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ObjectiveMyelodysplastic syndromes （MDS） is a group of clonal hematopoietic stem cell disorders，and this study aims to investigate the expression of hypoxia-inducible factor-1α（HIF-1α） in the bone marrow cells of patients with MDS and its correlation with the clinical features of MDS，the therapeutic efficacy of arsenic-containing Chineseherbal compound，and the survival prognosis. MethodAccording to the inclusion and exclusion criteria，27 MDS patients treated with arsenic-containing Chinese herbal compound in the Department of Hematology，Xiyuan Hospital，China Academy of Chinese Medical Sciences from January 2022 to September 2022 were included，and their bone marrow samples were collected by myelotomy. HIF-1α expression level in bone marrow cells was detected by real-time polymerase chain reaction （PCR） to analyze its correlation with clinical features，and logistic and Cox regression was used to analyze the risk factors affecting the efficacy and prognostic survival of MDS patients. ResultThe HIF-1α mRNA expression level was lower in bone marrow cells of MDS patients than in healthy subjects. HIF-1α was positively correlated with the degree of myelodysplasia（r=0.384，P<0.05） and bone marrow granulocytic system%（G%）（r=0.560，P<0.01）. Logistic regression showed that HIF-1α was a risk factor for the prognosis in the follow-up of the efficacy of treatment（P<0.05）and Cox regression showed that HIF-1α was an independent factor affecting the survival prognosis of MDS patients ［odds ratio（OR）=398.968，95% confidence interval（CI）（1.281，116 858.743），P<0.05］. ConclusionThe level of HIF-1α expression in bone marrow cells of MDS patients was closely related to the degree of clinical myelodysplasia and G%，and HIF-1α was a risk factor for the efficacy for and survival prognosis of MDS patients.
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ObjectiveTo explore the effects of Bushen Jianpi prescription on the autophagy and phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway in the patients with aplastic anemia （AA）. MethodA total of 30 AA patients admitted to Xiyuan Hospital and 6 healthy donors who were prepared to undergo peripheral blood hematopoietic stem cell transplantation in 304 Hospital from September 2020 to August 2021 were enrolled and assigned into an AA group and a control group. The AA group was treated with Bushen Jianpi prescription combined with cyclosporin A （CsA） and androgen for 3 months. The mononuclear cells from bone marrow in the AA group before and after treatment and the peripheral blood of the control group were collected. Transmission electron microscopy was then employed to detect autophagosomes. Western blotting was employed to determine the protein levels of microtuble-associated protein 1 light chain 3 （LC3）Ⅰ， LC3Ⅱ， mTOR， phosphorylated （p）-mTOR， Akt， p-Akt， PI3K， and p-PI3K， and real-time polymerase chain reaction （PCR） to determine the mRNA levels of LC3， mTOR， Akt， and PI3K. ResultIn the AA group， the treatment was completed in 29 patients， and the total response rate was 51.72% （15/29）. ① The AA group showed lower levels of white blood cell （WBC）， hemoglobin （HGB）， platelet （PLT）， and absolute neutrophil count （ANC） in the peripheral blood （P<0.01） and lower number of intracellular autophagosomes than the control group before treatment. Moreover， the AA group showed lower mRNA level of LC3 （P<0.01） and protein levels of LC3Ⅰ and LC3Ⅱ （P<0.01） and higher mRNA levels of mTOR， Akt， and PI3Kα （P<0.01） and protein levels of Akt， p-Akt， PI3K， p-PI3K， mTOR， and p-mTOR （P<0.01） than the control group. ② In AA group， the levels of HGB and PLT elevated （P<0.05） and the number of intracellular autophagosomes increased after treatment compared with those before treatment. Moreover， the mRNA level of LC3 and the protein levels of LC3Ⅰ and LC3Ⅱ were up-regulated （P<0.01）， the mRNA levels of mTOR， Akt， and PI3Kα （P<0.01） and the protein levels of Akt， p-PI3K （P<0.01）， p-Akt， PI3K， mTOR， p-mTOR （P<0.05） were down-regulated after treatment. ConclusionAA patients show lower autophagy levels， while Bushen Jianpi prescription can effectively improve the autophagy level and down-regulated the expression of PI3K/Akt/mTOR signaling pathway in AA patients.
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Objective:To construct a prognostic model for lung squamous cell carcinoma (SqCLC) based on autophagy-related genes analyzed by bioinformatics and validate it.Methods:Expression profile data and clinical information of 268 SqCLC patients were downloaded from The Cancer Genome Atlas (TCGA) database and a dataset of normal lung tissues of 336 healthy people was downloaded from the Genotype Tissue Expression (GTEx) database; the autophagy-related genome was obtained from the GO_AUTOPHAGY genome of the Human Autophagy Database (HADb) and the Molecular Signature Database (MSigDB) 6.2. R 4.0.3 software was applied to analyze the differentially expressed genes between SqCLC tissues in TCGA database and normal lung tissues in GTEx database. Screening of autophagy-related genes differentially expressed between SqCLC tissues and normal lung tissues in the TCGA database (referred to as differentially expressed autophagy genes) was performed using R 4.0.3 software. The Cox proportional risk model was applied to analyze the relationship between the differentially expressed autophagy genes and prognosis of SqCLC patients in TCGA database, and a prognostic model was constructed. The SqCLC patients in TCGA database were divided into high-risk group and low-risk group based on the median risk score of the prognostic model, and the Kaplan-Meier method was used to compare the overall survival of the two groups; the time-dependent receiver operating characteristic (ROC) curve of the 3-, 5- and 10-year overall survival rates of 268 patients in TCGA database predicted by the prognostic model was plotted. Cox regression was used to analyze the independent influencing factors of overall survival of SqCLC patients in TCGA database, and the prognostic index formula was established. Based on the consistency index and restricted mean survival (RMS) curve, the predictive efficacy for the survival of patients in TCGA database between prognostic index of prognostic model risk score alone and prognostic index of risk score combined with independent influencing factors was compared. R 4.0.3 software was used to construct the nomogram for predicting patients' 3-, 5- and 10-year overall survival rates.Results:Six prognosis related differentially expressed autophagy genes were screened, and a prognostic model was constructed as: risk score=PEX14×0.337+CASPASE-8×(-0.280)+TM9SF1×0.292+UBB×0.472+P4HB×0.163+CTSA×0.173. In TCGA database, the overall survival of high-risk group was worse than that of low-risk group ( P < 0.001). Time-dependent ROC curve analysis showed that the area under the curve (AUC) of the prognostic model risk score for predicting the 3-, 5- and 10-year overall survival rates of 268 patients in TCGA database was 0.715, 0.715 and 0.831, respectively. Multivariate Cox regression analysis showed that age, staging and prognostic model risk score were independent factors affecting the overall survival of SqCLC patients in TCGA database, and the prognostic index=0.998×risk score+0.725×staging+0.559×age. The RMS curve showed that compared with the prognostic model risk score, the prognostic index combined with 3 independent prognostic factors had a better effect on predicting the overall survival (consistency index: 0.68 vs. 0.65, P =0.045). Using age, staging and prognostic model risk score, a nomogram was constructed to predict the survival of patients with SqCLC, and its calibration curve was close to the ideal curve. Conclusions:A prognostic model of SqCLC based on 6 characteristic differentially expressed autophagy-related genes has been successfully established. Internal validation shows that this model combined with other clinicopathological factors could be helpful in predicting the survival of SqCLC patients.
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Objective:To assess the long-term follow-up results of intensity-modulated radiotherapy (IMRT) combined with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitor (TKI) in patients with hepatocellular carcinoma (HCC) showing macrovascular invasion (MVI).Methods:A retrospective analysis was conducted for 63 patients with HCC showing MVI without distant metastasis treated in Peking University Cancer Hospital from October 2015 to October 2018. Among them 28 patients were treated with IMRT combined with TACE and sorafenib (Group A) and 35 patients were treated with IMRT combined with TACE (Group B). Propensity score matching (PSM) was applied to assess the progression-free survival (PFS) and the overall survival (OS) of both groups.Results:The median follow-up time was 62 months. Before PSM, the median OS of group A and B were 19.0 months and 15.2 months ( χ2=3.15, P=0.076), respectively, and the median PFS of groups A (10.7 months) was longer than that of group B (8.6 months; χ2=3.99, P=0.046). After PSM, the median OS of group A (30.6 months) was significantly longer than that of group B (15.2 months; χ2=5.34, P=0.023), and the PFS of groups A (12.5 months) was still longer than that of group B (8.3 months; χ2=4.79, P=0.026). In the whole group, 10 patients (15.9%) suffered from grade-3 hematologic toxicity, and seven patients (11.1%) experienced grade-3 hepatic toxicity. The incidence of skin reactions, hand-foot syndrome, and diarrhea in group A was higher than that in group B, but all these adverse events were grade 1-2. Moreover, no grade-4 adverse events, radiation-induced liver disease, and treatment-related mortality occurred in both groups. Conclusions:As demonstrated by the long-term follow-up result, IMRT combined with TACE and TKI could improve both the PFS and the OS of patients with HCC showing MVI after PSM.
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The traditional-immunological strategies for clinical laboratories often rely on large and expensive instruments and skilled operators, and the measurement time is also long. However, the sensitivity of these strategies is still unsatisfactory. It is urgent to research and develop the point-of-care testing (POCT) featured as a highly sensitive, accurate, and rapid/POCT diagnosis. The Microfluidic chips have multi-advantages that are suitable for the clinical POCT diagnosis: high sensitivity, throughput, and automation. Recently, the Microfluidic-immune chips developed based on the microfluidic technology combined with immune detection have considered not only hotspots in the related research but also benefit to the tumor marker detection, antigen and antibody detection of infectious diseases, autoantibody detection, hormone detection, and other fields. However, there are still many challenges to be overcome during the application of chips, such as more effective microfluidic manipulation, more sensitive collection, and analysis of reaction signals.
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Chimeric antigen receptor T (CAR-T) cell has achieved excellent efficacy in hematological tumors, especially for lymphoma. Many products have been approved to market all over the world, and 2 products targeting CD19 have been approved to treat relapsed and refractory large B-cell lymphoma in China. The current experiences of using CAR-T cells come from previous clinical studies. How to use CAR-T cells in a standardized and rationalized way is still a challenge faced by our clinicians. Based on the CAR-T cell treatment experiences from Peking University Cancer Hospital and the latest research progresses in CAR-T in China and abroad, this article will elaborate on patient screening, peripheral blood mononuclear cell collection, bridging treatment, lymphocyte depletion chemotherapy, CAR-T cell infusion, the monitoring and treatment of adverse events after infusion, and long-term follow-up after infusion, in order to guide clinicians to better use CAR-T cell and to bring maximum benefits to patients.
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During the epidemic of COVID-19, The Fifth Hospital of Harbin Medical University organized and operated online blended teaching based on BOPPPS teaching mode. Before the opening of the school, the college concentrated on theoretical learning and online practice in BOPPPS teaching mode to ensure that teachers mastered online teaching methods before teaching. In the course of teaching, various means were used to strengthen the application of six modules in BOPPPS teaching mode. A multilevel online teaching supervision and feedback mechanism for colleges, teaching and research sections, teachers and students, and continuously improve the quality of teaching. The teaching practice of the first four weeks have shown that through the unified organization and implementation of the college, online teaching based on BOPPPS teaching mode can be realized efficiently, student-centered and participatory learning can be realized, and the online teaching ability of teachers can also be improved with satisfactory results.
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Novel coronavirus pneumonia, also known as coronavirus disease 2019 (COVID-19), is caused by a new coronavirus that infects the lungs. Although some patients with COVID-19 may be combined with neurological symptoms, there is no direct evidence that this new coronavirus can directly invade nerve system. A case of COVID-19 with tuberculous meningitis is reported to remind that when patients with COVID-19 present symptom of encephalitis or meningitis, a comprehensive pathogen examination is recommended.
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Objective@#To introduce a method for calibrating the conversion from CT Hounsfield units (HU) to relative stopping power (RSP) for proton therapy, and improve the precision of the conversion in the region for adipose tissues.@*Methods@#The HU and RSP values of human tissues were calculated by a stoichiometric calibration method. Animal tissue was used to simulate subcutaneous adipose tissue of patients, and the HU and RSP of the animal tissue were measured. The effect of subcutaneous adipose tissue on conversion between HU and RSP were analyzed by piecewise fitting.@*Results@#The precision of conversion curve was improved significantly with the measured HU and RSP of adipose tissue in the fitting. The effect caused by different choice in different ionization energy was less than 0.6%, and the effect of proton energy differential was less than 0.8%.@*Conclusions@#The precision of conversion curve for the transformation of HU into RSP in adipose tissues could be improved by taking subcutaneous adipose tissue into account, which would reduce the range error of proton beams when such tissues are present in the target volumes or in the beam path.
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Objective To investigate the efficacy of concurrent chemoradiotherapy for anal squamous cell carcinoma (ASCC) in the era of intensity-modulated radiotherapy.Methods A total of 19 patients with ASCC who underwent definitive radiotherapy in our hospital since 2011 were collected.The survival curves were depicted with K-M method.Risk factors of disease progression were analyzed using case-control study.Results The median follow-up time was 31 months.The 3 year-LFS and 3 year-OS were 88.1％ and 91.7％,respectively.Grade 3 acute toxicities during the chemoradiotherapy were mainly white blood cell reduction (15.8％),platelet reduction (10.5％),diarrhea (15.8％),and skin reaction (31.6％).Compared with historical data,volumetric intensity modulated arc therapy was superior to conventional radiotherapy in the treatment outcome and normal tissue protection in ASCC.Univariate analysis showed that concurrent chemotherapy with capecitabine was a favorable factor in disease progression (P＜ 0.05).Conclusions Volumetric intensity modulated arc therapy for ASCC may have advantages in terms of efficacy and normal tissue protection.Concurrent chemotherapy with a double-drug regimen containing capecitabine may be a beneficial factor in disease progression.
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Objective To investigate the current knowledge and execution status of venous thromboembolism (VTE) prevention and management among critical care practitioners in cancer hospitals in China. Methods A self-designed electronic questionnaire was used to survey the registered medical members from the Critical Care Medicine Society of China Anti-Cancer Association (CACA), 409 practitioners participated in the survey with validated questionnaires. The respondents were divided into physician group (n = 142) and nurse group (n = 267) according to the occupation. The practitioners' basic knowledge situation of VTE prevention, the daily practice of VTE prophylaxis, and the prevention of anti-coagulation situation in patients undergoing tumor surgery and non-surgery treatment were analyzed. Results Respondents from 24 Departments of Critical Care Medicine of Cancer Hospitals in 17 provinces and 4 municipalities across China participated in the survey, accounting for 29.0% of the total registered members of the Critical Care Medicine Society of CACA. ① Practitioners' current basic knowledge and attitude of VTE prevention:45.8% (11/24) of the hospitals involved in the survey had established VTE quality control system; 66.5% (272/409) of the respondents very concerned about VTE; the proportion of respondents very concerned about VTE [83.8% (119/142) vs. 57.3% (153/267)] and proportion of respondents who thought that VTE had a significant effect on prognosis [84.5% (120/142) vs. 74.9% (200/267)] in physician group were significantly higher than those in nurse group (both P < 0.05); a similar proportion of the respondents in physician and nurse groups suggested energetic prevention of VTE should be carried out [70.4% (100/142) vs. 69.3% (185/267), P > 0.05]. ② Daily practice of VTE prevention: compared with American College of Chest Physicians (ACCP) and National Comprehensive Cancer Network (NCCN) guidelines, the proportion of the respondents who were familiar with the VTE guidelines from the Chinese society of clinical oncology (CSCO) was significantly higher [61.4% (251/409) vs. 38.9% (159/409), 38.1% (156/409)]; 99.0% (405/409) of the respondents believed guidelines were necessary for the VTE prevention and management of critically ill cancer patients, meanwhile 60.6% (248/409) suggested the implementation of the current guidelines needed to be adjusted according to the clinical practical situation; 85.1% (348/409) of the respondents performed regular VTE risk assessment in clinical practice; 81.9% (335/409) implemented VTE prevention strategy based on difference in risk stratification results; 66.7% (273/409) of the respondents selected Caprini score recommended by the guidelines for VTE risk assessment. ③ VTE prophylaxis for critically ill cancer patients: for postoperative cancer patients, 78.5% (321/409) of the respondents implemented both mechanical prophylaxis and anticoagulants for prevention of VTE, 66.3% (271/409) respondents discontinued the mechanical prophylaxis and 54.0% (221/409) discontinued prophylactic anticoagulation once the patients were ambulatory; for patients with critical cancer illness under medical treatment, only 9.5% (39/409) of the respondents routinely implemented prophylactic anticoagulation, while the majority of respondents 82.4% (337/409) implemented prophylactic anticoagulation based on a comprehensive risk assessment for bleeding; 61.1% (250/409) discontinued mechanical prophylaxis and 42.3% (173/409) discontinued prophylactic anticoagulation once the patients were ambulatory. Conclusions The results of this nation-wide survey reveal the current knowledge and practice status of the VTE prevention and management among critical care practitioners in China, indicating that VTE prophylactic anti-coagulation practice for critically ill cancer patients is still suboptimal. The present guidelines are not directing to the VTE preventive works for such patients, resulting in that the VTE preventive strategy remains largely based on experiences of medical workers rather than scientific evidence from clinical trials. Establishing and improving expert consensus or guidelines for critical cancer patients are beneficial and of great importance to elevate the level of standardizing prevention and management of VTE in China.
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Objective To introduce a method for calibrating the conversion from CT Hounsfield units (HU) to relative stopping power ( RSP) for proton therapy, and improve the precision of the conversion in the region for adipose tissues. Methods The HU and RSP values of human tissues were calculated by a stoichiometric calibration method. Animal tissue was used to simulate subcutaneous adipose tissue of patients, and the HU and RSP of the animal tissue were measured. The effect of subcutaneous adipose tissue on conversion between HU and RSP were analyzed by piecewise fitting. Results The precision of conversion curve was improved significantly with the measured HU and RSP of adipose tissue in the fitting. The effect caused by different choice in different ionization energy was less than 0. 6％, and the effect of proton energy differential was less than 0. 8％. Conclusions The precision of conversion curve for the transformation of HU into RSP in adipose tissues could be improved by taking subcutaneous adipose tissue into account, which would reduce the range error of proton beams when such tissues are present in the target volumes or in the beam path.
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Objective@#To analyze the gene mutations in the patients with myelodysplastic syndromes (MDS).@*Methods@#Forty-seven patients with MDS newly diagnosed in Xiyuan Hospital, China Academy of Chinese Medical Sciences from January 2016 to July 2017 were enrolled. NGS 127-gene panel was used to detect the gene mutations, and the relationship between the gene mutations and the clinicopathological features was also analyzed.@*Results@#Thirty-one (66.0 %) cases had gene mutations in 47 patients with MDS, and 23 gene mutations were detected with clinical significances. There were 7 mutant genes with a mutation frequency over 5 % in the population, including U2AF1 (23.4 %), SF3B1 (12.8 %), ASXL1 (10.6 %), TET2 (8.5 %), BCOR (8.5 %), TP53 (8.5 %) and DNMT3A (6.4 %) in turn. Among 31 patients with gene mutations, 16 (51.6 %) patients had ≥ 2 synergistic mutations, and 12 cases had synergistic mutations in different genetic functional groups, which was higher than that in same genetic functional groups (4 cases). There was a tendency of coexistence in IDH2-KRAS, IDH2-SRSF2, IDH2-STAG2, KRAS-SRSF2, KRAS-STAG2, RUNX1-PHF6, EZH2-ASXL1, EZH2-ZRSR2, and NPM1-NRAS (all P < 0.05). The variant allele frequency (VAF) of signaling pathway related genes including JAK2, KRAS, NRAS, SH2B3 was low in general and in a sub-clone status. JAK2 gene mutation was observed in 1 case with MDS-U. SH2B3 gene mutation was observed in a patient with very poor prognosis of karyotype. SETPB1 and EZH1 gene mutations were observed in two patients with high-risk revised international prognostic scoring system (IPSS-R).@*Conclusions@#The common mutated genes include U2AF1, SF3B1, ASXL1 and TET2. The genes in different genetic functional groups tend to synergistic mutations. Gene mutations can be used to predict the prognosis of diseases and become the target in the treatment of MDS.
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Objective To explore the risk factors influencing the outcomes of radiation brain injury after intensity-modulated radiotherapy (IMRT) in patients diagnosed with nasopharyngeal carcinoma.Methods Clinical data of 1 300 nasopharyngeal carcinoma patients treated with IMRT in our hospital during 2006 and 2013 were retrospectively analyzed.Fifty-eight patients presented with radiation brain injury after IMRT.MRI data of these patients during 3-24 months follow-up were collected.The clinical efficacy in the treatment of radiation brain injury was evaluated according to RECIST guidelines.Results Forty-six patients with intact follow-up data were enrolled.The median latency of radiation brain injury was 34 months.Patients were divided into the response (CR+PR) and non-response groups.The risk factors influencing the response rate during 10-12 months and 18-24 months were identified and analyzed.Univariate analysis demonstrated that gender,age,smoking history,T stage,and high-intensity treatment exerted no significant effect upon the objective remission rate during these two time intervals periods.Patients treated with gangliosides obtained high response rate.The response rate was 68.8％ in 10-12 months (P=0.000),and 81.8％ in 18-24 months (P=0.008).Multivariate analysis revealed that use of gangliosides was a favorable factor for mitigating radiation brain injury in two time intervals (OR=19.8 and 13.5;P=0.001 and 0.005).Conclusions Use of gangliosides probably accelerates the healing of radiation brain injury,whereas the clinical efficacy remains to be elucidated by prospective clinical trials.
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Objective To investigate the dosimetric effect of carbon fiber couch through virtual simulation in the XiO treatment planning system (TPS).Methods A treatment couch model of iBEAM evo Extension 650 was scanned with a big bore spiral CT and its contour was stored in the XiO TPS.The attenuation coefficient of couch was obtained by measuring the attenuated dose with and without a solid water phantom on the couch at different gantry angles (100°-180°).The optimal relative electron density (RED) values of the carbon fiber (CF) cover and foam core (FC) were adjusted according to the comparison between measured and simulated attenuation dose.The effects of the couch in the TPS on pass rate were evaluated by Octavius 4D phantom with 10 cases with lung cancer.Results The optimal RED values of CF and FC were 0.75 and 0.10 g/cm3,respectively.The measured attenuation error was the maximal at gantry angle of 120° (4.84％) without the treatment couch in the TPS.The average measured attenuation errors without the couch in the TPS dropped significantly from (2.54 ± 1.48) ％ to (-0.04 ± 0.36) ％ after inclusion of the treatment couch during dose calculation (Z =-3.621,P ＜ 0.05).The three-dimensional dose verification γ pass rate (3 mm/3％) without the couch increased significantly from (91.79± 1.25)％ to (94.74± 1.69)％ after inclusion of the couch in the dose calculation (t =6.027,P ＜ 0.05).Conclusions The effect of couch on the attenuation dose is significant.Inclusion of a virtual model of couch in XiO TPS can simulate the attenuation effect properly and improve the accuracy of dose calculation.
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Objective To investigate the survival of oral arsenic-containing Qinghuang Powder (QHP) and low intensive chemotherapy (LIC) in the treatment of elderly patients with acute myeloid leukemia (AML).Methods Forty-two AML patients older than 60 years in Xiyuan Hospital from January 2015 to December 2017 were retrospectively analyzed.Of them,20 cases were treated with QHP (QHP group),22 cases were treated with LIC (LIC group).The survivals of the two groups were compared.Results There was no significant difference of median survival time (13 months vs.13.5 months,x2 =0.096,P =0.757),1-year survival rates (59.1％ vs.70.0 ％,x2 =0.543,P =0.461),2-year survival rates (13.6 ％ vs.15.0 ％,x2 =0.016,P ＞ 0.05),and 3-year survival rates (4.6 ％ vs.5.0 ％,x2 =0.005,P ＞ 0.05) between LIC and QHP groups.There was no significant difference of median survival time in age ≥75 year (12 months vs.12.5 months,x2 =1.317,P =0.251),performance status scores ＞ 2 (12 months vs.12 months,x2 =0.834,P =0.361),hematopoietic stem cell transplantation with combined disease index ＞ 2 (12 months vs.13 months,x2 =1.726,P =0.189),secondary AML (10 months vs.14 months,x2 =1.552,P =0.213),and poor cytogenetics (12 months vs.8 months,x2 =0.479,P =0.489) between LIC and QHP group.Conclusion The survival of elderly AML patients is considerable in patients treated with oral QHP and LIC,which suggests that oral QHP may be an equivalent alternative treatment since elderly AML (especially more than 75 years) patients refused to LIC therapy.
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Objective To evaluate the dosimetric effects of air cavity on primary tumor and organs at risk (OARs) during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma patients.Methods Nine patients with nasopharyngeal carcinoma had CT simulation before treatment and on the 25 fraction of radiotherapy.Radiotherapy plan1 was first created by delineating the target volumes and OARs on the first CT image, which was then copied and merged with the second CT image.Air cavity that was formed following tumor volume regression was delineated on the first CT image, and the density of air cavity was set to zero.A new gross target volume (GTV) was formed by subtracting the air cavity from the original GTV, and the new CT image was named CTAir.Plan2 was then created by calculating the dose distribution on CTAir using the same portals and parameters as Plan1.Assuming that Plan1 and Plan2 were both used throughout the course of radiotherapy, the dosimetric parameters of nasopharyngeal tumor and OARs in the absence and presence of air cavity were then compared using the paired t-test.Results Dmean, D95, D90, D10, and D5 of tumor were significantly higher in plan2 than in plan1(P=0.000, 0.001, 0.001, 0.001, and 0.005, respectively), with a<0.5 Gy increase in dose.A dose build-up effect was observed within the tumor region posterior to the air cavity, where the highest dose was 1.4 cm posterior to the air cavity, resulting in a dose difference of 0.36 Gy.In addition, D2cc and D1cc of the brain stem were significantly higher in plan2 than in plan1(P=0.036 and 0.044, respectively).Dmax of the optical chiasm, left optical nerve, and right optical nerve were also increased in the presence of air cavity (P=0.438, 0.434, and 0.477, respectively), but the change in dose was<0.12 Gy.Conclusions Air cavity induces a small but negligible increase in the tumor and OARs dose in patients with nasopharyngeal carcinoma during IMRT.However, closer monitoring should be conducted for patients with OARs that is close to or has surpassed tolerance prior to radiotherapy.
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Objective To analyze the clinical efficacy and safety of compound Qinghuang powder (compound QHP) for treatment of myelodysplastic syndromes (MDS) and its association with blood arsenic concentration (BAC). Methods 40 patients with MDS were treated with compound QHP, and the clinical efficacy, safety, and its association with BAC were evaluated after treatment for 6, 9 months, respectively. Results After treatment for 6 months, the rate of hematology improvement was 32.5 % (13/40), and the effective rate was 87.5%(35/40). 21 cases depended on the blood transfusion before treatment, after treatment 6 cases completely got rid of blood transfusion and the blood transfusion of another 6 cases was decreased by more than 50 %. The absolute neutrophil count was increased from (0.50±0.13)×109/L to (0.93±0.33)×109/L (t= 4.130, P= 0.0008). The hemoglobin content was increased from (71.06±14.82) g/L to (80.41±27.35) g/L (t= 2.233, P= 0.0321). After treatment for 9 months, 76.2 % (16/40) of the patients got rid of blood transfusion or blood transfusion reduction was more than 50%. The platelet count was increased from (45.04 ± 24.38)×109/L to (60.65±29.46)×109/L (t= 2.241, P= 0.0335). The incidence of abdominal pain and diarrhea after treatment for 1, 3 and 6 months were 12.5 % (5/40), 10.0 % (4/40) and 5.0 % (2/40), respectively, all belonging to mild level . Before treatment , there were 12 patients with abnormal liver function , including 6 cases back to normal after treatment, and 6 cases of significantly relieved, without new case with abnormal liver function. Before treatment, there were 10 cases with abnormal myocardial enzymes, including 1 cases back to normal after treatment and 9 cases significantly relieved, without new case with abnormal myocardial enzymes. No patient with abnormal renal function was observed before and after treatment. The BAC was (7.71±5.65) μg/L before treatment, which was significantly lower than that of 1, 3 and 6 months [(29.27±9.07)μg/L, (27.79 ±10.18) μg/L and (31.98 ±12.55) μg/L respectively, all P 0.05). The BAC in efficacy group [(33.48 ±12.56) μg/L] was significantly higher than that in non-efficacy group [(21.46 ±6.00) μg/L] (t=2.089, P=0.035). 12.5% (5/40) of the patients had mild gastrointestinal side effects after treatment for 1 month, while the BAC of them [(16.93 ±1.80) μg/L] was significantly lower than that in patients without gastrointestinal side effects [(31.78±1.39 ) μg/L, P<0.0001]. The occurrence rate of abdominal pain and diarrhea was decreased after treatment for 3 and 6 months, while the BAC was increased gradually. Conclusions Compound QHP is effective in the treatment of MDS with mild adverse reactions. There is no damage to the heart, liver, and renal function. Besides, it shows that reducing the gastrointestinal adverse reactions and maintaining the effective concentration of BAC play a significant role in the effect of compound QHP in the treatment of MDS.
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Objective To search for application ways for the safe and effective clinical methods of arsenic-containing Compound Qinghuang Powder (Compound QHP) for the treatment of myelodysplastic syndrome (MDS). Methods Totally 200 patients with MDS were included in the study and treated with Compound QHP. After one-month treatment, the 60 patients with the blood arsenic concentrations 0.05). Conclusion In application of Compound QHP, the blood arsenic concentration can be monitored to adjust the daily dose of realgar, thus to increase the effective blood arsenic concentration, and then improving efficacy without increasing the clinical toxicity.
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Objective To analyze the blood arsenic concentration and the safety of compound Qinghuang powder(compound QHP)in patients with myelodysplastic syndrome(MDS).Methods A total of 45 MDS patients received treatment with compound QHP (the treatment group, n=45). The concentration of blood arsenic in different time was determined by atomic fluorescence spectrometry. The clinical safety of compound QHP was evaluated by analyzing the symptoms of adverse reaction and organ function. The comparison were MDS patients with Qinghuang powder (QHP group, n=47) and healthy people. Results There was no significant difference of the blood arsenic concentration between the treatment group and the healthy control group (P=0.450),while after the treatment for 1 month those concentrations significantly increased (P=0.000). There were no significant difference between the blood arsenic concentration after treatment for 1, 3, and 6 months (P=0.240). The incidence of adverse reaction in the treatment group was significantly lower than that in QHP group(χ2=4.720, P=0.030). The incidence of adverse reactions in the digestive tract was significantly lower in the treatment group than that in QHP group (χ2=4.650, P=0.034). The blood arsenic concentration of patients with abdominal pain diarrhea was significantly lower than those without abdominal pain diarrhea (P=0.020). Before treatment in the compound QHP group, there were 21 cases with increased myocardial enzymes, 10 cases with abnormal liver function and 4 cases with renal dysfunction, respectively. After treatment at 6th month, these indicators returned to normal with 7 cases of myocardial enzymes, 6 cases of liver function and 1 case of renal function, respectively. There was no new case with abnormal myocardial enzymes, liver function and renal dysfunction, respectively. Conclusions Arsenic could be absorbed in the digestive tract into blood in MDS patients after treatment with arsenic-containing compound QHP, and the blood arsenic concentration remained stable during the course of treatment. The adverse reactions were mainly mild gastrointestinal symptoms, but no heart, liver or renal function damage was observed. The incidence of abdominal pain diarrhea in patients treated with compound QHP was significantly lower than that with QHP.