Establishment of Primary Adult MDS Nested Case-Control Study Cohort and Study of Risk Factors Associated with MDS Evolution to Leukemia / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To establish a nested case-control study cohort in myelodysplastic syndrome (MDS) patients and investigate the clinical characteristics, WHO subtype and risk factors associated with MDS evolution to leukemia of this cohort.</p><p><b>METHODS</b>All patients, ≥18 years of age, provided by 24 Shanghai hospitals with initial clinical findings consistent with a hematopoietic abnormality between June 2003 and April 2007, were the candidates for inclusion in this study. The blood and bone marrow samples of every patient should be provided at baseline. Diagnosis was made by incorporating morphologic, immunophenotypic, cytogenetic and molecular features according to WHO classification criteria. Cytogenetic analysis was performed using conventional G-banding karyotyping and fluorescence in situ hybridization (FISH) techniques. Cumulative risk of evolution was estimated by Kaplan-Meier method. Prognostic factors were evaluated by univariate Log-rank method and multivariate Cox proportional hazard models.</p><p><b>RESULTS</b>A total of 435 patients were diagnosed as MDS. The median age of MDS onset was 58(18-90) years, with 248 male patients and 187 female patients (male: female 1.33: 1). The percentage of cases with refractory cytopenia with multilineage dysplasia (RCMD) was the highest (65.5%), while that of refraetory anemia (RA) (2.3%), refractory anenia with ring sideroblast (RARS) (1.1%) and 5q-syndrome (0.5%) was lower. Trisomy 8 (+8) was the most common chromosome abnormalities (71 cases, 12.7%). The mean follow-up time was 20.3 (4.2-57.1) months. Cases were patients with evolution by the end of follow-up, while controls were patients without evolution by that time. Case group included 41 patients and control group included 342 patients. Univariate analysis showed that the age, sex, WHO subtype, WBC count, absolute neutrophil count (ANC), IPSS cytogenetic subgroup, IPSS group and bone marrow blast percentage were significant risk factors for leukemia-free survival (LFS). Multivariate analysis of COX model showed that the age, sex, WHO subtype, IPSS cytogenetic subgroup and bone marrow blast were independent risk factors for LFS.</p><p><b>CONCLUSION</b>A nested case-control study cohort of MDS patients is established. The clinical characteristics and WHO subtype of MDS patients in Chinese Shanghai are different from that in Western countries. The independent risk factors for MDS evolution are age, sex, WHO subtype, IPSS cytogenetic subgroup and bone marrow blast percentage.</p>

Prognostic value of clinical characteristics and immunophenotypic biomarkers in 115 patients with primary central nervous system lymphoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Clinical outcome in patients with primary central nervous lymphoma (PCNSL) is variable and poorly predictable. This study investigated the association of clinical features and immune markers with prognosis of patients with PCNSL.</p><p><b>METHODS</b>One hundred and fifteen newly diagnosed PCNSL patients at the study institution were considered eligible for this study. Clinical characteristics and biochemical assay data were collected. Immunohistochemical staining of Cyclin D3, Cyclin E, Foxp1, and LMO2 were performed. All cases were followed-up regularly.</p><p><b>RESULTS</b>The common sites of involvement were frontal lobe (54.8%) and thalamus (16.5%). Diffuse large B-cell lymphoma composed of 96.5% of the cases. The median overall survival was 22 (4 - 41) months, and the 5-year survival rate was 22.8%. Age > 65 years, serum globulin > 40 g/L, large size of tumor, lymphocyte count ≥ 1 × 10(9)/L, and expression of Cyclin D3 and Cyclin E were associated with poor prognosis of PCNSL. Expressions of Foxp1, LMO2, and CD44 were not related to the survival. Expression of Cyclin E, large tumor size, and high serum globulin were independent prognostic factors for PCNSL.</p><p><b>CONCLUSIONS</b>PCNSL prognosis is relatively poor. Age, high tumor burden, higher lymphocyte count, expression of Cyclin D3, and Cyclin E are inferior prognostic factors for PCNSL.</p>

Establishment of human homoharringtonine-resistant SKM-1 cell line and its biological characteristics / 中华血液学杂志

<p><b>OBJECTIVE</b>To establish a homoharringtonine (HHT)-resistant SKM-1 cell line and explore its biologic characteristics and mechanisms for drug resistance.</p><p><b>METHODS</b>The HHT-resistant SKM-1 cell line was established by repeatedly exposing the cells to comparatively large doses of HHT with a short-time duration, and gradually elevating the drug concentration to an endurable level. The morphology of the resistant and parental cell lines was observed through optical microscope. The MTT assay was used to determine the doubling time and the resistance index to draw growth curve. The immunophenotype, cell cycle distribution and DNR accumulation between SKM-1 and SKM-1/HHT were analyzed by flow cytometry, and the karyotypes by R-banding. Semi-quantitative real-time PCR was performed to evaluate the expression levels of mdr1, MRP and topo-IIa.</p><p><b>RESULTS</b>The HHT-resistant cell line SKM-1/HHT was eventually established following 7-month drug induction. Both the resistant and the parental cell lines were similar with regard to morphology and immunophenotype. The karyotypes of the former was more complicated with differences located in chromosome 20, X, 4, 5, 9 and 11. The resistant cell line had more G(1) phase cells (64.04% vs 41.91%), less S phase cells (34.92% vs 53.53%), and less G(2) phase cells (1.04% vs 4.56%) compared with the parental cell line. The SKM-1/HHT cell line showed significant drug resistance to HHT, VCR, DNR and etoposide, the resistance indices of HHT, VCR, DNR and etoposide were 17.94, 8.75, 5.99 and 13.76 respectively. DNR accumulation was impaired in SKM-1/HHT cell line as less fluorescence of DNR (698 ± 36 vs 858 ± 54). The expression of mdr1 increased dramatically in the resistant cell line, its 2(-ΔCt) value was 20.1 higher than that of the parental cell line \[(3.42 ± 0.46)×10(-2) vs (0.17 ± 0.01)×10(-2), P < 0.05\], while MRP also increased in the resistant by 3.56 folds \[(4.77 ± 0.87)×10(-3) vs (1.34 ± 0.56)×10(-3), P < 0.05\]; However there was a slightly decrease of topo-IIa, the ratio of the resistant to the parental calculated by their 2(-ΔCt) values was 0.619:1 \[(1.91 ± 0.30)×10(-4) vs (3.08 ± 0.21)×10(-4), P < 0.05\].</p><p><b>CONCLUSION</b>A HHT-resistant cell line SKM-1/HHT was established. The prominent overexpression of mdr1 may be the main cause for multidrug resistance.</p>

Expression of FOXP1 and cyclinE in primary central nervous system lymphoma and its significance / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the value of FOXP1 and Cyclin E gene in primary central nervous system lymphoma(PCNSL) of immunocompetent patients on prognostic significance.</p><p><b>METHODS</b>Clinical data of 71 patients with newly diagnosed PCNSL from 2002 to 2007 was analyzed retrospectively. Immunohistochemistry method (HRP-EnVision(TM)) was performed to observe the expression of FOXP1 and Cyclin E gene in tumor tissue samples. The survival was analyzed by Kaplan-Meier survival curve, survival factors analysis by the Log-rank test and COX proportional hazards regression model.</p><p><b>RESULTS</b>FOXP1 positive was observed in 35 of 51 patients (68.63%) and Cyclin E staining was present in 29 of 50 cases (58.00%). FOXP1(+) patients had a shorter overall survival (OS) than FOXP1(-) ones. 2-year OS rate in FOXP1(+) and FOXP1(-) patients were 23.33% and 73.56%, respectively(P = 0.0015). Cyclin E(+) patients had a shorter overall survival(OS) than cyclinE(-) ones. 2-year OS rate in Cyclin E(+) and Cyclin E(-) patients were 17.56% and 69.76%, respectively (P = 0.0017). Multivariate analysis showed that Cyclin E expression was an independent prognostic factor for shorter OS (P = 0.048). FOXP1 expression might be an important prognostic factor for shorter OS (P = 0.065).</p><p><b>CONCLUSION</b>Cyclin E expression is an independent prognostic factor and FOXP1 expression is a possible prognostic factor for poor clinical outcome in patients with PCNSL.</p>

Assessment of the young rat model of visceral hypersensitivity by measuring electrical discharge of external oblique / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the value of measuring electrical discharge of external oblique in assessment of young rat model of visceral hypersensitivity.</p><p><b>METHODS</b>Eight-day-old neonatal Sprague-Dawley rats were randomly assigned to two groups: an experimental group and a control group (n=16 each). Rats in the experimental group were subjected to mechanical colorectal irritation daily for 7 consecutive days, while the rats in the control group did not received colorectal irritation treatment. On the 6th week of their lives, the spike amplitude of external oblique were measured to evaluate the bowel sensitivity.</p><p><b>RESULTS</b>When the colorectal distention (CRD) pressure was 30 and 45 mmHg, the 95% confidence interval of the spike amplitude in the experimental group was significantly higher than that in the control group (P<0.01). When the CRD pressure were 60 and 75 mmHg, the 95% confidence interval of the spike amplitude in female rats was significantly higher than that in males (P<0.05).</p><p><b>CONCLUSIONS</b>The electrical discharge of external oblique confirmed that chronic colorectal irritation in neonatal rats can result in a chronic visceral hypersensitivity in the juvenile stage, with gender differences. Electrophysiological assessment is a quantitative test, and can objectively reflect visceral sensibility of pain.</p>

Prognostic analysis of refractory anaemia in adult myelodysplastic syndromes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients with myelodysplastic syndrome (MDS) display a very diverse pattern. In this study, we investigated prognostic factors and survival rate in adult patients with MDS refractory anaemia (MDS-RA) diagnosed according to French-American-British classification and evaluated the International Prognostic Scoring System (IPSS) for Chinese patients.</p><p><b>METHODS</b>A multi-center study on diagnosis of MDS-RA was conducted to characterize the clinical features of Chinese MDS patients. The morphological criteria for the diagnosis of MDS-RA were first standardized. Clinical data of 307 MDS-RA patients collected from Shanghai, Suzhou and Beijing from 1995 to 2006 were analyzed using Kaplan-Meier curve, log rank and Cox regression model.</p><p><b>RESULTS</b>The median age of 307 MDS-RA cases was 52 years. The frequency of 2 or 3 lineage cytopenias was 85.6%. Abnormal karyotype occurred in 35.7% of 235 patients. There were 165 cases (70.2%) in the good IPSS cytogenetic subgroup, 44 cases (18.7%) intermediate and 26 cases (11.1%) poor. IPSS showed 20 (8.5%) categorized as low risk, 195 cases (83.0%) as intermediate-I risk and 20 cases (8.5%) as intermediate-II risk. The 1-, 2-, 3-, 4- and 5-year survival rates were 90.8%, 85.7%, 82.9%, 74.9% and 71.2% respectively. Fifteen cases (4.9%) transformed to acute myeloid leukaemia (median time 15.9 months, range 3 - 102 months). Lower white blood cell count (< 1.5 x 10(9)/L), platelet count (< 30 x 10(9)/L) and cytogenetic abnormalities were independent prognostic factors by multivariate analysis, but age (= 65 years), IPSS cytogenetic subgroup and IPSS risk subgroup were not independent prognostic factors associated with survival time.</p><p><b>CONCLUSIONS</b>Chinese patients were younger, and had lower incidence of cytogenetic abnormalities, more severe cytopenias but a more favourable prognosis than Western patients. The major prognostic factors were lower white blood cell count, lower platelet count and fewer abnormal karyotypes. The international prognostic scoring system risk group was not an independent prognostic factor for Chinese myelodysplastic syndrome patients with refractory anaemia patients.</p>

A case-control study of risk factors for myelodysplastic syndromes / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To determine the risk factors involved in myelodysplastic syndromes (MDS).</p><p><b>METHODS</b>A 1:2 case-control study was conducted in 20 Shanghai' hospitals over a 3-year period, covering 266 "de novo" MDS cases corresponded to FAB criteria, and 532 age- and gender-matched controls from same hospitals with MDS cases. Subjects were all surveyed using the same standard questionnaire including histories of medications (Chloramphenicol, Sulfonamides, Meprobamate, Phenytoin, Colchicine, Cyclophosphamide, Propylthiouracil, Anti-TB medication, Tolbutamide, Primaquine and Chinese traditional herbs such as Bezoar, Angelica, Arsenic, Thunder cloud vine) at least 5 years prior to the onset of the disease, tumors, exposure to benzene, heavy metal, organic phosphates, pesticides, petrol/diesel, organic solvents, dye and hair dye products, radiation, house decorating, alcohol and smoking.</p><p><b>RESULTS</b>Occupational exposure to benzene increased significantly the risk of MDS (OR: 8.52, 95% CI: 2.30 - 31.10). Living near high voltage power lines (100 m) increased significantly the risk of MDS (OR: 1.60, 95% CI: 1.10 - 2.32). House decorating (one year prior to the onset of the disease) increased significantly the risk of MDS (OR: 2.40, 95% CI: 1.38 - 4.14). Other investigated occupational poisons did not increase significantly the risk of MDS. Hair dye products, alcohol and smoking did not increase significantly the risk of MDS.</p><p><b>CONCLUSION</b>Occupational exposure to benzene, living near high voltage power lines and house decorating are the risk factors of MDS.</p>

Mechanism underlying IL-2 inhibition on T cell specific immune response / 中国实验血液学杂志

The study was aimed to investigate the effect of IL-2 on the acquired immune response of naive T cells, and to explore the influence of IL-2 on suppressor of cytokine signaling 3 (SOCS-3) expression of naive T cells, as well as to elucidate the role of SOCS-3 on antigen specific immune response in vitro. Naive DO11.10 T cells were pre-stimulated with IL-2 (50 U/ml), and stimulated with OVA(323 - 329) antigen after removing IL-2, then the proliferation of naive DO11.10 T cells was detected. Naive DO11.10 T cells were stimulated with IL-2 (50 U/ml), and SOCS-3 expression was detected by real-time PCR. Naive DO11.10 T cells were stimulated with OVA(323 - 329) antigen, and SOCS-3 expression was detected by means of (3)H-TdR. The results showed that after IL-2 pre-stimulation, the proliferation of naive DO11.10 T cells decreased significantly when stimulated with OVA(323 - 329) antigen; SOCS-3 expression of naive DO11.10 T cells was up-regulated significantly after IL-2 stimulation, the up-regulation began obviously at 4 hours and reached peak at 6 hours. SOCS-3 expression on naive DO11.10 T cells was down-regulated markedly after OVA(323 - 329) antigen stimulation, the expression level of SOCS-3 was lowest on day 2 and returned to normal on day 4 after stimulation. It is concluded that the antigen specific immune response of naive DO11.10 T cells is inhibited after pre-stimulation with IL-2, which may be mediated by SOCS-3.

Functional study of mdr1 and GSTpi expression reversed by hairpin siRNA in K562/A02 cell line / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the effect of hairpin small interference RNA (shRNA) on mdr1 and GSTpi protein expression in multidrug resistance human leukemia cell line K562/A02.</p><p><b>METHOD</b>The shRNAs were synthesized targeting the coding region sequences of mdr1 (79 - 99 nt) and GSTpi (308 - 327 nt) respectively, and cloned to plasmid pSilencer2.1-U6 neo. The cloned products pSilence mdr1 and pSilence GSTpi were transfected into K562/A02 cells. Western blot and immunofluorescence analysis were used to detect the effectiveness and the specificity of the gene silence. 50% inhibition concentration (IC(50)) of doxorubicin (ADM) on K562/A02 cells was determined by MTT method.</p><p><b>RESULT</b>pSilence mdr1 and pSilence GSTpi reduced the expression of P-gp and GSTpi protein from 0.75 +/- 0.02 and 0.54 +/- 0.02 to 0.48 +/- 0.05 and 0.39 +/- 0.02 (P < 0.01) respectively, with no effect on alpha-tubulin expression in comparison with the mock treatment. Transfection of pSilence lamin A/C into K562/A02 decreased lamin A/C expression but had no effect on the expression of P-gp and GSTpi. Immunofluorescence assay also showed that shRNAs significantly reduced the P-gp and GSTpi positive cells from (71.25 +/- 9.65)% and (81.25 +/- 6.49)% to (35.25 +/- 5.97)% and (41.25 +/- 4.43)% (P < 0.01), respectively, compared with the mock treatment. The resistance indexes after transfection were decreased to 8 (pSilence mdr1) and 10 (pSilence GSTpi) respectively from 23 (mock transfection) (P < 0.01).</p><p><b>CONCLUSION</b>The shRNA could effectively and specifically reverse the multidrug resistance on K562/A02 cell line.</p>

A Study of the modulation for multidrug resistance cell line K562/A02 using a specific siRNA against mdrl,GST? / 肿瘤研究与临床

Objective To investigate the modulation for multidrug resistance cell line K562/A02 us- ing a specific siRNA against mdrl,GST?.Methods siRNA were synthesized targeting the coding region se- quences of mdrl(79～99 nt)and GST?(308～327nt)respectively,and cloned to plasmid pSilence2.1-U6.The cloned products pSilenee-mdr1 and pSilence-GST? were transfected into K562/A02 cells.Expression of mdr1 and GST? mRNA were assayed by SYBR Green Ⅰ real-time PCR.The apoptosis of cell line K562/A02 was examined by Flow cytometry,50% inhibition concentration(IC_(50))of doxorubicin on K562/A02 cell was deter- mined by MTT method.Results The siRNA expression vector against mdr1,GST? mRNA was constructed successfully.After transfected with pSilenee-mdr1,the expression of mdr1 mRNA in K562/A02 in was re- duced 71.5 % compared to the mock transfeetion,from(2.8?1.65)?10~8 copy/?g RNA to(3.9?2.37)?10~7 copy/?g RNA(P

Genetic polymorphism of tumor necrosis factor-alpha in patients with chronic benzene poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the relationship between genetic polymorphism of tumor necrosis factor-alpha (TNF-alpha, sites at -238 nt and -308 nt) and susceptibility to chronic benzene poisoning.</p><p><b>METHOD</b>The polymorphism of TNF-alpha gene were detected by nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique from 50 benzene poisoning patients and 60 control individuals exposed to benzene.</p><p><b>RESULTS</b>The frequency of the TNF-alpha-238G/G, A/G and A/A in controls (95%, 5% and 0%, respectively), were not significantly different from those in patients (92%, 6% and 2%, respectively, P > 0.05). The frequency of the TNF-alpha-308G/G, A/G and A/A in patients were 76%, 24% and 0% respectively, and that in control individuals were 93%, 7% and 0% respectively. Chi(2) test showed that frequency of TNF-alpha-308A/G in patients was significantly higher than that in controls (chi(2) = 6.22, P = 0.013). Logistic analysis showed that TNF-alpha-308A/G was the independent risk factor of benzene poisoning (OR = 5.3, P < 0.05).</p><p><b>CONCLUSION</b>Individuals with TNF-alpha-308A/G gene polymorphism are susceptible to benzene poisoning.</p>

Reversal of multidrug resistance of K562/A02 cell line by mdr1 and GSTpi gene silence / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the effect of short hairpin RNA (shRNA) on mdr1 and GSTpi expression of human multidrug resistant leukemia cell line K562/A02.</p><p><b>METHODS</b>shRNAs were synthesized according to the sequence targeting mdr1 and GSTpi coding region of 79-99nt and 308 approximately 327nt, and cloned into pSilencer 2.1-U6 neo vector. The cloned products, pSilence-mdr1 and pSilence-GSTpi, were transfected into K562/A02 cell line. Expression of mdr1 and GSTpi mRNA was assayed by real time PCR. 50% inhibition concentration (IC(50)) of doxorubicin (ADM) for K562/A02 cell line was determined by MTT method.</p><p><b>RESULTS</b>After transfected with pSilence mdr1, the expression of mdr1 mRNA in K562/A02 cells was reduced by 71.5%, from (2.80 +/- 1.65) x 10(8) copy/microg RNA to (3.90 +/- 2.37) x 10(7) copy/microg RNA(P < 0.01). While the expression of GSTpi mRNA in pSilence-GSTpi transfected K562/A02 cells reduced by 39.8%, from (2.30 +/- 1.14) x 10(5) copy/microg RNA to (5.40 +/- 2.45) x 10(4) copy/microg RNA (P < 0.01). The resistance indexes after transfection were decreased to 8 and 10 respectively as compared to 23 of the mock transfection (P < 0.01).</p><p><b>CONCLUSION</b>The shRNA could effectively reverse the multidrug resistance of K562/A02 cell line.</p>

Experimental study of K562 cell apoptosis induced by siRNA / 中华血液学杂志

<p><b>OBJECTIVES</b>To construct a siRNA expression vector pBCR6 that produces siRNA against bcr/abl mRNA and detect apoptosis rate of K562 cells after pBCR6 transfection.</p><p><b>METHODS</b>Template sequence for siRNA was designed, synthesized and inserted into an expression vector pSilencer1.0-U6. Restriction analysis and sequencing were performed to verify the pBCR6 vector. Then pBCR6 was transfected into K562 cells by X-tremeGene Q2. pSilencer1.0-U6 was used as the control. At different time point after transfection, apoptosis rate was determined by Tunel and Annexin V+ PI with FCM.</p><p><b>RESULT</b>pBCR6 was verified by restriction analysis and sequencing. The apoptosis rate of K562 cells markedly increased at 48 and 72 hour after transfected with pBCR6, and increased in a time-dependent manner [the apoptosis rate of transfected K562 cells was (47.80 +/- 1.63)% at 72 hrs, whereas the control group was (6.67 +/- 0.37)%, P < 0.0001] No prominent change in apoptosis rate was found in the control.</p><p><b>CONCLUSION</b>The siRNA expression vector against bcr/abl mRNA was successfully constructed. The pilot study showed that pBCR6 could effectively induce K562 cells apoptosis. siRNA may be a new tool for molecular target therapy for chronic myelogenous leukemia.</p>

Study on the targeting effects of M1-GS RNA on K562 cells / 中华血液学杂志

<p><b>OBJECTIVE</b>To determine the effects of M1-GS RNA (M1 RNA) on bcr-abl mRNA and oncoprotein after M1 RNA with guide sequence (M1-GS RNA) targeting the oncogene was transfected into K562 cells.</p><p><b>METHODS</b>pAVGS4 (an eukaryocyte expression vector containing M1-GS RNA sequence) and pNAV-1 (as the control) were transfected into K562 cells by X-tremeGENE Q2. Total RNA was extracted at 24, 48, 72 and 96 hours after transfection. Then RT-PCR was done to compare the products at different time point. After collecting pAVGS4-transfected cells and the control cells at 48 and 96 hours after transfection, total protein was extracted and quantified. Change of P210 was determined by Western blot. Colony formation was analyzed at 96 hours after transfection.</p><p><b>RESULTS</b>RT-PCR based on transfected cells at different time point showed that the amount of bcr-abl mRNA began to decrease at 24 hours and reduced to 9.2% and 2.5% respectively at 48 and 72 hours after transfection. Western blot showed that the expression of P210 in the pAVGS4 group reduced to 10.4% of the control at 48 hours and 6.7% of the control at 96 hours after transfection. The inhibition rate of colony formation was 81.3% after K562 cells were transfected by pAVGS4.</p><p><b>CONCLUSION</b>pAVGS4 can efficiently destroy bcr-abl mRNA in K562 cells. The transcript level of bcr-abl mRNA was reduced with the time after transfection. The expression of P210 was decreased significantly at 48 and 96 hours after transfection. K562 cell colony formation was prominently inhibited.</p>

Study on the quality of life in long-term survivors with acute leukemia in Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the quality of life (QOL) in long-term survivors with acute leukemia (AL).</p><p><b>METHODS</b>Ninety-five long-term survivors with AL drawn from 29 hospitals in Shanghai during the period 1984 - 1994 were studied. Questionnaire FACT-G was completed in order to assess the QOL for long-term survivors with AL.</p><p><b>RESULTS</b>Questionnaires assessing QOL were filled in by 95 long-term survivors with AL. Majority of the survivor turned out having normal QOL. The average QOL score was 85. Patients aged over 60 years old and illiterate had higher QOL score. About 50% of the patients had returned to full-time job or school. 12.6% of the patients had had secondary diseases due to chemotherapy. Nearly half of the married patients were not satisfied with their sexual life.</p><p><b>CONCLUSION</b>Thus, prevention of having secondary diseases and to keep sexual function must call for serious attention during chemotherapy. The biggest challenge was to prevent relapse and the affordability to treatment.</p>

Cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: Markov decision analysis / 中华流行病学杂志

<p><b>OBJECTIVE</b>Using Markov model Monte Carlo simulation to conduct a cost-effectiveness analysis of screening Helicobacter pylori (H. pylori) infection to prevent gastric cancer.</p><p><b>METHODS</b>The Markov model was developed based on the natural course from H. pylori infection to gastric cancer. Two strategies were compared: (1) screening for H. pylori and treatment for those with positive tests, and (2) without screening and treatment. Data used for model simulation including transition probability, efficacy of test and treatment were collected from related research publications. Markov model Monte Carlo simulation combined with bootstrap method was used to perform base-case analysis and estimate the confidence interval of cost-effectiveness ratios. The probability sensitivity analysis was used to estimate the cost-effectiveness in multiple uncertainty factors.</p><p><b>RESULTS</b>Assuming H. pylori eradication will prevent 50% of attribute gastric cancer, the screening strategies would prevent 16.6% cases of gastric cancer. Cost-effectiveness were 10,405 Yuan (95% CI: 4,238 - 27,727 Yuan) per GC prevented, 64 Yuan (95% CI: 31 - 97 Yuan) per QALY saved and 1,374 Yuan (95% CI: 352 - 86,624 Yuan) per life year saved.</p><p><b>CONCLUSION</b>Screening and treatment for H. pylori infection in population was potentially effective in the prevention of gastric cancer, and screening in high incidence area of gastric cancer would be more effective and economic.</p>