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.

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.

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.

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.

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.

Consensus of primary care in acute pancreatitis in Japan

The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as thediagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy:A case report

BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.

Basal or bolus dose, which is the key factor in CSII?

Objective: To observe the value of HbA1c level evaluating the total daily basal insulin dose by continuous subcuta- neous insulin infusion (CSII) in 268 patients with type 2 diabetes mellitus. Methods: 5-point capillary blood glucose was moni- tored in pre- and post-CSII and the insulin dose which could stabilize blood glucose was defined as the total daily dose of insulin, including basal and bolus total dose. Correlation between HbA1c level and total daily dose of insulin in patients with type 2 dia- betes mellitus was analyzed. Correlation between HbA1c level and 5-point capillary blood glucose was also analyzed. Results: Obvious correlation was observed between HbA1c level and the basal total daily dose of insulin if HbA1c was more than 9.3% (r=0.635, P<0.05). The average of 5-point capillary blood glucose was best correlated with HbA1c and fasting blood glucose next best. Conclusion: HbA1c level can forecast basal total daily dose of insulin in CSII.

Pharmacokinetic and Pharmacodynamic Efficacies of Continuous versus Intermittent Administration of Meropenem in Patients with Severe Sepsis and Septic Shock： A Prospective Randomized Pilot Study

Background： The antibiotic meropenem is commonly administered pharmacokinetic, clinical, and bacteriological efficacies of continuous patients. n patients with severe sepsis and septic shock. We compared the infusion of meropenem versus internaittent administration in such Methods： Patients admitted to the Intensive Care Unit （ICU） with severe sepsis or septic shock who received meropenem were randomly assigned to either the continuous （n = 25） or intermittent groups 01 = 25）. The continuous group received a loading dose of 0.5 g of meropenem lbllowed by a continuous infusion of 3 g/day： the intermittent group received an initial dose of 1.5 g lbllowed by 1 g lbr every 8 h. Clinical success, microbiological eradication, superinfection, ICU mortality, length of ICU stay, and duration of meropenem treatment were assessed. Serial plasma meropenem concentrations tbr the first and third dosing periods （steady state） were also measured. Results： Clinical success was similar in both the continuous （64%） and intermittent （56%） groups （P = 0.564）： the rates of microbiological eradication and superinfection （81.8% vs. 66.7% [P = 0.255] and 4% vs. 16% [P 0.157], respectively） showed improvement in the continuous group. The duration of meropenem treatment was significantly shorter in the continuous group （7.6 vs. 9.4 days; P = 0.035）, where a better steady-state concentration was also achieved. Peak and trough concentrations were significantly different between the continuous and intermittent groups both in the first （Cmax： 19.8 mg/L vs. 51.8 mg/L, P = 0.000; Cmin： 11.2 mg/L vs. 0.5 nag/L, P = 0.000） and third dosing periods （Cmax： 12.5 mg/L vs. 46.4 rag/L, P = 0.000; Cmin： 11.4 mg/L vs. 0.6 rag/L, P = 0.000）. For medium-susceptibility pathogens, continuous inthsion concentrations above the minimal inhibitory concentration were 100%, which was better than that in the intermittent group- Conclusions： Continuous infusion of meropenem provides significantly shorter treatment duration and a tendency for superior bacteriological efficacy than intermittent administration. Continuous inthsion may be more optimal against imermediate-susceptibility pathogens.

A 2-way cross-over,open-labeled trial to compare efficacy and safety of insulin Aspart and Novolin R delivered with CSII in 21 Chinese diabetic patients

Background Subcutaneous absorption is accelerated by the monomeric conformation of insulin Aspart, which provides good glycemic control with a lower risk of hypoglycemia and less body weight increase. In the present study we investigated the efficacy and safety of a rapid-acting human insulin analogue （insulin Aspart） delivered with continuous subcutaneous insulin infusion （CSII） into Chinese diabetic patients. Methods A total of 21 patients with type 1 or type 2 diabetes were recruited for the 2-way cross-over, open-labeled trial, and then randomized to Group A （n=-10, treated with insulin Aspart） or Group B （n=11, treated with Novolin R）. Insulin Aspart and Novolin R were administered by CSII. Capillary glucose concentrations were measured at 8 time points, pre-prandial and postprandial, bedtime （10 pm）, midnight （2 am） every day during the treatment. Results The average capillary glucose profiles for the day were much better controlled in Group A than in Group B （P〈0.01）. The blood glucose levels were particularly better controlled in Group A than in Group B at pre-breakfast （（6.72±1.24） mmol/L vs （7.84±1.58） mmol/L, P=0.014）, post-breakfast （（8.96±2.41） mmol/L vs （11.70±3.11） mmol/L, P=0.0028）, post-supper （（8.15±2.10） mmol/L vs （10.07±2.36） mmol/L, P=0.008）, bed time （（7.73±1.72） mmol/L vs （9.39±.2.05） mmol/L, P=0.007） and midnight （（6.32±1.16） mmol/L vs （7.48±1.36） mmol/L, P=0.0049）. There was no significant difference in the frequency of hypoglycemic episodes between the two groups. Conclusion Insulin Aspart results in better control of blood glucose levels than regular human insulin （Novolin R） in diabetic patients during delivery by CSII.