脂质体紫杉醇联合奈达铂与紫杉醇联合奈达铂一线治疗晚期非小细胞肺癌的临床观察

目的比较脂质体紫杉醇联合奈达铂与紫杉醇联合奈达铂一线治疗晚期非小细胞肺癌(NSCLC)的临床疗效和不良反应。方法将56例初治晚期NSCLC患者采用回顾性分析的方法分为两组,每组28例,分别给予脂质体紫杉醇(175 mg/m^2)+奈达铂(90 mg/m^2)方案(试验组)和紫杉醇注射液(175 mg/m^2)+奈达铂(90 mg/m^2)方案(对照组)化疗,两组化疗周期均为21天,均不少于2周期。化疗2周期后,比较两组患者的疗效和不良反应。结果观察组与对照组总有效率相比无明显差异(P>0.05),而观察组周围神经炎和肌肉、关节痛等不良反应的发生率明显低于对照组(P<0.05)。结论用脂质体紫杉醇联合奈达铂与紫杉醇联合奈达铂治疗晚期NSCLC相比,疗效相当,但不良反应的发生率明显降低。

Itopride therapy for functional dyspepsia:A meta-analysis

AIM:To evaluate the therapeutic effects of itopride vs other drugs(placebo,domperidone,mosapride) for functional dyspepsia(FD).METHODS:Randomized controlled trials(RCTs) of itopride for FD were retrieved from databases.Relevant information was extracted and analyzed,using the relative risk(RR) and weighted mean deviation,as appropriate.A random or fixed effect model was used,based on the heterogeneity of the included articles,and visual inspection of funnel plots was used to evaluate publication bias.RESULTS:Nine RCTs enrolling 2620 FD cases were included;1372 cases received itopride treatment and 1248 cases received placebo or other drugs(control groups).Compared with control groups,itopride had superior RR values of 1.11 [95%CI:(1.03,1.19),P = 0.006],1.21 [95%CI:(1.03,1.44),P = 0.02],and1.24 [95%CI:(1.01,1.53),P = 0.04] for global patient assessment,postprandial fullness,and early satiety,respectively.For the Leeds Dyspepsia Questionnaire score,the weighted mean deviation was-1.38 [95%CI:(-1.75,-1.01),P < 0.01].The incidence of adverse effects was similar in the itopride and control groups.The funnel plots for all indicators showed no evidence of publication bias.CONCLUSION:Itopride has good efficacy in terms of global patients assessment,postprandial fullness,and early satiety in the treatment of patients with FD and shows a low rate of adverse reactions.Itopride can greatly improve FD syndromes-score.

The clinical observation of neoadjuvant chemotherapy in locally advanced breast cancer with DX regimen

The recent clinical curative effect and adverse events of docetaxel and capecitabine （DX） of neo- adjuvant chemotherapy in patients with locally advanced breast cancer was discussed. Methods： The data of 72 cases of neoadjuvant chemotherapy （DX） in locally advanced breast cancer after 4 cycles were retrospectively analyzed. Docetaxel 75 mg/m^2 by infusion 1 h on dl, capecitabine 2000 mg/m^2 by oral for twice daily on d1-14, 21 days was a cycle. Results： All 72 patients were assessed for efficacy and adverse events. The total effective rate was 80.5% （58/72）, including pathological complete response （pCR） was 7 （9.7%）, clinical complete remission （cCR） was 15（20.8%）, clinical partial response （PR） was 43 （59.7%）, stable disease （SD） was 8 （11.1%） and progressive disease （PD） was 6 （8.3%）. The main adverse events were gastrointestinal reactions and bone marrow suppression. The 3 to 4 degrees of adverse reactions including granulocytopenia in 7 patients （20.6%）, hand-foot syndrome in 6 patients （15.2%）. Conclusion： The DX regimen provide a favorable efficacy and safety profile in patients with locally advanced breast cancer for neoadjuvant chemotherapy.

Clinical Analysis of 30 Cases of Deep Lamellar Keratoplasty for the Treatment of Corneal Disease

purpose： to analyze clinical therapeutic effect of deep lamellar keratoplasty on treatment of corneal disease. Method： select 30 cases of corneal disease patients with a total of sick eyes, from 2012 January to 2013 January; all patients underwent deep lamellar keratoplasty, then observe and analyze visual acuity, corneal and occurrence of complications, to comprehensively assess the clinical therapeutic effect. Result： after receiving treatment of deep lamellar keratoplasty, of the 30 patients and 40 eyes, 31 corneal grafts are transparent; 9 corneal grafts are translucent; postoperative visual acuity： I0 eyes are 0.01-0.04; 13 eyes are 0.05~0.1; 14 eyes are 0.1-0.4; 3 eyes are above 0.5; 10 eyes have descemet micro-perforation or small perforation; 7 eyes have complications; these conditions are all controlled after active treatment. Conclusion： for patients with corneal disease, deep lamellar keratoplasty can not only achieve the similar transparency and visual rehabilitation as penetrating keratoplasty, but also reduce the incidence of adverse reactions and reject reaction after operation, to achieve the purpose of treatment and vision improvement; it has significant clinical effect, and greatly improve the quality of patients＇ life, so it is worthy of clinical application.

The observation of single-agent gemcitabine maintenance therapy in patients with metastatic breast cancer

Objective:The aim of the study was to evaluate the efficacy and tolerability of single-agent gemcitabine in the maintenance treatment of histologically confirmed metastatic breast cancer cases.Methods:The 45 patients carried efficacious chemotherapy were divided into maintenance therapy group(n=23) and control group(n=22) according to the different treatment methods.Patients in the maintenance therapy group received gemcitabine therapy until 6 cycles,disease progression or adverse effect intolerance.Within the control group,the patients were given best supportive care.Follow-up was made until disease progression,death or 2 years.The short-term clinical efficacy and adverse effects,progression-free survival(PFS) and median survival of recurrence(MSR) of these two groups were compared and analyzed.Results:Compared with the control group,the experiment group had higher response rate(RR;73.9% vs 31.8%;P<0.05),and significantly progress of median PFS(13.1 vs 9.6 months;P<0.05).However,the progression of MSR had no statistically difference with the control group(23.3 vs 21.1 months;P>0.05).Most of the treatment-related adverse events were mild,and the most common adverse event was hematologic toxicity.The 3 cases occurred grades 3–4 neutropenia and 3 cases occurred grades 3–4 thrombocytopenia.The 1 patient stopped treatment because of grade 3 allergic reaction,and 4 patients required dose reduction for grade 4 adverse events.Other adverse effects were grades 1–2,and all were recovered after symptomatic treatment.There was no significant side effect which threatened the life.Conclusion:In the extension maintenance treatment,gemcitabine can consolidate the therapeutic effect in advance and significantly prolong median PFS of metastatic breast cancer patients.In conclusion,gemcitabine monotherapy with a favorable safety profile is an effective maintenance treatment in metastatic breast cancer patients.

Clinical observation on docetaxel plus S1 in the treatment of advanced metastatic breast cancer

Objective: The aim of our study was to observe the efficacy and adverse reactions of docetaxel plus S1 in patients with advanced metastatic breast cancer. Methods: Twenty-seven patients with advanced metastatic breast cancer receiving docetaxel plus S1 in our hospital were analyzed. The efficacy and safety were evaluated according to RECIST and NCI CTC 3.0. Results: The clinical efficacy and toxicity were evaluated in all the 27 patients, including 1 case of CR, 12 of PR, 6 of SD, and 8 of PD (ORR = 48.1%, CBR = 70.3%). The median time to tumor progression (mTTP) was 7.3 months. No IV degree of adverse reaction was observed in the observation group. Most adverse reactions were degrees I and II, the most common reactions were neutropenia (59.3%), abnormal liver function (33.3%), gastrointestinal adverse events (29.6 %) and stomatitis (7.4%). Conclusion: With good efficacy and low toxicity, docetaxel plus S1 could be administered in the treatment of advanced metastatic breast cancer.

Clinical efficacy and safety of intravenous itraconazole in patients with invasive fungal infections in emergency intensive care unit

This study aimed to analyze the clinical efficacy and safety of itraconazole. We investigated 68 patients with invasive fungal infections（IFI） in emergency intensive care unit（EICU）. A retrospective analysis was performed in patients with IFI who were treated in the authors＇ institution, a grade III first class hospital in Beijing, China, between Feb. 2013 and Feb. 2015. The age of patients ranged from 35 to 90 years old with the mean age of（75.1±11.1） years old. The study population comprised 36 male and 32 female patients. Total response rate was 60.3%. The response rates in definitive diagnosis, clinical diagnosis and presumed diagnosis were 33.3%, 59.5% and 65.2%, respectively（P〈0.05）. The empirical treatment should be provided for patients with presumed diagnosis as earlier as possible. Eleven（16.2%） cases had adverse drug event（ADE） during treatment. The main signs were hepatic functional impairment and hypokalemia of ADE. The clinical efficacy and safety of intravenous itraconazole were precisely assessed. To reduce the adverse drug reaction（ADR）, hepatic and renal function and other biochemical criterion should be closely monitored.

The XIA's No. 1 Sleeping Prescription for the Treatment of Insomnia of the Deficiency Type:A Clinical Observation of 60 Cases

Objective： To evaluate the therapeutic effects and safety of the XIA＇s No.1 Sleeping Prescription for the treatment of insomnia of the deficiency type. Methods： 120 cases conformed to the diagnostic criteria of the Chinese Classification of Mental Disorders-Version 3 （CCMD-3） and were diagnosed as having insomnia of the deficiency type were divided randomly into a treatment group and a control group, 60 cases in each group. The treatment group was treated with the XIA＇s No.1 Sleeping Prescription, while the control group was given estazolam （ling） for 6 weeks. The Athens Insomnia Scale （AIS） was used to evaluate the clinical therapeutic effects, while the treatment emergent symptom scale （TESS） was used to evaluate adverse reactions. Results： The total effective rate of the treatment group （80%） was higher than that of the control group （70%）, but with no significant difference （P〉0.05）. The effective rate for long-term insomnia was 77.8% in the treatment group and 52.4% in the control group, with a significant difference between the two groups （P〈0.05）. The adverse reactions shown in the treatment group were obviously fewer and milder than those in the control group. Conclusion： The XIA＇s No. 1 Sleeping Prescription is effective for insomnia of the deficiency type and with no obvious toxic side effects.

Curative effect of Dingqi analgesic patch on cancer pain:a single-blind randomized controlled trail

OBJECTIVE:To observe the curative effect of an acupoint application with a Dingqi analgesic patch on moderate to severe pain caused by liver cancer.METHODS:Forty patients with moderate to severe pain caused by liver cancer were randomly divided intoatreatmentgroup(TG)andacontrolgroup(CG).Patients with moderate pain were given 100 mg qd of a sustainably released tablet of tramadol hydrochloride;patientswithseverepainweregiven4.2mg q3d of the fentanyl transdermal system.The ashi points Ganshu(BL 18),Danshu(BL 19) and Qimen(LR 14) were chosen for the acupoint application intervention.CG patients were given a sham patch and TG patients were given a Dingqi analgesic patch.A visual analogue scale(VAS) was used before treatment and after 1,3,6,9 and 12 days of treatment.The Karnofsky score was measured before treatment and after 12 days of treatment.Any main adverse reactions(e.g.nausea,constipation,dizziness and headache) were recorded after 6 and 12 days of treatment.Any skin side effects(i.e.skin irritation and allergic reactions) were recorded.RESULTS:The VAS in TG was significantly lower than that in CG after 3,6,9 and 12 days of treatment(P<0.05).There was no significant difference in the Karnofsky score before treatment and after 12 days of treatment between CG and TG.There were also no significant differences in the main adverse reactions or skin side effects after 6 and 12 days of treatment between CG andTG(P>0.05).CONCLUSION:The Dingqi analgesic patch can enhance the analgesic effect of tramadol and fentanyl.

Clinical Research Progress of Acupuncture-moxibustion for Chronic Urticaria

To learn the current research status of acupuncture-moxibustion in treating chronic urticaria, the relevant clinical reports indexed by CNKI and VlP databases during 2000 and 2012 were retrieved, and then summarized and analyzed from the aspects of treatment method, acupoint selection, medicine, treatment frequency, and criteria of therapeutic efficacy, for guiding the treatment of chronic urticaria with acupuncture-moxibustion. The results show that acupuncture-moxibustion therapy has stable therapeutic efficacy in treating chronic urticaria with low adverse reaction rate, but the current evaluation criteria are too subiective to cluantifv.

Clinical Research into Qufeng Zhidong Recipe Used to Treat 31 Children with Tic Disorder

Objective: To assess the therapeutic effect and adverse reaction of Qufeng Zhidong Recipe (a recipe for dispelling wind to stop abnormal movement) used to treat children with tic disorder (TD). Methods: The enrolled patients were randomized into a TCM group (31 cases) treated with Qufeng Zhidong Recipe and a Western medicine group (30 cases) treated with haloperidol and trihexyphenidyl. Two courses of treatment were observed with 12 weeks as one course. The therapeutic effect and adverse reaction were assessed with Yale Global Tic Severity Scale (YGTSS), Tic Symptom Score Scale (TSSS), TCM Syndrome Score Scale (TCMSSS), Treatment Emergent Symptom Scale (TESS) and laboratory examinations. Results: The total effective rate was 100% in the TCM group and 60% in the Western medicine group with statistical significance in difference (P<0.05). All the scores in the TCM group were better than those in the Western medicine group (P<0.05). Conclusion: Qufeng Zhidong Recipe can obviously relieve the symptoms and signs of TD children without toxic side-effects.

Hepatitis D infection:from initial discovery to current investigational therapies

Hepatitis D is the most severe form of viral hepatitis associated with a more rapid progression to cirrhosis and an increased risk of hepatocellular carcinoma and mortality compared with hepatitis B mono-infection.Although once thought of as a disappearing disease,hepatitis D is now becoming recognized as a serious worldwide issue due to improvement in diagnostic testing and immigration from endemic countries.Despite these concerns,there is currently only one accepted medical therapy(pegylated-interferon-a)for the treatment of hepatitis D with less than desirable efficacy and significant side effects.Due to these reasons,many patients never undergo treatment.However,increasing knowledge about the virus and its life cycle has led to the clinical development of multiple promising new therapies that hope to alter the natural history of this disease and improve patient outcome.In this article,we will review the literature from discovery to the current investigational therapies.

血管移植物感染影像学特征及评价

血管移植物感染(VGI)是血管移植术后的罕见但严重的并发症,其高致死率和致残率对病人的健康构成重大威胁。明确诊断和及时治疗对于改善病人预后具有重要意义。VGI的诊断主要依赖于临床表现、实验室检查和影像学检查。影像学检查在早期发现感染灶、评估病变范围和性质方面发挥了关键作用。临床表现方面,VGI通常表现为发热、不明原因的菌血症、体重减轻、局部疼痛等非特异性症状。实验室检查中常见炎症指标如白细胞计数、C反应蛋白和红细胞沉降率升高,但特异性较低,基因检测等新兴技术可显著提高病原体检测的阳性率。影像学检查包括超声、CT、MRI和核医学成像。CT血管成像(CTA)是疑似VGI的首选检查,可直观显示感染特征,如血管周围的积气、积液和假性动脉瘤等。18氟-脱氧葡萄糖正电子发射计算机断层扫描(18F-FDG PET/CT)具有较高的敏感度,可显示感染的代谢信息,在诊断和鉴别诊断中提供重要依据。主动脉移植物感染管理协作组(MAGIC)标准为VGI的诊断提供了系统的分类方法,包括主要指标和次要指标,当满足一个主要指标或来自不同类别的两个次要指标时,需高度怀疑VGI。通过影像学检查、实验室检测与临床表现的综合评估,可实现对VGI的早期识别和诊断,为后续治疗提供可靠依据。影像学技术在确定病变范围、指导手术规划及治疗效果评估中具有不可替代的价值。未来,随着成像技术的进一步发展,VGI的诊断和治疗将更加精确高效。