吉西他滨联合顺铂与长春瑞滨联合顺铂治疗晚期非小细胞肺癌的临床疗效观察

目的 观察吉西他滨联合顺铂与长春瑞滨联合顺铂治疗晚期非小细胞肺癌的(NSCLC)的临床疗效及毒副作用.方法 78例Ⅲ～Ⅳ期NSCLC患者,随机分为GP组和NP组,GP组:国产吉西他滨(泽菲)1 000 mg/m2,静滴,d 1、d 8;顺铂80 mg/m2,静滴,d 1,联合化疗.NP组:国产长春瑞滨(盖诺)25 mg/m2,静滴,d 1、d 8;顺铂80 mg/m2,静滴,d 1,联合化疗.两个方案均为每3周一个周期.结果 78例NSCLC均可评价疗效,GP组40例,完全缓解(CR) 部分缓解(PR)16例,有效率40.0%,NP组38例,CR PR 15例,有效率39.5%,两组有效率相当(P=0.985).主要不良反应均为骨髓抑制.其中NP组的Ⅲ～Ⅳ度白细胞减少和静脉炎的发生率明显高于GP组(P＜0.05),GP组的Ⅲ～Ⅳ度血小板减少高于NP组(P＜0.05),两组的其他不良反应相近(P＞0.05).而住院费GP组高于NP组.结论 吉西他滨联合顺铂与长春瑞宾联合顺铂治疗晚期NSCLC两者疗效相当,而前者不良反应发生率要低于后者,更适合老年体弱者,但费用稍贵,临床可根据不同病人选择不同方案.     

紫杉醇及长春瑞滨联合顺铂治疗晚期非小细胞肺癌的临床对照分析

目的探讨国产紫杉醇及长春瑞滨加顺铂联合治疗晚期非小细胞肺癌(NSCLC)的疗效和不良反应。方法选取初治晚期NSCLC 76例,分别应用TP(国产紫杉醇+顺铂)、NP(长春瑞滨+顺铂)方案治疗。每例均完成2周期化疗后评价疗效及其不良反应。结果两组患者近期有效率分别为TP组36.1%、NP组35.0%,两组间有效率比较差异均无统计学意义(χ2=0.108.6,P0.05)。TP组中位生存期8.9月,NP组中位生存期8.4月(P0.05)。TP组1、2、3年生存率分别为40.0%、18.3%、5.0%;NP组1、2、3年生存率分别为39.0、16.9%、5.1%,两组间比较差异无统计学意义(χ2=0.1404,P0.05)。两组不良反应均以骨髓抑制、脱发及恶心呕吐为主,但均未影响治疗。两组病例均无化疗相关死亡发生。结论 TP、NP联合方案是晚期NSCLC有效且耐受性较好的治疗方案。     

长春瑞宾联合不同铂类治疗晚期非小细胞肺癌的比较

目的观察长春瑞宾分别联合顺铂、奈达铂、奥沙利铂治疗晚期非小细胞肺癌(NSCLC)的临床疗效及毒副反应。方法可评价疗效的NSCLC患者均为初治患者,其中长春瑞滨联合顺铂治疗(NP组)30例,长春瑞宾联合奈达铂治疗(NN组)30例,长春瑞滨联合奥沙利铂治疗(NL组)35例。结果 NP组总有效率为46.67%,NN组总有效率为40.00%,NL组总有效率为37.14%。各组近期疗效比较差异无统计学意义(P>0.05);主要毒副反应为骨髓抑制、胃肠道反应及神经毒性。结论 长春瑞宾分别联合顺铂、奈达铂、奥沙利铂治疗晚期NSCLC的近期疗效无明显差异,联合奥沙利铂或奈达铂治疗晚期NSCLC疗效确切,患者耐受性良好,为晚期NSCLC的治疗提供了新的选择。     

艾素或长春瑞滨联合顺铂治疗晚期非小细胞肺癌的临床对照研究

目的比较艾素（多烯紫杉醇）或长春瑞滨联合顺铂方案对晚期非小细胞肺癌（NSCLC）的疗效和副作用。方法选取初治晚期NSCLC病人66例,分别应用TP（艾素＋顺铂）、NP（长春瑞滨＋顺铂）方案进行治疗。每例均完成两周期化疗后评价疗效及副作用。结果TP、NP组病人近期有效率分别为40.6%、38.2%,两组比较差异无显著性（P〉0.05）。两组副作用均以骨髓抑制、恶心呕吐为主,但均未影响治疗。两组均无化疗相关死亡发生。结论TP、NP均为治疗晚期NSCLC有效且耐受性较好的方案。     

长春瑞滨联用顺铂与吉西他滨联用顺铂治疗晚期非小细胞肺癌的临床观察

目的探讨NP方案(长春瑞滨联用顺铂)和GP方案(吉西他滨联用顺铂)对晚期非小细胞肺癌(NSCLC)的疗效和不良反应。方法回顾分析35例接受化疗的晚期NSCLC患者资料,其中Ⅲ期NSCLC患者19例,占54.3%,Ⅳ期NSCLC患者16例,占45.7%。总结接受化疗方案为NP组和GP组且每个患者至少接受2个周期以上的同一化疗方案的患者资料,观察方案治疗的近期疗效和不良反应。结果NP和GP总的有效率分别为12.5%,10.5%。NP组和GP组的不良反应均在可耐受的范围。结论NP和GP方案均对晚期非小细胞肺癌有效且耐受性较好,可作为晚期初治NSCLC的一线化疗方案。     

化疗联合艾迪注射液治疗中晚期非小细胞肺癌49例疗效观察

目的：观察化疗联合艾迪注射液治疗中晚期非小细胞肺癌（NSCLC）的疗效。方法：98例NSCLC随机分为两组，治疗组（49例）接受艾迪加第三代含铂方案紫杉醇＋顺铂（TP）或长春瑞滨＋顺铂（NP）或吉西他滨＋顺铂（GP）或多西紫杉醇＋顺铂（DP），对照组（49例）单用第三代含铂方案（TP或NP或GP或DP）。两组均以3周为1个周期，重复3个周期。结果：治疗组比对照组的近期客观有效率高，治疗组完全缓解（Ca）3例，部分缓解（PR）28例，有效率为63．3％，对照组CR2例，PR27例，有效率为59．2％，两组差异无显著性（P〉0．05）；而生存质量改善率治疗组为61．2％，对照组为24．5％，两组差异有显著性（P〈0．05）。结论：化疗联合艾迪注射液有助于NSCLC患者临床症状的改善并提高其生存质量。     

TP与NP方案全身化疗治疗NSCLC疗效观察

目的研究紫杉醇联合顺铂(TP方案)与长春瑞滨联合顺铂(NP方案)系统化疗治疗中晚期非小细胞肺癌(NSCLC)的疗效观察。方法选择50例NSCLC患者,随机分成2组,每组25例,分别与TP及NP方案治疗,所有患者至少完成2个周期的化疗,评价疗效、生活质量及毒副反应。结果试验组有效率为48%,对照组为44%,试验组略好于对照组。与对照组相比,试验组中位总生存期及中位无进展生存期均无明显统计学差异,不良反应2组亦无明显差异(P>0.05)。结论 TP及NP方案治疗NSCLC,2种化疗方案比较前者略好于后者。     

含铂双药方案治疗老年非小细胞肺癌的疗效和安全性分析

目的观察顺铂联合长春瑞滨、多西他赛或吉西他滨治疗老年非小细胞肺癌的疗效和安全性。方法回顾性研究分别接受长春瑞滨+顺铂、多西他赛+顺铂和吉西他滨+顺铂方案化疗的114例老年非小细胞肺癌的疗效和副反应。结果 3组治疗的有效率分别为35.71%、39.39%、35.9%。副反应以骨髓抑制常见,白细胞减少3级以上者3组分别为26.2%、33.3%、23.1%,3级以上的血小板减少及贫血在全组病例发生率分别为5.26%、0.88%。结论年龄不是含铂双药化疗的禁忌,老年晚期非小细胞肺癌患者可接受含铂的双药方案化疗,并能取得一定近期疗效。     

长春瑞滨联合顺铂治疗晚期非小细胞肺癌疗效观察

目的:观察长春瑞滨(盖诺)联合顺铂(NP方案)治疗晚期非小细胞肺癌(NSCLC)的疗效及毒副作用。方法:42例经病理或细胞学诊断为非小细胞肺癌患者,采用国产长春瑞滨25mg/m2,第1、8天静滴;顺铂(DDP)60～80mg/m2,第1～3天静滴,28d为1个周期。结果:CR3例,PR15例,SD16例,PD8例,总有效率(CR+PR)为42.9%。主要毒副反应为白细胞减少及胃肠反应。结论:长春瑞滨联合顺铂治疗晚期NSCLC疗效确切,毒副反应可耐受。     

非小细胞肺癌术后应用吉西他滨联合顺铂方案行辅助化疗的疗效观察

目的探讨非小细胞肺癌(NSCLC)术后应用吉西他滨联合顺铂方案行辅助化疗的疗效。方法 95例非小细胞癌患者分为2组,观察组使用吉西他滨联合顺铂,对照组使用长春瑞滨联合顺铂。比较2组患者疗效和不良反应发生情况。结果观察组总有效率为52.08%,高于对照组的40.43%。2组患者不良反应发生例数和症状比较无显著差异(P0.05)。2组患者化疗后白细胞、粒细胞和血小板计数均减少。观察组6个月后复发率为10.42%,对照组复发率为14.89%。结论吉西他滨联合顺铂治疗NSCLC疗效更好,值得推广应用。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."