化斑汤用于头颈部肿瘤急性放射性口咽损伤效果观察

目的：探讨化斑汤用于头颈部肿瘤急性放射性口腔、咽喉损伤的效果。方法：将67例头颈部肿瘤患者在DT达20Gy时，随机分为中药组35例和对照组32例，以RTOG急性放射损伤分级判定标准，观察两组治疗效果。结果：在DT达50Gy时，两组1级、2级、3级急性放射性口腔、咽喉损伤情况比较均有极显著性差异（P〈0．01）。结论：对头颈部肿瘤急性放射性口腔、咽喉损伤患者应用化斑汤，可降低急性放射损伤等级，延缓放射损伤发生，减轻患者痛苦。     

清得佳凝胶预防头颈部肿瘤患者急性放射性皮肤损伤的效果观察

目的:观察清得佳凝胶对头颈部肿瘤患者急性放射性皮肤损伤的预防效果。方法:将57例首次行放射治疗的头颈部肿瘤患者随机分为观察组、对照组各29例,放射治疗剂量50～70Gy/5～7周,常规分割,2Gy/次,1次/d,5d/周。观察组自放疗开始于每次放疗后放射野内涂抹约1mm厚清得佳凝胶,1次/d,同时放射野行常规皮肤护理,发生Ⅱ度湿性放射性皮肤损伤后常规用生理盐水或0.1%新洁尔灭清洁创面后,再涂清得佳凝胶。对照组不用清得佳凝胶,其余同观察组。结果:两组放射性皮炎、放射性疼痛、瘙痒总的发生率相比无统计学意义,但重度瘙痒的发生率两组比较P(0.05,具有统计学意义;发生I度放射性疼痛的放射剂量:观察组平均为(49±12)Gy,对照组平均为(35±16)Gy,两组比较P(0.05。发生I度瘙痒的放射剂量:观察组平均为(38±11)Gy,对照组平均为(30±15)Gy,两组比较(P(0.05),具有统计学意义。结论:清得佳凝胶的应用延缓了头颈部患者放疗过程中放射性疼痛及瘙痒的发生,降低了重度瘙痒的发生率。     

康复新液联合医用射线防护剂对头颈部肿瘤放射性皮炎的应用研究

目的探讨康复新液联合医用射线防护剂治疗头颈部肿瘤放射性皮炎的临床疗效。方法选择90例需行放射治疗的头颈部肿瘤患者随机分成A、B、C 3个组,每组30例。A组患者放射治疗时用康复新液联合医用射线防护剂治疗放射性皮炎;B组患者在放疗时单用医用射线防护剂;C组患者在放疗时单用康复新液。所有患者均行放射治疗,医用射线防护剂与康复新液每日使用3次,使用前与放射治疗结束后拍照片,根据美国肿瘤放射治疗协会皮肤急性放射损伤分级标准评估疗效。结果 A组治疗后有效率高于对照组B组(χ~2=5.76,P0.05)及C组(χ~2=5.23,P0.05)。B组与C组患者放射性皮炎疗效比较,差异无统计学意义(χ~2=1.26,P0.05)。结论康复新液联合医用射线防护剂对防治头颈部肿瘤放射性皮炎有明显疗效,延缓皮肤损伤的发生,加快皮肤损伤的愈合,值得在临床肿瘤放射治疗护理中进一步推广应用。     

化斑汤用于头颈部肿瘤急性放射性口咽损伤效果观察

目的:探讨化斑汤用于头颈部肿瘤急性放射性口腔、咽喉损伤的效果.方法:将67例头颈部肿瘤患者在DT达20Gy时,随机分为中药组35例和对照组32例,以RTOG急性放射损伤分级判定标准,观察两组治疗效果.结果:在DT达50Gy时,两组1级、2级、3级急性放射性口腔、咽喉损伤情况比较均有极显著性差异(P<0.01).结论:对头颈部肿瘤急性放射性口腔、咽喉损伤患者应用化斑汤,可降低急性放射损伤等级,延缓放射损伤发生,减轻患者痛苦.     

放射性肺损伤

放射治疗是肿瘤治疗的主要手段之一。放射线是把双刃剑 ,它既能杀灭肿瘤细胞 ,同时又可能造成正常组织的损伤 ,认识放射线损伤与认识和掌握放射线对肿瘤细胞的杀伤作用同等重要。在胸部肿瘤 (如肺癌、乳腺癌、纵隔淋巴瘤等 )的放射治疗中 ,肺组织往往会受到一定剂量的照射 ,造成不同程度的放射损伤。肺的放射损伤有两种表现形式 ,即早期的急性放射性肺炎和后期的放射性纤维化。ＲＴＯ (美国放射肿瘤治疗协作组 )放射性损伤评价标准中将发生放疗开始后 90天内者称为急性放射性损伤 ,发生在 90天以后者称为后期放射性损伤。放射性肺炎通常发生…     

头颈部肿瘤病人急性放射性口腔黏膜炎的临床观察与护理

[目的]观察头颈部肿瘤放射治疗病人急性放射性口腔黏膜炎的口腔干预效果。[方法]将90例头颈部肿瘤放射治疗病人随机分成观察组和对照组,每组45例,对照组常规口腔漱口,观察组采用碳酸氢钠、维生素B12、地塞米松口腔含漱。比较两组病人治疗后第2周、第4周、第6周口腔黏膜炎放射损伤程度。[结果]观察组病人治疗后第4周、第6周口腔黏膜放射损伤程度低于对照组。[结论]对头颈部肿瘤放射治疗病人进行口腔干预,可减轻病人口腔黏膜放射损伤程度。     

贝优芬预防头颈部肿瘤放射性皮炎效果观察

放射治疗是恶性肿瘤主要治疗手段之一,所致损伤是一种不可逆的、潜在性的、累计性的损伤[1].头颈部肿瘤放射治疗致使放射野皮肤出现不同程度的放射性皮炎.2009年1～ 12月,我们对56例头颈部肿瘤放射治疗患者应用贝优芬凝胶预防放疗性皮炎,效果满意.现报告如下.     

捷克信联合抗辐喷对局部晚期头颈部肿瘤所致急性放射性口炎患者的疗效研究

目的探讨局部晚期头颈部肿瘤患者急性放射性口炎应用捷克信联合抗辐喷的短期疗效。 方法选择广州医科大学附属肿瘤医院于2020年8月至2021年8月局部晚期头颈部肿瘤所致急性放射性口炎患者102例,依据随机数字表法分为观察组（n=51）与对照组（n=51）。观察组男32例,女19例,年龄（56.32±7.86）岁;对照组男34例,女17例,年龄（55.87±8.39）岁。两组均给予剂量模式为6 996 cGy/33 f,每周5次的局部晚期头颈部肿瘤调强放射治疗。对照组采用抗辐喷;观察组采用捷克信联合抗辐喷。两组患者在放疗结束后7 d评估疗效。比较两组临床短期疗效,治疗前后急性放射性口腔炎分级、疼痛数字评分标准（NRS）评分、口腔评估指南（OAG）量表评分、唾液白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平变化。 结果观察组治疗7d的短期疗效总有效率为84.31%,对照组为66.67%,差异有统计学意义（P＜0.05）。两组治疗后急性放射性口腔炎严重程度较治疗前降低（P＜0.05）;观察组治疗后急性放射性口腔炎严重程度低于对照组（P＜0.05）。两组治疗后NRS评分、OAG评分、唾液IL-6和TNF-α较治疗前降低（P＜0.05）;观察组治疗后NRS评分、OAG评分、唾液IL-6和TNF-α均低于对照组,分别为［（2.85±0.45）分 vs （3.76±0.63）分,P＜0.001］、［（9.20±1.05）分 vs （12.76±1.96）分,P＜0.001］、［（13.85±2.97）ng/L vs （21.08±4.43）ng/L,P＜0.001］、［（28.49±5.24）ng/L vs （39.96±6.56）ng/L,P＜0.001］。 结论局部晚期头颈部肿瘤患者急性放射性口炎应用捷克信联合抗辐喷的短期疗效优于单独抗辐喷的疗效,可减轻疼痛,改善口腔情况。     

放射性口腔黏膜炎的防护现状

放射治疗是头颈部恶性肿瘤最重要的治疗手段之一,急性放射性口腔黏膜炎是治疗过程中常见的一种并发症。李少兰等报道鼻咽癌放疗中口腔黏膜损伤发生率40％～100％。其不仅会加重患者的临床症状、影响患者的睡眠及营养的摄入,更重要的是降低了患者局部正常组织对放射线照射的耐受性,限制了临黏膜床放射治疗剂量的应用,从而影响了头颈部肿瘤患者放射治疗的效果。     

不同雾化吸入时机对放射性急性口腔黏膜炎治疗效果的影响

目的了解不同雾化吸入开始时间对放射性急性口腔黏膜炎治疗效果的影响。方法便利抽样法选择2012年10月至2013年7月,上海交通大学附属第六人民医院肿瘤放疗科收治的头颈部恶性肿瘤行根治性放射治疗的患者60例,按入院先后将其分为观察组和对照组各30例,观察组患者放疗开始即给予雾化吸入,对照组患者放疗过程中出现放射性急性口腔黏膜炎后再给予雾化吸入,评价并比较两组患者放射性急性口腔黏膜炎的发生情况、口腔黏膜损伤及疼痛程度。结果放疗期间,观察组患者放射性急性口腔黏膜炎的发生率、口腔黏膜损伤及疼痛程度均低于或轻于对照组患者,差异均有统计学意义(P0.05或P0.01)。结论放疗开始即给予雾化吸入,有利于降低头颈部恶性肿瘤行根治性放射治疗患者放射性急性口腔黏膜炎的发生率,减轻黏膜的损伤及疼痛程度,保证放疗的顺利进行,从而提高患者的生活质量。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.