Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations. Methods According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.
Objective To investigate the protective effects of cardioplegic solution with creatine phosphate on donor heart preservation in rats, and the possibility of prolonging outofbody heart preservation in lack of blood supply to improve on transplantation quality. Methods Twenty Wistar rats were randomly divided into two groups, control group (n=10): pure St.ThomasⅡ cardioplegic solution was perfused to protect donor hearts; experimental group (n=10): St.ThomasⅡ cardioplegic solution with 2.5g/L sodium creatine phosphate was perfused to protect donor hearts. After 4 hours of refrigerated preservation, myocardial tissues were tested for adenosinetriphosphate(ATP) level and super oxide dismutase (SOD) activity. Cardiac ultrastructure and mitochondria swelling condition were monitored with light and electron microscopes. Results After the 4hour low temperature preservation of donor hearts, ATP content in experimental group cardiac tissue was significantly higher than that in control group (2.75±0.99μmol/mg vs. 1.77±0.86μmol/mg, Plt;0.05); SOD in experimental group cardiac tissue was significantly higher than that in control group（49.6±2.52 U/mg vs. 45.27±2.21 U/mg，Plt;0.05）. Electron microscopic inspection demonstrates that in the control group, chromatin condensed and dissolved inside the nuclear membrane; mitochondria ridge gap disappeared; myocardial cell pyknosis and mesenchymal vascular endothelia necrosis appeared. In contrast, myocardial cell nuclei remained in the center; sarcomere band structure was distinct; sarcoplasmic reticulum expanded and intercalated disk band structure was clear in experimental group. Conclusion Cardioplegic solution with creatine phosphate is able to enhance donor heart myocardial protection significantly.
目的 評估非小細胞肺癌患者中癌癥相關性乏力的發生情況及其與患者臨床病理特征和生存期之間的相互關系。 方法 應用簡明疲勞量表中文版評估2008年12月－2009年12月間收治的72例初治肺癌患者，入組患者均完成根治性手術及術后生存隨訪。 結果 72例早期非小細胞肺癌患者中，無乏力9例（12.5%），輕度乏力48例（66.7%），中度乏力15例（20.8%），重度乏力0例（0%），乏力總體發生率為87.5%。乏力指數與患者的年齡、性別、吸煙史均無相關性，與患者的體力狀況評分（ECOG PS）、TNM分期呈正相關，與中位生存期呈負相關，均有統計學意義（P＜0.05）。 結論 癌癥相關性乏力作為非小細胞肺癌患者中普遍存在的一種癥狀，不僅能夠反映患者當時的主觀感受和生活狀況，還可能是判斷患者術后病理分期及最終總生存期的預測因素。
Objective To compare germicidal effect of three disinfectants acting on frequently-touched surfaces in Intensive Care Unit (ICU) at different time points after disinfection so as to put forward the reasonable disinfection method and interval before the next disinfection. Methods We wiped the four frequently-touched surfaces in ICU with disinfectant containing acidic electrolyzed oxidizing water (EOW) from the building system of hospital, disinfectant wipes, and 500 mg/L chlorine respectively. The culture samples were collected from the surfaces before wiping, and 10 minutes, 30 minutes, 1 hour, 2 hours and 4 hours after wiping respectively. The bacterial clearance rate and the qualified rate of bacterial colony counts on the surfaces were compared among the three different disinfectants at different time points after disinfection. Results The bacterial killing rate of three methods for disinfection of object surfaces decreased with the passing of time. The bacterial killing rate of EOW from the building system of hospital was lower than that of the other two methods at all five time points after disinfection (P< 0.05). The bacterial killing rate at hour four after disinfection using chlorine-containing disinfectant and disinfectant wipes was higher than 90.0%. The qualified rate of bacterial colony counts on the surfaces at 10 and 30 minutes after disinfection among the three groups was not significantly different (P>0.05). The qualified rate of bacterial colony counts on the surfaces disinfected by EOW from the building system of hospital was lower than that in the other two groups at the other three time points (P<0.05), and it was totally unqualified at hour four after disinfection. Conclusions The germicidal effect of EOW from the building system of hospital is inferior to chlorine disinfectant and disinfectant wipes. Moreover, the surface can be easily recontaminated after disinfection. It is suggested that EOW should be used in ICU every other hour. and the other two disinfection methods should be used every two hours.
【摘要】 目的 研究2型糖尿病（type 2 diabetes mellitus，T2DM）合并非酒精性脂肪性肝病（non-alcoholic fatty liver disease， NAFLD）患者血漿脂肪細胞特異性脂肪酸結合蛋白（adipocyte-specific fatty acid-binding protein，A-FABP）的水平及其相關因素。 方法 2009年10月—2010年10月選取T2DM合并NAFLD組（A組）60例，未合并NAFLD組56例（B組）為研究對象。測定體質量指數（body mass index，BMI），檢測血脂、糖化血紅蛋白（hemoglobin A1c，HbA1c）等生化指標。放射免疫法測定空腹胰島素（fasting insulin，FINS），空腹C肽水平（fasting C-peptide，FCP），計算胰島素抵抗指數（homeostasis model of assessment-insulin resistance，HOMA-IR）、胰島素敏感指數（insulin sensitivity index，ISI），測定A-FABP、C反應蛋白（C-reaction protein，CRP）及腫瘤壞死因子-α（tumor necrosis factor-α，TNF-α）。 結果 與B組患者相比，A組患者其血漿A-FABP水平、BMI、腰圍、腰臀比、丙氨酸氨基轉移酶、門冬氨酸氨基轉移酶、CRP、TNF-α、FCP、FINS、總膽固醇、甘油三酯、Ln（HOMA-IR）升高，Ln（ISI）降低，差異有統計學意義（Plt;0.05）；兩組HbA1c差異無統計學意義（Pgt;0.05）。A-FABP水平變化與TNF-α、HOMA-IR、CRP呈正相關，與ISI呈負相關。 結論 T2DM伴NAFLD中，A-FABP升高與胰島素抵抗是并存的，且存在明顯相關關系，二者在疾病的發生發展中均可能具有重要的作用。【Abstract】 Objective To analyze the serum level of adipocyte-specific fatty acid-binding protein (A-FABP) in patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD), and its related factors. Methods From October 2009 to October 2010, 112 patients with T2DM were categorized into two groups: the group with NAFLD (group A) with 60 patients, and the group without NAFLD (group B) with 56 patients. Body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and hemoglobin A1c (HbA1c) were detected. Radioimmunoassay was carried out to measure fasting insulin (FINS) and fasting C-peptide (FCP), and homeostasis model of assessment-insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) were calculated. At the same time, A-FABP, C-reaction protein (CRP) and tumor necrosis factor-α (TNF-α) were also detected. Results Compared with patients in group B, plasma levels of A-FABP, BMI, waistline, waist to hip ratio, ALT, AST, TG, TC, HDL-C, LDL-C, CRP, FCP, FINS, and HOMA-IR for patients in group A were all higher, while ISI was lower; and the differences in the above-mentioned parameters were statistically significant (Plt;0.05). The levels of HbA1c in the two groups were not significantly different (Pgt;0.05). The change of A-FABP level was positively correlated with TNF-α, HOMA-IR and CRP, while it wasnegatively correlated with ISI. Conclusions In patients with T2DM with NAFLD, there is an obvious correlation between the coexisting A-FABP rise and insulin resistance. Both of them played critical roles in the onset and developing of the disease.