Current status of diagnosis and treatment of chronic lymphocytic leukemia in China: A national multicenter survey research / 中华血液学杂志

Objective: To understand the current status of diagnosis and treatment of chronic lymphocytic leukemia (CLL) /small lymphocytic lymphoma (SLL) among hematologists, oncologists, and lymphoma physicians from hospitals of different levels in China. Methods: This multicenter questionnaire survey was conducted from March 2021 to July 2021 and included 1,000 eligible physicians. A combination of face-to-face interviews and online questionnaire surveys was used. A standardized questionnaire regarding the composition of patients treated for CLL/SLL, disease diagnosis and prognosis evaluation, concomitant diseases, organ function evaluation, treatment selection, and Bruton tyrosine kinase (BTK) inhibitor was used. Results: ①The interviewed physicians stated that the proportion of male patients treated for CLL/SLL is higher than that of females, and the age is mainly concentrated in 61-70 years old. ②Most of the interviewed physicians conducted tests, such as bone marrow biopsies and immunohistochemistry, for patient diagnosis, in addition to the blood test. ③Only 13.7% of the interviewed physicians fully grasped the initial treatment indications recommended by the existing guidelines. ④In terms of cognition of high-risk prognostic factors, physicians' knowledge of unmutated immunoglobulin heavy-chain variable and 11q- is far inferior to that of TP53 mutation and complex karyotype, which are two high-risk prognostic factors, and only 17.1% of the interviewed physicians fully mastered CLL International Prognostic Index scoring system. ⑤Among the first-line treatment strategy, BTK inhibitors are used for different types of patients, and physicians have formed a certain understanding that BTK inhibitors should be preferentially used in patients with high-risk factors and elderly patients, but the actual use of BTK inhibitors in different types of patients is not high (31.6%-46.0%). ⑥BTK inhibitors at a reduced dose in actual clinical treatment were used by 69.0% of the physicians, and 66.8% of the physicians had interrupted the BTK inhibitor for >12 days in actual clinical treatment. The use of BTK inhibitors is reduced or interrupted mainly because of adverse reactions, such as atrial fibrillation, severe bone marrow suppression, hemorrhage, and pulmonary infection, as well as patients' payment capacity and effective disease progression control. ⑦Some differences were found in the perceptions and behaviors of hematologists and oncologists regarding the prognostic assessment of CLL/SLL, the choice of treatment options, the clinical use of BTK inhibitors, etc. Conclusion: At present, a gap remains between the diagnosis and treatment of CLL/SLL among Chinese physicians compared with the recommendations in the guidelines regarding the diagnostic criteria, treatment indications, prognosis assessment, accompanying disease assessment, treatment strategy selection, and rational BTK inhibitor use, especially the proportion of dose reduction or BTK inhibitor discontinuation due to high adverse events.

Efficacy and safety of mitoxantrone hydrochloride liposome injection in treatment of peripheral T-cell lymphomas: a multicenter, non-interventional, ambispective cohort, real-world study (MOMENT) / 白血病·淋巴瘤

Objective:To evaluate the efficacy and safety of mitoxantrone hydrochloride liposome injection in the treatment of peripheral T-cell lymphoma (PTCL) in a real-world setting.Methods:This was a real-world ambispective cohort study (MOMENT study) (Chinese clinical trial registry number: ChiCTR2200062067). Clinical data were collected from 198 patients who received mitoxantrone hydrochloride liposome injection as monotherapy or combination therapy at 37 hospitals from January 2022 to January 2023, including 166 patients in the retrospective cohort and 32 patients in the prospective cohort; 10 patients in the treatment-na?ve group and 188 patients in the relapsed/refractory group. Clinical characteristics, efficacy and adverse events were summarized, and the overall survival (OS) and progression-free survival (PFS) were analyzed.Results:All 198 patients were treated with mitoxantrone hydrochloride liposome injection for a median of 3 cycles (range 1-7 cycles); 28 cases were treated with mitoxantrone hydrochloride liposome injection as monotherapy, and 170 cases were treated with the combination regimen. Among 188 relapsed/refractory patients, 45 cases (23.9%) were in complete remission (CR), 82 cases (43.6%) were in partial remission (PR), and 28 cases (14.9%) were in disease stabilization (SD), and 33 cases (17.6%) were in disease progression (PD), with an objective remission rate (ORR) of 67.6% (127/188). Among 10 treatment-na?ve patients, 4 cases (40.0%) were in CR, 5 cases (50.0%) were in PR, and 1 case (10.0%) was in PD, with an ORR of 90.0% (9/10). The median follow-up time was 2.9 months (95% CI 2.4-3.7 months), and the median PFS and OS of patients in relapsed/refractory and treatment-na?ve groups were not reached. In relapsed/refractory patients, the difference in ORR between patients with different number of treatment lines of mitoxantrone hydrochloride liposome injection [ORR of the second-line, the third-line and ≥the forth-line treatment was 74.4% (67/90), 73.9% (34/46) and 50.0% (26/52)] was statistically significant ( P = 0.008). Of the 198 PTCL patients, 182 cases (91.9%) experienced at least 1 time of treatment-related adverse events, and the incidence rate of ≥grade 3 adverse events was 66.7% (132/198), which was mainly characterized by hematologic adverse events. The ≥ grade 3 hematologic adverse events mainly included decreased lymphocyte count, decreased neutrophil count, decreased white blood cell count, and anemia; non-hematologic adverse events were mostly grade 1-2, mainly including pigmentation disorders and upper respiratory tract infection. Conclusions:The use of mitoxantrone hydrochloride liposome injection-containing regimen in the treatment of PTCL has definite efficacy and is well tolerated, and it is a new therapeutic option for PTCL patients.

Clinical treatment analysis of newly treated peripheral T-cell lymphoma / 白血病·淋巴瘤

Objective:To investigate the treatment methods of peripheral T-cell lymphoma (PTCL).Methods:The clinical data of 251 newly treated PTCL patients in the First Hospital of Jilin University from August 2011 to October 2021 were retrospectively analyzed, from which 168 patients were intercepted from February 2015 (the first targeted drug of PTCL, chidamide, was launched in China) to October 2021, among which 20 patients received chemotherapy combined with brentuximab vedotin (BV, BV group), 37 patients received chemotherapy combined with chidamide (chidamide group), and 111 patients received non-targeted therapy (non-targeted therapy group); all patients received ≥2 courses of treatment. Ten patients received autologous peripheral blood hematopoietic stem cell transplantation, with non-transplanted patients in the same period as controls. The clinical efficacy and prognosis of patients with different treatment methods were analyzed. Kaplan-Meier method was used for survival analysis and log-rank test was performed.Results:Of all 251 patients with PTCL, 26.7% (67/251) received targeted therapy in combination with chemotherapy. In the chidamide group, the efficacy could be evaluated in 36 cases, with an overall response rate (ORR) of 91.7% (33/36); in the non-targeted therapy group, the efficacy could be evaluated in 88 cases, with an ORR of 71.6% (63/88); in the BV group, 20 cases were evaluable, with an ORR of 75.0% (15/20). The difference in ORR between the non-targeted therapy group and the chidamide group was statistically significant ( χ2 = 5.89, P = 0.015), and the difference in ORR between the non-targeted therapy group and the BV group was not statistically significant ( χ2 = 0.09, P = 0.759). The 1-year progression-free survival (PFS) rates were 79.9%, 88.2% and 64.2%, and the 1-year overall survival (OS) rates were 85.7%, 89.7% and 70.1% in the chidamide, BV and non-targeted therapy groups, respectively; the PFS and OS in the chidamide and BV groups were better than those in the non-targeted therapy group (all P < 0.05), and the adverse effects were mostly tolerable. Among patients treated with chemotherapy combined with BV, the ORR of patients with CD30 expression rate <60% and ≥60% were 54.5% (6/11) and 100.0% (9/9), and the difference was statistically significant ( P = 0.038). In the 10 hematopoietic stem cell transplanted patients and 50 non-transplanted patients, 1-year PFS rates were 87.5% and 59.5%, 1-year OS rates were 90.0% and 67.1%, and the differences were not statistically significant (both P > 0.05). Conclusions:Chemotherapy-based combination therapy is the main treatment methods for PTCL, and chemotherapy combined with chidamide or BV targeted therapy and hematopoietic stem cell transplantation can improve the long-term survival of PTCL patients.

Characteristics of Epstein-Barr virus-positive diffuse large B-cell lymphoma and the treatment progress in the era of new drugs / 白血病·淋巴瘤

Epstein-Barr virus (EBV) -positive diffuse large B-cell lymphoma, not otherwise specified (DLBCL-NOS), an aggressive B-cell lymphoma associated with chronic EBV infection, is an entity included in 2016 World Health Organization classification of lymphoid neoplasms. EBV-coding RNA (EBER) is expressed in the nucleus of these tumor cells. EBV -positive DLBCL can be mostly found in the elderly who have poor immunochemotherapy effect and short overall survival time, and this poor prognosis is inconsistent with international prognostic index (IPI) stratification. CD30 and programmed death 1/programmed death ligand 1 are expected to be the potential prognostic indicators and therapeutic targets. This paper reviews the relationship between EBV-positive DLBCL-NOS and EBV infection, clinicopathological characteristics, prognostic evaluation factors and treatment in the era of new drugs.

Progress of targeted therapy for primary central nervous system lymphoma / 白血病·淋巴瘤

Primary central nervous system lymphoma (PCNSL) is a rare invasive non-Hodgkin lymphoma. Although high dose methotrexate-based induced chemotherapy regimen has significantly improved prognosis of patients, 30 percent -40 percent of patients still relapse with poor prognosis. With the development of molecular biology, new targeted drugs like cell signaling pathway kinase inhibitors have become new treatment options for PCNSL.

Refractory primary central nervous system lymphoma treated with programmed death-1 monoclonal antibody and Bruton tyrosine kinase inhibitor combined with rituximab: report of 1 case and review of literature / 白血病·淋巴瘤

Objective:To investigate the effect and safety of rituximab, programmed death 1 (PD-1) monoclonal antibody, and Bruton tyrosine kinase (BTK) inhibitor on elderly refractory primary central nervous system lymphoma (PCNSL).Methods:The clinical data of an elderly patient with refractory PCNSL treated with the combination of rituximab, PD-1 monoclonal antibody and BTK inhibitor in the First Hospital of Jilin University in February 2020 were retrospectively analyzed. The relevant literature was reviewed.Results:The patient had primary central nervous system diffuse large B-cell lymphoma (high-risk group), and the Memorial Sloan Kettering Cancer Center (MSKCC) score was 2 (estimated overall survival time was 7 months). Disease progressed after 1 course of treatment. Complete remission was achieved after the therapy of rituximab, PD-1 monoclonal antibody combined with BTK inhibitor. PD-1 monoclonal antibody maintenance therapy was performed and patient was followed up until November 17, 2021. The patient's condition was stable. The second progression-free survival (PFS) time was 20 months, and the overall survival time was 21 months. The patient well tolerated the new drug treatment, and no adverse reactions of grade 3 or above occurred.Conclusions:The new targeted combination therapy can be used as a treatment option for elderly PCNSL patients, which can further improve the curative effect and significantly improve the prognosis.

Mechanisms of new targeted drugs in follicular lymphoma and clinical options / 白血病·淋巴瘤

Follicular lymphoma is the most common indolent lymphoma. At present, it is commonly treated with immunochemotherapy, but the prognosis of patients with progression and relapse is still poor. New targeted drugs include cell surface antibodies, immunomodulators, cell signaling pathway kinase inhibitors, and chimeric antigen receptor T cell therapy and dendritic cell vaccines have greatly extended the survival period of these patients and provided more options for clinical treatment.

Clinical significance of bone marrow immunopathologic detection: analyses of 266 newly diagnosed lymphoma cases / 白血病·淋巴瘤

Objective To investigate the clinical significance of bone marrow immunopathogenesis in the diagnosis and staging of lymphoma. Methods Clinical data of 266 patients with newly diagnosed lymphoma admitted to Department of Hematology in the First Hospital of Jilin University from August 2015 to December 2017 were retrospectively analyzed. The results of lymphoma diagnosis and staging in different bone marrow detection methods were compared, SPSS 22.0 software was used to make statistical analysis and χ2 test was used to compare the positive rates of lymphoma bone marrow infiltration in different methods. Results In the 266 patients, 64 cases (24.1 %) were diagnosed with lymphoma by using bone marrow detection on the condition that no lymph node pathology was available and all the immunophenotypes of 64 cases were identified by bone marrow immunopathology. Bone marrow infiltration was identified in 121 patients (45.5 %), among which the rate of bone marrow infiltration was 0 (0/12) in Hodgkin lymphoma (HL) and 47.6 % (121/254) in non-Hodgkin lymphoma (NHL). The rate of bone marrow infiltration was 50.0 % (105/210) and 36.4 % (16/44) in B type and T type NHL respectively. The positive rate of bone marrow infiltration detected by bone marrow smear, bone marrow biopsy, bone marrow flow cytometry and bone marrow immunopathology were 78.5 % (95/121), 87.6 % (106/121), 89.3 % (108/121), 96.7 % (117/121) respectively. Bone marrow immunopathology was more advantageous than any other methods, and there was a statistical difference (χ2＝18.38, 9.09, 3.76; all P < 0.05). Among 121 patients who were identified with bone marrow infiltration by bone marrow detection, the staging of 42 patients (34.7 %) were amended, including the staging of 39 amended patients (32.2 %) through bone marrow immunopathologic detection. Conclusion Bone marrow immunopathology can be used for the diagnosis and classification of lymphoma, which has an obvious advantage in detecting bone marrow infiltration of lymphoma compared with bone marrow smear, bone marrow biopsy, bone marrow flow cytometry, and it can be used to amend the clinical staging.

Application of 18F-FDG PET-CT in detection and accurate staging of extranodal non-Hodgkin lymphoma / 白血病·淋巴瘤

Objective To investigate the value of 18F-FDG PET-CT in detection and accurate staging of extranodal non-Hodgkin lymphoma (NHL).Methods The results of PET-CT of 94 patients with NHL were retrospectively analyzed.The consistency of checking out lesions and accurate staging by PET-CT were compared with those by other imaging examination in extranodal NHL.Results 432 lesions were checked out by PET-CT, including 319 (73.8 ％) lymphoid tissues and organs with the average SUVmax of 13.4 (3.4-33.4), and 113 (26.2 ％) extranodal lesions with the average SUVmax of 13.5 (3.1-55.0).The detection consistent rate between CT and PET-CT for lymphoid tissues and lymph organ lesions was 95 ％, while the consistent rate of the extranodal lesions was only 54.9 ％.The detection rates of PET-CT for soft tissue, bone and gastrointestinal lesions were higher than those of CT, but the detection rate for the bone marrow lesion was lower than that for the bone marrow cytology.According to the results of PET-CT, the stages of 29 patients (31.0 ％) were re-adjusted, including up-regulated for 75.9 ％ (22/29) because of high detection rates of PET-CT for soft tissue and skeletal lesions, and down-regulated for 24.1％ (7/29) mainly due to the strong resolution capability of PET-CT for detection of non-neoplastic lymph nodes and spleen increasing or effusion.Conclusion 18F-FDG PET-CT can improve the detection rate of NHL extranodal lesions, especially for diffuse non-mass lesions in bone and soft tissues, which facilitates the accurate lymphoma staging.

Clinicopathological features and prognostic analysis of 151 patients with primary extra-nodal non-Hodgkin's lymphoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the epidermiology, clinicopathological features and prognosis of primary extra-nodal non-Hodgkin's lymphoma (PE-NHL).</p><p><b>METHODS</b>The clinicopathological data of 151 patients diagnosed as PE-NHL in the First Affiliated Hospital of Jilin University between January 2007 and December 2011 were reviewed and analyzed.</p><p><b>RESULTS</b>The proportion of PE-NHL patients was 58.8% among all the non-Hodgkin's lymphoma cases, with the average age of 52 years, and the male/female ratio was 1.16:1. The most frequently involved site was the stomach (30.5%) followed by nose and sinuses (19.9%) and Waldeyer's ring (17.2%). The most common subtype was diffuse large B-cell lymphoma (DLBCL) (55.0%), followed by NK/T (18.5%) and extra-nodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) ( 13.2%). The distribution of clinical stages was as follows: stage I 20.5%, II 29.8%, III 29.1%, and IV 20.5%. Most nasal PE-NHL is in early stages, with a proportion of 76.7% in stages I & II. The 3-year overall survival rate was 73.2% and 3-year progression free survival rate was 46.6% in the PE-DLBCL patients. The International Prognosis Index (IPI) could be used to estimate the prognosis of PE-DLBCL well. Multivariate analysis showed that ESR and curative effect of the first treatment were independent prognostic factors for PE-DLBCL patients.</p><p><b>CONCLUSIONS</b>The incidence of PE-NHL is quite high, and the most common primary extra-nodal site is the gastro-intestinal tract and the most common subtype is diffuse large B-cell lymphoma. Risk groups based on IPI can indicate the prognosis of PE-DLBCL to some extent, but only the ESR and curative effect of the first treatment are confirmed to be independent risk factors.</p>

Comparison of clinical-pathological characteristics and prognosis of diffuse large B-cell lymphoma from different origins / 白血病·淋巴瘤

Objective To evaluate the difference between nodal and extra-nodal diffuse large B-cell lymphoma (DLBCL) in clinical-pathological feature and prognosis.Methods The clinical data of 134 cases of DLBCL patients were reviewed and analyzed.Results The DLBCL patients accounted for 52.14 ％ (134/257) of non-Hodgkin lymphoma of the same period and the extra-nodal DLBCL patients accounted for 69.4 ％.The proportion of stage Ⅲ/Ⅳ disease in extra-nodal DLBCL and nodal DLBCL were 55.9 ％ (52/93) and 75.6 ％(31/41),respectively.Elevated LDH was reported in 33.3 ％ (31/93) of extra-nodal DLBCL and 58.5 ％ (24/41)of nodal DLBCL Other clinical characteristics such as B symptoms,bulky disease,elevated ESR,ECOG scores and IPI scores were not significantly different between these two groups (all P ＞ 0.05).No difference in the frequency of GCB and non-GCB subtypes was observed between extra-nodal and nodal DLBCL (P =0.623).The 3-year overall survival rates and 3-year progression free survival rates for extra-nodal and nodal DLBCL were 73.2 ％,55.2 ％ (P =0.065) and 46.3 ％,44.1％ (P =0.748).Conclusions The morbidity of extranodal DLBCL is high.Primary extra-nodal DLBCL patients present early-stage disease and normal LDH more frequently than the nodal DLBCL,while no significant difference in the frequency of pathological subtypes and 3-year OS and PFS is observed between these two groups.

The study on relationship between age and cytogenetic subgroups in 640 patients with de novo acute myeloid leukemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To analyze the cytogenetic characteristics of different age subgroups in patients with acute myeloid leukemia (AML), and to explore the relationship between age and cytogenetics.</p><p><b>METHODS</b>Between January 2004 and December 2011, Bone marrow (BM) samples from 640 patients with de novo AML were analyzed retrospectively. The analyses were performed according to standard culturing and banding techniques, and clonal abnormalities were defined and described according to the International System for Human Cytogenetic Nomenclature (ISCN 2009). The cytogenetic subtypes were performed as normal, balanced, and unbalanced karyotypes. In the last group, the age distribution of complex and monosome karyotypes were further analyzed. The patients were divided into 8 age groups: 0 - 9, 10 - 19, 20 - 29, 30 - 39, 40 - 49, 50 - 59, 60 - 69, and ≥ 70 year old groups.</p><p><b>RESULTS</b>The distribution of normal, balanced, and unbalanced karyotypes showed age specific characteristics. The incidence of normal karyotype increased from 6.67% (0 ∼ 9 year old) to 58.33% (≥ 70) (χ(2) = 20.68, P = 0.001) and balanced karyotype decreased from 73.33% (0 ∼ 9) to 11.11% (≥ 70) (χ(2) = 48.22, P < 0.01). The frequency of unbalanced karyotypes increased from 20.0% (0 ∼ 9) to 30.56% (≥ 70) (χ(2) = 18.963, P = 0.008). The frequency of complex karyotype was 6.67% in 0 - 9 year old group, followed by 0% in 10 - 19 and 20 - 29 year old group, and from 1.72% to 11.11% from 30 - 39 to ≥ 70 year old group (χ(2) = 8.341, P = 0.08). Monosome karyotype was only detected in patients in 30 year old or older groups. Although an increased tendency was observed with ages, there was no significant difference (χ(2) = 4.778, P = 0.311).</p><p><b>CONCLUSION</b>The different age profiles of the cytogenetic subtypes may indicate the different mechanisms of the pathogenesis of AML, which may also offer beneficial information for etiological research of AML.</p>

Clinical analysis of recombinant activated factor VIIa for 18 patients with severe bleeding / 中华血液学杂志

<p><b>OBJECTIVE</b>To find a kind of quick and effective haemostasis to decrease the mortality of severe bleeding.</p><p><b>METHODS</b>18 severe bleeding patients with different cause received recombinant activated factor VIIa (rFVIIa) were analyzed retrospectively.</p><p><b>RESULTS</b>Of total 18 cases with severe bleeding, 13 cases cured, 3 cases were effective, 2 cases ineffective. The total clinical effective rate is 88.89%. After using rFVIIa, the PT, APTT and fibrinogen level of 6 DIC patients returned to normal within 12 hours; 13 patients whose the amount of bleeding can be evaluated stopped bleeding quickly. The fastest onset time was 10 min.</p><p><b>CONCLUSION</b>rFVIIa can stanch severe bleeding for a variety of reasons rapidly and effectively, including coagulopathy, thrombocytopenia, and obstetric hemorrhage. Application of rFVIIa may decrease mortality, when conventional treatment is not valid.</p>

The regional genomic instability induced by 60Co γ-rays in B16 cells transfected by GFP / 中华放射医学与防护杂志

Objective To detect the regional genomic instability of B16 cells treated with 60Co γ-rays by a green fluorescence protein (GFP)-based genomic instability reporting system.Methods Three groups were employed as non-transfection group,vector control group and transfection group.The GFP-marked reporter construct pCMV-EGFP2XhoI for regional genomic instability was successfully transfected into B16 cells using liposome.B16 cells were selected by screening of G418 with a series of concentrations and limiting dilution cultures to yield a single colony.B16 cells with the genomic instability report system were then irradiated by 60Co γ-rays at doses of 0,2 and 4 Gy.The regional genomic instability of B16 cellswas quantified by counting the number of cells with GFP expression.Results B-16 cell strain steadilyexpressing the GFP-based genomic instability reporting system was established successfully.GFP-positiveB16 cells were observed at 1 d after irradiation with 60Co γ-rays at doses of 2 and 4 Gy.Positive correlations between fluorescence intensity and dose and fluorescence intensity and time were also observed.The positive expression rate of GFP followed the increased of dose (F =36.55,36.76,P ＜ 0.05) and time (t =-3.27,-3.16,-4.26,-6.11,-7.17,P ＜ 0.05),and differences between groups were significant.The positive expression rate of GFP increased significantly at 3 d,and maximum expression was observed at 5 d(2.46 ± 0.24 and 3.82 ± 0.35).The level was tending towards stability.Spontaneous GFP expression at a ratio of 1/600 000 was observed in 0 Gy group after 2 weeks of culture.Conclusions The regional genomic instability of B16 cells induced by 60Co γ-rays can be detected using a GFP-labelled genomic instability reporter system.

Pathologic observation on animal model of silicosis / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To explore the pathological changes of pulmonary fibrosis induced by SiO2 in rats and pigs.</p><p><b>METHODS</b>The silicosis models in rats and pigs were established by non-exposure method. The pathologic changes in lung tissues of rats and pigs were observed with HE staining under a light microscopy and under a transmission electron microscopy (TEM), the expression of cytokines was detected by immunohistochemistry.</p><p><b>RESULTS</b>(1) The main pathologic changes of silicosis models in rats and pigs included: in 7 ∼ 15 days after treatment, silica dusts, dust cells, a lot of macrophages, lung epithelial cells, a few neutrophils, macrophage alveolar inflammation and nodules of stage I were found in alveolar space; in 30 ∼ 90 days after treatment, many nodules of stage I-III or IV with lymphocytes infiltration were observed in respiratory bronchioles, alveoli, interlobular septa, the subpleural and around blood vessels and bronchi. (2) The expression levels of CK protein, SP-A protein, CD68, b-FGF, TNF-α, IL-6, TGF-β1, NFKappa/P50, Kappa/P65 and VEGF reduced with exposure time, but still were higher than those of the control. (3) The shed alveolar type I cells, proliferation of alveolar type II cells or macrophages and activated cellular function induced by silica were observed under TEM.</p><p><b>CONCLUSION</b>The development of pulmonary fibrosis in silicosis models corresponded with the process from macrophages alveolar inflammation to pulmonary fibrosis.</p>

Investigation on heart rate turbulence in patients with decreased left ventricular diastolic function / 中国综合临床

Objective To assess the characteristics of heart rate turbulencer (HRT) in elderly patients with decreased left ventricular diastolie function.Methods 40 patients were divided into two groups:20 patients with enlarged left atrium and 20 patients without enlarged left atrium.20 healthy people were selected as controls. Turbu1ence onset (TO) and turbulence slope (TS) were measured,and correlation was analyzed between TO,TS and the E/A,index of Macruz and heart rate variability (HRV).Results TO was higher (P<0.05) and TS was lower in patients (P<0.01),TO was higber in patients with enlarged left atrium than in with out enlarged lef atrium people (P<0.05) and TS was lower (P<0.01).TO was positively (P<0.01) and TS Was negatively (P<0.05),correlated with the index of Macruz.TO Was negatively (P<0.05) and TS was positively (P<0.05) related to SDNN and SDANN.Conclusion HRT can be used as a potential risk predictor in decreased left ventricular diastolic function patients.