[Application of Mecapegfilgrastim for Peripheral Blood Hematopoietic Stem Cell Mobilization in Patients With Hematologic Neoplasms and Analysis of Predictors for Poor Mobilization].

Objective: To evaluate the efficacy of applying mecapegfilgrastim for peripheral blood hematopoietic stem cell (PBSC) mobilization in patients with hematologic neoplasms, and to investigate the influencing factors of PBSC collection. Methods: Patients who underwent PBSC mobilization in the Department of Hematology, Mianyang Central Hospital between April 2016 and May 2022 were retrospectively analyzed. The CD34 + cell collection results of two groups, the mecapegfilgrastim group ( n=28), or the PEG group, and the recombinant human granulocyte colony-stimulating factor (rhG-CSF) group ( n=30), were compared, and the influencing factors of collection failure were analyzed. Results: The success rates of CD34 + cells collection in the PEG group and the rhG-CSF group were 75.0% and 63.3%, respectively ( P>0.05). The median CD34 + cell counts were 3.37×10 6/kg and 2.68×10 6/kg, respectively, showing no significant difference. After combined mobilization with plerixafor, the median counts of CD34 + cells collected in the PEG group and rhG-CSF group were 4.23×10 6/kg and 3.26×10 6/kg, respectively, showing no significant difference ( P>0.05). There was no significant difference in hematopoietic system reconstruction and infections between the two groups ( P>0.05). Multivariate analysis found non-plasma cell disease (odds ratio [ OR]=19.697, 95% confidence interval [ CI] : 1.501-258.537, P=0.023), anemia before collection ( OR=18.571, 95% CI: 1.354-254.775, P=0.029) and white blood cell count before collection under 32×10 9 L -1 ( OR=85.903, 95% CI: 4.947-1491.807, P=0.002) to be independent risk factors for PBSC collection failure. Conclusion: The effect of PBSC mobilization with mecapegfilgrastim was comparable to that of rhG-CSF in patients with hematologic neoplasms. Furthermore, combined mobilization with plerixafor was feasible and effective. Patients with leukemia or lymphoma, anemia, and WBC<32×10 9 L -1 before stem cell collection have a high probability of PBSC collection failure.

Isolated coagulopathy without classic CRAB symptoms as the initial manifestation of multiple myeloma: A case report.

BACKGROUND: Multiple myeloma patients usually present with CRAB symptoms (hypercalcemia, renal disease, anemia and bone diseases) as initial manifestations. Bleeding symptoms are less common, most of which result from thrombocytopenia or infiltration of plasmacytoma. Relatively, coagulopathy is not so common, especially isolated coagulopathy without CRAB manifestations, which is very rare. Herein, we report a 54-year old female who was hospitalized for intermittent and recurrent mild oral mucosal hemorrhage without other bleeding symptoms for almost one month or typical myeloma features. CASE SUMMARY: Two months before admission, the patient underwent implantation of a permanent pacemaker due to sick sinus syndrome. Prothrombin time and activated partial thromboplastin time were significantly prolonged. Factor X deficiency was demonstrated to account for the coagulation dysfunction. An M protein peak was shown by serum protein electrophoresis. 26.11% of abnormal plasma cells were detected in bone marrow by flow cytometry, expressing CD38, CD138, CD56 and intracellular immunoglobulin Kappa light chain. Bone marrow biopsy also proved the presence of abnormal plasma cells, but Congo red stain was negative. The patient was finally diagnosed with multiple myeloma IgA-κ type. A literature review indicated that factor X deficiency was highly related to amyloidosis. Before bleeding signs, the patient had cardiac arrhythmia, enlargement of the heart, and progressive heart failure; thus, cardiac amyloidosis was suspected. CONCLUSION: Bleeding related to coagulation dysfunction is uncommon in multiple myeloma, especially as the initial manifestation. Amyloidosis is a well-recognized cause of isolated acquired factor X deficiency.

CircEAF2 counteracts Epstein-Barr virus-positive diffuse large B-cell lymphoma progression via miR-BART19-3p/APC/ß-catenin axis.

BACKGROUND: Epstein-Barr virus (EBV) represents an important pathogenic factor of lymphoma and is significantly associated with poor clinical outcome of diffuse large B-cell lymphoma (DLBCL). Circular RNAs (circRNAs) play an essential role in lymphoma progression. However, the underlying mechanism of circRNA on DLBCL progression related to EBV remains largely unknown. METHODS: CircRNA was screened by high-throughput sequencing in tumor samples of 12 patients with DLBCL according to EBV infection status. Expression of circEAF2, as well as the relationship with clinical characteristics and prognosis, were further analyzed in tumor samples of 100 DLBCL patients using quantitative real-time PCR. Gain- and loss-of-function experiments were conducted to investigate the biological functions of circEAF2 both in vitro and in vivo. The underlying mechanism of circRNA on DLBCL progression were further determined by RNA sequencing, RNA pull down assay, dual-luciferase reporter assay, rescue experiments and western blotting. RESULTS: We identified a novel circRNA circEAF2, which was downregulated in EBV + DLBCL and negatively correlated with EBV infection and DLBCL progression. In EBV-positive B lymphoma cells, circEAF2 overexpression induced lymphoma cell apoptosis and sensitized lymphoma cells to epirubicin. As mechanism of action, circEAF2 specifically targeted EBV-encoded miR-BART19-3p, upregulated APC, and suppressed downstream ß-catenin expression, resulting in inactivation of Wnt signaling pathway and inhibition of EBV + DLBCL cell proliferation. In EBV-positive B-lymphoma murine models, xenografted tumors with circEAF2 overexpression presented decreased Ki-67 positivity, increased cell apoptosis and retarded tumor growth. CONCLUSIONS: CircEAF2 counteracted EBV + DLBCL progression via miR-BART19-3p/APC/ß-catenin axis, referring circEAF2 as a potential prognostic biomarker. Therapeutic targeting EBV-encoded miRNA may be a promising strategy in treating EBV-associated lymphoid malignancies.

Experimental Study and Preliminary Clinical Application of Mini-invasive Percutaneous Internal Screw Fixation for Scaphoid Fracture under the Guidance of a 3D-printed Guide Plate.

This study explored the feasibility of employing computer-aided design (CAD) and 3 dimensional (3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid. The study consisted of two parts: (1) experimentation on upper limbs from corpses and (2) preliminary clinical application. Corpse experiments involved upper limbs of 6 adult corpses. The specimens of upper limbs were subjected to plain CT scan. Then the CT data were input into computer to conduct 3D reconstruction of wrist region. The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid. The carpal bone model and the guide plate were designed and 3D-printed. By using the guide plates, the guide wire was placed and the cannulated compression screw was inserted. The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid. The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion. For clinical application, the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique. Our results showed that, in the 6 corpse limbs, the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session. X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design. For 4 patients, the guide wire and screw were all precisely inserted into place in one session. The operation time and X-ray exposure times were apparently reduced. The imaging examination exhibited satisfactory results and the hand functioned well. It was concluded that the operative guide plate used for the mini-invasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times, thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone. Its use can also improve the learning curve of surgeons.

[Relation of MiR-34a Expression in Diffuse Large B Cell Lymphoma with Clinical Prognosis].

OBJECTIVE: To investigate the expression of miR-34a in serum of DLBCL patients, and to analyze its correlation with the expression of BCL-2 protein and clinical prognosis. METHODS: The clinical data of 65 DLBCL patients and 22 cases of lymphonode reactive hyperplasia (RH) were collected, the serum expressions of miR-34a and BCL-2 were detected by real-time fluorescence quantitative PCR, and the relationship of miR-34a and BCL-2 expression with clinical pathological features and prognosis was analyzed. RESULTS: The miR-34a lowly expressed in DLBCL and the BCL-2 highly expressed in DLBCL, the miR-34a expression level correlated negatively with BCL-2 expression (P<0.01). The survival time of patients with high expression of miR-34a was significantly longer than that of patients with miR-34a low expression. Multivariate Cox regression analysis revealed that the expression of miR-34a (P<0.01) and BCL-2 (P<0.01) as well as clinical staging (P<0.01) were independent factors influencing the prognosis of patients with DLBCL. CONCLUSION: The low expression of miR-34a in DLBCL patients may be involved in the occurrence and development of diffuse large B cell lymphoma, the MiR-34a is correlated with prognosis of diffuse large B cell lymphoma.

Clinical analysis of 1629 newly diagnosed malignant lymphomas in current residents of Sichuan province, China.

Previous studies in other provinces of China (Beijing, Xinjiang, Shanxi, Jiangxi, Shanghai, Guangdong, and Taiwan) suggest that the distributions of lymphoma subtypes differ compared with Western populations. In order to evaluate the characteristics of malignant lymphoma in Sichuan, China, we analyzed case series data from incident lymphoma patients diagnosed in 2008 from three hospitals, including a total of 1629 cases and including only current residents of Sichuan. The median age of diagnosis for cases was 54 years, with a higher proportion of male cases compared with female cases. The most commonly diagnosed subtypes included diffuse large B-cell lymphoma (40.4%), NK/T-cell lymphoma (NKTCL; 11.8%), mixed cellularity Hodgkin lymphoma (7.0%), mantle cell lymphoma (4.8%), and marginal zone B-cell lymphoma (3.9%). Differences in demographic characteristics between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) cases were apparent for median age at diagnosis (HL: 34 years; NHL: 57 years), and NHLs accounted for nearly all (99.3%) of the 931 cases of extranodal lymphoma. These findings indicate a higher proportion of NKTCL cases and a lower proportion of follicular lymphoma cases (2.3%) in these hospitals in Sichuan, relative to reports from some other provinces within China (e.g., Shanghai and Shanxi) and the USA. Copyright © 2015 John Wiley & Sons, Ltd.

[Clinical outcome of 489 patients with diffuse large B-cell lymphoma and associated factors].

OBJECTIVE: To investigate the clinical outcome of 489 patients with diffuse large B-cell lymphoma (DLBCL), and to identify factors associated with the clinical outcome. METHODS: Medical records of 489 DLBCL patients admitted to the West China Hospital of Sichuan University from Jan 2000 to Dec 2010 were retrospectively reviewed. The patients were divided into CHOP and RCHOP (rituximab plus CHOP) groups depending on their chemotherapy regimens. The clinical outcomes of the two groups of patients were compared. RESULTS: The RCHOP group had a higher response rate than the CHOP group (84.3% vs. 75.6%, P = 0.015). The multivariate analysis showed that splenomegaly, low absolute lymphocyte count (ALC), high IPI scores, and CHOP was associate with the low overall-response rate. In the CHOP group, low ALC (OR = 2.060, 95% CI: 1.159-3.661, P = 0.014) and high IPI scores (OR= 2. 157, 95% CI: 1.170-3.978, P = 0.014) were associate with low response rate. In the RCHOP group, anemia (OR = 3.010, 95% CI: 1.238-7.314, P = 0.015) and high IPI scores (OR = 2.872, 95% CI: 1.193-6. 914, P = 0.019) were associate with low response rate. For patients with 0.8 x 10(9)/L-1.0 x 10(9)/L ALC, RCHOP therapy was more effective than CHOP. The expression of Bcl-2 and the phenotype of immuno-classification (GCB/non-GCB) were not associated with the difference of overall response rate between the CHOP and RCHOP groups. CONCLUSION: RCHOP therapy increases the overall response rate compared with CHOP alone. Low ALC and anemia is associate with low response rate to CHOP and RCHOP therapy, respectively.

[The clinical characteristics of 681 patients with diffuse large B-cell lymphoma].

OBJECTIVE: To analyze clinical features and the differences of GCB and non-GCB phenotypes for diffuse large B-cell lymphoma (DLBCL) in different age groups, Ki-67 index and international prognostic index (IPI). METHODS: Clinical data of 681 patients with DLBCL hospitalized in West China Hospital from January 2000 to December 2010 were retrospectively analyzed. RESULTS: Of these DLBCL cases, the median age was 56 years old with a male predominance, 51.4% stage III-IV, 37.6% B symptoms, 30.2% IPI 3-5 scores, 49.8% from extranodal sites, 29.0% gastrointestinal tract infiltration, 38.3% low absolute lymphocyte count (ALC), 56.1% elevated serum lactate dehydrogenase (LDH) level, 83.0% elevated ß(2)-microglobulin (ß(2)-MG) level. B symptoms was associated with bone marrow involvement with the odds ratio 5.212 (95%CI 2.821 - 9.632, P = 0.000). Among 268 with DLBCL patients classified by Hans' classification, 28.4% were GCB and 71.6% non-GCB. The proportions of patients with HBsAg-positive, elevated serum LDH level and Bcl-2 positive expression in non-GCB group was higher than those in GCB group (P < 0.05). The differences between GCB and non-GCB DLBCL were not revealed in terms of age subgroups, Ki-67 expression status and IPI subgroups. The high (≥ 60%) Ki-67 group included more patients with extranodal site involvement compared with the low (< 60%) Ki-67 group (51.8% vs 38.7%, P = 0.008). The proportion of patents with low ALC in IPI 3-5 scores group was higher than in IPI 0-2 scores group (P = 0.000). The multivariate analysis showed that high IPI had statistically significant negative influence on survival (P = 0.000). CONCLUSIONS: Most patients with DLBCL were middle-aged male from our data. The patients with primary nodal (PN) was almost equal to those with primary extranodal (PEN). The most frequent extranodal site was gastrointestinal tract. The non-GCB phenotype was significantly more common than GCB phenotype in this study, and the non-GCB group included more patients with HBsAg-positive and Bcl-2 positive expression. Low ALC was observed predominantly in the high risk group. IPI score was an independent prognostic indicator for survival.

[Study on quality of flavone in various cultivars of Chrysanthemum morifolium for medicine].

OBJECTIVE: To study on dynamic accumulation of various flavone in Chrysanthemum morifolium, in order to appraise the quality of flavone. METHOD: The extract was hydrolyzed and the flavonoid components were determined by RP-HPLC. RESULT AND CONCLUSION: In the samples from Tongxiang, Tezhongboju showed the highest flavonoids content with the total flavone 9.81%, quercetin 4.17 per thousand and apigenin 17.02 per thousand. In the samples from Sheyang, Hongxinju showed the highest content of luteolin with 6.84 per thousand. In the samples from Jiangning, Tezhongboju showed the highest content of total flavone with 7.59%, Yizhongdabaiju showed the highest content of quercetin with 2.78 per thousand, Sheyangxiaobaiju showed the highest content of luteolin with 4.27 per thousand, Sheyanghongxinju showed the highest content of apigenin with 11.20 per thousand. There were differences in the content of flavonoids among the different cultivars, and the same cultivars showed also different when planted in different areas.