Several hot questions such as selection of patients and favorable time of transplantation, design of conditioning regimen, monitoring of chimerism and complication of graft versus host disease (GVHD) in allogeneic hematopoietic stem cell transplantation following reduced intensity regimen (RIC-HSCT) as salvage therapy for refractory leukemia are discussed in this article. More and more investigators began to recognize that it was not a fundamental to undergo transplantation in complete remission for patients with refractory leukemia, since it may expend patients' physical status. RIC-HSCT may be substantially considered as a kind of adoptive immunotherapy, so that immunologic attacking targets and the latency of immunoreactian must be considered when making the decision to use, lacking of attacking targets and rapidly growing diseases seemed to be less susceptible to control. Commonly used reduced intensity regimens differed significantly, but it was clear that dose intensity was very important in refractory leukemia. In fact, many investigators used intermediate dosage between criteria of non-myeloablative and conventional myeloablative regimens. Complete donor chimerism is the hallmark of engraftment but often delayed in RIC-HSCT. Since sustained complete donor chimerism induced persistent graft-versus-leukemia (GVL) effect play an important role in patients' long-term survival, it was recommended that sensitive techniques (eg. STR-PCR) should be used to analysis chimerism and should be measured more frequently (every 2-4 weeks), and lineage-specific chimerism (eg. T cell) analysis was also recommended. As compared with traditional HSCT, the incidences of acute and chronic GVHD are similar and the onset of GVHD is associated with the GVL effect. Decrease or interruption of immunosuppressive drugs early after transplantation and donor lymphocyte infusion may facilitate transformation to complete donor chimerism, so that it may benefit patients with advanced disease at time of transplantation from avoiding disease relapse in one hand, but may induce GVHD in the other hand.

Objective To explore the relevance of the microRNA-192 (miR-192) levels and prognosis in patients with diabetic nephropathy (DN).Methods A total of 59 cases with duration of type 2 diabetes mellitus (T2DM) ≥10 years from January 2010 to July 2011 were retrospectively admitted.The miR-192 levels were determined after admission,and other relevant clinical data were collected.And the patients were followed-up for 24 months.According to the patient's prognosis,the patients were divided into DN group(20 cases) and non-DN group(39 cases),and the relevant information was analyzed in two groups.Results The miR-192 levels in DN group were lower than those in non-DN group[(4.47 ± 2.27) μ g/L vs.(7.28 ± 2.39) μ g/L],and there was significant difference (P ＜ 0.05).Multivariate Logistic regression analysis showed that hypertension history,smoking history,high glycosylated hemoglobin,low fasting C-peptide,low 24 h urine protein,low miR-192 level,high body mass index was the independent risk factors of prognosis of T2DM (P ＜ 0.05).The area under the receiver operating characteristic (ROC) curve was 0.697 in miR-192 levels individual predicting progression to DN stage,0.823 in six others without miR-192.After joining seven indicators forecast area under the curve increased significantly(0.856,95％ CI:0.832-0.904).The miR-192 levels 5.14 μ g/L was the best predictive value to the critical value of community,and the patients were divided into miR-192 ＜ 5.14 μ g/L group (28 cases) and miR-192 ≥ 5.14 μ g/L group (31 cases).The number of progression to DN within 24 months in miR-192 ＜ 5.14 μg/L group was more than that in miR-192 ≥5.14 μ g/L group (16/28 vs.4/31,P ＜ 0.05).Conclusions A reduced level of miR-192 is an independent risk factor that can lead to poor prognosis in patients with DN,and can predict adverse outcomes in patients with T2DM effectively.

Objective: To evaluate the expression levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in various types of cognitive impairment. Methods: A total of 212 patients were included in the study. They were divided into mild cognitive impairment (MCI) (n = 46), Alzheimers disease (AD) (n = 58), vascular dementia (VD) (n = 84), and control (n = 24) groups after being screened and evaluated. The concentrations of plasma Lp-PLA2 of patients in each group were measured and compared. The correlation between the Lp-PLA2 level and dementia was analyzed through Cox proportional hazards model. Results: Circled digit oneThe Lp-PLA2 levels in the MCI, AD and VD groups were 45 ± 4 μg/L, 83 ± 15 μg/L, and 112 ± 22 μg/L, respectively, and they were higher than 34 ± 3 μg/L in the control group. The difference was statistically significant (P < 0.05). Circled digit twoThe Lp-PLA2 level was 93 ± 8 μg/L in men, and it was higher than 73 ± 13 μg/L in women in the AD group. The difference was statistically significant (P < 0.05). The Lp-PLA2 level in men was 127 ± 21 μg/L, and it was higher than 97 ± 10 μg/L in women in the VD group. The difference was statistically significant (P < 0.05). Circled digit threeThe Cox proportional hazards model showed that the Lp-PLA2 level was correlated with the high risk of dementia. The correlation of VD was the highest, then AD, and MCI was the lowest. Conclusion: High level of Lp-PLA2 has correlation with mild cognitive impairment, and has gender differences in patients with vascular dementia and Alzheimer's disease, it may be contributive to early diagnosis of cognitive impairment.

ObjectiveTo investigate sleep disorder of patients with depression and find out the regularity.Methods78 depression cases in the east-region of Shenyang were evaluated by Pittsburgh Sleep Quality Index (PSQI) questionnaire and mental health symptom checklist-90 (SCL-90). The results were contrasted with normal control group.Results63 depression cases (80%) had sleep disorder (PSQI scores≥8) and were significantly higher than normal control group. The PSQI evaluation showed that sleep quality, enter-sleep time, sleep efficiency, sleep disorder, hypnotige drugs, function of daytime and total scores of PSQI of the depression group were significantly higher than that of normal control group (P<0.05～0.01). The SCL-90 test showed that scores of somatic, obsessive, depressive, anxiety, phobia, paranoid and mental-illness, etc. and total quota of bad-sleep quality group were significantly higher than that of the fine-sleep quality group (P<0.05～0.01).ConclusionDepression patients have significantly descent in sleep quality, latter is often closely related to the mental psychotic expressiveness of somatic, obsession, depression, anxiety, phobia, etc.

Objective To observe the anesthesia effect of dezocine and pentazocine in painless artificial abortion, in order to provide a basis for safe use of anesthesia drug in clinical practice. Methods Totally,300 patients undergoing painless artificial abortion were included in this study.The patients were randomly divided into four groups: group A (simple propofo), group B ( propofol combined with fentanyl) ,group C ( propofol combined with dezocine) and group D ( propofol combined with pentazocine)(n=75 each).Four groups of patients were intravenously injected with propofol (1-1.5 mg?kg-1) according to the situation in operation when necessary to maintain anesthesia effect.Heart rate (HR),mean arterial pressure (MAP),arterial oxygen saturation ( SpO2 ) and respiratory frequency were observed and recorded before induction,after induction,at the beginning of the operation,during operation and anesthesia recovery. The onset time of anesthesia, the recovery time, the recovery time of orientation,the postoperative pain score and the incidence of adverse reaction of the four groups were recorded. Results All of the patients achieved good effects of anesthesia in operations. There was no significant difference in the onset time of anesthesia (P>0.05).Awakening time and time of orientation recovery in groups B,C and D were significantly shorter than those in group A (P<0.05).The dosages of propofol in group C and D were significantly less than those in group A and B (P<0.05).The changes of HR,MAP,SpO2 and respiratory frequency after induction were not significantly different in group B,C and D (P>0.05),but the changes were relatively stable as compared with group A (P<0.05).The rates of adverse reactions in group B,C and D were significantly lower than that in group A (P<0.05).The incidence rates of respiratory depression,nausea and vomiting in group C and D were significantly lower than those in group A and B (P<0.05).The postoperative pain scores of VAS in group B,C and D were significantly lower than that of group A (P<0.05). Conclusion The analgesia effects of dezocine and pentazocine are similar.Application of them can reduce the dosage of propofol and shorten the anesthesia awakening time in painless artificial abortion,at the same time they have less adverse reactions,and they are safe and effective to be used in clinical anesthesia.

Objective To retrospectively compare the clinical results of locking plate of proximal humerus (LPPH) and traditional AO plates in treatment of proximal humerus fractures in aged osteoporotic population. Methods From July 2002 to May 2005, 37 old osteoporotic patients with humerus fractures were treated with LPPH and traditional AO plates respectively in our department. The results were compared retrospectively. Results Follow-ups were conducted six weeks, 12 weeks and one year postoperatively to assess shoulder scores, bone healing and necrosis of humerus head. Comparison showed that the results for LPPH group were statistically better than those for traditional AO plate group in rate of implant loosening and SPADI (shoulder pain and disability index) scores. Conclusion LPPH has an obvious advantage over traditional AO plate in treatment of proximal humerus fractures in aged osteoporotic people.

Aim To study the activation of Nrf2 in-duced by baicalein ( BAI ) , and its protection against carbon tetrachloride ( CCl4 ) , ethanol and acetamino-phen ( APAP )-induced hepatotoxicity. Methods A reporter gene assay was conducted in human normal liver L-02 cells to detect the activation of transcription factor Nrf2 induced by baicalein. APAP ( 10 mmol · L-1 ) , CCl4 (10 mmol·L-1 ) and Ethanol (100 mmol · L-1 ) were used to induce hepatotoxicity in L-02 cells. After the pre-incubation with Baicalein (0, 1, 10, 25, 50, 100 μmol·L-1 ) for 15 min, cells were administrated with or without those above hepatotoxins. 48 h later, cell viability was detected by 3-(4, 5-dim-ethylthiazol-2-yl ) 2 , 5-diphenyltetrazolium bromide (MTT) method. Results Baicalein (25, 50 μmol· L-1 ) induced the activation of Nrf2 ( P <0. 01 , P <0. 05) in the reporter gene assay. As compared with control, three hepatotoxins ( APAP, CCl4 , Ethanol ) all decreased cell viability ( P<0. 01 ) , and baicalein significantly reversed such decreases in a concentra-tion-dependent manner ( P<0. 01 ) . Conclusion Ba-icalein can induce the activation of transcription factor Nrf2 , which is probably one of the mechanisms con-tributing to the protection of baicalein against hepato-toxins (APAP, CCl4, Ethanol)-induced hepatotoxici-ty.

Objective To evaluate the effect of continuous renal replacement therapy (CRRT) on extracorporeal membrane oxygenation (ECMO)-induced expression of inflammatory factors in pig kidney.Methods Twenty-four adult pigs of either sex,weighing 25-32 kg,were randomly divided into 4 groups (n =6 each) using a? random number table:control group (group C),sham operation group (group S),ECMO group and CRRT group.Anesthesia was induced with ketamine,diazepam and atropine and maintained with ketamine and diazepam.The pigs were tracheotomized,intubated and mechanically ventilated.The left femoral arteries were cannulated for MAP monitoring.Heparin 150 U/kg was injected intravenously.Right femoral artery and left internal jugular vein were cannulated for blood-letting and fluid infusion.In ECMO and CRRT groups,ECMO was performed for 24 h starting from 1 h after cannulation,in addition CRRT was performed for 24 h simultaneously in ECMO group.The pigs were then sacrificed and kidney specimens were obtained for determination of the content of interleukin-1β (IL-1 β),IL-6 and tumor necrosis factor-α (TNF-α) by ELISA.Results There was no significant differ-ence in the content of IL-1β,IL-6 and TNF-α between C and S groups (P ＞ 0.05).Compared with C and S groups,the content of IL-1β,IL-6 and TNF-α was significantly increased in E and CRRT groups (P ＜ 0.01).Compared with group E,the content of IL-1β,IL-6 and TNF-α was significantly decreased in group CRRT (P ＜0.01).Conclusion CRRT can decrease ECMO-induced expression of inflammatory factors in pig kidney to some extent,indicating that it can alleviate the inflammatory responses in kidney.

Background and purpose: Accumulation of genetic and epigenetic changes that lead to the activation of proto-oncogenes or inactivation of tumor suppressor genes play important roles in development and progression of bladder cancer. We aimed to investigate the methylation patterns of TWIST1 gene in bladder cancer. Methods:A total number of 78 histologically conifrmed bladder tumor samples and paired 75 urine samples constituted the study group and was compared with 75 age-matched and gender-matched non-cancerous individuals. DNA was puriifed from both tumor, adjacent tissues and urine samples. The methylation status of the TWIST1 gene was analyzed by methylation-specific polymerase chain reaction (MSP) in both urinary bladder cell carcinoma samples, adjacent tissues and urine samples. Sensitivity and speciifcity values of the method were assessed and compared with the results of the cytology test. Results:Methylation of TWIST1 was detected in 88.5%of carcinoma samples and 84%of the paired urine samples,respectively;11.5%carcinoma adjacent tissues and 5.3%control urine sample was methylated. The sensitivity by urine cytology detection method was 49.3%in in bladder cancer patients, and was 17.3%in control group. The sensitivity of TWIST1 genes was 66.7%for low-grade cases. The sensitivity of urine cytology was 33.3%for the same low-grade cases. Conclusion:The methylation analysis of TWIST1 gene may be a simple, non-invasive, sensitive, and speciifc method for early detecting bladder cancer cells in urine.