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1.
Adv Exp Med Biol ; 1226: 87-95, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030678

RESUMEN

The pathological features of the appendix tumors fundamentally recall those of the more frequent colorectal neoplasms, although with a higher relative incidence of carcinoids, due to the abundant presence of enteroendocrine cells in the appendix wall. Moreover, different types of lymphomas, Hodgkin and non-Hodgkin, arising from the extra-nodal mucosal-associated lymphatic tissue, can be encountered. The appendix tumor microenvironment (TME) consists of a cellular component and of a noncellular component: the former includes the immunocompetent cells, while the latter represents the support stroma. Particularly in carcinoids, the immune cell reaction can be explicated by tumor-infiltrating lymphocytes, which, in some circumstances, may arrange around and inside the tumor in a brisk fashion influencing favorably the prognosis. This active reaction has to be distinguished from any preexisting inflammatory condition of the appendix and from superimposed tumor complications, such as infection or ischemia. In practice, we consider the appendix TME a complex framework with immunological, mechanic, and metabolic functions, all supported by a marked neo-lymphoangiogenesis.


Asunto(s)
Neoplasias del Apéndice , Microambiente Tumoral , Neoplasias del Apéndice/inmunología , Neoplasias del Apéndice/metabolismo , Neoplasias del Apéndice/patología , Apéndice/inmunología , Apéndice/metabolismo , Apéndice/patología , Tumor Carcinoide/inmunología , Tumor Carcinoide/metabolismo , Tumor Carcinoide/patología , Humanos , Pronóstico
2.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(1): 11-16, 2020 Feb 01.
Artículo en Chino | MEDLINE | ID: mdl-32037760

RESUMEN

OBJECTIVE: The expression of microRNA-125b in tongue squamous cell carcinoma (TSCC) was detected and analyzed for its relationship with the clinicopathological features of TSCC. METHODS: Real time fluorescence-quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression of microRNA-125b in 35 TSCC tissues and adjacent normal tissues from 35 TSCC cases. The relationship between the expression of microRNA-125b in TSCC tissues and the clinicopathological features of patients with TSCC was analyzed. In situ hybridization (ISH) was used to detect the expression level of microRNA-125b gene in the TSCC tissues and adjacent normal tissues. RESULTS: RT-qPCR results showed that the relative expression levels of microRNA-125b in the TSCC issues was 2.32±0.69, and that of normal tissues was 0.87±0.32. The statistical results showed that the expression level of microRNA-125b was significantly higher in the TSCC tissues than in the normal tissues (P<0.001). The expression level of microRNA-125b in the TSCC tissues was not significantly correlated with age, gender, pathological grade, and lymph node metastasis but was positively correlated with TNM stage. Patients with high TNM stage had high microRNA-125b expression levels (P<0.05). The ISH results showed that the expression levels of microRNA-125b in the TSCC tissues were 0.010±0.003, and that of normal tissues was 0.004±0.001. The expression levels of microRNA-125b in the 35 TSCC tissues were significantly higher than those in the normal tissues (P<0.05). CONCLUSIONS: MicroRNA-125b is highly expressed in TSCC and associated with TNM stage, suggesting that high microRNA-125b expression may be involved in the development of TSCC.


Asunto(s)
Carcinoma de Células Escamosas , MicroARNs , Neoplasias de la Lengua , Humanos , Metástasis Linfática , Pronóstico , Reacción en Cadena en Tiempo Real de la Polimerasa
3.
J Assoc Physicians India ; 68(2): 31-34, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009359

RESUMEN

Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in present days. Recent epidemiological and clinical evidences suggest that serum uric acid can be one of the useful markers in assessing the risk of mortality in acute myocardial infarction. Objective: To find out the association in serum uric acid level and Killip classes and ejection fraction. Methodology: It was an observational prospective study. 100 patients of acute myocardial infarction were enrolled and physical examination with special reference to Killip classification, ECG, 2D- Echocardiogram, Serum uric acid and all routine investigations were carried out on 0, 3rd and 7th day. Serum uric acid and Killip class and ejection fractions on day 0, day 3 and day 7 were compared. Results: In this present study majority of the patients were in the age group of >50 years (68%). There was statistically significant increase in uric acid levels with increasing Killip class on day 0, day 3 and day 7. Mean serum uric acid level was 4.4 mg/dl in Killip class I, 7.01 mg/dl in class II, 8.29 mg/dl in class III, and 9.87 mg/ dl in class IV on day 0; 4.46 mg/dl in Killip class I, 7.09 mg/dl in class II, 8.53 mg/ dl in class III, and 9.43 mg/dl in class IV on day 3; 4.72 mg/dl in Killip class I, 6.62 mg/dl in class II, on day 7. There was statistically significant negative correlation (p-value 0.0009, 0.001, 0.0326 at day 0, 3 & 7) between serum uric acid levels and ejection fraction at all the three occasions i.e. day 0, day 3 and day 7. Conclusion: The present study concludes that serum uric acid level have significant association with Killip class, left ventricular failure and mortality i.e. higher the serum uric acid, higher the Killip class, more severe left ventricular dysfunction and higher the mortality.The present study concludes that serum uric acid level have significant association with Killip class, left ventricular failure and mortality i.e. higher the serum uric acid, higher the Killip class, more severe left ventricular dysfunction and higher the mortality.


Asunto(s)
Infarto del Miocardio/diagnóstico , Ácido Úrico/sangre , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Disfunción Ventricular Izquierda
4.
J Assoc Physicians India ; 68(2): 47-50, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009363

RESUMEN

Objective: The present study intend to determine the association of anatomical site and clinical outcome in intracerebral hemorrhage patients with or without intraventricular extension. Methods: The present 1-year cross-sectional study included 56 patients presenting with spontaneous intracerebral hemorrhage with or without intraventricular extension. Relevant data were collected through a detailed interview with either the patient or the attender. Clinical examination was performed with the help of a predesigned and pretested proforma. Anatomical site of intracerebral hemorrhage and volume of ventricular bleed was estimated by computed tomography/magnetic resonance imagining scans. Clinical outcome was assessed based on modified Rankin scale score and Glasgow outcome scale. Mann-Whitney U test and chi-square test were employed in the analysis. Results: The most common clinical presentations were neuronal deficits, speech disorder, and cranial nerve dysfunction. Hypertension was the most important risk factor observed among the patients. Age, gender, habits, severity of hypertension, duration of hypertension, and site of bleed (P > 0.05) were not significantly associated with outcome. However, clinical features including neuronal deficits (P = 0.01), cranial nerve palsy (P = 0.0002), altered sensorium (P = 0.004), vomiting (P = 0.0006), volume or quantum of bleed (P < 0.04), and IVE of ICH (P = 0.026; significantly affected the outcome. Conclusion: The present study revealed that immediate outcome of patients with intracerebral hemorrhage associated with the clinical presentation of patients, quantum of bleed, and intraventricular extension of bleed.


Asunto(s)
Hemorragia Cerebral , Estudios Transversales , Humanos , Hipertensión , Pronóstico , Factores de Riesgo
5.
Bone Joint J ; 102-B(2): 254-260, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009436

RESUMEN

AIMS: The aim of this study was to assess whether supine flexibility predicts the likelihood of curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment. METHODS: This was a retrospective analysis of patients with AIS prescribed with an underarm brace between September 2008 to April 2013 and followed up until 18 years of age or required surgery. Patients with structural proximal curves that preclude underarm bracing, those who were lost to follow-up, and those who had poor compliance to bracing (<16 hours a day) were excluded. The major curve Cobb angle, curve type, and location were measured on the pre-brace standing posteroanterior (PA) radiograph, supine whole spine radiograph, initial in-brace standing PA radiograph, and the post-brace weaning standing PA radiograph. Validation of the previous in-brace Cobb angle regression model was performed. The outcome of curve progression post-bracing was tested using a logistic regression model. The supine flexibility cut-off for curve progression was analyzed with receiver operating characteristic curve. RESULTS: A total of 586 patients with mean age of 12.6 years (SD 1.2) remained for analysis after exclusion. The baseline Cobb angle was similar for thoracic major curves (31.6° (SD 3.8°)) and lumbar major curves (30.3° (SD 3.7°)). Curve progression was more common in the thoracic curves than lumbar curves with mean final Cobb angles of 40.5° (SD 12.5°) and 31.8° (SD 9.8°) respectively. This dataset matched the prediction model for in-brace Cobb angle with less mean absolute error in thoracic curves (0.61) as compared to lumbar curves (1.04). Reduced age and Risser stage, thoracic curves, increased pre-brace Cobb angle, and reduced correction and flexibility rates predicted increased likelihood of curve progression. Flexibility rate of more than 28% has likelihood of preventing curve progression with bracing. CONCLUSION: Supine radiographs provide satisfactory prediction for in-brace correction and post-bracing curve magnitude. The flexibility of the curve is a guide to determine the likelihood for brace success. Cite this article: Bone Joint J 2020;102-B(2):254-260.


Asunto(s)
Rango del Movimiento Articular/fisiología , Escoliosis/diagnóstico por imagen , Escoliosis/terapia , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/fisiopatología , Posición Supina/fisiología , Adolescente , Axila , Tirantes , Niño , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Escoliosis/fisiopatología
6.
Praxis (Bern 1994) ; 109(2): 87-95, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-32019459

RESUMEN

Everyone Has Low Back Pain: Degenerative Lumbar Spinal Disorders and Their Treatment Options Abstract. Back pain is one of the most widespread diseases. Up to 84 % of people have low back pain at some point in their lives. Unspecific back pain is treated conservatively. As supportive measure, interventional pain therapy can be performed. Surgery for low back pain should be considered in selected cases only. However, accompanying neurological symptoms are frequent, such as radiation, i.e. sciatica. Typical etiologies are disc herniation or - increasingly frequent, and due to the aging population increasingly frequent - spinal canal stenosis. Surgery has a better prognosis in cases where conservative management failed. If severe neurological symptoms are present, surgery is indicated. Osteoporotic compression fractures cause acute back pain. The decision whether these patients should undergo kypho- or vertebroplasty should be based on guidelines.


Asunto(s)
Dolor de la Región Lumbar , Enfermedades de la Columna Vertebral , Estenosis Espinal , Anciano , Humanos , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/terapia , Vértebras Lumbares , Pronóstico , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/terapia , Estenosis Espinal/complicaciones , Estenosis Espinal/terapia
7.
Adv Exp Med Biol ; 1224: 63-77, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32036605

RESUMEN

Mucosal-associated invariant T (MAIT) cells are innate T lymphocytes that circulate in blood and also reside in mucosal tissues. Blood MAIT cells are typically highly Th1-polarized, while those in mucosal tissues include both Th1- and Th17-polarized subsets. MAIT cells mount cytokine and cytolytic responses as a result of T cell receptor (TCR)-mediated recognition of microbially derived metabolites of riboflavin (vitamin B2) presented by the MR1 antigen-presenting molecule. Additionally, MAIT cells can be activated by inflammatory cytokines produced by antigen-presenting cells (APCs) that have been exposed to pathogen-associated molecular patterns (PAMPs). Since the antigenic metabolites of riboflavin recognized by MAIT cells are produced by many microorganisms, including pathogens as well as non-pathogenic colonists, the inflammatory state of the tissue may be a key feature that determines the nature of MAIT cell responses. Under normal conditions where inflammatory cytokines are not produced, MAIT cell responses to microbial metabolites may simply serve to help maintain a healthy balance between epithelial cells and microbial colonists. In contrast, in situations where inflammatory cytokines are produced (e.g., pathogenic infection or damage to epithelial tissue), MAIT cell responses may be more potently pro-inflammatory. Since chronic inflammation and microbial drivers are associated with tumorigenesis and also trigger MAIT cell responses, the nexus of MAIT cells, local microbiomes, and epithelial cells may play an important role in epithelial carcinogenesis. This chapter reviews current information about MAIT cells and epithelial tumors, where the balance of evidence suggests that enrichment of Th17-polarized MAIT cells at tumor sites associates with poor patient prognosis. Studying the role of MAIT cells and their interactions with resident microbes offers a novel view of the biology of epithelial tumor progression and may ultimately lead to new approaches to target MAIT cells clinically.


Asunto(s)
Células Epiteliales/patología , Células T Invariantes Asociadas a Mucosa , Neoplasias/patología , Citocinas/inmunología , Humanos , Células T Invariantes Asociadas a Mucosa/efectos de los fármacos , Células T Invariantes Asociadas a Mucosa/inmunología , Neoplasias/tratamiento farmacológico , Pronóstico , Receptores de Antígenos de Linfocitos T/inmunología
8.
Medicine (Baltimore) ; 99(5): e18927, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000406

RESUMEN

Cytomegalovirus (CMV) gastritis is a rare opportunistic infection with diverse clinical manifestations. Our study aimed to investigate the clinical features of Chinese patients with CMV gastritis.Six inpatients diagnosed with CMV gastritis were retrospectively enrolled, based on the finding of inclusion bodies in routine hematoxylin and eosin staining or positive anti-CMV monoclonal antibodies under immunohistochemistry in the gastric biopsy. Data, including demographics, diagnostic measurements, and medications, were collected.Abdominal pain was the most frequently reported symptom, occurring in 4 patients. Five patients were immunocompromised with associated underlying diseases, and 3 patients had decreased leukocyte differentiation antigen 4 positive (CD4) T lymphocyte counts. Only 3 patients had either positive cytomegalovirus (CMV)-immunoglobulin (Ig) M or increased copies of CMV-DNA peripherally. All patients had gastric lesions in the antrum of the stomach, including ulcers or erosions observed by gastroscopy. All patients received ganciclovir by intravenous injection (IV) as the first line anti-CMV therapy, and attained complete (4) or partial remission (2) during the follow-up.CMV gastritis should be taken into consideration in patients with immunocompromised status who have abdominal pain, nausea, or vomiting. Gastroscopy and necessary biopsy are the major diagnostic methods for CMV gastritis. Early diagnosis leads to a better prognosis for these patients.


Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/epidemiología , Gastritis/diagnóstico , Gastritis/epidemiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Adulto , Anciano , Biomarcadores/sangre , Biopsia , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/patología , Femenino , Gastritis/tratamiento farmacológico , Gastritis/patología , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Náusea/diagnóstico , Náusea/tratamiento farmacológico , Náusea/epidemiología , Náusea/etiología , Pronóstico , Estudios Retrospectivos , Estómago/diagnóstico por imagen , Estómago/patología , Centros de Atención Terciaria , Vómitos/diagnóstico , Vómitos/tratamiento farmacológico , Vómitos/epidemiología , Vómitos/etiología
9.
Medicine (Baltimore) ; 99(5): e18942, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000414

RESUMEN

This study analyzed independent risk factors that could improve the qSOFA scoring system among sepsis patients.This retrospective study evaluated 821 patients (2015-2016) who fulfilled the 2001 International Sepsis Definitions Conference diagnostic criteria. Patients were classified based on their survival outcomes after 28 days, and the predictive values of various predictive scores at admission were compared.The independent risk factors for 28-day mortality were fibrinogen, plasma lactic acid, albumin, oxygenation index, and procalcitonin level >0.5 ng/mL (all P < .05). The "PqSOFA" score combined the qSOFA score with procalcitonin, which provided an area under the curve value of 0.751 (95% CI: 0.712-0.790) for predicting 28-day mortality. A cut-off score of 2 points provided sensitivity of 83.2%, specificity of 54.9%, negative predictive value (NPV) of 33.03%, positive predictive value (PPV) of 92.47%, positive-likelihood ratio (PLR) of 1.85, and negative-likelihood ratio (NLR) of 0.31. The area under the curve for predicting 28-day mortality was significantly greater for the PqSOFA score than for the qSOFA score (Z = 7.019, P < .0001). The PqSOFA score was comparable to the SOFA and APACHE II scores.The PqSOFA score independently predicted poor short-term outcomes among high-risk sepsis patients.


Asunto(s)
Sepsis/diagnóstico , Enfermedad Aguda , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Sepsis/mortalidad , Sepsis/terapia , Índice de Severidad de la Enfermedad
10.
Medicine (Baltimore) ; 99(5): e19017, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000446

RESUMEN

O-(2-[F]fluoroethyl)-L-tyrosine positron-emission tomography/computed tomography (F-FET PET/CT) is well known in brain tumor management. Our study aimed to identify the prognostic value of F-FET PET/CT in high-grade gliomas (HGG) according the current 2016 World Health Organization (WHO) classification.Patients with histologically proven WHO 2016 HGG were prospectively included. A dynamic F-FET PET/CT was performed allowing to obtain 2 static PET frames (static frame 1: 20-40 minutes and static frame 2: 2-22 minutes). We analyzed static parameters (standard uptake value [SUV]max, SUVmean, SUVpeak, TBRmax, TBRmean, tumoral lesion glycolysis, and metabolic tumoral volume) for various isocontours (from 10% to 90%). PET parameters, clinical features, and molecular biomarkers were compared with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analysis.Twenty-nine patients were included (grade III n = 3, grade IV n = 26). Mean PFS and OS were, respectively, 8.8 and 13.9 months. According to univariate analysis, SUVmean, SUVpeak, TBRmax, and TBRmean were significantly correlated with OS. In static 1 analysis, TBRmax seemed to be the best OS prognostic parameter (P = .004). In static 2 analysis, TBRmean was the best parameter (P = .01). In static 1 analysis, only SUVpeak was significant (P = .05) for PFS. Good performance status (PS < 2; P < .0001) and extent of resection (P = .019) identified the subgroup of patients with the best OS. Only TBRmax (P = .026) and extent of resection (P = .025) remained significant parameters in multivariate analysis.Our data suggested that high TBRmax seemed to be the most significant OS independent prognostic factor in patients with newly diagnosed HGG.


Asunto(s)
Glioma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Medios de Contraste , Femenino , Glioma/patología , Glioma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Estudios Prospectivos , Radiofármacos , Tasa de Supervivencia , Tirosina/análogos & derivados
11.
Medicine (Baltimore) ; 99(5): e19077, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000459

RESUMEN

Retinal arterial macroaneurysms (RAMs) develop as outpouchings of the arterial wall that is weakened by arteriosclerosis. The traditional treatment of RAMs comprises observation, focal laser photocoagulation, or surgery. Recently, intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs has been announced as an effective therapy for fovea-threatening RAMs and quickly improve visual acuity and central retinal thickness (CRT).In the retrospective series, medical charts and ocular images of 24 patients diagnosed as having RAM between May 2011 and November 2018 in our facility were reviewed to delineate clinical manifestations and visual prognosis in RAM patients receiving different treatment modalities. Twenty-four patients (25 eyes; 11 men and 13 women) were enrolled, and one eye with comorbidity of branch retinal vein occlusion was excluded. The mean age of the patients was 69.00 ±â€Š13.45 years. Fourteen patients (58.33%) had a history of hypertension, and 17 patients (70.83%) were aged > 60 years. Furthermore, patients with fovea-threatening RAMs presented with either hypertension or were aged > 60 years.Eyes with fovea involvement (n = 18) were analyzed and separated into two groups according to their treatment modalities: those receiving anti-VEGF intravitreal injections (n = 13) and observation only (n = 5). The baseline visual acuity revealed no significant difference in the two groups. In patients receiving anti-VEGF intravitreal injections, a significantly better visual acuity was detected after anti-VEGF intravitreal injections than the baseline visual acuity (logMAR, 0.78 ±â€Š0.51 vs 1.52 ±â€Š0.48, P < .001), and CRT significantly improved (505.50 ±â€Š159.26 µm vs 243.60 ±â€Š60.17 µm, P = .001). Patients receiving anti-VEGF intravitreal injections also revealed better final visual acuity than those in the observation group (logMAR, 0.78 ±â€Š0.51 vs 1.34 ±â€Š0.48, P = .04).A systematic work-up for hypertension and arteriosclerotic disease could be considered the recommended procedure once RAM has been diagnosed. With better final visual acuity, significant visual improvements, and fast reduction of CRT observed in patients with fovea-threatening RAMs receiving anti-VEGF intravitreal injections, intravitreal anti-VEGF was considered an effective therapy for complicated RAM. During the follow-up period, the majority of RAM eyes had good maintenance of visual function even with foveal complications.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Toma de Decisiones , /tratamiento farmacológico , Anciano , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Agudeza Visual
12.
Medicine (Baltimore) ; 99(5): e18666, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000373

RESUMEN

Ovarian cancer has the highest mortality among gynecological cancers. Although ovarian cancer usually responds well to chemotherapy, most patients still have a poor prognosis. EIF2B5 is a crucial molecule in posttranscriptional modifications involved in tumor progression, and here we investigated the prognostic role of EIF2B5 in ovarian cancer. We examined the differential expression of EIF2B5 mRNA in ovarian cancer by exploring The Cancer Genome Atlas (TCGA) database. The chi square test was used to identify a clinical correlation. Survival analysis and Cox regression model were performed to determine the association between EIF2B5 expression and overall survival (OS) in ovarian cancer patients. As a result, Low EIF2B5 expression was found in ovarian cancer tissues and correlated with survival status. Survival analysis showed that ovarian cancer patients with low EIF2B5 expression had a short OS. Moreover, Cox regression analysis indicated that low EIF2B5 expression was an independent risk factor for a poor prognosis in ovarian cancer. Additionally, according to gene set enrichment analysis, mesenchymal transition, angiogenesis, coagulation, and bile acid metabolism were differentially enriched in ovarian cancer with high EIF2B5 expression. In conclusion, Low EIF2B5 expression is an independent risk factor for a poor prognosis in ovarian cancer patients.


Asunto(s)
Factor 2B Eucariótico de Iniciación/metabolismo , Neoplasias Ováricas/metabolismo , Biomarcadores de Tumor/metabolismo , China/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/mortalidad , Pronóstico
13.
Zhonghua Yi Xue Za Zhi ; 100(3): 225-229, 2020 Jan 21.
Artículo en Chino | MEDLINE | ID: mdl-32008291

RESUMEN

Objective: To study the impact of KIT and other concomitant gene mutations on the prognoses of patients with core-binding factor acute myeloid leukemia (CBF-AML). Methods: A total of 104 newly diagnosed patients with CBF-AML in Hebei Yanda Lu Daopei Hospital from January 2014 to February 2018 were analyzed, and high-throughput gene sequencing for the detection of mutations among 58 genes was executed. Also, the clinical features of KIT mutation-positive CBF-AML (KIT+CBF-AML) patients and the effects of other concomitant gene mutations on the prognoses of patients were also analyzed. Results: A total of 56 cases (53.85%) with KIT mutations were found in 104 CBF-AML patients. Among this, KIT D816 mutation was the most common (32 patients), followed by the N822 mutation (17 patients). Patients with KIT+CBF-AML have a higher proportion of bone marrow blasts at the time of diagnoses and are more likely to have sex chromosome loss. Among the 52 patients with KIT+CBF-AML who were followed up, the allogeneic hematopoietic stem cell transplantation (allo-HSCT) group had a higher overall survival rate (OS) than that of the chemotherapy group (88.9% vs 57.1%, χ(2)=6.076, P<0.05). The event-free survival (EFS) and OS of patients with KIT+CBF-AML with FLT3 mutation were both significantly lower than those of the FLT3 mutation-negative group (EFS: 40.0% vs 72.3%, χ(2)=6.557, P<0.05; OS: 60.0% vs 87.2%, χ(2)=8.305, P<0.05). The OS of the patient with TET2 mutation was lower than that of the TET2 mutation-negative group (50.0% vs 87.5%, χ(2)=4.130, P<0.05). Conclusion: Patients with KIT+CBF-AML with concomitant gene mutations, especially FLT3 and TET2, have poor prognoses, which can be improved by allo-HSCT.


Asunto(s)
Leucemia Mieloide Aguda , Factores de Unión al Sitio Principal , Humanos , Mutación , Pronóstico , Proteínas Proto-Oncogénicas c-kit
14.
Lancet ; 395(10221): 350-360, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007170

RESUMEN

BACKGROUND: Improved markers of prognosis are needed to stratify patients with early-stage colorectal cancer to refine selection of adjuvant therapy. The aim of the present study was to develop a biomarker of patient outcome after primary colorectal cancer resection by directly analysing scanned conventional haematoxylin and eosin stained sections using deep learning. METHODS: More than 12 000 000 image tiles from patients with a distinctly good or poor disease outcome from four cohorts were used to train a total of ten convolutional neural networks, purpose-built for classifying supersized heterogeneous images. A prognostic biomarker integrating the ten networks was determined using patients with a non-distinct outcome. The marker was tested on 920 patients with slides prepared in the UK, and then independently validated according to a predefined protocol in 1122 patients treated with single-agent capecitabine using slides prepared in Norway. All cohorts included only patients with resectable tumours, and a formalin-fixed, paraffin-embedded tumour tissue block available for analysis. The primary outcome was cancer-specific survival. FINDINGS: 828 patients from four cohorts had a distinct outcome and were used as a training cohort to obtain clear ground truth. 1645 patients had a non-distinct outcome and were used for tuning. The biomarker provided a hazard ratio for poor versus good prognosis of 3·84 (95% CI 2·72-5·43; p<0·0001) in the primary analysis of the validation cohort, and 3·04 (2·07-4·47; p<0·0001) after adjusting for established prognostic markers significant in univariable analyses of the same cohort, which were pN stage, pT stage, lymphatic invasion, and venous vascular invasion. INTERPRETATION: A clinically useful prognostic marker was developed using deep learning allied to digital scanning of conventional haematoxylin and eosin stained tumour tissue sections. The assay has been extensively evaluated in large, independent patient populations, correlates with and outperforms established molecular and morphological prognostic markers, and gives consistent results across tumour and nodal stage. The biomarker stratified stage II and III patients into sufficiently distinct prognostic groups that potentially could be used to guide selection of adjuvant treatment by avoiding therapy in very low risk groups and identifying patients who would benefit from more intensive treatment regimes. FUNDING: The Research Council of Norway.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Aprendizaje Profundo , Anciano , Biomarcadores de Tumor/metabolismo , Estudios de Cohortes , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/terapia , Detección Precóz del Cáncer/métodos , Eosina Amarillenta-(YS)/metabolismo , Femenino , Hematoxilina/metabolismo , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos
15.
Zhonghua Shao Shang Za Zhi ; 36(1): 42-47, 2020 Jan 20.
Artículo en Chino | MEDLINE | ID: mdl-32023717

RESUMEN

Objective: To investigate the predictive value of the joint prediction model based on the modified systemic inflammatory response syndrome (SIRS) score (hereinafter referred to as the joint prediction model) for the mortality risk of patients with large area burns within 24 hours after admission. Methods: The clinical data of 158 patients [111 males, 47 females, aged 40 (28, 50) years] admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University from January 2005 to January 2018, conforming to the study criteria, were analyzed retrospectively by the method of case-control study. The age, gender, total burn area, full-thickness burn area, injury cause, with or without inhalation injury, severity of inhalation injury, and tracheotomy condition of patients were recorded, and the modified SIRS score and the modified Baux score of patients were calculated. According to the final outcome, all patients were divided into survival group (n=123) and death group (n=35). The clinical data of patients between two groups, except for modified Baux score, were compared by chi-square test or Mann-Whitney U test to screen the death-related factors of patients. The indexes with statistically significant difference between the two groups were included in the multivariate logistic regression analysis to screen the independent risk factors related to the death of patients, and the prediction model was constructed by combining the modified SIRS score. The receiver's operating characteristic curves of the modified SIRS score, the modified Baux score, and the joint prediction model of 158 patients were drawn to analyze their ability to predict death of patients. The area under curve (AUC) of the receiver's operating characteristic and the sensitivity and specificity of optimal threshold were calculated, and the quality of AUC of the three prediction indexes was compared with Jonckheere-Terpstra test. Results: (1) There were statistically significant differences between the two groups in the modified SIRS score, age, total burn area, full-thickness burn area, severity of inhalation injury, with or without inhalation injury, and tracheotomy condition of patients (Z=-4.356, -3.568, -5.291, -6.052, -4.720, χ(2)=12.967, 19.692, P<0.01). (2) The modified SIRS score, age, full-thickness burn area were the independent risk factors for the death of patients with large area burn (odds ratio=2.699, 1.069, 1.029, 95% confidence interval=1.447-5.033, 1.029-1.109, 1.005-1.054, P<0.05). (3) The AUC of modified SIRS score, the joint prediction model, and the modified Baux score for predicting death of 158 patients within 24 hours after admission were 0.730, 0.879, and 0.895 respectively (95% confidence interval=0.653-0.797, 0.818-0.926, 0.836-0.938, P<0.01). The sensitivities of the three optimal threshold values to death prediction were 54.3%, 91.4%, and 82.9% respectively, while the specificities were 81.3%, 76.4%, and 84.6% respectively. The AUC quality of the joint prediction model was similar to that of the modified Baux score (95% confidence interval=-0.057-0.088, P>0.05), and both of them were significantly better than that of the modified SIRS score (95% confidence interval=0.072-0.259, 0.023-0.276, P<0.05 or P<0.01). Conclusions: Both the joint prediction model and the modified Baux score are considered to be good to predict the death rate of patients with large area burns at early stage after admission. However, the joint prediction model has better clinical practice value due to its advantage of simple scoring and easier access to data acquisition.


Asunto(s)
Quemaduras , Síndrome de Respuesta Inflamatoria Sistémica , Adulto , Estudios de Casos y Controles , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos
16.
Zhonghua Xue Ye Xue Za Zhi ; 41(1): 10-15, 2020 Jan 14.
Artículo en Chino | MEDLINE | ID: mdl-32023748

RESUMEN

Objective: To analyze the frequency and composition of risk-related cytogenetic abnormalities (CAs) in patients with newly-diagnosed multiple myeloma (NDMM) . Methods: The frequency and composition of risk-related CAs from a cohort of 1 015 Chinese patients with NDMM were determined by interphase fluorescence in situ hybridization (iFISH) , individually or in combination. Results: Of the cohort of 1 015 Chinese patients with NDMM, the frequencies of IgH arrangement, del (13q) /13q14, 1q gain and del (17p) were 54.0%, 46.4%, 46.1% (35.8% and 12. 7% for 3 or more than 3 copies) and 9.9%, respectively. Among 454 patients who had the baseline information for all risk-related CAs [except t (14;20) , which was not covered by the FISH panels performed routinely at all five centers], the frequencies of t (4;14) , t (11;14) or t (14;20) were 14.1%, 11.2% and 4.8%, respectively; of them, 44.3% patients carried 2 or more CAs (28.0%, 13.4% and 2.9% for 2, 3 or ≥4 CAs) ; 83.3%, 95.0% or 68.6% patients with 1q gain, del (17p) or IgH rearrangement had 1 or more additional CA (s) , with del (13q) /13q14 as the most frequently accompanied CA; 57.7% patients carried at least 1 HRCA; the incidences of double-hit (DH) MM (DHMM) (=2 HRCAs) and triple-hit (TH) (THMM) (≥3 HRCAs) were 14.3% and 2.9%, respectively. Conclusions: Our results provided an up-to-date profile of CAs in Chinese NDMM patients, which revealed that approximately 58% patients might carry at least 1 HRCA, and 17% could experience so-called DHMM or THMM who presumably had the worst outcome.


Asunto(s)
Mieloma Múltiple , Aberraciones Cromosómicas , Análisis Citogenético , Humanos , Hibridación Fluorescente in Situ , Pronóstico , Estudios Retrospectivos
17.
Zhonghua Xue Ye Xue Za Zhi ; 41(1): 16-22, 2020 Jan 14.
Artículo en Chino | MEDLINE | ID: mdl-32023749

RESUMEN

Objective: To probe the prognostic value of consolidation chemotherapy in non-favorable acute myeloid leukemia (AML) patients who were candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT) with first complete remission (CR(1)) and negative minimal residual disease (MRD(-)) . Methods: A retrospective analysis was conducted on 155 patients with non-favorable AML who received allo-HSCT in CR(1)/MRD(-) from January 2010 to March 2019. The survival data were compared between patients who received and those not received pre-transplant consolidation chemotherapy. Results: A total of 102 patients received pre-transplant consolidation chemotherapy (consolidation group) , and 53 cases directly proceeded to allo-HSCT when CR(1)/MRD(-) was achieved (nonconsolidation group) . The median ages were 39 (18-56) years old and 38 (19-67) years old, respectively. Five-year post-transplant overall survival [ (59.3±7.5) % vs (62.2±6.9) %, P=0.919] and relapse-free survival [ (53.0±8.9) % vs (61.6±7.0) %, P=0.936] were not significantly different between the two groups (consolidation vs nonconsolidation) . There was a weak relationship between consolidation therapy and cumulative incidence of relapse [consolidation: (21.9±5.4) % vs nonconsolidation: (18.3±6.0) %, P=0.942], as well as non-relapse mortality [consolidation: (22.4±4.3) % vs nonconsolidation: (28.4±6.5) %,P=0.464]. Multivariate analysis indicated that pre-transplant consolidation and the consolidation courses (< 2 vs ≥2 courses) did not have an impact on allo-HSCT outcomes. Conclusion: Allo-HSCT for candidate patients without further consolidation when CR(1)/MRD(-) was attained was feasible.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide Aguda , Adolescente , Adulto , Anciano , Humanos , Leucemia Mieloide Aguda/terapia , Persona de Mediana Edad , Neoplasia Residual , Pronóstico , Estudios Retrospectivos , Trasplante Homólogo , Adulto Joven
18.
Zhonghua Xue Ye Xue Za Zhi ; 41(1): 28-33, 2020 Jan 14.
Artículo en Chino | MEDLINE | ID: mdl-32023751

RESUMEN

Objective: To explore the prognostic effects of mean corpuscular volume (MCV) in patients with myelodysplastic syndromes (MDS) . Methods: 321 newly diagnosed, untransfused primary MDS patients who administered from December 2009 to December 2017 were enrolled. The association of MCV with prognosis and several clinical features and genetic mutations were analyzed. Results: Patients were divided into MCV≤100 fl (n=148) and MCV>100 fl (n=173) cohorts. Median overall survival of patients with MCV≤100 fl was shorter than their counterparts (27 months vs 72 months, P<0.001) . In subgroup analysis, MCV≤100 fl patients had worse survivals in bone marrow blast <5% cohort (34 months vs not reached, P=0.002) , but not so in ≥5 % cohort (17 months vs 20 months, P=0.078) . MCV≤100 fl was still an independent adverse variable (HR=1.890, 95%CI 1.007-3.548, P=0.048) after adjusting for clinical and laboratory variables and mutation topography in bone marrow blasts<5% cohort. In bone marrow blasts<5% cohort, patients with MCV≤100 fl had higher hemoglobin levels [90 (42-153) g/L vs 78.5 (28-146) g/L, P=0.015].The proportions of Revised International Prognostic Scoring System (IPSS-R) high/very high risks and poor/very poor IPSS-R karyotypes were higher in MCV≤100 fl cohort (28.8% vs 10.8%, P=0.003; 24.7% vs 12.9%, P=0.049) . MCV≤100 fl cohort had more genetic mutations than those with MCV>100 fl though without significance (0.988 vs 0.769, P=0.064) . Mutated SF3B1 was less frequently in MCV≤100 fl cohort (4.7% vs 15.4%, P=0.018) . Conclusion: MCV≤100 fl was an independent adverse variable after adjusting for clinical and laboratory variables and mutation topography in MDS patients with bone marrow blasts<5%.


Asunto(s)
Médula Ósea , Síndromes Mielodisplásicos , Índices de Eritrocitos , Humanos , Cariotipificación , Pronóstico
19.
Zhonghua Xue Ye Xue Za Zhi ; 41(1): 40-46, 2020 Jan 14.
Artículo en Chino | MEDLINE | ID: mdl-32023753

RESUMEN

Objective: To explore the clinical characteristics, the best treatment and prognostic factors of primary pulmonary NK/T-cell lymphoma. Methods: A total of 24 cases with primary pulmonary NK/T-cell lymphoma from April 2011 to May 2019 were analyzed retrospectively. Survival analysis was performed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariate analysis using Cox proportional hazard regression model was conducted to confirm independent prognostic factors for overall survival (OS) and progression-free survival (PFS) . Results: ①The cohort of 24 patients included 16 male and 8 female with a median age of 49 years (range, 4-76 years) old. ②Most patients initially presented with a fever (66.7%) , cough and dyspnea. Chest imaging manifestations were primarily unilateral (45.8%) or bilateral (54.2%) pulmonary consolidation, nodules or mass. ③20 patients received chemotherapy, radiotherapy or hematopoietic stem cell transplantation, the rest 4 cases palliative treatment. Median OS was 9.5 months (range, 0.1-26.0 months) . The estimated 1-year OS rate was 45.8%. Overall response rate of patients treated with asparaginase-based regimen was 88.2%. ④In univariate survival analysis, age≤60 was prognostic for longer OS and PFS, compared with age>60 (P=0.002 and 0.004, respectively) ; ECOG≤2 was prognostic for longer OS and PFS, compared with ECOG>2 (P=0.042 and 0.004, respectively) . In multivariate survival analysis, age>60 and ECOG>2 were significantly correlated with inferior OS and PFS (OS: P=0.024 and 0.024, respectively; PFS: P=0.035 and 0.024, respectively) . Conclusions: Primary pulmonary NK/T-cell lymphoma was a rare disease with poor prognosis. Asparaginase-based regimens appeared to be effective. Age and ECOG served as independent prognostic factors for primary pulmonary NK/T-cell lymphoma patients.


Asunto(s)
Linfoma Extranodal de Células NK-T , Adolescente , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica , Asparaginasa , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Adulto Joven
20.
Zhonghua Xue Ye Xue Za Zhi ; 41(1): 47-53, 2020 Jan 14.
Artículo en Chino | MEDLINE | ID: mdl-32023754

RESUMEN

Objective: To analyze the prognostic value of baseline serum free light chain (sFLC) in immunoglobulin light-chain cardiac amyloidosis (AL-CA) . Methods: Thirty patients diagnosed with AL-CA from January 2012 to December 2016 at Beijing Chaoyang Hospital were included in this study to retrospectively evaluate the clinical data. The cut-off value of dFLC (involved sFLC minus uninvolved sFLC) was determined according to the receiver operator characteristic curve (ROC) and grouped, the prognoses of both groups were evaluated. Results: The onset age of all AL-CA patients was 57 years old. It occurred more commonly in men (21 cases, 70%) and the light chains of immunoglobulin composed mainly of type λ (22 cases, 73.3%) . Renal involvements occurred in 17 cases (56.7%) . The median value of difference between involved and uninvolved serum immunoglobulin free light chain levels (dFLC) was 162.9 (57.9-401.6) mg/L. More subjects in the high dFLC group had higher BNP (P=0.005) , and shorter median survival than those in the low dFLC group (15 months vs 47 months, P<0.001) . Similar results of median survival were observed when the patients were redivided by a new cut-off value of 180 mg/L for dFLC (high dFLC group: 22 months, low dFLC group: 40 months, P=0.001) , or a κ/λ ratio in which patients with κ type sFLC-ratio<3.79 and λ type sFLC-ratio≥0.06 were grouped into the low sFLC-ratio (37 months) , and the reverse the high sFLC-ratio ones (25 months, P=0.021) . In multivariate analysis, dFLC and New York Heart Association (NYHA) classification of cardiac function were two risk factors associated with all-cause mortality in patients, of them the hazard ratio for higher dFLC was 12.13 (95%CI 2.98-49.30, P<0.001) . Conclusion: Measurement of the sFLC level could implicate the prognosis of AL-CA.


Asunto(s)
Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas , Riñón , Femenino , Humanos , Cadenas Ligeras de Inmunoglobulina , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos
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