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Objective:To analyze the efficacy and safety of CLAG regimen (cladribine, cytarabine, granulocyte colony-stimulating factor) in treatment of relapsed/refractory acute myeloid leukemia (AML).Methods:The clinical data of 30 patients with relapsed/refractory AML who were admitted to Suzhou Hongci Blood Disease Hospital from January 2018 to February 2021 were retrospectively analyzed, and the efficacy and adverse reactions were observed.Results:Among 30 patients, 1 patient was not evaluated for efficacy due to treatment-related death. Among the 29 evaluable patients, 17 patients (58.6%) achieved complete remission (CR), 5 patients (17.3%) achieved partial remission (PR) and 7 patients (24.1%) had no remission (NR). One patient in low-medium-risk group achieved CR; the CR rate in medium-risk group was higher than that in high-risk group [68.8% (11/16) vs. 41.7% (5/12)], but the difference was not statistically significant ( P = 0.250). Seven patients with M 5 achieved CR. Five patients with positive MLL gene rearrangement achieved CR. Among 6 patients with extramedullary invasion of leukemia cells, 4 patients achieved CR, and among them 3 patients with central nervous system invasion achieved CR. Among 6 patients with cladribine 3.5 mg·m -2·d -1×5 d, 1 patient died of infection after chemotherapy, 1 patient had NR, and the rest achieved CR. Among 24 patients with cladribine 5 mg·m -2·d -1×5 d, the CR rate in patients with cytarabine 2 g·m -2·d -1×5 d was higher than that in patients with cytarabine 1 g·m -2·d -1×5 d [70.0% (7/10) vs. 42.9% (6/14)], but the difference was not statistically significant ( P = 0.240). All patients developed grade Ⅳ myelosuppression after chemotherapy. 12 patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CR, and 9 patients were still alive. Conclusions:CLAG regimen is effective and well tolerated in the treatment of relapsed/refractory AML. In order to improve the prognosis, allo-HSCT should be performed as soon as possible after CR.
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Objective To summarize the experiences of endovascular aortic repair (EVAR) for isolated iliac artery aneurysm (ⅡAA).Methods The clinical data of 23 patients with ⅡAA undergoing EVAR from Aug 2008 to Mar 2016 were retrospectively analyzed.There were 5 cases of internal iliac artey (internal iliac artery ⅡA) aneurysm,10 cases of unilateral common iliac artery(common iliac artery CIA) aneurysm,6 cases of bilateral CIA aneurysms.Unilateral ⅡA aneurysm was treated by coil embolization and covering the entrance;CIA aneurysm without involving ⅡA was treated by EVAR with covered stent,those involved unilateral ⅡAs or combined ⅡA aneurysms were treated by EVAR after ⅡA embolization.Those with bilateral ⅡA involvement were repaired by Sandwich technique;Bilateral ⅡA was treated in two phases.Results All endovascular procedures were successfully performed;No patients died during the perioperation period.Intraoperative endoleak found in 5 cases managed by balloon dilatation,or conservatively were cured.23 patients were followed-up for 2-60 months,one rebuilding ⅡA was occluded.One CIA anurysm complicated with endoleak was cured by coils embolization and stenting.Gluteal claudication and erectile dysfunction occured in 4 out of 15 cases with unilateral or bilateral ⅡAs occlusion.Conclusion EVAR is a safe and effective treatment for ⅡAA,after a proper management for ⅡA.
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Objective To evaluate the clinical effect of the endovascular treatment of iliac vein compression syndrome.Methods Thirty-three patients with iliac vein compression syndrome were treated with endovascular treatment.Of which,edema and varicose vein of the left lower extremity in 29 patients,complicated with acute deep vein thrombosis of left lower extremity in 3 patients,post deep venous thrombosis syndrome in 1 patient.Balloon dilatation and stent implantation were performed in all 33 patients.The diameter of balloon was 10-12 mm,diameter 12-14 mm Bard self expandable stent.Five patients with varicose vein and ulcer of left lower extremity were treated with two stage operation.Results The diagnosis was confirmed by left lower extremity deep veins angiography.There was no death patient,and no hematoma of hematoma locus.Follow-up for 3-30 months,the rate of follow-up was 100％(33/33).The edema of the lower extremity was markedly reduced or disappeared in 28 patients.Color Doppler ultrasound and left lower extremity angiography showed that the stent was unobstructed,no stent occlusion and new onset thrombosis cases.Conclusion Endovascular treatment is safe,effective with few complications,and is the first choice for the treatment of iliac vein compression syndrome.
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BACKGROUND:The endothelial dysfunction is the pathogenesis of arteriosclerotic disease, the quantity and function of endothelial progenitor cells are decreased within the cycle, leading to a poor capacity of neovascularizatio, the efficacy of stem celltransplantation alone is unclear, the combination of cytokines and gene-modified stem cells is the hotspot. OBJECTIVE:To observe the effect of stromal cel-derived factor-1 on the neovascularization after endothelial progenitor cells transplantation. METHODS:Unilateral hindlimb ischemia model was established in 20 athymic nude mice, and the mice were randomly divided into four groups:combined group (intravenous endothelial progenitor cells+intramuscular stromal cel-derived factor-1), endothelial progenitor cells group (intravenous injection of endothelial progenitor cells), stromal cel-derived factor-1 group (intramuscular injection of stromal cel-derived factor-1), and blank control group (intramuscular M199). The skin temperature of ischemic hindlimbs and survival of animals after transplantation were observed. The ratio of capil ary/skeletal muscle fiber was counted. The expression of CD31 and endothelial nitric oxide synthase were detected. RESULTS AND CONCLUSION:The fluorescence-labeled endothelial cells were embedded in ischemic hindlimb muscles after celltransplantation. Of the 20 nude mice, two mice died. The rate of ischemic hindlimb reserving was respectively 80%, 75%, 20%and 0 in combined group, endothelial progenitor cells group, stromal cel-derived factor-1 group, and blank control group. The capil ary/muscle fiber ratio in combined group and endothelial progenitor cells group was higher than that of blank control group (P0.05). Endothelial progenitor cells can migrate to ischemic tissues, endothelial progenitor cells transplantation can promote neovascularization, and stromal cel-derived factor-1 augments the neovascularization after celltransplantation, in which endothelial nitric oxide synthase is involved.
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Objective To review reoperation on blood vessel prosthesis occlusion after arterial bypass graft in lower limbs. Method The treatment effect of 21 patients with reoperation on blood vessel prothesis occlusion after arterial bypass graft in lower limbs was analyzed retrospectively. Results All the cases were followed up 6-36 (12 ±3) months. The limb salvage rate was 71.4%(15/21) ,the amputation rate was 28.6% (6/21). All 9 limbs that underwent revascularization from deep femoral artery reserved. Conclusions Endomembrane hyperplasy, occlusion of the inflow and outflow tracts are the major reasons for the occlusion of blood vessel prosthesis after arterial bypass graft in lower limbs. Appropriate procedures should be based on careful consideration of the occlusion reasons. Profundaplasty is an effective therapy for those who are treated by reoperation on blood vessel prosthesis occlusion in lower limbs.
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Objective To summarize experiences in treatment of traumatic aortic rupture. Methods Between July 2001 and December 2008, 17 patients with acute traumatic aortic rupture were treated in our department. One patient died of hemorrhagic shock one hour after admission before opera-tion. Nine patients underwent thoracotomy under general anesthesia with double lumen endotracheal tube and normothermic femoral-femoral partial cardiopulmonary bypass, with bypass time for 35-139 minutes and aortic clamping time for 25-87 minutes. Successful operation was performed in seven patients inclu-ding one treated with simple repair and the other six with partial replacement of thoracic aorta with artifi-cial vascular graft. The other seven patients underwent endovascular repair and received stent grafts at the site of thoracic injury via right lilac-femoral artery under general or local anesthesia. Results One pa-tient free from operation was died of hemorrhagic shock. Of nine patients treated with thoracotomy, two patients died of hemorrhagic shock during operation and the other seven survived, with operation time ran-ging from 100 to 180 minutes. Seven survivors were followed-up for 2-6 years, with no death during fol-low-up period. Seven patients in endovascular repair group recovered, wiht operation time ranging from 50 to 70 minutes. All these seven patients were followed up for 3-14 months, which showed no death. Reex-amined CT in six patients showed no mediastinal hematoma or leakage of contrast medium from the aorta isthmus at 2-5 months after operation. Conclusions Endovascular repair is simple, safe and effective for traumatic aortic rupture. The selection of thoracotomy and endovascular repair is based on following conditions: the combined injuries of patients, the equipments of hospital and the skills of operators.
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Objective To explore the feasibility of one-stage operation in periappendicural abscess.Methods The clinical data of 111 patients with periappendicural absecess from 1990 to 2007 were analyzed retrospectively.Results A1l operation were successful.the rate of wound infection was 7.2%(8/111),there was no operative death and no severe complication occurred.Conclusion Timely and appropriate one-stage operation in early periappendicural absecess is safe and feasible.
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90%).The expression of CXCR4 receptor was 74.8%.The migration cells of control,10,20 and 50 ?g/L were 3.5,7.4,24.9 and 28.0,respectively.The migration activity was significantly higher in SDF-1 group than that of control group(P
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Objective To evaluate percutaneous transluminal renal angioplasty ( PTRA) and stenting for the treatment of renal artery stenosis (RAS). Method From Feb 2003 through Jun 2005, 19 consecutive RAS patients received interventional therapy including PTRA and/or stents in 12 cases, aortorenal bypass procedures in 4 cases, nephrectomy in 1, and angiography in 2 cases. Among the 12 PTRA and/or stenting cases, stent was deployed in 10 cases, and 2 patients received PTRA only. Results All patients had hypertension preoperatively ( mean blood pressure 172/98 mmHg). Serum creatinine concentration was greater than 1.5 mg/dL in one patient. There was no perioperative mortality nor major complications. Technical success was achieved in 11 patients (91.7%). During follow-up, mean blood pressure was 156/88 mmHg. Hypertension was improved in 8 patients (66. 7% ). Renal function was stable except one patient with renal insufficiency. Restenosis was found in one patient (8.3%). Conclusion PTRA and/or stent is safe, effective for the treatment of RAS in appropriately selected patients.