目的 了解血液科护士在对患者抗肿瘤药物治疗护理过程中的防护现状。 方法 2009年12月－2010年3月对血液科一、二病区和骨髓移植层流病房的护理人员,采用便利抽样方式进行问卷调查。 结果 血液科化学疗法防护现状与国际水平有差距，护理人员虽有一定的防护意识，但仍较薄弱。 结论 加强护理人员化学治疗药物毒性及防护知识的教育，提高防范意识，并制定严格的防护措施及管理制度是确保护理人员职业安全的根本与途径。
目的 建立重组人内皮抑素（恩度）联合顺铂一线治疗肿瘤进展的小鼠模型，继续应用内皮抑素联合紫杉醇二线治疗，研究内皮抑素协同紫杉醇抗肿瘤的作用及其机制。 方法 建立小鼠Lewis 肺癌移植瘤动物模型，内皮抑素联合顺铂治疗后观察肿瘤生长情况，遴选出肿瘤进展小鼠16只，随机留取1只，余15只小鼠随机分成紫杉醇组和联合用药组治疗，观察疗效。另取上述肿瘤进展小鼠1只，剥离肿瘤组织，重新接种，将成瘤小鼠随机分成生理盐水组，紫杉醇组及联合用药组治疗，观察疗效。治疗结束后24 h处死所有小鼠，采用免疫组织化学CD31单克隆抗体标记检测微血管密度（MVD），采用原位末端转移酶（TUNEL）检测细胞凋亡。 结果 只肿瘤进展小鼠中，联合用药组相比紫杉醇组生存时间无明显延长，但肿瘤体积增长较慢；而在重新接种成瘤的小鼠中，联合用药组较其余各组微血管密度明显减低（P＜0.05），凋亡指数明显增加（P＜0.05），肿瘤体积抑制明显。 结论 在内皮抑素联合顺铂治疗肿瘤进展的小鼠模型中，继续应用内皮抑素治疗与紫杉醇有较明显的协同抗肿瘤作用。
ObjectiveTo systematically review the efficacy and safety of crizotinib in the treatment of non-small cell lung cancer (NSCLC).MethodWe electronically searched databases including the Cochrane Library (Issue 5, 2017), PubMed, Embase, China Biology Medicine Database, China National Knowledge Internet Database, VIP Database and Wangfang Data from the establishment to May 2017. The randomized controlled trials (RCTs), non-RCTs, case series and case reports on crizotinib for NSCLC were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed the methodological quality of included studies, then make Meta-analysis and descriptive analysis.ResultA total of 15 studies were included, including 4 RCTs, 1 non-RCT, 4 case series and 6 case reports. The results indicated that the progression-free survival time of crizotinib group was 8 months, which was better than chemotherapy group (4.6 months). The results of Meta-analysis showed that the response rate in the crizotinib group was higher than that in the chemotherapy group [RR=2.35, 95%CI (1.59, 3.46), P<0.000 1]. The one year survival rate in the crizotinib group was 74.5%-78.6%. The incidences of adverse reactions including dysopsia, dysgeusia, diarrhea, vomiting, constipation, transaminase lifts, upper respiratory tract infection, edema and dizziness in the crizotinib group were higher than those in the chemotherapy group (P<0.05), while the incidences of adverse reactions including leukopenia, thrombocytopenia, alopecia and fatigue in crizotinib group were lower than those in the chemotherapy group (P<0.05). Subgroup analysis under precision treatment showed the progression-free survival time of anaplastic lymphoma kinase (ALK)-positive group was 8 months, and it was longer than ALK-negative group of 4 months.ConclusionsBased on current evidence, crizotinib is better than chemotherapy for NSCLC. Due to limited quality of the included studies, the above conclusion needs to be verifed by more high quality studies.
ObjectiveTo systematically review the efficacy and safety of photodynamic therapy (PDT) and intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV), and to investigate the primary treatment tentatively. MethodsA systematic search of Pubmed, Embase, the Cochrane Library and the Wanfang Data was performed to identify all comparative studies that compared the outcomes of PDT alone, intravitreal VEGF inhibitors alone and combined intravitreal VEGF inhibitors and photodynamic therapy. Outcomes of interest included the regression and recurrence rate of polypoidal lesions, best corrected visual acuity (BCVA), central retinal thickness (CRT), therapeutic times, and the occurrence rate of adverse events. 2 randomized controlled trials (RCT) and 19 non-RTCs were identified. According to treatment methods, the data extracted was classified to 3 groups, analyzed with odds ratio (OR), weighted mean difference (WMD) and 95%confidence interval (95%CI). ResultsMeta-analysis suggests that the regression rate of polypoidal lesions (OR=0.34, 0.07; 95%CI=0.13-0.88, 0.02-0.36) and BCVA (WMD=0.25, 0.11; 95%CI=0.14-0.36, 0.01-0.21) in combined therapy group were significantly better than those in PDT group and intravitreal VEGF inhibitors group (P < 0.05). The recurrence rate of polypoidal lesions in PDT group was significantly lower than intravitreal VEGF inhibitors group (OR=0.35, 95%CI=0.16-0.74, P=0.006). BCVA (P=0.025) and the occurrence rate of adverse events (OR=60.36, 95%CI=6.04-603.50, P=0.000 5) in intravitreal VEGF inhibitors group were significant better than PDT group. ConclusionsCombined treatment appeared to be superior to PDT alone or intravitreal VEGF inhibitors alone. Combined treatment takes priority over all others in the primary treatment of PCV.
ObjectiveTo compare the efficacy of photodynamic therapy (PDT) alone or in combined with ranibizumab versus ranibizumab monotherapy (intravitreal injection, IVR) in patients with polypoidal choroidal vasculopathy (PCV). Methods80 eyes of 72 patients with PCV were enrolled into this retrospective and comparative study according to their therapeutic plan. 30 eyes of 28 patients, 28 eyes of 30 patients and 22 eyes of 21 patients were divided into PDT group, ranibizumab 0.5 mg group (IVR group) or the combination group, respectively. The patients with PCV were diagnosed according to clinical symptoms, optical coherence tomography (OCT) and fluorescent indocyanine green angiography (ICGA). The baseline best-corrected visual acuity (BCVA) before treatment was more than 0.05, and there was no retinal fibrosis and scar for all patients. There was no statistical difference of age (F=0.187), gender (χ2=0.423), average BCVA (F=1.120) and central retinal thickness (CRT) (F=0.431) among three groups (P > 0.05). They had not received any treatment before. Patients received verteporfin PDT in PDT group, 3 consecutive monthly IVRs starting day 1 in IVR group, and 3 IVRs after 3 days, 1 month, 2 months of PDT starting day 1 in combination group. Re-treatment was considered 3 months later if the follow up shown no changes in fundus photography, OCT and ICGA. The average follow-up time was 19 months. BCVA at baseline and follow-up visit at 1, 3, 6, 12 months was measured, and the proportion of patients with ICGA-assessed complete regression of polyps at month 6 was recorded as primary outcome. The CRT was measured at baseline and 6 months as secondary outcome. ResultsThere were significant difference of BCVA at 1, 3, 6 and 12 months among three groups(F=5.480, 5.249, 3.222, 4.711; P < 0.05). The average BCVA was significantly better at 1, 3, 6, 12 month than that at baseline(t=-6.632, -4.127, -3.904, -4.494; P < 0.05) in combination group, and was significantly better at 3, 6, 12 months than that at baseline (t=-5.636, -3.039, -3.833; P < 0.05) in IVR group. However there was no significant difference of the average BCVA in PDT group between follow-up at 1, 3, 6, l 2 months and baseline (t=1.973, 0.102, -0.100, -0.761; P > 0.05). The proportion of patients with complete regression of polyps at 6 months was higher in PDT (76.7%) or combination group (68.2%) than IVR group (35.7%) (χ2=0.003, 0.025; P < 0.05). There was no significant difference of CRT among 3 groups at baseline (P=0.651). The mean CRT decreased in all 3 treatment groups over 6 months (t=5.120, 3.635, 5.253; P < 0.05), but there was no significant difference of CRT among 3 groups (F=1.293, P > 0.05). ConclusionsThree therapies could effectively decrease CRT. IVR or IVR combined with PDT are both more effective than PDT therapy to improve vision of PCV patients. PDT or PDT combined with IVR was superior to IVR pnly in achieving complete regression of polyps in 6 months in PCV patients.
Objective To establish an rat model of the Anterior Isc hemic Optic Neuropathy (rAION), and identify its reliability by observing the fundus, fluorescein fundus angiography (FFA),optical coherence tomography (OCT), v isually evoked potential (VEP) and histopathology. Methods Thirty male Sprague-Dawley rats were randomly divided into group Naive with 5 rats, group Laser with 5 rats, group hematoporphyrin derivative(HPD) with 5 rats, group rAION with 15 rats. All of the right eyes were the experimental eyes and the left ones were the control. after administration of HPD in rats` vena caudalis. The rats in group Laser were treated with a krypton red 647nm/2/3disc spot laser for 120 seconds, the rats in group HPD were treated by administration of HPD in rats` vena caudalis, and the rats in group Na?ve were not treated. Results From 1 day to 6 day s after rAION induction, the ON was pale and swollen in the superior part. The ON at 90 days after induction was pale and shrunken.30 minutes after rAION induction, hyperfluoresc ence appeared in the superior part of the optic disc, and the hypofluorescence in the 23rd day. In early FFA, hypofluorescence appeared at the ischemic area of the optic disc, and in midst and later stage the ischemic area revealed hyperflu orescence in the 1st day after rAION induction, the hypofluorescence in midst and later stage in the sixth day after r-AION model. The latent period of F-VEP expanded. The amplitude cut down in the 1-2 days after r-AION induction and did not changed in 35nd day. The surface of optic disc showed higher and rougher tha n the surface of retina in the 6th day after r-AION induction in OCT. After fixation and hematoxylineosin staining of 6-mu;m sections, in high power field the o pt ic disc showed edema with the displacement of retina surrounding the disc 1 day after treatment. Rarefaction and degeneration in the nerve fiber of retina and r eduction of the number of nuclei of ganglion cells in the 23st day after the mod el induction, and the thinning of nerve fiber of the optic disc and its surround ings. In contrast, there was no change in group Na?ve, group Laser and group HPD. Conclusions The r-AION model is like the human AION in fundus, FFA, OCT, VEP and histopathology. The rAION model provides the ischemic changes of occurrence of AION, and is helpful for the fundamental study of the AION. (Chin J Ocul Fundus Dis,2008,24:90-94)
ObjectiveTo further compare the effect of intravitreal injection of bevacizumab (IVB) and photodynamic therapy (PDT) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia by meta-analysis. MethodsPertinent publications were identified through systemic searches of PubMed, EMBASE and the Cochrance Controlled Trials Register. All clinical comparative studies of IVB or PDT as initial treatment for CNV secondary to pathologic myopia were included. Meta analysis of these clinical trials was performed to analyze the effect of IVB and PDT for CNV secondary to pathologic myopia. Measurements included best corrected visual acuity (BCVA) and central foveal thickness (CFT). ResultsA total of 6 comparative studies involving 351 eyes were included. There were 196 eyes in IVB group and 215 eyes in PDT group. Funnel plots, Egger linear regression and Begg method did not show publication bias. Compared with PDT group, at 3, 6 and 12 months after IVB treatment, BCVA significantly increased . However, change of CFT at 3, 6 and 12 months did not vary significantly between IVB group and PDT group (3 months: WMD=-22.49, 95% CI=-93.49 to 48.52, P=0.53; 6 months: WMD=-17.34, 95% CI=-56.00 to 21.31, P=0.38; 12 months: WMD=-5.32, 95% CI=-56.37 to 45.74, P=0.84). ConclusionPatients with CNV secondary to pathologic myopia experienced a significant benefit of visual improvement after IVB, but reduction in CFT after the IVB or PDT did not vary significantly.
【摘要】 目的 探讨多发性骨髓瘤的临床特征及不同方案的疗效。 方法 回顾性分析2006年2月-2010年8月110例多发性骨髓瘤的临床特征及治疗情况，对不同方案的疗效进行比较。 结果 110例患者中Ⅲ期73例，40例伴发有基础疾病；24例接受MP方案，部分缓解10例，无变化1例，疾病进展8例，总有效率41.7%；其余86例接受联合化学疗法的患者完全缓解18例，部分缓解17例，轻微缓解30例，无变化17例，疾病进展4例，总有效率40.7%；两组总有效率差异无统计学意义（Plt;0.05）。联合化疗中PAD方案的总有效率最高，为62.5%。110例患者的中位生存期32.6个月，3年生存率为34.5%，加入沙利度胺组，总有效率为35.8%，3年生存率36.5%，联合硼替佐米治疗组总有效率为75%。 结论 多发性骨髓瘤患者多为晚期，有基础疾病，化疗后易感染，联合化疗组的有效率较MP方案高，但两组的总生存率无差异，加用新药沙利度胺或硼替佐米可以提高有效率。【Abstract】 Objective To analyze the clinical characteristics and clinical outcomes of patients with multiple myeloma treated with different regimens. Methods We retrospectively analyzed the clinical characteristics and treatments of 110 patients with multiple myeloma treated between February 2006 and August 2010, and compared the clinical outcomes of different treatment regimens. Results Seventy-three out of the 110 patients were at stage Ⅲ, and 40 patients had one or two more fundamental diseases. Twenty-two patients received MP regimen, among whom 10 gained partial alleviation, 1 had no change and 8 were aggravated with a total effective rate of 41.7%. Another 86 cases received combination chemotherapy, and among them, 18 gained complete alleviation, 17 attained partial alleviation, 30 achieved mild alleviation, 17 had no change, and 4 were aggravated with a total effective rate of 40.7%. In terms of the total effective rate, there was no statistical difference between these two groups. PAD-treated group had a highest effective rate of 62.5%. The median survival time for all the patients was 32.6 months; 3-year survival rate was 34.5%. For patients treated with thalidomide, the total effective rate and 3-year survival rate were 35.8% and 36.5% respectively, while for patients treated with bortezomib, the effective rate was 75%. Conclusions Patients with multiple myeloma at a late stage complicated with fundamental diseases can develop infections after chemotherapy. Total effective rate of combination chemotherapy is higher than that of MP treatment, but survival rate of the two treatments have no statistical difference. The effective rate can be increased after the using of novel agents such as thalidomide and bortezomib.