Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV)

Introduction Light chain involvement is observed in almost every patient (pt) with newly diagnosed multiple myeloma (MM). Owing to a relatively short half-life, rapid reduction in the involved free light chain (iFLC) is of potential prognostic value. Methods This retrospective analysis included 92 pts with newly diagnosed MM treated with bendamustine, prednisone, and bortezomib (BPV). Results After a median number of two (range 1–5) BPV cycles, the majority of pts (n = 86; 93%) responded with either sCR (n = 21), CR (n = 1), nCR (n = 25), VGPR (n = 20), or PR (n = 19). PFS and OS at 48 months were 39% and 67%, respectively. At baseline, 79 out of 92 pts (86%) had iFLC levels above the upper standard level and an abnormal ratio of involved to uninvolved free light chain ≥ 8. In a subgroup analysis of these pts, we evaluated the prognostic importance of an early reduction of the iFLC during the first two BPV cycles. A reduction ≥ 50% of the iFLC on day 8 of the first cycle was observed in 31 of 69 pts. These pts had a significantly better median PFS of 49 months as compared to 20 months in 38 pts with a lower iFLC reduction (p = 0.002). In contrast, OS did not differ significantly with a 48 months survival of 77% vs 69% (p > 0.05). Conclusion These results indicate that a rapid decrease in the iFLC on day 8 is an early prognostic marker for newly diagnosed MM pts undergoing BPV treatment.

Clinical features of the disease course in patients with solitary plasmacytoma and extramedullary multiple myeloma

Objective: to study the clinical laboratory features of the course of solitary plasmacytoma (SP) and extramedullary multiple myeloma (EMM).Material and methods. The study included 42 people (22 patients newly diagnosed with EMM and 20 patients diagnosed with SP of various localization). The results were evaluated after 3 years of the study. The median age in the SP group was 61.5 years, in the EMM group — 65 years.Results. A comparative analysis of the SP and EMM groups in terms of the clinical and laboratory parameters has found no statistical differences in the distribution of immunochemical variants. Significant differences were found in the frequency of determination of the abnormal ratio of immunoglobulin light chains (p = 0.046).In EMM, extramedullary lesions were the most common for patients with multiple lytic bone lesions of the skeleton. SP was the most frequently detected in lesions of the peripheral skeletal bones and vertebral bodies.Clinically, EMM was characterized by a more aggressive course if additional factors of an unfavorable prognosis (translocations, mutations) or unfavorable immunophenotypic markers (a combination of signs — expression of markers CD56 > 20 % and CD95 < 20 %) were identified or if the disease had been diagnosed at a young age.The presence of even a minimal number of tumor or aberrant plasma cells in the bone marrow of SP patients, an abnormal ratio of immunoglobulin light chains, paraprotein detected in blood serum or urine were all poor prognostic factors.Conclusion. The clinical course of SP and EMM combined with a young age, the presence of translocations or mutations, unfavorable immunophenotypic markers, is characterized by an increased frequency of progression or the development of resistance to the performed therapy.

Analysis on the MRI and BAEP Results of Neonatal Brain with Different Levels of Bilirubin

Background：To explore whether there is abnormality of neonatal brains’ MRI and BAEP with different bilirubin levels, and to provide an objective basis for early diagnosis on the bilirubin induced subclinical damage on brains.Methods: To prospective study: analyze the clinical data of 103 neonatal patients, who had been hospitalized in Neonatology Department of Taicang First People’s Hospital from March 2013 to September 2015, to conduct routine brain MRI examination , BAEP testing and to analyze BAEP and MRI image results of the neonatal patients, who were divided into three groups based on the levels of total serum bilirubin concentration (TSB), 16 cases in mild group (TSB:0.0~229.0μmol/L), 49 cases in moderate group (TSB: 229.0~342.0μmol/L) and 38 cases in severe group (TSB≥342.0μmol/L); Results: We found as follows: A. Comparison of the bilirubin value of the different group : 1. The bilirubin value of the mild group is 171.99±33.50 μmol/L, the moderate group is293.98±32.09 μmol/L, and the severe group is 375.59±34.25 μmol /L . And the comparison of bilirubin values of the three groups of neonates (P＜0.01) indicates the difference is statistically significant (P＜0.01). 2. The bilirubin value of the pre-term group is 289.70±85.38μmol/Land the full-term group is 310.36±72.32 μmol/L, but the comparison of the bilirubin values between pre-term group and full-term group indicates that the difference is not statistically significant (P＞0.05).3. The bilirubin value of the normal brain MRI group(82) is 305.55±74.54 μmol/L and the abnormal brain MRI group is 303.56±83.04μmol/L; the comparison of bilirubin values between the two groups indicates that the difference is not statistically significant(P＞0.05). B. The weight value of the ﹤2500g group is 2.04±0.21 and the ≥2500ggroup is 3.39±0.46; the weight comparison of the two groups indicates that the difference is statistically significant (P＜0.01). C. Comparison of the abnormal MRI of the different groups: 1.The brain MRI result's abnormal ratio of the mild group is 31.25%, the moderate group is 16.33% and the severe group is 21.05%, but the comparison of brain MRI results of the three neonates groups indicates that the difference is not statistically significant (P＞0.05). 2.The brain MRI result's abnormal ratio of the pre-term is 30.77% and the full-term group is 16.88%, but the comparison of brain MRI results between prem-term group and full-term group indicates that the difference is not statistically significant (P＞0.05). 3.The brain MRI result's abnormal ratio of the ﹤2500g group is 37.50% and the ≥2500g group is 17.24%; but the comparison of brain MRI results of two neonates groups indicates that the difference is not statistically significant(P＞0.05). D. Comparison of abnormal MRI signal values of globus pallidus on T1WI in different groups: 1. The comparison of normal group signal values with that of mild group (p < 0.05), with that of moderate group and with that of severe group (p < 0.01) indicates that the difference is statistically significant; 2. The comparison of signal values between mild and moderate groups (p < 0.05) and between mild group and severe group (p < 0.01) indicates that the difference is statistically significant; 3. The comparison of signal values between moderate group and severe group indicates that the difference is statistically significant(p < 0.05). E. Comparison of BAEP testing results in groups: 1. There were 27(26.21%) cases in abnormalities of the BAEP results of all 103cases bilirubin patients. 2. There were 15(18.29%) cases in abnormalities of the BAEP result of the 82 cases normal brain MRL , 2(40%) cases in abnormalities of the BAEP result of the 5 cases abnormal MRI in mild bilirubin group, 4（50%） cases in abnormalities of the BAEP result of the 8 cases abnormal MRI in moderate bilirubin group and 6（75%）cases in abnormalities of the BAEP result of the 8 cases abnormal brain MRI in severe bilirubin group. 3. After one month review of the BAEP result, there was 0（0.00%） abnormal case in the normal MRI and the mild group; there were 1（20%） abnormal case in the moderate group and 2（25%） cases in the severe group. Conclusion: At low level of bilirubin, central nervous system damage may also occur and can be detected as abnormality by MRI and BAEP. Meanwhile, MRI and BAEP can also provide early abnormal information for the judgment of central nervous system damage of the children with NHB who have no acute bilirubin encephalopathy (ABE) clinical features, and provide clues for early treatment and early intervention.

The level of lactate dehydrogenase and ferritin in the blood of Covid-19 patients compared to healthy people in Iraq

60 samples were collected, 40 samples were for patients with CO-19 and 20 samples were for healthy control people. Tests were performed to know the patients people through the ADVIA Chemistry XPT System and an analysis was performed to find out the ratio of ferritin to patients based on I CHORMA. As for the LDH analysis, use the Cedex Bio Analyzer to find results were found that showed the great effect on ferritin and LDH, where the ratio of standard deviation to LDH to patients people was 441.5641 ± 234.80 and for control 185.08 ± 35.26 as for the analysis of ferritin, where the ratio of standard deviation was 853.92 ± 516.13 to patients people and for control 88.48 ± 59.44 And through the work of statistical analysis to know the effect of the CO-19 on the abnormal ratio, as the statistical analysis proved that there is a positive effect on ferritin and LDH to patients people and the control has a negative effect, and this explains the reason for the lack of the amount of iron present in the body is little if the person is a carrier of the disease

How Ultrasound Can Be Useful for Staging Chronic Kidney Disease in Dogs: Ultrasound Findings in 855 Cases

In patients affected by chronic kidney disease (CKD), some ultrasonographic (US) abnormalities have been shown to correlate better than others with the progression of the disease. The aim of the study was to evaluate the prevalence of the most frequent renal US abnormalities in dogs at different stages of CKD, and to investigate their association with CKD International Renal Interest Society (IRIS) stages. Medical records and ultrasonographical report of 855 dogs were retrospectively included. The most frequent renal ultrasonographic abnormalities were: increased cortical echogenicity, abnormal ratio of cortico-medullary junction (C/M) and pyelectasia. A statistically significant difference in the prevalence of irregular contour, abnormal cortico-medullary junction, abnormal C/M, increased cortical echogenicity, and pyelectasia was found for dogs at different IRIS stages. The number of dogs with more than one US abnormality increased significantly with the progression of IRIS stage. In conclusion, increased cortical echogenicity, abnormal C/M junction and pyelectasia were the most prevalent US abnormalities in our CKD population. Although none of the US abnormalities showed a significantly higher prevalence, the number of dogs presenting > 3 US abnormalities increased significantly from IRIS 2 to IRIS 4. Renal US is an excellent ancillary diagnostic test, which should be used together with renal functional parameters, to monitor the progression of CKD.

Evaluation of diagnostic accuracy of the automatic system for the analysis of digital lung X-ray for detection of spherical masses

Rationale: Most data on the effectiveness of systems for the analysis of digital X-ray images have been provided by their developers and require a high-quality validation in databases prepared independently of the developer.Aim: To analyze the information content of automatic identification of spherical lung masses with digital X-ray imaging using one of the widely available diagnostic algorithms on publicly unaccessible reference datasets.Materials and methods: The study was based on the recognition and analysis of digital X-ray images from two publicly inaccessible reference datasets that have the state registration (Russian Federation) with one of the publicly available diagnostic algorithms (FutureMed Analyzer). The study was performed using two models of X-ray screening as examples: Model 1 consisted of 100 X-ray images of the lungs with a normal: abnormal ratio of 94%: 6%; Model 2 consisted of 5150 chest X-ray images with a normal: abnormal ratio of 97%: 3%.Results: According to the results of the analysis of the X-ray images with the diagnostic system, 98% of the images were correctly interpreted with Model 1 and 95% of the images, with Model 2. 83% of the cases from Model 1 and 69% from Model 2% were interpreted as images with lung abnormalities. The percentage of correct answers for differentiation of the chest X-ray images into two categories (normal vs. abnormal) for Model 1 and Model 2 was 95% and 98%, respectively. The sensitivity for detection of abnormal masses ranged from 69% to 83%. The specificity was 99% for the Model 1 chest X-ray images and 96% for the Model 2 chest X-ray images. The underdiagnosis rate was quite low ranging for Model 1 – 17%, and for Model 2 – 31%. The area under the curve for Model 1 was 0.91 and for Model 2 0.85.Conclusion: The diagnostic efficiency of the automatic image analysis based on the convolutional neuronal networks approaches that of the radiologists. This system of automatic identification of abnormalities was unable to solve the most complex problems of detecting low density spherical masses (like "ground glass" area on computed tomography) and that of shadow summation for abnormalities located in such difficult to interpret zones as lung apices, clavicles, ribs, etc. To select a suitable system, medical institutions need to conduct preliminary testing in their own models equivalent to the studies performed in a given institution (parameters for radiography, nature and frequency of abnormalities).

Analysis on the MRI and BAEP Results of Neonatal Brain with Different Levels of Bilirubin

Background：To explore whether there is abnormality of neonatal brains’ MRI and BAEP with different bilirubin levels, and to provide an objective basis for early diagnosis on the bilirubin induced subclinical damage on brains.Methods: To retrospectively analyze the clinical data of 103 neonatal patients, who had been hospitalized in Neonatology Department of Taicang First People’s Hospital from March 2013 to September 2015, to conduct routine brain MRI examination , BAEP testing and to analyze BAEP and MRI image results of the neonatal patients, who were divided into three groups based on the levels of total serum bilirubin concentration (TSB), 16 cases in mild group (TSB:0.0~229.0μmol/L), 49 cases in moderate group (TSB: 229.0~342.0μmol/L) and 38 cases in severe group (TSB≥342.0μmol/L); Results: We found as follows: A. Comparison of the bilirubin value of the different group : 1. The bilirubin value of the mild group is 171.99±33.50 μmol/L, the moderate group is293.98±32.09 μmol/L, and the severe group is 375.59±34.25 μmol /L . And the comparison of bilirubin values of the three groups of neonates (P＜0.01) indicates the difference is statistically significant (P＜0.01). 2. The bilirubin value of the pre-term group is 289.70±85.38μmol/Land the full-term group is 310.36±72.32 μmol/L, but the comparison of the bilirubin values between pre-term group and full-term group indicates that the difference is not statistically significant (P＞0.05).3. The bilirubin value of the normal brain MRI group(82) is 305.55±74.54 μmol/L and the abnormal brain MRI group is 303.56±83.04μmol/L; the comparison of bilirubin values between the two groups indicates that the difference is not statistically significant(P＞0.05). B. The weight value of the ﹤2500g group is 2.04±0.21 and the ≥2500ggroup is 3.39±0.46; the weight comparison of the two groups indicates that the difference is statistically significant (P＜0.01). C. Comparison of the abnormal MRI of the different groups: 1.The brain MRI result's abnormal ratio of the mild group is 31.25%, the moderate group is 16.33% and the severe group is 21.05%, but the comparison of brain MRI results of the three neonates groups indicates that the difference is not statistically significant (P＞0.05). 2.The brain MRI result's abnormal ratio of the pre-term is 30.77% and the full-term group is 16.88%, but the comparison of brain MRI results between prem-term group and full-term group indicates that the difference is not statistically significant (P＞0.05). 3.The brain MRI result's abnormal ratio of the ﹤2500g group is 37.50% and the ≥2500g group is 17.24%; but the comparison of brain MRI results of two neonates groups indicates that the difference is not statistically significant(P＞0.05). D. Comparison of abnormal MRI signal values of globus pallidus on T1WI in different groups: 1. The comparison of normal group signal values with that of mild group (p < 0.05), with that of moderate group and with that of severe group (p < 0.01) indicates that the difference is statistically significant; 2. The comparison of signal values between mild and moderate groups (p < 0.05) and between mild group and severe group (p < 0.01) indicates that the difference is statistically significant; 3. The comparison of signal values between moderate group and severe group indicates that the difference is statistically significant(p < 0.05). E. Comparison of BAEP testing results in groups: 1. There were 27(26.21%) cases in abnormalities of the BAEP results of all 103cases bilirubin patients. 2. There were 15(18.29%) cases in abnormalities of the BAEP result of the 82 cases normal brain MRL , 2(40%) cases in abnormalities of the BAEP result of the 5 cases abnormal MRI in mild bilirubin group, 4（50%） cases in abnormalities of the BAEP result of the 8 cases abnormal MRI in moderate bilirubin group and 6（75%）cases in abnormalities of the BAEP result of the 8 cases abnormal brain MRI in severe bilirubin group. 3. After one month review of the BAEP result, there was 0（0.00%） abnormal case in the normal MRI and the mild group; there were 1（20%） abnormal case in the moderate group and 2（25%） cases in the severe group. Conclusion: At low level of bilirubin, central nervous system damage may also occur and can be detected as abnormality by MRI and BAEP. Meanwhile, MRI and BAEP can also provide early abnormal information for the judgment of central nervous system damage of the children with NHB who have no acute bilirubin encephalopathy (ABE) clinical features, and provide clues for early treatment and early intervention.

Impact of sFLC Ratio on Outcome in Patients with MM: Validating the Utility of sFLC in Response Definition

Background: The treatment of Multiple Myeloma (MM) has evolved significantly in the past decade with the introduction of novel agents and drug combinations, thus enhancing treatment efficacy and allowing more patients to achieve complete response (CR). This has created a need to identify surrogates for depth of treatment response. Serum free light chain (sFLC) ratio normalization has been shown to be prognostic for progression free survival as well as overall survival in patients achieving a complete response to therapy. Consequently, it has been incorporated as a defining feature for stringent CR, along with lack of clonal plasma cells by immunohistochemistry (IHC) or low sensitivity flow cytometry. The routine use of multiparametric flow cytometry with higher sensitivity to detect residual disease than IHC or the older 4-color flow cytometry, has raised the question as to whether sFLC ratio is still a valid indicator of response depth. Moreover, in nearly half of the patients with an abnormal sFLC ratio after treatment, the abnormality is secondary to suppression of one or both serum light chains. Therefore, we designed a retrospective study to address these issues. Patients and Methods: This is a retrospective study using the Multiple Myeloma Database at Mayo Clinic, Rochester. We included patients who, after any line of therapy, had negative serum and urine immunofixation and absence of clonal bone marrow plasma cells by flow cytometry (PC-PRO), which has a sensitivity of >10-4. Simultaneous sFLC data was also extracted. Patients were grouped into three categories based on their sFLC ratios: 1) normal ratio (normal), 2) abnormal ratio due to suppression of the uninvolved light chain (LC), involved LC, or both (Abn-suppressed) and 3) abnormal ratio due to elevation of the involved LC (Abn-inv elevated). The primary endpoint was the median time to next treatment (TTNT), defined as the time from sample collection to the time of initiation of the subsequent therapy or time of last follow up if a subsequent line of treatment was not initiated. Results: The cohort consisted of 510 patients. 285 (56%) were males and 225 (44%) females. Median age was 61 years (IQR: 55-67). Median Follow-up was 41 months. The last treatments administered prior to data collection included stem cell transplant (SCT) (with or without maintenance) in 290 (57%) patients, and non-SCT regimens in the others. The sFLC ratio was normal in 337 (66%) and abnormal in 173 (34%) patients. Among the patients with abnormal sFLC ratios, 81 had elevated involved LC, 25 had suppression of the involved LC, 45 had suppression of the uninvolved LC and 22 had suppression of both LCs. We first examined the TTNT for the three groups and found that the TTNT was identical for those with a normal ratio and those with an abnormal ratio due to suppression of one or both light chains (Figure 1). So, we combined these two groups (Normal-Abn suppressed) and compared their outcomes to the patients with abnormal sFLC ratio due to elevated involved LC. The Abn-inv elevated group had a shorter TTNT as shown in Figure 2 (log-rank 0.06, Wilcoxon <0.01). The Abn-inv elevated group also had decreased overall survival compared to the other group (log-rank: 0.05, Wilcoxon: 0.01) (Figure 3). Conclusion: This study provides 2 important observations. First, patients with an abnormal ratio due to suppression of one or both LCs have outcomes similar to those with a normal ratio, suggesting a need to clarify the current definition of stringent CR. Second, the study suggests an important prognostic value for an abnormal sFLC ratio due to elevated involved LC, suggesting this as an important surrogate for depth of response. Disclosures Kapoor: Janssen: Research Funding; Takeda: Honoraria, Research Funding; Cellectar: Consultancy; Celgene: Honoraria; Sanofi: Consultancy, Research Funding; Amgen: Research Funding; Glaxo Smith Kline: Research Funding. Dispenzieri:Akcea: Consultancy; Intellia: Consultancy; Janssen: Consultancy; Pfizer: Research Funding; Takeda: Research Funding; Celgene: Research Funding; Alnylam: Research Funding. Gertz:Ionis: Honoraria; Alnylam: Honoraria; Prothena: Honoraria; Celgene: Honoraria; Janssen: Honoraria; Spectrum: Honoraria, Research Funding. Lacy:Celgene: Research Funding. Dingli:Karyopharm: Research Funding; Rigel: Consultancy; Millenium: Consultancy; Janssen: Consultancy; alexion: Consultancy. Leung:Takeda: Research Funding; Aduro: Membership on an entity's Board of Directors or advisory committees; Prothena: Membership on an entity's Board of Directors or advisory committees; Omeros: Research Funding. Kumar:Celgene: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Takeda: Research Funding.

SPECIFIC FEATURES OF MAJOR ANGULAR PARAMETERS OF CRANIO-FACIAL COMPLEX IN MALES AND FEMALES WITH MESIAL OCCLUSION IN THEIR FIRST MATURE A

Uneven growth, leading to an abnormal ratio of the upper and lower jaws, underlies the development of various occlusion issues . The respective literature holds it that the dental anomalies variability in different areas ranges from 11% to 90%. The high prevalence of occlusion issues should be attributed primarily to the difficulty associated with their correct and timely diagnostics . The research carried out to identify occlusion anomalies reveal the lack of a decrease trend, which means there are stable mechanisms triggering the development of this pathology, which keep its prevalence at a stable level . Besides, this pathology is complicated with occlusive and musculo-articular disorders .