放疗联合化疗治疗局部晚期鼻咽癌的疗效观察

目的 观察局部晚期鼻咽癌患者单纯放疗和放疗联合化疗的疗效和毒副作用。方法 将89例Ⅲ～Ⅳa期鼻咽癌患者随机分为两组，研究组（A组）45例，放疗同期应用化疗（化疗方案：顺铂20mg／a，静脉滴注，第1～5天；氟脲嘧啶500mg／a，静脉滴注，第1～5天；亚叶酸钙0．2g／a，静脉滴注，第1～5天）；对照组（B组）44例，单纯放疗。结果 研究组和对照组的完全缓解率、颈淋巴结残留率分别为82．22％、75．00％和11．54％、26．09％，差异无统计学意义，P〉0．05。2年及5年生存率分别为53．33％、47．73％和26．67％、20．45％，差异无统计学意义，P〉0．05。两组毒副作用差异有统汁学意义，研究组胃肠道反应、骨髓抑制比对照组明显增大，P〈0．05。结论 放疗联合化疗对局部晚期鼻咽癌的疗效提高不能完全肯定。     

超分割放疗+同步化疗与单纯常规分割放疗治疗局部晚期鼻咽癌的近期疗效分析

目的 探讨超分割放疗+同步化疗与单纯常规分割放疗治疗局部晚期鼻咽癌的近期疗效.方法 将40例局部晚期鼻咽癌患者随机分为两组:试验组(20例)为超分割放疗+同步化疗患者,采用每周连续5 d照射,2次/d,2次间隔6～8 h,1.2 Gy/次,总量为80 Gy/7周,放疗第1天开始行同步化疗,方案为紫杉醇90 mg d1、8、15静脉滴注(2～4 h),卡铂500mg d1静脉滴注,4周为1个周期,共化疗4～6个周期.对照组(20例)为单纯常规分割放疗患者,采用每周连续5 d照射,1次/d,2Gy/次,总量为70 Gy/7周.结果 试验组治疗有效率为80%(16/20),对照组为45%(9/20),两组有效率比较差异有统计学意义(P＜0.05).结论 治疗局部晚期鼻咽癌时,超分割放疗+同步化疗比单纯常规分割放疗可明显提高近期疗效.     

超分割放疗＋同步化疗与单纯常规分割放疗治疗局部晚期鼻咽癌的近期疗效分析

目的探讨超分割放疗＋同步化疗与单纯常规分割放疗治疗局部晚期鼻咽癌的近期疗效。方法将40例局部晚期鼻咽癌患者随机分为两组：试验组（20例）为超分割放疗＋同步化疗患者，采用每周连续5d照射，2次／d，2次间隔6—8h，1．2Gy／次，总量为80Gy／7周，放疗第1天开始行同步化疗，方案为紫杉醇90mgd1、8、15静脉滴注（2—4h），卡铂500mgd1静脉滴注，4周为1个周期，共化疗4—6个周期。对照组（20例）为单纯常规分割放疗患者，采用每周连续5d照射，1次，d，2Gy／次，总量为70Gy／7周。结果试验组治疗有效率为80％（16／20），对照组为45％（9／20），两组有效率比较差异有统计学意义（P〈0．05）。结论治疗局部晚期鼻咽癌时，超分割放疗＋同步化疗比单纯常规分割放疗可明显提高近期疗效。     

三维适形放疗联合热化疗治疗局部晚期胰腺癌的临床观察

目的 评价三维适形放疗联合热化疗对局部晚期胰腺癌的临床疗效.方法 将2008年6月至2011年6月间本院收治的70例局部晚期胰腺癌患者分为两组:单纯放疗组30例仅采用单纯放疗,综合治疗组40例在放疗同时及以后给予热化疗.放疗采用三维适形放疗,90％ ～ 95％等剂量曲线,单次剂量1.8 ～2.0 Gy,总放射剂量50 ～70 Gy;热化疗自三维适形放疗开始后同步进行,热疗时维持温度41.5 ～43.5℃,每次1h,每周2次,共6次.热疗中同时给予注射用三氧化二砷20mg、重组改构人肿瘤坏死因子1000万U静脉滴注,进行4～6次,或三维适形放疗同时及治疗后给予吉西他滨0.6 ～1.0 g/m2 d1、8静脉滴注;顺铂20～30mg/m2 d1～3静脉滴注,每28天重复一次,总疗程3～6个周期.结果 治疗后3个月综合治疗组总有效率CR+ PR为70.0％(49/70),其中放疗联合化疗组、放疗联合热化疗组有效率分别为56.5％、88.2％,单纯放疗组有效率56.7％.放疗联合热化疗组有效率与放疗联合化疗组、单纯放疗组相比差异均有统计学意义(x2=4.68,4.98,P＜0.05),而后两者比较差异无统计学意义(P＞0.05).全组1年、2年生存率分别为46.8％和20.3％,其中综合组分别为52.4％和26.7％,单纯放疗组分别为42.5％和16.2％,两组1年、2年生存率比较差异均有统计学意义(x2=14.17,P＜0.05;x2 =9.74,P＜0.05),治疗及随访期间未见穿孔、大出血、持续高热等严重并发症.结论 三维适形放疗联合热化疗治疗局部晚期胰腺癌患者近期疗效满意,毒副反应可耐受,且能提高患者生存质量及生存期,是治疗局部晚期胰腺癌较好的方法.     

放疗结合化疗在鼻咽癌治疗后期的临床效果

目的 探讨放疗结合化疗对局部中晚期鼻咽癌治疗的临床效果.方法 将该院70例中晚期鼻咽癌患者随机分成观察组(35例)与对照组(35例),对照组采用单纯放疗法,2Gy/d,1次/d,5次/7d.观察组采用放疗结合化疗法,每个疗程21d,共化疗4个疗程.结果 随访5年,随访率100％.观察组患者1、3、5年生存率、局部控制率及远处转移率与对照组比较,P＜0.05,差异有统计学意义.结论 放疗结合化疗可提高局部中晚期鼻咽癌患者生存率、局部控制率,并降低远处转移率,临床疗效满意,值得临床广泛推广.     

颅底野补量对T3、T4期鼻咽癌复发的影响

目的分析颅底野补量对T3、T4期鼻咽癌患者颅底复发的影响。方法对从2004年1月~2005年4月收治的303例经病理确诊为鼻咽癌,分期T3、T4的初治患者做随机分组研究,对照组鼻咽常规放疗剂量为(70.05±1.05)Gy。研究组在常规放疗后接受颅底补量4～8Gy(补量组),对照组未进行颅底补量。结果补量组2、3、5年颅底局控率分别为98%、91.8%、86.8%,对照组分别为93.4%、76.4%、65.1%,两组之间的差异具有统计学意义(P﹤0.05)。中位复发时间补量组为46个月,对照组为38个月,差异有统计学意义(P=0.02)。补量组与对照组的放射性脑损伤发生率分别为12.08%和7.79%,两组间的差异无统计学意义(P﹥0.05)。结论颅底补量放疗可减少T3、T4分期鼻咽癌患者的颅底复发率,放射性脑病发生率未增加。     

化、放疗联合治疗Ⅲ、Ⅳa下行型鼻咽癌的临床观察

局部晚期鼻咽癌的主要治疗手段是放疗,由于其临床靶区较大,局部复发和远处转移是局部晚期鼻咽癌治疗的主要失败原因.然而常规放疗配合化疗对肿瘤局部控制率及远处转移率的影响各家报道不一.笔者收集了1993年5月～1996年4月140例Ⅲ、Ⅳa期下行型鼻咽癌患者进行化、放疗,以探讨化疗在局部晚期鼻咽癌放疗中的临床意义.     

N3鼻咽癌患者常规放疗同步PF方案化疗的疗效及预后影响因素

目的 探讨N3鼻咽癌患者常规放疗同步PF方案(顺铂联合氟尿嘧啶)化疗的疗效及预后影响因素。方法 选取2019年1月至12月本院收治的N3鼻咽癌患者39例,随机分为单纯放疗组19例、同步化疗组20例。均采用6MVX高能X线的全身照射技术进行常规放疗,同步化疗组采用PF方案;治疗3个月后依据实体瘤疗效评定标准(RECIST)进行疗效评价。治疗后随访2年,记录第1年和第2年的远处转移、局部复发以及生存情况,将患者按照生存情况分为生存组和死亡组。结果 单纯放疗组治疗毒副作用发生率为26.32%(5/19),同步化疗组治疗毒副作用发生率为30.00%(6/20),两组治疗毒副作用发生率比较差异无统计学意义(P>0.05)。治疗3个月后,同步化疗组患者鼻咽部病灶完全缓解率、客观有效率明显高于单纯放疗组患者,无变化率和进展率明显低于单纯放疗组患者,差异均有统计学意义(均P<0.01);同步化疗组患者颈部淋巴结完全缓解率、部分缓解率及客观有效率明显高于单纯放疗组患者,无变化率和进展率明显低于单纯放疗组患者,差异均有统计学意义(均P<0.01)。同步化疗组患者治疗1年后和治疗2年后的远...     

调强适形放疗与常规放疗治疗中晚期鼻咽癌临床效果分析

目的 探讨调强适形放疗(IMRT)与常规放疗在中晚期鼻咽癌同步放化疗中的临床效果.方法 将74例中晚期鼻咽癌患者按随机数字表法分为两组,每组37例,IMRT组采用IMRT联合化疗,常规放疗组采用常规放疗联合化疗,比较两组的疗效和不良反应.结果 两组患者均完成化疗.IMRT组完全缓解(CR)7例、部分缓解(PR)12例、稳定(SD)11例、疾病进展(PD)7例,有效率为51.4％(19/37),疾病控制率为81.1％(30/37).常规放疗组CR 3例、PR 8例、SD 12例、PD 14例,有效率为29.7％(11/37),疾病控制率为62.2％(23/37).两组有效率、疾病控制率比较差异均有统计学意义(P＜0.05).IMRT组患者皮肤、黏膜、口干症状的不良反应较轻,与常规放疗组比较差异有统计学意义(P＜0.05).两组骨髓抑制比较差异无统计学意义(P＞0.05).结论 IMRT能有效降低患者不良反应,提高生活质量,值得广泛应用.     

鼻咽癌后程加速超分割与常规分割放疗的疗效比较

目的 对比分析常规分割与后程加速超分割放疗对鼻咽癌的远期疗效及不良反应.方法 将108例鼻咽癌患者随机分为常规分割组53例,后程加速超分割组55例.两组均采用6MV X射线面颈联合野对穿照射,先用常规分割照射36～40 Gy,2 Gy/次,5次/周,3.5～4周完成.后改为小面颈野对穿避脊髓照射.常规分割组仍用常规分割照射总剂量至70 Gy 7周完成.后程加速超分割组采用加速超分割1.5 Gy/次,2次/d,间隔≥6 h,5 d/周,总剂量70 Gy 6周完成.结果 1、3、5年肿瘤局部控制率后程加速超分割组分别为95.3%、92.8%、85.5%,常规分割组分别为87.2%、72.6%、65.3%,两组差异有统计学意义（P〈0.05）.1、3、5年生存率后程加速超分割组分别为97.8%、75.5%、67.2%,常规分割组分别为93.6%、72.1%、64.3%,两组差异无统计学意义（P〉0.05）.鼻咽癌复发率明显低于常规分割组（P〈0.05）.两组急性口腔黏膜反应及放射后遗症差异无统计学意义（P〉0.05）.颈部淋巴结复发率及远处转移率差异无统计学意义（P〉0.05）.远期毒副反应差异也无统计学意义（P〉0.05）.结论 后程加速超分割与常规分割相比,前者局部控制率明显提高,鼻咽癌部复发率降低,患者能耐受,不增加远期不良反应,但对颈部淋巴结复发率及远处转移率作用不明显.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.