AIM： Complete resection of the bile duct carcinoma is sometimes difficult by subepithelial spread in the duct wall or direct invasion of adjacent blood vessels. Nonresected extrahepatic bile duct carcinoma has a dism...AIM： Complete resection of the bile duct carcinoma is sometimes difficult by subepithelial spread in the duct wall or direct invasion of adjacent blood vessels. Nonresected extrahepatic bile duct carcinoma has a dismal prognosis,with a life expectancy of about 6 mo to i year. To improve the treatment results of locally advanced bile duct carcinoma, we have been conducting a clinical trial using regional hyperthermia in combination with chemoradiation therapy.METHODS： Eight patients complaining of obstructive jaundice with advanced extrahepatic bile duct underwent thermo-chemo-radiotherapy （TCRT）. All tumors were located in the upper bile duct and involved hepatic bifurcation, and obstructed the bile duct completely.Radiofrequency capacitive hyperthermia was administered simultaneously with chemotherapeutic agents once weekly immediately following radiotherapy at 2 Gy.We administered heat to the patient for 40 rain after the tumor temperature had risen to 42℃. The chemotherapeutic agents employed were cis-platinum （CDDP,50 mg/m^2） in combination with 5-fluorouracil （5-FU,800 mg/m^2） or methotrexate （MTX, 30 mg/m^2） in combination with 5-FU （800 mg/m^2）. Number of heat treatments ranged from 2 to 8 sessions. The bile duct at autopsy was histologically examined in three patients treated with TCRT.RESULTS： In respect to resolution of the bile duct, there were three complete regression （CR）, two partial regression （PR）, and three no change （NC）. Mean survival was 13.2＋10.8 mo （mean＋SD）. Four patients survived for more than 20 too. Percutaneous transhepatic biliary drainage （PTBD） tube could be removed in placement of self-expandable metallic stent into the patency-restored bile duct after TCRT. No major side effects occurred. At autopsy, marked hyalinization or fibrosis with necrosis replaced extensively bile duct tumor and wall, in which suppressed cohesiveness of carcinoma cells and degenerative cells were sparsely observed.CONCLUSION： Although the number of cases is rather small, TCRT in the treatment of locally advanced bile duct carcinoma is promising in raising local control and thus,long-term survival.展开更多
Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morb...Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.展开更多
As China is accelerating into an aging society,the coexistence of multiple diseases,multiple drugs,and the decline of body function are serious problems faced by elderly patients.Therefore,it is imperative to carry ou...As China is accelerating into an aging society,the coexistence of multiple diseases,multiple drugs,and the decline of body function are serious problems faced by elderly patients.Therefore,it is imperative to carry out the comprehensive prevention and control of chronic diseases,strengthen the health guidance and comprehensive intervention of common and chronic diseases of the elderly,and strengthen the health management of elderly patients.Collaborative drug therapy management(CDTM)is a drug treatment management mode that emerged in pharmaceutical services under the situation of new medical reform,aiming to expand the role of pharmacists in the medical team and improve the quality of hospital medical service.Although CDTM has shown some favorable effects in managing chronic diseases in the elderly population,the popularization of CDTM in China is limited by the differences in supporting facilities,management mode,and pharmacist’s abilities in hospitals.By exploring the CDTM mode for elderly patients with chronic diseases,we provided a reference for further promoting the CDTM services and laid a good foundation for displaying pharmacist value and the realization of real pharmaceutical care.展开更多
文摘AIM： Complete resection of the bile duct carcinoma is sometimes difficult by subepithelial spread in the duct wall or direct invasion of adjacent blood vessels. Nonresected extrahepatic bile duct carcinoma has a dismal prognosis,with a life expectancy of about 6 mo to i year. To improve the treatment results of locally advanced bile duct carcinoma, we have been conducting a clinical trial using regional hyperthermia in combination with chemoradiation therapy.METHODS： Eight patients complaining of obstructive jaundice with advanced extrahepatic bile duct underwent thermo-chemo-radiotherapy （TCRT）. All tumors were located in the upper bile duct and involved hepatic bifurcation, and obstructed the bile duct completely.Radiofrequency capacitive hyperthermia was administered simultaneously with chemotherapeutic agents once weekly immediately following radiotherapy at 2 Gy.We administered heat to the patient for 40 rain after the tumor temperature had risen to 42℃. The chemotherapeutic agents employed were cis-platinum （CDDP,50 mg/m^2） in combination with 5-fluorouracil （5-FU,800 mg/m^2） or methotrexate （MTX, 30 mg/m^2） in combination with 5-FU （800 mg/m^2）. Number of heat treatments ranged from 2 to 8 sessions. The bile duct at autopsy was histologically examined in three patients treated with TCRT.RESULTS： In respect to resolution of the bile duct, there were three complete regression （CR）, two partial regression （PR）, and three no change （NC）. Mean survival was 13.2＋10.8 mo （mean＋SD）. Four patients survived for more than 20 too. Percutaneous transhepatic biliary drainage （PTBD） tube could be removed in placement of self-expandable metallic stent into the patency-restored bile duct after TCRT. No major side effects occurred. At autopsy, marked hyalinization or fibrosis with necrosis replaced extensively bile duct tumor and wall, in which suppressed cohesiveness of carcinoma cells and degenerative cells were sparsely observed.CONCLUSION： Although the number of cases is rather small, TCRT in the treatment of locally advanced bile duct carcinoma is promising in raising local control and thus,long-term survival.
文摘Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.
文摘As China is accelerating into an aging society,the coexistence of multiple diseases,multiple drugs,and the decline of body function are serious problems faced by elderly patients.Therefore,it is imperative to carry out the comprehensive prevention and control of chronic diseases,strengthen the health guidance and comprehensive intervention of common and chronic diseases of the elderly,and strengthen the health management of elderly patients.Collaborative drug therapy management(CDTM)is a drug treatment management mode that emerged in pharmaceutical services under the situation of new medical reform,aiming to expand the role of pharmacists in the medical team and improve the quality of hospital medical service.Although CDTM has shown some favorable effects in managing chronic diseases in the elderly population,the popularization of CDTM in China is limited by the differences in supporting facilities,management mode,and pharmacist’s abilities in hospitals.By exploring the CDTM mode for elderly patients with chronic diseases,we provided a reference for further promoting the CDTM services and laid a good foundation for displaying pharmacist value and the realization of real pharmaceutical care.
