Technetium-99m tetrofosmin myocardial perfusion scan: comparison of 1-day and 2-day protocols

Nineteen patients with angina were recruited in this study for comparison of two 1-day protocols (stress-4 h rest and rest-4-h stress) and a 2-day protocol of technetium-99m tetrofosmin single-photon emission tomography (SPET). All of them underwent coronary angiography before or after the study. Exercise stress-rest study and rest-stress study were performed on two consecutive days. Delayed imaging was performed before the rest injection on the 2nd day. The stress study on the 1 st day and rest study on the 2nd day were considered as a 2-day protocol. The 1-day stress-rest protocol had a sensitivity of 100% (18/18) and an accuracy of 100% (19/19) in diagnosing ischaemic heart disease. The 1-day rest-stress protocol had a sensitivity of 94.4% (17/18) and an accuracy of 94.7% (18/19). These differences were not statistically significant (P=0.5 for sensitivity and accuracy). There was also no statistically significant difference between the two protocols in the diagnosis of ischaemic heart disease in individual artery territories. For the left descending artery, sensitivity was 88.2% (15/17) vs 76.5% (13/17) (P=0.48) for the stress-rest and rest-stress studies respectively. For the left circumflex artery, sensitivity was 90% (9/10) vs 80% (8/10) (P=1) and specificity was 66.7% (6/9) vs 77.8% (7/9) (P=1) respectively. For the right coronary artery, the sensitivity was 100% (16/16) vs 94% (15/16) (P=1) respectively, while the specificity was 33.3% (1/3) in both studies. Three hundred and forty-two myocardial segments were analysed. The stress-rest and 2-day protocols showed no statistically significant difference in the overall identification of segments with reversible ischaemia (48/141 segments vs 48/141 segments) or in respect of individual artery territories. There was also no significant difference in the identification of reversible ischaemic segments between the rest-stress and 2-day protocols (48/141 segments vs 34/135 segments,P=0.14). Abdominal activity was seen in 36 studies and interpretation was affected in five of them. Five patients with 24-h delayed images were evaluated and 24 segments with washout were identified. It is concluded that^99mTc-tetrofosmin is a valuable new tracer in the investigation of ischaemic heart disease. The 1-day stress-rest protocol is as good as the 1-day rest-stress protocol in diagnosing coronary heart disease. The 1-day protocols and the 2-day protocol display no difference in identifying segments with reversible ischaemia.     

抗肿瘤药物和免疫抑制剂相关的乙型肝炎病毒再激活

肿瘤患者接受抗肿瘤联合化疗方案和免疫抑制剂治疗时可导致潜伏或静止状态的乙型肝炎病毒（HBV）发生再激活,出现肝炎症状,伴随HBV DNA水平高于基线10倍以上或绝对值大于20 000 IU/ml。HBV再激活可致4.5%～8.1%的患者死于肝病,23.3%～71.0%的患者中断或改变肿瘤化疗方案。肿瘤患者化疗后HBV 再激活的机制可能是抗肿瘤药物及免疫抑制剂抑制了机体对HBV起免疫作用的T细胞和自然杀伤细胞,导致HBV大量复制。肿瘤患者HBV再激活与患者的HBV感染状况、肿瘤类型和化疗方案有关。拉米夫定等核苷（酸）类药物可有效预防和治疗肿瘤患者的HBV再激活。肿瘤患者接受化疗前应常规进行HBV筛查,对高风险患者预防性使用核苷（酸）类药物可明显降低HBV再激活的发生率和严重程度。     

乳腺癌化疗患者症状测评量表的编制与信效度检验

目的 发展适用于乳腺癌化疗患者的症状测评量表.方法 在文献回顾及现有的癌症患者多症状测评工具基础上拟定乳腺癌化疗患者症状测评量表条目池;通过专家评定,形成乳腺癌化疗患者症状测评量表.采用症状测评量表及简明健康调查量表(the Medical Outcomes Study 36-item Short-Form Health Survey,SF-36)对194例治疗前、中、后的乳腺癌患者进行测评,并在1周后对30例治疗中患者进行二次测评.结果 经2轮专家评定后,形成包含26个条目的量表,各条目内容效度指数数值范围为0.800～1.000,量表全体一致率为0.885,均值量表水平内容效度指数为0.977;治疗前、中、后乳腺癌患者之间的症状得分的差异具有统计学意义(P＜0.01),治疗中患者得分高于治疗后患者(P＜0.01),治疗后患者得分高于治疗前患者(P＜0.01);治疗中患者症状得分与SF-36各维度得分均呈负相关(P＜0.01);症状测评量表Cronbach's α系数为0.818,重测信度为0.745.结论 所研制的乳腺癌化疗患者症状测评量表具有较好的效度和信度,适用于在临床中测评化疗期乳腺癌患者的症状.     

参麦联合CAG方案治疗老年急性髓系白血病的疗效观察

目的观察参麦注射液联合CAG方案治疗老年急性髓系白血病(AML)的临床疗效及不良反应。方法 42例初治老年AML患者随机分为两组。联合治疗组(20例)以参麦注射液联合CAG方案治疗;对照组(22例)则仅采用CAG方案治疗。结果两组治疗总有效率分别为65.0%和59.1%,差异无统计学意义(P>0.05);两组患者治疗后红细胞、白细胞、血红蛋白和血小板等均明显下降(P<0.05),而对照组治疗后下降更为明显(P<0.05);两组不良反应发生率分别为45.0%和63.6%,两组比较差异有统计学意义(P<0.05)。结论参麦注射液联合CAG方案治疗老年急性髓系白血病具有缓解骨髓抑制,减轻不良反应的作用,值得在临床推广。     

Has the time to reinstate elective orthopedic procedures come?

BackgroundThe coronavirus pandemic changed how we manage and operate patients in orthopaedic practice. Although elective orthopaedic procedures were halted to prevent spread of the disease as well as sustain supplies of essential protective equipment and healthcare workers, trauma services were continued. We studied the orthopaedic trauma cases operated over 6 months of the pandemic, and discuss the protocols used to minimize disease spread.MethodsData was collected for all orthopaedic emergency cases operated at our centre from 1 st March – 10 th August 2020. During this time specific protocols were used for first aid, pre-operative care, inside the operation theatre, post-operative stay as well as for follow ups.ResultsA total of 851 patients were operated. A sharp decline in surgeries was seen during the lockdown. Average stay in the hospital was 4 days. Only 44% of the patients came for follow-up visits. None of the contacted patients or their relatives developed symptoms or tested positive for COVID after discharge.ConclusionMultiple waves and various mutant strains of COVID-19 have made this pandemic longer than expected. Elective orthopaedic cases cannot be ignored for forever, as it leads to poor quality of life and an increasing burden of such patients. We suggest, that using the protocols used at our centre, we have successfully operated on cases without risking spread of the virus. Thus, we believe it’s time to reinstate elective orthopaedic procedures, in a phased manner.     

Efficacy and safety of Xinglouchengqi decoction for acute ischemic stroke with constipation: study protocol for a randomized controlled trial

Objective

To investigate the efficacy and safety of Xinglouchengqi (XLCQ) decoction in treatment of acute ischemic stroke with constipation.

胃食管反流病维持治疗及有关影响因素的评估

评估胃管反反流病（GERD）维持治疗的疗效及影响因素。方法：通过症状评分,内镜检查、食管压力测定和24h食管pH监测等方法。调查73例GERD患者对维持治疗的反应并分析有关影响因素。结果：间断治疗有效组（间断组）患者40例,维持治疗有效组（维持组）30例,治疗无效组（无效组）3例,间断且患者病程较维持短（P＜0．001）,下食管括约肌压力（LESP）和上食管括约肌压力（UESP）均比维持组高（P＜0．05）,食管体部蠕动收缩波幅高于维持,量无显著差异,间断组患者在内镜下反流性食管炎（RE）以0级和I级为主,而维持组以III级为主（P＜0．01,症状评分和24h食管pH监测结果是间断组和维持组患者无显著差异。结论：有些GERD患者的远期治疗可采取间断维持的方式,RE的严重程度和LESP减低是决定是否需长期维治疗的重要预测因素。     

老年结直肠癌患者术后PICC置管化疗的临床观察及护理

目的探讨和观察老年结直肠癌患者术后使用PICC置管化疗的临床效果并总结其护理方法。 方法选取我院全军普通外科中心2012年3月~?2014年3月收治的老年结直肠癌化疗患者120例为研究对象,并随机分为观察组和对照组各60例,观察组患者使用PICC置管化疗,对照组采用浅表静脉留置针法化疗,化疗期间对PICC置管患者进行全面护理。比较两组患者静脉置管期间出现静脉炎、药物外渗、感染等并发症的发生率以及感觉舒适度。 结果观察组患者静脉炎（X²=9.22,P<0.01）、药物外渗（X²=8.57,P<0.05）以及感染（X²=6.98,P<0.05）等并发症的发生率均明显低于对照组,两组患者舒适度对比,观察组明显高于对照组（X²=8.01,P<0.05）。 结论对老年结直肠癌患者采用PICC置管化疗可明显降低静脉炎、药物外渗、感染等并发症的发生率并能提高患者舒适度,值得在临床上推广使用。