Investigation of ABO allelic competition phenomena in a pedigree with Bw11 subtype / 中华医学遗传学杂志

OBJECTIVE@#To investigate the serological and molecular characteristics of a pedigree carrying an allele for ABO*BW.11 blood subgroup.@*METHODS@#The ABO blood type of 9 pedigree members were determined by serological methods. Exons 6 and 7 of the ABO gene were amplified by PCR and directly sequenced. The patient and her father were also subjected to clone sequencing analysis.@*RESULTS@#Serological tests demonstrated that the proband and her younger brother had an ABw subtype, whilst her father and two daughters had Bw subtype. Clone sequencing found that the exon 7 of the ABO gene of the proband had a T>C substitution at position 695, which was identified as a BW.11 allele compared with the reference sequence B.01. This BW.11 allele was also identified in the proband's father, brother and two daughters. Due to allelic competition, the A/BW.11 and BW.11/O alleles demonstrated significantly different phenotypes.@*CONCLUSION@#The c.695T>C substitution of the ABO gene may lead to allelic competition in the Bw11 subtype. Combined molecular and serological methods is helpful for precise blood grouping.

Serological characteristics and matching strategy of CD38 monoclonal antibody following the treatment of multiple myeloma / 中国输血杂志

【Objective】 To understand the serological characteristics of antibodies produced by CD38 monoclonal antibody( mAb) in the treatment of multiple myeloma, solve the daratumumab interference with blood compatibility testing, and formulate the corresponding blood transfusion strategy. 【Methods】 5 patients with multiple myeloma in our hospital after CD38 mAb chemotherapy were observed in terms of the time of the first presence of positive antibody in screening test, the agglutination intensity and titer, the reaction with the newborn red blood cells or not. The 0.2 mol/L DDT was used to treat the antibody screening cells, the panel cells and the donor erythrocytes, and microcolumn gel method was used for crossmatch. 【Results】 After daratumumab chemotherapy, the time of first presence of positive antibodies in identification tests was 24.8 d on average, the antibody strength was between 2+ and 3+, the titer of antibody was between 1/1 024 and 1/4 906, and they did not respond to those newborn red blood cells. After the treatment of red blood cells with DDT, antibody screening, antibody identification and the major crossmatch became negative. The hemoglobin review showed that blood transfusion after blood cross matching was effective. 【Conclusion】 0.2 mol/L DDT could be used to solve the daratumumab interference with blood compatibility, which presents as panreactivity in the antibody screen, and microcolumn gel method can be used to check the results of antibody screening and crossmatch.

Genetic analysis of one family with congenital limb malformations / 中华医学遗传学杂志

Objective@#To detect potential mutation in a Chinese pedigree affected with congenital limb malformations.@*Methods@#Clinical data was collected. Genomic DNA was extracted from peripheral blood samples of family members. The zone of polarizing activity regulatory sequence (ZRS) were amplified by PCR and subjected to direct sequencing.@*Results@#Among the 13 individuals in this pedigree, there were 4 PPD patients, who were characterized by varying degrees of deformity. The female patients suffered triphalangeal thumb and preaxial polydactyly, while the male patients only had preaxial polydactyly. Only one patient had foot involvement. TA heterogeneous mutations was discovered in the ZRS (105C>G) in all patients, the same mutation was not detected in 2 healthy family members.@*Conclusion@#The inheritance pattern of PPD was autosomal dominant inheritance. There was a significant variability of symptoms among family patients. The heterozygous mutation of the ZRS (105C>G) probably underlie the disease.

Genetic analysis of one family with congenital limb malformations / 中华医学遗传学杂志

OBJECTIVE@#To detect potential mutation in a Chinese pedigree affected with congenital limb malformations.@*METHODS@#Clinical data was collected. Genomic DNA was extracted from peripheral blood samples of family members. The zone of polarizing activity regulatory sequence (ZRS) were amplified by PCR and subjected to direct sequencing.@*RESULTS@#Among the 13 individuals in this pedigree, there were 4 PPD patients, who were characterized by varying degrees of deformity. The female patients suffered triphalangeal thumb and preaxial polydactyly, while the male patients only had preaxial polydactyly. Only one patient had foot involvement. TA heterogeneous mutations was discovered in the ZRS (105C>G) in all patients, the same mutation was not detected in 2 healthy family members.@*CONCLUSION@#The inheritance pattern of PPD was autosomal dominant inheritance. There was a significant variability of symptoms among family patients. The heterozygous mutation of the ZRS (105C>G) probably underlie the disease.

Role of sarcolemmal KATP channel in sevoflurane-induced maintenance of electrophysiological stabili-ty of ventricular myocardium in diabetic rats / 中华麻醉学杂志

Objective To evaluate the role of sarcolemmal ATP-sensitive potassium ( sarcKATP ) channel in sevoflurane-induced maintenance of electrophysiological stability of ventricular myocardium in di-abetic rats. Methods Clean-grade healthy male Sprague-Dawley rats, aged 3 months, weighing 280-320 g, in which diabetes mellitus ( DM) was induced by intraperitoneal streptozotocin 60 mg/kg and confirmed by blood glucose ≥16. 7 mmol/L, were used in this study. Their hearts were excised after anesthesia and retrogradely perfused in a Langendorff apparatus at 4 weeks after establishing the DM model. Twenty-four Langendorff-perfused hearts were divided into 3 groups ( n=8 each) using a random number table method:DM group ( group D) , DM plus sevoflurane group ( group DS) and DM plus sevoflurane plus HMR-1098 group (group DSH). Another 8 Langendorff-perfused hearts of normal rats were selected as control group ( group C) . Hearts were perfused with 37℃ K-H solution via the aorta in each group, 15 min of equilibra-tion later hearts were continuously perfused for 30 min with K-H solution in C and D groups, with K-H solu-tion saturated with 2. 5％ sevoflurane in group DS, or with K-H solution saturated with 10 μmol/L HMR-1098 and 2. 5％ sevoflurane in group DSH. Monophasic action potential (MAP) duration at 50％ and 90％repolarization ( MAPD50 and MAPD90 ) in the endocardium and epicardium of the left ventricular anterior wall were recorded at 15 min of equilibration ( T0 ) and 15 and 30 min of reperfusion ( T1,2 ) , transmural dispersion of repolarization ( TDR) was calculated. S1S2 program-controlled stimulation was performed at the end of perfusion to record the effective refractory period (ERP), ventricular arrhythmia (VA) induced and the longest pacing cycle length ( PCL) of ventricular fibrillation threshold ( VFT) induced. ERP/MAPD90 ratio was calculated. Results Compared with group C, TDR was significantly increased at T0 , ERP/MADP90 ratio was decreased, the incidence of VA induced was increased, and the longest PCL of VFT induced was prolonged in group D ( P＜0. 05) . Compared with group D, TDR was significantly decreased at T2 in group DS (P＜0. 05), and ERP/MADP90 ratio was significantly increased, the incidence of VA in-duced was decreased, and the longest PCL of VFT induced was shortened in DS and DSH groups ( P＜0. 05). TDR was significantly smaller at T2 in group DSH than in group DS (P＜0. 05). Conclusion sarcKATP channel is involved in sevoflurane-induced maintenance of electrophysiological stability of ventricu-lar myocardium in diabetic rats.

A Risk Prediction Model for Invasive Fungal Disease in Critically Ill Patients in the Intensive Care Unit

PURPOSE: Developing a risk prediction model for invasive fungal disease based on an analysis of the disease-related risk factors in critically ill patients in the intensive care unit (ICU) to diagnose the invasive fungal disease in the early stages and determine the time of initiating early antifungal treatment. METHODS: Data were collected retrospectively from 141 critically ill adult patients with at least 4 days of general ICU stay at Sun Yat-sen Memorial Hospital, Sun Yat-sen University during the period from February 2015 to February 2016. Logistic regression was used to develop the risk prediction model. Discriminative power was evaluated by the area under the receiver operating characteristics (ROC) curve (AUC). RESULTS: Sequential organ failure assessment (SOFA) score, antibiotic treatment period, and positive culture of Candida albicans other than normally sterile sites are the three predictors of invasive fungal disease in critically ill patients in the ICU. The model performs well with an ROC-AUC of .73. CONCLUSION: The risk prediction model performs well to discriminate between critically ill patients with or without invasive fungal disease. Physicians could use this prediction model for early diagnosis of invasive fungal disease and determination of the time to start early antifungal treatment of critically ill patients in the ICU.

Protective Mechanism of containing sevoflurane HTK Solution on Cardiac Electrophysiology in Isolated Rat Cardiac Transplantation / 实用医学杂志

Objective To investigate the electrophysiological protective effect of HTK solution containing sevoflurane on rat cardiac transplantation. Methods Twenty-four male Sprague-Dawley rats were divided into the control group,sevoflurane group and Heptanol group. Rat hearts in 3 groups were stored in HTK solution,containing sevoflurane and sevoflurane+heptanol HTK solution for 6 h. Heart resuscitation time,the duration of arrhythmia and monophasic action potential(MAP)and heart rate(HR)at different time points were recorded.Monophasic action potential duration of repolarization at 50% and 90%(MAPD50 and MAPD90),monophasic action potential amplitude(MAPA)and maximal velocity(Vmax)were analyzed. Results The isolated rat hearts in each group can be successfully restored to the spontaneous heart beat. Compared with group C ,heart resuscitation time in group S and group H was significantly shortened,heart rate(HR)was significantly decreased at T1,MAPD50 and MAPD90 in heart intima and epicardium were shortened at T1 ~ T2,the incidence of ventricular fibrillation and reperfusion arrhythmia Scores were reduced,with the shorter duration of ventricular fibrillation(P<0.05). No significant difference was found in Vmax and MAPA among the three groups at each time point. Conclusion HTK solution containing sevoflurane and HTK solution containing heptanol had similar electrophysiological effects ,which could inhibit the prolonged monophasic action potential(MAP)and reduce arrhythmia. The electrophysiological protective effect of HTK solution containing sevoflurane may be associated with the inhibition of gap junction function.

Effects of different concentrations of sevoflurane on monophasic action potential of myocardium of ische-mia-reperfusion / 临床麻醉学杂志

Objective To study the effects of different concentrations of sevoflurane on monophasic action potentials (MAPs)of three-layer myocardium of ischemia reperfusion in isolated rat hearts.Methods Thirty-two healthy SD male rats,weighing 280-320 g,were randomly divided into four groups after successful preparation of langendorff isolated heart perfusion model and 1 5 min perfusion and balance of K-H fluid.In the ischemia-reperfusion group(group IR),K-H fluid perfusion was stopped and balanced for 15 min and cardiac arrest was induced for 60 min with the injection of Thomas solution (4℃,20 ml/kg)while the heart was protected by the low temperature Thomas so-lution (4℃)around it.Reperfusion of Thomas solution (4℃,10 ml/kg)was performed for 30 min and the heart was resuscitated by the perfusion of K-H fluid for 60 min.In the 0.5 MAC sevoflurane group (group Sev0.5 ),K-H fluid contained 0.5 MAC sevoflurane and other procedures were the same as in group IR.1.0 MAC sevoflurane group (group Sev1.0 ),K-H fluid contained 1.0 MAC sevoflurane and other procedures were the same as in group IR.2.0 MAC sevoflurane group (group Sev2.0),K-H fluid contained 2.0 MAC sevoflurane and other procedures were same as in group IR. HR,MAPs including time course (MAPD50,MAPD90)and MAP amplitude of endocardium,mid-layer myodardium and epicardium was recorded at the time of continuous balance perfusion for 1 5 min (T0),continuous perfusion for 15 min (T1),reperfusion for 15 min (T2)and 30 min (T3). Results Compared with T0and T1,HR was slower at T2and T3(P<0.05);Compared with group IR at T2and T3,HR in group Sev0.5 and group Sev1.0 was higher,that in group Sev2.0 was slower P<0.05);At T2,arrhythmia was observed in 6 rats in group IR,while arrhythmia was observed in 1 rats in group Sev0.5 ,and arrhythmia was observed in 2 rats in group Sev1.0 and arrhythmia was observed in 1 rats in group Sev2.0;Compared with group IR at T3,MAPD50in group Sev0.5 was shorter in three sites(P<0.05);Compared with group IR at T3,MAPD90in other three groups was shorter.Conclusion Different concentrations of sevoflurane can shorten MAPD90of MAPs,and the effects don＇t depend on the concertrations of sevoflurane when it changes from 0.5 MAC to 2.0 MAC;which may be the mechanism of decreased arrhythmias risk caused by sevoflurane.

Effect of sevoflurane-containing HTK solution on electrophysiological stability of rat donor heart during reperfusion / 中华麻醉学杂志

Objective To evaluate the effect of sevoflurane-containing HTK solution on electro-physiological stability of rat donor heart during reperfusion. Methods Male Sprague-Dawley rats, weighing 280-320 g, aged 3 months, in which a Langendorff-perfused isolated rat donor heart model was estab-lished, were used in this study. Sixteen donor hearts were obtained and divided into 2 groups (n＝8 each) using a random number table method: control group (group C) and sevoflurane group (group S). HTK so-lution was used as preservation solution in group C. HTK solution containing 2. 5% sevoflurane was used as preservation solution in group S. Hearts were stored for 6 h in the corresponding preservation solution at 4℃ and then reperfused, and the perfusion temperature was gradually restored to 37 ℃ in two groups. The time of spontaneous recovery of heart beat and development of arrhythmia were recorded. Heart rate, monophasic action potential (MAP) duration at 50% and 90% repolarization (MAPD50, MAPD90), MAP amplitude and maximum velocity and development of early after-depolarization and delayed after-depolariza-tion were recorded at 30 and 45 min of reperfusion. Results Compared with group C, the time of sponta-neous recovery of heart beat was significantly shortened, the incidence of ventricular fibrillation and arrhyth- mia score were decreased, the ventricular fibrillation interval was shortened, and MAPD50and MAPD90of epicardium and endocardium were shortened at 30 and 45 min of reperfusion (P＜0. 05), and no significant change was found in hear rate, maximum velocity or MAP amplitude in group S (P＞0. 05). Early after-de-polarization and delayed after-depolarization were not found in two groups. Conclusion Sevoflurane-contai-ning HTK solution can maintain electrophysiological stability of rat donor heart during reperfusion and de-crease the occurrence of arrhythmia.

Clinical research on Cyclophosphamide drug metabolism in children with lupus nephritis / 中华实用儿科临床杂志

Objective To study the pharmacokinetic status of Cyclophosphamide (CYC) in children with lupus nephritis (LN),as well as the relationship between the pharmacokinetic results and clinical indicators,adverse reactions,curative effect evaluation.Methods Thirty patients hospitalized at Tianjin Children's Hospital from January 2014 to December 2016 were treated with glucocorticoid (GC) combined with CYC.Blood samples were collected in 6 point-in-time after intravenous CYC,a high performance liquid chromatography (HPLC) method was used to detect the blood drug concentration,and the pharmacokinetic results were calculated.All patients were followed up for 24 weeks,and the levels of serum albumin (ALB),24 hours urinary protein,serum creatinine (Scr),complement 3 (C3),therapeutic effect and systemic lupus erythematosus disease activity index scores were evaluated at the same time.Results Pharmacokinetic curve showed the second chamber model,the area under the curve (AUC) of time-effect relationship was (143.55 ±42.43) g/(L · h),peak concentration (Cmax) was (20.02 ± 3.55) g/L,and half-time period (T1/2) was(4.21 ± 0.96) h.Age and gender had no influence on AUC,Cmax and T1/2,and statistically significant correlation was found between serum ALB and T1/2,which was positively correlated (r =0.517,P ＜ 0.05).After 16 weeks of treatment,7 patients were partially responsive,22 cases had a complete remission,and the invalid case was only one.Followed up for 24 weeks,6 patients were partially responsive,24 cases had a complete remission.After 16 weeks of treatment,there were statistical differences in AUC among patients with complete response,partial response or no remission.And after 24 weeks,the patients between complete remission and partial remission had no statistically significant difference in the AUC.After 16 weeks and 24 weeks,T1/2 and Cmax had no statistical differences among those groups of patients.Adverse reactions included leukopenia (3 cases,10.00％),gastrointestinal symptoms (4 cases,13.33％) and respiratory tract infection (6 cases,20.00％).There was no statistical relationship between pharmacokinetic parameters and the occurrence of adverse reactions.Single factor analysis showed that there was a statistical significance between ALB,urine protein quantity and treatment effect,but multi-factor analysis showed that the relation between factors and therapeutic effect had no statistical significance.Conclusions HPLC method can be used for the detection of cyclophosphamide blood drug concentration.The cyclophosphamide pharmacokinetic status of children and adult is similar.ALB and T1/2 show a linear positive correlation.Single factor analysis shows a correlation between ALB and treatment effect.Therefore,the increasing level of plasma propagated before treatment can improve therapeutic effect possibly.Cyclophosphamide pharmacokinetic status has nothing to do with the occurrence of adverse drug reactions in the study.

Effect of sevoflurane on electrophysiological stability of ventricular myocardium in diabetic rats / 中华麻醉学杂志

Objective To evaluate the effect of sevoflurane on the electrophysiological stability of ventricular myocardium in diabetic rats.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,aged 3 months,weighing 180-220 g,were divided into 4 groups (n=8 each) using a random number table:control group (group C),sevoflurane group (group S),diabetes mellitus group (group D) and diabetes mellitus plus sevoflurane group (group D+S).After the model of diabetes mellitus was established,the hearts were rapidly excised and perfused in a Langendorff apparatus with oxygenated (95％ O2-5％ CO2) K-H solution.After 15 min stabilization,the hearts were continuously perfused for 30 min with K-H solution in C and D groups and with K-H solution saturated with 2.5％ sevoflurane in S and D+S groups.At 15 min of stabilization (T0) and 15 and 30 min of perfusion (T1-2),heart rate (HR) and monophasic action potential (MAP) duration at 50％ and 90％ repolarization (MAPD50,MAPD90) in the two layers (endocardium,epicardium) of the anterior left ventricular wall were recorded.Transmural dispersion of repolarization (TDR) was calculated.S1S2 program-controlled stimulation was performed at the end of perfusion,and the occurrence of effective refractory period (ERP) and ventricular arrhythmia (VA) was recorded.ERP/MAPD90 was calculated.Results Compared with group C,HR was significantly decreased at T1-2 in group S,HR was significantly decreased and MAPD50 and MAPD90 in epicardium and endocardium were prolonged at T0-2 in D and D + S groups,TDR was significantly enlarged at T0and ERP/MAPD90 was decreased in group D,and the incidence of arrhythmia and induction rate of VA were significantly increased in D and D+S groups (P＜0.05).Compared with group D,TDR was significantly decreased at T2,the incidence of arrhythmia and induction rate of VA were decreased,and ERP/MAPD90 was enlarged in group D+S (P＜0.05).Conclusion Sevoflurane can enhance electrophysiological stability of ventricular myocardium in diabetic rats and decrease the risk of ventricular arrhythmia.

LPS preconditioning mediate Nrf2 to protect spinal cord injury / 中国免疫学杂志

Objective:To investigate the neuroprotective effect and possible mechanism on rats with low dose Lipopoly -saccharide ( LPS) preconditioning after spinal cord injury.Methods:120 female SD rats were randomly divided into the empty virus (EV) group,LPS+empty virus (LPS+EV) group,Nrf2 interference virus (NIV) group,LPS+Nrf2 interference virus (LPS+NIV) group.The model of traumatic spinal cord injury ( TSCI) was established by the modified Allen′s method,motor function of the rat hind limb was assessed by the Basso Beattie and Bresnahan (BBB) score at 1,3,7,14 and 28 d after the operation.The injured spinal cord tissue samples were harvested at each time ,and the pathological changes of rat spinal cord were observed by HE staining ,the Nissl body and neuron survival index were observed by Nissl staining ,the expressions of Nrf2 and GCLC protein level were detected by immunohis-tochemical staining and Western blot.Results:The rat BBB score of LPS+EV group increased significantly than EV group at 7,14,28 d after operation ( P<0.05 ,P<0.01 );The NIV group between LPS+NIV group have no statistical significance at each time.As compared with EV group:the Nrf2 protein of LPS+EV group was expression increased significantly and Nissl staining showed that the neurons survival index was increased at 1,3 and 7 d(P<0.05,P<0.01);The GCLC protein of LPS+EV group was expression increased significantly at 1-14 d( P<0.05 );HE staining showed that the injured spinal cord pathological changes of LPS +EV group was obviously improved.Conclusion:Low dose lipopolysaccharide preconditioning can accelerate the nerve function recovery on rats with traumatic spinal cord injury ,the mechanism may be regulated by activating the Nrf 2 antioxidant stress pathway.

Application research of parenteral nutrition with high branched-chain amino acid content for criti-cally ill patients in general ICU / 临床外科杂志

Objective To research the effects of parenteral nutrition(PN)with high branchedchain amino acid(BCAA)content for critically ill patients in general ICU.Methods A total of60 patientsfrom the general ICU were randomly divided into the control group(30 cases)and treatment group(30 cases).The control group was given PN with balanced amino acids,while the treatment group received PNwith high content of BCAA.Therapeutic outcomes and the blood parameters were measured betweengroups.Results Total protein (TP),albumin (ALB),prealbumin (PA),arm muscle circumference(AMC)and arm circumference(MAC)of the treatment group increased significantly(P <0.05).In thecontrol group,the change of TP,ALB and PA after 7 days was statistically significant(P <0.05).Compared to the control group,the improvement of parameters in the treatment group was more obvious.Conclusion For patients in general ICU,parenteral nutrition with high BCAA content is able to provide effective nutritional support without relative sideeffects.

Efficacy of low dose amphotericin B for treating invasive fungal infection in hematologic malignancies / 中国综合临床

Objective To investigate the efficacy and safety of low dose amphotericin B for treating invasive fungal infection (IFI) in hematologic malignancies.Methods Ninety-eight patients with hematologic diseases who visited our hospital from January 2008 to June 2012 were randomly divided into the control group (n =47) and the treatment group(n =51).Patients in the control group were treated with amphotericin B,50-60 mg per day and patients in treatment group were given amphotericin B,25-30 mg per day.Clinical efficacy and side effects were compared between the two groups.Results There was no significant difference on the median cumulative dose between the control group and the treatment group(725 (175,1595) mg vs 735 (225,1485) mg,P =0.834).But there was significant difference on median treatment days between the control group and the treatment group(19(8,34) d vs 29(11,58) d,P =0.000).After treatment for 14 days,the patients who can be evaluated for efficacy were 37 and 48 cases respectively in the control group and in the treatment group,and there was no significant difference on the total efficacy rate,the rate of progress and the rate of fever between the control group and the treatment group (all P ＞ 0.05).There were 14 patients and 6 patients terminated treatment because of adverse reaction,and the difference was significant (29.8％ vs 11.8％,P =0.027).The side effect rates of hepatic and renal impairment in the control group was significantly higher than that in the treatment group(27.7％ (13/47) vs 11.8％ (6/51),P =0.047).Conclusion The efficacy of 25-30 mg per day's amphotericin B treatment is not lower than amphotericin B at 50-60 mg per day on IFI in hematologic malignancies.It is not only relatively safe and less expensive,but also operability and practicality in the treatment of IFI.

The protective mechanism of fructose-1,6-disphophate on the hypoxic-ischemic brain damage of neonatal rats / 国际儿科学杂志

Objective To explore the protective mechanism of fructose-1, 6-disphophate on the hypoxic-ischemic brain damage of neonatal rats.Methods Seven-day-old Wistar rats were randomly divided into HIBD control group,saline-treated group, FDP-treated group. FDP-treated group was redivided into groups of high, middle and low dose.The expression of caspase-3mRNA was detected at 24h after HIBD with RT-PCR. Results There were no sifnificant differences of the caspase-3 mRNA expression among the saline-treated group, HIBD group and low dose FDP-treated group(P >0.05).The expressions of caspase-3 mRNA in the middle and high dose FDP-treated groups decreased significantly as campared to the above three groups (P < 0.05), but there was no significant difference between the two groups (P > 0.05). Conclusion The neuronal protective mechanism of FDP might be related to dewnregulate the gene expression of caspase-3 in brain tissue,and decrease the apoptosis of neuron after HIBD.

Granulocyte-macrophage colony stimulating factor bladder irrigation prevents hemorrhagic cystitis after hematopoietic stem cell transplantation / 中国组织工程研究

BACKGROUND: Hemorrhagic cystitis remains a common complication of hematopoietlc stem cell transplantation.Granulocyte-macrophage colony stimulating factor (GM-CSF) affects proliferation and differentiation of hematopoietic stem/progenitor cells, adjusts functions of monocytes, granulocytes, lymphocytes and endothelial cells.OBJECTIVE: To investigate the protective effects of GM-CSF bladder irrigation in hemorrhagic cystitis after allogeneic hematopoietic stem call transplantation.DESIGN: Case analysis.PARTICIPANTS: A total of 15 hematopathy patients undergoing allogenic hematopoietic stem cell transplantation at the Zhongshan Hospital of Sun Yat-sen University from January 2004 to August 2006 (routine treatment group). A total of 16 hematopathy patients undergoing allogenic hematopoietic stem cell transplantation from September 2006 to December 2008 (GM-CSF group).METHODS: In the routine treatment group, patients received mesna, hydration, alkalization and forced diuresis in the prevention of hemorrhagic cystitis. In the GM-CSF group, GM-CSF was infused into the bladder in addition to mesna,hydration, alkalization and forced diuresis in the prevention of hemorrhagic cystitis 24 hours before cyclophosphamide treatment. Catheter was extracted 3 days following cyclophosphamide withdraw. Following washing with saline, the bladder was emptied. 10 mL of saline and 5 mL of lidocaine were added into 300 μg of GM-CSF. The mixture was infused into the bladder for 60-120 minutes.MAIN OUTCOME MEASURES: The following parameters were measured: occurrence of hemorrhagic cystitis and its correlation to graft versus host disease, as well as the occurrence of cytomegalovirus infection and urinary system infection.RESULTS: Compared with routine treatment group, the occurrence rate of hemorrhagic cystitis was significantly decreased in the GM-CSF group (x2=4.39, P < 0.05), mean duration of hemorrhagic cystitis and duration of hospitalization were significantly shortened (t=3.97, P < 0.05; t=3.13, P < 0.05), and the occurrence rate of over grade HI hemorrhagic cystitis was significantly reduced (x2=5.04, P < 0.05). Cystitis degree was associated with degree and duration of graft-versus-host disease (r = 0.76).Compared with the routine treatment group, cytomegalovirus infection rate was slightly decreased in the GM-CSF group (x2=0.28, P> 0.05), and occurrence rate of over grade Ⅲ hemorrhagic cystitis was higher in patients with cytomegalovirus infection.Compared with the routine treatment group, the occurrence rate of urinary system infection was slightly reduced in the GM-CSF group (x2=0.28, P > 0.05).CONCLUSION: GM-CSF bladder irrigation is well tolerated and often effective, and should be considered as a preparative regimen of hemorrhagic cystitis after allogeneic hematopoietic stem call transplantation.