Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). ...However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto-HSCT.
We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score ≥ 2. From 2006 to 2011, among the 150 DLBCL patients aged ≤ 60 years who were treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), 23 high-risk patients with a complete response (CR) were treated with auto-HSCT. For comparison, we selected 35 well-matched high-risk patients with CR who completed R-CHOP treatment alone. In addition, there were 81 low-risk patients and 11 refractory patients.
DLBCL patients with an aaIPI score ≥ 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone.
We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level.
Sodium butyrate, a short-chain fatty acid naturally present in the human colon, is able to induce cell cycle arrest, differentiation and apoptosis in various cancer cells. Sodium butyrate is most ...probably related to the inhibition of deacetylases leading to hyperacetylation of chromatin components such as histones and non-histone proteins and to alterations in gene expression. In this study, we demonstrate for the first time that sodium butyrate selectively up-regulated DR5 but had no effect on the expression of the other TNF-α-related apoptosis-inducing ligand (TRAIL) receptor, DR4. Sodium butyrate-induced expression of DR5 involves the putative Sp1 site within the DR5 promoter region. Using a combination of the electrophoretic mobility shift assay and the luciferase reporter assay, we found that a specific Sp1 site (located at −195 bp relative to the transcription start site) is required for sodium butyrate-mediated activation of the DR5 promoter. When HCT116 cells were incubated with sodium butyrate and TRAIL, enhanced TRAIL-mediated apoptosis was observed. The enhanced apoptosis was measured by fluorescent activated cell sorting analysis, DNA fragmentation, poly (ADP-ribose) polymerase cleavage, down-regulation of XIAP and caspase activity. Taken together, the present studies suggest that sodium butyrate may be an effective sensitizer of TRAIL-induced apoptosis.
Appendiceal orifice inflammation (AOI) is a common 'skip lesion' in patients with ulcerative colitis (UC). However, other skip lesions are less well known.
To evaluate the atypical distribution of UC ...lesions, other than AOI, in terms of their frequency, pattern, risk factors and prognostic implications.
A retrospective analysis of colonoscopic findings and clinical course of 240 adult UC patients who were initially diagnosed at Asan Medical Center (Seoul, South Korea) was performed. #
Of 240 patients, 46 (19.2%) showed an atypical distribution of lesions at initial colonoscopy: eight (3.3%) had rectal sparing (segmental-type UC); and 38 (15.8%) had patchy⁄segmental skip lesions other than AOI. Skip lesions were detected more frequently in proximal segments of the colon than in distal segments (P=0.001). An atypical distribution was more common in patients with AOI (31.3%) than in those without AOI (10.6%; P<0.001). The clinical course of patients with an atypical distribution was not different from that of patients with a typical distribution in terms of remission, relapse, disease extension, colectomy and mortality. In addition, of the 36 patients with an atypical distribution of lesions at diagnosis who underwent follow-up colonoscopy, 24 (66.7%) demonstrated a typical distribution of lesions.
Patchy⁄segmental skip lesions and rectal sparing occur not infrequently in adult patients with newly diagnosed, untreated UC. As such, these features alone should not be considered to be definitive evidence against a diagnosis of UC. There does not appear to be a prognostic implication of an atypical distribution of lesions.
A variety of retrievable and other types of temporarily placed stents are currently being used. However, only a few studies have considered primary endoscopic realignment with temporary urethral ...stent insertion in the event of traumatic bulbar urethral injury. We aimed to compare the clinical effectiveness and complications between thermo-expandable urethral stents and polymer-coated bulbar urethral stents (BUSs) for the treatment of traumatic bulbar urethral strictures. Between September 2011 and March 2018, 30 patients who had been diagnosed with complete bulbar urethral rupture following blunt trauma underwent temporary urethral stent placement after primary realignment. Thermo-expandable nickel-titanium alloy urethral stents were placed for 15 patients (group M), and retrievable self-expandable polymer-coated BUSs were placed for another 15 patients (group A). All stents were removed within 6 months after placement. The complications and maintained patency rates were compared between the two groups. The mean stent indwelling period was 5.0 ± 2.5 months in group M and 4.9 ± 4.0 months in group A. Both groups maintained high patency rates (Group M 12/15 (80.0%) and group A 13/15 (86.7%)). Five patients who developed urethral stricture underwent direct visual internal urethrotomy (DVIU), and no patients required repeat DVIU or open surgical urethroplasty. Both groups maintained the mean maximal urinary flow rate (Qmax) at 12 months after stent removal. Discomfort (46.7% vs. 6.7%), granulation tissue formation (73.3% vs. 26.7%) and post-void dribbling (80.0% vs. 20.0%) were more frequent in group M than in group A (
= 0.013,
= 0.011 and
= 0.001, respectively). In conclusion, both stents were effective for managing traumatic complete bulbar urethral rupture after primary realignment. However, the thermo-expandable urethral stents had a higher complication rate while the stent was in situ than the BUSs.
In this letter, we propose a round robin-based wear leveling (RRWL) for flash memory systems. RRWL uses a block erase table (BET), which is composed of a bit array and saves the erasure histories of ...blocks. BET can use one-to-one mode to increase the performance of wear leveling or one-to-many mode to reduce memory consumption. However, one-to-many mode decreases the accuracy of cold block information, which results in the lifetime degradation of flash memory. To solve this problem, RRWL consistently uses one-to-one mode based on round robin method to increase the accuracy of cold block identification, with reduced memory size of BET, like in one-to-many mode. Experiments show that RRWL increases the lifetime of flash memory by up to 47% and 14%, compared with BET and HaWL, respectively.
Background: The authors previously developed deep-learning models for the prediction of colorectal polyp histology (advanced colorectal cancer, early cancer/high-grade dysplasia, tubular adenoma with ...or without low-grade dysplasia, or non-neoplasm) from endoscopic images. While the model achieved 67.3% internal-test accuracy and 79.2% external-test accuracy, model development was labour-intensive and required specialised programming expertise. Moreover, the 240-image external-test dataset included only three advanced and eight early cancers, so it was difficult to generalise model performance. These limitations may be mitigated by deep-learning models developed using no-code platforms. Objective: To establish no-code platform-based deep-learning models for the prediction of colorectal polyp histology from white-light endoscopy images and compare their diagnostic performance with traditional models. Methods: The same 3828 endoscopic images used to establish previous models were used to establish new models based on no-code platforms Neuro-T, VLAD, and Create ML-Image Classifier. A prospective multicentre validation study was then conducted using 3818 novel images. The primary outcome was the accuracy of four-category prediction. Results: The model established using Neuro-T achieved the highest internal-test accuracy (75.3%, 95% confidence interval: 71.0–79.6%) and external-test accuracy (80.2%, 76.9–83.5%) but required the longest training time. In contrast, the model established using Create ML-Image Classifier required only 3 min for training and still achieved 72.7% (70.8–74.6%) external-test accuracy. Attention map analysis revealed that the imaging features used by the no-code deep-learning models were similar to those used by endoscopists during visual inspection. Conclusion: No-code deep-learning tools allow for the rapid development of models with high accuracy for predicting colorectal polyp histology.
Previous studies have suggested that early surgery after coronary angiography may be associated with the risk of acute kidney injury (AKI) in cardiac surgery with cardiopulmonary bypass. However, the ...effect of coronary angiography on the risk of AKI after off-pump coronary artery bypass graft surgery (OPCABG) remains uncertain.
We assessed preoperative and perioperative data in 1,364 consecutive adult patients who underwent elective OPCABG surgery after coronary angiography. Acute kidney injury was defined by Acute Kidney Injury Network criteria based on changes in serum creatinine within the first 48 hours after OPCABG. Multivariable logistic regression was performed to evaluate the association of the time interval between coronary angiography and OPCABG with postoperative AKI.
Acute kidney injury occurred in 391 patients (28.7%). The unadjusted and adjusted rates of AKI according to the length of time between coronary angiogram and OPCABG did not show any increasing or decreasing trend (p = 0.86 and p = 0.33 for trends of unadjusted and adjusted AKI rates, respectively), and early OPCABG after coronary angiography was not related to postoperative AKI. Results were the same in high-risk patients with preoperative renal insufficiency, low ejection fraction, or who received an ionic contrast agent or a high dose of contrast agent.
The risk of postoperative AKI was not related to the time between coronary angiography and OPCABG. These findings suggest that delaying elective OPCABG after coronary angiography owing to the sole concern for renal function may be unnecessary.
Influenza leads to many deaths every year and is a threat to human health. For effective prevention, traditional national-scale statistical surveillance systems have been developed, and numerous ...studies have been conducted to predict influenza outbreaks using web data. Most studies have captured the short-term signs of influenza outbreaks, such as one-week prediction using the characteristics of web data uploaded in real time; however, long-term predictions of more than 2-10 weeks are required to effectively cope with influenza outbreaks. In this study, we determined that web data uploaded in real time have a time-precedence relationship with influenza outbreaks. For example, a few weeks before an influenza pandemic, the word "colds" appears frequently in web data. The web data after the appearance of the word "colds" can be used as information for forecasting future influenza outbreaks, which can improve long-term influenza prediction accuracy. In this study, we propose a novel long-term influenza outbreak forecast model utilizing the time precedence between the emergence of web data and an influenza outbreak. Based on the proposed model, we conducted experiments on: 1) selecting suitable web data for long-term influenza prediction; 2) determining whether the proposed model is regionally dependent; and 3) evaluating the accuracy according to the prediction timeframe. The proposed model showed a correlation of 0.87 in the long-term prediction of ten weeks while significantly outperforming other state-of-the-art methods.
PDF
