Standardisierte Kontrastmittelsonographie (CEUS) in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin (CEUS-Akut)

Die Anaesthesiologie -     

基于CiteSpace可视化分析代谢组学在中医药领域的研究现状及趋势＊

目的 应用可视化方法分析代谢组学在中医药领域的现状及趋势。方法 检索中国知网数据库（CNKI）和Web of Science 核心合集数据库2021年3月15日之前收录的中医药领域代谢组学研究的相关文献，应用CiteSpace软件对纳入的文献进行关键词、作者、研究机构等内容进行可视化分析。结果 共纳入中文文献247篇，英文文献350篇。文献数量在波动中迅速上升。中、英文文献作者合作网络显示，张爱华是中医药领域代谢组学研究发文量最多的作者，并形成了核心研究团队。发文机构显示，中国医学科学院是该领域的重要研究机构，机构间合作紧密。中、英文文献关键词分析显示，研究内容主要集中在核磁共振、代谢标记物、冠心病、质谱技术、代谢通路等相关领域。结论 中医药领域代谢组学研究的热点主要为中医药治疗代谢性疾病的机制研究。研究趋势为卵泡代谢组学研究及中药有效成分的研究。     

Phase I Dose-Escalation Study of SCB01A,a Microtubule Inhibitor with Vascular Disrupting Activity,in Patients with Advanced Solid Tumors

Lessons Learned

• SCB01A is a novel microtubule inhibitor with vascular disrupting activity.
• This first‐in‐human study demonstrated SCB01A safety, pharmacokinetics, and preliminary antitumor activity.
• SCB01A is safe and well tolerated in patients with advanced solid malignancies with manageable neurotoxicity.

BackgroundSCB01A, a novel microtubule inhibitor, has vascular disrupting activity.MethodsIn this phase I dose‐escalation and extension study, patients with advanced solid tumors were administered intravenous SCB01A infusions for 3 hours once every 21 days. Rapid titration and a 3 + 3 design escalated the dose from 2 mg/m² to the maximum tolerated dose (MTD) based on dose‐limiting toxicity (DLT). SCB01A‐induced cellular neurotoxicity was evaluated in dorsal root ganglion cells. The primary endpoint was MTD. Safety, pharmacokinetics (PK), and tumor response were secondary endpoints.ResultsTreatment‐related adverse events included anemia, nausea, vomiting, fatigue, fever, and peripheral sensorimotor neuropathy. DLTs included grade 4 elevated creatine phosphokinase (CPK) in the 4 mg/m² cohort; grade 3 gastric hemorrhage in the 6.5 mg/m² cohort; grade 2 thromboembolic event in the 24 mg/m² cohort; and grade 3 peripheral sensorimotor neuropathy, grade 3 elevated aspartate aminotransferase, and grade 3 hypertension in the 32 mg/m² cohort. The MTD was 24 mg/m², and average half‐life was ~2.5 hours. The area under the curve‐dose response relationship was linear. Nineteen subjects were stable after two cycles. The longest treatment lasted 24 cycles. SCB01A‐induced neurotoxicity was reversible in vitro.ConclusionThe MTD of SCB01A was 24 mg/m² every 21 days; it is safe and tolerable in patients with solid tumors.     

某二级公立医院员工满意度与影响因素分析

目的:通过调查、分析某二级公立医院员工满意度现状及影响因素,为探寻提升员工满意度路径提供依据。方法:按分层随机抽样法,抽取医院276名员工进行满意度问卷调查,对搜集到的数据进行统计分析。结果:医院员工满意度为(71.26±8.57)分;各维度评分中得分最高的是"领导与管理"维度,为(15.52±2.02)分;最低的是"薪酬与福利"维度,为(12.57±2.77)分。学历和岗位是影响该院员工满意度的主要因素。结论:医院员工满意度处于一般水平,医院应从健全薪酬福利机制、做好职业规划、重视不同群体需求、营造文化氛围等路径入手,提升员工满意度。     

The clinical dilemma of JAK inhibitor failure in myelofibrosis: Predictive characteristics and outcomes

Two Janus-associated kinase inhibitors (JAKi) (initially ruxolitinib and, more recently, fedratinib) have been approved as treatment options for patients who have intermediate-risk and high-risk myelofibrosis (MF), with pivotal trials demonstrating improvements in spleen volume, disease symptoms, and quality of life. At the same time, however, clinical trial experiences with JAKi agents in MF have demonstrated a high frequency of discontinuations because of adverse events or progressive disease. In addition, overall survival benefits and clinical and molecular predictors of response have not been established in this population, for which the disease burden is high and treatment options are limited. Consistently poor outcomes have been documented after JAKi discontinuation, with survival durations after ruxolitinib ranging from 11 to 16 months across several studies. To address such a high unmet therapeutic need, various non-JAKi agents are being actively explored (in combination with ruxolitinib in first-line or salvage settings and/or as monotherapy in JAKi-pretreated patients) in phase 3 clinical trials, including pelabresib (a bromodomain and extraterminal domain inhibitor), navitoclax (a B-cell lymphoma 2/B-cell lymphoma 2-xL inhibitor), parsaclisib (a phosphoinositide 3-kinase inhibitor), navtemadlin (formerly KRT-232; a murine double-minute chromosome 2 inhibitor), and imetelstat (a telomerase inhibitor). The breadth of data expected from these trials will provide insight into the ability of non-JAKi treatments to modify the natural history of MF.     

基于标准化患者法评价四川农村基层医生两种慢性病诊断准确性及其影响因素

目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。     

老年人生命晚期获知疾病信息意向及影响因素CSCD

目的了解老年人生命晚期获知疾病相关信息意向及影响因素。方法2016年10月至2017年6月,采用生命晚期疾病信息意向问卷,利用方便抽样法对福州市中心城区7所养老机构及15个社区的414例年龄≥60岁的老年人进行横断面调查,采用单因素分析、多元线性回归与有序多分类logistic回归分析老年人对疾病相关信息的需求水平、获知程度意向及其影响因素。结果414例老年人疾病相关信息需求得分为(17.1±4.9)分;48.8%(202/414)希望详尽知晓,30.7%(127/414)希望选择性了解,20.5%(85/414)不想知道任何信息;多元线性回归分析显示,年龄、文化程度、是否接受/见过其他生命维持治疗(LSTs)是影响老年人疾病相关信息需求水平的主要因素(标准化回归系数分别为-0.141、0.116、0.115,均P<0.05);有序多分类logistic分析显示,年龄(以60~69岁为参照,70~79岁:OR=0.544,95%CI:0.310~0.957;80~89岁:OR=0.526,95%CI:0.289~0.956)、文化程度(以小学及以下为参照,大专及以上:OR=2.166,95%CI:1.093~4.290)、主要生活费来源(以其他补贴为参照,家人支持:OR=7.303,95%CI:1.157~46.108;退休金:OR=9.288,95%CI:1.502~57.415;公积金/储蓄:OR=15.676,95%CI:2.122~115.793)、是否接受/见过其他LSTs(以是为参照,OR=1.985,95%CI:1.150~3.425)是影响老年人疾病相关信息获知程度意向的主要因素。结论老年人生命晚期获知疾病相关信息的意向程度较高,年龄、文化程度、主要生活费来源、是否接受/见过其他生命维持治疗等是其主要影响因素。     

三阴性乳腺癌治疗的研究进展

三阴性乳腺癌（triple negative breast cancer，TNBC）是雌激素受体(estrogen receptor，ER)、孕激素受体（progesterone receptor，PR）及人类表皮生长因子受体（human epidermal growth factor-2,HER-2）均不表达的乳腺癌。按其功能特征可归纳为5类分子分型:以DNA修复缺陷或生长因子为途径的基底细胞样三阴性乳腺癌；以上皮-间充质转化和肿瘤干细胞为特征的间质样三阴性乳腺癌；免疫调节型三阴性乳腺癌；雄激素受体过表达的管腔／分泌型三阴性乳腺癌；HER-2富集型三阴性乳腺癌。三阴性乳腺癌恶性程度高且异型性较大，其治疗困难且预后较差，内分泌治疗及靶向治疗不敏感。目前很多学者对于三阴性乳腺癌的治疗各有研究，并有临床试验证实下述治疗有效。