The role of Huaiqihuang Granules in the long-term management of bronchial asthma in young children: a multicenter real-world study / 中华实用儿科临床杂志

Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

Efficacy and safety of Omalizumab for the treatment of pediatric allergic asthma: a retrospective multicenter real-world study in China / 中华实用儿科临床杂志

Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.

Research on the clinical application of drainage tube after the operation of percutaneous endoscopic lumbar discectomy / 中国骨伤

OBJECTIVE@#To investigate the clinical significance and related factors of drainage tube after percutaneous endoscopic lumbar discectomy(PELD).@*METHODS@#The clinical data of 151 patients with lumbar disc herniation who underwent PELD from January 2019 to September 2019 was retrospectively analyzed. According to whether the drainage tube was used after operation, the patients were divided into drainage tube group and non drainage tube group. The placement time and total drainage volume were recorded. The characteristics of patients, such as age, gender, body mass index, lumbar disc herniation segment, smoking history, basic diseases and whether taking anticoagulants, were analyzed by single factor and multiple factor.@*RESULTS@#Drainage tubes were used in 32 patients after PELD. There were statistical differences in visual analogue scale(VAS) and Japanese Orthopaedic Assiciation(JOA) scores between postoperative and preoperative of that in two groups(P<0.05). There were statistical differences in VAS and JOA scores at discharge between two groups(P<0.05), while there were no statistical differences at other time points(P>0.05). Univariate analysis showed that age, basic diseases and whether taking anticoagulants were related to the use of drainage tube, but gender, body mass index, lumbar disc herniation segment and smoking history were not significantly related to the use of drainage tube. Multivariate analysis showed that elderly patients, complicated with hypertension and diabetes, taking anticoagulants were related to the use of drainage tube.@*CONCLUSION@#The use of drainage tube after percutaneous endoscopic lumbar discectomy can improve the symptoms of lumbar and leg pain in early stage. For elderly patients with hypertension, diabetes and taking anticoagulants drugs, drainage tube can be considered after transforaminal endoscopy.

Comparsion of corneal astigmatism measurement among iTrace, IOL Master 700 and Pentacam HR in cataract eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the difference and consistency among iTrace, IOL Master 700 and Pentacam HR in measuring corneal astigmatism before cataract surgery.<p>METHODS: Across-sectional study. From May 2020 to May 2021, a total of 149 cataract patients(181 eyes)were collected in our hospital. Presurgery, steep keratometry(Ks), flat keratometry(Kf), mean keratometry(Km), astigmatism magnitude(Cyl), and steep astigmatic axis values measured by the three instruments of the iTrace, IOL Master 700 and the Pentacam HR. The difference and consistency of the measurement indexes of the three instruments were analyzed.<p>RESULTS: Statistical differences existed in Ks, Kf, Km among the three instruments(<i>F</i>=4.912, 3.514, 4.873, all <i>P</i><0.05)and there was no difference in Cyl and Axis(<i>F</i>=0.523, 0.128, all <i>P</i>>0.05). Bland-Altman analysis showed the outcomes revealed that the Ks and Kf measured by iTrace and the other two instruments have poor consistency, and the consistency of Cyl and Axis was good. But the difference of Axis is not clinically acceptable. There were no statistically differences between the iTrace and the other two devices among the low astigmatism(50 eyes), moderate astigmatism(34 eyes)and high astigmatism(18 eyes)groups(all <i>P</i>>0.05). <p>CONCLUSION: In the preoperative measurement of cataract patients except for the good consistency of astigmatism, the iTrace, IOL Master 700 and Pentacam HR showed different Ks and Kf, and the Axis difference exceeded the clinically acceptable range, especially in the highly astigmatism group. The measurement of corneal astigmatism before cataract surgery should be evaluated by multiple measurement methods and make comprehensive planning for the surgical plan.

Effect of femtosecond laser-assisted cataract surgery on macular morphology / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the effect of femtosecond laser-assisted cataract surgery on macula morphology.<p>METHODS: Retrospective study. From June 2019 to May 2020, 79 eyes of 79 cataract patients were performed cataract surgery in both groups: femtosecond laser-assisted(study group: 38 cases)and conventional phacoemulsification(control group: 41 cases). Fovea and parafoveal macular thickness of cataract patients were measured by Heidelberg OCT preoperatively and 1wk, 1mo postoperatively, and then the difference of measurement results were analyzed.<p>RESULTS: The retinal thickness of the fovea, the fovea area and the outer retinal ring did not show significant difference in the both groups preoperatively and postoperatively(<i>P</i>>0.05). Retinal thickness in the inner ring in the both groups increased significantly postoperatively, which was statistically significant(<i>P</i><0.001). In the study group, the macular thickness in the inner ring increased slightly 1wk postoperatively, which was no statistical difference(<i>P</i>=0.057). The inner ring thickness at 1mo increased significantly compared with preoperatively and 1wk postoperatively, and the differences were statistically significant(<i>P</i><0.001); In the control group, the inner macular ring was significantly thicker at 1wk and 1mo(<i>P</i><0.001), and the thickness at 1mo was higher than 1wk, which was statistical difference(<i>P</i>=0.017). Comparison between the two groups: the thickness of macular in the inner ring in the control group was significantly higher than the study group 1wk and 1mo postoperatively, which was statistically significant(<i>t</i>=6.233; <i>t</i>=7.055, all <i>P</i><0.05).<p>CONCLUSION: Femtosecond laser does not increase the risk of macular damage during operation. Femtosecond laser-assisted cataract surgery is less inflammation and lower macular edema in early, which is a safe surgical option.

Multi-dimensional evaluation on management effectiveness of safe injec-tion in a tertiary general hospital / 中国感染控制杂志

Objective To explore scientific and effective management methods for safe injection,provide reference for improving compliance rate of safe injection behavior and achieving continuous improvement in safe injection. Methods A special safety injection program was formulated,baseline survey and safe injection-related training were carried out,safe injection system and standard procedures were formulated,on-site supervision and examination were strengthened,quantitative indexes such as qualified rate of safe injection facilities,theoretical examination re-sult,behavior compliance rate,and occurrence rate of sharp injury before intervention (baseline survey in May 2016)and after intervention (2017)were compared.Results Through comprehensive intervention,facilities alloca-tion rates of safe injection in whole hospital were all＞97%,qualified rates of all medical waste disposal were all＞93%,actual average consumption of alcohol-based hand rub in the whole hospital increased from (5.56±2.13) mL/bed-day to (9.95±5.38)mL/bed-day;the average score of safety injection knowledge examination of health care workers(HCWs)increased from (71.20±12.22)before intervention to (92.59±5.99)after intervention;HCWs’compliance rate to safe injection increased from 62.50% before intervention to 88.53% after intervention, difference were all statistically significant (P＜0.05).Reporting rate of sharp injuries in the whole hospital within a week increased from 15.79% before intervention to 71.43% after intervention;occurrence rate of case incidence of sharp injuries in the whole year and 100-day hospitalization decreased from 9.98% and 0.0276% before intervention to 5.31% and 0.0168% after intervention respectively,differences were both statistically significant (both P＜0.05).Conclusion Effective comprehensive intervention measures can strengthen the awareness of safe injection, improve compliance rate of safe injection behavior,effectively prevent the occurrence of occupational injuries in HC-Ws caused by unsafe injection,and prevent the spread of healthcare-associated infection.

Expression features of osteoprotegerin, receptor activator of nuclear factor kappa-B and receptor activator of nuclear factor kappa-B ligand in avascular necrosis femoral head / 中国生化药物杂志

Objective To determine the protective effect of osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B (RANK) and RANK ligand (RANKL) on avascular necrosis femoral head.Methods Necrotic tissue or corresponding normal tissues were collected from 29 avascular necrosis femoral head patients.Quantitative Real TimePCR ( qPCR ) is used to evaluate mRNA expression of OPG , RANK and RANKL.OPG and RANKL protein levels were estimated by Western blot.Results The results of qPCR showed that the expression of OPG in the necrotic tissue was significantly higher than that in the normal tissue (4.56 ±0.37) (3.39 ±0.52) (P<0.05).The expression levels of RANKL mRNA in necrotic tissues and normal tissues were (0.86 ±0.11) and (0.31 ±0.08), respectively,the difference was statistically significant (P<0.05).The expression levels of RANK mRNA in necrotic tissues and normal tissmes were(0.87 ±0.12), (0.56 ±0.13) respectively,the difference was statistically significant (P<0.05).The ratio of RANKL/OPG and RANK/OPG in normal tissues were 0.69 and 0.52, respectively.In the necrotic tissues, RANKL/OPG and RANK/OPG ratios were 1.35 and 0.61, respectively.Results of Western blot showed that the expression of OPG in necrotic tissues was consistent with that in normal tissues.The expression of RANKL protein was detected in all samples , and the expression of RANKL protein in necrotic tissue and normal tissue was almost the same.RANK protein expression was not detected in all samples.Conclusion OPG, RANK and RANKL play important roles in progress of bone remodeling in necrotic area and in disturbance of bone homeostasis and might have an effect on bone destruction and subsequent collapse of hip joint.

Characteristics of pulmonary function in children with atypical asthma with chest tightness as chief complaint before and after bronchial provocation test / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of pulmonary function in children with atypical asthma with chest tightness as the chief complaint before and after a bronchial provocation test.</p><p><b>METHODS</b>This study included 34 children with atypical asthmas who underwent bronchial provocation test between January 2010 and December 2013. Thirty-four children with typical asthmas were selected as the control group. The pulmonary function of the atypical asthma group was examined before and after the bronchial provocation test and compared with that of the control group in the acute episode and remission stages.</p><p><b>RESULTS</b>The forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, peak expiratory flow, forced expiratory flow 25%, 50%, 75% (FEF25, FEF50, FEF75), and maximum mid-expiratory flow (MMEF75/25) in the atypical asthma group before the bronchial provocation test were (105±12)%, (104±12)%, (100±7)%, (88±13)%, (90±14)%, (81±17)%, (73±25)%, and (80±17)%, respectively; these functional indices were significantly higher than in the control group in the acute episode stage (P<0.05), but were similar to those of the control group in the remission stage (P>0.05). In addition, no significant difference in pulmonary indices was observed between the atypical asthma group after the bronchial provocation test and the control group in the acute episode stage (P>0.05), but functional indices above were significantly lower in the atypical asthma group after the bronchial provocation test than in the control group in the remission stage and the atypical asthma group before the bronchial provocation test (P<0.05).</p><p><b>CONCLUSIONS</b>Bronchial provocation test is useful in the diagnosis of atypical asthma in children.</p>

Clinical study of therapeutic effect of benazepril on nonproliferative diabetic retinopathy / 中国医师杂志

Ojectvie To investigate therapeutic effect of benazepril on nonproliferative diabetic retinopathy ( NPDR) .Meth-ods Twenty nine patients with early diabetic nephropathy complicated with type 2 diabetes and NPDR were randomly divided into benazepril group ( n =12) and conventional therapy control group ( n =17).The changes of blood pressure , blood glucose, glycosy-lated hemoglobin , blood creatinine , urinary albumin , best corrected visual acuity ( BCVA ) , and fluorescein fundus angiography ( FFA) were observed before and after 3 and 6 months of treatment .Results After 3 months of treatment by benazepril , all laboratory detection parameters were no significant difference compared with before treatment and conventional therapy control group ( P >0.05);While after 6 months, compared with before treatment and control group , blood pressure, blood glucose, glycosylated hemoglo-bin, blood creatinine , and urinary albumin were significantly decreased ( P <0.05 ); According to the results of BCVA and FFA , progression of pathological changes of NPDR were significantly slower in benazepril group compared with control group ( P <0.05 ) . Conclusions Benazepril has some protection effect for NPDR to delay NPDR development and decrease serious complications .

Analysis of central corneal thickness in different degrees of diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study central corneal thickness ( CCT ) and correlation in different degrees of diabetic retinopathy ( DR) . METHODS:A total of 65 cases (130 eyes) with different degrees of DR and 35 normal cases (70 eyes) as the age-and gender-matched control group were examined by corneal endothelial microscope, to measure CCT and statistics RESULTS: Compared to control group, there were no significant difference of CCT both mild and medium nonproliferative diabetic retinopathy ( NPDR) groups ( P>0. 05 ). While the CCT of severe NPDR group and proliferative diabetic retinopathy ( PDR ) group were thicker than control group, and the differences were statistically significant (P CONCLUSION: The CCT increases with severity of DR. Taking care of protecting corneal endothelium is very important in the time of therapeutic measure, especially intraocular operation, to decrease complication.

A clinical comparative study on treatment of severe newly diagnosed immune thrombocytopenia by recombinant human thrombopoietin combined with glucocorticoid / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) combined with glucocorticoid in treatment of severe newly diagnosed primary immune thrombocytopenia (ITP).</p><p><b>METHODS</b>From June 2009 to December 2012, 24 male patients and 38 female patients with the diagnosis of severe primary ITP in our hospital were randomized into trial group (31 cases) or control group (31 cases), the median age was 50 years (range: 21-84 years). Trial group was treated with rhTPO combined with glucocorticoid, and control group was treated with glucocorticoid only.</p><p><b>RESULTS</b>At the day 3, 7 and 14 from the beginning of treatment, the average platelet count (APC) in trial group[(35.5±24.9)×10⁹/L, (135.2±94.9)×10⁹/L and (192.0±109.1)×10⁹/L]were significantly higher than that in control group[(24.5±15.6)×10⁹/L, (78.2±121.9)×10⁹/L and (95.8±60.5)×10⁹/L, P=0.022, 0.009 and 0.001, respectively]. There was no significant difference in APC between the two groups at day 28 and 90 after treatment[(147.8±59.1)×10⁹/L vs (105.1±56.9)×10⁹/L, P=0.243; (137.4±52.3)×10⁹/L vs (104.3±59.8)×10⁹/L, P=0.568, respectively]. At the day 7, 14 and 28, the complete response rates in trial group were 61.3%, 87.1% and 80.6%, which were also significantly higher than that in control group (16.1%, 29.0% and 48.3%, P=0.000, 0.000 and 0.004, respectively). The median time to response in trial group was 3 days while in the control group was 5 days; the median duration of complete response in trial group was 76 days while in the control group was 54 days. In trial group, there were 4 cases treated with platelet transfusion, while in control group there were 11 cases, respectively.</p><p><b>CONCLUSION</b>For patients with severe primary ITP, rhTPO combined with glucocorticoid could rapidly increase the platelet count, significantly improve the complete response rate and prolonged the effect with a low incidence of tolerable adverse events compared to single use of glucocorticoid. rhTPO combined with glucocorticoid could be a new therapeutic choice to those patients.</p>

Data analysis of surveillance results of iodine deficiency disorders in Guangdong Province in 2011 / 中国地方病学杂志

Objective To assess the effectiveness of prevention program on iodine deficiency disorders and iodine nutritional status of residents in Guangdong Province.Methods Probability proportionate to size sampling(PPS) was employed in surveillance of iodine deficiency disorders.Thirty counties(cities,districts) were selected in Guangdong Province.In each county(city,district) one township(street) was selected; in each township (street) one primary school was selected and in each primary school 40 children aged 8-10 were chosen to examine their thyroid and to collect salt samples at their home for determination of salt iodine.Out of the 40 children,12 children were chosen to collect urine samples for determination of urinary iodine.From the primary schools chosen,40 grade 5 students were selected for intelligence quotient(IQ) test.In the nearby of the primary schools,3 townships(towns,street) were selected and in each township(town,street) 5 pregnant and 5 lactating women were selected to collect their urine samples for determination of urinary iodine.Type-B ultrasonic was used in measuring the thyroid volume.The iodine content of urine samples was measured by the method of arsenic and cerium catalysis spectrophotometry.The iodine content of salt was determined quantitatively with the titration method.IQ was tested by Chinese combined Raven's test.According to geographical location and the implementation of iodized salt,the effects of iodized salt on iodine deficiency disorders were analyzed in the plains and the Pearl River Delta Coastal region with mild iodine deficiency(iodized salt implementation region,referred to as the plains and the PRD),historical iodine deficiency areas (iodized implementation region) and the eastern and the western coastal areas of Guangdong(areas with non-iodized salt problem,referred to as the eastern and the western Guangdong).Results A total of 1200 children aged 8 to 10 were examined by type-B ultrasonic test,and goiter rate was 3.5％ (42/1200).The differences of goiter rate between the plains and the PRD,the historical iodine deficiency areas and the eastern and the western Guangdong were statistically significant (x2 =6.6,P ＜ 0.05).The goiter rate (6.1％) in the eastern and the western Guangdong was significantly higher than that of the plains and the PRD and the historical iodine deficiency areas (3.3％,2.0％,x2 =5.6,7.1,all P ＜ 0.05).A total of 1200 salt samples were examined.The median and coefficient of variation of iodine in the salt were 31.0 mg/kg and 23.2％,respectively.Coverage of iodized salt was 97.5％(1170/1200) while 96.1％(1153/1200) of consumed iodized salt was qualified.The median urinary iodine of 1200 children aged 8-10 was 186.5 μg/L,and the differences of median urinary iodine between the plains and the PRD,the historical iodine deficiency areas and the eastern and the western Guangdong were statistically significant(x2 =5.9,P ＜ 0.05).The median urinary iodine of the eastern and the western Guangdong(162.4 μg/L) was significantly lower than that of the plains and the PRD(207.5 μg/L,x2 =8.7,P ＜ 0.01).The difference of median urinary iodine between the plains and the PRD,the historical iodine deficiency areas and the eastern and the western Guangdong was statistically significant(x2 =58.9,P＜ 0.01).The median urinary iodine of the eastern and the western Guangdong(109.6 μg/L) was significantly lower than that of the historical iodine deficiency areas and the plains and the PRD(152.9,155.2 μg/L,x2 =18.3,20.6,all P ＜ 0.05).The mean IQ of the 1208 grade 5 students was 102.8 ± 14.3.The IQ of the plains and the PRD(104.3 ± 13.9) and the historical iodine deficiency areas(102.7 ± 14.3) was significantly higher than that of the eastern and the western Guangdong(100.3 ± 14.7,t =3.8,2.1,P＜ 0.01 orP＜ 0.05).Conclusions The goal of iodine deficiency disorders elimination is achieved as scheduled in Guangdong Province.The health level of general population has been improved significantly.Iodine nutrition is in the appropriate range (100-199 μg/L) in general population but low in pregnant women.The selling of non-iodized salt in the eastern and the western Guangdong Province should be followed closely.

Prognostic power of abnormal cytogenetics for multiple myeloma: a multicenter study in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chromosomal abnormalities have been shown to play an important prognostic role in multiple myeloma (MM). Interphase fluorescence in situ hybridization (i-FISH) has been much more effective to identify cytogenetic aberrations in MM than conventional cytogenetic technique (CC). To clearly determine the cytogenetic features of Chinese MM patients and identify their prognostic implications, we designed a multicenter study based on i-FISH including 672 patients from 52 hospitals in China.</p><p><b>METHODS</b>All 672 patients were systematically screened for the following genomic aberrations: del(13q), IgH rearrangement, del(p53) and 1q21 amplifications.</p><p><b>RESULTS</b>The analysis showed that the chromosomal changes were detected in 22.1% patients by CC and in 82.3% patients by i-FISH. The most common abnormalities by CC were chromosome 1 aberrations (48.4%), -13/13q- (37.6%), hyperdiploidy (36.6%), hypodiploidy (30.1%) and IgH rearrangements (23.7%). The most frequent abnormalities by FISH was del(13q), which was found in 60.4% patients, whereas IgH rearrangement, 1q21 amplification and p53 deletions were detected in 57.6%, 49.0% and 34.7% cases, respectively. By statistical analysis, -13/13q- by CC was associated with low level of platelet (P = 0.015), hyperdiploidy was associated with low level of serum albumin (P = 0.028), and IgH rearrangement by FISH was associated with high level of β2 microglobulin (P = 0.019). Moreover, 1q21 amplification and del(p53) by FISH conferred a high incidence of progressive disease (PD) after initial therapy. Metaphase detection of IgH rearrangements and chromosome 1 aberrations concurrently was associated with a short progression free survival (PFS) (P = 0.036). No significant prognostic implications of other cytogenetic abnormalities were found associated with overall survival and PFS.</p><p><b>CONCLUSIONS</b>Chinese MM patients had similar cytogenetic abnormalities compared with the previous reported studies. However, the prognostic significance of FISH aberrations were not clearly determined and further study is required.</p>

Impaired interleukin-10 secretion by CD5(+) B cells in patients with primary immune thrombocytopenia / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the number of peripheral blood CD5(+) B cells and their ability of secreting IL-10 in patients with immune thrombocytopenia (ITP).</p><p><b>METHODS</b>Peripheral blood lymphocytes were isolated from 57 pre-treated, 40 post-treated ITP patients and 25 controls using Ficoll-Hypaque density centrifugation and then stained with PE-CD5/FITC-CD19 for flow cytometric analysis. After 24-hour culture, lymphocytes were stained with APC-IL-10 for intracellular cytokine detection. ELISA assay was employed to determine IL-10 concentration in supernatants.</p><p><b>RESULTS</b>The percentage and absolute number of CD5(+) B cells in peripheral blood from pre-treated ITP patients were significantly higher than that from normal controls (3.75 ± 2.37)% vs (2.10 ± 1.08)%, P < 0.01; (6.29 ± 5.77)× 10(7)/L vs (3.06 ± 1.90)× 10(7)/L, P < 0.01. CD5(+) B cells expressed more intracellular IL-10 than other lymphocyte subsets both in ITP patients and normal controls. The percentages of IL-10(+) cells within CD5(+) B cells in pre-treated ITP patients and normal controls were (29.51 ± 20.73)% and(15.90 ± 9.58)%, respectively(P < 0.01). Intracellular mean fluorescence intensity (MFI) of IL-10 in CD5(+) B cells was 27.95 ± 13.99 in pre-treated patients, which was significantly higher than that in controls (P < 0.01). In contrast, IL-10 concentration in supernatants was (173.05 ± 102.50) ng/L in pre-treated ITP group, which was lower than that (230.61 ± 76.96) ng/L in controls. In patients who achieved remission, the number of CD5(+) B cells decreased to level comparable to normal controls. While intracellular IL-10 MFI of CD5(+) B cells in post-treated ITP patients remained as high as in pre-treated ones, the IL-10 concentration in supernatants increased to level similar to controls.</p><p><b>CONCLUSION</b>The significantly increased number of CD5(+) B cells and accumulated IL-10 in CD5(+) B cells suggested impaired IL-10 secretion in ITP patients. The number and the ability of secreting IL-10 of CD5(+) B cells could be restored after effective treatments in patients with ITP.</p>

Evaluation of the impact of R-CHOP chemotherapy on efficacy, safety and prognosis in newly diagnosed diffuse large B-cell lymphoma patients and its prognostic impact: a multicenter retrospective study with long term follow-up / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy, safety and prognostic impact of rituximab plus CHOP (R-CHOP) regimen on patients with diffuse large B-cell lymphoma (DLBCL), to access the impact of R-CHOP on patients' prognosis and to compare that with CHOP regimen.</p><p><b>METHODS</b>Five hundred and seven newly diagnosed DLBCL patients were enrolled from Jan. 1, 2000 to May 1, 2010. Patients were administered with 6 cycles of CHOP or at least 4 cycles of R-CHOP treatments. Rituximab was administered intravenously on day 1 at a dose of 375 mg/m(2). The typical CHOP regimen include cyclophosphamide (750 mg/m(2), IV), doxorubicin (50 mg/m(2), IV) and vincristine (1.4 mg/m(2), IV, maximum 2 mg) and prednisone (60 - 100 mg, oral, day 3 - 7). The complete response (CR) rates, overall response (OR) rates, and side events of these 2 groups were compared.</p><p><b>RESULTS</b>Of the 411 analyzable patients, 224 received CHOP regimen and 187 received R-CHOP regimen. CR rate for R-CHOP group and CHOP group was 77.01% and 71.43%, respectively. OR rate in R-CHOP group was higher than that in the CHOP group (95.19% vs 87.95%, P = 0.007). The median follow-up time of R-CHOP group was 28.1 months vs that of 35.2 months in CHOP group. There was significant difference in progression free survival (PFS) and overall survival (OS) between 2 groups (P = 0.018 and 0.034, respectively). At the end of follow-up, the estimated median PFS in R-CHOP group had not been reached, while that was 84.8 months in CHOP group. The median OS in both groups had not yet been reached. The adverse events in R-CHOP group were similar with that in CHOP group.</p><p><b>CONCLUSIONS</b>R-CHOP is a safe and effective regimen for management of newly diagnosed DLBCL, with a better remission rate, PFS and OS.</p>

Epidemiological characteristics on the clustering nature of pandemic (H1N1) 2009 in China / 中华流行病学杂志

Objective To study the epidemiological characteristics on the clustering nature of pandemic (H1N1) 2009 in China.Methods Time and place distribution of pandemic (H1N1) 2009on the nature of clustering through data from Public Health Emergency Management Information System were described.Results As of August 10,2010,2773 pandemic (H1N1) 2009 clusters,a total of 77363 cases (including 20 deaths) were reported in the mainland of China.The most reported number of clusters was from schools and kindergartens with the total number of 2498 (accounted for 90.08％ of the total number).Middle schools appeared the have the most clusters (1223,accounting for 48.96％ ).The number of clusters reported in the southern provinces (cities) accounted for 77.03％ of the total,and was more than that in the northern provinces (cities).Two reported peaks in the southern provinces (cities) were in June and November,2009,respectively.There was only one reported peakin the northern provinces in September,2009.Conclusion Time and place distribution characteristics on the clusters of pandemic (H1N1) 2009 were similar to the seasonal influenza,but the beginning of winter peak was much earlier and intensity of reporting was much higher on the clusters of pandemic (H1N1 ) 2009 than that of seasonal influenza.

Risk factors for influenza A (H1N1) -associated pneumonia on hospitalized people less than 18years old in China, 2009-2010 / 中华流行病学杂志

Objective To describe the epidemiological and clinical features of hospitalized people less than 18 years old with influenza A (H1N1)-associated pneumonia and associated risk factors.Methods Through Chinese Reporting System of Influenza A (H 1 N1 ),children aged under 18 years who were hospitalized with laboratory confirmed influenza A (H1N1),case report forms and related information on pneumonia were collected between 1 September 2009 and 4 July 2010.Epidemiological and clinical characteristics including demographics,underlying chronic diseases,treatment,complications and clinical outcome etc.were described.Hospitalized children with pneumonia were compared with those without the above mentioned features,through the univariate and multivariate analysis.Results There were 4240 influenza A (H1N1)-associated hospitalized children with case report forms identified.Of the 4107 influenza A (H1N1) -associated hospitalized children with related information on pneumonia shown in the case report forms,2289 (55.7％) of them had pneumonia.Hospitalized children with influenza A (H1N 1 ) -associated pneumonia had a younger median age (4.9year old),when compared with those without pneumonia (13.1 year old,P＜ 0.0001 ).When compared with the hospitalized children without pneumonia,those hospitalized children with pneumonia were more likely to require intensive care unit care,using mechanical ventilation epuipmentto develop ARDS,respiratory failure or leading to death.Data from multivariate analysis showed that children aged ＜6months(OR=7.08,95％CI:4.15-12.06) between 6 and 23 months(aOR=8.26,95％CI:6.10-11.20) or between 2 to 4 year old (aOR=9.53,95％CI:7.39-12.29) were more likely to develop pneumonia than children aged 5 to 17.Factors as having asthma (OR=12.19,95％ CI:5.18-28.72),cardiovascular disease (OR=5.19,95％ CI:1.94-13.90),chronic renal diseases (OR=2.14,95％ CI:1.02-4.53),chronic hepatic diseases ( OR =5.26,95％ CI:1.40-19.81 ) and allergy (OR=2.54,95％ CI:1.64-3.93 )were significantly associated with influenza A (H1N1) -associated pneumonia.Risk of complication with pneumonia had an increase when oseltamivir treatment was initiated ＞2 days after the onset of illness.Conclusion Pneumonia was a common complication among children hospitalized with influenza A (H1N1).Hospitalized children with influenza A (H1N1)-associated pneumonia were more likely to develop either severe clinical courses or outcomes than those without pneumonia.

Conventional dose of prednisone regulates Th-associated gene expression in de novo ITP patients / 中国实验血液学杂志

This study was aimed to investigate the T cell (helper T cells) immune status in ITP patients and its relation with therapeutic response. 20 de novo ITP patients were enrolled (8 males, 12 females) with a median age of 41 (20 to 81). Real-time RT-PCR method was used to measure the gene expression of Th cells including T-bet, IFN-γ, GATA-3, TGF-β, Foxp3, IL-2, IL-4 in PBMNC of ITP patients before and after conventional dose of prednisone therapy [1 mg/(kg·d)] and in PBMNC of 20 normal controls. The results showed that T-bet, IFN-γ and IL-2 were significantly over-expressed in PBMNC of ITP patients before treatment compared with that in normal controls (p < 0.01), and compared with that before treatment, T-bet, IFN-γ, and IL-2 were markedly down-regulated in ITP patients after treatment. Before treatment, the expressions of Foxp3, TGF-β, GATA3 and IL-4 in ITP patients did not show difference from normal controls, while after treatment Foxp3 were more up-regulated than that before treatment (p < 0.05). After treatment, TGF-β expression showed a different pattern between old and young patients. TGF-β expression was down-regulated (p < 0.05) among ITP patients younger than 60, while up-regulated in older patients. It is concluded that there is an imbalance of Th1/Th2/Treg cytokines in ITP patients, which can be reversed by glucocorticoid treatment. The conventional dose of glucocorticoid may be regarded as effective therapy for de novo ITP patients, it may correlate with improvement of imbalance between Th1/The2/Treg cytokines.

Implication of MAPK in sodium salicylate-induced heat shock protein 27 expression in human lens eplthelial Cells in vitro / 中华实验眼科杂志

Background Heat shock proteins (HSPs) are highly conserved proteins that are induced in cells when confronted with a wide variety of proteotoxic stresses.HSP27 has a high degree of similarity with α-crystallin protein.The abnormality of HSP27 structure and expression are closely related to the formation of cataracts.Our previous study showed sodium salieylate has the protective effect on H2O2-induced lens damage.Objective This study was to investigate the roles of MAPK signal pathway in sodium salicylate-induced the expression of HSP27 in human lens epithelial cells (LECs) in vitro.Methods Human LECs were incubated in the fresh media containing sodium salicylate at different concentrations (0-55 mmol/L) for different times (1-5 hours) and allowed to be recovered in fresh medium without sodium salicylate for 1-24 hours with or without pretreatment with P38MAPK inhibitor (SB203580), ERK1/2 inhibitor (PD98059) and JNK/SAPK inhibitor ( SP600125). The expressions of P38MAPK, EBK1/2, JNK/SAPK, phosphorylated P38MAPK, phosphorylated ERK1/2, phosphorylated JNK/SAPK and HSP27 were detected by Western blot. HSP27 mRNA was detected by RT-PCR. The expression of HSP27 was also detected by immunohistochemistry. Results There was only weak expression of HSP27 in normal human LECs.After stimulation of 35-55 mmol/L sodium salicylate was removed and human LECs were cultured again for 6 hours,the expression of HSP27 in LECs were significantly increased ( F= 509. 953,P<0. 01). HSP27 was absent expressed in human LECs in 55 mmol/L sodium salicylate stimulation for 1-5 hours groups, but LECs were re-cultured for 3,6 hours after removed the stimulation, the expression of HSP27 was elevated (F = 452. 534, P<0. 01). Activation of P38 M APK occurred after sodium salicylate stimulation 30 minutes and 1 hour ( F = 865.68, P<0. 01). However, ERK 1/2 was expressed after sodium salicylate was eliminated for 1-6 hours ( F = 388.84, P<0. 01). JNK/SAPK was inactived by sodium salicylate. The expression of HSP27 could be down-regulated with the pretreatment of SB203580 and PD98059. Conclusion Sodium salicylatc can induce the expression of HSP27 in human (LECs) . The effects are mediated,at least in part ,through the activation of P38MAPK and ERK1/2 signaling pathway .

Trend in the incidence and geographic variations of acute lymphoblastic leukemia in Shanghai, China from 2002 to 2006 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Great advances have been made in the diagnosis, molecular pathogenesis and treatment of acute lymphoblastic leukemia (ALL) in the past decade. Due to the lack of large population-based studies, the recent trends in the incidence and geographic variations of ALL in Shanghai, China have not been well documented. To better understand the incidence and epidemiological features of ALL in Shanghai, we conducted a retrospective survey based on the database from the Shanghai Center for Disease Control and Prevention (CDC) and the medical records in all large-scale hospitals in Shanghai, especially those 30 major hospitals with hematology department.</p><p><b>METHODS</b>According to the data from Shanghai CDC, 544 patients, with a median age of 32 years (ranging 1.2 - 89 years), were diagnosed as de novo ALL from January 1, 2002 to December 31, 2006, and they were followed up until December 31, 2007.</p><p><b>RESULTS</b>The average annual incidence of ALL in Shanghai was 0.81/100 000. The incidence in men (0.86/100 000) was slightly higher than that in women (0.75/100 000). The age-stratified incidence showed that the incidence was 2.31/100 000 in patients ≥ 17 years old, 0.54/100 000 in those 18 - 34 years old, 0.46/100 000 in those 35 - 59 years old, and 0.94/100 000 in those ≥ 60 years old. Moreover, there were substantial geographic variations in the incidence of ALL, with the incidence in Chongming county, an island in the east of Shanghai city being 0.60/100 000, much lower than those of other districts. Both French-American-British (FAB) and World Health Organization (WHO) classification systems were applied in the present study. Eighty-eight patients were diagnosed as L1 (26.2%), 193 L2 (57.4%), and 55 L3 (16.4%). For 302 patients with immunophenotypic results, 242 were identified as B cell origin (80.1%), 59 as T cell origin (19.5%), and 1 as biphenotype (0.4%). The leukemia cells in 61 patients co-expressed one or two myeloid antigen (20.2%). For 269 patients with cytogenetic results, the incidences of t(9;22) in patients aged < 10, 11 - 17, 18 - 44, 45 - 59 and ≥ 60 years old were 4.2%, 11.4%, 19.2%, 23.1% and 5.3%, respectively.</p><p><b>CONCLUSION</b>Compared with the previous data, the incidence of ALL is increased in Shanghai, and has a geographic distribution characteristic.</p>