The clinical value of continuous increase of blood lactic acid in prognosis evaluation of patients with sepsis / 中国医师杂志

Objective:To investigate the clinical value of continuous increase of blood lactic acid (Lac) in prognosis evaluation of patients with sepsis.Methods:From January 2016 to December 2018, 84 patients with sepsis in the Department of Critical Medicine of Lanzhou First People's Hospital were retrospectively analyzed. According to the final outcome, the patients were divided into death group and survival group. The general condition, initial Lac, Lac at 6, 12, 18, 24 h, and the duration of Lac>2 mmol/L (T Lac>2) were compared between the two groups. Receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), initial lac, 6, 12, 18, 24 h lac, T Lac>2 in evaluating the prognosis of patients with sepsis. At the same time, the relationship between these parameters and the prognosis of patients was analyzed by Cox regression analysis to evaluate the clinical value of the time of continuous increase of blood lactate in the prognosis of patients with sepsis. Results:There was no significant difference in age, gender, APACHE Ⅱ score and initial lac between the two groups ( P>0.05). The Lac of death group was higher than that of survival group at 6, 12, 18 and 24 h after treatment ( P<0.05), and T Lac>2 in death group was significantly longer than that in survival group ( P<0.05). Cox regression analysis showed that age, gender, APACHE Ⅱ score, initial Lac, 6, 12, 18, 24 h lac had no significant effect on the prognosis of sepsis patients, while T Lac>2 was significantly correlated with survival rate and death risk. The longer T Lac>2 was, the lower the survival rate and the higher the risk of death. At the same time, ROC curve analysis showed that gender, age, APACHE Ⅱ score and area under the curve (AUC) of initial lac showed that these indicators could not effectively evaluate the prognosis of patients ( P>0.05). The area under the curve of T Lac>2 was the largest, and the evaluation of prognosis was the best, followed by 24 h Lac and 18 h, 12 h and 6 h Lac. In addition, the sensitivity of T Lac>2, 24, 18, 12, 6 h for sepsis mortality risk assessment were 90.9%, 81.8%, 81.8%, 81.8%, 88.6%, and the specificity were 71.4%, 52.5%, 52.5%, 47.7% and 25.2%, respectively. Conclusions:Transient increase of lactic acid can not evaluate the prognosis of patients with sepsis, but the duration of lactic acid increase has a significant impact on the prognosis of patients with sepsis. The longer the increase of Lactic acid (T Lac>2) is, the lower the survival rate and the higher the risk of death. The sensitivity and specificity of lactic acid duration in evaluating the risk of death were higher than those of other parameters, and the prognostic efficacy was the best.

NT5C2 expression in children with acute leukemia and its clinical significance / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the expression level and analyze the clinical significance of NT5C2, which is an nucleoside analogues metabolism related gene, in children with acute leukemia (AL).</p><p><b>METHODS</b>Real-time PCR and immunohistochemistry were presented to detect the level of NT5C2 mRNA and its protein product cN- Ⅱ in bone marrow samples of 63 patients initially diagnosed with AL, 15 patients who achieved complete remission, 7 patients who relapsed and 16 non- hematologic malignancie controls. The expression of NT5C2 mRNA in different groups of AL and its relevance with clinical indicators were analyzed.</p><p><b>RESULTS</b>①The expression of NT5C2 mRNA in newly diagnosed B-ALL, TALL, AML and controls were 1.16 (0.89-2.25, 0.96 (0.74-1.25, 1.66 (0.84-3.15) and 0.88 (0.61-1.21), respectively. NT5C2 mRNA expression in AML (P<0.01) and B-ALL (P<0.05) cases were higher than that in controls; NT5C2 mRNA expression in T- ALL and in controls showed no significant difference (P>0.05). Changes of NT5C2 mRNA level were observed between preliminary diagnosis and complete remission in 15 patients. NT5C2 mRNA levels were significantly decreased in complete remission stage than that in newly diagnosis AL (P<0.01). NT5C2 mRNA levels of relapsed-refractory group were higher than that of complete remission group and controls (P<0.01). ② Immunohistochemical staining results revealed that NT5C2 protein levels were consistent with the trend of mRNA levels. ③NT5C2 mRNA levels in AML (r=0.434) and T-ALL (r=0.389) were positively correlated with risk classification (P<0.05). ④ During chemotherapy of patients with AML, the NR rate of bone marrow in NT5C2 high expression group was higher than that of low expression group after 9 days induction chemotherapy (35.2% vs 0) and before consolidation therapy (25.0% vs 0); The positive rate of minimal-residual disease (36.4% vs 14.3%) and relapse rate of AL (38.5% vs 28.6%) were increased in NT5C2 high expressed patients than that in low expressed patients, but all the differences were insignificant (P>0.05).</p><p><b>CONCLUSION</b>High expression of NT5C2 was found to be a related risk factor of AL children with unfavourable prognosis. NT5C2 promises a new target for guiding individualized chemotherapy and evaluating the prognosis of childhood acute leukemia and monitoring recurrence.</p>

Establishment of HLH-like mouse model with CPG-ODN and IFN-γ / 中华血液学杂志

<p><b>OBJECTIVE</b>To establish a hemophagocytic lymphohistiocytosis (HLH)-like mouse model induced by CpG oligodeoxynucleotide (CpG-ODN1826) and interferon (IFN)-γ for further study on therapy.</p><p><b>METHODS</b>Wild type adult C57BL/6 mice were administered with PBS or CpG-ODN1826 (50 μg) by intraperitoneal injection every two day and IFN-γ subcutaneous injection every day. Parameters of HLH were evaluated on day 10.</p><p><b>RESULTS</b>As compared to control, HLH-like symptoms in CpG group were characterized with pancytopenia accompanied by increased ratios of monocytes, alanine aminotransferase [(198.7±54.2)IU/L], triglyceride level [(12.1±0.6)g/L], and serum ferritin [(708.4±11.8)pmol/L]; decreased albumin [(217.7±4.3)g/L], fibrinogen [(17.1±1.9)g/L] (all P<0.05). Hepatosplenomegaly was obvious in CpG group. The liver in CpG group had multifocal hepatocytes necrosis and perivascular inflammations. Spleen had expanding red pulp and hyperplastic nucleated cells. Furthermore, macrophages in the liver and spleen were largely activated. Hemophagocytosis were observed in liver, spleen and bone marrow smear. The CpG group was alive during experiment, other than significant decreased activity after the first injection of CpG-ODN.</p><p><b>CONCLUSION</b>These data demonstrate that repeated administration of CpG-ODN1826 and IFN-γ could induce HLH-like symptoms without fatal condition in wild type C57B/L mice. This protocol could establish a mild HLH-like mouse model, which could be useful for further study on HLH.</p>

SALL4 expression in children with acute leukemia and its clinical significance / 中国肿瘤临床

Objective:To investigate the expression of sal-like 4 (SALL4) gene in children with acute leukemia and analyze its clinical significance. Methods:Real-time PCR and immunohistochemistry were used to detect SALL4 mRNA and SALL4 protein ex-pressions in 50 patients initially diagnosed with acute leukemia and in 15 patients with immune thrombocytopenic purpura (ITP), which served as controls. Changes were detected in SALL4 mRNA expression from preliminary diagnosis and after complete remission of 5 acute leukemia patients. The relationship between SALL4 mRNA expression and clinical indicators was analyzed. Results: SALL4 mRNA expression is higher in initially diagnosed B-ALL [13.89 (1.00-63.15)] and AML [11.12 (2.31-56.59)] than in ITP controls [1.00 (0.29-1.71)] (P0.05). SALL4 protein expression is in agreement with SALL4 mRNA expression. SALL4 mRNA expression significant-ly decreased in complete remission stage [0.98 (0.22-1.09)] than in acute phase [28.64 (11.20-87.46)] in acute-leukemia patients (P0.05). Conclusion:SALL4 was found to play an important role in pro-moting childhood B-ALL and AML, which promises a new target for monitoring the therapeutic effects and evaluating the prognosis of childhood B-ALL and AML.

A study of correlation between nut-cracker phenomenon and varicocele in adults / 中国医师进修杂志

Objective To explore the correlation and significance between adult nut-cracker phenomenon (NCP) and varicocele. Methods The clinical characters of 226 adult patient (including inpatients and outpatients)with NCP diagnosed by color Doppler ultrasound examination were analyzed retrospectively, whose chief complaints were asymptomatic bematuria or/and orthostatic proteinuria (microalbuminuria). The ratio of left renal vein inner diameter before and after being compressed≥2 was regarded as the criteria of diagnosis of NCP. Among 226 cases, 184 male NCP patients were taken as study group, and the incidence of varicocele was tested. One hundred and fifty-six male adults who had physical examination in the same period and whose ages matched with study group were taken as control group, they were not NCP patients examined by color Doppler ultrasound. The incidence of varicocele was compared between two groups. The indexes associated NCP were examined in detail in study group. Logistic regression analysis was used to study the correlation between NCP and left varicocele. Results There were 184 male patients in study group, among which there were 22 patients with left sub-clinical varicocele (accounted for 11.96%), 47 patients with left varicocele (accounted for 25.54%).The total incidence of varicocole was 37.50%(69/184). There were 156 male adults in control group, among which there were 13 patients with sub-clinical varicocole(accounted for 8.33%), 8 patients with varicocele (accounted for 5.13%).The total incidence of varicocele was 13.46%(21/156). The total incidence of varicocele in study group was significantly higher than that in control group (P=0.000). In study group, there were 22 patients with left sub-clinical varicocele,with average age (24.73±1.03) years. The inner diameter of left renal vein(LRV) in front of spine was (3.65±0.11) mm(a),the inner diameter of LRV at left side of spine was (8.41±0.11)mm(b), and b/a ratio was 2.31± 0.06. The angle between superior mesenterie artery (SMA) and abdominal aorta(AA) was (15.95±0.59)°. There were 47 patients with left varicocele, with average age(26.62±1.74)years. The inner diameter of LRV in front of spine was (3.43±0.08)mm(a),the inner diameter of LRV at left side of spine was (8.72±0.14) mm (b), and b/a ratio was 2.54±0.08. The angle between SMA and AA was (14.54±0.53)°. In study group, Lagistic regression analysis proved that male patients with NCP were complicated with varicocele easier when the angle between SMA and AA became smaller, the inner diameter of LRV at the left side of spine (b)and age increased. Conclusions Male adult patients with NCP are complicated with left varicocele, which is significantly higher than that in non-NCP male adults at the same age. It shows that NCP is one important cause for varicocele and there is a close correlation between NCP and varicocele in male adults.

Simvastatin inhibits ROS mediated the neonatal rat cardiac myocyte hypertrophy induced by endothelin-1 / 中国药理学通报

AIM To explore the inhibitory effects of simv astatin on ROS generation and cardiac myocytes hypertrophy induced by ET-1. METHODS The study was performed with primary cultured neonatal rat cardiac myocytes. Intrace llular fluorescence signal was assayed by fluorescence convert microscope. The l evel of intracellular ROS was measured by the ROS-specific probe 2′, 7′-dich lorofluorescin diacetate (DCF-DA). The RNA content was determined by RNA-sensitive fluoresce nce probe propidium iodide (PI) and the total protein of cell was measured by th e methods of coomassie brilliant blue. The cell surface area was measured by ima ge analysis program. RESULTS ①Fluorescence intensity of intracel lular DCF-DA and myocyte hypertrophy increased by ET-1 in dose-dependent mann er. Antioxidant catalase(0 2 U?L -1 ) attenuated the ET-1-induced incre ase of fluorescence intensity of intracellular DCF-DA and myocyte hypertrophy.②Simvastatin inhibited the increase of fluorescence intensity of intracellular DCF-DA and cardiac myocyte hypertrophy induced by ET-1(10 -8 mol?L -1 )in a dose-dependent manner. CONCLUSION ET-1 increases int racellular ROS in the cultured neonatal rat cardiac myocytes. Simvastatin inhibi ted the generation of ET-1-induced ROS and cardiomyocytes hypertrophy.

Effects of myofibrillogenesis regulator on myocardial hypertrophy / 中国病理生理杂志

AIM: To investigate the effects of myofibrillogenesis regulator-1 (MR1) on myocardial hypertrophy. METHODS: Three stem-loop structures of rMR1 mRNA were selected as targets to establish RNA interference carriers. After transient transfection with plasmids, cultured cardiomyocytes of neonatal were used to perform RT-PCR for choosing the first target to carry out RNA interference blocking MR1 gene. In order to observe the effect of MR1 gene silence on myocardial hypertrophy induced by angiotensin Ⅱ (AngⅡ), the radiation intensity of tritium-leucine ([3H]-Leu) was used to label the cardiomyocytes. Morphological observation, protein extraction and Western blotting were also used to investigate protein synthesis rate, cell surface area and expression of rMR1. RESULTS: The radiation intensity of tritium-Leucine in AngⅡ group increased 21.4% (P