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@#Intramyocardial dissecting hematoma (IDH) is an uncommon complication of myocardial infarction that can potentially lead to cardiac rupture.[1] Two distinguishable types of cardiac rupture have been identified: a simple tear, which is the most common case and is characterized by a lineal or tortuous tear along the myocardial wall, and complex hemorrhagic dissection. IDH is generally classified as complex hemorrhagic dissection, in which blood infiltrates into the myocardial wall.[2] IDH is characterized by a serpiginous tract within the myocardium, which is also known as subepicardial aneurysm. The mechanisms of IDH are multifactorial and contribute to the rupture of intramyocardial vessels, diminished tensile strength of the infarcted myocardium, abrupt increases in perfusion pressure during the perfusion phase, or in rare cases, iatrogenesis.[3] Furthermore, the anatomical substrate of IDH is the spiral helical structure of the heart that favors hemorrhage spreading along the spiral myocardial fibers.[4] IDH is often a challenging diagnosis and prone to misdiagnosis because of its rarity and various clinical presentations. Here, we report a patient with IDH.
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Objective:To explore the changes in activity of indoleamine 2, 3-dioxygenase(IDO)before and after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer(NSCLC) and its relationship with survival.Methods:The retrospective study was to assess IDO activity by serum kynurenine (Kyn) and Kyn to tryptophan (Trp) ratio before and after SBRT of early stage NSCLC.Thirty early stage NSCLC patients who received SBRT in the Cancer Hospital of the University of Chinese Academy of Sciences were enrolled, from December 2014 to July 2017. High-performance liquid chromatography and mass spectrometry were used to detect serum Kyn and Trp before and after SBRT. The ratios of Kyn after SBRT to Kyn before SBRT were divided into high and low group according to the median value. Similarly, the ratios of Kyn to Trp after SBRT were divided into high and low group.The correlation between overall survival (OS), progression-free survival (PFS) and IDO activity was evaluated. The factors influencing prognosis were analyzed.Results:In all patients, lower ratio of Kyn after SBRT to Kyn before SBRT significantly was correlated with better PFS (median PFS: not reached vs. 26.8 months, HR=0.31, 95% CI =0.11-0.90, P<0.05). The lower Kyn∶Trp ratio after SBRT had longer OS (median OS: not reached vs. 36.5 months, HR=0.27, 95% CI =0.079-0.95, P<0.05). In multivariate analysis, smoking <30 packs/year, higher BED, and lower ratio of Kyn after SBRT to Kyn before SBRT were associated with longer PFS. Lower Kyn∶Trp ratio after SBRT and higher BED were associated with longer OS. Conclusions:SBRT could alter IDO-mediated antitumor immune activity. IDO is a potentially valuable biomarker for monitoring immune status and predicting survival in early NSCLC patients after SBRT.
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Objective@#To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients.@*Methods@#By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT, the overall survival, progression-free survival, cancer-specific survival and adverse effects were determined.@*Results@#The median follow-up was 18.4 months. The 1-, 2-, and 3-year overall survival rates were 92.2%, 92.2% and 80.6%, respectively. The corresponding cause-specific survivals were 95.7%, 95.7% and 83.7%. The progression-free survivals were 70.2%, 54.1% and 40.6%. The local control rates were 100%, 94.4%, and 94.4%. The regional controls were 84.2%, 72.1%, and 54.1%; and distant controls were 84.6%, 72.4% and 64.3%, respectively. Twenty patients (66.7%) developed symptoms of grade 1 radiation-related toxicities: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 radiation pneumonitis, and one patient experienced grade 4 radiation pneumonitis.@*Conclusions@#SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities.
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Objective To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients.Methods By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT,the overall survival,progression-free survival,cancer-specific survival and adverse effects were determined.Results The median follow-up was 18.4 months.The 1-,2-,and 3-year overall survival rates were 92.2％,92.2％ and 80.6％,respectively.The corresponding cause-specific survivals were 95.7％,95.7％ and 83.7％.The progression-free survivals were 70.2％,54.1％ and 40.6％.The local control rates were 100％,94.4％,and 94.4％.The regional controls were 84.2％,72.1％,and 54.1％;and distant controls were 84.6％,72.4％ and 64.3％,respectively.Twenty patients (66.7％) developed symptoms of grade 1 radiation-related toxicities:dyspnea,chest pain,fatigue,cough,esophagitis,or pneumonia.Among these,5 patients suffered grade ≥ 2 radiation pneumonitis,and one patient experienced grade 4 radiation pneumonitis.Conclusions SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC,imposing tolerable toxicities.