Objective To investigate HR-MR imaging characteristics of non-Hodgkin lymphomas (NHL) of the orbits in extraconal compartment. Methods The HR-MR images of 16 patients with NHL of the orbits identified pathologically were retrospectively analyzed. MRI of the orbit at a 1.5 T scanner was performed with 4-cm surface coil, thin slice, suitable bandwidth, small FOV, and large matrix. T1-weighted (before and after i.v. bolus injection of contrast medium) and fast spin-echo T2-weighted sequences were acquired in all patients. All cases were performed with fat suppression techniques. The analyzed criteria of imaging appearance included location, number, size, shape, margins, extension, adjacent structures, and signal intensity of the lesions. Results The lesions in 13 of 16 cases located in anterior part of extraconal compartment, posterior to the orbital septum, and with irregular cast shape. The other 3 patients showed diffuse lesions with infiltration in extraconal compartment and with irregular shape. Eleven lesions had the large volume above 3.0 ml, 4 lesions with medium volume ranging from 1.0 to 3.0 ml, and only one with small volume less than 1.0 ml. 13 cases had a poor-defined margin with infiltration of extraocular muscles, but without mechanical shift of the muscles. 7 patients had infiltration of eyeball, but only 3 cases with exophthalmos. Destruction of orbital bone was evident in 2 cases with diffuse lesions but never in isolated orbital lymphoma. On the T_1-weighted images, the signal intensity of the lymphoma was isointense compared with that of the muscle in all patients. The T_2-weighted fast SE images showed a hyperintense signal in 13 cases and intermediate in 3 cases. All lesions enhanced after intravenous Gd-DTPA administration, 15 cases with homogeneous enhancement, and 10 cases with reliably visible enhancement in the T_1-weighted fat-suppressed sequences. Conclusion Most NHL of the orbits in extraconal compartment have the characteristic findings on HR-MR imaging, including anterior part of extraconal compartment location, posterior to the orbital septum, irregular cast shape, large volume, poor-defined margin with infiltration but without mechanical shift of extraocular muscles, uniform signal characteristics and marked enhancement after injection of contrast medium, and without bony destruction in isolated orbital lymphoma. The understanding of HR-MRI features of orbital NHL in extraconal compartment is very useful for making the differential diagnosis with other orbital diseases.

OBJECTIVETo explore the value of the technique of multiplex fluorescence in sit hybridization (M-FISH) combined with interphase fluorescence in situ hybridization (FISH) in the identification of the chromosomal aberrations in multiple myeloma (MM) and to investigate the frequency of 13q14 deletion, IgH translocations and 17p13 deletion.

METHODSSeven MM patients with complex chromosomal abnormalities (CCAs) were analyzed by combining the technique of conventional cytogenetics (CC) with M-FISH and FISH.

RESULTSM-FISH identified the aberrations which were undetected by CC, including twelve kinds of numeral aberrations and twenty-nine kinds of structural aberrations, In addition, abnormalities of chromosome 1, chromosomes 13 deletion and IgH translocations were the most frequent aberrations. Using the LSI D13S319 probe specific for 13q14, we observed a deletion of 13q14 in 6 MM patients; using the LSI p53 probe specific for 17p13, we observed p53 deletion in 4 MM patients; using the LSI IGHC/IGHV probe specific for 14q32, we observed a translocation involving 14q32 in 5 MM patients (43.5%), two translocations in two cases (case 6 and 7).

CONCLUSIONM-FISH combined with FISH could refine the cytogenetics of MM patients and detect the missed abnormalities or correct the misidentified abnormalities analyzed by CC. It provides an ideal method for the research of chromosomal aberrations in MM.

Adult ; Aged ; Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Human, Pair 1 ; Chromosomes, Human, Pair 13 ; Female ; Humans ; Immunoglobulin Heavy Chains ; In Situ Hybridization, Fluorescence ; methods ; Karyotyping ; Male ; Middle Aged ; Multiple Myeloma ; genetics ; Translocation, Genetic

OBJECTIVETo determine the effect of proton pump inhibitor (PPI) on in-stent restenosis (ISR) in patients receiving clopidogrel therapy.

METHODSTotal 439 patients underwent percutaneous coronary intervention (PCI) were enrolled in the study,including 250 post-PCI patients discharged on clopidogrel alone and 189 patients discharged on clopidogrel with PPI. The in-stent restenosis (ISR) ratio of the patients in these two groups were observed.

RESULTSDuring a mean follow-up period of (13 ± 5.9) months, the post-PCI patients discharged on concomitant clopidogrel-PPI therapy had higher risk of ISR than those discharged on clopidogrel alone (19.6% Compared with 8%, P<0.001).

CONCLUSIONConcomitant use of clopidogrel and PPI after hospital discharge would increase the risk of ISR for post-PCI patients.

Angioplasty, Balloon, Coronary ; Coronary Restenosis ; etiology ; Drug Antagonism ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Platelet Aggregation Inhibitors ; therapeutic use ; Proton Pump Inhibitors ; therapeutic use ; Retrospective Studies ; Risk ; Stents ; Ticlopidine ; analogs & derivatives ; therapeutic use

BACKGROUNDThe gender difference on long-term outcome in unselected patients after percutaneous coronary intervention (PCI) has not yet been fully investigated. This study aimed to evaluate the gender difference on five-year outcomes following EXCEL biodegradable polymer-coated sirolimus-eluting stenting in patients with coronary disease.

METHODSA total of 2077 "all comers", consisting of 1528 (73.6%) men and 549 (26.4%) women, who were exclusively treated with EXCEL coronary stents were enrolled in the prospective CREATE study at 59 centers from four countries. After propensity score matching, the baseline characteristics of the two groups were well matched. Recommended antiplatelet regimen was clopidogrel and aspirin for six months followed by chronic aspirin therapy. The primary outcome that was the rate of major adverse cardiac events (MACE), defined as a composite of cardiac mortality, non-fatal myocardial infarction (MI) and target lesion revascularization (TLR), and stent thrombosis (ST) at five years were compared between the two gender groups.

RESULTSIn the two groups, women had higher proportions of clinical risk factors, such as being elderly, diabetes mellitus, hypertension and hyperlipidemia, compared to men. Besides, the mean target vessel number per patient was higher and the mean reference vessel diameter smaller for women. Men had higher risks of cardiac death (3.7% vs. 1.6%, P = 0.021) and MACE (8.4% vs. 4.7%, P = 0.004) at five years compared with women. However, the cumulative hazards of non-fatal MI and TLR were similar between men and women. The incidence of Academic Research Consortium (ARC) definite or probable stent thrombosis was similar between the two groups (1.3% vs. 1.0%, P = 0.639). Prolonged clopidogrel therapy (>6 months) did not reduce the cumulative hazards of ST from six months to five years in both men (χ(2) = 0.098, log rank P = 0.754) and women (χ(2) = 2.043, log rank P = 0.153) patients.

CONCLUSIONSWomen had a lower MACE and cardiac death rate than men after biodegradable polymer-coated sirolimus-eluting stenting in long term follow-up. Effects of prolonged dual antiplatelet therapy (DAPT) in preventing stent thrombosis was similar with six-month DAPT after EXCEL stent implantation in both men and women groups.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Polymers ; chemistry ; Prospective Studies ; Sex Factors ; Sirolimus ; therapeutic use ; Treatment Outcome

Objective To better understand the characteristics of spatial distribution of malaria epidemics in Hainan province and to explore the relationship between malaria epidemics and environmental factors, as well to develop prediction model on malaria epidemics. Methods Data on Malaria and meteorological factors were collected in all 19 counties in Hainan province from May to Oct. , 2000, and the proportion of land use types of these counties in this period were extracted from digital map of land use in Hainan province. Land surface temperatures (LST)were extracted from MODIS images and elevations of these counties were extracted from DEM of Hainan province. The coefficients of correlation of malaria incidences and these environmental factors were then calculated with SPSS 13.0, and negative binomial regression analysis were done using SAS 9.0. Results The incidence of malaria showed (1) positive correlations to elevation, proportion of forest land area and grassland area; (2) negative correlations to the proportion of cultivated area, urban and rural residents and to industrial enterprise area, LST; (3) no correlations to meteorological factors, proportion of water area, and unemployed land area. The prediction model of malaria which came from negative binomial regression analysis was: Ⅰ(monthly, unit:1/1 000 000) = exp( - 1. 672 - 0. 399 × LST). Conclusion Spatial distribution of malaria epidemics was associated with some environmental factors, and prediction model of malaria epidemic could be developed with indexes which extracted from satellite remote sensing images.

Objective To study the clinical characters,management and the prognosis of patients with adenoid cystic carcinoma of the maxillary sinus. Methods The clinical data were analyzed retrospectively for 36 patients with adenoid cystic carcinoma of the maxillary sinus to evaluate the treatment results of different modalities. The contribution of every factors influencing on survival were also analyzed.Survival analysis was performed by life table method,comparison among/between groups was performed using log-rank test,and multivariate analysis was carried out using Cox proportional hazard model. Results The 5-year survival rate was 58.33% in all patients, while they were only 75.0% and 42.9% in stage Ⅲ and stage Ⅳ lesions respectively. The 5-year survival rate of 66.7% was obtained in patients who received surgery combined with radiotherapy, 71.4% and 12.5% respectively in those treated by surgery and by radiotherapy alone. Multivariate analysis indicated that stage, treatment modality,and the tumour residues in the primary treatment were the predict factors for the prognosis. Conclusions Advanced adenoid cystic carcinoma should be treated by combined surgery and radiotherapy. Stage,treatment approach and shortterm therapeutic response are the most important factors affecting the prognosis of the patients with adenoid cystic carcinoma of the maxillary sinus.

OBJECTIVETo study the clinical characteristics of ecotopic viral integration site-1 (EVI1) and BCR/ABL positive childhood leukemia.

METHODSClinical data of four children with EVI1 and BCR/ABL positive leukemia and eight children with BCR/ABL positive but EVI1 negative chronic myeloid leukemia (CML) were retrospectively analyzed.

RESULTSIn the four children with EVI1 and BCR/ABL positive leukemia, two were initially diagnosed with chronic phase of CML, one with accelerated phase of CML and one with high-risk acute lymphoblastic leukemia (ALL). There were no significant differences in clinical characteristics at diagnosis between the patients with EVI1 and BCR/ABL positive leukemia and BCR/ABL positive but EVI1 negative leukemia. CD33 and CD38 were highly expressed and t(9;22) abnormality was present in all patients with EVI1 and BCR/ABL positive leukemia. Two of the 3 children with EVI1 and BCR/ABL positive CML achieved complete remission one or three months after treatment. Acquired negative status conversion occurred for EVI1 but not BCR/ABL in one CML case. The 3 children with EVI1 and BCR/ABL positive CML survived 20, 13 and 14 months, respectively, without recurrence. The child with EVI1 and BCR/ABL positive ALL failed to achieve complete remission after the first course of treatment and discontinued further treatment.

CONCLUSIONSCo-expression of EVI1 and BCR/ABL fusion gene can be found in childhood CML and ALL. The relatively rare leukemia has not significant difference respect to clinical characteristics. Prognosis of the disease needs to be determined by clinical studies with a larger sample size.

Child ; DNA-Binding Proteins ; genetics ; Female ; Genes, abl ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; genetics ; MDS1 and EVI1 Complex Locus Protein ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; Prognosis ; Proto-Oncogenes ; genetics ; Retrospective Studies ; Transcription Factors ; genetics

OBJECTIVETo study the expression of ecotropic viral integration site (EVI1) gene in childhood acute myeloid leukemia (AML) and the clinical features of EVI1-positive children with AML.

METHODSThe clinical data of EVI1-positive children with AML were collected and analyzed. RT-PCR and real-time quantitative PCR were used for qualitative and quantitative analysis of expression of EVI1. Flow cytometry (FCM) was used for determining the immunophenotypes of bone marrow cells. Multiparameter FCM was used for monitoring minimal residual disease. The karyotypes were determined.

RESULTSOf 241 children with AML, 33 (13.7%) were positive for EVI1 expression. There were no significant differences in age at first visit as well as the white blood cell count, hemoglobin level, and platelet count in peripheral blood between EVI1-positive and EVI1-negative children with AML (P>0.05), but EVI1-positive children had a significantly increased proportion of females compared with EVI1-negative children (P<0.05). The change in EVI1 expression was not synchronous with clinical remission and the change of MRD: some children had clinical remission or negative conversion of MRD before negative conversion of EVI1, while some had negative conversion of EVI1 before clinical remission or while MRD showed positive. EVI1 gene was usually co-expressed with other fusion genes. CD33 (100%), CD38 (88%), and HLADR (76%) were highly expressed in EVI1-positive children with AML. Abnormal chromosome structure or number was found in 15 patients. Compared with EVI1-negative children, EVI1-positive children had significantly lower complete remission rates after the first course of treatment (P<0.05).

CONCLUSIONSEVI1-positive children with AML have a poor short-term prognosis. In the development of AML, the activation of EVI1 gene is not isolated, but the result of interactions with other genes or chromosome abnormalities, and the mechanism of activation and its function need further study.

Adolescent ; Child ; Child, Preschool ; Chromosome Aberrations ; DNA-Binding Proteins ; genetics ; Female ; Flow Cytometry ; Gene Expression Regulation, Neoplastic ; Humans ; Immunophenotyping ; Infant ; Leukemia, Myeloid, Acute ; genetics ; immunology ; MDS1 and EVI1 Complex Locus Protein ; Male ; Neoplasm, Residual ; Prognosis ; Proto-Oncogenes ; genetics ; Transcription Factors ; genetics

OBJECTIVETo investigate viral relapse and the associated risk factors during a long-term follow-up study of chronic hepatitis C (CHC) patients who achieved end-of-treatment response (ETR) after interferon and ribavirin therapy.

METHODSThis retrospective study was conducted on 146 CHC patients treated with a combination of ribavirin and pegylated (PEG) interferon-alpha (IFNa) (n=126) or conventional IFNa (n=20) for 24 (hepatitis C virus (HCV) non-genotype 1b) or 48 (HCV genotype 1b) weeks. The main outcome measure was serum HCV RNA load. The risk factors analyzed included age, sex, HCV genotype, baseline HCV RNA load, and IFN type.

RESULTSThe mean follow-up time for all patients was 33.45+/-16.41 months (range: 12-85 months). The cumulative relapse rate during follow-up was 14.80%. The relapse rate within six months (8.90%) was significantly higher than other periods during two years of follow-up, and no relapse occurred after 30 months. Of all relapsers (n=20), 65% occurred within six months, followed by 35% within 7-24 months after antiviral therapy. The relapse rates in patients with HCV genotype 1b and non-1b were not significantly different (20.37% vs. 12.12%, X2 =1.517, P=0.315). The mean baseline HCV RNA load was significantly higher in the relapsers than that in the non-relapsers (t=0.915, P=0.362). Relapse rates were similar in patients treated with PEG-IFNa-2b, PEG-IFNa-2a and IFNa (12.12% vs. 13.97% vs. 15.00%, respectively; X2=0.104, p=0.949). The mean age of relapsers was significantly higher than that of non-relapsers (P less than 0.005).

CONCLUSIONThe maximum probability of relapse for CHC patients exists within six months from when ETR is achieved by interferon and ribavirin therapy. A lower risk for relapse persists past this period. Thus, ETR CHC patients, especially older patients, should be carefully monitored during the two years after cessation of antiviral therapy. Standard antiviral therapy based on HCV genotype eliminates the influence of viral factors on treatment-response.

Adolescent ; Adult ; Aged ; Antiviral Agents ; therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis C, Chronic ; drug therapy ; pathology ; virology ; Humans ; Interferon-alpha ; therapeutic use ; Middle Aged ; Polyethylene Glycols ; therapeutic use ; RNA, Viral ; Recurrence ; Retrospective Studies ; Ribavirin ; therapeutic use ; Treatment Outcome ; Young Adult

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.
Humans ; Mesentery/surgery* ; Digestive System Surgical Procedures ; Fascia/anatomy & histology*