Clinicopathological features and prognosis of breast cancer combined with symptomatic bone marrow metastases: A 10-year, single-center, real-world study of 67 cases.

PURPOSE: Bone marrow metastasis (BMM) is uncommon in breast cancer (BC), and early diagnosis is challenging. BMM lacks definitive treatment options and poses a great threat to the survival of patients. Herein, we investigated the clinical features, prognosis, and factors affecting the prognosis of BC patients with symptomatic BMM to help improve the understanding of this disease and provide effective diagnostic and treatment strategies. METHODS: Clinical data of 67 patients with BC and BMM were retrospectively analyzed for clinical characteristics, treatment, and prognosis of BMM. Univariate and multivariate analyses were performed to determine factors affecting overall survival following BMM (BMMOS). RESULTS: Among patients with BMM, 86.6% were diagnosed after bone metastasis (BM), while 13.4% were diagnosed simultaneously with BM. A total of 73.1%, 13.4%, and 13.4% of the patients had hormone receptor-positive/human epidermal growth factor 2-negative (HR+/HER2-) tumors, HER2+ tumors, and triple-negative tumors, respectively. The most common symptoms of BMM were the coexistence of anemia and thrombocytopenia (26.9%), anemia (19.4%), and pancytopenia (17.9%). The median BMMOS was 7.6 months (95% CI, 3.9-11.3). Univariate and multivariate analyses showed that BMMOS was associated with platelet count <75 × 109 /L at the time of BMM diagnosis. The BMMOS of patients who underwent endocrine therapy, combined chemotherapy, and mono-chemotherapy after BMM was 15.7, 9.7, and 8.6 months, respectively, whereas that of untreated patients was 2.9 months, and the difference among the results was statistically significant (χ2  = 20.102, p < 0.0001). Changes in patient hemogram and/or body temperature during treatment were consistent with the overall effect of the disease (p < 0.0001). CONCLUSION: BMM should be considered in BC patients with BM, an unexplained reduction in hemogram parameters, especially anemia and thrombocytopenia, and/or fever without chills. Active, effective, individualized treatment strategies can prolong BMMOS.

Effects of lactitol on intestinal microflora and plasma endotoxin in patients with chronic viral hepatitis.

OBJECTIVES: To investigate the effects of lactitol on intestinal flora and the levels of plasma endotoxin in patients with chronic viral hepatitis. METHODS: Sixty patients with chronic viral hepatitis and gut-derived endotoxemia were randomly divided into two groups: lactitol group (n=30) and control group (n=30). Patients in the control group received standard medical treatment for 3 weeks, while patients in the lactitol group received lactitol orally in addition to the standard medical treatment. Fecal flora and plasma endotoxin were measured before and after the treatment. RESULTS: In the lactitol group, the numbers of Bifidobacterium and Lactobacillus per gram of wet feces were significantly increased (p<0.01) and Clostridium perfringens count was decreased markedly (p<0.001). The levels of plasma endotoxin decreased after the treatment from 72.89 ng/L to 33.33 ng/L in the lactitol group and from 66.00 ng/L to 51.07 ng/L in the control group, but the plasma endotoxin levels in the lactitol group decreased far more than in the control group (p<0.01). CONCLUSIONS: Lactitol can decrease the levels of plasma endotoxin more effectively than standard medical treatment in patients with chronic viral hepatitis through improving intestinal microflora.