培门冬酶治疗鼻腔NK/T细胞淋巴瘤主要不良反应的观察和护理对策

[目的]观察含培门冬酶的化疗方案在临床上治疗鼻腔自然杀伤(NK)/T细胞淋巴瘤时的主要不良反应,总结其护理。[方法]观察含培门冬酶联合方案化疗的20例鼻腔NK/T细胞淋巴瘤病人不良反应,共计65个疗程,采取针对性护理措施。[结果]血淀粉酶升高发生率为23.1%,其中发生急性胰腺炎的1例,骨髓抑制的10例;低蛋白血症发生率为87.6%,其中25g/L有12例次;变态反应1例,采取针对性护理措施药物的不良反应均得到缓解。[结论]含培门冬酶的联合化疗在治疗淋巴瘤中发生不良反应的几率较高,护理上应严密观察,采取个性及时有效的护理措施,以帮助病人尽早恢复健康。     

培门冬酶联合Chop方案治疗NK/T细胞淋巴瘤病人不良反应的护理

[目的]探讨培门冬酶联合Chop方案治疗NK/T细胞淋巴瘤病人不良反应的护理。[方法]选择使用Chop方案(环磷酰胺、长春新碱、吡柔比星)联合培门冬酶化疗的70例次NK/T细胞淋巴瘤病人,密切观察病人组使用药物过程中的不良反应,并给予有效的护理措施。[结果]出现胃肠道反应有19例,骨髓抑制有17例,凝血因子Ⅰ降低20例,高脂血症有12例,精神疲乏10例,皮肤出现皮疹瘙痒9例,过敏反应无。[结论]培门冬酶联合Chop方案治疗NKT细胞淋巴瘤病人发生的不良反应发生率高,医护人员应在病人使用药物期间严密观察病情,给予及时有效的护理,提高用药的安全性及病人对治疗的满意度。     

培门冬酰胺酶替代治疗的不良反应观察及护理

目的:探讨培门冬酰胺酶替代治疗时出现不良反应的临床观察与护理。方法:总结我院2009年11月～2010年10月因使用左旋门冬酰胺酶过敏而使用培门冬酰胺酶替代治疗患儿74例的不良反应发生情况以及护理措施。结果:本组74例使用培门冬酰胺酶替代治疗的病例中出现过敏反应8例,占10.81%,其中过敏反应包括皮疹2例,寒战3例,面色苍白伴哭闹1例,过敏性休克2例;局部反应6例为臀部肌肉疼痛,占8.11%;器官功能改变49例,占66.22%,包括胰腺炎1例,血糖升高1例,白蛋白<3.0 g/L 8例,纤维蛋白原<1.5 g/L 15例,抗凝血酶原Ⅲ<75 g/L 24例。结论:培门冬酰胺酶作为对左旋门冬酰胺酶过敏病例的替代治疗用药,应注意相关不良反应的观察、治疗和护理,做到早发现、早干预,以确保培门冬酰胺酶的安全使用。     

吉西他滨联合培门冬酶、顺铂、地塞米松方案治疗晚期结外鼻型NK/T细胞淋巴瘤的临床效果分析

目的:分析吉西他滨联合培门冬酶、顺铂、地塞米松方案治疗晚期结外鼻型NK/T细胞淋巴瘤的临床效果。方法:选取2017年4月至2018年6月于本院收治的50例结外鼻型NK/T细胞淋巴瘤患者为研究对象,将其随机划分为观察组与对照组。对照组采取吉西他滨联合培门冬酶治疗方案,观察组采取吉西他滨联合培门冬酶、顺铂、地塞米松方案,对比两组患者临床治疗效果。结果:观察组患者与对照组患者接受2~6周的化疗,在治疗过程中,观察组死亡2例,死亡率为8.0%。对照组患者死亡6例,死亡率为24.0%。两组患者临床疗效、治疗过程中不良反应率对比,观察组明显优于对照组。两组患者各项指标对比,组间数据差异具有统计学意义(P<0.05)。结论:吉西他滨联合培门冬酶、顺铂、地塞米松方案治疗晚期结外鼻型NK/T细胞淋巴瘤,应用疗效显著,可最大程度减少患者治疗过程中的不良反应与过敏发生率。     

联合化疗治疗NK/T细胞淋巴瘤的疗效及安全性分析

回顾分析2010年1月~2015年1月接受门冬酰胺酶与培门冬酶联合化疗的80例NK/T细胞淋巴瘤患者的临床资料,随机分成门冬酰胺酶组及培门冬酶组,比较门冬酰胺酶及培门冬酶的患者的疗效性及安全性。门冬酰胺酶组42例,8例(19%)有转氨酶异常,15例(35.7%)有血浆纤维蛋白原浓度异常,7例降低,临床无凝血功能障碍和血栓等表现。培门冬酶38例,10例(26%)有转氨酶异常;11例(28.9%)有血浆纤维蛋白原浓度异常,5例降低,临床无凝血功能障碍和血栓等表现。4例(10.5%)出现肾功能异常,以尿素氮增高(2例)为主,临床未发现肾功能不全的表现。3例(7.8%)发生高血糖症,1例(2%)急性胰腺炎的病例发生。38例次培门冬酶治疗中,仅2例(5%)发生了典型的过敏反应,以明显的风团样皮疹伴瘙痒为主要表现,有一过性喉头异物感,经吸氧、镇静等处理后很快缓解。无过敏性休克。PEG-Asp和L-Asp在NK/T细胞淋巴瘤治疗中疗效相当,但PEG-Asp具有使用方便、不良反应发生率低、缩短住院日的优点。     

PEMD方案治疗NK/T细胞淋巴瘤不良反应的护理

目的总结PEMD方案治疗NK/T细胞淋巴瘤不良反应的护理经验。方法对25例NK/T细胞淋巴瘤患者采用PEMD方案(甲氨蝶呤、培门冬酶、地塞米松、依托泊苷)治疗,分析主要不良反应,并加强护理。结果所有患者共进行97个疗程的治疗,57例次(59%)出现中性粒细胞减少(1×109/L),35例次(36%)发生Ⅲ~Ⅳ级感染。24例次出现不同程度的口腔黏膜损伤,3例次中毒性表皮松解症。39例次(40%)血小板减少(50×109/L),22例次(23%)发生低纤维蛋白血症,16例次(17%)ATPP时间延长。12例次(12%)血糖升高(空腹血糖7mmol/L)。9例次(9%)血清淀粉酶升高。结论对症、预防性的护理对减轻患者痛苦,积极配合完成治疗有着重要的作用。     

培门冬酶联合化疗治疗淋巴瘤的疗效观察

目的探讨培门冬酶联合化疗治疗淋巴瘤的疗效观察。方法选取2016年2月～2017年3月就诊于我院的82例NK/T细胞淋巴瘤患者,按随机数字表法将其分为观察组和对照组各41例。两组均行奥沙利铂、吉西他滨、地塞米松化疗,对照组加用左旋门冬酰胺酶,观察组加用培门冬酶治疗。比较两组临床疗效、生存时间、无进展生存时间、不良反应发生情况。结果观察组治疗总有效率显著高于对照组,差异有统计学意义(P0.05);观察组总生存时间、无进展生存时间较长,差异有统计学意义(P0.05);观察组高血糖、消化道反应、粒细胞减少、过敏反应发生率显著低于对照组,差异有统计学意义(P0.05);观察组肾功能不全发生率略低于对照组,差异无统计学意义(P0.05)。结论培门冬酶联合化疗治疗淋巴瘤疗效显著,可有效延长生存时间与无进展生存时间,减少不良反应发生,安全性较高。     

培门冬酰胺酶联合吉西他滨治疗结外NK/T细胞淋巴瘤的安全性和疗效观察

目的探讨培门冬酶联合吉西他滨治疗结外NK/T细胞淋巴瘤的疗效及安全性。方法结外NK/T细胞淋巴瘤患者54例分为CHOPL组25例和培门冬酶联合吉西他滨组(联合组)29例。CHOPL组给予CHOP加左旋门冬酰胺酶,联合组为培门冬酶联合吉西他滨、奥沙利铂、地塞米松治疗。比较2组治疗有效率及副作用。结果 54例患者的总有效率为88.9%。CHOPL组有效率为84%,联合组有效率为93.1%,差异无统计学意义(χ2=1.127,P=0.289)。CHOPL组患者消化道反应、高血糖、过敏反应的发生率均高于联合组(P0.05)。结论培门冬酶联合吉西他滨对结外NK/T细胞淋巴瘤的近期治疗效果较好安全性高。     

培门冬酶和左旋门冬酰胺酶治疗儿童急性淋巴细胞白血病患者的临床对比

目的探讨培门冬酶(PEG-ASP)和左旋门冬酰胺酶(L-ASP)治疗儿童急性淋巴细胞白血病(ALL)的临床效果。方法收集2018年1月至2019年1月某院收治的89例ALL患儿作为研究对象,随机数表法分为试验组45例和对照组44例。试验组患儿采用含培门冬酶的方案进行化疗,对照组患儿则给予含左旋门冬酰胺酶的方案进行化疗。比较两组患儿治疗的临床效果,不良反应发生率以及用药次数和住院时间等指标。结果试验组和对照组总有效率分别为95.56%、93.18%,组间比较,差异无统计学意义(P0.05);两组患儿在化疗期间的不良反应多在Ⅰ～Ⅱ级,各项常见不良反应情况经临床比较,差异无统计学意义(P0.05)。试验组患儿用药次数和住院时间均低于对照组,差异有统计学意义(P0.05)。结论培门冬酶和左旋门冬酰胺酶用于治疗儿童ALL均有较高的临床效果,且不良反应方面相近,不过培门冬酶作用时间长,给药次数少,临床应用更为方便。     

以培门冬酶为基础的改良SMILE方案治疗晚期、复发难治性结外NK/T细胞淋巴瘤

目的：探讨以培门冬酶（PEG-Asp）为基础的改良SMILE方案治疗晚期或复发难治性结外NK/T细胞淋巴瘤的临床疗效。方法纳入2012年2月-2013年9月接受改良SMILE方案化疗的结外NK/T细胞淋巴瘤患者5例,其中,4例ⅣB期,1例复发难治。2例患者接受自体造血干细胞移植。结果5例患者中,4例可评价疗效,2例完全缓解（CR）,1例部分缓解（PR）,1例疾病进展（PD）,1例稳定（SD）。5例均发生Ⅲ-Ⅳ度中性粒细胞减少。结论以培门冬酶为基础的改良SMILE方案对晚期及复发难治的结外NK/T细胞淋巴瘤具有一定疗效。与左旋门冬酰胺酶相比,疗效相当,免疫原性小,过敏反应发生率低,使用更为安全。此外,培门冬酶半衰期长,可能延长作用时间。     

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.     

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.     

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.     

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.     

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.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.