Precision medicine is a growing field worldwide.Despite its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical practice.The main o...Precision medicine is a growing field worldwide.Despite its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical practice.The main obstacles are associated with the quality of samples used for genomic analysis。展开更多
Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is...Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is to report a case of Demons-Meigs syndrome, to determine its different characteristics and to make clinicians aware of the malignant predictive value of CA 125 in front of an ovarian tumor. Observation: The patient was 42 years old and had no previous history. She presented with intense abdominal pain of sudden onset, prompting a medical consultation. On clinical examination, the abdomen was distended with signs of peritoneal effusion and right pleural effusion. Ultrasound revealed a well-circumscribed, ovarian mass with an internal fluid component and hypervascularization on Doppler. The CA 125 level was elevated (293.9 U/ml). Exploratory laparotomy revealed two bilateral, firm, solid ovarian tumors without vegetation or peritoneal lesions. Macroscopically, one of the tumors was well circumscribed, lobulated with a smooth outer surface. It measured 20 × 17 × 8 cm and weighed 1400 g. The other tumor measured 19 × 11 × 5 cm, weighed 1090 g and had the same characteristics as the other tumor. Histologically, both tumors were a proliferation of fibroblastic spindle cells organized in short intersecting or storiform bundles, without cyto-nuclear atypia or excess mitoses. The diagnosis retained was bilateral ovarian fibroma in the context of a Demons-Meigs syndrome. Conclusion: Demons-Meigs syndrome is a rare entity. The concomitant elevation of the CA 125 level is not always an indicator of ovarian cancer. The curative treatment is surgical based on tumor removal ensuring the disappearance of peritoneal and pleural effusions.展开更多
Patients living with chronic kidney disease (CKD) are at high risk of cardiovascular events. Our aim in this study was to assess the cut-off value for lipoprotein (a) (Lp(a)) in CKD patients with a history of cardiova...Patients living with chronic kidney disease (CKD) are at high risk of cardiovascular events. Our aim in this study was to assess the cut-off value for lipoprotein (a) (Lp(a)) in CKD patients with a history of cardiovascular disease (CVD). This was a cross-sectional study. Variables including age, sex, history of CVD, body mass index and CKD stage, were collected during CKD patient’s first admission in the nephrology dialysis department. Blood samples were collected for quantitative determination of Lp(a) by immunoturbidimetric method. They were divided into two groups: CKD patients without history of CVD and CKD patients with history of CVD. Fisher’s exact test was used to assess associations with a significance level of 0.05%. Area under the curve (AUC) and new cut-off value for Lp(a) were identified by drawing Receiver Operating Characteristic (ROC) curve. A total of seventy CKD patients with median age of 43 years [minimum-maximum = 15 - 78 years] were included. Patients with history of CVD were 65.71% (46/70). New Lp(a) cut-off point in CKD patients with history of CVD was 66.50 nmol/L [sensitivity, 87.00%;specificity, 58.30%;AUC = 0.727;p = 0.000]. ROC curve demonstrated good performance of Lp(a) to screen CKD patients with history of CVD. Further research is needed to determine an LPA gene polymorphism’s contribution to increasing risk for CVD at each kidney disease stage.展开更多
Introduction: Meningiomas are tumors formed by arachnoid cells, typically attached to the inner surface of the dura mater. Malignant forms are rare and no case has been reported in the Malagasy literature. The objecti...Introduction: Meningiomas are tumors formed by arachnoid cells, typically attached to the inner surface of the dura mater. Malignant forms are rare and no case has been reported in the Malagasy literature. The objective of our study is to report two Malagasy cases of malignant meningioma and to discuss the epidemiological and anatomical-clinical particularities of this tumor. Observation: The first patient, a 41-year-old woman, presented with a rapidly progressive intracranial hypertension syndrome. The patient had undergone surgery two years earlier for a grade II meningioma and had no family history of meningioma, neurofibromatosis, or personal history of brain irradiation or head trauma. Her brain scan showed a heterogeneous polylobed left parieto-occipital mass with a meningeal implantation base. The anatomopathological examination of the samples revealed a malignant meningioma. The second patient was a 33-year-old man, operated for grade I meningioma eleven months before admission, with no other personal or family history. The patient was hospitalized for tumor recurrence with signs of intracranial hypertension. The brain computed tomography (CT) scan showed a heterogeneous extra-axial tumor in right temporo-parietal lobe. Surgical excision was performed. On histological examination, a proliferation of tumor cells of meningothelial appearance with papillary architecture was observed, leading to the diagnosis of malignant meningioma. Conclusion: Malignant meningioma is a rare and serious entity. The clinical manifestations are nonspecific and imaging may mimic a low-grade meningioma. The diagnosis of certainty is histological and is based on essentially morphological criteria. The latter condition the overall survival of the patient and the therapeutic conduct.展开更多
Summary: The aim of this work was to determine the frequency of rectal prolapse and to describe the therapeutic aspects. Material and Methods: A descriptive study with a retrospective collection was carried out betwee...Summary: The aim of this work was to determine the frequency of rectal prolapse and to describe the therapeutic aspects. Material and Methods: A descriptive study with a retrospective collection was carried out between January 2013 and May 2016 in 29 months in the pediatric surgery department at the Center University Hospital of Brazzaville. Children between the ages of 1 and 15 years of age, treated for rectal prolapse and whose records were exploitable were included. The variables studied were: age, gender, parental socio-economic status, consultation time, preference factors, pre-admission treatment, treatment initiated and progression. Results: In 29 months, 22 cases of rectal prolapse were collected, i.e. a hospital frequency of 0.96%. The mean age was 4.5 years extremes (1 and 11 years). The average time of consultation was 5 days extremes (1 and 21 days). Diarrhea 5 cases (23%), constipation diarrhea 3 cases (14%), constipation 10 cases (45%), bronchopneumopathy 4 cases (18%). The treatment was surgical according to the Thiersch technique in all cases. The evolution was favorable. Conclusion: Rectal prolapse, a benign pathology, is relatively uncommon. Constipation remains the main factor favoring the need to take care of upstream. Treatment by the Thiersch method remains the first choice in children.展开更多
BACKGROUND Unintended pregnancy occurs when an individual or couple conceives without planning or desire,which can potentially affect a child’s physical,mental,and social well-being.This can then lead to long-term so...BACKGROUND Unintended pregnancy occurs when an individual or couple conceives without planning or desire,which can potentially affect a child’s physical,mental,and social well-being.This can then lead to long-term socioeconomic challenges for families and communities.Although its impact on child growth and development is a pressing concern,research remains limited particularly in multicenter settings.AIM To examine the long-term consequences of unintended pregnancy on the critical years of early childhood growth and development.METHODS This analytical observational study employed a case-control design and was conducted in research centers across Indonesia,encompassing those located in Central Java,Lampung,Bali,and West Nusa Tenggara.A total of 700 children aged≤5 years with histories of intended or unintended pregnancies participated.Data collection involved structured interviews and direct anthropometric and developmental assessments.Data analyses were conducted using multivariate statistics and partial least squares structural equation modeling.RESULTS Unintended pregnancy was found to have a statistically significant effect on both child growth(t=8.178;P<0.001)and child development(t=25.688;P<0.001).Key growth problems identified included underweight,undernutrition,abnormal head circumference,and stunting.Developmental challenges prominently associated with unintended pregnancy included behavioral and emotional disorders,autism spectrum disorder,attentiondeficit/hyperactivity disorder,social and motor skill deficits,as well as visual and hearing impairments.CONCLUSION Unintended pregnancy significantly affects child growth and development,underscoring the need for early intervention,quality prenatal care,and strengthened family planning policies.展开更多
Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarte...Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.展开更多
BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic f...BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.展开更多
AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancrea...AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and < 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(95% vs 61%,P = 0.004),and absence of lymph nodemetastases(60% vs 18%,P = 0.036) were significantly associated with the 5-year survival.CONCLUSION: Negative surgical margins and a tumor size ≤ 20 mm were independent favorable prognostic factors.Histologically curative resection and early tumor detection are important factors in achieving long-term survival.展开更多
AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma. METHODS: A retrospective analysis of patient data was performed, which...AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma. METHODS: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up. RESULTS: Preoperative levels of cancer antigen 125 (12.51 +/- 9.31 vs 23.20 +/- 21.86, P < 0.05) and carbohydrate antigen 19-9 (22.56 +/- 26.30 vs 72.55 +/- 115.99, P < 0.05) were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications. CONCLUSION: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refine...Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refined staging system for PDAC.Methods:Data were collected from the China Pancreas Data Center(CPDC)for patients with resected PDAC in 2016 and 2017,and cancer-specific survival(CSS)was evaluated using the Kaplan-Meier method and log-rank test.Univariate and multivariate analyses based on Cox regression were performed to identify prognostic factors.The recursive partitioning analysis(RPA),Kaplan-Meier method,and log-rank test were performed on the training dataset to generate a proposed modification for the 8 th TNM staging system utilizing the preoperative carbohydrate antigen(CA)19-9 level.Validation was performed for both staging systems in the validation cohort.Results:A total of 1,676 PDAC patients were retrieved,and the median CSS was significantly different between the 8 th TNM groupings,with no significant difference in survival between stage IB and IIA.The analysis of T and N stages demonstrated a better prognostic value in the N category.Multivariate analysis showed that the preoperative serum CA19-9 level was the strongest prognostic indicator among all the independent risk factors.All patients with CA19-9>500 U/mL had similar survival,and we proposed a new staging system by combining IB and IIA and stratifying all patients with high CA19-9 into stage III.The modified staging system had a better performance for predicting CSS than the 8 th AJCC staging scheme.Conclusions:The 8 th AJCC staging system for PDAC is suitable for a Chinese cohort of resected patients,and the N category has a better prognostic value than the T category.Our modified staging system has superior accuracy in predicting survival than the 8 th AJCC TNM staging system.展开更多
AIM： To evaluate the clinicopathologic characteristics of patients with metastases to the gallbladder （MGBs）. METHODS： We performed a single-center retrospective study of 20 patients with MGBs diagnosed pathologic...AIM： To evaluate the clinicopathologic characteristics of patients with metastases to the gallbladder （MGBs）. METHODS： We performed a single-center retrospective study of 20 patients with MGBs diagnosed pathologically from 1999 to 2007. RESULTS： Among 417 gallbladder （GB） malignancies, 20 （4.8%） were MGBs. The primary malignancies originated from the stomach （n = 8）, colorectum （n = 3）, liver （n = 2）, kidney （n = 2）, skin （n = 2）, extrahepatic bile duct （n = 1）, uterine cervix （n = 1）, and appendix （n = 1）. Twelve patients were diagnosed metachronously, presenting with cholecystitis （n = 4）, abdominal pain （n = 2）, jaundice （n = 1）, weight loss （n = 1）, and serum CA 19-9 elevation （n = 1）; five patients were asymptomatic. The median survival after the diagnosis of MGB was 8.7 mo. On Cox regression analysis, R0 resection was the only factor associated with a prolonged survival [hazard ratio （HR）： 0.01, P = 0.002]; presentation with cholecystitis was associated with poor survival （HR： 463.27, P = 0.006）. CONCLUSION： MGBs accounted for 4.8% of all pathologically diagnosed GB malignancies. The most common origin was the stomach. The median survival of MGI3 was 8.7 mo.展开更多
The journey to implement cancer genomic medicine(CGM)in oncology practice began in the 1980s,which is considered the dawn of genetic and genomic cancer research.At the time,a variety of activating oncogenic alteration...The journey to implement cancer genomic medicine(CGM)in oncology practice began in the 1980s,which is considered the dawn of genetic and genomic cancer research.At the time,a variety of activating oncogenic alterations and their functional significance were unveiled in cancer cells,which led to the development of molecular targeted therapies in the 2000s and beyond.Although CGM is still a relatively new discipline and it is difficult to predict to what extent CGM will benefit the diverse pool of cancer patients,the National Cancer Center(NCC)of Japan has already contributed considerably to CGM advancement for the conquest of cancer.Looking back at these past achievements of the NCC,we predict that the future of CGM will involve the following:1)A biobank of paired cancerous and non-cancerous tissues and cells from various cancer types and stages will be developed.The quantity and quality of these samples will be compatible with omics analyses.All biobank samples will be linked to longitudinal clinical information.2)New technologies,such as whole-genome sequencing and artificial intelligence,will be introduced and new bioresources for functional and pharmacologic analyses(e.g.,a patient-derived xenograft library)will be systematically deployed.3)Fast and bidirectional translational research(bench-to-bedside and bedside-to-bench)performed by basic researchers and clinical investigators,preferably working alongside each other at the same institution,will be implemented;4)Close collaborations between academia,industry,regulatory bodies,and funding agencies will be established.5)There will be an investment in the other branch of CGM,personalized preventive medicine,based on the individual's genetic predisposition to cancer.展开更多
Sanming model in healthcare reform has attracted much attention due to its comprehensive and efficient exploration,while its impact on physicians’prescribing behavior remains unknown.In the present study,we aimed to ...Sanming model in healthcare reform has attracted much attention due to its comprehensive and efficient exploration,while its impact on physicians’prescribing behavior remains unknown.In the present study,we aimed to evaluate the impact of Sanming reform on physicians’medicine use in county-level public hospitals.We collected outpatient prescriptions in the internal medicine and pediatric departments from nine county public hospitals in Sanming from January 2011 to December 2017.We used six prescribing indicators to analyze physicians’medicine use.The Mann-Kendall test was used to examine trends in the study outcomes.A total of 1577904 outpatient prescriptions were included in this study.The average prescription rate of antibiotics and combined antibiotics were 57.5%and 12.2%in 2011,respectively,which were declined to 28.2%(P=0.007)and 2.9%(P=0.003)in 2017,respectively.The average prescription rate of injection was 30.2%in 2011 and declined to 5.3%(P=0.003)in 2017.As for the subgroup analysis of the internal medicine and pediatric departments,the average prescription rate of antibiotics was 39.3%and 71.4%in 2011,respectively,which was declined to 10.2%(P=0.003)and 47.3%(P=0.035)in 2017,respectively.The average prescription rate of combined antibiotics was 15.9%and 9.4%in 2011,respectively,which was declined to 2.9%(P=0.003)and 2.9%(P=0.016),respectively.The average prescription rate of injection was 17.8%and 39.6%in 2011,respectively,which was declined to 1.9%(P=0.003)and 9.0%(P=0.003),respectively.Our study showed a significant decreasing trend in antibiotic use in county-level public hospitals after the Sanming healthcare reform,indicating that the reform successfully promoted the appropriate use of medicine to some extent.展开更多
Objective:To identify the predictors of mortality among in-hospital melioidosis patients.Methods:A total of 453 patients in Hospital Sultanah Bahiyah,Kedah,and Hospital Tuanku Fauziah,Perlis with culture-confirmed mel...Objective:To identify the predictors of mortality among in-hospital melioidosis patients.Methods:A total of 453 patients in Hospital Sultanah Bahiyah,Kedah,and Hospital Tuanku Fauziah,Perlis with culture-confirmed melioidosis were retrospectively included in the study.Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis.The analysis was performed using STATA/SE 14.0.Results:A total of 50.11%(227/453)of the patients died at the hospital,and a majority(86.75%,393/453)of cases were bacteremic.The logistic regression estimated that the bacteremic type of melioidosis,low platelet count,abnormal white blood cell counts,and increased urea value were predictors of mortality.The results showed that bacteremic melioidosis increased the risk of death by 4.39 times(OR 4.39,95%CI 1.83-10.55,P=0.001)compared to non-bacteremic melioidosis.Based on laboratory test,the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease[high white blood cell(>10×10^(9)/L):OR 2.43,95%CI1.41-4.17,P<0.001;low white blood cell(<4×10^(9)/L):OR 3.82,95%CI 1.09-13.34,P=0.036;low platelet(<100×10^(9)/L):OR 4.19,95%CI 1.89-9.30,P<0.001;high urea(>7800μmol/L):OR 5.53,95%CI 2.50-12.30,P<0.001;and low level of urea(<2500μmol/L):OR 3.52,95%CI 1.71-7.23,P=0.001].Conclusions:Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.展开更多
Aim： To evaluate the efficacy and safety of SK3530, a newly developed type 5 phosphodiesterase inhibitor （PDE5I）, in Korean men with erectile dysfunction （ED）. Methods： A total of 119 patients were randomized at...Aim： To evaluate the efficacy and safety of SK3530, a newly developed type 5 phosphodiesterase inhibitor （PDE5I）, in Korean men with erectile dysfunction （ED）. Methods： A total of 119 patients were randomized at 10 centers in Korea to receive either SK3530 （50, 100, or 150 mg; n = 89） or placebo （n = 30） taken 1 h before anticipated sexual activity for an 8-week period. The patients were evaluated at baseline and 4 and 8 weeks after beginning therapy. Efficacy was assessed using the International Index of Erectile Function （IIEF）, Sexual Encounter Profile （SEP）, and the Global Assessment Question （GAQ）. Safety was analyzed by adverse events, laboratory values and vital signs. Results： At the end of the study, all the primary and secondary efficacy end-points were statistically significantly improved by SK3530 compared with placebo （P 〈 0.05）. Of the 89 patients in the treatment arm, 36 （42.3 %） achieved normal erectile function after treatment, including six patients with severe ED. Treatment-related adverse events occurred in 32 patients. The most common adverse events were flushing, headache, dizziness and eye redness （10.9%, 7.6%, 2.5% and 2.5%, respectively）, and most were mild. Only two patients discontinued treatment during the study period because of adverse events. Conclusion： The results of our phase Ⅱ study have confirmed the efficacy and safety of SK3530 in a broad population of men with ED of various etiologies and severity. The optimal doses in terms of efficacy and safety were determined to be 50 mg and 100 mg, respectively.展开更多
Background: The optimal rate of feeding advancement after initiation of early enteral nutrition (EEN) for underweight, critically ill patients is unknown. Methods: We conducted a retrospective chart review in intensiv...Background: The optimal rate of feeding advancement after initiation of early enteral nutrition (EEN) for underweight, critically ill patients is unknown. Methods: We conducted a retrospective chart review in intensive care unit (ICU) patients with a body mass index (BMI) < 20.0 kg/m<sup>2</sup>. Patients were categorized into Group R, which reached the energy target within 3 days of EEN initiation, and Group S, which reached the energy target 4 or more days after EEN initiation. Results: A total of 65 patients with a median age of 73 years were included in the study. No significant differences were observed between the two groups for all-cause mortality, ICU-free days, or length of hospital stay. Ventilator-free days (VFDs) were significantly fewer in Group R than in Group S (18.0 [0.0 - 22.0] vs. 21.0 [16.3 - 24.8] days;P = 0.046). A significantly higher number of patients requiring mechanical ventilation (MV) at hospital discharge were observed in Group R than in Group S (29% vs. 8%;P = 0.030). Multivariable analyses with adjustment for confounders found that days required to reach target energy intake after EEN initiation were significantly and independently associated with the requirement for MV at hospital discharge, but not with VFDs. Conclusion: A slow rate of feeding advancement after initiation of EEN in critically ill patients having a BMI of <20.0 kg/m<sup>2</sup> might be associated with a reduced requirement for MV at hospital discharge. These results require confirmation in a large multicenter trial of underweight, critically ill patients.展开更多
Background: The nutritional support after hematopoietic stem cell transplantation (HSCT) has not been well established due to the scarcity of clinical trials. To conduct international clinical trials in Asia, we perfo...Background: The nutritional support after hematopoietic stem cell transplantation (HSCT) has not been well established due to the scarcity of clinical trials. To conduct international clinical trials in Asia, we performed the questionnaire survey to investigate the current standard of nutritional support after HSCT. Method: We sent the questionnaire to the physicians nominated by the Asia Pacific Blood and Marrow Transplantation (APBMT) members of each country/ region. Result: We received 15 responses from 7 different countries/regions. The target calorie amount is 1.0 - 1.3 × basal energy expenditure (BEE) in 11 institutes when partial parenteral nutrition is used. When total parenteral nutrition (TPN) is used, the target calorie amount is 1.0 - 1.3 × BEE in 9 institutes and 1.3 - 1.5 × BEE in 4 institutes. Lipid emulsion is routinely used in 12 institutes. Multivitamins and trace elements are routinely added to TPN used in most institutes. It is still uncommon to use the immunonutrition. Blood glucose levels are routinely monitored in all institutes, but the target range varies (<110 in 2 institutes, <150 in 4 institutes, and <200 in 8 institutes). Conclusions: Basic nutritional support is similar in participating institutes. However, the target glucose level varies and the use of immunonutrition is rather rare. These points can be the theme of future clinical trials.展开更多
Objective:To evaluate whether Ding Kun Dan(DKD)can improve the vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)outcomes in patients with predicted poor ovarian response(POR)safely ...Objective:To evaluate whether Ding Kun Dan(DKD)can improve the vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)outcomes in patients with predicted poor ovarian response(POR)safely and effectively.Methods:Prospective,multicenter,randomized controlled trial;A total of 278 POR patients were randomized in DKD group or immediate treatment group.Both groups received IVF or ICSI as a standard treatment while in the DKD group,DKD was administrated for 3 months before the IVF/ICSI cycle.The primary outcome was the ongoing pregnancy rate.The secondary outcomes include clinical pregnancy rate,biochemical pregnancy rate,total gonadotropin(Gn)dosage and duration,estradiol(E2)and progesterone(P)levels on human chorionic gonadotropin(hCG)trigger day,cycle cancellation rate,number of oocytes retrieved,high-quality embryo rate and any adverse events.Results:Compared to the immediate IVF treatment group,oral administration of DKD for 3 months before IVF led to a significant increase in ongoing pregnancy rate(30.0%v.s.17.6%,P<0.05),biochemical pregnancy rate(39.2%vs.25.2%,P<0.05),clinical pregnancy rate(36.7%vs.22.7%,P<0.05)and high-quality embryo rate(40.8%vs.32.4%,P<0.05),and a significant decrease in Gn duration(P<0.05).However,no significant differences were found in total dosage of Gn,number of retrieved oocytes,cycle cancellation rate,E2 level and P level on hCG trigger days(P>0.05).No serious adverse events occurred during the intervention period in either group.Conclusion:DKD is a safe and effective intervention to improve the IVF/ICSI-ET outcomes in patients with POR.展开更多
基金the Japan Agency for Medical Research and Development(Grant Nos.20lk0201002j0001,21lk0201005j0001,and 22lk0201007j0001)。
文摘Precision medicine is a growing field worldwide.Despite its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical practice.The main obstacles are associated with the quality of samples used for genomic analysis。
文摘Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is to report a case of Demons-Meigs syndrome, to determine its different characteristics and to make clinicians aware of the malignant predictive value of CA 125 in front of an ovarian tumor. Observation: The patient was 42 years old and had no previous history. She presented with intense abdominal pain of sudden onset, prompting a medical consultation. On clinical examination, the abdomen was distended with signs of peritoneal effusion and right pleural effusion. Ultrasound revealed a well-circumscribed, ovarian mass with an internal fluid component and hypervascularization on Doppler. The CA 125 level was elevated (293.9 U/ml). Exploratory laparotomy revealed two bilateral, firm, solid ovarian tumors without vegetation or peritoneal lesions. Macroscopically, one of the tumors was well circumscribed, lobulated with a smooth outer surface. It measured 20 × 17 × 8 cm and weighed 1400 g. The other tumor measured 19 × 11 × 5 cm, weighed 1090 g and had the same characteristics as the other tumor. Histologically, both tumors were a proliferation of fibroblastic spindle cells organized in short intersecting or storiform bundles, without cyto-nuclear atypia or excess mitoses. The diagnosis retained was bilateral ovarian fibroma in the context of a Demons-Meigs syndrome. Conclusion: Demons-Meigs syndrome is a rare entity. The concomitant elevation of the CA 125 level is not always an indicator of ovarian cancer. The curative treatment is surgical based on tumor removal ensuring the disappearance of peritoneal and pleural effusions.
文摘Patients living with chronic kidney disease (CKD) are at high risk of cardiovascular events. Our aim in this study was to assess the cut-off value for lipoprotein (a) (Lp(a)) in CKD patients with a history of cardiovascular disease (CVD). This was a cross-sectional study. Variables including age, sex, history of CVD, body mass index and CKD stage, were collected during CKD patient’s first admission in the nephrology dialysis department. Blood samples were collected for quantitative determination of Lp(a) by immunoturbidimetric method. They were divided into two groups: CKD patients without history of CVD and CKD patients with history of CVD. Fisher’s exact test was used to assess associations with a significance level of 0.05%. Area under the curve (AUC) and new cut-off value for Lp(a) were identified by drawing Receiver Operating Characteristic (ROC) curve. A total of seventy CKD patients with median age of 43 years [minimum-maximum = 15 - 78 years] were included. Patients with history of CVD were 65.71% (46/70). New Lp(a) cut-off point in CKD patients with history of CVD was 66.50 nmol/L [sensitivity, 87.00%;specificity, 58.30%;AUC = 0.727;p = 0.000]. ROC curve demonstrated good performance of Lp(a) to screen CKD patients with history of CVD. Further research is needed to determine an LPA gene polymorphism’s contribution to increasing risk for CVD at each kidney disease stage.
文摘Introduction: Meningiomas are tumors formed by arachnoid cells, typically attached to the inner surface of the dura mater. Malignant forms are rare and no case has been reported in the Malagasy literature. The objective of our study is to report two Malagasy cases of malignant meningioma and to discuss the epidemiological and anatomical-clinical particularities of this tumor. Observation: The first patient, a 41-year-old woman, presented with a rapidly progressive intracranial hypertension syndrome. The patient had undergone surgery two years earlier for a grade II meningioma and had no family history of meningioma, neurofibromatosis, or personal history of brain irradiation or head trauma. Her brain scan showed a heterogeneous polylobed left parieto-occipital mass with a meningeal implantation base. The anatomopathological examination of the samples revealed a malignant meningioma. The second patient was a 33-year-old man, operated for grade I meningioma eleven months before admission, with no other personal or family history. The patient was hospitalized for tumor recurrence with signs of intracranial hypertension. The brain computed tomography (CT) scan showed a heterogeneous extra-axial tumor in right temporo-parietal lobe. Surgical excision was performed. On histological examination, a proliferation of tumor cells of meningothelial appearance with papillary architecture was observed, leading to the diagnosis of malignant meningioma. Conclusion: Malignant meningioma is a rare and serious entity. The clinical manifestations are nonspecific and imaging may mimic a low-grade meningioma. The diagnosis of certainty is histological and is based on essentially morphological criteria. The latter condition the overall survival of the patient and the therapeutic conduct.
文摘Summary: The aim of this work was to determine the frequency of rectal prolapse and to describe the therapeutic aspects. Material and Methods: A descriptive study with a retrospective collection was carried out between January 2013 and May 2016 in 29 months in the pediatric surgery department at the Center University Hospital of Brazzaville. Children between the ages of 1 and 15 years of age, treated for rectal prolapse and whose records were exploitable were included. The variables studied were: age, gender, parental socio-economic status, consultation time, preference factors, pre-admission treatment, treatment initiated and progression. Results: In 29 months, 22 cases of rectal prolapse were collected, i.e. a hospital frequency of 0.96%. The mean age was 4.5 years extremes (1 and 11 years). The average time of consultation was 5 days extremes (1 and 21 days). Diarrhea 5 cases (23%), constipation diarrhea 3 cases (14%), constipation 10 cases (45%), bronchopneumopathy 4 cases (18%). The treatment was surgical according to the Thiersch technique in all cases. The evolution was favorable. Conclusion: Rectal prolapse, a benign pathology, is relatively uncommon. Constipation remains the main factor favoring the need to take care of upstream. Treatment by the Thiersch method remains the first choice in children.
文摘BACKGROUND Unintended pregnancy occurs when an individual or couple conceives without planning or desire,which can potentially affect a child’s physical,mental,and social well-being.This can then lead to long-term socioeconomic challenges for families and communities.Although its impact on child growth and development is a pressing concern,research remains limited particularly in multicenter settings.AIM To examine the long-term consequences of unintended pregnancy on the critical years of early childhood growth and development.METHODS This analytical observational study employed a case-control design and was conducted in research centers across Indonesia,encompassing those located in Central Java,Lampung,Bali,and West Nusa Tenggara.A total of 700 children aged≤5 years with histories of intended or unintended pregnancies participated.Data collection involved structured interviews and direct anthropometric and developmental assessments.Data analyses were conducted using multivariate statistics and partial least squares structural equation modeling.RESULTS Unintended pregnancy was found to have a statistically significant effect on both child growth(t=8.178;P<0.001)and child development(t=25.688;P<0.001).Key growth problems identified included underweight,undernutrition,abnormal head circumference,and stunting.Developmental challenges prominently associated with unintended pregnancy included behavioral and emotional disorders,autism spectrum disorder,attentiondeficit/hyperactivity disorder,social and motor skill deficits,as well as visual and hearing impairments.CONCLUSION Unintended pregnancy significantly affects child growth and development,underscoring the need for early intervention,quality prenatal care,and strengthened family planning policies.
基金supported by grants from the National Natural Science Foundation of China(91959203,82272836 and 82373017)。
文摘Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.
文摘BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.
文摘AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and < 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(95% vs 61%,P = 0.004),and absence of lymph nodemetastases(60% vs 18%,P = 0.036) were significantly associated with the 5-year survival.CONCLUSION: Negative surgical margins and a tumor size ≤ 20 mm were independent favorable prognostic factors.Histologically curative resection and early tumor detection are important factors in achieving long-term survival.
文摘AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma. METHODS: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up. RESULTS: Preoperative levels of cancer antigen 125 (12.51 +/- 9.31 vs 23.20 +/- 21.86, P < 0.05) and carbohydrate antigen 19-9 (22.56 +/- 26.30 vs 72.55 +/- 115.99, P < 0.05) were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications. CONCLUSION: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
基金supported by grants from the National Natural Science Foundation of China(No.81672353 and 81871954)。
文摘Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refined staging system for PDAC.Methods:Data were collected from the China Pancreas Data Center(CPDC)for patients with resected PDAC in 2016 and 2017,and cancer-specific survival(CSS)was evaluated using the Kaplan-Meier method and log-rank test.Univariate and multivariate analyses based on Cox regression were performed to identify prognostic factors.The recursive partitioning analysis(RPA),Kaplan-Meier method,and log-rank test were performed on the training dataset to generate a proposed modification for the 8 th TNM staging system utilizing the preoperative carbohydrate antigen(CA)19-9 level.Validation was performed for both staging systems in the validation cohort.Results:A total of 1,676 PDAC patients were retrieved,and the median CSS was significantly different between the 8 th TNM groupings,with no significant difference in survival between stage IB and IIA.The analysis of T and N stages demonstrated a better prognostic value in the N category.Multivariate analysis showed that the preoperative serum CA19-9 level was the strongest prognostic indicator among all the independent risk factors.All patients with CA19-9>500 U/mL had similar survival,and we proposed a new staging system by combining IB and IIA and stratifying all patients with high CA19-9 into stage III.The modified staging system had a better performance for predicting CSS than the 8 th AJCC staging scheme.Conclusions:The 8 th AJCC staging system for PDAC is suitable for a Chinese cohort of resected patients,and the N category has a better prognostic value than the T category.Our modified staging system has superior accuracy in predicting survival than the 8 th AJCC TNM staging system.
文摘AIM： To evaluate the clinicopathologic characteristics of patients with metastases to the gallbladder （MGBs）. METHODS： We performed a single-center retrospective study of 20 patients with MGBs diagnosed pathologically from 1999 to 2007. RESULTS： Among 417 gallbladder （GB） malignancies, 20 （4.8%） were MGBs. The primary malignancies originated from the stomach （n = 8）, colorectum （n = 3）, liver （n = 2）, kidney （n = 2）, skin （n = 2）, extrahepatic bile duct （n = 1）, uterine cervix （n = 1）, and appendix （n = 1）. Twelve patients were diagnosed metachronously, presenting with cholecystitis （n = 4）, abdominal pain （n = 2）, jaundice （n = 1）, weight loss （n = 1）, and serum CA 19-9 elevation （n = 1）; five patients were asymptomatic. The median survival after the diagnosis of MGB was 8.7 mo. On Cox regression analysis, R0 resection was the only factor associated with a prolonged survival [hazard ratio （HR）： 0.01, P = 0.002]; presentation with cholecystitis was associated with poor survival （HR： 463.27, P = 0.006）. CONCLUSION： MGBs accounted for 4.8% of all pathologically diagnosed GB malignancies. The most common origin was the stomach. The median survival of MGI3 was 8.7 mo.
文摘The journey to implement cancer genomic medicine(CGM)in oncology practice began in the 1980s,which is considered the dawn of genetic and genomic cancer research.At the time,a variety of activating oncogenic alterations and their functional significance were unveiled in cancer cells,which led to the development of molecular targeted therapies in the 2000s and beyond.Although CGM is still a relatively new discipline and it is difficult to predict to what extent CGM will benefit the diverse pool of cancer patients,the National Cancer Center(NCC)of Japan has already contributed considerably to CGM advancement for the conquest of cancer.Looking back at these past achievements of the NCC,we predict that the future of CGM will involve the following:1)A biobank of paired cancerous and non-cancerous tissues and cells from various cancer types and stages will be developed.The quantity and quality of these samples will be compatible with omics analyses.All biobank samples will be linked to longitudinal clinical information.2)New technologies,such as whole-genome sequencing and artificial intelligence,will be introduced and new bioresources for functional and pharmacologic analyses(e.g.,a patient-derived xenograft library)will be systematically deployed.3)Fast and bidirectional translational research(bench-to-bedside and bedside-to-bench)performed by basic researchers and clinical investigators,preferably working alongside each other at the same institution,will be implemented;4)Close collaborations between academia,industry,regulatory bodies,and funding agencies will be established.5)There will be an investment in the other branch of CGM,personalized preventive medicine,based on the individual's genetic predisposition to cancer.
基金the Health and Family Planning Commission of Sanming for their support and cooperation
文摘Sanming model in healthcare reform has attracted much attention due to its comprehensive and efficient exploration,while its impact on physicians’prescribing behavior remains unknown.In the present study,we aimed to evaluate the impact of Sanming reform on physicians’medicine use in county-level public hospitals.We collected outpatient prescriptions in the internal medicine and pediatric departments from nine county public hospitals in Sanming from January 2011 to December 2017.We used six prescribing indicators to analyze physicians’medicine use.The Mann-Kendall test was used to examine trends in the study outcomes.A total of 1577904 outpatient prescriptions were included in this study.The average prescription rate of antibiotics and combined antibiotics were 57.5%and 12.2%in 2011,respectively,which were declined to 28.2%(P=0.007)and 2.9%(P=0.003)in 2017,respectively.The average prescription rate of injection was 30.2%in 2011 and declined to 5.3%(P=0.003)in 2017.As for the subgroup analysis of the internal medicine and pediatric departments,the average prescription rate of antibiotics was 39.3%and 71.4%in 2011,respectively,which was declined to 10.2%(P=0.003)and 47.3%(P=0.035)in 2017,respectively.The average prescription rate of combined antibiotics was 15.9%and 9.4%in 2011,respectively,which was declined to 2.9%(P=0.003)and 2.9%(P=0.016),respectively.The average prescription rate of injection was 17.8%and 39.6%in 2011,respectively,which was declined to 1.9%(P=0.003)and 9.0%(P=0.003),respectively.Our study showed a significant decreasing trend in antibiotic use in county-level public hospitals after the Sanming healthcare reform,indicating that the reform successfully promoted the appropriate use of medicine to some extent.
基金supported by Universiti Sultan Zainal Abidin(grant number:Uni SZA/2018/DPU/16)
文摘Objective:To identify the predictors of mortality among in-hospital melioidosis patients.Methods:A total of 453 patients in Hospital Sultanah Bahiyah,Kedah,and Hospital Tuanku Fauziah,Perlis with culture-confirmed melioidosis were retrospectively included in the study.Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis.The analysis was performed using STATA/SE 14.0.Results:A total of 50.11%(227/453)of the patients died at the hospital,and a majority(86.75%,393/453)of cases were bacteremic.The logistic regression estimated that the bacteremic type of melioidosis,low platelet count,abnormal white blood cell counts,and increased urea value were predictors of mortality.The results showed that bacteremic melioidosis increased the risk of death by 4.39 times(OR 4.39,95%CI 1.83-10.55,P=0.001)compared to non-bacteremic melioidosis.Based on laboratory test,the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease[high white blood cell(>10×10^(9)/L):OR 2.43,95%CI1.41-4.17,P<0.001;low white blood cell(<4×10^(9)/L):OR 3.82,95%CI 1.09-13.34,P=0.036;low platelet(<100×10^(9)/L):OR 4.19,95%CI 1.89-9.30,P<0.001;high urea(>7800μmol/L):OR 5.53,95%CI 2.50-12.30,P<0.001;and low level of urea(<2500μmol/L):OR 3.52,95%CI 1.71-7.23,P=0.001].Conclusions:Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.
文摘Aim： To evaluate the efficacy and safety of SK3530, a newly developed type 5 phosphodiesterase inhibitor （PDE5I）, in Korean men with erectile dysfunction （ED）. Methods： A total of 119 patients were randomized at 10 centers in Korea to receive either SK3530 （50, 100, or 150 mg; n = 89） or placebo （n = 30） taken 1 h before anticipated sexual activity for an 8-week period. The patients were evaluated at baseline and 4 and 8 weeks after beginning therapy. Efficacy was assessed using the International Index of Erectile Function （IIEF）, Sexual Encounter Profile （SEP）, and the Global Assessment Question （GAQ）. Safety was analyzed by adverse events, laboratory values and vital signs. Results： At the end of the study, all the primary and secondary efficacy end-points were statistically significantly improved by SK3530 compared with placebo （P 〈 0.05）. Of the 89 patients in the treatment arm, 36 （42.3 %） achieved normal erectile function after treatment, including six patients with severe ED. Treatment-related adverse events occurred in 32 patients. The most common adverse events were flushing, headache, dizziness and eye redness （10.9%, 7.6%, 2.5% and 2.5%, respectively）, and most were mild. Only two patients discontinued treatment during the study period because of adverse events. Conclusion： The results of our phase Ⅱ study have confirmed the efficacy and safety of SK3530 in a broad population of men with ED of various etiologies and severity. The optimal doses in terms of efficacy and safety were determined to be 50 mg and 100 mg, respectively.
文摘Background: The optimal rate of feeding advancement after initiation of early enteral nutrition (EEN) for underweight, critically ill patients is unknown. Methods: We conducted a retrospective chart review in intensive care unit (ICU) patients with a body mass index (BMI) < 20.0 kg/m<sup>2</sup>. Patients were categorized into Group R, which reached the energy target within 3 days of EEN initiation, and Group S, which reached the energy target 4 or more days after EEN initiation. Results: A total of 65 patients with a median age of 73 years were included in the study. No significant differences were observed between the two groups for all-cause mortality, ICU-free days, or length of hospital stay. Ventilator-free days (VFDs) were significantly fewer in Group R than in Group S (18.0 [0.0 - 22.0] vs. 21.0 [16.3 - 24.8] days;P = 0.046). A significantly higher number of patients requiring mechanical ventilation (MV) at hospital discharge were observed in Group R than in Group S (29% vs. 8%;P = 0.030). Multivariable analyses with adjustment for confounders found that days required to reach target energy intake after EEN initiation were significantly and independently associated with the requirement for MV at hospital discharge, but not with VFDs. Conclusion: A slow rate of feeding advancement after initiation of EEN in critically ill patients having a BMI of <20.0 kg/m<sup>2</sup> might be associated with a reduced requirement for MV at hospital discharge. These results require confirmation in a large multicenter trial of underweight, critically ill patients.
文摘Background: The nutritional support after hematopoietic stem cell transplantation (HSCT) has not been well established due to the scarcity of clinical trials. To conduct international clinical trials in Asia, we performed the questionnaire survey to investigate the current standard of nutritional support after HSCT. Method: We sent the questionnaire to the physicians nominated by the Asia Pacific Blood and Marrow Transplantation (APBMT) members of each country/ region. Result: We received 15 responses from 7 different countries/regions. The target calorie amount is 1.0 - 1.3 × basal energy expenditure (BEE) in 11 institutes when partial parenteral nutrition is used. When total parenteral nutrition (TPN) is used, the target calorie amount is 1.0 - 1.3 × BEE in 9 institutes and 1.3 - 1.5 × BEE in 4 institutes. Lipid emulsion is routinely used in 12 institutes. Multivitamins and trace elements are routinely added to TPN used in most institutes. It is still uncommon to use the immunonutrition. Blood glucose levels are routinely monitored in all institutes, but the target range varies (<110 in 2 institutes, <150 in 4 institutes, and <200 in 8 institutes). Conclusions: Basic nutritional support is similar in participating institutes. However, the target glucose level varies and the use of immunonutrition is rather rare. These points can be the theme of future clinical trials.
基金This study was supported by the National Natural Science Foundation of China Nos.81774351the Tianjin Health&Family Planning Commission(Tianjin scientific research project of priority area of traditional Chinese medicine,Nos.2018008)Shanxi Guangyuyuan TCM Co.,Ltd.
文摘Objective:To evaluate whether Ding Kun Dan(DKD)can improve the vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)outcomes in patients with predicted poor ovarian response(POR)safely and effectively.Methods:Prospective,multicenter,randomized controlled trial;A total of 278 POR patients were randomized in DKD group or immediate treatment group.Both groups received IVF or ICSI as a standard treatment while in the DKD group,DKD was administrated for 3 months before the IVF/ICSI cycle.The primary outcome was the ongoing pregnancy rate.The secondary outcomes include clinical pregnancy rate,biochemical pregnancy rate,total gonadotropin(Gn)dosage and duration,estradiol(E2)and progesterone(P)levels on human chorionic gonadotropin(hCG)trigger day,cycle cancellation rate,number of oocytes retrieved,high-quality embryo rate and any adverse events.Results:Compared to the immediate IVF treatment group,oral administration of DKD for 3 months before IVF led to a significant increase in ongoing pregnancy rate(30.0%v.s.17.6%,P<0.05),biochemical pregnancy rate(39.2%vs.25.2%,P<0.05),clinical pregnancy rate(36.7%vs.22.7%,P<0.05)and high-quality embryo rate(40.8%vs.32.4%,P<0.05),and a significant decrease in Gn duration(P<0.05).However,no significant differences were found in total dosage of Gn,number of retrieved oocytes,cycle cancellation rate,E2 level and P level on hCG trigger days(P>0.05).No serious adverse events occurred during the intervention period in either group.Conclusion:DKD is a safe and effective intervention to improve the IVF/ICSI-ET outcomes in patients with POR.
