The common therapy of colorectal cancer is FOLFOX scheme,which contains flurouracil,leucovorin and oxaliplatin.Numerous clinical trials have demonstrated that bevacizumab combined with FOLFOX scheme in cancer's therapy is safe and effective.But the adverse reactions including hypertension,neurovirulence,gastrointestinal bleeding and perforation are raised up.Scholars have carried out a series of studies for the overall survival times,tumor response rates and survival qualities for the patients with metastatic colorectal cancer which using the joint scheme,but they draw different conclusions the usefulness and safety of the joint scheme still need more RCT and meta-ananlysis to be proved.
Key words:
Colorectal neoplasms; Drug therapy; Bevacizumab
CRC (colorectal cancer) is one of the most common malignant tumors, with an upward trend in incidence rate in recent decades. FOLFIRI regimen (fluorouracil + leucovorin + irinotecan) as a cytotoxic chemotherapy regimen for patients with CRC has an obvious efficacy. Bevacizumab is a recombinant humanised monoclonal antibody, which was approved by American FDA (Food and Drug Administration) of the United States and used as the first-line treament for CRC. Bevacizumab which is tageting VEGF (vascular endothelial growth factor) can paticularly inhibit angiogenesis in tumor tissues and inhibit the growth and metastasis of tumor cells. This review summarizes the efficacy and safety of bevacizumab in combination with standard chemotherapy regimen FOLFIRI for patients with metastatic CRC. DOI:10.3781/j.issn.1000-7431.2013.06.016
Background: The addition of bevacizumab (BEV) to cytotoxic chemotherapy regimens (CTX) was believed to be effective; however, its magnitude of benefits is still controversial. So a meta-analysis and systematic review seems to be necessary. Methods: PubMed and the Cochrane library were systematically searched. All relevant citations comparing CTX with/without BEV were considered for inclusion. Sensitivity and meta-regression analysis were performed to identify potential confounders. All pooled estimates were performed using a random-effects model. All statistical analyses were performed by StataSE 12.0. Results: The search strategy identified 10 eligible random control trials (RCTs) (n=1366). In our pooled estimates, the additional benefits of BEV to CTX were identified in overall survival (OS) hazard ratio (HR, 0.76; 95% CI, 0.69 to 0.82) and progression-free survival (PFS) (HR, 0.56; 95% CI, 0.51 to 0.60), and prolonged survival duration were also identified for OS (18.2 vs. 16.3, p=0.0003) and PFS (8.9 vs. 6.5, p<0.001). Subgroup analyses stratified by CTX was also performed, evident benefits of additional BEV in OS and PFS can be identified in all subgroups, except for the CTX containing capecitabine in OS. Moreover, the increased rate of incidence was also identified in hypertension, thrombosis, proteinuria, gastrointestinal perforation, and fatigue. Conclusion: BEV, acting as a targeted agent to CTX, its additional benefit to CTX is at the cost of increased toxicity.
To study the correlation of electroencephalogram (EEG) background evolution with the degree of brain injury in neonates with hypoxic-ischemic encephalopathy (HIE).A retrospective analysis was performed for 56 neonates with HIE who underwent continuous video electroencephalogram (cVEEG) and brain magnetic resonance imaging (MRI) examinations. According to clinical symptoms, they were divided into a mild group with 3 neonates, a moderate group with 36 neonates, and a severe group with 17 neonates. EEG background grading and MRI score were determined for each group to analyze the correlation of EEG background evolution with the degree of brain injury.Compared with the moderate group, the severe group had significantly lower gestational age and Apgar score at 5 minutes after birth, a significantly higher resuscitation score, significantly lower base excess in umbilical cord blood or blood gas within 1 hour, a significantly higher proportion of neonates on mechanical ventilation, and a significantly higher incidence rate of short-term adverse outcomes (P<0.05). For the neonates in the mild and moderate groups, MRI mainly showed no brain injury (67%, 2/3) and watershed injury (67%, 16/24) respectively, and EEG showed mild abnormality in 62% (13/21) of the neonates on the 3rd day after birth. For the neonates in the severe group, MRI mainly showed basal ganglia/thalamus + brainstem injury (24%, 4/17) and whole brain injury (71%, 12/17), and EEG showed moderate or severe abnormalities on the 3rd day after birth. EEG background grading was correlated with clinical grading, MRI score, and short-term outcome on days 1, 2, 3 and 7-14 after birth (P<0.01). The highest correlation coefficient between EEG grading and MRI score was observed on the 3rd day after birth (rs=0.751, P<0.001), and the highest correlation coefficients between EEG grading and clinical grading (rs=0.592, P=0.002) and between EEG grading and short-term outcome (rs=0.737, P<0.001) were observed 7-14 days after birth. Among the neonates with severe abnormal EEG, the neonates without brain electrical activity had the highest MRI score, followed by those with status epileptics and persistent low voltage (P<0.05).There is a good correlation between EEG background grading and degree of brain injury in neonates with HIE, which can help to evaluate the degree and prognosis of brain injury in the early stage.目的: 探讨新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy，HIE）患儿脑电图（electroencephalogram，EEG）背景演变与脑损伤程度之间的相关性。方法: 回顾性研究56例确诊为HIE并完善了连续视频脑电监测（continuous video electroencephalogram，cVEEG）与头部磁共振（magnetic resonance imaging，MRI）的患儿，根据临床症状分为轻度组（3例）、中度组（36例）、重度组（17例），各组进行EEG背景分度及MRI脑损伤评分，分析EEG背景演变与脑损伤程度之间的关系。结果: 与中度组患儿相比，重度组胎龄小、生后5 min Apgar评分低、复苏评分高、脐动脉血或生后1 h内动脉血剩余碱低、机械通气比例高及短期不良结局发生率高（P<0.05）。轻中度组患儿头部MRI以无脑损伤（67%，2/3）和分水岭区损伤（67%，16/24）为主，62%（13/21）EEG在生后第3天内改善至轻度异常；重度组患儿头部MRI以基底节/丘脑+脑干（24%，4/17）和全脑型损伤（71%，12/17）为主，至生后第3天仍均为中重度异常。在生后第1天、第2天、第3天及第7~14天4个时间段EEG背景分度与临床症状分度、MRI评分及短期结局均具有相关性（P<0.01）。EEG分度与MRI评分的相关系数在生后第3天最高（rs=0.751，P<0.001），与临床症状分度（rs=0.592，P=0.002）及短期结局（rs=0.737，P<0.001）的相关系数在生后第7~14天最高；重度异常EEG患儿中无脑电活动者MRI评分最高，惊厥持续状态者次之，持续低电压者最低，差异有统计学意义（P<0.05）。结论: HIE患儿的EEG背景分度与脑损伤程度之间有良好的相关性，可帮助早期评估脑损伤程度及预后。.
To analyze the preventive and therapeutic effects of comprehensive nursing interventions on chemotherapy-induced oral mucositis in pediatric patients with hematologic malignancies.
To explore a new method for electroencephalography (EEG) background analysis in neonates with hypoxic-ischemic encephalopathy (HIE) and its relationship with clinical grading and head magnetic resonance imaging (MRI) grading.A retrospective analysis was performed for the video electroencephalography (vEEG) and amplitude-integrated electroencephalography (aEEG) monitoring data within 24 hours after birth of neonates diagnosed with HIE from January 2016 to August 2022. All items of EEG background analysis were enrolled into an assessment system and were scored according to severity to obtain the total EEG score. The correlations of total EEG score with total MRI score and total Sarnat score (TSS, used to evaluate clinical gradings) were analyzed by Spearman correlation analysis. The total EEG score was compared among the neonates with different clinical gradings and among the neonates with different head MRI gradings. The receiver operating characteristic (ROC) curve and the area under thecurve (AUC) were used to evaluate the value of total EEG score in diagnosing moderate/severe head MRI abnormalities and clinical moderate/severe HIE, which was then compared with the aEEG grading method.A total of 50 neonates with HIE were included. The total EEG score was positively correlated with the total head MRI score and TSS (rs=0.840 and 0.611 respectively, P<0.001). There were significant differences in the total EEG score between different clinical grading groups and different head MRI grading groups (P<0.05). The total EEG score and the aEEG grading method had an AUC of 0.936 and 0.617 respectively in judging moderate/severe head MRI abnormalities (P<0.01) and an AUC of 0.887 and 0.796 respectively in judging clinical moderate/severe HIE (P>0.05). The total EEG scores of ≤6 points, 7-13 points, and ≥14 points were defined as mild, moderate, and severe EEG abnormalities respectively, which had the best consistency with clinical grading and head MRI grading (P<0.05).The new EEG background scoring method can quantitatively reflect the severity of brain injury and can be used for the judgment of brain function in neonates with HIE.目的: 探讨一种新的新生儿缺氧缺血性脑病（hypoxic-ischemic encephaloapthy，HIE）脑电背景评价方法，以及其与临床分度和头部磁共振成像（magnetic resonance imaging，MRI）分度的关系。方法: 回顾性分析2016年1月—2022年8月诊断为HIE患儿的出生24 h内视频脑电图（video electroencephalography，vEEG）和同步振幅整合脑电图（amplitude-integrated electroencephalography，aEEG）的监测资料。将脑电背景分析有关项目全部纳入评估系统，按严重程度分层赋分，汇总得到脑电图（electroencephalography，EEG）总分。对EEG总分与头部MRI总分和Sarnat总分（total Sarnat score，TSS；用于评估临床分度）做相关分析。比较不同临床分度组和不同头部MRI分度组间EEG总分是否存在差异。采用受试者工作特征曲线的曲线下面积（area under the curve，AUC）评估EEG总分法对头部MRI中-重度异常和临床中-重度异常的诊断价值，并与aEEG分度法相比较。结果: 共收集50例HIE患儿。EEG总分与头部MRI总分、TSS均呈正相关（分别rs=0.840、0.611，P<0.001）。不同临床分度组和不同头部MRI分度组间EEG总分比较差异均有统计学意义（P<0.05）。EEG总分法和aEEG分度法判断头部MRI中-重度异常的AUC分别为0.936和0.617（P<0.01），判断临床中-重度异常的AUC分别为0.887和0.796（P>0.05）。界定EEG总分≤6分、7~13分、≥14分分别为EEG轻度、中度和重度异常，与临床分度和头部MRI分度一致性最佳（P<0.05）。结论: 新的脑电背景评分方法可以定量化反映脑损伤的严重程度，适用于新生儿HIE的脑功能判断。.
Abstract Background: To investigate the characteristics of sleep cycle in children with severe acute bronchopneumonia treated with invasive mechanical ventilation at different sedation depths. Methods： We included 35 pediatric patients with severe acute bronchopneumonia treated using mechanical ventilation in Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University. They were divided into deep sedation group (n=21; ramsay score 5-6) and light sedation group (n=14; ramsay score3-4) based on sedation depth achieved during mechanical ventilation. Long-term video electroencephalography (EEG) monitoring was performed within the first 24h after starting mechanical ventilation and after weaning from mechanical ventilation and discontinuing sedatives and analgesics. The results were analyzed and compared with those of normal children to analyze changes in sleep cycle characteristics at different sedation depths and mechanical ventilation stages. Results : There were 29 cases altered sleep architecture. The deep sedation group had a significantly higher incidence of sleep architecture altered, total sleep duration, and non-rapid eye movement sleep-1(NREM-1) loss incidence than the light sedation group. Moreover, the deep sedation group had a significantly lower awakening number and rapid eye movement sleep (REM) percentage than the light sedation group. The sleep cycle returned to normal in 27 (77%) patients without NREM-1 or REM sleep loss. Conclusions: Deep sedation during mechanical ventilation allows longer total sleep duration, fewer awakenings, and an increased deep sleep proportion, butsleep architecture is severely altered. After weaning from mechanical ventilation and sedative discontinuation, lightly sedated children exhibit better sleep recovery.
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