Effect of temozolomide on survival in elderly patients with glioblastoma and impaired performance status: a propensity score-matching analysis.

OBJECTIVE: At present, there is no consensus regarding the standard treatment for glioblastoma (GBM) in elderly patients with impaired Karnofsky performance status (KPS) scores. This study aimed to determine the effects of temozolomide (TMZ) versus best supportive care (BSC) in this population. MATERIALS AND METHODS: We conducted a retrospective observational study of patients aged ≥65 years with histologically confirmed GBM and KPS scores ≤70 who were treated at our institution between January 2006 and July 2014. Demographic data, treatments, and outcomes were evaluated. Univariate and multivariate analyses were performed to identify the independent prognostic factors of overall survival (OS) and progression-free survival (PFS). The impact of TMZ on survival was analyzed by the application of propensity score matching of clinicopathological factors among patients who received TMZ vs BSC. RESULTS: There were 153 patients (86 men, 56.2%) in this study. The median patient age was 70 years (range: 65-83 years). The median KPS score was 60 (range: 30-70). Seventy-eight patients (51.0%) received TMZ, whereas 75 (49.0%) received BSC. Median OS and PFS were 6.0 and 4.5 months, respectively. Compared with BSC, TMZ was associated with improved OS (hazard ratio [HR]: 0.38, 95% CI: 0.17-0.70; P=0.002) and PFS (HR: 0.41, 95% CI: 0.21-0.76; P=0.003) after propensity score matching. Factors independently associated with OS were KPS score (HR: 2.11, 95% CI: 1.48-7.67; P=0.016), extent of resection (HR: 1.98, 95% CI: 1.45-5.14; P=0.026), and treatment group (HR: 0.49, 95% CI: 0.23-0.87; P=0.019). The most frequent toxicity in the TMZ group was myelosuppression. CONCLUSION: Compared with BSC, TMZ increased survival with acceptable toxicity in elderly GBM patients with KPS scores ≤70.

Surgical selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture.</p><p><b>METHODS</b>From June 2000 to August 2010, 72 patients with membranous urethral trauma caused by pelvic fracture were selected. There were 46 males and 26 females,ranging age from 26 to 62 years (averaged 35.2 years). The time from injury to hospitalization time was 1 to 3 hours. According to Tile pelvic fracture classification, there were 8 patients with type A, 45 patients with type B, 19 patients with type C. Thirty of the 35 patients with partial rupture of posterior urethral were treated by catheterization,5 patients treated by rupture anastomosis on the stage I combined with cystostomy; 25 of the 37 patients with complete rupture of posterior urethra were treated by early realignment, and 12 patients were treated by cystostomy. Urinary incontinence, impotence and urethrostenosis were evaluated.</p><p><b>RESULTS</b>All patients were followed up for 5 to 10 years (mean 7.7 years). Incidence of urethrostenosis, impotence and urinary incontinence in patients treated by cystostomy were significantly higher than rupture anastomosis on the stage I and early realignment (P < 0.05); while incidence in patients treated by catheterization was significantly lower than other groups (P < 0.05).</p><p><b>CONCLUSION</b>For patients with partial rupture of posterior urethral, catheterization and rupture anastomosis on the stage I are preferred methods; while patients with complete rupture of posterior urethra, early realignment is a preferred method with advantages of simple operation and less complications.</p>

Role of enzyme-linked immunospot assay and tuberculin skin test in the auxiliary diagnosis of initial pulmonary tuberculosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare enzyme-linked immunospot assay (ELISPOT) and tuberculin skin test (TST) and explore their roles in the auxiliary diagnosis of initial pulmonary tuberculosis.</p><p><b>METHODS</b>Totally 123 patients with initial pulmonary tuberculosis (tuberculosis group) and 102 patients with non-tuberculosis pulmonary disease (control group) were enrolled. The peripheral blood mononuclear cells of all participants were co-cultured with early secretiny antigen target-6/culture filtrate protein-10 fusion protein (ESAT-6/CFP-10), and spot forming cells (SFCs) were enumerated by ELISPOT (ESAT-6/CFP-10-ELISPOT). TST was also performed simultaneously.</p><p><b>RESULTS</b>ESAT-6/CFP-10-ELISPOT showed significantly higher numbers of SFCs after stimulation in tuberculosis group than in control group (P = 0.000). The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of ESAT-6/CFP-10-ELISPOT were 91.1% (111/123), 81.4% (82/102), 4.60, 0.12, 0.85, and 0.87 respectively, while the above values of TST were 65.6% (59/90), 45.1% (46/102), 1.31, 0.76, 0.51, and 0.60, respectively. The sensitivity and specificity of ESAT-6/CFP-10-ELISPOT were significantly higher than those of TST (all P = 0.000). The number of SFCs were not significantly different between smear-positive tuberculosis subgroup and smear-negative tuberculosis subgroup (P = 0.166). The sensitivities were 91.8% (67/73) and 88.0% (44/50) in these two subgroups, respectively, (P = 0.448).</p><p><b>CONCLUSIONS</b>ESAT-6/CFP-10-ELISPOT may be a more accurate approach for the auxiliary diagnosis of initial pulmonary tuberculosis; meanwhile, it offers certain diagnostic evidences for smear-negative tuberculosis. However, its specificity may be affected by latent tuberculosis infection. On the contrary, TST has poor value in the auxiliary diagnosis of initial pulmonary tuberculosis.</p>