Efficacy and safety of secondary allogeneic hematopoietic stem cell transplantation in 70 patients with recurrent hematologic malignancies after transplantation / 中华血液学杂志

Objectives: To investigate the role of donor change in the second hematopoietic stem cell transplantation (HSCT2) for hematological relapse of malignant hematology after the first transplantation (HSCT1) . Methods: We retrospectively analyzed patients with relapsed hematological malignancies who received HSCT2 at our single center between Mar 1998 and Dec 2020. A total of 70 patients were enrolled[49 males and 21 females; median age, 31.5 (3-61) yr]. Results: Forty-nine male and 21 female patients were enrolled in the trial. At the time of HSCT2, the median age was 31.5 (3-61) years old. Thirty-one patients were diagnosed with acute myeloid leukemia, 23 patients with ALL, and 16 patients with MDS or other malignant hematology disease. Thirty patients had HSCT2 with donor change, and 40 patients underwent HSCT2 without donor change. The median relapse time after HSCT1 was 245.5 (26-2 905) days. After HSCT2, 70 patients had neutrophil engraftment, and 62 (88.6%) had platelet engraftment. The cumulative incidence of platelet engraftment was (93.1±4.7) % in patients with donor change and (86.0±5.7) % in patients without donor change (P=0.636). The cumulative incidence of CMV infection in patients with and without donor change was (64.0±10.3) % and (37.0±7.8) % (P=0.053), respectively. The cumulative incidence of grade Ⅱ-Ⅳ acute graft versus host disease was (19.4±7.9) % vs (31.3±7.5) %, respectively (P=0.227). The cumulative incidence of TRM 100-day post HSCT2 was (9.2±5.1) % vs (6.7±4.6) % (P=0.648), and the cumulative incidence of chronic graft versus host disease at 1-yr post-HSCT2 was (36.7±11.4) % versus (65.6±9.1) % (P=0.031). With a median follow-up of 767 (271-4 936) days, 38 patients had complete remission (CR), and three patients had persistent disease. The CR rate was 92.7%. The cumulative incidences of overall survival (OS) and disease-free survival (DFS) 2 yr after HSCT2 were 25.8% and 23.7%, respectively. The cumulative incidence of relapse, OS, and DFS was (52.6±11.6) % vs (62.4±11.3) % (P=0.423), (28.3±8.6) % vs (23.8±7.5) % (P=0.643), and (28.3±8.6) % vs (22.3±7.7) % (P=0.787), respectively, in patients with changed donor compared with patients with the original donor. Relapses within 6 months post-HSCT1 and with persistent disease before HSCT2 were risk factors for OS, DFS, and CIR. Disease status before HSCT2 and early relapse (within 6 months post-HSCT1) was an independent risk factor for OS, DFS, and CIR post-HSCT2. Conclusion: Our findings indicate that changing donors did not affect the clinical outcome of HSCT2.

Dynamic monitoring of plasma Epstein-Barr Virus DNA load can predict the occurrence of lymphoproliferative disorders after haploidentical hematopoietic stem cell transplantation / 中华血液学杂志

Objective: To determine the optimal cutoff value of Epstein-Barr virus (EBV) DNA load that can assist in the diagnosis of post-transplant lymphoproliferative disease (PTLD) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: The data of patients with EBV infection after haplo-HSCT from January to December 2016 were retrospectively analyzed. Through constructing the receiver operating characteristic (ROC) curve and calculating the Youden index to determine the cutoff value of EBV-DNA load and its duration of diagnostic significance for PTLD. Results: A total of 94 patients were included, of whom 20 (21.3% ) developed PTLD, with a median onset time of 56 (40-309) d after transplantation. The median EBV value at the time of diagnosis of PTLD was 70,400 (1,710-1,370,000) copies/ml, and the median duration of EBV viremia was 23.5 (4-490) d. Binary logistic regression was used to analyze the peak EBV-DNA load (the EBV-DNA load at the time of diagnosis in the PTLD group) and duration of EBV viremia between the PTLD and non-PTLD groups. The results showed that the difference between the two groups was statistically significant (P=0.018 and P=0.001) . The ROC curve was constructed to calculate the Youden index, and it was concluded that the EBV-DNA load ≥ 41 850 copies/ml after allogeneic hematopoietic stem cell transplantation had diagnostic significance for PTLD (AUC=0.847) , and the sensitivity and specificity were 0.611 and 0.932, respectively. The duration of EBV viremia of ≥20.5 d had diagnostic significance for PTLD (AUC=0.833) , with a sensitivity and specificity of 0.778 and 0.795, respectively. Conclusion: Dynamic monitoring of EBV load in high-risk patients with PTLD after haplo-HSCT and attention to its duration have important clinical significance, which can help clinically predict the occurrence of PTLD in advance and take early intervention measures.

Study on the differences in chemical composition of Scutellaria baicalensis leaves from different origins in Shanxi Province based on plant metabolomics and targeted quantitative analysis / 药学学报

By integrating plant metabonomics and target quantitative analysis methods, this study systematically analyzed the differences of chemical constituents in Scutellaria baicalensis leaves from different producing areas in Shanxi, so as to provide theoretical basis for rational and effective utilization of Scutellaria baicalensis leaves. Based on the idea of plant metabonomics, the liquid quality of 53 batches of Scutellaria baicalensis leaves from 8 different producing areas in Shanxi was analyzed by UPLC-QTOF-MS, and the collected data were imported into SIMCA 14.1 software for multivariate statistical analysis to screen the different chemical constituents among different habitats in Shanxi. Meanwhile, a method for simultaneous determination of 7 flavonoids and 3 organic acids in Scutellaria baicalensis leaves was optimized and established to quantitatively analyze the differences of chemical components in Scutellaria baicalensis leaves from different producing areas in Shanxi. The results of plant metabonomics showed that there were differences in the chemical composition of Scutellaria baicalensis leaves in northern Shanxi (Datong, Xinzhou), Jinzhong (Yangquan, Luliang) and southern Shanxi (Changzhi, Yuncheng, Jincheng, Linfen): there were 14 significant differences in chemical composition between northern Shanxi and Jinzhong; there were 18 significant differences in chemical constituents between southern Shanxi and central Shanxi. There were 15 significant differences in chemical constituents between northern Shanxi and southern Shanxi. Among them, scutellarin and isocarthamidin-7-O-glucuronide were the common differences among the three regions, and the content of scutellarin was the highest in southern Shanxi and the lowest in northern Shanxi. The content of isocarthamidin-7-O-glucuronide was the highest in Jinzhong area and the lowest in northern Shanxi area. Quantitative analysis further confirmed that the average contents of apigenin, naringenin and citric acid were the highest in northern Shanxi, scutellarin, caffeic acid, apigenin-7-O-glucuronide, malic acid and wogonoside were the highest in southern Shanxi, and wogonoside and baicalin were the highest in central Shanxi. This study is of great significance to the quality control of Scutellaria baicalensis leaf resources, and provides theoretical basis for rational and effective utilization of Scutellaria baicalensis leaf resources.

Clinical analysis of the usefulness of letermovir for prevention of cytomegalovirus infection after haploidentical hematopoietic stem cell transplantation / 中华内科杂志

Objective: To analyze the efficacy and safety of letermovir in primary prophylaxis of cytomegalovirus (CMV) reactivation in patients receiving haploidentical hematopoietic stem cell transplantation. Methods: This retrospective, cohort study was conducted using data of patients who underwent haploidentical transplantation at Peking University Institute of Hematology and received letermovir for primary prophylaxis between May 1, 2022 and August 30, 2022. The inclusion criteria of the letermovir group were as follows: letermovir initiation within 30 days after transplantation and continuation for≥90 days after transplantation. Patients who underwent haploidentical transplantation within the same time period but did not receive letermovir prophylaxis were selected in a 1∶4 ratio as controls. The main outcomes were the incidence of CMV infection and CMV disease after transplantation as well as the possible effects of letermovir on acute graft versus host disease (aGVHD), non-relapse mortality (NRM), and bone marrow suppression. Categorical variables were analyzed by chi-square test, and continuous variables were analyzed by Mann-Whitney U test. The Kaplan-Meier method was used for evaluating incidence differences. Results: Seventeen patients were included in the letermovir prophylaxis group. The median patient age in the letermovir group was significantly greater than that in the control group (43 yr vs. 15 yr; Z=-4.28, P<0.001). The two groups showed no significant difference in sex distribution and primary diseases, etc. (all P>0.05). The proportion of CMV-seronegative donors was significantly higher in the letermovir prophylaxis group in comparison with the control group (8/17 vs. 0/68, χ2=35.32, P<0.001). Three out of the 17 patients in the letermovir group experienced CMV reactivation, which was significantly lower than the incidence of CMV reactivation in the control group (3/17 vs. 40/68, χ2=9.23, P=0.002), and no CMV disease development observed in the letermovir group. Letermovir showed no significant effects on platelet engraftment (P=0.105), aGVHD (P=0.348), and 100-day NRM (P=0.474). Conclusions: Preliminary data suggest that letermovir may effectively reduce the incidence of CMV infection after haploidentical transplantation without influencing aGVHD, NRM, and bone marrow suppression. Prospective randomized controlled studies are required to further verify these findings.

Preparation quality control and clinical application observation of pooled platelets with leukocytes reduced / 中国输血杂志

【Objective】 To investigate the preparation quality and clinical application effect of pooled platelets with leukocytes reduced. 【Methods】 The quality and clinical effect of the buffy-coated method prepared pooled platelets leukocytes reduced (experimental group, n=40) and apheresis platelets leukocytes reduced (control group, n=40) were compared. 【Results】 The platelet volume (mL), platelet count (×1011), red blood cell contamination (×108) and residual white blood cell (×106) of the experimental group and control group were 278.90±7.92 vs 276.52±8.01, 2.66±0.09 vs 2.66±0.83, 0.54±0.42 vs 0.83±0.84, 0.29±0.54 vs 0.27±0.51, respectively, with no significant difference. The results of bacterial culture were negative, all met the requirements of relevant national standards. In addition, the CCI (×103, 24 h) and PPR (%) were 15.11±9.86 vs 14.61±12.55 and 54.23±18.70 vs 61.41±19.09 respectively, with no significant difference, indicating a certain degree of therapeutic effect. 【Conclusion】 The quality and clinical therapeutic effect of pooled platelets leukocytes reduced were consistent with that of apheresis platelets leukocytes reduced.

Identification and analysis of AP2/ERF gene family of Panax notoginseng and function of PnDREB84 gene / 药学学报

The AP2/ERF gene family is one of the largest transcription factor families in the plant kingdom, and plays an important role in response to biological and abiotic stresses, plant hormone responses, and plant growth and development. In this study, the AP2/ERF family of Panax notoginseng was identified by bioinformatics methods, and the physicochemical properties, structure, phylogenetic relationship, expression pattern and function of PnDREB4 gene of the family were analyzed. The results showed that 140 AP2/ERF family members were identified in P. notoginseng, which were divided into DREB, ERF, AP2, RAV and Sololit subgroups. The physicochemical properties and motifs of proteins were similar among the subgroups. There were 34 differentially expressed genes in the AP2/ERF family of Fusarium oxysporum infected P. notoginseng plants, and 19 genes were up-regulated. The expression level of PnDREB84 was up-regulated with the extension of Fusarium oxysporum infection time in the range of 0-96 h. The content of ABA and SA in P. notoginseng plants overexpressing PnDREB84 gene increased after 4 ℃ stress. The results showed that PnDREB84 gene plays a dual regulatory role in the process of biological stress and abiotic stress. PnDREB84 gene can be used as a potential molecular marker for the breeding of new varieties of P. notoginseng. The identification of AP2/ERF transcription factor and function analysis of PnDREB84 gene of P. notoginseng provided data support for the analysis of stress resistance mechanism of P. notoginseng and the breeding of new varieties.

A retrospective comparative study of haplotype hematopoietic stem cell transplantation and human leukocyte antigen-matched sibling donor hematopoietic stem cell transplantation in the treatment of acute B-lymphocyte leukemia / 中华血液学杂志

Objective: To investigate whether haplotype hematopoietic stem cell transplantation (haplo-HSCT) is effective in the treatment of pre transplant minimal residual disease (Pre-MRD) positive acute B lymphoblastic leukemia (B-ALL) compared with HLA- matched sibling donor transplantation (MSDT) . Methods: A total of 998 patients with B-ALL in complete remission pre-HSCT who either received haplo-HSCT (n=788) or underwent MSDT (n=210) were retrospectively analyzed. The pre-transplantation leukemia burden was evaluated according to Pre-MRD determinedusing multiparameter flow cytometry (MFC) . Results: Of these patients, 997 (99.9% ) achieved sustained, full donor chimerism. The 100-day cumulative incidences of neutrophil engraftment, platelet engraftment, and grades Ⅱ-Ⅳ acute graft-versus-host disease (GVHD) were 99.9% (997/998) , 95.3% (951/998) , and 26.6% (95% CI 23.8% -29.4% ) , respectively. The 3-year cumulative incidence of total chronic GVHD was 49.1% (95% CI 45.7% -52.4% ) . The 3-year cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) of the 998 cases were 17.3% (95% CI 15.0% -19.7% ) and 13.8% (95% CI 11.6% -16.0% ) , respectively. The 3-year probabilities of leukemia-free survival (LFS) and overall survival (OS) were 69.1% (95% CI 66.1% -72.1% ) and 73.0% (95% CI 70.2% -75.8% ) , respectively. In the total patient group, cases with positive Pre-MRD (n=282) experienced significantly higher CIR than that of subjects with negative Pre-MRD [n=716, 31.6% (95% CI 25.8% -37.5% ) vs 14.3% (95% CI 11.4% -17.2% ) , P<0.001]. For patients in the positive Pre-MRD subgroup, cases treated with haplo-HSCT (n=219) had a lower 3-year CIR than that of cases who underwent MSDT [n=63, 27.2% (95% CI 21.0% -33.4% ) vs 47.0% (95% CI 33.8% -60.2% ) , P=0.002]. The total 998 cases were classified as five subgroups, including cases with negative Pre-MRD group (n=716) , cases with Pre-MRD<0.01% group (n=46) , cases with Pre-MRD 0.01% -<0.1% group (n=117) , cases with Pre-MRD 0.1% -<1% group (n=87) , and cases with Pre-MRD≥1% group (n=32) . For subjects in the Pre-MRD<0.01% group, haplo-HSCT (n=40) had a lower CIR than that of MSDT [n=6, 10.0% (95% CI 0.4% -19.6% ) vs 32.3% (95% CI 0% -69.9% ) , P=0.017]. For patients in the Pre-MRD 0.01% -<0.1% group, haplo-HSCT (n=81) also had a lower 3-year CIR than that of MSDT [n=36, 20.4% (95% CI 10.4% -30.4% ) vs 47.0% (95% CI 29.2% -64.8% ) , P=0.004]. In the other three subgroups, the 3-year CIR was comparable between patients who underwent haplo-HSCT and those received MSDT. A subgroup analysis of patients with Pre-MRD<0.1% (n=163) was performed, the results showed that cases received haplo-HSCT (n=121) experienced lower 3-year CIR [16.0% (95% CI 9.4% -22.7% ) vs 40.5% (95% CI 25.2% -55.8% ) , P<0.001], better 3-year LFS [78.2% (95% CI 70.6% -85.8% ) vs 47.6% (95% CI 32.2% -63.0% ) , P<0.001] and OS [80.5% (95% CI 73.1% -87.9% ) vs 54.6% (95% CI 39.2% -70.0% ) , P<0.001] than those of MSDT (n=42) , but comparable in 3-year NRM [5.8% (95% CI 1.6% -10.0% ) vs 11.9% (95% CI 2.0% -21.8% ) , P=0.188]. Multivariate analysis showed that haplo-HSCT was associated with lower CIR (HR=0.248, 95% CI 0.131-0.472, P<0.001) , and superior LFS (HR=0.275, 95% CI 0.157-0.483, P<0.001) and OS (HR=0.286, 95% CI 0.159-0.513, P<0.001) . Conclusion: Haplo HSCT has a survival advantage over MSDT in the treatment of B-ALL patients with pre MRD<0.1% .

Cross-sectional analysis of gonadal hormone expression and relevant factors in female centenarians in Hainan, China / 中南大学学报(医学版)

OBJECTIVES@#Gonadal hormone is essential for the health of postmenopausal women, however, few studies have focused on the epidemiological distribution of gonadal hormones in postmenopausal women in very late postmenopausal women. This study aims to investigate and analyze the differences of serum gonadal hormone content and its influential factors among female centenarians in Hainan, China.@*METHODS@#The questionnaire and physical examination data of 741 female centenarians and 401 elderly females in Hainan Province were collected, and venous blood samples were taken to detect the indexes of lipid metabolism, bone metabolism, and gonadal hormone. The differences of gonadal hormones and relavant factors in female centenarians were analyzed and compared.@*RESULTS@#The serum levels of estradiol and progesterone of female centenarians were significantly higher than those of the elderly females (both P<0.001). The serum levels of estradiol and testosterone of ethnic minority centenarians were higher than those in Han nationality (P<0.001), and the serum estradiol and testosterone concentrations were relatively higher when the daily activities were more than 10 min (both P<0.05). Serum estradiol concentration was negatively correlated with apolipoprotein A-I, high density lipoprotein, triglyceride and bone formation markers such as calcium, inorganic phosphorus and vitamin D3, and was positively correlated with the special sequence of β-collagen (markers of bone resorption) (all P<0.01).@*CONCLUSIONS@#For the extremely late postmenopausal women (such as centenarians), there may be characteristic expressions of gonadal hormones, especially estradiol. There is an unprotective correlation of serum estradiol with lipid metabolism index and bone metabolism index in female centenarians, so it is necessary to evaluate the estrogen content and the use of estrogen therapy in postmenopausal women.

Study on the characteristics of immunoglobulin and complement expression in centenarians in Hainan / 中华老年医学杂志

Objective:To investigate the characteristics of serum immunoglobulin and complement levels in centenarians in Hainan.Methods:Fasting venous blood samples from 969 centenarians in Hainan province were collected and from 364 seniors serving as the control group.Levels of serum immunoglobulin A, G, M and E, immunoglobulin light chain κ and λ, and complement C3 and C4 were measured.Serum immunoglobulin and complement levels were analyzed in subjects based on age, sex, ethnicity, diet and smoking.Results:Serum levels of immunoglobulin G and E, and immunoglobulin light chain κ were higher in the centenarian group than in the control group[15.9(13.8, 18.3)g/L vs.14.9(13.1, 16.9)g/L; 270.0(85.5, 851.0) vs.180.5 kU/L(58.0, 556.2)kU/L, 4.1(3.5, 4.9)g/L vs.4.0(3.1, 4.6)g/L, P<0.05]. Serum levels of immunoglobulin M, and complement C3 and C4 were lower in the centenarian group than in the control group[1.0(0.7, 1.4)g/L vs.1.1(0.8, 1.5)g/L, 1.0(0.9, 1.2) vs.1.1(1.0, 1.3), 0.2(0.2, 0.3) vs.0.3(0.2, 0.3), P<0.05]. Serum levels of immunoglobulin M and complement C3 were higher in female centenarians than in male centenarians[1.1(0.7, 1.4) vs.1.0(0.7, 1.3), 1.0(0.9, 1.1) vs.1.0(0.8, 1.1), P<0.05]. There were significant differences in immunoglobulin A, G and E, and immunoglobulin light chain κ and λ between centenarians of different ethnicities( P<0.01). Serum immunoglobulin M levels were higher in centenarians with a long history of milk-drinking than in those without the history[1.2(0.8, 1.5) vs.1.0(0.7, 1.4), P<0.01]. Conclusions:Serum levels of immunoglobulins and complements are different among centenarians of different ages, genders, ethnicities and diet habits.Factors such as advanced age, female gender, ethnic minority and milk drinking tend to promote the expression of immunoglobulins and complements.

Establishment of reference intervals for thyroid stimulating hormone measurement by big data and indirect method in adults / 中华检验医学杂志

Objective:To establish the sex-, age-and season-specific (month) reference intervals (RI) for thyroid stimulating hormone (TSH) measurement by big data and indirect method in adults.Methods:TSH data of anonymous patients were collected from Beijing Chaoyang Hospital Affiliated to Capital Medical University in 2016, the data were selected and outliers were removed. Indirect methods (Hoffmann method and Bhattacharya method) were used to calculate TSH reference intervals of whole population, different genders, ages and seasons (months). TSH RI from two indirect methods of total population, selected population, physical examination population was compared with RI from reagent instruction according to reference change value ( RCV) based on biological variability. Results:A total of 61 599 records were obtained from 90 699 records including 18 776 males and 42 823 females. The TSH RI were obtained by Hoffmann method: the whole population, 0.59-5.59 μIU/ml (1 μIU/ml=1 mIU/L), male, 0.53-5.16 μIU/ml, female, 0.59-6.11 μIU/ml. The upper limits of TSH RI were higher with age and in winter (January): 18-30 years old, 0.62-5.57 μIU/ml, 71-80 years old, 0.49-6.45 μIU/ml; January, 0.59-6.40 μIU/ml, August, 0.60-5.56 μIU/ml; The RI of TSH by Bhattacharya method: the whole population, 0.58-5.80 μIU/ml, male, 0.55-5.02 μIU/ml, female, 0.62-6.21 μIU/ml. The upper limits of TSH RI were also higher with age and in winter (January): 18-30 years old, 0.65-5.67 μIU/ml, 71-80 years old, 0.46-5.99 μIU/ml, January: 0.61-6.52 μIU/ml, August: 0.61-5.69 μIU/ml. Compared to RI from reagent instruction, the differences of TSH RI from two indirect methods of total population, selected population, physical examination population were acceptable.Conclusions:TSH RI was established by indirect method. With the increase of age and winter, the upper limit of TSH reference interval tends to increase.

Utilization and Demand of Health Care Service for Children with Mental Disabilities in China / 中国康复理论与实践

Objective:To investigate the utilization and demand of health care services for children with mental disabilities and provide implications for the development and update of related policies. Methods:Data of utilization and demand of health care services for children with mental disabilities aged 0 to 17 years were selected from The Second China National Sample Survey on Disability in 2006. The difference of utilization and demands of health care services for children was analyzed in socio-economic characteristics including gender, age, urban and rural areas, disabled level, parents' highest level of education and family income. Results:The utilization rate of health care service was relatively low (44.35%), and the demands was high (98.26%) among children with mental disabilities. Medical services and assistance, rehabilitation training and services, and aid and support for poor people with disabilities were the most-utilized and most-demanded services for children with mental disabilities. In terms of utilization, the utilization rates of medical services and assistance, and rehabilitation training and services were higher among children with mental disabilities in urban areas than in rural areas (χ2 > 11.028, P < 0.01). And the utilization rate of these two services also was higher among mentally disabled children from family with higher parental education and income than among the counterparts from families with low socioeconomic status (χ2 > 9.169, P < 0.05). In terms of demand, children with more severe mental disability had higher demand of aid and support for poor people with disabilities (χ2 = 17.822, P < 0.001). And higher demand of rehabilitation training and services was found among mentally disabled children with better family socio-economic status (χ2 = 7.797, P < 0.05). Conclusion:The demands for health care services among children with mental disabilities urgently need to be further met. Reinforcing the development of above three types of services, addressing the imbalance of health care services allocation between urban and rural areas, and improving the economic conditions of disabled families will effectively improve the utilization of the health care service for mentally disabled children.

Protective effect of the Chinese medicine composition on the radon exposure induced injuries in mice lung and bronchial epithelial cells / 中华放射医学与防护杂志

Objective:To explore the effect of a Chinese medicinal composition ( Xiadanqi) on the prevention of radon exposure induced injuries of lung in vitro and in vivo. Methods:Mice were randomly divided into three groups of blank control group, radon-exposed group alone and radon-exposed group intervened with Chinese medicinal composition. The pathological changes of lung tissues in each group after 120 WLM were observed by HE and Masson staining, and the expressions of α-SMA protein and Vimentin protein in lung tissues were detected by immunohistochemistry staining. The levels of oxidative stress in lung tissue of each group were detected with SOD and MDA kits. At the same time, a radon exposed cell model and a radon exposure + Xiadanqi intervention cell model were constructed using an ecological radon chamber. The cell adhesion abilities of different groups were detected by an adhesion kit. The cell migration ability of each group was determined by the transwell migration experiment. The expression of E-cadherin and Vimentin protein was detected by Western blot. Results:Compared with the radon exposure group, the concentration of MDA was decreased ( t=4.43, P<0.05), the activity of SOD was increased ( t=3.22, P<0.05), and α-SMA and Vimentin protein expressions were decreased ( t=3.08, 7.57, P<0.05) in lung tissue of mice intervened with 2 mg/g Xiadanqi. In vitro, compared with radon exposure group, the migration ability was reduced ( t=4.78, 13.01, P<0.05), the cell adhesion property was enhanced ( t=3.41, 12.55, P<0.05), the expression of E-cadherin protein was increased ( t=2.96, 19.57, P<0.05), and the expression of Vimentin protein was obviously reduced ( t=21.00, 33.32, P<0.05) in radon-exposed cells with the treatment of Chinese medicine (150 μg/ml and 200 μg/ml). Conclusions:The Chinese medicinal composition ( Xiadanqi) has a certain radioprotective effect on radon exposure induced injury by reducing oxidative stress, attenuating EMT and fibrosis, and thus it may be applied as a protective agent for radon induced injury.

Influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice / 中华消化外科杂志

Objective@#To investigate the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice.@*Methods@#The retrospective case-control study was conducted. The clinicopathological data of 121 patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University between March 2013 and June 2018 were collected. There were 70 males and 51 females, aged (69±9)years, with a range from 39 to 85 years. Of 121 patients, 112 underwent open radical pancreaticoduodenectomy, and 9 underwent totally laparoscopic radical pancreaticoduodenectomy. Observation indicators: (1) situations of jaundice resolution after pancreaticoduodenectomy; (2) influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Univariate analysis was performed using the chi-square test, t test, Fisher exact probability or Mann-Whitney U test. Multivariate analysis was performed by the Logistic regression model using P<0.10 as an inclusion criteria in the univariate analysis .@*Results@#(1) Situations of jaundice resolution after pancreaticoduodenectomy: of 121 patients, 97 had good jaundice resolution after pancreaticoduodenectomy, and 24 had poor jaundice resolution after pancreaticoduodenectomy. (2) Influencing factors for poor jaundice resolution after pancreaticoduodenectomy: results of univariate analysis showd that preoperative level of serum total bilirubin, comorbidity with diabetes mellitus were influencing factors for poor jaundice resolution after pancreaticoduodenectomy (t=-2.073, χ2=10.201, P<0.05). Postoperative pancreatic fistula was also an influencing factor for poor jaundice resolution after pancreaticoduodenectomy (P<0.05). Results of multivariate analysis showed that comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after pancreaticoduodenectomy (odds ratio=0.258, 0.129, 95% confidence interval: 0.087-0.769, 0.023-0.726, P<0.05).@*Conclusions@#Preoperative level of serum total bilirubin, diabetes mellitus, and postoperative pancreatic fistula are influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Comorbidity with diabetes mellitus and postoperative pancreatic fistula are independent risk factors for poor jaundice resolution after pancreaticoduodenectomy.

Influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice / 中华消化外科杂志

Objective To investigate the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice.Methods The retrospective case-control study was conducted.The clinicopathological data of 121 patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University between March 2013 and June 2018 were collected.There were 70 males and 51 females,aged (69±9)years,with a range from 39 to 85 years.Of 121 patients,112 underwent open radical pancreaticoduodenectomy,and 9 underwent totally laparoscopic radical pancreaticoduodenectomy.Observation indicators:(1) situations of jaundice resolution after pancreaticoduodenectomy;(2) influencing factors for poor jaundice resolution after pancreaticoduodenectomy.Measurement data with normal distribution were represented as Mean ± SD.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers.Univariate analysis was performed using the chi-square test,t test,Fisher exact probability or Mann-Whitney U test.Multivariate analysis was performed by the Logistic regression model using P＜0.10 as an inclusion criteria in the univariate analysis.Results (1) Situations of jaundice resolution after pancreaticoduodenectomy:of 121 patients,97 had good jaundice resolution after pancreaticoduodenectomy,and 24 had poor jaundice resolution after pancreaticoduodenectomy.(2) Influencing factors for poor jaundice resolution after pancreaticoduodenectomy:results of univariate analysis showd that preoperative level of serum total bilirubin,comorbidity with diabetes mellitus were influencing factors for poor jaundice resolution after pancreaticoduodenectomy (t =-2.073,x2 =10.201,P＜0.05).Postoperative pancreatic fistula was also an influencing factor for poor jaundice resolution after pancreaticoduodenectomy (P ＜ 0.05).Results of multivariate analysis showed that comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after pancreaticoduodenectomy (odds ratio=0.258,0.129,95％ confidence interval:0.087-0.769,0.023-0.726,P＜0.05).Conclusions Preoperative level of serum total bilirubin,diabetes mellitus,and postoperative pancreatic fistula are influencing factors for poor jaundice resolution after pancreaticoduodenectomy.Comorbidity with diabetes mellitus and postoperative pancreatic fistula are independent risk factors for poor jaundice resolution after pancreaticoduodenectomy.

Effect of Effective Components of Salvia Miltiorrhiza on TGF-β1 Induced Interstitial Transformation of Pulmonary Epithelial Cells / 中国实验方剂学杂志

Objective::To screen out the effective components of Salvia miltiorrhiza by establishing an in vitro model of pulmonary epithelial mesenchymal transformation. Method::Different concentrations of salvianolic acid A (10, 20, 40, 80, 160 μmol·L-1), salvianolic acid B (10, 20, 40, 80, 160 μmol·L-1), tanshinol (10, 20, 40, 80, 160 μmol·L-1), tanshinoneⅡA (10, 20, 40, 80, 160 μmol·L-1) and the blank group were applied to A549 cell, cell proliferation and cytotoxicity assay (MTS) were used to detect the proliferation effect of menthol on A549 cells.After screening the safe concentration of the active ingredients of salvia miltiorrhiza by MTS, cells were divided into blank group, model group, salvianolic acid A group, salvianolic acid B group, tanshinol group and tanshinoneⅡA.Then, the inhibitory effect of the active ingredients of salvia miltiorrhiza on the proliferation of A549 cells induced by TGF-β1 was detected by MTS. Enzyme linked immunosorbent assay (ELISA) method to detect salvia miltiorrhiza effective component of fiber protein(FN), collagen type I (COL-Ⅰ) expression. Based on the above results, the active components of salvia miltiorrhiza, which have best inhibition were screened out, and their effects on the expression of E-calcium-viscosity (E-Cad) protein were detected by Western blot. Result::Compared with blank group, salvianolic acid A 40 μmol·L-1, salvianolic acid B 160 μmol·L-1, tanshinol 160 μmol·L-1 had toxic effects on A549 cells (P<0.05). In the non-toxic concentration range, compared with the model group, salvianolic acid A 10, 20 μmol·L-1, salvianolic acid B 80 μmol·L-1 showed inhibition effect after 24 h culture (P<0.05). After 72 h culture, salvianolic acid A 5, 10, 20 μmol·L-1, salvianolic acid B 40, 80 μmol·L-1inhibition effect was very significant (P<0.01). ELISA results showed that with the blank group, model group cells the expression of FN and COL-Ⅰ increased significantly (P < 0.01). Compare with model group, salvianolic acid A 20 μmol·L-1, salvianolic acid B 80 μmol·L-1 inhibited FN and COL-Ⅰ(P<0.05). Western blot results showed that salicylic acid A and salicylic acid B had protective effects on E-Cad (P<0.01). Conclusion::Salvianolic acid A and salvianolic acid B have inhibitory effects on epithelial mesenchymal transformation by TGF-β1, which may be the main effective components of salvianolic acid in the treatment of pulmonary fibrosis.

Association between Socio-economic Status and Rehabilitation Service Utilization for Adults with Different Disabilities / 中国康复理论与实践

Objective:To analyze the relationship between socio-economic status and utilization of rehabilitation services for adults with different disabilities. Methods:Adults with single disability were selected from the Second China National Sample Survey on Disability. Their education level and per capita household income were used as socio-economic index, controlled with sex, age group, residence, disabled level and marriage. Results:The prevalence of rehabilitation service utilization was 2.98% to 15.97%, and it was more in urban people than in rural ones. Education level trended to be a positive factor to utilization of rehabilitation service, but different with the types of disabilities. Per capita household income was mixed for the utilization of rehabilitation service, which was positive for some disabilities, negative for some ones, and no significant for others. Conclusion:The utilization of rehabilitation services needs to improve for adults with disabilities. Policies can be made targeting to the people with different disabilities.

Effect of postoperative application of tranexamic acid on recovery and prognosis after unilateral total hip arthroplasty / 中国医师进修杂志

Objective@#To study the effect of postoperative application of tranexamic acid on recovery and prognosis of unilateral total hip arthroplasty.@*Methods@#One hundred and twenty patients who received unilateral total hip arthroplasty in 541st General Hospital of Dongzhen Town from August 2016 to August 2018 were divided into observation group and control group by random number table method, with 60 cases in each group. The control group received intravenous injection of tranexamic acid 10 min before skin incision after anesthesia; on the basis of the control group, the observation group was given tranexamic acid intravenously again 3 h after operation, and the control group was no longer given repeated injection of tranexamic acid. The hemorrhage, hemoglobin (Hb), hematocrit(HCT), hip joint Harris score and complications were compared between the two groups.@*Results@#There was no significant difference in intraoperative blood loss and transfusion between the two groups (P>0.05); the drainage volume, total blood loss, dominant blood loss and recessive blood loss in the observation group were lower than those in the control group [(227.43 ± 20.14) ml vs. (280.91 ± 23.56) ml, (601.01 ± 42.84) ml vs. (667.04 ± 49.21) ml, (281.93 ± 18.50) ml vs. (322.06 ± 21.23) ml, (330.94 ± 21.73) ml vs. (370.03 ± 25.90) ml] (P<0.05). After operation 3 d, the levels of Hb and HCT in observation group were higher than those in control group [(117.07 ± 9.60) g/L vs. (102.19 ± 8.31) g/L, (35.05 ± 2.91)% vs. (32.01 ± 2.77)%] (P<0.05). After operation 2 weeks and 1 month after operation, the hip joint Harris score in observation group was higher than that in control group [(52.03 ± 4.02) scores vs. (48.37 ± 5.05) scores, (67.86 ± 5.29) scores vs. (61.23±5.10) scores] (P<0.05). There was no significant difference in the occurrence of intermuscular venous thrombosis, local hematoma and incision exudation between the two groups(P>0.05).@*Conclusions@#On the basis of preoperative application of tranexamic acid, combined postoperative application of tranexamic acid can significantly reduce the blood loss after unilateral total hip arthroplasty, and help the early recovery of joint function, without increasing complications and with high safety.

Effect of postoperative application of tranexamic acid on recovery and prognosis after unilateral total hip arthroplasty / 中国医师进修杂志

study the effect of postoperative application of tranexamic acid on recovery and prognosis of unilateral total hip arthroplasty. Methods One hundred and twenty patients who received unilateral total hip arthroplasty in 541st General Hospital of Dongzhen Town from August 2016 to August 2018 were divided into observation group and control group by random number table method, with 60 cases in each group. The control group received intravenous injection of tranexamic acid 10 min before skin incision after anesthesia; on the basis of the control group, the observation group was given tranexamic acid intravenously again 3 h after operation, and the control group was no longer given repeated injection of tranexamic acid. The hemorrhage, hemoglobin (Hb), hematocrit(HCT), hip joint Harris score and complications were compared between the two groups. Results There was no significant difference in intraoperative blood loss and transfusion between the two groups (P＞0.05); the drainage volume, total blood loss, dominant blood loss and recessive blood loss in the observation group were lower than those in the control group [(227.43 ± 20.14) ml vs. (280.91 ± 23.56) ml, (601.01 ± 42.84) ml vs. (667.04 ± 49.21) ml, (281.93 ± 18.50) ml vs. (322.06 ± 21.23) ml, (330.94 ± 21.73) ml vs. (370.03 ± 25.90) ml] (P＜0.05). After operation 3 d, the levels of Hb and HCT in observation group were higher than those in control group [(117.07 ± 9.60) g/L vs. (102.19 ± 8.31) g/L, (35.05 ± 2.91)% vs. (32.01 ± 2.77)%] (P＜0.05). After operation 2 weeks and 1 month after operation, the hip joint Harris score in observation group was higher than that in control group [(52.03 ± 4.02) scores vs. (48.37 ± 5.05) scores, (67.86 ± 5.29) scores vs. (61.23±5.10) scores] (P＜0.05). There was no significant difference in the occurrence of intermuscular venous thrombosis, local hematoma and incision exudation between the two groups(P＞0.05). Conclusions On the basis of preoperative application of tranexamic acid, combined postoperative application of tranexamic acid can significantly reduce the blood loss after unilateral total hip arthroplasty, and help the early recovery of joint function, without increasing complications and with high safety.

Advances in precision immunotherapeutic research of sepsis / 中国中西医结合急救杂志

Sepsis is caused by maladjustment of host response to infection, resulting in life-threatening organ dysfunction, which is equivalent to infection + sequential organ failure score (SOFA) > 2 scores, and it is the out of control of the host's responses to infection leading to an imbalance of the pro-inflammatory-anti-inflammatory responses. In recent years, besides the antibiotics, etiological treatment, fluid resuscitation and organ functional support, there has been no single adjuvant therapy for sepsis. The focus of previous treatments has been on immunosuppression, however immune paralysis induced by sepsis was playing an increasingly important role in the processes of patient's disease onset and death, leading to a shift in the field of research to enhancing immune responses. Therefore, it is crucial to identify a septic patient with a severely suppressed or hyperactive immune system, and accurately monitor both immune and therapeutic responses. This review outlines the advances and challenges of precision immunotherapy in patients with sepsis.

Therapeutic effect of brain protein hydrolysate and simvastatin on carotid atherosclerotic plaques in CI patients and its influence on LVEF and CRP level / 心血管康复医学杂志

Objective : To explore clinical value of brain protein hydrolysate (BPH ) and simvastatin in treatment of patients with cerebral infarction (CI) complicated carotid atherosclerotic plaques (CAP).Methods : A total of 90 CI + CAP patients treated in our hospital from Mar 2016 to May 2017 were selected ,randomly and equally divided into routine treatment group and combined treatment group (received simvastatin + BPH based on routine treat-ment) ,both groups were treated for four weeks- Therapeutic effect ,United States National Institutes of Health Stroke Score (NIHSS) ,CAP-related indexes ,hemorheology indexes ,LVEF and CRP before and after treatment and incidence of adverse events were compared between two groups .Results : Compared with routine treatment group after treatment ,there were significant reductions in NIHSS score [ (15-56 ± 6-33) scores vs.(12-14 ± 3-18) scores] ,CAP size [ (1-54 ± 0-32) cm2 vs.(1-34 ± 0-30) cm2 ] ,intima-media thickness [ (1-37 ± 0-08) mm vs. (1-15 ± 0-04) mm] ( P＜0-01 all) ,and significant rise in total effective rate (80-00% vs.95-56%, P＝0-024) in combined treatment group ; there were significant reductions in hematocrit [ (44-24 ± 3-24 )% vs.(37-72 ± 2-41)%] ,platelet aggregation rate [ (45-62 ± 15-95)% vs.(38-10 ± 2-52)%] ,fibrinogen [ (4-06 ± 1-43) g／L vs. (3-18 ± 1-15) g／L] ,whole blood viscosity [ (2-66 ± 0-77) mPa·s vs.(1-55 ± 0-25) mPa·s] ,plasma viscosity [ (1-45 ± 0-11) mPa·s vs.(1-21 ± 0-16) mPa·s] and serum CRP level [ (4-36 ± 1-03) mg／L vs.(1-70 ± 0-20) mg／L] ,and significant rise in LVEF [ (49-30 ± 3-74)% vs.(56-67 ± 4-37)%] in combined treatment group , P＜0-01 all- Incidence rate of cardio-and cerebrovascular events in combined treatment group was significantly lower than that of routine treatment group (4-44% vs.17-18%, P＝ 0-004 ).Conclusion : Simvastatin combined BPH based on routine treatment can achieve better total therapeutic effect and reduce incidence rate of complications in CI + CAP patients .