Knowledge levels of chronic obstructive pulmonary disease among physicians in primary care and related factors: a survey in Zhumadian City of Henan Province / 中华全科医师杂志

Objective:To survey the knowledge levels of chronic obstructive pulmonary disease(COPD) among physicians in primary care and related factors.Methods:A questionnaire survey was conducted during December 2020 to December 2021 among 1 232 primary care doctors in Zhumadian City of Henan Province. The questionnaire included basic information, knowledge of COPD and its management, and the training received. The COPD-related knowledge levels and the influencing factors were analyzed using logistic regression model.Results:A total of 1 232 questionnaires were collected, and 1 221(99.1%) were valid, which were included in the analysis. The survey showed that the COPD-related knowledge level was significantly associated with the educational level of primary care physicians(χ2=9.91, P<0.05); and the Pearson correlation analysis showed that the knowledge level was positively correlated with educational level( r=0.09, P<0.05). In terms of risk factors, causes of acute exacerbations, and treatment and management of COPD, there was a linear relationship between the education level and knowledge level(χ2=13.86, P<0.001;χ2=20.93, P<0.001); the Pearson correlation analysis showed that the knowledge level was correlated with higher educational level( r=0.11, P<0.001; r=0.13, P<0.001). In terms of symptoms and diagnosis, there was no correlation between educational level and awareness level(χ2=1.90, P=0.168). Logistic regression model showed that compared to doctors aged 20-30, those aged 31-40 had a higher COPD-related knowledge level( OR=2.24, 95% CI: 1.16-4.30, P=0.016); compare to the doctors with associate degree, doctors with bachelor degree or above had a higher COPD-related knowledge( OR=1.71, 95% CI:1.24-2.37, P=0.001); compared to doctors without professional title, those with primary or middle-rank professional title had a higher knowledge level( OR=1.65, 95% CI: 1.28-2.13, P<0.001; OR=2.15, 95% CI: 1.46-3.16, P<0.001); compared to doctors with training time<3, those with training time ≥3 had a higher knowledge level( OR=1.15, 95% CI: 1.21-2.61, P=0.021). Conclusion:The COPD-related knowledge levels(especially in knowledge of risk factors and causes of acute exacerbations, and treatment and management of COPD) among doctors in primary care are affected by age, educational background, professional title, and the number of training sessions.

Diagnosis, treatment and management status of COPD in county-level hospitals of China / 中华健康管理学杂志

Objective:To understand the current management status of chronic obstructive pulmonary disease (COPD) in county-level hospitals in China from 2020 to 2021.Methods:This survey was led by the China Association of County Hospital President. In 2021, a questionnaire survey was conducted on 633 secondary and tertiary hospitals from 24 provinces, and the questionnaire was filled out according to the actual situation of the hospital in 2020, including diagnosis, treatment, rehabilitation and comprehensive management of COPD. The nature of the hospital was divided into public or private. The type of hospital was divided into general or specialist. The economic zones was divided into eastern, central or western. Through the content of the questionnaire, the influencing factors of the diagnosis, treatment and management capabilities of COPD in county-level hospitals were explored.Results:A total of 633 questionnaires were collected in this survey, and 26 were removed due to the incorrect information or information loss. Thus, a total of 607 questionnaires were finally included in this survey, including 425 secondary hospitals and 182 tertiary hospitals; 591 public hospitals and 16 private hospitals. For the capabilities of diagnosis and treatment, the tertiary hospital was significantly better than the secondary hospital on the availability of respiratory outpatient clinics, COPD outpatient clinics, outpatient comprehensive clinics, respiratory ward and intensive care unit (ICU) (94.5% and 78.4%, 51.1% and 32.7%, 79.7% and 67.3 %, 84.6% and 59.8%, 78.6% and 61.9%, respectively) (all P<0.01). In terms of lung function test and bronchodilation test, tertiary hospitals performed significantly better than secondary hospitals ( P<0.05). There was no difference in availability of inhaled bronchodilators and expectorant drugs among different hospital levels, nature, type, and economic zones ( P>0.05). However, the proportion of hospitals with available triple inhalation drugs was lower in secondary hospitals than tertiary hospitals. For the non-drug treatment, the proportion of general hospitals carrying out vaccination was significantly higher than that of specialized hospitals (52.7% and 28.1%, P=0.010). The tertiary hospitals performed significantly better than secondary hospitals in smoking cessation guidance (98.4% and 94.4%, P=0.031). In terms of rehabilitation, tertiary hospitals also performed significantly better than secondary hospitals (79.7% and 61.9%, P<0.001). The proportion of hospitals carrying out long-term management of COPD in tertiary hospitals was significantly higher than secondary hospitals, and the proportion in public hospitals was significantly higher than private hospitals (80.2% and 61.2%, 68.2% and 18.8%, both P<0.001). Conclusions:County hospitals in China have a good overall performance in the diagnosis and drug treatment of COPD, but need to be further improved in non-drug treatment, rehabilitation, and comprehensive management. The hospital level is the main factor affecting the management ability of COPD. The nature and type of hospital mainly affect the construction of departments and comprehensive management of COPD.

Screening status of high-risk population of chronic obstructive pulmonary disease in areas where “Happy Breathing” is running / 中华健康管理学杂志

Objective:To analyze the screening status of high-risk population of chronic obstructive pulmonary disease (COPD) in areas where “Happy Breathing” project was carried out.Method:There were 1 008 518 COPD screening questionnaires (COPD-SQ) filled out in 18 pilot areas of “Happy Breathing” program from November 2017 to October 2019. Within subjects who scored 16 points or more with COPD-SQ, 63 523 of them underwent pulmonary function tests before bronchodilator inhalation. Stratified analysis, chi-square test and other statistical methods were performed to analyze the distribution of COPD high-risk groups, the prevalence of COPD among high-risk groups and risk factors of COPD.Results:Results in this study suggested that the high-risk population of COPD accounted for 18.99% (191 498/1 008 518) of the population who received the questionnaire screening. Among the high-risk population who received lung function test, 31.59% (20 070/63 523) were screened and diagnosed as COPD patients. As for risk factors of COPD, the proportion of high-risk population was higher in people with a smoking index ≥600 compared with never-smokers (54.20% vs 12.60%), and the prevalence of COPD was also higher in people with a smoking index ≥600 (35.62% vs 25.22%); people who were exposed to second-hand smoke almost every day also showed an increased proportion of high-risk groups (27.39% vs 10.97%) and a high prevalence of COPD (31.36% vs 27.93%) than those without second-hand smoke exposure; the presence or absence of biofuel exposure also caused the difference in the proportion of high-risk groups (33.92% vs 13.11%); compared with people without a family history of respiratory diseases, the proportion of high-risk groups (56.38% vs 16.42%) and the prevalence of COPD in high-risk groups (32.40% vs 29.19%) were both higher in those with family history of respiratory diseases.Conclusion:The high-risk group of COPD accounts for a high proportion of the screened population, suggesting that the “Happy Breathing” project is feasible and necessary in COPD screening, which is helpful for the development of COPD diagnosis and treatment.

Analysis of RECQL4 gene variant in a child with Rothmund-Thomson syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a child with Rothmund-Thomson syndrome (RTS).@*METHODS@#The child has featured poikeloderma, short stature, cataract, sparse hair and skeletal malformation. Peripheral blood samples of the child and her family members were collected and subjected to whole exome sequencing. Candidate variants were verified by Sanger sequencing.@*RESULTS@#The child was found to harbor compound heterozygous variants of the RECQL4 gene, namely c.1048_1049delAG and c.2886-1G>A, among which c.2886-1G>A was unreported previously. According to the ACMG guidelines, the c.1048_1049delAG was predicted to be pathogenic (PVS1+PM3_Strong+PM2), while the c.2886-1G>A was predicted to be likely pathogenic (PVS1+PM2).@*CONCLUSION@#The compound heterozygous variants of the RECQL4 gene probably underlay the pathogenesis of RTS in this patient. Above finding has enriched the mutational spectrum of the RECQL4 gene.

Analysis of clinical phenotype and genotype of Chinese children with disorders of sex development / 中华儿科杂志

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.

Relationship between body mass index and sexual development in Chinese children / 中华儿科杂志

Objective: To investigate the relationship between body mass index (BMI) and sexual development in Chinese children. Methods: A nationwide multicenter and population-based large cross-sectional study was conducted in 13 provinces, autonomous regions and municipalities of China from January 2017 to December 2018. Data on sex, age, height, weight were collected, BMI was calculated and sexual characteristics were analyzed. The subjects were divided into four groups based on age, including ages 3-<6 years, 6-<10 years, 10-<15 years and 15-<18 years. Multiple Logistic regression models were used for evaluating the associations of BMI with sexual development in children. Dichotomous Logistic regression was used to compare the differences in the distribution of early and non-early puberty among normal weight, overweight and obese groups. Curves were drawn to analyze the relationship between the percentage of early puberty and BMI distribution in girls and boys at different Tanner stages. Results: A total of 208 179 healthy children (96 471 girls and 111 708 boys) were enrolled in this study. The OR values of B2, B3 and B4+ in overweight girls were 1.72 (95%CI: 1.56-1.89), 3.19 (95%CI: 2.86-3.57), 7.14 (95%CI: 6.33-8.05) and in obese girls were 2.05 (95%CI: 1.88-2.24), 4.98 (95%CI: 4.49-5.53), 11.21 (95%CI: 9.98-12.59), respectively; while the OR values of G2, G3, G4+ in overweight boys were 1.27 (95%CI: 1.17-1.38), 1.52 (95%CI: 1.36-1.70), 1.88 (95%CI: 1.66-2.14) and in obese boys were 1.27 (95%CI: 1.17-1.37), 1.59 (95%CI: 1.43-1.78), and 1.93 (95%CI: 1.70-2.18) (compared with normal weight Tanner 1 group,all P<0.01). Analysis in different age groups found that OR values of obese girls at B2 stage and boys at G2 stage were 2.02 (95%CI: 1.06-3.86) and 2.32 (95%CI:1.05-5.12) in preschool children aged 3-<6 years, respectively (both P<0.05). And in the age group of 6-10 years, overweight girls had a 5.45-fold risk and obese girls had a 12.54-fold risk of B3 stage compared to girls with normal BMI. Compared with normal weight children, the risk of early puberty was 2.67 times higher in overweight girls, 3.63 times higher in obese girls, and 1.22 times higher in overweight boys, 1.35 times higher in obese boys (all P<0.01). Among the children at each Tanner stages, the percentage of early puberty increased with the increase of BMI, from 5.7% (80/1 397), 16.1% (48/299), 13.8% (27/195) to 25.7% (198/769), 65.1% (209/321), 65.4% (157/240) in girls aged 8-<9, 10-<11 and 11-<12 years, and 6.6% (34/513), 18.7% (51/273), 21.6% (57/264) to 13.3% (96/722), 46.4% (140/302), 47.5% (105/221) in boys aged 9-<10, 12-<13 and 13-<14 years, respectively. Conclusions: BMI is positively correlated with sexual development in both Chinese boys and girls, and the correlation is stronger in girls. Obesity is a risk factor for precocious puberty in preschool children aged 3-<6 years, and 6-<10 years of age is a high risk period for early development in obese girls.

Central precocious puberty with primary pigmented nodular adrenocortical disease: One case report / 中华内分泌代谢杂志

To report the clinical, imaging, and pathological feature of a rare case of central precocious puberty with primary pigmented nodular adrenocortical disease(PPNAD), and to conduct a retrospective analysis of PPNAD with relevant literatures. The pubic hair was found in the child for more than one year. Physical examination showed Cushing′s syndrome. ACTH in blood decreased, cortisol rhythm was disordered, 24-hour urine free cortisol increased and the paradoxical increase of urine free cortisol after high dose dexamethasone suppression test. Adrenal enhancement computed tomography(CT)showed multiple small nodular shadows in bilateral adrenal glands. Gonadotropin releasing hormone(GnRH)stimulation test supported central precocious puberty and GnRH analogue was used to control the sexual development. PPNAD was supported by pathology result. The symptoms of Cushing′s syndrome were relieved partially after left adrenalectomy.

Congenital lipoid adrenal hyperplasia with 46, XY karyotype and male external genitalia: Two cases and literature review / 中华内分泌代谢杂志

Congenital lipoid adrenal hyperplasia (CLAH) is a rare autosomal recessive disorder, which is characterized by adrenal insufficiency and 46, XY sex reversal. Two cases of CLAH with 46, XY karyotype exhibited male external genitalia were reported to explore the clinical and genetic features. A retrospective analysis of CLAH with relevant literatures was performed.

Analysis of Clinical Characteristics and Prognosis in Children with Acute Megakaryoblastic Leukemia without Down Syndrome / 中国实验血液学杂志

OBJECTIVE@#To analyze the clinical characteristics and treatment effects of children with acute megakaryoblastic leukemia without down syndrome (non-DS-AMKL).@*METHODS@#The clinical data of 19 children with non-DS-AMKL treated in the Pediatric Hematology Ward in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2008 to April 2018 were analyzed retrospectively. The clinical characteristics, laboratory test and treatment methods of the children were concluded. All patients were followed up to evaluate the effect of treatment.@*RESULTS@#The 19 cases of children included nine male and ten female, the median age of onset was 2 years old. The clinical manifestations showed nonspecific. The median white blood cell of peripheral blood was 15.88×10@*CONCLUSION@#Non-DS-AMKL was rare in children and difficult to be diagnosed. Determination of MICM classification as early as possible was helpful for diagnosis, and genetic testing played an important role for diagnosis and prognosis evaluation. Early hematopoietic stem cell transplantation in patients with CR after chemotherapy might be an effective way to cure AMKL.

Clinical efficacy of membrane induction technique for postoperative infection of tibial plateau fracture in adults / 中华创伤杂志

Objective:To investigate the clinical efficacy of membrane induction technique in the treatment of postoperative infection of tibial plateau fractures in adults.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 adult patients with postoperative infection of tibial plateau fractures treated with membrane induction technique from April 2013 to May 2017 in Southwest Hospital of Army Medical University. There were 19 males and two females, aged 19-60 years [(44.1±5.8)years]. There was one patient with type IV fractures, 14 with type V, and 6 with type VI according to the initial fracture typing by Schatzker's classification. There were three patients with infection period of within 3 weeks, 12 of 3-10 weeks, and 6 of over 10 weeks. All patients underwent two-stage operation using membrane induction technique to place cement in the bone defect area. After removal of internal fixation and thorough debridement, antibiotic cement and internal fixation plate were placed at stage I. Bone graft and reconstruction was performed at stage II. The infection indicators were recorded. Infection indices were monitored, including white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Clearance of infection, bony union and complications were evaluated. Range of motion (ROM) and scoring of Hospital for Special Surgery (HSS) were used to evaluate the function of knee joint.Results:All patients were followed up for 12-62 months with an average of 23.5 months. Compared with 3 months after stage II, the indicators of infection at stage I showed that WBC was decreased from (10.6±2.3)×10 9/L to (6.7±3.5)×10 9/L, ESR decreased from (26.0±5.3)mm/h to (12.1±4.3)mm/h, and CRP decreased from (10.0±1.5)mg/L to (5.8±1.0)mg/L ( P<0.05). Infection was cleared in 17 patients after stage I operation, and the other 4 patients had infection recurrence, which were given stage I debridement again to control the infection. Two patients were treated with local flap transfer to cover the wound because of skin soft tissue defect after debridement. Another two patients underwent knee arthrodesis, and none was amputated. X-ray film indicated bony union in 21 patients at 46 months (mean, 4.5 months) after operation, and clinical bone healing was acquired in all 21 patients. One patient showed donor site infection. No nonunion, recurrence of infection after stage II, deep vein thrombosis or pulmonary embolism occured after the second stage. At the latest follow-up, ROM in patients with infection periods within 3 weeks and 3-10 weeks was singnificantly improved from [(95.2±10.4)° and (85.7±11.5)°] to [(120.2±10.5)° and (98.6±12.2)°] ( P<0.01), but not in patients with infection periods of over 10 weeks ( P>0.05). The HSS score in all patients was significantly improved after operation [(65.6±8.2)points vs. (82.0±6.6)points]( P<0.01). Conclusion:For adult patients with tibial plateau fracture, membrane induction technique can effectively control the postoperative infection, achieve clinical bone healing and improve the knee function.

Preliminary Study of Chidamide Combined with Hematopoietic Stem Cell Transplantation in the Treatment of Childhood Acute T-Lymphoblastic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safety of combination chidamide and hematopoietic stem cell transplantation (HSCT) in the treatment of childhood acute T lymphoblastic leukemia (T-ALL).@*METHODS@#Seven children with acute T lymphoblastic leukemia received hematopoietic stem cell transplantation in SUN Yat-Sen Memorial Hospital of SUN Yat-Sen University were selected. 7 cases of T-ALL were divided into 2 groups: HSCT plus chidamide-treated group (4 cases) and traditional HSCT-treated group (3 cases) as control. The incidence of GVHD and other related complications, as well as implantation, recurrence and survival were compared between the two groups, and the side effects of chidamide were observed. All the patients were follow-up until January 2019.@*RESULTS@#All the 7 patients were alive and, there was no difference in the incidence of acute GVHD between the HSCT plus chidamides treated group and the traditional HSCT-treated group. The implantation rate of HSCT was 100%, and there were no recurrence occurred. During the application of chidamide, 3 cases showed adverse reactions, of which 2 cases had adverse reactions of grade 3 or higher, and 2 cases were hematological adverse reactions (neutropenia, thrombocytopenia), other adverse reactions were non-hematologic adverse reactions (transaminase elevation, fatigue, nausea, vomiting), there were no serious adverse reactions occurred. In the HSCT plus chidamide-treated group, 2 cases were found that mature lymphocytes were not expressed by tumors, during examing for minimal redidaul disease (MRD). Compared with the immunophenotype and TCR rearrangement at first diagnosis, the results did not support the source of residual T-ALL tumor cells. During the review of MRD, it was found that the abnormal T cells showed an increasing trend, indicating that chidamide might induce leukemia cell differentiation through some pathways.@*CONCLUSION@#Hematopoietic stem cell transplantation is still an effective method to cure children's T-ALL. In some cases, abnormal T-cell nonclonal amplification occurs during the application of chidamide, and the children with T-ALL can tolerable adverse reactions of chidamide.

Clinical and genetic analysis of a child with spondyloepimetaphyseal dysplasia type 1 and joint laxity / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a child with spondyloepimetaphyseal dysplasia type 1 and joint laxity.@*METHODS@#High-throughput sequencing and Sanger sequencing were used to analyze potential variant of the B3GALT6 gene.@*RESULTS@#DNA sequencing has identified 2 variants of the B3GALT6 gene in the patient, namely c.694C>T and c.539_540insCCT, which were respectively derived from his father and mother.@*CONCLUSION@#The c.694C>T and c.539_540insCCT variants of the B3GALT6 gene probably underlie the disease in the patient. The result has enabled molecular diagnosis, genetic counseling and prenatal diagnosis for his family.

Epidemic characteristics and treatment effect of the first dengue fever outbreak in Hubei Province / 公共卫生与预防医学

Objective To analyze the epidemic characteristics of the first local outbreak of dengue fever in Huangzhou District, Huanggang City, Hubei Province in August 2019, to evaluate the treatment effect of the epidemic situation, and to provide reference for the prevention and control of dengue fever in the future. Methods Retrospective investigation was carried out according to the case definition. The serum IgM, IgG, NS1 antigen, and dengue virus nucleic acid of the patients were detected. The density of mosquito larvae was monitored by Breteau index and the density of adults was monitored by a double mosquito net method. Results A total of 50 cases were detected from the first case on June 21 to the last case on September 11. No severe cases or deaths occurred. The main clinical manifestations were fever (94.00%), weakness (78.00%), headache (48.00%), muscle and joint pain (37.00%), and skin rashes (26.00%). The epidemic peak was from August 20 to September 1. The cases were distributed in two villages adjacent to one street (Yuwang Street) (49 cases in Weijialiangting Village and 1 case in Fanjiawan Village). Among the patients, 23 were male and 27 were female. The male to female ratio was 0.85:1. The age of onset was mainly 50 years and above, accounting for 89.1%. The occupational distribution was dominated by farmers and housework and unemployed, each accounting for 26.10%, followed by workers at 13.00%. The epidemic family aggregation was obvious. Eight cases were positive for dengue virus nucleic acid and the genotype was DENV-1. From the discovery of the outbreak to the end of the emergency response, the living environment of villagers of all towns (streets) in Huangzhou District had been significantly improved, and BI of key streets dropped below 5. Conclusion This was a local outbreak caused by an imported case. Insufficient medical personnel for the diagnosis and identification, poor environmental sanitation, and high mosquito density were the main reasons for the outbreak of dengue fever. The focus of prevention and control is the early detection and standardized management of infection sources, the cleaning of mosquito breeding environment and the rapid killing of adult mosquitoes.

Comparative measurement of intraocular pressure by Rebound and non-contact tonometry in patients wearing bandage contact lenses after pterygium excision / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the measurement of intraocular pressure(IOP)through a bandage contact lens with the “native” measurement by rebound tonometry and non-contact tonometry in patients after pterygium excision. <p>METHODS: Fifty consecutive patients(50 eyes)undergone pterygium excision(unilateral nasal, primary pterygium, horizontal length <4mm), and conjunctival autografting were included in this prospective study. IOP measurements were obtained by Rebound tonometry and non-contact tonometry in random order with(lens measurement)and without(native measurement)a bandage contact lens half a month after operation. We compared the mean values(validity parameter)and standard deviation(precision parameter)of the two individual measurements in each case using the paired t-test 14d after surgery. <p>RESULTS: With the rebound tonometry we detected statistically significant higher values in the contact lens measurements(18.20±3.19 <i>vs</i> 15.17±3.80mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.884 and mean difference was 3.04±1.79mmHg; With the non-contact tonometry we detected statistically significant higher values in the contact lens measurements(15.74±3.23 <i>vs</i> 13.19±3.89mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.876 and mean difference was 2.55±1.88mmHg. In the contact lens measurements and native measurements, we detected statistically significant higher values by Rebound tonometry than that by non-contact tonometry(<i>P</i><0.001), and mean difference was 2.46±1.45mmHg, 1.98±1.67mmHg. <p>CONCLUSION: The use of rebound tonometry and non-contact tonometry shows good consistency between lens measurement and native measurement. However, it should be noted that the average of the measurements over contact lens by rebound tonometry and non-contact tonometry were found to be higher than that in native measurement, and the average of the measurements with and without lens by rebound tonometer was found to be higher than what was measured by non-contact tonometry.

Efficacy of BMMSCs on aGVHD and Its Correlation with SerumInflammatory Cytokines in Pediatric Patients with Severe Refractory Acute Graft-Versus-Host Disease / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy of bone marrow mesenchymal stem cells (BMMSC) on children with refractory graft-versus-host disease (GVHD) and to judge the efficacy of BMMSC by dynamically monitoring the changes of cytokines in children with GVHD before and after infusion of BMMSC, so as to provide a theoretical basis for clarifying the mechanism of BMMSC.@*METHODS@#17 children with refractory aGVHD including 7 of grade II, 6 cases of grade III and 4 cases of grade IV after allo-HSCT were enrolled. All the children with aGVHD, who received routine immunosuppressive therapy, but the state of disease not improved, were treated with immunosuppressive drugs combined with BMMSC infusion. Study endpoints included safety of BMMSC infusion, response to BMMSC, and overall response of aGVHD. The serum levels of IL-2α, IL-6, IL-10, IL-8 and TNF-α in aGVHD patients were measured by chemiluminescence before infusion of BMMSCs and Day 7, Day 14 after infusion of BMMSCs.@*RESULTS@#The cumulative median dose of BMMSCs was 5.5 (3.4-11.1) × 10/kg for average of 3.7 times, and the median time of 16.5 (4-95) days for the first infusion of MSCs. In 17 cases of refractory GVHD, 14 responded to treatment, whereas 3 patients failed. The total effective rate was 82.4% and no adverse reactions occurred. Of the 14 survived cases (82.4%), the median follow-up time was 944 (559-1245) days from the first infusion of MSCs. The levels of TNF-α in children with grade II, III and IV GVHD before treatment were 9.5±4.3 pg/ml, 16.3±10.9 pg/ml and 35.8±21.2 pg/ml respectively. The difference between grade II and IV, III and IV was statistically significant (P<0.05). Compared with the ineffective group of BMMSC infusion, the serum TNF-αlevel in the BMMSCs treatment effective group was 10.8±5.6 pg/ml vs 40.6±14.8 pg/ml (t=-3.901, P<0.05) before treatment. In the effective group of BMMSCs infusion, IL-10 20±17.4 pg/ml of day 14 was significantly higher than that 7.3±3.1 pg/ml before the treatment (t=-2.850, P<0.05), while , the serum levels of IL-2α, IL-6, IL-8, TNF-α were not statistically significantly different (P＞0.05).@*CONCLUSION@#The infusion of BMMSC is safe and effective in the treatment of refractory GVHD in children. TNF-αlevel relates with the severity of GVHD. BMMSC may play an anti-GVHD role by up regulating the level of cytokine IL-10 in vivo.

Comparative measurement of intraocular pressure by Rebound and non-contact tonometry in patients wearing bandage contact lenses after pterygium excision / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the measurement of intraocular pressure(IOP)through a bandage contact lens with the “native” measurement by rebound tonometry and non-contact tonometry in patients after pterygium excision. <p>METHODS: Fifty consecutive patients(50 eyes)undergone pterygium excision(unilateral nasal, primary pterygium, horizontal length <4mm), and conjunctival autografting were included in this prospective study. IOP measurements were obtained by Rebound tonometry and non-contact tonometry in random order with(lens measurement)and without(native measurement)a bandage contact lens half a month after operation. We compared the mean values(validity parameter)and standard deviation(precision parameter)of the two individual measurements in each case using the paired t-test 14d after surgery. <p>RESULTS: With the rebound tonometry we detected statistically significant higher values in the contact lens measurements(18.20±3.19 <i>vs</i> 15.17±3.80mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.884 and mean difference was 3.04±1.79mmHg; With the non-contact tonometry we detected statistically significant higher values in the contact lens measurements(15.74±3.23 <i>vs</i> 13.19±3.89mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.876 and mean difference was 2.55±1.88mmHg. In the contact lens measurements and native measurements, we detected statistically significant higher values by Rebound tonometry than that by non-contact tonometry(<i>P</i><0.001), and mean difference was 2.46±1.45mmHg, 1.98±1.67mmHg. <p>CONCLUSION: The use of rebound tonometry and non-contact tonometry shows good consistency between lens measurement and native measurement. However, it should be noted that the average of the measurements over contact lens by rebound tonometry and non-contact tonometry were found to be higher than that in native measurement, and the average of the measurements with and without lens by rebound tonometer was found to be higher than what was measured by non-contact tonometry.

Detection Rate of Central Nervous System Leukemia Can Be Improved by Cell Preservation Solution / 中国实验血液学杂志

OBJECTIVE@#To investigate whether cell preservation solution can prolong the survival time of leukemia cells and increase the survival rate, so as to improve the detection rate of central nervous system leukemia.@*METHODS@#Kasumi cells were added into cerebrospinal fluid (CSF) supernatant with or without cell preservation solution to compare cell viability and biological characteristics at different time point. Wright Giemsa staining was used to compare cell morphology; cell counting, CCK-8 method, and trypan blue staining were used to compare the cell number, and flow cytometry was used to compare the cell viability. The expression of AML-ETO tumor fusion gene was detected by fluorescence quantitative RT-PCR.@*RESULTS@#At different time points (8 h and 24 h), the survival, molecular biological characteristics and RT-PCR result of the cells in CSF with cell preservation solution were significantly better than those in normal cerebrospinal fluid.@*CONCLUSION@#Cell preservation solution can effectively improve the survival time and survival rate of leukemic cells, thereby increase the detection rate of CNS leukemia.

Clinical Analysis of 164 Children of Blood Disease Complicated with Invasive Fungal Disease / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical characteristics, prevention and treatment of invasive fungal disease (IFD).@*METHODS@#The clinical data of 164 patients who met the diagnostic criteria of IFD in our center from January 2012 to January 2015 were retrospectively analyzed. The incidence, clinical characteristics, related factors, treatment methods and prognosis were analyzed.@*RESULTS@#Among 1289 cases of blood diseases, 164 cases suffered from IFD with inciduce of 12.7%. The main infection sites were as followed: lung, blood and gastrointestinal tract, with incidence of 84.2%, 5.5% and 3% respectively. The funge was found in 35 cases by detection; among fungi, the detected rate of candida albicans. aspergillus and candida glabrata was more high with 51.5%, 20% and 14.3% respectively. Among 164 childen with blood deseases complicated by IFD, 36 cases gained complete remission, 97 cases gained partial remission, 10 cases were stable, 11 cases were progressive and 10 cases died, the overall effective rate reached 81.1%. The univariate analysis showed that the gramulopenia, granulocyte recovery, long-term use of corticosteroid and immuno-suppressive agents, as well as different grades of diagnosis were significant factors affecting the efficacy of antifungal therapy for blood disease children with IFD, the multivariate analysis further showed that the granulocyte recovery and diagnosis grades were independent prognostic factors affecting the therapeutic efficacy for IFD children. The overall survival rate of IFD children with 12 weeks of antifungal treatnment was 81.7%, out of which the survival rate of IFD children at 12 weeks of treatment with itraconazole, voriconazole, amphotericin B and caspofungin was 81.4%, 80%, 69.4% and 97.1% respectively, there were significant differences in survival rate between each other by long rank test. In addition of caspofungin, the other 3 kinds of drugs had toxic side effects of different degrees, but IFD children could tolerated these effects after symptomatic treatment.@*CONCLUSION@#The incidence of IFD in children with blood deseases in our hospital is 12.7%, the lung is most common infective site, moreover patogens of IFD mainly is candida. The promotion of granulocyte recovery and early stratified diagnosis can contribule to the treatment of IFD. For the IFD children with better economic condition, the caspofungin is a potent antifungal agent with high efficacy, low toxicity and better prognosis.

Effects of Physical Activities on Functioning and Health for Aging People Using ICF / 中国康复理论与实践

Objective:To explore the developmental model of physical activities and function of older adults in the perspective of ICF to research the influence of physical activities on their body function, activity and participation, including related environmental factors and personal health behavior. Methods:Theory and methods of ICF had been implemented. Results:A framework of physical activities and overall function for aging people was developed based on ICF. Physical activities positively affected on the overall function, activities of daily living and participation for aging people. Different exercises played different roles on fitness, motor function and cognitive function. Conclusion:The theoretical framework of physical activities and functional health for aging people has been established based on the bio-psycho-social model of ICF. For aging people, physical activities contribute to improvement of functioning and health, such as overall function, functional independence and activities of daily living, as well as physical fitness, and cognitive function. There are different effects of different types of sports on the body function for aging people. Moderate to moderate-vigorous aerobic (endurance) exercise could reduce 30% or more the risks of morbidity and mortality. Exercise and sports may delay or prevent the impairment of cognitive function. Long-term resistance exercise and aerobic exercise can reduce the risk of dementia.

Inhibitory effect of oridonin on proliferation and migration of human esophageal squamous cancer cell lines KYSE-150 and KYSE-450 / 解剖学报

Objective To explore the effect of oridonin (ORI) on proliferation, apoptosis, cell cycle and migration of esophageal squamous carcinoma cell (ESCC) lines KYSE-150 and KYSE-450. Methods The effect of ORI on the proliferation and clony formation of esophageal cancer cells were detected by MTT and colony formation assays. Flow cytometry was performed to examine the impact of ORI on cell apoptosis and cell cycle. Transwell assay was applied to detect the role of ORI on cell migration. The effect of ORI on the expression of anti-apoptotic protein Bcl-2, cell cycle inhibitory protein p21Cip1/Waf1, epithelial-mesenchymal transition (EMT) related markers were examined by Western blotting. Results ORI had a significant inhibitory effect on the proliferation, migration and clone formation of KYSE-150 and KYSE-450 cells (P<0. 05) in a time and dose-dependent manner. With the increase of ORI concentration, apoptosis rate and the proportion of cells in G2/M phase increased significantly (P<0. 05), and the proportion of cells in G0/G1 phase decreased significantly (P < 0. 0 5). Bcl-2, vimentin and p-catenin were down-regulated and p21Cipl/Wafl, Ecadherin were up-regulated after treatment of ORI on ESCC cells for 48 hours. Conclusion ORI may inhibit ESCC cell proliferation and clony formation by inducing apoptosis and resting cells in G2/M phase, and suppress ESCC cell migration via inhibiting EMT process.