Background and objectiveSurgical resection remains the mainstay of treatment for patients with early-staged thymic tumors, while chemotherapy is most commonly used in stage IV cases. As for locally advanced thymic tumors, especially those unsuitable for surgery, the optimal therapy is still controversial. hTus, we conducted this retrospective study by comparing three nonsurgical treatment modalities to ifnd some clues.Methods hTree treatment modalities were used in 42 pa-tients from October 2000 to December 2010, including radiotherapy (RT) alone, sequential chemoradiation (SCRT) and con-current chemoradiation (CCRT). Objective response rate (ORR), overall survival (OS) and toxicity of the three regimens were compared accordingly.Results The ORR in all 42 patients was 61.9%, and 5-year OS was 46%. The ORR of RT, SCRT and CCRT were 43.8%, 50% and 87.5%, respectively (RTvs SCRT,P=0.692; RTvs CCRT,P=0.009; SCRTvs CCRT,P=0.051). The 5-year OS of RT, SCRT and CCRT were 30%, 50% and 61.9%, respectively (RTvs SCRT,P=0.230; RTvsCCRT,P=0.011; SCRTvs CCRT,P=0.282). Eleven patients developed neutropenia of grade 3-4, with 7 in CCRT group and 4 in SCRT, respec-tively. Nine patients experienced esophagitis of grade 3 with 2 in RT, 3 in SCRT and 4 in CCRT. There were also two cases of grade 3 radiation induced pneumonitis in CCRT group. No life-threatening side effects were noted.Conclusion When used to treat locally advanced thymic tumors unsuitable for surgery, CCRT performed more favorably than RT alone or SCRT in both tumor response and long time survival, but probably with the increasing risk of pulmonary damage. CCRT may offer the best chance of disease control in the management of locally advanced disease.

Objective:To investigate the prevalence of sarcopenia as defined by the third lumbar skeletal muscle index (L3-SMI) and explore its impact on drug therapy in patients with inflammatory bowel disease (IBD).Methods:The baseline abdominal CT images of 230 patients with IBD hospitalized in the First Hospital of Shanxi Medical University from December 2018 to December 2022 were retrospectively analyzed to obtain L3-SMI. The optimal cut-off value of L3-SMI to define sarcopenia was determined using receiver operating characteristic curve analysis. The IBD group included 164 cases of ulcerative colitis (UC) and 66 cases of Crohn's disease (CD), compared with 100 cases of the normal control. The clinical data and biochemical indicators, such as body mass index (BMI), albumin (ALB), pre-albumin (PA), disease activity and therapeutic drugs, were collected. Outcomes were followed up, including the optimization of baseline drug therapy, the initiation of additional biological agents or combined drug therapy. Multivariate logistic regression analysis was used to identify risk factors for the escalation of drug therapy, and the nomogram was constructed and evaluated for the prediction of drug regimen escalation in patients with IBD.Results:The prevalence of sarcopenia in the IBD population in this study was 39.6%, among whom 36.0% were with ulcerative colitis and 48.5% with Crohn's disease. The prevalence of malnutrition (BMI<18.5) in IBD patients was 18.7%, whereas 69.2% of patients with concurrent IBD and sarcopenia had a BMI≥18.5 . The median L3-SMI of IBD patients was significantly lower than that of normal controls (36.30 cm 2/m 2vs. 39.37 cm 2/m 2, P=0.004). Sarcopenia ( OR=3.33, 95% CI: 1.06 to 10.50, P=0.040) was associated with the escalation of drug therapy in patients with IBD. Based on the patient's age, presence or absence of sarcopenia, albumin and BMI, the nomogram prediction model was established, with the area under the curve (AUC) of 0.762 (95% CI: 0.691 to 0.834), showing good discriminating performance. The calibration curve and Hosmer-Lemeshow goodness-of-fit test demonstrated good consistency between the predicted and observed data ( χ2 =11.906, P=0.156). Decision curve analysis showed potential benefits of the prediction model in clinical settings. Conclusion:Sarcopenia is common in patients with IBD, which is related to the escalation of drug therapy in patients with IBD.

Background: Intravenous (IV) oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose (ED) and the 95% effective dose (ED) of an IV bolus of oxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone. Methods: Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon's up-and-down method was used to obtain EDdata for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men (step size was 0.01 mg/kg). Next, a dose-response curve from the probit analysis was generated to determine the EDand EDto blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 min before propofol injection. Results: Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED and EDof oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg (95% confidence interval [CI], 0.220-0.328 mg/kg) and 0.357 mg/kg (95% CI, 0.297-2.563 mg/kg), respectively. In men, the ED and EDwere 0.324 mg/kg (95% CI, 0.274-0.381 mg/kg) and 0.454 mg/kg (95% CI, 0.384-2.862 mg/kg), respectively. Men required 28% more oxycodone than women for induction (P < 0.01). The most common adverse events were dizziness (87.3%), vertigo (66.7%), sedation (74.6%), and respiratory depression (66.7%). Conclusions Oxycodone can be used for induction to prevent intubation reactions. Gender affected the EDand EDof oxycodone for blunting the tracheal intubation reaction.
Adult ; Anesthetics, Intravenous ; Female ; Hemodynamics ; drug effects ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; Male ; Middle Aged ; Narcotics ; administration & dosage ; Oxycodone ; administration & dosage

POEMS syndrome is a rare condition associated with plasma cell disorders， and it often involves multiple systems and has diverse clinical manifestations. This article reports two cases of POEMS syndrome with hepatosplenomegaly as the initial manifestation. During the course of the disease， the patients presented with lower limb weakness， hepatosplenomegaly， lymph node enlargement， ascites， hypothyroidism， positive M protein， and skin hyperpigmentation， and ¹⁸F-FDG PET-CT imaging revealed bone lesions mainly characterized by osteolytic changes and plasma cell tumors. There was an increase in the serum level of vascular endothelial growth factor. The patients were finally diagnosed with POEMS syndrome， and the symptoms were relieved after immunomodulatory treatment.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause acute respiratory distress syndrome, hypercoagulability, hypertension, and multiorgan dysfunction. Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis. In an analysis of a randomly collected cohort of 124 patients with COVID-19, we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity. By virtual screening of a U.S. FDA approved drug library, we identified an anticoagulation agent dipyridamole (DIP) , which suppressed SARS-CoV-2 replication . In a proof-of-concept trial involving 31 patients with COVID-19, DIP supplementation was associated with significantly decreased concentrations of D-dimers ( < 0.05), increased lymphocyte and platelet recovery in the circulation, and markedly improved clinical outcomes in comparison to the control patients. In particular, all 8 of the DIP-treated severely ill patients showed remarkable improvement: 7 patients (87.5%) achieved clinical cure and were discharged from the hospitals while the remaining 1 patient (12.5%) was in clinical remission.