Helical tomotherapy and systemic targeted therapies in solitary plasmacytoma: Pilot study

AIM: To assess the feasibility of the combination of helical tomotherapy(HT) and a concurrent systemic targeted therapy in patients with solitary plasmacytoma (SP) with the aim to decrease toxicity while improving therapeutic efficacy. METHODS: Six patients with biologically, histologically, and radiologically confirmed SP were treated using HT and a systemic targeted treatment concomitantly. Total dose was 40 Gy/20 fractions. Four patients received 4 cycles of concurrent lenalidomide-dexamethasone combination and two patients were treated with concomitant bortezomib-dexamethasone. All toxicities were described using the Common Terminology Criteria for Adverse Effects v3.0.RESULTS: Five patients had a bone tumor and one patient had an isolated pancreatic mass. Five patients presented with pain, one had neurologic symptoms related to medullary compression, which was treated by an emergency surgery. Median age was 59.5 years (range, 50-74 years). All patients had initial positron emission tomography-computed tomographys, three patients had total body bone magnetic resonance imaging examination, and three patients had computed tomodensitometry scans. The toxicity profile was excellent with no higher than grade 1 toxicity. Four of the six patients experienced a partial radiological response, four had complete response on positions emission tomography and 5/6 patients experienced a complete relief of their symptoms 4 mo after treatment. At a median follow-up of 18 mo, 5/6 patients were controlled clinically, radiologically, and biologically. CONCLUSION: Using HT, we could deliver a highly conformal irradiation concurrently with a molecularly targeted therapy. This association yielded in a high response rate and a low toxicity. A prospective study with longer follow-up will help determining the true benefit of such strategy.

Therapy-related acute promyelocytic leukemia with FMS-like tyrosine kinase 3-internal tandem duplication mutation in solitary bone plasmacytoma: A case report

BACKGROUND Therapy-related acute promyelocytic leukemia(t-APL)is a rare complication observed in solitary bone plasmacytoma(SBP),and SBP after radiotherapy evolving to APL harboring the FMS-like tyrosine kinase 3-internal tandem duplication(FLT3-ITD)mutation has never been reported.Here,we present the first case reported until now.CASE SUMMARY We describe a 64-year-old woman who presented with lumbar pain and was initially diagnosed with SBP.However,after one year of radiotherapy treatment,this patient experienced a long-standing bone-marrow-suppressive period and finally developed APL harboring the FLT3-ITD mutation,as confirmed by analyses of clinical features,bone marrow morphology,flow cytometry,cytogenetic examination,and molecular biology.On admission,the patient had disseminated intravascular coagulation and intracranial hemorrhage,and the peripheral blood and bone marrow smear displayed abundant abnormal promyelocytes.Unfortunately,she died when the definite diagnosis was made.CONCLUSION The patient with t-APL harboring FLT3-ITD mutation evolving from SBP after radiotherapy had not been reported and had poor clinical outcomes.FLT3-ITD mutation in t-APL may be a potential pathogenesis of leukemogenesis.We should consider the potential risk of secondary neoplasms in SBP patients after radiotherapy.

MR Imaging Features of Solitary Plasmacytoma of the Spine

OBJECTIVE To evaluate the MR imaging features of solitary plasmacytomas of the spine. METHODS The MR images of 7 patients with histologically proven solitary plasmacytomas of the spine were reviewed. RESULTS All tumors showed predominantly isoto hypointensity relative to muscle on Tl-weighted MR images and intermediate signal intensity between muscle and fat on T2- weighted images. Curvilinear low signal intensity structures were seen within the lesions on T1 and T2-weighted images in five tumors. Moderate to strong enhancement was seen in all 6 tumors that underwent contrast enhanced MR examination. All tumors showed areas of high signal intensity on T2-weighted images and heterogeneous enhancement, except the 2 largest tumors without pathologic fracture in the sacrum. Intervertebral discs were preserved in all tumors. CONCLUSION The MR imaging features that suggest plasmacytorna of the spine include predominant intermediate signal intensity on T2-weighted images, curvilinear low signal intensity structures, moderate to strong enhancement, relatively homogeneous appearance if there are no pathologic fracture and preservation of the intervertebral discs.

Clinicopathological Analysis of a Primary and Solitary Brain Plasmacytoma: Case Report with an Encepha-locoele

A primary and solitary plasmacytoma with an encephalocoele is an extremely rare tumortx. The origin of plasmacytoma cells has not been clarified, but a number of studies have suggested the possibility that it originates from the meninges and reticular cells of the Virchow-Robin space. Other studies have suggested that plasmacytoma cells may possibly arise from original reticular and stem cells.

Extramedullary plasmacytoma with the uvula as first affected site:A case report

BACKGROUND Extramedullary plasmacytoma(EMP)represents one of the rarer forms of plasma cell malignancies,capable of impacting a variety of tissues and organs throughout the body.The majority of EMP cases are predominantly found in the head and neck region,especially within the laryngopharynx,as well as in the gastrointestinal tract.While there have been documented instances of oropharyngeal involvement in EMP cases in the academic literature,it is important to note that EMP specifically affecting the uvula is exceedingly uncommon.Furthermore,it is noteworthy that over 60% of epithelial carcinomas in the upper respiratory tract and oropharynx tend to metastasize to the cervical lymph nodes,indicating a propensity for regional spread in these types of cancers.In this context,we present a rare case of extramedullary plasmacytoma where the uvula served as the initially affected site.This case emphasizes the need for heightened awareness among clinicians regarding such unusual comorbidities,as early recognition and diagnosis can significantly influence patient management and treatment outcomes.In addition,a review of the relevant literature is included to further educate and inform healthcare professionals about this rare presentation,ultimately aiming to enhance clinical understanding and improve patient care in similar situations.CASE SUMMARY A 51-year-old man was admitted to our hospital because of a slowly enlarging neck mass.A physical examination revealed a palpable left lymph node,and magnetic resonance imaging(MRI)of the oropharynx and the neck showed a soft tissue mass in the oropharynx and enlargement of multiple lymph nodes in the neck.The soft tissue mass was diagnosed as plasmacytoma by immunohistochemical analysis.Monoclonal immunoglobulins and bone marrow biopsy showed normal results.Therefore,we diagnosed that as EMP of the uvula.After four cycles of adjuvant chemotherapy dominated by bortezomib,MRI reexamination showed a significant reduction of the mass in the oropharynx and the cervical lymph nodes.Afterwards,the λ light chain returned to normal levels.There was no evidence of evolution to multiple myeloma.CONCLUSION We have reported a rare case of extramedullary plasmacytoma with the uvula as the first affected site and the relevant literature is reviewed to improve clinicians'awareness of such rare comorbidities.

Experimental Study on the Variation of Optical Imaging Characteristics with Zenith Angle due to Internal Solitary Waves in Sunglint

Internal solitary waves(ISWs)change the roughness of the sea surface,thus producing dark and bright bands in optical images.However,reasons for changes in imaging characteristics with the solar zenith angle remain unclear.In this paper,the optical imaging pattern of ISWs in sunglint under different zenith angles of the light source is investigated by collecting optical images of ISWs through physical simulation.The experiment involves setting 10 zenith angles of the light source,which are divided into area a the optical images of ISWs in the three areas show dark-bright mode,single bright band,and bright-dark mode,which are consistent with those observed by optical remote sensing.In addition,this study analyzed the percentage of the dark and bright areas of the bands and the change in the relative gray difference and found changes in both areas under different zenith angles of the light source.The MODIS and ASAR images display a similar brightness-darkness distance of the same ISWs.Therefore,the relationship between the brightness-darkness distance and the characteristic half-width of ISWs is determined in accordance with the eKdV theory and the imaging mechanism of ISWs of the SAR image.Overall,the relationship between them in the experiment is almost consistent with the theoretical result.

Loads and Dynamic Response Characteristic on FPSO Under Internal Solitary Waves

According to the established prediction model of internal solitary wave loads on FPSO in the previous work,the lumped mass model and the movement equations of finite displacement in time domain,the dynamic response model of interaction between internal solitary waves and FPSO with mooring lines were established.Through calculations and analysis,time histories of dynamic loads of FPSO exerted by internal solitary waves,FPSO’s motion and dynamic tension of mooring line were obtained.The effects of the horizontal pretension of mooring line,the amplitude of internal solitary wave and layer fluid depth on dynamic response behavior of FPSO were mastered.It was shown that the internal solitary waves had significant influence on FPSO,such as the large magnitude horizontal drift and a sudden tension increment.With internal solitary wave of −170 m amplitude in the ocean with upper and lower layer fluid depth ratio being 60:550,the dynamic loads reached 991.132 kN(horizontal force),18067.3 kN(vertical force)and−5042.92 kN·m(pitching moment).Maximum of FPSO’s horizontal drift was 117.56 m.Tension increment of upstream mooring line approached 401.48 kN and that of backflow mooring line was−140 kN.Moreover,the loads remained nearly constant with different pretension but increased obviously with the changing amplitude and layer fluid depth ratio.Tension increments of mooring lines also changed little with the pretension but increased rapidly when amplitude and layer fluid depth ratio increased.However,FPSO’s motion increased quickly with not only the horizontal pretension but also the amplitude of internal solitary wave and layer fluid depth ratio.

Interaction between internal solitary waves and the seafloor in the deep sea

Internal solitary wave(ISW),as a typical marine dynamic process in the deep sea,widely exists in oceans and marginal seas worldwide.The interaction between ISW and the seafloor mainly occurs in the bottom boundary layer.For the seabed boundary layer of the deep sea,ISW is the most important dynamic process.This study analyzed the current status,hotspots,and frontiers of research on the interaction between ISW and the seafloor by CiteSpace.Focusing on the action of ISW on the seabed,such as transformation and reaction,a large amount of research work and results were systematically analyzed and summarized.On this basis,this study analyzed the wave–wave interaction and interaction between ISW and the bedform or slope of the seabed,which provided a new perspective for an in‐depth understanding of the interaction between ISW and the seafloor.Finally,the latest research results of the bottom boundary layer and marine engineering stability by ISW were introduced,and the unresolved problems in the current research work were summarized.This study provides a valuable reference for further research on the hazards of ISW to marine engineering geology.

Study on the Load Characteristics of Submerged Body Under Internal Solitary Waves on the Continental Shelf and Slope

Based on the high-quality observation data and the numerical simulation,the evolution characteristics of internal solitary waves(ISWs)and the load on the suspend submerged body are studied on the continental shelf and slope separately.The observed ISWs exhibit the first mode depression ISWs.The amplitudes of ISWs on the shelf and slope areas reach 50 m and 80 m,respectively.The upper layer velocity in the westward direction is about 0.8 m/s on the continental shelf and 0.9 m/s on the continental slope during the passing through of ISWs.The lower layer is dominated by the eastward compensating flow.In the vertical direction,the water in front of the wave flows downward,while the water behind the wave flows upward,and the maximum vertical velocity exceeds 0.2 m/s.Numerical simulation results show that the larger the amplitude of ISWs,the larger the load on the submerged body.The force on the submerged body by ISWs is dominated by the vertical force,and the corresponding maximum vertical forces on the continental shelf and slope are−25 kN and −27 kN.The submerged body is subjected to a large counterclockwise moment and the sudden change of the moment will also cause the submerged body to capsize.This paper not only gives a deeper understanding of the characteristics of ISWs from the deep continental slope to the shallow continental shelf,but also has a certain guiding value for the prediction of ISWs and for marine military activities.

Unveiling three-dimensional sea surface signatures caused by internal solitary waves:insights from the surface water ocean topography mission

Internal solitary waves(ISW),characterized by large amplitude and long propagation distance,are widespread in global oceans.While remote sensing images have played an essential role in studying ISWs,they mainly exploit two-dimensional image information.However,with the launch of the surface water ocean topography(SWOT)satellite on December 16,2022,a unique opportunity has emerged to capture wide-swath three-dimensional ISW-induced sea surface information.In this study,we examine ISWs in the Andaman Sea using data from the Ka-band Radar Interferometer(KaRIN),a crucial sensor onboard SWOT.KaRIN not only provides backscattering satellite images but also employs synthetic aperture interferometry techniques to retrieve wide-swath two-dimensional sea surface height measurements.Our observations in the Andaman Sea revealed the presence of ISWs characterized by dark-bright strips and surface elevation solitons.The surface soliton has an amplitude of 0.32 m,resulting in an estimation of ISW amplitude of approximately 60 m.In contrast to traditional two-dimensional satellite images or nadir-looking altimetry data,the SWOT mission’s capability to capture threedimensional sea surface information represents a significant advancement.This breakthrough holds substantial promise for ISW studies,particularly in the context of ISW amplitude inversion.

Experimental study on the variation of optical remote sensing imaging characteristics of internal solitary waves with wind speed

Optical remote sensing has been widely used to study internal solitary waves(ISWs).Wind speed has an important effect on ISW imaging of optical remote sensing.The light and dark bands of ISWs cannot be observed by optical remote sensing when the wind is too strong.The relationship between the characteristics of ISWs bands in optical remote sensing images and the wind speed is still unclear.The influence of wind speeds on the characteristics of the ISWs bands is investigated based on the physical simulation experiments with the wind speeds of 1.6,3.1,3.5,3.8,and 3.9 m/s.The experimental results show that when the wind speed is 3.9 m/s,the ISWs bands cannot be observed in optical remote sensing images with the stratification of h_(1)∶h_(2)=7∶58,ρ_(1)∶ρ_(2)=1∶1.04.When the wind speeds are 3.1,3.5,and 3.8 m/s,which is lower than 3.9 m/s,the ISWs bands can be obtained in the simulated optical remote sensing image.The location of the band’s dark and light extremum and the band’s peak-to-peak spacing are almost not affected by wind speed.More-significant wind speeds can cause a greater gray difference of the light-dark bands.This provided a scientific basis for further understanding of ISW optical remote sensing imaging.

Spatiotemporal variations of parameters of internal solitary waves in the northern South China Sea

The dynamic parameters for internal solitary waves(ISWs)derived from the extended Korteweg-de Vries(eKdV)equation play an important role in the understanding and prediction of ISWs.The spatiotemporal variations of the dynamic parameters of the ISWs in the northern South China Sea(SCS)were studied based on the reanalysis of long-term temperature and salinity datasets.The results for spectrum analysis show that there are definite geographical differences for the periodic variation of the parameters:in shallow water,all parameters vary with a wave period of one year,while in deep water wave components of the parameters at other frequencies exist.Using wavelet analysis,the wavelet power spectral densities in deep water exhibited an inter-annual variation pattern.For example,the wave component of the dispersion coefficient with a wave period of about half a year reached its power peak once every two years.Based on previous work,this inter-annual variation pattern was deduced to be caused by dynamic processes.In further work on the regulatory mechanisms,empirical orthogonal function(EOF)decomposition was performed.It was found that the modes of the dispersion coefficient have different geographical distributions,explaining the reason why the wave components in different frequencies appeared in different locations.The numerical simulation results confirm that the variations in the parameters of the ISWs derived from the eKdV equation could affect the waveforms significantly because of changes in the polarity of the ISWs.Therefore,the periodic variations of the dynamic parameters are related to the geographical location because of dynamic processes operating.

Shoaling Internal Solitary Waves and the Formation of Boluses

An internal solitary wave of elevation in a two-layer density stratified system of an incompressible, viscous and homogeneous fluid was studied. The run-up of a wave of elevation encountering different slopes was investigated numerically based on solving the continuity, Navier-Stokes and convective-diffusion equations within the Boussinesq approximation. The commercial software COMSOL Multiphysics was used to conduct the numerical simulations. For gradual shoals, a bolus formed that transported dense fluid up the shoal. The bolus disappeared when it reached its maximum height on the slope due to the draining of the dense fluid. Various shoal angles were simulated to detect the critical angle above which a bolus does not form. An angle of 30 or less resulted in the formation of a bolus. In addition, the simulations demonstrated that the size of the bolus induced by shallower slopes was larger and that the vertical height traveled by the bolus was insensitive to the slope of the shoal.

Study of the ability of SWOT to detect sea surface height changes caused by internal solitary waves

Surface Water and Ocean Topography(SWOT)is a next-generation radar altimeter that offers high resolution,wide swath,imaging capabilities.It has provided free public data worldwide since December 2023.This paper aims to preliminarily analyze the detection capabilities of the Ka-band radar interferometer(KaRIn)and Nadir altimeter(NALT),which are carried out by SWOT for internal solitary waves(ISWs),and to gather other remote sensing images to validate SWOT observations.KaRIn effectively detects ISW surface features and generates surface height variation maps reflecting the modulations induced by ISWs.However,its swath width does not completely cover the entire wave packet,and the resolution of L2/L3 level products(about 2 km)cannot be used to identify ISWs with smaller wavelengths.Additionally,significant wave height(SWH)images exhibit blocky structures that are not suitable for ISW studies;sea surface height anomaly(SSHA)images display systematic leftright banding.We optimize this imbalance using detrending methods;however,more precise treatment should commence with L1-level data.Quantitative analysis based on L3-level SSHA data indicates that the average SSHA variation induced by ISWs ranges from 10 cm to 20 cm.NALTs disturbed by ISWs record unusually elevated SWH and SSHA values,rendering the data unsuitable for analysis and necessitating targeted corrections in future retracking algorithms.For the normalized radar cross section,Ku-band and four-parameter maximum likelihood estimation retracking demonstrated greater sensitivity to minor changes in the sea surface,making them more suitable for ISW detection.In conclusion,SWOT demonstrates outstanding capabilities in ISW detection,significantly advancing research on the modulation of the sea surface by ISWs and remote sensing imaging mechanisms.

Nonlinear interaction of head-on solitary waves in integrable and nonintegrable systems

This study numerically investigates the nonlinear interaction of head-on solitary waves in a granular chain(a nonintegrable system)and compares the simulation results with the theoretical results in fluid(an integrable system).Three stages(the pre-in-phase traveling stage,the central-collision stage,and the post-in-phase traveling stage)are identified to describe the nonlinear interaction processes in the granular chain.The nonlinear scattering effect occurs in the central-collision stage,which decreases the amplitude of the incident solitary waves.Compared with the leading-time phase in the incident and separation collision processes,the lagging-time phase in the separation collision process is smaller.This asymmetrical nonlinear collision results in an occurrence of leading phase shifts of time and space in the post-in-phase traveling stage.We next find that the solitary wave amplitude does not influence the immediate space-phase shift in the granular chain.The space-phase shift of the post-in-phase traveling stage is only determined by the measurement position rather than the wave amplitude.The results are reversed in the fluid.An increase in solitary wave amplitude leads to decreased attachment,detachment,and residence times for granular chains and fluid.For the immediate time-phase shift,leading and lagging phenomena appear in the granular chain and the fluid,respectively.These results offer new knowledge for designing mechanical metamaterials and energy-mitigating systems.

Ion acoustic solitary waves in an adiabatic dusty plasma:Roles of superthermal electrons,ion loss and ionization

We investigate propagation of dust ion acoustic solitary wave(DIASW)in a multicomponent dusty plasma with adiabatic ions,superthermal electrons,and stationary dust.The reductive perturbation method is employed to derive the damped Korteweg-de Vries(DKdV)equation which describes DIASW.The result reveals that the adiabaticity of ions significantly modifies the basic features of the DIASW.The ionization effect makes the solitary wave grow,while collisions reduce the growth rate and even lead to the damping.With the increases in ionization cross sectionΔσ/σ_(0),ion-to-electron density ratioδ_(ie)and superthermal electrons parameterκ,the effect of ionization on DIASW enhances.

Selective Impact of Dispersion and Nonlinearity on Waves and Solitary Wave in a Strongly Nonlinear and Flattened Waveguide

The waveguide which is at the center of our concerns in this work is a strongly flattened waveguide, that is to say characterized by a strong dispersion and in addition is strongly nonlinear. As this type of waveguide contains multiple dispersion coefficients according to the degrees of spatial variation within it, our work in this article is to see how these dispersions and nonlinearities each influence the wave or the signal that can propagate in the waveguide. Since the partial differential equation which governs the dynamics of propagation in such transmission medium presents several dispersion and nonlinear coefficients, we check how they contribute to the choices of the solutions that we want them to verify this nonlinear partial differential equation. This effectively requires an adequate choice of the form of solution to be constructed. Thus, this article is based on three main pillars, namely: first of all, making a good choice of the solution function to be constructed, secondly, determining the exact solutions and, if necessary, remodeling the main equation such that it is possible;then check the impact of the dispersion and nonlinear coefficients on the solutions. Finally, the reliability of the solutions obtained is tested by a study of the propagation. Another very important aspect is the use of notions of probability to select the predominant solutions.

Solitary plasmacytoma of the left rib misdiagnosed as angina pectoris:A case report

BACKGROUND Solitary plasmacytoma in the left rib is rare and can cause chest discomfort such as chest pain and tightness,and its clinical manifestations are not typical,so it is often misdiagnosed.We report a case of left costal plasmacytoma misdiagnosed as angina pectoris.We also review the literature and provide suggestions as to how to avoid misdiagnosis.CASE SUMMARY A 77-year-old man with a history of intermittent chest tightness for 3 years presented with pain in the left chest for 1 wk and was admitted to hospital.The cardiologists initially diagnosed angina pectoris but the findings of coronary angiography were not consistent with the symptoms.Computed tomography showed that the left eighth rib mass was accompanied by bone destruction.The patient was transferred to our department for further treatment.Preoperative biopsy indicated that the lesion was possibly malignant,and elective surgery was performed to remove the lesion.The size of the tumor was about 4 cm.The tumor was spindle-shaped and protruded into the pleural cavity,without invading the lungs.Postoperative pathology confirmed that the left rib lesion was plasmacytoma.After 14 mo follow-up,the patient died of systemic metastasis.CONCLUSION Left rib solitary plasmacytoma is a rare disease confined to a specific rib and can cause local pain.Attention should be paid to the differential diagnosis of angina pectoris to avoid misdiagnosis.

SOLITARY PLASMACYTOMA OF BONE AND EXTRAMEDULLARY PLASMACYTOMA

Among plasma cell disorders, solitary plasmacytoma (solitany-plasmacytoma of bone, SPB and extramedullary plasmacytoma, EMP) is rare as compared with mulitiple myeloma (MM). Furthermore.the relationship between solitary plasmacytoma and MM remains unclear.Between 1960 and 1994, 24 patients with SPB and 20 with EMP were treated. The criteria for diagonosis were: (1) No evidence of other lesions based on clinical and radiologic examinations;(2) Biopsy evidence of a plasma cell neoplasm; (3) Bone marrow biopsy specimen with negative findings (less than 10% plasma cell); (4) No anemia, hypercalcemia or renal involvement. The average follow-up period was 112 months (from 6 to 360 months). Fifty-four percent of patients with SPB and 40% of patients with EMP developed MM, however, there was no significant statistical difference between SPB and EMP (P <0.05).We suggested that solitary plasmacytomas be classified as two types, latent and aggressive. The former was histologically well-differentiated plasmacytomas. The latter was poorly differentiated tumors which easily progress to MM. The treatment of choice is wide excision or thorough curettage, by cryogenic necrosis with liquid nitrogen or cautery of the bony wall with phenol and the cavity filled with bone grafts or cement. All patients with apparently isolated plasmacytoma should he given if the tumor turns out to be poorly differentiated, in order to delay their progression to MM.

Solitary bone plasmacytoma of the upper cervical spine: A case report

BACKGROUND Solitary bone plasmacytoma(SBP)of the upper cervical spine is a rare diagnosis.The exact role of surgery for SBP remains unclear.CASE SUMMARY We present the first case of SBP of the C2.A 69-year-old Chinese woman presented with severe neck pain and limitation of rotative activity for 2 mo.She underwent anterior one-stage debridement combined with cement augmentation in the C2 to reconstruct stability of the spine.The patient did not receive postoperative radiotherapy.She now remains disease free with no neck pain or neurological deficit after follow-up of 3 years.CONCLUSION Anterior one-stage debridement combined with cement augmentation of the upper cervical spine may be an alternative treatment for SBP.