2023 Volume 25 Issue 4 Published: 28 April 2023
  

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  • Tang Haochun, Meng Jun
    Abstract ( ) PDF ( )
    With the widespread use of immune checkpoint inhibitors (ICIs) in cancer therapy, immune-related adverse events (irAEs) are receiving increasing attention. Among them, ICI-related pneumonitis (CIP) is more common. This article introduces the clinical features, disease classification, and treatment strategies, etc. of CIP, and suggests multidisciplinary cooperation to carried out whole-process management for patients receiving ICIs treatment, early detection, early diagnosis, and establish clear and effective prevention and early warning strategies to maximize the benefits of cancer patients.
  • Guo Nan, Gao Ping, Jin Haobin, Sheng Jia, Shi Yaru, Bi Yunyan, Lyu Zhimei, Zhang Wen
    Abstract ( ) PDF ( )
    To explore the characteristics and factors affecting the occurrence of renal injury in patients with abnormal biochemical indexes of renal function after the use of immune checkpoint inhibitors (ICIs), and to provide reference for selection of clinical treatment regimen. Methods Patients who were treated with immune checkpoint inhibitors researched and developed independently in China including camrelizumab, sintilimab, tislelizumab, and toripalimab from March 1, 2021 to February 28, 2022 and showed estimated glomerular filtration rate (eGFR) <90-ml/(min·1.73 m2) and/or serum creatinine (Scr)>105-μmol/L were retrieved from the China Hospital Pharmacovigilance System. The clinical data including general information, anti-tumor treatment regimen, laboratory test results, and concomitant medications were collected. Patients were divided into kidney injury group and non-kidney injury group, and all the clinical characteristics were compared between the 2 groups, the influencing factors of kidney injury were analyzed using a binary logistic regression model, the odds ratio (OR) and its 95% confidence interval (CI) were calculated. Results A total of 222 patients were entered in the analysis, including 170 males and 52 females, with a median age of 67 (36, 85) years. Of them, 144 patients were treated with carrilizumab, 38 with sindilizumab, 31 with tirelizumab, and 9 with treprolizumab; 29 patients (13.1%) developed kidney injury, including 26 cases of grade 1 and 3 cases of grade 2 renal injuries; the time of renal injury occurrence was 19-355 days after the first application of ICIs, and the median time was 108 days. After diagnosed of kidney injury, 13 out of 29 patients stopped ICIs, of which 6 had recovered kidney function and 7 had no improvement; 16 patients continued the ICIs treatment, of which 10 patients had recovered or improved kidney function and 6 had no improvement. The clinical characteristics of patients in the 2 groups were compared, and 10 variables including age, gender, baseline renal function, previous use of carboplatin, previous radiotherapy, combined chemotherapy containing cisplatin, combined paclitaxel chemotherapy, combined tyrosine kinase inhibitor (TKI) anti-vascular therapy, combined proton pump inhibitors, and combined radiotherapy were screened for the binary logistic regression analysis. The results showed that female (OR=3.046, 95%CI: 1.149-8.077), ≤65 years (OR=3.649, 95%CI: 1.435-9.274), combined TKI anti-vascular therapy (OR=4.773, 95%CI: 1.496-15.227), and combined radiotherapy (OR=8.655, 95%CI: 1.268-59.076) were independent risk factors for the development of kidney injury. Conclusions The incidence of kidney injury in patients with eGFR <90-ml/(min·1.73 m2) and/or Scr >105-μmol/L after using ICIs is 13.1%. In these patients, female, ≤65 years, combined TKI anti-vascular therapy, and combined radiotherapy may be risk factors for the development of ICI-associated kidney injury.
  • Cai Junying, Chen Wanwen, He Yuwen
    Abstract ( ) PDF ( )
    Objective To explore the influencing factors of immune checkpoint inhibitor-related pneumonitis (CIP) in lung cancer patients caused by programmed cell death 1 receptor (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors. Methods A retrospective analysis was conducted on clinical data of lung cancer patients treated with PD-1/PD-L1 inhibitors in the First Affiliated Hospital of Guangzhou Medical University from January 2018 to June 2022. Patients with CIP were included in the CIP group, and those who did not experience any immune-related adverse events during the same period were screened in a 1∶1 ratio and included in the control group. The clinical characteristics in patients of the 2 groups were compared and influencing factors of CIP were analyzed using binary logistic regression method. The effect sizes were the odds ratio (OR) and its 95% confidence interval (CI). Results A total of 246 patients (123 in the CIP group and 123 in the control group) were entered in the analysis, including 208 males and 38 females, aged (63±9) years with a range of 32 to 86 years. The diagnosis was non-small-cell lung cancer in 234 patients and small cell lung cancer in 12 patients. There were no statistically significant differences in age, gender, history of respiratory diseases, tumor histological types, TNM stages, and types of immune checkpoint inhibitors used in patients between the 2 groups (all P>0.05). Compared with the control group, patients in the CIP group had a lower body mass index [(21.5±3.2) kg/m2 vs. (22.6±3.0) kg/m2, P=0.004], higher proportion of patients with Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) ≥2 points[39.0% (48/123) vs. 22.0% (27/123), P=0.004], higher proportion of patients with a history of radiation therapy [25.2% (31/123) vs. 13.8% (17/123), P=0.024], and lower proportion of patients with combination therapy with chemotherapy/targeted drugs[82.9%(102/123) vs. 97.6%(120/123), P<0.001]. Before immunotherapy, the peripheral blood interleukin-1β and interferon-α were lower [1.97 (1.04, 2.74) ng/L vs. 2.40 (1.75, 4.03) ng/L, P=0.021; 2.08 (0.89, 3.00) ng/L vs. 2.76 (1.97, 3.94) ng/L, P=0.012], lymphocyte count was lower [1.4(1.0, 1.8)×109/L vs. 1.5(1.2, 2.1)×109/L, P=0.030], and the neutrophil-to-lymphocyte ratio was higher [3.85 (2.50, 6.40) vs. 3.11 (2.25, 4.61), P=0.006] in patients of the CIP group than those in the control group. The binary logistic regression analysis showed that baseline ECOG-PS ≥2 points (OR=3.400, 95%CI: 1.180-9.798, P=0.023) and combination of PD-1/PD-L1 inhibitors and chemotherapy/targeted therapy (OR=0.047, 95%CI: 0.005-0.454, P=0.008) were independent influencing factors for the occurrence of CIP. Conclusion The ECOG-PS ≥ 2 points before immunotherapy is an influencing factor for CIP, and the combination with chemotherapy/targeted therapy may reduce the risk of developing CIP in patients treated with PD-1/PD-L1 inhibitors.
  • Chen Lu, Xu Lei
    Abstract ( ) PDF ( )
    Objective To investigate the occurrence and clinical characteristics of immune-related adverse events (irAEs) caused by pembrolizumab (PEM) in elderly patients with advanced lung cancer. Methods The subjects were selected from the elderly patients with advanced lung cancer who received PEM therapy (200-mg was given by intravenous infusion once every 21 days and 21 days was a cycle) in the Affiliated Hospital of Inner Mongolia Medical University from August 2020 to July 2022. The medical records of patients meeting the inclusion criteria were collected through the Hospital Electronic Medical Record Information System, the clinical data such as patients′ basic information, pathological type of lung cancer, clinical stage, whether or not combination with chemotherapy, the occurrence time of irAEs, clinical manifestations, intervention, and prognosis were recorded and analyzed retrospectively. The irAEs were graded according to the Common Terminology Criteria for Adverse Event (CTCAE) Version 5.0 developed by the National Cancer Institute of the United States. Results A total of 100 patients were enrolled in the analysis, of which 22 (22%) patients developed irAEs. Among the 22 patients, 19 were male and 3 were female, aged from 61 to 90 years, including 15 lung squamous cell carcinomas and 7 lung adenocarcinomas. There were 4 patients with clinical stage Ⅲ and 18 patients with stage Ⅳ; one patient received PEM monotherapy and 21 patients received PEM combined with chemotherapy. A total of 28 cases of irAEs occurred in 22 patients (19 cases of 1 type of irAE, 1 case of 2, 3, and 4 types of irAE each), including 10 cases of skin irAEs (3 in grade 1, 3 in grade 2, and 4 in grade 3), 8 cases of immune-related pneumonitis (1 in grade 1, 7 in grade 2), 7 cases of irAEs involving the endocrine system (1 case of hypothyroidism in grade 1, 3 cases of hypothyroi- dism in grade 2, 1 case of adrenocortical dysfunction in grade 1, 1 case of hyperglycemia in grade 1, and 1 case of pituitary inflammation in grade 4), 2 cases of immune-associated hepatitis (1 in grade 1, 1 in grade 3), 1 case of ICI-related myocarditis in grade 3. The shortest occurrence time of the 28 cases of irAEs was on the day of initial medication, the longest was 20 days after the 17th cycle of medication, and 22 cases occurred between the 1st to 8th cycles of medication. After the occurrence of irAEs, 5 patients discontinued PEM and most received hormone and/or symptomatic treatment. Twenty patients were cured or self-healed, 1 partially recovered, and 1 was not improved. Conclusions Elderly patients with advanced lung cancer who receive PEM may experience skin, lung, endocrine system, liver, and heart irAEs, mostly occurring between the 1st to 8th cycles of medication, mostly in grades 1 and 2. Discontinuation of medication and hormone and/or symptomatic treatment can lead to a better prognosis.
  • Zhu Xiuping, Xu Chen, Yu Lingyan, Zhang Jiali, Dai Haibin
    Abstract ( ) PDF ( )
    Objective To investigate the incidence of alopecia after pediatric liver transplantation and its related risk factors. Methods A retrospective case-control study was used. The subjects were children who underwent liver transplantation in the Second Affiliated Hospital, Zhejiang University School of Medicine from July 2019 to December 2020. The information such as gender, age, primary disease, preoperative body mass index (BMI), graft-to-recipient weight ratio (GRWR), albumin, hemoglobin and total bilirubin before the operation, and blood concentration of tacrolimus were collected from the hospital information system. The follow-up content included whether there was alopecia after surgery, the site of alopecia, the degree of alopecia, the occurrence time and recovery time of alopecia after surgery. The children were divided into alopecia group and non-alopecia group according to whether there were alopecia, and the related indicators were analyzed by univariate analysis, and the results were expressed by odds ratio (OR) and its 95% confidence interval (CI). Results A total of 40 children who met the inclusion criteria were collected, including 20 males and 20 females. The median age at surgery was 20(11, 43) months and the age ranged from 5 months to 13 years. The BMI was (17.1±2.1) kg/m2 and the GRWR was (2.6±0.7)%. The serum TBil, blood albumin, and hemoglobin before the operation were 120 (27, 191) μmol/L, (33±5) g/L, and (100±14) g/L, respectively. The blood concentration of tacrolimus was (10.37±2.15) μg/L within one month after the operation. Among the 40 children, 17 developed alopecia, including 8 males and 9 females. The severity of alopecia was S1 in 16 cases and S2 in 1 case. There were 14 cases of local hair loss and 3 cases of general hair loss. The occurrence time of alopecia in all 17 patients was distributed from 4 days to 9 months after operation, including 15 cases within 1 month after operation, and 2 cases 3 and 9 months after operation, respctively. All patients did not receive symptomatic treatment for alopecia and returned to normal within 1 year after the operation. Univariate analysis showed that low preoperative albumin level and high concentration of tacrolimus within one month after surgery were risk factors for alopecia after pediatric liver transplantation [(31±4)g/L vs. (34±5)g/L, OR=0.83, 95%CI: 0.71-0.98, P=0.026; (12.0±2.1)μg/L vs. (9.2± 1.2)μg/L, OR=2.80, 95%CI: 1.55-5.05, P=0.001]. Conclusion Low preoperative albumin level and high concentration of tacrolimus within one month after surgery may be risk factors for alopecia in children after liver transplantation.
  • Chen Shuifang, Chen Hui, Chen Xuemei, Lyu Meiling, Shen Jiumei, Ji Fengqing
    Abstract ( ) PDF ( )
    Objective To investigate the protective effect of reduced glutathione (GSH) on diclo- fenac-induced acute kidney injury (AKI) in rats and its mechanism. Methods Thirty-three male 8-week-old specified pathogen-free SD rats were randomly divided into control, model, and GSH groups (11 rats in each group) according to a random number table method. Diclofenac sodium solution (200-mg/kg) was intragastrically administered to rats in the model group and GSH group to establish the AKI model. Thirty minutes later, rats in the GSH group were treated with intragastric administration of GSH solution (500-mg/kg), while rats in the control and model groups were with 0.9% sodium chloride injection of equal volume. After 24-hours of administration, blood sample was collected and kidneys were isolated. Kidney function [blood urea nitrogen (BUN), serum creatinine (Scr)], kidney histopathology, and serum and kidney tissue oxidative stress indicators such as malondialdehyde (MDA), superoxide dismutase (SOD), and the inflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin 6 (IL-6) were examined. The results of each examination results among rats of the 3 groups were compared. Results The BUN and Scr in rats of the model group were significantly higher than those in the control and GSH groups[BUN: (14.34±8.47) mmol/L vs. (7.89±2.20) and (8.46±3.58) mmol/L; Scr: (34.44±6.56) μmol/L vs. (24.77±9.50) and (29.28±4.33) μmol/L, all P<0.05]. Glomerular and tubular morphological changes were observed in both model and GSH rats, but the change in rats of GSH group was less severe than that of the model group. The mean levels of MDA, TNF-α, and IL-6 in both serum and kidney tissue in rats of GSH group were significantly lower than those of the model group[MDA: (9.5±0.2) nmol/ml vs. (10.2±0.6) nmol/ml, (3.6±0.3) nmol/ml vs. (4.0±0.2) nmol/ml; TNF-α: (2.9±2.5) pg/ml vs. (5.4±3.0) pg/ml, (420.9±40.3) pg/ml vs. (470.4±31.3) pg/ml; IL-6: (92.1±34.4) pg/ml vs. (123.9±16.6) pg/ml, (7-547±604) pg/ml vs. (8-047±470) pg/ml, all P<0.05], while the activity of SOD was significantly higher than that in the model group[(102.8±2.8) U/ml vs. (99.7±4.1) U/ml, (387.0±12.7) U/ml vs. (375.9±11.7) U/ml, all P<0.05]. Conclusion GSH has a protective effect on diclofenac-induced acute kidney injury in rats, and its possible mechanism is to inhibit oxidative stress and inflammatory reactions.
  • Zhang Chong, Chen Guiju, Pan Jie, Lu Juan, Cheng Yujie
    Abstract ( ) PDF ( )
    Objective To explore the effects of inhaled budesonide (i-BUD) on the growth rate and height of asthmatic children. Methods Databases of PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched (up to April 30, 2022), and randomized controlled trials (RCTs) and high-quality cohort studies on the effects of i-BUD on growth rate and height in asthmatic children were collected. Patients in the observation group were treated with i-BUD, and those in the control group were treated with placebo or no drug. The outcome index was the height and growth rate of the children in short- and long-term treatment with i-BUD. The Cochrane Collaboration risk of bias assessment tool was used for methodological quality assessment of RCT studies, and the Newcastle Ottawa scale (NOS) was used for quality assessment of cohort studies. Stata 11.0-software was used for the meta-analysis, and the effect sizes were expressed as mean difference (MD) with its 95% confidence interval (CI). Results A total of 16-studies were included in the meta-analysis (15 RCTs and 1 cohort study), including 2-578 patients in the observation group and 2-422 in the control group. Risk of bias was low in 9 of the 15 RCTs, high in 2 RCTs, and unclear in 4 RCTs. The NOS score of the only prospective cohort study was 8 (high quality). The short-term effects of i-BUD on the growth rate of the lower limbs in children were examined in 6 studies. The exposure time to i-BUD in children in the observation group ranged from 2 to 8 weeks and the meta-analysis showed that the growth rate of lower limbs of children was significantly slower than that of children in the control group (MD=-0.18-mm/week, 95%CI: -0.24--0.13 mm/week, P<0.01). Subgroup analysis by dose showed that the growth rate of children′s lower limbs was similar in the 2 groups at 200 μg/d of inhaled i-BUD (MD=-0.10-mm/week, 95%CI: -0.25-0.05 mm/week, P=0.209); the growth rate of children′s lower limbs was significantly lower in the observation group at 400-μg/d and 800-μg/d of inhaled i-BUD than that in the control group (MD=-0.17-mm/week, 95%CI: -0.23--0.10 mm/week, P<0.01; MD=-0.34-mm/week, 95%CI: -0.48--0.20 mm/week, P<0.01). The effect of long-term (≥1 year) exposure to i-BUN on children′s height was observed in 10 studies. The meta-analysis showed that the height of children under long-time exposure to i-BUD was significantly lower than that of children in the control group (MD=-0.72-cm, 95%CI: -0.86--0.58 cm, P<0.01). The subgroup analysis according to the i-BUD exposure time showed that the height of children with 1-year, 2-years, and 4-6 years of i-BUD exposure was significantly lower than that in the corresponding control group (MD=-0.60-cm, 95%CI: -0.75--0.44 cm, P<0.01; MD=-1.30-cm, 95%CI: -1.70--0.90 cm, P<0.01; MD=-1.15-cm, 95%CI: -1.67--0.64 cm, P<0.01), but the impact of i-BUD on height of children was not significant when the average exposure time was 9.2 years (MD=-0.60-cm, 95%CI: -2.15-0.95 cm, P=0.448). Conclusion Short-term and long-term application of i-BUN both may affect the growth rate and height of asthmatic children.
  • Wang Xinyu, Yu Hui, Yang Zhiyan, Zhang Yundi, Li Yue, Li Yan
    Abstract ( ) PDF ( )
    Objective To explore the risks of medication errors of insulin degludec(IDeg) in clinical application using failure mode and effect analysis (FMEA). Methods A research group on the risk points of medication errors was established in the First Affiliated Hospital of Shandong First Medical University. The risk points of medication errors were collected through questionnaire survey, literature research, and on-the-spot investigation. The severity, frequency of occurrence, and likelihood of detection were scored to determine the risk priority number (RPN) and formulate corresponding preventive measures. Results After comprehensive evaluation, 32 risk points were found in the 4 links of physician prescription, pharmacist dispensing, nurse administration, and patient medication. The RPN was ranked from high to low, and 10 key risk points (RPN>70 points) were selected. (1)The pharmacist did not give the patients guidance on the use of IDeg; (2)Patients did not know that they should actively report to the physicians about the use feeling and adverse reactions of the drug; (3)Patients did not clear about the content of medication monito- ring; (4)Patients did not master how to use the drug; (5)Pharmacists did not conduct medication feedback survey on patients; (6)Patients did not attach importance or thought it was unnecessary to receive medication guidance from pharmacists; (7)Physician′s prescription was wrong, resulting in overdose; (8)Doctors and patients did not communicate well, and patients did not know what medicine they were using; (9)Pharmacists did not fully understand drug information such as drug properties, prohibited population, interaction, medication time, etc.; (10)Pharmacists ignored the commonly used dose of the drug, applicable population, and other information in the process of reviewing the prescription. According to above-mentioned risk points, the risk intervention suggestions of IDeg were put forward, including the maintenance of basic drug information, the prescription of doctors, the dispensing of pharmacists, the patient medication link, the nurse administration link, the collection of medication error reports, and the strengthening of personnel training. Conclusion The FMEA method can be used to effectively find out the risk points of medication errors in the clinical application of IDeg, the priority of IDeg risk management can be determined through quantitative evaluation, and corresponding preventive measures can be formulated.
  • Wang Yan, Zhao Xinyan, Jia Jidong
    Abstract ( ) PDF ( )
    Immune checkpoint inhibitors (ICIs) play the role of anti-tumor by activating the immune system in human, but they can also cause immune-mediated liver injury, which is different from conventional drug-induced liver injury in the incidence, clinical manifestations, pathogenesis, and prognosis. The main pathogenesis is that ICIs block key nodes of negative regulation of the immune response, including cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death 1 receptor/programmed cell death ligand 1. Liver-injury occurs when the immune system is overactivated and loses immune tolerance to the liver. Immune-mediated liver injury includes immune-mediated hepatitis and immune-mediated cholangitis. Histopathological examination of the liver shows damage in hepatocytes and bile ducts, accompanied by central venous dermatitis mostly and granulomatous lesions partially. After diagnosis of immune-mediated liver injury, treatment should be given based on the severity, and glucocorticoids or immunosuppressants are often necessary.
  • Yang Haipeng, Chen Shuang, Zhao Weiwei, Zhao Liling, Xie Ruohan, Li Junxia
    Abstract ( ) PDF ( )
    A 43-year-old male patient with type 2 diabetes mellitus underwent off-pump coronary artery bypass grafting due to coronary atherosclerotic heart disease. Dapagliflozin was stopped 24-hours before the operation, fasting and discontinuing oral medication started at 8:00-pm 1 day before the operation. On the day of surgery, blood gas analysis and blood glucose were normal before undergoing cardiopulmonary bypass. Tracheal intubation was successfully removed 7 hours after operation. Blood glucose and anion gap were 11.2-mmol/L and 13-mmol/L, respectively on the 2nd day after operation. The treatments of hypogly- cemic, antihypertensive and lipid-regulating drugs and normal diet were restored. On the morning of the 3rd day after operation, the patient developed symptoms such as shallow rapid breathing, poor appetite, excessive urine, and irritability. Blood gas analysis showed pH 7.05, arterial partial pressure of carbon dioxide (PaCO2) 11-mmHg, base excess -24.5-mmol/L, actual bicarbonate 21.7-mmol/L; blood glucose 10.4-mmol/L, potassium 5.3-mmol/L, and routine urine test showed ketone body (+++) in urine. Treatments such as fluid replacement, electrolyte correction, and acid-base balance, and insulin therapy were given. Ten hours later, the blood gas analysis showed pH 7.44, PaCO2-32-mmHg, alkali residual -2.5-mmol/L, actual bicarbonate 21.7-mmol/L, anion gap 12-mmol/L, blood glucose was 6.7-mmol/L, and routine urine test showed ketone body (++) in urine. The patient′s symptoms were gradually improved on the 4th day after the operation and then metformin, acarbose, and insulin injection were given for blood glucose management. It was considered that the patient had ketoacidosis, which might be associated with dapagliflozin. Then the hypoglycemic regimen was adjusted to oral metformin 0.85 g twice daily, acarbose 50-mg twice daily, and glimepiride 2-mg twice daily on the 15th day after operation. After that, the fasting blood glucose in the patient was maintained at 8.2-10.6-mmol/L, the postprandial blood glucose was maintained at 8.2-13.1-mmol/L, and the glycosylated hemoglobin was 7.3%. The patient′s ketoacidosis did not recur.
  • Li Caiyun, Xie Cheng, Zhang Xiaolan
    Abstract ( ) PDF ( )
    A 23-year-old healthy male received subcutaneous injection of recombinant human granulocyte colony-stimulating factor injection (rhG-GSF) 600-μg once daily for 6 days before allogeneic hematopoietic stem cell transplantation as a donor. Before medication, there were no abnormalities in the patient′s coagulation markers, blood routine and biochemical tests, as well as electrocardiographic examination. Seven days after discontinuation of the drug, the patient developed sudden chest pain, sweating, and vomiting. Laboratory tests showed high sensitivity cardiac troponin T 3 144-ng/L, creatine kinase MB>300 μ G/L, myoglobin 505.6-μg/L, N-terminal pro-brain natriuretic peptido 1-138-ng/L, white blood cell count 17.7×109/L, platelet count 160×109/L. The electrocardiogram showed ST segment elevation myocardial infarction. A dual antiplatelet therapy of aspirin and ticagrelor was administered in conjunction with percutaneous transluminal coronary angioplasty. After surgery, anticoagulation, antiplatelet, and lipid-lowering treatments were given. On the 3rd day after surgery, the patient developed toe pain, fever, and a platelet count of 382×109/L, symptoms were gradually relieved after symptomatic treatment, but platelet count increased to 566×109/L. After consultation with hematologists and rheumatologists, combined with relevant laboratory test indicators, autoimmune and hematological system-related diseases were excluded. It was considered that coronary artery thrombosis and thrombocytosis may be related to the use of rhG-CSF, and platelet count gradually decreased to 275×109/L without special treatment. During the follow-up of 7 months, his platelet count was 235×109/L .
  • Yang Wenjuan, Sun Zhe, Yang Canyu, Liu Fang
    Abstract ( ) PDF ( )
    An 85-year-old male patient received left thyroxine sodium (LT4) 50 μg orally once daily for replacement therapy because of ischemic stroke and hypothyroidism. Next day, laboratory test showed that blood potassium was 3.0 mmol/L. He was given potassium chloride sustained-release tablets 1 g orally thrice daily. Six days later, the patient complained of a rapid heartbeat after slight activity. Laboratory tests showed that blood potassium was 3.3 mmol/L and a potassium magnesium aspartate tablet was administered orally thrice daily. After 8 days of potassium supplementation treatments, the patient's blood potassium level was 3.5 mmol/L, while the blood pressure increased to 163/90 mmHg. Losartan potassium 50 mg once daily was given orally.  Clinical pharmacist consulted and learned that the patient continued to take his own LT4 75 μg once daily while following the doctor's instructions to take LT4 50 μg once daily. The patient was instructed to immediately stop taking his own medication and the LT4 dose was adjusted to 75 μg once daily. Thirteen days later, the patient's serum potassium returned to 4.0 mmol/L and no further discomfort occurred.
  • Wang Quan, Tang Huaying, Wang Bing, Li Jinfeng
    Abstract ( ) PDF ( )
    A 62-year-old male patient with esophageal squamous cell carcinoma received immunotherapy combined with chemotherapy regimen (intravenous infusions of tislelizumab 200-mg on day 1, paclitaxel liposome 240-mg and nedaplatin 120-mg on day 2, 21 days as a cycle) for a total of 4 cycles. The patient′s condition was partially relieved. Then the treatment was changed to intravenous infusion of tislelizumab 200-mg on day 1 and tegafur, gimeracil and oteracil potassium 40-mg in the morning and 60-mg in the evening by mouth from the first day to the 14th day, 21 days as a cycle. Only one cycle was given. After the last treatment (the 98th day of immunotherapy combined with chemotherapy), the patient developed acute muscle weakness, sensory impairment, and decreased tendon reflexes. Nerve conduction and electromyography showed peripheral nerve damage in the limbs. Peripheral neuropathy caused by tislelizumab was considered. The patient received the treatments of methylprednisolone sodium succinate, mecobalamin, and vitamin B1. Nine days later, his symptom of myasthenic was improved, and pain and warm sensation was recovered gradually. Since then, the patient had not been treated with immunotherapy.