系统评价宫颈癌术前应用新辅助化疗的临床价值

Objective To evaluate clinical value of neoadjuvant chemotherapy(NACT) before surgery for cervical cancer. Methods The author searched the clinical trials on the treatment of cervical cancer comparing NACT followed by surgery versus initial surgery in the main medical data resources(MEDLINE、PUBMED、ELSEVIER ScienceDirect、CNKI、CBMdisc、Cochrane Library and EMBASE)published in English and Chinese literature. We abstracted data about positive pelvic nodes, interstitial infiltration, vascular invasion, positive surgical margin,3-year overall survival (OS),3-year disease-free survival(DFS),5-year OS,5-year DFS from both NACT group and control group, and a meta-analysis was applied. Results The hazard ratio (HR) of positive pelvic nodes on NACT group versus control group was 0.52 (95 % CI 0.42 ～ 0.64, P<0.0001), HR of interstitial infiltration was 0.41 (95 % CI 0.32 ～ 0.55, P<0.0001), HR of vascular invasion was 0.25 (95 % CI 0.16 ～0.38, P<0.0001), and HR of positive surgical margin was 0.44 (95 % CI 0.22 ～ 0.87, P=0.02), all differences were statistically significant. And there were significant difference on the HRs of 3-year DFS, and 5-year DFS, which were 1.45 (95% CI 1.10 ～ 1.91,P=0.008)and 1.33 (95 % CI 1.05 ～ 1.77,P=0.04). And there were no significant difference on HRs of 3-year OS and 5-year OS, which were 1.11 (95 % CI 0.85 ～ 1.46, P =0.46)and 1.11(95%CI 0.87 ～1.40,P= 0.40)respectively. Conclusion For cervical cancer,NACT could reduce pathological risk factors and maybe improve prognosis.     

Value of serum procalcitonin and B-type natriuretic peptide in diagnosis and predicting prognosis of hospital-acquired pneumonia in critically ill patients北大核心CSCD

Objective To examine the value of serum procalcitonin (PCT) and B-type natriuretic peptide (BNP) in diagnosis and prognosis evaluation of hospital-acquired pneumonia (HAP) in critically ill patients prospectively. Methods A total of 72 critically ill HAP patients were enrolled in intensive care unit (ICU). Another 30 patients surviving the perioperative period in ICU were taken as control. Serum levels of PCT and BNP were determined on days 1, 2, 3 and 7 after HAP diagnosis and compared with control group. The value of the two indicators for diagnosis of HAP was analyzed by the area under receiver operating characteristic (ROC) curve (AUC). The HAP patients were assigned to survivor group (n=53) or non-survivor group (n=19) based on 28-day survival state after diagnosis. Dynamic change of PCT and BNP levels (ΔPCT, ΔBNP) was compared between two groups to assess the value of PCT and BNP change in predicting the prognosis of HAP. Results The initial PCT and BNP levels in HAP group were significantly higher than those in control group (P < 0.05). The AUC of PCT and BNP were 0.627±0.059 (95% CI: 0.511-0.742, P=0.045), 0.894±0.030 (95% CI: 0.835-0.954, P=0.000), respectively. The sensitivity, specificity, positive predictive value and negative predictive value of PCT were 65.3%, 66.7%, 82.5% and 44.5%, respectively; and of BNP were 72.2%, 93.3%, 96.3% and 58.3%, respectively. During the first two days after diagnosis, no significant difference was found beween survivor group and non-survivor group in terms of serum PCT or BNP level, but significant difference was found on Days 3 and 7 (P<0.05). There was no significant correlation beween ΔPCT or ΔBNP and ICU stay (P>0.05). The AUC of ΔPCT and ΔBNP was 0.804±0.065 (95% CI: 0.605-0.861, P=0.003) and 0.733±0.065 (95% CI: 0.677-0.932, P=0.000), respectively. The sensitivity, specificity, positive predictive value and negative predictive value of ΔPCT were 77.4%, 78.9%, 56.8% and 90.7%, respectively; and of ΔBNP were 75.5%, 68.4%, 46.1% and 88.6%, respectively. Conclusions Monitoring of the dynamic change of serum PCT and BNP levels only provides limited utility in diagnosis and prognosis evaluation of HAP in critically ill patients. © by Editorial Department of Chinese Journal of Infection and Chemotherapy.     

Application of positive behavior management in patients after breast cancer surgery

BACKGROUND As a radical treatment,breast cancer surgery has a positive psychological impact on most patients.However,some patients do not have a clear understanding of the disease,which requires a more scientific and comprehensive consideration during clinical intervention and are based on cognition.The positive behavior management model is based on this kind of background-derived new interventions,which can better serve the clinical rehabilitation process of patients.The positive behavior management model based on cognitive architecture is a new type of intervention derived from this background,which can better serve the clinical rehabilitation process of patients.AIM To analyze the influence of a positive behavior management model based on cognitive framework on the degree of hope and self-efficacy of patients with breast cancer surgery.METHODS Eighty-four patients with breast cancer who underwent surgical treatment in our hospital from August 2016 to December 2018 were included in the study.The patients were divided into the experimental group(n=42)and control group(n=42)by random number table grouping.The control group received traditional nursing intervention,while the experimental group received a positive behavior management model based on cognitive framework based on the traditional intervention of the control group.General Self-efficacy Scale,Herth Hope Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale and Cancer Patient Specific Scale were used to evaluate the two groups before and 1 wk after intervention.RESULTS After the intervention,self-efficacy and hope level of the experimental group were significantly higher than those of the control group(P<0.05).The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores in the experimental group were significantly lower than those in the control group(P<0.05).There was no significant difference in the quality of life scores between the two groups before intervention(P>0.05).The quality of life scores in all aspects in the experimental group after intervention were significantly higher than those in the control group(P<0.05).CONCLUSION The positive behavior management model based on cognitive framework applied to patients with breast cancer surgery improved hope for treatment and selfefficacy,reduced negative emotion,and improved quality of life.     

进展期直肠癌术中植入氟尿嘧啶缓释剂的疗效观察

Objective To assess the effect of intraperitoneal interstitial implant of Sustained-release 5-Fluorouracil during operation for advanced rectal cancer. Methods One hundred and four cases with advanced rectal cancer were enrolled into the study and divided into 3 groups: treatment group 1(n = 37), underwent combined hypotonic peritoneal chemo-hyperthermia and Sustain-released 5-fluorouracil implantation treatment during operation; treatment group 2(n = 34), underwent combined intraoperative hypotonic peritoneal chemohyperthermia and early postoperatively intraperitoneal chemotherapy treatment; and control group(n = 33),underwent peritoneal lavage during radical resection alone. Results Digestive tract toxicity in group 1 was significantly lower than that in group 2(2. 70% vs. 20. 59%, x2 = 9. 104, P ＜ 0. 05). There were significant difference on 1 year survival rate among the three groups. The 2-year survival rate of group 1 was significantly higher than that in the control group (78. 37% vs. 48. 48%, x2 = 1. 297 ,P ＜ 0. 05). After two years follow-up the 2-year local recurrence rate of group 1 was significantly lower than that in the control group(21.62% vs 32. 35 %, x2 = 7. 001, P ＜ 0. 05). However, no significant difference was found compared to group 2, which was 32. 35%. Conclusion lntraperitoneal interstitial implant of Sustain-released 5-Fluorouracil during operation is an effective intraperitoneal chemotherapy with mild side effects for advanced rectal cancer.     

支持性心理干预对宫颈癌术后患者婚姻质量的影响

Objective To probe into the effect of supportive psychological intervention on the marriage quality of patients after cervical cancer operation. Metheds Hospitalized patients totaled 50 cases were divided into observation group and control group.The control group was treated with routine nursing and on that basis the observation group wao treated with individual supportive psychological intervention (including dependents).6 mouths later,investigation was done radomly with Olson Marriage Quality Test.Results After carrying out supportive psychological interveation,patients' unhealthy emotion was eliminated and unhealthy behaviors were changed consciously,the marital quality was improved greatly and the differences between two groups were significantly(P＜0.01).Conclusions Supportive psychological intervention can improve the marital quality of patients greatly after cervical cancer operation.     

支持性心理干预对宫颈癌术后患者婚姻质量的影响

Objective To probe into the effect of supportive psychological intervention on the marriage quality of patients after cervical cancer operation. Metheds Hospitalized patients totaled 50 cases were divided into observation group and control group.The control group was treated with routine nursing and on that basis the observation group wao treated with individual supportive psychological intervention (including dependents).6 mouths later,investigation was done radomly with Olson Marriage Quality Test.Results After carrying out supportive psychological interveation,patients' unhealthy emotion was eliminated and unhealthy behaviors were changed consciously,the marital quality was improved greatly and the differences between two groups were significantly(P＜0.01).Conclusions Supportive psychological intervention can improve the marital quality of patients greatly after cervical cancer operation.     

无创正压通气对急性呼吸衰竭患者拔管后再插管率和预后影响的荟萃分析

Objective To evaluate the effects of noninvasive positive pressure ventilation (NPPV)used after extubation on mortality and rate of reintubation in patients with acute respiratory failure (ARF).Method Pubmed, Embase, Web of Science databases were searched to collect data from randomized controlled trials (RCT) of the relevant subject from January 1995 to May 2010. Meta analysis of data about NPPV on mortality and rate of reintubation in patients after extubation carried out by using the methods recommended by the Cochrane Collaboration. Results Six RCTs included sample size of 381 NPPV and 379routine medical care. In total, the mortalities of patients in NPPV group and routine medical care group were 18.6% (62/334) vs. 21.6% (72/333), respectively, and the rates of reintubation of the two groups were 30.2% (115/381) vs. 33.5% (127/379), respectively. Compared with routine medical care, NPPV did not significantly reduce the mortality ( OR: 0.83, 95% CI =0.57 ～ 1.21 ,P =0.34) and rate of reintuation( OR: 0.83, 95% CI = 0.59 ～ 1.16, ( P = 0.27). When the analysis was focused to the four studies of them in which patients received NPPV as soon as extubation, the results were quite different. From these four studies, the mortalities of patients in NPPV group and routine medical care group were 12. 2% (22/181) vs.23.9% (44/184),(P=0.004), and the rate of reintubation of the two groups were 14.0% (32/228) vs.20.4% (47/230), (P =0.07). Compared with routine medical care, early application of NPPV to patients after extubation reduced the mortality. Conclusions This study suggests the favorable effects of early application of NPPV to patients after extubation on the mortality of acute respiratory failure.     

多重实时PCR检测高危型人乳头瘤病毒感染

目的 调查不同宫颈病变组妇女生殖道13种高危型HPV(HR HPV)感染情况,分析HR HPV感染与宫颈病变的关系.方法 选择深圳市宝安区妇幼保健院宫颈专科门诊患者350例,利用TCT技术检测其宫颈上皮细胞学状况,根据细胞学结果分组.采用多重实时PCR(mRT PCR)检测其生殖道HR HPV感染情况和病毒载量,采用χ2检验或Fisher精确概率法比较各组间HR HPV感染率,采用Kruskal-Wallis或Wilcoxon秩和检验比较各组间HR HPV阳性者的病毒载量,采用Wilcoxon秩和检验比较HR HPV阳性和阴性组的年龄分布情况.结果 未见上皮内病变或恶性病变(NILM)组、意义不明的非典型鳞状上皮细胞增生(ASCUS)组、鳞状上皮细胞低度病变(LSIL)组、鳞状上皮细胞高度病变(HSIL)组的HR HPV阳性例数分别为10例(3.4%)、7例(20.0%)、11例(78.6%)和6例(6/6).NILM组HR HPV阳性率低于ASCUS组、LSIL组,ASCUS组HR HPV阳性率低于LSIL组,差异有统计学意义(χ2值分别为14.43、107.69、14.76,P均<0.01);NILM组低于HSIL组、ASCUS组低于HSIL组,差异有统计学意义(P值分别为0.000 1、0.000 4).NILM组、ASCUS组、LSIL组和HSIL组HR HPV阳性者的病毒载量分别为4.10 (3.38～6.27)、5.33 (3.63～6.66)、5.77 (4.01～7.01)和5.58 (4.19～5.85)(拷贝/ml,lg).将ASCUS组、LSIL组和HSIL组3组合并为宫颈细胞异常组,病毒载量为5.58(3.63～7.01)(拷贝/ml,lg)高于NILM组,差异有统计学意义(U=43.0,P<0.05).HR HPV阳性组平均年龄36(21～56)岁,与阴性组[33(21～58)岁]比较,差异无统计学意义(U=4 544,P>0.05).结论 HR HPV感染与宫颈病变有关;HR HPV病毒载量高低与宫颈病变程度无相关性,但病毒载量越高,存在宫颈病变的可能性越大.HR HPV阳性组与阴性组的年龄分布无差异.

Abstract：

Objective To investigate 13 high-risk types of HPV (HR HPV) infection rates in women with different grades of cervical lesions.Methods A total of 350 women, who were hospitalized in the department of gynecology in Bao′an Maternity & Child health hospital, were enrolled for the study.TCT technology was used to evaluate the cervical epithelium.The group were divided according to the cytology results.Multiplex real time PCR (mRT PCR) was used to detect the viral loads.HR HPV infection rate of different groups were analyzed using χ2 test or Fisher exact test.HR HPV viral loads of patients in different grades of cervical lesion groups were compared using Kruskal-Wallis or Wilcoxon test, and the age distribution of HR HPV positive group and negative group was analyzed by using Wilcoxon test.Results The HR HPV infection rates of NILM, ASCUS, LSIL, HSIL were 3.4% (10/295), 20.0% (7/35), 78.6% (11/14) and 100.0% (6/6), respectively.HR HPV positivity in NILM was lower than ASCUS (χ2=14.43,P<0.01) and LSIL (χ2=107.69,P<0.01), HR HPV positivity in ASCUS was lower than LSIL (χ2=14.76,P<0.01). The median of HR HPV viral loads in NILM, ASCUS, LSIL and HSIL were 4.10 (3.38-6.27), 5.33 (3.63-6.66), 5.77 (4.01-7.01) and 5.58 (4.19-5.85) respectively (copies/ml,lg).Combined ASCUS, LSIL and HSIL groups into cervical lesion group, HR HPV viral load of which was higher than that of NILM (U=43.0, P<0.05).The median Ages of HR HPV positive group and negative group were 36 and 33, respectively.No statistical significance was found between them (U=4 544, P>0.05).Conclusions The present study revealed that HR HPV infection was related to cervical lesion, but there was no correlation between viral load and cervical lesion grade. In additional, no difference in age distribution was found between HR HPV positive group and negative group.     

宫颈癌手术患者心理干预35例临床对比性分析

Objective To discuss the effect of psychological intervention on the patients of cervical cancer. Methods Take 35 patients of cervical cancer in psychological intervention group at random, at the same time, take the other 36 cases as control group. Evaluate condition of anxiety (SAS) and depression (ADS) before and after operation. Evaluate the time of getting out of bed and satisfaction of sex lives after operation. Results There were no significance in SAS, SDS before operation. The scores of SAS、SDS in psychological intervention group were significant lower than thcee in control group after operation. The time of getting out of bed in psychologi-cal intervention group was significant less than that in control group, and the satisfaction of sex lives after opera-tion was significant higher. Conclusions Psychological intervention on patients before and after cervical cancer plays an important role in physical and mental recovering of patient and rebuilding beautiful life.     

血浆sHLA-G在宫颈癌和癌前病变检测中的应用

目的 探讨血浆sHLA-G在诊断CIN及宫颈癌中的应用价值.方法 采用ELISA检测102例宫颈癌患者、72例CIN患者和20名健康对照者血浆sHLA-G水平,并分析其对宫颈癌的诊断价值及与宫颈癌临床病理参数间的关系.其中,宫颈癌患者经FIGO分期分为:Ⅰ期32例、Ⅱ期28例、Ⅲ期25例、Ⅳ期17例;按肿瘤大小分为:＜4 cm 63例、≥4 cm 39例;按病理组织类型分为:鳞癌78例、腺癌24例;高分化57例、中分化29例、低分化16例;无淋巴结转移64例、淋巴结转移38例.CIN患者中Ⅰ级21例、Ⅱ级25例、Ⅲ级26例.结果 血浆sHLA-G在宫颈癌组为193.6(151.3～287.4)kU/L,CIN Ⅰ级组为48.3(34.6～57.2)kU/L、CIN Ⅱ级组为91.3(68.2～118.6)kU/L、CIN Ⅲ级组为106.4(73.8～165.7)kU/L、健康对照组为45.2(38.0～55.5)kU/L;各组间血浆sHLA-G水平差异有统计学意义(H=13.287,P＜0.01),且宫颈癌组明显高于CIN Ⅰ级组、CIN Ⅱ级组、CIN Ⅲ级组及健康对照组(U值分别为8.832、6.456、4.017、9.873,P均＜0.05);CIN Ⅱ级组和CIN Ⅲ级组血浆sHLA-G水平明显高于CIN Ⅰ级组和健康对照组(U值分别为4.361、4.892、5.139、5.485,P均＜0.05).SCC-Ag在健康对照组、CIN Ⅰ级组、CIN Ⅱ级组、CIN Ⅲ级组和宫颈癌组的水平分别为0.43(0.38～0.69)μg/L、0.47(0.35～0.72)μg/L、0.65(0.53～0.81)μg/L、0.82(0.54～1.03)μg/L和1.02(0.62～1.87)μg/L.宫颈癌组血浆SCC-Ag水平明显高于CIN Ⅰ级组、CIN Ⅱ级组及健康对照组(U值分别为7.926、4.877、8.132,P均＜0.05);CIN Ⅲ级组血浆SCC-Ag水平明显高于CIN Ⅰ级组和健康对照组(U值分别为6.574、6.763,P均＜0.05).CA125在健康对照组、CIN Ⅰ级组、CIN Ⅱ级组、CIN Ⅲ级组和宫颈癌组的水平分别为14.38(6.14～21.82)kU/L、15.42(6.25～23.53)kU/L、21.34(9.82～32.58)kU/L、25.69(14.47～38.71)kU/L和27.72(14.29～43.87)kU/L.宫颈癌组血浆CA125水平明显高于CIN Ⅰ级组、CIN Ⅱ级组及健康对照组(U值分别为7.564、4.522、7.429,P均＜0.05);CIN Ⅲ级组血浆CA125水平明显高于CIN Ⅰ级组和健康对照组(U值分别为5.871、5.435,P均＜0.05).ROC曲线分析sHLA-G的AUC为0.828(95% CI:0.768～0.879),其诊断价值高于SCC-Ag[0.727(95% CI:0.658～0.788);Z=2.294,P＜0.05]和CA125[0.705(95%CI:0.636～0.769);Z=2.842,P＜0.05];SCC-Ag与CA125的诊断效能比较,差异无统计学意义(Z=0.672,P＞0.05).经ROC曲线分析确定sHLA-G诊断临界值为109.6 kU/L时,其敏感度为86.3%,特异度为76.1%,阳性预测值为80.0%,阴性预测值为83.3%,准确性为78.4%.宫颈癌患者血浆sHLA-G水平与FIGO分期及淋巴结转移密切相关(U值分别为6.085、4.451,P均＜0.05),而与患者年龄、肿瘤大小、组织形态及细胞分化无关(U值分别为1.274、1.956、1.268、2.719,P均＞0.05).结论 血浆sHLA-G水平检测有助于宫颈癌及癌前病变的早期发现,并且可以作为宫颈癌病情进展及淋巴结转移的判断指标.

Abstract：

Objective To explore the application value of plasma sHLA-G in diagnosis of CIN and cervical cancer. Methods The plasma sHLA-G levels were detected by ELISA in 102 cases with cervical cancer( FIGO Ⅰ stage 32 cases, Ⅱ stage 28 cases, Ⅲ stage 25 cases and Ⅳstage 17 cases; tumor size:＜4 cm 63 cases and ≥4 cm 39 cases; squamous cell carcinoma 78 cases and adenocarcinoma 24 cases;cell differentiation:well 57 cases, moderate 29 cases and poor 16 cases; lymph nodes metastasis negative64 cases and positive 38 cases ), 72 cases with CIN( Ⅰ grade 21 cases, Ⅱ grade 25 cases and Ⅲ grade26 cases ) and 20 cases of healthy controls. The diagnostic value of sHLA-G and its correlations with clinical parameters were analyzed. Results The plasma levels of sHLA-G were 193.6( 151.3-287.4 ) kU/L in cervical cancer group, 48.3( 34.6-57.2 ) kU/L in CIN Ⅰ group, 91.3( 68.2-118.6 ) kU/L in CIN Ⅱ group, 106.4( 73.8-165.7 ) kU/L in CIN Ⅲ group and 45.2( 38.0-55.5 ) kU/L in health control group.The level of sHLA-G was significantly higher in cervical cancer group than that in CIN Ⅰ group, CIN Ⅱ group, CIN Ⅲ group and healthy control group( U value of 8.832, 6.456, 4.017, 9.873, P ＜ 0.05,respectively ). The level of sHLA-G was significantly higher in CIN Ⅱ group and CIN Ⅲ group than that in CIN Ⅰ group and health control group( U value of 4.361,4.892, 5.139, 5.485, P ＜0.05, respectively ).The levels of SCC Ag in healthy control group, CIN Ⅰ group, CIN Ⅱ group, CIN Ⅲ group and cervical cancer group were 0.43( 0.38-0.69 )μg/L, 0.47( 0.35-0.72 )μg/L, 0.65( 0.53-0.81 )μg/L, 0.82( 0.54-1.03 )μg/L and 1.02( 0.62-1.87 )μg/L. The level of SCC-Ag was significantly higher in cervical cancer group than that in CIN Ⅰ group, CIN Ⅱ group and healthy control group( U value of 7.926, 4.877, 8.132,P ＜0.05, respectively ). The level of SCC-Ag was significantly higher in CIN Ⅲ group than that in CIN Ⅰ group and health control group( U value of 6.574, 6.763, P ＜0.05, respectively ). The levels of CA125 in healthy control group, CIN Ⅰ group, CIN Ⅱ group, CIN Ⅲ group and cervical cancer group were 14.38 ( 6.14-21.82 ) kU/L, 15.42( 6.25-23.53 ) kU/L, 21.34( 9.82-32.58 ) kU/L, 25.69( 14.47-38.71 )kU/L and 27.72( 14.29-43.87 ) kU/L. The level of CA125 was significantly higher in cervical cancer group than that in CIN Ⅰ group, CIN Ⅱ group and healthy control group( U value of 7.564, 4.522, 7.429, P ＜0.05, respectively ). The level of CA125 was significantly higher in CIN Ⅲ group than that in CIN Ⅰ group and health control group( U value of 5.871, 5.435, P ＜0.05, respectively ). ROC curve analysis showed AUC for sHLA-G was 0.828( 95% CI:0.768-0.879 ), which was high as compared with the AUC of SCC-Ag [ 0.727( 95% CI:0.658-0.788 );Z = 2.294, P ＜ 0.05 ] and the AUC of CA125 [ 0.705( 95% CI:0.636-0.769 );Z =2.842 ,P ＜0.05 ]. There was no significant difference of diagnostic efficiency between SCC and CA125( Z =0.672, P ＞ 0.05 ). When cutoff value of sHLA-G was 109.6 kU/L, the diagnostic sensitivity,specificity, positive predictive value, negative predictive value and accuracy rate were 86.3%, 76.1%,80.0%, 83.3%, and 78.4%, respectively. The levels of sHLA-G in cervical cancer patients were significantly correlated with FIGO stages and lymphoid node metastasis ( U value of 6.085, 4.451, P ＜0.05, respectively ), while there were no significant differences between the levels of sHLA-G and age,tumor size, histological type and cell differentiation( U value of 1.274, 1.956, 1.268, 2.719, P ＞0.05,respectively ). Conclusions sHLA-G can be used for the early screening of cervical cancer and its precancerous lesion. It could also be used as an index for judging progression and lymphoid node metastasis.