Tea consumption has increased due to its beneficial effects. Results from a lab study on the effect of sucrose (5 g per cup, 150 mL) and/or ascorbic acid (2 mL per cup, 150 mL) on dissolved aluminum compounds during t...Tea consumption has increased due to its beneficial effects. Results from a lab study on the effect of sucrose (5 g per cup, 150 mL) and/or ascorbic acid (2 mL per cup, 150 mL) on dissolved aluminum compounds during the infusion of two commercial types of dry tea leaves (black, green) with boiling water (5, 15 min infusion time) are presented. Factors influencing the presence of dissolved aluminum in the infusions of both tea leaves were infusion time and sugar contents, as well as the interaction between ascorbic acid and sucrose (p < 0.05). Aluminum contents found after 15 min of infusion were 0.7 mg L–1 for black tea infusions added with sugar, and 0.69 mg L–1 for green tea added with both sugar and ascorbic acid. Both concentrations are higher than the level accepted in Mexico for drinking water (there is no act concerning tea infusions), that is 0.2 mg L–1.展开更多
AIM:To study the safety and effectiveness associated with accelerated infliximab infusion protocols in patients with inflammatory bowel disease(IBD).METHODS:Original protocols and infusion rates were developed for the...AIM:To study the safety and effectiveness associated with accelerated infliximab infusion protocols in patients with inflammatory bowel disease(IBD).METHODS:Original protocols and infusion rates were developed for the administration of infliximab over 90-min and 60-min.Then the IBD patients on stable maintenance infliximab therapy were offered accelerated infusions.To be eligible for the study,patients needed a minimum of four prior infusions.An initial infusion of 90-min was given to each patient;those tolerating the accelerated infusion were transitioned to a 60-min infusion protocol at their next and all subsequent visits.Any patient having significant infusion reactions would be reverted to the standard 120-min protocol.A change in a patient's dose mandated a single 120-min infusion before accelerated infusions could be administered again.RESULTS:The University of Virginia Medical Center's Institutional Review Board approved this study.Fifty IBD patients treated with infliximab 5mg/kg,7.5mg/kg and 10mg/kg were offered accelerated infusions.Forty-six patients consented to participate in the study.Nineteen(41.3%) were female,five(10.9%) were African American and nine(19.6%) had ulcerative colitis.The mean age was 42.6 years old.Patients under age 18 were excluded.Ten patients used immunosuppressive drugs concurrently out of which six were taking azathioprine,three were taking 6-mercaptopurine and one was taking methotrexate.One of the 46 study patients used corticosteroid therapy for his IBD.Seventeen of the patients used prophylactic medications prior to receiving infusions;six patients received corticosteroids as pre-medication.Four patients had a history of distant transfusion reactions to infliximab.These reactions included shortness of breath,chest tightness,flushing,pruritus and urticaria.These patients all took prophylactic medications before receiving infusions.46 patients(27 males and 19 females) received a total of fifty 90-min infusions and ninety-three 60-min infusions.No infusion reactions were reported.There were no adverse events,including drug-related infections.None of the patients developed cancer of any type during the study timeframe.Total cost savings for administration of the both 90-min and 60-min accelerated infusions compared to standard 120-min infusions was estimated to be $53 632($116 965 vs $63 333,P=0.001).One hundred and eighteen hours were saved in the administration of the accelerated infusions(17 160 min vs 10 080 min,P=0.001).In the study population,overweight females [body mass index(BMI)>25.00kg/m2] were found to have statistically higher BMIs than overweight males(mean BMI 35.07±2.66kg/m2 vs 30.08±0.99kg/m2,P=0.05),finding which is of significance since obesity was described as being one of the risk factors for Crohn's disease.CONCLUSION:We are the first US group to report substantial cost savings,increased safety and patient satisfaction associated with accelerated infliximab infusion.展开更多
Pharmacokinetic compartment models are the only models that can extract pharmacokinetic parameters from data collected in clinical studies but their estimates lack accuracy, explanations and physiological significance...Pharmacokinetic compartment models are the only models that can extract pharmacokinetic parameters from data collected in clinical studies but their estimates lack accuracy, explanations and physiological significance. The objective of this work was to develop particular solutions to drug concentration and AUC in the form of mathematical series and Heaviside functions for repetitive intermittent infusions in the one- and two-compartment models, as a function of dose number and total time using differential calculus. It was demonstrated that the central and peripheral compartment volumes determined from regression analysis of the aminoglycoside antibiotic Sisomicin concentration in plasma represent the actual physiological body fluid volumes accessible by the drug. The drug peak time and peak concentration in the peripheral compartment were also calculated as a function of dose number. It is also shown that the time of intercompartmental momentary distribution equilibrium can be used to determine the drug’s apparent volume of distribution within any dosing interval in multi-compartment models. These estimates were used to carry out simulations of plasma drug concentration with time in the one-compartment model. In conclusion, the two-compartment open mammillary pharmacokinetic model was fully explained for the aminoglycoside antibiotic sisomicin through the new concept of the apparent volume of distribution.展开更多
A simple iterative process can be used to generate intravenous drug infusion profiles. It overcomes limitations in deriving compartmental pharmacokinetic models and has application to evaluation of new drugs and to cl...A simple iterative process can be used to generate intravenous drug infusion profiles. It overcomes limitations in deriving compartmental pharmacokinetic models and has application to evaluation of new drugs and to clinical practice.展开更多
Currently,teas and herbal infusions represent an important part of the human diet.Most contain phenolic com-pounds with high antioxidant activity,usually associated with human health protective functions.This attribut...Currently,teas and herbal infusions represent an important part of the human diet.Most contain phenolic com-pounds with high antioxidant activity,usually associated with human health protective functions.This attribute defines teas and infusions as nutraceutical foods.In Argentina,several native species are traditionally used for medi-cal purposes.Some of those species are Larrea cuneifolia,Larrea nitida,Grindelia chiloensis,Pteromonnina dictyo-carpa,Mandevilla laxa,and Monttea aphylla.The objectives of this study were to analyze the antioxidant power and the scavenging capacity of infusions obtained from those six medicinal plants,to characterize the phenolic profile,and to study in vitro their safety or cytotoxicity.Additionally,the potential use of two infusions as antioxidant additives in a food model was evaluated.The results indicated that the analyzed plant species are rich in phenolic acids(e.g.,caffeic,ferulic,and chlorogenic acid),and flavonoids(e.g.,quercetin and kaempferol),with high antioxi-dant power.The infusion blend obtained with G.chiloensis and L.cuneifolia exhibited the highest value of antioxidant capacity measured with the FRAP technique(193.4μg EAA/mg DW).On the other hand,L.cuneifolia infusion showed the greatest antioxidant capacity determined by FRAP(131.9±5.2μg EAA/mg DW)and DPPH assays(0.453 mL/mg s).Additionally,L.cuneifolia infusion showed the highest phenolic content(232.8μg GAE/mg DW)and flavonoid content(153.3μg QE/mg DW).None of the infusions showed toxicity in mammalian cells,except for G.chiloensis.Furthermore,the L.cuneifolia and L.nitida infusions showed a high inhibitory effect on lipid oxidation in ground beef(55%and 51%at 4 days of storage,respectively).The results suggest that the studied infusions are safe and a rich source of antioxidants,which supports their use in traditional medicine.However,further exhaustive studies of G.chiloensis infusion are needed to ensure its safety,as it has shown cytotoxicity.Besides,it is worthwhile to advance the study of L.cuneifolia and L.nitida as sources of dietary antioxidants,due to their high antioxidant power and ability to protect against lipid peroxidation.展开更多
BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion...BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.展开更多
Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation ...Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.展开更多
Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular junction.In amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann c...Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular junction.In amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann cell function may also be impaired.Recently,important signaling and potential trophic activities of Schwann cell-derived exosomal vesicles have been reported.This case report describes the treatment of a patient with advanced amyotrophic lateral sclerosis using serial intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles,marking,to our knowledge,the first instance of such treatment.An 81-year-old male patient presented with a 1.5-year history of rapidly progressive amyotrophic lateral sclerosis.After initial diagnosis,the patient underwent a combination of generic riluzole,sodium phenylbutyrate for the treatment of amyotrophic lateral sclerosis,and taurursodiol.The patient volunteered to participate in an FDA-approved single-patient expanded access treatment and received weekly intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles to potentially restore impaired Schwann cell and motor neuron function.We confirmed that cultured Schwann cells obtained from the amyotrophic lateral sclerosis patient via sural nerve biopsy appeared impaired(senescent)and that exposure of the patient’s Schwann cells to allogeneic Schwann cell-derived exosomal vesicles,cultured expanded from a cadaver donor improved their growth capacity in vitro.After a period of observation lasting 10 weeks,during which amyotrophic lateral sclerosis Functional Rating Scale-Revised and pulmonary function were regularly monitored,the patient received weekly consecutive infusions of 1.54×1012(×2),and then consecutive infusions of 7.5×1012(×6)allogeneic Schwann cell-derived exosomal vesicles diluted in 40 mL of Dulbecco’s phosphate-buffered saline.None of the infusions were associated with adverse events such as infusion reactions(allergic or otherwise)or changes in vital signs.Clinical lab serum neurofilament and cytokine levels measured prior to each infusion varied somewhat without a clear trend.A more sensitive in-house assay suggested possible inflammasome activation during the disease course.A trend for clinical stabilization was observed during the infusion period.Our study provides a novel approach to address impaired Schwann cells and possibly motor neuron function in patients with amyotrophic lateral sclerosis using allogeneic Schwann cell-derived exosomal vesicles.Initial findings suggest that this approach is safe.展开更多
This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy...This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.展开更多
Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a...Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a promising modality for treating advanced HCC,particularly in Asian clinical practice,its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials.This editorial reviews and comments on the meta-analysis conducted by Zhou et al,which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC.The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments,such as sorafenib and transarterial chemoembolization(TACE).In this work,HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination.HAIC in combination with lenvatinib,ablation,programmed cell death 1 inhibitors,and radiotherapy further enhanced patient outcomes,indicating a synergistic effect.This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC.It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.展开更多
This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
Objective:To observe the guiding role of image navigation technology in the treatment of patients with tuberculosis.Methods:A total of 188 patients with multidrug-resistant tuberculosis(MDR-TB)and rifampin-resistant t...Objective:To observe the guiding role of image navigation technology in the treatment of patients with tuberculosis.Methods:A total of 188 patients with multidrug-resistant tuberculosis(MDR-TB)and rifampin-resistant tuberculosis(RR-TB)who were hospitalized in the hospital from September 2023 to September 2024 were included.After random equal division,94 patients were included in the control group and received systemic anti-tuberculosis chemotherapy;94 patients were included in the treatment group.Based on systemic anti-tuberculosis treatment,digital subtraction angiography(DSA)technology was used to inject targeted drugs into the bronchial lumen through bronchoscopy to complete anti-tuberculosis treatment.The changes in sputum bacteria and imaging were observed in the two groups.Results:The sputum negative conversion rate in the treatment group was significantly higher than that in the control group(86.2%;70.2%)(u=2.74,P<0.01).The absorption rate of CT imaging lesions(significant absorption)was significantly higher than that of the control group(83.0%;50%)(u=2.45,P<0.05).The closure rate of chest CT cavities was significantly higher than that of the control group(74.2%;39.1%)(u=2.20,P<0.05).During the treatment process,the improvement of clinical symptoms was significantly higher than that of the control group,and the difference was statistically significant.There was no statistically significant difference in the incidence of adverse reactions between the two groups(x^(2)=0.434,P>0.05).Conclusion:Based on DSA,targeted drug infusion within the bronchoscope can significantly improve the efficacy of the disease,with mild adverse reactions that patients can tolerate.It is worthy of promotion and application.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic c...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.展开更多
Hepatic arterial infusion chemotherapy (HAIC) is an advanced targeted therapeuticapproach for hepatocellular carcinoma (HCC), the most common type ofprimary liver cancer. HAIC has demonstrated significant potential in...Hepatic arterial infusion chemotherapy (HAIC) is an advanced targeted therapeuticapproach for hepatocellular carcinoma (HCC), the most common type ofprimary liver cancer. HAIC has demonstrated significant potential in managingadvanced HCC, particularly in regions with high prevalence rates. Despite itspromise, several challenges and areas for future research remain. Clinical studieshave substantiated the efficacy of HAIC in enhancing survival outcomes forpatients with advanced hepatic carcinoma. Notably, combination therapiesinvolving immune checkpoint inhibitors, such as lenvatinib and programmeddeath-1 inhibitors, have shown substantial improvements in median overallsurvival and progression-free survival compared to systemic chemotherapy.These combination therapies have also exhibited superior response rates anddisease control, with manageable and often less severe adverse events relative tosystemic treatments. This article is based on the review by Zhou et al and aims todiscuss the current status and future directions in the treatment of HCC, emphasizingthe role of HAIC and its integration with novel therapeutic agents.展开更多
Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metast...Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.展开更多
In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using networ...In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy in China,primarily diagnosed at advanced stages,which limits treatment options and increases mortality rates.Conversion therapy,which includes systemic...BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy in China,primarily diagnosed at advanced stages,which limits treatment options and increases mortality rates.Conversion therapy,which includes systemic and locoregional treatments,aims to render unresectable tumors resectable.Nonetheless,research is scant on the risks of disease progression during the temporary cessation of targeted drugs and immune checkpoint inhibitors before surgery.CASE SUMMARY This report describes a 58-year-old male with HCC who developed lung meta-stases following the discontinuation of lenvatinib and tislelizumab,revealing the necessity for further investigation into the management of HCC patients during the perioperative period,particularly concerning the timing and duration of tar-geted therapy and immunotherapy.CONCLUSION Our study highlights the complex challenges in managing advanced HCC and emphasizes the critical need for ongoing research to refine treatment strategies and improve patient outcomes.展开更多
The rapid evolution of systemic therapies for hepatocellular carcinoma(HCC),one of the most common types of liver cancer,has attracted significant attention especially to hepatic arterial infusion chemotherapy(HAIC)as...The rapid evolution of systemic therapies for hepatocellular carcinoma(HCC),one of the most common types of liver cancer,has attracted significant attention especially to hepatic arterial infusion chemotherapy(HAIC)as a highly promising treatment approach.This method,which delivers chemotherapy directly into the liver's arterial supply,is designed to maximize the concentration of anti-cancer drugs at the tumor site while minimizing systemic side effects.Despite the potential and the encouraging results observed in various studies,HAIC has not yet achieved widespread acceptance and utilization.Sorafenib is a widely used systemic therapy that targets multiple pathways involved in tumor growth and angiogenesis,while transarterial chemoembolization(TACE)is a locoregional therapy that combines arterial embolization with chemotherapy.These treatments have been the mainstay of HCC management,yet they have limitations that HAIC may potentially overcome.This article specifically comments on the network meta-analysis that examined the current research status of HAIC,highlighting its effectiveness and safety profile in comparison to established standard treatments such as Sorafenib and TACE.Through an extensive review of existing studies,the authors conclude that patients receiving HAIC often experience better survival rates and longer periods without disease progression compared to those receiving Sorafenib or TACE.展开更多
Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long c...Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long catheters in the hospital from March 2024 to March 2025 were selected and randomly divided into a control group and an observation group,with 45 patients in each group.The control group received routine nursing intervention,while the observation group received clinical nursing pathway intervention.The nursing risk events,catheter indwelling time,and nursing satisfaction were evaluated in both groups.Results:The observation group had a shorter catheter indwelling time,fewer risk events during intravenous therapy(total incidence rate of 2.22%),and higher nursing satisfaction.Additionally,negative emotional feedback was reduced,and the SAS score(31.02±1.12)was lower in the observation group compared to the control group.There were significant differences between the two groups in all indicators(P<0.05).Conclusion:Applying the clinical nursing pathway during intravenous therapy via peripheral mid-long catheters can help ensure infusion safety,improve unstable emotional states,and promote high-quality service standards.展开更多
BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).Howeve...BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.展开更多
文摘Tea consumption has increased due to its beneficial effects. Results from a lab study on the effect of sucrose (5 g per cup, 150 mL) and/or ascorbic acid (2 mL per cup, 150 mL) on dissolved aluminum compounds during the infusion of two commercial types of dry tea leaves (black, green) with boiling water (5, 15 min infusion time) are presented. Factors influencing the presence of dissolved aluminum in the infusions of both tea leaves were infusion time and sugar contents, as well as the interaction between ascorbic acid and sucrose (p < 0.05). Aluminum contents found after 15 min of infusion were 0.7 mg L–1 for black tea infusions added with sugar, and 0.69 mg L–1 for green tea added with both sugar and ascorbic acid. Both concentrations are higher than the level accepted in Mexico for drinking water (there is no act concerning tea infusions), that is 0.2 mg L–1.
文摘AIM:To study the safety and effectiveness associated with accelerated infliximab infusion protocols in patients with inflammatory bowel disease(IBD).METHODS:Original protocols and infusion rates were developed for the administration of infliximab over 90-min and 60-min.Then the IBD patients on stable maintenance infliximab therapy were offered accelerated infusions.To be eligible for the study,patients needed a minimum of four prior infusions.An initial infusion of 90-min was given to each patient;those tolerating the accelerated infusion were transitioned to a 60-min infusion protocol at their next and all subsequent visits.Any patient having significant infusion reactions would be reverted to the standard 120-min protocol.A change in a patient's dose mandated a single 120-min infusion before accelerated infusions could be administered again.RESULTS:The University of Virginia Medical Center's Institutional Review Board approved this study.Fifty IBD patients treated with infliximab 5mg/kg,7.5mg/kg and 10mg/kg were offered accelerated infusions.Forty-six patients consented to participate in the study.Nineteen(41.3%) were female,five(10.9%) were African American and nine(19.6%) had ulcerative colitis.The mean age was 42.6 years old.Patients under age 18 were excluded.Ten patients used immunosuppressive drugs concurrently out of which six were taking azathioprine,three were taking 6-mercaptopurine and one was taking methotrexate.One of the 46 study patients used corticosteroid therapy for his IBD.Seventeen of the patients used prophylactic medications prior to receiving infusions;six patients received corticosteroids as pre-medication.Four patients had a history of distant transfusion reactions to infliximab.These reactions included shortness of breath,chest tightness,flushing,pruritus and urticaria.These patients all took prophylactic medications before receiving infusions.46 patients(27 males and 19 females) received a total of fifty 90-min infusions and ninety-three 60-min infusions.No infusion reactions were reported.There were no adverse events,including drug-related infections.None of the patients developed cancer of any type during the study timeframe.Total cost savings for administration of the both 90-min and 60-min accelerated infusions compared to standard 120-min infusions was estimated to be $53 632($116 965 vs $63 333,P=0.001).One hundred and eighteen hours were saved in the administration of the accelerated infusions(17 160 min vs 10 080 min,P=0.001).In the study population,overweight females [body mass index(BMI)>25.00kg/m2] were found to have statistically higher BMIs than overweight males(mean BMI 35.07±2.66kg/m2 vs 30.08±0.99kg/m2,P=0.05),finding which is of significance since obesity was described as being one of the risk factors for Crohn's disease.CONCLUSION:We are the first US group to report substantial cost savings,increased safety and patient satisfaction associated with accelerated infliximab infusion.
文摘Pharmacokinetic compartment models are the only models that can extract pharmacokinetic parameters from data collected in clinical studies but their estimates lack accuracy, explanations and physiological significance. The objective of this work was to develop particular solutions to drug concentration and AUC in the form of mathematical series and Heaviside functions for repetitive intermittent infusions in the one- and two-compartment models, as a function of dose number and total time using differential calculus. It was demonstrated that the central and peripheral compartment volumes determined from regression analysis of the aminoglycoside antibiotic Sisomicin concentration in plasma represent the actual physiological body fluid volumes accessible by the drug. The drug peak time and peak concentration in the peripheral compartment were also calculated as a function of dose number. It is also shown that the time of intercompartmental momentary distribution equilibrium can be used to determine the drug’s apparent volume of distribution within any dosing interval in multi-compartment models. These estimates were used to carry out simulations of plasma drug concentration with time in the one-compartment model. In conclusion, the two-compartment open mammillary pharmacokinetic model was fully explained for the aminoglycoside antibiotic sisomicin through the new concept of the apparent volume of distribution.
文摘A simple iterative process can be used to generate intravenous drug infusion profiles. It overcomes limitations in deriving compartmental pharmacokinetic models and has application to evaluation of new drugs and to clinical practice.
基金supported by the following grants:Universidad Nacional del Comahue(UNCo)(PIN 04/N037)Consejo Nacional de Investigaciones Científicas y Técnicas(CONICET)(PIP 2020-1243)Agencia Nacional de Promoción Científica y Tecnológica(ANPCyT)(PICT 2020-3049).
文摘Currently,teas and herbal infusions represent an important part of the human diet.Most contain phenolic com-pounds with high antioxidant activity,usually associated with human health protective functions.This attribute defines teas and infusions as nutraceutical foods.In Argentina,several native species are traditionally used for medi-cal purposes.Some of those species are Larrea cuneifolia,Larrea nitida,Grindelia chiloensis,Pteromonnina dictyo-carpa,Mandevilla laxa,and Monttea aphylla.The objectives of this study were to analyze the antioxidant power and the scavenging capacity of infusions obtained from those six medicinal plants,to characterize the phenolic profile,and to study in vitro their safety or cytotoxicity.Additionally,the potential use of two infusions as antioxidant additives in a food model was evaluated.The results indicated that the analyzed plant species are rich in phenolic acids(e.g.,caffeic,ferulic,and chlorogenic acid),and flavonoids(e.g.,quercetin and kaempferol),with high antioxi-dant power.The infusion blend obtained with G.chiloensis and L.cuneifolia exhibited the highest value of antioxidant capacity measured with the FRAP technique(193.4μg EAA/mg DW).On the other hand,L.cuneifolia infusion showed the greatest antioxidant capacity determined by FRAP(131.9±5.2μg EAA/mg DW)and DPPH assays(0.453 mL/mg s).Additionally,L.cuneifolia infusion showed the highest phenolic content(232.8μg GAE/mg DW)and flavonoid content(153.3μg QE/mg DW).None of the infusions showed toxicity in mammalian cells,except for G.chiloensis.Furthermore,the L.cuneifolia and L.nitida infusions showed a high inhibitory effect on lipid oxidation in ground beef(55%and 51%at 4 days of storage,respectively).The results suggest that the studied infusions are safe and a rich source of antioxidants,which supports their use in traditional medicine.However,further exhaustive studies of G.chiloensis infusion are needed to ensure its safety,as it has shown cytotoxicity.Besides,it is worthwhile to advance the study of L.cuneifolia and L.nitida as sources of dietary antioxidants,due to their high antioxidant power and ability to protect against lipid peroxidation.
文摘BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.
文摘Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.
基金support from the Miami Project to Cure Paralysis,the Buoniconti Fund,and the Interdisciplinary Stem Cell Institute(to AK,WDD,JDG,and ADL)the unconditional support of Dean Henri Ford of the Leonard M.Miller School of Medicine at the University of Miami.
文摘Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular junction.In amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann cell function may also be impaired.Recently,important signaling and potential trophic activities of Schwann cell-derived exosomal vesicles have been reported.This case report describes the treatment of a patient with advanced amyotrophic lateral sclerosis using serial intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles,marking,to our knowledge,the first instance of such treatment.An 81-year-old male patient presented with a 1.5-year history of rapidly progressive amyotrophic lateral sclerosis.After initial diagnosis,the patient underwent a combination of generic riluzole,sodium phenylbutyrate for the treatment of amyotrophic lateral sclerosis,and taurursodiol.The patient volunteered to participate in an FDA-approved single-patient expanded access treatment and received weekly intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles to potentially restore impaired Schwann cell and motor neuron function.We confirmed that cultured Schwann cells obtained from the amyotrophic lateral sclerosis patient via sural nerve biopsy appeared impaired(senescent)and that exposure of the patient’s Schwann cells to allogeneic Schwann cell-derived exosomal vesicles,cultured expanded from a cadaver donor improved their growth capacity in vitro.After a period of observation lasting 10 weeks,during which amyotrophic lateral sclerosis Functional Rating Scale-Revised and pulmonary function were regularly monitored,the patient received weekly consecutive infusions of 1.54×1012(×2),and then consecutive infusions of 7.5×1012(×6)allogeneic Schwann cell-derived exosomal vesicles diluted in 40 mL of Dulbecco’s phosphate-buffered saline.None of the infusions were associated with adverse events such as infusion reactions(allergic or otherwise)or changes in vital signs.Clinical lab serum neurofilament and cytokine levels measured prior to each infusion varied somewhat without a clear trend.A more sensitive in-house assay suggested possible inflammasome activation during the disease course.A trend for clinical stabilization was observed during the infusion period.Our study provides a novel approach to address impaired Schwann cells and possibly motor neuron function in patients with amyotrophic lateral sclerosis using allogeneic Schwann cell-derived exosomal vesicles.Initial findings suggest that this approach is safe.
文摘This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.
文摘Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a promising modality for treating advanced HCC,particularly in Asian clinical practice,its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials.This editorial reviews and comments on the meta-analysis conducted by Zhou et al,which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC.The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments,such as sorafenib and transarterial chemoembolization(TACE).In this work,HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination.HAIC in combination with lenvatinib,ablation,programmed cell death 1 inhibitors,and radiotherapy further enhanced patient outcomes,indicating a synergistic effect.This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC.It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
基金Science and Education Department Harbin Health Committee Project。
文摘Objective:To observe the guiding role of image navigation technology in the treatment of patients with tuberculosis.Methods:A total of 188 patients with multidrug-resistant tuberculosis(MDR-TB)and rifampin-resistant tuberculosis(RR-TB)who were hospitalized in the hospital from September 2023 to September 2024 were included.After random equal division,94 patients were included in the control group and received systemic anti-tuberculosis chemotherapy;94 patients were included in the treatment group.Based on systemic anti-tuberculosis treatment,digital subtraction angiography(DSA)technology was used to inject targeted drugs into the bronchial lumen through bronchoscopy to complete anti-tuberculosis treatment.The changes in sputum bacteria and imaging were observed in the two groups.Results:The sputum negative conversion rate in the treatment group was significantly higher than that in the control group(86.2%;70.2%)(u=2.74,P<0.01).The absorption rate of CT imaging lesions(significant absorption)was significantly higher than that of the control group(83.0%;50%)(u=2.45,P<0.05).The closure rate of chest CT cavities was significantly higher than that of the control group(74.2%;39.1%)(u=2.20,P<0.05).During the treatment process,the improvement of clinical symptoms was significantly higher than that of the control group,and the difference was statistically significant.There was no statistically significant difference in the incidence of adverse reactions between the two groups(x^(2)=0.434,P>0.05).Conclusion:Based on DSA,targeted drug infusion within the bronchoscope can significantly improve the efficacy of the disease,with mild adverse reactions that patients can tolerate.It is worthy of promotion and application.
基金Supported by Shenzhen Clinical Research Center for Gastroenterology(Gastrointestinal Surgery),No.LCYSSQ20220823091203008.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.
文摘Hepatic arterial infusion chemotherapy (HAIC) is an advanced targeted therapeuticapproach for hepatocellular carcinoma (HCC), the most common type ofprimary liver cancer. HAIC has demonstrated significant potential in managingadvanced HCC, particularly in regions with high prevalence rates. Despite itspromise, several challenges and areas for future research remain. Clinical studieshave substantiated the efficacy of HAIC in enhancing survival outcomes forpatients with advanced hepatic carcinoma. Notably, combination therapiesinvolving immune checkpoint inhibitors, such as lenvatinib and programmeddeath-1 inhibitors, have shown substantial improvements in median overallsurvival and progression-free survival compared to systemic chemotherapy.These combination therapies have also exhibited superior response rates anddisease control, with manageable and often less severe adverse events relative tosystemic treatments. This article is based on the review by Zhou et al and aims todiscuss the current status and future directions in the treatment of HCC, emphasizingthe role of HAIC and its integration with novel therapeutic agents.
文摘Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.
文摘In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy in China,primarily diagnosed at advanced stages,which limits treatment options and increases mortality rates.Conversion therapy,which includes systemic and locoregional treatments,aims to render unresectable tumors resectable.Nonetheless,research is scant on the risks of disease progression during the temporary cessation of targeted drugs and immune checkpoint inhibitors before surgery.CASE SUMMARY This report describes a 58-year-old male with HCC who developed lung meta-stases following the discontinuation of lenvatinib and tislelizumab,revealing the necessity for further investigation into the management of HCC patients during the perioperative period,particularly concerning the timing and duration of tar-geted therapy and immunotherapy.CONCLUSION Our study highlights the complex challenges in managing advanced HCC and emphasizes the critical need for ongoing research to refine treatment strategies and improve patient outcomes.
文摘The rapid evolution of systemic therapies for hepatocellular carcinoma(HCC),one of the most common types of liver cancer,has attracted significant attention especially to hepatic arterial infusion chemotherapy(HAIC)as a highly promising treatment approach.This method,which delivers chemotherapy directly into the liver's arterial supply,is designed to maximize the concentration of anti-cancer drugs at the tumor site while minimizing systemic side effects.Despite the potential and the encouraging results observed in various studies,HAIC has not yet achieved widespread acceptance and utilization.Sorafenib is a widely used systemic therapy that targets multiple pathways involved in tumor growth and angiogenesis,while transarterial chemoembolization(TACE)is a locoregional therapy that combines arterial embolization with chemotherapy.These treatments have been the mainstay of HCC management,yet they have limitations that HAIC may potentially overcome.This article specifically comments on the network meta-analysis that examined the current research status of HAIC,highlighting its effectiveness and safety profile in comparison to established standard treatments such as Sorafenib and TACE.Through an extensive review of existing studies,the authors conclude that patients receiving HAIC often experience better survival rates and longer periods without disease progression compared to those receiving Sorafenib or TACE.
文摘Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long catheters in the hospital from March 2024 to March 2025 were selected and randomly divided into a control group and an observation group,with 45 patients in each group.The control group received routine nursing intervention,while the observation group received clinical nursing pathway intervention.The nursing risk events,catheter indwelling time,and nursing satisfaction were evaluated in both groups.Results:The observation group had a shorter catheter indwelling time,fewer risk events during intravenous therapy(total incidence rate of 2.22%),and higher nursing satisfaction.Additionally,negative emotional feedback was reduced,and the SAS score(31.02±1.12)was lower in the observation group compared to the control group.There were significant differences between the two groups in all indicators(P<0.05).Conclusion:Applying the clinical nursing pathway during intravenous therapy via peripheral mid-long catheters can help ensure infusion safety,improve unstable emotional states,and promote high-quality service standards.
基金Supported by the National Key R and D Program of China,No.2021YFC2501700 and No.2021YFC2501705and the National Natural Science Foundation of China,No.82171580 and No.81672646.
文摘BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.
