The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse r...The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse risk.Participants were SCC patients aged≥18 years who enrolled between June 2019 and December 2021,completed follow-up assessments at one and three months,and reported abstinence at one month.Short-term relapse was defined as self-reported smoking at the three-month follow-up.Treatments included counseling,first-line cessation medications,and traditional Chinese medicine(TCM).Logistic regression was used to identify factors associated with short-term relapse.Among 10,724 eligible SCC patients,11.6%experienced short-term relapse.Factors positively associated with relapse included the number of previous quit attempts(1–5 attempts:OR=1.422,95%CI:1.254–1.613,>5 attempts:OR=1.382,95%CI:1.057–1.808),high perceived difficulty in quitting(OR=1.297,95%CI:1.061–1.586),and moderate(OR=1.383,95%CI:1.174–1.629)or weak(OR=1.517,95%CI:1.251–1.841)willingness to quit.Factors negatively associated with relapse included having a college degree or higher(OR=0.796;95%CI:0.650–0.973),high confidence in quitting(OR=0.786;95%CI:0.629–0.983),and use of TCM(OR=0.276;95%CI:0.158–0.482).Enhancing self-efficacy in quitting appears crucial for preventing short-term relapse.The use of TCM may reduce relapse risk and warrants further investigation.展开更多
To the editor:Schizophrenia is a chronic and severe mental disorder characterised by profound disruptions in thinking,affecting language,perception and the sense of self. These disruptions can significantly impair an ...To the editor:Schizophrenia is a chronic and severe mental disorder characterised by profound disruptions in thinking,affecting language,perception and the sense of self. These disruptions can significantly impair an individual’s ability to function socially and occupationally, leading to a high burden on both the individuals affected and society as a whole.展开更多
With the advances in allogeneic hematopoietic cell transplantation(allo-HCT)and supportive care,the number of allo-HCT for elderly patients has been increasing in recent years.However,the advanced donor age limits the...With the advances in allogeneic hematopoietic cell transplantation(allo-HCT)and supportive care,the number of allo-HCT for elderly patients has been increasing in recent years.However,the advanced donor age limits the availability of human leukocyte antigen(HLA)-matched sibling donors(MSD)for elderly individuals.展开更多
The purpose of this article is to analyze the efficacy of molecular diagnostic techniques for monitoring tuberculosis relapse.After analyzing the connotation of molecular diagnostic techniques and their specific appli...The purpose of this article is to analyze the efficacy of molecular diagnostic techniques for monitoring tuberculosis relapse.After analyzing the connotation of molecular diagnostic techniques and their specific application process in tuberculosis relapse monitoring,a total of 200 cured tuberculosis patients were selected(100 in the experimental group and 100 in the control group).During the 12-month follow-up period,the experimental group was monitored by molecular diagnostic techniques,while the control group was monitored by traditional techniques.Finally,by comparing the performance indicators of the two monitoring methods,as well as the relapse situations and outcomes of patients,it was demonstrated that molecular diagnostic techniques have higher efficacy in tuberculosis relapse monitoring.展开更多
Depression is a prevalent mental health disorder characterized by high relapse rates,highlighting the need for effective preventive interventions.This paper reviews the potential of reinforcement learning(RL)in preven...Depression is a prevalent mental health disorder characterized by high relapse rates,highlighting the need for effective preventive interventions.This paper reviews the potential of reinforcement learning(RL)in preventing depression relapse.RL,a subset of artificial intelligence,utilizes machine learning algorithms to analyze behavioral data,enabling early detection of relapse risk and optimization of personalized interventions.RL's ability to tailor treatment in real-time by adapting to individual needs and responses offers a dynamic alternative to traditional therapeutic approaches.Studies have demonstrated the efficacy of RL in customizing e-Health interventions and integrating mobile sensing with machine learning for adaptive mental health systems.Despite these advantages,challenges remain in algorithmic complexity,ethical considerations,and clinical implementation.Addressing these issues is crucial for the successful integration of RL into mental health care.This paper concludes with recommendations for future research directions,emphasizing the need for larger-scale studies and interdisciplinary collaboration to fully realize RL’s potential in improving mental health outcomes and preventing depression relapse.展开更多
Background: Acute Leukemia is the most common childhood cancer, with two main types: ALL and AML. In Tanzania, recent improvements in treatment and survival have been noted, but the latest data is from 2013. This stud...Background: Acute Leukemia is the most common childhood cancer, with two main types: ALL and AML. In Tanzania, recent improvements in treatment and survival have been noted, but the latest data is from 2013. This study will update survival and relapse information from 2013 to 2020 to help enhance future treatment strategies. Methodology: This study was conducted at two tertiary hospitals in Tanzania. The study analyzed data from children diagnosed with Acute Leukemia between January 2015 to December 2020. Patient data were collected via questionnaires and analyzed using STATA software. Results: This study included a total of 95 participants 64 had age less than 10 years and majority were males 56.8%, 55 had duration of symptoms for more than 1 month 66 had ALL, 49 had attained remission, the overall three years survival was 44.2% with those children with no health insurance having high risk of dying, rate of relapse was 18.4%, with those diagnosed with B-ALL having low risk of relapse. Conclusion: This study provides insights into survival and relapse predictors for childhood leukemia in northern Tanzania. It found an overall survival rate of 44.2%, with health insurance and minimal residual disease after induction being key predictors of survival. The relapse rate was 18.4%, with health insurance linked to a lower relapse risk. Health insurance emerged as a strong predictor of better survival, leading to the recommendation that all children should have health insurance. Additionally, the study suggests that policymakers should support the expansion of global health coverage in Tanzania.展开更多
Multiple myeloma is a complex and challenging blood cancer,particularly in cases where the disease has relapsed or become resistant to treatment.These situations often have a significant impact on both patient surviva...Multiple myeloma is a complex and challenging blood cancer,particularly in cases where the disease has relapsed or become resistant to treatment.These situations often have a significant impact on both patient survival and quality of life.Over recent years,advances in precision medicine and translational medicine have brought about a shift in treatment strategies,moving toward more personalized and targeted approaches.This review highlights the latest developments in the management of refractory and relapsed multiple myeloma,focusing on the current state of precision diagnosis and treatment,the role of translational medicine,and potential future directions in research.By reviewing key studies and clinical trial data,we aim to offer fresh perspectives and strategies that could improve clinical outcomes.展开更多
CD5-positive(CD5+)diffuse large B-cell lymphoma(DLBCL)represents a special subgroup of DLBCL with a more aggressive disease course and is more likely to develop into relapsed/refractory(r/r)DLBCL in response to immuno...CD5-positive(CD5+)diffuse large B-cell lymphoma(DLBCL)represents a special subgroup of DLBCL with a more aggressive disease course and is more likely to develop into relapsed/refractory(r/r)DLBCL in response to immunochemotherapy.The incidence of CD5+DLBCL is 5%–10%among DLBCL patients1.展开更多
Diffuse large B-cell lymphoma(DLBCL),the most common subtype of non-Hodgkin’s lymphoma(NHL)worldwide,accounts for 39% and 44% of nodal and extranodal NHL cases in China,respectively1.Standard first-line treatment for...Diffuse large B-cell lymphoma(DLBCL),the most common subtype of non-Hodgkin’s lymphoma(NHL)worldwide,accounts for 39% and 44% of nodal and extranodal NHL cases in China,respectively1.Standard first-line treatment for DLBCL is chemo-immunotherapy with rituximab,cyclophos-phamide,doxorubicin,vincristine,and prednisone,which cures 50%-60% of patients2.展开更多
Multiple myeloma(MM),one of the most common hemato logical neoplasms worldwide,originates from malignant plasma cells in the bone marrow.MM remains an incurable disease,although continued treatment advancements have m...Multiple myeloma(MM),one of the most common hemato logical neoplasms worldwide,originates from malignant plasma cells in the bone marrow.MM remains an incurable disease,although continued treatment advancements have markedly increased overall survival.Many patients with MM eventually experience relapse or become treatment-refractory1.Patients with relapsed or refractory multiple myeloma(RRMM)become progressively more challenging to manage and have poor prognosis2.展开更多
AIM To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis(UC) patients.METHODS In this prospective pilot study, UC patients in clinical remission were ...AIM To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis(UC) patients.METHODS In this prospective pilot study, UC patients in clinical remission were recruited and followed-up at 12 mo to assess a clinical relapse, or not. At baseline information on demographic and clinical parameters was collected. Serum and urine samples were collected for analysis of metabolomic assays using a combined direct infusion/liquid chromatography tandem mass spectrometry and nuclear magnetic resolution spectroscopy. Stool samples were also collected to measure fecal calprotectin(FCP). Dietary assessment was performed using a validated self-administered food frequency questionnaire. RESULTS Twenty patients were included(mean age: 42.7 ± 14.8 years, females: 55%). Seven patients(35%) experienced a clinical relapse during the follow-up period. While 6 patients(66.7%) with normal body weight developed a clinical relapse, 1 UC patient(9.1%) who was overweight/obese relapsed during the follow-up(P = 0.02). At baseline, poultry intake was significantly higher in patients who were still in remission during follow-up(0.9 oz vs 0.2 oz, P = 0.002). Five patients(71.4%) with FCP > 150 μg/g and 2 patients(15.4%) with normal FCP(≤ 150 μg/g) at baseline relapsed during the follow-up(P = 0.02). Interestingly, baseline urinary and serum metabolomic profiling of UC patients with or without clinical relapse within 12 mo showed a significant difference. The most important metabolites that were responsible for this discrimination were trans-aconitate, cystine and acetamide in urine, and 3-hydroxybutyrate, acetoacetate and acetone in serum. CONCLUSION A combination of baseline dietary intake, fecal calprotectin, and metabolomic factors are associated with risk of UC clinical relapse within 12 mo.展开更多
Background: In patients with difuse large B?cell lymphoma(DLBCL), central nervous system(CNS) relapse is uncom?mon but is nearly always fatal. This study aimed to determine the risk factors for CNS relapse in DLBCL pa...Background: In patients with difuse large B?cell lymphoma(DLBCL), central nervous system(CNS) relapse is uncom?mon but is nearly always fatal. This study aimed to determine the risk factors for CNS relapse in DLBCL patients and to evaluate the eicacy of rituximab and intrathecal chemotherapy prophylaxis for CNS relapse reduction.Methods: A total of 511 patients with newly diagnosed DLBCL treated at the Sun Yat?sen University Cancer Center between January 2003 and December 2012 were included in the study. Among these patients, 376 received R?CHOP regimen(rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment, and 135 received CHOP regimen(cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment. Intrathe?cal chemotherapy prophylaxis(methotrexate plus cytarabine) was administered to those who were deemed at high risk for CNS relapse. In the entire cohort and in the R?CHOP set in particular, the Kaplan–Meier method coupled with the log?rank test was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis. Diferences were evaluated using a two?tailed test, and P < 0.05 was considered signiicant.Results: At a median follow?up of 46 months, 25(4.9%) patients experienced CNS relapse. There was a trend of reduced occurrence of CNS relapse in patients treated with rituximab; the 3?year cumulative CNS relapse rates were 7.1% in CHOP group and 2.7% in R?CHOP group(P = 0.045). Intrathecal chemotherapy prophylaxis did not confer much beneit in terms of preventing CNS relapse. Bone involvement [hazard ratio(HR) = 4.21, 95% conidence interval(CI) 1.38–12.77], renal involvement(HR = 3.85, 95% CI 1.05–14.19), alkaline phosphatase(ALP) >110 U/L(HR = 3.59, 95% CI 1.25–10.34), serum albumin(ALB) <35 g/L(HR = 3.63, 95% CI 1.25–10.51), treatment with rituxi?mab(HR = 0.34, 95% CI 0.12–0.96), and a time to complete remission ≤ 108 days(HR = 0.22, 95% CI 0.06–0.78) were independent predictive factors for CNS relapse in the entire cohort. Bone involvement(HR = 4.44, 95% CI 1.08–18.35), bone marrow involvement(HR = 11.70, 95% CI 2.24–60.99), and renal involvement(HR = 10.83, 95% CI 2.27–51.65) were independent risk factors for CNS relapse in the R?CHOP set.Conclusions: In the present study, rituximab decreased the CNS relapse rate of DLBCL, whereas intrathecal chemo?therapy prophylaxis alone was not suicient for preventing CNS relapse. Serum levels of ALB and ALP, and the time to complete remission were new independent predictive factors for CNS relapse in the patients with DLBCL. In the patients received R?CHOP regimen, a trend of increased CNS relapse was found to be associated with extranodal lesions.展开更多
Relapse after allogeneic hematopoietic stem cell transplantation（allo-HSCT） remains a main question on treatment failure. Current strategies for management that usually include salvage chemotherapy, donor lymphocyti...Relapse after allogeneic hematopoietic stem cell transplantation（allo-HSCT） remains a main question on treatment failure. Current strategies for management that usually include salvage chemotherapy, donor lymphocytic infusion and second transplantation. Our study assessed the efficacy of decitabine（DAC） for treating patients with acute lymphoblastic leukemia（ALL） who relapsed after allogeneic hematopoietic stem cell transplantation（allo-HSCT）. We retrospectively analyzed the outcomes of 12 patients with relapsed ALL after allo-HSCT who received DAC therapy. Nine patients received DAC combined with chemotherapy and donor stem cell infusion, and 3 patients received single-agent DAC. Ten of the 12 patients achieved complete remission（CR）, 1 achieved a partial remission（PR）, and 1 had no response（NR） after treatment at the latest follow-up（LFU）, the median survival was 11.2 months（range, 3.8–34, 7 months）. The 1-and 2-year overall survival（OS） rates were 50%（6/12） and 25%（3/12）, respectively. Five patients were still alive; 4 had maintained CR and 1 was alive with disease. Patients with Philadelphia chromosome-positive ALL had higher survival rate than patients with Philadelphia chromosome-negative ALL（57.1% vs. 20%）. No aggravated flares of graft-versus-host disease（GVHD） were observed during DAC treatment. Therefore, DAC may be a promising therapeutic agent for ALL recurrence after allo-HSCT.展开更多
Drugs can cause obvious damage to the brain. To verify the relationship between acupuncture, neurotrophic factor expression and brain cell structural changes, this study established a rat model of heroin relapse using...Drugs can cause obvious damage to the brain. To verify the relationship between acupuncture, neurotrophic factor expression and brain cell structural changes, this study established a rat model of heroin relapse using intramuscular injection of increasing amounts of heroin. During the detoxification period, rat models received acupuncture at Baihui （DU20） and Dazhui （DU14）. Electron microscopy demonstrated that the structure of the ventral tegmental area in heroin relapse rats gradually became normalized after acupuncture treatment. Immunohistochem- ical staining exhibited that the expression of brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor increased in the ventral tegmental area following acupuncture. Moreover, the effects were similar to that of methadone, a type of medicine called an opioid. Results suggested that acupuncture at Baihui and Dazhui protected brain neurons against injury in rats with heroin relapse by promoting brain-derived neurotrophic factor and glial cell line-de-rived neurotrophic factor expression.展开更多
BACKGROUND Asymptomatic children with Crohn's disease(CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.AIM In a cohort of pediatric CD patients, we aimed to assess the utility o...BACKGROUND Asymptomatic children with Crohn's disease(CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.AIM In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.METHODS In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn's Disease Activity Index, Creactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.RESULTS 53 children were included and eighteen patients(34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median(interquartile range), relapse 723μg/g(283-1758) vs 244 μg/g(61-627), P = 0.02]. Fecal calprotectin levels > 250μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo(area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).CONCLUSION Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.展开更多
Acute myeloid leukemia （AML） is an aggressive hematological cancer. Despite therapeutic regimens that lead to complete remission, the vast majority of patients undergo relapse. The molecular mechanisms underlying AM...Acute myeloid leukemia （AML） is an aggressive hematological cancer. Despite therapeutic regimens that lead to complete remission, the vast majority of patients undergo relapse. The molecular mechanisms underlying AML development and relapse remain incompletely defined. To explore whether loss of DNA mismatch repair （MMR） function is involved in AML, we screened two key MMR genes, MSH2 and MLH1, for mutations and promoter hypermethylation in leukemia specimens from 53 AML patients and blood from 17 non-cancer controls. We show here that whereas no amino acid alteration or promoter hypermethylation was detected in all control samples, 18 AML patients exhibited either mutations in MMR genes or hypermethylation in the MLH1 promoter. In vitro functional MMR analysis revealed that almost all the mutations analyzed resulted in loss of MMR function. MMR defects were significantly more frequent in patients with refractory or relapsed AML compared with newly diagnosed patients. These observations suggest for the first time that the loss of MMR function is associated with refractory and relapsed AML and may contribute to disease Datho8enesis.展开更多
Background: Despite the recent development of new therapies, multiple myeloma(MM) remains an incurable disease. Thus, new, efective treatments are urgently needed, particularly for relapsed or refractory MM(RRMM). In ...Background: Despite the recent development of new therapies, multiple myeloma(MM) remains an incurable disease. Thus, new, efective treatments are urgently needed, particularly for relapsed or refractory MM(RRMM). In an earlier phase I study, a novel form of recombinant human Apo2L/tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) that is currently in clinical development for the treatment of hematologic malignancies, i.e., circularly permuted TRAIL(CPT), was well tolerated at a dose of 2.5 mg/kg per day and showed promising preliminary activity in patients with RRMM. This phase II, open-label, multicenter study further investigated the eicacy and safety of 2.5-mg/kg per day CPT as single-agent therapy for patients with RRMM.Methods: Patients with RRMM were treated once daily with CPT(2.5 mg/kg, intravenously) for 14 consecutive days for each 21-day cycle. Clinical response and toxicity were assessed after each treatment cycle.Results: Twenty-seven patients received CPT. Using the European Group for Blood and Marrow Transplantation criteria, we calculated the overall response rate of 33.3% with 1 near-complete response(n CR) and 8 partial responses(PRs). The clinical beneit rate(48.1%) included 1 nCR, 8 PRs, and 4 minimal responses. The most common treatmentrelated adverse events(TRAEs) were fever, aspartate aminotransferase elevation, alanine aminotransferase elevation, leucopenia, rash, neutropenia, and thrombocytopenia. We graded toxicity using the Common Toxicity Criteria for Adverse Events, version 3.0, and determined that 37.0% of patients had at least 1 grade 3–4 TRAE.Conclusions: CPT as a single agent can elicit a response in patients with RRMM and is well tolerated. Further clinical investigation is warranted.展开更多
Despite the advancement of treatments,adults with relapsed/refractory(R/R)B-lineage acute lymphoblastic leukemia(B-ALL)have poor prognosis,with an expected five-year overall survival(OS)rate of 10%‒20%(Nguyen et al.,2...Despite the advancement of treatments,adults with relapsed/refractory(R/R)B-lineage acute lymphoblastic leukemia(B-ALL)have poor prognosis,with an expected five-year overall survival(OS)rate of 10%‒20%(Nguyen et al.,2008;Oriol et al.,2010).Extramedullary relapse of B-ALL is regarded as a highrisk factor generally associated with poor survival,occurring in about 15%to 20%of all relapsed patients(Ding et al.,2017;Sun et al.,2018).The central nervous system(CNS)and the testes are the most common sites of extramedullary relapse of B-ALL.In addition,extramedullary leukemia can appear in the skin,eyes,breasts,bones,muscles,and abdominal organs.The prognosis of relapsed extramedullary B-ALL after allogeneic hematopoietic stem cell transplantation(allo-HSCT)is extremely poor(Spyridonidis et al.,2012;Dahlberg et al.,2019).Conventional chemotherapy or radiation is often ineffective in such patients.At present,there are no optimal treatment strategies for treating extramedullary leukemia after allo-HSCT.展开更多
Objective To identify the direct causes of drug relapse and abstainers’ demand, and to develop programs for the prevention of drug relapse. Methods Abstainers in a Compulsive Detoxification Center in Wuhan City, capi...Objective To identify the direct causes of drug relapse and abstainers’ demand, and to develop programs for the prevention of drug relapse. Methods Abstainers in a Compulsive Detoxification Center in Wuhan City, capital of Hubei Province were randomly selected. An investigation on the direct causes of drug relapse and abstainers’ demands was conducted with multiple-choice questionnaires and face to face interviews. Data were analyzed with SPSS 12.0. Results The direct causes leading to drug relapse included： temptation to use drug again by themselves or by their drug mates, seeking pleasure and ecstasy from drug use, relatively well off living, mental stress, irritation, demoralization, family conflicts, unemployment, feeling distrusted by the family, lack of care and love from the family, and discrimination by others. abstainers’ demands after detoxification and returning to the society included： care and support from the family, employment assistance, changing living environment, understanding by others, support from the society, and keeping far away from drugs. Conclusions Environmental factors are the direct causes of drug relapse, and negative irritation is its predisposing causes. Leaving former residence, more care and help given by both the family and the society and raising their overall quality of life are the demands of abstainers.展开更多
AIM:To investigate the virological relapse rate in hepatitis B e antigen(HBeAg)-negative patients after antiviral therapy discontinuation and analyze the factors associated with virological relapse.METHODS:Among patie...AIM:To investigate the virological relapse rate in hepatitis B e antigen(HBeAg)-negative patients after antiviral therapy discontinuation and analyze the factors associated with virological relapse.METHODS:Among patients diagnosed with chronic hepatitis B infection between May 2005 and July2010,204 were eligible for analysis.The Kaplan-Meier method and log-rank test were used to calculate the cumulative rate of relapse and compare cumulative relapse rates between groups.The Cox proportional hazards regression model was used to evaluate the predictive factor of virological relapse.RESULTS:The 2 and 1 year cumulative risks of virological relapse after antiviral therapy discontinuation were 79.41%(162/204) and 43.82%(71/162),respectively.Multivariate analysis revealed that only post treatment hepatitis B surface antigen(HBsAg)level was associated with virological relapse {P= 0.011).The cumulative risk of virological relapse was higher in the patients with HBsAg levels ≥1500 IU/L than in those with HBsAg levels < 1500 IU/L(P= 0.0013).The area under the curve was 0.603(P= 0.033).The cutoff HBsAg value for predicting virological relapse was 1443IU/L CONCLUSION:We found that the virological relapse rate remained high after antiviral therapy discontinuation in the HBeAg-negative patients and that the post treatment HBsAg levels predicted virological relapse.展开更多
文摘The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse risk.Participants were SCC patients aged≥18 years who enrolled between June 2019 and December 2021,completed follow-up assessments at one and three months,and reported abstinence at one month.Short-term relapse was defined as self-reported smoking at the three-month follow-up.Treatments included counseling,first-line cessation medications,and traditional Chinese medicine(TCM).Logistic regression was used to identify factors associated with short-term relapse.Among 10,724 eligible SCC patients,11.6%experienced short-term relapse.Factors positively associated with relapse included the number of previous quit attempts(1–5 attempts:OR=1.422,95%CI:1.254–1.613,>5 attempts:OR=1.382,95%CI:1.057–1.808),high perceived difficulty in quitting(OR=1.297,95%CI:1.061–1.586),and moderate(OR=1.383,95%CI:1.174–1.629)or weak(OR=1.517,95%CI:1.251–1.841)willingness to quit.Factors negatively associated with relapse included having a college degree or higher(OR=0.796;95%CI:0.650–0.973),high confidence in quitting(OR=0.786;95%CI:0.629–0.983),and use of TCM(OR=0.276;95%CI:0.158–0.482).Enhancing self-efficacy in quitting appears crucial for preventing short-term relapse.The use of TCM may reduce relapse risk and warrants further investigation.
基金funded by Peking University Sixth Hospital(BDLYYLZL2024-01)the Capital Health Development Research Project Program of China(2014-4-4112).
文摘To the editor:Schizophrenia is a chronic and severe mental disorder characterised by profound disruptions in thinking,affecting language,perception and the sense of self. These disruptions can significantly impair an individual’s ability to function socially and occupationally, leading to a high burden on both the individuals affected and society as a whole.
基金supported by National Natural Science Foundation of China(No.82370215,82020108003,and 82330008)Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD),Jiangsu Provincial Medical Innovation Center(No.CXZX202201)Science and Technology Program of Suzhou(No.SKY2023047)。
文摘With the advances in allogeneic hematopoietic cell transplantation(allo-HCT)and supportive care,the number of allo-HCT for elderly patients has been increasing in recent years.However,the advanced donor age limits the availability of human leukocyte antigen(HLA)-matched sibling donors(MSD)for elderly individuals.
文摘The purpose of this article is to analyze the efficacy of molecular diagnostic techniques for monitoring tuberculosis relapse.After analyzing the connotation of molecular diagnostic techniques and their specific application process in tuberculosis relapse monitoring,a total of 200 cured tuberculosis patients were selected(100 in the experimental group and 100 in the control group).During the 12-month follow-up period,the experimental group was monitored by molecular diagnostic techniques,while the control group was monitored by traditional techniques.Finally,by comparing the performance indicators of the two monitoring methods,as well as the relapse situations and outcomes of patients,it was demonstrated that molecular diagnostic techniques have higher efficacy in tuberculosis relapse monitoring.
文摘Depression is a prevalent mental health disorder characterized by high relapse rates,highlighting the need for effective preventive interventions.This paper reviews the potential of reinforcement learning(RL)in preventing depression relapse.RL,a subset of artificial intelligence,utilizes machine learning algorithms to analyze behavioral data,enabling early detection of relapse risk and optimization of personalized interventions.RL's ability to tailor treatment in real-time by adapting to individual needs and responses offers a dynamic alternative to traditional therapeutic approaches.Studies have demonstrated the efficacy of RL in customizing e-Health interventions and integrating mobile sensing with machine learning for adaptive mental health systems.Despite these advantages,challenges remain in algorithmic complexity,ethical considerations,and clinical implementation.Addressing these issues is crucial for the successful integration of RL into mental health care.This paper concludes with recommendations for future research directions,emphasizing the need for larger-scale studies and interdisciplinary collaboration to fully realize RL’s potential in improving mental health outcomes and preventing depression relapse.
文摘Background: Acute Leukemia is the most common childhood cancer, with two main types: ALL and AML. In Tanzania, recent improvements in treatment and survival have been noted, but the latest data is from 2013. This study will update survival and relapse information from 2013 to 2020 to help enhance future treatment strategies. Methodology: This study was conducted at two tertiary hospitals in Tanzania. The study analyzed data from children diagnosed with Acute Leukemia between January 2015 to December 2020. Patient data were collected via questionnaires and analyzed using STATA software. Results: This study included a total of 95 participants 64 had age less than 10 years and majority were males 56.8%, 55 had duration of symptoms for more than 1 month 66 had ALL, 49 had attained remission, the overall three years survival was 44.2% with those children with no health insurance having high risk of dying, rate of relapse was 18.4%, with those diagnosed with B-ALL having low risk of relapse. Conclusion: This study provides insights into survival and relapse predictors for childhood leukemia in northern Tanzania. It found an overall survival rate of 44.2%, with health insurance and minimal residual disease after induction being key predictors of survival. The relapse rate was 18.4%, with health insurance linked to a lower relapse risk. Health insurance emerged as a strong predictor of better survival, leading to the recommendation that all children should have health insurance. Additionally, the study suggests that policymakers should support the expansion of global health coverage in Tanzania.
基金supported by grants from the 925th Science Foundation(Grant Nos.2023-3 and 2024-2/3).
文摘Multiple myeloma is a complex and challenging blood cancer,particularly in cases where the disease has relapsed or become resistant to treatment.These situations often have a significant impact on both patient survival and quality of life.Over recent years,advances in precision medicine and translational medicine have brought about a shift in treatment strategies,moving toward more personalized and targeted approaches.This review highlights the latest developments in the management of refractory and relapsed multiple myeloma,focusing on the current state of precision diagnosis and treatment,the role of translational medicine,and potential future directions in research.By reviewing key studies and clinical trial data,we aim to offer fresh perspectives and strategies that could improve clinical outcomes.
基金supported by funding from the National Natural Science Foundation of China(Grant No.82170167 to Xiaoxi Zhou and Grant No.82300226 to Hui Luo)。
文摘CD5-positive(CD5+)diffuse large B-cell lymphoma(DLBCL)represents a special subgroup of DLBCL with a more aggressive disease course and is more likely to develop into relapsed/refractory(r/r)DLBCL in response to immunochemotherapy.The incidence of CD5+DLBCL is 5%–10%among DLBCL patients1.
基金sponsored by Shanghai Roche Pharmaceuticals Ltd.
文摘Diffuse large B-cell lymphoma(DLBCL),the most common subtype of non-Hodgkin’s lymphoma(NHL)worldwide,accounts for 39% and 44% of nodal and extranodal NHL cases in China,respectively1.Standard first-line treatment for DLBCL is chemo-immunotherapy with rituximab,cyclophos-phamide,doxorubicin,vincristine,and prednisone,which cures 50%-60% of patients2.
基金supported by grant from the National Natural Science Foundation of China(Grant No.82300231).
文摘Multiple myeloma(MM),one of the most common hemato logical neoplasms worldwide,originates from malignant plasma cells in the bone marrow.MM remains an incurable disease,although continued treatment advancements have markedly increased overall survival.Many patients with MM eventually experience relapse or become treatment-refractory1.Patients with relapsed or refractory multiple myeloma(RRMM)become progressively more challenging to manage and have poor prognosis2.
基金Supported by Alberta Innovates-Bio Solutionsa graduate studentship from Alberta Innovates-Health Solutions(to Keshteli AH)
文摘AIM To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis(UC) patients.METHODS In this prospective pilot study, UC patients in clinical remission were recruited and followed-up at 12 mo to assess a clinical relapse, or not. At baseline information on demographic and clinical parameters was collected. Serum and urine samples were collected for analysis of metabolomic assays using a combined direct infusion/liquid chromatography tandem mass spectrometry and nuclear magnetic resolution spectroscopy. Stool samples were also collected to measure fecal calprotectin(FCP). Dietary assessment was performed using a validated self-administered food frequency questionnaire. RESULTS Twenty patients were included(mean age: 42.7 ± 14.8 years, females: 55%). Seven patients(35%) experienced a clinical relapse during the follow-up period. While 6 patients(66.7%) with normal body weight developed a clinical relapse, 1 UC patient(9.1%) who was overweight/obese relapsed during the follow-up(P = 0.02). At baseline, poultry intake was significantly higher in patients who were still in remission during follow-up(0.9 oz vs 0.2 oz, P = 0.002). Five patients(71.4%) with FCP > 150 μg/g and 2 patients(15.4%) with normal FCP(≤ 150 μg/g) at baseline relapsed during the follow-up(P = 0.02). Interestingly, baseline urinary and serum metabolomic profiling of UC patients with or without clinical relapse within 12 mo showed a significant difference. The most important metabolites that were responsible for this discrimination were trans-aconitate, cystine and acetamide in urine, and 3-hydroxybutyrate, acetoacetate and acetone in serum. CONCLUSION A combination of baseline dietary intake, fecal calprotectin, and metabolomic factors are associated with risk of UC clinical relapse within 12 mo.
基金supported by the National Natural Science Foundation of China(81372883,81001052)Natural Science Foundation of Guangdong Province,China(2015A030313020 and 8151008901000043)+3 种基金Science and Technology Planning Project of Guangdong Province,China(2011B031800222)Young Talents Key Project of Sun Yat?sen University(2015ykzd13,to Qing-qing Cai)Young Talents Project of Sun Yat-sen University(11ykpy56,to Qing-qing Cai)the Sister Institution Network Fund of MD Anderson Cancer Center(to Qing-qing Cai and Hui-Rao)
文摘Background: In patients with difuse large B?cell lymphoma(DLBCL), central nervous system(CNS) relapse is uncom?mon but is nearly always fatal. This study aimed to determine the risk factors for CNS relapse in DLBCL patients and to evaluate the eicacy of rituximab and intrathecal chemotherapy prophylaxis for CNS relapse reduction.Methods: A total of 511 patients with newly diagnosed DLBCL treated at the Sun Yat?sen University Cancer Center between January 2003 and December 2012 were included in the study. Among these patients, 376 received R?CHOP regimen(rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment, and 135 received CHOP regimen(cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment. Intrathe?cal chemotherapy prophylaxis(methotrexate plus cytarabine) was administered to those who were deemed at high risk for CNS relapse. In the entire cohort and in the R?CHOP set in particular, the Kaplan–Meier method coupled with the log?rank test was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis. Diferences were evaluated using a two?tailed test, and P < 0.05 was considered signiicant.Results: At a median follow?up of 46 months, 25(4.9%) patients experienced CNS relapse. There was a trend of reduced occurrence of CNS relapse in patients treated with rituximab; the 3?year cumulative CNS relapse rates were 7.1% in CHOP group and 2.7% in R?CHOP group(P = 0.045). Intrathecal chemotherapy prophylaxis did not confer much beneit in terms of preventing CNS relapse. Bone involvement [hazard ratio(HR) = 4.21, 95% conidence interval(CI) 1.38–12.77], renal involvement(HR = 3.85, 95% CI 1.05–14.19), alkaline phosphatase(ALP) >110 U/L(HR = 3.59, 95% CI 1.25–10.34), serum albumin(ALB) <35 g/L(HR = 3.63, 95% CI 1.25–10.51), treatment with rituxi?mab(HR = 0.34, 95% CI 0.12–0.96), and a time to complete remission ≤ 108 days(HR = 0.22, 95% CI 0.06–0.78) were independent predictive factors for CNS relapse in the entire cohort. Bone involvement(HR = 4.44, 95% CI 1.08–18.35), bone marrow involvement(HR = 11.70, 95% CI 2.24–60.99), and renal involvement(HR = 10.83, 95% CI 2.27–51.65) were independent risk factors for CNS relapse in the R?CHOP set.Conclusions: In the present study, rituximab decreased the CNS relapse rate of DLBCL, whereas intrathecal chemo?therapy prophylaxis alone was not suicient for preventing CNS relapse. Serum levels of ALB and ALP, and the time to complete remission were new independent predictive factors for CNS relapse in the patients with DLBCL. In the patients received R?CHOP regimen, a trend of increased CNS relapse was found to be associated with extranodal lesions.
基金supported by grants from the National Natural Science Foundation of China(No.81300412 and No.81470333)
文摘Relapse after allogeneic hematopoietic stem cell transplantation（allo-HSCT） remains a main question on treatment failure. Current strategies for management that usually include salvage chemotherapy, donor lymphocytic infusion and second transplantation. Our study assessed the efficacy of decitabine（DAC） for treating patients with acute lymphoblastic leukemia（ALL） who relapsed after allogeneic hematopoietic stem cell transplantation（allo-HSCT）. We retrospectively analyzed the outcomes of 12 patients with relapsed ALL after allo-HSCT who received DAC therapy. Nine patients received DAC combined with chemotherapy and donor stem cell infusion, and 3 patients received single-agent DAC. Ten of the 12 patients achieved complete remission（CR）, 1 achieved a partial remission（PR）, and 1 had no response（NR） after treatment at the latest follow-up（LFU）, the median survival was 11.2 months（range, 3.8–34, 7 months）. The 1-and 2-year overall survival（OS） rates were 50%（6/12） and 25%（3/12）, respectively. Five patients were still alive; 4 had maintained CR and 1 was alive with disease. Patients with Philadelphia chromosome-positive ALL had higher survival rate than patients with Philadelphia chromosome-negative ALL（57.1% vs. 20%）. No aggravated flares of graft-versus-host disease（GVHD） were observed during DAC treatment. Therefore, DAC may be a promising therapeutic agent for ALL recurrence after allo-HSCT.
基金This study was supported by the National Natural Science Foundation of China,No.81173325the Anhui Provincial Higher Learning School Excellent Youth Project,No.2010SQRL105Anhui Provincial Higher Learning Natural Science Project,No.KJ2013Z180
文摘Drugs can cause obvious damage to the brain. To verify the relationship between acupuncture, neurotrophic factor expression and brain cell structural changes, this study established a rat model of heroin relapse using intramuscular injection of increasing amounts of heroin. During the detoxification period, rat models received acupuncture at Baihui （DU20） and Dazhui （DU14）. Electron microscopy demonstrated that the structure of the ventral tegmental area in heroin relapse rats gradually became normalized after acupuncture treatment. Immunohistochem- ical staining exhibited that the expression of brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor increased in the ventral tegmental area following acupuncture. Moreover, the effects were similar to that of methadone, a type of medicine called an opioid. Results suggested that acupuncture at Baihui and Dazhui protected brain neurons against injury in rats with heroin relapse by promoting brain-derived neurotrophic factor and glial cell line-de-rived neurotrophic factor expression.
基金an unrestricted grant from the Lutsky FoundationAbbvie pharmaceuticals provided initial funding to purchase the Buhlmann ELISA kits
文摘BACKGROUND Asymptomatic children with Crohn's disease(CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.AIM In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.METHODS In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn's Disease Activity Index, Creactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.RESULTS 53 children were included and eighteen patients(34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median(interquartile range), relapse 723μg/g(283-1758) vs 244 μg/g(61-627), P = 0.02]. Fecal calprotectin levels > 250μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo(area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).CONCLUSION Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.
文摘Acute myeloid leukemia （AML） is an aggressive hematological cancer. Despite therapeutic regimens that lead to complete remission, the vast majority of patients undergo relapse. The molecular mechanisms underlying AML development and relapse remain incompletely defined. To explore whether loss of DNA mismatch repair （MMR） function is involved in AML, we screened two key MMR genes, MSH2 and MLH1, for mutations and promoter hypermethylation in leukemia specimens from 53 AML patients and blood from 17 non-cancer controls. We show here that whereas no amino acid alteration or promoter hypermethylation was detected in all control samples, 18 AML patients exhibited either mutations in MMR genes or hypermethylation in the MLH1 promoter. In vitro functional MMR analysis revealed that almost all the mutations analyzed resulted in loss of MMR function. MMR defects were significantly more frequent in patients with refractory or relapsed AML compared with newly diagnosed patients. These observations suggest for the first time that the loss of MMR function is associated with refractory and relapsed AML and may contribute to disease Datho8enesis.
文摘Background: Despite the recent development of new therapies, multiple myeloma(MM) remains an incurable disease. Thus, new, efective treatments are urgently needed, particularly for relapsed or refractory MM(RRMM). In an earlier phase I study, a novel form of recombinant human Apo2L/tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) that is currently in clinical development for the treatment of hematologic malignancies, i.e., circularly permuted TRAIL(CPT), was well tolerated at a dose of 2.5 mg/kg per day and showed promising preliminary activity in patients with RRMM. This phase II, open-label, multicenter study further investigated the eicacy and safety of 2.5-mg/kg per day CPT as single-agent therapy for patients with RRMM.Methods: Patients with RRMM were treated once daily with CPT(2.5 mg/kg, intravenously) for 14 consecutive days for each 21-day cycle. Clinical response and toxicity were assessed after each treatment cycle.Results: Twenty-seven patients received CPT. Using the European Group for Blood and Marrow Transplantation criteria, we calculated the overall response rate of 33.3% with 1 near-complete response(n CR) and 8 partial responses(PRs). The clinical beneit rate(48.1%) included 1 nCR, 8 PRs, and 4 minimal responses. The most common treatmentrelated adverse events(TRAEs) were fever, aspartate aminotransferase elevation, alanine aminotransferase elevation, leucopenia, rash, neutropenia, and thrombocytopenia. We graded toxicity using the Common Toxicity Criteria for Adverse Events, version 3.0, and determined that 37.0% of patients had at least 1 grade 3–4 TRAE.Conclusions: CPT as a single agent can elicit a response in patients with RRMM and is well tolerated. Further clinical investigation is warranted.
基金supported by the National Natural Science Foundation of China(Nos.81730008,82130003,and 81870153).
文摘Despite the advancement of treatments,adults with relapsed/refractory(R/R)B-lineage acute lymphoblastic leukemia(B-ALL)have poor prognosis,with an expected five-year overall survival(OS)rate of 10%‒20%(Nguyen et al.,2008;Oriol et al.,2010).Extramedullary relapse of B-ALL is regarded as a highrisk factor generally associated with poor survival,occurring in about 15%to 20%of all relapsed patients(Ding et al.,2017;Sun et al.,2018).The central nervous system(CNS)and the testes are the most common sites of extramedullary relapse of B-ALL.In addition,extramedullary leukemia can appear in the skin,eyes,breasts,bones,muscles,and abdominal organs.The prognosis of relapsed extramedullary B-ALL after allogeneic hematopoietic stem cell transplantation(allo-HSCT)is extremely poor(Spyridonidis et al.,2012;Dahlberg et al.,2019).Conventional chemotherapy or radiation is often ineffective in such patients.At present,there are no optimal treatment strategies for treating extramedullary leukemia after allo-HSCT.
基金This research was supported by NSFC (Grant No. 30271140).
文摘Objective To identify the direct causes of drug relapse and abstainers’ demand, and to develop programs for the prevention of drug relapse. Methods Abstainers in a Compulsive Detoxification Center in Wuhan City, capital of Hubei Province were randomly selected. An investigation on the direct causes of drug relapse and abstainers’ demands was conducted with multiple-choice questionnaires and face to face interviews. Data were analyzed with SPSS 12.0. Results The direct causes leading to drug relapse included： temptation to use drug again by themselves or by their drug mates, seeking pleasure and ecstasy from drug use, relatively well off living, mental stress, irritation, demoralization, family conflicts, unemployment, feeling distrusted by the family, lack of care and love from the family, and discrimination by others. abstainers’ demands after detoxification and returning to the society included： care and support from the family, employment assistance, changing living environment, understanding by others, support from the society, and keeping far away from drugs. Conclusions Environmental factors are the direct causes of drug relapse, and negative irritation is its predisposing causes. Leaving former residence, more care and help given by both the family and the society and raising their overall quality of life are the demands of abstainers.
基金Supported by Natural Science Foundation of Jiangsu Province,China,No.BK2011515Medical Project of Health Department Jiangsu Province,No.H201248+1 种基金Preventive Medicine research projects of Jiangsu Province,No.Y2012016the Social Development Project of Zhenjiang City,No.SH2013056
文摘AIM:To investigate the virological relapse rate in hepatitis B e antigen(HBeAg)-negative patients after antiviral therapy discontinuation and analyze the factors associated with virological relapse.METHODS:Among patients diagnosed with chronic hepatitis B infection between May 2005 and July2010,204 were eligible for analysis.The Kaplan-Meier method and log-rank test were used to calculate the cumulative rate of relapse and compare cumulative relapse rates between groups.The Cox proportional hazards regression model was used to evaluate the predictive factor of virological relapse.RESULTS:The 2 and 1 year cumulative risks of virological relapse after antiviral therapy discontinuation were 79.41%(162/204) and 43.82%(71/162),respectively.Multivariate analysis revealed that only post treatment hepatitis B surface antigen(HBsAg)level was associated with virological relapse {P= 0.011).The cumulative risk of virological relapse was higher in the patients with HBsAg levels ≥1500 IU/L than in those with HBsAg levels < 1500 IU/L(P= 0.0013).The area under the curve was 0.603(P= 0.033).The cutoff HBsAg value for predicting virological relapse was 1443IU/L CONCLUSION:We found that the virological relapse rate remained high after antiviral therapy discontinuation in the HBeAg-negative patients and that the post treatment HBsAg levels predicted virological relapse.
