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1.
Recent Results Cancer Res ; 214: 1-70, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31473848

RESUMO

Exploiting the unique specificity of monoclonal antibodies has revolutionized the treatment and diagnosis of haematological and solid organ malignancies; bringing benefit to millions of patients over the past decades. Recent achievements include conjugating antibodies with toxic payloads resulting in superior efficacy and/or reduced toxicity, development of molecular imaging techniques targeting specific antigens for use as predictive and prognostic biomarkers, the development of novel bi- and tri-specific antibodies to enhance therapeutic benefit and abrogate resistance and the success of immunotherapy agents. In this chapter, we review an overview of antibody structure and function relevant to cancer therapy and provide an overview of pivotal clinical trials which have led to regulatory approval of monoclonal antibodies in cancer treatment. We further discuss resistance mechanisms and the unique side effects of each class of antibody and provide an overview of emerging therapeutic agents.


Assuntos
Anticorpos Monoclonais/farmacologia , Imunoterapia , Neoplasias/terapia , Ensaios Clínicos como Assunto , Humanos
2.
Recent Results Cancer Res ; 214: 71-91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31473849

RESUMO

Bispecific T cell engagers are antibody constructs directed to a tumor-specific target on the one hand and to CD3-positive T cells on the other hand. Blinatumomab is a compound with specificity for the pan-B cell marker CD19. Clinical activity was tested in relapsed and refractory (R/R) non-Hodgkin's Lymphoma (NHL), R/R acute lymphoblastic leukemia (ALL), and ALL patients with minimal residual disease. Trials have already been started in de novo ALL. The most clinically relevant toxicities are neurologic events and cytokine release syndrome as with other T cell-activating therapies. The mechanisms of resistance are not fully understood. Higher leukemia load and later stage disease represent unfavorable factors. Besides, an upregulation of regulatory T cells and inhibitory molecules like PD-1/PD-L1 may have a role as the loss of target by several mechanisms. The future will show whether the use of bispecifics in ALL can change the standard treatment algorithms and whether bispecific T cell engagers will also be successfully used in other malignant entities.


Assuntos
Anticorpos Biespecíficos/farmacologia , Linfoma não Hodgkin/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Linfócitos T/citologia , Antígenos CD19 , Ensaios Clínicos como Assunto , Humanos , Neoplasia Residual/terapia
3.
Recent Results Cancer Res ; 214: 93-128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31473850

RESUMO

As a specifically programmable, living immunotherapeutic drug, chimeric antigen receptor (CAR)-modified T cells are providing an alternative treatment option for a broad variety of diseases including so far refractory cancer. By recognizing a tumor-associated antigen, the CAR triggers an anti-tumor response of engineered patient's T cells achieving lasting remissions in the treatment of leukemia and lymphoma. During the last years, significant progress was made in optimizing the CAR design, in manufacturing CAR-engineered T cells, and in the clinical management of patients showing promise to establish adoptive CAR T cell therapy as an effective treatment option in the forefront.


Assuntos
Imunoterapia Adotiva , Neoplasias/terapia , Receptores de Antígenos Quiméricos , Antígenos de Neoplasias/imunologia , Ensaios Clínicos como Assunto , Humanos , Receptores de Antígenos de Linfócitos T , Linfócitos T/imunologia
4.
Recent Results Cancer Res ; 214: 129-151, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31473851

RESUMO

The adoptive cell transfer (ACT) of genetically engineered T cell receptor (TCR) T cells is one of the burgeoning fields of immunotherapy, with promising results in current clinical trials. Presently, clinicaltrials.gov has over 200 active trials involving adoptive cell therapy. The ACT of genetically engineered T cells not only allows the ability to select for TCRs with desired properties such as high-affinity receptors and tumor reactivity but to further enhance those receptors allowing for better targeting and killing of cancer cells in patients. Moreover, the addition of genetic material, including cytokines and cytokine receptors, can increase the survival and persistence of the T cell allowing for complete and sustained remission of cancer targets. The potential for improvement in adoptive cell therapy is limitless, with genetic modifications targeting to improve weaknesses of ACT and to thus enhance receptor affinity and functional avidity of the genetically engineered T cells.


Assuntos
Engenharia Genética , Imunoterapia , Neoplasias/terapia , Receptores de Antígenos de Linfócitos T , Linfócitos T/citologia , Humanos
5.
Recent Results Cancer Res ; 214: 153-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31473852

RESUMO

After more than a century of efforts to establish cancer immunotherapy in clinical practice, the advent of checkpoint inhibition (CPI) therapy was a critical breakthrough toward this direction (Hodi et al. in Cell Rep 13(2):412-424, 2010; Wolchok et al. in N Engl J Med 369(2):122-133, 2013; Herbst et al. in Nature 515(7528):563-567, 2014; Tumeh et al. in Nature 515(7528):568-571, 2014). Further, CPIs shifted the focus from long studied shared tumor-associated antigens to mutated ones. As cancer is caused by mutations in somatic cells, the concept to utilize these correlates of 'foreignness' to enable recognition and lysis of the cancer cell by T cell immunity seems an obvious thing to do.


Assuntos
Vacinas Anticâncer , Epitopos/imunologia , Imunoterapia , Neoplasias/terapia , Antígenos de Neoplasias/imunologia , Humanos
6.
Recent Results Cancer Res ; 214: 169-187, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31473853

RESUMO

Treatment of patients with advanced metastatic melanoma has for decades been a story of very limited success. This dramatically changed when therapy with anti-PD-1 checkpoint blocking antibodies was approved in the USA and Europe in 2014 and 2015, respectively. The therapy exploits the capacity of CD8+ T cells to specifically kill tumor cells. Within the tumor microenvironment, CD8+ T cell activity is blocked by suppressive signals received via PD-1, an inhibitory co-receptor and so-called checkpoint of T cell activation. PD-1 binds to its ligand PD-L1 on melanoma cells which dampens the T cell's activity. Antibodies blocking inhibitory PD-1/PD-L1 interaction release T cells from suppression. Treatment of late-stage disease melanoma patients with antibodies targeting the PD-1/PD-L1 axis, termed immune checkpoint blocking therapy (ICBT), yields clinical frequently long-lasting responses in 30-40% of cases. Despite this remarkable breakthrough, still the majority of patients resists ICBT or develops resistance after initial therapy response. Administration of anti-PD-1 antibodies in combination with antibodies targeting CTLA-4, another inhibitory immune checkpoint increased clinical responses rate up to 50% but at costs of higher treatment-related toxicities. Thus, strong efforts are now directed toward the understanding of therapy resistance, the identification of biomarkers predicting therapy response, and the development of alternative PD-1-based combination treatment to improve patient outcomes.


Assuntos
Linfócitos T CD8-Positivos/citologia , Imunoterapia , Melanoma/terapia , Receptor de Morte Celular Programada 1 , Anticorpos Monoclonais , Antígeno B7-H1 , Europa (Continente) , Humanos , Microambiente Tumoral
7.
Z Psychosom Med Psychother ; 65(3): 224-238, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31476994

RESUMO

App-controlled feedback devices can support sustainability of weight loss. Multicentre QUANT-study shows additional weight loss and gain of QoL via multiple feedback-devices in OPTIFAST®52-program Objective: Are three app-controlled feedback devices, tested against a simple pedometer in a weight reduction program, supporting sustainable therapy success and quality of life (QoL)? Methods: In this multi-centre randomised controlled study adults with obesity (n = 89, m = 46.5 years, women n = 54), achieved high weight loss (from 42.7 kg/m² to 35.2 kg/m²) while completing the first three month of the OPTIFAST®52-program. Thereafter the intervention group (IG) used feedback devices (BIA scale, blood pressure monitor, step counter), the control group a mechanical pedometer without app for another year. Intention-to-treat analysis (ITT) and As-treated analysis (AT) were carried out. Results: Feedback devices had a positive effect on fat-loss and secondary study objectives like QoL, leading to a better sustainability of these improvements. Participants in IG (AT for t2-t0) had improvements for Waist-to-Height-ratio (WHtR) and physically and mentally quality of life. Conclusion: The results are presumably based on an increase in self-efficacy and the experience of control. Future studies should be preceded by a pilot study to analyse acceptance problems.


Assuntos
Manutenção do Peso Corporal , Retroalimentação , Aplicativos Móveis , Obesidade/terapia , Qualidade de Vida , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Prax Kinderpsychol Kinderpsychiatr ; 68(6): 475-487, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480944

RESUMO

Chances of Psychotherapeutic Interventions and Stabilization with Unaccompanied Minor Refugees During Clearing Procedure and During the Transition Phase to Youth Welfare In the present clinical report, the experiences with psychotherapeutic crisis intervention for unaccompanied refugee minors in an initial reception and clearing office in Berlin, which have been financed since December 2016 by the association Spatz e. V. from the St Joseph hospital in Berlin-Tempelhof, is reflected. The financing offer results due to the developments in 2015 - a year with an above-average increase in incoming refugees. The significant increase also led to significantly longer waiting times in the clearing process. The forced persistence in a provisional state often led to instability of the psychic coping capacity of the adolescents. However, although there is a high level of psychological distress, post-traumatic as well as depressive symptoms the refugee adolescents have no access to outpatient psychotherapy during the clearing procedure (or the financial coverage of the discussions by health insurance or youth welfare offices). Despite uncertain framework conditions by an unclear future perspective and the resulting lack of "external safety", psychotherapeutic sessions with a focus on stabilization, empowerment and psychoeducation is nevertheless helpful in order to support young people in crisis situation, to counteract acute crisis and to counteract chronification of existing symptoms.


Assuntos
Intervenção na Crise , Menores de Idade/psicologia , Psicoterapia , Refugiados/psicologia , Adolescente , Criança , Depressão/psicologia , Depressão/terapia , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia
9.
Gan To Kagaku Ryoho ; 46(8): 1230-1234, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501362

RESUMO

Patient participation is defined as incorporation of opinions by patients and citizens when clinical trials are planning. It has been early established in the USA and the UK. The Japan Clinical Oncology Group(JCOG)has recently launched a subcommittee of patient participation and has tried to input opinions of patients and citizens in clinical trials. We, Hepatobiliary and Pancreatic Oncology Group in JCOG, has held 3 meetings of patient participation for 3 years. We introduced our policy and clinical trials and discussed off-label drugs or treatments. In the third meeting in 2019, we have discussed precision medicine using genome analysis and clinical trials which are currently planning in our group. There are some significances and expectations to patient participation from the points of views of researchers. It is meaning to pick up clinicalunmet medicalneeds from patient participation and input requests and opinions of patients to a protocol. Opinions of patients and citizens may be useful to make informed consent form easy to read and understand for patients and their family. In order to accelerate recruitment of patients in clinical trials, it is important that patients and citizens understand exactly clinical trials through patient participation. Patient participation has just begun in Japan. It is expected to establish Japanese patient participation in the near future. It is important for not only researchers but also patients to obtain some benefits from patient participation.


Assuntos
Neoplasias/terapia , Humanos , Consentimento Livre e Esclarecido , Japão , Oncologia , Médicos , Medicina de Precisão
10.
Gan To Kagaku Ryoho ; 46(8): 1265-1273, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31501368

RESUMO

Autologous peripheral blood stem cell transplantation(auto-PBSCT)combined with high-dose chemotherapy has been considered as the standard therapy for relapsed or induction therapy-refractory aggressive lymphomas sensitive to chemotherapy. While various regimens have been applied as the conditioning,none has yet been established as the standard. We have begun to employ high-dose ranimustine,cytarabine,etoposide and cyclophosphamide(MCVAC)regimen. The present study was undertaken to review the efficacy and safety of MCVAC. Regimen: We carried out a retrospective analysis of 20 patients diagnosed as diffuse large B-cell lymphoma. The median follow-up duration of 20 patients was 13.05 months(range, 0.57-49.5 months). The 4-year OS and PFS were 57.8% and 30.2%,respectively. Relapse was the most frequent cause of treatment failure(n=7). The major toxicities were anorexia/nausea(95%),diarrhea (75%),hypokalemia (70%). One patient died of hepatic veno-occlusive disease(VOD). The serious adverse events included hypokalemia,arrhythmia,cerebral hemorrhage,and heart failure(1 case[5%]each). There was 1 case of a late-onset adverse event: therapy-related myelo- dysplastic syndrome/acute myeloblastic leukemia(MDS/AML). MCVAC regimen was concluded as effective and well-toler- ated. However,we should carefully monitored for the possible development of VOD and MDS/AML. Further follow-up is needed to evaluate the long-term efficacy and safety.


Assuntos
Linfoma Difuso de Grandes Células B , Transplante de Células-Tronco de Sangue Periférico , Protocolos de Quimioterapia Combinada Antineoplásica , Ciclofosfamida , Etoposídeo , Humanos , Linfoma Difuso de Grandes Células B/terapia , Estudos Retrospectivos , Condicionamento Pré-Transplante , Transplante Autólogo
11.
Gan To Kagaku Ryoho ; 46(8): 1275-1279, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501369

RESUMO

BACKGROUND: The gap between patients' and physicians' expectations from treatment has been a difficult problem in oncology because it affects decision-making. This study identified patients' expectations from their treatment and concerns when palliative chemotherapy was initiated. METHODS: Patients completed a questionnaire, which included open-ended questions about their expectations from the treatment and their biggest concerns at that moment after a clear explanation that the nature of their metastatic or recurrent cancer treatment was palliative and not curative. One hundred and sixty-five consecutive Japanese patients were included in this study. RESULTS: Twenty-nine percent of the patients described their expectation as "symptomatic improvement,"28% as"objective treatment effect,"and 19%as"cure."The most common concern was the toxicity(41%). No significant change was revealed in later-line treatment. CONCLUSION: The patients' expectation from palliative chemotherapy and concerns should be considered more precisely in each phase. Dedicated palliative care and explanation of toxicity controlon the initiation of treatments are essential.


Assuntos
Motivação , Neoplasias , Tomada de Decisões , Humanos , Neoplasias/terapia , Cuidados Paliativos , Inquéritos e Questionários
12.
Gan To Kagaku Ryoho ; 46(8): 1307-1309, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501376

RESUMO

Neoadjuvant imatinib may prevent tumor rupture and the need for extended surgery by reducing the tumor size by approximately 35%, especially for large gastric gastrointestinal stromal tumors(GISTs), as shown in a previous phase Ⅱ study (Kurokawa et al. BJC 2017); however, the use ofneoadjuvant imatinib is not prevalent in clinical practice. Herein, we report a large gastric GIST that was successfully treated with neoadjuvant imatinib. A 74-year-old woman complained ofabdominal pain, and abdominal computed tomography(CT)revealed a 14 cm oval tumor in the left upper abdominal cavity. Gastric biopsy revealed that the tumor was a GIST. The patient also had a small lung tumor that was diagnosed as a primary lung carcinoma in the right upper lobe. We performed neoadjuvant imatinib for 6 months as the primary treatment. After 7 months ofimatinib administration, CT revealed that the GIST decreased in size but the lung cancer was slightly enlarged. Therefore, we performed right upper lung lobectomy and continued imatinib therapy for an additional 3 months. After a total of9 months ofneoadjuvant imatinib treatment, we performed partial gastrectomy combined with splenectomy without tumor rupture. The patient is scheduled to continue imatinib therapy for a total of 3 years.


Assuntos
Tumores do Estroma Gastrointestinal , Terapia Neoadjuvante , Neoplasias Gástricas , Idoso , Antineoplásicos , Feminino , Tumores do Estroma Gastrointestinal/terapia , Humanos , Mesilato de Imatinib , Neoplasias Gástricas/terapia
13.
Zhen Ci Yan Jiu ; 44(8): 589-93, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31475493

RESUMO

OBJECTIVE: To observe the clinical effect of early acupuncture treatment of limb paralysis in patients with traumatic brain injury (TBI) and changes of serum interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) levels, so as to explore its mechanism underlying improvement of TBI. METHODS: A total of 70 TBI inpatients were equally divided into a medication group and an acupuncture plus medication group according to a random number table. The medication contained intravenous drip of Mannitol Injection (125 mL, once every 8 h ) and Oxiracetam Injection (4 g, once a day). Starting 72 h after TBI, acupuncture therapy was applied to main points as Fenglong (ST40), Zusanli (ST36), Guanyuan (CV4), Baihui (GV20), Shuigou (GV26) and Fengchi (GB20), etc. The treatment was given once a day for total 28 days. Before and after the treatment, plasma IL-6, BDNF and NGF contents were detected using radioimmunoassay, the volume of the injured brain tissue was detected by using CT scan. The neurological deficit severity was evaluated by using Glasgow Coma Scale (GCS), and the degree of activity of daily living (ADL) ability was assessed by using simplified Fugl-Meyer assessment (FMA) scale, and modified Barthel index (BI), separately. RESULTS: After the treatment, the GCS score on day 28, FMA and ADL-BI scores on day 28 and 60 were significantly increased in both medication and acupuncture plus medication groups in comparison with their own pre-treatment (P<0.05). The focal volume values of the injured brain were significantly decreased on day 14 and 28 in both groups compared with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture plus medication was obviously superior to that of simple medication in lowering focal injured volume on day 14 and 28, and in increasing FMA and ADL-BI scores on day 28 and 60 (P<0.05). Compared with pre-treatment, the levels of plasma IL-6 on day 3, 7 and 14 were significant decreased, and those of plasma BDNF and NGF on day 3, 7 and 14 considerably increased in both groups in comparison with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture plus medication was evidently superior to that of simple medication in lowering IL-6 on day 3 and 7, and in increasing BDNF and NGF levels on day 3, 7 and 14 (P<0.05). CONCLUSION: Early acupuncture treatment can significantly improve the TBI patient's limb motor function and daily life activities, which may be related with its effects in reducing the inflammation and increasing BDNF and NGF levels.


Assuntos
Terapia por Acupuntura , Lesões Encefálicas Traumáticas , Paralisia/terapia , Lesões Encefálicas Traumáticas/complicações , Fator Neurotrófico Derivado do Encéfalo , Humanos , Interleucina-6 , Paralisia/etiologia
14.
Zhen Ci Yan Jiu ; 44(8): 605-9, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31475496

RESUMO

OBJECTIVE: To observe the clinical therapeutic effect of "Tiaoshen Zhitong" (mental regulating and pain relieving) needling and its influence on serological indicators in the treatment of post-stroke shoulder pain, so as to provide new therapeutic thoughts and approach for post-stroke shoulder pain. METHODS: A total of 80 inpatients with post-stroke shoulder pain were randomly divided into a control group (routine needling, 39 cases) and an observation group ("Tiaoshen Zhitong" needling, 41 cases) according to the random number table. Patients of the two groups accepted basic medication treatment including anticoagulants, hypotensive drugs, hypoglycermic drugs, lipid-lowering drugs, etc. In addition, patients of the control group were also treated by routine acupuncture stimulation (uniform reinforcing-reducing stimulation) of Jianyu (LI15), Jianqian (EX-UE12), Jianhou (Extra), Jianliao (TE14), Waiguan (TE5) and Hegu (LI4) on the affected side, and those of the observation group also treated by "Tiaoshen Zhitong" needling of Ear-Shenmen (MA-TF1), bilateral Neiguan (PC6, lifting-thrusting-reducing method), Shuigou (GV26, lifting-thrusting-reducing method), and Jianyu (LI15), Jianliao(TE14), Jianzhen (SI9) and Yanglingquan (GB34, the latter 4 points were stimulated with uniform reinforcing-reducing method) on the affected side. The treatment was given once every day, 6 days a week for 4 weeks. The pain severity was assessed by using visual analogue scale (VAS), the upper limb function evaluated by using Fugl-Meyer assessment (FMA) scale, the shoulder-joint function evaluated by using Constant-Murley score (CMS) questionnaire, and the daily living ability assessed by using Barthel index (BI) scale. The enzyme linked immunosorbent assay (ELISA) was used to determine the contents of serum beta-endorphin (ß-EP), enkephalin (ENK) and dynorphin (Dyn). The clinical therapeutic effect was evaluated by using Nimodipine scale method. RESULTS: Of the 39 and 41 cases in the control and observation groups, 7(17.95%) and 12(29.27%) were basically cured, 12(30.77%) and 13(31.71%) experienced marked improvement, 8(20.51%) and 11(26.83%) were effective, 12(30.77%) and 5 (12.19%) failed, with the total effective rate being 69.23% and 87.80%, respectively. The effective rate of the observation group was significantly higher than that of the control group (P<0.05). After the treatment, the VAS score was obviously reduced (P<0.01), and the scores of FMA scale, CMS questionnaire and BI scale, and contents of serum ß-EP, ENK and Dyn were all increased obviously in the two groups compared with their own pre-treatment (P<0.01). The therapeutic effect of "Tiaoshen Zhitong" needling was significantly superior to that of the routine needling in lowering VAS, and in raising scores of FMA scale, CMS questionnaire and BI scale and in up-regulating serum ß-EP, ENK and Dyn levels (P<0.01). CONCLUSION: "Tiaoshen Zhitong" needling is effective in reducing post-stroke shoulder pain and improving the motor function of the upper limb and shoulder-joint as well as the quality of daily life in stroke patients with shoulder pain. Its analgesic effect is probably related to the increase of the levels of serum ß-EP, ENK and Dyn.


Assuntos
Terapia por Acupuntura , Dor de Ombro/terapia , Acidente Vascular Cerebral , Humanos , Ombro , Dor de Ombro/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
15.
Zhen Ci Yan Jiu ; 44(8): 610-4, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31475497

RESUMO

OBJECTIVE: To observe the clinical therapeutic effect of Fuyang-pot warming combined with electroacupuncture (EA) in the treatment of scapulohumeral periarthritis (SPA). METHODS: A total of 90 cases of SPA patients were randomized into EA, Fuyang-pot warming and EA plus Fuyang-pot warming (combination) groups (n=30 per group). Fuyang-pot warming including pressing, mild moxibustion, scraping-pushing, cupping, tapping, etc. was applied to Fengchi (GB20), Dazhui (GV14), Jianjing (GB21), Jianyu (LI15), Zhongfu (LU1), Ashi-point, etc., and EA (2 Hz /100 Hz,1-1.5 mA) was appled to GB20, GV14, GB21, LI15, Binao (LI14), Tiaokou (ST38), Chengshan (BL57), Ashi-point, etc. The treatment was performed for 30 min every time, once every other day for 2 weeks. The visual analogue scale (VAS, 0-10 points) was used to assess the pain severity. The Constant-Murley shoulder assessment scale (100 points in total, including 15 points in pain severity and 20 points in daily living activities, 40 points in joint motion range, and 25 points in myodynamia) was used to assess the functional state of the shoulder. The rating scale of the American Shoulder and Elbow Surgeons (ASES, 4 grades) was used to evaluate the ability of daily living activities. RESULTS: Following the treatment, intra-group comparison showed that the VAS score was significantly reduced in the three groups in comparison with their own pre-treatment (P<0.01). The total scores of Constant-Murley scale, and scores of activities of daily living and active motion range, myodynamia, and ASES shoulder-joint function were all considerably increased in the three groups in comparison with their own pre-treatment (all P<0.01). The therapeutic effect of EA plus Fuyang-pot warming was significantly superior to that of simple EA and simple Fuyang-pot warming in reducing VAS score and increasing total score of Constant-Murley scale and scores of activities of daily living, active motion range, myodynamia as well as ASES shoulder joint function (P<0.01). Of the 30, 29 and 30 cases in the combination, EA and Fuyang-pot warming groups, 9, 2 and 4 were basically cured, 14, 8 and 12 experienced marked improvement, 4, 12 and 9 were improved, and 3, 7 and 5 failed in the treatment, with the cured plus effective rates being 76.67%, 34.48% and 53.33%, respectively. The cure plus effective rate was apparently higher in the combined treatment group than in the simple EA and simple Fuyang-pot warming groups (P<0.01), but had no significant difference between the simple EA and simple Fuyang-pot warming groups (P>0.05). CONCLUSION: Fuyang-pot warming combined with EA is effective in relieving pain, and enhancing the daily life quality in scapulohumeral periarthritis patients.


Assuntos
Eletroacupuntura , Moxibustão , Periartrite , Atividades Cotidianas , Pontos de Acupuntura , Humanos , Periartrite/terapia
16.
Zhonghua Yi Xue Za Zhi ; 99(32): 2511-2515, 2019 Aug 27.
Artigo em Chinês | MEDLINE | ID: mdl-31484278

RESUMO

Objective: To analyze the clinical characteristics and treatment of female stress urinary incontinence (SUI) combined with bladder neck obstruction (BNO). Methods: The clinical data of 17 cases of female SUI patients with BNO, who was admitted to the Urology department, Beijing Chaoyang hospital from November 2011 to April 2018, were retrospectively analyzed. The mean age was (60.3±2.6) years old and the mean body mass index was (23.8±0.5) kg/m(2). All patients had the first stage bladder neck incision with the second stage suprapubic urethral support sling. The clinical characteristics, curative effects and outcomes were analyzed. Results: The maximum flow rate was increased significantly after the bladder neck incision compared with preoperative [(9.3±0.5) vs (25.6±0.8) ml/s, P<0.001]. The postvoid residual urine volume and PdetQmax were decreased significantly than that preoperative [(167.5±4.4) vs (4.1±0.5) ml, P<0.001; (49.4±1.3) vs (24.9±0.7) cmH(2)O, P<0.001]. The incontinence questionnaire-short form score was significantly lower after the second stage suprapubic urethral support sling [(2.4±0.4) vs (14.9±0.3), P<0.001]. The number of subjective and objective case of suprapubic urethral support sling was 13, and the treatment effect of other patients was improved. The hospitalization and operation time of the bladder neck incision and the suprapubic urethral support sling were short. All patients had no intraoperative complications, two cases had dysuria and one case had groin pain after the suprapubic urethral support sling operation. Conclusions: The patients of female SUI combined with BNO are most elderly and obese population. The effectiveness and safety of the first stage bladder neck incision and the second stage suprapubic urethral support sling are high, and the surgeries can effectively relieve the obstruction and improve the quality of patients' life.


Assuntos
Slings Suburetrais , Obstrução do Colo da Bexiga Urinária , Incontinência Urinária por Estresse , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/complicações , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Procedimentos Cirúrgicos Urológicos
17.
Medicina (B Aires) ; 79(4): 251-256, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487243

RESUMO

Our objective was to evaluate clinical characteristics, results and morbi-mortality in primary angioplasty (PA), of patients treated with PA within 36 hours of a myocardial infarction (MI), included in a prospective, transversal, multicenter and national survey (ARGEN-IAM-ST). A total of 1142 patients treated with PA were registered, 61.2 ± 12 years old, 88% male, 20% diabetics and 58% with hypertension; 77.6% in Killip Kimball I and 6.2% in cardiogenic shock. The time from the onset of pain until admission was 153 (75-316) minutes, and door-balloon of 91 (60-150) minutes. The transferred patients (17%) showed longer delay to admission, 200 minutes (195-420; p = 0.0001) and door-to-balloon 113.5 minutes (55-207); p = 0.099. In 47.6% of the cases, the PA was made in the anterior descending artery, in 36.4% in the right coronary artery, in 14.8% in the circumflex artery and in 1.2% in the left coronary artery; in 95% with stent (29% pharmacological); 95% was successful, 1.3% presented post-infarct angina (APIAM), 1.3% re-infarct, 8.8% shock and 3.2% bleeding. Age > 64 years (OR 6.2 (95% CI: 3.2-12), p <0.001), diabetes (OR 2.5, 95% CI 1.6-3.9, p < 0.001), re-infarction or APIAM (OR 3.3, 95% CI 1.3-8.3, p = 0.011) and shock (OR 29.2 (15.6-54.8), p < 0.001) were independently associated with higher mortality. In-hospital mortality of acute myocardial infarction with ST-segment elevation treated with PA was 7.6%. Transference from other center was associated with delay in the admission and treatment. Cardiogenic shock and post-infarct ischemia were associated with high mortality. There were no procedural variables associated with mortality.


Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Angioplastia Coronária com Balão/mortalidade , Argentina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Resultado do Tratamento
18.
Medicina (B Aires) ; 79(4): 291-294, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487251

RESUMO

Clostridium difficile infection is an increasingly recognized cause of diarrhea in inpatients, frequently associated to high mortality. Vancomycin is the treatment of choice for all Clostridium difficile- associated diarrheas, with different degrees of severity. However, some patients develop refractory forms to that treatment and there are no alternative antibiotic schemes recommended for these cases. Fecal microbiota transplantation has been shown to be successful in a series of cases of severe diarrhea associated with this organism. We present a case of refractory C. difficile infection successfully treated with fecal microbiota transplantation.


Assuntos
Infecções por Clostridium/terapia , Clostridium difficile , Diarreia/terapia , Transplante de Microbiota Fecal , Idoso de 80 Anos ou mais , Infecções por Clostridium/complicações , Diarreia/microbiologia , Feminino , Humanos , Resultado do Tratamento
20.
Klin Lab Diagn ; 64(8): 484-489, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479604

RESUMO

The aim of research was to evaluate the effectiveness of the effect of eradication therapy on the cytokine status of gastric juice in patients with chronic non-atrophic gastritis (CNG) and duodenal ulcer (DU) associated with Helicobacter pylori. Clinical observations and laboratory-instrumental studies performed in 95 patients aged 20 to 55 years with CNG and duodenal ulcer with determination of cytokine content of IL-1ß, IL-6 and TNF-α in the fasting portion of gastric juice. The most pronounced decrease in the content of proinflammatory cytokines in gastric juice on the background of treatment was found in patients of the 1st group who received combined therapy according to the scheme omeprazole + clarithromycin + amoxicillin. Analysis of the content of proinflammatory cytokines (IL-1ß, IL-6 and TNF-α) in gastric juice in patients with acute exacerbation showed that their concentration in all 8 patients after the course of therapy exceeded the norm (P < 0.05) and was IL -1ß - 30,30 + 1,15 pg/l, IL-6 - 10,4 + 0,83 pg / l and TNF-α - 32,5 + 1,13 pg / l. At the same time, the level of proinflammatory cytokines in gastric juice correlated with the degree of dissemination of H. pylori in the mucosa of the gastroduodenal zone. Helicobacter pylori infection in inflammation and ulceration in the mucous membrane of the stomach and duodenum, possibly in addition to other mechanisms, affects the activation of pro-inflammatory cytokines (IL-1beta, IL-6, TNF-alpha) in gastric juice. Incomplete eradication of H. Pylori after treatment during clinical endoscopic remission in patients with duodenal ulcer in the vast majority of cases is accompanied by the preservation of an increased level of pro-inflammatory cytokines in gastric juice, which may be one of the reasons for the relapse of the disease.


Assuntos
Citocinas/análise , Suco Gástrico/química , Gastrite/terapia , Infecções por Helicobacter/terapia , Adulto , Mucosa Gástrica , Gastrite/microbiologia , Helicobacter pylori , Humanos , Pessoa de Meia-Idade , Adulto Jovem
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