目的 评估替比夫定与阿德福韦酯联合治疗优化阿德福韦酯单药治疗应答不佳的阳性慢性乙型肝炎患者的疗效。 方法 选择2008年6月－2009年8月间共26例阿德福韦酯治疗至少12个月且病毒学应答不佳的乙型肝炎病毒e抗原（HBeAg），阳性的慢性乙型肝炎患者，在10 mg阿德福韦酯治疗的基础上，加用600 mg替比夫定。肝功能和乙型肝炎病毒（HBV） DNA每3个月评估1次，乙型肝炎两对半和腹部B型超声每半年评估1次。 结果 在第1年的治疗期间，所有患者血清HBV DNA水平均呈进行性下降，其中24例（92.3%）血清HBV DNA水平在联合治疗12个月时低于检测值下限，有25例（96.2%）患者丙氨酸转氨酶水平复常。治疗6个月时，分别有7例（26.9%）和2例（7.7%）患者发生HBeAg消失和血清学转换；治疗12个月时，分别有11例（42.3%）和8例（30.8%）患者发生HBeAg消失和血清学转换。整个治疗期间，26例患者均未出现病毒学突破。 结论 阿德福韦酯单药治疗应答不佳时，加用替比夫定可有效控制病毒，使患者获得较好的病毒学、生化学和免疫学应答。Objective To evaluate the curative efficacy of telbivudine combined with defovir dipivoxil on positive-HBeAg chronic hepatitis B patients with suboptimal response to adefovir dipivoxil. Methods A total of 26 HBeAg-positive patients with suboptimal response to adefovir dipivoxil (treated with adefovir dipivoxil for more than 12 months) were treated with adefovir dipivoxil 10 mg in addition to telbivudine 600 mg between June 2008 and August 2009. Liver function and serum hepatitis B virus (HBV) DNA tests were assessed at the baseline and 3-month intervals, whereas HBV serological markers and abdominal ultrasonography were carried out every 6 months. Results During the first year of treatment, all patients showed a progressive decline of serum HBV DNA levels; while undetectable serum HBV DNA and normalization of alanine aminotransferase was achieved in 24(92.3%) and 25 (96.2%) patients, respectively, at the end of the first year of treatment. The 6- and 12-month cumulative rates of HBeAg loss were 26.9% (7/26) and 42.3% (11/26), respectively; and corresponding cumulative rates of HBeAg/anti-HBe seroconversion were 7.7% (2/26) and 30.8 (8/26), respectively. During the observation period, no virological breakthrough was detected. Conclusion Telbivudine combined with defovir dipivoxil may be a good choice for patients with suboptimal response to adefovir dipivoxil, which could induce effective viral inhibition and help patients obtain more virological, biochemical and immunological responses.
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
COPD 被定义为一种慢性肺部“炎症”性疾病。COPD 的炎症反应由吸烟、大气污染等有害颗粒或气体所诱发, 主要累及小气道和肺实质, 导致慢性支气管炎和气道阻塞; 同时还导致肺实质的破坏, 引起肺气肿, 形成不完全可逆的气流受限。COPD 的炎症以中性粒细胞为主, 肺泡巨噬细胞、CD8 + T细胞以及肥大细胞、嗜酸粒细胞、CD4 + T细胞和B 细胞等都可能参与了COPD 炎症过程。 糖皮质激素( 简称激素) 具有广泛的抗炎作用, 是临床最常用的抗炎药物。激素用于哮喘治疗取得了良好的临床疗效。但是在COPD 治疗上却存在许多争议．．．．．．
Objective To investigate the effects of exogenous bone morphogenetic protein(BMP) and transforming growth factor-β(TGF-β) on biomechanical property for ulna of fracture healing.Methods Thirty-six adult rabbits were made the model of right ulnar fracture and treated locally with TGF-β/PLA, BMP/PLA，TGF-β+BMP/PLA or PLA(as control group). Fracture healing was evaluated by measurement of the mechanical parameters and geometric parameters.Results As compared with control group, the geometric parameters, the bending broken load, the ultimatebending strength, the bending elastic modulus, the ultimate flexural strength, the flexural elastic modulus, the ultimate compressing strength, the compressingelastic modulus, and the ultimate tensile strength for ulna of fracture healingincreased significantly in the treatment groups(P＜0.01). These parameters were higher in TGF-β+BMP/PLA group than in TGF-β/PLA group or in BMP/PLA group andin TGF-β/PLA group than in BMP/PLA group(P＜0.05). There was no significant difference in bone density between the treatment groups and control group. Conclusion Local application of exogenous TGF-β and BMP canincrease the callus formation and enhance biomechanical strength of bone after fracture healing. A combination of TGF-β and BMP has synergetic effect in enhancing fracture healing.
Objective To evaluate the effectiveness of PTD regimen (pamidronate disodium + thalidomide + dexamethasone) and TD regimen (thalidomide + dexamethasone) in the treatment of multiple myeloma. Methods The patients meeting the inclusion criteria were randomly treated with PTD and TD regimens from January 2004 to December 2008. The effectiveness and safety of the two groups were observed after 8 weeks and the statistical analyses were performed using SPSS 13.0 software. Results A total of 25 patients were included, of which 13 were treated with PTD regimen and the other 12 were treated with TD regimen. The results showed overall response rates were 84.6% and 83.3% in the PTD and TD groups, respectively, with no significant difference (Pgt;0.05). The complete response rate (5/13 vs. 1/12) and early response rate (within 2 weeks, 4/13 vs. 1/12) for bone pain in the PTD group were better than those of TD group (Plt;0.05). Conclusion Compared with TD regimen, PTD regimen has more dramatic and faster effects on bone pain relief for multiple myeloma, but for overall response rate, further larger sample size randomized controlled trials are needed.
We correct some misunderstandings of hypertension therapy and update the knowledge of hypertensive drugs by reviewing the progress of evidence-based research of hypertension in 2004.
目的 比较拉米夫定+阿德福韦酯联合治疗与阿德福韦酯单药治疗对阿德福韦酯停药后出现病毒学反弹而无基因型耐药变异患者的疗效及安全性。 方法 回顾研究2007年1月－2012年1月在传染科门诊就诊的67例阿德福韦酯治疗获得病毒学应答但停药后出现病毒学反弹的e抗原阳性慢性乙型肝炎患者，分别给予拉米夫定+阿德福韦酯联合治疗（联合组，n=35）和阿德福韦酯单药治疗（单药组，n=32）。 结果 治疗1年后，联合组（32例，85.7%）较单药组（21例，65.6%）有更多的患者重新获得了丙氨酸转氨酶复常（P=0.009），联合组34例（97.1%）乙型肝炎病毒DNA阴转，单药组22例（68.8%）阴转，两组差异有统计学意义（P=0.002）；在血清学转换方面，联合组和单药组分别有4例（11.4%）和1例（3.1%）患者获得了e抗原的血清学转换。在治疗中所有患者均未发生任何严重不良反应。 结论 阿德福韦酯停药后出现病毒学反弹，选择拉米夫定与阿德福韦酯联合治疗可使患者重新获得较好的生化学和病毒学应答。
【摘要】 目的 观察阿德福韦酯联合拉米夫定治疗阿德福韦酯治疗48周后应答不佳，HBeAg阳性慢性乙型肝炎的疗效和安全性。 方法 选择2006年1月-2010年12月间阿德福韦酯治疗48周后乙型肝炎病毒 DNAgt;104 copies/mL的26例慢性乙型肝炎患者，给与拉米夫定（100 mg，1次/d）联合治疗。观察治疗12周，24周时的应答情况。 结果 所有纳入26例患者在联合拉米夫定优化治疗24周后，无论是病毒学应答还是血清学应答都获得显著的改善，无一例患者观察到有耐药以及药物不良反应发生。 结论 联合拉米夫定是对阿德福韦酯应答不佳慢性乙型肝炎患者安全有效的干预策略之一。【Abstract】 Objective To observe the effect and safety of adefovir dipivoxil (ADV) combined with lamnivudine (LAM) in treating HBeAg-positive chronic hepatitis B (CHB) patients with poor response to ADV monotherapy for 48 weeks. Methods Twenty-six HBeAg-positive CHB patients received initial treatment of ADV from January 2006 to December 2010, and their serum HBV-DNA still maintained over or equal to 1.0×104 copies/mL after 48 weeks. These patients received the optimized treatment of ADV (10 mg, one time per day) combined with LAM (100 mg, one time per day). Patients′ responses to the treatment at the 12th and 24th week were observed. Results Compared with baseline, ADV plus LAM had an improved response rate of virological response, biochemical response and HBeAg/HBeAb seroconversion. No LAM-resistant or ADV-resistant mutations were detected. In all the 26 patients, no adverse reactions were observed. Conclusion Optimized therapy combining LAM and ADV can be a good choice for patients with hepatitis B who have a poor response to ADV monotherapy.
目的:探讨小剂量吲哒帕胺联合比索洛尔治疗原发性高血压患者的安全性和疗效。方法: 60例初诊的高血压Ⅰ级、Ⅱ级患者,随机分为治疗组及对照组。治疗组予以吲哒帕胺25mg/次,及比索洛尔25mg/次,每天早晨7时服药1次;对照组单用吲哒帕胺25mg/次,每天早晨7时口服1次,疗程8周。结果: 两组患者血压(收缩压及舒张压)均有下降,但以治疗组血压下降明显。治疗组显效13例,有效14例;对照组显效8例,有效15例;治疗组总有效率为90%,治疗组无效率为10%;对照组有效率767%,无效率233%,2组疗效差异有统计学意义(Plt;005)。两组不良反应相似,治疗前后生化指标变化差别无统计学意义。结论:比索洛尔联合吲哒帕胺治疗原发性高血压安全有效,对糖、脂代谢无明显影响。