Diagnostic significance of lymph node core needle biopsy for lymphoproliferative disease: a clinicopathologic study of 1 013 cases / 中华病理学杂志

Objective@#To study the clinicopathologic features of lymphoproliferative disease by lymph node core needle biopsy(CNB)and to evaluate the diagnostic significance of CNB for lymphoproliferative disease.@*Methods@#The annual distribution, entity constitute, clinical finding, gross feature, morphologic change, affiliate study and repeat biopsy diagnosis of 1 013 cases of lymph node CNB diagnosed at West China Hospital of Sichuan University from January 2009 to December 2015 were investigated.@*Results@#(1) Proportion of lymph node CNB in total amount of biopsy specimens increased from 0.2% in 2009 to 0.8% in 2015.(2) The study cohort included 471 lymphomas, 12 atypical lymphoid hyperplasia (ALH), 136 suspected lymphomas, 372 benign lesions, and 22 cases of descriptive diagnoses. The most common types were diffuse large B cell lymphoma and T-lymphoblastic lymphoma. (3) Majority of patients were adolescents and children younger than 20 years or the elderly older than 60 years. 53.1% CNB tumor specimen consisted of ≥4 tissue cores and 40.5% were >2 cm in length. (4) 104 CNB cases with previous history of excision biopsy was included 45 carcinomas(no metastatic carcinoma was found), 32 lymphomas for treatment observation.1/14 suspicious lymphomas, 1/1 ALH and 3/22 cases benign lesions were diagnosed as lymphoma by repeat biopsy respectively. (5) 217 CNB cases were diagnosed as lymphoma by subsequent CNB (70), or subsequent excision biopsy (147) including 78.5%(73/93) suspected lymphomas, 5/7 ALH and 32.3%(20/62)benign lesions.@*Conclusions@#Lymph node CNB has certain clinical indications, although limited for the diagnosis of lymphoproliferative disorders. Suspected lymphomas and ALH diagnosed by CNB should be followed by repeat tissue biopsy. For the benign lesions by CNB it does not rule out additional biopsy to further investigate the lesion.

Efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model / 中华心血管病杂志

Objective@#To explore the efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model.@*Methods@#This study was a prospective randomized controlled study, 80 patients from Beijing Electrical Power Hospital and Beijing Jingmei Group General Hospital with acute coronary syndrome were included from June to December 2015 and divided into 2 groups. Patients in rehabilitation group (n=52) received tertiary hospital(Peiking University Peoples′ Hospital) guided and community-driven family self-help cardiac rehabilitation for 3 months, and patients in control group (n=28) received routine secondary treatment for 3 months. Following parameters including 6 minutes walk distance, score of life quality (evaluated by Short Form-12), score of anxiety (evaluated by Generalized Anxiety Disorder-7), score of depression (evaluated by Perceived Health Questionnaire-9), self-management competency (evaluated by questionnaire) were collected at baseline and after treatment for 3 months.@*Results@#Compared with control group, 6 minutes walk distance was longer in rehabilitation group((60.2±6.8) meters vs. (24.9±10.5)meters, P<0.01). The difference values between after and before intervention of life quality scores((0.14±3.90)scores vs.(-7.44±5.85)scores, P>0.05), anxiety scores((-0.16±2.12 ) scores vs.(0.70±1.13)scores, P>0.05) and depression scores((-1.17±2.79) scores vs.(0.60±0.36)scores, P>0.05) were similar between the 2 groups. The amplification of patients with regular exercise (50.26% vs. 0, P<0.05), limit sugary foods usually and always (53.22% vs. 3.98%, P<0.05), eat 200-400 g fruits usually and always (78.61 % vs. 0, P<0.05), eat 300-500 g vegetables usually and always (9.74% vs. 0, P<0.05), and answering very confident to questions such as let the physicians know about your diseases (40.17% vs. 5.00%, P<0.05), know how to take medicines (44.52% vs. 5.00%, P<0.05), know how much exercise was right for yourself (26.43% vs.0, P<0.05) were significantly higher in rehabilitation group than in control group. There were no cardiac rehabilitation training related cardiovascular events.@*Conclusion@#Tertiary hospital guided and community-driven family self-help cardiac rehabilitation model is an effective and safe management model of cardiovascular disease in chronic phase, and it is necessary to further expand the study population to verify the efficacy of this model.

Survey on Drug Storage and Medication Habits of the Empty-nest Elderly from 2 New and Old Communities of Shanghai / 中国药房

OBJECTIVE:To provide reference for better carrying out safe medication intervention for the empty-nest elderly.METHODS:Two communities with different levels of income and culture were collected from Pudong New District of Shanghai,i.e.new community A and traditional community B.By cluster sampling,69 and 110 empty-nest elderly were selected as respondents respectively.The questionnaire survey about drug storage and medication habits of the elderly was conducted.The data of the survey were analyzed statistically.RESULTS:A total of 69 and 110 questionnaires were sent out,and 44 and 63 questionnaires were recovered with effective recovery rate of 63.8％ and 57.3％,respectively.The rate of drug storage in families from traditional community B was higher than new community A (100％ vs.88.6％,P=0.010).The proportions of residents in two communities storing their drugs in special drawers were the highest (59.0％ and 57.1％).Nearly half of the surveyed households in 2 communities did not form the habit of regularly clearing stored drugs.The frequency of residents who cleared stored drugs in traditional community B was higher than those in new community A (P=0.009).Nearly more than 70％ of the residents threw their expired drugs to garbage and only 11％ to drug stores or community health service center.The proportion of residents who were used to reading drug instructions in new community A was higher than traditional community B (95.5％ vs.77.8％,P=0.024).The proportion of the residents consulted community doctors when they were puzzled by drug use in new community A was lower than traditional community B (56.8％ vs.76.2％);The proportion of the residents consulted physicians in major hospitals was higher than traditional community B (34.1％ vs.9.5 ％);there was statistical significance (P=0.034).The most popular health service for the residents in the new community A was the hotline for the drug use (65.9％),while the residents in traditional community B needed blood pressure and sugar monitoring service and set up the health records (41.3％).The proportion of the residents' following demands in new community A was higher than traditional community B:opening drug use hotline,publicizing the knowledge of diseases and medication and conducting lectures (P＜0.001,P=0.006,P=0.018).CONCLUSIONS:The proportion of drug storage in empty-nest families of two communities is in very high level,but drug storage methods,cleaning frequency are not satisfactory.There are still a small number of elderly people who do not have the habit of reading drug instructions.There are some differences between the old and new communities.At the same time,the needs of health services in new and old communities are different.

Diffuse large B-cell lymphoma with aberrant expression of CD56: a clinicopathologic and immunohistochemical study / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and significance of aberrant CD56 expression in diffuse large B-cell lymphoma (DLBCL).</p><p><b>METHODS</b>The clinical and pathologic profiles of 10 cases of DLBCL with aberrant expression of CD56 were investigated. Immunohistochemical staining, in-situ hybridization for Epstein-Barr virus encoded RNA and gene rearrangement for IgH and Igκ were carried out.</p><p><b>RESULTS</b>There were 6 male and 4 female patients. The medium age of patients was 46 years. All of them presented with extranodal lymphoma involvement, with gastrointestinal tract being the commonest site (5/10). Histologic examination showed that most of the atypical lymphoid cells were centroblast-like and demonstrated a diffuse growth pattern. Apoptosis and necrosis were identified in some cases. Immunohistochemical study showed that the tumor cells were positive for CD20 or CD79α and aberrantly expressed CD56. Five cases had the GCB phenotype while the remaining cases had the non-GCB phenotype, according to Hans classification. Bcl-6 was positive in most cases (9/10). All cases showed a high proliferation index by Ki-67. The tumor cells were negative for CD3ε, CD138 and granzyme B. In-situ hybridization for Epstein-Barr virus encoded RNA was performed in 7 cases and none of them showed positive signals. IgH gene rearranged bands were detected in 4 cases (4/6) and Igκ was detected in 3 cases (3/6). Follow-up data were available in 8 patients. Two patients died of disease progression within 5 to 13 months after diagnosis and the other 6 patients were alive 8 to 60 months after therapy.</p><p><b>CONCLUSIONS</b>DLBCL with aberrant expression of CD56 is rare. Most of them present with extranodal involvement, show high frequency of bcl-6 expression and high proliferation index. The patients often have good response to chemotherapy.</p>

Methods of Developing Adaptive Treatment Strategies for Traditional Chinese Medicine Syndrome Differentiation and Treatment / 世界科学技术-中医药现代化

Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which em-bodies the concept of individualized diagnosis and dynamic treatment on a holistic view. RCT was frequently used in TCM clinical study. However, it cannot reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies (ATS) in clinical research can adjust therapy in patients according to the change of disease, so it can reflect personalized medicine and dynamic treatment. From this perspective, the process of treat-ment based on syndrome differentiation was a process of adaptive treatment decision. So the method for developing ATS can effectively evaluate the efficacy of different treatment strategies in TCM clinical study. ATS had been used in some clinical studies from published literatures abroad. However, the use of ATS in domestic clinical research was seldom been reported. This paper gave an outline of the concept of ATS. In addition, this paper focused on three methods which can take the delayed effects of current treatment action into consideration and can compare the over-all effect of different ATS. It was hoped to lay foundation for future scientific research of TCM in the implementation of SMART and provide a new idea.

Adaptive Treatment Strategies and Prospective of Their Application in Traditional Chinese Medicine Research / 中国中医药信息杂志

Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which is the core technology that can embody the characteristics and advantages of TCM diagnosis and treatment. This is based on holistic view to illustrate individual diagnosis and treatment and dynamic treatment. However, RCT, which is frequently used in TCM clinical studies, can not reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies in clinical researches can adjust therapy in patients according to the changes of diseases, so it can reflect individual diagnosis and treatment and dynamic treatment. From this perspective, the process of treatment based on syndrome differentiation is a process of decision-making of adaptive treatment. So the method for developing adaptive treatment strategies can effectively evaluate the efficacy of different treatment strategies in TCM clinical studies. Adaptive treatment strategies have been used in some clinical studies from some published foreign literatures. However, the use of adaptive treatment strategies in domestic clinical researches is seldom reported. This article discussed the concept of adaptive treatment strategies and their important components in detail. In addition, it presented three methods which can take the delayed effects of the current treatment action into consideration and can compare the overall effect of different adaptive treatment strategies, with a purpose to lay some foundation for future TCM researches in the development of optimal clinical pathway and provide new ideas and methods for researches.

Analysis of Repeated Data of Multi-center Clinical Trial for Traditional Chinese Medicine by Hierarchical Linear Model / 中国中医药信息杂志

Objective To explore the applicability and feasibility of the hierarchical linear model in dealing with the repeated measurement data by applying it into multi-center clinical trials’ evaluation of new Chinese medicine. Methods The theoretical research described the basic concepts and principles of hierarchical linear model and compared the applying conditions of traditional statistical methods with hierarchical linear model. In the empirical study, the hierarchical linear model was used into a real multicenter clinical trial research of traditional Chinese medicine, with the TCM syndrome score as the analysis indicator. Results The hierarchical linear model added time, group and time×group as random variables into the model to get the final result. All of the three variables were significant in the result. The interaction (time×group) statistical result was t=2.65, P=0.008 1. During the whole treatment, the TCM syndrome mean score of trial group reduced 8.5 and the control group reduced 7.47. At the end of treatment, the TCM syndrome mean score of trial group was 2.46, and the control group was 3.31, which was higher than trail group. For this result, combining with the TCM syndrome score’s developing trend, we can see that the efficacy of trial group is not worse than the control group. Conclusion By comparing the data requirements, applying conditions and analysis results, the hierarchical linear model could be an effective method which can be used in multi-center trial to evaluate traditional Chinese drug.

Progress on molecular genetics in atypical hemolytic uremic syndrome / 国际儿科学杂志

Atypical hemolytic uremic syndrome(aHUS) has recently been shown to be a rare disease of genetic predisposition, including genes of complement factor H(CFH), membrane cofactor protein(MCP, CD46)and complement factor Ⅰ(CFI), which are complement regulatory genes. Genes mutation is about 50%,involving the three genes mutation, including nonsense mutation, missen mutation, silent mutation, splice mutation and insertion mutation. Autosomal dominant inheritance and autosomal recessive inheritance have been reported, however, for autosomal dominant inheritance, the three genes mutations are incomplete penetrance.

Application of Factorial Design in Study of Intervention Effects of Acupuncture on Spinal Cord Injury Rats / 中国康复理论与实践

@# Objective To study and observe the intervention effects of Acupuncture on spinal cord injury rats by using factorial design. The best combination rules of the best time course and electrical stimulation site were explored.Methods 96 experimental spinal cord injury rats were randomly divided into four groups: acupuncture on head intervention group (group A), acupuncture on body intervention group (group B), complex intervention group (group A+B) and nonintervention group (group D) . There were 24 rats in each group. The rats received electrical stimulation according experimental design. The motor function of the rats' hind limbs were detected at different time sites(1 w, 2 w, 4 w, 8 w and 12 w).Results The Results among different Methods of electrical stimulation are significantly different. The levels of the rat's BBB scale, and evoked potential(MEP) in the group A+B were the best among four groups (P＜0.05). The BBB scale and evoked potential(MEP)of the rats in each group are significantly different at different time sites (P＜0.05). It means that each kind of electrical stimulation plays a positive role in promoting restoration of motor function. The correct analysis for factorial design data is helpful to the fully application of information.Conclusion Factorial design can be used in research projects of Acupuncture, especially the design for multiple factors and multiple levels.

Effect of Electrical Stimulation on Expression of Growth Associated Protein-43, basic Fibroblast Growth Factor, Insulin-like Growth Factor in Spinal Cord Injured Rats after Human Umbilical Cord Blood Stem Cells Transplantation / 中国康复理论与实践

@# Objective To explore the effects of electrical stimulation in different acupoints on the expression of growth associated protein-43 (GAP-43), basic fibroblast growth factor (bFGF), insulin-like growth factor (IGF) in spinal cord injured rats after the human umbilical cord blood stem cells transplantation.Methods 192 SD rats were injured at T10-11 level with NYU, and divided randomly into groups: Group A received electric stimulation in the scalp of motor area (A1 group received electric stimulation and transplantation of umbilical cord blood stem cell, the rats of A2 group only received electric stimulation); group B received local electric stimulation at damaged site (B1 with electric stimulation and transplantation, B2 only with electric stimulation); group C received electric stimulation in the scalp of motor area and at damaged site (C1 with electric stimulation and transplantation, C2 only with electric stimulation); D1 received transplantation without electric stimulation, D2 neither with transplantation nor electric stimulation. The expression of GAP-43, bFGF and IGF were detected 1, 2, 3, 4, 8 and 12 weeks after operation. Results Electric stimulation increased the expression of GAP-43, bFGF, IGF, stimulating scalp and body were more than stimulated scalp or body alone, combined with the stem cells transplantation were more than no transplantation. Conclusion Both electric stimulation and stem cells transplantation can improve the microenvironment for neural recovery synergistically. Stimulating scalp and body is more effective than alone.

Expression of GAP-43, MBP by Electrical Stimulation in Different Sites of Spinal Cord Injured Rats after Human Umbilical Cord Blood Stem Cells Transplantation / 中国康复理论与实践

@#Objective To explore the application values of effect on the expression of growth associated protein-43 (GAP-43) and myelin basic protein(MBP) by electrical stimulation in different sites of spinal cord injured rats after the human umbilical cord blood stem cells transplantation. Methods In this study the subjects adopted are clean grade rats, which were performed with Allen's method by NYU blow device, resulting in SCI models. 192 rats successfully modeled were divided into groups according to the random table. Group A received electric stimulation in the scalp surface projection area of motor area: Group A1 received electric stimulation and transplantation of umbilical cord blood stem cell, while Group A2 only received electric stimulation; Group B received local electric stimulation at damaged site: Group B1 received electric stimulation and transplantation of umbilical cord blood stem cell, while Group B2 only received electric stimulation; Group C received electric stimulation in the scalp surface projection area of motor area and local electric stimulation at damaged site: Group C1 received electric stimulation and transplantation of umbilical cord blood stem cell, while Group C2 only received electric stimulation; Group D are just the SCI models: Group D1 received transplantation of umbilical cord blood stem cell without electric stimulation, while Group D2 neither received cell transplantation nor electric stimulation. The sacrifice time of rats was the 1st week, 2nd week, 3rd week, 4th week, 8th week, and 12th week after operation respectively. The distribution of the remained or regenerative neurons at damaged areas by corticospinal tract anterograde tracer with Biotinylated dextran amine (BDA), and we also detected the content changes of GAP-43, MBP and the MAB1281 specific expression of the human nucleus of human umbilical cord blood stem cells. Results 1). NYU is a blow device for Allen's rat model of SCI, which could quantify the crash potential energy, and gain a stable and repeated model with high successful rate. 2). At each time site in this study, the factors that benefit for the neurofunction restoration after electric stimulation in the microenvironment into which the stem cells have been transplanted are GAP-43 and MBP, and they are all positive; the effects of the combination of head acupuncture with body acupuncture are much better than single head acupuncture or body acupuncture. 3). At each time site in this study, the factors that benefit for the neurofunction restoration after injury are GAP-43 and MBP, and the effects of them are all positive, which do not depend on whether the stem cell transplantation has been done. Conclusion 1). After the stem cell transplantation have been done, the changes of the microenvironment develops in the direction of benefiting for restoring neurofunction, which means that stem cell transplantation can promote the restoration of neurofunction and the stem cell transplantation is successful in this study. 2). Electric stimulation is significantly positive for the factors (GAP-43, MBP) which benefit for restoring neurofunction in the microenvironment after stem cell transplantation, the effects of the combination of head acupuncture with body acupuncture is better than single head acupuncture or body acupuncture. The significantly positive effects of the electric stimulation on microenvironment after injuries are independent, which do not depend on whether the stem cell transplantation has been done. Electric stimulation and stem cell transplantation are significantly synergistic at the microenvironment.