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1.
Bajor A Kilander A Sjövall H Rudling M Ung KA 《Digestive diseases and sciences》2008,53(11):2935-2940
The stability of bile acid turnover rate was evaluated retrospectively using repeat SeHCAT tests in patients with chronic
diarrhoea and prospectively for 16 years in healthy subjects. The SeHCAT values were stable in 39 patients with chronic diarrhoea,
as shown by a comparison of the test results [data presented as median and (25th–75th percentile)]: 18% (8–23) in the first
test versus 14% (9–21) in the second test [n = 39, P = 0.37, time interval 44 months (16–68), repeatability index >95%]. In contrast, they were reduced after 16 years in healthy
subjects: 38% (30–49.5) in the first test versus 31% (21–49.5) in the second test (P < 0.03). In healthy subjects, the body mass index increased by 13% from 23.2 kg/m2 (21–24.6) to 26.2 kg/m2 (22.5–27.8) (P < 0.01) during the 16 years. There was a negative correlation between hepatic bile acid synthesis and the SeHCAT values (r = −0.615, P = 0.02, n = 14). In conclusion, the turnover rate of bile acids is stable over a long period of time in patients with chronic diarrhoea
irrespective of bile acid malabsorption, suggesting that a repeat SeHCAT test is dispensable. There is a significant negative
correlation between bile acid synthesis and SeHCAT test results in healthy subjects. The SeHCAT test values are slightly reduced
in healthy subjects after 16 years. 相似文献
2.
Kumar L Malik PS Prakash G Prabu R Radhakrishnan V Katyal S Hariprasad R 《Annals of hematology》2011,90(11):1317-1328
Limited information is available from developing countries about complications, pattern of infections, and long-term outcome
of patients following high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ASCT). Between April,
1990 and December 2009, 228 patients underwent ASCT. Patients’ median age was 48 years, ranging from 11 to 68 years. There
were 158 males and 70 females. Indications for transplant included multiple myeloma, n = 143; lymphoma, n = 44 (Hodgkin’s, n = 25 and non-Hodgkin’s, n = 19); leukemia, n = 22; and solid tumors, n = 18. Patients received HDCT as per standard protocols. Following ASCT, 175 (76.7%) patients responded; complete, 98 (43%);
very good partial response, 37 (16.2%); and partial response, 40 (17.5%). Response rate was higher for patients with good
Eastern Cooperative Oncology Group (ECOG) performance status (0–2 vs. 3–4, p < 0.001), pretransplant chemo-sensitive disease (p < 0.001) and those with diagnosis of hematological malignancies (p < 0.003). Mucositis, gastrointestinal, renal, and liver dysfunctions were major nonhematologic toxicities, 3.1% of patients
died of regimen-related toxicities. Infections accounted for 5.3% of deaths seen before day 30. At a median follow-up of 66 months
(range, 9–234 months), median overall (OS) and event-free survival (EFS) were 72 months (95% CI 52.4–91.6) and 24 months (95%
CI 17.15–30.9), respectively. For myeloma, OS and EFS were 79 months (95% CI 52.3–105.7) and 30 months (95% CI 22.6–37.4),
respectively. Pretransplant good performance status and achievement of significant response following transplant were major
predictors of survival. Our analysis demonstrates that such procedure can be successfully performed in a developing country
with results comparable to developed countries. 相似文献
3.
Myron John Tong Carlos Hsien Joanna Jungeun Song Jia Horng Kao Hai-En Sun Leeyen Hsu Steven-Huy Han Francisco Antonio Durazo Sammy Saab Lawrence Mitchell Blatt 《Digestive diseases and sciences》2009,54(6):1337-1346
Background and Aims Hepatitis B viral markers and liver tests were used as predictors for development of hepatocellular carcinoma and progression
to end-stage liver disease in 128 cirrhosis patients with hepatitis B. Results During a median follow-up of 63.5 months, 28 patients (21.9%) developed HCC and 36 (28.1%) died from non-HCC liver deaths.
By multivariate analysis, independent predictors of HCC development and their hazard ratios were high alfa-fetoprotein (HR2.83,
95% CI 1.60–5.00, P = 0.0003), negative HBeAg (HR2.33, 95% CI 1.04–5.29, P = 0.04), and low alanine aminotransferase value (HR1.42, 95% CI 1.08–1.89, P = 0.02). Independent predictors of non-HCC liver deaths were HBeAg positivity (HR3.39, 95% CI 1.16–9.93, P = 0.02), decrease albumin (HR1.61, 95% CI 0.99–2.63, P = 0.05), decrease platelet count (HR2.54, 95% CI 1.03–6.25, P = 0.04), high ALT value (HR1.22, 95% CI 1.03–1.43, P = 0.02), and onset of encephalopathy (HR3.34, 95% CI 1.21–9.27, P = 0.02). Concusions HBeAg negativity, elevated AFP, and low ALT values predicted HCC development, while HBeAg positivity, abnormal liver tests,
and low platelet counts identified patients with non-HCC liver deaths. 相似文献
4.
Chisaki Mizumoto Junya Kanda Tatsuo Ichinohe Takayuki Ishikawa Masashi Matsui Norimitsu Kadowaki Tadakazu Kondo Kazunori Imada Masakatsu Hishizawa Hiroshi Kawabata Momoko Nishikori Kouhei Yamashita Akifumi Takaori-Kondo Toshiyuki Hori Takashi Uchiyama 《International journal of hematology》2009,89(4):538-545
We evaluated the efficacy of a post-grafting immunosuppressive regimen consisting of tacrolimus, methotrexate, and mycophenolate
mofetil (MMF) in 21 adults (median age, 55 years) with poor-risk hematologic malignancy who underwent unrelated bone marrow
transplantation after fludarabine-based reduced-intensity conditioning (RIC). In combination with intravenous tacrolimus and
minidose methotrexate (5 mg/m2 on days 1, 3, and 6), MMF was orally administered at 30 mg/kg daily in three divided doses between days 7 and 27. All patients
achieved neutrophil recovery with donor-type chimerism at a median of 19 days (range, 13–35). Cumulative incidences of grades
II–IV and III–IV acute graft-versus-host disease (GVHD) were 33% (95% CI, 15–53%) and 5% (95% CI, 0.3–20%), respectively.
Five of 20 evaluable patients developed extensive chronic GVHD. Toxicities associated with the use of MMF were acceptable,
although one patient experienced intractable GVHD immediately after the cessation of MMF. With a median follow-up of 24 months,
overall survival at 3 years was 38% (95% CI, 14–63%). No late graft failure was observed. In conclusion, post-transplant MMF
combined with tacrolimus and methotrexate was well tolerated and conferred stable donor cell engraftment, low risk of severe
acute GVHD, and encouraging overall survival in unrelated donor marrow transplantation after RIC regimens. 相似文献
5.
Mikkel Andreassen Jens Faber Andreas Kjær Claus Leth Petersen Lars Østergaard Kristensen 《Pituitary》2010,13(4):329-336
Long-term treatment of acromegaly prevents aggravation and reverses associated heart disease. A previous study has shown a
temporary increase in serum levels of the N-terminal fraction of pro B-type natriuretic peptide (NT-proBNP) suggesting an
initial decline in cardiac function when treatment of acromegaly is initiated. This was a three months prospective study investigating
short-term cardiac effects of treatment in acromegalic patients. Cardiac function was evaluated by the gold standard method
cardiac magnetic resonance imaging (CMRI) and circulating levels of B-type natriuretic peptides (BNP and NT-proBNP). CMRI
was performed at baseline and after 3 months of treatment. Levels of IGF-I, BNP and NT-proBNP were measured after 0, 1, 2
and 3 months. Eight patients (5 males and 3 females, mean age 53 ± 12 years (range 30–70)) and 8 matched healthy control subjects
were included. Median IGF-I Z-score decreased from 4.5 (range 2.5–6.4) to 2.3 (−0.1 to 3.3). At baseline the patients had
increased left ventricle mass index (LVMI) compared to control subjects (ΔLVMI 35 g/m2 (95% CI 8–63 g/m2, P = 0.016). After 3 months of treatment there was an increase in end-diastolic volume index EDVI (ΔEDVI 9 mL/m2 (95% CI 3–14), P = 0.007) and an increase in levels of BNP (median (ranges) 7 (0.58–286) vs. 20 (1–489) pg/mL, P = 0.033) and of NT-proBNP (63 (20–1004) vs. 80 (20–3391) pg/mL, P = 0.027). Assessed by the highly sensitive and precise CMRI method, 3 months treatment of acromegaly resulted in an increase
in EDVI, and increased levels of BNP and NT-proBNP suggesting an initial decrease in cardiac function. 相似文献
6.
Hoda A. Makhlouf Ahmed Helmy Ehab Fawzy Madiha El-Attar Hebat Alla G. Rashed 《Hepatology International》2008,2(3):353-360
Purpose Identification of risk factors associated with antituberculosis drug-induced hepatotoxicity (anti-TB-DIH) is important, especially
in endemic area for TB and liver disease. This study assessed the incidence and risk factors of anti-TB-DIH in upper Egyptian
patients treated for active pulmonary and extra-pulmonary TB.
Methods A total of 100 consecutive TB patients were prospectively followed up both clinically and biochemically before and during
their course of anti-TB therapy with daily doses of isoniazid, rifampin, ethambutol, and pyrazinamide, or streptomycin.
Results Anti-TB-DIH developed in 15 (15%) patients within 15–60 days (median: 30 days) from the onset of therapy. Liver function normalized
in 10 (60%) patients within 2 weeks from cessation of therapy. No recurrence of DIH was observed after reintroduction of therapy.
Only 1 patient died from fulminant hepatic failure despite discontinuation of all anti-TB drugs. By univariate analysis, patients
with anti-TB-DIH had more pre-existing liver disease (P = 0.024; OR: 3.60; 95% CI: 1.16–11.18), lower body mass index (BMI; P = 0.037; OR: 3.73; 95% CI: 1.04–10.56), lower serum albumin (P = 0.035; OR: 3.31; 95% CI: 1.04–10.56), and more extensive disease (P = 0.033; OR: 3.50; 95% CI: 1.11–11). Age, gender, raised baseline transaminases level, inclusion of pyrazinamide, and inactive
hepatitis B or C carrier state were not significant risk factors of DIH. Using multivariate regression analysis, only pre-existing
liver disease and lower BMI of 20 kg/m2 or less were independent predictors of DIH (P = 0.024 and P = 0.047, respectively).
Conclusion Anti-TB-DIH is not uncommon, needs early recognition and treatment, and is more in patients with pre-existing liver disease
and low BMI. 相似文献
7.
Serpil Muge Deger Mehmet Akif Ozturk Mehmet D. Demirag Selcuk Aslan Berna Goker Seminur Haznedaroglu A. Mesut Onat 《Rheumatology international》2011,31(5):623-628
The aim of the present study was to investigate the health-related quality of life (HRQOL) and mood conditions in familial
Mediterranean fever (FMF) patients. Ninety FMF patients (F/M 60/30, median age 29) and 67 control subjects (F/M 46/21, median
age 30) were included in this study. HRQOL was assessed with short form-36 (SF-36) and mood conditions were assessed with
hospital anxiety depression scale (HADS). FMF patients had significantly lower mean scores on SF-36 physical components compared
to the control group. However, mental components were comparable between groups. FMF patients were significantly more likely
to have depression and anxiety compared to the control group [30 (33%) vs. 8 (12%), respectively, χ
2 = 9.58, OR (95% CI) = 3.7 (1.5–8.7), p < 0.01 for depression and 48 (53%) and 11 (16%), respectively, χ
2 = 22.31, OR (95% CI) = 5.8 (2.7–12.5), p < 0.001 for anxiety]. When frequency of anxious subjects was adjusted for the presence of concomitant depressive status as
a confounding factor, the difference between the groups remained statistically significant [χ
2 = 11.86, OR (95% CI) = 5.4 (2.1–13.7), p < 0.01]. However, the difference of depression status between groups was not statistically significant when adjusted for
the presence of concomitant anxiety status [χ
2 = 0.08, OR (95% CI) = 1.3 (0.5–3.8), p = 0.78] and FMF was found to be independently associated with only anxiety [OR (95% CI) = 7.1 (2.3–20.3)]. In addition, pure
anxious FMF subgroup had significantly lower scores of mental health and mental component summary when compared to normal
mood subgroup. In conclusion, FMF might adversely affect HRQOL. Depression and anxiety are more frequent in FMF patients than
healthy subjects. 相似文献
8.
This study aimed to evaluate the efficacy and safety of iodine 125 (125I) radioactive seed implantation for small cell lung cancer at the limited stage of relapse as second line therapy. We collected 6 patients with recurred limited stage small cell lung cancer, who got pathological diagnosis after a bronchoscopic biopsy and then received standard first line treatment, combined chemotherapy and radiotherapy, including prophylactic cranial irradiation. These recurred small cell lung cancer patients got 125I seed implantation treatment as second line therapy, if the treatment not good responsive or the disease got rapid progress, we used the second line chemotherapy as salvage treatment. Clinical data of these patients were collected and short-term effects were observed. The follow-up period lasted for 42 months. All the patients tolerated the procedure of 125I radioactive seed implantation very well. We followed up the patients to 42 months. Five patients got complete remission and 1 patient got partial remission at 1 month after implantation. The objective response rate was 100%. The median survival time was 26 months. And median progression-free survival was 12 months after 125I treatment. And about the complications, 1 patient suffered from the light aerothorax, 1 patient had a little hemoptysis. Our study showed that 125I seed implantation as second line regimen in small cell lung cancer that recurred locally after first line treatment was effective and safe. That could improve the overall survival and progression-free survival only comparing to the second line chemotherapy. Therefore 125I seed implantation as brachytherapy protocol is a promising method and can be applied as second line treatment to control the locally recurred small cell lung cancer. 相似文献
9.
Reitter SE Waldhoer T Mayerhofer M Eigenbauer E Ay C Kyrle PA Pabinger I 《Annals of hematology》2011,90(5):585-594
Limited data are available regarding long-term survival following venous thromboembolism (VTE). The objectives of this study
are to evaluate long-term survival by retrospective survival analysis in patients with a history of VTE and to compare their
survival with that of the general population. Patients with a history of VTE (min. 3 months after VTE) without cancer, who
were referred to our department between 1994 and 2007, were included in the analysis. Information concerning mortality was
available through the Austrian Central Death Register. The survival of patients was compared with that of the age- and gender-matched
general Austrian population. Three thousand two hundred-nine patients (mean age, 46.2; range, 14–89 years) were included.
Median time interval between the first VTE and inclusion was 14 months; median observation period was 6.6 years. During the
considered time period, 169 patients (5.3%) died. The cumulative survival in patients was 0.97 and 0.87 after 5 and 10 years;
men had a higher death rate than women; patients with idiopathic VTE had a less favourable survival than those with a triggering
event. When patients were compared to the general population, the cumulative relative survival was 1.02 (95% CI 1.00–1.03).
In none of the analysed subgroups (different sites of VTE; idiopathic vs. secondary VTE) was a reduced cumulative relative
survival found. The relative survival of male patients was even slightly better, whereas that of women equalled that of the
normal population. Our results indicate that after the initial phase, VTE does not seem to impair long-term survival of patients
with a history of VTE without cancer. 相似文献
10.
Ali A. El-Solh Philippe Abou Jaoude Jahan Porhomayon 《Internal and emergency medicine》2010,5(4):367-347
The use of supplemental sodium bicarbonate for the treatment of patients with septic shock and elevated blood lactate levels
remains a controversial therapy. We conducted a retrospective study between March 2004 and February 2009 of 36 consecutive
patients diagnosed with septic shock who received continuous infusion of bicarbonate therapy. A control group was matched
1:1 for age, site of infection, and predicted mortality by APACHE II. All patients were managed according to standard protocols.
The median time until reversal of shock did not achieve statistical significance between the bicarbonate group (44.5 h [95%
confidence interval [CI] 34–54] and the control group (55.0 h [95% CI 39–60] (p = 0.09). The median time to liberation of mechanical ventilation was significantly reduced in the bicarbonate group (10 days
[95% CI 5.0–13.0] compared to the control group (14 days [95% CI 9.0–19.0], p = 0.02). The length of intensive care unit (ICU) stay was also shorter in the surviving patients who received bicarbonate
compared to controls (median 11.5 days (95% CI 6.0–16.0) vs. 16.0 days (95% CI 13.5–19.0), respectively; p = 0.01). However, there was no difference in 28-day mortality between the two study groups (28%; 95% CI 14–45% vs. 33%; 95%
CI 19–51%, respectively; p = 0.79). Infusion of sodium bicarbonate in septic patients with arterial hyperlactatemia may facilitate weaning from mechanical
ventilation and reduce length of ICU stay. 相似文献
11.
Dindo D Weishaupt D Lehmann K Hetzer FH Clavien PA Hahnloser D 《Diseases of the colon and rectum》2008,51(12):1768-1774
Purpose The clinical and morphologic outcome of patients with obstructed defecation syndrome after stapled transanal rectal resection
was prospectively evaluated.
Methods Twenty-four consecutive patients (22 women; median age, 61 (range, 36–74) years) who suffered from obstructed defecation syndrome
and with rectal redundancy on magnetic resonance defecography were enrolled in the study. Constipation was assessed by using
the Cleveland Constipation Score. Morphologic changes were determined by using closed-configuration magnetic resonance defecography
before and after stapled transanal rectal resection.
Results After a median follow-up of 18 (range, 6–36) months, Cleveland Constipation Score significantly decreased from 11 (range,
1–23) preoperatively to 5 (range, 1–15) postoperatively (P = 0.02). In 15 of 20 patients, preexisting intussusception was no longer visible in the magnetic resonance defecography.
Anterior rectoceles were significantly reduced in depth, from 30 mm to 23 mm (P = 0.01), whereas the number of detectable rectoceles did not significantly change. Complications occurred in 6 of the 24
patients; however, only two were severe (1 bleeding and 1 persisting pain requiring reintervention).
Conclusions Clinical improvement of obstructed defecation syndrome after stapled transanal rectal resection correlates well with morphologic
correction of the rectal redundancy, whereas correction of intussusception seems to be of particular importance in patients
with obstructed defecation syndrome.
Presented at Presented at the Congress of the Swiss Surgical Society, Basel, Switzerland, May 28 to 30, 2008. 相似文献
12.
Purpose Clostridium difficile diarrhea is common in elderly patients and leads to prolonged hospitalization. Patients with severe or recurrent Clostridium difficile diarrhea have poor antitoxin antibody responses. Intravenous immunoglobulin has been advocated in these patients. This study
was designed to assess the response of patients with refractory, recurrent, or severe Clostridium difficile diarrhea to intravenous immunoglobulin.
Methods Retrospective review (November 2003–January 2005) of 14 patients with severe, refractory, recurrent Clostridium difficile diarrhea treated with intravenous immunoglobulin (Flebogamma?, 150–400 mg/kg) from 264 Clostridium difficile toxin-positive patients.
Results Median age was 79 (range, 54–91) years. Median length of symptoms before intravenous immunoglobulin was 29 (range, 3–90) days.
Patients received a median of three (range, 1–5) courses of vancomycin or metronidazole before intravenous immunoglobulin.
All had hypoalbuminemia (median, 22 g/l; range, 18–33) and raised C-reactive protein (median, 47 mg/l; range, 25–255) at time
of infusion. The median white cell count was 15.3 × 109/liters (range, 4–24). Eight patients had evidence of pancolitis on abdominal imaging, suggesting severe Clostridium difficile diarrhea. All patients tolerated intravenous immunoglobulin without side effects. Nine (64 percent) responded with bowels
normalizing in a median of ten (range, 2–26) days; one patient received two doses. One patient had a partial response from
two doses but died two months later after a recurrence. The other four patients died of other causes within three weeks of
infusion.
Conclusions Intravenous immunoglobulin may be effective for severe, refractory, or recurrent Clostridium difficile diarrhea after failed conventional treatment.
Presented at Digestive Diseases Week, Chicago, Illinois, May 14 to 19, 2005, and the meeting of the British Society of Gastroenterology,
Birmingham, England, March 14 to 17, 2005.
Reprints are not available. 相似文献
13.
Cashen A Juckett M Jumonville A Litzow M Flynn PJ Eckardt J LaPlant B Laumann K Erlichman C DiPersio J 《Annals of hematology》2012,91(1):33-38
The inhibition of histone deacetylase (HDAC) can induce differentiation, growth arrest, and apoptosis in cancer cells. This
phase II multicenter study was undertaken to estimate the efficacy of belinostat, a potent inhibitor of both class I and class
II HDAC enzymes, for the treatment of myelodysplastic syndrome (MDS). Adults with MDS and ≤2 prior therapies were treated
with belinostat 1,000 mg/m2 IV on days 1–5 of a 21-day cycle. The primary endpoint was a proportion of confirmed responses during the first 12 weeks
of treatment. Responding patients could receive additional cycles until disease progression or unacceptable toxicity. Twenty-one
patients were enrolled, and all were evaluable. Patients were a median 13.4 months from diagnosis, and 14 patients (67%) had
less than 5% bone marrow blasts. Seventeen patients (81%) were transfusion dependent. Prior therapy included azacytidine (n = 7) and chemotherapy (n = 8). The patients were treated with a median of four cycles (range, 1–8) of belinostat. There was one confirmed response—hematologic
improvement in neutrophils—for an overall response rate of 5% (95% CI, 0.2–23). Median overall survival was 17.9 months. Grades
3–4 toxicities considered at least to be possibly related to belinostat were: neutropenia (n = 10), thrombocytopenia (n = 9), anemia (n = 5), fatigue (n = 2), febrile neutropenia (n = 1), headache (n = 1), and QTc prolongation (n = 1). Because the study met the stopping rule in the first stage of enrollment, it was closed to further accrual. 相似文献
14.
This study has shown that in aged rat brain (22–24 months) crude synaptosomes in comparison to that in young animals (4–6 months),
a striking decrease in the activity of Na+,K+-ATPase occurs along with decreased K
m and V
max but without any change in enzyme content as seen by immunoblotting. This is associated with an accumulation of peroxidative
damage products in aged brain. When rats are given antioxidant supplementation in the diet with a combination of N-acetylcysteine, α-tocopherol and α-lipoic acid daily from 18 months onwards and sacrificed at 22–24 months for experimentation,
the age associated decrease of Na+,K+-ATPase activity, alterations of its kinetic parameters and accumulation of peroxidative damage products in brain synaptosomes
are prevented nearly completely. Because of the critical importance of Na+,K+-ATPase in neuronal functions, the results of this study may be of potential implications in controlling age-related functional
deficits of the brain. 相似文献
15.
M. Zaccarelli P. Lorenzini V. Tozzi F. Forbici F. Ceccherini-Silberstein C. Gori R. D’Arrigo M. P. Trotta P. Narciso C. F. Perno A. Antinori 《Infection》2009,37(3):203-209
Abstract
Background:
Treatment guidelines for multi-experienced HIV patients have recently evolved from aiming to preserve immunity to achieving
virological success, largely due to the availability of new antiretroviral drugs and drug classes. To assess the role of viral
suppression on clinical progression following a genotypic resistance test (GRT), we have examined a database on patients failing
to respond to combined antiretroviral therapy (cART).
Methods:
Patients undergoing a GRT after failure to respond to cART between January 1999 and May 2006 were followed up to December
2006. Time-to-death or a new AIDS event/death were considered to be analysis end-points. Viral suppression (< 50 copies/ml
[c/ml]) after GRT, a time-dependent covariate, was tested as predictor of disease progression.
Results:
Overall, 1,389 patients were included in this observational study. After the GRT, patients were followed up to 72 months (median
28 months, IQ range 13–51 months). During the follow-up, 124 patients (9%) died, and 86 (6%) experienced a new AIDS event.
774 patients (56%) achieved < 50 c/ml HIV-RNA. The results of an adjusted Cox model showed that undetectable HIV-RNA after
the GRT was significantly associated with a lower risk of death (harzard ration [HR] 0.46, 95% confidence interval [CI] 0.27–0.76)
and AIDS/death (HR 0.43, 95% CI 0.28–0.65). The adjusted hazard ratios suggested a twofold risk reduction. A threefold risk
reduction of death related to achieved undetectable viral load was found in patients with resistance to more than one drug
class and with CDC-C diagnosis; a fourfold reduction was found in patients with < 200 CD4+/mm3.
Conclusions:
Maximal viral suppression has a large impact on HIV progression, particularly in heavily pre-treated individuals. Our findings
support the latest treatment guidelines, which have rapidly evolved from an initial lack of indication to suggestions, and
finally to strong recommendations for achieving the goal of suppressing viremia. 相似文献
16.
Hołowiecki J Grosicki S Kyrcz-Krzemien S Skotnicki AB Piatkowska-Jakubas B Warzocha K Seferynska I Zdziarska B 《Annals of hematology》2008,87(5):361-367
In 1992–1993, synergistic interaction of ribonucleotide reductase inhibitors (fludarabine, cladribine) and cytarabine (Ara-C)
increasing Ara-CTP concentration in myeloblasts was proved. Based on these findings and encouraging results of the addition
of cladribine to standard daunorubicin+Ara-C induction regimen (DAC) in acute myeloid leukemia (AML), the Polish Adult Leukemia
Group (PALG) conducted a pilot study on the administration of cytarabine, daunorubicin, and fludarabine (DAF) as a reinduction
treatment of AML to assess tolerance, toxicity, and early outcome. The DAF regimen consisted of daunorubicine 60 mg m−2 day−1 iv on days 1–3 and fludarabine 25 mg m−2 day−1 iv on days 1–5 given before cytarabine 200 mg m−2 day−1 in ci on days 1–7. Thirty-four AML patients with median age 39, 24% relapsed and 76% refractory, were included into the study
between September 2003 and August 2004. Achieved response rate in the whole study population was 56%; n = 16 patients with complete remission (CR), and n = 3 patients with partial remission (PR). Fifteen of 16 patients achieved CR after the first course of therapy. Only 9% of
total population died before the assessment of remission. All patients developed severe neutropenia. Serious infections were
observed in 47% of the cases. Severe thrombocytopenia was observed in 72% of the patients. All patients required substitution
of platelet concentrates (median 4), and PRBC (median 5). Severe alopecia, mucositis, vomiting were of low frequency. Liver,
kidney, or circulatory failure, diarrhea, or polyneuropathy were not observed. The probability of overall survival (OS) for
1 year for the whole study population (34 patients) and the group of 16 patients in CR was: 44% (95% confidence interval [CI]
36–52%) and 69% (95% CI 55–83%), respectively. The probability of leukemia-free survival (LFS) for 1 year was 38% (95% CI
22–54%). Summarizing, DAF regimen used as the induction therapy in relapsed/refractory AML was well tolerated with acceptable
toxicity and early efficacy. 相似文献
17.
Tsukamoto S Fujita S Yamaguchi T Yamamoto S Akasu T Moriya Y Taniguchi H Shimoda T 《International journal of colorectal disease》2008,23(11):1109-1113
Background To clarify the oncological outcome of rectal well-differentiated neuroendocrine tumors (W/D NETs), we examined the clinicopathological
characteristics and prognosis of patients with this neoplasm.
Materials and methods A total of 23 patients who underwent surgical treatment with lymph node dissection for rectal W/D NETs between 1973 and 2007
were reviewed.
Results Median tumor size measured preoperatively was 13 mm (range, 4–25 mm), and the median number of dissected lymph nodes was 16
(range, 1–46). The incidence of lymph node metastasis was 61% (14 of 23 cases). The smallest W/D NETs with lymph node metastasis
was 10 mm in diameter. All the patients without lymph node metastasis survived without recurrence. Among 11 patients who had
only regional lymph node metastasis, only one developed liver metastasis and died 13 months after initial surgery. Among three
patients with lateral pelvic lymph node metastasis, two survived more than 5 years, although two had liver metastasis.
Conclusions Because the incidence of lymph node metastasis is very high in patients with rectal W/D NETs greater than 10 mm in diameter,
radical surgery is required. In this series, the outcome of rectal W/D NETs patients with lateral pelvic lymph node metastasis
was better than expected. 相似文献
18.
Lazzeri C Valente S Chiostri M Picariello C Gensini GF 《Internal and emergency medicine》2012,7(1):33-39
Controversy still exists about uric acid as a potential prognosticrisk factor for outcomes in patients with acute myocardial
infarction. We prospectively assessed, in 856 patients with ST-elevation myocardial infarction (STMI) consecutively admitted
to our Intensive Cardiac Care Unit after primary percutaneous coronary intervention (PCI) whether uric acid (UA) levels are
associated with in-hospital mortality and complications. Killip classes III-–IV were more frequent in the 3° UA tertile that
was associated with the highest values of peak Tn I (p = 0.005), NT-proBNP (p < 0.001), and fibrinogen (p = 0.036). Uric acid was associated with mortality (crude OR: 1.24; 95% CI 1.03–1.51; p = 0.025), but, when adjusted for Tn I and renal failure (as inferred by eGFR <60 ml/min/1.73 m2), uric acid lost its statistical significance, while Tn I (100 pg/ml step OR: 1.002; 95% CI 1.000–1.003; p = 0.007) and renal failure (OR 9.16; 95% CI 3.60–23.32; p < 0.001) were independent predictors for in-ICCU mortality. Uric acid remained as independent predictor for in-ICCU complications
(1 mg/dl step OR: 1.11; 95% CI 1.01–1.21; p = 0.030) together with admission glycemia (1 g/dl step OR: 1.50; 95% CI 1.19–1.91; p < 0.001) and renal failure (OR: 1.46; 95% CI 0.99–2.16; p < 0.001). In STEMI patients submitted to PCI, increased uric acid levels identify a subgroup more prone to in-ICCU complications,
probably because hyperuricemia stems from several complex mechanisms ranging from pre-existing risk factors to the degree
of myocardial ischemia (as indicated by Killip class, ejection fraction) and to the acute metabolic response (as inferred
by glucose levels). Hyperuricemia is not independently associated with early mortality when adjusted for renal function and
the degree of myocardial damage. 相似文献
19.
Tim Lane H. Fisher Raymond Sibongile Dladla Joseph Rasethe Helen Struthers Willi McFarland James McIntyre 《AIDS and behavior》2011,15(3):626-634
The Soweto Men’s Study assessed HIV prevalence and associated risk factors among MSM in Soweto, South Africa. Using respondent
driven sampling (RDS) recruitment methods, we recruited 378 MSM (including 15 seeds) over 30 weeks in 2008. All results were
adjusted for RDS sampling design. Overall HIV prevalence was estimated at 13.2% (95% confidence interval 12.4–13.9%), with
33.9% among gay-identified men, 6.4% among bisexual-identified men, and 10.1% among straight-identified MSM. In multivariable
analysis, HIV infection was associated with being older than 25 (adjusted odds ratio (AOR) 3.8, 95% CI 3.2–4.6), gay self-identification
(AOR 2.3, 95% CI 1.8–3.0), monthly income less than ZAR500 (AOR 1.4, 95% CI 1.2–1.7), purchasing alcohol or drugs in exchange
for sex with another man (AOR 3.9, 95% CI 3.2–4.7), reporting any URAI (AOR 4.4, 95% CI 3.5–5.7), reporting between six and
nine partners in the prior 6 months (AOR 5.7, 95% CI 4.0–8.2), circumcision, (AOR 0.2, 95% CI 0.1–0.2), a regular female partner
(AOR 0.2, 95% CI 0.2–0.3), smoking marijuana in the last 6 months (AOR 0.6, 95% CI 0.5–0.8), unprotected vaginal intercourse
in the last 6 months (AOR 0.5, 95% CI 0.4–0.6), and STI symptoms in the last year (AOR 0.7, 95% CI 0.5–0.8). The results of
the Soweto Men’s Study confirm that MSM are at high risk for HIV infection, with gay men at highest risk. HIV prevention and
treatment for MSM are urgently needed. 相似文献
20.
Shuangxi Li Xuewen He Lei Dang Fangyu Xu Jin Fang Fenqiang Li Wenhui Wang 《Digestive diseases and sciences》2018,63(2):321-328