目的:探讨老年营养风险指数(GNRI)与初诊多发性骨髓瘤(MM)患者预后的关系。方法:选取2010年5月至2022年9月在我院就诊并规范治疗的107例60岁以上初诊MM患者,基于受试者工作特征(ROC)曲线计算出GNRI的最佳截断值,比较高GNRI组和低GNRI组...目的:探讨老年营养风险指数(GNRI)与初诊多发性骨髓瘤(MM)患者预后的关系。方法:选取2010年5月至2022年9月在我院就诊并规范治疗的107例60岁以上初诊MM患者,基于受试者工作特征(ROC)曲线计算出GNRI的最佳截断值,比较高GNRI组和低GNRI组基线资料、无进展生存期(PFS)、总生存期(OS)的差异;采用Kaplan-Meier进行生存分析并绘制生存曲线,Log-rank检验比较组间生存差异,Cox比例风险模型进行多因素分析,对年龄、细胞遗传学、血肌酐水平分层绘制生存曲线进行亚组分析。结果:107例患者的中位年龄为68(60~86)岁,其中男性62例(57.9%),女45例(42.1%),中位PFS为26个月,中位OS为39个月。基于ROC曲线得出GNRI的最佳截断值为99,低GNRI组中位PFS和OS均较高GNRI组短(17 vs 47,P=0.014;29 vs 63,P=0.015)。多因素分析显示,GNRI≤99(HR 0.485,95%CI 0.253~0.930,P=0.029)、高危细胞遗传学(HR 2.062, 95%CI 1.180~3.603,P=0.011)、血肌酐> 177μmol/L(HR 2.316,95%CI 1.160~4.626,P=0.017)是影响老年MM患者OS的独立预后危险因素。亚组分析显示,截至末次随访,初诊年龄为60~65岁或血清肌酐水平≤177μmol/L患者中低GNRI组的中位OS(22 vs未达到,P=0.002;39 vs 64,P=0.019)和中位PFS(15 vs未达到,P=0.001 9;26 vs 63,P=0.012)更短,高危细胞遗传学患者中低GNRI组的中位PFS(15 vs 49.5,P=0.032)更短。结论:GNRI评分对老年MM患者预后有潜在评估价值,且GNRI≤99的患者PFS和OS更短。展开更多
Splenic hamartomas(SHs)are uncommon,benign vascular lesions of unclear etiology and are mostly found incidentally on abdominal images,at surgery,or at autopsy.Since the first case description,in 1861,less than 50 pedi...Splenic hamartomas(SHs)are uncommon,benign vascular lesions of unclear etiology and are mostly found incidentally on abdominal images,at surgery,or at autopsy.Since the first case description,in 1861,less than 50 pediatric SH cases have been reported in the literature.In this article,we have performed an analysis of all SH cases in children published in the literature to date and presented our case of an 8-year-old male with SH.These lesions in children were shown to cause symptoms more often than in the adult population.The observed SH sizes in children ranged from a few millimeters to 18 cm,and the symptomatic lesions were mostly larger or multiple.The most common clinical finding was splenomegaly.Signs of hypersplenism were present in children with a single SH larger than 4.5 cm(diameter range:4.5-18.0 cm)and in those with multiple hamartomas,ranging from a few millimeters to 5 cm.Eighty percent of patients with available laboratory findings had hematological abnormalities such as anemia,thrombocytopenia,or pancytopenia.Other symptoms and signs included abdominal pain,recurrent infections,fever,night sweats,lethargy,growth retardation,and weight loss.The use of multiple imaging modalities may suggest the preoperative diagnosis of a splenic mass in children and determine the therapeutic approach.However,the final diagnosis of SH relies on histopathological evaluation.Surgery,including total or partial splenectomy(PS),is the mainstay of SH management.Milickovic M et al.Splenomas in children WJCC https://www.wjgnet.com 1910 April 16,2024 Volume 12 Issue 11 Although total splenectomy carries a greater risk of overwhelming post-splenectomy infection than PS it has remained the most performed surgical procedure in children with SH.In the majority of pediatric patients with symptomatic SH,resolution of symptoms and resolution or improvement of cytopenias occurred after surgical treatment.展开更多
原发性脾淋巴瘤(primary splenic lymphoma,PSL)是一种极为罕见的疾病,在所有非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)中占比<1%[1]。弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)是PSL和NHL最常见的组织学亚型,其...原发性脾淋巴瘤(primary splenic lymphoma,PSL)是一种极为罕见的疾病,在所有非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)中占比<1%[1]。弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)是PSL和NHL最常见的组织学亚型,其他亚型包括脾绒毛性淋巴瘤、脾边缘区淋巴瘤和滤泡性淋巴瘤[2]。PSL的临床症状无特异性,极易造成误诊。现将曲靖市第一人民医院肝胆胰外科收治的一例PSL误诊为脾脓肿病例诊治经过报道如下,以期提高对PSL的临床认识。展开更多
文摘目的:探讨老年营养风险指数(GNRI)与初诊多发性骨髓瘤(MM)患者预后的关系。方法:选取2010年5月至2022年9月在我院就诊并规范治疗的107例60岁以上初诊MM患者,基于受试者工作特征(ROC)曲线计算出GNRI的最佳截断值,比较高GNRI组和低GNRI组基线资料、无进展生存期(PFS)、总生存期(OS)的差异;采用Kaplan-Meier进行生存分析并绘制生存曲线,Log-rank检验比较组间生存差异,Cox比例风险模型进行多因素分析,对年龄、细胞遗传学、血肌酐水平分层绘制生存曲线进行亚组分析。结果:107例患者的中位年龄为68(60~86)岁,其中男性62例(57.9%),女45例(42.1%),中位PFS为26个月,中位OS为39个月。基于ROC曲线得出GNRI的最佳截断值为99,低GNRI组中位PFS和OS均较高GNRI组短(17 vs 47,P=0.014;29 vs 63,P=0.015)。多因素分析显示,GNRI≤99(HR 0.485,95%CI 0.253~0.930,P=0.029)、高危细胞遗传学(HR 2.062, 95%CI 1.180~3.603,P=0.011)、血肌酐> 177μmol/L(HR 2.316,95%CI 1.160~4.626,P=0.017)是影响老年MM患者OS的独立预后危险因素。亚组分析显示,截至末次随访,初诊年龄为60~65岁或血清肌酐水平≤177μmol/L患者中低GNRI组的中位OS(22 vs未达到,P=0.002;39 vs 64,P=0.019)和中位PFS(15 vs未达到,P=0.001 9;26 vs 63,P=0.012)更短,高危细胞遗传学患者中低GNRI组的中位PFS(15 vs 49.5,P=0.032)更短。结论:GNRI评分对老年MM患者预后有潜在评估价值,且GNRI≤99的患者PFS和OS更短。
文摘Splenic hamartomas(SHs)are uncommon,benign vascular lesions of unclear etiology and are mostly found incidentally on abdominal images,at surgery,or at autopsy.Since the first case description,in 1861,less than 50 pediatric SH cases have been reported in the literature.In this article,we have performed an analysis of all SH cases in children published in the literature to date and presented our case of an 8-year-old male with SH.These lesions in children were shown to cause symptoms more often than in the adult population.The observed SH sizes in children ranged from a few millimeters to 18 cm,and the symptomatic lesions were mostly larger or multiple.The most common clinical finding was splenomegaly.Signs of hypersplenism were present in children with a single SH larger than 4.5 cm(diameter range:4.5-18.0 cm)and in those with multiple hamartomas,ranging from a few millimeters to 5 cm.Eighty percent of patients with available laboratory findings had hematological abnormalities such as anemia,thrombocytopenia,or pancytopenia.Other symptoms and signs included abdominal pain,recurrent infections,fever,night sweats,lethargy,growth retardation,and weight loss.The use of multiple imaging modalities may suggest the preoperative diagnosis of a splenic mass in children and determine the therapeutic approach.However,the final diagnosis of SH relies on histopathological evaluation.Surgery,including total or partial splenectomy(PS),is the mainstay of SH management.Milickovic M et al.Splenomas in children WJCC https://www.wjgnet.com 1910 April 16,2024 Volume 12 Issue 11 Although total splenectomy carries a greater risk of overwhelming post-splenectomy infection than PS it has remained the most performed surgical procedure in children with SH.In the majority of pediatric patients with symptomatic SH,resolution of symptoms and resolution or improvement of cytopenias occurred after surgical treatment.
文摘原发性脾淋巴瘤(primary splenic lymphoma,PSL)是一种极为罕见的疾病,在所有非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)中占比<1%[1]。弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)是PSL和NHL最常见的组织学亚型,其他亚型包括脾绒毛性淋巴瘤、脾边缘区淋巴瘤和滤泡性淋巴瘤[2]。PSL的临床症状无特异性,极易造成误诊。现将曲靖市第一人民医院肝胆胰外科收治的一例PSL误诊为脾脓肿病例诊治经过报道如下,以期提高对PSL的临床认识。
