两种方法预防化疗性静脉炎的疗效观察

目的探讨化疗性静脉炎的有效预防方法.方法将320例行静脉化疗的患者随机分为3组, 治疗Ⅰ组:在静脉化疗时,用新鲜芦荟叶片在穿刺处外敷(除针眼);治疗Ⅱ组:在静脉化疗时,用生土豆片在穿刺处外敷(除针眼);对照组:常规化疗,穿刺处未用任何方法外敷.结果应用芦荟叶片组和应用生土豆片组与对照组相比有显著性差异(P＜0.01),新鲜芦荟组与生土豆片组相比无显著性差异(P>0.05).结论新鲜芦荟或生土豆片外敷预防化疗性静脉炎效果明显,且取材方便,价格便宜,值得临床推广.     

R-CHOP方案与CHOP方案治疗初治弥漫性大B细胞淋巴瘤的临床研究

为比较利妥昔单克隆抗体联合标准CHOP方案与标准CHOP方案治疗初治CD20阳性的弥漫慢大B细胞淋巴瘤（DLBCL）患者的疗效和安全性，采用同期（2003年7月至2006年12月）非随机对照的前瞻性研究方法，将69例在我院住院的初治DLBCL患者分为R—CHOP组和CHOP组，其中CHOP组36例，R—CHOP组33例，比较两组的完全缓解率、生存期及不良反应情况。结果显示：R—CHOP组23例（69．7％）获完全缓解（CR），部分缓解（PR）6例（18.2％），总有效率为88．5％，高于CHOP组；CHOP组17例（47．2％）获CR，11例（30．6％）获PR，总有效率77．8％（P=0.049）。尤其在男性、AnnArbor Ⅲ—Ⅳ和IPI3—5分的患者中，R—CHOP方案的CR率明显高于CHOP方案，且差异具有统计学意义（P=0．017、P=0．005和P=0．000）。R—CHOP组预计的平均生存时间（OS）为45．7个月，长于CHOP组的35．2个月，但经Log—Rank检验，差异无统计学意义（P=0．145）；R—CHOP组预计的平均无疾病进展生存时间（PFS）为38．5个月，长于CHOP组的24．6个月，经Log—Rank检验，差异有统计学意义（P=0.017）。R—CHOP组的不良反应主要为发热等输注相关的不良反应，而骨髓抑制情况与CHOP组类似：结论：利妥昔单克隆抗体联合CHOP方案治疗CD20阳性的DLBCL与单纯CHOP方案相比，能显著提高疗效，同时并不增加化疗的毒副反应。     

循证护理在预防肿瘤患者化疗药物外渗中的应用

目的探讨循证护理预防肿瘤患者化疗药物外渗的应用效果。方法将94例应用化疗药物的肿瘤患者随机分为对照组和观察组各47例,化疗过程中对照组实施常规护理,观察组实施循证护理。观察2组化疗药物外渗情况,比较2组并发症发生情况、护理满意度及护理前后生活质量评分。结果观察组化疗药物外渗发生率2.13%,显著低于对照组12.77%(P0.01);静脉炎、胃肠道反应、口腔黏膜损害等并发症发生率也显著低于对照组(P0.05或P0.01);观察组护理满意度为91.49%,显著高于对照组61.70%(P0.01);与护理前比较,观察组5个功能量表评分及总体健康评分均升高,均显著高于对照组护理后(P0.01)。结论循证护理可有效降低化疗药物外渗的发生,减少相关并发症,提高肿瘤患者的护理满意度及生活质量。     

华蟾素片联合SOX方案治疗晚期胃癌的临床研究

目的探讨华蟾素片联合SOX方案(奥沙利铂+替吉奥)治疗晚期胃癌的临床疗效。方法选取2015年1月—2017年12月涟水县人民医院收治的60例晚期胃癌患者作为研究对象,根据不同的治疗方式将患者分为对照组和治疗组,每组各30例。对照组患者采用SOX方案治疗:静滴注射用奥沙利铂130 mg/(m~2·d),用10%葡萄糖注射液500 mL稀释后静滴3 h,21 d给药1次;同时餐后用温水送服替吉奥胶囊,80 mg/(m~2·d),2次/d,连续14 d,停药7 d。治疗组在对照组基础上口服华蟾素片,3片/次,3次/d。21 d为1个周期,两组患者均进行2个周期的治疗。观察两组患者的临床疗效,同时比较两组治疗前后的血清肿瘤指标水平、疼痛评分(VAS)和生活质量综合评定问卷评分。结果治疗后,治疗组的总有效率(RR)和肿瘤控制率(DCR)分别为63.3%、83.3%,均明显高于对照组的36.7%、60.0%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的癌胚抗原(CEA)和糖类抗原19-9(CA19-9)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05),且治疗后治疗组血清肿瘤指标均明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者VAS评分均明显降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组的VAS评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的社会功能、心理功能、功能和物质生活评分均明显提高,同组治疗前后比较差异具有统计学意义(P0.05),且治疗后治疗组生活质量水平显著高于对照组,两组比较差异具有统计学意义(P0.05)。结论华蟾素片联合SOX化疗方案治疗晚期胃癌具有较好的临床疗效,在不增加化疗副反应的情况下,可有效缓解患者的癌性疼痛状况并可改善患者的预后,值得临床推广应用。     

曲妥珠单抗联合IP方案或SOX方案化疗在人类表皮生长因子受体-2阳性晚期胃癌中的有效性和安全性比较

目的 探讨人类表皮生长因子受体-2(HER-2)阳性晚期胃癌中曲妥珠单抗联合IP方案或SOX方案化疗的有效性和安全性。方法 连续性纳入自2015年6月至2017年6月内蒙古医科大学附属医院收治的58例HER-2阳性晚期胃癌,利用随机数字表法分为SOX组和IP组,每组29例。SOX组给予曲妥珠单抗联合替吉奥+奥沙利铂治疗;IP组给予曲妥珠单抗联合伊立替康+顺铂治疗,比较两个疗程后两组病人血清肿瘤标志物和新生血管标志物的变化,以及化疗效果和不良反应差异。结果 两个治疗疗程后,两组病人血清肿瘤标志物癌胚抗原(CEA),糖类蛋白19-9(CA19-9),糖类抗原125(CA125)以及组织多肽特异性抗原(TPS)水平均差异无统计学意义(t=0.628,P=0.532;t=0.879,P=0.383;t=0.828,P=0.411;t=0.719,P=0.476);新生血管标志物内皮生长因子(VEGF)、血管生成素-2(Ang-2)、内皮抑素(ES)、色素上皮衍生因子(PEDF)水平亦差异无统计学意义(t=0.701,P=0.486;t=0.955,P=0.343;t=1.803,P=0.077;t=0.991,P=0.326;);SOX组客观有效率(ORR)及病控制率(DCR)分别为44.83%和82.76%;IP组ORR及DCR分别为34.48%和69.97%,均差异无统计学意义(χ²=0.648,P=0.421;χ²=1.506,P=0.219)。但IP组骨髓抑制(58.62%)和恶心呕吐(3.45%)发生率明显高于SOX组(31.03%,6.90%),差异有统计学意义(χ²=4.461,P=0.035;χ²=5.836,P=0.016)。结论 曲妥珠单抗联合SOX化疗方案或IP方案在HER-2阳性晚期胃癌病人中疗效相当,但SOX方案不良反应发生率较少,值得临床推广。     

铂类敏感型复发性卵巢癌治疗的研究进展

卵巢癌是妇科最重要的恶性肿瘤之一,其病死率居妇科恶性肿瘤之首。随着卵巢癌复发率的逐年增高,对复发的治疗就显得尤为重要。根据病人对铂类药物的敏感性,以初次治疗(达到临床缓解)停药后6个月为界,可将复发性卵巢癌大致分为铂类敏感型和耐药型。治疗铂类敏感性复发性卵巢癌的手段很多,包括化疗、二次手术、放疗等,现对其目前的治疗及进展情况进行综述。     

同步放化疗治疗术后复发性直肠癌的近期疗效观察

目的评价三维适形放疗同步化疗治疗术后复发性直肠癌的近期疗效及毒副反应。方法 15例术后复发性直肠癌采用同步放化疗,先盆腔适形放疗46Gy,后缩野继续适形放疗肿瘤补量,使肿瘤总量达到60～70Gy;化疗采用XELOX方案,于放疗第1、21、42天开始同步进行3周期。结果患者中位随访时间为1年,治疗后3个月、1年复查,局部控制率达到86.7%,症状缓解率达到93.3%,1年生存率为86.7%。不良反应主要有胃肠道反应、骨髓抑制、神经毒性,多为1～2级。结论三维适形放疗同步化疗可提高术后复发性直肠癌的控制率,改善患者生活质量,延长生命,不良反应可以耐受。     

MHC-mismatched mixed chimerism augments thymic regulatory T-cell production and prevents relapse of EAE in mice

Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system with demyelination, axon damage, and paralysis. Induction of mixed chimerism with allogeneic donors has been shown to not cause graft-versus-host disease (GVHD) in animal models and humans. We have reported that induction of MHC-mismatched mixed chimerism can cure autoimmunity in autoimmune NOD mice, but this approach has not yet been tested in animal models of MS, such as experimental autoimmune encephalomyelitis (EAE). Here, we report that MHC-mismatched mixed chimerism with C57BL/6 (H-2^b) donor in SJL/J (H-2^s) EAE recipients eliminates clinical symptoms and prevents relapse. This cure is demonstrated by not only disappearance of clinical signs but also reversal of autoimmunity; elimination of infiltrating T, B, and macrophage cells in the spinal cord; and regeneration of myelin sheath. The reversal of autoimmunity is associated with a marked reduction of autoreactivity of CD4⁺ T cells and significant increase in the percentage of Foxp3⁺ Treg among host-type CD4⁺ T cells in the spleen and lymph nodes. The latter is associated with a marked reduction of the percentage of host-type CD4⁺CD8⁺ thymocytes and an increase of Treg percentage among the CD4⁺CD8⁺ and CD4⁺CD8⁻ thymocytes. Thymectomy leads to loss of prevention of EAE relapse by induction of mixed chimerism, although there is a dramatic expansion of host-type Treg cells in the lymph nodes. These results indicate that induction of MHC-mismatched mixed chimerism can restore thymic negative selection of autoreactive CD4⁺ T cells, augment production of Foxp3⁺ Treg, and cure EAE.Multiple sclerosis (MS) is an inflammatory autoimmune disease that attacks the central nervous system, resulting in demyelination, damage to neuronal cells, and paralysis (1–3). MS patients have quantitative and qualitative defects in peripheral Foxp3⁺ Treg cells (4–6). Different from other autoimmune diseases, such as autoimmune type-1 diabetes and systemic lupus, MS often manifests with a progressive pattern of remission and relapse (1). Remission is associated with an increase of peripheral Treg cells in humans and an enhanced suppressive capacity of Treg cells in mouse models; however, effective Treg therapy has not been reported (7, 8).Induction of mixed chimerism with HLA-matched allogeneic hematopoietic cell transplantation (HCT) has been shown to provide transplantation immune tolerance without causing any signs of graft-versus-host disease (GVHD) in humans (9). Even so, HLA-matched mixed chimerism has been unable to reverse systemic lupus (9). However, induction of MHC-mismatched mixed chimerism is able to reverse autoimmunity in mouse models (10, 11). In particular, we have reported that induction of mixed chimerism under a radiation-free anti-CD3/CD8 conditioning regimen reversed autoimmune type 1 diabetes (T1D) and systemic lupus (12–19). Induction of MHC-mismatched mixed chimerism can restore central tolerance by deleting autoreactive thymocytes with cross-reactivity (18), and tolerize residual T cells in the periphery and delete preexisting and immature autoreactive B cells (15, 17). Because of the lack of suitable anti-human CD3 and anti-human CD8 mAb, translation of this regimen has been hindered. To promote mixed chimerism as a curative therapy for autoimmune diseases, we have developed a radiation-free conditioning regimen that uses the clinically available reagents cyclophosphamide (CY), pentostatin (PT), and antithymocyte globulin (ATG), each of which has been used in the clinic before and after hematopoietic cell transplantation (HCT) for the conditioning of recipients and prevention of GVHD (20).In the current studies, we conditioned experimental autoimmune encephalomyelitis (EAE) SJL/J mice with a combination of low-dose CY, PT, and ATG and then transplanted the mice with CD4⁺ T-depleted spleen and bone marrow (BM) cells from MHC-mismatched C57BL/6 donors. We found that induction of MHC-mismatched mixed chimerism was able to eliminate spinal cord tissue infiltration and augment regeneration of myelin sheath and cure EAE in mice that did not have axon damage.     

Aclarubicin and Low-Dose Cytosine Arabinoside in Combination with Granulocyte Colony-Stimulating Factor in Treating Acute Myeloid Leukemia Patients with Relapsed or Refractory Disease and Myelodysplastic Syndrome: A Multicenter Study of 112 Chinese Patients

One hundred twelve patients with geriatric acute myeloid leukemia (AML), refractory or relapsed AML, or myelodysplastic syndrome and refractory anemia with excess of blasts in transformation (MDS-RAEBt) were entered into this study to receive CAG (aclarubicin and low-dose cytosine arabinoside [Ara-C]in combination with granulocyte colony-stimulating factor [G-CSF]) with the objective of evaluating the efficacy and tolerance of this regimen. Low-dose Ara-C was given subcutaneously at a dosage of 10 mg/m2 every 12 hours on days 1 to 14. Aclarubicin was administered intravenously at a dosage of 14 mg/m2 per day on days 1 to 4 (CAG regimen A) or 7 mg/m2 on days 1 to 8 (CAG regimen B). Recombinant G-CSF was given subcutaneously at a dosage of 200 3g/m2 per day on days 1 to 14. We demonstrated comparable overall complete remission rates for the 4 groups of patients: 30.8% (8/26) in the elderly patients, 48.4% (30/62) in the refractory AML patients, 44.4% (8/18) in the relapsed AML patients, and 38.5% (5/13) in the MDS-RAEBt patients. Of the 52 patients followed up, the 12-month progression-free survival (PFS) and overall survival (OS) rates estimated by the Kaplan-Meier method were 40.73% 3 8.15% and 42.85% 3 8.23%, respectively. The median PFS and OS times were 9.0 3 2.2 months and 11.0 3 1.6 months, respectively. Toxic effects were very rare and mainly consisted of neutropenia and thrombocytopenia due to myelosuppression; approximately 70% to 80% of patients had neutropenia or thrombocytopenia that exceeded National Cancer Institute grade II. Nonhematologic toxicities were not observed in this study.The CAG regimen seems promising, with acceptable toxicity, for the treatment of various categories of poor-prognosis AML and MDS-RAEBt.     

Impacto da frequência posológica na adesão terapêutica em doenças cardiovasculares crónicas: revisão sistemática e meta‐análise

Introduction and ObjectiveNon‐adherence to drug treatment is a major health problem. In Europe, it has been estimated that 9% of cardiovascular events can be attributed to non‐adherence. The complexity of dosing regimens is one of the factors identified as contributing to non‐adherence. In this systematic review we aimed to assess the impact of dosing frequency on adherence to drug treatment in patients with chronic cardiovascular disease.MethodsMEDLINE and the Cochrane Library (November 2013) were searched for randomized controlled trials (RCTs) comparing different dosing regimens (once‐daily administration vs. two or more daily administrations) and assessing adherence to therapy in patients with chronic cardiovascular disease. Only trials with at least five months of follow‐up were included. The results of the studies were pooled through a random effects meta‐analysis. Relative risk (RR) and 95% confidence interval (CI) were derived. Statistical heterogeneity was calculated using the I² test.ResultsFour RCTs (a total of 2557 patients) were included. Dosing regimens with once‐daily administration were associated with a significant 56% reduction in risk of non‐adherence to drug therapy (RR: 0.44; 95% CI: 0.35‐0.54, I²=25%).ConclusionsFew clinical trials have assessed the long‐term impact of dosing frequency on medication adherence in chronic cardiovascular disease. The best available evidence suggests that taking medication once daily decreases the risk of non‐adherence to treatment by approximately 50%. The impact on clinical outcomes remains to be established.