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Objective:To study the efficacy and safety of laparoscopic surgery in treatment of recurrent hepatocellular carcinoma.Methods:The clinical data of 58 patients with recurrent hepatocellular carcinoma who underwent surgical treatment from January 2010 to January 2018 at Hunan Provincial People’s Hospital were retrospectively analyzed. There were 50 males and 8 females, ranging in age from 28 to 78 (53.0±10.8) years old. Patients were divided into laparoscopic group ( n=27) and laparotomy group ( n=31) according to different surgical procedures. The differences in operative time, intraoperative blood loss, hospital stay, postoperative anal exhaustion time, postoperative complications and prognosis between the two groups were compared. Results:The intraoperative blood loss of laparoscopy group and laparotomy group were 100.0(50.0, 400.0) ml vs 300.0(100.0, 500.0) ml, the postoperative anal exhaustion time were (2.7±0.6) d vs (3.3±0.6) d, the hospital stay were (14.8±3.8) d vs (21.4±6.3) d, and these differences were statistically significant (all P<0.05). The operative time of the two groups were (243.4±27.2) min vs (217.5±34.7) min, with no statistical significance ( t=0.59, P=0.344). There were no significant differences between the two groups in postoperative complications (bile leakage, abdominal infection, hemorrhage, pleural effusion and hepatic encephalopathy) (all P>0.05); thetumor free survival, 1-year, and 3-year overall survival rates of the two groups were also not significantly different (both P>0.05). Conclusion:Laparoscopic surgery is safe and effective in the treatment of recurrent hepatocellular carcinoma, and its prognosis is similar to laparotomy, its complications are not significantly increased, which is worthy of promotion in clinic.
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Objective To investigate the role of P-I-R classification and Laennec grading in evaluating histological changes in patients with hepatitis B cirrhosis after receiving antiviral therapy, as well as the association of these two evaluation systems with clinical prognosis. Methods A total of 218 patients from 14 centers were consecutively screened from October 2013 to October 2014, and these patients were diagnosed with liver cirrhosis based on pathology (Ishak score ≥5), received antiviral therapy for 72 weeks, completed two liver biopsies, and met the P-I-R classification criteria. The 218 patients were divided into non-hepatocellular carcinoma (HCC) group with 186 patients and HCC group with 32 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. For the comparison of HCC after antiviral therapy, the non-parametric Mann-Whitney U test was used for continuous variables, and for the comparison of P-I-R classification and Laennec grading, the non-parametric Kruskal-Wallis H test was used for continuous variables. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio ( HR ) and 95% confidence interval ( CI ), and the Kaplan-Meier method was used to calculate the cumulative incidence rate of HCC. Results After 72 weeks of antiviral therapy, there was a significant difference in P-I-R classification between the non-HCC group and the HCC group ( P < 0.001). There were significant differences in the distribution of Laennec grading and P-I-R classification before and after antiviral therapy ( P < 0.001). After antiviral therapy, the 218 patients were divided into 4A group with 33 patients, 4B group with 71 patients, and 4C group with 114 patients according to Laennec grading, and there were significant differences between these three groups in platelet count (PLT) ( H =36.429, P < 0.001), liver stiffness measurement (LSM) ( H =13.983, P =0.004), Ishak score ( χ 2 =23.060, P < 0.001), and HAI score ( P < 0.001). After antiviral therapy, the 218 patients were divided into R group with 70 patients, I group with 52 patients, and P group with 96 patients according to P-I-R classification, and there were significant differences between these three groups in PLT ( H =7.193, P =0.028), LSM ( H =6.238, P =0.045), Ishak score ( χ 2 =7.986, P < 0.001), HAI score ( P =0.002), and HCC ( P < 0.001). There was a significant difference in the incidence rate of HCC between the P and R groups based on P-I-R classification ( HR =24.21, 95% CI : 0.46-177.99, P =0.002). After adjustment for other confounding factors, P-I-R classification was an independent predictive factor for HCC ( HR =12.69, 95% CI : 4.63-34.80, P =0.002). Conclusion Both P-I-R classification and Laennec grading can reflect the features and changes of fibrosis before and after antiviral therapy, and P-I-R classification is more sensitive to fibrosis changes after antiviral therapy. P-I-R classification (after treatment) can be used to assess the risk of HCC in patients after antiviral therapy.
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@#Objective To analyze the clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect (VSD). Methods The clinical data of patients with congenital VSD undergoing right subaxillary incision surgery in our hospital from January 2017 to January 2020 were retrospectively analyzed. According to the surgical methods, the patients were divided into two groups: a conventional surgery group (conventional group) and a transthoracic occlusion group (occlusion group). There were 221 patients in the conventional group, including 97 males and 124 females, with an average age of 2.6±2.2 years and an average weight of 13.4±6.2 kg; there were 185 patients in the occlusion group, including 90 males and 95 females, with an average age of 3.2±2.6 years and an average weight of 14.7±6.6 kg. The clinical effectiveness was compared. Results The success rate of surgery was 100% in both groups. The intraoperative blood loss was less in the occlusion group (P<0.05). The incision length, operation time, postoperative mechanical ventilation time, retention time in the intensive care unit, the time to resume normal diet and normal activities after operation were all shorter than those in the conventional group (P all <0.05). The total cost during hospitalization of the conventional group was less than that of the occlusion group (P<0.001). There was no statistical difference in the incidence rate of perioperative complications between the two groups (P>0.05). During the follow-up (15.8±8.8 months), the incidence of complications in the conventional group was higher than that in the occlusion group with a statistical difference (P<0.001). Conclusion Compared with conventional surgery, transthoracic occlusion for VSD via right subaxillary incision has the advantages of smaller incision, shorter operation time, less blood loss, shorter postoperative recovery time and less long-term complications. However, the total hospitalization cost is relatively high, mainly because of the high consumables cost, and the long-term effects still need further comparative observation.
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@#Objective To reveal the risk factors for delayed recovery and complications in infants with weight≤ 5.0 kg after surgical ventricular septal defect (VSD) closure. Methods We retrospectively reviewed a consecutive series of 86 patients with weight≤5.0 kg who were admitted to our institution for surgical VSD closure between January 2016 and July 2019, including 31 males and 55 females with an age of 17-266 (80.3±40.4) d and a weight of 2.5-5.0 (4.4±0.6) kg. The VSDs were divided into perimembranous (n=65, 75.6%), subaortic (n=17, 19.8%) and subaortic combined muscular types (n=4, 4.7%). Mechanical ventilation (MV) time≥24 h or ICU stay≥72 h were defined as delayed recovery. Death, sudden circulatory arrest, complete heart block requiring a permanent or temporary pacemaker implantation, neurological complications, reoperation (for residue shunt or valvular regurgitation), reintubation and diaphragmatic paralysis were considered as significant major adverse events. Results There was no death, reoperation due to residual VSD or neurological complication. Totally 51 (59.3%) patients had MV timec≥24 h and 51 (59.3%) patients stayed in the ICU≥ 72 h. Two (2.3%) patients required temporary pacemaker and six (7.0%) patients required reintubation. During the follow-up of 3-36 (15.8±8.8) months, 1 patient died of pneumonia after discharge, 5 patients suffered mild tricuspid valve regurgitation and 1 patient suffered decreased left ventricular systolic function in the follow-up. No aortic valve injuries occurred. Conclusion For patients whose weight≤5.0 kg, short-term results of surgical VSD closure are excellent. Low weight and age may prolong MV time; low birth weight and pulmonary hypertension may prolong ICU stay, but are not independent risk factors.
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Objective@#To study the relationship between nutrition status and physical fitness in 8-10 year-old children in 3 cities, and to provide a scientific reference for improving physical condition of chidren of pre-school age.@*Methods@#To investigate the weight, height and physical fitness (standing long jump, endurance running, rope skipping in one minute and sit-ups in one minute) of 1 384 children in grade four from 24 primary schools in Beijing, Changzhi, Urumchi in 2018. Evaluated overweight and obesity by using the standard of “Screening for Overweight and Obesity among School-age Children”. Then used mixed linear model to compare the physical fitness of students with different nutritional status and to analyze the relationship between BMI and physical fitness.@*Results@#The prevalence of overweight and obesity were 17.41% and 23.48%, respectively. And the prevalence in boys was both more than that in girls(χ2=9.84，47.68，P<0.01). The increase in BMI of children from the same age and the same gender was related with the decrease in physical fitness by correlation analysis(P<0.05). In comparison method, the performance of the students of normal weight was better than obese students, but the male and female students had got the same results in their physical fitness test(P<0.05).@*Conclusion@#There is a negative correlation between nutrition status and physical fitness and the physical fitness in normal weight and obese children are better than the overweight children or obese children.
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Triptolide had broad-spectrum and high-efficient anti-cancer activity, however, its clinical application was limited by the poor water solubility, in vivo rapid elimination, and strong toxicities and side effects. New drug delivery system was the ideal vehicle for targeted delivery of triptolide, which can effectively deliver triptolide to the cancer tissue, and increase the efficiency of tumor therapy. New drug delivery system had great application prospect in improving solubility of triptolide, reducing side effect, and increasing bioavailability. This article reviewed the research progress of new drug delivery system of triptolide based on liposome, polymer micelle and nanoparticle in the past decade, providing some references for the development and application of new drug delivery system of triptolide.
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OBJECTIVE@#To study the mechanism of naoxintong capsule (NXT) -inhibiting peripheral ischemic inflammation.@*METHODS@#Mice were randomly double-blindly divided into 3 groups: sham-operation group, model group and NXT group. Both model and NXT groups underwent the hind limb ischemia (HLI) surgery followed by oral gavage with saline or NXT, respectively, one hour after operation. Three days after operation, the percentages of neutrophils and macrophages in the gastrocnemius muscle were examined by flow cytomety and immunohistochemical method. The changes in gene and protein expressions induced by NXT were examined by real-time PCR and protein chip, respectively. The changes of signaling pathways were analyzed.@*RESULTS@#Compared with sham oparation and model groups, NXT could decrease the ratios of neutrophils and macrophages in gastrocnemius inflammation site (P＜0.01), and downregulate the mRNA expression of gene EMR1 (P＜0.01). NXT reduced the expression of TNF-α and IL-1β at both mRNA (P＜0.001) and protein levels (P＜0.05). The proteomic analysis showed that the use of NXT resulted in the expression changes of 13 proteins. The expression of 6 cytokines was increased, and the secretion of 7 proteins was upregulated. Besides, most of identified 13 proteins were involved in the function regulation of other immune cells.@*CONCLUSION@#NXT can significantly alleviate ischemia-induced peripheral inflammation by reducing the ratio of immune cells and altering the expression patterns of mRNA and protein. The expression changes provide theoretical guidance and the potential targets for the clinical use of NXT in the treatment of ischemia-induced peripheral inflammatory diseases.
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Animals , Mice , Drugs, Chinese Herbal , Inflammation , Drug Therapy , Ischemia , Proteomics , Tumor Necrosis Factor-alphaABSTRACT
BACKGROUND: Our research team has confirmed that compared to the adenoviral vector, transfection by lentiviral vector to rabbit bone marrow mesenchymal stem cells (BMSCs) is more effective that the expression of enhanced green fluorescent protein (EGFP)/bone morphogenetic protein 2 (BMP-2) can be persistent for a longer term. But further investigations are needed to explore whether BMSCs transfected with hBMP-2 through lentivirus combined with demineralized bone matrix (DBM) can promote bone defect repair. OBJECTIVE: To evaluate the effect of lentivirus-mediated hBMP-2/BMSCs/DBM (LV-hBMP-2/BMSCs/DBM) on the repair of large-segmental femoral defects and to explore the new treatments for large-segmental femoral defects. METHODS: Large-segmental bone defect models were made in the right femur of 48 New Zealand white rabbits by cutting the middle femoral bone and steel plate fixation. Then, animal models were randomly divided into four groups (n=12 per group) and implanted with nothing (control), DBM, hBMP-2/DBM, and LV-hBMP-2/BMSCs/DBM. Three rabbits from each group were sacrificed at 2, 4, 8 and 12 weeks after surgery to evaluate the repairing effect of femoral defects through hematoxylin-eosin staining, biomechanical analysis and radiological examination. RESULTS AND CONCLUSION: X-ray results revealed that osteotylus formed in all the four groups to different extents, and Lane - Sandhu X-ray scores were ranked as follows: control group < DBM group < hBMP-2/DBM group < LV-hBMP-2/BMSCs/DBM group (P < 0.05). Findings from the three-point bending test showed that the maximum load of the LV-hBMP-2/BMSCs/DBM group was significantly higher than that of the hBMP-2/DBM group, but is still lower than that of the normal femur at 8 and 12 weeks after modeling (P < 0.05). Hematoxylin-eosin staining results revealed that a few trabecular bones arranged disorderedly and a large amount of fibrous tissues in the control group; the DBM scaffold was basically degraded in the DBM group presenting with partially disordered trabecular bones and a large amount of fibrous tissues; the trabecular bones in the bone defect area were basically connected into line to start the shaping of the cortical bone, and recanalization of the medullary cavity was insignificant in the hBMP-2/DBM group; new cortical bone formed in the bone defect area and the medullary cavity was recanalized in the LV-hBMP-2/BMSCs/DBM group. These findings indicate that LV-hBMP-2/BMSCs/DBM can produce a large amount of calluses, promote formation of new cortical bone, and promote bone conduction, bone induction and osteogenesis after implantation into the bone defect; and this material has good repairing effect on large-segmental femoral defects of rabbits.
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BACKGROUND: Lumbosacral vertebral fusion operation is an important treatment for lumbosacral vertebral degenerative disease. Traditional open surgery has great trauma; postoperative recovery time is longer; there are more complications. To reduce the damage to normal tissue and increase the rate of healing, scholars in and outside China improve the lumbar spine fusion surgery, and lumbar fusion becomes a tendency of the development of minimally invasive surgery. In 2004, Cragg introduced lumbosacral vertebral axial fusion (AxiaLIF, axial lumbar intervertebral fusion). The operation is through posterior rectal wall and presacral space approach, axially nailing for fusion of L5/S1. Muscle, ligament and blood vessels of the spine were retained. Mechanical stability was similar to that of traditional fusion. Osseous fusion rate was high at the operation segment. This is in line with the concept of minimally invasive surgery of the spine. OBJECTIVE: To summarize the advantages and disadvantages of traditional and present fusion techniques from traditional lumbar fusion and present lumbar fusion angle, and to explore the application of AxiaLIF in lumbosacral fusion. METHODS: We retrieved PubMed, Web of Science, and Springer database with the English key words of "Axial interbody fusion and (properties or evaluation), biomechanics, spine mechanical test, spine and (kinematics or motion)", and Chinese Journal Full-Text Database with the Chinese key words of "Axial fusion, biomechanics research assessment, biomechanics, anterior sacral space, minimally invasive spine" for studies concerning lumbar fusion, complications, biomechanics, and humanistic medicine that had been published in recent 5 years. Repetitive studies were excluded, and 46 studies were analyzed and discussed. RESULTS AND CONCLUSION: In the past 90 years, scholars in and outside China had studied the methods of lumbar fusion from various levels, analyzed and summarized the advantages and disadvantages of various operative methods, and identified the indications of lumbar spinal fusion. By comparing characteristics of open surgery and minimally invasive surgery, this study suggested that minimally invasive lumbar fusion has become a trend. In-depth understanding of biomechanical stability, complications, and postoperative recovery time after AxiaLIF is still a long way to go in future medical research.
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Objective To investigate the changes of immune function and blood coagulation function in pa-tients with pulmonary tuberculosis(PTB)with chronic obstructive pulmonary disease(COPD)and its correla-tion with lung function.Methods 65 cases of PTB patients with COPD were selected as PTB with COPD group,50 cases of patients with PTB were selected as PTB group,another 50 healthy people were selected as control group;the level of immune function and coagulation function were compared between the three groups,and the relationship between immune function,coagulation function and pulmonary function was ana-lyzed.Results The differences of CD3+,CD4+,CD4+/CD8+,TT,APTT,PT,FIB,FEV1,FVC and MMEF between the three groups were statistically significant(P<0.05);The levels of CD3+,CD4+,CD4+/CD8+, APTT,FEV1,FVC and MMEF in PTB group and PTB group with COPD were significantly lower than those in control group,and PTB group with COPD group was significantly lower than that in PTB group,the differ-ence was statistically significant(P<0.05);The levels of TT and FIB in PTB group and PTB group with COPD were significantly higher than those in control group,and PTB group with COPD group was significant-ly higher than that in PTB group,the difference was statistically significant(P<0.05);The results of corre-lation analysis showed that FEV1,FVC and MMEF had significant positive correlation with CD3+,CD4+, CD4+/CD8+,APTT and PT(P<0.05),and negatively correlated with TT and FIB(P<0.05),and there was no significant correlation between FEV1,FVC,MMEF and CD8+(P>0.05).Conclusion The patients with PTB accompanied with COPD have abnormal cellular immune function and abnormal coagulation func-tion,and the level is significantly correlated with lung function.
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Chimeric antigen receptor T-cell (CAR-T) is one of the effective methods for treatment of lymphoma. The way to improve the efficacy and control the reverse reactions still needs to be explored further. Several clinical trials have indicated CAR-T could have favorable effects on the B-cell lymphoma patients with controllable reverse reactions. However, antigen loss is a major factor for the acquired resistance to CD19 CAR-T therapy. Other clinical researches, including CD22 for treatment of B-cell lymphoma and CD30 for Hodgkin lymphoma, have increased the efficacy of CAR-T. Moreover, lots of trials have suggested that the patients who received cyclophosphamide or bendamustine plus fludarabine lymphodepletion can get a high effective rate.
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Objective To apply intervention of integrated pharmaceutical care (IPC) for asthma-COPD overlap syn-drome patients,so as to reduce the side effects of drugs,enhance medication compliance,promote reasonable drug application,cut down the medical expenses in ACOS patients. Methods A total of 60 ACOS patients were randomly divided into IPC group (group A) (n=34) and contrast group(group B) (n=26).The patients in group A were given IPC measurements such as noso-comial guidance,classroom teaching,regular follow-up,life coaching and psychological advice.While the patients in group B were not given any intervention measures. Results In group A,patients' awareness rate of action and side-effects of drugs were ob-viously increased;Knowledges of inhalation preparation were greatly improved;the ratio of ADRs was significantly reduced;The FEV1 and the value added of FEV1 was dramatically improved.Furthermore,the differences showed statistical significance as com-pared with group B(P<0.05).Total medical costs and anti-bacterial drug costs per year were significantly lower in group A than group B. Conclusion IPC is beneficial to enhance drug compliance,promote reasonable drug application and bring down the medical expenses in ACOS patients.
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<p><b>OBJECTIVE</b>To investigate the clinical results of new external spinal skeletal fixation combined with percutaneous injury vertebra bone grafting in the treatment of two-segment thoracolumbar fractures without neural dysfunction.</p><p><b>METHODS</b>The clinical data of 28 patients with two-segment thoracolumbar fractures without neural dysfunction treated from January 2013 to August 2015 were retrospectively analyzed. There were 17 males and 11 females, with a mean age of(37.5±10.3) years (ranging from 19 to 55 years). According to fracture AO classification, all 28 cases were type A, including 2 cases of T₁₀,₁₁, 3 cases of T₁₁,₁₂, 9 cases of T₁₂-L₁, 4 cases of L₁,₂, 5 cases of L₂,₃, 4 cases of L₃,₄, 1 case of L₄,₅. All 28 patients received treatment of new external spinal skeletal fixation and percutaneous injury vertebra bone grafting. Operation time, intraoperative bleeding and related complications were recorded. The informations of vertebral anterior border height percentage and bone fusion were observed by radiography before and after operation, before removed external fixation and final follow-up. Visual analogue scale(VAS) was used to evaluate the clinical effects.</p><p><b>RESULTS</b>All the patients were followed up for 13 to 32 months with an average of (24.5±3.5) months. There was significant difference by the time of 3 days postoperatively, before removed external fixation, final follow-up comparing with the preoperative in vertebral anterior border height percentage and VAS score(<0.05). There was no significant difference in vertebral anterior border height percentage by the time of 3 days postoperatively, before removed external fixation comparing with final follow-up(>0.05). While the VAS score showed a gradually declining trend, screw lossening ocurred in 2 cases and nail tracker infection occurred in 1 case after operation, and no other complications were found.</p><p><b>CONCLUSIONS</b>New external spinal skeletal fixation and percutaneous injury vertebra bone grafting can got satisfactory clinical effect in treating two-segment thoracolumbar fractures without neural dysfunction, which is an effective method of minimally invasive surgery.</p>
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Cancer immunotherapy uses the host′s immune system to mobilize immune cells to rec-ognize and eventually eliminate cancer cells .At present, studies in terms of cancer immunotherapy mainly focus on programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) antibody, cytotoxic T-lymphocyte-associated protein 4 ( CTLA-4 ) antibody, chimeric antigen receptor T-cell immunotherapy (CAR-T), T cell receptor Immunotherapy (TCR-T), etc.Despite the fact that cancer immunotherapies elicit unprecedented durable responses in clinical therapy , they appear to be ineffective to some patients .In addition, some responders relapse and show resistance to immunotherapies even if their symptoms are re -lieved for a time .Resistance to cancer immunotherapy can be categorized into primary , adaptive and ac-quired, which can occur in every stage during the process of anti-tumor response.In this review, we discuss the known mechanisms of resistance and provide a rationale for the use of combination therapy to overcome resistance.
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Objective:To bring to doctors' attention to the first time attack of epilepsy in the patients with Parkinson' s disease, enhance the rational drug use and reduce the occurrence of adverse reactions in clinics. Methods: A Parkinson patient with the first time attack of epilepsy was synthetically analyzed on the mechanism of disease, therapy regimen and pharmaceutical care. Results:It was difficult to distinguish the symptom of epilepsy during the treatment of Parkinson' s disease from that of L-dopa induced dyskinesia, therefore, the suitable treatment was difficult to perform. Moreover, antiepileptic drug valproic acid could aggravate Parkinson syn-drome imperceptibly, which was easy to be ignored in clinics. Conclusion:L-dopa induced dyskinesia should try to avoid during the treatment of Parkinson, and should distinguish from the first time attack of epilepsy in order to choose proper antiepileptic drugs.
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Objective To investigate the clinical efficacy of Sheng's six-meridian diagnosis and treatment-based acupuncture in treating cervical spondylotic arteriopathy.Method Seventy patients with cervical spondylotic arteriopathy were randomly allocated to treatment and control groups, 35 cases each. The treatment group received Sheng's six-meridian diagnosis and treatment-based acupuncture and the control group, conventional acupuncture. Doppler-detected vertebral artery blood flow velocity was measured, and the clinical symptom and sign score and the cervical vertigo symptom and functional assessment scale score were recorded in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Result The total efficacy rate was 85.7% in the treatment group and 62.9% in the control group; there was a statistically significant difference between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in Doppler-detected vertebral artery blood flow velocity, the clinical symptom and sign score and the cervical vertigo symptom and functional assessment scale score in the two groups (P<0.01,P<0.05).Conclusion Sheng's six-meridian diagnosis and treatment-based acupuncture is an effective way to treat cervical spondylotic arteriopathy.
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Objective To investigate the clinical efficacy of Sheng's six-meridian diagnosis and treatment-based acupuncture in treating cervical spondylotic arteriopathy.Method Seventy patients with cervical spondylotic arteriopathy were randomly allocated to treatment and control groups, 35 cases each. The treatment group received Sheng's six-meridian diagnosis and treatment-based acupuncture and the control group, conventional acupuncture. Doppler-detected vertebral artery blood flow velocity was measured, and the clinical symptom and sign score and the cervical vertigo symptom and functional assessment scale score were recorded in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Result The total efficacy rate was 85.7% in the treatment group and 62.9% in the control group; there was a statistically significant difference between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in Doppler-detected vertebral artery blood flow velocity, the clinical symptom and sign score and the cervical vertigo symptom and functional assessment scale score in the two groups (P<0.01,P<0.05).Conclusion Sheng's six-meridian diagnosis and treatment-based acupuncture is an effective way to treat cervical spondylotic arteriopathy.
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Objective:To investigate the ways of pharmaceutical care performed by clinical pharmacists for the patients with severe infection. Methods:Through deciding the anti-infection therapeutic regimen, providing drug counselling and pharmacy education and focusing on adverse drug reactions, pharmacists offered suggestions for one patient with severe legionella pneumonia complicated with AECOPD. Results:The pharmaceutical care performed by clinical pharmacists could solve the problems and improve the compliance, safety, effectiveness and rationality in the drug treatment of the patient. Conclusion:According to the individual condition of patients, clinical pharmacists can realize their own values through looking for the breakthrough points of pharmaceutical care and participating in clinical practice.
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Objective:To compare the therapeutic efficacy and safety of Hyper-CVAD/MA regimen and CHOP/CHOP-like regimen in the treatment of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Methods:The 78 primary PTCL-NOS patients who were initially diagnosed and treated in Tianjin Medical University Cancer Institute and Hospital and Tianjin Union Medical Center from June 2004 to June 2012 were retrospectively analyzed. The patients were then divided into two groups:Hyper-CVAD/MA group (n=21) and CHOP/CHOP-like group (n=57). Curative efficacies and toxicities were analyzed by Chi-square test, and survival was estimated by Ka-plan-Meier method. Results: In the Hyper-CVAD/MA group, complete response (CR) was 42.9%, overall response rate (ORR) was 85.7%, median progression-free survival (PFS) was 20 months, and the three-year overall survival (OS) was 56.9%. In the CHOP/CHOP-like group, the CR, ORR, and three-year OS were 28.1%, 59.6%, and 49.6%, respectively, and the median PFS was 13 months. Compara-tive analysis showed that the ORR and three-year OS were statistically significant (P0.05). The incidence rates ofⅢ/Ⅳneutrocytopenia and thrombocytopenia in Hyper-CVAD/MA group (66.7%and 61.9%, respectively) were significantly higher than those of the CHOP/CHOP-like group (22.8%and 14.0%, respec-tively) (P<0.05). Conclusion:Hyper-CVAD/MA regimen can achieve satisfactory efficacy in parents with PTCL-NOS, and toxicity can be controlled with granulocyte colony stimulating factor (G-CSF).
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Objective In cerebral aneurysm clipping and embolization, blood pressure control and temporary parent artery blocking are common methods to prevent aneurysm rupture. Their influence on the prognosis is uncertain. In this study, we try to find out the association between methods above and prognostic indicators.Methods We held a retrospective analysis on patients' medical records of cerebral aneurysms surgical clipping and endovascular coiling , and recorded gender, age, diagnosis, Hunt-Hess grade, Glasgow coma scale score, treatment methods, a history of hypertension, preoperative systolic blood pressure, with or without controlled hypotension, systolic blood pressure difference before and after controlled hypotension, with or without temporary artery blocking, with or without hypertension after treated aneurysm, prognostic indicators including mortality after 1 month, intensive care unit (ICU) stay time of survivors, discharged Glasgow outcome scale (GOS) score. Prognostic indicators were regarded as dependent variable, all the factors were regarded as independent variable, and the strength analysis of influence factors on prognostic indicators was made by binary logistic regression.Results Total cases were 165, including 68 males and 97 females, with an average age of 56 (12-85) years. The mortality after 1 month was 10.9% (18 cases). The ICU stay time of survivors was 7.35 (0-67) days. GOS score at discharge was 1-3 in 40 (24.2%) patients and 4-5 in 125 (75.8%) patients. Systolic blood pressure difference before and after controlled hypotension was an independent factor influencing mortality (t=2.273, P=0.024), and the greater the difference was, the higher the mortality would be. Timely hypertension after aneurysm treated was an independent factor affecting ICU stay time of survivors and patients with hypertension had shorter ICU stay time (χ=10.017, P=0.001). Blood pressure control (χ=0.088, P=0.767) and temporary blocking (χ=1.307, P=0.253) did not show significant influence on GOS score at discharge.Conclusions Timely controlled hypertension after aneurysm clipping and embolization can significantly shorten the stay time in ICU. The degree of controlled hypotension associates with postoperative mortality, the greater systolic blood pressure difference before and after antihypertensive treatment is, the higher the mortality will be.