Résumé
Objective:To explore the efficacy and safety of a novel Tripterygium preparation (Kunxian Capsules)in kidney transplant recipients developing refractory proteinuria after transplantation.Methods:A total of 59 kidney transplant recipients received regular follow-ups from August 2018 to July 2021.Severity of proteinuria, kidney graft function and adverse effects were retrospectively recorded before and at Month 1/2/3/6 months after Kunxian treatment.They were divided into two groups of effective and void to explore the potential effect-related factors.Results:Six-month treatment was completed in 57 patients except for 2 cases of discontinued treatment due to severe adverse effects.A significant reduction in amount of proteinuria was observed at Month 1 [1.09(0.42, 2.59 g/24 h)vs 1.82(1, 2.7 g/24 h, P<0.01)]and the trend continued during subsequent follow-ups.Twenty-nine patients(50.9%)responded remarkably.Eighteen patients(31.6%)showed no response.The overall effective rate was 68.4%.Inter-group comparison revealed strong correlations between treatment efficacy and baseline serum creatinine levels, early initiation of treatment and symptom duration from onset to treatment.Kidney graft IgA nephropathy demonstrated the highest effective rate(11/13, 84.6%). Furthermore, elevated blood concentration of tacrolimus hinted at a potential drug interaction. Conclusions:Kunxian Capsules is efficacious and safe for renal transplant recipients developing moderate-severe proteinuria and not responding to traditional medications.Early initiation of treatment before graft function decline is recommended.Reducing tacrolimus dose cautiously in advance and monitoring adverse events are also essential.
Résumé
Cervical stump cancer is rare in clinic, which leads to insufficient understanding of it by clinicians. Radiotherapy alone is often used in the early stage, but the treatment mode has gradually changed recently. However, there is still no uniform treatment standard for residual cancer, and the prognostic differences of residual cancer patients under the new treatment mode have not been reported in real time. In order to improve the management of cervical stump, this article reviewed its clinical characteristics, treatment and prognosis.
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Objective To compare the effect of intensity modulated radiotherapy (IMRT) and conventional radiotherapy (CRT) combined with intracavitary brachytherapy on patients with cervical stump cancer. Methods A total of 47 patients with cervical stump cancer who were admitted to the First Hospital of China Medical University from October 2007 to September 2017 were retrospectively reviewed. Of the 47 patients, 19 patients received CRT combined with intracavitary brachytherapy (CRT group), and 28 patients received IMRT combined with intracavitary brachytherapy (IMRT group). In order to reduce the effects of selection bias and confounding factors, propensity score matching was performed to compare the groups. Results After the propensity score matching, there were 19 patients in each group. The 1-, 3-and 5-year overall survival (OS) rate for matched patients were 100.0％, 85.1％ and 63.8％ in IMRT group, and 84.2％, 57.9％ and 42.1％ in CRT group, respectively, and the difference in survival between the two groups was statistically significant (PLog-rank= 0.029, PCox= 0.043, HR= 3.723, 95％CI 1.044-13.280). The median progression-free survival (PFS) time of the IMRT group was better than that of the CRT group [median PFS time had not been reached (7-72 months) vs. 17 months (2-125 months), PLog-rank= 0.032, PCox= 0.042, HR=2.773, 95％CI 1.037-7.417]. The incidence of late rectal and bladder radiation injury was 15.8％ (3/19) and 0 (0/19) in IMRT group, and 57.9％ (11/19) and 26.3 ％(5/19) in CRT group, respectively, and the difference was statistically significant (P= 0.017, P= 0.046). Conclusion Compared with CRT combined with intracavitary brachytherapy, IMRT combined with intracavitary brachytherapy has a better effect on patients with cervical stump cancer, and the incidence of complications is low, this method is worthy of clinical application.
Résumé
Cervical stump cancer is rare in clinic,which leads to insufficient understanding of it by clinicians.Radiotherapy alone is often used in the early stage,but the treatment mode has gradually changed recently.However,there is still no uniform treatment standard for residual cancer,and the prognostic differences of residual cancer patients under the new treatment mode have not been reported in real time.In order to improve the management of cervical stump,this article reviewed its clinical characteristics,treatment and prognosis.