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OBJECTIVE To analyze the influential factors of cardioto xicity in patients with positive breast cancer of human epidermal growth factor receptor 2（HER-2）treated by trastuzumab combined with chemotherapy. METHODS From April 2017 to January 2021，200 HER-2 positive breast cancer patients receiving pirarubicin + cyclophosphamide combined with sequential paclitaxel+trastuzumab were collected from our hospital. According to the presence or absence of cardiotoxicity ，the patients were divided into cardiotoxicity group and non-cardiotoxicity group. The clinical data and echocardiographic results of the patients were collected，and the influential factors of cardiotoxicity were analyzed. RESULTS Among 200 patients，43 patients suffered from cardiotoxicity with the incidence of 21.5％. The proportion of patients with cardiotoxicity during pirarubicin+cyclophosphamide therapy accounted for 5.5％（11/200），and the proportion of patients with cardiotoxicity during sequential paclitaxel+trastuzumab therapy accounted for 20.5％（41/200）；the latter was significantly higher than the former （P＜0.01）. At the same time ，the decrease of left ventricular ejection fraction during sequential therapy of paclitaxel and trastuzumab was significantly higher than that during pirarubicin+cyclophosphamide therapy [ 14％（12％，17％）vs. 7％（3％，10％），P＜0.001]. Compared with patients without cardiotoxicity ，the proportion of patients with cardiotoxicity with a history of hyperlipidemia was significantly higher （P＜ 0.01），while the proportion of patients receiving dexrazoxane was significantly lower （P＜0.01）. Results of binary Logistic regression analysis showed that the history of hyperlipidemia [OR ＝3.672，95％ CI（1.499，8.992），P＝0.004] and the use of dextrazoxane [OR ＝0.154，95％ CI（0.072，0.330）， P＜0.001] were associated with the occurrence of cardiotoxicity. CONCLUSIONS Hyperlipidemia is an independent risk factor for cardiotoxicity induced by pirarubicin + cyclophosphamide combined with sequential paclitaxel+trastuzumab in HER 2 positive breast cancer patients ，while the use of dextrazoxane is a protective factor.
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OBJECTIVE:To improve the safety management level of high-risk drug Insulin injection in our hospital. METH-ODS:The standard management of Insulin injection(400 u/injection)was conducted by using PDCA(plan-do-check-action). The application of Insulin injection in wards was compared before and after six months of management. RESULTS:By strengthening training,improving ward baseline insulin management register system,adjusting the specification of insulin in information system, etc.,the application and storage of insulin became more standard;no expired drugs occurred;the rate of waste drug decreased from 95.06% before management to 22.00% after management,decreasing by 73.06%. CONCLUSIONS:PDCA cycle can im-prove the safety management of Insulin injection in wards effectively.
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OBJECTIVE:To observe therapeutic efficacy of Rhodiola wallichiana injection for swelling and pain in fracture pa-tients during perioperative period. METHODS:120 patients with closed fresh extremity long bones fracture were randomly divided into trial group and control group,with 60 cases in each group. Both groups received open reduction and plate fixation. Before and after op-eration,control group was given routine medicine and anti-inflammatory treatment;trial group was additionally given R. wallichiana in-jection 10 ml(250 ml added into 5%Glucose injection)intravenously,qd,on the basis of control group. A treatment course lasted for 10 d. The swelling degree before operation,1 d and 3 d after operation,pain degree on the day of operation and 1,2,3 and 7 d after operation,complication and average length of stay were observed and compared between 2 groups. RESULTS:The extent of swelling and pain,the incidence of complications and average hospitalization days of trial group were lower or shorter than control group,with statistical significance (P<0.05). CONCLUSIONS:R. wallichiana injection can promote blood circulation and remove blood stasis, ease the hydropsia and pain,relieve swelling and pain,reduce the incidence of complications and shorten hospitalization day.
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BACKGROUND:In recent years, interventional therapy because of its high success rate, good curative effect, little trauma has been widely recognized, but vascular intimal injury due to interventional therapy stil has no effective treatment, resulting in long-term postoperative severe restenosis. Stem cel transplantation has brought a new drawn for the repair of impaired endothelial function, reendothelialization and aided restoration of the blood supply to ischemic tissues. OBJECTIVE: To summarize the recent progress in umbilical cord blood stem cels transplantation and endovascular treatment for treatment of diabetic lower limb ischemic disease. METHODS: A computer-based search of PubMed and CNKI was performed for relevant articles published from January 2000 to March 2015 using the keywords of “umbilical cord blood stem cel transplantation, percutaneous transluminal angioplasty, diabetic lower limb ischemia, restenosis” in English and Chinese. Totaly 216 relevant literatures were initialy obtained, and 44 articles were ultimately included. RESULTS AND CONCLUSION:By comparing the therapeutic efficacy and long-term prognosis of umbilical cord blood stem cel transplantation and endovascular treatment, it is concluded that umbilical cord blood stem cel transplantation combined with endovascular treatment is better than either of them alone, which can promote the establishment of colateral circulation, improve the impaired endothelial function and reduce the occurrence of restenosis after interventional therapy.
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Objective To investigate the effects of early tracheotomy on the prognosis of patients with severe brain lesions .Methods The clinical data of 68 patients with severe brain lesions were retrospectively analyzed . According to the time of tracheotomy ,we assigned 68 patients to receive either early tracheotomy or late tracheotomy . 34 patients who were given tracheotomy within 72 hours in Intensive Care Unit were selected as the early tracheotomy group (ET group).34 patients who were given tracheotomy after 14 days in Intensive Care Unit were selected as the late tracheotomy group(LT group).The time of mechanical ventilation,length of hospital stay,and the incidence of ventilator associated pneumonia ( VAP ) , sedative drug use time , antibiotic use time , in-hospital mortality were compared between the two groups.Results In ET group,the hospitalization time,mechanical ventilation time, incidence of VAP,sedative drug use time,antibiotic use time were (4.2 ±2.4)d,(3.5 ±0.6)d,(14.5 ±3.2)%, (1.5 ±0.5)d,(3.3 ±0.3)d,those in LT group were (12.5 ±4.8)d,(8.5 ±5.6)d,(28.6 ±8.6)%,(6.3 ±1.2)d, (13.2 ±1.1) d respectively,the differences between the two groups were statistically significant ( t =3.14,2.96, 3.28,3.46,2.57,all P<0.05).The hospitalization mortality rates of ET group ,LT group were (23.8 ±4.38)%, (24.5 ±4.16)%,respectively no significant difference between the two groups ( t=1.49,P<0.05).Conclusion The use of early tracheotomy can reduce the hospitalization time ,shorten the time of mechanical ventilation ,reduce the incidence of ventilator associated pneumonia ,and reduce the time of using sedative drugs and antibiotics ,but the mor-tality has no significant effect in the severe craniocerebral injury patients .
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Objective To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. Methods A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group,with 16 cases in each group. Beside the treatment for primary disease,the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons,and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. Results Compared with control group,the time from diagnosis to operation(minutes:8.00±1.36 vs. 23.06±3.83,t=14.790,P=0.000)and the operation time were significantly shortened(days:5.37±1.02 vs. 7.31±1.70,t=7.286,P=0.000),the frequency of drainage tube replacement(times:0.18±0.40 vs. 3.87±1.14,t=12.128,P=0.000)and the times of repeated chest radiography(times:1.12±0.34 vs. 2.93±0.77,t=8.589,P=0.000)in observation group were significantly reduced,the length of hospital day was significantly shortened(days:8.30±1.37 vs. 24.56±5.62,t=17.289, P=0.000),the rates of dislocation of drainage tube(0 vs. 3 cases),obstruction of the tube(0 vs. 5 cases),and subcutaneous emphysema(3 vs. 16 cases)were reduced obviously,but there was no difference in incidence of incision infection(1 vs. 3 cases)and infection of thoracic cavity(0 vs. 2 cases). Conclusions The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure,and its effect is positive.
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Aim To provide an electrophysiological basis for hippocampus involved emotional changes caused by tinnitus, the effects of salicylate on electro-physiological characteristics of the voltage-gated calci-um channels in hippocampal neurons were performed. Method The effects of salicylate on voltage-gated cal-cium channels in rat hippocampal neurons were stud-ied, using the whole-cell voltage clamp method. Re-sults Salicylate blocked the voltage-gated calcium channels ( ICa ) in a concentration-dependent manner (0.1~10 mmol · L-1 ) . The half-inhibition concen-tration ( IC50 ) values for the blocking action of salicy-late on ICa were 1.64 mmol·L-1 . With 1 mmol·L-1 salicylate applicalted into bath solution, the steady-state activation curve of calcium channel was shifted by about 9 mV in the hyperpolarizing direction, and its steady-state inactivation curve was not changed. Con-clusion Salicylate inhibits ICa in rat hippocampal neu-rons and significantly affects the activation kinetics of ICa ,which could be related to emotional changes caused by tinnitus.
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ObjectiveTo explore the treatment efficacy and feasibility of large dose of cytidine diphosphate choline (CDPC) in cardiopulmonary cerebral resuscitation.MethodsOne hundred and thirtytwo patients with sudden cardiac arrest successfully treated by the cardiopulmonary cerebral resuscitation were divided into treatment group ( 75 patients) and control group (57 patients) by random number tables.Two groups of patients were given adrenaline resuscitation drugs,reducing the intracranial pressure drugs,hypothermia,hormones and other basic treatment.Control group used CDPC 0.25 g with glucoseinjection 300 ml to do intravenous drip (once a day,21 days as a period of treatment),and treatment group added CDPC to 2.00 g.The patients were treated by basic traditional analeptic.The Glasgow coma scale (GCS) was carried out in two groups in admission to hospital and 3,7,14,21 days after treatment,and the changes of lysophosphatidic acid (LPA) and phosphatidic acid (AP) level were monitored.ResultsThe GCS score was significantly higher in treatment group 7,14,21 days after treatment(P ＜ 0.05 or ＜ 0.01 ),but GCS score had no significant difference before and after treatment in control group(P ＞ 0.05).The level of LPA in treatment group was significantly decreased 14 days after treatment [ (2.98 ± 0.28) μmol/L ] and 21 days after treatment[ (1.85 ± 0.21)μmol/L],and had significant difference compared with that admission to hospital [ (3.75 ± 0.22) μ mol/L ] (P ＜ 0.05 or ＜ 0.01 ).In control group,there was no significant difference before and after treatment (P ＞0.05).The level of AP in treatment group 21 days after treatment was significantly decreased compared with that in control group [ ( 3.45 ± 0.23 ) μ mol/L vs.( 5.20 ± 0.21 ) μ mol/L ](P ＜ 0.01).ConclusionLarge dose of CDPC can improve neurological function of cardiopulmonary cerebral resuscitation,which is a safe,effective and easy way to be popularized.