[Relationship between Changes of Lymphocyte Subsets and Early Hematologic Response in Immunosuppressive Therapy of Severe Aplastic Anemia Patients].

OBJECTIVE: To explore the relationship between the change of lymphocyte subsets before and after immunosuppressive therapy (IST) with disease severity of severe aplastic anemia (SAA) and hematologic response to IST. METHODS: The clinical data of 94 patients with SAA/VSAA treated by r-ATG and CsA in our hospital from December 2009 to October 2011 was analyzed retrospectively. Among them, 26 patients who had sequential data of lymphocyte subsets and cytokines before and after treatment were enrolled. The relationship between lymphocyte subsets, cytokine level before IST and disease severity, as well as the relationship between changes if lymphocyte subsets, changes of cytokine and the HR after IST for 6 months was analyzed. RESULTS: There were no statistical differences in the ratio and absolute count of lymphocyte, the ratio and absolute count of each lymphocyte subsets, including CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells, CD3-CD16+1CD56+NK cells, and CD19+B cells, and the level of cytokines, such as IL-1, IL-2, IL-4, IL-6 and TNF-α before IST between SAA and VSAA groups. Also, there were no statistical difference in the levels of above-motional parameter at 3 and 6 months after IST. The ratio and absolute count of Lym, absolute count of CD3+T cells, absolute count of B cells and IL-2 level in response group after IST for 3 and 6 months was significant lower than those before IST. However, only ratio of Lym showed significant decrease after IST for 3 and 6 months in non-response group. After IST for 3 months, the absolute count of CD3+T and CD4+T cells in response group was significant higher than those in non-response group. CONCLUSION: The hematopoietic recovery and early hematologic remission may be affected by the intensity of immune suppression reflected from the changes of lymphocyte subsets and the immune reconstruction reflected from the recovery of lymphocyte subsets. The immune reconstruction is most significant within 3 months after IST.

Next generation sequencing reveals co-existence of hereditary spherocytosis and Dubin-Johnson syndrome in a Chinese gril: A case report.

BACKGROUND: Hereditary spherocytosis (HS) is a hereditary disease of hemolytic anemia that occurs due to the erythrocyte membrane defects. Dubin-Johnson syndrome (DJS), which commonly results in jaundice, is a benign hereditary disorder of bilirubin clearance that occurs only rarely. The co-occurrence of HS and DJS is extremely rare. We recently diagnosed and treated a case of co-occurring HS and DJS. CASE SUMMARY: A 21-year-old female patient presented to our department because of severe jaundice, severe splenomegaly, and mild anemia since birth. We eventually confirmed the diagnosis of co-occurring DJS and HS by next generation sequencing (NGS). The treatment of ursodeoxycholic acid in combination with phenobarbital successfully increased hemoglobin and reduced total bilirubin and direct bilirubin. CONCLUSION: The routine application of NGS can efficiently render a definite diagnosis when inherited disorders are suspected.

[Predicting early response to immunosuppressive therapy in severe aplastic anemia by soluble transferrin receptor assay].

OBJECTIVE: To evaluate the value of serum soluble transferrin receptor (sTfR) concentration in predicting early response to immunosuppressive therapy (IST) in severe aplastic anemia (SAA). METHODS: Clinical data and hematologic responses of 140 SAA patients treated with rabbit antithymocyte globulin (rATG) combination with cyclosporine in our hospital were retrospectively analyzed. Correlation of pre-IST baseline of sTfR and IST responses was statistically analyzed and receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of sTfR in prediction of early responses. RESULTS: Serum concentration of sTfR in very SAA (VSAA) patients were significantly lower than SAA and transfusion dependent non-SAA cases (P=0.001). The responders, especially at 3 months, had significantly higher pre- IST baseline of sTfR [median, 0.89 (range, 0.21-2.42) mg/L] than that [median, 0.58 (range, 0.13-1.88) mg/L] of non-responders (P=0.005). The cutoff level of 0.91 mg/L and 0.88 mg/L for predicting responses at 3 and 6 months were established based on the ROC curve, with the degree of accuracy of 65.0% and 60.7% respectively. Multivariate analysis showed that pre-IST baseline of sTfR was the independent factor of predicting response at 3 months (P=0.007) and at 6 months (P=0.021). CONCLUSION: As a indicator of bone marrow failure severity, sTfR could predict early response to IST therapy in aplastic anemia.

[Adaptive optimized technologies for ecological sanitation and their complex ecological benefits].

Aiming at the ecological characters of the cities in central and west China, several ecological sanitary (ecosan) technologies with different adaptability were integrated, and five adaptive optimized technologies were established. The environmental effects, resources recyclable potential, economic benefits, management difficulties, and public acceptance of each of the technologies were studied, with the possible complex eco-benefits of the technical improvement assessed. The results showed that decentralized ecosan technologies had the advantages of conserving water, recycling nutrients and saving cost, but also had the problems in management and public acceptance. Centralized ecosan technologies had the advantages in management and public acceptance, but were short in high cost and low recycling potential. If the sanitary system was improved through applying ecosan technologies, the greenhouse gases emission (CO2 equivalent) and water pollution (calculated as BOD5) could be reduced by 70% and 30%, respectively, while recycled nutrients (the sum of N, P, K) could be increased by 15 times. The optimized system could supply 3% of domestic energy, 10% of domestic water, and 15% of food demand, and the total cost could be reduced by 56% when the resource-recycling benefits were taken into account.

[Application of inverse distance weighted interpolation method in contaminated site assessment].

There are many difficulties in ascertaining the area that needs to be remedied in contaminated site. This paper integrated the experts' judgments with grids as the sampling strategy in an abandoned pesticide plant in northern China, and applied a geostatistical method, inverse distance weighted interpolation (IDW), to simulate the pollutants- and risk spatial distribution. Based on soil environmental benchmark, two scenarios were designed for ascertaining the polluted area. The results showed that the area needed to be remedied and determined by IDW was somewhat larger, according to the national environmental 2nd standard for agricultural soils, but the area and cost needed for remedy were smaller and more economic and reasonable, based on the health risk threshold level and IDW method. A combination of IDW and health risk assessment in ascertaining polluted area would be a new way for site assessment and soil remediation in the future.

[Ecological risk assessment and its research progress].

Ecological risk is a hotspot in the present environmental management study, which mainly focuses on the chemical, physical, and biological stressors that may damage ecosystem or its components. Ecological risk assessment (ERA) has a great significance for making scientific environmental management strategies. In order to lessen the damage of ecosystem or its parts, and to manage the ecosystem effectively, it is necessary to predict the probability the adverse ecological effects would occur and the consequences. This paper summarized the research methods, tools and trends of ERA, and pointed out the areas that need to be further studied. It was suggested that under the background of urbanization, urban ecological risk should be given more attentions. The prospects of further study were discussed, based on the issues existed in current researches.