中国儿童心脏移植操作规范(2019版)

儿童心脏移植是治疗年龄18岁终末期心力衰竭患者的有效手段。1967年美国Adrian Katrowitz实施第一例儿童心脏移植,近五年全球80家单位每年开展500例左右。中国儿童心脏移植起步晚、发展慢。自1995年开展第一例儿童心脏移植以来,目前国内已登记病例超过130例。中华医学会器官移植学分会组织心脏移植专家,总结国内外相关研究最新进展,结合国际指南和临床实践,针对儿童心脏移植受者选择及常用术式的操作要点、程序和方法,以及各类复杂先天性心脏病心脏移植的特殊操作,制订《中国儿童心脏移植适操作规范(2019版)》。     

白血病病人骨髓抑制期实施防感染措施时机的研究

目的 :研究白血病病人在化疗期间 ,不同时间实施预防感染护理的效果。方法 :对照组在化学疗法结束后给予预防感染的护理措施 ,实验组在化学疗法开始前 3～ 7d实施预防性护理措施。观察两组病人感染发生率。结果 :感染发生率实验组明显低于观察组。结论 :在化学疗法开始前实施预防性护理措施有助于降低感染发生率     

Long-term results of first-line sequential high-dose carboplatin, etoposide and ifosfamide chemotherapy with peripheral blood stem cell support for patients with advanced testicular germ cell tumor

OBJECTIVE: Standard chemotherapy shows relatively low long-term survival in patients with poor-risk testicular germ cell tumor (GCT). First-line high-dose chemotherapy (HD-CT) may improve the result. High-dose carboplatin, etoposide, ifosfamide chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) was investigated as first-line chemotherapy in patients with advanced testicular GCT. METHODS: Fifty-five previously untreated testicular GCT patients with Indiana 'advanced disease' criteria received three cycles of bleomycin, etoposide and cisplatin (BEP) followed by one cycle of HD-CT plus PBSCT, if elevated serum tumor markers were observed after three cycles of the BEP regimen. RESULTS: Thirty patients were treated with BEP alone, because the tumor marker(s) declined to normal range. Twenty-five patients received BEP and HD-CT. One patient died of rhabdomyolysis due to HD-CT. Three and six (13% and 25%) out of 24 patients treated with BEP and HD-CT achieved marker-negative and marker-positive partial responses, respectively. The other patients achieved no change. Fifteen (63%) are alive and 14 (58%) are free of disease at a median follow-up time of 54 months. Severe toxicity included treatment-related death (4%). CONCLUSIONS: HD-CT with peripheral stem cell support can be successfully applied in a multicenter setting. HD-CT demonstrated modest anticancer activity for Japanese patients with advanced testicular GCT and was well tolerated. This regimen might be examined for further investigation in randomized trials in first-line chemotherapy for patients with poor-risk testicular GCT.     

糖尿病脑内胰岛移植临床初步研究(附三例报告)

本文报告胰岛细胞脑内移植治疗I型糖尿病共3例,分别经过3个月、4个月、6个月的临床观察,其临床症状明显改善或消失,空腹血糖由移植前平均12.38mmol/L下降至7.77mmol/L;3例患者普通胰岛素用量平均每日62.3~u,移植后第21～30天均完全停用胰岛素,其中1例已持续撤离胰岛素治疗达5个月。观察结果提示:胰岛移植物在患者的脑内成活,并具有良好的内分泌功能。     

肝移植患者术后早期精神症状的观察

目的探讨肝脏移植术后早期精神系统并发症发生的原因和防治经验。方法回顾性分析 12 5例原位肝脏移植患者的临床资料 ,以术后 2周作为观察时点 ,分析肝脏移植术后早期精神系统并发症发生的原因 ,总结防治经验。结果有症状组和无症状组在性别、年龄、肝功能以及血环孢素A浓度方面无明显差异 ;但有症状组的无肝期时间 (93 74± 2 8 98)min和手术时间 (4 14 6 5±6 1 92 )min却长于无症状组 (P <0 0 5 ) ;另外 ,术前有无肝性脑病、术后感染以及静脉使用免疫抑制剂和术后精神症状的发生明显相关。结论肝脏移植术后早期精神系统并发症发生的原因是多方面的 ,通过积极的对症支持治疗 ,预后良好。     

Recommendations for the Conduct of Acute Inhalation Limit Tests

This paper reviews the scientific issues related to exposureconcentrations and particle sizes used in acute inhalation limittests. The current United States Environmental Protection Agency(USEPA) recommended exposure concentration for such tests is5 mg/liter, while this level is very high, it is often achievable.On the other hand, its toxicological relevance is questionable.The USEPA recommendation that 25% of the particle distributionbe less than 1 µm is a more difficult issue to address.Physical laws for aerosol particle generation and behavior limitthe minimum size of particles in an exposure atmosphere at aconcentration of 5 mg/liter. Particle size also influences depositionsite in the respiratory tract. Since damage to any region ofthe respiratory tract can produce lethality, and it is not possibleto predict, a priori, the most responsive region of the tractor the most harmful particle size of an untested agent, acutelimit testing should employ particles in a size range that depositsthroughout the entire rodent respiratory tract. Particles between1 and 4 µm mass median aerodynamic diameter (MMAD) arewell suited for such studies. It is, therefore, recommendedthat the limit test concentration should be the highest concentration(up to 5 mg/liter) that can be achieved while still maintaininga particle size distribution having an MMAD between 1 and 4µm.     

肝细胞肝癌外科治疗方法的选择

2008年9月底制定了肝细胞肝癌外科治疗方法的选择,全文如下.