Application of umbilical cord blood transplantation in the treatment of paroxysmal nocturnalhemoglobinuria / 中华器官移植杂志

Objective:To explore the feasibility and efficacy of umbilical cord blood transplantation (UCBT) in the treatment of paroxysmal nocturnal hemoglobinuria (PNH).Methods:From May 2014 to December 2019, clinical data were retrospectively reviewed for 7 PNH patients undergoing UCBT. The grades were severe ( n=6) and extremely severe ( n=1). The causes were primary PNH ( n=4) and PNH-aplastic anemia (AA) syndrome ( n=3). There were 5 males and 2 females with a median age of 29 (20-47) years, a median weight of 60(50-71) kg and a median time from diagnosis to transplantation of 62.5(7.7-171) months. All of them were accompanied by transfusion dependence. Myeloablative ( n=6) and reduced-intensity ( n=1) pretreatment was offered. The regimen of preventing GVHD was cyclosporine A plus short-term mycophenolate mofetil without ATG. The median number of input nucleated cells was 2.4(1.71-4.28)×10 7/kg and the median number of CD34+ cells 1.58(0.88-3.02)×10 5/kg. Results:Neutrophil and erythroid engraftment was obtained with a median neutrophil engraftment time of 17(15-21) days and a median erythroid engraftment time of 27. Engraftment time of 37(25-101) days for platelets >20×10 9/L and 62(27-157) days for platelets >50×10 9/L. The incidence of 100-day acute GVHD was 28.6%(95%CI 0-55.3%). The severity of GVHD was grade Ⅱ° acute ( n=2) and mild ( n=1). The median follow-up period was 13.5(3-71.4) months. Six patients survived while another with PNH-AA syndrome with iron overload died of gastrointestinal hemorrhage. The 2-year overall survival rate was 83.3%(95%CI 27.3-97.5%). Conclusions:With excellent engraftment and survival in the treatment of PNH, UCBT is indicated for patients without HLA full-match donor. PNH-AA syndrome with iron overload may be one of the important prognostic factors.

Preliminary study on the relationship between chronic inflammation and biopsy results in prostate biopsy / 中华泌尿外科杂志

Objective:To investigate the correlation between chronic inflammation and biopsy results in the first prostate biopsy and the predictive effect of chronic inflammation on the results of repeated prostate biopsy.Method:From January 2016 to January 2019, 771 patients who underwent transperineal prostate biopsy for the first time in the Second Hospital of Tianjin Medical University were included. The average age was 69.6 years old(39-89), with PSA level of 16.1 ng/ml(4-50), PSAD level of 0.6 ng/ml 2(0.1-1.3), prostate volume(PV)of 40.2 ml(16.7-129.5), transition zone volume(TZ) of 23.9 ml(0.7-49.5). The biopsy was performed under general anesthesia in the lithotomy position, and transrectal ultrasound(TRUS)and prostate puncture template were used to guide the biopsy. The association between chronic inflammation and pathological results or Gleason scores in prostate cancer (PCa) were analyzed. The univariate and multivariate logistic regression analyses were performed to select the independent risk factors for prostate biopsy results. The relationship between chronic inflammation and pathological results in patients with repeated biopsy within 3 years after the first biopsy was assessed. The independent risk factors related to the results of the repeated biopsy were also evaluated. Result:A total of 771 patients were included, including 354 cases of PCa and 144(40.7%) cases associated with chronic inflammation. In addition, 332 cases were benign prostatic disease (BPD), including 263(79.2%) cases with chronic inflammation, and 85 cases were prostate high-grade intraepithelial neoplasia group (HGPIN), including 13(15.3%) cases with chronic inflammation. The PV, TZ and chronic inflammation rates were statistically significantly lower in PCa and HGPIN than those in BPD, while the level of PSA and PSAD were significantly higher than those in BPD. Multivariate logistics regression analysis showed that PSAD and chronic inflammation rates were independent risk factors for PCa and HGPIN. According to the biopsy results of Gleason score from 6 to 10, the chronic inflammation rates was 70%(35/50), 61%(36/59), 33%(69/209), 12%(3/25) and 9%(1/11) respectively ( P<0.05), which indicated that the chronic inflammation was negatively correlated with higher grade tumors. The repeated biopsy was performed in 30 patients within 3 years after the first biopsy. The average age was 71.2 years old (45-80), with PSA level of 20.1 ng/ml (4-39), PSAD level of 0.7 ng/ml 2(0.2-1.3), PV of 39.3 ml(18.5-119.0), and TZ of 19.9 ml(12.5-40.5). The results of the repeated biopsy showed that there were 9 cases with PCa(3 cases with chronic inflammation)and 21 cases without PCa (16 cases with chronic inflammation). The level of PSA ( P=0.031) and PSAD ( P=0.032) were statistically significantly higher in PCa than those in benign disease, while the chronic inflammation rates were significantly lower than those in benign disease( P=0.042). Multivariate logistics regression analysis showed that PSAD ( OR=0.7, P=0.012) and chronic inflammation( OR=13.7, P<0.001)were independent risk factors in the positive repeated biopsy. In patients with repeated biopsy, considering PSAD (cut off value 0.15) and first biopsy with chronic inflammation, the predicted results were positive in 8 cases and negative in 22 cases. The real number of cases in the two groups is 6 and 19 respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of repeated biopsy results were 66.7%, 90.4%, 75.0%, and 86.3%, respectively. Conclusion:Chronic inflammation was negatively correlated with positive biopsy results and high-grade tumors. For the patients with PSAD<0.15 and the first biopsy with chronic inflammation, the repeated biopsy should be avoided in most of the cases.

Effect of pretransplant iron overload on clinical efficacy of allogeneic hematopoietic stem cell transplantation on severe aplastic anemia / 器官移植

Objective To evaluate the effect of pretransplant iron overload on the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with severe aplastic anemia (SAA). Methods Clinical data of 80 SAA recipients who underwent allo-HSCT for the first time were retrospectively analyzed. According to the incidence of iron overload, all recipients were divided into the iron overload group (n=20) and non-iron overload group (n=60). The engraftment rate, incidence of postoperative complications and clinical prognosis of the recipients afterallo-HSCT were statistically compared between two groups. The influencing factors of 2-year overall survival (OS) and 180 d transplantation related mortality (TRM) were analyzed by Cox proportional hazards regression model. Results The engraftment rate of neutrophils in the non-iron overload group was 98% (59/60), significantly higher than 75% (15/20) in the iron overload group (P < 0.05). The engraftment rate of platelet in the non-iron overload group was 90% (54/60), significantly higher than 65% (13/20) in the iron overload group (P < 0.05). The incidence rate of bloodstream infection in the non-iron overload group was 23% (14/60), remarkably lower than 40% (8/20) in the iron overload group (P < 0.05). The 180 d TRM of the recipients in the non-iron overload group was 17%, significantly lower than 45% in the iron overload group (P < 0.05). The 1- and 2-year OS of the recipients in the non-iron overload group were 82% and 80%, significantly higher than 50% and 44% in the iron overload group (both P < 0.05). Iron overload or not was an independent risk factor of the OS and TRM of the recipients (both P < 0.05). Conclusions Iron overload can affect the OS and TRM of SAA patients after allo-HSCT.

Etiology and clinical features of post-engraftment blood stream infection in UCBT recipients / 中华器官移植杂志

Objective To analyze the epidemiologic and clinical features of post-engraftment blood stream infection (pePSI) after unrelated cord blood transplant (UCBT) in our hospital,and provide the basis for empiric antibacterial treatment.Methods 484 patients with hematological malignancies who received single-unit high intensity myeloablative UCBT in our hospital between April 2011 and November 2017 were enrolled.The incidence,etiology of BSI and associated mortality,drug resistance rate in the post-engraftment phase were investigated.Results Totally 25 episodes of BSI among 22 patients in the post-engraftment phase were documented,and the incidence of peBSI was 5 ％.Gram-negative organisms predominated over Gram positive,with Escherichia coli being the most frequent Gram-negative organism isolated (31.5％).Among Gram positive organisms,methicillin resistant Staphylococcus (MRS) was the most frequent species isolated (66％).Nearly 33％ of Escherichia coli isolates and 60％ Klebsiella pneumonia isolates were carbapenem-resistant.All Grampositive bacteria were sensitive to vaneomyein and linezolid.Among the 22 patients,14 patients were cured and survived (63％) eventually.Conclusion The most frequent causative agents of the peBSI after UCBT were Escherichia coli,Klebsiella pneumonia and MRS,etc.Combined antibacterial treatment including a carbapenem or beta lactamase inhibitor can be used for patients suffering fever in the post-engraftment phase as empiric antibacterial therapy.Vaneomyein and linezolid can be used as the first-line therapy for Gram-positive bacteria.

The research of double antiplatelet drug combined with pantoprazole in the treatment of ischemic stroke / 中国基层医药

Objective To research whether double antiplatelet drug combined with pantoprazole can reduce digestive tract damage,or aggravate cardiovascular system side effect.Methods 270 patients diagnosed as ischemic stroke received double antiplatelet drug were randomly divided into two groups.The treatment group received panto-prazole,the control group did not took any gastric drug.The side effect of the digestive and cardiovascular system was observed.Results 268 patients were followed up for 90 days,and digestive system side effect of the treatment group (136 cases)included indigestion in 26 cases(19.11%),stool occult blood(+)in 11 cases(8.08%),melena in 8 cases(5.89%),hematemesis in 0 case,and the control group (132 cases)included indigestion in 42 cases (31.82%),stool occult blood(+)in 23 cases(17.42%),melena in 19 cases(14.39%),hematemesis in 4 cases. There were significant differences between the two groups(χ2 =6.66,4.56,11.2 and 4.18,all P 0.05 ).Conclusion Double antiplatelet drug combined with pantoprazole had a positive significance in reducing the digestive tract damage of ischemic stroke patients,and didn't increase the incidence of cardiovascular sys-tem side effect.

Effect of second line treatment with S-1 and thalidomide in patients with advanced pancreatic cancer / 中华胰腺病杂志

Objective To investigates the efficacy and tolerability of second line treatment with S-1 plus thalidomide in patients with advanced pancreatic cancer.Methods Sixty patients hospitalized in Department of Oncology of Cangzhou Central Hospital from July 2010 to October 2012 were included in this study.All the patients were diagnosed as having pancreatic carcinoma.The patients were randomly divided into two groups,one group was treated with S-1 alone,and the other group was treated with S-1 plus thalidomide.Then the efficacy and toxicity of two groups was evaluated.Results The disease control rates were 36.7％ and 46.7％ in the S-1 alone group and the S-1 plus thalidomide group,and the difference between the two groups was not statistically significant (P =0.31).The progression free survival (PFS) was 2.9 months and 3.3 months,and the difference between the two groups was statistically significant (P ＜ 0.05),the Karnofsky score,pain,sleep and weight improvement rate was 63.3％,46.7％,66.7％ and 53.3％ in combination group,which were significantly better than those in control group (30.0％,13.3％,30.0％ and 20.0％),and the difference between the two groups was statistically significant (P ＜ 0.05).The major adverse events were nausea,vomiting,fatigue and drowsiness,mainly of grades Ⅰ ～ Ⅱ.Conclusions S-1 plus thalidomide as second line treatment of pancreatic cancer can prolong the PSF of patients with advanced pancreatic cancer with excellent safety,and patients' quality of life is also improved.

Efficacy analysis of unrelated cord blood transplantation for 58 acute myelogenous leukemia patients / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic efficacy and related risk factors of acute myelogenous leukemia （AML） patients treated with unrelated cord blood transplantation （UCBT）.</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 58 AML patients that consisted of 1 case of M0, 1 case M1, 35 cases M2, 3 cases M4, 14 cases M5, 3 cases M6, and 1 case acute mixed leukemia, respectively. Of them, 1 case AML secondary to myelodysplastic syndrome, and 36 in first complete remission （CR1）, 14 in second complele remission （CR2）, 8 in non- remission （NR）, 43 cases were refractory or high-risk patients（70.1%）. The median age was 14.5 years with the median weight of 45 kg, 49 patients received sUCBT and 9 dUCBT. All the patients conditioned with intensified myeloablative regimen and received a combination of Cyclosporine A（CsA）and mycophenolate mofetil（MMF）to prevent graft- versus- host disease（GVHD）.</p><p><b>RESULTS</b>56 out of 58 patients achieved engraftment with implantation rate 96.6%. The median time of ANC≥0.5×10⁹/L was 17（12-37）days, and that of PLT≥20× 109/L 33（17-140）days respectively. 24 cases developed acute GVHD（aGVHD）, the incidence rate of grade Ⅱ to Ⅳ aGVHD was 30.4%. The chronic GVHD（cGVHD）was occured in 7 patients of the 49 evaluable patients, all were limited. The estimated 3-year overall survival（OS）and disease-free survival （DFS）were（60.3±6.4）% and（60.1±6.5）% respectively. And the cumulative incidences of 3-year nonrelapse mortality（NRM）and relapse were 33.3% and 9.1% respectively. The 3- year OS rates of AML patients were（66.0 ± 6.7）% for CR and（25.0 ± 15.3）% for NR, differences were statistical significance.</p><p><b>CONCLUSION</b>For AML patients, UCBT was conducive to improve outcome with lower incidences of cGVHD and relapse, the patients after transplantation could obtain high quality of life.</p>

Impacts of ABO incompatibility on early outcome after single unit unrelated cord blood transplantation: a retrospective single center experience / 中华血液学杂志

<p><b>OBJECTIVE</b>To retrospectively study the impacts of ABO incompatibility on early outcome after single unit unrelated cord blood transplantation（UCBT）, such as cumulative incidence of engraftment, incidence of acute graft- versus- host disease （aGVHD） and 180- day transplant- related mortality（TRM）.</p><p><b>METHODS</b>208 patients underwent single unit UCBT from April 2008 to October 2014 were analyzed, included 99 ABO- identical, 60 minor, 38 major and 11 bidirectional ABO- incompatible recipients. All the patients received intensified myeloablative conditioning, and a combination of cyclosporine A and mycophenolate mofetil was given for GVHD prophylaxis.</p><p><b>RESULTS</b>Cumulative incidences of neutrophil engraftment, platelet recovery, erythroid lineage reconstitution, Ⅱ-Ⅳ aGVHD, Ⅲ-Ⅳ aGVHD and 180- day TRM showed no significant difference among the patients receiving ABOidentical, minor, major, and bidirectional UCBT（all P>0.05, respectively）. What's more, none of the patients developed pure red- cell aplasia（PRCA）after UCBT. Group A donor and a group O recipient patients didn't appeared to influence the clinical results when compared with others（all P>0.05, respectively）.</p><p><b>CONCLUSION</b>Patients receive ABO- incompatible UCBT may not develop PRCA. The presence of ABO- incompatibility did not influence the hematopoietic reconstitution, the incidence of aGVHD and 180-day TRM in this cohort. There is not support for the need to regard ABO-compatibility as an UCB-graft selection criterion.</p>

The impact of HLA matching on outcome of single unit unrelated cord blood transplantation: a retrospective single center clinical analysis / 中华血液学杂志

<p><b>OBJECTIVE</b>To retrospectively study the impact of human leukocyte antigen (HLA) mtyping mismatching between donor and recipient on outcome of single unit unrelated cord blood transplantation (sUCBT).</p><p><b>METHODS</b>139 patients with hematological malignancies received sUCBT in single center from May 2008 to August 2012 were analyzed. Of 139 patients at enrollment, 22 were 0 mismatched (mm), 69 1 mm, 48 2 mm by low-resolution HLA-A, -B, and high-resolution (HR) DRB1. All patients'conditioning regimen was myeloablative, and a combination of cyclosporine A (CsA) and mycophenolate mofetil (MMF) was given for graft-versus-host disease (GVHD) prophylaxis for all patients. The cohort of patients were followed-up until December 15, 2013.</p><p><b>RESULTS</b>Patients of 0 mm had a statistically significant higher cumulative incidence of neutrophil engraftment by day 42 than those of 1 and 2 mm (P=0.042 and 0.002, respectively), patients of 0 mm with either a higher prefreeze total nucleated cell (TNC) dose (>5 × 10⁷/kg) or lower dose (<5 × 10⁷/kg) had a statistically significant higher cumulative incidence of neutrophil engraftment by day 42 than those of 2 mm (P=0.01 and 0.02, respectively). Patients of 0 mm had a statistically significant lower cumulative incidence of acute GVHD by day 100 than those of 1 and 2 mm (P=0.006 and 0.001, respectively). The difference of 1-year transplant-related mortality (TRM) between 0 and 2 mm patients was statistically significant (P=0.03). Patients of 2 mm received UCB units with a TNC dose less than 5 × 10⁷/kg had a higher 1-year TRM than of 0 mm patients (P=0.03). Patients of 0 mm had a statistically significant higher 3-year disease free survival (DFS) than those of 2 mm (P=0.03), compared with patients of 2 mm given CB units with a TNC dose less than 5 × 10⁷/kg, 0 mm patients and 1mm patients received UCB units with a TNC dose greater than 4 × 10⁷/kg had higher DFS rates (P=0.02 and 0.02, respectively).</p><p><b>CONCLUSION</b>The HLA typing mismatching between donor and recipient had a great impact on neutrophil engraftment and long term DFS after sUCBT, 2mm cord blood unit with less TNC (<5 × 10⁷/kg) was not an optimum UCB graft.</p>

A clinical observation of simethicone, mosapride combined with flupentixol-meiltracen for treatment of patients with functional dyspepsia / 中国基层医药

ObjectiveTo observe the efficacy of simethicone, mosapride combined with flupentixol-meiltracen in the treatment for functional dyspepsia(FD). MethodsThe diagnosis of functional dyspepsia patients treated according to Zung Self-rating Anxiety Scale (SAS) ＞ 40, Hamilton Depression Scale(HAMD) ＞ 17 for inclusion criteria,a total of 64 patients were selected and randomly divided into two groups. The treatment group( simethicone,mosapride combined with flupeentixol-meiltracen) in 33 cases and the control group ( single flupenthixol melitracen) in 31cases. 2 groups of the period of treatment was 4 weeks. Evaluation before and after treatment with mood disorder scale score changes and syndrome efficacy and adverse reactions. ResultsThe treatment group after treatment, regardless of scale score change of mood disorders, syndrome treatment efficacy were significantly better than the control group,especially in the syndrome efficacy difference was significant( P ＜0.05 ,P ＜0.01 ) ;after the treatment without obvious adverse reaction. ConclusionThe simethicone, mosapride combined with flupentixol-meiltracen treatment with anxiety and depression in patients with functional dyspepsia could effectively relieve the symptoms of functional dyspepsia,and relieve the patient's psychological disorder;certainly result in fewer adverse reactions.

The clinical effects of tumor necrosis factor-α antagonist combined with glucocorticoid in patients with ulcera tive colitis / 中国基层医药

Objective To explore the effect of tumor necrosis factor-α antagonist (Remicade) on the patients with active moderate to severe ulcerative colitis (UC) who failed to response to mesalazine or sulfasalazine Sah'cyloyl treatment for six months period.Methods The patients were collected in our hospital,who diagnosed by colonoscopy as moderate to severe ulcerative colitis and failed to response to mesalazine or sulfasalazine Salicyloyl treatment for six months period;These patients were randomly divided into control group(22 cases) and treatment group(28 cases) ;glucocorticoid was used alone in control group while it was combined with Remicade in treatment group.After treatment for six months,they were suffered from colonoscopy and clinical evaluation.Results There were significant differences between control and treatment group of the recover rate concerning the clinic symptoms such as abdominal pain,diarrhea,and mucous bloody stool.There were 7 cases complete remission,13 cases effective outcome and 9 cases ineffective,with complete remission rate of 31.67% .efficiency rate 59.09% in control group.There are 17 cases complete remission,25 cases effective outcome and 3 cases ineffective,with complete remission rate of 60.71% ,efficiency rate 89.28% in treatment group.There was significant difference (P<0.05) between two groups of complete remission rate and efficiency rate.There were 3 cases recurring in control group,with the recurrence rate of 13.67% ,while there were 2 cases recurring in treatment group with the recurrence rate of 7.14%.There was significant dif-ferene( P<0.05) between two groups with regards to recurrence rate;Besides,there were no significant adverse effect.Conclusion The combination with Remicade and glucocorticoids in the treatment of refractory severe ulcerative colitis was more effective and can also reduce the relapse rate.

Detection of Metallo-?-lactamases Produced by Multi-drug Resistant Acinetobacter baumannii / 中华医院感染学杂志

OBJECTIVE To investigate antimicrobial resistance of Acinetobacter baumannii and detect metallo-?-lactamases (MBLs) in clinical isolates from ICU. METHODS Forty-two strains of A. baumannii were isolated from sputum samples between Jul 2005 and Mar 2007 in Affiliated Hospital of North Sichuan Medical College. Bacteria identification and antimicrobial susceptibility test were performed by VITEK-32 system and K-B disk method. Meanwhile,MBLs were detected by Etest. RESULTS Cefoperazone/sulbactam with low resistance accounted for 2.4%. The resistance to imipenem was 66.7%. The resistance to other antibiotics ranged from 69.4% to 100%. Nine MBLs-producing strains were detected by Etest. CONCLUSIONS Metallo-?-lactamases produced by A. baumannii are one of important mechanisms which caused resistance to imipenem. Cefoperazone/sulbactam and polymyxin can be chosen to treat resistant A. baumannii.