BACKGROUND & AIMS: :Chondrolipoma is an extremely rare variant of lipoma with cartilaginous metaplasia. The presence of nonlipomatous components can lead to a variety of entities in the differential diagnosis from the radiologic findings. We describe an unusual case of a chondrolipoma occurring in the right ankle of a 9-year-old female. Physical examination showed a 3.5-cm, elastic-hard, poorly mobile, nontender mass adherent to the Achilles tendon. Plain radiographs revealed a faintly calcified soft tissue mass without bone involvement. Magnetic resonance imaging showed a well-defined mass with 2 components with heterogeneous signal intensity, suggesting the coexistence of a fatty area and another nonlipomatous component. Marginal excision of the tumor was performed. Histologically, the tumor was composed of mature adipose tissue studded with islands of mature hyaline cartilage. Based on these findings, the tumor was diagnosed as a chondrolipoma. The patient had no evidence of local recurrence within 9 months of follow-up. To the best of our knowledge, this is the first case of chondrolipoma originating from the ankle in a child.

背景与目标： : 软骨脂肪瘤是脂肪瘤的一种极其罕见的变异型软骨化生。非脂肪瘤性成分的存在可导致放射学发现的鉴别诊断疾病中的各种实体。我们描述了一个9岁女性右脚踝发生软骨脂肪瘤的不寻常病例。体格检查显示跟腱附着有3.5厘米，弹性坚硬，移动不良，不柔软的肿块。X线平片显示微弱的钙化软组织肿块，没有骨受累。磁共振成像显示出一个明确的质量，其中有2个成分，信号强度不均匀，表明脂肪区域和另一种非脂肪瘤成分并存。进行了肿瘤的边缘切除术。从组织学上讲，肿瘤由成熟的脂肪组织组成，这些脂肪组织散布着成熟的透明软骨岛。根据这些发现，该肿瘤被诊断为软骨脂肪瘤。在随访的9个月内，患者没有局部复发的证据。据我们所知，这是第一例起源于儿童脚踝的软骨脂肪瘤。

BACKGROUND & AIMS: INTRODUCTION:Abnormal ankle-brachial index (ABI) is associated with increased morbidity and mortality in hemodialysis patients. However, whether the decrease in ABI over time carries the prognostic value is unknown. The aim of this study was to assess whether the decrease in ABI over time was a good predictor of poor cardiovascular (CV) prognosis in hemodialysis patients. METHODS:This study enrolled 234 routine hemodialysis patients and 173 patients completed the follow-up. The ABI was measured by an ABI-form device at baseline and at the first year follow-up. The ΔABI was defined as ABI measured at the first year follow-up minus ABI measured at baseline. Progressors of ABI were defined as patients with ΔABI < -0.3. CV events were defined as CV death, hospitalization for unstable angina, nonfatal myocardial infarction, hospitalization for arrhythmia, hospitalization for congestive heart failure and stroke. RESULTS:The follow-up period was 37.8 ± 11.1 months. In the multivariate analysis, progressors of ABI (hazard ratio, 2.71; 95% confidence interval, 1.10-6.68, P = 0.03), decreased albumin and increased high-sensitivity C-reactive protein were associated with increased CV events. CONCLUSIONS:This longitudinal study showed ΔABI < -0.3 was independently associated with an increase in CV events. Hence, a great decrease in ABI over time might be a useful indicator of poor CV prognosis in hemodialysis patients.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Individuals with HIV disease often must adhere to complex medication regimens. To date, regimen complexity has not been examined in the literature using standardized procedures incorporating all important elements of antiretroviral (ARV) regimens. OBJECTIVE:This article presents a novel method of quantifying regimen complexity using objective criteria addressing the factors that may complicate adherence to ARV regimens. METHODS:Part 1 of this article describes the development of the Antiretroviral Regimen Complexity (ARC) Index scoring system. Based on input from pediatric and adult patients, caregivers of pediatric patients, and health care professionals, this comprehensive system includes the number of medications, dosing schedules, administration methods, special instructions, and required preparations associated with ARV regimens. Weights are applied for each of these factors to produce an overall score representing the regimen's level of complexity. Part 2 of this article presents reliability and validity data for the system. RESULTS:The ARC Index demonstrates excellent test-retest and interrater reliability as well as strong construct and discriminant validity. An on-line version of this system minimizes computation errors. CONCLUSIONS:Although modifications may be necessary for patients requiring nonstandard dosing instructions, preliminary evidence supports the utility of this measure as a reliable and valid indicator of the complexity of antiretroviral treatment regimens.

背景与目标：

BACKGROUND & AIMS: :It is unclear whether overweight but otherwise healthy boys with delayed puberty have a variation of constitutional delay of growth and maturation (CDGM) or a different etiology for their pubertal delay. To characterize better this group of boys and investigate whether their growth pattern distinguishes them from boys with typical CDGM, growth data were analyzed in eight overweight (BMI SDS > or = 85th percentile) and 37 non-overweight (BMI SDS <85th percentile) boys with delayed puberty. Primary outcome measures included predicted height (PH) and adult height (AH). At diagnosis of delayed puberty, the overweight boys had less delayed bone ages (chronological age [CA] - bone age [BA] = 1.2 +/- 1.0 vs 2.5 +/- 1.1 years, p <0.01), greater height SDS for CA (-0.5 +/- 0.7 vs -2.4 +/- 0.8, p <0.001), and greater height SDS for BA (0.6 +/- 0.9 vs -0.4 +/- 1.1, p <0.05). PH for the overweight boys exceeded their mid-parental height (MPH) by 5.0 +/- 7.2 cm while non-overweight boys were predicted to fall below their MPH by 2.8 +/- 6.3 cm (p <0.01). Available AH data corroborated the differences in PH, with a trend for overweight boys to have greater height relative to their MPH than the non-overweight boys. These observations suggest that in the context of delayed puberty, being overweight may modulate adult height and/or that the etiology of delayed puberty in overweight boys may differ from typical CDGM.

背景与目标： : 尚不清楚青春期延迟的超重但健康的男孩是否存在生长和成熟的体质延迟 (CDGM) 或青春期延迟的不同病因。为了更好地描述这一组男孩，并调查他们的生长模式是否将他们与典型CDGM男孩区分开，对8名超重 (BMI SDS> 或 = 85百分位) 和37名非超重 (BMI SDS <85百分位) 青春期延迟男孩的生长数据进行了分析。主要结局指标包括预测身高 (PH) 和成人身高 (AH)。在诊断青春期延迟时，超重男孩的骨龄延迟较少 (按时间顺序年龄 [CA] -骨龄 [BA] = 1.2/- 1.0 vs 2.5/- 1.1岁，p <0.01)，CA的更高高度SDS (-0.5 +/- 0.7 vs -2.4 +/- 0.8，p <0.001)，BA的更高高度SDS (0.6 +/- 0.9 vs -0.4 +/- 1.1，p <0.05)。超重男孩的ph值超过其父母中等身高 (MPH) 5.0 +/-7.2厘米，而非超重男孩预计将低于其MPH 2.8 +/-6.3厘米 (p <0.01)。可用的AH数据证实了PH的差异，超重男孩的身高相对于其MPH的趋势比非超重男孩更大。这些观察结果表明，在青春期延迟的情况下，超重可能会调节成人身高和/或超重男孩青春期延迟的病因可能与典型的CDGM不同。

BACKGROUND & AIMS: :The effect of body mass index (BMI) and obesity on apolipoprotein (apo) A-I levels and kinetics was examined by gender. Apo A-I kinetics were determined with a primed, constant infusion of deuterated leucine in the fed state in 19 men and 13 postmenopausal women. Compared with nonobese men, nonobese women had a higher level of high-density lipoprotein cholesterol (HDL-C) and apo A-I due to a 48% higher apo A-I production rate (PR) (P = .05). Obesity had no significant effects on apo A-I kinetics in women. In contrast, compared with nonobese men, obese men had a 9% lower apo A-I level due to a 64% higher fractional catabolic rate (FCR) partially offset by a 47% higher PR. Obese women had a 52% higher HDL-C than obese men (50 vs 33 mg/dL, respectively; P = .012), a finding related to the faster apo A-I FCR in obese men. BMI was directly correlated with apo A-I FCR (r = 0.84, P < .001) and PR (r = 0.79, P < .001) in men but not in women. Sixty-two percent of the variability in PR and 71% of the variability in FCR were due to BMI in men and only 3% and 23%, respectively, in women. In conclusion, BMI has a significant effect on apo A-I PR and FCR in men but not in women.

背景与目标： : 通过性别检查了体重指数 (BMI) 和肥胖对载脂蛋白 (apo) A-I水平和动力学的影响。在19名男性和13名绝经后女性中，通过在进食状态下持续不断地输注氘代亮氨酸来确定Apo A-I动力学。与非肥胖男性相比，非肥胖女性的高密度脂蛋白胆固醇 (hdl-c) 和apo a-I水平较高，原因是apo A-I的生产率 (PR) 48% 较高 (P = .05)。肥胖对女性的apo A-I动力学没有显着影响。相反，与非肥胖男性相比，肥胖男性的apo a-I水平9% 较低，这是由于64% 较高的分解代谢率 (FCR) 部分被47% 较高的PR抵消。肥胖女性的hdl-c比肥胖男性高52% (分别为50 vs 33 mg/dL; P = .012)，这一发现与肥胖男性的apo a-I FCR更快有关。BMI与男性的apo A-I FCR (r = 0.84，P <.001) 和PR (r = 0.79，P <.001) 直接相关，而女性则不相关。PR变异性的60 2% 和FCR变异性的71% 是由于男性的BMI，而女性分别只有3% 和23%。总之，BMI对男性的apo a-I PR和FCR有显着影响，而女性则没有。

BACKGROUND & AIMS: :Hepatocellular carcinoma (HCC) is a common malignancy and the main cause of mortality in patients with chronic liver diseases. This study reports the inhibitory effect of boron on HCC induced in rats by administering thioacetamide (TAA) (0.03%) in drinking water for 400days. Boron (4mg/kg body weight) was administered orally after induction of carcinoma. Treatment was continued for 122days, and cell proliferation, histology and biochemistry of treated and control group of rats were studied. Proliferating cell nuclear antigen (PCNA), and [(3)H]-thymidine incorporation, which increased in rats exposed to carcinogen, significantly decreased after boron treatment. PCNA index decreased from 80 in HCC rats to 32 after boron treatment. In the control group, it was 20. Boron caused a dose-dependent decrease in carcinogen-induced [(3)H]-thymidine uptake by the rat hepatocyte. It could partially reverse the activity of selected biochemical indicators of hepatic damage, oxidative stress, selenium and serum retinol, which are depleted in liver cancer, and improved overall health of animal. The study implicates the elevated levels of mammalian molybdenum Fe-S containing flavin hydroxylases, which increase the free radical production and oxidative stress, consequently causing increased hepatic cell proliferation in HCC, and reports boron to ameliorate these changes in liver cancer.

背景与目标： 肝细胞癌 (HCC) 是一种常见的恶性肿瘤，是慢性肝病患者死亡的主要原因。这项研究报告了硼通过在饮用水中施用硫代乙酰胺 (TAA) (0.03%) 400天对大鼠诱导的HCC的抑制作用。诱导癌后口服硼 (4mg/kg体重)。持续治疗122天，并研究了治疗组和对照组大鼠的细胞增殖，组织学和生物化学。在暴露于致癌物的大鼠中，增殖细胞核抗原 (PCNA) 和 [(3)H]-胸苷掺入增加，在硼处理后显着减少。硼处理后，PCNA指数从肝癌大鼠的80下降到32。对照组为20。硼导致大鼠肝细胞对致癌物诱导的 [(3)H]-胸苷摄取的剂量依赖性降低。它可以部分逆转肝癌中肝损伤，氧化应激，硒和血清视黄醇的某些生化指标的活性，并改善动物的整体健康状况。该研究暗示了含有黄素羟化酶的哺乳动物钼Fe-S水平升高，这会增加自由基的产生和氧化应激，从而导致HCC中肝细胞增殖增加，并报道硼可以改善肝癌中的这些变化。

BACKGROUND & AIMS: :Inflammation affects the reliability of ferritin. The serum level of transferrin receptor protein (sTfR) represents true demand of iron in the body. This study attempts to identify levels of sTfR and correlate the trends of sTfR/ferritin index with BMI in the population of Karachi. 132 gender matched volunteers between the ages of 20-60 years were recruited for this cross-sectional study. BMI was calculated using the formula: (weight in kg / height in m2). Following groups were made according to South Asian criteria of BMI; Group A: normal weight (18.0-22.9 kg/m2), Group B: overweight (23.0-24.9 kg/m2), Group C: obese (>25.0 kg/m2). Serum ferritin, sTfR and CRP levels were determined using ELISA kits. Statistical comparisons were performed using Mann Whitney U and Spearman's rank correlation, where p<0.05 was considered significant. The results identified increased in TIBC, sTfR, ferritin and CRP in obese as compared to normal weight individuals (p<0.001). sTfR/ferritin ratio was 0.822 which signifies increased risk of acute myocardial infarction in group C. Serum iron (r=-0.359,p=0.004) showed negative correlation with BMI while serum ferritin (r=0.237,p< 0.001) and sTfR (r=0.263,p= 0.036) levels were positively associated to BMI. This study highlights a novel finding that sTfR is most likely a better clinical measure of iron status in inflammatory conditions as its expression is effected by erythropoiesis and not by inflammation. Risk of Acute myocardial infarction can also be predicted by increased sTfR/ferritin ratio.

背景与目标： : 炎症影响铁蛋白的可靠性。血清转铁蛋白受体蛋白 (sTfR) 水平代表体内铁的真正需求。这项研究试图确定sTfR的水平，并将sTfR/铁蛋白指数的趋势与卡拉奇人口的BMI相关联。这项横断面研究招募了132名年龄在20-60岁之间的性别匹配志愿者。BMI的计算公式为 :( 体重kg/身高m2)。根据南亚BMI标准分为以下组; A组: 正常体重 (18.0-22.9千克/m2)，B组: 超重 (23.0-24.9千克/m2)，C组: 肥胖 (> 25.0千克/m2)。使用ELISA试剂盒测定血清铁蛋白，sTfR和CRP水平。使用Mann Whitney U和Spearman秩相关进行统计比较，其中p<0.05被认为是显著的。结果表明，与正常体重个体相比，肥胖者的TIBC，sTfR，铁蛋白和CRP升高 (p<0.001)。0.822了sTfR/铁蛋白比值，这表明C组发生急性心肌梗死的风险增加。血清铁 (r =-0.359，p = 0.004) 与BMI呈负相关，而血清铁蛋白 (r = 0.237，p< 0.001) 和sTfR (r = 0.263，p = 0.036) 与BMI呈正相关。这项研究强调了一项新发现，即sTfR最有可能是炎症条件下铁状态的更好的临床指标，因为其表达受红细胞生成而不是炎症影响。急性心肌梗死的风险也可以通过增加sTfR/铁蛋白比率来预测。

BACKGROUND & AIMS: PURPOSE:To investigate the effect of the glycemic index (GI) of pre-exercise snack bars on substrate utilization during subsequent moderate intensity exercise. METHODS:Fourteen male participants (Age: 27 ± 5 yr; BMI: 22.5 ± 2.7 kg m(-2); [Formula: see text]: 48.7 ± 6.1 mL kg(-1 )min(-1)) completed two trials in a randomized and counterbalanced crossover design. Two iso-caloric snack bars with different GI values (20, LGI versus 68, HGI) were provided to the participants. Ninety minutes later, all participants completed 45 minutes of ergometer cycling at 65% [Formula: see text]. Substrate utilization was measured using indirect calorimetry. RESULTS:During exercise, higher fat oxidation and lower carbohydrate (CHO) oxidation were observed in the LGI trial (LGI versus HGI: CHO, 87.3 ± 20.1 versus 99.2 ± 19.0 g, p < 0.05; Fat, 15.0 ± 5.8 versus 9.7 ± 7.0 g, p < 0.05). CONCLUSION:Compared with an iso-caloric HGI snack bar, pre-exercise LGI snack bar consumption may facilitate a shift of substrate utilization from CHO to fat during subsequent moderate intensity exercise.

背景与目标：

BACKGROUND & AIMS: :We have studied the effects of ankle arthrodesis on the gait of three subjects with special attention to the time and sagittal plane kinematic and kinetic characteristics. Each subject had a painless arthrodesis and no other gait limitation. To compensate for this disability they showed an increased range of movement at the ipsilateral mid-tarsal, knee and hip joints, and required greater than normal resuftan joint moments to be generated at the ipsilateral knee and hip joints. The subjects exhibited stride-to-stride kinetic compensation at the knee and hip joints, with associated variability in resultant joint moments and power patterns. However, they achieved a symmetric gait by mimicking ipsilateral movements with the opposite limb.

背景与目标： : 我们研究了踝关节固定术对三名受试者步态的影响，特别注意时间和矢状面运动学和动力学特征。每个受试者都有无痛性关节固定术，没有其他步态限制。为了弥补这种残疾，他们显示同侧中，膝和髋关节的运动范围增加，并且需要在同侧膝关节和髋关节处产生比正常的resuftan关节力矩更大的运动。受试者在膝关节和髋关节表现出步幅运动补偿，并在关节力矩和动力模式上产生相关的变异性。但是，他们通过模仿与相反肢体的同侧运动来实现对称步态。

BACKGROUND & AIMS: OBJECTIVE:To assess the use of the International Index of Erectile Function (IIEF), routinely used in patients being treated for localized prostate cancer, including potency-preserving, nerve-sparing radical prostatectomy (RP), as many patients complain that the results of the IIEF over 4 weeks before RP are not representative. PATIENTS AND METHODS:The study included 123 consecutive patients (mean age 64.6 years, range 52-78) who had endoscopic-extraperitoneal RP and who completed the IIEF. The interval between the diagnosis of the disease and surgery was >4 weeks in all. The patients completed the same questionnaire referring to the last 4 weeks before their prostate biopsy, as a modified index of their sexual status (IIEFm and EFm). RESULTS:The clinical stage of disease was cT1c (34.9%), cT2a (49.5%), cT2b (5.7%) and cT2c (9.9%) before RP. The mean IIEF score was 42.8 and the mean EF domain score was 16.9; the mean IIEFm was 54.9 and the EFm domain score was 23.7. All the differences were statistically significant (P < 0.001). CONCLUSION:The IIEF questionnaire scores are influenced by many factors. Depression after a diagnosis of cancer, and the prostate biopsy-related symptoms, e.g. prostatitis, perineal pain and haemospermia, might compromise the patients' well-being and libido, and thus affect the IIEF scores before RP. We therefore suggest using the IIEFm and EFm scores before prostate biopsy to assess the patients' sexual status before any treatment for localized prostate cancer.

背景与目标：

BACKGROUND & AIMS: :A brachial loop is a rare anatomic variation and can result in the failure of transradial coronary procedures. We report a brachial loop encountered in a patient undergoing a coronary angiogram. During this angiogram, a 0.035'' J-tipped Teflon-coated guidewire met with resistance in the brachial artery because of this rare vascular loop. In this case report, we discuss the technique we used to manage this rare condition. Interventional cardiologists should keep in mind that resistance of the guidewire can result in major vessel complications during the transradial approach.

背景与目标： 肱动脉环是一种罕见的解剖变异，可导致经桡动脉冠状动脉手术失败。我们报告了在接受冠状动脉造影的患者中遇到的臂环。在此血管造影中，由于这种罕见的血管回路，0.035的J形尖头聚四氟乙烯涂层的导丝在肱动脉中遇到阻力。在本案例报告中，我们讨论了用于管理这种罕见情况的技术。介入心脏病学家应记住，导丝的阻力可能会导致经radial入路时的主要血管并发症。

BACKGROUND & AIMS: OBJECTIVE:Cross-sectional data suggest that obesity, particularly central obesity, may be associated with decreased production of sex steroid hormones in men. However, longitudinal hormone data on men in relation to obesity status are limited. Previous studies have not consistently demonstrated whether sex steroids are associated specifically to body mass index or to measures of central obesity. Our objective was to examine the relation of obesity (body mass index > 30 kg/m2), and of central obesity (waist circumference > 100 cm or waist to hip ratio > 0.95) to longitudinal change in sex steroid hormones in men. DESIGN:Prospective follow-up of a population-based sample of men in Boston. PATIENTS:Nine hundred forty-two (942) men in the Massachusetts Male Ageing Study with complete anthropometry and hormone data at baseline (1987-1989, ages 40-70) and follow-up (1995-1997). MEASUREMENTS:Free and total testosterone (FT and TT), dehydroepiandrosterone sulphate (DHEAS), and sex hormone-binding globulin (SHBG) were assessed using standardized methods. Health behaviours and medical history were obtained by structured interview. Repeated measures regression was used to describe trends in steroid hormones and SHBG in relation to obesity status, adjusting for age, smoking, alcohol, comorbidities, and physical activity. RESULTS:Obesity was associated with decreased levels of total and free testosterone, and of SHBG at follow-up relative to baseline. For any given baseline concentration of TT, FT or SHBG, follow-up levels were lowest among men who remained obese or who became obese during follow-up. This was true for all three indices of obesity. Central adiposity was associated with lower DHEAS levels at follow-up, while elevated body mass index was not. CONCLUSIONS:Obesity may predict greater decline in testosterone and SHBG levels with age. Central adiposity may be a more important predictor of decline in DHEAS than is body mass index.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Recent studies of pancreatic cancer suggest a role for hyperinsulinemia in carcinogenesis. Because insulin is secreted in response to elevated blood glucose concentrations, dietary factors that increase these concentrations may be important in pancreatic carcinogenesis. OBJECTIVE:The objective was to examine prospectively the relation between pancreatic cancer risk and dietary glycemic load (GL), overall glycemic index (GI), and intake of total carbohydrates and mono- and disaccharides. DESIGN:The Netherlands Cohort Study consisted of 120,852 men and women who completed a baseline questionnaire in 1986. After 13.3 y of follow-up, 408 pancreatic cancer cases were detected, 66% of which were microscopically confirmed. A validated 150-item food-frequency questionnaire, completed at baseline, was used to calculate carbohydrate and mono- and disaccharide intakes and the GL and GI of the diet. RESULTS:Dietary GL, GI, or intake of carbohydrates and mono- and disaccharides were not associated with pancreatic cancer risk in this cohort. Also, the associations were not modified by sex. Our results did not change after the analysis was restricted to microscopically confirmed pancreatic cancer cases or after individuals who reported a history of diabetes at baseline were excluded from the analyses. CONCLUSIONS:Overall, our findings do not support the hypothesis that GL, GI, or intake of carbohydrates and mono- and disaccharides are positively associated with pancreatic cancer risk. This is in agreement with previous prospective studies that investigated the relation between GL and GI and pancreatic cancer risk.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Successful hemodialysis requires reliable vascular access that can deliver adequate blood flow. An arteriovenous fistula is preferred for access because of its longevity and low frequency of complications, but up to 60% of arteriovenous fistulas created surgically are never suitable for hemodialysis because of nonmaturation (insufficient vascular dilatation). Decreased arterial elasticity may impair dilatation, thereby affecting fistula maturation. This study evaluated the feasibility of brachial artery elasticity measurement in patients with chronic kidney disease obtained during routine pre-operative mapping ultrasound (US) imaging before hemodialysis access placement and compared the measurements to those obtained in healthy volunteers. METHODS:Brachial artery functional US studies were collected from 75 patients undergoing routine preoperative mapping for hemodialysis access and 50 healthy volunteers. Vascular strain was calculated from the change in intima-media thickness between end systole and end diastole, and vascular stress was estimated from the pulse pressure. Assuming a linear elastic medium, the elastic modulus was estimated as the ratio of vascular stress to strain. RESULTS:Elastic modulus measurements were significantly higher in patients than in volunteers (130 versus 100 kPa; P = .01). With combined volunteer and patient data, there was a significant correlation between elasticity and systolic blood pressure (R2 = 0.23; P < .001). Elasticity was correlated with age in volunteers but not in patients (R2 = 0.14; P = .017; R2 < .001; P = .829, respectively). CONCLUSIONS:This analysis of clinical arterial vessel biomechanics shows that a noninvasive US measurement can detect elastic modulus differences between patients with chronic kidney disease and healthy individuals. Future studies will correlate the elastic modulus with histologic characteristics and eventual arteriovenous fistula maturation, which may provide supplemental information on arterial biomechanical properties as a useful addition to current predictors of fistula success.

背景与目标：

BACKGROUND & AIMS: We demonstrated that the prognosis of breast cancer patients who received adjuvant immunochemotherapy with Krestin (PSK) showed a tendency to be better than that of breast cancer patients receiving chemotherapy only. We retrospectively investigated the usefulness of HLA typing for selecting patients to receive adjuvant immuno-chemotherapy with PSK. One hundred and thirty-four patients with operable breast cancer were typed as HLA-A, -B, -C by a lymphocytotoxicity test. Patients without vascular invasion had no adjuvant therapy (NA group). Patients with vascular invasion in the tumor and/or in the metastatic lymph node were randomized into two groups. In group 1 (FEMP only), a combination chemotherapy of 100 mg of 5-fluorouracil (F), 50 mg of cyclophosphamide (E), 2 mg of mitomycin C (M), and 5 mg of predonisolone (P) was orally administered daily for 28 days (one course). In group 2 (FEMP+PSK), FEMP and 3.0 g of PSK were orally administered for 28 days (one course). Two courses a year of these agents were given for five years in both groups. Each group (NA, FEMP, FEMP+PSK) was stratified by the presence of HLA B40 type (B40(+)) or not (B40(-)). Five- and 10-year disease-free survival (DFS) rates (93%, 80%, respectively) of patients with B40(+) seemed to be better than those (83% and 51%) of patients with B40(-). In the NA group, 5- and 10-year DFS were 100% and 71% in patients with B40(+), 92% and 76% in those with B40(-), respectively. In the FEMP group (chemotherapy only), 5- and 10-year DFS of patients with B40(+) were both 84%. These were not statistically significant compared with those (82% and 33%) of patients with B40(-). On the other hand, in the FEMP+PSK group, 5- and 10-year DFS of patients with B40(+) were both 100%, and those of patients with B40(-) were 76% and 55%, respectively. DFS of patients with B40(+) was significantly better than that of patients with B40(-). It is concluded that HLA typing may be a predictive index in determining the use of immunochemotherapy combined with PSK for patients with operable breast cancer.

背景与目标： 我们证明，接受Krestin (PSK) 辅助免疫化疗的乳腺癌患者的预后显示出比仅接受化疗的乳腺癌患者更好的趋势。我们回顾性研究了HLA分型对选择接受PSK辅助免疫化疗的患者的有用性。通过淋巴细胞毒性试验将134例可手术的乳腺癌患者分为hla-a，-B，-C。无血管侵犯的患者没有辅助治疗 (NA组)。肿瘤和/或转移淋巴结中血管浸润的患者被随机分为两组。在第1组 (仅FEMP) 中，每天口服给药100 mg 5-氟尿嘧啶 (F)，50 mg环磷酰胺 (E)，2 mg丝裂霉素c (M) 和5 mg泼尼松龙 (P) 的联合化疗，持续28天 (一个疗程)。在第2组 (FEMP + PSK) 中，FEMP和3.0g PSK口服给药28天 (一个疗程)。在两组中，这些代理商每年接受两次课程，为期五年。每组 (NA，FEMP，FEMP PSK) 均通过存在HLA B40型 (B40 ()) 或不存在 (B40(-)) 进行分层。B40(+) 患者的5年和10年无病生存率 (DFS) (分别为93% 、80%) 似乎优于B40(-) 患者的 (83% 和51%)。在NA组中，B40(-) 患者的5年和10年DFS分别100% 和71%，B40(-) 患者的92% 和76%。在FEMP组 (仅化疗) 中，B40(+) 患者的5年和10年DFS均为84%。与B40(-) 患者的 (82% 和33%) 相比，这些没有统计学意义。另一方面，在FEMP PSK组中，B40 () 患者的5年和10年DFS均为100%，B40(-) 患者的5年和10年DFS分别为76% 和55%。B40(+) 患者的DFS显著优于B40(-) 患者。结论HLA分型可能是确定免疫化疗联合PSK用于可手术乳腺癌患者的预测指标。