Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy:a meta-analysis

BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.

High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding:A meta-analysis

AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis.The primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and mortality.The meta-analysis was performed with a fixed effects model or random effects model.RESULTS:Nine eligible RCTs including 1342 patients were retrieved.The results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.

Predictors of post-treatment stenosis in cervical esophageal cancer undergoing high-dose radiotherapy

AIM To evaluate toxicity and treatment outcome of highdose radiotherapy(RT) for cervical esophageal cancer(CEC).METHODS We reviewed a total of 62 consecutive patients who received definitive RT for stage Ⅰ to Ⅲ cervical esophageal cancer between 2001 and 2015. Patients who received < 45 Gy, treated for lesions below sternal notch, treated with palliative aim, treated with subsequent surgical resection, or diagnosed with synchronous hypopharyngeal cancer were excluded. Treatment failures were divided into local(occurring within the RT field), outfield-esophageal, and regional [occurring in regional lymph node(s)] failures. Factors predictive of esophageal stenosis requiring endoscopic dilation were analyzed.RESULTS Grade 1, 2, and 3 esophagitis occurred in 19(30.6%), 39(62.9%), and 4 patients(6.5%), respectively, without grade ≥ 4 toxicities. Sixteen patients(25.8%) developed post-RT stenosis, of which 7 cases(43.8%) were malignant. Four patients(6.5%) developed tracheoesophageal fistula(TEF), of which 3(75%) cases were malignant. Factors significantly correlated with post-RT stenosis were stage T3/4(P = 0.001), complete circumference involvement(P < 0.0001), stenosis at diagnosis(P = 0.024), and endoscopic complete response(P = 0.017) in univariate analysis, while complete circumference involvement was significant in multivariate analysis(P = 0.003). A higher dose(≥ 60 Gy) was not associated with occurrence of postRT stenosis or TEF. With a median follow-up of 24.3(range, 3.4-152) mo, the 2 y local control, outfield esophageal control, progression-free survival, and overall survival(OS) rates were 78.9%, 90.2%, 49.6%, and 57.3%, respectively. Factors significantly correlated with OS were complete circumference involvement(P = 0.023), stenosis at diagnosis(P < 0.0001), and occurrence of post-RT stenosis or TEF(P < 0.001) in univariate analysis, while stenosis at diagnosis(P = 0.004) and occurrence of post-RT stenosis or TEF(P = 0.023) were significant in multivariate analysis. CONCLUSION Chemoradiation for CEC was well tolerated, and a higher dose was not associated with stenosis. Patients with complete circumferential involvement require close follow-up.

Dose-individualization Efficiently Maintains Sufficient Exposure to Methotrexate without Additional Toxicity in High-dose Methotrexate Regimens for Pediatric Acute Lymphoblastic Leukemia

Objective:Methotrexate(MTX)can be safely administered to most patients but may cause severe toxicity in others.This study aimed to summarize the characteristics of high-dose methotrexate(HD-MTX)chemotherapy and to evaluate whether the modified dose-adjustment program was able to improve the maintenance of sufficient MTX exposure levels while minimizing toxicities.Methods:We evaluated 1172 cycles of high-dose MTX chemotherapy from 294 patients who were treated according to the CCCG-ALL-2015 protocol(clinical trial number:ChiCTR-IPR-14005706)and analyzed the data of actual MTX dosage,MTX concentration,toxicity,and prognosis.We compared data between the dose-adjustment Program 1(fixed 20%reduction in dose)and the dose-adjustment Program 2(dose-individualization based on reassessment of the creatine clearance rate and the MTX concentration-monitoring point at 16 h),which were applied if the MTX clearance was delayed in the previous cycle.Results:The patients who used Program 2 had higher actual MTX infusion doses and infusion rates and were able to better maintain the MTX concentration at 44 h at the established target value than those on Program 1(P<0.001).No significant differences in toxicities were found between these two programs except that abnormal serum potassium levels and prolonged myelosuppression in intermediate-risk/high-risk patients were more frequently observed in patients using Program 2(P<0.001).No significant correlations were observed between the MTX dose,dose-adjustment programs,or MTX concentrations and relapse-free survival.Conclusion:Adjusting the MTX dose using Program 2 is more efficient for maintaining sufficient MTX exposure without significantly increasing the toxicity.

The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study

Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-centered care. Methods: Cervical cancer patients (n = 31) undergoingmultiple fraction HDR brachytherapy treatment at the National Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety intensity using 11-point verbal analog scales, at 6 key time points over 2 brachytherapy insertion procedures and 4 brachytherapy fractions. Women were evaluated for psychological status at baseline before starting the brachytherapy process using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0 - 7 = normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in 12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported, with a maximum intensity in the operating room during spinal anesthesia (3.23 ± 1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety scores were reported in 25.8% and 22.6% of patients respectively. Level of education showed a significant correlation with anxiety scores (p = 0.027). Pain increased significantly during the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary multifraction high-dose rate brachytherapy is associated with mild to moderate levels of pain and anxiety, although a subset of patients reported more severe symptoms and may require additional medical and psychological support, with particular emphasis on bed-rest duration and applicator removal. The development of effective interventions (both pharmacological and non-pharmacological) is needed to improve women’s experiences of brachytherapy for locally advanced cervical cancer.

Very-high-dose olanzapine for treatment-resistant schizophrenia

Treatment-resistant schizophrenia has an extremely negative impact on mental health and social life. If clozapine, the gold standard treatment, fails, there are very few options left. The literature suggests that high-dose olanzapine (20 - 60 mg/day) is a possible alternative. We report two cases in which very high doses of olanzapine were administered, with significant clinical improvements above 60 mg/day. Clinical, metabolic and cardiac tolerance was good. This report highlights the usefulness of very-high-dose olanzapine in treatment-resistant schizophrenia. The main hypotheses concerning the psychopharmacological mechanisms of very-high-dose olanzapine are discussed.

Comparison of High-Dose Dexamethasone and Prednisone for Initial Treatment of Adult Primary Immune Thrombocytopenia

Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the definition of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%;P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM produced longer response duration compared to a conventional dose of prednisone. Randomized clinical trials are warranted to establish the optimal initial steroid therapy for adult ITP.

A New Variant of Combined Pulmonary Fibrosis and Emphysema from Long-Term High-Dose of Glucocorticoid Therapy: A Case Report

Recent studies have described the combination of both pulmonary emphysema and idiopathic interstitial lung disease (ILDs) by means of high-resolution computed axial tomography (HRCT). Definition of this syndrome was first named by Cottin as combined pulmonary fibrosis and emphysema (CPFE). Functional and radiological findings have showed that these patients are suffering from severe breathlessness, but whose pulmonary functional tests revealed no signs of obstruction, normal static lung volumes, and depressed DLco, most with a history of smoking [1] [2]. The radiological and endoscopic studies especially show that these patients have both areas of upper-lobe predominant emphysema and lesions compatible with fibrosis in both lung bases [3]. No prior research has reported any cases of such condition in person with no prior history of smoking as well as long-term high-dose of glucocorticoid therapy. In this case report, we discuss the presentation, diagnosis, and management of a 53-year-old non-smoker with increasing shortness of breath with a long-term high-dose of glucocorticoid therapy discovered to have an abnormal variant or presentation of CPFE. The cause of disease was attributed to a certain history of smoking in most studies;other potential risk factors have yet to be properly analyzed. This clinical report features a special case about the problem and solution surrounding this issue.

环境净化处理条件下急性非淋巴细胞白血病应用DNR、Ara-C、6-TG方案诱导缓解19例疗效观察

急性白血病诱导缓解化疗期最常见的并发症是感染,其次是出血,两者互相影响,常因此使化疗受挫,诱导缓解失败,甚至使患者致命。为了研究在既无隔离监护病室,又缺无菌空气层流病房的设备,在一般病室常规条件下,创造较好地净化病人内、外小环境,预防各种感染的简便有效的措施,应用常规全量有效化疗方案,进一步提高急性非淋巴细胞白血病(ANLL)初治病例的完全缓解(CR)率的目的,于1987年9月至1990年2月我们采取了一系列净化措施,并注意加强患者一般支持疗法,应用DAT(DNR,Ara-C,6-TG)

铁超载与铁剥夺对Ara-C诱导HL-60细胞凋亡的影响

目的 :探讨铁超载对铁剥夺对Ara C诱导HL 60细胞凋亡的影响。方法 :细胞培养法、台盼蓝活细胞拒染实验、细胞活力测定、光镜形态学观察、DNA琼脂糖电脉及流式细胞仪 (FCM )等方法检测HL 60细胞凋亡。观察不同浓度的三氯化铁 (FeCl3 )、铁剥夺剂 去铁胺 (DFO)等对HL 60细胞的作用 ,选择 10 0 μmol/LFeCl3 和 10 μmol/LDFO与Ara C共同作用于HL 60细胞 ,并以单用Ara C及生理盐水作对照。结果 :①FeCl3 (10 0 μmol/L) +Ara C(10 0 μg/ml) 6h ,12h ,2 4h ,APO %和Sub -G1%低于单用Ara C(10 0 μg/ml)组 ,两组相比有显著差异性 (P <0 0 5 )。②DFO(10 μmol/L) +Ara C(10 0 μg/ml)组APO %、DNA电泳ladder数目 ,FCM检测Sub -G1%均比单用Ara C高 (P <0 0 1)。③等摩尔的DFO与等摩尔FeCl3 共同作用于HL 60细胞 ,结果与生理盐水组相同 ;等摩尔DFO加等摩尔FeCl3 和Ara C(10 0 μg/ml)与单用Ara C(10 0 μg/ml)结果相同。 结论 :铁超载抑制化疗药物Ara C诱导HL 60细胞凋亡作用 ,铁剥夺 (DFO)可促进化疗药物Ara C诱导HL 60细胞凋亡作用。临床上可采用铁剥夺的方法协同治疗白血病 。

去甲氧柔红霉素联合Ara-C治疗难治性白血病

目的 :应用去甲氧柔霉素 ( IDA)联合 Ara- C组成的 IA方案治疗难治性白血病观察其疗效。方法 :IDA5 mg/ d～ 10 mg/ d ivgtt连续 3 d,Ara- C10 0 mg/ d～ 2 0 0 mg/ d ivgtt连续 5 d为一疗程。结果 :5例难治性白血病 (急淋 4例 ,急非淋 1例 ) ,采用 IA方案治疗 1个～ 2个疗程后 ,完全缓解 3例 ,部分缓解 2例。结论 :应用 IA方案治疗难治性白血病取得较好疗效 ,主要副作用为骨髓抑制 ,粒细胞减少 ,未发现心、肝。

羟基喜树碱联合Ara-C治疗骨髓增生异常综合症28例

目的观察羟基喜树碱联合Ara-C治疗MDS的效果及毒副作用。方法选择我院住院的MDS患者56例,随机分为对照组和治疗组各28例,对照组:应用维甲酸片20～40mg/次,每日一次,阿糖胞苷100～200mg/m2?d-1治疗,第1～7天,1月1疗程。治疗组:加用羟基喜树碱10mg/日,10天1疗程,1月1次,连用3疗程,同时两组均给以对症处理。结果对照组:基本缓解1例、部分缓解3例、进步7例、无效17例、总有效率39%。治疗组:基本缓解4例、部分缓解6例、进步10例、无效8例、总有效率70%。除轻度胃肠道反应外,无明显毒副作用。结论羟基喜树碱联合阿糖胞苷可以作为治疗MDS的新的有效治疗方法之一,尤其适合基层医院。

人类ERMAP-siRNA对Ara-C诱导K562细胞向红细胞系分化过程的影响

为探讨人类ERMAP基因在红细胞分化发育过程中的作用,本研究设计ERMAP-dsDNA,制备ERMAP-shRNA表达质粒,并建立稳定表达ERMAP-shRNA的K562细胞系(即ERMAP-shRNA/K562细胞系),观察Ara-C诱导ERMAP-shRNA/K562细胞向红细胞系分化过程中,细胞形态、联苯胺染色细胞阳性率和细胞表面标记等的变化,同时以FQ-PCR检测K562细胞人类ERMAP基因表达量的变化。结果发现:经Ara-C诱导72小时,ERMAP-shRNA/K562细胞与对照组比较,体积较大,胞浆量较少,着色大部分呈深蓝色或蓝紫色,部分细胞仍可见1-2个核仁;联苯胺染色阳性率由1.17%增加至2.04%(p<0.05),但仍低于Ara-C诱导K562组(p<0.05);CD36-/CD235a+细胞比例从8.83%增至11.28%,CD36+/CD235a+细胞比例从1.23%增至2.64%,CD36+/CD235a-细胞比例从0.59%增至1.47%,均明显低于Ara-C诱导K562细胞组;与此同时,ERMAP-shRNA/K562细胞ERMAP基因的表达量从诱导前的2.52×10-3缓慢增加至诱导72小时后的4.53×10-3,明显低于K562细胞组。结论:ERMAP-shRNA可抑制Ara-C诱导K562细胞向红系分化的过程,这进一步提示人类ERMAP基因与红细胞分化发育过程有关。

美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤的疗效观察(附6例)

目的:分析美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤的治疗效果。方法:总结2014年10月至2016年10月,我院收治的6例伯基特淋巴瘤患者的特征,均采用美罗华联合Hyper-CVAD/MTX+Ara-C方案化疗,历时4个周期共8个疗程,病程中腰穿及鞘注。结果:6例初诊患者临床分期(Arbor分期)Ⅲ期1例,Ⅳ期5例;首发部位多见于腹部包块及浅表淋巴结,均有B症状,乳酸脱氢酶(LDH)水平偏高,骨髓侵犯3例,中枢神经系统侵犯1例,有结外侵犯者3例。总疗程结束后评估,CR 5例,PR 1例,平均缓解期2.3个月。随访2.5年,5例患者病情稳定,1例死亡。结论:美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤有一定效果,患者对联合化疗的耐受性尚可。

Effect of Concurrent Use of rh-IL-3 and rh-GM-CSFon Apoptosis of HL-60 Cells Induced by Ara-C

The myeloid leukemic cell line HL-60 was studied by using DNA gel electrophoresis, flow cytomery, McAb C-myc, McAb Bc1-2 and CFU-L. From zero to 36 h,the apoptosis rates of 8 different phases and other indexes were observed. The results showed that with the prolonged time of drug incubation,apoptosis of HL-60 cells increased progressively. This effect can be enhanced obviously by rh-IL-3 and rh-GM-CSF. At the same time,the killed rate of leukemic cells by Ara-C induction was increased. C-myc expression was decreased and Bc1-2 expression did not display apparent change. Interestingly, the normal hemopoietic cells were not affected by these two kinds of cytokine. The theoretical basis was provided for concurrent use of rh-IL-3, rh-GM-CSF and cytotoxic drugs whose purpose is to elevate remission rate during the phase of induced remission of leukemia.