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1.
J Colloid Interface Sci ; 605: 602-612, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34343733

RESUMO

Hexavalent chromium (Cr(VI)) is considered to be a potential metal contaminant because of its toxicity and carcinogenicity. In this work, the surface charge density of nickel-iron layered double hydroxide (NiFe LDH) is tuned through iron valence change to improve the performance in adsorption of Cr(VI). The addition of iron divalent in the precursor enhances the surface positivity and reducibility of Fe2+-NiFe LDH, resulting in a nearly 150% Cr(VI) maximum adsorption capacity improvement. The increase of hydroxyl groups and charge density on the surface of NiFe LDH is due to the topological chemical transition from Ni2+-Fe2+ LDH to Ni2+-Fe3+ LDH. The adsorption of Cr(VI) onto Fe2+-NiFe LDH prepared via topochemical approach is highly pH-dependent. The adsorption dynamics and isotherms results may be clearly elucidated by the pseudo-second-order model and Langmuir isotherm model. Electrostatic attraction, interlayer anion exchange and adsorption-coupled reduction are proven to be the main Cr(VI) removal mechanisms for Fe2+-NiFe LDH. This finding demonstrates that Fe2+-NiFe LDH adsorbents have potential application for efficient removal of Cr(VI) pollutants.


Assuntos
Ferro , Poluentes Químicos da Água , Adsorção , Cromo/análise , Hidróxidos , Cinética , Níquel , Poluentes Químicos da Água/análise
2.
ACS Omega ; 6(43): 28587-28597, 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34746554

RESUMO

To reduce the cost of synthetic organic corrosion inhibitors in corrosion protection, dye wastewater exhibiting a synergistic effect is used with organic corrosion inhibitors to reduce the amount of high-cost molecules. The corrosion inhibition effects of the cationic dye methylene blue (MB) and the anionic dye methyl orange (MO) are tested. The test methods include electrochemical methods, weight-loss tests, and so on. MB exhibits better performance on the tested steel, with the anticorrosion efficiency reaching as high as 75.40%, which is chosen as an additive for organic corrosion inhibitors. After that, an organic inhibitor decamethylene bis-pyridinium dibromide (DBP) is selected for compounding with MB, and the corrosion inhibition effect under different ratios is tested. Similar effects of the compound inhibitor to the pristine sample are obtained at a ratio of MB/DBP = 6:4. In addition to experiments, theoretical calculations have also confirmed that the addition of dye molecules can inhibit corrosion. This research not only provides a way to reuse dye wastewater but also proposes measures to reduce the cost of organic corrosion inhibitors and, at the same time, provides new ideas for environmental protection and metal protection.

3.
Front Psychiatry ; 12: 589687, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759845

RESUMO

The phenomenon of female preponderance in depression has been well-reported, which has been challenged by higher rates of suicide and addictive behaviors in males, and a longer life-span in females. We thus propose an alternative hypothesis "Gender differences in self-reporting symptom of depression," suggesting mild-moderate depression tends to be reported more often by females, and severe depression and suicide tend to be reported more often by males. Potential mechanisms that account for this difference may include three aspects: covariation between estrogen levels and the incidence peak of female depression, gender differences in coping style (e.g., comparative emotional inexpressiveness and non-help-seeking in males), and gender differences in symptom phenotypes (e.g., atypical symptoms in male depression). Our newly presented hypothesis implied the overlooked under-diagnosis and under-treatment of depression in males. For effective diagnoses and timely treatment of male depression, it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria, encourage males to express negative emotions, and increase awareness of suicidal behavior in males.

4.
ACS Synth Biol ; 10(11): 2833-2841, 2021 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-34734710

RESUMO

Efficient enabling technology is required for synthetic biology in Streptomyces due to its natural product reservoir. Though the CRISPR-Cas9 system is powerful for genome editing in this genus, the proposed Cas9 toxicity has limited its application. Here on the basis of previous inducible Cas9 expression at the transcriptional and translational levels coupled with atpD overexpression, a Cas9 cognate inhibitor AcrIIA4 was further introduced to fine-tune the Cas9 activity. In both laboratory and industrial Streptomyces species, we showed that, compared to the constitutively expressed Cas9, incorporating AcrIIA4 increased the conjugation efficiency from 700- to 7000-fold before induction, while a comparable 65%-90% editing efficiency was obtained even on multiple loci for simultaneous deletion after Cas9 expression was induced, along with no significant off-targets. Thus, AcrIIA4 could be a modulator to control Cas9 activity to significantly improve genome editing, and this new toolkit would be widely adaptable and fasten genetic engineering in Streptomyces.

5.
BMC Infect Dis ; 21(1): 1156, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34775956

RESUMO

BACKGROUND: Streptococcus pneumoniae (S. pneumoniae) is a major cause of bacterial meningitis, septicemia and pneumonia in children. Inappropriate choice of antibiotic can have important adverse consequences for both the individual and the community. Here, we focused on penicillin/cefotaxime non-susceptibility of S. pneumoniae and evaluated appropriateness of targeted antibiotic therapy for children with IPD (invasive pneumococcal diseases) in China. METHODS: A multicenter retrospective study was conducted in 14 hospitals from 13 provinces in China. Antibiotics prescription, clinical features and resistance patterns of IPD cases from January 2012 to December 2017 were collected. Appropriateness of targeted antibiotics therapy was assessed. RESULTS: 806 IPD cases were collected. The non-susceptibility rates of S. pneumoniae to penicillin and cefotaxime were 40.9% and 20.7% respectively in 492 non-meningitis cases, whereas those were 73.2% and 43.0% respectively in 314 meningitis cases. Carbapenems were used in 21.3% of non-meningitis cases and 42.0% of meningitis cases for targeted therapy. For 390 non-meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were used in 17.9% and 8.7% of cases respectively for targeted therapy. For 179 meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were prescribed in 55.3% and 15.6% of cases respectively. Overall, inappropriate targeted therapies were identified in 361 (44.8%) of 806 IPD cases, including 232 (28.8%) cases with inappropriate use of carbapenems, 169 (21.0%) cases with inappropriate use of vancomycin and 62 (7.7%) cases with inappropriate use of linezolid. CONCLUSIONS: Antibiotic regimens for IPD definite therapy were often excessive with extensive prescription of carbapenems, vancomycin or linezolid in China. Antimicrobial stewardship programs should be implemented to improve antimicrobial use.


Assuntos
Antibacterianos , Infecções Pneumocócicas , Antibacterianos/uso terapêutico , Criança , China/epidemiologia , Humanos , Lactente , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/epidemiologia , Prescrições , Estudos Retrospectivos
6.
Chem Commun (Camb) ; 57(92): 12285-12288, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34730570

RESUMO

Divergent synthesis provides an indispensable route to rapid acquisition of structurally diverse chemical scaffolds from identical starting materials. Herein, we describe unprecedented divergent annulations of o-hydroxyarylenaminones promoted by tert-butyl nitrite (TBN) under mild conditions. Two different types of benzo-oxa-heterocycle, including oximinochromanones and oximinocoumaranones, were smoothly assembled with a broad substrate scope and good functional group compatibility.

7.
J Thorac Dis ; 13(10): 5954-5963, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34795943

RESUMO

Background: Atrial fibrillation (AF) relapse following radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (PeAF) continues to be a concern. This study establishes a connection between left atrial appendage peak flow velocity (LAAV) and recurrence of AF in individuals having PeAF following first RFCA. Methods: We retrospectively studied 164 successive PeAF patients who had first RFCA between January 2018 and December 2019. Before the ablation, the LAAV was recorded using transesophageal echocardiography (TEE). The demographic and clinical data of the individuals were gathered. Participants were monitored at regular intervals to monitor for recurrence of AF. We employed Cox proportional hazards regression to determine if LAAV, as well as other clinical indicators, were predictive of AF recurrence in follow-up. Results: In this study, AF relapse was seen in 43 patients (26.2%) following a median follow-up of 15 [interquartile range (IQR): 12-18] months. It was shown that the LAAV was decreased in individuals who had recurrences of AF (0.36±0.05 vs. 0.45±0.17 m/s, P=0.004). Using Kaplan-Meier analysis, it was discovered that the low LAAV (0.37 m/s) group had a poorer event-free survival rate compared to the high LAAV (>0.37 m/s) group (17.6 vs. 21.2 months, log-rank P=0.002) group. Based on the results of the multivariate Cox regression analysis, a LAAV of fewer than 0.37 m/s [hazard ratio (HR): 2.32; 95% confidence interval (CI): 1.177-4.227; P=0.014] was shown to be an independent predictor of AF recurrence following RFCA. Conclusions: A low LAAV is associated with AF relapse, and it is a predictor of AF relapse following the first RFCA for PeAF. This discovery may be useful in the optimization of treatment strategies and the care of patients with PeAF.

8.
Nat Commun ; 12(1): 6471, 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753932

RESUMO

Very recently, increasing attention has been focused on non-Abelian topological charges, e.g., the quaternion group Q8. Different from Abelian topological band insulators, these systems involve multiple entangled bulk bandgaps and support nontrivial edge states that manifest the non-Abelian topological features. Furthermore, a system with an even or odd number of bands will exhibit a significant difference in non-Abelian topological classification. To date, there has been scant research investigating even-band non-Abelian topological insulators. Here, we both theoretically explore and experimentally realize a four-band PT (inversion and time-reversal) symmetric system, where two new classes of topological charges as well as edge states are comprehensively studied. We illustrate their difference in the four-dimensional (4D) rotation sense on the stereographically projected Clifford tori. We show the evolution of the bulk topology by extending the 1D Hamiltonian onto a 2D plane and provide the accompanying edge state distributions following an analytical method. Our work presents an exhaustive study of four-band non-Abelian topological insulators and paves the way towards other even-band systems.

9.
Nanoscale ; 13(45): 18883-18911, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34783819

RESUMO

Functional separators have played important roles in improving the electrochemical performance of lithium-sulfur (Li-S) batteries by addressing the key issues of both the sulfur cathode and lithium anode. Compared with other materials that are used for separator functionalization, two-dimensional (2D) materials with atomic layer thickness and infinite lateral dimensions feature several advantages of ultra-thin laminate structure, remarkable physical properties and tunable surface chemistry, which show potential applications in separator functionalization towards addressing the issues of both the shuttle effect and formation of Li dendrites in Li-S batteries. In this review, the unique advantages of 2D materials for separator functionalization in Li-S batteries and their common construction methods are introduced. Then, recent progress and advances in the construction of 2D materials functional separators are summarized in detail towards inhibiting the shuttle effect of polysulfides and suppressing Li dendrite growth in Li-S batteries. Finally, some opportunities and challenges of 2D materials for constructing high-performance functional separators are proposed. We anticipate that this review will provide new insights into separator functionalization for developing advanced Li-S batteries.

10.
PeerJ ; 9: e12475, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34820197

RESUMO

Knowledge of demography is essential for understanding wildlife population dynamics and developing appropriate conservation plans. However, population survey and demographic data (e.g., capture-recapture) are not always aligned in space and time, hindering our ability to robustly estimate population size and demographic processes. Integrated population models (IPMs) can provide inference for population dynamics with poorly aligned but jointly analysed population and demographic data. In this study, we used an IPM to analyse partially aligned population and demographic data of a migratory shorebird species, the snowy plover (Charadrius nivosus). Snowy plover populations have declined dramatically during the last two decades, yet the demographic mechanisms and environmental drivers of these declines remain poorly understood, hindering development of appropriate conservation strategies. We analysed 21 years (1998-2018) of partially aligned population survey, nest survey, and capture-recapture-resight data in three snowy plover populations (i.e., Texas, New Mexico, Oklahoma) in the Southern Great Plains of the US. By using IPMs we aimed to achieve better precision while evaluating the effects of wetland habitat and climatic factors (minimum temperature, wind speed) on snowy plover demography. Our IPM provided reasonable precision for productivity measures even with missing data, but population and survival estimates had greater uncertainty in years without corresponding data. Our model also uncovered the complex relationships between wetland habitat, climate, and demography with reasonable precision. Wetland habitat had positive effects on snowy plover productivity (i.e., clutch size and clutch fate), indicating the importance of protecting wetland habitat under climate change and other human stressors for the conservation of this species. We also found a positive effect of minimum temperature on snowy plover productivity, indicating potential benefits of warmth during night on their population. Based on our results, we suggest prioritizing population and capture-recapture surveys for understanding population dynamics and underlying demographic processes when data collection is limited by time and/or financial resources. Our modelling approach can be used to allocate limited conservation resources for evidence-based decision-making.

12.
Aging Cell ; : e13523, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34811857

RESUMO

The liver plays a pivotal role in mammalian aging. However, the mechanisms underlying liver aging remain unclear. Cisd2 is a pro-longevity gene in mice. Cisd2 mediates lifespan and healthspan via regulation of calcium homeostasis and mitochondrial functioning. Intriguingly, the protein level of Cisd2 is significantly decreased by about 50% in the livers of old male mice. This down-regulation of Cisd2 may result in the aging liver exhibiting non-alcoholic fatty liver disease (NAFLD) phenotype. Here, we use Cisd2 transgenic mice to investigate whether maintaining Cisd2 protein at a persistently high level is able to slow down liver aging. Our study identifies four major discoveries. Firstly, that Cisd2 expression attenuates age-related dysregulation of lipid metabolism and other pathological abnormalities. Secondly, revealed by RNA sequencing analysis, the livers of old male mice undergo extensive transcriptomic alterations, and these are associated with steatosis, hepatitis, fibrosis, and xenobiotic detoxification. Intriguingly, a youthful transcriptomic profile, like that of young 3-month-old mice, was found in old Cisd2 transgenic male mice at 26 months old. Thirdly, Cisd2 suppresses the age-associated dysregulation of various transcription regulators (Nrf2, IL-6, and Hnf4a), which keeps the transcriptional network in a normal pattern. Finally, a high level of Cisd2 protein protects the liver from oxidative stress, and this is associated with a reduction in mitochondrial DNA deletions. These findings demonstrate that Cisd2 is a promising target for the development of therapeutic agents that, by bringing about an effective enhancement of Cisd2 expression, will slow down liver aging.

13.
Opt Express ; 29(21): 33424-33433, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34809154

RESUMO

To precisely measure and evaluate X-ray generation and evolution in a hohlraum during an implosion process, we present a two-dimensional (2D) time- and space-resolved diagnostic method by combining a compressed ultrafast photography (CUP) system and a simplified version of space-resolving flux detector (SSRFD). Numerical experiment results showed that the reconstruction quality of the conventional CUP significantly improved owing to the addition of the external SSRFD, especially when a coded mask with a large pixel size was used in the CUP. Further, the performance of the CUP cooperation with the SSRFD was better than that of adding an external charge-coupled device or streak camera. Compared with existing ultrafast imaging techniques in laser fusion, the proposed method has a prominent advantage of measuring the 2D evolution of implosion by combining high temporal resolution of streak camera and high spatial resolution of SSRFD; moreover, it can provide guidance for designing diagnostic experiments in laser fusion research.

14.
Cardiovasc Diagn Ther ; 11(5): 1047-1057, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34815955

RESUMO

Background: In the 6th World Symposium on Pulmonary Hypertension (PH), the hemodynamic definition of PH was reduced from a mean pulmonary artery pressure (mPAP) ≥25 to >20 mmHg. This study aimed to evaluate the impact of the revised hemodynamic definition on the diagnosis of precapillary PH. Methods: We retrospectively enrolled patients who underwent right heart catheterization from January 2012 to December 2018. All included patients were reassessed according to the revised hemodynamic definition. Results: A total of 1,251 patients were included for analysis, of whom 1,044 patients had precapillary PH and 182 patients had mPAP <25 mmHg. After applying the revised definition, 33 (18.1%) of 182 patients with mPAP <25 mmHg were reclassified as having PH. However, only 7 of these 33 patients had a pulmonary vascular resistance ≥3 wood units and could be considered to have precapillary PH, accounting for 0.7% of the existing precapillary PH population. More importantly, 12 patients with mPAP ≥25 mmHg were delisted from precapillary PH for pulmonary vascular resistance <3 wood units (5 patients from Group III, 4 patients from Group IV, 3 patients from Group V). Overall, there was a net 0.5% decrease [(12-7)/1044×100%] in the population with precapillary PH. Conclusions: The revised hemodynamic definition had a minor impact on the diagnosis of precapillary PH. It should be noted that the revised definition would influence not only patients with mPAP =21-24 mmHg, but also patients with mPAP ≥25 mmHg.

15.
Nanomaterials (Basel) ; 11(11)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34835649

RESUMO

Lithium-sulfur (Li-S) batteries are deemed to be one of the most optimal solutions for the next generation of high-energy-density and low-cost energy storage systems. However, the low volumetric energy density and short cycle life are a bottleneck for their commercial application. To achieve high energy density for lithium-sulfur batteries, the concept of synergistic adsorptive-catalytic sites is proposed. Base on this concept, the TiN@C/S/Ta2O5 sulfur electrode with about 90 wt% sulfur content is prepared. TiN contributes its high intrinsic electron conductivity to improve the redox reaction of polysulfides, while Ta2O5 provides strong adsorption capability toward lithium polysulfides (LiPSs). Moreover, the multidimensional carbon structure facilitates the infiltration of electrolytes and the motion of ions and electrons throughout the framework. As a result, the coin Li-S cells with TiN@C/S/Ta2O5 cathode exhibit superior cycle stability with a decent capacity retention of 56.1% over 300 cycles and low capacity fading rate of 0.192% per cycle at 0.5 C. Furthermore, the pouch cells at sulfur loading of 5.3 mg cm-2 deliver a high areal capacity of 5.8 mAh cm-2 at low electrolyte/sulfur ratio (E/S, 3.3 µL mg-1), implying a high sulfur utilization even under high sulfur loading and lean electrolyte operation.

16.
EBioMedicine ; 73: 103654, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34740104

RESUMO

BACKGROUND: Age-related changes affecting the ocular surface cause vision loss in the elderly. Cisd2 deficiency drives premature aging in mice as well as resulting in various ocular surface abnormalities. Here we investigate the role of CISD2 in corneal health and disease. METHODS: We studied the molecular mechanism underlying the ocular phenotypes brought about by Cisd2 deficiency using both Cisd2 knockout (KO) mice and a human corneal epithelial cell (HCEC) cell line carrying a CRISPR-mediated CISD2KO background. We also develop a potential therapeutic strategy that targets the Ca2+ signaling pathway, which has been found to be dysregulated in the corneal epithelium of subjects with ocular surface disease in order to extend the mechanistic findings into a translational application. FINDINGS: Firstly, in patients with corneal epithelial disease, CISD2 is down-regulated in their corneal epithelial cells. Secondly, using mouse cornea, Cisd2 deficiency causes a cycle of chronic injury and persistent repair resulting in exhaustion of the limbal progenitor cells. Thirdly, in human corneal epithelial cells, CISD2 deficiency disrupts intracellular Ca2+ homeostasis, impairing mitochondrial function, thereby retarding corneal repair. Fourthly, cyclosporine A and EDTA facilitate corneal epithelial wound healing in Cisd2 knockout mice. Finally, cyclosporine A treatment restores corneal epithelial erosion in patients with dry eye disease, which affects the ocular surface. INTERPRETATION: These findings reveal that Cisd2 plays an essential role in the cornea and that Ca2+ signaling pathways are potential targets for developing therapeutics of corneal epithelial diseases. FUNDING: This study was supported by the Ministry of Science and Technology (MOST) and Chang Gung Medical Research Foundation, Taiwan.

17.
J Biomed Inform ; 124: 103939, 2021 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-34752858

RESUMO

Cataracts are the most crucial cause of blindness among all ophthalmic diseases. Convenient and cost-effective early cataract screening is urgently needed to reduce the risks of visual loss. To date, many studies have investigated automatic cataract classification based on fundus images. However, existing methods mainly rely on global image information while ignoring various local and subtle features. Notably, these local features are highly helpful for the identification of cataracts with different severities. To avoid this disadvantage, we introduce a deep learning technique to learn multilevel feature representations of the fundus image simultaneously. Specifically, a global-local attention network (GLA-Net) is proposed to handle the cataract classification task, which consists of two levels of subnets: the global-level attention subnet pays attention to the global structure information of the fundus image, while the local-level attention subnet focuses on the local discriminative features of the specific regions. These two types of subnets extract retinal features at different attention levels, which are then combined for final cataract classification. Our GLA-Net achieves the best performance in all metrics (90.65% detection accuracy, 83.47% grading accuracy, and 81.11% classification accuracy of grades 1 and 2). The experimental results on a real clinical dataset show that the combination of global-level and local-level attention models is effective for cataract screening and provides significant potential for other medical tasks.

18.
BMC Pulm Med ; 21(1): 378, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34802431

RESUMO

OBJECTIVE: Obstructive sleep apnoea (OSA) is one cause of pulmonary hypertension (PH) and can also emerge along with PH. The clinical diagnosis and treatment of OSA in patients with PH are still controversial. The purpose of this clinical observation study was to observe and summarize the incidence and clinical characteristics of OSA in patients with PH and to explore possible predictors of PH combined with OSA. METHODS: Patients with PH diagnosed by right heart catheterization who underwent overnight cardiorespiratory monitoring from December 2018 to December 2020 were enrolled. OSA was defined as an apnoea-hypopnoea index of ≥ 5/h with ≥ 50% of apnoeic events being obstructive. Baseline clinical characteristics and parameters were collected to compare PH patients with and without OSA. Logistic regression analysis was run to determine the risk factors for OSA in PH patients. RESULTS: A total of 35 (25%) of 140 patients had OSA. OSA is relatively frequent in patients with PH, especially in patients with chronic thromboembolic pulmonary hypertension and patients with lung disease- or hypoxia-associated PH. The patients who had OSA were mostly male and had a higher age and a lower daytime arterial oxygen pressure. Logistic regression analysis found that older age, male sex, and lower daytime arterial blood oxygen pressure correlated with OSA in PH patients. CONCLUSION: OSA is common in patients with PH. Lower daytime arterial oxygen pressure is a risk factor for OSA in older male patients with PH.

19.
Front Pharmacol ; 12: 748102, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34776965

RESUMO

Tumor microenvironment-responsive polypeptide nanogels belong to a biomaterial with excellent biocompatibility, easily adjustable performance, biodegradability, and non-toxic properties. They are developed for selective delivery of antitumor drugs into target organs to promote tumor cell uptake, which has become an effective measure of tumor treatment. Endogenous (such as reduction, reactive oxygen species, pH, and enzyme) and exogenous (such as light and temperature) responsive nanogels can release drugs in response to tumor tissues or cells to improve drug distribution and reduce drug side effects. This article systematically introduces the research progress in tumor microenvironment-responsive polypeptide nanogels to deliver antitumor drugs and provides a reference for the development of antitumor nanoformulations.

20.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(5): 1637-1644, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34627453

RESUMO

OBJECTIVE: To analyze the clinical characteristics, diagnosis and prognostic factors of bone marrow necrosis (BMN) patients, aim to avoid misdiagnosis, missed diagnosis or delayed treatment. METHODS: The clinical data of 51 BMN patients treated in the Affiliated Hospital of Xuzhou Medical University from January 2010 to December 2017 were retrospectively analyzed. The types of primary disease, etiology, clinical manifestations, laboratory tests, radiological findings, treatment outcomes and prognostic factors were summrized, and the reasons for misdiagnosis were analyzed. RESULTS: Among 51 BMN patients, the hematologic tumor was detected out in 32 patients; solid tumors caused- BMN was detected out in 14 patients, benign lesions for 5 patients. The time of interval from the appearance of symptoms to the confirmation of BMN was 7 days to 6 months, with a median of 35 days. Misdiagnosis and missed diagnosis occurred in 25.5% of the BMN patients. Anemia was found in all of the 51 BMN patients, fever accounted for 58.8%, systemic bone pain for 52.9%, bleeding for 29.4%, lymphadenectasis for 37.3%, and hepatosplenomegaly for 19.6%. Leukoerythroblastic anemia accounted for 84.3%, bicytopenia for 51.0%, pancytopenia for 25.5%, and monocytopenia for 23.5%. The serologic test revealed no specific results. The first bone marrow aspiration were 38 patients and multi-site puncture were 7 patients. The diagnostic coincidence rate of bone marrow smear was 88.2%. Among 51 BMN patients, 41 patients received bone marrow biopsy, and the diagnostic coincidence rate of bone marrow biopsy was 75.6%. The abnormal signals were found in multiple vertebral bodies by spinal/pelvic MRI scan in 13 BMN patients; PET-CT scan revealed a diffuse pattern of low FDG uptake in the bone marrow in 16 patients, with a local increase in FDG uptake accompanied by bone marrow involvement. For 46 patients with BMN combined with malignancies, among which 35 patients died (76.1%) and the median survival time was 25 days. Among the 32 patients with hematologic tumors, early death occurred in 12 patients, BMN disappeared in 11 out of 20 patients received active chemotherapy for the primary disease, 9 patients died within 1 week to 3 months. Fourteen patients combined with bone marrow metastatic carcinoma died within 2 weeks to 3 months. Focal necrosis disappeared in 4 out of 5 BMN patients secondary to non-malignant diseases after symptomatic supportive treatment and still alived. Multiple logistic regression was performed to analyze factors affecting the prognosis of BMN patients, the result showed that the prognosis of BMN was closely related to the factors of primary disease (benign and malignant). The reasons for misdiagnosis and missed diagnosis were as follows: hidden onset of the primary disease, nonspecific symptoms, insufficient understanding and alertness of the physicians regarding the primary clinical characteristics and hematological abnormalities, and failure to receive multiple sites bone marrow punctures or bone marrow biopsies. CONCLUSION: BMN usually occurs concomitantly to hematologic tumors and bone marrow metastases from solid tumors. Its prognosis is closely related to the nature and severity of the primary disease and its own severity. In the clinic, BMN should be suspected in patients with severe bone pain, fever, hepatosplenomegaly, hemocytopenia, lymphadenectasis and leukoerythroblastic anemia. Bone marrow puncture at multiple positions and bone marrow biopsy can compensate for each other in the diagnosis of BMN. The combined use of the two methods can improve the diagnostic coincidence rate of BMN, and the positive rate of the etiological diagnosis of BMN.


Assuntos
Medula Óssea , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Erros de Diagnóstico , Humanos , Necrose , Prognóstico , Estudos Retrospectivos
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