Objective To examine the serum homocysteine,folic acid and Vitamin B12 levels in macrocytic anemia patients and observe their dynamic changes following therapy. Methods Homocysteine,folic acid and Vita-min B12 were analyzed by electro-chemiluminescence immunoassay. Complete blood cell count was analyzed by opti-cal method and resistance method. Results The homocysteine is significantly higher in nutritional megaloblastic a-nemia[ (71.26±27.84)μmoL/L ] than in drug-induced megaloblastic anemia[(11.44±5.06)μmol/L],in myel-odysplastic syndrome[ (9.51±4.13)μmol/L] and in the normal control group[(8.74±5.42)μmoL/L] (P<0.01). After treated with low-dosage folic acid and Vitamin B12,the patients with megaloblastic anemia presented slow declining but eventually normal homocysteine levels,compared with those received high-dosages. Conclusion Homocysteine can be used for differential diagnosis of macrocytic anemia. The duration of remaining of abnormal ho-mecysteine levels is related to the dosage of folic acid and Vitamin B12.

Objective To analyze the clinical efficacy,adverse events and corresponding preventive measures of high dose methotrexate in the treatment of acute lymphoblastic leukemia(ALL).Methods Ninety-two patients with ALL who hospitalized in Heamotology Department of Jinshan Hospital Affiliated to Fudan University were randomly divided into observation group and control group,and each group had 46 cases.Patients in observation group were given high dose melhotrexate + vincristine + cytoxan + pirarubicin chemotherapy treatment,and in control group were given soft red enzyme + vincristine + metacortan dracin + L-asparaginase treatment.The clinical efficacy,adverse events and the required course of remission of two groups were compared.Results The total effective rate in the observation group was 84.78％,while it was 80.43％ in the control group,and there was no statistically significant difference (x2 =0.45,P ＞ 0.05).The average remission was (1.26 ± 0.28) in the observation group,while (1.31 ± 0.31) in the control group,and no significant difference was observed (t =2.13,P ＞ 0.05).The complete remission rate of initial treatment,retreatment and refractory were 75.00％ (24/32),50.00％ (4/8) and 33.33％ (2/6) respectively in observation group,while 76.67％ (23/30),50.00％ (4/8) and 25.00％ (2/8) respectively in control group,and there was no statislically significant difference between two groups (x2 =0.98,P ＞0.05).The rate of bone marrow suppression in the observation group(23.91％) was lower than that in the control group(43.48％),while the rate of liver and kidney injury(54.35％) was higher than that inthe control group(17.39％),which showed significant difference (P ＜ 0.05).The survival rate of 5 years in observation group was 67.39％,while 45.65％ in control group,and there was statistically significant difference between two groups (P ＜ 0.05).Conclusion The high dose methotrexate in the treatment of acute lymphoblastic leukemia was proved to be effective and the adverse reactions could be tolerated.

Described in the paper is the reform made at public hospitals in Zhejiang province,with analysis of its problems and causes. Based on such,the authors proposed the following actions:to accelerate the reform of public hospitals centering on health promotion, and encourage such hospitals to shoulder the health care responsibility on behalf of the government; to proceed with hierarchical medical system and contract-based service focusing on capacity building of general practitioners; to attract private capital into building the healthcare system; and to motivate non-governmental organizations to cater to diversified healthcare needs of the people.

Background and purpose: It has been demonstrated that cyclooxygenase-2 (COX-2) is over-expressed in some subtypes of non-Hodgkin’s lymphoma (NHL), and COX-2 correlates with the expression of P-glycoprotein and Bcl-2, which may contribute to chemotherapy-resistance in NHL. The purpose of this study was to investigate the expression of COX-2 in B-cell lymphoma cell lines and the potential mechanisms of celecoxib, a selective COX-2 inhibitor, to sensitize lymphoma cell lines to epirubicin. Methods: Quantitative fluorescent real-time poly-chain-reaction (qRT-PCR) and Western blot were employed to determine the expression of COX-2 in Raji, Jeko-1 and Namalwa cell lines, as well as in peripheral blood B cells from normal controls. Cell lines were treated with celecoxib at gradient concentrations, followed by the detection of cell viabilities by cell counting kit-8 (CCK-8).Meanwhile, the changes in expression of MDR-1 mRNA and Bcl-2 mRNA before and after celecoxib treatment were determined by qRT-PCR. Raji cells were treated with epirubicin alone or in combination with gradient concentrations of celecoxib for 72 h, then CCK-8 was used to analyze whether celecoxib sensitize Raji cells to epirubicin. Results:Neither lymphoma cell lines nor normal B cells expressed detectable COX-2 in this study. Celecoxib inhibited the proliferation of the 3 lymphoma cell lines, and the mRNA expressions of MDR-1 and Bcl-2 were decreased by celecoxib in a concentration-dependent manner, except for that MDR-1 was undetectable in Jeko-1 cells. In addition, celecoxib sensitized Raji cells to epirubicin, indicating a synergistic anti-tumor effect between the two agents. Conclusion:Selective COX-2 inhibitor celecoxib down-regulates the expressions of MDR-1 mRNA and Bcl-2 mRNA in B-cell-originated lymphoma cell lines, and sensitizes Raji cells to epirubicin.