OBJECTIVE:To investigate the clinical efficacy and adverse reactions of gemcitabine/nab-paclitaxel (AG regimen) combined with anlotinib and PD-1 inhibitors as a first-line treatment for advanced pancreatic cancer (PC). METHODS:Data of 52 patients with advanced PC who were treated in the Affiliated Hospital of Xuzhou Medical University (Xuzhou, China) between August 2019 and March 2023 were retrospectively analyzed. According to the treatment regimen, patients were divided into two groups, including 27 patients in the chemotherapy group (AG regimen) and 25 patients in the combined treatment group (AG regimen combined with anlotinib and PD-1 inhibitors). Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse reactions were compared between the two groups. The survival curves of the two groups were drawn using the Kaplan-Meier method, and the differences in PFS and OS between the two groups were compared by the log-rank test. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors influencing prognosis. RESULTS:The median OS and PFS in the combined treatment group were significantly longer than those in the chemotherapy group (OS, 12.8 vs. 7.9 months, P = 0.005; PFS, 5.6 vs. 4.4 months, P = 0.003). There was no significant difference in ORR between the two groups (32.0 % vs. 25.9 %, P = 0.629), and DCR in the combined treatment group was significantly better than that in the chemotherapy group (84.0 % vs. 59.3 %, P = 0.049). Grade 1-2 adverse reactions were predominant in both groups, and no adverse reaction-related deaths occurred. CONCLUSION:Compared with chemotherapy alone, AG regimen combined with anlotinib and PD-1 inhibitors exhibited to have a higher efficacy for the first-line treatment of advanced PC, and the adverse reactions were also controllable.
目的 探讨江苏地区孕妇全孕期增补叶酸对妊娠期糖尿病(GDM)的影响.方法 选取2017年1月至2018年12月间在江苏省分娩的胎龄≥28周的产妇.根据是否服用叶酸分为未服叶酸组和服用叶酸组.根据服用叶酸的剂量和时间分为六组:早孕期单纯0.4 mg/d叶酸(0.4 mg叶酸)组、早孕期含叶酸0.4 mg/d的复合维生素(MV+0.4 mg叶酸)组、早孕期含叶酸0.8 mg/d的复合维生素(MV+0.8 mg叶酸)组、全孕期单纯0.4 mg/d叶酸(0.4 mg叶酸)组、全孕期含叶酸0.4 mg/d的复合维生素(MV+0.4 mg叶酸)组、全孕期含叶酸0.8 mg/d的复合维生素(MV+0.8 mg叶酸)组.通过问卷调查表,由培训专员收集并记录产妇的一般情况、叶酸增补情况、孕产史、职业和环境因素及GDM等信息.应用logistic回归及χ2检验等方法对全孕期叶酸增补情况与GDM的相关性进行统计分析.结果 共纳入10662例产妇,未服叶酸组与服用叶酸组GDM的发生率分别为9.7％(100/1028)、10.5％(1014/9634),差异无统计学意义.与未服叶酸组相比,无论是否校正协变量,全孕期增补叶酸的女性发生GDM的风险显著增加,尤其是年龄小于35岁、孕前体质量指数(BMI)在正常范围及有分娩史的女性.结论 孕期叶酸增补应适量,全孕期增补叶酸的女性发生GDM风险增加.
Objective To investigate the risk factors of intravenous immunoglobulin（IVIG） resistance in patients with Kawasaki disease（KD） in this region.Methods A retrospective analysis was performed for KD patients who were hospitalized in Children’s Hospital of Soochow University from January 2017 to June 2021 and received IVIG when the fever course was less than 5 days.The epidemiological data,clinical characteristics and laboratory indexes of patients in IVIG-responsive group and IVIG-resistance group were analyzed.Results A total of 122 eligible patients with KD were enrolled in the study,IVIG resistance was noted in 23 patients（18.85%）.There was no statistical significance in gender and age between the IVIG-responsive and IVIG-resistant group.The incidence of coronary artery lesions（CALs） was not statistical difference between the IVIG-resistant group and the IVIG-responsive group during the acute phase and after six months of follow-up.The percentage of neutrophils（N）,C-reactive protein（CRP）,serum bilirubin（TB） [（24.44 ±23.07） μmol/L vs.（9.89±8.17） μmol/L] in IVIG-resistant patients before treatment were significantly higher than those in the IVIG-responsive group（P＜0.05）,and platelet count（PLT） [（271.17±62.08）×109/L vs.（358.94±88.70）×109/L] and serum sodium（Na+）before treatment were significantly lower than those in the IVIG-responsive group（P＜0.05）.Multivariate Logistic regression analysis showed that TB and PLT were significantly related to IVIG resistance in patients with KD（P＜0.05）.Conclusion PLT and TB can be used as important indicators to predict the resistance of IVIG in patients with KD when the fever course was less than 5 days..
Objective To observe the relationship of procalcitonin（PCT）, D-Dimer, antithrombin Ⅲ with sepsis patients, and to explore its value in evaluating the prognosis.Methods A total of 212 patients diagnosed with sepsis in Qingdao Municipal Hospital from January 2019 to December 2020 were analyzed retrospectively. The basic information of patients, PCT, D-dimer and antithrombin Ⅲwithin 24 hours of admission were collected, and APACHEⅡ score and SOFA score were calculated by the worst index in 24 hours after admission. According to the outcome of 28 days, the patients were divided into death group and survival group. The predictive value of PCT, D-dimer and antithrombin Ⅲ in prognosis of patients with sepsis was analyzed.Results The levels of PCT and D-dimer in the death group were higher than those in the survival group, PCT in the death group was（40.92±32.62）μg/L, which was higher than that in the survival group（30.67±32.34）μg/L, D-dimer in the death group was（8.54±6.82） mg/L, which was higher than that in the survival group（6.25±6.06） mg/L, P＜0.05; and the level of antithrombin Ⅲ was lower than those in the survival group, the level of antithrombinⅢ in the death group was（60.75±19.71） %, which was lower than that in the survival group（67.97±16.16） %, P＜0.05. Logistic regression analysis showed that age, APACHEⅡ score and SOFA score were independent risk factors for death in patients with sepsis, but PCT, D-dimer and antithrombin Ⅲ could not be used as independent risk factors for death [OR 95%CI: age odds ratio1.05（1.02,1.88）;APACHEⅡ score1.11（1.03,1.19）; SOFA score: 1.14（1.03,1.27）; PCT: 1.00（0.99,1.02）; D-dimer 1.01（0.96,1.07）.Antithrombin Ⅲ:0.99（0.97,1.01）].The ROC curve analysis showed that the area under the ROC curve（AUC） of APACHEⅡ score, SOFA score, PCT, Ddimer and antithrombin Ⅲ to predict the 28 day death of patients with sepsis were 0.79, 0.78, 0.61, 0.62 and 0.59, respectively. The AUC of combined detection was 0.82, which was significantly higher than that of single index: SOFA score, PCT, D-dimer and antithrombinⅢ（Z 1 = 2.42, Z 2 = 4.32, Z 3 = 4.08, Z 4 = 4.73, all P＜0.05）.Conclusion Detection of PCT, D-dimer and antithrombin Ⅲ levels is helpful to evaluate the severity of sepsis, and combined detection is helpful to improve the accuracy of prognosis evaluation.
目的 对儿童及婴幼儿不完全型川崎病的超声心动图资料数据分析,为临床医生对该疾病的早诊断、早治疗提供依据,以便减少该疾病的漏诊与误诊.方法 回顾性选取电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院2019年1月至2021年4月收治的128例不完全型川崎病(iKD)病儿为观察组,另选取该院同期收治的297例典型川崎病(cKD)病儿为对照组.比较两组病儿超声心动图(UCG)表现,实验室检查血白细胞、红细胞沉降率(ESR)、C反应蛋白(CRP)以及血小板等炎性指标的差异性.结果 425例KD病儿中,iKD 128例(31.1％),cKD 297例(69.9％).全部KD病儿发生冠状动脉扩张有121例(28.5％),其中iKD组有40例(32.3％),cKD组有78例(27.3％);性别、左冠状动脉主干(LMCA)、左前降支(LDA)、回旋支、右冠状动脉(RCA)、RCA中段、二尖瓣反流(MR)、三尖瓣反流(TR)、冠脉管壁毛糙、CRP的差异有统计学意义(P<0.05).iKD组发生冠状动脉扩张,LMCA、LDA、RCA、RCA中段、MR、TR、冠脉管壁毛糙的差异有统计学意义(P<0.05).cKD组发生冠状动脉扩张,性别、LMCA、LDA、回旋支、RCA、RCA中段、MR、冠脉管壁毛糙的差异有统计学意义(P<0.05).iKD组与cKD组发生冠状动脉扩张,MR、TR、冠脉管壁毛糙、血小板的差异有统计学意义(P<0.05).结论 iKD病儿UCG主要表现为冠状动脉扩张、MR、TR、冠状动脉管壁毛糙,且实验室炎性指标血小板明显升高.UCG可以更早、及时地发现冠状动脉管壁的改变及各瓣膜是否存在反流,能更好的为临床诊断提供证据.
