Transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed for hepatocellular carcinoma with major portal vein tumor thrombus

AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma(HCC) with major portal vein tumor thrombus(MPVTT).METHODS eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin(50 mg in 250 m L of glucose) was infused by pump for 4 h,followed by raltitrexed(2 mg in 100 m L of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated afterthe transarterial chemoembolization(TACe).RESULTS Full or partial embolization was achieved in 86 cases,where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses(CRs),partial responses(PRs),stable disease(SD),and disease progression(PD) for intrahepatic disease were observed in 0,45,20,and 21 patients,respectively. The 1-,2-and 3-year overall survival rates of the 86 patients were 40.7%,22.1%,and 8.1% respectively,and the median survival time was 8.7 mo. Complication was limited. CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.

Continuous regional arterial infusion for the treatment of severe acute pancreatitis: a meta-analysis

BACKGROUND： Continuous regional arterial infusion（CRAI） is a drug delivery system, which dramatically increases the drug concentration in the pancreas. Previous clinical and basic studies have demonstrated the possible therapeutic efficacy of CRAI for severe acute pancreatitis（SAP）. This meta-analysis of all published randomized controlled trials（RCTs） was conducted to assess the efficacy and safety of CRAI for the treatment of SAP. DATA SOURCES： Up to August 10, 2014, RCTs comparing CRAI with intravenous infusion for SAP in PubM ed, Embase, EBSCO, MEDLINE, Science Citation Index Expanded, Cochrane Library, China Academic Journals Full-Text Database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database were selected by two independent reviewers. The relative risk（RR） and their 95% confidence intervals（CI） for duration of elevated serum amylase and urine amylase, duration of abdominal pain, infection rate, incidence of complication, overall mortality, curative rate, hospital stay and details of subgroup analysis were extracted. Meta-analyses were made using the software Review Manager（RevM an version 5.10）.RESULTS： Six RCTs with 390 patients meeting the inclusion criteria were included in the final analysis. Compared with intravenous infusion route, CRAI significantly shortened the duration of elevated urine amylase（MD=-2.40, 95% CI=-3.20,-1.60; P〈0.00001） and the duration of abdominal pain（MD=-1.46, 95% CI=-1.94,-0.98; P〈0.00001）, decreased the incidence of complication（RR=0.35, 95% CI=0.15, 0.81; P=0.01） and overall mortality（RR=0.25, 95% CI=0.08, 0.78;P=0.02）, shortened the duration of hospital stay（MD=-10.36, 95% CI=-17.05,-3.68; P=0.002）, and increased the curative rate（RR=1.66, 95% CI=1.13, 2.46; P=0.01）. No mortality and catheter-related infections due to CRAI administration was reported in these studies. Subgroup analysis showed that the combination of drug administration via CRAI did not significantly improve the outcomes.CONCLUSION： CRAI is effective for the treatment of SAP, and the combination of drug administration via CRAI did not have a significant effect on the improvement of the outcomes.

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Background: Management of postoperative pain after caesarean section (C/S) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.

Continuous intravenous infusion of recombinant human endostatin using infusion pump plus chemotherapy in non-small cell lung cancer

BACKGROUND Lung cancer is one of the deadliest cancers in the world with the highest incidence and mortality rate among all cancers.Non-small cell lung cancer(NSCLC)accounts for approximately 80%of primary lung cancer.However,efficacy and safety of the current regimens for NSCLC is unsatisfactory.Therefore,there has been an increasing urgency for development of potential therapeutic therapies for NSCLC.AIM To investigate the therapeutic outcomes and safety of continuous intravenous infusion of recombinant human endostatin(Rh-endostain)using an infusion pump in retreated advanced NSCLC.METHODS Patients with retreated advanced NSCLC who were admitted to Zhejiang Provincial People's Hospital from October 2017 to April 2019 were recruited.These patients received continuous intravenous infusion of Rh-endostain using an infusion pump.Objective response rate(ORR),clinical benefit rate(CBR),median progression-free survival(mPFS),and incidences of adverse events(AEs)were analyzed after treatment.RESULTS A total of 45 patients with retreated advanced NSCLC were included,and all of them were evaluated.In these patients,ORR was 22.2%,CBR was 84.4%,and mPFS was 5.3 mo.The following AEs were observed,decreased hemoglobin(34 cases,75.6%),nausea/vomiting(32 cases,71.1%),elevated transaminase(24 cases,53.3%),leukopenia(16 cases,35.6%),thrombocytopenia(14 cases,31.1%),and constipation(1 case,3.4%).None of the patients had leukopenia,nausea/vomiting,and constipation of grade III and above.CONCLUSION The patients showed improved adherence to 5-d continuous intravenous infusion of Rh-endostain using an infusion pump.Favorable efficacy and safety of this treatment regimen were achieved in retreated advanced NSCLC.

Clinical observation of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction

Objective： The aim of the study was to observe the effectiveness of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction （MBO）. Methods： Clinical data were retrospectively analyzed in 26 carcinoma patients complicated with MBO, in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China, from March 2007 to April 2009. All 26 carcinoma patients with MBO were divided into no groups： the controlling group （CG, routine therapy, 15 patients） and the octreotide group （OG, 11 patients）. The octreotide group received routine therapy combined with octreotide （0.3 mg/d） by 24 hours continuously subcutaneous octreotide infusion. The changes of curative effectiveness related to symptoms, the times of recovering exsufflation and defecation, the average drain of gastrointestinal drainage tube, the duration of gastrointestinal drainage tube and the rate of extubation, were observed and compared between the two groups. Results： After treatment, remarkable changing rates of MBO related symptoms were 81.8% （9/11） in OG, and 46.7% （7/15） in CG （P 〈 0.05）. The 78% of SG and 30% of CG recovered the exsufflation and defecation, and the mean times they needed were 3.2 d and 5.8 d, respectively （P 〈 0.05）. The durations of gastrointestinal drainage tube of OG and CG were （5 ± 1.2） d and （10 ±2.3） d, respectively, and the rates of extubation were 54.5% and 20%, respectively. The improvement rate in the octreotide group was better than that in the controlling group and the difference was significant （72.7% and 26.7%, P 〈 0.05）. Conclusion; The administration of octreotide in combination with routine treatment can be very effective in the treatment of MBO. It can relieve the symptoms of MBO effectively and improve the quality of life of the end-stage patients. It has provided one kind of new treating thought and method for treatment of malignant bowel obstruction.

Continuous Intra-Articular Ropivacaine/Tramadol Combination Infusion Therapy Improves Postoperative Outcome of Total Knee Arthroplasty

Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.

In Frail Elderly Patients, Low-Dose Gemcitabine over 6-Hour Infusion Is Equally Effective and Less Toxic Than the Standard Gemcitabine Protocol for Advanced Pancreatic Adenocarcinoma: A Randomized Phase II Trial

Background:?Treatment of frail elderly patients with pancreatic cancer is still a major problem due to intolerance to standard chemotherapy doses. Aim:?This study aims to compare the low-dose gemcitabine over 6 hours (LD6H) to the standard gemcitabine protocol in terms of clinical benefit, survival, and safety in the frail elderly patients with advanced pancreatic adenocarcinoma. Methods:?Patients enrolled in this trial were randomly assigned by in a 1:1 fashion via closed envelope method to either receive gemcitabine of 1000 mg/m2?over 30-minute infusion on days 1, 8, and 15 of every 4-week cycle (standard protocol arm) or gemcitabine as a weekly low-dose (250 mg/m2) over 6-hour infusion (LD6H arm). Results:?We enrolled eighty-two eligible frail elderly patients with advanced pancreatic cancer. The patients were randomly assigned to receive either standard gemcitabine protocol (40 patients) or low-dose (250 mg/m2) gemcitabine over 6-hour infusion, given weekly (42 patients). There was no significant difference between the standard group and low-dose group as regard of the overall response rate (p = 0.654), the disease control rate (DCR) (p = 0.845), the median progression-free survival (PFS) (p = 0.908) and the overall survival (OS) (p = 0.331). The low-dose regimen had a significantly lower incidence of adverse effects grades 3 or 4 when compared to the standard regimen: (p = 0.024 for fatigue, p = 0.027 for hypotension, p = 0.012 for each anemia as well as thrombocytopenia, and p = 0.006 for neutropenia). Conclusion:?Low-dose gemcitabine over 6-hour infusion is equally effective and less toxic when compared to standard gemcitabine protocol in frail elderly patients with advanced pancreatic adenocarcinoma. So, we recommend the low-dose gemcitabine for frail elderly patients with advanced pancreatic cancer.

PREOPERATIVE CHEMOTHERAPY OF CONTINUOUS INFUSION OF 5-FLUOROURACIL, EPIRUBICIN OR PIRARUBICIN AND CYCLO- PHOSPHAMINE IN OPERABLE PRIMARY BREAST CANCER

Objective: To evaluate the feasibility and activity of continuous-infusion of fluorouracil in association with epirubicin or pirarubicin and cyclophosphamine as neoadjuvant regimen in patients with primary breast cancer. Methods: A total of 111 (including 114 breasts) were entered into the study. Chemotherapy consisted of two to six cycles of epirubicin 50 mg/(m2穌) and cyclophosphamide 500 mg/(m2穌) on day 1 and 8, and continuous intravenous administration of 5-fluorouracil 200 mg/(m2穌) from day 1 to 28 with a microinfusional elastomer (CEFci) or pirarubicin 35 mg/(m2穌) on day 1 and 8 instead of epirubicin (CTFci). Results: The overall response rate was 87.7%. Forty-five patients (39.5%) attained a complete clinical response and 27 (23.7%) attained a pathological complete response. CTFci regimen was superior to CEFci regimen in response rate,the pathological complete response rate (pCR) of former regimen was significantly higher than that of latter regimen (34.8% vs. 16.2%) (P=0.022). The pCR rate in ER/PgR negative tumor was significantly higher than that of ER/PgR positive tumor, achieving 33.3% and 7.5% respectively (P=0.001, x2=11.043). There was no relationship between HER-2 expression and tumor response. The toxicity of two regimens was well tolerated. Alopecia was mild in CTFci regimen comparing with CEFci regimen but neutropenia in CTFci regimen was higher than CEFci regimen. Conclusion: Continuous-infusion of fluorouracil in association with epirubicin or pirarubicin and cyclophosphamine is effective regimens as neoadjuvant chemotherapy for primary breast cancer and the toxicity is well tolerated. Pirarubicin regimen was superior to epirubicin regimen in response rate.

Effects of Tube Depth and Infusion Rate of Continuous Humidification by Endotracheal Intubation on Humidification Effect

Objective: To investigate the continuous humidification tube insertion depth of endotracheal intubation and the flow rate of the wetting effect. Methods: From October 2008 to May 2010, among 132 patients of oral and maxillofacial surgery with tracheal intubation, continuous infusion can be adjusted to the wet method;according to the wet pipe, insertion depth of the flow rate is divided into four groups, by four different depths and velocities of the wetting effect, to be analyzed. Results: B group was significantly lower than other groups satisfied with indicators of four significantly different effects of humidification. Conclusion: When continuous humidification tube insertion depth of endotracheal intubation is 10 - 12 cm, and flow rate is 15 - 20 ml/h, the wetting effect will achieve greater satisfaction.

The Effects of Dexmedetomidine Continuous Rate Infusion (CRI) on Isoflurane Anaesthesia in Healthy Horses

The concept of the modern anaesthesiological technique partial intravenous anaesthesia (PIVA) is by means of infusion of different pharmacological agents as a supplement to inhalation anaesthetics to reduce the concentration of volatile agents maintaining surgical anaesthesia and to decrease their noxious side effects mainly on cardiovascular and respiratory systems. Alpha-2 agonists are agents with frequent use in equine practice either as sedatives or in general anaesthesia PIVA protocols. The most selective amongst them, dexmedetomidine, is characterized by fewer side effects, lower doses, and fast elimination which make it appropriate for application as a continuous rate infusion (CRI). The purpose of this study was to trace out the effects of dexmedetomidine continuous rate infusion (CRI) as part of PIVA using isoflurane on volatile agent requirements, cardiovascular function, respiration and coagulation parameters, and recovery in healthy horses. Six healthy horses with average age 9.0 ± 5.1 year and mean body weight 247.7 ± 71.4 kg were subjected to either 3-hour lasting isoflurane or isoflurane-dexmedetomidine anaesthesia two weeks apart. The main clinical and anaesthesiological parameters were monitored in 10 minutes intervals. Electrolytes, acid-base, blood gases, and coagulation parameters were measured at the beginning and at the end of each anaesthesia. Recovery times and qualities were also recorded. The results showed that, the addition of dexmedetomidine by CRI at 1.75 μg·kg-1·hour-1 to isoflurane anaesthesia slightly reduced isoflurane requirement for maintenance of surgical anaesthesia but had negligible effects on the recovery time and quality. PIVA using dexmedetomidine and isoflurane produced respiratory acidosis similar to isoflurane anaesthesia alone but with significantly more pronounced hypoxaemia and hyperlactaemia. Both investigated anaesthesia protocols did not influence significantly haemocoagulation parameters.

Study of concentration of vancomycin in serum during continuous intravenous infusion

Objective Pharmacokinetics/pharmacodynamics of vancomycin in serum were studied after continuous infusion. Methods Twelve neurosurgical postoperative patients with ventricular drainage were enrolled in this study. In each patient,a loading dose of vancomycin of 0. 5 g was administered for 1 h followed

Efficacy of continuous arterial perfusion chemotherapy combined with transarterial chemoembolization regional arterial thermal perfusion in the treatment of pancreatic cancer with liver metastases

Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic cancer with liver metastasis.Methods:Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study.In the treatment group,31patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion,whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1.All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen.Treatment efficacy,quality of life,survival,and toxicity were evaluated.Results:Efficacy was better in the treatment group than in the control group,as reflected by the objective remission,partial remission,and disease progression rates(all P<0.05).The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group(both P<0.05).In survival analysis,the 1-year overall survival rates in the treatment and control groups were64.516%and 10.345%,respectively,whereas the median overall survival times were 16 and 6 months,respectively(both P<0.05).The6-month progression-free survival rates in the treatment and control groups were 77.419%and 13.790%,respectively,and the median progression-free survival times were 12 and 3 months,respectively(both P<0.05).The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group(both P<0.05).Although the rate of liver dysfunction was higher in the treatment group,this finding had no adverse effects on prognosis.Conclusions:Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis,suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.

Prolonged Infusion of Low Dose Gemcitabine in Advanced Pancreatic Carcinoma

Background: Gemcitabine was established as a monotherapy or in combination for locally advanced or metastatic pancreatic carcinoma. Aim: This study aimed to evaluate the efficacy of the low-dose gemcitabine over 6-hour infusion in patients with advanced pancreatic adenocarcinoma. Methods: 26 patients with locally advanced or metastatic pancreatic carcinoma were recruited into the study from December 2013 to October 2014. Patients received the treatment in Clinical Oncology Department, Sohag University, and Medical Oncology Department, Assiut University. Patients received low-dose gemcitabine (250 mg/m2) over 6-hour infusion, weekly for seven weeks and then on days 1 and 8 every 3 weeks till unacceptable toxicity or progression of the disease. Results: Twenty-six patients were enrolled in this study. After starting 7 weeks of treatment, the disease control rate was 38.5% in the form of complete response in 3.8% of patients, partial response in 26.9%, and stationary response in 7.7%. However, disease progression occurred in 61.5%. Progression-free survivals were 65.38%, 23.07%, 7.69% and 3.84% after 3, 6, 9 and 12 months, respectively. Also, overall survivals at 3-month, 6-month, 9-month, and 12-month were 61.53%, 42.30%, 23.07%, and 7.69%, respectively. Conclusion: Prolonged infusion of low dose gemcitabine is a tolerable and a good option in locally advanced or metastatic pancreatic carcinoma. There may be a benefit of that protocol in patients with bad performance status. More clinical trials with a combination of other cytotoxic agents or target therapy are needed to get better survival and lesser toxicity.

围手术期2型糖尿病患者胰岛素泵治疗期间低血糖发生情况及其危险因素分析

目的:探讨围手术期2型糖尿病(type 2 diabetes mellitus,T2DM)患者胰岛素泵治疗期间低血糖发生情况及其相关危险因素。方法:研究对象选取北京积水潭医院骨折合并T2DM围手术期行胰岛素泵强化治疗患者,共96例。收集病史,检测糖化血红蛋白(glycosylated hemoglobin,HbA1c)、肝功能、肾功能等指标,观察低血糖发生及术后并发症情况。采用Logistic回归分析探讨低血糖相关危险因素。结果:骨折合并T2DM患者术前胰岛素泵强化治疗至血糖达标时间为(2.8±1.3)d,总体低血糖发生率为15.6%。低血糖组15例,非低血糖组81例,与非低血糖组相比,低血糖组的年龄更大[(71.1±11.1)岁比(56.0±10.6)岁,P=0.000]、病程更长[14.0(8.8~17.8)年比5.0(2.8~12.0)年,P=0.017]、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)更低[(78.7±27.5)mL/(min·1.73 m^(2))比(106.8±15.0)mL/(min·1.73 m^(2)),P=0.005]、术后感染发生率更高(25%比3%,P=0.024)。多因素Logistic回归分析显示年龄大(OR=1.172,95%CI:1.027~1.091,P=0.012)、病程长(OR=1.193,95%CI:1.001~1.420,P=0.049)和eGFR低(OR=0.950,95%CI:0.903~0.998,P=0.049)是围手术期T2DM患者胰岛素泵治疗发生低血糖的危险因素。结论:围手术期T2DM患者胰岛素泵治疗可使血糖快速达标;年龄大、糖尿病病程长以及eGFR水平低是低血糖发生的危险因素。

不同包被缓释尿素的瘤胃缓释效果的评价

[目的]本文旨在通过体外批次发酵、瘤胃灌注和持续动态人工瘤胃模拟系统等不同方法评价包被缓释尿素的瘤胃缓释效果。[方法]体外发酵试验:选取1种普通尿素和4种商业包被缓释尿素,体外培养24 h,采集不同时间点(0、1、3、6、9、12、24 h)发酵液测定氨氮浓度,将筛选出缓释效果最好的缓释尿素用于进一步的研究。瘤胃灌注试验:12只体重(平均27.6 kg)相近的安装有瘤胃瘘管的育肥公湖羊,随机平均分为2组,分别向瘤胃中灌注剂量为日干物质采食量0.5%的普通尿素或日采食量0.55%的缓释尿素(等氮当量),灌注后不同时间点(0、1、3、6、9、12和24 h)采集瘤胃液,测定pH值和氨氮浓度。人工瘤胃试验:在基础日粮中分别添加3.5%的豆粕(普通日粮组)、0.5%的普通尿素(普通尿素组)和0.55%的缓释尿素(缓释尿素组),使用玉米补充普通尿素和缓释尿素组能量的缺乏;试验重复3次,每次持续7 d(4 d适应期和3 d采样期),采样期每天早上投料前后不同时间点采集发酵液和溢流液,测定发酵参数和微生物蛋白浓度。[结果]体外发酵试验:在发酵开始的9、12 h,缓释尿素A组的氨氮浓度显著低于普通尿素组和其余3个缓释尿素处理组(P<0.05)。体内瘤胃灌注试验:在灌注尿素后1 h,缓释尿素组瘤胃pH值和氨氮浓度显著低于普通尿素组(P<0.05),在灌注尿素后6 h,缓释尿素组的pH值显著高于普通尿素组(P<0.05)。人工瘤胃模拟试验:相比于其他2组,日粮添加缓释尿素显著提高了发酵液中丙酸和微生物蛋白的浓度(P<0.05);相比于普通日粮组,日粮添加缓释尿素显著降低了发酵液pH值(P<0.05)。[结论]不同包被缓释尿素的瘤胃缓释效果存在差异,体外发酵筛选出的缓释尿素A在动物瘤胃灌注条件下同样表现出较好的缓释效果。在人工瘤胃发酵试验中添加缓释尿素A能够改善瘤胃发酵,促进微生物蛋白的合成,但对生长性能和瘤胃菌群的影响仍需动物饲养试验做进一步的验证。

Meta-analysis of gemcitabine at 30 min standard-dose infusion versus prolonged low-dose infusion for advanced non-small cell lung cancer

To evaluate the efficacy and safety of gemcitabine （GEM） at 30 min standard-dose infusion （30 min-SDI） compared with prolonged low-dose infusion （P-LDI） in patients with advanced non-small-cell lung cancer （NSCLC）. Electronic databases including Pubmed, EMbase, Cochrane Library, CNKI, CBM, and VIP were searched using keywords ＂GEM＂, ＂P-LDI＂, and ＂NSCLC＂. Review Manager 5.3 was used to perform the recta-analysis. Primary endpoints were overall response rate （ORR） and 1-year survival rate （1-year SR）. Secondary endpoints were grade 3/4 hematotoxicity and nausea/vomiting. Six randomized controlled trials （RCTs） with a total of 637 patients were included. The results showed that P-LDI was superior in ORR （OR = 1.50, 95% CI： 1.08-2.10, P = 0.02）, but had an equal 1-year SR （OR = 1.27, 95 % CI： 0.90-1.79, P = 0.18） as compared with 30 min-SDl. For grade 3/4 adverse events, there was no significant difference in anemia （OR = 1.84, 95% CI： 0.61-5.57, P = 0.28） and nausea/vomiting （OR = 1.15, 95% CI： 0.63-2.12, P = 0.64） between the two treatments. However, patients with P-LDI experienced less leukopenia （OR = 0.64, 95% CI： 0.43-0.97, P = 0.04） and thrombocytopenia （OR = 0.37, 95% CI： 0.17-0.80, P = 0.01）. P-LDI was superior in terms of ORR, experienced less grade 3/4 thrombocytopenia and leukopenia compared with 30 min-SDI, and could be a viable treatment option for advanced NSCLC.

低剂量持续输注瑞马唑仑对颌面外科术后患者首夜睡眠质量的影响

目的 探讨低剂量持续输注瑞马唑仑对颌面外科术后患者首夜睡眠质量的影响。方法 选取2021年8月9日至2013年8月9日中国医学科学院整形外科医院颌面外科手术患者80例。随机分为对照组和瑞马唑仑组,每组40例。对照组术后无镇静药物输注,瑞马唑仑组术后首夜低剂量持续输注瑞马唑仑[0.2 mg/(kg·h)]。比较两组术后首夜N1、N2、N3及快动眼(rapid eye movement, REM)期睡眠时间、清醒时间、觉醒次数、睡眠效率,术后首夜不良反应及镇静镇痛药物补救情况。结果 80例患者中,男16例,女64例,年龄18~40岁,平均(26.3±5.7)岁。瑞马唑仑组N1期睡眠时间及睡眠效率高于对照组[177.7(108.1,262.4)min比90.5(70.6,131.8)min、81.3%(54.7%,96.0%)比68.6%(53.4%,82.8%)]、REM期睡眠时间及觉醒次数低于对照组[2.3(0.0,11.1)min比47.1(1.6,91.1)min、6.5(2.0,12.0)次比26.0(18.3,43.3)次];瑞马唑仑组SpO2<90%及心动过速的比例高于对照组(70.0%比37.5%、95.0%比80.0%),差异均有统计学意义(P<0.05),两组其他不良反应及镇静镇痛药物补救情况的比较,差异均无统计学意义(P>0.05)。结论 低剂量持续输注瑞马唑仑可有效延长颌面外科患者术后N1期睡眠时间,缩短REM期睡眠时间,减少觉醒次数,提高睡眠效率,无严重不良反应。

硬脊膜穿破的程控硬膜外间歇脉冲输注技术在分娩镇痛的应用研究

目的比较硬脊膜穿破的持续恒速输注和程控硬膜外间歇脉冲输注模式的分娩镇痛效果。方法收集有分娩镇痛需求的单胎妊娠产妇90例作为研究对象。所有患者均先采用硬脊膜穿破的硬膜外阻滞(DPE),根据药物输注装置的注药模式将患者随机分为持续恒速输注组(CEI组,n=45)和程控硬膜外间歇脉冲输注组(PIEB组,n=45)。实时记录镇痛前(T0),试验后5 min(T_(1)),负荷量后10 min(T_(2))、30 min(T_(3))、60 min(T_(4))、120 min(T_(5))、180 min(T_(6))、240 min(T_(7))及宫口开全(T_(8))9个时间点上不同指标情况。选取的观察指标包括数字评定量表评分(NRS)、下肢运动神经阻滞评分(Bromage评分)以及产妇心率、脉搏氧饱和度、呼吸频率、胎心率。记录分娩镇痛期间自控镇痛次数、爆发痛次数及分娩镇痛期间药物用量。记录镇痛分娩期间低血压、发热、宫缩乏力、胎心减慢、恶心呕吐及瘙痒、头痛等不良反应发生例数;统计胎儿娩出后的新生儿评分(Apgar评分)。结果CEI组与PIEB组产妇各时间点NRS评分比较差异无统计学意义(P>0.05)。与CEI组比较,PIEB组爆发痛次数、患者自控硬膜外镇痛(PCEA)按压次数、补救镇痛次数明显减少,差异有统计学意义(P<0.05)。PIEB组在硬膜外分娩镇痛负荷量后120 min(T_(5))、180 min(T_(6))、240 min(T_(7))时Bromage评分小于CEI组,差异有统计学意义(P<0.05)。2组胎儿娩出后1 min、5 min的Apgar评分及镇痛分娩期间的不良反应比较差异无统计学意义(P>0.05)。结论硬脊膜穿破硬膜外分娩镇痛持续给药与间歇脉冲给药均有良好镇痛效果。硬脊膜穿破硬膜外分娩镇痛程控间歇脉冲给药模式可有效降低爆发痛次数、PCA按压次数,减少分娩镇痛期间药物用量,并且不增加产妇及胎儿的相关不良事件。

Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients.AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion(CSII).METHODS Based on the treatment modality received,the patients were allocated into two cohorts:The CSII group and the multiple daily injections(MDI)group,with each cohort comprising 210 patients.Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5,homocysteine,and C1q/TNF-related protein 9.Furthermore,outcomes such as fasting plasma glucose,2-hour postprandial glucose levels,pain assessment scores,and the incidence of complications were evaluated post-treatment.RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group(P<0.05).Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group(60.00%)in contrast to the MDI group(36.19%)(P<0.05).Additionally,the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group(P<0.05).However,there were no significant variances observed in other pregnancy outcomes between the two groups(P>0.05).A statistical analysis revealed a significant difference in the incidence of complications between the groups(χ^(2)=11.631,P=0.001).CONCLUSION The utilization of CSII via an insulin pump,as opposed to MDI,can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery.This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar,reducing the likelihood of adverse pregnancy outcomes and complications.The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

日点评分析法结合微信延续护理对门诊输液厅静脉留置针患者不良事件的预防效果

目的:探讨日点评分析法结合微信延续护理对门诊输液厅静脉留置针患者不良事件的预防效果,为减少不良事件的发生提供参考依据。方法:选取2021年1月—2022年1月福建省立医院门诊输液厅76例使用静脉留置针进行静脉输液治疗的患者作为研究对象,采用随机数表法将其分为对照组与研究组,每组各38例。对照组采用常规护理,研究组实施日点评分析法结合微信延续护理。比较两组患者舒适度[中文版简化舒适状况量表(GCQ)评分]、静脉留置针留置时间及不良事件发生情况。结果:干预后,研究组患者GCQ中各维度评分均明显高于对照组,差异有统计学意义(t=3.876、5.215、4.713、6.071,P<0.05)。研究组患者静脉留置针留置时间为(4.46±1.35) d,长于对照组的(2.71±1.09) d,差异有统计学意义(t=6.217,P<0.05)。研究组患者各类不良事件发生率均明显低于对照组,差异有统计学意义(χ^(2)=3.934、5.352、5.208、5.029、6.514、5.352、3.934,P<0.05)。结论:日点评分析法结合微信延续护理可提高门诊输液厅静脉留置针患者的舒适度,预防或减少不良事件发生,延长患者的静脉留置针留置时间。