Salvage Research Articles

Effect of compound electrolyte injection on phosphatidylserine exposure in erythrocytes after blood salvage-retransfusion in dogs

Objective To evaluate the effect of compound electrolyte injection on phosphatidylserine (PS) exposure in erythrocytes after blood salvage-retransfusion in dogs. Methods Twenty healthy mongrel dogs, weighing 10-15 kg, aged 3-5 weeks, were divided into 2 groups (n=10 each) using a random number table method: normal saline group (group NS) and compound electrolyte injection group (group MEI). The process of intraoperative blood salvage-retransfusion was simulated in both groups: femoral vein was cannulated for blood withdrawal until the volume of blood lost was 400 ml, and the shed blood was salvaged by a blood recovery machine.The washing solution was normal saline in group NS and compound electrolyte injection in group MEI.The erythrocytes were retransfused after being labeled with fluorescein isothiocyanate.Blood samples were obtained before and after blood salvage for determination of erythrocyte ATP content by enzyme-linked immunosorbent assay.Blood samples were obtained at 24, 48 and 72 h after blood retransfusion, and the PS exposure rate of the salvaged erythrocytes was determined by flow cytometry.The spleen was taken at 72 h after retransfusion to detect the phagocytosis rate of salvaged erythrocytes by monocytes. Results There was no significant difference in ATP content before and after blood salvage between the two groups (P>0.05). Compared with NS group, the PS exposure rate of the salvaged erythrocytes at each time point after retransfusion and phagocytosis rate of salvaged erythrocytes by monocytes were significantly decreased in MEI group (P<0.05). Conclusion Compound electrolyte injection as a washing solution for intraoperative blood salvage can reduce the PS exposure in salvaged erythrocytes and is helpful in prolonging the lifespan of erythrocytes after retransfusion in dogs. Key words: Electrolytes; Erythrocytes; Operative blood salvage; Phosphatidylserines; Monocytes

Ruxolitinib in myelofibrosis: solutions for side effects and treatment failure

Myelofibrosis(MF) is a type of myeloproliferative neoplasms which is difficult to be treated. With the discovery of V617F mutation in Janus kinase(JAK)2, JAK inhibitor provides a new treatment strategy for patients with myelofibrosis.Ruxolitinib is the first JAK1/2 inhibitor which approved by the Food and Drug Administration(FDA) for the treatment of patients with international prognostic scoring system(IPSS)intermediate-2 or high risk myelofibrosis. In clinical experiments, ruxolitinib demonstrates significant improvements in splenomegaly and disease-related constitutional symptoms, and prolongs patients′ overall survival. However, the side effects of the drug (hematocytopenia, infections and secondary neoplasms) and treatment failure of some patients has been observed in treatments. The adverse reaction and solutions of ruxlitinib; the definition, reason, high risk factors and prognosis of treatment failure; the salvage therapy after treatment failure will be discussed in this review. Key words: Primary myelofibrosis; Janus kinases; Treatment failure; Salvage therapy; Adverse reaction; Ruxolitinib

Up-regulation of miR-381 inhibits NAD+ salvage pathway and promotes apoptosis in breast cancer cells.

Nicotinamide phosphoribosyltransferase (NAMPT), a rate-limiting enzyme involved in nicotinamide adenine dinucleotide (NAD) salvage pathway, is overexpressed in many human malignancies such as breast cancer. This enzyme plays a critical role in survival and growth of cancer cells. MicroRNAs (miRNAs) are among the most important regulators of gene expression, and serve as potential targets for diagnosis, prognosis, and therapy of breast cancer. Therefore, the aim of this study was to assess the effect of NAMPT inhibition by miR-381 on breast cancer cell survival. MCF-7 and MDA-MB-231 cancer cell lines were transfected with miR-381 mimic, inhibitor, and their corresponding negative controls (NCs). Subsequently, the level of NAMPT and NAD was assessed using real-time PCR, immuno-blotting, and enzymatic methods, respectively. In order to evaluate apoptosis, cells were labelled with Annexin V-FITC and propidium iodide and analyzed by flow cytometry. Bioinformatics analysis was performed to recognize whether NAMPT 3′-untranslated region (UTR) is a direct target of miR-381 and the results were authenticated by the luciferase reporter assay using a vector containing the 3′-UTR sequence of NAMPT. Our results revealed that the 3′-UTR of NAMPT was a direct target of miR-381 and its up-regulation decreased NAMPT gene and protein expression, leading to a notable reduction in intracellular NAD and subsequently cell survival and induction of apoptosis. It can be concluded that miR-381 has a vital role in tumor suppression by down-regulation of NAMPT, and it can be a promising candidate for breast cancer therapy.

The role of radiotherapy in primary central nervous system lymphoma

Objective To explore the role of radiotherapy in the treatment of primary central nervous system lymphoma. Methods Clinical data of 60 patients diagnosed with primary central nervous system lymphoma from September 2010 to December 2017 were retrospectively analyzed. Among them, 50 cases were diagnosed by histopathological examination after stereotactic biopsy or tumor resection and 10 patients were diagnosed by gadolinium enhanced magnetic resonance imaging (MRI). Fifty-two patients underwent chemotherapy, and 45 of them received methotrexate-based chemotherapy, 25 received rituximab-based regimen. Twenty-seven patients were given with planned whole brain radiotherapy, while 33 patients were not. Salvage radiotherapy was delivered in 9 patients after treatment failure. Results The median follow-up time was 28 months (5-70 months). The median overall survival time and median progression-free survival time of the whole patients was 22 months (5-65 months) and 13 months (5-55 months), respectively. The 4-year overall survival rate and progression-free survival rate were 61% and 33%, respectively. The 4-year overall survival rates between patients with and without planned whole brain radiotherapy were 68% and 54%(P=0.083). The 4-year progression-free survival rates between patients with and without planned whole brain radiotherapy were 47% and 20%(P=0.014), respectively. Patients with and without salvage whole brain radiotherapy had a 4-year overall survival of 49% and 68%, respectively (P=0.398). Among patients who received whole brain radiotherapy, patients with a lower dose of ≤36 Gy had a similar overall survival compared with those with a higher dose of>36 Gy (80% vs. 45%, P=0.136). Conclusions Radiotherapy is part of the comprehensive treatment of primary central nervous system lymphoma. Planned radiotherapy may bring clinical benefits to patients during the comprehensive therapy. However, the irradiation dose to the whole brain should not be too high because of neurotoxicity. Key words: Primary central nervous system lymphoma/radiotherapy; Primary central nervous system lymphoma/chemotherapy; Prognosis

Timely Management of Testicular Torsion: A Collaborative QI Approach

Background Testicular torsion is a surgical emergency requiring timely operative care (ideally within 240 minutes) to achieve optimal testicular salvage and functional outcome. At our institution, approximately 14% patients had a delay in operative management (92 patients, January 2014 - November 2016, with a mean of 164 minutes and range of 48-565 minutes). Objective To increase the percentage of patients arriving to the operating room (OR) within 240 minutes from time of emergency department (ED) arrival from 86% to 95% in 18 …

Application of vacuum sealing drainage in limb salvage of multiple trauma patients with Gustilo type III C open fracture

Objective To investigate the safety and effectiveness of vacuum sealing drainage treatment on limb salvage in multiple trauma patients combined with Gustilo type IIIC fracture. Methods A retrospective case control study was conducted to analyze the clinical data of 102 patients diagnosed with multiple trauma combined with Gustilo type III C fracture admitted to Tongji Hospital from October 2005 to October 2015. There were 66 males and 36 females, aged 17-65 years [(34.2±10.1)years]. The injury severity score (ISS) ranged from 18 to 26 points [(19.8±3.2)points]. There were 34 patients with femur fracture, 66 with tibia/fibula fracture, 35 with femur and tibia/fibula fracture. Among the patients, 58 were treated with VSD (VSD group) and 44 were treated with routine dressing change after emergency operation (routine group). The two groups were compared for active bleeding, re-vascular exploration, osteofascial compartment syndrome, wound infection and necrosis, gas gangrene, delayed amputation, systemic inflammatory response syndrome (SIRS), sepsis, deep venous thrombosis (DVT) incidence, per capita debridement times, length of stay, skin graft/skin flap rate, fracture fixation rate, incidence of refractory wounds, incidence of nonunion, incidence of complete nerve damage, British medical research council (BMRC) score, and amputation rate/salvage rate. Results All patients were followed up for 6-14 months [(8.4±2.1)months]. There was no significant difference in limb salvage rate between the two groups after operation (P>0.05). Among the indexes of limb salvage treatment after operation, no significant differences were found between the routine group and VSD group in active bleeding, gas gangrene, re-vascular exploration and delayed amputation (P>0.05); the wound infection and necrosis rates were 32% and 15% (P<0.05); the incidence rates of osteofascial compartment syndrome were 22% and 7% (P<0.05). During the hospital stay, there were no significant differences in DVT incidence and fracture internal fixation rate between the two groups; SIRS incidence rates of routine group and VSD group were 92% and 73% (P<0.05); the incidence rates of sepsis were 28% and 10% (P<0.05); the per capita debridement times in routine group and VSD group were 4.2 times and 3.2 times, respectively (P<0.05); hospitalization durations were 42.1 days and 30.2 days (P<0.05); skin graft/skin flap rates were 69% and 46% (P<0.05). In the follow-up results, there was no significant difference in the amputation rate/salvage rate between the two groups (P<0.05). The incidence of refractory wounds was 28% in routine group and 10% in VSD group (P<0.05); the incidence of nonunion was 22% and 6% (P<0.05); the incidence of complete neurological damage was 36% and 12% (P<0.05); the excellent and good rate of BMRC score was 83% and 96% (P<0.05). Conclusions VSD technology can promote wound healing after operation, prevent complications, reduce the number of debridement operations and shorten hospital stay, significantly improving the prognosis and limb function of patients. It is a relatively safe and effective method for the treatment of multiple trauma combined with Gustilo type III C fracture. Key words: Multiple trauma; Negative-pressure wound therapy; Fractures, open; Prognosis

Salvaging a Sense of the Future

Salvaging a Sense of the Future

One-stage hybrid management of patients with critical limb ischemia due to complex multilevel arterial occlusions

Aim To evaluate the safety and efficacy of one-stage hybrid revascularization modality in patients with complex multifocal arterial occlusive lesions. Patients and methods A prospective study design was established. Included patients were those admitted to the Vascular and Endovascular Surgery Department between November 2015 and November 2016 and presenting with Rutherford stages 5 and 6 critical limb ischemia due to multilevel arterial occlusion involving common femoral artery and one or both of inflow (iliac) and outflow arteries (superficial femoral and leg arteries) with nonsignificant aortic lesions and underwent a one-stage hybrid revascularization procedure aiming limb salvage. Common femoral artery endarterectomy was a fixed step in all cases. For inflow lesions; plain balloon angioplasty with bare metal stenting was first attempted then a femoro-femoral bypass if failed the endovascular approach. For outflow lesions, plain balloon angioplasty with selective stenting was tried in all cases and to stop if failed provided the presence of sufficient profunda flow. The study end points were 1-year primary patency, secondary patency, limb salvage, and complication rates. Results This study included 30 patients (30 limbs), with a mean age of 65±10.28 years. Technical success was achieved in 46 (95.8%) of 48 performed procedures and hemodynamic or clinical success in all patients (100%). Twelve-month primary and secondary patency rates were 67 and 80%, respectively. One-year limb salvage rate was 93.3%. Postoperative complications were reported in four (13.3%) cases. Conclusion One-stage hybrid procedures may be considered a safe and effective modality in the treatment of patients with critical limb ischemia due to multilevel complex arterial occlusions.

Analysis of oncological prognosis and survival of prosthesis after surgery for distal femoral malignant tumors

Objective To investigate the oncological prognosis, prosthesis survival rate and other related factors after limb salvage surgery for distal femoral malignant bone tumors. Methods A total of 42 patients who received the surgery of resection of malignant bone tumor of distal femur and prosthesis replacement of knee joint tumor in the Second Hospital of Shanxi Medical University from January 2008 to December 2013 were retrospectively analyzed. The patient's oncological prognosis, prosthesis survival rate and related influencing factors were analyzed. Results The follow-up period was 18-97 months. Of 42 patients with malignant bone tumors, 21 cases (50%) survived without tumor, 7 cases (16%) survived with tumor, and the 5-year overall survival rate was 66%. The overall survival rate of patients with Enneking stage ⅡB tumor was 55.4%, and that of patients with stage ⅡA tumor was 75.0%, and the difference was statistically significant (χ 2=4.350, P=0.037). The survival rate of artificial prosthesis was 78.6% (22/28), the different length of osteotomy affected the survival rate of prosthesis (χ 2=4.248, P=0.039), but the different types of prosthesis did not affect the survival rate of prosthesis (χ 2=2.177, P=0.140). Conclusions The distal femoral malignant bone tumor has a good oncological prognosis after limb salvage surgery, Enneking staging is an important factor affecting the oncological prognosis. The different length of osteotomy at the distal femur affects the survival rate of the prosthesis, the longer the prosthesis, the lower the survival rate of the prosthesis. Key words: Bone neoplasms; Distal femur; Limb-salvage treatment; Prosthesis; Survival rate

Progress of CD5-positive diffuse large B-cell lymphoma

CD5-positive diffuse large B-cell lymphoma (CD5+ DLBCL) is a special type of DLBCL, which is characterized with later clinical staging, high-risk of relapse in extranodular tissues like bone marrow and central nervous system (CNS). Combined chemotherapy including rituximab and salvage autotransplantation/allotransplantation can not significantly improve the prognosis. This article reviews the clinicopathological features, the possible pathogenesis, treatment status and dilemma in order to get the better understanding of CD5+ DLBCL and avail the early diagnosis and individualized treatment. Key words: Lymphoma, large B-cell, diffuse; CD5; Antineoplastic combined chemotherapy protocols; Prognosis

Posaconazole in prophylaxis and salvage treatment of invasive fungal infections during neutropenia in pediatric patients with leukemia: a retrospective analysis

Objective To investigate the efficacy and safety of Posaconazole (Posa) in prophylaxis and salvage treatment of invasive fungal infections (IFI) during neutropenia in pediatric patients with leukemia. Methods A total of 18 pediatric patients (55 case-time) with leukemia in neutropenia stage receiving Posa treatment from December 2015 to August 2017 in Zhujiang Hospital of Southern Medical University, were analyzed retrospectively.Taking one induction chematherapy or one consolidation chemotherapy stage receiving Posa treatment was defined as 1 case-time. Results Out of 18 participants, 13 cases were patients with acute myeloid leukemia (AML) and 5 cases were patients with acute lymphocytic leukemia (ALL), including 36 males and 19 females.Median age of the participants was 7 years, ranged from 10 months to 14 years.Out of 55 case times, 45 of them were of primary prevention and the neutropenia periods ranged from 4 to 46 days, with the median of 15 days, and 93.33% of them were prevented from fungal infection.However, 3 of the 45 cases had sudden fungal infections and the Voriconazole was an effective treatment, and no one died.Six cases in this study experienced secondary prevention, and no patient experienced reinfection.The neutropenia terms of the 6 cases ranged from 10 to 17 days, with the median of 14 days.Four patients who suffered from Voriconazole and/or Carbophenol therapy failure received Posa as a rescue therapy and the response rate was 100%.None of patients had Posa intolerance due to severe adverse reaction and no Posa treatment-related grade Ⅱ toxic effects occurred. Conclusions Posa is an effective and safe therapy for pediatric patients with leukemia and IFI, and available for long-time usage.Serious adverse reaction is rare. Key words: Posaconazole; Leukemia; Invasive fungal infection; Neutropenia; Child

Clinical efficacy and toxicity of intensity-modulated radiation therapy following prostatectomy for 98 elderly patients with prostate cancer

Objective To evaluate the clinical efficacy and toxicity of intensity-modulated radiation therapy (IMRT) following prostatectomy for elderly patients with prostate cancer. Methods Ninety-eight prostate cancer patients receiving IMRT after prostatectomy were included in this study. The median age was 68 years old. The number of patients with low-, middle-and high-risk prostate cancer was 10, 21 and 67, respectively. Two patients had oligometastases (pelvic bone metastases). Sixty-four patients were treated with IMRT combined with endocrine therapy. Among them, 43 cases received adjuvant volumetric modulated arc therapy (VMAT), and 55 patients received salvage IMRT.The median radiotherapy dose was 72 Gy for the tumor bed. Twenty-nine patients received radiotherapy of the pelvic node region with a median dose of 50 Gy. Results The median follow-up time was 40 months. The 5-year overall survival (OS), biochemical recurrence-free survival (BRFS) and local control (LC) were 90%, 76% and 100%, respectively. The OS (88.8% vs. 90.8%, P=0.94), BRFS (75.9% vs. 71%, P=0.79) or LC (100% vs. 100%, P=0.32) did not significantly differ between the adjuvant and salvage radiotherapy groups, respectively. The incidence of grade I-Ⅱ late rectal toxicities was 24.1%, and no ≥ grade 3 late toxicity was observed. The incidence of grade 1-2 late bladder toxicities was 29.9%, and 3.4% for grade 3. Conclusion IMRT following prostatectomy yields high clinical efficacy and slight late toxicities in elderly patients with prostate cancer. Key words: Prostate neoplasms/intensity-modulated radiotherapy; Prostate neoplasms/ volumetric modulated arc therapy; Treatment outcome

LIMB SALVAGE IN RECURRENT GIANT CELL TUMOUR PROXIMAL END RADIUS

An 18years old male patient had undergone surgery for a giant cell tumour upper end of the right radius in Jan 2007. The tumour recurred within two months. Patient took alternative methods of treatment including indigenous medicines for the condition; all these failed and the patient was advised an above elbow amputation. By Sep 2008 the tumour had grown to a 14”x11”x11” swelling in the forearm extending to the distal arm with neurovascular involvement. A total resection of the tumour was done; vascular continuity of the brachial to the ulnar artery was done with a vein graft to salvage the limb. In 2012 tendon transfer was done to restore function to the wrist. Now there is no recurrence of the tumour and the patient has a fully functional limb.

Ankle distraction arthroplasty with platelet-rich plasma injection for post-traumatic ankle arthritis

Objective To evaluate the surgical techniques and clinical outcomes of ankle distraction arthroplasty with platelet-rich plasma (PRP) injection for post-traumatic ankle arthritis. Methods From May 2012 to May 2017, 32 patients with post-traumatic ankle arthritis were treated at Department of Or-thopaedic Surgery, Shanghai Sixth People’s Hospital.They were 22 males and 10 females, with an age of 32.6±5.8 years (from 18 to 40 years).Their course of disease was 14.0±2.8 months (from 6 to 24 months).After failure of the conservative management for at least 6 months, they received ankle distraction arthroplasty with PRP injection.American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the final overall outcomes.Range of motion (ROM) of the ankle joint and complications were also recorded postoperatively. Results Pin tract infection occurred in 12 patients but responded to alcohol care.All the patients were followed up for an average of 36 months (from 18 to 60 months).The VAS score decreased significantly from preoperative 6.8±1.2 to postoperative 1.8±1.4; the AOFAS ankle-hindfoot score increased significantly from preoperative 38.5±6.2 to 80.3±8.1 at the final follow-up; dorsal expansion and plantar flexion of the ankle increased significantly from pre-operative 8.3°±7.0° and 24.7°±6.4° to 12.8°±6.5° and 31.4°±5.3° at the final follow-up, respectively(all P<0.05).Two patients had to receive salvage arthrodesis after conservative management failed to re-lieve their symptoms or delay the progression of their post-traumatic arthritis. Conclusion Ankle dis-traction arthroplasty with PRP injection is an effective ankle preserving surgery which can relieve symptoms, improve functions and delay progression of post-traumatic ankle arthritis. Key words: Ankle joint; Arthritis; Arthroplasty; Platelet-rich plasma

Application of intraoperative red cell salvage and autologous blood transfusion in cesarean section of pregnant women with central type of placenta previa

Objective To observe the safety and effect of intraoperative cell salvage and autologous blood transfusion during cesarean section with central placenta previa. Methods From April 2015 to March 2016, 25 pregnants with central placenta previa diagnosed by MRI and ultrasound and underwent selected caesarean section in the People′s Hospital of Wenzhou were included. When the amount of blood in the recovery tank was 450 mL or the obstetrician required, the wash and retransfusion device was started-up. Hb and Hct were measured before and after the parturient, and the blood was recovered. The blood loss, recovery of blood, blood transfusion, allogeneic RBC infusion and the side effects after transfusion and 42 d of postpartum were recorded. Results No serious complications were recorded in all pregnants. Five cases(20%) were only recovered and the autologous blood transfusion and transfusion of the allogeneic RBC were not carried out. In 14 cases(56%), only the autologous blood was returned to the puerpera. The volume of blood transfusion was 705 mL(430, 1 535). Six cases(24%) had massive bleeding during the operation, 3690 mL(1 900, 8 750), and the autologous blood transfusion volume was 2939 mL(1 167, 4 206), and the allogeneic RBC transfusion was 3.5U(1.5, 11.5). Conclusion Autologous blood transfusion can be used safely in the caesarean section of the central placenta previa, and can reduce the allogeneic RBC transfusion. Key words: Placenta previa; Cesarean section; Operative blood salvage; Erythrocytes; Hemoglobins; Hematocrit

Salvaging Democracy after Election 2004

Salvaging Democracy after Election 2004

Drug-eluting balloon angioplasty versus bare-metal stent in treating chronic total occlusion of femoropopliteal arterial segment: a review of 1-year outcome of 90 patients with TASC C and D lesions

Background Bare-metal stent (BMS) scaffolding of superficial femoral artery occlusive lesions has been associated with high rates of late clinical failure. Maintaining the patency of recanalized arterial segments was the main issue behind the concept of leaving nothing behind to be evolved and percutaneous balloon angioplasty becomes the preferred option for endovascular therapy. Drug-eluting balloons (DEBs) have shown to be an effective alternative to BMS for patients with de novo complex superficial femoral occlusive disease. Aims The aim was to compare the outcome of DEB versus BMS in treating complex chronic total occlusion of superficial femoral and proximal popliteal artery in patients with disabling claudication and critical limb ischemia regarding technical success, primary patency, clinically driven target lesion revascularization (cd-TLR), and limb salvage rate. Materials and methods The current study is a multicenter, prospective, randomized study. Ninety patients (110 limbs) complaining of disabling and critical limb ischemia due to complex femoropopliteal occlusive lesions were randomly allocated into two groups according to the intervention method performed. Group A included 48 patients (57 limbs) who were submitted for treatment with paclitaxel DEBs and group B included 42 patients (53 limbs) submitted for treatment with BMS. The follow-up period was for 1, 6, and 12 months. Statistical analysis was performed by using the IBM SPSS Statistics version 22 for Windows Program Package (SPSS Inc., Chicago, IL, USA). Results BMSs seem to have lower patency and higher cd-TLR rates compared with patients who received paclitaxel drug-coated balloons but was not statistically significant. The primary patency rates were 100, 96, and 86.2% at 1, 6, and 12 months’ respectively’ in the DEB group versus 100, 89.8, and 77.6% at 1, 6, and 12 months, respectively, in the BMS group. Clinically driven TLR rates were 2 and 7.8% at 6 and 12 months, respectively, in the DEB group versus 6.1 and 14.2% at 6 and 12 months, respectively, in the BMS group. Conclusion Percutaneous therapy for Trans atlantic inter-societies consensus (TASC) C and D femoropopliteal lesion using DEB or BMS is safe and effective with a high patency rate of 1 year. Paclitaxel drug-eluting balloons seem to have a promising role in the prevention of restenosis and recurrence of peripheral arterial occlusive disease. However, stents are still playing important bailout role in the treatment of residual stenosis and dissection. Further follow-up is essential to obtain and document long-term outcome of different percutaneous therapy for complex and long superficial femoral artery (SFA) lesions.

Difficulties in diagnosis and treatment of pediatric severe adenovirus pneumonia

Adenovirus is a common cause of respiratory infection in children.Severe adenovirus pneumonia often occurs in infants or immunocompetent persons.The high incidence age is from 6 months to 2 years old.The clinical symptoms are hyperpyrexia, pale face, poor mental state, respiratory distress or wheezing, and fever may last 4-7days or longer.Severe extra-pulmonary complications are common especially in cardiovascular and hepatic dysfunction.Symptoms are similar to severe bacterial infections, but antibiotics is not effective, and mortality is high.X-ray imaging in acute phase is characterized by asymmetric exudation of lung, partial exudation fusion and interstitial emphysema.Rapid identification of adenovirus infection remains a difficult problem.Multiple nested polymerase chain reaction is helpful.Appropriate oxygen therapy and organ support are the main therapeutic strategies.Extracorporeal membrane oxygenation needs to be further explored as salvage therapy. Key words: Adenovirus pneumonia; Clinical features; Complications; Mortality; Extracorporeal membrane oxygenation; Children

Hemophagocytic Lymphohistiocytosis and Infections: An Update.

Hemophagocytic Lymphohistiocytosis and Infections: An Update.

Research progress in immunotherapy against PD-1/PD-L1 for advanced urothelial carcinoma

Cisplatin-based chemotherapy is not effective in patients with advanced urothelial carcinoma. Recently, the application of immunological checkpoint inhibitors has brought new insight to resolve this problem. Since May 2016, five drugs, including Atezolizumab, Pembrolizumab, Nivolumab, Avelumab, and Durvalumab, targeting the PD-1/PD-L1 pathway have been approved by the FDA for the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, of which Pembrolizumab and Atezolizumab are the first-line drugs in the above treatments. The clinical efficacy and safety of these drugs are similar in different trials, but only Pembrolizumab is supported by a current level I evidence from a large randomized phase clinical trials. The results show that in the case of cisplatin ineligibility, Pembrolizumab is more effective than the traditional salvage chemotherapy in overall survival rate. Pembrolizuma is most effective in the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, while Pembrolizumab and Atezolizumab have similar efficacy in clinical applications of patients with cisplatin ineffective. Key words: Advanced urothelial carcinoma; Immune checkpoint inhibitors; PD-1/PD-L1; Clinical trials