Objective:To investigate the clinical application value of blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) to the protection of language function in patients with unilateral frontal and temporal lobes glioma receiving postoperative intensity modulation radiation therapy (IMRT).Methods:A total of 27 patients with unilateral frontal and temporal lobe gliomas were treated with postoperative radiotherapy. The planning CT and BOLD-fMRI were performed before radiotherapy, and the language functional areas were delineated based on the fused images of 3D T1 and CT. IMRT technology was used to develop radiotherapy plans with and without language function area protection, naming conventional and protective radiotherapy plans respectively. The maximum radiation dose ( Dmax), average radiation dose ( Dmean), target conformal (CI) and dose uniformity (HI) of PTV of the two plans were compared and analyzed to ensure that the protective radiotherapy plan could meet the radiotherapy standard. Then, the Dmax and Dmean of the language function area were compared and analyzed to evaluate whether the Dmax and Dmean of the language function area were decreased in the protective radiotherapy plan. Results:There were no significant differences in CI, HI, Dmax and Dmean of PTV between the conventional radiotherapy plan and protective radiotherapy plan ( P>0.05). There were statistically significant differences in Dmax and Dmean of Wernicke′s and Broca′s (healthy side and affected side) between the conventional radiotherapy plan and protective radiotherapy plan ( t=3.073-12.707, P<0.05). Dmax and Dmean of Wernicke′s and Broca′s (healthy side and affected side) were decreased in the protective radiotherapy plan compared with the conventional radiotherapy plan, and the decrease was significant in the healthy side. Conclusions:BOLD-fMRI combined with IMRT can not only guarantee the target dose of patients with glioma receiving postoperative radiotherapy, but also reduces the radiation dose to the language function area. Chinese reading task and paragraph comprehension task are the stimulation mode of language function in patients after brain tumor surgery. These tasks are simple and the effect is accurate.

BACKGROUNDIntensive treatment such as autologous peripheral blood stem cell (PBSC) transplantation is an important therapeutic strategy in many hematologic malignancies. A number of factors have been reported to impact PBSC mobilization, but the predictive factors varied from one study to another. This retrospective study assessed our current mobilization and collection protocols, and explored the factors predictive of PBSC mobilization in patients with hematologic malignancies.

METHODSData of 64 consecutive patients with hematologic malignancies (multiple myeloma, n = 22; acute leukemia, n = 27; lymphoma, n = 15) who underwent PBSC mobilization for over 1 year were analyzed. Four patients with response to treatment of near complete remission or better were administered granulocyte colony-stimulating factor (G-CSF) to mobilize PBSCs. Sixty patients received G-CSF followed by chemotherapy mobilizing regimens. Poor mobilization (PM) was defined as when ≤ 2.0'10(6) CD34(+) cells/kg body weight were collected within three leukapheresis procedures.

RESULTSThe incidence of PM at the first mobilization attempt was 19% (12/64). The PM group was older than the non-PM group (median age, 51 vs. 40 years; P = 0.013). In univariate analysis, there were no significant differences in gender, diagnosis, and body weight between the PM and non-PM groups. A combination of chemotherapy and G-CSF was more effective than G-CSF alone as a mobilizing regimen (P = 0.019). Grade III or IV hematopoietic toxicity of chemotherapy had no significant effect on the mobilization efficacy. Supportive care and the incidence of febrile neutropenia were not significantly different between the two groups. In multivariate analysis, age (odds ratio (OR), 9.536; P = 0.002) and number of previous chemotherapy courses (OR 3.132; P = 0.024) were two independent negative predictive factors for CD34(+) cell yield. PM patients could be managed well by remobilization.

CONCLUSIONOlder age and a heavy load of previous chemotherapy are the negative risk factors for PBSC mobilization.

Adult ; Aged ; Female ; Granulocyte Colony-Stimulating Factor ; metabolism ; Hematologic Neoplasms ; metabolism ; pathology ; Hematopoietic Stem Cell Mobilization ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo investigate the therapeutical effect and side-effect of docetaxel combined with cisplatin (DDP) on the treatment of local advanced esophageal cancer with concomitant radiation therapy.

METHODSNinety patients with LOCAL advanced esophageal squamous cell carcinoma were divided into two groups: (DDP + 5-Fu) group and (docetaxel + DDP) group. Chemotherapy was carried out every 4 weeks for a total of 4 courses. The radiation dose was 50.4 Gy/28FX.

RESULTSThe median survival time of patients in the (DDP + 5-Fu) group was 16 months and that in (docetaxel + DDP) group was 21 months (P = 0.0278). The 3-year survival rate in the (docetaxel + DDP) group was obviously higher than that in the (DDP + 5-Fu) group (23.9% vs. 12.1%). The ORR in (docetaxel + DDP) group (84.5%) was significantly higher than that in the (DDP + 5-Fu) group (71.1%) (P = 0.025). No significant differences were observed in the incidence of side-effects in the two groups.

CONCLUSIONSThe conventional dose chemotherapy of docetaxel + DDP with concomitant radiation therapy showed a better partial remission rate and long-term survival rate for the treatment of local advanced esophageal cancer than the traditional chemotherapy (DDP + 5-Fu) with concomitant radiation therapy and the side-effects are not increased.

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; radiotherapy ; Cisplatin ; administration & dosage ; adverse effects ; Combined Modality Therapy ; Cystic Fibrosis ; etiology ; Dose Fractionation ; Esophageal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; Follow-Up Studies ; Humans ; Leukopenia ; chemically induced ; Male ; Middle Aged ; Neoplasm Staging ; Remission Induction ; Survival Rate ; Taxoids ; administration & dosage ; adverse effects ; Young Adult

Objective To explore the management of spontaneous intraspinal hematoma.Methods From January 2011 to July 2018,29 cases with spontaneous intraspinal hematoma were admitted to our department.Date on etiology,clinical presentation,radiological features,treatment strategy and prognosis were analyzed retrospectively.The prognosis was assessed by American Spinal Injury Association impairment scale (ASIA) before and after the treatment.Results Total of 29 cases,only 10 cases (34.5％) revealed specific etiology,including 7 cases of spinal vascular malformation,2 of tumor apoplexy,1 of cavernous hemangioma.After 2 weeks of conservative treatment,3 patients with grade D and 3 patients with grade E were assessed for spinal function.The average interval from onset to surgery was(9.4±7.5) days,the ASIA after two weeks of the operation was as follows:5 patients were assessed at grade A,5 patients at grade C,8 patients at grade D and 4 patients at grade E.28 patients were followed up for (48.7±23.1) months on average,6 patients without surgery were E,22 cases with surgery were as follows:4 cases A,18 cases D/E.Conclusions The etiology of spontaneous intraspinal hematoma is hard to define even after complete preoperative examination and exploratory operation.The preoperative neurologic functions are important predicting factors for the prognosis of spontaneous intraspinal hematoma.For patients who had neurologic function deficit,surgical treatment should be performed urgently to remove the hematoma and release the decompression of spinal cord.The majority of these patients can achieve a positive prognosis after surgery.

Objective To analyze the effect of clinical application of ultrasound in microsurgical treatment of intramedullary tumors in the superior cervical spinal cord.Methods Retrospective study the clinical data of 15 patients with intramedullary tumors in the superior cervical spinal cord,which were underwent a laminectomy for microsurgical tumor resection during January,2014 and January,2018.Intraoperative ultrasound and neuromonitoring was accompanied by the whole surgical procedure for each case.The follow-up data was collected by outpatient department visits and telephone interviews.Results All the described patients were performed with microscopic tumor resection by using intraoperative neurophysiological monitoring and ultrasound.The pathological diagnosis was ependymocytoma (n=8) and astrocytoma (n=7).Gross total resections comprised 86.7％ of cases (n=13),and subtotal resections 13.3％ (n=2).The neurological outcome was as follows:Mc-Cormick scale grade Ⅰ,10 patients;grade Ⅱ,3 patients;grade Ⅲ,1 patient;and grade Ⅳ 1 patient;Follow-up was applied for (19.2±7.6) months in 13 cases and 12.0 months in 2 cases.Compared to the preoperative period,66.6％ of patients recovered postoperatively,20.0％ improved,6.7％ remained without deficit and deterioration persisted in 6.7％.Conclusion The microscopic resection of tumors is the effective way to cure this disease.By using intraoperative neurophysiological monitoring and ultrasound,the complete tumor resection and the minimal spinal cord injury were certainly achieved.

Objective:To explore the clinical features, surgical treatments and treatment effects of children with skull defect.Methods:Sixty children with skull defect, admitted to our hospital from January 2010 to December 2020, were chosen in our study. These children were divided into encephalocele group ( n=28) and non-encephalocele group ( n=32) according to the imaging results (whether brain tissues were 1.5 cm higher than the bone window plane or not). The time and area of skull defect were compared between the two groups. Titanium mesh or polyether ether ketone material were used to repair the skull defect; 24 children without nerve fiber bundle distribution from encephalocele group underwent resection of the encephalocele tissues additionally. All children were followed up for 3-10 years in the outpatient department, and the prognoses of children from the two groups were evaluated by Glasgow Outcome Scale (GOS) one year after surgery. Results:As compared with the non-encephalocele group, children in the encephalocele group had significantly younger age accepted skull removal, significantly longer skull defect course, significantly higher incidence of epilepsy, significantly more common secondary changes in the brain tissues around the defect, but statistically smaller skull defect area ( P<0.05). There was no bleeding, severe edema, wound infection or cerebrospinal fluid leakage after surgery in both groups, and primary healing was achieved. In the encephalocele group, 16 children were complicated with epilepsy; 10 got complete seizure control, and 6 got seizure improvement. In the non-encephalocele group, 8 children were complicated with epilepsy; 6 got complete seizure control, and 2 got seizure improvement. Postoperative follow-up showed that GOS scores in the non-encephalocele group were significantly higher than those in encephalocele group ( P<0.05). Conclusion:As ompared with skull defect children without encephalocele, skull defect children with encephalocele have earlier defect age, longer course of disease, higher incidences of ventricular perforation malformation and epilepsy, and a relatively poorer prognosis.

This paper explored the curative effect of combined modality therapy and extended field radiotherapy for early-stage Hodgkin's Lymphoma. 104 cases of early-stage Hodgkin's Lymphoma from Jan 1987 to Dec 2010 in PLA Hospital 307 were retrospectively analyzed, including 76 cases in combined modality therapy group and 28 cases in extended field radiotherapy group, and the long-term efficacy and toxicity of two therapy modalities were evaluated. The results showed that the median survival time of 104 cases was 85.42 months, the complete remission rates of combined modality therapy and extended field radiotherapy groups were 72.4 and 71.4 respectively (P = 0.924); the overall response rates of combined modality therapy and extended field radiotherapy groups were 97.4 and 96.4 respectively (P = 0.779); the 5-year overall survival (OS) rates in the 2 groups were 89.5 and 89.1 respectively, and the 8-year OS rates of the 2 groups were 81.3 and 70.6. No statistical difference was found in above-mentioned 2 groups. Moreover, the 5-year progression free survival (PFS) rates of these 2 groups were 84.2 and 69.0 (P = 0.04), and 8-year PFS rates of these 2 groups were 80.0 and 55.5 (P = 0.04) respectively, the 5-year relapse rates of these 2 groups were 28.1 and 45.6 (P = 0.023) respectively. It is concluded that the combined modality therapy can raise the PFS rate and reduce the relapse rate as compared with extended field radiotherapy for early-stage Hodgkin's Lymphoma, but there is no difference in the overall survival rate between the 2 groups.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; Child ; Combined Modality Therapy ; Female ; Hodgkin Disease ; drug therapy ; radiotherapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Young Adult

BACKGROUNDRelapse happens frequently after allogeneic hematopoietic cell transplantation (allo-HCT) in the patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL). Detection of the minimal residual disease (MRD) before and after allo-HCT is associated with higher relapse rate. Early administration of imatinib after allo-HCT may prevent recurrent Ph(+) ALL. The aim of this study was to evaluate the safety and efficacy of imatinib in preventing hematological relapse when imatinib was administrated in the first 90 days after allo-HCT.

METHODSPatients with Ph(+) ALL that underwent allo-HCT were enrolled in a prospective study. A TaqMan-based real-time quantitative polymerase chain reaction (RQ-PCR) technique was used to detect the MRD (bcr-abl transcript levels). Imatinib therapy was initiated prior to 90 days after allo-HCT if the patient's absolute neutrophil count (ANC) was above 1.0 × 10(9)/L (without granulocyte colony-stimulating factor (G-CSF) administration) and the platelet count was greater than 50.0 × 10(9)/L, or if the bcr-abl transcript levels were elevated in two consecutive tests, or if the bcr-abl transcript levels were ≥ 10(-2) after the initial engraftment. The initial daily dose of imatinib was 400 mg/d for adults and 260 mg/m(2) for children (younger than 17 years). Imatinib was administered for at least 1 month and the bcr-abl TaqMan results were negative for 3 consecutive tests, or complete molecular remission (CR(mol)) was sustained for at least 3 months.

RESULTSFrom May 2005 to October 2008, 29 patients were enrolled in this study, of whom, 19 patients were male and 10 were female. The median age of the enrolled patients was 33 years (range 6 - 50 years). Imatinib therapy was started at a median time of 60 days (range 20 - 122 days) post HCT (only one patient started Imatinib therapy at 122nd day after HCT). Twenty-five adult patients could tolerate a dose of 300 - 400 mg/d of imatinib, and three children tolerated a dose of 260 mg×m(-2)×d(-1). Sixty-eight percent of the patients experienced various adverse events during imatinib therapy, hematological toxicity being the most common adverse event. The median duration of imatinib treatment was 3 months (range 7 days-18 months). During the median follow-up of 24 months (range 16.0 - 54.5 months), 3 out of 27 patients that could be evaluated for efficacy died from relapse. The 3-year probability of relapse for the evaluated patients was (11.3 ± 0.61)%. The relapse rates among the subgroup of positive and negative bcr-abl patients before allo-HCT were 13.6% and 0, respectively (P > 0.05). The relapse rates among the subgroups of bcr-abl positive and negative patients after allo-HCT were 20.0% and 5.9%, respectively (P > 0.05). The relapse rates among the patients in first complete remission (CR(1)) and second complete remission/non-remission (CR(2)/NR) before transplantation were 0 and 31.4%, respectively (P < 0.05). The 3-year probability of overall survival (OS) and disease-free survival (DFS) for the all enrolled patients were (75.3 ± 8.1)%. The 3-year probabilities for OS and DFS among the subgroup of patients in CR(1) and CR(2)/NR before transplantation were (87.7 ± 8.2)% and (54.6 ± 15.0)%, respectively (P < 0.05).

CONCLUSIONSAdministration of imatinib at a dose of 300 - 400 mg/d in the first 90 days after allo-HCT is feasible in Ph(+) ALL patients. With this treatment, bcr-abl positive patients before or after transplantation do not have a higher relapse rate after allo-HCT compared with the bcr-abl negative patients. Because of lower relapse rate and better OS and DFS, we recommend that Ph(+) ALL patients receive allo-HCT in CR₁.

Adolescent ; Adult ; Antineoplastic Agents ; administration & dosage ; therapeutic use ; Benzamides ; Child ; Drug Administration Schedule ; Female ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Imatinib Mesylate ; Male ; Middle Aged ; Piperazines ; administration & dosage ; therapeutic use ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; therapy ; Prospective Studies ; Pyrimidines ; administration & dosage ; therapeutic use ; Transplantation, Homologous ; methods ; Young Adult

OBJECTIVETo analyze the characteristics and the number of organs involved in acute graft-versus-host disease (aGVHD) among different donors of allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSClinical data were retrospectively analyzed in 289 patients received allo-HSCT in our hospital, between November 2007 and December 2008. Clinical features of the involved organs between different donors were compared.

RESULTSThe cumulative incidence of aGVHD was 57.4% (166/289), grades I-II and grades III-IV were 52.1% and 11.0%, respectively. Skin was involved in 116 (69.9%) of the total 166 cases, gut 97 (47.6%), and liver 25(15.1%). Organs involved in HLA-identical sibling transplantation and in haplo-identical ones were skin 19 (42.2%), gut 25 (55.6%), and liver 12 (26.7%), and 79 (80.2%), 54 (44.6%) and 13 (10.7%) respectively. More aGVHD involvements of skin were found in HLA haplo-identical HSCT than in HLA identical sibling HSCT (P = 0.000). The involvement of skin grade II was 8(17.8%) and 38.8% (P = 0.01), gut grade II was 22 (48.9%) and 36 (29.8%) (P = 0.028) in HLA identical sibling transplantation and in haploidentical HSCT, repectively. The incidences of aGVHD grades I to II and grade III to IV were 103 (62.0%) versus 12 (7.2%) in the single organ involved group, 37 (22.3%) versus 11 (6.6%) in the double organs involved group, and 0% versus 3 (1.8%) in the triple organs involved group.

CONCLUSIONThe percentage of aGVHD with skin involvement in haploidentical HSCT is significantly higher than that in HLA identical HSCT. There is a significant difference in mild skin or GI aGVHD between HLA matched and mismatched HSCT, but no difference in severe skin or GI aGVHD between the two groups. The percentage of severe aGVHD was higher if three organs were involved.

Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Retrospective Studies ; Siblings ; Tissue Donors ; Transplantation, Homologous

OBJECTIVETo investigate stress gastrointestinal bleeding in critically ill patients and its effect on the prognosis.

METHODSClinical data of 1148 critically ill patients consecutively admitted to Intensive Care Unit of East Campuses of Peking Union Medical College Hospital during 2008 were analyzed retrospectively. The main contents of investigation included morbility and mortality of stress gastrointestinal bleeding in critically ill patients and its relationship with multiple organ dysfunction.

RESULTSAmong the 1148 critically ill patients, organ dysfunction occurred in 254 cases, including 57 cases with shock, 124 with respiratory dysfunction, 46 with acute renal dysfunction, 192 with coagulation dysfunction and 40 with stress gastrointestinal bleeding. The patients with stress gastrointestinal bleeding took up 15.7% among organ dysfunction patients and 3.5% among critically ill patients. 97.5% stress gastrointestinal bleeding accompanied with other organ dysfunction. The mortality of stress gastrointestinal bleeding was 40.0%, which was higher than that of shock (28.1%), respiratory dysfunction (22.6%), renal dysfunction (30.4%) and coagulation dysfunction (13.5%) (all P<0.05). Binary Logistic regression analysis found that stress gastrointestinal bleeding was an independent risk factor associated with mortality (P<0.05).

CONCLUSIONThe patients with stress gastrointestinal bleeding usually have a poor prognosis.

Critical Illness ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; Humans ; Logistic Models ; Prognosis ; Retrospective Studies ; Stress Disorders, Traumatic, Acute ; complications