奥沙利铂为基础的方案治疗老年晚期结直肠癌的临床观察

目的探讨奥沙利铂为基础的方案治疗老年晚期结直肠癌的疗效及安全性。方法选择经病理学确诊的46例老年晚期结直肠癌患者,均采用奥沙利铂为基础的方案化疗,其中包括FOLFOX方案18例,XELOX方案25例,另有3例为奥沙利铂联合氟尿嘧啶方案。所有患者至少完成2个周期的化疗,观察客观有效率(RR)、疾病控制率(DCR)、中位疾病进展时间(TTP)、总生存时间(OS)和化疗相关不良反应。结果 46例患者中,RR及DCR分别为39.1%和80.4%,TTP和OS分别为7.0月和24.0月。化疗相关不良反应可以耐受,Ⅰ~Ⅱ度不良反应主要包括中性粒细胞减少、血小板减少、贫血等,Ⅲ~Ⅳ度不良反应少见,主要为中性粒细胞减少和腹泻。结论奥沙利铂为基础的方案治疗老年晚期结直肠癌安全有效,值得在老年人群中进一步研究推广。     

奥沙利铂为基础的方案治疗老年晚期结直肠癌的疗效及安全性分析

目的探讨奥沙利铂为基础的化疗方案对老年晚期结直肠癌的治疗疗效并分析其治疗安全性。方法选择70例老年晚期结直肠癌患者,按入院顺序随机平均分为两组,研究组35例采用奥沙利铂联合希罗达方案治疗,对照组35例采用氟尿嘧啶(5-FU)联合亚叶酸钙(CF)方案。治疗至少2个周期后对其疗效及不良反应进行评价。结果研究组近期疗效总有效率为51.43%,明显高于对照组的37.14%,比较差异具有统计学意义(P0.05);研究组在消化道不良反应、骨髓抑制、周围神经毒性及手足综合征的Ⅰ~Ⅱ级不良反应发生率分别为17.14%、14.29%、5.71%及5.71%,明显低于对照组34.29%、22.86%、11.43%及11.43%,差异具有统计学意义(P0.05);研究组Ⅲ~Ⅳ级不良反应较少发生,且低于对照组,多表现为腹泻、中性粒细胞减少症状。结论奥沙利铂为基础的方案治疗老年晚期结直肠癌疗效安全可靠,值得推广应用。     

重组人血管内皮抑制素联合化疗治疗老年结肠癌患者的临床疗效及安全性研究

目的探讨重组人血管内皮抑制素(恩度)联合化疗方案治疗老年结直肠癌患者的临床疗效及安全性。方法选取我院2011年1月~2013年8月收治的结直肠癌老年患者共101例,随机分为治疗组50例和对照组51例,治疗组与对照组均采用FOLFOX4(奥沙利铂+亚叶酸钙+5-氟尿嘧啶)或XELOX(奥沙利铂+卡培他滨)化疗方案,治疗组予以恩度联合化疗,比较两组间的差异。结果与对照组相比,治疗组生活质量明显改善、疾病控制率提高(P<0.05),两组不良反应率、无疾病生存期无明显统计学差异(P>0.05)。结论在老年结直肠癌患者中,恩度联合化疗可以提高疾病控制率,改善生活质量,临床耐受性良好,有较好的疗效和安全性,值得临床推广应用。     

替吉奥联合奥沙利铂与改良FOLFOX6方案一线治疗进展期胃癌的随机对照研究

目的比较国产替吉奥联合奥沙利铂方案(SOX)与改良FOLFOX6方案(mFOLFOX6)一线治疗局部晚期或转移性胃癌的近期疗效、远期生存及安全性。方法 40例进展期胃癌患者随机分为A、B组,A组采用SOX联合化疗方案,B组采用mFOLFOX6方案。2组患者均接受至少2周期化疗,每2周期评判1次近期疗效。结果 A组客观有效率、疾病控制率、中位疾病进展时间、中位生存期、1年生存率分别为45.0%、80.0%、6.0个月、15.0个月和45.0%;B组分别为40.0%、90.0%、5.5个月、11.0个月和35.0%。2组客观有效率及生存期无显著差异。2组不良反应均为血液系统毒性、恶心/呕吐和外周神经毒性,A组不良反应整体略轻微,但无显著性差异。结论氟尿嘧啶类药物联合奥沙利铂一线治疗进展期胃癌有较好的近期和远期疗效;替吉奥口服与氟尿嘧啶静脉化疗在疗效上无显著差异,不良反应均可耐受,可根据患者个体状况选择应用。     

XELOX与FOLFOX6方案一线治疗晚期结直肠癌的近期疗效及不良反应比较

目的比较卡培他滨联合奥沙利铂(XELOX)和亚叶酸钙(CF)、5-氟尿嘧啶(5-FU)联合奥沙利铂(FOLFOX6)治疗晚期结直肠癌的近期疗效和不良反应发生率,以指导晚期结直肠癌的治疗。方法将80例患者按照自愿原则分为X组和F组。X组采用XELOX方案治疗,F组采用FOLFOX6方案治疗,统计两组的疗效和不良反应发生情况。结果 X组完全缓解(CR)、部分缓解(PR)、无变化(NC)和进展(PD)分别有7例、13例、14例和6例,治疗有效率(RR)为50.0%,F组治疗有效率为47.5%,两组治疗有效率比较无统计学差异(P0.05)。在不良反应方面,X组神经毒性、中性粒细胞减少、血小板减少发生率显著低于F组(P0.05),但是手足综合征发生率明显高于F组(P0.05)。结论 XELOX和FOLFOX6方案治疗晚期结直肠癌的近期疗效并无显著差异。相比于F方案,X治疗方案用药更为方便,可以显著减少或并不增加除手足综合征外其他不良反应的发生,因此值得在临床中根据患者具体情况考虑优先使用。     

贝伐珠单抗联合不同化疗方案治疗晚期结直肠癌的效果观察

目的 探讨贝伐珠单抗分别联合mFOLFOX6和CapeOX治疗对晚期结直肠癌患者血清肿瘤标志物和生存期的影响。方法 选取确诊的68例晚期结直肠癌患者,采用随机数字表法分为观察组和对照组各34例。对照组行贝伐珠单抗联合mFOLFOX6方案治疗,观察组采用贝伐珠单抗联合CapeOX方案治疗。比较两组临床疗效及治疗前后癌胚抗原(CEA)、糖类抗原19-9(CA19-9)的变化,比较两组不良反应和1年生存情况。结果 治疗后,两组总有效率无显著差异(P>0.05);两组CEA、CA19-9水平均低于治疗前,且观察组CEA低于对照组(P<0.05);两组神经毒性的发生无显著差异(P>0.05);观察组恶心呕吐、血常规异常、手足综合征明显少于对照组(P<0.05);观察组1年总生存率显著高于对照组(P=0.027),两组无病生存率无明显差异(P=0.341)。结论 贝伐珠单抗联合CapeOX可明显降低晚期结直肠癌患者CEA水平,提高1年生存率。     

卡培他滨在转移性结直肠癌维持化疗中的疗效观察

将40例既往接受过卡培他滨+奥沙利铂联合化疗后取得有效和稳定的转移性结直肠癌患者随机分为治疗组和对照组,治疗组行卡培他滨维持化疗+最佳对症治疗,对照组行最佳对症治疗。分别评价两组治疗效果及观察不良反应。治疗组可延长患者的疾病进展时间(P<0.05)。卡培他滨在转移性结直肠癌维持治疗中的疗效确定,不良反应率低,可以耐受。     

希罗达联合奥沙利铂治疗老年转移性结直肠癌

[目的]观察希罗达联合奥沙利铂治疗老年(≥70岁)转移性结直肠癌患者的疗效及不良反应.[方法]采用XELOX方案治疗23例老年转移性结直肠癌,d1予奥沙利铂130 mg/m2,d1～14希罗达1 000 mg/(m2·d)口服,2次/天,3周1个周期,至少2个周期.[结果]23例患者中,完全缓解1例(4%),部分缓解9例(39%),稳定8例(35%),肿瘤进展5例(22%).总有效率为43%(10/23),中位肿瘤进展时间8.1(6.7～11.1)个月,中位总生存期13.9(10.9～17.2)个月.最常见的不良反应为消化道反应、骨髓抑制、神经感觉障碍及手足综合征,多为Ⅰ～Ⅱ度.[结论]XELOX是治疗老年转移性结直肠癌安全有效的化疗方案.     

卡培他滨联合奥沙利铂的改良方案一线治疗转移性结直肠癌的临床研究

目的 证实卡培他滨联合奥沙利铂的改良方案（mXELOX）,与FOLFOX6改良方案（mFOL-FOX6）比较,一线治疗转移性结直肠癌（mCRC）的非劣效性.方法 采用随机、平行的Ⅱ期临床研究.310例未经治疗的mCRC患者被随机分配接受mXELOX或mFOLFOX6化疗（mXELOX 158例;mFOLFOX6 152例）,每2周为1周期.以总体反应率（0RR）、无进展生存（PFS）、总生存（0S）和化疗不良反应为评价指标.mXELOX用法：卡培他滨（2000 mg/m2,d1 ～9）联合奥沙利铂（85 mg/m2,d1）.mFOLFOX6用法：OXA 85 mg/m2,d1;继之予以亚叶酸钙400 mg/m2,d1静脉滴注2h;然后5-FU 400 mg/m2,d1静脉推注后;予以5-FU 2400 mg/m2,46h连续静脉滴注.结果 分析符合方案数据集,mXELOX与mFOLFOX6之间的ORR、中位PFS、中位OS均无显著差异;ORR分别为45％与47％,单侧95％可信区间上限为13.8％（非劣效性所需的上限为15％）;中位PFS分别为8.7个月与9.1个月;中位OS分别为20.9个月与21.5个月.mXELOX与mFOLFOX6的3/4级不良反应发生率：神经病变分别为18％与19％ （P ＞0.05）;腹泻分别为15％与17％ （P ＞0.05）;手足综合征分别为19％与8％（P＜0.01）;中性粒细胞减少分别为17％和28％ （P ＜0.01）.结论 mXELOX一线治疗mCRC非劣效于mFOLFOX6化疗.     

K-ras突变型晚期结直肠癌患者采用奥沙利铂或伊立替康联合氟尿嘧啶治疗的临床对比研究

目的观察并探讨奥沙利铂或伊立替康联合氟尿嘧啶治疗K-ras突变型晚期结直肠癌患者的疗效和安全性,以找出一种更合适的化疗方案。方法收集2012~2015年收治的56例K-ras基因突变型晚期结直肠癌患者的临床资料。其中接受以奥沙利铂为基础的化疗方案者36例(奥沙利铂组),接受以伊立替康为基础的化疗方案者20例(伊立替康组)。比较两组近期治疗效果和远期治疗效果,评价两组不良反应情况。结果奥沙利铂组与伊立替康组治疗后有效率分别为22.2%和15.0%,奥沙利铂组稍高于伊立替康组,但两组间比较差异无统计学意义(P0.05);奥沙利铂组与伊立替康组治疗后疾病控制率分别为77.8%和85.0%,两组间比较差异无统计学意义(P0.05)。截止2016年9月1日,奥沙利铂组患者的平均中位无病生存时间(PFS)为8.2个月,95%CI(6.1~9.8)个月;伊立替康组患者的平均中位PFS为7.1个月,95%CI(5.9~7.9)个月,两组中位PFS比较也无显著统计学差异(P=0.6750.05)。安全性方面两组患者不良反应均以1~2级为主,患者均可耐受。结论与伊立替康方案相比较,对于K-ras基因突变型晚期结直肠癌患者能从奥沙利铂方案中获益更多,应优先选择奥沙利铂为基础的化疗方案。     

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.