A randomized comparison of once weekly epoetin alfa to extended schedule epoetin or darbepoetin in chemotherapy-associated anemia

Study on sentinel symptoms and influencing factors of postoperative chemotherapy in patients with gastric cancer

PURPOSE

To explore the symptom clusters of gastric cancer patients receiving postoperative chemotherapy, identify the sentinel symptom of each symptom cluster, and compare the differences in sentinel symptoms of patients for gastric cancer with different characteristics.

METHODS

This was a cross-sectional study. Patients with postoperative gastric cancer who received chemotherapy in the medical oncology department from October 2021 to July 2022 were selected for the study using a convenience sampling method.The General Information Questionnaire and the MD Anderson Symptom Inventory Gastrointestinal Cancer (MDASI-GI) were used for the survey.

RESULTS

A total of 245 patients participated in the study. There were five symptom clusters in the patients. Fatigue, nausea, sadness, and taste alteration were the sentinel symptoms of the disease symptom cluster, gastrointestinal symptom cluster, emotional symptom cluster, and neurotoxic symptom cluster, respectively. No clear sentinel symptom was found in the gastric-cancer-specific symptom cluster. Statistically significant differences were observed in fatigue, nausea, sadness, and taste alteration among patients receiving postoperative chemotherapy for gastric cancer with differences in gender, duration since diagnosis, tumor site, chemotherapy regimen, chemotherapy cycle, red blood cell count, hemoglobin level, albumin level, plasma D-dimer level, indirect bilirubin level, glutamic pyruvic transaminase level, total bile acid level, and uric acid level.

CONCLUSION

People with postoperative chemotherapy for gastric cancer experience multiple concurrent symptoms. Of the multiple symptoms that occur simultaneously, patients tend to focus on 1 or 2 symptoms of particular significance and use the occurrence of 1 symptom to explain the others. The understanding of symptom clusters and sentinel symptoms could be beneficial to assess and manage both in postoperative patients with gastric cancer during chemotherapy. Clinical staff should use sentinel symptoms as the targets for symptom cluster evaluation and effective intervention.

Does erythropoietin affect the outcome and complication rates of patient with traumatic brain injury? A pooled-analysis

OBJECTIVE

The aim of this meta-analysis was to review the scientific literature published until April 18, 2021, to summarize existing knowledge on the efficacy and safety of erythropoietin (EPO) for traumatic brain injury (TBI).

METHODS

This systematic review followed PRISMA guidelines. Randomized controlled trials (RCTs) reporting on the efficacy and safety of EPO in the treatment of TBI were systematically searched in relevant electronic databases according to a pre-designed search strategy. The primary outcomes are the mortality; and secondary outcomes are the good functional outcome (GFO) and adverse events (AEs).

RESULTS

A total of 10 RCTs involving 2,402 participants fulfilled the inclusion criteria. The results showed that there is a significant difference in terms of the mortality (RR = 0.67, 95% CI = 0.54-0.84, P = 0.0003) and seizure rate (RR = 0.52, 95% CI = 0.29-0.96, P = 0.04) between the EPO groups compared to those in the control groups. However, compared with the control groups, the GFO in the EPO groups was not statistically significant (RR = 1.18, 95% CI = 0.93-1.48, P = 0.17).

CONCLUSIONS

Findings of the present meta-analysis suggest that the use of EPO could reduce mortality rate in patients with TBI, without increasing the incidence of AEs. EPO has potential research and application value in the treatment of TBI.

Prolonged Duration of Erythropoiesis-Stimulating Agents' Action Delays Disease Progression in Anti-Thy 1 Antibody-Induced Chronic Glomerulonephritis Rats

BACKGROUND

Although erythropoiesis-stimulating agents (ESAs) exert renoprotective effects in renal disease models, it has not been revealed whether the prolonged duration of action of ESAs contributes to their renoprotective effects.

OBJECTIVE

We examined whether the prolonged duration of ESAs' action contributes to their renoprotective effects by comparing a divided administration of a short-acting ESA, epoetin beta (EPO), or a single administration of a long-acting ESA, epoetin beta pegol (continuous erythropoietin receptor activator; C.E.R.A.), to a single administration of EPO in chronic glomerulonephritis (GN) rats.

MATERIALS AND METHODS

Chronic GN was induced by intravenous injection of anti-Thy 1.1 antibody (0.6 mg/kg) into uninephrectomized rats (day 0). Chronic GN rats were intravenously injected once with vehicle (disease control; DC), EPO 5,000 IU/kg (single EPO), or C.E.R.A. 25 μg/kg (single C.E.R.A.) on day 1; or 3 times during the first week with EPO 1,667 IU/kg from day 1 (divided EPO; total 5,000 IU/kg). Hemoglobin (Hb) level and urinary total protein (U-TP) level which are the indexes of hematopoiesis and renoprotective effects, respectively, were measured several times over 8 weeks.

RESULTS

Divided EPO and single C.E.R.A. increased Hb levels more greatly than did single EPO. In all chronic GN rats, elevated U-TP levels decreased transiently 2 weeks after chronic GN induction and then flared again. Single EPO significantly suppressed this exacerbation of U-TP levels compared to DC. Divided EPO and single C.E.R.A. each significantly suppressed the exacerbation of U-TP levels compared to single EPO.

CONCLUSION

Prolonged duration of ESAs' action contributed significantly to their renoprotective effects.

Severe case of fetal hemolytic disease caused by anti-C(w) requiring serial intrauterine transfusions complicated by pancytopenia and cholestasis

BACKGROUND

Anti-C(w) are rarely found as a source for severe fetal and neonatal hemolytic diseases. We report a case with serial intrauterine transfusions complicated by pancytopenia and cholestasis in the neonatal period.

CASE REPORT

A 37-year-old woman revealed anti-C(w) with a titer of 512 in her fourth pregnancy. The fetus developed fetal anemia and a severe hydrops requiring three intrauterine red blood cell (RBC) transfusions. After birth at 33 + 0 weeks the newborn presented only transfused RBCs and suffered from anemia, thrombocytopenia, leukopenia, and a cholestatic liver disease. Blood counts improved after transfusion of 2 RBC units and one platelet concentrate and administration of hematopoietic growth factors. The symptoms of cholestasis improved slowly after therapy with ursodeoxycholic acid, vitamins, and medium-chain triglyceride-enriched formula feeding.

CONCLUSION

Anti-C(w) may lead to severe fetal anemia and consecutive complications. Surveillance of affected pregnancies with high antibody titers using sonographic evaluation of the middle cerebral artery peak systolic velocity should be warranted, especially in multiparous women.