Analysis of the efficacy and prognosis of radiotherapy in acute leukemia with extramedullary infiltration / 重庆医学

Objective To investigate the clinical characteristics,treatment methods,and prognosis of a-cute leukemia patients with extramedullary infiltration.Methods The clinical characteristics and treatment methods of 47 acute leukemia patients with extramedullary infiltration admitted to the Affiliated Hospital of Guizhou Medical University from April 2014 to April 2023 were retrospectively analyzed.Subgroup analysis was performed according to whether there was extramedullary infiltration before transplantation,and whether there was isolated extramedullary recurrence after transplantation.Based on this analysis,the patients were di-vided into the pre-transplantation radiotherapy group and pre-transplantation non-radiotherapy group,the post-transplantation radiotherapy group and post-transplantation non-radiotherapy group.According to the treatment methods of central nervous system leukemia(CNSL),the patients were divided into the intrathecal injection group(n=12)and combination of intrathecal injection and radiotherapy group(n=13).The local remission situation,survival duration,and toxic and side effects of radiotherapy and chemotherapy were com-pared.Results For acute leukemia patients with extramedullary infiltration,the overall survival time(OS)in the radiotherapy group was better than that in the non-radiotherapy group(median OS:706 d vs.151 d,P=0.015).Subgroup analysis showed that the OS of the pre-transplantation radiotherapy group was better than that of the pre-transplantation non-radiotherapy group(median OS:592 d vs.386 d,P=0.035).For CNSL,the combination of intrathecal injection and radiotherapy group had a better OS than the intrathecal injection group(median OS:547 d vs.388 d,P=0.045).The event-free survival time(EFS)of the radiotherapy group was better than that of the non-radiotherapy group(median EFS:175 d vs.50 d,P=0.005).The COX pro-portional-hazards model showed that treatment with or without radiotherapy had a significant impact on the OS of acute leukemia patients with extramedullary infiltration.The risk of death in the pre-transplantation non-radiotherapy group was 2.231 times higher than that in the pre-transplantation radiotherapy group(HR=3.231,95％CI:1.021-10.227,P=0.046).Compared with the non-radiotherapy group,the radiother-apy group had a higher local remission and a lower risk of haematological toxicity,infection,and haemorrhage.Conclusion Radiotherapy can rapidly alleviate the local symptoms of acute leukemia complicated with extr-amedullary infiltration,prolong the survival time of these patients,and reduce the risk of hematologic toxicity,infection,and haemorrhage.

Efficacy of intravenous thrombolysis combined with Solitaire FR stent thrombectomy in treatment of acute LAO cerebral infarction / 中华老年心脑血管病杂志

Objective To explore the effects of intravenous thrombolysis combined with Solitaire FR stent thrombectomy on vascular recanalization,neurologic function and prognosis in patients with acute cerebral infarction(ACI)due to large artery occlusion(LAO).Methods A total of 172 patients with ACI-LAO treated in our department between October 2020 and March 2023 were retrospectively enrolled.According to treatment regimens,they were assigned into control group(86 cases,alteplase intravenous thrombolysis)and study group(86 cases,alteplase intravenous thrombolysis combined with Solitaire FR stent thrombectomy).Vascular recanalization,neurolog-ic function,cerebral perfusion and occurrence of adverse events were compared between the two groups.After 90 d of follow-up,their prognosis was evaluated with modified Rankin scale.Results There was no significant difference in success rate of vascular recanalization between the two group(P＞0.05),but complete recanalization rate was statistically higher in the study group than the control group(68.60％vs 50.00％,P＜0.05).The study group had obviously lower NHISS scores at 7 and 14 d after treatment,higher cerebral blood volume and cerebral blood flow,but shorter mean transit time when compared with the control group(P＜0.05,P＜0.01).No notable difference was observed in the total incidence of adverse events between them(P＞0.05).After 90 d of follow-up,the proportion of good prognosis was higher in the study group than the control group(80.23％vs 63.95％,P＜0.05).Conclusion Intravenous thrombolysis combined with Soli-taire FR stent thrombectomy shows better efficacy in ACI-LAO patients,with better vascular re-canalization and great improvements in neurologic function and prognosis.

Clinical Study of Zoledronic Acid Combined with Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture / 中国药房

OBJECTIVE:To explore the clinical effect and safety of Zoledronic acid injection combined with percutaneous ver-tebroplasty for osteoporotic vertebral compression fracture(OVCF). METHODS:A total of 130 OVCF patients selected from our hospital during Jan. 2014-Dec. 2015 were divided into observation group and control group according to random number table,with 65 cases in each group. Control group was given bone cement by percutaneous vertebroplasty. Observation group was additionally given Zoledronic acid injection 5 mg,ivgtt,once a year(dripping time ≥15 min),on the basis of control group. Both groups were given calcium and vitamin D orally after surgery. VAS scores,Oswestry disability index(ODI)and ADL scores were ob-served in 2 groups 1 week and 6 months after treatment. Bone density of lumbar vertebra L1-L4 and femoral neck were detected in 2 groups after one year of treatment. RESULTS:Before treatment,there was no statistical significance in VAS scores,ODI or ADL scores,bone density of lumbar vertebra LI-L4 and femoral neck between 2 groups(P>0.05). VAS scores and ODI of 2 groups were decreased significantly,while ADL scores were increased significantly 1 week and 6 months after treatment;obser-vation group were significantly better than control group,with statistical significance(P<0.05). One year after treatment,bone density of lumbar vertebra L1-L4 and femoral neck in observation group were significantly higher than control group,with statis-tical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups as fever,dizziness, bone and joint pain,muscle soft tissue pain and new fracture(P>0.05). CONCLUSIONS:Zoledronic acid combined with per-cutaneous vertebroplasty in the treatment of OVCF can significantly relieve pain,improve dysfunction and enhance bone density with good safety.

Clinical Study of Zoledronic Acid Combined with Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture / 中国药房

OBJECTIVE:To explore the clinical effect and safety of Zoledronic acid injection combined with percutaneous ver-tebroplasty for osteoporotic vertebral compression fracture(OVCF). METHODS:A total of 130 OVCF patients selected from our hospital during Jan. 2014-Dec. 2015 were divided into observation group and control group according to random number table,with 65 cases in each group. Control group was given bone cement by percutaneous vertebroplasty. Observation group was additionally given Zoledronic acid injection 5 mg,ivgtt,once a year(dripping time ≥15 min),on the basis of control group. Both groups were given calcium and vitamin D orally after surgery. VAS scores,Oswestry disability index(ODI)and ADL scores were ob-served in 2 groups 1 week and 6 months after treatment. Bone density of lumbar vertebra L1-L4 and femoral neck were detected in 2 groups after one year of treatment. RESULTS:Before treatment,there was no statistical significance in VAS scores,ODI or ADL scores,bone density of lumbar vertebra LI-L4 and femoral neck between 2 groups(P>0.05). VAS scores and ODI of 2 groups were decreased significantly,while ADL scores were increased significantly 1 week and 6 months after treatment;obser-vation group were significantly better than control group,with statistical significance(P<0.05). One year after treatment,bone density of lumbar vertebra L1-L4 and femoral neck in observation group were significantly higher than control group,with statis-tical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups as fever,dizziness, bone and joint pain,muscle soft tissue pain and new fracture(P>0.05). CONCLUSIONS:Zoledronic acid combined with per-cutaneous vertebroplasty in the treatment of OVCF can significantly relieve pain,improve dysfunction and enhance bone density with good safety.

The clinical features and prognosis of EBER negative extranodal natural killer/T-cell lymphoma / 中国癌症杂志

Background and purpose:Extranodal natural killer/T-cell lymphoma (ENKTL) is a form of non-Hodgkin’s lymphoma. The ENKTL incidence in China is much higher than that in the Western countries. The disease is highly malignant, not sensitive to chemotherapy, has short survival period and poor prognosis. Epstein-Barr virus (EBV) infection has close relationship with the development of the disease. However, there are still a few patients without EBV infection. This study aimed to discuss the clinical features and prognosis of EBV-encoded small RNA (EBER) in situ hybridization negative ENKTL.Methods:From Aug. 2011 to Oct. 2015, 326 cases were diagnosed with ENKTL from the First Affliated Hospital of Zhengzhou University. The expression of EBER was detected by in situ hy-bridization technique. The clinical pathological characteristics and prognosis of EBER-negative patients were analyzed. Results:In 326 patients with ENKTL, the negative rate of EBER was 2.45% (8/326). In 8 EBER-negative patients, the median survival time was 17 months. The log-rank test revealed that there was a signiifcant difference between EBER-negative and EBER-positive curves (χ2=6.407,P=0.011). Multivariate Cox proportional hazards regression analysis showed that in EBER-negative ENKTL, only lactate dehydrogenase (LDH) predicted survival time (P=0.008). EBV-DNA copy number in plasma was not signiifcantly correlated with survival time (P>0.05).Conclusion:The inci-dence of EBER-negative ENKTL is low. Patients with EBER-negative ENKTL have poorer prognosis than EBER-posi-tive patients. Elevated LDH may be a factor indicating poor prognosis.

Prognostic Value of Infarct size Measured by Gated sPECT scintigraphy / Valor pronóstico del tamaño del infarto de miocardio cuantificado mediante SPECT gatillada

Background: Despite the improved sensitivity and specificity of SPECT myocardial perfusion imagingto detect myocardial involve-ment after acute myocardial infarction (AMI), there is little information about the usefulness of early infarct size (IS) measurement by this method for risk stratification and prognosis. Objectives: The goal of this study was to evaluate the usefulness of quantifying IS by gated SPECT scintigraphy to predict cardio­vascular events in patients with a first AMI. Methods: Patients with a first ST-segment elevation AMI were included from 2009 to 2014. Infarct size was estimated using the Cedars QPS software. The incidence of events (heart failure, ventricular arrhythmias, mortality and a composite of the three events) was evaluated at one year. Results: One-hundred and forty nine patients were included in the study; mean age was 59±11 years and 81.9% were men. Diabetes was present in 16.1% of cases, 9.4% had a history of myocardial revascularization, 84.6% were admitted in Killip and Kimball class A, 43% of AMIs were located in the anterior wall and 69.8% of the patients underwent reperfusion. Left ventricular ejection fraction estimated by gated SPECT scintigraphy was 51%±14%. Follow-up was completed in 95.9% of cases. An IS cutoff point of 22% (ROC curve) was established to predict the composite endpoint at follow-up (sensitivity 92%, specificity 81%, AUC: 0.94%), dividing the sample into two groups: Group I (IS <22%) and Group II (IS ≥22%). The prevalence of the composite endpoint was greater in Group II (2.1% Group I vs. 50% Group II; p<0.001). Infarct size ≥ 22% was the only variable identified as predictor of events during follow-up (OR 1.978; 95% CI 1.887-1.996; p<0.001). Conclusion: Early quantification of IS by gated SPECT scintigraphy is an independent risk predictor at one year that allows risk stratification in patients with a first AMI.

Introducción: Si bien la SPECT de perfusión miocárdica ha mejorado la sensibilidad y la especificidad en la detección del compromiso miocárdico luego de un infarto agudo de miocardio (IAM), aún es escasa la información sobre la determinación precoz del tamaño del infarto (TI) con este método para la estratificación del riesgo y su valor pronóstico. Objetivos: Evaluar la utilidad de la cuantificación del TI estimado por SPECT gatillada en la predicción de complicaciones cardio­vasculares en pacientes con un primer IAM. Material y métodos: Se analizaron los pacientes con IAM con elevación del ST desde 2009 a 2014, excluyéndose aquellos con IAM previo. El cálculo del TI se realizó con el softwareCedars QPS. Se evaluaron eventos al año: insuficiencia cardíaca, arritmias ventri-culares, muerte y la combinación de los tres eventos. Resultados: Se incluyeron 149 pacientes, con edad media de 59±11 años,el 81,9% de sexo masculino. El 16,1% eran diabéticos y el 9,4% presentaban revascularización previa. El 84,6% ingresaron en Killip y Kimball A, el 43% de los IAM fueron de territorio anterior y el 69,8% de los pacientes fueron reperfundidos. La fracción de eyección del ventrículo izquierdo por SPECT gatillada fue del 51% ±14%. Se realizó seguimiento clínico en el 95,9% de los casos. El punto de corte del TI (curva ROC) para predecir eventos combinados al seguimiento se estableció en 22% (sensibilidad: 92%, especificidad: 81%, ABC: 0,94),con el cual la muestra se dividió en dos grupos: Grupo I (TI<22%) y Grupo II (TI≥22%). La prevalencia de eventos combinados fue mayor en el Grupo II (2,1% Grupo Ivs. 50% Grupo II; p<0,001). El TI ≥22% se identificó como la única variable predictora de eventos al seguimiento (OR 1,978; IC 95% 1,887-1,996; p<0,001). Conclusión: La cuantificación precoz del TI mediante SPECT es un predictor independiente de riesgo al año que permite establecer una estratificación del riesgo en pacientes con un primer IAM.

nm23-H1 Protein Expression and Gene Mutation in 150 Patients with Non-Hodgkin's Lymphomas

The metastasis-suppressing role of the nm23 gene in the metastatic spread of malignant tumor is still debated. We examined the nm23-H1 protein expression and gene mutation in non-Hodgkin's lymphomas to compare with the clinicopathologic parameters. The expression of nm23-H1 protein was immunohistochemically examined in 150 cases of non-Hodgkin's lymphomas; 85 diffuse large B cell lymphomas (DL-BCL), 18 marginal zone B cell lymphomas (MZL), 3 mantle cell lymphomas, 25 peripheral T cell lymphomas, not otherwise specified (TCLNOS), and 19 NK/T cell lymphomas (NK/T). Eighty-one cases (58 DLBCL, 6 MZL, 4 TCLNOS, and 13 NK/T) were studied for nm23-H1 gene mutation in exon 1 to 5. The high expression of nm23-H1 protein was associated with the high IPI score (p=0.019) and the low survival rate of the patients (p=0.0039). The gene mutation of nm23-H1 was detected in 10.3% of DLBCL and 30.7% of NK/T; but none in MZL and TCLNOS. The mutation was found in exon 1 in 5 cases, exon 2 in two cases, exon 4 in one case and both exon 1 and 2 in two cases. Our results suggest that the expression of nm23-H1 protein can be used as a poor prognostic marker in non-Hodgkin's lymphomas, and the mutational change of gene may operate in the lymphomagenesis.