Establishing a noninvasive canine model of lumbar intervertebral disc degeneration through cumulative axial load and compound motion / 中华骨科杂志

Objective:To investigate the feasibility of establishing a canine model of lumbar intervertebral disc degeneration through the application of cumulative axial load and a six-phase combined motion on the vertical sitting dog's lumbar spine.Methods:Twenty adult female grass dogs, each weighing 10.0±0.5 kg, were randomly divided into two groups, with 10 dogs in each group. In the model group, dogs were secured to an exercise machine in a vertical position, and six phases of lumbar spine movement (flexion and extension, left and right lateral flexion, left and right rotation, 45° each) were combined with a specific number of cycles under continuous axial load (245 N). In the control group, dogs were secured to the exercise machine in a vertical position without any intervention. Radiographic examinations were performed before and after 20,000, 50,000, 100,000, and 150,000 compound exercises in the model group. The disc height index (DHI) was measured through lateral X-ray, and MRI T2-mapping was used for quantitative analysis of intervertebral disc degeneration. When intervertebral disc degeneration was evident on MRI T2-weighted imaging (modified Pfirrmann system > Grade V), the combined motion was halted. Micro-CT quantitative analysis of bone mineral density (BMD) in the upper and lower endplates, trabecular bone structure, and histological staining (HE staining, "O" staining, Sirius red staining) were employed to verify and assess the degree of intervertebral disc degeneration.Results:After 50,000 compound exercises, mild degeneration of the intervertebral discs at L 6-7 and L 7S 1 was observed on T2-weighted imaging. With the accumulation of exercise load, the degree of degeneration progressively increased, reaching a moderate degree of degeneration after 100,000 composite exercises, and DHI began to decrease. Mild degeneration was also observed in the upper L 5-6 intervertebral disc. When the cumulative exercise volume reached 150,000 repetitions, the height of intervertebral spaces in the L 5-6, L 6-7, and L 7S 1 segments further decreased, and the intervertebral discs exhibited severe degeneration (improved Pfirrmann grading system Grades IV-VI). The upper L 4-5 intervertebral discs also displayed mild degeneration. Histological scores were as follows: L 5-6 (8.2±0.8), L 6-7 (9.5±0.7), and L 7S 1 (10.3±0.5), indicating a degree of degeneration in the order of L 5-6<L 6-7<L 7S 1. HE and safranine "O" staining confirmed the significant collapse of the intervertebral spaces in the L 5-6, L 6-7, and L 7S 1 segments, characterized by severe shrinkage of the nucleus pulposus tissue, a disordered internal structure, and nearly absent vacuolar-like nucleus pulposus cells. Sirius red staining revealed pronounced folds, disordered arrangement, and multiple fractures in the fibers of the anterior and posterior rings of the intervertebral disc. The posterior ring of the disc exhibited more pronounced changes than the anterior ring, and the thickness of the bone endplate and bone trabecular density became thinner and less dense. Micro-CT quantitative analysis further confirmed that the BMD and number of trabeculae in the upper and lower endplates of the L 5-6, L 6-7, and L 7S 1 segments were significantly lower than those in the control group and other segments of the model group, while the trabecular separation was significantly higher than that in the control group and other segments of the model group. Conclusion:The utilization of the "Lumbar Composite Exercise Machine" can effectively replicate the biomechanical and kinematic characteristics of human lumbar intervertebral discs. Cumulative axial load and six-phase composite exercise can induce varying degrees of chronic degeneration in canine lumbar intervertebral discs, which is related to the exercise load, particularly in the L 5-6, L 6-7, and L 7S 1 segments.

MR-guided focused ultrasound surgery for localized prostate cancer: a preliminary investigation / 中华放射学杂志

Objective:To investigate the safety and efficacy of MR-guided focused ultrasound surgery (MRgFUS) in treating localized prostate cancer.Methods:Six patients with localized prostate cancer who underwent MRgFUS treatment from August 2020 to September 2021 in Beijing Hospital were prospectively enrolled in this study. The patients were all over 18 years old, with an average age of (68±10) years, and had not received any prior treatment for prostate cancer. Pretreatment pelvic MR and CT scans were performed to determine the region of treatment (ROT). Different urinary catheterization measures were given based on the location of the lesion. Under general anesthesia, the lesions were treated by MRgFUS using a specialized rectal ultrasound transducer on the treatment bed. The patients were followed up at 1, 3, and 6 months after treatment and annually thereafter. During follow-up, prostate-specific antigen (PSA) levels, pelvic MR scans, International Prostate Symptom Score (IPSS), International Index of Erectile Function-15 (IIEF-15) scores, and adverse events were assessed.Results:(1) All six patients underwent MRgFUS treatment for six lesions, with an average duration of (126±56) minutes, an average number of (7.3±3.2) focal ultrasound pulses per lesion, and an average non-perfusion volume of (3.8±1.1) cm 3, which covered the entire treatment target area. No treatment-related adverse events were reported. (2) The PSA levels at baseline, 1, 3, 6, and 12 months after treatment were (6.6±0.8), (3.6±1.3), (3.4±3.0), (2.5±1.7), and (2.3±1.8) ng/ml, respectively. PSA levels increased in 2 out of 6 patients during follow-up, and pelvic MR scan revealed recurrent lesions, while PSA levels continued to decrease in the remaining 4 patients, and pelvic MR scan were normal. (3) The IPSS scores at baseline, 1, and 3 months after treatment were 13.0 (4.0, 16.0), 10.0 (4.0, 12.0), and 5.0 (3.0, 6.0) points, respectively. For the three sexually active patients, the IIEF-15 scores at baseline were 40, 51, and 14 points, respectively, and IIEF-15 at 1 month after treatment were 9, 8, and 14 points, respectively, and at 3 months after treatment were 9, 66 and 26 points, respectively. (4) One patient was diagnosed with recurrence 10 months after treatment, and another patient was found to have a new lesion 6 months after treatment. Conclusions:MRgFUS might be a safe, non-invasive, and effective treatment for localized prostate cancer, but regular follow-up is vital for detecting tumor recurrence.

The cases of twins with sialidosis type 1 / 中华神经科杂志

Sialidosis is a rare lysosomal storage disease caused by NEU1 gene mutation at 6p21.33. It is characterized by myoclonic, ataxia, epilepsy, and decreased vision. A pair of twins with sialidosis type 1 are reported to enrich clinicians ′ understanding of the disease, so as to improve the diagnosis and treatment. The proband was a 16-year-old male. The main symptom was intermittent limb involuntary trembling for 2 years, with paroxysmal loss of consciousness. Fundus examination showed cherry-red spots. His twin brother had similar symptoms, but the overall performance was mild. Whole exome sequencing results showed that both patients carried compound heterozygous mutations of c.239C>T (p.P80L) and c.803A>G (p.Y268C) in NEU1 gene, which were from their normal phenotype mother and father.

Effectiveness of 13-valent pneumococcal conjugate vaccine against invasive disease caused by serotype 19A in children: a meta-analysis / 中华预防医学杂志

Objective: Using Meta-analysis to evaluate the vaccine effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) against invasive Streptococcus pneumoniae disease (IPD) caused by serotype 19A in children <5 years old. Methods: "Streptococcus pneumoniae infection""invasive pneumococcal disease""13-valent pneumococcal polysaccharide conjugate vaccine""PCV13""effectiveness""infant""child" and related terms were searched from China National Knowledge Infrastructure (CNKI), WANFANG DATA, PubMed, SCOPUS and Web of science with no limited on language, region and research institution. The retrieval time was limited from January 2010 to February 2023 and cohort study, case-control study and randomized controlled trial were included. Data were extracted from eligible studies by two independent reviewers, and after study quality assessment by NOS scale, Meta-analysis was completed using Stata 16.0 software. Results: A total of 2 340 related literatures were searched, and 10 literatures were finally included, including 5 case-control studies and 5 indirect cohort studies, which showed good literature quality. The vaccine effectiveness against serotype 19A IPD of PCV13 in children was 83.91% (95%CI: 78.92%-88.89%), and the subgroup analysis (P=0.240) showed there was no significant difference among the case-control study (VE=87.34%, 95%CI:79.74%-94.94%) and the indirect cohort study (VE=81.30%, 95%CI:74.69%-87.92%). The funnel plot and Egger test suggested that the possibility of publication bias was small. Conclusion: The present evidence indicates that PCV13 has a good vaccine effectiveness against serotype 19A IPD in children, and it is recommended to further increase the vaccination rate of PCV13 to reduce the disease burden of IPD in children <5 years old.

Effectiveness of 13-valent pneumococcal conjugate vaccine against invasive disease caused by serotype 19A in children: a meta-analysis / 中华预防医学杂志

Objective: Using Meta-analysis to evaluate the vaccine effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) against invasive Streptococcus pneumoniae disease (IPD) caused by serotype 19A in children <5 years old. Methods: "Streptococcus pneumoniae infection""invasive pneumococcal disease""13-valent pneumococcal polysaccharide conjugate vaccine""PCV13""effectiveness""infant""child" and related terms were searched from China National Knowledge Infrastructure (CNKI), WANFANG DATA, PubMed, SCOPUS and Web of science with no limited on language, region and research institution. The retrieval time was limited from January 2010 to February 2023 and cohort study, case-control study and randomized controlled trial were included. Data were extracted from eligible studies by two independent reviewers, and after study quality assessment by NOS scale, Meta-analysis was completed using Stata 16.0 software. Results: A total of 2 340 related literatures were searched, and 10 literatures were finally included, including 5 case-control studies and 5 indirect cohort studies, which showed good literature quality. The vaccine effectiveness against serotype 19A IPD of PCV13 in children was 83.91% (95%CI: 78.92%-88.89%), and the subgroup analysis (P=0.240) showed there was no significant difference among the case-control study (VE=87.34%, 95%CI:79.74%-94.94%) and the indirect cohort study (VE=81.30%, 95%CI:74.69%-87.92%). The funnel plot and Egger test suggested that the possibility of publication bias was small. Conclusion: The present evidence indicates that PCV13 has a good vaccine effectiveness against serotype 19A IPD in children, and it is recommended to further increase the vaccination rate of PCV13 to reduce the disease burden of IPD in children <5 years old.

Magnetic resonance guided focused ultrasound surgery for the treatment of low- to intermediate-risk localized prostate cancer / 中华泌尿外科杂志

Objective:To evaluate the feasibility, safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery (MRgFUS) in the treatment of localized prostate cancer (PCa).Methods:The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed. The median age was 73 (58-80) years, with the median PSA of 7.34 (5.19-8.40) ng/ml, and a median prostate volume of 27.96 (21.50-37.91) ml. The median pretreatment international prostate symptom score (IPSS) was 13(0-18). Of the 3 patients with intention of erectile function preservation, the pretreatment international index of erectile function-15 (IIEF-15) score was 12, 23 and 3, respectively. All patients had histopathology-proven PCa of grade group ≤ International Society of Urological Pathology (ISUP) 3, pre-operative PSA level <20 ng/ml, and a clinical stage ≤T 2b. A total of 6 lesions was confirmed by biopsy, with 3 of ISUP grade group 3 and 3 of ISUP grade group 1. All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging (MRI). PSA, MRI and repeated biopsy were conducted to monitor recurrence. Questionnaires consisted of IPSS, IIEF-15, and the International Consultation on Incontinence-questionnaire-Short Form (ICI-Q-SF) were recorded before and after MRgFUS to evaluate the impact on functional preservation. Results:A total of 5 patients received MRgFUS. In total, 5 of the 6 lesions were treated. 1 lesion unvisible on MRI was not clinically significant and was left untreated. The median time in MRI scanner was 190 (140-355) min, and the median sonication time was 64 (35-148) min with the median sonications of 8 (5-13). The median catheter indwelling time was 1 (1-8) days. No other adverse effects were reported. The PSA level of all 5 patients decreased, with the nadir PSA of 1.196 ng/ml, 4.398 ng/ml, 4.135 ng/ml, 1.562ng/ml and 1.350ng/ml, respectively. 4 of the patients had a PSA decrease over 50%. No PCa lesion was seen on MRI at 3-month follow-up visit. As for functional preservation, the post-MRgFUS IPSS declined compared with the baseline score, and the IPSS of last follow-up was 5(0-14). Of the 3 patients with intention to preserve the erectile function, the erectile function score of IIEF-15 were 12, 30 and 9 three months after the treatment, respectively. No incontinence occurred postoperatively.Conclusions:MRgFUS is a feasible and safe way for the treatment of low- to intermediate-risk localized PCa, with satisfactory performance on functional preservation and low incidence of complications. The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.

Feasibility and clinical effect of gelatin sponge in reducing bone cement leakage in percutaneous kyphoplasty / 中华创伤杂志

Objective:To explore the feasibility and clinical efficacy of gelatin sponge packing in reducing bone cement leakage in percutaneous kyphoplasty (PKP).Methods:A retrospective case-control study was conducted in data of 171 patients (171 vertebrae) with monosegmental lumbar osteoporosis compressive fracture treated by PKP from January 2015 to December 2018 in Sichuan Orthopedic Hospital. There were 66 males and 105 females, with the age of (67.9±6.7)years (range, 60-87 years). There were 22 patients with T 10 fracture, 28 with T 11 fracture, 37 with T 12 fracture, 34 with L 1 fracture, 32 with L 2 fracture and 18 with L 3 fracture. A total of 80 patients were pre-filled with gelatin sponge before injection (Group A), and 91 patients were not filled with gelatin sponge before injection (Group B). The operation time, amount of bone cement, and rate of bone cement leakage were recorded. The change of anterior vertebral height, Cobb angle, visual simulation score (VAS) and Oswestry disability index (ODI) were compared before operation and at postoperative 1 day, 3 months, 6 months, 12 months. Results:All patients were followed up for 1-12 months [(12.8±0.6)months]. The operation time in Group A and B was (48.3±1.2)minutes and (42.3±1.3)minutes ( P<0.05). The amount of bone cement in Group A and B was (5.4±0.8)ml and (5.6±0.7)ml ( P>0.05). The incidence of bone cement leakage in Group A and B was 11% (9/80) and 26% (24/91) ( P<0.05). There was no significant difference between the two groups in the anterior height of injured vertebrae, change of Cobb angle, VAS and ODI before and after operation ( P>0.05). Conclusion:Gelatin sponge can reduce the rate of bone cement leakage in PKP for the treatment of thoracolumbar osteoporosis compressive fracture, and has similar effect with PKP in correcting kyphosis, alleviating pain and improving life quality.

Application of enhanced recovery after surgery in postoperative rehabilitation of osteoporotic lumbar compression fractures with percutaneous vertebroplasty or percutaneous kyphoplasty / 中国骨伤

OBJECTIVE@#To study effects of postoperative regular training of core muscle strength guided by the concept of enhanced recovery after surgery (ERAS) on the rehabilitation of elderly patients with osteoporotic lumbar vertebral compression fracture after vertebroplasty (PVP) and kyphoplasty(PKP).@*METHODS@#Ninety-four elderly patients with osteoporotic lumbar compression fractures who underwent PKP or PVP from January 2016 to January 2018 and met inclusion criteria were divided into observation group and control group. All the patients were treated with routine anti osteoporosis therapy after operation. There were 47 patients in the observationgroup, including 18 males and 29 females, with an average age of (62.62±3.21) years old;in the control group, there were 47 cases, including 17 males and 30 females, with an average age of (62.38±2.84) years old. The patients in the control group were trained by traditional way, and the patients in observation group were instructed to conduct regular training of core muscle strength according to ERAS concept. The patients were followed up for 1, 3 and 6 months after operation. Patients' conditions were quantitatively evaluated according to Barthel scale, JOA low back pain score and Oswestry Disability Index, and the differences in treatment effects between two groups were statistically analyzed and compared.@*RESULTS@#All the patients were followed up, and the Barthel scale, JOA low back pain score and Oswestry Disability Index score of the observation group were all better than those of the control group on the 1st and the 3rd months after surgery(@*CONCLUSION@#Early regular core strength training has a positive effect on early functional recovery and improvement of life ability after PKP or PVP for elderly patients with osteoporotic lumbar compression fractures, which is in line with the concept of accelerated rehabilitation surgery.

Children's Internet hospital: Construction and practice / 第二军医大学学报

Internet hospital is an online service, diagnosis and treatment platform that relies on the traditional hospital, and it can connect doctors and patients through Internet, providing patients with the whole process of medical service through the integration of online and offline services. To construct children's Internet hospital, the following measures were adopted: Using Internet technology, we constructed a whole process online and offline child service platform; using the concept of health closed-loop management, we carried out core medical service such as online diagnosis and treatment; and based on telemedicine technology, the collaborative medical interaction service between doctors was achieved. We also created our own platform to ensure information security and children's medical experience with the help of system data interaction and cloud technology. Besides, an Internet hospital management system was established to ensure medical quality and safety. The children's Internet hospital can improve not only the medical service efficiency, but also the children's medical experience.

Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly / 中国骨伤

OBJECTIVE@#From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures.@*METHODS@#A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them, 23 patients were in CPC/PMMA group, with an average age of (77.6±2.2) years old, 39 patients in PMMA group, with an average age of (77.1±1.1) years old. The indexes between two groups were compared, including the visual analogue scale (VAS), height ratio of anterior vertebra (AVHR), local Cobb angle, cement leakage, new adjacent vertebral fracture(NAVF).@*RESULTS@#There were no significant difference in gender, age, follow-up time and preoperative VAS, AVHR, local Cobb angle between two groups (>0.05), at the 1 day after operation, VAS, AVHR, local Cobb angle in all patients got obvious improvement (0.05). At the same time, there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (>0.05). The pain in both groups continued to improve at follow up after operation (<0.05), the local Cobb angle increased (<0.05) and AVHR decreased slightly (<0.05). However, the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth.@*CONCLUSION@#CPC/PMMA composite bone cement is safe and reliablein PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures, which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future, although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture, CPC degeneration or new bone ingrowth.

The preliminary study on clinical application of CRT+ARC technique in patients with locally advanced lung cancer / 实用肿瘤学杂志

Objective This paper investigated the clinical application of CRT+ARC technique in locally advanced lung cancer. Methods A total of 100 patients with locally advanced lung cancer who underwent radiotherapy in our hospital from March 1,2016 to March 1,2017 were randomly assigned to the experimental and control groups. Each group consisted of 50 patients. The CRT+ARC plans were made for the experimental group,and the CRT + intensity-modulated radiotherapy(IMRT)(CRT+IMRT) plans for the control group. According to the World Health Organization( WHO) criteria,the short-term efficacy of patients was as-sessed. According to the imaging examination and the Radiation Therapy Organization Group(RTOG)standard,the occurrence of major side effects of radiation pneumonia was identified. Results The effective rate of treatment was 82% in the experimental group and 76% in the control group. There was no difference in the effective rate between the two groups(χ2 =0. 542,P=0. 461). The incidence of pneumonia in the experimental group was 22% ,and 18% in the control group. There was also no difference in the incidence of pneumonia between the two groups(χ2 =0. 250,P=0. 617). Conclusion In the clinical application of locally advanced lung cancer, CRT+ARC technique has no difference in the short-term efficacy and the main side effects of radiation pneumonitis compared with CRT+IMRT.

Research Progress on Diagnosis and Treatment of Chronic Osteomyelitis / 中国医学科学杂志(英文版)

We review the representatives literatures on chronic osteomyelitis, sum up the new insights in recent years into diagnostic options and treatment regimens, analyze the advantages and disadvantages of various diagnostic approaches and treatment strategies, and propose areas of interest to make current diagnostic and treatment strategies more specific.

Physicochemical properties of hydroxyapatite/dicalcium phosphate dehydrate bone cement / 中国组织工程研究

BACKGROUND:β-tricalcium phosphate (β-TCP) and monocalciumphosphate monohydrate (MCPM) are traditionally considered as reactants for dicalcium phosphate dehydrate (DCPD) bone cement,but little is reported on the hydroxyapatite (HA) as a reactant.OBJECTIVE:To verify whether HA and MCPM can be used to prepare DCPD bone cement and to explore the physicochemical properties.METHODS:The HA and β-TCP were prepared by wet chemical precipitation method,and mixed with appropriate proportion of MCPM.Then,the HA-DCPD and β-TCP-DCPD were obtained by adding a proper amount of curing water.The composition and structure of the two materials were analyzed by X-ray diffraction,the morphology was observed by scanning electron microscope,and the mechanical strength was tested by Instron5567 universal material test machine.These two kinds of materials were placed in simulated body fluid for detecting the weight loss ratio,soaked for 14 days and taken out for X-ray diffraction and scanning electron microscope detection.RESULTS AND CONCLUSION:X-ray diffraction findings indicated that these two kinds of materials both belonged to high-purity DCPD bone cement.Under the scanning electron microscope,β-TCP-DCPD bone cement had dense crystal structure,with less pore number;however,the HA-DCPD bone cement presented with finer grains,loose structure,and higher pore number.With the increase of curing time,the mechanical strength of two kinds of bone cements was correspondingly increased,but the compressive strength of β-TCP-DCPD bone cement was significantly higher than that of HA-DCPD bone cement (P ＜ 0.05).In the simulated body fluid,the weight loss ratio of β-TCP-DCPD bone cement was significantly lower than that of HA-DCPD bone cement (P ＜ 0.05).At 14 days after soaking in the simulated body fluid,a layer of spherical particles that was formed on the surface of both materials was identified as hydroxyapatite by scanning electron microscope observation and X-ray diffraction analysis.In summary,HA-DCPD bone cement has good biodegradability,excellent bioactivity and bone conductivity,but poor mechanical properties.

Dual-antigen sandwich-type time-resolved fluoroimmunoassay for phospholipase A2 receptor antibody, a new marker of membranous nephropathy / 中华核医学与分子影像杂志

Objective To establish a time-resolved fluoroimmunoassay (TRFIA) method for detecting M-type phospholipase A2 receptor (PLA2R) antibody and to investigate the diagnostic value of serum PLA2R antibody for idiopathic membranous nephropathy (IMN).Methods The microplates coated with recombined PLA2R antigen and Eu3+-streptavidin labeled PLA2R antigen were used to establish a dual-antigen sandwich-type TRFIA for PLA2R antibody detection (anti-PLA2R-TRFIA).The serum concentrations of PLA2R antibody in 63 IMN patients (36 males,27 females,age 25-75 years) and 90 healthy volunteers (30 males,60 females,age 22-53 years) were quantitatively analyzed.Kruskal-Wallis H test and MannWhitney u test were used to analyze the data.Results The range of anti-PLA2R-TRFIA was 0-10 mg/L and the sensitivity was 5 μg/L,while ED20,ED50 and ED80 of the standard curve were (0.144±0.012),(0.707±0.029) and (3.466±0.098) mg/L,respectively.The CV of inter-and intra-assay were 4.7％ and 5.1％,respectively.The average concentration of serum PLA2R antibody in healthy volunteers was 0.455(0.320,0.593) mg/L,but in IMN patients it was 2.690(0.717,7.750) mg/L (z=-3.688,P＜0.05).Meanwhile,the serum levels of PLA2R antibody in IMN patients were significantly different between different stages and ages (x2 values:10.328,9.716,both P＜0.05).According to the receiver operating characteristic (ROC) curve,when the diagnostic cut-off was set at 0.80 mg/L for IMN detection,the sensitivity and specificity of anti-PLA2R-TRFIA were 73.0％ (46/63) and 95.6％ (86/90),respectively.Conclusions AntiPLA2R-TRFIA has been well established.This quick and easy-performance method could increase the diagnostic accuracy for IMN.

Clinicopathological Characteristics and Prognosis Analysis of the Patients with Plasmablastic Lymphoma / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathological characteristics, treatment and prognosis of the patients with plasmablastic lymphoma(PBL).</p><p><b>METHODS</b>The clinical and pathological data of 21 patients with PBL diagnosed and treated in our center between January 2009 and September 2017 were retrospectively analyzed. The clinical and pathological features, treatment and therapentic outcome were summarized and the high risk factors affecting the prognosis of patients were investigated.</p><p><b>RESULTS</b>The 21 PBL patients included 12 males and 9 females, and their median age was 52 years old. The human immunodeficiency virus (HIV) was negative in all patients. The primary involved sites of 16 patients were extranodal, and the patients staged in III-IV accounted for 81%; 18 patients receved first-line chemotherapy with standard CHOP(E) (cyclophosphamide +epirubicin +vincristine +prednisone±etoposide). After treatment, only 1 patient achieved complete response (CR), and 8 patients achieved partial response (PR). The median overall survival time was 6.3 months. Multivariate analysis showed the America Eastern Cooperative Oncology Group (ECOG) physical score and bone marrow infiltration were significant prognostic factors (P<0.01).</p><p><b>CONCLUSION</b>Plasmablastic lymphoma frequently occurrs in the middle-old aged persons with all HIV negative. Primary extranodal lesions are frequent. Most patients were in advanced stage with poor treatment response. ECOG score≥2 and bone marrow infiltration are independent prognostic factors related with worse prognosis.</p>

Updated concepts on the pathophysiology and the clinical management of trauma hemorrhage and coagulopathy / 中华创伤杂志(英文版)

Uncontrolled hemorrhage and subsequent trauma-induced coagulopathy (TIC) are still the principle causes for preventable death after trauma and early detection and aggressive management have been associated with reduced mortality. Despite increasing knowledge about trauma resuscitation, best practice to treat this newly defined entity is still under debate. A synopsis of best current knowledge with reference to the updated European trauma guideline on the management of severe trauma hemorrhage and TIC is presented. The implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome is advocated.

Gene Variations of Sixth Complement Component Affecting Tacrolimus Metabolism in Patients with Liver Transplantation for Hepatocellular Carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Orthotopic liver transplantation (OLT) improves the prognosis of patients with hepatocellular carcinoma (HCC). Moreover, the complement system is a powerful immune effector that can affect liver function and process of liver cirrhosis. However, studies correlating the complement system with tacrolimus metabolism after OLT are scarce. In this study, the role of single nucleotide polymorphisms (SNPs) associated with the sixth complement component (C6) in tacrolimus metabolism was investigated during the early stages of liver transplantation.</p><p><b>METHODS</b>The study enrolled 135 adult patients treated with OLT for HCC between August 2011 and October 2013. Ten SNPs in C6 gene and rs776746 in cytochrome P450 3A5 (CYP3A5) gene were investigated. The tacrolimus levels were monitored daily during 4 weeks after transplantation.</p><p><b>RESULTS</b>Both donor and recipient CYP3A5 rs776746 allele A were correlated with decreased concentration/dose (C/D) ratios. Recipient C6 rs9200 allele G and donor C6 rs10052999 homozygotes were correlated with lower C/D ratios. Recipient CYP3A5 rs776746 allele A (yielded median tacrolimus C/D ratios of 225.90 at week 1 and 123.61 at week 2), C6 rs9200 allele G (exhibited median tacrolimus C/D ratios of 211.31 at week 1, 110.23 at week 2, and 99.88 at week 3), and donor CYP3A5 rs776746 allele A (exhibited median C/D ratios of 210.82 at week 1, 111.06 at week 2, 77.49 at week 3, and 85.60 at week 4) and C6 rs10052999 homozygote (exhibited median C/D ratios of 167.59 at week 2, 157.99 at week 3, and 155.36 at week 4) were associated with rapid tacrolimus metabolism. With increasing number of these alleles, patients were found to have lower tacrolimus C/D ratios at various time points during the 4 weeks after transplantation. In multiple linear regression analysis, recipient C6 rs9200 group (AA vs. GG/GA) was found to be related to tacrolimus metabolism at weeks 1, 2, and 3 (P = 0.005, P = 0.045, and P = 0.033, respectively), whereas donor C6 rs10052999 group (CC/TT vs. TC) was demonstrated to be correlated with tacrolimus metabolism only at week 4 (P = 0.001).</p><p><b>CONCLUSIONS</b>Recipient C6 gene rs9200 polymorphism and donor C6 gene rs10052999 polymorphism are new genetic loci that affect tacrolimus metabolism in patients with HCC after OLT.</p>

Improved treatment of frozen red blood cells by red blood cell processing technology / 军事医学

Objective To improve the buffer for washing frozen red blood cells(RBCs)and explore the feasibility of replacing the middle buffer of 2% NaCl with 0.9% NaCl solution in the protocol of deglycerolization and the effect was evaluated.Methods Two units of RBCs separated from whole blood of healthy donors were frozen at -80℃.The thawed frozen RBCs were treated with a washing machine.On the basis of the old protocol(protocol 1),the middle buffer of 2%NaCl was replaced,and the usage of washing buffer and the washing steps were adjusted to create a new protocol(protocol 2).The quality of RBCs washed by the two protocols was evaluated.Results According to the results of the detection of RBCs treated by protocol 1 and 2: the hemoglobin contents(g)were 42.18 ±3.35 and 44.98 ±1.68,respectively,free hemoglobin contents(g/L)were 0.53 ±0.06 and 0.45 ±0.05 respectively, the residual amount of white blood cells (×107)was 1.92 ±1.04 and 1.12 ±1.12,and the osmolarities(mOsm)were 327.0 ±9.06 and 331.8 ±10.62 respectively. Sterile experiments were negative for both bacteria and fungi.The hemolysis rates(%)were 12.02 ±5.78 and 14.30 ± 5.67 respectively.The deforming abilities(%)were 21.42 ±1.45 and 21.32 ±0.84 respectively.The RBC recoveries (%)were 77.18 ±5.58 and 79.63 ±2.06 respectively.The processing time(min)was 79.60 ±0.55 and 78.80 ±1.30 respectively.There was no significant difference in the quality of frozen RBCs washed by the old protocol(protocol 1)and the new protocol(protocol 2)(P>0.05).Conclusion The quality of frozen RBCs washed by the two protocols meet national standards.

Diagnosis of 320-row detector dynamic volume CT in complex congenital heart disease with double outlet right ventricle / 重庆医学

Objective To explore the diagnosis value of 320-row detector dynamic volume CT in complex congenital heart disease (CCHD)with double outlet right ventricle(DORV).Methods Seventy-eight patients who proveed DORV by surgery in Xinqiao Hospital of Third Military Medical University were reviewed.Thirty-six patients of group A performed 320-row detector dynamic volume CT by using segmental analysis,and were compared with the group B(42 Cases) performed conventional 64-slice CT respectively.Results In 36 cases of DORV confirmed by surgery in group A,MSCT provided accurate qualitative diagnosis in all cases.The accuracy rate of diagnosis of the group B was 90.7％.There was no significant differences compared with the group A (P＞0.05).There were ventricular septal defect in all the 78 cases,pulmonary stenosis in 56 cases,atrial septal defect in 34 cases,pulmonary hypertension in 21 cases,patent ductus arteriosus in 16 cases,coarctation of aorta in 9 cases.Conclusion The 320-row detector dynamic volume CT has important diagnostic value for DORV of the anatomical diagnosis.

Clinical significance of MR-guided prostate biopsy based on diffusion-weighted imaging abnormalities for prostate cancer diagnosis in elderly men / 中华老年医学杂志

Objective To evaluate the diagnostic efficacy of magnetic resonance(MR)-guided prostate biopsy based on abnormal diffusion weighted imaging for prostate cancer in elder men.Methods From July 2014 to Dec 2016,56 patients (age≥ 65 years) with diffusion weighted imaging (DWI)abnormalities undergoing MR-guided prostate biopsy were retrospectively evaluated.According to pathological diagnosis,patients were divided into prostate cancer and non-prostate cancer groups.The clinical data of two groups were analyzed.The correlation of Gleason score,prostate specific antigen(PSA),and the location and number of biopsy were compared.Results Among 56 cases,32 (57.1％)were diagnosed as prostate cancer,and 24 (42.9％)as chronic prostatitis and prostatic hyperplasia (non-prostate cancer).There were statistically significant differences between prostate cancer and non-prostate cancer in age[(73.0±5.7)vs.(70.1±4.3)year]and PSA[(9.3±6.0)μg/L vs.(6.0± 3.9)μg/L] (both P＜0.05),and no statistical differences in biopsy location and biopsy number(t =2.08,2.37,P＞ 0.05).Gleason score had no correlation with PSA level and biopsy location and biopsy number(r=0.189、-0.183、0.082,P＞0.05).Conclusions MR-guided prostate biopsy based on MR-DWI has some merits,such as accurate positioning,fewer numbers of biopsy,and lower false-negative rate.