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Objective To study the impact of peripheral blood absolute lymphocyte count ( ALC) on survival in adult patients with acute lymphoblastic leukemia ( ALL ) at the end of induction chemotherapy. Methods 122 adult patients with ALL from January 2011 to December 2017 in the Second Hospital of Shanxi Medical University were retrospectively analyzed. The impact of ALC at the end of induction and ALC ratios for relapse-free( RFS) and overall survival ( OS ) of adult ALL were analyzed. Results The study cohort was divided into the two groups according ALC-28 values ( <675cells/μL and ≥675cells/μL). The median RFS (8 months vs 12 months,P=0. 001),median OS (16 months vs 23 months,P=0. 010) between the two groups had statistically significant differ-ences. ALC-28/ALC-1 was bordered by 43％. The RFS and OS in the low ratio group were significantly shorter than those in the high ratio group (P<0. 05). ALC-28/ALC-8 was compared with 86％ cut-off. Longer RFS and OS in the higher ALC-28/ALC-8 group (all P<0. 05). Low ALC-28 was independent risk factor for RFS. Low ALC-28,and low ALC-28/ALC-1 were independent risk factors of OS. Conclusion ALC at the end of induction and ALC ratios are associated with RFS and OS of adult ALL. Higher the value,the longer the survival time.
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The prognosis of acute lymphoblastic leukemia (ALL) is affected by multiple factors.As a simple and inexpensive prognostic indicator,the peripheral blood absolute lymphocyte count (ALC) is more and more concerned.Relevant studies show that ALC values of different time points during induction therapy and its ratio show important value in the assessment of ALL prognosis,which is expected to provide a basis for subsequent individualized treatment.
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FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) mutation is a commonly found type of mutation in acute myeloid leukemia (AML), and this mutation is closely related to the development of AML and affects the prognosis of patients. FLT3-ITD-positive AML patients have poor prognosis and high relapse rate after treated with chemotherapy alone. The efficacy of allogeneic hematopoietic stem cell transplantation for this disease is controversial. Targeted therapies such as sorafenib and the combination of different type of therapies have been carried out and have shown preliminary effect in preclinical or clinical trials. In this paper, the clinical effect of FLT3-ITD in AML patients and the latest progress of its treatment were reviewed.
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Objective To observe the clinical efficacy of breeze heat treatment with site blood circulation for abdominal purpura allergic acupoint application therapy. Methods 96 patients were randomly divided into treatment and control group ,with 48 people in each. Both groups received traditional Chinese medicine with conventional therapy. Control group was given oral medicine treatment and acupoint application while the treatment group was given enema treatment. Clinical parameters observed includes degree of symptoms released ,the number of days in hospital and laboratory test results. Results The number of days in treatment group and hospital stay significantly decreased compared with control group (P<0.05). In terms of laboratory tests,the degree of improve?ment of the treatment group than the control group was statistically significant (P<0.05). Conclusions Treatment of dispersing heat blood circulation acupoint sticking with the treatment for abdominal type allergic purpura can sig?nificantly improve symptoms and laboratory tests ,with no obvious adverse reactions.
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Objective To observe the efficacy and safety of the etomidate target controlled in-fusion (TCI)in the total thoracoscopic mitral valve replacement surgery.Methods One hundred and ten patients,aged 29-55 years,48 males and 62 females with ASA grade Ⅱ or Ⅲ rheumatic mitral valve disease planned to be corrected with total thoracoscopic mitral valve replacement surgery were randomly divided into group E and group P,55 cases in each group.In group E,etomidate-sufentanil target controlled infusion was used for induction (the initiate plasma concentration of etomidate was 0.2 ng/ml and increased 0.1 ng/ml per minute according to the bispectral index and the effect-site concentration of sufentanil was maintained at 1.0 ng/ml)and maintenance.In group P,using propo-fol-sufentanil target controlled infusion for induction (the initiate plasma concentration of propofol was 1.0 ng/ml and increased 0.3 ng/ml per minute according to the bispectral index and the effect-site concentration of sufentanil was maintained at 1.0 ng/ml)and maintenance.We documented the incidence of hypotension during the induction phase, recorded the basic clinical parameters of patients,the dosage of vasopressors during induction and sufentanil during anesthesia,time of eyelash reflex absence,operation time,CPB time,clamping time,APACHE Ⅱ score when enter CCU,pos-itive inotropic score 24 h postoperatively,wakening time,mechanical ventilation time,CCU stay,in-hospital stay,blood glucose and lactic acid preoperatively,2,6,24 h postoperatively,cortisol,aldo-sterone and adrenocorticotropin preoperatively and 24 h postoperatively and postoperative complications in both groups.Results The incidence of hypotension during induction in group E was much lower than that in group P (P<0.05).The dosage of norepinephrine during the induction in group E were much less than group P (P <0.05).The wakening time,mechanical ventilation time,CCU stay and in-hospital stay in group E were significantly shorter than group P (P <0.05).The blood glucose and lactic acid at postoperative 2,6,24 h were much higher than the preoperative value within each group (P <0.05).They reached the maxim at 6 h postoperatively and began to decline at 24 h postoperatively. Blood glucose and lactic acid at all the time points between two groups were similar.Cortisol at 24 h postoperatively was much higher than the preoperative value in group P (P <0.05).The dosage of cortisol and aldosterone 24 h postoperatively in group E were much less than that in group P (P <0.05).The incidence of postoperative lung infection in hospital in group E was remarkably lower than that in group P (P <0.05).Conclusion Etomidate target controlled infusion can maintain stable he-modynamics during the induction period, shorten postoperative recovery time and reduce postoperative lung infection obviously,which can be safely used in total thoracoscopic mitral valve re-placement surgery.
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Objective To explore the relationship between T-cell acute lymphoblastic leukemia and the Notch signaling pathway.Methods Human T-cell acute lymphoblastic leukemia SupT1 cells were infected with the lentiviral vector made up specific Notch1-shRNA gene and nonspecific Notch1-shRNA gene.The inhibitive rate of SupT1 cells was detected by CCK-8.The rates of early apoptotic cells (Annexin V+/ 7-AAD-) and late apoptotic cells (Annexin V+/7-AAD+) were analyzed by flow cytometry and the expression levels of Notch1 receptor gene and downstream target genes were assessed by quantitative reverse transcription and polymerase chain reaction (QT-PCR).Results The cell inhibition rates of Notch1 interference group,control group and empty vector group at 96 h were 0.902±0.013,0,and 0.486±0.084,respectively,and it was increased obviously in Notch1 interference group (both P ＜ 0.05).The cell early apoptosis rates of the three groups were (15.27±0.31) ％,(5.57±0.25) ％,(5.80±0.20) ％,respectively.The cell early apoptosis rate of Notch1 interference group was increased obviously compared with the control group and empty vector group (both P ＜ 0.05).While the cell late apoptosis rates had no significant difference among the three groups (P ＞ 0.05).The mRNA expression levels of Notch1 receptor gene and its target genes (Hesl,c-myc,NF-κB) at 48 h,72 h and 96 h were higher than those in the control group and empty vector group (all P ＜ 0.05).Conclusions The specificity of Notch1-shRNA can effectively decrease the Notch1 mRNA expression,and reduce the expression level of downstream target genes.Notch1 cut can inhibit the proliferation of SupT1 cells,and promote the early apoptosis.
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Objective To detect the proliferation and the expression levels of downstream target genes of Notch pathway of T-ALL CCRF-CEM(CEM)cell line treated with exogenous DLK1 protein,in order to investigatethe effects of DLK1 protein on the Notch pathway in CEM cells.Methods CCK-8 assay was performed to examine the proliferation of CCRF-CEM cells,which were treated with various concentration(0.5,1.0,1.5 μg/ml)DLK1 for various time(24,48,72 h).RFQ-PCR was applied to assess the mRNA expression level of Notch1 receptor and downstream target genes of Notch pathway in CEM cells,which were treated for various time(24,48,72 h).Results DLK1 protein stimulated the proliferation of CCRF-CEM cells,and the proliferation rates with different concentrations of DLK1 were 0.14±0.03,0.17±0.04,0.55±0.01 in 72 hours,respectively,there were statistic differences between that in the experimental group and that in the control group(P＜0.05).DLK1 protein up-regulated the Notch1 receptor and its downstream target genes HES1,c-myc and NF-κB.The relative transcript levels of target genes HES1 in 72 hours,c-myc in 48 hours and NF-κB in 72 hours were 3.2551±0.3100,1.6086±0.0941,2.0515±0.3453 respectively,and there were statistic differences between that in the experimental group and that in the control group(P＜0.05).Conclusion DLK1 protein stimulates the proliferation of T-ALL CCRF-CEM cells by up-regulating Notch1 receptor and downstream target genes HES1,c-myc and NF-κB of Notch pathway.
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Objective To explore the effect of ProSeal laryngeal mask airway and endotracheal tube on analepsia stage of general anesthesia in geriatric patients undergoing radical mastectomy.Methods Thirty geriatric females with breast cancer of American Standards Association (ASA)Ⅰ-Ⅱscheduled for selective radical mastectomy under general anesthesia were randomly allocated to two groups: ProSeal laryngeal mask airway group(PLMA group, n=15) and endotracheal tube group (ET group, n=15). The patients were put on PLMA or were intubated with ET under general anesthesia in the two groups, respectively. The heart rate (HR), systolic blood pressure(SBP)and diastolic blood pressure (DBP) were recorded at the time points of 5 min after entering operation room (T0), end of surgery (T1), opening eyes (T2), after extubation (PLMA) immediately (T3) and 3 min after extubation (PLMA) (T4). The numbers of patients who were given antihypertensive agent,showed bucking, agitation or sore throat, nausea and vomiting after extubation were recorded during the analepsia stage of general anesthesia. Results The blood pressure (BP) and HR were mildly.increased in PLMA group at T2, and there was no significant difference compared with T0(P＞0.05). But the BP and HR were significantly higher at T3 than at T0 (P＜0.05). In ET group, the BP and HR were both significantly elevated at T2 and T3 than at T0 (P＜0.05), and reached the peak at T3. The increased levels of BP and HR were significantly lower in PLMA group than in ET group at T2 and T3 (P＜0.05). The quantities of patients who were given antihypertensive agent, showed bucking and sore throat were less in PLMA group than in ET group(P＜0.05). No differences in incidence rate of agitation, nausea and vomiting after extubation between the two groups were observed(P＞0.05). Conclusions PLMA can obviously reduce the occurrence of complications in analepsia stage of general anesthesia in geriatric patients scheduled for selective radical mastectomy,and is beneficial to provide much safer anesthesia.
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Objective To investigate the role of Notch signaling pathway in cerebral ischemic tolenmce induced by clectroacupuncture (EA) preconditioning.Methods Fifty-two adult male SD rats weighing 280-320 g were randomly divided into 2 groups(n=each):control group(group C)and electroacupuncture preconditionig group(group EA).Group C received no treatment.Group EA received EA at the Baihui acupoint (GV20) for 30 min a day for 5 days.Twenty-four hours after the last preconditionig,focal cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) for 120 min,followed by 72 h of reperfusion.Notch intracellular domain(NICD)expression was determined by Western blot and expression of Notch1,Notch4,Jag1,and Hes1 mRNA by real-time PCR immediately before iachemia and 24 and 72 h of reperfusion.The neurological deficit was scored at 72 h of reperfusion.The infarct volumes were then determined after evaluation of the neurological deficit score .Results There was no significant difference in Hesl mRNA and NICD expression immediately before ischemia between group EA and C(P>O.05).NICD expression was up-regulated at 24 and 72 h of reperfusion in both groups, and Hesl mRNA expression at 72 h of reperfusion in group C and at 24 h of reperfusion in group EA was up-regulated compared with those immediately before ischemia (P < 0.05). Hes1 mRNA and NICD expression was up-regulated in group C, while down-regulated in group EA at 72 h of reperfusion compared with those at 24 h of reperfusion ( P < 0.05 ). Compared with group C, the expression of Notchl,Notch4 and Jag1 mRNA was up-regulated immediately before ischemia, and Hes1 mRNA and NICD expression was up-regulated at 24 h of reperfusion while down-regulated at 72 h of reperfusion in group EA( P < 0.05). EA preconditioning significantly reduced infarct volumes and increased neurological deficit scores at 72 h of reperfusion (P < 0.05 ). Conclusion Notch signaling pathway may participate in cerebral ischemic tolerance induced by EA preconditioning.
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Objective To investigate the effect of methylene blue(MB)on liver ischemia-reperfusion (I/R) injury in rabbits.Methods Twenty-four healthy New Zealand white rabbits of both sexes welshins 2.0-2.3 kg were randomly divided into 3 groups (n=8 each):group Ⅰ sham operation(group s);group Ⅱ I/R and group Ⅲ methylene blue (group MB).The animals were anesthetized with intravenous 2% pentobarbital 30 mg/kg.Liver I/R was produced by occlusion of hepatic blood flow for 40 min followed by 60 min repeffusion.In group MB methylene blue 5 mg/kg was injected iv at 20 min before liver ischemia.Femoral artery was carmulated for MAP monitoring and blood sampling.MAP and HR were recorded immediately before(T1,baseline)and at 20 and 40 min of ischemia (T2,3) and 1,5,30,60 min(T4-7)of repedusion.Blood samples were collected at T1,T5,T6 and T7 for measurement of seruln TNF-α and IL-6 concentrations.Plasma AST and ALT activities were measured at T1,T6 and T7.Liver specimens were obtained at the end of experiment for determination of SOD activity and MDA content.Results In group I/R MAP was significantly decreased at T4-7 during reperfusion and HR at T7 as compared with the baseline at T1;while in group MB no significant change in MAP and HR Was observed during ischemia and reperfusion as compared with the baseline.The gerum TNF-α and IL-6 concentrations and the plasma ALT and AST activities were significantly increased during reperfusion as compared with the baseline immediately before ischemia in group I/R and MB and were significantly lower in group MB than in group. I/R. The SOD activity was significantly higher while MDA content was significantly lower in group MB than in group I/R. Microscopic examination showed that liver damage was less severe in group MB than in group I/R. Conclusion The administration of MB can maintain hemodynamic stability and attenuate liver I/R injury in rabbits.
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Objective To assess the efficacy and safety of target-controlled infusion of propofol and remifentanil in geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation. Methods Thirty geriatric patients with primary hepatocellular carcinoma of ASA Ⅱ-Ⅲ scheduled for percutaneous radiofrequency ablation under monitored anesthesia care (MAC) were randomly allocated to two groups: target-controlled infusion of propofol and remifentanil group (PR group, n= 15) and intravenous injection of midazolam and fentanyl group (MF group. n= 15). The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) of patients were recorded during the treatment. The Ramsay Score, Patient Cooperation Score, VAS Score and postoperative Patient Satisfaction Score were recorded as well. Results The Ramsay Score, Patient Cooperation Score, VAS Score and Patient Satisfaction Score were all higher in PR group than in MF group (all P<0.05). The maximum values of MAP and HR [( 108.7± 8.6) mm Hg, (83.8±7.1) times/min] were significantly higher than the baseline values [( 99.3 ± 8.5) mm Hg, (76.3±7.1) times/min] in MF group, and the degree of increment of MAP and HR were significantly greater in MF group than in PR group (both P<0.05). The minimum values of MAP and HR [(84.5±6.5) mm Hg, (66.6 ± 6.6) times/min] were significantly lower than the baseline values [(97.7±6.5) mm Hg, (75.4±7.3) times/min] in PR group, and the degree of decrement of MAP and HR were significantly greater in PR group than in MF group (both P<0.05). SpO2 of both groups decreased significantly (the minimum values of PR and MF groups were 95.1±2.0 and 95.5± 2.2, respectively), but there was no statistical difference between two groups (P>0.05) . Conclusions MAC with target-controlled infusion of propofol and remifentanil is more suitable for geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation, as it can provide ideal analgesia and sedation, but the respiration and the change of hemodynamics of patients must be observed seriously.
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Objective To detect the ZAP-70 and CD38 expression in these patients with chronic B lymphocytic leukemia (B-CLL) and explore their relationship and clinical significance. Methods The expressions of ZAP-70 and CD38 in bone marrow or peripheral blood of 21 patients with B-CLL were detected by flow cytometry. Results ZAP-70 was positively expressed in 9 of all patients, CD38 was positive in 8 of all patients. ZAP-70 and CD38 were both expressed in 8 patients, ZAP-70 and CD38 were none expressed in 8 patients. Conclusion CD38 and ZAP-70 expression can offer important prognostic information. Cases of B-CLL positive for ZAP-70 and CD38 indicate a worse prognosis. There is a good correlation between these new prognostic factors.
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Objective To seek a scalp venipuneture method with high success rate and less pain for patients. Methods Taking the rapid parallel straight method as the control group, and the rapid vertical straight method as the experimental group, 400 patients were randomly divided into the control group and the experimental group with 200 patients in each group. The success rate of two groups were counted, pain scores were got by VAS visual imitation assessment and the results undergoing statistical analysis. Results The success rate was 91.5% in the control group, and 99.5% in the experimental group. Distinguished sig-nificance existed in VAS visual imitation score. Conclusions The rapid vertical straight method is supe-rior to rapid parallel straight method in scalp venipuncture.