紫杉醇联合放化疗治疗28例晚期非小细胞肺癌疗效观察

目的:探讨紫杉醇联合放化疗治疗晚期非小细胞肺癌疗效及不良反应。方法:28例患者均为不能手术切除的-期非小细胞肺癌,采用紫杉醇全身化疗联合应用直线加速器外照射放疗。结果:完全缓解3例、部分缓解17例、无变化6例、恶化2例,总有效率(完全缓解 部分缓解)71.4%,放、化疗后CA125有明显下降,与治疗前相比P<0.05有显著差异,不良反应较轻。结论:紫杉醇联合放、化疗是治疗不能手术切除的中晚期非小细胞肺癌的有效方法之一。     

支气管动脉灌注化疗联合腔内高剂量率放疗治疗晚期中央型肺癌的研究

目的 探讨支气管动脉灌注化疗联合腔内高剂量率放疗治疗晚期中央型肺癌的近期疗效、毒副反应及安全性.方法 64例晚期肺癌患者分别接受全身静脉化疗联合腔内高剂量率放疗和支气管动脉灌注化疗联合腔内高剂量率放疗.化疗用药:非小细胞肺癌采用MVP方案、小细胞肺癌采用EP方案,化疗3周期,每次间隔3、4周.均于第1次化疗结束2周后通过支气管镜置入施源器、模拟定位机后用192铱后装治疗机行腔内局部高剂量率放疗3次,腔内治疗每周一次,每次6～8 Gy,共4次;化疗疗程结束后评估近期疗效和毒副反应.结果 支气管动脉灌注化疗组完全缓解率75.00%、总有效率为93.75%,较全身静脉化疗组的50.00%和68.75%明显增高;其1年生存率为81.25%,较全身静脉化疗组43.75%显著提高;症状改善及KPS评分显效率分别高达96.88%和87.50%,较全身静脉化疗组62.50%和50.000%显著提高.毒副作用:支气管动脉灌注化疗组白细胞下降18.75%,恶心、呕吐25.00%,便秘、腹泻1.25%,较全身化疗组62.50%、62.50%和25.00%明显减轻.差异均有显著性.结论 支气管动脉灌注化疗联合经支气管镜腔内高剂量率放疗治疗晚期肺癌近期疗效好、副作用少、安全性高、依从性好,是较为有效的综合治疗方法.     

经皮植入化疗泵动脉灌注治疗恶性肿瘤生存率分析

目的 :探讨化疗泵的理想植入方法 ,总结其治疗恶性肿瘤生存率情况。方法 :对70例不能手术的恶性肿瘤患者行化疗泵植入术 ,并定期灌注化疗药物治疗。结果 :埋泵成功率98.6 %(69/70)。肺癌患者临床症状改善 ,病灶缩小 ,其中2例行ΙΙ期手术切除。24例肝癌和12例直结肠癌病例中 ,分别有21例(87.5 %)和8例(66.7 %)显示病灶缩小。结论 :经皮植入化疗泵治疗恶性肿瘤具有诸多优点 ,疗效显著可以提高带瘤患者生存率。     

支气管动脉灌注化疗同步三维适形放疗治疗局部晚期非小细胞肺癌的临床研究

目的探讨支气管动脉灌注化疗同步三维适形放疗治疗局部晚期非小细胞肺癌的临床价值。方法 18例局部晚期非小细胞肺癌按随机数字表法分成研究组(8例)和对照组(10例)。研究组采用支气管动脉灌注化疗同步三维适形放疗方案,对照组采用静脉化疗同步三维适形放疗方案。观察2组治疗方案的有效率、生存期和不良反应。结果研究组和对照组的有效率分别为75%和70%,1年生存率分别为75%、70%,2年生存率分别为50%、40%。2组比较差异均无统计学意义(P均>0.05)。2组毒副反应比较差异无统计学意义(P>0.05)。结论支气管动脉灌注化疗同步三维适形放疗和全身静脉化疗同步三维适形放疗治疗不可手术的局部晚期非小细胞肺癌的疗效和毒副反应相似。     

晚期肺癌多次介入治疗疗效分析

目的:探讨多次支气管动脉灌注化疗术(BAI)治疗晚期肺癌的疗效。方法:36例晚期肺癌患者均行多次支气管动脉灌注化疗术,用Seldinger's方法选择性插管至参与肿瘤血供的支气管动脉,并注入化疗药物。其中有33例行2次BAI,3例行3次BAI。结果:所有病例治疗后临床症状均明显缓解;总有效率(CR PR)69.44%。其中,有3例患者在第2次BAI术后选择手术治疗,随访至今,无复发、转移等。结论:对于晚期肺癌及失去外科手术机会的肺癌患者,多次支气管动脉灌注化疗术是一种安全、有效的治疗方法。     

经气管镜微创介入治疗中心型肺癌疗效分析

目的 观察化疗联合经气管镜微创介入治疗中晚期中心型肺癌的临床疗效。方法 选择36例中晚期中心型肺癌患者,采用全身标准一线化疗方案吉西他滨+顺铂(GP)联合经气管镜微创介入治疗即经气管镜,氩氦刀切除肿瘤后放置气管支架(联合治疗组),两个化疗周期后评定临床疗效;同时设对照组即单纯化疗组(49例)仅采用全身标准一线化疗方案吉西他滨+顺铂(GP)方案治疗两个周期后评价疗效。结果 联合治疗组有效率为72.2%,症状缓解率为69.4％,1年生存率77.8%;单纯化疗组有效率为28.6％,症状缓解率为38.8％;1年生存率44.9%,两组比较差异均有统计学意义(P<0.01)。结论 化疗联合气管镜微创介入治疗中心型肺癌疗效显著、症状缓解迅速,是目前治疗中晚期中心型肺癌的较好选择。     

胃动脉插管置泵化疗治疗晚期胃癌疗效分析

目的探讨胃动脉插管置泵化疗对晚期胃癌的疗效。方法将40例不能根治切除的晚期胃癌随机分为两组。治疗组18例术中行胃动脉插管置泵、术中及术后经泵灌注化疗,对照组22例术后行静脉全身化疗。结果治疗组半年生存率83.3%,1年生存率38.9%,对照组半年生存率59.1%,1年生存率18.2%(P<0.05)。结论胃动脉插管置泵化疗对晚期胃癌疗效明显优于静脉全身化疗。     

选择性支气管动脉内注药治疗晚期肺癌的护理

对于晚期中心型肺癌患者,用手术切除的成功率极低,用全身化疗及放疗的效果也不理想。目前我科采用选择性支气管动脉内灌注化学药物(BAI)治疗晚期肺癌患者共计39例69次,其中男31例,女8例;年龄在34～67岁。经过2～18个月随访观察,治疗后患者症状明显改善,肿瘤阴影消退显著、迅速,总有效率达90%。现将我们在治疗中的配合和护理情况介绍如下。     

晚期肺癌区域灌注化疗的临床应用

原发性肺癌主要以手术切除为主，对于晚期肺癌和因各种原因不能手术切除的肺癌，我们采取了经支气管动脉和肺动脉区域灌注化疗。现将我院2000年至2003年采用该方法治疗的21例病例报告如下。     

支气管动脉灌注联合静脉及口服化疗治疗中晚期肺癌的疗效评价

目的:观察支气管动脉灌注化疗联合静脉化疗及口服VP-16治疗中晚期肺癌的近期疗效。方法:将经病理证实的中晚期肺癌110例随机分为单纯静脉化疗组、支气管动脉灌注化疗组(BAI)、BAI联合静脉化疗及口服VP-16组(观察组),WHO实体瘤疗效评定不同治疗方法对肺癌的近期疗效。结果:静脉化疗组40例,CR4例,PRl5例,总有效率47.5%;BAI组35例,CR2例,PRl6例,总有效率51.4%;观察组35例,CR6例,PR19例,总有效率71.4%:观察组分别与静脉化疗组和BAI组比较均有显著性差异(P<0.05),观察组的疗效优于静脉化疗组和BAl组的疗效。BAl组对局部疗效好,但对远处转移疗效差,而观察组对远处转移疗效较好。结论:支气管动脉灌注联合静脉化疗及口服VP-16治疗肺癌,其控制原发灶和转移灶的疗效优于单一的静脉化疗和BAI化疗的疗效,可作为中晚期肺癌较有效的治疗方法。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.