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Objective:To study the value of cell paraffin block immunohistochemistry and pleural fluid Crk like protein (CRKL) and macrophage inhibitory cytokine-1 (MIC-1) in the diagnosis of malignant pleural effusion.Methods:A total of 98 patients with pleural effusion treated in Shantou Central Hospital from February 2020 to February 2021 were retrospectively selected as the research objects, including 58 benign cases and 40 malignant cases. The levels of CRKL and MIC-1 in pleural effusion were detected by enzyme-linked immunosorbent assay. The pleural effusion was analyzed by cell paraffin block immunohistochemistry. The levels of various indexes in benign group and malignant group were compared. The diagnostic value of cell paraffin block immunohistochemistry and pleural effusion CRKL and MIC-1 for benign and malignant pleural effusion was analyzed by receiver operating characteristic (ROC) curve.Results:With pathological results as the gold standard, 54 cases of benign and 44 cases of malignant were diagnosed by cell paraffin block immunohistochemistry. The diagnostic accuracy was 75.5% (74/98) , and the sensitivity and specificity were 75.0% (30/40) and 75.9% (44/58) respectively. The levels of pleural effusion CRKL [2.84 (2.17, 3.98) ng/ml vs. 1.88 (0.94, 2.62) ng/ml], MIC-1 [2.28 (1.67, 2.98) ng/ml vs. 1.76 (1.22, 2.32) ] ng/ml] in the malignant group were higher than those in the benign group, with statistically significant differences ( Z=-4.57, P<0.001; Z=-3.09, P<0.001) . The optimal critical value of CRKL in pleural effusion for the diagnosis of malignant pleural effusion was 2.33 ng/ml, the area under the curve (AUC) was 0.76 (95% CI: 0.66-0.85) , and the sensitivity and specificity were 67.5% (27 /40) , 74.1% (43/58) . The optimal critical value of MIC-1 in pleural effusion for the diagnosis of malignant pleural effusion was 2.10 ng/ml, the AUC was 0.74 (95% CI: 0.64-0.85) , and the sensitivity and specificity were 60.0% (24/40) , 82.8% (48/58) . The AUC of MIC-1 and CRKL in pleural effusion combined with cell paraffin block immunohistochemistry for the diagnosis of malignant pleural effusion was 0.83 (95% CI: 0.75-0.91) , and the sensitivity and specificity were 85.0% (34/40) and 70.7% (41/58) . The sensitivity and AUC of combined diagnosis were significantly higher than those of CRKL and MIC-1 alone (sensitivity: χ2=4.26, P=0.046; χ2=6.27, P=0.012; AUC: Z=3.53, P<0.001; Z=4.14, P<0.001) . Conclusion:CRKL and MIC-1 in pleural effusion of patients with malignant pleural effusion are highly expressed, which can be used as indicators for the diagnosis of malignant pleural effusion. Detection combined with cell paraffin block immunohistochemistry can improve the diagnostic value of malignant pleural effusion.
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A young male diagnosed with severe hemophilia A since childhood, was presented with recurrent joint and urinary bleeding. Annualized bleed rates dropped below five with low dose prophylactic medication.Bleeding in the right knee joint recently aggravated. Due to coexisting HIV infection and advanced hemophilic arthritis, the patient was managed by a multi-disciplinary team(MDT).Total knee arthroplasty was performed by an experienced surgeon using modern prosthesis design and intraoperative navigation technologies.Physical and rehabilitation therapy was provided during the postoperative period, and joint function improved. The MDT managed the young patient with HIV infection and advanced hemophilic arthritis. The patient was diagnosed with osteoporosis thought to have been caused by hemophilia, HIV infection and antiviral drugs; and he received treatment. The treatment of this patient reflects the importance of multidisciplinary cooperation in the management of difficult and rare diseases.
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To analyze the distribution of HPV infection subtypes and HPV vaccination intention in Liaoyang area. Methods A total of 3 612 women in Liaoyang area who underwent HPV screening at the Department of Gynecology and Obstetrics of Liaoyang Central Hospital from November 2017 to December 2019 were enrolled in this study. The HPV infection in the population was analyzed, and the differences in HPV infection and multiple HPV infection of people at different ages were compared. The influencing factors of vaccination willingness were analyzed. Results There were 576 patients with HPV infection, and the infection rate was 15.95%. The difference in HPV infection at different ages was statistically significant (χ2=9.261, P=0.000), and the difference in multiple HPV infections at different ages was statistically significant (P<0.05). Among low-risk infections, HPV55, HPV61, and HPV81 were the main subtypes, and among high-risk infections, HPV16, HPV51, HPV66, and HPV53 were the main subtypes. In the multivariate analysis, the HPV vaccination intention of people with lower age and lower monthly family income, college students and students with non-medical majors was significantly lower. Conclusion The high-risk types of HPV in Liaoyang area are mainly HPV16, HPV51, HPV66, and HPV53. It is recommended to focus on the intervention of young people, people with low family monthly income, college students and students with a non-medical major to reduce the incidence of cervical cancer.
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Objective:To compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more.Methods:A retrospective case-control study was conducted to analyze the clinical data of 43 elderly patients aged 90 years or more with intertrochanteric fractures admitted to Henan Provincial People's Hospital from January 2017 to June 2018. There were 12 males and 31 females, aged 90-102 years [(92.3±2.5)years]. A total of 31 patients were treated by PFNA (PFNA group) and 12 patients by bipolar hemiarthroplasty (hemiarthroplasty group). Comparisons were made between the two groups in terms of operation time, intraoperative blood loss, time of weight bearing after operation, rate of blood transfusion, incidence of complications 2 weeks and 3 months after operation, Harris score 12 months after operation and mortality 12 months after operation.Results:All patients were followed up for 1-30 months [(19.1±9.8)months] in PFNA group and for 0.5-29 months [(18.6±10.6)months] in hemiarthroplasty group. Operative time was (95.8±31.0)minutes in PFNA group, shorter than (128.8±40.5)minutes in hemiarthroplasty group ( P<0.05). Intraoperative blood loss was (71.3±25.7)ml in PFNA group and (212.5±113.1)ml in hemiarthroplasty group ( P<0.05). Time of weight bearing after operation was (43.9±31.9)days in PFNA group, longer than (5.9±2.8)days in hemiarthroplasty group ( P<0.05). The perioperative blood transfusion rate in PFNA group (29%) was less than hemiarthroplasty group (75%) ( P<0.05). Incidence of complications 2 weeks after operation was similar between PFNA group (23%) and hemiarthroplasty group (42%) ( P>0.05). Incidence of complications 3 months after operation in PFNA group was 26%, similar with 42% in hemiarthroplasty group ( P>0.05). Harris score 12 months after operation in PFNA group was (56.3±32.3)points, comparable to (59.3±36.7)points in hemiarthroplasty group ( P>0.05). Mortality rate 12 months after operation was 19% in PFNA group and 25% in hemiarthroplasty group ( P>0.05). Conclusion:For intertrochanteric fractures in elderly patients aged 90 years or more, PFNA and bipolar hemiarthroplasty are both effective treatments, but PFNA may be a better choice with shorter operation time and less intraoperative blood loss.
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Objective To explore the correlation between childhood obesity and adult metabolic diseases. Methods A total of 3 542 people who underwent physical examination in the General Hospital of Fuming from January 2018 to January 2019 were selected as research subjects. They were divided into childhood obesity group and control group according to the childhood body mass index (BMI). Single factor and multivariate logistic regression analysis were performed on relevant factors that may affect adult metabolic diseases by comparing clinical data with laboratory parameters. Results A total of 113 adult patients with metabolic diseases were found in the control group, with an incidence rate of 4.56%. In the childhood obesity group, 322 adult patients with metabolic diseases were found, with an incidence rate of 30.32%. The incidence of adult metabolic diseases in the childhood obesity group was significantly higher than that of the control group, while the HDL-C level in the childhood obesity group was significantly lower than that in the control group. The differences were statistically significant (P<0.05). Univariate analysis showed that the gender and childhood obesity were significantly correlated to adult metabolic diseases (P<0.05). Multivariate logistic regression analysis showed that the childhood obesity was an independent risk factor for adult metabolic diseases (P<0.05). Conclusion There was a difference in the incidence of adult metabolic diseases and laboratory indicators in the adulthood between childhood obese patients and childhood non-obese patients. Childhood obesity is an independent risk factor for adult metabolic diseases.
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Objective@#To compare the differences in population pharmacokinetic (PK) parameters between two recombinant coagulation factor Ⅷ (FⅧ) preparations, Kogenate FS and Advate, in patients with hemophilia A, and to provide the theoretical basis of precise individualized treatment for those patients.@*Methods@#Patients with moderate or severe hemophilia A who had at least one injection of Kogenate FS or Advate at 41 international hemophilia centers were enrolled as subjects from the WAPPS-Hemo project since January 2015 to December 2017. The half-lives of the two drugs and the time of FⅧ activity reaching 2% (TAT 2%) were calculated, and the differences of PK between the two drugs among different age and dose subgroups were further analyzed.@*Results@#①The mean age of patients in the Kogenate FS (n=117) and Advate groups (n=120) were (27.6±17.7) and (23.4±16.2) years old, respectively. All patients in the two groups were males. ②The administration doses in the Kogenate FS and Advate groups were (31.5±13.1) IU/kg and (38.17±14.83) IU/kg, respectively; the half-lives of the two drugs were (12.3±3.5) h and (10.8±2.9) h, respectively; and the TAT 2% were (65.2±21.7) h and (57.0±17.9) h, respectively. ③In the Kogenate FS group, the drug half-lives in patients aged ≥12 and <12 years old were (12.7±3.7) h and (11.1±2.5) h, respectively; the TAT 2% were (68.6±22.9) h and (55.8±14.6) h, respectively. In the Advate group, the drug half-lives in patients aged ≥12 and <12 years old were (11.4±3.1) h and (9.4±1.8) h, respectively; and the TAT 2% were (61.1±18.0) h and (45.2±11.3) h, respectively. ④In the Kogenate FS group, the drug half-lives in <20 IU/kg, (20-29) IU/kg, (30-39) IU/kg and ≥40 IU/kg groups were (13.3±4.0) h, (12.3±3.6) h, (12.2±3.5) h and (11.6±2.6) h, respectively; and the TAT 2% were (61.5±21.4) h, (63.9±22.4) h, (67.0±24.3) h and (68.0±19.5) h, respectively. In the Advate group, the drug half-lives in <20 IU/kg, (20-29) IU/kg, (30-39) IU/kg and <40 IU/kg groups were (11.5±3.8) h, (11.4±3.7) h, (11.0±2.9) h and (10.4±2.3) h, respectively; and the TAT 2% were (50.8±19.2) h, (56.7±21.0) h, (58.2±18.8) h and (58.1±15.8) h, respectively.@*Conclusion@#The PK parameters of Kogenate FS are superior to those of Advate among different age and dose subgroups.
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Objectives@#To assess the diagnostic values of latex immunoturbidimetric assay (LIA) and particle immunofiltration assay (PIFA) for heparin-induced thrombocytopenia (HIT) .@*Methods@#Samples from 94 patients with suspected HIT from May 2016 to July 2018 in our hospital were prospectively analyzed by the two immunoassays. Their medical records and further follow-up data were also collected and analyzed by our hematologists to make the 4Ts scores and confirm the diagnosis of HIT, respectively. Performance characteristics of the two immunoassays were assessed, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) . Their post-test probabilities (PTP) were also calculated based on the 4Ts score.@*Results@#Among 94 cases, 15 (16.0%) had a positive HIT, including 6 of 37 (16.2%) with an intermediate, and 9 of 15 (60.0%) with a high 4Ts score. PIFA operating characteristics were: sensitivity 100.0% (15/15) , specificity 51.9% (41/80) , PPV 28.3% (15/53) , NPV 100.0% (41/41) . The positive PTP in intermediate and high 4Ts score group were 28.7% and 75.7%, respectively, while negative PTP were all 0. At manufacturers’ cutoffs, LIA operating characteristics were: sensitivity 66.7% (10/15) , specificity 94.9% (75/79) , PPV 71.4% (10/14) and NPV 93.8% (75/80) . The positive and negative PTP in intermediate 4Ts score group were 71.8% and 6.3%, while 95.2% and 34.4% in high 4Ts score group, respectively. Receiver operating characteristic (ROC) analysis manifested that LIA was preferable than PIFA, and combining the 2 assays together was significantly better than single test.@*Conclusions@#4Ts score is still an important tool for the diagnosis of HIT. Combining clinical score with heparin/PF4 antibody assay can increase the accuracy of confirming or excluding HIT. Although PIFA is inferior to LIA in the diagnostic value, its user friendliness and 100% NPV have major advantages. Combining the 2 assays together can achieve a higher diagnostic value.
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Objective To observe the serum levels of endothelial microparticles (EMP) and tissue factor-bearing microparticles (TF+MP) in patients with acute leukemia before and after daunorubicin-based chemotherapy. Methods From July 2012 to February 2013, 15 patients with newly diagnosed acute leukemia in Peking Union Medical College Hospital received DA (daunorubicin + cytarabine) regimen or VDCLP (vincristine + daunorubicin + cyclophosphamide + L-asparaginase + prednisone) regimen chemotherapy. There were 8 males and 7 females, and the median age of patients was 44 years old. Eleven patients were acute myeloid leukemia (M01 case, M11 case, M29 cases), and 4 were acute lymphocytic leukemia. The peripheral blood samples were taken before induction chemotherapy and after 3 days of daunorubicin. Levels of EMP and TF+MP were assessed using flow cytometry. Results The serum EMP and TF+MP levels were significantly higher after 3-day daunorubicin infusions than those before induction chemotherapy (28.94/μl vs. 10.74/μl, P= 0.001; 64.24/μl vs. 43.80/μl, P= 0.02). Conclusion Daunorubicin-based chemotherapy may cause increased numbers of EMP and TF+MP in patients with acute leukemia.
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Objective@#To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO.@*Methods@#Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×109/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×109/L.@*Results@#A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×109/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×109/L) at 4th week, 8th week and 12th week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×109/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild.@*Conclusion@#Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.
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Objective To study the effect of curcumin on the radiosensitivity of the human papillary thyroid cancer cell line TPC?1, to investigate the signaling pathway probably targeted by curcumin, and to provide new insights for the development of radiosensitizers for thyroid cancer. Methods The human papillary thyroid cancer cell line TPC?1 was treated with curcumin and radioactive iodine. CCK?8 assay, colony formation assay, and flow cytometry were used to evaluate cell proliferation, colony formation ability, and cell apoptosis, respectively. Western blot was used to measure the expression of p50, p65, and apoptosis?related proteins, Bcl?2 and Bax. Cell proliferation, colony formation ability, and cell apoptosis were determined again after the activity of the NF?κB signaling pathway was blocked by a NF?κB signaling pathway inhibitor PDTC. Results After treatment with curcumin and radioactive iodine, the human papillary thyroid cancer TPC?1 cells had reduced cell proliferation and colony formation, an elevated apoptosis rate, downregulated expression of anti?apoptotic Bcl?2, and upregulated expression of pro?apoptotic Bax in a dose?dependent manner. These results indicated that curcumin enhanced the radiosensitivity of TPC?1 cells. Curcumin inhibited the activation of the NF?κB signaling pathway in the TPC?1 cells treated with radioactive iodine. When the activity of the NF?κB pathway was blocked by PDTC, cell proliferation and colony formation were reduced and the apoptosis rate was increased, indicating an enhanced radiosensitivity of TPC?1 cells. Conclusions Curcumin is likely to target the NF?κB signaling pathway. It regulates the radiosensitivity of thyroid cancer cells by inhibiting the activity of the NF?κB signaling pathway.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of anagrelide in essential thrombocythemia (ET).</p><p><b>METHODS</b>Patients who diagnosed as ET according to the World Health Organization classification were enrolled. Each patient was assigned to take anagrelide hydrochloride capsule or hydroxyurea tablet by random 1∶1 ratio. Dose of anagrelide started at 2 mg/d, then increased gradually and the maximum dose was 10 mg/d until the platelet counts dropped to (100-400) × 10⁹/L, one month later gradually reduced to maintain dose. The dose of hydroxyurea was 1000 mg/d at beginning, then increased gradually, when platelet counts dropped to (100-400)×10⁹/L and kept for one month, reduced to maintain dose as 10 mg·kg⁻¹·d⁻¹. The observation period was 12 weeks.</p><p><b>RESULTS</b>A total of 222 patients were enrolled in seventeen centers (including 113 patients treated with anagrelide and 109 with hydroxyurea). Therapy efficacy can be evaluated in 198 patients (including 97 patients administered with anagrelide and 101 with hydroxyurea). At 12th weeks of therapy, the hematologic remission rate was 87.63% (85/97) in anagrelide group and 88.12% (89/107) in hydroxyurea group, the differences between the two groups were not significant (P=0.173). Treatment with anagrelide lowered the platelet counts by a median of 393 (362-1 339) × 10⁹/L from a median of 827 (562-1657) × 109/L at the beginning of the observation to 400(127-1130)×10⁹/L after 12 weeks (P<0.001), which were similar to the treatment result of hydroxyurea by a median drop of 398 (597-1846)× 10⁹/L (P=0.982). The median time to achieving response of anagrelide group was 7 (3-14) days, superior to that of hydroxyurea for 21 (14-28) significantly (P=0.003). Frequency of anagrelide related adverse events was 65.49 % (74/113), including cardiopalmus (36.28% ), headache (21.24% ), fatigue (14.16% ) and dizzy (11.50% ).</p><p><b>CONCLUSION</b>Anagrelide was effective in patients with ET which had similar hematologic remission rate to hydroxyurea and could take effect more quickly than hydroxyurea. Incidence of adverse events was undifferentiated between anagrelide and hydroxyurea, but anagrelide treatment had tolerable adverse effects and no hematologic toxicity.</p>
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Humanos , Hidroxiureia , Usos Terapêuticos , Inibidores da Agregação Plaquetária , Usos Terapêuticos , Contagem de Plaquetas , Quinazolinas , Usos Terapêuticos , Trombocitemia Essencial , Tratamento Farmacológico , Resultado do TratamentoRESUMO
Objective To investigate the relationships among free triiodothyronine( FT3 ), free thyroxine (FT4 ), and thyroid-stimulating hormone( TSH) in both plasma and breast milk of patients with thyroid diseases. Methods A total of 102 female subjects with hyperthyroidism(GD), normal thyroid function(NC), and Hashimoto′s hypothyroidism(HT or hypothyroidism)were enrolled. Their plasma and breast milk were collected for measurement of FT3 and FT4 , and TSH. Meanwhile, 11 infants of patients with hyperthyroidism and another 11 infants of patients with hypothyroidism were selected, blood FT3 , FT4 , and TSH content were determined during lactating period and 2 months after lactation. Results (1) FT3 and FT4 contents in breast milk among 3 groups were different[(1. 48 ± 0. 81), (7. 79 ± 3. 56), and (0. 77 ± 0. 42)pg/ ml; (2. 94 ± 1. 43), (14. 78 ± 7. 40), and (1. 51 ± 0. 40)pg/ ml, P0. 05). (2) FT3 ratio of breast milk to plasma of the hyperthyroidism group was different to other 2 groups(0. 42 ± 0. 04 vs 0. 35 ± 0. 03, 0. 36 ± 0. 03, P0. 05). (3)Blood FT3 , FT4 , and TSH contents from infants of patients with hyperthyroidism and hypothyroidism were different, both during lactating period and 2 months after lactation[(5. 06 ± 1. 76)vs (6. 51 ± 2. 23)pg/ ml, (17. 39 ± 2. 78)vs (19. 87 ± 3. 26)pg/ ml, (1. 34 ± 1. 33)vs (0. 74 ± 0. 78)mIU/ L; (1. 43 ± 0. 74)vs (1. 83 ± 0. 91)pg/ ml, (4. 28 ± 1. 55)vs (5. 00 ± 1. 75)pg/ ml, (6. 48 ± 2. 70) vs (5. 49 ± 2. 39) mIU/ L; all P<0. 05]. (4) FT3 and FT4 contents were positively correlated in plasma and breast milk(all P<0. 05), while TSH contents were positively correlated only in hypothyroidism group(P<0. 05). Conclusion FT3 , FT4 , and TSH in blood and breast milk are correlated.
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BACKGROUND:In high-intensity exhaustive exercise process, the body must bear the exercise intensity decreasing splanchnic blood flow“ischemia”, at the same time, along with the movement of energy and material consumption, metabolite accumulation and oxidative stress in the body cause pathological damage, leading to a decline in exercise capacity. Thus, what is the impact on kidney filtration barrier? How to adapt to the change of renal tissue? Houttuynia cordata has the functions of heat clearing and detoxifying, dieresis for treating strangurtia, hemostatic, expel ing phlegm to arrest coughing and analgesia, if it has a protective effect on the renal injury caused by acute exhaustive exercise and its mechanism has not been reported in the literature. OBJECTIVE:To explore the effect of acute exhaustive exercise on kidney filtration barrier in rats and the intervention effect of Houttuynia cordata.METHODS:After resting and watching for 3 days, Sprague-Dawley rats received adaptive running for 15 minutes at a speed of 10 m/min on a 0° treadmil . A total of 24 rats, which can finish the running, were selected. They were divided into normal control group, exhaustive exercise group and dosed exhaustive exercise group according to the weight of layer (n=8). Rats in the exhaustive exercise group and dosed exhaustive exercise group on the 10° treadmil received once exhaustive exercise. Dosed exhaustive exercise group received intraperitoneal injection of sodium houttuyfonate 10 mL/kg at 30 minutes before exercises. The normal control group did not do any exercise. RESULTS AND CONCLUSION:Compared with the normal control group, serum urea nitrogen, serum creatinine, urine protein content, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly increased, but nitric oxide content and nitric oxide synthase activity in the renal tissue were significantly deceased in the exhaustive exercise group (P<0.05 or 0.01). Glomerular filtration epithelial cells, the kidney filtration barrier of basement membrane and podocyte damage were obvious, showing abundant cellapoptosis, occasional y necrosis. Compared with the exhaustive exercise group, urine protein content, serum creatinine, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly reduced, but nitric oxide content and nitric oxide synthase activity were significantly increased in the dosed exhaustive exercise group (P<0.05). No obvious pathological changes were detected, but apoptosis was visible. These findings confirmed that houttuynine made a reduction in renal cellinjury induced by exhaustive exercise and possibly significantly reduced apoptosis, increased nitric oxide synthase content, decreased malonaldehyde, and apparently increased superoxide dismutase activity, and final y protected injured renal tissue induced by exhaustive exercise.
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Objective Myelodysplastic spndrome (MDS) patients' chromosome aberrations were detected by CC and FISH method respectively,to establish standard FISH platform of diagnosis of MDS,to compare the differences of FISH and CC in the detection of MDS chromosome aberrations.Methods Chinese MDS patients fulfilled with the Vienna minimum diagnostic criteria were tested by CC and FISH method,and the patients' clinical data was collected at the same time.Results The standard FISH platform of diagnosis of MDS was established successfully,including probe combination of-5/5q-,+8,-7/7q-,20q-,-Y,the success rate was 100 ％.In 83 cases of MDS,chromosome aberrations rate detected by two methods was 42.2 ％,30.1％ of CC method and 33.7 ％ of FISH method,the accordant diagnostic rate was 76.1％.FISH had higher positive rate than CC method (29.6 ％ vs 18.6 ％,P =0.049) in the IPSS intermedian-risk 1 group,but lower positive rate in IPSS intermedian-risk 2 group (62.5 ％ vs 81.2 ％,P =0.036).There were 11 (19.0 ％) cases of clonal chromosome aberrations detected by FISH method but not detected by CC method,in which 10 (90.9 ％) cases were intermedian-risk 1 group (IPSS grouping).Evaluate IPSS by FISH and CC respectively,the accordant rate was 86.7 ％.Evaluate IPSS by CC alone will result in 3 patients (3.6 ％)decline in risk stratification,and evaluate IPSS by FISH alone will result in 8 patients (9.6 ％) decline in risk stratification.There were 35 (42.2 ％) cases of chromosome aberrations detected by the two methods,including 13 (15.7 ％) cases of complex karyotype and 22 (26.5 ％) cases of single abnormal karyotype.The most common chromosomal aberration was +8,a total of 9 (10.8 ％) cases,followed by abnormalities of chromosome 7,a total of 7 (8.4 ％) cases.Conclusion The study has established standard FISH platform of diagnosis of MDS,the method is stable,sensitive and rapid.FISH technology joint CC technology can improve the patients with MDS chromosome aberration detection rate.Compared to CC,FISH technique can improve the detection rate of the intermedian-risk 1 IPSS grouping MDS patients.Because of limited probe,FISH technique can not entirely replace the role of CC method in MDS,but can complement each other.
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Objectives To investigate the incidence of the heparin-induced thrombocytopenia (HIT) and positivity of anti-heparin/platelet factor 4 complex antibody (HIT-antibody) in inpatients treated with heparin preparations.Methods A total of 197 consecutive patients,including 120 men and 77 women,who were treated with unfractioned heparin (UFH) or low molecular weight heparin (LMWH),were enrolled in this study.HIT-antibody was detected by enzyme-linked immunosorbent assay (ELISA).All patients were classified into subgroups based on 4Ts (Pretest Clinical Scoring System) and types of underlying disorders.The incidence of HIT and positivity of HIT-antibody among different groups were analyzed.Results The overall incidence of HIT was 3.0％ (6/197),and the positivity of HIT antibody was 12.2％ (24/197).The positivity of HIT-antibody was 10.1％ (18/178),7.7％ (1/13) and 83.3％(5/6) in low,moderate and high HIT probability group respectively.There were significant differences of HIT positivity and mean level of HIT-antibody between the high HIT probability group and the low or moderate HIT probability group (P =0.000).Both the incidence of HIT and positivity of HIT-antibody were higher in surgical patients than in medical patients (5.8％ vs 0.9％,P =0.047 and 19.8％ vs 6.3％,P =0.004).Conclusions The incidence of HIT and positivity of HIT-antibody were 3.0％ and 12.2％ respectively,both of which were related with the types of disorders.Detection of HIT-antibody has a better applicable value in patients with high HIT probability.
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Objective To analyze the clinical features,diagnosis and treatment of thrombotic thrombocytopenic purpura (TTP) in patients with systemic lupus erythematosus (SLE).Methods Clinical manifestations,laboratory findings,diagnosis,treatment and prognosis of 14 SLE patients with TTP were retrospectively analyzed.Results Of the 14 patients diagnosed with SLE and TTP,4 were men and 10 were women.The median age at diagnosis was 23 (17-69) years old.In five patients,the onset of SLE preceded TTP,and in nine patients SLE and TTP occurred simultaneouslv.All the 14 patients had thrombocytopenia and hemolytic anemia,12 had fever,11 had neurologic abnormalities,and 11 had renal dysfunction.Eight patients presented with the classic pentad of symptoms.Six patients were given steroids (alone or in combination with intravenous immunoglobulin and cyclophosphamide),and eight patients were treated with steroids in combination with plasmapheresis,with response rates of 2/6 and 6/8,respectively.Six patients died,with overall mortality rate of 6/14.No patients relapsed during the follow-up period.Conclusions SLE and TTP share some similar clinical symptoms.As a result,repeated examinations of peripheral blood smears are very important for early diagnosis.The renal damage in patients of co-existing diseases is more serious than those with TTP alone or SLE alone.Early diagnosis and prompt treatment with plasma exchange and steroids may improve the prognosis in SLE patients with TTP.
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Objective To investigate the characteristics and related risk factors of patients with lymphoma complicated with tuberculosis (TB), the possible pathogenesis and effective therapy. Methods Twenty-one cases of lymphoma combined with TB were retrospectively analyzed by clinical manifestations,pathological features,diagnostic methods,treatments and prognosis.Results Six cases were diagnosed as TB after the diagnosis of lymphoma,5 cases of which were undergoing chemotherapy for lymphoma; 13 cases were diagnosed as lymphoma after TB,including 6 of 10 obsolete pulmonary TB were reactivated during undergoing chemotherapy. Two cases were diagnosed lymphoma and TB simultaneously. Six cases of 21 cases were Hodgkin lymphoma, whereas the other 15 cases were non-Hodgkin lymphoma. Conclusion TB and lymphoma may exist in the same patient in areas where TB is endemic; among this population,the proportion of Hodgkin lymphoma was higher than in the general population.Therefore,the possibility of TB reactivation when undergoing chemotherapy must be focused on.
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ObjectiveTo investigate the change of serum vitamin D level in type 2 diabetes mellitus(T2DM) patients,and explore the role of vitamin D in the metabolic disturbance of T2DM and relationship with other metabolic indexes.MethodsBased on the diagnostic criteria of diabetes mellitus of the WHO (1999) and Asian adult obesity criterion established by International Obesity Special Work Group in 2002,32 patients were selected as T2DM group A[body mass index (BMI)≥25.00 kg/m2],and 38 patients were selected as T2DM group B(BMI ＜ 25.00 kg/m2).Thirty-three healthy subjects were selected as control group.The biochemical parameters of human were measured and serum 25-hydroxyvitamin D3 [ 25 (OH)D3] was measured by enzyme-linked immunoassay.The statistic data were compared among three groups.ResultsThe levels of serum 25 (OH)D3 in T2DM group A,T2DM group B and control group were (20.59 ± 4.82 ),( 27.07 ± 5.73 ) and ( 32.27 ±: 8.49 ) μ g/L,and there were significant differences among three groups (P ＜ 0.05 ).The level of serum 25 (OH)D3 was (25.51 ± 6.12) μ g/L in T2DM patients with normal blood pressure (43 cases),(21.87 ± 5.78) μ g/L in T2DM patients with hypertension (27 cases),there was significant difference between the two patients ( P ＜ 0.05 ).The level of serum 25 ( OH ) D3 was (28.42 ± 5.20) pg/L in T2DM patients with normal blood lipids (8 cases),(23.55 ±6.15)μg/L in T2DM patients with dyslipidemia (62 cases),there was significant difference between the two patients (P＜ 0.05).The level of serum 25 (OH)D3 was negatively associated with weight,waistline,BMI,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,fasting insulin,insulin resistance index,total cholesterol,triaeylglycerol and low density lipoprotein cholesterol(P ＜ 0.01 or ＜ 0.05 ),and had no significant association with parathyroid hormone,calcium,phosphorus,high density lipoprotein cholesterol and age (P ＞ 0.05).ConclusionThe level of serum vitamin D decrease in T2DM patients,especially remarkably in patients combined with obesity,hypertension and dyslipidemia.
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Objective To analyze the clinical manifestations and the criteria for the diagnosis of POEMS syndrome.Methods The clinical characteristics of 36 cases of POEMS syndrome were retrospectively reviewed and compared with the cases reported in literature.Results In addition to the typical characteristics of polyneuropathy(100%),organomegaly(92%),endocrinopathy(86%),monoclonal plasmaproliferative disorder(100%) and skin changes(86%),the patients of POEMS syndrome also have other important features including extravascular volume overload(97%),papilledema(57%) and bone lesions(25%).Furthermore,25% of POEMS syndrome patients have co-existent Castleman disease.Conclusion To make the diagnosis of POEMS syndrome,both major and minor criteria are required.The former includes polyneuropathy and monoclonal plasmaproliferative disorder and the latter includes osteosclerotic bone lesions,Castleman disease,papilledema,organomegaly,edema or serous cavity effusion,endocrinopathy and skin changes.
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Objective To establish a new method using Flaer for detecting abnormal clone in patients with paroxysmal nocturnal hemoglobinuria(PNH).Methods Peripheral WBC and bone marrow mononuclear cells from patients with PNH and normal controls were isolated and stained with flaer,CD55 PE,CD59 FITC and CD34 PE.Results PNH cells can easily be distinguished by flare.Compared with CD55,CD59,Flaer showed advantage in detecting minor clone of PNH,either in peripheral blood or in CD34+ bone marrow cells.Conclusion Flaer can be a new,simple and effective method to detect PNH clone,and especially when the PNH clone is small.