Objective To make an individulized treatment plan for a patient with locally advanced non-small cell lung cancer (NSCLC). Methods After clinical problems were put forward, evidence was collected from http://www. nccn.org. The Cochrane Library (Issue 4, 2008), Medline (PubMed 1990. 1-2008.11) and CHKD periodical database were searched. Results A total of 21 RCTs, 5 systematic reviews and 13 CT phase Ⅲ trials were identified. A rational treatment plan was made upon a serious evaluation of the data. After nine monthes of follow-up, the plan was proved optimal. Conclusion For locally advanced NSCLC patients, an individulized treatment plan made by evidence-based methods not only can inprove the treatment efficacy but also can lead both of doctors and patients to assume the indeterminateness of medicine.
Objective To study polyuria during mechanical ventilation in patients with chronic obstructive pulmonary disease ( COPD) and its possible mechanisms. Methods The plasma and urine concentrations of cystatin C ( CyC) were measured by enzyme immunometric assay in 26 COPD patients who received mechanical ventilation at timepoints of 0 h, 24 h, 48 h, 72 h and 1 week. And plasma levels of atrial natriuretic factor ( ANF ) , antidiuretic hormone ( ADH) and aldosterone ( ALD) were detected byradioimmunoassay at the same time-point. The urine volume was recorded every day. The samples of 30 healthy volunteers were measured as control. Results Polyuria phenomenon was found in majority of patients in 24 to 72 hours after mechanical ventilation. At 0h, the concentrations of plasma CyC, urine CyC,plasma ANF, ADH and ALD were all increased significantly compared with those of the control, respectively [ ( 4. 87 ±0. 51) mg/L vs ( 1. 29 ±0. 27) mg/L, ( 0. 58 ±0. 13) mg/L vs ( 0. 07 ±0. 02) mg/L, ( 37. 02 ±4. 35) pmol /L vs ( 22. 51 ±1. 18) pmol /L, ( 8. 61 ±1. 43) pmol /L vs ( 0.94 ±0. 34) pmol /L, ( 925. 4 ±142. 7) pmol /L vs ( 297. 5 ±135. 8) pmol /L, all P lt; 0. 01] , then decreased gradually after mechanical ventilation. The levels of plasma CyC and ANF at 24 h, plasma ADH at 72 h, and urine CyC at 1 week were similar to those of the control( all P gt;0. 05) , respectively, except the level of plasma ALD was still higher by 1 week( P lt; 0. 05) . Conclusions Polyuria is not a rare phenomenon for COPD patients receiving mechanical ventilation. Polyuria is related to the readjustment and mal-adaptation of ADH and reninangiotensin-aldosterone-systems during mechanical ventilation.