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。
【摘要】 目的 观察时辰化学疗法联合放射治疗对比常规化学疗法联合放射治疗对鼻咽癌的近期疗效及其不良反应。 方法 2006年2月-2010年3月经病理学证实未接受过化学疗法的38例晚期鼻咽癌患者随机分为常规化学疗法联合放射治疗组（A组，n=20）和时辰化学疗法联合放射治疗组（B组，n=18）。两组均采用常规二维放射治疗。A组化学疗法方案为顺铂（DDP）80 mg/m2，采用完全水化方案，第1天静脉滴注；氟尿嘧啶800 mg/（m2•d），第2~6天120 h连续静脉滴注。B组时辰化学疗法采用Melodies多通道编程输液泵进行正弦曲线式时间调节给药。两组均为DDP 80 mg/m2，于10:00~22:00给药，浓度高峰设定在16:00；氟尿嘧啶800 mg/m2，于22:00~次日10:00给药，浓度高峰设定在凌晨4:00。每21天重复1次，行2~6疗程。 结果 A组3程化学疗法后有效率（PR）为95%（19/20），全程结束完全缓解率（complete remission，CR）达75%（15/20）；B组在2程化学疗法后PR达100%，全程治疗结束CR达94.4%（17/18）。两组不良反应主要为迟发性血小板减少，发生率分别为35%（7/20）和22.2%（4/18），其他不良反应两组间无明显差别。 结论 时辰化学疗法联合放射治疗对晚期鼻咽癌在减轻化学疗法造成的血小板减少方面有明显的优势，值得临床推广应用以及进一步发掘时辰化学疗法在临床治疗的价值。【Abstract】 Objective To investigate the efficacy and the adverse effects of routine chemotherapy and chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal cancer patients. Methods From March 2006 to March 2010, 38 patients diagnosed pathologically to have advanced nasopharyngeal cancer were randomly divided to the routine chemotherapy and radiotherapy group (group A, n=20) and the chrono-chemotherapy and radiotherapy group (group B, n=18). Patients in both groups received bi-dimensional radiotherapy. Patients in group A received a full hydration method, cisplatin (DDP) 80 mg/m2 intravenous infusion was also carried out on day 1; fluorouracil 800 mg/(m2•d) chemotherapy, and 120 hours of continuous intravenous infusion from day 2 to day 6. For patients in group B, Melodies multi-channel infusion pump programming to adjust the time of drug administering with a sinusoidal style was adopted; DDP 80 mg/m2 was administered intravenously on day 1 between 10:00 and 22:00 with the peak concentration set at 16:00; fluorouracil 800 mg/m2 was administered between 22:00 and 10:00 on the next day from day 2 to day 6 with the concentration peak set at 4:00. The treatments in both groups were repeated every 21 days, which was repeated for two to six courses of tremtment. Results After three courses of treatment for group A, partial response (PR) rate was 95% (19/20), and after six courses of treatment, the complete remission (CR) rate was 75% (15/20); After two courses of treatment for group B, the PR rate was 100%, and after six courses of treatment, the CR rate was 94.4% (17/18). The main adverse effect was thrombocytopenia at an incidence rate of 35% (7/20) and 22.4% (4/18) in the two groups respectively. There was no obvious difference in other adverse effects between the two groups. Conclusion Chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal carcinoma has obvious advantages in reducing thrombocytopenia caused by chemotherapy, and it is worth further exploring the clinical applications and values of chrono-chemotherapy.
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.
Objective lt;brgt;To study the clinical results and safty of photodynamic therapy (PDT) after single and multi-treatments of patients with subfoveal choroidal neovascularization (CNV) caused by wet agerelated macular degeneration (AMD). lt;brgt; lt;brgt;Methods lt;brgt;From July, 2000 to July, 2001, 20 wet AMD patients (31 eyes) 4788 years old (mean 68.2 years old) with best-corrected visual acuity from FC/10 cm to 0.6 diagnosed through optic coherence tomography (OCT), fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were treated with PDT. All cases were assigned to benzoporphyrin derivative mono acid (BPD) (6 mg per square meter of body surface area), administered via intravenous infusion of 30 ml over 10 minutes. Fifteen minutes after the start of the infusion, a laser light at 689 nm (Zeiss company, German) delivered 50 J/cm2 at an intensity of 600 mW/cm2 over 83 seconds on CNV. Visual acuity, photochrome of ocular fundus, OCT, FFA, ICGA were used to evaluate the effects of photodynamic therapy with BPD. Follow-up of these patients was planned 1-2 week and every 3 month after PDT. Once the lesion area progressed, PDT was applied again. Tweenty cases (31 eyes) were followed up from 3 to 18 months (average 12 month).In 1 affected eye, PDT was applied fow 4 times, 4 eye for 2 times, and the other 26 eyes for 1 time. lt;brgt;Results lt;brgt;The visual acuity in 13 (41.9%) eyes was improved (increase≥2 lines) after PDT. Stabilized (±1 line) in 17 (54.8%) eyes and decreased 2 lines（attributed to the recur of CNV ）in 1 (3.2%) eye. After PDT, the fundus haemorrhage and fluid leakage reduced. FFA and ICGA showed. cessation and obvious reduction of fluorescein leakage from CNV in all patients 2 weeks after photodynamic therapy, and retreatment decreased the leakage step by step. Fluorescein leakage from at least a portion of the CNV reappeared by 1-3 month after treatment in some cases. OCT also showed the reduction of the size of CNV, moreover, the edema of surrounding retina and choriodal and serous neural epithelial detachment recovered obviously. No side affect during and after PDT was noticed. lt;brgt;Conclusions lt;brgt;PDT with BPD can achieve short-term effect on part or total cessation of fluorescein leakage from CNV without loss of vision or growth of classic CNV in patients with age-related macular degeneration, retreatment of PDT was also effective. lt;brgt; lt;brgt;(Chin J Ocul Fundus Dis, 2002, 18: 175-179)
目的 探讨电化学疗法(EChT)对肝海绵状血管瘤(CHL)的治疗价值。方法 应用EChT在剖腹下治疗8例CHL，17个瘤灶。1例合并结节性肝硬变，5例为多发性CHL，14个瘤灶。结果 治疗过程中肝出血量均不超过20 ml。术后无胆漏、腹腔内出血、黄疸、气体栓塞等并发症产生。治疗后随访5～7年，无1例出现瘤灶复发。结论 EChT是治疗CHL的安全而有效的新方法，适合伴有背景肝病的CHL和多发性CHL的治疗，且易于在基层医院推广。
Objective To evaluate the safety and efficacy of gefitinib in comparison with platinum-based doublets chemotherapy as a first-line precision treatment for advanced non-small cell lung cancer (NSCLC), and find the benefit population of gefitinib. Methods The Cochrane Library, PubMed, Embase, China National Knowledge Internet, VIP database and China Biology Medicine database were searched to collect the randomized contolled trials (RCTs) of gefitinib vs. platinum-based doublets chemotherapy for advanced NSCLC from inception to November, 2017. The data in the included RCTs were extracted, and the qualities were assessed in accordance with Cochrane Collaboration, and a Meta-analysis was conducted with RevMan 5.3 software. Results Four trials were included, including 968 subjects in the gefitinib group and 968 subjects in the chemotherapy group, and a majority of the subjects were diagnosed advanced adenocarcinoma, and all of the subjects were East Asians. The results of Meta-analysis showed that in all population or patients with epidermal growth factor receptor (EGFR) mutation-positive, gefitinib was better than chemotherapy in progression-free survival (PFS) [in all population: hazard ratio (HR)=0.76, 95% confidence interval (CI) (0.67, 0.85), P<0.000 01; in patients withEGFR mutation-positive: HR=0.42, 95%CI (0.35, 0.50), P<0.000 01] and objective response rate (ORR) [in all population: risk ratio (RR)=1.30, 95%CI (1.15, 1.47), P<0.000 1; in patients withEGFR mutation-positive: RR=1.92, 95%CI (1.46, 2.52), P<0.000 01], and there was no significant difference between the two groups in overall survival (OS) (P>0.05); but inEGFR mutation-negative, chemotherapy was better than gefitinib in PFS [HR=2.09, 95%CI (1.05, 4.13), P=0.03]. Subgroup analysis showed that in female patients, for patients with Performance Status (PS) score 0 or 1, and the ones who never smoked, gefitinib was better than chemotherapy in PFS (P<0.05); but there was no significant difference between the two groups in OS (P>0.05). The incidences of rash, itching, dry skin, paronychia, diarrhea, aminotransferase abnormality were higher in the gefitinib group (P<0.05), while the incidences of hair loss, vomiting, nausea, constipation, anorexia, leukopenia, thrombocytopenia, and neutropenia, anemia, fatigue, nerve toxicity reaction were higher in the chemotherapy group (P<0.05). Conclutions Based on the current evidence, in patients with adenocarcinoma of East Asians, the benefit population are those with the characteristics of EGFR mutation-positive, female, never smoking, and PS 0 or 1. In the aspect of safety, the common adverse drug events in subjects treated with gefitinib are the damage of skin mucous membrane, but the incidences of digestive system diseases and the blood system diseases are less in patients treated with gefitinib than those with chemotherapy.
ObjectiveTo evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Methods35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT. Best-corrected visual acuity(BCVA), central macular thickness (CMT) were measured before and after treatment (1, 3 and 6 months). The mean BCVA was 0.28±0.22, mean CMT was(384.5±85.0)μm. The situation of subretinal fluids (SRF) absorption was observed. ResultsIn 35 eyes, SRF of 29 eyes (82.9%) completely absorbed and 6 eyes (17.1%) not completely absorbed after one month of treatment. SRF of all eyes (100.0%) completely absorbed after three months of treatment. After 6 months of treatment, SRF of 3 eyes (8.6%) were recurrence, which might be completely absorbed when a half-dose maintenance therapy PDT was used again. The mean BCVA significantly improved to 0.14±0.13 at 1 months, 0.05±0.11 at 3 months and 0.05±0.12 at 6 months after PDT (t=5.410, 7.830, 7.758; P < 0.05). The mean CMT decreased to (224.3±61.4) μm at 1 months, (199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856, 11.781, 11.900; P < 0.05). The mean CMT of controlled 32 eyes after treatment was (198.5±33.9) μm, much lower than the fellow eyes(232.3±17.5) μm (t=-3.988, P < 0.05). ConclusionsHalf-dose verteporfin PDT was safe and effective in treating chronic CSC, but may cause thinning of CMT.
Objective To analyze the efficacy and safety of Intra-arterial chemotherapy (IAC) as secondly treatment in children with retinoblastoma (RB). Methods 42 eyes of 34 consecutive RB patients were enrolled in the study after intravenous chemotherapy (IVC), including 26 males and 8 females. The average age is 14.1 months. 21 cases were bilateral and 7 cases were unilateral. A total of 42 eyes of 34 patients were classified according to the International Intraocular Retinoblastoma Classification（IIRC）as group B(n=1, 2.4%), group C (n=3, 7.1%), group D (n=32, 76.2%), or group E (n=6, 14.3%). Tumor recurrence and tumor enlargement after IVC were 4 and 10 eyes respectively, accounting for 9.0% and 24.0% respectively. Sequential treatment after IVC followed by IAC were 28 eyes, accounting for 67.0%. All treatment eyes received IAC combined with laser, cryotherapy and other eye local treatment. The IAC regimen adopted the combination and alternation administration mode, by the combination of melphalan and carboplatin or the combination of melphalan and topotecan. According to the tumor changes after IAC decide whether IAC again. If tumors increased, vitreous or subretinal implants increased will be termination of IAC and enucleation. The mean follow-up time was (21.4±3.7) months after the last IAC treatment and (6.2±2.9) months after enucleation. Ocular preservation rate and complication were evaluated. Results The average IAC procedures performed on 42 eyes were (4.0±0.9). An overall ocular preservation rate of 76.2% was observed during follow-up periods due to calcification or inactivation of tumors (32 eyes), including group B (n=1, 100%), group C (n=1, 33.3%), group D (n=27, 84.4%), group E (n=3, 50%). 10 eyes were enucleated. Among them, 2 eyes of the tumor did not shrink after IAC, tumor recurrence (n=3), vitreous hemorrhage (n=3), enophthalmos (n=1), vitreous disseminated (n=1). 34 cases of children, transient eyelid oedema were 18 cases, vitreous hemorrhage and bone marrow suppression (Ⅰ-Ⅳ) were 1, 22 casese respectively. Conclusions IAC as secondly treatment is safe and effective for RB patients, however, there is still tumor recurrence. No serious ocular local and systemic complications were observed.
Objective To evaluate short-term effects of a single photodynamic therapy (PDT) treatment with visudyne (CIBA Vision Corp.) for choroidal neovascularization (CNV) in age-ralated macular degeneration (AMD). Methods Thirty cases (35 eyes) diagnosed as AMD patients with classic CNV were treated with PDT. The data of visual acuity testing, fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography （OCT) were used to evaluate the effects of a single treatment of PDT before and 1 week, 1 ,3 month after treatment. Results The visual acuity of 34 eyes were stable or improved in 3 months follow-up；and the visual acuity of 1 eye was decreased. Decrease or dispearance of fluorescein leakage from CNV was noted in 19 eyes. No serious complication occurred. Conclusion Single treatment of PDT for CNV in AMD can achieve short-term decrease or cessation of fluorescein leakage from CNV without loss of visual acuity. (Chin J Ocul Fundus Dis, 2002, 18: 171-174)