Value of F-FDG PET/CT Scan Quantization Parameters for Prognostic Evaluation of Patients with Diffuse Large B-cells Lymphoma / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the prognostic value of F-FDG PET/CT scan quantization parameters, max standardized uptake value （SUVmax）, metabolic tumor volume （MTV）, total lesion glycolysis （TLG） and other clinical factors for prognostic evaluation of paticnts with diffuse large B-cell lymphoma （DLBCL）.</p><p><b>METHODS</b>PET/CT scan and clinical data of a total of 65 newly diagnosed DLBCL patients who received Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone （R-CHOP） chemotherapy as first-line treatment were analyzed. All patients received a PET/CT scan at diagnosis and an interim PET/CT after 2-4 circles of chemotherapies. The related parameters of SUVmax, MTV and TLG were acquired by analyzing and calculating the scan results. The receiver operating characteristic （ROC） curve was used to determine the optimal cut-off of parameters. Pearson chi-square test, Kaplan-Meier method and COX proportional hazard model were performed to analyze the prognostic value of PET/CT related parameters and clinical factors in progression-free survival （PFS）.</p><p><b>RESULTS</b>Age, B symptom, Ann Arbor stage and extra-nodal involvement in major organs significantly related with PFS （P<0.05）, but the SUVmax didn't relalt with the prognosis. The cut-off values of MTV0, MTV1, TLG0 and TLG1 for disease recurrence or progression were 172.20cm , 4.32cm , 1043.33g and 14.07g. The lower MTV and TLG groups showed longer PFS significantly. In the multivariate Cox regression model, B symptoms, MTV1 and TLG1 were the independent prognostic risk factors.</p><p><b>CONCLUSION</b>MTV and TLG at baseline and in the interim and NCCN-IPI correlate with disease prognosis. SUVmax related parameters hare no significant relationship with prognosis. Besides MTV and TLG during treatment are the independent prognostic risk factors suggesting more predictive value than NCCN-IPI.</p>

Clinical outcomes of intravascular ultrasound in guiding the treatment of non-left main intermediate coronary lesions for patients with acute coronary syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the long-term clinical outcomes of intravascular ultrasound(IVUS) in guiding the treatment of non-left main intermediate coronary lesions for patients of acute coronary syndrome (ACS).</p><p><b>METHODS</b>A total of 25 patients with intermediate coronary lesions(stenosis of 40%-70%) confirmed by coronary angiography were performed with IVUS. When MLA≥4 mm, we deferred the PCI treatment and performed optimal medical treatment (OMT). The patient were followed up for 12 month. The primary outcome was target vessel revascularization (TVR) and secondary outcome was major adverse cardiac events (MACEs).</p><p><b>RESULTS</b>A total of 25 lesions of 25 patients were examined by IVUS. 19(76%) lesions were attenuated plaque, 4(16%)were echo-lucent plaque, 2(8%) were calcified plaque. Most of the plaque (18/25, 72%) were eccentric. Positive remodeling was found in 20(80%) lesions and negative remodeling in 5(20%) lesions with meanremodeling index of 1.17=0.15. Thrombus was found in 1 case, accounting for 4%. The diameter stenosis, area stenosis, minimal lumen area and the reference diameter mea-sured by IVUS were larger than those measured by quantitative coronary angiography (all P<0.05). One patient with non-ST segment elevated myocardiac infarction was performed revascularization because MI attacked again, and 2 patients with Unstable angina were treated with OMT but they were still rehospitalization because of angina occurred repeatedly. The incidence of TVR was 4.00%, so as 16.00% of MACE.</p><p><b>CONCLUSION</b>IVUS can be used to guide the treatment of non-left main intermediate coronary lesions for patients of acute coronary syndrome.</p>

Interleukin-20 targets podocytes and is upregulated in experimental murine diabetic nephropathy

Interleukin (IL)-20, a proinflammatory cytokine of the IL-10 family, is involved in acute and chronic renal failure. The aim of this study was to elucidate the role of IL-20 during diabetic nephropathy development. We found that IL-20 and its receptor IL-20R1 were upregulated in the kidneys of mice and rats with STZ-induced diabetes. In vitro, IL-20 induced MMP-9, MCP-1, TGF-β1 and VEGF expression in podocytes. IL-20 was upregulated by hydrogen peroxide, high-dose glucose and TGF-β1. In addition, IL-20 induced apoptosis in podocytes by activating caspase-8. In STZ-induced early diabetic nephropathy, IL-20R1-deficient mice had lower blood glucose and serum BUN levels and a smaller glomerular area than did wild-type controls. Anti-IL-20 monoclonal antibody (7E) treatment reduced blood glucose and the glomerular area and improved renal functions in mice in the early stage of STZ-induced diabetic nephropathy. ELISA showed that the serum IL-20 level was higher in patients with diabetes mellitus than in healthy controls. The findings of this study suggest that IL-20 induces cell apoptosis of podocytes and plays a role in the pathogenesis of early diabetic nephropathy.

78-year-old woman with fecaloid vaginal discharge

A 78-year-old woman with a history of colon cancer with metastasis to the liver was presented to our emergency department because of bilateral groin pain and difficulty in walking, which had gradually increased during the previous 5 days. The pain was of sudden onset, radiating to the back, without aggravating or relieving factors. It was associated with constipation, dysuria and vaginal discharge. She reported passing fecal matter from the vagina one month ago. On physical examination, she appeared malnourished. Her blood pressure was 98/65 mmHg, with a 108 beats/min heart rate and 28 breaths/min respiratory rate. She was afebrile. Physical examinations were unremarkable, except for pale conjunctiva, abdominal distention, and diffuse tenderness especially over the umbilicus with guarding tenderness. Bowel sounds were decreased. Pelvic examination showed a yellowish odorous vaginal discharge from the external orifice of uterus. A complete blood cell count showed the following: leukocyte count, 34,200/mm3; segmented neutrophils, 87.5%; hemoglo-bin level of 7.4 mg/dl; hematocrit, 18.8%; and platelet, 180000/uL. Other laboratory studies included: glucose, 86 mg/dL; serum urea nitrogen, 28 mg/dL; serum creatinine, 0.87 mg/dL; sodium, 142 mEq/L; potassium, 4.8 mEq/L; albumin, 2.5g/dL; a carbohydrate antigen 19-9 level of 3,244 U/ml, and a carcinoembryonic antigen [CEA] level of 64.6 ng/ml. Coronal and axial cuts of patient's abdominopelvic computed Tomography [CT] are shown in figures 1 and 2