Medicine
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Case Reports
Successful sirolimus therapy of an aplastic anemia patient with chronic kidney disease: A case report.
It is very difficult to treat patients with aplastic anemia accompanied by chronic kidney disease. The nephrotoxicity of cyclosporine limits its use in these patients. Most of these patients also lack suitable sibling donors. Sirolimus, as a new type of immunosuppressive agent, has good therapeutic effect, lower toxicity, especially lower nephrotoxicity, thus attracting the attention of hematologists. ⋯ We consider that sirolimus is a safe, effective, and well-tolerated oral drug that can be used as a treatment for aplastic anemia patients with chronic kidney disease.
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Observational Study
Effects of tyrosine kinase inhibitor therapy on skin toxicity and skin-related quality of life in patients with lung cancer: An observational study.
Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy is the primary treatment option for patients with non-small cell lung cancer (NSCLC). However, one of the major adverse effects associated with this therapy is skin toxicity, which impacts the patient's quality of life. This study aimed to describe the severities and locations of skin toxicity, and to analyze their association with the quality of life in patients with advanced NSCLC who received EGFR-TKI therapy as first-line treatment. ⋯ Patients who required EGFR-TKI dose reduction had experienced more severe skin symptoms than had patients who did not require it (7.35 vs 5.01, P < .001). Skin toxicity related to EGFR-TKI treatment impacts the quality of life in patients with NSCLC. During the treatment period, skin assessment and tailored management should be incorporated into the daily care plan.
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Sarcopenia might have impact on the outcome of patients with hepatoma carcinoma (HCC). This study was to determine whether pre-sarcopenia is associated with the outcome of HCC patients undergoing radiofrequency ablation (RFA). Patients with newly diagnosed HCC undergoing RFA were enrolled. ⋯ Multivariate analysis showed pre-sarcopenia (HR: 2.110 (1.092-4.078); P = .026) was the only factor significantly associated with overall survival (OS); however, there were no factors associated with HCC recurrence. For patients without and with pre-sarcopenia, the 1-, 3-, and 5-year OS rates were 92.0%, 77.6%, 68.9%, and 81.8%, 54.5%, 44.1% respectively (P = .007). For early-stage HCC patients undergoing RFA, pre-sarcopenia is the prognostic factor of OS, but not of recurrence, with a worse 5-year OS rate of 44.1%.
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Observational Study
Japanese parturient body mass index and the role in initial nerve block height of women undergoing cesarean delivery with spinal anesthesia.
The present retrospective cohort study was designed to determine body mass index (BMI) at the delivery in women undergoing cesarean section in a Japanese urban area, and whether the nerve block height after spinal anesthesia upon the cesarean delivery relates to the lower maternal BMI, less gestational age, or underweight fetus at birth in the population. A total of 401 pregnant women undergoing cesarean delivery with spinal anesthesia were evaluated retrospectively. We examined background differences, including BMI at the delivery, gestational age, and fetal birth weight between the cases with and without the adequate initial nerve block height less than the sixth thoracic vertebral level (Th6) after the spinal dose administration. ⋯ There was a risk of the low initial block height caused by either preoperative BMI <23, gestational age <37 weeks, or fetal birth weight <2500 g in the population. In a Japanese urban area, parturient median BMI undergoing cesarean delivery is in the normal range. Such lower BMI, in addition to less gestational age or underweight fetus, seems one of the factors causing the low initial block height upon spinal anesthesia.
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Observational Study
Evaluation of lumbar fusion using the anterior to psoas approach for the treatment of L5/S1 spondylolisthesis.
To date, no studies have evaluated the outcomes of lumbar interbody fusion using the anterior to psoas (ATP) approach in patients with spondylolisthesis at L5/S1. We; therefore, aimed to evaluate short-term surgical outcomes of interbody fusion using the ATP approach combined with posterior fixation in these patients. We performed a retrospective analysis of 9 patients with grade I spondylolisthesis at L5/S1 who were treated with fusion and posterior fixation using the ATP approach at our hospital from April to July 2018. ⋯ The ATP approach was safe and effective for the treatment of spondylolisthesis at L5/S1. It showed low vascular injury and cage shift rates and was technically easy to perform. We recommended that surgeons identify the vessels in the surgical field preoperatively so that they can be secured or safely ligated during surgery.