[Treatment of orbital vascular malformations with intralesional bleomycin injection and N-butyl-2-cyanoacrylate glue embolization]

Objective: To evaluate the clinical efficacy of bleomycin lavage combined with N-butyl-2-cyanoacrylate glue embolization and resection in the treatment of orbital vascular malformations. Methods: It was a retrospective case series study. Patients with orbital vascular malformations diagnosed at the Ophthalmology Division of Chinese PLA General Hospital from January 2018 to October 2021 were included and divided into exophthalmos group and non-exophthalmos group based on whether the patients had postural exophthalmos. Intralesional bleomycin injection and N-butyl-2-cyanoacrylate glue embolization were performed. The preoperative and postoperative visual acuity, the dosages of bleomycin and isobutyl cyanoacrylate glue, pathological results, imaging findings and remission rate were recorded and analyzed. The Chi-square test, Wilcoxon signed rank analysis and Mann-Whitney U test were used for statistical analysis. Results: A total of 58 patients (58 eyes)were included, and there were 22 males (37.9%)　and 36 females (62.1%). Nineteen (32.8%) patients had postural exophthalmos, and 39 (67.2%) patients did not suffer postural exophthalmos. The patient's age of the two groups was 39.0 (28.0, 54.5) years vs. 14.0 (5.7, 26.5) years, with a statistically significant difference (Z=-3.96, P<0.001). There was no significant difference in gender, eye laterality, follow-up time and the disease course between the two groups (all P>0.05). During the operation, the dosage of bleomycin was 15 000 (13 500, 15 000) U in the exophthalmos group, and 15 000 (9 000, 16 500) U in the non-exophthalmos group (Z=-0.70, P=0.944). The dosages of N-butyl-2-cyanoacrylate glue were 2.8 (1.0, 3.0) ml and 1.7 (1.0, 2.2) ml, respectively, in the two groups, with no significant difference (Z=-1.11, P=0.268). There was no visual impairment in both groups, while the visual acuity in 5 patients without postural exophthalmos was improved postoperatively. The imaging examination results showed no difference in the malformed vascular area before and after the treatment in the exophthalmos group [384.0 (329.0, 458.0) mm² vs. 330.5 (271.6, 356.7) mm²; Z=-1.26, P=0.208], but a significantly decreased area after the treatment in the non-exophthalmos group [960.8 (822.1, 1058.3) mm² vs. 311.6 (164.6, 361.6) mm²; Z=-2.67, P=0.008]. All patients had no obvious local or systemic adverse reactions during the follow-up. The pathology reports showed vascular malformations in all 15 specimens obtained from the exophthalmos group, as well as vascular malformations in 41.0% (16/39) of specimens and venous lymphatic malformations in 59.0% (23/39) of specimens from the non-exophthalmos group. Thirty-nine patients had complete remission (67.2%), 19 patients had partial remission (32.8%), and the effective treatment rate was 100%. Conclusion: Bleomycin lavage combined with N-butyl-2-cyanoacrylate glue embolization can achieve good therapeutic effects on orbital vascular malformations.

[A case report of orbital epithelioid hemangioendothelioma]

A 70-year-old male patient, who had a right upper eyelid tumor excision 4 years ago, complained of eyelid swelling and ptosis for 3 months. Orbital CT and MRI showed an orbital cystic lesion with hemorrhage in the right eye. The tumor was resected under general anesthesia. The pathological diagnosis was epithelioid hemangioendothelioma. (Chin J Ophthalmol, 2021, 57:696-698).

Preparation of Nano-Copper Sulfide and Its Adsorption Properties for 17α-Ethynyl Estradiol

In the present work, a tubular nano-copper sulfide was successfully synthesized by hydrothermal method. The physical and chemical properties of the prepared materials were characterized by XRD, SEM, TEM, and BET. The synthesized copper sulfide was used as an adsorbent for removing 17α-ethynyl estradiol (EE2) and exhibited excellent adsorption properties. At 25 °C, 15 mg of adsorbent was applied for 50 mL of 5 mg/L EE2 solution, adsorption equilibrium was reached after 180 min, and the adsorption rate reached nearly 90%. In addition, the kinetics, isothermal adsorption, and thermodynamics of the adsorption process were discussed on the basis of theoretical calculations and experimental results. The theoretical maximum adsorption capacity of copper sulfide was calculated to be 147.06 mg/g. The results of this study indicated that copper sulfide was a stable and efficient adsorbent with promising practical applications.

A randomized, placebo-controlled phase 2 study of ganitumab (AMG 479) or conatumumab (AMG 655) in combination with gemcitabine in patients with metastatic pancreatic cancer

BACKGROUND

We evaluated the efficacy and safety of ganitumab (a mAb antagonist of insulin-like growth factor 1 receptor) or conatumumab (a mAb agonist of human death receptor 5) combined with gemcitabine in a randomized phase 2 trial in patients with metastatic pancreatic cancer.

PATIENTS AND METHODS

Patients with a previously untreated metastatic pancreatic adenocarcinoma and an Eastern Cooperative Oncology Group (ECOG) performance status ≤1 were randomized 1 : 1 : 1 to i.v. gemcitabine 1000 mg/m(2) (days 1, 8, and 15 of each 28-day cycle) combined with open-label ganitumab (12 mg/kg every 2 weeks [Q2W]), double-blind conatumumab (10 mg/kg Q2W), or double-blind placebo Q2W. The primary end point was 6-month survival rate. Results In total, 125 patients were randomized. The 6-month survival rates were 57% (95% CI 41-70) in the ganitumab arm, 59% (42-73) in the conatumumab arm, and 50% (33-64) in the placebo arm. The grade ≥3 adverse events in the ganitumab, conatumumab, and placebo arms, respectively, included neutropenia (18/22/13%), thrombocytopenia (15/17/8%), fatigue (13/12/5%), alanine aminotransferase increase (15/5/8%), and hyperglycemia (18/2/3%).

CONCLUSIONS

Ganitumab combined with gemcitabine had tolerable toxicity and showed trends toward an improved 6-month survival rate and overall survival. Additional investigation into this combination is warranted. Conatumumab combined with gemcitabine showed some evidence of activity as assessed by the 6-month survival rate.

Prognostic factors by histologic subtype in stage IV non-small cell lung cancer (NSCLC): A population-based survival analysis of data from the Surveillance, Epidemiology, and End Results (SEER) Program (1988–2003)

11053

Background: Representing roughly 85% of all lung cancers, NSCLC is frequently diagnosed at an advanced stage and has a poor prognosis. To better understand the prognostic importance of select patient and tumor characteristics in late-stage disease, we examined survival in patients diagnosed with stage IV NSCLC. Methods: Data from SEER were used to study 53,319 patients with stage IV NSCLC diagnosed between 1988 and 2003, with follow-up through 2005. The distribution of cases according to time period of diagnosis and select patient and tumor characteristics was described for each histologic subtype (squamous; adenocarcinoma (bronchioloalveolar adenocarcinoma (BAC), non-BAC); large cell; and other/unknown). Kaplan-Meier and multivariate Cox proportional hazard models were used to examine the influence of these variables on overall survival by histologic subtype. Results: Most recent period of diagnosis (1998–2003 versus 1988–1992) conferred a survival advantage across histologic subtypes, independent of gender, age, ethnicity/race, tumor grade, and uptake of surgery/radiation. This was especially pronounced for those diagnosed with large cell tumors (adjusted hazard ratio (aHR): 0.76, 95% confidence interval (CI): 0.71–0.82). Similarly, females survived longer than males across histologic groups, particularly for those with BAC tumors (aHR: 0.77, 95% CI: 0.66–0.89). Increasing age was associated with reduced survival in all histologic subtypes except BAC, where prognosis was poorest in the youngest age group. The influence of ethnicity/race also varied with histology: compared to Whites, American Indians/Alaskan Natives with squamous tumors and Blacks with large cell tumors had a poorer prognosis, whereas Asians/Pacific Islanders with either non-BAC or large cell tumors demonstrated superior survival. Conclusions: Survival among stage IV NSCLC patients improved over the study period, which may reflect the use of third generation chemotherapy as well as better supportive care. Nonetheless, lung cancer remains a deadly disease, and the prognostic effect of demographic factors varies with histologic subtype.

[Table: see text]

Effect of zoledronic acid (Zol) compared with placebo on overall disease and bone lesion progression in patients (pts) with bone metastases from certain solid tumors: Stratification by baseline characteristics

18541

Background: Zol has been shown to significantly reduce the risk of skeletal complications compared with placebo in pts with bone metastases from a wide range of solid tumors including a delay of bone lesion progression in pts with renal cancer. To assess whether Zol may reduce the risk of overall disease or bone lesion progression in pts with solid tumors other than breast, non-small cell lung, and prostate cancers, we conducted a retrospective analysis of pts enrolled in a large, randomized, controlled trial. Methods: Pts treated with Zol or placebo were retrospectively stratified by baseline characteristics, including Brief Pain Inventory (BPI) composite pain score, time from initial cancer diagnosis to development of bone metastases, and duration of cancer. The relative risk (RR) of disease progression during 25 months on study was analyzed using the Cox proportional hazards model (stratified log rank). Results: Median baseline BPI pain score was 2.75, median time with cancer was 15 months, and median time to development of bone metastases was 8.5 months. In pts with a baseline BPI score ≥ 2.75 (n = 236), Zol treatment significantly reduced the RR of disease progression by 34% (hazard ratio [HR] = 0.657; P = .014) and the RR of bone lesion progression by 32% (HR = 0.680; P = .028) compared with placebo. Additionally, in pts with cancer duration <15 months (n = 193), Zol treatment reduced the RR of disease progression by 45% (HR = 0.547; P = .002) and the RR of bone lesion progression by 40% (HR = 0.605; P = .016) compared with placebo. Similarly, among pts who developed bone metastases < 8.5 months from initial diagnosis of cancer (n = 193), Zol treatment significantly reduced the RR of disease progression by 39% and the RR of bone lesion progression by 48% compared with placebo (HR = 0.611; P = .009 and HR = 0.519; P = .004, respectively). Conclusions: This exploratory analysis suggests that Zol has potential antitumor effects that may reduce the risk of overall disease and bone lesion progression in pts who have higher pain scores and shorter time to development of bone metastases. Prospective studies are needed to confirm this result.

[Table: see text]

Effect of zoledronic acid (Zol) compared with pamidronate (Pam) on disease progression in breast cancer (BC) patients with bone metastases stratified by baseline characteristics

678

Background: Zol has been shown to significantly reduce the risk of skeletal complications compared with Pam in BC pts with bone metastases. Zol has also demonstrated antitumor effects in animal models of human BC and significantly delayed bone lesion progression in pts with renal cancer. To assess whether Zol may reduce the risk of overall disease progression compared with Pam, we conducted a retrospective analysis of BC pts enrolled in a large randomized, controlled trial. Methods: Patients treated with Zol or Pam were retrospectively stratified by baseline characteristics, including Brief Pain Inventory (BPI) composite pain score, time from initial cancer diagnosis to development of bone metastases, and duration of cancer. The relative risk of overall disease progression during 25 months on study was analyzed using the Cox proportional hazards model. Results: Median BPI pain score at baseline was 2.75, median time to development of bone metastases was 44 months, and median time with cancer was 58 months for all patients. In the subset of pts with a baseline BPI score ≥ 2.75 (n = 556), treatment with Zol significantly reduced the risk of disease progression by 21% compared with Pam (hazard ratio [HR] = 0.793; P = .018). Similarly, among pts who developed bone metastases < 44 months from initial diagnosis of cancer (n = 564) and pts with cancer for < 58 months (n = 563), treatment with Zol reduced the risk of disease progression by approximately 20% compared with Pam (HR = 0.805; P = .026 and HR = 0.800; P = .023, respectively). Conclusions: Zol significantly reduced the risk of overall disease progression compared to Pam in specific subsets of pts with higher pain scores and shorter time to development of bone metastases. This exploratory analysis suggests that Zol has potential antitumor effects that may reduce the risk of disease progression in this patient population. These results are consistent with published reports and provide the initiative for further investigations with additional clinical studies.

[Table: see text]

Effect of zoledronic acid (Z) on pain in prostate cancer patients with bone metastases based on performance status

14544

Background: Z has demonstrated efficacy in reducing, preventing, delaying the occurrence of an SRE (Skeletal Related Event) including pathologic fractures, severe bone pain requiring radiation therapy, spinal cord compression, surgery to bone and hypercalcemia of malignancy which could lead to a loss of independence. Effects of Z on pain were analyzed in a subgroup of patients based on performance status. Methods: Subjects were randomised to Z 4mg (n = 201) or placebo (n = 201). The short form of the Brief Pain Inventory (BPI) was administered at baseline (visit 2), and visits 3 (weeks 3–4), 4 (weeks 6–8), and then every second visit (every 6 weeks) until study end. Changes in BPI individual item scores and the Pain severity and Pain Interference scale scores were compared between Z and placebo groups. Post baseline missing data were replaced by Last Observation carried forward (LOCF). Changes in scores were examined in the subgroup of patients with ECOG performance status scores of ≥ 1. Results: For patients ECOG score of ≥ 1 at baseline (n = 227), Z was superior to placebo in the BPI items ‘pain at its worst’, ‘pain at its least’, ‘pain on average’, and the Pain Severity scale at visit 4 (weeks 6–8) and visit 6 (week 12) (p < 0.05). At visit 8 (weeks 18–20) Z was superior to placebo on the ‘pain on average’ item and Pain Severity scale (p < 0.05). For visit 12 (weeks 30–32) and for LOCF Z was superior to placebo for ‘pain at its worst’, ‘pain on average’ and Pain Severity (p < 0.05 for all). For the ‘pain right now’ item there were statistically significant differences at visits 4, 6, 12 and LOCF (p < 0.05). In addition, at visit 6 (week 12), Z was superior to placebo for changes in items assessing interference with: sleep, general activities, mood, walking and enjoyment of life (p < 0.05). Z was also superior to placebo for ‘interference with general activities’ at visits 12 (weeks 30–32), 16 (weeks 42–44) and LOCF (p < 0.05). Conclusion: Results suggest Z provides significant benefit in pain reduction and Z may have an impact on patients’ daily activities which may lead to a preservation of patients’ functionality.

[Table: see text]

[The significance of the postburn expression of proto -- oncogenes c -- fos and c -- myc mRNA and proteins in rat myocardial cells]

OBJECTIVE

To investigate the postburn expression of proto -- oncogenes c -- fos and c -- myc mRNA and proteins in rat myocardial cells following severe burn.

METHODS

Wistar rats inflicted with 30% TBSA III degree burn on the back were employed as the model and randomly divided into four groups: burn (B), resuscitation (R), verapamil (V) and control (C) groups. The expressions of c -- fos and c -- myc mRNA were examined by in situ hybridization and that of the proteins by immunohistochemistry.

RESULTS

The expressions of the proteins and mRNA of c -- fos and c -- myc in every experimental groups increased to peak values and then decreased along with time lapsing. And the expressions of c -- fos and c -- myc were weakest in B group, while that in V group was stronger than that in R group.

CONCLUSION

The expression of postburn immediate -- early genes c -- fos and c -- myc could be induced in the myocardial cells in all the groups by severe burns. And the expression features were different from the gene expression in patients with myocardial infarction and with cardiac over -- load. This implied that there were different signal transduction and modulation mechanism among these pathological conditions.