Objective To determine the correlation between central macular thickness (CMT) and the visual function in patients iwht macular edema (ME). Methods The clinical data of 42 eyes of 40 patients with ME which were examined by optical coherence tomography (OCT) and microperimetry (MP-1) wereretrospectively analyzed. In 40 patients (42 eyes), diabetic ME (DME) was in 27 eyes,branch retinal vein occlusion was in 11eyes, and central retinal vein occlusion was in 4 eyes. All of the eyes had undergone OCT,MP-1 and best-corrected visual acuity (BCVA) test. Central macular thickness (CMT) was measured by fast macular scans using OCT. Retinal sensitivity (MS) and fixation patterns were evaluated by Mp-1.The position was chosen :2 disc diameters (DD) temporal to the disc and one third of a DD inferior to the centre of the disc. Results The correlation between CMT and BCVA is not significant (r=-0. 429, P=0. 069) as well as the correlation between CMT and MS (r=-0. 433,P=0. 058). The difference of CMT between the unstable and stable group was significant (F = 3. 262, P = 0. 039). The difference of CMT between the central fixation group and preferred retinal locus (PRL) group was significant (F=3. 173,P=0. 044). Conclusions BCVA and MS have no significant correlation with CMT. When CMT increases, the fixation stability decreases, fixation location, changes, and PRL occurs.

The use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in the treatment of sensitive EGFR mutation in non-small cell lung cancer(NSCLC)has been proved significant curative effect.However,the ac-quisition of the drug resistance to EGFR-TKIs is almost inevitable, and common drug resistance mechanisms include T790M mutation,cMET amplification,etc.One of the rare resistance mechanisms of EGFR-TKIs is the transformation from NSCLC into small cell lung cancer (SCLC), which account for about 3%-15%. It is an important rare drug resistance mechanism which is not well understood. Therefore, it is necessary to review the present situation and the progress of the this drug resistance mechanism. This article summarizes these hypothesizes from two parts, which are respectively the "common origin" and"transformation time node". At present, two possible mechanisms of this kind of transformation has been proposed, which are respectively the hypothesis of the tumor heterogeneity and the hypothesis of the transformation from NSCLC into SCLC. This article also involves a lot of changes in the level of molecules,such as the lack of RB1 gene,the inactivation of P53 gene and the mutation of PTEN M264I gene,etc.At the same time,this article summarizes the characteristics,the diagnostic methods and the treatment strategy of this kind of transformation. There are still many problems which need further research and resolution.

Objective:To investigate the characteristics of computed tomography(CT) and magnetic resonance imaging(MRI)of focal peliosis hepatis (PH).Methods:From January 1, 2015 to December 31, 2022, a total of 8 PH patients (10 lesions) diagnosed pathologically in Yueqing People′s Hospital were collected. The location, size, and shape of the lesions, as well as the CT (4 patients with 4 lesions) and MRI (5 patients with 7 lesions) characteristics of the patients were analyzed. Descriptive method was used for statistical analysis.Results:Among the 8 PH patients, 6 patients had lesions located in the right lobe of the liver, 1 in the left lobe of the liver, and 1 (3 lesions) in both left and right lobes of the liver. Eight lesions were round or round-like, and 2 lesions were irregularly shaped. The median maximum diameter of the lesions was 4.2 cm (ranged from 2.2 to 9.3 cm), of which the maximum diameters of 2 lesions were less than 3.0 cm, those of 6 lesions were 3.1 to 5.0 cm, and those of 2 lesions were more than 6.0 cm. Nine lesions had clear boundaries, and 1 lesion had blurred boundary; 9 lesions had capsule, 1 lesion had no capsule; 1 lesion had blood vessels passing through it. The CT plain scan of 4 patients (4 lesions) showed that 3 lesions had uniform density and 3 lesions had low density, the CT enhancement showed that 2 lesions were significantly enhanced in the arterial phase, 3 lesions were sustained moderately enhanced in the portal phase, and 2 lesions were sustained mildly enhanced in the delayed phase. The MRI plain scan of 5 patients (7 lesions) showed uniform signals in 6 lesions, low signal in 3 lesions and equal signal in 4 lesions on T1-weighted images, high signal in 6 lesions on T2-weighted images, high signal in 3 lesions and equal signal in 4 lesions on diffusion-weighted images. The MRI enhancement showed that 4 lesions were significantly enhanced in the arterial phase, 5 lesions were sustained moderately enhanced in the portal phase, and 6 lesions showed sustained mild enhanced in the delayed phase.Conclusion:The PH lesions are round or round-like, with clear or unclear boundaries and uniform or uneven density, and are characterised by low density on CT and MRI plain scan, low signal on T1-weighted images, and high signal on T2-weighted images and diffusion-weighted images, and moderate or significant sustained enhancement on CT and MRI enhancement.

Levetiracetam (LEV) is the second generation of broad-spectrum antiepileptic drugs. Compared with other antiepileptic drugs, LEV has unique antiepileptic mechanism, good efficacy and tolerance, and its target is synaptic vesicle protein 2A. With the widespread use of LEV, more and more adverse reactions have been reported, especially mental related adverse reactions. This paper reviewed the research progress of LEV pharmacogenomics related targets, metabolism, adverse reaction related genetic variation and efficacy prediction, so as to provide decision-making for the application of LEV individualized treatment in clinical practice, improve the quality of life of epileptic patients and reduce the disease burden of patients with epilepsy.

OBJECTIVETo investigate the efficacy of liposomal doxorubicin together with etoposide and high dose methylprednisolone (DEP) as a salvage therapy for adult refractory hemophagocytic lymphohistiocytosis (HLH).

METHODSTotal 41 patients with refractory HLH were enrolled in this study. The efficacy of treatment with DEP regimen after 2 and 4 weeks were evaluated according to the United States Midwest Cooperative HLH Group.

RESULTSOf 41 refractory HLH patients, 28 were males and 13 females. The median age was 31(18-62) years old. The overall response rate (ORR) was 78.1%(32/41), including 12 patients (29.3%) achieved complete remission (CR) and 20 (48.8%) achieved partial remission (PR). The underlying disease of HLH were identified in 33 patients, including 1 case of primary HLH (CR), 20 cases of lymphoma associated HLH and 12 cases of EBV associated HLH. There were still 8 cases with unknown underlying disease. The 9 patients who had no response to DEP died within 2 to 4 weeks after salvage therapy. Twenty of the 32 patients who achieved PR or CR survived to undergo subsequent chemotherapy, allogenic hematopoietic stem cell transplantation (allo-HSCT) or splenectomy.

CONCLUSIONThe single-arm study suggested that DEP regimen appeared to be an effective salvage protocol for adult patients with refractory HLH.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Cisplatin ; administration & dosage ; Etoposide ; administration & dosage ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Lymphohistiocytosis, Hemophagocytic ; drug therapy ; Male ; Middle Aged ; Prednisone ; administration & dosage ; Remission Induction ; Salvage Therapy ; Young Adult

OBJECTIVETo analyze the clinical manifestations, laboratory data, therapy, and prognosis in patients with hemophagocytic lymphohistiocytosis (HLH).

METHODSA retrospective study was carried out in 192 adult patients with HLH between 2003 and 2013.

RESULTSOf the 192 cases, 70 cases were secondary to cancer and 64 cases secondary to infection. According to HLH-2004 criteria, the coincidence rate of indices were: fever (98.96%), high level of serum ferritin (94.27%), increased level of soluble interleukin- 2 receptor(sCD25) (94.79%), decreased or absent activity of NK cells (94.27%), cytopenias (80.73%), splenomegaly (80.21%), emophagocytosis in bone marrow, spleen or lymph nodes (74.48%), hypofibrinogenemia (50.52%), hypertriglyceridemia (37.50%). In addition, 94.27% of patients were presented with liver dysfunction, 96.35% with infections, and 75.52% with coagulopathy. Incidences of central nervous system symptoms and rash were 19.27% and 20.31%, respectively. Among cancer, infection and rheumatic group, there were statistically differences on white blood cells (WBC), platelet (PLT), sCD25, alanine aminotransferase, aspartate aminotransferase, total bilirubin and globulin(GLO) (P<0.05). The differences of WBC, PLT, albumin (ALB), GLO, brain natriuretic peptide, creatinine, urea nitrogen between survival group and death group had statistical significance.

CONCLUSIONThe secondary HLH occurs from various underlined diseases. Cancer, especially T- cell lymphoma, is the main cause, Secondly, it is EB virus infection. The diagnostic sensitive indicators are Persistent fever, higher level of serum ferritin, low or absent NK-cell activity, and increased sCD25 were the most valuable parameters for diagnosis. Cytopenias were not common in early phase of HLH secondary to rheumatic diseases. WBC, PLT, ALB, GLO could be used as the preliminary parameters for diagnosis. Cardiac insufficiency, renal insufficiency and coagulation dysfunction play important roles in prognosis.

Adult ; Bone Marrow ; Fever ; Humans ; Killer Cells, Natural ; Lymphohistiocytosis, Hemophagocytic ; Prognosis ; Retrospective Studies

OBJECTIVETo investigate the outcomes, survival status, and the prognostic factors of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) patients.

METHODSA retrospective study was carried out to analyze the clinical data of 61 EBV-HLH cases, from January 2008 to July 2014. Prognostic factors were analyzed through COX model (single factor and multiple factors).

RESULTSA total of 246 patients with HLH were diagnosed, among which 102 cases were with EBV infection (including 61 EBV-HLH, 36 lymphoma associated HLH, 5 primary HLH. Among the 61 cases, 40 were male and 21 were female, with a ration of 1.9:1. The median age was 28 years (range, 12-78). 1, 3, 6 and 12-month overall survival rates of 61 EBV-HLH were 65.6%, 47.5%, 32.4%, and 25.0%, respectively. The median follow-up time was 3 (0.5-28) months. 12 patients didn't use etoposide within 4 weeks after diagnosis, while HLH-94 protocol was used in 33 patients and HLH-2004 protocol was used in 16 patients. Response rates of theses three groups were 33.3%, 51.5%, and 43.8%, respectively (P=0.401). There was statistically difference between the group without etoposide and the HLH-94/ HLH-2004 group in the overall survival rate (P=0.033). Serum albumin level (P=0.033) and whether EBV could became negative (P=0.010) were independent predictors for EBV-HLH.

CONCLUSIONEBV-HLH patients have severe clinical feature and poor prognosis. Early application of immune chemotherapy based on etoposide can improve survival. Serum albumin level and whether EBV can become negative are independent prognostic factors for survival.

Adolescent ; Adult ; Aged ; Child ; Epstein-Barr Virus Infections ; Etoposide ; Female ; Herpesvirus 4, Human ; Humans ; Lymphohistiocytosis, Hemophagocytic ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Young Adult