放射治疗同期合并每周奥沙利铂治疗局部晚期鼻咽癌的随机Ⅱ期临床对照研究

目的：比较常规放射治疗与放射治疗同期合并每周奥沙利铂治疗局部晚期鼻咽癌的有效性．同时评价此联合治疗方式的安全性方法：从2001年1月至2002年2月，77例局部晚期鼻咽癌患者（Ⅲ，Ⅳa，92分期）被随机分八同期放化疗组（CCRT）和单纯放疗组（RT），其中同期放化疗组39例，单纯放疗组38例。两组患者均接受常规的放射治疗方法；同期放化疗组于放射治疗的第1天开始，静脉滴注奥沙利铂70mg／m^2，每周1次，连续6周结果：77例患者均可评价毒副反应及客观疗效：97％的患者完成了计划剂量的放射治疗及奥沙利铂治疗，少见严重的毒性反应，中位随访24个月后，CCRT组2年总的生存率（OS）为100％，RT组为76％（P=0．02），2年无转移生存率（MFS）CCRT组为91％，RT组为76％（P=0．04），2年无复发生存率（RFS）CCRT组为95％，RT组为83％（P=0．11）．CCRT组在0S，MFS方面均优于RT组，且差异有统计学意义，结论：以常规放疗同期联合每周奥沙利铂化疗的方式治疗局部晚期鼻咽癌，患者耐受性好，且可改善患者的生存．值得进一步研究．     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

临床药学人才培养实践

目前我国的临床药学工作已经开展了近20年,但由于各种原因,效果不是很理想.本文结合社会及学校的实际情况,就临床药学人才培养方面的教学计划制订、师资队伍建设、加强与政府部门合作等问题进行阐述.     

基于真实世界的内镜下金属钛夹联合艾普拉唑治疗非静脉曲张性上消化道出血的临床研究

目的 基于真实世界数据,通过倾向性评分法验证内镜下金属钛夹联合艾普拉唑在非静脉曲张性上消化道出血患者中的实际止血有效性和安全性。方法 选取非静脉曲张性上消化道出血患者200例,根据治疗方案将患者分为A组(内镜下金属钛夹+奥美拉唑)和B组(内镜下金属钛夹+艾普拉唑),各100例。采用倾向性评分控制混杂因素后,对比两组的止血有效率、再出血率、肠鸣音恢复正常时间、住院时间及不良反应发生率。结果 按照倾向性评分值及1∶1匹配原则进行配对,成功配对59对。A组和B组止血有效率分别为77.97%(46/59)、91.53%(54/59),B组显著高于A组,差异有统计学意义(P<0.05)。B组肠鸣音恢复正常时间及住院时间较A组短(均P<0.05)。两组再出血率及不良反应发生率差异均无统计学意义(均P>0.05)。结论 内镜下金属钛夹联合艾普拉唑治疗非静脉曲张性上消化道出血效果显著,能提高止血有效率,降低再出血率,且不良反应较少。     

利妥昔单抗联合化疗治疗HBsAg阳性的非霍奇金淋巴瘤患者的安全性分析

【目的】观察利妥昔单抗与化疗联合治疗 HBsAg阳性的非霍奇金淋巴瘤（NHL）患者的有效性及安全性。【方法】回顾性分析2009年2月至2013年12月广州中山大学附属肿瘤医院病理确诊的 N H L伴HBsAg阳性的149例住院患者的临床资料。149例中男92例,女57例,中位年龄44（19～74）岁。所有患者均接受利妥昔单抗联合化疗,所有患者每日口服拉米夫定100 mg或恩替卡韦500μg ,化疗后定期监测肝功能及HBV‐DNA。【结果】149例患者治疗后均无严重肝功能损伤。其中病毒高拷贝数35例（HBV DNA＞104 copy／mL ）,无一例病毒激活。化疗前肝功能异常33例,无肝功能损害加重现象。【结论】在有效抗病毒及激素减量的同时,密切监测乙肝DNA及肝功能,并严格遵循抗病毒药物的停药时间,HBsAg阳性淋巴瘤患者接受利妥昔单抗联合化疗安全有效。     

薄层CT诊断胸段食管癌淋巴结转移的病理对照研究

目的 通过对比薄层CT扫描与术后病理结果,评价薄层螺旋CT对食管癌淋巴结转移的诊断的临床价值.方法 对43例胸段食管癌患者术前1周内行薄层CT扫描,按照严格的淋巴结分组,将CT对各组淋巴结转移的诊断与病理结果对照,计算薄层CT诊断的敏感性、特异性及准确率.结果 薄层CT扫描诊断食管癌淋巴结转移的敏感性、特异性及准确性分别为50%、91.3%和72.1%.对各分组淋巴结诊断的敏感性、特异性及准确率分别为30.3%、98.8%和95%.结论 薄层CT扫描对食管癌淋巴结转移诊断有一定的临床参考价值,但是敏感性较低.     

促智药普拉西坦的合成

氯乙酰氯与N,N-二异丙基乙二胺在碱性条件下进行酰化,所得中间体与2-吡咯烷酮烷基化,得普拉西坦。     

CT增强薄层扫描异形血管强化征对小肺癌诊断的价值

目的：探讨ＣＴ增强薄层扫描图像上显示的异形血管强化征对小肺癌诊断和鉴别诊断的临床价值。方法：用ＣＴ增强薄层扫描和常规ＣＴ增强扫描对比研究３７例直径＜３ｃｍ的小肺癌,并同期研究１８例需鉴别的肺炎性假瘤和肺结核球作对照,分析这３种病变的ＣＴ增强薄层扫描征象特点。结果：①ＣＴ增强薄层扫描能清晰显示小肺癌病灶内肿瘤血管的特征性表现一异形血管强化征,而常规ＣＴ扫描难以显示该征象;②肺炎性假瘤和肺结核球病灶内一般不出现该种病理血管征象。结论：异形血管强化征对小肺癌的诊断和鉴别诊断具有特殊意义。     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.