肝动脉栓塞化疗联合立体定向适形放疗对原发性肝癌患者的疗效观察

目的观察肝动脉栓塞化疗联合立体定向适形放疗对原发性肝癌患者的疗效。方法收集本院收冶的未接受手术治疗的原发性肝癌患者66例,按治疗方式分为肝动脉栓塞化疗联合立体定向适形放疗的观察组43例,和单纯接受肝动脉栓塞化疗的对照组23例。观察两组患者的近期疗效、远期疗效,治疗前后甲胎蛋白（AFP）的变化及不良反应的发生等。结果观察组患者的近期治疗有效率为72．1％,显著优于对照组（43．5％）;观察组患者总生存时间和一年生存率均显著优于对照组;2组患者治疗前AFP值无显著差异,治疗后观察组患者AFP显著低于对照组;2组不良反应的发生无统计学差异。结论肝动脉栓塞化疗联合立体定向适形放疗可显著提高患者的治疗效果。     

立体定向放射疗法联合肝动脉化疗栓塞对原发性肝癌患者的疗效及对免疫功能的影响

目的研究立体定向放射疗法联合肝动脉化疗栓塞对原发性肝癌患者的疗效及对免疫功能的影响。方法选取确诊为原发性肝癌患者100例作为研究对象,将其按照随机数字表法分为观察组和对照组各50例。对照组采用立体定向放射疗法,观察组在对照组基础上联合肝动脉化疗栓塞疗法。观察两组患者治疗效果,免疫功能以及不良反应情况。结果观察组总有效率92.00%显著高于对照组的68.00%(P0.05);治疗后观察组与对照组CD4~+、CD4~+/CD8~+以及自然杀伤细胞(NK)免疫指标均有所上升,CD8~+均有所下降,其中观察组免疫功能指标明显优于对照组(P0.05);观察组不良反应发生率28.00%低于对照组40.00%(P0.05)。结论立体定向放射疗法联合肝动脉化疗栓塞治疗原发性肝癌患者,能有效缓解临床症状,提高生活质量,增强免疫功能,值得临床应用。     

肝动脉化疗栓塞术联合射频消融治疗肝癌患者的疗效及安全性

目的探讨肝动脉化疗栓塞术联合射频消融治疗肝癌患者的疗效及安全性。方法 124例肝癌患者分为对照组和观察组。对照组接受肝动脉化疗栓塞术治疗,观察组接受肝动脉化疗栓塞术联合射频消融治疗。比较2组影像检查、复发率及血液等指标。结果 2组甲胎蛋白、肿瘤最大直径有显著差异(P0.05)。观察组复发率较对照组低(P0.05)。观察组3、6个月的疗效、生存率明显优于对照组(P0.05)。结论肝动脉化疗栓塞术联合射频消融治疗可有效控制患者的病灶部位,降低复发率,提高生存率。     

肝动脉化疗栓塞与伽马刀序贯联合疗法在中晚期肝细胞癌治疗中的临床应用研究

目的对中晚期肝细胞癌治疗中肝动脉化疗栓塞联合伽玛刀序贯治疗的应用方法和临床疗效进行分析。方法选取南阳市肿瘤医院2010年3月至2012年5月收治中晚期肝细胞癌患者62例,随机分为两组。其中对照组30例接受单纯肝动脉化疗栓塞治疗,观察组32例接受肝动脉化疗栓塞与伽玛刀序贯联合治疗,对两组患者治疗后临床疗效进行对比。结果两组患者经治疗后,观察组总有效率显著高于对照组,甲胎蛋白水平恢复情况显著优于对照组,1年生存率显著高于对照组（P〈0．05）。结论中晚期肝细胞癌治疗中,肝动脉化疗栓塞与伽玛刀序贯联合疗法具有显著临床疗效,可明显改善患者预后,显著延长患者生存期,值得在临床中推广。     

经动脉化疗栓塞术联合槲芪散或槐耳颗粒治疗原发性肝癌的疗效对比分析

目的:对比分析经动脉化疗栓塞术联合槲芪散或槐耳颗粒治疗原发性肝癌的临床疗效.方法:选取2009年8月至2010年5月我科收治的原发性肝癌患者85例作为研究对象,我们将上述患者随机分成两组,观察组43例,在经动脉化疗栓塞术后再给予槲芪散治疗;对照组42例,在经动脉化疗栓塞术后再给予槐耳颗粒治疗.口服槲芪散或槐耳颗粒的时间为期24周.结果:(1)治疗前,两组患者生存质量评分差异无统计学意义(P＞0.05);治疗后,观察组生存质量评分显著大于对照组,两组比较差异有统计学意义(P＜0.05).(2)观察组的治疗有效率显著高于对照组,两组比较差异有统计学意义(P＜0.05).(3)观察组治疗后1年的生存率显著高于对照组,两组比较差异有统计学意义(P＜0.05). 结论:经动脉化疗栓塞术后再联合使用槲芪散可以显著提高原发性肝癌患者的生存质量、治疗有效率、生存率等指标.     

肝动脉灌注化疗联合栓塞介入治疗原发性肝癌的疗效

[目的]探讨肝动脉灌注化疗联合栓塞介入治疗原发性肝癌对患者预后的影响.[方法]选取2012年6月至2017年12月在本院经肝穿刺活检或影像学检查被确诊为中晚期原发性肝癌的140例患者,按照随机表法分为对照组(n=68)和观察组(n=72),对照组患者采用单纯肝动脉灌注化疗,观察组患者采用肝动脉灌注化疗联合栓塞介入.对比两组甲胎蛋白水平变化情况、治疗效果、KPS评分、不良反应发生情况及术后生存情况.[结果]治疗前两组患者甲胎蛋白水平、KPS评分比较差异无显著性(P>0.05),治疗后,观察组甲胎蛋白水平低于对照组,KPS高于对照组,疗效显著高于对照组,且胃肠道不良反应发生率显著低于对照组,术后6个月和1年的生存率高于对照组,且差异均有统计学意义(均P<0.05).[结论]肝动脉灌注化疗栓塞介入治疗原发性肝癌疗效显著,安全性提高,且显著提高患者术后生存率.     

三维适形放疗对原发性肝癌合并门静脉癌栓患者近期疗效及生存状况的影响

目的探讨三维适形放疗对原发性肝癌合并门静脉癌栓患者近期疗效及生存状况的影响。方法选择原发性肝癌合并门静脉癌栓患者72例,根据治疗方法将其分为观察组与对照组,每组36例。对照组采用经导管肝动脉栓塞化疗(TACE)疗法,观察组采用TACE+三维适形放疗治疗。随访1年,比较两组近期疗效、生存状况及不良反应。结果观察组近期疗效优于对照组,差异有统计学意义(P0.05);治疗后,两组生活质量评分明显升高,且观察组高于对照组,差异有统计学意义(P0.05)。观察组1年生存率高于对照组,差异有统计学意义(P0.05)。结论三维适形放疗治疗原发性肝癌合并门静脉癌栓能提高患者近期疗效,改善患者生活质量,延长患者生存时间。     

支气管动脉灌注化疗和栓塞化疗治疗肺癌的临床效果

目的对支气管动脉灌注化疗和栓塞化疗治疗肺癌的临床效果进行分析和探讨。方法选取102例肺癌患者,随机将患者分为观察组和对照组各51例,两组患者均接受支气管动脉灌注化疗的治疗,观察组患者在此基础上再接受栓塞化疗的治疗,对比两组患者的临床效果。结果观察组治疗总有效为84.31%,高于对照组的64.71%,差异有统计学意义(P0.05);不良反应及并发症发生率两组比较差异未见统计学意义(P0.05);观察组1、2年生存率显著高于对照组(P0.05)。结论支气管动脉灌注化疗联合栓塞化疗治疗肺癌效果显著,可有效提高患者治疗有效率和生存率,同时不会给患者带来严重不良反应,效果安全可靠。     

复方苦参注射液联合TACE治疗对中晚期肝癌患者 疗效、肝功能、毒副作用改善观察

目的:观察复方苦参注射液联合经肝动脉化疗栓塞介入治疗对中晚期肝癌患者疗效、肝功能、毒副作用改善情况。方法:将2015年8月～2018年6月收治的150例中晚期肝癌患者随机分为对照组和观察组,每组75例。对照组进行经肝动脉化疗栓塞介入治疗,观察组在对照组治疗基础上加用复方苦参注射液。比较两组临床疗效、肝功能改善情况及毒副作用发生情况。结果:治疗后,观察组肝功能相关指标水平显著优于对照组,P0.05;观察组治疗有效率为64.00%,明显高于对照组的34.67%,P0.05;观察组毒副反应发生率均低于对照组,P0.05。结论:复方苦参注射液联合经肝动脉化疗栓塞介入治疗可有效改善中晚期肝癌患者肝脏功能,减轻手术带来的毒副作用,提高临床疗效。     

放疗联合卡培他滨+奥沙利铂治疗Ⅱ/Ⅲ期直肠癌术后临床观察

目的:观察放疗联合卡培他滨+奥沙利铂治疗Ⅱ/Ⅲ期直肠癌术后的临床疗效。方法:选取2015年6月~2017年6月中山市小榄人民医院收治的Ⅱ/Ⅲ期直肠癌患者80例作为研究对象,将所有患者随机分为两组,每组40例。对照组采用单纯放疗治疗,观察组在放疗基础上联合卡培他滨+奥沙利铂治疗。对比两组近期疗效及不良反应发生率。结果:对照组局部/区域复发率高于观察组,1年无瘤生存率、腹泻、骨髓抑制及手足综合征发生率明显低于观察组,P0.05,差异有统计学意义;两组患者恶心呕吐发生率比较,P0.05,差异无统计学意义。结论:与单纯化疗相比,放疗联合卡培他滨+奥沙利铂治疗Ⅱ/Ⅲ期直肠癌临床效果更加显著,术后复发率低,不良反应均在患者可耐受的范围,值得推广。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.