BMP may be introduced to China for lumbar spine arthrodesis. Before it is applied extensively, further large-scale, high-quality randomized controlled trials are needed. Meanwhile, more research is necessary to determine the proper dosage and preparation form for the dominant Chinese population.
ObjectiveTo evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis (AS) through the gap of a pathological fracture.MethodsBetween April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of 51 years (range, 37-74 years). The history of AS was 1-40 years (mean, 21.7 years) and disease duration of stress fracture was 2-60 months (mean, 18.5 months). The segmental lesions included T8, 9 in 1 case, T10, 11 in 2 cases, T11 in 2 cases, T12, L1 in 1 case, L1, 2 in 1 case, and L2, 3 in 1 case. The nerve function before operation according to Frankel grading was grade D in 3 cases and grade E in 5 cases. The pre- and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis (GK), local kyphosis (LK), angle of the fusion levels (AFL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Visual analogue scale (VAS) score was used to assess the back pain intensity.ResultsThe operation time was 210-320 minutes (mean, 267 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 963 mL). Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal of drainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months (mean, 28.4 months). No internal fixator loosening, fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months (mean, 6.8 months). At 3 months after operation, 3 cases with spinal cord injury of preoperative Frankel grade D recovered to grade E. The GK, LK, AFL, PI, PT, SVA, and VAS scores at 1 week after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). Except for VAS score at last follow-up was significantly improved when compared with that at 1 week after operation (P<0.05), there was no significant difference in the other indexes between at 1 week after operation and at last follow-up (P>0.05).ConclusionPosterior osteotomy through the gap of a pathological fracture is a safe and effective surgical procedure for kyphosis correction and relief of back pain in AS patients combined with thoracolumbar stress fracture. Successful bony fusion and good clinical outcomes can also be achieved by this surgical procedure.
Objective To investigate the roles of cell apoptosis and the gene expressions of Fas, FasL, bcl-2 and bax in acute rejection of pancreaticoduodenal transplantation and to evaluate the function of duodenum biopsy for early detection of rejection in rats. Methods Wistar and SD rats were divided into two groups: ①Wistar rats that underwent allogenic pancreaticoduodenal transplantation from the organs of SD rats; ②Wistar rats that received homogenic transplantation. The grafts were then harvested on day 3, 5 and 7 after the transplantation, and all graft samples were observed with HE staining and TUNEL was also used to detect apoptotic cells. The expressions of Fas, FasL, bcl-2 and bax were measured by immunochemical method. According to Nakhleh’s score, pathologic features of transplanted pancreas and duodenum were ranged from one to three scores in order. Results The percentage of same or different scores between the pathological scores of pancreas and duodenum in allogenic pancreaticoduodenal transplantation group were 61.1% (11/18) and 38.9% (7/18) respectively, and there were 6 specimens of pancreatic tissue got higher scores with only one higher score for duodenum. There were significant differences of histopathologic rejection scores and apoptotic indices between the two groups, respectively (P＜0.05， P＜0.01). Apoptotic indices of pancreas and duodenum both showed positive correlations with histopathologic rejection scores (r=0.965， P＜0.01; r=0.942, P＜0.01). The rejection score and apoptotic index elevated, the expression of FasL increased, bcl-2 decreased, and Fas and bax changed over time after operation. Conclusion Apoptosis maybe significantly positive correlated with the degrees of damage of the acute pancreaticoduodenal allograft rejection, and the apoptotic index maybe valuable to estimate the damage. FasL and bcl-2 were significantly related to the impairment of acute pancreatic allograft rejection as well. Duodenum biopsy may contribute to the early diagnosis of the rejecting transplanted tissues.
Objective To study the ectopic osteogenesis and vascularization ofthe tissue engineered bone promoted by an artificial bone composite that consists of coral hydroxyapatite (CHA), 1,25-(OH)2 D3, human marrow stromal osteoblast (hMSO), and human umbilical vein endothelial cell (hUVEC).Methods After the isolation and the culture in vitro, hMSO and hUVEC were obtained. Then, hMSO (5×105/ml) and hUVEC (2.5×105/ml) were seeded at a ratio of 2∶1 onto the CHA scaffolds coated with 1,25-(OH)2 D3 (the experimental group) or onto the CHA scaffolds without 1,25-(OH)2 D3 (the control group). The scaffolds were culturedin vitro for 3 days, and then the scaffolds were implanted into the pockets that had beenmade on the backs of 18 nude mice. Then, 6 of the mice were implanted with one experimental engineered bone bilaterally; another 6 mice were implanted with onecontrol engineered bone bilaterally; the remaining 6 mice were implanted with one experimental engineered bone and one control engineered bone on each side. At4, 8 and 12 weeks after operation, the retrieved scaffolds and cells were examined by the nake eye and histology as well as by the scanning electron microscopy. The quantitative assessment of the newly-formed bone and the quantitative analysis of the newly-formed blood vessels were performed. Results The evaluationsby the histology revealed that at 4 weeks the original bone tissues grew into the scaffolds in all the groups, but significantly more newly-formed bone tissuesand newly-formed blood vessels were found in the experimental group. At 12 weeks the newly-formed bone tissues were found in all the groups, but there was a typical bone unit found in the experimental group. There was a significantly smaller amount of capillary vessels in the control group than in the experimental group at all the time points. The evaluations by the scanning electron microscopy revealed that at 4 weeks in the experimental group there were great amounts of extracelluar matrix that embedded the cells, and plenty of capillary vessels were found on the surface of the implanted bone materials and some of them grew into the materials; however, in the control group there was a smaller amount of capillary vessels although much extracelluar matrix was still found there. At 8 weeks sarciniform osteoids were found on some of the implanted materials, with much extracelluar matrix and many newly-formed capillary vessels in the experimental group; however, in the control group there were fewer capillary vessels and lower degrees of the bone maturity. The quantitative assessment of the newly-formed bone showed that the newformed bones were 3.1±0.52 in the experimental group but2.30±0.59 in the control group at 8 weeks (Plt;0.05), and 4.63±0.55 vs. 3.53±0.62 at 12 weeks. There was a significant difference at these two time points between the two groups (Plt;0.05). The quantitative analysis of the newly-formed blood vessels showed that the vascular areas were 28.74％±7.81％i n the experimental group but 19.52％±4.57% in the control group at 4 weeks (Plt;0.05), and 24.66％±7.38％ vs. 1784%±5.22% at 12 weeks. There was a significant difference at these two time points between the two groups (Plt;0.05). Conclusion 1,25-(OH)2 D3 as an active factor can increase the interaction between hMSO and hUVEC, and thus promote the ectopic osteogenesis and vascularization in the tissue engineered bone.
ObjectiveTo explore the classification of ultrasound breast imaging reporting and data system (BI-RADS) classification combined with serum trefoil factor 1 (TFF1) and human growth differentiation factor 3 (GDF3) in the differential diagnosis of benign and malignant breast masses. MethodsThe prospective study collected 113 female patients with breast masses who got treatment in Tangshan People’s Hospital from September 2020 to September 2023. Ultrasound diagnostic equipment was applied for ultrasound BI-RADS classification, ELISA method was applied to detect serum TFF1 and GDF3 levels, Consistency Kappa test was used to compare the consistency of ultrasound BI-RADS classification, serum TFF1 and GDF3 alone and combined in the diagnosis of benign and malignant breast masses and pathological results, In addition, receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the above indicators in the diagnosis of benign and malignant breast masses. ResultsAmong the 113 patients with breast mass, the pathological diagnosis showed benign mass in 48 cases and malignant mass in 65 cases. The serum levels of TFF1 [(1.62±0.25) μg/L vs (1.24±0.27) μg/L] and GDF3 [(118.62±21.73) ng/L vs (96.47±16.05) ng/L] in malignant patients were obviously higher than those in benign patients (P<0.001). There were 70 cases of malignant breast masses and 43 cases of benign breast masses according ultrasound BI-RADS classification combined with serum TFF1 and serum GDF3. The diagnosis consistency with pathological results was very high and Kappa value was 0.835 (P<0.001). The sensitivity and specificity of ultrasound BI-RADS classification combined with serum TFF1 and serum GDF3 in differential diagnosis of benign and malignant breast masses were 96.92% (63/65), 85.42% (41/48), respectively, the negative predictive value was 95.35% (41/43), and positive predictive value was 90.00% (63/70). The sensitivity, negative predictive value and accuracy were higher than those of ultrasonic BI-RADS classification and serum GDF3 alone (P<0.05), and the missed diagnosis rate was lower than that of ultrasonic BI-RADS classification and serum GDF3 alone (P<0.05). ConclusionsThe serum levels of TFF1 and GDF3 increase in patients with malignant breast masses. The combination of ultrasound BI-RADS classification and serum TFF1 and GDF3 can improve the sensitivity and accuracy of the diagnosis of benign and malignant breast masses, and reduce the missed diagnosis rate.
目的 观察阿德福韦酯联合胸腺五肽治疗乙型肝炎病毒e抗原（HBeAg）阳性慢性乙型肝炎2年的疗效。 方法 2007年1月－2009年1月间178例慢性乙型肝炎患者随机分为试验组91例和对照组87例。试验组给予胸腺五肽1 mg，隔日皮下注射，疗程52周；同时阿德福韦酯10 mg/d口服104周。对照组给予阿德福韦酯10 mg/d，口服104周。治疗26、52、104周及停药52周时，分别检测血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、乙型肝炎病毒（HBV）DNA含量及HBV血清标志物。 结果 治疗52周后，试验组在ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率与HBeAg/HBeAb血清转换率方面都比对照组高。停药52周时，试验组与对照组的ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率、HBeAg/HBeAb血清转换率分别为74.73%与51.72%、75.82%与54.02%、25.27%与8.05%、26.37%与10.34%、18.68%与8.05%（χ2=10.652、9.313、9.421、7.574、4.313，P＜0.05）。 结论 阿德福韦酯联合胸腺五肽治疗HBeAg阳性慢性乙型肝炎比单独使用阿德福韦酯抗病毒治疗效果更好，有助于提高HBeAg/HBeAb血清转换率，减少停药后病毒学突破，并且使用安全。Objective To evaluate the efficacy of adefovir dipivoxil (ADV) combined with thymopentin on chronic hepatitis B patients with positive hepatitis B e antigen (HBeAg). Methods Between January 2007 and January 2009, 178 chronic hepatitis B patients with positive HBeAg were randomly divided into two groups: the treatment group (91 cases) and the control group (87 cases). All patients in two groups received 10 mg of ADV once a day for 104 weeks, while the patients in the treatment group received 1 mg of thymopentin for subcutaneous injection every other day for 52 weeks. The rates of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) normalization, serum hepatitis B virus (HBV) DNA clearance and HBeAg loss and anti- HBeAg seroconversion were evaluated at pretreatment, and 52, 104 and 156 weeks after treatment, respectively. Results After 52-week treatment, The rates of ALT and AST normalization, serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion in the treatment group were higher than those in the control group. In 52-week follow-up after 104 weeks treatment, the rates of ALT and AST normalization , serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion of two groups were 74.73% versus 51.72%, 75.82% versus 54.02%, 25.27% versus 8.05%, 26.37% versus 10.34%, 18.68% versus 8.05%, respectively (χ2 = 10.652, 9.313, 9.421, 7.574, 4.313; P＜0.05). Conclusions It is more effective for adefovir dipivoxil combined with thymopentin on HBeAg-positive patients with chronic hepatitis B than using adefovir alone. Combination treatment could improve the rates of HBeAg seroconversion and reduce the breakthrough of HBV after drug withdrawal. And it is safe.