How to improve RCHOP as frontline therapy for diffuse large B-cell lymphoma: a systematic review and meta-analysis of 21 randomized controlled trials

RCHOP is the standard of care for patients with diffuse large b-cell lymphoma (DLBCL) but failures occur in approximately 40% of them. We performed a meta-analysis of 21 randomized controlled trials (RCTs) comparing experimental regimens with RCHOP. We searched the database of PubMed with proper criteria, and data of efficacy (Progression Free Survival-PFS) in the ITT population were extracted and analyzed. Cross comparisons of RCTs were performed by using the CINEMA software. Odds ratio (OR) and 95% confidence intervals (95%, CI) are reported. The literature search yielded 21 RCTs including 5785 patients in the RCHOP arm and 5648 patients in the experimental arm. Odds ratio (OR) for PFS in the total cohort was OR (95%, CI): 0.87 (0.76-0.99), p=0.02. Among different strategies to improve RCHOP, addition of a novel agent on RCHOP improved PFS. In total 1740 patients in the RCHOP arm were compared with 1755 in the RCHOP plus a novel agent arm, and the OR (95% CI) for PFS was 0.84 (0.71-0.97), p=0.02. Indirect comparisons of nine studies adding a novel agent on RCHOP does not give prominence to any agent. Subgroup analysis according to cell of origin was performed for non-GC DLBCL patients. In this subgroup, 1546 patients treated with RCHOP were compared with 1538 patients treated with experimental regimens. The OR (95% CI) for PFS was 0.86 (0.73-1.02), p=0.34. Overall survival data extracted from 18 studies showed no superiority of experimental regimens over RCHOP. Efficacy of RCHOP backbone is marginally improved when adding a novel anti-lymphoma agent.

Primary Renal Vein Aneurysm Rupture: Case Report of a Catastrophic Entity

BACKGROUND

Renal vein aneurysms (RVAs) are uncommon entities, which are usually incidental findings or may cause mild nonspecific symptoms. Modern radiological imaging, mainly multislice computed tomography (CT), has substantially contributed to a prompt and accurate diagnosis. Treatment may range from watchful waiting to aneurysmorraphy, aneurysmectomy, and nephrectomy. Potential complications include thrombosis, pulmonary embolism, pressure to other structures, and rupture.

CASE

A 58-year-old male patient was admitted at the emergency department with abdominal pain. He underwent an emergency CT scan which showed a huge retroperitoneal hematoma around the right kidney, while soon afterward he had a hypovolemic shock, less than an hour after a temporary loss of consciousness after an acute emotional distress episode. He underwent an emergency laparotomy and a right nephrectomy because of an RVA. Interestingly, his postoperative course was uneventful and his six-month follow-up was normal.

DISCUSSION

This report presents the rupture of an RVA for the first time, which was successfully treated through nephrectomy by general surgeons in a secondary hospital. This is a catastrophic event which may be lethal, in case prompt diagnosis and surgical intervention delay. Due to the rarity of the disease, its etiology and optimal treatment remain to be clarified.

Perfusion parameters analysis of the vertebral bone marrow in patients with Ph¹⁻ chronic myeloproliferative neoplasms (Ph(neg) MPN): a dynamic contrast-enhanced MRI (DCE-MRI) study

PURPOSE

To evaluate perfusion parameters of the vertebral bone marrow in patients with Philadelphia negative chronic myeloproliferative neoplasms (Ph(neg) MPN) using dynamic contrast-enhanced MRI (DCE-MRI).

MATERIALS AND METHODS

The study enrolled 24 patients with Ph(neg) MPN: 12 patients with myelofibrosis (Group A), 6 with essential thrombocythemia (ET), and 6 with polycythemia vera (PV) (Group B) who underwent DCE-MRI of the lumbosacral spine. Twelve normal individuals served as control group (Group C). Wash-in (WIN), wash-out (WOUT), maximum contrast-enhancement (CE  max), time-to-peak (TTPK), time-to-maximum slope (TMSP), and the WIN/TMSP ratio (WTSP) were calculated.

RESULTS

WIN, CE(max) , and WTSP parameters were higher in Group A than in Group C (P < 0.05). These parameters were significant (P < 0.0001) in discriminating patients with myelofibrosis from normal individuals with sensitivities 74.14%, 87.93%, 74.14%, and specificities 91.07%, 83.93%, 91.07%, respectively. WIN, WOUT, CE(max) , and WTSP parameters were higher in Group A than in Group B (P < 0.05). Group B exhibited no differences in perfusion parameters as compared with Group C with the exception of WOUT.

CONCLUSION

Patients with myelofibrosis exhibited increased perfusion parameters in vertebral bone marrow, which could be consisted with increased vascularity, probably related to neoangiogenesis as opposed to ET or PV patients showing no increased perfusion. DCE-MRI may be of value in discriminating subgroups of Ph(neg) MPN patients and in indicating those progressing to myelofibrosis.

Optic nerve sheath meningioma: a case report

A case of a 75-year old male with right-sided exopthalmos is presented. Outside proptosis of the right eye was initially observed 6 years ago. Opthalmological and endocrinological clinical examination as well as laboratory tests revealed no pathology from optic nerve disc, optic bulb and thyroid related hormones. MRI study demonstrated an optic nerve meningioma. The key imaging findings and the differential diagnosis were discussed in this present paper.

Pedunculated uterine leiomyoma mimicking abdominal mass: a case report

A 48-year-old woman presented with abdominal fullness and a palpable "mass" in the left lower quadrant. Ultrasonography showed a large, rounded, hypoechoic mass. Contrast-enhanced helical CT of the abdomen demonstrated a well-circumscribed, heterogeneously but vividly enhancing mass. The uterus had a leiomyomatous configuration on CT. Uterus and mass revealed the same enhancing pattern. Thin section CT revealed a long, thin stalk connecting the mass with the body of the uterus. Surgical removal of both uterus and the mass confirmed the diagnosis of a pedunculated subserosal leiomyoma originating from a leiomyomatous uterus.

Relaxation phenomena in poly(vinyl alcohol)/fumed silica affected by interfacial water

Interaction of poly(vinyl alcohol) (PVA) with fumed silica was investigated in the gas phase and aqueous media using adsorption, broadband dielectric relaxation spectroscopy (DRS), thermally stimulated depolarization current (TSDC), infrared spectroscopy, thermal analysis, and one-pass temperature-programmed desorption (OPTPD) mass-spectrometry (MS) methods. PVA monolayer formation leads to certain textural changes in the system (after suspension and drying) because of strong hydrogen bonding of the polymer molecules to silica nanoparticles preventing strong interaction between silica particles themselves. This strong interaction promotes associative desorption of water molecules at lower temperatures than in the case of silica alone. Interaction of PVA with silica and residual water leads to depression of glass transition temperature (T(g)). There are three types of dipolar relaxations at temperatures lower and higher than the T(g) value. A small amount of adsorbed water leads to significant conductivity with elevating temperature.

Structure and relaxation dynamics of poly(amide urethane)s with bioactive transition metal acetyl acetonates in hard blocks

Structural characteristics, thermal transitions and molecular dynamics of selected poly(amide urethane)s with transition metal acetyl acetonates Me(AcAc)(2) (Me = Sn(4+), Zn(2+), Cu(2+), Pb(2+)) as chain extenders, were comparatively investigated using small- and wide-angle X-ray scattering (SAXS, WAXS), differential scanning calorimetry (DSC), and dielectric techniques (dielectric relaxation spectroscopy, DRS; thermally stimulated currents, TSC). We studied the influence of metal chelates on the mixing of the soft-segment (SS) and hard-segment (HS) domains and the related degree of microphase separation (DMS). The reactivity of Me(AcAc)(2) with macrodiisocyanate was found to decrease in the order Sn(AcAc)(2)Cl(2) > Cu(AcAc)(2) > Zn(AcAc)(2) > Pb(AcAc)(2). While Pb(AcAc)(2) shows a higher tendency for crystallisation, both the dielectric and calorimetric results suggest that the corresponding polyurethane has comparatively low DMS. The type of the transition metal has moderate effect on the glass transition temperature and no influence on the shape of the dielectric alpha relaxation signal, indicating weak interactions between metal ions and SS domains. In contrast, structural parameters and the dielectric behaviour of the beta relaxation suggest preference for hydrogen-bonding interactions between Sn(4+) and Cu(2+) metal-chelates and HS domains. The temperature dependence of dc conductivity sigma(dc) is described by the Vogel-Tammann-Fulcher equation and signifies the coupling between the mobility of polymeric chains and charges' motion. It may be expected that the present combination of techniques and particular results with respect to DMS will contribute to the development and testing of novel biodegradation-resistant and antibacterial metal-polyurethanes for biotechnological and industrial applications.

The dynamics of water in nanoporous silica studied by dielectric spectroscopy

Broad-band dielectric spectroscopy is used to investigate the dynamics of hydration water on the surface of the cylindrical pores of a nanostructured silica material (MCM-41, with pore diameter of 3.2 nm) at various hydrations, in the temperature range 250-150 K. We focus our attention on orientational relaxations that shift from 0.5 MHz at 250 K to less than 1 Hz at 150 K. The measurements distinguish the relaxation of the hydroxyl groups at the surface of silica from the orientational dynamics of hydration water which strongly depends on the degree of hydration. Although it is significantly faster than the dynamics of water in ice, the orientational relaxation of "non-freezing" water has an activation energy comparable to that in ice when the hydration layer is complete and approximately two-molecule thick.