A preliminary study on the outcome of lower-risk myelodysplastic syndrome by low-dose decitabine / 中华血液学杂志

Objective@#To assess the efficiency and safety of low-dose decitabine in patients with lower-risk myelodysplastic syndrome (MDS) to couple with the clinical significance of MDS-related gene mutations.@*Methods@#This study was done in 4 institutions in Zhejiang Province. A total of 62 newly diagnosed patients with lower-risk MDS were assigned to two groups of decitabine (12 mg·m-2·d-1 for 5 consecutive days) and best supportive care (BSC) . Their bone marrow samples were subject to examinations of MDS-related 15 gene mutations. The primary endpoints were the proportion of patients who achieved overall response (ORR) after at least two cycles and progression-free survival (PFS) , and their relevances to the gene mutations.@*Results@#Of 62 enrolled patients, and 51 cases were included in the final analysis. 16 of 24 patients (66.7%) in decitabine group achieved ORR versus 8 of 27 (29.6%) in BSC group (χ2=6.996, P=0.008) ; PFS prolongation of decitabine versus BSC was statistically significant (not reached vs 13.7 months, P=0.037) . Among 51 patients, at least one gene mutation was identified in 20 patients (39.2%) , including 4 single SF3B1 mutation. PFS in cases with gene mutations (not including single SF3B1 mutation) was significantly shorter than of no gene mutation (9.2 months vs 18.5 months, P=0.008) , but not for ORR (37.5% vs 58.1%, P=0.181) . Among 16 patients with mutated genes, ORR in decitabine and BSC groups were 75% (6/8) and 0 (0/8) , respectively. The most adverse events in decitabine group were grade 3 to 4 neutropenia (45.8%) and grade 3 to 4 infections (33.3%) .@*Conclusion@#This preliminary study showed that low-dose decitabine produced promising results with an acceptable safety in lower-risk MDS patients, especially for those with mutated genes. Further study targeting poor prognostic lower-risk MDS patients should be warranted.

Relationship between Neonatal Umbilical Cord Blood Irisin Level and Birth Weight and Intrauterine Growth Restriction / 医学研究杂志

Objective SGA and IURG fetuses are important risk factors for metabolic disease in adulthood,but the mechanism is not clear.In this study,Irisin levels in umbilical cord blood of different birth weight and IURG neonates were measured and the relationship between Irisin and neonatal weight,gestational age and other factors was explored.Methods This study was conducted in the cross-sectional study of neonates born in our hospital from 2014 to 2016.Newborns were divided into small-for-gestational age (SGA),greater-than-gestational age (LGA),gestational age (AGA) and newborns with intrauterine growth restriction (IUGR).The levels of irisin in umbilical cord blood of 4 newborns were detected.Results In this study,there were a total of 110 cases of newborns.The mean gestational age and mean birth weight of newborns in the SGA group was lower than that in the other three groups(P =0.000).The mean Irisin levels in the SGA and IUGR groups [54.4(45.6-66.7) ng/ml,53.7 (40.3-62.4) ng/ml] were significantly lower than those in the AGA group [67.7 (53.8-78.1) ng/ml,64.7 (53.6-71.2) ng/ml] (P =0.000).The mean insulin levels in the LGA group [7.54(0.83-58.96)mIU/ml] were significantly higher than those in the AGA group [38.00(34.40-39.30)mIU/ml] and IU-GR [3.86(0.49-16.15)] and SGA [4.19 (0.62-14.42)mIU/ml] (P =0.000).In the present study,the correlation analysis showed that Irisin level in neonatal umbilical cord blood was significantly correlated with neonatal gestational age (r =0.22,P ＜ 0.01),fetal weight (r =0.17,P ＜0.01) and maternal age (r =-0.12,P =0.021).However,only in the LGA group,the level of Irisin in cord blood of neonates was positively correlated with insulin level (r =0.41,P =0.042).Multivariate linear regression analysis revealed that SGA (β =-0.14,P =0.02) and fetal weight (β =0.05,P =0.008) were independent risk factors for neonatal umbilical cord blood Irisin levels.Conclusion There was a positive correlation between irisin level and neonatal umbilical cord blood birth weight.The levels of irisin in the neonates of the SGA and IURG groups were significantly lower than those of the AGA and LGA groups,but irisin levels did not differ between the SGA and IURG groups and between AGA and LGA groups.And irisin levels in the LGA group were positively correlated with insulin levels.Our results also reveal that singleton infants of mothers with preeclampsia had lower cord blood irisin levels compared to infants of mothers without preeclampsia.

Qualitative study on the experience and needs of caregivers of patients with hematopoietic stem cell transplantation / 中国实用护理杂志

Objective To investigate the experience and needs of caregivers of patients with hematopoietic stem cell transplantion (HSCT) , in order to provide the basis for targeted intervention. Methods Using qualitative phenomenological research methods, semi- structured interviews of 10 caregivers of HSCT patients were conducted, then the data were summarized and analyzed. Results Four themes were extracted: heavy caregiving burden, adaptation to the caregiving role, professional support needs, humanistic care needs. Conclusions The medical staff should strengthen the health education on HSCT caregivers to improve their ability and their own health concerns, alleviate their psychological pressure, and mobilize social forces to reduce the burden of care.

Analysis for the effect of different regimens on ocular myasthenia gravis in children / 中南大学学报(医学版)

Objective:To evaluate the efficacy,recurrent risk factors and transferable ratio of treatments with 3 different regiments on children with systematic myasthenia gravis (MG).Methods:The data of 104 children with ocular MG from June 2010 to March 2014 were collected from Department of Pediatric Neurology of Xiangya Hospital and they were retrospectively studied.The patients were divided into 3 groups:a methylprednisolone group (n=44),a prednisone group (n=48) and a bromine pyridostigmine group (n=12).Evaluative system from American MG foundation was used to evaluate the efficacy of treatment and the ratio of ocular MG transformed into systematic MG.Results:The efficacy in the methylprednisolone group was better than that in the prednisone group,and both of them were better than that in the bromine pyridostigmine group (both P＜0.05).Methylprednisolone,prednisone combined with bromine pyridostigmine could reach a better long-term efficacy in children with ocular MG.Early treatment with glucocorticoid could reduce clinical relapse.Conclusion:A treatment with high-dose methylprednisolone pulse can improve early clinical remission in children with ocular MG.However,there is a similar efficacy in the long run of different glucocorticoid therapeutic regiments.A relatively order onset age,infection and thyroid dysfunction are recurrent risk factors in children with ocular MG.

Research progress of relationship between female infertility and Human papillomavirus / 中国医师杂志

Human papillomavirus (HPV) is one of the most common infection of the virus in the reproductive tract,a growing number of studies found that HPV infection is closely related to female infertility.This paper mainly introduces the structure characteristics of HPV,the correlation of reproductive tract infection of HPV and infertility,the related factors of infertility by reproductive tract infection of HPV,the influence of early pregnancy and adverse pregnancy outcomes,the relationship with assisted reproductive technology,etc.

Vaginitis in pregnancy is related to adverse perinatal outcome

Objective: To determine whether education level and occupation are risk factors of vaginitis in pregnant women and to investigate relationship between vaginitis occurrence during pregnancy and perinatal mortality rates. Methods: A total of 319 women of early pregnancy or mid-pregnancy were enrolled. Six specimens were collected from posterior fornix of each pregnant woman and then cultured for identification of Neisseria gonorrhoeae, intestinal bacteria, general bacteria, fungi, mycoplasma, and chlamydia, respectively. Results: The pregnant women in the "elementary school or below" group and the "middle school" group had significantly higher incidences of vaginitis compared with the pregnant women in the groups of "high school", "skill education", and "college or above". The pregnant women in the groups of "Worker", "Government employee", "Company employee", and "Professionals" had significantly lower vaginitis incidences. The women with infections of Neisseria gonorrhoeae, intestinal bacteria, and general bacteria had higher perinatal mortalities [0.063 +/- 0.011, 0.052 +/- 0.012, and 0.017 +/- 0.008, respectively] than women with infections of fungi, mycoplasma, and Chlamydia [0.002 +/- 0.007, 0.003 +/- 0.004, and 0.001 +/- 0.001, respectively]. Conclusions: Education level and occupation are risk factors related to incidences of vaginitis in pregnant women. The bacteria-related vaginitis is a major reason of perinatal mortality

Analysis of the karyotype abnormalities and its prognostic in 298 patients with myelodysplastic syndrome / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between cytogenetic markers with World Health Organization (WHO) classification, disease progress and prognosis in cases with primary myelodysplastic syndromes (MDS).</p><p><b>METHODS</b>298 patients with de novo MDS from the first affiliated hospital of medical school, Zhejiang University were enrolled in the retrospective analysis of WHO classification, karyotype, and prognosis. Follow-up study was also conducted.</p><p><b>RESULTS</b>The WHO classifications at first diagnosis were as follows: refractory cytopenia with unilineage dysplasia (RCUD), 18 cases; refractory anemia with ring sideroblasts (RARS), 8 cases; refractory cytopenia with multiline dysplasia (RCMD), 104 cases; refractory anemia with excess blasts-1, 76 cases; refractory anemia with excess blasts-2, 85 cases; MDS unclassified (MDS-U), 5 cases involved; and single del (5q), 2 cases. 39.6% of MDS patients carried karyotypic abnormalities. Among them, the frequency of numerical abnormalities, structural abnormalities and the existence of composite abnormalities were 45, 31, and 42, respectively. The composite abnormalities were unbalanced translocations and complex chromosomal abnormalities. The incidence of both karyotypic abnormalities and complex chromosomal abnormalities in RAEB group was higher than that in non-RAEB group (P<0. 05). An analysis based on IPSS-R Scoring System showed that advanced risk stratification (except the low-risk group) gradually enhanced the incidence of karyotypic abnormalities (P<0.05). In addition, the probability of evolution to leukemia increased with the higher IPSS-R score (P<0.05). In RAEB group, the cases with +8 chromosome, accounting for 19.5% of karyotypic abnormalities, had worse prognosis than those with normal chromosomes.</p><p><b>CONCLUSION</b>Karyotype was identified with an independent risk factor in MDS patients. Therefore, the information on cytogenetic analysis was critical for diagnosis, prognosis and individual treatment. MDS patients presenting+8 chromosome, an intermediate risk factor, were associated with a poorer outcome compared to cases with normal chromosomes in RAEB group.</p>

Effects of parent-adolescent conflict and cohesion on relational aggression among junior students / 中华行为医学与脑科学杂志

Objective To explore the effects of parent-adolescent conflict and cohesion on relational aggression among junior students.Methods Parent-adolescent Conflict Questionnaires,Parent-adolescent Cohesion Questionnaires,and the Relational Aggression Questionnaires were used in investigating 392 junior students.Results The level of relational aggression of junior students was low (22.52±5.15).There was no differences between relational aggression of male students (22.93± 5.43) and female students (22.00± 4.73) (P＞ 0.05),and of grade 1 students(22.72±5.14)and grade 2 students(22.64±5.67),grade 3 students(21.93±4.22) (P＞0.05).The students' relational aggression showed a significantly positive correlation with frequency and intensity of parent-adolescent conflict(r=0.269,r=0.307,r=0.268,r=0.271,P＜0.01),and negative correlation with father-adolescent cohesion(r=-0.171,P＜0.01).Parent-adolescent cohesion was negative predictor of relational aggression(β=-0.123,P＜0.05),and the intensity of parent-adolescent conflict was positive predictor(β=0.301,P＜0.01).Conclusion Parent-adolescent conflict and cohesion have significant effect on relational aggression among junior students.

Influence of esmolol on plasma NT-proBNP, heart-type fatty acid binding protein and cardiac function in acute cerebral infarction patients with myocardial enzyme abnormalities / 中国生化药物杂志

Objective To analyse the influence of esmolol on plasma N terminal pro-brain natriuretic peptide ( NT-proBNP) , heart-type fatty acid binding protein ( H-FABP) and cardiac function in acute cerebral infarction patients with myocardial enzyme abnormalities.Methods 86 acute cerebral infarction patients with myocardial enzyme abnormalities from September 2010 to July 2014 in our hospital were selected and divided into experimental group and control group randomly (43 cases in each group).All patients were accompanied by myocardial enzyme abnormalities, patients in control group were given basic treatment, while patients in experimental group were given esmolol hydrochloride intravenous injection on the basis of control group.Plasma NT-proBNP, H-FABP levels and cardiac function were analyzed in two groups.Results Myocardial enzyme levels had no significant difference between two groups on admission.Plasma NT-proBNP levels also had no statistical differences after admission hospital of 6 h, 15 h and 3 d , and experimental group was significantly lower than control group ( P<0.05 ) after admission hospital of 5 day and 7 days.H-FABP levels had no statistical differences after admission hospital of 6 h, 15 h, and the experimental group was significantly lower than the control group (P<0.05) after admission hospital of 3, 5, 7 days.Cardiac function with Killip classification showed no significant difference when on admission and after admission hospital of 3 days, and the experimental group was significantly better than control group (P<0.05) after admission hospital of 5, 7 days.Conclusion Acute cerebral infarction patients with myocardial enzyme abnormalities given esmolol on the basic treatments significantly reduce NT-proBNP and HAFBP levels, and improve cardiac function, which is worthy of promotion in clinical applications.

Early clinical characteristics and follow-up treatment of alternating hemiplegia in children / 中华神经医学杂志

Objective To discuss the clinical features and prognosis of patients with childhood alternating hemiplegia (AHC).Methods The clinical presentation and follow up data of 9 patients diagnosed as AHC in our hospital from January 2010 and June 2014.Results Onset appeared within 18 months of born in these 9 patients;no migraine family history, repeated and alternated limbs dyskinesia, varying degrees of delayed psychomotor development, and with/without abnormal eye movements were noted in these patients.No specific auxiliary examination results were noted.All the patients were treated in our hospital with flunarizine (2.5-5 mg per time for one time every night), and among them, one also treated with topiramate.Two patients were lost to follow-up.One patient had fluctuated condition after taking drugs: the frequency of attack declined one month after drug taking, but then, rebounded gradually.One had frequency of attack declining to three times a month from four times a month.Two added the dose offlunarizine to 10 mg, leading to the obvious decline of both frequency and duration.Three had no release.Conclusion It is hoped to improve patients' life quality and prognosis by recognizing AHC early, insistting long-term pharmacotherapy and avoiding the inducing factors.

Effect of itermittent subglottic secretions drainage on management of artificial airway to prevent tube-related pulmonary pneumonia / 现代临床护理

Objective To estimate the effect of itermittent subglottic secretions drainage(ISSD)on management of artificial airway to prevent tube-related pulmonary pneumonia.Methods One hundred ICU patients with intubation for artificial airway were divided equally into control and experiment group by random digits table.Both were managed with construction of artificial airway and besides the experiment group received ISSD. The two groups were compared in terms of incidence and occurrence time of catheter-related pneumonia, time for airway opening and ICU stay.Result The incidence and the occurrence time of pneumonia, time for airway opening and ICU stay time in the experiment group were significantly lower or shorter than those in the control group with statistical difference(all P<0.05).Conclusion ISSD is effective in decreasing the incidence of catheter related pneumonia, shortening the occurrence time of catheter related pneumonia and ICU stay time for the patients with artificial airway.

Transcranial doppler in carotid endarterectomy / 中华神经医学杂志

Objective To explore the application value oftranscranial doppler (TCD) in carotid endarterectomy (CEA) through monitoring the hemodynamic changes of intracranial arteries during the perioperative period.Methods Eighty-two patients with internal carotid artery stenosis (ICAS),admitted to our hospital from January 2012-January 2013,were chosen in our study.Preoperative,intraoperative and postoperative TCD evaluations on these patients accepted CEA were performed; degrees of artery stenosis and fluency of lateral branch of the patients before CEA were evaluated; microembolic signals (MESs) and hemodynamics of the middle cerebral artery (MCA) in the surgery side were monitored during the perioperative period; the MCA velocity (VMCA) and the states of collateral circulation were observed after CEA.Results All 82 patients showed severe ICAS,low blood VMCA and low pulsatility index of MCA; anterior and posterior communicating branch did not exist in 6 patients; the other 76 patients showed different status of communicating artery.MESs were captured immediately after opening the clamp of common carotid artery (CCA) in 31 patients; when the ipsilateral CCA was clamped,2 patients showed a rapidly decreased VMCA to 0 cm/s,and a vascular shunt was used to ensure the brain blood supply.About 93.9％ patients presented an increase in the blood velocity and pulsatility index ofipsilateral MCA,together with a subsequent close of collateral circulation; over 1.5 times increase of VMCA was observed in about 24.7％ patients.Acute cerebral infarction in one patient occurred on the same day of CEA.Conclusions TCD could assess the hemodynamics of the contralateral MCA and the closure of collateral communication,thus,helping us predict the hyperperfusion and analyze the pathogenesis of cerebral infarction during perioperative CEA.

Relationship between thyroid hormones and renal function after kidney transplantation / 中华器官移植杂志

Objective Monitoring the thyroid hormone levels in patients before and after renal transplantation to realize the relationship between thyroid hormones and renal function.Methods Fifty-seven patients were subdivided into stabled graft function group (50 cases) and delayed graft function (DGF) group (7 cases).Thirty healthy men served as control group.Serum triiodothyronine (T3),thyroxine (T4),thyroid-stimulating hormone (TSH) and serum creatinine (Scr) were determined respectably before transplantation and on different days after transplantation.Correlations between thyroid hormones and Scr at 10th day after transplantation were analyzed.Results Serum T3 and T4 levels before transplantation in the two groups were significantly lower than those in the control group (P＜0.01).These four parameters levels had no significant difference between stabled graft function group and DGF group (P＞0.05).In stabled graft function group:T3 level was decreased obviously by 30％ in the 1st day after transplantation,which was higher than the others,elevated at the 1st week post-transplantation,reached the normal range.at the 2nd week post-operation,and higher than pre-transplantation (P ＜ 0.01) at 3rd week; T4 revealed a decrease trend after transplantation and was elevated at 10th day post-transplantation,returned to the pre-transplantation level at 3rd week; TSH had slight decrease after operation,and had no significant difference among every period in comparing with pre-transplantation; Scr revealed a decrease trend continuously and returned to the normal level at the 7th day post-transplantation.In DGF group,Hormones levels were obviously decreased as compared with stabled graft function group; T3 reached the normal range at the 3rd week post-transplantation,whereas T4 returned to pre-transplantation levels at the 30th day; TSH had a significant decrease at the 5th day,and began to increase at the 10th day post-operation; Scr retuned to the normal range at the 30th day post-operation.The correlation coefficients between Scr and T3,T4 were 0.546 and 0.423 respectively.Conclusion There is a significant correlation between thyroid hormones and renal function (T3,T4).Monitoring the thyroid hormones,specially T3,can diagnose renal function change.

Investigation and reflection on giving extracurriulm lecture of physiology among medical students / 中华医学教育探索杂志

Objective To explore the teaching effects of physiology lectures and students' attitude to lectures,their suggestions for contents,forms and other aspects of lectures.Methods Random sampling questionnaire survey was conducted among 500 students of 2008 grade and 2009 grade in Xiangya medical school of central south university.The percentage of the option in the questionnaire was calculated and the findings were directly described.Results All students thought that physiology lectures were necessary.Teachers should arrange lectures which students were interested in,pay attention to inspire thinking and enhance teacher-student interaction.67.6％ of students thought that the knowledge learned from lectures can be used in expanding scientific thinking.Conclusions The lectures are popular among most students,playing an important role in cultivating students' ability of strict scientific thinking.

Screening significance of transcranial Doppler for patients with patent foramen ovale induced cerebral embolism / 中国医师进修杂志

Objective To investigate the screening significance of transcranial Doppler (TCD) for patients with patent foramen ovale ( PFO) induced cerebral embolism and to improve the treatment aiming at the causes.Methods Thirty-six patients of less than 60 years old with unknown-cause cerebral embolism and transient ischemic attack were enrolled.Besides conventional examination,the 24 h Holter,transthoracic echocariiography,carotid artery Doppler ultrasonography (CAU),routine TCD,TCD foaming test,transesophageal echocardiography (TEE),CT angiography (CTA) of head and neck,ultrasonography of vein in bilateral lower limbs were examined in all patients.Results All the patients showed no atrial fibrillation.No structural heart disease and intracardiac occupying lesion were shown in transthoracic echocardiography.No carotid stenosis was shown in carotid artery Doppler ultrasonography.Routine TCD showed no intracranial artery stenosis.No thrombus was found in ultrasonography of deep veins in bilateral lower limbs.CTA of head and neck showed everything was normal.Fourteen patients were observed with right-to-left shunt in heart by TCD foaming test,including 10 cases with microbubble signals(MBS) in 10 s,and 4 cases with MBS after Valsalva maneuver.Among 14 patients,12 patients were proved PFO by TEE.Conclusions PFO is one of the causes of cardiogenic cerebral embolism.TCD is accurate and reliable for the screening of PFO.