Clinical research of HLA-haploidentical peripheral hematopoietic stem cell transplantation following reduced intensity conditioning regimen with hematological malignancy patients over 50 years old / 中华血液学杂志

Objective: To analyze the efficacy of HLA-haploidentical peripheral hematopoietic stem cell transplantation (haplo-PBSCT) following reduced intensity conditioning (RIC) regimen to treat the patients with hematological malignancies who were older than 50 years old. Methods: Eighteen patients with hematological malignancies over 50 years were enrolled, including 8 male and 10 female patients. The median age of all patients was 52 (range: 50-66) years. Of them, 8 patients had acute myeloid leukemia (AML) , 2 chronic myelocytic leukemia (CML) , 5 myelodysplastic syndrome (MDS) , 2 acute lymphoblastic leukemia (ALL) , and 1 aggressive natural killer cell leukemia (ANKL) . All patients received fludarabine, cytarabine and melphalan with rabbit anti-human thymocyte globulin (FAB+rATG regimen) and transplanted with high dose non-T cell-depleted peripheral hematopoietic stem cells from donors. Enhanced graft versus host disease (GVHD) prophylaxis and infection prevention were administered. Results: Fifteen days after transplantation, 16 patients achieved complete donor chimerism. One of them rejected the donor graft completely at thirty days after transplantation, and the other 2 patients had mixed chimerism 15 days after transplantation and converted to complete recipient chimerism at 30 days after transplantation. The cumulative incidence of acute GVHD (aGVHD) was 61.1% (95%CI49.6%-72.6%) . The incidence of grade Ⅱ-Ⅳ aGVHD was 35.4% (95%CI 21.1%-49.7%) , whereas grade III-IV was 13.8% (95%CI 4.7%-22.9%) . The 2-year cumulative incidence of chronic GVHD (cGVHD) rate was estimated at 38.2% (95%CI 25.5%-50.9%) . Patients were followed-up for a median of 14.5 months (range, 3-44 months) . The Kaplan Meier estimates of 2-year overall survival (OS) and disease-free survival (DFS) was 72.6% (95%CI 60.1%-85.1%) and 63.7% (95%CI 49.2%-78.2%) , respectively. The 2-year cumulative incidence of relapse and non-relapse-mortality (NRM) was 31.2% (95%CI 16.5%-45.9%) and 12.5% (95%CI 4.2%-20.8%) , respectively. Conclusion: RIC-haplo-PBSCT protocol can achieve better results in patients with hematologic malignancies over 50 years old.

Variation analysis on serum uric acid level in hypertention with target organ damage / 上海预防医学

Objective To investigate the changes of the level of serum uric acid ( SUA ) in hypertension patients with target organ damage and its clinical significance. Methods From January 2013 to December 2014,a series of 1320 cases of primary hypertension in our hospital were included as a case group.According to the cases with or without target damage, they were allocated into two groups:organ damaged and organ non-damaged,with 100 healthy cases as control group.The SUC levels deteced were compared between the groups. Results Of the 1320 cases with target organ damage, 1091 cases (82.65%) were found to have level of SUA significantly higher than that in control group (P<0.05);SUA level in organ damaged group was higher than that in non-damaged group ( P<0 .05 );SUA level in cases with 3 or more target organs damage was significantly higher than that in cases with 1 and 2 target organs damage(P<0.05),indicating a significant positive correlation.The age of hypertensive patients,and their SUA TC,TG,LDL-C,BUN,Cr,FBG,LVMI,SBP,DBP(r>0, P<0.05), were positively correlated with SUA, which was significantly negatively correlated with HDL-C (r<0, P<0.05).Multivariate logistic regression analysis showed that the hypertension course(OR=5.669), SBP(OR=4.323),DBP(OR=4.215),LVMI(OR=4.323),SCR(OR=4.215) and target organ damage(OR=7.145) all had remarkable impact with SUA levels in patients ( P <0.05 ) . Conclusion The level of SUA in hypertension is generally elevated and closely related with target organ damage and glucolipid metabolic disorder, and the course of hypertension.

Analysis of the therapeutic efficacy and prognosis for acute myeloid leukemia M2a patients treated by IA and DA regimens / 中国实验血液学杂志

This study was purposed to compare the therapeutic efficacy and prognosis of acute myeloid leukemia M2a (AML-M2a) patients treated by idarubicin (IDA) combined with cytarabine (Ara-C) (IA) and daunorubicin (DNR) combined cytarabine (Ara-C) (DA) regimens. The clinical data of 65 patients with AML-M2a in our hospital were collected from May 2009 to May 2013 and analyzed. The results indicated the complete remission in IA group was slightly higher than that in DA group, there was no statistically significant difference(P > 0.05); leukocyte minimum value in IA group [(0.58 ± 0.40)×10(9)/L] was obviously lower than that in DA group [(0.99 ± 0.67)×10(9)/L] (P < 0.05); neutrophil minimum value in IA group [(0.19 ± 0.09)×10(9)/L] was significantly lower than that in DA group [(0.21 ± 0.16)×10(9)/L] (P < 0.05); the neutropenia duration in IA group (12.59 ± 5.31)d was much longer than that in DA group (9.17 ± 7.04)d (P < 0.05). The median survival time of patients in IA group was 36.67 months, which was obviously longer than that of patients in DA group (21.45 months) (P < 0.05). The lactate dehydrogenase (LDH) value and chemotherapy regimens were the independently risk factor affecting the prognosis of AML-M2a patients. It is concluded that as compared with DA regimen, the IA regimen can prolong the median survival time and has better long-term therapeutic efficacy, thus it can be used as the first chemotherapy regimen for treatment of AML-M2a.

Characterization of patients and its relationship with medical complaints / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patient characteristics may be an internal factor influencing patient complaints, but in China patient characterization is restricted to patient satisfaction surveys, and few studies have considered the relationship between patient characteristics and patient complaints. The aim of this research was to determine the reasons for complaints.</p><p><b>METHODS</b>In this study, we analyzed the characteristics of hospitalized patients and explored their relationship with medical complaints.</p><p><b>RESULTS</b>The significant factors were age (P = 0.045), hospital cost (P = 0.003), household nature (P < 0.001), and education (P < 0.001). The complaint rate decreased when the patients' age increased (regression coefficient, -0.606; OR, 0.545, and 95%CI, 0.301 - 0.987). The complaint rate increased with an increase in hospital cost (regression coefficient, 0.818; OR, 2.266; and 95%CI, 1.320 - 3.889). Patients from non-agricultural households had a higher complaint rate (regression coefficient, 1.051; OR, 2.861; and 95%CI, 1.611 - 5.082). Patients with higher education levels had lower complaint rates (regression coefficient, -0.944; OR, 0.389; and 95%CI, 0.234 - 0.647).</p><p><b>CONCLUSION</b>The survey confirms that older patients and patients with higher education levels had lower complaint rates, while non-agricultural population and patients with higher hospital expenses had higher complaint rates.</p>