Research advances in the risk factors for recurrence of common bile duct stone after choledocholithotomy / 临床肝胆病杂志

Cholelithiasis is a common and frequent disease of the digestive system, and its incidence rate tends to increase with the improvement of living standards. Patients suffering from both gallbladder stones and common bile duct stones account for 5%-15%. Choledocholithiasis can cause a series of serious complications such as acute cholangitis and biliary pancreatitis. Choledocholithotomy is the main method for the treatment of choledocholithiasis, but there is still a high recurrence rate after surgery. The recurrence of choledocholithiasis seriously affects the life of patients and increases their economic burden. With reference to the latest published clinical studies, this article summarizes the influencing factors for the recurrence of choledocholithiasis from the aspects of anatomical factors, stone-related factors, biliary factors, and surgical factors, so as to provide a reference for the treatment of choledocholithiasis and the prevention of its recurrence.

Clinical effect of Qingre Lidan granules in preventing the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy / 临床肝胆病杂志

ObjectiveTo investigate the effect of Qingre Lidan granules in preventing the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy through a retrospective cohort study. MethodsA total of 337 inpatients with choledocholithiasis （including those with cholecystolithiasis at the same time） who underwent laparoscopy combined with choledochoscopic lithotomy in The First Affiliated Hospital of Dalian Medical University from January 1， 2010 to December 31， 2020 were enrolled， and related clinical data were collected. According to the follow－up results， the patients were divided into exposure group （conventional treatment+Qingre Lidan granules） with 225 patients and non－exposure group （conventional treatment） with 112 patients. The recurrence of choledocholithiasis and the administration of Qingre Lidan granules were recorded in detail for both groups. The recurrence rate of choledocholithiasis and the time to recurrence were observed for both groups， and the risk factors for the recurrence of choledocholithiasis were analyzed. The independent－samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann－Whitney U test was used for comparison of non－normally distributed continuous data between two groups； the chi－square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Kaplan－Meier curve was used to estimate the cumulative probability of choledocholithiasis recurrence in the two groups， and the Log－rank test was used for comparison between two groups. ResultsA total of 26 patients experienced the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy， with 12 patients （5.33%） in the exposure group and 14 （12.5%） in the non－exposure group， and the exposure group had a significantly lower recurrence rate than the non－exposure group （χ2=5.394， P=0.020）. The exposure group had a significantly longer mean time to the recurrence of choledocholithiasis than the non－exposure group （40.1±26.7 months vs 19.2±13.5 months， t=2.383， P=0.017）. The Kaplan－Meier curve analysis showed that the non－exposure group had a significantly higher cumulative recurrence rate than the exposure group in different periods of time （P<0.05）. The multivariate logistic regression analysis showed that common bile duct diameter ≥14 mm （odds ratio 〔OR〕=2.935， P=0.031） and multiple calculi （OR=2.911， P=0.029） were independent risk factors for the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopic lithotomy. ConclusionQingre Lidan granules can effectively reduce the recurrence rate of choledocholithiasis and prolong the time to the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy and has a certain clinical effect in preventing the recurrence of choledocholithiasis after surgery.

Research progress on molecular mechanism of transcription factor C/EBPβ in lung diseases / 中华危重病急救医学

CCAAT enhancer binding protein β (C/EBPβ), as a nuclear transcription factor necessary for the development of liver, airway epithelium, and adipose tissue, plays a vital role in physiological processes related to cell proliferation, apoptosis, and differentiation. However, the up-regulation of C/EBPβ activates signal pathways related to inflammatory response, epithelial-mesenchymal transition, cell proliferation and invasion, immune response, and angiogenesis by regulating a series of downstream genes transcription promotes the development of lung diseases. Therefore, targeting C/EBPβ may be a potential treatment strategy for lung diseases. This paper summarizes the regulatory effects of C/EBPβ and related signaling pathways in lung infection, asthma, chronic obstructive pulmonary disease, lung injury, pulmonary fibrosis, and lung cancer to provide a theoretical basis for the precision medicine of lung diseases.

Research progress on application of metabolomics in acute lung injury / 中华危重病急救医学

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a life-threatening lung disease characterized by refractory hypoxemia. Metabolomics is an emerging discipline for qualitative and quantitative analysis of small molecular weight metabolites in organisms or cells. Mass attention has been paid to its role in disease diagnosis and treatment. Recently, many metabolites based on metabolomics have been proposed as potential biomarkers for early development and prognosis of ALI/ARDS, and provide insights into new targeted interventions. Based on metabolomics, this article discusses the role of endogenous metabolites in the pathogenesis and biomarkers of ALI/ARDS, and summarizes its application in medical therapy.

Serpins as important protective factors in the pathogenesis of acute lung injury/acute respiratory distress syndrome / 中华危重病急救医学

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a common respiratory disease in clinic, and with a pathological manifestation of pulmonary edema, decreased pulmonary compliance as well as pulmonary epithelial/endothelial cells injury. At present, it was suggested that systemic inflammatory response syndrome (SIRS) caused by various causes which play an important role in the occurrence and development of ALI/ARDS. Widely activated neutrophils can migrate to lung tissue and release plenty of proteases in the procedure of SIRS, including neutrophil serine proteases (NSPs), lysozyme, myeloperoxidase and collagenase, which can induce severe lung injury. Meanwhile, NSPs, such as neutrophil elastase (NE), cathepsin G (CG), proteinase 3 (PR3) and neutrophil serine proteinase 4 (NSP4), are important in the pathogenesis of ALI/ARDS. Therefore, Serpins may protect lung tissue by inhibiting NSPs. However, the specific mechanism of Serpins is not totally clear. In this article, we will discuss the mechanism of action of NSPs in the inflammatory response of ALI/ARDS, the structural overview of Serpins, the primary role of Serpins in ALI/ARDS,such as the inhibition of NSPs activity, other roles of Serpins in ALI/ARDS, such as the inhibition of inflammatory factor release, regulation of apoptosis and protection of vascular endothelial cells and pulmonary surfactant-associated glycoprotein D (SP-D), and the clinical application of exogenous Serpins in ALI/ARDS to explore the role of Serpins in the pathogenesis of ALI/ARDS. The aim is to provide new ideas and strategies for the clinical treatment of ALI/ARDS.

Outcomes of 138 myelodysplastic syndrome patients with HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

Objective@#To evaluate the outcomes of myelodysplastic syndromes (MDS) patients who received HLA-matched sibling donor allogeneic peripheral blood stem cell transplantation (MSD-PBSCT) .@*Methods@#The clinical data of 138 MDS patients received MSD-PBSCT from Sep. 2005 to Dec. 2017 were retrospectively analyzed, and the overall survival (OS) rate, disease-free survival (DFS) rate, relapse rate (RR) , non-relapse mortality (NRM) rate and the related risk factors were explored.@*Results@#①After a median follow-up of 1 050 (range 4 to 4 988) days, the 3-year OS and DFS rates were (66.6±4.1) % and (63.3±4.1) %, respectively. The 3-year cumulative incidence of RR and NRM rates were (13.9±0.1) % and (22.2±0.1) %, respectively. ②Univariate analysis showed that patients with grade Ⅲ-Ⅳ acute graft-versus-host disease (aGVHD) or hematopoietic cell transplantation comorbidity index (HCT-CI) ≥2 points or patients in very high-risk group of the Revised International Prognostic Scoring System (IPSS-R) had significantly decreased OS[ (42.9±13.2) %vs (72.9±4.2) %, χ2=8.620, P=0.003; (53.3±7.6) %vs (72.6±4.7) %, χ2=6.681, P=0.010; (53.8±6.8) %vs (76.6±6.2) %vs (73.3±7.7) %, χ2=6.337, P=0.042]. For MDS patients with excess blasts-2 (MDS-EB2) and acute myeloid leukemia patients derived from MDS (MDS-AML) , pre-transplant chemotherapy or hypomethylating agents (HMA) therapy could not improve the OS rate[ (60.4±7.8) %vs (59.2±9.6) %, χ2=0.042, P=0.838]. ③Multivariate analysis indicated that the HCT-CI was an independent risk factor for OS and DFS (P=0.012, HR=2.108, 95%CI 1.174-3.785; P=0.008, HR=2.128, 95%CI 1.219-3.712) .@*Conclusions@#HCT-CI was better than the IPSS-R in predicting the outcomes after transplantation. The occurrence of grade Ⅲ-Ⅳ aGVHD is a poor prognostic factor for OS. For patients of MDS-EB2 and MDS-AML, immediate transplantation was recommended instead of receiving pre-transplant chemotherapy or HMA therapy.

Minimally invasive integrated traditional Chinese and Western medicine therapy for hepatolithiasis based on the SELECT concept / 临床肝胆病杂志

Hepatolithiasis is difficult to treat in clinical practice and has high recurrence rate and incidence rate of complications, improper diagnosis and treatment can easily lead to hepatic insufficiency, and thus it has become one of the difficult problems to be solved in clinical practice. With the improvement of medical equipment and the wide application of various minimally invasive endoscopic techniques, most patients with hepatolithiasis can receive effective treatment. Traditional Chinese medicine therapy can prevent the recurrence of calculi and promote patients’ recovery during the perioperative period. Based on the SELECT (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, Traditional Chinese Medicine) concept, minimally invasive treatment with a combination of various endoscopies should be selected according to the type and clinical features of hepatolithiasis and integrated traditional Chinese and Western medicine therapy should be given in the perioperative period to realize the minimally invasive, diversified, and individualized integrated traditional Chinese and Western medicine therapy for hepatolithiasis.

Application of minimally invasive integrated traditional Chinese and Western medicine therapy based on the SELECT concept in the diagnosis and treatment of biliary and pancreatic tumors / 临床肝胆病杂志

Among digestive malignancies, compared with gastrointestinal tumors, biliary and pancreatic tumors are difficult to diagnose in the early stage and have fewer opportunities for radical surgical resection, with a shorter survival time and poorer quality of life, and the clinical diagnosis and treatment of such tumors remain a difficult issue that needs to be solved urgently in clinical practice. Based on the different locations and features of biliary and pancreatic tumors, the SELECT concept selects the optimal combination of minimally invasive endoscopies (laparoscopy, choledochoscopy, duodenoscopy, Spyglass, and endoscopic ultrasound) and applies traditional Chinese medicine treatment in the perioperative period, so as to achieve early diagnosis and treatment, prolong the survival time with tumor, improve quality of life, and strive to realize the goal of cure.

Application of minimally invasive integrated traditional Chinese and Western medicine therapy based on the SELECT concept in the treatment of acute pancreatitis / 临床肝胆病杂志

Acute pancreatitis (AP) is one of the common digestive diseases. With the advances in technology, the treatment concept of AP has changed, more and more minimally invasive techniques have been applied in the treatment of AP, especially severe acute pancreatitis (SAP). Although there are various different minimally invasive treatment methods for AP, no reliable clinical studies have reported that one technique is significantly better than others. The therapeutic effect of integrated traditional Chinese and Western medicine therapy in acute pancreatitis (AP) has been widely recognized. In recent years, our team has accumulated rich experience in integrated traditional Chinese and Western medicine therapy for AP and has proposed the innovative SELECT concept (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, and Traditional Chinese Medicine) for diagnosis and treatment. The optimal combination of various endoscopies is SELECTed based on the severity and etiology of AP, and traditional Chinese medicine treatment can be used as well to realize the advantages of minimally invasive integrated traditional Chinese and Western medicine therapy in the treatment of AP. This article elaborates on the minimally invasive treatment methods for each clinical stage of SAP based on the SELECT concept.

Application of minimally invasive integrated traditional Chinese and Western medicine therapy based on the SELECT concept in the diagnosis and treatment of hepatobiliary and pancreatic diseases / 临床肝胆病杂志

Hepatobiliary and pancreatic diseases are common and frequently occurring diseases in the digestive system, and several hepatobiliary and pancreatic diseases are difficult to diagnose and treat, with a high incidence rate of complications. With the development of minimally invasive devices and instruments and the application of various laparoscopic/endoscopic techniques, most hepatobiliary and pancreatic diseases can be diagnosed and treated by minimally invasive techniques. Traditional Chinese medicine plays an important synergistic role during the perioperative period for hepatobiliary and pancreatic diseases and can accelerate the recovery of patients. The team of Liaoning Provincial Center for Integrated Traditional Chinese and Western Medicine Therapy for Biliary and Pancreatic Diseases led by the authors has mastered various laparoscopic and endoscopic techniques and proposed the concept of SELECT (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, and traditional Chinese medicine) by summarizing the successful experience in the treatment of hepatobiliary and pancreatic diseases in recent years. The optimal combination of minimally invasive multi-endoscopic techniques is selected based on the features of different hepatobiliary and pancreatic diseases, and traditional Chinese medicine treatment is also applied in the perioperative period, so as to achieve minimally invasive, individualized, and precise integrated traditional Chinese and Western medicine therapy for hepatobiliary and pancreatic diseases.

HLA-10/10 matched unrelated donor versus sibling donor hematopoietic stem cell transplantation for adult acute myeloid leukemia / 中华血液学杂志

Objective@#To evaluate the outcomes of human leukocyte antigen (HLA) matched unrelated donor hematopoietic stem cell transplantation (MUD-HSCT) for adult acute myeloid leukemia (AML) in a single center.@*Methods@#Consecutive adult AML who received MUD-HSCT in our center from January 2008 to April 2017 were studied retrospectively, comparing with patients undergoing matched sibling donor (MSD) -HSCT in the same period. The rates of overall survival (OS) , disease free survival (DFS) , relapse, non-relapse mortality (NRM) , engraftment, acute and chronic graft-versus-host disease (aGVHD and cGVHD) were analyzed.@*Results@#A total of 247 consecutive cases were enrolled, including 46 patients with MUD-HSCT and 201 with MSD-HSCT. All the patients experienced neutrophil engraftment except for one patient who died early in the MSD group, but the median day of engraftment was longer in the MUD group (15.0 vs 14.0, P=0.017) . The accumulative engraftment rate of platelet was comparable between the two groups (93.5%vs 98.0%, P=0.128) . The accumulative incidences of aGVHD (50.0%vs 46.3%, P=0.421) and cGVHD (37.8%vs 43.0%, P=0.581) were not statistically different between the two groups. Compared with the MSD group, the accumulative NRM rate at+36 months after transplantation was significantly higher in the MUD group (22.0%vs 10.4%, P=0.049) , while the relapse rate was not statistical difference (20.5 vs 28.3%, P=0.189) . Both the 3-year OS (61.6%vs 63.3%, P=0.867) and DFS (57.5%vs 61.6%, P=0.760) were comparable between the two groups. Four independent risk factors were confirmed by the multivariate analysis: patient age ≥45 years old, CR2 or NR before transplantation, a history of extramedullary infiltration and the occurrence of grade Ⅲ-Ⅳ aGVHD. No statistical differences were demonstrated in the survival rate between MUD-and MSD-HSCT in different subgroups.@*Conclusions@#The outcomes, such as GVHD, relapse, OS and DFS, were comparable between MUD-and MSD-HSCT for adult AML, but higher incidence of NRM and longer time to neutrophil engraftment in the MUD group. MUD-HSCT is practical and feasible for adult AML who are lack of MSD.

Allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia / 中华器官移植杂志

Objective To explore the therapeutic efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in chronic myelomonocytic leukemia (CMML) patients .Methods The clinical data were retrospectively analyzed for 19 CMML patients undergoing allo-HSCT .Engraftment ,graft versus host disease (GVHD ) , infection , relapse , splenomegaly and survival were observed . And the clinical outcomes of allo-HSCT for CMML were analyzed .Results Hematopoiesis reconstitution was not attained in 2 recipients due to early death post-transplantation .Neutrophil engraftment was obtained in 17 recipients with a median time of 14(11-18) days .Neutrophil engraftment and platelet engraftment were achieved in 15 recipients with a median time of platelet engraftment at 15 (12～70) days .Seven patients developed acute GVHD (grade 1 ,n=5;grade 2～4 ,n=3) while another 8 patients had chronic GVHD (extensive ,n=5) . Ten patients (52 .6 ％ )had palpable splenomegaly (SPM ) before allo-HSCT ,8 patients were diagnosed ultrasonically after transplantation ,all 4 patients without a significant reduction of spleen died while all 4 patients with a significant reduction of spleen survived . After a median follow-up period of 31 (6-68 ) months ,3-year overall survival (OS) ,disease-free survival (DFS) ,cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) were (58 .2 ± 12 .5)％ ,(36 .3 ± 14)％ ,(39 .9 ± 19)％ and (37 ± 12 .6)％ respectively .Conclusions As an effective therapy for CMML ,allo-HSCT may improve the survival of CMML patients .Palpable SPM pre-transplantation and no significant reduction post-transplantation are probably poor prognostic factor .

Effect of pre-transplantation iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation patients with non-hepatitis-related severe aplastic anemia / 中华器官移植杂志

Objective To explore the effect of iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patiems with non-hepatitis related severe aplastic anemia (SAA).Methods The clinical data were retrospectively analyzed for 98 patients with non-hepatitis related SAA undergoing allo-HSCT from July 2012 to late July 2018 at a single center.Serum ferritin (SF) was measured within 2 momhs before HSCT.They were divided into iron overload (SF＞800.0 ng/ml,n =49) and control (SF＜800.0 ng/ml,n =49) groups according to SF level.Overall survival (OS),hematopoietic reconstitution and common complications after allo-HSCT were analyzed.Results The median pre-transplantation SF value was 798.7 (52.0-11060.01) ng/ml.Patients with pre-transplantation iron overload had a higher incidence of cytomegaloviremia (P =0.041),delayed recovery of neutrophil/platelet (P =0.001,P =0.005 respectively) and transfusion-dependence in donor-recipient blood group-matched patients (P =0.043) after allo-HSCT.The 3-year OS was (65.1 ± 7.1) ％ in iron overload group and (93.3 ± 3.7) ％ in control group (P =0.001).Multivariate analysis indicated that 3-year OS was independently correlated with pre-transplantation iron overload (P =0.022),blood group of donor & recipient (P =0.015),early bacteremia (P=0.003) and cytomegaloviremia (P =0.003).Conclusions Iron overload is common in patients with non-hepatitis-related SAA before transplantation.Pre-transplantation iron overload has a significant impact on OS,hematopoietic reconstitution and cytomegaloviremia after allo

The value of combined detection of sFIt-1, PLGF and Survivin in the diagnosis of early-onset preeclampsia / 中国医师进修杂志

s] Objective To analyze the diagnostic value of combined detection of sFIt-1, PLGF and Survivin in early onset preeclampsia. Methods From January 2017 to January 2018, 100 patients with early-onset PE were selected as observation group and 100 healthy pregnant women as control group in Tangshan Maternal and Child health Hospital Gynecology and Obstetrics. The expression levels of sFIt-1, PLGF and Survivin in serum were detected by enzyme-linked immunosorbent assay (ELISA), and the diagnostic value of each index was analyzed separately and jointly. Results The levels of sFIt-1 in the observation group were significantly higher than those in the control group: (36.58 ± 18.34) μg/L vs. (28.43 ± 3.28) μg/L (P<0.05), and the levels of PLGF and Survivin in the observation group were significantly lower than those in the control group: (213.18 ± 48.23) ng/L vs. (398.17 ± 41.19) ng/L, (0.72 ± 0.29) μg/L vs. (1.43 ± 0.32) μg/L (P<0.05); 103 cases of positive sFIt-1, 108 cases of positive PLGF, 107 cases of positive Survivin, 121 cases of positive parallel combined diagnosis and 121 cases of positive series combined diagnosis were found. The sensitivity and negative predictive value of parallel combined diagnosis were significantly higher than those of individualized diagnosis (P<0.05), and the specificity and positive predictive value of series combined diagnosis were significantly higher than those of individualized diagnosis (P < 0.05). Conclusions The combined detection of sFIt-1, PLGF and Survivin in serum can effectively improve the diagnostic accuracy of early-onset preeclampsia and has high clinical value.

Clinical efficacy and safety of porcine antihuman lymphocyte immunoglobulin in alternative donor allogeneic hematopoietic cell transplantation for severe aplastic anemia / 中华血液学杂志

Objective@#To compare eficacy and safety of porcine antihuman lymphocyte immunoglobulin (pALG) and rabbit antithymocyte immunoglobulin (rATG) as a part of alternative donor allogeneic hematopoietic stem cell transplantation (AD allo-HSCT) for severe aplastic anemia (SAA).@*Methods@#The clinical data of 46 SAA patients received AD allo-HSCT from January 2006 to November 2016 were retrospectively analyzed. The cohort of patients were divided into two groups based on rATG or pALG as a part of conditioning regimen to compare implantation rate, transplantation related complications and outcome.@*Results@#In rATG group 30 patients achieved ANC reconstitution, 27 patients achieved PLT reconstitution. In pALG group all 16 patients achieved ANC and PLT reconstitutions. There were no significant differences between the two groups in terms of acute graft-versus-host disease (aGVHD) (P=0.475), Ⅲ-Ⅳ grade aGVHD (P=0.876), chronic GVHD (cGVHD) (P=0.309), extensive cGVHD (P=0.687), graft rejection (GR) (P=0.928), bloodstream infection (P=0.443), invasive fungal disease (P=0.829), cytomegalovirus viremia (P=0.095) respectively. Prospective 5-year overall survival (OS) in rATG and pALG groups were (75.1±8.2)% and (53.6±13.3)% with median follow-up of 14(2-102) and 23(4-63) months, respectively (P=0.190).@*Conclusion@#As a part of conditioning regimen, pALG could achieve similar efficacy as rATG, without increasing the incidences of transplantation complications such as GVHD, GR and infection, in the setting of AD allo-HSCT for SAA patients.

Allogeneic hematopoietic stem cell transplantation for treatment of refractory and relapsed acute myeloid leukemia: outcomes and prognostic factors / 中华血液学杂志

Objective@#To evaluate the outcomes and prognostic factors of patients with refractory and relapsed acute myeloid leukemia (AML) who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) .@*Methods@#The overall survival (OS) , disease free survival (DFS) , acute and chronic graft-versus-host disease (GVHD) , relapse rate (RR) , transplantation related mortality (TRM) and their related risk factors were analyzed retrospectively.@*Results@#All the patients (median age 35 years, range 6 to 58) received myeloablative conditioning regimens. All patients had successful engraftment, and the median time of neutrophils engraftment was 14 days (range 9 to 25) . Of the patients who survived more than 100 days, the accumulative incidence of grade Ⅱ-Ⅳ acute GVHD and chronic GVHD (cGVHD) were 27.3% (95%CI 18.9%-36.3%) , 33.9% (95%CI 24.6%-43.5%) , respectively. Meanwhile, the accumulative incidence of extensive cGVHD was 9.3% (95%CI 4.5%-16.1%) . The 3-year OS, DFS, RR, and TRM was 45.0% (95%CI 34.6%-55.4%) , 45.0% (95%CI 34.8%-55.2%) , 36.6% (95%CI 26.9%-46.4%) and 19.7% (95%CI 12.4%-28.3%) respectively. Multivariate analysis revealed four independent risk factors: non remission status before transplantation[P=0.009, HR=2.21 (95%CI 1.22-4.04) ], WBC at diagnosis>50×109/L[P=0.024, HR=2.11 (95%CI 1.11-4.02) ], donor age>35 years [P=0.031, HR=1.96 (95%CI 1.06-3.60) ]and without cGVHD[P=0.008, HR=0.38 (95%CI 0.18-0.78) ]. According to the risk factors before transplantation (non remission status, WBC at diagnosis>50×109/L, donor age>35 years) , we then defined three subgroups with striking different OS at 3 years: no adverse factor (75.0%) ; one adverse factor (46.9%) ; two or three adverse factors (15.4%) (χ2=26.873, P<0.001) .@*Conclusion@#Allo-HSCT is a promising and safe choice for patients with refractory and relapsed AML and relapse is the major cause of the transplantation failure. Disease status before transplantation, donor age, WBC at diagnosis and cGVHD are confirmed as prognostic factors for these patients who received allo-HSCT.

Research advance on function and molecular mechanism of takeda G protein-coupled receptor 5 in obstructive jaundice / 中华消化外科杂志

Bile acid can not only emulsify fat and facilitate the absorption of fat soluble substances,but also it is an important signaling molecules that plays an important physiological role by activating specific bile acid receptors.Takeda G proteincoupled receptor 5 (TGRS) is a membrane receptor of the bile acid,it can activate G-protein effectors and promote the expression of the second messenger and activate a variety of signal transduction pathways to exert physiological functions.The obstructive jaundice bile acid can cause a series of pathophysiological reactions through activating TGR5,which plays a significant role in the obstructive jaundice.In this article,the latest researches about the function and molecular mechanism of TGR5 in obstructive jaundice were reviewed in order to provide a new idea for exploring the new method and strategy to cure the disease.

Protect role of Netrin-1 in inflammatory response / 中华危重病急救医学

Neuronal guidance factor Netrin-1 has been known to be involved in nervous system development by controlling neuronal migration through both chemoattractive and chemo-repulsive signaling by binding different receptors. Netrin-1 has been shown to play a positively regulatory role during inflammatory process recently. Since the chemorepulsive receptors were found in leukocytes, it is suggest that Netrin-1 played a protective role in tissue through inhibiting leukocyte trafficking and accumulating during inflammatory process in researches. It is demonstrated that Netrin-1 can limit inflammatory response through the involvement of inflammatory cascades, attenuate hypoxia-inducible tissue injury and suppress apoptosis concurrently. It is indicated that Netrin-1 can be a novel target in future through preventing and inhibiting inflammatory diseases in these researches. This review will focus on recent relevant advances and in-depth study to elucidate its mechanism of anti-inflammation.

IL-18 single nucleotide polymorphisms in hematologic malignancies with HLA matched sibling donor allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the impact of interleukin-18 (IL-18) single nucleotide polymorphisms on outcomes of hematologic malignancies with HLA-matched sibling donor hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>Single- nucleotide polymorphisms in IL-18 promoter was detected by PCR-sequence-specific primer analysis (PCR-SSP) in 93 recipients and their HLA matched sibling donors. Hematopoietic reconstitution, incidences of graft versus host disease (GVHD) and infections, transplant related mortality (TRM), and disease free survival (DFS) were analyzed.</p><p><b>RESULTS</b>In comparison with -137 G/C+C/C donor genotype, patients with -137 G/G donor genotype had shorter duration of neutrophil recovery [15(11-23) days vs 17(11-24) days, P=0.01], higher incidence of extensive chronic GVHD (20.6% vs 3.3%, P=0.029), but no difference in the interval of platelet recovery [20(11-46) days vs 20(7-38) days, P=0.844]. The incidence of extensive chronic GVHD in -607 C/C donor genotype (31.6%) was significantly higher than that (10.8%) in C/A + A/A donor genotype (P=0.024). Recipients with -607 C/C genotype also had higher incidence (33.3%) of extensive chronic GVHD than those with C/A+A/A genotype (10.7%, P=0.016). There were no differences in acute GVHD, TRM, and DFS between different genotypes.</p><p><b>CONCLUSION</b>IL-18 -137 G homozygous genotype in donor facilitated neutrophil reconstitution, but increased the risk of extensive chronic GVHD in patients with allo-HSCT.</p>

Role of IL-10 gene polymorphisms in promotor region in HLA matched sibling donor allogeneic hematopoietic stem cell transplantation / 中华器官移植杂志

Objective To explore the impact of IL-10 gene polymorphisms on the outcome in HLA matched sibling hematopoietic stem cell transplantation (HSCT).Methods PCR-sequencespecific primer (PCR-SSP) assay was used to analyze the SNP of IL-10 in 77 recipient and donor pairs:-1082 A/G,-819 T/C,-592 C/A.Results IL-10 ATA/ATA (1082,-819,-592) genotype in recipients significantly decreased the incidence of grade Ⅱ-Ⅳ acute graft vursus-host disease (aGVHD) (6.1％ vs.25.0 ％,P＜0.05),reduced 5-year transplant-related mortality (TRM) (10.7 ％± 5.9％ vs.29.7％ ± 5.2％,P＜0.05) and increased disease free survival (DFS) (81.8％ ± 6.7％ vs.56.8％ ± 7.5％,P＜0.05).With regard to the donor genotype,the incidence of grade Ⅱ-Ⅳ aGVHD,extensive chronic GVHD,5-year TRM and DFS had no signicant difference between IL-10 ATA/ATA and non ATA/ATA subgroup.Multivariable analysis also revealed that IL-10 non-ATA/ATA genotype in recipients and high-risk status of disease were two independent risk factors for DFS (HR =2.911,P =0.029; HR =2.686,P =0.027).Conclusion In HLA-matched sibling HSCT,the presence of recipient IL-10 ATA/ATA significantly decreased the incidence of grade Ⅱ-Ⅳ aGVHD and TRM,and increased DFS.