侵袭性NK细胞白血病的临床研究--附九例报告

目的提高对侵袭性NK细胞白血病(ANKL)的认识,对其诊断标准进行总结。方法回顾性分析临床病例。结果和结论ANKL患者常有发热、肝脾肿大、黄疸、肝功能异常和全血细胞减少,疾病进展迅速,短期内出现多脏器功能衰竭、噬血细胞综合征,中位生存期小于2个月。目前较公认的诊断标准:①常有发热及肝、脾、淋巴结肿大;②外周血可以有中性粒细胞减少、贫血和血小板减少,淋巴细胞比例增高,大颗粒淋巴细胞可以增多,但不是诊断的必要条件;③骨髓涂片和活检均可见较多的大颗粒淋巴细胞浸润;④细胞免疫表型为CD2( ),表面CD3(-),胞质CD3( ),CD56( ), CD57(-),CD11b和CD16可以阳性,无T细胞受体重排;⑤有EB病毒抗体阳性的证据;⑥没有特异的染色体异常,较多见的核型异常为de1(6)(q21q25);⑦排除其他引起大颗粒淋巴细胞增多的疾病。     

Prognostic Factors for Isolated Locoregional Recurrences in Colon Cancer and Survival After Salvage Surgery: a Cohort Study

The purpose of this study was to establish the factors affecting development of locoregional recurrence (LR) and survival following salvage surgery in patients operated on for stage I–III colon adenocancer with curative purposes and using a standard technique by an experienced surgeon in elective circumstances. This was a cohort study of patients diagnosed with colon cancer, operated on (n = 312) between January 2003 and 2015. Isolated LR was detected in 15 patients (4.8%) among 312 consecutive patients (99.7% R₀ resection) in a mean follow-up period of 60.5 months. The most important prognostic factors affecting LR development were found to be R₁ resection, pT₄ tumor (tm), postoperative development of morbidity, T₄ tm, N₂ tm, and mucinous tm. All patients who were detected to have isolated LR were re-operated with curative intent (80% R₀). Prognostic factors for cancer-specific survival (CSS) in those cases were development of distant metastasis, localization of the recurrent tumor (pelvis), and symptomatic patient. Mean survival in the whole series was 125.2 months and 5-year CSS was 89%, while respective values in cases with development of LR were 47.4 months and 54.4%, respectively. Although development of isolated LR worsens the prognosis considerably, a long survival and even cure can be provided in some patients. Survival is closely related with resectability and localization of the recurrent tumor and development of distant metastasis. Close follow-up of high-risk patients, early diagnosis and treatment in patients with development of recurrence, experienced team and standardized curative surgery, and a multidisciplinary approach improve the prognosis.     

Quality-of-life scores improve after 96 weeks of PEG-IFNa-2a treatment of hepatitis D: An analysis of the HIDIT-II trial

Background & Aims

Infection with the hepatitis D virus (HDV) causes the most severe form of viral hepatitis with a high risk to develop clinical complications of liver disease. In addition, hepatitis delta has been shown to be associated with worse patient-reported outcomes. Until recently, only pegylated interferon alfa could be used to treat hepatitis delta.

Methods

Here, we investigated quality of life (QOL) as assessed by the Short Form 36 Health Survey (SF-36) in patients undergoing antiviral therapy with pegylated interferon alfa (PEG-IFNa-2a)-based treatment in the HIDIT-II trial. HIDIT-II was a randomized prospective trial exploring PEG-IFNa-2a with tenofovir disoproxil (TDF) or placebo for 96 weeks in patients with compensated hepatitis delta. Surveys completed by 83 study participants before, during, and after treatments were available.

Results

Overall, we observed a reduced QOL of HDV patients compared with a reference population, both in physical as well as mental scores. Interestingly, PEG-IFNa-2a treatment showed only minor impairment of the QOL during therapy. Moreover, HDV-RNA clearance was not associated with relevant changes in physical or social SF-36 scores, whereas an improvement of fibrosis during treatment was associated with increased QOL. Overall, slight improvements of the QOL scores were observed 24 weeks after the end of treatment as compared with baseline. TDF co-treatment had no influence on QOL.

Conclusions

Overall, our findings suggest that PEG-IFNa-2a was reasonably tolerated even over a period of 96 weeks by hepatitis D patients reporting SF-36 questionnaires. Of note, several patients may benefit from PEG-IFNa-2a-based therapies with off-treatment improvements in quality of life.     

USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge. This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.     

The protective role of melatonin and curcumin in the testis of young and aged rats

We aimed to investigate the effect of melatonin and curcumin treatment on oxidative stress, apoptosis, and histology of testicular tissue in our study. Four groups were formed using young (4 months old, n = 6) and aged (20–22 months old, n = 18) male Wistar albino rats: (a) Young control (1% ethanol:phosphate‐buffered saline [PBS], subcutaneously [s.c.]); (b) Aged control (CTL; n = 6, 1% ethanol:PBS, s.c.); (c) Aged Melatonin (MLT; n = 6, 10 mg/kg, s.c.); (d) Aged Curcumin (CUR; n = 6, 30 mg/kg, i.p.). At the end of 21 days, the rats were sacrificed, and testicular tissues were removed. Malondialdehyde (MDA) in the testicular tissue was determined with thiobarbituric acid reactive substances formation, and glutathione (GSH) was determined with modified Ellman method; testosterone level was determined with chemiluminescence method and histologic changes were determined with Haematoxylin‐Eosin and Johnsen's scoring; Apoptotic cell counts were made with TUNEL staining of seminiferous tubule in testis. With ageing, MDA level increased in testicular tissue, but GSH and blood testosterone levels decreased. Melatonin treatment for aged rats significantly decreased Paired total testicular/body weight ratio compared to aged control group (p < 0.05). Curcumin treatment for aged rats significantly increased GSH level compared to the aged control group (p < 0.05). Besides, melatonin and curcumin treatment significantly decreased the number of apoptotic cells and significantly increased Johnsen's score (p < 0.05).