Analysis of test indexes of 150 cases of thalassemia in Xiaoshan area of Hangzhou / 中华地方病学杂志

Objective:To explore the types, gene mutation types and constituent ratio of thalassemia in Xiaoshan area of Hangzhou, and to analyze the value of test index of erythrocyte parameter calculation formula (Matos & Carvalho Index, MCI) in differential diagnosis.Methods:Using the method of retrospective analysis, 150 cases of thalassemia and 124 cases of iron deficiency anemia treated in Xiaoshan Hospital Affiliated to Hangzhou Normal University from January 2019 to April 2021 were included in the study to collect the diagnostic results of α and β-thalassemia genes, ferritin and erythrocyte parameters, the test indexes were compared and analyzed, and the value of MCI in differentiating thalassemia from iron deficiency anemia was analyzed.Results:In 150 cases of thalassemia, there were 58 cases of α-thalassemia (38.67%), of which 8 cases (5.33%) were complicated with iron deficiency; there were 88 cases of β-thalassemia (58.67%), of which 3 cases (2.00%) were complicated with iron deficiency; αβ-compound thalassemia occurred in 4 cases (2.67%). The proportion of α-thalassemia was lower than β-thalassemia, the difference was statistically significant (χ 2 = 12.01, P = 0.001) . Four kinds of α-thalassemia allele were detected in 58 cases of α-thalassemia, mainly -- SEA, a total of 48 cases (82.76%); eight gene mutation types were detected in 88 cases of β-thalassemia, of which CD41-42 was the most, a total of 33 cases (37.50%). The basic parameters of β-thalassemia, red blood cell (RBC), hemoglobin (HGB) and red blood cell specific volume (HCT) were lower than those of α-thalassemia ( t = - 2.88, - 3.49, - 4.33, P < 0.05); mean hemoglobin concentration (MCHC) and red cell volume distribution width (RDW) were higher than those of α-thalassemia ( t = 3.22, 2.43, P < 0.05). The MCI value of thalassemia group was significantly higher than that of iron deficiency anemia group (23.14 ± 1.73 vs 20.47 ± 1.45, t = 13.61, P < 0.001). The area under the curve of MCI (AUC) = 0.885. The diagnostic cut-off point was set according to the maximum Jorden index method (0.594). The diagnostic cut-off point in this study was 21.375, with a sensitivity of 82.0% and specificity of 77.4%. Conclusions:The genotyping of thalassemia in Xiaoshan area of Hangzhou indicates that β-thalassemia is dominant, with the most mutations in CD41-42 genotype, followed by α-thalassemia, with -- SEA genotype mutation most. MCI has great screening value in identifying small cell anemia.

The value of bone marrow imprint in diagnosis of plasma cell myeloma and monitoring the remission after chemotherapy / 中国医师杂志

Objective To investigate the value of bone marrow imprint in the diagnosis of plasma cell myeloma and the remission rate after chemotherapy.Methods Bone marrow aspiration,bone marrow imprint,and bone marrow biopsy of plasma cell myeloma with 128 patients were collected.The bone marrow biopsy was used as the standard.Bone marrow imprint was compared to bone marrow aspiration in bone marrow nucleated cells quantity,infiltration degree,and diagnostic coincidence rate.Sensitivity,specificity,positive predictive value,and Youden index were evaluated.Results The results of bone marrow imprint showed that the number of nucleated cells was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞ 0.05).Bone marrow biopsy combined with CD38 (+) showed the degree of infiltration of bone marrow as the standard,and the bone marrow imprint was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞0.05).To evaluate the compliance rate of bone marrow infiltration in bone marrow imprint:In phase Ⅰ,the compliance rate of bone marrow aspiration was 95.83％ (23/24) and bone marrow imprint of 91.67％ (22/24),the difference was not statistically significant (P ＞ 0.05);In phase Ⅱ,bone marrow imprint coincidence rate was 92.86％ (65/70),which was significantly higher than that of bone marrow aspiration in 65.71％ (46/70) (P ＜0.05);In phase Ⅲ,bone marrow imprint coincidence rate was 79.41％ (27/34),which was significantly higher than that of bone marrow aspiration in 44.12％ (15/34) (P ＜ 0.05).The other parameters,such as sensitivity,specificity,positive predictive value,and Youden index were better than those of bone marrow aspiration.Conclusions Bone marrow imprint has characteristics that both bone marrow aspiration and bone marrow biopsy have.It has obvious advantages in diagnosis of plasma cell myeloma and monitoring the remission after chemotherapy.

The value of bone marrow imprint in diagnosis of plasma cell myeloma and monitoring the remission after chemotherapy / 中国医师杂志

Objective To investigate the value of bone marrow imprint in the diagnosis of plasma cell myeloma and the remission rate after chemotherapy.Methods Bone marrow aspiration,bone marrow imprint,and bone marrow biopsy of plasma cell myeloma with 128 patients were collected.The bone marrow biopsy was used as the standard.Bone marrow imprint was compared to bone marrow aspiration in bone marrow nucleated cells quantity,infiltration degree,and diagnostic coincidence rate.Sensitivity,specificity,positive predictive value,and Youden index were evaluated.Results The results of bone marrow imprint showed that the number of nucleated cells was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞ 0.05).Bone marrow biopsy combined with CD38 (+) showed the degree of infiltration of bone marrow as the standard,and the bone marrow imprint was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞0.05).To evaluate the compliance rate of bone marrow infiltration in bone marrow imprint:In phase Ⅰ,the compliance rate of bone marrow aspiration was 95.83％ (23/24) and bone marrow imprint of 91.67％ (22/24),the difference was not statistically significant (P ＞ 0.05);In phase Ⅱ,bone marrow imprint coincidence rate was 92.86％ (65/70),which was significantly higher than that of bone marrow aspiration in 65.71％ (46/70) (P ＜0.05);In phase Ⅲ,bone marrow imprint coincidence rate was 79.41％ (27/34),which was significantly higher than that of bone marrow aspiration in 44.12％ (15/34) (P ＜ 0.05).The other parameters,such as sensitivity,specificity,positive predictive value,and Youden index were better than those of bone marrow aspiration.Conclusions Bone marrow imprint has characteristics that both bone marrow aspiration and bone marrow biopsy have.It has obvious advantages in diagnosis of plasma cell myeloma and monitoring the remission after chemotherapy.

The value of minimal residual disease with acute myeloid leukemia in prognostic evaluation and its correlation with cell morphology and genetics / 中国医师杂志

Objective To explore the value of minimal residual disease with acute myeloid leukemia in prognostic evaluation and its correlation with cell morphology and genetics.Methods A total of 105 patients with acute myeloid leukemia (AML) (non M3) was used as the research subjects to evaluate the correlation between the level of minimal residual disease (MRD) and the degree of cellular morphological remission,and cytogenetics.According to the different levels of MRD,78 patients of cell morphology complete remission (CR) were grouped to evaluate the one-year recurrence rate after the first chemotherapy treatment.Results The correlation was evaluated between MRD level and morphological remission in 105 patients with AML after initial chemotherapy.In the degree of cellular morphological remission cell evaluation showed 78 (74.29％) cases of CR,27 (25.71％) cases of partial remission (PR) or non remission (NR).Among 78 cases of CR,MRD negative rate was 66.67％ (52/78),MRD was 33.33％ (26/78);and 27 cases of NR or PR,MRD was 100％ (27/27).The correlation between MRD level and cytogenetic evaluation,cytogenetic prognosis group and prognosis of middle group and poor prognosis group,and the negative rate of MRD were 66.67％,45.90％,and 35.29％,without significant difference (P ＞ 0.05).Seventy eight patients with CR were divided into two groups according to the level of MRD to evaluate the recurrence rate of the 1 year,the recurrence rate of the positive group was significantly higher than that of the negative group (P ＜ 0.05).Conclusions With the development of hematology,the meaning of CR deeply,using flow cytometry method to detect the MRD,MRD positive cells relapse earlier than the traditional morphology,it has important clinical significance for guiding treatment and early prediction of recurrence of CR AML.

Localization of gestational age reference table and its application in prenatal screening / 浙江大学学报·医学版

To establish a fetal biparietal diameter (BPD)-gestational age formula based on the data of pregnant women from Xiaoshan District of Hangzhou, and to evaluate its application in prenatal screening.Data of 3500 pregnant women with gestational age between 15 weeks and 19 weeks+6 receiving prenatal screening in Xiaoshan Hospital during May 2014 and May 2015 were collected. BPDs were used to establish a localized BPD-gestational age formula. The localized formula was used to evaluate the prenatal screening risks in 1759 pregnant women with irregular menstrual cycles or uncertain last menstrual period (LMP) in Xiaoshan District, and the results were compared with those calculated using formula in LifeCycle 4.0.With localized formula, the total positive rate of Down syndrome, trisomy 18 syndrome and deformity of neural tube was decreased from 6.96% to 5.85% (<0.05), in which the positive rate of Down syndrome decreased (<0.05), that of deformity of neural tube increased (<0.05), and that of trisomy 18 syndrome remained the same (>0.05). The median MoMs of free-hCG β and α-fetoprotein calculated using localized formula were significantly different from those calculated using the formula in LifeCycle 4.0 (all<0.05), and the former ones were more closer to 1. For women of fetus diagnosed with the above diseases, the positive rate calculated using localized formula was almost the same as that calculated using the formula in LifeCycle 4.0.BPD-gestational age formula should be localized based on the statistical analysis of the local population, which will help to reduce the false positive rate, and make the results more accurate and reliable in prenatal screening.

An analysis of laboratory results of parameters of organ function in patients with heat stroke / 中华危重病急救医学

ObjectiveTo explore the role of parameters of organ function during heat stroke (HS) on the prognosis, and to form the treatment strategy through an analysis of parameters of organ function during HS. Methods A retrospective study was conducted. Thirty-seven patients with HS (HS group) and 54 patients with mild-to-moderate stroke (stroke group) admitted to Zhejiang Xiaoshan Hospital from 2011 to 2014 were enrolled. The experimental results of organs function indicators for patients were recorded including:① cardiac markers:troponin I (TnI);② myocardium zymogram: creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST);③ renal function indexes: blood urea nitrogen (BUN), uric acid (UA), and serum creatinine (SCr);④ electrolyte: serum K+, Na+, and Cl-;⑤coagulation function: prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and D-dimer;⑥ blood gas analysis: pH value, arterial partial pressure of carbon dioxide (PaCO2), base excess (BE), standard bicarbonate (SB), and actual bicarbonate (AB);⑦ routine blood test: blood platelet count (PLT);⑧ hepatic function: alanine aminotransferase (ALT). Abnormal rates of laboratory parameters of 37 HS patients were statistically analyzed. Various laboratory parameters of organs function as well as the initial value and extreme value (maximum or minimum value) during treatment of CK and PLT in HS patients were compared between two groups.Results The abnormal rates of 37 HS patients were more than 70%, including incipient value of TnI, CK, LDH, AST, serum Na+, ALT, D-dimer, PaCO2, AB, maximum value of CK, and minimum value of PLT, the abnormal rates being 73.0%, 70.3%, 81.1%, 78.4%, 78.4%, 70.3%, 70.3%, 70.3%, 75.7%, 81.1%, 75.7%, respectively. The abnormal rates of other parameters were less than 70%. There were significant differences in incipient value of TnI, CK, LDH, AST, serum K+, serum Na+, D-dimer, and PLT between HS group and mild-to-moderate stroke group [TnI (μg/L): 0.087 (0.026, 0.306) vs. 0.007 (0.004, 0.110),Z = -7.017,P = 0.000;CK (U/L): 392.30 (287.60, 524.10) vs. 137.10 (106.33, 607.80),Z = -7.930,P = 0.000; LDH (U/L): 317.98±122.74 vs. 207.85±57.71, t = 1.678,P = 0.000; AST (U/L): 94.90 (52.80, 155.80) vs. 26.10 (18.13, 317.40),Z = -6.157, P = 0.000; serum K+ (mmol/L): 3.46±0.65 vs. 3.86±0.57,t = 1.662,P = 0.001; serum Na+ (mmol/L): 129.75±7.34 vs. 138.79±4.26,t = 1.674,P = 0.000; D-dimer (mg/L): 2.53 (0.63, 6.00) vs. 0.30 (0.21, 9.71),Z = -5.084, P = 0.000; PLT (×109/L): 144.62±86.14 vs. 219.48±64.76,t = 1.669,P = 0.000]. There were also statistically significant differences in the initial value and extreme value of CK and PLT between HS group and mild-to-moderate stroke group [CK (U/L): 392.30 (287.60, 524.10) vs. 721.50 (546.30, 964.10),Z = -6.351,P = 0.000; PLT (×109/L):132.40±82.55 vs. 68.24±44.62,t = 1.688,P = 0.000].Conclusions HS can impair several organs and systems, having complications, and it is a heavy insult for body. Increasing of CK and decreasing of PLT has some value to assess illness changes. It is helpful of laboratory results for doctors to estimate complications on time.

The diagnostic value of bone marrow tissue imprints in cytomorphology / 中国医师杂志

Objective To investigate the value of bone marrow imprints in the cytomorphology diagnosis.Methods A total of 354 cases of bone marrow smears,imprints,and sections were analyzed from January 2011 to December 2013 to detect morphological diagnosis difference.Results Bone marrow imprints in groups of extremely reduced,significantly reduced,normal,slightly increased,increased significantly,and extreme increase were better than that of smear which nucleated cells quantity assessment(P ＜ 0.01).Smears and imprints were similar (P ＞0.05).Imprints nucleated cell number decreased mostly were the same as smear,but smear reduced imprints mostly normal or increased.The bone marrow sections nucleated cells quantity as the standard,smears and imprints had high coincidence rate in the group of nucleated cells reduced (87.5％ and 96.9％),and imprints were higher than smear in the group of nucleated cells quantity in normal and increased(87.8％ and 95.7％ vs 68.3％ and 55.8％),and the difference was statistically significant.Imprints were better than smear in specificity,Youden index,and sensitivity.Patients with plasma cell myeloma (PCM) imprint plasma cell volume and immature plasma cells were higher than that of smear (42.73 ± 10.47 and 13.60 ± 4.83 vs 24.67 ± 11.18 and 11.07 ± 5.82) with a statistically significant difference (P ＜ 0.05).Conclusions Imprints have characteristics both smear and sections,and imprints are superior to smears in assessment of nucleated cells and tumor cell invasion degree.Smear combined with imprints can improve the diagnosis level of bone marrow cell cytomorphology.

Impact of carbon dioxide pneumoperitoneum on laparoseopic cholecystectomy for patients with chronic renal failure / 中华全科医师杂志

Fifteen patients with chronic renal failure(CRF)underwent laparoscopic cholecystectomy(LC)at carbon dioxide(CO2)pneumoperitoneum pressure of 10-12 mm Hg(Group A,n=9)or 13-15 mm Hg(Group B,n=6).Renal function and urinary volume(UV)of Group A showed no remarkable change following the operation.But in Group B,the levels of blood urine nitrogen(BUN)and serum creatine(Scr)were increased significantly,and creatinine clearance rate(Ccr)and UV were remarkably decreased(P＜0.05).These variants gradually retumed tO the preoperative levels after 1 week.The analysis showed that laparoscopic choleeystectomy at CO2 pneumoperitoneum pressure of 10-12 mm Hg in CRF patients might be safe.Higher CO2 pneumoperitoneum pressure could result in reversible renal Email:yuanhuizhong2000@yahoo.com.cnfunction change.