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Among 14 subtypes of serotonin receptors (5-HTRs), 5-HT 2AR plays important roles in drug addiction and various psychiatric disorders. Agonists for 5-HT 2AR have been classified into three structural groups: phenethylamines, tryptamines, and ergolines. In this study, the structure-activity relationship (SAR) of phenethylamine and tryptamine derivatives for binding 5-HT 2AR was determined. In addition, functional and regulatory evaluation of selected compounds was conducted for extracellular signal-regulated kinases (ERKs) and receptor endocytosis. SAR studies showed that phenethylamines possessed higher affinity to 5-HT 2AR than tryptamines. In phenethylamines, two phenyl groups were attached to the carbon and nitrogen (R 3 ) atoms of ethylamine, the backbone of phenethylamines. Alkyl or halogen groups on the phenyl ring attached to the β carbon exerted positive effects on the binding affinity when they were at para positions. Oxygen-containing groups attached to R 3 exerted mixed influences depending on the position of their attachment. In tryptamine derivatives, tryptamine group was attached to the β carbon of ethylamine, and ally groups were attached to the nitrogen atom. Oxygen-containing substituents on large ring and alkyl substituents on the small ring of tryptamine groups exerted positive and negative influence on the affinity for 5-HT 2AR, respectively. Ally groups attached to the nitrogen atom of ethylamine exerted negative influences. Functional and regulatory activities of the tested compounds correlated with their affinity for 5-HT 2AR, suggesting their agonistic nature. In conclusion, this study provides information for designing novel ligands for 5-HT 2AR, which can be used to control psychiatric disorders and drug abuse.
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A young male diagnosed with severe hemophilia A since childhood, was presented with recurrent joint and urinary bleeding. Annualized bleed rates dropped below five with low dose prophylactic medication.Bleeding in the right knee joint recently aggravated. Due to coexisting HIV infection and advanced hemophilic arthritis, the patient was managed by a multi-disciplinary team(MDT).Total knee arthroplasty was performed by an experienced surgeon using modern prosthesis design and intraoperative navigation technologies.Physical and rehabilitation therapy was provided during the postoperative period, and joint function improved. The MDT managed the young patient with HIV infection and advanced hemophilic arthritis. The patient was diagnosed with osteoporosis thought to have been caused by hemophilia, HIV infection and antiviral drugs; and he received treatment. The treatment of this patient reflects the importance of multidisciplinary cooperation in the management of difficult and rare diseases.
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Objective:To explore the optimum time of ambulation of atrial fibrillation patients after radiofrequency ablation, to provide basis for patients' early postoperative rehabilitation.Methods:By convenient sampling method, a total of 120 patients with atrial fibrillation after radiofrequency ablation were collected at Yanghu Branch and City Branch of Changzhou Second People's Hospital from January 2020 to May 2021. They were divided into the early group, middle group and late group according to the random number table method, each group were 40 cases. All patients received routine postoperative intervention, the time of ambulation were 4, 6 and 12 h after operation in the early group, middle group and late group, respectively. The complication rate within 24 h after operation was compared among the three groups, and the comfort level of the three groups at 24, 48 and 72 h after operation was evaluated with Comfort Status Scale (GCQ).Results:Finally, 111 patients were included, including 37 in the early group, 38 in the middle group and 36 in the late group. There was no significant difference in the incidence of bleeding or hematoma, urinary retention, lumbago within 24 h after operation among the three groups ( P>0.05). The incidence of postural hypotension within 24 h after operation in the early group was 2.7% (1/37), which was lower than 21.1% (7/38) and 25.0% (9/36) in the middle and late groups, with a statistically significant difference ( χ2=4.86, 7.67, both P<0.05). At 48 and 72 h after operation, the scores of physiological dimension, psychological dimension and the total score of GCQ in the early group were (20.68 ± 3.07), (22.54 ± 3.35), (81.68 ± 6.11) and (22.54 ± 3.73), (24.38 ± 2.49), (84.92 ± 6.37), higher than those in the middle group (19.16 ± 2.19), (21.32 ± 2.27), (78.24 ± 5.58), (20.93 ± 2.85), (22.32 ± 2.04), (81.66 ± 6.56), and those in the late group (18.44 ± 1.50) (21.31 ± 1.99), (78.06 ± 4.32), (20.89 ± 2.25), (21.58 ± 1.86), (80.28 ± 6.44), the differences were statistically significant ( t values were 2.19-4.15, all P<0.05). Conclusions:Ambulation at 4 h after operation does not increase peripheral vascular complications, but can reduce the incidence of postural hypotension and improve the comfort of patients with atrial fibrillation after radiofrequency ablation.
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Objectives@#To assess the diagnostic values of latex immunoturbidimetric assay (LIA) and particle immunofiltration assay (PIFA) for heparin-induced thrombocytopenia (HIT) .@*Methods@#Samples from 94 patients with suspected HIT from May 2016 to July 2018 in our hospital were prospectively analyzed by the two immunoassays. Their medical records and further follow-up data were also collected and analyzed by our hematologists to make the 4Ts scores and confirm the diagnosis of HIT, respectively. Performance characteristics of the two immunoassays were assessed, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) . Their post-test probabilities (PTP) were also calculated based on the 4Ts score.@*Results@#Among 94 cases, 15 (16.0%) had a positive HIT, including 6 of 37 (16.2%) with an intermediate, and 9 of 15 (60.0%) with a high 4Ts score. PIFA operating characteristics were: sensitivity 100.0% (15/15) , specificity 51.9% (41/80) , PPV 28.3% (15/53) , NPV 100.0% (41/41) . The positive PTP in intermediate and high 4Ts score group were 28.7% and 75.7%, respectively, while negative PTP were all 0. At manufacturers’ cutoffs, LIA operating characteristics were: sensitivity 66.7% (10/15) , specificity 94.9% (75/79) , PPV 71.4% (10/14) and NPV 93.8% (75/80) . The positive and negative PTP in intermediate 4Ts score group were 71.8% and 6.3%, while 95.2% and 34.4% in high 4Ts score group, respectively. Receiver operating characteristic (ROC) analysis manifested that LIA was preferable than PIFA, and combining the 2 assays together was significantly better than single test.@*Conclusions@#4Ts score is still an important tool for the diagnosis of HIT. Combining clinical score with heparin/PF4 antibody assay can increase the accuracy of confirming or excluding HIT. Although PIFA is inferior to LIA in the diagnostic value, its user friendliness and 100% NPV have major advantages. Combining the 2 assays together can achieve a higher diagnostic value.
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Objective@#To observe the safety and efficiency of face-lift combined with fat grafting in facial rejuvenation.@*Methods@#We performed a retrospective study, which included 23 patients. SMAS suspension and multi-site suspension were combined to correct the nasolabial fold, mid-cheek aging and malar mounds. Structural fat grafting was performed to treat the volume loss in mid-face.@*Results@#All patients demonstrated a significant improvement in midfacial appearance. No infection or nerve injury were found in this study. Only three patients did not get primary healing in temple region, which led to temporal hair loss from secondary healing.@*Conclusions@#This study demonstrates that fat grafting and multiple layers face-lift are efficient method for facial rejuvenation. These approaches appear to be very promising for facial anti-aging techniques.
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OBJECTIVE:To provide reference for exploring the way to improve the ability of pharmaceutical care in primary pharmaceutical staff. METHODS:Questionnaire survey was conducted among pharmaceutical staff(including head of pharmacy department),director/vice-director of hospital in charge of pharmacy,medical staff and patients from primary medical institutions in 9 provinces(regions,cities). The results of investigation were analyzed statistically. RESULTS:A total of 77 primary medical institutions involved in the survey. Totally of 2 273 questionnaires were sent out,and 2 248 effective questionnaires were collected with effective recovery rate of 98.9%. Among effective questionnaires,278 questionnaires were filled out by pharmaceutical staff (68 by head of pharmacy department),48 by director/vice-director of hospital in charge of pharmacy,771 by medical staff and 1 151 by patients. Results of survey showed that only 140 pharmaceutical staff had obtained pharmacy practice qualification,accounting for 50.4%. The surveyed primary medical institutions provided limited pharmaceutical care projects,and the projects with high proportion were medication explanation(85.7%)and medication consultation(84.4%). The establishment of Health Service Record Card in elderly patients(19.5%),the development of chronic disease management(23.4%)and the development of chronic disease related pharmaceutical knowledge publicity at the primary level(37.7%)took up low proportion relatively. Overall satisfaction of surveyed medical staff to pharmaceutical care of pharmaceutical staff was general(77.2%). Surveyed patients greatly satisfied with the attitude of pharmaceutical staff(85.5%)but overall satisfaction of them to professional knowledge of pharmaceutical staff(78.2%)was general. Surveyed pharmaceutical staff training needs in descending order were medication explanation(74.5%),medication counseling(71.9%)and providing pharmaceutical information(64.0%). However,the projects which had low proportion of training needs included chronic disease management(22.3%)and lifestyle guidance (27.0%),etc. The more favorite training forms in descending order were further study in medical institution at higher level(65.4%),expert lectures(60.1%)and training in the training base (57.9%). CONCLUSIONS:The primary medical institutions provided limited pharmaceutical care. It is necessary to further explore and standardize pharmaceutical care criteria. The overall satisfaction of medical staff and patients on pharmaceutical care of pharmaceutical staff is not high in primary institutions,and it needs to be further improved. The related pharmacy training for primary pharmaceutical staff still needs to be strengthened,and can be conducted according to the favorite form of training so as to improve the ability of pharmaceutical care.
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A teaching case library of clinical pharmacy was constructed to improve case teaching for pharmacy residents. Through establishment of draft requirement and organizing a group of authors consti-tuted by preceptors of pharmacy residents, the teaching cases were written, the contents and forms of which were assessed by teaching demonstration, interactively examined and revised by fellow teachers, audited and screened by senior pharmacists , and thus a case library was collaborated , processed and established . Finally, a case library was formed, which included 11 systems, such as endocrine, cardiovascular and neu-rological systems, and 32 cases of drug treatment for common diseases in each system. The construction ofcase library has enhanced the teaching consciousness and skills of resident pharmacists' teaching team. This case library will become an important resource for teaching and scientific research in the future.
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Objective@#To explore the effects of combined application of culture supernatant of human umbilical cord mesenchymal stem cells (hUCMSCs) and ciprofloxacin on Staphylococcus aureus (SA) in vitro.@*Methods@#hUCMSCs were isolated from umbilical cord tissue of full-term healthy fetus after cesarean section and cultured. Cells in the third passage were used in the experiments after identification. SA strains isolated from wounds of burn patients in our burn wards were used in the experiments. Cells were divided into 0, 10, 100, and 1 000 ng/mL lipopolysaccharide (LPS) groups according to the random number table (the same dividing method below). Cells were cultured with culture medium of mesenchymal stem cells (MSCs) after being treated with medium containing the corresponding mass concentrations of LPS for 12 h. At post culture hour (PCH) 6, 12, and 24, 6 wells of culture supernatant of cells in each group were obtained to measure the content of LL-37 with enzyme-linked immunosorbent assay. Ninety blood agar plates were divided into ciprofloxacin control group (CC), ciprofloxacin+ supernatant group (CS), and ciprofloxacin+ supernatant+ LL-37 antibody group (CSL), with 30 blood agar plates in each group. Blood agar plates in group CC were coated with 1.5×108 colony forming unit (CFU)/mL bacteria solution prepared with normal saline. Blood agar plates in group CS were coated with 1.5×108 CFU/mL bacteria solution prepared with normal saline and culture supernatant of hUCMSCs (cultured by culture medium of MSCs, the same below) in double volume of normal saline. Blood agar plates in group CSL were coated with 1.5×108 CFU/mL bacteria solution prepared with normal saline, culture supernatant of hUCMSCs in double volume of normal saline, and 2.6 μL LL-37 antibody in the concentration of 2 μg/mL. At PCH 12, 24, and 48, 10 blood agar plates of each group were harvested to observe the distribution of SA colony on blood agar plate and to measure the diameter of bacterial inhibition ring of ciprofloxacin. The minimum inhibitory concentration (MIC) of ciprofloxacin against SA of each group was recorded. Fractional inhibitory concentration (FIC) indexes of ciprofloxacin in groups CS and CSL at PCH 12, 24, and 48 were calculated, and the effect of synergy was evaluated. Data were processed with analysis of variance of factorial design, one-way analysis of variance, LSD-t test, Kruskal-Wallis test, and Mann-Whitney U test.@*Results@#(1) At each PCH, the content of LL-37 in culture supernatant of cells in 10, 100, and 1 000 ng/mL LPS groups was higher than that in 0 ng/mL LPS group (with t values from 11.22 to 33.36, P values below 0.01); the content of LL-37 in culture supernatant of cells in 100 and 1 000 ng/mL LPS groups was higher than that in 10 ng/mL LPS group (with t values from 2.24 to 18.73, P<0.05 or P<0.01); the content of LL-37 in culture supernatant of cells in 1 000 ng/mL LPS group was higher than that in 100 ng/mL LPS group (with t values from 12.46 to 14.70, P values below 0.01). (2) At PCH 12, 24, and 48, the bacterial colonies in groups CC, CS, and CSL began to integrate over time. At PCH 12, 24, and 48, the diameters of bacterial inhibition ring of ciprofloxacin in group CC were 26, 24, and 23 mm, respectively, with no obvious change. At PCH 12, 24, and 48, the diameters of bacterial inhibition ring of ciprofloxacin in groups CS and CSL were 82, 71, 68 mm, and 74, 59, 56 mm, respectively, significantly longer than those of group CC. (3) At each PCH, the MIC of ciprofloxacin against SA was significantly higher in group CC than in groups CS and CSL (with Z values from 6.22 to 6.71, P values below 0.01); the MIC of ciprofloxacin against SA was significantly higher in group CSL than in group CS (with Z values all equal to 6.72, P values below 0.01). (4) FIC indexes of ciprofloxacin in groups CS and CSL at PCH 12, 24, and 48 were 0.011, 0.032, 0.032, and 0.122, 0.350, 0.350, respectively. The results indicated that culture supernatant of hUCMSCs had synergistically antibacterial effect on ciprofloxacin.@*Conclusions@#hUCMSCs can secrete LL-37, and the secretion level is increased with increase of LPS concentration. Combination of culture supernatant of hUCMSCs and ciprofloxacin can decrease the dosage of ciprofloxacin in resisting SA. Once LL-37 is neutralized, the synergistically antibacterial effect of culture supernatant of hUCMSCs is decreased.
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Objective@#To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO.@*Methods@#Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×109/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×109/L.@*Results@#A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×109/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×109/L) at 4th week, 8th week and 12th week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×109/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild.@*Conclusion@#Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.
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Objective: To establish an education program for resident pharmacists to improve clinical problem solving skills with pharmaceutical knowledge.Methods: A case-based education program for resident pharmacists with drug knowledge was established after a questionnaire survey in resident pharmacists and the discussion with clinical teachers.A teaching team was built and the resident pharmacists were divided into several study groups.After a pilot run, the program was operated in pharmacy department.The program was divided into 10 sections by drug indications, and each section was composed of basic drug knowledge lecture and case discussions, which mobilized the study initiative of resident pharmacists.At the half time, resident pharmacists and clinical teachers participated in a midterm survey by a questionnaire.Results: More than 95% resident pharmacists and teachers believed that basic drug knowledge lecture before case discussion was necessary, and compared with previous trainings, the program could further increase study interests of resident pharmacists and improve the clinical problem solving skills.However, 33.3% resident pharmacists and 60% teachers thought the cases were difficult, and 18.5% resident pharmacists and 10% teachers disagreed the cases were close to the actual work.Conclusion: The program is effective in drug knowledge training for resident pharmacists, which can improve pharmaceutical care for patients, while further modifications are still needed to satisfy the demands of resident pharamcists with different working years.
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OBJECTIVE:To provide reference for the training and evaluation for hospital pharmacy teachers. METHODS:19 pharmacists-in-charge in the pharmacy department of our hospital received training of teaching ability,and theory test and multi-sta-tion practical technique test were conducted after training. The items examined in theory test included training rules,the profession-al knowledge of pharmacy and teaching method;the content of practical technique test included checking prescriptions/medication orders,drug dispensing,medication management,patient education and ADR report. Each teacher’s test included 3 of 5 items above based on different responsibilities. All scores were analyzed and summarized. RESULTS:The score of practical technique test was higher than the score of theory test;teachers’grasp of training rules was the worst in theory test;in practical technique test,the score of medication management was the highest for teachers worked at the post of dispensing;while the score of patient education was higher than the score of ADR report for teachers who were clinical pharmacists,the differences were statistically sig-nificant(P<0.05). CONCLUSIONS:In order to improve teaching ability, teachers should receive intensive training on the train-ing rules and the professional knowledge of pharmacy;the multi-station examination mode will be improved in many modes such as increasing stations,standardized test paper and standardized trainees;meanwhile,the young pharmacists should be encouraged for positive commitment to the teaching work and continuously enriched with experience.
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Objectives To explore the feasibility ofdiagnosis of Perimembranous Ventricular Septal Defect with Right Aortic Valve Prolapse by ultrasonic echocardiography. Methods 131 VSD patients aged 1 to 22 years, weight 8.0 to 54.0 kg, underwent transthoracic echocardiography (TTE) and left ventricular angiography to show the diameter of VSD and the degree of AVP. Results Among 131 patients, 87 cases were diagnosed as VSD,14 as VSD with slight AVP, 12 as, VSD with middle AVP, and 18 as VSD with severe AVP by ultrasonic echocardiography respectively. After the left ventricular angiography and aortic root angiography , it proved that positive rate of VSD was 44.8%, positive rate of VSD with slight AVP was 42.86%, positive rate of VSD with middle AVP was 58.3%,and positive rate of VSD with severe AVP was 83.3%. Conclusion The transthoracic echocardiography (TTE) contributes to diagnosis of severe degree of AVP,while TTE evaluates the slight degree of AVP incorrectly enough. Left ventricular angiography and aortic root angiography are needed to realize the di-agnosis of AVP.
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Drug-induced liver injury ( DILI) is a significant rea-son of acute liver failure and is the main cause of therapeutic drugs withdrawal from the market .Multiple mechanisms can cul-minate in DILI , but metabolism and genetics play distinct roles in this process .This review will cover papers we consider have addressed these mechanisms of DILI in commonly used medica-tions for adults , and discuss the hot issues .The aim is to gener-ate discussion about the potential clinical significance among these researchs and point out the key areas for further study of DILI.
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OBJECTIVE:To investigate the status quo of teachers'teaching ability of standardized training for hospital pharma-cists in Beijing area,and provide reference for strengthening the faculty construction. METHODS:A dynamic assessment of stan-dardized training base for hospital pharmacists of 17 inpatients in Beijing area was conducted to organize evaluation experts to as-sess the teaching ability of outpatient pharmacy,ward pharmacy and clinical pharmacy in training base. Questionnaire was designed and trainees were organized to evaluate the teaching ability,time,attitude,feedback and others and related results of teaching in bases were vegarded as objects for analysis and summary. RESULTS:The overall ability of teaching was high,and the most promi-nent was clinical pharmacy,which was well received by trainees. But there are differences among departments,the ability of ward pharmacy is slightly lower than the clinical pharmacy and outpatient pharmacy. And the teaching ability still had great improvement. CONCLUSIONS:In order to improve the overall teacher strength in training base,competence-based training for hospital pharma-cists must be strengthened to encourage teachers to attend training courses,strengthen cultivation of humanistic quality and enrich students'evaluation forms.
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Objective To observe the effect of Shenxian Yiganling Tablets ( SYT) , a Chinese herbal recipe with the actions of tonifying kidney and removing toxicity, combined with HBsAg gene-modified dendritic cells (DC/HBsAg) on immune response and hepatocyte damage of hepatitis B virus (HBV) transgenic mice. Methods HBV transgenic mice ( Tg mice) were immunized with injection of DC/HBsAg ( 100 μg every three weeks) through caudal vein, and then were given intragastric administration of SYT in the dosage of 12.8, 23.5, and 47.0 mg/d for four weeks. HBV Tg mice splenic T cell cytokines of interleukin 2 ( IL-2) and interferon gamma ( IFN-γ) levels as well as serum alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) conents were detected by enzyme-linked immunosorbent assay ( ELISA) . Lactate dehydrogenase ( LDH) release assay was used to detect the in-vitro cytotoxic activity of splenic HBsAg specific T lymphocytes. Serum HBsAg level of HBV Tg mice was detected by ELISA after immunization. Results Compared with DC/HBsAg administration alone, DC/HBsAg combined with SYT could significantly increase HBV Tg mice splenic T cells cytokines IL-2 and IFN-γ levels ( P<0.05 or P<0.01) , increase the cytotoxic activity of HBsAg-specific T lymphocytes ( P<0.05 or P<0.01), increase the inhibition rate of HBsAg expression (P<0.05 or P<0.01), and reduce hepatocyte damage. Conclusion SYT could enhance the immune response of Tg mice to DC/HBsAg immunization, and relieve the hepatic damage, which enable the HBV clearance process out of hepatic damage in the case of anti-HBV activity of IFN-γbeing unaffected.
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<p><b>OBJECTIVE</b>To investigate the characteristics, treatment and outcome of patients with primary central nervous system lymphoma （PCNSL）.</p><p><b>METHODS</b>A total of 37 patients with PCNSL treated in Peking Union Medical College Hospital from June 1999 to June 2012 were enrolled into this retrospective study. The clinical characteristics, results of treatment and prognostic factors were analyzed.</p><p><b>RESULTS</b>The median age of 37 patients with PCNSL at diagnosis was 57 years（range 17 to 78 years） with a male to female ratio of 2.7:1. The symptoms or signs of elevated intracranial pressure and cognitive dysfunction were the most common initial manifestations. The median time period between onset of symptoms and diagnosis was 1.5 months. The majority of lesions were located in the cerebral hemisphere. At a median follow-up of 50 months, the median overall survival for all treated patients was 36.0 months （95% CI 21.7-50.3 months）, with a progression-free survival of 18.0 months（95% CI 9.1-26.9 months）. The 3-year cumulative survival rate was 46.9%. Compared to chemotherapy alone, combined-modality regimens which did not improve outcome were associated with a greater risk of neurotoxicity.</p><p><b>CONCLUSION</b>The prognosis of PCNSL was still poor, and the optimal treatment strategy for these patients should be explored in the future clinical trials.</p>
Sujets)
Adolescent , Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Pékin , Tumeurs du système nerveux central , Diagnostic , Anatomopathologie , Survie sans rechute , Lymphome malin non hodgkinien , Pronostic , Études rétrospectives , Taux de survieRésumé
<p><b>OBJECTIVE</b>To highlight the current understanding of mixed phenotype acute leukemia (MPAL).</p><p><b>DATA SOURCES</b>We collected the relevant articles in PubMed (from 1985 to present), using the terms "mixed phenotype acute leukemia", "hybrid acute leukemia", "biphenotypic acute leukemia", and "mixed lineage leukemia". We also collected the relevant studies in WanFang Data base (from 2000 to present), using the terms "mixed phenotype acute leukemia" and "hybrid acute leukemia".</p><p><b>STUDY SELECTION</b>We included all relevant studies concerning mixed phenotype acute leukemia in English and Chinese version, with no limitation of research design. The duplicated articles are excluded.</p><p><b>RESULTS</b>MPAL is a rare subgroup of acute leukemia which expresses the myeloid and lymphoid markers simultaneously. The clinical manifestations of MPAL are similar to other acute leukemias. The World Health Organization classification and the European Group for Immunological classification of Leukaemias 1998 criteria are most widely used. MPAL does not have a standard therapy regimen. Its treatment depends mostly on the patient's unique immunophenotypic and cytogenetic features, and also the experience of individual physician. The lack of effective treatment contributes to an undesirable prognosis.</p><p><b>CONCLUSION</b>Our understanding about MPAL is still limited. The diagnostic criteria have not been unified. The treatment of MPAL remains to be investigated. The prognostic factor is largely unclear yet. A better diagnostic criteria and targeted therapeutics will improve the therapy effect and a subsequently better prognosis.</p>
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Humains , Leucémie aigüe biphénotypique , Diagnostic , Métabolisme , microARN , MétabolismeRésumé
Objective To review the clinical features,diagnostic work-up,classification,prognosis and treatment of systemic mastocytosis (SM).Methods The clinical data of 3 SM patients admitted to Peking Union Medical College Hospital (PUMCH) were retrospectively analyzed and the review of recent literatures was performed.Results All the 3 cases were pathologically diagnosed.According to WHO 2008 classification criteria,2 cases were diagnosed as aggressive SM (ASM) and the other one was diagnosed as indolent SM (ISM).Case 1 was a 60-year-old female patient who had overt mediator release syndrome manifesting as episodes of flushing,fever,vomiting,palpitation,hypotension and syncope.She was diagnosed as aggressive SM based on significantly increased number of abnormal mast cells (accounting for 6％ of all nucleated cells) in the bone marrow aspiration sample and biopsy specimen which accompanied with decreased other myeloid and erythroid elements.Her disease was refractory to the treatment of H2 antihistamines and led to a fatal outcome eventually.Case 2 was a 72-year-old male patient who underwent extended proximal gastrectomy with esophagogastric anastomosis due to endoscopically detected diffuse thickening of the gastric fundic mucosa.The diagnosis as indolent SM was established according to the dense infiltrate of abnormal mast cells in the surgically resected part of stomach and regional lymph nodes.He had been in complete remission for more than 6 years ever since then.Case 3 was a 41-year-old female patient who presented with fever,urticaria pigmentosa and diffuse bone lesions.A bone biopsy specimen demonstrated a dense infiltrate of mast cells while the assays for KIT-D816V mutation and FIP1L1-PDGFRα fusion gene yielded negative results.She was diagnosed as aggressive SM and a progression-free survival of more than 1 year had been achieved with the treatment of prednisone,interferon-α and pamidronate.Conclusions SM is a rare disease.Diagnosis is primarily dependent on histopathology.There is currently no curative therapy for systemic mastocytosis.Treatment is intended to reduce symptoms and improve quality of life.The prognosis of ISM is much better than that of ASM.
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Objectives To investigate the incidence of the heparin-induced thrombocytopenia (HIT) and positivity of anti-heparin/platelet factor 4 complex antibody (HIT-antibody) in inpatients treated with heparin preparations.Methods A total of 197 consecutive patients,including 120 men and 77 women,who were treated with unfractioned heparin (UFH) or low molecular weight heparin (LMWH),were enrolled in this study.HIT-antibody was detected by enzyme-linked immunosorbent assay (ELISA).All patients were classified into subgroups based on 4Ts (Pretest Clinical Scoring System) and types of underlying disorders.The incidence of HIT and positivity of HIT-antibody among different groups were analyzed.Results The overall incidence of HIT was 3.0％ (6/197),and the positivity of HIT antibody was 12.2％ (24/197).The positivity of HIT-antibody was 10.1％ (18/178),7.7％ (1/13) and 83.3％(5/6) in low,moderate and high HIT probability group respectively.There were significant differences of HIT positivity and mean level of HIT-antibody between the high HIT probability group and the low or moderate HIT probability group (P =0.000).Both the incidence of HIT and positivity of HIT-antibody were higher in surgical patients than in medical patients (5.8％ vs 0.9％,P =0.047 and 19.8％ vs 6.3％,P =0.004).Conclusions The incidence of HIT and positivity of HIT-antibody were 3.0％ and 12.2％ respectively,both of which were related with the types of disorders.Detection of HIT-antibody has a better applicable value in patients with high HIT probability.