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Venous thromboembolism (VTE) is a complication in children with acute lymphoblastic leukemia (ALL). The Chinese Children's Cancer Group-ALL-2015 protocol was carried out in China, and epidemiology, clinical characteristics, and risk factors associated with VTE were analyzed. We collected data on VTE in a multi-institutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019. First, VTE occurred in 159 (2.08%) patients, including 90 (56.6%) during induction therapy and 108 (67.92%) in the upper extremities. T-ALL had a 1.74-fold increased risk of VTE (95% CI 1.08-2.8, P = 0.022). Septicemia, as an adverse event of ALL treatment, can significantly promote the occurrence of VTE (P < 0.001). Catheter-related thrombosis (CRT) accounted for 75.47% (n = 120); and, symptomatic VTE, 58.49% (n = 93), which was more common in patients aged 12-18 years (P = 0.023), non-CRT patients (P < 0.001), or patients with cerebral thrombosis (P < 0.001). Of the patients with VTE treated with anticoagulation therapy (n = 147), 4.08% (n = 6) had bleeding. The VTE recurrence rate was 5.03% (n = 8). Patients with VTE treated by non-ultrasound-guided venous cannulation (P = 0.02), with residual thrombus (P = 0.006), or with short anticoagulation period (P = 0.026) had high recurrence rates. Thus, preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.
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Humans , Child , Venous Thromboembolism/etiology , East Asian People , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Risk Factors , Thrombosis/chemically induced , China/epidemiology , Anticoagulants/adverse effects , RecurrenceABSTRACT
【Objective】 To evaluate the safety and efficacy of the collection of peripheral blood stem cells (PBSCs) in pediatric patients with thalassemia major (TM) weighing 20 kg or less. 【Methods】 PBSCs collection data of 170 pediatric patients with TM weighing 20 kg or less from January 2013 to December 2020 in our center were reviewed. Safety was assessed by the occurrence of adverse events during apheresis procedures, and efficacy was evaluated by the number of CD34+ cells collected. 【Results】 A total of 171 PBSCs procedures were performed on 170 patients with TM weighing 20 kg or less, with a median age of (4.98±1.53) years and a median weight of (17.30±2.18) kg. The probability of collecting at least 1×106 CD34+ cells/kg during a single course of apheresis was 99.41% (169/170), with a median (5.88±4.23) ×106 CD34+ cells collected per kg of weight of the recipient. A minimum pre-apheresis hemoglobin (Hb) of 60 g/L in patients with TM weighing 20 kg or less was safe and feasible. The most common adverse event of G-CSF mobilization in TM patients is bone pain, with the incidence of 7.65% (13/170), which was higher than that of healthy children donors in our center. The most common adverse events during the collection were pain at the puncture site of the femoral vein (6.47%, 11/170) and low pressure of the fluid (2.92%, 5/170). And no serious complications related to PBSCs mobilization, central venous catheter(CVC)placement or the apheresis procedure occurred. 【Conclusion】 PBSCs collection by COM.TEC blood cell separator in children weighing 20 kg or less is safe and efficacious.
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Objective To evaluate the effect of continuous infusion of dexmedetomidine on the oxidative stress in patients undergoing percutaneous coronary intervention (PCI).Methods Fifty patients, with acute myocardial infarction who required for emergency PCI, 39 males, 11 females, aged 47-79 years, weighting 45-83 kg, ASA physical status Ⅲ or Ⅳ, were selected and randomly divided into two groups (n=25 each) using a random number table: the control group (group C) and the dexmedetomidine group (group D).In group D, a loading dose of dexmedetomidine 0.5 μg/kg was infused intravenously for 10 min before surgery, and then dexmedetomidine was infused at a rate of 0.2-1.0 μg·kg-1·h-1 during the operation until the end of operation.Patients in group C received the same dose saline in the same way.RASS score was maintained at-2-2 scores in the two groups.Blood samples were collected before the anesthesia induction (T0), at the end of the operation (T1), 6 h after the operation (T2) and 24 h after the operation (T3) to determine the observed changes of PMN, SOD and MDA.The intraoperative adverse reactions including hypotension, bradycardia and hypoxemia were recorded.Results Compared with T0, the number of PMN and the serum concentration of MDA at T1-T3 significantly increased, while effective serum SOD at T1-T3 significantly decreased (P＜0.01 or P＜0.05).The serum concentration of MDA and the number of PMN at T1-T3 in group D were significantly lower than those in group C, while the effective serum SOD was significantly higher than that in group C (P＜0.05).There was no significant difference of intraoperative adverse reactions including hypotension, bradycardia and hypoxemia between the two groups.Conclusion Continuous infusion of dexmedetomidine can decrease oxidative stress thus to alleviate myocardial reperfusion injury.
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Objective To calculate the chest volume for an evaluation of lung development ,the degree of thorax narrowing and pectus excavatum deformity by the surface measurements .Methods Ninety normal Sprague Dawley (4 weeks) rats were ran‐domly divided into experimental and control groups .Experimental group had 70 rats and control group had 20 rats .Cutting off the lower three cartilage from parasternal of rats to produce Pectus excavatum model in experimental groups .We measured many chest radial lines before surgery ,2 ,4 ,8 and 12 weeks after surgery respectively ,then made comparison between parallel group .Thoracic volume size was calculated by a mathematical formula ,Archimedes measurement and the CT three dimensional reconstruction ,and the t test and linear regression were analyzed by SPSS17 .0 .Results this experiment used multiple radial lines to get measurement results ,and through mathematical calculations ,Archimedes measurement and CT reconstruction ,we found there were significant differences between the experimental group and the control group (P<0 .05) .Conclusion It is practicable of surface measurement to calculate chest volume .This method could replace the CT examination to evaluate the change of the chest volume along the process of pectus excavatum formation .
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Objective To investigate the autophagy and apoptosis in acute myelogenous leukemia U937 cell induced by Sirolimus.Methods U937 cells were subcultured, and blank control group(normal) and Sirolimus treated groups(12 h, 24 h,48 h) were established.The Sirolimus treated groups were treated by 2 μmol/L concentration of Sirolimus for 12 h,24 h and 48 h, respectively.The cell morphology of U937 cells treated by Sirolimus was observed after 12 h,24 h and 48 h.The survival rate of cells was detected by cell counting kit-8 method.Cell apoptosis was detected by flow cytometry using Annexin V-FITC/PI double labeled.Real-time PCR was used to detect the level of mRNA expression in autophagy specific protein maker mictotubule-associated protein light chain 3 (LC3)-Ⅱ in different treated times by Sirolimus.Sirolimus LC3 protein expression levels after treatment were detected by Western blot method.Results Under inverted microscope, the cell number of Sirolimus treatment group reduced gradually after 12 h ,24 h and 48 h culture, volume of cells became smaller, cells got ruptured, and the nucleus pycnosis and cellular debris increased.With the extension of time, U937 cells survival rate was falling, and there was statistical differences compared with those of the control group(P =0.031).With Sirolimus treatment, U937 cells after 12 h,24 h and 48 h, U937 cell apoptosis rate increased, and there were statistically significances, compared with those of the control group (P =0.027).With Sirolimus treatment U937 cells after 12 h,24 h and 48 h,LC3-Ⅱ mRNA expression and protein expression were down-regulated compared with those of the control group, and there were statistically significances (P =0.029).Conclusions Sirolimus can induce autophagy and apoptosis in U937 cells.Autophagy protein LC3-Ⅱ in gene and protein expression levels were lowered, and LC3-Ⅱ may play an important role in regulating the leukemia cell autophagy.
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<p><b>OBJECTIVE</b>To observe the status of iron deposition in patient with β thalassemia major, and to formulate appropriate treatment strategies.</p><p><b>METHOD</b>The data of status of transfusion and chelation in 135 patients aged from 6 years and 4 months to 17 years and 11 months with β thalassemia major were collected and analyzed. Serum ferritin levels were determined and cardiac and hepatic iron deposition was determined using MRI T2(*) technology.</p><p><b>RESULT</b>Of the 135 cases studied, 66 were male, and 69 were female, their average age was 12.1 years. Serum ferritin (SF) was determined for 111 cases, it varied from 1 086.8 µg/L to 15 011.5 µg/L. Among them, 16 cases had SF level <2 000 µg/L (14.5%) , in 41 cases SF were between 2 000 and 4 000 µg/L (36.0%) ;in 54 cases SF >4 000 µg/L (48.7%) . Liver MRI T2(*) results showed that in only 8 cases (5.9%) iron content in the liver was in normal range, 19 cases (14.9%) showed mild liver iron deposition;34 (25.2%) moderate and 74 (54.8%, the youngest one was only 6 years and 4 months of age) had severe iron deposition respectively. Cardiac MRI T2(*) showed that in 89 cases (65.9%) iron content in the heart was in normal range;19 cases (14.1%) had mild cardiac iron deposition and 27 (20.0%) presented severe iron deposition (the youngest one was only 9 years and 3 months of age) . SF level was obviously related to liver and cardiac iron deposition (MRI T2(*)) r and P value were -0.284, 0.003 and -0.374, 0.000 respectively. In 108 cases regular transfusion and chelation were delayed due to financial problem. The late and insufficient dosage administered and irregular chelation caused the higher SF level and the severe iron deposition.</p><p><b>CONCLUSION</b>The survival status of β thalassemia major in China is worrisome. Majority of them had not received regular transfusion and chelation. Liver and cardiac iron deposition occur early and had a high incidence.</p>
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Adolescent , Child , Female , Humans , Male , Ferritins , Blood , Iron , Metabolism , Iron Chelating Agents , Therapeutic Uses , Iron Overload , Epidemiology , Liver , Metabolism , Magnetic Resonance Imaging , Myocardium , Metabolism , Radiography , Retrospective Studies , Transfusion Reaction , beta-Thalassemia , Diagnostic Imaging , Metabolism , TherapeuticsABSTRACT
BACKGROUND:Cytokines play an important role in the occurrence and development of graft-versus-host disease, but there is a current lack of reports on the association between cytokines and graft-versus-host disease after al ogeneic hematopoietic stem cel transplantation for treatment ofβ-thalassemia major. OBJECTIVE:To investigate the association between cytokines and graft-versus-host disease after al ogeneic hematopoietic stem cel transplantation forβ-thalassemia major. METHODS:We observed the dynamic variation of interleukin 6, interleukin 8, interleukin 12, tumor necrosis factor-αand macrophage migration inhibitory factor in 11 children withβ-thalassemia major before onset of graft-versus-host disease, when graft-versus-host disease occurred, at days 4 and 7 after onset of graft-versus-host disease, and when graft-versus-host disease disappeared. RESULTS AND CONCLUSION:There was a significant difference in serum levels of interleukin-6, interleukin-12, tumor necrosis factor-α, macrophage migration inhibitory factor in different time points, and the highest levels of different cytokines appeared when graft-versus-host disease occurred, fol owed by those at 7 days after graft-versus-host disease. There was a significant difference in serum levels of interleukin-8 in different time points, and the highest level appeared at 4 days after graft-versus-host disease. The dynamic expression of interleukin-6, interleukin-8, interleukin-12, tumor necrosis factor-α, macrophage migration inhibitory factor can estimate the immune function ofβ-thalassemia major patients who develops graft-versus-host disease after al ogeneic hematopoietic stem cel transplantation, and can be used as the immunobiology indicators for the early diagnosis of graft-versus-host disease.
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<p><b>OBJECTIVE</b>To assess the value of magnetic resonance imaging T2* tests in the detection of myocardial and liver iron overload in patients with β-thalassemia major (β-TM).</p><p><b>METHODS</b>From 2010 to 2011, 28 β-TM patients over 10 years old under blood transfusion therapy and chelation care with serum ferritin (SF)>1000 µg/L underwent myocardial and liver MRI T2* tests on a voluntary basis. The results were analyzed in relation with age, SF, and left ventricular ejection fraction (LVEF).</p><p><b>RESULTS</b>Fourteen out of the 28 cases (50%) were found to have myocardial iron overload, including 7 severe cases, 2 moderate cases, and 5 mild cases. All the 28 cases had liver iron overload, including 2 mild cases, 7 moderate cases, and 19 severe cases. Two out of the 28 cases had lowered LVEF (7.14%), and one of them had severe myocardial iron overload. There was a negative correlation between myocardial MRI T2* and SF (r=-0.479, P=0.01). Myocardial MRI T2* was positively correlated with liver MRI T2* (r=0.378, P=0.047). Age was not significantly correlated with SF, LVEF, or liver MRI T2*.</p><p><b>CONCLUSION</b>Magnetic resonance imaging (T2*) detection is an effective and non-invasive means for detecting myocardial and liver iron overload in patients with β-thalassemia major receiving blood transfusion. T2* combined with SF is the main diagnostic indicator to assess iron overload in the vital organs.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Ferritins , Blood , Iron , Metabolism , Iron Overload , Diagnosis , Metabolism , Pathology , Liver , Metabolism , Magnetic Resonance Imaging , Myocardium , Metabolism , beta-Thalassemia , Diagnosis , Metabolism , PathologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the effects of different doses of antithymocyte globubin-fresenius (ATG-F) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with beta-thalassemia Major.</p><p><b>METHODS</b>Sixty-four children with beta-thalassemia major undergoing allo-HSCT were divided into two equal groups to receive ATG-F pretreatments at high (30 mg/kg) or low (15 mg/kg) doses as part of the conditioning regimen including mainly cyclophosphamide, busulfan, fludarabine, and thiotepa. The outcomes of the patients were compared between the two groups.</p><p><b>RESULTS</b>No obvious difference were noted in the time to leukocyte and platelet engraftment between the two groups. The incidence of grade II-IV acute graft-versus-host disease (aGVHD) appeared to be higher in the low-dose group than in the high-dose group (12.5% vs 9.4%). The incidence of grade III-IV aGVHD was also higher in the low dose group (12.5% vs 6.3%), but the difference was not statistically significant. Application of high-dose ATG-F was associated with a higher rate of probable and possible fungal infection (P<0.05).</p><p><b>CONCLUSION</b>The two doses of ATG-F is feasible as a part of the conditioning regimen for allo-HSCT in children with beta-thalassemia major.</p>
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Adolescent , Animals , Child , Child, Preschool , Female , Humans , Male , Rabbits , Antilymphocyte Serum , Allergy and Immunology , Hematopoietic Stem Cell Transplantation , Methods , Lymphocytes , Allergy and Immunology , Transplantation Conditioning , Methods , beta-Thalassemia , Allergy and Immunology , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of human cytomegalovirus (HCMV) infection on T lymphocyte subsets in children with β-thalassemia major (TM) during the initial 6 months after allogeneic hematopoietic stem cell transplantation (Allo-HSCT).</p><p><b>METHODS</b>From January, 2010 to January, 2011, 35 children with TM underwent Allo-HSCT. Peripheral blood samples were obtained from the children 6 month after the transplantation to examine the changes of T lymphocytes subsets in relation to HCMV seropositivity.</p><p><b>RESULTS</b>Thirteen children were found seropositive and 22 were seronegative for HCMV. The HCMV-seropositive children had a higher CD8⁺ cell percentage but a lower CD4⁺ cell percentage than those without HCMV infection. Compared with those seronegative for HCMV, the children with HCMV seropositivity showed increased percentages of CD8⁺ cells and CD8⁺CD28⁻ cells with a decreased percentage of CD8⁺CD28⁺ cells. A positive linear correlation was found between the percentages of CD8⁺CD28⁻ cells and CD8⁺ cells.</p><p><b>CONCLUSION</b>HCMV infection can lead to the accumulation of CD8⁺CD28 cells to cause increased CD8⁺ T cells in the peripheral blood in TM children after Allo-HSCT. The percentages of CD8⁺CD28⁻ cells has a positive linear correlation to that of CD8⁺ cells.</p>
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Adolescent , Child , Child, Preschool , Female , Humans , Male , CD8-Positive T-Lymphocytes , Allergy and Immunology , Cytomegalovirus , Cytomegalovirus Infections , Allergy and Immunology , Hematopoietic Stem Cell Transplantation , Postoperative Period , T-Lymphocyte Subsets , beta-Thalassemia , Allergy and Immunology , General Surgery , VirologyABSTRACT
Pediatrics internship is a bridge that brings medical theory into clinical reality.Cultivate systematic clinical thinking during internship is the key to the growth of clinical doctors.Good outcome has been achieved among these eight-year medical students by using teaching methods such as case discussions,lectures,teacher instructions,which can cultivate proper clinical thinking and make students more active.
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OBJECTIVE: To investigate the curative effect of combined transplantation of bone marrow and umbilical cord blood of same sibling in children with β-thalassemia major.METHODS: Eight thalassemia major patients undergoing combined transplantation of bone marrow and umbilical cord blood of same sibling aged from 4.0 to 7.5 years, 5 boys and 3 girls, were recruited at the Department of Pediatrics, Nanfang Hospital,Southem Medical University from January 2005 to March 2009. The patients were classified into three classes according to Pesarothalassamia classification, class Ⅰ to class Ⅱ 7 cases and class Ⅲ 1 case. Donors ranged 1-4 years received 10 μg/kg per day of subcutaneous granulocyte colony-stimulating factor (G-CSF) for 5 consecutive days. Bone marrow was harvested on the fifth day. Bone marrow and umbilical cord blood of the same sibling then were transfused into the patient.RESULTS: Recovery of hematopoiesis was gained in all patients 4 weeks following transplantation. Seven patients suffered from infection of different degree. Four patients developed mild venous occlusive disease. Two patients developed grade Ⅰ acute graft-versus-host disease (GVHD), and one developed grade Ⅰ chronic GVHD. Seven patients were alive and one died of pulmonary infection and heart failure 32 days following transplantation.CONCLUSION: Combined transplantation of granulocyte colony-stimulating factor primed bone marrow and umbilical cord blood of same sibling in children with β-thalassemia major is safe and effective with promising results. However, complications should be paid high attention following transplantation.
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BACKGROUND: According to present theories and our clinical experience, immune ablative and tolerance inducing theory is proposed. Immune ablative means to clear out mutate cell clones and without transfusion of hemopoietic stem cells afterwards; intolerance inducing means to induce animal models not to react to mutate somatic cells, which avoids relapse or new occurrence of autoimmune disease. OBJECTIVE: To explore the effects of immune-ablative and tolerance inducing therapy in treating animal model of immune polymyositis (PM). DESIGN, TIME AND SETTING: Randomized, controlled animal experiment was performed at the Animal Experimental Center of Nanfang Hospital from December 2008 to April 2009. MATERIALS: One New Zealand rabbit, female, weighing 4.1 kg and 36 England guinea pigs, female, weighing 400-500 g, were used. METHODS: New Zealand rabbit's muscle tissue homogenate and complete Freund's adjuvant (CFA) were injected into guinea pigs to make PM animal models. The 28 animal models were randomly divided into intense immune-ablative and tolerance inducing group (Busulfan 1 mg/kg, every 12 hours, totally 8 doses; followed by CTX 40 mg/kg per day for 4 days; then cyclosporine A (CsA) 3 mg/kg per day was given till animals were dead); cyclophosphamide (CTX) group: CTX was given, 10 mg/kg per day for 3days; immune-ablative and tolerance inducing group: Busulfan 0.8 mg/kg, CTX 30 mg/kg, CsA 3 mg/kg; the administration time and dose were the same as group 1. Control group was not treated.MAIN OUTCOME MEASURES: Full blood count (FBC) and biochemical index were tested before and after treatment, and surviving time was recorded. In addition, muscle pathological changes were observed.RESULTS: Compared with control group, number of white cells was significantly decreased in the other groups, and hematopoiesis function gradually restored after administration. The number of white cells in the immune-ablative and tolerance inducing group was the most, and striated muscle pathology showed PM. Following administration, the glutamic oxaloacetic transaminase and creatine kinase of intense immune-ablative and tolerance inducing and immune-ablative and tolerance inducing groups were significantly reduced (P < 0.05, P < 0.01), but no obvious striated muscle pathological changes were found. The glutamic oxaloacetic transaminase, lactic dehydrogenase and creatine kinase in the CTX and control groups remained unchanged. Survival time of intense immune-ablative and tolerance inducing group was the shortest among all groups, and there was no significant difference between CTX and control groups. The animals in immune-ablative and tolerance inducing group survived for the longest time. CONCLUSION: Immune-ablative and tolerance inducing therapy has preferable effect on treating animal models of PM, and its prognosis is better than intense immune-ablative and tolerance inducing therapy and regular CTX therapy.
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This article analyzes the factors of influencing practice quality from such aspects as hospital management,medical reform,clinical teachers and students and points out that only by enhancing the management of practice hospital as well as the system of examining and assessment,raising the teacher guidance and teaching consciousness and guiding the students to properly handle with the relations between employment,entrance exam for postgraduate and practice can we guarantee the clinical practice quality.
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The teaching hospitals'particularity of practicing protrudes the promoting role of train the students comprehensive quality by practice and hospital culture. The article discusses promotion of medical students' professional skills and puts forward the corresponding counter-measure proposal.
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Objective To discuss operative treatment of the postoperative infection after total hip arthroplasty. Methods 11 cases of infected hip arthroplasty, 6 males and 5 females, with a mean age of 63 years old (from 54 to 71 years), were treated operatively in our department. Their preoperative mean Harris score was 33 (from 25 to 40), and their mean erythrocyte sedimentation rate (ESR) was 61 mm/h (from 34 to 80 mm/h). Bacterial cultures and drug susceptibility tests were carried out before and during operation. One- stage revision was performed for 6 cases, and two- stage revision was performed for 5 cases. Of the 11 cases, 2 were classified as early postoperative infection and 9 as late chronic infection. Preoperative microorganism cultures of joint aspiration or pus in sinus were positive in 8 cases but negative in 3 cases. 5 had staphylococcus epidermidis infection, 2 had escherichia coli infection and 1 had staphylococcus aureus infection. Results No recurrence of infection was found after a mean follow- up period of 17 months (from 12 to 31 months). ESR and blood tests after operation revealed nothing abnormal. The mean Harris score increased significantly to 84.2 (from 79 to 92) after revision (P
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Objective To evaluate the therapeutic effect of different types of biliary tract reconstruction on the post- resection of congenital choledochal cyst (CCC). Methods 106 cases of CCC undergoing resection of CCC with Roux-en-Y hepaticojejunostomy as biliary tract reconstruction were followed up and analysed. Results In this series, three kinds of biliary tract reconstruction were performed, including single Roux-en-Y hepaticojejunostomy in 48 cases, intussusceptive valve and rectangular valve lying on the jejunal segmental of Roux-en-Y hepaticojejunostomy in 37 and 21 cases, respectively. 61 cases were followed up for 4.82 years in average. None of them occurred anastomasis stricture. There were 4 cases with ascending cholangitis after primary operation: of them 3 after single Roux-en-Y hepaticojejunostomy; symptoms of 2 out of the 3 cases disappeared after reoperation to set up an intussusceptive valve plasty on the jejunal segmental of Roux-en-Y hepaticojejunostomy; another one was in rectangular valve group. Occasional abdominal pain tooke place in 8 patients, of them, 5 in single Roux-en-Y hepaticojejunostomy group, 2 and 1 in intussusceptive valve and rectangular valve groups, respectively. No patients suffered from ascending cholangitis in the intussusceptive valve plasty group. Conclusions The postoperative ascending cholangitis and anastomasis stricture can be prevented effectively, if a prophylactic intussusceptive valve on the jejunal segmental of Roux-en-Y hepaticojejunostomy is carried out after resection of CCC for biliary tract reconstruction. This procedure corresponds to the biliary tract physiology.