The indications for myelodysplastic syndrome (MDS) to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) were established on the basis of FAB diagnosis,International Prognosis Scoring System (IPSS) and World Health Organization Prognosis Scoring System (WPSS).It was recommended that patients of IPSS intermediate risk Ⅱ and of high risk should receive allo-HSCT at diagnosis,and those with intermediate risk Ⅰ and of low risk might benefit from deferred transplantation.Dynamic monitoring of marrow morphology and the risk of disease are needed for appropriate timing of transplant.Patients of intermediate risk and low risk with low platelet count,pneutropenia or blood infusion dependence are indicated for transplantation.The advantage of chemotherapy pre-HSCT in those indicated patients has been controversial.Up to now,there has been few data showing benefit of pre-chemotherapy or hypomethylating therapy.

The clinical features were reviewed for polycythemia vera, primary throbocythemia and primary myelofibrosis. Their indications and rational for allogeneic hematopoietic stem sell transplantation (allo-HCT) were recommended. The outcome after allo-HCT was described briefly. The significance of JAK2 mutation, especially V617F, detected for the minimal residual disease was introduced.

The indications for patients with Myelodysplastic Syndrome (MDS) to receive allogeneic hematopoietic stem cell transplantation (Allo-HCT) are:intermediate risk-2 and high risk groups according to IPSS,and intermediate risk-1 group with poor karyotype,severe multilineage cytopenia or infusion-dependent.Constant follow-up and evaluation is important for therapeutic decision.Unrelated or related haploidentical donor could be an alternative in case of absence of identical sibling donor.Remission through chemotherapy before the transplantation is recommended in patients with advanced MDS who receive reduced-intensity conditioning.Demethylation drugs followed by Allo-HCT do not show additional transplantation-related toxicity,whose efficiency remains to be determined.

Objective To investigate the effect of bone morphogenetic protein-7 (BMP-7) on high glucose-induced expression of fibronectin (FN) and collagen Ⅳ (Col Ⅳ) and activity of nuclear factor-?? (NF-??) in human renal tubular epithelial cells. Methods Human renal tubular epithelial cells (HKCs) in culture were divided into 5 groups: normal glucose group with 5.5 mmol/L glucose (NG), high glucose group with 25 mmol/L D-glucose (HG), HG+100 ng/ml BMP-7, NG+100 ng/ml BMP-7 and high osmolality group with 25 mmol/L mannitol (HM). Thus HKCs were respectively stimulated with high glucose, high mannitol and BMP-7. Expression of collagen Ⅳ and fibronectin was determined by immunocytochemistry and enzyme linked immunosorbent assay (ELISA) and activity of nuclear factor-?? was assessed with electrophoretic mobility shift assay (EMSA). Results Compared with normal glucose, high glucose concentration up-regulated expression of FN and Col Ⅳ and activity of NF-?? (P0.05). With addition of BMP-7 in a concentration of 100ng/ml to the high glucose medium, expression of Col Ⅳ and FN was suppressed, and the activity of nuclear factor-?? was inhibited in human tubular epithelial cells (P

Objective To study the value of c-reactive protein (CRP) level in the diagnosis and efficacy evaluation of clinical complications in patients after bone marrow transplantation.Methods Sixty-six patients with different complications after bone marrow transplantation were included and CRP levels were tested.The relationship between CRP levels and corresponding clinical complications were analyzed.Results The levels of CRP were significantly different in different complications after the bone marrow transplantation.CRP may marketly increase in the patients with bacterial infection,bacteria-associated mixed infection,ultra-acute GVHD,and ATG reaction;CRP may mildly increase in patients with bacterial infection,fungal infection,bacteria-associated mixed infection,acute/chronic GVHD;CRP did not increase in the patients with viral infection.CRP level reached the highest value in patients with most obvious clinical symptoms of bacterial infection,gradually decreased in patients after effective treatment,those restored to normal but then increased CRP always indicated new clinical complications.Conclusion CRP is a valuable mark for the early differential diagnosis and efficacy of therapy for complications in patients after bone marrow transplantation.

20.0?109/L was day 13(11~21).All the patients got engraftment successfully and attained CR.Acute Ⅰ~Ⅱ GVHD occurred in 5 patients,no acute Ⅲ~Ⅳ GVHD occurred and extensive chronic GVHD did in 2 patients.All the patients were alive and only one patient relapsed after 3~53 months follow-up.Conclusion TBI-based conditioning regimen appears to be safe and effective for non-T-depleted HLA mismatched hemotopoietic stem cell transplants,especially for high-risk and second transplant patients.

OBJECTIVE:To analyze the blood drug monitoring results of vancomycin and clinical administration behavior and then to provide a clinical reference for its rational utilization. METHODS:We retrospectively collected the blood drug monitoring results of vancomycin and drugrelated information from July 2007 to October 2008 in our hospital. These data were from the electronic clinical pharmacy workstation and initial written case history. RESULTS:Among the 76 cases,non-clinical significant results due to doctor’s irregular manipulation in collecting blood sample accounted for 32.89%. In renal failure group,the rate of peak concentration above the effective blood concentration range was 44.46% . Every patient was averagely administered 21.85 kinds of drugs mainly by intravenous injection during vancomycin application. Clinical response rate of vancomycin was 65.00%. CONCLUSION:During the blood concentration monitoring of vancomycin,we should take clinical need into consideration,collect blood samples rightly,consider the factors such as special pathophysiologic status of patients,drug combination,and adjust the dosage timely.

Objective Monitoring the thyroid hormone levels in patients before and after renal transplantation to realize the relationship between thyroid hormones and renal function.Methods Fifty-seven patients were subdivided into stabled graft function group (50 cases) and delayed graft function (DGF) group (7 cases).Thirty healthy men served as control group.Serum triiodothyronine (T3),thyroxine (T4),thyroid-stimulating hormone (TSH) and serum creatinine (Scr) were determined respectably before transplantation and on different days after transplantation.Correlations between thyroid hormones and Scr at 10th day after transplantation were analyzed.Results Serum T3 and T4 levels before transplantation in the two groups were significantly lower than those in the control group (P＜0.01).These four parameters levels had no significant difference between stabled graft function group and DGF group (P＞0.05).In stabled graft function group:T3 level was decreased obviously by 30％ in the 1st day after transplantation,which was higher than the others,elevated at the 1st week post-transplantation,reached the normal range.at the 2nd week post-operation,and higher than pre-transplantation (P ＜ 0.01) at 3rd week; T4 revealed a decrease trend after transplantation and was elevated at 10th day post-transplantation,returned to the pre-transplantation level at 3rd week; TSH had slight decrease after operation,and had no significant difference among every period in comparing with pre-transplantation; Scr revealed a decrease trend continuously and returned to the normal level at the 7th day post-transplantation.In DGF group,Hormones levels were obviously decreased as compared with stabled graft function group; T3 reached the normal range at the 3rd week post-transplantation,whereas T4 returned to pre-transplantation levels at the 30th day; TSH had a significant decrease at the 5th day,and began to increase at the 10th day post-operation; Scr retuned to the normal range at the 30th day post-operation.The correlation coefficients between Scr and T3,T4 were 0.546 and 0.423 respectively.Conclusion There is a significant correlation between thyroid hormones and renal function (T3,T4).Monitoring the thyroid hormones,specially T3,can diagnose renal function change.

Objective:To assess the ration of atomization inhalation medicine which was given to the patients in the perioperative period to provide possible reference for the application of medicine in operations.Method:From the clinical pharmacy workstation combined with manual retrieval method,a research was done among some patients who had once received treatments in the four surgical wards of our hospital in order to assess the related index of the ration of atomization inhalation medicine given to the patients in the perioperative period.Result:Among the 186 patients,the proportion of the used atomization inhalation medicine ration ranged from 63.79%to 100.00%.The medicines used in the largest amount were Ambroxol Hydrochloride Injection,Sodium Chloride Injection and Etimicin Sulfate for Injection.The qualified proportion of the ration of the medicine applied to patients each single time was 56.59%.The proportions of single medicine and double medicine were 31.71%and 54.15%,respectively.Conclusion:The atomization inhalation medicine applied to the patients is basically rational in our hospital,but the overdose use of medicine in a single time and the irrational combined use of different medicines still exist.The clinicians and pharmacists need a close cooperation with each other,and analyze the process comprehensively in order to improve the atomization inhalation medicine's application.

Objective To evaluate the value of monitoring serum cystatin C in assessment of renal function in patients with renal transplantation.Methods Serum cystatin C, creatinine (SCr), β2-microproglobin (β2-MG) and urea nitrogen (BUN) levels were determined at different time points (pre- or post-operation) in 58 renal transplant patients.Glomerular filtrated rate (GFR) was determined by using of 99mTc-DTPA at the seventh day after operation.The correlation between GFR and the four markers was analyzed.Diagnostic characteristics and ROC curve for the four markers were obtained using a GFR cut-off of 1.5 ml/s.Intra-individual coefficients of variation (CV) for cystatin C and SCr according to different time points during post-operation monitoring and the ratio (R) between CVSCr and CVcystatin C were calculated.Results Cystatin C was decreased by 48.1 % at the first day after operation, which was higher than others.The correlation coefficients between GFR and cystatin C, SCr, β2-MG, and BUN were 0.876, 0.691, 0.589, 0.516 respectively.Diagnostic characteristics for GFR and cystatin C, SCr, β2-MG, and BUN were as follows:sensitivity (91.3 %, 87.2 %, 82.6 %, 87.0 %); specificity (80.0 %, 69.2 %, 71.4 %, 42.9 %), positive predictive value (82.0 %, 73.7 %, 74.3 %, 60.4 %); positive likelihood rate (4.81, 2.83, 2.87, 1.53).The area under the curve (AUC) for GFR and cystatin C, SCr, β2-MG, and BUN was 0.914, 0.828, 0.803, and 0.765 respectively.The CVSCr was significantly lower than CVcystatin C (P＜ 0.01).R was less than 1 in most patients with cystatin C＜2 mg/L.In patients with cystatin C＞2 mg/L, R tended value 1 with increasing concentrations of cystatin C.Conclusion Cystatin C showes the best correlation to GFR, and is superior to the other markers in accurate in differentiate mild renal impairment from moderate and severe renal impairment.When renal function has minimal change, the cystatin C level has significant change.When the renal function has mild impairment, great changes in serum cystatin C indicate the unstable renal function.