血清胱抑素C测定的临床意义及方法学研究进展

<正>胱抑素C是一种低分子量蛋白质,Grubb等[1]首先报道其血清浓度与gFR密切相关,可作为肾小球滤过功能指标[1]。近年来有关胱抑素C测定的临床应用及方法报道日渐增多,本文就胱抑素C的结构与功能,作为反映肾小球滤过功能的内源性标志物及方法学进展作一综述。1胱抑素C的结构与功能胱抑素C,以前也被称为γ微量蛋白及γ后球蛋白,是一种低分子量、碱性非糖化蛋白质,分子量为13 kDa,由120个氨基酸残基组成,是一种分泌性蛋白质。细胞先合成一个带     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

前列腺癌大分割调强放疗副反应初步分析

Objective To analyze the acute and late toxicities in patients with prostate cancer trea-ted with hypofractionated intensity-modulated radiotherapy (IMRT). Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target vol-ume (CTV) was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and semi-hal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 - 2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5-75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 a-cute gastro-intestinal (GI) toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3%, 35.1% and 2.7% of the patients, respectively. The rectal V50>27% and V55>20% were highly significantly associat-ed with grade ≥1 acute GI toxicity. Grade 1,2 and 3 acute genitourinary (GU) toxicity occurred in 68%, 0% and 3% of the patients, respectively. The bladder V50> 10% was significantly associated with grade ≥1 acute GU toxicity. The incidence of late GI toxicity was low. No grade ≥3 late GI toxicity was observed. The incidence of late grade 1 and 2 GI toxicity was 24% and 5%, respectively. The rectal V65> 10% was highly significantly associated with grade ≥1 late GI toxicity. No late grade 4 GU toxicity was observed. The incidence of grade 1, 2 and 3 late GU toxicity was 49%, 11% and 3%, respectively. Grade ≥2 late GU toxicity was correlated with V40, V50 and mean dose of the bladder. Conclusions Acute and late toxicity of hypofractionated IMRT is acceptable in patients with prostate cancer.     

人力资源管理在医院文化建设中的作用

<正> 先进的医院文化是保证医院持续发展的重要因素,是立院之本,拓展之源。如何积极推动医院文化的创造和发展是我们应深入思考的重要课题。以人为本,以病人为中心的观念是医院文化的重要指导思想。人力资源管理与医院文化的载体都是人,人力资源管理过程中的理念、制度、手段、方法等长期渗透性地影响着医院文化的形成,通过人力资源的战略规划、管理制度、政策、培训等手段逐步丰富着医院文化的内涵,使之更加多元化,优秀的医院文化能增强组织的凝聚力,消除组织中的消极因素,保持组织持续旺盛的生命力,人力资源管理与医院文化之间可以相辅相成,并对促进医院文化建设发挥独特的作用。1 基础作用在医院高层管理活动中,最重要的是对人、财、医疗市场的战略性预测、规划和管理。随着中国加入WTO,人才是第一资源的观念必须体现于管理战略中。曾有学者说过,管理     

去离子水污染导致生化分析仪单一检测项目失控故障一例

本文对去离子水被污染而导致的甘油三酯单一检测项目失控的原因进行了分析.     

2005-2016年某部新兵MOR/M-AMP检测假阳性调查分析及规避措施研究

目的 调查分析2005-2016年某部队新兵尿液MOR/M-AMP(吗啡/甲基安非他明)检测假阳性现状、原因及规避措施,做出正确体检结论.方法 按规定对某部15928名新兵进行尿液MOR/M-AMP检测,对初筛阳性的新兵进行二次复检及自制问卷调查,对二次复检阳性的新兵采用随机抽查.结果 2005-2016年15928名新兵中共发现MOR/M-AMP假阳性150例,假阳性率0.94%,调查分析药物干扰占70.7%,食品干扰占11.3%,药物+食品干扰占6.7%,饮料干扰占8.0%,不明原因占3.3%;二次复检阳性标本15例,随机抽检2次均为阴性.结论 部分药物和饮食的干扰是导致MOR/M-AMP的检测出现假阳性的重要因素,只有通过问卷调查、复检、随机抽检,并结合生化、免疫学指标等综合判断,才能作出正确的体检结论.     

膀胱癌放疗疗效分析

目的 回顾分析局限于盆腔的肌壁浸润性膀胱癌放疗疗效及影响因素、膀胱功能保存情况及不良反应。 方法 自1999-2016年在我院接受放疗的肌壁浸润性膀胱癌患者 45例(移行细胞癌 41例)。全膀胱 ±盆腔淋巴引流区 ±局部补量放疗,膀胱中位剂量45 Gy,肿瘤局部中位剂量56 Gy,24例接受了同步化疗,14例接受了新辅助化疗,29例放疗前接受过经尿道膀胱肿瘤电切术。 结果 中位随访28个月(4~101月),3年总生存率为51%,同步化放疗、单纯放疗 3年总生存率分别为64%、30%(P=0.001),有无新辅助化疗的 3年总生存率分别为59%和47%(P=0.540),放疗前有无局部电切的 3年总生存率分别为58%和43%(P=0.160),有无复发的 3年生存率分别为20%和79%(P=0.001)。局部复发 9例,远处转移 14例,放疗后≥3个月肠道损伤发生率2级 2例,泌尿道损伤发生率2级 4例、3级 2例。除 7例因膀胱肿瘤未控或放疗损伤严重影响患者膀胱功能外,其余均保持了基本正常膀胱功能。 结论 盆腔局限性肌壁浸润性膀胱癌同步化放疗可取得优于单纯放疗疗效,膀胱癌放疗后大部分患者可以保存正常膀胱功能,不良反应可接受。     

益生菌对病毒性腹泻患者菌群结构及黏膜屏障功能变化的影响

目的分析益生菌对病毒性腹泻患者肠道菌群结构和肠道黏膜屏障功能的影响。方法选择2015年5月至2016年5月在台州市中心医院诊断为病毒性腹泻的患者80例,根据患者是否使用益生菌治疗分为试验组和对照组,试验组在病毒性常规治疗的基础上给予益生菌治疗,对照组患者给予病毒性腹泻的常规治疗,并以同期20例健康体检者作为健康对照组。结果治疗前试验组和对照组患者大肠埃希菌、双歧杆菌、乳酸杆菌和肠球菌含量对比差异无统计学意义(t=1.104、0.232、0.893、0.428,P0.05),治疗后试验组患者双歧杆菌和乳酸杆菌含量分别为(7.42±1.56)lgCFU/g和(8.36±1.58)lgCFU/g,高于治疗前(t=9.972、8.181,P0.05)和对照组治疗后(t=2.819、6.492,P0.05),而大肠埃希菌和肠球菌含量低于治疗前(t=6.942、4.335,P0.05)和对照组治疗后(t=2.992、2.408,P0.05),治疗前试验组和对照组患者血清LPS、DAO、D-乳糖含量比较差异有统计学意义(t=0.586、0.116、0.351,P0.05),治疗后试验组患者LPS、DAO、D-乳糖水平分别为(20.54±6.37)pg/ml、(4.38±1.20)U/ml和(6.36±1.64)mg/L,低于治疗前(t=11.809、6.356、4.853,P0.05)和对照组治疗后(t=5.587、4.874、2.427,P0.05),治疗后试验组有效24例、显效14例、无效2例,有效率为95.00%,与对照组相比差异有统计学意义(χ2=4.112,P0.05)。结论肠道益生菌有助于改善病毒性腹泻患者肠道菌群和肠道粘膜功能,值得临床推广运用。     

骨髓涂片免疫组化在形态学难以诊断的急性白血病中的临床研究

目的 分析骨髓涂片免疫组化在急性白血病中的诊断价值.方法 采用骨髓涂片免疫组化,对40例形态学难以诊断的急性白血病进行免疫表型分析,与单独用形态学诊断的结果比对,对两种结果进行一致性检验有差异的与流式细胞仪分型对照.结果 骨髓涂片免疫组化的结果和FCM有较好的一致性,采用免疫表型分析的结果为临床诊断和预后提供了更有力的帮助,对M0和MAL的诊断有决定性的意义,较形态学诊断的结果更好.结论 骨髓涂片免疫组化在形态学难以诊断的急性白血病分型中有较好的临床价值,能更好地进一步分型.