调强放疗联合时辰化疗治疗局部进展期鼻咽癌的近期疗效及不良反应

目的 比较时辰化疗与常规化疗联合调强放疗在局部进展期鼻咽癌患者治疗过程中的不良反应、免疫功能、近期疗效。方法 选取2015年7月至2017年4月在贵州医科大学附属肿瘤医院初治局部进展期鼻咽癌患者159例,采用简单随机分组法,前瞻性将159例初治局部进展期鼻咽癌患者随机分为时辰化疗组与常规化疗组,前者采用时辰化疗模式给药,后者采用常规模式给药,两组均采用调强放射治疗,评价近期疗效及观察不良反应。结果 时辰化疗组与常规化疗组近期疗效完全缓解（CR）、部分缓解（PR）、稳定（SD）、进展（PD）差异无统计学意义（P>0.05）,两组有效率（CR+PR）差异无统计学意义（P>0.05）;时辰化疗组的白细胞减少（Z=-2.222,P<0.05）、中性粒细胞减少（Z=-1.999,P<0.05）、呕吐（Z=-2.298,P<0.05）、口腔黏膜炎（Z=-3.571,P<0.05）发生率低于常规化疗组,差异有统计学意义;时辰化疗组CD16+56+淋巴细胞计数高于常规化疗组（Z=-2.332,P<0.05）。结论 时辰化疗作为一种新的治疗模式,与调强放疗联合可在不降低临床疗效的同时减轻治疗相关不良反应的发生率及严重程度,减轻免疫抑制,值得临床推广及应用。     

Upper eyelid platinum chain placement for treating paralytic lagophthalmos

For the definitive treatment of lagophthalmos and satisfactory rehabilitation of the affected eye, different surgical strategies have been proposed, including static or dynamic procedures. Although some of these can have good results, lid loading is now the most common technique for treating paralytic long-term lagophthalmos. Among the different types of loading, the use of a platinum chain is preferred to the use of a standard gold weight because platinum has a higher density than gold and is also more biocompatible.In this paper authors retrospectively analyzed 43 patients with regards to functional and cosmetic results. Questionnaires were also employed to assess changes and improvements in the patients' quality of life. Analysis of the excellent results achieved confirmed that platinum chain lid loading should be considered as a first-line treatment for paralytic lagophthalmos rehabilitation. It is a simple, reliable, and effective technique that significantly improves the health-related quality of life of patients.     

Optimized outcome prediction of oncogenetic mutations in non-early T-cell precursor acute lymphoblastic leukemia

BackgroundEarly biomarkers allowing effective treatment stratification in adult T-cell acute lymphoblastic leukemia (T-ALL) patients remain elusive.Materials and methodsThe mutation spectrum of 116T-ALL adult patients enrolled in the Shanghai Institute of Hematology (SIH)-based hospital network or Multicenter Hematology-Oncology Protocols Evaluation System (M-HOPES) in China were studied by using RNA-sequencing or targeted next generation sequencing. A comprehensive survival analysis based on clinical characteristics, immunophenotype and oncogenetic classifier was performed.ResultsEarly T-cell precursor acute lymphoblastic leukemia (ETP-ALL) has higher mutation rates of N/K-RAS and lower mutation rates of FBXW7 compared to non-ETP ALL, but the survival probability of ETP-ALL patients is similar to that of non-ETP ALL patients. T-ALLs with a NOTCH1/FBXW7 (N/F) mutation in the absence of RAS or PTEN abnormalities (NFRP class I) show a more favorable outcome compared to T-ALLs with no N/F mutation and/or with the presence of RAS/PTEN alterations (NFRP class II). A survival analysis of T-ALL, taking into account both the ETP-ALL/non-ETP T-ALL groups and the NFRP oncogenetic classifier, demonstrates that, within the non-ETP T-ALL subtype, NFRP class II identifies a group with poor prognosis and significant decreases of both OS (14.8% versus 50.9%, P = 0.019) and EFS (11.4% versus 42.4%, P = 0.001). In contrast, no survival difference is observed within ETP-ALL between the NFRP class I or class II (OS: 37.9% versus 33%, P = 0.876; EFS: 39.8% versus 33.7%, P = 0.969).ConclusionIn summary, the oncogenetic classifier based on the NFRP classes is particularly useful to improve the stratification of non-ETP ALL.     

Inferior alveolar nerve preservation during resection and reconstruction of the mandible for benign tumors as a factor improving patient's quality of life

This prospective study aimed to evaluate neurosensory disturbance and quality of life in patients who underwent mandibular resection for benign tumors and whose inferior alveolar nerve (IAN) was either preserved or sacrificed. Mandibular resection was indicated owing to the presence of osteoradionecrosis in 25 patients and ameloblastoma in 15 patients. Resection was unilateral in 24 patients and bilateral in 16 patients.The authors assessed the inferior alveolar nerve's sensory dysfunction by measuring the electroexcitability of skin receptors using an electro-odontometer. Study participants' quality of life was estimated with the oral health impact profile (OHIP)-14 and short-form (SF)-36 questionnaire. All the patients in whom the inferior alveolar nerve was sacrificed experienced persistent numbness in the area of innervation with mental nerve on the affected side. The average pain threshold reached preoperative levels (point 1–22.7 ± 2.5, p-value = .025; point 2–25.8 ± 2.7, p-value = .023) 6 months after the operation in patients in whom the IAN was preserved (point 1–23.7 ± 2.3, p-value = .022; point 2–25.4 ± 2.8, p-value = .025). The results of the OHIP-14 and SF-36 showed that patients with preserved IANs had a significantly better quality of life than the patients in whom the IAN was sacrificed. The results of OHIP-14 twelve months after the operation in unilateral resection: control group - 16.0 ± 1.6, p-value = .029; study group - 8.0 ± 0.8, p-value = .029, and in bilateral resection: control group - 26.0 ± 3.2, p-value = .044; study group - 9.0 ± 0.7, p-value = .027. The possibility of sparing the inferior alveolar nerve should not be ignored when planning mandibular resection and reconstruction.     

动态增强磁共振预测鼻咽癌原发灶化疗疗效的临床研究

  目的  探讨动态增强磁共振成像在局部晚期鼻咽癌化疗疗效预测中的价值，为进行个体化治疗提供依据。  方法  64例2010UICC分期为Ⅲ~Ⅳb期的初治鼻咽癌患者，行TPF方案诱导化疗3周期。诱导化疗前行DCE-MR检查，获取造影剂到达组织时间（T1 on set），造影剂到达强化高峰时间（TTP），最大信号强度值（SI），强化峰值（PV），强化百分数（SI%）等参数, 将其与诱导化疗后肿瘤缩小率进行相关性分析。  结果  1）诱导化疗后鼻咽癌原发灶PR24例，NC40例。2）鼻咽癌原发灶缩小率与T₁ on set（r=-0.378，P < 0.001）及TTP（r=-0.285，P=0.02）负相关；与SI（r=0.027，P=0.834）、PV（r=0.042，P=0.741）、SI%（r=0.026，P=0.841）无明确相关关系。  结论  造影剂到达组织及达到强化高峰时间早的病例化疗后肿瘤缩小率大；肿瘤强化程度与化疗后肿瘤缩小率无相关性；T₁ on set、TTP有可能作为鼻咽癌化疗疗效预测指标之一。      

Clinical outcomes following surgical treatment of lentigo maligna of the head and neck

Introduction: Lentigo maligna (LM), a subtype of melanoma in-situ commonly occurring in the head and neck region, often presents a treatment challenge due to anatomical constraints, particularly on the face of mostly elderly patients. This study sought to assess the clinical outcomes of wide local excision of head and neck LM, identify predictors of recurrence and define optimal excision margins.Materials and Methods: Patients with LM treated between January 1997 and December 2012 were identified from the large institutional database of a tertiary center and their data were analyzed.Results: In 379 patients, 382 lesions were eligible for analysis. Median maximal lesion diameter was 10.5 mm. The mean surgical excision and histopathological clearance margins were 6.2 mm and 4.0 mm, respectively. Median follow-up was 32 months. The LM recurrence rate was 9.9%, and subsequent invasive melanoma developed in 2.3% of cases (mean Breslow thickness 0.7 mm). The recurrence rate was 27.2% if the histological margin was <3.0 mm (median time to recurrence 46.5 months) compared with 2.6% if the margin was ≥3.0 mm. The mean surgical margin required to achieve a histological clearance of ≥3.0 mm was 6.5 mm.Conclusions: Our data suggest that to minimize recurrence, a histological margin of ≥3.0 mm is required. To achieve this, a surgical margin of ≥6.5 mm was required. This is greater than the 5 mm margin recommended in some national guidelines. Careful long-term follow-up is required for all patients because of the risk of recurrence.     

Plasmacytoid dendritic cells mediate the tolerogenic effect of CD8+regulatory T cells in a rat tolerant liver transplantation model

BackgroundTolerance is more easily induced in liver transplant models than in other organs; CD8⁺CD45RC^lowregulatory T cells (Tregs) have been shown to induce tolerance in heart allografts. Whether CD8⁺CD45RC^lowTregs could induce tolerance in a liver transplant model and how dendritic cells (DCs) mediate the CD8⁺CD45RC^lowTregs effect remains to be investigated.MethodsA rat liver transplantation model was established and used to test tolerance and acute rejection compared to control groups. Liver function and histopathological changes of allograft were examined by enzyme-linked immunosorbent assay (ELISA) and haematoxylin and eosin (H&E) staining, respectively. The distribution and proportion of CD8⁺CD45RC^lowTregs and plasmacytoid dendritic cells (pDCs) in the allografts and spleen were determined using flow cytometry. Cytokine secretion levels were determined using ELISA and real-time quantitative PCR (qRT-PCR).ResultsThe rat liver transplantation model was well established, with a success rate of 93.3% (28/30). The mean survival time of the tolerant and acute-rejection rats were 156 and 14 days, respectively. The proportions of CD8⁺CD45RC^lowTegs were higher in the allografts of tolerant rats than in those of acute-rejection rats (33.1 ± 4.3 and 12.4 ± 4.6, respectively; P = 0.04). Significant accumulation of pDCs was observed in tolerant liver graft rats compared to that in acute-rejection rats (1.46 ± 0.23 and 0.80 ± 0.20, respectively; P = 0.02). Importantly, CD8⁺CD45RC^lowTregs were positively associated with the frequency of pDCs (P = 0.001, r² = 0.775). The protein and mRNA expression of IL-10 and TGF-β in the allograft group were increased, possibly being responsible for tolerance induction.ConclusionCD8⁺CD45RC^lowT cells interact with pDCs through the induction of IL-10 and TGF-β expression and are responsible for inducing immune tolerance in rat liver transplantation.