Table of Content

  

10 May 2018
Volume 56 Issue 5

Status and prospect of fertility preservation treatment for gynecologic malignancies

YANG Jiaxin, SHEN Keng, WANG Yao

Journal of Shandong University (Health Sciences). 2018, 56(5):  1-7.  doi:10.6040/j.issn.1671-7554.0.2018.228

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For gynecologic malignancies, surgery, chemotherapy and radiotherapy are traditional therapeutic approaches, which do harm to the reproductive organs and patients will lose fertility permanently. Therefore, how to preserve fertility has always been the objective of gynecologic oncologists. So far, early diagnosis, improvement on the recovery rate and development of assisted reproductive technique have provided more opportunities and posed new challenges in the meanwhile.

Application of anti-Mullerian hormone in gynecologic oncology

CAO Dongyan, BI Xiaoning, SHEN Keng

Journal of Shandong University (Health Sciences). 2018, 56(5):  8-12.  doi:10.6040/j.issn.1671-7554.0.2018.431

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Anti-Mullerian hormone has been widely used as a marker of ovarian reserve in the field of reproductive endocrinology. With the development of oncology treatment and oncofertility, ovarian function and fertility problems in gynecological oncological patients have drawn widespread attention. As a relatively constant marker in the menstrual cycle, AMH plays a crucial role in monitoring the recurrence of gynecological tumors, assessing surgical injuries, and guiding fertility preservation treatment for gynecologic malignancies.

Prognostic factors for oncology and fertility outcomes of early stage epithelial ovarian cancer patients who accepted fertility-sparing surgery

ZHANG Ying, YANG Jiaxin, CAO Dongyan, YU Mei, SHEN Keng, HUANG Huifang, PAN Lingya, WU Ming, LANG Jinghe, YOU Yan

Journal of Shandong University (Health Sciences). 2018, 56(5):  13-17.  doi:10.6040/j.issn.1671-7554.0.2018.220

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Objective To investigate the influencing factors of tumor and fertility prognosis for patients with early stage epithelial ovarian cancer(EOC)who accepted fertility-sparing surgery(FSS). Methods A retrospective study was done on the clinical data of 38 patients with EOC who had undergone FSS to assess the influencing factors such as age, surgery, pathological type, histological grade, clinical stage, or chemotherapy after the surgery, on the clinical and fertility outcomes. Results The median time of follow-up was 90.5 months. The 5-year overall survival(OS)rate and 5-year progression-free survival(PFS)rate was 97% and 80%, respectively, while the rate of relapse was 28.9%. Only grade G2/G3 influenced PFS significantly(χ2=39.36, P<0.001). No significant difference was found between stage ⅠA and ⅠC1/ⅠC2(P>0.05). The conception rate was 62.5%, and 40.6% of the patients had live birth. Fertility outcomes were not influenced by age, surgery, FIGO stage, chemotherapy or relapse. Conclusion Conservative treatment for early EOC patients can be performed reasonably because of the good outcomes of tumor and fertility prognosis. Histological grade is risk factor that should be considered for the patients’ treatment.

Fertility-sparing radical trachelectomy for young women with early stage cervical cancer: surgical and obstetrical outcomes

ZHOU Huimei, YANG Jiaxin, CAO Dongyan, SHEN Keng, XIANG Yang, WU Ming, PAN Lingya, HUANG Huifang, LANG Jinghe

Journal of Shandong University (Health Sciences). 2018, 56(5):  18-22.  doi:10.6040/j.issn.1671-7554.0.2018.227

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Objective To evaluate the surgical and obstetrical outcomes of patients with early stage cervical cancer who underwent laparoscopic-assisted radical vaginal trachelectomy(LARVT). Methods A retrospective analysis was performed including young women with stage ⅠA1 and stage ⅠB1 cervical cancer who were treated with LARVT at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital from January 2003 to January 2017. Results Eighty-eight patients with early stage cervical cancer(ⅠA1, n=5; ⅠA2, n=8; ⅠB1, n=75)were selected as candidates for the inclusion criteria during the period analyzed. The patients’ average age was 30.9 years(range, 18-44 years). Histology included 68 cases with squamous cell carcinoma, 14 cases with adenocarcinoma, 3 cases with adeno-squamous carcinoma, and 3 cases with clear cell carcinoma. Twelve patients(13.7%)had a tumor >2 cm and 76 cases had a tumor ≤ 2 cm. The median duration of follow-up reached 54.1 months(2.0-176.9 months). Eleven patients(12.5%)had recurrent diseases. The median interval between the initial surgery and recurrence was 34.1 months(range, 9.3-90.1 months). A total of 40 patients had attempted to conceive, resulting in 21 pregnancies and 15 healthy babies. Conclusion LARVT should be offered as an alternative treatment for women with early stage cervical cancer who want to preserve their fertility. The oncologic outcome and pregnancy outcome should be further investigated for long-term follow-up.

Diagnosis and management in patients with recurrent stage I endometrial cancer after primary fertility-preserving treatment

YU Mei, YANG Jiaxin, CAO Dongyan, WANG Yao, SHEN Keng

Journal of Shandong University (Health Sciences). 2018, 56(5):  23-29.  doi:10.6040/j.issn.1671-7554.0.2018.229

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Objective To evaluate the efficacy and prognosis of secondary treatment on patients with recurrent endometrial cancer(EC)after complete remission(CR)for primary fertility-preserving therapy. Methods Thirty-six cases with recurrent EC after CR for primary fertility-preserving therapy from January 2004 to September 2017 at Peking Union Medical College Hospital were retrospectively analyzed. Twenty-five patients received the second course of fertility-preserving treatment and 11 patients received hysterectomy. The clinical efficacy and prognosis of the retreatment were also analyzed. Results Of the 36 recurrent patients with a median disease free interval period of 17 months(ranged 6 to 55 months), 22 were pathologically diagnosed as EC, and 14 were pathologically diagnosed as atypical hyperplasia(AH)or endometrial intraepithelial neoplasia(EIN). Twenty-five patients met the criteria of fertility-preserving therapy and repeated hormonal therapy, and 21 patients were evaluable for efficacy, among whom, 16 patients achieved CR(16/21, 76.2%)with the lower CR rate than that of primary fertility-preserving treatment(93.6%), P= 山 东 大 学 学 报 (医 学 版)56卷5期 -俞梅,等.早期子宫内膜癌保留生育功能治疗后复发的诊治 \=-0.016. According to the pathologic diagnosis of recurrence, the CR rate in AH/EIN patients was higher than that in EC patients while without a statistical difference(90.9% vs 60.0%, P=0.149). Among 16 patients achieved CR, 2 got pregnant and delivered successfully, while 2 relapsed again. Five cases failed to retreatment of fertility-preserving therapy then took the surgery; two of them were of stage ⅢA and three of stage ⅠA; three of them needed adjuvant radiotherapy +/- chemotherapy postoperatively, and no recurrence was observed during the follow-up. Eleven patients received surgery, eight of whom were treated in our hospital with one of stage ⅢC₂, five of stage ⅠA, two diagnosed as EIN or AH1-2, and no recurrence was observed during the follow-up. Other three patients were lost to follow-up. Conclusion For patients with recurrent EC after primary fertility-preserving treatment, CR rate of retreatment was lower than that of primary treatment, while still attain a promising response and have possibilities of successful pregnancies.

Prognosis related factors of patients with ovarian Sertoli-Leydig cell tumor after fertility-preserving surgery

YANG Ni, CAO Dongyan, YANG Jiaxin, YOU Yan, SHEN Keng

Journal of Shandong University (Health Sciences). 2018, 56(5):  30-34.  doi:10.6040/j.issn.1671-7554.0.2018.223

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Objective To evaluate the prognosis and its related factors of patients with ovarian Sertoli-Leydig cell tumor(SLCT)after fertility-preserving surgery. Methods Detail clinical data, including survival rates, recurrence, death and fertility states, of 52 SLCT patients after fertility-preserving surgery in Peking Union Medical College Hospital were retrospectively reviewed. Results Forty-one cases showed androgenic manifestations, while 11 cases had no endocrine symptoms. All tumors located in unilaterl ovary; the mean tumor diameter was 10.0 cm(range 2-34 cm); fifty cases were at stage Ⅰ(36 cases at stage ⅠA, 14 cases at stage ⅠC), one was at stage ⅢC, ones stage was unknown; four(7.7%)tumors were well differentiated, 14(26.9%)were intermediately differentiated, 34(65.4%)were poorly differentiated. In the poorly differentiated tumors, 9 had a retiform pattern, 4 had heterologous elements. Six patients(11.5%)underwent cystectomy, 36(69.2%)underwent unilateral salpingo-oophorectomy, and 10(19.2%)underwent standard staging surgery. Twenty-nine patients received systematic chemotherapy(1-4 courses of treatment)after 山 东 大 学 学 报 (医 学 版)56卷5期 -杨旎,等.卵巢支持间质细胞肿瘤保留生育功能治疗的预后及相关因素 \=-the initial surgery. The average follow-up period was 72 months; six cases recurred, in whom 3 cases died. The poor prognosis was correlated with no endocrine symptoms, bigger tumor size, clinical stage >ⅠA, and probably correlated with poor differentiation, retiform pattern and heterologous elements, while not correlated with surgery type and postoperative chemotherapy. Conclusion SLCT is a rare type of sex cord-stromal tumor of the ovary. Most SLCT patients have androgenic manifestations and abdominal masses, and tumors without endocrine changes may indicate more aggressive biological behaviors. The prognosis is correlated with tumor size and clinical stage, and probably correlated with the degree of differentiation. Conservative surgery is acceptable for young patients wishing to preserve fertility, and postoperative adjuvant chemotherapy and long-term follow up are recommended to those with high-risk factors of recurrence.

Preserve fertility in recurrent and uncontrolled malignant ovarian germ cell tumors

WANG Jinhui, YANG Jiaxin, YUAN Zhen, CAO Dongyan, SHEN Keng, HUANG Huifang, WU Ming, PAN Lingya, GUO Lina

Journal of Shandong University (Health Sciences). 2018, 56(5):  35-40.  doi:10.6040/j.issn.1671-7554.0.2018.233

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Objective To explore the clinical characteristics, salvage therapy and prognosis of recurrent and uncontrolled malignant ovarian germ cell tumor(MOGCT)and to evaluate the possibility of secondary fertility-sparing surgery. Methods The clinical data of 41 recurrent and uncontrolled MOGCT cases treated during Jan. 1st, 2000 and Mar. 31st, 2017 were retrospectively analyzed. Results There were 18 recurrent and 23 uncontrolled cases. The patients age ranged from 6 to 37 years. FIGO stage: stage I in 25 cases, stage II in 1 case, stage III in 14 cases, and stage IV in 1 case. There were 18 cases of immature teratoma, 14 cases of yolk sac tumor, 1 case of dysgerminoma and 8 cases of mixed germ cell tumor. Secondary fertility-sparing cytoreductive surgery was performed in 31 cases, and secondary cytoreductive surgery without fertility-sparing was performed in 8 cases. During the median follow-up of 30.3 months after recurrence, 2 cases were loss to follow-up, 13 cases(33.3%)had a second relapse, and 10 patients(25.6%)died. The 5-year survival rate after recurrence was 68.7%, and the 5-year progress-free survival rate after recurrence 山 东 大 学 学 报 (医 学 版)56卷5期 -王瑾晖,等.复发和未控卵巢恶性生殖细胞肿瘤保留生育功能的治疗 \=-was 71.5%. FIGO stage and patients satisfaction with cytoreductive surgery were the independent prognostic factors(P<0.05). Conclusion The standardized primary therapy should be emphasized in the treatment of MOGCT. For recurrent and uncontrolled MOGCT, optimal cytoreductive surgery and adjuvant standardized chemotherapy have significant impacts on the prognosis of patients. For young nulliparous patients, secondary fertility-sparing salvage therapy can be taken into consideration.

Clinical characteristics of 21 cases with primary vaginal endodermal sinus tumor in children

WANG Tao, CAO Dongyan, YU Mei, ZHANG Ying, LIU Wei, SONG Hongmei, SHEN Keng, GUO Lina, YANG Jiaxin

Journal of Shandong University (Health Sciences). 2018, 56(5):  41-45.  doi:10.6040/j.issn.1671-7554.0.2018.224

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Objective To analyze the clinical characteristics,treatment,and outcomes of children with primary vaginal endodermal sinus tumor. Methods A retrospective analysis was performed on clinical and pathological data of 21 children with pathologically confirmed primary vaginal endodermal sinus tumor between January 1997 and December 2017.The patients ranged from 4 months to 4 years old, with median age being 11 months old. There were 14 cases younger than one year old. All patients were treated with chemotherapy, mainly PEB(cisplatin, etoposide, bleomycin)after an IV port implanted into subclavian vein. Detection of serum α-fetoprotein(AFP)level, examination under anesthesia and biopsy by hysteroscope were performed before and after treatment to evaluate the tumor status. Results Bleeding or blood-tinged discharge was the most common clinical presentation. The patients received chemotherapy for a median of 5 courses(ranged from 3 to 13 courses). Twenty patients obtained complete remission(95.2%). The patients were followed up for a median of 44 months(ranged from 4 months to 20 years). Nineteen patients(90.5%)remained alive. 山 东 大 学 学 报 (医 学 版)56卷5期 -王涛,等.幼女原发性阴道内胚窦瘤21例临床分析 \=-One child died of disease progression. One child received 4 courses of PEB chemotherapy and died of infection and heart failure. Two patients were recurrent but obtained complete remission after chemotherapy again. Conclusion Vaginal endodermal sinus tumors are rare in children and extremely sensitive to chemotherapy. To allow preservation of sexual and reproductive function, PEB chemotherapy with conservative surgery should be considered for children with vaginal endodermal sinus tumor. Combination of serum AFP with vaginal examination are reliable evaluating methods.

Effects of simvastatin on TGF-β induced epithelial-to-mesenchymal transition in ovarian cancer

HE Pengjuan, YAN Lei, FAN Mingjun, LIU Xiangbin, ZHAO Xingbo

Journal of Shandong University (Health Sciences). 2018, 56(5):  46-51.  doi:10.6040/j.issn.1671-7554.0.2018.171

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Objective To investigate the effects of simvastatin on epithelial-to-mesenchymal transition(EMT)induced by transforming growth factor-β(TGF-β)in ovarian cancer cells(Skvo3 and A2780). Methods The ovarian cancer cells were divided into the control group, simvastatin group, TGF-β group, and simvastatin+TGF-β group. The effects of simvastatin and TGF-β at different concentrations on the cell proliferation were detected with CCK-8. The migration and invasion ability were assessed with wound healing assay and Transwell assay respectively. The changes of EMT and signaling pathway were determined with Western blotting. Results In Skvo3 and A2780 cells, simvastatin reduced cell proliferation and TGF-β-promoted cell proliferation, decreased cell migration and invasion, and reduced TGF-β-induced cell migration and invasion, and reversed EMT and TGF-β-induced EMT. Further experiments showed that simvastatin could reduce the expression of sperm-associated antigen 9(SPAG9)/c-Jun N-terminal kinase(JNK)pathway and reverse TGF-β-induced SPAG9 /JNK pathway(P<0.05). Conclusion Simvastatin can reduce the proliferation, migration, invasion and EMT induced by TGF-β in ovarian cancer cells, possibly by regulating SPAG9 / JNK pathway.

Effects of stigma maydis polysaccharides on liver protection and glycometabolism in diabetic mice

ZHANG Zhongyi, ZHANG Qi, JIE Yi, ZHOU Si, WU Haiyan, ZANG Ying, PAN Jingxue, WU Yuping, NA Xiaodong

Journal of Shandong University (Health Sciences). 2018, 56(5):  52-57.  doi:10.6040/j.issn.1671-7554.0.2017.1137

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Objective To investigate the effects of stigma maydis polysaccharides on glycometabolism and liver protection in diabetic mice. Methods Fifty mice were divided into normal control group(NC group), hyperglycemia control group(HG group), metformin group(MET group), 25 mg/kg polysaccharide derived from stigma maydis group(SMP25 group), and 50 mg/kg polysaccharide derived from stigma maydis group(SMP50 group), ten in each group. The diabetic mice models were prepared by peritoneal injection of alloxan, the fasting plasma glucose(FPG)were measured by a blood glucose tester, the content of liver glycogen in mice were measured by colorimetry, and the liver injury was evaluated by drug-induced liver injury-pathological scroring system(DILI-PSS). Results Compared with 山 东 大 学 学 报 (医 学 版)56卷5期 -张众一,等.玉米须多糖对糖尿病小鼠肝损伤及糖代谢的影响 \=-HG group, FPG value was reduced by 34.3%(P<0.001), the content of glycogen was increased by 321.5% in SMP50 group; compared with MET group, the contents of glycogen were increased(P<0.001), and hepatocyte edema and hepatic steatosis were reduced(P<0.001)in SMP25 and SMP50 groups; the effects of blood sugar control and liver protection in SMP50 group is better than those in SMP25 group(P<0.001). Conclusion Polysaccharides derived from stigma maydis can significantly reduce the FPG concentration, promote the synthesis of glycogen, reduce the liver injury caused by modeling drugs and hyperglycemia in diabetic mice, and is expected to provide a effective adjuvant treatment option for diabetics.

Human neurofilament medium polypeptide immunogenicity and specificity of antibodies

LI Xin, LIU Jianwei, XUE Hao, ZHENG Wenhui, ZHENG Wen, QIN Zeming, WEN Hongling, ZHOU Xiaoying, WANG Zhiyu, ZHAO Li

Journal of Shandong University (Health Sciences). 2018, 56(5):  58-63.  doi:10.6040/j.issn.1671-7554.0.2017.843

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Objective To explore the immunogenicity of human middle subunit of neurofilament(NFM)polypeptide and the specificity of the antibodies in order to provide basis for the preparation of monoclonal antibody(McAb)and establishment of an ELISA detection method. Methods The amino acid sequences of NFM in humans, rats and mice were analyzed. Four polypeptides(P1, P2, P3, P4)were selected, synthesized and coupled with KLH. Then the coupled polypeptides were used as antigens to immunize mice. After immunization, the mice serum was harvested, and the titer of the antibodies were determined with ELISA. The reactivity of antibodies to humans, rats, mice and NFM expressed in vitro were detected with Western blotting and immunohistochemistry(IHC). Results The four peptides had 山 东 大 学 学 报 (医 学 版)56卷5期 -李昕,等.人神经丝中分子量亚单位多肽的免疫原性及其抗体的特异性 \=-strong immunogenicity, and antibodies of high titer were obtained. The IHC showed that all of the four antibodies were able to respond to NFM in human glioma, rat and mouse brain tissues. Western blotting indicated that anti-P1 and anti-P4 antibodies could react with the NFM in human glioma, rat and mouse brain tissues, and the anti-P1 antibody had two strips. Anti-P1, anti-P2 and anti-P3 could react with NFM expressed in vitro. Conclusion The four peptides have strong immunogenicity. The antibodies produced by mice can respond to NFM in human glioma, rat and mouse brain tissues and NFM expressed in vitro. They can be used in preparing McAb.

Uterine adenosarcoma: a study of 15 cases

XIA Xuewei, ZHANG Guiyu, WANG Lijie, ZHANG Airong, WANG Guoyun, JIANG Jie, ZHANG Shiqian, ZHANG Hui, WANG Wenxia, CUI Baoxia

Journal of Shandong University (Health Sciences). 2018, 56(5):  64-69.  doi:10.6040/j.issn.1671-7554.0.2018.313

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Objective To investigate the clinical symptoms, diagnosis and treatment of uterine adenosarcoma(UA). Methods The clinical data of 15 UA patients treated during Oct. 2009 and Oct. 2017 were retrospectively analyzed and related literatures were reviewed. Results Irregular vaginal bleeding was observed in 80% of cases. The other symptoms included lower abdominal pain, cervical spondylolysis and so on. The adenosarcoma was located on the cervix in 5 cases and 2 of them had sarcoma overgrowth. According to the FIGO stage(2009), of the 5 cervical adenosarcoma cases, 4 were ⅠB1, and 1 was ⅣB. Of the 10 uterine body adenosarcoma, 2 were ⅠA, 4 were ⅠB, and other 4 were ⅠC, ⅡA, ⅢB and ⅢC respectively. All 15 cases underwent surgical treatment, and 13 of them were treated with chemotherapy. During the follow-up, 4 patients died of disease progression, 1 died of pulmonary embolism after chemotherapy, and 10 survived progression-free. Conclusion UA is a rare disease. As the symptoms and signs are nonspecific, it can easily be misdiagnosed. Therefore, it needs to be differentiated from other benign and malignant lesions, and confirmed by postoperative pathological and immunohistochemical examinations. The disease generally occurs in postmenopausal women, but can also be found in young women. Although it is not malignant, the risk of postoperative recurrence should be evaluated carefully, especially in patients with sarcoma overgrowth, deep myometrial invasion and heterogenous differentiation.

Efficacy of atenolol on the treatment of acute coronary syndrome complicated with arrhythmia and the prognosis

GENG Erdong, NING Juan

Journal of Shandong University (Health Sciences). 2018, 56(5):  70-73.  doi:10.6040/j.issn.1671-7554.0.2018.185

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Objective To explore the efficacy of atenolol in the treatment of acute coronary syndrome complicated with arrhythmia and its effect on the prognosis. Methods According to the admission time, 200 patients with acute coronary syndrome complicated with arrhythmia treated during Dec. 2013 and Jan. 2017 were divided into two groups: control group(n=100, received conventional treatment)and treatment group(n=100, received atenolol besides conventional treatment). After 2-week treatment, the levels of blood lipid, high-sensitivity C-reactive protein(hsCRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)and mortality of the two groups were observed. Results The total effective rate was 95% in the treatment group and 79% in the control group, and the difference was statistically significant(P<0.05). After treatment, the levels of lipid, hsCRP, IL-6 and TNF-α in both groups were significantly higher than those before treatment, and these were superior in the treatment group than in the control group(P<0.05). The mortality was 5% in the treatment group and 20% in the control group(P<0.05). The incidences of grade III and grade IV cardiac function were significantly lower in the treatment group than in the control group(P<0.05). Conclusion Atenolol can not only reduce blood lipid but also inhibit inflammatory reaction and reduce mortality in patients with acute coronary syndrome complicated with arrhythmia.

Clinical features of epilepsic seizures in patients with MELAS

YANG Xiaxin, MENG Mingzhu, JI Kunqian, WANG Xiaotang, TONG Lili, WANG Aiqin, ZHAO Xiuhe

Journal of Shandong University (Health Sciences). 2018, 56(5):  74-80.  doi:10.6040/j.issn.1671-7554.0.2018.144

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Objective To explore the clinical and electrophysiological characteristics of epileptic seizures in patients with mitochondrial encephalomyopathy with lactate acidosis and stroke-like episodes(MELAS). Methods The clinical data of 57 MELAS cases treated during Jan. 2009 and Jul. 2017 were retrospectively analyzed, including seizure semiology and electroencephalography(EEG)findings. In order to evaluate the relation between epileptic seizure and new stroke-like lesion, the patients were divided into two groups according to the results of cranial MRI: group with and without new stroke-like lesions. To study the relation between drug-resistant epilepsy and the first onset symptom and the first onset age, the patients were divided into four groups: group whose initial symptom was epileptic seizure, group whose initial symptom was not epileptic seizure, adult group(the first onset age ≥18 years), and non-adult group(the first onset age <18 years). Results The incidence of epileptic seizure was 82.5%. Of all patients, 35.1% had epileptic seizures as the onset symptom, and the most common type was tonic-clonic seizure(87.2%). Among the 22 patients who received EEG examination, 21(95.5%)showed unspecific EEG abnormalities and 15(68.2%)showed epileptiform discharges. The incidence of seizure was higher in patients with new stroke-like lesions than in those without 山 东 大 学 学 报 (医 学 版)56卷5期 -杨夏鑫,等.线粒体脑肌病伴高乳酸血症和卒中样发作中癫痫发作的临床特征 \=-(P=0.022). The incidence of drug-resistant epilepsy was higher in patients whose initial symptom was epileptic seizure, but there was no significant difference(P=0.545). The incidence of drug-resistant epilepsy was higher in the non-adult group than in the adult group(P=0.016). Conclusion Seizure is one of the common and the first onset symptoms in MELAS. The seizure semiology is various. The most common EEG characteristic is unspecific slow activity. New stroke-like lesions and the first onset age are important risk factors.

Safety and efficacy of single dose rituximab in primary immune thrombocytopenia

NIE Mu, NI Xiaofei, QIN Ping, YANG Dandan, LI Qiang, HOU Ming, PENG Jun, ZHANG Xiaolin, SHI Yan

Journal of Shandong University (Health Sciences). 2018, 56(5):  81-84.  doi:10.6040/j.issn.1671-7554.0.2018.210

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Objective To investigate the activity, safety and response duration of single dose rituximab(RTX)in previously treated primary immune thrombocytopenia(ITP). Methods Thirty patients with ITP who had failed to respond to glucocorticosteroids were treated with a single dosage of 500 mg rituximab in Department of Hematology, Qilu Hospital of Shandong University. The clinical effect, onset time, duration of efficacy and adverse reactions were observed. Results Response and complete response were achieved in 9(30.00%)and 13(43.33%)patients, respectively. In responders, the median time to response was 30 days(range: 7-60 d). Sustained response was maintained for over 12 months in 68.18%(15/22)patients with the shortest sustained response time of 3 months. No serious infectious, hematologic or extra-hematologic complications were documented during follow-up. Conclusion The single dose of 500 mg rituximab may be effective and safe for corticosteroid-resistant or relapsed patients with ITP.

Three-dimensional analysis of the hyoid bone position in the dental and maxillofacial complex in adult women

LI Dingyang, CAO Shanshan, GUO Jing

Journal of Shandong University (Health Sciences). 2018, 56(5):  85-90.  doi:10.6040/j.issn.1671-7554.0.2018.024

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Objective To explore the correlation between the hyoid bone position and dental maxillofacial complex in adult women and to obtain the accurate measurement to predict the hyoid bone position. Methods A total of 53 female subjects aged 18.4-30.7 years(average 22.7 years)were selected. Lateral cephalograms and cone-beam computed tomography(CBCT)scans were performed. After orientation of the head posture, 24 measurements of the dental maxillofacial complex, tongue and hyoid position were calculated with Dolphin Imaging^® software. And then these measurements were compared and analyzed using SPSS 22.0 software. Results The upper first molars’ central fossa width(U₆CW)was negatively correlated with the upper first molars’ furcation width(U₆FW)(r=-0.262, P=0.029), and the distance from hyoid to the mandibular plane(H-MP)(r=-0.313, P=0.023). The lower mandibular angle(FMA)was positively correlated with H-MP(r=0.298, P=0.030). Hyoid bone position of Osseous Ⅱ was lower than that of 山 东 大 学 学 报 (医 学 版)56卷5期 -李丁洋,等.成年女性舌骨位置与牙颌面相关指标的三维分析 \=-osseous Ⅲ(P=0.017). The position of hyoid bone in patients with vertical growth patterns was lower than that in patients with horizontal and average growth patterns(P=0.016; P=0.014). The length of the tongue(TT-Eb)was positively correlated with the low position of the tongue and hyoid bone(P=0.007). Conclusion The position of hyoid bone is correlated with the maxillofacial complex in adult women. In patients with vertical growth patterns, narrow dental arch and low hyoid position, the hyoid bone position tend to be lower.