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Blinatumomab, as a novel bispecific antibody targeting CD19 and CD3, can induce T lymphocytes to precisely target CD19 positive B lymphocytes to apoptosis. At present, it is the only bispecific antibody approved for the treatment of hematological malignancies in China. Blinatumomab is effective in the treatment of newly diagnosed, relapsed/refractory, minimal residual disease positive patients with B-cell acute lymphoblastic leukemia (B-ALL) . It can improve the survival of the patients and is well tolerated. The further study of blinatumomab can provide theoretical basis and new ideas for induction therapy, salvage therapy and subsequent hematopoietic stem cell transplantation in patients with B-ALL.
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Objective@#To investigate the effects of maternal exposure to ambient fine particles (PM2.5) in Fuzhou during pregnancy on immune responses to ovalbumin (OVA) in neonatal rats and the possible mechanisms.@*Methods@#Pregnant Sprague-Dawley rats were randomly assigned into four groups (ten in each): filtered air (FA) plus normal saline (NS), airborne PM2.5 plus NS (PM2.5-NS), FA plus OVA (FA-OVA) and PM2.5 plus OVA (PM2.5-OVA) groups. Pregnant dams in the PM2.5 exposure groups were placed in a PM2.5 exposure chamber in which the PM2.5 concentration was equal to the ambient air from the beginning of gestation till delivery, whereas the other dams inhaling air without particulate matters were put into a clean chamber. OVA sensitization was conducted through intraperitoneal injection of OVA at 50 μg per dam at 4 and 9 days of gestation, followed by inhalation of atomized 1% OVA for 30 min at 18, 19 and 20 days of gestation. Dams without OVA sensitization were given NS in the same way. Levels of interleukin (IL)-4, IL-5 and interferon-γ (IFN-γ) in neonatal rats' plasma were measured by enzyme-linked immunosorbent assay just after birth. Protein levels of transcription factors GATA-3 and T-bet in lung were analyzed by Western-blotting. Changes in microRNA(miR)-146a and miR-146b in spleen were detected by real-time polymerase chain reaction. Histological changes in lung were observed under light microscope. One-way analysis of variance and LSD test were used as statistical methods.@*Results@#(1) IL-4 level in plasma was significantly increased in PM2.5-NS [(18.56±7.04) ng/L], FA-OVA [(34.04±7.06) ng/L] and PM2.5-OVA groups [(45.67±8.18) ng/L] as compared with that in FA-NS group [(10.51±2.88) ng/L], and the level of IL-4 in PM2.5-OVA group was higher than that in PM2.5-NS and FA-OVA groups (F=54.667, P<0.001). Significantly increased IL-5 level in plasma was found in FA-OVA and PM2.5-OVA groups as compared with that in FA-NS group (F=6.253, P=0.023). Among the four groups, FA-OVA group showed significantly increased IFN-γ level in plasma (F=28.604, P<0.001). (2) GATA-3 level in lung tissues was significantly increased in PM2.5-NS (31.09±3.54), FA-OVA (35.24±5.00) and PM2.5-OVA groups (47.81±3.63) as compared with that in FA-NS group (24.19±3.12), and higher in PM2.5-OVA group than in PM2.5-NS and FA-OVA groups (F=96.581, P<0.001). T-bet level was significantly lower in FA-OVA and PM2.5-OVA groups than in FA-NS group. Moreover, PM2.5-OVA group showed decreased T-bet level as compared with that in PM2.5-NS and FA-OVA groups (F=30.852, P<0.001). (3) Expression of miR-146a in spleen was significantly enhanced in PM2.5-NS (1.72±0.27), FA-OVA (1.56±0.37) and PM2.5-OVA groups (3.06±0.52) than in FA-NS group (1.05±0.25). Moreover, PM2.5-OVA group showed enhanced expression of miR-146a as compared with that in PM2.5-NS and FA-OVA groups (F=42.276, P<0.001). Changes in the expressions of miR-146b were similar to those in miR-146a (F=28.776, P<0.001). (4) Stenosis or disappearance of alveolar spaces, accompanied with infiltration of inflammatory cells in interstitial substance and congestion in alveolar septum, was seen in FA-OVA and PM2.5-OVA groups and conditions in the latter group were more severe.@*Conclusions@#Intrauterine exposure to ambient PM2.5 negatively affects fetal lung development and immunological function in rats, especially when the dams are sensitized with OVA during pregnancy.
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Objective To analyze the influential factors of the prognosis of neonatal cholestasis. Methods The data on 106 newborns with neonatal cholestasis collected from January 1, 2009 to June 30, 2016 was collected and analyzed retrospectively. All cases were divided into cure group (99 patients) and improvement group (7 patients) according to the effect of oral ursodeoxycholic acid therapy and comprehensive medical treatment. There was no cure for invalid case. The clinical features, course of disease and curative effect were observed. The levels of total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase (γ-GT), total bile acid (TBA) were compared between two groups. The ratio of neonatal bacterial infection, cytomegalovirus (CMV) infection, sex, total intravenous nutrition (more than 7 d), perinatal hypoxia, premature birth, maternal complicated intrahepatic cholestasis of pregnancy (ICP) were compared between two groups. Multiple Logistic regression analysis was used to analyze the prognosis factors of neonatal cholestasis. Results The levels of serum ALT, AST, γ-GT, TB, DB and TBA in improvement group were significantly higher than those in cure group, the course of disease in improvement group was significantly longer than that in cure group, there were significant differences (P<0.05). A strong linear correlation was showed between course of disease and the levels of serum ALT, AST, TB, DB and TBA (tALT=13.050, tAST=14.696, tTB=12.771, tDB=13.776, tTBA=12.019, P < 0.05). Multiple Logistic regression analysis showed that the prognosis of neonatal cholestasis was associated with bacterial infection, CMV infection, total intravenous nutrition (more than 7 d) and premature ( OR=9.375, 7.909, 11.333, 11.333, P < 0.05). Conclusions The higher the level of serum TB, DB, TBA, ALT and AST, the longer the course of the disease. Bacterial infection, CMV infection, total venous nutrition( ≥ 7 d) and premature are the risk factors of the prognosis of neonatal cholestasis. Therefore, prevention of neonatal bacterial and CMV infection, reduction of the occurrence of preterm delivery and reduction of the total parenteral nutrition time are very important to improve the prognosis of neonatal cholestasis.
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Objective To investigate the effects of maternal exposure to ambient fine particles (PM2.5) in Fuzhou during pregnancy on immune responses to ovalbumin (OVA) in neonatal rats and the possible mechanisms.Methods Pregnant Sprague-Dawley rats were randomly assigned into four groups (ten in each):filtered air (FA) plus normal saline (NS),airborne PM2.5 plus NS (PM2.5-NS),FA plus OVA (FA-OVA) and PM2.5 plus OVA (PM2.5-OVA) groups.Pregnant dams in the PM2.5 exposure groups were placed in a PM2.5 exposure chamber in which the PM2.5 concentration was equal to the ambient air from the beginning of gestation till delivery,whereas the other dams inhaling air without particulate matters were put into a clean chamber.OVA sensitization was conducted through intraperitoneal injection of OVA at 50 μ g per dam at 4 and 9 days of gestation,followed by inhalation of atomized 1％ OVA for 30 min at 18,19 and 20 days of gestation.Dams without OVA sensitization were given NS in the same way.Levels of interleukin (IL)-4,IL-5 and interferon-γ (IFN-γ) in neonatal rats' plasma were measured by enzyme-linked immunosorbent assay just after birth.Protein levels of transcription factors GATA-3 and T-bet in lung were analyzed by Western-blotting.Changes in microRNA(miR)-146a and miR-146b in spleen were detected by real-time polymerase chain reaction.Histological changes in lung were observed under light microscope.One-way analysis of variance and LSD test were used as statistical methods.Results (1) IL-4 level in plasma was significantly increased in PM2.5-NS [(18.56±7.04) ng/L],FA-OVA [(34.04±7.06) ng/L] and PM2.5-OVA groups [(45.67±8.18) ng/L] as compared with that in FA-NS group [(10.51 ±2.88) ng/L],and the level of IL-4 in PM2.5-OVA group was higher than that in PM2.5-NS and FA-OVA groups (F=54.667,P＜0.001).Significantly increased IL-5 level in plasma was found in FA-OVA and PM2.5-OVA groups as compared with that in FA-NS group (F=6.253,P=0.023).Among the four groups,FA-OVA group showed significantly increased IFN-γ level in plasma (F=28.604,P＜0.001).(2) GATA-3 level in lung tissues was significantly increased in PM2.5-NS (31.09 + 3.54),FA-OVA (35.24± 5.00) and PM2.5-OVA groups (47.81 ±3.63) as compared with that in FA-NS group (24.19±3.12),and higher in PM2.5-OVA group than in PM2.5-NS and FA-OVA groups (F=96.581,P＜0.001).T-bet level was significantly lower in FA-OVA and PM2.5-OVA groups than in FA-NS group.Moreover,PM2.5-OVA group showed decreased T-bet level as compared with that in PM2.5-NS and FA-OVA groups (F=30.852,P＜0.001).(3) Expression of miR-146a in spleen was significantly enhanced in PM2.5-NS (1.72±0.27),FA-OVA (1.56±0.37) and PM2.5-OVA groups (3.06± 0.52) than in FA-NS group (1.05 ±0.25).Moreover,PM2.5-OVA group showed enhanced expression of miR-146a as compared with that in PM2.5-NS and FA-OVA groups (F=42.276,P＜0.001).Changes in the expressions of miR-146b were similar to those in miR-146a (F=28.776,P＜0.001).(4) Stenosis or disappearance of alveolar spaces,accompanied with infiltration of inflammatory cells in interstitial substance and congestion in alveolar septum,was seen in FA-OVA and PM2.5-OVA groups and conditions in the latter group were more severe.Conclusions Intrauterine exposure to ambient PM2.5 negatively affects fetal lung development and immunological function in rats,especially when the dams are sensitized with OVA during pregnancy.
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Objective To evaluate the effect and safety of a modified Prolift procedure, without preceding partial trachelectomy or hysterectomy for pelvic organ prolapse (POP) with coexistent cervical elongation. Methods Clinical data of 72 patients that underwent a modified Prolift procedure for POP with coexistent cervical elongation, between December 2008 and June 2012 in Fuzhou General Hospital of Nanjing Military Command was retrospectively analysed. A comparison was carried out between preoperative and postoperative parameters of pelvic organ prolapse quantitation system (POP-Q), and an objective evaluation was made according to the overall cure rate and recurrence rate. Pelvic floor distress inventory-short form 20 (PFDI-20) was used to investigate the subjective cure rate and improvement of symptoms. Results Patients were followed up at median 52 months (36-78 months). One bladder perforation and one rectum perforation occurred during the procedure. Four patients (6%, 4/72) had uterine prolapse at 9-19 months after the opertaion and had transvaginal hysterectomy laterly. The overall anatomical correction rate was 94%(68/72). Six patients (8%, 6/72) had mesh exposures at 3-9 months after the opertaion. Scores of PFDI-20 decreased sifnificantly after the procedure (118.2±25.2 vs 12.1±8.0 vs 12.5±9.5 vs 13.0±9.9, P<0.05). The patients′ satisfaction rate was 92% (66/72). Conclusion This modified Prolift procedure, without preceding partial trachelectomy or hysterectomy, could effectively and safely correct POP with coexistent cervical elongation.
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Objective To analyze the risk factors of voiding dysfunction after mid-urethral sling surgery for stress urinary incontinence.Methods Clinical data of 573 consecutive patients undergoing midurethral sling surgery from January 2003 to December 2010 were collected and analyzed retrospectively.All relative risk factors were evaluated by univariate and multivariate Logistic analysis to identify risk factors of voiding dysfunction.Results Voiding dysfunction occurred in 28 patients,with an incidence of 4.9％ (28/573).Univariate analysis showed that age,previous pelvic surgery,pre-operative postvoid residuals,maximum flow rate,average urine flow rate,Valsalva leak point pressure,concomitant anterior pelvic repair and operator performing＜50 procedures were the relative risk factors (P＜0.05) for voiding dysfunction.Multivariate logistic regression analysis revealed that the maximum flow rate (Qmax) ≤ 15 ml/s (OR=3.782,P=0.003) was an independent risk factor for voiding dysfunction and surgery experience was its protection factors (OR=0.295,P=0.016).Conclusions Qmax ≤ 15 ml/s on preoperative urodynamic study is an independent risk factor for voiding dysfunction after mid-urethral sling procedure.Improving skill of surgery and strengthening technical training will help to reduce the incidence of this complication.
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Objective To observe the clinical efficacy and adverse reactions of antibiotic in treating tubal infertility,which provide support in the clinical applicaiton.Methods 68 cases of tubal infertility caused by Uu and Ct were randomly divided into the control group and observation group according to random digital table.There were 34 cases in each group.The control group was taken hydrotubation.The observation group was given doxycycline 0.1g orally twice a day for 7 days and azithromycin according the results of drug sensitive test on the basis of the control group.In two groups mycoplasma and chlamydia positive rate,pregnancy,clinical efficacy and adverse reactions were compared.Results After 7 days of treatment,Uu positive rate in the observation group was 14.7%.Ct positive rate was 17.6%.Uu positive rate in the control group was 58.8%.Ct positive rate was 64.7%;Uu positive rate and Ct the positive rate in both group showed significant difference(χ2 =14.23,15.54,all P0.05).Conclusion Antibiotic in treating patients with tubal infertility showed significant clinical efficacy and little side effects.We could draw a conclusion that this program was worthy of further clinical application and study.
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Objective To study risk factors with the occurrence of the mesh exposure after pelvic floor reconstruction.Methods From Mar.2007 to Mar.2011,a retrospective study was made on the clinical data of 353 patients undergoing vaginal mesh pelvic floor reconstruction.The related complications of the mesh were surveyed,and risk factors associated with the mesh's exposure were studied by single factor and multiple factors logistic regression.Results It was found that the exposure rate was 9.6％ (34/353) after 1 year postoperative follow-up.Single factor analysis showed that patients who were not less than 70 years old,patients who were on their menopause stage,the occurrence of not less than three parturition,history of pelvic surgery,diabetes and smoking had a significant correlation (all P ＜ 0.05) with the occurrence of the mesh exposure after pelvic floor reconstruction.Multiple factors logistic regression analysis showed that patients who were not less than 70 years of age (OR =2.389),the occurrence of not less than three parturition (OR =2.688),the history of diabetes (OR =3.545),the history of pelvic surgery (OR =5.385) were the independent risk factors,and the operation experience was the protection factors (OR =0.134).Conclusions Mesh exposure is a common complication after pelvic floor reconstruction.Old age,multiple delivery,history of diabetes and history of pelvic surgery are the risk factors of mesh exposure.Preoperative full assessment and the quality of training contribute to reduce the incidence.
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Objective To evaluate the safety and efficacy of modified Prolift pelvic floor reconstruction with improving the placement of Prolift-A in treatment of severe pelvic floor dysfunction and stress urinary incontinence (SUI).Methods From July 2008 to September 2010,170 cases with severe pelvic organ prolapse(POP) treated by modified Prolift pelvic floor reconstruction surgery in Fuzhou General Hospital were enrolled in this study.The Prolift-A was laid tension-free under the mid-urethra with the position of Prolift-A displaced from the neck of bladder to the mid-urethra.No concomitant tension-free urethra suspender via vagina was performed.Primary outcomes were assessed with POP quantitation ( POPQ) system to evaluate the postoperative anatomical replacement stage.Secondary outcome measure were:urogenital distress inventory 6 ( UDI-6),the incontinence impact questionnaire 7 ( IIQ-7 ) and the pelvic floor incontinence questionnaire 7 (PFIQ-7) to evaluate the impact on life quality at the follow-up of 1,6,12 months.Results At 6 and 12 months after surgery,168 cases and 163 cases were followed up.The anatomical cure rates were 98.8％ (166/168) at 6 months and 97.5％ (159/163) at 12 months,respectively.One case with bladder injury and 1 case with rectum injury were observed.Five cases with recurrence were observed,including 2 cases with anterior vagina prolapse,2 cases with uterine prolapse and 1 case with posterior vagina prolapse.Meanwhile,3 cases with hematoma and 7 cases with mesh erosion were observed.Quality of life of all patients were improved significantly by UDI-6,IIQ-7 and PFIQ-7 scoring system evaluation.Among 79 POP patients with SUI,the cure rate of SUI was 93.7％ (74/79).Of 5 cases with symptomatic SUI,2 cases were needed surgical intervention.Twenty-three cases were found with minimal SUI symptoms and subjective satisfaction without objective influence on quality of life.Seven patients presented dysuria after surgery,5 cases recovered urination with 10 days,1 case recovered with 1 months,and 1 case with 6 months by bladder drainage.Eleven cases with discomfort urination and 3 cases with slow urination were found.Conclusions The modified Prolift pelvic reconstructive surgery was safe and efficacy intervention in treatment of POP and prevention of SUI.
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ObjectiveTo study the curative effect of early intervention on selective head sub-hypothermia in full term infant with severe asphyxia.MethodsForty two full term infant with severe asphyxia were randomly divided into treatment(n =22) and control ( n =20) group,all patients were treated according to three supportive therapy and three heteropathy after resuscitation,and meanwhile the treament group combined with selective head sub-hypothermia.In the 2 groups,heart and breath oxygen saturation,blood sugar were measurded within 72 hours after treatment,and the Chinese 20-item neonate nerve behaviors were evaluated 28 days after birth.Test were conducted with the Bayley infant development scale in 2 months after birth.ResultsAfter 72 hours of treatment,the heart rate of treatment group reduced and showed significant difference from that of contol group and restored to normal.There were no significant differences in breath,blood pressure(BP),degree of blood ozygen saturation,blood sugar between the 2 groups.After 28 days of birth,scores of neonate nerve behaviors were ( 37 ± 3) in treatment group and (31 ± 3) in control group,respectively ;which showed significant difference ( P ＜ 0.01 ).In the 2nd months of birth,scores of Bayley infant development scale were (91 ± 3 ) in treatment group and ( 86 ± 4 ) in control group,respectively,which showed significant difference(P ＜ 0.05 ).ConclusionSelective head sub-hypothermia was convenient and safe,and had reliable curative effect by relieving or prenventing sequel and raising quality of life.
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Asymmetric dimethylarginine(ADMA) is an endogenous inhibitor of nitric oxide synthases(NOS),which is a risk marker of cardiovascular endothelial dysfunction.Recent studies found that ADMA was a predictor not only for acute cardiovascular disease,but also for critical illness and mortality.Studies have found that exogenous ADMA altered lung function and induced apoptosis in animal experiments and vitro experiments.The levels of plasma ADMA significantly increased in children with hypoxia,PPHN,brain damage,and preterm infants who required mechanical ventilation.ADMA could be a independent risk factor to predict neonatal complications and death.
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Objective To explore the protective ventilation strategies in hyaline membmne disease(HMD) of neonates,in order to decrease the incidence of ventilator-associated lung injury(VAU).Methods 68 newborn infants,diagnosed as of neonatal hyaline membrane disease and needed ventilator support,were recruited from the neonatal intensive care unit from 2003 to 2005.Infant with HMD were divided into the conventional ventilation practice group (the control group) and protective ventilation strategies group (the experimental group).The ventilator settinns,artery blood gas analysis,ventilator-associated lung injury and other clinical data were analyzed and compared.Results The incidence of ventilator-associated lung injury in the experimental group wag significantly lower than that in the cntrol group(2.94% VS 17.6%,P＜0.05).PaCO2 in experimental group was significantly higher than that in control group.The mortality in the experimental group was significantly lower than that in control group.Condusion The protective ventilation strategies can decrease the incidence of ventilator-associated lung injury in neonatal HMD.the protective ventilation strategies can decrease the mortality in neonatal HMD.
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Objective To investigate methods for prenatal molecular diagnosis of fetuses at high risk for X-linked adrenoleukodystrophy(X-ALD).Methods The amniotic fluid was obtained and genomic DNA was isolated from amniotic fluid cells.Maternal contamination was evaluated by paternity test.PCRRFLP,sequencing and denaturing high performance liquid chromatography(DHPLC)were used to detect the ABCD1 gene of fetal genome.Results In the pedigree 1,the PCR product(799 bp)of the fetus 1 and her father(normal control)could be digested with BcnI. No P560L mutation,which was present in the index patient,was detected in the ABCD1 gene from the genomic DNA of the fetus 1 using direct sequencing.In the pedigree 2,the PCR product(232 bp)of the fetus 2 and her father could not be digested with MaeI and no Q177X mutation,which was present in the propositus,was detected in the ABCD1 gene from the genomic DNA of the fetus 2 using direct sequencing.In the pedigree 3,the PCR product(271 bp)was digested with AciI.the pattern of the fetus 3 and the propositus being the same,and the R617C mutation was found in the ABCD1 gene from the genomic DNA of the fetus 3 using direct sequencing.In the pedigree 4,the PCR product(269 bp)was analyzed with the DHPLC,and the pattern of elution peaks of the fetus 4 and her father was similar,but different from that of the propositus.No K276E mutation was detectable in the ABCD1 gene from the genomic DNA of the fetus 4 by using direct sequencing.Judging from the sex of the fetuses,fetuses 1 and 2 were normal homozygotes,fetus 3 was an ALD hemizygote,and fetus 4 was a normal hemizygote.Conclusion A new protocol for X-ALD prenatal molecular diagnosis is proposed,which would ensure the accuracy of prenatal diagnosis.
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Objective To observe the changes in inflammatory mediators in plasma in respiratory distress syndrome(RDS) of neonates received lung protective ventilation treatment. Methods Sixty newborn infants,diagnosed as RDS of neonatal and needed ventilator support, were recruited from the intensive care unit from May 2003 to May 2006. Infant with RDS were randomly divided into two groups. Both had 30 newborn infants. The infants in the experimental groups received lung protective ventilation treatment tidal volume:5-8 ml/kg,positive end-expiratory pressure (PEEP):0.51~0.98 kPa, and the control groups received large tidal volume ventilation (tidal volume:10-15 ml/kg,PEEP:0-0.29 kPa). The contents of TNF-?, interleukin-6 in plasma were measured. Results After those two therapies, the contents of tumor necrosis factor-?(TNF-?), interleukin-6 in plasma decreased obviously, especially after receiving lung protective ventilation treatment. Conclusions There are statistical differences in the amount of inflammatory mediators released between the experimental group under lung protective ventilation treatment and the control group received large tidal volume ventilation,and better effects are seen in RDS infants under lung protective ventilation treatment .
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Objective To study the value of hysteroscopy in the diagnosis and treatment of infertility caused by intrauterine lesions. Methods Hysteroscopic examinations and operations were performed in 82 cases of infertility caused by intrauterine lesions. Results No abnormal findings were found in 4 cases,while the other 78 cases of intrauterine abnormity comprised 23 cases of endometrial polyp, 29 cases of adhesive uteritis,18 cases of submucous myoma or adenomyosis, and 6 cases of uterine deformity. After hysteroscopic surgery and related treatment, the postoperative pregnancy rate reached 62 32% (43 of 69). Conclusions Hysteroscopy may be effectively used in the diagnosis and treatment of infertility caused by intrauterine factors.
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Objective To compare the efficacy of surgically managing stress urinary incontinence (SUI) with tension free vaginal tape(TVT)and autologous fascia lata pubovaginal sling(Lata) Methods Sixty seven patients suffering from SUI entered this prospective study The patients were divided into two groups randomly, 48 in TVT group and 19 in Lata group The average follow up time post operation was 20 months in TVT group and 37 months in Lata group Results The operating time was(27?5)min in TVT and (125?13)min in Lata The volume of blood loss during surgery was:(27?6)ml in TVT and (67?11)ml in Lata The post operative recovery period in the hospital was: TVT, 1 8 days and Lata, 7 2 days The differences between the two groups for these three parameters were statistically significant( P