Lenalidomide in combination with dexamethasone: effective regimen in patients with relapsed or refractory multiple myeloma complicated by renal impairment

Over the past decade, treatment options for patients with multiple myeloma (MM) have improved substantially, resulting in better response rates and prolonged overall survival (OS). Nevertheless, MM remains a challenging disease, especially if renal insufficiency (RI) or extensive pre-treatment aggravates the assignment of the optimal treatment schedule. In this retrospective study, we analyzed the outcome of lenalidomide plus dexamethasone in 167 patients with relapsed or refractory MM with focus on RI. The baseline creatinine clearance (CL_Cr) was normal in 94 patients (CL_Cr ≥ 80 ml/min), while RI was observed in 73 patients, including 40 patients with mild RI (50 ≤ CL_Cr < 80 ml/min) and 33 patients with moderate or severe RI (CL_Cr < 50 ml/min). Response rates declined depending on the severity of RI, being 67% among patients with normal kidney function, 60% among patients with mild RI and 49% among patients with moderate or severe RI. Time to progression (TTP) was significantly reduced in patients with severe RI and in case of >2 previous treatment lines. OS was not significantly different between patients with normal and impaired renal function. In contrast, the number of previous treatment lines (2 vs. <2) and the use of novel agents like bortezomib or thalidomide prior to lenalidomide plus dexamethasone therapy had a more adverse effect on OS. In conclusion, lenalidomide plus dexamethasone is an effective regimen for relapsed or refractory patients with MM complicated by RI with manageable toxicity.     

Protective Effects of Korean Red Ginseng on Radiation-Induced Oral Mucositis in a Preclinical Rat Model

Numerous studies' attempts to improve radiation-induced oral mucositis have not produced a qualified treatment yet. Our aim was to investigate the effectiveness of Korean red ginseng (KRG) on radiation-induced damage in an in vivo rat model. After 20 Gy of irradiation, rats were divided randomly into the following 4 groups: control, KRG only, radiotherapy (RT) only, and RT + KRG group. The rats were monitored in terms of survival rate, activity, mucositis grade, oral intake, and body weight. The tongue, buccal mucosa, and submandibular gland (SMG) were harvested, and the weight of the SMG was analyzed. The samples then underwent hematoxylin and eosin, TUNEL, and immunohistochemical staining. Radiation-induced severe oral mucositis and SMG injury led to poor oral intake and delayed healing, resulting in the death of some rats. We found that survival rate, oral intake, and body weight increased. Moreover, rats treated with KRG showed less severe mucositis and decreased histologic changes of the oral mucosa and SMG. Furthermore, we showed that the protective effects of KRG were caused by inhibition of the apoptotic signal transduction pathway linked to caspase-3. In conclusion, KRG protects the oral mucosa and SMG from radiation-induced damage by inhibiting caspase-mediated apoptosis in rats.     

两种方法治疗肛门瘙痒症的疗效观察

目的为比较两种方法治疗肛门瘙痒症的疗效及复发情况。方法将100例肛门瘙痒症患者随机分为对照组和治疗组,每组50例,对照组采用长效麻醉剂封闭,治疗组采用消风散配合针灸治疗。结果治疗2周后,对照组总显效率为48%(24∕50),治疗组总显效率为98%(49∕50),治疗组总显效率明显高于对照组,P<0.05;6个月后随访,对照组复发32例(64%),治疗组复发3例(6%),治疗组复发率明显低于对照组,组间差异有统计学意义,P<0.05。结论消风散配合针灸治疗肛门瘙痒症疗效肯定,且复发率低。在常规封闭疗法无效的情况下,可行消风散配合针灸治疗。     

A Case of Acquired Idiopathic Pterygium Inversum Unguis

Pterygium inversum unguis (PIU) is a rare nail abnormality in which the distal nail bed adheres to the ventral surface of the nail plate, with obliteration of the distal groove. Because of the rarity of this condition, its exact origin is unknown. This disorder can be either congenital or acquired, with or without a family history. The acquired forms may be idiopathic or secondary to systemic connective tissue diseases or other causes such as stroke, neurofibromatosis, leprosy, or the use of nail fortifiers. We present an unusual case of acquired idiopathic PIU of the 10 fingernails in a 22-year-old man.     

Treat cancers by targeting survivin: Just a dream or future reality?

Since the discovery of survivin (BIRC5) as a cancer-related molecule by Grazia Ambrosini and Dario C. Altieri at 1997, our knowledge related to the function of this molecule has been extended from simple apoptosis inhibition to complicated, interlinked processes that involve interference of mitosis, apoptosis, autophagy, and even DNA repair recently. However, despite the growing amount of knowledge related to survivin in the last ten years, the development of survivin inhibitors or survivin-related molecular therapies is surprisingly and relatively slow as compared to other therapeutic inhibitors for cancer treatment. Here, the molecular functions of survivin and the progress of development of survivin-targeting therapies are discussed in detail. Functional differences between different survivin-specific inhibitors are discussed from both structural and biochemical point of views. This review also reveals different challenges that scientists are currently facing in the development of survivin inhibitors for clinical application. Finally, future directions for the development of survivin-targeted therapies are discussed in this review.     

Obstetric outcomes in women with polycystic ovary syndrome and isolated polycystic ovaries undergoing in vitro fertilization: a retrospective cohort analysis

Objective: This retrospective cohort study evaluated the obstetric outcomes in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovaries (PCO) undergoing in vitro fertilization (IVF) treatment.

Methods: We studied 104 women with PCOS, 184 with PCO and 576 age-matched controls undergoing the first IVF treatment cycle between 2002 and 2009. Obstetric outcomes and complications including gestational diabetes (GDM), gestational hypertension (GHT), gestational proteinuric hypertension (PET), intrauterine growth restriction (IUGR), gestation at delivery, baby’s Apgar scores and admission to the neonatal intensive care unit (NICU) were reviewed.

Results: Among the 864 patients undergoing IVF treatment, there were 253 live births in total (25 live births in the PCOS group, 54 in the PCO group and 174 in the control group). The prevalence of obstetric complications (GDM, GHT, PET and IUGR) and the obstetric outcomes (gestation at delivery, birth weight, Apgar scores and NICU admissions) were comparable among the three groups. Adjustments for age and multiple pregnancies were made using multiple logistic regression and we found no statistically significant difference among the three groups.

Conclusion: Patients with PCO?±?PCOS do not have more adverse obstetric outcomes when compared with non-PCO patients undergoing IVF treatment.     

Pulsatile luteinizing hormone (LH) release during the progesterone-induced LH surge in the female rhesus monkey

LH pulses during the progesterone (P)-induced LH surge were examined in ovariectomized and estrogen-treated female monkeys. Animals received a 2.5-mg P or oil injection 24 h after administration of 30 micrograms estradiol benzoate. The animals were fitted with jugular catheters connected to a tether-swivel system. Blood samples were collected at 10-min intervals starting 3-4 h before and ending 12-20 h after P or oil injection. Plasma LH was measured by both bioassay and RIA. LH pulses were determined by the PULSAR program. P administration induced a BIA-LH surge with a latency of 71 +/- 10 min in all seven animals. The P-induced bioassayable LH (BIA-LH) surge consisted of an ascending phase (204 +/- 24 min), a plateau period (174 +/- 32 min), and a descending phase (376 +/- 60 min). Oil injection did not cause a LH surge (n = 4). BIA-LH release before P and that during the P-induced LH surge were pulsatile. Pulse intervals of BIA-LH before P treatment (57.1 +/- 5.2 min) were not different from those before (55.0 +/- 11.7 min) and after (62.9 +/- 16.3 min) oil injection. In contrast, pulse intervals during the ascending phase (35.0 +/- 4.0 min), plateau period (34.6 +/- 2.6 min), and descending phase (45.0 +/- 3.1 min) were significantly shorter (P less than 0.02) than those before P. Pulse amplitudes of BIA-LH during the ascending phase (125.3 +/- 28.7 ng/ml) and plateau period (253.9 +/- 27.0 ng/ml) were significantly (P less than 0.001) higher than those (44.7 +/- 12.6 ng/ml) before P and during the descending phase (66.9 +/- 11.1 ng/ml). Radioimmunoassayable LH results were quite similar to those for BIA-LH, except that amplitude changes in radioimmunoassayable LH after P treatment were smaller than those in BIA-LH. It was concluded, therefore, that both the frequency and amplitude of pulsatile LH release increase during the P-induced LH surge, especially during the ascending phase and plateau period, in female rhesus monkeys. Furthermore, the present results support our previous conclusion that P facilitates pulsatile LHRH release with increases in frequency and amplitude in ovariectomized and estrogen-treated monkeys.     

猪股骨头支持带动脉入头分支的解剖学研究

目的　探索猪股骨头支持带动脉入头分支的数量、分布规律及外径大小并阐述其意义。 方法　解剖39例带有髋周血管的猪股骨头离体标本,分离支持带动脉,采用30%硫酸钡悬浮液显微灌注,观察支持带动脉入头分支的走形、数量、分布及外径。以时钟点位记录支持带动脉入头的分布规律,显微标尺测量支持带动脉入头分支的外径,并对各组支持带动脉入头最粗支的位置进行测量统计。 结果　猪股骨头共有（6.10±1.32）支动脉入头,主要分为后上、后下及前方3组,每组支持带动脉最粗支入头的时钟点位分别为（11：22~01：29）、（06：36~08：15）、（02：01~03：59）;直径分别为（0.37±0.11）、（0.52±0.11）、（0.35±0.09）mm。 结论　猪股骨头入头动脉的数量及位置相对恒定,入头动脉最粗支平均直径为（0.52±0.11）mm,来自后下组支持带动脉,为猪股骨头重要的血供来源。