BACKGROUND & AIMS: A 53-year-old man was admitted to the hospital for management of pneumonia and a giant fluid-filled bulla. He appeared acutely ill and had persistent fever despite prolonged therapy with parenteral antibiotics and aggressive bronchial drainage. Percutaneous placement of an 8.5F catheter into the bulla enabled drainage of both fluid and air within the bulla and led to resolution of his symptoms within 24 h. This report demonstrates that drainage of giant fluid-filled bullae may lead to rapid resolution of symptoms and describes a novel management technique for this condition.

背景与目标： 一名53岁的男子因治疗肺炎和巨大的充满液体的bulla而入院。尽管长期使用肠胃外抗生素治疗和积极的支气管引流，但他似乎病情严重，并持续发热。将8.5F导管经皮放置到大疱中，可以在大疱中排出液体和空气，并在24小时内缓解症状。该报告表明，巨大的充满液体的大疱的引流可能会导致症状的快速解决，并描述了一种针对这种情况的新颖管理技术。

BACKGROUND & AIMS: :With the increased incidence of terrorism worldwide, it is important for surgeons to understand the role of shrapnel injury in mass casualty events. Several diagnostic modalities are available, including plain radiography, computed tomography, ultrasound, angiography, and computerized surgical navigation based on real-time acquisition of fluoroscopic data. Shrapnel management techniques are selected based on the following chronologic phases: acute, subacute, and late.

背景与目标： : 随着全世界恐怖主义发生率的增加，对于外科医生来说，了解弹片损伤在大规模伤亡事件中的作用非常重要。有几种诊断方式可用，包括平片，计算机断层扫描，超声，血管造影和基于实时获取荧光镜数据的计算机手术导航。弹片管理技术是根据以下时间顺序选择的: 急性，亚急性和晚期。

BACKGROUND & AIMS: :Our knowledge about, and the availability of, orthobiologic materials has increased exponentially in the last decade. Although previously confined to the experimental or animal-model realm, several orthobiologics have been shown to be useful in a variety of clinical situations. As surgical techniques in vascular anastomosis, soft-tissue coverage, limb salvage, and fracture stabilization have improved, the size and frequency of bony defects (commensurate with the severity of the initial injury) have increased, as well. Because all methods of managing segmental bony defects have drawbacks, a need remains for a readily available, void-filling, inexpensive bone substitute. Such a bone substitute fulfills a permissive role in allowing new bone to grow into a given defect. Such potential osteoconductive materials include ceramics, calcium sulfate or calcium phosphate compounds, hydroxyapatite, deproteinized bone, corals, and recently developed polymers. Some materials that have osteoinductive properties, such as demineralized bone matrix, also display prominent osteoconductive properties.

背景与目标： : 在过去的十年中，我们对正交生物材料的了解和可用性呈指数增长。尽管以前仅限于实验或动物模型领域，但已显示几种原位生物制剂在各种临床情况下均有用。随着血管吻合，软组织覆盖，肢体挽救和骨折稳定方面的外科手术技术的改善，骨缺损的大小和频率 (与初始损伤的严重程度相称) 也增加了。由于所有处理节段性骨缺损的方法都有缺点，因此仍然需要一种容易获得的，填充空隙的，廉价的骨替代品。这种骨替代物在允许新骨长成给定的缺损方面发挥了允许的作用。此类潜在的骨传导材料包括陶瓷，硫酸钙或磷酸钙化合物，羟基磷灰石，脱蛋白骨，珊瑚和最近开发的聚合物。一些具有骨诱导特性的材料，如脱矿质骨基质，也显示出突出的骨传导特性。

BACKGROUND & AIMS: Marked increases in case rates of drug-resistant tuberculosis and nontuberculous mycobacterial infections have brought renewed urgency to the development of new treatment regimens for mycobacterial infections. Preclinical data, such as in vitro measures of drug activity and pharmacokinetics, are used in the design of new treatment regimens. This review surveys the extensive published clinical experience concerning the treatment of drug-susceptible tuberculosis to evaluate the use of these preclinical measures in predicting clinical outcomes of antimycobacterial therapy. In vitro measures of drug activity predict the potency of a drug to prevent the emergence of resistance to other antimycobacterial drugs but do not predict the sterilizing activity of a drug or the activity of drug combinations. In vitro measures of drug activity do not allow reliable predictions of the level at which an organism should be considered resistant. Assays of drug penetration in tissues and activity against intracellular bacilli add modestly to the predictive value of in vitro measures of drug activity but still do not predict sterilizing activity. In contrast, animal models of tuberculosis have predicted relative drug potency (including sterilizing activity), the efficacy of multidrug regimens, and the duration of therapy needed. Despite pharmacokinetic parameters that would suggest the need for multiple doses per day, all of the first-line antituberculous drugs are active when given as infrequently as twice weekly. It is difficult to predict the efficacy of therapy for an intracellular pathogen that has the capacity for dormancy. Better in vitro models are needed, particularly ones that predict sterilizing activity.

背景与目标： 耐药结核病和非结核分枝杆菌感染的病例率显着增加，为开发新的分枝杆菌感染治疗方案带来了新的紧迫性。临床前数据，例如药物活性和药代动力学的体外测量，用于设计新的治疗方案。这篇综述调查了有关药物敏感结核病治疗的广泛已发表的临床经验，以评估这些临床前措施在预测抗细菌治疗临床结果中的应用。药物活性的体外测量可以预测药物的效力，以防止对其他抗细菌药物的耐药性出现，但不能预测药物的灭菌活性或药物组合的活性。药物活性的体外测量无法可靠地预测生物体应被认为具有抗性的水平。药物在组织中的渗透和对细胞内杆菌的活性的测定适度增加了药物活性的体外测量的预测值，但仍不能预测灭菌活性。相反，结核病的动物模型已经预测了相对的药物效力 (包括灭菌活性)，多药疗法的功效以及所需的治疗持续时间。尽管药代动力学参数表明每天需要多次剂量，但所有一线抗结核药物在每周两次的情况下均具有活性。很难预测具有休眠能力的细胞内病原体的治疗效果。需要更好的体外模型，尤其是可以预测灭菌活性的模型。

BACKGROUND & AIMS: :Differential killing of the patient's cancer cells versus normal cells is a necessity for chemotherapy. Advantage can be taken of close regulations of gene expression and of enzyme activity that are essential for normal cell functioning, and that are altered during tumor progression. Summarized here is our research on four such progression changes of cancer cells; some deregulate proliferation control and others decrease programmed death (apoptosis). These processes will be illustrated with examples of potential chemotherapies based on them. Methods for discovery of such changes include Differential Display and microarrays.

背景与目标： : 对患者癌细胞与正常细胞的差异杀伤是化疗的必要条件。可以利用基因表达和酶活性的密切调节，这些调节对于正常细胞功能至关重要，并且在肿瘤进展过程中会发生改变。这里总结了我们对癌细胞四种此类进展变化的研究; 一些放松增殖控制，另一些减少程序性死亡 (凋亡)。这些过程将通过基于它们的潜在化学疗法的示例进行说明。发现这种变化的方法包括差分显示和微阵列。

BACKGROUND & AIMS: BACKGROUND:Although the benefit of thrombolytic therapy in reducing mortality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in large trials.

METHODS AND RESULTS:We analyzed the baseline characteristics, outcomes, and incidence of bleeding by location, severity, and treatment assignment among 41,021 patients in the GUSTO-I trial of thrombolysis for acute myocardial infarction. Of the 40,903 patients for whom there were complete data, 1.2% suffered severe bleeding and 11.4% experienced moderate hemorrhage at a variety of sites. The most common sources of bleeding were procedure related. The thrombolytic regimen was strongly related to the incidence of bleeding; comparatively more bleeding was seen with the therapies of streptokinase plus intravenous heparin and the streptokinase and tissue plasminogen activator plus intravenous heparin combination. In multivariate analysis, the four most powerful independent predictors of hemorrhage were older age, lighter body weight, female sex, and African ancestry; they remained the most important predictors of bleeding when multivariate analysis was performed on patients who did not undergo invasive procedures. The presence of serious hemorrhage was associated with other undesirable outcomes (recurrent events, left ventricular dysfunction, arrhythmia, or stroke).

CONCLUSIONS:Important predictors of bleeding in this population are increased age, lighter weight, female sex, African ancestry, and experiencing invasive procedures. Other nonhemorrhagic adverse clinical outcomes were associated with moderate and severe bleeding, which was in turn associated with increased length of hospital stay and mortality at 30 days.

背景与目标： 背景 : 尽管溶栓治疗在降低急性心肌梗死死亡率方面的益处已得到充分证实，但在大型试验中，出血类型和出血危险因素的描述较少。
方法和结果 : 在GUSTO-I急性心肌梗死溶栓试验中，我们分析了41,021名患者的基线特征，结局和出血发生率，按位置，严重程度和治疗分配。在40,903例有完整数据的患者中，1.2% 例严重出血，11.4% 例在不同部位出现中度出血。最常见的出血来源与手术有关。溶栓方案与出血发生率密切相关; 链激酶加静脉肝素以及链激酶和组织型纤溶酶原激活剂加静脉肝素联合治疗的出血相对较多。在多变量分析中，出血的四个最有效的独立预测因子是年龄较大，体重较轻，女性和非洲血统; 当对未接受侵入性操作的患者进行多变量分析时，它们仍然是出血的最重要预测因子。严重出血的存在与其他不良结果 (复发事件，左心室功能障碍，心律失常或中风) 相关。
结论 : 该人群出血的重要预测因素是年龄增加，体重减轻，女性，非洲血统，经历侵入性手术。其他非出血性不良临床结局与中度和重度出血相关，而中度和重度出血又与30天时的住院时间和死亡率增加相关。

BACKGROUND & AIMS: PURPOSE:A phase II trial of Photofrin-mediated i.p. photodynamic therapy shown in a previous report limited efficacy and significant acute, but not chronic, toxicity. A secondary aim of this trial and the subject of this report is to determine Photofrin uptake in tumor and normal tissues. EXPERIMENTAL DESIGN:Patients received Photofrin, 2.5 mg/kg, i.v., 48 hours before debulking surgery. Photofrin uptake was measured by spectroflurometric analysis of drug extracted from tumor and normal tissues removed at surgery. Differences in drug uptake among these tissues were statistically considered using mixed-effects models. RESULTS:Photofrin concentration was measured in 301 samples collected from 58 of 100 patients enrolled on the trial. In normal tissues, drug uptake significantly (P<0.0001) differed as a function of seven different tissue types. In the toxicity-limiting tissue of intestine, the model-based mean (SE) Photofrin level was 2.70 ng/mg (0.32 ng/mg) and 3.42 ng/mg (0.24 ng/mg) in full-thickness large and small intestine, respectively. In tumors, drug uptake significantly (P=0.0015) differed as a function of patient cohort: model-based mean Photofrin level was 3.32 to 5.31 ng/mg among patients with ovarian, gastric, or small bowel cancer; 2.09 to 2.45 ng/mg among patients with sarcoma and appendiceal or colon cancer; and 0.93 ng/mg in patients with pseudomyxoma. Ovarian, gastric, and small bowel cancers showed significantly higher Photofrin uptake than full-thickness large and/or small intestine. However, the ratio of mean drug level in tumor versus intestine was modest (

BACKGROUND & AIMS: :Passive immunity against gastrointestinal infections has recently been successfully applied as prophylaxis and therapy in patients in a variety of virally and bacterially induced infections. Campylobacter jejuni is frequently associated with acute diarrhoea in humans, and several species of animals have been shown to transmit the disease, although birds have been implicated as the main source of infection. We used bovine and chicken immunoglobulin preparations from the milk and eggs, respectively, of immunized animals for prophylactic and therapeutic treatment of chickens infected with C. jejuni. A marked prophylactic effect (a >99% decrease in the number of bacteria) was noted using either antibody preparation, whereas the therapeutic efficacy, i.e. when antibodies were given after the infection was established, was distinctly lower (80-95%) as judged by faecal bacterial counts. These observations may serve as a starting point for experiments aimed at elimination of the infection in an industrial or farm setting. It may also encourage future attempts to treat, prophylactically or therapeutically, patients with Campylobacter-induced diarrhoea.

背景与目标： : 针对胃肠道感染的被动免疫最近已成功地应用于各种病毒和细菌诱导感染的患者的预防和治疗。空肠弯曲菌经常与人类急性腹泻有关，尽管鸟类是主要传染源，但已显示几种动物可以传播这种疾病。我们分别使用免疫动物的牛奶和鸡蛋中的牛和鸡免疫球蛋白制剂对感染空肠杆菌的鸡进行预防和治疗。使用任一种抗体制剂观察到显著的预防效果 (细菌数量99% 减少)，而治疗效果，即当在感染建立后给予抗体时，如通过粪便细菌计数判断，明显较低 (80-95%)。这些观察结果可以作为旨在消除工业或农场环境中感染的实验的起点。它还可能鼓励将来尝试预防或治疗弯曲杆菌引起的腹泻患者。

BACKGROUND & AIMS: OBJECTIVES:Cases of hypophosphataemia (often coincident with renal dysfunction) have been reported in HIV-infected patients taking tenofovir disoproxil fumarate (TDF), but randomized placebo-controlled trials of HIV-infected persons with normal baseline renal function have found a comparable incidence of hypophosphataemia in the TDF and placebo groups. We assessed the incidence of grade 2 and higher hypophosphataemia in the HIV Outpatient Study (HOPS). METHODS:We analysed a prospective cohort of patients who initiated either a TDF-containing highly active antiretroviral therapy (HAART) regimen [TDF-exposed (TDF+) group; n = 165] or a TDF-sparing HAART regimen [TDF-unexposed (TDF-) group; n = 90], and who had normal baseline phosphate and creatinine values. RESULTS:The TDF+ and TDF- groups had comparable median follow-up times (10.9 vs 8.8 months, respectively; P = 0.18) and number of phosphate measurements (median = 3 for both) and were similar on most clinical and demographic factors. During follow up, 12.7% of TDF+vs 6.7% of TDF-patients developed grade 2 hypophosphataemia (2.0-2.4 mg/dL), and 2.4% of TDF+ patients vs 0% of TDF-patients developed grade 3 hypophosphataemia (1.0-1.9 mg/dL); none developed grade 4 hypophosphataemia (<1.0 mg/dL). The incidence of grade 2 or higher hypophosphataemia was 16.7 per 100 person-years among TDF+ patients vs 8.0 per 100 person-years among TDF-patients (P = 0.11). CONCLUSIONS:The incidence of hypophosphataemia was somewhat elevated in HOPS patients who took TDF-containing HAART compared with those who took TDF-sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant. Longer follow-up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphataemia.

背景与目标：

BACKGROUND & AIMS: :Neoadjuvant or adjuvant multimodality therapy in oesophageal cancer is introduced in an effort to improve prognosis. However, in a substantial fraction of patients there is no response to this non-surgical therapy. Non-invasive imaging modalities such as computed tomography (CT), endoscopic ultrasound (EUS) and 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) have been evaluated for assessing patient response to therapy, and these are described in this review. Currently, FDG-PET seems to be the best available tool for neoadjuvant therapy response assessment in oesophageal cancer.

背景与目标： : 为了改善预后，引入了食管癌的新辅助或辅助多模式疗法。但是，在很大一部分患者中，这种非手术疗法没有反应。已经评估了非侵入性成像方式，例如计算机断层扫描 (CT)，内窥镜超声 (EUS) 和18f-2-氟-2-脱氧-d-葡萄糖正电子发射断层扫描 (fdg-pet)，以评估患者对治疗的反应，这些在本综述中进行了描述。目前，fdg-pet似乎是食管癌新辅助治疗反应评估的最佳工具。

BACKGROUND & AIMS: :Agricultural soils of two Italian maize farms were treated for five years with an industrially produced high-quality compost. Cattle manure and the usual mineral fertilizer were used for comparison purposes. The effects of the organic and mineral fertilizer treatments were studied by analyzing the compost and manure, cultured soils, and harvested material. The grain yield was also determined. Organic fertilization improved soil pH, CEC, content of organic matter and NPK. Soil respiration and N mineralization were found to be higher than in the purely mineral-treated soil. Plant K take-up was improved, whereas grain yield was not affected. It was confirmed that organic fertilization, particularly compost use, maintained and increased soil fertility. The study demonstrated the feasibility of using in loco analytical facilities to follow the entire recycling process-from waste to compost production-and the use of the final product in the field.

背景与目标： : 意大利两个玉米农场的农业土壤用工业生产的高质量堆肥处理了五年。牛粪和通常的矿物肥料用于比较目的。通过分析堆肥和肥料，培养的土壤和收获的材料，研究了有机和矿物肥料处理的效果。还确定了谷物产量。有机施肥改善了土壤pH，CEC，有机质和NPK的含量。发现土壤呼吸作用和氮矿化作用高于纯矿物处理的土壤。提高了植物的K用量，而不影响谷物产量。已经证实，有机施肥，特别是堆肥的使用，可以维持和提高土壤肥力。该研究证明了在loco分析设施中使用从废物到堆肥生产的整个回收过程以及在现场使用最终产品的可行性。

BACKGROUND & AIMS: :Zalcitabine is a dideoxynucleoside antiretroviral agent that is phosphorylated to the active metabolite 2',3'-dideoxycytidine 5'-triphosphate (ddCTP) within both uninfected and HIV-infected cells. At therapeutic concentrations, ddCTP inhibits HIV replication by inhibiting the enzyme reverse transcriptase and terminating elongation of the proviral DNA chain. The results of 3 large pivotal trials comparing zidovudine monotherapy with combination therapy have now clearly established that zalcitabine plus zidovudine combination with an improvement in viral load and CD4+ cell count compared with zidovudine monotherapy. More recently, clinical end-point and surrogate marker data have established the efficacy of zalcitabine in combination with the protease inhibitor saquinavir in zidovudine-experienced patients. Other studies have demonstrated the utility of zalcitabine in combination with ritonavir and the nucleoside analogue lamivudine. Importantly, early use of zalcitabine in the treatment sequence does not appear to limit the therapeutic efficacy of subsequent therapy with other nucleoside analogues such as lamivudine. Peripheral neuropathy is the most frequent dose-limiting adverse effect associated with zalcitabine therapy and is generally reversible on discontinuation of treatment. Stomatitis and mouth ulcers may occur frequently with zalcitabine therapy but tend to resolve with continuing treatment. Haematological toxicity, which is a common adverse effect associated with zidovudine, is reported infrequently with zalcitabine. Overall, combination therapy with zalcitabine plus zidovudine or saquinavir has been shown to have a tolerability profile comparable to that of either agent alone, although treatment with zidovudine plus zalcitabine was associated with a significant increase in the incidence of haematological toxicity compared with zidovudine monotherapy in one study. Therefore, current data suggest that zalcitabine is a useful antiretroviral agent for inclusion as a component of initial double combination therapy with zidovudine or as part of triple combination therapy including zidovudine plus a protease inhibitor in the management of patients with HIV infection.

背景与目标： : 扎西他滨是一种双脱氧核苷抗逆转录病毒药物，在未感染和HIV感染的细胞中被磷酸化为活性代谢物2 '，3'-二脱氧胞苷5 '-三磷酸 (ddCTP)。在治疗浓度下，ddCTP通过抑制反转录酶和终止前病毒DNA链的延伸来抑制HIV复制。比较齐多夫定单药治疗与联合治疗的3项大型关键试验的结果现已清楚地确定，与齐多夫定单药治疗相比，扎西他滨加齐多夫定联合治疗的病毒载量和CD4细胞计数有所改善。最近，临床终点和替代标记数据已经确定了扎西他滨与蛋白酶抑制剂沙奎那韦联合使用齐多夫定经验的患者的疗效。其他研究表明扎西他滨与利托那韦和核苷类似物拉米夫定联合使用。重要的是，在治疗序列中早期使用扎西他滨似乎不会限制随后使用其他核苷类似物 (例如拉米夫定) 进行治疗的疗效。周围神经病变是与扎西他滨治疗相关的最常见的剂量限制性不良反应，并且在停止治疗后通常是可逆的。扎西他滨治疗可能经常发生口腔炎和口腔溃疡，但随着继续治疗而趋于缓解。扎西他滨很少报道血液学毒性，这是与齐多夫定相关的常见不良反应。总体而言，扎西他滨联合齐多夫定或沙奎那韦的联合治疗已被证明具有与单独使用任何一种药物相当的耐受性特征，尽管在一项研究中，与齐多夫定单药治疗相比，齐多夫定联合扎西他滨治疗与血液学毒性发生率显着增加有关。因此，目前的数据表明，扎西他滨是一种有用的抗逆转录病毒药物，可作为齐多夫定的初始双重联合疗法的一部分或作为齐多夫定加蛋白酶抑制剂的三重联合疗法的一部分纳入HIV感染患者。

BACKGROUND & AIMS: :With currently available combination chemotherapy regimens, the outcome of the patients newly diagnosed with aggressive non-Hodgkin's lymphoma (NHL) identified as 'high' and 'high-intermediate' risk groups according to the international prognostic index (IPI) is still unsatisfactory and a more innovative therapy is urgently required to improve the survival of the patients. The purpose of this study was to compare the efficacy of rituximab given in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and ESHAP (etoposide, methylprednisolone, high-dose Ara-C, cisplatin) vs CHOP-ESHAP and upfront high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) vs standard CHOP in patients aged < or = 65 years old newly diagnosed with 'high' and 'high-intermediate' risk aggressive lymphoma enrolled onto two consecutive treatment trials at the institute. Between May 1995 - July 2002, 84 patients, aged 15 - 65 years old, with newly diagnosed aggressive NHL and an age-adjusted IPI of 2 or 3 were enrolled. The median age of the patients was 38 years (range 15 - 65). The baseline demographic features, in particular the major prognostic variables, were similar between the treatment groups. Patients treated with rituximab-CHOP-ESHAP received eight cycles of rituximab (375 mg m(-2) on day 1 of cycles 1 - 6 and days 21 and 28 of cycle 7) plus CHOP (day 3 of cycles 1, 3 and 5) and ESHAP (day 3 of cycles 2, 4 and 6 and day 1 of cycle 7) at 21-day intervals. Patients enrolled onto the CHOP-ESHAP-HDT arm (n = 23) were treated with three courses of CHOP and then switched to two or four cycles of ESHAP followed by HDT. Patients treated with CHOP alone (n = 25) were treated with the standard eight cycles of CHOP. The rate of complete remission was significantly improved with rituximab-CHOP-ESHAP compared with either CHOP-ESHAP-HDT or CHOP alone (67% compared with 44% and 36%, respectively; p = 0.043). With a median follow-up time of 53 months, the 5-year overall survival (OS) was improved by the addition of rituximab-61% with rituximab-CHOP-ESHAP, compared with 43% for CHOP-ESHAP-HDT and 24% for CHOP alone (p = 0.088). Significant increases in failure-free survival (FFS) and disease-free survival (DFS) (61% and 96%), compared with CHOP-ESHAP-HDT (34% and 90%) and CHOP (16% and 44%; p = 0.002 and p < 0.001, respectively) were observed. Compared to CHOP, rituximab-CHOP-ESHAP yielded significantly superior OS (p = 0.014), FFS (p < 0.001) and DFS (p < 0.001). The survivals, however, were not significantly different from patients treated with CHOP-ESHAP-HDT. It is concluded that rituximab-ESHAP-CHOP is superior over standard CHOP and fares comparably to upfront HDT/ASCT in previously untreated patients with aggressive lymphoma. A prospective randomized controlled trial is warranted to confirm these results.

背景与目标： : 根据目前可用的联合化疗方案，根据国际预后指数 (IPI)，新诊断为侵袭性非霍奇金淋巴瘤 (NHL) 的患者的预后仍不令人满意，迫切需要一种更具创新性的疗法来改善患者的生存。本研究的目的是比较利妥昔单抗与CHOP (环磷酰胺，阿霉素，长春新碱，泼尼松) 和ESHAP (依托泊苷，甲基强的松龙，大剂量Ara-C，顺铂与CHOP-ESHAP以及前期大剂量治疗 (HDT) 和自体干细胞移植 (ASCT) 与标准CHOP在新诊断为 “高” 和 “高中间” 风险侵袭性淋巴瘤的年龄 <或 = 65岁的患者中加入了该研究所的两项连续治疗试验。在1995年5月2002年7月之间，纳入了84例年龄在15-65岁之间的新诊断为侵袭性NHL且年龄校正后的IPI为2或3的患者。患者的中位年龄为38岁 (范围15-65岁)。治疗组之间的基线人口统计学特征，特别是主要预后变量相似。利妥昔单抗-CHOP-ESHAP治疗的患者接受8个周期的利妥昔单抗 (第1-6周期的第1天和第7周期的第21天和第28天的375 mg m(-2)) 加CHOP (第1、3和5周期的第3天) 和ESHAP (第2周期的第3天，第4和第6周期以及第7周期的第1天) 间隔21天。纳入CHOP-ESHAP-HDT臂 (n = 23) 的患者接受了三个疗程的CHOP治疗，然后切换到两个或四个周期的ESHAP，然后进行HDT。仅接受CHOP治疗的患者 (n = 25) 接受标准的8个CHOP周期治疗。与单独使用CHOP-ESHAP-HDT或单独使用CHOP相比，利妥昔单抗-CHOP-ESHAP显著提高了完全缓解率 (分别与44% 和36% 相比67%; p = 0.043)。中位随访时间为53个月，通过添加利妥昔单抗-CHOP-ESHAP的rituximab-61 %，改善了5年总生存率 (OS)，而CHOP-ESHAP-HDT为43%，CHOP单独为24% (p = 0.088)。与CHOP-ESHAP-HDT (34% 和90%) 和CHOP (16% 和44%; 分别为p = 0.002和p <0.001) 相比，无失败生存率 (FFS) 和无病生存率 (DFS) 显著增加 (61% 和96%)。与CHOP相比，利妥昔单抗-CHOP-ESHAP产生显著优越的OS (p = 0.014) 、FFS (p < 0.001) 和DFS (p <0.001)。然而，生存率与接受CHOP-ESHAP-HDT治疗的患者没有显着差异。结论是，在先前未经治疗的侵袭性淋巴瘤患者中，利妥昔单抗-ESHAP-CHOP优于标准CHOP，与前期HDT/ASCT相比。需要进行前瞻性随机对照试验来证实这些结果。

BACKGROUND & AIMS: :In Taiwan, the authorities have spent years working on remedying polluted rivers. Generally, the remediation planning works are divided into two phases. During the first phase, the allowed pollution discharge quantity and abatement quantity of each drainage zone, including the assimilative capacity, are generated based on the total river basin. In the second phase, the abatement action plans for each pollution source in each drainage zone are respectively devised by the related organizations based on the strategies generated during the first phase. However, the effectiveness of linking the two phases is usually poor. Highly integrated performances are not always achieved because the separate two-phase method does not take system and management thinking into consideration in the planning stage. This study pioneers the use of the Managing for Results (MFR) method in planning strategies and action plans for river water quality management. A sustainable management framework is proposed based on the concept and method of MFR, Management Thinking, and System Analysis. The framework, consisting of planning, implementation, and controlling stages, systematically considers the relationships and interactions among four factors: environment, society, economy, and institution, based on the principles of sustainable development. Based on the framework, the Modified Bounded Implicit Enumeration algorithm, which is used as a solving method, is combined with Visual Basic software and MS Excel to develop a computer system for strategy planning. The Shetzu River, located in northern Taiwan, is applied as a case study. According to the theoretical, practical, and regulatory considerations, the result-oriented objectives are defined to first improve the pollution length of the Shetzu River in specific remediation periods to finally meet regulated water quality standards. The objectives are then addressed as some of the constraints for the strategy planning model. The model objective is to pursue the maximum assimilative capacity (environmental phase) subjected to the constraints of water quality standards (institutional phase), social equity (social phase), and proper available technology (economic phase). The pollution quantity abatement and allocation, which are named the top strategies, of each drainage zone for different scenarios can be obtained based on each water quality standard. The middle as well as lower strategies and action plans, which consist of pollution quantity abatement and allocation of each class (domestic, industrial, livestock, and non-point pollution sources) and their individual pollution sources in each drainage zone, are then generated based on the top strategies. The performance indicators and measure plans are proposed based on the action plans to promote the comprehensive effectiveness of river water quality management. The authorities have begun to develop a budget based on the strategies and action plans developed in this study. The analytical results indicate that the objectives, strategies, and action plans developed based on the sustainable management framework and strategy planning system can effectively help the related authorities to fulfill the tasks of water quality management for a river basin.

背景与目标： : 在台湾，当局花了数年时间对污染的河流进行补救。通常，补救计划工作分为两个阶段。在第一阶段，根据整个流域产生每个流域的允许排污量和减排量，包括同化能力。在第二阶段，相关组织根据第一阶段产生的策略，分别为每个排水区的每个污染源制定减排行动计划。然而，将这两个阶段联系起来的有效性通常很差。并非总是能够实现高度集成的性能，因为在计划阶段，单独的两阶段方法并未考虑系统和管理思想。这项研究率先在河流水质管理的规划策略和行动计划中使用了结果管理 (MFR) 方法。基于MFR的概念和方法，管理思想和系统分析，提出了可持续管理框架。该框架由规划，实施和控制阶段组成，根据可持续发展的原则，系统地考虑了环境，社会，经济和制度四个因素之间的关系和相互作用。基于该框架，将作为求解方法的改进的有界隐式枚举算法与Visual Basic软件和MS Excel相结合，开发了用于策略规划的计算机系统。以台湾北部的Shetzu河为例。根据理论，实践和法规方面的考虑，定义了以结果为导向的目标，以首先在特定的整治时期改善Shetzu河的污染长度，以最终达到规定的水质标准。然后将目标作为战略规划模型的一些约束条件来解决。模型目标是在水质标准 (制度阶段)，社会公平 (社会阶段) 和适当的可用技术 (经济阶段) 的约束下，追求最大的同化能力 (环境阶段)。根据每个水质标准，可以获得每个排水区针对不同情况的污染量减少和分配 (称为顶级策略)。然后生成中间和较低的策略和行动计划，其中包括减少和分配每一类 (家庭，工业，牲畜和面源污染源) 及其在每个排水区中的单个污染源根据顶级策略。根据促进河流水质管理综合成效的行动计划，提出了绩效指标和措施计划。当局已开始根据本研究中制定的战略和行动计划制定预算。分析结果表明，基于可持续管理框架和战略规划系统制定的目标，战略和行动计划可以有效地帮助相关当局完成流域水质管理的任务。

BACKGROUND & AIMS: PURPOSE:Medication and nutrient administration considerations after bariatric surgery are discussed. SUMMARY:Bariatric surgery is categorized by surgical technique (i.e., restrictive procedure or a combination of restrictive and malabsorptive procedures). Roux-en-Y gastric bypass is the most frequently performed bariatric surgery in the United States. Patients who have undergone this surgery are at risk for nutrient deficiencies. Several factors, such as pH and absorption sites, should be considered when providing these patients with appropriate supplementation. Drug solubility and surface area for absorption are also affected by gastric bypass procedures. By bypassing major portions of the small intestine, Roux-en-Y procedures drastically reduce the surface area for absorption. These changes may warrant manipulation in drug route or dose to ensure adequate delivery. Drugs with long absorptive phases that remain in the intestine for extended periods are likely to exhibit decreased bioavailability in these patients. The reduced size of the stomach after surgery can place patients at risk for adverse events associated with some medications. Medications implicated in such adverse events include nonsteroidal antiinflammatory drugs, salicylates, and oral bisphosphonates. Drugs that are rapidly and primarily absorbed in the stomach or duodenum are likely to exhibit decreased absorption in patients who have had combination restrictive-malabsorptive procedures. Because reduced drug absorption may result in decreased efficacy rather than toxicity, increased patient monitoring for therapeutic effects can help detect potential absorption problems. CONCLUSION:Selection of appropriate nutrient salts can improve nutrient replacement in patients who have undergone bariatric surgery. Changes in dosage forms based on drug characteristics can improve bioavailability.

背景与目标：