附子入药方剂的现代研究进展

从现代医学研究角度综述附子入药方剂的现代研究进展,阐明各方剂药理作用及机制,为多靶点协同用药理念奠定理论基础。本文检索国内外相关文献,从中药配伍、药理作用及机制等方面综述各方剂研究现状。发现附子常与红参、甘草、麻黄、大黄等中药配伍,其方剂具有增效减毒的药理作用,但方剂中有效成分在体内作用的多靶点调控网络有待进一步的系统化探究。附子入药方剂的配伍方式和治疗效果为疾病多靶点协同治疗策略提供新思路。     

Survival Analysis Using Albumin-Bilirubin (ALBI) Grade for Patients Treated with Drug-Eluting Embolic Transarterial Chemoembolization for Hepatocellular Carcinoma

PurposeThe albumin-bilirubin (ALBI) grade has been established as an improved predictor of survival in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization and yttrium-90 radioembolization. The purpose of the study was to investigate the utility of ALBI grade in prognosticating outcomes in patients with HCC treated with drug-eluting embolic (DEE) transarterial chemoembolization (TACE).Materials and MethodsA single-center retrospective review was performed to compare the efficacy of ALBI grade and Child-Pugh (CP) classification in predicting the survival of patients with HCC receiving DEE-TACE. A total of 303 patients with HCC were identified who had received DEE-TACE without concomitant locoregional therapy within 30 days. Survival analysis was performed using Kaplan-Meier methods and censored for curative therapy. Survival curves were stratified based on the ALBI grade, CP class, Barcelona Clinic Liver Cancer (BCLC) stage, Eastern Cooperative Oncology Group performance status, and presence of ascites. The discriminatory ability of survival curves was calculated by C-Index.ResultsKaplan-Meier survival curves stratified by the ALBI grade produced distinct, nonoverlapping curves (P < .001), showing greater discriminatory ability than the CP classification (C-index = 0.568 and 0.545, respectively). The substratification of the BCLC stage by the ALBI grade yielded greater discriminatory ability than the substratification by the CP classification (C-index = 0.573 and 0.565, respectively). For patients with BCLC stage B, the substratification by the ALBI grade yielded distinct curves, whereas the substratification by the CP classification did not (P = .011 and P = .379, respectively).ConclusionsALBI grade showed improved discriminatory ability compared with CP classification in differentiating overall survival among patients with HCC receiving DEE-TACE. Furthermore, ALBI grade was effective in substratifying survival among patients categorized as CP class A and patients with BCLC stage B, whereas CP classification was not effective.     

“双重管理”模式在大型综合性医院导医管理中的应用研究

目的探讨该院第三方劳务派遣制导医"双重管理"模式的可行性和有效性。方法在该院门诊部使用第三方劳务派遣制导医,实行医院门急诊部和导医服务公司对导医的"双重管理",主要的管理措施包括:制定导医管理制度,明确各岗位导医工作职责、流程和考核方案,强化带教培训、现场管理和"护士加导医"的合作服务模式。结果导医离职率由2016年的28%下降至2018年的8%;门诊综合满意度由2016年的93%上升至2018年的97%。结论通过对第三方劳务派遣制导医实行科学有效的"双重管理",不断提高导医服务能力,能提升医院综合服务水平,有效提高患者满意度。     

Perioperative ECX chemotherapy in older adults with gastroesophageal adenocarcinoma

Introduction

Perioperative epirubicin, cisplatin and 5-FU or capecitabine (ECF/X) chemotherapy is recognised as a standard of care for patients with resectable gastroesophageal adenocarcinoma; however, there is limited evidence regarding its use in older patients. The aims of this study were to assess the effectiveness and tolerability of perioperative ECX chemotherapy in patients aged ≥70?years-old (group 1) compared with a younger population (group 2), and to assess differences in the histology of these groups.

Geriatric assessment in oncology: Moving the concept forward. The 20 years of experience of the Centre Léon Bérard geriatric oncology program

Objectives

The management of cancer in aging people remains a challenge for physicians. Specialists agree on the assistance provided by a multidimensional geriatric assessment (MGA) to guide the cancer treatment decision-making process. We aim to explore the use of MGA in treatment decision and to identify MGA parameters likely to influence the planned cancer treatment.

Cetuximab Combined With Induction Oxaliplatin and Capecitabine,Followed by Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer: SWOG 0713

Background

Neoadjuvant chemoradiation (NCRT) is standard treatment for locally advanced rectal cancer. Pathologic complete response (pCR) has associated with improved survival. In modern phase III trials of NCRT, pCR ranges from 10% to 20%. Cetuximab improves response in KRAS (KRAS proto-oncogene) wild type (wt) metastatic colorectal cancer. S0713 was designed to assess improvement in pCR with additional use of cetuximab with induction chemotherapy and NCRT for locally advanced, KRAS-wt rectal cancer.

新疆不同区域参合农民对新农合满意度差异分析

目的 分析新疆不同区域参合农民对新农合满意度的差异所在.方法 采用多阶段随机抽样方法,对新疆维吾尔族自治区南疆、北疆和东疆地区参合农民对新农合定点医疗机构、新农合制度和经办机构的满意度进行随机调查,共收回有效问卷1 140份.结果 参合农民对基层医疗机构满意度较低,得分在3.5分左右,南疆对定点医疗机构满意度相对较高;参合农民对新农合制度的满意度较低,其中,北疆个人缴费水平较多的占12%,封顶线、起付线和报销比例等均低于其他两疆(P<0.001);南北疆新农合报销繁琐程度在30%以上;报销过程问题较多,南北疆较为突出.结论 应加大基层医疗机构卫生资源投入,尤其是南疆;完善医院和新农合管理信息系统建设;简化就医和报销流程;加强北疆"医德医风"建设,改善服务态度;提高补偿设置的合理性;增加筹资渠道,增强筹资能力.     

欧洲医学院校的分组协作学习方式

通过对欧洲高等医学教育中分组协作学习方法的内涵、要素、程序及功效等进行分析和总结,为我国医学教育改革提供参考。     

新农合制度下参合人员住院费用现状及对策分析

目的：对陕西省某县参合人群的住院费用情况进行分析,为进一步完善新农合费用控制和补偿政策提供建议。方法以2011年某县全年参合患者住院人次变化、住院费用以及补偿费用等为研究指标,利用 SAS 统计分析软件进行数据分析。结果45岁以上人群住院人次构成比高于14%且呈上升趋势,住院费用较高;男性住院费用高于女性,在县外医疗机构尤其明显;单病种住院费用均值1323元(中位数851)低于非单病种3467元(中位数1780);家庭年住院次数集中于1~2次的占90.35%。结论45岁以上人群卫生服务利用率逐渐增多,县外住院费用偏高,且男性多于女性。单病种付费减轻了患者负担,但单病种数量相对较少。