食管癌同步放化疗52例

[目的]评价食管瘤同步放化疗的疗效。[方法]回顾性分析1983年1月至1992年12月353例无锁骨上转移的食管癌。按治疗方法分三级：Ⅰ组：单纯放疗301例，放疗剂量48Gy－75Gy；Ⅱ组：放疗加平阳霉素26例，放疗剂量50Gy－76Gy，平阳霉素10mg肌注，每周1－2次，共6－7周；Ⅲ组：放疗加顺钻26例，放疗剂量54Gy－70Gy，顺钢20mg－30mg，静脉滴注，每周1－2次，共6－7周。所有病例均随访5年以上。[结果]1年生存车Ⅰ、Ⅱ、Ⅲ组分别为48．2％、61．5％和53．8％，三组间无统计学差异。3年生存率各组分别为21．6％、26．9％和42．3％，其中Ⅲ组与Ⅰ、Ⅱ组有显著性差异（P＜0．05）。5年生存率各组分别为11．3％、154％和26．9％，Ⅲ组与Ⅰ、Ⅱ组间有显著性差异（P＜0。05）。[结论]同步放化疗可提高食管癌的疗效，尤以放疗加顺铂为佳。     

同期放化疗治疗晚期非小细胞肺癌

目的探讨长春瑞滨联合顺铂同期放疗综合治疗晚期非小细胞肺癌的疗效和毒副作用。方法对33例晚期非小细胞肺癌患者进行同期放化疗，化疗在放疗开始时同期进行，用药长春瑞滨25mg／m^2第1、8天静脉滴注；顺铂40mg／m^2第1、2天静脉滴注。28d为1个周期，共给6周期。放疗采用常规分割照射（1．8～2Gy／次，5次／周），总剂量为45～55Gy。治疗结果与同期单纯放疗的41例晚期非小细胞肺癌进行对照。结果放化同期组的近期有效率为57．6％，单纯放疗组为34．1％（x^2=4．06，P〈0．05）。放化同期组1、2年生存率分别为63、6％、39．4％，单纯放疗组分别为29．3％、14．696（1年生存率的卡方检验：x^2=8．74，P〈0．01；2年生存率的卡方检验：x^2=5．87，P〈0．05）。放化同期组肿瘤进展时间平均为10．2个月，单纯放疗组为4．5个月（Log Rank检验：x^2=6．34，P〈0．05）。两组结果相比有显著性差异。两组患者治疗过程中出现的毒副反应主要为骨髓抑制，以及放射性食管炎等。但所有病例均顺利完成治疗过程，无治疗相关死亡。结论长春瑞滨联合顺铂同期放疗可以提高晚期非小细胞肺癌的近期疗效和远期生存率，是一种安全有效的综合治疗手段。     

Concurrent analysis: validation of the domains within the Birth Satisfaction Scale

Background and aim: Measuring women’s satisfaction with their birth experience has been problematic. Recently, an attempt has been made to capture birth satisfaction’s generalised meaning and incorporate it into an evidenced-based tool. Standard procedures for validation have limitations. Qualitative techniques such as domain analysis offer an alternative and assist in better understanding the importance of each item. This article examines the parsimony of the Birth Satisfaction Scale (BSS), which is a 30-item questionnaire designed to measure satisfaction with childbirth, with women’s actual experience of childbirth. Methods: Primary free text data collected from 207 women who originally tested the BSS was concurrently analysed with first-hand accounts of birth satisfaction collected from 19 qualitative papers. Results: The domain analysis confirmed three explanatory items within the BSS: ‘being in control’, ‘things going as planned’, and ‘being supported’. Conclusions: The BSS accounts for all the analysed data, suggesting it is a robust measure of satisfaction in childbirth. Strengths and limitations of the method are discussed, as are implications for practice. With further development, the instrument could be used to establish correlates with other psychometric measures, i.e. self-efficacy, anxiety, depression, locus of control and bonding; and evaluate models or care systems as a standalone instrument, or as a screening test prior to detailed qualitative work.     

‘It’s not good to eat a candy in a wrapper’: male students’ perspectives on condom use and concurrent sexual partnerships in the eastern Democratic Republic of Congo

This paper reports on fieldwork carried out in 2011 with aim to investigate young men’s perspectives about condoms use, concurrent sexual partnerships and sex in the context of HIV/AIDS. This study employed a qualitative approach to collect data from 28 boys aged 16–20 from two urban and two rural high schools in South Kivu province. Four focus group discussions and 20 individual interviews were conducted among them. The findings showed that most students identified condoms as unsafe and untrustworthy. Reasons given for the mistrust of condoms were related to the belief that condoms do not give enough protection from Sexually Transmitted Infections, HIV and pregnancies. Most participants believe that condoms have a ‘small hole’ or are unreliable and are therefore not effective in prevention. They also mentioned that condoms encourage inappropriate sexual activity. They prefer flesh-to-flesh sex rather than protected sex using a condom. However, a few participants acknowledged the importance of condom use. Despite the risk of HIV transmission, boys believe that it is appropriate for them to have concurrent sexual partnerships. They justified the concurrent sexual partnerships as a way of ensuring that they cannot miss a girl to satisfy their sexual desire. Given the boys’ failure to use condoms and their strong inclination to concurrent sexual partnerships, there is a need for heath groups and stakeholders within the area to increase awareness about condoms’ effectiveness and improve knowledge dissemination on Sexually Transmitted Diseases and how they are prevented.     

Persistent infection of Strongyloides venezuelensis and normal expulsion of Nippostrongylus brasiliensis in Mongolian gerbils, Meriones unguiculatus, with reference to the cellular responses in the intestinal mucosa

The kinetics of daily faecal egg count, worm burdens, and intestinal cellular responses were examined in Mongolian gerbils after infection with either Strongyloides venezuelensis or Nippostrongylus brasiliensis alone, or concurrently with both parasites. The results show that, both in individual and concurrent infections, S. venezuelensis infection persisted for over 10 weeks and elicited a gradual increase in number of mast cells in the jejunal mucosa. On the other hand, N. brasiliensis worms were expelled by 3 weeks in association with goblet cell hyperplasia. These results suggest that effector/regulator cells involved in worm expulsion are different and highly selective depending on the genus of intestinal helminths.     

预防性使用聚乙二醇化重组人粒细胞集落刺激因子在肺癌患者同步放化疗中的作用

目的 评价预防性使用聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)在肺癌同步放化疗期间预防中性粒细胞减少症的作用。方法 回顾性分析2020年4月至2021年4月于北京大学肿瘤医院接受同步放化疗的149例肺癌患者的临床资料,其中预防组79例,包括初级预防组(全程同步放化疗中预防使用PEG-rhG-CSF)48例,次级预防组(出现粒细胞减少后的化疗周期中预防使用PEG-rhG-CSF)31例;未预防组70例。对比预防组和未预防组之间3~4级中性粒细胞减少症的发生率、同步放化疗完成率、放化疗剂量减量和治疗时间延迟发生率。结果 全组患者在放化疗中出现3~4级中性粒细胞减少症的发生率为32.2%(48/149)。其中,初级预防组的发生率为6.3%(3/48),次级预防组的发生率为9.7%(3/31),未预防组的发生率为35.7%(25/70)。预防组(初级预防+次级预防)与未预防组中性粒细胞减少症的发生率差异有统计学意义(χ²=17.81,P＜0.001)。全组粒细胞缺乏伴发热的发生率为3.4%(5/149),未在初级预防组出现。同步放化疗足量完成率在预防组为96.2%(76/79),明显高于未预防组的82.9%(58/70),差异有统计学意义(χ²=7.30,P=0.007)。预防组放化疗剂量减量和治疗时间延迟发生率为19.0%(15/79),未预防组为40.0%(28/70),差异有统计学意义(χ²=7.98,P=0.005)。结论 PEG-rhG-CSF的预防使用可以有效降低3~4级中性粒细胞减少症的发生,更好地保证肺癌患者同步放化疗按计划完成。     

放化同步治疗中老年局部晚期非小细胞肺癌时紫杉醇剂量选择的研究

目的探讨放化同步治疗中老年非小细胞肺癌（NSCLC）时紫杉醇剂量的选择。方法选择60例NSCLC患者,其中男性36例,女性24例;年龄55~65岁。随机分为A、B、C、D、E 5组,每组12例患者。所有患者先经过3个周期的诱导化学治疗,1个月后进行放化同步治疗。三维适形放射治疗在5~6周内完成,控制总剂量在60 Gy;化学治疗时使用紫杉醇,A组2次/周,每次10mg/m2;B组2次/周,每次15 mg/m2;C组2次/周,每次20 mg/m2;D组3次/周,每次10 mg/m2;E组3次/周,每次15 mg/m2,6周完成治疗。当任何一组患者在治疗期间出现半数以上的患者发生3度以上急性不良反应即停止该组试验。结果 A、B、D 3组出现3度以上不良反应的患者均未超过半数,完成所有治疗,近期总有效率分别为41.67%、75.00%、66.67%;C、E两组因出现3度以上不良反应的患者超过半数而停止试验。结论在诱导化疗后使用放化同步治疗中老年局部晚期NSCLC患者时紫杉醇最佳使用剂量的选择为每周30 mg/m2,可根据患者具体身体状况调整每次给药剂量和给药次数,并于5~6周完成治疗。