Efficacy and Safety of Cladribine-based Intensified Conditioning Regimen in Hematopoietic Stem Cell Transplantation in Patients with High-Risk Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy, safety and the risk factors affecting prognosis of high-risk acute myeloid leukemia (AML) patients treated by cladribine-based intensified conditioning regimen.@*METHODS@#The clinical data of 28 patients with high-risk AML treated by cladribine in combination with busulfan plus cyclophosphamide (BuCy) intensified conditioning regimen before allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Zhujiang Hospital, Southern Medical University from October 2016 to June 2020 were analyzed retrospectively. The overall survival (OS) rate, cumulative progression-free survival (PFS) rate, relapse rate, non-relapse mortality (NRM), regimen related toxicity (RRT) and risk factors affecting prognosis of the patients were analyzed.@*RESULTS@#The 1-year OS and PFS of the patients after implantation was (78.8±8.6)% and (79.8±8.1)%, while the 1-year cumulative relapse rate and NRM of the patients was 9.3% and 22.0%, respectively. The 1-year expected OS of MRD- high-risk patients before HSCT was 100%. The 1-year expected OS and PFS of the patients in pre-transplant relapse group was (46.9±18.7)% and (50.0±17.7)%, respectively. The incidence of I/II grade RRT was 39.3%. NO III/IV grade RRT were found in 28 patients. Multivariate analysis showed that pre-transplant relapse was the independent risk factor affecting OS and PFS of the patients.@*CONCLUSION@#The intensified conditioning regimen of cladribine in combination with BuCy can reduce the relapse rate of high-risk AML transplantation, and its RRT is mild, exhibiting good safety. MRD- high-risk patients before HSCT can achieve better transplant benefits, but the prognosis of patients with relapse before transplantation is not significantly improved. Therefore, for non-relapsed high-risk AML patients, this intensified conditioning regimen deserves to be considered.

Optimal method for the preparation of tincture from Paeonia Anomala L / Монголын эм зүй, эм судлал

Introduction@#Due to social transition and change of many societal activities in Mongolia, there is an increasing need for pharmaceutical drugs to treat anxiety, stress, fatigue and insomnia. It is considered that medicinal plants used in traditional medicine as sedatives, anti-anxiety and anti-depressive activities could be effective. Our study focuses on exploring optimal methods for preparing tinctures from <i>Paeonia</i> L. genus species, a sedative in Mongolian traditional medicine, and studying their phytochemical compositions.@*Materials and methods@#Root and herb of <i>Paeonia anomala</i> L., grown in Mogod soum in Bulgan province, were used for the study.</br> Prepared herb and root were chopped and sieved into 1 mm, 2 mm, 3 mm, 4 mm and 5 mm sizes. Then from each size of two samples, a set was created with a 1:1 ratio. Finally 40 % ethanol (1:10 ratio with a set) was applied to prepare tincture through a traditional maceration method. The obtained tincture was analyzed for its color, quantity of biologically active compounds, dry residue, and absorption coefficient using an optimal particle size of samples, volume of the extractive liquid and tincture yield.</br> Tincture from the set of herb and root of <i>Paeonia anomala</i> L. was prepared using 3 methods, namely, by the traditional maceration; intensified maceration using the ultrasonic bath processing with 45 kHz at an ambient temperature; constant shaking in a heat of 30o-40oC. @*Conclusion@#The more optimal and effective method for preparing tincture from <i>Paeonia anomala</i> L. has been found to be the ultrasonic bath processing with 45 kHz for 6 h at an ambient temperature. Crude drug mixture of 2 mm sizes with 40% ethanol (where volume absorption coefficient was accounted to be 2.8) was mixed at a ratio of 1:10. In the obtained tincture, total phenols were determined as 0.58±0.003% in gallic acid equivalent and total monoterpene glycosides as 1.96±0.002% in paeoniflorin, which were the highest compared to other methods, indicating the method is the more optimal one.

Implementing an intensified mentorship approach towards accelerated medical laboratory accreditation in 10 counties in Kenya

Background: Despite Kenya's roll-out of the Strengthening Laboratory Management Towards Accreditation programme in 2010, most laboratories had not made significant or tangible improvements towards accreditation by 2016. In April 2016, the University of Maryland, Baltimore enrolled 27 facilities in the standard Strengthening Laboratory Management Towards Accreditation programme. Objective: This study aimed to describe and evaluate the implementation of an intensified mentorship strategy on laboratory accreditation. Methods: In October 2017, the University of Maryland, Baltimore implemented intensive mentorship in 27 hospital laboratories in Nairobi, Kiambu, Meru, Embu, Muranga, Nyeri, Laikipia, Nyandarua, Tharaka-Nithi, and Kirinyaga counties in Kenya. Laboratories were paired with competent mentors whose skills were matched to facility gaps. Baseline and follow-up assessments were done between April 2016 and March 2019 using the World Health Organization's Stepwise Laboratory Quality Improvement Process Towards Accreditation Checklist and overall scores of the 12 Quality System Essentials and star ratings (from zero to five, based on scores) used to evaluate the effectiveness of the intensified mentorship.Results: In September 2017, 14 laboratories scored zero stars, three scored one star, eight scored two stars, one scored three stars, and one laboratory was accredited. By March 2019, eight laboratories were accredited, five scored four stars, 10 scored three stars, three scored two stars, and only one scored one star. The average score change with the intensified approach was 81.5 versus 53.9 for the standard approach.Conclusion: The intensified mentorship strategy resulted in fast-tracked progress towards laboratory accreditation and can be adopted in similar resource-limited settings

Protocolos de recuperación mejorada en cirugía cardiaca. Revisión sistemática con metanálisis de ensayos clínicos aleatorizados / Improved recovery protocols in cardiac surgery: Systematic review with metaanalysis of randomized clinical trails

Introducción: Múltiples son los esfuerzos realizados para incluir los protocolos de recuperación mejorada como un indicador de calidad en la atención al paciente quirúrgico, bajo la premisa de acelerar la recuperación de los enfermos, sin que esto vaya en detrimento del proceso asistencial y obtener su alta satisfacción. Para ello se hace necesario el desarrollo de la investigación avalada por la mejor evidencia científica y práctica. Objetivo: Estimar, a través de la literatura publicada, la efectividad de la aplicación de los protocolos de recuperación precoz sobre la evolución perioperatoria de pacientes a los que se les realizan procedimientos quirúrgicos cardíacos. Método: Se incluyeron ensayos clínicos controlados y aleatorizados, publicados entre enero del año 2013 y mayo de 2020. La revisión sistemática se realizó según las recomendaciones del manual 5.1.0 para revisores de la biblioteca Cochrane. Resultados: Se analizaron 6 estudios (687 pacientes/Grupo estudio=345, Grupo Control=342). La calidad metodológica de la mayoría de las investigaciones evaluadas fue buena. Se muestra una superioridad de los protocolos, ya que se acompañan de una disminución en la incidencia de complicaciones perioperatorias (RR=0,61 [0,40, 0,93]). De forma similar se encuentran relacionados con la disminución la estadía hospitalaria (diferencia de medias, efecto aleatorio, fue de -2,98 [-3,31, -2,65]. Conclusiones: A pesar de los pocos estudios incluidos, la evidencia sugiere que estos programas mejoran la evolución perioperatoria de los pacientes(AU)

Introduction: Multiple efforts are made to include improved recovery protocols as an indicator of quality in care for surgical patients, under the premise of accelerating the recovery of patients, without this being detrimental to the care process, and thus guarantee high patient satisfaction. In view of this, the development of research supported by the best scientific and practical evidence is necessary. Objective: To estimate, through the published literature, the effectiveness of the application of early recovery protocols on the perioperative evolution of patients who undergo cardiac surgical procedures. Method: Randomized controlled clinical trials, published between January 2013 and May 2020, were included. The systematic review was carried out according to the recommendations of the Cochrane Library manual 5.1.0 for reviewers. Results: Six studies were analyzed (687 patients/study group: 345, control group: 342). The methodological quality of most of the researches assessed was good. A superiority of the protocols is shown, since they are accompanied by a decrease in the incidence of perioperative complications (RR=0.61 [0.40, 0.93]). Similarly, they are related to the decrease in hospital stay (mean difference, random effect, was -2.98 [-3.31, -2.65]). Conclusions: Despite the few studies included, the evidence suggests that these programs improve the perioperative outcome of patients(AU)

Vigilancia intensificada de enfermedades durante los incendios forestales, Paraguay, 2019

RESUMEN El humo de los incendios forestales puede influir en la mortalidad, las emergencias y las visitas ambulatorias, especialmente en personas con problemas respiratorios y cardiovasculares. La vigilancia intensificada exige sumar recursos adicionales a las actividades rutinarias de vigilancia. En agosto del 2019, se registraron 25.299 focos de incendios en varios departamentos del Paraguay. Se describen los hallazgos de la vigilancia intensificada de enfermedades en la población afectada por incendios forestales en Paraguay en el 2019. Se realizó un estudio descriptivo trasversal entre el 15/08/19 al 4/10/2019 en todo el territorio nacional. Como fuente de datos, se incluyen reportes de las Unidades Epidemiológicas Regionales, organizados en una base de datos con las variables: departamento, distrito, población indígena, número de atenciones médicas, motivo de consulta, heridos graves, desaparecidos y fallecidos, identificación de riesgos potenciales para la salud. Fueron afectados 12 (12/17) departamentos y la Capital del país, 30 distritos y 12 comunidades indígenas. Se realizaron 1.681 atenciones médicas, de los cuales 1.291 (77%) eran de Alto Paraguay. Las enfermedades más frecuentes fueron Infecciones Respiratorias Agudas no neumonías (36%), y Enfermedades Tipo Influenza (18%). No se registraron heridos graves, personas desaparecidas ni fallecidas. Como riesgos potenciales para la salud: pérdidas de viviendas en comunidades indígenas, cultivos, ganados y la interrupción de provisión de agua. En conclusión, los cuadros respiratorios fueron más frecuentes durante los incendios forestales, no se registraron personas desaparecidas ni fallecidas. Se identificaron riesgos potenciales para la salud por afectación de medios de vida y sustento, sobre todo en poblaciones indígenas.

ABSTRACT Smoke from wildfires can influence mortality, emergencies and outpatient visits, especially in people with respiratory and cardiovascular problems. Intensified surveillance requires adding up additional resources to routine surveillance activities. In August 2019, 25,299 fire outbreaks were registered in de various departments Paraguay. The findings of the intensified surveillance of diseases in the population affected by wildfires in Paraguay in 2019 are described. A descriptive cross-sectional study was carried out between 08/15/19 to 10/4/2019 throughout the national territory. As a data source, reports from the Regional Epidemiological Units, organized in a database with the variables: department, district, indigenous populations, number of medical care, reason for consultation, seriously injured, missing and deceased people, identification of potential health risks. Twelve (12/17) departments and the capital of the country, 30 districts and 12 indigenous peoples were affected. One thousand six hundred and eighty-one medical services were performed, of which 1,291 (77%) were from Alto Paraguay. The most frequent diseases were non-pneumonia Acute Respiratory Infections (36%), and Influenza-like illness (18%). There were no injured, missing or dead people. Among the potential health risks: loss of dwellings in indigenous people, crops, livestock and the interruption of water supply. In conclusion, respiratory symptoms were the most frequent during the wildfires, there were no injured, missing or dead people. Potential health risks were identified due to the impact on livelihoods, especially in indigenous populations.

As consequências paradoxais do trabalho intensificado: um estudo com gestores de logística / The paradoxical consequences of intensified work: a study with logistic managers

O artigo aborda os resultados de uma pesquisa qualitativa sobre as consequências do trabalho intensificado para dez gestores do setor de logística de transportes. O trabalho se torna intensificado pelo emprego de diversos mecanismos, especialmente aqueles que conduzem ao aumento do ritmo de execução das atividades ou da jornada de trabalho. As principais consequências do trabalho intensificado identificadas mostraram-se paradoxais, já que, se por um lado, os gestores apontaram efeitos negativos (impactos na saúde, dificuldades de conciliação da vida privada com as demandas laborais e diluição das barreiras entre tempo de trabalho e não trabalho), por outro lado, indicaram algumas vantagens, como o gosto pelo ritmo elevado e os benefícios financeiros e de carreira decorrentes da aceitação de condições de trabalho intensificadas. A influência da ideologia gerencialista foi considerada na compreensão e ponderação sobre esses benefícios do trabalho intensificado.

The article addresses the results of a qualitative research on the consequences of intensified work for ten managers in the transport logistics sector. The work becomes intensified by the use of several mechanisms, especially those that lead to an increase in the rate of execution of activities or work hours. The main consequences of the intensified work identified proved to paradoxical, since, on the one hand, the managers pointed out negative effects (health impacts, difficulties in reconciling private life with work demands and diluting of barriers between working time and non-work), on the other hand, indicated some advantages, such as the preference for the high rate and the financial and career benefits resulting from the acceptance of intensified working conditions. The influence of managerial ideology was considered in the understanding and weighting about these benefits of intensified work.

Comparison of the Effectiveness and Safety of Intensified Dose and Standard Dose of Mycophenolic Acids for Adult Renal Transplant Recipients ：A Meta-analysis / 中国药房

OBJECTIVE：To compare the effectiveness and safety of int ensified dose and standard dose of mycophenolic acids （MPA）for kidney transplant recipients ，and to provide evidence-based reference for clinical use of drugs. METHODS ：Retrieved from Embase ，PubMed，Cochrane library ，Clinical trials ，CNKI，Wanfang database and CBM ，randomized controlled trial （RCT） and cohort study about intensified dose and standard dose of clinical commonly used Mycophenotate mofetil （MMF） and Mycophenolate sodium enteric-coated tablet （EC-MPS）for adult kidney transplant recipients were collected during the inception to Mar. 2020. After literature screening and data extraction ，the quality of RCTs were evaluated with bias risk evaluation tool recommended by Cochrane system evaluator manual 5.0. The quality of cohort study was evaluated by NOS scale. Meta-analysis was performed by using Rev Man 5.3 software，and sensitivity analysis was conducted. RESULTS ：A total of 8 studies were included，involving 6 RCTs，2 cohort studies ，with 1 637 patients involved. Meta-analysis results showed that ，the incidence of biopsy-proven acute rejection （BPAR）[RR＝0.65，95％CI（0.48，0.89），P＝0.007] and cytomegalovirus （CMV）infection [RR ＝ 0.39，95％CI（0.17，0.91），P＝0.03] in intensified dose groupwere significantly lower than control group. Subgroup analysis by drug showed that the incidence of BPAR in MMF intensive dose group [RR ＝0.72，95％CI（0.53，0.99），P＝0.04] and EC-MPS intensive dose group [RR ＝0.19，95％ CI （0.04， 0.81），P＝0.03] was significantly lower than that in standard zhaorongsheng@bjmu.edu.cn dose group ； there was n o statistical significance in the incidence of CMV infection in MMF intensive dose group [RR ＝0.16，95％CI（0.02，1.33），P＝0.09] and EC-MPS intensive dose group [RR ＝0.51，95％CI（0.20，1.30），P＝0.16]，compared with standard dose group （P＞0.05）. There was no significant difference in the incidence of rejection，treatment failure ，graft loss ，termination of treatment ，death，overall adverse events ， infection（overall），BK virus infection ，urinary tract infection ，hematological adverse events （overall），leucopenia，anemia， thrombocytopenia，gastrointestinal adverse events （overall），nausea，vomiting or diarrhea between 2 groups（P＞0.05）. Sensitivity analysis showed that the incidence of rejection ，CMV infection and leukopenia were generally stable. CONCLUSIONS ：The efficacy and safety of early intensive dose of MPA in adult renal transplant recipients were similar to those of standard dose ，but the incidence of rejection ，CMV infection and leucopenia should be carefully interpreted.

Clinical Study on the Application of Alanyl-glutamine Dipeptide-intensified Early Enteral Nutrition Sup-port in Sepsis Patients / 中国药房

OBJECTIVE:To investigate the effects of alanyl-glutamine dipeptide-intensified early enteral nutrition (EN) sup-port on nutritional indexes,immune indexes,renal indexes and complications of sepsis patients. METHODS:A total of 112 cases of sepsis admitted into our hospital during May 2013-Jan. 2015 were selected and divided into observation group and control group according to random number table,with 56 cases in each group. Both groups received routine antibiotic therapy and early EN support(48 h)with nitrogen supplement 0.2 g/kg,calories 25 kcal/kg and nonprotein calories 19-21 kcal/kg each day. Observation group was additionally given Alanyl-glutamine for injection 0.5 g/kg with 0.9% sodium chloride injection 100 mL,continuous pump within 24 h,for 4 d. The levels of nutritional indexes (ALB,PAB,Hb),immune indexes (CRP,IgG,IgA and IgM), APACHEⅡ scores,SOFA scores,liver and renal function indexes (the levels of ALT,AST,Cr and BUN) were compared be-tween 2 groups before and after treatment. The prognosis and the occurrence of complication were also observed in 2 groups. RE-SULTS:Before treatment,there was no statistical significance in the levels of ALB,PAB,Hb,CRP,IgG,IgA,IgM,ALT, AST,Cr,BUN and APACHEⅡ scores,SOFA scores between 2 groups(P>0.05). After treatment,the levels of ALB and PAB in observation group were increased significantly compared to before treatment,and the observation groups was significantly higher than control group,with statistical significance(P<0.05). APACHEⅡ score and SOFA score of 2 groups were decreased significantly compared to before treatment,and the observation group was significantly lower than the control group,with statis-tical significance(P<0.05). CRP of 2 groups were decreased significantly while IgG were increased significantly;the observa-tion group was significantly better than the control group,with statistical significance (P<0.05). Cr and BUN levels of 2 groups were decreased significantly compared to before treatment,and the level of Cr in observation group was significantly con-trol group,with statistical significance (P<0.05). The time of ICU stay,ventilator supporting time and antibiotics application time in observation group were significantly shorter than control group,and the incidence of diarrhea and gastric retention were significantly lower than control group,with statistical significance (P<0.05). CONCLUSIONS:Alanyl-glutamine dipeptide-in-tensified early EN support can significantly improve immune function and liver and renal function of sepsis patients and reduce the occurrence of complications.

Influence of 3R intensified nursing on patients with vascular dementia from the neuropsychological perspective / 现代临床护理

Objective To observe the effect of 3R intensified nursing care on the patients with vascular dementia (VD) from the neuropsychological perspective. Methods Sixty patients from the outpatient and inpatient department of cardiology of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were randomized into the experiment group and control group according to the random number table. The control group was given routine nursing care and the experiment group was given 3R intensified nursing care for 12 weeks. The patients′ cognitive abilities, daily living abilities and mental capacities were compared before and after the treatment between the two groups. Result The total effective rate of the patients′ cognitive abilities and daily living abilities after the treatment in the experiment group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of VD patients with 3R intensified nursing care is effective in that it can improve patients′ cognitive abilities, daily living abilities, and mental capacities.

Serial Clinical Screening for Active Tuberculosis among HIV-infected Kenyan Adults.

Setting: Urban, non-governmental HIV outpatient clinic in Mombasa, Kenya. Objective: To report outcomes and assess feasibility of serial clinical screening for active TB among adults enrolled in outpatient HIV care in a resource-limited setting. Design: Longitudinal analysis of screening conducted during routine clinic visits of HIVinfected Kenyan adults. The provider-initiated screen included TB symptom assessment and targeted physical exam. Participants with >1 symptom/sign were to submit sputum for microscopy and undergo chest radiography. Results: Over 33 months, 4,854 HIV-infected outpatients were serially screened for active TB at a median interval of 3 months. Treatment for active TB was started in 127 (2.6%). Of those 127, 77 (60.6%) were diagnosed based on first screen, and 50 (39.4%) were diagnosed thereafter. Among those 50 diagnosed upon subsequent screens, 28 (56%) were identified in association with positive screens, suggesting that 22% (28 of 127) of TB diagnoses could be attributed to the serial screening protocol. Conclusion: Provider-initiated serial clinical screening during routine visits of HIV-infected outpatients continued to prompt treatment of active TB beyond initial screening. Serial screening strategies may lead to earlier TB treatment in patients receiving ongoing HIV care in resource-limited settings.

Application of scenario simulation practice in professional ICU nursing students' intensified skill training before internship / 中华医学教育探索杂志

Objective To investigate the effect of applying scenario simulation practice in the professional ICU nursing students' emergency and intensive care intensified skill training before internship.Methods Totally 120 professional ICU nursing students from grade 2010 and 2011 were enrolled.Control group included 60 students from grade 2010 and experimental group included 60 students from grade 2011.Studnets in control group accepted standardized routine training while those in experimental group accepted scenario simulation practice.All students participated in skill examination after training.Two questionnaires were designed to survey nursing students and clinical teachers respectively at one month after internship.One questionnaire was to evaluate students' attitude to the training and the other one was to survey clinical teachers' evaluation of students' abilities.T test was used to statistically analyze skill examination performance and questionnaire scores between two groups.Results Skill examination performance of experimental group was better than that of control group (P＜0.01).Effects of intensified training were better in experimental group than in control group (P＜0.05,P＜0.01) including the aspects of combining theory and practice,shortening internship role transition time,enhancing selfconfidence of clinical practice and relieving tension anxiety before practice,etc.Clinical teachers thought that the experimental group's analysis ability,strain capacity,operation ability,communication ability,team cooperation ability and actively acquiring knowledge ability were stronger than those of control group (P ＜ 0.01).Conclusions Scenario simulation practice is helpful to improve operation ability and comprehensive ability.Nursing students can adapt to the clinical work better.Findings may be beneficial to the improve-ment of teachers' professional level.

Allogeneic hematopoietic stem cell transplantation for blastic plasmacytoid dendritic cell neoplasms / 白血病·淋巴瘤

Objective To investigate the effect of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with intensified conditioning regimen followed by rapidly tapering immunosuppressants and sequential minimal residual disease (MRD)-guided donor lymphocyte infusion (DLI) post-transplantation on outcome of blastic plasmacytoid dendritic cell neoplasm (BPDCN).Methods Two cases of BPDCN from January 2009 to May 2011 in Nanfang hospital were diagnosed according to 2008 WHO classification of tumours of haematopoietic and lymphoid tissues.Case 1 initially presented with typical cutaneous involvement and was promptly diagnosed with CD+4CD+56LCA+TdT+CD+43 BPDCN by skin biopsy.Case 2 was recognized as acute lymphocyte leukemia and acute non-lymphocytic leukemia,which was diagnosed to BPDCN at recurrence through flow cytometry analysis.Total-body-irradiation plus cyclophosphamide based intensified conditioning regimen were followed by allo-HSCT from sibling donor.Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and methotrexate.Anti-thymocyteglobulin was included additionally for haploid donor allo-HSCT.Multi-color labeling flow cytometry was performed to monitor MRD.Rapidly tapering of prophylactic immunosuppressants and sequential MRD-guided donor lymphocyte infusion (DLI) were performed to control relapse of primary malignancy.Results Two cases of BPDCN received allo-HSCT from sibling donor after intensified conditioning regimen.Both patients achieved complete remission and complete donor engraftment.Case 1 survived refractory acyclovir-resistant Epstein-Barr virus viremia benefiting from preemptive treatment with rituximab and DLI-induced grade Ⅳ acute GVHD,but died of thrombotic microangiopathy mixed with diffuse alveolar hemorrhage and sepsis on +243 days.Case 2 relapsed just 2 months after allo-HSCT despite DLI and rapidly tapering of CsA,died of sepsis followed by diffuse intravascular coagulation on +101 days.Conclusion BPDCN is characterized with typical cutaneous and/or bone marrow involvement with CD4+CD+56CD+123CD+43 blastic plasmacytoid dendritic cell and highly aggressive clinical course.Allo-HSCT seems to be a promising treatment for early phase of aggressive BPDCN aided with MRD monitoring and DLI,but it deserves more intensive researches to promote outcome of advanced staged BPDCN.

T- Lymphoblastic lymphoma in adults / Linfoma linfoblástico T dos adultos

Adult T-lymphoblastic lymphoma is rare and has a poor prognosis. In the 80s, following the introduction of sequential, intensified chemotherapy, complete remissions in the order of 75 percent-95 percent of treated patients, were achieved. However, several patients, namely those with advanced disease, continued to relapse either in remission or during maintenance therapy. Moreover, all these early studies were not able to detect any valuable prognostic index to predict the outcome. In an attempt to reduce the relapse rate, upfront autologous stem cell transplantation in patients in complete remission was introduced. The results obtained with this approach were quite homogeneous, indicating a probability of disease-free survival of about 65 percent-75 percent and an overall survival rate of 60 percent. Successive therapies designed since 2000 were able to obtain complete remissions of above 90 percent, with a relapse rate in the order of 30 percent and an overall survival comparable to that obtained with the transplant procedure. Yet, these studies were also unable to detect valuable prognostic factors predictive of the outcome. Moreover, no study on the biologic profile of the disease has been developed. To improve the prognosis of T-lymphoblastic lymphoma it seems necessary to create national registries to collect both clinical and biological data of all lymphoblastic lymphoma patients. In this way it will be possible to reach critical numbers of data with which valid statistical analysis may be performed that is able to detect factors influencing the outcome. Moreover, subsets of patients needing intensified procedures such as stem cell transplant may be detected at diagnosis.

O linfoma linfoblástico de célula T é raro e com prognóstico ruim. Após introdução de terapêutica quimioterápica seqüencial e intensificada, remissões completas passaram a ser obtidas em 75 por cento-95 por cento dos pacientes. Entretanto, muitos pacientes, particularmente aqueles com a chamada doença avançada, continuaram a recair tanto durante a terapia de indução como na manutenção. Além disso, todos estes estudos iniciais não foram capazes de detectar qualquer índice prognóstico capaz de prever a evolução dos pacientes. No sentido de reduzir as taxas de recidiva, o transplante autólogo de célula progenitora hematopoética em pacientes em remissão completa foi introduzido. Os resultados obtidos com esta abordagem foram bastante homogêneos, indicando uma probabilidade de sobrevida livre de doença de 65 por cento-75 por cento e uma sobrevida global de 60 por cento. Sucessivos tratamentos desenhados já nos anos 2000, foram capazes de obter remissões completas acima de 90 por cento, com taxas de recidivas da ordem de 30 por cento e uma sobrevida global comparável à obtida com o transplante. Ainda, estes estudos também não foram capazes de detectar fatores prognósticos relacionados à evolução válidos. Mais ainda, qualquer estudo com perfil biológico foi desenvolvido. Para melhorar o prognóstico do LLB-T parece ser necessário esforço multicêntrico, de caráter nacional ou internacional, para coletar dados clínicos e biológicos. Nesta linha, é possível alcançar número crítico de dados com valor estatístico que poderiam ser capazes de detectar fatores com influência prognóstica. Finalmente, grupos de pacientes necessitam ser identificados para selecionar aqueles que poderiam se beneficiar do transplante de célula progenitora hematopoética detectados ao diagnóstico.

Clinical Observation of Intensified TPN for Acute Exacerbations of Chronic Obstructive Pulmonary Disease / 中国药房

0.05),PaO2,PaCO2 of patient and to shorten the number of application days in intensified group were better than in routine group.The improvement of nutritional status in intensified group was also superior to routine group.There was significant difference between 2 groups (P

The Effect of Intensified Induction Using Vanderbilt Regimen in Patients with an Intermediate Grade Non-Hodgkin's Lymphoma Having 2 or 3 Adverse Factors on the Age-adjusted International Prognostic Index / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of our study was to evaluate the outcome of intensified induction therapy using the Vanderbilt regimen in patients with a poor prognosis non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: We retrospectively analyzed the results of two pilot studies, which enrolled the patients aged 60 years or less, with a previously untreated NHL of intermediate grade on the Working formulation, having 2 or 3 adverse prognostic factors on the age- adjusted International Prognostic Index. Patients received an intensified induction, with the regimen described by the Vanderbilt group. RESULTS: Thirty-five patients were analyzed. After induction, 29 patients (83%) achieved more than partial response (PR): 22 (63%) complete response (CR) and 7 (20%) PR. Three of the PRs were subsequently converted to CR following consolidation therapy. The overall CR rate, following the completion of treatment, was 71%. The 3-year overall survival (OS) rate of all patients was 53%. In the univariate analysis, age (50 years) was the only factor affecting the OS. The 3-year disease-free survival (DFS) rate of patients with CR was 68%. In the univariate analysis, age and bone marrow involvement were the factors affecting the DFS. Two patients died from the treatment-related toxicity of the induction therapy: one due to sepsis and the other due to congestive heart failure. CONCLUSION: Although the CR rate was relatively high, the OS or DFS of patients with a poor prognosis NHL, who had received the intensified induction using the Vanderbilt regimen, were no different from those that had received the conventional chemotherapy, as reported by the International Prognostic Index Project. However, the OS or DFS in the young patient groups were encouraging. To test the hypothesized benefits of our approach in the young patient groups, a larger cohort of patients aged 50 years or less should be studied.

Effect of Treatment with Intensified Induction Regimen in Adult Acute Lymphocytic Leukemia / 대한혈액학회지

BACKGROUND: Adult acute lymphocytic leukemia (ALL) is a hematologic malignant disease characterized by an uncontrolled proliferation of immature lymphocytes and their progenitors. Progress in the treatment of adults with ALL has been more difficult to achieve, and until recently there was general agreement that adults have lower remission rates, briefer duration of remissions, and shorter survival times than that of children receiving identical treatment. METHODS: Twenty one patients with ALL were treated with remission induction chemotherapy consisting of vincristine, prednisolone, daunorubicin and L-asparaginase. After successful remission induction, consolidation-intensification and maintenance therapy, CNS prophylaxis were done. RESULTS: 1) The overall complete remission (CR) rate was 66.7% (14/21). The median remission duration for the 14 patients with CR was 16 months (3~31 months) and the median overall survival time was 11 months (1~35 months). The 3-year relapse free survival rate was 14.3% and the median time to complete remission was 41 days (18~71 days). The median overall survival time of complete remission group was 31.8 months and non-response group was 1.4 months. 2) Five (23.8%) patients died during the induction therapy period and two patients did not respond to treatment. 3) Six out of fourteen patients (42.9%) who had achieved remission relapsed and the sites of relapse were the bone marrow (66.7%) and CNS (16.7%). 4) Fourteen patients (66.7%, 14/21) died during follow-up period. The main causes of death were infection in eight cases (57.1%) and hemorrhage in two (14.3%). 5) Favorable factors influencing the remission rate were initial response to chemotherapy and sex (P=0.031), and factor influencing survival time was complete remission (P=0.005). CONCLUSION: This induction regimen was thought to be effective in remission rate, but it has considerable number of side effects and the shortness of the remission duration. In the future, more intensified induction and consolidation chemotherapy should be considered.

An experimental study of the change of aerobic ability in rat skeletal muscle after intensified cyclic training / 解放军医学杂志

Objective To compare the effectiveness of running training, swimming training and intensified cyclic training by means of morphometry and to determine the most effective training mode to develop the aerobic ability of the skeletal muscle. study the adaptability of rat skeletal muscle to different endurance training modes. Methods Twenty-five healthy male Wistar rats of 8 weeks old were divided into five groups, 10 of them having no exercise be divided into control group 1 and control group 2, others took part in running exercise, swimming exercise and intensified cyclic exercise respectively. The rats in control group1 were killed at the beginning of the exercise. The free activity group was taken as the control group 2, the rats were not given any interventions, they could move freely in the cage and be killed at the end of the exercise (n=5). The rats in running group were forced to take part in an upward-slope (+5?) running task of medium load, the rats should kept running at the speed of 16m per minute for 45 minutes. The rats in swimming group were forced to keep swimming in the pool for 45 minutes, The rats in intensified cyclic group were kept running for 30 minutes (the running mode was same to the running group), then had a rest for 15 minutes, and at last the rats were forced to keep swimming in the pool for 30 minutes. The rats in training groups were trained for 6 days every week with 1-day rest for 8 continuous weeks. We observed the change of aerobic ability of the soles muscle in different training modes. Results The three kinds of endurance training developed the aerobic metabolism ability of skeletal muscle in rats effectively. The intensified cyclic training can do better than swimming training and running training in promoting remodeling reconstruction of skeletal muscle, and developing the muscle, function. Conclusion The intensified cyclic training can shorten the period of remodeling reconstruction of skeletal muscle, and more effective in developing the aerobic ability of the skeletal muscle than other endurance training modes.