Objective To explore the prophylaxis and treatment of hypoxic spells on patients with TOF.Methods Retrospectively analysed and compared the case history of the inpatients with TOP in our hospital,to analyse the epilepticus cause of hypoxic spells and study the hypoxia mechanism and summarize the prevention and control measures.Results 4(17%)cases of TOF died after hypoxic spells,the epilepticus cause of hypoxic spells included suckling,early getting up,crying,standing abruptly after stool,scorching climate,infection fever and anemia,the hypoxia mechanism was likely to the increase of infundibulum cardiac muscle contraction,the systemic circulation resistance drop suddenly,hypezventilation,high-viscosity syndrome.Conclusion To control the epilepticus cause and perform operative treatment early can reduce the hypoxic spells.The prevention and control measures were strengthening the live nurse,disconnected oxygen inhalation,oral beta-blocker therapy and venons injection 5% sodium bicarbonate.Early operative treatment was the best redical treatment.

AIM: To observe the local expression of nuclear factor-?B(NF-?B) in spontaneously hypertensive rat(SHR) kidney and effects of AT1 receptor contagonist valsartan.METHODS: 16 SHRs were randomly divided into two groups: SHR control group and valsartan group.Another 8 WKY rats act as normal control group.Systolic blood pressure(SBP) of SHR was measured at the beginning and the end of 2,4,6 and 8 weeks of intervention treatment.Radioimmunoassay was used to determine the activities of rennin and angiotensin II(AngII).The renal tissue NF-?B protein expression was detected by immunobiochemistry.RESULTS: SBP of SHR was remarkably decreased after valsartan intervention.However,the rennin activities and AngII level in plasma increased in valsartan group.In the renal tissue of SHR,there was remarkably increased in expression of NF-?B protein.Valsartan could significantly reduced NF-?B expression.CONCLUSION: Valsartan can depress NF-?B renal expression in protein level and might benefit hypotension renal function.

Objective To evaluate the response and toxicity of the chemo-radiotherapy assisted with Shenqi Fuzheng injection(SFI)in non-small-cell lung cancer(NSCLC).Methods 58 cases of NSCLC(from Jun.2004 to Dec.2006)were divided at random into two groups.30 cases(trial group)were given chemo-radiotherapy with Shenqi Fuzheng injection while another 28 cases(control group)only chemo-radiotherapy.The radiotherapy was carried out between two cycles of induction chemotherapy with NVB 25 mg/m2 d1,8,DDP 30 mg/m2 d1-3.The radiation dose was 60 Gy/30 f/6 W.Shenqi Fuzheng injection was used in 250 ml/d,for 21days as one cycle and after 7 day intervals, given another one cycle.The cycles of same regimen chemotherapy were given again after one week when the radiotherapy had been completed.Results Shortterm therapeutic effectiveness.the rates of complete remission and partial remission as well as the overall effective rates in patients of the trial group and control group were 16.7%,60.0%and 76.7%,and 10.7%,50.0%and 60.7%,respectively,the differences between two groups be not significant(P＞0.05).The 0.5,1,2year survival rates in patients of the trial group and control group were 96.7%,65.2%,45.0%and 89.3%,48.0%,35.0%,respectively,the differences between two groups were not significant(P＞0.05).Shenqi Fuzheng injection was shown to have changes in chemo-radiotherapy effects on clinical symptom,quality of life (QOL)and immune function and toxicity in the treatment of patients with NSCLC(P＜0.05).Conclusion Shenqi Fuzheng injection is shown to have changes in ehemo-radiotherapy effects on clinical symptom,QOL and immune function and toxicity in the treatment of patients with NSCLC,but it could not increase survival rate of the patients.

Objective:To explore the relationship between level of urinary iodine excretion (UIE) before 131I treatment and excellent response (ER) in low-to-intermediate risk differentiated thyroid carcinoma (DTC) patients. Methods:A retrospective analysis was performed with 432 DTC patients (124 males, 308 females, age: (42.1±11.0) years) who were treated with 131I for the first time after total thyroidectomy from June 2017 to October 2018 in Department of Nuclear Medicine, the Second Hospital of Shandong University. All patients were divided into 4 groups: G1, group 1, UIE<50 μg/L; G2, group 2, 50 μg/L≤UIE<100 μg/L; G3, group 3, 100 μg/L≤UIE<200 μg/L; G4, group 4, UIE≥200 μg/L. Patients were given 131I with a fixed dose (3 700 MBq). Response was evaluated 6 to 8 months after 131I treatment: ER, indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR). χ2 test and Kruskal-Wallis rank sum test were used to analyze the data. The adjusted standardized residual (residual) and Cramer′s V between G1-G4 and different treatment reactions were calculated to judge the difference among groups. IDR, BIR and SIR were classified into non-ER (NER) group, and binary logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to find the influencing factors of treatment reactions. Results:There were 51.9%(41/79), 64.9%(98/151), 53.8%(63/117), 30.6%(26/85) patients achieved ER in G1-G4, and the proportion of G4 was significantly lower than that of G1-G3 ( χ2 values: 7.695-25.697, all P<0.05), and there was no significant difference among G1-G3 ( χ2 values: 0.072-3.667, all P>0.05). The UIE level of patients in ER, IDR, BIR, SIR group was 87.5(57.0, 129.0), 97.0(55.7, 211.5), 141.0(74.0, 231.0), 148.0(68.5, 221.0) μg/L( H=15.977, P=0.001), and there was significant difference between those of patients in ER and SIR groups ( χ2=8.729, P=0.019). There was a certain correlation between UIE levels and different treatment reactions (Cramer′s V=0.151, P=0.001). UIE (≥200 μg/L), gender and preablative stimulated thyroglobulin could be used as independent factors affecting ER ( Wald values: 4.029, 7.185, 56.301, all P<0.05). Conclusion:Among DTC patients with low-to-intermediate risk, 131I treatment does not affect ER when the UIE level is less than 200 μg/L, while 131I treatment should be performed carefully when the UIE level is more than 200 μg/L.

Objective: To investigate the relationship of clinicopathological characteristics with neoadjuvant chemotherapeutic efficacy and prognosis of inflammatory breast cancer (IBC) patients. Methods: Medical records of 81 patients who underwent neoadjuvant chemotherapy for IBC in Tianjin Medical University Cancer Institute and Hospital between January 2010 and December 2013, were retrospectively analyzed. Clinicopathological features, response to neoadjuvant chemotherapy, and prognostic factors were studied by univariate and multivariate analyses. Results: The 3-year overall survival rate (OS) and disease-free survival rate (DFS) of patients were 53.1％ and 37.0％, respectively. The pathologic complete response (pCR) rate of patients after accepting neoadjuvant chemotherapy was 13.6％ (11/81). Statistically significant association was observed between pCR and pathological types in IBC (P<0.05). However,pCR had no benefit in improving the clinical outcomes of IBC patients (P>0.05). Preoperative lymph node stage was an independent prognostic factor of overall survival (OS) and disease- free survival (DFS) in IBC patients (P<0.05). Neoadjuvant chemotherapy and lymph vessel tumor emboli were independent factors of DFS (all P<0.05). Conclusion: Clinicopathological characteristics of IBC patients affected chemosensitivity. We could predict the prognosis of these patients by preoperative lymph node stage and lymph vessel tumor emboli and select chemotherapy to achieve the best curative effect.

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 investigate the impact of mycophenolate mofetil (MMF) prophylaxis duration on acute graft-versus-host disease (aGVHD) after haploidentical stem cell transplantation (haplo-HSCT) using 'Beijing Protocol’. Methods: Adult patients (≥14 years) received haplo-HSCT in Peking University Institute of Hematology from Sep, 2016 to Mar, 2017 were retrospectively reviewed if they fulfilled the criterias: ①diagnosed with hematological maligancies; ②standard-risk status at haplo-HSCT. A total of 237 patients [including 102 patients with long MMF duration (defined as started on day -9 with 100 mg/d, adjusted to 500 mg/d from day +30 and discontinued on day +45 to +60 or occurrence of CMV/EBV reactivation or late-onset hemorrhagic cytitis), and 135 patients with short MMF duration (defined as started on day -9 with 500 mg/d and discontinued on the day achieved neutrophil engraftment)] were reviewed. The incidence of aGVHD, virus infection and overall survival (OS) were compared between the two groups. Results: The median durations of MMF prophylaxis of long and short duration groups were 27(7-71) and 15(9-24) days, respectively after haplo-HSCT. There were no differences of baseline characteristics (including sex, patient age, disease, mismatched HLA loci, donor-recipient relation, donor-recipient sex and donor age) between the two groups. The incidences of the grade Ⅱ-Ⅳ and Ⅲ/Ⅳ aGVHD in long and short duration groups were 31.1% versus 17.6% (P=0.018) and 7.4% verus 7.8% (P=0.900), respectively. The duration of MMF prophylaxis was not found to be associated with gradeⅡ-Ⅳ aGVHD by the multivariate analysis. There were no significant differences in terms of CMV viremia, EBV viremia, hemorrhagic cytitis and OS between the two groups. Conclusion Prophylaxis with short duration MMF in the setting of 'Beijing protocol’ haplo-SCT was not associated with increased acute GVHD with no impact on OS, which indicated that short duration MMF might be a feasible GVHD prophylaxis regimen.

Objective:Donor cytomegalovirus (CMV) serological negative status may have an adverse effect on the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT), while there is inadequate data for Chinese people. This study is to explore the impact of donor CMV serological status on the outcome of CMV seropositive patients receiving allo-HSCT.Methods:Our study retrospectively analyzed 16 CMV seropositive patients with hematological malignancies receiving allogeneic grafts from CMV seronegative donors (antibody IgG negative) at Peking University People′s Hospital from March 2013 to March 2020, which was defined as D -/R + group. The other 64 CMV seropositive patients receiving grafts from CMV seropositive donors at the same period of time were selected as matched controls through a propensity score with 1∶4 depending on age, disease state and donor-recipient relationship (D +/R + group). Results:Patients in D -/R + group developed CMV DNAemia later than patients in the D +/R + group (+37 days vs. +31 days after allo-HSCT, P=0.011), but the duration of CMV DNAemia in D -/R + group was longer than that of D +/R + group (99 days vs. 34 days, P=0.012). The rate of CMV reactivation 4 times or more in D -/R + group was 4/16, significantly higher than that of D +/R + group (4.7%, 3/64, P=0.01). The incidences of refractory CMV DNAemia (14/16 vs. 56.3%, P=0.021) and CMV disease (4/16 vs. 4.7%, P=0.01) in D -/R + group were both higher than those in D +/R + group. In addition, the application of CMV-CTL as the second-line antiviral treatment in D -/R + group was more than that in D +/R + group. Univariate analysis and multivariate analysis suggested that CMV serological negativity is an independent risk factor for refractory CMV DNAemia and the duration of CMV infection. The cumulative incidence of aGVHDⅡ-Ⅳ, cGVHD, 3-year probability of NRM, overall survival, and the cumulative incidence of relapse were all comparable in two groups. Conclusions:Although there is no significant effect on OS and NRM, the incidence of refractory CMV DNAemia, the frequency of virus reactivation, and the development of CMV disease in D -/R + group are higher than those in controls. Therefore, CMV seropositive donors are preferred for CMV seropositive patients.

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.

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.