酸枣仁提取物急性毒性实验研究

目的 观察酸枣仁醇提取物的急性毒性反应.方法 ①小鼠尾静脉注射不同剂量的酸枣仁醇提取物,连续观察14 d,记录小鼠的急性毒性反应,并计算LD50及LD50 95%可信限;②小鼠灌胃给药,测定一次给予酸枣仁醇提取物的安全剂量.结果 ①静脉注射酸枣仁醇提取物后,部分小鼠出现中毒反应并死亡,测得LD50为27.5 g·kg-1,LD50 95%可信限为25.1～30.1 g·kg-1,死亡动物尸检,其主要脏器未见病理改变.14 d后存活小鼠体重平均增加20.4%,略高于生理盐水组(18.2%).②小鼠灌胃给药(340 g·kg-1,相当于成人一次用量的326倍)后,连续观察14 d,小鼠全部存活,无明显毒性反应,小鼠体重平均增长17.2%.结论 酸枣仁醇提取物毒性很低,临床给药安全可靠.     

物理楔形野两种处方剂量计算方法的对比实验研究

目的比较物理楔形野两种不同方法计算处方剂量与实测值的偏差,为物理楔形野处方剂量计算提供参考。方法在SIEMENS Primus-M型医用加速器产生的6MV X线和15MV X线条件下,用SCAN-DITRONIX RFA300三维水箱采集处方剂量计算所需的各种物理数据,2种方法分别计算处方剂量,与NEFarmer2670剂量仪实测值进行比较。结果传统方法计算值与实测值偏差较大,在6MV X线、45°楔形板、25cm×25cm射野、20cm深度条件下偏差达9.1%,而改进方法计算值与实测值偏差不超过1.2%。结论物理楔形野处方剂量计算的传统方法在某些条件下存有较大误差,建议完善物理楔形野处方剂量计算所需相关物理数据,采用改进方法进行计算。     

两种剂量奥曲肽治疗食管及胃曲张静脉出血效果比较

①目的　比较两种剂量奥曲肽治疗食管、胃曲张静脉出血的临床效果。②方法　将 88例食管、胃曲张静脉出血病人随机分为奥曲肽 5 0 μg/h和 2 5 μg/h剂量组 ,观察平均止血时间、止血率、再出血率和不良反应。 ③结果　 5 0 μg/h组平均止血时间明显短于 2 5 μg/h组 (t=2 .2 4 ,P <0 .0 5 ) ,总止血率明显高于 2 5 μg/h组 (χ2 =5 .36 0 ,P <0 .0 5 ) ,再出血率较 2 5 μg/h组低 (χ2 =7.990 ,P <0 .0 5 )。两组均有 1例病人出现恶心。④结论　奥曲肽 5 0 μg/h剂量治疗食管、胃曲张静脉出血的效果优于 2 5 μg/h剂量     

Dose finding with drug combinations in cancer phase I clinical trials using conditional escalation with overdose control

We present a Bayesian adaptive design for dose finding of a combination of two drugs in cancer phase I clinical trials. The goal is to estimate the maximum tolerated dose (MTD) as a curve in the two‐dimensional Cartesian plane. We use a logistic model to describe the relationship between the doses of the two agents and the probability of dose limiting toxicity. The model is re‐parameterized in terms of parameters clinicians can easily interpret. Trial design proceeds using univariate escalation with overdose control, where at each stage of the trial, we seek a dose of one agent using the current posterior distribution of the MTD of this agent given the current dose of the other agent. At the end of the trial, an estimate of the MTD curve is proposed as a function of Bayes estimates of the model parameters. We evaluate design operating characteristics in terms of safety of the trial design and percent of dose recommendation at dose combination neighborhoods around the true MTD curve. We also examine the performance of the approach under model misspecifications for the true dose–toxicity relationship. Copyright © 2014 John Wiley & Sons, Ltd.     

Common and rare side-effects of low-dose thalidomide in multiple myeloma: focus on the dose-minimizing peripheral neuropathy

OBJECTIVES: Thalidomide has demonstrated a remarkable efficacy in the treatment of multiple myeloma but its use may cause several toxicities. We have investigated the common and rare side-effects, especially analysing peripheral neuropathy, in order to optimise the thalidomide dose for minimizing this harmful side-effect. METHODS: Fifty-nine patients were treated with thalidomide alone or combined with oral melphalan. The median age was 69 yr. The initial dose of thalidomide was 100 mg/day increasing weekly by 100 mg increments until a maximum dose of 400 mg was attained. Melphalan was administered at a dose of 0.20 mg/kg/d for 4 d every 28 d. RESULTS AND CONCLUSIONS: Nearly one-fourth of patients discontinued thalidomide because of toxicity. Constipation (71%), somnolence (36%) and fatigue (20%) were the most common side-effects and they were not dose dependent. Peripheral neuropathy occurred in 39% of patients and a thalidomide median daily dose of more than 150 mg was significantly associated with higher frequency and actuarial risk of peripheral neuropathy without improving the response rate. Deep venous thrombosis was observed in 7% of patients and other side-effects were rare. In patients with advanced multiple myeloma we found that a thalidomide daily dose of 150 mg minimizes peripheral neuropathy without jeopardizing response and survival.     

纤维支气管镜辅助治疗重症呼吸机相关性肺炎的疗效

目的:分析纤维支气管镜辅助治疗重症呼吸机相关性肺炎的疗效。方法:选取2017年6月~2019年4月本院收治的重症呼吸机相关性肺炎患者80例为研究对象,将其按照随机方式平均分为两组,对照组40例患者采用常规治疗,观察组40例患者在常规治疗基础上采用纤维支气管镜辅助治疗,观察两组患者治疗前后的IL-6和CRP水平以及治疗有效率。结果:治疗前两组患者的IL-6和CRP水平差异无统计学意义(P>0.05),治疗后观察组患者的IL-6和CRP水平分别为(101.21±10.88)pg/mL和(35.82±5.43)mg/L,均低于对照组患者的(116.78±10.35)pg/mL和(43.31±5.76)mg/L,差异有统计学意义(P<0.05)。观察组患者中治疗显效患者25例,治疗有效患者13例,总治疗有效率为95.00%;对照组患者中治疗显效患者18例,治疗有效患者13例,总治疗有效率为77.50%,组间差异有统计学意义(P<0.05)。结论:对于重症呼吸机相关性肺炎患者采用纤维支气管镜辅助治疗有助于降低患者的炎症因子水平,提高治疗有效率。     

卡培他滨联合周剂量艾恒治疗晚期大肠癌18例

目的　观察卡培他滨联合周剂量艾恒治疗晚期大肠癌的疗效和毒性。方法　卡培他滨 12 5 0mg/ (m2 ·d)分两次口服 ,第 1～14天 ,艾恒 60mg/m2 静脉滴入第 1,8,15天。结果　 18例中CR 2例 ,PR 7例 ,总有效率 (CR PR)为 5 0 %,主要毒副反应为恶心呕吐 ,感觉性神经毒性 ,药物热 ,口腔黏膜炎 ,腹泻 ,手足综合症。结论　卡培他滨联合艾恒方案对晚期大肠癌有效且安全     

流动便携式重症监护病房急救车的研制及其在灾害事故急救中的应用

目的 为提高突发灾害事故伤员现场救护的水平,研制了流动便携式重症监护病房(ICU)急救车,评价其价值.方法 回顾与分析国内外有关突发灾害、载人航天航天员意外伤害及局部战争造成伤害的资料并分析其原因,结合多次参加医疗紧急救治的体会,从车辆设备配置、技术功能等方面研制了流动便携式ICU急救车.结果 流动便携式ICU急救车上增加了救命性的手术功能及可移动的自动心肺复苏功能,即使在城市交通阻塞的情况下,伤病员也能在车上得到有效的救治.在突发灾害事故中得到了应用,能达到快速反应、有效救护的目的,能使危重病现场救治抢救成功率更高.结论 流动便携式ICU急救车能够降低突发灾害及局部战争中伤员的伤残率和病死率.     

Cerebral CT angiography with iterative reconstruction at 70 kVp and 30 mL iodinated contrast agent: Initial experience

ObjectivesTo evaluate the radiation dose and image quality of cerebral CT angiography (CTA) at 70 kVp with 30 mL iodinated contrast agent.MethodsOne hundred patients were prospectively classified into two groups: Group A (n = 50), 120 kVp cerebral CTA with 60 mL iodinated contrast agent reconstructed by filtered back projection (FBP) and Group B (n = 50), 70 kVp with 30 mL iodinated contrast agent reconstructed by sinogram-affirmed iterative reconstruction (SAFIRE). CT values, noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the internal carotid artery (ICA) and middle cerebral artery (MCA) were measured. Subjective image quality was evaluated. Effective dose (ED) was calculated.ResultsThe mean CT values of the ICA and MCA of Group B were higher than those of Group A (all P < 0.001). The mean noise of Group A was lower than that of Group B (P < 0.001). SNR_ICA, SNR_MCA and CNR_ICA, CNR_MCA of Group A were higher than Group B (all P < 0.001). There was no difference in vessel sharpness, noise, and overall quality between the two groups (all P > 0.05). ED of Group B (0.2 ± 0.0 mSv) was lower than Group A (1.3 ± 0.1 mSv) (p < 0.001).ConclusionCerebral CTA with iterative reconstruction at 70 kVp and 30 mL iodinated contrast agent is feasible, allowing for substantial dose reduction compared with conventional cerebral CTA protocol.     

心血管病介入诊疗程序中第一术者有效剂量估算方法的比较研究

目的 通过模拟实验测量,比较国际辐射防护委员会（ICRP）139号报告推荐的4种单双剂量计算法对估算心血管介入诊疗程序中第一术者有效剂量之间的差异,以探讨这4种算法对介入诊疗场景的适用性。方法 模拟第一术者的男性躯干模体穿戴铅衣和铅围脖,在其体内布放热释光探测器,在其铅衣内外布放热释光个人剂量计,模拟心血管病介入诊疗场景,通过模拟测量得到的器官剂量计算第一术者的有效剂量,与通过个人剂量计及4种单双剂量计算法得到的结果进行比较。结果 在本实验条件下,由模拟测量计算得到的有效剂量为0.581 mSv;而用Swiss ordinance法、McEwan法、Von Boetticher法与Martin-Magee法估算得到的有效剂量分别为0.667、0.484、0.485和0.726 mSv,与模拟测量得到的有效剂量的相对偏差分别为14.8%、-16.7%、-16.5%和24.9%。结论 4种计算方法得到第一术者有效剂量与模拟测量结果均有较大的差异;从辐射防护观点出发,推荐使用Swiss ordinance法开展心血管病介入诊疗程序中第一术者的个人剂量监测。