Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy: long term results

BACKGROUND: Organ preservation has been investigated in patients with muscle-invasive bladder carcinoma over the past decades as an alternative to radical cystectomy. The majority of studies reported that trimodal schedules, including transurethral resection of bladder tumor (TURB), radiotherapy (RT), and chemotherapy, are a feasible and safe organ-sparing approach without deferring the survival probability. However, to the authors' knowledge the best combination of RT and chemotherapy has yet to be well defined. The current study evaluated the long-term results of a schedule of concurrent cisplatin and 5-fluorouracil (5-FU) administered as protracted intravenous infusions (PVI) during hyperfractionated radiotherapy (HFRT) with organ-sparing intent in patients with infiltrating transitional cell carcinoma of the bladder (TCCB). METHODS: Seventy-seven patients with a classification of T2-T4aN0M0 TCCB were enrolled in the current study. After a complete TURB and bladder mapping, 42 of 77 patients underwent 2 cycles of induction chemotherapy. All 77 patients underwent HFRT and a schedule of cisplatin (4-6 mg/m(2) per day) and 5-FU (180-220 mg/m(2) per day) as concomitant PVI (radiochemotherapy [RCT]). Six to 8 weeks after RCT, patient response was evaluated by computed tomography scan, urine cytology, and TURB. Patients who achieved a complete response (CR) were followed at regular intervals. For patients with residual or recurrent invasive tumor, salvage cystectomy was recommended. RESULTS: Seventy-two patients were evaluable for response: 65 achieved a CR (90.3%) and 7 (9.7%) achieved a partial response. No significant difference was observed for the different prognostic factors with the exception of stage of disease (T2 [95.7%] vs. T3-T4a [80.0%]; P = 0.04). The observed toxicity, mainly hematologic, was higher among the patients who received induction chemotherapy compared with the patients who did not receive induction chemotherapy, even though the difference was not statistically significant. After a median follow-up of 82.2 months (range, 30-138 months), 44 of 65 (57.1%) patients who achieved a CR were alive. Of these 44 patients, 33 had tumor-free bladders. The 5-year overall, bladder-intact, tumor-specific, disease-free, and cystectomy-free survival rates for all 77 patients were 58.5%, 46.6%, 75.0%, 53.5%, and 76.1%, respectively. No associations were observed in overall and tumor-specific survival with different prognostic factors. CONCLUSIONS: Combined treatment appeared to provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients who refuse or are unsuitable for surgery.     

老年高血压患者颈动脉粥样硬化与动态脉压及脉压指数的关系分析

目的 探讨老年高血压患者动脉脉压、脉压指数与颈动脉粥样硬化之间的关系.方法 选取2018年7月至2019年7月本院门诊收治的120例年龄>60岁的老年高血压患者作为研究对象,其中60例患者根据24 h血压动态脉压检测结果分为24 h动态脉压≥60 mmHg组(n=35)和24 h动态脉压<60 mmHg组(n=25),...     

Improvement in dressings for packet therapy for psoriasis

目的 探索银屑病封包疗法中安全、舒适、经济、简便的换药方法.方法 对99例(其中双侧肢体病变30例)前臂或背部需要封包疗法的慢性斑块状银屑病患者均分为三组各43例次,分别采用绷带、保鲜膜、自制棉布方巾作为封包敷料进行包扎,1次/d.2周后评价效果.结果 三组疗效比较,差异无统计学意义(P＞0.05);三组封包时间、敷料松脱、局部过敏率比较,差异有统计学意义(均P＜0.01).结论 棉布方巾用于银屑痛封包疗法具有操作时间短、封包牢固、安全的优点,且相对优于绷带和保鲜膜包扎.     

A redox-sensitive core-crosslinked nanosystem combined with ultrasound for enhanced deep penetration of nanodiamonds into tumors

Nanodiamonds (NDs) as drug delivery vehicles are of great significance in anticancer therapy through enhancing drug retention. However, the major barrier to clinical application of NDs is insufficient tumor penetration owing to their strong aggregation and low passive penetration efficiency. Herein, the core-crosslinked pullulan carrier, assembled using the visible light-induced diselenide (Se–Se) bond crosslinking method for encapsulating nanodiamonds-doxorubicin (NDX), is proposed to improve monodispersity. Furthermore, the core-crosslinked diselenide bond provides the nanosystem with redox-responsive capability and improved structural stability in a physiological environment, which prevents premature drug leakage and achieves tumor site-specific controlled release. What''s more, ultrasound (US) is utilized to promote nanosystem intratumoral penetration via enlarged tumor vascular endothelium cell gaps. As expected, the nanosystem combined with ultrasound can enhance anti-tumor efficacy with deep penetration and excellent retention performance in a HepG2 xenograft mouse model. This study highlights the ability of the integrated therapeutic paradigm to overcome the limitation of nanodiamonds and the potential for further application in cancer therapy.

A redox-sensitive core-crosslinked nanosystem is developed as a drug vehicle combined with ultrasound for efficient enhanced deep penetration of nanodiamonds into tumors.     

冠心病及高血压患者血浆同型半胱氨酸和一氧化氮水平的变化

目的探讨冠心病及高血压患者血浆同型半胱胺酸、一氧化氮水平的变化。方法选取本院2018年7月至2019年7月收治的65例冠心病合并高血压患者为冠心病组,并选取同期收治的55例单纯高血压患者为高血压组。比较两组血浆同型半胱氨酸,一氧化氮水平。结果冠心病组血浆同型半胱氨酸浓度明显高于高血压组(P<0.05),冠心病组一氧化氮浓度明显低于高血压组(P<0.05)。结论血浆同型半胱氨酸的增高与冠心病的发生密切相关,血浆同型半胱氨酸浓度与一氧化氮水平呈负相关,且血浆同型半胱氨酸水平与血管受损程度有一定的相关性。     

Effect of lipoic acid on tyrosine metabolism in patients with open-angle glaucoma]

Lipoic acid effects on tyrosine metabolism and ocular hydrodynamics were examined in patients with primary open-angle glaucoma. Glaucoma patients not administered the drug and patients with ocular hypertension made up two reference groups. In the majority of glaucoma patients administration of lipoic acid did not result in improvement of tyrosine metabolism, whereas hydrodynamic parameters somewhat increased. Tyrosine metabolism normalized in the patients administered lipoic acid in complex with tyrosine catabolism cofactors (pyridoxal phosphate, ascorbic acid, iron ions). The studied parameters improved in ocular hypertension patients administered lipoic acid. The authors' findings and the literature data permit recommending lipoic acid in complex with vitamins B1, B2, B5 (PP), B6 (pyridoxal phosphate), C to glaucoma patients. Judging from the reaction to lipoic acid administration, tyrosine catabolism enzyme activities in glaucoma patients are related to a peculiar sensitization of the body.