前列腺素E1治疗老年慢性肺心病急性期的疗效观察

目的 :探讨前列腺素E1(PGE1)对老年慢性肺心病急性期的疗效。方法 :对 40例老年慢性肺心病急性期患者应用PGE110 0 μg·d-1静脉滴注 ,疗程 7d。于治疗前后同步检测患者血浆D -二聚体 (D -dimer) ,血清纤维蛋白降解产物 (FDP) ,动脉血氧分压 (PaO2 ) ,及动脉血二氧化碳分压 (PaCO2 )并观察症状体征变化 ,同时与对照组患者及 2 0例健康者进行比较。结果 :两组老年慢性肺心病急性期患者的D -二聚体和FDP显著高于健康组 (P <0 .0 1) ,治疗组病例治疗后D -二聚体及FDP较治疗前显著降低 (P <0 .0 1) ,症状体征显著改善 (P <0 .0 5～ 0 .0 1) ,对照组的D -二聚体 ,FDP及部分症状和体征 ,治疗前后比较差异有显著性 (P <0 .0 5～ 0 .0 1)。治疗后PaO2 两组均显著增高 (P <0 .0 1) ,组间比较无差别 (P >0 .0 5 )。治疗后PaCO2 两组均降低 ,但治疗组降低幅度更明显 (P <0 .0 1)。结论 :PGE1对老年慢性肺心病急性期确有良好疗效     

基于TNM分期的胆囊癌手术治疗

选择合适的手术方式使病人获得良好预后是目前胆囊癌外科治疗的重要研究方向。具体手术方式应根据胆囊癌分期而定,目前国内外最常用的是TNM分期。对于Tis、T1a 期胆囊癌病人行单纯胆囊切除术即可达到治愈目的,T1b、T2、T3、T4N0-1M0期胆囊癌病人可根据术中评估结果采取根治切除术或扩大根治切除术,从而达到R0切除。M1期病人行扩大根治切除手术意义已不大,可采取姑息手术治疗,以改善病人生活质量为目标。     

肾移植术后Ⅰ型原发性高草酸尿症复发致移植肾功能不全的多学科综合诊疗

目的探讨肾移植术后Ⅰ型原发性高草酸尿症(PH)复发的临床特点和多学科综合诊疗(MDT)的经验。方法对1例接受同种异体肾移植手术后不明原因移植肾功能短期内迅速下降的病例进行MDT讨论,总结MDT在诊断罕见遗传性疾病以及提高肾移植受者长期存活中的作用。结果经MDT讨论,患者确诊为Ⅰ型PH复发,排除排斥反应后恢复常规免疫抑制方案,嘱大量饮水,予优质蛋白和低磷饮食、维生素B6、钙剂等保守治疗措施并积极防治并发症。患者移植肾功能恶化延缓,但仍在肾移植术后5个月恢复规律血液透析至投稿日。结论肾移植术后Ⅰ型PH复发较为罕见,临床主要表现为复发性肾结石,移植肾功能下降,且并发症多,患者预后不良。通过MDT讨论患者病情,明确诊断,确定最佳治疗方案,延缓了病情进展,改善了患者预后。     

Description synthétique des trajectoires des patients insuffisants rénaux chroniques terminaux à partir du registre REIN

Context and objectivesSince 2001, the aim of the REIN registry has been to identify patients suffering from end-stage renal disease and benefiting from replacement therapy in France. The analysis of trajectories aims to evaluate the flow of patients between the different types of treatment in order to better understand and predict patient pathways. The objective of this study was to analyse the incoming and outgoing flows at 1 year of patients prevalent in the REIN registry on 12/31/2017.MethodsFlow analysis was carried out on patients prevalent on 12/31/2017 in the REIN registry by studying the before and after treatment modalities on 12/31/2016 and 12/31/2018. This analysis was initially carried out on all patients, then in sub-groups for each of the 5 treatment modalities.ResultsThe analyses covered 85,472 patients prevalent on 12/31/2017. The overall analysis showed that more than 20% of patients had been diagnosed with end-stage renal disease the year before. Regarding inflow, there was a relative stability for patients treated with self-care hemodialysis, in-center haemodialysis, peritoneal dialysis, and graft, in contrast to patients treated with hemodialysis in a medical unit. Regarding outgoing flows, proportion of deaths at one year was 9%. Peritoneal dialysis was the modality with the highest outflow proportion at one year.ConclusionAnalysis of patients’ trajectories shows variable evolution profiles according to treatment modality and thus could be a valuable tool in the evaluation and improvement of management and care in the field of end-stage renal disease.     

迪利单抗对肺癌患者嗜酸性气道炎症的研究

目的 探讨信迪利单抗对肺癌患者嗜酸性气道炎症的影响。方法 选取2019年4月—2020年4月于徐州医科大学附属宿迁医院就诊的60例IV期非鳞非小细胞肺癌患者,随机分为对照组(单纯化疗组)和试验组(信迪利单抗联合化疗组);对照组给予培美曲塞500 mg/m2联合顺铂75 mg/m2静脉注射;试验组在对照组治疗方案基础上联合免疫检查点抑制剂信迪利单抗200 mg静脉注射,均21天为1个周期。6个周期治疗后检测两组患者呼出气一氧化氮(Fractional exhaled nitric oxide,FeNO)、外周血嗜酸性粒细胞计数、肺功能及动脉血气;分析信迪利单抗治疗组严重不良事件(SAE)及免疫相关性肺炎(CIP)的发生率。结果 ⑴试验组在第2、4、6周期治疗后FeNO水平、外周血嗜酸性粒细胞计数相较于基线水平出现升高趋势,但差异无统计学意义(PFeNO=0.536; PEos=0.762)。⑵两组患者经6个周期治疗后,第1秒用力呼吸容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、一氧化碳弥散量占预计值百分比(DLco%)较治疗前均无明显变化(PFEV1=0.615; PFVC=0.473; PFEV1/FVC=0.637; PDLco%=0.598);动脉血气分析中PH、PaO2、PaCO2水平较治疗前均无明显变化(PPH=0.457; PPaCO2=0.242; PPaO2=0.631)。⑶试验组免疫相关SAE发生率和CIP的发生率均为0。结论 6周期治疗后信迪利单抗对肺癌患者的嗜酸性气道炎症、肺功能、动脉血气分析无明显影响,未出现免疫相关SAE及CIP。     

精准护理在新型冠状病毒肺炎流行期间肿瘤晚期患者中的应用

目的探讨精准护理在新型冠状病毒肺炎流行期间肿瘤晚期患者中的应用效果。方法选取2020年1—3月于医院肿瘤科住院的82例肿瘤晚期患者作为研究对象,所有患者住院后均实施精准护理,比较患者在入院和出院时的焦虑自评量表(SAS)及抑郁自评量表(SDS)评分。结果出院时,患者的SAS及SDS评分均低于入院时,差异有统计学意义(P<0.05)。结论精准护理可有效降低新型冠状病毒肺炎流行期间肿瘤晚期患者的焦虑及抑郁水平。     

Comparisons of interval breast cancers with other breast cancers detected through mass screening and in outpatient clinics in Japan

In a nation-wide collaborative study on mass screening for breast cancer, we collected 152 cases of interval breast cancer diagnosed at 35 hospitals or clinics distributed throughout Japan. The definition of interval breast cancer used in the present study is "breast cancer cases which were diagnosed as having 'no malignant findings' in a previous screening for breast cancer but subsequently diagnosed as 'breast cancer' at a hospital or medical clinic within two years of the previous screening." The clinical stages and prognoses of these interval cancer were analyzed and compared with those of other breast cancers detected through mass screening and in outpatient clinics. In the clinical staging of interval breast cancer, Tis (non infiltrating cancer) accounted for only 2.1%, compared to 8.0% in cases detected through mass screening. At stage I 43.4% were interval breast cancers compared to 32.9% breast cancers detected through mass screening and 25.4% diagnosed in outpatient clinics. The stage differences between interval breast cancers and breast cancers detected through mass screening were not statistically significant. Five-year survival rates were 85.6% for interval breast cancers, 91.7% for breast cancers detected through mass screening and 84.7% for breast cancers diagnosed in outpatient clinics. Ten-year survival rates were 75.9, 80.5 and 78.1%, respectively, suggesting the interval breast cancer cases to show a similar prognosis to that of breast cancer cases diagnosed in outpatient clinics. The differences in five- and 10-year survival rates among the three groups were not statistically significant. From the present study we were not able to confirm the general belief of interval cancer being more aggressive in nature and showing a poorer prognosis than cancer detected through periodic screening. The reasons for this are discussed.     

晚期肿瘤的治疗及其价值

晚期肿瘤是否有治疗意义的讨论越来越受到社会的关注。作者从医学及伦理学两方面论述晚期肿瘤的治疗意义,认为治疗有助于疾病的控制,有利于提高患者的生存质量。指出晚期肿瘤的治疗并非无效治疗,患者能从治疗中得益。     

持续性枕后位的处理

目的：探讨如何处理持续性枕后位,以尽可能减少母儿并发症。方法：总结分析了１２０例持续性枕后位的孕周、胎儿体重、产重长短对分娩方式的影响以及不同分娩方式对母儿的影响。结果：当孕周大于等于４０周,胎儿体重大于等于３５００ｇ,潜伏期大于８ｈ,活跃期大于４ｈ时,剖宫产率明显增高,持续性枕后位所致的产程延长及手术助产增加了新生儿窒息率和产妇的并发症。结论：对持续性枕后位应正确观察处理各产程,早期诊断,充分估计其阴道分娩的可能性,对不适于阴道分娩者,应果断行剖宫产术,以降低母儿并发症。［