A Systematic Review and Meta-Analysis of Deferiprone Monotherapy and in Combination with Deferoxamine for Reduction of Iron Overload in Chronically Transfused Patients with β-Thalassemia

β-Thalassemia major (β-TM) patients require life-long blood transfusions, resulting in iron overload with multi-organ morbidity and mortality. Evidence from small randomized controlled trials (RCTs) published to date for deferiprone (DFP) monotherapy or in combination with deferoxamine (DFO) is unclear. We summarized evidence on the efficacy of DFP monotherapy compared to DFO, and DFP-DFO combination therapy compared to DFP or DFO monotherapy in chronically transfused β-TM. We searched four electronic databases and examined the grey literature. Two authors independently assessed trial quality and extracted data. We calculated the relative risk for dichotomous outcomes and mean difference (MD) for continuous outcomes. We identified 15 RCTs (1003 participants) that met the inclusion criteria. Deferiprone was more efficacious than DFO in improving cardiac ejection fraction [MD 2.88, 95% CI (95% confidence interval) 1.12 to 4.64, p?=?0.001) and endocrine dysfunction (MD 0.09, 95% CI 0.08 to 0.10, p?p?=?0.008). There was no significant difference in all other outcomes examined. Meta-analysis on changes in myocardial iron content was not possible due to differences in data presentation. The quality of evidence for all outcomes was low. There is currently insufficient evidence to show that DFP is superior to DFO in the treatment of iron overload. The use of DFP must be weighed against the potential side-effects, patient compliance and preference. Large RCTs with clinically relevant outcomes are required.     

经动脉化学栓塞和经皮冷冻序贯治疗肝细胞癌

目的 评价经动脉化学栓塞(TACE)和经皮冷冻序贯治疗无法切除的肝细胞肝癌(HCC)的疗效.方法 将420例无法手术切除的HCC患者分为TACE-冷冻序贯治疗组290例(序贯组)和单纯冷冻组130例(冷冻组).TACE按常规操作,术后2～4周行经皮冷冻治疗.1个月及以后每2～3个月随访1次,包括肝脏超声和(或)腹部CT,并检测血清甲胎蛋白(AFP).结果 平均随访(42±17)个月(范围24～70个月),所有患者消融灶局部复发率为17%,序贯组和冷冻组分别为11%和24%(P=0.001).1、2、3、4和5年平均存活率分别为72%、57%、47%、39%和31%.序贯组1年和2年存活率(71%和61%)与冷冻组(73%和54%)相似(P值分别=0.69和0.147);而4年和5年存活率,序贯组(49%和39%)高于冷冻组(21%和23%,P=0.001).序贯组有18例肿瘤直径＞5cm的患者存活逾5年,而冷冻组无一例.全组并发症发生率为24%,序贯组和冷冻组分别为21%和26%(P=0.06).冷冻组肝出血的发生率显著高于序贯组(P=0.02),且有2例发生肝破裂.结论 冷冻治疗前先行TACE能提高冷冻消融的疗效,减少其并发症,特别是肝出血.TACE和冷冻序贯疗法可能是治疗不能切除性HCC,特别是大肝癌的较好方法 .     

Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma

AIM： To evaluate the efficacy of sequential use of transarterial chemoembolization （TACE） and percutaneous cryosurgery for unresectable hepatocellular carcinoma （HCC）. METHODS： Four hundred and twenty patients were enrolled in this study. The patients, who were considered to have unresectable tumors due to their location or size or comorbidity, were divided into sequential TACE-cryosurgery （sequential） group （n = 290） and cryosurgery alone （cryoalone） group （n = 130）. Patients in the sequential group tended to have larger tumors and a greater number of tumors than those in the cryo-alone group. Tumors larger than 10 cm in diameter were only seen in the sequential group. TACE was performed with the routine technique and percutaneous cryosurgery was conducted under the guidance of ultrasound 2-4 wk after TACE. RESULTS： During a mean follow-up period of 42 ± 17 mo （range, 24-70 mo）, the local recurrence rate at the ablated area was 17% for all patients, 11% and 23% for patients in sequential group and cryoalone groups, respectively （P = 0.001）. The overall 1-, 2-, 3-, 4- and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1- and 2-year survival rates （71% and 61%） in sequential group were similar to those （73% and 54%） in cryo-alone group （P = 0.69 and 0.147）, while the 4- and 5-year survival rates were 49% and 39% in sequential group, higher than those （29% and 23%） in cryo-alone group （P = 0.001）. Eighteen patients with large HCC （〉 5 cm in diameter） survived for more than 5 years after sequential TACE while no patient with large HCC （〉 5 cm in diameter） survived more than 5 years after cryosurgery. The overall complication rate was 24%, and the complication rates were 21% and 26% for the sequential and cryo-alone groups, respectively （P = 0.06）. The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group （P = 0.02）. Liver crack only occurred in two patients of the cryoalone group. CONCLUSION： Pre-cryosurgical TACE can increase the cryoablation efficacy and decrease its adverse effects, especially bleeding. Sequential TACE and cryosurgery may be the better procedure for unresectable HCC, especially for large HCC.     

对氨基水杨酸钠/力克肺疾治疗耐药肺结核之评价

目的 评价对氨基水杨酸钠和力克肺疾序贯疗法治疗复治耐药肺结核的疗效。方法 59例复发和耐药结核病人（男性30名，女性29名）在起初3个月内两组均给予AKHP静脉滴注和VTh(z）口服治疗；序贯治疗组的30名病人在6个月的巩固期内给予DVTh(Z）口服，而对照则给予EVTh(Z)。结果 治疗9个月后，序贯治疗组痰菌涂片、培养阴转率明显高于对照组（P＜0.05）；其病灶吸收率、空洞闭合和缩小率也均高于对照组。结论 对氨基水杨酸钠／力克肺疾序贯疗法治疗复治耐药肺结核是较理想的方案之一。     

Effect of atrioventricular sequential pacing in patients with no ventriculoatrial conduction

Candidates for the dual chamber "universal" (DDD) pacemaker are frequently tested for the presence of intact ventriculoatrial (VA) conduction to identify those at risk for developing endless loop tachycardia. However, recent reports have cited instances where clinical endless loop tachycardia has occurred even when no VA conduction could be demonstrated during ventricular pacing. A pacing protocol was designed to assess the effect of atrioventricular (AV) sequential pacing on VA conduction in 13 patients who showed no evidence of VA conduction during routine electrophysiologic testing. The absence of VA conduction was inferred by pacing the ventricle at several cycle lengths without obtaining a retrograde atrial capture. With the AV sequential method, which consisted of an AV sequential drive with a programmed AV interval of 100 to 160 ms, the presence or absence of VA conduction was tested utilizing a premature ventricular stimulus (V2) over a wide range of coupling intervals. During the AV sequential method, the V2 effectively propagated to the atria in 5 of 13 patients with V2A2 intervals ranging from 200 to 460 ms (mean 304 +/- 97). It is concluded that in patients showing absent VA conduction during routine testing, the ability of a paced ventricular impulse to propagate retrogradely can be demonstrated in a significant number of cases with AV sequential pacing. Although the exact mechanism could not be determined, it is postulated that as compared with ventricular pacing alone, a longer input into the AV node (first anterogradely during the AV sequential drive and then retrogradely with V2) may be partly responsible for the facilitative effect of the AV sequential method.     

Lamivudine/pegylated interferon alfa-2b sequential combination therapy compared with lamivudine monotherapy in HBeAg-negative chronic hepatitis B

BACKGROUND AND AIM: Monotherapy has been proven insufficient in achieving sustained control of chronic hepatitis B. We aimed to assess the efficacy of combined sequential administration of lamivudine and pegylated interferon alfa-2b in patients with hepatitis Be antigen (HBeAg)-negative chronic hepatitis B. METHODS: Eighteen patients were given sequential combination treatment starting with 3 months of lamivudine monotherapy followed by 9 months of pegylated interferon alfa-2b (after a 3-month period of concomitant administration of the two drugs) and 24 patients received lamivudine monotherapy. RESULTS: At the end of treatment, 88.9% of the patients who received sequential combination treatment and 70.8% of those who received lamivudine monotherapy had hepatitis B virus (HBV) DNA levels below 400 copies/mL (P = not significant). At the end of treatment, 72.2% of the patients who received sequential combination treatment and 70.8% of those who received lamivudine monotherapy achieved alanine aminotransferase normalization (P = not significant). After 12 months of follow up, 33.3% of the patients who received sequential combination treatment and 16.7% of those who received lamivudine monotherapy had HBV-DNA levels below 400 copies/mL (P = 0.4). After 12 months of follow up, 72.2% of the patients who received sequential combination treatment and 25.0% of those who received lamivudine monotherapy had normal alanine aminotransferase levels (P < 0.01). Twenty-five percent of the patients in the lamivudine monotherapy group had virological breakthrough compared to none in the sequential combination treatment group (P = 0.06). CONCLUSIONS: Sequential combination treatment is able to improve sustained biochemical response rates and prevent the emergence of lamivudine-resistant mutants in patients with HBeAg-negative chronic hepatitis B.     

Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure.

OBJECTIVES: The InSync III study evaluated sequential cardiac resynchronization therapy (CRT) in patients with moderate-to-severe heart failure and prolonged QRS. BACKGROUND: Simultaneous CRT improves hemodynamic and clinical performance in patients with moderate-to-severe heart failure (HF) and a wide QRS. Recent evidence suggests that sequentially stimulating the ventricles might provide additional benefit. METHODS: This multicenter, prospective, nonrandomized, six-month trial enrolled a total of 422 patients to determine the effectiveness of sequential CRT in patients with New York Heart Association (NYHA) functional class III or IV HF and a prolonged QRS. The study evaluated: whether patients receiving sequential CRT for six months experienced improvement in 6-min hall walk (6MHW) distance, NYHA functional class, and quality of life (QoL) over control group patients from the reported Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial; whether sequential CRT increased stroke volume compared to simultaneous CRT; and whether an increase in stroke volume translated into greater clinical improvements compared to patients receiving simultaneous CRT. RESULTS: InSync III patients experienced greater improvement in 6MHW, NYHA functional class, and QoL at six months compared to control (all p < 0.0001). Optimization of the sequential pacing increased (median 7.3%) stroke volume in 77% of patients. No additional improvement in NYHA functional class or QoL was seen compared to the simultaneous CRT group; however, InSync III patients demonstrated greater exercise capacity. CONCLUSIONS: Sequential CRT provided most patients with a modest increase in stroke volume above that achieved during simultaneous CRT. Patients receiving sequential CRT had improved exercise capacity, but no change in functional status or QoL.     

他汀序贯疗法对急性冠状动脉综合征合并2型糖尿病患者炎性因子和脂联素影响的研究

目的探讨他汀序贯疗法对急性冠状动脉综合征(ACS)合并2型糖尿病患者炎性因子和脂联素的影响。方法选择ACS患者119例,将合并糖尿病患者61例分为对照1组32例和序贯治疗1组29例,ACS未合并糖尿病患者58例分为对照2组28例和序贯治疗2组30例;另选糖尿病患者31例为糖尿病对照组,正常体检者26例为正常对照组。比较各组脂联素、可溶性血管细胞黏附因子1(sVCAM-1)、脂蛋白磷脂酶A2(Lp-PLA2)、妊娠相关蛋白A(PAPP-A)水平。结果与正常对照组比较,糖尿病对照组脂联素明显降低,sVCAM-1、Lp-PLA2、PAPP-A明显升高(P<0.01)。与对照1组和对照2组比较,序贯治疗1组和序贯治疗2组脂联素水平明显升高,sVCAM-1、Lp-PLA2、PAPP-A明显降低(P<0.01)。结论他汀序贯疗法可明显提高合并或未合并糖尿病ACS患者的脂联素水平,降低其炎症标记物水平。ACS合并或未合并糖尿病患者应用他汀序贯疗法后,对脂联素和血清炎症标记物的影响无明显差异。     

Similar outcome of allogeneic stem cell transplantation after myeloablative and sequential conditioning regimen in patients with refractory or relapsed acute myeloid leukemia: A study from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire

Patients with acute myeloid leukemia (AML) in relapse or refractory to induction therapy have a dismal prognosis. Allogeneic hematopoietic stem cell transplantation is the only curative option. In these patients, we aimed to compare the results of a myeloablative transplant versus a sequential approach consisting in a cytoreductive chemotherapy followed by a reduced intensity conditioning regimen and prophylactic donor lymphocytes infusions. We retrospectively analyzed 99 patients aged 18‐50 years, transplanted for a refractory (52%) or a relapsed AML not in remission (48%). Fifty‐eight patients received a sequential approach and 41 patients a myeloablative conditioning regimen. Only 6 patients received prophylactic donor lymphocytes infusions. With a median follow‐up of 48 months, 2‐year overall survival was 39%, 95% confidence interval (CI) (24‐53) in the myeloablative group versus 33%, 95% CI (21‐45) in the sequential groups (P = .39), and 2‐year cumulative incidence of relapse (CIR) was 57% versus 50% respectively (P = .99). Nonrelapse mortality was not higher in the myeloablative group (17% versus 15%, P = .44). In multivariate analysis, overall survival, CIR and nonrelapse mortality remained similar between the two groups. However, in multivariate analysis, sequential conditioning led to fewer acute grade II‐IV graft versus host disease (GVHD) (HR for sequential approach = 0.37; 95% CI: 0.21‐0.65; P < .001) without a significant impact on chronic GVHD (all grades and extensive). In young patients with refractory or relapsed AML, myeloablative transplant and sequential approach offer similar outcomes except for a lower incidence of acute GvHD after a sequential transplant.     

Atrioventricular sequential pacing: differential effect on retrograde conduction related to level of impulse collision

Patients with DDD pacemakers who have intact retrograde conduction are known to be at risk of developing ventricular and "endless loop" tachycardia. To address this problem, a pacing protocol was designed in which V2A2 conduction was assessed in 16 patients during ventricular pacing alone (standard method) and during paced atrioventricular (AV) sequential drive (AV sequential method); the results were then compared. In eight of 16 patients who had intact retrograde conduction with both methods (group 1), the V2A2 intervals were significantly shorter (by 60 to 340 msec) with the AV sequential method. In the remaining eight patients, who demonstrated V2A2 block with the standard method, no V2A2 block occurred with the AV sequential method. In this study, two sets of AV intervals were programmed to produce collision of the two impulses (atrial and ventricular), either in the AV node or the His-Purkinje system (HPS). The site of V2A2 facilitation was related to the site of impulse collision. These results can be explained by earlier excitation by the atrial impulse (of AV node and/or HPS) during AV sequential pacing. However, in some cases it was evident that antegrade propagation of the atrial impulse was responsible for subsequent facilitation. The data suggest that assessment of retrograde conduction in candidates for DDD pacemakers can be made most accurately by the AV sequential method.     

不同切换时机的序贯机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭临床效果的网状Meta分析

背景 序贯机械通气是治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的强有力手段,其治疗关键是选择恰当的切换时机,但目前切换时机的界定标准尚未统一.目的 采用网状Meta分析方法比较不同切换时机的序贯机械通气治疗COPD合并呼吸衰竭患者的临床效果,旨在为序贯机械通气切换时机的选择提供参考.方法 计算机检索PubMed、We...     

Reduction of the internal atrial defibrillation threshold with balanced orthogonal sequential shocks

INTRODUCTION: The aim of this study was to determine the atrial defibrillation threshold (ADFT) of a first shock across the standard right atrium (RA) to distal coronary sinus (dCS) configuration followed by a second shock along the atrial septum with a standard sequential waveform (the second shock leading edge equaled the first shock trailing edge) and a balanced sequential waveform (the leading edges of both shocks were equal). METHODS AND RESULTS: In nine sheep atrial fibrillation was induced with acetyl-beta-methylcholine and burst pacing. A catheter was placed with electrodes in the dCS, proximal coronary sinus (pCS), and RA. A J-shaped catheter was positioned with an electrode at Bachmann's bundle (BB) while another catheter was positioned with an electrode in the superior vena cava (SVC). The ADFTs of six single- and dual-pathway configurations were determined with single, standard sequential, or balanced sequential shocks. The ADFT of the RA-->dCS configuration (0.86 +/- 0.27 J, 159 +/- 29 V, 2.42 +/- 0.36 A) was significantly reduced when followed by an SVC-->pCS (0.58 +/- 0.17 J, 112 +/- 20 V, 1.64 +/- 0.39 A) or a BB-->pCS shock (0.64 +/- 0.16 J, 119 +/- 18 V, 1.81 +/- 0.38 A) with standard sequential shocks. With balanced sequential shocks, the peak voltage and current ADFTs were further significantly reduced (85 +/- 11 V and 1.24 +/- 0.21 A for second shock SVC-->pCS, and 93 +/- 13 V and 1.38 +/- 0.27 A for second shock BB-->pCS). CONCLUSION: The ADFT of the standard RA-->dCS shock is significantly reduced when followed by a second shock along the atrial septum delivered between electrodes in the pCS and either SVC or BB and ADFT is further reduced with balanced sequential shocks.     

经鼻高流量氧疗在慢性阻塞性肺疾病急性加重患者有创呼吸机序贯治疗中的临床效果

目的:探讨经鼻高流量(HFNC)氧疗在慢性阻塞性肺疾病急性加重(AECOPD)患者有创呼吸机序贯治疗中的效果。方法:筛选患AECOPD需气管插管行有创呼吸机治疗的患者35例,经治疗患者病情改善出现"肺部感染控制窗"后,将患者随机分为有创-HFNC序贯组18例和有创-无创序贯组(NIV)17例。观察患者48 h内再插管率、ICU住院时间以及不良事件发生率。结果:48 h内HFNC组3例(16.7%)患者需要再插管,NIV组2例(11.8%)患者再插管(P0.05),HFNC组ICU住院时间明显短于NIV组[(10.4±1.8)d vs(14.2±1.1)d,P=0.023],不良事件HFNC组发生1例(5.6%),NIV组5例(29.4%),2组比较有明显统计学差异(P0.01)。结论:以"肺部感染控制窗"为切换点实施有创呼吸机-经鼻高流量序贯通气策略与无创序贯通气治疗效果相似,且可缩短ICU住院时间,显著减少无创通气的不良事件发生率。     

Alteration of left ventricular performance by left bundle branch block simulated with atrioventricular sequential pacing

The effects of atrioventricular (AV) sequential pacing-induced left bundle branch block (LBBB) on left ventricular (LV) performance were evaluated during cardiac catheterization in 9 randomly selected patients being investigated for chest pain. All patients were in normal sinus rhythm with a normal P-R interval and QRS duration. LV performance was assessed by both hemodynamic and angiographie measurements. The maximal rate of LV pressure increase (dP/dt), rate of maximal LV pressure decrease ($\text{?dP}\text{dt}$), LV end-diastolic pressure (LVEDP), end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume and percent ejection (EF) were measured during right atrial and AV sequential pacing at a constant pacing rate. The average pacing rate was 97 ± 3 beats/min (mean ± standard error of the mean). In each patient, both dP/dt and $\text{?}\text{dP}\text{dt}$ decreased significantly (p < 0.001) during AV sequential pacing compared with atrial pacing at the same rate, from 1,541 ± 68 to 1,319 ± 56 mm Hg/s for dP/dt and from 1,506 ± 86 to 1,276 ± 92 for $\text{?dP}\text{dt}$. LVEDP did not change significantly when atrial (17 ± 3 mm Hg) and AV sequential pacing (16 ± 2 mm Hg) were compared. Mean LVEDV did not change during atrial (135 ± 13 ml) or AV sequential pacing (137 ± 14 ml). In contrast, the LVESV during AV sequential pacing was higher by 15 ml (23 % ) (from 48 ± 10 to 63 ± 12 ml) (p < 0.001); as a result, the stroke volume was lower by 13 ml (15%) and the EF decreased by 10 %, from 66 to 56 % (?15 %).These changes in LV performance during acutely induced LBBB by AV sequential pacing as compared with atrial pacing at the same rate were independent of altered preload, because both LVEDP and LVEDV were similar during the 2 different pacing modes. Peak systolic pressure during AV sequential pacing was significantly lower than that during atrial pacing (161 ± 10 vs 145 ± 10 mm Hg, p < 0.01), and thus afterload was presumably altered during the different pacing modes. However, because the observed change in systolic pressure (afterload) was lower during AV sequential pacing, this change should improve rather than result in deterioration of ejection phase indexes. Because the opposite was observed, it is concluded the deterioration in LV function noted during AV sequential pacing must be due in part to the asynchronous pattern of ventricular activation induced by this intervention.     

肺彗星对血液透析患者心功能的评估作用

目的:评估肺彗星对血液透析患者心功能的评估作用。方法:选取维持性血液透析患者142例,根据美国心脏病协会(NYHA)心功能分级方法进行分级,142例患者中NYHA分级1～2级66例,3～4级76例,所有患者进行多普勒超声肺部及心脏检测;并检测血常规、生化、超敏C反应蛋白、肿瘤坏死因子水平。结果:NYHA 1～2级组透析龄、血红蛋白、血白蛋白、胆固醇、左室射血分数均高于NYHA 3～4级组;NYHA 1～2级组的平均年龄、透析间期体重增加、肺彗星数目、肺动脉收缩压、超敏C反应蛋白、肿瘤坏死因子、肌钙蛋白均低于NYHA 3～4级组(均P0.05)。多因素logistics回归分析显示肺彗星数目、左室射血分数、透析龄是NYHA独立相关危险因素(均P0.05)。肺彗星是预示NYHA恶化的独立危险因素(标准化回归系数为8.6662)。结论:不同心功能分级的血液透析患者出现肺部彗星指数不同,肺彗星是心功能变化的良好标记物,肺彗星对血液透析患者心力衰竭判断有重要作用。     

Sequential,within‐season infection with influenza A (H3N2) in a usually healthy vaccinated child

Cocirculation of varying influenza types, strains, and lineages allows coinfection and intra‐season sequential infection, although a same‐strain sequential infection has not been previously described. This case report describes the first known case of sequential laboratory‐confirmed influenza A (H3N2) infections in a child within one season.     

核苷(酸)类似物序贯联合聚乙二醇干扰素α治疗血清HBsAg低水平的慢性乙型肝炎患者疗效分析*

目的 探讨核苷(酸)类似物(NAs)序贯联合聚乙二醇干扰素α(Peg-IFN-α)治疗血清HBsAg低水平的慢性乙型肝炎(CHB)患者的疗效和安全性。方法 2015年11月～2018年10月我院NAs经治的HBsAg ≤ 1500 IU/mL的CHB患者106例,其中42例在继续NAs治疗的基础上联合Peg-IFNα-2a/2b治疗48 w(序贯联合),停用Peg-IFN-α后再随访48 w;另64例继续口服原NAs治疗(NAs治疗组),定期随访观察96 w。结果 序贯联合组中有2例患者失访,NAs组中有4例患者失访。意向性分析(ITT分析)显示两组基线资料具有可比性;在治疗48 w结束时,序贯联合组血清HBsAg转阴率和血清学转换率分别为19.0%和14.3%,均显著高于对照组的0.0%和0.0%(P均<0.001);在随访48 w结束时,序贯联合组血清HBsAg转阴率和血清学转换率分别为21.4%和19.0%,均显著高于NAs组的1.6% 和1.6%(P均<0.001);序贯联合组肝脏硬度检测(LSM)值为(7.2±0.3) kPa,显著低于NAs治疗组【(12.5±0.4)kPa,P <0.001】。结论 NAs序贯联合Peg-IFN-α治疗血清HBsAg低水平的CHB患者可以显著提高血清HBsAg转阴率及其血清学转换率,改善肝纤维化程度,可使一部分患者获得临床治愈。     

三维适形序贯化放疗治疗Ⅲ期非小细胞肺癌的临床观察

目的探讨三维适形序贯化放疗治疗Ⅲ期非小细胞肺癌的疗效和不良反应。方法将84例Ⅲ期NSCLC患者随机分为两组:序贯治疗组(A)41例及单纯化疗组(B)43例,A组先采用GP方案化疗,先化疗2周期后行放疗,放疗结束后再行2周期化疗;B组采用GP方案化疗。结果序贯治疗组治疗有效率(CR+PR)68.29%;化疗组治疗有效率(CR+PR)34.88%,两组差异有显著性(P<0.05);1年生存率A组53.66%,B组25.58%,差异有显著性(P<0.05);2年生存率A组19.51%,B组11.63%,差异无显著性。两组病人均能耐受治疗中的不良反应。结论三维适形序贯化放疗可提高晚期NSCLC的近期疗效,毒性反应低,患者耐受性好。     

Modified sequential therapy regimens for Helicobacter pylori eradication: A systematic review

BackgroundDifferent modified sequential therapies have been proposed for Helicobacter pylori eradication. However, the efficacy of these regimens is controversial.MethodsWe performed a systematic review of the literature and pooled-data analysis to assess: (a) the efficacy of different modified sequential therapies for H. pylori eradication, (b) the eradication rates achieved by these regimens as compared to either standard triple therapies or standard sequential regimen when available.ResultsOverall 21 trials met inclusion criteria. The most used modified sequential therapy was the seven plus seven tetracycline-based regimen which achieved an overall 73.3% eradication rate (6 trials). Such therapy was more effective than the 14-day triple therapy (77.2% vs. 63.6%; 3 trials). The most used five plus five levofloxacin-based sequential therapy achieved a 95.8% and 90% cure rates when 250 mg and 500 mg levofloxacin twice daily were used, respectively. These success rates were higher as compared to that of either standard sequential or triple therapies. Other modified sequential therapies did not achieved acceptably high cure rates. Contradictory results emerged from 2 studies assessing the efficacy of a levofloxacin-based sequential regimen as a second-line therapy.ConclusionsBoth levofloxacin- and tetracycline-based sequential therapies have been proved to be more effective than standard triple therapies, confirming that the ‘sequential’ administration of drugs is a successful therapeutic procedure for H. pylori infection.     

Carotid sinus hypersensitivity: evaluation of the vasodepressor component

The basis of the vasodepressor response in patients with carotid sinus hypersensitivity (CSH) is unknown, and prevention of recurrent vasodepressor-induced hypotension in these patients has not been possible. In this study we assessed the effectiveness of atrioventricular sequential pacing and pharmacologic interventions in the prevention of carotid sinus massage (CSM)-induced vasodepressor responses in eight patients with CSH. Maintenance of constant heart rate (80 beats/min) and atrioventricular synchrony (atrioventricular interval 150 msec) with sequential pacing did not significantly alter mean CSM-induced fall in systolic pressure (CSM control, -60 +/- 12 mm Hg vs CSM with atrioventricular sequential pacing, -48 +/- 19 mm Hg). Similarly, neither pharmacologic muscarinic blockade nor combined muscarinic and beta-adrenergic blockade significantly attenuated CSM-induced fall in systolic pressure (CSM with atropine, -43 +/- 16 mm Hg; CSM with atropine plus propranolol, -47 +/- 18 mm Hg; both p = NS vs atrioventricular sequential pacing alone). On the other hand, intravenous norepinephrine and oral ephedrine blunted the CSM-induced drop in systolic pressure (CSM with norepinephrine, -19 +/- 12 mm Hg; CSM with ephedrine, -21 +/- 11 mm Hg; both p less than .01 vs atrioventricular sequential pacing alone). Thus, vasodepressor responses were not prevented by control of heart rate, maintenance of atrioventricular synchrony, pharmacologic muscarinic blockade, or combined muscarinic and beta-adrenergic blockade, but were attenuated by drugs believed to be predominantly alpha-adrenergic agonists. Consequently, atrioventricular sequential pacing alone may be inadequate to prevent hypotension in patients with pronounced vasodepressor responses, whereas administration of vasoconstrictors such as ephedrine may diminish symptoms.