ABSTRACT
Chronic myeloid leukemia (CML) is one of the most common hematological malignancies and characterized by the formation of Philadelphia (Ph) chromosome. Recently, tyrosine kinase inhibitors (TKI) treatment greatly improved the prognosis of CML. However, the options may be limited when a patient develops traditional TKI resistance or gene mutation. Herein, we reported a case. A 38-year-old male CML patient developed a BCR-ABL1 gene mutation of T315I after 2.5 years of TKI treatment, including imatinib and dasatinib. We adjusted the treatment with the combined application of dasatinib and axitinib. BCR-ABL1 gene copies dropped down and achieved an early molecular response at 2 months later. Subsequently, he received hematopoietic stem cell transplantation. Axitinib and dasatinib were applied for another half year after the allogeneic hematopoietic stem cell transplantation (allo-HSCT). Two years after the allo-HSCT, the BCR-ABL1 gene was still undetectable. It provided a successful example in treating CML patients carrying BCR-ABL1 T315I mutation via combination of axitinib with conditional TKI.
Subject(s)
Adult , Humans , Male , Axitinib , Dasatinib , Therapeutic Uses , Drug Resistance, Neoplasm , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Drug Therapy , Genetics , Mutation , Protein Kinase Inhibitors , Therapeutic UsesABSTRACT
Objective@#To evaluate the feasibility and safety of maintaining general anesthesia without neuromuscular blockade in oral double-balloon enteroscopy.@*Methods@#Totally 120 patients undergoing oral double-balloon enteroscopy under general anesthesia were randomly assigned into two groups: the observation group and the control group. The observation group was not given muscle relaxants for anesthesia maintenance, while the control group was given muscle relaxants punctually. Observation indexes were monitored, including the mean arterial pressure (MAP), heart rate (HR), peak airway pressure (Ppeak) and end-tidal CO2 partial pressure (PETCO2) before anesthesia (T0), immediately after intubation (T1), at the time of endoscopy placement (T2), at the end of endoscopy withdrawal (T3), and at the time of waking-up (T4). The cases of spontaneous breathing recovery before the end of endoscopy, postoperative recovery time, extubation time, length of PACU stay, postoperative adverse reactions and satisfactory rates were recorded.@*Results@#Twelve cases were removed by the exclusion criteria, and the remaining 108 cases completed the study, including 56 cases in the observation group and 52 cases in the control group. The one-time success rate of induction was both 100% in the two groups. There were no significant differences in MAP, HR, Ppeak, and PETCO2 between the two groups at each observation point (all P>0.05), and the same is true for within group comparison with T0 (all P>0.05). The recovery rate of spontaneous respiration in the observation group was significantly higher than that in the control group [100% (56/56) VS 42% (22/52), χ2=44.73, P=0.000]. The awaken time, extubation time and length of PACU stay were 6±2 min, 10±3 min, and 11±4 min, respectively, in the observation group, compared with 15±5 min (t=-12.64, P=0.000), 17±5 min (t=-8.90, P=0.000), and 17±7 min (t=-5.73, P=0.000) in the control group. None of the patients required assisted ventilation. Hypoxemia occurred in 2 cases and nausea in 3 cases in the control group, while only nausea occurred in 1 patient in the observation group. The overall incidence of adverse reactions was not statisticaly different between the two groups (P>0.05). Anesthesia satisfaction rate of two groups was 100%.@*Conclusion@#It is feasible and safe to perform oral double-balloon enteroscopy without muscle relaxants during maintaining under general anesthesia, with quick recovery of spontaneous breathing and awakening, early extubation and less cost.
ABSTRACT
Objective To evaluate the feasibility and safety of maintaining general anesthesia without neuromuscular blockade in oral double-balloon enteroscopy. Methods Totally 120 patients undergoing oral double-balloon enteroscopy under general anesthesia were randomly assigned into two groups:the observation group and the control group. The observation group was not given muscle relaxants for anesthesia maintenance,while the control group was given muscle relaxants punctually. Observation indexes were monitored,including the mean arterial pressure (MAP),heart rate (HR),peak airway pressure (Ppeak)and end-tidal CO2 partial pressure (PETCO2 )before anesthesia (T0),immediately after intubation (T1),at the time of endoscopy placement (T2),at the end of endoscopy withdrawal (T3),and at the time of waking-up (T4). The cases of spontaneous breathing recovery before the end of endoscopy,postoperative recovery time,extubation time,length of PACU stay,postoperative adverse reactions and satisfactory rates were recorded. Results Twelve cases were removed by the exclusion criteria,and the remaining 108 cases completed the study,including 56 cases in the observation group and 52 cases in the control group. The one-time success rate of induction was both 100％ in the two groups. There were no significant differences in MAP,HR,Ppeak,and PETCO2 between the two groups at each observation point (all P>0. 05),and the same is true for within group comparison with T0 (all P>0. 05). The recovery rate of spontaneous respiration in the observation group was significantly higher than that in the control group [100％ (56/ 56)VS 42％(22/ 52),χ2 = 44. 73,P = 0. 000]. The awaken time,extubation time and length of PACU stay were 6±2 min,10±3 min,and 11± 4 min,respectively,in the observation group,compared with 15± 5 min (t= -12. 64,P= 0. 000),17±5 min (t = -8. 90,P = 0. 000),and 17±7 min (t = -5. 73,P = 0. 000)in the control group. None of the patients required assisted ventilation. Hypoxemia occurred in 2 cases and nausea in 3 cases in the control group,while only nausea occurred in 1 patient in the observation group. The overall incidence of adverse reactions was not statisticaly different between the two groups (P > 0. 05). Anesthesia satisfaction rate of two groups was 100％. Conclusion It is feasible and safe to perform oral double-balloon enteroscopy without muscle relaxants during maintaining under general anesthesia,with quick recovery of spontaneous breathing and awakening,early extubation and less cost.
ABSTRACT
Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for children with pancreaticobiliary diseases. Methods Data of children under 14 years old who have underwent ERCP in Nanjing Drum Tower Hospital between September 2007 and August 2016 were reviewed for completion, complications and therapeutic methods. Results A total of 41 children underwent 68 ERCP, including 6(8. 8%) diagnostic and 62(91. 2%) therapeutic procedures. All procedures were performed under deep sedation. Cannulation failed in only 1 child with anomalous junction of pancreaticobiliary duct. The procedure success rate was 98. 5%( 67/68 ) . There were 8 adverse events, including 7 mild post?ERCP pancreatitis and 1 fever. Incidence of adverse event was 11. 8%( 8/68) . There was no such severe adverse event as bleeding, perforation, death, or other anesthesia related adverse event. Thirty?two children ( 78. 0%) had follow?up, ranging from 2 month to 6 years. Children followed lived well with no long?term adverse event. Conclusion ERCP is an effective and safe procedure for the diagnosis and treatment of pancreaticobiliary diseases in children.
ABSTRACT
High mobility group box-1 (HMGB1) is an evolutionarily conserved protein,which widely exists in mammals.HMGB 1 contains the nucleus localization sequences.Intracellular and extracellular HMGB1 shows different biological functions.Extracellular HMGB1 is closely related to sepsis,cancer,rheumatoid immune,atherosclerosis,ischemia-reperfusion injury and so on.The mobilization of HMGB 1 from the nucleus to the cytoplasm and subsequent release involves the processes of post-translation modification,active secretion and nuclear localization.
ABSTRACT
Objective To evaluate the efficacy and safety of the conscious analgesia/sedation scheme with remifentanil and propofol on the elderly patients under gastroenterological endoscopic procedure. Methods Retrospective analysis was performed on 3 500 cases with remifentanil and small?dose propofol under gastroenterological endoscopic procedures, and the procedure achievement, effects of the narcotic, adverse reactions and satisfactory results were summarized. Results All procedures were completed successfully. The ratio of the patients whose intended sedation depth arrived at referential induction was up to 91?3%(3 196/3 500).Hemodynamic change was slight and almost all patients could open eyes in no time, with short hospital stay. No serious adverse effects were observed except several patients complaining about mild bucking, abdominal distension and stomachache. The degree of patients′ satisfaction was high. Conclusion The conscious analgesia/sedation scheme with remifentanil and propofol can be effectively and safely used on gastroenterological endoscopic procedure among the elderly, but precise monitor and timely treatment of complications are still needed.
ABSTRACT
Objective:To evaluate the effect of cryopreservation on clonogenic ability and apoptosis rate of mono-nuclear cells and CD34+cells in umbilical blood (UB), and to choose the index to present the freezing injury and optimize the cryopreservation of UB. Methods:hTe mono-nuclear cells (MNC) and CD34+cells were separated from UB and frozen.Atfer 30 days, they were thawed in warm water. Clonogenic capacity and clonogenic recovery before and atfer the cryopreservation was compared. We also used Annexin V-FITC-PI to investigate the apoptosis rate of the cells before and atfer the cryopreservation of these 2 types of cells. Results:hTe number of colony forming unit-granulocyte/monocyte (CFU-GMs) was not changed atfer freezing and thawing in both MNCs and CD34+cells, while the number of colony forming unit-granulocyte, erythrocyte, monocyte and megakaryocyte (CFU-GEMM) was obviously reduced after freezing in CD34+cells. The 2 types of cryopreserved cells had certain degree of apoptosis before the cryopreservation. MNC-type cryopreservation increased the cells apoptosis a little, while CD34+-type cryopreservation increased more. Conclusion:hTe cells have certain degree of apoptosis before the cryopreservation. hTe freezing and thawing procedure does affect the early stage progenitor cells-CFU-GEMM in the CD34+-type cryopreserved cells in UB. hTe damage may be induced by the cell apoptosis.
ABSTRACT
Objective To evaluate the effect of lidocaine and tramadol on remifentanil combined general anesthesia. Methods Eighty patients undergoing abdominal hysterectomy were divided into group LT,L,T and C by random digits table,each with 20 cases .In group LT,during induction,the patients were intravenously. In group L,only used lidocaine as introduced in group LT. In group T,only used tramadol as shown in group LT. In group C,used the same volume of saline solution. The changes of mean arterial pressure (M A P) and heart rate during the operation, dysphoria grade (RS), Ramsay score (RSS), pain score (VAS),extubation time(ET),medication and dose,complications were recorded. Results In group LT,the dosage of propofol [(450 ± 178) mg] was less (P ＜ 0.05), ET [(15.0 ± 4.8) min] was shorter (P ＜ 0.05),during recovery time, RS was lower, RSS was higher,the cases needad fentanyl (1 case), 48 h after operation, only 1 case needed pethidine to relieve pain was less than those in other groups (P ＜ 0.05). In group L there was a tend that its RS and the cases needed fentanyl and fentanyl dosage were more, RSS was less than those in group T during recovery time,but 48 h after operation,the cases needed pethidine was less than that in group T. Conclusions Using lidocaine during operation may relieve pain after operation, reduce the dosage of analgesic;giving tramadol may alleviate the acute pain and lower dysphoria incidence rate after remifentanil anesthesia. Combining them will get a better effect.
ABSTRACT
OBJECTIVE@#To observe the effect of programmed cell death 5 (PDCD5) protein on the apoptosis of multiple myeloma KM3 cells induced by dexamethasone and to understand its mechanism.@*METHODS@#The human recombinant PDCD5 (rhPDCD5) protein was added (alone of different concentrations or associated with dexamethasone) into KM3 cells. Cultured together for certain time, the cells were collected for the following experiments: (1)The effect of rhPDCD5 protein and dexamethasone on the apoptotic rate of KM3 cells was determined by flowcytometry (FCM) analysis after the cells were stained by Annexin V-FITC & PI (propidium iodide). (2)Caspase-3 activity of KM3 cells was evaluated by Western blot. (3)The expression of survivin protein in KM3 cells was detected by immunocytochemistry.@*RESULTS@#The apoptotic rate of KM3 cells and the activity of caspase-3 increased significantly, and that treated with rhPDCD5 protein and dexamethasone was higher than that treated with rhPDCD5 protein only. The expression of survivin protein in the rhPDCD5 with dexemethas group was down-regulated, and with the concentration of rhPDCD5 and dexamethasone increasing, the changes was more obviously.@*CONCLUSION@#PDCD5 protein can induce the apoptosis of KM3 cells, and accelerate the apoptosis of KM3 cells induced by dexamethasone. PDCD5 protein may reduce the expression of survivin protein and increase activation of caspase-3 to play its role in promoting apoptosis.
Subject(s)
Humans , Apoptosis , Apoptosis Regulatory Proteins , Pharmacology , Caspase 3 , Metabolism , Cell Line, Tumor , Dexamethasone , Pharmacology , Drug Synergism , Inhibitor of Apoptosis Proteins , Metabolism , Multiple Myeloma , Pathology , Neoplasm Proteins , Pharmacology , Recombinant Proteins , Pharmacology , SurvivinABSTRACT
OBJECTIVE To investigate the effect and safety of teicoplanin to cure the neutropenic patients with infection.METHODS The 64 neutropenic patients with fever were treated with teicoplanin for empirical therapy,and then its effect and safety were evaluated.RESULTS Teicoplanin was effective in 53 patients,its effective rate was 88.3%,the adverse event rate was only 4.7%,and the adverse reactions were slight and reversible and it was well tolerant to patients.CONCLUSIONS Teicoplanin is one of the antibiotic agents with high performance,low toxicity and fast effect,which is an ideal agent for empirical therapy for neutropenic patients with fever in hematology units.