RESUMO
Objective To investigate the clinical and biological features of patients with mixed﹣phenotype acute leukemia (MPAL). Methods The clinical data of 24 de novo adult patients with MPAL who were admitted to Fujian Medical University Union Hospital from January 2012 to October 2018 were retrospectively analyzed. These patients were diagnosed according to the World Health Organization (WHO) 2016 criteria. The clinical and biological characteristics of the patients were analyzed by morphological and cytochemical staining, immunophenotyping, cytogenetics and molecular biology. Results Of the 24 patients, 16 were male and 8 were female, and the median age of the patients at diagnosis was 27 years old (5-66 years old). The average blasts of bone marrow were (57.41 ±23.20)% . Thirteen cases (54.2% ) were diagnosed as MPAL morphologically, while 5 cases (20.8% ) were diagnosed as acute myeloid leukemia (AML), 5 cases (20.8%) were diagnosed as acute lymphoblastic leukemia (ALL) and 1 case (4.2%) was inconclusive. Eighteen patients (75.0%) co﹣expressed B﹣lymphoid and myeloid markers, while 5 patients (20.8%) with T﹣lymphoid and myeloid markers and 1 patient (4.2%) with B﹣lymphoid and T﹣lymphoid markers, respectively. The positive rate [median (range)] of CD38, HLA﹣DR and CD34 was 90.5% (0.1%-99.7%), 90.1% (1.1%-98.8% ) and 81.3% (0.1%-97.8%), respectively. Eighteen cases underwent chromosome examination, of which 5 cases carried with t(9;22)(q34;q11), 3 cases with t(v;11q23.3), 2 cases with complex karyotypes, and 2 cases with t(9;22)(q34;q11) and complex karyotypes, respectively. Twenty﹣one cases underwent genetic examination, of which 6 cases were positive for BCR﹣ABL, 3 cases were positive for MLL, 1 case was positive for MLL and BCR﹣ABL, 1 case was positive for BCR﹣ABL and TP53, and 1 case was positive for PHF6 and ASXL1 respectively. Of the 24 patients, 7 refused chemotherapy and 17 received induction chemotherapy. Of the patients receiving chemotherapy, 9 cases achieved complete remission (CR), 1 case was partial remission (PR), and 7 cases were not relieved (NR). In 11 patients treated by ALL﹣type induction regimen and 6 patients treated by ALL and AML﹣type induction regimen, 8 cases and 1 case achieved CR, the difference in CR rate was statistically significant (P<0.05). In 6 patients with Philadelphia chromosome (Ph) positive and 11 patients with Ph negative, 1 case and 8 cases achieved CR, the difference in CR rate was statistically significant (P<0.05). The median follow﹣up time was 5.5 months (0-36 months). The 3﹣year overall survival (OS) rate was 17.5% and the median OS time was 6 months. The 3﹣year OS rates in the allogeneic hematopoietic stem cell transplantation and non﹣transplanted groups were 75.2% and 0, respectively, and the median OS time was not reached and 4 months (P< 0.05). Conclusions MPAL is rare, it mostly co﹣expresses lymphoid and myeloid antigens and shows a much higher incidence of CD34, CD38 and HLA﹣DR. MPAL is often associated with Ph positive and complex karyotypes. MPAL has a low remission rate and poor prognosis, and a reasonable and effective treatment plan should be further explored.
RESUMO
Objective To investigate the clinical characteristics and prognostic factors for patients with primary intestinal B-cell lymphoma. Methods The clinical data of 50 patients with primary intestinal B-cell lymphoma in Fujian Medical University Union Hospital from January 2004 to December 2013 were retrospectively analyzed. An analysis was also conducted in their clinical characteristics and related prognostic factors. Results A total of 50 patients included 35 males and 15 females with the median age of 58 years old (16-79 years old). The clinical symptoms were abdominal pain or abdominal distension [70 % (35/50)]. The common origins were small intestine and ileocecus, and the most common pathological type was diffuse large B-cell lymphoma (DLBCL) [54 % (27/50)]. The median survival time of 43 cases was 49.4 months. The 1-year, 3-year and 5-year overall survival (OS) rates were 79.1 %, 72.1 %, 58.1 %, respectively. Univariate analysis indicated that hemoglobin levels, albumin levels, lactic dehydrogenase (LDH), the maximum diameter of mass, international prognostic index (IPI) score, Lugano stage, and Eastern Cooperative Oncology Group (ECOG) score were the affecting factors of OS. Multivariate analysis showed that IPI score ≥ 2 was an independent risk factor for the prognosis of intestinal B-cell lymphoma ( OR＝ 6.766, 95 % CI 1.853-24.702, P＝ 0.004). The efficacy analysis showed that 5-year cumulative OS rate of R-CHOP like treatment group was better than that of CHOP like treatment group (91.7 % vs. 44.7 %, P ＝0.048). Conclusion IPI score can be used as an important indicator for clinical treatment and prognosis evaluation of primary intestinal B-cell lymphoma. Some patients with primary intestinal B-cell lymphoma can benefit from rituximab.
RESUMO
Objective To investigate whether sex,age-of-onset,education and asymmetry affect non-motor symptoms (NMS)in Parkinson disease,and to analyze the relationship between motor symptoms and NMS in Parkinson's disease.Methods The detailed clinical information of 157 patients with idiopathic Parkinson's disease(PD)was recorded and followed up.The data was calculated with SPSS statistic software.Sex had an impact on sleeping disorder (P＜ 0.05).Sleep disorder in female was more prominent.Cognitive disorder was affected by age-of-onset and education duration.The pain and sensory disorder were affected by age-of-onset (P ＜ 0.05).Differences in the effects of asymmetry on NMS were not statistically significant (P＞ 0.05).The higher the scores of postural instability and gait difficulty (PIGD)were,the lower the Mini-Mental State Examination (MMSE)score was(β=-1.837,P =0.004).The higher the tremor score was,the higher the Hamilton Depression Scale(HAMD) score was(β=3.460,P =0.001).The higher the rigidity akinesia score was,the higher the autonomic dysfunction score was(β=0.104,P=0.006).Conclusions The non-motor symptoms of Parkinson's disease are affected by the age,sex and cultural level.Symmetryor-not does not affect Parkinson's disease.Non-motor symptoms and motor symptoms are closely linked.The encountered posture and gait abnormalities of patients should trigger physician alerts to focus on patients' cognitive function.The encountered tremor of patients should trigger physician alerts to focus on their emotional changes.Facing to the patient with rigidity and less moving,physician should alert to the occurrence of autonomic symptoms.
RESUMO
Objective To evaluate the diagnostic value of virtual touch imaging quantification (VTIQ) technique in the differential diagnosis between benign and malignant breast lesions.Methods From September to December 2015, the imaging data of 115 breast lesions in 100 patients confirmed by pathology on conventional ultrasound (2DUS) and VTIQ were retrospectively analyzed. The breast nodules were examined by 2DUS firstly and then the lesions were classified by breast imaging reporting and data system (BI-RADS). The maximum, minimum and average of shear wave velocity (SWV) values were obtained from multiple SWV measurement under the VTIQ speed mode. According to the pathology results, receiver operating characteristic (ROC) curve were plotted to determine the most accurate SWV value and the cut-off value for differential diagnosis. And the diagnosis efficiency was compared between 2DUS and VTIQ.Results There were 38 malignant nodules and 77 benign nodules in 115 breast nodules. BI-RADS grading≥4b level was set as the malignant nodules and grading≤ 4a level as the benign nodules. The SWVmax, SWVmin, and SWVmean on VTIQ of benign and malignant breast nodules were (5.11±1.61) m/s, (2.90±0.86) m/s, (3.73±1.02) m/s, and (7.22±0.94) m/s, (4.33±1.31) m/s, (5.73±1.11) m/s. There were significant differences between malignant and benign breast nodules in SWVmax, SWVmin, and SWVmean on VTIQ (t=-7.442,-7.047,-9.356, allP<0.001). Based on the area under curve of ROC, the SWVmean value in the nodule was the best value in comparison with other SWV values. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of diagnose malignant lesion conducted by 2DUS were 89.5％, 85.7％, 87.0％, 0.63 and 0.84, respectively. The cut-off value of VTIQ mean was 4.34 m/s. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for the diagnosis of malignant lesion conducted by VTIQ were 89.5％, 85.7％, 87.0％, 0.76 and 0.95, respectively. The diagnosis efficiency of VTIQ was better than 2DUS.Conclusion The study proved that the VTIQ SWVmean is the best parameter for differential diagnosis and VTIQ plays an important role in differential diagnosis of breast nodules.
RESUMO
Objective To investigate the efficacy and safety of intravenous itraconazole in different antifungal strategies for hematologic diseases patients with invasive fungal disease. Methods The efficacy and safety of intravenous itraconazole injection in the treatment of 160 hematologic diseases patients with invasive fungal disease, including the related factors were retrospectively analysed. Results The total efficacy rate of itraconazole was 58.12 %(93/160). The response rates in therapy for undefined patients without any evidence of patients, diagnostic-driven therapy for possible IFD patients, targeted therapy for proven IFD patients were 65.82 %(52/79), 53.57 %(30/56) and 44.00 %(11/25), respectively (P=0.054). The incidence rate of itraconazole-related adverse effect was 8.13 % (13/160), and the main adverse reaction was liver impairment. Multiple-factor analysis showed that the efficacy of itraconazole for the treatment of hematologic diseases patients with invasive fungal disease was not associated with age, medical history, agranulocytosis, and initial treatment. Conclusion Itraconazole itraconazole is effective and safe in the treatment of fungal therapy for patients with hematologic diseases.
RESUMO
Objective: To study the effects of propafenone on action potential (AP) of rabbit ventricular myocytes with the tonic block and use-dependent block of transient sodium current (INa-T). Methods: A total of 10 adult New Zealand white rabbits were sacriifced and 10 individual ventricular myocytes were isolated by enzyme digestion method. Microelectrode technologies were used to record AP-related parameters: maximum diastolic potential (MDP), maximum rate of rise of the action potential upstroke (Vmax), action potential amplitude (APA) and action potential duration at 20%, 50% and 90% (APD20, APD50 and APD90).INa-T was measured, I-V curves and peak currents at different frequencies were detected by whole cell patch clamp before and after propafenone perfusion at 10 μmol/L. Results: There was no statistical difference in MDP at before and after propafenone perfusion as (-80 ± 6) mV vs (-82 ± 5) mV,P>0.05. After perfusion, APA was signiifcantly decreased as (95 ± 12) mV vs ( 125 ± 10) mV,P0.05, (16 ± 3) ms vs (12 ± 3) ms,P>0.05 and (86 ± 14) ms vs (85 ± 12) ms,P>0.05. After propafenone perfusion, I-V curve ofINa-T was shifted upward and the peak current was decreased as (3001 ± 383) pA vs (4193 ± 378) pA, P0.05. After perfusion, no significant use-dependent block was observed when stimulated at 0.06 Hz and 1 Hz,P>0.05, while at 2 Hz, 5 Hz and 10 Hz, propafenone perfusion demonstrated signiifcant use-dependent block uponINa-T with the inhibition fractions of (22 ± 11)%, (38 ± 14)% and (52 ± 17)% respectively, those were signiifcantly different from the inhibition fractions at either 0.06 Hz or 1Hz,P<0.05. When the inhibition fractions were compared by each 2 conditions, allP<0.05. Conclusion: Propafenone may slow down the Vmax of AP, reduce APA and without the impact on APD; the effects onINa-T is not only in tonic block, but also more obviously in use-dependent block in isolated ventricular myocytes of New Zealand rabbit. Such inlfuences minimized the impact on QT interval and meanwhile, decreased the incidence of brad arrhythmia.
RESUMO
Objective To investigate the relationship of blood pressure variability(BPV) and heart rate variability(HRV) with prostatic volume (PV) in patients with benign prostatic hyperplasia (BPH).Methods A total of 133 patients admitted to our department between January 2011 to April 2013 were analyzed retrospectively.The patients were divided into BPH group and non-BPH group according to the PV value.The ambulatory blood pressure monitoring was used to measure the blood pressure parameters,including 24-hour systolic blood pressure (SBP),24-hour diastolic blood pressure (DBP),day time systolic blood pressure(DSBP),day time diastolic blood pressure (DDBP),night systolic blood pressure (NSBP),night diastolic blood pressure(NDBP),the standard deviation of DSBP(DSBPSD),DDBPSD,NSBPSD,and NDBPSD.At the same time,heart rate variability was measured by 24 hours Holter monitor.The ambulatory electrocardiogram was used for calculating normal to normal intervals (SDNN),standard deviation of the averages of R-R internals in all 5-minute segments(SDANN),rate mean square of the differences of successive RR intervals(RMSSD),percentage of RR intervals differing ＞50 ms (PNN50％).The differences of the ambulatory blood pressure parameters or heart rate variability were compared between the two groups.Results The levels of 24-hour SBP,DSBP,and DSBP-SD were higher in the BPH group than in the non-BPH group[(126.03±14.66)mmHg (1 mmHg=0.133 kPa) vs.(118.88 ±10.79) mmHg,(126.97±14.46)mmHg vs.(119.94±11.24)mmHg,(12.52±3.85)mmHg vs.(11.04±2.44)mmHg,all P＜0.05].All the parameters of HRV were significantly different between the two groups [(97.22±38.14)mmHg vs.(119.23±36.16)mmHg、(90.11±34.4)mmHg vs.(107.1144.4)mmHg、(19.11±2.76)mmHg vs.(31.96±21.10)mmHg、(2.31±2.87)％ vs.(5.02±4.88)％,all P＜0.05]Conclusions The BPV and HRV are the important influencing factors for PV in BHP patients.
RESUMO
Objective To investigate the correlation between brain natriuretic peptide(BNP)and left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.Methods 128 elderly patients with diabetes mellitus were divided into diabetes without hypertension (n=63)and with hypertension(n=65),and other 62 normal subjects were selected as control group.Plasma BNP levels and indexes of echocardiography,including left ventricular mass index(LVMI),the mitral peak flow velocity during early(E)and late diastole(A),ratio of E/A,average peak velocities at mitral annuluses of six sites in left ventricular wall during early(MEm)and late diastole (MAm),and relative E/MEm were measured in all patients.Results LVMI,E/MEm and the levels of BNP were significantly higher in groups of diabetes without and with hypertension[(91.6 ±17.3)g/m2 and(116.7±20.5)g/m2,(10.3±1.8)and(12.5±1.4),(47.7±29.4)ng/L and(105.7±32.5)ng/L]than in control group[(78.7±19.5)g/m2,(8.9± 1.6)and(20.8±11.63)ng/L,respectively](F=11.54,13.83 and 9.75,all P＜0.05),while MEm in two diabetes groups[(6.8±1.0)and(5.4±0.9)cm/s]were decreased as compared with control group[(8.0± 1.1)cm/s,F=11.26,P＜0.05].The BNP levels were negatively correlated with E/A and MEm(r =-0.42 and -0.51,all P＜0.01),and positively correlated with LVMI and E/MEm(r=0.48 and 0.58,all P＜0.01).Conclusions Left ventricular diastolic function is impaired in diabetes mellitus and more severely impaired in diabetic patients with hypertension.A combination of plasma BNP and echocardiography parameter may be helpful to accurately evaluate left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.
RESUMO
ObjectiveTo assess the left ventricular systolic and diastolic function in patients with type 2 diabetes mellitus(DM) using quantitative tissue velocity imaging(QTVI) ,and to provide reliable evidence for early diagnosis and prevention in diabetic cardiomyopathy.MethodsOne hundred and twenty one type 2 DM patients were divided into two DM 1 groups (61 patients without microangiopathy) and DM2 group (60 patientswith microangiopathy).Fifty normal subjects were enrolled as control group.The index of echocardiography,including the LVEF, FS and mitral peak flow velocity during early and late diastole (E/A) were measured by conventional echocardiography,and the ratio of E/A was calculated.The average peak velocities of six LV wall sites at mitral annuluses during systole, early and late diastole(MEm, MEm, MAm) were measured by QTVI, and the ratio of MEm/MAm was calculated.Results Compared with the normal group, MSm ([7.13 ± 1.42])cm/s vs.([6.49 ± 1.29]cm/s), MEm ([6.22 ± 1.39]cm/s) vs.([4.53 ± 0.94]cm/s) and MEm/MAm ([0.79 ±0.17]vs.[0.59 ± 0.19]) in DM patients were significantly decreased(F = 5.32,8.01 ,4.89 ; Ps ＜0.05).There was no significant differences among three groups in the comparisons of LVEF ([67.45 ±5.47]％),([65.91 ±4.83]％),([68.01 ±6.16]％) and FS([38.84±4.23]％,[37.82±5.43]％),([40.17 ± 4.53]％)(F = 1.89 and 2.46 respectively, P ＞ 0.05) .In addition, E/A of DM2 group (0.71 ±0.21)decreased more dramatically than DM1 and normal (0.91 ± 0.18,1.02 ± 0.24)(F = 4.71, P ＜ 0.05)ConclusionCompared with EF,FS and E/A obtained by conventional echocardiography,QTVI-derived MSm,MEm and MEm/MAm are more sensitive indexes to defect early LV dysfunction.The functional disorder appears early than microangiopathy, and the left ventricular systolic and diastolic function gets worse along with the microangiopathy.
RESUMO
Objective To investigate the clinical values of brain natriuretic peptide (BNP) in combination with TDI in diagnosing left ventricular hypertrophy (LVH) and impaired diastolic function in elderly hypertensive patients. Methods The 140 elderly hypertensive patients were divided into LVH group (n=69) and NLVH group (n=71). Control group consisted of 50 normal subjects. Plasma BNP level and index of echocardiography, including mitral peak flow velocity during early and late diastole (E, A), ratio of E/A, average peak velocities of six LV wall sites at mitral annuluses during early and late diastole (MEm, MAm), ratios of MEm/MAm and E/MEm were measured in all patients. The correlation of plasma BNP level with cardiac ultrasonographic findings was also examined. Results The level of BNP [(61.64±37.18)ng/L, (138. 65±30. 23)ng/L] and the ratio of E/MEm (11.3±1.83, 15.7±1.45) were significantly higher in NLVH group and LVH group than in normal group (P＜0. 05 or P＜0. 01). MEm [(6.32±0. 94)cm/s, (4.29±0. 91)cm/s]and MEm/MAm (0.76±0.19, 0.51±0. 11) were significantly lower in NLVH and LVH group than in normal group (P＜0.05 or P＜0. 01). The BNP level was negatively correlated with E/A, MEm and MEm/MAm (r=- 0. 294, r= 0. 387 and r= 0. 422, all P＜0. 01), and was positively correlated with LVMI and E/MEm (r=0.342, r=0.501, all P＜0.01). Conclusions Left ventricular diastolic function is impaired in elderly hypertension patients regardless of LVH or NLVH.Plasma BNP level in combination with echocardiography parameter is accurate to evaluate the LVHand impaired diastolic function in elderly hypertensive patients.
RESUMO
Objective To prepare and characterize the monoclonal antibodies (McAbs) against recombinant adhesion protein 33 (AP33) of Trichomonas vaginalis. Methods The purified recombinant fusion protein AP33 was used as antigen to immunize BALB/c mice. Sp2/0 myeloma cells were fused with the splenocytes from immunized BALB/c mice. After ELISA screening and 4 times of limited dilution, 5 positive hybridoma cell lines were obtained, and the biological properties of the McAbs were identified by Western blotting. Indirect immunofluorescent antibody test (IFAT) was performed and the inhibition effect of McAbs on the cytoadherence of T.richomonas vaginalis to HeLa cell was assayed. Results Western blotting demonstrated that 5 McAbs, designated as 4A2, 4F11, 4F8, 4E7 and 4H11, specifically combined with the recombinant AP33 of T.vaginalis. The McAbs were IgG1 isotypes. Four of them (4F11, 4F8, 4E7 and 4H11) showed parasite recognition by IFAT. Parasite cytoadherence to a monolayer of HeLa cells was inhibited in vitro with a inhibition rate of 50.08%, 65.03%, 50.70% and 49.08% by the 4 McAbs under a concentration of 200, 200, 400 and 200?g/ml, respectively. Conclusions The prepared McAbs against the recombinant AP33 show a protective inhibition on cytoadherence of Trichomonas vaginalis in vitro.