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BACKGROUND/OBJECTIVES@#This study examined the relationship between famine exposure in early life and the risk of type 2 diabetes in adulthood during the 1959–1961 Chinese Famine. @*SUBJECTS/METHODS@#A total of 3,418 individuals aged 35–74 years free of diabetes from two studies in 2006 and 2009 were followed up prospectively in 2009 and 2012, respectively. Famine exposure was classified as unexposed (individuals born in 1962–1978), fetal exposed (individuals born in 1959–1961), child exposed (individuals born in 1949–1958), and adolescent/adult exposed (born in 1931–1948). A logistic regression model was used to assess the relationship between famine exposure and diabetes after adjustment for potential covariates. @*RESULTS@#During a three-year follow-up, the age-adjusted incidence rates of type 2 diabetes were 5.7%, 14.5%, 12.7%, and 17.8% in unexposed, fetal-exposed, child-exposed, and adolescent/adult-exposed groups, respectively (P < 0.01). Relative to the unexposed group, the relative risks (95% confidence interval) for diabetes were 2.15 (1.29–3.60), 1.53 (0.93– 2.51), and 1.65 (0.75–3.63) in the fetal-exposed, child-exposed, and adolescent/adult-exposed groups, after controlling for potential covariates. The interactions between famine exposure and obesity, education level, and family history of diabetes were not observed, except for the urbanization type. Individuals living in rural areas with fetal and childhood famine exposure were at a higher risk of type 2 diabetes, with relative risks of 8.79 (1.82–42.54) and 2.33 (1.17–4.65), respectively. @*CONCLUSIONS@#These findings indicate that famine exposure in early life is an independent predictor of type 2 diabetes, particularly in women. Early identification and intervention may help prevent diabetes in later life.
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Eight compounds were isolated from ethyl acetate fraction of 80% ethanol extract of the hulls of Garcinia mangostana by silica gel, Sephadex LH-20 column chromatography, as well as prep-HPLC methods. By HR-ESI-MS, MS, 1D and 2D NMR spectral analyses, the structures of the eight compounds were identified as 16-en mangostenone E(1), α-mangostin(2), 1,7-dihydroxy-2-(3-methy-lbut-2-enyl)-3-methoxyxanthone(3), cratoxyxanthone(4), 2,6-dimethoxy-para-benzoquinone(5), methyl orselinate(6), ficusol(7), and 4-(4-carboxy-2-methoxyphenoxy)-3,5-dimethoxybenzoic acid(8). Compound 1 was a new xanthone, and compound 4 was a xanthone dimer, compound 5 was a naphthoquinone. All compounds were isolated from this plant for the first time except compounds 2 and 3. Cytotoxic bioassay suggested that compounds 1, 2 and 4 possessed moderate cytotoxicity, suppressing HeLa cell line with IC_(50) va-lues of 24.3, 35.5 and 17.1 μmol·L~(-1), respectively. Compound 4 also could suppress K562 cells with an IC_(50) value of 39.8 μmol·L~(-1).
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Humans , Garcinia mangostana/chemistry , HeLa Cells , Antineoplastic Agents , Magnetic Resonance Spectroscopy , Xanthones/pharmacology , Garcinia/chemistry , Plant Extracts/chemistry , Molecular StructureABSTRACT
Acteoside is among the most widespread of thedisaccharide caffeoyl esters that are widely distributed in the plant kingdom with diverse biological activities. Recent studies have shown that acteoside has neuroprotective activity in neurodegenerative diseases. This review examines and extrapolates from the recent literature to build support for the use of acteoside in mitigating neuropathy in neurodegenerative disease, including Parkinson ' s disease (PD) and Alzheimer' s disease (AD). We summarize the main pharmacokinetic parameters of acteoside in animals after different administration routes. Meanwhile, we point out both problems and shortcomings, and highlight its future development trend.
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Objective To observe the therapeutic effect of discontinuation pyeloplasty in children with hydronephrosis.Analyze the factors that affect the recovery of postoperative renal function.Methods A retrospective analysis was performed on 125 children with hydronephrosis caused by unilateral ureteropelvic junction obstruction from January 2014 to December 2015 in Hunan Children's Hospital.Preoperative and postoperative renal pelvis anteroposterior diameter,renal parenchymal thickness,segmental artery resistance index,glomerular filtration rate (GFR),blood urea nitrogen,serum creatinine and other indicators were observed.The measurement data were expressed as mean ± standard deviation (Mean ± SD),and paired t-test was used for inter-group comparison,and Chi-square test was used for inter-group comparison of counting data.Logistic regression analysis was performed on the factors such as sex,age,hydronephrosis location and hydronephrosis degree before operation,and the important factors affecting postoperative renal function recovery were screened out.Results Postoperative renal pelvis anteroposterior diameter (1.87 ± 1.02) cm,renal parenchyma thickness (6.34 ± 1.41) mm,segmental arterial resistance index (0.68 ± 0.05),GFR (40.54 ± 3.25) ml/min,blood urea nitrogen (2.18 ± 1.24) mmol/L and serum creatinine (27.54 ± 6.21) μg/ml and other indicators were better than preoperative,the difference were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed that the degree of hydronephrosis,age and level of renal function were the influencing factors of renal function recovery (P ＜ 0.05).The postoperative recoveryof renal function was not related to gender,location of hydronephrosis,surgical methods and other factors (P ＞ 0.05).Conclusions Pyeloplasty is good for children with hydronephrosis,it can improve the degree of patients with hydronephrosis,improve renal function recovery.Preoperative patients with age,degree of hydronephrosis and sub-renal function levels affect postoperative renal function recovery.
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Objective@#To analyze the relationship between the expression of homeobox A13 (HOXA13), epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) gene in prepuce tissue of children with congenital hypospadias, discuss the relationship and significance of HOXA13, EGF and EGFR genes in congenital hypospadias and to understand their role in the pathogenesis of hypospadias.@*Methods@#65 cases of hypospadias were selected as the experimental group and 42 cases of phimosis as the control group. Hematoxylin-eosin (HE) staining was used to observe the pathological characteristics of prepuce tissues in the two groups. Immunohistochemistry, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blot were used to detect the expression of HOXA13, EGF and EGFR in the two groups.@*Results@#⑴ HE staining showed that the epidermis of hypospadias was composed of keratinized stratified flat epithelium and epidermis of penile skin. The prepuce of phimosis children showed only infiltration of inflammatory cells in the superficial layer of the inner prepuce, blood vessel congestion, no obvious appendage structure, mostly fibroblasts. ⑵ Immunohistochemistry: The positive expressions of HOXA13, EGF and EGFR in the control group were significantly higher than those in the experimental group (P<0.01). ⑶ qRT-PCR: The expression levels of HOXA13, EGF and EGFR in the control group were 53.447±33.471, 80.012±20.430, 75.012±14.339, and the expression levels of HOXA13, EGF and EGFR in the experimental group were 9.128±5.996, 45.521±18.242, 32.043±10.215, respectively. The expression of HOXA13, EGF and EGFR in the control group was significantly higher than that in the experimental group (P<0.01). ⑷ Western blot: The expression levels of HOXA13, EGF and EGFR in the experimental group were lower than those in the control group.@*Conclusions@#The expression of HO-XA13, EGF and EGFR in prepuce tissue of children with hypospadias is low, which may be related to hypospadias.
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Objective To analyze the relationship between the expression of homeobox A13 (HOXA13),epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) gene in prepuce tissue of children with congenital hypospadias,discuss the relationship and significance of HOXA13,EGF and EGFR genes in congenital hypospadias and to understand their role in the pathogenesis of hypospadias.Methods 65 cases of hypospadias were selected as the experimental group and 42 cases of phimosis as the control group.Hematoxylin-eosin (HE) staining was used to observe the pathological characteristics of prepuce tissues in the two groups.Immunohistochemistry,real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blot were used to detect the expression of HOXA13,EGF and EGFR in the two groups.Results (1) HE staining showed that the epidermis of hypospadias was composed of keratinized stratified flat epithelium and epidermis of penile skin.The prepuce of phimosis children showed only infiltration of inflammatory cells in the superficial layer of the inner prepuce,blood vessel congestion,no obvious appendage structure,mostly fibroblasts.(2) Immunohistochemistry:The positive expressions of HOXA13,EGF and EGFR in the control group were significantly higher than those in the experimental group (P ＜ 0.01).(3) qRT-PCR:The expression levels of HOXA13,EGF and EGFR in the control group were 53.447 ±33.471,80.012 ±20.430,75.012 ± 14.339,and the expression levels of HOXA13,EGF and EGFR in the experimental group were 9.128 ± 5.996,45.521 ± 18.242,32.043 ± 10.215,respectively.The expression of HOXA13,EGF and EGFR in the control group was significantly higher than that in the experimental group (P ＜0.01).(4) Western blot:The expression levels of HOXA13,EGF and EGFR in the experimental group were lower than those in the control group.Conclusions The expression of HOXA13,EGF and EGFR in prepuce tissue of children with hypospadias is low,which may be related to hypospadias.
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Objective To analyze the evaluation results of malaria elimination and summarize the experience in Jiujiang City, so as to provide the evidence for formulating the surveillance work plan post-malaria elimination. Methods According to the requirements and arrangements of Jiangxi Eliminating Malaria Action Plan (2010 – 2020), the evaluation of malaria elimination was completed in all 13 counties (cites and districts) of Jiujiang City from 2013 to 2016, and the data were collected and analyzed. Results In Jiujiang City, the last local malaria case was reported in 2008. From 2010 to 2016, there were 20 imported malaria cases reported, including 12 cases of falciparum malaria, 7 cases of vivax malaria, and 1 case of mixed infection. Totally 67 501 fever patients were tested for Plasmodium and 13 cases were positive, with the positive rate of 0.02%. The comprehensive evaluation scores were between 88.75 and 98.15 in all the 13 counties (cities and districts), which meant they all reached the evaluative criteria. Conclusion All 13 counties (cities and districts) of Jiujiang City have passed the city level evaluative criteria of malaria elimination, and the key work should be the prevention and surveillance of imported malaria in the future.
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Objective To analyze the evaluation results of malaria elimination and summarize the experience in Jiujiang City, so as to provide the evidence for formulating the surveillance work plan post-malaria elimination. Methods According to the requirements and arrangements of Jiangxi Eliminating Malaria Action Plan (2010 – 2020), the evaluation of malaria elimination was completed in all 13 counties (cites and districts) of Jiujiang City from 2013 to 2016, and the data were collected and analyzed. Results In Jiujiang City, the last local malaria case was reported in 2008. From 2010 to 2016, there were 20 imported malaria cases reported, including 12 cases of falciparum malaria, 7 cases of vivax malaria, and 1 case of mixed infection. Totally 67 501 fever patients were tested for Plasmodium and 13 cases were positive, with the positive rate of 0.02%. The comprehensive evaluation scores were between 88.75 and 98.15 in all the 13 counties (cities and districts), which meant they all reached the evaluative criteria. Conclusion All 13 counties (cities and districts) of Jiujiang City have passed the city level evaluative criteria of malaria elimination, and the key work should be the prevention and surveillance of imported malaria in the future.
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We assessed genetic and environmental effects on bone development of the hand and wrist, and on key anthropometric measures in Chinese young twins. In total, 139 monozygotic and 95 dizygotic twin pairs aged from 5 to 18 years were recruited. The twin correlations of total hand and wrist scores for monozygotic (MZ) and dizygotic (DZ) twins were 0.71 and 0.36, respectively. Bivariate model analysis showed moderate genetic correlations only for total skeletal maturity vs. weight and total skeletal maturity vs. waist circumference (r, 0.51 and 0.46, respectively). Our findings demonstrated that genetic factors played important roles in bone development of the hand and wrist in Chinese young twins, and that these genetic effects might be distinct from those influencing anthropometric measures.
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Adolescent , Child , Child, Preschool , Humans , Bone Development , Genetics , China , Environmental Exposure , Hand Bones , Twins, Dizygotic , Twins, Monozygotic , WristABSTRACT
<p><b>OBJECTIVE</b>To determine whether elevated serum uric acid (UA) levels are associated with type 2 diabetes diagnosed using HbA1c levels among Chinese adults.</p><p><b>METHODS</b>We conducted two population-based cross-sectional studies in Qingdao in China in 2006 and 2009. A total of 6894 (39.4% men) subjects aged 35-74 years were included in the data analysis. Newly diagnosed diabetes was defined as HbA1c level of ⋝6.5%, and prediabetes was classified as HbA1c level between 5.7% and 6.4% according to the International Diabetes Federation criteria. Multivariate logistic regression was employed to assess the association between UA and prevalence of type 2 diabetes defined using Glycated hemoglobin A1c (HbA1c) levels.</p><p><b>RESULTS</b>Subjects with prediabetes had higher UA levels than those with normal glucose tolerance, newly diagnosed diabetes, and known diabetes, with corresponding values of 325.1 (82.5) µmol/L, 310.9 (84.2) µmol/L, 291.3 (81.7) µmol/L, 305.2 (83.6) µmol/L, respectively (P<0.001 for all comparisons). Binary logistic regression analysis showed that UA was a possible predictor for the prevalence of type 2 diabetes diagnosed using HbA1c levels, and the second quartile of UA levels had a higher odds ratio (OR: 4.088; 95% CI: 2.900-5.765) for HbA1c than the other quartiles after adjusting for age, body mass index, sex, marital status, education, income, alcohol consumption, smoking, and cardiometabolic parameters.</p><p><b>CONCLUSION</b>Serum UA is significantly associated with type 2 diabetes diagnosed using HbA1c levels, independent of other cardiometabolic parameters.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Asian People , China , Epidemiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , Blood , Epidemiology , Glycated Hemoglobin , Metabolism , Prevalence , Uric Acid , BloodABSTRACT
<p><b>OBJECTIVE</b>Since the incidence rates and risk factor for type 2 diabetes in Chinese populations had not been well known, the aim of this study was to evaluate the impact of weight change and other risk factors on incident type 2 diabetes in Qingdao, China.</p><p><b>METHODS</b>A prospective population-based cohort study was carried out, based on subjects aged 35-74 years who participated in the 'Qingdao Diabetes Survey' in 2006. Subjects were free of diabetes at baseline. A total of 1 294 subjects attended the follow up survey between 2009 and 2011. The diagnostic criteria for Diabetes was classified according to both the World Health Organization and the International Diabetes Federation 2006. A logistic regression was built using the backward stepwise selection to assess the effects of risk factors on the incident type 2 diabetes.</p><p><b>RESULTS</b>During a 4-year follow up period, 120 cases with incident type 2 diabetes were identified, with cumulative incidence of diabetes as 11.8% . Participants who developed type 2 diabetes were significantly older, having significantly higher age-adjusted BMI/waist circumference/systolic blood pressure and total cholesterol, than those subjects who remained non-diabetic both in urban and rural areas. Among individuals with no diabetes at the baseline, factors as age, living in the rural areas, baseline BMI and weight change had all independently contributed to the development of diabetes. The multivariate adjusted relative risks (95%CIs) related to the incidence of diabetes were 1.45 (1.13-1.87), 1.93 (1.12-3.34), 1.46 (1.05-2.03) and 1.49 (1.18-1.88), respectively, for a one standard deviation increase in continuous variables. Compared with the reference group of non-obese and with stable weight, factor as weight loss >5% and BMI <28 kg/m² were independently associated with a 67% (RR = 0.33, 95% CI: 0.11-0.97)reduction in the risk of type 2 diabetes, while BMI >28 kg/m² could increase the risk across the levels of weight change. Similar trends were observed in higher waist and weight gain at baseline.</p><p><b>CONCLUSION</b>This study confirmed the critical importance of obesity in the development of type 2 diabetes. Baseline BMI and weight gain appeared independent predictors on type 2 diabetes.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Body Mass Index , Body Weight , China , Epidemiology , Diabetes Mellitus, Type 2 , Epidemiology , Follow-Up Studies , Incidence , Logistic Models , Prospective Studies , Risk Factors , Weight GainABSTRACT
Objective To evaluate the clinical features,therapies and prognosis in patients with mucosa-assoeiated lymphoid tissue (MALT) lymphoma in ocular adnexal marginal zone (OAML).Methods A retrospective analysis was made upon clinical data from 21 patients with OAML admitted into Beijing Tongren Hospital from June,2008 to December,2011.Results There were 12 (57.1 ％) men and 9(42.9％) women,with a median age of 57 (23-79) years old.Majority of patients had localized pathological changes.Among them,16 patients (76.2％) were in stage Ⅰ E,and 5 (23.8％) in stage Ⅳ E.Surgical resection as the sole treatment was performed in 13 patients (61.9％),and positron emission tomography CT(PET-CT) imaging demonstrated normal fluorine 18-fluorodeoxyglucose (FDG) uptake after surgical resection,who were managed with no further therapy.All the 13 patients were followed up for median 14 (5-38) months,and all in complete remission.Combination chemotherapy was given to 8(38.1％) patients.Three patients in stage Ⅰ E treated with COP (cyclophosphamide,vineristine and prednisone) or CHOP (cyclophosphamide,adriamycin,vincristine and prednisone) were all in partial remission.Five patients in stage ⅣE were treated with COP/CHOP in combination with rituximab,and all in complete remission.The 3-year overall survival rate and disease-free survival rate in the total patients were 100.0％ and 74.9％ respectively.Conclusions The patients with OAML generally have localized disease,show indolent clinical course,and present low lymphoma-related mortality.Surgical resection is a very important treatment in the patients with local disease.Systemic chemotherapy should be considered in patients at advanced stages.Rituximab in combination with chemotherapy can improve the remission rate.
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Objective To study clinical features, treatment and prognosis of nasal NK/T cell lymphoma associated Hemophagocytic Syndrome (HPS).Methods Retrospectively analysis method was used to analyze the clinical data of 3 patients with nasal NK/T cell lymphoma associated HPS. Results 3 patients with nasal NK/T cell lymphoma fulfilled the criteria of HPS. All patients had adverse prognostic factors of lymphoma.1 patient developed HPS as the main primary manifestations of underlying lymphoma,the other 2 patients developed HPS during lymphoma progression. In three cases, bone marrow was infiltrated with lymphoma cells.When HPS occurred,the disease progressed rapidly.The most obvious clinical features were fever,pancytopenia,hypofibrinogenemia,hyperferritinemia,and hemophagocytosis in bone marrow. After being treated according to the HLH-2004 combined with chemotherapy, all patients showed a clinical response,but with the progression of lymphoma,HPS quickly relapsed,and all patients died of severe hepatic dysfunction,coagulopathy,or DIC.Conclusion Nasal NK/T lymphoma associated HPS is an invariably fatal disease with poor prognosis,typically occurring at advanced stage or the terminal phase of the disease.HLH-2004 based protocol in combination with chemotherapy is helpful for nasal NK/T cell lymphoma associated HPS,which may delay disease progression and provid opportunities for the treatment of primary disease.
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<p><b>OBJECTIVE</b>To compare the expression of nuclear matrix proteins (NMPs) in benign prostatic hyperplasia (BPH) epithelial cell line BPH-1 versus those in androgen-dependent human prostate cancer cell line LNCap and androgen-independent prostate cancer cell line PC-3.</p><p><b>METHODS</b>We isolated NMPs from the BPH-1, LNCap and PC-3 cell lines by 2-dimensional electrophoresis (2-DE), analyzed the differentially expressed proteins by matrix-assisted laser desorption / ionization time of flight mass spectrometry (MALDI-TOF-MS), and identified them by peptide mass fingerprint and database searching.</p><p><b>RESULTS</b>We successfully obtained well-resolved reproducible 2-DE patterns of NMPs in human prostate cancer cell lines, identified 12 differentially expressed NMPs including enzymes, regulatory proteins, RNA-binding protein and various other factors, 3 up-regulated and 9 down-regulated in prostate cancer cell lines.</p><p><b>CONCLUSION</b>There are obvious differences in the expressions of NMPs between human prostate cancer cell lines and benign prostatic hyperplasia epithelial cell line.</p>
Subject(s)
Humans , Male , Cell Line , Cell Line, Tumor , Electrophoresis, Gel, Two-Dimensional , Nuclear Matrix-Associated Proteins , Metabolism , Prostatic Hyperplasia , Metabolism , Prostatic Neoplasms , Metabolism , Proteome , Proteomics , Spectrometry, Mass, Matrix-Assisted Laser Desorption-IonizationABSTRACT
The aim of this study was to analyze the efficacy of first-line chemotherapy in treating patients with ocular adnexal extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). Eight consecutive newly diagnosed ocular adnexal MALT lymphoma patients were treated with chemotherapy, in which 3 patients in stage IE were treated with a combination of cyclophosphamide, vincristine and prednisolone (COP) or cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP), 5 patients in stage IV were treated with COP/CHOP in combination with rituximab. The results showed that chemotherapy resulted in an overall response rate of 100%, 3 patients in stage IE were in partial remission (PR), 5 patients in stage IV were in complete remission (CR). After a median follow-up of 21 months, 3 patients in stage IE were still in PR status, 5 patients in stage IV were still in CR status, and no relapses or disease progression were observed. It is concluded that the first-line chemotherapy has been confirmed to be effective and well tolerated in patients with localized ocular adnexal MALT lymphoma. Rituximab combined with chemotherapy can increase remission rate, it is feasible option as first-line treatment for ocular adnexal MALT lymphoma.
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Adult , Aged , Female , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Eye Neoplasms , Drug Therapy , Lymphoma, B-Cell, Marginal Zone , Drug TherapyABSTRACT
This paper introduces the familiar mothed for standard clinic novitiate, lecture compiling, preparation before the classes and concrete execution. By compiling standard lecture, training the teaches, regulating the novitiate teaching quality for practical curricula can be improved.
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OBJECTIVE@#To investigate the causes and features of medical disputes in percutaneous coronary intervention (PCI) in the cardiology and to provide references for forensic expert testimony and medical disputes prevention.@*METHODS@#Fifty one disputed fatal cases in PCI were analyzed in terms of the cause of death, informed consent and medical operations retrospectively.@*RESULTS@#Thirty five cases were due to medical negligence, 28 due to defect technical operation, 2 due to mistake medical management and 5 due to both defect technical operation and mistake medical management.@*CONCLUSION@#The causes of PCI medical negligence are defect medical operation, violate medical disciplines and insufficiency of informed consent.
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Adult , Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Cause of Death , Coronary Artery Disease/therapy , Expert Testimony , Malpractice , Medical Errors/statistics & numerical data , Myocardial Infarction/etiology , Postoperative Complications/etiology , Retrospective StudiesABSTRACT
Objective To explore the clinical related prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treating malignant hematological diseases. Methods From September 1997 to August 2008,a total of 26 patients with hematological diseases were treated with allo-HSCT from HLA identical-sibling and haplo-identical donors in our hospital, including 14 patients with acute leukemias,10 with chronic myeloid leukemias,and 2 myelodysplastic syndromes. Results All patients achieved sustained full donor type engraftment. The cumulative overall survival (OS) was 63.9 %,and cumulative disease free survival (DFS) was 62.6 %. Fifteen patients had graft-versus-host disease (GVHD) (57.7 %),including 8 acute GVHD(aGVHD) (30.8 %) (grade Ⅲ-Ⅳ aGVHD was 15.4 %) and 7 chronic GVHD. GVHD between HLA identical-sibling and haplo-identical donors was different and there was statistic difference between the two groups (P=0.014). 4 patients relapsed,7 patients died. The univariate analysis showed OS were correlated with grade Ⅳ aGVHD (P=0.05) and CMV infection (P=0.027). Conclusion Allo-HSCT is effective for the cure of patients with malignant hematological diseases. The key to improve the efficacy of HSCT is to reduce the incidence of transplant-related complications,especially GVHD and infection.
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Objective To study the engraftment syndrome (ES) and the possible etiology after haploidentical allognneic hematopoietic stem cell transplantation (al]o-HSCT). Methods The clinical manifestation, treatment and outcome of a chronic myeloid leukemia patient who after allo-HSCT were presented. Results The patient started to cough on day 2 after allo-HSCT, dry cough at beginning, white foam sputum, non-infectious fever, fluid retention, weight gain, transient encephalopathy on day 4. The clinical symptoms were improved after treatment with corticosteroids, in which ES was diagnosed. Conclusion ES is a series of clinical syndromes following transplantation which is different from acute graft versus host disease. It occurred after HSCT, and corticosteroids are often effective. Therefore early recognition and accurate diagnosis is very important.
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<p><b>OBJECTIVE</b>To explore early diagnosis of hemophagocytic syndrome (HPS) and effective treatment.</p><p><b>METHODS</b>A multicenter retrospective study was carried out to analyze the causes, clinical features, laboratory findings, treatment and clinical outcomes of 72 patients with HPS.</p><p><b>RESULTS</b>Among the 72 patients, EBV infection and T lymphoma were the most common initiating diseases. The most common clinical features were persistent fever (100%) and splenomegaly (83.3%). The diagnostic sensitivity was persistent fever (100%), peripheral cytopenia in two or more lineages (97.2%), high concentration of serum soluble CD25 (93.1%) and low NK cell activity (94.4%). The median percentage of serum glycosylated ferritin was significantly lower in patients in HPS group \[(17.4 +/- 16.0)%\] than in control group \[(53.6 +/- 13.3)%\] (P < 0.01). And the median level of serum TNF-alpha was significantly higher in patients group \[(143.2 +/- 64.8) microg/L\] than in controls \[(66.9 +/- 19.4) microg/L\] (P < 0.01). Hepatic dysfunction was seen in most patients (83.6%) mainly manifested as elevated liver enzymes and hypoalbuminemia. The 15-week total survival rate was 46.8% in 47 treated patients, and was 63% in 27 treated with fludarabine in combination with high dose methylprednisolone. The platelet count and fibrinogen level were significantly lower in death group than in survival group.</p><p><b>CONCLUSIONS</b>The diagnostic sensitivities of presistent fever, peripheral cytopenia in two or more lineages, high concentration of serum soluble CD25 and low NK cell activity are relatively high and lacking hemophagocytosis does not exclude the diagnosis. Low percentage of glycosylated ferritin and high concentration of TNF-alpha would be helpful to the diagnosis. High dose methylprednisolone combined with fludarabine is an effective therapy. Platelet count and fibrinogen level are poor prognostic factors for HPS.</p>