Risk factors for postoperative pulmonary infection in lung cancer patients: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To systematically evaluate the risk factors for postoperative pulmonary infection in patients with lung cancer (PPILC), and to provide a theoretical reference for clinicians to prevent the occurrence of PPILC. Methods     The databases of CNKI, Wanfang data, VIP, CBM, PubMed, EMbase and The Cochrane Library were searched by computer to collect researches on the risk factors for PPILC. The search period was from 2012 to 2021. Two clinicians independently screened literature and extracted data and assessed studies for risk of bias, cross-checked and agreed. Meta-analysis was performed using RevMan 5.3 software. Results     A total of 25 studies were included, including 20 case-control studies, 1 cohort study, and 4 cross-sectional studies, covering 15 129 patients. Twenty case-control studies and 1 cohort study had Newcastle-Ottawa Scale (NOS) scores≥6 points, and 4 cross-sectional studies had the Agency for Health Care Quality and Research (AHRQ) scale scores≥6 points. The results of meta-analysis showed that the risk factors for PPILC included: (1) 4 patient's own factors: age≥60 years, male, smoking history, smoking index≥400; (2) 7 preoperative factors: suffering from diabetes, chronic heart failure and chronic obstructive pulmonary disease, the ratio of forced expiratory volume in 1 second to forced expiratory volume<70%, the ratio of forced expiratory volume in 1 second to the predicted value, preoperative airway colonization, non-standard use of prophylactic antibiotics before surgery; (3) 3 intraoperative factors: operation time≥3 h, thoracotomy, the number of resected lobe≥2; (4) 3 postoperative factors: postoperative pain, postoperative mechanical ventilation≥12 h, postoperative invasive operation. Large number of preoperative lymphocyte, intraoperative systematic lymph node dissection, TNM stage Ⅰ and Ⅱ, and enhanced recovery after surgery were protective factors for PPILC. Conclusion     The current research evidence shows that multiple factors are associated with the risk of PPILC. However, considering the influence of the quality and quantity of the included literature, the results of this study urgently need to be further verified by more high-quality clinical studies.

Evaluation of the retention effect of nasointestinal canal indwelling in severe neurosurgical patients guided by miniature visualization system / 中国实用护理杂志

Objective:To investigate the feasibility, safety and reasonable operation of nasointestinal canal indwelling guided by miniature system in severe neurosurgery patients, and compare its advantages and disadvantages with traditional blind insertion.Methods:A prospective randomized controlled trial design was used to select 128 critically ill patients in need of enteral nutrition support at the Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from March 2022 to October 2023 by convenient sampling method. They were divided into blind insertion group and visualization group by random number table method, with 64 cases in each group. Nasointestinal canal indwelling was performed in the blind insertion group by traditional blind insertion method, and in the visualization group, nasointestinal canal indwelling was performed by indentations guided by the miniature visualization system. The success rate of initial catheterization, the time of catheterization, complications, changes of vital signs during catheterization and changes of nutritional indexes after catheterization were evaluated in 2 groups.Results:In the blind insertion group, there were 35 males and 29 females, aged (59.44 ± 13.84) years old. In the visualization group, there were 41 males and 23 females, aged (58.28 ± 12.08) years old. The success rate of the first catheter placement in the visual group was 96.8% (62/64), higher than that in the blind group 82.8% (53/64), and the difference was statistically significant ( χ2=6.94, P<0.05). The catheter placement time of the visualization group was (20.08 ± 2.69) min, which was shorter than that of the blind insertion group (38.19 ± 3.79) min, and the difference between the two groups was statistically significant ( t=29.99, P<0.05). There was no significant difference in the incidence of complications, changes of vital signs during catheterization and the changes of nutritional indexes after catheterization between two groups (all P>0.05). Conclusions:Compared with traditional blind nasointestinal canal indwelling, nasointestinal canal indwelling guided by the miniature visualization system can improve the success rate of the first catheterization and shorten the catheterization time. Although there is no difference in the complication rate, changes in vital signs during catheterization and changes in nutritional indexes after catheterization, it is believed that with the continuous development and upgrading of this technology, it will further reflect the advantages of this technology, which is worthy of further clinical trials and application.

Correlation Between Expression of HIF-1α and Prognosis of Arsenic-containing Chinese Herbal Compound in Treatment of Myelodysplastic Syndrome / 中国实验方剂学杂志

ObjectiveMyelodysplastic syndromes （MDS） is a group of clonal hematopoietic stem cell disorders，and this study aims to investigate the expression of hypoxia-inducible factor-1α（HIF-1α） in the bone marrow cells of patients with MDS and its correlation with the clinical features of MDS，the therapeutic efficacy of arsenic-containing Chineseherbal compound，and the survival prognosis. MethodAccording to the inclusion and exclusion criteria，27 MDS patients treated with arsenic-containing Chinese herbal compound in the Department of Hematology，Xiyuan Hospital，China Academy of Chinese Medical Sciences from January 2022 to September 2022 were included，and their bone marrow samples were collected by myelotomy. HIF-1α expression level in bone marrow cells was detected by real-time polymerase chain reaction （PCR） to analyze its correlation with clinical features，and logistic and Cox regression was used to analyze the risk factors affecting the efficacy and prognostic survival of MDS patients. ResultThe HIF-1α mRNA expression level was lower in bone marrow cells of MDS patients than in healthy subjects. HIF-1α was positively correlated with the degree of myelodysplasia（r=0.384，P<0.05） and bone marrow granulocytic system%（G%）（r=0.560，P<0.01）. Logistic regression showed that HIF-1α was a risk factor for the prognosis in the follow-up of the efficacy of treatment（P<0.05）and Cox regression showed that HIF-1α was an independent factor affecting the survival prognosis of MDS patients ［odds ratio（OR）=398.968，95% confidence interval（CI）（1.281，116 858.743），P<0.05］. ConclusionThe level of HIF-1α expression in bone marrow cells of MDS patients was closely related to the degree of clinical myelodysplasia and G%，and HIF-1α was a risk factor for the efficacy for and survival prognosis of MDS patients.

Bushen Jianpi Prescription Regulates Autophagy in Patients with Aplastic Anemia / 中国实验方剂学杂志

ObjectiveTo explore the effects of Bushen Jianpi prescription on the autophagy and phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway in the patients with aplastic anemia （AA）. MethodA total of 30 AA patients admitted to Xiyuan Hospital and 6 healthy donors who were prepared to undergo peripheral blood hematopoietic stem cell transplantation in 304 Hospital from September 2020 to August 2021 were enrolled and assigned into an AA group and a control group. The AA group was treated with Bushen Jianpi prescription combined with cyclosporin A （CsA） and androgen for 3 months. The mononuclear cells from bone marrow in the AA group before and after treatment and the peripheral blood of the control group were collected. Transmission electron microscopy was then employed to detect autophagosomes. Western blotting was employed to determine the protein levels of microtuble-associated protein 1 light chain 3 （LC3）Ⅰ， LC3Ⅱ， mTOR， phosphorylated （p）-mTOR， Akt， p-Akt， PI3K， and p-PI3K， and real-time polymerase chain reaction （PCR） to determine the mRNA levels of LC3， mTOR， Akt， and PI3K. ResultIn the AA group， the treatment was completed in 29 patients， and the total response rate was 51.72% （15/29）. ① The AA group showed lower levels of white blood cell （WBC）， hemoglobin （HGB）， platelet （PLT）， and absolute neutrophil count （ANC） in the peripheral blood （P<0.01） and lower number of intracellular autophagosomes than the control group before treatment. Moreover， the AA group showed lower mRNA level of LC3 （P<0.01） and protein levels of LC3Ⅰ and LC3Ⅱ （P<0.01） and higher mRNA levels of mTOR， Akt， and PI3Kα （P<0.01） and protein levels of Akt， p-Akt， PI3K， p-PI3K， mTOR， and p-mTOR （P<0.01） than the control group. ② In AA group， the levels of HGB and PLT elevated （P<0.05） and the number of intracellular autophagosomes increased after treatment compared with those before treatment. Moreover， the mRNA level of LC3 and the protein levels of LC3Ⅰ and LC3Ⅱ were up-regulated （P<0.01）， the mRNA levels of mTOR， Akt， and PI3Kα （P<0.01） and the protein levels of Akt， p-PI3K （P<0.01）， p-Akt， PI3K， mTOR， p-mTOR （P<0.05） were down-regulated after treatment. ConclusionAA patients show lower autophagy levels， while Bushen Jianpi prescription can effectively improve the autophagy level and down-regulated the expression of PI3K/Akt/mTOR signaling pathway in AA patients.

Analysis of Predictive Factors for Efficacy of Yiqi Yangxue Prescription Combined with Western Medicine in Treatment of Aplastic Anemia in Non-elderly Adults / 中国实验方剂学杂志

ObjectiveTo explore the predictive factors for the efficacy of Yiqi Yangxue prescription combined with western medicine in treating aplastic anemia （AA） in non-elderly adults， so as to provide a reference for predicting the prognosis of this therapy. MethodA retrospective study was conducted with the clinical data of non-elderly adult AA patients who visited 19 hospitals including Xiyuan Hospital of the China Academy of Chinese Medical Sciences from September 2018 to March 2021 and were treated with Yiqi Yangxue Prescription combined with western medicine. According to the efficacy evaluation results at the 6th month of treatment， the patients were assigned into effective and ineffective groups. The two groups were compared in terms of the gender， age， disease classification ［non-severe aplastic anemia （NSAA）/severe aplastic anemia （SAA）］， course of disease， family history， complications， history of drug allergy， baseline blood routine examination ［hemoglobin （HGB）， white blood cell （WBC）， neutrophil （ANC）， platelet （PLT）， and reticulocyte （Ret）］， T lymphocyte subsets， degree of proliferation of nucleated cells in bone marrow， and expression of T-bet and GATA-3. ResultA total of 101 non-elderly adult AA patients were enrolled in this study， including 81 in the effective group and 20 in the ineffective group. The effective group had a higher proportion of the patients without a history of drug allergy than the ineffective group （P<0.05）. The body height， body weight， gender， age， disease classification， course of disease， family history， and complications showed no significant differences between two groups. The effective group had higher levels of ANC and PLT before treatment （P<0.05） and higher proportion of patients with ANC≥1.6×109/L and PLT≥25×109/L （P<0.05， P<0.01） than the ineffective group. The baseline levels of WBC， HGB， and Ret showed no significant statistical differences between two groups. The levels of CD3+HLA-DR+T cells in the effective group before treatment was higher than that in the ineffective group （P<0.05）. The levels of CD3+CD19-T cells， CD4+T cells， CD8+T cells， Th1 cells， Th2 cells， and CD3+CD25+T cells showed no significant statistical differences between two groups before treatment. The proportion of patients with active bone marrow nucleated cells proliferation in the effective group before treatment were significantly higher than that in the ineffective group, while the proportion of patients with reduced or extremely reduced proliferation were significantly lower than that in the ineffective group （P<0.05）. The expression levels of T-bet and GATA-3 genes had no significant differences between two groups before treatment. The multivariate binary logistic regression analysis showed that the ANC level before treatment and history of drug allergy were independent influencing factors for efficacy （P<0.05， P<0.01）， while other indicators were not influencing factors for efficacy. The receiver operating characteristic （ROC） curve was applied to analyze the predictive value of the ANC level before treatment in the treatment of AA in non-elderly adults with Yiqi Yangxue prescription combined with western medicine. The area under the curve was 0.679 （P<0.05）， with the critical value of 1.595×109/L， the sensitivity of 0.42， and the specificity of 0.95. ConclusionThe history of drug allergy， pre-treatment ANC， PLT， CD3+HLA-DR+ T cell levels， and proliferation of nucleated cells in bone marrow before treatment are predictive factors for the efficacy of Yiqi Yangxue prescription combined with western medicine in treating AA in non-elderly adults. This therapy tends to be more effective for the patients with no history of drug allergy， higher ANC and PLT levels before treatment， especially those with ANC≥1.6×109/L， PLT≥25×109/L， and higher CD3+ HLA-DR+T cell levels and the more active proliferation of nucleated cells in bone marrow before treatment.

Association between polarization status of microglia/macrophage in brain tissue and edema around hematoma in patients with acute cerebral hemorrhage / 新乡医学院学报

Objective To explore the correlation between polarization status of microglia/macrophages(MG/MP)in brain tissue and edema around hematoma in patients with acute cerebral hemorrhage.Methods A total of 52 patients with acute intracerebral hemorrhage admitted to Anyang People's Hospital from December 2020 to November 2022 were selected as the research subjects.All patients underwent craniotomy to remove hematoma,and the normal brain tissue in the cortical area that was not invaded by the hematoma and the fragmented brain tissue around the hematoma(brain tissue around the hematoma)on the surgical pathway were obtained.The expression levels of inflammatory factors such as interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),IL-10 and transforming growth factor-β(TGF-β)protein in brain tissue were detected by Western blot.The expression levels of IL-1 β,IL-6,TNF-α,IL-10 and TGF-β mRNA in brain tissue were detected by fluorescence quantitative polymerase chain reaction.The levels of M1-type and M2-type MG/MP in brain tissue was detected by immunofluorescence confocal technique.CT images data of patients before operation were collected and the relative-erihema-tomal edema(r-PHE)was calculated.The patients were divided into high r-PHE group(2.0≤ r-PHE＜2.5)and low r-PHE group(1.5＜r-PHE＜2.0)according to r-PHE.The relative expression of IL-1 β,IL-6,TNF-α,IL-10 and TGF-β mRNA in brain tissue around the hematoma of patients between the high r-PHE group and the low r-PHE group was compared.Results The relative expressions of IL-1 β,IL-6,TNF-α protein and mRNA in brain tissue around the hematoma were significantly higher than those in the normal brain tissues(P＜0.05),but there was no significant difference in the relative expressions of IL-10 and TGF-β protein and mRNA between the brain tissue around the hematoma and the normal brain tissue(P＞0.05).The levels of M1 type and M2 type MG/MP in the brain tissue around the hematoma were significantly higher than those in normal brain tissue(P＜0.05).The relative expressions of IL-1β,IL-6 and TNF-α mRNA in the brain tissue around the hematoma of patients in the high r-PHE group were significantly higher than those in the low r-PHE group(P＜0.05),and there was no significant difference in the relative expressions of TGF-β and IL-10 mRNA in the brain tissue around the hematoma of patients between the two groups(P＞0.05).Conclusion The levels of pro-inflammatory factors and M1-type MG/MP are increased in the brain tissue around the hematoma in patients with acute cerebral hemorrhage,and the degree of polarization of M1-type MG/MP is consistent with the degree of edema around hematoma after cerebral hemorrhage.

Effects of Interaction Between Carbon Nanotubes on Membrane-Wrapped Carbon Nanotubes / 医用生物力学

Objective For the system of two single-walled carbon nanotubes (CNTs) placed in parallel onto a cell membrane, effects of the interaction between carbon nanotubes on wrapping manner of carbon tubes by the membrane were investigated, and the energy-optimized configurations were obtained. Methods A physical model for membrane-wrapped CNTs considering the interaction between two CNTs, and parameters describing the morphology of cell membrane and positions of CNTs were introduced. The Helfrich model based on continuum mechanics was used to calculate the membrane’s bending energy and the Lennard-Jones potential was introduced to describe the interaction between CNTs. Free energy of the system at different distances of NTs was calculated by the look-up table method, and the typical configurations of the membrane-wrapped CNTs was obtained. Results Compared with the case wherein the interaction between CNTs was not considered, the free energy profile of the system significantly changed. Deep well appeared on energy curve, when the distance between CNTs of carbon was 0.3 times of the tube diameter; as the distance between CNTs increased, the energy returned to the case wherein the interaction between CNTs was not considered. Conclusions With introduction of the interaction between CNTs, the wrapping manner of CNTs by the cell membrane changed, and the two CNTs tended to contact during their endocytosis. These results provide theoretical references for understanding and developing novel nanotube-based system for drug delivery.

Association of FAT atypical cadherin 1 with clinicopathological parameters and prognosis in esophageal squamous cell carcinoma / 中华消化外科杂志

Objective:To investigate the association of FAT atypical cadherin 1 (FAT1) with clinicopathological parameters and prognosis in esophageal squamous cell carcinoma (ESCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 124 patients with ESCC who were admitted to Shanxi Cancer Hospital from January 2011 to December 2015 were collected. There were 85 males and 39 females, aged from 40 to 72 years, with a median age of 60 years. The ESCC tissues surgically removed and adjacent tissues specimens were collected to prepare tissue microarray for immunohistochemical staining. The 5 cases of ESCC tissues and adjacent tissues were analyzed by real-time quantitative polymerase chain reaction (qRT-PCR). Observation indicators: (1) the expression of FAT1 protein in ESCC and adjacent tissues; (2) the expression of FAT1 RNA in ESCC and adjacent tissues; (3) the expression of FAT1 protein in ESCC tissues and its association with clinicopathological parameters; (4) follow-up and survival. Follow-up using outpatient examination and telephone interview was conducted to detect survival of patients up to February 13, 2019. The survival time was from surgical date to tumor-related death or endpoint of follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the non parameter rank sum test. The Kaplan-Meier method was used to calculate survival time, and Log-rank test was used for survival analysis. Results:(1) The expression of FAT1 protein in ESCC and adjacent tissues: of 124 specimens, the 107 cases of ESCC tissues and 93 cases of adjacent tissues were finally obtained because of exfoliative tissues. There were 76 cases of ESCC tissues and corresponding adjacent tissues matched. Results of immuno-histochemical staining showed that FAT1 protein was expressed in both ESCC and adjacent tissues and was brown after staining. FAT1 was located in cytomembrane, with high expression of FAT1 as ≥75 and low expression as <75. The relative expression levels of FAT1 protein in ESCC and adjacent tissues were 68±42 and 77±37, showing a significant difference between ESCC and adjacent tissues ( t=2.380, P<0.05). (2) The expression of FAT1 RNA in ESCC and adjacent tissues: results of qRT-PCR showed that the relative expression levels of FAT1 RNA in 5 cases of ESCC and adjacent tissues were 1.6±0.4 and 2.5±0.3, with a significant difference between them ( t=3.560, P<0.05). (3) The expression of FAT1 protein in ESCC tissues and its association with clinicopathological parameters: of the 107 ESCC patients, 58 cases had high expression of FAT1. There were 42 and 16 cases with high expression of FAT1 in 65 non-drinking patients and 42 drinking patients, respectively, showing a significant difference between them ( χ2=7.229, P<0.05). (4) Follow-up and survival: 96 of 107 ESCC patients were followed up for 38.0?94.9 months, with a median follow-up time of 45.9 months. Survival analysis showed that the survival time of patients with high FAT1 expression was 24 months, versus 22 months of patients with low FAT1 expression, indicating no significant difference between them ( χ2=1.773, P>0.05). Results of subgroup analysis showed that the survival time was 24 months and 21 months of female patients with high and low FAT1 expression, 23 months and 22 months of non-smoking patients with high FAT1 expression and low FAT1 expression, 23 months and 21 months of non-drinking patients with high FAT1 expression and low FAT1 expression, respectively, showing significant differences between them ( χ2=8.769, 12.827, 10.724, P<0.05). Conclusions:The expression of FAT1 in ESCC tissues is low. Female, non-smoking and non-drinking ESCC patients with high FAT1 expression have good survival.

Effect of degree of initial deformity of impacted femoral neck fractures under 65 years of age on femoral neck shortening / 中国组织工程研究

BACKGROUND: Non-surgical treatment for impacted femoral neck fractures is a strategy rarely used at present. Hollow screw internal fixation is the main treatment for impacted femoral neck fractures. Studies on impacted femoral neck fractures so far have focused on treatment patterns and risk factors affecting internal fixation failure, but the effect of initial degree of deformity of impacted femoral neck fractures on postoperative femoral neck shortening was not studied. OBJECTIVE: To analyze the relationship between the degree of shortening and initial deformity of impacted femoral neck fractures after hollow screw fixation in patients under 65 years of age and the effect of femoral neck shortening on hip function. METHODS: Fifty-three impacted femoral neck fractures patients with complete medical records were included, and treated with three hollow screws for internal fixation. The patients were followed up for 12-24 months. Hip Harris score was used to evaluate the recovery of function. The posterior inclination angle, valgus angle, and Pauwels angle of the affected femoral head were measured by X-ray examination of pelvis and hip joint before treatment. X-ray films of pelvis were taken at the last follow-up to calculate the percentage of joint-coarsal distance decrease representing the degree of femoral neck shortening. Not less than 30% is significantly shortened (SFNS) and less than 30% is not significantly shortened (NSFNS). The related factors of neck shortening and the effect on hip function were analyzed. RESULTS AND CONCLUSION: (1) All 53 patients healed without adverse events such as femoral head necrosis. Seven cases (13.2%) had obvious neck shortening. (2) Independent-sample t-test found that neck shortening was associated with valgus angle (P=0.000), posterior dip angle (P=0.001) and body mass index (P=0.001). Logistic regression analysis found that valgus angle was a significant predictor of neck shortening (P=0.041). (3) The hip Harris score decreased with the increase of femoral neck shortening. The hip Harris scores were (82.57±5.12) and (94.15±4.03) in the SFNS group and NSFNS group, respectively, with significant difference. (4) It is indicated that the degree of valgus deformity is an independent risk factor for neck shortening in impacted femoral neck fractures, and femoral neck shortening is associated with hip function.

Functional relationship between photosynthetic leaf gas exchange in response to silicon application and water stress mitigation in sugarcane

BACKGROUND: Water stress is one of the serious abiotic stresses that negatively influences the growth, development and production of sugarcane in arid and semi-arid regions. However, silicon (Si) has been applied as an alleviation strategy subjected to environmental stresses. METHODS: In this experiment, Si was applied as soil irrigation in sugarcane plants to understand the mitigation effect of Si against harmful impact of water stress on photosynthetic leaf gas exchange. RESULTS: In the present study we primarily revealed the consequences of low soil moisture content, which affect overall plant performance of sugarcane significantly. Silicon application reduced the adverse effects of water stress by improving the net photosynthetic assimilation rate (Anet) 1.35-18.75%, stomatal conductance to water vapour (gs) 3.26-21.57% and rate of transpiration (E) 1.16-17.83%. The mathematical models developed from the proposed hypothesis explained the functional relationships between photosynthetic responses of Si application and water stress mitigation. CONCLUSIONS: Silicon application showed high ameliorative effects on photosynthetic responses of sugarcane to water stress and could be used for mitigating environmental stresses in other crops, too, in future.

Exploration of silicon functions to integrate with biotic stress tolerance and crop improvement

In the era of climate change, due to increased incidences of a wide range of various environmental stresses, especially biotic and abiotic stresses around the globe, the performance of plants can be affected by these stresses. After oxygen, silicon (Si) is the second most abundant element in the earth's crust. It is not considered as an important element, but can be thought of as a multi-beneficial quasi-essential element for plants. This review on silicon presents an overview of the versatile role of this element in a variety of plants. Plants absorb silicon through roots from the rhizospheric soil in the form of silicic or monosilicic acid. Silicon plays a key metabolic function in living organisms due to its relative abundance in the atmosphere. Plants with higher content of silicon in shoot or root are very few prone to attack by pests, and exhibit increased stress resistance. However, the more remarkable impact of silicon is the decrease in the number of seed intensities/soil-borne and foliar diseases of major plant varieties that are infected by biotrophic, hemi-biotrophic and necrotrophic pathogens. The amelioration in disease symptoms are due to the effect of silicon on a some factors involved in providing host resistance namely, duration of incubation, size, shape and number of lesions. The formation of a mechanical barrier beneath the cuticle and in the cell walls by the polymerization of silicon was first proposed as to how this element decreases plant disease severity. The current understanding of how this element enhances resistance in plants subjected to biotic stress, the exact functions and mechanisms by which it modulates plant biology by potentiating the host defence mechanism needs to be studied using genomics, metabolomics and proteomics. The role of silicon in helping the plants in adaption to biotic stress has been discussed which will help to plan in a systematic way the development of more sustainable agriculture for food security and safety in the future.

Clinical Characteristics and Bone Marrow Histopathology Features in Essential Thrombocythaemia Patients with Different Gene Mutation in China / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical characteristics, laboratorial and bone marrow pathological features of primary thrombocytopenia (ET) patients with different mutations of CALR, JAK2 and MPL genes.@*METHODS@#The chinical data of 120 cases of ET in Jiangsu provincial people's hospital/ The First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2017 were collected and analyzed, including 76 cases with JAK2 gene mutation, 40 cases with CALR gene mutation, 2 cases with MPL gene mutations, 2 cases without gene mutation.@*RESULTS@#Among the ET patients, compared with the JAK2 gene mutation, CALR gene mutation showed statistically significant deareament of white blood cells and hemoglobin (P=0.001, P=0.01) and the male platelets in CALR group showed significant increament (P=0.04). Fourthermore, the average number of megakaryocytes and its cluster numbers in each hight power field of vision showed statistically significant decreament in CALR group as compared with JAK2 group (P=0.001, P=0.001), and thrombotic events in CALR group were signicantly lower than those in JAK2 group (7.5% vs 18.4%) (P=0.03).@*CONCLUSION@#Mutations of CALR, JAK2 have different clinical characteristics and blood pathological changes of Chinese ET patients, and their clinical significance is worth to explore.

Clinicopathologic analysis of 38 male breast cancers / 中国实用外科杂志

OBJECTIVE: To analyze the clinicopathologic characteristics and molecular subtype in male breast cancer(MBC). METHODS: The clinical features, histological features and molecular subtype of 38 cases of male breast cancers admitted from January 2013 to March 2019 in Clinical Pathology Diagnostic Center of Ningbo were analyzed retrospectively. RESULTS: Thirty-eight patients were diagnosed with MBC, accounting for 0.83% of all the breast cancer in the same term. The median age was 68.5(range from 24 to 88). Tumor were located in left side in 20 cases, right side in 18 cases. Twenty-nine cases were diagnosed as invasive ductal carcinoma, two cases of secretory breast cancer, one case of invasive solid papillary carcinoma, two cases of intraductal papillary carcinoma with microinvasive, and four cases of encapsulated papillary carcinoma(two of them with microinvasive). Sixteen patients had lymphatic metastasis when the tumor was diagnosed. Imunohistochemically, ER was positive in 36 cases, while PR was positive in 35 cases.Eighteen cases were Luminal A type, while sixteen were Luminal B type and two cases were basal-like subtype.CONCLUSION: MBC is a rare malignant neoplasm, and most patients are diagnosed older and at advanced clinical stage,what is more, there is more possibility of second non-breast primary cancer. All suggesting that early diagnosis,treatment and more intensive surveillance are important. MBC needs further study.

Genetic characteristics of myelodysplastic syndromes / 白血病·淋巴瘤

Myelodysplastic syndromes (MDS) is a clinical heterogeneous disease characterized by impaired hematopoietic function and morphologic abnormalities of the bone marrow. Genomic studies show that MDS is usually driven by a series of multistep somatic cell genetic processes that affect the core genome. By definition, reproducible MDS drives mutations leading to cloning advantage. In addition, exposure factors, such as cytotoxic chemotherapy or genetic propensity of the reproductive system, could affect the pathogenesis and clinical outcomes of the disease. Combined with the reports in the 59th American Society of Hematology (ASH) Annual Meeting, the article introduces the genetic characteristics of MDS, in order to improve the diagnosis of MDS and the understanding of the pathogenesis of treatment-related MDS as well as the genetic tendency of MDS in the reproductive system.

Treatment strategies of low-risk myelodysplastic syndromes / 白血病·淋巴瘤

The support treatment of low-risk myelodysplastic syndromes (MDS) patients whose revised international prognostic score system (IPSS-R) is defined as 3.5 points remains the main treatment. The erythropoiesis stimulating agent (ESA) is the best choice for patients with del (5q) MDS as long as the endogenous erythropoietin (EPO) level is less than 500 U/L (preferably<200 U/L). The application of EPO for patients with treatment failure or relapsed after transfusion, chooses are immunosuppressant, transforming growth factor beta inhibitors and lenalidomide. Del (5q) syndrome could benefit from lenalidomide, and some patients after discontinuation of treatment still have been stable in peripheral blood. Thrombocytopenia caused serious hemorrhage rarely; thrombopoietin receptor analogs could reduce bleeding and improve the platelet count. These drugs can be used in patients with bone marrow blast counts of < 0.05. If treatment failed or advanced to high-risk MDS or transformed to acute myeloid leukemia, allogeneic hematopoietic stem cell transplantation might be required. Combined with reports in the 59th American Society of Hematology (ASH) Annual Meeting, this article describes the treatment strategies for low-risk MDS.

Analysis on 4 cases of polycythemia vera transforming to acute myeloid leukemia / 重庆医学

Objective To explore the clinical characteristics,diagnosis and treatment of polycythemia vera(PV) transforming to acute myeloid leukemia(AML).Methods The clinical features and process of diagnosis and treatment in 4 cases of PV transforming to AML were analyzed.Results The case 1 had 10 years history of PV,after experiencing PV,had myelofibrosis and transformed to AML at the end stage of natural disease course;the case 2 had 7 years history of PV,orally took hydroxyurea(HU) treatment in recent 2 years and transformed to AML at present,his chromosome karyotype analysis showed 46,XY,del(7)(q31q36),del (18) (q22)[10],which was considered as treatment-related AML;the case 3 and 4 orally took H U for a long time after diagnosing HU,and respectively turned into AML during the pathologic polyemia stage after 6 and 7 years.Conclusion PV can be transformed to AML,the safety of HU in treatment should by paid attention to.

Options for patients with myelodysplastic syndromes after the treatment failure of hypomethylating agent / 白血病·淋巴瘤

The treatment of patients with myelodysplastic syndromes (MDS) has included primarily supportive care (blood transfusions, colony stimulating agents, iron chelation, etc.) and new drugs, including 5-azacytidine, deoxyazacytidine, and lenalidomide. For those who are no longer benefiting from these agents, there is nearly nothing to do with effective therapies. When those drugs are ineffective, what the doctors could do is optimizing the delivery of hypomethylating agents (HMT) by dosing appropriately, sequencing appropriately, and using thoughtful combinations; as well as improving drug formulations (oral formulations and/or novel formulations) and working toward better selection of patients for best upfront mutation-directed therapy. Hopefully, the drug targeting and patient selection for optimal HMT treatment of MDS will be improved. Furthermore, ongoing research is focused on identifying unique agents to rescue MDS patients who have progressed despite HMT. Agents such as rigosertib are now focused on its application in specific MDS populations who might most likely benefit from this therapeutic approach [primary refractory and high-risk international prognostic scoring system (IPSS) patients]. Doctors eagerly await results of single-agent programmed death 1 (PD-1) and its inhibitors, or combination with HMT to the upfront and relapsed MDS setting. For the minority of patients who have specific targetable mutations, the selective agents (IDH1/2) are highly promising. Bone marrow transplantation remains the only offer for cure, but is depressingly unrealistic given the majority of the elderly and frail patients at the time of MDS progression.

Options for patients with myelodysplastic syndromes after the treatment failure of hypomethylating agent / 白血病·淋巴瘤

The treatment of patients with myelodysplastic syndromes (MDS) has included primarily supportive care (blood transfusions, colony stimulating agents, iron chelation, etc.) and new drugs, including 5-azacytidine, deoxyazacytidine, and lenalidomide. For those who are no longer benefiting from these agents, there is nearly nothing to do with effective therapies. When those drugs are ineffective, what the doctors could do is optimizing the delivery of hypomethylating agents (HMT) by dosing appropriately, sequencing appropriately, and using thoughtful combinations; as well as improving drug formulations (oral formulations and/or novel formulations) and working toward better selection of patients for best upfront mutation-directed therapy. Hopefully, the drug targeting and patient selection for optimal HMT treatment of MDS will be improved. Furthermore, ongoing research is focused on identifying unique agents to rescue MDS patients who have progressed despite HMT. Agents such as rigosertib are now focused on its application in specific MDS populations who might most likely benefit from this therapeutic approach [primary refractory and high-risk international prognostic scoring system (IPSS) patients]. Doctors eagerly await results of single-agent programmed death 1 (PD-1) and its inhibitors, or combination with HMT to the upfront and relapsed MDS setting. For the minority of patients who have specific targetable mutations, the selective agents (IDH1/2) are highly promising. Bone marrow transplantation remains the only offer for cure, but is depressingly unrealistic given the majority of the elderly and frail patients at the time of MDS progression.

Study on Safe and Effective Clinical Methods for Arsenic-containing Compound Qinghuang Powder in Treatment of Myelodysplastic Syndrome / 中国中医药信息杂志

Objective To search for application ways for the safe and effective clinical methods of arsenic-containing Compound Qinghuang Powder (Compound QHP) for the treatment of myelodysplastic syndrome (MDS). Methods Totally 200 patients with MDS were included in the study and treated with Compound QHP. After one-month treatment, the 60 patients with the blood arsenic concentrations 0.05). Conclusion In application of Compound QHP, the blood arsenic concentration can be monitored to adjust the daily dose of realgar, thus to increase the effective blood arsenic concentration, and then improving efficacy without increasing the clinical toxicity.

Role of epileptogenicity index in the epileptogenic zone and network localization / 中华神经科杂志

Objective To propose a novel stereo-electroencephalography(SEEG) quantitative measure analyzing ictal high frequency (60-90 Hz) and calculating high frequency epileptogenicity index (HFEI) to localize epileptogenic zone and evaluate epileptogenic network. Methods The clinical presurgical evaluation and SEEG data of 15 patients who were performed SEEG electrodes implantation from April 2015 to March 2016 were analyzed retrospectively. Post-implantation head CT images and 3D MRI data were fused for accurately identifying and locating each electrode contact. Ictal SEEG quantitative measure HFEI was calculated and threshold was set. The epileptogenic network was divided into focal, regional, multiple regional and bilateral ones and the results were compared with the pathological results.Results The epileptogenic network was focal for four patients, regional for four patients, multiple regional for six patients and bilateral for one patient (7/15). In terms of the pathology,two cases with hippocampal sclerosis both showed regional network. In four cases with cerebral malacia, two cases showed multiple regional network and the other two cases showed focal network. In six cases with cortical malformation, three cases showed multiple regional network, the other three cases showed focal, regional and bilateral networks respectively. Conclusions We explored a novel SEEG quantitative measure based on the high frequency power analysis,which is objective and could localize epileptogenic zone and evaluate the epileptic network.