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Gastric cancer is a common type of malignant tumor. Recently, a growing number of clinical researches initiated by investigators have provided valuable evidence for clinical practice. Here we review the perioperative treatment of locally advanced gastric cancer, and summarize the optimization of neoadjuvant treatment regimens, the exploration of new combinational treatment models and new adjuvant chemotherapy schemes, and the changes in the status of chemoradiotherapy in adjuvant therapy. At the same time, for the comprehensive treatment of advanced gastric cancer, the advances in the optimization of first-line chemotherapy regimens, emerging immunotherapy and targeted therapy are reviewed as well. Gastric cancer is a highly heterogeneous tumor. For further development of precision medicine represented by targeted therapy and immunotherapy, genetic testing-guided precise molecular subtyping will be the direction.
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Objective To explore the electrophysiological examination results and risk factors of type 2 diabetic peripheral neuropathy. Methods 337 patients with type 2 diabetes from August 2014 to December 2016 in the first people's hospital in Shizuishan city were divided into DPN group (n=218) and NPDN group(n=119) according to the results of NCV and SSR examinations. The general information and laboratory biochemical indicators in the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of DPN. Results The diagnosis rate of DPN detected by NCV combined with SSR was higher than that of NCV or SSR alone(P<0.05);There were significant differences in age,duration of diabetes,history of hypertension,systolic blood pressure,2h FBG,HbA1c,FINS,2 h INS,FC-P, 2h FC-P,ACR between the DPN group and NPDN group(P<0.05);Logistic multivariable analysis showed that age, duration of diabetes, 2h FBG, HbA1c, ACR were independent risk factors for DPN. Conclusion It is beneficial to increase the diagnosis rate of DPN by NCV combined with SSR. There is a higher incidence rate of DPN type 2 diabetes patients with older grade, longer duration of diabetes, higher 2h FBG, HbA1c and ACR.
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La diabetes mellitus afecta a gran parte de la población mundial, por lo que educar al paciente con medidas de autocuidado y manejo de la enfermedad es hoy en día la primera opción en los pasos de la terapéutica. Objetivo: Determinar la relación entre el autocuidado y la adherencia al tratamiento en pacientes con diabetes, que acuden al servicio de medicina interna, del Hospital Universitario Dr. Ángel Larralde. Materiales y Métodos: investigación no experimental, descriptiva, muestra no probabilística. Se empleó el instrumento "Summary of Diabetes Self-Care Activities measure (SDSCA)", en pacientes que cumplían criterios de inclusión. Se realizó análisis estadístico empleando el programa estadístico SPSS versión 20. Resultados: se aplicó el instrumento a 100 pacientes, durante el periodo de enero a julio del año 2016, con una edad promedio de 55,35 ± 12,52 años y distribución según el sexo de 57% sexo masculino y 43% femenino, con una tasa de adherencia a la medicación de 76,86% ± 32,1 en la población de estudio. Un 63,33% de los pacientes refiere no conocer qué representa la hemoglobina glicada (HbA1c), así como la frecuencia de su determinación (96,67%). Conclusión: En el grupo de estudio de pacientes con diabetes se determinó buena relación entre el autocuidado y la tasa de adherencia al tratamiento, así como el buen cumplimiento de la alimentación y medidas de automonitoreo de glicemia. Se evidenció tener un nivel de conocimiento bajo respecto al test de HbA1c y las metas de buen control glicémico(AU)
Diabetes mellitus affects a broad part of the worldwide population, which is why to educate and inform the patient ways of self-care and self-management is nowadays the first option in the therapeutic approach. Objective: to determine the relation between self-care and treatment adherence in patients with diabetes in the Internal Medicine Service of the University Hospital Dr. Ángel Larralde. Methods and Materials: non experimental, descriptive investigation with non probabilistic sample. The "Summary of Diabetes Self-Care Activities measure (SDSCA)" was used as instrument, applied to patients who met the inclusion criteria. The statistic analysis was made using SPSS statistics software, version 20. Results: the instrument was applied to 100 patients, in the period of January to July of 2016, with an average age of 55,35 ± 12,52 years and sex distribution of 57% men and 43% female, with an adherence to treatment rate of 76,86% ± 32,1 in the study population. A 76% of patients refered not to know what glicosilated hemoglobin represents, neither frequency of its determination (96%). Conclusions: The studied population had a good relation between selfcare and adherence to treatment, as with the implementation of a good diet regimen, and realization of self-monitoring of capillary glucose, with a low level of knowledge about Hb A1c test and treatment goals in the population of patients with diabetes(AU)
Subject(s)
Humans , Self Care/methods , Diabetes Mellitus/physiopathology , Hyperglycemia/complications , Metabolic Diseases/etiology , Treatment Adherence and Compliance , Internal MedicineABSTRACT
The vertebral artery has four segments. The horizontal portion of the V3 segment is the most exposed portion of the vertebral artery to potential iatrogenic injuries during surgical approaches to the posterior fossa.We present an unusual case of a patient who was operated on a giant neuroma of the left vagus nerve, with incidental vertebral artery iatrogenic injury, the development of a delayed giant pseudoaneurysm, and the treatment for this complication. We conclude that endovascular treatment may be a good option for the management of this serious surgical complication.
A artéria vertebral tem quarto segmentos. A porção horizontal do segmento V3 é a mais exposta a potenciais lesões iatrogênicas durante procedimento cirúrgico de acesso à fossa posterior. Apresentamos caso incomum de paciente submetido à cirurgia para neuroma gigante no nervo vago esquerdo, com acidental lesão da artéria vertebral iatrogênica, desenvolvimento de posterior pseudoaneurisma gigante e tratamento para esta complicação. Concluímos que o tratamento endovascular pode ser uma boa opção para o cuidado desta grave complicação cirúrgica.
Subject(s)
Humans , Male , Adult , Postoperative Complications , Vertebral Artery/pathology , Aneurysm, False/surgery , Cranial Fossa, Posterior/surgery , Iatrogenic Disease , Neuroma/surgery , Decompression, Surgical/methods , Endovascular Procedures/methodsABSTRACT
Currently, the most widely prescribed standard therapy for chronic hepatitis C consists of pegylated-interferon combined with ribavirin. Although the response rate to interferon-based treatments has improved since interferon monotherapy was first combined with ribavirin, and then pegylated-interferon was adopted, patients eligible for this treatment are limited; the side effects are unbearable in some patients, and the response rates are still unsatisfactory for those who have unfavorable clinical features. Achievements in molecular research have led to the discovery of enormous molecules with anti-hepatitis C virus (HCV) activity. Telaprevir, boceprevir, simeprevir, and sofosbuvir have already been approved by the U.S. Food and Drug Administration and many new drugs are being evaluated in ongoing clinical trials. We review the clinical efficacy of approved new anti-HCV drugs, along with many promising treatment options under development.
Subject(s)
Humans , Hepatitis C, Chronic , Interferons , Ribavirin , United States Food and Drug Administration , SimeprevirABSTRACT
Desde a década de 1950 até o final do século passado, o investimento em saneamento básico no Brasil ocorreu pontualmente em alguns períodos específicos, com um destaque para as décadas de 1970 e 1980. Em decorrência disso, o Brasil ainda está marcado por uma grande desigualdade e déficit ao acesso, principalmente em relação à coleta e tratamento de esgoto. Atualmente, o setor tem recebido maior atenção governamental e há uma quantidade significativa de recursos a serem investidos. Todavia, faz-se necessário que esses investimentos sejam sustentáveis. Desta forma, o presente trabalho pretendeu, por meio de uma pesquisa descritiva-exploratória, verificar como foram realizados os investimentos em saneamento básico no Brasil, com ênfase no tratamento de esgoto, e discutir como estão sendo disponibilizados os recursos para atender aos aspectos legais aos quais se submetem os municípios neste início de século. Para isto, foram utilizadas, como fontes primárias, entrevistas não estruturadas com técnicos do setor de saneamento e, como fontes secundárias, foram coletadas informações nos sites dos principais órgãos públicos e privados que têm relevância quanto ao saneamento no Brasil. Foram identificadas possíveis falhas no planejamento do setor ao longo destes últimos anos, além de terem sido encontradas evidências que apontam possíveis falhas nas avaliações dos investimentos que estão sendo realizados, não sendo considerada a sustentabilidade dos mesmos. Como contribuição, procurou-se identificar algumas novas formas de gestão em saneamento básico, o que poderá auxiliar os gestores municipais no cumprimento dos seus objetivos.
Subject(s)
Wastewater/statistics & numerical data , Basic Sanitation , Domestic Effluents , Investments , Public Policy , Sewerage , Sustainable Development , Water Supply/statistics & numerical data , LegislationABSTRACT
OBJECTIVE: To evaluate the outcomes of intensive conservative treatment on extraforaminal lumbar disc herniations. METHOD: Twenty five patients with extraforaminal lumbar disc herniations with symptomatic radicular pain were included. Under fluoroscopic guidance, 40 mg of triamcinolone was infused around the nerve root after provocation of patient's usual radicular pain. Lumbosacral dynamic stabilization exercise, thermal and electrical therapy, and education of posture correction were added. The clinical outcomes were measured by visual analogue scale (VAS) and Oswestry disability index (ODI) before treatment, one, three, six, and twelve months after the treatment. After twelve months, patients' satisfaction was classified to four categories: excellent, good, fair, or poor. Four patients were dropped out. RESULTS: Follow-up VAS and ODI significantly decreased since post-treatment one month (p<0.0001). The average score of VAS for lower extremity and back pain reduced significantly from 6.6, 4.5 at pretreatment to 1.5, 1.9 at 12 months post-treatment, respectively (p<0.0001). The averages of ODI reduced significantly from 65.4% at pretreatment to 25.4% at post-treatment 12 months (p<0.0001). In patients' satisfaction, seventeen patients (81.0%) were recorded as excellent or good after post-treatment 12 months. CONCLUSION: Intensive conservative treatment was effective on patients who underwent extraforaminal lumbar disc herniation. Pain relief and functional improvement sustained for 12 months.
Subject(s)
Humans , Back Pain , Follow-Up Studies , Lower Extremity , Posture , Prospective Studies , TriamcinoloneABSTRACT
Es un análogo nucleósido de guanosina con actividad selectiva contra hepatitis B, que ha surgido como una opción terapéutica en pacientes que desarrollan resistencia a la lamivudina con un perfil de seguridad similar a esta, encontrándose prácticamente ausencia de resistencia en casos de tratamiento por 1 año con una dosis de 1mg/día.
It is a nucleoside analogue of guanosine with selective activity against hepatitis B. It has come out as a therapeutic option for patients who develop resistance to Lamivudine with a security profile similar to this medicine. There is absence of resistance in case of 1 year treatments with a dosage of 1mg/day.
Subject(s)
Humans , Guanosine Diphosphate/administration & dosage , Hepatitis B virusABSTRACT
BACKGROUND: To find out effectiveness of multimodality treatments based on induction chemotherapy(CTx) in patients with clinical stage IIIA NSCLC METHODS: From 1997 to 2002, 74 patients with clinical stage IIIA NSCLC underwent induction CTx at the hospital of Chungnam National University. Induction CTx included above two cycles of cisplatin-based regimens(ectoposide, gemcitabine, vinorelbine, or taxol) followed by tumor evaluation. In 30 complete resection group, additional 4500-5000cGy radiotherapy(RTx) was delivered in 15 patients with pathologic nodal metastasis. 29 out of 44 patients who were unresectable disease, refusal of operation, and incomplete resection were followed by 60-70Gy RTx in local treatment. Additional 1-3 cycle CTx were done in case of induction CTx responders in both local treatment groups. RESULTS: Induction CTx response rate were 44.6%(complete remission 1.4% & partial response 43.2%) and there was no difference of response rate by regimens(p=0.506). After induction chemotherapy, only 33 out of resectable 55 ones(including initial resectable 37 patients) were performed by surgical treatment because of 13 refusal of surgery by themselves and 9 poor predicted reserve lung function. There were 30(40.5%) patients with complete resection, 2(2.6%) persons with incomplete resection, and 1(1.3%) person with open & closure. Response rate in 27 ones with chest RTx out of non-operation group was 4.8% CR and 11.9% PR. In complete resection group, relapse free interval was 13.6 months and 2 year recur rate was 52%. In non-complete resection(incomplete resection or non-operation) group, disease progression free interval was 11.2 months and 2 year disease progression rate was 66.7%. Median survival time of induction CTx 74 patients with IIIA NSCLC was 25.1months. When compared complete resection group with non-complete resection group, the median survival time was 31.7 and 23.4months(p=0.024) and the 2-year overall survival rate was 80% and 41% . In the complete resection group, adjuvant postoperative RTx subgroup significantly improved the 2-year local control rate(0% vs. 40%, p= 0.007) but did not significantly improve overall survival(32.2months vs. 34.9months, p=0.48). CONCLUSION: Induction CTx is a possible method in the multimodality treatments, especially followed by complete resection, but overall survival by any local treatment(surgical resection or RTx) was low. Additional studies should be needed to analysis data for appropriate patient selection, new chemotherapy regimens and the time when should RTx be initiated.