Recommend maintenance therapy with lenalidomide in multiple myeloma

Thalidomide was the first immunomodulatory drug used as maintenance after autologous stem cell transplant (ASCT) in multiple myeloma (MM). This showed improved progression-free survival (PFS) and in some cases, overall survival (OS). Despite this, use of thalidomide was limited due to toxicity and high rates of therapy discontinuation. Lenalidomide, an analog of thalidomide, had a more favorable toxicity profile making its use in maintenance a potential approach. The use of lenalidomide as a maintenance therapy after ASCT in newly diagnosed MM patients has been investigated in four phase III randomized control studies.     

维持性血液透析治疗糖尿病肾病的疗效观察

目的观察维持性血液透析治疗糖尿病肾病的方法与临床效果。方法回顾性分析本院2010年1月—2011年10月56例维持性血液透析治疗糖尿病肾病患者的临床资料。结果本组56例治疗过程中死亡9例,其中死于脑血管意外4例,心血管3例,感染1例,因患者失去治疗信心或经济等原因放弃治疗14例,仍维持性血液透析33例。治疗前后各项指标均有明显改善。结论在糖尿病肾病患者的临床治疗中,及早发现、及早进行维持性血液透析治疗,对于提高患者的临床治愈率,减少死亡率具有积极的影响。     

营养干预对维持性血液透析患者营养不良的影响

目的　分析营养干预对维持性血液透析(MHD)患者营养不良发生率的影响。方法　选取本院MHD患者196例，应用随机数字表随机分为研究组和对照组，每组98例，研究组进行营养干预6个月，对照组自主饮食，观察并对比两组6个月后的营养不良发生率。结果　干预组和对照组基线情况一致，无论是年龄、生化指标还是营养不良发生率差异均无统计学意义(均P＞0.05)。6个月后，尽管研究组营养不良率［35.7%（35/98）］较基线水平［33.7%(33/98)］略有增加，但是差异无统计学意义（P=0.764）；而对照组自主饮食6个月后营养不良率［59.2%(58/98)］显著增加，与基线相比差异有统计学意义（P=0.000）； 营养干预6个月后研究组营养不良发生率较对照组下降，差异有统计学意义（P=0.000）。结论　对MHD患者进行营养干预6个月，可以明显降低营养不良的发生率，改善预后，但长期疗效有待于进一步研究。     

助产士怎样自我维护身心健康

伴随高质量护理服务需求的增加，其中以母婴护理最为突出。要求助产士不仅要熟练掌握专业技能和知识，还要有良好的心理素质。但是目前大部分助产士的身心健康均存在一定的问题，已威胁到助产护理的质量，甚至是母婴的安全，而且还影响到助产士的积极性及正常的护理工作。     

Optimal treatment strategies in myeloma: An argument against maintenance therapy after autologous stem cell transplantation

Despite continuing advancements in novel therapeutics for multiple myeloma (MM), high-dose therapy with autologous stem cell rescue continues to represent the standard approach to treat transplant-eligible, newly diagnosed patients. As the disease remains essentially incurable, and median progression-free survival (PFS) times after autologous transplant are measured in years and not decades, attempts to improve outcomes in the post-transplant setting have been extensive and commonly focused on a “maintenance” approach. Although multiple trials have demonstrated PFS advantages for a variety of maintenance strategies, it is our position that the potential risks outweigh the benefits of this approach and this should not be the standard of care outside of clinical trials.     

不同剂量的首剂肝素在维持性血液透析患者中的抗凝效果

目的探讨不同剂量的首剂肝素在维持性血液透析患者中的抗凝效果。方法 62例维持性血液透析患者随机分为A、B两组,A组30例,B组32例。肝素抗凝方法:A组每次透析开始时从静脉端给予首次剂量肝素28~32 mg(约0.5 mg/kg),维持期用肝素泵每小时追加肝素6~10mg;B组每次透析开始时从静脉端给予首次剂量肝素14~20 mg(约0.3 mg/kg),维持期用肝素泵每小时追加肝素8~12 mg;同时监测2组患者0、0.5、2、3.5及4 h活化凝血时间(activated clotting time,ACT)及变化曲线,观察治疗过程中管路和透析器凝血情况,治疗后穿刺点压迫止血平均时间、组织器官24 h内出血情况以及在线KT/V情况。结果 2组患者首剂肝素量及维持期肝素用量存在显著性差异,而肝素总量无差异。2组均能顺利完成血液透析,A组透析充分性更好。A组血液透析治疗0.5及2 h ACI较B组明显延长,而在透析3.5及4 h时ACT明显缩短,2组比较均有显著性差异(P0.01);2组ACT 0.5与3.5 h自身比较,A组有明显下降趋势(P0.05),B组无明显差异。2组患者透析器凝血情况、穿刺点压迫时间、透析治疗后24 h内组织器官出血情况比较A组优于B组,差异有统计学意义(P0.01)。结论选择合适剂量的首剂肝素及维持期肝素用量是血液透析顺利进行的关键,首剂肝素用量为28~32 mg(约0.5 ng/kg)时抗凝效果好、透析充分性好,透析后患者出血机会少。     

维持性血液透析患者首次使用综合征的护理

目的 探讨维持性血液透析治疗（MHD）患者首次使用综合征（FUS）的有效护理方法.方法 对143例MHD患者在常规透析治疗期间,采取加强生命体征观察、动-静脉瘘保护及心理疏导等综合护理措施,并分析FUS的发生情况.结果 143例MHD患者透析治疗期间,其中发生FUS 4例,发生率为2.8%.结论采取全方位、立体式护理措施,可有效降低FUS发生率,提高患者透析治疗效果.     

Recurrence of chronic pulmonary aspergillosis after discontinuation of maintenance treatment by antifungal triazoles

ObjectiveTo assess the prevalence and risk factors of recurrence of chronic pulmonary aspergillosis (CPA) after discontinuation of antifungal triazoles.MethodWe reviewed the medical records of CPA patients who achieved resolution of clinical and radiographic manifestations and stopped taking antifungal triazoles between June 2006 and June 2012 at Tokyo National Hospital. We evaluated whether there was CPA recurrence within 1 year after treatment cessation and investigated risk factors for relapse. The association of anti-Aspergillus antibody conversion with CPA recurrence was also reviewed.ResultsA total of 39 patients were included in this study and there was CPA recurrence in 14 patients. Compared with the Non-recurrence group, the Recurrence group exhibited 1) younger age (p = 0.017), 2) more than one lung lobe affected by CPA more frequently (p = 0.008), 3) longer duration needed to remit manifestations of chest radiograph (p = 0.031), 4) longer antifungal treatment duration (p = 0.042). The present study did not reveal an association between negative conversion of serum anti-Aspergillus antibody and recurrence risk. Multivariate logistic regression analysis revealed that patients with CPA with affected area of more than one lung lobe had increased risk (odds ratio, 10.20; 95% confidence interval, 1.49–69.77; p = 0.018).ConclusionCPA recurrence can be seen in about one-third of cases after discontinuing azole treatment. We should make decisions about treatment duration and follow up depending on the severity of each case, particularly on the expansion of CPA-affected area.