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Objective To investigate the clinical and pathological features of adenoid basal cell carcinoma(ABC),adenoid cystic carcinoma(ACC),and basaloid squamous cell carcinoma(BSCC)with basaloid charac-teristics and improve the diagnostic and differential diagnostic ability of clinicians and pathologists for these lesions.Methods A retrospective study was conducted on the clinical and pathological data of 4 cases of ABC,1 case of ACC,and 3 cases of BSCC diagnosed and treated at Shenzhen Maternal and Child Health Hospital,Southern Medical University from April 2018 to December 2022.Pathological slides were reviewed and relevant literature was analyzed and summarized.Results All three types of tumors were common in postmenopausal women and were associated with high-risk HPV infection.ABC was a low-grade cancer and patients were often clinically asymp-tomatic.It was usually detected incidentally during cervical screening due to cytological abnormalities,or after cervical cone biopsy or hysterectomy for HSIL.It presented as superficial cervical infiltration and clinical staging was often early.ACC and BSCC were intermediate to high-grade cancers and they often presented with postmenopausal vaginal bleeding.A visible mass was observed on the cervix.The clinical staging was intermediate to advanced.The three types of lesions could coexist.Careful observation of the morphological characteristics and immunohistochemical staining could help with differential diagnosis.None of the 8 patients experienced recurrence or metastasis during follow-up.Conclusion Cervical ABC,ACC and BSCC are rare and they originate from reserve cells.They share the similarities in clinical and pathological morphology,but differ in treatment and prognosis.So,accurate differen-tiation among them has important clinical significance.
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BACKGROUND:Abnormal activation of osteoclasts plays an important role in the bone destruction due to spinal tuberculosis.During the pathogenesis of osteoporosis,miR-155 knockdown activates adenosine phosphate-dependent protein kinase(AMPK)by increasing the expression of leptin receptors,thereby inhibiting osteoclast differentiation and bone resorption.However,the role of miR-155/leptin receptor(LEPR)/AMPK axis in the bone destruction due to spinal tuberculosis remains unclear. OBJECTIVE:To investigate the role and mechanism of miR-155/LEPR/AMPK axis in tuberculin-induced osteoclast formation. METHODS:RAW264.7 cells were cultured and treated with different concentrations of purified protein derivative(PPD)(1.0,2.5,5.0,10.0 IU/mL)and transfected with negative control(NC)sequence or miR-155 inhibitor,NC siRNA sequence or LEPR siRNA sequence.Tartrate resistant acid phosphatase staining was used to detect the number of osteoclasts.Fluorescence quantitative PCR was used to detect the expression of miR-155.Western blot was used to detect the expression of LEPR and p-AMPK.Double luciferase reporter gene was used to verify miR-155 targeting LEPR. RESULTS AND CONCLUSION:Compared with the control group,the number of osteoclasts and the expression level of miR-155 significantly increased,while the expression level of LEPR and p-AMPK significantly decreased in 2.5,5.0,and 10.0 IU/mL PPD groups(P＜0.05).Compared with NC+5.0 IU/mL PPD group,the number of osteoclasts and the expression level of miR-155 significantly decreased,while the expression level of LEPR and p-AMPK significantly increased in the miR-155 inhibitor+5.0 IU/mL PPD group(P＜0.05).Compared with the NC group,the fluorescence activity of LEPR wild-type double luciferase reporter gene was increased in the miR-155 inhibitor group,and decreased in the miR-155 mimic group(P＜0.05).Compared with si-NC+miR-155 inhibitor+5.0 IU/mL PPD group,the expression level of miR-155 had no significant change,the number of osteoclasts significantly increased,and the expression levels of LEPR and p-AMPL significantly decreased in si-LEPR+miR-155 inhibitor+5.0 IU/mL PPD group(P＜0.05).To conclude,tuberculin can induce osteoclast formation by increasing miR-155 expression and inhibiting downstream LEPR expression and AMPK activation.
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Cognitive impairment is a common clinical complication in type 2 diabetes (T2DM). T2DM-related cognitive impairment has complex and multifactorial pathogenesis. Cerebral microvascular dysfunction is an important pathological change in patients with T2DM and pre-T2DM, and it can induce blood-brain barrier injury and impaired blood perfusion regulation, with disturbed neurovascular coupling and cerebral autoregulation, leading cognitive impairment. This article reviews the epidemiology and pathophysiological mechanisms related to T2DM cerebral microvascular lesions and cognitive impairment, and how to monitor changes of cerebral microvascular structure and function so as to provide new approach for diagnosis and treatment of T2DM-related cognitive impairment.
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With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.
Subject(s)
Humans , Aged , Aged, 80 and over , Biliary Tract Surgical Procedures , Gallstones , Laparoscopy , Treatment Outcome , Aging , Retrospective Studies摘要
The two forms of brain-derived neurotrophic factor (BDNF), mature BDNF (mBDNF) and BDNF precursor (proBDNF), bind to corresponding receptors and mediate a series of biological signals, which play important roles in proliferation, survival and apoptosis. More and more studies have focused on the role of unbalanced transformation from proBDNF to mBDNF in neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease, as well as their potential as biomarkers and treatment targets. This article reviews the mechanism and therapeutic application of BDNF and proBDNF/mBDNF imbalance in the above-mentioned neurodegenerative diseases to provide new perspective and approach for the pathogenesis, early diagnosis and treatment of neurodegenerative diseases such as AD and PD.
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Objective:The purpose of this study was to explore the critical values of monitored indexes of perioperative major adverse cardiac events(MACE), so as to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function to further improve the perioperative safety of elderly patients with biliary diseases.Methods:The clinical data of 246 elderly patients with biliary diseases in our hospital from May 2016 to February 2022 were collected.According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.The differences of clinical data, the monitoring indexes of postoperative cardiac function, and the coagulation function between the two groups were compared and analyzed.Logistic regression was used to analyze the independent risk factors of perioperative MACE, the cut-off value of the receiver operating characteristic(ROC)curve was calculated, and the Logistic multivariate prediction model was established.Results:In the MACE compared with the non-MACE group, age, postoperative complications and mortality, postoperative hospital stay, and the levels of postoperative high sensitivity troponin-I(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and D-dimer(D-D)were significantly increased(all P<0.05). Multivariate Logistic regression showed that postoperative BNP and D-D were two independent risk factors for perioperative MACE, and their cut-off values in the ROC curve were 382.65 pg/mL and 0.975mg/L respectively.The Logistic multivariate prediction model established by the Logistic regression equation was P= ex/(1+ ex), X=-5.710+ 0.003X 1+ 0.811X 2, where X 1 was the postoperative BNP level and X 2 was the postoperative D-D level.The accuracy, specificity and sensitivity of this prediction model for predicting perioperative MACE were 96.3%(237/246), 100.0%(235/235), and 18.2%(2/11). Conclusions:The Logistic multivariate prediction model established in this study can effectively predict the occurrence of perioperative MACE in elderly patients.Postoperative BNP and D-D were two independent risk factors for perioperative MACE.The cut-off values of BNP and D-D in the ROC curve could be used as critical values for monitoring perioperative MACE.Therefore, it is of great clinical significance to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function, and further improve the perioperative safety of elderly patients with biliary diseases.
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BACKGROUND@#Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.@*METHODS@#Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).@*RESULTS@#We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.@*CONCLUSION@#The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01597232.
Subject(s)
Humans , Adult , Postoperative Complications , Erythrocyte Transfusion/adverse effects , Blood Transfusion , Hospitals , Hemoglobins/analysis摘要
Background and Objectives@#Chronic kidney disease (CKD) has a major impact on the quality of life of patients, and renal fibrosis is a critical pathological change in the disease. It is very important to control the process of renal fibrosis to improve the quality of life of patients with CKD. The pathological mechanism of renal fibrosis is very complicated, and the current treatment strategy also has many flaws. @*Methods@#and Results: To explore a better treatment, we collected exosomes from pluripotent stem cell (PSC)-derived mesenchymal stem cells (MSC) and verified their therapeutic effect on renal fibrosis through In Vivo and In Vitro experiments. In this study, we found that PSC-MSC-derived comes could prevent the epithelial differentiation of NRK-52E cells, and with increasing exosome concentrations, the effect was improved. Furthermore, PSC-MSC-derived exosomes could reduce the pathological process of renal fibrosis, reduce inflammatory reactions and improve renal function in UUO mice. Moreover, the protective effect of exosomes against renal fibrosis may be achieved by increasing the expression of SIRT6 and decreasing the expression of β-catenin and its downstream products. @*Conclusions@#These findings suggest the possibility of PSC-MSC-derived exosomes as a new, effective therapeutic tool for kidney fibrosis.
摘要
Background and Objectives@#Chronic kidney disease (CKD) has a major impact on the quality of life of patients, and renal fibrosis is a critical pathological change in the disease. It is very important to control the process of renal fibrosis to improve the quality of life of patients with CKD. The pathological mechanism of renal fibrosis is very complicated, and the current treatment strategy also has many flaws. @*Methods@#and Results: To explore a better treatment, we collected exosomes from pluripotent stem cell (PSC)-derived mesenchymal stem cells (MSC) and verified their therapeutic effect on renal fibrosis through In Vivo and In Vitro experiments. In this study, we found that PSC-MSC-derived comes could prevent the epithelial differentiation of NRK-52E cells, and with increasing exosome concentrations, the effect was improved. Furthermore, PSC-MSC-derived exosomes could reduce the pathological process of renal fibrosis, reduce inflammatory reactions and improve renal function in UUO mice. Moreover, the protective effect of exosomes against renal fibrosis may be achieved by increasing the expression of SIRT6 and decreasing the expression of β-catenin and its downstream products. @*Conclusions@#These findings suggest the possibility of PSC-MSC-derived exosomes as a new, effective therapeutic tool for kidney fibrosis.
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Objective:To explore the clinical predictive effect of the preoperative ratio of C reactive protein to albumin (CAR) on perioperative delirium (POD) in geriatric patients with femoral intertrochanteric fracture.Methods:The clinical data were analyzed retrospectively of the 398 patients who had undergone surgery for femoral intertrochanteric fractures at Department of Orthopedics, Xuanwu Hospital from January 2013 to March 2016. According to the presence or absence of POD, all the patients were divided into 2 groups: a delirium group and a normal group. The 2 groups were compared in terms of general clinical data like gender, age, body mass index, blood routine, CAR, biochemical indicators, blood coagulation indicators and concomitant internal diseases. After a single factor logistic regression analysis of the general clinical data of the patients, factors with P<0.10 were introduced into the multivariate logistic binary regression model to screen out the risk factors for POD in geriatric patients with femoral intertrochanteric fracture. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value and optimal cut-off point of CAR for POD in geriatric patients with femoral intertrochanteric fracture. Results:The incidence of POD in this cohort was 14.32%(57/398). The age, C-reactive protein, CAR, platelet and probability of pulmonary infection in the delirium group were significantly higher than those in the normal group, but the hemoglobin, albumin and prealbumin in the former were significantly lower than those in the latter ( P< 0.05). The multivariate logistic binary regression analysis showed that hemoglobin ( OR=0.975, 95% CI: 0.957 to 0.993, P=0.006) and CAR( OR=53.713, 95% CI: 17.713 to 162.876, P<0.001) were risk factors for POD in geriatric patients with femoral intertrochanteric fracture. The area under ROC of CAR in predicting POD in geriatric patients with femoral intertrochanteric fracture was 0.906 (95% CI: 0.873 to 0.933, P<0.001), and the cut-off point was 2.06. When CAR>2.06, its predicted incidence of POD was 50.50%, with a sensitivity of 89.47% and a specificity of 85.34%. Conclusion:As CAR is a risk factor for POD in geriatric patients with femoral intertrochanteric fracture, it can be used as an effective indicator to predict POD.
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Objective To study protective and therapeutic measures to improve perioperative safety in extremely elderly patients with biliary diseases.Methods A retrospective case-control study was conducted.The clinical data of elderly patients with biliary diseases treated at the Department of General Surgery,Beijing Electric Power Hospital,from July 2013 to December 2018,were collected.According to age,the patients were divided into the high age (HA) group (≥80.0 years) and the middle-low age (MLA) group (60.0～79.0 years).The related indexes of perioperative safety such as preoperative coexisting diseases,functions of liver,kidney,heart and lung,surgical procedures,intraoperative blood loss,operation time,postoperative hospital stay and postoperative hospital stay were analyzed and compared between the two groups.Results Of the 372 included patients,there were 168 males and 204 females,aged 60.0 to 96.0 (72.0 ± 8.6) years.There were 69 elderly patients (37 males and 32 females) aged 80.0 to 96.0 (84.4 ±3.8) years in the HA group.There were 303 patients in the middle and lower age group (131 men and 172 women),aged 60.0 to 79.0(68.4 ±5.8) years (MLA group).(1) Preoperative coexisting diseases were significantly increased in the HA compared with the MLA group (all P ＜ 0.05),including the proportion of coexisting coronary heart disease [34.8％ (24/69) vs.18.5％ (56/303)],hypertension [68.1％ (47/69)vs.46.9％ (142/303)],chronic bronchitis with emphysema [17.4％ (12/69) vs.3.6％ (11/303)],hypoproteinemia [39.1％ (27/69) vs.26.7％ (81/303)],and anemia [42.0％ (29/69) vs.11.9％ (36/303)].(2) Laboratory examinations:the functions of liver,kidney,heart,lung and blood coagulation were significantly worse in the HA compared with the MLA group (P ＜ 0.05).(3) Surgical procedures:the proportion of open cholecystectomy with transcystic common bile duct exploration (OC + OTCBDE) was higher [17.4％ (12/69) vs.6.9％ (21/303)],while laparoscopic cholecystectomy (LC) was lower [43.5％ (30/69) vs.62.7％ (190/303)],in the HA compared with the MLA group (P ＜0.05,totally).(4) Operative effects:the intraoperative blood loss [30.0 (20.0,75.0) ml vs.20.0 (10.0,30.0) ml],operation time [90.0(72.5,137.5) min vs.77.0(55.0,115.0) min],postoperative hospital stay [10.0(6.0,18.0) d vs.7.0(4.0,11.0) d],and length of hospitalization [17.0(11.5,23.0) d vs.13.0(9.0,19.0) d] were significantly increased or prolonged in the HA compared with the MLA group (all P ＜0.05).(5) Postoperative complications:the incidence of postoperative complications was significantly higher [30.4％ (21/69) vs.12.2％ (37/303)] in the HA compared with the MLA group (P ＜ 0.05).(6) Therapeutic outcomes:there was a cure rate of 95.7％ (66/69) in the HA group,and 97.7％ (296/303)in the MLA group.No significant difference in the therapeutic effects was found between the two groups (P ＞ 0.05).Conclusions Operation in extremely elderly patients with biliary diseases is safe and feasible.The key is to take measures such as actively treating preoperative coexisting diseases,strictly mastering operative indications,reasonably selecting surgical procedures,accurately carrying out precise operation,strictly monitoring and dealing with intraoperative emergency,timely preventing and treating postoperative complications,and especially focusing on maintaining cardiopulmonary function during the perioperative period.
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Liver injury caused by viral and non-viral factors is an important stage of chronic liver disease, and the pathogenesis of liver injury is still a research hotspot. With the deepening of the research on gut microbiota, substantial evidence indicates that gut microbiota participates in the development and progression of liver injury, and it has been confirmed that Akkermansia muciniphila (Akk) has a beneficial effect against liver injury. This article summarizes the role and potential mechanism of Akk in immune-mediated liver injury, alcoholic liver disease, and nonalcoholic fatty liver disease. It is believed that Akk may provide new directions and choices for the prevention and treatment of liver injury.
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BACKGROUND: Acute myeloid leukemia (AML) patients with non-remission (NR) after the first cycle of standard induction chemotherapy remain a challenge owing to poor response and tolerance to re-induction regimen. We retrospectively evaluated the efficacy and safety of three regimens in AML patients refractory to the first course of standard induction regimen. MATERIALS AND METHODS: The three regimens consisted of (1) High-dose cytarabine, aclarubicin and granulocyte colony-stimulating factor (HD-CAG) regimen (n = 44); (2) intermediate/high-dose cytarabine (I/HDAC) regimen (n = 30); and (3) standard-dose cytarabine (SDAC) combination regimen that was identical to the first course of standard induction regimen (n = 27). RESULTS: Results indicated that after the second course, the overall response (OR), i.e., complete remission [CR]+partial remission [PR]) rates in HD-CAG was higher than in the I/HDAC group (84.1% vs. 56.7%, P = 0.009), whereas the CR rates among 3 groups were not statistically different (P = 0.541). Meanwhile, the proportion of subjects reporting certain adverse effects in the HD-CAG group was lower than the I/HDAC or SDAC groups. There were no significant differences in overall survival (OS) and disease-free survival (DFS) rates among the 3 groups (P = 0.881 and P = 0.872, respectively). CONCLUSION: Our preliminary results indicate that HD-CAG regimen may represent a better alternative option for AML patients with NR after the first course of standard induction chemotherapy.
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Objective@#To compare the outcomes between haploidentical donor hematopoietic stem cell transplantation (haplo-HSCT) and matched-sibling donor transplantation (MSD-HSCT) for paroxysmal nocturnal hemoglobinuria (PNH) .@*Methods@#The clinical data of 40 PNH patients received HSCT (haplo-HSCT=25, MSD-HSCT=15) from July 2007 to May 2018 were analyzed retrospectively to compare the outcomes between haplo-HSCT and MSD-HSCT groups.@*Results@#There were no differences in terms of gender, age, patients of PNH-AA and median time from diagnosis to transplantation between the 2 groups (P>0.05) . The median values of absolute mononuclear cell counts and CD34+ cells infused were 10.74 (4.80-22.86) ×108/kg and 12.19 (5.14-17.25) ×108/kg (P=0.866) , 3.57 (0.68-7.80) ×106/kg and 4.00 (3.02-8.42) ×106/kg (P=0.151) respectively, in haplo-HSCT and MSD-HSCT groups. All patients attained complete engraftment, no patient occurred graft failure. The median durations for myeloid and platelet engraftment were 12 (range, 9-26) and 11 (range, 7-15) days (P=0.065) , 19 (range, 11-75) and 13 (range, 11-25) days (P=0.027) respectively, in haplo-HSCT and MSD-HSCT groups. During a median follow-up of 26 (4-65) months in haplo-HSCT and 36 (4-132) months in MSD-HSCT groups (P=0.294) , the incidences of grade Ⅰ-Ⅳ acute graft-versus-host disease (aGVHD) were 32.0% and 20.0% (P=0.343) , grade Ⅱ-Ⅳ aGVHD were 16.0%, 13.3% (P=0.759) , chronic GVHD were 30.7% and 24.6% (P=0.418) , moderate-severe chronic GVHD were 12.7% and 7.1% (P=0.522) respectively, in haplo-HSCT and MSD-HSCT groups. The incidences of infection were 32.0% (8/25) and 26.7% (4/15) (P=1.000) respectively, in haplo-HSCT and MSD-HSCT groups. No patients occurred early death and relapse. Three-year estimated overall survival (OS) were (86.5±7.3) % and (93.3 ±6.4) % (P=0.520) , GVHD-free and failure-free survival (GFFS) were (78.3±8.6) % and (92.9±6.9) % (P=0.250) respectively, in haplo-HSCT and MSD-HSCT groups.@*Conclusion@#The preliminary results indicated that haplo-HSCT was a feasible choice for PNH with favorable outcomes, haplo-HSCT and MSD-HSCT produced similar therapeutic efficacy.
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Objective@#To compare the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for paroxysmal nocturnal hemoglobinuria (PNH) with paroxysmal nocturnal hemoglobinuria-aplastic anemia (PNH-AA) syndrome.@*Methods@#The outcomes of 46 patients who received allo-HSCT (16 PNH patients, 30 PNH-AA patients) from July 10, 2007 to June 2, 2018 were analyzed retrospectively. The conditioning regimen was busulfan, cyclophosphoramide, and ATG in haploidentical donors and unrelated donors. Patients with matched sibling donors were treated with the fludarabine, cyclophosphamide, and ATG regimen.@*Results@#There were no differences of baseline data between the 2 groups except gender distribution and the numbers of haploidentical donor transplantation. The median values of absolute nucleated cell counts were 10.58 (3.83-13.83) ×108/kg in the PNH group and 10.81 (3.96-33.40) ×108/kg in the PNH-AA group (P=0.668) . The median doses of CD34+ cells infused were 5.00 (3.14-8.42) ×106/kg and 3.57 (1.97-6.17) ×106/kg (P=0.002) , respectively. All patients obtained complete engraftment. The median time for myeloid engraftment were 11 (7-14) days in the PNH group and 12 (10-26) days in the PNH-AA group (P=0.003) . The median time for platelet engraftment were 13 (11-16) days and 18 (12-75) days (P=0.002) , respectively, after a median follow-up of 36 (4-132) months in the PNH group and 26 (4-75) months in the PNH-AA group (P=0.428) . There were no differences of incidence rates of acute graft-versus-host disease (aGVHD) , chronic GVHD and infection between PNH and PNH-AA groups (P>0.05) . No patient occurred early death and relapse. The estimated 3-year overall survival (OS) of PNH and PNH-AA groups were (100.0±0.0) % and (85.7± 6.6) % (P=0.141) , GVHD-free and failure-free survival (GFFS) were (100.0±0.0) %, (78.7±7.7) % (P=0.067) .@*Conclusions@#allo-HSCT is effective for patients with PNH and PNH-AA syndrome. The preliminary results indicate that myeloid and platelet engraftment in PNH group were faster than PNH-AA group. There were no differences in OS and GFFS between PNH group and PNH-AA group.
摘要
Objective@#To evaluate the outcome of combination of haploidentical donor (HID) hematopoietic stem cell transplantation (HSCT) with an unrelated cord blood unit for severe aplastic anemia (SAA).@*Methods@#The clinical data of 127 SAA patients [including 74 male and 53 female patients, 65 very severe aplastic anemia (vSAA), the median age as 23.5(3-54) years] received HID-HSCT from September 2011 to April 2017 were analyzed retrospectively. The median interval from SAA diagnosis to transplantation was 2 (0.5-180) months. The conditioning was modified Bu/Cy+ATG/ALG-based (Busulfan + cyclophosphamide + antithymocyte immunoglobulin/antilymphocyte immunoglobulin) regimen. Cord blood units were selected based on the results of HLA typing and cell doses evaluated before freezing. Units with at least 4/6 matched HLA loci became the candidates. Prophylaxis for graft-versus host disease (GVHD) was by cyclosporine (CsA), mycophenolate mofetil (MMF) plus short-term methotrexate (MTX).@*Results@#The median values of absolute nucleated cell counts were 10.87 (3.61-24.00)×108/kg in the haploidentical grafts and 2.22 (1.10-7.30)×107/kg in the cord blood units, respectively. The median doses of CD34+ cells infused were 3.49(1.02-8.89) ×106/kg in the haploidentical grafts and 0.56 (0.16-2.27) ×105/kg in the cord blood units, respectively. Of the 127 patients, 5 patients occurred early death, one patient occurred primary graft failure. All 121 surviving patients attained complete haploidentical engraftment. The median durations of myeloid engraftment were 11 (9-28) days and 15 (9-330) days for platelets, with a cumulative platelet engraftment incidence of 96.1%. The incidence of infection was 58.27% (74/127). During a median follow-up of 20.5 (4-60) months, the incidence of grade Ⅱ-Ⅳ acute GVHD was 24.79% (30/121), moderate-severe chronic GVHD was 14.15% (15/106), 4-year estimated overall survival was (78.5±4.3) %, 4-year estimated failure-free survival was (77.4±4.3) %, respectively.@*Conclusion@#Combination of HID-HSCT and an unrelated umbilical cord blood unit was a feasible choice with favorable outcome for SAA patients without matched donors.
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Objective@#To investigate the efficacy and adverse reactions of palonosetron and dexamethasone in preventing cisplatin-induced nausea and vomiting.@*Methods@#From September 2015 to August 2017, a total of 217 nasopharyngeal carcinoma patients in the 163rd Hospital of PLA were randomly divided into two groups according to the digital table.The control group (n=108) was given palonosetron when used cisplatin treatment, the study group(n=109) was given palonosetron combined with dexamethasone.The clinical efficacy and adverse reactions in the two groups were observed.@*Results@#After treatment of 1-6 weeks, the incidence rates of headache, dizziness and fatigue in the study group were 7.2%, 2.9% and 3.4% respectively, which were significantly lower than those in the control group(12.7%, 6.0% and 6.3%), the differences between the two groups were statistically significant(χ2=10.902, 7.412, 6.207, all P<0.05). The prevention rate of nausea and vomiting in the control group was 75.5%, which in the study group was 80.9%, and at delay period, the prevention rate of nausea and vomiting in the control group was 85.5%, which in the study group was 91.0%, the differences between the two groups were statistically significant(χ2=5.615, 9.442, all P<0.05).@*Conclusion@#Palonosetron and dexamethasone are effective in the treatment of nasopharyngeal carcinoma with cisplatin-induced nausea and vomiting, and can reduce the side effects of palonosetron.
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Objective To investigate the effect of miR-17-5p on the inflammatory response and oxidative stress in the development of atherosclerosis. Methods ApoE-/ - mice were fed with high fat diet for 12 weeks to con-struct atherosclerosis (AS) model, and then miR-17-5p antagonist was injected to the caudal vein of mice subse-quently. HE staining was used to observe the pathological changes of the aorta. The apoptosis of aorta cells was de-tected by TUNEL staining. Western blot was used to detect the expression of apoptosis-related proteins and the ex-pression of inflammatory cytokines weas detected by ELISA. Oxidative stress were assessed by malondialdehyde ( MDA) levels and the activity of superoxide dismutase ( SOD) and myeloperoxidase ( MPO) . Results Inhibition of miR-17-5p alleviated the aortic lesion and apoptosis in AS mice, reduced the expression of Bax, cleaved-caspase-3 and cleaved-PARP and up-regulated the expression of Bcl-2. After inhibition of miR-17-5p, the levels of TNF-α and IL-6 in AS mice decreased, and the level of IL-10 increased. Inhibition of miR-17-5p also resulted in decrease in MDA and MPO activity, but increase in SOD activity. Conclusion Inhibition of miR-17-5p can atten-uate atherosclerotic lesions by reducing the inflammatory response and oxidative stress in the aorta of atherosclerotic mice. MiR-17-5p may be a potential target for the treatment of atherosclerosis.
摘要
Objective To investigate the effects of glucocorticoid combined with spleen aminopeptide on immune function and pulmonary function in children with combined allergic rhinitis and asthma syndrome (CARAS).Methods A total of 166 cases of CARAS were divided into observation group (84 cases) and control group (82 cases),the patients in the control group were treated by nasal inhalation of Budesonide Aerosol,in addition to the treatment of control group the observation group was given spleen aminopeptide oral lyophilized powder for treatment,and two groups were treated continuously for 3 months.The effect of 2 groups of children,and the changes of immune and lung function before and after treatment were compared.Results Rhinitis and asthma were significantly reduced in two groups of children after treatment,and the reductions of the score of rhinitis symptoms and the asthma score in the observation group were more significant than those in the control group(P＜0.05).The humoral immunity index (IgG,IgM and IgA) of the 2 groups increased significantly after treatment.CD3+,CD4+ and the ratio of CD4+/CD8+ in the cellular immune indexes increased significantly,and CD8+ decreased significantly.The immune indexes in the observation group were significantly improved compared with those in the control group (P＜0.05).After treatment,the forced expiratory volume in one second(FEV1) and maximal expiratory flow rate (PEFR) of the 2 groups increased significantly compared with those before treatment,and the degree of increase in the observation group was significantly higher than that in the control group(P＜0.01).Conclusion Glucocorticoid combined with spleen aminopeptide could not only improve the symptoms and signs of children with CARAS,but also significantly enhance cellular immunity,humoral immunity and pulmonary function.
摘要
Objective: To explore protective effect of atorvastatin preconditioning on myocardial ischemia reperfusion injury (MIRI) in rats. Methods: A total of 175 20-week old Wistar rats were randomly divided into sham operation group (n=55), ischemia/reperfusion (I/R) group (n=60) and atorvastatin group (n=60). MIRI model in rat was established after 7d continuous fasting gavage. Levels of lactate dehydrogenase (LDH), creatine kinase (CK) and high sensitive C reactive protein (hsCRP) were measured and compared among three groups; after another 28d continuous gavage, left and right ventricular mass and interventricular septal thickness (IVST) were compared among three groups. Results: Compared with sham operation group on 180min after I/R, there were significant rise in levels of LDH [(583. 15±73. 16) U/L vs. (1537. 67±280. 73) U/L vs. (1035. 07±137. 92) U/L], CK [(932. 72±62. 82) U/L vs. (2872. 45±136. 3) U/L vs. (2434. 07±192. 81) U/L]and hsCRP [(20. 98±1. 86) mg/L vs. (48. 39±1. 31) mg/L vs. (40. 29±2. 33) mg/L]in I/ R group and atorvastatin group, but those of atorvastatin group were significantly lower than those of I/R group (P＜0. 05 or＜0. 01). Compared with sham operation group on 28d after I/R, there were significant rise in left ventricular relative mass [(1. 21±0. 17) mg/g vs. (1. 94±0. 33) mg/g vs. (1. 53±0. 35) mg/g], right ventricular relative mass [(0. 16± 0. 12) mg/g vs. (0. 39±1. 21) mg/g vs. (0. 27±0. 07) mg/g]and IVST [(1. 26±0. 35) mm vs. (2. 03±0. 38) mm vs. (1. 65±0. 38) mm]in I/R group and atorvastatin group, but those of atorvastatin group were significantly lower than those of I/R group, P＜0. 01 all. Conclusion: Atorvastatin preconditioning can significantly relieve myocardial ischemia reperfusion injury and improve ventricular remodeling.