【摘要】 目的 比较上臂三角肌下缘及腹部脐周皮下注射药物的疼痛程度以及两种注射部位药物注射后局部不良反应。 方法 将2009年9月-2010年5月在我院门诊注射室执行皮下注射的患者200例。采用自身对照，分别在三角肌下缘与腹部脐周行皮下注射，根据视觉模拟评分法，对所有患者进行疼痛程度评估，将所得数据进行对比分析。 结果 腹部脐周皮下注射较上臂三角肌下缘注射疼痛评分低，差异有统计学意义（Z=6.02，Plt;0.005），两组注射局部均无不良反应。 结论 腹部脐周皮下注射疼痛程度较上臂三角肌下缘皮下注射疼痛程度轻。【Abstract】 Objective To compare the difference in pain degrees between subcutaneous injection at the lower edge of upper arm deltoid and at the abdominal peri-umbilicus, and to observe the adverse reactions of the two ways of injection. Methods A total of 200 patients who were in the outpatient injection room from September 2009 to May 2010 were injected subcutaneously at the lower edge of upper arm deltoid and the abdominal peri-umbilicus with the method of self control; the pain degrees were assessed by visual analog score and the data were analyzed. Results The pain scores between the two groups differed much (Z=6.02,Plt;0.005), while the difference in space distributions between the two groups was not significant. Conclusion The pain of subcutaneous injection at the abdominal peri-umbilicus is lighter than that at the lower edge of upper arm deltoid.
Objective To systematically evaluate the clinical effectiveness and safety of raltitrexed plus cisplatin in the treatment of malignant pleural mesothelioma (MPM) when compared with other chemotherapy regimens. Methods We electronically searched PubMed, Embase, The Cochrane Library and Chinese Biomedicine Database to March, 2007. Randomized controlled trials (RCTs) and quasi-RCTs were identified, and Revman 4.2.10 was applied for statistical analyses. Results One RCT involving 250 patients was included, which compared raltitrexed plus cisplatin versus cisplatin alone in the treatment of MPM. In the intention-to-treat population, the median survival time was statistically longer in the raltitrexed plus cisplatin group as compared to cisplatin alone group. (11.4 versus 8.8 months, P=0.048). The incidence of grade 3/4 toxicities was similar between the two groups. Conclusion The current evidence available showed that, the combination of raltitrexed and cisplatin may prolong the survival time for MPM patients, with a low incidence of grade 3/4 toxicities. However, more high-quality RCTs are required to further define its clinical effectiveness.
ObjectiveTo study the changes of body weight, body length, tail length, femur length, bone mineral density, serum osteocalcin content and apoptosis of bone cells in rats under intermittent hypoxia condition, so as to explore the effects of intermittent hypoxia on bone growth.MethodsForty healthy male SD rats aged 3 to 4 weeks were selected and divided into 2 groups, 20 rats in each group. Group A: normoxic control group (normal diet and normoxic environment); group B: intermittent hypoxia group (normal feeding and was put into the hypoxic chamber to establish intermittent hypoxia environment), 8 hours a day (09:00 to 17:00), 4 weeks of modeling. The body weight, body length and tail length of the two groups were measured in every morning. At the end of 4 weeks after anesthesia, the body weight, body length, tail length and right femur length were measured. The body weight growth rate, body length growth rate and tail length growth rate were calculated. Blood samples were collected from the abdominal aortic, and the content of serum osteocalcin was measured by enzyme linked immunosorbent assay; the right femur bone mineral density was measured by automatic dual-energy X-ray bone densitometer; the apoptosis of bone cells was detected by immunofluorescence staining+TUNEL.ResultsThe body weight growth rate, body length growth rate, tail length growth rate and right femur length in group A were all higher than those in group B (P<0.05); serum osteocalcin content in group A was higher than that in group B (P<0.05); bone mineral density in group A was higher than that in group B (P<0.05); the apoptotic index of bone cells in group B was higher than that in group A (P<0.05). Pearson correlation analysis showed that the serum osteocalcin content was significantly positively correlated with the growth rate of body length, femoral length and bone mineral density (P< 0.01).ConclusionIntermittent hypoxia could reduce osteocalcin secretion, inhibit bone growth and sclerosis, and induce osteocyte apoptosis, thus delay the bone growth.
ObjectiveTo explore the mechanism of renal tubular epithelial cell apoptosis induced by endoplasmic reticulum stress in rats with intermittent hypoxia (IH) and the intervention effect of losartan.MethodsSixty SPF grade healthy male SD rats were randomly divided into four groups (15 rats in each group), namely as group A (control group), group B (IH group), group C (IH+losartan group), and group D (IH+saline group). The group C and D were intraperitoneally injected with losartan 30 mg/kg and the same dose of saline 30 minutes daily before the experiment, and then the group B, C and D were placed in the intermittent hypoxia chamber. After 6 weeks of modeling, serum of the rats was sampled to detect the renal function. Hematoxylin-eosin staining was used to observe histomorphological changes of the kidney; transmission electron microscopy was used to observe ultrastructural changes of the kidney; TUNEL was used to detect apoptotic index of the renal tubular epithelial cells; and RT-PCR method was used to detect expressions of caspase-12, JNK and CHOP mRNA in the kidney.ResultsThe differences of renal function among these four groups were statistically significant (all P<0.05). Hematoxylin-eosin staining and transmission electron microscopy showed the histomorphological and ultrastructural changes of the kidneys in group B, C and D compared with group A, and the damages in group B and D were more significant. TUNEL results showed that the apoptotic index of renal tubular epithelial cells in group B and D was significantly higher than that in group A (P<0.01), while that in group C was significantly lower than that in group B and D (all P<0.01). RT-PCR results showed that caspase-12, JNK and CHOP mRNA expressions were significantly higher in group B and D than those in group A (all P<0.01); caspase-12 mRNA expression was significantly lower in group C than that in group B and D (P<0.01; P<0.05); and CHOP mRNA expression was significantly lower in group C than that in group B and D (all P<0.01).ConclusionsIH may induce apoptosis of renal tubular epithelial cells by activating endoplasmic reticulum stress through caspase-12, JNK and CHOP. Losartan has protective effects on the kidney of rats with intermittent hypoxia. Its mechanism may be related to the inhibition of apoptotic pathways mediated by endoplasmic reticulum stress.
Objective To formulate an evidence-based treatment plan for a patient with malignant pleural mesothelioma.Methods Based on an adequate assessment of the patient’s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2007), PubMed (1996 to February 2007) and EMbase (1974 to February 2007) to identify the best available clinical evidence. Results Five randomized controlled trials, 4 systematic reviews and 1 health economic evaluation were included. According to the current evidence, as well as the patient’s clinical condition and preference, 5 cycles of raltitrexed plus cisplatin were given to the patient along with thoracic drainage and other symptomatic treatment. And the follow-up after 4 months indicated that this treatment plan was appropriate for the patient. Conclusion Evidence-based approaches helped us to prepare the most appropriate chemotherapy plan for this patient and will help improve the therapeutic results for patients with malignant pleural mesothelioma.
Objective To analyze the equipment and the working model of Pakistan international medical rescue team in Wenchuan earthquake in order to provide the first hand references for our medical rescue. Methods We analyzed the aim, the staff composition, the medical equipment, the logistic material and the working model of the Pakistan international medical rescue team by working with the Pakistan team, and summarized its strengths and weaknesses. Result The main aim of the Pakistan international medical rescue team is to search, rescue and treat the wounded and sick in mass casualty incident. The team consisted of 28 staffs, including 2 leaders (the executive leader was an epidemic expert, and the vise leader was an administrative officer), 6 clinical doctors, 2 nurses, 3 medical technicians, 10 field search and rescue staffs and 5 logistics staffs. The medical equipment included a field ambulance, 7 field tents and 2 marine satellite phones. The medical equipment and instruments include an X-ray table, a B-ultrasound scanner, an ECG tester, a set of surgery operation equipment and 2 sets of ICU instruments. The main medicines included antibiotics, analgesics and for trauma treatment. Narcotic drugs and surgical supplies supported 200 patients; fluid infusion and drugs were enough for 500 patients; other laboratory reagents were enough for 500 patients; oral drugs, disinfection cotton and bandages were for 3 000 patients. Logistics materials contained a set of cooking appliances, 2 sets of toilet facilities and enough rice, flour and water for the whole team for two weeks. The field tent hospital was built in one day. In the field tent hospital, 1 256 patients were treated, 14 surgeries were performed, 236 X-ray and B-ultrasound examinations as well as 314 biochemical examinations were conducted within 10 days. Conclusion With complete disciplines and rational structure, the configuration of the Pakistan team is fitful for its aim, and it balances the function of search, rescue and public health. Apart from equipment and instruments enough for 300-500 patients rescue, the team also considers both its own survival and environmental protection. The outcome would be better if they could arrive at the spot in the first week after the earthquake happened.