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Abstract:Non-Hodgkin’s lymphoma (NHL) is a kind of hematological malignant disease common in the elderly. Elderly NHL patients present specific clinical characteristics different from young and middle aged ones. Due to poor general status, comorbidities, and poor response to treatment, elderly NHL patients have poor prognosis. So individualized therapy for elderly NHL patients is strongly recommended, and support treatment is also very important.

Abstract:Objective To investigate the clinical characteristics and prognostic factors of diffuse large B-cell lymphoma (DLBCL) in the elderly. Methods A total of 50 DLBCL patients (≥70 years old) admitted in our department from Jan. 2010 to Jan. 2013 were enrolled in this study. Clinical data including age, Ann-Arbor stage, B symptoms, international prognostic index (IPI), serum levels of lactic dehydrogenase (LDH), β2-microglobulin (β2-MG) and Ki-67, and other indices were collected and retrospectively analyzed. Survival analysis was performed by Kaplan-Meier survival analysis (the Log-rank test), and the correlation of these indices with prognosis was performed by univariate analysis. Results Among the 50 elderly with initial DLBCL, 60% were at Ann-Arbor stage of Ⅲ?Ⅳ, 54% got IPI score of 3?5 points, 52% had B symptoms, and 75% were with extranodal as primary site of the disease. In the cohort, the therapeutic effect was better in the patients given dose-adjusted chemotherapy than those receiving radiotherapy and supportive therapy. Moreover, the complete remission (CR) rate was higher in the patients getting R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine and prednison) than those of CHOP/COP regimens. The median survival time was 8 months, and the 1-, 2-, 3-year overall survival rate (OS) was 48.5%, 30.8% and 11.5%, respectively. Survival analysis showed Ki-67 had great effect on prognosis, and those with Ki-67 ＞80% had poor outcome. Conclusion Elderly patients are characterized by being at late stage of disease, with various combined diseases, and having short survival time, and have a high incidence of DLBCL. Ki-67 is regarded as an important factor for poor prognosis. The R-CHOP scheme greatly improves CR rate, and adequate chemotherapy is important to prolong survival time in the elderly DLBCL patients.

Abstract:Objective To investigate the clinical features of early stage gastric mucosa-associated lymphoid tissue (MALT) lymphoma and the efficacy of eradication of Helicobacter pylori (Hp) and anti-tumor therapy. Methods Clinical data of 52 patients diagnosed as gastric MALT-lymphoma of stages Ⅰ/Ⅱ in our hospital from April 2003 to May 2013 were collected and retrospectively analyzed. Hp eradication was attempted in the patients with Hp infection. Patients with lymphoma persistence or progression following Hp treatments were given further anti-tumor treatments. Results Hp infection rate was 88.4% in the 52 patients with early stage gastric MALT. The efficiency of Hp eradication was 91.3%. For the 18 patients receiving anti-tumor treatments, the efficiency was 66.7%. The 5-year overall survival rate and progression free survival rate were 92.3% and 83.1%, respectively. Conclusion Hp eradication is an irrational and efficient approach in the treatment of early stage gastric MALT lymphoma. For the patients who fail to respond to Hp therapy, anti-tumor treatment is necessary for their long-term benefits.

Abstract:Objective To analyze the different causes of death and influencing factors for non-Hodgkin’s lymphoma (NHL) in order to provide reference for clinical practice. Methods Clinical data of 76 patients who died of NHL in our hospital from January 2004 to December 2014 were collected and retrospectively analyzed to summarize the causes of death. Univariate analysis was performed to estimate single-factor based on cause of death, and the obtained related factors further underwent multivariate logistic analysis. Results Ann Arbor Ⅳ phase and B symptoms were the independent risk factors for the organ failure induced death. The combined diabetes and primary lymph nodes tumor were the independent risk factors for the infection induced death. Conclusion NHL patients should be properly evaluated before the treatment. Attention should be paid to high-risk factors related to death in order to improve the prognosis.

Abstract:Objective To investigate the clinical features, treatment efficiency and prognosis of non-Hodgkin’s lymphoma-associated hemophagocytic syndrome (LAHS). Methods Clinical data of 32 LAHS patients treated in the Department of Hematology in Ruijin Hospital from January 2005 to December 2013 were retrospectively collected. Kaplan-Meier survival analysis was used to estimate survival functions. Cox regression model was performed to evaluate 14 factors affecting survival. Results Among the 32 patients, 7(22%) were of high risk (4-5 points) according to the international prognostic index (IPI). T-cell or natural killer (NK)/T cell subtypes were the most predominant pathological subtypes. Of the 23 patients who were treated with the regimens containing etoposide, 8 patients (35%) achieved complete remission (CR) and 6 patients (26%) partial remission (PR), with an overall response rate (ORR) of 61%. Of the 9 patients who were treated with the regimens without etoposide, only 1 patient (11%) achieved CR and none PR (0%). The regimens with etoposide were more efficient than those without etoposide (Chi square＝4.874, P＝0.036). The median overall survival (OS) of the cohort was 122 days (95%CI＝79.0165.0). Multivariate analysis showed that CR non-achievement (P＝0.001) and subnormal hypofibrinogenemia (＜1.5g/L, P＝0.031) were the predictive parameters for total survival rate. Conclusion LAHS is usually accompanied with multi-organ dysfunctions, and has rapid progression and poor prognosis. Regimens containing etoposide significantly improve the treatment outcome of those patients.

Abstract:Objective To investigate the efficacy and side effects of metronomic chemotherapy of gemcitabine, dexamethasone and cisplatin (GDP) for elderly relapsed and refractory non-Hodgkin’s lymphoma (NHL). Methods Eighteen elderly patients with identified relapsed and refractory NHL admitted in our institute from January 2012 to January 2015 were enrolled in this study. They were all treated by GDP metronomic chemotherapy. Clinical efficacy and adverse reactions were evaluated. Results For the patients with B-cell NHL, there were 3 cases obtaining complete remission (CR), and 2 cases of partial remission (PR), and for those with T cell NHL, there were 3 cases of CR and 1 case of PR. The total effective rate of the cohort was 50%, and no treatment-related deaths were found during follow-up. According to the evaluation criteria for chemotherapy toxicity established by WHO, the major adverse reactions were mainly concentrated in 0 ?Ⅰ degree, no Ⅳ degree was seen, and the liver and kidney toxicity was mild. The main side effects were myelosuppression as well as gastrointestinal reactions. No obvious neurotoxicity and cardiotoxicity occurred. Conclusion GDP metronomic chemotherapy is effective in the treatment of elderly relapsed and refractory NHL, which has a lower incidence of side effects and worthy of further promotion.

Abstract:Objective To investigate the clinical features of mantle cell lymphoma (MCL) and the prognostic factors in order to guide the clinical practice. Methods Clinical data of 18 patients with MCL admitted in our hospital from July 2008 to July 2014 were collected and retrospectively analyzed in this study. Their sex, age, B symptoms, invasion of bone marrow, scores of Mantle Cell Lymphoma International Prognostic Index (MIPI), Eastern Cooperative Oncology Group (ECOG) scores, serum levels of Ki-67 and lactate dehydrogenase (LDH), white blood cell (WBC) and lymphocyte (LYM) counts, clinical stages, initial therapy and clinical outcomes were analyzed. Fisher exact test was used to compare the cumulative survival. Kaplan-Meier survival analysis was employed to draw survival curve. The prognostic factors were analyzed by Cox proportional hazard model. Results Age (younger or older than 65 years, P＝0.036), MIPI scores (low-, medium- and high-risk, P＝0.049) and Ki-67 level (＜30% and ≥30%, P＝0.001) were correlated with prognosis, but sex, ECOG scores, B symptoms, β2-microglubulin, LDH level, WBC count, LYM count, clinical stages and initial therapy were not (P＞0.05). Conclusion Younger than 65 years, low or medium MIPI scores and Ki-67 below 30% are favorable prognostic factors for MCL.

Abstract:Objective To investigate the clinical characteristics and prognosis of non-Hodgkin’s lymphoma(NHL) in the elderly. Methods Clinical data of 120 elderly patients with identified NHL admitted in our hospital from December 2002 to December 2012 were collected and retrospectively analyzed. Results Most of the cohort were at the age of 65 to 75 years, and had diffuse large B-cell lymphoma (55.0%) as the most common pathological type. The median time was 78d from the presentation of initial symptoms to diagnosis. When diagnosed, most patients (62.5%) had their Eastern Cooperative Oncology Group (ECOG) score from 0 to 1. Forty-five percentage of the patients suffered from comorbidities, with hypertension most common. Univariate analysis showed that the clinical stage, systemic symptoms, ECOG score, and international prognostic index (IPI) were correlated with overall survival time (P＜0.05). Conclusion Elderly NHL is characterized by multiple complications, atypical symptoms, difficulty to be diagnosed, but slower progression. Clinical stage, systemic symptoms, ECOG score and IPI are closely associated with overall survival time.

Abstract:Objective To detect the expression of B7 family molecules and illuminate their significance in non-Hodgkin’s lymphoma (NHL). Methods Peripheral blood monocyte cells (PBMCs) were separated by density gradient centrifugation from peripheral blood samples of healthy volunteers. Real-time fluorescence quantitative PCR (RQ-PCR) was used to determine the mRNA expression levels of PD-L1 and PD-L2 in the cell lines of B cell lymphoma, T cell lymphoma and NK/T cell lymphoma (NKTL). Results PD-L1 and PD-L2 were expressed in NHL cell lines at different mRNA levels. Their expression was significantly higher in T cell lymphoma and NKTL cell lines than in normal PBMCs (P＜0.05). However, there was no significant difference in their expression between B cell lymphoma cell lines and PBMCs (P＞0.05). Conclusion B7 family molecules such as PD-L1 and PD-L2 may be involved in the tumor immune escape in NKTL and T cell lymphoma, and they might be novel targets for NHL immunotherapy.

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Abstract:Objective To determine the clinical efficacy and safety of levosimendan for the very elderly patients with left heart failure. Methods A total of 58 very elderly patients [age: (86.8±1.5) years, 21 males and 37 females] with chronic left heart failure admitted in our department from September 2014 to April 2015 were prospectively recruited in this study. A self-controlled trial was carried out on the efficacy of levosimendan. Serum B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and 6-minute walking test (6MWT) were measured before and in 3 d and 3 months after treatment. Results In 3d after levosimendan treatment, their serum levels of BNP was significantly decreased, and the values of LVEF, LVFS and 6MWT were much better than before treatment (all P＜0.01). After 3 months’ treatment, the BNP level was obviously lower, and the values of LVEF, LVFS and 6MWT were greatly improved than those before treatment (all P＜0.01). There was no significant difference in blood pressure values, liver function parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-transglutaminase (γ-GT)], and renal function indices [serum creatinine (SCr), blood urea nitrogen (BUN), and serum uric acid (SUA)] in the cohort before and in 3d and 3 months after treatment (P＞0.05). Conclusion Single dose levosimendan is efficient and safe in the treatment of heart failure for the very elderly.

Abstract:Objective To investigate the status and demand of continuing education in geriatrics in China. Methods All participants attending the Peking Union Medical College Hospital-Johns Hopkins Geriatrics Conference (PUMCH-JH GC) during the years of 2012 to 2014 were investigated through questionnaires. All valid questionnaires were collected and analyzed, and the findings were compared. Results There was no significant change in the awareness of geriatrics among the participants in the 3 consecutive years. Acquaintances of geriatric syndromes, including falls, dementia, incontinent urinate, depression, sleep disorder and constipation accounted for more than 80%, but those of syncope, elderly abuse and living wills were quite low. With the gradual implementation of educational activities, great improvement was seen in the participants on their attitude and coping styles to geriatric syndrome. Meanwhile, our findings indicated that the numbers of older participants (aged 35?49 years) and of those with senior titles were all significantly higher than those of the participants of 2012 (P＜0.001). Conclusion The participants have not enough knowledge on geriatrics and on how to cope with senile problems. Though certain achievements have been made in continuing education in geriatrics in China, it is not well enough in the promotion of its understanding as a whole. Therefore, more efforts are needed on the continuing education in geriatrics.

Abstract:Objective To investigate the correlation of serum level of paraoxonase 1 (PON1) with alterations of cardiac structure in the patients with chronic renal failure (CRF). Methods Eighty CRF patients admitted in our hospital from January 2013 to April 2015 were recruited in this study, and 40 individuals without any renal diseases who took physical examination during the same period served as controls. The serum PON1 level, total oxidation state (TOS), total anti-oxidation state (TAS) and oxidative stress index were measured and analyzed. Echocardiography was carried out to evaluate the heart structure. Results Left ventricular end diastolic diameter (LVDd), left ventricular mass (LVM) and left ventricular mass index(LVMI) were significantly larger in CRF patients at stage 5 chronic kidney disease (CKD) than in controls (P＜0.05). TAS was significantly lower, while oxidative stress index (OSI) higher in CRF patients at stage 5 CKD than in controls (P＜0.05). The serum level of PON1 was negatively correlated with LVM (r＝-0.641, P＝0.033) and LVMI (r＝-0.562, P＝0.029), and as an independent variable, it could enter the linear regression model with LVM (P＝0.013) and LVMI (P＝0.037) as dependent variables, respectively. Conclusion The serum level of PON1 is significantly decreased in CRF patients, and can be regarded as an independent risk factor for cardiac structure.

Abstract:Objective To determine the killing effects of cytokine-induced killer cells bound with the bispecific antibodies for CD3 and CD133(BsAb-CIK) on CD133-high expression colorectal cancer cells. Methods The bispecific antibodies were generated by chemical coupling with anti-CD3 and anti-CD133 antibodies. CCK-8 kit was used for comparing the killing effects of CIK and BsAb-CIK on CD133-high expression colorectal cancer cell lines (SW620 and HT29) and CD133-low expression colorectal cancer cell line (LOVO). Cytokines secreted in the supernatant were detected. The xenograft for nude mice was established, and then given CIK or BsAb-CIK cells infusion via abdominal cavity. Tumor weight were compared between the groups after 1 month. Results At the different ratio of effector cells to target cells (1∶5, 1∶10, 1∶20), the cytotoxic effects of BsAb-CIK cells on CD133-high expression colorectal cancer cells (SW620 and HT29) were stronger than that of general CIK cells (P＜0.05), but there was no significant difference on CD133-low expression colorectal cancer cells (LOVO). The secretary amount of IFN-γ was higher in the supernatant of BsAb-CIK cells than the general CIK cells when killing experiments were performed. The treatment with BsAb-CIK cells resulted in a more remarkable inhibition on xenograft tumor growth than that with general CIK cells (P＜0.05). Conclusion The BsAb-CIK cells can effectively kill CD133-high expression colorectal cancer cells.

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Abstract:We reported a 64-year-old male with intrahepatic cholangiocarcinoma (ICC), whose main manifestations were abdominal pain, fever and multiple hepatic masses. He was once diagnosed with acute cholecystitis and hepatic metastatic carcinoma. After anti-infective therapy, his fever was still difficult to control. The serum level of carbohydrate antigen 199 (CA199) was as high as 3 222U/ml, and ultimately, he was diagnosed with ICC and neoplasm necrosis accompanied with infection and acute cholecystitis after liver puncture biopsy. The patient was given palliative and symptomatic treatment, and died in 2 months later. Based on literature and our clinical experience, it is difficult to diagnose ICC at early period. It has high malignancy, may be accompanied with necrosis and infection sometimes, has few opportunities for radical excision, and thus, poor prognosis finally. In order to facilitate the early diagnosis and treatment of this disease, geriatric gastroenterology physicians should be familiar with the characteristics of ICC, and pay more attention to health examination.

Abstract:Recent researches show that Alzheimer’s disease (AD), like other common chronic diseases, develops as a result of interaction of multiple factors rather than a single cause. This article reviewed some factors that can increase the risk of AD, such as age, smoke, genetic mutations, apolipoprotein E (APOE)-ε4 gene, cardiovascular and cerebrovascular diseases, type 2 diabetes mellitus and traumatic brain injury. We aimed to discuss their roles in the development of AD, and thus provide a foundation for prevention and treatment of AD.

Abstract:Guide wire cattle horn (GWCH) is a modified approach for percutaneous dilational tracheotomy (PDT). Recent researches showed that this approach was superior to guide wire dilating forceps (GWDF) and guide wire dilating spire (GWDS) in surgery operation skills, dealing with complications and other aspects. In intensive care unit, percutaneous tracheostomy horns expansion technique is a safer minimal invasive technology for critically ill patients who need airway opening, and is worthy of wide application.