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Objective:To systematically evaluate the efficacy and clinical value of early enteral nutrition (EEN) combined with microecological agents in the treatment of severe acute pancreatitis (SAP).Methods:China National Knowledge Infrastructure, Chinese biomedical literature database, Wanfang Database, VIP, Cochrane Library, PubMed, Embase, and Web of Science were analyzed, and the retrieval time range is from the establishment of the datebase to November 1, 2019. To compare the clinical efficacy of EEN combined with microecological agents (experiment group) and single EEN treatment (control group) in SAP patients, and to compare the main outcome indicators: serum C-reactive protein level, incidence of multiple organ dysfunction syndrome, incidence of pancreatic infection necrosis, incidence of other complications, mortality, and length of hospital stay. And secondary outcome measures: plasma interleukin-8 (IL-8), tumor necrosis factor-α level, gastrointestinal score, and incidence of surgical intervention. The quality of the included literature was evaluated by using the Cochrane systematic evaluator's manual 5.1.0 risk of bias assessment tool, and meta-analysis was performed by using Stata16.0 software.Results:A total of 762 patients were enrolled in 9 RCTs. The results of meta-analysis showed that: among the main outcome indicators, C-reactive protein level [Mean Difference ( MD)=-7.58, 95% CI: -23.71-8.55, P>0.05], incidence of multiple organ dysfunction syndrome [Logarithm Risk Ratio (Log RR)=-0.30, 95% CI: -0.71-0.10, P>0.05], incidence of pancreatic infection and necrosis (Log RR=-0.21, 95% CI: -0.57-0.16, P>0.05) and mortality rate (Log RR=0.13, 95% CI: -0.36-0.62, P>0.05) the differences were not statistically significant. The incidence of complications in the experimental group was significantly lower than that in the control group (Log RR=-0.29, 95% CI: -0.51-0.07, P<0.05), and the length of hospital stay in the experimental group ( MD=-4.45, 95% CI: -7.47--1.43, P<0.05) was significantly shorter than that in the control group. Plasma IL-8 levels ( MD=-7.43, 95% CI: -14.28--0.57, P<0.05), TNF-α level ( MD=-38.96, 95% CI: -72.96--4.95, P<0.05)and gastrointestinal score ( MD=-0.15, 95% CI: -0.17--0.13, P<0.05)were significantly lower in the experimental group than in the control group, and the incidence of surgical intervention was significantly lower than that of the control group (Log RR=-1.63, 95% CI: -8.96-0.57, P>0.05) no statistical significance. Conclusion:EEN combined with microecological preparations can reduce the length of hospital stay in SAP patients and the incidence of complications. Therefore, EEN combined with microecological agents may be beneficial for SAP patients.
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Objective:To investigate the clinical efficacy and safety of ibrutinib in treatment of chronic lymphocytic leukemia (CLL).Methods:The clinical data of 68 patients with CLL in Fujian Medical University Union Hospital from May 1998 to October 2019 were retrospectively analyzed, including 39 cases receiving ibrutinib as the first therapy, 20 cases receiving ibrutinib as the second therapy, and 9 cases receiving ibrutinib as the second and above therapy. The clinical characteristics, IGHV gene mutation, the short-term therapeutic efficacy and survival of patients with stratified chromosomal karyotype were analyzed; the adverse events were also analyzed.Results:The median follow-up time was 53.2 months until May 2020. The objective remission rate (ORR) was 83.8% (57/68), including 8 cases (11.8%) of complete remission, 49 cases (72.1%) of partial remission, 5 cases (7.4%) of the stable disease, 6 cases (8.8%) of progression of the disease. The ORR of patients without IGHVmutation was higher than that of those with IGHV mutation [93.3% (28/30) vs. 76.3% (29/38), χ2=33.656, P<0.05]; the ORR of patients with low risk and low-moderate risk International Prognostic Index (IPI) score was higher than that of those with moderate-high risk and high risk [90.6% (29/32) vs. 77.8% (28/36), χ2=7.248, P = 0.007], and differences in the ORR of patients stratified by other factors were not statistically significant (all P > 0.05). Among 68 patients, 31 cases (45.6%) had adverse reactions and they insistently received the treatment; 26 cases (38.2%) had grade1-2 adverse reactions, 5 cases (7.4%) had grade 3 and above adverse reactions; 2 cases (2.9%) had drug withdrawal because of adverse reactions. The median progression-free survival (PFS) time and overall survival (OS) time of CLL patients treated with ibrutinib had not been reached. The 5-year PFS rate of patients with IGHV mutation was higher than that of patients with IGHV non-mutation (100.0% vs.72.1%, P = 0.020), the 5-year PFS rate of patients with normal chromosome karyotype was higher than that of those with abnormal chromosome karyotype (100.0% vs.74.3%, P = 0.019). Conclusion:Ibrutinib is effective and safe in treatment of CLL patients.
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With continuous discovery of tumor immune targets and continuous changes in antibody research and development technology, antibody drugs are becoming more and more widely used in clinical practice. However, some targets are not only expressed on tumor cells, but also on red blood cells. Therefore, the clinical application of antibodies against the corresponding targets may interfere with the detection of blood transfusion compatibility, resulting in difficulty in blood matching or delay of blood transfusion. This consensus summarizes the current solutions for the interference of CD38 monoclonal antibody (CD38 mAb) in transfusion compatibility testing. After analyzing the advantages and disadvantages of different methods, polybrene and sulfhydryl reducing agents [dithiothreitol (DTT) or 2-mercaptoethanol (2-Me)], as a solution for CD38 mAb interference in blood compatibility testing, are recommended for Chinese patients, so as to eliminate blood transfusion interference produce by CD38 mAb and further provide a pre-transfusion workflow for clinicians and technicians in Department of Blood Transfusion.
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Sphingolipids, especially ceramide and S1P, are structural components of biological membranes and bioactive molecules which participate in diverse cellular activities such as cell division, differentiation, gene expression and apoptosis. Emerging evidence demonstrates the role of sphingolipids in hepatocellular death, which contributes to the progression of several liver diseases including ischaemia-reperfusion liver injury, steatohepatitis or hepatocarcinogenesis. Furthermore, some data indicate that the accumulation of some sphingolipids contributes to the hepatic dysfunctions. Hence, understanding of sphingolipid may open up a novel therapeutic avenue to liver diseases. This review focuses on the progress in the sphingolipid metabolic pathway with a focus on hepatic diseases and drugs targeting the sphingolipid pathway.
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Objective To evaluate the efficacy and safety of sequential treatment of newly diagnosed de novo acute myeloid leukemia (AML) patients with IA and low-dose HA combined with G-CSF regimens as remission induction therapy.Methods Fifty-seven patients with AML were enrolled,which marrow biopsy was hypocellular or active proliferation on the third day from the end of the first course with IA regimen.32 cases of them received the second course with low-dose HA combined with G-CSF regimen,compared with other 25 cases received the second course with another IA regimen.Clinical manifestations,blood count,blood biochemical parameters and bone marrow smears were measured during the courses.Results In study group,21 of 32 cases reached CR,4 PR,and 11 of 20 cases reached CR,2 PR in control group.Overall remission rate (ORR) was higher in study group than that in control group (78.1％ vs 52.0 ％,P =0.038).Both median duration of agranulocytosis and median time for PLT to reach 50×109/L from the lowest were shorter in study group than those in control group (9.5 d vs 28.0 d,U=32.5,P＜ 0.001; 11 d vs 19 d,U=193.0,P=0.001).Component transfusion,not only RBC but PLT,decreased in study group,compared with control group (8 U vs 16 U,U =206.5,P =0.002; 20 U vs 60 U,U =149,P ＜ 0.001).Median durable time of antibiotic intravenous injection was shorter in study group than that in control group (14 d vs 21 d,U=249.5,P=0.015).Visceral hemorrhage rate reduced in study group,compared with control group (x2 =3.90,P =0.048).Conclusion IA and low-dose HA combined with G-CSF regimens sequential treatment as remission induction therapy for newly diagnosed de novo AML patients is effective and well tolerated.
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Objective:To explore the expression and clinical significance of IRF-1 gene in leukemia.Methods:Revert polymerase chain reaction(RT-PCR) and gel image analysis system were used to analyse the expression of IRF-1 gene in 77 leukemias and 4 leukemic cell lines.Results:IRF-1 gene was found in 18 patients with acute leukemia.Significant low expression of IRF-1 gene was detected in the acute leukemia?chronic myelogenous leukemia(CML) and 3 leukemic cell lines HL 60 K 562 and U 937 compared with the normal and non-mallignant hematonosis (P