Objective:To investigate the clinical efficacy of ibrutinib combined with venetoclax in the treatment of relapsed/refractory diffuse large B-cell lymphoma(R/R DLBCL),and to analyze the factors affecting efficacy and prognosis.Methods:Clinical data of 62 R/R DLBCL patients admitted to our hospital from August 2017 to July 2022 were retrospectively analyzed.All patients were treated with ibrutinib combined with venetoclax.The clinical efficacy and drug safety were evaluated.The effects of clinical features on short-term efficacy and overall survival(OS)were analyzed.Results:The objective response rate(ORR)of 62 patients was 48.39％.The extranodal lesions,intermediate-high/high risk of NCCN-IPI,intermediate-high/high risk of IPI,progression or recurrence time＜12 months were the risk factors affecting the short-term efficacy of chemotherapy in R/R DLBCL patients(all P＜0.05).The most common adverse effect was neutropenia(75.19％),and the incidence of grade Ⅱ-Ⅳ neutropenia was 52.71％.The l-year and 2-year OS rates of 62 patients were 48.51％and 31.56％,respectively,and the median OS time was 12 months.Multivariate analysis showed that objective remission after chemotherapy[HR=0.080(95％CI:0.028-0.235)]was a protective factor for OS in R/R DLBCL patients,and intermediate-high/high risk of NCCN-IPI[HR=4.828(95％CI:1.546-15.080)]was an independent risk factor affecting the prognosis of R/R DLBCL patients.Conclusion:Ibrutinib combined with venetoclax can be used as an effective treatment regimen for R/R DLBCL,and NCCN-IPI can be used as a prognostic indicator.Objective remission after chemotherapy is beneficial for R/R DLBCL patients to achieve better OS.

Severe hypokalemia is defined as the concentration of serum potassium lower than 2.5 mmol/L, which may lead to serious arrhythmias and cause mortality. We report an unusual case of potentially fatal ventricular arrhythmias induced by severe hypokalemia in a patient undergoing laparoscopic partial nephrectomy in Peking University Third Hospital due to irregular use of indapamide before operation. Indapamide is a sulfonamide diuretic with vasodilative and calcium antagonistic effects, which enhances sodium delivery to the renal distal tubules resulting in a dose-related increase in urinary potassium excretion and decreases serum potassium concentrations. The electrolyte disorder caused by the diuretic is more likely to occur in the elderly patients, especially those with malnutrition or long-term fasting. Hence, the serum potassium concentration of the patients under indapamide therapy, especially elderly patients, should be monitored carefully. Meanwhile, the potassium concentration measured by arterial blood gas analysis is different from that measured by venous blood or laboratory test. According to the previous research, the concentration of potassium in venous blood was slightly higher than that in arterial blood, and the difference value was 0.1-0.5 mmol/L. This error should be taken into account when rapid intravenous potassium supplementation or reduction of blood potassium level was carried out clinically. In the correction of severe hypokalemia, the standard approach often did not work well for treating severe hypokalemia. The tailored rapid potassium supplementation strategy shortened the time of hypokalemia and was a safe and better treatment option to remedy life-threatening arrhythmias caused by severe hypokalemia with a high success rate. Through the anesthesia management of this case, we conclude that for the elderly patients who take indapamide or other potassium excretion diuretics, the electrolyte concentration and the general volume state of the patients should be comprehensively measured and fully evaluated before operation. It may be necessary for us to reexamine the serum electrolyte concentration before anesthesia induction on the morning of surgery in patients with the history of hypokalemia. For severe hypokalemia detected after anesthesia, central venous cannulation access for individualized rapid potassium supplementation is an effective approach to reverse the life-threatening arrhythmias caused by severe hypokalemia and ensure the safety of the patients.
Humans ; Aged ; Hypokalemia/complications* ; Indapamide/adverse effects* ; Arrhythmias, Cardiac/therapy* ; Diuretics/adverse effects* ; Potassium ; Electrolytes/adverse effects* ; Anesthesia, General/adverse effects*

Objective:To systematically evaluate the efficacy of oral Chinese herbal prescriptions combined with transcatheter arterial chemoembolization （TACE） against primary hepatic carcinoma （PHC） and screen the basic Chinese herbs，in order to provide certain reference for clinical medication. Method:The randomized controlled trials concerning the treatment of PHC with oral Chinese herbal prescriptions plus TACE were retrieved from CBM，China National Knowledge Infrastructure （CNKI），Chongqing Weipu Database for Chinese Technical Periodicals （VIP），and Wanfang Data Knowledge Service Platform.The quality of the included trials was evaluated by Cochrane handbook，and the Meta-analysis was performed using RevMan 5.3.The enumeration data were expressed by odds ratio （OR），the measurement data by mean difference （MD） or standardized mean difference （SMD），and the effect size by 95% confidence interval （CI）.The data of oral Chinese herbal prescriptions involved in trials were sorted out and subjected to association rule analysis and frequency analysis based on the Traditional Chinese Medicine Inheritance Support System （TCMISS），for exploring the basic Chinese herbs and their dosages against PHC. Result:A total of 75 randomized controlled trials were included，involving 7 406 cases. As revealed by the Meta-analysis，oral Chinese herbal prescriptions combined with TACE was significantly better than TACE alone in improving the short-term curative effect ［OR=2.05，95%CI（1.83，2.29）］，decreasing alpha fetoprotein （AFP） ［MD=-59.02，95%CI（-79.03，-39.01）］，ameliorating liver function ［SMD=-1.23，95%CI（-1.58，-0.88）］，boosting immunity ［SMD=1.08，95%CI（0.84，1.32）］，adjusting Karnofsky Performance Status （KPS） scale score ［OR=2.7，95%CI（1.11，11.02）］，elevating survival rate ［OR=2.31，95%CI（1.96，2.71）］，and reducing adverse reactions ［OR=0.38，95%CI（0.34，0.43）］.Data mining results showed that the basic Chinese herbs against PHC were Bupleuri Radix，Paeoniae Alba Radix，Atractylodis Macrocephalae Rhizoma，Poria，and Glycyrrhizae Radix et Rhizoma，with their clinical dosages listed as follows：6-15 g for Bupleuri Radix，10-15 g for Paeoniae Alba Radix，9-15 g for Atractylodis Macrocephalae Rhizoma，10-15 g for Poria，and 3-10 g for Glycyrrhizae Radix et Rhizoma. Conclusion:The oral Chinese herbal prescriptions combined with TACE produce better effects in treatment of PHC as compared with TACE alone.These five basic Chinese herbs have anti-cancer effect，and their dosages are within the ranges stipulated in 2020 edition of Chinese Pharmacopoeia.This Meta-analysis has provided certain reference for clinical medication.

Data mining is an important method to obtain the key information from a large amount of data, and it is widely applied in the research on the modernization of traditional Chinese medicine(TCM). The compatibility law of herbs is a key issue in the research of TCM prescriptions. This reflects the flexibility and effectiveness of TCM prescriptions, and it is also a crucial link to the development of TCM modernization. Therefore, it is the core purpose of the research on TCM prescriptions to find the compatibility law of herbs and clarify the scientific connotation. Data mining, as an effective method and an important approach, has formed a standardized system in the research of compatibility law of herbs, which can reveal the relationship between different Chinese herbs and summarize the internal rules in compatibility. Two hundred and twenty two effective papers were sorted out and categorized in this article. The results showed that data mining was mainly applied in finding the core Chinese herb pairs, summarizing the utility and attributes of TCM prescriptions, revealing the relationship between prescriptions, Chinese herbs and syndromes, finding the optimal dose of Chinese herbs, and producing the new prescriptions. The problems of data mining in research of herbs compatibility rules were summarized, and its development and trend in current researches were discussed in this article to provide useful references for the in-depth study of data mining in the compatibility law of Chinese herbs.
Data Mining ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Prescriptions ; Syndrome

Background: With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China. Methods: The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution. Results: Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) Conclusions: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China. Clinical trial registration NCT02285257, https://clinicaltrials.gov/ct2/show/record/NCT02285257.

BACKGROUNDAtopic dermatitis (AD) is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczema/AD and to propose Chinese diagnostic criteria for adult/adolescent AD.

METHODSA hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients (12 years and over) with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software.

RESULTSA total of 2662 valid questionnaires were collected (1369 male and 1293 female). Of all 2662 patients, 2062 (77.5%) patients had the disease after 12 years old, while only 600 (22.5%) patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine (80.4%) patients had the disease for more than 6 months. One thousand one hundred and forty-four (43.0%) patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight (58.2%) patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients.

CONCLUSIONLate-onset of eczema or AD is common. The clinical manifestations of AD are heterogeneous. We have proposed Chinese diagnostic criteria for adolescent and adult AD, which are simple and sensitive for diagnosis of adult/adolescent AD.

Adolescent ; Adult ; Dermatitis, Atopic ; diagnosis ; immunology ; Eczema ; diagnosis ; Female ; Humans ; Immunoglobulin E ; blood ; Male ; Middle Aged ; Retrospective Studies ; Surveys and Questionnaires

Objective To study the effect and mechanism of the dysfunction of CD4

OBJECTIVEMeasures of ventilation-CO₂output relationship have been shown to be more prognostic than peak O₂uptake in assessing life expectancy in patients with chronic heart failure (CHF). Because both the ratios (VE/Vco₂) and slopes (VE-vs-Vco₂) of ventilation-co₂ output of differing durations can be used, we aim to ascertain which measurements best predicted CHF life expectancy.

METHODSTwo hundred and seventy-one CHF patients with NYHA class II-IV underwent incremental cardiopulmonary exercise testing (CPET) and were followed-up for a median duration of 479 days. Four different linear regression VE-vs- Vco₂ slopes were calculated from warm-up exercise onset to: 180 s, anaerobic threshold (AT), ventilatory compensation point (VCP); and peak exercise. Five VE/Vco₂ ratios were calculated for the following durations: rest (120 s), warm-up (30 s), AT (60 s), lowest value (90 s), and peak exercise (30 s). Death or heart transplant were considered end-points. Multiple statistical analyses were performed.

RESULTSCHF patients had high lowest VE/Vco₂ (41.0 ± 9.2, 141 ± 30%pred), high VE/Vco₂ at AT (42.5 ± 10.4, 145 ± 35%pred), and high VE-vs-Vco₂ slope to VCP (37.6 ± 12.1, 126 ± 41%pred). The best predictor of death was a higher lowest VE/Vco₂ (≥ 42, ≥ 141%pred), whereas the VE-vs-Vco₂slope to VCP was less variable than other slopes. For death prognosis in 6 months, %pred values were superior: for longer times, absolute values were superior.

CONCLUSIONThe increased lowest VE/Vco₂ ratio easily identifiable and simply measured during exercise, is the best measurement to assess the ventilation-co₂output relationship in prognosticating death in CHF patients.

Carbon Dioxide ; metabolism ; Chronic Disease ; Disease Progression ; Exercise Test ; Heart Failure ; diagnosis ; mortality ; physiopathology ; Humans ; Life Expectancy ; Respiratory Function Tests

OBJECTIVEWe investigate the magnitudes of waveform changes of arterial blood gas (ABG) in patients with heart failure.

METHODSFive patients with heart failure were selected, continuous collecting radial artery blood and measured PaO2, PaCO2, pHa and Sao2. We selected two typical breaths cycles of waveform changes of ABG from each patient for data analysis. Comparison of the adjacent highest and lowest values to verify the presence of a periodic waveform changes of ABG, and in addition, we used t test to analysis the range of waveform changes of ABG in patients with heart failure and patients with normal cardiac function and compared whether the difference between them.

RESULTSThe 5 patients (2 surgical and 3 ICU) with heart failure, were 4 male and 1 female, (69 ± 7)year, (169 ± 10) cm, (75 ± 19)kg, LVEF = (38 ± 3)%. The heart beat numbers for full blood into the blood sampling pipe were 17 ± 2, and all covered more than 2 breath cycles. There were significant changes of PaO2, PaCO2, [H+]a and SaO2 (P < 0.05). The magnitudes of changing PaO2, PaCO2, [H+]a and Sao2 were (7.94 ± 2.02)mmHg, (1.18 ± 0.56)mmHg, (0.54 ± 0.17)nmol/L and (0.21 ± 0.07)%, and they were (6.1 ± 1.5)%, (3.2 ± 1.5)%, (1.5 ± 0.5)% and (0.2 ± 0.1)% from their mean respectively. Even these magnitudes fo all ABG parameters were trendily lower than those of patients with normal cardiac function, but only PaO2 and [H+]a were significant (P < 0.05).

CONCLUSIONUsing this simple continuous beat-by-beat arterial blood sampling method, we obtained a clear evidence of periodic waveform of ABG parameters following by breath cycle in patients with heart failure, but the magnitude trendily be decreased.

Aged ; Blood Gas Analysis ; Cardiovascular Diseases ; Female ; Heart Failure ; Heart Rate ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods

OBJECTIVESince 2011 EB-APS conference, we hypotheses that phase switching of inspiration-expiration is dominantly initiated by oscillatory information PaO2, PaCO2 and [H+] via fast peripheral chemical receptors. However, the evidence of the waveform of ABG is lack.

METHODSSix surgery patients with normal heart function and negative Allen test, had been placed the arterial catheterization directly connected to 3 x 1 000 mm pre-heparin plastic pipe for continuous collecting arterial blood. We counted the number of heart beat for the blood collecting time, and separated the blood pipe into the heart beat numbers' short pieces using haemostatic forceps, then put pipe into iced water at once fir analyzing PaO2, PaCO2, pH and SaO2 as soon as possible. We selected two breaths cycles of waveform from each patient for data calculations of magnitudes and time interval.

RESULTSThe heart beat numbers for filling blood into pipe were 16 ± 2, and all covered more than 2 breathing cycles. Each breathing cycle is cover 5 ± 0.6 heart beat. There were significant changes of PaO2, PaCO2, [H+] a and SaO2 (i.e. the highest high values compare to the next lowest values, P < 0.05). The time interval of changing PaO2, PaCO2, [H+]a and SaO2 magnitudes were 11.28 ± 1.13 mmHg, 1.77 ± 0.89 mmHg, 1.14 ± 0.35 nmol/L and 0.52% ± 0.44% respectively.

CONCLUSIONThis simple continuous beat-by-beat arterial blood sampling and ABG analyzing method is new and practicable. We obtain a clear evidence of periodic parameters ABG waveform, which following breathing cycle.

Arteries ; physiology ; Blood Gas Analysis ; Heart Rate ; Humans ; Monitoring, Physiologic ; methods ; Respiration