BACKGROUND Helicobacter pylori(H.pylori)eradication rates have fallen globally,likely in large part due to increasing antibiotic resistance to traditional therapy.In areas of high clarithromycin and metronidazole resi...BACKGROUND Helicobacter pylori(H.pylori)eradication rates have fallen globally,likely in large part due to increasing antibiotic resistance to traditional therapy.In areas of high clarithromycin and metronidazole resistance such as ours,Maastricht VI guidelines suggest high dose amoxicillin dual therapy(HDADT)can be considered,subject to evidence for local efficacy.In this study we assess efficacy of HDADT therapy for H.pylori eradication in an Irish cohort.AIM To assess the efficacy of HDADT therapy for H.pylori eradication in an Irish cohort as both first line,and subsequent therapy for patients diagnosed with H.pylori.METHODS All patients testing positive for H.pylori in a tertiary centre were treated prospectively with HDADT(amoxicillin 1 g tid and esomeprazole 40 mg bid×14 d)over a period of 8 months.Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy.A delta-over-baseline>4%was considered positive.Patient demographics and treatment outcomes were recorded,analysed and controlled for basic demographics and prior H.pylori treatment.RESULTS One hundred and ninety-eight patients were identified with H.pylori infection,10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing.In all 139 were included in the analysis,55%(n=76)were female,mean age was 46.6 years.Overall,93(67%)of patients were treatment-naïve and 46(33%)had received at least one previous course of treatment.The groups were statistically similar.Self-reported compliance with HDADT was 97%,mild side-effects occurred in 7%.There were no serious adverse drug reactions.Overall the eradication rate for our cohort was 56%(78/139).Eradication rates were worse for those with previous treatment[43%(20/46)vs 62%(58/93),P=0.0458,odds ratio=2.15].Age and Gender had no effect on eradication status.CONCLUSION Overall eradication rates with HDADT were disappointing.Despite being a simple and possibly better tolerated regime,these results do not support its routine use in a high dual resistance country.Further investigation of other regimens to achieve the>90%eradication target is needed.展开更多
Objective: A pilot study to test the feasibility and efficacy of high dose IFO and standard dose ADR and DTIC with G-CSF support in treatment of advanced soft tissue sarcoma (STS). Methods: 35 patients of no prior che...Objective: A pilot study to test the feasibility and efficacy of high dose IFO and standard dose ADR and DTIC with G-CSF support in treatment of advanced soft tissue sarcoma (STS). Methods: 35 patients of no prior chemotherapy with metastatic or locally advanced unresectable STS were treated by this regimen, including 18 rhabdomyosarcomas, 7 malignant fibrous histiocytomas, 2 neurofibrosarcomas, 2 fibrosarcomas, 2 leiomyosarcomas, 2 synoviosarcomas, and 2 malignant hemangiopericytomas. IFO dose was 2 g/m2 on day 1–5 (with mesna uroprotection), ADR 50mg/m2 on day 1 and DTIC 250 mg/m2 on day 1–5. G-CSF (2 μg/kg/d) was administered on day 6 to 15 or until recovery of leukocytes account. The cycles were repeated every 3 weeks. Result: There were five complete responses (CR including pathologic CR) and eleven partial responses for overall 46% objective response rate. Most responses were observed within two cycles. The median survival was 15 months. Following CR, two patients remain disease free at 45 and 28 months, respectively. 6/120 (5%) cycles were complicated by grade IV neutropenia, 46/120 (38%) cycles had grade III neutropenia. No patients had treatment-related deaths. Nonhematologic toxicity consisted predominantly of anorexia and vomiting. No other severe toxicities were seen, especially no severe cardiotoxicity. Conclusion: This regimen is well tolerated and has substantial benefits for patients with advanced soft tissue sarcomas.展开更多
Objective:This study was designed to characterize the pharmacokinetics and pharmacodynamicsof high dose epirubicin in cancer patients.Methods:Eleven patients with malignant tumors were administered with adose of 100 m...Objective:This study was designed to characterize the pharmacokinetics and pharmacodynamicsof high dose epirubicin in cancer patients.Methods:Eleven patients with malignant tumors were administered with adose of 100 mg·m2 epirubicin.The concentration of epirubicin was determined by high-performance liquidchromatographic(HPLC)assay.The modelling data were performed with a compartment pharmacokinetic modellingprogram(PCNONLIN).Hematological toxicity was used as the pharmacodynamic index.The relationships amongthe pharmacokinetics and pharmacodynamics and other factors affecting dose modulation were assessed.Results:The pharmacokinetics of high dose epirubicin was best described by a typical three-compartment model.It showedwide interindividual variation.There was no correlation between its pharmacokinetics and pharmacodynamics.Agewas closely correlated with epirubicin clearance.Conclusions:There was no difference in the pharmacokineticparameters between high dose and low dose.Total clearance appeared to decrease with age,which indicatesthe necessity of reducing dose for the elderly patients.The tolerance was good for patients receiving a dose of100 mg·m2 epirubicin.展开更多
Dear Editor,Sildenafil citrate（Viagra;Pfizer Pharmaceuticals,New York,NY,USA）,a selective inhibitor of phosphodiesterase type 5（PDE-5）,is widely used for erectile dysfunction.Its clinical recommended dosage is 25 ...Dear Editor,Sildenafil citrate（Viagra;Pfizer Pharmaceuticals,New York,NY,USA）,a selective inhibitor of phosphodiesterase type 5（PDE-5）,is widely used for erectile dysfunction.Its clinical recommended dosage is 25 to 100 mg per day.展开更多
Neurological signs and segmcntal demyelination in a cervical nerve were observed in rats treated orally with permethrin (300 mg/kg/day) for 5 days. Inflammatory and degenerative signals were recorded in the diaphragm ...Neurological signs and segmcntal demyelination in a cervical nerve were observed in rats treated orally with permethrin (300 mg/kg/day) for 5 days. Inflammatory and degenerative signals were recorded in the diaphragm muscle. These effects were more intense with the trade grade than with the technical grade product. The possible influence of the percentage of cisitrans isomers on the intensity of the observed effects is discussed. 5 imi Academic Press.Inc.展开更多
Fifteen patients with unresectable hepatocellular carcinoma were treated with unresectable hepatocellular carcinoma were treated with high dose MMC or ADR via hepatic artery with drug filtration in our hospital from A...Fifteen patients with unresectable hepatocellular carcinoma were treated with unresectable hepatocellular carcinoma were treated with high dose MMC or ADR via hepatic artery with drug filtration in our hospital from April to December 1988. Among them, 11 cases (73%) had symptoms relief, 3 cases (20%) tumor minimal remission and AFP decreased in 4 cases (33%). One case dide of hep'atoma 8 months after HAI-F and another case was followed up only 2 months after treatment, the remaining 13 cases are alive for 5 to 10 months after HAI-F. The reasons of unsatisfactory results were analyzed and possible ways of improvement were suggested.展开更多
Objective： To explore the effect of high dose of glucocorticoid （GC） on the synthesis of corticotropin releasing hormone （CRH） and transcription of its mRNA in hypothalamus paraventricular nuclei （PVN） in order...Objective： To explore the effect of high dose of glucocorticoid （GC） on the synthesis of corticotropin releasing hormone （CRH） and transcription of its mRNA in hypothalamus paraventricular nuclei （PVN） in order to investigate its difference with that of traditional GC effects and to add a new possible explanation to the mechanism of clinical applications of high dose of GC. Methods： A total of 60 rats were divided into 5 groups： blank control, 10^-6 mol/L dexamethasone （DEX） group, 10^-9 mol/L DEX group, 0.9% saline group and GR blocking group （10^-2mol/L RU486）. All agents were administrated through the femoral vein. CRH protein expression was measured by immunohistochemistry and laser confocal scanning microscopy （LCSM）; CRH mRNA level was explored by in situ hybridization. Results： 10^-6 mol/L DEX made CRH mRNA transcripted after 20 min and its protein expressed in PVN after 30 min, while normal level of DEX and 0.9% saline could not. If GR was blocked in advance, the effect of high dose of DEX disappeared. Conclusion ： High dose of GC can have CRH increased in PVN, which differs to the effect of traditional GC. And mGRH may play an important role in the effect of high dose of GC but not classic iGR.展开更多
Objective: High dose therapy (HDT) with autologous hematopoietic stem cell transplantation (ASCT) has become one of the important salvage treatments for the Hodgkin抯 Lymphoma patients with relapsed or resistant disea...Objective: High dose therapy (HDT) with autologous hematopoietic stem cell transplantation (ASCT) has become one of the important salvage treatments for the Hodgkin抯 Lymphoma patients with relapsed or resistant disease, but its role as the primary treatment remains indefinite. This study was designed to further evaluate its status in the combined modality treatment, especially, to discuss its value in the primary treatment of the patients who had advanced disease with poor prognostic factors. Methods: Eleven patients who had advanced or relapsed disease with poor prognostic factors were enrolled in this study. Among them, 9 cases had primary treatment, and 2 cases had secondary treatment; one patient received autologous bone marrow transplantation (ABMT), and 10 patients received autologous peripheral blood stem cell transplantation (APBSCT). After induction treatment 4 cases achieved complete response (CR) and 7 cases achieved partial response (PR). High dose chemotherapy combined with total body irradiation (TBI) or total lymph node irradiation (TLI)/subtotal lymph node irradiation (STLI) were adopted in 7 cases and only high dose chemotherapy were adopted in 4 cases as the transplant preparative regimens. 5 cases received complementary irradiation in the primary sites after transplant. Results: The patients who had CR before transplantation were given consolidative therapy. Among the rest with PR, 2 cases achieved CR, 1 case PR, and 4 cases SD. Furthermore all these patients who maintained SD had bone involvement. With a median follow-up for all patients of 13(1-80) months, all of them are alive currently. Four cases are event-free survival (EFS); 4 cases with bone involvement are progression-free survival (PFS); 3 cases experienced relapse after transplant, one of them is EFS for 42 months again after a local relapsed site irradiation; the other two cases are being given further salvaged treatment now. According to the Life Tables method, the cumulative probability of 6-year PFS and OS is 55.68% and 100% respectively. The dominating transplant- related toxicity was bone marrow suppression in grades IV. No obvious cardiac, hepatic, and nephritic toxicity was found. No transplant related mortality. Conclusion: HDT combined with ASCT is a method worthwhile to further study for the treatment of the patients with advanced or relapsed Hodgkin抯 Lymphoma with poor prognostic factors.展开更多
Objective: The aim of this study was to establish cervical cancer patients’ expectations and experiences during high dose-rate (HDR) intracavitary brachytherapy procedure, as part of a process to develop guidelines f...Objective: The aim of this study was to establish cervical cancer patients’ expectations and experiences during high dose-rate (HDR) intracavitary brachytherapy procedure, as part of a process to develop guidelines for quality patient-centered care. Methodology: A prospective, qualitative study with a descriptive phenomenological approach was used. Purposive sampling was carried out to recruit 31 women undergoing HDR brachytherapy for cervical cancer from June to August 2020 at the National Institute of Oncology in Rabat. Semi-structured, one-to-one interviews guided by a theme list were conducted by a female radiation oncologist in Arabic before, during and after treatment. The following aspects were discussed: expectations, experiences in the waiting room, in the treatment room, and suggestions for improvement. Data was transcribed, translated and thematic analysis performed. Results: Most of the patients felt unprepared and did not have a clear understanding of brachytherapy. Brachytherapy was a difficult experience causing fear and anxiety throughout treatment. Most women dreaded the procedure, before receiving the first treatment and even after having had one. Pain was a major problem for the participants. Some women compared this pain to childbirth, a process they preferred to brachytherapy. Patients agreed that the preventative medication received was not efficient to relieve the pain. Despite these negative experiences, patients were left with a positive outlook. Dialogue with the healthcare professionals, support from their family and fellow patients, envisaged outcomes and desires to heal were used to cope, whilst faith and spirituality gave them strength to endure the procedure. Conclusion: Women undergoing uterovaginal brachytherapy for cervical cancer experience pain and emotional distress. Providing patients with adequate information, more sensitive support during the procedure and debriefing afterwards could lessen feelings of fear and anxiety. Our findings advocate for the revision of pain management protocols. Further studies should be carried out to define patient-centered recommendations and provide quality care to this group of women.展开更多
Dyed polymer films, prepared by a simple technique of casting aqueous solutions of poly(vinyl alcohol) PVA or poly(vinyl butyral) PVB containing quinaldine red (QR) on a horizontal glass plate, are useful as routine h...Dyed polymer films, prepared by a simple technique of casting aqueous solutions of poly(vinyl alcohol) PVA or poly(vinyl butyral) PVB containing quinaldine red (QR) on a horizontal glass plate, are useful as routine high-dose dosimeters. These flexible plastic film dosimeters are bleached when exposed to gamma rays. The response of these dosimeters depends on the concentration of QR and the polymer material. The radiation chemical yield (G-value) of both PVA and PVB dyed films was calculated and was found to increase with increasing dye concentration. The effect of relative humidity during irradiation as well as pre- and post-irradiation storage, on the response of the films is examined. These films are not affected by humidity change in the intermediate range of 10% - 50%.展开更多
A lthough advanced stage aggressive non-Hodgkin'slymphomas and Hodgkin's disease are thought to be che-motherapy-responsive cancers, a considerable number of patients either relapse or never attain a remission...A lthough advanced stage aggressive non-Hodgkin'slymphomas and Hodgkin's disease are thought to be che-motherapy-responsive cancers, a considerable number of patients either relapse or never attain a remission. High-dose therapy(HDT) followed by autologous stem cell transplantation(ASCT) is often the only possibility of cure for most of these patients. However, many controversial issues still remain with respect to HDT/ASCT for lymphomas, including its role for, the optimal timing of transplantation, the best conditioning regimen and the potential use of localized radiotherapy or immunologic methods to decrease post-transplant recurrence. Recently, mainly due to the unavailability of carmustine, several novel conditioning protocols have been clinically developed, with the aim of improving the overall outcome by enhancing the anti-lymphoma effect and, at the same time, by reducing short and long-term toxicity. Furthermore, the better safety profiles of novel approaches would definitively allow patients aged more than 65-70 years to benefit from this therapeutic option. In this review, we will briefly discuss the most relevant and recent data available regarding HDT/ASCT in lymphomas.展开更多
Testicular germ cell cancer(TGCC) is rare form of malignant disease that occurs mostly in young man between age 15 and 40. The worldwide incidence of TGCC is 1.5 per 100000 man with the highest rates in North Europe. ...Testicular germ cell cancer(TGCC) is rare form of malignant disease that occurs mostly in young man between age 15 and 40. The worldwide incidence of TGCC is 1.5 per 100000 man with the highest rates in North Europe. After discovery of cisplatin cure rates of TGCC are very favorable between 90%-95% and unlike most solid tumors, cure rate for metastatic TGCC is around 80%. Metastatic TGCC is usually treated with 3-4 cycles of bleomycin, etoposide, cisplatinum chemotherapy with or without retroperitoneal surgery and cure rates with this approach are between 41% in poor risk group and 92% in good risk group of patients. Cure rates are lower in relapsed and refractory patients and many of them will die from the disease if not cured with first line chemotherapy. High dose chemotherapy(HDCT) approach was used for the first time during the 1980 s. Progress in hematology allowed the possibility to keep autologous haematopoietic stem cells alive ex-vivo at very low temperatures and use them to repopulate the bone marrow after sub-lethal dose of intesive myeloablative chemotherapy. Despite the fact that there is no positive randomized study to prove HDCT concept, cure rates in relapsed TGCC are higher after high dose therapy then in historical controls in studies with conventional treatment. Here we review clinical studies in HDCT for TGCC, possibilities of mobilising sufficient number of stem cells and future directions in the treatment of this disease.展开更多
The study was intended to highlight functional outcome and survival advantage when High Dose Rate (HDR) interstitial implant was used for anterior 2/3rd tongue, either as a primary or as boost depending upon stage of ...The study was intended to highlight functional outcome and survival advantage when High Dose Rate (HDR) interstitial implant was used for anterior 2/3rd tongue, either as a primary or as boost depending upon stage of disease. Materials and Methods: Fifty-one patients with squamous cell carcinoma of anterior 2/3rd tongue received interstitial brachytherapy either as primary or as boost with Iridium 192 remote after loading high dose rate (Microselectron or Gamma MediX) machines from November 2008 to September 2013. Age group ranged from 32 to 73 years, mean 52.1. Of these 51, 37 were males and 14 were females. 8 patients belonged to Stage I, 18 from Stage II and 28 patients were Stage III. Stage I patients received primary brachytherapy alone of dose 38.50 Gy to 40 Gy and fraction dose ranged from 250 cGy to 350 cGy. Stage II and Stage III patients received external beam radiation of dose 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. Stage III patients received concurrent chemotherapy with Injection Cisplatin along with external beam radiotherapy 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. 55% of patients were habituated to tobacco and alcohol in one form or the other or both. Surprisingly 45% of patients were nonsmokers and non-alcoholic. Results: Follow-up period ranged from eight months to sixty months. 42 patients had complete response. 9 patients had residual disease. 2 patients died due to non-cancerous cause though they had excellent local control, one with pulmonary tuberculosis and the other with massive Myocardial Infarction. 2 patients died due to disease progression. Overall complete response rate was 82.35%. Those patients who had good coverage index and conformal index had good response compared to those patients with lesser these values. Conclusion: It is surprising to observe from the study that oral cavity cancers are not uncommon in non-smokers and non-alcoholics. Overall complete response of 82% is comparable to any other study quoted in literature. Surgery offers same cure rate but at the rate of organ loss and functional impairment. Organ preservation with good functional outcome is possible in radiotherapy unlike surgery. This study proves brachytherapy can be considered as a surrogate to surgery in early stage tongue cancers with good functional outcome and with lesser morbidity.展开更多
Background: Treatment of Cervical cancer includes a combination of external beam radiotherapy (EBRT) with intracavitary brachytherapy (ICBT). ICBT helps to boost radiation dose to primary disease. Organs like rectum, ...Background: Treatment of Cervical cancer includes a combination of external beam radiotherapy (EBRT) with intracavitary brachytherapy (ICBT). ICBT helps to boost radiation dose to primary disease. Organs like rectum, bladder, sigmoid and small bowel lie close to the cervix region and these organs receive dose from EBRT as well as ICBT and we want to know the dose to these organ at risk (OAR). Materials & Methods: Dosimetric details of 174 ICBT applications done in 58 patients were retrospectively analysed. All patients received EBRT dose of 50.4 Gy in 28 fractions. All patients had ICBT, three sessions with 7 Gy prescribed to point A. Dosimetric data including dose to right and left point A and dose to OARs were recorded from Oncentra Planning System. Results: Mean dose to point A on right side was 6.89 Gy and left side was 6.91 Gy. Mean D2cc dose to rectum, bladder, sigmoid and small bowel was 3.5 Gy, 5.25 Gy, 4.75 Gy and 4.2 Gy respectively. Mean EQD2 dose combining EBRT and ICBT in point A was 78.7 Gy on right side and 79 Gy on left side. Mean EQD2 doses to D2cc of rectum, bladder, sigmoid and small bowel was 62 Gy, 74.4 Gy, 70.5 Gy and 66.5 Gy respectively. Conclusion: From the results of this dosimetric study it is evident that OARs like rectum, sigmoid, bladder & bowel are receiving only acceptable doses of radiation using point A prescribed CT based ICBT planning. Hence with regards to OAR doses, CT based ICBT planning with dose prescribed to point A is a feasible option.展开更多
Total skin electron therapy (TSET) is used for the treatment of Mycosis Fungoides. Several tech-niques have been developed, in order to achieve homogeneous dose distribution over the complete body surface. To implemen...Total skin electron therapy (TSET) is used for the treatment of Mycosis Fungoides. Several tech-niques have been developed, in order to achieve homogeneous dose distribution over the complete body surface. To implement a TSET technique, one has to optimize a variety of parameters. Monte Carlo simulation of TSET can facilitate this optimization. The aim of this study was to commission and optimize a TSET technique using the 4 and 6 MeV electron and the high dose rate facility on the Elekta Precise accelerator. The EGS4nrc/BEAMnrc Monte Carlo code was used. The beam data were calculated and measured at two different scoring planes for a single beam. The Model was validated by comparing the simulation with measurements. Two different vertical angles were used to obtain a uniform dose. The angle was optimized for best dose uniformity. The Rando phantom is placed on a rotating platform and rotates 60 degrees apart to facilitate the six patient position orientations. The doses delivered in a phantom by complete treatment were measured with Kodak EDR2 films and TLDs. The dose distribution varied among various scanning directions by 2 - 3 mm and 3 - 4 mm for 4 and 6 MeV respectively. The composite percentage depth dose of all six dual fields for the 4 and 6 MeV yielded an R80 of ~4 mm and ~6 mm, respectively. Dose uniformity was ±6% for 4 MeV and ±5% for 6 MeV. The bremsstrahlung contamination was 0.9% - 1.3%. Good agreements were found with published literature and inline with international protocols.展开更多
Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma accounting for approximately half of all cutaneous T-cell lymphomas. Radiation therapy is an effective treatment for early stage MF and has been show...Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma accounting for approximately half of all cutaneous T-cell lymphomas. Radiation therapy is an effective treatment for early stage MF and has been shown to result in long-term disease-free intervals, with even curative potential. Radiation is also effective as palliative treatment for the localized lesion resistant to the topic or other treatments. In the current study, we report using high dose rate (HDR) radiation treatment for a patient with resistant mycosis fungoides involving the wrist. We report a convenient treatment with an ideal radiation dose distribution, and a excellent clinical outcome.展开更多
Radiotherapy(RT)resistance in head and neck squamous cell carcinoma(HNSCC)significantly hampers local control and patient prognosis.This study investigated the efficacy and molecular mechanisms of high-energy X-ray-ba...Radiotherapy(RT)resistance in head and neck squamous cell carcinoma(HNSCC)significantly hampers local control and patient prognosis.This study investigated the efficacy and molecular mechanisms of high-energy X-ray-based ultra-high dose rate radiotherapy(UHDR-RT)in overcoming RT resistance.The established RT-resistant HNSCC cell lines and animal models were subjected to UHDR-RT or conventional RT(Conv-RT)via a high-power rhodotron accelerator.Cellular assays assessed the malignant phenotype,viability,and degree of DNA damage,whereas in vivo evaluations focused on tumor proliferation and the tumor immune microenvironment(TiME).Transcriptome sequencing and Olink proteomics were employed to explore the underlying mechanisms involved.In vitro experiments indicated that UHDR-RT suppressed radioresistant cell proliferation and invasion,while promoting apoptosis and exacerbating DNA damage.In contrast,its efficacy in radiosensitive cells was comparable to that of Conv-RT.In vivo studies using patient-derived xenograft nude mice models demonstrated that UHDR-RT only partially reversed RT resistance.Transcriptomic and proteomic analyses of C57BL/6J mice models revealed the predominant role of TiME modulating in reversing radioresistance.Immunofluorescence and flow cytometry confirmed increased CD8^(+)T cells and an increased M1/M2 macrophage ratio post-UHDR-RT.Mechanistically,UHDR-RT activated CD8^(+)T cells,which stimulated M1 macrophages through paracrine IFN-y signaling,thereby enhancing TiME activation.Furthermore,the activated M1 macrophages secreted CXCL9,which in turn reactivated CD8^(+)T cells,forming a feedforward loop that amplifed TiME activation.This study elucidates the dual role of UHDR-RT in directly inducing DNA damage and modulating the TiME,highlighting its potential in treating radioresistant HNSCC.展开更多
Helicobacter pylori(H.pylori)infections may cause chronic gastritis,peptic ulcer disease,gastric cancers,and other conditions outside of the gastrointestinal tract.Hence,it is important to diagnose and treat it early....Helicobacter pylori(H.pylori)infections may cause chronic gastritis,peptic ulcer disease,gastric cancers,and other conditions outside of the gastrointestinal tract.Hence,it is important to diagnose and treat it early.H.pylori is resistant to certain drugs in traditional eradication therapy,so alternative therapy protocols are needed,such as high-dose amoxicillin dual therapy(HDADT).This article aims to comment on a recent paper by Costigan et al in the World Journal of Clinical Cases.In this study,the authors recruited 139 patients diagnosed with H.pylori,all treated with HDADT.Of these,93 were treatment-naïve and 46 had received at least one alternative treatment in the past.Four weeks after the end of the treatment,the urea breath test was administered to estimate the eradication rate.The total eradication rate was 56%(78/139),62%for the treatment-naïve arm and 43%for the previous treatment arm,thus indicating a lower success rate for the arm that had previously received a different treatment regimen.In conclusion,a therapeutic approach with first-line HDADT may potentially be a better treat-ment,but the results are not sufficient to recommend the use of this regimen in a country with high levels of dual resistance.展开更多
In this editorial I comment on the article,published in the current issue of the World Journal of Clinical Oncology.Primary central nervous system lymphoma(PCNSL)is a disease of elderly and immunocompromised patients....In this editorial I comment on the article,published in the current issue of the World Journal of Clinical Oncology.Primary central nervous system lymphoma(PCNSL)is a disease of elderly and immunocompromised patients.The authors reported clinical results of 19 patients with PCNSL treated with zanubrutinib/high dose methotrexate(HD-MTX)until disease progression.They demonstrated that the combination of zanubrutinib with HD-MTX led to a marked clinical response and tolerability among these patients.They also observed that cerebrospinal fluid liquid biopsy to detect circulating tumor DNA may be a good option for evaluating treatment response and tumor burden in patients with PCNSL.PCNSL is a challenging disease for treatment as these patients present with different neurological states and comorbidities.Treatment has evolved over the years from whole brain radiotherapy to HD-MTX followed by autologous stem cell transplant.Gradually,treatment of patients with PCNSL is going to become individualized.展开更多
Objective:To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis.Methods:The subjects included in this study were admitted to the hospital for ...Objective:To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis.Methods:The subjects included in this study were admitted to the hospital for maintenance hemodialysis treatment from January 2021 to January 2023.All patients had a high risk of bleeding and received 4%trisodium citrate anticoagulant treatment,administered at a rate of 200 mL/h before and after the dialyzer.The anticoagulant effects achieved by the patients were observed and analyzed.Results:The total number of patients who received high-dose segmented citrate extracorporeal anticoagulation dialysis treatment was 50,with each patient undergoing 100 treatments.During the treatment,2 patients had to end the treatment early due to transmembrane pressure exceeding 30 mmHg and an increase in venous pressure exceeding 250 mmHg;the treatment times for these patients were 20 minutes and 200 minutes,respectively.The remaining patients successfully completed the 4-hour treatment.Blood pH and calcium ion concentration in the venous pot were monitored.It was observed that before dialysis,after 2 hours of dialysis,and at the end of dialysis,the blood pH of the patients remained within a relatively normal range.Although some patient levels changed after dialysis,they remained within the normal range.No adverse reactions(such as numbness of the limbs or convulsions)were observed during the anticoagulant treatment.Conclusion:Administering 4%trisodium citrate at a rate of 200 mL/h before and after the dialyzer achieves a good anticoagulant effect,maintains the patient’s blood gas levels within the normal range at the end of dialysis,and causes no adverse reactions.展开更多
文摘BACKGROUND Helicobacter pylori(H.pylori)eradication rates have fallen globally,likely in large part due to increasing antibiotic resistance to traditional therapy.In areas of high clarithromycin and metronidazole resistance such as ours,Maastricht VI guidelines suggest high dose amoxicillin dual therapy(HDADT)can be considered,subject to evidence for local efficacy.In this study we assess efficacy of HDADT therapy for H.pylori eradication in an Irish cohort.AIM To assess the efficacy of HDADT therapy for H.pylori eradication in an Irish cohort as both first line,and subsequent therapy for patients diagnosed with H.pylori.METHODS All patients testing positive for H.pylori in a tertiary centre were treated prospectively with HDADT(amoxicillin 1 g tid and esomeprazole 40 mg bid×14 d)over a period of 8 months.Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy.A delta-over-baseline>4%was considered positive.Patient demographics and treatment outcomes were recorded,analysed and controlled for basic demographics and prior H.pylori treatment.RESULTS One hundred and ninety-eight patients were identified with H.pylori infection,10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing.In all 139 were included in the analysis,55%(n=76)were female,mean age was 46.6 years.Overall,93(67%)of patients were treatment-naïve and 46(33%)had received at least one previous course of treatment.The groups were statistically similar.Self-reported compliance with HDADT was 97%,mild side-effects occurred in 7%.There were no serious adverse drug reactions.Overall the eradication rate for our cohort was 56%(78/139).Eradication rates were worse for those with previous treatment[43%(20/46)vs 62%(58/93),P=0.0458,odds ratio=2.15].Age and Gender had no effect on eradication status.CONCLUSION Overall eradication rates with HDADT were disappointing.Despite being a simple and possibly better tolerated regime,these results do not support its routine use in a high dual resistance country.Further investigation of other regimens to achieve the>90%eradication target is needed.
文摘Objective: A pilot study to test the feasibility and efficacy of high dose IFO and standard dose ADR and DTIC with G-CSF support in treatment of advanced soft tissue sarcoma (STS). Methods: 35 patients of no prior chemotherapy with metastatic or locally advanced unresectable STS were treated by this regimen, including 18 rhabdomyosarcomas, 7 malignant fibrous histiocytomas, 2 neurofibrosarcomas, 2 fibrosarcomas, 2 leiomyosarcomas, 2 synoviosarcomas, and 2 malignant hemangiopericytomas. IFO dose was 2 g/m2 on day 1–5 (with mesna uroprotection), ADR 50mg/m2 on day 1 and DTIC 250 mg/m2 on day 1–5. G-CSF (2 μg/kg/d) was administered on day 6 to 15 or until recovery of leukocytes account. The cycles were repeated every 3 weeks. Result: There were five complete responses (CR including pathologic CR) and eleven partial responses for overall 46% objective response rate. Most responses were observed within two cycles. The median survival was 15 months. Following CR, two patients remain disease free at 45 and 28 months, respectively. 6/120 (5%) cycles were complicated by grade IV neutropenia, 46/120 (38%) cycles had grade III neutropenia. No patients had treatment-related deaths. Nonhematologic toxicity consisted predominantly of anorexia and vomiting. No other severe toxicities were seen, especially no severe cardiotoxicity. Conclusion: This regimen is well tolerated and has substantial benefits for patients with advanced soft tissue sarcomas.
文摘Objective:This study was designed to characterize the pharmacokinetics and pharmacodynamicsof high dose epirubicin in cancer patients.Methods:Eleven patients with malignant tumors were administered with adose of 100 mg·m2 epirubicin.The concentration of epirubicin was determined by high-performance liquidchromatographic(HPLC)assay.The modelling data were performed with a compartment pharmacokinetic modellingprogram(PCNONLIN).Hematological toxicity was used as the pharmacodynamic index.The relationships amongthe pharmacokinetics and pharmacodynamics and other factors affecting dose modulation were assessed.Results:The pharmacokinetics of high dose epirubicin was best described by a typical three-compartment model.It showedwide interindividual variation.There was no correlation between its pharmacokinetics and pharmacodynamics.Agewas closely correlated with epirubicin clearance.Conclusions:There was no difference in the pharmacokineticparameters between high dose and low dose.Total clearance appeared to decrease with age,which indicatesthe necessity of reducing dose for the elderly patients.The tolerance was good for patients receiving a dose of100 mg·m2 epirubicin.
文摘Dear Editor,Sildenafil citrate（Viagra;Pfizer Pharmaceuticals,New York,NY,USA）,a selective inhibitor of phosphodiesterase type 5（PDE-5）,is widely used for erectile dysfunction.Its clinical recommended dosage is 25 to 100 mg per day.
文摘Neurological signs and segmcntal demyelination in a cervical nerve were observed in rats treated orally with permethrin (300 mg/kg/day) for 5 days. Inflammatory and degenerative signals were recorded in the diaphragm muscle. These effects were more intense with the trade grade than with the technical grade product. The possible influence of the percentage of cisitrans isomers on the intensity of the observed effects is discussed. 5 imi Academic Press.Inc.
文摘Fifteen patients with unresectable hepatocellular carcinoma were treated with unresectable hepatocellular carcinoma were treated with high dose MMC or ADR via hepatic artery with drug filtration in our hospital from April to December 1988. Among them, 11 cases (73%) had symptoms relief, 3 cases (20%) tumor minimal remission and AFP decreased in 4 cases (33%). One case dide of hep'atoma 8 months after HAI-F and another case was followed up only 2 months after treatment, the remaining 13 cases are alive for 5 to 10 months after HAI-F. The reasons of unsatisfactory results were analyzed and possible ways of improvement were suggested.
文摘Objective： To explore the effect of high dose of glucocorticoid （GC） on the synthesis of corticotropin releasing hormone （CRH） and transcription of its mRNA in hypothalamus paraventricular nuclei （PVN） in order to investigate its difference with that of traditional GC effects and to add a new possible explanation to the mechanism of clinical applications of high dose of GC. Methods： A total of 60 rats were divided into 5 groups： blank control, 10^-6 mol/L dexamethasone （DEX） group, 10^-9 mol/L DEX group, 0.9% saline group and GR blocking group （10^-2mol/L RU486）. All agents were administrated through the femoral vein. CRH protein expression was measured by immunohistochemistry and laser confocal scanning microscopy （LCSM）; CRH mRNA level was explored by in situ hybridization. Results： 10^-6 mol/L DEX made CRH mRNA transcripted after 20 min and its protein expressed in PVN after 30 min, while normal level of DEX and 0.9% saline could not. If GR was blocked in advance, the effect of high dose of DEX disappeared. Conclusion ： High dose of GC can have CRH increased in PVN, which differs to the effect of traditional GC. And mGRH may play an important role in the effect of high dose of GC but not classic iGR.
基金supported by a grant f rom National“95”Key Program of China(No.96-906-01-12)Huo Ying-dong Foundation for the Young Teacher of Academy and College
文摘Objective: High dose therapy (HDT) with autologous hematopoietic stem cell transplantation (ASCT) has become one of the important salvage treatments for the Hodgkin抯 Lymphoma patients with relapsed or resistant disease, but its role as the primary treatment remains indefinite. This study was designed to further evaluate its status in the combined modality treatment, especially, to discuss its value in the primary treatment of the patients who had advanced disease with poor prognostic factors. Methods: Eleven patients who had advanced or relapsed disease with poor prognostic factors were enrolled in this study. Among them, 9 cases had primary treatment, and 2 cases had secondary treatment; one patient received autologous bone marrow transplantation (ABMT), and 10 patients received autologous peripheral blood stem cell transplantation (APBSCT). After induction treatment 4 cases achieved complete response (CR) and 7 cases achieved partial response (PR). High dose chemotherapy combined with total body irradiation (TBI) or total lymph node irradiation (TLI)/subtotal lymph node irradiation (STLI) were adopted in 7 cases and only high dose chemotherapy were adopted in 4 cases as the transplant preparative regimens. 5 cases received complementary irradiation in the primary sites after transplant. Results: The patients who had CR before transplantation were given consolidative therapy. Among the rest with PR, 2 cases achieved CR, 1 case PR, and 4 cases SD. Furthermore all these patients who maintained SD had bone involvement. With a median follow-up for all patients of 13(1-80) months, all of them are alive currently. Four cases are event-free survival (EFS); 4 cases with bone involvement are progression-free survival (PFS); 3 cases experienced relapse after transplant, one of them is EFS for 42 months again after a local relapsed site irradiation; the other two cases are being given further salvaged treatment now. According to the Life Tables method, the cumulative probability of 6-year PFS and OS is 55.68% and 100% respectively. The dominating transplant- related toxicity was bone marrow suppression in grades IV. No obvious cardiac, hepatic, and nephritic toxicity was found. No transplant related mortality. Conclusion: HDT combined with ASCT is a method worthwhile to further study for the treatment of the patients with advanced or relapsed Hodgkin抯 Lymphoma with poor prognostic factors.
文摘Objective: The aim of this study was to establish cervical cancer patients’ expectations and experiences during high dose-rate (HDR) intracavitary brachytherapy procedure, as part of a process to develop guidelines for quality patient-centered care. Methodology: A prospective, qualitative study with a descriptive phenomenological approach was used. Purposive sampling was carried out to recruit 31 women undergoing HDR brachytherapy for cervical cancer from June to August 2020 at the National Institute of Oncology in Rabat. Semi-structured, one-to-one interviews guided by a theme list were conducted by a female radiation oncologist in Arabic before, during and after treatment. The following aspects were discussed: expectations, experiences in the waiting room, in the treatment room, and suggestions for improvement. Data was transcribed, translated and thematic analysis performed. Results: Most of the patients felt unprepared and did not have a clear understanding of brachytherapy. Brachytherapy was a difficult experience causing fear and anxiety throughout treatment. Most women dreaded the procedure, before receiving the first treatment and even after having had one. Pain was a major problem for the participants. Some women compared this pain to childbirth, a process they preferred to brachytherapy. Patients agreed that the preventative medication received was not efficient to relieve the pain. Despite these negative experiences, patients were left with a positive outlook. Dialogue with the healthcare professionals, support from their family and fellow patients, envisaged outcomes and desires to heal were used to cope, whilst faith and spirituality gave them strength to endure the procedure. Conclusion: Women undergoing uterovaginal brachytherapy for cervical cancer experience pain and emotional distress. Providing patients with adequate information, more sensitive support during the procedure and debriefing afterwards could lessen feelings of fear and anxiety. Our findings advocate for the revision of pain management protocols. Further studies should be carried out to define patient-centered recommendations and provide quality care to this group of women.
文摘Dyed polymer films, prepared by a simple technique of casting aqueous solutions of poly(vinyl alcohol) PVA or poly(vinyl butyral) PVB containing quinaldine red (QR) on a horizontal glass plate, are useful as routine high-dose dosimeters. These flexible plastic film dosimeters are bleached when exposed to gamma rays. The response of these dosimeters depends on the concentration of QR and the polymer material. The radiation chemical yield (G-value) of both PVA and PVB dyed films was calculated and was found to increase with increasing dye concentration. The effect of relative humidity during irradiation as well as pre- and post-irradiation storage, on the response of the films is examined. These films are not affected by humidity change in the intermediate range of 10% - 50%.
文摘A lthough advanced stage aggressive non-Hodgkin'slymphomas and Hodgkin's disease are thought to be che-motherapy-responsive cancers, a considerable number of patients either relapse or never attain a remission. High-dose therapy(HDT) followed by autologous stem cell transplantation(ASCT) is often the only possibility of cure for most of these patients. However, many controversial issues still remain with respect to HDT/ASCT for lymphomas, including its role for, the optimal timing of transplantation, the best conditioning regimen and the potential use of localized radiotherapy or immunologic methods to decrease post-transplant recurrence. Recently, mainly due to the unavailability of carmustine, several novel conditioning protocols have been clinically developed, with the aim of improving the overall outcome by enhancing the anti-lymphoma effect and, at the same time, by reducing short and long-term toxicity. Furthermore, the better safety profiles of novel approaches would definitively allow patients aged more than 65-70 years to benefit from this therapeutic option. In this review, we will briefly discuss the most relevant and recent data available regarding HDT/ASCT in lymphomas.
文摘Testicular germ cell cancer(TGCC) is rare form of malignant disease that occurs mostly in young man between age 15 and 40. The worldwide incidence of TGCC is 1.5 per 100000 man with the highest rates in North Europe. After discovery of cisplatin cure rates of TGCC are very favorable between 90%-95% and unlike most solid tumors, cure rate for metastatic TGCC is around 80%. Metastatic TGCC is usually treated with 3-4 cycles of bleomycin, etoposide, cisplatinum chemotherapy with or without retroperitoneal surgery and cure rates with this approach are between 41% in poor risk group and 92% in good risk group of patients. Cure rates are lower in relapsed and refractory patients and many of them will die from the disease if not cured with first line chemotherapy. High dose chemotherapy(HDCT) approach was used for the first time during the 1980 s. Progress in hematology allowed the possibility to keep autologous haematopoietic stem cells alive ex-vivo at very low temperatures and use them to repopulate the bone marrow after sub-lethal dose of intesive myeloablative chemotherapy. Despite the fact that there is no positive randomized study to prove HDCT concept, cure rates in relapsed TGCC are higher after high dose therapy then in historical controls in studies with conventional treatment. Here we review clinical studies in HDCT for TGCC, possibilities of mobilising sufficient number of stem cells and future directions in the treatment of this disease.
文摘The study was intended to highlight functional outcome and survival advantage when High Dose Rate (HDR) interstitial implant was used for anterior 2/3rd tongue, either as a primary or as boost depending upon stage of disease. Materials and Methods: Fifty-one patients with squamous cell carcinoma of anterior 2/3rd tongue received interstitial brachytherapy either as primary or as boost with Iridium 192 remote after loading high dose rate (Microselectron or Gamma MediX) machines from November 2008 to September 2013. Age group ranged from 32 to 73 years, mean 52.1. Of these 51, 37 were males and 14 were females. 8 patients belonged to Stage I, 18 from Stage II and 28 patients were Stage III. Stage I patients received primary brachytherapy alone of dose 38.50 Gy to 40 Gy and fraction dose ranged from 250 cGy to 350 cGy. Stage II and Stage III patients received external beam radiation of dose 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. Stage III patients received concurrent chemotherapy with Injection Cisplatin along with external beam radiotherapy 44 Gy/200cGy per fraction for 22 fractions followed by spinal cord sparing for 6 Gy/200cGy per fraction for 3 fractions. Brachytherapy boost of dose 21 Gy was delivered after external beam radiation. 55% of patients were habituated to tobacco and alcohol in one form or the other or both. Surprisingly 45% of patients were nonsmokers and non-alcoholic. Results: Follow-up period ranged from eight months to sixty months. 42 patients had complete response. 9 patients had residual disease. 2 patients died due to non-cancerous cause though they had excellent local control, one with pulmonary tuberculosis and the other with massive Myocardial Infarction. 2 patients died due to disease progression. Overall complete response rate was 82.35%. Those patients who had good coverage index and conformal index had good response compared to those patients with lesser these values. Conclusion: It is surprising to observe from the study that oral cavity cancers are not uncommon in non-smokers and non-alcoholics. Overall complete response of 82% is comparable to any other study quoted in literature. Surgery offers same cure rate but at the rate of organ loss and functional impairment. Organ preservation with good functional outcome is possible in radiotherapy unlike surgery. This study proves brachytherapy can be considered as a surrogate to surgery in early stage tongue cancers with good functional outcome and with lesser morbidity.
文摘Background: Treatment of Cervical cancer includes a combination of external beam radiotherapy (EBRT) with intracavitary brachytherapy (ICBT). ICBT helps to boost radiation dose to primary disease. Organs like rectum, bladder, sigmoid and small bowel lie close to the cervix region and these organs receive dose from EBRT as well as ICBT and we want to know the dose to these organ at risk (OAR). Materials & Methods: Dosimetric details of 174 ICBT applications done in 58 patients were retrospectively analysed. All patients received EBRT dose of 50.4 Gy in 28 fractions. All patients had ICBT, three sessions with 7 Gy prescribed to point A. Dosimetric data including dose to right and left point A and dose to OARs were recorded from Oncentra Planning System. Results: Mean dose to point A on right side was 6.89 Gy and left side was 6.91 Gy. Mean D2cc dose to rectum, bladder, sigmoid and small bowel was 3.5 Gy, 5.25 Gy, 4.75 Gy and 4.2 Gy respectively. Mean EQD2 dose combining EBRT and ICBT in point A was 78.7 Gy on right side and 79 Gy on left side. Mean EQD2 doses to D2cc of rectum, bladder, sigmoid and small bowel was 62 Gy, 74.4 Gy, 70.5 Gy and 66.5 Gy respectively. Conclusion: From the results of this dosimetric study it is evident that OARs like rectum, sigmoid, bladder & bowel are receiving only acceptable doses of radiation using point A prescribed CT based ICBT planning. Hence with regards to OAR doses, CT based ICBT planning with dose prescribed to point A is a feasible option.
文摘Total skin electron therapy (TSET) is used for the treatment of Mycosis Fungoides. Several tech-niques have been developed, in order to achieve homogeneous dose distribution over the complete body surface. To implement a TSET technique, one has to optimize a variety of parameters. Monte Carlo simulation of TSET can facilitate this optimization. The aim of this study was to commission and optimize a TSET technique using the 4 and 6 MeV electron and the high dose rate facility on the Elekta Precise accelerator. The EGS4nrc/BEAMnrc Monte Carlo code was used. The beam data were calculated and measured at two different scoring planes for a single beam. The Model was validated by comparing the simulation with measurements. Two different vertical angles were used to obtain a uniform dose. The angle was optimized for best dose uniformity. The Rando phantom is placed on a rotating platform and rotates 60 degrees apart to facilitate the six patient position orientations. The doses delivered in a phantom by complete treatment were measured with Kodak EDR2 films and TLDs. The dose distribution varied among various scanning directions by 2 - 3 mm and 3 - 4 mm for 4 and 6 MeV respectively. The composite percentage depth dose of all six dual fields for the 4 and 6 MeV yielded an R80 of ~4 mm and ~6 mm, respectively. Dose uniformity was ±6% for 4 MeV and ±5% for 6 MeV. The bremsstrahlung contamination was 0.9% - 1.3%. Good agreements were found with published literature and inline with international protocols.
文摘Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma accounting for approximately half of all cutaneous T-cell lymphomas. Radiation therapy is an effective treatment for early stage MF and has been shown to result in long-term disease-free intervals, with even curative potential. Radiation is also effective as palliative treatment for the localized lesion resistant to the topic or other treatments. In the current study, we report using high dose rate (HDR) radiation treatment for a patient with resistant mycosis fungoides involving the wrist. We report a convenient treatment with an ideal radiation dose distribution, and a excellent clinical outcome.
基金supported by Postdoctoral Fellowship Program of CPSF(GZC20231809)Sichuan Science and Technology Program(24NSFSC2900)+6 种基金National Natural Sciences Foundation of China(82473434)Sichuan Provincial Science and Technology Department Key Research and Development Program(2022YFSY0012)Sichuan Science and Technology Program(2024YFHZ0041,2024ZYD0054)Science and Technology Project of Sichuan Provincial Health Commission(Clinical Research Special Project JH2023082)International Science and Technology Cooperation Program of Chengdu Science and Technology Bureau(2024-YF06-00011-HZ and 2022-GH03-00004-HZ)1.3.5 project for disciplines of excellence from West China Hospital of Sichuan University(ZYYC23006)Clinical Research Incubation Project of West China Hospital(23HXFH001).
文摘Radiotherapy(RT)resistance in head and neck squamous cell carcinoma(HNSCC)significantly hampers local control and patient prognosis.This study investigated the efficacy and molecular mechanisms of high-energy X-ray-based ultra-high dose rate radiotherapy(UHDR-RT)in overcoming RT resistance.The established RT-resistant HNSCC cell lines and animal models were subjected to UHDR-RT or conventional RT(Conv-RT)via a high-power rhodotron accelerator.Cellular assays assessed the malignant phenotype,viability,and degree of DNA damage,whereas in vivo evaluations focused on tumor proliferation and the tumor immune microenvironment(TiME).Transcriptome sequencing and Olink proteomics were employed to explore the underlying mechanisms involved.In vitro experiments indicated that UHDR-RT suppressed radioresistant cell proliferation and invasion,while promoting apoptosis and exacerbating DNA damage.In contrast,its efficacy in radiosensitive cells was comparable to that of Conv-RT.In vivo studies using patient-derived xenograft nude mice models demonstrated that UHDR-RT only partially reversed RT resistance.Transcriptomic and proteomic analyses of C57BL/6J mice models revealed the predominant role of TiME modulating in reversing radioresistance.Immunofluorescence and flow cytometry confirmed increased CD8^(+)T cells and an increased M1/M2 macrophage ratio post-UHDR-RT.Mechanistically,UHDR-RT activated CD8^(+)T cells,which stimulated M1 macrophages through paracrine IFN-y signaling,thereby enhancing TiME activation.Furthermore,the activated M1 macrophages secreted CXCL9,which in turn reactivated CD8^(+)T cells,forming a feedforward loop that amplifed TiME activation.This study elucidates the dual role of UHDR-RT in directly inducing DNA damage and modulating the TiME,highlighting its potential in treating radioresistant HNSCC.
文摘Helicobacter pylori(H.pylori)infections may cause chronic gastritis,peptic ulcer disease,gastric cancers,and other conditions outside of the gastrointestinal tract.Hence,it is important to diagnose and treat it early.H.pylori is resistant to certain drugs in traditional eradication therapy,so alternative therapy protocols are needed,such as high-dose amoxicillin dual therapy(HDADT).This article aims to comment on a recent paper by Costigan et al in the World Journal of Clinical Cases.In this study,the authors recruited 139 patients diagnosed with H.pylori,all treated with HDADT.Of these,93 were treatment-naïve and 46 had received at least one alternative treatment in the past.Four weeks after the end of the treatment,the urea breath test was administered to estimate the eradication rate.The total eradication rate was 56%(78/139),62%for the treatment-naïve arm and 43%for the previous treatment arm,thus indicating a lower success rate for the arm that had previously received a different treatment regimen.In conclusion,a therapeutic approach with first-line HDADT may potentially be a better treat-ment,but the results are not sufficient to recommend the use of this regimen in a country with high levels of dual resistance.
文摘In this editorial I comment on the article,published in the current issue of the World Journal of Clinical Oncology.Primary central nervous system lymphoma(PCNSL)is a disease of elderly and immunocompromised patients.The authors reported clinical results of 19 patients with PCNSL treated with zanubrutinib/high dose methotrexate(HD-MTX)until disease progression.They demonstrated that the combination of zanubrutinib with HD-MTX led to a marked clinical response and tolerability among these patients.They also observed that cerebrospinal fluid liquid biopsy to detect circulating tumor DNA may be a good option for evaluating treatment response and tumor burden in patients with PCNSL.PCNSL is a challenging disease for treatment as these patients present with different neurological states and comorbidities.Treatment has evolved over the years from whole brain radiotherapy to HD-MTX followed by autologous stem cell transplant.Gradually,treatment of patients with PCNSL is going to become individualized.
文摘Objective:To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis.Methods:The subjects included in this study were admitted to the hospital for maintenance hemodialysis treatment from January 2021 to January 2023.All patients had a high risk of bleeding and received 4%trisodium citrate anticoagulant treatment,administered at a rate of 200 mL/h before and after the dialyzer.The anticoagulant effects achieved by the patients were observed and analyzed.Results:The total number of patients who received high-dose segmented citrate extracorporeal anticoagulation dialysis treatment was 50,with each patient undergoing 100 treatments.During the treatment,2 patients had to end the treatment early due to transmembrane pressure exceeding 30 mmHg and an increase in venous pressure exceeding 250 mmHg;the treatment times for these patients were 20 minutes and 200 minutes,respectively.The remaining patients successfully completed the 4-hour treatment.Blood pH and calcium ion concentration in the venous pot were monitored.It was observed that before dialysis,after 2 hours of dialysis,and at the end of dialysis,the blood pH of the patients remained within a relatively normal range.Although some patient levels changed after dialysis,they remained within the normal range.No adverse reactions(such as numbness of the limbs or convulsions)were observed during the anticoagulant treatment.Conclusion:Administering 4%trisodium citrate at a rate of 200 mL/h before and after the dialyzer achieves a good anticoagulant effect,maintains the patient’s blood gas levels within the normal range at the end of dialysis,and causes no adverse reactions.
