Objective To evaluate clinical treatment method and efficacy of newly diagnosed acute promyelocytic leukemia (APL),and analyze the relevant factors about the long-term survival.Methods The clinical data of 48 patients with newly diagnosed APL were analyzed retrospectively.All of them used alltrans retinoic acid (ATRA) combined with anthracycline as induction remission therapy.After induction remission,ATRA combined with chemotherapy was used as consolidation therapy,and ATRA,arsenic trioxide and conventional chemotherapy alternated as maintenance therapy.Short-term efficacy was analyzed.Patients were followed up,and the rates of overall survival (OS) and disease-free survival (DFS) were analyzed.Long-term efficacy was analyzed by COX proportional hazards regression models univariate analysis.Results The complete remission (CR) rate was 87.5％(42/48) in all 48 patients with APL.The time from treatment beginning to CR was (30.7 ± 4.6) d.Age was the only factor affecting the rate of CR.The rates of 1-year,3-year and 5-year OS were (87.5 ± 4.8)％,(85.4 ± 5.1)％ and (78.3 ± 6.7)％ in 48 patients with APL.The rates of 1-year,3-year and 5-year DFS were (97.6 ±2.4)％,(93.9 ±4.2)％ and (89.5 ± 5.9)％ in 42 patients with CR.COX proportional hazards regression model univariate analysis result showed that the patient' s age,gender,lactate dehydrogenase,diffuse intravascular clotting,risk stratification and bone marrow abnormalities promyelocyte ratio had no correlation with the rate of DFS (P ＞0.05).Conclusions ATRA combined with anthracycline as induction remission therapy,after induction remission ATRA combined with chemotherapy as consolidation therapy,and ATRA,arsenic trioxide and conventional chemotherapy alternated as maintenance therapy can get a higher rate of CR and long-term survival in patients with newly diagnosed APL.It is worthy of clinical application.

Objective To evaluate the value of diffusion-weighted imaging (DWI)in diagnosing the acute centrum ovale infarction, and also to investigate the pathogenesis of the infarction. Methods All 58 patients underwent conventional MRI and DWI scanning after symptoms’ onset. DWI findings were compared to the findings of T_1WI and T_2WI. Results The sensitivity and specificity in diagnosing the ischemia stroke were 96.4% and 98.8% within 7 days after onset. Of all the cases, 62.1% were associated with the cerebral large-vessel disease and emboligenic heart disease. Only 36.2% had a classic lacunar syndrome but 69.0% had more frequently an abrupt onset of symptoms. Conclusion DWI is of high accuracy for diagnosing centrum ovale infarction and detecting early infarction lesions which are difficult to be displayed in conventional MRI, and very helpful in differentiating the acute from non-acute lesions; symptomatic centrum ovale infarction is suggested to be associated with large-vessel and heart disease which should be distinguished from the lacunar infarcts.

Objective To investigate the safety and efficacy of hepatitis B surface antigen (HBsAg) positivity of the donors on graft survival and liver complications in HBsAg (+) renal transplant recipients.Methods We retrospectively evaluated 96 HBsAg (+) patients who received HBsAg(+) donor kidney transplant fellow-up during 20～ 139 months,in order to observe the renal allograft dysfunction,liver dysfunction and others complications.Results All 96 patients underwent renal transplantation successfully in our hospital.during the follow-up period,18 cases accepted entecavir-treated,one case lost graft function,two cases died,one of them developed drug resistance and liver function failure,the other because of cancer of the liver.Twenty-three of the 78 lamivudinetreated patients (29.5％) developed drug resistance in 7～96 months,and 3 cases developed liver function failure,2 cases died and one cured,15 of the 19 cases who been salvage treated with entecavir was successful and well tolerated after 1 year,2 cases who been salvage treated with adefovir and lamivudine with HBV DNA-negative after 12 months and 23 months.The 5-year patient/graft rates of patients who been treated with lamivudine and entecavir were 88.5％/84.6％ and 88.9％/83.3％ respectively.Conclusion It is safe and feasible for renal transplantation from HBsAg(+) donors to HBsAg(+) recipients with antiviral treatment,patients would require lifelong anti-viral suppression and strictly follow-up,which is important for patient and graft survival,anti-viral drugs resistance and the liver complications should be closely monitored and treated.

Objective To investigate the validity and reliability of the Chinese version HCL-32(CV-HCL-32) in the patients with bipolar disorder(BP) and the best cut-off between the patients with BP and patients with major depression disorder (unipolar depression disorder, UP). Methods The English version HCL-32 was translated into Chinese version after the agreement of the author of the HCL-32. 300 consecutive patients with BP and 156 consecutive patients with UP in outpatients and inpatients departments diagnostically interviewed with DSM-Ⅳ were rated by CV-HCL-32. The test-retest reliability with interval of eight to fourteen days was investigated in 155 patients (51.7%) with BP in the bipolar patients. Results A two-factor solution was preferred by the factors analysis. The Eigenvalues of the two factors were 6.32, 3.00 respectively. The two factors together accounted for 29.1% of the total variance. The internal consistency( Cronbach's alpha) of the CV-HCL-32 was 0.86.The test-retest reliability of the CV-HCL-32 was 0.62(P＜ 0.01 ). The frequency of positive responses to various items ranged from 11.6% to 89.7%. The mean score of CV-HCL-32 was statistically higher in patients with BP( 16.6 ± 6.2) than that of UP ( 10.9 ± 6.4). A CV-HCL-32 screening score of 14 was chosen as the optimal cutoff between the patients with BP and UP, as it provided good sensitivity (0.74) and specificity (0.66). The positive and negative predictive power for this cut-off was 0.81 and 0.57. Conclusions The study demonstrated the suitable validity and reliability of CV-HCL-32, suggested that the CV-HCL-32 is useful questionnaire for screening bipolar disorder in China.

Objective To analyze the clinical characteristics of the recipients infected with cryptococcus neoformans after renal transplantation. Methods Clinical data of 9 patients infected with cryptococcus neoformans after renal transplantation were retrospectively analyzed, including the infection site, clinical manifestations, mycological, histopathological, imaging examination results, treatment process and clinical prognosis. Results Nine recipients were treated with routine triple immunosuppressive therapy of tacrolimus (FK506) + mycophenolate mofetil (MMF)+prednisone. The median time of onset was 6 years (1-13 years) after operation. Among them, 1 case was diagnosed with cryptococcal meningitis, 5 cases of cryptococcal meningitis complicated with cryptococcal pneumonia, 2 cases of cryptococcal pneumonia and 1 case of cutaneous cryptococcal infection. Cryptococcal pneumonia was clinically manifested as fever, cough, expectoration, shortness of breath and chest pain, etc. Chest CT demonstrated the signs of nodules and pleural effusion, etc. The diagnosis was mainly confirmed by lung biopsy and negative ink staining of the alveolar lavage fluid. Clinical manifestations of cryptococcal meningitis primarily included fever and paroxysmal headache accompanied by vomiting, which was mainly confirmed by blood culture and negative ink staining of the cerebrospinal fluid. Cutaneous cryptococcal infection was characterized by a mass in the right shoulder, which was confirmed by skin biopsy. All patients were given with standard antifungal therapy including amphotericin B and fluconazole, and immunosuppressive therapy at a reduced dosage. Among 9 recipients, 1 recipient died, and the other recipients obtained excellent clinical prognosis. Conclusions Cryptococcus neoformans infection dominantly occurs in the middle and late stage after renal transplantation presenting with non-specific clinical symptoms. Blood culture, lung biopsy and cerebrospinal fluid examination should be timely performed to validate the diagnosis of this disease. Standard anti-fungal therapy can reduce the mortality rate.

Objective ToexplorethevalueofMR DKIinevaluationofmicrostructuredamageincervicalspinalcordinjury(CSCI) Methods 32casesofCSCIpatientsconfirmedbyclinicalexaminationand20casesofhealthycontrolgroupwereinvestigatedbyconventional MRIandDKIexamination.AccordingtoT2WIsignal,theinjurygroupweredividedintoA,Bgroup,Agroupofhighsignalgroup(n＝14)andBgroupofnegativegroup (n＝18).A,BgroupsandcontrolgroupweremeasuredbyFA,meandiffusivity(MD)and mean kurtosis(MK)valuesatdifferenttimes (acute,4 weeksafterinjury,2to3 monthsafterinjury)andthedata wereanalyzedby SPSS17.0statisticalsoftware.TheROCcurvewasusedtoevaluatetheabilityofdifferentparametersindiagnosingCSCI.Results In A,BgroupsFAvaluesdecreasedearlyandincreasedgradually,butwerealwayslowerthanthecontrolgroup,andthedifferencewas statisticallysignificant(P＜0.001).InAgroup MDvalueincreasedearlyanddecreasedgradually,butwashigherthanthecontrol group (P＜0.001).InAgroup MKvaluedecreasedearlyandincreasedsignificantly(P＜0.001).InBgroup MDvalueincreasedand MKvaluedecreasedintheacutephase(P＜0.001),lateron MDand MKvaluesgraduallytendtothecontrolgroup,thedifference wasnotstatisticallysignificant(P＞0.05).Conclusion DKIcannoninvasivelyreflectthemicroGdamageofCSCI,whichcannotbedisplayed byconventionalMRIfortheearlydetectionofspinalcordabnormalities.TheFAvalueisofhighdiagnosticvalue.

Immune checkpoint inhibitors(ICIs)have become the most widely used drugs in tumor immunotherapy, with ipilimumab and nivolumab as their representatives.However, the use of immune checkpoint inhibitors has brought about many immune-related adverse events, of which myocarditis is one of the most fatal adverse reactions.The pathogenesis of immune checkpoint inhibitor-associated myocarditis is not fully understood, mainly involving autoimmune T lymphocyte infiltration, regulatory T-cell dysfunction, cytokines, autoantibody production, genetic factors, the gut microbiome, etc.The treatment and management of immune checkpoint inhibitor-associated myocarditis require concerted efforts of multidisciplinary experts.

OBJECTIVETo explore and analyze the feasibility of Community Health Service Center(CHSC)-based HIV prevention and intervention in China.

METHODSData on case finding and case management indexes were collected from 42 CHSCs in 8 cities from November, 2011 to December, 2012, and complemented by questionnaires to investigate the willingness to accept community-based HIV services among health care providers and the service targets.

RESULTSDuring November, 2011 and December, 2012, 6 729 person-times HIV tests were carried out among MSM in the cooperation between CHSCs and CBOs, and 235 HIV positives were found. A total of 40 CHSCs among 42 have conducted HIV rapid tests. The sample sources were broad and the HIV screening positive detection rate from high-risk populations in key divisions of CHSCs 0.66% (38/5 769) was higher than that in outreach high-risk populations 0.41% (15/3 623) and people receiving physical check 0.31% (20/6 532). HIV positive detection rate in CHSCs was higher 0.4% (96/23 609) than that in conventional medical institutions 0.1% (11 870/9 644 944) and newly found positives among the confirmed positives was a little lower 73.7% (56/76) than conventional programs 80.1% (8 038/10 039). The case follow-up and CD4(+) T cell testing rates in CHSCs were 100.0% (1 046/1 046) and 99.1% (1 037/1 046), respectively. The testing cost was 6.1 RMB per person on average, and the cost of 1 case found positive was 2 727.3 RMB on average. Among 361 service providers, 68.1% (246)and 91.4% (330) service providers were willing to be involved in AIDS response and support HIV service in local CHSCs. Among 755 service targets including people who seek health care in key divisions of CHSCs, MSM, and high-risk populations in local communities, 77.3% (348), 73.9% (173) and 78.1% (57) were willing to accept free HIV tests in local CHSCs.

CONCLUSIONThe effect of case finding and case management in CHSCs was good and the cost of conducting HIV tests and finding new cases were relatively low, meanwhile, most of the service provides in CHSCs and service targets support HIV service in local CHSCs. The future CHSC-based HIV prevention and intervention was feasible.

China ; Community Health Centers ; Community Health Services ; HIV Infections ; prevention & control ; HIV Seropositivity ; Health Care Costs ; Humans ; Mass Screening ; Surveys and Questionnaires