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ObjectiveTo investigate the characteristics of traditional Chinese medicine syndrome and the evolution of pathogenesis in different stages of atherosclerotic thrombotic cerebral infarction （ATCI）. MethodsClinical data of 3088 ATCI patients from 8 hospitals in 6 provinces and cities were collected from the hospital information system during January 1， 2015 to December 31， 2019. After staging and counting clinical symptoms， common factors were extracted using the principal component analysis method in factor analysis. Cluster analysis was then carried out on the basis of the factor analysis. The results of the combination of the evidence element identification， cluster analysis and expert discussion were used to discuss the evidence of the different disease stages of atherosclerotic cerebral infarction. ResultsOf the 3088 ATCI patients included， 2290 cases were in the acute phase and 798 in the non-acute phase. Excluding the main symptoms of ischaemic stroke， such as numbness and weakness of limbs， unfavourable movement， unfavourable speech and dizziness， we identified 84 indicators with a frequency ≥5% of the four diagnostic information variables. Of these， 36 indicators were observed in the acute phase and 35 in the non-acute phase. Factor analysis extracted 14 common factors from each phase. We selected factors with a loading coefficient ＞0.3 for evidence determination. These 14 groups of common factors were used as variables for clustering. After clustering， the acute， non-acute phase were each divided into 5 categories. Based on a combination of clinical practice and expert opinion， the symptoms identified in the acute period were syndrome of deficiency of both qi and yin， syndrome of blockade of wind-phlegm-static blood （36.07%）， syndrome of qi deficiency and blood stasis （20.74%）， syndrome of upward disturbance of wind-fire （15.15%）， syndrome of stirring wind due to yin deficiency （9.43%）， and syndrome of spleen deficiency and liver hyperactivity （3.80%）. In the non-acute phase， the symptoms were qi and yin deficiency with syndrome of qi stagnation and blood stasis （45.49%）， syndrome of deficiency of both qi and yin （20.05%）， syndrome of qi stagnation and blood stasis （16.42%）， spleen-kidney deficiency syndrome （8.52%）， and syndrome of hyperactivity of liver yang （4.89%）. ConclusionThe acute phase of AICI is mainly characterized by blood stasis， fire， internal wind， hyperactivity of yang， qi deficiency and yin deficiency， while the non-acute phase is characterized by yin deficiency， qi deficiency， blood stasis and qi stagnation. The main pathomechanism of ATCI involves deficiency of qi and yin， as well as obstruction of the channels by phlegm and blood stasis， and the fundamental pathomechanism is deficiency of qi and yin.
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Objective:To investigate the clinical characteristics of the severe trauma patients with Acute kidney injury (AKI) ,and analyze the risk factors and clinical prognosis.Methods:Clinical data of severe trauma patients admitted to ICU of Xiaolan Hospital of Southern Medical University, from July 2018 to December 2020 were retrospectively analyzed. Demographic data, basic diseases, critical disease score, serum creatinine, hemoglobin, treatment options, blood transfusion volume, and clinical outcomes were collected to establish a clinical database. AKI was diagnosed and graded according to the Kidney Disease Improving Global Outcomes (KDIGO) criterion, and trauma type was classified according to the main injury part. The clinical data and laboratory examination of different groups were compared to analyze the clinical characteristics and prognosis in severe trauma patients. The risk factors of AKI in severe trauma patients were analyzed by Logistic regression.Results:(1) A total of 175 patients with severe trauma were eligible for inclusion, and the incidence of AKI was 30.9%(54/175), including 29 patients with AKI stage 1(16.6%), 15 patients with AKI stage 2 (8.6%), and 10 patients with AKI stage 3 (5.7%). In the cohort, the rate of in-hospital renal replacement therapy was 4%, in-hospital mortality was 5.7%, and 28-day mortality was 16.6%. (2) The age, shock patients, ICU admission serum creatinine, APACHEⅡscore and ISS score of AKI group were significantly higher than those of non-AKI group ( P<0.05). There were no significant differences between the two groups in gender, underlying diseases (hypertension and diabetes), ICU admission hemoglobin level and contrast agent utilization rate( P>0.05). Compared with the non-AKI group, AKI group had higher rates of surgical treatment (63% vs. 44.6%), more blood transfusion [875(720,1110)mL & 670(610,750)mL], longer ICU stay [6(4,11)d & 4(2.5,7.5)d], and higher rates of mechanical ventilation (96.3% vs. 81%), renal replacement therapy rate (13% vs. 0), in-hospital mortality (13% vs. 2.5%) and 28-day mortality (25.9% vs. 12.4%), the differences were statistically significant ( P<0.05). (3) The incidence of AKI was different in patients with different types of severe trauma, and the abdominal trauma group with a highest rate (50%). The serum creatinine at ICU admission and the peak value during hospitalization in abdominal trauma group were significantly higher than those in other injury types ( P<0.05). (4) Logistic regression analysis showed Age [ OR=1.020, 95% CI(1.003,1.038), P=0.024], APACHEⅡscore [ OR=1.137, 95% CI(1.053,1.228), P=0.001], shock [ OR=1.102, 95% CI(0.906,1.208), P=0.034], ICU admission serum creatinine [ OR=1.068, 95% CI(1.036,1.102), P=0.000], surgical treatment [ OR=4.205, 95% CI(1.446,12.233), P=0.008], blood transfusion volume [ OR=1.006, 95% CI(1.002,1.009), P=0.001] were independent risk factors for AKI in severe trauma patients. Conclusions:Severe trauma patients yield a high incidence of AKI influencing clinical prognosis. The incidence of AKI varies with different types of severe trauma. Age, APACHEⅡscore, shock, ICU admission serum creatinine, surgical treatment, and blood transfusion volume are independent risk factors for AKI in severe trauma patients.
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Objective:To investigate the clinical value of neuron specific enolase (NSE) and bispectral index (BIS ) in predicting the neurological prognosis in patients with severe intracerebral hemorrhage.Methods:Patients with severe intracerebral hemorrhage admitted to the ICU of Xiaolan Hospital of Southern Medical University from January 2019 to December 2020 were selected, and serum NSE detection and BIS monitoring were performed at an early stage. According to the Glasgow outcome scale (GOS) at 90 days after intracerebral hemorrhage, the patients were divided into the good neurologic prognosis group (GOS 4-5) and poor neurologic prognosis group (GOS 1-3). The levels of NSE and BIS between the two groups were compared. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive value of NSE, BIS and their combination in predicting neurological prognosis.Results:A total of 126 patients with severe intracerebral hemorrhage were enrolled in this study, and 32 patients (25.4%) had poor neurological prognosis. The level of NSC in the poor neurological prognosis group was significantly higher than that in the good neurologic prognosis group [28 (13.7, 50.4) ng/mL vs. 13.5 (9.6, 18.5) ng/mL, P < 0.05], while the BIS level was significantly lower than that in the good neurologic prognosis group [32 (25.2, 45) vs. 55 (48, 62.2), P <0.05]. For detection of poor neurologic outcome in patients with severe intracerebral hemorrhage, NSE and BIS yielded the AUC values of 0.768 (0.685, 0.839) and 0.866 (0.793, 0.920), respectively, with cut-off values of 21.7 ng/mL and 47, respectively. The combination of NSE and BIS yielded a remarkably higher AUC value of 0.927 (0.867, 0.966) for predicting poor neurologic outcome than each index alone ( P<0.05). Conclusions:Early monitoring of NSE and BIS can effectively predict the neurological prognosis of patients with severe intracerebral hemorrhage, and the combination of NSE and BIS can further improve the prediction efficiency.
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Endothelial cell injury is a major contributor to cardiovascular diseases.The 2,3,5,4’-Tetrahydroxystilbene-2-O-β-D-Glucoside (TSG) contributes to alleviate human umbilical vein endothelial cells (HUVECs) injury through mechanisms still know a little. This study aims to clarify the TSG effects on gene expression (mRNA and microRNA) related to oxidative stress and endoplasmic reticulum stress induced by H2O2 in HUVECs. We found that TSG significantly reduced the death rate of cells and increased intracellular superoxide dismutase activity. At qRT-PCR, experimental data showed that TSG significantly counteracted the expressions of miR-9-5p, miR-16, miR-21, miR-29b, miR-145-5p, and miR-204-5p. Besides, TSG prevented the expression of ATF6 and CHOP increasing. In contrast, TSG promoted the expression of E2F1. In conclusion, our results point to the obvious protective effect of TSG on HUVECs injury induced by H2O2, and the mechanism may through miR16/ATF6/ E2F1 signaling pathway.
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Objective:To construct and evaluate a decision tree based on biomarkers for predicting severe acute kidney injury (AKI) in critical patients.Methods:A prospectively study was conducted. Critical patients who had been admitted to the department of critical care medicine of Xiaolan Hospital of Southern Medical University from January 2017 to June 2018 were enrolled. The clinical data of the patients were recorded, and the biomarkers, including serum cystatin C (sCys C) and urinary N-acetyl-β-D-glucosaminidase (uNAG) were established immediately after admission to intensive care unit (ICU), and the end points were recorded. The test cohort was established with patient data from January to December 2017. The decision tree classification and regression tree (CART) algorithm was used, and the best cut-off values of biomarkers were used as the decision node to construct a biomarker decision tree model for predicting severe AKI. The accuracy of the decision tree model was evaluated by the overall accuracy and the receiver operating characteristic (ROC) curve. The validation cohort, established on patient data from January to June 2018, was used to further validate the accuracy and predictive ability of the decision tree.Results:In test cohort, 263 patients were enrolled, of whom 57 developed severe AKI [defined as phase 2 and 3 of Kidney Disease: Improving Global Outcomes (KDIGO) criterion]. Compared with patients without severe AKI, severe AKI patients were older [years old: 64 (49, 74) vs. 52 (41, 66)], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were higher [23 (19, 27) vs. 15 (11, 20)], the incidence of hypertension, diabetes and other basic diseases and sepsis were higher (64.9% vs. 40.3%, 28.1% vs. 10.7%, 63.2% vs. 29.6%), the levels of sCys C and uNAG were higher [sCys C (mg/L): 1.38 (1.12, 2.02) vs. 0.79 (0.67, 0.98), uNAG (U/mmol Cr): 5.91 (2.43, 10.68) vs. 2.72 (1.60, 3.90)], hospital mortality and 90-day mortality were higher (21.1% vs. 4.4%, 52.6% vs. 13.1%), the length of ICU stay was longer [days: 6.0 (4.0, 9.5) vs. 3.0 (1.0, 6.0)], and renal replacement therapy requirement was higher (22.8% vs. 1.9%), with statistically significant differences (all P < 0.05). ROC curve analysis showed that the areas under ROC curve (AUC) of sCys C and uNAG in predicting severe AKI were 0.857 [95% confidence interval (95% CI) was 0.809-0.897) ] and 0.735 (95% CI was 0.678-0.788), and the best cut-off values were 1.05 mg/L and 5.39 U/mmol Cr, respectively. The structure of the biomarker decision tree model constructed by biomarkers were intuitive. The overall accuracy in predicting severe AKI was 86.0%, and AUC was 0.905 (95% CI was 0.863-0.937), the sensitivity was 0.912, and the specificity was 0.796. In validation cohort of 130 patients, this decision tree yielded an excellent AUC of 0.909 (95% CI was 0.846-0.952), the sensitivity was 0.906, and the specificity was 0.816, with an overall accuracy of 81.0%. Conclusion:The decision tree model based on biomarkers for predicting severe AKI in critical patients is highly accurate, intuitive and executable, which is helpful for clinical judgment and decision.
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Endothelial cell injury is a major contributor to cardiovascular diseases.The 2,3,5,4’-Tetrahydroxystilbene-2-O-β-D-Glucoside (TSG) contributes to alleviate human umbilical vein endothelial cells (HUVECs) injury through mechanisms still know a little. This study aims to clarify the TSG effects on gene expression (mRNA and microRNA) related to oxidative stress and endoplasmic reticulum stress induced by H2O2 in HUVECs. We found that TSG significantly reduced the death rate of cells and increased intracellular superoxide dismutase activity. At qRT-PCR, experimental data showed that TSG significantly counteracted the expressions of miR-9-5p, miR-16, miR-21, miR-29b, miR-145-5p, and miR-204-5p. Besides, TSG prevented the expression of ATF6 and CHOP increasing. In contrast, TSG promoted the expression of E2F1. In conclusion, our results point to the obvious protective effect of TSG on HUVECs injury induced by H2O2, and the mechanism may through miR16/ATF6/ E2F1 signaling pathway.
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Objective@#To compare the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for paroxysmal nocturnal hemoglobinuria (PNH) with paroxysmal nocturnal hemoglobinuria-aplastic anemia (PNH-AA) syndrome.@*Methods@#The outcomes of 46 patients who received allo-HSCT (16 PNH patients, 30 PNH-AA patients) from July 10, 2007 to June 2, 2018 were analyzed retrospectively. The conditioning regimen was busulfan, cyclophosphoramide, and ATG in haploidentical donors and unrelated donors. Patients with matched sibling donors were treated with the fludarabine, cyclophosphamide, and ATG regimen.@*Results@#There were no differences of baseline data between the 2 groups except gender distribution and the numbers of haploidentical donor transplantation. The median values of absolute nucleated cell counts were 10.58 (3.83-13.83) ×108/kg in the PNH group and 10.81 (3.96-33.40) ×108/kg in the PNH-AA group (P=0.668) . The median doses of CD34+ cells infused were 5.00 (3.14-8.42) ×106/kg and 3.57 (1.97-6.17) ×106/kg (P=0.002) , respectively. All patients obtained complete engraftment. The median time for myeloid engraftment were 11 (7-14) days in the PNH group and 12 (10-26) days in the PNH-AA group (P=0.003) . The median time for platelet engraftment were 13 (11-16) days and 18 (12-75) days (P=0.002) , respectively, after a median follow-up of 36 (4-132) months in the PNH group and 26 (4-75) months in the PNH-AA group (P=0.428) . There were no differences of incidence rates of acute graft-versus-host disease (aGVHD) , chronic GVHD and infection between PNH and PNH-AA groups (P>0.05) . No patient occurred early death and relapse. The estimated 3-year overall survival (OS) of PNH and PNH-AA groups were (100.0±0.0) % and (85.7± 6.6) % (P=0.141) , GVHD-free and failure-free survival (GFFS) were (100.0±0.0) %, (78.7±7.7) % (P=0.067) .@*Conclusions@#allo-HSCT is effective for patients with PNH and PNH-AA syndrome. The preliminary results indicate that myeloid and platelet engraftment in PNH group were faster than PNH-AA group. There were no differences in OS and GFFS between PNH group and PNH-AA group.
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Objective@#To compare the outcomes between haploidentical donor hematopoietic stem cell transplantation (haplo-HSCT) and matched-sibling donor transplantation (MSD-HSCT) for paroxysmal nocturnal hemoglobinuria (PNH) .@*Methods@#The clinical data of 40 PNH patients received HSCT (haplo-HSCT=25, MSD-HSCT=15) from July 2007 to May 2018 were analyzed retrospectively to compare the outcomes between haplo-HSCT and MSD-HSCT groups.@*Results@#There were no differences in terms of gender, age, patients of PNH-AA and median time from diagnosis to transplantation between the 2 groups (P>0.05) . The median values of absolute mononuclear cell counts and CD34+ cells infused were 10.74 (4.80-22.86) ×108/kg and 12.19 (5.14-17.25) ×108/kg (P=0.866) , 3.57 (0.68-7.80) ×106/kg and 4.00 (3.02-8.42) ×106/kg (P=0.151) respectively, in haplo-HSCT and MSD-HSCT groups. All patients attained complete engraftment, no patient occurred graft failure. The median durations for myeloid and platelet engraftment were 12 (range, 9-26) and 11 (range, 7-15) days (P=0.065) , 19 (range, 11-75) and 13 (range, 11-25) days (P=0.027) respectively, in haplo-HSCT and MSD-HSCT groups. During a median follow-up of 26 (4-65) months in haplo-HSCT and 36 (4-132) months in MSD-HSCT groups (P=0.294) , the incidences of grade Ⅰ-Ⅳ acute graft-versus-host disease (aGVHD) were 32.0% and 20.0% (P=0.343) , grade Ⅱ-Ⅳ aGVHD were 16.0%, 13.3% (P=0.759) , chronic GVHD were 30.7% and 24.6% (P=0.418) , moderate-severe chronic GVHD were 12.7% and 7.1% (P=0.522) respectively, in haplo-HSCT and MSD-HSCT groups. The incidences of infection were 32.0% (8/25) and 26.7% (4/15) (P=1.000) respectively, in haplo-HSCT and MSD-HSCT groups. No patients occurred early death and relapse. Three-year estimated overall survival (OS) were (86.5±7.3) % and (93.3 ±6.4) % (P=0.520) , GVHD-free and failure-free survival (GFFS) were (78.3±8.6) % and (92.9±6.9) % (P=0.250) respectively, in haplo-HSCT and MSD-HSCT groups.@*Conclusion@#The preliminary results indicated that haplo-HSCT was a feasible choice for PNH with favorable outcomes, haplo-HSCT and MSD-HSCT produced similar therapeutic efficacy.
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Objective@#To investigate the influence of serum creatinine (sCr) at different time-points on prognosis of critically ill patients with acute kidney injury (AKI).@*Methods@#This study was retrospectively analyzed the clinical data of critical patients with AKI who admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 and January 2016. According to the clinical prognosis, the patients were divided into the renal replacement therapy (RRT) group and non-renal replacement therapy (non-RRT) group, 28-day renal loss group and renal recover group, hospital death group and survival group. Serum Cr at different time-points and clinical data were collected. The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to evaluate the capability of sCr at different time-points in predicting clinical prognosis.@*Results@#During the study, 85 AKI patients were enrolled. The in-hospital mortality was 20%, RRT rate was 15.3%, and renal lose at 28 days after ICU admission was 31.8%. The levels of sCr out of ICU (o-sCr) and the peak of sCr were significantly higher in the RRT group than the non-RRT group (P<0.01). The o-sCr and p-sCr predicted RRT during the hospital stay with a higher AUC value (0.806 vs 0.833) than b-sCr and a-sCr. The levels of b-sCr, a-sCr, o-sCr, and p-sCr were all significantly higher in the28-day renal loss group than the kidney recover group (P<0.01). The levels of o-sCr and p-sCr were significantly higher in the hospital death group than the survival group (P<0.05). The o-sCr predicted renal lose at 28 days and hospital death with the highest AUC value of 0.850 and 0.797, respectively.@*Conclusions@#It cannot be ignored to monitor dynamically the level of sCr at different time-points in critical patients with AKI, which can predict the clinical prognosis such as hospital death, RRT and renal lose at 28 days after ICU admission.
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Objective To investigate the influence of serum creatinine (sCr) at different time-points on prognosis of critically ill patients with acute kidney injury (AKI).Methods This study was retrospectively analyzed the clinical data of critical patients with AKI who admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 and January 2016. According to the clinical prognosis, the patients were divided into the renal replacement therapy (RRT) group and non-renal replacement therapy (non-RRT) group, 28-day renal loss group and renal recover group, hospital death group and survival group. Serum Cr at different time-points and clinical data were collected. The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to evaluate the capability of sCr at different time-points in predicting clinical prognosis.Results During the study, 85 AKI patients were enrolled. The in-hospital mortality was 20％, RRT rate was 15.3％, and renal lose at 28 days after ICU admission was 31.8％. The levels of sCr out of ICU (o-sCr) and the peak of sCr were significantly higher in the RRT group than the non-RRT group (P<0.01). The o-sCr and p-sCr predicted RRT during the hospital stay with a higher AUC value (0.806vs 0.833) than b-sCr and a-sCr. The levels of b-sCr, a-sCr, o-sCr, and p-sCr were all significantly higher in the28-day renal loss group than the kidney recover group (P<0.01). The levels of o-sCr and p-sCr were significantly higher in the hospital death group than the survival group (P<0.05). The o-sCr predicted renal lose at 28 days and hospital death with the highest AUC value of 0.850 and 0.797, respectively.Conclusions It cannot be ignored to monitor dynamically the level of sCr at different time-points in critical patients with AKI, which can predict the clinical prognosis such as hospital death, RRT and renal lose at 28 days after ICU admission.
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<p><b>OBJECTIVE</b>To observe the multiple symptom distribution, severity and quality of life of female pelvic floor dysfunction(FPFD) patients with constipation as chief complaint.</p><p><b>METHODS</b>One hundred FPFD patients with constipation as chief complaint from Speciaty Outpatient Clinic, Pelvic Floor Center of Nanjing Municipal Hospital of Traditional Chinese Medicine between September 2015 and February 2017 were retrospectively enrolled in this study. A comprehensive medical history questionnaire survey and systematical evaluation of severity and quality of life of these patients with constipation was conducted. Constipation scoring system scale (CSS) and patient-assessment of constipation quality of life questionnaire (PAC-QOL) were applied to evaluate the constipation. Other scales included: (1)pain visual analogue scale (VAS) and short form-36 questionnaire (SF-36): if combined with chronic functional anal rectal pain; (2) international consultation on incontinence questionnaire-short form (ICIQ-SF) and urinary incontinence quality of life questionnaires (I-QOL):if combined with urinary incontinence; (3) fecal incontinence severity score scale (Wexner-FIS) and fecal incontinence quality of life questionnaire (FI-QOL):if combined with fecal incontinence.</p><p><b>RESULTS</b>The mean age of 100 FPFD patients was (57.9±13.9) (24-89) years and the mean disease course was (7.0±8.2)(0.5-40.0) years. Seventy-five cases (75%) were complicated with anal pain, 70 with urinary incontinence, 37 with rectocele, 19 with nocturia, 11 with urinary frequency, 10 with defecation incontinence. Complication with only one symptom was observed in 20 cases (20%), and with two or more symptoms was observed in 80 cases (80%). Pelvic floor relaxation syndrome patients were dominant (58 cases, 58%). The severity of constipation (CSS) was 6-22 (13.89±3.79) points and the quality of life (PAC-QOL) was 45-133 (87.13±18.57) points in FPFD patients. VAS and SF-36 of patients combined with chronic functional anal rectal pain were 1-8 (3.0±1.9) points and 14.4-137.0(71.5±31.4) points respectively. ICIQ-SF and I-QOL of patients combined with urinary incontinence were 1-17 (6.1±3.6) points and 52-110 (90.0±15.8) points respectively. Wexner-FIS and FI-QOL of patients combined with fecal incontinence were 1-11 (4.4±3.0) points and 52-116 (83.4±23.3) points respectively.</p><p><b>CONCLUSIONS</b>The symptoms of FPFD patients with constipation as chief complaint are complex. They are mainly complicated with anal diseases, then urinary incontinence, and mostly with more than 2 symptoms. Their quality of life is poor.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Young Adult , Constipation , Fecal Incontinence , Pelvic Floor , Pelvic Floor Disorders , Diagnosis , Quality of Life , Retrospective Studies , Surveys and QuestionnairesABSTRACT
Objective@#To investigate the survival and prognostic factors of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) for patients with myeloid neoplasms and RUNX1 mutations.@*Methods@#From July 2014 to April 2018, the clinical data of forty-two AML/MDS patients with RUNX1 mutations in the First Affiliated Hospital of Soochow University were retrospectively analyzed. The clinical characteristic features and distribution of the mutations frequently observed with RUNX1 mutations were summarized, the prognosis of allo-HSCT for these patients was also analyzed.@*Results@#Among 42 AML/MDS patients with RUNX1 mutations, 27 were male, 15 were female. The median age was 43.5 (16-68) years old. There are 31 patients in allo-HSCT group and 11 patients in chemotherapy group. RUNX1 mutations co-occurred with many other gene mutations, the most frequent mutations were FLT3 (26.2%, 11/42) . Interestingly, FLT3 mutations only occurred in AML patients compared with MDS patients (P=0.014) . ASXL1 (25%, 3/12) mutations were observed as the most frequent co-mutations in MDS patients. One-year overall survival (OS) , disease-free survival (DFS) of allo-HSCT and chemotherapy patients were (70.6±9.0) %, (61.0±9.4) % and (34.4±16.7) %, (22.4±15.3) %, respectively. When OS and DFS between allo-HSCT and chemotherapy patients were compared, significant differences (χ2=4.843, 4.320, P<0.05) were showed. In univariate analysis, transplant age >45 years was a negative effect for OS [HR=4.819 (95% CI 1.145-20.283) , P=0.032] and DFS [HR=5.945 (95% CI 1.715-20.604) , P=0.005]. Also, complex chromosome karyotype abnormality was a negative effect for OS [HR=5.572 (95%CI 1.104-28.113) , P=0.038].@*Conclusion@#Transplant age (>45 years) and complex chromosome karyotype abnormality were negative prognostic factors in allo-HSCT for myeloid neoplasms patients with RUNX1 mutations.
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Objective@#To evaluate the outcome of combination of haploidentical donor (HID) hematopoietic stem cell transplantation (HSCT) with an unrelated cord blood unit for severe aplastic anemia (SAA).@*Methods@#The clinical data of 127 SAA patients [including 74 male and 53 female patients, 65 very severe aplastic anemia (vSAA), the median age as 23.5(3-54) years] received HID-HSCT from September 2011 to April 2017 were analyzed retrospectively. The median interval from SAA diagnosis to transplantation was 2 (0.5-180) months. The conditioning was modified Bu/Cy+ATG/ALG-based (Busulfan + cyclophosphamide + antithymocyte immunoglobulin/antilymphocyte immunoglobulin) regimen. Cord blood units were selected based on the results of HLA typing and cell doses evaluated before freezing. Units with at least 4/6 matched HLA loci became the candidates. Prophylaxis for graft-versus host disease (GVHD) was by cyclosporine (CsA), mycophenolate mofetil (MMF) plus short-term methotrexate (MTX).@*Results@#The median values of absolute nucleated cell counts were 10.87 (3.61-24.00)×108/kg in the haploidentical grafts and 2.22 (1.10-7.30)×107/kg in the cord blood units, respectively. The median doses of CD34+ cells infused were 3.49(1.02-8.89) ×106/kg in the haploidentical grafts and 0.56 (0.16-2.27) ×105/kg in the cord blood units, respectively. Of the 127 patients, 5 patients occurred early death, one patient occurred primary graft failure. All 121 surviving patients attained complete haploidentical engraftment. The median durations of myeloid engraftment were 11 (9-28) days and 15 (9-330) days for platelets, with a cumulative platelet engraftment incidence of 96.1%. The incidence of infection was 58.27% (74/127). During a median follow-up of 20.5 (4-60) months, the incidence of grade Ⅱ-Ⅳ acute GVHD was 24.79% (30/121), moderate-severe chronic GVHD was 14.15% (15/106), 4-year estimated overall survival was (78.5±4.3) %, 4-year estimated failure-free survival was (77.4±4.3) %, respectively.@*Conclusion@#Combination of HID-HSCT and an unrelated umbilical cord blood unit was a feasible choice with favorable outcome for SAA patients without matched donors.
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Aim Toinvestigatetheeffectofhigh,me-dium and low doses of Mahuang decoction on the re-lease amount of rat hippocampal neural transmitter (Glu,Gly,Asp,GABA),then compare Mahuang de-contion with ephedra alkaloids and ephedra.Methods Ratswererandomlydividedinto6groupsandgiven orally with Mahuang decoction of high dose (calculated by ephedra 4 g·kg-1 ),medium dose (calculated by ephedra 2 g·kg-1 ),low dose (calculated by ephedra 1 g · kg-1 ),ephedra (calculated by ephedra 2 g · kg-1 ),ephedra alkaloids (ephedrine 7 mg · kg-1 , pseudoephedrine 2. 4 mg · kg-1 , methylephedrine 1. 12 mg · kg-1 )and blank control group.Samples were obtained from the hippocampus of conscious rat by microdialysis sampling technique.The content of ami-no acid neurotransmitters in dialysates was detected u-sing the established HPLC-ECD with OPA pre-column derivationmethod.Results Fouraminoacidneuro-transmitters could be well separated in 28 min.High, medium and low doses of Mahuang decoction,ephedra and ephedra alkaloids significantly increased the con-tent of these four amino acid neurotransmitters,com-pared with blank control group (P<0. 05 ).Ephedra alkaloids significantly reduced the levels of inhibitoryamino acid neurotransmitters GABA and Gly in 90 min,compared with the medium dose of Mahuang de-coction.Excitatory neurotransmitters of ASP and Glu in hippocampus showed the trend of increase first and then decrease after oral administration of Mahuang de-coction and ephedra. The levels of Glu and Asp reached peaks from 90 min to 120 min after treatment with Mahuang decoction,and also increased along with dose increase of Mahuang decoction.In comparison with the medium dose of Mahuang decoction group,the level of Glu reached peak at 90 min and 150 min in ephedra alkaloids group and ephedra group respective-ly,and the content of Glu significantly increased at peaktime.Conclusions Increasedcontentofexcita-tory amino acid neurotransmitters (Asp and Glu ) shows positive correlation with the dose of Mahuang de-coction.Other components in Mahuang decoction in-hibits the up-regulation effect of ephedra and ephedra alkaloids on Glu,and promotes the up-regulation effect of ephedra alkaloids on GABA and Gly.
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Objective To evaluate the safety and efficacy of Yinhua Pinggan granule of Qingjie Xuantou lung defense prescription in the treatment of patients with upper respiratory tract infection accompanied by traditional Chinese medicine (TCM) syndrome of pathogen stagnated in lung-defense phase and to explore the best effective dose.Methods A randomized double blinded, positive drug parallel controlled and multicentric clinical trial was conducted, 270 patients with upper respiratory infection were collected from the First Affiliated Hospital of Zhejiang Chinese Medical University, Affiliated Hospital of Jiangxi Medical University, the Second Affiliated Hospital of Tianjin University of TCM, Tongde Hospital of Zhejiang Province, and Fujian Province Institute of TCM, after screening only 242 cases were consistent with the criteria of enrollment into the Per-Protocol Set (PPS) population, and they were divided into three groups: high dose observation group (82 cases), low dose observation group (79 cases) and control group (81 cases). The high and low dose observation groups were treated with Yinhua Pinggan granule (5 g per bag), high dose means once 1 bag orally taken 3 times a day, low dose indicates once 1 bag taken twice a day; the control group was treated with Yinqiao Jiedu granule (5 g per bag) once 1 bag, 3 times a day; the curative effects of the above groups were all evaluated after consecutive oral administration of the drug respectively for 1 therapeutic course (3 days). The main efficacy evaluation indexes included the TCM syndrome total score and the total score of main symptoms of upper respiratory tract infection; the secondary efficacy evaluation indexes included the situations of patients with different scores of main symptoms of fever and chills, and of disappearance of TCM symptoms; the clinical comprehensive therapeutic effect and the changes of proportion of neutrophils were observed and the safety of drugs was evaluated.Results In PPS population, after treatment the TCM syndrome total score and the total score of main symptoms in the control group and the high and low dose observation groups were all significantly lower than those before treatment, on the 3rd day statistical significant differences were shown (4.4±3.9 vs. 15.5±4.6, 3.7±3.2 vs. 15.0±4.3, 3.0±2.7 vs. 15.2±3.9, 2.8±2.6 vs. 9.7±2.7, 2.3±2.1 vs. 9.5±2.5, 2.0±1.9 vs. 9.6±2.4, respectively, all P < 0.01). After treatment for 1 day, the numbers of patients with 6 score in the control group and the high and low dose observation groups were reduced significantly compared with those before treatment in main symptoms of fever with chills (7 vs. 32 cases, 6 vs. 31 cases, 4 vs. 28 cases, respectively); 3 days after treatment, compared with those before treatment, the numbers of patients with main symptoms of fever with chills score being 0 were significantly increased in the above three groups (65, 73, 77 cases vs. 0 cases, respectively), the numbers of patients with the score being 3 were significantly decreased (16 vs. 47 cases, 5 vs. 46 cases, 5 vs. 52 cases, respectively); the control and high dose observation group had no patients with the score being 6, there was only 1 case with the score being 6 in the low dose observation group. The results showed that the treatments of high and low dose observation groups and the control group all could alleviate the clinical symptoms, and the changes of numbers of patients with the scoresbeing 0 and 3 in high and low dose groups were more significant than those in the control group (respectively 73, 77 vs. 65 cases, 5, 5 vs. 16 cases, allP < 0.05), showing that the antipyretic effect of Yinhua Pinggan granule was superior to that of the Yinqiao Jiedu granule. The disappearance rates of fever with chills symptoms in high and low dose observation groups were significantly higher than that in the control group [respectively 93.9% (77/82), 92.4% (73/79) vs. 80.2% (65/81), allP < 0.05]. The TCM syndrome cure and obvious effect rate and effective rate in high and low dose observation groups were higher than those in the control group [respectively 87.80% (72/82), 79.75% (63/79) vs. 74.07% (60/81) and 98.78% (81/82), 96.20% (76/79) vs. 96.30% (78/81)]; the cure and marked effective rate and effective rate of controlling symptoms of upper respiratory tract infection in high and low dose observation groups were higher than those in the control group [respectively 78.05% (64/82), 74.68% (59/79) vs. 65.43% (78/81) and 98.78% (81/82), 96.20% (76/79) vs. 96.30% (78/81)], comparisons of efficacy among the three groups possessed clinical practical significance, but the differences were not statistically significant (allP > 0.05). The percentages of neutrophils in high and low dose observation groups and control group were significantly lower than those before treatment (respectively 0.61±0.08 vs. 0.63±0.08, 0.62±0.08 vs. 0.64±0.08, 0.61±0.09 vs. 0.64±0.09, allP < 0.05). Yinhua Pinggan granule was safe in the prescribed course of treatment and range of therapeutic dose.Conclusions Yinhua Pinggan granule is a safe and effective drug in the treatment of patients with upper respiratory tract infection accompanied by syndrome of pathogen stagnated in lung-defense phase.
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Objective To investigate the influence of Guhong injection (GHI) on ATPase activity and inflammatory response after cerebral ischemia/reperfusion (I/R) injury in rats, and evaluate its protective effects on cerebral I/R injury. Methods Seventy-two male Sprague-Dawley (SD) rats were divided into sham group, I/R group, nimodipine group, and the low-dose (2.5 mL/kg, GHI-L), medium-dose (5.0 mL/kg, GHI-M), and high-dose (10.0 mL/kg, GHI-H) of GHI groups according to the random number table method, with 12 rats in each group. The middle cerebral artery occlusion (MCAO) model was established by the intraluminal suture method to prepare the model of focal cerebral ischemia, and reperfusion was performed after 1.5 hours of occluding the middle cerebral artery; the sham group had the same operation process except inserting the nylon thread. The injection of drug in various drug-treated groups was carried out via a tail vein at 0, 12, 24 hours after the onset of reperfusion, while the sham group and I/R group received the same amount of normal saline. At 12 hours after last drug administration, the scores of neurological deficit symptoms were evaluated; the cerebral infarction was observed by triphenyl tetrazolium chloride (TTC) staining; the Na+-K+-ATPase and Ca2+-ATPase activities in the brain tissue were measured by phosphorus determination; the contents of interleukin-6 (IL-6), monocyte chemotactic factor-1 (MCP-1), nitric oxide (NO) in serum were detected by enzyme linked immunosorbent assay (ELISA). Results Compared with the sham group, the neurological function score was significantly decreased, the cerebral infarction was serious, the activities of ATPase was obviously decreased, and the levels of serum inflammatory factors were significantly increased in I/R group. Compared with the I/R group, the neurological function scores were significantly increased in GHI-L group, GHI-M group, GHI-H group and nimodipine group (9.03±0.63, 10.54±2.55, 12.33±1.87, 12.06±1.89 vs. 8.17±1.05, all P < 0.05), the volumes of cerebral infarction were obviously reduced [(18.51±1.80)%, (15.98±1.34)%, (8.61±1.16)%, (8.09±0.96)% vs. (26.52±2.07)%, all P < 0.01], the activities of ATPase were significantly increased [Na+-K+-ATPase (μmol·mg-1·h-1):5.10±0.30, 5.34±0.26, 6.19±0.17, 5.86±0.31 vs. 3.98±0.35, Ca2+-ATPase (μmol·mg-1·h-1): 3.68±0.44, 4.43±0.29, 5.03±0.27, 4.17±0.30 vs. 1.87±0.46, all P < 0.01], and the levels of serum inflammatory factors were decreased obviously [IL-6 (ng/L): 51.61±5.55, 43.88±4.05, 39.71±2.22, 41.28±2.66 vs. 60.11±6.61, MCP-1 (ng/L): 227.82±7.07, 201.58±13.10, 177.23±10.46, 126.80±8.49 vs. 296.01±12.85, NO (μmol/L): 54.48±3.23, 46.84±2.69, 41.15±2.80, 48.62±2.34 vs. 65.25±3.88, all P < 0.05]. Conclusions GHI not only can improve the energy metabolism of brain tissue in a dose-dependent manner, but also inhibit the inflammatory cascade of damage after cerebral I/R in rats, which might be its protective mechanism on cerebral ischemia injury.
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Objective To investigate the influence of Guhong injection (GHI) on ATPase activity and inflammatory response after cerebral ischemia/reperfusion (I/R) injury in rats, and evaluate its protective effects on cerebral I/R injury. Methods Seventy-two male Sprague-Dawley (SD) rats were divided into sham group, I/R group, nimodipine group, and the low-dose (2.5 mL/kg, GHI-L), medium-dose (5.0 mL/kg, GHI-M), and high-dose (10.0 mL/kg, GHI-H) of GHI groups according to the random number table method, with 12 rats in each group. The middle cerebral artery occlusion (MCAO) model was established by the intraluminal suture method to prepare the model of focal cerebral ischemia, and reperfusion was performed after 1.5 hours of occluding the middle cerebral artery; the sham group had the same operation process except inserting the nylon thread. The injection of drug in various drug-treated groups was carried out via a tail vein at 0, 12, 24 hours after the onset of reperfusion, while the sham group and I/R group received the same amount of normal saline. At 12 hours after last drug administration, the scores of neurological deficit symptoms were evaluated; the cerebral infarction was observed by triphenyl tetrazolium chloride (TTC) staining; the Na+-K+-ATPase and Ca2+-ATPase activities in the brain tissue were measured by phosphorus determination; the contents of interleukin-6 (IL-6), monocyte chemotactic factor-1 (MCP-1), nitric oxide (NO) in serum were detected by enzyme linked immunosorbent assay (ELISA). Results Compared with the sham group, the neurological function score was significantly decreased, the cerebral infarction was serious, the activities of ATPase was obviously decreased, and the levels of serum inflammatory factors were significantly increased in I/R group. Compared with the I/R group, the neurological function scores were significantly increased in GHI-L group, GHI-M group, GHI-H group and nimodipine group (9.03±0.63, 10.54±2.55, 12.33±1.87, 12.06±1.89 vs. 8.17±1.05, all P < 0.05), the volumes of cerebral infarction were obviously reduced [(18.51±1.80)%, (15.98±1.34)%, (8.61±1.16)%, (8.09±0.96)% vs. (26.52±2.07)%, all P < 0.01], the activities of ATPase were significantly increased [Na+-K+-ATPase (μmol·mg-1·h-1):5.10±0.30, 5.34±0.26, 6.19±0.17, 5.86±0.31 vs. 3.98±0.35, Ca2+-ATPase (μmol·mg-1·h-1): 3.68±0.44, 4.43±0.29, 5.03±0.27, 4.17±0.30 vs. 1.87±0.46, all P < 0.01], and the levels of serum inflammatory factors were decreased obviously [IL-6 (ng/L): 51.61±5.55, 43.88±4.05, 39.71±2.22, 41.28±2.66 vs. 60.11±6.61, MCP-1 (ng/L): 227.82±7.07, 201.58±13.10, 177.23±10.46, 126.80±8.49 vs. 296.01±12.85, NO (μmol/L): 54.48±3.23, 46.84±2.69, 41.15±2.80, 48.62±2.34 vs. 65.25±3.88, all P < 0.05]. Conclusions GHI not only can improve the energy metabolism of brain tissue in a dose-dependent manner, but also inhibit the inflammatory cascade of damage after cerebral I/R in rats, which might be its protective mechanism on cerebral ischemia injury.
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Objective To investigate the effect of double lumen tube applied in the simple negative pressure drainage.Methods Forty cases were divided into two groups by a random table method,with 20 cases in each group. The double lumen tube was used in observation group while the normal gastric tube was used in control group,then the indexes on the drainage effect and wound healing were quantized and analyzed.Results In the observation group,one case suffered obstruction at 2 -4 days,1 case after 4 days of treatment,the obstruction rate was 10%.In the control group,two cases suffered obstruction at 2 -4 days,and 2 cases after 4 days of treatment,the obstruction rate was 25%.There was significant difference between two groups(χ2 =9.212,5.021,P =0.027,0.032).There were two cases of delayed healing and 17 cases with effective in the observation group,but 8 cases delayed healing and 11 cases with effective in the control group,there was statistically significant difference (χ2 =5.833,4.800,P =0.016, 0.028).Conclusion Double lumen tube can delay the occurrence time and reduce the occurrence rate of obstruction in simple negative pressure drainage,which promotes wound healing,and it is worth popularizing and using clinically.
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OBJECTIVE:To observe therapeutic efficacy of ulinastatin in the treatment of acute pancreatitis. METHODS:A to-tal of 80 acute pancreatitis patients were randomly divided into control group and observation group,with 40 cases in each group. Control group was given conventional treatment as gastrointestinal decompression,analgesia and spasmolysis,anti-infective treat-ment,fluid replacement,electrolyte disturbances balance,in vivo microcirculation improvement;observation group was additional given ulinastatin 100 000 U added into 5% Glucose injection 250 ml,ivgtt,bid,on the basis of control group,and then given medicine qd after improving symptoms;finally,stopped taking medicine immediately the symptom disappeared. Both groups was given 8d of treatment. Serum levels of IL-6 and TNF-α were observed in 2 groups before and after treatment,and clinical symp-tom,the time of sign and lab index improvement were also observed. Clinical efficacy was evaluated. RESULTS:After treatment, serum levels of IL-6 and TNF-α in observation group was significantly lower than in control group;the time of clinical symptom and sign,lab indicator improvement were significantly shorter than in control group,with statistical significance(P<0.01). The ef-fective rate (95.00%) of observation group was significantly higher than that (70.00%) of control group,with statistical signifi-cance(P<0.05). CONCLUSIONS:Ulinastatin can significantly reduce acute pancreatitis significantly,improve clinical symptom, promote disease recovery and clinical efficacy.
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<p><b>OBJECTIVE</b>To observe the short- and long-term efficacy of acupuncture combined with biofeedback in the treatment of functional anorectal pain (FARP).</p><p><b>METHODS</b>Clinical data of 142 patients who met the functional gastrointestinal disorders and functional anorectal pain based on criteria of Rome III( undergoing acupuncture with biofeedback therapy from August 2010 to November 2015 in Pelvic Floor Center of The Third Affiliated Hospital of Nanjing University of Chinese Medicine were retrospectively analyzed. Telephone and outpatient clinic recheck were used as standard follow-up. The clinical effect of short-term and long-term data collected from the disease-based database was evaluated with visual analogue pain scale (VAS) (0-10 points), short form health survey questionnaire (SF-36) (0-148 points). The overall satisfaction and effectiveness (VAS was >30%) were evaluated at the end of treatment (short-term) and during follow-up (long-term).</p><p><b>RESULTS</b>The effective follow-up data were obtained from 71.1%(101/142) of patients and the median follow-up time was 28(3-67) months. The VAS of 101 cases was 6.09±1.78, 1.99±1.89 and 3.55±2.60 before treatment, at the end of treatment and during follow-up respectively. Though the VAS during follow-up was higher than that at the end of treatment, but still significantly lower than that before treatment(P<0.05). The SF-36 score of 31 patients was 82.0±16.9, 94.0±15.1 and 88.1±15.3 before treatment, at the end of treatment and during follow-up respectively. Though the SF-36 score during follow-up was lower compared to at the end of treatment, but still significantly higher compared to before treatment (P<0.05). The effective rates were 85.9%(122/142) at the end of treatment and 75.2%(76/101) during follow-up, and the satisfactory rates were 92.3%(131/142) and 84.2%(85/101), respectively.</p><p><b>CONCLUSION</b>Acupuncture with biofeedback has significant short-term and long-term efficacy in treating functional anorectal pain, and its degree of satisfaction is high.</p>