Complementary therapists’ training and cancer care: A multi-site study

PurposeTo explore professional experience and training of complementary therapists working within cancer care.MethodA Questionnaire survey of complementary therapists practising in three cancer care settings in North West England.ResultsRespondents (n = 51; n = 47 female; mean age 50 years, range 23–78 years) had varied career backgrounds; 24 were healthcare professionals who also practised as complementary therapists (nurse n = 19; physiotherapist n = 3; doctor n = 2) whilst 27 were complementary therapists with no prior healthcare background. Twenty-eight respondents reported working as therapists within a supportive and palliative care setting for over 6 years. Forty-seven respondents had undertaken healthcare-related continuing professional development in complementary therapies, although only just over half of the sample (n = 27) had received cancer-specific training. Cancer-related complementary therapy training related to the adaptation of therapies and comprised predominantly short courses. There was a lack of standardisation in the training received, nor was it clear how many courses were accredited.ConclusionFindings highlight the need for standardisation of training for complementary therapy provision in cancer care and statutory review of continuing professional development within this emerging field.     

Endoscopic management of biliary complications after adult living donor liver transplantation

OBJECTIVES: Biliary complications and their treatment in adult cadaveric liver transplantation (CLT) are well described. However, biliary complications and their management in living donor liver transplantation (LDLT) are not well characterized. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and management of biliary complications following LDLT. METHODS: We performed a retrospective cohort analysis of all LDLT recipients with duct-to-duct anastomoses (n = 15). Specific data included referral for ERCP, diagnosis, and therapy. Comparisons were made to a 260 CLT recipient cohort. RESULTS: Greater percentage of LDLT recipients underwent ERCP (73%) compared to CLT recipients (25%; p= 0.001). Biliary complications diagnosed by ERCP in LDLT recipients consisted of bile leaks and strictures, and were more frequent than in CLT recipients (leaks: 53%vs 12%; p= 0.001; strictures: 27%vs 5%; p= 0.01). Most leaks occurred at T-tube sites (LDLT: 87%; CLT: 65%). Diagnosis and therapy of leaks required a median of 2 ERCP procedures in both groups. Bile leaks were successfully treated endoscopically in 100% and 84% of LDLT and CLT recipients, respectively (p= 0.56). Most biliary strictures were anastomotic (LDLT: 100%; CLT: 64%). Strictures were diagnosed and treated with a median of 1.5 and 2 ERCP procedures in the LDLT and CLT groups, respectively. The duration of endoscopic therapy was a median of 10 and 14 wk, and success rates were 75% and 62% (p= 1.0) in LDLT and CLT groups, respectively. CONCLUSIONS: LDLT is associated with increased biliary complications as compared to CLT. ERCP is useful for diagnosis, can successfully treat most LDLT-related biliary complications, and should be attempted prior to more invasive interventions.     

Diphenhydramine versus nonsedating antihistamines for acute allergic reactions: a literature review.

First-generation antihistamines can have adverse effects on the central nervous system and thereby complicate discharge planning from the emergency department (ED). Newer antihistamines are potentially safer, causing less sedation with similar efficacy. The aim of this study was to review the literature to better define which antihistamines are good options for the treatment of acute allergic reactions. A Medline search was conducted to identify English language articles published between January 1975 and March 2006 on antihistamines, sedation, and acute allergic reactions. Bibliographies from included studies were further investigated. We focused on sedative potential, effect on cognitive function, efficacy, onset of clinical activity, and cost of antihistamines. Diphenhydramine impairs psychomotor performance and cognitive function. Loratadine and desloratadine are nonsedating but less efficacious than cetirizine or fexofenadine. The incidence of sedation with cetirizine is less than that of first-generation antihistamines but is greater than placebo. Cetirizine has the fastest onset of action among the newer antihistamines. Fexofenadine does not impair psychomotor or cognitive skills and shows no dose-related increase in sedation but has a slower onset of action than diphenhydramine and cetirizine. Newer antihistamines cost approximately $0.52-2.39 more per dose than diphenhydramine ($0.37). Newer antihistamines provide similar efficacy as first-generation antihistamines but with less sedation. We believe this benefit outweighs the small increase in cost and that newer antihistamines should be considered in the management of acute allergic reactions. Although comparative ED-based trials are not available, newer antihistamines are an option for management of acute allergic reactions when sedation is a concern.     

酶免疫法对沙眼衣原体诊断价值的Meta分析

目的系统评价酶免疫法诊断沙眼衣原体的准确性。方法计算机检索PubMed（1966～2011．12）、TheCochraneLibrary（2011．12）、EMbase（1974～2011．12）、CNKI（1994—2011．12）、VIP（1989—2011．12）和CBM（1978—2011．12）,并辅助手工检索和其他检索,收集EIA诊断沙眼衣原体的试验研究。由两名评价者依据QUADAS质量评价标准评价纳入研究的质量后,采用MetaAnalyst和RevMan5．0软件进行Meta分析。结果最终共纳入17个研究,9461例受试者。Meta分析结果显示：酶免疫法诊断沙眼衣原体的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和SROC曲线下面积分别为O．847[95％CI（O．571,O．995）]、0．964[95％CI（0．890,0．994）j、25．972195％CI（18．587,36．293）j、0．156[95％CI（0．114,0．212）j、228．875[95％CI（127．136,412．028）]和0．953。结论酶免疫法对诊断沙眼衣原体具有较高的敏感度和特异度,推荐酶免疫法用于沙眼衣原体的初筛及确诊高度疑似病例或症状体征不明显的患者。     

Structure and Crystallization of High-Calcium,CMAS Glass Ceramics Synthesized with a High Content of Slag

In this work, more than 70 wt % of ferromanganese slag (containing 40 wt % CaO) was used to synthesize high-calcium, CaO-MgO-Al₂O₃-SiO₂ (CMAS) glass ceramics. The effect of SiO₂/CaO on the structure, crystallization behavior and microstructure of high-calcium, CMAS, slag glass ceramics was studied by IR, NMR, DSC, XRD and SEM. The results showed that in the high-calcium, CMAS glass ceramics, the main existing forms of silicon–oxygen tetrahedra (Qⁿ) were Q⁰ and Q¹. With the increase in the SiO₂/CaO, Qⁿ changed from Q⁰ and Q¹ (main units) to Q¹ (main units) and Q², and then to Q¹ and Q² (main units). The polymerization degree of Qⁿ changed from low to high, making the glass more stable, which led to the increase in crystallization temperature and the decrease in crystallization kinetic constant (k) and frequency factor (υ). At the same time, the change in the Qⁿ structure resulted in a gradual change to the main crystal, from akermanite to diopside–wollastonite.     

荧光PCR熔解曲线法检测耐多药肺结核患者对左氧氟沙星和莫西沙星耐药性的效能研究

目的: 探究荧光PCR熔解曲线法快速检测耐多药肺结核患者对左氧氟沙星(Lfx)和莫西沙星(Mfx)耐药性的临床价值。 方法: 以2018年11月至2019年12月在黑龙江省传染病防治院采用BACTEC MGIT 960全自动分枝杆菌培养及比例法药物敏感性试验(简称“药敏试验”)确诊为耐多药肺结核的195例患者为研究对象,同时经荧光PCR熔解曲线法进行筛查,通过与药敏试验结果进行对比,分析荧光PCR熔解曲线法检测结核分枝杆菌对Lfx和Mfx耐药性的准确性。结果: 195株耐多药结核分枝杆菌经比例法药敏试验检测,对Lfx和Mfx耐药率分别为46.15%(90/195)和48.72%(95/195);以比例法药敏试验结果为标准,荧光PCR熔解曲线法检测结核分枝杆菌对Lfx和Mfx耐药性的敏感度分别为95.56%(86/90)和95.79%(91/95),特异度分别为73.33%(77/105)和77.00%(77/100),一致率分别为83.59%(163/195)和86.15%(168/195),Kappa值分别为0.83和0.85。 结论: 荧光PCR熔解曲线法检测耐多药肺结核患者对Lfx和Mfx耐药的结果与比例法药敏试验结果高度一致,适用于筛查耐多药肺结核患者对Lfx和Mfx的耐药性。     

安徽省宿州地区人群幽门螺杆菌感染率及CagA和VacA的表达

目的探讨安徽省宿州地区人群幽门螺杆菌(Hp)的感染率及毒力CagA和VacA表达与胃部疾病的相关性。方法回顾性分析宿州市立医院2017年1月至2020年7月体检中心及住院患者共66449例,其中体检中心碳呼气试验检测患者33634例,医院就诊患者碳呼气试验检测患者23116例,同期就诊患者血清学Hp抗体检测患者9647例(因消化系病就诊4336例),分别测定Hp感染率、各年龄段感染率及男女性别差异等情况,并探讨Hp毒力CagA和VacA表达与年龄、性别、胃部疾病相关性。结果宿州市健康体检人群Hp感染阳性率为38.9%,男女差异不显著(P=0.10);医院就诊成年患者中碳呼气试验与血清学Hp抗体分型检测的Hp感染阳性率分别为35.72%和36.40%,医院消化系疾病就诊患者Hp抗体分型阳性率为36.53%,差异无统计学意义。Hp感染率与年龄有明显的相关性,婴幼儿及青少年Hp感染率较低,20岁以后感染阳性率逐渐升高,50~59岁年龄段达到高峰;消化科就诊Hp阳性患者中Hp-Ⅰ型比例较低,约为17.97%,但Hp-Ⅰ型患者中合并慢性萎缩性胃炎、消化道溃疡和消化道肿瘤等胃部疾病比例较高。结论安徽省宿州地区患者Hp感染率低于全国平均值,Hp感染与年龄具有相关性,CagA和VacA阳性表达与年龄、胃部疾病具有一定相关性。     

CT测量肝外基质体积分数评估慢性乙型肝炎患者肝纤维化临床应用研究*

目的 应用多期动态CT检查测量肝外基质体积分数(fECV)评估慢性乙型肝炎(CHB)患者肝纤维化(HF)程度。 方法 2015年1月～2020年1月我院诊治的CHB患者138例,接受肝活检和CT增强扫描检查,并测定肝外基质体积分数(fECV),绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC),评估fECV诊断肝纤维化的效能。结果 在本组138例CHB患者中,经组织病理学诊断F0期14例,F1期28例,F2期45例,F3期36,F4期15例,即F0～1组42例,F2～4组96例,F3～4组51例;F0～1组肝实质CT强化值为(24.6±8.8)HU,与F2～4组的(25.2±5.6)HU比,差异无统计学意义(P>0.05),但主动脉CT强化值、fECV和红细胞压积分别为(44.8±9.4)HU、(27.8±4.5)%和(40.8±5.2)%,与F2～4组比,差异显著【分别为(40.6±7.2)HU、(37.5±4.8)%和(37.6±6.2)%,P<0.05】;fECV诊断CHB患者F2～4、F3～4和F4的截断点、AUC及95%CI、敏感度、特异度和准确度分别为30.2%、0.71(0.59～0.84)、65.5%、78.0%和74.5%;34.0%、0.76(0.62～0.89)、75.8%、74.2%和75.0%和36.8%、0.81(0.67～0.96)、90.5%、72.6%和86.8%。结论 采用多期动态CT增强扫描检查测量fECV可以帮助诊断CHB患者HF,值得临床进一步验证。     

严重脓毒症/脓毒症休克患者预后的高危因素

目的分析严重脓毒症/脓毒症休克患者的临床资料、致病菌分布及生化指标情况,探讨影响危重脓毒症患者预后的高危因素。 方法选择我院2004年12月至2014年12月收治的1 013例严重脓毒症/脓毒症休克患者作为研究对象,记录患者一般资料、生理学和慢性健康状况评分Ⅱ(APACHE Ⅱ)、感染部位及致病菌、生化指标等,根据预后情况分为存活组562例和死亡组451例,采用logistic回归分析影响患者预后的独立危险因素。 结果死亡组患者与存活组相比,年龄(59.62±11.21 vs. 46.32±9.46)岁、APACHE Ⅱ评分(25.26±8.75 vs. 13.67±6.57)、脓毒症休克所占比率(54.99% vs. 27.22%)均明显增加(P<0.05),存活组患者的血清白蛋白与血小板计数水平明显高于死亡组患者(P<0.05),降钙素原与血乳酸水平明显低于死亡组患者,差异均具有统计学意义(P<0.05)。2组患者呼吸系统感染比例(35.05% vs. 36.59%)与G^-菌感染比例(46.44% vs. 63.64%)最高,患者年龄、APACHEⅡ评分、血乳酸、降钙素原与危重脓毒症患者的预后呈负相关关系(r＝-0.359、-0.876、-0.582、-0.821,P<0.05),血清白蛋白与危重脓毒症患者的预后呈正相关关系(r＝0.637,P<0.05)。年龄+APACHEⅡ+血乳酸+血降钙素原+血清白蛋白联合检测对严重脓毒症/脓毒症休克患者死亡具有更高的预测价值(AUC＝0.981)。 结论年龄、APACHEⅡ评分、血乳酸、降钙素原及血清白蛋白是影响严重脓毒症/脓毒症休克患者预后的独立危险因素,对早期预测和有效改善严重脓毒症/脓毒症休克患者预后具有具有重要的临床。