ObjectiveTo observe the alteration of serum homocysteine (Hcy) levels of advanced non-small cell lung cancer (NSCLC) patients during gemcitabine with cis-platinum (GP) program of chemotherapy and to explore the clinical value of monitoring Hcy in evaluating chemotherapy curative effect. MethodsA total of 49 advanced NSCLC patients (including 28 squamous carcinoma and 21 adenocarcinoma) first treated between May 2012 and April 2015 were selected. The Hcy, cytokerantin-19-fragment (CYFRA21-1) and carcinoembryonic antigen (CEA) levels of the morning fasting venous blood were measured before the first and after the second cycle of chemotherapy. Combined the pathological types of NSCLC, statistical analysis was carried out on the test results. ResultsAll of the 49 patients completed two cycles of GP chemotherapy, and the chemotherapy was effective on 31 and ineffective in 18. Before the chemotherapy, the differences in the positive rates of Hcy, CYFRA21-1, and CEA were statistically significant respectively between squamous carcinoma and adenocarcinoma patients (P < 0.05). But when combined the two types, the differences of three indicators's positive rates were not significant (P > 0.05). After two cycles of GP chemotherapy, in the patients with effective chemotherapy, the Hcy, CYFRA21-1 and CEA levels were lower in both squamous carcinoma and adenocarcinoma patients compared with that before the chemotherapy; the difference in the decrease of Hcy levels in both of the two pathological types was significant (P < 0.05), while CEA levels was significant only in adenocarcinoma patients (P < 0.05) and CYFRA21-1 levels was significant only in squamous carcinoma patients (P < 0.05). Among the patients with ineffective chemotherapy, the Hcy, CYFRA21-1 and CEA levels increased compared with those before the chemotherapy; the difference in the increase of Hcy levels were significant in both of the two pathological types (P < 0.05), while CYFRA21-1 levels was significant only in squamous carcinoma patients (P < 0.05) and CEA levels was not significant in both of the two pathological types (P > 0.05). ConclusionThe effect of chemotherapy and the pathogenetic condition can be assessed by monitoring serum Hcy levels of NSCLC patients during the chemotherapy.
ObjectiveTo investigate and analyze the strategies for choosing venous access devices for critically ill patients. MethodsThe medical staffs in ICU were required to fulfill a questionnaire on the knowledge and application of venous access devices in critically ill patients in May 2015.A descriptive statistical analysis was carried out on the answers generated from the questionnaire using SPSS 19.0 software. ResultsA total of 50 questionnaires were distributed randomly and 46 valid questionnaires were recovered.The effective response rate was 92.0%.The proportion of junior, intermediate and senior medical staffs was 80.4%, 13.0% and 6.6%, respectively.The proportion of doctors and nurses was 39.1% and 60.9%, respectively.The average seniority was (5.7±4.9)years.The proportion of ICU medical staffs who were acquainted with PIV, ACVC, PICC, TCVC, PORT and Midline was 100.0%, 100.0%, 100.0%, 69.6%, 43.5% and 13.0%, respectively.The proportion of ICU medicial staffs who would take the styles of drug, the time of treatment, the patients' condition and the costs into consideration when choosing venous access devices was 100.0%, 100.0%, 64.0% and 18.0%, respectively.91.3% and 39.1% of ICU medical staffs would choose PIV and ACVC respectively if the time of treatment was less than 1 week.56.5%, 69.6% and 26.1% of ICU medical staffs would choose PIV, ACVC and PICC respectively if the time of treatment was between 1 and 4 weeks.30.4%, 39.1%, 82.6% and 32.6% of ICU medical staffs would choose PIV, ACVC, PICC and PORT respectively if the time of treatment was more than 4 weeks.52.2% of ICU medical staffs were acquaint with the styles and the indication of antibiotic coating central venous catheter.The main reasons for infusion failure were poor vascular condition (91.3%), old age (52.2%), skin lesions (39.1%) and pipeline plugging (26.1%).The main reasons for choosing the peripheral vein were lower risk of infection (87.0%), short-term treatment (82.6%), common transfusion (78.3%) and antibiotic treatment (47.8%).The main reasons for choosing central venous infusion were irritant drugs (82.6%), peripheral vascular puncture difficulty (69.6%), long-term infusion (65.2%) and hemodynamic monitor (56.5%). ConclusionsIt is difficult to establish a vascular access for critically ill patients.The ICU medical staffs are experienced to PIV, ACVC and PICC but not to Midline, TCVC and PORT.A comprehensive evaluation is essential to choose a suitable and reliable venous access device for critically ill patients.