Gray zone lymphoma effectively treated with cyclophosphamide,doxorubicin,vincristine,prednisolone,and rituximab chemotherapy:A case report

BACKGROUND B-cell lymphoma,unclassifiable,with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma(BCLu-DLBCL/cHL),also referred to as gray zone lymphoma(GZL),is known to share features with cHL and DLBCL.However,GZL is often difficult to diagnose.There is no consensus regarding the optimal therapeutic regimen.Most reported cases of GZL have been in Caucasian and Hispanic individuals,and its incidence is lower in African-American and Asian populations,including the Japanese population.CASE SUMMARY A 69-year-old female presented at our hospital with a growing mass on the right side of her neck.An elastic,soft mass measuring 9 cm×6 cm was palpable in the right cervical region.Laboratory analyses showed pancytopenia,increased serum lactate dehydrogenase levels,and markedly increased levels of soluble interleukin-2 receptor.Enhanced computed tomography(CT)and fluorodeoxyglucose positron emission tomography(PET)/CT revealed multiple lesions throughout her body.She was diagnosed with GZL based on the characteristic pathological findings,the immunophenotype[CD20+,PAX5+,OCT2+/BOB1(focal+),CD30+,CD15-],and the strong positive expression of neoplastic programmed cell death protein ligand 1(PD-L1)in her lymphoma cells.The lymphoma was stage IV according to the Lugano classification and high-risk according to the International Prognostic Index for aggressive non-Hodgkin lymphoma.The patient received cyclophosphamide,doxorubicin,vincristine,prednisolone,and rituximab(R-CHOP)chemotherapy because the tumor cells were CD20+.She has remained in complete remission for 3 years.CONCLUSION GZL was diagnosed based on histopathology and immunophenotyping with ancillary PD-L1 positivity.R-CHOP chemotherapy was an effective treatment.

The value of B7-H3 expression in expressed prostatic secretions in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone

Objective To investigate the value of BT-H3 in expressed prostatic secretions ( EPS) in differential diagnosis of patients with inflammatory elevation of PSA in t - PSA gray zone ( 4 - 10 ng /ml) . Methods One hundred and sixteen patients from ages of 19 to 80 years ( mean,40 years) were studied. In the group there

Analysis of Pressure Forcings for the Vertical Turbulent Fluxes in the Convective Boundary Layer at Gray Zone Resolutions

At kilometer and sub-kilometer resolutions,known as the numerical gray zone for boundary layer turbulence,the atmospheric boundary layer turbulence becomes partially resolved and partially subgrid-scale(SGS) in a numerical model,thus requiring scale-adaptive turbulence schemes.Such schemes are often built by modifying the existing parameterizations,either the planetary boundary layer(PBL) schemes or the large-eddy simulation(LES) closures,to produce the right SGS turbulent fluxes at gray zone resolutions.However,the underlying forcings responsible for the changes in the vertical turbulent fluxes are largely ignored in these approaches.This study follows the original approach of Wyngaard(2004) and analyzes the turbulent buoyancy and momentum flux budgets,to gain a better understanding of the variations of flux forcings at gray zone resolutions.The investigation focuses on the pressure covariance term,which is one of the most dominant terms in the budget equations.By using the coarse-grained LES of a dry convective boundary layer(CBL) case as reference,two widely-used pressure covariance models are evaluated and optimized across the gray zone resolution range.The optimized linear model is further evaluated a priori against another dry CBL case with a different bulk stability,and a shallow-cumulus-topped boundary layer case.The model applies well to both cases,and notably shows good performance for the cloud layer.Based on the analysis of the flux forcings and the optimized pressure model,a scale-adaptive turbulence model for the gray zone is derived from the steady-state flux budgets.

Measurement of serum zinc improves prostate cancer detection efficiency in patients with PSA levels between 4 ng/mL and 10 ng/mL

Aim： To investigate whether the measurement of serum zinc may improve the detection of prostate cancer （PCa） in men who had total prostate-specific antigen （PSA） levels higher than 4.1 ng/mL. Methods： A mass screening for PCa of 3940 men over 50 years old was undertaken using total serum PSA. Of the 190 men （4.8 %） with elevated PSA, 143 （3.6 %） underwent a transrectal ultrasonography （TRUS）-guided biopsy of the prostate, and 42 men （1% of total and 29.3 % of men undergoing biopsy） were found to have cancer. The areas under the receiver operating characteristic curves （ROC-AUC） were used to compare the diagnostic power of cancer detection by means of serum zinc, and free PSA/total PSA ratio （fit）. Results： The men with levels of serum zinc that ranged from 40 ng/mL-60 ng/mL, had an age-adjusted odds ratios（OR） of 5.0. A cutoff value of 100 gg/mL for-serum zinc concentration provided a sensitivity of 90.5 % and a specificity of 32.7 % in elevated PSA range, and a sensitivity of 93.3 % and specificity of 27.1% in gray zone, respectively. In the gray zone ranges of 4.1 ng/mL-10.0 ng/mL, the ROC-AUC for zinc was 73.0 % higher than 62.7 % of f/t PSA ratio and 56.7 % of total PSA. Conclusion： PCa displays a lower serum zinc concentration. The measurement of zinc levels improves PCa detection in the gray zone compared with the f/t PSA ratio and total PSA. （Asian J Androl 2005 Sep; 7： 323-328）

Antiviral Therapy Favors a Lower Risk of Liver Cirrhosis in HBeAg-negative Chronic Hepatitis B with Normal Alanine Transaminase and HBV DNA Positivity

Background and Aims:Direct evidence on the outcomes of hepatitis B e antigen(HBeAg)-negative chronic hepatitis(CHB)patients with normal alanine transaminase after long-term antiviral treatment is lacking.Methods:HBeAg-nega-tive patients with normal ALT and positive HBV DNA(≥20 IU/mL)were retrospectively enrolled.The endpoints included virological response(HBV DNA<100 IU/mL),changes in as-partate aminotransferase to platelet ratio index(APRI)and fibrosis-4 index(FIB-4),and the incidence of liver nodules,cirrhosis,and hepatocellular carcinoma(HCC).Results:This.cohort(n=194)was divided into three subgroups,untreated(n=67),treatment-continued(n=87),and treatment-dis-continued patients(n=40),with a median follow-up of 54 months.The treatment-continued group achieved 100%(95%CI:94.7-100)virological response,and significantly reduced APRI and FIB-4 scores(both p<0.001).The risk of liver nodules and cirrhosis in that group was reduced by 76%(HR:0.24,95%CI:0.11-0.54,p<0.001)and 89%(HR:0.11,95%CI:0.14-0.91,p=0.041)vs.the untreated group and by 77%(HR:0.23,95%CI:0.10-0.49,p<0.001)and 95%(HR:0.05,95%CI:0.01-0.44,p=0.006)vs.the treat-ment-discontinued group.For patients with HBV DNA≥2,000 IU/mL,adherence to treatment lowered the risks of liver cirrhosis by 92%(95%CI:0.01-0.67)and 93%(95%CI:0.01-0.53)vs.the untreated and treatment-discontinued patients,respectively.No patient adhering to treatment de-veloped HCC,but one in each of the remaining groups did.Conclusions:Continuous nucleos(t)ide analog(NA)treat-ment has a satisfactory effectiveness and helps to lower the risk of liver cirrhosis in HBeAg-negative CHB patients with normal alanine transaminase,especially in those with HBV DNA22,000 IU/mL.

Clinical application of free/total PSA ratio in the diagnosis of prostate cancer in men over 50 years of age with total PSA levels of 2.0-25.0 ng ml^(−1) in Western China

The goal of this study was to investigate the clinical application of free/total prostate-specific antigen(F/T PSA)ratio,considering the new broad serum total PSA(T-PSA)“gray zone”of 2.0–25.0 ng ml^(−1)in differential diagnosis of prostate cancer(PCa)and benign prostate diseases(BPD)in men over 50 years in Western China.A total of 1655 patients were included,528 with PCa and 1127 with BPD.Serum T-PSA,free PSA(F-PSA),and F/T PSA ratio were analyzed.Receiver operating characteristic curves were used to assess the efficiency of PSA and F/T PSA ratio.There were 47.4%of cancer patients with T-PSA of 2.0–25.0 ng ml^(−1).When T-PSA was 2.0–4.0 ng ml^(−1),4.0–10.0 ng ml^(−1),and 10.0–25.0 ng ml^(−1),the area under the curve(AUC)of F/T PSA ratio was 0.749,0.769,and 0.761,respectively.The best AUC of F/T PSA ratio was 0.811 when T-PSA was 2.0–25.0 ng ml^(−1),with a specificity of 0.732,a sensitivity of 0.788,and an optimal cutoff value of 15.5%.The AUC of F/T PSA ratio in different age groups(50–59 years,60–69 years,70–79 years,and≥80 years)was 0.767,0.806,0.815,and 0.833,respectively,and the best sensitivity(0.857)and specificity(0.802)were observed in patients over 80 years.The T-PSA trend was in accordance with the Gleason score,tumor node metastasis(TNM)stage,and American Joint Committee on Cancer prognosis group.Therefore,the F/T PSA ratio can facilitate the differential diagnosis of PCa and BPD in the broad T-PSA“gray zone”.Serum T-PSA can be a Gleason score and prognostic indicator.