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Objective:To investigate the pathogenesis and prognosis of transformation of primary myelofibrosis (PMF) to B-cell acute lymphoblastic leukemia (B-ALL).Methods:The diagnosis and treatment process of a patient transferred from PMF to B-ALL in Affiliated Tumor Hospital of Zhengzhou University in November 2018 were retrospectively analyzed, and the relevant literature was reviewed.Results:The patient was a 64-year-old female, she was initially diagnosed with PMF, and then she developed B-ALL 17 months later after receiving treatment of prednisone, danazole, levamisole, aspirin, thalidomide and jaktinib. After induction therapy, the patient received 8 months of continuous remission, and then the reexamination showed relapse. There was no remission after reinduction therapy. The patient gave up treatment and was discharged 2 months later. JAK2 V617F gene mutation was positive before and after leukemia transformation.Conclusions:The patients with transformation of PMF to B-ALL have poor clinical prognosis and short survival time. The possible mechanism of its transformation may be related to additional genetic events or certain high-risk genes. However, the specific mechanism is still unclear, and further investigation of the etiology is needed to seek targeted treatment.
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BACKGROUND:Bone transplantation is the only method for the repair of bone defects. However, traditional bone transplantation has some disadvantages. Bone tissue engineering, as a new treatment strategy, can achieve the desire therapeutic outcomes. OBJECTIVE:To fabricate a new tissue-engineered scaffold for improving bone repair effectively. METHODS:Hydroxyapatites (HA) with different Ca/P (1.50/1.67) ratios were synthesized by chemical precipitation method and microwave radiation method. Composite scaffolds of palygorskite (APC)/HA/polycaprolactone (PCL)/col agen (COL), APC/calcium deficiency HA (CDHA)/PCL/COL, and APC/PCL/COL (control group) were prepared by solution perfusion-solvent evaporation and ion leaching method. The material characterization, active ingredients, hydrophilic property, and mechanical properties were evaluated by scanning electron microscope, infrared spectrometer, surface contact measuring instrument and universal mechanics, respectively. The histocompatibility of the implant with the host was assessed through animal experiments. RESULTS AND CONCLUSION:By precise control of pH range, HA with different Ca/P ratios could be synthesized. The mechanical properties, air permeability, hydrophilic property of the APC/HA/PCL/COL and APC/CDHA/PCL/COL composite materials were significantly increased compared with the APC/PCL/COL composite material (P<0.05), while the porosity, water absorption expansion rate were significantly decreased (P<0.05). Results from our animal experiments showed that no immune inflammatory reaction was observed suggesting that the composite materials hold good histocompatibility. To conclude, the APC/HA (1.50/1.67)/PCL/COL composite materials are promising bone substitutes in bone tissue repair.
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OBJECTIVE: To fabricate salidroside/collagen/polycaprolactone (PCL) nerve conduit composite and to investigate the effect of composite nerve conduits for repairing sciatic nerve defect. METHODS: The salidroside microspheres were prepared by W/O/W method, and the sustained release rate of microspheres was detected. The microspheres containing 10, 20, and 40 μg salidroside were mixed with collagen to prepare the nerve conduit core layer by freeze-drying method. The shell layer of collagen/PCL scaffold material was fabricated by electrospinning technology. The genipin cross-linked salidroside/collagen/PCL nerve conduit composite was prepared. The structure of nerve conduit was observed before and after cross-linked by scanning electron microscope. Thirty-eight Wistar rats were used to make the right sciatic nerve defect model of 15 mm in length, and randomly divided into groups A, B, C, D (n=9), and group E (n=2), then defect was repaired with the collagen/PCL conduit in group A, autologous nerve in group E, the 10, 20, and 40 μg/mL salidroside/collagen/PCL conduit in groups B, C, and D, respectively. The survival of rats was observed. The sciatic functional index (SFI) was evaluated at 1, 3, and 6 months after operation. At 6 months, the tissue of defect area was harvested for the general, electrophysiology, histological, and immunohistochemical[S-100 and peripheral myelin protein 0(P0)] staining observations. RESULTS: Salidroside microspheres showed burst release at 3 days, and then it tended to be stable at 13 days and lasted for 16 days, with a cumulative release rate of 76.59%. SEM showed that the disordered fiber of nerve conduit shell layer after crosslinking became conglutination, shrinkage, and density, and had void. The channels of core layer were clearly visible before and after crosslinking. The rats had no infection or death after operation. The SFI of group E was significantly higher than that of groups A, B, C, and D at 1, 3, and 6 months (P0.05); there was no significant difference in SFI among groups A, B, C, and D at 3 months (P>0.05); SFI was significantly higher in group C than groups A, B, and D and in groups A and B than group D (P0.05) at 6 months. In addition, no significant difference was shown among different time points in the other groups (P>0.05) except groups C and E at 1, 3, and 6 months (P0.05). The histological observation showed that the nerve fiber tissue of groups B, C, and E was obviously more than that of groups A and D, and group C was similar to group E in the nerve fiber arrangement, and the core layer material of each group was completely degraded. Immunohistochemical staining showed that S-100 and P0 proteins expressed in all groups; and the expression level of groups B, C, and E was significantly higher than that of groups A and D, and gradually increased (P0.05), and P0 expression level of group A was significantly lower than that of group D (P<0.05). CONCLUSIONS: Salidroside/collagen/PCL nerve conduit can promote sciatic nerve defect repair.
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ObjectiveTo explore the clinical features and factors inlfuencing the prognosis of childhood non-Hodgkin's lymphoma (NHL).MethodsPathologically diagnosed 78 pediatric patients with NHL and treated in the Afifliated Hospital of Qingdao University from January 2004 to August 2013 were collected and analyzed. Patients were grouped according to age, sex, tumor size, immunologic classiifcation, B-symptoms, LDH, hemoglobin and clinical staging. The 5-years event-free survival rate (EFS) were calculated and analyzed by Kaplan-Meier method, and the difference of the survival rate between groups were com-pared. Using Cox proportional hazards model, we analyzed the possible factors that might inlfuence 5-years event-free survival rate EFS , such as age and clinical staging. TheOR value and the 95%CI were calculated.ResultsAmong the 78 cases, median age of onset is 7 years old, male to female ratio is 2.90:1, there are 25 cases of T-cell type and 53 cases of B-cell type. According to pathological types,Burkitt lymphoma is the most common (34.6%), followed by T-lymphoblastic lymphoma (20.5%), diffuse large B-cell lymphoma (11.5%). According to the St. Jude malignant lymphoma staging system, there are 2 cases in stage I, 9 in stageⅡ, 35 in stageⅢ and 32 in stageⅣ. Swelling of periphery lymph node (80.7%) was observed as initial symptom in 26 cases of lymphoblastic lymphoma. Among 45 cases of mature B-cell tumor, the main clinical feature including abdominal cavity and gingival were observed in 27 cases of Burkitt lymphoma. Among the 73 cases received treatments, 66 cases (90.5%) attained CR (complete remission) and 4 cases (5.5%) attained PR (partial remission) by cytology and radiographic assessment after two course of combined chemotherapy, 2 cases (2.7%) rapidly relapsed after the remisson of one course treatment, 1 case (1.3%) appeared the central nervous system inifltration in the chemotherapy. With median follow-up time of 42 months, the 5-year EFS of the 73 cases was (67.0+5.5)%. Single factor analysis showed that B-symptom, LDH, and clinical staging were signiifcantly correlated with prognosis (P0.05). Multiple factor analysis showed that LDH and clinical staging inlfuenced the prognosis (OR=3.34,95%CI 2.275?10.683,P<0.01;OR=4.354,95%CI 1.519?12.475,P<0.01) .Conclusionclinical features of childhood NHL are variable. LDH and clinical staging at primary diagnosis are important factors affecting the prognosis.
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Clopidogrel is an essential drug for the treatment of ischemic stroke.It has been recommended by the multinational stroke treatment guidelines and has been widely used in clinical practice.Many patients with ischemic stroke may still have stroke recurrence after the standard treatment of clopidogrel; therefore,we must pay attention to the phenomenon of clopidogrel resistance.This article reviews the biochemical mechanisms,gene polymorphism,laboratory testing,and response measures of clopidogrel resistance.
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The manifestation of clinical symptoms of cerebral small-vessel disease (SVD) is cognitive disorders. Its pathological changes are manifested as leukoaraiosis and/or lacunar infarction. However, it is not clear whether cognitive disorders caused by SVD is correlated with the severity of white matter damage. Magnetic resonance spectroscopy analysis can noninvasively detect metabolite concentrations of brain tissue in vivo and directly reflect cerebral metabolism; Diffusion-tensor imaging is a novel noninvasive technique for specific observation of white matter through different parameters such as mean diffusivity and anisotropy for quantitative evaluation of the abnormalities of fine structure of white matter. The combination of magnetic resonance spectroscopy analysis and diffusion-tensor imaging may more sensitively reveal the severity of white matter damage, and provide a research tool for cognitive disorders caused by SVD.resonance imaging
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Objective To further observe the effect of botulinum toxin A(BTXA) treatment on hemifacial spasm(HFS) patients and to investigate the value of double stimulation of blink reflex(BR) before and after BTXA injection. Methods Among 134 cases of HFS treated by local injection of BTXA, the changes of BR in 42 cases was recorded before and after the injection. Results Of totally 134 treated cases, 60 (44 8%) cases were completely relieved and the rest 74 (55 2%) cases were obviously improved after treatment, with an effective duration of 16 5?5 7 weeks.In 42 patients with determination of BR value,before injection the latency of R 1, R 2, R' 2 of the affected side showed within normal limit.The interval of R 2 was shorter and the amplitudes of R 1,R 2,R' 2 were higher .After injection , the R 1 disappeared in 7 patients,and R 1,R 2,R' 2 all disappeared in 5 patients,for the rest 30 patients,the latency of R 1,R 2,R' 2 was prolonged slightly,but showing no apparent differences The amplitudes of R 1,R 2 and R' 2 were lowered significantly ( P