BACKGROUND Microangiopathic hemolytic anemia(MAHA) with thrombocytopenia and organ failure caused by tumor-associated thrombotic microangiopathy(TMA) is a lifethreatening oncological emergency. Rapid diagnosis and pre...BACKGROUND Microangiopathic hemolytic anemia(MAHA) with thrombocytopenia and organ failure caused by tumor-associated thrombotic microangiopathy(TMA) is a lifethreatening oncological emergency. Rapid diagnosis and precise distinction from other forms of TMA is crucial for appropriate therapy, which aims at treating the underlying malignancy. However, the prognosis of patients with cancer-related(CR)-MAHA is limited. To date, less than 50 patients with gastric cancer and CRMAHA have been reported, mainly as single case reports, and detailed information on treatment strategies and outcome are scarce. We analyzed the characteristics and outcomes data of CR-MAHA patients with gastric cancer treated at our center between 2012 and 2019.AIM To gain knowledge about CR-MAHA and the course of disease.METHODS We retrospectively analyzed patients using an institutional prospectively maintained database. Patients who had CR-MAHA but other cancer types or cancer of unknown primary were excluded. The basic requirements for inclusion were: Histologically proven gastric adenocarcinoma;and clinical diagnosis of hemolytic anemia with schistocytes with or without thrombocytopenia. The observation period for each patient started with the first day of documented symptoms. The follow-up period for this analysis ended on February 1, 2020.RESULTS We identified eight patients with a median age of 54 years. Histologically, all patients had(partial) diffuse subtypes of gastric adenocarcinoma with partial or complete signet cell morphology. All patients had metastatic disease and one patient had a microsatellite instability-high(MSI-H) tumor. In three patients, clinical signs of MAHA preceded the diagnosis of cancer, and in two patients, CRMAHA indicated recurrent disease. All patients had severe hemolytic anemia and thrombocytopenia. Six patients experienced severe bone pain, and five patients had dyspnea. Systemic, 5-fluorouracil-based combination chemotherapy was initiated in six patients, which resulted in rapid initial response with significant improvement of clinical symptoms and blood values. Progression-free survival(PFS) of the whole cohort was 1.9 wk and median overall survival(OS) was 1.9 wk. For patients with chemotherapy, PFS was 9.0 wk and OS was 10.3 wk. The patient with the MSI-H tumor has been undergoing immunotherapy for more than 3 years.CONCLUSION The benefit of chemotherapy in CR-MAHA patients is limited. Immunotherapy for patients with MSI-H tumors may lead to long-term tumor control even in CRMAHA patients.展开更多
This article reports on track-monitoring and analyzing machine clearances during wood forwarding across seasons and weather, using ultrasonic distance sensors in combination with time-stamped GPS xy locations, at 10 s...This article reports on track-monitoring and analyzing machine clearances during wood forwarding across seasons and weather, using ultrasonic distance sensors in combination with time-stamped GPS xy locations, at 10 sec intervals. The resulting data, obtained from 54 harvesting blocks, were analyzed by machine type (two wood forwarders and one grapple skidder), stand type (softwood plantation versus natural hardwood stands), month, slope, cartographic depth-to-water (DTW) classes, number of passes along track, and machine speed. For the most part, clearances were highly variable, due to passing over stumps, rocks, harvest slash, brushmats, ruts, and snow cover when present. This variability was on average greater for the lighter-weight wood forwarders than for the heavier-weight skidder, with the former mostly moving along equally spaced lines on brushmats, while the paths of the latter spread away from central wood-landing sites. In terms of trends, machines moved 1) more slowly on wet ground, 2) faster during returning than forwarding, and 3) fastest along wood-landing roads, as to be expected. Low clearances were most notable during winter on snow-covered ground, and on non-frozen shallow DTW and wet multiple-pass ground. During dry weather conditions, clearances also increased from low-pass tracks to multi-pass tracks due to repeat soil compaction of broadened tracks. These results are presented block-by-block and by machine type. Each block-based clearance frequency pattern was quantified through regression analysis and using a gamma probability distribution function.展开更多
文摘BACKGROUND Microangiopathic hemolytic anemia(MAHA) with thrombocytopenia and organ failure caused by tumor-associated thrombotic microangiopathy(TMA) is a lifethreatening oncological emergency. Rapid diagnosis and precise distinction from other forms of TMA is crucial for appropriate therapy, which aims at treating the underlying malignancy. However, the prognosis of patients with cancer-related(CR)-MAHA is limited. To date, less than 50 patients with gastric cancer and CRMAHA have been reported, mainly as single case reports, and detailed information on treatment strategies and outcome are scarce. We analyzed the characteristics and outcomes data of CR-MAHA patients with gastric cancer treated at our center between 2012 and 2019.AIM To gain knowledge about CR-MAHA and the course of disease.METHODS We retrospectively analyzed patients using an institutional prospectively maintained database. Patients who had CR-MAHA but other cancer types or cancer of unknown primary were excluded. The basic requirements for inclusion were: Histologically proven gastric adenocarcinoma;and clinical diagnosis of hemolytic anemia with schistocytes with or without thrombocytopenia. The observation period for each patient started with the first day of documented symptoms. The follow-up period for this analysis ended on February 1, 2020.RESULTS We identified eight patients with a median age of 54 years. Histologically, all patients had(partial) diffuse subtypes of gastric adenocarcinoma with partial or complete signet cell morphology. All patients had metastatic disease and one patient had a microsatellite instability-high(MSI-H) tumor. In three patients, clinical signs of MAHA preceded the diagnosis of cancer, and in two patients, CRMAHA indicated recurrent disease. All patients had severe hemolytic anemia and thrombocytopenia. Six patients experienced severe bone pain, and five patients had dyspnea. Systemic, 5-fluorouracil-based combination chemotherapy was initiated in six patients, which resulted in rapid initial response with significant improvement of clinical symptoms and blood values. Progression-free survival(PFS) of the whole cohort was 1.9 wk and median overall survival(OS) was 1.9 wk. For patients with chemotherapy, PFS was 9.0 wk and OS was 10.3 wk. The patient with the MSI-H tumor has been undergoing immunotherapy for more than 3 years.CONCLUSION The benefit of chemotherapy in CR-MAHA patients is limited. Immunotherapy for patients with MSI-H tumors may lead to long-term tumor control even in CRMAHA patients.
文摘This article reports on track-monitoring and analyzing machine clearances during wood forwarding across seasons and weather, using ultrasonic distance sensors in combination with time-stamped GPS xy locations, at 10 sec intervals. The resulting data, obtained from 54 harvesting blocks, were analyzed by machine type (two wood forwarders and one grapple skidder), stand type (softwood plantation versus natural hardwood stands), month, slope, cartographic depth-to-water (DTW) classes, number of passes along track, and machine speed. For the most part, clearances were highly variable, due to passing over stumps, rocks, harvest slash, brushmats, ruts, and snow cover when present. This variability was on average greater for the lighter-weight wood forwarders than for the heavier-weight skidder, with the former mostly moving along equally spaced lines on brushmats, while the paths of the latter spread away from central wood-landing sites. In terms of trends, machines moved 1) more slowly on wet ground, 2) faster during returning than forwarding, and 3) fastest along wood-landing roads, as to be expected. Low clearances were most notable during winter on snow-covered ground, and on non-frozen shallow DTW and wet multiple-pass ground. During dry weather conditions, clearances also increased from low-pass tracks to multi-pass tracks due to repeat soil compaction of broadened tracks. These results are presented block-by-block and by machine type. Each block-based clearance frequency pattern was quantified through regression analysis and using a gamma probability distribution function.
