Nonremission and Recurrent Tumor-Induced Osteomalacia: A Retrospective Study

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome. It is curable by excision of the causative tumor. However, a few cases may persist or relapse after tumor resection. We aimed to investigate the rate of these events and related factors. We retrospectively studied TIO patients treated with surgery in a tertiary hospital. TIO was established based on a pathologic examination or the reversion of hypophosphatemia. Refractory TIO patients consisted of those with nonremission or recurrent hypophosphatemia after surgery. A total of 230 patients were confirmed as having TIO. After primary surgery, 26 (11.3%) cases persisted, and 16 (7.0%) cases recurred. The overall refractory rate was 18.3%. The median time of recurrence was 33 months. Compared with patients in the recovery group, patients in the refractory group were more likely to be female (59.5% versus 41.0%, p = .029) and have a lower serum phosphate level (0.44 ± 0.13 versus 0.50 ± 0.11 mmol/L, p = .002). The refractory rate was lowest in head/neck tumors (7.5%) and highest in spine tumors (77.8%). Regarding the tissue involved of tumor location, the refractory rate was higher in tumors involving bone than tumors involving soft tissue (32.7% versus 7.0%, p < .001). The outcomes of malignant tumors were worse than those of benign tumors (p < .001): nonremission rate, 21.4% versus 9.7%; recurrence rate, 28.6% versus 6.5%. In the multivariate regression analysis, female sex, spine tumors, bone tissue-involved tumors, malignancy, and low preoperation serum phosphorus levels were identified as risk factors for refractory outcomes. High preoperative fibroblast growth factor 23 (FGF23) levels were also associated with refractory after adjusting for involving tissue and tumor malignancy. In summary, we are the first to report the rate and clinical characteristics of refractory TIO in a large cohort. For patients with multiple risk factors, especially spine tumors, clinical practitioners should be aware of a poor surgical prognosis. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.     

中药早期干预对急性心肌梗塞远期预后的影响

探讨中药早期干预对急性心肌梗塞远期预后的影响。【方法】157例急性心肌梗塞患者按照住院期间是否接受辨证论治中药汤剂治疗分为中药治疗组(129例)和对照组(28例)两个队列,并对所有病例的年龄、性别、梗塞部位、并发症、既往相关病史等方面逐项统计,随访患者的生存情况及所有事件(死亡及其他重要心脑血管事件)发生情况。【结果】以死亡为终点事件,治疗组的生存曲线在观察期间均高于对照组,但差异无统计学意义(P=0．1166);以所有事件为终点,治疗组的生存曲线在观察期间任何时点也都高于对照组(P=0．048)。【结论】治疗组免于发生包括死亡在内的重大事件的概率在任何观察时点都比对照组高。     

p53蛋白表达与乳癌预后的相关性研究

目的 探讨p５３蛋白表达在判断乳癌预后中的作用。方法 应用免疫组化ＡＢＣ法染色检 测７３例乳癌,１２例乳腺良性增生性疾病及１０例正常乳腺组织的ｐ５３蛋白的表达。结果 ７３例乳腺组织均为阴性反应。ｐ５３蛋白的异常表达与肿瘤的分类、淋巴转移情况、术后复发及生存率均无相关性。结论 ｐ５３蛋白异常表达与乳癌预后无显著相关性。可能为乳癌的早期表现。     

端粒酶活性在乳腺癌中的表达及临床病理学相关性研究

目的　探讨端粒酶活性在乳腺癌的诊断价值及其临床病理学相关性。方法　应用端粒酶ＰＣＲ 酶联免疫吸附法定量检测４０ 例乳癌,３１ 例乳腺良性病变和９ 例正常乳腺组织端粒酶活性,同时与硝酸银染色定性检测对比。结果　端粒酶在乳癌、乳腺良性病变、正常乳腺组织表达的阳性率分别为７０ ％ （２８／４０） ,２９ ％ （９／３１） 和０ ％ （０／９） 。按定量检测其ＯＤ值分别为０．６０３,０．２５８ 和０．０３,３ 组之间均有显著性差异（ Ｐ ＜ ０ ．００１） 。端粒酶活性在乳癌中心和癌旁组织分别为０．６０３ 和０．２９３（ Ｐ ＜ ０ ．００１） 。按ＴＮＭ 分期,Ⅲ期（０．７８０ ±０．３９４） 高于Ⅱ期（０．５１１ ±０．４４７）（ Ｐ ＜ ０ ．０５） 。ＰＲ 阴性组（０．７８６ ±０．４４７） 高于ＰＲ 阳性组（０．５０１ ±０．３９３）（ Ｐ ＜ ０ ．０５） 。结论　良、恶性乳腺肿瘤端粒酶活性有显著性差异,可作为乳癌诊断的辅助指标之一;端粒酶活性与临床分期和ＰＲ 受体相关,提示端粒酶可作为反映乳癌侵袭性和预后的指标。     

Use of imatinib mesylate in elderly patients in Northern Ireland: evidence of comparable haematological and molecular responses to younger patients

Abstract

Advanced age is an indicator of poor prognosis in chronic myeloid leukaemia (CML). Since obtaining its UK licence in 2001, the tyrosine kinase inhibitor imatinib mesylate has effected a paradigm shift in the treatment of CML. We compared survival and molecular response rates in elderly patients to younger patients presenting with CML since the introduction of imatinib. Twenty-five patients aged >60 years were identified. No significant survival difference was found when this group was compared with younger patients. In the elderly group, 53% of those with molecular data (36% of all elderly patients) had a major molecular response as assessed by real time quantitative PCR (RT-PCR). The advent of imatinib therapy appears to have ameliorated much of the negative impact of advancing age on survival in patients with CML.     

Prognostic cytogenetic markers in childhood acute lymphoblastic leukemia: Cases from Mansoura Egypt

The objective of the work was to evaluate children with acute lymphoblastic leukemia (ALL) showing resistance to immediate induction chemotherapy in relation to conventional and advanced cytogenetic analysis. The study was conducted on 63 ALL children (40 males and 23 females) with age range 4.5 months–16 years (mean = 7.76 years). They included 37 cases who attained a true remission and 26 complicated by failure of remission, early relapse or death. They were subjected to history, clinical examination and investigations including CBC, BM examination, karyotyping, FISH for translocations and flowcytometry for immunophenotyping and minimal residual disease diagnosis.

Cases aged <5 years; male sex with organomegaly had better remission although statistically insignificant. Initially low HB <8 gm/dl, high WBCs and platelet counts >50.000/mm³ also showed better but non-significant remission rates. Most of our cases were L₂ with better remission compared to other immunophenotypes. About 40 informative karyotypes were subdivided into 15 hypodiploid, 10 pseudodiploid, 8 normal diploid and 7 hyperdiploid cases; the best remission rates were noticed among the most frequent ploidy patterns. Chromosomes 9, 11 and 22 were the most frequently involved by structural aberrations followed by chromosomes 5, 12 and 17. Resistance was noted with aberrations not encountered among remission group; deletions involving chromosomes 2p, 3q, 10p and 12q; translocations involving chromosome 5; trisomies of chromosomes 16 and 21; monosomies of 5 and X and inversions of 5 and 11. Our conclusions were that cytogenetic and molecular characterizations of childhood ALL could add prognostic criteria for proper therapy allocation.     

Identification of new markers discriminating between myeloid and lymphoid acute leukemia

Abstract

Background: The heterogeneity of acute myeloid leukemia (AML) with respect to biology and clinical course resides in the fact that patients belonging to the same group show marked differences in their response to chemotherapy, necessitating a refinement of AML classification.

Methods: In order to define molecular markers for AML, we performed microarray analysis on peripheral blood cells from two M5 AML patients, and selected four differentially expressed genes to validate their expression by real-time quantitative PCR (RT-PCR).

Results: We have shown that two downregulated genes in AML, those encoding guanine nucleotide-binding protein γ11 (GNG11) and amphiregulin (AREG), are also downregulated in B-lineage acute lymphoblastic leukemia (B-ALL) and T-lineage acute lymphoblastic leukemia (T-ALL) patients. A second gene, that encoding ceruloplasmin (CP), is upregulated in AML but not in B-ALL and T-ALL. The level of expression of these genes varies from one patient to another.

Conclusion: Since the number of patients studied is limited, further studies are needed with a larger series of patients to evaluate the potential utility of GNG11, AREG and CP as molecular markers for AML subtype classification. Our study is the first to analyze these genes in AML, B-ALL, T-ALL and chronic leukemia (myeloid and lymphoid) patients by RT-PCR. This rapid and sensitive method could be used to screen these genes in different types of leukemia.     

重症急性胰腺炎的治疗

目的 探讨重症急性胰腺炎（ＳＡＰ）的治疗方法。方法 回顾性分析１０７例ＳＡＰ患者非手术治疗及手术治疗的疗效。结果 １０７例中治愈９８例（９１．６％）,死亡９例（８．４％）。８９例采用非手术治疗（其中１６例因并发症行延期手术治疗）,其中仅３例１周内死于早期休克,２例２周后死于继发性感染;３４例行手术者（包括１６例延期手术者）,４例死于术后并发症。结论 ＳＡＰ早期手术并非完全必要,手术治疗的“个体化”