Objective To investigate the therapeutic effects and side effects of FLAG and MEA regimen in the treatment of relapsed and refractory adult acute myeloid leukemia.Methods Use retrospective analysis to Observe the therapeutic effects and side effects of the 51 cases of relapsed and refractory adult acute myeloid leukemia (M3 except) from January 2009 to June 2012 in our hospital,which are divided into FLAG group (23 cases) and MEA group (28 cases) according to chemotherapy.Results In FLAG group,the rate of complete remission was 30.4 ％ (7/23),the rate of partial remission was 17.4 ％ (4/23),the effective rate was 47.8 ％ (11/23).In MEA group,the rate of complete remission was 35.7 ％ (10/28),the rate of partial remission was 21.4 ％ (6/28),the effective rate was 57.1％ (16/28),difference between two groups was not statistically significant. Both groups appeared Ⅳ degrees myelosupression,and there were no significant differences between them on incidences of secondary infection [95.7 ％ (22/23) vs 89.3 ％ (25/28)] and haemorrhagia [82.6 ％ (19/23) vs 85.7 ％ (24/28)].Difference on cardiac toxicity was statistically significant.Conclusions Compared with MEA regimen, FLAG regimen are similar effective and can be well tolerated,which has lower cardiac toxicity. Thus, FLAG regimen can be used as first-line treatment for relapsed and refractory adult acute myeloid leukemia.

BACKGROUND:The CD4+CD25+FOXP3+Treg cells have immunosuppression effect, and it is speculated that these cells may restrain the occurrence of acute graft-versus-host disease. OBJECTIVE:To observe the variety of the CD4+CD25+FOXP3+Treg cells in the peripheral blood from donors before and after granulocyte colony stimulating factor mobilization, and study the relationship between CD4+CD25+FOXP3+Treg cells and acute graft-versus-host disease. METHODS:Ninety patients with malignant blood diseases who undertook al ogeneic hematopoietic stem celltransplantation and their donors were observed. Granulocyte colony stimulating factor 5μg/kg was injected subcutaneously into the donor per 12 hours for 5 days, and the stem cells were col ected before and after mobilization. The ratio of CD4+CD25+FOXP3+Treg cells in the peripheral blood was detected before and after mobilization with flow cytometry, and the ratio of these cells in the stem cellsuspension was measured by the same method. The patients were divided into two groups according to the CD4+CD25+FOXP3+Treg cells ratio:high dosage group (≥5%) and low dosage group (<5%). The incidence of acute graft-versus-host disease was observed in the two groups after transplantation. RESULTS AND CONCLUSION:The ratio of the CD4+CD25+FOXP3+Treg cells in the donor before and after mobilization were 11.3%and 1.5%,respectively, and there was a significant difference (P<0.05). The ratio of the CD4+CD25+FOXP3+Treg cells was 3.4%in the patients with acute graft-versus-host disease, and 15.7%in the patients with no acute graft-versus-host disease, showing a significant difference (P<0.05). After hematopoietic reconstitution, the incidence of acute graft-versus-host disease was 18.4%in the high dosage group and 48.1%in the low dosage group, and there was a significant difference between the two groups (P<0.05). Therefore, the granulocyte colony stimulating factor can lower the ratio of CD4+CD25+FOXP3+Treg cells in the human peripheral blood. The increase in CD4+CD25+FOXP3+Treg cells can restrain the occurrence of acute graft-versus-host disease.

Objective To observe the antibacterial and synergistic effect of Xianglian Suppository with miconazole suppository for the treatment of simple vulvovaginal candidiasis ( VVC) , and to explore the advantages of integrative Chinese and western medicine for the treatment of simple VVC. Methods According to the principle of randomized trial, 65 simple VVC patients were divided into two groups, 35 cases in test group and 30 in control group. The test group was given Xianglian suppository and miconazole suppository, and the control group was treated with miconazole suppository, the medication lasting for 7 days. The changes of symptom scores before and after treatment were observed, and the therapeutic effect and safety were also evaluated in both groups. Results ( 1) After treatment for one course, the markedly effective rate and total effective rate were 60.00%, 88.57% in the test group, and were 23.33%, 60.00% in the control group, respectively, the differences being significant between the two groups ( P<0.01). ( 2) After treatment, symptom scores were decreased in both groups ( P<0.01 compared with those before treatment) , and the decrease in the test group was superior to that in the control group (P<0.01). (3) One case of the test group had the complaint of severer pruritus vulvae after medication, and the results of physical examination showed the case had vulvovaginal flush but had no edema, blister or other discomfort. The manifestations disappeared when the medication continued, indicating that the case had no allergic reaction. No case had allergic reaction in the control group. Conclusion For the treatment of simple VVC, Xianglian suppository combined with miconazole suppository can obviously relieve the clinical symptoms, and is effective and safe.

Objective To explore the relationship between gene mutation of JAK2 V617F, JAK2 (exon12), CALR, MPL and clinical features of patients with bcr-abl negative myeloproliferative neoplasms (MPN), and to analyze the risk factors of thrombosis. Methods Clinical features and laboratory tests of 115 patients with bcr-abl negative MPN were analyzed retrospectively. 34 patients with thrombosis were treated as the observation group, and 81 patients without thrombosis were treated as the control group. Results Among 71 primary thrombocythemia cases, the white blood cell count (WBC) and hemoglobin level of JAK2 V617F positive group and CALR positive group was higher than that of 4 gene mutations in negative group (F= 5.835, P= 0.005; F= 3.405, P= 0.039). The incidence of splenomegaly in JAK2 V617F positive group and CALR positive group was higher than that of 4 gene mutations in negative group (χ2=16.902, P=0.0002; χ2= 12.658, P= 0.001). The patients'proportion of JAK2 V617F positive, high hemoglobin level (male ≥160 g/L, female ≥150 g/L), hypertension and over 60 years old in the observation group was higher than that in the control group (χ2= 5.585, P= 0.025; χ2= 4.909, P= 0.043; χ2= 8.891, P= 0.004; χ2=15.933, P=0.023). Conclusion The detection of JAK2 V617F, JAK2 (exon12), CALR and MPL gene mutations is helpful to the diagnosis of bcr-abl negative MPN; JAK2 V617F positive, high hemoglobin level, hypertension, and elderly age are risk factors of thrombosis.

Objective To evaluate the quality of intraoperative wake?up test in the patients undergoing scoliosis correction surgery under etomidate?based anesthesia. Methods Thirty patients of both sexes, aged 13-32 yr, weighing 40-65 kg, of ASA physical statusⅠorⅡ, undergoing elective scoliosis correction surgery, were randomly assigned into etomidate group ( group E, n=15 ) or propofol group (group P, n=15) using a random number table. Anesthesia was induced with etomid 0.3 mg∕kg (group E) or propofol 2mg∕kg ( group P ) injected intravenously, midazolam, fentanyl and rocuronium. The patients were mechanically ventilated after naso?tracheal intubation. Etomidate 0.6-1. 2 mg · kg-1 · h-1 and propofol 8- 10 mg·kg-1 ·h-1 were infused intravenously during surgery in E and P groups, respectively. Both remifentanil and cisatracurium were used for maintenance of anesthesia in the two groups. Cisatracurium infusion was stopped before wake?up test. The infusion rate of propofol was adjusted to 4 mg·kg-1 ·h-1 at 15 min before wake?up test. After the scoliotic angle was corrected, infusion of etomidate and propofol was stopped, and the infusion rate of remifentanil was adjusted to 0.025μg·kg-1 ·min-1 in both groups. The wake?up time was recorded, and the quality of wake?up was assessed. Mean arterial pressure (MAP) and heart rate were recorded before anesthesia ( T0 ) , immediately before the patients were awakened ( T1 ) , when the patients responded to commands from doctors ( T2 ) , and after anesthesia was deepened ( T3 ) . At T0 , the end of surgery ( T4 ) , and 24 h after surgery ( T5 ) , blood samples were collected from the internal jugular vein for determination of plasma cortisol concentrations. Results The patients were awakened successfully in the two groups, and there were no significant differences in the wake?up time, quality of wake?up, and MAP, HR and plasma cortisol concentrations at each time point between the two groups. MAP and HR were significantly higher at T2 than at T0 in the two groups. MAP and HR were within the normal range during wake?up test, and no patients developed severer cardiovascular events in the two groups. Conclusion Etomidate?based anesthesia provides better quality of intraoperative wake?up test in the patients undergoing scoliosis correction surgery, which is similar to that of propofol?based anesthesia.

Objective To evaluate the clinic effect of leaflet enlargement with autologous pericardium in repairing mitral valve disease and to describe the technique and discuss its indications. Methods Between July 2004 and June 2008, 45 pa-tients with isolated mitral valve disease, included stenosis in 10 and regurgitation in 35. The causes were congenital heart dis-ease in 8, rheumatic in 21, degenerative in 7 and endecarditis in 9. The procedures were: posterior leaflet enlargement with autologuus pericardium in 14, anterior leaflet enlargement in 8, both anterior and posterior leaflet enlargement in 23. In addi-tion, eye to eye technique was in 12, artificial chordal in 12, chordal transfer in 6, papillary muscle vepesitioning in 4. Mitral anuuloplasty was performed in all cases. Before and after surgery, cardiac function parameters were compared. Results No operative deaths occurred. One case wastransfered to mitral valve replacement due to regurgation, lntraoperative transesophageal echocardiography showed no mitral regurgitation in 38 and small regurgitation in 6 cases. The mean mitral valve effective orifice area(MVEOA) was (2.8±0.6) cm~2, with a mean gradient pressure of (6.21±1.34) mm Hg after operation. The mean followed up was ( 18.0±2.1 ) months. Echocardiography study showed that no mitral regurgitation in 35 cases, slight regurgi-tation in 9, mean mitral effective orifice area was (2.5±0. 8 ) cm~2, mean gradient pressure of (7.21±0. 45 ) mm Hg, no one need reoperation. Postoperative cardiac functions were significantly improved: the average left ventricular end-diastolic diameter (LVEDD) was (48±7) mm [ preoperative (56±6) nun, P <0.05], ejection fraction (EF) was 0.51～0.24( preoperative 0.45± 0.23, P < 0.05 ), the average left atrium diameter ( LA ) was ( 50±11 ) mm [ preoperative ( 62±23 ) mm, P <0. 05 ]. The function of mitral valves was well performed. Conclusion Leaflet enlargement with autologous pericardium com-bined with mitral annuloplasty was effective in repairing of diseased mitral valve. The advantages of the procedure including simplicity, good compatibility, avoiding foreign body and no need for anticoagulation.

BACKGROUND:The prognosis of malignant hematologic diseases has improved greatly with the application of the hematopoietic stem cell transplantation. Peripheral blood stem cell transplantation (PBSCT) has been used as an alternative to bone marrow transplantation (BMT).OBJECTIVE:To observe curative effect and clinical outcome in 53 patients with hematological malignancy undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) or autologous peripheral blood stem cell transplantation (auto-PBSCT).DESIGN:Randomized controlled study.SETTING:BMT Center, Hematology Department of the First Affiliated Hospital of Zhengzhou University.PARTICIPANTS:From July 2003 to May 2006, 53 patients (33 males and 20 females) with a median age of 37 years underwent PBSCT. Thirty-five patients received allo-PBSCT, including 13 of acute myelocytic leukemia (AML), 7 of acute lymphocytic leukemia (ALL), 10 of chronic myelocytic leukemia (CML), 2 of multiple myeloma (MM), and 3 of myelodysplastic syndrome (MDS). Eighteen patients underwent auto-PBSCT, including 7 AML, 6 ALL, 2 MM, and 3 non-Hodgkin lymphoma (NHL). Thirty-three donors (20 males and 13 females) with a median age of 35 age in the allo-PBSCT were HLA-identical siblings, 2 donors (5.7%) had one mismatch. Sixteen allografts were sex mismatched. Study was authorized by the Ethic committee of the hospital, and all patients had signed an inform consent.METHODS:① PBSC were mobilized with granulocyte colony-stimulating factor (G-CSF) or chemotherapy combined with G-CSF. A median of 6.2×106 CD34+ cells/kg was infused for allo-PBSCT and 3.0×106 CD34+ cells/kg was infused for auto-PBSCT. Amended BU/CY was used as conditioning regimen in allo-PBSCT and MAC was used in auto-PBSCT. Methotrexate (MTX) combined with cyclosporine A (CsA) and mycophenolate mofetil (MMF) was used as graft-versus-host disease (GVHD) prophylaxis. ALG was used in 1 patient with 1 locus mismatched in allo-PBSCT. ② Time to engraftment was calculated from the time of transplantation to neutrophil recovery ≥ 0.5×109 L-1 and platelet recovery ≥ 20×109 L-1, GVHD and relapse were observed until 1 year of follow-up.MAIN OUTCOME MEASURES:① Time to neutrophil and platelet recovery; ② GVHD occurrence after transplantation; ③ outcome of treatment.RESULTS:All the 53 patients were analyzed. ① Engraftment of neutrophils (> 0.5×109 L-1) and platelets (> 20×109 L-1) was achieved at a median of 13 days for neutrophils and 19 days for platelets in auto-PBSCT, and 12 days and 15 days respectively in allo-PBSCT. ② In allo-PBSCT, I-VI acute GVHD occurred in 31.4% cases, and chronic GVHD developed in 71.4% cases. ③ The relapse rate was 38.9% in auto-PBSCT, and 5.7% in allo-PBSCT. CONCLUSION:PBSCT can provide rapid hematopoietic reconstitution. It is an important method to cure the malignant hematologic diseases.

OBJECTIVE: To investigate the effects of human cerebrospinal fluid (CSF) during development phase on migration and differentiation of fetal brain neural stem cells (NSCs).METHODS: Fetal brain cells of gestational age of 16 weeks that were frozen in liquid nitrogen were obtained, resuscitated and incubated in DMEM/F12 medium containing epithium growth factor (EGF), basic fibroblast growth factor (bFGF), B27 and N2. The neurospheres cultured for 14 days were obtained. CSF was absorbed from the subarachnoid cavity and brain ventricle in the embryonic group. CSF was collected by lumbar puncture or ventricular puncture in the child group. The neurospheres cultured for 14 days were transplanted into the pure CSF in an incubator containing 5% CO_2 at 37 ℃. Cellular migration and growth of neurospheres in CSF were observed. Effects of CSF on neural cell differentiation were identified by immunofluorescence. RESULTS: Neural stem cells in the form of neurospheres derived from fetal brain were inoculated into the pure CSF, and cell migration were commonly observed besides few of neurospheres in child CSF culture at 6 hours following culture. Surrounding cells of neurospheres extended processes, forming cell cord that became cell webs after extension. Compared with the embryonic group, positive rate of glial fibrillary acidic protein was significantly increased in the children group (P < 0.01), but positive rates of nerve fiber and nestin were significantly decreased (P < 0.01). In addition, galactocerebroside-positive cells were only found in 3 baby CSF cultures. CONCLUSION: There existed significant affections on both migration and differentiation of human neural stem cells when cultured in pure CSF with different developmental phase, suggesting that CSF is one of major niche factors for central neural system development.

Objective To investigate the associations of peripheral CD4+ CD25 + CD127low/-regulatory T cells (Treg) with HBV viral load and liver pathology in hepatitis B virus (HBV) carriers.Methods Forty six chronic HBV carriers admitted in the first hospital of Jiaxing during October 2012 and February 2014,and 23 healthy subjects (controls) were enrolled in the study.CD4+ CD25 + CD127low/-Treg in peripheral blood of the two groups were detected by flow cytometry.Ultrasound-guided liver biopsies were performed in chronic HBV carriers and HBV DNA load was determined by real-time PCR method.Independent samples t test was used for the comparison between groups,and Spearman rank correlation or Pearson linear correlation analyses were performed.Results The frequency of the peripheral CD4+ CD25+CD127low/-Treg in 46 HBV carriers was (5.11 ±1.47)％,which was significantly higher than that in healthy controls [(3.46 ± 1.23) ％,t =4.629,P ＜ 0.01].The HBV DNA load in HBV carriers was (6.21 ±1.98)lg copies/mL,which was positively correlated with the CD4+ CD25+ CD127low/-Treg level (r =0.405,P ＜ 0.01).Among 46 HBV carriers,21 (45.65％) were of inflammation grade 2 or above,and 16 (34.78％) were of fibrosis stage 2 or above.Peripheral CD4+ CD25+ CD127low/-Treg level was negatively correlated with inflammation and fibrosis in HBV carriers (r =-0.343 and-0.452,P ＜ 0.05).Conclusion CD4 + CD25 + CD127low/-Treg may be associated with the chronicity of HBV infection and the degree of liver damage.