Objective: To investigate the antiatherosclerotic effect of the extract from grape seed in C57BL/6J mice. Method: The mice were fed with atherosclerotic diet for 20 w and then with basic diet or different dosage of grape seed extract for 4 w. The blood samples were examined for blood lipid. The sections of aorta were examined and scored microscopically. Results: After fed with atherogenic diet for 20 w, the aortic score was 7.2?1.3 and TG, Chol and MDA in serum were significantly increased. After fed with the extract of grape seed for 4 w, the aortic score was reduced to 6.0?1.2, and TG, TC, and MDA levels also decreased. Conclusion: The extract of grape seed has antiatherosclerotic effect.

Objective To investigate the efficacy and toxicity of neoadjuvant regional arterial chemotherapy in the treatment of advanced gastric cancer. Methods The clinical data of 158 patients with advanced gastric cancer and with the same clinical stages who were admitted to Renji Hospital of Shanghai Jiaotong University from February 2002 to May 2005 were retrospectively analysed. Preoperative regional arterial chemotherapy was applied to 76 patients (test group) and the remaining 82 patients only received surgical treatment (control group). The chemotherapy regimen was epirubicin (50 mg/m2) + cisplatin (60 mg/m2) + 5-fluorouracil (1000 mg/m2).This regimen was modified to oxaliplatin (130 mg/m2) + 5-fluorouracil (1000 mg/m2) since 2003, and surgery was performed 6-11 days after the chemotherapy. All patients received postoperative intravenous chemotherapy.The clinical effects, radical resection rate, operative complications and long-term survival of the two treatment methods were evaluated. All data were analysed using the chi-square test and Kaplan-Meier analysis. Results The radical resection rate was significantly higher at 86% (65/76) in the test group compared with 71% (58/82)in the control group ( x2 = 5.01, P ＜ 0. 05 ). The toxicity of the chemotherapy in the test group was mild. The postoperative complication rate was 20% (15/76) in the test group and 16% (13/82) in the control group, with no significant difference between the two groups (x2 = 0.41, P＞0.05). The median survival time was 41 months in the test group and 23 months in the control group. The 5-year overall survival rate was higher in the test group (44.6%) than that in the control group (29.1%) (x2 =3.95, P＜0. 05). Conclusions Neoadjuvant regional arterial chemotherapy is well tolerated by patients with advanced gastric cancer. It is also effective for increasing the radical resection rate and improving the long-term survival.

Objective To study the efficacy and safety of human leukocyte antigen (HLA)mismatched hematopoietic stem cell transplantation (HSCT) on severe aplastic anemia(SAA). Methods From January 2006 to May 2010, 17 patients received mismatched HSCT. HLA antigens were 3-locimismatched in 9 patients, 2-loci-mismatched in 8. All patients received recombinant human granulocyte colony-stimulating factor (rhG-CSF) primed bone marrow cells plus peripheral blood stem cells after modified busulfan/cyclophosphamide + antithymocyte immunoglobulin (BU/CY + ATG ) conditioning regimen. Results All patients achieved full donor type engraftment. Grade Ⅲ-Ⅳ graft versus host disease (GVHD) occurred in 3 patients and extensive chronic GVHD in 1. With a median following-up time of 285(60-1670) d, 11 patients were alive, 9 of them had normal blood counts and the other 2 were blood transfusion independent. Six patients died of transplant-related complications. Conclusion Mismatched HSCT is a feasible and safe option for SAA patients without sibling identical donors.

Objective To investigate the risk factors and prognosis of transplant-associated thrombotic microangiopathy (TA-TMA) following acute graft-versus-host disease (aGVHD),and to evaluate the factors that might influence the prognosis of TA-TMA.Methods A nested case-control study was designed.Cases with TA-TMA (n =33) and controls (n =77) matched for age at allogeneic hematopoietic stem cell transplantation (allo-HSCT) and length of follow-up were identified from a cohort of 356 patients who suffered from aGVHD after allo-HSCT between 2009 and 2011.Results The median time to presentation of TA-TMA was 3.5 (1.2-23.0) months post-HSCT.The median time from diagnosis and first-line treatment failure of aGVHD to TA-TMA diagnosis was 25 (7-257) days and 15 (5-257) days,respectively.aGVHD occurring beyond 60 days after allo-HSCT,initial grade Ⅲ-Ⅳ aGVHD,first-line treatment failure and receiving tacrolimus as second-line treatment were independently associated with the occurrence of TA-TMA,and patients with two or more risk factors were at higher risk (OR =210.0,P =0.000).Twenty-two (66.7％) TA-TMA patients died.Progressive TA-TMA was the significantly adverse factor affccting the survival of TA-TMA cases.None of therapies could improve prognosis of patients with TA-TMA.Conclusion Many characteristics of aGVHD were associated with TA-TMA,which help us to identify the individuals who are at higher risk of developing TA-TMA following aGVHD and to select the more reasonable GVHD therapeutic strategies.

Objective To investigate the incidence and pathogenesis of fever within the first 24　hours following allogeneic peripheral stem cell transfusion and to analyze the associated risk factors.Methods Totally 114 patients received allogeneic hematopoietic stem cell transplantation(allo-HSCT)between October 2009 and August 2010 were enrolled and clinical data of febrile patients within 24 hours　following peripheral stem cell transfusion were retrospectively analyzed.Multivariate logistic regression analysis was performed to identify the risk factors for transfusion related fever.Results Thirty-two (28.1％)out of the 114 patients had a fever within 24 hours after allo-HSCT.All of them were human leukocyte antigen(HLA)mismatch transplantation.The median time of the temperature elevated was 2.5(0-18.0)hours after the infusion with a median time of the peak of 7.8(3.5-23.0)hours after the infusion.Fever was attributed to definite infection in 6 patients and no definite infection in the remaining 26 patients.None of them were hemolytic,which was attributed to transfusion related fever.Multivariate analysis showed that female donor and high count of peripheral leukocyte of donor peripheral blood were significant predictors for transfusion related fever.Conclusions Most of post-infusion fever within 24 hours after HLA mismatch related transplantation has no identifiable infectious focus.The risk factors for transfusion related fever are female donor and high number of peripheral leukocyte of donor blood.

Objective To explore the incidence, diagnosis and treatment of nephrotic syndrome ( NS ) following allogeneic hematopoietic stem cell transplantation ( allo-HSCT) in one single center.Methods Analysis were carried out based on the records of 1464 patients following allo-HSCT hospitalized in Peking University People's Hospital from January 1996 to April 2009, so as to evaluate the incidence and outcomes of NS. A total of 1464 patients whose survival time was longer than 100 d were enrolled. Eight patients (0.6%) had NS following allo-HSCT. Using the nested case-controlled study, 56 cases who received transplantation within the same period were selected as control group for risk factors analysis. Results The median time of NS was 488(54-1185)d after allo-HSCT. Lower extremities' edema and heavy proteinuria were present in all the patients. Two patients were accompanied with impaired renal function. Six patients suffered from chronic graft-versus-host disease (GVHD). Three patients with NS were accompanied with other symptoms of GVHD. Renal biopsy examination showed typical features of minimal change diseases in 3 patients and membranous nephropathy in 1 patient. All cases achieved complete remission (CR) after taking combined immunosuppressant agents. One patient relapsed soon after all the immunosuppressant agents were stopped. Six patients were still surviving with disease free. One patient died of the relapse of leukemia and another patient died of early discharge from hospital after allo-HSCT. The possible factors correlated with the occurrence of NS were analyzed, and the occurrence of chronic GVHD was identified as an independent factor of NS. Conclusions NS should be carefully taken into consideration when edema and proteinuria are present in patients following allo-HSCT. The occurrence of NS is probably related with chronic GVHD. NS responds well to immunosuppressant agents.

Objectlve To analyze the epidemiologic features of blood stream infection(BSI)during the period of agranulocytosis after hematopoietic stem cell transplantation(HSCT)in our hospital,and provide the basis for the empirical therapy.Methods The consecutive hematopoietic stem cell transplantation recipients conducted between January 2008 and October 2010 were studied retrospectively,to identify the current incidence,etiology for BSI and associated mortality during the period of agranulocytosis.Results Totally 75 patients were diagnosed as BSI.The incidence of BSI was 9.6%(75/784)in HSCT during the period of agranulocytosis,17.0%(75/441)in febrile patients.The pathogen testing showed that 64.4%were G-bacteria,30.1%were G+ bacterial and 5.5%were fungi.All G-bacteria except one were sensitive to carbapenems;all G+ bacteria except one were sensitive to vancomycin.Among the 75 patients,9(12.0%)experienced septic shock and 5(6.7%)died.Conclusions The pathogens of the BSI in the cohort are G-bacteria,followed by G+ bacteria and fungi.Carbapenems and vancomycin are the first drugs for the experiential therapy.

Objective To investigate the efficacy and safety of rituximab on Epstein-Barr virus (EBV) disease post allogeneic hematopoietic stem-cell transplantation.Methods A retrospective analysis was performed based on clinical data of 26 patients diagnosed as EBV disease and received rituximab from June 2006 to March 2012 in People's Hospital,Beijing University.Eleven patients were diagnosed as posttransplant lymphoproliferative disorders (PTLD) by histopathology and remaining 15 were diagnosed as probable EBV disease.Patients received a rituximab dose of 375 mg/m2 once a week.Efficacy was evaluated as revised response criteria for non-hodgkin lymphoma (NHL),and side effects during infusion were evaluated by Common Terminology Criteria for Adverse Events.Results Patients received 78 infusions with a median of 3 (1-6) infusions in each.There were no severe side effects during the infusion of rituximab.The 1st,2nd,3rd,4th,8th week cumulative complete remission (CR) were (11.5 ± 6.3)％,(42.2 ±10.2) ％,(64.4 ± 10.0) ％,(74.6 ± 9.4) ％,(87.3 ± 7.9) ％,respectively.The overall response rate was 84.5％,and the CR rate was 73.1％.The CR rate was higher among patients with single organ involved than those with multiple organs involved (10/10 vs 9/16,P =0.023).The CR rate was higher in patients with probable EBV disease than those with PTLD (13/15 vs 6/11,P =0.095),while there was no statistically significant difference.The incidence of one-year and two-year overall survival since onset of rituximab were (55.7 ± 10.2)％ and (39.6 ± 12.4)％,respectively.Survival rate was higher among the patients with single organ involved than those with multiple organ involved (8/10 vs 5/16,P =0.041).Survival rate was higher in patients with probable EBV disease than those with PTLD(11/15 vs 2/11,P =0.015).Conclusions Rituximab appears to be safe and effective for EBV disease.Due to a potential good response in probable EBV disease,we suggest rituxmab should be given based on probable EBV disease;meanwhile the pathological results should get early if possible.Prospective trial is needed to provide evidence so as to define optimal therapy of rituxmab.

Objective To investigate the safety and efficacy of second allogeneic hematopoietic stem cell transplantation for the relapsed hematologic malignancies. Methods The data of 25 relapsed patients received the second allogeneic transplantation as a salvage therapy in Institute of Hematology Peking University between October 1999 and March 2010 were analyzed retrospectively. Twenty-four patients relapsed at 8. 8 (1-55) months after the first transplantation, except one received the second transplantation as prophylaxis therapy. They received the second transplantation after 3(0. 3-20) months' therapy. The median time between the 2 transplants was 10. 6(0. 6-59. 0) months. Results Most of the patients were given the conditioning regimen including total body irradiation (TBI, 700-779 cGy) or modified busulfan and cyclophosphamide (BUCY, BU 12 mg). All patients survived more than 30 days and achieved sustained white blood cell engraftment. Sinus obstructive syndrome, irradiation dermatitis and acute myocardial infraction were occurred in 3 patients and recoverable. Until January 31 in 2011, with a median observation period of 9. 1 (2. 0-131. 1) months, 8 patients had been living with a overall survival (OS) of 30.9%.Twelve patients relapsed at a median 4. 4 months and 10 died of it. The other 7 patients died of transplant related complications. The non-relapsed mortality was 35. 1 %. The disease status at the 2nd transplantation was the only factor which effected the OS (P = 0. 009). Conclusions The second allogeneic transplantation is a viable option for patients relapsing after the first transplantation. Reduced intensive conditioning regimen ensures the graft engraftment and reduces transplant related toxicity.

Under the premise of radical resection in the treatment, it is of great significance to preserve partial gastric function so that the early gastric cancer (EGC) patients' postoperative quality of life (QOL) can be improved. In the patients with EGC in the upper third of the stomach, the emphasis is on the prevention of reflux esophagitis caused by bile and gastric juice reflux. Pylorus-preserving gastrectomy (PPG) is applicable to the patients with EGC in the middle third of the stomach. In the patients with EGC in the lower third of the stomach, distal gastrectomy (DG) is performed in general. Various anastomosis ways are applied to reduce the negative impact of pylorus resection after DG. Furthermore, it should also be considered that reasonable vagal nerves preservation and lymph node dissection are both important for function preserving gastrectomy of EGC. Rational use of laparoscopy-assisted gastrectomy has advantages of lower invasiveness, faster recovery, etc. And the amplification effect of laparoscope can contribute to preserving nerves and gastric function.
Esophagitis, Peptic ; prevention & control ; Gastrectomy ; methods ; Gastroenterostomy ; Gastroesophageal Reflux ; prevention & control ; Humans ; Laparoscopy ; Lymph Node Excision ; Organ Sparing Treatments ; Postoperative Period ; Pylorus ; surgery ; Quality of Life ; Stomach Neoplasms ; surgery ; Vagus Nerve