放化疗联合治疗局部晚期非小细胞肺癌临床疗效观察

目的探讨放疗同期紫杉醇联合卡铂方案与序贯放化疗治疗局部晚期非小细胞肺癌(NSCLC)疗效及毒副反应。方法将60例局部晚期NSCLC患者随机分为放化同步组(同步组)和放化疗组(序贯组)各30例;两组均行适形放疗,化疗均为PC方案,同步组每周一次;序贯组每3周一次,化疗2周期后再行放疗。观察两组治疗近期有效率、生存率及急性毒副反应。结果两组均完成放化疗,同步组总有效率86.67%,序贯组63.33%(P0.05);3~4级骨髓抑制发生率同步组为30.0%,序贯组为23.3%;同步组和序贯组3~4级放射性肺炎发生率分别为13.4%和6.7%(P0.05);均可耐受。结论同步放化疗能够显著提高局部晚期NSCLC生存率,急性毒副反应均可耐受。     

非小细胞肺癌放疗同期联合化疗临床疗效分析

目的比较同步及序贯放化疗模式治疗Ⅲ期非小细胞肺癌的临床疗效和不良反应。方法对本院收治的Ⅲ期非小细胞肺癌68例,随机分为同步和序贯放化疗两组。前者38例,采用三维适形放疗(3-DCRT)同时TP方案化疗。后者30例,先行TP化疗2周期,2周后再行放疗,放疗结束再行TP化疗2周期。两组均于治疗结束后4周评价疗效。结果近期有效率同步优于序贯组(P0.05)。两组1、2、3年远期生存率无统计学差异。不良反应同步组高于序贯组。结论同步放化疗治疗Ⅲ期非小细胞肺癌近期疗效优于序贯放化疗组,但反应较重。     

同步放化疗与序贯放化疗治疗Ⅲ期非小细胞肺癌的临床疗效比较

目的探讨同步放化疗与序贯放化疗治疗Ⅲ期非小细胞肺癌的临床疗效及安全性。方法对我院住院治疗的86例Ⅲ期非小细胞肺癌患者临床资料进行分析。86例患者中行同步放化疗者46例,行序贯放化疗者40例。比较两组近期疗效、中位生存时间及毒副反应。结果同步放化疗组与序贯放化疗组患者治疗有效率(CR+PR)分别为69.6%和50.0%,差别具有统计学意义(P<0.05);同步放化疗组中位生存时间显著优于序贯放化疗组(P<0.05);骨髓抑制、放射性食管炎、消化道反应及放射性肺炎是两组的主要毒副反应,同步放化疗组患者Ⅲ～Ⅳ级不良反应发生率高于序贯放化疗组,但两者差异无统计学意义(P>0.05)。结论与序贯放化疗相比,同步放化疗可显著提高Ⅲ期非小细胞肺癌近期疗效,延长生存期。     

序贯放化疗和同期放化疗治疗老年晚期非小细胞肺癌患者的疗效比较

目的对比序贯放化疗和同期放化疗治疗老年晚期非小细胞肺癌(NSCLC)患者的临床效果。方法收集老年晚期NSCLC患者82例,采用随机数字表法将其分为序贯放化疗组与同期放化疗组,每组41例,比较两组近期疗效,对两组患者1年、2年中位生存时间及生存率进行比较,并对两组患者毒副反应进行比较。结果同期放化疗组有效率为61.0%,而序贯放化疗组有效率为36.6%,两组有效率差异显著(P0.05)。序贯放化疗组中位生存时间是15个月,而同期放化疗组中位生存时间是22个月;序贯放化疗组1年生存率63.4%,2年生存率43.4%,而同期放化疗组1年生存率75.1%,2年生存率64.0%,两组患者1年生存率及2年生存率之差异显著(P0.05);序贯放化疗组与同期放化疗组患者在血液学和肺部的毒副作用方面差异显著(P0.05),两组患者在胃肠道、肾、神经系统及心血管方面的毒副反应差异无统计学意义(P0.05)。结论同期放化疗治疗老年晚期NSCLC患者的临床效果优于序贯放化疗组,然而其在血液学和肺部的毒副作用的发生率较序贯放化疗组的高。     

对比分析同期放化疗和序贯放化疗治疗局部晚期非小细胞肺癌的临床效果

目的对比分析同期放化疗与序贯放化疗应用于局部晚期非小细胞肺癌(NSCLC)治疗的临床效果。方法选取2012年6月-2014年6月我院收治的86例局部晚期NSCLC患者作为研究对象,通过数字表示法将患者随机均分为同期组和序贯组,同期组在放疗开始同时进行化疗,序贯组在进行4周期化疗后开始行放疗治疗。随访1年,分析两组的临床疗效、存活率、副作用以及生存质量。结果同期组治疗有效率79.1%显著高于序贯组58.1%(P0.05),但两组1年内存活率相比差异无统计学意义(P0.05);同期组骨髓抑制、放射性食管炎和胃肠道反应的发生率明显高于序贯组(P0.05);同期组QOL量表的各项目评分均显著高于序贯组(P0.05)。结论同期放化疗治疗局部晚期NSCLC有较好的临床效果,可以提高患者生存质量,但毒副作用大,临床治疗NSCLC的具体方案应根据患者实际情况综合考虑。     

不同方案治疗局部晚期NSCLC对疾病控制及安全性分析

目的探讨不同方案治疗局部晚期非小细胞肺癌(NSCLC)对疾病控制及安全性。方法选择2014年3月-2015年3月在我院接受治疗的治疗的局部晚期NSCLC患者90例为研究对象,随机分为观察组与对照组,每组各45例。观察组患者应用同步放化疗进行治疗,对照组采用序贯放化疗进行治疗,观察两组患者治疗后的近期效果、生活质量改善率、1年生存率、2年生存率以及不良反应情况。结果观察组治疗总有效率高于对照组(68.89%vs 44.44%,P0.05);生活质量改善率高于对照组(80.00%vs 60.00%,P0.05);1年生存率高于对照组(64.44%vs 42.22%,P0.05);2年生存率与对照组对比无统计学意义(P0.05);观察组患者的肿瘤标志物改善与对照组具有明显差异(P0.05)。两组患者治疗后不良反应包括外周静脉炎、肾功能损害、肝功能损害、脱发、恶心呕吐、白细胞减少、血小板减少、血红蛋白减少的发生率比较没有显著性的差异(P0.05)。结论与序贯放化疗相比,同步放化疗治疗局部NSCLC的疗效更为显著,可较好的改善患者的生活质量,延迟患者生存期,且毒副作用较小,安全性高,值得推广应用。     

同步放化疗联合巩固化疗与序贯放化疗对老年晚期非小细胞肺癌患者血清Chemerin水平及预后的影响比较

目的比较同步放化疗联合巩固化疗与序贯放化疗对老年晚期非小细胞肺癌(NSCLC)患者血清Chemerin水平及预后的影响。方法选择老年晚期NSCLC患者160例,随机分为对照组和观察组,各80例。对照组给予序贯放化疗方式治疗,观察组给予同步放化疗联合巩固化疗,2组进行3个月治疗。观察两组治疗后的疗效(采用RECIST进行评价)、癌因性疲乏评分及治疗前后血清Chemerin、CYFRA21-1水平变化和两组预后情况,包括:无进展生存期(PFS)、生存时间(OS)、1年生存率。结果观察组治疗后总有效率明显高于对照组,差异有统计学意义(P<0. 05)。治疗前,2组癌因性疲乏评分各维度评分差异无统计学意义(P>0. 05)。治疗后,对照组与治疗前相比差异有统计学意义(P<0. 05),观察组与治疗前及对照组治疗后相比,差异均有统计学意义(P<0. 05)。治疗前,两组血清Chemerin、CYFRA21-1水平差异无统计学意义(P>0. 05)。治疗后,两组血清Chemerin、CYFRA21-1水平均较治疗前显著下降,差异有统计学意义(P<0. 05),观察组与治疗前及对照组治疗后相比明显下降,差异均有统计学意义(P<0. 05)。观察组PFS、OS及1年生存率均显著高于对照组,差异有统计学意义(P<0. 05)。结论与序贯放化疗相比,同步放化疗联合巩固化疗对老年晚期NSCLC的治疗优势更明显,能显著降低血清Chemer-in、CYFRA21-1水平,且能明显延长生存期。     

老年局部晚期非小细胞肺癌三种治疗模式的临床对比分析

目的 评价三种治疗模式对老年局部晚期非小细胞肺癌(NSCLC)的临床疗效和安全性.方法 对近年我院采用三种治疗模式治疗老年局部晚期NSCLC的疗效进行回顾性分析.结果 (1)近期疗效:同步放化疗组(70.0%)＞序贯放化疗组(61.8%)＞单纯化疗组(35.7%),同步放化疗组和序贯放化疗组有效率均明显高于单纯化疗组(P＜0.05);而同步放化疗组和序贯放化疗组之间无显著性差异(P＞0.05).(2)远期疗效:序贯放化疗组(67.6%)＞同步放化疗组(65.0%)＞单纯化疗组(39.3%),序贯放化疗组明显高于单纯化疗组(P＜0.05),而单纯化疗组与同步放化疗组、序贯放化疗组和同步放化疗组间无显著性差异(均P＞0.05).(3)毒副反应:同步放化疗组的骨髓抑制、食管炎、放射性肺炎和恶心呕吐发生率均明显高于单纯化疗组(均P＜0.05),而单纯化疗组和序贯放化疗组间无显著性差异(均P＞0.05).结论 同步放化疗会加重毒副反应,尤其是老年患者,对提高近期疗效和生存率并无益处.在临床实践中可优先考虑序贯化放疗作为老年局部晚期NSCLC的治疗方案.     

EP方案同步放化疗治疗局限期小细胞肺癌的疗效分析

目的评价EP方案同步放化疗对比序贯放化疗治疗局限期小细胞肺癌的临床疗效。方法局限期小细胞肺癌患者53例,分为同步放化疗组21例,序贯放化疗组32例,比较两者患者的临床疗效。结果同步放化疗组中位疾病进展时间为9.1±2.2个月,序贯放化疗组为5.2±1.6个月。同步放化疗组无进展生存时显著长于序贯放化疗组;总生存比较两组差别无统计学意义(HR=0.93,95%CI:0.47～1.81 P=0.82)。结论 EP方案同步放化疗可以显著延长患者无进展生存时间,但不能延长患者总的生存时间。     

联合治疗对非小细胞肺癌疗效观察

目的肺癌探讨三维适形放疗联合PD化疗治疗对老年非小细胞肺癌疗效。方法选取84例本院呼吸科老年非小细胞肺癌患者作为研究对象,随机分为两组,第一组对照组采取PD化疗方案,第二组实验组采取PD化疗方案并结合三维适形放疗方法,总剂量60Gy/30次,5周完成。结果两组有效率分别为57.1%和76.2%,缓解率分别为7.14%(3/42)和26.2%(11/42),(P0.05)。两组患者五年内平均生存期分别为14.3个月和20.5个月(P0.05)。两组后期均出现放射病反应,主要为骨髓抑制和放射性肺炎。结论三维适形放射治疗同期PD化疗方案治疗局部晚期非小细胞肺癌,与序贯放化疗相比,可提高局部晚期非小细胞肺癌的近期疗效,生存期也有提高的趋势,但是放射病反应有所增加。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.