Update on drug-eluting coronary stents

The introduction of drug-eluting stents (DES) to interventional cardiology practice has resulted in a significant improvement in the long-term efficacy of percutaneous coronary interventions. DES successfully combine mechanical benefits of bare-metal stents and stabilizing the lumen, with direct delivery and the controlled elution of a pharmacologic agent to the injured vessel wall to suppress further neointimal proliferation. The dramatic reduction in restenosis has resulted in the implementation of DES in clinical practice, and has rapidly expanded the whole spectrum of successfully treatable coronary conditions, particularly in high-risk patients and complex lesions. In this review the authors present current data on DES. Currently, two types of DES are available in the USA: sirolimus-eluting stents (SES) CYPHER? (Cordis Corp., FL, USA) and paclitaxel-eluting stents (PES) TAXUS?(Boston Scientific, MA, USA), and many more are on the way to approval. In addition to sirolimus and paclitaxel, several other drugs have been successfully used in DES. Everolimus and ABT-578 are both analogs of sirolimus that also have immunosuppressive and antiproliferative properties. Another approach in the development of DES is to use drugs that can accelerate re-endothelialization and restore normal endothelial function following vascular injury. Recent advances in vascular gene transfer have also demonstrated potential new treatment modalities for cardiovascular disease, particularly in the treatment of vascular restenosis.     

归芪三七口服液联合恩替卡韦在HBV相关性肝癌经动脉柱塞化疗中的临床应用价值

目的：探讨归芪三七口服液联合恩替卡韦（ETV）在HBV相关性肝癌经动脉栓塞化疗（TACE）中的临床应用价值。方法：将80例患者随机分为对照组与治疗组各40例,2组均在行TACE治疗前始给予恩替卡韦治疗,治疗组在恩替卡韦治疗的同时加用归芪三七口服液治疗,行TACE治疗后1月监测血常规、肝脏功能、HBVDNA定量的变化情况。结果：治疗组血常规、肝脏功能的改善情况明显优于对照组（P〈0．05）,但HBVDNA定量2组无明显差异（P〉0．05）。结论：归芪三七口服液联合恩替卡韦在HBV相关性肝癌行TACE治疗后,可以降低肝脏损害的严重程度,预防肝功能的进一步恶化。     

三氧化二砷联合肝动脉化疗栓塞治疗中晚期原发性肝癌的临床观察

目的评价三氧化二砷（AS2O3）联合肝动脉化疗栓塞（TACE）治疗中晚期原发性肝癌的近远期疗效和不良反应。方法选择2009年11月至2012年12月确诊的中晚期原发性肝癌62例,其中以AS2O3联合TACE治疗的30例为AS2O3组,以单纯TACE治疗的32例为对照组,观察两组患者治疗后近远期疗效,甲胎蛋白（AFP）下降情况、生活质量变化、肝内外转移发生率和不良反应发生率。结果 AS2O3组客观有效率、获益率、中位进展时间、1年生存率、AFP下降率、生活质量改善率和肝内外转移发生率分别为20.0%、80.0%、6.2个月、52.0%、76.5%、50.0%和20.0%。对照组客观有效率、获益率、中位进展时间、1年生存率、AFP下降率、生活质量改善率和肝内外转移发生率分别为15.6%、71.8%、5.3个月、46.0%、66.7%、43.8%和37.5%。两组患者不良反应差异无统计学意义（P〉0.05）。两组患者在客观有效率、获益率、TTP、1年生存率、AFP下降率、生活质量改善率方面差异有统计学意义（P〈0.05）。AS2O3组患者肝内外转移发生率显著低于对照组,差异有统计学意义（P〈0.05）。结论 AS2O3联合TACE治疗中晚期原发性肝癌与以单纯TACE治疗相比较,AS2O3联合TACE治疗中晚期原发性肝癌有较好的近远期疗效,不增加不良反应,而且可降低肝癌肝内外转移的发生率。     

Antimicrobial Susceptibilities of Streptococcus pyogenes Isolated from Adult Patients with Respiratory Tract and Skin and Soft Tissue Infections in Four Southern European Countries

Abstract

Neuroendocrine tumors, particularly those of gastrointestinal tract origin, have a predisposition for metastasizing to the liver, causing parenchymal substitution and paraneoplastic syndrome. Lipiodol embolization combined with anticancer drugs is a recent tool in regional therapy. It has been proven that chemoembolization reduces tumor bulk and hormone levels, and that it palliates the symptoms of many patients with liver-dominant neuroendocrine metastases. Beginning in December 1988, ten patients with unresectable and chemotherapy-refractory liver metastatic neuroendocrine tumors were treated with chemoembolization based on a mixture of lipiodol, mitomycin, cisplatin, epirubicin, followed by gelfoam powder and contrast media. Toxicity encountered included: upper right quadrant pain requiring narcotics, elevation of lactate dehydrogenase, alkaline phosphatase, and transaminases. One patient had liver abscess and persistent fever for 2 weeks. We obtained two complete remissions lasting 12 and 34 months and 5 partial remissions. The median survival was 22 months. Four patients had urinary elevation of 5-hydroxyindolacetic acid (5-HIAA). They showed more than a 75% decrease in urinary secretion after treatment. In a patient with transplanted liver we noticed a partial response lasting 7 months. We conclude that chemoembolization will improve the clinical condition of a significant percentage of patients with liver metastases, that future therapy of carcinoid tumors will be based on specific tumor biology and that treatment will be customized for each individual patient combining the use of cytoreductive procedures including radiofrequency ablation, laser treatment and chemoembolization.     

流通池法测试雷帕霉素支架涂药工艺稳定性初探

目的:用美国药典流通池方法测试雷帕霉素药物洗脱冠脉支架体外释放度,作为企业出厂检验方法,以评价其工艺稳定性。方法:用美国药典释放度测定第4法规定的溶出装置联机紫外分光光度计。释放介质为2%十二烷基硫酸钠溶解在10%乙腈-PBS(pH=5.0)的缓冲液;检测波长为280 nm。结果:相同批号(n=6)和不同批号(n=3)的药物支架的雷帕霉素在24 h的释放曲线一致。结论:本法适合评价冠脉支架涂药的工艺稳定性,快速简便,符合美国药典流通池法的要求,检测结果较为满意。     

全身热疗联合导管化疗栓塞对中晚期肝癌的疗效观察

目的 观察全身热疗联合导管化疗栓塞治疗中晚期肝癌的疗效及安全性.方法 128例中晚期肝癌患者分为单纯介入栓塞化疗组（A组）和介入栓塞化疗联合全身热疗组（B组）,其中A组64例给予5-氟尿嘧啶、表柔比星、丝裂霉素介入栓塞化疗2周期,B组64例用同样药物介入栓塞化疗,同时给予深度镇静下全身热疗,使全身温度升至40~42 ℃,维持90 min,2周期;观察A组和B组患者的疗效及毒副反应.结果 A组患者中,CR 0例,PR 29例,SD 19例,PD 16例,有效率为45.3%;B组患者中,CR 0例,PR 41例,SD 18例,PD 5例,有效率为64.1%;2组有效率比较差异有统计学意义（P〈0.05）.Ⅲ、Ⅳ度肝功能损害、肾功能损害、骨髓抑制及胃肠道反应发生率A组为25.3%、13.1%及18.5%;B组为23.9%、11.4%及20.1%,2组比较差异均无统计学意义（P〉0.05）.结论 全身热疗联合导管化疗栓塞治疗中晚期肝癌安全有效.     

恶性滋养细胞肿瘤化疗栓塞疗效观察

目的观察用夹心疗法治疗恶性滋养细胞肿瘤的疗效。方法采用Seldinger方法股动脉穿刺,经髂内动脉超选择性插入子宫动脉,进行先栓塞后注入化疗药,再栓塞的方法。结果5例患者经过2～3次治疗获得了满意疗效。结论夹心疗法是用明胶海绵颗粒及条混悬液栓塞远端末梢血管和近端主干,其中间注入化疗药的疗法,使肿瘤供血动脉局部保持持续较高的药物浓度。可进一步提高效果,且毒副作用明显减轻,完全可替代无全身转移的全身化疗。