Objective. To evaluate the combination of cisplatin and irinotecan as first-l ine treatment of patients with advanced, persistent, or recurrent squamous cell carcinoma of the cervix. Methods. Patients with no prior tr...Objective. To evaluate the combination of cisplatin and irinotecan as first-l ine treatment of patients with advanced, persistent, or recurrent squamous cell carcinoma of the cervix. Methods. Patients with no prior treatment for metastati c disease, presence of measurable tumors, performance status of 0 or 1, and adeq uate bone marrow, renal, and hepatic functions were potentially eligible for thi s trial. Cisplatin and irinotecan were givenweekly at starting doses of 25 and 6 5mg/m2, respectively, for three con secutive weeks. Cycles were to be repeated every 28 days with dose adjustments as required. Patient accrual was based on a two-stage design with at least sev en responses out of 28 patients in the first stage required to proceed to a seco nd stage of accrual seeking a response rate of 40%or better. Results. Of 34 pat ients entered onto the study, 31 were eligible and 27 were evaluable for respons e. Ten had received prior chemoradiation containing cisplatin. Among the five (t wo complete and three partial) observed responses, two were in the subset of pat ients who had received prior chemoradiation. This level of activity was deemed i nsufficient to warrant a second stage of accrual. Predominant toxicities were my elosuppression and gastroin-testinal symptoms, although six patients experience d none of these adverse effects. Conclusion. At these doses, weekly cisplatin an d irinotecan failed to demonstrate sufficient activity to undertake a phase III study. Although not apparent in this study, prior chemoradiation may affect resp onse to platinumbased combinations and its impact should be considered in the de sign of future trials.展开更多
Background and aims: An increased occurrence of anti- Saccharomyces cerev/s/ae antibodies (ASCA) is reported in unaffected members of families with Crohn’ s disease. Whether ASCA is a familial trait due to genetic fa...Background and aims: An increased occurrence of anti- Saccharomyces cerev/s/ae antibodies (ASCA) is reported in unaffected members of families with Crohn’ s disease. Whether ASCA is a familial trait due to genetic factors or is caused by exposure to environmental factors is unknown. To assess the genetic influence of ASCA we studied its occurrence in a twin population. Patients and methods: ASCA were analysed in 98 twin pairs with inflammatory bowel disease and were related to clinical phenotype and CARD15/NOD2 genotype. Results: ASCA were more common in Crohn’ s disease than in ulcerative colitis (40/70 (57% ) twins v 5/43 (12% ) twins). Associations with ileal Crohn’ s disease, stricturing/ penetrating behaviour, and young age, but not CARD15/NOD2 were confirmed. ASCA were found in 1/20 (5% ) healthy siblings in discordant monozygotic pairs with Crohn’ s disease compared with 7/27 (26% ) in discordant dizygotic pairs. Using the intraclass correlation coefficient (ICC), no agreement in ASCA titres was observed in discordant twin pairs with Crohn’ s disease, in monozygotic (ICC = - 0.02) or dizygotic (ICC = - 0.26) pairs. In contrast, strong agreement was seen within concordant monozygotic twin pairs with Crohn’ s disease (ICC = 0.76). Conclusions: These findings question the concept of ASCA as a marker of genetic susceptibility for Crohn’ s disease. The agreement in ASCA titres within concordant monozygotic twin pairs with Crohn’ s disease, suggests that the level of increase is genetically determined. We propose that ASCA are a marker of a response to an environmental antigen and that a specific gene(s) other than CARD15/NOD2 determines the level of response and perhaps also specific phenotypic characteristics.展开更多
昏迷是重症医学科(intensive care unit,ICU)患者十分常见的临床表现,昏迷患者意识障碍程度的评估对患者病情评估和指导临床治疗有着重要意义.目前临床客观评估意识障碍程度的方法主要使用昏迷评分量表,其作为对意识障碍程度定量评估的...昏迷是重症医学科(intensive care unit,ICU)患者十分常见的临床表现,昏迷患者意识障碍程度的评估对患者病情评估和指导临床治疗有着重要意义.目前临床客观评估意识障碍程度的方法主要使用昏迷评分量表,其作为对意识障碍程度定量评估的工具,具有可量化、简便易行、重复性好等优势[1].历史上曾出现过多种昏迷评分量表,如Jouvet昏迷量表、Moscow评分、格拉斯哥-列日评分、意识综合水平评分及因斯布鲁克昏迷评分[2],但多数评分量表因临床可操作性差或应用范围狭窄已被弃用.目前临床常用的3种昏迷评分量表为机体反应水平评分、格拉斯哥评分及全面无反应量,本文对该3种昏迷评分量表的使用范围、优缺点及临床应用综述如下.展开更多
文摘Objective. To evaluate the combination of cisplatin and irinotecan as first-l ine treatment of patients with advanced, persistent, or recurrent squamous cell carcinoma of the cervix. Methods. Patients with no prior treatment for metastati c disease, presence of measurable tumors, performance status of 0 or 1, and adeq uate bone marrow, renal, and hepatic functions were potentially eligible for thi s trial. Cisplatin and irinotecan were givenweekly at starting doses of 25 and 6 5mg/m2, respectively, for three con secutive weeks. Cycles were to be repeated every 28 days with dose adjustments as required. Patient accrual was based on a two-stage design with at least sev en responses out of 28 patients in the first stage required to proceed to a seco nd stage of accrual seeking a response rate of 40%or better. Results. Of 34 pat ients entered onto the study, 31 were eligible and 27 were evaluable for respons e. Ten had received prior chemoradiation containing cisplatin. Among the five (t wo complete and three partial) observed responses, two were in the subset of pat ients who had received prior chemoradiation. This level of activity was deemed i nsufficient to warrant a second stage of accrual. Predominant toxicities were my elosuppression and gastroin-testinal symptoms, although six patients experience d none of these adverse effects. Conclusion. At these doses, weekly cisplatin an d irinotecan failed to demonstrate sufficient activity to undertake a phase III study. Although not apparent in this study, prior chemoradiation may affect resp onse to platinumbased combinations and its impact should be considered in the de sign of future trials.
文摘Background and aims: An increased occurrence of anti- Saccharomyces cerev/s/ae antibodies (ASCA) is reported in unaffected members of families with Crohn’ s disease. Whether ASCA is a familial trait due to genetic factors or is caused by exposure to environmental factors is unknown. To assess the genetic influence of ASCA we studied its occurrence in a twin population. Patients and methods: ASCA were analysed in 98 twin pairs with inflammatory bowel disease and were related to clinical phenotype and CARD15/NOD2 genotype. Results: ASCA were more common in Crohn’ s disease than in ulcerative colitis (40/70 (57% ) twins v 5/43 (12% ) twins). Associations with ileal Crohn’ s disease, stricturing/ penetrating behaviour, and young age, but not CARD15/NOD2 were confirmed. ASCA were found in 1/20 (5% ) healthy siblings in discordant monozygotic pairs with Crohn’ s disease compared with 7/27 (26% ) in discordant dizygotic pairs. Using the intraclass correlation coefficient (ICC), no agreement in ASCA titres was observed in discordant twin pairs with Crohn’ s disease, in monozygotic (ICC = - 0.02) or dizygotic (ICC = - 0.26) pairs. In contrast, strong agreement was seen within concordant monozygotic twin pairs with Crohn’ s disease (ICC = 0.76). Conclusions: These findings question the concept of ASCA as a marker of genetic susceptibility for Crohn’ s disease. The agreement in ASCA titres within concordant monozygotic twin pairs with Crohn’ s disease, suggests that the level of increase is genetically determined. We propose that ASCA are a marker of a response to an environmental antigen and that a specific gene(s) other than CARD15/NOD2 determines the level of response and perhaps also specific phenotypic characteristics.
文摘昏迷是重症医学科(intensive care unit,ICU)患者十分常见的临床表现,昏迷患者意识障碍程度的评估对患者病情评估和指导临床治疗有着重要意义.目前临床客观评估意识障碍程度的方法主要使用昏迷评分量表,其作为对意识障碍程度定量评估的工具,具有可量化、简便易行、重复性好等优势[1].历史上曾出现过多种昏迷评分量表,如Jouvet昏迷量表、Moscow评分、格拉斯哥-列日评分、意识综合水平评分及因斯布鲁克昏迷评分[2],但多数评分量表因临床可操作性差或应用范围狭窄已被弃用.目前临床常用的3种昏迷评分量表为机体反应水平评分、格拉斯哥评分及全面无反应量,本文对该3种昏迷评分量表的使用范围、优缺点及临床应用综述如下.
