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1.
Article in Chinese | WPRIM | ID: wpr-928301

ABSTRACT

OBJECTIVE@#To investigate the surgical skills and clinical curative results of arthroscopic treatment of ankle instability combined with anteromedial impingement syndrome.@*METHODS@#From February 2019 to August 2020, 13 patients with ankle instability combined with anteromedial impingement were retrospectively analyzed. There were 10 males and 3 females with age of (40.0±15.1) years old. The course of disease was(44.1±33.2) months. All patients had history of ankle sprain. MRI showed the injury of anterior talofibular ligament. All patients had anteromedial pain and pressing pain when ankle dorsiflexion. All patients were treated with ankle debridement and Brostr?m-Gould surgery under ankle arthroscopic. Postoperative results were evaluated by VAS(visual analogue scale) and AOFAS-AH(American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, AOFAS-AH).@*RESULTS@#All 13 patients completed the surgery successfully with an operative time of 60 to 90 minutes. All the surgical incisions healed by first intention, and no complications such as incision infection, skin necrosis and neurovascular injury. Follow-up time was (18.1±4.7) months. At the latest follow-up, the VAS score was 1.2±1.1, which was significantly lower than the preoperative score 4.8±1.5 (P<0.05);the AOFAS-AH score 94.2±5.1 was significantly higher than the preoperative score 65.5±11.5 (P<0.05). The AOFAS-AH score at the final follow-up ranged from 84 to 100. All patients walked with normal gait without ankle instability or impingement recurrence.@*CONCLUSION@#Ankle anteromedial impingement syndrome combined with ankle instability is easy to be ignored clinically. Such kind of anteromedial impingement syndrome is mostly related to osteophyte at dorsal medial talar neck. Arthroscopic treatment of ankle instability combined with anteromedial impingement syndrome has satisfactory curative effect with safety and minimal injury.


Subject(s)
Adult , Ankle , Arthroscopy/methods , Female , Humans , Joint Instability/surgery , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
2.
Organ Transplantation ; (6): 288-2022.
Article in Chinese | WPRIM | ID: wpr-923572

ABSTRACT

Immune tolerance after liver transplantation refers to discontinuing use of immunosuppressants in varying patterns and maintaining the long-term stability of liver function of the recipients. At present, immune tolerance may be achieved by passive immune tolerance, active operational immune tolerance and induced immune tolerance. Multiple clinical trials have confirmed the safety and feasibility of these approaches. Compared with adults, pediatric recipients undergoing liver transplantation have better potential of immune tolerance, especially the living donor liver transplant recipients. Nevertheless, it remains a challenge to predict whether a certain individual may achieve immune tolerance. In this article, research progresses on the characteristics of immune tolerance in pediatric recipients, induction of immune tolerance, operational immune tolerance, induced immune tolerance, screening of recipients and tolerance markers were reviewed, aiming to provide reference for the formulation of postoperative immunosuppressant regimens, reduce the overall exposure to immunosuppressants and lower the risk of adverse reactions induced by immunosuppressants in children undergoing liver transplantation.

3.
Article in Chinese | WPRIM | ID: wpr-880115

ABSTRACT

OBJECTIVE@#To investigate the factors affecting the chronicity of childhood primary immune thrombo-cytopenia (ITP) and compare the efficiency of different first-line treatment regimens.@*METHODS@#Children with ITP hospitalized in our hospital from September 2013 to October 2018 were retrospectively analyzed.@*RESULTS@#Three hundred and one children (150 males and 151 females) were included in this study, with a median age of 8 (0.17-17) years old, and 110 (36.5%), 92 (30.6%), and 99 (32.9%) cases were grouped into newly diagnosed, persistent, and chronic ITP, respectively. The median of follow-up was 41.92 (1.07-74.03) months. At the end of the follow-up (October 2019), among the 202 newly diagnosed/persistent ITP children, 79 cases (59 newly diagnosed and 20 persistent ITP) achieved remission within 1 year after initial diagnosis, with a remission rate of 39.3%; 122 cases (50 newly diagnosed and 72 persistent ITP) developed chronic disease, with a chronicity rate of 60.7%; one case underwent splenectomy. In 99 cases with chronic ITP, 5 cases underwent splenectomy. Multivariable logistic regression analysis showed that, the insidious onset of symptoms (OR=3.754, 95%CI: 1.882-7.488, P=0.000) increased the risk of chronicity, while the positive antibody to anti-platelet membrane glycoprotein (OR=0.446, 95%CI: 0.224-0.888, P=0.021) might reduce the risk of chronicity. And no difference was found by the analysis of subtype of anti-platelet membrane glycoprotein (P=0.305). The efficacy of the first-line treatment of intravenous immunoglobulin (IVIG) alone or combined with steroid was better than that of steroid alone (P=0.028, 0.028), however, the efficiency was not significantly different between IVIG alone and combined with steroid (P=0.086).@*CONCLUSION@#Insidious onset of symptoms in pediatric ITP increases the risk of chronicity, while the positive titer of anti-platelet membrane glycoprotein may reduce the risk. In the first-line treatment for the newly diagnosed/persistent children. The efficacy of IVIG alone or combined with steroid is better than that of steroid alone.


Subject(s)
Adolescent , Child , Child, Hospitalized , Female , Humans , Immunoglobulins, Intravenous , Male , Purpura, Thrombocytopenic, Idiopathic , Retrospective Studies , Splenectomy
4.
Article in Chinese | WPRIM | ID: wpr-908678

ABSTRACT

Objective:To compare the sonographic features of clinical lymph node negative (cN 0) stage papillary thyroid microcarcinoma (PTMC) and non-PTMC, and improve the early diagnosis of cN 0 stage PTMC. Methods:The clinical data of 223 patients with papillary thyroid carcinoma from January 2015 to December 2017 in Dalian Municipal Center Hospital were retrospectively analyzed. Preoperative ultrasonography of all patients showed lymph node negative, and all patients received radical thyroidectomy. Among them, PTMC was in 143 cases (tumor diameter ≤1 cm, PTMC group), and non-PTMC in 80 cases (tumor diameter >1 cm, non-PTMC group). The sonographic features, including echogenicity, boundary, morphology, calcification, posterior echo attenuation, blood flow and ratio of length and width were compared between 2 groups.Results:There were no significant differences in the incidences of unclear boundary, irregular shape and posterior echo attenuation between the two groups ( P>0.05). The incidences of extremely low or low echo and ratio of length and width ≥1 in PTMC group were significantly higher than those in non-PTMC group: 88.1% (126/143) vs. 67.5% (54/80) and 37.8% (54/143) vs. 7.5% (6/80), the incidences rate of calcification and peripheral or internal blood flow were significantly lower than those in the non-PTMC group: 55.9% (80/143) vs. 72.5% (58/80) and 49.0% (70/143) vs. 77.5% (62/80), and there were statistical differences ( P<0.01 or <0.05). Conclusions:The ultrasonographic features of cN 0 stage PTMC and non-PTMC are different.

5.
Article in Chinese | WPRIM | ID: wpr-908492

ABSTRACT

Objective:To investigate the risk factors for abdominal infection after liver transplantation (LT).Methods:The retrospective case-control study was conducted. The clinical data of 356 patients who underwent LT in the First Affiliated Hospital of Xi′an Jiaotong University from January 2015 to December 2018 were collected. There were 273 males and 83 females, aged from 21 to 67 years, with the median age of 46 years. Observation indications: (1) abdominal infec-tion after LT and distribution of pathogens; (2) analysis of risk factors for abdominal infection after LT; (3) follow-up and survival. Follow-up was performed using outpatient examination and tele-phone interview to detect postoperative 1-year survival rate and cases of death up to June 2020. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were described as M(range). Count data were expressed as absolute numbers or percentages. Univariate analysis was conducted using the chi-square test, t test, Mann-Whitney U test and Fisher exact probability. Multivariate analysis was done using the Logistic regression model. The Kaplan-Meier method was used to calculate sruvival time and survival rates. Log-Rank test was used for survival analysis. Results:(1) Abdominal infection after LT and distribution of pathogens: 63 of 356 recipients had abdominal infection after LT, with the overall incidence of 17.70%(63/356). Of the 63 recipients, 41 cases had abdominal infection within postoperative 2 weeks, 17 cases had multi-drug resistant organism infection. A total of 116 strains of bacteria were isolated from 63 recipients with abdominal infection, 52 of which were gram-negative bacteria, 48 were gram-positive bacteria, 16 were fungi. (2) Analysis of risk factors for abdominal infection after LT: results of univariate analysis showed that preoperative model for end-stage liver disease (MELD) score, preoperative serum albumin, preoperative leukocytes, preoperative prothrombin time, preoperative alanine aminotransferase, preoperative aspartate aminotransferase, operation time, volume of intraoperative blood loss, days of postoperative antibiotic use, postoperative renal failure, postoperative delayed graft function,duration of postoperative intensive care unit stay were related factors for abdominal infection after LT ( Z=-2.456, t=-1.982, Z=-3.193, -2.802, -2.336, -2.276, -2.116, -3.217, χ2=15.807, 10.395, 6.750, Z=-4.468, P<0.05). Liver retransplantaiton and postoperative bile leakage were related factors for abdominal infection after LT ( P<0.05). Results of multivariate analysis showed that preoperative MELD score>20 and liver retransplantation were independent risk factors for abdominal infection after LT ( odds ratio=2.871, 12.875, 95% confidence interval as 1.106-7.448, 1.290-128.521, P<0.05). (3) Follow-up and survival: 356 recipients were followed up for 1-66 months, with a median follow-up time of 32 months. The postoperative 1-year overall survival rate of 63 recipients with abdominal infection and 293 recipients without abdominal infection were 84.60% and 97.03%, respectively, showing a significant difference ( χ2=11.660, P<0.05). During the follow-up, 58 recipients died. Conclusion:Preoperative MELD score>20 and liver retransplantation are independent risk factors for abdominal infection after LT.

6.
Chinese Critical Care Medicine ; (12): 1074-1079, 2020.
Article in Chinese | WPRIM | ID: wpr-866976

ABSTRACT

Objective:To analyze the risk factors of acute kidney injury (AKI) in hospitalized patients with infective endocarditis (IE), construct prediction model, and discuss its predictive value.Methods:The clinical data of 402 adult inpatients diagnosed with IE admitted to the Affiliated Hospital of Qingdao University from January 2010 to January 2020 were retrospectively analyzed. The patients were divided into the AKI group and the non-AKI group. The clinical data, such as gender, age, presence of diabetes, basic estimated glomerular filtration rate (eGFR), laboratory indexes at admission, involvement of valves, presence of sepsis, medication during hospitalization, surgery and outcome of the two groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of AKI in IE inpatients. A predictive model was constructed, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the model.Results:A total of 290 patients with IE were enrolled, including 198 non-AKI patients and 92 AKI patients. The incidence of AKI was 31.7%. Among the 92 AKI patients, 46 patients were at AKI stage 1 (50.0%), while 46 patients were at AKI stage 2 and stage 3 (50.0%). Compared with the non-AKI group, patients in the AKI group were older [years old: 64 (55, 71) vs. 55 (46, 63)], and had lower basic eGFR (mL·min -1·1.73 m -2: 64.6±13.6 vs. 82.9±19.5), higher proportion of diabetic and incidence of sepsis (16.3% vs. 8.6%, 38.0% vs. 13.1%), more frequent use of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists (ACEI/ARB), diuretics and non-steroidal anti-inflammatory drugs (NSAIDs; 25.0% vs. 15.2%, 82.6% vs. 63.1%, 58.7% vs. 24.2%), more abnormal urine test results (hematuria or proteinuria, 35.9% vs. 22.7%), higher pathogen culture negative rate (73.9% vs. 51.5%), lower Gram positive (G +) cocci infection rate and surgery rate (22.8% vs. 40.4%, 60.9% vs. 81.8 %), with significant differences (all P < 0.05). There were no significant differences in the gender, number and location of involved valves, and laboratory indexes at admission between the two groups. Compared with the non-AKI group, the inpatient mortality rate of the AKI group was higher (30.4% vs. 8.6%, P < 0.01), and the inpatient mortality rate of patients with AKI stage 2 and stage 3 was significantly higher than that of patients with AKI stage 1 (43.5% vs. 17.4%, P < 0.01). In multivariate Logistic regression analysis, the lower basic eGFR [hazard ratio ( HR) = 0.136, 95% confidence interval (95% CI) was 0.066-0.280], sepsis ( HR = 6.100, 95% CI was 2.394-15.543), demand for NSAIDs ( HR = 2.990, 95% CI was 1.184-7.546) and radiocontrast agent ( HR = 3.153, 95% CI was 1.207-8.238) were independent risk factors for AKI in hospitalized patients with IE (all P < 0.05). A prediction model was constructed based on the above risk factors, and ROC curve analysis showed that the area under the ROC curve (AUC) of prediction model for AKI was 0.888 (95% CI was 0.833-0.943, P < 0.01) with sensitivity of 86.4% and specificity of 80.9%. Conclusions:In the IE-susceptible population, low basic eGFR, sepsis, the need for NSAIDs and contrast agent are independent risk factors to AKI. The predictive model constructed by the above risk factors has certain predictive value for the occurrence of AKI in the IE inpatients.

7.
Article in Chinese | WPRIM | ID: wpr-862982

ABSTRACT

Recurrent respiratory tract infection(RRTI)is a common disease in pediatrics.It is more common in 2~6 years old, and the incidence rate is increasing year by year.Its etiology is complicated, and the condition is prolonged and repeated, which seriously affects children′s physical and mental health.At present, the clinical understanding of the disease is still inadequate, and the use of broad-spectrum antibiotics has increased the number of drug-resistant bacteria, further increasing the difficulty of treatment.With the research in recent years, in addition to immunomodulators, applications of vitamin AD and probiotics have gradually attracted attention.This article summarizes the definition, etiology, pathogenesis, balance of intestinal flora, related pathogenic mechanisms and treatments of recurrent respiratory tract infections.The related functions further provide new ideas and methods for the diagnosis and treatment of the disease, thereby improving the long-term prognosis.

8.
Chinese Medical Journal ; (24): 334-343, 2020.
Article in English | WPRIM | ID: wpr-877961

ABSTRACT

BACKGROUND@#High agglomeration of myeloid-derived suppressor cells (MDSCs) in neuroblastoma (NB) impeded therapeutic effects. This study aimed to investigate the role and mechanism of targeted inhibition of MDSCs by low-dose doxorubicin (DOX) to enhance immune efficacy in NB.@*METHODS@#Bagg albino (BALB/c) mice were used as tumor-bearing mouse models by injecting Neuro-2a cells, and MDSCs were eliminated by DOX or dopamine (DA) administration. Tumor-bearing mice were randomly divided into 2.5 mg/kg DOX, 5.0 mg/kg DOX, 50.0 mg/kg DA, and control groups (n = 20). The optimal drug and its concentration for MDSC inhibition were selected according to tumor inhibition. NB antigen-specific cytotoxic T cells (CTLs) were prepared. Tumor-bearing mice were randomly divided into DOX, CTL, anti-ganglioside (GD2), DOX+CTL, DOX+anti-GD2, and control groups. Following low-dose DOX administration, immunotherapy was applied. The levels of human leukocyte antigen (HLA)-I, CD8, interleukin (IL)-2 and interferon (IFN)-γ in peripheral blood, CTLs, T-helper 1 (Thl)/Th2 cytokines, perforin, granzyme and tumor growth were compared among the groups. The Wilcoxon two-sample test and repeated-measures analysis of variance were used to analyze results.@*RESULTS@#The slowest tumor growth (F = 6.095, P = 0.018) and strongest MDSC inhibition (F = 14.632, P = 0.001) were observed in 2.5 mg/kg DOX group. Proliferation of T cells was increased (F = 448.721, P < 0.001) and then decreased (F = 2.047, P = 0.186). After low-dose DOX administration, HLA-I (F = 222.489), CD8 (F = 271.686), Thl/Th2 cytokines, CD4+ and CD8+ lymphocytes, granzyme (F = 2376.475) and perforin (F = 488.531) in tumor, IL-2 (F = 62.951) and IFN-γ (F = 240.709) in peripheral blood of each immunotherapy group were all higher compared with the control group (all of P values < 0.05). The most significant increases in the aforementioned indexes and the most notable tumor growth inhibition were observed in DOX+anti-GD2 and DOX+CTL groups.@*CONCLUSIONS@#Low-dose DOX can be used as a potent immunomodulatory agent that selectively impairs MDSC-induced immunosuppression, thereby fostering immune efficacy in NB.


Subject(s)
Animals , Doxorubicin/therapeutic use , Mice , Mice, Inbred C57BL , Myeloid-Derived Suppressor Cells , Neuroblastoma/drug therapy , Tumor Microenvironment
9.
Article in Chinese | WPRIM | ID: wpr-802306

ABSTRACT

Objective:To discuss the effect of volatile oil from Xanthii Fructus on airway remodeling of rats with bronchial asthma, in order to discuss the mechanism of action through matrix metalloteinases-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), platelet derived growth factor (PDGF), transforming growth factor-β1 (TGF-β1), Smad2, Smad3 and Smad7 mRNA expressions. Method:Forty-eight rats (half males and half females) were randomly divided into six groups (n=8), namely normal saline group, model group, volatile oil from Xanthii Fructus (7.5, 15, 30 mg·kg-1) groups and dexamethasone group (0.5 mg·kg-1). Except for normal saline group, airway remodeling of rats were established through ovalbumin sensitization and atomization inhalation method. At volatile oil group, rats got volatile oil spray since the first time (the 4th week after modeling) of inspiration of asthma to the last day before the end of test. Histopathological changes of bronchus and lung were analyzed by htoxylin eosin (HE) stain. And airway remodeling was observed, and perimeter of bronchial lumen (Pi), smooth muscle area of bronchi (S), tube wall area (W) and nuclei of smooth muscle cells (N) were recorded. And levels of endothelin-1 (ET-1) and insulin-like growth factor-1(IGF-1) in irrigation solution of Alveoli (BALF) were detected. And mRNA expressions of MMP-9, TIMP-1, PDGF, TGF-β1, Smad2, Smad3 and Smad7 were detected by real-time quantitative-polymerase chain reaction (Real-time PCR). Result:In the model group, infiltration of a large number of inflammatory cells were found at the peribronchial wall, airway smooth muscle thickness and basement membrane increased, and bureaucratic cavity was narrower and flatter. Volatile oil from Xanthii Fructus can ameliorate pathological damage of bronchopulmonary tissue. Levels of S/Pi, W/Pi and N/Pi, BALF, ET-1, IGF-1 and MMP-9/TIMP-1 and mRNA expressions of MMP-9 and PDGF in volatile oil group and dexamethasone group were lower than those in model group (Pβ1, Smad2 and Smad3 were less than those in model group (PPConclusion:Volatile oil from Xanthii Fructus can regulate levels of MMP-9, TIMP-1, MMP-9/TIMP-1, TGF-β1/Smad, inhibit expressions of PDGF, ET-1 and IGF-1, and suppress subepithelial fibrosis, extracellular matrix synthesis, proliferation and migration of airway smooth muscle cells to relieve or inhibit airway remodeling, so as to prevent and treat asthma.

10.
Article in Chinese | WPRIM | ID: wpr-802077

ABSTRACT

Objective: To observe the clinical efficacy of Jieyu Tongluo decoction on post-stroke depression (PSD) and its regulatory effect on neurotransmitter. Method: One hundred and twenty-five patients with PSD were randomly divided into control group (62 cases) and observation group (63 cases) by random number table. Both groups got psychological support, health education, and sertraline hydrochloride tablets, 25-50 mg/time, 2 times/days. Patients in control group got Shugan Jieyu capsules, 2 grains/time, 2 times/days. Patients in observation group got Jieyu Tongluo decoction, 1 dose/day. And a course of treatment was 6 weeks. Before and after treatment, hamilton depression scale (HAMD-17), patient health questionnaire-9 (PHQ-9), national institutes of health stroke scale (NHISS),traditional Chinese medicine(TCM) syndrome and activity of daily living scale (ADL) were scored. And levels of 5-serotonin (5-HT), norepinephrine (NE), dopamine (DA), brain-derived neurotrophic factor (BDNF), serum S100-β and neuron enolase (NES) were detected. Result: By rank sum test, after treatment, the clinical efficacy of observation group was superior to that in control group (Z=2.384, PPZ=2.266, PZ=2.817, Pβ and neuron enolase (NES) were lower than those in control group (PPConclusion: In addition to psychotherapy and SSRI, Jieyu Tongluo decoction can relieve degree of depression, depressive symptoms and degree of neurologic impairment, increase activities of daily living, regulate neurotransmitter expression, and improve the reparation of cranial nerve tissue, with obvious clinical effects, and is worthy to be used in clinic.

11.
Chinese Journal of Hematology ; (12): 1031-1034, 2019.
Article in Chinese | WPRIM | ID: wpr-800491

ABSTRACT

Objective@#To evaluate the efficacy and safety of eltrombopag in the treatment of pediatric primary immune thrombocytopenia (ITP) .@*Methods@#The clinical characteristics of 23 pediatric ITP patients who received eltrombopag from May 2015 to March 2019 were retrospectively analyzed. Eltrombopag started with an initial dose of 12.5-50.0 mg/d and the maximum dose was 75.0 mg/d.@*Results@#Among 23 children, there were 11 boys and 12 girls with median age 11.0 (2.0-17.0) years. Four cases were newly diagnosed ITP, the other 8 of persistent ITP and 11 of chronic ITP. The duration of eltrombopag application ranged from 4.5 to 95 weeks (8/23 still ongoing) . The median platelet (PLT) counts at 2 weeks, 4 weeks, 3 months and the 6 months after treatment were 40 (4-170) ×109/L, 20 (4-130) ×109/L, 60 (4-110) ×109/L, and 70 (18-160) ×109/L, which were all significantly higher than that before treatment 14 (2-82) ×109/L (z=-3.440, P=0.001; z=-1.964, P=0.049; z=-4.339, P<0.001;z=-5.794, P<0.001 respectively) . The overall response rate was 60.87% (14/23 cases) . The median time to PLT count ≥30×109/L was 10.5 (3-42) days. Seven patients (30.43%) responded within the first week, and 10 cases (43.48%) achieved PLT counts ≥30×109/L within 2 weeks. All patients were divided into three groups according to the age (<6 years old, 6-12 years old, 13-17 years old) . The response rates were similar in three groups, as 33.33%, 60.00%, 85.71%, respectively. WHO bleeding scores as 0, 1, 2 were corresponded to 4, 12 and 7 patients before treatment. Patient numbers changed to 13, 7, 3 with bleeding scores 0, 1, 2 respectively after treatment (χ2=7.558, P=0.006) . Eltrombopag was well tolerated, the common adverse events included elevated transaminase (4 cases) and serum bilirubin (4 cases) ; mild nausea (1 case) , vomiting (1 case) and dizziness (1 case) . No drug withdrawal occurred due to adverse events.@*Conclusion@#Eltrombopag is safe and effective in pediatric patients with primary ITP.

12.
Chinese Journal of Hematology ; (12): 1008-1014, 2019.
Article in Chinese | WPRIM | ID: wpr-800487

ABSTRACT

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

13.
Chinese Journal of Hematology ; (12): 837-842, 2019.
Article in Chinese | WPRIM | ID: wpr-796973

ABSTRACT

Objective@#To analyze the gene mutation spectrum, clinical features, and the factors of disease progression and prognosis in patients with essential thrombocytosis (ET) .@*Methods@#A retrospective analysis was conducted on 178 newly diagnosed ET patients admitted from February 1st, 2009 to November 1st, 2018.@*Results@#Of the 178 patients, 89 were male and 89 female, and the median diagnosis age was 49.5 (3-86) years old. JAK2V617F, CALR and MPL mutations frequencies were 16.45% (1.67%-43.90%) , 40.00% (10.00%-49.15%) and 25.10% (25.00%-40.00%) , respectively. Compared with patients with CALR mutations, patients with JAK2V617F mutation had higher diagnosis age (P=0.035) , higher white blood cell count (P=0.040) , higher hemoglobin concentration (P=0.001) , and lower platelet count (P=0.002) , respectively. Of them, 47 patients (27.01%) developed thrombotic events before diagnosis, and 3 ones (1.72%) experienced thrombotic events after diagnosis. Multivariate analysis revealed age >60 years (P=0.013, OR=4.595, 95%CI 1.382-15.282) and cardiovascular risk factors (CVF) (P<0.001, OR=8.873, 95%CI 2.921-26.955) as risk factors for thrombotic events, CALR mutation (P=0.032, OR=0.126, 95%CI 0.019-0.838) as a protective factor for thrombotic events. Age >60 years (P=0.042, OR=4.045, 95%CI 1.053-15.534) was found to be a risk factor for the overall survival (OS) of ET patients. OS of age ≤60 years and age>60 years were calculated by Kaplan-Meier analysis to be (115.231±1.899) months and (83.291±4.991) months (χ2=6.406, P=0.011) , respectively.@*Conclusion@#Age>60 years and CVF were risk factors for thrombotic event. CALR mutation was a protective factor for thrombotic event. Age >60 years was a risk factor for OS in ET patients.

14.
Article in Chinese | WPRIM | ID: wpr-744420

ABSTRACT

Objective To summarize and analyze the clinical features,diagnostic methods and treatment measures of patients with advanced spontaneous esophageal rupture. Methods Retrospective analysis of clinical characteristics of 10 patients with advanced spontaneous esophageal rupture was conducted. Results The average age of the patients was 49. 3 years old. The average time of diagnosis was 82. 6 hours. The cause of onset was drastic vomiting except for one case falling down. The main clinical manifestations were chest pain,abdominal pain,and shortness of breath,fever and elevation of hemogram,pleural effusion appeared in all patients,1 case was not treated in time,and 9 cases of the first checks were delayed for diagnosis and treatment in other specialties. Conservative treatment(closed thoracic drainage,gastrointestinal decompression,enteral nutrition support and antimicrobial therapy) was given to all patients. All 10 cases were cured by conservative treatment,the average time of hospitalization was 49. 4 days,followed up for 2 years, no chronic empyema, stricture of the esophagus and reflux esophagitis were observed. Conclusion Late spontaneous rupture of the esophagus is caused by delays in the diagnosis and treatment of the esophagus,the effect of comprehensive conservative treatment is satisfactory.

15.
Article in Chinese | WPRIM | ID: wpr-744312

ABSTRACT

Objective To evaluate in vitro antimicrobial effect of fosfomycin sodium single use and combination with other antimicrobial agents on clinically isolated Staphylococcus aureus (S.aureus), Klebsiella pneumoniae (K.pneumoniae) and Pseudomonas aeruginosa (P.aeruginosa) in China.Methods Combined antimicrobial susceptibility testing was performed with checkerboard method, minimal inhibitory concentrations (MICs) were detected by two-fold agar dilution method, susceptibility of S.aureus (n=113 strains), K.pneumoniae (n=108 strains), and P.aeruginosa (n=110 strains) isolated from 18 hospitals in China in recent three years was determined by single and combined antimicrobial susceptibility testing.Results MIC50 value of fosfomycin sodium single use were all≤32 mg/L against all tested strains, regardless of whether strains were resistant to other antimicrobial agents or not.The synergistic rate of fosfomycin sodium with levofloxacin, minocycline, oxacillin, and clindamycin against methicillin-resistant S.aureus (MRSA) was>43%.Synergistic rate of fosfomycin sodium with levofloxacin and imipenem against imipenem-nonsusceptible P.aeruginosa was>35%, synergistic rates of fosfomycin sodium with tested antimicrobial agents against imipenem-susceptible P.aeruginosa were all>35%.Conclusion Fosfomycin sodium still has good antimicrobial activity against common clinical drug-resistant bacteria, such as MRSA, extended-spectrumβ-lactamase-producing K.pneumoniae and so on, it has synergistic effect with many other kinds of antimicrobial agents, suggesting that in the limited treatment of infection caused by drug-resistant bacteria, fosfomycin in combination with other antimicrobial agents may be a useful choice.

16.
Article in Chinese | WPRIM | ID: wpr-755986

ABSTRACT

Objective To analyze the status of the treatment for atrial fibrillation (AF) in a community health service center in Shanghai Pudong New Area. Methods Clinical data of all patients with AF attended in Hudong Community Health Service Center of Shanghai Pudong from August 2016 to August 2017 were retrospectively reviewed. The gender,age,smoking history,drinking history,concomitant diseases, antithrombotic therapy, rhythm control, ventricular rate control drugs, health education, needs for setting up AF clinics in the community were analyzed. Result The study included 220 patients,with average age of (59.7±10.4) years; 34.1%(75/220)patients had hypertension and the blood pressure was controlled in 41.3%(31/75); 20.5%(45/220)patients had diabetes mellitus and glycosylated hemoglobin(HbA1c)was controlled well in 26.7%(12/45). Three cases of mitral stenosis were treated with warfarin anticoagulation. Among 217 patients without valvular atrial fibrillation,157 had thromboembolic risk score≥2,20.4% (32/157) of whom used warfarin anticoagulation,10.8% (17/157) used new oral anticoagulant (NOAG) and 58.1% (91/157) had never used warfarin or NOAG anticoagulation. The reasons were as follows:doctors did not prescribe (41.9%, 39/91),patients did not accept (35.2%,32/91), and so on. There were 21.8% (48/220) of patients undergoing drug cardioversion,and 5.9% (13/220) undergoing electrical cardioversion. For control of ventricular rate, 55.9% (123/220) patients used beta blockers,13.6% (30/220) used non?dihydropyridine calcium antagonists, and 23.6% (52 / 220) used digitalise. Less than 55% of patients were given health education of physical exercise,weight management and medicine use. For AF clinic in community hospital,56.8% (125/220) of patients needed,and 17.3% (38/220) very need; 50.0% (110/220) patients trusted and 12.3% (27/220) very trusted in anticoagulation management in community hospitals. Conclusion The anticoagulant rate is relatively low, treatment of concomitant diseases is less satisfactory and the health education might be incomplete in the community surveyed in this study.

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Article in Chinese | WPRIM | ID: wpr-755956

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Objective To explore the diagnosis and treatment of parvovirus B19 infection-associated anemia after pediatric liver transplantation (LT) .Methods The clinical data were retrospectively reviewed for 2 children with severe anemia caused by parvovirus B19 infection after LT .Case 1 was a 2-year-old girl with a weight of 10 .7 kg .Classical orthotopic LT was performed due to ornithine carbamoyltransferase deficiency . Hemoglobin level began to progressively decline since Day 2 post-transplantation .And case 2 was a 5-month-old girl with an age of 5 months and a weight of 7 .2 kg .She underwent classic orthotopic LT for biliary atresia and decompensated liver cirrhosis .Hemoglobin level progressively declined at nearly 2 months post-transplantation . Results In case 1 ,bone marrow aspiration was performed at Day 54 post-transplantation .There was pure red cell aplasia and the detection of microvirus B19 nucleic acid was positive .Intravenous immunoglobulin was prescribed at a dose of 2 .5 g/day for 10 days ,tacrolimus was switched to cyclosporine and hemoglobin level spiked from 62 to 105 g/L after one-month treatment .In case 2 ,hemoglobin decreased to 44 g/L at 2 .5 months post-transplantation and the result of polymerase chain reaction of parvovirus B 19 was 9 .7 × 107 copies/ml .Then intravenous immunoglobulin was dosed at 2 .5 g/day for 10 days and hemoglobin level rose to 122 g/L at 25 days after treatment . Hemoglobin level decreased to 63 g/L again at 4 .5 months post-transplantation .Anemia was corrected by intravenous immunoglobulin injection plus a temporary discontinuation of tacrolimus and a reduced dose of tacrolimus .Conclusions Infection of parvovirus B19 can cause pure red cell aplasia after LT in children . Early diagnosis with intravenous immunoglobulin and modification of immunosuppressive regimen can obtain excellent therapeutic efficacies .

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Article in Chinese | WPRIM | ID: wpr-755925

ABSTRACT

Objective To employ high-throughput next generation sequencing (NGS) for analyzing the expression of lneRNAs and mRNAs in donor samples from pediatric living donor liver transplantation and search differentially expressed lncRNAs and drag metabolic gene for individualized guidance of immunosuppressive agents.Methods Between October 2016 and December 2017,10 liver tissue specimens from living donor liver transplantation children were collected and divided into fast and slow metabolic groups (n =5 each) according to the postoperative profiles of drug metabolism.Samples were assayed for high-throughput NGS.Target analysis was used for functional pathways and screening target genes prediction.Results There were differentially expressed 908 mRNAs and 1228 lncRNAs between slow metabolic and fast metabolic groups (P<0.05).According to the abundance and difference,22 up-regulated and 18 down-regulated mRNAs,13 up-regulated and 24 down-regulated lncRNAs were selected.In addition to CYP3A5,CYP2C19,CYP1A2 and UGT1A1 might affect the metabolism of tacrolimus.At the same time,NONHSAT108617.2 in differemially expressed lncRNAs might regulate the expression of CYP3A5 gene.Conclusions This study has comprehensively analyzed the expression of lncRNAs in donor liver from pediatric liver transplantation.Some differentially expressed drug metabolism related genes may affect tacrolimus metabolism in vivo and thus the postoperative use of immunosuppressive drugs.

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Article in Chinese | WPRIM | ID: wpr-777943

ABSTRACT

@# Objective To analyze the epidemiological characteristics of mumps in Jiamusi city, and predict the incidence trend, so as to provide evidence for taking targeted prevention and control measures in the cold areas in Heilongjiang Province. Methods The mumps cases were collected from China Information System for Disease Control and Prevention in Jiamusi city from 2004 to 2017.Descriptive epidemiologic method was used for analyzing the epidemic of mumps in Jiamusi city during 2004-2017, and the autoregressive integrated moving average (ARIMA) was used to forecast the incidence of mumps in 2018. Results A total of 1 586 cases of mumps were reported in Jiamusi city during 2004-2017, the average annual incidence rate was 4.52/100 000. The incidence of mumps increased year by year from 2015 to 2017.The ratio of male to female was 1.67 :1,those aged from 3 to 19 years accounted for 86.32% of the total cases, the higher incidence rates were found at the age of 5-9 and 10-14 years.The incidence of mumps presented obviously seasonal characteristics.Most cases concentrated from April to July and from November to January. The incidence of urban disease was higher than that of other counties; The established finally mode was ARIMA(4,1,2)(2,0,0)12 and the predicted incidence from January 2018 to June 2018 was consistent with the actual one.From July 2018 to December 2018,predictive mumps incidence were:0.30/100 000, 0.35/100 000, 0.38/100 000, 0.39/100 000, 0.35/100 000, 0.33/100 000. Conclusions ARIMA model could predict the trend of mumps in Jiamusi city.To reduce the incidence of children, it is recommended to develop a second dose of mumps vaccine at the preschool age(3-6 years)or primary school;At the same time, surveillance and control should be continually strengthened in kindergartens and schools.

20.
Article in Chinese | WPRIM | ID: wpr-774338

ABSTRACT

OBJECTIVE@#To investigate the joint health status of patients with hemophilia treated on-demand and to analyze the incidence trend of hemophilic arthritis, so as to probide the scientific clinical data for furture study.@*METHODS@#The clinical data of patients with hemophilia admitlted in Tianjin municipal first central hospital form March 2016 to October 2017 were collected, the basic information of patients was recorded; the joint health status was evaluated by using the hemophillia Joint Health Score (HJHS) 2.1; the life guality of patients was analyzed by using the MOS item short form-36 health survey, SF-36; the correlation of joint function with life guatity was analyzed by pearson correlation test.@*RESULTS@#196 ont of 210 patients with hemophila were treated on demand. The average age of patients was 27.81(2-73) years old, Among 196 patients, 189 was hemophilia A (96.43%) and 9 was hemophilia B (3.57). The patients without joint involvement, patients with 1 joint and 32 jionts involvement accounted for 3.57%, 11.72% and 84.71% respectively. The incidonce of involvement in elbow, knae and ankle joints was 71.93%, 80.61% and 82.91% respectively. The joint invlvement rate in patients with mild, intermediate and severe hemphilia accounted for 61.66%, 72.40% and 80.73% respectively. The mean HJHS in intermediate and severe henophilia patients was 23.59±17.02 scores and 26.69±17.68 scores respectively, there was no statistical difference (P>0.05). The joint fanction in hemophilia patients negatively correlated with life gnality of patients (r = 0.076).@*CONCLUSION@#The incidence of arthritis in hemophilia patients is high, and at least 1 joint has been involved in patients aged over 10 years old, moreover the multiple joint involvement exrsts in most patients. The impairment of joint function affects the routine behavious and activities.


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Health Status , Hemophilia A , Hemophilia B , Humans , Middle Aged , Young Adult
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