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Objective:To investigate the clinical characteristics, diagnosis, treatment and prognosis of acute leukemia (AL) with NUP98-DDX10 fusion gene-positive.Methods:The clinical data of 2 AL patients with NUP98-DDX10 fusion gene-positive who admitted to Blood Diseases Hospital, Chinese Academy of Medical Sciences in April 2020 and February 2021, respectively were retrospectively analyzed. Transcriptome gene sequencing was used to detect fusion gene, and the fusion gene fragment was amplified by using reverse transcription polymerase chain reaction (RT-PCR), and Sanger sequencing was used to clarify sequences. The clinical and experimental indicators characteristics were analyzed and the relevant literatures were reviewed.Results:According to the clinical diagnosis, 1 patient was diagnosed as acute myeloid leukemia M 5 (AML-M 5) and 1 patient was diagnosed as acute leukemia of ambiguous lineage, not otherwise specified (ALAL-NOS). The AML-M 5 patient presented with severe coagulation abnormalities, and fulfilled the diagnostic criteria for diffuse intravascular coagulation (DIC) at the initial visit. Transcriptome sequencing of 2 patients showed NUP98-DDX10 fusion gene- positive. RT-PCR confirmed that sequencing results identified 2 different splice fusion modes: one was NUP98 exon 14 fused with DDX10 exon 7(usually called "type Ⅱ"), the other was NUP98 exon 14 fused with DDX10 exon 13, which was never reported and named as "type Ⅳ". From 1997 to 2018, a total of 16 cases with NUP98-DDX10 related hematologic neoplasms were reported in the literature. A summary analysis of 16 cases added with 2 patients in our center included 13 males and 5 females with median age 31.5 years (0.08-61 years). The median overall survival was 12 months (1-46 months). Conclusions:A novel fusion gene NUP98-DDX10 transcriptome is identified in ALAL-NOS patient. Hematological malignancies with NUP98-DDX10 are very rare. They respond poorly to conventional treatment and require allogeneic hematopoietic stem cell transplantation (allo-HSCT) to improve the prognosis.
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Objective:To investigate the functional mechanism of circular RNA signal-induced proliferation-associated gene 1(circSIPA1L1) on proliferation, migration and invasion of renal cell carcinoma cells, as well as to explore its mechanism.Methods:The study was completed between January 2019 and December 2019. Bioinformatics was used to analyze the expression of circular RNA(circRNA), circSIPA1L1 in renal cancer tissue and the information of circSIPA1L1. The expression of circSIPA1L1 mRNA, miR-22-3p in renal cancer tissues and renal cancer cells was detected by RT-qPCR. The circSIPA1L1 interference vector negative control (si-NC group), circSIPA1L1 interference vector (si-circSIPA1L1 group), si-circSIPA1L1+ miR-22-3p suppression vector plasmid negative control (anti-miR-NC group), si-circSIPA1L1 + miR-22-3p inhibition vector plasmid (anti-miR-22-3p group) were transfected into A498 and OSRC2 cells respectively. Dual luciferase reporter gene experiment was used to verify the targeting relationship. Clone formation experiment and Transwell chamber were used to detect cell proliferation, migration and invasion. The xenograft model was established by subcutaneous injection of A498/sh-circSIPA1L1 or A498/sh-NC (2×10 6 in 0.2 ml PBS/mice) on the right back of nude mice, and nude mice were divided into sh-circSIPA1L1 group and sh-NC group. Nude mice tumor formation experiments were used to detect tumor formation ability. Results:The expression of circSIPA1L1 mRNA in adjacent tissues and renal cancer tissues were (1.09±0.44) and (3.89±1.35) respectively. The expression of miR-22-3p were (1.02±0.30) and (0.44±0.19)respectively. The difference of the expression of circSIPA1L1 mRNA and miR-22-3p in kidney cancer tissue and adjacent tissues were statistically significant ( P<0.05). Compared with normal kidney cell KiMA, the expression of circSIPA1L1 mRNA in renal cancer cells A498 and OSRC2 was increased, and the expression of miR-22-3p was decreased ( P<0.05). The cell clone number of A498 and OSRC2 in the si-circSIPA1L1 group (130.67±15.04, 99.00±14.80) was lower than that in the si-NC group (314.33±29.57, 234.67±21.50), the number of cell migration (108.33±17.01, 85.67±11.93) was lower than si-NC group (265.00±20.00, 210.33±18.58), cell invasion number (84.00±12.00, 66.00±10.15) was lower than si-NC group (210.33±18.58, 173.00±17.52), and the differences were all statistically significant ( P< 0.05). CircSIPA1L1 targets and negatively regulates miR-22-3p expression. The cell clone number of A498 and OSRC2 in the si-circSIPA1L1+ anti-miR-22-3p group (234.20±21.90, 185.06±20.72) was higher than that in the si-circSIPA1L1+ anti-miR-NC group (134.65±26.55, 106.14±16.38), the migration cell number (187.02±23.54, 117.86 ±15.09) was higher than that of the si-circSIPA1L1+ anti-miR-NC group (110.59±12.12, 91.70±14.83), and the number of cell invasion (168.23±11.69, 103.70±9.23) was higher than that of the si-circSIPA1L1+ anti-miR-NC group (90.46±11.53, 61.35±9.10). The differences were all statistically significant ( P<0.05). The tumor volumes of nude mice in the sh-NC group and sh-circSIPA1L1 group on day 35 were (578.65±68.67) mm 3 and (242.56±42.35) mm 3 respectively, the tumor weights of nude mice were (0.68±0.06) g and (0.38±0.04) g respectively, the differences were statistically significant ( P<0.05). Conclusions:CircSIPA1L1 can promote the deterioration of renal cancer, promote the proliferation, migration, invasion of cancer cells and tumor growth. The mechanism of action is related to the direct targeting of miR-22-3p.
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Objective@#To observe the clinical characteristics, treatment responses and prognosis of patients with myelodysplastic syndrome (MDS) -del (5q) syndrome who met WHO (2016) diagnostic typing criteria.@*Methods@#A total of 77 patients with del (5q) syndrome, according to WHO (2016) classification, were retrospectively analyzed between January 2008 and April 2018 in the Blood Diseases Hospital, Chinese Academy of Medical Sciences. Clinical characteristics, lenalidomide (LEN) efficacy and survivals were compared between the patients with del (5q) alone and those with one additional cytogenetic abnormality (ACA) with the exception of monosomy 7 or del (7q) . Treatment response and overall survival (OS) were compared between patients who were treated with LEN and traditional non-LEN drugs.@*Results@#Of 77 patients, 64 were isolated del (5q) and 13 were del (5q) with ACA. There were significant differences of the median age and percentage of patients who had small megakaryocytes in bone marrow smear by immunohistochemistry (CD41) between the patients with isolated del (5q) and the patients with del (5q) + ACA[58 (29-64) years old vs 63 (31-82) years old, z=2.164, P=0.030; and 91.7%vs 60.0%, P=0.046, respectively]. The overall hematological response rate (78.9%vs 80.0%) , complete hematological remission (CR) rate (57.9% vs 60.0%) , cytogenetic response (CyR) rate[69.2% (9/13) vs 66.7% (4/6) ] and complete cytogenetic response (CCyR) rate [61.5% (8/13) vs 33.3% (2/6) ] of LEN were similar between the patients with isolated del (5q) (n=19) and with del (5q) + ACA (n=10) , as well as the median Overall survival (OS) between these two groups of patients (62 months vs 78 months, P=0.388) . The hematological response rate (79.3% vs 36.0%) , CR rate (58.6% vs 8.0%) , CyR rate [68.4% (13/19) vs 11.1% (1/9) ] and CCyR rate [52.6% (10/19) vs 0 (0/9) ] were higher among patients treated with LEN (n=29) than those treated with non-LEN therapy (n=25) . There was no statistically significant difference in OS between the patients with LEN or non-LEN therapy (78 months vs 62 months, P=0.297) .@*Conclusion@#Comparing del (5q) syndrome patients with isolated del (5q) or with del (5q) + ACA, two groups of patients had similar clinical characteristics, median OS and LEN efficacy. LEN showed better treatment response than traditional drugs in patients with del (5q) syndrome.
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Objective@#To investigate the application values of immunophenotypic analysis and molecular genetics in the diagnosis of acute promyelocytic leukemia (APL) .@*Methods@#The retrospective analyses of flow cytometric (FCM) immunophenotypic anyalysis, chromosome karyotype and chromosome fluorescence in situ hybridization (FISH) of 798 outpatient or hospitalization APL patients referred to our hospital between May 2012 and December 2017 were performed to further study the application values of FCM and molecular genetics in the diagnosis of APL.@*Results@#The sensitivity and specificity of FCM were 91.9% and 98.7% respectively. The typical characteristic immunophenotype for APL was as of follows: a high SSC, absence of expression of cluster differntiation (CD) CD34 and HLA-DR, and expression or stronger expression of CD33, consistent expression of CD13, CD9, CD123, expression of CD56, CD7, CD2 (sometimes) . The rest 10% of the cases harbored atypical APL phenotypes, generally accompanied by CD34 and/or HLA-DR expression, decreased SSC and often accompanied by CD2 expression, it was difficult to definitively diagnose APL by this FCM phenotype, and their diagnoses depended on the results of genetics or molecular biology tests. Compared with normal individuals, complex karyotypes APL with t (15;17) translocation, other variant translocations and variant t (11;17) , t (5;17) had no significant differences in terms of their FCM phenotypes.@*Conclusions@#FCM could rapidly and effectively diagnose APL. Despite the fact that complex karyotypes with various additional chromosomal abnormalities were detected in approximately one third of APL cases in addition to the pathognomonic t (15;17) (q22;q21) , they had no observable impact on the overall immunophenotype. Molecular and genetic criteria were the golden criteria for the diagnosis of APL. About 10% of immunophenotyping cases relied on molecular genetics for diagnosis.
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Objective@#To investigate the clinical characteristics, diagnosis, treatment and prognosis of therapy-related myeloid neoplasms (t-MNs) after successful treatment for acute promyelocytic leukemia (APL) .@*Methods@#Clinical data of 4 patients, diagnosed as t-MNs secondary to APL at Hematology Hospital of Chinese Academy of Medical Sciences from October 2012 to January 2019, were collected retrospectively. T-MNs related literature was reviewed.@*Results@#The 4 cases were all females, with the median age 42 (range 40-53) years old at the diagnosis of APL. Regarding the induction and consolidation regimens, 3 patients received all-trans retinoid acid (ATRA) and arsenic trioxide (ATO) combined with anthracycline/anthraquinone and/or cytosine. One patient only received ATRA and other auxiliary drugs. Alkylating agents were not administrated. The 4 patients developed t-MNs 40 to 43 months after complete remission (CR) of APL, including 1 case of therapy-related myelodysplastic syndrome (t-MDS) and 3 cases of acute myeloid leukemia (t-AML) . The PML-RARα fusion genes were all negative when t-MNs developed. The three patients with t-AML were treated with 3 to 4 re-induction regimens, one of whom underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after complete remission (CR) . One patient with t-MDS received hypomethylating agents. After a median follow-up of 54.5 (48-62) months, 2 patients with t-AML died, the median overall survival after t-MN was 12 (5-18) months. From 1989 to 2018, a total of 63 t-MN cases were reported in the literature. Therefore, 67 cases were analyzed when four patients in our center were added, including 27 males and 40 females with median age 52.5 (15-76) years. The median latency was 39 (12-126) months and the median overall survival after diagnosis of t-MN was 10 (1-39) months.@*Conclusions@#Although rare, t-MNs may occur after successful control of APL. There are no existing guidelines for prevention and treatment of t-MNs, which have very poor prognosis. If cytopenia or other abnormalities of peripheral blood cells develop after 3 years of APL, t-MNs should be considered as a differential diagnosis.
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Objective@#To investigate the genetic screening methods for cryptic acute promyelocytic leukemia (APL) to further explore its clinical prognosis.@*Methods@#From June 2016 to November 2018, we collected 373 newly diagnosed APL cases. The patients were retrospected by the results of PML-RARα detections both by RT-PCR and i-FISH, those who harbored positive PML-RARα detection by RT-PCR and negative by i-FISH were chosen. Metaphase FISH and Sanger sequencing were further performed to verify these results.@*Results@#A total of 7 cryptic APL cases were discovered. These cases had tiny fragment of RARα inserted into PML in chromosome 15, formed ins (15;17) . The 7 cryptic APL cases had no PML-RARα gene subtype specificity, involving 5 cases in L subtype, 1 case in S subtype and 1 case in V subtype respectively. After the treatment of retinoic acid and arsenic or anthracyclines, 6 cases achieved complete remission, 1 case died of intracranial hemorrhage on the 6th day of therapy.@*Conclusion@#The size and covering position of PML-RARα probe should be taken into account when PML-RARα was performed by FISH on APL patients. Furthermore, combination with Metaphase FISH could improve the recognition of cryptic APL. There were no differences between the cryptic and common APL patients in terms of clinical features and treatment choices. Cryptic APL patients also had a good response to the therapy of retinoic acid and arsenic or anthracyclines.
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Objective@#To explore the predictive value of minimal residual disease (MRD) level in Ph-negative precursor B-acute lymphoblastic leukemia (ALL) patients.@*Methods@#De novo 193 Ph-negative B-ALL patients from Sep 2010 to Nov 2017 were involved in the study. The patients' MRD evaluation which can be performed by multiparametric flow cytometry (MFC) after 1 month, 3-month, 6-month treatment. Relapse free survival (RFS) and overall survival (OS) were compared in patients with different MRD level.@*Results@#The median follow-up was 22 months. All patients was evaluated at 497 MRD level. Patients who reach the good MRD level at 1 month (<0.1% or ≥0.1%), 3-month (negative or positive), 6-month (negative or positive) had a significantly higher probability of estimated RFS (74.5% vs 29.9%; 75.6% vs 29.7%; 74.6% vs 11.6%) and of estimated OS (67.5% vs 30.3%; 71.6% vs 27.8%; 74.0% vs 15.7%). Patients who reach the MRD negative at all 3 times had a significantly higher probability of estimated RFS (80.5% vs 30.5%) and better estimated OS (77.1% vs 29.4%) compared to patients with at least MRD failure in one time (P<0.001). Multivariable analysis showed MRD level at 3-month was an independent prognostic factor for DFS and OS.@*Conclusion@#MRD is an important prognosis factor for Ph-negative B- ALL patients.
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Objective@#To investigate the clinical features and therapeutic strategies of childhood myeloid neoplasms associated with eosinophilia and platelet-derived growth factor receptor beta (PDGFRB) gene rearrangement.@*Methods@#Clinical data of myeloid neoplasms associated with eosinophilia and t (1;5) (q21;q33) chromosomal translocation of PDGFRB gene rearrangement in a child hospitalized in Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences on May 2015 was collected and analyzed. Using'eosinophilia child’and'PDGFRB’as keywords, the relevant reports in literature were searched from China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and Biomedical Literature Database (PubMed) until April 2017.@*Results@#The patient was a boy, 19 months old, who began to get sick at six months after birth, with the main clinical manifestations of high fever, diarrhea, epistaxis and hepatosplenomegaly. Peripheral blood smear showed a significant elevation in white blood cells (127×109/L) and eosinophils(20.32×109/L). Bone marrow examination showed hyperplastic marrow, increased proportion of granulocytes, apparent visible eosinophils and decreased megakaryocytes. Chromosome karyotype detection revealed t (1; 5) (q21; q33) translocation. Fluorescence in situ hybridization (FISH) examination uncovered that PDGFRB gene rearrangement was positive. The final diagnosis was myeloid neoplasms with eosinophilia and PDGFRB gene rearrangement. After treatment with oral imatinib 100 mg, once a day for 2 months, complete hematologic remission, complete cytogenetic and molecular remission were all achieved. The relevant literature was reviewed, no Chinese cases had been reported, 6 reports in English literature have complete clinical data. Four cases had t (1; 5) translocation. Four pediatric patients treated with imatinib achieved complete remission.@*Conclusion@#Myeloid neoplasms associated with eosinophilia and PDGFRB gene rearrangement is extremely rare in children. Imatinib treatment can make these patients quickly achieve complete hematologic remission, complete cytogenetic and molecular remission. Imatinib should be recommended as the first line treatment of these patients.
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Objective@#To explore the prognostic factors in newly diagnosed multiple myeloma (NDMM) patients with 1q21 amplification/gain treated with bortezomib-based regimens followed by autologous hematopoietic stem cell transplantation (ASCT) . @*Methods@#We retrospectively assayed 35 NDMM patients with 1q21 amplification/gain who received bortezomib-based chemotherapy followed by ASCT and maintenance therapy between January 2008 and August 2015. @*Results@#①The median age of 35 patients were 49(33-63)years old. Ratio of male to female was 22∶13. Monosomy1q21 amplification/gain was only seen in 3(8.6%) patients, the other 32 patients were with additional cytogenetic abnormalities including 13q14 deletion, t(11,14), t(4,14), t(14,16), 17p deletion and complex karyotype aberrations. ②The complete remission (CR) rate was 57.0% (20/35), the very good partial remission(VGPR) rate was 37.1%(13/35) and the partial remission (PR) rate was 5.7%(2/35) after ASCT. At a median follow-up of 24 (8-85) months, 3-year estimated progression free survival (PFS) and overall survival (OS) rate were (66.5±9.7)% and (69.6±9.9)%, respectively. ③As 13 patients with high-risk cytogenetic abnormalities, the median PFS and OS time was 26 and 28 months. The 3-year estimated PFS and OS was (28.0±15.9)% and (36.5±16.4)%, respectively. Another 22 patients without other high-risk cytogenetic abnormalities, the median PFS and OS time was 54 months and not reached. The 3-year estimated PFS and OS was (71.5±12.7)% and (92.3±7.4)% in this group, respectively. The presence of additional other high-risk cytogenetic abnormalities resulted in significantly shortened PFS (χ2=5.404, P=0.020) and OS (χ2=7.596, P=0.006) compared with no high-risk cytogenetic patients. @*Conclusion@#NDMM patients with isolated1q21 amplification/gain were rarely and usually had additional other cytogenetic abnormalities. The outcomes in this group treated with bortezomib-based chemotherapy followed by ASCT and maintenance therapy were satisfied, additional other high-risk cytogenetic abnormalities made PFS and OS further shortened.
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Objective@#To analyze the clinical and laboratory characteristics, and prognosis of adult acute myeloid leukemia (AML) patients with MLL gene rearrangements.@*Methods@#The medical records of 92 adult AML patients with MLL gene rearrangements from January 2010 to December 2016 were retrospectively analyzed.@*Results@#92 cases (6.5%) with MLL gene rearrangements were identified in 1 417 adult AML (Non-M3) patients, the median age of the patients was 35.5 years (15 to 64 years old) with an equal sex ratio, the median WBC were 21.00(0.42-404.76)×109/L, and 78 patients (84.8%) were acute monoblastic leukemia according to FAB classification. Eleven common partner genes were detected in 32 patients, 9 cases (28.1%) were MLL/AF9(+), 5 cases (15.6%) were MLL/AF6(+), 5 cases (15.6%) were MLL/ELL(+), 2 cases (6.3%) were MLL/AF10(+), 1 case (3.1%) was MLL/SETP6(+), and the remaining 10 patients’ partner genes weren’t identified. Of 92 patients, 83 cases with a median follow-up of 10.3 (0.3-74.0) months were included for the prognosis analysis, the complete remission (CR) rate was 85.5% (71/83), the median overall survival (OS) and relapse free survival (RFS) were 15.4 and 13.1 months, respectively. Two-year OS and RFS were 36.6% and 29.5%, respectively. Of 31 patients underwent allogeneic hematopoietic stem-cell transplantation (allo-HSCT), two-year OS and RFS for patients received and non-received allo-HSCT were 57.9% and 21.4%, 52.7% and 14.9%, respectively (P<0.001). Among patients with partner genes tested, 9 of 32 cases (28.1%) were MLL/AF9(+), the median follow-up was 6.0(4.1-20.7) months. 3 patients with MLL/AF9 underwent allo-HSCT. 23 cases (71.9%) were non- MLL/AF9(+), the median follow-up was 7.8 (0.3-26.6) months. 14 patients (60.1%) with non-MLL/AF9 underwent allo-HSCT. One-year OS for patients with MLL/AF9 and non-MLL/AF9 were 38.1% and 55.5%, respectively (P=0.688). Multivariate analysis revealed that high WBC (RR=1.825, 95% CI 1.022-3.259, P=0.042), one cycle to achieve CR (RR=0.130, 95% CI 0.063-0.267, P<0.001), post-remission treatment with allo-HSCT (RR=0.169, 95% CI 0.079-0.362, P<0.001) were independent prognostic factors affecting OS.@*Conclusions@#AML with MLL gene rearrangements was closely associated with monocytic differentiation, and MLL/AF9 was the most frequent partner gene. Conventional chemotherapy produced a high response rate, but likely to relapse, allo-HSCT may have the potential to further improve the prognosis of this group of patients.
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Objective To explore the feasibility of continuous sciatic nerve block via lateral poplit eal approach with single shot femoral nerve block for enhanced recovery after surgery in ankle and foot surgery.Methods Sixty adult patients scheduled for elective ankle and foot surgery were randomly assigned into 2 group (n =30 each):Group A received sciatic nerve block via lateral popliteal approach with a catheter placed and a single shot femoral nerve block under ultrasound guidance followed by patient-controlled postoperative analgesia with 0.2％ ropivacaine through the perineural catheter;Group B received the routine epidural puncture and a catheter placement at L2-3 level followed by postoperative analgesia with 0.2％ ropivacaine through the catheter.Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart beat (HR) were recorded before and after anesthesia.The block efficacy,the volume of fluid influsion during operation and the usage of ephedrine were recorded.The pain severity at rest and upon movement with a 0-10 numeric rating scale (NRS,0 =no pain and 10 =worst possible pain),the modified Bromage score of the motor block of the affected extremity,the number of effective patient-controlled bolus of ropivacaine and the number of need for opioid rescue within 48 h after surgery were assessed.The first time of leaving bed after operation,the length of hospital stay and the occurring of complication related to puncture and analgelsia were also recorded.Results SBP and DBP at each time point after anesthesia were higher in group A than those in group B (P ＜ 0.05).The volume of fluid infusion during operation and the occurence of ephedrine use were less in group A than those in group B (P ＜0.05).There was no indifference in terms of the NRS scores at rest and upon movement,the number of effective patient-controlled bolus of ropivacaine and the number of need for opioids rescue (P ＞ 0.05),but the complications such as nausea and vomiting,urinary retention occurred more in group B (P ＜0.05).The modified Bromage score of the motor block at each time point within 24 h after surgery was lower in group B than that in group B (P ＜ 0.05).The first time of leaving bed after operation and the length of hospital stay were shorter in group A than those in group B (P ＜ 0.05).Conclusions Ultrasound-guided continuous sciatic nerve block via lateral popliteal approach with single shot femoral nerve block can provide exact anesthetic effect with minimal interference on haemodynamics and excelent postoperative analgesia with less influence on movement.It's helpful in the ankle and foot surgery to improve the recovery after surgery.
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Objective To investigate the clinical characteristics of plasma cell malignancies with t(11;14) and the effect of t(11;14) on prognosis. Methods A cohort of 380 newly diagnosed patients with plasma cell malignancies were analyzed,including 146 females and 234 males.There were 370 cases of newly diagnosed multiple myeloma (NDMM), as well as 10 cases of primary plasma cell leukemia (PCL). The relationship between the categorical variables was evaluated by using the bilateral Fisher exact probability test, with 95 % confidence interval. Results Of 370 NDMM cases, t(11;14) was detected in 101 cases (27.3 %). Of 10 PCL cases, 8 cases displayed t(11;14). The detection rate of t(11;14) was significantly higher in IgD, IgM and non-secreting MM [50.9 % (27/53)] than that in IgA MM [21.6 % (16/78)] and IgG [28.4 % (52/183)] (both P= 0.002). The rate of CD56+in t(11;14) positive group was lower than that in t(11;14) negative group [51.6 % (48/93) vs. 72.0 % (167/232), P= 0.001], and the rate of CD117+was also significantly decreased [23.7 % (22/93) vs. 37.7 % (87/231), P= 0.019]. There were 86 cases of non-t(11;14) IgH rearrangement in 269 cases of NDMM without t(11;14), which mainly were t(4;14) or t(14;16). The detection rate of high risk MM was only 11.9 %(12/101)in t(11;14)positive group,while that rate was 27.5 % (74/269) in t(11;14) negative group, the difference was statistically significant (P = 0.001). Conclusion MM with t(11;14)displays distinct biological,clinical and laboratory features,it is a heterogeneous disease.
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Objective To investigate the clinical characteristics of plasma cell malignancies with t(11;14) and the effect of t(11;14) on prognosis. Methods A cohort of 380 newly diagnosed patients with plasma cell malignancies were analyzed,including 146 females and 234 males.There were 370 cases of newly diagnosed multiple myeloma (NDMM), as well as 10 cases of primary plasma cell leukemia (PCL). The relationship between the categorical variables was evaluated by using the bilateral Fisher exact probability test, with 95 % confidence interval. Results Of 370 NDMM cases, t(11;14) was detected in 101 cases (27.3 %). Of 10 PCL cases, 8 cases displayed t(11;14). The detection rate of t(11;14) was significantly higher in IgD, IgM and non-secreting MM [50.9 % (27/53)] than that in IgA MM [21.6 % (16/78)] and IgG [28.4 % (52/183)] (both P= 0.002). The rate of CD56+in t(11;14) positive group was lower than that in t(11;14) negative group [51.6 % (48/93) vs. 72.0 % (167/232), P= 0.001], and the rate of CD117+was also significantly decreased [23.7 % (22/93) vs. 37.7 % (87/231), P= 0.019]. There were 86 cases of non-t(11;14) IgH rearrangement in 269 cases of NDMM without t(11;14), which mainly were t(4;14) or t(14;16). The detection rate of high risk MM was only 11.9 %(12/101)in t(11;14)positive group,while that rate was 27.5 % (74/269) in t(11;14) negative group, the difference was statistically significant (P = 0.001). Conclusion MM with t(11;14)displays distinct biological,clinical and laboratory features,it is a heterogeneous disease.
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Objective To identify the characteristics oral fungus in HIV-infected patients with HAART in Kunming.Methods Oral mucosal swab samples were collected from 99 patients with HIV infection with or without HAART.The fungi were isolated and cultured,and were identified by using API 20 C AUX yeast identification system.Results The positive rate of oral Candida in was significantly higher in HIV-infected patients without HAART (53.3％) than those with HAART (20.4％) (x2=11.669,P＜0.01).In 41 strains of isolated candida,C.albicans was the most prevalent (78.0％),followed by C parapsilosis (9.8％),C.glabrata (9.8％) and C tropicalis (2.4％).Conclusions HAART can decrease the positive rate of oral Candida in patients with HIV infection,but has little effect on asymptomatic HIV carrier.
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Objective To study the effect of papaverine on vasospasm caused by PICC intubation with B-mode ultrasonography. Method Three mg papaverine were injected into the median cubital vein for at least 2 minutes in 15 patients with vasospasm. Results The vasospasm in the 15 patients was relieved 36~270 s seconds after injection. The followed intubation was all successful. There was no abnormality in their liver function and heart rate, or abnormal bleeding, or other serious complications. Conclusion Papaverine can relieve vasospasm caused by PICC intubation, so it can allow another intubation. It also can avoid delayed intubation reduce patients′pain and cost and reduce psychological pressure of the nursing practitioner.
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Objective: To investigate the feasibility of thoracic paravertebral block [TPVB] for percutaneous nephrolithotomy [PCNL] in comparison with epidural anesthesia [EA] combined with moderate sedation
Subjects and Methods: One hundred American Society of Anesthesiologists [ASA] I-II adult patients scheduled for first-stage unilateral PCNL were randomly assigned to receive either TPVB or EA. All patients were given standard sedation and analgesia with propofol and sufentanil. Patient characteristics, surgical outcomes, anesthetic outcomes, and time to first use of a patient-controlled intravenous analgesic [PCIA] device and postoperative consumption of sufentanil in the first 24 h were recorded. Intergroup differences of the parameters were analyzed using an independent t test, Mann-Whitney test, and X2 test as appropriate
Results: Patients who received TPVB consumed more propofol during ureteroscopy [56.2 +/- 28.4 vs. 42.9 +/- 27.5 mg, p < 0.05] and more sufentanil during ureteroscopy [9.7 +/- 4.8 vs. 3.9 +/- 2.7 microg, p < 0.05] and during PCNL [7.0 +/- 4.3 vs. 1.9 +/- 1.8 microg, p < 0.05] than those who received EA. The volume fluids infused in patients who received TPVB was less than in those who received EA [854 +/- 362 vs. 1,320 +/- 468 ml, p < 0.05]. Time to first PCIA use, postoperative 24-hour consumption of sufentanil, and other parameters were comparable between groups
Conclusions: In this study, TPVB was as effective and safe as EA in providing intraoperative anesthesia and postoperative analgesia for PCNL, although more sedatives and analgesics were used during PCNL in patients who received TPVB
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<p><b>OBJECTIVE</b>To analyze the ultra microstructures and the expression of platelet peroxidase (PPO) of megakaryocytes from bone marrow, their clinical manifestations and laboratory characteristics in patients with acute megakaryoblastic leukemia (AMKL).</p><p><b>METHODS</b>Karyocytes from bone marrow of 22 AMKL patients were divided into two parts by lymphocyte separation liquid, one part was used to prepare the ordinary transmission electron microscope specimens to observe the morphological structures of megakaryocytes, the other was used to prepare the histochemical specimens of platelet peroxidase to analyze the positive reaction of PPO in AMKL, which were coupled with the patients' data of with bone marrow morphology, cell chemistry, and chromosome karyotype examination.</p><p><b>RESULTS</b>Megakaryocytes from 17 of 22 patients were in the first stage, less than 20 µm in diameter, the nucleis were round, the cytoplasm contained microtubules, membranous vesicles and minute dense granules, no demarcation membrane system and surface-connected canalicular system, less dense granules and α-granules; Megakaryocytes in 5 cases were mainly in the first stage, while containing second and third stage megakaryocytes; the positive rate of PPO in megakaryocytes of 22 patients was 0-80%. The primitive and naive megakaryocytes were found in bone marrow smears of 22 cases, CD41 staining of the megakaryocytes was detected in the primitive and naive megakaryocytes, and more complex chromosome karyotype anomalies were observed.</p><p><b>CONCLUSION</b>The majority of megakaryocytes in AMKL patients were the first stage ones, the rest were second and third stage ones, and the positive PPO reaction was significantly different. CD41 staining of the megakaryocytes was specific with complex chromosome karyotypeswere.</p>
Subject(s)
Humans , Blood Platelets , Bone Marrow , Pathology , Cell Count , Chromosome Aberrations , Chromosome Disorders , Karyotyping , Leukemia, Megakaryoblastic, Acute , Diagnosis , Pathology , Megakaryocytes , Pathology , Peroxidase , Metabolism , Staining and LabelingABSTRACT
Objective To investigate the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine mixed with sufentanil on the sleep quality after spinal surgery.Methods Eighty patients of both sexes, aged 21-72 yr, weighing 48-100 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective spinal surgery, were randomly assigned into sufentanil group (group S) and dexmedetomidine mixed with sufentanil group (group DS) with 40 cases in each group.In group S, PCIA solution contained sufentanil 2 μg/kg and tropisetron 6 mg in 100 ml of normal saline.In group DS, PCIA solution contained sufentanil 2 μg/kg, dexmedetomidine 3 μg/kg and tropisetron 6 mg in 100 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Sufentanil 5 μg injected intravenously and celecoxib 200 mg given orally were used as rescue analgesics, and numeric rating scale (NRS) score at rest was maintained ≤4 within 48 h after surgery.Ramsay sedation scores were recorded at 1, 2, 6, 12, 24 and 48 h after surgery.Sleep quality was evaluated using the Medical Outcomes Study Sleep Scale (MOS-SS), and the average time of daily sleep and Sleep Problems Index (SPI) were recorded at week 1 before and after surgery.Patient's satisfaction with sleep was assessed on the night of surgery and 1st day after surgery.The requirement for rescue analgesics was recorded.Results There was no significant difference in the requirement for rescue analgesics between group S and group DS (P＞0.05).Compared with the value before surgery, the average time of daily sleep was significantly shortened, and SPI was increased at week 1 after surgery in group S (P＜0.05 or 0.01), and no significant change was found in group DS (P＞0.05).Compared with group S, the Ramsay sedation scores were significantly increased at 1, 2, and 6 h after surgery, the average time of daily sleep was prolonged at week 1 after surgery, the SPI was decreased at week 1 after surgery, and the degree of satisfaction with sleep was increased on 1st day after surgery in group DS (P＜0.05 or 0.01).Conclusion PCIA with dexmedetomidine mixed with sufentanil is helpful in improving the sleep quality after spinal surgery in the patients.
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OBJECTIVE@#To evaluate short term quality of life of patients with chronic rhinosinusitis by using Chinese version of the sinonasal outcome test-22 (SNOT-22) and to formulate an ideal therapy system for patients with chronic rhinosinusitis.@*METHOD@#Using prospective randomized controlled design,we chose the SNOT-22 to evaluate and compare 78 CRS patients' quality of life (QOL) before surgery, at 1-month,3-month, 6-month and 9-month after functional endoscopic sinus surgery(FESS). At the same time, we randomly chose 100 healthy controls to compare their QOL with those of CRS patients after FESS.@*RESULT@#We found that except for 5 items (cough, ear expanding, otalgia, facail pain and weary ), the grade of 17 other items of CRS patients were significantly higher than those of the healthy controls (P0. 05). There was no significant difference in 9 items (blow noses, sneeze, rhinorrhea, nasal discharge thickness, dizziness, night wake, tired of wake, attention deficit, sense of loss) at 6 months after FESS between chronic rhinosinusitis patients and healthy controls (P>0. 05). There was no significant difference in nasal obstruction at 6 months after FESS between chronic rhinosinusitis patients and healthy controls (P>0.05), at this time the totle grade was normal (P>0. 05). The recovery period of QOL in patients was about 9 months (P>0. 05). The 5 great items were nasal obstruction, olfactory sensation, hypogeusis, nasal discharge, nasal discharge thickness and blow noses. There was no difference in items except for bad sleep replacing nasal discharge thickness between 1-month and 9-month after surgery.@*CONCLUSION@#The Chinese vesion of SNOT-22 could evaluate QOL of CRS patients in this area. The recovery of QOL of CRS patients needs about 6 months after FESS, but problems of olfactory sensation, hypogeusis, nasal discharge and difficult to sleeep still needs to be resolved.
Subject(s)
Humans , Asian People , Chronic Disease , Nasal Obstruction , Prospective Studies , Quality of Life , Rhinitis , General Surgery , Sinusitis , General Surgery , Smell , Treatment OutcomeABSTRACT
Objective To compare the effects of 6MV and 10MV-X-ray intensity modulated radiotherapy (IMRT) on non-small-cell lung cancer (NSCLC) . Methods We randomly selected 20 patients with NSCLC, 6MV and 10MV X-ray were used respectively for each NSCLC patient with IMRT plan design, the ADAC Pinnacle 8.0f treatment planning system was applied to provide the convolution/iteration algorithm, for the same target IMRT plan design with two kinds of energy. By comparing the dose volume histogram (DVH),PTV parameter (Dmean, Dmin and Dmax), conformal index (CI) and homogeneity index (HI),we analyzed the metrology parameters . Results 6MV and 10MV radiation therapy plan DVH, PTV parameters,CI,HI and isodose line was similar,no statistically significant differences. But target dose homogeneity and the degree of target coverage in high dose of 6MV plan was better than that in 10MV plan. Endanger organs (OAR) such as normal lung tissue, heart, esophagus and spinal cord had basically same dose amount. Conclusion 6MV X-ray plan may be the better choice of radiotherapy on NSCLC.