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Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.
Subject(s)
Humans , Hemoperfusion , Hemorrhage/therapy , Organophosphorus Compounds , Pesticides , Poisoning/therapy , Risk FactorsABSTRACT
Objective:To explore the efficacy of nimodipine in treating cognitive impairment of cerebral small vessel disease (CSVD) and the value of magnetic resonance diffusion tensor imaging (DTI) in CSVD.Methods:A total of 80 patients with CVSD and cognitive dysfunction who admitted to Suzhou Municipal Hospital from February 2018 to February 2019 were selected, and the patients were divided into control group (40 patiengts) and observation group (40 patients) by random number table method. The control group received basic treatment and donepezil, and the observation group added nimodipine on the basis of control group. All patients were followed up for 12 months. Before treatment, 6 months after treatment and 12 months after treatment, the patients’Montreal cognitive assessment scale (MoCA) score, daily living ability scale (ADL) score, and Tinetti balance and gait analysis(TGA) were recorded. The levels of total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), homocysteine (Hcy) and high-sensitivity C-reactive protein (hs-CRP) before and after treatment were recorded. The changes of DTI data before and after 12 months′ treatment in the two groups were recorded.Results:The MoCA score, ADL score, and TGA score of the two groups were higher than those before treatment and at 6 months and 12 months after treatment, and those 12 months after treatment were higher than those at 6 months after treatment. There were significant differences ( P<0.05). The MoCA and ADL scores of the observation group were higher than those of the control group at 6 and 12 months after treatment at 6 months: (24.61 ± 2.54) scores vs. (22.21 ± 2.83) scores, (71.53 ± 6.25) scores vs. ( 69.51 ± 6.81) scores; 12 months: (26.39 ± 2.16) scores vs. (23.76 ± 2.64) scores, (78.39 ± 5.76) scores vs. (72.39 ± 6.12) scores, P<0.05. At 6 months and 12 months after treatment, the visual space and execution ability, delayed memory, and orientation scores were higher than those before treatment, and in the observation group 12 months after treatment was higher than those 6 months after treatment: (5.97 ± 1.37) scores vs. (5.36 ± 1.29) scores, P<0.05. The observation group′s visual space and executive ability, abstract thinking, delayed memory, and orientation score were higher than those in the control group at the same period ( P<0.05). The levels of TC, TG, LDL-C, Hcy and hs-CRP of the two groups after treatment for 6 and 12 months were lower than those before treatment, and the levels of these index at 12 months after treatment were lower than those at 6 months after treatment ( P<0.05). The levels of Hcy and hs-CRP in the observation group were lower than those in the control group at 12 months after treatment, and Hcy was lower than that in the control group at 6 months after treatment ( P<0.05). After treatment, the fractional anisotropy (FA) values of the center, frontal lobe, and parietal lobe of both sides of the two groups were higher than those before treatment, and the difference in the observation group before and after treatment was higher than that of the control group ( P<0.05). After treatment, the mean diffusivity (MD) values of both frontal lobe and parietal lobe of the two groups were lower than those before treatment, and the difference between the observation group before and after treatment was higher than that of the control group ( P<0.05). Conclusions:Nimodipine has a good effect on the treatment of CVSD, which can effectively improve the patients′ cognitive impairment and other symptoms. DTI can sensitively sense the white matter integrity and cerebral blood flow perfusion of patients, which has a positive significance for the prevention and treatment of CVSD.
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OBJECTIVE@#To summarize and compare the clinical baseline characteristics of patients with monoclonal gammopathy of undetermined significance (MGUS), primary light chain amyloidosis (pAL), multiple myeloma (MM), or MM with concurrent amyloidosis, especially the differences in cytogenetic abnormalities.@*METHODS@#The clinical data of 15 cases of MGUS, 34 cases of pAL, 842 cases of MM and 23 cases of MM with concurrent amyloidosis were analyzed and compared retrospectively.@*RESULTS@#Cytogenetic statistics showed that the incidence of t (11; 14) in the four groups (MGUS vs pAL vs MM vs MM with concurrent amyloidosis) was 0%, 33.3%, 16.4%, and 15.8%, respectively (P=0.037); that of 13q deletion was 20.0%, 14.7%, 45.8% and 56.5%, respectively (P<0.001); gain of 1q21 was 50.0%, 12.5%, 47.4% and 40.9%, respectively (P=0.001). Proportion of pAL patients with 0, 1 and≥2 cytogenetic abnormalities (including 13q deletion, 17p deletion, 1q21 amplification and IgH translocation) accounted for 41.9%, 41.9% and 16.1%, respectively; while the proportion of the same category in MM was 17.6%, 27.3%, and 55.2% respectively; this ratio of MM with concurrent amyloidosis was more similar to MM. Subgroup analysis showed that genetic abnormalities (including 13q deletion, 17p deletion and 1q21 amplification) were comparable within t (11; 14) negative and positive groups. Compared with positive cases, t(11; 14) negative patients with MM or MGUS were more likely to have 13q deletions and multiple genetic abnormalities.@*CONCLUSION@#Clinical characteristics of pAL, especially cytogenetic abnormalities, are significantly different from MM with concurrent amyloidosis. It suggests that although the onset characteristics are similar, actually the two diseases belong to different disease subtypes which should be carefully predicted and identified.
Subject(s)
Humans , Amyloidosis , In Situ Hybridization, Fluorescence , Monoclonal Gammopathy of Undetermined Significance/complications , Multiple Myeloma , Retrospective StudiesABSTRACT
Discoidin domain receptor 1(DDR1)is a critical member of the receptor tyrosine kinase family.It may be related to tumor invasion and metastasis,and the abnormal activation of DDR1 can lead to the occurrence and development of malignant tumors,inflammation,and fibrosis.DDR1 are involved in cell adhesion,migration,proliferation,secretion of cytokines,and remodeling of extracellular matrix,thus playing a critical role in various pathophysiological processes of the human body.In this review,we demonstrate the research progress of DDR1 in breast cancer and other malignant tumors,in order to provide a new theoretical basis for the prevention and treatment of breast cancer and other tumors.
Subject(s)
Female , Humans , Breast Neoplasms/genetics , Cell Adhesion , Discoidin Domain Receptor 1 , Fibrosis , Receptor Protein-Tyrosine Kinases/geneticsABSTRACT
Objective:To analysis the effect of two methods of transposition of pectoralis major in different degrees deep sternal wound infection(DSWI) after undergoing cardiac surgery.Methods:128 patients with DSWI after cardiac surgery were treated, 72 were mild, and 56 were severe. 66 cases of pectoralis major muscle flap docking method(medial muscle flap docking group) and 62 cases of lateral pectoralis major muscle flap turnover method(lateral muscle flap turnover group) were implemented respectively. Drainage tube indwelling time, reoperation rate, incidence of lung infection, long-term thoracic stability and other aspects were observed to compared the treatment effect.Results:In the mild patients, the medial muscle flap docking group and the lateral muscle flap turnover group were compared( P<0.05). The postoperative hospital stay [(14.2±4.7)days vs.(17.1±3.9)days], drainage tube retention time[(6.2±1.7)h vs.(9.1±2.9)h], and reoperation rate(2.4% vs. 6.7%), the incidence of lung infection(14.3% vs. 23.3%), long-term thoracic stability[73.8%(31/42)vs.43.3%(13/30)]. In the severe patients, the medial muscle flap docking group and the lateral muscle flap turnover group were compared. The postoperative hospital stay[(24.2±7.2)days vs.(20.1±3.5)days], drainage tube retention time[(20.2±6.6)h vs.(13.2±3.1)h], reoperation rate(20.8% vs.12.5%), incidence of pulmonary infection(41.7% vs. 31.3%), long-term thoracic stability[25.0%(6/24)vs.68.8%(22/32)]. The differences of the indicators in each group were significant , P<0.05. In the mild group, each index of the pectoralis major medial muscle flap docking method was superior to the lateral muscle flap turnover method, but the treatment results of the two methods in the severe group were opposite. Conclusion:Patients with mild deep DSWI treated with medial pectoralis major muscle flap docking and suture have less hospital stay, less reoperation rate, less complications and better treatment effect than reverse lateral pectoralis major muscle flap turnover. But the two treatments in the severe DSWI have the opposite effect.
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Objective To compare the value of MRI total burden and diffusion tensor tract-based spatial statistics (TBSS) for identifying cognitive impairment in patients with cerebral small vascular disease (CSVD).Methods Consecutive patients with CSVD diagnosed in Suzhou Hospital Affiliated to Nanjing Medical University from January 2018 to June 2019 were enrolled.They were divided into cognitive impairment group and cognitive normal group.The MRI overall burden was evaluated,and TBSS analysis was performed to obtain regions with differences in diffusion parameters between the two groups.Multivariatelogistic regression analysis was used to determine the independent risk factors for cognitive impairment.The receiver operating characteristic (ROC) curve was used to identify the recognition ability of the MRI overall burden and TBSS analysis for cognitive impairment in patients with CSVD.Results A total of 71 patients with CSVD were enrolled,including 41 (57.75％) in the cognitive impairment group and 30 (42.25％) in the cognitive normal group.There was a statistically significant difference in the proportion of patients with white matter hyperintensities between the two groups,but the MRI overall burden was not statistically significant difference.After adjusting for the confounding factors such as age and gender,multivariatelogistic regression analysis showed that white matter hyperintensities was an independent risk factor for cognitive impairment inpatients with CSVD (odds ratio 3.459,95％ confidence interval 1.196-10.007;P=0.022).Diffuse parameters of the white matter area,such as the genu of corpus callosum,anterior thalamic radiation,fasciculus longitudinalis superior,and frontal-occipital fasciculus in the cognitive impairment group were significantly different from those in the cognitive normal group (all P ＜0.05).The fractional anisotropy of left anterior thalamic radiation (r =0.252,P =0.036) and the radial diffusivity of the genu of corpus callosum (r =-0.246,P =0.042) were significantly correlated with cognitive scores.ROC analysis showed that the areas under the curve of the MRI total burden,the fractional anisotropy of left anterior thalamic radiation,and the radial diffusivity of the genu of corpus callosum for identifying cognitive impairment were 0.61,0.56 and 0.57,respectively.Conclusion White matter hyperintensities is an independent risk factor for cognitive impairment in patients with CSVD.TBSS analysis may be superior to MRI overall burden assessment in the specific recognition of cognitive impairment in patients with CSVD.Some diffuse parameters have a certain correlation with the overall cognitive status,and may be used as early imaging markers for cognitive impairment in patients with CSVD.
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Objective@#To compare the value of MRI total burden and diffusion tensor tract-based spatial statistics (TBSS) for identifying cognitive impairment in patients with cerebral small vascular disease (CSVD).@*Methods@#Consecutive patients with CSVD diagnosed in Suzhou Hospital Affiliated to Nanjing Medical University from January 2018 to June 2019 were enrolled. They were divided into cognitive impairment group and cognitive normal group. The MRI overall burden was evaluated, and TBSS analysis was performed to obtain regions with differences in diffusion parameters between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for cognitive impairment. The receiver operating characteristic (ROC) curve was used to identify the recognition ability of the MRI overall burden and TBSS analysis for cognitive impairment in patients with CSVD.@*Results@#A total of 71 patients with CSVD were enrolled, including 41 (57.75%) in the cognitive impairment group and 30 (42.25%) in the cognitive normal group. There was a statistically significant difference in the proportion of patients with white matter hyperintensities between the two groups, but the MRI overall burden was not statistically significant difference. After adjusting for the confounding factors such as age and gender, multivariate logistic regression analysis showed that white matter hyperintensities was an independent risk factor for cognitive impairment in patients with CSVD (odds ratio 3.459, 95% confidence interval 1.196-10.007; P=0.022). Diffuse parameters of the white matter area, such as the genu of corpus callosum, anterior thalamic radiation, fasciculus longitudinalis superior, and frontal-occipital fasciculus in the cognitive impairment group were significantly different from those in the cognitive normal group (all P<0.05). The fractional anisotropy of left anterior thalamic radiation (r=0.252, P=0.036) and the radial diffusivity of the genu of corpus callosum (r=-0.246, P=0.042) were significantly correlated with cognitive scores. ROC analysis showed that the areas under the curve of the MRI total burden, the fractional anisotropy of left anterior thalamic radiation, and the radial diffusivity of the genu of corpus callosum for identifying cognitive impairment were 0.61, 0.56 and 0.57, respectively.@*Conclusion@#White matter hyperintensities is an independent risk factor for cognitive impairment in patients with CSVD. TBSS analysis may be superior to MRI overall burden assessment in the specific recognition of cognitive impairment in patients with CSVD. Some diffuse parameters have a certain correlation with the overall cognitive status, and may be used as early imaging markers for cognitive impairment in patients with CSVD.
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Objective To explore the effect of Kruppel like factor 4 (KLF4) on epithelial-to-mesenchymal transition and invasion ability of pancreatic cancer.Methods The expression of KLF4 in 70 pancreatic cancer tissues and 10 normal pancreatic tissues was detected by immunohistochemistry,and the correlations between KLF4 expression and pathological characteristics were analyzed.Small hairpin RNA targeting KLF4 (sh-KLF4) and negative control shRNA were constructed.After the transfection of shRNA,qRT-PCR and western blot were used to detect the mRNA and protein expression of KLF4,E-cadherin and vimentin,and cell scratch-wound assay and transwell assay were utilized to determine the ability of invasion and metastasis.Results KLF4 expression (47.1％) was lower in pancreatic cancer tissues compared with normal pancreatic tissues (80.0％),and negatively correlated with cell differentiation,tumor stage and distant metastasis.Down-regulated KLF4 expression in PANC1 cell caused decreased mRNA and protein expression of E-cadherin (F =25.71,P =0.0011) and increased mRNA and protein expression of vimentin (F =24.95,P=0.0012).Knockdown of KLF4 in PANC1 cell promoted the transition from epithelial morphology to mesenchymal morphology,and enhanced the healing ability (F =47.82,P ＜ 0.001),migration (F =53.68,P=0.0001) and invasion (F=27.65,P=0.0009).Conclusions Knockdown of KLF4 can promote EMT and enhance the invasion ability of pancreatic cancer.
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Objective To investigate the effect of Shenxiong glucose injection on platelet reactivity during aspirin treatment in patients with acute ischemic stroke.Methods A total of 263 patients with acute ischemic stroke admitted to 12 hospitals from January 2014 to December 2016 were enrolled prospectively.They were randomly divided into aspirin group and aspirin + Shenxiong glucose injection group.The changes of platelet maximum aggregation rate induced by 4 platelet aggregating agents (arachidonic acid,adenosine diphosphate,collagen and platelet activating factor) were detected before and after the treatment.Results There were no significant differences in the demographic data and baseline clinical characteristics between the aspirin group (n =132) and the Shenxiong glucose injection + aspirin group (n =131).At baseline,the maximum aggregation rate of platelet induced by arachidonic acid and platelet activating factor in Shenxiong glucose injection + aspirin group was significantly higher than that in the aspirin group (all P ＜0.05).On the 6th day after treatment,the maximum aggregation rate of platelets induced by the 4 aggregating agents in the Shenxiong glucose injection + aspirin group was significantly lower than that in the aspirin group (all P ＜ 0.001).Conclusion Shenxiong glucose injection had a significant inhibitory effect on platelet reactivity during aspkin treatment in patients with acute ischemic stroke.
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Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a main question on treatment failure.Current strategies for management that usually include salvage chemotherapy,donor lymphocytic infusion and second transplantation.Our study assessed the efficacy of decitabine (DAC) for treating patients with acute lymphoblastic leukemia (ALL) who relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT).We retrospectively analyzed the outcomes of 12 patients with relapsed ALL after allo-HSCT who received DAC therapy.Nine patients received DAC combined with chemotherapy and donor stem cell infusion,and 3 patients received single-agent DAC.Ten of the 12 patients achieved complete remission (CR),1 achieved a partial remission (PR),and 1 had no response (NR) after treatment at the latest follow-up (LFU),the median survival was 11.2 months (range,3.8-34,7 months).The 1-and 2-year overall survival (OS) rates were 50％ (6/12) and 25％ (3/12),respectively.Five patients were still alive;4 had maintained CR and 1 was alive with disease.Patients with Philadelphia chromosome-positive ALL had higher survival rate than patients with Philadelphia chromosome-negative ALL (57.1％ vs.20％).No aggravated flares of graft-versus-host disease (GVHD) were observed during DAC treatment.Therefore,DAC may be a promising therapeutic agent for ALL recurrence after allo-HSCT.
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BACKGROUND: Previous studies have found that electroacupuncture (EA) could effectively inhibit the expression of p38 and Fas mRNA mediated by MAPK signaling pathways, to further inhibit the apoptosis of chondrocytes. Meanwhile,EA delays the degeneration of articular cartilage mediated by JAK-STAT signaling pathway through upregulating the expression levels of transforming growth factor β1 as well as the mRNA expression levels of STAT3, Smad3 and LepR.OBJECTIVE: To explore the effect of EA on the cartilage ultrastructure and mRNA expression levels of Ras, Raf,MEK1/2 and ERK1/2 in the rat with knee osteoarthritis.METHODS: The rat models of knee osteoarthritis were established, and randomized into four groups at 2 weeks after modeling: model group received no interventions; 15- and 30-minute EA groups were given EA at the Hsiyen (medical,extra) of bilateral knee joints for 15 and 30 minutes, respectively; PD98059 group was given the intravenous injection of extracellular signal-regulated kinase inhibitor PD98059. The intervention time was 3 months. Those rats received normal feeding served as blank control group.RESULTS AND CONCLUSION: Transmission electron microscopy showed that compared with the model group, the chondrocytes in the 15- and 30-minute EA and PD98059 groups changed little, the nucleus was larger, partial endoplasmic reticulum cisterna expanded, and the mitochondria structure was clear. ELISA results showed that the 15-and 30-minute EA and PD98059 groups had a significant decrease in the level of tumor necrosis factor α compared with the model group (P < 0.01). RT-PCR revealed that the mRNA expression levels of Ras, Raf, MEK1/2 and ERK1/2 in the 15- and 30-minute EA and PD98059 groups were significantly downregulated (P < 0.05 or P < 0.01). These results indicate that EA can alleviate chondrocyte injury in the rat osteoarthritic model, reduce the level of tumor necrosis factor α in the synovium, and downregulated the expression levels of Ras, Raf, MEK1/2 and ERK1/2 mRNA, further delaying the chondrocyte degeneration in osteoarthritis.
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Objective To evaluate the value of proton magnetic resonance spectrum (1H-MRS) in the differential diagnosis of Alzheimer's disease (AD) and vascular dementia (VD) patients with white matter lesions (WMLs).Methods Multi voxel 1H-MRS were performed to 30 patients with AD,30 patients with VD,and 30 normal control volunteers.The levels of the N-acetylaspartate (NAA),myo-inositol (mI),glutamate (Glu),and creatine (Cr) were measured in the white matter adjacent to the lateral ventricles.The ratios of NAA/Cr,mI/Cr and Glu/Cr were calculated and compared among the group.Comparisons of the 1H-MRS indexes among AD,VD and NC group were conducted by one-way ANOVA.Results NAA/Cr ratios of the region of interesting in AD (1.59±0.15)and VD(1.53±0.12) group were significantly decreased compared with NC (1.79±0.22)group (P＜0.05),and Glu/Cr ratios of the region of interesting in AD(0.41±0.03) and VD(0.49±0.04) group were significantly decreased compared with NC(0.57±0.05) group (P＜0.05).However,there were not significant differences for NAA/Cr ratios of the paraventricular white matter region between AD and VD group (P＞0.05),and Glu/Cr ratios in AD and VD groups were significantly different (P＜0.05).A significantly increased mI/Cr was found in AD (0.68±0.05) group than in VD(0.57±0.04) and NC(0.55±0.03) groups (P＜0.05),and there were no significant changes in mI/Cr ratios between VD and NC groups (P＞0.05).Conciusion Multi-voxel 1H-MRS is an effective method in the differential diagnosis of dementia,and changes of the mI/Cr and Glu/Cr ratios of the white matter adjacent to the lateral ventricles may help to identify the AD and VD patients.
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Breviscapine, a flavone glucuronide, is a cardiovascular medicine extracted from a Chinese herb Erigeron breviscapinus. Modern pharmacological research shows breviscapine has a therapeutic effect on cardiovascular diseases such as cerebral thrombus,cerebral ischemia hemiparesis and platelet aggregation et al. However, its poor water solubility and low bioavailability in vivo severely restrict the clinical application. In this article, we reviewed the marketing preparations of breviscapine and its research progress on the new dosage forms.
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Humans , Biomedical Research , Brain Ischemia , Drug Therapy , Dose-Response Relationship, Drug , Drugs, Chinese Herbal , Economics , Flavonoids , EconomicsABSTRACT
<p><b>OBJECTIVE</b>Calibrated Automated Thrombogram(CAT) is a test to monitor the generation of thrombin. It can be described by four parameters: lag time, peak thrombin, endogenous thrombin potential (ETP) and time to peak (ttPeak). This study aims to determine the normal ranges of CAT parameters in Chinese, and evaluate whether thrombin generation is correlated with the concentration of heparin/low molecular weight heparin.</p><p><b>METHODS</b>Plasma from 120 healthy subjects were collected to determine the normal rangea of CAT parameters in Chinese. Normal plasma pool (NPP, n=25) spiked with different concentrations of heparin or enoxaparin were used to detecte CAT parameters. The overall and age specific normal ranges of CAT parameters were calculated using descriptive statistics method with mean±2SD. The correlation between CAT parameters and age or concentrations of heparin, enoxaparin were analyzed with linear regression model.</p><p><b>RESULTS</b>The normal ranges for lag time, peak thrombin, ETP, ttPeak in the subjects were 3.648±2.465 min, 367.39±151.93 nmol/L, 2277±1030 nmol/L•min and 6.372±4.280 min respectively. Age was linearly correlated with lag time (r=-0.6583, P<0.0001), peak thrombin (r=0.4863, P<0.0001), ETP (r=0.3608, P<0.0014) and ttPeak (r=-0.6313, P<0.0001). The values of ETP/peak ratio were linearly correlated with concentrations of heparin.</p><p><b>CONCLUSION</b>The normal ranges of four CAT parameters for Chinese were determined. CAT parameters are associated with age. ETP/peak ratio could be used to monitor the process of anticoagulation therapy.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Aging , Blood , Asian People , Blood Coagulation Tests , Reference Standards , China , Healthy Volunteers , Heparin , Reference Values , ThrombinABSTRACT
Middle cerebral artery occlusion model with suture-occluded method in rats is widely regarded as the standard animal model of focal cerebral ischemia .In the process of preparation , it is easy to be influenced by multiple factors;among them the successful operation plays a key role .This article summarized from several aspects , such as the anatomic locations of the major arteries in the rat ’ s neck , where to perform the incision , which side to perform the operation and where to insert the suture .
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BACKGROUND: Atypical spinal tuberculosis (TB) usually presents in a slowly indolent manner with nonspecific clinical presentations making the diagnosis a great challenge for physicians. New technologies for the detection of atypical spinal TB are urgently needed. The aim of this study was to assess the diagnostic value of an enzyme-linked immunospot (ELISPOT) assay in clinically suspected cases of atypical spinal TB in China. METHODS: From March 2011 to September 2012, a total of 65 patients with suspected atypical spinal TB were enrolled. In addition to conventional tests for TB, we used ELISPOT assays to measure the IFN-I response to ESAT-γ and CFP-10 in T-cells in samples of peripheral blood mononuclear cells. Patients with suspected atypical spinal TB were classified by diagnostic category. Data on clinical characteristics of the patients and conventional laboratory results were collected. RESULTS: Out of 65 patients, 4 were excluded from the study. 18 (29.5%) subjects had cultureconfirmed TB, 11 (18.0%) subjects had probable TB, and the remaining 32 (52.5%) subjects did not have TB. Generally, the features of atypical spinal TB include the following aspects: (1) worm-eaten destruction of vertebral endplate; (2) destruction of centricity of the vertebral body or concentric collapse of vertebral body; (3) tuberculous abscess with no identifiable osseous lesion; (4) contiguous or skipped vertebral body destruction. 26 patients with atypical spinal TB had available biopsy or surgical specimens for histopathologic examination and 23 (88.5%) specimens had pathologic features consistent with TB infection. The sensitivities of the PPD skin test and ELISPOT assay for atypical spinal TB were 58.6% and 82.8%, and their specificities were 59.4% and 81.3%, respectively. Malnutrition and age were associated with ELISPOT positivity in atypical spinal TB patients. CONCLUSIONS: The ELISPOT assay is a useful adjunct to current tests for diagnosis of atypical spinal TB.
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Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Enzyme-Linked Immunospot Assay , Mycobacterium tuberculosis/immunology , Tuberculosis, Spinal/diagnosis , Biopsy , China , Sensitivity and Specificity , Tuberculosis, Spinal/pathologyABSTRACT
<p><b>OBJECTIVE</b>To analyze the genetic characterization of the complete genome from a human coxsackievirus B3 strain A103/KM/09 isolated in Yunnan province, 2009.</p><p><b>METHODS</b>By using RT-PCR, all the eight fragments which containing about 1000 nucleotides and covering full viral genome, were sequenced. By using Mega 5.05,Geneious, RDP 3 and SimPlot 3.5.1 software, sequences were aligned with other enterovirus reference sequences. Phylogenetic and recombination analysis were also carried out.</p><p><b>RESULTS</b>The A103/KM/09 isolate genome showed 7389 nucleotides in length , encoding for 2185 amino acids. In the complete genome, the homology of nucleotide and amino acid among the seven coxsackievirus B3 isolates were 81.0%-88.0% and 95.7%-98.0%, respectively. There appeared 81.0% and 95.7% homology when compared with that of Nancy prototype strain. Results from the Phylogenetic analysis showed that the coxsackievirus B3 formed five distinct clades, I-V. Nucleotide divergence rates between clades were 16.2%-24.3% . The A103/KM/09 strain belonged to clade V. Clade V was further divided into four sub-clades,A-D. The nucleotide divergence between sub-clades was 4.3%-11.4%. Putative recombinant event for A103/ KM/09 was detected.</p><p><b>CONCLUSION</b>All coxsackievirus B3 isolates could be divided into five clades, with A103/KM/09 strain belonged to Clade V-D. Evolution of coxsackievirus B3 had occurred in China.</p>
Subject(s)
Child, Preschool , Humans , Male , Base Sequence , China , Epidemiology , Encephalitis, Viral , Epidemiology , Virology , Enterovirus B, Human , Genetics , Enterovirus Infections , Epidemiology , Virology , Genome, Viral , Phylogeny , Viral Proteins , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To investigate the relationship between colorectal adenocarcinoma with invasive micropapillary carcinoma (IMPC) component, lymphovascular invasion, and lymph node metastasis.</p><p><b>METHODS</b>One hundred and thirty one cases of colorectal adenocarcinoma with invasive micropapillary carcinoma component were evaluated by H&E and immunohistochemical staining. The main pathological features, percentage of IMPC component, lymphovascular invasion, and lymph node metastasis were assessed and compared to 296 cases of conventional colorectal adenocarcinoma.</p><p><b>RESULTS</b>The maximum diameter of the tumors of the IMPC group was significantly lower than the conventional group. The degree of differentiation, the lymph node metastatic rate, the average number of metastatic lymph nodes, the number of cases with lymphovascular tumor emboli were significantly higher in the IMPC group (P = 0.000). The rate of distant metastasis at operation was higher in the IMPC group (14.5%) compared to the conventional group (10.8%) even though statistical significance was not achieved (P = 0.278) . In IMPC group, as the IMPC component increased, the rate of lymph node metastasis also showed an increasing trend. The rate of lymph node metastasis were 53.0% (157/296) , 67.7% (42/62) and 85.5% (59/69) " respectively" for conventional adenocarcinoma, adenocarcinoma with ≤ 10% IMPC component and adenocarcinoma with > 10% IMPC component; the difference was statistically significant (P = 0.000).</p><p><b>CONCLUSIONS</b>Compared to conventional colorectal adenocarcinomas, the colorectal carcinomas with IMPC component show a significantly higher rate of lymphovascular invasion, lymph node metastasis and distant metastasis. The percentage of IMPC component in colorectal adenocarcinoma is significantly correlated to the rate of lymph node metastasis. Therefore, presence of IMPC component and degree of tumor differentiation are predicting factors of lymph node metastasis.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Adenocarcinoma , Metabolism , Pathology , Cadherins , Metabolism , Carcinoma, Papillary , Metabolism , Pathology , Colorectal Neoplasms , Metabolism , Pathology , Lymphatic Metastasis , Mucin-1 , Metabolism , Neoplasm Metastasis , Tumor BurdenABSTRACT
<p><b>BACKGROUND</b>Elevated fibrinogen (Fg) level is a known risk factor for ischemic stroke. There are few clinical trials on oral fibrinogen-depleting therapies for secondary ischemic stroke prevention. We aimed to assess the effects of one-year therapy with oral lumbrokinase enteric-coated capsules on secondary ischemic stroke prevention.</p><p><b>METHODS</b>This is a multicenter, randomized, parallel group and controlled study that began treatment in hospitalized patients with ischemic stroke and continued for 12 months. Patients were randomized to either the control group that received the standard stroke treatment or the fibrinogen-depleting group that received the standard stroke treatment plus enteric-coated lumbrokinase capsules. The NIH Stroke Scale scores (NIHSSs) and plasma Fg level were recorded. The carotid artery intima-media thickness (IMT) and status of plaques were examined through carotid ultrasound examination. Primary outcomes included all-cause mortality, any event of recurrent ischemic stroke/transient ischemic attack (TIA), hemorrhagic stroke, myocardial infarction and angina, and other noncerebral ischemia or hemorrhage. Kaplan-Meier survival analysis and the Long-rank test were used to compare total vascular end point incidence between the two groups. Comparison of median values between two groups was done by the Student t test, one-way analysis of variance (ANOVA), or non-parametric rank sum test.</p><p><b>RESULTS</b>A total of 310 patients were enrolled, 192 patients in the treatment group and 118 patients in the control group. Compared to the control group, the treatment group showed favorable outcomes in the Fg level, carotid IMT, the detection rate of vulnerable plaques, the volume of carotid plaques, NIHSS scores, and incidence of total vascular (6.78% and 2.08%, respectively) and cerebral vascular events (5.93% and 1.04%, respectively) (P < 0.05). In the treatment group, the volume of carotid plaques was significantly related to the carotid IMT, the plaque diameter, width and number (P = 0.000, 0.000, 0.000, 0.022; F = 13.51, 2.52, 11.33, -3.29, but there was a weak correlation with the Fg level (P = 0.056). After 1-year therapy, the incidence of overall vascular end points was reduced by 4.7%.</p><p><b>CONCLUSION</b>Long-term oral fibrinogen-depleting therapy may be beneficial for secondary ischemic stroke prevention.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Administration, Oral , Carotid Intima-Media Thickness , Endopeptidases , Therapeutic Uses , Fibrinogen , Metabolism , Secondary Prevention , StrokeABSTRACT
<p><b>OBJECTIVE</b>To explore the efficacy and prognosis of first-line autologous hematopoietic stem cell transplantation (ASCT) for newly diagnosed patients with multiple myeloma(MM).</p><p><b>METHODS</b>From January 2005 to December 31, 2012, 60 patients with MM were enrolled. All patients received thalidomide or/and bortezomib-based induction therapy, then received high-dose melphalan (200 mg/m²) and autologous stem cell support to get a ≥ partial response (PR), and followed by thalidomide-dexamethasone (TD) ±bortezomib as consolidation or maintenance treatment. With the follow up to December 31, 2012, the overall survival (OS), progression free survival (PFS) and the prognostic factors, including ISS stage, response and fluorescent in situ hybridization (FISH) data of cytogenetics were analyzed.</p><p><b>RESULTS</b>With a median follow up of 36.8 (12.0-102.5) months, the median OS and PFS estimate were not reached and 86.5 months, respectively. After transplantation, all (100%) patients received very good partial response (VGPR), and 34 (56.7%) patients achieved complete response (CR) after consolidation or maintenance treatment. The patients that achieved CR resulted in long term PFS (P=0.030), with no difference in OS (P=0.942). The univariate analysis showed that the abnormalities, including 13q14 deletion, 1q21 gain, IgH location and p53 deletion had the prognostic impacts. If the t(4;14) or p53 deletion was excluded, there would be no correlation between 13q14 deletion or 1q21 gain with PFS and OS. The patients with p53 deletion had a worst survival.</p><p><b>CONCLUSION</b>There has been significant improvement in the outcome for young MM patients by using ASCT and novel drugs. Cytogenetic abnormalities and response to therapy are the main factors affecting the survival of patients.</p>