Objective With the improvement of technology and strategy , reduced field-of-view diffusion weighted imaging ( rFOV DWI) has provided more robust imaging .This article was intended to compare the clinical utility between rFOV DWI and con-ventional DWI in the diagnosis of prostate cancer . Methods Retrospective analysis was made on 58 prostate cancer patients under-going verification of biopsy or surgery after 3.0 T MRI rFOV DWI and regular DWI examinations in Nanjing General Hospital of Nan-jing Military Command from August 2014 to September 2015 , among whom prostate cancer and benign prostatic hyperplasia were 31 cases and 27 cases respectively .Independent grading was made by 2 radiol-ogists who were unaware of any clinical data and sequences in the as-pects of distortion on DW images , lesion conspicuity on DWI ( b=1000 ) and ADC images according to a 4-point Likert scale .rFOV and conventional DWI sequences were acquired using b =400,1000,0s/mm2.The IVIM double exponential model software was applied to generate ACD value, slow dispersive coefficient(D value) and parameterized image of volume fraction of fast dispersion (f value).Se-quence analysis was made in suspected peripheral tumor regions of prostate cancer patients and and healthy peripheral zones of patients with benign prostatic hyperplasia respectively to get ACD , D and f values .The ratio values rADC , rD and rf were attained compared with obturator internus .ROC analysis was made on the efficacy of different parameters of two sequences in prostate cancer . Results Image qualities of rFOV DWI were rated superior to conventional DWI (P<0.001,Wilcoxon Signed-Rank Test).Compared with con-ventional DWI, ADC value (0.728 ±0.094 vs 0.789 ±0.116, P<0.05)and D value(0.622 ±0.077 vs 0.651 ±0.099, P<0.05)of peripheral tumor regions in rFOV DWI were lower and the difference was statistically significant , whereas no significant difference was found in f value(P=0.932).No difference was found in area under ROC curve of f value between rFOV DWI and traditional DWI (0.853 vs 0.767, P=0.283). Conclusion The rFOV DWI sequence yielded can efficiently improve image quality , which is of important value to the clinical diagnosis of prostate cancer .

AIM:To establish the quality standard for Xuesaitong Granule(total saponins of Radix et Rhizoma Notoginseng). METHODS:The contents of notoginsenoside R1,ginsenoside Rg1 and Rb1 were determined on the Shim-Pack C 18 (250 mm?4.6 mm,5 ?m) column,with CH3CN—H2O gradual elution and monitored at 203 nm. RESULTS:The average recovery of notoginsenoside R1 was 100.0% (RSD=1.00%,n=6),the minimum detection quantity cannot be lower than 5% labelled weight. The average recovery of ginsenoside Rg1 was 99.8 % (RSD=0.47%,n=6),the minimum detection quantity cannot be lower than 20% labelled weight. The average recovery of ginsenoside Rb1 was 99.8% (RSD=0.79%,n=6),the minimum detection quantity cannot be lower than 30% labelled weight. CONCLUSION:The method is simple,reliable,accurate and can be applied to the quality control of Xuesaitong Granules.

Objective To investigate independent prognostic factors for overall survival (OS) in extensive disease small cell lung cancer (EDSCLC). Methods Between January 2003 and December 2006, 154 patients diagnosed with extensive stage small cell lung cancer were enrolled in this study.Prognostic factors such as gender, age, performance status, smoking history, weight loss, distant metastasis, the number of matastasis, brain metastasis, the cycle of chemotherapy and thoracic radiation therapy (TRT) for EDSCLC patients were evaluated by univariate and multivariate analysis. Results The median following-up time was 40. 5 months. The rate of follow-up was 92. 2%. The MST and overall survival rates at 3-year in smoking group and no-smoking group were 13 months, 11.8% and 17 months,22. 8%,respectively (χ2=3.40,P =0. 064);in ChT/TRT group and ChT group, they were 17. 2 months, 17.9%and 9.3 months,13.9%, respectively(χ2=10.47,P=0.001);and in the cycle of chemotherapy ≥4 group and ＜ 4 group, they were 16 months, 20. 1% and 9.3 months, 2. 9%, respectively (χ2=17.79,P=0. 000). By multivariate analysis, smoking history was a statistically significant unfavorable factor for OS in EDSCLC patients (versus no-smoking, hazard ratio (HR)=1.462, χ2=4.40, P=0.036). In addition, ≥4 cycles of chemotherapy and TRT were favorable prognostic factors ( ≥4 cycles vs ＜4 cycles, HR =0. 420,χ2 = 17. 17, P = 0. 000; ChT/TRT vs ChT, HR = 0. 634, χ2 = 6. 20, P = 0. 013). Conclusions Smoking is a independent unfavorable prognostic factor and ≥ 4 cycles of chemotherapy And TRT are independent favorable prognostic factors for OS in EDSCLC.

Objective:To compare the efficacy of a single injection of pegylated filgrastim with daily doses of filgrastim as pro-phylaxis for chemotherapy-induced neutropenia in Chinese cancer patients. Methods:Single-institution data from a phase 2 study and a phase 3 trial on pegylated filgrastim were combined to analyze the efficacy and safety parameters. In the two randomized crossover tri-als, patients with previously untreated cancers received two cycles of chemotherapy with identical regimen. In the study cycle, the pa-tients received a single subcutaneous injection of pegylated filgrastim (100 μg/kg), whereas those in the control cycle received daily subcutaneous injections of filgrastim (5μg/kg). Results:Among the 56 patients enrolled, 53 were evaluable for efficacy. These patients received one cycle with pegylated filgrastim prophylaxis and one cycle with filgrastim support each. Results indicated that 94.3%(50/53) of the cycles with pegylated filgrastim or filgrastim support did not develop grade 4 neutropenia. Moreover, febrile neutropenia did not occur in the cycles. The incidence rates of antibiotic administration were 7.5%(4/53) and 3.8%(2/53) in the pegylated filgrastim and filgrastim cycles, respectively (P=0.678). The median duration of filgrastim administration was 10 days (3-14 days). Generally, the safety profile of pegylated filgrastim is similar to that of filgrastim, including skeletal pain, pain at the injection site, palpitation, fever, and fatigue. Conclusion:A single dose of pegylated filgrastim demonstrated comparable efficacy with 10 consecutive doses of filgras-tim as prophylaxis for chemotherapy-induced neutropenia.

Objective To evaluate the efficacy and safety of sorafenib in the treatment of Chi-nese patients with metastatic renal cell carcinoma. Methods This muhicenter phase Ⅱ clinical trial was performed from May 2006 to December 2006. Sixty-two patients with metastatic renal cell carci-noma not suitable for curative treatment were enrolled. All patients received oral sorafenib as single a-gent at the dose of 400 mg twice a day until disease progression or intolerable toxicities occurred. Re-salts Partial responses were recorded as best response in 11 patients, while complete remission was found in 1 patient and stable diseases were found in another 35 patients. According to the intents-to-treatment population, the overall response rate was 19.4% (12/62), and the disease control rate was 77.4%(48/62). The median progression free survival time was 9.6 months with 1-year progression-free survival rate of 41.9%. However, the median survival time had not reached due to the short fol-low-up. The most frequent adverse events included alopecia (66.1%), diarrhea (62.9%), hand-foot syndrome (58.1%), anorexia (40.3%), rash(37.1%), fatigue (37.1%), hypertension (35.5%), hoarseness(32.3%), joint pain (25.8%), hypophosphatemia (21.0%), fever (19.4%), nausea (19.4%), abnormal transeaminase( 11.3% ), elevated total bilirubicin( 16.1% ), leucopenia( 12.9% ), bleeding under nail(16.1%), and gum bleeding(11.3%). Grade 3 adverse events included hand-foot syndrome (16.1%), hypertension (12.9%), diarrhea(6.5%), hypophosphatemia (4.8%), joint pain (3.2%), and leucopenia(3.2%). Conclusions Sorafenib has prominent anti-tumor activity in Chi-nese metastatic renal cell cancer patients with most adverse events being grade 1 or 2. More attention should be paid to hypertension and cardio-cerebral vascular events during the application of sorafenib.

Objective:Primary gastric diffuse large B-cell lymphoma (PGLBCL) is a highly common subtype of extranodal non-Hodgkin lymphoma. We analyzed the disease's clinical features and prognosis to guide better treatment. Methods:We retrospectively collect-ed data from PGLBCL cases seen from January 1999 to March 2012 in one cancer center. We then analyzed the demographic character-istics, clinical stage, histological diagnosis, complications, treatment, and prognostic characteristics of such patients. Results:A total of 126 patients with median age of 49 years old (range:16-81 years) were included in the study. The male-to-female ratio was 68:58. A to-tal of 96 patients were pathologically diagnosed with pure diffuse large B-cell lymphoma (DLBCL), 27 with mucosa-assouated lymphoid (MALT) component, and 3 with plasmacytoid differentiation. Meanwhile, 90%of the patients were in the early stage of the disease. For the early-stage patients, treatment strategy included surgery+chemotherapy ± radiotherapy for 38 cases, chemoradiotherapy for 39 cases, chemotherapy alone for 37 cases, and surgery alone for 1 case. Under a median follow up of 48 months, the 4-year progres-sion free survival (PFS) and overall ourvival (OS) rate of the whole group were 75.6%and 82.7%, respectively. PFS rates for early and advanced stage patients were 77%and 41.7%(P=0.005), respectively. For the early-stage patients treated with chemotherapy alone, chemoradiotherapy, and surgery with therapy, the PFS rates were 67.3%, 77.8%, and 77.8%(P=0.588), respectively. The patients with international prognostic index (IPI) score of 0, 1, and>1 achieved PFS of 85.4%, 74.4%, and 55.6%(P=0.011), respectively. The PFS rates were 81.2%and 66.1%(P=0.018) for stagesⅠandⅡ, respectively, and 86.6%and 63.3%(P=0.006) for the normal and elevated LDH levels, respectively. The pathological type of pure DLBCL or a MALT component, GCB or non-GCB origin, and age more than 60 years old were not associated with prognosis. Conclusion:The majority of the PGLBCL patients were in the early stage of disease, but the outcome of early-stage disease was favorable. Surgery did not improve outcomes. Univariate analysis demonstrated that IPI score>1, stageⅡdisease, and elevated LDH levels were associated with poor prognosis in the early-stage patient.

OBJECTIVETo detect the contaminating minimal residual disease (MRD) in autologous peripheral blood stem cells (APBSC) and evaluate its impact on the prognosis of non-Hodgkin's lymphoma NHL patients.

METHODSMinimal residual disease was detected in 72 APBSC samples from 33 NHL patients through PCR or PCR combined with DNA single-strand conformation polymorphism analysis (SSCP) with the BCL-2/IgH, clonal rearrangement of IgH and TCR gamma gene as markers. Minimal residual disease was also monitored in bone marrow samples collected pre-, post-induction chemotherapy and post-transplantation.

RESULTSMRD was positive in 17/72 (23.6%) APBSC samples. The incidence of positive MRD in bone marrow pre-, post-induction chemotherapy and post-transplantation was 44.0% (11/25), 28.1% (9/32) and 11.5% (3/26) respectively. Six (66.6%) of 9 patients with positive MRD in pre-mobilization bone marrow, compared with 2 (8.7%) of 23 patients with negative MRD in bone marrow, were positive in contamination (P < 0.01). The estimated overall 3-year post-transplantation survival rate for patients with positive and negative MRD in their APBSC would be 71.4% and 71.2% respectively, and the estimated 3-year disease free survival rates of 25.0% and 61.5% respectively (P = 0.53).

CONCLUSIONAPBSC collected from NHL patients after mobilization by chemotherapy combined with colony stimulating factor may be contaminated by lymphoma cells. The presence of minimal residual disease in bone marrow at mobilization may increase the incidence of APBSC contamination.

Adolescent ; Adult ; Child ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Lymphoma, Non-Hodgkin ; pathology ; therapy ; Male ; Middle Aged ; Neoplasm, Residual ; therapy ; Polymerase Chain Reaction ; Prognosis

Objective To evaluate the effect of continuous veno venous hemofiltration (CVVH) on neutrophil gelatinase associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI).Methods Critically ill patients with AKI who needed CVVH and admitted to Department of Critical Care Medicine of Peking Union Medical College Hospital were enrolled prospectively from January 2015 to June 2015.AN69 membrane filters were used for CVVH.Prefilter,postfilter,and plasma NGAL measurements were taken at 10 mins,4 hours and 8 hours (T 10 min,T 4 h,T 8 h) after CVVH.The influence of membrane filter and volume management on NGAL level was analyzed.Results Forty patients were recruited.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 22.9±7.0.The sequential organ failure score (SOFA) was 12.1±2.9,and ICU mortality was 27.5％.During CVVH,there were no significant differences in NGAL levels between prefilter [T 10 min:39.3 (24.8,62.4)μg/min;T 4 h:(45.1±23.2)μg/min;and T 8 h:(45.5±22.4)μg/min] and postfilter [T 10 min:33.5 (25.1,60.7)μg/min;T 4 h:(44.2±24.3)μg/min,and T 8 h:(45.9±22.4)μg/min] (P＞ 0.05 for all).Compared with the survival group[310.0(162.0,588.0) μg/L],plasma NGAL level in T 10 min [684.0(270.0,944.0) μg/L] was significantly higher in death group (P=0.033).After fluid balance correction,T 4 h [603.4(484.8,620.2) μg/L] and T 8 h [590.2(475.9,749.4) μg/L] plasma NGAL levels in death group were significantly higher than those in the survival group [T4 h:419.5 (227.5,552.4)μg/L;T 8 h:400.7(196.1,517.4) μg/L] with statistical significance (P＜0.01 for both).Conclusions During CVVH,AN69 membrane filter does not have significant effect on plasma NGAL level in critically ill patients with AKI.After volume balance correction,plasma NGAL level could be used as an effective indicator in these patients.

OBJECTIVETo analyze the clinical features, therapeutic outcome and prognostic factors of mantle cell lymphoma (MCL).

METHODSClinical data of a total of 68 patients with MCL admitted from August 2003 to June 2013 in our department were retrospectively analyzed.

RESULTSOf all the patients, the median age was 58.5 years, with marked male predominance (2.8:1), 59 patients (86.8%) were in Ann Arbor stage III/IV. 56 cases (82.4%) primarily showed lymph node involvement, 49 cased showed extranodal involvement and 19 cases (38.8%) had bone marrow involvement. Patients were followed up for 4 to 122 months with a median follow up time of 35 months. The 3- and 5-year overall survival (OS) rates were 78.5% and 64.1%, respectively. The 2- and 3-year progression-free survival (PFS) rates were 41.3% and 23.7%, respectively, and the median time to progression was 20.0 months. The overall response rate (ORR) of CHOP regimen was superior to that of intense regimens (P = 0.036). Univariate analysis showed that stage III/IV,IPI score of 3-5, expression of Ki-67 higher than 30%, elevated LDH, elevated β2-MG, blastic variant, more than 5 lymph nodes involved, and failure to chemotherapy were the negative factors. Multivariate analysis showed that Ki-67 index, LDH and the response to chemotherapy were independent factors affecting survival.

CONCLUSIONSMost patients with MCL were elderly males with advanced stage and usually had bone marrow involvement. Although ORR of CHOP regimen is superior to intense regimens, the prognosis of MCL remains poor.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; Cyclophosphamide ; Disease Progression ; Disease-Free Survival ; Doxorubicin ; Female ; Humans ; Lymphoma, Mantle-Cell ; diagnosis ; Male ; Middle Aged ; Multivariate Analysis ; Prednisolone ; Prognosis ; Retrospective Studies ; Survival Rate ; Vincristine

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.