目的 回顾性观察糖皮质激素联合小剂量吗替麦考酚酯（MMF）对IgA肾病的临床疗效及安全性。 方法 2010年9月－2012年9月在我科门诊就诊的28例IgA肾病患者接受了小剂量MMF联合激素治疗。醋酸泼尼松起始剂量为0.6 mg/（kg·d），MMF起始剂量为0.5～1.0 g/d，2～4周内调节药物剂量使血药浓度（MPA-AUC）维持在30～60 mg·h/L。治疗前及治疗后每月随访观察血清肌酐、血清白蛋白、尿蛋白定性、24 h尿蛋白定量及药物不良反应等指标。诱导期初定为6个月，若6个月未完全缓解（CR）则延长至9个月，总疗程至少12个月，主要评价指标为诱导治疗期的完全缓解率。 结果 全部患者均完成了12个月的随访观察，全组28例中CR 8例（28.6%），部分缓解（PR）14例（50.0%），未缓解（NR）6例（21.4%），总有效率78.6%。随访过程中，3例患者出现呼吸道感染，其中2例住院治疗；2例患者出现尿路感染，1例患者出现腹泻。 结论 小剂量MMF治疗IgA肾病安全、有效且能在一定程度上节省患者费用，可作为其他免疫抑制方案治疗无效或复发时的一种治疗选择。
Objective To evaluate the effects of Shengji Yuhong collagen on promoting angiogenesis of the ischemia tissues and probe the possible mechanisms. Methods Forty-eight Wistar rats were divided by random method of paired into blank group， control group （collagen），and experimental group （Shengjiyuhong collagen）. After made the rats hind limb ischemia model， collagens with or without the extracts of Shengji Yuhong Gao were randomly paired implanted locally in hind limb ischemia tissues of rats in experimental group or control group. The samples of collagens and tissues about 0.5 cm large surrounding the collagen were explanted respectively on day 3，7， 14， and 28 for detected the hemog-lobin contents in colagen， microvascular counting by using CD34 immunohistochemical markers， and the expressions of HIF-1α mRNA and VEGF mRNA by using real-time fluorescent quantitative RT-PCR. The blood perfusion of the ischemic tissues at each time were determined by using laser speckle imaging system of Moor-FLPI. Results The results of Moor-FLPI showed that the obvious ischemia condition after model made， the blood perfusion was significantly lower than that before operation （P＜0.01）. On day 3 after operation it showed obvious congestion in the ischemic tissues， and from day 7 to day 14， it showed the ischemia state locally till day 28 after operation which showed improved situation of ischemic. Except for the day 3， the blood perfusion of experimental group were higher than those of blank group （P＜0.05）. There was no statistical significance between the blank group and control group （P＞0.05）. The blood perfusion on day 7 and day 14 after operation of experimental group were higher than those of control group （P＜0.05）. The hemoglobin contentsof each time point in the experimental group were higher than those in the control group （P＜0.01）. The microvascular counting on day 7 and day 14 in experimental group were higher than those of control group （P＜0.05）. The expressions of HIF-1α mRNA and VEGF mRNA at each time point of experimental group were higher than those of control group and blank group （P＜0.05）， and there was no significant differences between the control group and blank group （P＞0.05）. Conclusion The effects on promoting angiogenesis of rat hind limb ischemia tissues with Shengji Yuhong collagen may though inducing the expressions of HIF-1 α mRNA and VEGF mRNA locally.
Objective To explore the axillary lymph node dissection (ALND) could be safely exempted in younger breast cancer patients (≤40 years of age) who receiving breast-conserving surgery combined with radiotherapy in metastasis of 1–2 sentinel lymph node (SLN) and T1–T2 stage. Methods The data of pathological diagnosis of invasive breast cancer from 2004 to 2015 in SEER database were extracted. Patients were divided into SLN biopsy group (SLNB group) and ALND group according to axillary treatment. Propensity matching score (PSM) method was used to match and equalize the clinicopathological features between two groups at 1∶1. Multivariate Cox proportional risk model was used to analyze the relationship between axillary management and breast cancer specific survival (BCSS), and stratified analysis was performed according to clinicopathological features. Results A total of 1 236 patients with a median age of 37 years (quartile: 34, 39 years) were included in the analysis, including 418 patients (33.8%) in the SLNB group and 818 patients (66.2%) in the ALND group. The median follow-up period was 82 months (quartile: 44, 121 months), and 111 cases (9.0%) died of breast cancer, including 33 cases (7.9%) in the SLNB group and 78 cases (9.5%) in the ALND group. The cumulative 5-year BCSS of the SLNB group and the ALND group were 90.8% and 93.4%, respectively, and the log-rank test showed no significant difference (χ2=0.70, P=0.401). After PSM, there were 406 cases in both the SLNB group and the ALND group. The cumulative 5-year BCSS rate in the ALND group was 4.1% higher than that in the SLNB group (94.8% vs. 90.7%). Multivariate Cox proportional hazard analysis showed that ALND could further improve BCSS rate in younger breast cancer patients [HR=0.578, 95%CI (0.335, 0.998), P=0.049]. Stratified analyses showed that ALND improved BCSS in patients diagnosed before 2012 or with a character of lymph node macrometastases, histological grade G3/4, ER negative or PR negative. Conclusions It should be cautious to consider the elimination of ALND in the stage T1–T2 younger patients receiving breast-conserving surgery combined with radiotherapy when 1–2 SLNs positive, especially in patients with high degree of malignant tumor biological behavior or high lymph node tumor burden. Further prospective trials are needed to verify the question.