Clostridium difficile (C. difficile) is one of the important pathogens which cause antibiotic-associated diarrhea (AAD) -diarrhea following antibiotic therapy. There are some reports of nosocomial outbreak of AAD caused by C. difficile.We analyzed risk factors and epidemiology of C. difficile-associated diarrhea (CAD) in Kumiai Hospital. From March 2003 to February 2004, 53 in patients developed AAD, of whom 35 patients (66%) were diagnosed as having CAD. Advanced age, bed-rest, tube-feeding, and prolonged administration of antibiotics were regarded as risk factors.In initial two months, seven cases developed CAD in one ward and five in another ward. After hand-washing and use of gloves were enforced in treating CAD patients, the incidence of CAD decreased. Epidemiological analysis was performed using PCR ribotyping of C. difficile strains recovered from 20 among 35 CAD cases in the different wards. Nineteen of 20 strains were identical, typed as the ribotype. These results may suggest nosocomial diarrhea but we cannot conclude that is a hospital infection as yet.Although all C. difficile strains recovered in this study were toxin A-positive, the result of the test using a toxin A detecting kit was negative in three cases. It is necessary toculture C. difficile in addition to detecting toxin A to diagnose CAD.
cytarabine/daunorubicin ; Carbon ion ; Diarrhea ; Clostridium difficile ; Toxins

Usually, tumor stem cells have been assessed functionally in animals with various in vivo transplantation assays or with in vitro colony forming assays. Such studies indicate the tumor stem cell assays can be used to study the properties of tumor stem cells and to delineate the difference in individual sensitivities to chemotherapeutic agents. Over the past year (1987,5-1988,4) we attempted to culture the epithelial tumor cells in laboratory to test the chemosensitivity to Methotrexate, cytarabine, and daunorubicin in different concentrations. The in vitro chemosensitivity of these cells to anticancer drugs was disappointed in much. Only 14% of the cultured cells were inhibited the growth more than 50% in over-all.
Animals ; Carcinoma, Transitional Cell ; Cells, Cultured ; Cytarabine ; Daunorubicin ; Methotrexate ; Neoplastic Stem Cells

OBJECTIVETo compare the complete remission rate (CRR) and adverse reaction of the 3 different chemotherapy regimens (daunorubicin, idarubicin, imported idarubicin combined with cytarabine) for the treatment of adult patients with newly diagnosed non-M3 acute myeloid leukemia (AML).

METHODSSeventy-one adult patients with newly diagnosed non-M3 AML were divided into 3 groups: 17 cases treated with daunorubicin plus cytarabine as group A, 24 cases treated with idarubicin plus cytarabine as group B, 30 cases treated with the imported idarubicin plus cytarabine as group C. The curative effects and adverse reactions were compared among the 3 groups after treatment.

RESULTSCCR in group C (86.67%) was significantly higher than that in group A (52.94%) and group B (70.83%), and the CRR in group B was significantly higher than that in group A (P<0.05). The incidence of adverse reaction such as nausea, vomiting, myelosuppression and infection among 3 groups were not statistically significantant (P>0.05).

CONCLUSIONThe curative effect of idarubicin for the treatment of non-M3 AML patients is better than that of daunorubicin, especially the curative efficiency of imported darubicin is much higher; the adverse reaction after treatment by daunorubicin and idarubicin can be controllable, so daunorubicin and idarubicin can be used as first-line drug for the patients with AML, and patients can choose more appropriate drug according to their own economic ability.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; Cytarabine ; Daunorubicin ; Humans ; Idarubicin ; Leukemia, Myeloid, Acute ; Remission Induction

We repoarted a rare case of AML atypical M2 who developed granulocytic granulocyte sarcoma in the meninges which was induced complete remission with all-trans retinoic acid (ATRA), daunorubicin and cytosine arabinoside (Ara-C). Morphological and immunophenotypic study of leukemic cells in this patient suggested acute promyelocytic leukemia. However, leukemic clees lacked both t (15;17) and PML-RARalpha gene rearragement, rather showed t (8;21). The patient was diagnosed as AML atypical M2.
Cytarabine ; Daunorubicin ; Drug Therapy* ; Granulocytes ; Humans ; Leukemia, Promyelocytic, Acute ; Meninges* ; Sarcoma ; Sarcoma, Myeloid* ; Tretinoin*

OBJECTIVETo compare the effectiveness and side effects of two chemotherapy regimens [pirarubicin + cytarabine (TA) and daunorubicin + cytarabine (DA)] in patients with acute myeloid leukemia (AML).

METHODSFrom Oct 2006 to Jul 2009, there were 207 newly diagnosed AML patients randomized into DA or TA group from 72 centers all over the country. The aim of this clinical trial is to observe and evaluate complete remission rate (CR), total remission rate (TRR), and side effect after one or two circles of therapy.

RESULTSIn 198 evaluable patients, 126 cases in TA group and 72 in DA group were evalvable, with a ratio of 1.75:1. CR was 69.8% and TRR (CR + PR) was 81.8% in TA group and 63.9%, 80.9% in DA group, correspondingly (P > 0.05). For patients with subtype M(2), CR (77.1%) in TA group was higher than that in DA (60%). There was no difference in side effect between the two groups.

CONCLUSIONThere is no difference of the effect between TA and DA chemotherapy for newly diagnosed AML patients. But for subtype M(2), TA is more efficacy. And there is no difference in side effect between the two regimens.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cytarabine ; administration & dosage ; Daunorubicin ; administration & dosage ; Humans ; Leukemia, Myeloid, Acute ; drug therapy ; Prospective Studies

OBJECTIVETo explore whether daunorubicin (DNR) combined with cytosine arabinoside (Ara-C) and DNR alone have similar effect on acute promyelocytic leukemia (APL) cell line NB4 and acute myeloblastic leukemia cell line HL-60 in vitro.

METHODSCell morphology, cells viability, and cell apoptosis (Annexin-V by flow cytometry assay) were analysed.

RESULTSAfter incubation with DNR plus Ara-C for 24 hours,NB4 cell viability [(36.75 +/- 3.82)%] (n = 6) and cell apoptosis rate [(21.24 +/- 5.82)%] (n = 3) did not change significantly compared to that treated with DNR alone for 24 hours [(35.73 + 6.28 )%, (22.55 +/- 3.26)%, respectively] (P > 0.05). However, HL-60 cell viability [(67.17 +/- 2.07)%] and cell apoptosis rate [(48.05 +/- 0.92)%] changed significantly in DNR plus Ara-C group compared with DNR alone [(63.31 +/- 1.80)% ,(41.51 +/- 0.89)%, respectively] (P < 0.01 and < 0.05, respectively).

CONCLUSIONDNR plus Ara-C and DNR alone have similar effect on NB4 cells, but have different effect on HL-60 cells.

Apoptosis ; drug effects ; Cytarabine ; pharmacology ; Daunorubicin ; pharmacology ; HL-60 Cells ; drug effects ; Humans ; Leukemia, Promyelocytic, Acute ; pathology

BACKGROUND: Anthracycline is the most important chemotherapy drug of acute myelocytic leukemia (AML). It has been reported that idarubicin could have better complete remission (CR) rate than daunorubicin. However, it is not completely established concerning the effectiveness of idarubicin. There are many prognostic indicators of AML, however, many discrepancies still exist in prognostic indicators among each centers. METHODS: We analyzed initial CR rate of 39 AML patients treated with combination of cytarabine plus idarubicin or daunorubicin at Samsung Medical Center from April, 1995 to December, 1997. We subgrouped the patients according to age, sex, initial WBC count, status of initial CR, CD34, and chromosome. We analyzed the initial CR rate and long term survival of each subgroups. RESULTS: Initial CR rates of idarubicin and daunorubicin were 76.5% and 72.7%, respectively. The median survival days of 39 patients was 727+/-308.8 days. 1-year survival rate and 1-year event free survival rate were 64.2% and 59.6%, respectively. Patients who had failure of initial CR, old age (>60 years), and initial high WBC counts (>100,000/L) showed a statistically significant shorter survival in univariate analysis. However, we could not find the significant difference in the positivity of CD34 and chromosomal abnormalities. CONCLUSION: The effectiveness of idarubicin may be equivalent to that of daunorubicin. Failure of initial CR, old age, and high WBC counts were regarded as a prognostic risk factors of AML. However, a more definitive characterization of prognostic factors is warranted in further prospective study.
Chromosome Aberrations ; Cytarabine ; Daunorubicin* ; Disease-Free Survival ; Drug Therapy ; Humans ; Idarubicin* ; Leukemia, Myeloid, Acute* ; Risk Factors ; Survival Rate

BACKGROUND: The combination of cytarabine plus anthracycline has been considered standard chemotherapy for acute myelogenous leukemia (AML). We retrospectively analyzed the treatment results of the patients with de novo AML who received cytarabine plus daunorubicin or idarubicin as induction chemotherapy. METHODS: From 1989 to 1998, 149 patients with AML were included. For induction chemotherapy, the patients received cytarabine 100~ 200 mg/m2/day given by continuous 7-day in fusion plus either daunorubicin 40~45 mg/m2/ day (A+D) or idarubicin 12 mg/m2/day (A+I) administered for the first 3 days of treatment. We reviewed clinical records of the patients and analyzed the treatment results such as complete remission (CR) rate, disease free survival (DFS), and overall survival (OS). RESULTS: The CR rates were 67.1% (100 of 149); 69.3% (70 of 101) in A+D group and 62.5 % (30 of 48) in A+I group (P=0.409). The frequent reason of induction failure was resistant disease in A+D group (54.8%) and early death in A+I group (66.7%). The median DFS was 344 days; 344 days in A+D group and 314 days in A+I group. The median OS was 379 days; 389 days in A+D group and 379 days in A+I group. Age < or =60 years and allogeneic BMT as postremission therapy were independent favorable factors both for DFS and OS. AML M3 was favorable factor only for DFS. CONCLUSION: The combination of cytarabine plus daunorubicin or idarubicin was effective for the treatment of AML. We can not find significant difference in CR rate, disease free survival and overall survival between A+D and A+I group.
Cytarabine* ; Daunorubicin* ; Disease-Free Survival ; Drug Therapy ; Humans ; Idarubicin* ; Induction Chemotherapy* ; Leukemia, Myeloid, Acute* ; Leukemia, Promyelocytic, Acute ; Retrospective Studies

OBJECTIVE: To investigate the effect and mechanism of artesunate (ARTS) combined with cytarabine(Ara-C) and/or daunorubicin (DNR) on the proliferation and apoptosis of MV4-11 human mixed-lineage leukemia rearranged（MLL-r） acute myeloid leukemia (AML) cell line. METHODS: CCK-8 assay was used to detect the proliferation effect of individual or in combination of ARTS, DNR, Ara-C on MV4-11 cells. The IC₅₀ of ARTS, DNR and Ara-C was calculated separately. The cell apoptosis and expression of receptors DR4 and DR5 were detected by flow cytometry. Western blot was used to detect the expression of Caspase-3 and Caspase-9 in each groups. RESULTS: The inhibition effect of ARTS, Ara-C and DNR on the proliferation of MV4-11 were all dose-dependently (r=0.99, 0.90 and 0.97, respectively). The IC₅₀ of ARTS, Ara-C and DNR on MV4-11 for 48 hours were 0.31 μg/ml, 1.43 μmol/L and 22.47 nmol/L, respectively. At the dose of ARTS 0.3 μg/ml， Ara-C 1.0 μmol/L and DNR 15 nmol/L, the proliferation rate for 48 hours of the tri-combination treatment was significantly lower than that of the bi-combination treatment, while both were significantly lower than that of the individual treatment (all P＜0.05). In terms of bi-combination treatment, the cells proliferation rate for 48 hours of the ARTS+Ara-C group was significantly lower than that of the ARTS+DNR group, while both were significantly lower than that of the Ara-C+DNR group (all P＜0.05). The cooperativity index (CI) of bi- and tri-combination treatment were all less than 1. After 48 hours of drug action, the cell apoptosis rate of the ARTS+DNR+Ara-C group was significantly higher than that of the Ara-C+DNR group, while both were significantly higher than that of the ARTS+DNR group (all P＜0.05). Meanwhile, the was no statistical difference between the cells apoptotic rate of the ARTS+DNR+Ara-C group and the ARTS+Ara-C group (P>0.05). The expression of DR4 and DR5 also showed no difference between control group and drug group. Compared with the DNR+Ara-C group, the expressions of Caspase-3 were significantly down-regulated in both the ARTS+DNR+Ara-C group and the ARTS+Ara-C group (all P＜0.05). The down-regulation of Caspase-3 expression was the most significantly in the combination group of three drugs, while the Caspase-9 expressions in different groups showed no apparent change. CONCLUSION The in vitro study showed that tri-combination of ARTS+Ara-C+DNR and bi-combination of ARTS+Ara-C could inhibit the proliferation and promote apoptosis of MV4-11 cell line. The inhibition effect of these two combinations were significantly superior to that of the traditional Ara-C+DNR treatment. The mechanism underlying this finding may be identified by the down regulation of Caspase-3, while no altered expression was observed of Caspase-9, DR4 and DR5.
Humans ; Cytarabine/pharmacology* ; Daunorubicin/pharmacology* ; Caspase 3 ; Caspase 9 ; Artesunate/pharmacology* ; Leukemia, Myeloid, Acute ; Apoptosis ; Cell Line

PURPOSE: Important advances in the treatment of acute myelogenous leukemia have been made with the introduction of cytosine arabinoside(ara-C) and anthracycline(daunorubicin) over the past 20 years. Currently, 50 to 85% of patients with acute myelogenous leukemia achieve complete remission with induction chemotherapy consisting of ara-C and daunorubicin. About 25% of complete responders will have extended long-term survival and may be cured. Therefore we treated patients having acute myelogenous leukemia with AD(7+3) regimen and analyzed factors complete remission rate, remission duration, and survival duration. MATERIALS AND METHODS: Induction therapy; Thirty seven patients with previously untreated acute myelogenous leukemia treated with AD(7+ 3) regimen(ara-C, 200 mg/m2/d by continuous infusion for seven days, and daunorubicin, 45 mg/m2/d for 3 days). The second course of therapy was AD(5+2), if the patients failed to enter remission. Consolidation therapy; three cycles of consolidation chemotherapy were administrated with at least 4 week interval following remission. Course 1; ara-C at 100 mg/m2 by continuous infusion every 12 hour for five days, 6-thioguanine at 100 mg/m2/day orally for 5 days. Course 2; ara-C is same as course 1, vincristine at 1.2 mg/m2(maximum 2 mg) by bolus injection for 1 day, prednisolone at 40 mg/m'(maximum 60 mg) orally for 5 days. Course 3; ara-C is same as course 1, daunorubicin at 45 mg/m2 by 1 hour infusion for 2 days. RESULT: 62.2 percent of the 37 patients entered complete remission. The remission duration for all patients in complete remission ranged from 2 months to 63+ months, with the median of 15.1 months. The median duration of survival in complete responder group was 23.3 months. Among various prognostic factors, females and groups with normal chromosome and t(8;21) or t(15;17) had significantly higher complete remission rate than males and groups with other chromosomal abnormalities, respectively. Factors influencing on survival duration were female, normal chromosome, t(8;21) or t(15;17), Auer rod-positive, and peripheral blast % less than 50% at diagonosis. Groups with Auer rod-positive, normal chromosome, and t(8;21) or t(15;17) also had significantly longer remission duration. CONCLUSION: Combination chemotherapy with cytosine arabinoside and daunorubicin is a effective regimen for acute myelogenous leukemia as much as other regimen for acute myelogenous leukemia. Further clinical trials for effective treatment regimen are necessary to increase the complete remissioin rate.
Chromosome Aberrations ; Consolidation Chemotherapy ; Cytarabine* ; Cytosine* ; Daunorubicin ; Drug Therapy, Combination* ; Female ; Humans ; Induction Chemotherapy ; Leukemia* ; Leukemia, Myeloid, Acute ; Male ; Prednisolone ; Thioguanine ; Vincristine