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Objective:To investigate the clinical relationship between carbapenem-resis-tant Klebsiella pneumoniae (CRKP) infection and the severity of acute pancreatitis. Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 109 patients with acute pancreatitis who were admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2017 to January 2018 were collected. There were 66 males and 43 females, aged (48±17)years. Blood, body fluid or anal swab samples of patients were collected aseptically. Patients were treated with gallbladder puncture and drainage, nasobiliary drainage, surgical debridement, computed tomography (CT) guided interventional drainage or conservative treatment, respectively, after being comprehensively diagnosed. Observation indicators: (1) severity of acute pancreatitis and results of CRKP infection test; (2) diagnostic value of CRKP infection for severity of acute pancreatitis; (3) treatment of acute pancreatitis; (4) prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Spearman correlation analysis were performed for correlation analyses. The receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value. Results:(1) Severity of acute pancreatitis and results of CRKP infection test: of 109 patients, there were 37 cases with mild acute pancreatitis, 8 cases with moderate-severe acute pancreatitis, 64 cases with severe acute pancreatitis. There were 45 cases with mild disease and 64 cases with severe disease, 48 cases with CRKP infection and 61 cases without CRKP infection. There were 3 cases and 45 cases with CRKP infection in the 45 mild disease cases and 64 severe disease cases, respectively, showing a significant difference ( χ2=43.430, P<0.05). Result of Pearson correlation analysis showed that CRKP infection was positively correlated with the severity of acute pancreatitis ( r=0.631, P<0.05). The duration of hospital stay were (66±6)days and (24±3)days for the cases with CRKP infection and cases without CRKP infection, respectively, showing a significant difference ( t=47.661, P<0.05). (2) Diagnostic value of CRKP infection for severity of acute pancrea-titis: the area under the ROC curve, sensitivity, and specificity of CRKP infection for the diagnosis of SAP were 0.799 (95% confidence interval as 0.714?0.885, P<0.05), 0.688, and 0.911, respectively. (3) Treatment of acute pancreatitis: of 109 patients, 17 cases underwent nasobiliary drainage, 19 cases underwent gallbladder puncture and drainage, 42 cases underwent surgical debridement, 48 cases underwent CT guided interventional drainage and 43 cases underwent conservative treatment. One patient may undergo multiple treatments. Of 109 patients, 66 patients underwent one and more invasive treatments with 47 cases undergoing CRKP infection and 43 patients did not undergo invasive treatment with 1 case undergoing CRKP infection, respectively, showing a significant difference ( χ2=50.134, P<0.05). (4) Prognosis of patients: all 109 patients were followed up for 3?9 months, with a median follow-up time of 6 months. During the follow-up, there were 15 cases and 6 cases dead in the 48 cases with CRKP infection and the 61 cases without CRKP infection, respec-tively, showing a significant difference ( χ2=7.919, P<0.05). Conclusion:CRKP infec-tion is positively correlated with the severity of acute pancreatitis, and CRKP infection is associated with the duration of hospital stay and types of invasive treatments.
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Prostate cancer is a common and frequently-occurring disease in elderly male patients,timely diagnosis and treatment is essential for protecting the health and lives of the elderly. The early diagnosis and treatment of prostate cancer in the elderly were reviewed.
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The overall 5-year survival rate for patients with metastatic colorectal cancer(CRC) is less than 10%.Median survival with 5-fluorouracil(5-FU)/leucovorin(LV) therapy is approximately 12 months.Recent additions to the chemotherapy armamentarium for this disease have begun to prolong median survival times.In trials in which patients are exposed to all three approved chemotherapy agents,oxaliplatin,irinotecan,and 5-FU/LV,or capecitabine during the course of their disease,median survival has reached 20 months. The addition of oxaliplatin and irinotecan to 5-FU/LV regimens has also led to the maintenance of quality of life for longer intervals than were traditionally observed with 5-FU/LV alone.Current standard first-line regimens for metastatic CRC are FOLFOX(infusional 5-FU/LV with oxaliplatin) and FOLFIRI(infusional 5-FU/LV with irinotecan).Ongoing investigations will identify a place for molecular targeted combination chemotherapy on metastatic colorectal cancer(CRC) and some trials achieved better efficiency.In this review,we discuss the current advances in combined management of metastatic colorectal cancer of 5-Fu,chemotherapy,Molecular targeted therapy.
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<p><b>BACKGROUND</b>Endostar™ (rh-endostatin, YH-16) is a new recombinant human endostatin developed by Medgenn Bioengineering Co. Ltd., Yantai, Shandong, P.R.China. Pre-clinical study indicated that YH-16 could inhibit tumor endothelial cell proliferation, angiogenesis and tumor growth. Phase I and phase II studies revealed that YH-16 was effective as single agent with good tolerance in clinical use.The current study was to compare the response rate , median ti me to progression (TTP) ,clinical benefit andsafety in patients with advanced non-small cell lung cancer ( NSCLC) , who were treated with YH-16 plus vi-norelbine and cisplatin (NP) or placebo plus NP.</p><p><b>METHODS</b>Four hundred and ninety-three histologically or cy-tologically confirmed stage IIIB and IV NSCLC patients , withlife expectancy > 3 months and ECOG perform-ance status 0-2 , were enrolledin a randomized ,double-blind ,placebo-controlled , multicenter trial ,either trialgroup : NP plus YH-16 (vinorelbine 25 mg/m² on day 1 and day 5 ,cisplatin 30mg/m² on days 2 to 4 , YH-167.5mg/m² on days 1 to 14) or control group : NP plus placebo (vinorelbine 25 mg/m² on day 1 and day 5 ,cis-platin 30 mg/m² on days 2 to 4 ,0.9% sodium-chloride 3 .75 ml on days 1 to 14) every 3 weeks for 2-6 cycles .The trial endpoints included response rate ,clinical benefit rate ,time to progression,quality of life and safety .</p><p><b>RESULTS</b>Of 486 assessable patients , overall response rate was 35.4% in trial group and 19.5% in controlgroup (P=0 .0003) . The median TTP was 6 .3 months and 3 .6 months for trial group and control group respectively (P < 0 .001) . The clinical benefit rate was 73 .3 %in trial group and 64.0% in control group (P=0 .035) .In untreated patients of trial group and control group ,the response rate was 40 .0% and 23.9%(P=0 .003) ,the clinical benefit rate was 76 .5 % and 65 .0 % (P=0 .023) ,the median TTP was 6 .6 and 3 .7months (P=0 .0000) ,respectively .In pretreated patients of trial group and control group ,the response ratewas 23.9% and 8.5%(P=0 .034) ,the clinical benefit rate was 65.2% and 61.7%(P=0 .68) ,the median TTP was 5 .7 and 3 .2 months (P=0 .0002) ,respectively . The relief rate of clinical symptoms in trial groupwas higher than that of those in control group ,but no significance existed (P > 0 .05) . The score of quality oflife in trial group was significantly higher than that in control group (P=0 .0155) after treatment . There were no significant differences in incidence of hematologic and non-hematologic toxicity , moderate and severe sideeffects betweentrial group and control group .</p><p><b>CONCLUSIONS</b>The addition of YH-16 to NP regimen results in significantly and clinically meaningful improvement in response rate , median time to tumor progression,and clinical benefit rate compared with NP alone in advanced NSCLC patients . YH-16 in combination with chemotherapy shows a synergic activity and a favorable toxic profile in advanced cancer patients .</p>
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Purpose:To study the response rate and adverse reactions of gemcitabine and cisplatin in the treatment of advanced liver cancer and the disease related symptoms improvement(DRSI). Methods:16 patients of advanced liver cancer were treated from Dec. 1999 to Dec. 2001.Gemcitabine was used intravenously by infusion for 30 min with the dose from 1 000 mg/m 2 to 1 250 mg/m 2 on day 1,8,cisplatin was infused intravenously with a dose of 25 mg/m 2 on day 1,2,3.Twenty one days were counted as one cycle. After 2 cycles of the treatment the response rate and adverse reaction and clinical symptoms were evaluated. Results:Among these 16 patients,there was no complete response,PR 4(25%),MR 6(37.5%),SD 4(25%),PD 2(12.5%),and clinical benefit response(CR+PR+MR+SD)14(87.5%). DRSI could be observed in 31.3%(5/16) for 1 cycle and 68.8%(11/16) for 2 cycles.The main adverse reactions were hematologic toxicity(grade 3/4),which included leucopenia 15.4%(6/39),anemia 12.8%(5/39),thrombocytopenia 25.6%(10/39),and nonhematologic toxicity was mild.Conclusions:Combination of gemcitabine with cisplatin was an effective and new chemotherapy for advanced liver cancer,it has high DRSI and mild adverse reactions.