儿童肿瘤 化疗调整指南 pediatric cancer chemotherapy adjustment guidelines - PubMed 文献(第 4 页)
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儿童肿瘤 化疗调整指南 的 PubMed 搜索结果(第 4 页)
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31. Late effects of high-dose methotrexate treatment in childhood cancer survivors-a systematic review.
31. 大剂量甲氨蝶呤治疗对儿童癌症幸存者的晚期影响——一项系统综述PMID:期刊:日期:2022-03-14[中文摘要] 高剂量甲氨蝶呤（HD-MTX）用于治疗不同的儿童癌症，包括白血病，这是最常见的癌症类型，通常定义为每次应用至少1g/m体表面积的静脉注射剂量。缺乏对HD-MTX对不同器官晚期影响的系统综述。我们在PubMed上进行了系统的文献检索，包括1985年至2020年间以英语或德语发表的研究。每项研究的人群必须包括至少75%的癌症儿童幸存者（CCS），他们在评估晚期效应前至少12个月完成了癌症治疗，并接受了HD-MTX。文献检索并不局限于特定的癌症诊断或有晚期影响风险的器官系统。我们排除了病例报告、病例系列、评论、社论、海报摘要、叙述性评论和仅报告晚期效应患病率的研究。我们遵循PRISMA指南，根据GRADE标准评估合格研究的质量，并在PROSPERO上注册了方案（ID:CRD42020212262）。我们纳入了1731项已确定的研究中的15项。大多数研究包括诊断为急性淋巴细胞白血病的CCS（n = 12). 纳入的研究调查了HD-MTX对中枢神经系统的晚期影响（n = 10),肾（n = 2) 骨骼健康（n = 3). 9项研究表明，与未接触CCS、健康对照组或参考值相比，接触CCS的神经心理测试结果不佳。没有研究显示接触CCS的人骨密度较低或肾功能较差。作为限制，每个器官系统的研究总体质量低到非常低，主要是由于选择偏差、重要混杂因素的调整缺失和精度低。用HD-MTX治疗的CCS可能受益于神经心理测试，以便在结果异常的情况下进行早期干预。所用测试的方法论缺陷和异质性使得无法确定最合适的测试。基于对肾功能和骨骼健康的少数研究，定期筛查功能障碍似乎是不合理的。在接受HD-MTX治疗的CCS中，只需要筛查神经认知晚期效应。
[英文摘要] High-dose methotrexate (HD-MTX) is used in the treatment of different childhood cancers, including leukemia, the most common cancer type and is commonly defined as an intravenous dose of at least 1 g/m body surface area per application. A systematic review on late effects on different organs due to HD-MTX is lacking. We conducted a systematic literature search in PubMed, including studies published in English or German between 1985 and 2020. The population of each study had to consist of at least 75% childhood cancer survivors (CCSs) who had completed the cancer treatment at least twelve months before late effects were assessed and who had received HD-MTX. The literature search was not restricted to specific cancer diagnosis or organ systems at risk for late effects. We excluded case reports, case series, commentaries, editorial letters, poster abstracts, narrative reviews and studies only reporting prevalence of late effects. We followed PRISMA guidelines, assessed the quality of the eligible studies according to GRADE criteria and registered the protocol on PROSPERO (ID: CRD42020212262). We included 15 out of 1731 identified studies. Most studies included CCSs diagnosed with acute lymphoblastic leukemia (n = 12). The included studies investigated late effects of HD-MTX on central nervous system (n = 10), renal (n = 2) and bone health (n = 3). Nine studies showed adverse outcomes in neuropsychological testing in exposed compared to non-exposed CCSs, healthy controls or reference values. No study revealed lower bone density or worse renal function in exposed CCSs. As a limitation, the overall quality of the studies per organ system was low to very low, mainly due to selection bias, missing adjustment for important confounders and low precision. CCSs treated with HD-MTX might benefit from neuropsychological testing, to intervene early in case of abnormal results. Methodological shortcomings and heterogeneity of the tests used made it impossible to determine the most appropriate test. Based on the few studies on renal function and bone health, regular screening for dysfunction seems not to be justified. Only screening for neurocognitive late effects is warranted in CCSs treated with HD-MTX.
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32. Anticoagulation stewardship from menstruation to menopause: a toolkit for clinical management.
32. 从月经到绝经的抗凝管理：临床管理工具包PMID:日期:2025-12-09[中文摘要] 接受抗凝治疗的行经个体的管理十分复杂，且在现行临床指南中常被忽视。尽管现有建议广泛涉及抗凝药物的使用，但对这一人群的月经出血管理、避孕及生殖阶段过渡等方面几乎未提供指导。为填补这些空白，我们开发了一套实用的临床工具包，聚焦于行经个体（从青春期至绝经期）的抗凝管理。这一专家驱动的资源概述了识别和管理月经过多、优化避孕咨询以及在妊娠、手术和围绝经期等高风险时期协调照护的最佳实践。该工具包还为特殊人群提供指导，包括青少年、跨性别及性别多元个体，以及医疗可及性有限的人群。关键主题包括药物选择、剂量调整、贫血筛查以及适当时转诊至妇科。该工具包强调多学科团队——包括血液科、妇科、初级保健和抗凝服务——在提供以患者为中心、公平的照护中的作用。它还重点介绍了将月经健康纳入常规抗凝管理的实用策略，促进共同决策，并改善受影响个体的生活质量。
[英文摘要] The care of menstruating individuals on anticoagulation is complex and often overlooked in current clinical guidelines. Although existing recommendations address anticoagulant use broadly, they provide little guidance on managing menstrual bleeding, contraception, or reproductive transitions in this population. To address these gaps, we developed a practical clinical toolkit focused on anticoagulation stewardship for individuals who menstruate-from adolescence through menopause. This expert-driven resource outlines the best practices for identifying and managing heavy menstrual bleeding, optimizing contraceptive counseling, and coordinating care during high-risk periods such as pregnancy, surgery, and perimenopause. It also offers guidance for special populations, including adolescents, transgender and gender-diverse individuals, and those with limited access to care. Key topics include medication selection, dose adjustment, screening for anemia, and referral to gynecology when appropriate. The toolkit emphasizes the role of multidisciplinary teams-including hematology, gynecology, primary care, and anticoagulation services-in delivering patient-centered, equitable care. It also highlights practical strategies for integrating menstrual health into routine anticoagulation management, promoting shared decision making, and improving quality of life for affected individuals.
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33. Medical Outcomes, Quality of Life, and Family Perceptions for Outpatient vs Inpatient Neutropenia Management After Chemotherapy for Pediatric Acute Myeloid Leukemia.
33. 儿童急性髓系白血病化疗后中性粒细胞减少的门诊与住院管理的医疗结局、生活质量和家庭认知PMID:日期:2021-10-01[中文摘要] 儿童急性髓系白血病（AML）需要多疗程强化化疗，导致中性粒细胞减少，并伴随显著的感染并发症风险。支持治疗指南建议住院直至中性粒细胞恢复。然而，支持门诊优于住院管理的证据很少。旨在评估儿童AML门诊与住院中性粒细胞减少管理的效果。本队列研究采用定性和定量方法，比较门诊与住院中性粒细胞减少管理之间的医疗结局、患者健康相关生活质量（HRQOL）以及患者和家属的感受。研究纳入来自17家美国儿童医院的患者，前线化疗开始日期范围为2011年1月至2019年7月，但各具体分析因设计和相对时间不同，具体日期范围有所差异。数据分析时间为2019年8月至2020年2月。暴露因素为出院后门诊与住院中性粒细胞减少管理。主要结局指标为各疗程菌血症发生率、至下一疗程的时间以及患者HRQOL。各疗程死亡率为次要医疗结局。主要定量分析纳入554例患者（272例[49.1%]女孩和282例[50.9%]男孩；平均[SD]年龄，8.2[6.1]岁）。门诊与住院管理期间菌血症发生率无显著差异（67个疗程[23.8%] vs 265个疗程[29.0%]；校正率比，0.73；95% CI，0.56至1.06；P = .08）。与住院管理相比，门诊管理与至下一疗程的延迟无关（平均[SD]30.7[12.2]天 vs 32.8[9.7]天；校正平均差，-2.2；95% CI，-4.1至-0.2，P = .03）。在巩固治疗II期间，接受门诊管理的患者死亡率高于接受住院管理的患者（3例患者[5.4%] vs 1例患者[0.5%]；P = .03），但在其他疗程中与住院管理相当（例如，诱导治疗I期间，0例患者 vs 5例患者[1.3%]；P = .59）。在97例接受HRQOL评估的患者中，门诊与住院管理之间的结局无差异（平均[SD]儿科生活质量量表总分，70.1[18.9] vs 68.7[19.4]；校正平均差，-2.8；95% CI，-11.2至5.6）。共有86名受访者（门诊管理20名[23.3%]，住院管理66名[76.7%]）完成了定性访谈。无论接受何种管理策略，74名受访者（86.0%）表示对其经历满意。对住院管理不满意的原因包括照护者对医院相关感染的担忧（7名对照护者不满意的受访者中有6名[85.7%]）和家庭分离（2名对住院管理不满意的患者受访者中有2名[100%]）。对门诊管理不满意的原因是在家照护中性粒细胞减少患儿的压力（3名对门诊管理不满意的受访者中有3名[100%]）。本队列研究发现，在儿童AML患者中，与住院中性粒细胞减少管理相比，门诊中性粒细胞减少管理与更高的菌血症发生率、治疗延迟或更差的HRQOL无关。虽然门诊管理对许多患者可能是安全的，但各疗程死亡率差异提示，巩固治疗II期间的门诊管理应谨慎对待。患者和家属的经历各不相同，提示门诊管理可能为部分家庭所偏好，但并非对所有家庭都可行。有必要进一步开展研究以完善和标准化安全的门诊管理实践。
[英文摘要] Pediatric acute myeloid leukemia (AML) requires multiple courses of intensive chemotherapy that result in neutropenia, with significant risk for infectious complications. Supportive care guidelines recommend hospitalization until neutrophil recovery. However, there are little data to support inpatient over outpatient management. To evaluate outpatient vs inpatient neutropenia management for pediatric AML. This cohort study used qualitative and quantitative methods to compare medical outcomes, patient health-related quality of life (HRQOL), and patient and family perceptions between outpatient and inpatient neutropenia management. The study included patients from 17 US pediatric hospitals with frontline chemotherapy start dates ranging from January 2011 to July 2019, although the specific date ranges differed for the individual analyses by design and relative timing. Data were analyzed from August 2019 to February 2020. Discharge to outpatient vs inpatient neutropenia management. The primary outcomes of interest were course-specific bacteremia incidence, times to next course, and patient HRQOL. Course-specific mortality was a secondary medical outcome. Primary quantitative analyses included 554 patients (272 [49.1%] girls and 282 [50.9%] boys; mean [SD] age, 8.2 [6.1] years). Bacteremia incidence was not significantly different during outpatient vs inpatient management (67 courses [23.8%] vs 265 courses [29.0%]; adjusted rate ratio, 0.73; 95% CI, 0.56 to 1.06; P = .08). Outpatient management was not associated with delays to the next course compared with inpatient management (mean [SD] 30.7 [12.2] days vs 32.8 [9.7] days; adjusted mean difference, -2.2; 95% CI, -4.1 to -0.2, P = .03). Mortality during intensification II was higher for patients who received outpatient management compared with those who received inpatient management (3 patients [5.4%] vs 1 patient [0.5%]; P = .03), but comparable with inpatient management at other courses (eg, 0 patients vs 5 patients [1.3%] during induction I; P = .59). Among 97 patients evaluated for HRQOL, outcomes did not differ between outpatient and inpatient management (mean [SD] Pediatric Quality of Life Inventory total score, 70.1 [18.9] vs 68.7 [19.4]; adjusted mean difference, -2.8; 95% CI, -11.2 to 5.6). A total of 86 respondents (20 [23.3%] in outpatient management, 66 [76.7%] in inpatient management) completed qualitative interviews. Independent of management strategy received, 74 respondents (86.0%) expressed satisfaction with their experience. Concerns for hospital-associated infections among caregivers (6 of 7 caregiver respondents [85.7%] who were dissatisfied with inpatient management) and family separation (2 of 2 patient respondents [100%] who were dissatisfied with inpatient management) drove dissatisfaction with inpatient management. Stress of caring for a neutropenic child at home (3 of 3 respondents [100%] who were dissatisfied with outpatient management) drove dissatisfaction with outpatient management. This cohort study found that outpatient neutropenia management was not associated with higher bacteremia incidence, treatment delays, or worse HRQOL compared with inpatient neutropenia management among pediatric patients with AML. While outpatient management may be safe for many patients, course-specific mortality differences suggest that outpatient management in intensification II should be approached with caution. Patient and family experiences varied, suggesting that outpatient management may be preferred by some but may not be feasible for all families. Further studies to refine and standardize safe outpatient management practices are warranted.
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34. A review of the chemistry, biological action, and clinical applications of anabolic-androgenic steroids.
34. 合成代谢-雄激素类固醇的化学、生物学作用及临床应用综述PMID:日期:2001-09[中文摘要] 自1935年发现睾酮以来，已合成了众多睾酮衍生物，其目标是延长其在体内的生物活性、产生口服活性雄激素，以及开发通常称为合成代谢-雄激素类固醇（AAS）的产品，使其比母体分子具有更强的合成代谢作用和更弱的雄激素作用。本文综述了睾酮及一些最常用AAS的结构、生物转化和作用机制。讨论了AAS的临床应用，并概述了尽量减少其副作用的指南和治疗策略。本综述纳入的文献通过威斯康星大学医学院和药学院的图书馆、作者的个人文件以及MEDLINE、科学引文索引、生物学文摘和化学文摘的检索来确定。睾酮及其衍生物的肌营养作用和对大脑的刺激效应导致运动员和“娱乐性”药物使用者广泛使用AAS。因此，1991年所有AAS均被列为III类管制物质。尽管如此，AAS在多种人类疾病中显示出益处，包括HIV相关的肌肉消耗和其他分解代谢状况，如慢性阻塞性肺疾病、严重烧伤和酒精性肝炎。由于其多样的生物学作用，AAS已被用于治疗多种其他疾病，包括骨髓衰竭综合征、儿童体质性生长迟缓和遗传性血管性水肿。AAS治疗与多种副作用相关，这些副作用通常与剂量相关；因此，为健美和增强运动表现而非法使用大剂量AAS可导致严重且不可逆的器官损害。AAS最常见的副作用是女性和儿童出现一定程度男性化、行为改变（如攻击性）、肝毒性以及血脂水平和凝血因子的改变。为尽量减少或避免AAS治疗的严重毒性，密切的医学监督和定期监测非常重要，并酌情调整剂量以达到最低有效剂量。鉴于AAS的生物学效应和潜在不良反应，孕妇、患有乳腺癌或高钙血症的女性、患有前列腺癌或乳腺癌的男性以及肾病综合征或严重肝功能不全的患者应避免使用这些药物。
[英文摘要] Since its discovery in 1935, numerous derivatives of testosterone have been synthesized, with the goals of prolonging its biological activity in vivo, producing orally active androgens, and developing products, commonly referred to as anabolic-androgenic steroids (AAS), that are more anabolic and less androgenic than the parent molecule. This article reviews the structure, biotransformation, and mechanism of action of testosterone and some of the most commonly used AAS. Clinical applications of the AAS are discussed, and guidelines and therapeutic maneuvers for minimizing their side effects are outlined. Literature for inclusion in this review was identified using the libraries of the University of Wisconsin Medical School and School of Pharmacy, the author's files, and searches of MEDLINE, Science Citation Index, Biological Abstracts, and Chemical Abstracts. The myotrophic action of testosterone and its derivatives and their stimulatory effects on the brain have led to widespread use of AAS by athletes and "recreational" drug users. Consequently, all AAS were classified as class III controlled substances in 1991. Nonetheless, AAS have shown benefit in a variety of human disorders, including HIV-related muscle wasting and other catabolic conditions such as chronic obstructive pulmonary disease, severe burn injuries, and alcoholic hepatitis. Because of their diverse biological actions, AAS have been used to treat a variety of other conditions, including bone marrow failure syndromes, constitutional growth retardation in children, and hereditary angioedema. AAS therapy is associated with various side effects that are generally dose related; therefore, illicit use of megadoses of AAS for the purpose of bodybuilding and enhancement of athletic performance can lead to serious and irreversible organ damage. The most common side effects of AAS are some degree of masculinization in women and children, behavioral changes (eg, aggression), hepatotoxicity, and alteration of blood lipid levels and coagulation factors. To minimize or avoid serious toxicities with AAS therapy, close medical supervision and periodic monitoring are important, with dose adjustment as appropriate to achieve the minimum effective dose. Given the biological effects and potential adverse effects of AAS, administration of these agents should be avoided in pregnant women, women with breast cancer or hypercalcemia, men with carcinoma of the prostate or breast, and patients with nephrotic syndromes or significant liver dysfunction.
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35. Antiviral Use in Canadian Children Hospitalized for Influenza.
35. 加拿大因流感住院儿童的抗病毒药物使用情况PMID:期刊:日期:2021-09-21[中文摘要] 抗病毒药物推荐用于因流感住院的儿童，但使用不足。我们描述了加拿大儿科中心流感住院期间的抗病毒药物处方情况，并识别与抗病毒药物使用相关的因素。我们对2010-2011年至2018-2019年期间在12家加拿大免疫监测项目主动医院中≤16岁儿童实验室确诊流感住院病例进行了主动监测。采用逻辑回归分析识别与抗病毒药物使用相关的因素。在7545例患者中，57.4%为男性；中位年龄为3岁（四分位距：1.1-6.3）。总体而言，41.3%接受了抗病毒药物；72.8%接受了抗生素。抗病毒药物使用因中心而异（范围，10.2%至81.1%）和流感季节而异（范围，19.9%至59.6%），并且在患有≥1种慢性健康状况的儿童中更为频繁（52.7% vs 36.7%；< .001）。在多变量分析中，与抗病毒药物使用相关的因素包括年龄较大（调整比值比[aOR] 1.04 [95%置信区间(CI)，1.02-1.05]）、较近的季节（2018-2019年最高aOR 9.18 [95% CI，6.70-12.57]）、流感高峰期入院（aOR 1.37 [95% CI，1.19-1.58]）、当地治疗指南的可及性（aOR 1.54 [95% CI，1.17-2.02]）、实验室确认的时间（入院前可获得结果时最高aOR 2.67 [95% CI，1.97-3.61]）、存在慢性健康状况（癌症时最高aOR 4.81 [95% CI，3.61-6.40]）、影像学确诊肺炎（aOR 1.39 [95% CI，1.20-1.60]）、抗生素治疗（aOR 1.51 [95% CI，1.30-1.76]）、呼吸支持（1.57 [95% CI，1.19-2.08]）和ICU入住（aOR 3.62 [95% CI，2.88-4.56]）。流感抗病毒药物在加拿大儿科医院中使用不足，包括在高危慢性健康状况的儿童中。处方因中心差异很大，随时间增加，并与患者和医院层面的特征相关。有必要采取多方面的医院干预措施，以加强对抗流感治疗指南和抗菌药物管理实践的依从性。
[英文摘要] Antivirals are recommended for children hospitalized with influenza but are underutilized. We describe antiviral prescribing during influenza admissions in Canadian pediatric centers and identify factors associated with antiviral use. We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from 2010-2011 to 2018-2019. Logistic regression analyses were used to identify factors associated with antiviral use. Among 7545 patients, 57.4% were male; median age was 3 years (interquartile range: 1.1-6.3). Overall, 41.3% received antiviral agents; 72.8% received antibiotics. Antiviral use varied across sites (range, 10.2% to 81.1%) and influenza season (range, 19.9% to 59.6%) and was more frequent in children with ≥1 chronic health condition (52.7% vs 36.7%; < .001). On multivariable analysis, factors associated with antiviral use included older age (adjusted odds ratio [aOR] 1.04 [95% confidence interval (CI), 1.02-1.05]), more recent season (highest aOR 9.18 [95% CI, 6.70-12.57] for 2018-2019), admission during peak influenza period (aOR 1.37 [95% CI, 1.19-1.58]), availability of local treatment guideline (aOR 1.54 [95% CI, 1.17-2.02]), timing of laboratory confirmation (highest aOR 2.67 [95% CI, 1.97-3.61] for result available before admission), presence of chronic health conditions (highest aOR 4.81 [95% CI, 3.61-6.40] for cancer), radiographically confirmed pneumonia (aOR 1.39 [95% CI, 1.20-1.60]), antibiotic treatment (aOR 1.51 [95% CI, 1.30-1.76]), respiratory support (1.57 [95% CI, 1.19-2.08]), and ICU admission (aOR 3.62 [95% CI, 2.88-4.56]). Influenza antiviral agents were underused in Canadian pediatric hospitals, including among children with high-risk chronic health conditions. Prescribing varied considerably across sites, increased over time, and was associated with patient and hospital-level characteristics. Multifaceted hospital-based interventions are warranted to strengthen adherence to influenza treatment guidelines and antimicrobial stewardship practices.
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36. Clinical characteristics and outcomes for 7,995 patients with SARS-CoV-2 infection.
36. 7995例SARS-CoV-2感染患者的临床特征和结局PMID:日期:2021-03-31[中文摘要] 严重急性呼吸综合征病毒（SARS-CoV-2）已在全球感染数百万人。我们的目标是识别与SARS-CoV-2患者入院及疾病严重程度相关的危险因素。这是一项观察性、回顾性研究，基于临床数据存储库中7,995例SARS-CoV-2患者的真实世界数据。耶鲁纽黑文健康系统（YNHH）是一个由五家医院组成的学术型医疗系统，服务于多元化的患者群体，在城市和郊区均设有社区及教学机构。本研究纳入2020年3月1日至4月30日期间在YNHH接受SARS-CoV-2检测的成年患者。主要结局为经RT-PCR检测确诊的SARS-CoV-2感染患者的入院率和院内死亡率。我们还评估了与需要呼吸支持相关的特征。在28,605例接受SARS-CoV-2检测的患者中，7,995例（27.9%）发生感染（中位年龄52.3岁），其中2,154例（26.9%）发生相关入院（中位年龄66.2岁）。在入院患者中，2,152例（99.9%）在研究期结束时已有出院去向。其中，329例（15.3%）需要有创机械通气，305例（14.2%）死亡。年龄增大和男性与入院及院内死亡率（中位年龄80.7岁）呈正相关，而合并症与入院或死亡风险的关联则弱得多。黑人种族（OR 1.43，95%CI 1.14-1.78）和西班牙裔族裔（OR 1.81，95%CI 1.50-2.18）被确定为入院的危险因素，但在出院患者中，经年龄校正后的院内死亡率在种族和族裔群体间无显著差异。这项观察性研究在SARS-CoV-2感染检测阳性人群中识别出，年龄较大和男性是与SARS-CoV-2感染患者入院及院内死亡率关联最强的危险因素。尽管少数种族和族裔群体的疾病负担和入院风险增加，但出院患者经年龄校正后的院内死亡率在种族和族裔群体间无显著差异。需要持续开展研究以继续评估这些风险，尤其是在治疗指南不断演变的背景下。
[英文摘要] Severe acute respiratory syndrome virus (SARS-CoV-2) has infected millions of people worldwide. Our goal was to identify risk factors associated with admission and disease severity in patients with SARS-CoV-2. This was an observational, retrospective study based on real-world data for 7,995 patients with SARS-CoV-2 from a clinical data repository. Yale New Haven Health (YNHH) is a five-hospital academic health system serving a diverse patient population with community and teaching facilities in both urban and suburban areas. The study included adult patients who had SARS-CoV-2 testing at YNHH between March 1 and April 30, 2020. Primary outcomes were admission and in-hospital mortality for patients with SARS-CoV-2 infection as determined by RT-PCR testing. We also assessed features associated with the need for respiratory support. Of the 28605 patients tested for SARS-CoV-2, 7995 patients (27.9%) had an infection (median age 52.3 years) and 2154 (26.9%) of these had an associated admission (median age 66.2 years). Of admitted patients, 2152 (99.9%) had a discharge disposition at the end of the study period. Of these, 329 (15.3%) required invasive mechanical ventilation and 305 (14.2%) expired. Increased age and male sex were positively associated with admission and in-hospital mortality (median age 80.7 years), while comorbidities had a much weaker association with the risk of admission or mortality. Black race (OR 1.43, 95%CI 1.14-1.78) and Hispanic ethnicity (OR 1.81, 95%CI 1.50-2.18) were identified as risk factors for admission, but, among discharged patients, age-adjusted in-hospital mortality was not significantly different among racial and ethnic groups. This observational study identified, among people testing positive for SARS-CoV-2 infection, older age and male sex as the most strongly associated risks for admission and in-hospital mortality in patients with SARS-CoV-2 infection. While minority racial and ethnic groups had increased burden of disease and risk of admission, age-adjusted in-hospital mortality for discharged patients was not significantly different among racial and ethnic groups. Ongoing studies will be needed to continue to evaluate these risks, particularly in the setting of evolving treatment guidelines.
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37. Five-year results of a treatment program for chronic hepatitis B in Ethiopia.
37. 埃塞俄比亚慢性乙型肝炎治疗项目的五年结果PMID:日期:2023-09-29[中文摘要] 在撒哈拉以南非洲，不到1%符合治疗条件的慢性乙型肝炎（CHB）患者接受了抗病毒治疗。需要来自当地CHB项目的经验，为该大陆的治疗指南和政策提供依据。在此，我们展示了撒哈拉以南非洲首批大规模CHB治疗项目之一的5年结果。2015年，埃塞俄比亚亚的斯亚贝巴的一项试点治疗项目纳入了成年CHB患者。在基线时及此后每6个月评估肝酶、病毒标志物和瞬时弹性成像。根据欧洲肝脏研究学会（EASL）标准并作部分修改后启动富马酸替诺福韦二吡呋酯治疗。采用Kaplan-Meier法进行生存分析。该项目共纳入1303例患者，其中291例（22.3%）在最初5年随访内开始抗病毒治疗。在接受治疗的患者中，基线无肝硬化患者的估计5年无肝细胞癌生存率为99.0%，而代偿期肝硬化患者为88.8%，失代偿期肝硬化患者为54.2%（p < 0.001）。基线时失代偿期肝硬化患者（校正风险比44.6，95%置信区间6.1-328.1）和年龄大于40岁患者（校正风险比3.7，95%置信区间1.6-8.5）的死亡风险显著更高。开始治疗后肝脏硬度显著下降；治疗1年、3年和5年后较基线的中位变化分别为-4.0 kPa、-5.2 kPa和-5.6 kPa。该试点项目表明，在资源有限的环境中，CHB治疗具有长期获益。肝硬化患者的高死亡率凸显了在撒哈拉以南非洲早期发现CHB并及时启动抗病毒治疗的必要性。该研究于2015年1月26日在ClinicalTrials.gov注册（NCT02344498）。
[英文摘要] In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large-scale CHB treatment programs in sub-Saharan Africa. Adults with CHB were enrolled in a pilot treatment program in Addis Ababa, Ethiopia, in 2015. Liver enzymes, viral markers, and transient elastography were assessed at baseline and thereafter at 6-month intervals. Tenofovir disoproxil fumarate was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. Survival analysis was performed using the Kaplan-Meier method. In total, 1303 patients were included in the program, of whom 291 (22.3%) started antiviral therapy within the initial 5 years of follow-up. Among patients on treatment, estimated 5-year hepatocellular carcinoma-free survival was 99.0% in patients without cirrhosis at baseline, compared to 88.8% in patients with compensated cirrhosis, and 54.2% in patients with decompensated cirrhosis (p < 0.001). The risk of death was significantly higher in patients with decompensated cirrhosis at baseline (adjusted hazard ratio 44.6, 95% confidence interval 6.1-328.1) and in patients older than 40 years (adjusted hazard ratio 3.7, 95% confidence interval 1.6-8.5). Liver stiffness declined significantly after treatment initiation; the median change from baseline after 1, 3, and 5 years of treatment was - 4.0 kPa, - 5.2 kPa, and - 5.6 kPa, respectively. This pilot program demonstrates the long-term benefits of CHB therapy in a resource-limited setting. The high mortality in patients with cirrhosis underscores the need for earlier detection of CHB and timely initiation of antiviral treatment in sub-Saharan Africa. The study was registered at ClinicalTrials.gov (NCT02344498) on January 26, 2015.
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38. Nasopharyngeal carcinoma in children and adolescents: The EXPeRT/PARTNER diagnostic and therapeutic recommendations.
38. 儿童和青少年鼻咽癌：EXPeRT/PARTNER诊断和治疗建议PMID:日期:2021-04-12[中文摘要] 鼻咽癌（NPC）是一种罕见的儿童肿瘤。过去数十年间开展的合作研究显示，与历史数据相比，治疗效果有所改善，但儿童鼻咽癌的诊断和管理标准化指南仍不可得。本研究介绍了由欧洲儿童罕见肿瘤合作研究组（EXPeRT）制定的儿童鼻咽癌诊断与治疗欧洲共识指南。主要建议包括采用顺铂和5-氟尿嘧啶进行诱导化疗，晚期疾病行同步放化疗，并考虑对选定的高危患者使用干扰素β（IFN-β）进行维持治疗。根据诱导化疗反应调整放疗剂量，可能降低影响大多数生存者的长期治疗相关并发症的发生率。
[英文摘要] Nasopharyngeal carcinoma (NPC) is a rare pediatric tumor. Collaborative studies performed over the last decades showed improved results compared to historical data, but standardized guidelines for diagnosis and management of pediatric NPC are still unavailable. This study presents a European consensus guideline for the diagnosis and treatment of pediatric NPC developed by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT). Main recommendations include induction chemotherapy with cisplatin and 5-flurouracil, concomitant chemoradiotherapy in advanced disease, and to consider maintenance treatment with interferon beta (IFN-β) for selected high-risk patients. Dose adjustments of radiotherapy based on response to induction chemotherapy may decrease the rates of long-term treatment-related complications that affect most of the survivors.
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39. Anticoagulation therapy: indications, monitoring, and complications.
39. 抗凝治疗：适应证、监测和并发症PMID:日期:2011-01[中文摘要] 抗凝治疗用于血栓栓塞性疾病，而出血作为抗凝治疗的主要并发症，虽不常见，但可能危及生命或肢体，并可能在儿科急诊科就诊。儿童血栓栓塞性疾病通常作为血管通路的并发症发生，主要见于先天性心脏病或癌症患儿。然而，用于治疗静脉血栓栓塞、肺栓塞和中心静脉导管堵塞的抗凝治疗并发症，以及动脉血栓栓塞，包括动脉缺血性卒中、川崎病和心脏手术后，均可能需要到儿科急诊科就诊。抗凝治疗可采用普通肝素、低分子量肝素、维生素K拮抗剂、乙酰水杨酸或溶栓治疗。儿童抗凝治疗的监测非常重要，并遵循成人指南。抗凝药物剂量可根据活化部分凝血活酶时间、抗Xa因子水平和国际标准化比率进行调整。
[英文摘要] Anticoagulation for thromboembolic disease and bleeding, the main complication of anticoagulation therapy, are uncommon but are potentially life- or limb-threatening conditions that may present in the pediatric emergency department. Thromboembolic disease in children usually occurs as a complication of vascular access, primarily in children with congenital heart disease or cancer. However, complications of anticoagulation therapy used in the treatment of venous thromboembolism, pulmonary embolism, and blocked central venous catheter; arterial thromboembolism, including arterial ischemic stroke, Kawasaki disease, and after cardiac surgery, may warrant a visit to n the pediatric emergency department. Anticoagulation therapy may take the form of unfractionated heparin, low-molecular weight heparin, vitamin K antagonists, acetylsalicylic acid, or thrombolytic therapy. Monitoring anticoagulation therapy in children is very important and follows adult guidelines. Anticoagulant dosing may be adjusted based on activated partial thromboplastin time, anti-factor Xa level, and international normalized ratio.
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40. The association between HIV drug resistance testing, viral suppression and mortality in Ontario: a retrospective cohort study.
40. 安大略省HIV耐药检测、病毒抑制与死亡率之间的关联：一项回顾性队列研究PMID:日期:2025-07-31[中文摘要] 耐药性会削弱抗逆转录病毒治疗（ART）的效果。许多高收入国家的指南建议在开始治疗前进行耐药检测，且已证实其可改善一线ART方案失败后的结局。关于其在未接受过治疗个体中的作用，证据有限。我们旨在研究在加拿大安大略省开始治疗的HIV感染者中，耐药检测与病毒抑制及死亡率之间的关联，该地区自2014年起将耐药检测作为标准诊疗。我们利用与安大略HIV治疗网络（OHTN）队列研究（OCS）相链接的安大略省健康行政数据库，开展了一项2005年至2018年的回顾性队列研究。符合条件的队列参与者为在随访时间范围内具有完整数据者。我们使用逻辑回归比较有治疗前耐药检测记录的HIV感染者与无此记录者之间病毒抑制（6-18个月时<200拷贝/mL）的比值比及死亡情况。我们对年龄、性别、开始ART的年份、种族、性取向、教育水平、收入、依从性、锚定药物、移民状态、注射吸毒、病毒载量和基线CD4计数进行了校正。在1806名符合条件的参与者中，716人被纳入死亡分析，其中3.7%在随访结束时死亡。699人被纳入病毒抑制分析，其中94.6%实现了病毒抑制。在校正协变量的模型中，ART开始前的耐药检测与病毒抑制（比值比[OR] 1.13；95%置信区间[CI] 0.58-2.22）或死亡（OR 1.06；95% CI 0.49-2.28）均无显著关联。年龄较大者以及以非核苷类逆转录酶抑制剂而非蛋白酶抑制剂开始治疗者，以及基线CD4计数较高者，更可能实现病毒抑制。年龄较大者的死亡比值比更高。耐药检测与病毒抑制和死亡均无关联。结局与临床和人口学因素相关，尤其是治疗方案、基线CD4计数和年龄。
[英文摘要] Drug resistance compromises the effectiveness of antiretroviral therapy (ART). Resistance testing prior to initiating therapy is recommended in guidelines in many high-income countries, and it has been shown to improve outcomes after first-line ART regimen failure. There is limited evidence on its role in treatment-naïve individuals. We sought to investigate the association between resistance testing and viral suppression and mortality in people living with HIV initiating treatment in Ontario, Canada, where resistance testing became standard of care in 2014. We conducted a retrospective cohort study from 2005 to 2018 using Ontario health administrative databases linked to the Ontario HIV Treatment Network (OHTN) Cohort Study (OCS). Eligible cohort participants were those who had complete data within the follow-up time range. We used logistic regression to compare the odds of viral suppression (<200 copies/mL, at 6-18 months) and death between people living with HIV who had a record of resistance testing prior to treatment and those who did not. We adjusted for age, sex, year ART was started, race, sexual orientation, level of education, income, adherence, anchor drug, immigration status, injection drug use, viral load and baseline CD4 count. Of 1806 eligible participants, 716 were analysed for death, of which 3.7% had died at the end of follow-up. Six hundred and ninety-nine (699) were analysed for viral suppression, of which 94.6% achieved viral suppression. Resistance testing prior to ART initiation had no significant association with viral suppression (odds ratio [OR] 1.13; 95% confidence interval [CI] 0.58-2.22) or death (OR 1.06 95% CI 0.49-2.28) in the covariate-adjusted models. Viral suppression was more likely in older age and in people who started treatment with non-nucleoside reverse transcriptase inhibitors compared to protease inhibitors, and in people with a higher baseline CD4 count. The odds of death were higher in individuals who were older. Resistance testing was not associated with viral suppression and death. Outcomes were associated with clinical and demographic factors, notably regimen, baseline CD4 count and age.