Erythrocytosis after hematopoietic stem cell transplantation: report of 3 cases and literature review / 中华内科杂志

This is a report of three cases of three male patients. One of the patients had myelodysplastic syndrome, and two had aplastic anemia; their ages were 28, 32, and 21 years old, respectively. Two patients underwent sibling allogeneic hematopoietic stem cell transplantation, and one underwent haploidentical hematopoietic stem cell transplantation. All the patients showed elevated hemoglobin and hematocrit at 6, 16, and 9 months after transplantation, with normal white blood cells and platelets and no splenomegaly. All causes of secondary polycythemia were ruled out. Bone marrow morphology showed no erythroid hyperplasia. The PCR result for BCR-ABL (P210, P230, P190, and variants) was negative, and there were no mutations at the amino acid site 617 of JAK2, exon 12 of JAK2, exon 9 of CALR, and amino acid site 515 of MPL. All three patients had hypertension. One patient was treated with amlodipine, and the other two patients were treated with angiotensin receptor blockers. The durations of erythrocytosis for these three patients were 6 years and 3 months, 4 years and 7 months, and 5 years and 3 months, respectively through December 2022. There was no tendency for spontaneous remission. Erythrocytosis after hematopoietic stem cell transplantation is a rare complication. Previous reports in the literature suggest that the mechanism of post-transplant erythrocytosis in recipients of allogeneic hematopoietic stem cell transplantation may be different from that of recipients of other transplants.

Clinical characteristics of patients with human adenovirus infection undergoing allogeneic hematopoietic stem cell transplantation / 中华内科杂志

Objective:To investigate the clinical characteristics and prognosis of human adenovirus (HAdV) infection in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:This is a retrospective case series study. Patients who received allo-HSCT and had symptoms of HAdV infection were tested in the Hematology Department at Perking University People′s Hospital from August 2015 to October 2019. Real-time quantitative PCR was used to detect HAdV DNA from 2 728 patients with potential infection. HAdV DNA-positive patients were defined as having HAdV infection. The clinical features of these patients were analyzed, and a case-pair method was used to select patients without HAdV infection as the control group in a 1∶3 ratio. The clinical results of the two groups were compared using Kaplan-Meier and Log-rank testing.Results:A total of 7 119 samples were tested for HAdV, of which 99 samples from 36 patients were positive. Of these patients, 22 developed HAdV viremia, and 24 patients had concurrent infection with another virus. Nineteen patients had fever (53%), 25 had gastrointestinal symptoms (69%), 11 had respiratory symptoms (31%), nine had reduced liver function (25%), and six had nervous system symptoms (17%). Twenty-three patients developed acute graft-versus-host disease of grade 2 or higher. Of all the patients with HAdV infection, nine were treated with cidofovir, seven of whom became HAdV negative and two had invalid treatment. The median follow-up time was 496 (216, 940) d post-HSCT. The overall survival at 5 years post HSCT was 48.4%±9.2% vs. 91.3%±3.5% ( χ2=65.03, P<0.001) in patients with and without HADV, respectively. The non-relapse mortality at 5 years post-HSCT was 40.8%±8.8% vs. 4.0%±2.0% ( χ2=34.17, P<0.001) in patients with and without HADV, respectively. Conclusions:After allo-HSCT, HAdV-infected patients are dominated by gastrointestinal and respiratory symptoms and have an increased risk of combined acute graft-versus-host disease of >2 degrees. Patients with HAdV infection have poor overall survival and high non-relapse mortality.

Recent advances in hippocampal sparing whole brain radiotherapy / 中华放射肿瘤学杂志

Whole brain radiotherapy (WBRT) is the standard radiotherapy regimen of preventive radiation for patients diagnosed with brain metastases and non-small cell lung cancer, which can improve intracranial control and prolong overall survival. However, neurocognitive functions (NCF) decline due to impaired hippocampal might occur thereafter. Recent studies have shown that hippocampal sparing WBRT (HS-WBRT) is capable of protecting neurocognitive function and improving quality of life (QOL). In this review, the authors described the methods and significance of hippocampal sparing, summarized the research progress on clinical trials related to HS-WBRT in combination with the development of radiotherapy technology and experimental drugs, and discussed the existing controversies and problems, aiming to provide reference for clinical work.

Second unmanipulated allogeneic transplantation could be used as a salvage option for patients with relapsed acute leukemia post-chemotherapy plus modified donor lymphocyte infusion / 医学前沿

Relapse is the main problem after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The outcome of a second allo-HSCT (HSCT2) for relapse post-HSCT has shown promising results in some previous studies. However, little is known about the efficacy of HSCT2 in patients with relapsed/refractory acute leukemia (AL) post-chemotherapy plus modified donor lymphocyte infusion (post-Chemo + m-DLI) after the first allo-HSCT (HSCT1). Therefore, we retrospectively analyzed the efficacy of HSCT2 in 28 patients with relapsed/refractory AL post-Chemo + m-DLI in our center. With a median follow-up of 918 (457-1732) days, 26 patients (92.9%) achieved complete remission, and 2 patients exhibited persistent disease. The probabilities of overall survival (OS) and disease-free survival (DFS) 1 year after HSCT2 were 25.0% and 21.4%, respectively. The cumulative incidences of nonrelapse mortality on day 100 and at 1 year post-HSCT2 were 7.1% ± 4.9% and 25.0% ± 8.4%. The cumulative incidences of relapse were 50.0% ± 9.8% and 53.5% ± 9.9% at 1 and 2 years post-HSCT2, respectively. Risk stratification prior to HSCT1 and percentage of blasts before HSCT2 were independent risk factors for OS post-HSCT2, and relapse within 6 months post-HSCT1 was an independent risk factor for DFS and relapse post-HSCT2. Our findings suggest that HSCT2 could be a salvage option for patients with relapsed AL post-Chemo + m-DLI.

Role of 11β-hydroxysteroid dehydrogenase 1 in metabolic diseases: the latest progress / 中华老年医学杂志

The 11β-hydroxysteroid dehydrogenase type 1(11β-HSD1)is the only enzyme in the body, which can convert inactive cortisone(11-dehydrocorticosterone in rodents)to active cortisol(corticosterone in rodents)in vivo.And it is vital for regulating the level of active glucocorticoids in local tissues.It has been implicated that glucocorticoid dysregulations are closely related to various metabolic diseases, such as obesity and type 2 diabetes mellitus(T2DM), etc.Therefore 11β-HSD1 may be a potential target for the treatment of metabolic diseases.In this review, we summarize the biological function and tissue distribution of 11β-HSD1, discuss how 11β-HSD1 participates in physiological and pathological mechanisms of obesity, T2DM, non-alcoholic fatty liver disease, hypertension and sarcopenia, and sum up the advanced developments of 11β-HSD1 inhibitors.

The effect of donor cytomegalovirus serological status on the outcome of allogeneic stem cell transplantation / 中华内科杂志

Objective:Donor cytomegalovirus (CMV) serological negative status may have an adverse effect on the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT), while there is inadequate data for Chinese people. This study is to explore the impact of donor CMV serological status on the outcome of CMV seropositive patients receiving allo-HSCT.Methods:Our study retrospectively analyzed 16 CMV seropositive patients with hematological malignancies receiving allogeneic grafts from CMV seronegative donors (antibody IgG negative) at Peking University People′s Hospital from March 2013 to March 2020, which was defined as D -/R + group. The other 64 CMV seropositive patients receiving grafts from CMV seropositive donors at the same period of time were selected as matched controls through a propensity score with 1∶4 depending on age, disease state and donor-recipient relationship (D +/R + group). Results:Patients in D -/R + group developed CMV DNAemia later than patients in the D +/R + group (+37 days vs. +31 days after allo-HSCT, P=0.011), but the duration of CMV DNAemia in D -/R + group was longer than that of D +/R + group (99 days vs. 34 days, P=0.012). The rate of CMV reactivation 4 times or more in D -/R + group was 4/16, significantly higher than that of D +/R + group (4.7%, 3/64, P=0.01). The incidences of refractory CMV DNAemia (14/16 vs. 56.3%, P=0.021) and CMV disease (4/16 vs. 4.7%, P=0.01) in D -/R + group were both higher than those in D +/R + group. In addition, the application of CMV-CTL as the second-line antiviral treatment in D -/R + group was more than that in D +/R + group. Univariate analysis and multivariate analysis suggested that CMV serological negativity is an independent risk factor for refractory CMV DNAemia and the duration of CMV infection. The cumulative incidence of aGVHDⅡ-Ⅳ, cGVHD, 3-year probability of NRM, overall survival, and the cumulative incidence of relapse were all comparable in two groups. Conclusions:Although there is no significant effect on OS and NRM, the incidence of refractory CMV DNAemia, the frequency of virus reactivation, and the development of CMV disease in D -/R + group are higher than those in controls. Therefore, CMV seropositive donors are preferred for CMV seropositive patients.

Correlation between airway remodeling and lung function in adult-onset eosinophilic asthma / 西安交通大学学报(医学版)

【Objective】 To investigate the airway parameters of adult-onset eosinophilic asthma （EA） and analyze the correlation between airway remodeling and lung function by quantitative CT. 【Methods】 From March 2015 to November 2016， totally 94 subjects from the “FACT-Digital Lung” Multi-research Center were divided into three groups： 30 normal subjects， 33 EA patients and 31 non-eosinophilic asthma （NEA） patients. We measured and recorded the bronchial parameters of RB1， LB1+2， RB10， and LB10， and small airway disease parameters. The indicators for quantitative evaluation of bronchial parameters include lumen area （LA）， wall thickness （WT）， wall area （WA）， and wall area percentage （WA%）. The parameters for the quantitative assessment of small airway disease included the percentage of inspiratory voxels below -950HU （IN-950）， the mean lung density （MLDin）， and the whole volume of the lung in inspiration （Vin）. Pearson or Spearman rank correlation analysis was used to evaluate the correlation between these parameters and lung function. 【Results】 The differences in LA/BSA， WT/√BSA， and WA/BSA between the three groups were statistically significant （P<0.05）. FEV1% had a significant correlation with IN-950 and MLDin （P<0.01）. FEV1/FVC had a significant correlation with Vin， IN-950， and MLDin （P<0.01）. EOS counts were positively related to IN-950 （r=0.343， P=0.011）， while EOS had a negative correlation with FEV1% （r=－0.343， P=0.015）. 【Conclusion】 With the increase of eosinophils counts in peripheral blood， the airway's stenosis in asthma patients gradually increased， and the extent of airflow limitation steadily increased. The IN-950 may be a sensitive imaging biomarker for evaluating the small airway disease in adult-onset eosinophilic asthma patients.

Differential expression of miRNAs during white adipose tissue browning induced by different methods and its potential regulatory mechanisms / 中华老年医学杂志

Objective:To investigate the differential expression of miRNAs during white adipose tissue(WAT)browning in mice under different stimulation conditions, and to analyze the potential regulatory mechanisms.Methods:Mouse models of subcutaneous WAT(sWAT)browning were established by different methods: cold-induced browning and intraperitoneal injection of CL316-243.HE staining and analysis of thermogenesis-related gene expression were used to validate the browning models.miRNAs expression profiles in different conditions were described by RNA-sequencing(RNA-seq)and miRNAs with similar expression patterns in the two groups were detected via screening.Target genes of miRNAs were predicted by bioinformatics, and their expression levels were verified by quantitative real-time PCR(qRT-PCR).Results:Both cold-induced browning and intraperitoneal injection of CL316-243 were able to activate the browning of sWAT, and the miRNA expression profile of sWAT showed significant differences before and after induction.After screening differentially expressed miRNAs, the expression of Mir-30E-3p was increased and the expression of Mir-181A-5p was decreased under different browning-inducing conditions in WAT.The prediction and validation of target genes revealed that cyclin-dependent kinase 6(Cdk6)and sirtuin 1(Sirt1)were potential targets regulated by miR-30e-3p and miR-181a-5p in the browning of sWAT, respectively.Conclusions:There are significant differences in miRNA expression during the browning of sWAT in mice induced by cold stimulation and CL316-243 injection.MiR-30e-3p and miR-181a-5p may be involved in the regulation of the sWAT browning process through target genes Cdk6 and Sirt1, respectively.

Correlation between anti-human leukocyte antigen antibodies and the outcomes of matched sibling donor transplantation in patients with hematological diseases / 白血病·淋巴瘤

Objective:To explore the relationship between anti-human leukocyte antigen (HLA) antibodies and transplant outcomes in patients with hematological diseases who underwent matched sibling donor transplantation (MSDT).Methods:A retrospective analysis was conducted in 168 patients with hematological diseases who received MSDT in Peking University People's Hospital from March 2015 to November 2017. All patients received detection of anti-HLA antibodies before transplantation, and the correlation between anti-HLA antibodies and transplant outcomes such as hematopoietic cells implantation, blood product transfusion and prognosis after transplantation were analyzed.Results:Among the 168 patients, 28 (16.7%) were positive for anti-HLA class Ⅰ or class Ⅱ antibodies, and 14 (8.3%) were positive for both anti-HLA class Ⅰ and class Ⅱ antibodies. All patients received neutrophil engraftment, 164 patients (97.9%) received platelet engraftment. Univariate analysis showed that there were no effects of anti-HLA antibodies on neutrophil engraftment and engraftment time, platelet engraftment and engraftment time, the volume of red cell transfusion, the volume of platelet transfusion, overall survival (OS) rate, disease free survival (DFS) rate and transplant-related mortality (TRM) in patients with hematological diseases underwent MSDT (all P > 0.05). Multivariate analysis showed that platelet engraftment was associated with better OS ( HR=0.065, 95% CI 0.017-0.252, P < 0.01), better DFS ( HR=0.083, 95% CI 0.024-0.289, P < 0.01) and lower TRM ( HR=0.094, 95% CI 0.014-0.626, P=0.015). Conclusion:Anti-HLA antibodies have no effect on transplant outcomes of patients with hematological diseases who have received MSDT.

Non-coding RNA promoting the browning of white adipose tissue: Research progression and a current perspective / 中华老年医学杂志

White fat with lipids storage in the body can be stimulated by physiological or medical conditions to have the brown fat-like functions of an increased heat production and a high-energy consumption,becoming a beige fat.The browning of white fat can be used as a potential target for the treatment of diseases such as obesity and metabolic syndrome.There are many factors,such as non-coding RNA (ncRNA),can promote the browning of white fat,with the resulting energy metabolism homeostasis of brown fat function.This paper reviews recent advances on the study of ncRNAs promoting the browning of white fat.

Clinic observation of bone metastasis treated with apatinib combined with radiotherapy / 国际肿瘤学杂志

Objective To evaluate the clinical efficacy and safety of apatinib combined with radiotherapy in patients with bone metastasis.Methods Thirty-one patients admitted to Radiation Oncology of the First Affiliated Hospital of Anhui Medical University with bone metastasis were recruited from April 2016 to February 2017.All patients were received apatinib 500 mg/d orally combined with radiotherapy (30 ～40 Gy/10 ～20 F).until disease progression or intolerable toxicity occurred.Clinical efficacy and safety were observed.Results The total response rate was 93.55％ (29/31),25.81％ (8/31) had complete response,58.06％ (18/31) had moderate response,9.68％ (3/31) had mild response,and 6.45％ (2/31) had no response;The time to exert its effect after the treatment was 6 days,and its median maintenance time was 7 months.The lesions complete response was 3.23％ (1/31),partial response was 51.61％ (16/31),became stable in 13 patients (41.94％),and deteriorated in 1 patient (3.23％),and the total control rate was 96.78％.The patients Karnofsky score increased obviously after the treatment (83.71 ± 5.77 vs.78.87 ± 7.49),and the difference was statistically significant (t =4.23,P =0.006).The median local progression-free survival and median overall survival were 6 months and 7 months,respectively.The main adverse reactions were hypertension,hand-foot syndrome,proteinuria and bone marrow depression.The rates of hypertension,hand-foot syndrome,proteinttria and bone marrow depression were 35.48％ (11/31),25.81％ (8/31),16.13％ (5/31),and 16.13％ (5/31),respectively.Conclusion Radiotherapy combined with apatinib is effective and tolerable for bone metastasis patients.

Clinical characteristics in patients with acute coronary syndrome and analysis of prognostic factors / 重庆医学

Objective To study the clinical characteristics in the patients with different types of acute coronary syndrome(ACS) undergoing percutaneous coronary intervention (PCI) and the factors affecting the PCI treatment.Methods A total of 377 inpatients with ACS undergoing PCI in this hospital from January 2014 to March 2015 were selected,including 172 cases of ST-elevation acute coronary syndrome (ST-ACS) group and 205 cases of non-ST-elevation ACS (NST-ACS group).The baseline data and detection indexes were collected,the GRACE score on admission was calculated,the database was established,regular follow-up was performed,and the prognosis was analyzed.Results The smoking history,emergency PCI,coronary angi-ography TIMI grade ≤ 1,H MGB1,GRACE score,heart rate on admission,white blood cell(WBC) count,neutrophil ratio,lymphocyte ratio,monocytes ratio,absolute neutrophil count,high density lipoprotein,apolipoprotein b,number of lesion vessels and left ventricular ejection fraction had statistical differences between the ST-ACS group and NST-ACS group (P ＜ 0.05);the correlation analysis showed that HMGB1 and GRACE score were significantly correlated (r=0.836,P＜0.01).The 2-year follow-up results showed that the previous myocardialinfarction and PCI history,Killip grade(Ⅱ-Ⅳ),coronary angiography TIMI grade≤ 1,HMGB1,GRACE score,mean platelet volume,age and number of lesion vessels had differences between the end point event occurrence group and end point event non-occurrence group (P＜0.05).The Logistic regression analysis showed that HMGB1,GRACE score,age,previous PCI histoty,Killip grade (Ⅱ-IV) were the independent risk factors for cardiovascular events (P ＜ 0.05).The Cox survival analysis showed that HMGB1,previous PCI history,Killip grade (Ⅱ-Ⅳ) were the independent risk factors for cardiovascular events (P＜0.05).The ROC survival curve showed that the accuracy of HMGB1 was good,the areas under the curve was 0.844 (95％CI:0.803-0.885,P＜0.05),the critical value predicting the end point events was 480.44 ng/mL.Conclusion HMGB1 has difference between the ST-ACS group and NST-ACS group,and has a good correlation with GRACE score.

Fenofibrate ameliorates insulin resistance in lipoprotein lipase heterozygous knockout mice and its possible mechanisms / 中华内分泌代谢杂志

Objective To investigate the effect of fenofibrate on glucolipid metabolism and insulin sensitivity in lipoprotein lipase heterozygous knockout ( LPL+/-) mice, and to explore its mechanism. Methods LPL+/- mice and wild type ( WT) C57 mice were selected and divided into 3 groups ( n=6 each group):LPL+/-( FB) group, LPL+/-(W)group,andWTgroup.MiceinLPL+/-(FB)groupweregavagedwithfenofibrate(50mg·kg-1·d-1)for8 weeks. Mice in LPL+/-( W) and WT groups were orally fed with the same volume water as that in LPL+/-( FB) group for 8 weeks. Body weight was observed. Plasma triglyceride ( TG ) and free fatty acid ( FFA ) were measured. Intraperitoneal glucose tolerance test in 3 groups of mice were performed. The glucose area under the curve ( AUCG) and homeostasis model assessment for insulin resistance index ( HOMA-IR) were calculated. Insulin-stimulated Ser473 Akt phosphorylation in liver and skeletal muscle was measured by Western blot. Reactive oxygen species ( ROS) levels in liver and skeletal muscle were determined by dihydroethidium staining method and superoxide dismutase ( SOD) and catalase ( CAT) mRNA expression levels were detected by real-time PCR. Results Compared with LPL+/-( W) mice, body weight of LPL+/-( FB) mice was lowered, plasma TG and FFA levels were decreased by about 46.0％and 76.5％respectively, and fasting insulin level and HOMA-IR were decreased while there were no significant differences in fasting glucose level and AUCG between two groups. Insulin-stimulated Ser473 Akt phosphorylation levels in liver and skeletal muscle of LPL+/-mice were enhanced by fenofibrate. ROS level in skeletal muscle of LPL+/-( FB) mice was lower than that in LPL+/-( W) mice while there was no significant difference in ROS of liver between two groups. Fenofibrate significantly increased SOD and CAT mRNA expressions in skeletal muscle of LPL+/-mice, but not in liver. Conclusion Fenofibrate reduces body weight, ameliorates lipid metabolism, and improves insulin sensitivity in LPL+/- mice, with reduced oxidative stress.

Role of nicotinic acetylcholine receptors in vascular cognitive impairment / 中华核医学与分子影像杂志

Nicotinic acetylcholine receptors (nAChRs) play an important role in cognitive function.Vascular cognitive impairment (VCI) seriously affects the health and quality of life.Early diagnosis and timely effective intervention of VCI may delay or even prevent the occurrence of dementia.The development of nAChRs agents and molecular imaging,such as PET/CT or PET/MR,may promote research on the early diagnosis and treatment of VCI.This review summarizes the pathogenesis of VCI,the relationship between nAChRs and VCI,the progress on nAChRs receptor imaging,and the treatment of VCI.

Predictive value of posttreatment whole body scan for radiation damage to the salivary glands in patients with differentiated thyroid carcinoma / 中华核医学与分子影像杂志

Objective To evaluate the predictive value of posttreatment whole body scan (RxWBS) for radiation damage to the salivary glands in patients with differentiated thyroid carcinoma (DTC).Methods From April 2015 to June 2015,24 patients (8 males,16 females;age:26-64 years) with DTC,who accepted 131I therapy only one time and underwent Rx-WBS 2-4 d after 131I treatment,were recruited from the First Hospital of China Medical University.All patients had normal salivary glands function on salivary gland scintigraphy (SGS) performed on the day before 131I treatment,and 21 patients underwent SGS again 3 months after 131I treatment.The SGS results and clinical manifestations were used to evaluate the function of salivary glands after 131I therapy.Rx-WBS was analyzed by visual analysis and quantitative analysis (salivary gland to background uptake ratios,SUR).The SUR was compared between patient groups with different function of salivary glands.Mann-Whitney u test was used.Receiver operating characteristic (ROC) curve analysis was used to calculate the sensitivity of SUR for predicting the salivary gland damage.Results The SUR in dysfunctional parotid glands (n =12) was significantly higher than that in other glands with normal function (n=30;3.60(2.55,4.33) vs 2.75(2.33,3.29);z=-2.005,P＜0.05).The SUR was not different between submandibular glands with lower function (n =15) and those with normal function (n=27;z=-0.144,P＞0.05).The SUR of parotid glands (n =32) in patients with parotitis was significantly higher than that in others (n=16;3.16(2.53,4.01) vs 2.49(206,2 81);z=-3.073,P＜0.05).The SUR of submandibular glands (n=28) in patients with sialadenitis was significantly higher than that in others (n=20;4.43(2.67,7.61) vs 2.93(1.92,4.65);z=-2.740,P＜0.05).When 2.97 and 3.66 were selected as cutoff values,the sensitivities of SUR for predicting parotitis and sialadenitis were 59％(19/32) and 64％ (18/ 28),respectively.Conclusion Rx-WBS may play a role in predicting radiation damage to the salivary glands.

The roles of high mobility group box1 and GRACE score in clinical prognosis of acute coronary syndrome patients undergoing selective percutaneous coronary intervention / 实用医学杂志

Objective To investigate the impact of high mobility group box1 and GRACE score on the clinical prognosis of patients with acute coronary syndrome undergoing selective percutaneous coronary intervention. Methods A total of 380 consecutive patients initially diagnosed with acute coronary syndrome undergoing selec-tive PCI between January 2014 and March 2015 were included,with 200 of them assigned into low high mobility group box1(HMGB1<445 ng/mL)and the other 180 patients into high mobility group box1(HMGB1≥445 ng/mL).The baseline characteristics and laboratory indexes were collected on admission,GRACE score were calculat-ed at admission.The difference between the high and low high mobility group box1 were analzyed and the influenc-ing factors of patients with acute coronary syndrome undergoing selective percutaneous coronary intervention were studied. The mean follow-up period was 24 months,and the clinical end points were deaths from various causes and readmission for coronary heart disease. Results There were significantly differences statistically between the groups of high and low high mobility group box1 in clinical diagnosis. lipoprotein associated phospholipase A2, GRACE score,mean platelet volume,red cell distribution width,age,and left ventricular ejection fraction(P <0.05). The correlation analysis showed that HMGB1 was significantly related to lipoprotein associated phospholi-pase A2 and GRACE score,with the correlation coefficents of 0.575,0.836,respectively(P<0.05).COX analy-sis showed that HMGB1,lipoprotein associated phospholipase A2,GRACE score had statistical significance for survival outcomes(P<0.05),and the area under the ROC curve drawn by combining the three was 0.851(95% CI 0.811 ~ 0.891,P < 0.05). Conclusion There was a good correlation between HMGB1 and GRACE score. HMGB1 is a good predictor of clinical outcomes in the patients with acute coronary syndromes undergoing elective PCI treatment.

Outcomes of alternative donor allogeneic hematopoietic stem cell transplantation for Fanconi anemia:a five cases report / 中华内科杂志

Five patients with Fanconi anemia who received hematopoietic cell transplantation were retrospectively analyzed. The conditioning regimens included fludarabine, cyclophosphamide and anti-thymocyte globulin. Two patients received both bone marrow and peripheral blood stem cells as the source of stem cell grafts from haploidentical matched related donors, while the others received peripheral blood stem cells from unrelated donors.All patients tolerated well and reached hematopoietic reconstitution. One patient died of intracranial infection.During follow-up,4 patients survived independent of transfusion with full donor chimerism.

Application of GP-IP teaching model in general practice residency training / 中华全科医师杂志

The unique concept,characteristics and service contents of general practice make its residency training to focus on outpatient teaching.General Practitioner Inquiry-Preceptor (GP-IP) is an outpatient teaching mode developed in the general practice residency training base of our hospital.The GP-IP teaching mode includes four modules:diagnosis and treatment package for medically unexplained physical symptoms,Pendleton and RICE inquiry model,video teaching and problem based learning.

Clinical value of PCR for viral detection of bronchoalveolar lavage fluid in the diagnosis and treatment of pneumonia after allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

Objective@#To analyze the clinical value of real-time PCR for virus detection in the diagnosis and treatment of patients after allo-HSCT who had no infection evidence of pneumonia using routine pathogen detection panel.@*Methods@#The clinical data of 71 episodes with acute lung injury from May 2015 to March 2017 after allo-HSCT in hematology department of Peking University People’s Hospital (PKUPH) were retrospectively analyzed. PCR for virus detection and other routine pathogen detection tests were performed on bronchoalveolar lavage fluid (BALF) samples.@*Results@#Among 71 episodes with acute lung injury, a total of 15 patients were diagnosed as lower respiratory tract disease merely associated with virus (detection rate of 21.13%) , 19 episodes were absent of lower respiratory tract infection. The median time from allo-HSCT to the occurrence of lung injury were 176 (49-1 376) d and 196 (57-457) d respectively (z=-0.191, P=0.864) . There were no statistical differences for baseline characteristics and clinical features between two groups. The 100-day attributable mortalities were 13.3% (2/15) and 26.3% (5/19) (χ2=0.864, P=0.426) . Patients with low-dose steroids treatment had favorable outcome than those with high-dose steroids treatment (the dose of methylprednisolone ≥250 mg/d as standard) [4.2% (1/24) vs 60.0% (6/10) ]. In patients with detectable virus in BALF, 2 patients died with early high-dose steroids treatment, while 11 patients survived with no steroids treatment or late application.@*Conclusions@#Virus infection should be considered in post-HSCT pneumonia patient with negative result using routine pathogen detection panel. Expanding virus detection panel by PCR in BALF could increase diagnostic precision and might be instructive to treatment.

Significance of PCR detection of HHV6 in gastro biopsy on the course of diarrhea in patients with severe diarrhea after allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

Objective@#To investigate the clinical significance of PCR detection of human herpesvirus 6 (HHV6) in gastro biopsy on the course of diarrhea in patients with severe diarrhea after allogeneic hematopoietic stem cell transplantation (HSCT) .@*Methods@#Data from a cohort of 45 HSCT recipients (including age, sex, transplantation conditions, graft-versus-host disease, treatments, clinical signs, outcome, HHV6, and other infections) performed between 2015 and 2016 were collected. Univariate analysis was used to evaluate influences between the different parameters.@*Results@#Of the 45 enrolled recipients, 21 patients (46.7%) presented HHV6 positive in gastro-biopsy during the analyzed period. The incidence of CMV viremia in the positive HHV6 group was comparable with that in the negative HHV6 group. But the incidence of EBV viremia in the positive HHV6 group was significantly higher than in the negative HHV6 group (P=0.028) . 44 out of 45 patients with severe diarrhea were given antiviral treatment with foscarnet and/or ganciclovir, the latter didn’t influence the course of the diarrhea.@*Conclusions@#Positive PCR results in GI tract samples didn’t necessarily reflect reactivation of HHV6. Further studies are needed to define the significance of HHV6 for GI tract symptoms after allo-HSCT.