Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

穴位埋线与天灸治疗变应性鼻炎近期疗效对比分析

目的:对比穴位埋线及三伏天天灸治疗变应性鼻炎的近期疗效.方法:将72例患者随机分为埋线组和天灸组各36例,于夏季的初伏、中伏、中伏加强、末伏这4天进行治疗,埋线组取肺俞、迎香,天灸组取风门、肺俞、脾俞、肾俞穴位贴敷治疗.治疗结束后10天统计疗效.结果:埋线组显效13例、有效22例、无效1例,天灸组分别为5例、21例和10例,两组疗效经统计学处理差异有非常显著性意义(P<0.01).结论:穴位埋线对变应性鼻炎有良好效果,近期疗效优于天灸疗法.     

鼻内镜下手术加射频治疗鼻腔鼻窦乳头状瘤疗效观察

目的 探讨鼻内镜下手术加射频治疗鼻内翻性乳头状瘤的疗效。方法 对2001年2月-2005年3月在我科行鼻内镜下手术加射频治疗的22例鼻内翻性乳头状瘤患者进行临床观察，并对临床资料进行分析，随访1年以上。结果 22例均在鼻内镜下全部切除肿瘤并在其创面加行射频治疗之后治愈。在随访期间有4例在1年内复发，并再次行柯-陆式手术配合鼻内镜手术创面加射频治疗后治愈，其他患者无复发。结论 鼻内镜下手术加射频治疗鼻内翻性乳头状瘤有良好疗效，射频治疗对防止复发有确切效果，是一种临床简便易行的控制术后复发的办法，但要选择好合适病例。     

红丝线草提取物对高血压并发高脂血症模型大鼠调脂作用的研究

目的:观察红丝线草提取物对肾性高血压并发高脂血症大鼠( RHHR)血清脂质、一氧化氮( NO)、总抗氧化能力( T- AOC)及卵磷脂胆固醇酰基转移酶( LCAT)活性的影响。方法:采用双肾双夹结合高脂乳剂灌胃法复制RHHR模型。大鼠造模后,连续5周灌胃给予红丝线草提取物,并于给药第5周末处死大鼠,取血测血清脂质、总抗氧化能力及卵磷脂胆固醇酰基转移酶活性。结果:红丝线草提取物高、低剂量和辛伐他汀均可明显降低RHHR血清中的总胆固醇、甘油三酯和低密度脂蛋白胆固醇,同时明显升高血清高密度脂蛋白胆固醇水平;红丝线草提取物高、低剂量明显提高血清NO含量、总抗氧能力和LCAT的活性。结论:红丝线草提取物对RHHR具有明显的调脂作用,其作用与提高血清LCAT活性、NO含量和总抗氧化能力有关     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

中医药治疗重症肌无力的经验特色

:本文总结了近年来治疗重症肌无力的经验体会,认为脾虚证是重症肌无力的主证,脾气虚型是重症肌无力最主要的证型,临床必须明确主证,才能执简驭繁。辨证论治必须谨守病机、各司其属,针对重症肌无力脾胃虚损的病机进行治疗,在峻补脾气时,需刻刻顾护胃阴,以免阳回气复而胃阴却伤,阴火因而上潜。对久病肝郁、思想顾虑较重者,必须把药物治疗和心理治疗有机地结合起来,并于峻补脾气的同时,加用疏肝解郁之品,对较特殊的病例,还必须知常达变,不拘一格地进行治疗,平时须加强调护,注意消除引起病情反复的因素。     

栀子抑制小鼠S_(180)和肝癌及促进小鼠肝癌细胞凋亡作用

目的探讨栀子提取物对荷瘤小鼠S_(180)肉瘤和肝癌的抑瘤作用及肿瘤凋亡相关基因蛋白bcl-2表达以及细胞凋亡的作用。方法分别采用荷瘤小鼠S_(180)肉瘤和肝癌模型,灌胃栀子提取物10g·(kg·d)~(-1),qd×10d;观察瘤重和肿瘤抑瘤率,以及用酶联免疫分析法检测肝癌小鼠血清肿瘤凋亡相关基因蛋白bcl-2含量及用流式细胞仪检测肿瘤细胞凋亡情况。结果栀子提取物能抑制荷瘤小鼠S_(180)肉瘤和肝癌的增重(P＜0．01),抑瘤率分别为44．8%和61．0%;下调荷瘤小鼠肝癌模型血清肿瘤凋亡相关基因bcl-2表达(P＜0．01),小鼠肝癌细胞凋亡率为52．6%。结论栀子提取物对荷瘤小鼠S_(180)肉瘤和肝癌有抑制作用,抑瘤作用机制是下调肿瘤凋亡相关基因bcl-2表达,从而诱导小鼠肝癌细胞凋亡。     

脑卒中并发情绪障碍的护理干预

目的探讨脑卒中合并情绪障碍患者的护理干预效果。方法采用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）进行问卷调查，并分出轻度、中度、重度3种情况进行护理干预。结果所有患者的焦虑、抑郁情况都能得到改善，能积极配合治疗和护理工作。结论护理人员对脑卒中合并情绪障碍患者进行护理干预，并注重心理护理，有效利用社会支持系统，可以消除焦虑抑郁情绪，增强康复信心。     

苏子降气汤的临床应用

苏子降气汤方出自《太平惠民和剂局方》,用以治疗咳喘病且有上盛下虚的病机证候,为降肺气的通治方剂.其方剂组成为：苏子15 g,半夏12 g,前胡12 g,生姜12 g,陈皮12 g,当归12g,肉桂9 g,甘草10 g九味药物组成（一方有沉香,而无肉桂）.本方经笔者多年来的临床加减应用,认为其治疗范围甚广,只要辨证恰当,疗效显著.