目的:探究不同输血方案在危急重症患者中的影响,为大剂量输血患者提供优化输血方案。方法:选取当阳市人民医院在2020年7月-2021年7月收治的60例需大剂量输血的危急重症患者作为研究对象。按不同的输血方案将患者分为对照组和观察组,每...目的:探究不同输血方案在危急重症患者中的影响,为大剂量输血患者提供优化输血方案。方法:选取当阳市人民医院在2020年7月-2021年7月收治的60例需大剂量输血的危急重症患者作为研究对象。按不同的输血方案将患者分为对照组和观察组,每组30例。对照组患者采用大剂量全血输血方案,观察组采用特定比例的大剂量成分输血方案[4 U红细胞(RBC)、400 ml新鲜冰冻血浆(FFP)、2 U血小板(PLT)]。比较两组凝血功能指标、血氧饱和度、中心静脉压、收缩压、预后情况、血常规、满意度等指标。结果:输血前,两组凝血酶原时间(PT)、纤维蛋白原水平(FIB)、部分凝血活酶时间(APTT)、凝血酶时间(TT)指标比较,差异无统计学意义(P>0.05)。输血24 h后,两组的APTT、PT和TT时间长于输血前,FIB水平低于输血前,且观察组患者的APTT、PT和TT时间明显短于对照组,FIB水平高于对照组(P<0.05);输血前,两组血氧饱和度(SpO_(2))、中心静脉压(CVP)、收缩压(SBP)水平比较,差异无统计学意义(P>0.05)。输血2 d后,观察组患者的SpO_(2)、CVP及SBP水平显著高于对照组(P<0.05);观察组患者的ICU治疗时间和住院时间短于对照组,治愈率高于对照组(P<0.05)。两组患者死亡率比较,差异无统计学意义(P>0.05);输血前,两组的血常规各指标比较差异无统计学意义(P>0.05)。输血后24 h,观察组患者的血细胞比容(HCT)、血红蛋白(HGB)、血小板计数(PLT)水平均明显高于对照组(P<0.05);观察组总满意28例,总满意度93.33%;对照组总满意22例,总满意度73.33%;观察组总满意度明显高于对照组(P<0.05)。结论:对需大剂量输血的危急重症患者进行特定比例的大剂量成分输血方案(4 U RBC、400 ml FFP、2 U PLT)治疗效果优于大剂量全血输血治疗,有利于改善患者的凝血功能,提高患者SpO_(2)、CVP、SBP水平及疾病治愈率,降低患者住院时间及死亡率。展开更多
Purpose： Evaluate the implementation of a large hospital system vancomycin dosing guideline in a community hospital with pharmacist vancomycin management. Design： Single center, retrospective and prospective quality...Purpose： Evaluate the implementation of a large hospital system vancomycin dosing guideline in a community hospital with pharmacist vancomycin management. Design： Single center, retrospective and prospective quality assessment study. Methods： Pharmacist-managed vancomycin therapy was evaluated pre and post-implementation of a new dosing guideline in a study population of 586 from one community hospital. Results： Of the study population, 274 patients evaluated pre-implementation were compared to 312 patients post-implementation of the large hospital-system guideline （46.8% and 53.2%, respectively）. There was no significant difference in demographics between both patient populations. Days of vancomycin therapy was shorter in the post-implementation group （4.32 ＋ 2.241） versus the pre-implementation group [（4.81 ±2.764）, p = 0.018]. Days to goal trough was longer in the post-implementation group （3.51 ±1.622） compared to the pre-implementation group [（3.09 ±2.046）, p = 0.054]. A post-hoe regression analysis was conducted, showing that age, days of vancomycin therapy and goal trough are predictors for 77% of cases within the post-implementation group. Conclusion： The implementation of a new vancomycin dosing guideline significantly impacted days of vancomycin therapy and days to goal trough in patients on vancomycin managed by pharmacists. Our results encourage completion of future studies utilizing the regression analysis data, which may impact the future care of patient on vancomycin managed by pharmacists.展开更多
Objective:The aim of the study was to investigate the effects as well as the possible mechanisms of low dose γ-ray pre-irradiation on hepatic damage,DNA damage of peripheral lymphocytes and genetic material damage ca...Objective:The aim of the study was to investigate the effects as well as the possible mechanisms of low dose γ-ray pre-irradiation on hepatic damage,DNA damage of peripheral lymphocytes and genetic material damage caused by high dosage of cyclophosphamide(CTX).Methods:Kunming strain male mice were randomly divided into five groups:control group,sham-irradiated group,low dose irradiation group(LDR group),cyclophosphamide chemotherapy group(CTX group) and low dose irradiation combined with chemotherapy group(LDR + CTX group).Having being raised for one week,all the mice were implanted subcutaneously with S180 cells in the left inguen(control group excluded).On days 8 and 11,mice of LDR and LDR + CTX groups were given 75 mGy whole-body γ-irradiation,30 h later mice of CTX and LDR + CTX groups were injected i.p.3.0 mg cyclophosphamide.All the mice were sacrificed on day 13.DNA damage of the peripheral lymphocytes was analyzed using single cell gel electrophoresis(SCGE);ALT activity,total protein(TP) and albumin(ALB) of the plasma were analyzed using automatic biochemistry analyzer;MDA content,SOD and GSH-PX activity of the hepatic homogenate were analyzed using chromometry;genetic material damage was analyzed using micronucleus frequency(MNF) of polychromatoerythrocytes(PCE) in bone marrow.Results:1.Differences of MDA contents,SOD and GSH-PX activity of hepatic homogenate between 5 groups had notable statistical significance(P < 0.01);in control group MDA content was the lowest,SOD and GSH-PX activity were the highest,while in CTX group MDA content was the highest,SOD and GSH-PX activity were the lowest;compared with CTX group MDA content decreased significantly(P < 0.01) and SOD and GSH-PX activity increased significantly(P < 0.05) in LDR + CTX group.2.Differences of ALT activity of plasma between 5 groups had no statistical significance(F = 1.262,P > 0.05).Differences of TP and ALB of plasma between 5 groups had statistical significance(F = 12.879 and 6.336 respectively,P < 0.01);TP and ALB in control group were higher than those of other groups and compared with sham-irradiated group,TP and ALB in LDR group elevated significantly(P < 0.05).3.Differences of DNA damage of peripheral lymphocytes had notable statistical significance(F = 6.383,P < 0.01);DNA damage in control group was the lightest,while DNA damage in CTX group was the severest;compared with CTX group,DNA damage in LDR + CTX group was much lighter(P < 0.05).4.MNF of PCE between 5 groups had remarkable significance(F = 179.652,P < 0.01);compared with control group and sham-irradiated group,MNF in CTX group increased significantly(P < 0.01);compared with CTX group,MNF in LDR + CTX group had a tendency of decline,which had no statistical significance(P > 0.05).Conclusion:1.CTX can damage the hepatic tissue through oxidative stress;75 mGy γ-irradiation before CTX chemotherapy can induce activities of anti-oxidative enzymes,promote elimination of free radicals,so as to alleviate the damaging effects of oxidative stress to hepatic tissue caused by high-dose chemotherapy.2.A 75 mGy γ-irradiation before CTX chemotherapy has no obvious effect on ALT activity of plasma,but may have protective effect on the protein synthesis function of liver.3.High-dose CTX chemotherapy can cause DNA damage of peripheral lymphocytes;75 mGy γ-irradiation before chemotherapy may have certain protective effect on DNA damage.4.CTX has potent mutagenic effect,can cause significant increase of MNF of PCE;75 mGy γ-ray pre-irradiation did not show obvious protection against genetic toxicity of high-dose CTX chemotherapy.展开更多
The properties of the high molecular water-absorbing compound sodium polyacrylate (SP) and its application in agriculture are reviewed;and its safety in application is also introduced.
Objective： By studying the influence of low-dose total body irradiation to proliferating cell nuclear antigens （PCNA）, epidermal growth factor receptor （EGFR）, erythropoietin （EPO） and vascular endothelial grow...Objective： By studying the influence of low-dose total body irradiation to proliferating cell nuclear antigens （PCNA）, epidermal growth factor receptor （EGFR）, erythropoietin （EPO） and vascular endothelial growth factor receptor （VEGFR） of tumor tissues in mice bearing S180 sarcoma, to further explore the mechanism of low doses radiation. Methods：S180 sarcoma cells were implanted subcutaneously into 58 male Kunming mice. Randomly these mice were divided into sham-irradiation （S） group and low-dose radiation （LDR） group. 12 days after implantation, the mice in LDR group were once delivered 75 mGy total-body ^60Co y-ray irradiation, while the mice in S group were left without irradiation. Then the mice in LDR group were executed at 6 h （LDR-6h group）, 12 h （LDR-12 h group）, 24 h （LDR-24 h group）, 48 h （LDR-48 h group） and 72 h （LDR-72h group） after irradiation. Tumor tissues were weighed and histological observed. Immunohistochemical staining was used to detect the expression of PCNA, VEGF, EPO and VEGFR of tumor tissues. Results： Though there was no significant difference between LDR group and S group in tumor weight, after irradiation the expression of PCNA and EPO of tumor tissues in LDR group decreased with time. LDR-24h, LDR-48h and LDR-72h groups were all statistically significantly different from S group. The expression of EGFR and VEGFR also decreased, and LDR-24h group was the lowest （P 〈 0.05）. Conclusion： Seventy-two h after low-dose total body irradiation, there was no significant change in tumor size of mice bearing S180 sarcoma. Low-dose total body radiation decreased the expression of PCNA inhibiting tumor growth; reduced the expression of EGFR in tumor tissue impacting the signal transduction of tumor cells. The study also indicated that low-dose total body irradiation, within a certain period of time, can decrease the expression of hypoxia factor EPO and VEGFR, which may improve the situation of tumor hypoxia and radiosensitivity of tumor itself.展开更多
OBJECTIVE To observe the dose and the complicationsfrom total body irradiation before hematopoietic stem celltransplantation.METHODS This study involved 312 patients with total bodyirradiation before hematopoietic ste...OBJECTIVE To observe the dose and the complicationsfrom total body irradiation before hematopoietic stem celltransplantation.METHODS This study involved 312 patients with total bodyirradiation before hematopoietic stem cell transplantation. Theywere entered into the treated research from May 1999 to October2005. All patients had received the irradiation from ^(60)Co of anabsorbed dose rate of (5.2 ± 1.13) cGy/min. The total dose of TBIwas 7～12 Gy, 1 f/d × 2 d. A high-dose rate group (≥10 Gy) included139 cases and a low-dose rate group (< 10 Gy) included 173 cases.RESULTS The probability of acute gastrointestinal reactionsin the high-dose rate group was more compared with that in thelow-dose rate group. The differences for other reactions, such ashematopoietic reconstitution and graft survival rate, between thetwo groups were insignificant.CONCLUSION Using fractional total body irradiation at a doserate of 5 cGy/min, with a total dose of 7～12 Gy, 1 f/d × 2 d , withthe lung receiving under 7.5 Gy is a safe and effective pretreatmentfor hematopoietic stem cell transplantation.展开更多
文摘目的探讨注射半剂量^(18)F-氟代脱氧葡糖(^(18)F-flurodeoxyglucose,^(18)F-FDG)对恶性肿瘤患者全身正电子发射计算机断层显像(positron emission tomography/computed tomography,PET/CT)图像质量的影响,以确定注射半剂量^(18)F-FDG对恶性肿瘤进行有效诊断的可行性。方法回顾性分析2021年2月至2021年9月在河南省人民医院PET/CT中心^(18)F-FDG全身显像40例确诊恶性肿瘤患者的PET/CT图像。患者分为全剂量组(3.70 MBq/kg,20例)和半剂量组(1.85 MBq/kg,20例)。两组患者均采用联影全景动态PET/CT扫描仪采集图像,全剂量组患者PET采集时间3 min,半剂量组患者PET采集时间10 min。由2名从业核医学5年以上的医生采用5分制(5分-优;1分-差)对两组图像打分,并对比两组肿瘤部位最大标准摄取值(maximum of the standard uptake value,SUVmax)值、肿瘤与肌肉摄取比值等指标,以评定图像质量,数据分析采用χ^(2)检验。结果全剂量组和半剂量组图像在性别、年龄、体质量指数、注射和成像间隔时间、肿瘤病变性质和病理类型等方面两组之间差异无统计学意义(P>0.05)。全剂量组和半剂量组图像质量平均评分接近,分别为(4.6±0.3)分和(4.5±0.2)分。两组肿瘤SUVmax和肿瘤与肌肉摄取比值等指标之间没有显著差异(P>0.05)。结论与全剂量组相比,半剂量组呈现了较好的信噪比。半剂量组获得的图像质量评分与全剂量组相比没有统计学意义上的差异。因此,患者在接受联影全景动态PET/CT检查时,如果^(18)F-FDG的总剂量有限,患者可通过注射半剂量的^(18)F-FDG并适当延长PET采集时间来满足临床诊断对图像的要求。
文摘目的:探究不同输血方案在危急重症患者中的影响,为大剂量输血患者提供优化输血方案。方法:选取当阳市人民医院在2020年7月-2021年7月收治的60例需大剂量输血的危急重症患者作为研究对象。按不同的输血方案将患者分为对照组和观察组,每组30例。对照组患者采用大剂量全血输血方案,观察组采用特定比例的大剂量成分输血方案[4 U红细胞(RBC)、400 ml新鲜冰冻血浆(FFP)、2 U血小板(PLT)]。比较两组凝血功能指标、血氧饱和度、中心静脉压、收缩压、预后情况、血常规、满意度等指标。结果:输血前,两组凝血酶原时间(PT)、纤维蛋白原水平(FIB)、部分凝血活酶时间(APTT)、凝血酶时间(TT)指标比较,差异无统计学意义(P>0.05)。输血24 h后,两组的APTT、PT和TT时间长于输血前,FIB水平低于输血前,且观察组患者的APTT、PT和TT时间明显短于对照组,FIB水平高于对照组(P<0.05);输血前,两组血氧饱和度(SpO_(2))、中心静脉压(CVP)、收缩压(SBP)水平比较,差异无统计学意义(P>0.05)。输血2 d后,观察组患者的SpO_(2)、CVP及SBP水平显著高于对照组(P<0.05);观察组患者的ICU治疗时间和住院时间短于对照组,治愈率高于对照组(P<0.05)。两组患者死亡率比较,差异无统计学意义(P>0.05);输血前,两组的血常规各指标比较差异无统计学意义(P>0.05)。输血后24 h,观察组患者的血细胞比容(HCT)、血红蛋白(HGB)、血小板计数(PLT)水平均明显高于对照组(P<0.05);观察组总满意28例,总满意度93.33%;对照组总满意22例,总满意度73.33%;观察组总满意度明显高于对照组(P<0.05)。结论:对需大剂量输血的危急重症患者进行特定比例的大剂量成分输血方案(4 U RBC、400 ml FFP、2 U PLT)治疗效果优于大剂量全血输血治疗,有利于改善患者的凝血功能,提高患者SpO_(2)、CVP、SBP水平及疾病治愈率,降低患者住院时间及死亡率。
文摘Purpose： Evaluate the implementation of a large hospital system vancomycin dosing guideline in a community hospital with pharmacist vancomycin management. Design： Single center, retrospective and prospective quality assessment study. Methods： Pharmacist-managed vancomycin therapy was evaluated pre and post-implementation of a new dosing guideline in a study population of 586 from one community hospital. Results： Of the study population, 274 patients evaluated pre-implementation were compared to 312 patients post-implementation of the large hospital-system guideline （46.8% and 53.2%, respectively）. There was no significant difference in demographics between both patient populations. Days of vancomycin therapy was shorter in the post-implementation group （4.32 ＋ 2.241） versus the pre-implementation group [（4.81 ±2.764）, p = 0.018]. Days to goal trough was longer in the post-implementation group （3.51 ±1.622） compared to the pre-implementation group [（3.09 ±2.046）, p = 0.054]. A post-hoe regression analysis was conducted, showing that age, days of vancomycin therapy and goal trough are predictors for 77% of cases within the post-implementation group. Conclusion： The implementation of a new vancomycin dosing guideline significantly impacted days of vancomycin therapy and days to goal trough in patients on vancomycin managed by pharmacists. Our results encourage completion of future studies utilizing the regression analysis data, which may impact the future care of patient on vancomycin managed by pharmacists.
基金Supported by a grant from National Natural Scientific Foundation of China (No:30030781)
文摘Objective:The aim of the study was to investigate the effects as well as the possible mechanisms of low dose γ-ray pre-irradiation on hepatic damage,DNA damage of peripheral lymphocytes and genetic material damage caused by high dosage of cyclophosphamide(CTX).Methods:Kunming strain male mice were randomly divided into five groups:control group,sham-irradiated group,low dose irradiation group(LDR group),cyclophosphamide chemotherapy group(CTX group) and low dose irradiation combined with chemotherapy group(LDR + CTX group).Having being raised for one week,all the mice were implanted subcutaneously with S180 cells in the left inguen(control group excluded).On days 8 and 11,mice of LDR and LDR + CTX groups were given 75 mGy whole-body γ-irradiation,30 h later mice of CTX and LDR + CTX groups were injected i.p.3.0 mg cyclophosphamide.All the mice were sacrificed on day 13.DNA damage of the peripheral lymphocytes was analyzed using single cell gel electrophoresis(SCGE);ALT activity,total protein(TP) and albumin(ALB) of the plasma were analyzed using automatic biochemistry analyzer;MDA content,SOD and GSH-PX activity of the hepatic homogenate were analyzed using chromometry;genetic material damage was analyzed using micronucleus frequency(MNF) of polychromatoerythrocytes(PCE) in bone marrow.Results:1.Differences of MDA contents,SOD and GSH-PX activity of hepatic homogenate between 5 groups had notable statistical significance(P < 0.01);in control group MDA content was the lowest,SOD and GSH-PX activity were the highest,while in CTX group MDA content was the highest,SOD and GSH-PX activity were the lowest;compared with CTX group MDA content decreased significantly(P < 0.01) and SOD and GSH-PX activity increased significantly(P < 0.05) in LDR + CTX group.2.Differences of ALT activity of plasma between 5 groups had no statistical significance(F = 1.262,P > 0.05).Differences of TP and ALB of plasma between 5 groups had statistical significance(F = 12.879 and 6.336 respectively,P < 0.01);TP and ALB in control group were higher than those of other groups and compared with sham-irradiated group,TP and ALB in LDR group elevated significantly(P < 0.05).3.Differences of DNA damage of peripheral lymphocytes had notable statistical significance(F = 6.383,P < 0.01);DNA damage in control group was the lightest,while DNA damage in CTX group was the severest;compared with CTX group,DNA damage in LDR + CTX group was much lighter(P < 0.05).4.MNF of PCE between 5 groups had remarkable significance(F = 179.652,P < 0.01);compared with control group and sham-irradiated group,MNF in CTX group increased significantly(P < 0.01);compared with CTX group,MNF in LDR + CTX group had a tendency of decline,which had no statistical significance(P > 0.05).Conclusion:1.CTX can damage the hepatic tissue through oxidative stress;75 mGy γ-irradiation before CTX chemotherapy can induce activities of anti-oxidative enzymes,promote elimination of free radicals,so as to alleviate the damaging effects of oxidative stress to hepatic tissue caused by high-dose chemotherapy.2.A 75 mGy γ-irradiation before CTX chemotherapy has no obvious effect on ALT activity of plasma,but may have protective effect on the protein synthesis function of liver.3.High-dose CTX chemotherapy can cause DNA damage of peripheral lymphocytes;75 mGy γ-irradiation before chemotherapy may have certain protective effect on DNA damage.4.CTX has potent mutagenic effect,can cause significant increase of MNF of PCE;75 mGy γ-ray pre-irradiation did not show obvious protection against genetic toxicity of high-dose CTX chemotherapy.
文摘The properties of the high molecular water-absorbing compound sodium polyacrylate (SP) and its application in agriculture are reviewed;and its safety in application is also introduced.
基金Supported by a grant from the National Natural Scientific Foundation of China (No: 30030781)
文摘Objective： By studying the influence of low-dose total body irradiation to proliferating cell nuclear antigens （PCNA）, epidermal growth factor receptor （EGFR）, erythropoietin （EPO） and vascular endothelial growth factor receptor （VEGFR） of tumor tissues in mice bearing S180 sarcoma, to further explore the mechanism of low doses radiation. Methods：S180 sarcoma cells were implanted subcutaneously into 58 male Kunming mice. Randomly these mice were divided into sham-irradiation （S） group and low-dose radiation （LDR） group. 12 days after implantation, the mice in LDR group were once delivered 75 mGy total-body ^60Co y-ray irradiation, while the mice in S group were left without irradiation. Then the mice in LDR group were executed at 6 h （LDR-6h group）, 12 h （LDR-12 h group）, 24 h （LDR-24 h group）, 48 h （LDR-48 h group） and 72 h （LDR-72h group） after irradiation. Tumor tissues were weighed and histological observed. Immunohistochemical staining was used to detect the expression of PCNA, VEGF, EPO and VEGFR of tumor tissues. Results： Though there was no significant difference between LDR group and S group in tumor weight, after irradiation the expression of PCNA and EPO of tumor tissues in LDR group decreased with time. LDR-24h, LDR-48h and LDR-72h groups were all statistically significantly different from S group. The expression of EGFR and VEGFR also decreased, and LDR-24h group was the lowest （P 〈 0.05）. Conclusion： Seventy-two h after low-dose total body irradiation, there was no significant change in tumor size of mice bearing S180 sarcoma. Low-dose total body radiation decreased the expression of PCNA inhibiting tumor growth; reduced the expression of EGFR in tumor tissue impacting the signal transduction of tumor cells. The study also indicated that low-dose total body irradiation, within a certain period of time, can decrease the expression of hypoxia factor EPO and VEGFR, which may improve the situation of tumor hypoxia and radiosensitivity of tumor itself.
文摘OBJECTIVE To observe the dose and the complicationsfrom total body irradiation before hematopoietic stem celltransplantation.METHODS This study involved 312 patients with total bodyirradiation before hematopoietic stem cell transplantation. Theywere entered into the treated research from May 1999 to October2005. All patients had received the irradiation from ^(60)Co of anabsorbed dose rate of (5.2 ± 1.13) cGy/min. The total dose of TBIwas 7～12 Gy, 1 f/d × 2 d. A high-dose rate group (≥10 Gy) included139 cases and a low-dose rate group (< 10 Gy) included 173 cases.RESULTS The probability of acute gastrointestinal reactionsin the high-dose rate group was more compared with that in thelow-dose rate group. The differences for other reactions, such ashematopoietic reconstitution and graft survival rate, between thetwo groups were insignificant.CONCLUSION Using fractional total body irradiation at a doserate of 5 cGy/min, with a total dose of 7～12 Gy, 1 f/d × 2 d , withthe lung receiving under 7.5 Gy is a safe and effective pretreatmentfor hematopoietic stem cell transplantation.
