Considerations of treatment standardization from the procession of NCCN guideline of esophagealcancer

Esophageal carcinoma is one of the most common malignant tumors, especially in China which is the high incidence area. As a result of mild symptoms of early-stage esophageal cancer, the majority of patients cannot be diagnosed until they develop to advanced cancer, and the treatment outcome of surgery or chemoradiotherapy is still unsatisfactory at present. The guidelines of esophageal cancer issued by National Comprehensive Cancer Network (NCCN) are regarded as important reference tools by clinical oncologists, and provide uniform criteria for the diagnosis and treatment of esophageal carcinoma. However, the guidelines are not always suitable for Chinese patients because the data come from European and American population which have significant ethnical difference from Chinese. We retrospectively analyzed the changes of treatment strategy of esophageal cancer in NCCN guidelines and the advance of treatment for esophageal carcinoma in China, aiming to provide our oncologists with new research ideas. We also hope to set up clinical cancer cooperation organizations, and release our own cancer guidelines to serve Chinese patients and oncologists.

Chinese quality control indices for standardized diagnosis and treatment of renal cancer(2022 edition)

Renal cancer is one of the most common malignancies of the urinary system,and the number of deaths continues to increase.The standardized management of the diagnosis and treatment of renal cancer is challenging due to the great differences in the diagnosis and treatment of renal cancer in different regions.The Renal Cancer Expert Committee of the National Cancer Quality Control Center(NCQCC)identified a lack of authoritative quality control standards as an opportunity to utilize its multidisciplinary membership to improve the standardized diagnosis and treatment of renal cancer.The Renal Cancer Expert Committee of the NCQCC aims to promote quality control and national standardization,uniformity,and normalization of renal cancer diagnosis and treatment,which ultimately improved the survival rate and quality of life of renal cancer patients.A panel of experts with renal cancer surgery,renal cancer medicine,medical imaging,pathology and radiotherapy were drawn together and determined the quality control standards for the standardized diagnosis and treatment of renal cancer.The Indices includes 20 items that cover all key areas in the diagnosis and treatment of renal cancer,such as standard diagnosis,surgery treatment,systemic treatment,and prognostic evaluation.

Effect of standard heat treatment on microstructure and properties of borided Inconel 718

Boronizing was applied to Inconel 718. In order to obtain the optimal combination of strength and ductility, the borided Inconel 718 was subjected to standard heat treatment. This consists of solution treatment and then a two-step aging treatment. The borided layer is composed of the compound layer and the boron diffusion zone. Because of the superior hardness of borides, the borided Inconel 718 exhibits a significant reduction in its wear rate and relatively low coefficient of friction （COF） compared with the unborided Inconel 718. The standard heat treatment efficiently promotes the diffusion of boron into the interior of the material and the generation of new borides （Fe2B, CrB）. The borided layer with standard heat treatment shows much better wear resistance due to the thicker borided layer （313.76 μm）.

Autoimmune hepatitis: standard treatment and systematic review of alternative treatments

Autoimmune hepatitis is a rare chronic inflammatory liver disease,affecting all ages,characterised by elevated transaminase and immunoglobulin G levels,positive autoantibodies,interface hepatitis at liver histology and good response to immunosuppressive treatment. If untreated,it has a poor prognosis. The aim of this review is to summarize the evidence for standard treatment and to provide a systematic review on alternative treatments for adults and children. Standard treatment is based on steroids and azathioprine,and leads to disease remission in 80%-90% of patients. Alternative first line treatment has been attempted with budesonide or cyclosporine,but their superiority compared to standard treatment remains to be demonstrated. Second-line treatments are needed for patients not responding or intolerant to standard treatment. No randomized controlled trials have been performed for second-line options. Mycophenolate mofetil is the most widely used second-line drug,and has good efficacy particularly for patients intolerant to azathioprine,but has the major disadvantage of being teratogenic. Only few and heterogeneous data on cyclosporine,tacrolimus,everolimus and sirolimus are available. More recently,experience with the anti-tumour necrosis factoralpha infliximab and the anti-CD20 rituximab has been published,with ambivalent results; these agents may have severe side-effects and their use should be restricted to specialized centres. Clinical trials with new therapeutic options are ongoing.

Standard heat treatment effects on TLP bonded IN-738LC superalloy using BNi-9 filler:An approach to make an ideal joint

The present research is focused on the effects of standard heat treatment on the microstructure and mechanical properties of diffusion brazed IN-738 LC superalloy.Three distinct heat treatment cycles of full solution annealing,partial solution annealing,and aging treatment were applied to the bonded specimens,sequentially.The results reveal that bonding at 1120℃for 5 min leads to incomplete isothermal solidification and formation of eutectic phases including Ni-and Cr-rich borides in the joint centerline.Increasing the holding time to 45 min leads to the full isothermal solidification and formation of a nickel proeutectic solid-solution phase(γ)in the joints.The standard heat treatment of isothermally solidified and non-isothermally solidified specimens results in the complete elimination of the boride phases in the diffusion-affected zone and also the formation ofγ’precipitates in the isothermally solidified zone.However,discontinuously re-solidified products are observed in joint district in the non-isothermally solidified sample.The highest shear strength(~801 MPa)is achieved for isothermally solidified specimen after standard heat treatment;this strength is approximately 99%that of the substrate material.

Chinese quality control indices for standardized diagnosis and treatment of gastric cancer(2022 edition)

Gastric cancer is one of the most common malignancies of the digestive system,and the number of deaths continues to increase.The standardized management of the diagnosis and treatment of gastric cancer is challenging due to the great differences in the diagnosis and treatment of gastric cancer in different regions.The Gastric Cancer Expert Committee of the National Cancer Quality Control Center(NCQCC)identified a lack of authoritative quality control standards as an opportunity to utilize its multidisciplinary membership to improve the standardized diagnosis and treatment of gastric cancer.The Gastric Cancer Expert Committee of the NCQCC aims to promote quality control and national standardization,uniformity,and normalization of gastric cancer diagnosis and treatment,which ultimately improved the survival rate and quality of life of gastric cancer patients.A panel of experts with gastrointestinal cancer surgery,gastrointestinal cancer medicine,medical imaging,pathology and radiotherapy were drawn together and determined the quality control standards for the standardized diagnosis and treatment of gastric cancer.The authors then utilized a modified Delphi approach to generate consensus recommendations.

Quality control indices for standardized diagnosis and treatment of esophageal cancer in China (2022 edition)

Esophageal cancer(EC)is particularly common in China.With the continuing progress of multi-disciplinary therapy including early screening,minimally invasive techniques,radiotherapy and chemotherapy,the 5-year survival of EC has been improved in China.However,there are considerable disparities in the diagnosis and treatment quality among different regions.The Esophageal Cancer Expert Committee of the National Cancer Quality Control Center(NCQCC)considers a set of authoritative quality control standards as an opportunity to eliminate the disparities and improve the overall survival and quality of life of EC.To further promote the quality control for standardized diagnosis and treatment of EC,the National Cancer Center commissioned the Esophageal Cancer Quality Control Expert Committee to draft and formulate the Chinese Quality Control Indices for Standardized Diagnosis and Treatment of Esophageal Cancer(2022 edition).The Indices includes 21 items that cover all key areas in the diagnosis and treatment of esophageal cancer,such as medical oncology,radiation oncology,endoscopy,and pathology.

线上线下同伴导师协同式健康管理方案在农村糖尿病不规范治疗患者中的应用研究

背景农村糖尿病患者不规范治疗现象尤为严重,预防和控制糖尿病并发症,降低其致残率和死亡率是当前我国农村糖尿病健康管理的首要问题。目的探讨线上线下(O2O)同伴导师协同式健康管理对农村糖尿病不规范治疗患者的风险感知及糖尿病管理自我效能的影响。方法采用便利抽样法,选取2023年4—11月在大庆市让胡路区喇嘛甸镇的农村糖尿病不规范治疗患者90例作为研究对象,采用随机数字表法分为试验组45例和对照组45例。试验组采用O2O同伴导师协同式健康管理方案,干预时间为6个月,对照组采用常规慢性病健康管理。比较两组患者在风险感知及糖尿病管理自我效能方面的差异。结果试验组42例,对照组41例完成该研究。干预后试验组糖尿病风险感知量表得分为(43.86±7.00)分,高于对照组的(32.56±4.24)分(t=8.864,P<0.001);干预后试验组糖尿病管理自我效能量表得分为(100.45±16.74)分,高于对照组的(75.54±13.82)分(t=7.384,P<0.001)。结论O2O同伴导师协同式健康管理方案能有效提高农村糖尿病不规范治疗患者的风险感知及糖尿病管理自我效能,提高其健康管理水平。

IL-28B polymorphisms and treatment response in hepatitis C virus patients with persistently normal alanine aminotransferase

AIM:To examine the association between the interleukin 28B(IL-28B)genotype and treatment response in hepatitis C virus(HCV)-infected patients with persistently normal alanine aminotransferase(PNALT).METHODS:We compared the treatment response of HCV-infected patients with PNALT to that of patients with non-PNALT.Between February 2010 and April2013,278 patients infected with HCV were enrolled in this study.All of the patients were treated with peginterferon-alpha 2a or 2b plus ribavirin.In addition,180μg of peginterferon alpha-2a or 1.5μg/kg peginterferon alpha-2b per week plus weight-based ribavirin(600-1000 mg/d)were typically administered for 24 wk to HCV genotype 2-infected patients or for 48-72 wk to HCV genotype 1-infected patients.In all of the patients,the IL-28B rs8099917 genotype was determined using a TaqMan single-nucleotide polymorphism assay.HCV RNA was measured using the COBAS TaqMan HCV test.RESULTS:Female patients were dominant in the PNALT group(P【0.0001).Among 72 HCV genotype 1-infected patients with PNALT,the early virologic response(EVR)rates(P【0.01)and the sustained virologic response(SVR)rates(P【0.01)were higher in patients with the IL-28B TT genotype than in those with the IL-28B TG/GG genotype.In HCV genotype 1-infected patients with PNALT,multivariate logistic-regression analysis showed that SVR was independently predicted by the IL-28B rs8099917 TT type(P【0.05)and having an EVR(P【0.01).The IL-28B rs8099917 TT genotype strongly correlated with treatment response in HCV genotype 1-infected Asian patients with PNALT.CONCLUSION:The IL-28B genotype may be useful for selecting HCV genotype 1-infected patients with PNALT who should receive interferon-based treatment.

类风湿关节炎治疗达标率的影响因素

目的:基于智能疾病管理系统分析影响类风湿关节炎治疗达标的因素,为进一步调整慢性病管理策略提供参考。方法:回顾性分析2018年1月—2020年12月在重庆市某三级甲等医院风湿病科接受慢性病管理的471例类风湿关节炎病人,根据是否达标分为达标组和未达标组,收集性别、年龄、病程、是否因药物副作用调整方案、是否规律用药、是否有经济负担、是否受其他疾病影响、是否受行动不便或路途远影响、是否定期复诊等资料,并分析其影响因素。结果:基于智能疾病管理系统对类风湿关节炎病人进行慢性病管理总达标率为57.3%,不同年龄、规律用药、定期复诊病人类风湿关节炎病人治疗达标率不同(P<0.05)。结论:应加强对老年病人的关怀,提高老年病人的依从性,指导病人规律用药和定期复诊有利于提高类风湿关节炎病人治疗的达标率。

病例导向教学联合实际操作训练在妇科常见疾病诊治规培中的应用

目的探讨妇科常见疾病诊治规培中实施病例导向教学(CBL)联合实际操作训练的效果和价值。方法选择2021年2月至2023年2月在潍坊医学院附属医院妇科接受常见疾病诊治规培的50名学生作为研究对象,根据随机数表法分为对照组(n=25)和观察组(n=25),对照组疾病诊治规培选用教学方法为传统教学法,观察组规培中选用CBL结合实际操作训练教学法。观察学生学习效果、岗位胜任能力变化情况及教学满意度情况等。结果观察组学生培训后理论知识、实践操作考核成绩及学习效果优良率高于对照组,差异有统计学意义(P<0.05);培训后观察组学生的岗位胜任能力评估各项评分及总评分均高于对照组,差异有统计学意义(P<0.05);观察组学生教师教学态度、教学内容、教学形式及教学效果满意度评分均高于对照组,差异有统计学意义(P<0.05)。结论妇科常见疾病诊治规培中运用CBL联合实际操作训练教学法,在学生学习质量提高、岗位胜任能力培养方面均发挥积极作用,可获得更高教学满意度。

左西孟旦在急性心肌梗死合并心力衰竭患者中的应用

目的 分析左西孟旦在急性心肌梗死(AMI)合并心力衰竭患者中的应用效果。方法 选取2018年1月至2022年11月北京市大兴区人民医院收治的106例AMI合并心力衰竭患者作为研究对象,按照随机数字表法将其分为两组,各53例。对照组采用标准化治疗,观察组同时联合左西孟旦治疗。比较两组治疗前后血清炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、血流动力学水平[心指数(CI)、全心舒张末容积指数(GEDVI)、全身血管阻力指数(SVRI)]、心功能指标[左室射血分数(LVEF)、每搏输出量(SV)、B型尿钠肽(BNP)],及临床疗效和不良反应总发生率。结果 治疗后,两组hs-CRP、IL-6、TNF-α、GEDI、SVRI、BNP水平均低于治疗前,且观察组低于对照组(P<0.05);治疗后,两组CI、LVEF、SV水平均高于治疗前,且观察组高于对照组(P<0.05)。观察组临床疗效高于对照组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 标准化治疗基础上联合左西孟旦治疗AMI合并心力衰竭能够有效缓解患者的炎症反应,稳定血流动力学,改善心功能和临床疗效,且无明显不良反应。

多靶点小分子酪氨酸激酶抑制剂联合免疫检查点抑制剂治疗标准治疗方案失败后晚期实体瘤患者的效果

目的研究多靶点小分子酪氨酸激酶抑制剂(MTKIs)和免疫检查点抑制剂(ICIs)联合治疗对标准治疗方案失败的晚期实体瘤患者的临床疗效与安全性。方法选择2021年1月至2023年1月在我院住院的≥2个标准治疗方案失败后的晚期实体瘤患者,采用了MTKIs联合ICIs的治疗方案,回顾性研究该方案的疗效与安全性。结果共纳入21例患者,截至2023年3月1日,整体人群ORR为38%,DCR为67%,中位无进展生存期(mPFS)为10个月,中位生存期(mOS)为15个月。常见的不良反应为肺炎、口腔溃疡等。结论对于标准治疗失败的晚期实体瘤患者,MTKIs和ICIs联合治疗方法可能是一种治疗选择,但需要更大样本量的前瞻性研究证实其疗效及安全性,以及探索出最有可能从这种治疗方法中获益的人群。

可切除胰腺癌新辅助治疗的研究及指南解读,肯定还是否定?

作为一种系统性疾病,胰腺癌恶性程度高,复发转移率高,诊治与管理尤为困难。近年来随着新辅助治疗理念的不断推广,胰腺癌的治疗愈发强调在全流程、多方位管理中制定综合性、个性化治疗方案。然而,目前针对新辅助治疗在可切除胰腺癌中的应用尚存诸多争议。本文拟结合国、内外指南及最新研究进展,针对可切除胰腺癌病人实施新辅助治疗中的热点话题及相关争议进行探讨,以期推动新辅助治疗在可切除胰腺癌中的规范化应用。

脑梗死患者标准化治疗的依从性与复发的关系分析

目的:探讨脑梗死患者接受标准化治疗时的依从性以及疾病复发的相关性。方法:选择2022年3月至2023年3月蚌埠医科大学第二附属医院收治的60例脑梗死患者作为案例。所有患者在住院期间均接受基于《中国急性缺血性脑卒中诊治指南2021》的生活指导与用药干预,同时在出院时提供规范指导用药,治疗依从性和复发的相关性。结果:出院后3月、6月、12月时患者使用降压药物、降糖药物的依从性相对较高,服用抗血小板药物、他汀类药物依从性较差。60例患者总复发率16.67%。出院后3月、6月、12月脑梗死复发和用药依从性高低有较大数据差异,P<0.05。结论:脑梗死患者在临床中仍然存在部分药物使用率较低的现象,治疗依从性和疾病复发有着密切关联,临床中应当注重标准化治疗的依从性管理,值得推广。

基于经筋理论探讨触诊对颈痛分期诊疗的意义

颈痛属于中医学“经筋病”的范畴。经筋理论与颈痛的生理病理关系紧密,并且对颈痛的诊疗具有指导意义。触诊是颈痛诊断和分期治疗的重要环节,根据经筋病理产物出现的部位不同,可以明确病变经筋;根据不同的病理变化会出现不同的指下触感,可以对颈痛进行分期,进行有针对性的治疗,从而达到精确施治、提高临床疗效的目的。同时,触诊为颈痛的诊疗提供了一定的规范化、客观化的参考。

关于钢质无缝气瓶热处理工艺评定规范性的思考

在钢质无缝气瓶的制造工序中,热处理工序对产品的安全性能起着至关重要的作用。TSG 23—2021《气瓶安全技术规程》和钢质无缝气瓶的制造标准均明确提出气瓶的热处理应按评定合格的热处理工艺进行。目前,国内还没有相应的规范或标准能够明确指导钢质无缝气瓶热处理工艺评定的制定过程,各制造厂在生产中的热处理工艺评定制定标准和水平也参差不齐。提出了钢质无缝气瓶的热处理工艺评定涵盖的内容及相应要求,并通过试验进行了举例。

针灸治疗质量安全管理标准的应用实践

中国医院协会颁布的《中国医院质量安全管理》团体标准“第2-27部分:患者服务中医药治疗”规范了针灸治疗质量与安全管理,科室人员基于此搭建针灸治疗质量安全管理标准框架,确立人员管理、治疗管理、不良事件处理3个环节、10个节点、14个要素的框架体系。标准实施后,针灸不良事件减少,门诊投诉率降低,院感防控落实度提高。

生态环境治理项目安全生产标准化评价模型及其应用

为提高生态环境治理项目安全生产标准化评价的准确性和客观性,针对安全生产标准化存在的管理缺陷及主要问题,首先结合相关文献和项目实际确定安全生产标准化评价指标体系,然后采用层次分析法计算各评价指标的权重,构建了安全生产标准化评价模型,最后应用安全生产标准化评价模型对某土地开发整理项目进行了实例应用与分析。结果表明,该评价模型适用于生态环境治理项目安全生产标准化量化评分,对今后生态环境治理项目安全生产标准化评价具有指导意义。

数字化多维度延展案例联合MDT教学在临床病理科住培中的应用

目的探讨数字化多维度延展案例联合临床多学科诊疗(multidisciplinary treatment,MDT)教学模式在临床病理科住院医师规范化培训(住培)中的应用效果。方法选取2020年9月至2023年8月在河南省人民医院临床病理科住培专业基地培训的36名住院医师为研究对象,随机分为2组,每组18名。观察组采用数字化多维度延展案例联合MDT教学,对照组采用传统教学模式。采用理论技能考核、教师评价及问卷调查评估教学效果。结果两组一般资料比较无统计学意义(P>0.05)。观察组理论知识和实践技能考核成绩均高于对照组(均P<0.05)。观察组病例分析及教师综合评价分数均高于对照组(P<0.05)。包括学习兴趣、理论知识巩固、技能提升、诊断思维方面的满意度问卷调查,观察组优于对照组(均P<0.05)。结论数字化多维度延展案例联合MDT教学在临床病理科住院医师培训中,有助于系统知识体系构建及临床实践能力提升,教学效果良好,应用前景广泛。