Objective:This study retrospectively analyzed the clinical characteristics of patients newly diagnosed with acute myeloid leukemia (AML) who were admitted to the hematology intensive care unit (HCU) with critical illness. It also examined factors associated with critical illness and early mortality in these patients.Methods:Clinical data were collected from 91 newly diagnosed AML patients admitted to the HCU of the Department of Hematology, First Affiliated Hospital of Soochow University, from October 2020 to 2024. Reasons for HCU admission, major therapeutic interventions, and risk factors for critical illness and early mortality were analyzed.Results:The median time from diagnosis to HCU admission was 3 days ( IQR: 3–9 days), and the median HCU stay was 10 days ( IQR: 3–23 days). Of the 91 patients, 71 were admitted to the HCU before induction chemotherapy, while 20 were transferred to the HCU after its initiation. The leading causes of HCU admission were pulmonary infection (78.0% ), respiratory failure (44.0% ), hepatic insufficiency (28.6% ), renal insufficiency (27.5% ), disseminated intravascular coagulation (DIC; 25.3% ), and sepsis (23.1% ). Median Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and SOFA scores at HCU admission were 14 ( IQR: 11–18) and the median Sepsis Related Organ Failure Assessment (SOFA) score was 7 ( IQR: 4, 10). Major HCU interventions included vasoactive drugs, noninvasive and invasive mechanical ventilation, continuous renal replacement therapy, therapeutic leukocyte clearance, and cardiopulmonary resuscitation. Among patients receiving induction chemotherapy, the composite complete remission rate was 65.4%, and the overall remission rate was 88.5%. Thirty-five (38.5% ) patients died within 28 days of HCU admission. Independent risk factors for 28-day mortality were DIC ( OR=9.350, 95% CI 1.999–43.745, P=0.005), sepsis ( OR=6.817, 95% CI 1.571–29.582, P=0.010), and cardiac insufficiency ( OR=12.281, 95% CI 2.385–63.254, P=0.003) . Conclusion:The main reason for HCU admission in newly diagnosed critically ill AML patients was pulmonary infection. Nearly 40% of patients experisenced early death, and DIC, sepsis, and heart failure were factors influencing early mortatlity.

This report presents the management of a critically ill 36-year-old woman diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph +ALL) at 28 weeks of gestation. The patient rapidly deteriorated, developing disseminated intravascular coagulation (DIC) , diffuse alveolar hemorrhage (DAH) , septic shock, and multi-organ dysfunction, necessitating admission to the hematological intensive care unit. Given her critical condition and advanced pregnancy, a chemotherapy-free induction regimen comprising imatinib and dexamethasone was initiated, alongside comprehensive supportive measures, including mechanical ventilation, continuous renal replacement therapy (CRRT) , broad-spectrum antibiotics, and high-dose corticosteroids. During treatment, intrauterine fetal demise occurred, and a stillborn was delivered following obstetric intervention. With aggressive treatment, the patient's respiratory failure, DIC, and DAH gradually resolved, and she achieved complete remission. She subsequently received consolidation chemotherapy, CAR-T cell therapy, and allogeneic hematopoietic stem cell transplantation, achieving sustained complete molecular remission on long-term follow-up. This case demonstrates that for critically ill pregnant patients with Ph + ALL, a chemotherapy-free regimen of targeted therapy and corticosteroids, when combined with intensive supportive care, is a safe and effective approach that may offer a therapeutic option for similar cases.

Objective:This study retrospectively analyzed the clinical characteristics of patients newly diagnosed with acute myeloid leukemia (AML) who were admitted to the hematology intensive care unit (HCU) with critical illness. It also examined factors associated with critical illness and early mortality in these patients.Methods:Clinical data were collected from 91 newly diagnosed AML patients admitted to the HCU of the Department of Hematology, First Affiliated Hospital of Soochow University, from October 2020 to 2024. Reasons for HCU admission, major therapeutic interventions, and risk factors for critical illness and early mortality were analyzed.Results:The median time from diagnosis to HCU admission was 3 days ( IQR: 3–9 days), and the median HCU stay was 10 days ( IQR: 3–23 days). Of the 91 patients, 71 were admitted to the HCU before induction chemotherapy, while 20 were transferred to the HCU after its initiation. The leading causes of HCU admission were pulmonary infection (78.0% ), respiratory failure (44.0% ), hepatic insufficiency (28.6% ), renal insufficiency (27.5% ), disseminated intravascular coagulation (DIC; 25.3% ), and sepsis (23.1% ). Median Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and SOFA scores at HCU admission were 14 ( IQR: 11–18) and the median Sepsis Related Organ Failure Assessment (SOFA) score was 7 ( IQR: 4, 10). Major HCU interventions included vasoactive drugs, noninvasive and invasive mechanical ventilation, continuous renal replacement therapy, therapeutic leukocyte clearance, and cardiopulmonary resuscitation. Among patients receiving induction chemotherapy, the composite complete remission rate was 65.4%, and the overall remission rate was 88.5%. Thirty-five (38.5% ) patients died within 28 days of HCU admission. Independent risk factors for 28-day mortality were DIC ( OR=9.350, 95% CI 1.999–43.745, P=0.005), sepsis ( OR=6.817, 95% CI 1.571–29.582, P=0.010), and cardiac insufficiency ( OR=12.281, 95% CI 2.385–63.254, P=0.003) . Conclusion:The main reason for HCU admission in newly diagnosed critically ill AML patients was pulmonary infection. Nearly 40% of patients experisenced early death, and DIC, sepsis, and heart failure were factors influencing early mortatlity.

This report presents the management of a critically ill 36-year-old woman diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph +ALL) at 28 weeks of gestation. The patient rapidly deteriorated, developing disseminated intravascular coagulation (DIC) , diffuse alveolar hemorrhage (DAH) , septic shock, and multi-organ dysfunction, necessitating admission to the hematological intensive care unit. Given her critical condition and advanced pregnancy, a chemotherapy-free induction regimen comprising imatinib and dexamethasone was initiated, alongside comprehensive supportive measures, including mechanical ventilation, continuous renal replacement therapy (CRRT) , broad-spectrum antibiotics, and high-dose corticosteroids. During treatment, intrauterine fetal demise occurred, and a stillborn was delivered following obstetric intervention. With aggressive treatment, the patient's respiratory failure, DIC, and DAH gradually resolved, and she achieved complete remission. She subsequently received consolidation chemotherapy, CAR-T cell therapy, and allogeneic hematopoietic stem cell transplantation, achieving sustained complete molecular remission on long-term follow-up. This case demonstrates that for critically ill pregnant patients with Ph + ALL, a chemotherapy-free regimen of targeted therapy and corticosteroids, when combined with intensive supportive care, is a safe and effective approach that may offer a therapeutic option for similar cases.

Objective To explore the influencing factors and correlation of positive surgical margin (PSM) and biochemical recurrence (BCR) in men after robot-assisted radical prostatectomy (RALP).Methods The clinical data of 190 patients with local or locally advanced prostate cancer who underwent RALP by single surgeon in the Department of Urology of Changhai Hospital from January 2016 to September 2017 were collected.Age was (67.5 ±6.9) years old;median body mass index (BMI),preoperative PSA,prostate weight were 24.2 kg/m2 (16.6-34.2 kg/m2),15.0 ng/ml (1.41-393.94 ng/ml) and 36.9 g (8.65-207.58 g) respectively.The group of surgical margin was divided into negative surgical margin,apex-only PSM,base-only PSM as well as apex and base PSM.Characteristics between patients stratified by surgical margin or BCR were compared using x2 test.The influencing factors of PSM were analyzed by logistic regression.Cox regression was used for the analysis of predictive factors of BCR.Log-rank test and Kaplan-Meier curves were used for comparing the BCR rate between the groups of surgical margin.Results Of all the 190 enrolled patients,total PSM rate was 24.7％ (47/190),apex-only PSM rate was 13.2 ％ (25/190),base-only PSM rate was 5.8％ (11/190),apex and base PSM rate was 5.8 ％ (11/190).Multivariate analysis showed the independent predictive factors influencing PSM were preoperative PSA (P =0.048) and pathological stage (P =0.004).The median follow-up period was 7.3 months (0.9-26.6months) and BCR happened in 19.5％ (37/190) patients.The rates of BCR were 15.4％ (22/143),16.0％ (4/25),27.3％ (3/11) and 72.7％ (8/11) in the patients with negative surgical margin,apexonly PSM,base-only PSM and both apex and base PSM respectively.Log-rank test revealed that the rate of BCR in patients with apex and base PSM was higher than that in patients with negative surgical margin (P ＜0.001) or patients with apex-only PSM(P =0.002).Cox analysis indicated that higher preoperative PSA (P =0.040),higher pathological stage (P =0.041) and higher pathological Gleason score (P =0.004) were the independent predictors of BCR.PSM was not a predictive factor of BCR (P =0.257).Conclusions Preoperative PSA and pathological stage are the influencing factors of PSM.Higher preoperative PSA,higher pathological stage and higher pathological Gleason Score are the predictive factors of BCR.PSM may not be a predictive factor of BCR.The relationship between PSM and BCR needs further study.

OBJECTIVETo compare the difference in CT manifestations between primary colorectal mucinous adenocarcinoma and signet ring cell carcinoma in order to improve radiologic diagnosis.

METHODSClinicopathological data and CT findings of 109 patients with colorectal mucinous adenocarcinoma and 46 patients with primary colorectal signet-ring cell carcinoma confirmed by surgery and pathology from March 2008 to February 2015 in the Tumor Hospital of Yunnan Province were retrospectively collected. Differences in age, gender, tumor location, length and thickness of the involved intestinal wall, thickening pattern of the intestinal wall, lesion density, calcification, contrast-enhanced form, peri-intestinal invasion, occurrence of intestinal obstruction and metastasis of other organs were compared between the two groups.

RESULTSAmong 109 patients with colorectal mucinous adenocarcinoma, 68 were men and 41 were women with a mean age of (56.8±15.4) years. Among 46 patients with primary colorectal signet-ring cell carcinoma, 26 were men and 20 were women with a mean age of (42.9±15.6) years. Compared with mucinous adenocarcinoma group, signet-ring cell carcinoma group showed more concentric bowel-wall thickening[93.5%(43/46) vs. 81.6%(89/109), χ=9.19, P=0.030], higher lesion density [(42.0±3.0) Hu vs. (28.5±1.5) Hu, t=37.30, P=0.000], more marked enhancement [54.3%(25/46) vs. 12.8%(14/109), χ=35.21, P=0.000], less vast-low-density region in enhanced CT imaging[2.2%(1/46) vs. 45.0%(49/109), χ=73.31, P=0.000] and more severe peri-intestinal invasion [41.3% (19/46) vs. 17.4%(19/109), χ=10.25, P=0.006]. Calcification was found in 18.3%(20/109) of mucinous adenocarcinoma cases, but was not found in signet-ring cell carcinoma cases (χ=9.69, P=0.002). Target ring sign in contrast-enhanced scan was observed in 15.2%(7/46) of signet-ring cell carcinoma cases, while in none of mucinous adenocarcinoma cases (χ=17.37, P=0.000). There were no statistically significant differences in lesion location, length and thickness of the involved intestinal wall, occurrence of intestinal obstruction, lymph node metastasis, liver or peritoneum metastasis between two groups(all P>0.05).

CONCLUSIONSSignet-ring cell carcinoma is often found in younger patients, whose CT manifestation is characterized by the target ring sign in contrast-enhanced scan, while primary colorectal mucinous adenocarcinoma is often in older patients, whose CT manifestation is characterized by calcification in unenhanced scan and low density region in enhanced CT show.

Adenocarcinoma, Mucinous ; diagnostic imaging ; pathology ; Adult ; Age Factors ; Aged ; Calcinosis ; diagnostic imaging ; pathology ; Carcinoma, Signet Ring Cell ; diagnostic imaging ; pathology ; China ; Colorectal Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Tomography, X-Ray Computed ; methods

Objective: To investigate the efficacy and safety of IA regimen which contains idarubicin (IDA) 8 mg/m², 10 mg/m² or 12 mg/m² as induction chemotherapy for adult patients with de-novo acute myeloid leukemia (AML) . Methods: A total of 1 215 newly diagnosed adult AML patients, ranging from May 2011 to March 2015 in the First Affiliated Hospital of Soochow University and other 36 clinical blood centers in China were enrolled in the multicenter, single-blind, non-randomized, clinical controlled study. To compare the response rate of complete remission (CR) , adverse events between different dose idarubicin combined with cytarabine (100 mg/m²) as induction chemotherapy in newly diagnosed patients of adult AML. Results: Of 1 207 evaluable AML patients were assigned to this analysis of CR rate. The CR rates of IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 73.6% (215/292) , 84.1% (662/787) and 86.7% (111/128) , respectively (P<0.001) . After adjusted for age, blast ratio of bone marrow, FAB classification and risk stratification, the odds ratios (95% CI) of IDA 10 mg/m² group and IDA 12 mg/m² group were 0.49 (0.34-0.70) and 0.36 (0.18-0.71) , as compared with the IDA 8 mg/m² group (P<0.001, P=0.003) . In the intermediate and favorable groups, CR rates was 76.5% (163/213) , 86.9% (506/582) and 86.1% (68/79) in different doses of IDA (P=0.007) . Interestingly, IA regimen with IDA 10 mg/m² was the only beneficial factor affecting CR in this group after adjusted for age, blast ratio of bone marrow and FAB classification[OR=0.47 (95% CI 0.31-0.71) , P<0.001]. CR rates in adverse group was 50.0% (18/36) , 60.6% (43/71) and 81.8% (18/22) respectively (P=0.089) . However, the odds ratios (95% CI) of IDA 12 mg/m² when compared with the IDA 8 mg/m² was 0.22 (0.06-0.80) , after adjusted for age, blast ratio of bone marrow and FAB classification. The median time (days) of neutrophil count less than 0.5×10⁹/L in IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 14 (11-18) , 15 (11-20) and 18 (14-22) , respectively (P=0.012) and of platelet count lower than 20×10⁹/L were 14 (7-17) , 15 (11-20) and 17 (15-21) , respectively (P=0.001) . The incidences of lung infection in the three groups were 9.8%, 13.5% and 25.2%, respectively (P<0.001) . Conclusions For young adult patients (aged 18-60 years) with AML in China, intensifying induction therapy with idarubicin 10 mg/m² is clinically superior to IDA 8 mg/m² and IDA 12 mg/m² in favorable intermediate AML subgroup. However, idarubicin 12 mg/m² is more suitable to adverse AML subgroup.

OBJECTIVETo observe the curative effect and side effect of tigecycline in the treatment of patients with infection caused by granulocytopenia.

METHODSThe clinical data of 107 patients who were treated with tigecycline for infection due to granulocytopenia were retrospectively reviewed. The tigecycline was administered by intravenously (30-60 min drip infusion)as the initial dose of 100 mg and maintenance does of 50 mg, every 12h. The whole treatment course kept for 5-7 d when the body temperature was normal and then the step-down treatment or discontinuation of the drug was adopted.

RESULTSA total of 104 strains of bacteria were isolated from 107 cases of hospitalized patient, including 60 multi-drug resistant strains (MDR) and 2 extensively-drug resistant strains (XDR). The total effective rate of tigecycline treatment was 62.6%, including 30 cases with tigecycline alone (63.3% of the effective rate), 21 cases with tigecycline as initial treatment followed by combination with other antibiotics (61.9% of the effective rate), and 56 cases with tigecycline in combination with other antibiotics from the beginning of the treatment (62.5% of the effective rate). There was no statistical significant difference between the 3 treatment groups (P=0.994). Among the 39 patients with MDR strains, 22 patients' temperature was controlled , 9 patients died, and 8 patients' temperature remained uncontrolled. The clinical effective rate of these patients was 56.4%. The median onset time of tigecycline treatment was 3 days. The adverse drug reactions of nausea (11.2% ) and vomiting (8.4% )were tolerable.

CONCLUSIONTigecycline is effective in treatment of resistant bacteria infection in patients with granulocytopenia. The side effects of tigecycline were few, safe and generally well tolerated.

Agranulocytosis ; complications ; microbiology ; Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; drug therapy ; Body Temperature ; Drug Resistance, Multiple, Bacterial ; Humans ; Minocycline ; analogs & derivatives ; therapeutic use ; Retrospective Studies ; Treatment Outcome

Purpose The study about the CT manifestations of primary colorectal signet-ring cell carcinoma is rarely reported by now, the purpose of this study is to explore the CT findings of primary colorectal signet-ring cell carcinoma, to improve the radiology acknowledge about it. Materials and Methods CT findings of 46 patients with primary colorectal signet-ring cell carcinoma and 46 patients with colorectal adenocarcinoma confirmed by surgery and pathology were retrospectively analyzed, the differences of age, gender, tumor location, length and thickness of the involved intestinal wall, the thickening pattern of the intestinal wall, the contrast-enhanced form, the peri-intestinal invasion, the occurrence of intestinal obstruction and metastasis of other organs were compared between the two groups. Results Compared with the colorectal adenocarcinoma group, patient age of colorectal signet-ring cell carcinoma group was younger (t=5.23, P<0.001), and involved intestinal wall was longer and thicker (t=4.78 and 5.76, P<0.001). There were statistically significant differences of focal thickening form, contrast-enhanced level, peri-intestinal invasion, with or without peritoneal metastasis difference between the two groups (χ2=54.29, 11.89, 30.17 and 16.51, P<0.01 and P<0.001), while in gender, lesion location, occurrence of intestinal obstruction, lymph node metastasis, or liver metastasis, there was no statistically significant difference (χ2=0.18, 8.33, 0.10, 0.18 and 0.50, P>0.05). Conclusion Signet-ring cell carcinomas are often found in younger patients, their CT manifestations including a long length of concentric bowel wall thickening and is characterized by the target ring sign in contrast-enhanced scan, which often involves the peri-intestinal space with peritoneal metastasis and peri-intestinal lymph node metastasis.