Efficacy and safety of VRD regimen of autologous hematopoietic stem cell transplantation in patients with newly diagnosed multiple myeloma / 中华内科杂志

Objective: To explore the stem cell collection rate and efficacy and safety of patients aged 70 and below with newly diagnosed multiple myeloma (MM) treated with the VRD (bortezomib, lenalidomide and dexamethasone) regimen followed by autologous stem cell transplantation (ASCT). Methods: Retrospective case series study. The clinical data of 123 patients with newly diagnosed MM from August 1, 2018, to June 30, 2020, at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hematology Hospital, who were eligible for VRD regimen sequential ASCT, were collected. The clinical characteristics, efficacy after induction therapy, mobilization regimen of autologous stem cells, autologous stem cell collection rate, and side effects and efficacy of ASCT were retrospectively analyzed. Results: Of the 123 patients, 67 were males. The median patient age was 56 (range: 31-70) years. Patients with IgG, IgA, IgD, and light-chain types accounted for 47.2% (58/123), 23.6% (29/123), 3.2% (4/123), and 26.0% (32/123) of patients, respectively. In addition, 25.2% (31/123) of patients had renal insufficiency (creatinine clearance rate<40 ml/min). Patients with Revised-International Staging System (R-ISS) Ⅲ accounted for 18.2% (22/121) of patients. After induction therapy, the rates of partial response and above, very-good partial response (VGPR) and above, and complete response (CR)+stringent CR were 82.1% (101/123), 75.6% (93/123), and 45.5% (56/123), respectively. Overall, 90.3% (84/93) of patients were mobilized with cyclophosphamide+granulocyte colony-stimulating factor (G-CSF) and 8 patients with G-CSF or G-CSF+plerixafor due to creatinine clearance rate<30 ml/min and one of them was mobilized with DECP (cisplatin, etoposide, cyclophosphamide and dexamethasone)+G-CSF for progressive disease. The rate of autologous stem cell collection (CD34+cells≥2×106/kg) after four courses of VRD regimen was 89.1% (82/92), and the rate of collection (CD34+cells≥5×106/kg) was 56.5% (52/92). Seventy-seven patients treated with the VRD regimen sequential ASCT. All patients had grade 4 neutropenia and thrombocytopenia. Among the nonhematologic adverse events during ASCT, the highest incidence was observed for gastrointestinal reactions (76.6%, 59/77), followed by oral mucositis (46.8%, 36/77), elevated aminotransferases (44.2%, 34/77), fever (37.7%, 29/77), infection (16.9%, 13/77) and heart-related adverse events (11.7%, 9/77). Among the adverse events, grade 3 adverse events included nausea (6.5%, 5/77), oral mucositis (5.2%, 4/77), vomiting (3.9%, 3/77), infection (2.6%, 2/77), elevated blood pressure after infusion (2.6%, 2/77), elevated alanine transaminase (1.3%, 1/77), and perianal mucositis (1.3%, 1/77); there were no grade 4 or above nonhematologic adverse events. The proportion of patients who achieved VGPR and above after VRD sequential ASCT was 100% (75/75), and the proportion of patients who were minimal residual disease-negative (<10-4 level) was 82.7% (62/75). Conclusion: In patients aged 70 and below with newly diagnosed MM treated with VRD induction therapy, the collection rate of autologous stem cells was good, and good efficacy and tolerability were noted after follow-up ASCT.

Study on risk factors of abnormal pulmonary function among dust-exposed workers and prediction model / 中华劳动卫生职业病杂志

Objective: To explore the influencing factors of abnormal pulmonary function in dust-exposed workers and establish the risk prediction model of abnormal pulmonary function. Methods: In April 2021, a total of 4255 dust exposed workers from 47 enterprises in 2020 were included in the study. logistic regression was used to analyze the influencing factors of abnormal pulmonary function in dust-exposed workers, and the corresponding nomogram prediction model was established. The model was evaluated by ROC curve, Calibrationpolt and decision analysis curve. Results: logistic regression analysis showed that age (OR=1.03, 95%CI=1.02~1.05, P<0.001) , physical examination type (OR=4.52, 95%CI=1.69~12.10, P=0.003) , dust type (Comparison with coal dust, Cement dust, OR=3.45, 95%CI=1.45~8.18, P=0.005, Silica dust (OR=2.25, 95%CI=1.01~5.03, P=0.049) , blood pressure (OR=1.63, 95%CI=1.22~2.18, P=0.001) , creatinine (OR=0.08, 95%CI=0.05~0.12, P<0.001) , daily exposure time (OR=1.06, 95%CI=1.10~1.12, P=0.034) and total dust concentration (OR=1.29, 95%CI=1.08~1.54, P=0.005) were the influencing factors of abnormal pulmonary function. The area under the ROC curve of risk prediction nomogram model was 0.764. The results of decision analysis curve showed that the nomogram model had reference value in the prevention and intervention of abnormal pulmonary function when the threshold probability exceeded 0.05. Conclusion: The accuracy ofthe nomogram model constructed by logistic regression werewell in predicting the risk of abnormal lung function of dust-exposed workers.

A single-center retrospective analysis of autologous hematopoietic stem cell transplantation for the treatment of multiple myeloma in the elderly / 中华老年医学杂志

Objective:To evaluate the efficacy and safety of autologous hematopoietic stem cell transplantation(auto-HSCT)for the treatment of multiple myeloma(MM)in elderly patients aged over 65 years.Methods:In this retrospective analysis, the efficacy and safety of auto-HSCT for the treatment of MM was examined in 28 patients aged >65 years diagnosed and treated at Soochow Hopes Hematology Hospital between March 1, 2020 and October 31, 2022.The functions of the major organs of these patients were evaluated before transplantation.Results:The 28 patients had a median age of 67(66-72)at the time of transplantation, a median number of 2.985 × 10 6/kg(2.036-9.5 × 10 6/kg)of collected CD34+ hematopoietic stem cells, and a median number of 2(1-3)days of collection.The median time to neutrophil implantation after hematopoietic stem cell transfusion was 10(9-14)days, and the median platelet implantation time was 11(10-29)days.The median follow-up time was 25 months, but the median progression-free survival time was not reached.The 1-year PFS rate was 89.3% and 2-year PFS rate was 76.3%, with 2 patients' starting point of PFS set at the time of pre-transplantation re-induction therapy because needed salvage auto-HSCT.The overall survival time was not reached, the 1-year overall survival rate was 100.0%, and the 2-year overall survival rate was 90.5%. Conclusions:Auto-HSCT is a safe and effective treatment for elderly MM patients aged over 65 years after screening and assessment.

Efficacy of total oral regimens containing ixazomib in patients with relapsed and refractory multiple myeloma / 中华内科杂志

To investigate the efficacy and safety of total oral regimen containing ixazomib in multidrug-resistant relapsed and refractory multiple myeloma(RRMM). A total of 38 patients were retrospectively analyzed from August 2018 to January 2020 in the First Affiliated Hospital of Soochow University. The overall response rate (ORR)was 36.8%. Among them, the very good partial response (VGPR) or better rate was 23.7%, and the complete response (CR) rate was 5.3%. The ORR was 41.7% in patients receiving ixazomib-lenalidomide-dexamethasone (IRD) regimen. Median PFS was 5 months and median OS was 7.5 months. The ORR was 50% after second-line therapy, 40% after third-line therapy and 12.5% after forth-line therapy or more. The ORR was 29.0% in bortezomib-refractory patients, 38.0% in lenalidomide-refractory patients, 21.4% in bortezmoib & lenalidomide dual refractory patients. Grade 3-4 hematological adverse events (AEs) were reported in 21% patients. Common hematological AEs included lymphopenia, neutropenia, thrombocytopenia. Other usual AEs were fatigue and diarrhea. No grade 3-4 peripheral neuropathy was recorded. In the treatment of relapsed/refractory multiple myeloma patients with multidrug resistance, the total oral regimens containing ixazomib demonstrate reliable efficacy and safety. Early administration of ixazomib at first or second relapse is suggested for more favorable clinical outcome.

A clinical retrospective analysis of newly diagnosed multiple myeloma patients with systemic light chain amyloidosis / 中华血液学杂志

Objective: To analyze the clinical characteristics, treatment response, and prognosis of newly diagnosed symptomatic multiple myeloma (MM) patients with systemic light chain amyloidosis (AL) . Methods: The clinical data of 160 patients with newly diagnosed MM treated at the First Affiliated Hospital of Soochow University from January 1, 2017 to October 31, 2018, were retrospectively analyzed. According to the histopathological biopsy results of bone marrow, skin, and other tissues, the patients were divided into two groups according to whether amyloidosis was combined or not, namely, the MM+AL group and the MM group. The clinical characteristics and treatment responses of the two groups were compared. Results: Among the 160 patients with newly diagnosed MM, there were 42 cases in the MM+AL group and 118 cases in the MM group. In terms of clinical features, the involved light chain and non-involved light chain (dFLC) in the MM+AL group was significantly higher than that in the MM group (P=0.039) . After induction treatment, the MM+AL group had a higher overall response rate (85.7%vs 79.7%, P<0.05) and higher excellent partial response (76.2%vs 55.1%, P<0.05) . After a median follow-up of 26 (0.25-41) months, there was no significant difference in the progression free survival and overall survival (OS) between the two groups (P>0.05) . The OS of patients in autologous hematopoietic stem cell transplantation group was better than that in non transplantation group (P<0.05) .The prognosis of patients with cardiac involvement in the MM+AL group was significantly worse than that in the MM group and MM+AL group without cardiac involvement (P<0.001) , with a median OS of only 13 months. Conclusion: The differential diagnosis between the MM+AL and MM groups requires histopathology, particularly for patients with significantly increased dFLC. The overall remission rate of patients in MM+AL group after 4 courses of induction chemotherapy was higher than that in MM group. The prognosis of patients with cardiac involvement in MM+AL group was poor.

Relationship of urinary pathogenic bacteria and stone composition in patients with infectious stones / 中华泌尿外科杂志

Objective:To study the relationship of pathogenic bacteria in midstream urine culture and stone composition of patients characteristics with infection stones.Methods:Between January 2016 and December 2020, 989 patients with infectious stones who attended Tsinghua Chang Gung Hospital, affiliated with Tsinghua University, for surgical treatment were enrolled in the study. There were 545 male and 444 female patients, with the mean age (48±14) years. The left and right side stones were 396 and 333, respectively. There were 260 bilateral stones, 264 single stones, 334 multiple stones, and 391 deer-stalker-shaped stones. The maximum diameter of stones was (33.4±26.5)mm, combined with diabetes in 109 cases and hypertension in 235 cases. Clean middle-urine was collected for bacterial culture, and intraoperative stone specimens were collected by percutaneous nephrolithotomy (PCNL). Personal characteristics of the patient such as gender, age, body mass index, clinical information such as stone size, location, comorbidities, results of urine culture and stone composition were recorded. The differences of infectious stone composition was analyzed between urease-producing, non-urease-producing bacteria.Results:Among the 989 patients with infectious stones, 259 were pure infectious stones, 131 were mixed infectious stones, and 599 were combined with infectious stone components. Urine cultures were positive in 627(63.4%) patients with infectious stones. The predominant urease-producing bacteria included Ureaplasma urealyticum(94 case), Proteus mirabilis(58 case), and Staphylococcus spp.(36 case). Pure infectious stones were common in Proteus mirabilis, while combined with infectious stone components were common in Ureaplasma urealyticum and Staphylococcus spp. The predominant non-urease-producing bacteria included Escherichia coli(175 case), Enterococcus spp.(76 case) and Streptococcus spp.(35 case). Escherichia coli commonly contained in infectious stone components and pure infectious stones, whereas Enterococcus spp. and Streptococcus spp. commonly contained in infectious stone components. Escherichia coli (61 case), Proteus mirabilis (44 case) and Enterococcus spp.(20 case) were the most common bacteria in 259 cases of pure infectious stones. Escherichia coli (36 case), Enterococcus spp. (14 case) and Ureaplasma urealyticum (10 case) were the most common bacteria in 131 cases of mixed infectious stones. The most common bacteria in 599 cases of combined infectious stones were Escherichia coli (78 case), Ureaplasma urealyticum (68 case) and Enterococcus spp. (42 case).Conclusions:Urease producing bacteria were not common in infectious stones. It was common for the Ureaplasma urealyticum in combined infectious stone components, while Escherichia coli was common in pure and combined infectious stone components.

Analyses of risk factors for basilar tip aneurysms rupture using CT angiography / 中华放射学杂志

Objective:To analyze risk factors for the rupture of basilar tip aneurysms (BTA) using morphological parameters assessed on CTA.Methods:The clinical data and CTA imaging characteristics of 62 patients with BTA from March 2016 to November 2020 in Huanhu Hospital of Tianjin were analyzed retrospectively. The patients were divided into un-rupture ( n=44) and rupture ( n=18) groups according to whether the BTA ruptured. The morphological parameters of aneurysms were measured and recorded. The number, shape and orientation of aneurysms were analyzed by χ 2 test between the two groups. The length (H max), height (H p), neck width (N D), aspect ratio (AR), size ratio (SR), angle of aneurysms (AA), flow angle (FA), basilar vessel angle (BVA), the angle between the proximal long axis of bilateral posterior cerebral artery P1 segment (P1-P1 angle), the angle between the proximal long axis of bilateral superior cerebellar arteries and bifurcation angle (the sum of the angle between the basilar artery and the bilateral posterior cerebral arteries) were analyzed by independent-sample t test between the two groups. On the basis of univariate analysis, logistic regression was used to identify the independent risk factors for BTA rupture. ROC curve analysis was further performed. Results:BTA with irregular shape was more likely to break (χ 2=5.412, P<0.05). The H max[(4.18±2.11)mm], N D [(3.06±1.75)mm], P1-P1 angle (148°±18°) in the rupture group were smaller than those in the un-rupture group [(6.38±2.21)mm, (5.20±1.59)mm, 178°±25°], with statistically significant difference ( P<0.05). While AR (1.19±0.13), BVA (82°±11°), and bifurcation angle (212°±18°) in the rupture group were larger than those in the un-rupture group (1.05±0.18, 70°±10°, 181°±27°), with statistically significant difference ( P<0.05). The logistic regression analysis showed that the shape of aneurysms (β=4.878, OR=11.418, P=0.019), BVA (β=0.165, OR=1.177, P=0.043), and P1-P1 angle (β=-0.223, OR=1.080, P=0.029) were independent risk factors for BTA rupture. The ROC curve analysis showed that the cut-off value of BVA and P1-P1 angle to predict the BTA rupture were 76.7° and 158.5°, and area under curve (AUC) were 0.79 and 0.86, respectively. The AUC of combined BVA with P1-P1 angle was 0.89. Conclusion:The shape of aneurysms, BVA and P1-P1 angle are independent risk factors for BTA rupture. BTA are prone to rupture when the shape of aneurysm is irregular, BVA>76.7 ° and P1-P1 angle<158.5 °.

Effect of Dahuang Zhechong Pills combined with TACE on VEGF, MMP-2, TGF-β1 and immune function of patients with primary liver cancer (blood stasis and collaterals blocking type) / 中国中药杂志

To investigate the effects of Dahuang Zhechong Pills combined with hepatic arterial chemoembolization(TACE) on tumor index and immune function of patients with primary liver cancer(blood stasis and collaterals blocking type), observe its application values in treatment of such patients, and provide effective treatment means for this disease. From June 2019 to December 2019, 79 patients with confirmed primary liver cancer(blood stasis and collaterals blocking type) treated in Wenzhou Hospital of Traditional Chinese Medicine were included in this study, all of which were grouped with random number table method before inclusion in this study. 40 patients in the control group were treated with TACE, while 39 patients in the observation group were treated with Dahuang Zhechong Pills combined with TACE. The efficacy was compared between two groups after 4 weeks of treatment. The immune function indexes of serum CD4~+ cells, CD4~+/CD8~+, CD3~+ cells of the observation group were higher than those in control group after treatment(P<0.05), and tumor indexes such as serum alpha-fetoprotein(AFP), carbohydrate antigen 199(CA199) and glutamic-pyruvic transaminase(ALT), total bilirubin(TBiL) levels were lower than those in the control group, with statistically significant differences(P<0.05). Plasma vascular endothelial growth factor(VEGF), transforming growth factor-β1(TGF-β1), and matrix metalloprotei-nase-2(MMP-2) levels in the observation group were lower than those in the control group after treatment, with statistically significant differences(P<0.05). The total effective rate of the observation group was 87.18%, higher than 67.50% in the control group, and the benefit rate was 94.87% in the observation group, higher than 85.00% in the control group(P<0.05). The total incidence of adverse reactions such as bone marrow suppression, gastrointestinal reaction, fever, renal function injury and peripheral nerve injury in the observation group was 48.72%, lower than 82.50% in the control group, with statistically significant difference(P<0.05). In summary, the combination of Dahuang Zhechong Pills with TACE could improve immunity, protect liver function, and reduce the risk of metastasis and the incidence of adverse reactions from chemotherapy, so it is worth popularizing for patients with primary liver cancer(blood stasis and collaterals blocking type).

Methylated CpG dinucleotides in the 5-α reductase 2 gene may explain finasteride resistance in benign prostatic enlargement patients / 亚洲男科学杂志(英文版)

The inhibition of 5-α reductase type 2 (SRD5A2) by finasteride is commonly used for the management of urinary obstruction resulting from benign prostatic enlargement (BPE). Certain BPE patients showing no SRD5A2 protein expression are resistant to finasteride therapy. Our previous work showed that methylated cytosine-phosphate-guanine (CpG) islands in the SRD5A2 gene might account for the absence or reduction of SRD5A2 protein expression. Here, we found that the expression of the SRD5A2 protein was variable and that weak expression of the SRD5A2 protein (scored 0-100) occurred in 10.0% (4/40) of benign adult prostates. We showed that the expression of SRD5A2 was negatively correlated with DNA methyltransferase 1 (DNMT1) expression. In vitro SRD5A2-negative BPH-1 cells were resistant to finasteride treatment, and SRD5A2 was re-expressed in BPH-1 cells when SRD5A2 was demethylated by 5-Aza-2'-deoxycytidine (5-Aza-CdR) or N-phthalyl-L-tryptophan (RG108). Furthermore, we determined the exact methylation ratios of CpG dinucleotides in a CpG island of SRD5A2 through MassArray quantitative methylation analysis. Ten methylated CpG dinucleotides, including four CpG dinucleotides in the promoter and six CpG dinucleotides in the first exon, were found in a CpG island located from -400 bp to +600 bp in SRD5A2, which might lead to the silencing of SRD5A2 and the absence or reduction of SRD5A2 protein expression. Finasteride cannot exert a therapeutic effect on patients lacking SRD5A2, which may partially account for the resistance to finasteride observed in certain BPE patients.

Application of Conditioning Regimen with Busulfan and Cyclophosphamide in Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To evaluate the safety and efficacy of BUCY (busulfan and cyclophosphamide) conditioning regimen for autologous hematopoietic stem cell transplantation (ASCT) in patients with multiple myeloma (MM).@*METHODS@#The clinical data of 72 MM patients received transplantation in the Hematology Department of the First Affiliated Hospital of Soochow University from May 2012 to June 2015 were retrospectively analyzed. Among them, 36 patients received BUCY conditioning regimen while the others received high-dose melphalan (HDM) conditioning regimen. The complication, post-transplantation hematopoietic reconstitution and efficacy between the two groups were compared.@*RESULTS@#There were no significant differences in sex, age, isotype, stage, induction therapy, mobilization method and proportion of conditioning regimen with Bortezomib between the two groups. The median time of neutrophil engraftment for the patients in BUCY and HDM groups was 10 (8-17) and 10 (9-13) d (P=0.046), and the median time of platelet engraftment was 10 (8-18) and 11 (9-47) d (P=0.017), respectively. The transplant related mortality of the patients in both groups was 2.7%. The CR rates of the patients after ASCT (38.9% and 50.0%) were higher than those before ASCT (27.8% and 19.4%) in the two groups. For the patients in BUCY group, the median follow-up time was 45 (0-61) months. Fifteen patients (41.7%) achieved disease progression. While for the patients in HDM group, the median follow-up time was 52(0-75) months. Twenty-two patients (61.1%) achieved disease progression.@*CONCLUSION@#The BUCY conditioning regimen is a safe and effective therapy for ASCT in patients with MM. Besides, in terms of safety and efficacy, BUCY regimen is not inferior to HDM regimen. BUCY regimen may replace HDM regimen as a standard conditioning regimen for ASCT in MM.

The clinical application value of potentially inappropriate drug assessment system in elderly inpatients / 中华老年医学杂志

Objective:To explore the clinical value of the geriatric potentially inappropriate medication(PIM)evaluation system in elderly inpatients.Methods:As a prospective cohort study, 203 elderly inpatients with polypharmacy were randomly divided into the control group and experimental group.Geriatric PIM evaluation system(based on the criteria for judging potential inappropriate drug use in Chinese elderly 2017 edition)on wechat platform was applied to patients of experimental group.During the 6 months, the number of elderly syndromes, types of drugs, the days in hospitalization, readmission rates and all-cause mortality were compared between two groups.Results:The age of 203 elderly inpatients ranged from 60 to 94(77.30±10.34)years, including 121 males and 82 females.The morbidity proportion of top five diseases were 69.95%(142/203)in cerebral infarction(non-acute phase), 62.07%(126/203)in hypertension, 24.14%(49/203)in coronary heart disease, 9.85%(20/203)in atrial fibrillation, and 6.40%(13/203)in cardiac insufficiency.The 97.53%(198/203)of elderly hospitalized patients had at least one senile syndrome, the average was 4.3±2.0.Insomnia, fall and frailty accounted for 32.87%(15/198), 28.45%(56/198)and 13.66%(27/198)respectively.Compared with the control group, the average length of stay in hospital in the experimental group significantly decreased[(16.38±4.29) vs.(21.32±6.10)d, t=2.438、 P=0.025], the number of senile syndrome, the score of fall, weakness and the re-admission rate were also decreased significantly(3.11±2.14 vs.4.32±1.50, t=0.854、 P=0.032; 6.19±1.35 vs.8.61±3.22, t=4.078、 P=0.044; 3.94±1.92 vs.5.65±1.34, t=2.843、 P=0.038; 9.81%(10/102) vs.1.98%(2/101), χ2=4.772、 P=0.029), and the frequency of PIM was significantly different between two groups(417.36±49.21 vs.210.25±38.23, t=2.136、 P=0.034). Conclusions:After making the drug adjustment on the elderly inpatients with multiple drugs, PIM evaluation system for the elderly are able to reduce the incidence of geriatric syndrome, shorten the length of stay in hospital, improve the rational use of drugs, and enhance the quality of life of the elderly patients.

Incidence of central nervous system metastases in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer treated with trastuzumab: A meta-analysis

This study aimed to estimate the incidence of central nervous system (CNS) metastases in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) treated with trastuzumab. Studies were identified through a literature search of electronic databases. Random-effects meta-analyses were performed to estimate the incidence rate of CNS metastases, trastuzumab therapy duration, and time from trastuzumab therapy to CNS metastasis diagnosis. A meta-analysis of odds ratios was performed to evaluate the significance of a difference in CNS metastasis incidence between patients with and without trastuzumab treatment. Thirty studies (8121 trastuzumab-treated and 3972 control patients) were included. The follow-up duration was 18.9 months (95% confidence interval [CI]: 13.8, 24.1). The trastuzumab treatment duration was 9.0 months (95% CI: 7.0, 11.0). The median interval between the start of trastuzumab therapy and CNS metastasis diagnosis was 12.2 months (95% CI: 9.5, 14.7). The incidence of CNS metastasis after the start of trastuzumab therapy was 22% (95% CI: 16, 27). The incidence of CNS metastases was significantly higher in trastuzumab-treated than in non-trastuzumab-treated patients (odds ratio: 1.39 [95% CI: 1.06, 1.82], p=0.02). The survival time from the start of the study was 23.4 months (95% CI: 19.7, 27.1) in trastuzumab-treated patients and 18.4 months (95% CI: 12.7, 24.1) in patients treated with control regimens. The survival time after the development of CNS metastases in trastuzumab-treated patients was 19.2 months (95% CI: 15.6, 25.9). Approximately 22% of patients with HER2-positive MBC who were treated with trastuzumab developed CNS metastases. However, trastuzumab-treated patients had a longer survival than patients who were not treated with trastuzumab.

Initial experience of domestic disposable digital flexible ureteroscope in the treatment of upper urinary tract stones / 中华泌尿外科杂志

Objective:To introduce the preliminary experience of domestic disposable digital flexible ureteroscope (ZebraScope?)in the treatment of upper urinary calculi.Methods:The clinical data of 16 patients with upper urinary calculi treated by ZebraScope? in our hospital from February to March 2020 were retrospectively analyzed. The scope is composed of a handle and shaft, the image can be transferred through the transmission line at the end of the handle. There were 10 males and 6 females. The mean age was 42.1 years (26-63 years). 12 cases of upper ureteral calculi and 4 cases of renal calculi included. Mean diameter was 1.3cm (0.8-2.1cm). Ureteral stents were preoperatively placed in 4 patients and no pre-stent were in 12 patients. Two patients had a history of endoscopic lithotripsy. The ureteral sheath was used in 4 patients with F12/14, 10 patients with F11/13, and 2 patients with F10/12. Eight patients were treated with a stone basket. Intra-operative lithotripsy was performed using 200um optical fiber combined with holmium laser, and 6Fr ureteral stent was routinely indwelling for 2-4 weeks. The operation time, postoperative complications, hospital-in time, stone clearance rate and other related parameters were summarized and analyzed.Results:Of the 16 patients, 14 succeed and 2 patients failed and secondary operation was applied due to poor ureteral condition. The mean operative time was 55.6 minutes (32-115 minutes). The average laser emission time was 25.2 minutes (10-65 minutes). There was no image degradation and scope damage during the operation. All the patients recovered well after the operation, and no postoperative complications such as fever and pain occurred. Two patients received external physical vibration lithecbole therapy. The average hospital-in time was 1.2 days (1-3 days). One month after the operation, the calculi clearance rate was 87.5% (14/16).Conclusion:Our preliminary study found that ZebraScope? could be safe and effective in the treatment of upper urinary calculi less than 2 cm. Futhter verification is required in larger renal stones.

Study on the temperature changes around calculi in needle perc nephroscopy holmium laser lithotripsy / 中华泌尿外科杂志

Objective:To investigate the characteristics of local temperature changes around the stones during needle perc nephroscopy holmium laser lithotripsy.Methods:In vitro, Choosing a hard-plastic kidney model (the same size as the human kidney), and polishing the monohydrate calcium oxalate stones collected clinically into a round shape with a diameter of about 1 cm. Pushing the stone into the renal pelvis from the broken end of the renal pelvis and ureter junction of the kidney model to form a kidney stone model. The experiment operation was performed by the same senior doctor with needle perc nephroscopy holmium laser lithotripsy. The temperature recorder probe was placed 5 mm around the stones in the renal pelvis. The laser power were selected as 4 W and 8 W, and the perfusion rate were 0, 25 ml/ min, 50 ml/min and 100 ml/min, the pulse width modes are divided into short pulse width and long pulse width. The fifth-generation EMS laser device was selected for the laser equipment. The temperature changes were recorded around the stone in real time. The test was repeated 3 times under each condition. The temperature change value is the temperature difference between the end of the experiment and the beginning. The characteristics and differences of the temperature around the nephrolithiasis treated by needle perc nephroscopy were compared.Results:The experiments of each group were successfully completed. When the holmium laser power was 4 W and the perfusion rate was 0, 25, 50 and 100 ml/min, there was no statistically significant difference in the temperature around the lithotripsy between long pulse width and short pulse width [(3.40±0.30) ℃ vs. (2.97±0.15)℃, (1.20±0.30) ℃ vs. (1.17±0.21)℃, (0.77±0.21) ℃ vs. (0.53±0.15)℃, (0.60±0.10) ℃ vs. (0.47±0.06)℃, all P >0.05]. When the holmium laser power was 8 W and the perfusion speed was 0, 25, and 50 ml/min, the difference in temperature around the lithotripsy stones between long pulse width and short pulse width was statistically significant [(8.63±0.06) ℃ vs. (5.97± 0.25)℃, (2.63±0.06)℃ vs. (1.77±0.25)℃, (2.07±0.31)℃ vs. (0.97±0.06)℃; P<0.05]. There was no significant difference when the perfusion rate was 100 ml/min [(0.47±0.06) ℃ vs. (0.67±0.12) ℃, P>0.05]. In the long pulse width mode, when the perfusion speed was 0, 25, and 50 ml/min, there was statistical difference in the temperature change around the stone with 4 W and 8 W holmium laser power ( P<0.05); when the perfusion rate was 100 ml/min, the difference was not statistically significant ( P>0.05). Conclusions:In needle perc nephroscopy holmium laser lithotripsy, compared with low holmium laser power and short pulse width mode, high holmium laser power and long pulse width can significantly increase the surrounding temperature of the stone at the perfusion rate of 0, 25 ml/min, and 50 ml/min. However, regardless of the mode of the pulse width, while the lithotripsy power ≤8 W, and the perfusion rate ≥25 ml/min, the temperature around the stone does not change significantly during the lithotripsy. This type of operation is safe and reliable.

Prospective and prognostic factors for hepatic metastasis of gastric carcinoma: A retrospective analysis

Aims: The aim of the study was to prospectively explore the prognostic factor for gastric cancer with liver metastasis (GCLM), since no prognostic factor was reported to be consistently significant across studies. Patients and Methods: One hundred and five patients with GCLM treated at our center between January 1, 2010, and March 31, 2016, were included and their clinical data were retrospectively analyzed. The univariate analyses were first applied for identify the potential independent prognostic and predictive factors for liver metastasis. These factors were further evaluated with Cox proportional-hazard regression model testing. Finally, survival curves were estimated. Results: The Eastern Cooperative Oncology Group (ECOG) score, number of other distant metastases, levels of cancer antigen (CA), and carcinoembryonic antigen (CEA) were independent prognostic factors (adjusted relative risk [RR]: 1.362–2.887; P = 0.000–0.027). The survival of patients who received radical gastrectomy would be associated with the ECOG score, staging (T stage and N stage), CA 19-9, and CEA levels (RR: 2.169–3.787; P = 0.000–0.027). Patients with following indicators 1 month postoperatively were prone to liver metastasis after radical gastrectomy (median, 6.9–12.03 months; P = 0.007–0.042): Venous/lymphatic invasion, pathological Stage IV (especially combined with T4 stage), intestinal Lauren type, and combined elevation of CEA and CA 19-9 levels. Conclusions: The therapy design for patients with GCLM should consider the general conditions and personal clinicopathological characters of patients. After balancing the benefit and risk factors, multidisciplinary treatment and individual treatment should be developed based on evidence-based medicine model for each patient

Construction of emergency medical service system based on 5G communication technology for large-scale social activities / 中华急诊医学杂志

Objective To develop medical emergency support information system for large-scale social activities based on 5G communication technology to improve efficiency of emergency medical services.Methods The project was completed in Hangzhou,China,from March 2016 to September 2019.Based on the medical service of large social activities,five information terminals are constructed,including on-site mobile terminal,on-board first aid terminal,expert remote consultation terminal,hospital terminal,and command dispatch center.The system can realize the real-time communication of medical information,patient's vital signs,audio,picture and video information,and can also make intelligent scheduling decisions for patients.Results 5G Emergency Medical information System for Large-scale Social Activities has been completed,which consists of three parts:command and control platform,onsite rescue platform,and evacuation support platform.The command and monitoring platform displays the information of on-site medical teams,ambulances,hospitals and experts through web pages,and realizes multi-party video communication at any time,as well as text,voice and image information of patients' current condition,so as to realize command,dispatch and display statistical summary information.On-site rescue terminal includes patient information input,video signal acquisition and physiological information acquisition equipment.It realizes multiple methods of patient information input,vital signs and physiological information acquisition,multi-angle video acquisition and transmission to the command center.The evacuation support platform includes vehicle emergency terminal,remote expert consultation terminal,hospital terminal and UAV system.Vehicle terminal can scan and transfer with on-site ambulance team,record physiological information during transit,and also acquire and transmit monitor,electrocardiogram and ultrasound information.Hospital terminals can obtain patient information at the first time and prepare for first-aid in hospital.The remote expert terminal can be dispatched by the command center and the hospital terminal,and can join the remote consultation at any time.Unmanned aerial vehicle (UAV) system can transfer medical material between any locations.Conclusions This system can guarantee the patients to be transported from the scene to the ambulance and finally to the hospital during the large-scale social activities.In the whole process,the information transmission and dispatching decision-making are initially realized,and the statistical report forms can be made.However,to fully exert its advantages,it still needs the support of the complete 5G network and continuous optimization in real scenarios.

Correlation between frailty status and anticoagulation therapy in elderly patients with atrial fibrillation / 中华老年医学杂志

Objective To investigate the correlation between frailty status and anticoagulation therapy in elderly patients with atrial fibrillation.Methods A total of 131 atrial fibrillation inpatients in our hospital aged 70 years and over with a mean age of(77.4 ±6.4)years were enrolled from January 2017 to June 2018 in this retrospective study.According to the state of anticoagulation therapy at discharge,patients were divided into the anticoagulation group (n =67) and the non-anticoagulation group (n =64).Data including gender,age,N-terminal pro-brain natriuretic peptide (NT-proBNP),glomerular filtration rate (eGFR),the type of medication,HAS-BLED(Hypertension,abnormal renal/liver function,stroke,bleeding history or predisposition,labile international normalized ratio,elderly,drugs/alcohol concomitantly),CHA2DS2-VASc scores,Charlson comorbidity index and clinical frailty scores(CFS)were recorded and compared between the two groups.Spearman correlation was used to analyze the correlation between frailty degrees and program of anticoagulant therapy.Two-class Logistic regression models were used to analyze the related factors for programs of anticoagulant therapy.Results The incidence of the frailty syndrome was 56.49％ in 131 elderly patients with atrial fibrillation.Compared with the anticoagulation group,non-anticoagulation group showed that the CFS score[(5.73±1.85)vs.(3.69±2.07),P＜0.05],the incidence of the frailty syndrome(67.19％ vs.46.27％,P＜0.05) and Charlson index [(6.09 ± 2.80) vs.(4.98± 2.61),P ＜0.05]were increased.While,there was no significant difference in HAB-BLED score and CHA2DS2-VASc score between the two groups (P ＞ 0.05).The correlation analysis showed that there was a negative correlation between the application of anticoagulants and CFS grade in elderly patients with atrial fibrillation(r =-0.138,P ＜ 0.05).Multivariate Logistic regression analysis showed that age,CFS score and the incidence of frailty state were risk factors in elderly atrial fibrillation patients without the anticoagulant therapy(P＜0.05).Conclusions The incidence of frailty state in elderly patients with atrial fibrillation is high,and the proportion of patients receiving the anticoagulant therapy is low.Age and frailty may be the most important influencing factors for anticoagulant therapy.Therefore,it is of great significance to incorporate frailty assessment into the management of anticoagulant therapy in elderly patients with atrial fibrillation.

Correlation between frailty status and anticoagulation therapy in elderly patients with atrial fibrillation / 中华老年医学杂志

Objective@#To investigate the correlation between frailty status and anticoagulation therapy in elderly patients with atrial fibrillation.@*Methods@#A total of 131 atrial fibrillation inpatients in our hospital aged 70 years and over with a mean age of(77.4±6.4)years were enrolled from January 2017 to June 2018 in this retrospective study.According to the state of anticoagulation therapy at discharge, patients were divided into the anticoagulation group(n=67)and the non-anticoagulation group(n=64). Data including gender, age, N-terminal pro-brain natriuretic peptide(NT-proBNP), glomerular filtration rate(eGFR), the type of medication, HAS-BLED(Hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), CHA2DS2-VASc scores, Charlson comorbidity index and clinical frailty scores(CFS)were recorded and compared between the two groups.Spearman correlation was used to analyze the correlation between frailty degrees and program of anticoagulant therapy.Two-class Logistic regression models were used to analyze the related factors for programs of anticoagulant therapy.@*Results@#The incidence of the frailty syndrome was 56.49% in 131 elderly patients with atrial fibrillation.Compared with the anticoagulation group, non-anticoagulation group showed that the CFS score[(5.73±1.85)vs.(3.69±2.07), P<0.05], the incidence of the frailty syndrome(67.19% vs.46.27%, P<0.05)and Charlson index[(6.09±2.80)vs.(4.98±2.61), P<0.05]were increased.While, there was no significant difference in HAB-BLED score and CHA2DS2-VASc score between the two groups(P>0.05). The correlation analysis showed that there was a negative correlation between the application of anticoagulants and CFS grade in elderly patients with atrial fibrillation(r=-0.138, P<0.05). Multivariate Logistic regression analysis showed that age, CFS score and the incidence of frailty state were risk factors in elderly atrial fibrillation patients without the anticoagulant therapy(P<0.05).@*Conclusions@#The incidence of frailty state in elderly patients with atrial fibrillation is high, and the proportion of patients receiving the anticoagulant therapy is low.Age and frailty may be the most important influencing factors for anticoagulant therapy.Therefore, it is of great significance to incorporate frailty assessment into the management of anticoagulant therapy in elderly patients with atrial fibrillation.

Clinical implication of minimal residual disease monitoring by 10-color flow cytometry in multiple myeloma / 中华血液学杂志

Objective@#To evaluate the prognostic significance of minimal residual disease (MRD) monitoring by 10-color flow cytometry in multiple myeloma (MM) patients after treatment.@*Methods@#150 patients with MM who were admitted to the First Affiliated Hospital of Soochow University from July 2015 to July 2017 were retrospectively analyzed. Clinical data, MRD data monitoring by 10-color flow cytometry and prognosis were analyzed.@*Results@#39.1% (34/87) patients were MRD negative after induction chemotherapy, and 49.3% (34/69) patients were MRD negative within 1 year after autologous hematopoietic stem cell transplantation (ASCT) . MRD-negative patients after induction chemotherapy or after transplantation have better progress-free survival (PFS) than MRD-positive patients (P=0.022 and P<0.001) . According to the changes of MRD pre-ASCT and after ASCT, the patients were divided into 4 groups: patients with MRD continued negativity,improved from MRD positive to MRD negative, MRD continued positivity, transformed from MRD negative to MRD positive. The two-year PFS of the four groups were 83%, 82%, 44%, 0, respectively, (P=0.002) . Multivariate analysis showed that the level of MRD after induction chemotherapy was an independent factor for PFS (P=0.002) , HR=4.808 (95%CI 1.818-12.718) .@*Conclusion@#Patients with MRD negative after treatment is a better prognosis marker than complete remission or even the best marker, which can evaluate prognosis by combining R-ISS and cytogenetic changes.

Study of CT perfusion in posterior circulation cerebral ischemia and hyperacute phase of cerebral infarction / 中华神经科杂志

Objective@#To evaluate the diagnostic value of CT perfusion (CTP) for posterior circulation cerebral ischemia and hyperacute phase of cerebral infarction.@*Methods@#CTP was performed in 184 patients with suspected posterior circulation acute ischemic stroke, and diffusion weighted imaging (DWI) of MRI was performed 24-72 hours after onset. According to the characteristics of various perfusion parameters, the perfusion defect area in CTP was divided into group Ⅰ (compensatory phase of cerebral circulation reserve), group Ⅱ (compensatory phase of cerebral metabolism reserve), group Ⅲ (hyperacute phase of cerebral infarction). The region of interest (ROI) in each perfusion defect area and the contralateral mirror perfusion normal area was delineated, and the mean values of regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT), and time to peak (TTP) in the ROI were recorded. The perfusion parameters of normal brain tissue were included in group Ⅳ (normal control group). One-way analysis of variance was used to compare the overall differences in CTP parameters measured in each group in each region, and the multiple comparisons were performed to assess statistical differences between the perfusion parameters of groups in all parts of the posterior circulation. The sensitivity, specificity and accuracy of CTP in evaluating the hyperacute phase of cerebral infarction in various parts of the posterior circulation were calculated by using DWI as a standard.@*Results@#A total of 271 cerebral ischemia or cerebral infarction lesions were detected in 184 patients, 107 in group Ⅰ, 75 in group Ⅱ, and 89 in group Ⅲ. There were statistically significant differences in the perfusion parameters of each group and each part of the posterior circulation (P<0.01). The changes of rCBF and MTT in each territory were not significant between group I and group II, but the decrease of rCBF and the increase of MTT in groups Ⅰ and Ⅱ were significantly different from those in group Ⅳ (P<0.05). The rCBF values of all the territories in group Ⅲ decreased significantly, and the differences between groupⅢ and groups Ⅰ, Ⅱ and Ⅳ were statistically significant (P<0.05). The MTT value of group Ⅲ was significantly increased, and the differences between group Ⅲ and groups Ⅰ, Ⅱ and Ⅳ were statistically significant (P<0.05), except for the difference between groups Ⅲ and Ⅱ in the blood supply area of P2 segment of posterior cerebral artery. rCBV values in cerebellum, pons and blood supply area of P1 and P2 segments of the posterior cerebral arteries were not significantly different among group Ⅰ, group Ⅱ, and group Ⅳ, but the rCBV values of group Ⅲ decreased significantly, and the differences with groups Ⅰ, Ⅱ and Ⅳ were statistically significant (P<0.05). The decrease of rCBV and increase of TTP in midbrain and thalamus of group Ⅱ were significantly different from those in group Ⅰ (P<0.05), while the rCBV value and TTP value of group Ⅱ were not significantly different from those of group Ⅲ. The total sensitivity, specificity and accuracy of CTP in the hyperacute phase of cerebral infarction in the posterior circulation were 79.0%, 99.7% and 98.5%, respectively.@*Conclusions@#The CTP parameter maps can reflect the pathophysiological changes of the posterior circulation cerebral ischemia and the hyperacute phase of cerebral infarction. CTP has adequate sensitivity and very high specificity and accuracy for the evaluation of posterior circulation cerebral infarction.