Efficacy of late concurrent hypofractionated radiotherapy in advanced melanoma patients failing anti-PD-1 monotherapy

Advanced melanoma patients who failed anti-PD-1 therapy have limited options. We analyzed a cohort of 133 advanced melanoma patients receiving anti-PD-1 monotherapy in a referral center between April 2015 and December 2017, and included the 26 patients with confirmed progressive (PD) or stable disease who received additional radiotherapy with an unmodified anti-PD-1 mAb regimen. Tumor evaluations were done on radiated and nonradiated (RECIST 1.1) lesions, with abscopal effect defined as a partial (PR) or complete response (CR) outside radiated fields. Primary endpoint was the CR + PR rate in radiated + nonradiated lesions. Secondary endpoints were progression-free survival (PFS), melanoma-specific survival (MSS) and safety. First late radiotherapy, consisting of hypofractionated radiotherapy (3–5 sessions, 20–26 Gy), standard palliative radiotherapy or brain radiosurgery was begun after a median of 6.3 months of anti-PD-1 in 23, 2 and 1 patient(s), respectively. Best response was 8 (31%) CR, 2 (8%) profound PR allowing surgical resection of remaining metastases and 16 (62%) PD. Abscopal effect was seen in 35% of patients. Median PFS and MSS since anti-PD-1 initiation was 15.2 [95% CI: 8.0 not achieved (na)] and 35.3 [95% CI: 18.5 na] months, respectively. PFS curves seemed to achieve a plateau. We discontinued anti-PD-1 therapy in 9/10 of patients with no residual evaluable disease and observed one relapse after a median of 10 months off anti-PD1-therapy. No unusual adverse event was recorded. Limitations of the study include its retrospective nature and limited size. Hypofractionated radiotherapy may enhance anti-PD1 monotherapy efficacy in patients who previously failed anti-PD-1 therapy. Controlled studies are needed.     

Timeliness of Treatment Initiation in Newly Diagnosed Patients With Breast Cancer

BackgroundEvidence-based timeliness benchmarks have been established to assess quality of breast cancer care, as delays in treatment are associated with poor clinical outcomes. However, few studies have evaluated how current breast cancer care meets these benchmarks and what factors may delay the timely initiation of treatment.Patients and MethodsDemographic and disease characteristics of 377 newly diagnosed patients with breast cancer who initiated treatment at Tufts Medical Center (2009-2015) were extracted from electronic medical records. Time from diagnosis to initial surgery and time from diagnosis to initiation of hormone therapy were estimated with Kaplan-Meier curves. Multivariable regression analysis was used to identify factors associated with treatment delays. Thematic analysis was performed to categorize reasons for delay.ResultsOf 319 patients who had surgery recommended as the first treatment, 248 (78%) met the 45-day benchmark (median, 28 days; 25th-75th %, 19-43). After adjusting for potential confounders, multivariable regression analysis revealed that negative hormone receptor status (odds ratio, 3.48; 95% confidence interval, 1.44-8.43) and mastectomy (odds ratio, 4.07; 95% confidence interval, 2.10-8.06) were significantly associated with delays in surgery. Delays were mostly owing to clinical complexity or logistical/financial reasons. Of 241 patients eligible for hormone therapy initiation, 232 (96%) met the 1-year benchmark (median, 147 days; 25th-75th %, 79-217).ConclusionMost patients met timeliness guidelines for surgery and initiation of hormone therapy, although risk factors for delay were identified. Knowledge of reasons for breast cancer treatment delay, including clinical complexity and logistical/financial issues, may allow targeting interventions for patients at greatest risk of care delays.     

The Effect of Treatment Sequence on Overall Survival for Men With Metastatic Castration-resistant Prostate Cancer: A Multicenter Retrospective Study

IntroductionWe aimed to evaluate the treatment sequence for patients with metastatic castration-resistant prostate cancer (mCRPC) in real-world practice and compare overall survival in each sequential therapy.Patients and MethodsWe retrospectively evaluated 146 patients with mCRPC who were initially treated with androgen deprivation therapy as metastatic hormone-naive prostate cancer in 14 hospitals between January 2010 and March 2019. The agents for the sequential therapy included new androgen receptor-targeted agents (ART: abiraterone acetate or enzalutamide), docetaxel, and/or cabazitaxel. We evaluated the treatment sequence for mCRPC and the effect of sequence patterns on overall survival.ResultsThe median age was 71 years. A total of 35 patients received ART-ART, 33 received ART-docetaxel, 68 received docetaxel-ART, and 10 received docetaxel-cabazitaxel sequences. The most prescribed treatment sequence was docetaxel-ART (47%), followed by ART-ART (24%). Overall survival calculated from the initial diagnosis reached 83, 57, 79, and 37 months in the ART-ART, ART-docetaxel, docetaxel-ART, and docetaxel-cabazitaxel, respectively. Multivariate Cox regression analyses showed no significant difference in overall survival between the first-line ART (n = 68) and first-line docetaxel (n = 78) therapies (hazard ratio [HR], 0.84; P = .530), between the ART-ART (n = 35) and docetaxel-mixed (n = 111) sequences (HR, 0.82; P = .650), and between the first-line abiraterone (n = 32) and first-line enzalutamide (n = 36) sequences (HR, 1.58; P = .384).ConclusionThe most prescribed treatment sequence was docetaxel followed by ART. No significant difference was observed in overall survival among the treatment sequences in real-world practice.     

慢性化脓性中耳炎患者综合护理的干预效果分析

目的 探讨对慢性化脓性中耳炎患者采用综合护理干预方式完成围术期护理后的临床效果.方法 选择医院2014年6月—2019年2月收治的80例慢性化脓性中耳炎患者作为实验对象;随机数表法分组后探究每组围术期选择的护理干预措施;对照组(40例):选择围术期基础护理措施;试验组(40例):选择围术期基础护理措施+综合护理干预措;比较两组中耳炎患者术后听力障碍恢复情况以及护理后并发症情况.结果 护理前,试验组慢性化脓性中耳炎患者听力障碍评分同对照组比较差异不明显(P>0.05);护理后,试验组听力障碍评分低于对照组明显(P<0.05);试验组慢性化脓性中耳炎患者并发症总发生率(2.50%)低于对照组(32.50%),差异明显(P<0.05).结论 慢性化脓性中耳炎患者于围术期接受综合护理干预后,对于听力障碍缓解、护理后安全指数提升,均获得显著作用效果,为慢性化脓性中耳炎患者康复状态的提升奠定基础.     

中医护理技术对粘连型肩周炎患者手法松解术后疗效的影响

目的:观察中医护理技术在粘连型肩周炎患者手法松解术后疗效的影响。方法:选取2016年1月~2017年8月在广州中医药大学第三附属医院运动医学科粘连型肩周炎患者80例,随机分成观察组和对照组各40例。两组患者均行肩关节黏连手法松解术,术后对照组行常规肩关节康复指导训练演示指导护理,观察组在行常规肩关节康复指导训练演示指导的基础上实施中医护理技术操作,具体内容为点穴按摩与中药熏蒸两部分,予以治疗两周后,对两组患者肩关节的疗效评定、肩关节功能Constant-Mur ley评分进行对比。结果:观察组总有效率显著高于对照组(P<0.05);治疗后,两组患者的肩关节疼痛、ADL、活动度、肌力、总分均较治疗前显著升高(P<0.05),且观察组治疗后的肩关节疼痛、ADL、活动度、肌力、总分显著高于对照组(P<0.05)。结论:中医护理技术的点穴按摩与中药熏蒸能更好的促进粘连型肩周炎患者手法松解术后康复治疗,巩固疗效。     

改良式女婴集尿袋的临床效果研究

[目的]观察改良式女婴集尿袋收集尿液标本的临床应用效果。[方法]将300例新生儿女婴随机分为试验组和对照组各150例,试验组采用改良式集尿袋收集尿标本,对照组采用传统集尿袋收集尿标本,分别比较两组收集尿液标本一次成功率及受大便污染率。[结果]试验组收集尿液标本一次成功率为79.3%明显高于对照组60.7%,试验组尿液标本受大便污染率为4.7%低于对照组12.7%(P均<0.05)。[结论]改良式女婴集尿袋的使用能明显提高留取尿液标本的一次成功率,同时降低受大便污染率。     

腹腔镜修补术治疗急性胃穿孔患者的效果

目的观察腹腔镜修补术治疗急性胃穿孔患者的临床效果。方法选取单县海吉亚医院收治的56例胃穿孔患者作为研究对象,按照入院时间先后顺序分成观察组(n=28)和对照组(n=28),两组患者均行急诊手术,对照组行传统开腹修补术,观察组行腹腔镜修补术,比较两组手术情况、临床疗效及术后并发症发生情况。结果观察组手术时间、排气时间、下床活动时间和住院时间均明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P<0.05);观察组治疗有效率为96.43%,明显高于对照组的67.86%,差异有统计学意义(P<0.05);观察组并发症发生率为3.57%,明显低于对照组的28.57%,差异有统计学意义(P<0.05)。结论腹腔镜修补术治疗急性胃穿孔患者可明显提高治疗有效率,改善手术指标水平,降低并发症发生率的效果优于传统开腹修补术治疗效果。     

微信打卡式监督法提高冠心病病人院外康复干预效果的观察

[目的]观察微信打卡式监督法提高冠心病病人院外康复锻炼干预的效果。[方法]将140例冠心病病人按随机数字表法分为观察组、对照组各70例,对照组实施常规冠心病院内护理及出院后电话随访,观察组将随访方式改为微信打卡式监督法,比较干预后两组病人心功能指标、锻炼依从性及满意度。[结果]干预后两组病人心功能指标均得到优化,但观察组优于对照组(P<0.05);干预后观察组病人心血管事件发生率低于对照组(P<0.05),依从性评分及满意度得分均高于对照组(P<0.05)。[结论]微信打卡式监督法在缓解冠心病症状、提高病人依从性与满意度方面均具有积极效应。     

液相色谱-电喷雾串联质谱分析人全血中环孢素的基质效应评估及其机理探究

目的： 评估液相色谱-电喷雾串联质谱（LC-ESI-MS/MS）分析人全血中环孢素的基质效应，并探究其发生机理。方法： 全血裂解物的蛋白沉淀上清液用作全血基质。分别用乙腈水溶液和全血基质配制等浓度环孢素A（CyA）、环孢素C（CyC）的质控样品。分别在添加H⁺、NH₄⁺和Na⁺的流动相中，用LC-ESI-MS/MS的MRM模式检测质控样品中CyA，CyC的[M+H]⁺、[M+NH₄]⁺和[M+Na]⁺（M=CyA，CyC）峰面积，以其计算基质效应因子；用MS Scan模式检查质控样品中CyA、CyC色谱流出峰的质谱离子组成情况，用于判断基质效应原因。结果： 在添加H⁺、NH₄⁺和Na⁺的流动相中，全血基质中CyA、CyC基质效应因子分别为-76.6%~-54.0%、-86.0%~-55.3%和-42.8%~-34.1%。在加H⁺、加NH₄⁺流动相中，标准液加全血基质的CyA、CyC色谱峰的质谱中出现丰度很高的[M+Na]⁺和[M+K]⁺，在加Na⁺流动相中它们出现丰度很高的[M+K]⁺，而对应的定量离子[M+H]⁺、[M+NH₄]⁺或[M+Na]⁺的丰度显著降低。结论： 全血基质对环孢素的LC-ESI-MS/MS分析产生明显的基质效应，其原因与基质中Na⁺、K⁺同添加在流动相中用于辅助电离的H⁺、NH₄⁺或Na⁺竞争与环孢素加合，导致定量目标加合离子丰度显著降低有关。