Clinical Characteristics and Survival Analysis of Carbapenem-Resistant Pseudomonas Aeruginosa Colonized or Infected Patients with Hematological Disorders / 中国实验血液学杂志

OBJECTIVE@#To observe the clinical characteristics and impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) colonized or infected patients with hematological disorders in order to provide evidence for the prevention and treatment of CRPA.@*METHODS@#The patients who were colonized or infected with CRPA in the Department of Hematology of The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2020 to March 2021 were selected as the research subjects, the clinical data such as hospitalization time, primary disease treatment regimen, granulocyte count, previous infection and antibiotic regimen of these patients were analyzed, meanwhile, antibiotic regimen and efficacy during CRPA infection, 30-day and long-term survival were also analyzed.@*RESULTS@#A total of 59 patients were included in this study, and divided into CRPA infection group (43 cases) and CRPA colonization group (16 cases). Univariate logistic regression analysis showed that ECOG score (P =0.003), agranulocytosis (P <0.001), and exposure to upper than 3rd generations of cephalosporins and tigecycline within 30 days (P =0.035, P =0.017) were the high-risk factors for CRPA infection. Multivariate logistic regression analysis showed that ECOG score of 3/4 ( OR=10.815, 95%CI: 1.260-92.820, P =0.030) and agranulocytosis ( OR=13.82, 95%CI: 2.243-85.176, P =0.005) were independent risk factors for CRPA infection. There was a statistically significant difference in cumulative survival rate between CRPA colonization group and CRPA infection group ( χ2=14.134, P < 0.001). Kaplan-Meier survival analysis showed that the influencing factors of 30-day survival in patients with CRPA infection were agranulocytosis (P =0.022), soft tissue infection (P =0.03), and time of hospitalization before CRPA infection (P =0.041). Cox regression analysis showed that agranulocytosis was an independent risk factor affecting 30-day survival of patients with CRPA infection (HR=3.229, 95%CI :1.093-3.548, P =0.034).@*CONCLUSIONS@#Patients with hematological disorders have high mortality and poor prognosis after CRPA infection. Bloodstream infection and soft tissue infection are the main causes of death. Patients with high suspicion of CRPA infection and high-risk should be treated as soon as possible.

Clinical evaluation of antral septal maxillary sinus floor elevation by the disk-up sinus reamer / 中华口腔医学杂志

Objective: To investigate the clinical effect of disk-up sinus reamer (DSR) in maxillary sinus floor elevation with maxillary sinus septum. Methods: Twenty-four patients were included between January 2019 to January 2020 in Department of Oral Implantology, The Affiliated Hospital of Qingdao University. There were 10 males and 14 females with the age of (39.3±11.7) years old (range 22-56 years). Pre-operative(T0) cone-beam CT (CBCT) was taken for measurement and analysis. All patients were divided into group E (easy situations, septum located anterior to the zygo-matic process), group M (moderate situations, septum located pos-terior to the zygo-matic process) and group D (difficult situations, sagittally oriented septum). The maxillary sinus floor was grafted through the crestal approach by DSR and implants were placed simultaneously. Permanent repair was performed 6-8 months after operation. All patients underwent CBCT before surgery, after surgery immediately (T1), 6 months after surgery(T2), 1 year after surgery(T3), 2 year after surgery(T4). The residual bone height (RBH) and the vertical bone height (VBH) were analyzed. The mucosal perforation rate, implant survival rate were counted. Results: All the 24 patients completed the Maxillary sinus lift surgery successfully and 24 implants were placed simultaneously. All patients had no headache, dizziness. The mucosal perforation rate was 0. The survival rate of implants during the healing period was 100%(24/24). The RBH was (5.81±2.56) mm pre-operation, the VBHT1, VBHT2, VBHT3 and VBHT4 were (11.82±1.09), (10.98±0.52), (10.66±0.44) and (10.40±0.33) mm, respectively. The differences between the groups by pairing test were statistically significant (F=187.70, P0.001), expect VBHT3 and VBHT4 (P=0.071). Bone resorption and remodeling mainly occurred 1 year after surgery. One patient developed peri-implantitis 18 months after surgery. Conclusions: With the RBH of implant site>2 mm and existence of maxillary sinus septum, using DSR for sinus floor elevation has a high success rate. It can obtain enough bone height and complete the simultaneous implantation to form a good osseointegration. The DSR is simple, safe and controllable, and can shorten the operation time.

Research Progress of NK Cells in Immunotherapy of Glioma / 中山大学学报(医学科学版)

Natural Killer （NK） cells are another type of anti-tumor immune cells with promising clinical application in addition to T cells. NK cell activity is mainly regulated by its surface receptors and immune microenvironment. The strong immunosuppressive microenvironment of glioma results in low efficiency of NK cell immunotherapy. This article reviews NK cells in the immunotherapy for glioma from the interaction of glioma-NK cell， and the latest research progress of targeted NK cells compounds， monoclonal antibody， and cytokine therapy， focusing on the genetic modification of NK cells in the present situation and trend of glioma immunotherapy， and molecular mechanism of glioma cells related to immune escape. We hope this article will provide theoretical basis and new ideas for NK cell-based immunotherapy of glioma.

Two cases report of heavy- and light-amyloidosis and literature review / 中华肾脏病杂志

Objective:To investigate the clinical manifestation, diagnosis and prognosis of heavy- and light-amyloidosis (AHL).Methods:The clinical data of two patients with AHL in Peking University People's Hospital and 21 cases of reported literature were reviewed to clarify the clinical and prognostic characteristics of AHL.Results:Compared with light-amyloidosis, most AHL patients were male, with high positive rate of blood and urine immunofixation electrophoresis and complete immunoglobulin. The manifestations of the kidneys were proteinuria, mainly composed of albumin, nephrotic syndrome and microscopic haematuria. The pathology of renal biopsy showed that Congo red staining positive substances were deposited in many sites (mesangial area, capillary wall, arteriole and renal interstitium), and immunofluorescence showed that monoclonal heavy chain with light chain (the type was consistent with the hematuria M protein) were clumpy deposition, which was consistent with amyloid deposition site. Heart involvement was rare, and the proportion of plasma cells in bone marrow was high.Conclusion:AHL is rare and its clinical manifestations of AHL are different from those of light-amyloidosis. The prognosis needs to be further observed.

Definition of cut-off value of anti-phospholipase A2 receptor antibody suitable for Chinese patients / 中华肾脏病杂志

Objective:To analyze the antibody level of phospholipase A2 receptor (PLA2R) in Chinese patients with primary membrane nephropathy (PMN) and its correlation with clinical indicators, and to explore more suitable cut-off value for Chinese patients.Methods:All hospitalized patients with renal biopsy at Peking University People's Hospital from January to August 2018 were retrospectively reviewed. According to the primary disease, patients were divided into PMN group (including patients with idiopathic membranous nephropathy and atypical membranous nephropathy of unknown cause) and control group (other pathological types, including secondary membranous nephropathy patients). Their clinical and pathological characteristics were analyzed, and the level of serum PLA2R antibodies was detected using the method of enzyme-linked immunosorbent assay (ELISA). Spearman correlation was used to analyze the correlation between PMN patients' blood anti-PLA2R antibody level and clinical indicators. The risk factors of PMN were analyzed by logistic regression model, and the optimal cut-off value of PMN was analyzed by ROC curve.Results:A total of 354 patients were included in this study, including 114 patients in PMN group and 240 patients in control group. The age of PMN group was (51.7±14.1) years old and the ratio of male to female was 2.2∶1. The median concentration of PLA2R antibody in PMN group was 16.87 RU/ml [inter-quartile range ( IQR) 1.88-57.26], which was significantly higher than that in control group (1.43 RU/ml, IQR 1.20-1.62, P<0.001). In PMN group, the concentration of anti-PLA2R antibody was correlated with the 24-hour urine protein ration ( r=0.278, P=0.003) and urine erythrocyte ( r=0.190, P=0.043), but not with serum albumin ( r=-0.149, P=0.114) and serum creatinine ( r=0.136, P=0.149). The ROC curve showed that the sensitivity of distinguishing PMN from other diseases was 69.3% (95% CI 60.3%-77.0%), the specificity was 92.9%(95% CI 89.0%-95.5%), and the area under the curve was 0.859(95% CI 0.813-0.905) when the cut-off value was set as 2.28 RU/ml, which was significantly better than the cut-off value of 20.00 RU/ml (the sensitivity/specificity was 46.5%/97.5%) and 14.00 RU/ml (the sensitivity/specificity was 53.5%/97.1%). Conclusions:PLA2R antibody is one of the main pathogenic antibodies of PMN. In China, it is recommended to lower its cut-off value to 2.28 RU/ml, which can improve the sensitivity of distinguishing PMN from other pathological types without reducing specificity.

Schistosomiasis control effect in Mianyang City in ten years after Wenchuan earthquake / 中国血吸虫病防治杂志

Objective To evaluate the effect of schistosomiasis control in Mianyang City in ten years after Wenchuan earth-quake, so as to provide the experiences for schistosomiasis control post-disaster. Methods The data of implementation of schistosomiasis control work in ten years after the Wenchuan earthquake were collected and analyzed for the epidemic situation of schistosomiasis in Mianyang City. Meanwhile, the awareness situation on schistosomiasis control of villagers and students was investigated by questionnaires in 2008 and 2015. Results All of the 6 counties (cities, districts) with schistosomiasis endemic in Mianyang City were hit by the earthquake disaster. After the disaster, the measurements including the conventional schistosomiasis control measures, the control of exogenous infection sources, the control of Oncomelania hupensis snails, and health education were carried out. The relevant departments of schistosomiasis control were cooperated to implement the prevention and control measures. The schistosomiasis prevalence of population and the snail condition rose in the year of the earthquake, but then declined year by year. In 2015, the awareness rates of schistosomiasis control of both villagers and the students were significantly improved compared with those in 2008. Conclusion The measures of schistosomiasis control after the earthquake disaster are effective in Mianyang City, and the goal to prevent major plague after the earthquake is achieved.

Schistosomiasis control effect in Mianyang City in ten years after Wenchuan earthquake / 中国血吸虫病防治杂志

Objective To evaluate the effect of schistosomiasis control in Mianyang City in ten years after Wenchuan earth-quake, so as to provide the experiences for schistosomiasis control post-disaster. Methods The data of implementation of schistosomiasis control work in ten years after the Wenchuan earthquake were collected and analyzed for the epidemic situation of schistosomiasis in Mianyang City. Meanwhile, the awareness situation on schistosomiasis control of villagers and students was investigated by questionnaires in 2008 and 2015. Results All of the 6 counties (cities, districts) with schistosomiasis endemic in Mianyang City were hit by the earthquake disaster. After the disaster, the measurements including the conventional schistosomiasis control measures, the control of exogenous infection sources, the control of Oncomelania hupensis snails, and health education were carried out. The relevant departments of schistosomiasis control were cooperated to implement the prevention and control measures. The schistosomiasis prevalence of population and the snail condition rose in the year of the earthquake, but then declined year by year. In 2015, the awareness rates of schistosomiasis control of both villagers and the students were significantly improved compared with those in 2008. Conclusion The measures of schistosomiasis control after the earthquake disaster are effective in Mianyang City, and the goal to prevent major plague after the earthquake is achieved.

Spectrum of somatic mutations and their prognostic significance in adult patients with B cell acute lymphoblastic leukemia / 中华血液学杂志

Objective: To investigate the spectrum of gene mutations in adult patients with B-acute lymphoblastic leukemia (B-ALL), and to analyze the influences of different gene mutations on prognosis. Methods: DNA samples from 113 adult B-ALL patients who administered from June 2009 to September 2015 were collected. Target-specific next generation sequencing (NGS) approach was used to analyze the mutations of 112 genes (focused on the specific mutational hotspots) and all putative mutations were compared against multiple databases to calculate the frequency spectrum. The impact of gene mutation on the patients' overall survival (OS) and recurrence free survival (RFS) was analyzed by the putative mutations through Kaplan-Meier, and Cox regression methods. Results: Of the 113 patients, 103 (92.0%) harbored at least one mutation and 29 (25.6%) harbored more than 3 genes mutation. The five most frequently mutated genes in B-ALL are SF1, FAT1, MPL, PTPN11 and NRAS. Gene mutations are different between Ph+ B-ALL and Ph- B-ALL patients. Ph- B-ALL patients with JAK-STAT signal pathway related gene mutation, such as JAK1/JAK2 mutation showed a poor prognosis compared to the patients without mutation (OS: P=0.011, 0.001; RFS: P=0.014,<0.001). Patients with PTPN11 mutation showed better survival than those without mutation, but the difference was not statistically significant (P value > 0.05). Besides, in Ph+ B-ALL patients whose epigenetic modifications related signaling pathway genes were affected, they had a worse prognosis (OS: P=0.038; RFS: P=0.047). Conclusion: Gene mutations are common in adult ALL patients, a variety of signaling pathways are involved. The frequency and spectrum are varied in different types of B-ALL. JAK family gene mutation usually indicates poor prognosis. The co-occurrence of somatic mutations in adult B-ALL patients indicate the genetic complex and instability of adult B-ALL patients.

Effect of Acinetobacter baumannii biofilm on antimicrobial resistance / 中国感染控制杂志

Objective To understand biofilm-forming ability of Acinetobacter baumannii(A.baumannii) in clinical isolates,and evaluate the effect of biofilm formation on antimicrobial resistance.Methods A total of 47 A.baumannii clinical isolates were collected,biofilm-forming ability was detected by crystal violet staining assay,the minimal inhibitory concentration(MIC) of 12 kinds of antimicrobial agents to biofilrn forming isolates were detected when the isolates were in planktonic or biofilm formatted condition;biofilm-forming ability of positive isolates at different culture condition (shaking or stable) and on different materials(glass tube or polypropylene plastic centrifugal tube) were detected.Results Thirteen isolates (27.66％) exhibited biofilm formation.In planktonic condition,antimicrobial resistance rates of these isolates were all ＜35％,no isolates shown resistance to polymyxin and tigecycline,in biofilm formatted condition,resistance rates to tigecycline was 15.38％,resistance rates to the other antimicrobial agents were all 100％.Of 13 tested isolates,≥10 isolates shown higher absorbance in the shaking condition than in the stable condition,≥10 tested isolates shown higher absorbance in polypropylene plastic centrifugal tube than in the glass tube.Conclusion The resistance of A.baumannii to antimicrobial agents is greatly changed after the formation of biofilm,which may results in the failure of antimicrobial therapy for infection.

Classification characteristics and clinical application of lumbar interspinous distraction system / 中国组织工程研究

BACKGROUND: With the disadvantages of lumbar fusion surgery complications and adjacent vertebral degeneration aggravating against the normal lumbar biomechanical characteristics, lumbar dynamic fixation technology in line with the normal lumbar biomechanics emerges as the times require. Lumbar interspinous distraction system as a representative of lumbar dynamic fixation technique has attracted extensive attentions of the field of spine surgery. OBJECTIVE: To review the current research progress of lumbar interspinous distraction system. METHODS: The first author retrieved in CNKI database and Wanfang database with the key words of "lumbar interspinous distraction device, interspinous distraction system, biomechanics, clinical application, lumbar interspinous distraction system complications", and searched PubMed database and SpringerLink database with the key words of "lumbar spine, interspinous process implant, interspinous devices, biomechanics, clinical application, postoperative complications". Recent studies were included after excluding the repeated studies. Finally, 55 studies were included, with 45 English studies and 10 Chinese studies. RESULTS AND CONCLUSION: (1) Lumbar distraction system core design concept was for expanding the interspinous space in the responsible segment and limiting their activities, which increases the spinal canal and foramen area, reduces intervertebral pressure, relieves nerve compression, can recover segmental stability to a certain degree, but does not significantly impact the motion range of adjacent segments. Simultaneously, it effectively avoids mechanical stimulation to the spinal cord and nerve root by opening the vertebral canal, replaces adjacent segments applied to the responsible section or combined application to fusion segments, and improves clinical symptoms and prevents the occurrence of adjacent vertebra disease. (2) Lumbar interspinous distraction device can effectively reduce stress load of intervertebral disc and small articular process, and maintain motion range of the corresponding segment. However, stress of the implant itself and upper and lower spinous process of the treated segments increases, warning that there is an increased risk of fracture of spinous process and fatigue fracture of the implant. (3) All kinds of lumbar interspinous distraction device have good clinical effect in short and medium follow-up. (4) The clinical curative effect of the distraction device can be comparable to spine fusion surgery. It is operated under local anesthesia, has small trauma, short operation time, quick recovery, short hospitalization time, less complications after surgery, retains lumbar motion range and prevents adjacent vertebral disease. Nevertheless, the device has some disadvantages, such as high medical cost, high revision rate, and inaccurate clinical effect.

The expression and value of Ax l receptor tyrosine kinase receptor tyrosine kinase in the kidney of patients with lupus nephritis / 中华风湿病学杂志

Objective To evaluate the value and the expression of Axl receptor tyrosine kinase (AxlTK) in renal pathology of lupus nephritis (LN) patients. Methods The expression of AxlTK were detected in 29 LN and 10 primary nephritic syndrome (NS) patients using immunohistochemistry in renal tissue. The correlations between the levels of AxlTK on glomeruli and clinical manifestations, laboratory parameters, disease activity, and renal pathology in LN patients were investigated. T test and single factor analysis of variance were used tp compare between groups, and Pearson or Spearman test was used for correlation analysis. Results AxlTK was extensively expressed on surface of mesangial cells, endothelial cells in glomeruli. There was more expression of AxlTK on mesangial cells in LN patients [(7.0 ±2.2)×10-2] than that in primary NS patients [(3.1 ±1.2) ×10-2] (t=5.382, P0.05). Conclusion The expression of Axl TK in glomerular is significantly increased in glomeruli in LN patients. The expression level of AxlTK on glomeruli is correlated with the occurrence of oral ulcers and AnuA. The level of AxlTK expression is related to pathological categories of kidney in LN patients. The results of this study suggest that AxlTK might participate in the pathogenesis of LN.

Effect of Chinese medicine treatment based on pattern identification on cellular immunophenotype of myelodysplastic syndrome / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the influence of treatment based on Chinese medicine pattern identification on cellular immunophenotype of the myelodysplastic syndrome (MDS).</p><p><b>METHODS</b>Sixty patients with MDS were randomly and equally assigned to the treatment group and the control group using a randomized digital table. Thirty patients in each group included 3 risk levels (low, moderate and high risks) with each level 10 patients according to the international prognostic scoring system. The control group was given conventional therapy which was also used in the treatment group. While the treatment group was given Zuogui Pill () and Yougui Pill () for low risk patients; Qingwen Baidu Decoction () and Bazhen Decoction () for moderate risk patients; Gexia Zhuyu Decoction () and Qinghao Biejia Decoction () combined with Shiquan Dabu Decoction () for high risk patients. After the treatment, the differences of overall response rate and immunophenotype (CD13, CD14, CD15, CD33 and CD34) of each group were analyzed.</p><p><b>RESULTS</b>The overall response rate of the treatment group was significantly higher than the control group in low risk and moderate risk patients (P=0.029), there was no statistical differences of overall response rate between the treatment group and the control group in high risk patients (P=0.089). The expressions of CD13, CD14, CD33 and CD34 in all three risk levels of the treatment group were obviously decreased after the treatment, while CD15 in all three risk levels of the treatment group was obviously increased after the treatment (P<0.05 or P<0.01). Meanwhile, the difference values of CD13 and CD33 in low risk level of the treatment group, CD33 and CD34 in moderate risk level of the treatment group as well as CD34 and CD15 in high risk level of the treatment group, were all greater than the control groups and they were statistically significant (P<0.05 or P<0.01).</p><p><b>CONCLUSIONS</b>It shows a better therapeutic effect if the MDS patients treated with Chinese medicine pattern identification in addition to conventional therapy. Since the treatment may inhibit the malignant clones and improve the dysmaturity of granulocyte differentiation, it is a feasible option in clinical practice.</p>

Problems and countermeasures of special diagnosis support during base training / 医疗卫生装备

Objective To explore the problems and countermeasures of special diagnosis support during base training.Methods The problems were analyzed in the allocation of special diagnosis equipment,equipment application in training,special diagnosis technician as well as the cooperation between personnel,equipment and etc,and some countermeasures were proposed accordingly.Results The special diagnosis support gained disadvantage in medical ultrasonic equipment while advantage in ECG machine.Field medical unit had medical technicians decreased after the new organization was implemented,and could meet the requirements after arrangement and strengthening communication facility.Conclusion The special diagnosis technicians in the field medical unit have to enhance their skills on medicine and field first aid.Medical ultrasonic equipment and ECG machine should be equipped in the field medical unit.The intra-and inter-group cooperation should be improved to facilitate special diagnosis support in the field medical unit.

Development of supporting pole for medical detachable camouflage net at field conditions / 医疗卫生装备

Objective To develop a supporting pole for medical detachable camouflage net at field conditions to enhance the timeliness of battlefield camouflage of deployable units such as medical tent.Methods The pole had a dumbbell-shaped,hollow and columnar structure,which was composed of a base,a pole body and a terminal disc.The pole body consisted of internal and external parts.The external part had a vertical opening at its top and screw thread at its side wall,which was equipped with a binding bolt.The terminal disc had a circular structure and a 20 cm outer diameter,which was fixed 10 cm under the top of the internal pole to support the net.The base had a center hole and a sleeve to hold the lower part of the external pole to immobilize the supporting pole.Results The supporting pole decreased the deployment time of the camouflage net from 5 min to 2 min and the withdrawal time from 4 min to 1.5 min,and enhanced the timeliness of all-element deployment of mobile medical unit during field practical training.Conclusion The supporting pole meets the tactical requirements for deployment,storage,transport and robustness,and thus is worthy promoting in medical unit.

Clinical features of mild encephalitis/encephalopathy with a reversible splenial lesion in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children.</p><p><b>METHODS</b>The clinical data of 8 children with MERS were retrospectively analyzed.</p><p><b>RESULTS</b>The mean age of onset was 5 years and 2 months (range 10 months to 12 years). The major clinical features included a history of prodromal infection, and among these children, 5 had pyrexia and 4 had vomiting. Of all the children, 6 were manifested as convulsion and 3 each were manifested as disturbance of consciousness and paroxysmal paropsia. Cranial diffusion-weighted magnetic resonance imaging (MRI) showed high signals in the splenium of the corpus callosum. Among these children, one child had symmetric and multiple long T1 and long T2 signals in the bilateral centrum semiovale and part of the temporal white matter. MRI reexamination performed after 5-30 days showed the disappearance of abnormal signals in all the children. The children were followed up for 3 months to 2 years, and no child experienced abnormal neurodevelopment.</p><p><b>CONCLUSIONS</b>The development of MERS in children is closely associated with infection. MERS is characterized by high signals in the splenium of the corpus callosum on cranial diffusion-weighted MRI. Most children have good prognosis.</p>

Renal damage caused by Rhupus syndrome associated with anti-neutrophil cytoplas-mic antibodies vasculitis and cryoglobulinemia / 北京大学学报(医学版)

SUMMARY We analyzed the clinicopathological characteristics of one patient with Rhupus syndrome as-sociated nephropathy in Peking University People ’s Hospital, and reviewed the related literature .The pa-tient was a middle aged female .She developed rheumatoid arthritis first , and then manifested mild sys-temic lupus erythematosus together with positive anti-neutrophil cytoplasmic antibodies ( ANCA ) and cryoglobulinemia several years later .The renal biopsy was performed and manifested as lupus nephritis . The transmission electron microscopy revealed cryoglobulinemia associated renal damage .This report shows that the clinicopathological characteristics in patients with Rhupus syndrome associated nephropathy are complicated .The renal pathology can be used as a diagnostic tool .

Treatment of myelodysplastic syndrome by hematopoietic stem cell transplantation combined with Chinese medical syndrome typing: a clinical study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of treating myelodysplastic syndrome (MDS) by hematopoietic stem cell transplantation (HSCT) combined with Chinese medical syndrome typing.</p><p><b>METHODS</b>From July 2009 to July 2013, 6 MDS patients were treated with allo-HSCT combined with Chinese medical syndrome typing from HLA-identical sibling donors at Department of Hematology, Zhejiang Provincial Hospital of Chinese Medicine. Patients were classified as refractory anemia (RA, 2 cases), refractory anemia with ringed sideroblast (RARS, 1 case), refractory cytopenia with multilineage dysplasia (RCMD, 2 cases), and RA with excess blasts-I (RAEB-I , 1 case). Modified BuCy conditioning regimen was used in all 6 cases. Two patients received bone marrow transplantation (BMT), 1 patient received peripheral blood stem cell transplantation (PBSCT), and 3 patients received BMT + PBSCT. In order to prevent the occurrence of graft-versus-host disease (GVHD), all patients were treated with cyclosporine + methotrexate + mycophenolate mofetil. Different Chinese medical treatment methods (by syndrome typing) were given to patients according to different criticality of international prognostic scoring system (IPSS, 5 at moderate risk and 1 at high risk).</p><p><b>RESULTS</b>All 6 patients successfully reconstructed their hematopoietic system. The time from transplantation to ANC ≥ 0.5 x 10(9)/L and platelet (PLT) ≥ 20 x10(9)/L were 13 (9-15) days and 11 (9-22) days respectively. Main complications were GVHD. Acute GVHD (aGVHD) occurred in 4 cases, 3 cases of grade I and 1 case of grade II, and local chronic GVHD (cGVHD) occurred in 1 patient. All cases survived with median follow-up of 18 (11-58) months. The overall survival (OS) and disease-free survival (DFS) rate were 100%.</p><p><b>CONCLUSIONS</b>HSCT combined with Chinese medical syndrome typing could improve clinical symptoms, reduce transplant as- sociated complications. So it was an effective treatment choice for MDS.</p>

Significance of PLSCR1 in Matrine Induced Differentiation of ATRA Resistant APL Cells / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the expression of phospholipid scramblase 1 (PLSCR1) in matrine (MAT) induced differentiation of all-trans retinoic acid (ATRA) resistant acute promyelocytic leukemia (APL) cells, and to explore its correlation to cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signal pathway.</p><p><b>METHODS</b>NB4 (an APL cell line sensitive to ATRA) and NB4-R1 (a resistant strain of ATRA) were observed as subjects in this study. Effects of combined treatment of 0.1 mmol/L MAT and 1 [mol/L ATRA on the differentiation of two cell lines were detected using nitroblue tetrazolium (NBT) reduction test and flow cytometry (CD11b). Expressions of PML/RARot and PLSCR1 protein/gene were detected using Western blot and Real-time fluorescence quantitative PCR assay. Meanwhile, H89, PKA antagonist, was used to observe cell differentiation antigen and changes of aforesaid proteins and genes.</p><p><b>RESULTS</b>MAT combined ATRA could significantly elevate positive rates of NBT and CD11 b in NB4-R1 cells, and significantly down-regulate the expression of PML/RARapha-fusion protein/gene (P < 0.05, P < 0.01). ATRA used alone could obviously enhance the expression of PLSCRI in NB4 cells at protein and mRNA levels (P < 0.01). But the expression of PLSCR1 was up-regulated in NB4-R1 cells, but with statistical.difference only at the protein level (P <0. 01). In combination of MAT, PLSCR1 protein expression was further elevated in the two cell lines (P < 0.01). Besides, there was statistical difference in mRNA expressions in NB4-R1 cells (P < 0.05). All these actions could be reversed by treatment of 10 micromol/L H89 (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>MAT combined ATRA could significantly induce the differentiation of NB4-R1 cells, and inhibit the expression of PML/RARalpha fusion gene/protein, which might be associated with up-regulating PLSCR1 expression.</p>

Research advance on the role of ubiquitin proteasome pathway in acute promyelocytic leukemia / 中国实验血液学杂志

Acute promyelocytic leukemia (APL) is characterized by PML-RARa expression. Ubiquitin proteasome-pathway (UPP) plays a key role in all-trans retinoid acid (ATRA) and arsenic trioxide (ATO)-induced degradation. In addition, the regulations of cell cycle and transcription are also related to this pathway. Deeply studying the role of ubiquitin-proteasome pathway in APL contributes to elucidate the mechanisms of some drugs and explode the clinical therapeutical insight for APL. In this article, the constitution of UPP, the role of UPP-mediated protein modification in APL, the application of ubiquitination-associated drugs in APL are reviewed.

Combined use of Chinese medicine with allogeneic hematopoietic stem cell transplantation for severe aplastic anemia patients / 中国结合医学杂志

<p><b>OBJECTIVE</b>To determine the effect of combined treatment with Chinese medicine (CM) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) on patients with severe aplastic anemia (SAA).</p><p><b>METHODS</b>Eleven patients were treated with CM plus allo-HSCT. Nine patients received a conditioning regimen consisting of fludarabine (Flu), anti-thymocyte globulin (pig ALG), or anti-lymphocyte globulin (Rabbit ATG) and cyclophosphamide (CY), and two patients received pig ALG and CY. All patients were treated with Kidney (Shen)-reinforcing, blood-activating, and stasis-removing (KBS) herbal preparation beginning at 1 week before transplantation and ending at 8 weeks after transplantation. Chimerism status was assessed by analyzing short tandem repeat (STR) polymorphisms.</p><p><b>RESULTS</b>All patients recovered hematopoietic function and none had graft failure. The median number of days required for the absolute neutrophil count (ANC) increased to >0.5×10(9)/L was 15 days (12-22 days) and for spontaneous platelet recovery to >20×10(9)/L without post-transplantation transfusion was 17 days (15-27 days). Nine patients were long-term survivors and achieved full donor chimerism. The overall cumulative incidence of acute graft versus host disease (GVHD) grades I-II and III-IV was 18.2% (2/11) and 9.1% (1/11), respectively. The overall accumulated incidence of chronic GVHD was 27.3% and all patients had limited chronic GVHD. At a median follow-up time of 32 months (range: 12-97 months), 9 patients were still alive. The estimated 5-year overall survival (OS) rate was 81.8%. The incidence of treatment-related mortality, 2-year post-transplantation, was 18.2%. Two patients died from GVHD after transplantation.</p><p><b>CONCLUSION</b>Treatment with the KBS formulation may reduce the rate of graft failure and treatment-related mortality and improve the rate of OS in SAA patients with allo-HSCT.</p>