Opinion and Evidence in Respiratory Medicine

Respiratory Medicine is a vast and evolving area for researchers, primary care physicians and specialists. To help keep you up-to-date with the latest advances worldwide on all aspects of drug therapy and management of respiratory disorders, this section of the journal brings you information selected from the drug therapy reporting service Inpharma Weekly ¹. The following reports are selected from the latest issues, summarizing the most important research and development news, clinical studies, treatment guidelines, pharmacoeconomic and adverse reaction news, and expert opinion pieces published across a broad range of literature sources.     

《医用生物力学》2015年第30卷总目次

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《医用生物力学》2015年第30卷第1～6期关键词索引

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Postoperative survival for patients with thymoma complicating myasthenia gravis—preliminary retrospective results of the ChART database

Background

It is so far not clear that how myasthenia gravis (MG) affected the prognosis of thymoma patients. The aim of this assay is to compare the postoperative survival between patients with thymoma only and those with both thymoma and MG.

Methods

The Chinese Alliance for Research in Thymomas (ChART) registry recruited patients with thymoma from 18 centers over the country on an intention to treat basis from 1992 to 2012. Two groups were formed according to whether the patient complicated MG. Demographic and clinical data were reviewed, patients were followed and their survival status were analyzed.

Results

There were 1,850 patients included in this study, including 421 with and 1,429 without MG. Complete thymectomy were done in 91.2% patients in MG group and 71.0% in non-MG group (P<0.05). There were more percentage of patients with the histology of thymoma AB, B1, or B2 (P<0.05) in MG group, and more percentage of patients with MG were in Masaoka stage I and II. The 5- and 10-year overall survival (OS) rates were both higher in MG group (93% vs. 88%; 83% vs. 81%, P=0.034) respectively. The survival rate was significantly higher in patients with MG when the Masaoka staging was 3/4 (P=0.003). Among patients with advanced stage thymoma (stage 3, 4a, 4b), the constituent ratios of 3, 4a, 4b were similar between MG and non-MG group. Histologically, however, there were significantly more proportion of AB/B1/B2/B3 in the MG group while there were more C in the non-MG group (P=0.000). Univariate analyses for all patients showed that MG, WHO classification, Masaoka stage, surgical approach, chemotherapy and radiotherapy and resectability were significant factors, and multivariate analysis showed WHO classification, Masaoka stage, and resectability were strong independent prognostic indicators.

Conclusions

Although MG is not an independent prognostic factor, the survival of patients with thymoma was superior when MG was present, especially in late Masaoka stage patients. Possible reasons included early diagnosis of the tumor, better histologic types, an overall higher R0 resection and less recurrence.     

The role of postoperative radiotherapy for stage I/II/III thymic tumor—results of the ChART retrospective database

Background

Postoperative radiotherapy (PORT) for thymic tumor is still controversial. The object of the study is to evaluate the role of PORT for stage I to III thymic tumors.

Methods

The Chinese Alliance for Research in Thymomas (ChART) was searched for patients with stage I to III thymic tumors who underwent surgical resection without neoajuvant therapy between 1994 and 2012. Univariate and multivariate survival analyses were performed. Cox proportional hazard model was used to determine the hazard ratio for death.

Result

From the ChART database, 1,546 stage I to III patients were identified. Among these patients, 649 (41.98%) received PORT. PORT was associated with gender, histological type (World Health Organization, WHO), thymectomy extent, resection status, Masaoka-Koga stage and adjuvant chemotherapy. The 5-year and 10-year overall survival (OS) rates and disease-free survival (DFS) rates for patients underwent surgery followed by PORT were 90% and 80%, 81% and 63%, comparing with 96% and 95%, 92% and 90% for patients underwent surgery alone (P=0.001, P<0.001) respectively. In univariate analysis, age, histological type (WHO), Masaoka-Koga stage, completeness of resection, and PORT were associated with OS. Multivariable analysis showed that histological type (WHO) (P=0.001), Masaoka-Koga stage (P=0.029) and completeness of resection (P=0.003) were independently prognostic factors of OS. In univariate analysis, gender, myasthenia gravis, histological subtype, Masaoka-Koga stage, surgical approach, PORT and completeness of resection were associated with DFS. Multivariate analysis showed that histological subtype (P<0.001), Masaoka-Koga stage (P=0.005) and completeness of resection (P=0.006) were independent prognostic factors for DFS. Subgroup analysis showed that patients with incomplete resection underwent PORT achieved better OS and DFS (P=0.010, 0.017, respectively). However, patients with complete resection underwent PORT had the worse OS and DFS (P<0.001, P<0.001, respectively).

Conclusions

The current retrospective study indicates that PORT after incomplete resection could improve OS and DFS for patients with stage I to III thymic tumors. However for those after complete resection, PORT does not seem to have any survival benefit on the whole.     

中国社区肺结核主动筛查循证指南

为实现终止结核病流行策略目标,迫切需要实施更强有力的措施来改善结核病患者的发现和治疗管理,而主动筛查作为实现目标的重要组成部分,旨在确保结核病患者的早期诊断。中国防痨协会结核病控制专业分会和老年结核病防治专业分会与《中国防痨杂志》编辑委员会共同组织专家,在解读吸收世界卫生组织2021年最新指南证据和建议的基础上,补充了后续新发表的文献和我国国内的相关文献和研究证据,结合中国结核病防治实践和研究结果制订了本指南。本指南系统总结了症状筛查、胸部影像学检查、C反应蛋白检测等筛查技术的特点,提出了在肺结核患者密切接触者、既往结核病患者、HIV/AIDS者、老年人、糖尿病患者和高疫情地区的一般人群等社区人群中开展肺结核主动筛查的方式,为国家和各地完善和优化重点人群肺结核主动筛查策略提供循证依据。     

中华医学会第八次全国心血管病学术会议纪要

中华医学会第八次全国心血管病学术会议于2004年10月28日-10月31日在沈阳召开。来自全国各地的代表1400多人参加了大会，收到论1300多篇。开幕式上颁发了我国第一批心血管病学分会专科会员证书。会议采取专题报告和论交流的方式对当前心血管病学界的热点问题和有争议的问题进行了交流和讨论，评选了优秀论和优秀壁报取得了圆满成功。现就会议的主要研讨内容总结如下。     

抗结核药物引起的副作用综合报告

目的了解各种抗结核药物引起的副作用并掌握一般处理原则。方法直接或间接证明６２例中由抗结核药物引起的副作用，观察并分析各种副作用分布情况、出现时间及表现形式。结果过敏反应频度占副作用的首位，共３７例，占６０％；严重副反应绝大多数由利福霉素类引起；副作用出现时间多为服药后２个月以内；药物服用过量易导致副反应发生；多种药物可同时或相继产生严重副作用。结论一旦发生严重药物副作用，必须立即停药，及时治疗，否则后果严重；利福霉素类药停药后再服，有可能加重过敏反应程度，故要详细询问既往用药情况，对有肝炎史、酗酒史、药物过敏史和年老体弱者用药过程中要严密观察；对多种药物过敏者，无论反应轻重，以快停药、早脱敏为原则；必须确定过敏原时，要使用常量的１／１０以下，并制定应急处理措施，严重过敏者不应进行重复验证