Search

Initiation of parenteral nutrition in critically ill children

Malnutrition is directly related to the outcomes of critically ill children. Providing ideal nutritional treatment can reduce the high catabolic state caused by the critically ill, reduce oxidative damage and regulate immune response, then improving clinical prognosis. Optimized nutritional supply for critically ill children has been transformed from auxiliary support to one of the important treatment methods. Enteral nutrition is the preferred way to provide nutrition, but parenteral nutrition is the only method of supplement and replacement when the supply of enteral nutrition is insufficient or deficient. This article reviews the timing of parenteral nutrition initiation, protein and amino acids in parenteral nutrition, the mechanism of possible adverse effects in early parenteral nutrition, and issues related to parenteral nutrition in premature infants, in order to help clinicians in pediatric intensive care unit improve the evaluation and management of parenteral nutrition use.

索拉非尼在中晚期肝癌的临床应用进展

肝细胞癌（肝癌）是常见的恶性肿瘤，其肿瘤相关性死亡率高，手术切除是目前肝癌治疗的首选方法。但大多数肝癌患者在诊断时已不适合手术治疗，预后差；系统化学疗法也被认为不能延长晚期肝癌的生存期。索拉非尼是一种口服的多靶点多酪胺酸激酶抑制剂，近年来被临床研究证实能改善晚期肝癌患者生存期。因此，其在肝癌患者中的应用备受关注。现就索拉非尼在中晚期肝癌的临床应用进展作一综述。

晚期恶性黑色素瘤的新药治疗进展

恶性黑色素瘤是起源于神经嵴黑色素细胞的高度恶性肿瘤。近10年来，恶性黑色素瘤发病率日益增加。世界卫生组织报道全球每年新发皮肤恶性黑色素瘤大约13.2万例，而我国每年新发病例已超过1万例。恶性黑色素瘤易于远处转移和扩散，而晚期患者的治疗手段有限，预后极差。近年来，恶性黑色素瘤相关的研究进展迅速，已经发现遗传和免疫因素与恶性黑色素瘤的发生、发展密切相关，这为恶性黑色素瘤的靶向和免疫治疗奠定了基础。不断的新药临床研究取得了重要临床成果。该文就此进行了综述。

Current Status of Treatment and Progress of Radiotherapy for Local Recurrence of Rectal Cancer

肾脏癌肉瘤一例

血管肌纤维母细胞瘤1例并文献复习

目的:检索有关血管肌纤维母细胞瘤的文献。方法:检索中国期刊全文数据库、中文期刊全文数据库、万方数字化期刊全数据库。结果:检索的所有文献中血管肌纤维母细胞瘤均以个案报道,主要为女性,发病部位大多位于外阴,其次为阴道、宫颈、腹股沟,也有男性阴囊、腹股沟以及1例口底区的报告。结论:血管肌纤维母细胞瘤多为良性病变,彻底手术切除后无复发,但也有复发及恶变报道,应做长期随访观察。

成人肾恶性横纹肌样瘤1例

膀胱小细胞癌一例

【摘要】　目的　总结膀胱小细胞癌的诊断及治疗。　方法　2009年8月1例行根治性膀胱切除、回肠代膀胱术患者经病理学、免疫组织化学检查确诊为膀胱小细胞癌。患者接受EP治疗方案治疗。　结果　治疗4周期后，复查CT未见转移，无Ⅲ~Ⅳ级毒副反应。　结论　膀胱小细胞癌需依靠病理学及免疫组织化学检查确诊，治疗目前参考小细胞肺癌治疗方案，以化学疗法为主，复习文献得出有无手术切除并不影响膀胱小细胞癌患者的预后，靶向药物的治疗尚需进一步研究。

Clinical Observation of Oxaliplatin Combined With S1 Capsule for Advanced Gastric Cancer

【摘要】　目的　探讨替吉奥胶囊联合奥沙利铂治疗晚期胃癌的近期疗效和毒性反应。　方法　2010年1-7月，16例晚期胃癌患者根据体表面积来确定初始剂量，体表面积lt;1.25 m2，替吉奥胶囊40 mg/次，2次/d；体表面积1.25~1.5 m2，替吉奥胶囊50 mg/次，2次/d；体表面积gt;1.5 m2，替吉奥胶囊60 mg/次，2次/d，早、晚饭后分别口服1次，连续服用28 d，停药14 d。奥沙利铂注射液130 mg/m2加入5%葡萄糖注射液500 mL避光缓慢静gt;2 h，第1、21天重复，连用2周期。按RECIST 1.1标准评价客观疗效和不良反应。　结果　16例患者中PR 9例（56.3%），SD3例（18.8%），PD 4例（25%），总有效率为69.0%。不良反应主要是血液学毒性、胃肠道反应及外周神经毒性，且均在Ⅰ~Ⅱ。　结论　替吉奥胶囊联合奥沙利铂方案治疗晚期胃癌的近期疗效较好，不良反应可以耐受，值得进一步研究应用。【Abstract】　Objective　To explore the early efficacy of Oxaliplatin combined with S1 capsule on advanced gastric cancer and observe the toxicity.　Methods　A total of 16 patients with advanced gastric cancer from January to July 2010 were treated with chemotherapy: oxaliplatin 130 mg/m2 mixed with 5% glucose injection 500 mL in the first day and repeated in the 21st day; Po after breakfast and dinner: S1 capsule with an initial dose according to the body surface area. Body surface lt;1.25 m2, 40 mg once, twice per day; body surface:1.25-1.5 m2,50 mg once, twice per day; body surface gt;1.5 m2, 60 mg once, twice per day. The medication lasted for 28 days, withdrew for 14 days. All of the patients underwent the treatment for two cycles. Efficacy and toxicities were evaluated according to the RECIST 1.1 standard.　Results　Of the 16 patients, partial remission (PR) was in nine (56.3%), stable disease was in three (18.8%) (SD), and progression disease was in four (PD). The total response rate was 69.0%. The major toxicities included leucopenia, nausea, vomiting and neurosensory abnormity.　Conclusion　Oxaliplatin combined with S1 capsule is effective on advanced gastric cancer, and the adverse effects are tolerable.

Dosimetric Comparison among Volumetric-modulated Arc Therapy, Intensity-modulated Radiotherapy and Three-dimensional Conformal Radiotherapy as Adjuvant Radiotherapy for Cervical Cancer

ObjectiveTo compare the dosimetric differences among the double-arc volumetric-modulated arc therapy (VMAT), 7 field intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) techniques in treatment planning for cervical cancer as adjuvant radiotherapy. MethodFifteen patients who underwent adjuvant chemotherapy for cervical cancer between March 1st and September 30th, 2013 were chosen to be our study subjects through random sampling. Under Pinnacle 9.2 planning system, the same CT image was designed through three different techniques:VMAT, IMRT and 3D-CRT. We then compared target zone fitness index, evenness index, D98%, D2%, D50% among those different techniques. Monitor unit (MU) and treatment time were also analyzed. ResultsThree techniques showed similar target dose coverage. The IMRT and VMAT plans achieved better target dose conformity, which reduced the V20 of the pelvic, the V50 of the rectum and bladder, as well as the V40/50 of the small intestine (P<0.05). The VMAT technique showed few dosimetric advantages over the IMRT technique. VMAT technique had the advantages of less MU (P>0.05) and shorter overall treatment time (P<0.01) compared with IMRT technique. ConclusionsThe IMRT and VMAT plans achieve similar dose distribution to the target, and are superior to the 3D-CRT plans, in adjuvant radiotherapy for cervical cancer. VMAT technique has the advantages of less MU and shorter overall treatment time.