Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

护士仪表、语言、行为在护理工作中的作用

临床工作中，护士和患接触最密切、最广泛、最深入，而护士的举止、言行、仪表又都会引起患的复杂反应。笔体会如下。     

邻指逆行指动脉皮瓣修复手指末节皮肤脱套伤

手指末节皮肤脱套伤目前尚无十分理想的修复方法。 1995年～ 2 0 0 0年我们应用邻指逆行指动脉皮瓣修复 11例 ,效果较好 ,报告如下。1　临床资料本组男 9例 ,女 2例 ,年龄 17～ 4 5岁。均为机器致伤手指末节皮肤、软组织套状撕脱、指骨及肌腱外露。其中食指 4例 ,中指 2例 ,环指 3例 ,小指 2例。均于伤后 5小时内手术。手术方法 :食、环指末节皮肤脱套伤分别采用中指桡、尺侧逆行指动脉皮瓣修复 ;中、小指末节皮肤脱套伤分别采用环指桡、尺侧逆行指动脉皮瓣修复。按伤指皮肤、软组织缺损的大小 ,沿供指中节侧方向背侧及掌侧设计皮瓣 ,皮瓣呈…     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

护理专业人才培养的现状与展望

多年来,我国护理人才的培养沿袭固定的模式,即初中毕业生进入护校,经过3年的专业培养,毕业后由国家统一分配至各级医疗机构,从事护理工作,再根据各单位的需要决定其具体工作岗位.这时,毕业生年龄大约在十八九岁左右,经过5年以上的一线锻炼,开始进入婚育年龄阶段,大约在30岁左右进入一个事业稳定时期,在专业技能及人际交往等方面,趋于成熟.这时,她可能会成为一名一线护理骨干或护士长.但与此同时,长期的工作、家庭压力及倒班等不规律的作息时间又使得她在35岁以后,精力、体力逐渐下降,40岁后更加明显,如晚上夜班时打针看不清血管,极易疲劳而又不易恢复.所以一名护士真正能在一线岗位上工作的时间也就只有在40岁以前,那么进入工作状态的时间越早,相对她在一线工作的时间也就会越长.     

糖尿病视网膜病变患者血清脂氧素A4和血管内皮生长因子的相关性研究

目的  研究血清脂氧素A4（LXA4）和血管内皮生长因子（VEGF）与糖尿病视网膜病变（DR）的相关性。方法  选取90例糖尿病患者按视网膜病变程度分为糖尿病无视网膜病变组（NDR）、单纯型糖尿病视网膜病变组（SDR）和增殖型糖尿病视网膜病变组（PDR）,另选健康体检者40例作为正常对照组。测定各组血清LXA4和VEGF浓度,并研究LXA4和VEGF的相关性。结果  ①NDR、SDR和PDR组血清LXA4水平均低于NC组;SDR、PDR组血清LXA4水平低于NDR组;PDR组血清LXA4水平均低于SDR组,差异有统计学意义（P <0.05）。②NDR组血清VEGF水平与NC组比较,差异无统计学意义（P >0.05）;SDR、PDR组血清VEGF水平高于NDR组、NC组;PDR组血清VEGF水平高于SDR组,差异有统计学意义（P <0.05）。③血清LXA4和VEGF呈负相关（P <0.05）。结论  血清LXA4水平下降、VEGF水平上升可能是糖尿病患者出现视网膜病变的危险因素。

     

星点设计响应面法优化滇南美登木总生物碱超声提取工艺

目的:筛选出滇南美登木中总生物碱提取的最优条件。方法:以盐酸小檗碱为对照品,采用酸性染料比色法,以总生物碱含量为指标,分别考察提取功率、提取时间、提取次数、液料比和乙醇的体积分数5个因素对超声提取滇南美登木中总生物碱的影响,在此基础上通过星点设计响应面试验确定最佳提取工艺,并进行验证。结果:滇南美登木中总生物碱的最佳超声提取工艺为:乙醇体积分数74%,提取功率457W,提取时间42min,提取次数为3次,液料比为20∶1(mL·g^-1)。验证试验测得最佳条件时总生物碱含量为(2.77±0.02)mg·g^-1(n=3,RSD=0.72%),与模型预测值结果接近。结论:本研究提取工艺简单,工艺参数可靠,提取效果良好,为滇南美登木中总生物碱的研究提供了科学的研究思路和试验依据。     

甲状腺乳头状癌中SphK1和Annexin A1的表达及意义

目的探讨鞘氨醇激酶1(sphingosine kinase1,SphK1)和膜联蛋白A1(Annexin A1)在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中的表达及相互关系。方法收集PTC 81例、结节性甲状腺肿(nodular goiter,NG) 30例、癌旁正常甲状腺组织(normal thyroid,NT) 26例。应用免疫组化En Vision两步法检测各组中SphK1和Annexin A1的表达,并分析两者表达与PTC临床病理特征的关系。结果 SphK1和Annexin A1在PTC中的阳性率(60. 5%和61. 7%)高于NG组(33. 3%和26. 7%)以及NT组(30. 8%和23. 1%)(P均0. 017)。Annexin A1和SphK1表达与PTC淋巴结转移和临床分期相关(P均0. 01),与患者性别、年龄、部位、肿瘤大小、TG-Ab值和TPO-Ab值无关(P均 0. 05)。SphK1与Annexin A1表达呈正相关(P 0. 01)。结论 SphK1与Annexin A1可能参与PTC的发生、发展和淋巴结转移,提示二者可能成为甲状腺肿瘤良恶性诊断和早期淋巴结转移风险评估的重要生物学因子。     

甘精胰岛素注射液联合格列美脲片治疗2型糖尿病的临床研究

目的观察甘精胰岛素注射液联合格列美脲片治疗2型糖尿病(T2DM)的临床疗效及安全性。方法将45例初治2型糖尿病患者随机分为对照组22例与试验组23例。对照组予以甘精胰岛素,起始剂量为0.2 U·kg^-1,qd,皮下注射;试验组在对照组治疗的基础上,予以格列美脲每次2~4 mg,qd,口服。2组患者均治疗12周。比较2组患者的血糖达标率和药物不良反应的发生情况。结果治疗后4,8,12周,试验组的血糖达标率分别为91.30%(21例/23例),100.00%(23例/23例)和100.00%(23例/23例),对照组的血糖达标率分别为54.54%(12例/22例),72.72%(16例/22例)和81.81%(18例/22例),差异均有统计学意义(均P<0.05)。试验组发生的药物不良反应以心慌为主,对照组发生的药物不良反应以头晕、心慌、憋气不适和出汗为主。试验组和对照组的总药物不良反应发生率分别为4.35%和31.82%,差异有统计学意义(P<0.05)。结论甘精胰岛素注射液联合格列美脲片治疗初治2型糖尿病的临床疗效确切,可有效地提高血糖达标率,且安全性较高。     

改良根治术后pT1-2N1期乳腺癌的局部区域复发部位——12个中心 5442例患者的联合分析

目的 分析改良根治术后pT1-2N1期乳腺癌患者的局部区域复发(LRR)部位及放疗对复发的影响。方法 收集中国12家医院符合条件的 5442例乳腺癌患者资料,分析放疗和未放疗患者的LRR部位及不同部位放疗对复发的影响。采用Kaplan-Meier法计算LRR率并log-rank法检验。结果 全组中位随访63.8个月,395例患者出现LRR。无论辅助放疗与否和不同分子分型,胸壁和锁骨上区均为最常见的LRR部位。全组胸壁照射和未照射患者的 5年胸壁复发率分别为2.5%和3.8%(P=0.003);锁骨上区照射和未照射患者的 5年锁骨上淋巴结复发率分别为1.3%和4.1%(P<0.001);腋窝照射和未照射患者的 5年无腋窝复发率分别为0.8%和1.5%(HR=0.31,95%CI为 0.04~2.23,P=0.219);内乳照射和未照射患者的 5年无内乳复发率分别为0.8%和1.5%(HR=0.45,95%CI为 0.11~1.90,P=0.268)。结论 改良根治术后pT1-2N1期乳腺癌患者的主要LRR部位是胸壁和锁骨上区,不受辅助放疗与否和分子分型的影响。胸壁和锁骨上区放疗显著降低相应部位的复发风险,而腋窝和内乳放疗未降低相应部位的复发风险。