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Purpose@#The unique chromosomal rearrangements of endometrial stromal sarcoma (ESS) make it possible to distinguish high-grade ESS (HGESS) and low-grade ESS (LGESS) from the molecular perspective. Analysis of ESS at the genomic and transcriptomic levels can help us achieve accurate diagnosis of ESS and provide potential therapy options for ESS patients. @*Materials and Methods@#A total of 36 ESS patients who conducted DNA- and/or RNA-based next-generation sequencing were retrospectively enrolled in this study. The molecular characteristics of ESS at genomic and transcriptomic levels, including mutational spectrum, fusion profiles, gene expression and pathway enrichment analysis and features about immune microenvironment were comprehensively explored. @*Results@#TP53 and DNMT3A mutations were the most frequent mutations. The classical fusions frequently found in HGESS (ZC3H7B-BCOR and NUTM2B-YWHAE) and LGESS (JAZF1-SUZ12) were detected in our cohort. CCND1 was significantly up-regulated in HGESS, while the expression of GPER1 and PGR encoding estrogen receptor (ER) and progesterone receptor (PR) did not differ significantly between HGESS and LGESS. Actionable mutations enriched in homologous recombination repair, cell cycle, and phosphoinositide 3-kinase/AKT/mammalian target of rapamycin pathways were detected in 60% of HGESS patients. Genes with up-regulated expression in HGESS were significantly enriched in five immune-related pathways. Most HGESS patients (85.7%) had positive predictors of immunotherapy efficacy. Moreover, immune microenvironment analysis showed that HGESS had relatively high immune infiltration. The degree of immune infiltration in HGESS patients with ZC3H7B-BCOR fusion was relatively higher than that of those with NUTM2B-YWHAE fusion. @*Conclusion@#This study investigated the molecular characteristics of ESS patients at the genomic and transcriptomic levels and revealed the potentially high sensitivity of targeted therapy and immunotherapy in a subset of HGESS with specific molecular features, providing a basis for guiding decision-making of treatment and the design of future clinical trials on precision therapy.
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Objective:To investigate the molecular classification of endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) treated with fertility-sparing therapy, and to analyze its relationship with clinicopathological factors and treatment efficacy.Methods:A total of 46 EC and AEH patients who received fertility-sparing therapy and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2021, were retrospectively collected. The relationships between molecular classification and clinicopathological factors and treatment outcomes were analyzed.Results:(1) Of the 46 patients, including 40 EC and 6 AEH patients, 32 cases (71%, 32/45) had complete response (CR) after treatment, with median CR time of 8 months, 6 cases (13%, 6/45) had partial response, and 8 cases (25%, 8/32) had recurrence. (2) The cases were distributed as no specific molecular profile (NSMP) 34 cases (74%, 34/46) subtype mainly, high microsatellite instability (MSI-H) 7 cases (15%, 7/46), POLE ultra-mutated 3 cases (7%, 3/46), and copy number high (CNH) 2 cases (4%, 2/46). Patients with CNH had the hightest serum cancer antigen 125 (CA 125) level [(34.3±35.2) kU/L]. MSI-H subtype had more family history of tumors (6/7), more with loss of mismatch repair (MMR) protein expression by immunohistochemical (7/7), and higher nuclear antigen associated with cell proliferation (Ki-67) expression level (3/3). (3) Patients in MSI-H subgroup had the lowest CR rate at 6 months (0/6; P=0.019), and survival analysis showed that they were less likely to achieve CR than those with NSMP subtype ( P=0.022). Subgroup analysis of patients with NSMP showed that age ≥30 years related with longer treatment time to CR ( P=0.010). In addition, CR was obtained after treatment in 2/3 POLE ultra-mutated cases and 2/2 CNH, respectively. Conclusions:Molecular classification relates with the treatment response in patients with EC and AEH treated with fertility-sparing therapy. Patients with MSI-H subtype have poor treatment efficacy, and patients with NSMP need to be further studied and predict treatment benefit. However, there are few cases in POLE ultra-mutated and CNH subtypes, which need further clinical research.
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Objective:To explore the effects of peer support groups-based dietary intervention on nutritional status among patients with gastrectomy.Methods:Eighty-two patients with gastrectomy from March 2018 to August 2019 in Gastrointestinal Surgery of Shanxi Bethune Hospital were assigned to the experimental group and control group with 41 cases in each group by random digits table method. Patients in the control group were recieved routine nursing care and dietary guidance, basis on the control group, the experimental group provided peer support groups-based dietary intervention as well. BMI, total serum protein, albumin were recorded at 1 day before discharge, 4 weeks and 12 weeks after discharge, the intervention effect was assessed by Patient-Generated Subjective Global Assessment (PG-SGA), diet related symptoms scale and diet compliance scale.Results:At 4, 12 weeks after discharge, diet related symptoms scale scores were (10.61 ± 2.37), (8.61 ± 1.64) points in the experimental group, significantly lower than (12.05 ± 1.49), (11.46 ± 2.44) points in the control group, the differences were statistically significant ( t=3.20, 6.05, both P<0.05). At 4, 12 weeks after discharge, diet compliance scale scores were (63.87 ± 4.60), (64.92 ± 6.394) points in the experimental group, significantly higher than (60.90 ± 4.94), (62.18 ± 5.07) points in the control group, the differences were statistically significant ( t=2.73, 2.09, both P<0.05). At 4, 12 weeks after discharge, PG-SGA scores were (4.11 ± 0.86), (3.53 ± 1.13) points in the experimental group, significantly lower than (5.15 ± 1.46), (4.28 ± 1.62) points in the control group, the differences were statistically significant ( t=3.85, 2.38, both P<0.05). At 12 weeks after discharge, the levels of total serum protein, albumin were (57.79 ± 3.95), (36.68 ± 3.11) g/L in the experimental group, significantly higher than (55.26 ± 3.66), (34.74 ± 2.41) g/L in the control group, the differences were statistically significant ( t=2.92, 3.06, both P<0.05). There was no significant difference in BMI in different time between the two groups ( P>0.05). Conclusions:Peer support groups-based dietary intervention can promote self catering management and nutritional status of patients with gastrectomy.
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Acute lymphoblastic leukemia (ALL) is a kind of the most common hematopoietic malignancy, its recurrence and drug resistance are closely related to the bone marrow microenvironment. Bone marrow stromal cell (BMSC) is an important part of the bone marrow microenvironment and their interaction with leukemia cells cannot be ignored. BMSC participates in and regulate signaling pathways related to proliferation or apoptosis of ALL cells by secretes cytokines or extracellular matrix proteins, thus affecting the survival of ALL cells. In this review, the research advance of several signaling pathways of the interaction between BMSC and ALL cells was summarized briefly.
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Humans , Apoptosis , Bone Marrow , Bone Marrow Cells , Mesenchymal Stem Cells , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Stromal Cells , Tumor MicroenvironmentABSTRACT
OBJECTIVE@#To investigate the effect of Chang'an II Decoction ( II ))-containing serum on intestinal epithelial barrier dysfunction in rats.@*METHODS@#Tumor necrosis factor (TNF)-α-induced injury of Caco-2 monolayers were established as an inflammatory model of human intestinal epithelium. Caco-2 monolayers were treated with blank serum and Chang'an II Decoction-containing serum that obtained from the rats which were treated with distilled water and Chang'an II Decoction intragastrically at doses of 0.49, 0.98, 1.96 g/(kg·d) for 1 week, respectively. After preparation of containing serum, cells were divided into the normal group, the model group, the Chang'an II-H, M, and L groups (treated with 30 ng/mL TNF-α and medium plus 10% high, middle-, and low-doses Chang'an II serum, respectively). Epithelial barrier function was assessed by transepithelial electrical resistance (TER) and permeability of fluorescein isothiocyanate (FITC)-labeled dextran. Transmission electron microscopy was used to observe the ultrastructure of tight junctions (TJs). Immunofluorescence of zonula occludens-1 (ZO-1), claudin-1 and nuclear transcription factor-kappa p65 (NF-κ Bp65) were measured to determine the protein distribution. The mRNA expression of myosin light chain kinase (MLCK) was measured by real-time polymerase chain reaction. The expression levels of MLCK, myosin light chain (MLC) and p-MLC were determined by Western blot.@*RESULTS@#Chang'an II Decoction-containing serum significantly attenuated the TER and paracellular permeability induced by TNF-α. It alleviated TNF-α-induced morphological alterations in TJ proteins. The increases in MLCK mRNA and MLCK, MLC and p-MLC protein expressions induced by TNF-α were significantly inhibited in the Chang'an II-H group. Additionally, Chang'an II Decoction significantly attenuated translocation of NF-κ Bp65 into the nucleus.@*CONCLUSION@#High-dose Chang'an II-containing serum attenuates TNF-α-induced intestinal barrier dysfunction. The underlying mechanism may be involved in inhibiting the MLCK-MLC phosphorylation signaling pathway mediated by NF-κ Bp65.
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Objective: To evaluate the cardiac functional changes in hypertrophic cardiomyopathy(HCM) patients with β-myosin heavy chain gene (MYH7) mutations by three-dimensional (3D) speckle tracking imaging(3D-STI) and conventional echocardiography modalities, and then to explore the potential predictors of adverse cardiovascular events in these patients. Methods: A consecutive series of 192 HCM patients admitted in our center from October 2014 to October 2016 were genetically screened to identify MYH7 mutations in this retrospective study. A total of 43 HCM patients with MYH7 mutations were enrolled. The patients were divided into events group(n=13) and no event group(n=30) according to the presence or absence of adverse cardiovascular events(primary and secondary endpoints). All patients were followed up to January 2019 after comprehensive evaluation of 3D-STI, two-dimensional and Doppler echocardiography. The adverse cardiovascular events were recorded. Results: The median follow up time was 1 012 (812, 1 330) days. During follow-up, 13 patients (30.2%) reached endpoints: 6 cases of the primary endpoints(2 cases of sudden cardiac death(SCD), 3 cases of survival after defibrillation, and 1 case of appropriate implantable cardioverter-defibrillator(ICD) discharge); 7 cases of the second endpoints(5 cases of heart failure hospitalization, 1 case of syncope and cardioversion due to supraventricular tachycardia, and 1 case of end-stage HCM). Patients with adverse cardiovascular events had higher prevalence of syncope and risk of SCD, enlarged left atrial volume index(LAVI) and reduced 3D left ventricular global longitudinal train (3D-GLS), as compared to those without adverse events(all P<0.05). The multivariate Cox regression analysis showed that reduced 3D-GLS(HR=0.814, 95%CI 0.663-0.999, P=0.049) was an independent predictor for adverse cardiovascular events. The cutoff value of 3D-GLS≤13.67% was linked with significantly increased risk of adverse cardiovascular events in this patient cohort(AUC=0.753, 95%CI 0.558-0.948, sensitivity 86%, specificity 69%, P<0.05). The Kaplan-Meier analysis indicated that the patients with the 3D-GLS≤ 13.67% faced higher risk of death than those with 3D-GLS>13.67%. Conclusion: 3D-GLS is useful on predicting adverse cardiovascular events in HCM patients with MYH7 mutations.
Subject(s)
Humans , Cardiac Myosins/genetics , Cardiomyopathy, Hypertrophic/genetics , Echocardiography , Mutation , Myosin Heavy Chains/genetics , Predictive Value of Tests , Retrospective Studies , Risk FactorsABSTRACT
Objective@#To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography.@*Methods@#A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states.@*Results@#①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P<0.05). Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM, followed by labile-obstructive and non-obstructive HCM, and the lowest in the control group (all P<0.05). ②At rest, the left ventricular global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as the twist of obstructive HCM were significantly lower than the other three groups (all P<0.05). As compared with the control group, the GLS and twist decreased in the labile-obstructive and non-obstructive HCM(all P<0.05), but there were no significant changes of GCS and GRS (all P>0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD) (all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001). ③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05).@*Conclusions@#In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise.
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Objective To evaluate the characteristics of left ventricular structure ,function ,myocardial mechanics ,hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy ( HCM ) using state‐of‐the‐art echocardiography . Methods A consecutive series of 85 adult HCM patients w ho were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected . According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography ,the patients were divided into three groups :patients with non‐obstructive HCM ( n ＝28) ,those with labile‐obstructive HCM ( n ＝27) ,and those with obstructive HCM ( n ＝ 30 ) . In addition ,16 normal family members of HCM patients were included as control group . T wo‐dimensional speckle tracking imaging ,tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states . Results ① As compared with the control group ,left ventricular end‐diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups ( all P ＜ 0 .05 ) . Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM , followed by labile‐obstructive and non‐obstructive HCM ,and the lowest in the control group ( all P ＜0 .05) . ②A t rest ,the left ventricular global longitudinal ,circumferential and radial strain ( GLS ,GCS and GRS) ,as well as the twist of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . As compared with the control group ,the GLS and twist decreased in the labile‐obstructive and non‐obstructive HCM ( all P ＜0 .05 ) ,but there were no significant changes of GCS and GRS ( all P ＞ 0 .05 ) . T he obstructive HCM had the lowest mitral annular plane systolic excursion ( M APSE ) and s′,and the longest systolic peaking time standard deviation( T s‐SD) and early diastolic peaking time standard deviation ( Te‐SD) ( all P ＜0 .05) . T he left ventricular diastolic function of obstructive HCM ( e′,the E/e′ratio and the left atrial volume index ) was the worst ,labile‐obstruction and non‐obstructive HCM were better ,and the control group was the best ( all P ＜ 0 .001 ) . ③ During exercise ,the GLS ,GCS ,GRS ,twist of the left ventricle and the M APSE were the lowest in the obstructive HCM ,which increased in the labile‐obstructive and non‐obstructive HCM ,and were best in the control group . T he T s‐SD and Te‐SD were the shortest in the control group ,were prolonged in non‐obstructive and labile‐obstruction HCM ,and were longest in obstructive HCM ( all P ＜ 0 .05 ) . Additionally ,the exercise time of the control group was the longest , followed by non‐obstructive and labile‐obstruction HCM ,and the shortest in the obstructive HCM ( all P ＜0 .05) . T he M ET s of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . Conclusions In obstructive HCM ,the left ventricular systolic strain and synchronization ,as well as the M APSE ,are significantly impaired in patients both at rest and during exercise . T he patients with labile‐obstructive and non‐obstructive HCM have reduced left ventricular GLS , twist ,and e′,but normal left ventricular GCS ,GRS ,synchrony ,and M APSE at rest ,which are all impaired during exercise .
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Objective To explore the changes of left ventricular torsion function in patients with latent obstructive hypertrophic cardiomyopathy ( HCM ) ,and provide quantitative informations for clinical evaluation of cardiac function . Methods A total of 49 consecutive patients with HCM without left ventricular outflow tract obstruction at rest were enrolled . All subjects underwent exercise stress echocardiography . After exercise left ventricular outflow tract pressure gradient ( LVO T‐PG ) ≥30 mm Hg was positive for exercise stress test ( latent obstruction) ,w hile LVO T‐PG＜ 30 mm Hg was negative for exercise stress test ( non‐obstruction) . An ultrasound system obtained two‐dimensional ultrasound images of resting and moving peaks . The global longitudinal strain ( GLS ) ,global circumferential strain ( GCS ) , global radial strain ( GRS) of the left ventricle 16 segments and left ventricular rotation ,twist were analysis using off‐line EchoPAC software . T he differences of the above parameters were compared between the two groups . Results T here were no significant differences in GLS ,GRS ,GCS and Rotation‐B between the two groups in resting and peak period of exercise ( all P ＞ 0 .05 ) ,GRS in both groups were significantly increased compared with that before exercise ( all P ＜ 0 .05 ) . Compared with the negative exercise stress group ,the left ventricular twist and Rotation‐A were significantly increased in resting and peak period of exercise in the positive exercise stress test group( all P ＜0 .05) . Compared with before exercise ,Rotation‐A and left ventricular twist were significantly decreased in the positive exercise stress test group ( all P ＜0 .05) ,while no significantly difference was found in the negative exercise stress group ( all P ＞ 0 .05 ) . Conclusions Left ventricular torsion function is significantly changed in rest and after exercise in latent obstructive HCM patients ,providing valuable quantitative information for clinical comprehensive evaluation of cardiac function .
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Objective To investigate whether three-dimensional speckle tracking imaging ( 3D-STI) combined with conventional echocardiography can identify cardiac functional characteristics and predict adverse cardiovascular events in patients with hypertrophic cardiomyopathy ( HCM ) . Methods One hundred and eighty HCM patients were involved in the study . All patients were followed up to March 2017 after comprehensive evaluation of 3D-STI and conventional echocardiography for endpoint events . The endpoint events were divided into the primary and secondary endpoints . The primary endpoints included sudden cardiac death ( SCD ) , survival after cardioversion and appropriate implantable cardioverter-defibrillator( ICD) discharge ;the secondary endpoints included acute myocardial infarction ,heart failure hospitalization ,thromboembolism and endstage HCM . The composite endpoints contained primary or secondary endpoints . Results ①Totally 175 HCM patients completed the follow-up [ ( 435 ± 204) days] . During follow-up ,25 patients ( 14 .3% ) reached composite endpoints :8 cases of the primary endpoints ( 3 cases of sudden cardiac death ,3 cases of survival after defibrillation ,and 2 cases of appropriate implantable cardioverter-defibrillator discharge ) ; 17 cases of the second endpoints ( 14 cases of heart failure hospitalization ,2 cases of thromboembolism ,and 1 case of end-stage HCM ) . ② Patients with primary endpoints had higher NYHA class ,reduced systolic and early diastolic mitral annular velocities (MV s′and MV e′) ,decreased systolic tricuspid annular velocity ( TV s′) ,and impaired 3D left ventricular global longitudinal strain ( GLS ) ,as compared to those without primary endpoints ( n ＝ 167 ) ( P ＜ 0 .05 ) . Impaired 3D GLS ( hazard ratio was 0 .72 ,95% CI was 0 .53 －0 .98 , P ＝ 0 .035) and decreased TV s′( hazard ratio was 0 .70 ,95% CI was 0 .54－0 .91 , P ＝0 .007) were independent predictor factor for primary endpoints . 3D GLS≤11 .7% or TV s′≤12 .7 cm/s raised the risk of primary endpoints . ③Similarly ,HCM patients with composite endpoints ( n ＝25) had higher NYHA class ,enlarged left atrial diameter ( LAD) , reduced MV s′,MV e′ and TV s′,as well as impaired 3D GLS ( P ＜ 0 .05) ,when compared to those without composite endpoints ( n＝150) . Moreover ,impaired 3D GLS ( hazard ratio was 0 .68 ,95% CI was 0 .56－0 .81 , P ＝0 .000) was independent predictor for composite endpoints ;and patients with 3D GLS≤12 .9% was more susceptible to composite endpoints . Conclusions 3D GLS combined with TV s′ are of value in predicting adverse cardiovascular events .
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Objective To explore the predictive value of routine echocardiographic and electrocardiographic parameters in late gadolinium enhancement ( LGE ) in hypertrophic cardiomyopathy ( HCM ) . Methods The study population consisted of a consecutive series of 95 HCM patients .According to the presence of LGE on cardiac magnetic resonance (CMR) ,these patients were divided into two groups :HCM patients with LGE ( n = 71) and HCM patients without LGE ( n = 24) . The parameters of routine echocardiography and electrocardiography were compared between the two groups . ROC and Logistic analysis were made to find the predictors of LGE . Results ① As compared to those without LGE ,HCM patients with LGE had higher prevalence of chest pain ( P = 0 .027) ,β-blocker treatment ( P = 0 .024) , increased maximal left ventricular wall thickness ( MLVWT ) ( P < 0 .0001 ) ,non-sustained ventricular tachycardia ( P = 0 .034) ,prolonged the rate-corrected cardiac QT interval ( QTc) ( P = 0 .011) ,T-wave inversion ( TWI) ( P = 0 .009) ,but reduced early diastolic mitral annular velocity ( e′) ( P = 0 .001) . ②Univariate predictors of LGE on CMR were :increased MLVWT ,reduced e′ ,prolonged QTc and more TWI . Only MLVWT ( OR = 1 .23 ,95％ CI = 1 .05 - 1 .44 , P = 0 .013) and e′( OR = 1 .23 ,95％ CI = 0 .52 - 0 .96 , P =0 .028) remained independent after multivariable analysis . Furthermore ,the ROC analysis showed that these two parameters had discriminative ability to identify those with LGE . To be specific ,HCM patients with MLVWT ≥ 21 .5 mm or e′ ≤ 5 .55 cm /s were more likely to present with LGE . ③ The leads number of TWI was positively correlated with percentage of LGE in left ventricular mass ( LGE ％ ) ( r = 0 .220 , P =0 .044) ,but there was no correlation between location of TWI on ECG and territory of LGE on CMR . Conclusions In HCM patients ,MLVWT and e′ are independent predictors of LGE on CMR . Furthermore , although the leads number of TWI is correlated with LGE ％ ,no correlation has been found between location of TWI on ECG and territory of LGE on CMR .
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Erlotinib inhibits the epidermal growth factor receptor and is used in patients with various cancers. However, it can affect the epidermis and hair because the receptor is expressed in normal skin cells. A 54-year-old woman with metastatic non-small-cell lung cancer presented with erythematous patches over her entire body and severe hair shedding 2 weeks after starting erlotinib. Histopathological examinations showed lymphocytic exocytosis; perivascular infiltration of lymphohistiocytes and eosinophils in the right arm; and marked infiltration of eosinophils, neutrophils, and lymphohistiocytes in the scalp. Erlotinib discontinuation improved hair loss and skin lesions. Hair loss has been reported in 5% of patients taking erlotinib. Our case was unusual in that there was complete baldness, and to our knowledge, no report of complete hair loss and exanthematous drug eruption after erlotinib treatment has been previously reported. Here, we report a case of severe hair loss with concurrent exanthematous drug eruption that may have been linked to erlotinib hypersensitivity.
Subject(s)
Female , Humans , Middle Aged , Alopecia , Arm , Drug Eruptions , Eosinophils , Epidermis , Erlotinib Hydrochloride , Exocytosis , Hair , Hypersensitivity , Lung Neoplasms , Neutrophils , ErbB Receptors , Scalp , SkinABSTRACT
A 72-year-old woman presented with recurrent painful erythematous nodules and ulcers on both legs. Latent tuberculosis was proven by a positive interferon-gamma release assay, and a histopathology examination revealed septolobular panniculitis with vasculitis. The initial diagnosis was erythema induratum associated with tuberculosis, but the leg ulcers became worse despite anti-tuberculosis medication and wound dressing. Computed tomography angiography showed occlusion of the superficial femoral and popliteal arteries bilaterally, supporting that the vascular event contributes to the ulcers according to the vascular territories. Under the diagnosis of peripheral arterial occlusive disease, she was treated with percutaneous transluminal angioplasty and antiplatelet medication. The skin ulcers were resolved. Elderly patients with erythema induratum have a risk of coincidental peripheral arterial occlusive disease, therefore dermatologists should be aware of the possibility of underlying vascular disease, so even minor trauma like skin biopsy can evoke serious condition shown in this patient. Here, we report a case of drastically aggravated erythema induratum due to co-existing peripheral arterial occlusive disease, which resolved with vascular intervention after not responding to antituberculosis medication.
Subject(s)
Aged , Female , Humans , Angiography , Angioplasty , Arterial Occlusive Diseases , Bandages , Biopsy , Diagnosis , Erythema Induratum , Erythema , Interferon-gamma Release Tests , Latent Tuberculosis , Leg , Leg Ulcer , Panniculitis , Popliteal Artery , Skin , Skin Ulcer , Tuberculosis , Ulcer , Vascular Diseases , Vasculitis , Wounds and InjuriesABSTRACT
Objective To investigate the role of contrast enhanced ultrasound (CEUS) in detecting type Ⅰ and Ⅱ endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).Methods PostEVAR patients who met the inclusion criteria were enrolled.All of patients underwent CEUS and computer tomography angiography (CTA) examination.The following parameters were evaluated:ultrasound contrast agent within aneurysmal sac,location and source of endoleaks,wash-in time of endoleaks and stentgraft since contrast agent injection.Analysis was performed to observe different types of endoleak features in CEUS.Results Nine cases were enrolled and all the cases had endoleaks.Three cases were type Ⅰ,6 cases were type Ⅱ.The wash-in time of type Ⅱ endoleaks delayed 9.8 seconds compared to type Ⅰ,and the results of CEUS diagnosis were consistent with CTA.Conclusions CEUS is an effective way to detect endoleaks.This technique can be used as a supplement for CTA in follow-up of post-EVAR patients.
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Objective@#To evaluate the predicting value of the 2014 European Society of Cardiology (ESC) guidelines risk prediction model for sudden cardiac death (HCM Risk-SCD) in Chinese patients with hypertrophic cardiomyopathy (HCM), and to explore the predictors of adverse cardiovascular events in Chinese HCM patients.@*Methods@#The study population consisted of a consecutive 207 HCM patients admitted in our center from October 2014 to October 2016. All patients were followed up to March 2017. The 5-year SCD probability of each patient was estimated using HCM Risk-SCD model based on electrocardiogram, echocardiography and cardiac magnetic resonance (CMR) examination results. The primary, second, and composite endpoints were recorded. The primary endpoint included SCD and appropriate ICD therapy, identical to the HCM Risk-SCD endpoint. The second endpoint included acute myocardial infarction, hospitalization for heart failure, thrombus embolism and end-stage HCM. The composite endpoint was either the primary or the second endpoint. Patients were divided into the 3 categories according to 5-year SCD probability assessed by HCM Risk-SCD model: low risk group<4%,intermediate risk group ≥4% to<6%, and high risk group≥6%.@*Results@#(1) Prevalence of endpoints: All 207 HCM patients completed the follow-up (350 (230, 547) days). During follow-up, 8 (3.86%) patients reached the primary endpoints (3 cases of SCD, 3 cases of survival after defibrillation, and 2 cases of appropriate ICD discharge); 21 (10.14%) patients reached the second endpoints (1 case of acute myocardial infarction, 16 cases of heart failure hospitalization, 2 cases of thromboembolism, and 2 cases of end-stage HCM). (2) Predicting value of HCM Risk-SCD model: Patients with primary endpoints had higher prevalence of syncope and intermediate-high risk of 5-year SCD, as compared to those without primary endpoints (both P<0.05). (3) Predicting value of HCM Risk-SCD model: The low risk group included 122 patients (59%), the intermediate risk group 42 (20%), and the high risk group 43 (21%). There was a clear trend towards to higher heart rate, higher values of PTFV1 and plane QRS-T angle, higher left ventricular mass index (LVMI), elevated maximal left ventricular outflow tract pressure gradient (LVOT-PGmax), enlarged left atrial dimension(LAD) and volume index (LAVI), reduced systolic mitral annular velocity (s'), and higher late gadolinium enhancement (LGE) volume and mass in patients with high risk of 5-year of SCD, as compared to those with low-intermediate risk (all P<0.05). Moreover, 5-year SCD probability was positively correlated with heart rate, plane QRS-T angle, LVMI, LAVI, LGE%, and negatively correlated with s'(r=0.161, P=0.019; r=0.669, P=0.001; r=0.206, P=0.004; r=0.284, P=0.000; r=0.351, P=0.000; r= -0.245, P=0.001; respectively). (4) LAD, LAVI, e' and s' were independent predictors for poor outcomes. HCM patients with LAD≥39 mm, LAVI≥49.6 ml/m2, e'≤6.5 cm/s and s'≤6.6 cm/s were more likely to have adverse cardiovascular events (AUC 0.702, 95%CI 0.604-0.799, P=0.001; AUC 0.700, 95%CI 0.567-0.833, P=0.001; AUC 0.716, 95%CI 0.616-0.817, P=0.000; AUC 0.764, 95%CI 0.676-0.853, P=0.000,respectively).@*Conclusions@#The HCM Risk-SCD model is of value in predicting SCD for Chinese HCM patients. The plane QRS-T angle and LGE% are the best predictors of 5-year SCD risk in Chinese HCM patients. Moreover, conventional echocardiographic parameters, including LAD, LAVI, e' and s', are useful to predict adverse cardiovascular events among Chinese HCM patients.
ABSTRACT
BACKGROUND: A number of anticancer agents are known to induce many adverse reactions in the skin. Related cutaneous adverse drug reactions influence the morbidity, mortality, and anti-cancer regimen of the patients. A multidisciplinary approach to cancer management has been emphasized. OBJECTIVE: To identify the causative anticancer agents and frequency of adverse reactions in the skin. METHODS: We retrospectively reviewed the medical records of patients who consulted at the Dermatology Department of Busan Paik Hospital and Haeundae Paik Hospital from January 2013 to February 2015. RESULTS: A total of 140 patients were enrolled. Among the 45 patients treated with antimetabolite analogs (30 cytarabine, 7 gemcitabine, 3 methotrexate, 2 fludarabine, 2 doxifluridine, and 1 decitabine), exanthematous drug eruption (49.1%) was the most common reaction, followed by hand-foot syndrome (28.3%). Among the 35 patients treated with fluorouracil (22 5-fluorouracil and 13 capecitabine), hand-foot syndrome (47.2%) was the most common, followed by acneiform eruption (25.0%). Among the 24 patients treated with epidermal grow factor receptor inhibitors (10 erlotinib, 10 cetuximab, and 4 gefitinib), acneiform eruption (54.8%) was the most common, followed by xerosis (19.4%). Among the 11 patients treated with anthracyclines (9 doxorubicin, 1 daunorubicin, and 1 idarubicin), acneiform eruption (45.5%) was the most common, followed by hand-foot syndrome (36.4%). Among the 7 patients treated with taxanes (4 docetaxel and 3 paclitaxel), hand-foot syndrome (42.8%) was the most common. Among the 6 patients treated with angiogenesis-inducing inhibitors (3 sorafenib, 2 pazopanib, and 1 sunitinib), hand-foot skin reaction (66.7%) was the most common. Only 2 patients (1.4%) changed treatments due to intolerable skin reactions. CONCLUSION: Clinicians should be aware of the various skin reactions of anticancer agents and predict their clinical course effectively.