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OBJECTIVE@#To explore the risk factors of cytomegalovirus (CMV) and refractory CMV infection (RCI) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and their influences on survival.@*METHODS@#A total of 246 patients who received allo-HSCT from 2015 to 2020 were divided into CMV group (n=67) and non-CMV group (n=179) according to whether they had CMV infection. Patients with CMV infection were further divided into RCI group (n=18) and non-RCI group (n=49) according to whether they had RCI. The risk factors of CMV infection and RCI were analyzed, and the diagnostic significance of Logistics regression model was verified by ROC curve. The differences of overall survival (OS) and progression-free survival (PFS) between groups and the risk factors affecting OS were analyzed.@*RESULTS@#For patients with CMV infection, the median time of the first CMV infection was 48(7-183) days after allo-HSCT, and the median duration was 21 (7-158) days. Older age, EB viremia and gradeⅡ-Ⅳacute graft-versus-host disease (aGVHD) significantly increased the risk of CMV infection (P=0.032, <0.001 and 0.037, respectively). Risk factors for RCI were EB viremia and the peak value of CMV-DNA at diagnosis≥1×104 copies/ml (P=0.039 and 0.006, respectively). White blood cell (WBC)≥4×109/L at 14 days after transplantation was a protective factor for CMV infection and RCI (P=0.013 and 0.014, respectively). The OS rate in CMV group was significantly lower than that in non-CMV group (P=0.033), and also significantly lower in RCI group than that in non-RCI group (P=0.043). Hematopoietic reconstruction was a favorable factor for OS (P<0.001), whereas CMV-DNA≥1.0×104 copies/ml within 60 days after transplantation was a risk factor for OS (P=0.005).@*CONCLUSION@#The late recovery of WBC and the combination of EB viremia after transplantation are common risk factors for CMV infection and RCI. CMV-DNA load of 1×104 copies/ml is an important threshold, higher than which is associated with higher RCI and lower OS risk.
Subject(s)
Humans , Viremia/complications , Retrospective Studies , Cytomegalovirus Infections/complications , Hematopoietic Stem Cell Transplantation/adverse effects , Risk Factors , Cytomegalovirus , Graft vs Host Disease/complicationsABSTRACT
OBJECTIVE@#To investigate the clinical significance of minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute leukemia.@*METHODS@#81 cases of patients with AL treated with allo-HSCT in Department of Hematology, the First Affiliated Hospital of Chongqing Medical University form July 2015 to July 2018 was selected and retorspectively analyed. of which 79 patients were in CR and two patients were in non-CR. The CR group was further divided into two groups of MRD and MRD based on the MRD level prior to HSCT.@*RESULTS@#Among 81 patients, there were statistically significant differences in the three-year overall survival(OS) (CR 82.2%: NCR 0%), cumulative relapse incidence(RI) (CR 17.7%; NCR 100%) and leukemia-free survival rate(LFS) (CR 42.3%: NCR 0%) between CR and NCR group(P<0.05). Among 79 CR patients, MRD was negative in 30 patients while positive in 49 patients, there was significant differences in the three-year overall survival between MRD and MRD group. The results of univariate analysis showed that the MRD group showed lower LFS compared with that of MRD group （10.5% vs 36.2%）(P＜0.001，95%CI).@*CONCLUSION@#MRD patients shows longer LFS as compared with that of MRD patients, therefore, MRD monitoring by MFC before allo-HSCT is very important for the prognosis of the AL patients.
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Objective To investigate the influence of surgery with the guideline of minimally invasive concept in prognosis of patients with hypertensive basal ganglia hematomas. Methods Fifty-seven patients with hypertensive intra-cerebral hemorrhage were randomly divided into 2 groups:Group A (admitted to our hospital from January 2007 to December 2008 and performed surgery under the condition that the content of hematoma reached the level for surgery,n=26) and Group B (admitted to our hospital from January 2009 to June 2011 and received surgery with the guideline of minimally invasive concept once noting the tendency ofexpanded hematoma,n=31).We evaluated the influence of surgery (total removal of the hematoma and proper stopping the bleeding) according to the condition that tendency of expanded hematoma appeared and with the guideline of minimally invasive concept in the prognosis of these patients. Results No significant differences in consciousness classification and hematoma volume before surgery were noted between the 2 groups (P＞0.05).Responsible vessels were noted in 15 patients from Group A and 27 patients from Group B, and significant difference was noted between these 2 groups (P＜0.05).The hematoma clearance rate was 75％ in Group A,and re-bleeding was noted in 4 patients (15.4％) after the surgery; while that was higher than 90％ in Group B, and re-bleeding was only noted in 2 patients (6.5％) whose responsible vessels could not be found.The good recovery rate in Group A was 46.2％ 3 months after surgery, while that in Group B was 74.2％, which indicated that the effect in group B was obviously better than that in group A (P＜0.05). Conclusion Tendency of expanded hematoma should be paid attention in patients with hypertensive basal ganglia cerebral hemorrhage; it is important to quickly identify the cases showing clear indications for surgery and to perform the procedures at the earliest time; the procedures, including completely removal of the hematoma and properly stopping the stanch bleeding under direct vision with the guideline of minimally invasive concept can improve the recovery fiom hypertensive basal ganglia cerebral hemorrhage.
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Objective To investigate the differences of proteasome subunit beta type-4 (PSMB4) expression between normal cerebral tissues and glioma tissues,and the relevance between its expression and glioma malignancy degree.Methods Seventy-five human glioma liquid nitrogen frozen specimens,collected and confirmed by pathology in our hospital from January 2008 to February 2012,including 21 with grade Ⅰ astrocytoma,21 with grade Ⅱ astrocytoma,27 with grade Ⅲ astrocytoma and 6 with grade Ⅳ glioblastoma,were chosen in our study; another 5 normal cerebral tissues from cerebral trauma patients performed decompression were chosen as controls.Immunohistochemistry wax employed to detect the PSMB4 expressions in both normal cerebral tissues and glioma tissues.Results PSMB4 protein expression was negative in the controls,while positive/strong positive in the gliomas.Statistical analysis showed that the PSMB4 protein expression level in the gliomas was significantly higher than that in the controls (P＜0.05).PSMB4 protein expression in gliomas of different degrees showed no statistically significant differences (P＞0.05).Conclusion PSMB4 protein expression in the glioma tissues is higher than that in the normal cerebral tissues,however,no relevance between PSMB4 expression and glioma malignancy grade is noted.
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<p><b>OBJECTIVE</b>To discuss the segmental monobloc osteotomy and bi-directional distraction for the treatment of Crouzon syndrome in an infant.</p><p><b>METHODS</b>A 9-month-old female infant underwent monobloc osteotomy through combined intra- and extra-cranial way. The facial skull was divided into frontal, orbital and maxillary segments. The external distractor was used to move the frontal segment, orbital segment and midface forward. The internal distractor was used to move the maxilla downward. The consolidation lasted for 3 months after distraction.</p><p><b>RESULTS</b>The osteotomy and distraction were successfully completed. The distraction distance reached 18 mm, showing by distractor. The real distraction distance of facial bone was 12 mm, documented by 3-D image. The skull deformity and severe depression of midface improved a lot. The exophthalmos and underbite were corrected. The obstructive sleep apnea also improved markedly. However, the downward movement of maxilla was limited.</p><p><b>CONCLUSIONS</b>Monobloc osteotomy with external distractor, as well as maxillary distraction, could be used for Crouzon syndrome in infant. It is safe and effective method which can be performed in an early age for Crouzon syndrome with obstructive sleep apnea.</p>
Subject(s)
Female , Humans , Infant , Craniofacial Dysostosis , General Surgery , Osteogenesis, Distraction , Methods , Osteotomy , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate the management of congenital scalp defects in infants.</p><p><b>METHODS</b>From 1996 to 2008, 6 infants with congenital scalp defects were treated with dressing change, flap transposition, or tissue expansion combined with skull defect reconstruction.</p><p><b>RESULTS</b>Parietal scalp defects in 6 cases were healed after treatment. 5 cases were followed up for 3 months to one year. 2 cases had scalp alopecia in some areas. The scar was inconspicuous in the other 3 cases.</p><p><b>CONCLUSIONS</b>Dressing change is suitable for small scalp defect, while flap transposition should be used for medium defect. For large full-thickness cranial defect, dressing change and tissue expansion should be performed at the first stage, followed by skull defect reconstruction and expanded flap transposition.</p>