Exploration on the management path of home-based aging-medical care integration of family doctor teams / 中华医院管理杂志

Under the background that the family doctor teams undertake the evaluation function of long-term care insurance for the elderlies living at home, it is imperative to further improve the efficiency of its integrated aging-medical care by strengthening the management. The Huacao community health service center and Hongqiao community health service center in Minhang District of Shanghai explored the construction of a family doctor′s home-based aging care management path, a practice launched since February 2021. This path was mainly designed with the entry criteria, management requirements for various services and evaluation indicators, with a service path form formulated on such basis. The form covered three stages: that before the on-site service, that on the day of the on-site service and that after the on-site service. Each stage was subdivided into three dimensions: the work content of the main aging-medical care, the key works of family doctors and the key works of assistant nurses. The implementation of this management path can enable such teams to provide further refined, standardized and procedural aging-medical care services, avoid service delays, improve service quality and management efficiency, and improve the utilization efficiency of health resources.

Therapy-related myeloid neoplasms after successful treatment for acute promyelocytic leukemia: a report of four cases and literature review / 中华血液学杂志

Objective@#To investigate the clinical characteristics, diagnosis, treatment and prognosis of therapy-related myeloid neoplasms (t-MNs) after successful treatment for acute promyelocytic leukemia (APL) .@*Methods@#Clinical data of 4 patients, diagnosed as t-MNs secondary to APL at Hematology Hospital of Chinese Academy of Medical Sciences from October 2012 to January 2019, were collected retrospectively. T-MNs related literature was reviewed.@*Results@#The 4 cases were all females, with the median age 42 (range 40-53) years old at the diagnosis of APL. Regarding the induction and consolidation regimens, 3 patients received all-trans retinoid acid (ATRA) and arsenic trioxide (ATO) combined with anthracycline/anthraquinone and/or cytosine. One patient only received ATRA and other auxiliary drugs. Alkylating agents were not administrated. The 4 patients developed t-MNs 40 to 43 months after complete remission (CR) of APL, including 1 case of therapy-related myelodysplastic syndrome (t-MDS) and 3 cases of acute myeloid leukemia (t-AML) . The PML-RARα fusion genes were all negative when t-MNs developed. The three patients with t-AML were treated with 3 to 4 re-induction regimens, one of whom underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after complete remission (CR) . One patient with t-MDS received hypomethylating agents. After a median follow-up of 54.5 (48-62) months, 2 patients with t-AML died, the median overall survival after t-MN was 12 (5-18) months. From 1989 to 2018, a total of 63 t-MN cases were reported in the literature. Therefore, 67 cases were analyzed when four patients in our center were added, including 27 males and 40 females with median age 52.5 (15-76) years. The median latency was 39 (12-126) months and the median overall survival after diagnosis of t-MN was 10 (1-39) months.@*Conclusions@#Although rare, t-MNs may occur after successful control of APL. There are no existing guidelines for prevention and treatment of t-MNs, which have very poor prognosis. If cytopenia or other abnormalities of peripheral blood cells develop after 3 years of APL, t-MNs should be considered as a differential diagnosis.

Screening of adult Ph-like acute lymphoblastic leukemia by multiplex real-time quantitative PCR / 中华血液学杂志

Objective@#To investigate the feasibility of multiplex real-time RT-PCR with fluorescent probes in early screening of Ph-like acute lymphoblastic leukemia (ALL) and analyze the clinical feature and prognos.@*Method@#A total of 118 adult B-ALL patients diagnosed between October 2010 and March 2016 were enrolled in this study. Multiplex RT-PCR was used to detect the Ph-like ALL related fusion gene and CRLF2 expression in 58 BCR-ABL and MLL rearrangement negative patients. The clinical features, treatment response and prognosis were analyzed in Ph-like fusion gene positive and/or CRLF2 over-expression patients.@*Result@#Among 58 patients, 9 patients (9/58, 15.5%) showed Ph-like ALL related fusion genes positive and 10 patients (10/58, 17.2%) showed CRLF2 over-expression. There were statistical differences in age, WBC count, immunophenotypes, cytogenetics and risk stratification among Ph-like fusion gene positive or CRLF2 over-expression patients, Ph+ patients, MLL+ patients and B-other patients. The 2-year overall survival rates were 65%, 47%, 64% and 74% respectively among these four groups (P=0.043) . The 2-year relapse free survival rates were 51%, 39%, 62% and 70% respectively among these four groups (P=0.010) .@*Conclusion@#Routine screening of Ph-like ALL by multiplex RTPCR is feasible.

Clinical study on the diagnosis of endoscopic ultrasonography and endoscopic treatment in patients with esophageal submucosal tumor / 中国医师进修杂志

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS), and explore the efficacy of endoscopic treatment in patients with esophageal submucosal tumor. Methods Sixty-eight patients with esophageal submucosal tumor were selected, and the tumor was derived from the muscularis mucosa and submucosa according to the common endoscope and endoscopic ultrasonography detection. Endoscopic mucosal resection (EMR) was applied to remove submucosal tumor with diameter less than 1.0 cm, endoscopic piecemeal mucosal resection (EPMR) or endoscopic submucosal dissection (ESD) was applied to remove submucosal tumor with diameter 1.1 - 1.5 cm, and ESD was applied to remove submucosal tumor bigger than 1.5 cm. Samples were examined by pathology after treatment. Results Tumors in all the patients were completely removed, and the tumor diameter was 0.6-2.3 cm. Forty-one cases were treated with EMR, 9 cases were treated with EPMR and 18 cases were treated with ESD. Four patients had intra-operative bleeding that was stopped by electrocoagulation hemostasis. No perforation occurred in all cases. Postoperative pathology revealed 43 cases had leiomyoma, 23 cases had interstitialoma, and 2 cases had lipoma. Patients were reviewed by gastroscope 3 months after operation. The white scars formed in all patients, and there was no residue or recurrence. Conclusions Different origin layers and property of esophageal submucosal tumor can be diagnosed accurately by EUS, and endoscopic therapy (EMR, EPMR and ESD) is an effective treatment for submucosal tumor from muscularis mucosa and submucosa. Endoscopic therapy is safe and effective. It provides sufficient pathological information.

The clinical application of symmetrical occluder in treating intercristal ventricular septal defect / 介入放射学杂志

Objective To investigate the interventional treatment strategy for occluding the intercristal ventricular septal defect (VSD) in order to improve the surgical safety and success rate. Methods During the period from January 2012 to December 2013, a total of 31 patients with intercristal VSD were admitted to authors’ hospital to receive interventional catheter occlusion therapy. Preoperative color Doppler ultrasound echocardiography showed that on the short axis view of the aorta the VSD interrupted port was situated at 12:00 - 1:00 o’clock region. Left ventricular and above aortic valve angiography indicated that the VSD location, shape and size, the split vent size on the left ventricle side and its distance from the aortic valve could be correctly measured when the VSD shunt was visualized , which were very helpful in guiding the operator to select the suitable occluder as well as to adjust the release pattern of the occluder. Postoperative imaging findings of the left ventricular and above aortic valve angiography were compared with the preoperative ones. Results Successful occlusion of VSD was obtained in 22 patients , in 13 among them the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in an obliquely upward direction. The basal width of the defect on the left ventricle side was (5.12 ± 1.38) mm, and(6 - 10) mm occluder was employed. In the remaining 9 patients the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in a direction almost parallel to the aortic valve , and the basal width of the defect on the left ventricle side was (7.18 ± 1.26) mm, and (9 - 12) mm zero-bias occluder was adopted. Interventional occlusion of VSD was unsuccessful in 9 cases as the intercristal hole was rather larger, and two of them had coexisting aortic sinus aneurysm complicated by mid-to-severe degree aortic valve regurgitation. Conclusion Based on the precise analysis of angiographic images by experienced radiologists optimal treatment scheme can be worked out. If conditions permit, symmetrical occluder should be employed so far as possible in order to reduce the degree of operation difficulty and improve the surgical safety and the success rate as well.

Biocatalytic desymmetric hydrolysis of 3-(4-chlorophenyl)-glutaronitrile to the key precursor of optically pure baclofen / 生物工程学报

We produced (S)-4-cyano-3-(4-chlorophenyl)-butyrate by highly stereoselective biocatalyst in this study. A nitrilase-producing strain, named Gibberella intermedia WX12, was isolated by 3-(4-chlorophenyl)-glutaronitrile as substrate in the screening with phenol-sodium hypochlorite method. The fermentation conditions and catalytic properties of this strain were investigated. The preferred carbon and nitrogen sources for nitrilase production were lactose (30 g/L) and peptone (20 g/L). After being cultivated for 96 h, the cells were collected for use in biotransformation. The hydrolysis of 3-(4-chlorophenyl)-glutaronitrile was performed at 30 degrees C in phosphate buffer (pH 8.0, 50 mmol/L) for 24 h to give (S)-4-cyano-3-(4-chlorophenyl)-butyric acid with 90% yield and > 99% of ee, which can be used for the synthesis of (R)- and (S)-baclofen. The configuration of product was determined by chemically converting it to baclofen and comparison with the authentic sample by chiral HPLC analysis.

Correlation of optimal angiographic viewing angles to body and heart types: A quantitative analysis / 中国组织工程研究

BACKGROUND: Coronary angiography is called "the golden standard" for the diagnosis of coronary heart disease (CAD). Foreshortening of vessel segments in angiographic projection images usually caused by the inappropriate projection angles or positions may lead to misdiagnosis or missed diagnosis.OBJECTIVE: To investigate the optimal angiographic views of main coronary artery and its branches in different somatotype or heart type patients and to investigate the specific relationships between the optimal angiographic views and the different somatotypes and heart types with computer-assisted techniques.DESIGN: A controlled observation.SETTING: Department of Cardiology, the Second Affiliated Hospital of Nanchang University.PARTICIPANTS: Altogether 1 369 patients were admitted to the Second Affiliated Hospital of Nanchang University to undergo coronary angiography from January 2001 to December 2006 and recruited for this study. Written informed consents of coronary angiography were obtained from all the patients. The protocol was approved by the Medical Ethics Committee of Medical College of Nanchang University.METHODS: All 1 369 inpatients were assigned into 3 groups by body mass index (BMI): fat somatotype group (n =489, BMI: 26-31 kg/m2, transverse heart type), general somatotype group (n =502, BMI: 23-25 kg/m2, general heart type), and thin somatotype group (n =378, BMI: 17-22 kg/m2 vertical heart type). In each group, all arteries including left main coronary artery (LM), proximal segment of the anterior descending coronary artery (LAD), distal-mid segment of LAD, proximal segment of circumflex branch (LCX), distal-mid segment of LCX, proximal-mid and distal segments of right coronary artery (RCA) were properly and carefully analyzed using Compart software, and then we got its optimal angiographic viewing angle. Finally, we arranged these data and induced whether different somatotype group patients have different optimal angiographic viewing angles specifically for some coronary artery or not.MAIN OUTCOME MEASURES: Optimal angiographic viewing angles.RESULTS: All 1369 patients participated in the final analysis. Optimal angiographic viewing angle for LM: left anterior oblique (LAO)(40±5)°/ caudal (CAU)(25±5)° or right left anterior oblique (RAO) 25°/CAU35°. In the fat somatotype group, the angle should be added 10° to its optimal angle, and in the thin somatotype group, the angle should be decreased by 10°, and the differences between the general somatotype group and the fat somatotype group or the thin somatotype group were statistically significant (all P < 0.05). Optimal angiographic viewing angle for proximal segment of LAD: RAO (50±8)°/ cranial (CRA)(23±8)°. In the fat somatotype group, the optimal angle should be added 10°, but in the thin somatotype group, it should be decreased by 10°. The differences between the general somatotype group and the fat somatotype group or the thin somatotype group were statistically significant (all P < 0.05). Optimal angiographic viewing angle for distal-mid segment of LAD: RAO (40±5)°/CRA (45±5)° or LAO (11±5)°/CRA (45±5)°. Optimal angiographic viewing angle for proximal segment of LCX: LAO (45±5)°/CAU (35±5)° or anteroposterior (AP)/CAU36°. Optimal angiographic viewing angle for distal-mid segmental of LCX: LAO (45±5)°/CAU (35±5)° or RAO (6±4)°/CAU (30±5)°. Optimal angiographic viewing angle for proximal-mid segment of RCA: LAO (35±5)°/CAU (14±5)° or LAO (48±5)°/CRA (15±5)°. For the thin or fat somatotype group, the optimal LAO angle should be increased by 15°, the optimal RAO angle should be decreased by10° for fat somatotype group and should be increased by 10° for thin somatotype group, and the differences between the general somatotype group and the fat somatotype group or the thin somatotype group were statistically significantly (P < 0.05). Optimal angiographic viewing angle for distal segment of RCA: LAO (53±5)°/CAU (17±5)°.CONCLUSION: The message can be got clearly about the whole coronary artery and the accuracy percentage of stenosis by changing angiographic viewing angle regularly to its own optimal angle in different somatotype or heart type patients. It's very important for making the choice of diagnosis and therapy