Prognostication in eye cancer: the latest tumor,node, metastasis classification and beyond

The tumour, node, metastasis (TNM) classification is a universal cancer staging system, which has been used for five decades. The current seventh edition became effective in 2010 and covers six ophthalmic sites: eyelids, conjunctiva, uvea, retina, orbit, and lacrimal gland; and five cancer types: carcinoma, sarcoma, melanoma, retinoblastoma, and lymphoma. The TNM categories are based on the anatomic extent of the primary tumour (T), regional lymph node metastases (N), and systemic metastases (M). The T categories of ophthalmic cancers are based on the size of the primary tumour and any invasion of periocular structures. The anatomic category is used to determine the TNM stage that correlates with survival. Such staging is currently implemented only for carcinoma of the eyelid and melanoma of the uvea. The classification of ciliary body and choroidal melanoma is the only one based on clinical evidence so far: a database of 7369 patients analysed by the European Ophthalmic Oncology Group. It spans a prognosis from 96% 5-year survival for stage I to 97% 5-year mortality for stage IV. The most accurate criterion for prognostication in uveal melanoma is, however, analysis of chromosomal alterations and gene expression. When such data are available, the TNM stage may be used for further stratification. Prognosis in retinoblastoma is frequently assigned by using an international classification, which predicts conservation of the eye and vision, and an international staging separate from the TNM system, which predicts survival. The TNM cancer staging manual is a useful tool for all ophthalmologists managing eye cancer.     

儿童恶性血液病患者中性粒细胞缺乏期医院感染的临床分析

目的探讨儿童恶性血液病患者中性粒细胞缺乏期医院感染发生的特点及防治对策。方法回顾性分析2000年1月-2005年6月174例儿童恶性血液病住院患者接受强化疗后在中性粒细胞缺乏期感染发生的特点、感染发生的因素及感染种类等以及治疗效果。结果儿童恶性血液病患者中性粒细胞缺乏期医院感染发生率为67.4%;以呼吸道感染最多见为45.4%,其次是口腔、血液、皮肤和肠道等;细菌感染为86.8%,真菌感染为13.2%;对革兰阴性杆菌(G-杆菌)较敏感的药物有亚胺培南/西司他丁、美罗培南、阿米卡星、头孢他啶、哌拉西林/他唑巴坦、替卡西林/克拉维酸;对革兰阴性球菌(G 球菌)敏感的药物有万古霉素,其他依次为亚胺培南/西司他丁、美罗培南、氨苄西林/舒巴坦、环丙沙星、克林霉素;医院感染致死率为44.4%。结论儿童恶性血液病患者中性粒细胞缺乏期医院感染发生率高,作好基础护理、加强肠道消毒、使用粒细胞刺激因子、合理使用抗菌药物与警惕真菌感染等是防治儿童恶性血液病患者中性粒细胞缺乏期医院感染的重要措施。     

HL-60细胞淫羊藿甙诱导后信号传导因子表达变化与意义

目的检测急性早幼粒白血病细胞HL-60经过淫羊藿甙(ICA)诱导后信号传导与转录激活因子(STAT1、STAT3)和有丝分裂原激活蛋白激酶(p38MAPK、p42MAPK)表达变化在分化中的作用。方法建立ICA诱导分化模型,用瑞氏染色观察细胞形态,MTT实验测定细胞增殖的变化,NBT还原实验测定细胞分化状态,RT-PCR方法检测STAT1、STAT3、p38MAPK、p42MAPK 的mRNA的表达。结果 HL-60细胞经ICA作用24 h后,随着细胞增殖降低和分化的发生, p42MAPK的mRNA表达增加,STAT3的mRNA表达降低,STAT1和p38MAPK的mRNA未见明显的表达。结论 p42MAPK和STAT3与ICA诱导HL-60细胞分化有关,而p38MAPK和STAT1则与ICA诱导HL-60细胞分化无关。     

活血化瘀法治疗下肢深静脉血栓形成134例临床及实验观察

报道了以中医活血化瘀法治疗下脚深静脉血栓形成患者１３４例，并作了血液流变学的多项指标观察，结果：（１）中医活血化瘀法为主治疗效果显著，治愈好转率１００％。（２）血液流变学多项指标治疗 前后有显著差异。     

Clinical application of a semimechanistic-physiologic population PK/PD model for neutropenia following pemetrexed therapy

Purpose: The objective of these analyses was to examine the effect of variations in the explanatory factors of neutropenic response, identified by semimechanistic-physiologic population pharmacokinetic/pharmacodynamic (PK/PD) modeling, on clinically important features of the absolute neutrophil count (ANC)-time profile (e.g, the nadir of the ANC [NANC], its timing [T _Nadir], and the timecourse of recovery [T _Rec]). Methods: Correlation analyses were used to evaluate the relationship of NANC, T _Nadir, and T _Rec as a function of overall systemic exposure (AUC) and each of the covariates contained in the population PK/PD model. Simulations using the final PK/PD model were used to generate complete ANC-time profiles. Frequency counts of NANCs from the simulated profiles were used to quantitatively explore differences in the incidence and severity of neutropenia associated with a variety of scenarios (500 mg/m² versus 600 mg/m², normal vitamin deficiency markers versus elevated vitamin deficiency markers, and body surface area-based versus renal function-based dosing) and to evaluate the effect of individual explanatory factors with respect to neutropenic response. Results: Information obtained from correlation analysis and simulations was helpful in quantitatively exploring the impact of dose, exposure, and/or patient characteristics on neutropenic response. The information gained from these simulations provided supportive evidence for the decision to routinely include vitamin supplementation during pemetrexed treatment as a means of managing the risk of severe neutropenia secondary to pemetrexed administration. These techniques also provided information regarding the specific T _Nadir and T _Rec for inclusion in product labeling and suggested that a 14-day treatment cycle might be feasible for pemetrexed. Conclusion: For population PK/PD models, to provide useful information for the practicing clinician or the clinical development team, it is not sufficient to look only at influences of covariates on model parameters. Rather, the modeling results need to be carefully investigated in terms of clinically relevant measures. James J Rusthoven, Robert D Johnson were employees of Eli Lilly and Company, Indianapolis, USA, at the time this work was completed     

山西省某既往有偿献血地区人免疫缺陷病毒感染的横断面研究

目的了解山西省某既往有偿献血地区人免疫缺陷病毒（HIV）感染率,并探索HIV感染的危险因素。方法选择山西省某县4个村所有18～64岁村民开展以社区为基础的横断面研究,采用标准化问卷收集研究对象的人口学、医疗史、危险行为等信息,采集静脉血用于检测HIV抗体。基于广义估计方程的logistic回归模型被用于分析HIV感染的危险因素。人群归因分值被用于测量危险因素在当地HIV感染发生中的公共卫生学意义。结果4个村中82．5％（3062／3711）的18～64岁村民参加本次调查,共发现40例HIV感染者,该地区HIV总的感染率为1．3％（40／3062）,献血人群和非献血人群HIV感染率分别为4．1％（37／904）和0．1％（3／2158）。多因素分析发现,献全血（调整OR=13．25,95％CI：3．02～58．25）和献血浆（调整OR=87．85,95％CI：22．22～347．27）与该地村民感染HIV有关,二者累计的人群归因分值（PAF）为89．8％。03号村村民感染HIV的危险性高于04号村村民（调整OR=12．26,95％CI：1．46～103．00）。结论该地区HIV感染流行水平相对较低,引起村民HIV感染流行的主要因素是既往有偿献血（浆）,未出现HIV从献血人群向非献血人群的明显蔓延。     

腹腔镜辅助小切口与开腹脾切除术治疗血液系统疾病的临床对比研究

目的比较腹腔镜辅助小切口与开腹脾切除术治疗血液系统疾病的近期临床效果。方法回顾分析1993年10月至2009年12月腹腔镜辅助小切口脾切除术51例（腹腔镜组）和同期开腹脾切除术56例（开腹组）患者的临床资料,比较两种术式的手术时间、术中出血量、术后排气时间、术后下地活动时间、并发症发生率、术后住院时间及术后住院总费用。结果腹腔镜组的平均手术时间、术后住院费用与开腹组差异无统计学意义（P〉0.05）。术中出血量、术后排气时间、术后下地活动时间、术后住院时间及并发症发生率均优于开腹组,差异有统计学意义（P〈0.05）。结论腹腔镜辅助小切口脾切除术的近期效果明显优于传统开腹手术,具有微创、安全、有效、恢复快等优点,值得推广应用。     

Current Status of Hematopoietic Cell Transplantation for Adult Patients with Hematologic Diseases and Solid Tumors in Japan

A nationwide survey of hematopoietic cell transplantation (HCT) was started in Japan in 1991, and the analyzed survey data have been presented as the annual report of the Japan Society for Hematopoietic Cell Transplantation. The 10-year overall survival (OS) rates after HCT for each disease are as follows: acute myelogenous leukemia, 44.2%; acute lymphocytic leukemia, 33.7%; adult T-cell leukemia, 24.6%; chronic myelogenous leukemia, 53.3%; myelodysplastic syndrome, 37.3%; non-Hodgkin's lymphoma, 41.5%; Hodgkin's lymphoma, 50.8%; aplastic anemia, 72.5%; breast cancer, 37.1%; germ cell tumor, 52.6%; and ovarian cancer, 44.2%. The 5-year OS rates for multiple myeloma and lung cancer were 40.6% and 23.6%, respectively. Except in cord blood transplantation, engraftment was accomplished in more than 90% of patients. The respective frequencies of acute graft-versus-host disease (GVHD) and chronic GVHD were 41.1% and 34.9% for related bone marrow transplantation (BMT), 66.8% and 34.5% for unrelated BMT, 52.9% and 36.0% for allogeneic peripheral blood stem cell transplantation, and 53.3% and 32.1% for allogeneic cord blood transplantation. OS for each disease was analyzed by patient age, stem cell source, donor type, disease status, and disease type. These data provide objective and valuable information for hematologists as well as for patients who need HCT.     

Role of CT-guided percutaneous lung biopsy in diagnosis of pulmonary fungal infection in patients with hematologic diseases

The goal of our study is to evaluate the efficiency and safety of CT-guided percutaneous lung biopsy for the diagnosis of pulmonary fungal infection in patients with hematologic disease. Medical records were retrospectively reviewed for 16 patients with hematologic diseases, who were initially suspected to have pulmonary fungal infection clinically and underwent further diagnostic methods including blood culture, sputum culture and percutaneous lung biopsy. Of the 16 patients, 10 were diagnosed fungal infection (8 aspergillus, 2 mold fungus), 4 chronic organizing pneumonitis, 1 tuberculosis, and 1 Pneumocystis carinii through histological examination after percutaneous lung biopsy. However, the results of blood culture and sputum culture were negative. CT-guided biopsy showed 100% overall accuracy and 62.5% (10/16) fungal infection rate. The biopsy-induced complications encountered were pneumothorax in 3/16 (18.75%) and hemoptysis in 1/16 (6.25%). No serious complication was found in this series. In conclusion, CT-guided percutaneous lung biopsy is an effective and safe method for the diagnosis of pulmonary fungal infection in patients with hematologic diseases.     

宫颈癌调强放疗中保护骨盆骨髓对血液毒性的影响

目的 观察宫颈癌患者调强放疗时保护骨盆骨髓对血液毒性的影响.方法 40例宫颈癌术后放疗患者随机分入研究组和对照组各20例,根据靶区勾画要求勾画临床靶区（CTV）及正常组织,观察组在放疗计划设计时按要求限制骨盆骨髓受照剂量和体积;对照组不予以限制骨盆骨髓受照剂量和体积.放疗前、放疗中每周及放疗结束时复查血常规.结果 观察组和对照组患者均未发生4级血液毒性反应;其4级以下血液学毒性发生率分别为50％和80％,差异有统计学意义（P＜0.05）.结论 宫颈癌调强放疗保护骨盆骨髓可以降低患者血液学毒性发生率.