Lumbar MR-based radiomics nomogram for detecting minimal residual disease in patients with multiple myeloma.

OBJECTIVES: Minimal residual disease (MRD) is a standard for assessing treatment response in multiple myeloma (MM). MRD negativity is considered to be the most powerful predictor of long-term good outcomes. This study aimed to develop and validate a radiomics nomogram based on magnetic resonance imaging (MRI) of the lumbar spine to detect MRD after MM treatment. METHODS: A total of 130 MM patients (55 MRD negative and 75 MRD positive) who had undergone MRD testing through next-generation flow cytometry were divided into a training set (n = 90) and a test set (n = 40). Radiomics features were extracted from lumbar spinal MRI (T1-weighted images and fat-suppressed T2-weighted images) by means of the minimum redundancy maximum relevance method and the least absolute shrinkage and selection operator algorithm. A radiomics signature model was constructed. A clinical model was established using demographic features. A radiomics nomogram incorporating the radiomics signature and independent clinical factor was developed using multivariate logistic regression analysis. RESULTS: Sixteen features were used to establish the radiomics signature. The radiomics nomogram included the radiomics signature and the independent clinical factor (free light chain ratio) and showed good performance in detecting the MRD status (area under the curve: 0.980 in the training set and 0.903 in the test set). CONCLUSIONS: The lumbar MRI-based radiomics nomogram showed good performance in detecting MRD status in MM patients after treatment, and it is helpful for clinical decision-making. KEY POINTS: • The presence or absence of minimal residual disease status has a strong predictive significance for the prognosis of patients with multiple myeloma. • A radiomics nomogram based on lumbar MRI is a potential and reliable tool for evaluating minimal residual disease status in MM.

Near-Infrared Light-Triggered Switchable Nanoparticles for Targeted Chemo/Photothermal Cancer Therapy.

Accumulation of nanoparticles in solid tumors depends on their extravasation, but their efficacy is often compromised by intrinsic physiological heterogeneity in tumors. The conventional solutions to circumvent this problem are size control of nanoparticles or increasing the vascular permeability. The aim of this study is to investigate the combination effect of size variation of stimuli-responsive nanoparticles and improved vascular permeability triggered by near-infrared (NIR) light irradiation. Doxorubicin (DOX), a clinically proven drug for bladder cancer, was encapsulated in the nanocomposites with high loading content up to 45%. We show that NIR light-responsive size-switchable nanocarriers could considerably enhance the tumor-targeting of DOX in bladder tumor-bearing mice. Moreover, a combination of NIR-induced hyperthermia and DOX-mediated chemotherapy resulted in remarkable inhibition of tumor growth in mice. Histological results suggest that the change in morphology of tumor microvasculature may account for enhanced extravasation and accumulation of the nanodrugs upon NIR irradiation. Together, these data suggest that external stimuli-responsive drug delivery system offers a safe and effective means of targeted chemo/photothermal therapy.

Association of polymorphisms in WWOX gene with risk and outcome of osteosarcoma in a sample of the young Chinese population.

The WW domain-containing oxidoreductase (WWOX) gene is a tumor suppressor gene, the abnormal expression of which will lead to osteosarcoma tumorigenesis. Polymorphisms of the WWOX gene are associated with the risk of several malignancies. We hypothesized that genetic variations in the WWOX gene were related to osteosarcoma risk and outcome. In this case-control study, we recruited 276 young osteosarcoma patients and 286 controls from the East Chinese population and genotyped seven tag single-nucleotide polymorphisms (SNPs) of the WWOX gene (rs10220974C>T, rs12918952G>A, rs3764340C>G, rs1074963C>G, rs383362G>T, rs1424110A>G, and rs12828A>G). We discovered that two SNPs (rs3764340C>G and rs383362G>T) were associated with osteosarcoma risk. The CG genotype and dominant model of rs3764340 indicated elevated risk of osteosarcoma, and similar results were found for rs383362. Furthermore, rs3754340C>G was also related to grade and metastasis risk of osteosarcoma. Taken together, our results provide the first evidence that WWOX gene polymorphisms have the potential to be predictive factors for assessing risk and outcome of osteosarcoma.

Evaluation of hGM-CSF/hTNFα surface-modified prostate cancer therapeutic vaccine in the huPBL-SCID chimeric mouse model.

To validate its efficacy in the context of the human immune system, a novel therapeutic vaccine of hGM-CSF/hTNFα surface-modified PC-3 cells against human prostate cancer was evaluated in the human peripheral blood lymphocytes-severe combined immunodeficiency (huPBL-SCID) chimeric mouse model. The hGM-CSF or/and hTNFα modified vaccines inhibited prostate cancer growth effectively so as to prolong the mouse survival significantly. The splenocytes from the hGM-CSF/hTNFα vaccine-inoculated mice showed the strongest tumor-specific cytotoxicity against PC-3 cells and the highest production of IFNɤ. These features indicated that type 1 protective immune response was induced efficiently against human prostate cancer and further enhanced through synergetic adjuvant effects of hGM-CSF and hTNFα.

[Interlocking intramedullary nailling and micro-invasive internal fixation with plate for multiple segmental tibiofibular fractures: a case-control study].

OBJECTIVE: To compare the clinical effects of interlocking intramedullary nail and micro-invasive internal fixation with plate for the treatment of multiple segmental tibiofibular fractures. METHODS: The clinical data of 39 patients with multiple segmental tibiofibular fractures received treatment from January 2010 to June 2013 were retrospectively analyzed. In the 39 patients, 18 cases were treated by the interlocking intramedullary nail (intramedullary nail group), there were 12 males and 6 females with the mean age of (40.6 ± 9.7) years old (ranged, 24 to 60 years);7 cases were type C2.1, 11 were type C2.2 according to the AO classification. The other 21 cases were treated by micro-invasive internal fixation with plate(plate group), there were 13 males and 8 females with the mean age of (41.7 ± 8.1) years old (ranged, 22 to 52 years), 7 cases were type C2.1, 13 were type C2.2, 1 was type C2.3. Preoperative preparation time, operation time, intraoperative blood loss, postoperative complications, fracture healing time were compared between two groups. Johner-Wruhs evaluation criteria was used to evaluate the clinical effect at last follow-up. RESULTS: All the patients were followed up from 10 to 28 months with an average of 15.2 months. Operative time, intraoperative blood loss in intramedullary nail group were (62.1 ± 5.8) min, (70.9 ± 7.1) ml, respectively; in plate group were (64.3 ± 7.7) min, (74.1 ± 8.5) ml,respectively. There was no significant difference in operation time and intraoperative blood loss between two groups (P > 0.05). However, preoperative preparation time, fracture healing time in intramedullary nail group were (5.3 ± 0.7) days, (11.1 ± 1.9) months, in plate group were (7.1 ± 0.8) days, (14.1 ± 2.2) months, respectively. No postoperative complications were found in intramedullary nail group, and five cases developed with complications in plate group. There was significant difference in preoperative preparation time, postoperative complications and fracture healing time between two groups (P < 0.05). According to Johner-Wruhs criteria at last follow-up, 11 cases got excellent results, 4 good, 3 fair in intramedullary nail group; 11 excellent, 5 good, 2 poor in plate group. CONCLUSION: Interlocking intramedullary nail has advantages of shorter preoperative preparation time, less postoperative complications and faster fracture healing time in treating multiple segmental tibiofibular fractures. But the application scope of interlocking intramedullary nail was inferior to micro-invasive internal fixation with plate , and its indications should be strictly controlled.

[Case-control study on double screws system and compressed three canulated screws in treating femoral neck fractures].

OBJECTIVE: To compare the clinical effects of double screws system and compressed three canulated screws in treating femoral neck fractures. METHODS: From January 2007 to June 2009, the clinical data of 67 patients with femoral neck fractures underwent operation were retrospectively analyzed. There were 38 males and 29 females,aged from 31 to 71 years with an average of 50.6 years, left was in 41 cases and right was in 26 cases. The patients were divided into two groups (group A and B) based on the different fixation method. Of them, 30 cases (group A,19 males and 11 females) were treated with double screws system and 37 cases (group B, 19 males and 18 females) with compressed three canulated screws. In group A, Pauwells angle was more than or equal 50 degrees in 16 cases and Pauwells angle less 50 degrees in 14 cases; in group B, Pauwells angle was more than or equal 50 degrees in 22 cases and Pauwells angle less 50 degrees in 15 cases. Duration of hospitalization, operative time, intraoperative blood loss, postoperative time in bed, infection of incision, postoperative complication, quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis, incidence of failure fixation, joint function (Harris score) were compared between two groups. RESULTS: All patients were followed up from 30 to 59 months with an average of 42 months. There was no significant differences in aspect of duration of hospitalization, infection of incision, intraoperative blood loss, walking time, postoperative complications between two groups(P>0.05). Operative time of group A [(31.1 +/- 9.7) min]was less than that of group B [(40.4 +/- 12.7) min] (P<0.05). There was no significant differences in quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis between two groups (P>0.05). In the patients with Pauwells angle more than or equal 50 degrees in group A, there was no retreated screws, broken screws, screw cut-off from the femoral head;a head;and in group B, retreated screws occurred in 2 cases, screw cut-off from the femoral head occurred in 2 cases, screws not completely getting in femoral head occurred in 2 cases; there was significant differences between two groups (P<0.05). The patients with Pauwells angle less 50 degrees in group A, screw loosening occurred in one case; and in group B, screw retreating occurred in one cases; there was no significant differences between two groups (P>0.05). All patients who suffered from screw loosening, retreating or cut-off from the femoral head were more than 65 years old. There was no significant differences in the joint function between two groups at 6 and 30 months after operations (P>0.05). CONCLUSION: Double screws system has advantages of minimal invasion, easy operation, reliable fixation in treatment of femoral neck fractures. Compared with the traditional compressed three canulated screws,double screws system has less fixation failure rate and higher hip function scoring. It has a good clinical effect especially for the patients with Pauwells angle more than or equal 50 degrees.

[Medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns].

OBJECTIVE: To study surgical outcomes of medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns. METHODS: From March 2010 to March 2012,20 patients with tibial plateau fractures involving three columns were treated with internal fixation by using T-shape, L-shape plate, or distal radius T-plate through medial plus anterolateral approaches. Among the patients, 13 patietns were male and 7 patients were female,ranging in age from 29 to 52 years old with an average of 39.4 years old. The intervals between injury and operation ranged from 8 to 12 days, with a mean of 9 days. At the latest follow-up,the American Hospital for Special Surgery score (HSS) was used to evaluate clinical effect,and the average loateau angle,posterior slope angle and femorotibial angle of tibia were measured on the X-ray films. RESULTS: The average operation time was 2.11 hours; average intraoperative blood loss was 452 ml and average hospital stay was 22.3 days. All the patients were followed up,and the duration ranged from 12 to 20 months,averaged 14.6 months. The fracture healing time ranged from 3 to 8 months, with a mean of 6.1 months. The average loateau angle, posterior slope angle and femorotibial angle of tibia at 3 days after operation were (86.1 +/- 2.7) degrees, (10.7 +/- 1.6) degrees and (168.0 +/- 4.7) degrees respectively; and (84.1 +/- 3.2) degrees, (13.7 +/- 1.9) degrees, (170.0 +/- 5.8) degrees respectively at 1 year after operation (P > 0.05). According to HSS, 11 patietns got an excellent result, 6 good, 2 poor and 1 bad. There were no postoperaive neural and vascular injuries, no plate lossening or broken. One patient had local infection. One patient had skin flap partial necrosis and was cured by conservative treatment. Four patients had postoperative numbness below the inside leg. CONCLUSION: Medial plus anterolateral approaches for the treatment of fractures involving three columns are effective to get good anatomic reduction and stable fixation without changing body position, which is helpful to early functional rehabilition of knee joint.