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Objective:To explore the safety and efficacy of chimeric antigen receptor T-cell (CAR-T) therapy for relapsed/refractory acute B-cell lymphoblastic leukemia (B-ALL) with T315I mutation.Methods:The clinical data of a patient with relapsed/refractory B-ALL with T315I mutation who underwent CAR-T therapy in the Second Affiliated Hospital of Anhui Medical University was analyzed, and the related literature was reviewed.Results:The patient was a 34-year-old man. He was diagnosed with chronic myelogenous leukemia (CML) in January 2017 and started to take imatinib orally. However, the primary affection transformed to B-ALL 4 months later. Because of the E355G gene mutation, the treatment drug was adjusted to dasatinib, and induction chemotherapy was given at the same time. The sequential consolidation chemotherapy was given for 3 times after complete remission (CR). After half a year of remission, T315I mutation was detected and re-induced chemotherapy was given, but ineffective. The patient was treated with CAR-T 3 days after FC regimen (fludarabine 30 mg/m 2 per day, day 1 to day 3; cyclophosphamide 200 mg/m 2, day 1 to day 3). The number of CD19 CAR-T was 1.0×10 9, 98% activity degree. Grade 1 cytokine-releasing syndrome appeared after infusion, and was resolved after symptomatic treatment. No serious adverse reactions were observed. CR was achieved half-month after CAR-T treatment, and umbilical cord blood transplantation was successfully performed 1 month later. At the last follow-up, the relapse-free survival time of the patient was 396 days. Conclusion:CAR-T therapy may be a new, safe and effective therapy for patients with relapsed/refractory B-ALL with T315I mutation.
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Background/Aim: Percutaneous thermal ablation combined with transarterial chemoembolization (TACE) becomes a treatment option for unresectable hepatocellular carcinoma (HCC). This study aims to investigate the safety and feasibility of percutaneous thermal ablation combined with simultaneous TACE for patients with HCC ≤ 5 cm. Materials and Methods: From June 2010 to February 2017, a total of 280 patients with HCC ≤ 5 cm who underwent percutaneous thermal ablation combined with simultaneous TACE were included in our study. Their clinical data were collected and analyzed. Results: Major complications occurred in five cases (1.8%). The complete necrosis rate was 91.9%. The median overall survival (OS) was 66.5 months (95% confidence interval [CI] = 57.7–75.2). The OS rates in 1-, 3-, 5-, and 7-year were 96.7%, 76.0%, 59.7%, and 31.1%, respectively. Tumor size (hazard ratio = 1.826; 95% CI = 1.131–2.947; P = 0.014) was considered as independent prognostic factors of long-term survival. Conclusion: Percutaneous thermal ablation combined with simultaneous TACE is a safe and effective treatment for HCC ≤ 5 cm.
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Objective@#To improve the understanding of high calcium risk in patients with diffuse large B-cell lymphoma (DLBCL) during the chemotherapy.@*Methods@#The diagnosis and treatment of high calcium risk in one patient with DLBCL during the chemotherapy in the Second Affiliated Hospital of Anhui Medical University was retrospectively analyzed, and the relevant literatures were reviewed.@*Results@#A 52-year-old man who was diagnosed with DLBCL (non-specific, non-germinal center source; stage Ⅳ group A; International prognosis index score 4 points, high-risk group) in June 2017. Two times R-CHOP chemotherapy was performed before diagnosis. This patient was admitted to the hospital for the third chemotherapy, and the disease assessment showed that the enlarged lymph nodes were not significantly smaller than before, and the tumor burden was still high. Therefore, the chemotherapy regimen was adjusted to R-GDP regimen. However, on the 8th day after the end of rituximab treatment, the patient had head pain, which might be related to the patient's poor sleep and primary invasion of the primary disease (blood calcium: 2.94 mmol/L). And then the ibuprofen and diuresis treatments were given, but the symptoms were still gradually worsening, and vomiting appeared on the 9th day, systemic fatigue with drowsiness and irritability appeared on the 12th day. Review blood calcium: 5.02 mmol/L. Adequate fluid hydration, diuretic, renal replacement treatments were given, and the level of blood calcium gradually returned to normal. Finally, the patient's symptoms were improved significantly, and he successfully completed R-GDP chemotherapy.@*Conclusion@#If a DLBCL patient has symptoms such as headache, lethargy, irritability or even coma during the chemotherapy, it is necessary to alert the possibility of hypercalcemia and to timely improve the relevant examination and make symptomatic treatment.
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Objective@#To evaluate the role of multidisciplinary team (MDT) clinic in the diagnosis of pancreatic diseases and patient compliance with MDT advice in the current medical system.@*Methods@#The study included 512 patients that had visited the pancreas-oriented MDT clinic of Zhongshan Hospital between May 2015 and May 2019.The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. Compliance was determined according to whether a patient received corresponding therapies or undergoing further checks or follow-ups.@*Results@#Among the 512 patients that had visited the MDT clinic, 121 patients were referred due to undetermined diagnosis. Classified according to the final diagnosis, the rate of undetermined diagnosis in different disease categories from high to low in order was inflammatory diseases of the pancreas (75.0%, 24/32), other lesions of the pancreas (56.1%,23/41), pancreatic cystic lesions (19.1%,17/89), pancreatic carcinomas (18.3%,48/262) and pancreatic neuroendocrine neoplasms (pNEN)(10.2%,9/88). The MDT clinic made diagnosis to 68 patients directly with an accuracy of 89.7%. The rate of compliance in the entire cohort was 63.4%. The rate of compliance of patients from June 2017 to May 2019 (68.4%) was higher than that of patients from May 2015 to May 2017(59.6%). The compliance rate of patients in different disease categories from high to low in order was inflammatory diseases of the pancreas(84.4%, 27/32), pancreatic carcinomas (67.9%, 178/262), pNEN(60.2%,53/88), other lesions of the pancreas (56.1%,23/41), and pancreatic cystic lesions(49.4%, 44/89). The compliance rate of patients with different MDT advice from high to low in order was best supportive care(78.6%,22/28), antitumor approaches beyond surgery(71.6%,159/222), further tests(62.6%, 77/123), surgery(53.7%, 65/121) and follow-up(49.2%, 31/63). In patients suggested for surgery, the compliance rate of patients with carcinomas(67.4%, 33/49) was higher than patients with other kinds of neoplasms.@*Conclusions@#MDT clinic could facilitate the diagnosis of pancreatic diseases conveniently and inexpensively. The overall compliance rate of MDT clinic patients is rather low, and patients with carcinomas have a relative high rate of compliance with the suggestion of surgery.
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Objective To investigate the diagnosis and treatment value of digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) for post pancreatectomy hemorrhage (PPH),and influencing factors of severity of PPH.Methods The retrospective case-control study was conducted.The clinicopathological data of 20 patients with PPH who were admitted to the Zhongshan Hospital of Fudan University from August 2009 to November 2016 were collected.Patients with PPH in the early stage underwent reoperations for hemostasis;patients with PPH in the later stage received conservative treatment,and then DSA and TAE were considered when patients had the stable vital signs.Observation indicators:(1) DSA situations:overall times,positive rate and bleeding sites;(2) TAE situations:successful rate of hemostasis,operating time and postoperative complications;(3) follow-up situations;(4) influencing factors analysis of severity of PPH.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of complications after discharging from hospital up to April 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio and proportion.The univariate analysis was done using the Fisher exact probability.Results (1) DSA situations:all the 20 patients underwent DSA,with overall times of 27.The direct sign was 18 times extravasation of the contrast medium,with a positive rate of 66.7％ (18/27).Of 18 times positive DSA,clear bleeding sites were located in 5 times gastroduodenal artery (3 times with pseudoaneurysm of gastroduodenal artery stump),in 4 times common hepatic artery (3 times with pseudoaneurysm of common hepatic artery),in 3 times superior mesenteric artery,in 2 times splenic artery,in 1 time left gastric artery,in 1 time right gastric artery,in 1 time left hepatic artery (pseudoaneurysm of left hepatic artery) and in 1 time inferior mesenteric artery.(2) TAE situations:of patients with 18 times positive DSA,patients with 15 times positive DSA received TAE,with a successful rate of hemostasis of 13/15,and patients with 5 times positive DSA received successful hemostasis by reoperation.A median operating time of TAE for patients with 15 times positive DSA was 30 minutes.There was no occurrence of adverse reaction,including fever,abdominal pain,melena,elevated aminotransferase and liver abscess.One patient complicated with splenic abscess after transcatheter splenic arterial embolization underwent puncture drainage and then had a good recovery.Of patients with 9 times negative DSA,patients with 8 times negative DSA were cured by conservative treatment and patient with 1 time negative DSA received successful hemostasis by operation.All the 20 patients were cured and then discharged from hospital.(3) Follow-up situations:20 patients were followed up for 4-92 months,with a median time of 24 months.During the follow-up,20 patients recovered well,without long-term complications.(4) Influencing factors analysis of severity of PPH:the results of univariate analysis showed that gender,age,preoperative blood sugar,preoperative combined jaundice,preoperative albumin (Alb),preoperative prothrombin time (PT) extended,preserving pylorus,pancreatic duct stent placement,pancreatic operation time,volume of intraoperative blood loss,intraoperative blood transfusion,property of tumor,postoperative pancreatic fistula and time of PPH were not factors affecting the severity of PPH (P＞0.05).Conclusion DSA is minimal-invasive in the diagnosis for PPH,and TAE is safe and effective for patients with positive DSA.
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Objective To investigate the safety,effectiveness and prognosis of percutaneous microwave ablation (MWA) combined with synchronous transarterial chemoembolization (TACE) to treat of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) with liver metastases (LMs).Methods This retrospective study included 19 cases of GEP-NENs with LMs patients who received percutaneous MWA combined with synchronous TACE treatment from 2013 to 2016.The mRECIST standard was selected to assess the curative effect.SPSS 21.0 software was applied in the statistical analysis of overall survival (OS),progression-free survival (PFS) and factors related to prognosis.Results All patients were capable of curative effect evaluation,including 1 case of complete remission (CR),3 cases of partial remission (PR),7 cases of progressive disease (PD) and 8 cases of stable disease (SD) respectively accounting for 5 ％,16 ％,37 ％,42 ％,which exhibited 21％ of response rate (RR) and 63％ disease control rate (DCR).In the present study,the median OS and median PFS was respectively 25 months and 34 months,and the one-year survival and three-year survival was respectively 95％ and 84％.Serum CA199,the WHO classification of LMs and the tumor burden of LMs were the major risk factors of prognosis through single factor analysis of survival,which showed that G3 of the WHO classification of LMs predicted a poor OS (P＜0.05) and tumor burden of LMs was negatively related to PFS (P＜0.05).It was obviously observed that serum CgA was decreased by the therapy of percutaneous MWA with synchronous TACEfor GEP-NENs (P＜0.05).Conclusions Percutaneous MWA combined with synchronous TACE is a safe and effective method to treat GEP-NENs with LMs.
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Objective To investigate the safety and efficacy of transarterial chemoembolization (TACE) combined with implantation of irradiation IVC stent in treating hepatocellular carcinoma (HCC)complicated by inferior vena cava tumor thrombosis (IVCTT).Methods The clinical data of 61 consecutive patients with HCC complicated by IVCTT were retrospectively analyzed.Irradiation IVC stent was prepared by strapping 125I particles on the bare stent,and it was employed in 33 patients (group A).Bare stent was adopted in 28 patients (group B).Propensity score matching method was used to conduct randomized analysis of the original data in order to reduce the selection bias.The survival time,remission rate of symptom and procedure-related adverse events of both groups were calculated and the results were compared between the two groups.Results The incidence of adverse reactions was similar in the two groups,and symptomatic treatment with internal medicine was adopted.The survival time in group A was superior to that in group B.The median survival time in group A was (203.0±28.1) days,which was (93.0±24.3) days in group B (P=0.006).Propensity score matching (24 pairs in total) cohort analysis showed that the median survival time was (200±31) days in group A and (66±23) days in group B (P=0.019).The edema remission rates in group A and in group B were 97.0％ and 96.4％ respectively.Multiple factor analysis revealed that irradiation stent implantation and objective tumor response were independent factors predicting a good prognosis.Conclusion For the treatment of HCC associated with IVCTT,TACE combined with irradiation stent implantation is safe and effective,this therapy can prolong the patient's survival time
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Objective To evaluate the safety and efficacy of brachytherapy with 125I seed strand in treating implanted main portal vein tumor thrombus (MPVTT) in experimental rabbits.Methods VX2 tumor cell line was implanted in the main portal vein (MPV) of 32 New Zealand white rabbits to establish MPVTT models.The rabbits were randomly divided into the treatment group (group T,n=16) and the control group (group C,n=16).125I seed strand was implanted in the MPVTT of the rabbits of group T,while blank seed strand was implanted in the MPVTT of the rabbits of group C.After the implantation,the changes in general condition,body weight and laboratory testing results were recorded.Two weeks after the treatment,every 8 rabbits from each group were sacrificed,and the specimens were collected and sent for pathological examination.The remaining rabbits were fed till they died,and then autopsy was conducted.Multi-slice spiral CT manifestations,histopathological findings,Ki-67 labeling index and apoptosis index were used to assess the curative effect,and the results were compared between the two groups.Results At each observation time point after brachytherapy,the weight loss of the experimental rabbits was more obvious in group C than in group T.No statistically significant differences in liver functions and white blood cell count existed between the two groups (P＞0.05).The mean MPVTT volume of group T and group C were (565.40±220.90) mm3 and (2 269.90±437.00) mm3 respectively (P＜0.001);the Ki-67 labeling indexes were (4.14±1.84)％ and (33.82± 6.07)％ respectively (P=0.001);the median survival days were (39.50±2.37) d and (27.38±1.22) d respectively (P=0.001).Conclusion For the treatment of implanted MPVTT in experimental rabbits,brachytherapy with 125I seed strand is safe and effective.
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Objective To compare the short-term safety and efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of large benign thyroid nodules.Methods A total of 34 patients with large benign thyroid nodules were studied retrospectively,including 13 patients treated with ultrasound-guided RFA and 21 patients treated with MWA between Jun.,2016 and Feb.,2017 in Zhongshan Hospital.The thyroid function parameters,serum antibodies,complications and thyroid nodules volume reduction rate(VRR) were compared between the two groups during the follow-up.Results There were no statistically significant differences(P＞0.05)among those patients before and after treatment in serum free triiodothyronine (fT3),free thyroxine (fT4),thyroid stimulating hormone (TSH),anti-thyroglobulin antibodies (TG-Ab) levels,and thyroid peroxidase antibodies (TPO-Ab).One patient in the MWA group had mild hoarseness after ablation and another patient in the RFA group had intraoperative hemorrhage for about 10 mL.There were no other complications such as neck scar,postoperative infection,skin burns,tracheal and esophageal injury.One day after the ablation,all nodules were showed hypoecho and contrast-enhanced ultrasound proved there was no blood supply.One month after treatment,no statistically significant difference was found in VRR between two groups (23.8％ vs.22.6％,P =0.127).Conclusions RFA and MWA are safe and effective treatments for large benign thyroid nodules,and no significant difference was observed in short-term follow-up.
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Objective To investigate the safety and feasibility of intraluminal brachytherapy using iodine-125 seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice.Methods Clinical data of 17 consecutive patients,from January 2010 to February 2015,diagnosed with pancreatic ductal adenocarcinoma (4 cases of T4 N0 M0 and 13 of T4 N1M0) with obstructive jaundice and received intraluminal brachytherapy using iodine-125 seed strand were collected and analyzed retrospectively.Liver function was evaluated using paired-samples t test.The iodine-125 seed strand radiation doses were calculated using iodine-125 radiation field distribution calculation software (version 0.1,Institute of Radiation Medicine,Fudan University,Shanghai,China) based on the American Association of Physicists in Medicine TG43U1 brachytherapy formula.Obstruction free survival and overall survival were calculated using the Kaplan-Meier method.Complications were assessed according to the CTCAE 4.0 criteria.Results The estimated mean accumulating dose (r =5 mm,240 days) was 167.2Gy,from 164.19Gy to 170.05Gy.The mean and median obstruction free survival time were (9.62 ± 1.47) months (95％CI:6.73-12.50) and (7.26 ± 1.71) months (95 ％CI:3.90-10.62).The mean and median overall survival time were (9.89 ± 1.59) months (95％CI:6.78-13.00) and (7.26 ± 1.71) months (95 ％ CI:3.90-10.62),retrospectively.Total bilirubin and conjugated bilirubin decreased significantly after the therapy.Two patients had adverse event of Grade 3,one of Grade 4.Stent dysfunction occurred in 1/17 (5.9 ％) patients.Conclusions Intraluminal brachytherapy using iodine-125 seed strand might be considered as a safe treatment option for the locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice.
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Objective To investigate the curative effect of transcatheter arterial chemoembolization (TACE) combined with endovascular 125I seed strip implantation for the treatment of primary hepatocellular carcinoma (PHC) complicated by extensive portal vein tumor thrombus. Methods The clinical data of 72 patients with PHC complicated by extensive portal vein tumor thrombus were retrospectively analyzed. The patients were divided into group A (n=32) and group B (n=40). TACE combined with endovascular 125I seed strip implantation was performed for the patients of group A, while only TACE was employed for the patients of group B. The changes of portal vein tumor thrombus, the survival time and procedure-related adverse events were recorded. The preoperative and postoperative measured values were compared using paired samples t test, the count data were evaluated by χ2 test, and the survival time was analyzed with Kaplan-Meier method. Results Technical success rate of portal vein 125I seed strip implantation was 100%. No serious procedure-related adverse events occurred. The median survival periods of group A and group B were 210 days and 141 days respectively, the difference between the two groups was statistically significant (P=0.012). Conclusion For the treatment of primary hepatocellular carcinoma complicated by extensive portal vein tumor thrombus, TACE combined with endovascular 125I seed strip implantation can significantly improve the patient’s survival time.
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Objective To detect the expression of human endogeneous retrovirus family W env1 (HERVWE1) in placentas of normal pregnant women and patients with preeclampsia and explore its role in the pathogenesis of preeclampsia.Methods Fifty-two cases of placental tissues provided by Shandong Maternity Hospital were from iodine deficiency areas (county or city:.Zhangqu, Changqing, Pingyin) of Shandong Province, including 30 cases of preeclampsia placentas as case group, 22 cases of normal term pregnancy placentas as control group.The mRNA expression of HERVWE1, human chorionic somator mammotropin (HCS), chorionic specific transcription factor (GCMa) and amino acyl carrier 2 (ASCT-2) in placentas of the two groups were determined by real-time PCR, and the protein expression of HERVWE1 was determined by Western blotting.Results The mRNA expression levels of HERVWE1 (0.149 ± 0.045 vs.0.409 ± 0.028) and HCS (336.600 ± 50.100 vs.815.600 ± 101.300) in placentas of patients with preeclampsia were significantly lower than those in the control group (t =25.60, 20.40,all P ＜ 0.05).There were no significant difference in GCMa (0.022 ± 0.007 vs.0.024 ± 0.009) and ASCT-2 (0.423 ± 0.050 vs.0.438 ± 0.060) between the two groups (t =0.87, 0.95, all P ＞ 0.05);Western blotting analysis showed that expression of HERVWE1 protein (0.340 ± 0.010 vs.0.580 ± 0.010) in placentas of the case group was lower than that in normal pregnant women (t =85.50, P ＜ 0.05).Conclusion The expression of HERVWE1 is significantly decreased in placentas of the case group and is associated with pathogenesis of preeclampsia.
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Objective To analyze the results and prognosis for patients with inoperable pancreatic carcinoma treated by interventional chemotherapy (IC) ,three-dimensional radiotherapy (RT), or IC + RT.Methods From 2003 to 2008,139 patients with locally advanced (82 patients, stage Ⅲ) or metastatic (57 patients, stage Ⅳ) pancreatic cancer were retrospectively analyzed, including 74 with pancreatic head carcinoma (53.2%).Three patients with ductal adenocarcinoma were diagnosed with fine-needle aspiration, all other patients were clinically diagnosed with imagings (CT, MRI and/or ultrasonosraphy),clinical symptoms and tumor markers, There were 71,34 and 34 patients receiving IC alone, 3DCRT alone and 3DCRT plus IC, respectively.Log-rank univariate and Cox model multivariate analyses were used to determine prognostic factors.Results The follow-up rate was 92.1%.115 and 98 patients were followedup longer than 1 and 2 years, respectively.The 1-and 2-year overall survival rates were 37.1% and 16.3%for all patients, 44% and 20% for patients with locally advanced disease.The corresponding rates were 18% and 5%, 61% and 29% ,48% and 25% (χ2= 14.65,P=0.001) for patients receiving IC alone, RT alone, and IC + RT, respectively.In univariate analysis, staging (χ2= 44.49, P = 0.035), radiotherapy (χ2= 15.32, P = 0.000) and tumor location (χ2= 10.741, P = 0.002) were prognostic factors.In multivariate analysis, tumor location (χ2= 5.00, P = 0.025) and radiotherapy (χ2= 7.93, P = 0.005) were prognostic factors.Conclusions Radiotherapy can improve overall survival among patients with inoperable pancreatic cancer.The effect of RT + IC should be further investigated.
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Percutaneous transhepatic biliary drainage(PTBD) is an effective therapeutic option for obstructive jaundice.With various novel puncture instruments being created,the manipulating technique being improved and medical idea being updated,PTBD has been widely employed in clinical practice for alleviating the biliary tract obstruction.In order to standardize this technique this paper aims to make some suggestions for the PTBD guidelines concerning the indications,contraindications,operative skill,postoperative management,complications and their preventions,points for attention,etc.
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Objective To evaluate the value of MRI in diagnosis of giant cell tumor of bone.Methods Nine cases with giant cell tumor of bone proved by pathology were examined preoperation with MRI and X-ray film.CT was processed in 7 caaes.There were 4 males and 5 females,with a mean age of 32(range 14~62 years).The location of the tumor was in the proximal tibia(5 cases),the distal femur(2 cases),the distal radius(1 case)and the scapula(1 case).Results In all cases,the signal intensity of the tumor was low to intermediate on T 1WI,high homogeneous signal intensity in 5 cases on T 2WI,heterogeneous signal intensity in 4 cases.There was destruction of cortical bone in 5 cases.There wasn't osteoplaque in 3 cases.In 2 cases,the soft tissues and the joint were involved.The pathological macrosection tumor was crimson or brown in 3 cases with heterogeneous signal intensity on MRI.In another 5 cases with homogeneous signal intensity on MRI was brownish yellow or yellow.Conclusion Comparing the MRI,CT and X-ray film,diagnostic value of the giant cell tumor of bone,we believe:(1)CT scan is considered superior to MRI in showing the cortical bone destruction or in showing the osteoplaque.(2)MRI is considered superior to CT scan and X-ray film in showing the soft tissues the joint involvement.(3)MRI is fair super to evaluating the extension of the giant cell tumor of bone,but not super to quality diagnosis in the bone tumor.