Status quo of current clinical drug regimens for small cell lung cancer and new progress in the potential target drug therapeutic regimens / 中国药房

Small cell lung cancer （SCLC） accounts for about 15% in lung cancer and is highly malignant， heterogeneous and invasive. Etoposide combined with platinum-based chemotherapy is the basis of standard first-line treatment for extensive-stage SCLC， but suffers from the problem of susceptibility to drug resistance and relapse. In recent years， the emergence of new immunological drugs and novel cytotoxic drugs has improved the survival of SCLC patients to a certain extent， especially bringing therapeutic hope to patients with relapsed/refractory SCLC. In this paper， we review the current clinical drug regimens and the new progress of potential target drug therapeutic regimens for the treatment of SCLC. At present， the first-， second- and third-line schemes of SCLC include etoposide+carboplatin， atezolizumab+etoposide+platinum， adebrelimab， topotecan， docetaxel， etc.； the current drug targets for the treatment of SCLC mainly focus on topoisomerase Ⅱ/Ⅰ， DNA， the immune checkpoint molecules programmed death-1/programmed death-ligand 1， tubulin， etc. The potential target drug therapeutic options include alisertib+ paclitaxel， rovalpituzumab， APG-1252， etc.， and mainly focus on DNA damage response pathways and immune pathways， which can achieve the prolongation of patient survival by exerting anti-tumor effects through aurora kinase A and other potential targets.

Síndromes mielodisplásicos, más allá de los hipometilantes / Myelodysplastic syndromes: beyond hypomethylating agents

Introducción: El comportamiento heterogéneo de los síndromes mielodisplásicos, así como los progresos en los últimos años en el campo de la genética y la biología molecular, han provocado la aparición de múltiples investigaciones con diferentes enfoques terapéuticos. Los agentes hipometilantes son hasta el momento el tratamiento estándar para esta entidad, pero desafortunadamente no son efectivos en el 100 % de los casos y la duración de su respuesta es variable. Objetivo: Analizar las opciones terapéuticas actuales para el tratamiento de los síndromes mielodisplásicos. Métodos: Se realizó una revisión de la literatura, en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google académico de artículos publicados en los últimos 5 años. Se hizo un análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: Actualmente existen múltiples opciones de tratamiento, la mayor parte dirigidos contra los eventos epigenéticos fundamentales: la hipermetilación, la modificación de las histonas diacetilasa y la activación de la respuesta inmune citotóxica contra clones anormales. Sin embargo, como no se ha establecido una única alteración, los tratamientos en la mayoría de los protocolos se adaptan al riesgo, incluyen un número reducido de casos y los resultados son limitados. Conclusiones: Se considera que una posible solución es dirigir el tratamiento a la alteración específica con base en las alteraciones moleculares y la medicina de precisión, fundamentalmente en los pacientes refractarios o en recaída postratamiento con los actuales agentes hipometilantes(AU)

Introduction: The heterogeneous characteristics of myelodysplastic syndromes, as well as the progress in recent years in the field of genetics and molecular biology, have led to the appearance of multiple investigations with different therapeutic approaches. Hypomethylating agents are so far the standard treatment for this entity, but unfortunately they are not effective in 100% of cases and the duration of their response is variable. Objective: To analyze current therapeutic options for the treatment of myelodysplastic syndromes. Methods: A literature review was carried out, in English and Spanish, through the PubMed website and the Google Scholar search engine, for articles published in the last five years. An analysis and summary of the revised bibliography was carried out. Information analysis and synthesis: Currently, there are multiple treatment options, most of which are directed against fundamental epigenetic events: hypermethylation, modification of histone diacetylase, and activation of the cytotoxic immune response against abnormal clones. However, as long as a single alteration has not been established, treatments, in most protocols, are adapted to risk and include a small number of cases, while their outcomes are limited. Conclusions: It is considered that a possible solution is to direct treatment to specific alteration based on molecular alterations and precision medicine, fundamentally in refractory or relapsed patients after treatment with current hypomethylating agents(AU)

Research status of polycythemia vera in China / 中国实用内科杂志

Polycythemia vera is a clonal malignant hematopoietic disorder that results from genetic alterations in hematopoietic stem cells, which is characterized by two or three-line blood cells increase, and mainly by erythrocytosis. This article reviews research situation of PV in China, including pathogenesis, clinical features, disease progression and therapeutic options, which helps clinical specialists to carry out precise diagnosis and treatment.

Fungal infections of the central nervous system in critically ill children / 中国小儿急救医学

Fungal infections of the central nervous system are still devastating and difficult to treat. A greater understanding of host characteristics, diagnostic criteria, and therapeutic options about the severe central nervous system fungal infection,has led to important advances in the diagnosis and management,and resulting in improved outcomes.

Characteristics and risk factors of lymphatic metastasis in early gastric cancer / 中华内科杂志

Objective To summarize the characteristics of regional lymph node metastasis in patients with early gastric cancer and analyze the risk factors for lymphatic metastasis. Methods 103 cases surgically treated for early gastric cancer in the Third Hospital of Peking University between March, 1988 and March, 2009 were analyzed retrospectively. Several clinicalpathologic variables including patients' age, gender, size of tumor, tumor location, macroscopic type, histological type, invasion depth were investigated by using chi-square test and logistic regression analysis for the possible relationship to lymphatic metastasis. Results The rate of lymph node metastasis in early gastric cancer was 17.5% (18/103), which in mucosal cancer was 4. 1% (2/49). Submucosal cancer had a lymph node metastatic rate of 29. 6% (16/54). Logistic regression indicated that invasion to submucosa and tumor size > 2 em were independent risk factors for lymph node metastasis of early gastric cancer. Metastatic cases of mucosal cancer were all signet ring cell cancer with diameters more than 2 cm. Lymph node metastatic rate in submueosal cancers within 2 cm was 16. 1% (5/31), that in > 2 cm submucosal cancers was 47. 8% (11/23) (P = 0. 012). Rate of lymph node metastasis in well-differentiated cancers was 0 (0/13), that in moderately-differentiated, poorly differentiated and signet ring cell cancers were 18. 2% (4/22), 16. 7% (5/30) and 23.7% (9/38) respectively (P = 0. 294). Patients' age, gender, tumor location and macroscopic type showed no relationship with lymph node state. Conclusion The tumor size and invasion depth are related with lymph node metastasis in early gastric cancer, considering these factors and assessing lymph node state is essential to appropriate therapeutic options for early gastric cancer.

Convulsiones neonatales refractarias / Neonatal refractory seizures

Las convulsiones del período neonatal y del primer año de vida pueden tener un origen, un tratamiento y un pronóstico muy distintos y serán el neonatólogo y el neuropediatra quienes mejor las conozcan y manejen con mayor experiencia. Existen formas graves de encefalopatía epiléptica del período neonatal como el Sídrome Ohtahara o la encefalopatía mioclónica de Aicardi, con un pronóstico muy reservado y una elevada morbimortalidad. Además existen algunas formas de convulsiones y epilepsias del período neonatal y del lactante joven que no responden al empleo de fármacos antiepilépticos (FAEs). En esta situación el iniciar precozmente otro tipo de terapia puede evitar el deterioro neurológico que, sin duda debido a las crisis convulsivas, se producirá y podrá permitir al paciente llevar una vida normal con la única obligación de tomar de por vida una medicación distinta de los FAEs. Revisamos el grupo de defectos metabólicos que dan lugar a convulsiones y epilepsias y cuyo tratamiento es muy distinto al de una epilepsia. Incluimos en esta revisión algunas formas de convulsiones y epilepsias del lactante joven que tienen en la actualidad tratamiento efectivo mediante sustancias totalmente distintas de los FAEs.

Convulsions appearing in the neonatal or first year of life can have a very different origin, treatment or prognosis and it shall be up to the neonatologist or neuropediatrician to resolve the problem since they are the ones who know their patients best. There are severe forms of epileptic encephalopathy in the neonatal period such as Ohtahara syndrome or Aicardi myoclonic encephalopathy with poor prognosis and high morbimortality. Furthermore, there are forms of convulsions and epilepsies during the neonatal and infant period which do not respond to AED. In such cases, it is important to initiate as soon as possible another type of treatment to prevent a neurological deterioration due to repeated convulsion crises and thus allow the patients to lead a normal life with the only obligation to take a different medication from AED during their whole life. We discuss the metabolic defects which lead to convulsions and epilepsies and their various treatments. We also include a revision of some forms of convulsions and epilepsies in the infant insisting on treatments with substances completely different from AEDs.

Therapeutic options to treate subaxial cervical fracture-dislocation with locked-facet / 中国矫形外科杂志

[Objective]To evaluate a simple,safty and effective therapeutic option to treate subaxial cervical fracture-dislocation with locked-facet.[Method]With the patients being awake and supervized under X-ray fluoroscopy,the authors used the early and continued closed skull traction-reduction to treate 16 cases of traumatic subaxial cervical fracture-dislocation with locked-facet.Before the beginning of the treatment,all the patients were taken for X-ray plain films and MRI/CT examinations as well as American Spinal Injury Association(ASIA) neurological function grade.The dynamic ASIA neurological function scale and X-ray fluoroscopy examnations were asked during the skull traction–reduction procedures.The average interval from the traumatic events to begin to skull traction–reduction was 31 hours(6-52 hours).The authors would continue the skull traction to maintain the anatomy position as soon as they succeeded in reducing the dislocation with locked-facet,forthmore they would take the anterior operation or combinations with anterior and posterior operations during the best condition.[Result]The MRI scans showed that there were 8 disc hernations and 5 disc disruptions at the dislocation levels before traction–reduction procedures.The ASIA scale were 7 grade C,5 grade D and 4 grade E,respectively.All the 16 cases succeeded in reduction as well as no neurological deterioration occurred.The postreduction MRI scans showed that 2 disc herations had converted to nearly normal disc position and another 4 disc hernations remained unchanged.Accordingly,2 disc disruption remained unchanged and another case had converted to disc hernation.The average traction weight was 19 kg(10~32 kg) and average traction time was 53 minutes(30~135 minutes).[Conclusion]Under the intensive dynamic ASIA neurological function grade and X-Ray fluoroscopy examnations,with the patients being awake and co-operation,the early and continued closed skull traction-reduction and then performing elective anterior or anterior-posterior surgery depending on the patient's overall and local status to treate subaxial cervical fracture-dislocation with locked-facet is safe and effective.

Seven cases of ureteroceles / 대한비뇨기과학회지

Ureterocele represents cystic dilatation of the intravesical segment of the ureter and there are numerous presentation and treatment of ureterocele. Herein, during the last 5 years we experienced 7 adults and children with ureterocele, four of them are single system ureterocele, and the rest three are duplex system ureterocele. Diagnosis was made by IVP, VCUG, USG and Renal scan. In two cases of four single system ureteroceles, transurethral incision of ureterocele were performed, in one case ureterocelectomy was performed, and ureterocelectomy with ureteroneocystostomy was performed in rest one case. In case of duplex system ureterocele, two cases were performed upper pole heminephrectomy with subtotal ureterectomy. and the other case was performed pyeloureterostomy. All patients were followed-up from 6 months to 2 years and we gained satisfactory results. Herein, we reached conclusion that despite of numerous therapeutic options of ureteroceles, it must be selected based on the pathophysiologic condition and on the preservation of the renal function of the involved kidney.