Fluorescence in Situ Hybridization (FISH) Utility for Risk Score Assessment in Patients With MDS With Normal Metaphase Karyotype

BackgroundCytogenetic profile is an essential parameter in myelodysplastic syndromes (MDS) risk stratification by both International Prognostic Symptom Score (IPSS) and Revised (R)-IPSS. Almost one-half of patients with MDS have normal cytogenetics by metaphase karyotype. Here we report the yield of MDS fluorescence in situ hybridization (FISH) panel detecting cytogenetic abnormalities in these patients and its impact on risk stratification.Patients and MethodsAmong patients with normal metaphase karyotype, we assessed those patients who had cytogenetic abnormalities detected by an MDS FISH panel, which included probes for del (5), del (7), del (20), trisomy 8, and del (17p). Risk stratification was calculated by both IPSS and R-IPSS.ResultsOf 1600 patients with MDS with normal metaphase karyotype, 53 (3%) patients had cytogenetic abnormality detected by MDS FISH panel. Integrating the MDS FISH panel cytogenetics (IPSS + FISH restaging) resulted in upstaging the score, where 53% of low-risk IPSS were upstaged to intermediate (int)-1, 56% of int-1 were upstaged to int-2, and 78% of int-2 were upstaged to high risk. Based on the R-IPSS, 61% of very low-risk patients, all low-risk patients, 92% of intermediate-risk patients, and 50% of high-risk patients with FISH abnormalities were upstaged, respectively.ConclusionThe yield of MDS FISH panel detecting cytogenetic abnormalities in patients with normal karyotype by G-banding is low and may not warrant ordering the panel in all patients. Among the 3% of patients with normal karyotype who had cytogenetic abnormality detected by FISH, the risk score assignment by IPSS and R-IPSS was upstaged.     

膀胱内前列腺突出度Ⅲ级前列腺增生患者TURP治疗和药物治疗疗效比较研究

目的:观察膀胱内前列腺突出度Ⅲ级前列腺增生患者TURP和药物治疗的临床疗效,比较两种治疗的疗效差别。方法:选取从2012年6月至2015年10月在我院泌尿外科门诊就诊和住院手术膀胱内前列腺突出度Ⅲ级前列腺增生患者的62例,根据患者意愿的分组方法分为药物对照组(非那雄胺片+盐酸坦洛新缓释胶囊)31例,手术治疗组(经尿道前列腺电切手术组)31例,两组患者在初诊时对患者的膀胱内前列腺突出度(IPP)、前列腺体积、残余尿量、最大尿流率、尿动力学检查最大尿流率时逼尿肌压力、前列腺体积、IPSS评分进行评估,以及对治疗组术后半年的前列腺体积、残余尿量、最大尿流率、药物对照组服药1年后的上述指标进行比较。结果:手术治疗组患者治疗前后患者的膀胱内前列腺突出度(IPP)、前列腺体积、残余尿量、最大尿流率、IPSS评分均有显著改善,差异有统计学意义(P0.001);药物对照组患者的最大尿流率、IPSS评分治疗后和治疗前相比有明显改善,差异有统计学意义(P0.05)IPP长度和最大尿流率时逼尿肌压力治疗后比治疗前显著加重,差异有统计学意义(P0.05);而前列腺体积和残余尿量治疗后和治疗前相比差异,无统计学意义(P0.05);治疗后手术治疗组和药物对照组相比,患者的前列腺突出度(IPP)、前列腺体积、残余尿量、最大尿流率、IPSS评分,治疗组的改善程度明显优于对照组,差异有统计学意义(P0.001)。结论:膀胱内前列腺突出度Ⅲ级前列腺增生患者应该及时行外科手术治疗,从而患者可能更快的缓解症状,减缓疾病的进展。     

罗红霉素缓释片联合丹参片治疗精囊炎的疗效

目的：研究罗红霉素缓释片联合丹参片治疗精囊炎的疗效及安全性。方法：将本院2010年1月~2014年5月门诊收治的92例精囊炎患者完全随机分为对照组和试验组,每组各46例。试验组口服罗红霉素缓释片联合丹参片,对照组口服罗红霉素缓释片,共4周。4周后通过尿常规、前列腺液常规、精液常规及细菌培养结果、慢性前列腺症状评分以及生活质量评分等观察指标来评估疗效。结果：试验组相对于对照组治疗后的前列腺液常规、精液常规、慢性前列腺症状评分以及生活质量评分和对照组相比差异有统计学意义（P〈0.05）,尿常规结果差异无统计学（P〉0.05）。结论：罗红霉素缓释片联合丹参片治疗精囊炎的可以有效缓解症状,安全可靠,效果确切。     

经尿道前列腺电切术在前列腺增生症治疗中的运用

目的 观察经尿道前列腺电切术治疗前列腺增生的临床效果.方法 选择我院收治的78例前列腺增生患者为研究对象,采用随机数字表法随机分为对照组和观察组,对照组采用传统开放性手术治疗.观察组采用经尿道前列腺电切术治疗,比较两组治疗前后前列腺增生临床症状改善情况及日常生活质量改善情况.结果 观察组、对照组患者治疗后IPSS评分（7.3±0.7）、（10.2±1.2）显著优于治疗前（15.4±2.1）、（15.3±2.1）,差异有统计学意义（P＜0.05）.观察组患者治疗后IPSS评分改善情况更佳.观察组、对照组患者治疗后生活质量指数（0.5±0.2）、（2.1±0.6）显著优于治疗前（5.2±0.6）、（5.3±0.7）,差异有统计学意义（P＜0.05）.观察组患者治疗后生活质量改善情况更佳.观察组患者治疗后残余尿量（19.3±4.3）mL及最大尿流率（12.9±2.5）mL/s改善显著优于对照组（50.1±4.5）mL、（10.9±2.3）mL/s,差异有统计学意义（P＜0.05）.结论 采用经尿道前列腺电切术治疗前列腺增生疗效显著,安全性好,可显著提高患者生活质量,值得临床推广应用.     

Primary myelofibrosis: risk stratification by IPSS identifies patients with poor clinical outcome

OBJECTIVES:

To evaluate whether risk scores used to classify patients with primary myelofibrosis and JAK-2 V617F mutation status can predict clinical outcome.

METHODS:

A review of clinical and laboratory data from 74 patients with primary myelofibrosis diagnosed between 1992 and 2011. The IPSS and Lille scores were calculated for risk stratification and correlated with overall survival.

RESULTS:

A V617F JAK2 mutation was detected in 32 cases (47%), with no significant correlation with overall survival. The patients were classified according to the scores: Lille - low, 53 (73.%); intermediate, 13 (18%); and high, 5 (7%); and IPSS – low, 15 (26%); intermediate-1, 23 (32%); intermediate-2, 19 (26%); and high, 15 (31%). Those patients presenting a higher risk according to the IPSS (high and intermediate-2) had a significantly shorter overall survival relative to the low risk groups (intermediate-1 and low) (p = 0.02).

CONCLUSIONS:

These results emphasize the importance of the IPSS prognostic score for risk assessment in predicting the clinical outcome of primary myelofibrosis patients.     

High flow cytometric scores identify adverse prognostic subgroups within the revised international prognostic scoring system for myelodysplastic syndromes

The estimation of survival of myelodysplastic syndromes (MDS) and risk of progression into acute myeloid leukaemia is challenging due to the heterogeneous clinical course. The most widely used prognostic scoring system (International Prognostic Scoring System [IPSS]) was recently revised (IPSS‐R). The aim of this study was to investigate the prognostic relevance of flow cytometry (FC) in the context of the IPSS‐R. Bone marrow aspirates were analysed by FC in 159 patients with MDS. A flow score was calculated by applying the flow cytometric scoring system (FCSS). Patients were assigned to IPSS and IPSS‐R risk groups. The FCSS correlated with the World Health Organization classification, IPSS and IPSS‐R risk groups. Mild flow cytometric abnormalities were associated with significantly better overall survival (OS) and lower risk of disease evolution. The presence of aberrant myeloid progenitors was associated with transfusion dependency and disease progression. Most importantly, the FCSS identified prognostic subgroups within the IPSS‐R cytogenetic good risk and low risk group. Flow cytometric analysis in patients with MDS provides additional prognostic information and is complementary to the IPSS‐R. The addition of a flow cytometric score next to the clinical parameters within the IPSS‐R is a further refinement of prognostication of patients with MDS.     

Development and validation of an Arabic version of the International Prostate Symptom Score

OBJECTIVE

To develop and validate an Arabic version of the International Prostate Symptom Score (IPSS).

PATIENTS, SUBJECTS AND METHODS

An Arabic version of the IPSS (IPSS‐Arb) was developed through a series of translations and modifications which involved the authors, urology and non‐urology medical and nursing staff. The validity and reliability were assessed in 76 patients with urinary symptoms due to benign prostatic hyperplasia (BPH) and in 63 control subjects without BPH; 25 patients had transurethral resection of prostate (TURP) whereas the remaining 51 patients were treated with terazosin. The reliability of the IPSS‐Arb was assessed by determining the internal consistency (Cronbach’s α coefficient) and by assessing the test‐retest reliability (intraclass correlation coefficient, ICC). Construct validity was assessed by determining the correlation between the IPSS‐Arb scores and the quality‐of‐life question (QoL‐Arb), and by determining the ability of the IPSS‐Arb to discriminate between the patients and controls by calculating the area under the receiver operating characteristic (ROC) curve.

RESULTS

The Cronbach’s α coefficient (internal consistency) for the IPSS‐Arb was 0.85, and 0.78–0.88 for the individual items. The test‐retest reliability (ICC) was 0.88 (P < 0.001). In addition, the IPSS‐Arb had a high correlation with the QoL‐Arb (Spearman rank correlation coefficient 0.82, P = 0.01). The mean (sem , 95% confidence interval) area under the ROC curve for the IPSS‐Arb was 0.93 (0.09, 0.89–0.97), whereas the area for its individual questions was 0.79–0.90. The IPSS‐Arb also showed a high sensitivity to change. The mean (sd ) IPSS‐Arb scores before and after TURP were 23.1 (6.4) and 6.9 (1.8), respectively (P < 0.001); in the terazosin group, the scores were 12.6 (7.4) and 8.2 (4.0), respectively (P < 0.001).

CONCLUSIONS

The IPSS‐Arb was shown to be a reliable and valid instrument for patients with BPH. We recommend using it for patient assessment and follow‐up, and as a research tool in Arabic‐speaking patients both in the Middle East and worldwide. In addition, this study provided another proof of the wide suitability of the IPSS among various nations worldwide.     

1 048例男性下尿路症状调查以及特点分析

目的 了解成年男性下尿路症状(LUTS)的发生情况、年龄分布与变化规律.方法 采用国际前列腺症状评分问卷表(IPSS)调查2008年参加健康体检的成年男性1 048人,年龄30～80岁,以10岁为一年龄段,分为5个年龄段,评估被调查者的LUTS发生情况.结果 各组LUTS发生的情况为:30岁～为347人,平均IPSS评分(2.48±0.38);40岁～为31 1人,平均IPSS评分(3.80±0.53);50岁～为114人,平均IPSS评分(4.78±1.07):60岁～为207人,平均IPSS评分(5.33±0.68);70～79岁为69人,平均IPSS评分(6.80±1.66).其中各年龄组储尿期症状平均评分分别为:1.20,1.66,2.24,2.57,3.20;排尿期症状平均评分分别为:1.28,2.14,2.54,2.76,3.59;生活质量平均评分为:(1.78±1.42),(1.84±0.30),(1.89±1.04),(2.03±1.08),(2.07±1.92).不同年龄组男性LUTS发生率及症状严重程度与年龄相关(J-T统计量为239743.50,P＜0.001),IPSS总评分、排尿期症状评分及储尿期症状评分与生活质量评分呈正相关,其中储尿期症状比排尿期症状对生活质量影响更大.结论 LUTS症状在成年健康男性中较普遍存在,发病率随年龄增大而增加.LUTS症状越重,对生活质量影响越大,其中储尿期症状较排尿期症状对生活质鼍影响更大.     

Prostatic Artery Embolization with 250-μm Spherical Polyzene-Coated Hydrogel Microspheres for Lower Urinary Tract Symptoms with Follow-up MR Imaging

Purpose

To evaluate clinical outcomes and possible MR imaging predictors of clinical success after prostatic artery embolization (PAE) with 250-μm hydrogel particles.