To compare the clinical features and prognosis in patients with cytomegalovirus pneumonia from other pneumonia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 118 patients with pulmonary complications after allo-HSCT from March 2016 to June 2019 were analyzed retrospectively, who were divided into cytomegalovirus (CMV) pneumonia group ( n=34) and the non-CMV pneumonia group ( n=84). Compared with non-CMV pneumonia group, CMV pneumonia group presented earlier median onset time (1.8 vs.6.0 months, P=0.015) after allo-HSCT, more dyspnea (41.2% vs. 19.0%, P=0.012), hypoxemia (38.2% vs. 13.1%, P=0.006), and interstitial pneumonia (82.4% vs. 23.8%, P<0.01).The incidence of CMV-viremia and serum viral load in CMV pneumonia group were significantly higher than those in non-CMV pneumonia group. Consistently, and the development of mixed infection in CMV pneumonia group was higher than that of non-CMV pneumonia group (41.2% vs. 16.7%, P=0.013). The median follow-up time was 12.8 (0.4-46.5) months. The 1-year attributable mortality in CMV pneumonia group was significantly higher than that in non-CMV pneumonia group (26.5% vs. 10.7%, P=0.004), while the 1-year overall survival rate was significantly lower than that in non-CMV pneumonia group (61.8% vs. 85.7%, P=0.001). Reduced-intensity conditioning (RIC)( P=0.036), high flow ventilation ( P=0.033) and negative CMV-viremia ( P=0.009) were unfavorable prognostic factors of patients with CMV pneumonia. Compared with those with non-CMV pneumonia, patients with CMV pneumonia had more characteristic clinical manifestations and imaging features. However, due to the higher incidence of mixed infections, the causes of pneumonia need to be identified by bronchoscopic alveolar lavage. In conclusion, patients with CMV pneumonia have worse clinical outcome. RIC, high flow ventilation and negative CMV-viremia are adverse prognostic factors for CMV pneumonia.

Adolescent ; Adult ; Bone Marrow ; pathology ; Bone Marrow Examination ; methods ; Child ; Child, Preschool ; Female ; Hematologic Neoplasms ; diagnosis ; pathology ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Middle Aged ; Retrospective Studies

The mechanics of a new shape memory alloy cervical hook for atlantoaxial instability was analyzed with finite element method on the basis of a three-dimensional model reconstructed from the images of CT scanning of an adult cadaveric upper cervical at 1-mm interval. The stress and displacement of every nodule and element in the course of deformation of the internal fixation were tested, and the results showed that the cervical hook was strong enough against tensile stress, which concentrates in the middle of the device. The pull was 237.58 N at the loading point. With such mechanical performance, this cervical hook can be reliable for correction of atlantoaxial instability.
Adult ; Alloys ; Atlanto-Axial Joint ; Cadaver ; Finite Element Analysis ; Humans ; Joint Instability ; diagnostic imaging ; surgery ; Male ; Memory ; Orthopedic Fixation Devices ; standards ; Orthopedic Procedures ; instrumentation ; methods ; Radiography ; Reproducibility of Results ; Tensile Strength

Craniofacial Dysostosis ; Humans ; Receptors, Fibroblast Growth Factor

ATP Binding Cassette Transporter, Sub-Family G, Member 2 ; ATP-Binding Cassette Transporters ; antagonists & inhibitors ; genetics ; Adenoviridae ; genetics ; Breast Neoplasms ; therapy ; Cell Line, Tumor ; Drug Resistance, Multiple ; Drug Resistance, Neoplasm ; Gene Silencing ; Humans ; Mitoxantrone ; pharmacokinetics ; Neoplasm Proteins ; antagonists & inhibitors ; genetics ; RNA Interference ; RNA, Small Interfering ; pharmacology

OBJECTIVETo analyse the clinical features, diagnostic methods and risk factors of cytomegalovirus (CMV) enteritis after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSAnalysis was made on 24 cases of CMV enteritis after allo-HSCT in Beijing Daopei Hospital from Aug. 2007 to Jul. 2009, including clinical data, endoscopic diagnosis, histopathological and virological results, and the association between CMV enteritis with viremia and graft-versus-host disease(GVHD).

RESULTS87.5% of the patients were over 18 years old. The median time to diagnosis of CMV enteritis was 63 days after HSCT. The mucosal lesions in enteroscopic examination had no significant differences between CMV enteritis and gastrointestinal GVHD complicated with the enteritis. The methods used in diagnosis included histopathology (32.1%) and virology (92.9%). The copies of CMVDNA in mucosal samples greater than 10(5)/10(6) PBNC was better diagnosis. A number of risk factors were compared between the survival and death groups: type of transplant, conditioning regimen, the time span of ganciclovir prophylaxis therapy, grade II-IV GVHD before enteritis, the time of diagnosis as GVHD, using MP > or = 1 mg/kg to treat GVHD, the time between GVHD and enteritis, CMV viremia before enteritis, the time of diagnosis as enteritis, CMVDNA quantitation, and there were no any statistic differences.

CONCLUSIONCytomegalovirus enteritis should be carefully diagnosed by histopathology and virology through endoscopic examination. It is better to undertake pan-colon endoscopy as well as terminal ileum examination for more accurate diagnosis. PCR can significantly improve the detection rate. CMVDNA detection in patients' stool may be helpful to diagnosis, especially for those patients who can not stand the endoscopy examination.

Adolescent ; Adult ; Cytomegalovirus ; Cytomegalovirus Infections ; etiology ; DNA, Viral ; isolation & purification ; Enteritis ; etiology ; virology ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Male ; Risk Factors ; Young Adult

OBJECTIVETo study the clinicopathologic features of follicular dendritic cell sarcoma (FDCS) and its differential diagnosis.

METHODSTen cases of FDCS were studied by light microscopy, immunohistochemistry and in-situ hybridization. The clinical features and follow-up information were analyzed.

RESULTSAmongst the 10 cases of FDCS studied, the male-to-female ratio was 1:1. The mean age of the patients was 42 years. Six of them were located in cervical and peritoneal lymph nodes and four in extranodal sites (including tonsil, pelvic cavity, tail of pancreas and spleen). Histologically, the tumor cells had whorled, storiform or diffuse growth patterns. They were spindle in shape and contained syncytial eosinophilic cytoplasm, with round or oval nuclei, vesicular chromatin, distinct nucleoli and a variable number of mitotic figures. Multinucleated tumor giant cells and intranuclear pseudoinclusions were occasionally seen. There was a sprinkling of small lymphocytes and neutrophils within the tumor as well as in the perivascular region. Immunohistochemical study showed that the tumor cells were diffusely or focally positive for CD21, CD23, CD35 and D2-40, but negative for LCA, CD20, CD3, CD1a, HMB45 and CK. Some of them showed EMA, CD68 and S-100 reactivity. In-situ hybridization for Epstein-Barr virus-encoded RNA (EBER) showed positive signals in only one case (which was diagnosed as inflammatory pseudotumor-like FDCS). Of the 7 patients with follow-up information available (duration: 2 months to 39 months; mean: 14 months), 2 cases with paraneoplastic pemphigus died of pulmonary infection at 5 and 7 months respectively. The remaining 5 patients were alive and disease-free after surgical excision (+/- chemotherapy and radiotherapy).

CONCLUSIONSFDCS is a rare low to intermediate-grade malignant tumor. Appropriate application of FDC markers, such as CD21, CD35 and D2-40, would be helpful for arriving at a correct diagnosis. Most cases are associated with good prognosis after surgical treatment, with or without chemotherapy and radiotherapy. Patients with paraneoplastic pemphigus carry a less favorable prognosis.

Adult ; Antibodies, Monoclonal, Murine-Derived ; metabolism ; Dendritic Cell Sarcoma, Follicular ; complications ; metabolism ; pathology ; surgery ; Dendritic Cell Sarcoma, Interdigitating ; pathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Male ; Meningioma ; pathology ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Paraneoplastic Syndromes ; complications ; Pemphigus ; complications ; Receptors, Complement 3b ; metabolism ; Receptors, Complement 3d ; metabolism ; Receptors, IgE ; metabolism ; Tonsillar Neoplasms ; metabolism ; pathology ; surgery ; Young Adult

This study was aimed to analyze the clinical and cytogenetic characteristics of acute leukemia with 11q23/mll rearrangement and explore the reasonable therapeutic principles. Characteristics in general situation, morphology, immunology, molecular biology, cytogenetics, treatment and overall survival of 36 cases of acute leukemias with mll gene rearrangement were studied and analyzed. The results showed that 36 cases with mll gene rearrangement were found positive (7.2%) in 494 patients with acute leukemia. Among the 36 cases of mll rearrangement positive, 32 cases were diagnosed as acute myeloid leukemia (AML) with myeloid antigen expression, of which 5 cases expressed lymphoblastic differentiation antigen; 4 cases were classified as B-lineage acute lymphoblastic leukemia (ALL), of which non-lineage myeloid expression pattern were found in 3 cases. In 29 out of 36 cases (80%) the clonal chromosomal aberration were detected, of which chromosome 11 aberration were observed in 22 cases. All patients received chemotherapy with a total response rate of 47.2%. Of the responded patients, 10 cases relapsed within 6 months, with a recurrence rate of 40%; 9 cases received hematopoietic stem cell transplantation (HSCT), 7 cases of which survived after transplantation. The median survival time of 36 cases was 16 months (range 2 - 46) and their 2-year overall survival rate was 41.4%. The 2-year overall survival rate of 9 patients who received HSCT was 87.5%. It is concluded that acute leukemia patients with mll gene rearrangement show poor response to chemotherapy, high recurrence rate and poor prognosis. Hematopoietic stem cell transplantation may be a reasonable treatment principle to improve these patients' survival situation.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Hematopoietic Stem Cell Transplantation ; Histone-Lysine N-Methyltransferase ; Humans ; Infant ; Leukemia ; classification ; diagnosis ; genetics ; therapy ; Leukemia, Myeloid, Acute ; diagnosis ; genetics ; therapy ; Male ; Middle Aged ; Myeloid-Lymphoid Leukemia Protein ; genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; genetics ; therapy ; Prognosis ; Survival Rate ; Young Adult

Objective To investigate the professional identity and general self-efficacy in undergraduate nursing students,and explore the correlation between them.Methods Two hundreds and fifteen undergraduate nursing students from one medical university were surveyed by general situation questionnaire,undergraduate nursing students' professional identity questionnaire and general self-efficacy scale questionnaire.Results Two hundreds and fifteen questionnaires were issued and 203 questionnaires were responsive with an effective response rate of 94.4％.The overall score of professional identity in the undergraduate nursing students was (84.50 ± 8.56),which was in the middle level.The score of professional expectation was highest (3.89 ±0.53),and the score of professional affection was lowest (2.75 ± 0.57).The overall score of general selfefficacy was 25.79 ± 4.86,and the general self-efficacy in the undergraduate nursing students was positively related with professional identity (r =0.199,P ＜ 0.001).Conclusions An in-depth understanding in the relationship of professional identity and general self-efficacy among the undergraduate nursing students could help teacher adopt individual coping styles so as to improve nursing students' professional identity and self-efficacy thereby promote the development of nursing.

Objective To investigate the strait-state of anxiety and influence factors of patients awaiting PCI surgery.Methods The general material questionnaire,State-Trait Anxiety Inventory,Social Support Rating Scale and Medical Coping Modes Questionnaire were used to investigate 149 PCI surgery patients.Results Among 149 PCI surgery patients,the number of them with anxiety was 66,the prevalence of anxiety in PCI surgery patients was 44.3％ ; The single factor analysis showed that gender (x2 =51.31,P =0.00),monthly income (x2 =9.06,P =0.029),the score of objective support (t =4.67,P =0.00),the score of subjective support (t =3.22,P =0.00),coping modes (t =2.07,P =0.04),avoidance (t =2.38,P =0.02),resignation (t =4.28,P =0.00) were associated with anxiety of patients awaiting PCI surgery.Multiple Logistic regression showed that the influencing factors of anxiety in PCI surgery were gender,subjective support and objective support (P ＜ 0.05).Conclusions The prevalence anxiety in patients awaiting PCI surgery is higher than norms,so we should focus on the nursing intervention models in order to promote the whole health of patients,and improve their satisfaction for doctors and nurses.