Clinical Analysis of Bevacizumab Plus FOLFIRI Regimen as Front-Line Therapy for Chinese Patients with Advanced Colorectal Cancer

The study was designed to evaluate the therapeutic and side effects of Bevacizumab plus FOLFIRI regimen as front-line therapy for Chinese patients with advanced colorectal cancer. A total of 15 previously untreated patients with advanced colorectal cancer received Bevacizumab plus FOLFIRI regimen as font-line therapy, in detail, irinotecan 180 mg/m2 was given intravenously on day1, then calcium folinate (CF) 200 mg/m2, F-fluorouracil (5-Fu) 400 mg/m2 given in bolus immediately after CF, day 1 - 2;5-Fu 600 mg/2 given continuously after bolus for 22 hours on day1, day2;Bevacizumab was given intravenously at dosage of 5 mg/kg, on day-1. Therapeutic and side effects were evaluated at least after four cycles of treatment. The results showed that all the cases among the group were valid for response evaluation, with CR 0, PR 10, SD 3, and PD 2. The response rate is 66.7% and median time to progression (mTTP) was 10.6 months. The main toxicities were bone marrow suppression, nausea and vomiting, stomach pain and diarrhea;there was no chemotherapy-related death. The data suggested that the combination regimen with Bevacizumab plus FOLFIRI regimen was effective as front-line therapy for Chinese patients with advanced colorectal cancer, and the side effects were tolerable and manageable.

Gefitinib combined with γ-ray stereotactic body radiation therapy has better efficacy than gefitinib alone for senile lung adenocarcinoma patients with EGFR mutations as first-line regimen

Objective： The senile lung adenocarcinoma patients harboring an activating epidermal growth factor receptor （EGFR） mutation shows good and rapid response to EGFR tyrosine kinase inhibitors （TKIs）. Whether gefitinib combined with y-ray stereotactic body radiation therapy has better efficacy than gefitinib alone for senile lung adenocarcinoma patients with EGFR mutations as first-line regimen is still under investigation. Methods： The 42 senile lung adenocarcinoma patients with EGFR mutations were divided into 2 groups according to the therapy method. Group A was the 22 patients treated with gefitinib combined with y-ray stereotactic body radiation therapy （SBRT）. Group B was the 20 patients treated with gefitinib alone. All of the patients received gefitinib of 250 mg/d from the first day until disease progression or other reasons. The patients of Group A were treated with y-ray stereotactic body radiation therapy from the second day. Radiation fields included the primary lesions and the integration of lymph nodes. Dose curve of this group was 50%-80%. Encircled dose was 4.0-6.5 Gy per fraction and the range of total dose was 40-52 Gy. We treated the patients 8-12 times and treated five times every week. Results： All the patients were examined by enhanced double helix CT at the second month. The tumor response rate （RR） of group A was 81.8% （18/22）. Disease control rate （DCR） was 90.9% （20/22）. The median overall survival （OS） was 24.2 months （range 8-58 months ） and the progression-free survival （PFS） was 18.6 months. The overall 1-year survival rate was 72.3% （16/22） and 2-year survival rate was 54.5% （12/22）. The main side effects included skin rash and diarrhea. The RR of group B was 50.0 % （10/20）. DCR was 75.0% （15/20）. OS was 17.4 months （range 6-32 months ） and PFS was 12.1 months. The overall 1-year survival rate was 60.0% （12/20） and 2-year survival rate was 40.0% （8/20）. The main side effects included skin rash and diarrhea. The group A who were treated with gefitinib combined with y-ray stereotactic body radiation therapy had a higher short term therapeutic effects （RR） and long term therapeutic effects （OS） than group B who were treated with gefitinib alone respectively （81.8% vs 50.0%, P = 0.029 〈 0.05, x2 = 4.773 and 24.2 vs 17.4, P = 0.024 〈 0.05, X2 = 5.098）. Conclu. sion： Gefitinib combined with y-ray stereotactic body radiation therapy has better efficacy than gefitinib alone for senile lung adenocarcinoma patients with EGFR mutations as first-line regimen. The side affects are acceptable.

Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis

Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is often linked to a heightened risk of recurrence.Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases,this approach has gained attention for its role in tumor downsizing,assessing biological behavior,and reducing the risk of postoperative recurrence.However,the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates.The balance between tumor reduction and the risk of hepatic injury,coupled with concerns about delaying surgery,necessitates a nuanced approach.This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases.Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion.Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative.The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing,such as RAS/BRAF and PIK3CA,in tailoring neoadjuvant regimens.Furthermore,the review emphasizes the need for a multidisciplinary approach to navigate the comp-lexities of CRLM.Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies.The management of progression following neoadjuvant chemotherapy requires a tailored approach,acknowledging the diverse biological behaviors that may emerge.In conclusion,this review aims to provide a comprehensive perspective on the considerations,challenges,and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM.By combining evidencebased insights with practical experiences,we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.

Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

AIM:To compare the incidence of early portal or splenic vein thrombosis(PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.METHODS:We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010.Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation,respectively.Group A(153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin(LMWH) irregularly.Group B(148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery,followed by oral warfarin and aspirin for one month regularly.The target prothrombin time/international normalized ratio(PT/INR) was 1.25-1.50.Platelet and PT/INR were monitored.Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS:The patients' data were collected and analyzed retrospectively.Among the patients,94 developed early postoperative mural PSVT,including 63 patients in group A(63/153,41.17%) and 31 patients in group B(31/148,20.94%).There were 50(32.67%) patients in group A and 27(18.24%) in group B with mural PSVT in the main trunk of portal vein.After the administration of thrombolytic,anticoagulant and antiaggregation therapy,complete or partial thrombus dissolution achieved in 50(79.37%) in group A and 26(83.87%) in group B.CONCLUSION:Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization,and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy.Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

Omeprazole-based triple therapy with low-versus high-dose of clarithromycin plus amoxicillin for H pylori eradication in Iranian population

AIM： To investigate the efficacy and tolerability of H pylori eradication in an omeprazole-based triple therapy with high and low dose of clarithromycin and amoxicillin. METHODS： One hundred and sixty H pylori positive patients were randomly assigned to two groups based on the following 2 wk investigation; （1） group A or low-dose regimen received omeprazole 20 mg b.i.d, clarithromycin 250 mg b.i.d and amoxicillin 500 mg b.i.d; and （2） group B or high-dose regimen received omeprazole 20 mg b.i.d, clarithromycin 500 mg b.i.d and amoxicillin 1000 mg b.i.d. During the study Hpylori status was assessed by histology and rapid urease test prior and by 13C-urea breath test 6 wk after the therapy. Standard questionnaires were administered to determine the compliance to treatment and possible adverse events of therapy. Data were subject to x^2 to compare the eradication rates in the two groups. The significant level of 95% （P ≤ 0.05） was considered statistically different. RESULTS： We found that the per-protocol eradication rate was 88% （68/77） in group A, and 89% （67/75） in group B. The intension-to-treat eradication rate was 85% （68/80） in group A and 83.75% （67180） in group B. Overall adverse events were 26% in group A and 31% in group B. The adverse events were generally mild in nature and tolerated well in both groups with a compliance of 98% in group A vs 96% in group B. CONCLUSION： The omeprazole-based low dose regimen of darithromycin and amoxicillin for two weeks in Hpylori eradication is as effective as high dose regimen in Iranian population.

Current status and future perspectives on neoadjuvant therapy in gastric cancer

Gastric cancer,with high morbidity and mortality rates,is one of the most heterogeneous tumors.Radical gastrectomy and postoperative chemotherapy are the standard treatments.However,the safety and efficacy of neoadjuvant therapy(NAT)need to be confirmed by many trials before implementation,creating a bottleneck in development.Although clinical benefits of NAT have been observed,a series of problems remain to be solved.Before therapy,more contributing factors should be offered for choice in the intended population and ideal regimens.Enhanced computed tomography(CT)scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors(RECIST),yet CT scanning results sometimes differ from pathological responses.After NAT,the appropriate time for surgery is still empirically defined.Our review aims to discuss the abovementioned issues regarding NAT for GC,including indications,selection of regimens,lesion assessment and NAT-surgery interval time.

Effect of Stereotactic Body Radiation Therapy on Diverse Organ Lesions in Advanced Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

Objective The combination of stereotactic body radiation therapy(SBRT)and immune checkpoint inhibitors(ICIs)is actively being explored in advanced non-small-cell lung cancer(NSCLC)patients.However,little is known about the optimal fractionation and radiotherapy target lesions in this scenario.This study investigated the effect of SBRT on diverse organ lesions and radiotherapy dose fractionation regimens on the prognosis of advanced NSCLC patients receiving ICIs.Methods The medical records of advanced NSCLC patients consecutively treated with ICIs and SBRT were retrospectively reviewed at our institution from Dec.2015 to Sep.2021.Patients were grouped according to radiation sites.Progression-free survival(PFS)and overall survival(OS)were recorded using the Kaplan-Meier method and compared between different treatment groups using the log-rank(Mantel-Cox)test.Results A total of 124 advanced NSCLC patients receiving ICIs combined with SBRT were identified in this study.Radiation sites included lung lesions(lung group,n=43),bone metastases(bone group,n=24),and brain metastases(brain group,n=57).Compared with the brain group,the mean PFS(mPFS)in the lung group was significantly prolonged by 13.3 months(8.5 months vs.21.8 months,HR=0.51,95%CI:0.28–0.92,P=0.0195),and that in the bone group prolonged by 9.5 months with a 43%reduction in the risk of disease progression(8.5 months vs.18.0 months,HR=0.57,95%CI:0.29–1.13,P=0.1095).The mPFS in the lung group was prolonged by 3.8 months as compared with that in the bone group.The mean OS(mOS)in the lung and bone groups was longer than that of the brain group,and the risk of death decreased by up to 60%in the lung and bone groups as compared with that of the brain group.When SBRT was concurrently given with ICIs,the mPFS in the lung and brain groups were significantly longer than that of the bone group(29.6 months vs.16.5 months vs.12.1 months).When SBRT with 8–12 Gy per fraction was combined with ICIs,the mPFS in the lung group was significantly prolonged as compared with that of the bone and brain groups(25.4 months vs.15.2 months vs.12.0 months).Among patients receiving SBRT on lung lesions and brain metastases,the mPFS in the concurrent group was longer than that of the SBRT→ICIs group(29.6 months vs.11.4 months,P=0.0003 and 12.1 months vs.8.9 months,P=0.2559).Among patients receiving SBRT with<8 Gy and 8–12 Gy per fraction,the mPFS in the concurrent group was also longer than that of the SBRT→ICIs group(20.1 months vs.5.3 months,P=0.0033 and 24.0 months vs.13.4 months,P=0.1311).The disease control rates of the lung,bone,and brain groups were 90.7%,83.3%,and 70.1%,respectively.Conclusion The study demonstrated that the addition of SBRT on lung lesions versus bone and brain metastases to ICIs improved the prognosis in advanced NSCLC patients.This improvement was related to the sequence of radiotherapy combined with ICIs and the radiotherapy fractionation regimens.Dose fractionation regimens of 8–12 Gy per fraction and lung lesions as radiotherapy targets might be the appropriate choice for advanced NSCLC patients receiving ICIs combined with SBRT.

Tailored eradication strategy vs concomitant therapy for Helicobacter pylori eradication treatment in Korean patients

BACKGROUND Antibiotic resistance to Helicobacter pylori(H.pylori)infection,which ultimately results in eradication failure,has been an emerging issue in the clinical field.Recently,to overcome this problem,an antibiotic sensitivity-based tailored therapy(TT)for H.pylori infection has received attention.AIM To investigate the efficacy and safety profiles of TT for H.pylori infection treatment compared to a non-bismuth quadruple therapy,concomitant therapy(CT)regimen.METHODS We included patients(>18 years)with an H.pylori infection and without a history of Helicobacter eradication who visited the Gil Medical Center between March 2016 and October 2020.After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner,patient compliance,eradication success rate(ESR),and patient-reported side effects profiles were assessed and compared between the two groups.H.pylori infection was diagnosed using a rapid urease test,Giemsa stain,or dual priming oligonucleotide polymerase chain reaction(DPO-PCR).Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation.For the TT group,a DPO-PCR test,which detected A2142G and/or A2143G point mutations,and a clarithromycin resistance test were performed.Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy,while those with sensitive results were treated with the standard triple regimen.RESULTS Of the 217 patients with a treatment naive H.pylori infection,110 patients[mean age:58.66±13.03,men,n=55(50%)]were treated with TT,and 107 patients[mean age:56.67±10.88,men,n=52(48.60%)]were treated with CT.The compliance(TT vs CT,100%vs 98.13%,P=0.30),and follow-up loss rates(8.18%vs 9.35%,P=0.95)were not significantly different between the groups.The ESR after treatment was also not statistically different between the groups(TT vs CT,82.73%vs 82.24%,P=0.95).However,the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group(22.77%vs 50.52%,P<0.001).CONCLUSION The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea,especially when physicians are confronted with increased antibiotic resistance rates.

Another simple regimen for perioperative management of diabetes mellitus

Persons with diabetes who require surgical procedures are increasing day by day.Many of the regimens available to manage patients with diabetes perioperatively are complex.Hence,the junior doctors and the paramedics(Primary care providers on a 24/7 basis)find it difficult to execute them.We need a simple regimen that can be executed in a primary care setting/general floor as it is becoming difficult to accommodate the patients in a sophisticated setting because of the increasing burden of the disease.We suggest a simple regimen in this article(Ram’s regimen)which we believe safer,economical and more effective than few simple regimens available to date.Moreover,this regimen does not require any additional equipment such as syringe pumps,measured-volume set,etc.Hence,this regimen can be implemented in a primary care setting/general floor easily and we hope that it will be useful for doctors of various specialties and their patients.

Desimplification to multi-tablet antiretroviral regimens in human immunodeficiency virus-type 1 infected adults: A cohort study

BACKGROUND Highly active antiretroviral therapy (HAART) is provided free of charge to all human immunodeficiency virus (HIV) positive residents in Italy. As fixed dose coformulations (FDCs) are often more expensive in comparison to the same drugs administered separately in a multi-tablet regimen (MTR), we considered a costeffective strategy involving patients in the switch from their FDCs to corresponding MTRs including generic antiretrovirals. AIM To verify if this would affect the virological and immunological response in comparison to maintaining the FDC regimens. METHODS From January 2012 to December 2013, we assessed the eligibility of all the HIV-1 positive adults on stable HAART being treated at our hospital-based outpatient clinic in Treviso, Italy. Participants who accepted to switch from their FDC regimen to the corresponding MTR joined the MTR group, while those who maintained a FDC regimen joined the FDC group. Clinical data, including changes in HAART regimens, respective reasons why and adverse effects, were recorded at baseline and at follow-up visits occurring at weeks 24, 48 and 96. All participants were assessed for virological and immunological responses at baseline and at weeks 24, 48 and 96. RESULTS Two hundred and forty-three eligible HIV-1 adults on HAART were enrolled: 163 (67%) accepted to switch to a MTR, joining the MTR group, while 80 (33%) maintained their FDCs, joining the FDC group. In a parallel analysis, there were no significant differences in linear trend of distribution of HIV-RNA levels between the two groups and there were no significant odds in favour of a higher level of HIV-RNA in either group at any follow-up and on the overall three strata analysis. In a before-after analysis, both FDC and MTR groups presented no significant differences in distribution of HIV-RNA levels at either weeks 48 vs 24 and weeks 96 vs 24 cross tabulations. A steady increase of mean CD4 count was observed in the MTR group only, while in the FDC group we observed a slight decrease (-23 cells per mmc) between weeks 24 and 48. CONCLUSION Involving patients in the switch from their FDC regimens to the corresponding MTRs for economic reasons did not affect the effectiveness of antiretroviral therapy in terms of virological response and immunological recovery.

Clinical observation of Fufangchangtai decoction combined with FOLFOX4 regimen for postoperative colorectal cancers

Objective:The aim of the study was to observe the therapeutic effect of FOLFOX4 regimen plus Fufangchangtai decoction on postoperative colorectal cancers.Methods:Thirty postoperative colorectal cancer patients were allocated into control and experiment groups respectively.Patients in experiment group were given Fufangchangtai decoction combined with FOLFOX4 regimen.Patients in control group were given FOLFOX4 regimen alone.Efficacy was evaluated after 2 periods of treatment.Results:The improvement rate of symptoms were 86.6% in experiment group compared to 53.3% in control group.KPS was stable in experiment group,and decreased in control group.QOL was increased in experiment group,and stable in control group after the treatment.For impact of immunity parameters,there were enhancements of CD3+ and CD4+ in experiment group,while they did not change in control group.In experiment group,WBC reduction was slighter than that of control group.The differences were not remarkable in PLT reduction,alimentary response,and toxicity of liver and kidney and nervous system.Conclusion:The clinical observation showed that Fufangchangtai decoction plus FOLFOX4 regimen could effectively enhance KPS,improve the symptoms,the quality of life and the immunity state,and down-regulate the side effects.In conclusion,Fufangchangtai decoction can decrease the toxicity so as to increase the treatment effect.

Antiretroviral regimen change among people infected with HIV:evidence from a crosssectional study in China

Background:The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy(HAART).However,the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern.The aim of this study was to determine factors in uencing antiretroviral regimen changes among people living with HIV/AIDS in China.Methods:This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART,and gathered relevant information from infectious disease hospitals.The following information were collected:social-demographic characteristics,antiretroviral therapies,CD4 cell counts,virus loads,reasons for changing medication and other related data.Mean and percentages were used to describe the frequency of regimen change among patients,and binary logistic regression was employed to test the factors in uencing regimen change.Results:1,123 people who had experienced regimen change were included in the analysis.On average,patients remained on HAART for 10.2 months before changing regimen,and the average CD4 cell count and viral load(VL)were 383.1 cells/ l and 28,132.4 copies/mL respectively when changing regimen.The reasons for modi cation were determined as treatment failure(52.5%),adverse reactions(32.3%),and other reasons including pregnancy(15.2%).There are significant differences in regimen change among people with different genders(P<0.001),modes of transmission(P<0.001),duration of HAART(P<0.001)and initial CD4 cell counts(P=0.0024).Males,drug users,people taking long-term medication,and those with lower initial CD4 counts when starting HAART tend to change regimen.Conclusion:Treatment failure was the main reason for the change of HAART regimen.Males,drug users,people on longterm medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.

抗肿瘤复方药物研发现状与挑战

目的 综述复方药物在抗肿瘤药物研发中的特点,以期为抗肿瘤复方药物研发提供参考。方法 通过检索国内外相关文献及数据库,对已上市的抗肿瘤复方药物及近3年美国食品药品监督管理局(FDA)批准的药物联合治疗方案进行分析。结果 目前上市的抗肿瘤复方药物通过多靶点协同作用或改善给药途径等方式,可提高药物治疗效果,改善患者依从性并降低药物毒性作用。结论 抗肿瘤复方药物具有治疗优势,但在研发过程中仍面临诸多挑战,未来人工智能可为复方药物研发提供技术支撑和创新动力。

早期心脏手术相关急性肾损伤患者连续性肾脏替代治疗系统化护理方案的构建

目的构建早期心脏手术相关急性肾损伤(CSA⁃AKI)患者连续性肾脏替代治疗(CRRT)系统化护理方案。方法采用文献分析、小组讨论等方法初步构建早期CSA⁃AKI患者CRRT系统化护理方案。基于德尔菲法,通过专家函询确定方案的条目,采用层次分析法确定条目的权重。结果两轮专家函询的问卷回收有效率均为100%;第一轮、第二轮专家函询的权威系数分别为0.888及0.909,各三级条目的重要性评分均值范围分别为3.84~4.84、4.10~5.00,标准差范围分别为0.43~1.20、0~0.61,肯德尔协调系数分别为0.124和0.158(P<0.05)。最终确定的系统化护理方案包含4个一级条目、15个二级条目、41个三级条目,各层次条目的一致性比率均<0.1。结论所构建的早期CSA⁃AKI患者CRRT系统化护理方案可为临床操作提供参考依据。

两种内膜准备方案对宫腔粘连术后患者冷冻胚胎移植妊娠结局的影响

目的比较激素替代治疗(HRT)方案和促排卵(OI)方案对宫腔粘连(IUA)术后患者冷冻胚胎移植妊娠结局的影响。方法选取2021年1月至2022年12月在昆明市妇幼保健院生殖医学中心行冷冻胚胎移植的IUA术后患者102例,根据妊娠结局分为活产组(39例)和非活产组(63例),比较两组患者的临床资料及不同内膜准备方案之间的差异,并对影响妊娠结局的因素进一步行logistic回归分析。结果两组年龄、体重指数(BMI)、基础激素水平[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)]、移植胚胎数、优质胚胎数比较,差异无统计学意义(P>0.05);活产组的不孕年限小于非活产组,转化日子宫内膜厚度大于非活产组,且应用OI方案比HRT方案更容易获得高的活产率,差异有统计学意义(P<0.05)。logistic回归分析显示,转化日内膜厚度是影响活产的独立保护因素(P<0.001);应用HRT方案是独立危险因素(P<0.05)。结论在IUA术后行冷冻胚胎移植的患者中,转化日内膜厚度与不同内膜准备方案均能影响妊娠结局,且OI方案在改善妊娠结局方面优于HRT方案。

肾脏替代治疗患者中万古霉素使用研究的文献计量和可视化分析

目的:探讨肾脏替代治疗患者中万古霉素使用研究领域的现况和趋势。方法:基于Web of Science Core Collection,对2007年1月1日至2023年10月11日发表的肾脏替代治疗患者中万古霉素使用研究的相关文献进行检索。采用VOSviewer和CiteSpace软件进行文献计量学和可视化分析,涉及发表趋势、地理分布特征、作者及机构、期刊分布特征和关键词信息等。结果:共纳入747篇文献。2007年以来,相关领域发文量波动上升,美国(264篇)是发文量最多的国家,其次为澳大利亚(76篇)和中国(71篇)。昆士兰大学(49篇)出版物最多。Jason A Roberts(24篇)、David W Johnson (19篇)和Jeffrey Lipman(19篇)是发文量居前3位的作者。《Peritoneal Dialysis International》(47篇)是发表相关文献最多的期刊。近年来的关键词聚焦于急性肾损伤、给药方案、治疗药物监测、群体药动学以及连续肾脏替代治疗等主题。结论:肾脏替代治疗患者中万古霉素的最佳使用剂量尚不清楚。通过治疗药物监测及群体药动学建模等方法,给予患者合适的给药方案,从而达到抗感染疗效并规避不良反应是该领域的热点和趋势。我国的研究机构与国际间缺乏紧密的合作交流。

含米诺环素、克拉霉素的铋剂四联方案在青霉素过敏的幽门螺杆菌感染初治患者中的应用价值

目的评价含米诺环素、克拉霉素的铋剂四联方案在青霉素过敏的幽门螺杆菌(Helicobacter pylori,H.pylori)感染初治患者中应用的根除疗效、依从性及安全性等情况。方法回顾性分析2022年9月至2023年7月于清华大学第一附属医院就诊的H.pylori感染初治且青霉素过敏的219例患者的临床资料,其中RMiCB组(69例)为雷贝拉唑+米诺环素+克拉霉素+复方铝酸铋颗粒方案;RMeCB组(71例)为雷贝拉唑+甲硝唑+克拉霉素+复方铝酸铋颗粒方案;RLCB组(79例)为雷贝拉唑+左氧氟沙星+克拉霉素+复方铝酸铋颗粒方案,疗程均为14 d,电话随访患者用药安全性、依从性及H.pylori根除情况。结果三组患者的基线资料差异无统计学意义(P>0.05)。RMiCB组、RMeCB组、RLCB组患者H.pylori根除率根据意向性分析(intention-to-treat analysis,ITT)分别为86.9%(60/69)、60.5%(43/71)、62.0%(49/79),符合方案分析(per-protocol analysis,PP)分别为90.9%(60/66)、66.2%(43/65)、68.1%(49/72)。按照PP分析,RMiCB组患者H.pylori根除率高于RMeCB、RLCB组,差异有统计学意义(χ^(2)=13.428,P=0.001),RMeCB、RLCB组H.pylori根除率差异无统计学意义(χ^(2)=0.056,P=0.857)。RMiCB组、RMeCB组、RLCB组患者药物不良反应发生率分别为13.0%(9/69)、16.9%(12/71)、16.5%(13/79),差异无统计学意义(χ^(2)=0.479,P=0.797)。结论含米诺环素、克拉霉素的铋剂四联方案在青霉素过敏的H.pylori感染初治患者中根除效果较好,且具有较高的依从性,可考虑作为一线治疗的备选方案。

气道分级管理方案配合音乐刺激疗法对老年肺炎机械通气患者脱机时间及谵妄的影响

目的探究气道分级管理方案配合音乐刺激疗法对老年肺炎机械通气患者脱机时间及谵妄的影响,为治疗该病症提供方法。方法选取2020年2月—2023年7月在锡山人民医院重症医学科接受机械通气治疗的老年肺炎患者80例,按随机信封法分为观察组和对照组,每组40例。对照组患者接受常规气道管理联合音乐刺激,观察组患者采用气道分级管理配合音乐刺激疗法治疗。记录并比较2组患者机械通气时间、一次性脱机成功率、住院时间、谵妄发生率及持续时间;评估并比较2组气道湿化效果及痰液分度。结果观察组机械通气时间、总住院时间均少于对照组,一次性脱机成功率高于对照组(均P<0.05);观察组谵妄发生率低于对照组(5.00%vs 22.50%,P<0.05);观察组谵妄持续时间少于对照组(P<0.05);观察组气道湿化满意率高于对照组(P<0.05);治疗后,观察组患者痰液粘稠度Ⅲ度的比例明显低于对照组(P<0.05)。结论气道分级管理方案配合音乐刺激疗法可缩短老年肺炎机械通气患者的脱机时间,减轻谵妄发生风险,并降低患者痰液粘稠度,在老年肺炎机械通气患者中具有一定的临床应用价值。

六字诀养生功结合刮痧疗法对慢性阻塞性肺疾病稳定期患者心肺功能和活动耐力的影响

目的探讨六字诀养生功结合刮痧疗法对慢性阻塞性肺疾病(COPD)稳定期患者心肺功能、活动耐力的影响。方法选取2021年5月—2023年6月就诊的158例COPD稳定期为研究对象,按照随机数字表法分为2组,各79例。对照组给予常规西药治疗,观察组在对照组基础上给予六字诀养生功结合刮痧疗法治疗,疗程均为3个月。比较2组临床疗效、不良反应,以及治疗前后中医证候积分、肺功能[呼气峰值流速(PEF)、第1秒用力呼气容积占预计值的百分比(FEV1%)、用力肺活量(FVC)]、活动耐力[6 min步行距离(6MWD)、30 s坐立次数]、血清免疫-炎性指标[降钙素原(PCT)、白细胞介素-8(IL-8)、免疫球蛋白A(IgA)、IgG]、圣乔治呼吸问卷(SGRQ)评分。结果观察组总有效率92.41%(73/79)高于对照组81.01%(64/79)(P<0.05)。治疗1、3个月后,观察组PCT、IL-8、SGRQ评分、各中医证候积分及总分均低于对照组,PEF、FEV1%、FVC、IgA、IgG、6MWD及30 s坐立次数均高于对照组(P<0.05)。不良反应总发生率2组比较差异无统计学意义(P>0.05)。结论六字诀养生功结合刮痧疗法治疗COPD稳定期患者效果显著,可提升患者肺功能、减轻临床症状、增强活动耐力、抑制炎症反应、提升免疫功能,从而有效改善预后,且安全性高。

以地西他滨为主的化疗方案治疗初治中、老年急性髓系白血病的临床研究

目的:研究以地西他滨为主的化疗方案治疗初治中、老年急性髓系白血病(AML)的安全性及有效性。方法:选取2013年1月-2016年12月就诊于本院年龄大于50岁的初诊急性髓系白血病患者(除M3)49例(所有患者均因各种原因不适合行异基因造血干细胞移植)。诱导治疗均采取以地西他滨为主的化疗方案,包括地西他滨单药(DAC)、地西他滨联合半量CAG方案(DAC-CAG)及地西他滨联合HAAG方案(DAC-HAAG)。在强化治疗方面对大部分患者继续应用原诱导方案治疗,部分患者给予标准"3+7"方案及中大剂量阿糖胞苷治疗。患者缓解后疗程数为2-4周期。结果:49例患者全部完成诱导治疗,完全缓解(CR)26例,部分缓解(PR)7例,无效(NR)16例,CR率53%,总有效率(ORR)67%。DAC组、DAC-CAG组及DAC-HAAG组有效率分别为17%、77%及63%。诱导过程感染14例,死亡1人,死因为肺部感染。诱导过程中平均输注红细胞9 U,输注血小板69U。白细胞恢复时间15 d,血小板恢复时间20 d。患者0.5、1和2年生存率分别为75%、30%及26%,0.5、1及2年无复发生存率分别为83%、54%及47%。诱导治疗是否能达到CR是影响预后的独立因素,而初诊时外周血白细胞和血小板数、年龄、诱导治疗效果、预后分层、化疗方案及诱导时是否合并肺炎均为非独立预后因素。结论:地西他滨联合化疗方案诱导效果优于单药,首次诱导治疗结果是独立的预后因素,而初诊时高白细胞、不良核型、合并症、伴有病态造血相关改变并不影响长期生存。DAC-CAG方案治疗有效率高,不良反应相对较少,适合应用于年龄大、合并症多、不适合常规方案化疗的中老年急性髓系白血病患者。