三维适形放射治疗联合紫杉醇每周方案化学治疗中晚期宫颈癌疗效观察

目的观察三维适形放射治疗联合紫杉醇每周方案化学治疗不能手术的中晚期宫颈癌临床疗效和副作用。方法选择临床确诊为ⅡB~ⅢB期中晚期宫颈癌患者100例,年龄30~81岁,平均年龄45.00岁。对照组40例进行全盆腔前后两野对穿照射。治疗组60例采用真空垫固定、CT模拟机定位,勾画肿瘤靶区(GTV)、临床靶区(CTV)和计划靶区(PTV),进行三维适形放射治疗,所有患者放射治疗期间同步紫杉醇单药治疗,药物剂量75mg/m2,每周1次。观察同步放化疗的近远期疗效和副作用。结果 60例治疗组宫颈癌患者总有效率为85.00%(51/60),与对照组有效率57.50%(23/40)比较,差异有显著统计学意义(P0.05)。治疗组患者1、2、3年生存率分别为100.00%(60/60)、100.00%(60/60)、96.67%(58/60),对照组患者1、2、3年生存率分别为100.00%(40/40)、90.00%(36/40)和85.00%(34/40)。统计学分析发现,二者差异无统计学意义(P0.05)。治疗组中晚期放射治疗反应主要为Ⅰ~Ⅱ级,无4级不良反应发生。结论与盆腔普通放射治疗相比较,三维适形放射治疗联合紫杉醇每周方案化学治疗中晚期宫颈癌有较高的有效率,不良反应轻,患者易耐受,且操作易行。     

肺结核并发真菌感染危险因素及药物敏感性情况分析

目的探讨肺结核并发真菌感染的危险因素及药物敏感性(药敏)情况,为该病的预防、诊断和治疗提供依据。方法选取2011年5月—2012年5月在本院住院治疗的肺结核患者179例,按真菌感染情况分为非真菌感染组(108例)和真菌感染组(71例)。分析2组的临床特点,采用酵母菌显色培养基判断菌种,应用ROSCO纸片扩散法进行药敏分析。结果肺结核并发真菌感染的危险因素为继发性肺结核、复治、痰涂片抗酸染色阴性、长期使用糖皮质激素和广谱抗生素以及合并基础疾病(OR均≥2)。导致肺部真菌感染的主要真菌为假丝酵母菌(87.32%),其中白色假丝酵母菌耐药率低,只有7株对5-氟胞嘧啶耐药;10株热带假丝酵母菌中各有2株对益康唑和两性霉素B耐药;光滑假丝酵母菌只对伊曲康唑敏感。结论①对继发性肺结核、复治、长期使用糖皮质激素和广谱抗生素以及合并基础疾病的肺结核患者要注意肺部真菌感染的预防治疗;②痰涂片抗酸染色阴性可作为早期诊断敏感指标;③对已感染真菌的肺结核患者要行药敏试验,选取最佳抗真菌药物,对光滑假丝酵母菌感染者应提高警惕。     

姜黄素烟酸酯对辐射诱导的巨噬细胞IL-1β、IL-18表达的影响*

目的 研究姜黄素烟酸酯对巨噬细胞受射线照射产生的炎症因子白细胞介素-1β（IL-1β）、白细胞介素-18（IL-18）的影响。方法 将巨噬细胞分为空白对照组、单纯照射组及不同浓度姜黄素烟酸酯组（1.0、3.0和9.0?μmol/L）,应用Western blotting检测IL-1β、IL-18的表达。结果 1.0、3.0和9.0?μmol/L的姜黄素烟酸酯组与单纯照射组比较,差异有统计学意义（P?<0.05）,各浓度姜黄素烟酸酯组IL-1β、IL-18的蛋白表达量较单纯照射组下降;单纯照射组IL-1β、IL-18的蛋白表达量较对照组升高（P?<0.05）。结论 姜黄素烟酸酯可抑制辐射诱导巨噬细内炎症因子IL-1β、IL-18的产生。     

针刺加红外线照射五脏调神穴联合药物治疗不寐40例

目的:观察针刺加红外线照射五脏调神穴联合药物治疗不寐的临床疗效。方法:纳入80例不寐患者,按照随机数字表法分为观察组与对照组各40例,对照组采取地西泮和谷维素口服治疗,观察组在对照组基础上加用针刺合红外线照射五脏调神穴治疗,10 d为1个疗程。3个疗程后,对比两组患者匹兹堡睡眠质量指数(PSQI)得分、临床疗效及脑电图主要睡眠参数变化。结果:两组治疗后PSQI得分得到优化,观察组得分优于对照组(P<0.05);两组治疗后睡眠参数得到优化,观察组优于对照组(P<0.05);观察组痊愈率高于对照组(P<0.05);两组皆无明显不良反应。结论:针刺加红外线照射五脏调神穴联合药物疗法治疗不寐具有较好效果,能够改善患者睡眠质量、脑电图参数,且不良反应较少。     

Radiation Dose Benchmarks During Cardiac Catheterization for Congenital Heart Disease in the United States

ObjectivesThe aim of this study was to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease.BackgroundThere is a paucity of published literature with regard to radiation dose levels during catheterization for congenital heart disease. Obtaining benchmark radiation data is essential for assessing the impact of quality improvement initiatives for radiation safety.MethodsData were obtained retrospectively from 7 laboratories participating in the Congenital Cardiac Catheterization Project on Outcomes collaborative. Total air kerma, dose area product, and total fluoroscopy time were obtained for the following procedures: 1) patent ductus arteriosus closure; 2) atrial septal defect closure; 3) pulmonary valvuloplasty; 4) aortic valvuloplasty; 5) treatment of coarctation of aorta; and 6) transcatheter pulmonary valve placement.ResultsBetween January 2009 and July 2013, 2,713 cases were identified. Radiation dose benchmarks are presented including median, 75th percentile, and 95th percentile. Radiation doses varied widely between age groups and procedure types. Radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. Total fluoroscopy time was a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product.ConclusionsThis study presents age-stratified radiation dose values for 6 common congenital heart interventional catheterization procedures. Fluoroscopy time alone is not an adequate measure for monitoring radiation exposure. These values will be used as baseline for measuring the effectiveness of future quality improvement activities by the Congenital Cardiac Catheterization Project on Outcomes collaborative.     

晚期妊娠孕妇B群链球菌定植状况及妊娠结局分析

目的探讨妊娠晚期孕妇B群链球菌（GBS）定植情况、抗菌药物敏感性及妊娠结局。方法纳入2016年1月至2018年12月在东部战区总医院和南京医科大学第一附属医院妇产科定期产检的孕妇，于孕35~37周采用标准方法采集阴道及直肠拭子进行GBS培养，并对阳性标本分离的菌株进行药物敏感性试验。按培养结果分为GBS阳性组和GBS阴性组，阳性组按照产程中是否使用了抗菌药物治疗分为用药组与未用药组，比较不同组别妊娠结局的差异。结果共13 000名孕妇入组，GBS总体定植率为3.65%（475/13 000）。GBS在阴道中定植率为2.33%（303/13 000），在直肠中定植率为1.75%（227/13 000）。通过对直肠标本的采集检测，GBS阳性检出率增加了56.77%（172/303）。GBS每月的定植率有明显波动，3月份和10月份最高（均 P < 0.05）。475份GBS阳性标本对头孢曲松、万古霉素和利奈唑胺的敏感率为100%，对氨苄西林和青霉素的敏感率分别为97.26%和93.47%，而对左氧氟沙星、克林霉素、红霉素、四环素的耐药率较高，分别为30.11%、48.00%、52.21%和88.63%。GBS阳性组胎膜早破、产后出血、产褥期感染、新生儿肺炎、败血症发生率较GBS阴性组明显增高（均 P < 0.01）。产程中预防性使用抗菌药物的GBS阳性孕妇产褥期感染、新生儿感染及新生儿重症监护室入住率明显低于未使用抗菌药物的孕妇（ P < 0.05或 P < 0.01）。 结论妊娠晚期孕妇GBS定植率较低，无明显的季节性，通过补充直肠检测能提高GBS检出率。头孢曲松、氨苄西林和青霉素是目前预防和治疗GBS相关疾病的首选药物。GBS感染会明显增加母婴并发症的发生可能，产程中抗菌药物治疗可以改善母婴的结局。     

Differences in distribution and drug sensitivity of pathogens in lower respiratory tract infections between general wards and RICU

Background

Lower respiratory tract infections (LRTIs) are common among patients in hospitals worldwide, especially in patients over the age of 60. This study investigates the differences in distribution and drug sensitivity of pathogens in LRTIs.

Methods

The clinical and laboratory data of 4,762 LRTI patients in the general ward and respiratory intensive care unit (RICU) of Xiangya Hospital (Changsha) were retrospectively analyzed.

Results

The infection rate of Gram-negative bacteria was significantly higher than that of Gram-positive bacteria in both the general ward and RICU (P<0.05). The incidence of Gram-negative bacteria infection was significantly higher in the RICU than in the general ward (P<0.05), whereas the incidence of Gram-positive bacteria infection is less in the RICU than in the general ward (P<0.05). In the general ward, the incidence of Gram-negative bacteria infection significantly increased (P<0.05) over time, whereas the incidence of Gram-positive bacteria infection significantly decreased from 1996 to 2011 (P<0.05). In the RICU, the incidence of Gram-positive bacteria infection decreased, while Gram-negative bacteria infections increased without statistical significance (P>0.05). Staphylococcus pneumoniae and Staphylococcus aureus were found to be the predominant Gram-positive strains in the general ward (34.70-41.18%) and RICU (41.66-54.87%), respectively (P>0.05). Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant gram negative strains in the general ward (19.17-21.09%) and RICU (29.60-33.88%), respectively (P>0.05). Streptococcus pneumoniae is sensitive to most antibiotics with a sensitivity of more than 70%. Staphylococcus aureus is highly sensitive to vancomycin (100%), linezolid (100%), chloramphenicol (74.36-82.19%), doxycycline (69.57-77.33%), and sulfamethoprim (67.83-72.46%); however, its sensitivity to other antibiotics is low and decreased each year. Sensitivity of Pseudomonas aeruginosa to most β-lactam, aminoglycoside, and quinolone group antibiotics decreased each year.

Conclusions

The distribution and drug sensitivity of LRTI pathogens exhibit a high divergence between the general ward and RICU. Streptococcus pneumoniae may not be the predominant pathogen in LRTIs in some areas of China.