Curative Efficacy of Rituximab for ITP Patients with Different Sensitivity to Hormone / 中国实验血液学杂志

OBJECTIVE@#To investigatc the curative efficacy of low dose rituximab for glucocorticoid ineffective on dependent ITP patients and its relation with sensitivity to glucocorticoid so as to provide reference basis for rational use of drugs in clinical treatmant.@*METHODS@#Seventy-ninth ITP patients enrolled in this study included the glucocorticoid-ineffective patients (19 cases) and glucocorticoid-dependent patients (60 cases). All ITP patients were treated with regimen consisted of high dose dexamethasone plus low dose rituximab (dexal-methasone 40 mg/d for 4 days per os, ritaximab 100 mg by intravenous infusion at D7, 14, 21 and 28 respectively). The patients after treatment were followed-up for 12 month, and the relation of patients sensitivity to glucocorticoid with therapentic response of rituximab was analyzed. The changes of Treg cell ratio and BAFF, IL-2 and sCD40L levels before and after treatment were detected by flow cytometry and ELISA respectively.@*RESULTS@#The overall response rate (ORR) of patients treated with above- mentioned regemen at 1, 3, 6 and 12 months after treatment was 79.7% (63/79), 69.6% (55/79), 63.3% (50/79) and 60.8% (48/79) respectivcly, out of which the ORR of glucocorticoid ineffective and glucocorticoid-dependent ITP patients treated with above-mentioned regimen at 1, 3, 6 and 12 months after treatment was 47.4% (9/19) vs 90.0% (54/60), 36.8% (7/19) vs 80.0% (48/60), 21.1% (4/19) vs 76.7% (46/60), 21.1% (4/19) vs 73.3% (44/60), and the difference between 2 groups was statistically significant. The detection of T reg cell showed that the T reg cell ratio in glucocorticoid- ineffective and dependent patients at 1, 3, 6 and 12 months after treatment was (1.70±0.43)% vs (3.47±0.72)%, (1.66±0.33)% vs (4.29±0.91)%, (1.71±0.37)% vs (4.44±0.97)%, (3.36±0.54)% vs (4.29±1.04)%, respectively. The detection of cytokines showed that the levels of BAFF, IL-2 and sCD40L in plasma of glucocorticoid-dependent patients at 1 month after treatment significanlly decreased (P＜0.05), the levels of BAFF, IL-2 and sCD40L in plasma of glucocorticoid-ineffective patients although decreased at 1 mouth after treatment, but there was no statistical difference as compared with glucocosticoid-depenment patients.@*CONCLUSION@#The treatment of glucocorticoid-dependent ITP patients with rituximab is more effective. The regulatory effect of rituximab on the T-reg cells, BAFF, IL-2 and sCD40L may be one of its mechanisms.

Preparation and preliminary evaluation of chitosan composite KGF-2 mutant thermal sensitive dressing / 军事医学

Objective To develop chitosan composite keratinocyte growth factor-2 mutant(KGF-2M)temperature-sen-sitive dressing and evaluate its physicochemical properties and dynamic release rule were used.Methods Chitosan, chi-tosan quaternary ammonium salt,β-glycerophosphate and other adjuvant materials to configure different formulations which were compounded with KGF-2M in order to develop temperature-sensitive dressing.Gelling time, temperature,the release rate of KGF-2M and other indicators were measured to analyze the physical and chemical properties of the temperature -sen-sitive dressing.Results Chitosan-KGF-2M composite dressing with temperature-sensitive properties was obtained by opti-mizing the formulation components of chitosan and related adjuvant materials.When the liquid dressing was above 35℃,it could be converted from liquid to solid gelatin within 10 minutes.The compound KGF-2M released from the gel was more than 98%at 4 h,and its bioactivity remained stable.Conclusion The thermo-sensitive gel has the characteristics of good conformability,moisturizing(moisture),isolation,wound healing,and a controlled release effect,which has great potential in wartime for wound repair.

Recombinase polymerase amplification combined with a lateral flow dipstick for rapid and visual detection of adenovirus / 军事医学

Objective To develop a rapid, accurate, visual, and portable detection method for adenovirus types B (AdvB) and E ( AdvE).Methods Universal primers were targeted on type-specific conserved regions to allow the simultaneous detection of both human Adv (HAdV) species.A detection method based on the combination of recombinase polymerase amplification ( RPA) and lateral flow dipstick ( LFD) was established the sensitivity and specificity evaluated , and throat swab specimens of 19 patients infected with AdvB and AdvE as well as 10 healthy volunteers were detected with this method.Results The detection limit of the method was 10 copies/μl Adv DNA, which was close to that of qPCR , and there were no cross-reactions with other species of Adv and unrelated virus .The detection could be finished within 15 to 20 min within the temperature range of 25 to 45℃.When applied to clinical samples , this method showed 100% sensitivity and specificity.Conclusion This detection assay is a sensitive , specific, rapid and simple method that eliminates the need for expensive equipment , trained personnel or laboratories .The characteristics of this system render it suitable for use in grass-roots healthcare departments , and the system is especially effective for field testing and on-site testing.

Recombinase polymerase amplification combined with a lateral flow dipstick for rapid and visual detection of adenovirus / 军事医学

Objective To develop a rapid, accurate, visual, and portable detection method for adenovirus types B (AdvB) and E ( AdvE).Methods Universal primers were targeted on type-specific conserved regions to allow the simultaneous detection of both human Adv (HAdV) species.A detection method based on the combination of recombinase polymerase amplification ( RPA) and lateral flow dipstick ( LFD) was established the sensitivity and specificity evaluated , and throat swab specimens of 19 patients infected with AdvB and AdvE as well as 10 healthy volunteers were detected with this method.Results The detection limit of the method was 10 copies/μl Adv DNA, which was close to that of qPCR , and there were no cross-reactions with other species of Adv and unrelated virus .The detection could be finished within 15 to 20 min within the temperature range of 25 to 45℃.When applied to clinical samples , this method showed 100% sensitivity and specificity.Conclusion This detection assay is a sensitive , specific, rapid and simple method that eliminates the need for expensive equipment , trained personnel or laboratories .The characteristics of this system render it suitable for use in grass-roots healthcare departments , and the system is especially effective for field testing and on-site testing.

Efficacy and safety of low-dose rituximab combined with different dosage of glucocorticoids for immune thrombocytopenia / 中华血液学杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of low-dose rituximab combined with different dosage of glucocorticoids for immune thrombocytopenia (ITP).</p><p><b>METHODS</b>Seventy-four patients (35 male, median age 34 years, range 18-70 years) including 60 newly-diagnosed, 6 persistent, 5 chronic and 3 refractory patients were enrolled in this study, and separated into control (36 cases) and experimental (38 cases) groups according to the dosage of glucocorticoids. Patients in both groups received dexamethasone 40 mg/day on days 1-4, followed by rituximab 100 mg on days 7, 14, 21, 28. The patients in experimental group also received decrements of prednisone 60, 30, 20, 10 mg/day on days 5-7, 8-14, 15-21, 22-28. The initial, long-term efficacy and safety were evaluated.</p><p><b>RESULTS</b>Platelet counts of all patients at day 4 remarkably increased, with the median platelet count from 11(1-26) × 10⁹/L to 84(23-132) × 10⁹/L in control group, and 10(2-20) × 10⁹/L to 80(22-115) × 10⁹/L in experimental group; the platelet counts of patients at day 14 in experimental group [163(19-262) × 10⁹/L] was higher than that of control group [98(18-238) × 10⁹/L] (P<0.05). The overall response (OR) rates at day 28 in experimental group (84.21%) was significantly higher than that of control group (66.67%, P = 0.03). There was no significant difference of sustained response (SR) rates in two groups (63.89%vs 65.79%, 58.33%vs 60.53%, P > 0.05) at six and twelve months follow-up points. Both groups showed similar incidence of adverse events, and no patients discontinued the treatment due to side effects.</p><p><b>CONCLUSION</b>Low-dose rituximab and glucocorticoids was an effective method for ITP patients, and maintenance treatment with decrements of prednisone contributed to improving earlier CR rate.</p>

Effect of different therapeutic regimens on regulatory T cells in patients of primary immune thrombocytopenia / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the change of CD4⁺CD25(high)CD127(low) regulatory T cells (Tregs) percentage in patients with primary immune thrombocytopenia (ITP) treated by different methods.</p><p><b>METHODS</b>One hundred and thirty-eight newly diagnosed adult ITP patients (57 male, median age 40 years, range 18-70 years) were enrolled in this study, who were randomly separated into three regiment groups, namely prednisolone (PSL, 1.5 mg/kg for 2-4 weeks and subsequently stepwise reduction) group enrolled 49 patients, dexamethasone [(one course of high-dose dexamethasone (HDD) 40 mg/day, d1-4] 45 patients, and rituximab plus HDD (rituximab 100 mg on days 7, 14, 21, 28 and HDD) group 44 patients. Peripheral blood was taken in ITP patients of each group before treatment, 14 d and 28 d after treatment. The percentages of CD4⁺CD25(high)CD127(low) Tregs in 30 healthy controls and 138 patients were analyzed by flow cytometry.</p><p><b>RESULTS</b>Overall response (OR) rates of PSL, HDD and R+HDD groups at day 28 were 69.4%, 66.7% and 79.5% respectively with no difference. After the following 12 months, sustained response (SR) was more pronounced in R+HDD group compared to the other two groups (R+HDD vs PSL: 66.7% vs 37.8%, P<0.05; R+HDD vs HDD: 66.7% vs 22.7%, P<0.05). The percentage of CD4⁺CD25(high)CD127(low) Tregs in peripheral blood of ITP patients [(1.67±0.70)%] was significantly lower than in healthy control group; After treatment, the percentages of Tregs in peripheral blood of patients both at day 14 and 28 in R+HDD group remarkably decreased compared with before treatment [(4.28±1.09)% vs (1.68±0.68)%, P<0.05; (4.44±0.63)% vs (1.68±0.68)%]. The percentages of Tregs at day 14 in both other two groups decreased notably compared with before treatment. But the Tregs levels measured at day 28 in PSL and HDD groups were similar with before treatment.</p><p><b>CONCLUSION</b>The percentage of CD4⁺CD25(high)CD127(low) Tregs in peripheral blood of ITP patients was lower than healthy individual. The higher SR of patients treated by R+HDD was related to its ability to up-regulate the percentage of CD4⁺CD25(high)CD127(low) Tregs.</p>

A three-dimensional quantitative measurement related to sigmoid sinus by using multi-slices spiral CT / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To provide a valuable imaging anatomic method for operation of the posterior transpetrosal approach and accurate positioning among relative structures in order to reduce the incidence of surgical complications.</p><p><b>METHODS</b>The clinical information of 119 adult cases (238 sides) was analyzed. All the cases underwent 16 layer helix CT scanning and three-dimensional image reconstruction of skull base without a skull base disease. Axial and coronal images were reconstructed using multiplanar reconstruction technique of ADW 4.2 workstation, and the anatomic objective structure were displayed by rotating imaging slices. The data were analyzed in statistically and compared with the published cadaver data.</p><p><b>RESULTS</b>Quantitative measurement of anatomic structure was shown as below: The distance of width of sigmoid sinus was (11.14 + or - 2.13) mm, the distance of depth of sigmoid sinus was (6.04 + or - 1.67) mm; the distance from the lateral wall of sigmoid sinus to the surface of mastoid process was (9.74 + or - 2.95) mm; the distance from the anterior wall of sigmoid sinus to the posterior wall of external auditory meatus was (12.98 + or - 2.71) mm; the distance from the most posterior portion of the posterior semicircular canal to the anterior wall of sigmoid sinus was (9.87 + or - 2.60) mm; the distance from the most posterior portion of the posterior semicircular canal to the posterior pyramidal wall was (3.18 + or - 1.30) mm; the distance from the posterior extremity of long axis of the lateral semicircular canal to the anterior wall of sigmoid sinus was (13.17 + or - 2.59) mm; the distance from the posterior extremity of long axis of the lateral semicircular canal to the posterior pyramidal wall was (5.46 + or - 1.38) mm; the vertical distance from the lateral semicircular canal to the jugular bulb was (6.69 + or - 3.08) mm; and the distance from the vertical portion of facial nerve to the jugular bulb was (5.32 + or - 2.13) mm. Statistically, there were no significant differences between imaging quantitative measurement and published cadaver data. However, the measurement result, included the distance from the lateral wall of sigmoid sinus to the surface of mastoid process and the distance from the lateral semicircular canal to the jugular bulb as well as the distance from the vertical portion of facial nerve to the jugular bulb, were found a positively correlated to the distance from the anterior wall of sigmoid sinus to the posterior wall of external auditory meatus (r value was 0.284, 0.145, 0.208, respectively, all P < 0.05).</p><p><b>CONCLUSIONS</b>The result of three-dimensional quantitative measurement by using multiplanar reconstruction technique of 16 layer spiral CT could represent a real distance of anatomic structures. The reconstruction of spiral CT images could display a anatomic feature of temporal bone accurately, and it may provide a valuable method for surgical approach and accurate positioning of relative structure in operation. As the location of sigmoid sinus moving forward, the lateral shift of it may occur more easily and the jugular bulb become closer to the vertical portion of facial nerve, while the extension of anterior location in sigmoid sinus should be a positively correlated to the height of jugular bulb.</p>