Intermittent androgen deprivation therapy(IADT)is now being increasingly opted by the treating physicians and patients with prostate cancer.The most common reason driving this is the availability of an off-treatment p...Intermittent androgen deprivation therapy(IADT)is now being increasingly opted by the treating physicians and patients with prostate cancer.The most common reason driving this is the availability of an off-treatment period to the patients that provides some relief from treatment-related side-effects,and reduced treatment costs.IADT may also delay the progression to castration-resistant prostate cancer.However,the use of IADT in the setting of prostate cancer has not been strongly substantiated by data from clinical trials.Multiple factors seem to contribute towards this inadequacy of supportive data for the use of IADT in patients with prostate cancer,e.g.,population characteristics(both demographic and clinical),study design,treatment regimen,on-and off-treatment criteria,duration of active treatment,endpoints,and analysis.The present review article focuses on seven clinical trials that evaluated the efficacy of IADT vs.continuous androgen deprivation therapy for the treatment of prostate cancer.The results from these clinical trials have been discussed in light of the factors that may impact the treatment outcomes,especially the disease(tumor)burden.Based on evidence,potential candidate population for IADT has been suggested along with recommendations for the use of IADT in patients with prostate cancer.展开更多
Background:Despite a growing population of patients starting hemodialysis in China,little is known about markers of mineral bone disease(MBD)and their management.We present data on prevalence and correlates of hypocal...Background:Despite a growing population of patients starting hemodialysis in China,little is known about markers of mineral bone disease(MBD)and their management.We present data on prevalence and correlates of hypocalcemia,hyperphosphatemia,and secondary hyperparathyroidism from the China Dialysis Outcomes and Practice Patterns Study(DOPPS),with evaluation of whether these laboratory markers triggered changes in management.Methods:We compared the frequency of measurement and prevalence of poor control of MBD markers in China DOPPS with other DOPPS regions.We also used generalized estimating equations to assess correlates of MBD markers,and separate models to assess predictors of vitamin D and phosphate binder prescriptions in the China DOPPS.Results:Severe hyperphosphatemia(>7 mg/dL)and secondary hyperparathyroidism(>600 pg/mL)were common(27%and 21%prevalence,respectively);both were measured infrequently(14.9%and 3.2%of patients received monthly measurements in China).Frequency of dialysis sessions was positively associated with hyperphosphatemia;presence of residual kidney function was negatively associated with both hyperphosphatemia and secondary hyperparathyroidism.Laboratory measures indicating poor control of MBD were not associated with subsequent prescription of active vitamin D or phosphate binder.Conclusions:There are substantial opportunities for improvement and standardization of MBD management in China.Development of country-specific guidelines may yield realistic targets and standardization of medication use accounting for availability and cost.展开更多
The scientific literature presents a modest amount ot evidence m the use or complementary ana al[erna- tire medicine (CAM). On the other hand, in practice, relevant results are common. The debates among CAM practiti...The scientific literature presents a modest amount ot evidence m the use or complementary ana al[erna- tire medicine (CAM). On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important, Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.展开更多
基金Ferring Pharmaceuticals provided funding for editorial assistance.The author acknowledges Dr.Payal Bhardwaj of Tata Consultancy Services,who provided editorial assistance.
文摘Intermittent androgen deprivation therapy(IADT)is now being increasingly opted by the treating physicians and patients with prostate cancer.The most common reason driving this is the availability of an off-treatment period to the patients that provides some relief from treatment-related side-effects,and reduced treatment costs.IADT may also delay the progression to castration-resistant prostate cancer.However,the use of IADT in the setting of prostate cancer has not been strongly substantiated by data from clinical trials.Multiple factors seem to contribute towards this inadequacy of supportive data for the use of IADT in patients with prostate cancer,e.g.,population characteristics(both demographic and clinical),study design,treatment regimen,on-and off-treatment criteria,duration of active treatment,endpoints,and analysis.The present review article focuses on seven clinical trials that evaluated the efficacy of IADT vs.continuous androgen deprivation therapy for the treatment of prostate cancer.The results from these clinical trials have been discussed in light of the factors that may impact the treatment outcomes,especially the disease(tumor)burden.Based on evidence,potential candidate population for IADT has been suggested along with recommendations for the use of IADT in patients with prostate cancer.
基金This work was supported by grants from the Global support for the ongoing DOPPS Programs without restriction on publications by a variety of funders(For details see https://www.dopps.org/AboutUs/Support.aspx)Dr.Shuchi Anand is supported by U.S.National Institute of Diabetes,and Digestive and Kidney Diseases(No.NIDDK K-235K23DK101826-03)Dr.Jun Wang is supported by the National Natural Science Foundation of China(No.81470972).
文摘Background:Despite a growing population of patients starting hemodialysis in China,little is known about markers of mineral bone disease(MBD)and their management.We present data on prevalence and correlates of hypocalcemia,hyperphosphatemia,and secondary hyperparathyroidism from the China Dialysis Outcomes and Practice Patterns Study(DOPPS),with evaluation of whether these laboratory markers triggered changes in management.Methods:We compared the frequency of measurement and prevalence of poor control of MBD markers in China DOPPS with other DOPPS regions.We also used generalized estimating equations to assess correlates of MBD markers,and separate models to assess predictors of vitamin D and phosphate binder prescriptions in the China DOPPS.Results:Severe hyperphosphatemia(>7 mg/dL)and secondary hyperparathyroidism(>600 pg/mL)were common(27%and 21%prevalence,respectively);both were measured infrequently(14.9%and 3.2%of patients received monthly measurements in China).Frequency of dialysis sessions was positively associated with hyperphosphatemia;presence of residual kidney function was negatively associated with both hyperphosphatemia and secondary hyperparathyroidism.Laboratory measures indicating poor control of MBD were not associated with subsequent prescription of active vitamin D or phosphate binder.Conclusions:There are substantial opportunities for improvement and standardization of MBD management in China.Development of country-specific guidelines may yield realistic targets and standardization of medication use accounting for availability and cost.
文摘The scientific literature presents a modest amount ot evidence m the use or complementary ana al[erna- tire medicine (CAM). On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important, Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.