同步放化疗与新辅助化疗术前用药在局部中晚期宫颈癌治疗中的临床疗效评价

目的:比较同步放化疗与新辅助化疗术前用药在治疗局部中晚期宫颈癌的临床疗效。方法:选择2002年3月至2005年3月我院收治的42例ⅠB2～ⅡB期宫颈癌患者,其中21例同步放化疗,21例新辅助化疗。两组化疗方案相同,鳞癌:顺铂(DDP)+博来霉素;腺癌:DDP+5-氟尿嘧啶(5-Fu)+丝裂霉素(MMC)。同步放化疗组化疗期间配合放疗,采用腔内近距离放疗。同步放化疗、新辅助化疗结束后选择合适时间手术。观察两组间的近期疗效、手术率及手术切缘阴性情况、毒副反应、远期疗效(1、3、5年生存率)。结果:两组间近期疗效差异无统计学意义(P>0.05)、手术率及手术切缘阴性率差异有高度统计学意义(P<0.01)。血液和胃肠道毒副反应差异无统计学意义(P>0.05),晚期并发症放射性直肠炎和膀胱炎差异有高度统计学意义(P<0.01)。1年、3年生存率差异无统计学意义(P>0.05),而5年生存率同步放化疗组高于新辅助化疗组(P<0.05)。结论:同步放化疗术前用药治疗局部中晚期宫颈癌优于新辅助化疗。     

2008—2015年天津市HIV-1新近感染特征及相关因素分析

对2008—2015年天津市HIV感染者和艾滋病患者（HIV/AIDS）报告病例进行新近感染判定,分析HIV-1新近感染相关因素。2008—2015年天津市男男同性性传播占全部HIV-1新近感染者比例由37.7%上升至83.7%。≤30岁（ OR=1.53,95 %CI：1.30~1.79）、汉族（ OR=1.40,95 %CI：1.02~1.91）、高中（ OR=1.28,95 %CI：1.05~1.56）和大学（ OR=1.23,95 %CI：1.00~1.50）学历、学生（ OR=1.79,95 %CI：1.28~2.51）感染者中为新近感染的可能性较高;通过自愿咨询检测（VCT）（ OR=2.58,95 %CI：2.026~3.29）、性病门诊（ OR=2.02,95 %CI：1.51~2.71）、男男性行为人群（MSM）专题调查（ OR=2.88,95 %CI：2.33~3.58）和无偿献血者筛查（ OR=2.64,95 %CI：1.84~3.79）发现的感染者为新近感染的可能性较高。     

鼻腔给药人体吸收的细胞模型方法学研究进展

经鼻给药具备起效快,生物利用度高,入脑效率高及非侵入性等优点。但复杂的鼻腔微环境,如黏膜屏障、纤毛运动、低pH值的黏液层及酶降解等因素,为鼻腔药物研发带来了诸多挑战。尽管大量动物试验方法已经为鼻腔药物的研发提供了研究手段,但物种间的差异、高额的费用及较长的周期等因素限制了这些方法在研发中的应用,特别是在新药临床前的化合物及处方早期筛选阶段。因此,选择一种具备良好体内外相关性的鼻腔细胞模型用于指导药物的临床前研发成为了关键。基于鼻腔给药途径,无论经鼻入脑或是经鼻入血,上皮细胞的屏障作用均直接决定药物的生物利用度与药效。此外,鼻腔药物黏膜刺激性等毒理评价也是研发成功的关键因素。因此,本文归纳了现阶段基于鼻腔上皮细胞构建的体外鼻腔模型在鼻用制剂研发中的应用现状。     

Critical limits to define a lab adverse event during phase I studies: a study in 1134 subjects

Objective: The first goal of phase I drug development is the determination of maximal tolerated dose, which must be established by case-by-case analysis, sometimes using a laboratory adverse event. Since no accurate rule defining lab adverse events, has been validated yet, we propose a new “combined method” based on combination of two thresholds: inclusion values and magnitude of variation. Using this combined method, the label “lab adverse event” is applied if any lab value exceeds the inclusion threshold and is associated with a variation from baseline exceeding the variation threshold defined from reference change limit. Thus, this study aimed to test this combined method on a large healthy volunteer population, studied in 19 phase I centres worldwide, and on five lab parameters: alanine amino transferase, aspartate amino transferase, alkaline phosphatases, creatinine and polymorphonuclear leukocytes. Methods: The inclusion threshold from each center was used. Reference change limits were defined from volunteers previously included in comparable studies and were expressed as absolute values: increases of 10?IU?·?l^?1 for alanine amino transferase or aspartate amino transferase, 15?IU?·?l^?1 for alkaline phosphatases, 15?μmol?·?l^?1 for creatinine and a 0.34 10⁹?·?l^?1 decrease for polymorphonuclear leukocytes. Comparison between the “combined method” and a normal range method was made using positive predictive value and a ratio between relevant and irrelevant results. This application was implemented in all young healthy volunteers (1134) included in 38 phase I studies sponsored by Rhône Poulenc Rorer from 1991 to 1993. Results: Seventy seven subjects (6.7%) were indicated in final study reports as having a lab adverse event (reference group). Of 179 subjects with lab abnormalities defined by the normal range method, 77 belonged to the reference group, inducing a poor 0.43 positive predictive value. Of ninety subjects with lab adverse events defined by the “combined method”, seventy-five belonged to the reference group, inducing a two-fold higher 0.83 positive predictive value. The combined method produced a high ratio of relevant/irrelevant results ( ) compared with the low ratio ( ) achieved using the normal range method. Conclusion: This new “combined method”, leading to a better definition of lab adverse event, seems an accurate and useful tool for routine case-by-case analysis within phase I drug development studies.     

养阴类中药成分与药理研究现状

本文综述了近年来养阴药的化学成分及药理作用,发现多糖、氨基酸、微量元素是其发挥功效的重要成分。     

水银血压计替代产品的最新进展

水银血压计是当今医院中使用极其广泛的无创测量血压的基本医疗器械之一。但是水银对自然环境及人类是有害的。随着全世界范围内对水银血压计的限制使用．水银血压计的淘汰将不可避免。从临床医护人员的需求以及在医学工程的技术角度上．提出水银血压计的替代产品也提出一些要求及其进展。     

胰岛素临床应用新进展

胰岛素是治疗糖尿病的一种常用药物,用于2型糖尿病（T2DM）患者早期治疗可改善胰岛β细胞功能;提高糖尿病褥疮治愈率并缩短治愈时间;改善代谢失调、炎性应答及出凝血状态,降低C-反应蛋白（CRP）水平;极化液（GIK）能改善心肌供血;非注射用胰岛素使糖尿病人的生活质量有质的突破。但其潜在不良影响还需进一步研究。     

应届毕业医学生心理健康现状调查及教育对策

目的调查应届毕业医学生的心理健康状况,研究心理健康教育对策。方法采用症状自评量表（SCL-90）对313名应届毕业医学件进行测查,测查时将评定时间跨度由最近一星期改为最近3个月。结果SCL-90测验结果,总分〉160分者49人,占15．65％;20．77％强迫因子分〉2,20．45％敌对因子分〉2;是否签约与各因子分相关有统计学显著性。有心理问题者人际关系敏感增分最高。结论应届毕业医学生总体心理健康状况良好,部分学生存在强迫、敌对等心理问题。是否找到工作是影响心理状态的重要因素。对其进行心理健康教育时,耍围绕就业进行,对个别学生要特别注重人际关系方面的训练。     

New frontiers in female contraception (and male condoms): 2012

Introduction: Contraception made profound contributions to women's health in the twentieth century and has the potential to help achieve each of the eight millennium development goals in the twenty-first. However, contraception has not met its full potential, in large part due to inconsistent use. Choice is uniquely important to contraceptive success, so continued innovation in all aspects of birth control is needed.

Areas covered: First, we will review recent advances in the introduction of new methods of birth control. Then we will report recent developments in areas that strongly influence contraceptive use, including non-contraceptive benefits, ways to minimize side effects and practice protocols designed to encourage ready access to various methods. In the second half of the paper we will discuss methods that are in development, but not yet available, as well as new research into non-contraceptive benefits, new approaches to reduce side effects and new ways to provide contraceptives so that users can be more successful.

Expert opinion: The goal of being planned and prepared for pregnancies is still only an abstract concept. Significant barriers to success from traditional sources (ambivalence, cultural and societal beliefs, the status of women, poverty) persist and are now joined by many other emerging structural problems. The consolidation of pharmaceutical companies reduces competition. The loss of profitability for contraceptives due to short-lasting patents, growing demand for generics and growing challenges from product liability reduce incentives for innovation. Healthcare reform in the US may further discourage new product development. However, new advances may still be possible from small start-up companies, philanthropic foundations and governmental research efforts. Other advances may be made by providing contraception in innovative ways and in the techniques we use to motivate patients to be more successful contraceptors.     

HIV-1新近感染两种检测方法在临床应用中的对比

目的比较HIV抗体明胶颗粒凝集检测法(Micro Liquid HIV PA,ML-PA)与BED-CEIA法在新近感染HIV患者中的检测结果,为ML-PA法的临床应用提供经验。方法对确认为HIV阳性的300例新报告感染者及132例长期感染样本分别用两种方法进行新近感染检测,获得2009-2011年第二季度常规检测新报告感染者及吸毒人群、男男同性恋人群新近感染比例。结果 300例新报告感染者样本中259例样本被两种方法同时判定为HIV长期感染,有4例样本被同时判定为HIV新近感染,两种方法对HIV-1是否为新近感染和长期感染结果判定不同(P=0.012<0.05)且一致性较差(Kappa值=0.127);对132例长期感染的样本检测结果显示,BED-CEIA法中128例判为长期感染,而ML-PA法中131例判定为长期感染。对2009-2011年第二季度常规检测新报告感染者及吸毒人群、男男性行为人群用两种方法进行检测得出结果显示流行趋势相同。结论两种方法检测新近感染结果显示一致性较差,但是可以用两种方法共同分析新近感染比例,ML-PA法可以进行更多、更大范围的应用。