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OBJECTIVE： To explore the role of clinical pharmacists on anlotinib-induced ADR in patients with advanced lung cancer， and to provide reference for safe drug use in clinic. METHODS： For 3 typical cases of ADR caused by the treatment of advanced lung cancer with anlotinib， clinical pharmacists provided pharmaceutical care to patients from the aspects of the use of anlotinib， medication education， the prevention and treatment of ADR， and assisted clinicians to solve ADR related to anlotinib such as hemoptysis， liver injury， elevated blood pressure， proteinuria， etc. RESULTS： For one case of anlotinib-induced hemoptysis， clinical pharmacists analyzed that the degree of hemoptysis was mild. They suggested that anlotinib should be discontinued and treated symptomatically with cough relief and hemostasis. If necessary， pituitrin should be added. Anlotinib could be continued after hemoptysis control， which doctors adopted. No hemoptysis occurred during the treatment period. For the case of anlotinib caused liver function damage， clinical pharmacists analyzed it as mild cholestasis type. They suggested that no discontinuation of anlotinib should be given and adenosylmethionine treatment should be given， which doctors adopted. After 5 days of treatment， the patients’ liver function returned to normal， and no obvious liver function damage was found in the later period. For the case of anlotinib induced hypertension with proteinuria， the patient had a history of hypertension. For hypertension， clinical pharmacists strengthened medication education for patients， instructed patients to adjust diet， appropriately activities， reduce mental stress and monitor blood pressure. The psychological intervention and other non-drug antihypertensive effects were poor， and then clinical pharmacists suggested to modify the antihypertensive treatment for patients. Doctors adopted it and changed the former antihypertensive drug nitrendipine to angiotensin receptor blocker valsartan. After 2 weeks of treatment， blood pressure returned to normal. For urinary protein， clinical pharmacists recommend to discontinue the use of anlotinib， and the urinary protein returned to normal after 2 weeks. Clinical pharmacists recommend to reduce the dose of anlotinib to continue treatment， which the doctors adopted. No abnormal urinary protein was found in the later review. CONCLUSIONS： Clinical pharmacists should actively provide pharmaceutical care for lung cancer patients treated with anlotinib， and strengthen medication education so as to promote rational drug use in clinic.
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Objective To discuss the application of endoscopic ultrasound-guided needle-based confocal laser endomicroscopy ( EUS-nCLE) in the diagnosis of pancreatic neoplasms. Methods Patients with pancreatic neoplasms were diagnosed by endoscopic ultrasonography and punctured by 19 G needle, and then the confocal microprobe was implanted through the needle. The lesions nature was estimated according to obtained images. The diagnostic yield and complication was evaluated and compared with pathology. Results A total of 28 patients successfully underwent EUS-nCLE, and high quality images were obtained in all patients. The final diagnosis were 5 cases of serous cystadenoma ( SCN ) , 3 cases of mucinous cystadenoma, 3 cases of intraductal papillary mucinous neoplasms ( IPMN) , 1 case of pseudocyst, 10 cases of ductal adenocarcinoma, 1 case of neuroendocrine tumor, 2 cases of solid pseudopapillary tumor, 2 cases of chronic pancreatitis, and 1 cases of lymphoma. The diagnostic yield in 26 patients with pathology was 73. 1%(19/26) and the specificity of SCN and IPMN was 100%(7/7). The complications, mostly pancreatitis and intracystic hemorrhage, occurred in 10. 7% ( 3/28) patients. Conclusion EUS-nCLE is a safe and feasible method in the diagnosis of pancreatic neoplasms, and shows high specificity in SCN and IPMN.
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Objective To discuss the application of endoscopic ultrasound-guided needle-based confocal laser endomicroscopy ( EUS-nCLE) in the diagnosis of pancreatic neoplasms. Methods Patients with pancreatic neoplasms were diagnosed by endoscopic ultrasonography and punctured by 19 G needle, and then the confocal microprobe was implanted through the needle. The lesions nature was estimated according to obtained images. The diagnostic yield and complication was evaluated and compared with pathology. Results A total of 28 patients successfully underwent EUS-nCLE, and high quality images were obtained in all patients. The final diagnosis were 5 cases of serous cystadenoma ( SCN ) , 3 cases of mucinous cystadenoma, 3 cases of intraductal papillary mucinous neoplasms ( IPMN) , 1 case of pseudocyst, 10 cases of ductal adenocarcinoma, 1 case of neuroendocrine tumor, 2 cases of solid pseudopapillary tumor, 2 cases of chronic pancreatitis, and 1 cases of lymphoma. The diagnostic yield in 26 patients with pathology was 73. 1%(19/26) and the specificity of SCN and IPMN was 100%(7/7). The complications, mostly pancreatitis and intracystic hemorrhage, occurred in 10. 7% ( 3/28) patients. Conclusion EUS-nCLE is a safe and feasible method in the diagnosis of pancreatic neoplasms, and shows high specificity in SCN and IPMN.
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Objective To evaluate the values of urinary liver-fatty acid binding protein (uL-FABP) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in diagnosis of acute kidney injury (AKI) caused by obstructive nephropathy and in the prediction of renal prognosis.Methods Clinical data of 30 patients with obstructive nephropathy were collected prospectively.uL-FABP and uNGAL were measured by ELISA at various time points.Risk factors of the renal outcome were evaluated.The patients were followed up for at least one year.Results Patients with AK1 had higher levels of uL-FABP and uNGAL compared to those without AKI [700.00(154.62-1216.14) μg/g· Cr vs 26.90 (16.77-41.38) μg/g·Cr; 1266.69 (671.57-3396.07) μg/g·Cr vs 179.12 (90.98-215.16) μg/g·Cr,all P ＜ 0.01].Positive correlations of uL-FABP and uNGAL with serum creatinine were found (r =0.552,0.553,all P ＜ 0.01).The AUCs of uL-FABP and uNGAL to detect AKI were 0.925 and 0.900.Patients with non complete renal recovery had higher levels of uL-FABP before operation and 72-hour after operation compared to those with complete renal recovery (all P ＜ 0.01).Before operation,the AUC of uL-FABP to detect renal prognosis was 0.948,sensitivity was 85.7％ and specificity was 90.9％.72-hour after operation,the AUC of uL-FABP to detect renal prognosis was 0.935,sensitivity was 85.7％ and specificity was 90.9％.Kaplan-Meier analysis revealed that uL-FABP before operation over 366.57 μg/g · Cr or uL-FABP 72-hour after operation over 223.60 μg/g · Cr were closely related to the poor progression of renal function.Conclusions uL-FABP and uL-NGAL have good accuracy in detecting AKI.The level of uL-FABP before operation and 72-hour after operation is helpful to predict the renal outcome of obstructive nephropathy.
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Objective To evaluate the value of dual energy computed tomography (DECT) for the diagnosis of gout.Methods Twenty-fivc consccutive patients with gout were selected as the experimental group and 20 patients with rheumatoid arthritis (RA) were selected as the control group.DECT scans were performed for every patient (all peripheral joints for the experimental group and affected joints for the control group).And every patient with gout had X-ray examination of the involved joints.x2 test and t-test were used for statistical analysis.Results All 25 patients with gout showed urate deposits on their DECT scans,whereas none of 20 controls showed urate deposits (P＜0.01).DECT scans revealed a total of 184 areas of urate deposition in 25 patients,in which 107 (58.2％) were at feet and ankle,72 (39.1％) were at knees,4 (2.2％) were at hands and wrists,1 (0.5％) was at elbows,whereas physical examination only showed 64 areas of urate deposition,in which 38(59.4％) were at feet and ankle,24(37.5％) were at knees,2(3.1％) at hands and wrists,0 was at elbows(P＜0.01 ).Only 6 patients with gout showed nonspecific manifestations on X-ray.Conclusion DECT scans may have potential value for the diagnosis of gout since it could produce evident colour displays for urate deposits and help to identify subclinical tophus deposits.
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Objective To evaluate the value of urinary liver-type fatty acid binding protein (L-FABP)as a biomarker in prediction of renal function progression in patients with chronic glomerulonephritis (CGN). Methods A total of 123 patients with newly diagnosed CGN by renal biopsy in Shanghai Renji Hospital between 2004 January and 2005 December were enrolled in the study,Twenty-eight healthy subjects were used as control group.Urine samples were collected before biopsy and treatment,and urinary L-FABP was measured by ELISA.The patients with follow-up every three months for 5 years were divided into progressive group and nonprogressive group.The progression of kidney function impairment was defined as a reduction of GFR ≥ 5 ml·min-1·(1.73 m2)-1·year-1 during follow-up.The risk factors of progressive renal function were evaluated and the Spearman correlation analysis was performed to find out the prognostic indicator of renal function deterioration. Results Urinary L-FABP level of CGN patients was significantly higher than that of healthy control group (P＜0.01).Urinary L-FABP in CGN patients was negatively correlated with eGFR (r=-0.565,P＜0.01) and positively correhted with proteinuria (r=0.501,P＜0.01) and Scr (r=0.601,P＜0.01).Kaplan-Meier analysis showed that urinary L-FABP excretion＞76.58 μg/g·cr predicted progression of renal function.The AUC of urinary L-FABP for prognosis of CGN progression was 0.95,with 87.5％ of sensitivity and 90.5％of specificity at the cutoff value of 119.8 μg/g·cr,which revealed its great value of predicting the prognosis of CGN patients. Conclusion Urinary L-FABP can be a novel biomarker of evaluation for renal injury and early progressive renal function deterioration in patients with CGN.
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Objective To investigate the correlation between plasma homoeysteine (HCY) level and coronary-heart disease (CHD). Methods 117 patients with coronary heart disease (CHD group) and 50 healthy controls (control group) were involved in the investigation. Plasma total HCY level was measured with enzymatic cycling assay. According to the clinical types, CHD cases were divide dinto stable angina pectoris (SAP) group (n = 35), unstable angina pectoris (UAP) group (n = 39) and acute myocardial infarction (AMI) group (n=43). Based on coronary angiography, the CHD cases were further divided into single-vessel (n = 31 ), double-vessel (n = 40) and triple-vessel (n = 46) groups. Results 1 ) Plasma HCY level was significantly higher in CHD group than that in control group (P<0. 01). 2) Plasma HCY level was associated with clinical types, higherst in AMI group, followed by that of UAP group, SAP group, healthy control group. There was statistical difference of HCY level between SAP group and UAP group, SAP group and AMI group, UAP group and AMI group (P<0. 01). 3) Plasma HCY level was gradually elevated in single-vessel, double-vessel and tri- ple-vessel group. There was statistical difference of HCY level between single-vessel group or double- vessel group and triple-vessel group (P<0.01). There was significant difference between single-vessel group and double-vessel group (P>0.05). Conclusion Plasma HCY level is elevated in patients with CHD, and elevated HCY is associated with increased number of stenotic coronary arteries. As a risk factor for CHD, HCY is closely associated with the occurrence and development of CHD.
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Objective:To study the effects of effective herbs in Yinchenhao Decoction(YD)on fatty deposition and TNF-?secretion of hepatic lipo-toxicity model in vitro.Methods:TG and TNF-?as the inspection target,apply the steatosis with TNF-?secretion lipo-toxicity model in vitro of HepG2 induced by long-chain FFA and uniform design U7(76)form for YD,which had 3 herbs,to compound 6 kinds of different prescriptions,in order to look for the effective herbs or optimized group in YD.Results:The Chinese medicine Yinchen and its optimized group-Yinchen and Zhizi combination can remarkably reduce the TG and TNF-?content.Conclusion:The Chinese medicine Yinchen and its optimized group-Yinchen and Zhizi combination were effective herbs in YD for inhibiting fatty deposition and TNF-?secretion of hepatic lipo-toxicity model in vitro.