三维适形放疗联合化疗治疗局部中晚期食管癌的疗效分析

目的探讨三维适形放疗联合化疗治疗局部中晚期食管癌的疗效。方法将符合条件的局部中晚期食管癌患者随机分为观察组和对照组各40例,分别行三维适形放疗联合化疗与单纯三维适形放疗治疗,观察治疗后的疗效及不良反应情况。结果观察组总体疗效相比对照组明显较好,差异有统计学意义(χ2=6.65,P0.0,1);放射性食管炎发生率比较差异无统计学意义(χ2=2.99,P=0.08),白细胞减少发生率比较差异有统计学意义(χ2=15.23,P=0.00)。结论三维适形放疗联合化疗治疗局部中晚期食管癌近期效果较好,骨髓抑制反应增加但可耐受。     

同步放化疗加后程三维适形治疗局部晚期非小细胞肺癌

目的:探讨紫杉醇/顺铂每周同步放化疗加后程三维适形放疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效及毒副反应。方法:按信封法将患者随机分成2组,一组(30例)采用"紫杉醇/顺铂"同步放化疗加后程三维适形放疗为化放组,化疗方案:每周一紫杉醇60mg/m2、顺铂25mg/m2化疗,连用3周,同时给予常规分割放射治疗DT40Gy,后程三维适形放疗,采用5~6个非共面野,每次3·5Gy,每日1次,每周5天,共7~8次,剂量DT24·5~28·0Gy,总剂量DT64·5~68·0Gy,6周完成;另一组(30例)为单放组,照射范围、方法及剂量同化放组。两组放疗结束后均予TP或NP方案化疗2~4疗程。放射治疗后2~3个月进行近期疗效评价。结果:总有效率(CR PR)、中位生存:化放组分别96·6%、23月,单放组分别86·7%、13月;1、2、3年生存率:化放组分别70·0%、46·7%、33·3%,单放组分别50·0%、20·0%、13·3%;白细胞减少、急性放射性肺炎、急性放射性食管炎发生率:化放组分别为83·3%、20·0%、73·3%,单放组分别为33·3%、13·3%、43·3%;放射性肺纤维化化放组为36·7%,单放组为46·7%,均为1~2级。未发现严重的食管及心脏晚期放射反应。结论:紫杉醇/顺铂同步放化疗加后程三维适形放疗治疗局部晚期非小细胞肺癌,患者耐受性好,是一种安全有效的治疗方法。     

同步放化疗治疗局部晚期鼻咽癌的疗效观察

目的 观察同步放化疗治疗晚期鼻咽癌的疗效和患者的耐受性.方法 72例晚期鼻咽癌患者随机分为同步放化疗组(放化组)37例和单纯放疗组(单放组)35例.放化组放疗第1周和第6周同步应用PF方案化疗两周期.化疗方案为:顺铂(DDP)12mg/(m2·d),1～5d,亚叶酸钙(CF)200mg/(m2·d),1～5d,5-氟脲嘧啶(5-Fu)500mg/(m2·d),1～5d,放疗结束后间隔28d重复应用1～2周期化疗.两组病人放疗方法一致,常规放疗,原发灶剂量70Gy/7周,颈部给予双锁骨上野预防照射50Gy/5周,淋巴结转移阳性者局部追加至(60～70)Gy/(6～7)周.结果 放化组CR 10例,PR 19例,总有效率(CR PR)78.4%;单放组CR 7例,PR 15例,总有效率(CR PR)62.9%.放化组有效率(78.4%)高于单放组(62.9%),两者差异有统计学意义(P＜0.05).放化组和单放组1年生存率分别为91.9%(34/37)和88.6%(31/35),两者比较P＞0.05,差异无统计学意义;3年生存率分别为59.5%(22/37)和40.0%(14/35),两者比较P＜0.05,差异具有统计学意义.放化组各项不良反应发生率均高于单放组,但对症处理后患者均可耐受.结论 同步放化疗能提高晚期鼻咽癌患者的局部控制率和生存率,毒副作用可以耐受,值得临床推广应用.     

同期放化疗治疗局部晚期鼻咽癌的前瞻性研究

目的:观察同期放化疗治疗晚期鼻咽癌的疗效。方法:170例晚期鼻咽癌患者随机分为单纯放疗组(A组)90例和同期放化疗组(B组)80例。放疗组行常规放疗,原发灶剂量70Gy/7周,颈部给予双锁骨上野预防照射50Gy/5周,淋巴结转移阳性者局部追加至(60~70)Gy/(6~7)周。放化组放疗第1周和第6周同期应用PF方案化疗两周期。化疗方案为:顺铂(DDP)12mg/(m2.d),1~5d,亚叶酸钙(CF)200 mg/(m2.d),1~5 d,5-氟脲嘧啶(5-Fu)500 mg/(m2.d),1~5 d,放疗结束后间隔28 d重复应用1~2周期化疗。结果:单放组CR15例,PR37例,总有效率(CR+PR)57.8%;放化组CR21例,PR40例,总有效率(CR+PR)76.2%。放化组有效率(76.2%)高于单放组(57.8%),两者差异有统计学意义(P<0.05)。单放组和放化组1年生存率分别为86.7%(78/90)和88.8%(71/80),两者比较P>0.05,差异无统计学意义;3年生存率分别为44.4%(40/90)和58.8%(47/80),两者比较P<0.05,差异具有统计学意义。放化组各项不...     

三维适形放疗同步化疗治疗局部晚期非小细胞肺癌效果

目的探讨三维适形放疗联合多西他赛和顺铂同步化疗治疗不可手术的局部晚期非小细胞肺癌（NSCLC）的效果和毒副反应。方法将52例局部晚期NSCLC病人随机分为2组,各26例。单放组采用三维适形放疗,每日单次剂量DT2Gy,总剂量DT60-64Gy。化放组给予多西他赛30mg／m^2和顺铂20mg／m^2化疗,第1、8、22、29天分别在放疗前进行,放疗方法同单放组。结果化放组和单放组有效率分别为92．3％、76．9％,两组比较差异有显著性（χ^2=10．8,P〈0．05）。两组急性毒副反应发生率差异无显著性（P〉0．05）。结论三维适形放疗联合多西他赛和顺铂同步化疗治疗不可手术的局部晚期NSCLC的效果和病人耐受性较好。     

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。     

食管癌三维适形常规分割与后程加速超分割放疗120例初步分析

目的 比较三维适形放疗(3D-CRT)和后程加速超分割(LCAF)适形放疗食管癌的疗效和不良反应,为中、晚期食管癌根治性放疗提供参考方案.方法 120例符合入组条件的食管癌患者分成两组:3D-CRT组65例,照射剂量60～70 Gy,每次2 Gy,每周5次,中位剂量66 Gy;LCAF组55例,前程为传统常规分割放疗,照射剂量30 Gy,后程改为加速起分割放疗,每次1.5 Gy,每天2次,照射剂量30～39 Gy,总剂量60～69 Gy,中位剂量63 Gy.结果3D-CRT组.1、2年局部控制率分别为88.1%和79.0%,较LCAF组的81.9%和62.9%高,但两组比较差异无统计学意义(均P0.05),而两组3年局部控制率分别为74.4%和47.9%,差异有统计学意义(P=0.003);两组1、2,3年生存率比较差异均无统计学意义(P0.05);3D-CRT组放射性食管炎发生率较LCAF组低,但差异无统计学意义(P=0.581),放射性肺炎发生率分别为12.3%和27.3%(P=0.036).结论 食管癌3D-CRT的局控率、近期生存率稍优于后程加速超分割放疗;并且其不良反应较LCAF组轻.     

三维适形放疗联合同步化疗治疗中晚期食管癌的临床研究

目的 分析三维适形放疗联合紫杉醇+顺铂(TP)方案同步化疗治疗中晚期食管癌患者的效果和不良反应。方法 选取2017年6月至2019年6月南阳医学高等专科学校第一附属医院收治的56例中晚期食管癌患者为研究对象,按照随机数字表法分为对照组与观察组,每组28例。对照组予以三维适形放疗,观察组在对照组基础上联合TP方案同步化疗。比较两组疗效、吞咽困难改善率、1年、2年复发率及不良反应发生率。结果 观察组治疗总有效率为96.43%(27/28),对照组为71.43%(20/28);观察组吞咽困难改善率为96.43%(27/28),对照组为71.43%(20/28);观察组1年、2年复发率为7.14%(2/28)、21.43%(6/28),对照组为28.57%(8/28)、46.43%(13/28),两组比较差异均有统计学意义(P均<0.05)。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论 三维适形放疗联合TP方案同步化疗治疗中晚期食管癌患者效果显著,可改善吞咽困难症状,降低肿瘤复发率,且不增加不良反应。     

食管癌三维适形大分割放疗的可行性分析

目的 评价三维适形大分割放疗在食管癌放射治疗中的近期疗效和放射反应。方法 食管癌患者160例,设为适形放疗组69例、常规放疗组91例,分别采用三维适形大分割放疗和常规放疗进行治疗。适形放疗组处方剂量3000～4500 cGy,分割剂量300 cGy,1次/d,5次/周,照射剂量参考线为90％等剂量曲线。常规放疗组处方剂量4000 ～6600 cGy,分割剂量180～200 cGy,1次/d,5次/周。比较2组的近期疗效、生存期,以及放射治疗的副反应。结果 适形放疗组完全缓解(CR)为42.0％ (29/69),部分缓解(PR) 49.3％ (34/69),近期有效率91.3％;常规放疗组CR为35.2％(32/91),PR 59.3％ (54/91),近期有效率94.5％,2组比较差异无统计学意义(x2=1.033,P＞0.05)。1年期生存率分别是82.6％ (57/69)与84.6％ (77/91),2组比较差异无统计学意义(P＞0.05)。急性放射性食管炎三维适形放疗组发生率为66.7％ (46/69),高于常规放疗组64.8％(59/91),但差异无统计学意义(P＞0.05)。结论 三维适形大分割放疗用于食管癌治疗是可行的。     

三维适形放疗加希罗达对晚期胰腺癌止痛效果的研究

目的:观察三维适形放疗联合希罗达同步治疗中晚期胰腺癌疼痛的疗效。方法:28例中晚期胰腺癌患者随机分为两组,综合组14例,采用三维适形放疗的同时给予希罗达同步化疗。放疗开始的第1d开始口服希罗达,每日1000mg/m2,bid.连用14d,停药7d,21d为一周期,至少用药2个周期以上。单放组14例,单独应用三维适形放疗。两组病人照射剂量相同(45~56Gy,1.8~2Gy/次,5次/周)。结果:综合组和单放组疼痛缓解率分别为85.7%、42.9%,疼痛改善持续时间分别为137d、102d。两组疼痛缓解率和疼痛改善持续时间有统计学差异(P<0.05)。中位生存期综合组(6.8个月)较单放组(4.7个月)延长(P<0.05)。结论:三维适形放疗联合希罗达可以改善晚期胰腺癌疼痛症状,延长生存期。希罗达可能有放射增敏作用。     

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.