Interim response in diffuse large B cell lymphoma on CT: what is the optimal size reduction (ΔSPD) for predicting outcome?

OBJECTIVES: To investigate whether there was an optimal interim size reduction (iΔSPD) cutoff value that could discriminate diffuse large B cell lymphoma (DLBCL) patients with poor prognosis. METHODS: This retrospective study enrolled 265 newly diagnosed DLBCL patients with baseline and interim (after 3 cycles) contrast-enhanced computed tomographic scan (CECT) available. Two radiologists evaluated CECT images and selected target lesions according to the Lugano Response Criteria. Lymph nodes greater than 15 mm in longest diameter (LDi) and extra-nodal lesions with LDi greater than 10 mm could be chosen as target lesions and used to calculate iΔSPD. A software tool, X-Tile, was used to calculate the optimal iΔSPD cutoff value to differentiate patients with good vs. poor prognosis. Receiver operating characteristic curve analysis, Cox regression analysis, and Kaplan-Meier analyses were further used to validate the optimal cutoff value. RESULTS: The optimal cutoff value of iΔSPD calculated by X-tile was 80%. Compared with 50% and 100%, 80% cutoff value had the intermediate sensitivity and specificity (57.75% and 86.69% for overall survival (OS), 48.98% and 92.22% for progression-free survival (PFS), respectively), but the maximal Youden index (0.4744 for OS, 0.4120 for PFS, respectively) and areas under the curve (0.737 [0.680, 0.789] for OS). Cox regression analysis also revealed that iΔSPD < 80% could independently predict an inferior OS and PFS (both p < 0.001) while neither iΔSPD < 50% nor iΔSPD = 100% could. CONCLUSIONS: iΔSPD with the cutoff value 80% is an independent predictor of PFS and OS for patients with DLBCL. Results suggest that treatment should be modified for patients with iΔSPD < 80%. KEY POINTS: • The aim of interim response assessment is to identify patients whose disease has not responded to or has progressed on induction therapy. • A cutoff value of 80% in size reduction (ΔSPD) is an independent predictor of PFS and OS for DLBCL patients and is better than 50%. • In DLBCL patients with interim ΔSPD < 80%, a change to a more efficient therapy should be considered.

Establishment of An Animal Model of Transfusion-related Acute Lung Injury and the Role of Soluble CD40 Ligand in the Development of Transfusion-related Acute Lung Injury / 中国医学科学院学报

Objective To establish an animal model of transfusion-related acute lung injury (TRALI) and investigate the role of soluble CD40 ligand (sCD40L) in the development of TRALI. Methods The TRALI animal model established by trauma-hemorrhage-transfusion. Lung edema was evaluated by histopathological examination and the protein and Evans blue dye accumulation in bronchoalveolar lavage fluid. The concentration of sCD40L in storage packed red blood cell (PRBC) and rat's plasma was measured by enzyme-linked immunosorbent assay (ELISA). Results There were obvious epithelial hyperplasia and inflammatory cell infiltration in the lung tissue of 7 d-PRBC-treated group. The accumulation of protein in bronchoalveolar lavage fluid of 7 d-PRBC-treated group [(13.17±5.76)mg] was significantly higher than that in normal controls [(1.21±0.66)mg] and normal saline (NS)-treated group [(4.94±2.15) mg] (F=17.605,P<0.001). The leakage amount of Evans blue dye in 7 d-PRBC-treated group [(0.0109±0.0067)%/min] was significantly higher than that in NS-treated group [(0.0026±0.0006) %/min] (t=2.998,P=0.03). The concentration of sCD40L of the 7 d PRBC [(451.58±73.28) pg/ml] was significantly higher than 0 d PRBC [(277.94±98.18)pg/ml] (t=2.834,P=0.03). The concentration of sCD40L in the plasma of 7 d-PRBC-treated group [(878.21±125.30)pg/ml] was significantly higher than those in normal controls [(289.78±62.60)pg/ml] and NS-treated group [(418.07±47.68)pg/ml] (F=78.715,P<0.001). Conclusion The TRALI animal model was successfully established with trauma-hemorrhage-transfusion. The concentration of sCD40L in plasma of rats with massive transfusion is remarkably increased,suggesting sCD40L may play a role in the development of TRALI.

Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion / 中国医学科学杂志(英文版)

Objective To evaluate the effect of point-of-care hemoglobin/hematocrit (POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice.Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference.Results In the hospitals where POC HGB/HCT device was used (n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011 (39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased (n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow.Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.

Predictors for Massive Blood Loss During Posterior Correction of Congenital Scoliosis in Pre-school Children:A Retrospective Observation / 中国医学科学院学报

Objective To investigate the predictors for massive blood loss during posterior correction of congenital scoliosis in pre-school children. Methods Totally 124 children under six years of age,who received posterior correction of congenital scoliosis,were divided into two groups according to the ratio of intraoperative blood loss (BL) and estimated blood volume (EBV). Massive blood loss was defined as BL/EBV>0.15,and minor or moderate blood loss as BL/EBV≤0.15. All the records,including demographics,intraoperative fluids,pre- or postoperative laboratory parameters,and the length of hospital stay,were compared between these two groups. Results There were 57 children in the moderate or minor blood loss group and 67 children in the massive blood loss group. When compared with moderate or minor blood loss group,children in massive blood loss group had significantly lower body weight,shorter body height,longer anesthesia period,and more autologous or allogeneic transfusion (P<0.05). Binary Logistic regression analysis showed that body weight lower than 15 kg was the independent predictor for massive blood loss (OR=0.435,95% CI=0.197-0.962). Conclusions The incidence of massive blood loss is about 54% in children under six years of age who have received posterior correction of congenital scoliosis. The body weight of lower than 15 kg is an independent predictor for massive blood loss during the surgery.

Preliminary study about the role of c-src in the initiation of primordial follicle in rat ovary / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To explore the role of c-src on the initiation of primordial follicles.</p><p><b>METHODS</b>2-days-old female SD rats' ovaries were cultured in Waymouth culture system and were used HE staining and immunohistochemy to observe the number of follicles after 0, 4, 8 days cultured. Use chemically synthesized small interference RNA (siRNA) transfected into ovarian tissue in cultured for RNA interference, and use HE staining and RT-PCR to detect the best siRNA and packaging it by lentiviruses to test the interference effect.</p><p><b>RESULTS</b>With the increase of culturing days, the nummber of the primordial follicles in ovarian gradually reduced. We packed the best siRNA by lentiviruses to doing RNA interference and found comparing with the blank control group and blank vector group, c-src mRNA of the best interference group were significantly decreased. The total number of primordial follicles was relatively greater and the development of primordial folliculars was inhibited.</p><p><b>CONCLUSION</b>c-src plays an important role in primordial follicle development and folliculogenesis initiation.</p>

The expression of proto-oncogene c-erbB₂ and its role in the initiation of primordial follicle growth in rat ovary / 生理学报

Little is known about the factors that control the initiation of growth of primordial follicles. The objective of the present study was to investigate the effect of c-erbB₂ on the onset of primordial follicle development, and whether c-erbB₂ mediates the effect of epidermal growth factor (EGF) in this process. We synthesized three pairs of siRNAs targeting the c-erbB₂ mRNA and transferred them into the newborn rat ovary cultured in vitro with Metafectene. After siRNAs transfection, the efficiency of siRNAs was tested by examining c-erbB₂ mRNA and protein levels. The level of c-erbB₂ mRNA was reduced by 49.6%, 46.7% and 82.6% respectively after transfecting siRNA1, siRNA2 and siRNA3, and the level of ErbB₂ protein also reduced remarkably after siRNA3 transfection. c-erbB₂ siRNA3 significantly inhibited the primordial follicle initiation and development; EGF augmented primordial follicles formation, but the effect was abolished by c-erbB₂ siRNA3. All of these results suggest that c-erbB₂ plays an important role in primordial follicle development and folliculogenesis initiation, and mediates the effect of EGF on primordial follicle development.

Exposure to carcinogenic PAHs for the vendors of broiled food.

Three types of popular vendors, including meat and non-meat food (e.g, fishballs), vendor group (I), rice sausage sandwiches vendor group (II), and roasted corn on-the-cob vendor group (III), from the night markets of Taiwan were chosen for this research. The average concentrations of carcinogenic polycyclic aromatic hydrocarbons (car-PAHs) were 2445 ng/m3 for vendor (II), 2276 ng/m3 for vendor (II), and 133 ng/m3 for vendor (III). Vendors groups (I) and (II) had exposure levels of Benzo(a)pyrene (BaP)-equivalent doses (BaPeq) approximately 16 and 13 times higher than those for vendor group (III). The daily exposure doses of BaPeq in working duration for vendor group (II) and (II) were 2.80 and 2.28 microg/day, respectively. The employees of five offices on campus were chosen as a control group. The daily exposure doses of BaPeq during working hours for vendor group (II) and (II) were about 22 times and 18 times, respectively, higher than those for control group. This exposure dose for vendors group (III) (0.18 microg/day) was comparable with the dose for control group (0.13 microg/day). The whole-day exposure doses of t-PAHs, car-PAHs, BaP, and BaPeq for vendor groups (I) and (II) were very close to those during daily working hours. However, the daily exposure doses of BaPeq during working hours for vendor group (III) occurred only in a proportion of 62% of the whole-day exposure doses.