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Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.
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Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26?G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25?G flat?tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.
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To explore the correlation between concentrate viscosity and molding quality of personalized traditional Chinese medicine(TCM) condensed water pill, this study established a concentrate viscosity characterization method with rotational rheometry. Seven model prescriptions were respectively concentrated to different degrees and the viscosity of each concentrate was determined. The pre-sence of 'viscosity jump' in the middle stage of 'flag hanging' of all the model prescriptions implied that there might be an ideal viscosity range in the preparation of condensed water pill. The further study of 22 model prescriptions demonstrated that the optimum viscosity range of concentrate was 5-15 Pa·s(25 ℃) for approximately 82% of the prescriptions. About 18% of the prescriptions had a wide range, which might be caused by the high proportions of mineral and crustacean drugs in the crushing part and sugar and fibrous drugs in the decocting part. This study clarified the optimum viscosity range for concentrates of personalized TCM condensed water pills and achieved a preparation technology without any excipient, laying a foundation for the on-line control of the preparation.
Subject(s)
Drugs, Chinese Herbal , Excipients , Medicine, Chinese Traditional , Viscosity , WaterABSTRACT
Resumen El carcinoma de labio es uno de los más comunes de la cabeza y el cuello. El tipo histológico más frecuente es el carcinoma escamocelular y afecta predominantemente al labio inferior. Existen distintas técnicas para la reconstrucción de los defectos del labio inferior posterior a la resección oncológica, sin embargo, preservar la funcionalidad y la estética de esta zona es un desafío debido a la alta incidencia de xialorrea, microstomia, alteraciones de la continencia y el habla posterior a la reconstrucción. Se presenta un caso de reconstrucción total de labio inferior ampliada hacia el mentón utilizando el triángulo de Burow y que obtuvo buenos resultados funcionales y estéticos.
Abstract Lip carcinoma is one of the most common malignancies in the head and neck region. Squamous-cell carcinoma is the most frequent type of histological cell carcinoma, chiefly affecting the lower lip. Different techniques for reconstructing defects of the lower lip after neoplasia resection are used; however, preserving the functionality and aesthetics of this area poses a challenge due to the anatomical position that causes accumulation of saliva, thus delaying the healing process. We present a total lower lip reconstruction extended towards the chin by using the Burow's triangle, significantly improving functional and aesthetic results.
Subject(s)
Humans , Research Report , Lip , Neoplasms , Carcinoma, Squamous CellABSTRACT
Objective: To explore the effects of two kinds of calcium phosphate transfection methods in the 293T cells, and to establish the method of achieving high-efficiency and stable calcium phosphate transfection in the 293T cells. Methods: Fluorescence microscope was used to observe the transfection efficiencies of transfection of pCDH-GFP-3xflag-TRAF6 plasmid into the 293T cells by two kinds of calcium phosphate transfection methods (traditional calcium phosphate transfection method and improved calcium phosphate transfection method). Real-time PCR and Western blotting method were used to detect the expression levels of TRAF6 mRNA and flag protein in the 293T cells after transfection of pCDH-GFP-3xflag-TRAF6 plasmid by two kinds of calcium phosphate transfection methods. Results: Under fluorescence microscope, compared with traditional calcium phosphate transfection method, the transfection efficiencies of improved calcium phosphate transfection method 24 an 48 h after transfection of pCDH-GFP-3xflag-TRAF6 plasmid into the 293T cells were significantly increased (P<0. 01). The Real-time PCR and Western blotting results showed that compared with traditional transfection method, the expression levels of TRAF6 mRNA and flag protein in the 293T cells 24 and 48 h after transfection of pCDH-GFP-3xflag-TRAF6 plasmid by calcicum phosphate transfection method were significantly increased (P<0. 01). Conclusion: The improved calcium phosphate transfection method established in this reseach is a highly efficient and stable DNA transfection method.
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A Perspectiva do Lazer Sério é um viés importante para compreensão do esporte universitário no tempo livre. Ela determina que praticantes de lazer sério apresentem persistência, carreira, empenho, benefícios duráveis, ethos único e identificação com uma prática de lazer. O flag prática derivada do futebol americano, um dos esportes que mais se populariza no Brasil na atualidade é praticado por atletas brasileiros também em nível universitário. Os objetivos desse estudo foram verificar a presença das qualidades do lazer sério nos atletas de flag do time masculino Eucalyptus Unicamp e verificar a importância do esporte em suas vidas. Este estudo de caso coletou dados por meio de observação, questionário, Inventário de Medidas em Lazer Sério e entrevistas. Os resultados apontam que as qualidades estão presentes no relacionamento atleta/flag, além de demonstrar a centralidade do esporte na vida dos participantes.
The Serious Leisure Perspective is an interesting bias for understanding college sports in Brazil and free time. It determines that serious leisure practitioners present persistence, career, effort, durable benefits, unique ethos and identification with the pursuit. The flag - practice derived from Football, one of the most popular sports in Brazil nowadays - is practiced by Brazilians also at college level. The objectives of this study were to verify the presence of serious leisure qualities in the relationship athletes of the Eucalyptus Unicamp men's team have with the sport and verify the importance of flag in their lives. This case study collected data through observation, questionnaire, Serious Leisure Inventory and Measure and interviews. The results point out that the qualities are present in the athlete/flag relationship, besides it was demonstrated the centrality of the sport in the participants' lives.
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Humans , Sports , Cultural Characteristics , Athletes , Football , Leisure Activities , Evaluation Studies as Topic , Qualitative ResearchABSTRACT
In this communication, we describe a technique for creation of a single stage, adequately sized capsulorrhexis in intumescent cataracts by depressurizing the anterior and posterior intralenticular compartments in a nonleaky anterior chamber (AC) to prevent capsulorrhexis extension and Argentina flag sign. Initially, an incomplete main-port incision is made by the partial entry of a 2.2-mm keratome. A cohesive dispersive ophthalmic viscosurgical device (OVD) is injected into AC. Standard side-port incisions are made, followed by anterior capsular staining. The fluid cortex in anterior intralenticular compartment is aspirated by puncturing anterior capsule in the center using a 30-gauge needle entered through a separate limbal stab incision. The nucleus edge is gently tipped posteriorly with the needle tip to release the fluid from posterior intralenticular compartment also and as much fluid aspirated as possible. OVD is again injected and capsulorrhexis is performed in a single stage using micro-capsulorrhexis forceps.
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The flagellin of Listeria monocytogenes is encoded by flaA gene;there is no detail report about the influence of flaA gene on the virulence of LM90 SB2.FlaA gene-deleted strain was constructed successfully with recombination technology.The influence of FlaA on LM90 SB2 virulence was evaluated by motility,BF formation,LD50,etc.Results showed that the colony morphology did not change,gene-deleted strain still had good genetic stability,but its growth was slow and the motility was decreased in the environment at 25 ℃,the morphological structure of the mutant BF was looser and incomplete,LD50 was increased from 4.27 × 106 cfu to 1.62 × 107 cfu.Results indicated that the flaA gene affected the flagellar formation of LM90 SB2 significantly,the ability of the BF formation and the virulence of the flaA deleted strain were decreased obviously.
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Objective@#To investigate the therapeutic effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with FLAG sequential busulfan/cyclophosphamide(Bu/Cy) conditioning regimen for refractory/relapsed acute myeloid leukemia.@*Methods@#From February 2012 to June 2017, 21 patients with refractory/relapsed acute myeloid leukemia underwent allo-HSCT with FLAG sequential Bu/Cy conditioning regimen. Transplantation-related complications and clinical outcome were retrospectively analyzed.@*Results@#After conditioning, no hepatic veno-occlusive disease (VOD) and grade Ⅲ hemorrhagic cystitis occurred. 76.2% (16/21) patients had fever with 4 septicemia. One patient died of septic shock before engraftment. Twenty patients achieved neutrophil engraftment with a median time of 13 days (range, 10 to 21 days). Seventeen patients achieved platelet engraftment with a median time of 18 days (range, 9 to 25 days). The cumulative incidence of acute graft-versus-host disease (aGVHD) was 39.5%, and 3 patients developed grade Ⅲ-Ⅳ aGVHD. Of 19 patients who survived more than 100 days after transplantation, 4 had local chronic graft-versus-host disease (cGVHD). Of 21 patients, the median survival time was 15 months (range, 0.5 to 67 months) post-transplantation. Transplantation-related mortality rate was 28.7%. Leukemia relapse occurred in 4 patients with a median time of 4 months (range, 3 to 8 months) after transplantation. The cumulative relapse rate at 1 year was 21.4%. The 1-year and 3-year overall survival (OS) rates were 60.7% and 54.9% respectively. Log-rank analysis revealed that bone marrow blasts ≥ 20% or extramedullary leukemia before transplantation, poor platelet engraftment and grade Ⅲ-Ⅳ aGVHD were significantly related to shortened OS (P<0.05).@*Conclusions@#Allo-HSCT with FLAG sequential Bu/Cy conditioning regimen in patients with refractory/relapsed myeloid leukemia has acceptable transplantation-related risk and relapse rate. The 1-year and 3-year OS rates are comparable with those in remission patients.
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ABSTRACT In vitro rhizome production, encapsulation and cold storage of Acorus calamus were attempted for its propagation and ‘true-to-type’ conservation. Shoot cultures were initiated using underground rhizome buds, on 6-benzyladenine (BA) containing Murashige and Skoog (MS) medium. Maximum microrhizome production was observed in presence of 33.3 µM BA, on modified MS medium containing 6% sucrose, 100 mg/L citric acid and 1 g/L polyvinyl pyrrolidone-40. Synthetic seeds were produced from regenerated microtubers by encapsulation in calcium alginate beads. These synthetic seeds were stored in complete darkness at 100C temperature for different durations for mid-term conservation. After cold storage, synthetic seeds were re-cultured in vitro, 100% survival was recorded after the storage of 1, 3 or 6 months; and 80% survival was observed after the storage of 12 months. The microrhizomes were produced roots in 4.9 µM indole-3-butyric acid containing half strength MS medium. All the regenerated plantlets were successfully transferred to field after acclimatization. It is the first report on successful one year in vitro cold storage of A. calamus.
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BACKGROUND: It is widely known that the prognosis of acute myeloid leukemia (AML) depends on chromosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission. METHODS: We reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital. RESULTS: The event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diagnosis, 8.2 vs. 11.9 mo, P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo, P=0.009). The overall survival (OS) was significantly correlated with karyotype classification only at diagnosis (unfavorable vs. favorable or intermediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo, P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo, P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treatment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399, P=0.010) and the PRS (hazard ratio=0.447, P=0.031). CONCLUSION: The karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naïve patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.
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Humans , Chromosome Aberrations , Classification , Clonal Evolution , Cytarabine , Diagnosis , Disease-Free Survival , Granulocyte Colony-Stimulating Factor , Hematology , Karyotype , Leukemia, Myeloid, Acute , Medical Records , Prognosis , Proportional Hazards Models , RecurrenceABSTRACT
Objective To observe clinical curative effect of the FLAG regimen combined donor lymphocyte infusion after granulocyte colony stimulating factor(G‐CSF) mobilization(G‐DLI) ,for the acute myeloid leukemia (AML) of allogeneic Peripheral blood hematopoietic stem cell trans‐plantation (allo‐HSCT) after recurrence of hematology .Methods For the patients with recur‐rence after allo‐HSCT ,giving the FLAG regimen chemotherapy when the WBC dropped to the lowest point ,followed by giving G‐DLI that infusion peripheral blood stem cell from the original donors ,to observe curative effect and survival situation .And searched the literature review through the PubMed etc .Results Through FLAG regimen combined G‐DLI ,3 cases of relapse after transplan‐tation again obtained complete remission (CR) .Case 1 :disease‐free survival (DFS) was 13 month and overall survival(OS) was 23 months after G‐DLI .The patient has been the central recurrence and remission in bone marrow ,he was dead after 23 months due to multipleorgan function failure .He occurred Ⅱ acute GVHD in Skin and Ⅰ acute GVHD in liver after G‐DLI and obtained effective control ,not chronic GVHD .Case 2 :DFS and OS were 12 months and 13 months ,as bone marrow relapse again and giving up treat‐ment ,so died a month later .Respectively ,he has limitations chronic GVHD in skin after G‐DLI .Case 3:DFS was 16 months after G‐DLI since the disease‐free survival ,had limitations GVHD in skin that was control for given small dose of immunosuppressive drugs .Conclusion Joint FLAG scheme and G‐DLI may be one of the effective treatment of postoperative recurrence of allo‐HSCT .
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Objective To construct an eukaryotic expression vector of human B-cell translocation gene 2 (BTG2), to express the FLAG-tagged BTG2 protein in HeLa cells,and to supply an experimental tool for investigating the function of BTG2 gene.Methods The full-length BTG2 fragment was obtained by PCR and inserted into the multiple cloning site of pcDNA3.1 (+)vector. Oligo DNA encoding FLAG tag was designed and inserted into pcDNA3.1(+)-BTG2 to construct another vector pcDNA3.1(+)-FLAG-BTG2.The HeLa cells were divided into pcDNA3.1(+)empty vector group,pcDNA3.1(+)-BTG2 group and pcDNA3.1(+)-FLAG-BTG2 group.The HeLa cells were transfected with recombinant plasmids.Western blotting using anti-FLAG antibody was performed to detect the expression of FLAG-BTG2 protein in HeLa cells.Results The sequence of the vector was verified by both BamH Ⅰ endonuclese digestion and DNA sequencing. The Western blotting analysis confirmed that FLAG-fused BTG2 was detected in pcDNA3.1(+)-FLAG-BTG2 group but not in empty vector or pcDNA3.1(+)-BTG2 groups. Conclusion The eukaryotic expression vector pcDNA3.1(+)-FLAG-BTG2 is successfully constructed and FLAG-tagged BTG2 protein is expressed in HeLa cells.
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Introducción: el Plano de Broadrick constituye un dispositivo que permite restaurar el plano de oclusión y crear la Curva de Spee cuando se diseñan restauraciones para los sectores posteriores. Objetivo: describir el proceso de restauración de la Curva de Spee empleando el Plano de Broadrick e identificar su utilidad en la rehabilitación de un paciente con implantes dentales. Presentación de caso: paciente femenina de 56 años de edad quien acudió a la consulta de Implantología de la Facultad de Estomatología de La Habana para rehabilitarse protésicamente. Después del traslado de la relación cráneomandibular, a través del arco facial, a un articulador semiajustable del tipo Dentatus, se procedió al encerado de las restauraciones definitivas teniendo en consideración los determinantes de la morfología oclusal y con el empleo del Plano de Broadrick. Conclusiones: su uso adecuado permitió al protesista y al técnico crear fácilmente la Curva de Spee; se tuvo como resultado final una rehabilitación implantosoportada, estéticamente aceptada, que restauró el equilibrio ocluso- articular de la paciente.
Introduction: the Broadrick flag constitutes a device that allows restoring the plane of occlusion and creating the Spee's curve when the restorations for the posterior sectors is design. Objective: show the process of restoration of de Spee´s curve using the Broadrick flag and to identify the benefits of this device in the implantological rehabilitation. Case report: female patient of 56 years old that came to the Implantology´s office of the Dentistry's Faculty of Havana to be rehabilitated by prosthesis. After transfer the craneomandibular relationship, through the face-bow, to the Dentatus's semiadjustable articulator, one proceeded to oilcloth the definitive restorations having under consideration the determining ones belonging to the occlusal morphology and using the Broadrick flag. Conclusions: the adequate use of the Broadrick flag allowed both, dentist and technician, created the Spee's Curve easily, having as a result ending an implantological rehabilitation, aesthetically accepted, that restored the patient's occlusal- joint equilibrium.
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Many of the patients with extensive abrasion need comprehensive restorative treatment. The abrasion is usually caused by attrition, besides of it, there are many reasons for it. The plan of treatment should be started on assessment of the type of attrition and the etiologic analysis. Patient with well-developed masticatory muscle, alveolar process, and high occlusal force and also with little muscle length difference between the stable and the contracted state should be carefully assessed for the vertical dimensional loss and the restoration should be carefully designed. Decrease of tooth length can be compensated by the growth of the alveolar bone height; therefore, consistency of the occlusal vertical dimension is maintained. Accordingly, a careless increase of the vertical dimension can produce muscle fatigue, depressed tooth and pain, and fracture of the restoration. In this case, the patient with multiple tooth abrasion and clenching habit, the edentulous maxillary area is restored with amalgam inserted RPD, and the dentulous area of the maxilla and mandible are treated with fixed restoration accompanying with the increase of vertical dimension. Consequently, we are going to report about the satisfying result in both functional and esthetic aspects.
Subject(s)
Humans , Alveolar Process , Bite Force , Contracts , Mandible , Masticatory Muscles , Maxilla , Mouth , Mouth Rehabilitation , Muscle Fatigue , Muscles , Tooth , Tooth Abrasion , Vertical DimensionABSTRACT
BACKGROUND: The BC-6800 (Mindray, China) is a recently developed hematology analyzer that utilizes 'SF Cube Technology' to improve the reliability of complete blood counts (CBC), white blood cell (WBC) differentials, and erythroblast counts. In this study, we evaluated the performance of the BC-6800 for CBC, WBC differentials, reticulocyte counts, and erythroblast counts and analyzed the efficiency of its flag system. METHODS: Specimens from 100 healthy controls and 95 patients were used. We performed precision and correlation studies of CBC, WBC differentials, reticulocyte counts, and erythroblast counts. We also analyzed the efficiency of the flag system in detecting abnormal blood cells. RESULTS: The coefficients of variation (CVs) of precision were 0.9800 for CBC except erythrocyte indices, and >0.9500 for WBC differentials except monocyte and basophil. The WBC differentials and erythroblast counts obtained using the BC-6800 were well correlated with those of manual counts. The efficiencies of the flag system were 77.9% for Blasts, 82.1% for Immature Gran, 86.3% for Atypical Lymph, and 92.6% for NRBC present. CONCLUSIONS: The BC-6800 showed good precision and correlation with pre-existing hematology analyzers. The flag systems were quite efficient for detecting abnormal blood cells. Our study demonstrated that the BC-6800 hematology analyzer exhibits suitable performance and is helpful in routine laboratories.
Subject(s)
Humans , Basophils , Blood Cell Count , Blood Cells , Eosinophils , Erythroblasts , Erythrocyte Indices , Hematology , Leukocytes , Monocytes , Neutrophils , Reticulocyte Count , Statistics as TopicABSTRACT
Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs.
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Objective To investigate the therapeutic effects and side effects of FLAG and MEA regimen in the treatment of relapsed and refractory adult acute myeloid leukemia.Methods Use retrospective analysis to Observe the therapeutic effects and side effects of the 51 cases of relapsed and refractory adult acute myeloid leukemia (M3 except) from January 2009 to June 2012 in our hospital,which are divided into FLAG group (23 cases) and MEA group (28 cases) according to chemotherapy.Results In FLAG group,the rate of complete remission was 30.4 ％ (7/23),the rate of partial remission was 17.4 ％ (4/23),the effective rate was 47.8 ％ (11/23).In MEA group,the rate of complete remission was 35.7 ％ (10/28),the rate of partial remission was 21.4 ％ (6/28),the effective rate was 57.1％ (16/28),difference between two groups was not statistically significant. Both groups appeared Ⅳ degrees myelosupression,and there were no significant differences between them on incidences of secondary infection [95.7 ％ (22/23) vs 89.3 ％ (25/28)] and haemorrhagia [82.6 ％ (19/23) vs 85.7 ％ (24/28)].Difference on cardiac toxicity was statistically significant.Conclusions Compared with MEA regimen, FLAG regimen are similar effective and can be well tolerated,which has lower cardiac toxicity. Thus, FLAG regimen can be used as first-line treatment for relapsed and refractory adult acute myeloid leukemia.
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Objective To explore in vitro effects and the mechanism for FLAG regimen compared with IA regimen in P-glycoprotein-positive and -negative acute myeloblastic leukemia(AML) cell lines. Methods The expression of P-glycoprotein in K562 and K562/A02 cells were analyzed by flow cytometry. The effects of FLAG and IA on the proliferation of K562 and K562/A02 cells were detected by MTT assay. The Ara-CTP and Ara-C levels in those cells were measured by HPLC,the gene expression of hENT1 in K562 and K562/A02 cells was detected by real-time PCR. Results The positive rates of P- glycoprotein were (1.32±0.24)% in K562 cell and (97.66±3.77)% in K562/A02 cell, respectively. The expression of P- glycoprotein had no change after treated with FLAG or IA. The cytotoxicity to K562 of IA was better than FLAG [(84.41±9.33) % v.s (73.17±13.20)%, P<0.05], and the cytotoxicity to K562/A02 of FLAG was better than IA [(70.55±11.32)% v.s (48.46±12.81)%, P<0.01]. Ara-C and Ara-CTP accumulation and hENT1 expression in AML cells treated with FLAG were higher than that treated with IA. Conclusion P-glycoprotein-positive AML cells are more sensitive to FLAG regimen than IA regimen. The biochemical modulation of Ara-CTP and Ara-C may be the major mechanism.
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A refractory and resistant disease to conventional induction chemotherapy and relapsed disease are considered as the most important adverse prognostic factors for acute myeloid leukemia (AML). Sixty-one patients (median age, 33.6 yr) with relapsed or refractory AML were treated with the FLAG regimen that consisted of fludarabine (30 mg/m2, days 1-5), cytarabine (2.0 g/m2, days 1-5) and granulocyte colony-stimulating factor. Of the treated patients 29 patients (47.5%) achieved complete remission (CR). Higher CR rates were observed for patients with a first or second relapse as compared to patients with a primary refractory response or relapse after stem cell transplantation (HSCT). There was a significant difference in the response rates according to the duration of leukemia-free survival (pre-LFS) before chemotherapy (P=0.05). The recovery time of both neutrophils (> or =500/microL) and platelets (> or =20,000/microL) required a median of 21 and 18 days, respectively. Treatment-related mortality (TRM) occurred in seven patients (11.4%), of which 71.4% of TRM was caused by an invasive aspergillosis infection. After achieving CR, 18 patients underwent consolidation chemotherapy and six patients underwent allogeneic HSCT. In conclusion, FLAG chemotherapy without idarubicin is a relatively effective and well-tolerated regimen for relapsed or refractory AML and the use of FLAG chemotherapy has allowed intensive post-remission therapy including HSCT.