ABSTRACT
OBJECTIVE：To study the effects of augmented renal clearance （ARC）on blood trough concentration of patients receiving high-dose regimen of teicoplanin. METHODS ：Patients who received high-dose regimen of teicoplanin in the ICU were prospectively collected from the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital during Jul. 2018-Jun. 2020. They were divided into ARC group and normal renal function group according to corrected creatinine clearance. The dosage regimen of teicoplanin in the two groups were loading dose of 600 mg，q12 h×3 doses，maintenance dose of 6-10 mg/kg，qd，and the dosage was adjusted in combination with creatinine clearance rate and blood trough concentration. The trough concentration of blood samples which were collected 30 min before the 4th and 8th-10th dosage of teicoplanin were determined by HPLC. Trough concentration ，clinical efficacy ，Gram-positive bacterial clearance rate and the occurrence of ADR were compared between 2 groups. RESULTS ：A total of 56 patients were included and divided into ARC group （18 cases）and normal renal function group （38 cases）. ARC group had younger age （P＜0.001）and lower serum albumin level （P＝0.025）than normal renal function group. The trough concentrations before administration of the 4th and 8th-10th dosage in ARC group were lower than normal renal function group （P＝0.034；P＝0.035）. The trough concentrations in the ARC group and normal renal function group before 8th-10th dosage were all higher than 30 min before the 4th dosage （P＝0.003；P＜0.001）. The clinical efficacy rate and the clearance rate of Gram-positive bacteria in ARC group were 77.8％ and 76.2％，which were lower than those of the normal renal function group ，but there was no statistical difference （P＝0.195；P＝0.223）. There was no liver function damage ，hemocytopenia and allergic reaction in both groups ，but in the normal renal function group ，the causal relationship between acute renal damage and teicoplanin was assessed as “very likely ”in one patient. CONCLUSIONS ：ARC patients are younger ，most of them have hypoproteinemia，and the blood trough concentrations of teicoplanin in high-dose regimen are significantly lower than those of normal renal function patients. For critical ill ARC patients ，it is advisable to increase the loading dose of teicoplanin to make the trough concentration reach the target concentration range quickly.
ABSTRACT
Objective:To investigate the clinical effect of local and systemic zoledronic acid in the treatment of giant cell tumor of bone.Methods:The clinical data of 42 patients with giant cell tumor of bone who were treated in the Department of Joint and Sports Medicine Surgery of Shandong Provincial Third Hospital from January 2000 to January 2017 were retrospectively analyzed. According to whether zoledronic acid was used during and after operation, the patients were divided into zoledronic acid group ( n=21) and non zoledronic acid group ( n=21). The perioperative indexes, pain visual analogue scale (VAS), international Musculoskeletal Tumor Society (MSTS) score of lower extremity function, adverse reactions and the postoperative recurrence were compared between the two groups. Results:The operative time of zoledronic acid group and non zoledronic acid group were (158.4±20.5) min and (169.5±19.5) min, the intraoperative bleeding volume were (236.3±9.7) ml and (228.2±16.5) ml, the postoperative drainage volume were (163.3±7.4) ml and (161.4±9.3) ml, and the healing time of incision were (13.8±2.1) d and (14.0±2.0) d, respectively, with no significant difference ( t=-1.798, P=0.080; t=1.936, P=0.062; t=0.733, P=0.468; t=-0.290, P=0.774). The preoperative VAS scores of zoledronic acid group and non zoledronic acid group were 6.54±1.76 and 6.72±1.51 respectively, the MSTS scores were 13.56±2.35 and 12.79±1.98 respectively, and the differences were not statistically significant ( t=-0.356, P=0.724; t=1.148, P=0.258). The VAS scores of the two groups were 1.32±0.31 and 1.92±0.19 at 4 weeks after operation, 0.93±0.29 and 1.47±0.38 at 3 months after operation respectively, and the differences were statistically significant ( t=-7.562, P<0.001; t=-5.177, P<0.001). The VAS scores of the two groups were 0.31±0.12 and 0.35±0.23 at the last follow-up, with no significant difference ( t=0.707, P=0.485). The MSTS scores of zoledronic acid group and non zoledronic acid group were 24.89±3.86 and 21.82±2.95 at 4 weeks after operation, 26.78±2.57 and 24.62±2.62 at 3 months after operation respectively, and the differences were statistically significant ( t=2.896, P=0.006; t=2.697, P=0.010). The MSTS scores of the two groups were 27.31±2.21 and 26.69±2.93 at the last follow-up, with no significant difference ( t=0.774, P=0.443). The postoperative recurrence time of the two groups was (9.79±2.58) months and (7.31±1.73) months respectively, and the difference was statistically significant ( t=3.659, P=0.001). There was no significant difference in recurrence Campanacci grade and recurrence tumor location between the two groups ( U=7.000, P=0.860; χ2=1.062, P>0.999). The occurrence rates of fever in zoledronic acid group and non zoledronic acid group were 23.81% (5/21) and 4.76% (1/21), the occurrence rates of myalgia were 19.05% (4/21) and 4.76% (1/21), the incidences of influenza like symptoms were 14.29% (3/21) and 0 (0/21), the occurrence rates of gastrointestinal reaction were 9.52% (2/21) and 4.76 (1/21), and the differences were not statistically significant ( χ2=1.750, P=0.186; χ2=0.980, P=0.341; χ2=1.436, P=0.231; χ2<0.001, P>0.999). All the patients had no serious adverse reactions such as liver and kidney function damage and mandible necrosis. Conclusion:Local and systemic application of zoledronic acid in the treatment of giant cell tumor of bone can improve the early postoperative pain and limb function, delay the recurrence time, and can be used as an auxiliary treatment of giant cell tumor of bone.