Clinical efficacy and influencing factors of 125I seeds implantation in the treatment of patients with advanced lung cancer after radiotherapy and chemotherapy / 中华核医学与分子影像杂志

Objective:To investigate the clinical efficacy and prognostic factors of 125I seeds implantation in the treatment of patients with advanced lung cancer after radiotherapy and chemotherapy. Methods:From January 2017 to December 2019, 44 patients (39 males, 5 females, age 41-84 years) with advanced lung cancer after radiotherapy and chemotherapy who received 125I seeds implantation in Hebei General Hospital were retrospectively analyzed. All patients were followed up for ≥12 months, and the clinical efficacies were observed. χ2 test was used to analyze the difference of effective rates between groups. The cut-off value of postoperative dose delivered to 90% gross tumor volume ( D90) was obtained by ROC curve analysis. Kaplan-Meier method was used to calculate the survival rate and log-rank test was used for univariate analysis. Cox proportional hazards model was used for multivariate analysis to find the influencing factors for clinical efficacy. Results:The total effective rate was 72.73%(32/44) after 6 months treatment. The cut-off value of D90 was 120 Gy with the AUC of 0.771. The short-term effective rate of D90≥120 Gy group was better than that of D90<120 Gy group (18/19 vs 56.00%(14/25); χ2=8.17, P=0.004). The 1-year survival rate was 77.27%(34/44). Univariate analysis showed that age ( χ2=3.99, P=0.046), preoperative Hb ( χ2=10.60, P=0.001), tumor maximum diameter ( χ2=11.50, P=0.001) and postoperative D90( χ2=5.81, P=0.016) could affect the survival of patients. Multivariate analysis showed that preoperative Hb (hazard ratio ( HR)=0.023, 95% CI: 0.001-0.882, P=0.043) and tumor maximum diameter ( HR=40.889, 95% CI: 1.458-1 146.586, P=0.029) were prognostic factors. Conclusions:125I seeds implantation shows a good effect in the treatment of lung cancer patients after the progress of radiotherapy and chemotherapy. The short-term effect of patients with D90≥120 Gy is better than that of patients with D90<120 Gy. Preoperative Hb and tumor maximum diameter are prognostic factors of survival after implantation.

Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Community acquired pneumonia (CAP) is one of the most common infectious disease in emergency department. In 2005 the concept of healthcare associated pneumonia (HCAP) was proposed by the ATS/IDSA guidelines. The clinical features and microbiology of HCAP are different from CAP, however, the initial antimicrobial treatment is still controversial. We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guideline-concordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents.</p><p><b>METHODS</b>We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012. Patients were divided into 2 groups according to their different initial antimicrobial treatment. We compared clinical features, distribution of pathogen, severity, days and spending on intravenous antimicrobial, length and charge of hospitalization and clinical outcomes, and meanwhile analyzed the clinical efficacy as well.</p><p><b>RESULTS</b>Of the 125 HCAP patients, 55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents. The major pathogens were Klebsiella pneumoniae, methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Escherichia coli. The 2 groups were similar at baseline, including old age, comorbidities, Pneumonia Severity Index scores, APACHE scores, and length of intravenous antimicrobial use and hospitalization duration, and in-hospital mortality. Overall efficacy rate occurred in 70.0% of HCAP agent patients and 50.9% of CAP agent patients (P = 0.029). Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients.</p><p><b>CONCLUSIONS</b>Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate, as well as antimicrobial charge and total hospital charge, but was not associated with shortening the length of stay, or lowering in-hospital mortality.</p>

The effect of hypothermia on the early inflammatory reaction in acute lung injury induced by intestinal ischemia-reperfusion in rabbits / 中华急诊医学杂志

Objective To study the effect of hypothemah on the early inflammatory reaction in acute lung injury induced by intestinal ischemia-repeffusion(IlR)in rabbits.Method Seventy-two healthy rabbits provided by Peking Union Medical Colege Hospital Anhnal center were randomly divided into four groups(n=18 pergroup):(1)normothermia control group (rectal temperature 37-38 C;sham group);(2)normothermia IlR group(rectal temperature 37-38 C);(3)mild hypothermia HR group(rectal temperature 32-35℃);and (4)moderate hypothermia IIR group(rectal temperature 28-31.9C).Acute lung injury was induced by claIllp.ithe superiornteric artery(SMA)for 1 hour and declamping the SMA for 6 hours.Hypothermia WaS induced by surface cooling.Before and 2.4 and 6 hours after IIR,the Olasmlevels o,IL-,IL-6 and IL10 were measured.All rabbits were killed 6 hours after IIR and water content in lung tissue Wttk'assessed.Iaght mieropic examination was performed tbr morphological assessment of the hmg.The data were analyzed by AN()VA.Statistical significance wag dned as a P of<0.05.Results In the IIR groups,the plasma levels ofTHE-a.IL-l,IL-6 and IL-10 and lung water were increased.There Was evidence of acute lung injury from morphologi-cal assessment of the lung.The acute lung injury induced by IIR was improved by hypethennia.Mild hypothermia Was similar to moderate hypothermia for the treatment of acute lung injury induced by IIR.ConclusiotMild hy-pothermia and moderate hypothermia Can significantly improve acute lung injury induced by IIR in rabbits.Mild hypothea had similar efficacy to moderate hypothermia for the treatment of acute lung injury induced by IIR.

A comparison of ropivacaine of different concentration for interscalene brachial plexus block on children / 中国基层医药

Objective To investigate the efficacy and safety to children of different concentration ropivacaine used for braehial plexus block in upper-limb paediatfic surgery.Methods After undergoing basal anesthesia with ketamine,100 children scheduled for hand and forearm surgery were randomly allocated to receive brachial olexus block.Brachial plexus block was performed separately with 0.33% ,0.25% ,0.2% ,0.167% ropivacaine in four group.The onset time and complete time of sensory blockade of ulner nerve,medial nerve and radial nerve;duration of analgesia;satisfaction degree of nerve block and complications were recorded.Results MAP and HR in group D was higher than before anesthesia at T1,T2,T3,and was higher compared with other three groups at T1,T2 ,T3.There wasn' t significantly difference in anesthetic effect among A,B,C group and D group was the worst,compared with other three groups.The amount of ketamine and the rate of adverse reactions in D group was significantly more than that in other three groups.The time of analgesic and movement to restore was shorter than that in other three groups.Conclusion 0.25% ropivacaine was more applicable to children with anesthetized perfectly and less complication.