The indications for myelodysplastic syndrome (MDS) to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) were established on the basis of FAB diagnosis,International Prognosis Scoring System (IPSS) and World Health Organization Prognosis Scoring System (WPSS).It was recommended that patients of IPSS intermediate risk Ⅱ and of high risk should receive allo-HSCT at diagnosis,and those with intermediate risk Ⅰ and of low risk might benefit from deferred transplantation.Dynamic monitoring of marrow morphology and the risk of disease are needed for appropriate timing of transplant.Patients of intermediate risk and low risk with low platelet count,pneutropenia or blood infusion dependence are indicated for transplantation.The advantage of chemotherapy pre-HSCT in those indicated patients has been controversial.Up to now,there has been few data showing benefit of pre-chemotherapy or hypomethylating therapy.

The clinical features were reviewed for polycythemia vera, primary throbocythemia and primary myelofibrosis. Their indications and rational for allogeneic hematopoietic stem sell transplantation (allo-HCT) were recommended. The outcome after allo-HCT was described briefly. The significance of JAK2 mutation, especially V617F, detected for the minimal residual disease was introduced.

The indications for patients with Myelodysplastic Syndrome (MDS) to receive allogeneic hematopoietic stem cell transplantation (Allo-HCT) are:intermediate risk-2 and high risk groups according to IPSS,and intermediate risk-1 group with poor karyotype,severe multilineage cytopenia or infusion-dependent.Constant follow-up and evaluation is important for therapeutic decision.Unrelated or related haploidentical donor could be an alternative in case of absence of identical sibling donor.Remission through chemotherapy before the transplantation is recommended in patients with advanced MDS who receive reduced-intensity conditioning.Demethylation drugs followed by Allo-HCT do not show additional transplantation-related toxicity,whose efficiency remains to be determined.

OBJECTIVE:To analyze the blood drug monitoring results of vancomycin and clinical administration behavior and then to provide a clinical reference for its rational utilization. METHODS:We retrospectively collected the blood drug monitoring results of vancomycin and drugrelated information from July 2007 to October 2008 in our hospital. These data were from the electronic clinical pharmacy workstation and initial written case history. RESULTS:Among the 76 cases,non-clinical significant results due to doctor’s irregular manipulation in collecting blood sample accounted for 32.89%. In renal failure group,the rate of peak concentration above the effective blood concentration range was 44.46% . Every patient was averagely administered 21.85 kinds of drugs mainly by intravenous injection during vancomycin application. Clinical response rate of vancomycin was 65.00%. CONCLUSION:During the blood concentration monitoring of vancomycin,we should take clinical need into consideration,collect blood samples rightly,consider the factors such as special pathophysiologic status of patients,drug combination,and adjust the dosage timely.

Objective To study the value of c-reactive protein (CRP) level in the diagnosis and efficacy evaluation of clinical complications in patients after bone marrow transplantation.Methods Sixty-six patients with different complications after bone marrow transplantation were included and CRP levels were tested.The relationship between CRP levels and corresponding clinical complications were analyzed.Results The levels of CRP were significantly different in different complications after the bone marrow transplantation.CRP may marketly increase in the patients with bacterial infection,bacteria-associated mixed infection,ultra-acute GVHD,and ATG reaction;CRP may mildly increase in patients with bacterial infection,fungal infection,bacteria-associated mixed infection,acute/chronic GVHD;CRP did not increase in the patients with viral infection.CRP level reached the highest value in patients with most obvious clinical symptoms of bacterial infection,gradually decreased in patients after effective treatment,those restored to normal but then increased CRP always indicated new clinical complications.Conclusion CRP is a valuable mark for the early differential diagnosis and efficacy of therapy for complications in patients after bone marrow transplantation.

20.0?109/L was day 13(11~21).All the patients got engraftment successfully and attained CR.Acute Ⅰ~Ⅱ GVHD occurred in 5 patients,no acute Ⅲ~Ⅳ GVHD occurred and extensive chronic GVHD did in 2 patients.All the patients were alive and only one patient relapsed after 3~53 months follow-up.Conclusion TBI-based conditioning regimen appears to be safe and effective for non-T-depleted HLA mismatched hemotopoietic stem cell transplants,especially for high-risk and second transplant patients.

Objective To investigate the effect of bone morphogenetic protein-7 (BMP-7) on high glucose-induced expression of fibronectin (FN) and collagen Ⅳ (Col Ⅳ) and activity of nuclear factor-?? (NF-??) in human renal tubular epithelial cells. Methods Human renal tubular epithelial cells (HKCs) in culture were divided into 5 groups: normal glucose group with 5.5 mmol/L glucose (NG), high glucose group with 25 mmol/L D-glucose (HG), HG+100 ng/ml BMP-7, NG+100 ng/ml BMP-7 and high osmolality group with 25 mmol/L mannitol (HM). Thus HKCs were respectively stimulated with high glucose, high mannitol and BMP-7. Expression of collagen Ⅳ and fibronectin was determined by immunocytochemistry and enzyme linked immunosorbent assay (ELISA) and activity of nuclear factor-?? was assessed with electrophoretic mobility shift assay (EMSA). Results Compared with normal glucose, high glucose concentration up-regulated expression of FN and Col Ⅳ and activity of NF-?? (P0.05). With addition of BMP-7 in a concentration of 100ng/ml to the high glucose medium, expression of Col Ⅳ and FN was suppressed, and the activity of nuclear factor-?? was inhibited in human tubular epithelial cells (P

Objective Monitoring the thyroid hormone levels in patients before and after renal transplantation to realize the relationship between thyroid hormones and renal function.Methods Fifty-seven patients were subdivided into stabled graft function group (50 cases) and delayed graft function (DGF) group (7 cases).Thirty healthy men served as control group.Serum triiodothyronine (T3),thyroxine (T4),thyroid-stimulating hormone (TSH) and serum creatinine (Scr) were determined respectably before transplantation and on different days after transplantation.Correlations between thyroid hormones and Scr at 10th day after transplantation were analyzed.Results Serum T3 and T4 levels before transplantation in the two groups were significantly lower than those in the control group (P＜0.01).These four parameters levels had no significant difference between stabled graft function group and DGF group (P＞0.05).In stabled graft function group:T3 level was decreased obviously by 30％ in the 1st day after transplantation,which was higher than the others,elevated at the 1st week post-transplantation,reached the normal range.at the 2nd week post-operation,and higher than pre-transplantation (P ＜ 0.01) at 3rd week; T4 revealed a decrease trend after transplantation and was elevated at 10th day post-transplantation,returned to the pre-transplantation level at 3rd week; TSH had slight decrease after operation,and had no significant difference among every period in comparing with pre-transplantation; Scr revealed a decrease trend continuously and returned to the normal level at the 7th day post-transplantation.In DGF group,Hormones levels were obviously decreased as compared with stabled graft function group; T3 reached the normal range at the 3rd week post-transplantation,whereas T4 returned to pre-transplantation levels at the 30th day; TSH had a significant decrease at the 5th day,and began to increase at the 10th day post-operation; Scr retuned to the normal range at the 30th day post-operation.The correlation coefficients between Scr and T3,T4 were 0.546 and 0.423 respectively.Conclusion There is a significant correlation between thyroid hormones and renal function (T3,T4).Monitoring the thyroid hormones,specially T3,can diagnose renal function change.

OBJECTIVE To analyze the antimicrobial therapeutic schemes in appendectomy inpatients so as to(evaluate) the economic impact factors of each project.METHODS Totally 286 medical cases of appendectomy inpatients were chosen and analyzed from 2003 to 2005.The antimicrobial agent costs of each scheme were evaluated by(using) cost minimization analysis of pharmacoeconomic method.RESULTS There were 24 kinds of antimicrobial therapeutic schemes used by 286 cases.The commonest schemes were nitrodazoles + ?-lactams and nitrodazoles + ?-lactams + aminoglycosides(or clindamycin). The drug costs were 1671.46 and 1977.13 yuan(RMB)(individually) in combination of two or three kinds of antimicrobial agents.Choosing metronidazole instead of ornidazole could reduce drug fee significantly,which was also observed in choosing ceftazidime instead of other ?-lactams.CONCLUSIONS The antimicrobial drug utilization in our hospital is rational as a whole.Considering of economic factors,using metronidazole and ceftazidime(administering clindamycin if necessary) may be better than other schemes for prventing wound infection.

Objective:To analyze the hospitalization expenses in inguinal hernia inpatients under the single-disease payment standard of medical insurance.Method:A retrospective study was performed to analyze the data of inguinal hernia patients who received inguinal herniorrhaphy in 2006.According to the regulations worked out by the Beijing Medical Insurance Affairs Administration,32 cases were selected and their medical costs were characterized.Result:The average hospitalization expense in inguinal hernia patients was 5722.37?2967.66 yuan,including surgery cost(45.6%) and drug cost(26.7%).The surgery cost level depended on the selection of various hernia prosthetic mesh and the drug cost depended on the selection of various anti-infective drugs.The hospitaliztion expenditures were lower in 18 cases than the payment permission in the medical insurance standard but higher in the other 14 cases.The sex composition,surgery cost, drug cost and laboratory cost showed a significant difference between the two groups(P