目的 系统评价5岁以下呼吸系数疾病患儿使用高流量鼻导管氧疗(high-flow nasal cannula,HFNC)的有效性和安全性.方法 计算机检索PubMed、Embase、The Cochrane Library、中国生物医学文献服务系统、万方数据库、中国知网和维普期刊数据库已发表的关于5岁以下呼吸系数疾病患儿使用HFNC的随机对照试验(randomized controlled trials,RCT),进行Meta分析.结果 纳入2015-2020年发表的RCT文献11篇,共2466例患儿.Meta分析结果显示,在<5岁肺炎伴轻度低氧血症、轻中度毛细支气管炎的患儿中,与常规氧疗比较,HFNC可以显著降低患儿治疗失败率(P<0.001);在<5岁重症肺炎伴呼吸衰竭、重度毛细支气管炎的患儿中,与经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)比较,鼻损伤发生率降低(P=0.004),但HFNC治疗失败率增加(P=0.032);分别与常规氧疗和nCPAP比较,HFNC对患儿插管率、住院病死率、气漏综合征发生率、总住院时间、ICU住院时间及用氧时间差异均无统计学意义(均P>0.05).结论 基于现有临床证据,HFNC可作为<5岁肺炎伴轻度低氧血症、轻中度毛细支气管炎患儿的呼吸支持措施,不建议在<5岁重症肺炎伴呼吸衰竭、重度毛细支气管炎的患儿中使用HFNC.

Objective:To systematically evaluate the rate of unplanned readmissions for children at 30 days after cardiac surgery, the causes and risk factors for unplanned readmissions for children at 30 days after cardiac surgery.Methods:We searched PubMed, Embase, Web of Science, CBM, CNKI, Wanfang Data, and VIP database to collect studies from inception to August 15, 2020 of unplanned readmission of children after cardiac surgery.RevMan5.3 software was used for Meta-analysis.Results:A total of 13 studies, involving 81 633 patients were included.Meta-analysis results showed that the unplanned readmission rate of children 30 days after cardiac surgery was 11.5%(95% CI 9.9%-13%). Cardiac complications[24%(95% CI 10.7%-45.7%)], infections[18.7%(95% CI 13.7%-25.3%)], respiratory complications[18.0%(95% CI 10.7%-27.5%)], pleural effusion[11.5%(95% CI 8.3%-16.7%)], and gastrointestinal complications[12.3%(95% CI 8.3%-17.4%)] were the main reasons for unplanned 30-day readmission, with statistically significant differences( P<0.001). Genetic syndrome( OR=1.25, 95% CI 1.18-1.33, P<0.05) and postoperative hospital stay >14 days( OR=1.62, 95% CI 1.05-2.50, P<0.05) were risk factors for unplanned 30-day readmission. Conclusion:The incidence rate of unplanned readmission among the children 30 days after cardiac surgery is relatively high.Cardiac complications, infection, respiratory complications, pleural effusion, and gastrointestinal complications are the main reasons for 30-day unplanned readmission.The genetic syndrome and postoperative hospital stay >14 days in children 30 days after cardiac surgery are the risk factors for unplanned readmission.

To summarize the concept，development，constituent elements and application effects of gold standards framework（GSF） in palliative care，and to summarize enlightenment brought by GSF.It was aimed at providing reference for researches and practice of palliative care in China.

Objective:To compare the dose distribution of conventional radiotherapy (CRT) with that of the intensity modulation radiation therapy (IMRT) in breast cancer patients after breast-conserving surgery (BCR), and to provide evidence for the application of IMRT in the treatment of the patients. Methods: The 3-dimensional treatment planning system was used to design CRT and IMRT plans for 10 post-BCR patients, with the prescribed dosage as 50Gy/25f. CRT and IMRT were compared by evaluation of the dose volume, dose profile and dose distribution homogeneity indices. Results: The V95%, V105%, V110% and V115% of PTV for CRT were (98.3+1.9)%, (42.7+15.1)%, (8.2+8.7)% and (2.2+5.3)%, and those for IMRT were (98.5+1.0)%, (8.6+4.5)%, (0+0.4)% and 0, respectively. Statistically significant differences were observed in V105%and V110% (P 0.05) but not in V95% (P 0.05). Dose distribution homogeneity indices of CRT and IMRT were 1.30±0.14 and 1.12±0.03, respectively, with statistically significant differences (P 0.05). Comparing with CRT, IMRT reduced the V30 and V40 of the heart by 70.69% and 93.33%, and the V20 and V30 of the lungs by 22.27% and 40.35%, respectively, both with statistically significant differences (P 0.05). Conclusion: For PTV after breast-conserving surgery, both CRT and IMRT plans had a satisfactory coverage, but the latter was more conformal and had a more uniform dose distribution than the former, and it could effectively reduce the radiation dose for normal organs such as the heart and lungs.

Objective To study the effect of radiotherapy combined with Tetrandrine(Tet)in the treatment of locally advanced and recurrent rectal cancer.Methods The data of 33 cases of locally advanced and recurrent rectal cancer from 2000 to 2005 were analysed retrospectively,of which 15 patients received radiotherapy(radiotherapy group),18 cases received radiotherapy combined with Tet(Tet group).All patients were treated with conventional radiotherapy by 15MVX ray to a total dose of 60-66Gy in 6-7 weeks for the respectable disease.During radiotherapy of the Tet group,all the patients took Tet 40mg every time and three times per day.Results Local symptom remission rate was 100% for the two groups.Symptoms remission beginning time of the Tet group was shorter than the radiotherapy group,but had no statistical difference(P0.05).Hematochezia and pain relief sustained median time of the Tet group and the radiotherapy group were 15 months and 8 months,and there was a significant difference between the two groups(P0.05).Effective power of the Tet group and the radiotherapy group were 72.2% and 64.3%,there was no significant difference(P0.05).1,2,3-year survival rates of the Tet group and the radiotherapy group were 77.8%,44.4%,27.8% and 64.3%,33.3%,20.0%,there was no significant difference(P0.05).Conclusion Tet with radiotherapy can effectively extend locally symptom remission time for advanced and recurrent rectal cancer,and survival rate have a trend of improvement.Tet may be an ideal radiosensitizer.

Objective To observe the radiosensitizing effect and side-effects of tetrandrine in combination with radiotherapy in treatment of nasopharyngeal carcinoma(NPC).Methods 112 patients with NPC were randomly divided into the sensitization group and the control group.In the sensitization group,all patients were treated by conventional fractional radiotherapy with a total dose of 66-70 Gy/33-36 F/6-7 W by 6 MV-X-ray.During radiotherapy of the sensitization group,all the patients took tetrandrine 40 mg every time and three times per day.In the Control group,all patients were given to the same as the sensitization group in radiotherapy.Results The short-term overall response rate of the sensitization group(89.3%) was significantly higher than the control group(69.6%).There was not a significant difference between the 2 groups(P0.05)on side-effects.Conclusion Tetrandrine is an ideal radiosensitizer during NPC radiotherapy.