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Objective@#To investigate the clinical features, diagnosis, occurrence sequence and clonal origin of chronic lymphocytic leukemia complicated with multiple myeloma.@*Methods@#The diagnosis and treatment of one patient with multiple myeloma and chronic lymphocytic leukemia who was admitted to the First Hospital of Jilin University in May 2018 was retrospectively analyzed, and the related literatures were reviewed.@*Results@#This patient began with lumbosacral pain, and he was diagnosed as chronic lymphocytic leukemia complicated with multiple myeloma after bone marrow aspiration, flow cytometry, and blood and urine immunofixation electrophoresis. It is recommended that Rd (lenalidomide + dexamethasone) or MPV (melphalan + prednisone + bortezomib) regimen, but the patient did not receive chemotherapy and died of infectious diarrhea 1 month later.@*Conclusions@#The occurrence of multiple myeloma and chronic lymphoblastic leukemia may originate from the same clone or different new clone. It is very rare that multiple myeloma and chronic lymphoblastic leukemia can co-occur. Therapeutic options tend to be more aggressive multiple myeloma-based regimen.
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Hilar cholangiocarcinoma (HCCA) is a malignant tumor arising from the epithelium of the bile duct, which involves the common hepatic duct, the left and right hepatic ducts, and the confluence areas of these bile ducts. HCCA has an insidious onset and most patients are in the advanced stage when jaundice is observed, and therefore it is considered a difficult issue in the field of surgery. Radical resection is the optimal method for the treatment of HCCA and has great influence on recurrence rate of tumor and patients’ survival time. Therefore, preoperative evaluation of tumor resectability is an important step of HCCA treatment. At present, there are eight main methods for HCCA staging and typing, i.e., Bismuth-Corlette classification system, modified T staging system, TNM staging system, JSBS staging system, Gazzaniga staging system, International Cholangiocarcinoma Group staging system, Mayo staging system, and Blechacz staging system. Each staging and typing system has its own advantages and disadvantages in clinical practice. This article reviews the staging and typing methods for HCCA, with a focus on the clinical value of each staging and typing system in preoperative evaluation of radical resection and prognosis.
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Objective:To investigate the clinical features, diagnosis, occurrence sequence and clonal origin of chronic lymphocytic leukemia complicated with multiple myeloma.Methods:The diagnosis and treatment of one patient with multiple myeloma and chronic lymphocytic leukemia who was admitted to the First Hospital of Jilin University in May 2018 was retrospectively analyzed, and the related literatures were reviewed.Results:This patient began with lumbosacral pain, and he was diagnosed as chronic lymphocytic leukemia complicated with multiple myeloma after bone marrow aspiration, flow cytometry, and blood and urine immunofixation electrophoresis. It is recommended that Rd (lenalidomide + dexamethasone) or MPV (melphalan + prednisone + bortezomib) regimen, but the patient did not receive chemotherapy and died of infectious diarrhea 1 month later.Conclusions:The occurrence of multiple myeloma and chronic lymphoblastic leukemia may originate from the same clone or different new clone. It is very rare that multiple myeloma and chronic lymphoblastic leukemia can co-occur. Therapeutic options tend to be more aggressive multiple myeloma-based regimen.
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Objective@#To evaluate the prognostic value of kinetic changes in minimal residual disease (MRD) status, as well as its relationship with risk stratification, therapeutic response and treatment in patients with newly-diagnosed multiple myeloma (MM) .@*Methods@#A total of 135 patients with newly-diagnosed MM were screened, and 105 patients who achieved VGPR or more as the best responses were included into this study. The MRD status was determined by multiparameter flow cytometry (MFC) at multiple intervals after two cycles of treatment until clinical relapse, death, or last follow-up. The statistical methods included Kaplan-Meier analysis, Cox regression, etc.@*Results@#①In all 135 patients, 57.8% (78/135) patients achieved MRD negativity (MRD-) after treatment. In 105 patients who achieved VGPR and thus included in this study, the MRD- rate was 72.4% (76/105) , with a median interval of 3 months from starting treatment to achievement of MRD- status. ②The 2-year PFS rate of patients with MRD- status was significantly higher than that of MRD+ status (62.2% vs 41.3%, P=0.001) , while MRD persistence (MRD+) was an independent factor for poor prognosis (multivariate analysis for PFS: P=0.044, HR=3.039, 95%CI 1.029-8.974) . ③Loss of MRD- status (i.e., MRD reappearance) showed inferior outcomes compared with MRD sustained negative ones, the PFS was 18 months versus not reach (P<0.001) and the OS was not reach for both (P=0.002) . ④The 2-year PFS and OS rates of patients with duration of MRD-status≥12 months were significantly higher than those of the control group (PFS: 77.7% vs 36.7%, P<0.001; OS: 96.4% vs 57.9%, P<0.001 respectively) . Duration of MRD- status was associated with a marked reduction in risk of relapse or death (univariate analysis for PFS: P<0.001, HR=0.865, 95%CI 0.815-0.918; for OS: P=0.001, HR=0.850, 95%CI 0.741-0.915 respectively) . ⑤Moreover, even in patients carrying high-risk cytogenetic abnormalities (CA) or ineligible for ASCT, MRD negativity remained its prognostic value to predict PFS (high-risk CA medianPFS: not reach vs 19 months, P=0.006; ineligible for ASCT medianPFS: not reach vs 25 months, P=0.052 respectively) . ⑥Last, treatment with the bortezomib-based regimens contributed to prolonged MRD- duration (median MRD- duratio: 25 months vs 10 months, P=0.034) .@*Conclusion@#Our findings supported MRD+ status as an independent poor prognostic factor in MM patients, which implicated that duration of MRD- status also played a significant role in evaluation of prognosis, while loss of MRD-status might serve as an early biomarker for relapse. Therefore, monitoring of MRD kinetics might more precisely predict prognosis, as well as guide treatment decision, especially for when to start retreatment in relapsed patients.
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Objective@#To compare the Bismuth-Corlette typing, modified T-staging and Mayo staging system in predicting the radical resection rates and prognosis of patients with hilar cholangiocarcinoma (HCC).@*Methods@#The clinical data of 138 patients with hilar cholangiocarcinoma treated in the First Bethune Hospital of Jilin University were retrospectively analyzed. Three different staging methods were used.@*Results@#With increase in the classification level of the Bismuth-Corlette classification, the radical resection rate did not significantly decrease (P>0.05). The radical resection rates of stage T1, T2 and T3 in the modified T-staging system were 60.0% (27/45), 36.0% (10/28) and 14.0% (9/65) respectively (all P<0.05). The radical resection rates of patients in the stages I, II, III, IV of the Mayo Staging System were 86.0% (12/14), 50.0% (14/28), 29.0% (19/66) and 3/0% (1/30) respectively (all P<0.05). The overall survival time were no significant differences between the different Bismuth-Corlette and the modified T-staging system patients (P>0.05). However, there were significant differences among the survival rates in the various tumor staging levels using the Mayo Staging System.@*Conclusions@#The modified T-staging system and the Mayo staging system were more accurate than the Bismuth-Corlette typing system in predicting radical resection rates in patients with hilar cholangiocarcinoma. The Mayo staging system was superior to the Bismuth-Corlette typing system and the modified T-staging system in predicting prognosis of patients with hilar cholangiocarcinoma.
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Objective@#To investigate the effect of 1q21 amplification (1q) on the therapeutic response and prognosis of bortezomib(Btz) in the treatment of newly diagnosed multiple myeloma (MM) patients.@*Methods@#A total of 180 newly diagnosed MM were included for analyses of clinical characteristics, cytogenetics, objective response rate (ORR), progression-free survival (PFS) and overall survival (OS), retrospectively. Gene expression profiling (GEP) was analyzed using publicly available R2 platform.@*Results@#① In 180 patients, 1q was found in 51.1% cases. Of them, 174 patients had complete follow-up data, including 88 cases with 1q and 86 without 1q (non-1q). ②Incidence of 1q was positively associated with percentage of IGH rearrangement (72.2%, P=0.017) and 1p deletion (1p) (27.8%, P=0.040). ③ The median PFS was 15.0 and 20.3 months for the 1q group and non-1q group, and the median OS was 29.4 and 44.0 months, respectively. Both PFS and OS of 1q group was significantly shorter than those of the non-1q group (P=0.029 and 0.038, respectively). Multivariate analysis further revealed that 1q was an independent prognostic factor for both PFS (HR=1.910, 95% CI 1.105-3.303, P=0.020) and OS (HR=2.353, 95% CI 1.090-5.078, P=0.029). ④ In 91 evaluable cases with 1q, very good partial remission (VGPR) rate was higher after treatment with Btz than those without Btz (62.1% vs 40.0%, P=0.032). Of note, the patients with 1q who received auto-HSCT after induction with Btz had significantly longer PFS than those without auto-HSCT (19 months vs 13 months, P=0.048). ⑤GEP analysis revealed that 1q21 amplification predominantly up-regulated expression of >50% genes within 1q21 region, and also altered expression of 28% genes in chromosome 1 and 10% genes in whole genome, particularly related to DNA repair and cell cycle.@*Conclusions@#1q is an independent adverse prognostic factor in patients with newly diagnosed MM. It is often associated with 1p deletion and IGH rearrangement. Patients with 1q respond well to Btz-based regimen, but they fail to gain long-term benefit from this treatment itself. However, auto-HSCT following Btz induction might improve survival of patients with 1q, suggesting a potential strategy to treat this high-risk subset of MM. GEP analysis warrants further attention in understanding the mechanisms underlying the high-risk of 1q.
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Objective To study the expression of pl6, FHIT genes in cervical carcinoma and its clinical significance. Methods By immunohistochemistry SP method, the expression of pl6, FHIT in different 118 cases of cervical lesions were detected and the results were analyzed in combination with clinical pathological features. Results Of 118 patients, 15 cases suffered cervicitis;38 cases took place cervical tumor-like changes;65 cases caught cervical cancer. p16 expression rates were 0, 33.3 %, 70.0 %, 87.5 %,and 92.3 % respectively;while FHIT expression rates were 73.3 %, 75.5 %, 60.0 %, 37.5%, and 30.8 % respectively. Compared with cervicitis, pl6 and FHIT expression rates in the cervix tumor-like changes,cervical carcinoma had significant difference (P <0.05). There was positive correlation in protein expression between p16 and FHIT (x2 =33.33, P <0.001). Conclusion Combination of p16, FHIT detection can be used as early diagnostic tool of cervical lesions and cervical cancer markers;meanwhile, the method can serve as a clinical evaluation of tumor biological behavior and prognosis of auxiliary indexes.
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Objective To investigate the expression fragile histidinetriad (FHIT) protein in cervical carcinoma and its relationship with clinicopathological feature of the disease. Methods Immunohistochemistry SP was used to detect the expression of FHIT protein in 20 cases with chronic cervsis and 95 cases with Ⅰ aⅢ b stage cervical carcinoma before and after treatment. The association of the expression of FHIT with clinicopathological feature was analyzed by the statistical method. Results There were significant differences between FHIT expression and histological grades and types of tissue, lymph node metastasis and invade depth (P ＜0.05). FHIT expression was not correlated with age and clinical stage (P ＞0.05). There were significant differences in FHIT protein expression levels in the patients with cervial cancer between before-after radiotherapy and the levels before radiotherapy was lower then those after radiotherapy (P ＜0.05). There was positively correlated in FHIT protein expression rates before and after radiotherapy (P ＜0.05). There were significant correlation between FHIT expression and 3-year survival rate, the positive rates of the expression FHIT protein higher then negative ones (P ＜0.05). Conclusion FHIT protein has great reference value that could be as a parameter for evaluating biological action and predicting the prognosis of cervical cancer.
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Objective:To explore the effect of radiotherapy on the FHIT protein expression and cell apoptosis of cervical squamous carcinoma and discuss the relationship between FHIT protein expression and cell apoptosis. Methods:Expression of FHIT protein was measured by immunohistochemical method and cell apoptosis was detected by TdT-mediated dUTP terminal nick end labeling (TUNEL) staining in 50 cases of squamous cell cervical carcinoma at ⅡB-ⅢB stages before, during (Dt 10 Gy and Dt 30 Gy), and after radiotherapy. Results:Of the 50 patients, the positive rates of the expression of FHIT protein was 56% at Dt 10 Gy, 68% at Dt 30 Gy, and 84% after radiotherapy, which were significantly increased compared with that before radiotherapy (36%, P<0.05). The positive rates of cell apoptosis was 52% at Dt 10 Gy, 64% at Dt 30 Gy and 78% after radiotherapy, which were significantly elevated compared with that before radiotherapy (28%, P<0.05). In the process of radiotherapy, cell apoptosis was positively related to the expression of FHIT protein (P<0.05). Conclusion:Radiotherapy reinforces the expression of FHIT protein and induces apoptosis cocurrently. FHIT protein has regulatory effects in cell apoptosis induced by radiotherapy.
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During opposing SARS, without vaccine, special medicine and immune barrier.Government had taken strong measures to control the epidemic situation in a short time starting with biological-mental-social factors. It was a concrete practice and great victory of modern medicine model. It will provide academic and practical bases of preventing diseases.
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The importance of clinical nursing is briefly discussed in this article and the significance of enhancing professional ethics is emphasized.In addition,the importance of cultivating the thought of "being disceet when alone" and improving the quality of nursing ethics are also stressed.
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Hilar cholangiocarcinoma (HCCA) is a malignant tumor arising from the epithelium of the bile duct, which involves the common hepatic duct, the left and right hepatic ducts, and the confluence areas of these bile ducts. HCCA has an insidious onset and most patients are in the advanced stage when jaundice is observed, and therefore it is considered a difficult issue in the field of surgery. Radical resection is the optimal method for the treatment of HCCA and has great influence on recurrence rate of tumor and patients’ survival time. Therefore, preoperative evaluation of tumor resectability is an important step of HCCA treatment. At present, there are eight main methods for HCCA staging and typing, i.e., Bismuth-Corlette classification system, modified T staging system, TNM staging system, JSBS staging system, Gazzaniga staging system, International Cholangiocarcinoma Group staging system, Mayo staging system, and Blechacz staging system. Each staging and typing system has its own advantages and disadvantages in clinical practice. This article reviews the staging and typing methods for HCCA, with a focus on the clinical value of each staging and typing system in preoperative evaluation of radical resection and prognosis.