全程督导化疗管治962例涂阳肺结核患者转归的队列分析

目的 探讨涂阳肺结核病例的转归,评价肺结核传染源的控制效果。方法 对962例涂阳肺结核病例的资料进行队列分析。结果 涂阳肺结核以青壮年男性多发,发病延误时间较长,治愈率呈上升趋势,治疗失败率呈持续下降。结论 严格执行的技术规范是控制肺结核病传染源的主要措施。     

全程督导化疗管治初治涂阳肺结核患者1197例疗效分析

探讨全程监化(DOTS)管治初治涂阳肺结核患者的疗效.方法选择1992年12月～2000年6月由我站结核科门诊登记初治涂阳肺结核患者为治疗组;同时选择1985年1月～1992年11月门诊登记初治涂阳肺结核患者为对照组,治疗组实施全程督导管理,对照组采用全程管理.结果治疗组患者的治愈率为95.57%,对照组患者的治愈率为42.07%.治疗组的治愈率明显高于对照组,两者有显著性差异(P＜0.001).结论结核病控制项目的治疗方案和DOTS管理方法确是世界先进的防治技术.     

493例涂阳肺结核患者全程督导化疗效果分析

目的：分析麻栗坡县2007－2012年493例涂阳肺结核患者全程督导化疗情况,为制定防治对策提供依据。方法按照初治涂阳治疗方案2H3R3Z3E3/4H3R3,即2个月的强化期和4个月的继续期;复治涂阳治疗方案2H3R3Z3E3S3/6H3R3E3,即2个月的强化期和6个月的继续期。均为隔日晨起空服,采用直接面试短程督导化疗和全程督导管理。结果2月末和3月末的痰菌阴转率分别为：初治涂阳95.70%和98.92%,治愈率达96.99%;复治涂阳2月末和3月末痰菌阴转率分别为88%和96%,治愈率达88%。结论两个阶段的全程间歇的短程化疗方案疗效高,不良反应少,患者依从性高,提高了肺结核病的防治成效,为今后结核病防治工作提供了事实依据。     

广州市海珠区1993～2001年新发涂阳肺结核病例队列分析

目的 通过对海珠区1993～2001年1417例新发涂阳肺结核病人的转归进行队列分析，以评价本地区传染病的控制效果。方法 以1993～2001年本区新登记涂阳病例为该年队列分析的对象，分析登记满一年时转归。初治、复治涂阳病例分别采用2H3R3Z3S3（E3）／4H3R3，2H3R3Z3S3E3／6H3R3E3方案，实施全程督导化疗。结果 九年平均治愈率为92．0％，仍阳性率2．5％。结论 严格执行DOTS的技术规范是控制肺结核传染的主要措施。DOTS是控制传染源的最佳措施。     

安徽省1990～1999年肺结核新发涂阳病例队列分析

目的 对1990－1999年全省新发涂阳患满1年队列分析,了解传染源控制情况,探讨防治工作重点。方法 根据安徽省1990－1999年卫统表－1、表－2,列表分析10年来全省登记的活动性肺结核痰涂片阳性病例的化疗及转归情况。结果 10年共登记新发涂阳患15442例,其中治愈10275例,治愈率66．54％,“仍旧性”及“失访”病例数偏高,分别达到15．25％和14．45％。结论 结核病归口管理工作不落实,化疗管理工作不力是困扰我省结核病控制的主要因素。今后工作应加强归口管理,提高患的治愈率和发现率。     

直接面视下短程化疗对涂阳肺结核患者疗效的影响

目的 了解直接面视下短程化疗对广东省实施世界银行贷款结核病控制项目涂阳肺结核患者的疗效。方法 收集1991～2001年广东省世行贷款结核病控制项目登记管治初、复活涂阳肺结核患者资料进行分析。结果 10年间全省共治疗涂阳肺阳肺结核患者18268例，治疗后2、3个月未痰菌阴转率初、复活分别为92％，96．7％和80．7％、88．7％，治愈率分别为96．0％和85．0％。结论 在全省城乡采取直接面视下短程抗结核化疗，推行DOTS策略，涂阳肺结核患者取得预期效果。     

初治涂阳肺结核短程间歇全监化疗近期疗效观察

目的评价WHO推荐的短程间歇化疗方案近期疗效和全程督导化疗(DOTS)的可行性。方法搜集本市1993-2001年结控项目有关病例治疗管理的资料进行统计分析。结果1746例2、3月末痰菌阴转率分别为88.0%和94.6%,治愈率为96.4%,失败率1.8%。结论WHO推荐的短程间歇化疗方案是高效的,全程督导化疗管理是可靠且可行的。     

隆昌县涂阳肺结核患者来源分析

目的探索涂阳肺结核患者来源,了解不同来源患者构成情况,寻找有效方法,不断提高肺结核患者发现率。方法收集2006—2011年隆昌县涂阳肺结核患者的来源资料,对患者来源情况进行综合分析。结果 2006—2011年隆昌县共接诊肺结核可疑症状者13 623例,就诊、转诊、因症推荐与其他途径来源的初诊患者所占比例分别为39.2%、58.7%、0.9%和1.2%,转诊的初诊患者数所占比例最大,超过50%,与其他3种途径比较,差异有统计学意义(χ2=1 036.5,P<0.01);转诊途径患者涂阳检出率(65.7%)明显高于其他3种途径的检出率,差异有统计学意义(χ2=70.9,P<0.01)。结论医院转诊已成为隆昌县发现涂阳肺结核患者的重要来源。落实结核病归口管理、加强医防合作、提高转诊到位率等是实现结核病防治规划中涂阳患者"高发现"目标的有效措施。     

涂阳肺结核139例患者分枝杆菌培养及药敏分析

目的了解本院住院肺结核患者的耐药情况。方法对2009年1月至2012年1月139例涂阳肺结核患者的分枝杆菌培养及药敏试验资料进行回顾性分析。结果 139例涂阳患者分枝杆菌培养:结核分枝杆菌130例,牛分枝杆菌5例,肺结核分枝杆菌4例。130例结核分枝杆菌总耐药90例,总耐药率69.2%,总耐多药率15.4%(20/130),总多耐药率22.3%(29/130)。结论本院住院涂阳肺结核患者的耐药情况严重,应加强对肺结核患者的管理,尤其是耐多药结核患者的管理;积极开展结核病的耐药监测,提高耐药结核病的发现率;采用个体化方案积极治愈耐多药结核病,以减少耐药性的产生,控制耐多药结核病的流行。     

老年复治涂阳肺结核65例临床分析

目的总结老年复治涂阳肺结核的临床特点,并探讨管理和治疗方法。方法对2001～2003年收治的65例老年复治涂阳肺结核进行回顾性分析。结果65例老年复治涂阳肺结核在疗程结束时痰菌阴转56例（占86．2％）,病灶吸收、好转59例（占90．7％）。结论老年复治涂阳肺结核应重在预防。坚持合理抗结核治疗,纠正各种并发症,采用DOTS管理方式,是取得良好效果的关键。     

脊柱结核患者术后腹胀原因分析及护理干预

目的 探讨脊柱结核患者术后腹胀原因及护理干预效果.方法 选取2011年6月～2012年7月在本院进行治疗的脊柱结核患者100例,随机分为对照组和观察组,每组50例.对照组患者给予术后常规治疗和护理,而观察组患者在对照组的基础上对脊柱结核患者进行腹胀原因分析,加强护理干预,1个疗程后对所有患者进行临床疗效的评价.结果 经过1个疗程的治疗,观察组总有效率（94％）明显高于对照组（78％）,两组差异有统计学意义（P＜0.05）.结论 分析脊柱结核患者术后腹胀的原因,加强针对性护理干预,可降低并发症的发生率,从而提高患者的生活质量.     

The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing. Method This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison. Main outcome measures The perspectives of patients with hypertension on issues relating to concordance in prescribing. Results Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication. Conclusions Participants indicated a willingness to be␣involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.     

Zopiclone as positive control in studies examining the residual effects of hypnotic drugs on driving ability

Zopiclone (7.5 mg) is frequently used as a positive control in studies that examine the residual effects of hypnotic drugs on driving ability and related skills. This review summarizes studies examining the effects of zopiclone, and discusses its usefulness as a comparator drug for investigations of residual effects of novel sleep medication. A literature review (Pubmed and Embase) was conducted searching for studies that tested zopiclone on driving. Cross references were checked for additional papers. Eight studies utilizing the standardized on-the-road driving test consistently showed that in the morning following bedtime administration zopiclone (7.5 mg) significantly impaired driving performance. A total of 191 healthy volunteers were tested after placebo and zopiclone (7.5 mg). Meta analyses showed no significant differences in driving performance after zopiclone (7.5 mg) between adult and elderly healthy volunteers. The combined effect size (ES) and 95% confidence interval (95%CI) for healthy volunteers was 0.782 (0.620, 0.944). Relative to placebo, an average increment of 3.0 cm in Standard Deviation of Lateral Position (SDLP) was observed when treated with zopiclone (7.5 mg). This deviation was higher than the increment in SDLP reported for drivers with a blood alcohol concentration of 0.05% (+2.4 cm). Results from driving simulators and psychometric tests are consistent with the on-road driving test results. In conclusion, zopiclone (7.5 mg) is a reliable positive control, that consistently shows significant and meaningful impairment on the on-the-road driving test.     

The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective

We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method

This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.

Main outcome measures

The perspectives of patients with hypertension on issues relating to concordance in prescribing.

Results

Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.

Conclusions

Participants indicated a willingness to be?involved in concordance in prescribing anti-hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

     

老年子宫脱垂患者整体护理方法及效果

目的探讨老年子宫脱垂患者整体护理方法,并评价其临床效果。方法选择48例患者随机分为两组,其中观察组使用本研究护理干预方法,对照组则仅实施入院指导、伤口护理、饮食指导等一般护理,比较两组患者干预前后焦虑、抑郁评分及患者对护理的整体满意度。结果干预后观察组焦虑、抑郁评分均低于对照组（P〈0．05）,观察组护理满意度高于对照组（P〈0．05）。结论老年子宫脱垂患者实施整体护理能有效缓解患者的心理压力,增进护患感情,提高护理满意度。     

New method for quantitative measurement of N-nitrosodimethylamine formation in the whole mouse

A simple method for the quantitative estimation of the formation of N-nitrosodimethylamine (NDMA) in mice has been developed. Mice were frozen in liquid nitrogen and homogenized. NDMA was then extracted and analyzed by a gas chromatograph equipped with a thermal energy analyzer. In normal mice NDMA (100 nmole) administered orally was rapidly metabolized and recovery of NDMA was about 10% after 60 min. However, when pyrazole (300 mg/kg) was injected i.p. to mice 60 min before the administration of NDMA, more than 80% of the administered NDMA could be recovered within 60 min. This result suggested that in pyrazole pretreated mice the accurate amount of NDMA formed could be estimated. Therefore the NDMA formation was measured in the pyrazole pretreated mice. When 0.25 mole of aminopyrine and from 0.25 to 2.0 umole of sodium nitrite were simultaneously administered orally, the amount of the NDMA formation in 20 min was found to be from 8.2 to 60.3 nmole. These values are equal to about from 30 to 200 g/kg of body weight which are nearly daily doses expected to cause the carcinogenic effect on mice or rats. This method of measuring NDMA in pyrazole pretreated mice appears to be useful for investigating the in vivo formation of NDMA quantitatively.     

The challenge of targeted therapies for gastric cancer patients: the beginning of a long journey

Introduction: Despite significant improvements in systemic chemotherapy over the last two decades, the prognosis of patients with advanced disease remains dismal. Collaborative, high-quality research and advances in high-throughput technologies have contributed to elucidate molecular pathways underpinning disease progression and have stimulated many clinical studies testing target therapies in the advanced disease setting. Although progress has been made thanks to trastuzumab in HER2 positive tumours, antiangiogenic drugs have produced conflicting results and EGFR-inhibitors have failed to show major improvements.

Areas covered: While commenting on the results of many key Phase III randomized trials, the Authors discuss the most promising classes of novel targeted agents and present the current challenges toward a customized treatment.

Expert opinion: Palliative chemotherapy became the worldwide standard of care for patients with advanced gastric cancers, producing significant life prolongation and improvement of life quality. Nevertheless, long-term outcomes of those patients remain poor. Because of the encouraging advancement in novel targeted therapies, such a disappointing scenario is now evolving. While results serve as a springboard for future research, more comprehensive efforts are needed to clarify the biological mechanisms underpinning cancer progression and help clinicians to develop new effective treatments.     

无创正压通气在老年慢性阻塞性肺疾病急性加重期患者中的应用效果分析

Objective To study the clinical effect of non-invasive positive pressure ventilation (NPPV) in elderly patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPD). Methods One hundred and Fourteen elderly patients with AECOPD were divided into two groups. The observed group of 58 patients was given oxygen, anti-inflammatory and other conventional treatment, at the same time NPPV treatment was given, But the control group of 56 cases was only given the conventional treatment. The difference of blood oxygen pressure ( PaO2 ), carbon dioxide partial pressure ( PaCO2 ), pH value, respiratory rate (RR) and heart rate (HR)between two groups were compared after 12 h. To compare two groups endotracheal intubation rate and mortality differences. Results The pH and PaO2 of the observation group were significantly higher than that before treatment , HR, RR and PaCO2 decreased significantly compared with before treatment, and the various indicators were better than the same period in the control group. The observation group endotracheal intubation rate and mortality were less than the control group ( all P ＜ 0. 05). Conclusions NPPV can effectively alleviate breathing difficulties of the elderly patients with AECOPD and correct hypoxia. NPPV can reduce the rate of endotracheal intubation and mortality.     

无创正压通气在老年慢性阻塞性肺疾病急性加重期患者中的应用效果分析

Objective To study the clinical effect of non-invasive positive pressure ventilation (NPPV) in elderly patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPD). Methods One hundred and Fourteen elderly patients with AECOPD were divided into two groups. The observed group of 58 patients was given oxygen, anti-inflammatory and other conventional treatment, at the same time NPPV treatment was given, But the control group of 56 cases was only given the conventional treatment. The difference of blood oxygen pressure ( PaO2 ), carbon dioxide partial pressure ( PaCO2 ), pH value, respiratory rate (RR) and heart rate (HR)between two groups were compared after 12 h. To compare two groups endotracheal intubation rate and mortality differences. Results The pH and PaO2 of the observation group were significantly higher than that before treatment , HR, RR and PaCO2 decreased significantly compared with before treatment, and the various indicators were better than the same period in the control group. The observation group endotracheal intubation rate and mortality were less than the control group ( all P ＜ 0. 05). Conclusions NPPV can effectively alleviate breathing difficulties of the elderly patients with AECOPD and correct hypoxia. NPPV can reduce the rate of endotracheal intubation and mortality.