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Objective To evaluate the effect of levosimendan on prognosis and circulation disorders of sepsis patients. Methods With the guidance of these following Chinese or English key words, such as sepsis, severe sepsis, septic shock, simendan, levosimendan, etc., some of Chinese and foreign published literatures on randomized controlled trials (RCTs) concerning the effects of levosimendan on the prognosis and circulatory function of septic patients were searched through China National Knowledge Infrastructure (CNKI) internet, VIP and Wanfang Databases, China Biomedicine Database (CMB), Pubmed in American National library, Holland Medical Abstract Database (Embase), Cochrane Library, etc databases, from the creation of above various databases to May 2017. The quality of the collected RCTs was evaluated by modified Jadad score; Revman 5.3 software was used to carry out Meta analysis; the publication bias was assessed by the funnel plots. Results A total of 18 RCTs, 9 in Chinese and 9 in English, but only half of the literatures were of high quality, and the other 9 of low quality, containing 688 cases in control group and 704 cases in experimental group were ultimately enrolled in this analysis. The Meta analyses showed that there was no statistical significant difference in the mortality between the experimental group and the control group [relative risk (RR) = 0.92, 95% confidence interval (95%CI) = 0.80 - 1.06, P = 0.27]; compared with control group, the time of stay in ICU was shortened [mean difference (MD) = -2.02, 95%CI = -2.90 to -1.13, P < 0.000 01], cardic output index was increased (MD = 0.63, 95%CI = 0.39 - 0.87, P < 0.000 01), and blood lactate level was decreased (MD = -1.37, 95%CI = -1.51 to-1.23, P < 0.000 01) in the experimental group, being significantly improved after levosimendan therapy. The funnel map evaluation showed that there might be a certain bias in the publication of the literature. Conclusion Levosimendan can improve circulatory disorders and reduce the time of stay in ICU for septic patients, but can not reduce their mortality.
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Objective@#To explore the prognostic value of the international prognostic index (IPI), the national comprehensive cancer network IPI(NCCN-IPI)and the age-adjusted IPI (aa-IPI) in diffuse large B cell lymphoma.@*Methods@#A total of 311 patients with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2003 to 2012 in Nanfang hospital were included. All patients were divided into CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) and R-CHOP (rituximab, CHOP) groups. Survival analysis was compared among IPI, NCCN-IPI and aa-IPI models. Discrimination of three different prognostic models was assessed using the Harrell’s C statistic.@*Results@#A total of 311 patients were analyzed. Among them, 128 patients were treated with CHOP regimen and other 183 patients were treated with R-CHOP regimen. In CHOP groups, both NCCN-IPI (5-year OS: 59.7% vs 26.8%, P<0.001) and aa-IPI (5-year OS: 71.0% vs 25.0%, P<0.001) showed better risk stratification for low-intermediate and high-intermediate group than the IPI (5-year OS: 47.6% vs 36.6%, P=0.003). However, in the patients treated with R-CHOP, NCCN-IPI showed better risk stratification in low, low-intermediate, high-intermediate groups (5-year OS: 96.0% vs 83.0% vs 66.5%, P=0.009). According to the Harrell’s C statistic, C-index of IPI, NCCN-IPI and aa-IPI for overall survival (OS) were 0.546, 0.667, 0.698 in CHOP group and 0.611,0.654, 0.695 in R-CHOP group respectively. In patients younger than 60 years old, C-index of IPI, NCCN-IPI and aa-IPI for OS were 0.534, 0.675, 0.698 in CHOP group and 0.584, 0.648, 0.695 in R-CHOP respectively.@*Conclusion@#The NCCN-IPI is more powerful than IPI and aa-IPI in DLBCL patients receiving R-CHOP. aa-IPI is a preferable model in predicting prognosis than IPI and NCCN-IPI in anthracycline-based chemotherapy without rituximab.
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Objective To evaluate the efficacy of itraconazole oral solution for prevention of invasive fungal infection ( IFI ) in neutropenic patients with acute leukemia after chemotherapy.Methods Clinical data of 136 neutropenic patients with acute leukemia after chemotherapy at the Department of Hematology,Nanfang Hospital from January 2008 to December 2010 were retrospectively analyzed.Patients were divided into itraconazole group ( n =67 ) and control group ( n =69).There were 36 patients with acute nonlymphocytic leukemia ( ANLL),31 with acute lymphoblastic leukemia (ALL) in itraconazole group;while in control group,there were 30 patients with ANLL,38 with ALL and 1 with biphenotypic acute leukaemia (BAL).Patients in itraconazole group received intraconazole after chemotherapy until the neutrophil count was increased to 0.5 × 109/L or the body temperature returned to normal and without any imaging evidence of IFI.The incidence of IFI and clinical features were compared between the groups using SPSS 13.0 software.Pearson x2 test was used for nominal variables,for measurement data,t (normal distribution) or Mann-Whitney U (skewed distribution) test were used.Results There were 12 cases ( 17.9％ ) suffering from IFI in itraconazole group and 32 cases (46.4％) in the control group (x2 =12.59,P ＜ 0.01 ).For ANLL patients,the incidence of IFI in itraconazole group was significantly lower than that in control group ( 16.7％ vs.56.7％,x2 =11.53,P ＜0.01 ).In itraconazole group,the incidence of IFI in female patients was significantly lower than that in male patients ( 8.6％ vs.28.1％,x2 =4.35,P ＜0.05 ).And for the female patients,the incidence of IFI in itraconazole group was significantly lower than thatin the control group (8.6％ vs.44.7％,x2 =11.98,P＜0.01).Conclusion Itranconzole oral solution can effectively prevent IFI in neutropenic patients with acute leukemia after chemotherapy,especially for the female patients with ANLL.
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treated with heat shock and OK-432 demonstrated enhanced biological activities,and could induce host lymphocytes to highly effective and specific eytotoxieity against PANC1 cells.