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Multiple myeloma is one type of hematological malignancy, characterized by the proliferation and accumulation of monoclonal plasma cells in bone marrow. Bone marrow microenvironment plays a key supporting role in the proliferation and survival of myeloma cells, where a large number of immune cells exist but are functionally suppressed. Based on the studies of myeloma immune microenvironment in recent years, we summarize the recent advances and existing problems in the treatment of multiple myeloma and put forward some considerations and suggestions, to provide references for researchers in this field.
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Objective:To investigate the effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treatment of high-risk multiple myeloma (MM) patients and its influencing factors of the prognosis.Methods:The clinical data of 44 high-risk MM patients treated with allo-HSCT in Changzheng Hospital Affiliated of Naval Military Medical University from April 2003 to March 2017 were retrospectively analyzed. The overall response rate (ORR), relapse rate, non-relapse-related death (NRM) rate, graft-versus-host disease (GVHD) incidence of patients were also analyzed. Kaplan-Meier was used to analyze the overall survival (OS) rate and progression-free survival (PFS) rate after transplantation. Cox proportional hazard model was used to make regression analysis of the factors affecting the prognosis.Results:Among 44 patients, 38 cases could be evaluated for efficacy after transplantation. The median follow-up time was 111 months (0-216) months, 22 cases survived, 22 cases died, 21 cases relapsed. Before transplantation, complete remission (CR) rate was 29.5%(13/44), very good partial remission(VGPR) rate was 45.5%(20/44), partial remission (PR) rate was 22.7% (10/44), stable disease (SD) rate was 2.3% (1/44); After transplantation, CR rate was 71.7%(27/38), VGPR rate was 13.2% (5/38), PR rate was 13.2% (5/38), the progression of the disease (PD) rate 2.6% (1/38). The 5-year OS rate and PFS rate was 51.8% and 47.8%, the 10-year OS rate and PFS rate was 51.3% and 43.1%, respectively; the 5-year and 10-year cumulative disease relapse rate was 38.6% and 45.4%, the 5-year cumulative NRM rate was 25.0%. Acute GVHD rate was 38.6% (17/44) and grade 3-4 acute GVHD rate was 6.8% (3/44); chronic GVHD rate was 27.3% (12/44). Cox univariate and multivariate analysis showed that the use of bortezomib before transplantation ( HR = 3.461, 95% CI 1.211-9.880, P = 0.020) and post-transplant infection ( HR = 0.283, 95% CI 0.098-0.819, P = 0.020) were independent factors affecting OS after transplantation. Conclusions:Allo-HSCT can overcome the high-risk factors of MM and is worth to try for high-risk MM patients. The use of bortezomib before transplantation and post-transplant infection can be important factors affecting OS after transplantation.
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Objective:To investigate the effects of thrombolytic therapy time on serum inflammatory factors, cathepsin S, connective tissue growth factor (CTGF), left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) in patients with acute ST-elevation myocardial infarction.Methods:The clinical data of 119 patients with acute ST-elevation myocardial infarction who received thrombolytic therapy in the People's Hospital of Taierzhuang District of Zaozhuang from January 2019 to May 2020 were retrospectively analyzed. These patients were assigned to three groups according to different time points at which thrombolytic therapy was performed: group A (the time from onset to thrombolytic therapy ≤ 3 hours, n = 27), group B (3 hours < the time from onset to thrombolytic therapy ≤ 6 hours, n = 39), group C (6 hours < the time from onset to thrombolytic therapy ≤ 12 hours, n = 53). Recanalization rate, recanalization time, ST segment resolution rate at 2 and 12 hours, serum levels of inflammatory factors [including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP)], cathepsin S, CTGF, LVEF, and LVEDD, and incidence of cardiovascular adverse events. Results:Recanalization time in group C was (148.73 ± 15.37) minutes, which was significantly longer than that in groups A and B [(89.34 ± 8.95) minutes, (98.76 ± 9.33) minutes]. Recanalization rate and ST segment resolution rate at 2 and 12 hours in group C were 45.28%, (40.17 ± 4.77) %, (73.92 ± 8.24) %, respectively, which were significantly lower than those in the groups A and B [96.30%, 79.49%, (47.42 ± 5.12)%; (83.68 ± 9.33)%, (43.56 ± 4.87)%, (78.73 ± 8.44)%] ( t/ χ2 = 248.088, 4.244, 20.204, 11.146, 18.508, 19.861, 6.271, 4.789, 17.995, 10.932, 3.339, 4.111, 4.100, 3.828, 3.100, 2.244, all P < 0.05). At 2 and 12 hours after thrombolytic therapy, IL-6, TNF-α and hs-CRP levels in group C were (23.29 ± 2.12) ng/L, (27.03 ± 2.75) ng/L, (6.49 ± 2.37) mg/L, (22.73 ± 2.05) ng/L, (26.24 ± 2.37) ng/L and (6.01 ± 2.53) mg/L, respectively, which were significantly higher than those in groups A and B ( t = 54.578, 54.578, 10.638, 8.584, 8.735, 5.199, 7.909, 7.171, 3.597, 1.382, 1.584, 1.008, 7.237, 5.190, 4.364, 8.829, 11.114, 2.585, 3.172, 6.815, 2.196, all P < 0.05). At 2 and 12 hours after thrombolytic therapy, cathepsin S and CTGF levels in group C were (29.97 ± 3.98) μg/L, (30.03 ± 4.79) μg/L, (28.05 ± 2.13) μg/L, (28.29 ± 4.31) μg/L, respectively, which were significantly higher than those in groups A and B [(31.74 ± 3.56) μg/L, (29.87 ± 4.91) μg/L; (20.81 ± 2.35) μg/L, (16.94 ± 3.46) μg/L; (30.95 ± 3.79) μg/L, (29.93 ± 4.95) μg/L; (26.37 ± 2.44) μg/L, (21.46 ± 4.79) μg/L, t = 93.870, 68.555, 15.039, 12.562, 6.345, 7.679, 3.096, 1.966, 13.882, 3.514, 11.863, 7.164, 9.239, 4.199, all P < 0.05). At 2 and 12 hours after thrombolytic therapy, LVEF and LVEDD in group C were (42.81 ± 4.77)%, (52.64 ± 4.71) mm, (43.13 ± 5.11)%, (51.57 ± 4.01) mm, respectively, which were significantly lower than those in groups A and B [(42.61 ± 4.58)%, (52.31 ± 4.47) mm, (46.33 ± 4.35)%, (47.75 ± 3.41) mm, (42.73 ± 4.79)%, (52.79 ± 4.76) mm, (44.79 ± 4.44)%, (49.93 ± 3.73) mm, t = 4.285, 9.193, 3.060, 4.214, 1.970, 2.953, 0.333, 1.259, 2.779, 1.626, 4.229, 1.996, 1.404, 2.416, all P < 0.05). The total incidence of cardiovascular adverse events was 7.41%, 12.82% and 33.96% in groups A, B and C, respectively ( χ2 = 4.383, all P < 0.05). Conclusion:The earlier the thrombolytic therapy time after acute ST-elevation myocardial infarction, the higher the recanalization rate and ST segment resolution rate, the milder the inflammatory reaction, atherosclerosis, the better the cardiac remodeling, the better the recovery of cardiac function, and the lower the incidence of cardiovascular adverse events.
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With continuous discovery of tumor immune targets and continuous changes in antibody research and development technology, antibody drugs are becoming more and more widely used in clinical practice. However, some targets are not only expressed on tumor cells, but also on red blood cells. Therefore, the clinical application of antibodies against the corresponding targets may interfere with the detection of blood transfusion compatibility, resulting in difficulty in blood matching or delay of blood transfusion. This consensus summarizes the current solutions for the interference of CD38 monoclonal antibody (CD38 mAb) in transfusion compatibility testing. After analyzing the advantages and disadvantages of different methods, polybrene and sulfhydryl reducing agents [dithiothreitol (DTT) or 2-mercaptoethanol (2-Me)], as a solution for CD38 mAb interference in blood compatibility testing, are recommended for Chinese patients, so as to eliminate blood transfusion interference produce by CD38 mAb and further provide a pre-transfusion workflow for clinicians and technicians in Department of Blood Transfusion.
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The application progress of machine learning in research of acupuncture and moxibustion was reviewed from three aspects: mining of acupuncture and moxibustion prescription and indications, acupuncture efficacy prediction and its influencing factors, acupoint specificity and acupuncture manipulation research, and the existing problems in current research and future research trends were discussed. It is believed that the appropriate machine learning algorithm should be selected to build the model according to the research purpose and data characteristics in the future research; attention should be paid to feature design, feature selection and feature cleaning; sample data collection should be a priority, and data sharing platform and standardized data collection should be developed to improve the data quality.
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Acupuncture , Acupuncture Points , Acupuncture Therapy , Machine Learning , MoxibustionABSTRACT
Objective@#To evaluate the prognostic value of serum free light chain ratio (rFLC) and difference (dFLC) in patients with multiple myeloma (MM) .@*Methods@#Clinical data of 479 cases of newly diagnosed MM patients with FLC test records referred to our hospital from January 2012 to March 2016 were collected. rFLC preferred cut-off values were selected as≤14.828,14.828-364.597, ≥364.597 according to the literatures. The dFLC was divided into ≤112.85,112.85-2891.83, ≥2891.83 mg/L three groups. The rFLC and dFLC values among the death, the non-death, the progress and the non-progress groups were compared by t test. The correlation analysis showed that the rFLC and dFLC values were related to the death or progression of the disease. Logistic regression was used to analyze the correlation between each factor and death or progression. Univariate survival analysis (PFS) and total survival (OS) were performed using Kaplan-Meier. Single-variable and multivariate prognostic analysis were performed using Cox model.@*Results@#The cutoff values of rFLC less than 14.828 or dFLC less than or equal to 112.85 mg/L impacted most significant on OS and PFS of the patients (P<0.05) . Different rFLC cut-off values between two groups showed that when rFLC=14.828, OS was significantly better than the other two groups (NR vs 61 & 47 months, P=0.019) ; different dFLC cut-off values between two groups disclosed that PFS and OS were statistically significant when dFLC less than or equal to 112.85 mg/L compared with the other two groups (P<0.05) . The 4-year PFS/OS rates in the initial dFLC≤112.85 mg/L and rFLC≤14.828 groups was significantly higher than of the other two groups.@*Conclusion@#Different cutoff levels of rFLC and dFLC might have obviously effects on the prognoses of patients with newly diagnosed MM. The difference of survival prognosis would be more pronounced when rFLC≤14.828 or dFLC≤112.85 mg/L with lower risk of death and lower risk ratio, which might be ideal cutoff value for determining the prognosis of these patients.
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Multiple myeloma (MM) is a hematologic malignancy of clonal proliferation of plasma cells, which ranks the second in he-matologic malignancy. Proteasome is a complex enzyme in the cell, which can degrade ubiquitin-labeled proteins and regulate intracel-lular protein levels and play an important role in maintaining the stability of the intracellular environment. In recent years, with the ap-plication of new proteasome inhibitors, great progress has been achieved in MM treatment, further improving the therapeutic efficacy of myeloma.
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<p><b>Background</b>Despite its limitations, unfractionated heparin (UFH) has been the standard anticoagulant used during percutaneous coronary intervention (PCI). This study compared the safety of low-dose UFH with sequential enoxaparin with that of UFH in patients with diabetes mellitus (DM) and complex coronary artery disease receiving elective PCI.</p><p><b>Methods</b>In this retrospective study, 514 consecutive patients with atherosclerotic cardiovascular diseases and type 2 DM were admitted to the hospital and received selective PCI, from January 2013 to December 2015. All patients with PCI received low-dose UFH with enoxaparin (intraductal 50 U/kg UFH and 0.75 mg/kg enoxaparin, n = 254; UFH-Enox group) or UFH only (intraductal 100 U/kg UFH, n = 260; UFH group). The study endpoints were major adverse cardiac events (MACEs), namely death, myocardial infarction (MI), stroke, target-vessel immediate revascularization (TVR), and thrombolysis in MI (TIMI) major bleeding, within 30 days and 1 year after PCI. Any catheter thrombosis during the procedure was recorded.</p><p><b>Results</b>Only one patient had an intraductal thrombus in the UFH group. At the 30-day follow-up, no MACE occurred in any group; seven and five cases of recurrent angina and/or rehospitalization were reported in the UFH-Enox and UFH groups, respectively; there was no significant difference between the two groups (χ = 0.11, P = 0.77). There was no TIMI major bleeding in the groups. With respect to the 1-year endpoint, two cases of recurrent MI and two of TVRs were reported in the UFH-Enox group, whereas in the UFH group, one case of recurrent MI and three of TVRs were reported; no significant difference existed between the two groups (χ = 0, P = 0.99). There were 30 and 25 recurrent angina and/or rehospitalizations in the UFH-Enox and UFH groups, respectively; there was no significant difference between the two groups (χ = 0.37, P = 0.57).</p><p><b>Conclusion</b>In elective PCI, low-dose UFH with sequential enoxaparin has similar effects and safety to the UFH-only method.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anticoagulants , Therapeutic Uses , Coronary Artery Disease , Drug Therapy , General Surgery , Diabetes Mellitus , Drug Therapy , General Surgery , Enoxaparin , Therapeutic Uses , Heparin , Therapeutic Uses , Percutaneous Coronary Intervention , Methods , Retrospective StudiesABSTRACT
Objective To investigate the clinical effect of atorvastatin combined with coenzyme Q 10 in the treatment of early cardiac dysfunction in patients with coronary heart disease .Methods From January 2015 to January 2017 ,86 patients with early cardiac dysfunction in the People's Hospital of Taierzhuang District were selected . According to the random number method ,the patients were divided into two groups ,with 43 patients in each group. The control group was treated with atorvastatin .The observation group was given atorvastatin combined with coenzyme Q10.All the patients were treated for 30 days.The levels of NT -porBNP and MMP -9 and the changes of echocardiographic parameters were compared between the two groups .Results After treatment, the levels of NT-porBNP and MMP -9 in the observation group were (150.1 ±20.1) pg/mL and (2.12 ±0.05)μg/L, respectively,which were lower than those in the control group (t=37.590,103.638,all P<0.05).The LVEDD and LVESD of the observation group were (46.0 ±3.6)mm and (41.5 ±2.9)mm,respectively,which were lower than those in the control group (all P<0.05).The LVEF of the observation group was (66.5 ±2.9)％,which was higher than that of the control group (P<0.05).Conclusion Atorvastatin combined with coenzyme Q10 treatment can significantly improve cardiac function and reduce myocardial injury .
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Objective: To preliminarily analyze the graft flow of right internal mammary artery (RIMA) in patients after coronary artery bypass grafting (CABG) using bilateral internal mammary artery (BIMA). Methods: A total of 52 patients received CABG by BIMA in our hospital from 2015-12 to 2016-07 were studied. The patients were younger than 65 years at the mean age of (56.6±6.8) years including 46 male. According to conduit grafting to left anterior descending artery (LAD), the patients were divided into 2 groups: RIMA anastomosed to LAD group, n=42 and LIMA anastomosed to LAD group, n=10. The immediate graft flow was measured by Veri Q system, surgical outcomes and graft flows were compared between 2 groups. Results: There were no operative death in all 52 patients, 1 had poor wound healing and received debridement and suturing, no one had operative complication in left 51 patients. The average LAD bridge flow in both groups were (28.7±11.5) ml/min and (31.8± 11.7) ml/min, the mean pulsation index (PI) were (2.3±0.7) and (2.0±0.4), P>0.05; the average RIMA graft flow were (28.7±11.5) ml/min and (21.1±11.0) ml/min, the mean PI were (2.3±0.7) and (2.6±1.1), P>0.05. Conclusion: Flows in RIMA-LAD graft and LIMA-LAD graft were similar; the flow of RIMA anastomosed to other target vessel was satisfactory which was an ideal graft for CABG.
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Objective To explore the clinical effect of Weikangling and Weifuchun treatment of chronic atrophic gastritis and precancerous lesions.Methods 85 cases of CAG precancerous lesions treated in our hospital from Jan.2012 to Dec.2016 were selected as the research object,and were randomly divided into control group (n =41) and study group (n =44).The control group were given Weifuchun,and the study group were given Wei Kangling.The pathological score and clinical efficacy were compared between the two groups before and after treatment.Results After treatment,inflammation,atrophy,intestinal metaplasia scores of the two groups were significantly decreased than before treatment in addition to dysplasia (P ＜ 0.05),and inflammation and intestinal metaplasia in the study group were significantly lower than those in the control group (P ＜ 0.05).The total effective rate of the study group was 90.91％,which was higher than75.61％ of the control group (P ＜ 0.05).Conclusions The effect of Wei Kangling in treating precancerous lesions of CAG is significant,especially for the histological changes of inflammation and intestinal metaplasia.
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Objective To explore the clinical effect of Weikangling and Weifuchun treatment of chronic atrophic gastritis and precancerous lesions.Methods 85 cases of CAG precancerous lesions treated in our hospital from Jan.2012 to Dec.2016 were selected as the research object,and were randomly divided into control group (n =41) and study group (n =44).The control group were given Weifuchun,and the study group were given Wei Kangling.The pathological score and clinical efficacy were compared between the two groups before and after treatment.Results After treatment,inflammation,atrophy,intestinal metaplasia scores of the two groups were significantly decreased than before treatment in addition to dysplasia (P ＜ 0.05),and inflammation and intestinal metaplasia in the study group were significantly lower than those in the control group (P ＜ 0.05).The total effective rate of the study group was 90.91％,which was higher than75.61％ of the control group (P ＜ 0.05).Conclusions The effect of Wei Kangling in treating precancerous lesions of CAG is significant,especially for the histological changes of inflammation and intestinal metaplasia.
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Objective: To introduce the construction idea and function for establishing China Cardiovascular Surgery Registry (CCSR)database and to provide a reference for domestic congener databases. Methods: Using peer database as reference, taking current status of cardiovascular surgery registry and hardware in our country with the necessity of international communication, we worked on a variables selection, metadata instruction, logic rules, case report form develpment and finally established a web-based, multi-functional database that enabled cross-database and international merging of data, forming a national intelligent data-exchanging platform for cardiovascular surgery. Results:CCSR database has over 300 variables of multiple topics including basic information, risk factors, medical procedures and endpoint events. Taking clinical and association data exchange standards as reference, it may conduct cross-discipline data connection, record important peri-operative information in relevant patients and meanwhile, it has the functions of automatic logic check, data report, statistical study, data export and importing the electronic medical records. Conclusion:CCSR database is a national platform accord with current status of Chinese cardiovascular surgery and characteristics, meanwhile it gives consideration to international communication and data exchange; which may play a important role in improving medical care and clinical investigation.
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OBJECTIVE: To study the influence of bioavailability of Epimedium flavonoids after processing by suet oil. METHODS: Pharmacokinetics parameters of rats Epimedium flavonoids and icariin and baohuoside I was determining by the method of pharmacology effect and plasma concentration method. RESULTS: The concentration of the Epimedium flavonoids, icariin and baohuoside I in micelles groups were higher than that of the active pharmaceutical ingredient(API). ρmax were increased by 77.94%, 38.99% and 49.90%; AUC0-t increased by 95.19%, 37.76% and 43.49%; AUC0-∞ increased by 119.35%, 35.37% and 46.26% on Epimedium flavonoids, icariin and baohuoside I group. CONCLUSION: Suet oil improved the bioavailability of Epimedium flavonoids and promoted its absorption.
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Objective@#To investigate the pathogen spectrum distribution and drug resistance of febrile neutropenic patients with hematological diseases in Shanghai.@*Methods@#A retrospective study was conducted on the clinical isolates from the febrile neutropenic patients hospitalized in the departments of hematology in 12 general hospitals in Shanghai from January 2012 to December 2014. The drug susceptibility test was carried out by Kirby-Bauer method. WHONET 5.6 software was used to analyze pathogenic bacteria and drug susceptibility data.@*Results@#A total of 1 260 clinical isolates were collected from the febrile neutropenic patients. Gram-positive bacteria accounted for 33.3% and Gram-negative bacteria accounted for 66.7%. Klebsiella pneumoniae (12.5%) , Stenotrophomonas maltophilia (9.5%) , Escherichia coli (9.1%) , Pseudomonas aeruginosa (8.7%) , Acinetobacter baumannii (6.6%) , Staphylococcus aureus (5.6%) and Enterococcus faecium (5.0%) were ranked in the first 7 of all pathogens. In the respiratory tract secretions specimens, non-fermented strains accounted for 56.2%. Stenotrophomonas maltophilia accounted for 15.2%. Enterobacteriaceae and coagulase-negative Staphylococci accounted for 42.3% (104/246) and 32.6% (85/246) respectively in blood samples. Enterobacteriaceae and Enterococcus bacteria accounted for 39.4% (76/193) and 28.5% (55/193) respectively in pus specimens. The detection rates of methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative Staphylococci (MRCNS) were 54.3% and 82.5%, respectively. Staphylococcus bacterial strain was not found to be resistant to linezolid, vancomycin and teicoplanin. The detection rate of Enterococcus vancomycin-resistant strains was 8.9%. Enterococcus was not detected resistance to oxazolidinone strains. Enterobacteriaceae bacteria were highly sensitive to carbapenems. The resistance rate of Pseudomonas aeruginosa to imipenem and meropenem was 34.1% and 15.8%, respectively. Stenotrophomonas maltophilia was more sensitive to minocycline hydrochloride, levofloxacin and sulfamethoxazole. The resistance rate of Acinetobacter baumannii only to cefoperazone-sulbactam was less than 10.0%. The antibiotic resistance rate of Klebsiella pneumoniae, Stenotrophomonas maltophilia, Pseudomonas aeruginosa and Acinetobacter baumanii to most of common antibiotics was lower than that of the CHINET surveillance.@*Conclusions@#The pathogenic strain distribution in common infection sites of febrile neutropenic patients was characterized. Bacterial resistance surveillance was better than the CHINET nationwide large sample surveillance in China.
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Objective@#To evaluate efficacy of the BiRd regimen, a combination of clarithromycin, lenalidomide, and dexamethasone, in the treatment of patients with relapsed/refractory multiple myeloma (RRMM) .@*Methods@#Patients with RRMM treated with BiRd between September 11, 2013 and August 1, 2016 at six centers were included to evaluate overall survival rate (ORR) , clinical benefit rate (CBR) , progression-free survival (PFS) , overall survival (OS) , as well as adverse events.@*Results@#Of 30 patients with RRMM, 27 patients were evaluable, and ORR and CBR were 51.9% (14/27) and 66.7% (18/27) respectively, including 1 sCR (3.7%) , 3 CR (11.1%) , 3 VGPR (11.1%) , and 7 PR (25.6%) . In 13 patients with prior Rd, ORR and CBR were 38.5% (5/13) and 61.5% (8/13) respectively, of which 5 patients with ≥MR carried high-risk cytogenetic[ (e.g.17p- or t (4;14) ] together with at least one of other adverse-prognostic cytogenetic (e.g.13q- and/or 1q21+) . In 24 patients with prior bortezomib-based therapy, ORR and CBR were 45.8 and 62.5%, respectively. With a median follow-up time of 14.9 (range 1.0-33.8) months, the median PFS and OS were 12.0 (95%CI 11.6-12.4) and 27.6 (95%CI 15.1-40.1) months, respectively. The BiRd regimen was well tolerated.@*Conclusion@#The BiRd regimen is an effective and safety protocol for RRMM, including those carrying high-risk cytogenetic markers.
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Objective@#To explore the clinical features and prognostic factors of elderly MM patients.@*Methods@#A retrospectively analysis of clinical characteristics in 93 newly diagnosed MM patients with more than 70 years of old between August 2011 and August 2016. Based on age, basic activities of daily living scale, instrumental activities of daily living scale, Charlson comorbidity index at diagnosis, patients were divided into three groups: Fit (score=0, n=15) , Intermediate fitness (score=1, n=31) , Frail (score≥2, n=47) according to a geriatric assessment system proposed by Antonio Palumbo et al. The treatment response rate, progression free survival time (PFS) and overall survival (OS) of the three groups were analyzed.@*Results@#Complete remission was 60.0% in Fit, 22.6% in Intermediate fitness and 12.8% in Frail (Fisher χ2=12.398, P=0.002) . The median PFS for the three groups were 31 months, 24 months and 13 months (χ2=17.832, P<0.001) . The median OS was not reached for Fit, 58 months for Intermediate fitness and 25 months for Frail (χ2=40.678, P<0.001) . In 47 Frail cases, patients who received chemotherapy containing new drugs (proteasome inhibitor or immune-modulator) had a longer PFS (17 months vs 9 months, χ2=6.454, P=0.011) and patients who achieved CR had prolonged PFS and OS than non-CR (PFS: 24 months vs 12 months, χ2=4.117, P=0.042; OS: 37 months vs 25 months, χ2= 6.507, P=0.011) .@*Conclusion@#The health status of the elderly MM patients was associated with better response and longer PFS and OS. Given on those with poor health status, new drugs may have better PFS and prolonged OS.
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Objective@#To explore the effect of 6 common cytogenetic abnormalities on the prognosis of multiple myeloma (MM).@*Methods@#Myeloma cells from a cohort of 532 newly-diagnosed MM patients enrolled were enriched by CD138 immunomagnetic beads, then detected 13q-, 17p-, 1q+, t (4;14), t (11;14) and t (14;16) and other common genetic abnormalities in MM by using interphase fluorescence in situ hybridization (FISH) technique to compare the influence of different genetic abnormalities on their prognoses.@*Results@#The rate of cytogenetic abnormalities was 78.20% (416/532) in 532 patients, of which 13q-accounted for 42.29% (225/532), 17p-16.35% (87/532), 1q+ 53.38% (284/532), t (4;14) 25.94% (138/532), t (11;14) 21.62% (115/532), t (14;16) 2.07% (11/532). Six kinds of cytogenetic abnormalities were analyzed, 13q- and 17p-, 1q+, t (4; 14), t (14;16) were all correlated (P <0.05). The univariate analysis indicated that 13q-, 1q+, t (4;14) and t (14;16) had a significant effect on progression-free survival (PFS), 13q-, 17p-, t (4;14) and t (14;16) had a marked influence on overall survival (OS). The multivariate analysis showed that 1q+, t (4;14) and t (14;16) were independent adverse factors of PFS, 17p-, t (4;14) and t (14;16) were independent unfavorable factors of OS. According to the independent prognosis factors number-based groups, the median PFS with 0, 1, 2, 3 independent prognosis factors of patients were 30.9, 28.4, 18.7 and 17.6 months (P =0.035) respectively, and the median OS were 54.4, 46.1, 38.0 and 21.2 months (P =0.004) respectively.@*Conclusion@#1q+, 17p-, t (4;14) and t (14;16) were independent prognostic factors affecting the survival of MM patients. 13q-is often accompanied by 17p-, 1q + and (or) t (4;14) , simply 13q- was not an independent prognostic factor; the more number of independent prognostic factors, the worse the prognosis of patients.
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Objective@#To assess the prognostic value of revised international staging system (R-ISS) for multiple myeloma (MM) in real world.@*Methods@#A total of 202 newly diagnosis symptomatic MM patients were enrolled from May 2010 to April 2015 and the clinical data were retrospectively analyzed. All the patients received at least four courses of bortezomib-based or thalidomide-based induction therapy.@*Results@#With a median follow-up of 31 months, the cohort included 56 cases in R-ISSⅠ, 108 in R-ISS Ⅱ, and 38 in R-ISS Ⅲ, and the median OS was not reached/61/38 months, respectively (P=0.001). According to the ISS system, 62 patients were classified in ISS-Ⅰ, 70 in ISS-Ⅱ and 70 in ISS-Ⅲ, with the median OS was 58, 52 and 40 months, respectively (P=0.001). The relative risk (HR) of R-ISS stage Ⅲ vs Ⅰ, Ⅱ vs Ⅰ were 9.606 (P=0.008) and 4.038 (P=0.029). The HR of Ⅲ vs Ⅰ, Ⅱ vs Ⅰ of ISS system were 4.127 (P=0.070) and 2.877 (P=0.005). In the subgroup analysis, R-ISS predicted survival for patients who were not transplanted (P=0.003) , receiving bortezomib-based therapy (P=0.010) , and patients younger than 65 years (P=0.001).@*Conclusion@#R-ISS system could better predict prognosis for OS in unselected nonclinical trial myeloma patients than ISS system, especially for the younger patients, patients with bortezomib-based therapy, and patients without transplantation.
ABSTRACT
<p><b>BACKGROUND</b>Foreign bodies within the sinuses, orbit, and skull base (FBSOS) are rare; hence, diagnosis and management guidelines are lacking. Endoscopic sinus surgery (ESS) removal is preferred because of the less invasiveness and minimal morbidity. This study was designed to summarize clinical experience with ESS management of FBSOS.</p><p><b>METHODS</b>We retrospectively reviewed clinical manifestations, imaging findings, treatment, and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center. The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS.</p><p><b>RESULTS</b>There were 23 male and five female patients, with median age of 11 years. FBSOS were located within the sinuses (86%), orbit (75%), and skull base/intracranial region (46%). Wooden FBSOS had a significantly higher risk of infection (78%) compared with nonwooden FBSOS (5%, P < 0.05). Contrast-enhanced computed tomography (CT) plus three-dimensional reconstruction was sensitive in all cases. Twenty-seven (96%) FBSOS were removed by ESS alone, while 1 (4%) FBSOS was removed using the combined ESS and lateral cervical approach. Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid (CSF) leak and received endoscopic CSF leak repair. Twelve (43%) patients suffered complications (meningitis, diplopia, and vision loss).</p><p><b>CONCLUSIONS</b>ESS is a minimally invasive, safe, and promising surgical approach for FBSOS removal. Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance. Wooden FBSOS had higher risk of infection, thus antibiotics are recommended.</p>