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The cultivation of medical humanistic quality is indispensable in the standardized training of pediatric residents, and it is urgent to explore new educational methods to improve their medical humanistic quality level. In this study, 60 standardized pediatricians participated in the standardized training, 36 in the experimental group received innovative interactive medical humanities education, while 24 in the control group were set up to receive traditional medical humanities education. Short-term and long-term test scores were conducted by questionnaire at the beginning of the standardized training and 2 years later. The results showed that there was no significant difference between the experimental group and the control group in the self-scores of professional quality, moral cultivation, communication skills, legal knowledge and innovative spirit (P>0.05) , but the scores of teaching teachers were improved except innovative spirit (P<0.05) . In addition, compared with the control group, the number of pediatricians with professional honor increased, the doctor-patient communication ability improved, the medical disputes reduced, and the family satisfaction improved in experimental group were increased (P<0.05) . These results indicated that innovative interactive medical humanistic education is an effective method to improve the medical humanistic quality of pediatric residents in standardized training.
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Objective@#To investigate the safety and efficacy of haploidentical hematopoietic stem cell transplantation with different intensity conditioning regimen in the treatment of childhood aplastic anemia (AA) .@*Methods@#Thirty-seven AA patients who underwent haploidentical transplantation in BaYi Children's Hospital Affiliated to PLA Army General Hospital from January 2013 to January 2017 were enrolled. According to the dosage of conditioning regimen, 34 patients excluding 3 other conditioning regimens were divided into high-dosage group (regimen 2, 22 cases) and low-dosage group (regimen 3, 12 cases). The data of Engraftment, graft-vs-host disease (GVHD), hematopoietic reconstitution, relapse, infection, overall survival (OS) were analyzed. The comparison between the two groups was tested by χ2 test.@*Results@#A total of 35 of 37 patients achieved primary engraftment; 2 cases died of regimen-related toxicity and severe infection before the infusing of the grafts. The activation rate of CMV and EBV was 60% (21/35) . Post-transplant lymphocyte disease (PTLD) of lung occurred in one case. The cumulative incidences of acute GVHD grade Ⅰ-Ⅳ and chronic GVHD were 29% (10/35) and 34% (12/35) respectively and the incidence of extensive chronic GVHD was 6% (2/35) . The median follow-up time was 18.8 (2.9-44.1) months, the OS was 92% (34/37) .All survived patients were no longer dependent on blood transfusion and none of them had recurrence. Comparing the rates of overall survival(86%(19/22) vs.100%(12/12)) and rates of chronic GVHD(40%(8/20) vs. 17%(2/12)) in regimen 2 and regimen 3 group, there were no significant difference (χ2=1.742, 1.841, all P>0.05) . Significant difference was found at the incidence of Ⅰ-Ⅳ acute GVHD (10% (2/20) vs. 50% (6/12) ,χ2=6.200, P=0.013).@*Conclusions@#Haploidentical hematopoietic stem cell transplantation is effective and safe. It is suitable for patients who are not eligible for matched donor transplantation. Application of reduced dose preconditioning in haploid transplantation is worth exploring.
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Significant improvements in hematopoietic stem cell transplantation (HSCT) with haploidentical family donors (HFD) have confirmed its therapeutic role in severe aplastic anemia (SAA) and led to the evolution of treatment algorithms. However, the optimal conditioning regimen for HFD-HSCT remains undefined, especially the dosage of cyclophosphamide (Cy). A total of 77 patients with SAA from two research centers, who received HFD-HSCT with reduced-intensity fludarabine + cyclophosphamide + thymoglobulin ± busulfan conditioning regimen plus third-party cells infusion were included in this study, of which 67 pairs had 4-5 loci mismatched. We were particularly interested in whether the dosage of Cy significantly impacted graft failure (GF) and overall survival (OS). All patients showed sustained hematopoietic engraftment without any increase in severe aGVHD and transplantation-related mortality (TRM). The incidences of grade II-IV aGVHD, grade III-IV aGVHD and extensive cGVHD were 18%, 10% and 7%, respectively. The probabilities of 1-year and 5-year OS were 93.1% and 87.9%, respectively. Furthermore, patient age <15 years, MNC cells >8×108/kg and donor age <45 years were associated with better survival (P=0.043, P=0.023, and P=0.037, respectively) and engraftment (P=0.019, P=0.008, and P=0.001, respectively). Our findings indicated that SAA patients lack MSD benefited the most if HFD-HSCT was performed with reduced-intensity fludarabine-based conditioning regimen. Improved outcomes with HFD-HSCT may lead to a salvaged therapy and an expanded direct role for SAA in the future.
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Haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) is widely carried out in China, and transplantation related complications decreased gradually with the transplant technology improving, and the overall survival(OS) increased year by year. However, relapse after transplantation is still one of the main causes of death in patients with hematological malignancy. In order to reduce the recurrence after HSCT, we set a tumorablative conditioning regimen (TAC ) regimen; the aim is as much as possible to eliminate the malignant clone to reduce the recurrence without increasing the conditioning toxicity. We retrospectively analyzed 102 cases of haplo-HSCT in our hospital from 2012 to 2017. Ninety-eight out of the 99 (99.0%) patients achieved primary engraftment. The 2-year OS and disease free survival (DFS) are 81.4% (83/102) and 77.45% (79/102). The cumulative incidence of leukemia relapse is 16.2% (16/99), Twenty-nine patients developed II-IV acute graft-versus-host disease (aGVHD) (29%) within 100 days and only nine patients have grade III-IV aGVHD (9%) in measurable 99 patients. The conditioning regimen was relatively well tolerated with limited regimen-related toxicity. The preliminary results show that TAC is safe and effective in haplo-HSCT of children with hematologic malignancies. This study will provide a clinical basis for the individualized conditioning regimen.
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Objective To evaluate the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) with supplemental umbilical cord blood (UCB) infusion in treatment of malignant hematological diseases.Method Clinical data of 66 patients with hematological malignancies treated with HSCT in our hospital between January 2010 and May 2013,were retrospectively analyzed.Among them 25 cases received infusion of human UCB before HSCT (experimental group) and other 41 cases had no UCB injection before HSCT (control group).Results There were no differences in age,gender,donor type,disease categories,disease status before transplant between two groups (P ＞ 0.05).There was a significant difference in conditioning regimes between two groups (P ＜ 0.05),but no clinical implication.The infused mononuclear cell (MNC) count in experimental group was higher than that in control group (9.94 ± 2.88 × 108/kg vs.7.80 ±0.82 × 108/kg,P =0.00),while there were no difference in infused CD34 + cell count (5.46 ±3.54 × 106/kg vs.3.54 ± 1.60 × 106/kg,P =0.16).Neutrophil recovery time in experimental group was shorter than that in control group (13.7 ±2.9 d vs.16.6 ±2.9 d,P =0.023).The incidences of grade Ⅲ-Ⅳ acute graft versus host disease (aGVHD,P =0.036),bacterial infection (P =0.001) and fungal infection (P =0.001)and hemorrhagic cystitis (P =0.00)in experimental group were lower than those in control group.There were no significant differences in platelet recovery time(P =0.43),the incidence of grade Ⅰ-Ⅱ aGVHD (P =0.27),implanted syndrome (P =0.24),sinusoidal obstruction syndrome (P =0.57)and viraemia (P =0.31)between two groups.Conclusion HSCT with supplemental infusion of human UCB may alleviate the degree of aGVHD,but the long-term outcome remains to be studied.
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<p><b>OBJECTIVE</b>To determine the predicative significance of HRV and HRT to premature beat on patients with coal-worker's pneumoconiosis.</p><p><b>METHODS</b>100 coal-worker's pneumoconiosis patients with premature beat (including 44 cases of occasional ventricular premature contraction and 56 cases of frequent ventricular premature contraction) were chosen as CWP group, and 50 healthy coal workers were chosen as control group. 24 h DCG was used to monitor and analyze the change of premature beat and to calculate HRV. Index: SDNN, SDANN, HFLF, HRT: TO, TS, compare HRV of CWP group and control group and the changes of HRT of both occasional and frequent ventricular premature contraction.</p><p><b>RESULTS</b>The incidence of CWP at night (66.1%, 37 cases) is higher than that during daytime (33.9%, 19 cases), and the difference is statistically significant with P < 0.05. HRV (SDNN SDANN HF HL) indexes of CWP group are lower than control group, and the difference is statistically significant with P < 0.05. HRV indexes of control group at night are higher than that during daytime, and the difference is statistically significant with P < 0.05. Comparison of CWP group HRV indexes between day and night is statistically insignificant with P > 0.05. Compared with control group, TO of CWP group is higher while TS is lower, and the difference is statistically significant with P < 0.05. Compared with occasional ventricular premature contraction patients in CWP group, TO of frequent ventricular premature contraction patients is higher while TS is lower, and the difference is statistically significant with P < 0.05.</p><p><b>CONCLUSION</b>Frequent ventricular premature contraction group in CWP group suffer from severe impaired autonomic nervous function injury, and abnormal HRV and HRT can be prognostic indicator of frequent ventricular premature contraction among coal-worker's pneumoconiosis patients.</p>
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Aged , Humans , Male , Middle Aged , Anthracosis , Case-Control Studies , Heart Rate , Physiology , Ventricular Premature Complexes , DiagnosisABSTRACT
Objective To explore the efficiency and prognosis of hematological malignancies treated by haploidentical hematopoietic stem cell transplantation.Methods 70 patients who received haploidentical hematopoietic stem cell transplantation were analyzed retrospectively.According to tumor burden before transplantation,the patients were divided into three groups,the low tumor burden group,the mediate tumor burden group and the high tumor burden group.And then the effection of the tumor burden to survival was analyzed,and the engraftment,GVHD,infection,conditioning related toxicity,relapse and survival rate were also observed.Results The follow-up was terminated on January 1,2014.Follow-ups were performed for a median of 34.05 (7.4-83.6) months after transplantation.All patients achieved engraftments.The cumulative incidence of GVHD of grades 2-4 was 47.14 ％ (33/70) and that of grades 3-4 was 21.4 ％ (15/70).The chronic extensive GVHD was 20.0 ％ (14/70).The overall survival was 68.6 ％.Transplant-related mortality was 12.8 ％ and the relapse was 18.6 ％.The overall survivals in low tumor burden group,mediate tumor burden group,high tumor burden group were 91.67 ％,72.7 ％,33.3 ％ respectively.By SPSS 20.0,tumor burden was the high risk factor affecting the survival (low tumor group vs high tumor group,mediate tumor group vs high tumor group,low tumor group vs high tumor group,P =0.000,P =0.038,P =0.016).Conclusions Haploidentical hematopoietic stem cell transplantation in hematological malignancies is safe and effective.And for hematological malignancies with poor prognosis disease,it should be accepted the HSCT as soon as possible after remission in order to reduce the recurrence rate of malignancy.
