Rituximab (anti-CD20 monoclonal antibody) as single first-line therapy for patients with follicular lymphoma with a low tumor burden: clinical and molecular evaluation

The clinical activity of rituximab, a chimeric monoclonal antibodywhich binds to the CD20 antigen, was evaluated as a single first-linetherapy for patients with follicular non-Hodgkin lymphoma (NHL). Fiftypatients with follicular CD20⁺ NHL and a low tumor burdenwere analyzed for clinical and molecular responses. They received 4 weekly infusions of rituximab at a dose of 375 mg/m². Theresponse rate a month after treatment (day 50) was 36 of 49 (73%),with 10 patients in complete remission, 3 patients in completeremission/unconfirmed, and 23 patients in partial remission. Tenpatients had stable disease, and the disease progressed in 3 patients. One of 13 (8%) patients in complete remission, 9 of 23 (39%) patients in partial remission, and 5 of 10 (50%) patients withstable disease exhibited disease progression during the first year.Within the study population, 32 patients were initially informative forpolymerase chain reaction (PCR) data on bcl-2-J_H rearrangement. On day 50, 17 of 30 patients (57%) were negative forbcl-2-J_H rearrangement in peripheral blood, and 9 of 29 (31%) were negative in bone marrow; a significant association wasobserved between molecular and clinical responses(P < .0001). At month 12, 16 of 26 patients (62%) werePCR negative in peripheral blood. These results indicate that earlymolecular responses can be sustained for up to 12 months and that thisresponse is highly correlated with progression-free survival. Rituximabhas a high clinical activity and a low toxicity and induces a highcomplete molecular response rate in patients with follicular lymphomaand a low tumor burden.     

The prognostic significance of early treatment response in pediatric relapsed acute myeloid leukemia: results of the international study Relapsed AML 2001/01

The prognostic significance of early response to treatment has not been reported in relapsed pediatric acute myeloid leukemia. In order to identify an early and easily applicable prognostic factor allowing subsequent treatment modifications, we assessed leukemic blast counts in the bone marrow by morphology on days 15 and 28 after first reinduction in 338 patients of the international Relapsed-AML2001/01 trial. Both day 15 and day 28 status was classified as good (≤20% leukemic blasts) in 77% of patients. The correlation between day 15 and 28 blast percentages was significant, but not strong (Spearman correlation coefficient = 0.49, P<0.001). Survival probability decreased in a stepwise fashion along with rising blast counts at day 28. Patients with bone marrow blast counts at this time-point of ≤5%, 6–10%, 11–20% and >20% had 4-year probabilities of survival of 52%±3% versus 36%±10% versus 21%±9% versus 14%±4%, respectively, P<0.0001; this trend was not seen for day 15 results. Multivariate analysis showed that early treatment response at day 28 had the strongest prognostic significance, superseding even time to relapse (< or ≥12 months). In conclusion, an early response to treatment, measured on day 28, is a strong and independent prognostic factor potentially useful for treatment stratification in pediatric relapsed acute myeloid leukemia. This study was registered with ISRCTN code: 94206677.     

乙型肝炎病毒基因的整合机制及对宿主的影响

乙型肝炎病毒是导致慢性肝炎、肝纤维化、肝细胞癌的主要病因,目前认为乙型肝炎病毒基因整合在其致病机制中具有重要作用,本文试就该领域内目前研究成果做一综述．     

The melanocortinergic pathway is rapidly recruited by emotional stress and contributes to stress-induced anorexia and anxiety-like behavior

Neurons producing melanocortin receptor agonist, alpha-MSH derived from proopiomelanocortin, and antagonist, agouti-related protein, are known to be sensitive to metabolic stress such as food deprivation and glucoprivation. However, how these neurons respond to emotional/psychological stress remained to be elucidated. We report here that acute emotional stressors, i.e. restraint and forced swim, evoked mRNA expression of c-fos, a neuronal activation marker, in a high percentage of proopiomelanocortin neurons (up to 53% for restraint stress and 62% for forced swim), with marked variations along the rostro-caudal axis of the arcuate nucleus. In contrast, only a small population of agouti-related protein neurons in this brain region was activated. These neuronal activation patterns were correlated with behavioral reactions. Both stressors suppressed feeding and induced anxiety-like behavior in the elevated plus-maze test, as reflected by a reduction in the percentage of entries and time spent in the open arms. Central pretreatment with SHU9119, a melanocortin receptor antagonist, dose dependently attenuated the anorectic and anxiogenic effects elicited by acute restraint or forced swim. These results indicate that the melancortinergic pathway can be rapidly recruited by acute emotional stress, and that activation of melanocortin signaling is involved in mediating stress-induced anorexia and anxiety.     

The epidemiology of typhoid fever in the Dong Thap Province, Mekong Delta region of Vietnam

A population-based surveillance for typhoid fever was conducted in three rural communes of Dong Thap Province in southern Vietnam (population 28,329) for a 12-month-period starting on December 4, 1995. Cases of typhoid fever were detected by obtaining blood for culture from residents with fever > or = 3 days. Among 658 blood cultures, 56 (8.5%) were positive for Salmonella typhi with an overall incidence of 198 per 10(5) population per year. The peak occurrence was at the end of the dry season in March and April. The attack rate was highest among 5-9 year-olds (531/10(5)/year), and lowest in > 30 year-olds (39/10(5)/year). The attack rate was 358/10(5)/year in 2-4 year-olds. The isolation of S. typhi from blood cultures was highest (17.4%) in patients with 5 to 6 days of fever. Typhoid fever is highly endemic in Vietnam and is a significant disease in both preschool and school-aged children.     

经额部与经颞部血肿钻孔引流术治疗高血压脑出血疗效的Meta分析

目的比较经额部与经颞部血肿钻孔引流术治疗高血压脑出血的疗效。 方法按照制定的检索策略,检索中国知网、万方、维普等中文数据库及Medline、Embase、Cochrane等英文数据库,对于符合纳入排除标准的研究利用RevMan 5.3软件进行Meta分析。 结果经检索,5个临床研究符合标准,共488例病例,其中经额部钻孔引流组236例,经颞部钻孔引流组252例。2组在手术时间、术后第7天血肿残余量及术后并发症发生率方面比较差异无统计学意义,经额部钻孔引流组在术后第3天血肿残余量、住院时间、术后日常活动能力方面更有优势。 结论经额部血肿钻孔引流较经颞部在血肿清除效率、改善预后方面更有优势。     

Ectopic opening of the common bile duct in the duodenal bulb: clinical implications

BACKGROUND: An ectopic opening of the common bile duct in the duodenal bulb is extremely rare, and the clinical significance of this anomaly has not been clarified. This study analyzed the clinical implications and cholangiographic findings of this anomaly. METHODS: A total of 18 patients (15 men, 3 women; median age, 51 years) with an ectopic opening of the common bile duct in the duodenal bulb were studied. Medical records, endoscopic findings, and cholangiographic and other radiographic findings were reviewed. RESULTS: All 18 patients had biliary pain; 7 had fever and chills. Fifteen (83%) had diffuse dilatation of the extrahepatic bile ducts with or without intrahepatic bile duct dilation. Associated bile duct stones were found in 10 (56%) patients. The papilla in the bulb had an orifice stained with bile at endoscopy, which was associated with duodenal ulcer disease found in 13 (72%) patients. The distal end of the common bile duct was tapered and narrowed and had a hook shape in all patients. CONCLUSION: An ectopic opening of the common bile duct in the duodenal bulb may be associated with clinical entities such as recurrent or intractable duodenal ulcer, choledocholithiasis, or acute cholangitis. Although these openings are rare, knowledge of the endoscopic and radiographic findings of an ectopic opening of the common bile duct in the duodenal bulb may help to clarify the cause of chronic recurrent duodenal ulcer disease in some patients and prevent damage to the bile duct during surgery.