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791.
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793.
Andrew Demeusy Motahar Hosseini Anne M Sill Steven C Cunningham 《World journal of hepatology》2016,8(35):1576-1583
AIM To investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts(IHPP).METHODS A literature search was performed using Pub Med(MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible. RESULTS We found 41 published articles describing 54 cases since the 1970 s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly(48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment(P = 0.006) and with the number of interventions required(P = 0.031). The duration of therapy also correlated with the initial white blood cell(WBC) count(P = 0.048).CONCLUSION Diagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution. 相似文献
794.
David M Hyman Michael W Sill Heather A Lankes Richard Piekarz Mark S Shahin Mildred R Ridgway Floor Backes Meaghen E Tenney Cara A. Mathews James S Hoffman Carol Aghajanian Martee L Hensley 《Gynecologic oncology》2017,144(1):96-100
Objective
This two-stage Phase II study assessed the activity of single agent alisertib in patients with recurrent/persistent uterine leiomyosarcoma (uLMS).Methods
Eligibility criteria included histologically-confirmed, recurrent or persistent uLMS, age ≥ 18, 1–2 prior cytotoxic regimens, and RECIST version 1.1 measurable disease. The primary objective of the study was to evaluate the efficacy of alisertib through the frequency of patients with objective tumor responses and the frequency who survived event-free for at least 6 months (EFS6). The endpoints for EFS were RECIST progression, death, or beginning a subsequent therapy. The null hypothesis jointly specified the probability of a patient experiencing a tumor response to less than or equal to 5% and the probability of a patient surviving event-free for at least 6 months to less than or equal to 20%. A two-stage design was used with a target accrual of 23 patients for stage 1 and 47 pts. cumulative for stage 2. Confidence intervals do not correct for multiplicity.Results
Twenty-three patients were enrolled with two patients excluded on central histology review, yielding 21 eligible patients. Median age was 61 years. Prior treatment was either 1 cytotoxic regimen (71.4%) or 2 (28.6%). The most common treatment related AEs (grade 3 or worse) were anemia Hensley et al. (2008a) , leukopenia Hensley et al. (2008b) , neutropenia Maki et al. (2007) , thrombocytopenia Huang et al. (2012) , mucositis Hensley et al. (2008a) , diarrhea Huang et al. (2012) , and palmer-planter syndrome Zivanovic et al. (2012) . There were no objective responses (0%; 90% CI: 0–10.4%). Best response was stable disease (38.1%); 12 patients had progressive disease (57.1%). EFS6 was 0% (90% CI: 0–10.4%). Median PFS and OS were 1.7 (90% CI: 1.4–3.2) and 14.5 months (90% CI: 7.6 - NA), respectively.Conclusion
Alisertib did not demonstrate clinically meaningful single agent activity in previously treated uLMS. 相似文献795.
Gould N Sill MW Mannel RS Thaker PH Disilvestro P Waggoner S Yamada SD Armstrong DK Wenzel L Huang H Fracasso PM Walker JL 《Gynecologic oncology》2012,125(1):54-58
Objective
To define the maximum tolerated dose (MTD) and assess the feasibility of intravenous (IV) paclitaxel, intraperitoneal (IP) carboplatin, and IP paclitaxel in women with newly diagnosed Stages II-IV ovarian, fallopian tube, or primary peritoneal carcinoma.Methods
Patients received escalating doses of paclitaxel IV and carboplatin IP on day 1 and paclitaxel IP 60 mg/m2 on day 8. A standard 3 + 3 design was used in the escalation phase. A two-stage group sequential design with 20 patients at the MTD was used in the feasibility phase. Patient-reported neurotoxicity was assessed pre and post treatment.Results
Patients were treated with paclitaxel 175 mg/m2 IV and carboplatin IP from AUC 5-7 on day 1 and paclitaxel 60 mg/m2 IP on day 8. The MTD was estimated at carboplatin AUC 6 IP and 25 patients enrolled at this dose level. Within the first 4 cycles, seven (35%) of twenty evaluable patients had dose-limiting toxicities (DLTs) including grade 4 thrombocytopenia (1), grade 3 neutropenic fever (3), > 2 week delay due to ANC recovery (1), grade 3 LFT (1), and grade 3 infection (1). De-escalation to paclitaxel 135 mg/m2 IV was given to improve the safety. After six evaluable patients completed 4 cycles without a DLT, bevacizumab was added and six evaluable patients completed 4 cycles with one DLT (grade 3 hyponatremia).Conclusions
Paclitaxel at 175 mg/m2 IV, carboplatin AUC 6 IP day 1 and paclitaxel 60 mg/m2 IP day 8 yield 18-56% patients with DLTs. The tolerability of the regimen in combination with bevacizumab was indicated in a small cohort. 相似文献796.
Objective
To estimate the activity and tolerability of iniparib plus paclitaxel and carboplatin as initial therapy of uterine carcinosarcoma.Methods
Eligible patients had advanced, persistent or recurrent carcinosarcoma of the uterus, measurable disease and no prior chemotherapy. Patients received paclitaxel 175 mg/m2 IV over 3 h followed by carboplatin area under the curve (AUC) = six over 30 min on day one of 21 day cycles plus iniparib 4 mg/kg IV over 1 h twice weekly beginning on day one. Treatment continued until disease progression or adverse effects prohibited further therapy. Common Terminology Criteria for Adverse Events (CTCAE) v3.0 was used to grade adverse events. The primary endpoint was tumor response. The study was conducted with a 2-stage group sequential design, targeting 20 and 25 patients in each stage. The study was designed to distinguish between 45% versus 65% responding with alpha = 10% and 90% power.Results
Twenty-two patients were entered onto the study with five excluded from analysis, leaving 17 evaluable for analysis. Treatment resulted in the expected hematologic and non-hematologic toxicities of the paclitaxel-carboplatin backbone. The observed proportion responding was 23.5% (4/17 patients). The two-sided, 90% confidence interval for the true probability of response was 8.5-46.1%. The required minimal number of responses to proceed to second stage was eight.Conclusions
Iniparib plus paclitaxel and carboplatin did not show significant activity to warrant further study. The rate of exclusion upon central pathology review (23%) suggests that review of pathology slides for confirmation of eligibility is important in this tumor type. 相似文献797.
Garcia AA Sill MW Lankes HA Godwin AK Mannel RS Armstrong DK Carolla RL Liepman MK Spirtos NM Fischer EG Leslie KK 《Gynecologic oncology》2012,124(3):569-574
Objective
Activation and dimerization of the ERBB family play a role in the pathogenesis and progression of ovarian cancer. We conducted a phase II trial to evaluate the activity and tolerability of lapatinib in patients with recurrent or persistent epithelial ovarian cancer (EOC) and to explore the clinical value of expression levels of epidermal growth factor receptors (EGFR), phosphorylated EGFR, HER-2/neu, and Ki-67, and the presence of EGFR mutations.Methods
Eligible patients had recurrent or persistent EOC or primary peritoneal carcinoma, measurable disease, and up to 2 prior chemotherapy regimens for recurrent disease. Patients were treated with lapatinib 1500 mg/day. The primary endpoint of efficacy was 6-month progression free survival (PFS).Results
Twenty-five of 28 patients were eligible and evaluable for analysis of efficacy and toxicity. Two (8.0%) were alive and progression-free at 6 months. No objective responses were observed. There were 1 grade 4 toxicity (fatigue) and few grade 3 toxicities. Associations between Ki-67 with prior platinum-free interval, PFS, and a polymorphism in EGFR were suggested.Conclusions
Lapatinib has minimal activity in recurrent ovarian cancer. Ki-67 expression may be associated with prior PFS and a polymorphism in EGFR exon 20 (2361G>A, Q787Q). 相似文献798.
Rakhmanina NY Sill A Baghdassarian A Bruce K Williams K Castel AD Rakusan T Singh N Spiegel HM 《The Pediatric infectious disease journal》2008,27(9):837-839
Between 2000 and 2005, 84 HIV-infected children were referred to Children's National Medical Center; 28 were born to immigrant mothers, 89% of whom were of African descent. Rates of antiretroviral prophylaxis were low regardless of maternal origin. Nonimmigrant mothers (30.4%) used illicit drugs (P < 0.001), and 50% of immigrant mothers breast-fed their children (P < 0.001). These data can guide intervention strategies. 相似文献
799.
不同血管通路血液透析患者透析充分性及并发症的比较 总被引:2,自引:0,他引:2
目的通过对不同血管通路血液透析患者透析充分性评估及并发症发生率的比较,探讨维持性血液透析患者理想的血管通路。方法选择上海交通大学医学院附属瑞金医院肾内科2006年1月至2008年3月间经新建立的长期血管通路行血液透析的患者,随访12~38月,评估以自体动静脉内瘘(AVF)、聚四氟乙烯(PTFE)移植血管和颈内静脉带袖套隧道导管(CTC)为血管通路的血液透析患者的Kt/V值,比较三种长期血管通路的并发症的发生率。结果98例维持性血液透析患者中,经AVF透析的患者68例;经PTFE移植血管透析的患者12例;经颈内静脉CTC透析的患者18例。AVF患者的年龄及感染的并发症较PTFE移植血管和CTC组低(P〈0.01);AVF患者栓塞的发生率较PTFE移植血管低(P〈0.01);CTC组患者在随访期间虽未发生栓塞并发症,但3例患者血流量不足;三种血管通路透析患者的Kt/V值大都〉1.2,以AVF为最高(与CTC相比P〈0.01)。结论经AVF透析患者的年龄较轻、栓塞和感染的发生率较低;AVF应是长期血管通路的首选,在AVF无法建立时,PTFE移植血管和CTC仍可作为较好的长期血液透析通路,均能达到较好的透析效果。 相似文献
800.
Electrospinning: applications in drug delivery and tissue engineering 总被引:20,自引:0,他引:20
Despite its long history and some preliminary work in tissue engineering nearly 30 years ago, electrospinning has not gained widespread interest as a potential polymer processing technique for applications in tissue engineering and drug delivery until the last 5-10 years. This renewed interest can be attributed to electrospinning's relative ease of use, adaptability, and the ability to fabricate fibers with diameters on the nanometer size scale. Furthermore, the electrospinning process affords the opportunity to engineer scaffolds with micro to nanoscale topography and high porosity similar to the natural extracellular matrix (ECM). The inherently high surface to volume ratio of electrospun scaffolds can enhance cell attachment, drug loading, and mass transfer properties. Various materials can be electrospun including: biodegradable, non-degradable, and natural materials. Electrospun fibers can be oriented or arranged randomly, giving control over both the bulk mechanical properties and the biological response to the scaffold. Drugs ranging from antibiotics and anticancer agents to proteins, DNA, and RNA can be incorporated into electrospun scaffolds. Suspensions containing living cells have even been electrospun successfully. The applications of electrospinning in tissue engineering and drug delivery are nearly limitless. This review summarizes the most recent and state of the art work in electrospinning and its uses in tissue engineering and drug delivery. 相似文献