Clinical analysis of 11 patients with neuroendocrine carcinoma in maxillofacial region / 中华口腔医学杂志

Objective: To investigate the clinicopathological features, treatment and prognosis of maxillofacial neuroendocrine carcinoma. Methods: A total of 11 patients with maxillofacial neuroendocrine carcinoma diagnosed in the Department of Pathology of The First Affiliated Hospital of Zhengzhou University from December 2010 to July 2022 were retrospectively enrolled, including 8 males and 3 females, aged (65.2±9.5) years (ranged from 49 to 87 years), with a disease course of 0.5 to 6.0 months. The clinicopathological data including head and neck CT, MRI and treatment methods were analyzed. Results: Submandibular gland and maxilla were involved in 3 cases, parapharynx in 2 cases, and face, tongue root and soft palate in 1 case respectively. Clinically, the initial symptom is a rapidly growing painless or tender mass, which may be accompanied by restricted mouth opening, dysphagia, and local numbness after invasion of masticatory muscles and nerves. The tumors were all invasive and low-density, with unclear boundaries from the surrounding tissues. Among the patients, 9 received surgical treatment, and 5 received adjuvant treatment after surgery (2 received chemotherapy, 3 received radiotherapy+chemotherapy). According to the 5th edition of the World Health Organization classification of head and neck tumors in 2022, there were 1 case (1/11) with poorly differentiated large cells and 10 cases (10/11) with poorly differentiated small cells. Histologically, the macrocell type is composed of large cells with rough chromatin, obvious vacuolar nucleolus, protruding nucleolus, and necrosis. The small cell type is dominated by small blue round cells with neuroendocrine characteristics, with active growth and multifocal necrosis. Immunohistochemical staining showed that cytokeratin (CK), epithelial membrane antigen (EMA) and synaptophysin (Syn) were diffusively expressed, 10 cases expressed CD56, 8 cases expressed p63, 6 cases expressed weakly punctated chromograin-A (CgA), and S-100 was not expressed. The Ki-67 index ranges from 20 to 90 percent. By the end of follow-up (0.5 to 127.0 months), 3 patients were alive, and the mean progression-free survival (21.0 months) of postoperative chemoradiotherapy patients was significantly longer than that of surgery and/or chemotherapy alone (3.3 months). Conclusions: Maxillofacial neuroendocrine carcinoma is characterized by low differentiation of small cells, high degree of malignancy and poor prognosis. Radical surgery combined with chemoradiotherapy has better local control effect.

Genetic characteristics and survival analysis of 27 cases of juvenile myelomonocytic leukemia / 中华儿科杂志

Objective: To investigate the genetic and genomic profiling of juvenile myelomonocytic leukemia (JMML) and factors affecting its survival rate. Methods: Clinical characteristics, cytogenetics, molecular biology results and survival status of children with 27 JMML cases admitted to the Hematology Department of Children's Hospital, Capital Institute of Pediatrics from December 2012 to December 2021 were analyzed retrospectively, and the outcomes of the children were followed up. Kaplan-Meier method was used for survival analysis. Univariate analysis was used for analyzing factors affecting the overall survival (OS) rates of patients who received hematopoietic stem cell transplantation (HSCT). Log-Rank test was used for comparison of survival curves. Results: Among 27 JMML cases, there were 11 males and 16 females. The age of disease onset was 28 (11,52) months. There are 20 cases of normal karyotype, 4 cases of monosomy 7, 1 case of trisomy 8,1 case of 11q23 rearrangement and 1 case of complex karyotype. A total of 39 somatic mutations were detected.Those involved in RAS signal pathway were the highest (64%(25/39)), among which PTPN11 mutation was the most frequent (44% (11/25)). A total of 17 cases (63%) received HSCT, 8 cases (30%) did not receive HSCT, and 2 cases (7%) lost follow-up. For children receiving transplantation, the follow-up time after transplantation was 47 (11,57) months. The 1-year OS rate of high-risk transplantation group (17 cases) and high-risk non transplantation group (6 cases) was (88±8)% and (50±20)% respectively, with a statistically significant difference (χ2=5.01, P=0.025). The 5-year OS rate of the high-risk transplantation group was (75±11)%. The survival time of those who relapsed or progressed to acute myeloid leukemia after transplantation was significantly shorter than that of those who did not relapse (χ2=6.80, P=0.009). The OS rate of patients with or without PTPN11 mutation was (81±12) % and (67±19)% respectively (χ2=0.85, P=0.356). Conclusions: The main pathogenesis involved in JMML is gene mutation related to RAS signaling pathway, and the most common driver gene of mutation is PTPN11. Allogeneic HSCT can significantly improve the survival rate of high-risk JMML patients. The recurrence or progression after transplantation was related to poor prognosis.

Clinical Efficacy of Haplo-HSCT of ATG Combined with PTCy for Children with Myelodysplastic Syndrome / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safety of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in combination of ATG and post-transplant cyclophosphamide (PTCy) -induced immune tolerance after transplantation in treatment of childhood myelodysplastic syndromes(MDS）.@*METHODS@#From July 2016 to November 2020, a total of 8 children with MDS receiving the haploidentical allo-HSCT combined with ATG and PTCy-induced immune tolerance after transplantation in our hospital were enrolled, whose clinical data were retrospected and analyzed.@*RESULTS@#Median age at diagnosis of the 8 children (1 male and 7 females) was 6.4 (range, 10 months to 15 years) years old. The median medical history of MDS was 2.7 years (range, 3 months to 8 years). Among the 8 patients, 7 cases were diagnosed with refractory cytopenia of childhood and one with refractory anemia with excess of blasts. The HSC donors were father, mother or brother of patients and HLA matching in 6-9/12 loci were identical. All the donors were healthy and didn't carry the same pathogenic genes as the recipients. The median age of donors was 36.4 (range, 25 to 49) years old. The median mononuclear cell (MNC) number of the graft was 19.8, ranging in (13.2-47.3)×108/kg, and the median CD34+ cell number was 11.8×106/kg, ranging in (5.0-18.3)×106/kg. Graft-versus-host disease prophylactic regimen was started on day 3 and 4 after transplantation, in which cyclophosphamide (50 mg/kg·d) was administered by intravenous infusion. From day 5 after transplantation, low-dose tacrolimus was administered by intravenous infusion and mycophenolate mofetil was administered orally. The median time of neutrophil and platelet engraftment was 12.6 (rang, 11 to 15) days and 13.3 (rang, 11 to 18) days, respectively. All the patients achieved full donor chimerism on neutrophil engraftment after transplantation. The median follow-up time was 1 032 (rang, 747 to 1 536) days. Both overall survival rate and disease-free survival rate were 100%.@*CONCLUSION@#Haplo-HSCT combined with ATG and PTCy-induced immune tolerance after transplantation is a safe and effective treatment for children with MDS.

Review of novel compounds that act on the AT2 receptor / 药学学报

Selective activation or inhibition of the angiotensin II type 2 (AT2) receptor can cause vasodilation, decrease cell proliferation, promote neurite outgrowth and block neuronal excitability. The AT2 receptor can be used as a potential drug target for the treatment of cardiovascular diseases, fibrosis, inflammation, neuronal diseases and tumors. Research and development of new drugs that selectively act on the AT2 receptor and the mechanism of intracellular signal transduction involving the AT2 receptor is a challenging but worthy endeavor. We review research progress on the AT2 receptor and compounds that act on the AT2 receptor, along with structure-activity relationship analysis, to provide reference and guidance for further research in this field.

Pneumoconiosis: current status and future prospects / 中华医学杂志(英文版)

Pneumoconiosis refers to a spectrum of pulmonary diseases caused by inhalation of mineral dust, usually as the result of certain occupations. The main pathological features include chronic pulmonary inflammation and progressive pulmonary fibrosis, which can eventually lead to death caused by respiratory and/or heart failure. Pneumoconiosis is widespread globally, seriously threatening global public health. Its high incidence and mortality lie in improper occupational protection, and in the lack of early diagnostic methods and effective treatments. This article reviews the epidemiology, safeguard procedures, diagnosis, and treatment of pneumoconiosis, and summarizes recent research advances and future research prospects.

Clinical analysis of two pediatric precursor B-cell acute lymphoblastic leukemia with C-MYC rearrangement / 中华实用儿科临床杂志

Objective:To explore the characteristics, diagnosis, and treatment of precursor B-cell acute lymphocytic leukemia with C- MYC rearrangement (preBLL) in children. Methods:The clinical data in 2 cases of childhood preBLL in Department of Hematology, Children′s Hospital Affiliated to Capital Institute of Pediatrics in June and August 2019 were summarized and analyzed.Results:Both cases were acute lymphoblastic leukemia with precursor B-cell immunophenotype.Hepatosplenomegaly and peripheral white blood cells were significantly increased, and the morphology of bone marrow was L3. C- MYC rearrangement was discovered by cytogenetic tests.Both children have received the treatment of the mature B-cell tumor protocol (FAB/LMB96), and early remission was developed in 1 case with TP53 gene mutation but relapsed thereafter and died finally.Another case had reached sustained complete remission after treatment. Conclusions:Children with preBLL is rare, and routine C- MYC rearrangement should be performed in children with Precursor B-cell lymphoblastic leukemia whose morphology of bone marrow was L3.Its treatment needs to be further studied, and multi-center clinical trials need to be actively conducted to analyze and summarize large numbers of cases to identify effective protocol and improve the prognosis.

A review on the effect of Claudin-18 on bronchopulmonary dysplasia in preterm infants / 中国当代儿科杂志

Bronchopulmonary dysplasia (BPD) has the main manifestations of pulmonary edema in the early stage and characteristic alveolar obstruction and microvascular dysplasia in the late stage, which may be caused by structural and functional destruction of the lung epithelial barrier. The Claudin family is the main component of tight junction and plays an important role in regulating the permeability of paracellular ions and solutes. Claudin-18 is the only known tight junction protein solely expressed in the lung. The lack of Claudin-18 can lead to barrier dysfunction and impaired alveolar development, and the knockout of Claudin-18 can cause characteristic histopathological changes of BPD. This article elaborates on the important role of Claudin-18 in the development and progression of BPD from the aspects of lung epithelial permeability, alveolar development, and progenitor cell homeostasis, so as to provide new ideas for the pathogenesis and clinical treatment of BPD.

Preliminary study of the relationship between novel coronavirus pneumonia and liver function damage: a multicenter study / 中华肝脏病杂志

To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Two new compounds from rifamycin resistant mutant strain Streptomyces sp. HS-NF-1046R / 药学学报

Using silica gel column chromatography, gel chromatography and HPLC, we isolated secondary metabolites in fermentation broth of a rifamycin resistant mutation strain Streptomyces sp. HS-NF-1046R. Based on spectroscopic data, the chemical structures of three compounds were identified as 3-hydroxyl-2-N-propionyl- anthranilamide (1), 2,3-dihydro-8-hydroxy-2,2-dimethyl quinazolin-4-(1H)-one (2) and 2-aminobenzamide (3). Compounds 1 and 2, as new entities, were evaluated for cytotoxicity against A549, HepG2, HCT-116 and K562 cells using the SRB assay. Compounds 1 and 2 exhibited no cytotoxicity with IC50 over 100 μmol·L-1.

Comparison of therapeutic effect on multi‐vessel coronary disease between minimally invasive coronary artery bypass grafting and coronary artery bypass grafting／ / 心血管康复医学杂志

To compare short‐and mid‐term therapeutic effect on aged patients with multi‐vessel coronary disease between minimally invasive coronary artery bypass grafting (MIDCAB) and coronary artery bypass grafting (CABG).Methods : A total of 72 patients with multi‐vessel disease , who were suitable for MIDCAB from 2016 to 2018 , were regarded as MIDCAB group .Another 96 patients with multi‐vessel disease , who were not suitable for MIDCAB , were enrolled as CABG group (received selective on‐pump CABG).Clinical data and incidence of major adverse cardio‐ and cerebrovascular events (MACCE ) within two‐year follow‐up were compared between two groups.Results : Men percentage of MIDCAB group was significantly higher than that of CABG group (83. 3% vs. 67. 7%, P＝0.022) ; compared with CABG group , there were significant reductions in percentages of left anterior descending proximal lesions (61.5% vs.34.7%) and chronic total occlusion disease (57.3% vs.34. 7%) in MID‐CAB group ( P＜0. 01 both) , there were no significant difference in other indexes between two groups , P＞ 0. 05 all.All subjects were followed up for two years , follow‐up rate was 90. 5% .There were no significant difference in incidence rates of all‐cause death and MACCE between two groups , P＞0.05 all.Conclusion : There is no signifi‐cant difference in incidence rate of short‐and mid‐term events between CABG and MIDCAB in patients with multi‐vessel coronary disease .MIDCAB is recommended for proper patients in clinic .

Comparison of therapeutic effect between PCI and CABG on multi-vessel coronary disease / 心血管康复医学杂志

Objective :To compare short-term and midterm therapeutic effect between sirolimus-eluting stent implan-tation (SES-PCI) and coronary artery bypass graft (CABG) in aged patients with coronary heart disease (CHD) and multi-vessel coronary disease (MVD).Methods : Aged MVD patients undergoing selective revascularization were en-rolled and divided into CABG group (n＝301) and SES-PCI group (n＝289).Major adverse cardio-and cerebrovas-cular events (MACCE) were followed up for 30d ,one ,two and five years .Logistic multi-factor regression was used to analyze independent risk factors for different therapeutic methods .Results : Compared with CABG group after 30d follow-up ,there was significant reduction in all-cause mortality (6-3% vs.2-8%) and significant rise in a sec-ond revascularization rate (RVR ,1-3% vs.8-3%) in SES-PCI group , P＜0-05 or ＜0-01 ;compared with CABG group during one ,two and five-year follow up ,there were significant reductions in all-cause mortality [one year :(11-6% vs.4-8%) ,five years :(23-3% vs.12-1%)] and incidence rate of cerebrovascular accidents [one year :(8-6% vs .3-5%) ,five years :(18-3% vs.6-9%)] ,and significant rise in incidence rate of non-fatal myocardial infarction [one year :(6-6% vs.11-8%) ,five years :(12-0% vs.24-9%)] and a second RVR [one year :(3-0%vs.16-3%) ,five years :(9-3% vs.24-6%)] in SES-PCI group , P＜0-05 or ＜0-01- Logistic multi-factor regres-sion analysis indicated that DM and EH were independent risk factors for SES-PCI (OR＝ 45-772 ,13-218 , P＝0-001 both) ,while peripheral vascular disease was independent protective factor for SES-PCI (OR＝ 0-007 , P＝0-001).Conclusion : Compared with CABG ,there are significant reductions in short-term and midterm all-cause mortality ,and significant rise in a second RVR in MVD patients undergoing PCI .

Correlation between fibrinogen level and severity of coronary stenosis in aged coronary heart disease people / 心血管康复医学杂志

Objective:To explore correlation between fibrinogen(Fg)level and coronary stenotic degree in aged coronary heart disease(CHD)people and its possible pathogenesis.Methods:A total of 112 patients,who were >65 years and diag-nosed as CHD by coronary angiography(CAG),were selected as CHD group.Another 108 non-CHD patients hospitalized during the same period were enrolled as non-CHD group.According to CAG results,CHD group was divided into single vessel coronary disease group(n=30,single vessel group)and multi vessel coronary disease group(n= 82,multi vessel group).Serum levels of Fg,D-dimer(D-D),C reactive protein(CRP),homocysteine(Hcy)and brain natriuretic peptide (BNP)were measured and compared between two groups.The correlation between serum Fg level and Gensini score was analyzed in CHD patients.Results:Compared with non-CHD group,there were significant rise in serum levels of Fg,D-D, triglyceride(TG),apolipoprotein B(ApoB),lipoprotein a,CRP,BNP and Hcy in CHD group,P=0.001 all;in CHD group,compared with single vessel group,there were significant rise in serum levels of Fg,D-D,ApoB,uric acid,lipo-protein a,CRP,BNP,Hcy,and significant reductions in serum levels of high density lipoprotein cholesterol,ApoA1 and ApoA1/ApoB in multi vessel group,P<0.05 or <0.01. Serum Fg level was significant positively correlated with coronary stenotic degree(Gensini score),r=0.303,P=0.001. Fg was independent risk factor of CHD(OR=2.74,95% CI:1.95~3.97,P=0.001).Conclusion:Serum Fg level is significant positively correlated with coronary stenotic degree in aged CHD patients.Its mechanism of triggering atherosclerosis may be related to risk factors such as dyslipidemia,hyper-homocysteinemia and inflammations etc.

Relationship between basal ganglia ischemic stroke and paroxysmal atrial fibrillation / 中华老年心脑血管病杂志

Objective To study the relationship between basal ganglia ischemic stroke (BGIS) and paroxysmal atrial fibrillation (PAF) due to abnormal vagus nerve tension.Methods A total of 1483 elderly ischemic stroke patients who underwent head CT or MRI in our hospital from January 2013 to December 2014 were divided into BGIS group (n=1045) and non-BGIS group (n=438).Their heart rate variability and frequency parameters (SDNN,RMSSD,PNNS0) were recorded.The LF/HF ratio was analyzed.Results The incidence of PAF was significantly lower in ＜69 years old patients of BGIS group than in those of non-BGIS group (P＜0.05) and was significantly higher in ≥70 years old patients of BGIS group than in those of non-BGIS group (P＜0.05).The incidence of ischemic stroke with PAF was significantly higher in BGIS group than in nonBGIS group (56.8％ vs 41.0％,P=0.031).The incidence of PAF was significantly higher in ＞79 years old patients of BGIS group than in those of non-BGIS group (P＜0.05).The incidence of AF increased with the increasing age of ischemic patients between the two groups.The SDNN,RMSSD,PNN50 were significantly higher while the LF/HF ratio was significantly lower in nonPAF patients of BGIS group than in those of non-BGIS group (P＜0.05).Conclusion The incidence of BGIS shows a tendency to increase.PAF is prone to occur in BGIS patients.The vagus nerve tension is increased in BGIS patients with PAF.

Complete Mitochondrial Genome of Echinostoma hortense (Digenea: Echinostomatidae)

Echinostoma hortense (Digenea: Echinostomatidae) is one of the intestinal flukes with medical importance in humans. However, the mitochondrial (mt) genome of this fluke has not been known yet. The present study has determined the complete mt genome sequences of E. hortense and assessed the phylogenetic relationships with other digenean species for which the complete mt genome sequences are available in GenBank using concatenated amino acid sequences inferred from 12 protein-coding genes. The mt genome of E. hortense contained 12 protein-coding genes, 22 transfer RNA genes, 2 ribosomal RNA genes, and 1 non-coding region. The length of the mt genome of E. hortense was 14,994 bp, which was somewhat smaller than those of other trematode species. Phylogenetic analyses based on concatenated nucleotide sequence datasets for all 12 protein-coding genes using maximum parsimony (MP) method showed that E. hortense and Hypoderaeum conoideum gathered together, and they were closer to each other than to Fasciolidae and other echinostomatid trematodes. The availability of the complete mt genome sequences of E. hortense provides important genetic markers for diagnostics, population genetics, and evolutionary studies of digeneans.

The Changes and Correlation of Serum IL-17, IL-6, IL-8,CRP and TNF-α of Patients with Chronic Obstructive Pulmonary Diseases / 昆明医科大学学报

Objective To study the changes and correlation of serum interleukin-17,-6 and-8 (IL-17,IL-6 and IL-8),c-reactive protein (CRP),tumor necrosis factor alpha (TNF-α) of patients with chronic obstructive pulmonary diseases (COPD),and discuss the role and clinical significance of these factors in the occurrence and development of COPD.Methods 100 COPD patients were selected (COPD group),and 50 healthy elderly people in the same period in outpatient medical examination were served as control (control group).The levels ofIL-17,IL-6 and IL-8,CRP,TNF-α in serum were detected with ELISA method.Results The serum levels of IL-17,IL-6,IL-8,CRP and TNF-α of patients in COPD group were higher than those in the control group (P ＜ 0.01),and of patients with acute aggravating period were higher than those of patients with stable period (P ＜ 0.05 or P ＜ 0.01).Pearson correlation analysis showed there were positive correlations among IL-17,IL-6,IL-8,CRP and TNF-α (P ＜ 0.05) Conclusion The serum levels of IL-17,IL-6,IL-8,CRP and TNF-α of COPD patients have abnormal increased,and will increase with the rise of the illness severity.The above factors may be involved in the airway in patients with acute inflammatory reaction and the development process.

Measures of infection source control of schistosomiasis and their effects in Four-lake regions of Hubei Province / 中国血吸虫病防治杂志

Objective To evaluate the effect of a new schistosomiasis control strategy based on the infection source control in four-lake regions of Hubei Province. Methods The new strategy based on the infection source control included the safe water sup-ply,feces harmless treatment,replacing cattle with machine,captive livestock,chemotherapy,Oncomelania hupensis snail con-trol in susceptible areas,hardening ditches,etc,and the new control strategy was implemented for 7 years in 9 counties(cities or districts)of the four-lake regions. The schistosomiasis situations were investigated before and after the intervention of the new strat-egy. Results The coverage rates of feces harmless toilets(three format toilets),biogas digesters,and safe water supply were 42.00%,23.16% and 93.76%,respectively. The number of ditch hardening was 1 960;the area of eliminating snails was 1 378.42 hm2;the number of persons who received the health education was 3 524 818 accounting for 92.17%of the total popula-tion;the number of person-time of taking active protection measures was 516 636 963. The average annual decline rates of schisto-some infection were 24.42%and 38.38%in residents and cattle,respectively. The endemic villages decreased by 4.77%,the vil-lages with snails decreased by 7.05%,and the villages with snails accounted between 63.19%and 66.21%of the total endemic vil-lages. The area with snails decreased by 90.35%,and the advance schistosomiasis patients decreased by 5.55%,and the fatality rate of advanced schistosomiasis patients decreased by 1.24%. No acute schistosomiasis patients occurred. Type One and Two en-demic(heavy endemic)villages decreased to zero;Type Three endemic(moderate endemic)villages decreased by 10.22%;but Type Four endemic(mild endemic)villages increased by 66.38%;and Type Five endemic(no endemic for 5 years)villages de-creased by 0.22%. The standards of schistosomiasis transmission controlled have achieved on schedule. Conclusion The imple-mentation of the new schistosomiasis control strategy based on the infection source control in four-lake regions of Hubei Province can effectively control schistosomiasis.

Detection of malignant B lymphocytes in cerebrospinal fluid by using BIOMED-2 PCR / 中国实验血液学杂志

The purpose of this study was to develop a sensitive method for the detection of malignant B lymphocytes in cerebrospinal fluid (CSF) from patients with diffuse large B-cell lymphoma (DLBCL) who were considered as risk of central nervous system (CNS) involvement. Nine CSF samples were collected and then centrifuged. The cell precipitate was lysed directly. The supernatant was used to detect immunoglobulin heavy chain (IgH) gene rearrangement (characteristic changes of malignant B lymphocytes ) by BIOMED-2 PCR. The sensitivity of this method was compared with that of cytology defection and flow cytometry. In addition, through a series of quantity/concentration of tumor cells, the sensitivity differences caused by two sample handling methods (direct cell lysis vs traditional DNA extraction) were analyzed, and the sensitivity of direct cell lysis combined with BIOMED-2 PCR was evaluated. The results showed that the positive clonality of IgH gene rearrangement were detected by BIOMED-2 PCR in 5 cases, but the positive were detected by cytology defection/flow cytometry only in 2 cases, which indicated that the BIOMED-2 PCR assay gives a better yield. In addition, when combined with BIOMED-2 PCR, direct cell lysis produced sensitivity much higher than DNA extraction. The former can enable clonality detection from a minimum of 0.1%/20 tumor cells. It is concluded the method of direct cell lysis combined with BIOMED-2 PCR is sensitive and suitable for paucicellular CSF detection. It may aid the diagnosis of CNS involvement in patients with DLBCL.

Clinical features of 121 infants below 3 months of age with congenital syphilis / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features and diagnosis of infants under 3 months of age with congenital syphilis.</p><p><b>METHOD</b>Data of 121 infants below 3 months of age with congenital syphilis were collected from January 1997 to May 2007 at the authors' hospital. Their clinical features, laboratory findings and treatment were reviewed.</p><p><b>RESULT</b>Clinical manifestations of congenital syphilis in the infants were diverse. The disease involved multiple systems such as the skin, respiratory, digestive, blood, and nervous system, skeleton and so on. Among the 121 infants, the manifestations included increased leukocyte count (89.3%), skin damage (59.5%), hepatomegaly (56.2%), splenomegaly (41.3%), anemia (38.8%), fever (28.9%), pathologic jaundice (24.0%), growth retardation after birth (12.4%) and bone damage (54.3%), etc. The rate of misdiagnosis was 17.4 percent, and the kinds of disease misdiagnosed were up to 10.</p><p><b>CONCLUSION</b>Clinical manifestations of congenital syphilis in infants under 3 months of age were complicated and nonspecific, therefore doctors misdiagnosed it very easily. Clinicians should attach great importance to it. At the same time, the restoration of antemarital examination, vigorously carrying out screening for syphilis and strengthening the management of immigrants are necessary to prevent congenital syphilis.</p>

Hyperthyroidism and primary hypothyroidism in patients with autonomic nerve function analysis / 中国地方病学杂志

Objective To investigate autonomic nervous system(ANS)function of hyperthyroidism and hyperthyroidism by analyzing the heart rate variability(HRV)of patients with the diseases.Methods 12-synchronous dynamic 24-hour monitoring and man-machine dialogue were performed in 49 patients with hyperthyroidism,25 patients with hypothyroidism and 40 controls after removing interference,and 24-hour electrocardiogram wag analyzed.Heart rate variability indicators observed included 24-hour time-domain indexes[standard deviation of all experimental time RR(SDNN),root of mean square standard deviation from adjacent RR interval(RMSSD)]and 24-hour frequency domain indicators[very low frequency power(VLF),low-frequency power(LF),high frequency power(HF),low frequency power/high frequency power(LF/HF)].Results Indicators of time domain in hyperthyroidism group,such as SDNN[(69.65±13.55)ms]and RMSSD[(12.98±3.20)ms]were obviously lower than those of the control group[(136.07±11.95),(29.70±5.85)ms],the differences being statistically significant (P＜0.01).Indicators of frequency domain HF[(5331±15.84)msz]were lower than those of the control group [(223.38±50.09)ms2],butVLF[(1823.55±238.13)ms2],LF[(501.88±92.47)ms2]and LF/HF(5.89±1.15)was higher compared with that in the control group,repectively[(325.68±60.47)ms2,(405.60±5 1.41)ms2,2.14±0.56,P＜0.01).Among time domain indicators in hypothyroidism group,SDNN[(77.00±15.48)ms]and RMSSD [(14.80±2.58)ms]were also obviously lower than those in the control group(P＜0.01),the difference being significant statistically(P＜0.01).Frequency domain index HF[(57.88±12.20)ms2],VLF[(251.48±24.67)ms2],LF[(128.68±43.78)ms2]also obviously lower than those in the control group(P＜0.01),but LF/HF,being 1.83±0.63,was in a normal range and did not significantly changed(P＞0.05). Conclusion In patients with hyperthyroidism both sympathetic and vagus nerves are hyperdynamic,while in patients with hypothyroidism,vagus nerves are hyperdynamic,while sympathetic nerve hypodynamic.

Extracorporeal membrane oxygenation treatment of a neonate with severe low cardiac output syndrome following open heart surgery / 中华儿科杂志

<p><b>OBJECTIVE</b>To summarize the experience of extracorporeal membrane oxygenation (ECMO) to rescue a neonate with severe low cardiac output syndrome following open heart surgery.</p><p><b>METHODS</b>The patient was a male, 2 d, 2.8 kg, G3P2 full-term neonate with gestational age 40 weeks, born by Cesarean-section with Apgar score of 10 at 1 min. He was admitted due to severe dyspnea with oxygen desaturation and heart murmur on the second day after birth. Physical examination showed clear consciousness, cyanosis, dyspnea, RR 70 bpm and a grade II/6 heart murmur. Bp was 56/45 mm Hg (1 mm Hg = 0.133 kPa) and SpO2 around 65%. Blood WBC 13.1 x 10(9)/L, N 46.1%, Hb 238 g/L, Plt 283 x 10(9)/L, CRP < 1 mg/L. Echocardiographic findings: TGA + ASD + PDA with left ventricular ejection fraction (LVEF) of 60%. After supportive care and prostaglandin E1 (5 ng/kg/min) treatment, his condition became stable with SpO2 85 - 90%. On the 6(th) day of life, the baby underwent an arterial switch procedure + ASD closing and PDA ligation. The time of aorta clamp was 72 mins. The cool 4:1 blood cardioplegia was given for 2 times during aortal clamp. Ultrafiltration was used. The internal and external volumes were almost equal and the electrolytes and blood gas and hematocrit (36%) were normal during extracorporeal bypass. Due to a failure (severe low cardiac output) to wean from cardiopulmonary bypass (263 min) with acidosis (lactate 8.8 mmol/L), low blood pressure (< 39/30 mm Hg), increased LAP (> 20 mmHg), bloody phlegm, decreased urine output [< 1 ml/(kg.h)], a V-A ECMO was used for cardio-pulmonary support. ECMO setup: Medtronic pediatric ECMO package (CB2503R1), carmeda membrane oxygenator and centrifugal pump (bio-console 560) were chosen. Direct cannulation of the ascending aorta (Edward FEM008A) and right atrium (TF018090) was performed using techniques that were standard for cardiopulmanory bypass. The ECMO system was primed with 400 ml blood, 5% CaCl(2)1g, 5% sodium bicarbonate 1.5 g, 20% mannitol 2 g, albumin 10 g, and heparin 5 mg. The blood was re-circulated until the temperature was 37 degrees C and blood gases and the electrolytes were in normal range. The patient was weaned from bypass and connected to V-A ECMO. Management of ECMO: the blood flow was set at 150 - 200 ml/kg/min. Venous saturation (SvO2) was maintained at the desired level (75%) by increasing and decreasing extracorporeal blood flow. Systemic blood pressure was maintained at 76/55 - 80/59 mm Hg by adjusting blood volume. Hemoglobin was maintained between 120 - 130 g/L. Platelet count was maintained at > 75,000/mm3 and ACT was maintained at 120 - 190 s. The mechanical ventilation was reduced to lung rest settings (FiO2 35%, RR 10 bpm, PIP 16 cm H(2)O, PEEP 5 cm H2O) to prevent alveolar collapse. Inotropic drug dosages were kept at a low level.</p><p><b>RESULTS</b>The patient was successfully weaned from ECMO following 87 hours treatment. LVEF on day 1, 2 and 3 following ECMO were 20%, 34% and 43% respectively. The circulation was stable after weaning from ECMO with Bp 75/55 mm Hg, HR 160 bpm and LAP 11 mm Hg under inotropic drug suppor with epinephrine [(0.2 microg/(kg.min)], dopamine [(8 microg/(kg.min)], milrinone [(0.56 microg/(kg.min)]. The blood gases after 1 h off-ECMO showed: pH 7.39, PaO2 104 mm Hg, PaCO2 45 mm Hg, lactate 3.8 mmol/L, Hct 35%, K(+) 3.8 mmol/L, Ca(++) 1.31 mmol/L. The serum lactate was normal after 24 h off-ECMO. On day 22 off-ECMO, the baby was successfully extubated and weaned from conventional ventilator. On day 58, the patient was discharged. Serial ultrasound imaging studies revealed no cerebral infarction or intracranial hemorrhage during and after ECMO. At the time of hospital discharge, the patient demonstrated clear consciousness with good activity, normal function of heart, lung, liver and kidney. However, more subtle morbidities, such as behavior problems, learning disabilities should be observed ria long term follow-up. The main ECMO complications were pulmonary hemorrhage, bleeding on the sternal wound, tamponade, hemolysis and hyperbilirubinemia.</p><p><b>CONCLUSION</b>ECMO is an effective option of cardio-pulmonary support for neonate with low cardiac output syndrome following open heart surgery.</p>