吉西他滨低剂量延时输注的研究进展

吉西他滨（gemcitabine,GEM）为抗嘧啶核苷酸代谢类药物。目前,GEM的标准给药方式为1 000~1 250 mg·m^-2,30 min静脉快速输注。但是,药理学研究表明,GEM延时输注可使细胞内有活性的GEM三磷酸盐达到最佳的蓄积速度,提示GEM延时输注在药动学方面要优于30 min快速输注。故本文对GEM低剂量延时输注的相关研究进行综述,以期为临床用药提供相关依据。     

持续小剂量补充铁剂对530例早产儿发育的影响

目的 对早产儿进行持续小剂量铁剂补充,为其健康发育推荐更佳补充铁剂的方式。方法 于2010-2016年前瞻性纵向队列方法收集530例早产高危儿,234例足月健康婴儿,共分为三组采用不同剂量与时间补充铁剂治疗,采用盖赛尔发展量表(GDS)评估智能发育,监测体格发育,观察各组发育情况到12月龄。结果 到12月龄时早产儿组间(A组和B组)比较,GDS量表中粗大运动发育(GMD),个人-社会能区(PS)、解决问题能区(CG)、言语能区(CM)的发育商值(DQ)以及睡眠规律性,差异有统计学意义(P<0.05);而观察组(A组)与正常对照组(C组)在以上方面比较均无明显差异(P>0.05)。体格发育评估到12月龄时两组早产儿组间(A组和B组)出现差异(P<0.05),而且A组与C组差异亦有统计学意义(P＜0.05)。结论 持续小剂量补充铁剂对生长发育高峰期的早产儿在神经运动言语认知发育、睡眠方面影响更大。而对体格发育有一定影响但没有达到追赶生长。     

Results of 10-year mobile low-dose computed tomography screenings for lung cancer in Shimane,Japan

BackgroundSome randomized controlled trials have evaluated the effects of low-dose computed tomography (CT) screening on lung cancer mortality in heavy smokers. Based on the results of those trials, our CT screening program recommended screening for people aged ≥40 years with a history of smoking. This retrospective study aimed to verify the validity of our CT screening program and elucidate the current state of CT screening program.MethodsWe retrospectively examined lung cancer detection in 25,189 participants who underwent chest CT screening by a mobile low-dose CT screening unit in the 10-year period from April 2009 to March 2019. Participants were recruited at Japan Agricultural Cooperatives (JA) Shimane Kouseiren. Participants requested CT screening for lung cancer. CT images were read by two pulmonologists.ResultsLung cancer was identified in 82 of the 25,189 participants over 10 years, an overall lung cancer detection rate (percentage of lung cancers detected among all participants) of 0.33%. Lung cancer among never smokers accounted for 54.9% of the detected cases. The lung cancer detection rate was similar for smokers versus never smokers. The stage IA detection rate (percentage of stage IA lung cancers among all lung cancers detected) was 62%, while the stage Ⅳ detection rate was 10%.ConclusionsChest CT detected lung cancer in never smokers as well as current or former smokers. Our CT screening program was not effective for never smokers; thus, further study of the effectiveness of CT screening in never smokers is needed.     

Effect of Low-Dose Aspirin on the Markers of Oxidative Stress

Summary. The present study estimates effects of low-dose enteric coated aspirin (ECA) on oxidative stress (OS) markers in a group of middle-aged men (mean age 51.2 ± 6.9 years) free of pre-existing ischemic heart disease.Methods. Serum products of lipid peroxidation, and measures of antioxidative status were detected in 25 healthy men in baseline and after two-week treatment period.Results. In respect to serum products of lipid peroxidation and markers of antioxidant status, no statistically significant differences between the pre- and after-treatment data were observed for any measures, with the exception of values of serum antioxidative capacity (39.0 ± 2.5 and 42 ± 4.6, respectively).Conclusions. Administration of ECA does not initiate the OS in blood and improves the general antioxidative potency of blood. This may imply towards certain antiatherogenic influence of low-dose ECA, exhibited even with a short-term treatment period. Regarding OS markers, a variety of individual responses observed in the selected subgroups should be investigated and possibly taken into account while treatment with ECA is initiated for primary prevention of cerebrovascular events.     

Gastric Changes in Coronary-Operated Patients with Low-Dose Aspirin

Low-dose aspirin is widely used in patients operated on for coronary disease as secondary prevention of coronary artery occlusion. The changes caused by aspirin in therapeutic doses to gastric mucosa are well documented, but the effect of long-term low-dose aspirin is not so well known. Forty-six volunteer coronary-operated patients with daily low-dose aspirin were interviewed postoperatively, and an upper gastrointestinal tract endoscopy was performed and biopsy specimens taken 3 months after the operation. The findings were compared with a normal population sample of 358 persons from a study previously published. There were significantly more erosions and ulcers or fresh scars in the study group than in the control population-11 of 46 patients and 24 of 358 patients, respectively. The presence of superficial gastritis was similar. Mostly, the lesions were asymptomatic. History of peptic ulcer disease, use of other ulcerogenic drugs, smoking, and alcohol consumption had no predictive value for acute lesions. In contrast, the lesions were associated with chronic superficial gastritis and infection.     

低剂量健择增敏放疗治疗胰腺癌的临床分析

目的探讨低剂量健择增敏放射治疗胰腺癌的疗效及毒副反应。方法48例胰腺癌患者,随机分成两组,每组24例,两组均采用三维放射治疗技术对局部进行放射治疗,总剂量达5.6GY;增敏放疗组同时给予低剂量健择50mg/m2,每周2次,共12次,静脉滴注。结果增敏放疗组和单纯放疗组的有效率(CR PR)分别为88%和75%;两组半年生存率、1年生存率、2年生存率分别为79.2%、58.3%、29.2%和66.7%、25.0%、12.5%;临床受益反应率分别为86.6%和53.2%;血液系统毒副反应3级以上发生率分别为54.1%和20.8%。差异均有显著性意义(P<0.05)。结论低剂量健择增敏放疗可提高胰腺癌的局部控制率和生存率及临床受益反应率,虽然血液系统毒副反应增加,但在可控制范围之内。     

低剂量PF方案持续注射治疗晚期肝癌的疗效观察

目的 观察低剂量PF方案持续注射治疗晚期原发性肝癌(PHC)的疗效和毒副反应.方法 70例晚期PHC随机分为两组,治疗组36例给予低剂量PF持续静脉注射方案:DDP 3 mg/(m2·d),civ,d1-5/周;CF 100 mg,civ,d1,4/周;5-Fu 170 mg/(m2·d),civ,6～8 h/d,d1-7/周,连用3周为1周期,至少完成1个周期或以上.对照组34例给予最佳支持治疗.结果 治疗组和对照组的临床症状改善(即临床受益反应)有效率分别为55.6%(20/36)、23.5%(8/34),差异有统计学意义(P<0.01),中位生存期均为17.00周,治疗组的毒副反应可以耐受.结论 低剂量PF持续静脉注射方案治疗晚期PHC,毒副反应可耐受,可以提高生存质量,但未延长生存期.     

Long-term efficacy and safety of very-low-dose amiodarone treatment for the maintenance of sinus rhythm in patients with chronic atrial fibrillation after successful direct-current cardioversion

Background Long-term maintenance of sinus rhythm after successful conversion of chronic atrial fibrillation （CAF）, often ameliorates patients＇ symptoms, reduces the risk of ischemic stroke and improves cardiovascular hemodynamics. This prospective study aims to evaluate the long-term efficacy and safety of very low-dose amiodarone （100 mg daily） for the maintenance of sinus rhythm after successful direct-current （DC） cardioversion in patients with CAF and rheumatic heart disease （RHD） post intervention. Methods This study was a randomized prospective trial. One day after successful DC cardioversion （remained normal sinus rhythm） in patients with CAF and RHD post intervention for more than six months and adequate anticoagulation, all were randomly administered either amiodarone 200 mg daily in group A or amiodarone 100 mg dally in group B. Results A total of 76 patients （40 men and 36 women） were examined from February 1998 to December 1999. The mean age of the patients was （664- 10） years, and the mean follow-up was （674-8） months （range 61 to 84 months）. Actuarial rates of the maintenance of sinus rhythm were similar in the two groups after 5 years of follow-up. Four patients （11%） in group A but none in group B experienced significant adverse effects that necessitated withdrawal of amiodarone. No death occurred during the study period. Conclusion A very low dose of amiodarone results in adequate long-term efficacy and is safe for maintaining sinus rhythm in patients with CAF and RHD post intervention after successful DC cardioversion.