Analgesic Effect of Ultrasound-Guided Anterior Quadratus Lumborum Block at the L2 Level in Patients Undergoing Laparoscopic Partial Nephrectomy: A Single-Center, Randomized Controlled Trial.

Objectives: This study aimed to evaluate the effect of ultrasound-guided anterior quadratus lumborum block (QLB) at the L2 level in patients undergoing laparoscopic partial nephrectomy. Methods: Patients who were 18-70 years old with an American Society of Anesthesiologists (ASA) physical status of 1-2 and were scheduled for elective laparoscopic partial nephrectomy were recruited into the cluster randomized controlled trial. Sixty-three patients were randomly allocated to receive QLB (group Q, n = 32) or no block (group C, n = 31). The patients were not masked to the group allocations. The postoperative follower was blinded to the group allocations. All patients received total intravenous anesthesia, the same multimodal analgesic regimen, and rescue analgesia when needed. The primary outcome was perioperative cumulative sufentanil consumption. Results: 30 patients in group Q and 29 patients in group C were included in the statistical analysis. Block-related complications were not found in this study. Sufentanil consumption during the perioperative period (155.41 [19.58] vs 119.37 [12.41] µg, p < 0.001) and sufentanil dosage during surgery and 0-6 h, 6-12 h, and 12-24 h after surgery were lower in group Q than in group C, while 24-48 h after surgery was similar between both groups. The median sensory blockade area in group Q was T9-L1. Comparison of invasive blood pressure (BP) and heart rate (HR) before and after skin incision in group C was statistically significant, but there was no significant difference in group Q. Both at rest and during activity, numerical rating scale (NRS) scores and the incidence of rescue analgesia were lower in group Q at any time point after surgery. The incidences of postoperative nausea and vomiting (PONV), time from postoperative to discharge, postoperative recovery quality, or anesthesia satisfaction were similar between the two groups. Conclusions: Anterior QLB at the L2 level can reduce the perioperative dosage of sufentanil and the degree of postoperative pain in patients undergoing laparoscopic partial nephrectomy, but it did not improve postoperative recovery quality and anesthesia satisfaction.

Randomized study of individualized pharmacokinetically-guided dosing of paclitaxel compared with body-surface area dosing in Chinese patients with advanced non-small cell lung cancer.

AIMS: This prospective, randomized study was initiated to assess the impact of pharmacokinetically (PK)-guided paclitaxel (PTX) dosing on toxicity and efficacy compared with body-surface area (BSA)-based dosing in Chinese non-small cell lung cancer patients. METHODS: A total of 319 stage IIIB/IV non-small cell lung cancer patients receiving first-line chemotherapy were enrolled. Patients were randomized to receive 3-weekly carboplatin plus PTX at a starting dose of 175 mg/m2 with subsequent PTX dosing based on either BSA or PK-guided dosing targeting time above a PTX plasma concentration of 0.05 µmol/L (PTXTc > 0.05 ) between 26 and 31 hours. The primary safety endpoint was grade 4 haematological toxicity. The secondary endpoints were neuropathy, objective response rate, progression-free survival and overall survival. RESULTS: In total, 275 (86%) patients completed ≥2 cycles of chemotherapy (140 in BSA arm and 135 in PK arm). In cycle 1, with the same PTX dose, average PTXTc > 0.05 was 37 hours (range = 18-57 hours). Over cycles 2-4, patients in the PK arm had significantly lower average PTX doses and exposure compared with the BSA arm (128 vs 161 mg/m2 , P < .0001 and 29 vs 35 hours, P < .0001). PK-guided dosing significantly reduced the cumulative incidence of grade 4 haematological toxicity (15% vs 24%, P = .004), grade 4 neutropenia (15% vs 23%, P = .009) and grade ≥ 2 neuropathy (8% vs 21%, P = .005). Objective response rate (32% vs 26%, P = .28) and overall survival (21.0 vs 24.0 months, P = .815) were similar in PK and BSA arms. Progression-free survival was slightly improved in PK arm (4.67 vs 4.17 months, P = .026). CONCLUSION: PK-guided PTX dosing significantly reduced grade 4 haematological toxicities and grade ≥ 2 neuropathy without an adverse impact on clinical outcomes.

Thick-wall cavity predicts worse progression-free survival in lung adenocarcinoma treated with first-line EGFR-TKIs.

BACKGROUND: Cavity occurs in 5.7 to 14.9% of patients with lung adenocarcinoma (ADC). However, the impact of cavity on the therapeutic response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in ADC patients with EGFR mutations remains unclear. The aim of the present retrospective study was to elucidate the incidence and detailed characteristics of EGFR-mutant cavitary ADC and investigate the efficacy of EGFR-TKI treatment in this subgroup. METHODS: Two hundred seventy-six consecutive patients with advanced EGFR-mutant lung ADC treated with first-line EGFR-TKIs were enrolled. Cavitation and the thickness of cavity wall were assessed based on high-resolution computed tomography scans. Progression-free survival (PFS) was analyzed by the Kaplan-Meier plots and the log-rank test was used to calculate the significance between groups. RESULTS: Cavity occurred in 5.4% (15/276) of patients with EGFR-mutant lung ADC and was more prevalent among male patients (66.7% vs. 33.3%, P = 0.008). Of the 15 EGFR-mutant cavitary ADC, 9 patients had exon 19 deletion (19DEL) and 6 harbored L858R mutation, 9 patients had thick-wall cavity while 6 had thin-wall cavity. Cavity had an adverse impact on the PFS of EGFR-mutant ADC treated with first-line EGFR-TKIs (noncavity versus cavity, 11.0 versus 6.5 months, hazard ratio [HR]: 0.33, 95% confidence interval [CI], 0.15-0.73, P = 0.003). The impaired effect was only observed in patients with L858R mutation (11.0 vs. 4.2 months, HR: 0.05, 95%CI, 0.01-0.27, P = 0.0003) but not in those with 19DEL (10.4 versus 9.7 months, HR: 0.73, 95%CI, 0.30-1.75, P = 0.483). All six L858R-mutant cavitary ADC patients had thick-wall cavity while thick-wall cavity was only identified in one thirds (3/9) of patients with 19DEL. Further analyses showed that patients with thick-wall cavity had worse PFS (6.0 versus 11.0 months, P = 0.013). Multivariate analysis identified cavity as an independent predictive factor for PFS (HR: 0.49, 95% CI, 0.26-0.90, P = 0.022). CONCLUSION: Cavitary ADC was associated with a worse PFS of first-line EGFR-TKI therapy, mainly in those with L858R mutation. Thick-wall cavity formation may be the main cause that contribute to the worse PFS.

Sex-specific cardiopulmonary exercise testing parameters as predictors in patients with idiopathic pulmonary arterial hypertension.

Cardiopulmonary exercise testing (CPET) has been used for prognosis in idiopathic pulmonary arterial hypertension (IPAH). We explored whether sex differences had an impact on prognostic assessments of CPET in IPAH. Data were retrieved from 21 male and 36 female incident IPAH patients who underwent both right heart catheterization and CPET from 2010 to 2016 at Shanghai Pulmonary Hospital. Cox proportional hazards analysis was used to assess the prognostic value of CPET. The mean duration of follow-up was 22±15 months. Nine men and 15 women had an event. The differences in clinical parameters in the whole population were not the same as the inter-subgroup differences. Event-free women had significantly higher cardiac output, lower pulmonary vascular resistance and percentage of predicted FVC compared with event men (all P<0.05). Event-free men had significantly higher end-tidal partial pressure of CO2 (PETCO2) at anaerobic threshold (AT), peak workload, PETCO2, maximum oxygen consumption (VO2)/minute ventilation (VE), and oxygen uptake efficiency slope and lower end-tidal partial pressure of O2 (PETO2) at AT, peak PETO2, and lowest VE/VCO2 compared with event men. Event-free women had dramatically higher peak VO2, VCO2, VE and O2 pulse than event women (all P<0.05). Peak PETCO2 was the independent predictor of event-free survival in all patients and males, whereas peak O2 pulse was the independent predictor of event-free survival in females. Men with peak PETCO2⩾20.50 mm Hg, women with peak O2 pulse ⩾6.25 ml per beat and all patients with peak PETCO2⩾27.03 mm Hg had significantly better event-free survival. Sex-specific CPET parameters are predictors of poor outcomes. Decreased peak PETCO2 in men and peak O2 pulse in women were associated with lower event-free survival in IPAH.

Allergies, antibiotics use, and multiple sclerosis.

BACKGROUND: The associations between allergies, antibiotics use, and multiple sclerosis (MS) remain controversial and their mediating or moderating effects have not yet been examined. We aimed to assess the direct and indirect influences of allergies and antibiotics use on MS development, and their interactions. METHODS: A 1:3 matched case-control study was performed using the National Ambulatory Medical Care Survey database from 2006 to 2013 in the USA. Multiple sclerosis was identified based on the ICD-9 code (340.0) in any position. Cases were matched to their controls based on survey year, age, gender, race, payer type, region, and tobacco use. Allergy diseases and antibiotics prescriptions were extracted by ICD-9 code and drug classification code, respectively. Both generalized structural equation model and MacArthur approach were used to examine their intrinsic relationships. RESULTS: The weighted prevalence of MS was 133.7 per 100,000 visits. A total of 829 MS patients and 2441 controls were matched. Both respiratory tract allergies (OR = 0.29, 95% CI: 0.18, 0.49) and other allergies (OR = 0.38, 95% CI: 0.19, 0.77) were associated with a reduction of the risk of MS. Patients with respiratory tract allergies were more likely to use penicillin (OR = 8.73, 95% CI: 4.12, 18.53) and other antibiotics (OR = 3.77, 95% CI: 2.72, 5.21), and those with other allergies had a higher likelihood of penicillin use (OR = 4.15, 95% CI: 1.27, 13.54); however, the link between antibiotics use and MS was not confirmed although penicillin use might mediate the relationship between allergies and MS. CONCLUSIONS: The findings supported allergy as a protective factor for MS development. We also suggest antibiotics use might not be a suitable indicator of bacterial infection to investigate the cause of MS.

Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis.

BACKGROUND: The treatment of irritable bowel syndrome (IBS) is a challenge because its cause remains unknown. Previous clinical trials to examine the efficacy of probiotic Bifidobacterium infantis 35624 (B. infantis) in patients with IBS have shown inconsistent findings. This study aimed to assess the combined effect of B. infantis on reducing the symptom severity of IBS based on the published data. METHODS: A meta-analysis was conducted using fixed-effect models to estimate the combined effect of B. infantis on primary outcomes, which included abdominal pain, bloating/distention, and bowel habit satisfaction. A systematic review was performed based on PubMed, Cochrane Library, and EMBASE databases to identify the randomized controlled trials comparing probiotic B. infantis with placebo in treating IBS symptoms, published up until 31 December 2016. The standardized mean difference (SMD) method was used to combine data since scales to measure the efficacy of probiotics were different among studies. RESULTS: A total of five studies were identified as suitable for inclusion, including three studies with single probiotic B. infantis and two studies with composite probiotics containing B. infantis. Treatment with single probiotic B. infantis didn't impact on abdominal pain, bloating/distention, or bowel habit satisfaction among IBS patients. However, patients who received composite probiotics containing B. infantis had significantly reduced abdominal pain (SMD, 0.22; 95% CI, 0.03-0.41) and bloating/distention (SMD, 0.30; 95% CI, 0.04-0.56). After combining the data from six studies, the improvement of bloating/distention among IBS patients remained significant (SMD, 0.21; 95% CI, 0.07-0.35). CONCLUSION: Composite probiotics containing B. infantis might be an effective therapeutic option for IBS patients, which could significantly alleviate the symptoms of IBS without significant adverse effects. However, the efficacy of single probiotic B. infantis on IBS has not been confirmed yet, which needs to be further validated by more large-sized randomized clinical trials.

Exercise Training for Patients Pre- and Postsurgically Treated for Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis.

BACKGROUND: This meta-analysis examined the effects of exercise training on length of hospital stay, postoperative complications, exercise capacity, 6-minute walking distance (6MWD), and health-related quality of life (HRQoL) in patients following resection of non-small cell lung cancer (NSCLC). METHODS: This review searched PubMed, EMBASE, and the Cochrane Collaboration data base up to August 16, 2015. It includes 15 studies comparing exercise endurance and quality of life before versus after exercise training in patients undergoing lung resection for NSCLC. RESULTS: This review identified 15 studies, 8 of which are randomized controlled trials including 350 patients. Preoperative exercise training shortened length of hospital stay; mean difference (MD): -4.98 days (95% CI = -6.22 to -3.74, P < .00001) and also decreased postoperative complications for which the odds ratio was 0.33 (95% CI = 0.15 to 0.74, P = .007). Four weeks of preoperative exercise training improved exercise capacity; 6MWD was increased to 39.95 m (95% CI = 5.31 to 74.6, P = .02) .While postoperative exercise training can also effectively improve exercise capacity, it required a longer training period; 6MWD was increased to 62.83 m (95% CI = 57.94 to 67.72) after 12 weeks of training ( P < .00001). For HRQoL, on the EORTC-QLQ-30, there were no differences in patients' global health after exercise, but dyspnea score was decreased -14.31 points (95% CI = -20.03 to -8.58, P < .00001). On the SF-36 score, physical health was better after exercise training (MD = 3 points, 95% CI = 0.81 to 5.2, P = .007) while there was no difference with regard to mental health. The I2 statistics of all statistically pooled data were lower than 30%. There was a low amount of heterogeneity among these studies. CONCLUSIONS: Evidence from this review suggests that preoperative exercise training may shorten length of hospital stay, decrease postoperative complications and increase 6MWD. Postoperative exercise training can also effectively improve both the 6MWD and quality of life in surgical patients with NSCLC, but requiring a longer training period.

Continuing EGFR-TKI treatment in combination with super-selective arterial infusion chemotherapy beyond disease progression for patients with advanced EGFR-mutant non-small cell lung cancer.

Regional therapy has shown promising results in patients with an oligo-metastasis after the occurrence of resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). This study evaluated the efficacy and safety of continuing EGFR-TKI therapy concurrently with arterial infusion chemotherapy in 6 patients (median age 55.9 years) with advanced EGFR-mutant non-small cell lung cancer (NSCLC) who had a locally progressive, centrally located lung lesion after EGFR-TKI therapy. The patients received a super-selective arterial infusion of docetaxel (75 mg/m(2)) every 28 days concurrently with EGFR-TKI therapy until further progressive disease (PD) or unacceptable adverse effects (AEs) occurred. Treatment outcomes were assessed via progression-free survival (PFS) times (PFS-1: time to PD after EGFR-TKI therapy; PFS-2: time to further PD after arterial infusion chemotherapy with EGFR-TKI therapy), the occurrence of treatment-related AEs, and patient responses to the QLQ-LC13 quality-of-life questionnaire. Three of the 6 patients achieved partial responses, and three had stable disease. The median PFS-1 was 10.42 months, and the median PFS-2 was 4.1 months (range, 2.1-5.7 months). The median overall survival (OS) was 28.6 months (range, 24.1-32.9 months). All AEs were either grade 1 or grade 2 in severity, and no unexpected AEs were observed. One patient died of lung cancer. The patients reported significant reductions from baseline in symptoms of cough, chest pain, dyspnea, and hemoptysis (P < 0.05 for all comparisons). Thus, continuing EGFR-TKI therapy in combination with super-selective arterial infusion chemotherapy beyond PD for patients with advanced EGFR-mutant NSCLC is feasible, and this approach warrants further investigation.

[Food water sources analysis of adults in four cities of China in summer].

OBJECTIVE: To investigate the food water sources of adults in the four cities of China in summer. METHODS: A total of 64 adults aged 18 - 60 yrs from four cities (Beijing, Shanghai, Chengdu and Guangzhou)were selected using convenient sampling method. The food samples were collected by using duplicate portion method and the water content of food samples were determined by using the national standard. The information on amounts and types of daily drinking soup was recorded by subjects using a quantitative measurement. RESULTS: A total of 63 subjects had completed the investigation. The median of daily water from food of subjects was 1157 ml, while water from staple food was 480 ml, the median ratio of which accounting for 41.8% of water from food. Water from dishes was 427 ml, the median ratio of which accounting for 37.9% of water from food. Water from soups was 133 ml, the median ratio of which accounting for 13.8% of water from food. Water from snacks was 0 ml, the median ratio of which accounting for 6.4% of water from food. The medians of water from staple food (384, 388 and 435 ml, respectively) in Beijing, Shanghai and Guangzhou was significant lower than that of Chengdu subjects' (900 ml, χ(2) = 21.27, P = 0.000). But the median proportion of water from staple food of subjects in Beijing (47.7%) was significantly higher than that in Chengdu (43.2%), Shanghai (42.9%) and Guangzhou (33.9%) (χ(2) = 8.69, P = 0.034). The median of amount and proportion of water from soups of subjects in Guangzhou (267 ml, 24.4%) and Chengdu(278 ml, 15.7%) was significantly higher than that in Shanghai (133 ml, 9.0%) and Beijing (100 ml, 5.8%) (amount: χ(2) = 22.52, P = 0.000;proportion: χ(2) = 16.27, P = 0.001). CONCLUSION: The staple food and dishes are the main sources of daily food water.

[Identification and biodiversity of yeasts isolated from Koumiss in Xinjiang of China].

A total of 87 yeast strains were isolated from 28 home-made koumiss samples, a traditional fermented mare milk product in Xinjiang of China. The isolates were identified by standard physiological and biochemical tests and analysis of the large-subunit (26S) rDNA gene D1/D2 domain sequences. They are proved to be Saccharomyces unisporus (48.3% of the isolates), Kluyveromyces marxianus (27.6%) and Pichia membranaefaciens (15.0%), Saccharomyces cerevisiae (9.2%). Among them, six isolates and a standard yeast strain were selected for analysis of D1/D2 domain sequences. They are indicated as S. unisporus, K. marxianus, S. cerevisiae, P. membranifaciens, P. fermentans, P. galeiformis and the standard yeast strain is indicated as K. lactis (100%). The results obtained demonstrate the value of using analysis of D1/D2 domain sequences methods, in conjunction with the traditional taxonomic methods based on phenotypic characteristics. This study forms an essential step towards the preservation and exploitation of the hidden oenological potential of the wealth of yeast biodiversity of the koumiss in Xinjiang Province. The result obtained shown that S. unisporus and K. marxianus were the predominant strains of koumiss in Xingjiang of China.