A prospective comparison of a modified miniaturised hand-held epifluorescence microscope and touch imprint cytology for evaluation of axillary sentinel lymph nodes intraoperatively in breast cancer patients.

BACKGROUND: The management of axillary lymph nodes in early-stage breast cancer patients has changed considerably, with the primary focus shifting from the examination of sentinel lymph nodes (SLNs) to toward the detection of all macro-metastases. However, current methods, such as touch imprint cytology (TIC) and frozen sections, are inadequate for clinical needs. To address this issue, we proposed a novel miniaturised epifluorescence widefield microscope (MEW-M) to assess SLN status intraoperatively for improved diagnostic efficiency. METHODS: A prospective, side-by-side comparison of intraoperative SLN evaluation between MEW-M and TIC was performed. RESULTS: A total of 73 patients with 319 SLNs consecutive enrolled in this study. MEW-M showed significantly superior image quality compared to TIC (median score 3.1 vs 2.1, p < 0.0001) and had a shorter time to issue results (10.3 vs 19.4 min, p < 0.0001). Likelihood ratio analysis illustrated that the positive likelihood ratio value of MEW-M compared with TIC was infinitely great vs 52.37 (95% CI, 21.96-124.90) in model 1 (classifying results into negative/positive), infinitely great vs 52.37 (95% CI, 21.96-124.90) in model 2 (classifying results into macro-metastasis/others, and TIC results followed the same classification as model 1), respectively. Similarly, the negative likelihood ratio values of MEW-M compared with TIC were 0.055 (95% CI, 0.018-0.160) and 0.074 (95% CI, 0.029-0.190) in model 1; and 0.019 (95% CI, 0.003-0.130) vs 0.020 (95% CI, 0.003-0.140) in model 2, respectively. CONCLUSIONS: MEW-M is a promising technique that can be utilised to provide a rapid and accurate intraoperative assessment of SLN in a clinical setting to help improve decision-making in axillary surgery.

Survey results of job status of residents in a standardized residency training program.

BACKGROUND: The history of standardized residency training programs (SRTP) in China is not long. As one of the top medical colleges in China, Peking Union Medical College Hospital (PUMCH) has the history and experience of the oldest SRTP in the country. Understanding the job status of PUMCH residents would be conducive to a better development of the national resident training in the future. METHODS: This study analyzed the demographic information, job burnout scale, working time, and job status of postgraduate year 1-3 residents that took part in the SRTP of the Department of Internal Medicine of PUMCH in August 2017. RESULTS: The survey data of 159 residents (including PUMCH residents, local-resident-trainees, and clinical postgraduates) were collected. The average working time was 11.38 ± 1.55 h per day and 83.28 ± 8.80 h per week. The average night shift frequency was 4.74 ± 0.59 days. There were 100 residents (62.2%) with symptoms of job burnout, which had a certain correlation with working time (p < 0.05). The self-evaluation of the clinical postgraduates about their working quality of life was lower than that of other residents (p < 0.05). There were various reasons for long working-time, great work pressure, and job burnout. Job burnout was independently associated with the average working time per day (OR = 2.35, 95% CI: 1.47-3.75, P < 0.001) and average length of duty period (OR = 1.52, 95% CI: 1.26-1.84, P < 0.001). CONCLUSION: The job burnout of residents that took part in SRTP at the PUMCH could not be ignored, which had a certain correlation with work time and early training background.

Good outcome of severe lupus patients with high-dose immunosuppressive therapy and autologous peripheral blood stem cell transplantation: a 10-year follow-up study.

OBJECTIVES: This study aimed to examine the long-term efficacy, remission and survival of patients with severe systemic lupus erythematosus (SLE) after the combination treatment with high-dose immunosuppressive therapy (HDIT) and autologous peripheral blood stem cell transplantation (APBSCT). METHODS: Chinese patients with severe SLE receiving combination therapy with HDIT and APBSCT in Peking Union Medical College Hospital were enrolled from July 1999 to October 2005. Disease activity, treatment, and adverse effects of these patients were evaluated. The 10-year overall survival and 10-year remission survival were also analysed. RESULTS: Among the 27 patients, one patient failed to collect enough CD34+ cells and data was missing for two patients. In the end, 24 patients were included in the final analysis. After APBSCT, one patient died, two patients achieved partial remission and 21 (87.5%) achieved remission at 6 months. The median follow-up duration of the 23 patients was 120 months. Fourteen patients had completed a ten-year follow-up. The median proteinuria level of the 14 patients with LN with ten years of follow-up significantly decreased from 4.00 g/24 hours at pre-treatment to 0.00g/24 hours at year 5 and 0.00 g/24 hours at year 10 (both p=0.001). The 10-year overall survival rate and 10-year remission survival rate were both 86.0% (95% CI: 71.1-100.9%). After a median follow-up for 120 months, 16 patients (66.7%) remained in remission, 4 patients were lost to follow-up, 2 patients died and 1 patient remained active. CONCLUSIONS: The combination of HDIT and APBSCT may be an option to improve the survival of severe lupus patients.

[An analysis of the questionnaire survey about the first year residency training in internal medicine in Peking Union Medical College Hospital].

OBJECTIVE: To evaluate the effects of medical residency training program in postgraduate-year-one (PGY-1) residents at Peking Union Medical College (PUMC) Hospital. METHODS: PGY-1 medical residents at PUMC Hospital were surveyed by a self-administered questionnaire after they completed their first year residency. RESULTS: Forty-nine residents who completed their first year residency training participated in the survey with a 100% response rate. Before training, only a few had bedside (n = 18) and on-call experiences (n = 10). At the end of the one-year-training, all the residents (100%) considered themselves being improved to certain degrees, especially in clinical practice capability, and passed all the examinations. However, 53.1% and 8.2% of all the residents agreed that they need to improve their abilities in teaching (n = 26) and doctor-patient communication (n = 4), respectively. All residents hoped to get further improved by taking part in various forms of teaching activities, including experience summary/sharing and basic skills training. During the first year, 95.9% of them participated in all teaching activities in medicine actively. CONCLUSIONS: The tradition and current models of medical residency training program at PUMC Hospital had a significant impact on professional development of the 1st year resident physicians. It is critical to focus on basic skill training and multi-level teaching to improve residents' clinical competency.

Patients with primary diffuse large B-cell lymphoma of female genital tract have high risk of central nervous system relapse.

The objective of this study was to evaluate retrospectively the clinical characteristics, treatments, and outcomes of patients with primary diffuse large B-cell lymphoma (DLBCL) of the female genital tract. The basic characteristics, treatments, and outcomes of six patients diagnosed with primary DLBCL of the female genital tract, including the ovary, uterine cervix, and vagina, treated in our hospital between 2000 and 2012, were analyzed retrospectively. Seven of 323 (2.2 %) newly diagnosed DLBCLs were diagnosed as primary female genital tract DLBCL. Six patients with complete medical data were included in the analysis. The median age at diagnosis was 52.5 years (range 20-65). The presenting symptoms included abnormal vaginal bleeding, increased vaginal discharge, abdominal fullness, and abdominal pain. Two patients had stage IE disease and four patients had stage IIE disease. Treatment included chemotherapy only in five patients, and combined chemotherapy and localized radiation in one patient. After a median follow-up of 58 months, four patients showed relapse in the central nervous system and two had died from progressive disease. The median progression-free survival was 27 months and the median overall survival for this group has not been reached. Patients with primary female genital tract DLBCL may have poor outcomes and a high risk of central nervous system relapse. Central nervous system prophylaxis might be considered in addition to systemic chemotherapy for DLBCL of the female genital tract.

Clinical characteristics and long-term outcome of patients with POEMS syndrome in China.

POEMS syndrome is a rare plasma cell dyscrasia characterized by polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes. This study reviewed the clinical characteristics and long-term outcome of 99 consecutive Chinese patients with newly diagnosed POEMS syndrome in a single institute. The median age of 99 patients was 45 years, and the ratio of men/women was 1.4. The median time from onset of symptoms to diagnosis was 18 months. The typical five features of peripheral neuropathy, organomegaly, endocrinopathy, M protein, and skin change remained to be essential for patients with POEMS syndrome in China. The unusual features like pulmonary hypertension (36%) and renal impairment (37%) were not uncommon in China. Eighty-three percent patients were alive after follow-up time of 25 months, and 10% patients had survived more than 60 months. Melphalan-based therapy (OR, 0.076; 95% CI, 0.02-0.285) and normal renal function (OR, 0.246; 95% CI, 0.076-0.802) were independent prognostic factors for the survival of patients with POEMS syndrome. In conclusion, POEMS syndrome in Chinese patients was a multi-systemic disease with clinical features similar to non-Chinese ones. Active therapy can effectively improve the prognosis of patients with POEMS syndrome.

[An analysis of disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital from 2004 to 2008, and the value of general internal medicine unit in comprehensive hospitals].

OBJECTIVE: To analyze the disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital, which is the first academic division of general internal medicine in the department of medicine within Chinese medical colleges and universities, and the value of general internal medicine unit in comprehensive hospitals. METHODS: A retrospective data review of patients admitted to the General Internal Medicine Unit from 2004 to 2008 was conducted from hospital information system and partially by chart review manually. Analysis of disease spectrum was performed thereafter. RESULTS: A total of 2593 patients were included in our study. It consisted of 1075 men and 1518 women, with an average age of 45.1 years old. Forty point three percent of these patients were from Beijing, the local city, and the remaining 59.7% were from outside of Beijing. Sixty-four point nine percent (1683/2593) of these patients did not have a clear diagnosis on admission, including 758 fever of unknown origin (FUO) cases and 925 non-FUO cases. The final diagnostic rate of the FUO cases was 89.2% [676/758, with the first three leading causes as diseases of the musculoskeletal system and connective tissue (29.8%), certain infectious and parasitic diseases (26.3%), and neoplasm (14.5%)]. The final diagnostic rate of the 928 non-FUO cases was 86.8% (803/925), with the first three leading causes as musculoskeletal system and connective tissue (24.9%), neoplasm (15.5%), and diseases of blood and blood-forming organs (11.4%). Despite most diagnoses fitting into the above categories, the array of diseases was broad with as many as 550 discharge diagnoses from 2004 to 2008. CONCLUSIONS: During 2004 - 2008, there was a high proportion of cases that presented to the General Internal Medicine Unit at Peking Union Medical College Hospital with an unclear diagnosis, and the spectrum of diseases diagnosed was very broad. This kind of patient admitting model might not only benefit patients with no clear admission diagnosis and patients with multidisciplinary medical problems for whom it is usually difficult to be admitted by a specialty unit, but would also benefit medical students and residents by providing a good clinical medicine teaching base. These features show the value of general internal unit in comprehensive hospitals.

[Efficacy and safety of high-dose dexamethasone-based regimens in the newly diagnosed multiple myeloma patients with renal impairment].

OBJECTIVE: To evaluate the efficacy and safety of high-dose dexamethasone-based regiments in newly diagnosed multiple myeloma patients with renal impairment. METHODS: The clinical data of 22 patients with newly diagnosed multiple myeloma patients with renal impairment who received high-dose dexamethasone-based regiments from August 2006 to August 2008 in Peking Union Medical College Hospital were retrospectively reviewed. RESULTS: After receiving a median 4 cycles of high-dose dexamethasone-based regiments, renal impairment was reversed in 7 patients (31.8%) with a median time to reversal of 31 days. Sixteen patients (72.7%) achieved overall response, including 7 patients (31.8%) had complete remission / near complete remission. The grade 3 or 4 adverse events included neutropenia (13.6%), infections (22.7%), peripheral neuropathy (9.1%), and ileus (4.5%). CONCLUSION: The high-dose dexamethasone-based regiments are safe and effective for newly diagnosed multiple myeloma patients with renal impairment.

[Comparison of efficacy and adverse effects between arsenic trioxide and all-trans retinoic acid in patients with acute promyelocytic leukemia].

OBJECTIVE: To compare the efficacy and adverse effects between arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). METHODS: The clinical data of 71 patients with newly diagnosed APL were retrospectively analyzed. Two groups were classified according to the induction regimens, namely ATO group (n = 41) and ATRA group (n = 30). The complete remission (CR) rate and the time to CR were compared between these two groups. RESULTS: The CR rate was 97.5% in ATO group and 93.3% in ATRA group (P > 0.05). The median time to CR was 29 days (21-45 days) in ATO group, which was significantly shorter than 38.5 days (24-63 days) in ATRA group (P < 0.001). Retinoic acid syndrome occurred in 52.9% of patients treated with ATRA, which affected the further use of ATRA. CONCLUSIONS: Both ATO and ATRA have high response rates for newly diagnosed patients with APL. Compared with ATRA, ATO induction therapy has shorter time to achieve CR and less adverse effects, and therefore may be the first-line therapy for APL.

[Prognostic differences among different age limits in Chinese elderly patients with non-Hodgkin's lymphoma].

OBJECTIVE: To explore the feasible age limits in Chinese elderly patients with non-Hodgkin's lymphoma (NHL). METHODS: The clinical data of 507 patients with NHL who were admitted to Peking Union Medical College Hospital (PUMCH) from January 1990 to December 2007 were retrospectively analyzed. They were further followed up by reviewing medical records or by phone. The deadline of follow-up was October 2008. RESULTS: The 5-year/8-year overall survival (OS) rates were 64.6%/45.7%, 53.0%/ 44.1%, 32.8%/17.5%, 40.0%/22.8%, and 19.8%/0, respectively, in patients aged < 60 years, 60-64 years, 65-69 years, 70-74 years, and > or = 75 years. The OS rate was significantly different between patients aged > or = 75 years and other age groups, and between patients aged 65-70 years and patients younger than 60 years (P < 0.05). Only age, serum albumin, and hemoglobin affected the survival status in elderly NHL patients. CONCLUSION: Sixty-five years can be regarded as the age limit in Chinese NHL patients.

[Blood concentration monitoring during high-dose methotrexate treatment].

OBJECTIVE: To explore the clinical value of blood concentration monitoring during high-dose methotrexate (MTX) treatment. METHODS: High-dose MTX (1.5-9.0 g) was infused to 105 patients with acute lymphoblastic leukemia or lymphoma, and then the blood MTX concentration was measured by fluorescence polarization immune assay (FPIA) 44 hours after the start of administration. The procedure was repeated every 6-12 hours until the concentration was less than 0.1 micromol/L. RESULTS: Forty-four hours after the start of administration, the blood MTX concentration (C(MTX/44h)) was > or = 5 micromol/L in 6 patients (2.8%) and was between 1 and 5 micromol/L in 23 patients (10.6%). C(MTX/44h) > or = 1 micromol/L was more common in patients received 5.0 g MTX. No severe adverse event was observed in all patients. CONCLUSIONS: Blood MTX concentration is different after high-dose MTX treatment due to individual metabolic differences, and therefore it is clinically important to monitor blood concentration of MTX. Elimination delay is more common in patients receive 5.0 g MTX. Application of high-dose MTX therapy under the monitoring of blood MTX concentration is safe and feasible.

Survey of job burnout and depression in standardized residency training programs in China.

To evaluate job burnout and its impacts on mental health among clinical residents in a 3-year standardized residency training program in China.This cross-sectional study was conducted among all residents in the Department of Internal Medicine of the Peking Union Medical College Hospital in August 2017. Job burnout and depressive symptoms were assessed using the Maslach Burnout Inventory-General Survey and the Center for Epidemiological Survey, Depression, respectively.Among the 159 residents who completed the survey, comprising 69 who had graduated from 8-year medical schools and 90 from 5-year schools, the rate of job burnout was 62.2% (100/159) and the rate of depression was 28.3% (45/159). Rates of job burnout and depression in residents completed different years of training showed no significant difference. Rate of job burnout was significantly higher among graduates of 5-year medical schools (76.7%) than among those of 8-year schools (44.9%, P < .001). Pearson chi-squared test revealed a significant correlation between depression and job burnout (P < .001). Multiple logistic regression revealed a significant correlation between job burnout and attendance at 5- or 8-year medical schools (P = .044).Job burnout may be more frequent among graduates from 5-year medical schools than among those from 8-year schools.

Diagnostic splenectomy in patients with fever of unknown origin and splenomegaly.

OBJECTIVE: To review the diagnostic significance, safety and possible risk factors of splenectomy in fever of unknown origin (FUO) with splenomegaly. METHODS: The records of 54 patients with FUO and splenomegaly who underwent splenectomy in our hospital in the past 20 years were reviewed retrospectively. Pathologic findings, morbidity, mortality and possible risk factors were analyzed. RESULTS: Histologic findings included 29 cases of non-Hodgkin lymphoma, 4 cases of spleen tuberculosis, 3 cases of Hodgkin lymphoma, 1 case of Castleman disease and 2 cases of hemophagocytic syndrome. An etiologic diagnosis was made in 72.2% of the patients undergoing splenectomy. Surgical complications occurred in 25.9% of the patients and 1-month operative mortality was 16.7%. The mortality rate 1 month after surgery was significantly associated with serous cavity effusion (46.2 vs. 7.5%, p = 0.006) and spleen weight >1,500 g (50.0 vs. 9.1%, p = 0.007). There was no significant difference in the mortality rate of the patients with or without jaundice, pancytopenia, elevated serum alanine aminotransferase (ALT) or elevated LDH (p > 0.5). Multivariate analysis revealed serous cavity effusion (odds ratio 21.0; 95% confidence interval 2.2-212.8; p = 0.01) and spleen weight >1,500 g (odds ratio 18.0; 95% confidence interval 1.9-173.8; p = 0.01) as independent risk factors. CONCLUSION: Splenectomy is an effective diagnostic modality for FUO presenting with splenomegaly. The presence of serous cavity effusions and spleen weight >1,500 g identifies patients with the greatest operative risk.

Primary T-cell lymphoma of the thyroid: case report and review of the literature.

Here we report a rare case of primary T-cell lymphoma of the thyroid gland. A 32-year-old Chinese man was admitted to our hospital because of marked goiter and subcutaneous nodules. Computed tomography (CT) scan of the neck disclosed diffuse enlargement of the thyroid gland. A diagnosis of peripheral T-cell lymphoma was made according to cytopathological findings of fine-needle aspiration (FNA) of the thyroid gland and skin biopsy. Immunohistochemistry stain showed that the tumor was positive for CD3 and negative for CD20. Clonal T-cell receptor (TCR-gamma) gene rearrangements were demonstrated by polymerase chain reaction. After six cycles of combination chemotherapy (bleomycin, cyclophosphamide, doxorubicin, vincristine, and prednisone), the thyroid retracted to normal size gradually.

A protein microarray prepared with phage-displayed antibody clones.

Using a large phage antibody library, a protein microarray spotted directly with phage-displayed antibody clones was created to discriminate between recognition profiles of samples from healthy donors and leukemia patients. The protocol for preparing antibody-displaying phage chips was presented. Some conditions such as substrates and blocking buffers were compared and optimized. The major improvements of this microarray are higher throughput and lower cost compared to previous antibody chips. Due to its convenience and sensitivity, it can be extensively used for rapid and high throughput detection of protein profiles of experimental and clinical samples.

Primary anaplastic large cell lymphoma of the lung. Report of two cases and literature review.

To our knowledge, only eleven cases of primary anaplastic large cell lymphoma (ALCL) of the lung have previously been reported. We describe here another two cases of primary pulmonary ALCL that developed in two Chinese women. Both patients presented with insidious symptoms related to pulmonary mass or nodule lesions. A comprehensive workup failed to show disease outside the chest. CD30-positive ALCL was demonstrated by histopathological studies of the lung tissue. Both patients were treated with 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy and had complete remission. Primary pulmonary lymphoma is a great challenge for pneumologists since the clinical presentations and radiological findings are nonspecific. Appropriate invasive biopsy is necessary for early diagnosis.

Peripheral blood CD34+ cell mobilization in 42 patients with severe autoimmune disease.

OBJECTIVE: To evaluate the feasibility and safety of peripheral CD34+ cell mobilization in patients with severe autoimmune disease. METHODS: Forty-two patients underwent a total of 46 mobilizations by the regimen of cyclophosphamide 2-3 g/m2+ recombinant human granulocyte colony stimulating factor (rhG-CSF) 5 microg x kg(-1) x d(-1). The positive selection of CD34+ cell was performed through the CliniMACS. RESULTS: In 8.1 +/- 2. 3 days after administration of cyclophosphamide, the peripheral white blood cell and mononuclear cell (MNC) decreased to the lowest level. In 3.7 +/- 1.6 days after injection of rhG-CSF, the peripheral absolute MNC and CD34+ cell counts were 0.95 x 10(9)/L and 0.035 x 10(9)/L, respectively. After 2.4 +/- 0.6 times of leukapheresis, there gained 4.46 x 10(8)/kg of MNC and 5.26 x 10(6)/kg of CD34+, respectively. After mobilization, the underlying diseases were ameliorated more or less. In systemic lupus erythematosus (SLE) patients, SLE Disease Activity Index (SLEDAI) decreased from a median of 17 to 3 (P < 0.01). In rheumatic arthritis patients, an American College of Rheumatology criteria for 20% (ACR20) response was achieved in all five patients. Totally, 17.4% of patients whose absolute neutrophil count < 0.5 x 10(9)/L suffered infection, and 31.0% of patients had bone pain after the injection of rhG-CSF. Two patients suffered severe complications, one with acute renal failure and recovered by hemodialysis, the other died of thrombotic thrombocytopenic purpura. Failed mobilization occurred in three patients. CONCLUSIONS: Sufficient CD34+ cells can be mobilized by low dose of cyclophosphamide and rhG-CSF. CD34+ cell mobilization for treatment of severe autoimmune disease not only is appropriate in both effectiveness and safety but ameliorates disease also.

[A clinical analysis of early stage infection after auto peripheral blood stem cell transplantation].

OBJECTIVE: To analyze the incidence, risk factors, treatment and prognosis of early stage infection after auto peripheral blood stem cell transplantation (APBSCT). METHODS: The clinical data of 120 patients receiving APBSCT were analyzed. RESULTS: The incidence rate of infection was 57.5% (69/120), with most of them (68/69) bacterial in origin. 2.5% (3/120) the patients died of infection. The first infection was usually observed on the 6th day after APBSCT and lasted for a median of 2 (1 - 23) days. Positive blood culture was found in 16.0% (11/69) of the patients, with all of them G(-) bacteria. Patients with age more than 45 years and not receiving CD(34)(+) sorting had higher infection rate. 61.8% (42/68) of the patients responded to treatment for the first infection within 48 hours. CONCLUSIONS: The early stage infection rate after APBSCT is 57.5%, with most of them bacterial in origin. Most of the infections respond to broad-spectrum antibiotics. Patients with age more than 45 years and not receiving CD(34)(+) sorting have higher infection rate.

[Long-term ability for hematopoiesis of CD34(+)CD59(+) cells from patients with paroxysmal nocturnal hemoglobinuria: experiment with mice].

OBJECTIVE: To obtain the evidence of long-term hematopoiesis by normal clone stem cells from patients with paroxysmal nocturnal hemoglobinuria (PNH). METHODS: 10 ml fresh bone marrow was collected from 2 PNH patients. Normal bone marrow was obtained from the ribs resected during operation of 2 patients without hematopathy. CD34(+)CD59(+) cells were isolated, purified, and expended. 12 total body irradiated SCID mice were divided into 2 equal group to undergo transplantation of the expanded CD34(+)CD59(+) cells from PNH patients (experiment group 1) or normal patients (control group 1). Four mice underwent transfusion of cell-free medium as blank control group 1. 30 and 60 days after the transplantation peripheral blood samples were collected and 90 days after the transplantation heart blood samples were collected. Spleens were taken out to prepare suspension of splenocytes and bacterium-free bone marrow cell suspension was prepared from the bilateral femurs. 90 days after the primary transplantation another 16 mice underwent total body irradiation and then divided into 2 equal groups to undergo transplantation of the bone marrow cells of the mice of the experiment group 1 and control group 1 (experiment group 2 and control group 2). Another 4 mice were transfused with cell-free medium fluid (blank control group 2). The levels of blood cells of all groups were calculated 30, 60, and 90 days after the primary and 30 days after the secondary transplantation. The cell percentages of peripheral blood, spleen, and bone marrow after the primary transplantation and 30 days after the secondary transplantation were detected by flow cytometry. PCR was used to detect whether the sex determining region Y existed in the female SCID mice after transplantation. RESULTS: Ninety days after primary transplantation, the peripheral blood cell levels of both experiment group 1 and control group 1 recovered to normal. Expression of CD45 was detected in the mice without significant difference between the 2 groups. Thirty days after the secondary transplantation, the peripheral blood cell levels of the experiment group 2 and control group 2. Expression of CD45 was detected in both the experiment group 2 and control group 2 without significant difference between these two groups. Human SRY gene could be detected by PCR in the female SCID mice after transplantation. CONCLUSION: CD34(+)CD59(+) cells isolated from PNH patients and expanded in vitro can be successfully engrafted with long-term ability in hematopoiesis not different from that of the normal CD34(+)CD59(+) cells.

[Hematological abnormalities in systemic lupus erythematosus and clinical significance thereof: comparative analysis of 236 cases].

OBJECTIVE: To investigate the hematological abnormalities and their relationship to the disease activity of systemic lupus erythematosus (SLE). METHODS: The clinical data of 236 SLE patients, 29 males and 207 females with the age of confirmed diagnosis of 33.4, were divided into 3 groups: anemia group, with the hemoglobin (Hgb) < 100 g/L, including 2 subgroups, i.e. subgroup of anemia caused by chronic diseases (ACD) and subgroup of hemolytic anemia; low white blood cell group 1 (Group WBC1) with the WBC count < 4.0 x 10(9)/L, white blood cell group 2 (Group WBC2) with the WBC count 3.0 approximately 3.9 x 10(9)/L, immune thrombopenic purpura group (ITP group) with a platelet count < 100 x 10(9)/L, and control group without hematological changes. 72 patients underwent morphologic characterization of their bone marrow. The hematological data and the relationship thereof to the disease activity in different groups were analyzed. RESULTS: Among the 236 SLE patients 168 (71.18%) had hematological abnormalities and 68 of them (28.82%) without hematological abnormalities. 123 of the 168 patients with hematological abnormalities (52.1%) had anemia, 82 of which (66.7%) had characteristics of anemia caused by chronic diseases, 18 (14.6%) had hemolytic anemia, 8 (6.6%) had hematopoietic abnormalities, and the remaining 15 patients (12%) had anemia caused by unknown reasons. 73 of the 236 SLE patients (30.9%) had a WBC count < 4.0 x 10(9)/L and 57 patients (24.2%) had a platelet count < 100 x 10(9)/L. In the groups with hemolytic anemia, WBC count < 3.0 x 10(9)/L and thrombocytopenia, the complement levels were significant lower, and the levels of C-reactive protein (CRP) and positive anti-dsDNA antibody were significantly higher than those of the controls (all P < 0.05) The rate of positive antiphospholipid antibody of the hemolytic anemic patients and patients with thrombocytopenia were 22.2% and 15.8% respectively, both significantly higher than that of the controls (2.9%, both P < 0.05). 49 of the 72 patients undergoing morphologic characterization of bone marrow had normal cell morphology and a normal appearing bone marrow, 10 had varying degrees of pathologic hematopoietic changes, 2 lacked megakaryocytes, 9 expressed decreased proliferation in all three hematopoietic lineages, and 2 had only a decrease in erythropoiesis. CONCLUSION: The reason of the high proportion of anemia among the SLE patients in China may be the higher proportion of anemia caused by ACD in comparison with that abroad. Although SLE patients have lower rates of hemolytic anemia, HA is an important index of SLE disease activity. Thrombocytopenia and a WBC count < 3.0 x 10(9)/L are related to SLE disease activity. Abnormalities of hemopoiesis by bone marrow is one of the reasons of sever hematological changes in part of the SLE patients.