[Clinical Analysis of Mitoxantrone Liposome in the Treatment of Children with High-Risk Acute Myeloid Leukemia].

OBJECTIVE: To investigate the safety and efficacy of mitoxantrone liposome in the treatment of children with high-risk acute myeloid leukemia (AML). METHODS: The children with high-risk AML who received the mitoxantrone liposome regimen at Wuhan Children's Hospital from January 2022 to February 2023 were collected as the observation group, and the children with high-risk AML who received idarubicin regimen were enrolled as controls, and their clinical data were analyzed. Time to bone marrow recovery, the complete remission rate of bone marrow cytology, the clearance rate of minimal residual disease, and treatment-related adverse reactions were compared between the two groups. RESULTS: The patients treated with mitoxantrone liposome showed shorter time to recovery of leukocytes(17 vs 21 day), granulocytes(18 vs 24 day), platelets(17 vs 24 day), and hemoglobin(20 vs 26 day) compared with those treated with idarubicin, there were statistical differences (P <0.05). The effective rate and MRD turning negative rate in the observation group were 90.9% and 72.7%, respectively, while those in the control group were 94.1% and 76.4%, with no statistical difference (P >0.05). The overall response rate of the two groups of patients was similar. CONCLUSION: The efficacy of mitoxantrone liposome is not inferior to that of idarubicin in children with high-risk AML, but mitoxantrone liposome allows a significantly shorter duration of bone marrow suppression and the safety is better.

Effectiveness of lenvatinib plus immune checkpoint inhibitors in primary advanced hepatocellular carcinoma beyond oligometastasis.

BACKGROUND: Targeted therapy combined with immune checkpoint inhibitors is considered a promising treatment for primary advanced hepatocellular carcinoma (HCC). Nevertheless, the difference between synchronous and asynchronous treatment of lenvatinib with programmed death receptor-1 (PD-1) inhibitor in advanced HCC is still unclear. The aim of this investigation is to evaluate the effectiveness of synchronous and asynchronous of lenvatinib and PD-1 inhibitor on the advanced HCC beyond oligometastasis. METHODS: In this study, 213 patients from four institutions in China were involved. Patients were split into two collections: (1) lenvatinib plus PD-1 inhibitor were used synchronously (synchronous treatment group); (2) patients in asynchronous treatment group received PD-1 inhibitor after 3 months of lenvatinib treatment prior to tumour progression. To analyse progression-free survival (PFS), overall survival (OS), efficacy and safety of patients in both groups, we employed propensity score matching (PSM). RESULTS: The 6-, 12- and 24-month OS rates were 100%, 93.4% and 58.1% in the synchronous treatment group and 100%, 71.5% and 25.3% in the asynchronous treatment group, respectively. In contrast to the asynchronous treatment group, the group treated synchronously exhibited a substantially enhanced OS (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.30-0.66; p < .001). The 6-, 12- and 18-month PFS rates were 82.6%, 42.6% and 10.8% in the synchronous treatment group and 63.3%, 14.2% and 0% in the asynchronous treatment group, respectively. A significant difference was observed in the PFS rate (HR, 0.46; 95% CI, 0.33-0.63; p < .001) between the two collections. CONCLUSIONS: Patients with advanced HCC beyond oligometastasis, simultaneous administration of lenvatinib and PD-1 inhibitor led to significant improvements in survival.

Early myocardial changes in patients undergoing rheumatic mitral valve repair versus replacement.

BACKGROUND: Rheumatic mitral valve repair and replacement techniques are frequently used with excellent outcomes in experienced centers. This study aims to evaluate the impact of procedural types on left ventricular function in quinquagenarians. METHODS: Between January 2018 and September 2019, patients with severe rheumatic mitral stenosis were prospectively recruited. Propensity score matching was performed to reduce the selection bias. We compared the strain, twist and synchrony parameters of left ventricle in 70 quinquagenarian patients who underwent rheumatic mitral valve repair and replacement 12 hours before surgery, at 7 days and 6 months postoperatively. RESULTS: The overall group displayed significant improvement of left ventricular deformation after rheumatic mitral valve surgery. Compared with patients undergoing posterior chordal-sparing mitral valve replacement, patients undergoing rheumatic mitral valve repair showed more significant amelioration in global longitudinal strain (-18.6% versus -16.2%, P<0.001), twist (18.2° versus 15.9°, P<0.001), torsion (1.8°/cm versus 1.3°/cm, P<0.001), apical rotation (10.5° versus 8.8°, P<0.001), basal rotation (-7.7° versus -7.1°, P=0.049), systolic dyssynchrony index (4.7% versus 5.1%, P=0.021), standard deviation of time to peak longitudinal (46.9 ms versus 49.3 ms, P=0.024) and radial strain (15.8 ms versus 17.1 ms, P=0.037) at 6-month follow-up. CONCLUSIONS: Rheumatic mitral valve repair might provide patients with better postoperative left ventricular performance than posterior chordal-sparing mitral valve replacement. Longer follow-up is required to compare long-term outcomes.

Clinical Analysis of 161 Cases of Surgical Treatment of Infective Endocarditis.

Objective: To evaluate the diagnostic criteria, surgical indications, and prognostic factors in the surgical treatment of infective endocarditis (IE). Methods: A total of 161 cases of post-operative IE treated at our hospital from January 2007 to December 2016 were included. The IE was diagnosed by the modified Duke criteria. Echocardiography and standard blood cultures were performed. These cases were divided into severe and non-severe adverse event groups. The association between prognostic factors and severe versus non-severe outcomes was examined using logistic regression. Results: Thirty patients (20.1%) with post-operative IE had positive pre-operative blood cultures, and 130 patients (80.7%) had valve vegetations. Four patients (2.5%) died within 30 days post-operatively. Twenty-two patients experienced severe adverse events. There were significant differences between the two groups regarding their serum albumin and creatinine concentrations, ejection fraction, and hospitalization, cardiopulmonary bypass, aortic cross-clamp, intensive care unit (ICU), and ventilation times (all p < 0.05). The bypass time, aortic cross-clamp time, and ICU time were identified as prognostic factors for severe adverse events. Conclusion: Echocardiography is an important diagnostic method for IE, and repeated tests might improve the sensitivity of diagnosis. Cardiac surgery seems to be an effective treatment for IE. Patient screening and reducing the operative time may improve the prognosis for patients who undergo surgical treatment for IE.

A predictor for mitral valve repair in patient with rheumatic heart disease: the bending angle of anterior mitral leaflet.

BACKGROUND: Mobility and flexibility of anterior mitral leaflet (AML) are considered to be the important factor for mitral valve (MV) repair in rheumatic population, we try to use the bending angle of AML to quantify its' mobility and flexibility and investigate whether it can predict the success of rheumatic MV repair or not. METHODS: Total 54 patients underwent rheumatic MV surgeries with mild lesions of subvalvular apparatus from August, 2017 to November, 2017 at the author institution, we divided the patients into MV repair and MV replacement groups which included directly MV replacement and repair attempt but failed repairing transfer to replacement intraoperatively. Patients' MV structure was carefully evaluated on transthoracic echocardiography (TTE) and scored by the Wilkins score (WS) preoperatively. The bending angle of AML was measured during systole and diastole at different level before surgery. RESULTS: The differences of patients' demographic characteristics between repair group and replacement group were not statistically significant (P value >0.05) and the differences among B-angle, T-angle, Bs-angle, C-angle of AML between repair group and replacement groups were not statistically significant (P value >0.05). Only BT-angle in repair group was significantly larger than that of replacement group (21.56°±3.84°, 10.29°±6.02°, respectively, P<0.001), therefore the BT-angle was tested as a predictor of reparability by observing the receiver operating characteristic (ROC) curve (ROC area: 0.944, standard error: 0.06, 95% CI: 0.826-1), BT-angle of AML on preoperative transthoracic echo of 15.5° or more predicts feasibility of rheumatic MV repair with 100% sensitivity and 85.7% specificity in patients with mild lesions of subvalvular apparatus. Logistic regression for a single area of calcification (diameter <0.8 cm) at commissure were shown that: ß: 0.08, Exp (ß): 1.083, P: 0.777>0.05, the minor single calcified area at commissure had no effect on reparability of rheumatic MV disease. The differences of total WS and each component score between repair group and replacement group were not statistically significant (P value >0.05). By observing the ROC curve for total WS (ROC area: 0.508), the WS cannot be a predictor for the rheumatic MV repair. CONCLUSIONS: The bending angle of AML which was considered as quantification of mobility and flexibility of AML can be a predictor for MV repair in patients with rheumatic heart disease (RHD). The small single area of commissural calcification had no effect on reparability of rheumatic MV disease. WS cannot appropriately predict the outcome of rheumatic MV repair.

Does injection of metanephric mesenchymal cells improve renal function in rats?

Chronic kidney disease (CKD) is a massive global health-care problem. Cell therapy offers a potential treatment for CKD. The aim of this study was to investigate whether the administration of a population of stem cells could be used to treat adriamycin (ADR)-induced glomerulopathy in rats, a form of CKD. We intravenously transplanted metanephric mesenchymal cells (MMCs) into rats treated with ADR. We also induced MMC differentiation in vitro using a medium derived from serum and homogenates of ADR-induced glomerulopathy rats. We detected the induction of an early epithelial phenotype (cytokeratin-18 expression) and a proximal tubule phenotype (vitamin D receptor expression) in vitro, and MMC-derived epithelial cells corresponding to the proximal tubule and glomeruli in vivo. Transplantation of MMCs after induction of glomerulopathy significantly increased the creatinine clearance rate (Ccr), a marker for glomerular filtration rate, but had no significant effect on other parameters (24-hour urinary protein excretion, serum albumin, total cholesterol). In addition, there was no significant difference in blood urea nitrogen or serum creatinine levels in rats with and without ADR administration. Our results indicate that MMCs might survive, engraft and differentiate into renal epithelia in vivo when transplanted into ADR-treated rats. However, further studies are needed to determine whether MMC transplantation improves renal function and causes renal repair in this model.