Antiphospholipid antibody syndrome(APS) is a well-known clinical syndrome characterized by recurrent arterial or venous thromboses, recurrent fetal loss, thrombocytopenia, together with high titers of sustained anticardiolipin antibody(aCL) or lupus anticoagulant(LA). Although systemic lupus erythematosus(SLB) and APS may coexist, a high proportion of patients manifesting the APS do not suffer from classical lupus or other connective tissue disease. The patient has been defined as having a primary antiphospholipid antibody syndrome. We experienced one case of primary APS with recurrent fetal loss, recurrent cerebral infarctions, positive anticardiolipin antibody IgG and fluttering vegetation on the mitral valve, without other connective tissue diseases including SLE. Forty-three old female had 2 out of 11 criteria for the diagnosis of SLE, such as thrombocytopenia and positive antinuclear antibody, but did not meet whole criteria. The patient was treated with ticlopidine, and anticoagulant therapy was recommended.
Background: Clinically significant portal hypertension (PHT) is considered as a contraindication for hepatectomy according to the guidelines of the European Association for Study of Liver and the American Association for Study of Liver Diseases. However, this issue remains controversial. Here we performed a metaanalysis to evaluate the impact of PHT on the results of hepatectomy for hepatocellular carcinoma (HCC). Methods: Cohort studies evaluating the impact of clinically significant PHT, defined as oesophageal varices and/or splenomegaly associated with thrombocytopenia, on the results of hepatectomy for HCC were identified using a predefined search strategy. Summary risk ratios (RRs) and 95% confidence intervals (95% CIs) for PHT and outcomes after hepatectomy for HCC were calculated. Results: Seven cohort studies which including 574 cases with PHT and 1,354 cases without PHT were considered eligible for inclusion. The meta-analysis showed that, in all patients, pooled RRs of post-operative liver failure, post-operative ascites, peri-operative blood transfusion, operative mortality, 3- and 5-year overall survival associated with PHT were 2.23 (95% CI: 1.48-3.34, P=0.0001), 1.77 (95% CI: 1.19-2.64, P=0.005), 1.23 (95% CI: 1.03-1.49, P=0.03), 2.58 (95% CI: 1.12-5.96, P=0.03), 0.82 (95% CI: 0.75-0.88, P<0.00001) and 0.76 (95% CI: 0.69-0.85, P<0.00001), respectively. In subgroup analysis, similar results were found in Child-Pugh class A patients. Conclusion: This meta-analysis suggests that presence of oesophageal varices and/or splenomegaly associated with thrombocytopenia is associated with higher rates of post-operative complications and poor long-term survival after hepatectomy for HCC.
Methotrexate (MTX) is an important drug for the treatment of childhood acute lymphoblastic leukemia (ALL). However, related toxicity occurs in many organs which may cause interruption of treatment, morbidity, and mortality. Single nucleotide polymorphisms (SNPs) of dihydrofolate reductase (DHFR) and gamma glutamyl hydrolase (GGH) are known to alter their enzymatic activity and thus affect the metabolism of MTX and influence the effectiveness. Therefore, we hypothesized that genetic variations of DHFR and GGH genes may influence the risk of toxicity after high dose MTX. The study population comprised of 105 children with ALL who were treated according to the modified St Jude Total XV protocol. The patients received 2.5 or $5g/m^2$ of MTX for 5 doses during the consolidation phase. Genotyping of DHFR 829C>T and GGH-401C>T was performed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The GGH-401CT and TT genotypes were associated with increased risk of leukopenia and thrombocytopenia after high dose MTX (OR 2.97, 95%CI; 1.24-7.13 and OR 4.02, 95%CI; 1.58-10.26). DHFR 829C>T was not associated with toxicity. In conclusion, the GGH-401CT and TT genotypes were found to increase the risk of severe leukopenia and thrombocytopenia after exposure to high dose MTX for childhood ALL therapy.
Inal, Ali;Kaplan, M. Ali;Kucukoner, Mehmet;Urakcl, Zuhat;Karakus, Abdullah;Islkdogan, Abdurrahman
Asian Pacific Journal of Cancer Prevention
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v.13
no.5
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pp.1837-1840
/
2012
Background: In spite of the fact that platinum-based doublets are considered the standard therapy for patients with advanced non-small-cell lung cancer (NSCLC), no elderly-specific platinum based prospective phase III regimen has been explored. The aim of this retrospective singlecenter study was to evaluate the efficacy and side effects of cisplatin-based therapy specifically for the elderly. Methods: Patients receiving platinum-based treatment were divided into three groups. In the first group (GC), Gemcitabine was administrated at 1000 $mg/m^2$ on days 1, 8 and cisplatin was added at 75 $mg/m^2$ on day 1. In the second group (DC), 75 $mg/m^2$ docetaxel and cisplatin were administered on day 1. The third group (PC) received 175 mg of paclitaxel and 75 mg of cisplatin on day 1. These treatments were repeated every three weeks. Result: GC arm had 36, the DC arm 42 and the PC arm 29 patients. Grade III-IV thrombocytopenia was higher in the GC arm (21.2% received GC, 2.8% received DC, and 3.8% received PC), while sensory neuropathy was lower in patients with GC arm (3.0%, 22.2%, and 23.1% received GC, DC and PC, respectively). There were no statistically significant difference in the response rates among the three groups (p>0.05). The median Progression-free survival (PFS) was 5.0 months and the median Overall survival (OS) in each group was 7.1, 7.4 and 7.1 months, respectively (p>0.05). Conclusion: The response rate, median PFS and OS were similar among the three treatment arms. Grade III-IV thrombocytopenia was higher in the GC arm, while the GC regimen was more favorable than the other cisplatin-based treatmetns with regard to sensory neuropathy.
Purpose: The purpose of this study was to determine the frequency of $CD4^+CD25^+FoxP3^+$ regulatory T cells (Treg) in the peripheral blood of patients with childhood chronic immune thrombocytopenic purpura (ITP) exhibiting thrombocytopenia and spontaneous remission. The findings of this study indicate the possibility of predicting spontaneous recovery and pathogenesis of childhood chronic ITP. Methods: Eleven children with chronic ITP (seven thrombocytopenic and four spontaneous remission cases; mean age, 8.8 years; range, 1.7-14.9 years) were enrolled in this study. Five healthy children and eight healthy adults were included as controls. The frequency of Treg was evaluated by flow cytometry in the peripheral blood. Results: In this study, four patients (36%) achieved spontaneous remission within 2.8 years (mean year; range, 1.0-4.4 years). The frequency of Treg was significantly lower in patients with persisting thrombocytopenia ($0.13%{\pm}0.09%$, P<0.05), than that in the patients with spontaneous remission ($0.30%{\pm}0.02%$), healthy adults controls ($0.55%{\pm}0.44%$), and healthy children controls ($0.46%{\pm}0.26%$). A significantly positive correlation was found between the frequency of Treg and the platelet count in children. Conclusion: These data suggest that a lower frequency of Treg contributes to the breakdown of self-tolerance, and may form the basis for future development of specific immunomodulatory therapies. Furthermore, Treg frequency has prognostic implication toward the natural course and long-term outcomes of childhood chronic ITP.
Purpose: Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). Materials and Methods: Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. Results: The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). Conclusions: This first study of NLR and mortality did not show any significant correlation. In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than $50{\times}10^9/l$ may be poor prognostic markers in MDS patients.
Effects of repeated administration of diminazene aceturate (Hoechst Veterin r GmbH. Ger- many) that has been introduced as effective compound against Babesiosis and trppanosomiasis were investigated in dogs experimentally infacted with Babesia gibsoni. Adull mongrel dogs of both sexes were inoculated will nonpreserved infected blood and then maintained chronic anemia. A single dose of diminazene aceturate of 7mg/kg b.w. was administrated intramnuscularIy on day 7.1 arid ,7. Clin- ical and hcmatological findings following inoculation and medication were observed and 7enlm bio chemical analysis also was monitored. Parasitemia was detected between 3 and 6 days after inoculation. The rate of parasitized erythrocytes,1 in peripheral blood reached the peak on the 13th day and was maintained the percentage of 0.1 to 1.0 until the medication of diminazene aceturate. RBC was significantly (p<0.01) decreased on the 3rd day and then kept on decreasing. The lowest value was observed on the 16th day. WBC remained generally within normal ranges. PCV revea1ed the sig-nificant (p<0.01) decrease within the range of 24-27% and platelet was significantly (p<0.05) decreased during the period. Senum chemical values (ALT, AST. total bilirubin. LDH BUN, area- tinine, total protein. albumin and glucose) were within normal ranges during the experimental period. Serum CPK values were significantly (p<0.01) increased on the 3rd day. There was no clinically, sig-nificant difference in a single dose of diminazene aceturate of 7 mg/kg b.w. But the administration of diminazene aceturate of 14 mg/kg b.w. revealed vomiting and anorexia and one dog died in 30 hours after administration. The administration of 14mg/kg b.w. resulted in vomiting, salivation, actor- exia, tremor of head and involuntary movement and one dog died in 27 hours after administration. WBC, RBC, PCV and Platelet values were no significant difference and hematological findings revealed persistent anemia and thrombocytopenia during chronic anemia after inoculation. AST activity its was significantly (p<0.01) increased 11\\`from 3 days after medication and AST activity was on the same trend. Serum CPK activity revealed significant (p<0.01) increase within 6 hors)\\`s after every administration and decreased in 48 howl·s after administration.
Lee, Won-Chang;Park, Seung-Yong;Choe, Nong-Hoon;Kwon, Young Hwan
Korean journal of aerospace and environmental medicine
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v.30
no.2
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pp.75-79
/
2020
This study focuses on the comparative and quantitative analysis of the epidemiologic trends and aspects of severe fever with thrombocytopenia syndrome (SFTS) outbreaks between Korea and Japan from 2013 to 2017. The following factors were analyzed; cumulative incidence rate (CIR), cases-fatality rate (CFR), and the epidemic aspects, including cases related to gender, male-to-female morbidity ratio (MFMR), age, seasonal, and geographical distributions. We observed 607 SFTS cases with CIR in Korea during the period 2013 to 2017 were as 0.24 per 100,000 populations and with a 127 fatal-cases (F.C.s), corresponding to a CFR of 20.9%, respectively. During the same period in Japan, 319 SFTS cases with a CIR of 0.05 and with 60 F.C.s to a CFR of 18.8% observed. When compared, the CIR of SFTS in Korea was significantly higher than in Japan (P<0.01), but there were no significant differences levels of the CFR and MFMR between Korea and Japan. Also, a higher incidence of SFTS was observed in people aged over 50-years or elders in Korea and those of 60-years or elders in Japan (P<0.01). The seasonal distribution of SFTS outbreak cases showed that the incidence in summer through autumn in Korea (92.4% of total cases) was higher than in Japan (65.2%), while the outbreaks of SFTS in spring was much higher in Japan (31.0%) than in Korea (7.4%), (P<0.01). The regional distribution revealed no significant difference between the eastern area (44.8%) and the western area (46.8%) of the Korean peninsula except Jeju-island (8.4%). However, in Japan, the incidence only occurred in Chubu-Kinki-Chugoku (30.3%), Shikoku (25.7%), Kyushu (42.6%) and Okinawa (0.3%), which are the western and southern areas of Japan. These differences in SFTS occurrence may reflect the influences of vector/hosts, climate, and geographical and cultural characteristics between the two countries.
Lee, JaeSeok;Moon, KyungHwan;Kim, YeongHo;Park, Ye eun;Jeon, Ji Hyang;Kim, Chae Won;Park, Sean;Woo, Ji Hyeon;Jeong, Yeo Jin;Eom, Jong Won;Lee, Wook-Gyo;Kim, Young Ho
Korean journal of applied entomology
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v.59
no.3
/
pp.233-241
/
2020
Several hard tick species in Ixodidae are medically important pests that transmit infectious disease including severe fever with thrombocytopenia syndrome (SFTS). In Korea, the number of SFTS patients continues to steadily increase since its first report in 2013, and Gyeongsangbuk-do (province) is the second most frequent area of SFTS patient occurrence. In order to investigate the distribution of ticks in Sangju city, we collected ticks using the flagging method from 26 sites comprising urban green area, vulnerable area of management, and rural area, and examined SFTS virus from the collected ticks in 2019. Based on Collection Index (CI = tick number / 1 h / 2 people), CI 143 ticks, including Haemaphysalis longicornis, Haemaphysalis flava, and Ixodes nipponensis, were collected; the most abundant species among the three tick species was H. longicornis (CI 138, 96.5%). Ninety two percent (CI 131) of ticks were collected in vulnerable area of management, where people cannot easily enter and are not managed by city hall, whereas only 8.4% (CI 12) were collected in the urban green area and rural area. Regarding SFTS virus detection, virus was not investigated from 26 pools containing CI 143 ticks. The results of this study are expected to be used as a recommendation for ensuring the safety of local residents from tick-borne diseases.
Background: This analysis was conducted to evaluate the efficacy and safety of temozolomide based chemotherapy in treating patients with glioma. Methods: Clinical studies evaluating the efficacy and safety of temozolomide based regimens for patients with glioma were identified using a predefined search strategy. Pooled response rates (RRs) were calculated. Results: In temozolomide based regimens, 5 clinical studies including 152 patients with advanced glioma were considered eligible for inclusion. Four clinical studies included temozolomide. Systematic analysis suggested that, in all patients, pooled CR was 21% (32/152), and PR was 21% (32/152). Grade 3/4 toxicity included neutropenia, thrombocytopenia, and anemia. No grade 3 or 4 renal or liver toxicity was observed. No treatment related death occurred with temozolomide based treatment. Conclusion: This systematic analysis suggests that temozolomide based regimens are associated with mild response rate and acceptable toxicity for treatment of glioma patients.
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