Clinical Analysis of Colistin Sulfate in the Treatment of Hematonosis Infected by Multidrug-Resistant Gram-Negative Bacteria / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safety of colistin sulfate in the treatment of hematonosis patients infected by multidrug-resistant (MDR) gram-negative bacteria (GNB), and discuss the possible factors that affect the efficacy of colistin sulfate.@*METHODS@#The clinical data of 85 hematologic patients infected with MDR GNB in the Soochow Hopes Hematonosis Hospital from April 2022 to November 2022 were collected and divided into clinically effective group with 71 cases and ineffective group with 14 cases according to the therapeutic efficacy of colistin sulfate. The age, gender, type of hematologic disease, status of hematopoietic stem cell transplantation, infection sites, type of pathogen, timing of administration, daily dose and duration of colistin sulfate, and combination with other antibacterial agents of patients in two groups were compared. Logistic regression was used to analyze on the meaningful variables to study the influencing factors of colistin sulfate. The adverse reactions of colistin sulfate were also evaluated.@*RESULTS@#There were no significant differences in age, gender, type of hematologic disease, hematopoietic stem cell transplantation status, infection sites and pathogen type between the effective group and the ineffective group (P>0.05). Compared with the medication time more than 7 days, meropenem used within 7 days in the clinical effective group, and timely replacement with colistin sulfate could obtain better efficacy, the difference was statistically significant (P=0.018). The duration of tigacycline before colistin sulfate did not affect the efficacy, and there was no significant difference in efficacy between the effective and ineffective groups. The therapeutic effect of colistin sulfate at daily dose of 500 000 U q8h was better than that of 500 000 U q12h, the difference was statistically significant (P=0.035). The time of colistin sulfate use in the clinically effective group was longer than that in the ineffective group, which had a statistical difference (P=0.003). Compared with the clinical ineffective group, the efficacy of combination regimens with colistin sulfate was better than that of colistin sulfate monotherapy, and the difference was statistically significant (P=0.013). Multivariate logistic regression analysis was performed on the indicators with statistical differences in the two groups of patients, which suggested that the use time of colistin sulfate (B: 2.358; OR: 10.573; CI: 1.567-71.361; P=0.015) and the combination of colistin sulfate (B: 1.720; OR: 5.586; CI: 1.210-25.787; P=0.028) were influential factors in the efficacy of colistin sulfate. During the treatment, the incidence of nephrotoxicity, hepatotoxicity and peripheral neurotoxicity were 5.9%, 1.2% and 1.2%, respectively.@*CONCLUSION@#The use of colistin sulfate improves the clinical efficacy of MDR GNB infections in hematological patients, and the timing of colistin sulfate administration and the combination of drugs are independent factors affecting its clinical efficacy, and the safety during treatment is high.

Effect of circulating immune complex on the efficacy of platelet transfusion / 中国输血杂志

【Objective】 To analyze the efficacy of ABO-matched platelet transfusions and ABO-mismatched platelet transfusions in patients with hematonosis and to explore the effect of circulating immune complexes (CIC) on the efficacy. 【Methods】 A total of 1 510 platelet transfusions involving 757 patients in our hospital from January 2013 to June 2018 were retrospectively analyzed. The patients were divided into ABO-matched group and ABO-mismatched group. The 12-hour percent platelet recovery (PPR) was used to evaluate the effect of platelet transfusion between the groups. TEG was used to evaluate the efficacy of the transfusions, and CIC value was measured before and after platelet transfusion. The effect of A-B/CIC (or AB-O/CIC) on platelet function was tested. 【Results】 1)The results showed that platelet transfusion was effective(PPR>30%) in both ABO-matched group[PPR=(66.5±52.8)%] and ABO-mismatched group[PPR=(47.7%±51.6)%], and there was no increase in the report of hemolytic transfusion reaction of ABO-mismatched group. The efficacy of ABO-matched platelet transfusions was significantly better than that of ABO-mismatched group(P 0.05. 2) In the experiment of simulating platelet transfusion in patients, no difference in MA value of TEG was noticed between ABO-mismatched groups and ABO-matched groups (all P>0.05). 3) There was no difference in CIC value before and after platelet transfusions (P>0.05) in the ABO-matched group, while CIC value decreased significantly in all ABO-mismatched groups (all P < 0.05). 4) The MA values (mm)of AB, A and O blood group platelets mixed with A-B/CIC and AB-O/CIC were 36.1 vs 31.1, 37.8 vs 35.0 and 43.1 vs 45.7, with the MA value (mm) in control group at 49.2 vs 49.5, respectively. 【Conclusion】 Platelet transfusion was effective in both ABO-matched group and ABO-mismatched group, and the efficacy of ABO-matched group was significantly better compared with the ABO-mismatched group. There was no increase in the safety risk of ABO-mismatched platelet transfusion with major mismatches/minor matches. CIC can inhibit the function of platelets and combine more with ABO-matched platelets than with ABO-mismatched platelets, therefore, CCI is an important influencing factor on the efficacy of platelet transfusions.

Application of RALE score in children with hematonosis/hematological malignancies complicated with acute respiratory distress syndrome / 解放军医学杂志

Objective: To explore the prognostic capacity of RALE scoring system in children with hematologic malignancies complicated with acute respiratory distress syndrome (ARDS). Methods: The clinical data were retrospectively analyzed of 57 ARDS child patients complicated with hematologic malignancies in pediatric intensive care unit (PICU) from Jan. 2014 to Jun. 2018. According to the therapeutic outcome within 28 days, they were divided into survival group (n=23) and non-survival group (n=34). The clinical features of the two groups were compared, and the relativity between RALE score and oxygenation index (P/F value) and the prognostic capacity of RALE score for ARDS were analyzed. Results: For the 57 child patients, the D1 P/F value was lower in non-survival group [116.0(70.0, 192.0)] than in the survival group [189.5(136.5, 251.3)], while the D1 pedicatic risk of mortality score (PRISM) HI, D1 RALE score and D3-D1 RALE score were higher in non-survival group [10.0(8.0, 16.0), 27.0(25.0, 37.0) and 5(0, 8), respectively] than in the survival group [7.6(4.0, 13.4), 24.0(13.8, 35.3) and -3.5(-7, 1), respectively]. The D1 RALE score was negatively correlated with the D1 P/F value (r=-0.831, P<0.001). A larger value of D3-D1 RALE score was an independent risk factor for 28 day mortality. The survival rate was higher in children when D1 RALE score ≤23 and the D3-D1 RALE score ≤-3 at D28. Conclusion: The RALE score can reflect the oxygenation status of ARDS, which is helpful for risk stratification and screening the high-risk patients.

Comparative analysis of risk degree of bleeding in patients with different kinds of hematonosis / 中国输血杂志

Objective To retrospectively analyze the platelet count and related factors in bleeding patients with hematonosis,and to calculate the risk of bleeding when the platelet count is at each exposure level.Methods Retrospective analysis of patients from Department of Hematology Inpatients in Nanjing Drum Tower Hospital,Nanjing First Hospital and Nanjing Jiangning Hospital from July 2013 to June 2017 was collected.And the risk of bleeding for different hematonosis was calculated.Results The tolerance of the 5 categories of hematonosis to low platelet counts is compared:AA and ITP can tolerate lower levels of platelet count;MDS and AML(except M3) are more prone to bleeding;ALL is the most susceptible to bleeding.Conclusion When platelet resources are scarce,priority should be given to ALL,MDS and AML patients,in order to ensure the safety of critically ill patients.For patients with AA and ITP,the platelet infusion threshold may be reduced appropriately,in oder to reduce the incidence of platelet transfusion refractoriness.

Treatment strategies for children with hematonosis and multi-drug resistant bacteria infection / 中华实用儿科临床杂志

Children with hematological diseases usually accompanied by low autoimmune function,and repeated chemotherapy exacerbated the damage to their immune system and hematopoietic function.Those lead to high incidence of nosocomial infection,most of infection were caused by multi-drug resistant bacteria and fungi.The major infections in hematological children are the following:multi-drug resistant Escherichia coli/Klebsiella pneumonia bacteria;multi-drug resistance Pseudomonas and Acinetobacte;Methicillin-resistant coagulase negative Staphylococcus and aureus;multi-drug resistance Enterococcus faecium.This review presents updated treatment strategies from the published clinical literature and provides recommendations for clinical treatment of multi-drug resistant bacteria in children with hematonosis.

Bone marrow biopsy pathology in combination with bone marrow smear and peripheral blood smear in diagnosis of stubborn hematonosis / 中国综合临床

Objective To investigate the diagnostic significance of synchronous observation on bone marrow biopsy,bone marrow smear and peripheral blood smear in stubborn hematonosis.Methods Thirty-seven patients with difficult and complicated hematologic diseases were detected by peripheral blood smear,bone marrow smear and bone marrow biopsy.Those slides and smears were observed.Results The 37 cases with blood disease was diagnosed of aplastic anemia in 3 cases,5 cases of myelodysplastic syndrome,6 cases of primary myelofibrosis,13 cases of secondary myelofibrosis,7 cases of lymphoma with bone marrow infiltration and 3 cases of metastatic carcinoma of bone marrow.In the diagnosis of aplastic anemia,myelodysplastic syndrome,primary and secondary myelofibrosis,lymphoma and metastatic carcinoma of bone marrow diagnosis,bone marrow biopsy is superior to smear.Conclusion Bone marrow biopsy,bone marrow smear and peripheral blood smear synchronous observation can effectively increase the diagnostic rate,decrease misdiagnosis rate,and correctly identify the stage of the disease.

Cause analysis and nursing of chemotherapeutic phlebitis in hematonosis children / 中国实用护理杂志

Objective To investigate the prevention and nursing measures of chemotherapeutic phlebitis in hematonosis children.Methods 233 children with first-attack of hematonosis were admitted to our department from January 2010 to January 2012,among whom 80 cases appeared different degrees of chemotherapeutic phlebitis.The related factors of chemotherapeutic phlebitis were explained and the nursing measures were established.Results After effective nursing measures,the chemotherapeutic phlebitis were properly handled.Conclusions Correct selection of vascular puncture site,strict aseptic operation and implementation of relevant nursing measures can prevent the incidence of chemotherapeutic phlebitis,and local closure,using of patches and external application of scald ointment can be adopted to treat chemotherapeutic phlebitis.

Progression of proteasome inhibitor in the targeted therapy for hematological sistemetic malignant tumor / 白血病·淋巴瘤

Proteasomes is a multienzyme complex.It can degradate cyclin,which control the process of cell cycle and cell apoptosis.Proteasome inhibitor regulate cell cycle and promote cell apoptosis through suppressing UP pathway.Proteasome inhibitor can stimulate apoptosis of various hematological systemetic malignant tumor and cause cell apoptosis through different mechanism in vivo and vitro.Therefore,proteasome inhibitor is a new-style tumor targeted therapy drug.