CD7 expression and its prognostic significance in acute myeloid leukemia patients with wild-type or mutant CEBPA / 中华血液学杂志

Objective: To analyze the prognostic value of CD7 expression in newly diagnosed acute myeloid leukemia (AML) patients, and to further explore the correlation between CD7 expression and CEBPA mutation, and to clarify the prognostic value of CD7(+) in AML patients with wild-type (WT) or mutant-type (MT) CEBPA. Methods: The clinical data of 298 newly diagnosed non-M(3) AML patients between January 2010 and December 2016 were analyzed retrospectively. The clinical characteristics and prognosis of CD7(+) and CD7(-) patients were respectively compared in all patients, and in patients with WT and MT CEBPA. The relationship between CD7 expression and CEBPA mutation was determined by chi-square, and the effects of CEBPA mutation on survival and prognosis in CD7(+) group by Kaplan-Meier method. Results: In CD7(+) group, the frequencies of CEBPA mutation were 10.1% (single site) and 33.9% (double site) , significantly higher than those of the CD7(-) group (5.3% and 4.2%) (P=0.000) . Subgroup prognostic analysis showed a lower CR rate (P=0.001) and a higher RR (P=0.023) in CD7(+) group comparing to those of CD7(-) group in AML patients with wild type CEBPA. There were no statistical difference between CD7(+) group and CD7(-) group in overall survival (OS) and disease free survival (P>0.05) , while in the CEBPA mutant group the CD7(+) group has higher OS (P=0.019) and DFS (P=0.010) . Based on the CD7 expression and CEBPA mutation, 298 cases were divided into 3 subgroups, named as CD7(+)-CEBPA MT group, CD7(-) and CD7(+)-CEBPA WT group. The 3-year OS of the 3 groups were 80.2%, 48.0% and 30.6%, respectively (P<0.001) , and the 3-year DFS were 74.1%, 37.4% and 22.2%, respectively (P<0.001) . Conclusion: The CEBPA mutation rate was higher in CD7(+) AML patients then that of CD7(-) patients. CD7 expression has opposite prognostic significance in AML patients carrying the wild-type or mutant-type CEBPA. Based on CD7 expression and CEBPA mutation, a new risk stratification model can be established, which is helpful to guide the clinical individualized treatment for AML patients.

Regulation of replanted progesterone on stress signal in endoplasmic reticulum stress during menstruation in mice at different periods / 医学研究生学报

Objective　Endoplasmic reticulum stress may be involved in the menstrual process, but the detailed mechanism is unclear. This article is to explore the effect of progesterone replantation at different periods on the endoplasmic reticulum stress-induced autophagy and apoptosis in mice during menstruation.　Methods　Mice were divided into 12h replantation group, 16h replantation group and the withdrawal group according to random number table, with 10 mice in each group. 12h (12h replantation group) and 16h (16h replantation group) after the withdrawal of progesterone, replanted respectively with progesterone tube, and withdrawal group were not replanted. Mice in each group were sacrificed 24h after the withdrawal of progesterone and were collected bilateral uterine horns. The expression and localization of t-PERK, p-PERK, t-eIF2α, p-eIF2α, ATF4, CHOP and Caspase12 mRNA and proteins in mouse endometrial tissues were detected by qPCR, Western blot and immunohistochemistry.　Results　At the mRNA level, the PERK and eIF2α(1.000 ± 0.000) of the 12h replantation group were significantly higher than those of the 16h replantation group (0.450 ± 0.049, 0.330 ± 0.015) and the withdrawal group (0.260 ± 0.233, 0.195 ± 0.014). The difference was statistically significant (P<0.05), and the 16h replantation group was higher than the withdrawal group (P<0.05). At the protein level, p-PERK / t-PERK (0.606 ± 0.051) and p-eIF2α / t-eIF2α (0.795 ± 0.074) in 12h replantation group were significantly higher than those in 16h replantation group (0.367 ± 0.019, 0.503 ± 0.038) and withdrawal group (0.243 ± 0.020, 0.293 ± 0.020). The difference was statistically significant (P<0.05) and the 16h replantation group was significantly higher than the withdrawal group. At the mRNA and protein levels, ATF4 of 12h replantation group were higher than 16h replantation group and the withdrawal group (P <0.05) , and the 16h replantation group was higher than the withdrawal group. The proteins of p-PERK, p-eIF2α and ATF4 are mainly expressed in the cytoplasm of decidual stromal cells which located at the junction of basal layer and decidualized stromal cells. At mRNA and protein levels, the expression levels of CHOP and Caspase12 in 12h replantation group were significantly lower than those in 16h replantation group , were also lower than the withdrawal group, and the 16h replantation group was lower than the withdrawal group (P<0.05). The proteins of CHOP and Caspase12 are mainly localized in cytoplasm of adequately decidualized stromal cells and the glandular epithelium cells.　Conclusion　Replantation of progesterone before the critical period of menstruation (12h) can effectively block the onset of menstruation in mice, which may be achieved by maintaining the expression of PERK/eIF2α/ATF4 signal and blocking the expression of apoptotic signaling pathway members CHOP and Caspase 12 in endometrial stromal cells. And this effect can only be partially achieved by progesterone replantationing after the critical period of menstruation (16h).

An Analysis of Self-reported Income Status and Related Determinants among Primary Care Providers in a County in Dali / 昆明医科大学学报

Objective To assess the income status of primary care providers and to explore the determinants of income in a county of Dali. Methods In August 2016, the questionnaire was employed to collect the data of income status of 191 rural health workers and 217 village doctors in the county. Results Through the study, we found that the income of rural health workers in the county was 34, 000 (26, 000, 46,000) yuan with a satisfaction rate of 62.3% (95% CI 55.4%～69.2%) and no change (74.7%) was seen in the income among majorities after implementing the Zero Mark-up Policy for essential medicines. For the village doctors, the income was 20,000 (15,000, 24,000) yuan with a satisfaction rate of 40.6% (95% CI 34.0%～47.1%) and a fall of the income was found in more than half of the doctors after the implement of the policy. Conclusion Health care workers in towns are quite satisfied with their income whereas those in health stations of villages are not content, compared with the average income at the national level. We should increase government's investments on grass-root healthcare team, improve the incentive pay plans and promote the integrated management of health facilities in towns and villages.

Application of full-field digital mammography three-dimensional positioning system for localization of nonpalpable breast lesions / 实用放射学杂志

Objective To evaluate the clinical value of full-field digital mammography three-dimensional (3D) positioning system for localization and excision of nonpalpable breast lesions.Methods 106 patients with nonpalpable breast lesions and underwent preoperative localization were analyzed retrospectively.They underwent wire-localization operation guided by mammography 3D positioning system (GE Senogrphe DS).The depth of wire insertion was calculated manually and automatically.Combined with the manual measurement, systematic measurement, skin elasticity and breast parenchyma structure, the positioning wire was placed.Then, the clinical resection was performed according to the wire localization.Results The localization accuracy of mammography 3D positioning system was 100%.11 patients appearedsyncope.With the rest, psychological comfort and fluid infusion, patients recovered quickly.Conclusion Full-field digital mammography 3D positioning system can improve the accuracy of clinical resection of nonpalpable breast lesion.

Itraconazole for secondary prophylaxis of invasive fungal infection in patients undergoing chemotherapy and stem cell transplantation / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of itraconazole for secondary prophylaxis of previous proven or probable invasive fungal infection (IFI) in patients undergoing chemotherapy or allogeneic hematopoietic stem cell transplantation (HSCT) in agranulocytosis state.</p><p><b>METHODS</b>A phase IV prospective, open-label, multicenter trial was conducted to evaluate itraconazole (200 mg q12h intravenously d1-2, 200 mg/d) as secondary antifungal prophylaxis in patients (18-65 years old) undergoing chemotherapy or HSCT with previous proven or probable IFI. Itraconazole was started when patients' neutrophils＜1.5 × 10⁹/L, and stopped when chemotherapy patients' neutrophils ＞0.5 × 10⁹/L and stem cell transplant recipients' neutrophils＞1.0 × 10⁹/L. The primary end-point of the study was the incidence of proven, probable or possible IFI.</p><p><b>RESULTS</b>Seventy one patients from November 2008 to September 2010 were enrolled in the trial. The median duration of itraconazole prophylaxis was 14 (4-35) days. No patients died of drug-related toxicity within trial. Five cases occurred IFI during the trial. The cumulative incidence of invasive fungal disease was 7.0%. One patient was withdrawn from the study due to treatment-related adverse events (liver malfunction and severe phlebitis).</p><p><b>CONCLUSION</b>Itraconazole appears to be safe and effective for secondary prophylaxis of systemic fungal infection after chemotherapy and allogeneic HSCT. The observed incidence of 7.0% is considerably lower than the relapse rate reported in historical controls, suggesting that itraconazole is a promising prophylactic agent in this population.</p>

Study on unrelated donor allogeneic bone marrow transplantation with Bu-CY2 conditioning regimen for myelodysplastic syndrome / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of Bu-CY(2) conditioning regimen on allogeneic bone marrow transplantation (BMT) with unrelated donor for myelodysplastic syndrome.</p><p><b>METHODS</b>Six patients received chemotherapy regimen of busulfan (Bu) and cyclophosphamide (CY) before allogeneic BMT (Bu 4 mg . kg(-1) . d(-1), -7 d - -4 d, CY 60 mg . kg(-1) . d(-1), -3 d - -2 d). Mycophenolate mofetil combined with cyclosporin A and methotrexate was used for prevention of acute graft-versus-host disease after transplantation. Lipo prostaglandin E(1)was used in prophylactic regimen for hepatic veno-occlusive disease.</p><p><b>RESULT</b>Neutrophil count began to be higher than 0.5 x 10(9)/Lat the 18th day after BMT. Platelet count began to be higher than 20 x 10(9)/Lat the 21st day after BMT. Disease-free survival in the six patients was 27 months.</p><p><b>CONCLUSION</b>Bu-CY(2) conditioning regimen on allogeneic bone marrow transplantation with unrelated donor is an effective therapy for patients with myelodysplastic syndrome.</p>

Tandem autotransplants of peripheral blood stem cells following sequential high-dose CHOEP chemotherapy for aggressive lymphoma / 中国实验血液学杂志

The purpose of this study was to evaluate the effecacy and safety of CHOEP mobilization regimen, and the effect and tolerance of sequential chemotherapy combined with tandem autotransplants of peripheral blood stem cells for aggressive lymphoma. The clinical data of 5 patients with recurrent, aggressive lymphoma treated with of sequential chemotherapy combined with tandem autotransplants were analyzed retrospectively. The patients included 1 HD and 4 NHL. Mobilization regimen was CHOEP combined with G-CSF 5 microg/(kg x d). The conditioning regimen for the tandem transplantation was high-dose CHOEP. The interval of the tandem autotransplantation was 9 (5 - 31) weeks. In tandem autotransplant, the cell number of MNC transfused was 3.05 (1.91 - 4.14) x 10(8)/kg and 3.55 (2.23 - 6.0) x 10(8)/kg; CD34(+) cells were 4.11 (2.59 - 4.94) x 10(6)/kg and 5.70 (2.77 - 10.6) x 10(6)/kg; CFU-GM was 2.96 (2.01 - 4.54) x 10(5)/kg and 2.44 (1.78 - 2.9) x 10(5)/kg respectively (P > 0.05). The results showed that all patients gained prompt and sustained hemotopoietic reconstitution. The interval of ANC >or= 0.5 x 10(9)/L was 10 (8 - 12) days and 10.5 (9 - 12) days; Pt >or= 2.0 x 10(9)/L was 11 (10 - 14) days and 12.5 (10 - 15) days respectively (P > 0.05). Four patients survived, three patients among them were alive in disease-free for median of 46 (9 - 88) months. The overall survival was 80%, and the disease-free survival was 60%. In conclusion, the method of sequential high-dose CHOEP chemotherapy combined with autotransplants of peripheral blood stem cells in tandem for aggressive lymphoma is probably safe and effective.

A comparison of clinical outcomes between HLA allele matched and 1 - 2 alleles mismatched unrelated allogeneic bone marrow transplantations / 中华血液学杂志

<p><b>OBJECTIVE</b>To compare the clinical outcomes between HLA allele matched (HLA-M) and 1 approximately 2 alleles disparity mismatched (HLA-mis) unrelated allogeneic bone marrow transplantation (URD-BMT).</p><p><b>METHODS</b>Thirty-nine patients received HLA-M and 21 received HLA-mis URD-BMT for the treatment of acute leukemia, chronic myeloid leukemia in chronic phase (CP) and myelodysplastic syndromes (MDS) in our hospital between November 1998 and December 2002. Conditioning regimen was Bu 16 mg/kg plus CTX 120 mg/kg, and mycophenolate mofetil (MMF), CsA and MTX were given to prevent aGVHD.</p><p><b>RESULTS</b>Thirty-eight of the HLA-M group and 18 of the HLA-mis group were engrafted successfully. The median follow-up duration was 11 (2.5 - 52.0) months for HLA-M group and 9 (2 - 46) months for HLA-mis group. The 3-year probabilities of disease-free survival (DFS) for HLA-M and HLA-mis group were (79.2 +/- 7.1)% and (45.8 +/- 15.5)%, respectively (P < 0.05). Grade II - IV aGVHD occurred in 10 (26.3%) patients in HLA-M group and 6 (33.3%) in HLA-mis group, respectively (P > 0.05).</p><p><b>CONCLUSION</b>URD-BMT is an effective modality for the treatment of leukemia and MDS. The outcome after URD-BMT can be optimized by matching the HLA-A, B and DR alleles between the donor and recipient.</p>

Treatment of childhood leukemia with unrelated donor allogeneic bone marrow transplantation / 中华儿科杂志

<p><b>OBJECTIVE</b>Allogeneic bone marrow transplantation has been established as a standard method for the treatment of a range of malignant and non-malignant hematologic diseases in children. Unfortunately, fewer than 30% of patients have a human leukocyte antigen (HLA)-matched sibling. Advances in our understanding of the HLA system and the development of large international donor registries encourage the increasing use of unrelated donors as an alternative source of stem cells. The purpose of this study was to evaluate the clinical efficacy and safety of unrelated donor allogeneic bone marrow transplantation (URD-BMT) for the treatment of childhood leukemia.</p><p><b>METHODS</b>Six patients with leukemia received URD-BMT. Two of them suffered from chronic myeloid leukemia (CML), 3 suffered from acute lymphocytic leukemia (ALL) and 1 suffered from acute promyelocytic leukemia (APL) (CR2). All cases were facilitated by Tzu Chi Marrow Donor Registry (TCTMDR). The high resolution DNA test for classIand II was carried out in HLA typing of all donor-receiver pairs. HLA allele matched in three cases, mismatched with one locus in two cases and with two loci in one case. All patients were prepared with cyclophosphamide (CY) 60 mg/kg/day for 2 days (total dose 120 mg/kg) and busulfan (Bu) 1 mg/kg x 4/day for 4 days (total dose 16 mg/kg). Mycophenolate mofetil (MMF), CsA and MTX were given to prevent acute graft-versus-host-disease (aGVHD). CsA of 3 mg/kg/d was continuously given by i.v. infusion, and then 6mg/kg/d by oral. The blood CsA concentration was 200 - 300 ng/ml. MTX was given at the dosage of 15 mg/m(2) on d 1 and 10 mg/m(2) on d 3, 6,9 or 11. MMF was given at the dosage of 0.25 - 0.5 g/d from day 0 to day 120. Prostaglandin E1 was given to prevent the hepatic veno-occlusive disease (VOD), Ganciclovir was used to prevent CMV infection until the CMV antigenemia became negative.</p><p><b>RESULTS</b>Analysis of DNA short tandem repeats showed total engraftment of donor marrow after transplantation in all cases. The median time when granulocyte exceeded 0.5 x 10(9)/L was 14.5 (13 - 18) days, platelets exceeded 20 x 10(9)/L was 16 (14 - 23) days. The acute GVHD grade II-IV occurred in 2 of 6 (33.3%) patients. There were 3 cases with chronic GVHD and none of them developed with the extensive chronic GVHD. All patients were alive in disease-free situation now with median follow-up 412 (187 - 1338) days.</p><p><b>CONCLUSION</b>URD-BMT is an effective method for the treatment of childhood leukemia.</p>