含奥沙利铂辅助化疗方案治疗结直肠癌可切除肝转移的预后分析

目的探讨含奥沙利铂术后辅助化疗方案对结直肠癌可切除肝转移患者的临床价值。方法回顾性分析2004年1月至2013年12月期间在中山大学附属第一医院行根治性手术的125例结直肠癌肝转移患者的总生存期和无复发生存期情况,其中66例患者术后接受了含奥沙利铂的辅助化疗。探讨含奥沙利铂辅助化疗方案对结直肠癌可切除肝转移患者预后和复发的影响。结果含奥沙利铂辅助化疗组和单纯手术组的5年总生存率分别为32.8%和20.8%(P=0.026),中位无复发生存期则分别为25.1月及15.7月(P=0.039)。多因素分析提示含奥沙利铂的辅助化疗是总生存期(HR=0.651,95%CI:0.410~0.903,P=0.042)和无复发生存期(HR=0.664,95%CI:0.441~0.999,P=0.045)独立预后影响因素。结论含奥沙利铂的辅助化疗方案能改善结直肠癌可切除肝转移患者的预后。     

XRCC1基因单核苷酸多态性对胃癌卡培他滨联合奥沙利铂化疗敏感性研究

目的 探讨XRCC1Arg194Trp、Arg399Gln基因单核苷酸多态性对胃癌患者卡培他滨联合奥沙利铂化疗敏感性有无影响.方法 选取我院2013年1月至2014年6月经病理确诊晚期胃癌患者86例,采用卡培他滨联合奥沙利铂化疗3个周期后进行临床疗效评价.收集临床资料和外周血标本,利用TaqMan-MGB探针等位基因分型技术对XRCC1Arg194Trp、Arg399Gln进行基因分型,比较不同基因型患者的联合化疗效果.结果 86例患者中52例化疗敏感(60.5%);XRCC1Arg194Trp位点,携带Trp (Arg/Trp+Trp/Trp)基因型化疗敏感率为70.8%,Arg/Arg基因型化疗敏感率为47.4%(P=0.027);Trp基因型患者中位TTP为9.48个月,Arg/Arg基因型患者中位TTP为7.36个月(P=0.024);Arg/Arg基因耐药风险显著高于Trp基因(OR:2.84,95%CI:0.772~4.313,P=0.031);XRCC1Arg399/Arg位点,携带Arg/Arg基因化疗敏感率为72.5%,Gln (Arg/Gln+Gln/Gln)基因型化疗敏感率为42.9%(P=0.007);Arg/Arg基因中位TTP为10.26个月,Gln基因型中位TTP为8.03个月(P=0.012);Gln基因耐药风险显著高于Arg/Arg基因(OR:4.62,95%CI:1.637~7.201,P=0.012).结论 XRCC1Arg194Trp、Arg 399Gln基因单核苷酸多态性可能与卡培他滨联合奥沙利铂化疗敏感性有关.     

卡培他滨联合洛铂对比联合奥沙利铂用于进展期胃癌D2术后辅助化疗

目的 探讨洛铂联合卡培他滨针对进展期胃癌D2术后辅助化疗的效果与安全性以及与奥沙利铂联合卡培他滨方案的差异.方法 行D2手术的进展期胃癌患者63例,术后病理分期均为Ⅱ期或Ⅲ期,其中28例接受洛铂联合卡培他滨的辅助化疗(XELLOBA组),35例接受奥沙利铂联合卡培他滨的辅助化疗(XELOX组),比较两组3年总生存率及安全性.结果 XELLOBA与XELOX两组3年总生存率分别为75.0%及62.9%(P=0.253);两组Ⅲ°以上化疗相关毒性反应发生率分别为21.42%及20.0%(P=0.889).结论 洛铂联合方案在疗效方面至少不低于奥沙利铂联合方案,且在安全性方面与后者相似,提示洛铂联合卡培他滨的方案在胃癌的辅助化疗中具有良好的临床应用前景.     

奥沙利铂联合替吉奥在胃癌术后辅助化疗中的研究

目的探讨奥沙利铂联合替吉奥对比XELOX(奥沙利铂联合卡培他滨)方案在胃癌术后辅助化疗中的临床疗效。方法将81例胃癌术后患者分为治疗组和对照组,治疗组(n=41)给予奥沙利铂联合替吉奥方案化疗,对照组(n=40)给予XEOLX方案化疗。结果治疗组与对照组的1年和2年无复发生存期(RFS)分别为51.3%和61.5%,25.6%和20.5%,两组比较差异无统计学意义(P=0.361,P=0.591)。治疗组和对照组1年和2年总生存期分别为64.1%和69.2%,30.8%和25.6%,两组比较差异无统计学意义(P=0.631,P=0.615)。两组的不良反应主要表现为骨髓抑制、胃肠道反应、手足综合征、口腔黏膜炎、末梢神经毒性及肝、肾功能损伤。对照组手足综合征的发生率明显高于治疗组,差异有统计学意义(P=0.001),所有不良反应经对症治疗后均好转。结论奥沙利铂联合替吉奥与奥沙利铂联合卡培他滨在胃癌术后治疗中疗效相当,不良反应患者可耐受。     

胃癌病人ERCC1和XPD基因多态性与奥沙利铂化疗预后关系

目的了解DNA损伤修复基因ERCC1 Asn118Asn和XPD Lys751Gln多态性与接受以奥沙利铂为基础化疗的晚期胃癌病人预后的关系。方法 90例晚期胃癌病人接受奥沙利铂化疗前抽取静脉血并提取DNA,应用real-ti me PCR法进行基因分型。比较病人不同基因型与生存期的关系。结果晚期胃癌病人ERCC1Asn118Asn基因型频率为C/C 47.78%,C/T42.22%,T/T10.00%;XPD基因型频率分别为A/A80.00%,A/C16.67%,C/C 3.33%。90例胃癌病人中位无疾病进展生存期(TTP)6.4个月,总生存期(OS)9.5个月。ERCC1C/C基因型病人中位TTP为6.6个月,OS为9.7个月;C/T+T/T型病人中位TTP为6.1个月,OS为9.1个月,二者差异无统计学意义(P>0.05)。XPD A/A基因型病人中位TTP为6.7个月,OS为9.7个月;A/C+C/C基因型病人中位TTP为4.8个月,OS为7.8个月,二者差异有统计学意义(χ2=20.244、17.113,P<0.05)。同时携带ERCC1 C/C及XPD A/A基因型、ERCC1 C/C及XPD A/C+C/C基因型、ERCC1 C/T+T/T及XPD A/A基因型、ERCC1 C/T+T/T及XPD A/C+C/C基因型的病人中位TTP分别为6.9、4.7、6.3和5.0个月,OS为9.9、7.7、9.3、8.0个月,4组差异有统计学意义(χ2=18.331、12.742,P<0.05)。结论 XPD Lys751Gln基因多态性与以接受奥沙利铂为基础化疗的晚期胃癌病人的生存期有关,ERCC1 Asn118Asn基因多态性与接受奥沙利铂为基础化疗的晚期胃癌病人的生存期无关。     

ＥＲＣＣ１ ｍＲＮＡ表达及基因多态性对胃癌辅助化疗预后的影响

目的:探讨切除修复交叉互补基(ERCC1)mRNA表达及118 C/T基因多态性与胃癌对奥沙利铂辅助化疗预后的关系.方法:根治术后胃癌患者62例,采用奥沙利铂为主的方案进行辅助化疗.采用半定量RT-PCR方法检测胃癌组织中ERCCl mRNA水平.采用PCR,LDR(连接酶检测反应)检测ERCCI 118C/T基因多态.结果:62例胃癌组织ERCC1 mRNA表达水平的中位值为0.672;ERCC1 118 C/C、C/T和T/T基因型分别占51.6%(32/66)、43.5%(27/62)和4.8%(3/62).ERCC1 mRNA高表达组(＞0.672)无复发生存率和总生存率均显著低于低表达组(P＜0.05);携带C/T和T/T基因型患者与C/C基因型患者的无复发生存率和总生存率差异无显著性(P＞0.05).多因素分析结果显示ERCC1 mRNA水平是影响患者预后的独立危险因素(P＜0.05),而ERCC1 118C/T多态与预后无关(P＞0.05).结论:ERCCI mRNA表达水平与接受奥沙利铂为主辅助化疗胃癌患者的预后有关,可用于其预后预测.     

胃癌新辅助治疗局部进展期胃癌病理完全缓解8例临床特征分析

目的分析胃癌新辅助治疗局部进展期胃癌原发灶病理学完全缓解(pathological complete response,pCR)患者的临床特征。方法筛选哈尔滨医科大学附属肿瘤医院2007年7月1日—2015年12月30日期间胃癌新辅助化疗原发病灶完全缓解的8例患者的临床资料,分析其临床特征;结合目前已有的临床试验结果讨论其个体化治疗策略。结果 8例患者治疗前均为局部进展期胃癌,2例接受SOX方案(替吉奥+奥沙利铂),2例接受XELOX方案(希罗达+奥沙利铂),1例接受TS方案(替吉奥+艾素),1例接受LF方案(希罗达+草铂),1例接受替吉奥+紫杉醇方案,1例接受多西他赛+奥沙利伯方案。结论胃癌新辅助化疗能有效改善胃癌总生存率,但是现有的胃癌新辅助治疗方案的pCR率较低,需要进一步探究新的、高效的化疗方案,实现真正的个体化治疗。     

5-Fu持续静脉滴注联合奥沙利铂或顺铂对胃癌辅助化疗的临床观察

目的 为寻找更好疗效的胃癌术后辅助化疗方案,提高胃癌的治愈率.方法 采用5-Fu持续静脉滴注联合奥沙利(铂奥沙利铂化疗组)或顺铂方案(顺铂化疗组)治疗59例胃癌术后Ⅲ期病人,并且进行随访.结果 随访率为91.53%.1年、3年生存率分别为前组89.66%和48.28%;后组88.00%和44.00%.结论 胃癌术后辅助化疗可以降低胃癌复发及转移.     

奥沙利铂治疗晚期胃癌的临床观察

目的：评价奥沙利铂对晚期胃癌的临床疗效。方法：64例晚期胃癌随机分为观察组(n=32)与对照组(n=32)，对照组使用标准的FLP方案，观察组则将FLP方案中顺铂改为奥沙利铂。结果：观察组与对照组肿瘤治疗的总有效率(OR)分别为43．8％、28．1％；观察组1年生存率高于对照组(37．5％vs28．1％)，奥沙利铂的毒副反应较顺铂轻。结论：以奥沙利铂为主的联合化疗方案对晚期胃癌有一定疗效，其1年生存率及毒副反应均优于顺铂为主的方案。     

XRCC1-194突变、RRM1-37多态性与晚期NSCLC患者含铂方案化疗效果的相关性研究

目的 探讨XRCC1-194突变、RRM1-37多态性与含铂方案治疗晚期非小细胞肺癌(NSCLC)患者对疗效及生存的关系.方法 采用PCR-RFLP技术同时检测54例晚期NSCLC(ⅢB～Ⅳ期)患者及50例健康献血者XRCC1-194突变、RRM1-37基因型,分析其基因型频率与晚期NSCLC患者采用以铂类为基础方案化疗疗效及生存间的相关性.结果 携带XRCC1Arg194Trp+Trp194Trp基因型的患者组化疗有效率为72.2％,高于携带野生型Arg194Arg基因型者(36.1％),x2=6.268,P=0.012,前者的化疗效率是后者的3倍(OR =3.453,95％ CI=1.361 ～8.764);Arg194Trp+Trp194Trp基因型患者中位生存期、1、2年生存率均优于携带野生型Arg194Arg基因型患者,但两组相比差异无统计学意义(x2=0.265,P=0.607).携带RRM137A/C、37CC基因型患者的化疗有效率分别为50.0％ (11/22)、46.9％ (15/32),两组间无统计学意义(x2=0.051,P=0.821);前组患者中位生存期、1、2年生存率与后组基因型患者相比,亦无统计学意义(x2=0.627,P=0.357).结论 化疗前对患者XRCC1-194进行突变检测,在一定程度上可以预测晚期NSCLC对铂类药物的敏感性.XRCC1-194突变、RRM1-37多态性与晚期NSCLC患者生存无明显相关性.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…