NP与MVP方案治疗晚期非小细胞肺癌近期疗效比较

目的:探讨NP与MVP方案治疗晚期非小细胞肺癌(NSCLC)近期临床效果及其毒性反应。方法:用NVB+DDP(NP组)与MMC+VDS+DDP(MVP组)联合化疗方案分别治疗NSCLC。结果:NP组总有效率(PR)41.94％(13/31),MVP组RR37.04%(10/27),P>0.05。2组主要毒性反应是骨髓抑制和消化道反应;Ⅱ～Ⅳ度静脉炎发生率NP组(19.35％)明显高于MVP组(3.7％)(P<0.01)。结论:NP和MVP方案治疗晚期NSCLC疗效相近。     

异环磷酰胺为主的联合方案治疗晚期复发鼻咽癌

[目的]观察比较异环磷酰胺(IFO)、顺铂(DDP)、5-氟尿嘧啶(5-Fu)联合方案(IPF方案)与DDP,5-Fu(PF方案)治疗晚期复发鼻咽癌(Ⅲ-Ⅳ期)的近期疗效及毒副反应。[方法]136例均经病理证实为晚期复发鼻咽癌患者,随机分为IPF组69例,PF组67例(对照组)[结果]IPF组和PF组有效率分别为69.56％(48/69)和43.3％(29/67),两组间差异有显著性(X2=8.519,P<0.01)。中位生存期:IPF组16个月(8-34个月),PF组为6.5个月(4-21个月),两组间差异有显著性(X2=22.36,P<0.05)。毒副作用主要为骨髓抑制,Ⅲ-Ⅳ度白细胞下降率IPF组为49.4％,PF组为5.97％,两组差异有显著性(X2=29.54,P<0.01)。Ⅲ-Ⅳ度血小板下降率IPF组为29.18％,PF组为0％(X2=30.29,P<0.01);Ⅲ-Ⅳ度消化道反应两组的发生率分别为15.94％和11.94％(x2=0.234,P>0.01).且以Ⅲ度为主。[结论]以IFO为主的方案联合治疗晚期复发鼻咽癌疗效好,毒副反应能耐受,可作为一线方案。     

多西紫杉醇联合顺铂与紫杉醇联合顺铂治疗晚期非小细胞肺癌疗效比较

目的比较多西紫杉醇联合顺铂（DDP）与紫杉醇联合DDP一线治疗晚期非小细胞肺癌（NSCLC）的临床疗效和毒性。方法65例ⅢB、Ⅳ期NSCLC患者随机分为两组，DC组33例子多西紫杉醇＋DDP方案；TC组32例子紫杉醇＋DDP方案，两组均每3周重复疗程。结果DC组和TC组患者的中位生存期分别是9．6月和9．0月（P〉0．05），1年存活率分别是32．3％和30．8％（P〉0．05），至疾病进展时间分别是25周和20周（P〈0．05），总有效率分别为39．3％、28．2％（P〉0．05），骨髓抑制发生率分别为78．8％和87．5％（P〉0．05），呕吐发生率分别为54．5％和59．4％（P〉0．05），骨关节及肌肉疼痛发生率分别为9．1％和28．1％（P〈0．05），DC组患者生活质量较TC组高。结论多西紫杉醇联合DDP与紫杉醇联合DDP方案治疗晚期NSCLC相比较总生存期无差别，但无进展生存期较长、神经肌肉不良反应较轻，是治疗晚期NSCLC较好的选择。     

化疗及放化疗联合治疗局部晚期非小细胞肺癌的临床研究

【目的】比较单纯化疗与放化疗联合治疗局部晚期非小细胞肺癌（NSCLC）的疗效及毒性反应。【方法]56例不能手术的局部晚期NSCLC患者按治疗方法不同分为单纯化疗组31例（A组）,放化疗联合组25例（B组）,对比两组疗效及安全性。【结果】治疗有效率、中位生存期及1、3年生存率A组分别为38．7％、8．8个月、29％和0,B组分别为68％、13．5个月、56％和8％,B组较A组明显提高,差异有显著性（P〈0．05）。白细胞减少、血小板减少及消化道反应A组发生率分别为48．4％、16．1％和71％,B组分别为72％、20％和80％,两组相比差异均无显著性（P〉0．05）。【结论】对不能手术的局部晚期NSCLC采用放化疗联合治疗优于单纯化疗,且毒副反应能耐受。     

吡南阿霉素与环磷酰胺及顺铂联合化疗治疗晚期乳腺部

目的：评价采用吡南阿霉素（THP）与环磷酰胺（CTX）及顺铂（DDP）联合化疗治疗晚期乳腺癌的疗效与毒性反应。方法：晚期乳腺癌135例，采用第一天分别静脉注射THP 40mg/m^2,CTX 600mg/m^2，同时DDP20mg/m^2，静脉滴注，第1－5天。21天为一疗程。结果：总有效率78．1％，完全缓解率19．3％，初治者总有效率100％。该方案胃肠道反应轻，轻度脱发（11．1％），白细胞减少96．3％，多为I、Ⅱ度（66．7％）。结论：THP联合CTX与DDP化疗治疗晚期乳腺癌疗效高，毒性低。     

MVP方案与CAP方案治疗晚期非小细胞肺癌的比较研究

目的评价丝裂霉素 (mitomycin c ,MMC)、长春地辛 (vindesine ,VDS)与顺铂 (cisplatin ,DDP)组成的MVP方案和环磷酰胺 (cyclophosphamide,CTX)、阿霉素 (adriamycine ,ADM)与顺铂组成的CAP方案对晚期非小细胞肺癌的效果及毒副作用。方法经病理学、细胞学确诊的非小细胞肺癌 62例 ,随机分为两组。治疗组 3 2例采用MVP方案 :MMC 6～ 8mg/m2 ,第 1天 ;VDS 4mg,第 1、8天 ;DDP 40mg第 1～ 3天每 4周重复 1次。对照组 3 0例采用CAP方案 :CTX 60 0mg/m2 ,第 1天 ;ADM 40mg/m2 ,第 1天 ;DPP 40mg,第 1～ 3天。每 4周重复 1次。结果治疗组中 ,完全缓解 (CR) 2例 ,部分缓解(PR) 17例 ,有效率 5 9.4%。CAP组中CR 1例 ,PR 10例 ,有效率 3 6.6% (P <0 .0 5 )。两组主要毒副作用均为骨髓抑制及消化道反应 ,而对照组中部分出现心电图异常。结论MVP方案治疗晚期非小细胞肺癌是一种疗效确切 ,毒副反应可以耐受的化疗方案     

吡南阿霉素与环磷酰胺及顺铂联合化疗治疗晚期乳腺癌

目的评价采用吡南阿霉素(THP)与环磷酰胺(CTX)及顺铂(DDP)联合化疗治疗晚期乳腺癌的疗效与毒性反应.方法晚期乳腺癌135例,采用第一天分别静脉注射THP 40 mg/m2,CTX 60 0 mg/m2,同时DDP 20 mg/m2,静脉滴注,第1～5天.21天为一疗程.结果总有效率78.1%,完全缓解率19.3%,初治者总有效率100%.该方案胃肠道反应轻,轻度脱发(1 1.1%),白细胞减少96.3%,多为Ⅰ、Ⅱ度(66.7%).结论 THP联合CTX与 DDP化疗治疗晚期乳腺癌疗效高,毒性低.     

改进的紫杉醇联合顺铂方案治疗晚期非小细胞肺癌的临床观察

目的 为比较紫杉醇联合顺铂改进的3周方案与传统3周方案治疗晚期NSCLC的疗效、毒副反应及1年生存率。方法75例经组织学或细胞学确诊的Ⅲb或Ⅳ期NSCLC患者，随机分为两组，分别接受改进方案（A组）和传统3周方案（B组）化疗。2周期后评价疗效与毒副反应，并随访1年生存率。结果A组无CR，A组总有效率为47．9％（18／37）；B组CR1例，总有效率为52．6％（20／38）。总有效率两组差异无显著性（P〉0．05），两组1年生存率分别为38．2％和35．6％。两组差异无显著性（P〉0．05）。主要毒副反应为恶心、呕吐、骨髓抑制、脱发、周围神经毒性、肝功能受损、心脏毒性等。A、B组差异无显著性（P〉0．05）。关节肌肉疼痛A组32．4％；B组84．2％，两组差异有显著性（P〈0．05）。结论紫杉醇联合顺铂改进的3周方案治疗NSCLC与传统3周方案相比，疗效相似，但血液学毒性明显下降，耐受性好。     

多西他赛联合奥沙利铂治疗晚期非小细胞肺癌的临床观察

目的观察多西他赛联合奥沙利铂治疗晚期非小细胞肺癌的临床疗效和毒副作用,并与多西他赛和顺铂联合化疗方案作比较。方法将60例晚期非小细胞肺癌病人随机分为两组,A组30例用多西他赛联合奥沙利铂治疗;B组30例用多西他赛联合顺铂治疗。比较两组临床疗效和毒副作用。结果A组总有效率56．7％;B组总有效率46．7％。A组治疗方案有效率高于B组（P〈0．05）。两组化疗方案的主要毒副作用A组发生率低于B组（P〈0．05）。A组治疗期间KPS评分高于B组（P〈0．05）。结论多西他赛联合奥沙利铂治疗晚期非小细胞肺癌的疗效较好,副作用较轻、能耐受,患者生活质量较高,值得进一步研究。     

TP方案与FLP方案治疗晚期食管癌对比研究

目的观察紫杉醇联合顺铂（TP方案）与5氟尿嘧啶联合亚叶酸钙、顺铂（FLP方案）治疗晚期食管癌的有效性和安全性。方法将44例晚期食管癌患者随机分为A、B两组，A组20例，应用TP方案；B组24例，应用FLP方案；治疗周期为21天。至少完成2个周期化疗方可评价疗效及不良反应。结果TP方案有效率为60％，FLP组有效率为25％，疗效差异有显著性（P〈0．05）。两组共同的毒性反应为骨髓抑制和消化道反应，TP组有肌肉关节痛。结论TP方案治疗晚期食管癌的疗效高于FLP方案。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.