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Objective@#To investigate the efficacy of sequential treatment with first-line administration of second-generation tyrosine kinase inhibitors (TKI) and first-generation TKI (imatinib) in patients with Ph+ acute lymphoblastic leukemia (Ph+ ALL) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT).@*Methods@#Retrospective analysis of clinical features and prognosis of 76 newly diagnosed Ph +ALL patients from June 2011 to December 2015 treated by allo-HSCT combined with first-line administration of second-generation or first-generation TKI was performed and the efficacy compared.@*Results@#Of 76 Ph+ ALL patients, first-generation TKI was administered in 57 cases, second-generation TKI in 19 cases, including 10 cases of nilotinib and 9 cases of dasatinib. There was no significant difference in age, WBC counts, additional chromosomal abnormalities, time form diagnosis to transplantation, transplantation type, conditioning regimen or TKI initiation time between the two groups. Complete remission (CR) rates at the fourth week of induction therapy in first-generation TKI group and second-generation TKI group was 93.0% and 94.7% (P=1.000), respectively. Major molecular response (MMR, BCR-ABL/ABL reduce 3 log) rates meanwhile were 46.0% and 40.0% (χ2=0.169, P=0.681). Relapse rates before transplantation were 14.0% and 10.5% (P=1.000). MMR rates before transplantation were 54.4% and 68.2% (χ2=1.152, P=0.283). The 2-year overall survival (OS) rates of first-generation and second-generation TKI group were 62.0% and 94.7% (χ2=5.765, P=0.016), 2-year event-free survival (EFS) rates were 46.3% and 84.2% (χ2=5.644, P=0.018), respectively. Univariate analysis showed that second-generation TKI could improve OS (HR=0.126, 95%CI 0.017-0.939, P=0.043). Multiple factors analysis showed that second-generation TKI (HR=0.267, 95%CI 0.081-0.873, P=0.029) and MMR before transplantation (HR=0.496, 95%CI 0.254-0.968, P=0.040) were good independent prognostic factors of EFS.@*Conclusions@#There was significant difference in the efficacy of second-generation TKI and first-generation TKI for Ph+ ALL patients treated by allo-HSCT. First-line administration of second-generation TKI showed better efficacy than that of first-generation TKI for Ph+ ALL patients.
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Objective To evaluate the complications and long-term efficacy of inside-out transobturator transvaginal tape ( TVT-O) for the treatment of stress urinary incontinence ( SUI) .Methods From January 2008 to December 2013,236 consecutive female patients (mean age 56 ±9 years,range 44-88 years)with the symptom of incontinence when abdominal pressure increasing (such as walking), underwent TVT-O operation.All these patients needed pads and were diagnosed with SUI by cough test and Marshall -bonny test before surgery , with the mean international consultation committee on incontinence questionnaire short form ( ICI-Q-SF) score of 15.6 ±3.9.Two grouping methods were used:the mid-term group including patients whose follow-up time was between 6 months and 3 years, the long-term group including patients whose follow-up time >3 years,the group of patients who underwent TVT-O only and the group of patients who underwent TVT-O plus pelvic floor repair at the same time . Their clinical and follow-up data , intraoperative and postoperative complications , subjective and objective effects were recorded and analyzed.Results Of these 236 patients,there were 1 case of bladder perforation (0.4%) and 1 case of intraoperative sling exposure to vagina ( 0.4%) .Postoperative complications included 36 ( 19.1%) groin/puncture point pain ,18 (9.5%) de novo frequency of micturition ,8 (4.2%) urinary retention /difficulty of urination.All the complications were relieved after symptomatic treatment or surgery except 2 cases of urinary retention/difficulty of urination.Their symptom kept existing after urethral dilatation and sling dissection and long-term intermittent self-catheterization was needed .One hundred and eighty-nine patients completed more than six months of follow-up, with mean follow-up time of ( 35.0 ±12.5 ) months.One hundred and sixteen (61.4%) cases was arranged to mid-term group and 73(38.6%) was arranged to long-term group.88.9%patients ( 168/189 ) were cured objectively and 9.5% patients ( 18/189 ) improved. There was also a significant subjective improvement ( ICI-Q-SF scores:15.6 ±3.9 preoperative versus 6.7 ± 2.3 postoperative,P0.05 ) . Patients who underwent TVT-O and those who underwent TVT-O +pelvic floor repair had no significant difference in efficacy (cured +improved rate 97.8%versus 100.0%,P>0.05).Conclusion TVT-O is a safe,effective and durable treatment for SUI , whether or not with concomitant procedure of pelvic floor repairment.
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Objective To compare the efficacy and safety of robot assisted laparoscopic radical prostatectomy (RALRP) and retropubic radical prostatectomy (RRP).Methods From May 2004 to September 2013,data from 124 prostate cancer patients were collected.Of them,41 cases underwent RALRP,and 83 cases underwent RRP.The following clinical data was reviewed and analyzed,including operation time,blood loss,transfusion rate,duration of catheterization,time of postoperative hospital stay,postoperative pathology,continence and biochemical recurrence.Results All the operations were successfully performed,without RALRP converted to open surgery.The mean operation time of the RALRP group and the RRP group was 224 min and 165 min,mean blood loss was 266 ml and 659 ml,the transfusion rates were 20％ and 86％,the mean postoperative hospital stay was 16.4 d and 17.9 d,the positive margin rates were 24％ and 10％,the differences were significant (P ＜ 0.05).The mean catheterization time was 27.2 d and 23.5 d (P ＞ 0.05).The 6-month,1-year and 2-year biochemical recurrence rates were 8％,21％ and 24％ in RALRP group,and 13％,16％,31％ in RRP group.The 3-month,6-month,1-year and 2-year continence rates were 56％,70％,80％ and 94％ in RALRP group,and 55％,70％,78％ and 79％ in RRP group.For biochemical recurrence and continence rates,there was no significant difference between the 2 groups.Conclusions RALRP possesses advantages of less bleeding and faster recovery.In addition,the effect of postoperative oncology and continence is similar to open surgery.
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BACKGROUND:Alpha-calcium sulfate hemiydrate/biphasic bioceramics (α-CSH/BCP) as a bone repair material has been widely used in the clinic, but there are stil some deficiencies. OBJECTIVE:To observe the effect of α-CSH/BCP on the repair of bone defects of the radius in rabbits. METHODS:The unilateral radius of 18 adult New Zealand white rabbits was selected to establish bone defect models, and then these rabbit models were randomized into three groups that were treated with α-CSH,α-CSH/BCP, BCP materials, respectively. At 4, 8, 12 weeks after implantation, bone samples were taken for gross and X-ray observations. RESULTS AND CONCLUSION: (1) Gross observation: At 12 weeks of implantation, the bone defect was completely repaired in the α-CSH/BCP group, and the defected radius recovered basicaly; in the α-CSH group, bone defects were visible; and in the BCP group, there was stil some material for filing and coverage. (2) X-ray observation: In the α-CSH group, the degradation of implanted materials was faster than new bone formation, and bone defects were visible; in the α-CSH/BCP group, bone defects were healed, cortical bone remodeling was good, and the bone marrow cavity was re-canalized; in the BCP group, the implanted materials were stil visible, and bone defects were not repaired. These findings indicate that the α-CSH/BCP bone repair material can significantly promote the repair of bone defects of rabbit radius, with a better repair effect than α-CSH or BCP alone.
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ObjectiveTo investigate the clinical efficacy and safety of solifenacin for female overactive bladder (OAB) who failed in toherodine treatment. MethodsFrom Jan 2010 to Oct 2010,48 cases of female OAB were treated with 5 mg/d solifenacin for 4 weeks after the failure of tolterodine treatment.The improvement of the perception of bladder condition as well as the mean numbers of day-time micturition,urgency episodes,urge incontinence episode per day,nocturia and pads usage were used as objective indexes for the evaluation of therapeutic effect. ResultsAfter 4-week solifenacin treatment,the mean numbers of day-time micturition,urgency episodes,urge incontinence episode per day,nocturia and pads usage were respectively decreased from the baselines ( 8.7 ± 1.5),(3.4 ± 2.1 ),( 2.4 ± 1.8 ),(2.1 ± 1.8 ) and (2.2 ±1.6) to be (7.2 ±2.5),(2.0 ±1.8),(1.5 ±1.2),(1.2 ±0.8) and (1.4 ±0.8).The perception of bladder condition was improved in 42 cases.The withdrawal from the treatment was seen in 3 cases due to headache and dry mouth.No severe adverse event was found in the rest 45 patients. Conclusion Solifenacin might be an effective and safe alternative agent in the treatment of female OAB who failed in tolterodine treatment.
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Objective To investigate the value of magnetic resonance (MR) diffusion weighted imaging(DWI) in the diagnosis of prostate cancer(PCa). Methods Fifty-seven patients with suspected prostate cancer underwent DWI and T_2-weighted imaging (T_2W). These images and apparent diffusion coefficient (ADC) maps results were compared with histopathologic findings. Receiver operating characteristic(ROC) analysis was used to compare the cancer detection performance of them. The results were rated on a scale of scores Ⅰ (benign) to Ⅴ (malignant) on the basis of ADC maps. Abnormal voxels were overlaid on the corresponding transverse TRUS images and used to perform voxel-guided biopsy. Results DWI had a sensitivity of 85%, specificity of 82%, positive predictive value of 80%, negative predictive value of 86% , and accuracy of 83%. T2WI had a sensitivity of 77%, specificity of 71%, positive predictive value of 69%, negative predictive value of 79%, and accuracy of 74%. The areas under the ROC curves for DWI and T_2WI were 0. 830 and 0. 742, respectively. The performance of DWI in PCa detection was significantly better than of T_2WI (P<0. 05). 6 of 30 patients with negative DWI results also had negative biopsy findings. PCa was detected in 17(85%) of 24 men findings with voxel score Ⅳ , with a sensitivity of 100%, specificity of 46%, positive predictive value of 71 %, negative predictive value of 100% , and accuracy of 77%. Conclusions The performance of DWI in PCa detection was better than of T_2 WI. ADC maps can be transferred to TRUS images and used to sample regions of cancer in men with rising PSA levels and negative findings at prior biopsy with good accuracy. DWI appears to be a robust and reliable method to examine the whole prostate within an acceptable scan time in clinical settings.
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Objective:To evaluate the clinical efficacy and safety ofHJ-RY-1 therapeutic pad ofsoft stone in treating osteoarthritis.Methods:Patients with osteoarthritis with syndrome ofqi stagnancy and blood stasis were enrolled according to the diagnostic criteria and the evaluation standard ofcurative effect in Instruction Principle ofClinical Research ofNew Chinese Medicines, and were randomly divided into experimental group(treating by HJ-RY-1 therapeutic pad ofsoft stone) and the control group(treating by the paster offar infrared bioactive ceramics).Put them respectively on the afflicted part for more than 12 hours a day, and the treatment course ofboth groups lasted 14 days.The main turnover was determined by the improvement of6 clinical parameter indices and the incidence rate ofwhole curative effect and side effect after a treatment of7 days and 14 days.Results:72 patients were randomly equally divided into two groups, and received predetermined interveneing therapy.There were similar baseline characteristics and comparabilities between them.Totally 68 patients finished 2 weeks follow-up observation and 4 cases were missed(33/36 in experimental group;35/36 in the control group).1 weeks later, there were no significant difference in clinical situation and overall curative effect between two groups.But after two weeks interveneing therapy, there were significant difference on activity pain(t-value was 3.3104), the joint movement range(t-value was 3.1596), self-sensation(t-value was 2.5521) and overall curative effect(t-value was 3.5694) between them(P
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Objective To study the changed status of mortality from urinary and male genital diseases in Shanghai Hongkou district in recent years. Methods Mortality from diseases in Shanghai Hongkou district population from 1991 to 1998 was studied and analyzed. Results There were 1130 persons died of urinary and male genital diseases,749 being male and 381 female.It accounted for 2.08% of the total death,being 2.58% in the male and 1.51% in the female.The 5 major urinary and male genital diseases were in turn nephritis and nephropathy,bladder cancer,benign prostatic diseases,prostate cancer and renal carcinoma.Mortality from bladder cancer,renal cancer,prostate cancer and other prostatic diseases has been rising as compared to those in the 80s especially protatic cancer and other prostatic diseases whereas mortality from nephritis and nephropathy,pyelonephritis and renal failure was decreasing. Conclusions Mortality from prostate cancer and other prostatic diseases in population is remarkably rising.Attention is called to the study,prophylaxis and treatment of prostatic diseases.
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Objective To evaluate the efficacy of oral etopside (VP16) and oral cyclophosphamide (CPM) combination in the treatment of hormone-refractory prostate cancer (HRPC). Methods Between June 2000 and July 2003,9 patients with HRPC were treated with oral etopside (50 mg/d) and oral cyclophosphamide (100 mg/d) for 21 days with every 28 days as a cycle.Inclusion criteria were previous complete androgen blockade,anti-androgen (flutamide) withdrawal evaluation,and clinical or biochemical disease progression.The therapy was continued until there was evidence of disease progression or the patients could not tolerate the adverse effects of the medications. Results All the 9 patients had a mean follow-up of 7.5 months.PSA levels decreased by at least 50%,from pre-treatment of (90.5?43.6)ng/ml to post-treatment of (24.8?22.2)ng/ml,in 4 patients. The mean duration of response was 6.8 months (range,2-15 months).An objective response was obtained in 2 patients (1 of CR and 1 of PR).Toxic and adverse effects were minimal. Conclusions The combination of oral VP16 and CPM may be an efficacious and well-tolerated regimen in patients with HRPC.
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Purpose:To improve the surgical technique in the treatment of renal pelvic and ureteral malignancy.Methods:From May. 1998 to December. 2000 intravesical ureterectomy has been carried out for 9 cases of renal pelvic malignancy . the distal ureter was intussuscepted into the bladder by traction of a ureteral catheter that had been attached to the cephalad end of the ureter after the kidney was removed. Patients have been followed up for 6 to 30 months with a mean of 18.6 months.Results:No surgical complication has been observed. On cystoscopy, no tumor occurrence has been found at the site of the removed ureteral orifice and other part of the bladder.Conclusions:The surgical technique is characterized by good results,few complication and simplicity.
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50% for more than 1 month as effective,and the efficacy for soft tissue metastases were classified as complete,partial remission,stabilization and progression.Results All patients were followed up for 6-24 months(mean,12 months) with the evaluation of efficacy and toxicity.PSA levels decreased by at least 50% in 6 of 12 cases(50%);it decreased from(63.9?47.3)ng/ml before treatment to(14.4?8.8)ng/ml after treatment,with a mean duration of response being 7.5 months(range,5-12 months).Partial remission of soft tissue metastases was obtained in 2 cases;the metastatic lesions were reduced from 4.0 cm?5.0 cm,(3.0cm?)(3.5) cm to 2.0 cm?2.0 cm,1.0 cm?1.5 cm,respectively,by the treatment,with response duration being 3 and 8 months,respectively.Toxicities were minimal with leukopenia at grade Ⅰ in 1 case,anemia at grade Ⅰ in 1,baldness at grade Ⅰ in 1,nausea at grade Ⅰ in 2 and impaired liver function at grade Ⅱ in 1.Conclusions The combination of oral estramustine phosphate and oral etoposide may be an effective and well-tolerated regimen in patients with HRPC.