Objective: To evaluate the impact of KIT D816 mutation on the salvage therapy in relapsed acute myeloid leukemia (AML) with t(8;21) translocation. Method: The characteristics of the first relapsed AML with t(8;21) translocation from 10 hospitals were retrospectively collected, complete remission (CR(2)) rate after one course salvage chemotherapy and the relationship between KIT mutation and CR(2) rate was analyzed. Results: 68 cases were enrolled in this study, and 30 cases (44.1%) achieved CR(2). All patients received KIT mutation detection, and KIT D816 mutation was identified in 26 cases. The KIT D816 positive group had significantly lower CR(2) compared with non-KIT D816 group (23.1% vs 57.1%, χ(2)=7.559, P=0.006), and patients with longer CR(1) duration achieved significantly higher CR(2) than those with CR(1) duration less than 12 months (74.1% vs 31.9%, χ(2)=9.192, P=0.002). KIT D816 mutation was tightly related to shorter CR(1) duration. No significant difference of 2 years post relapse survival was observed between KIT D816 mutation and non-KIT D816 mutation group. Conclusion: KIT D816 mutation at diagnosis was an adverse factor on the salvage therapy in relapsed AML with t(8;21) translocation, significantly related to shorter CR1 duration, and can be used for prediction of salvage therapy response. KIT D816 mutation could guide the decision-making of salvage therapy in relapsed AML with t(8;21) translocation.
Antineoplastic Combined Chemotherapy Protocols ; Cytarabine ; Humans ; Leukemia, Myeloid, Acute/therapy* ; Prognosis ; Retrospective Studies ; Salvage Therapy

BACKGROUNDUrine output (UO) is an essential criterion of the Kidney Disease Improving Global Outcomes (KDIGO) definition and classification system for acute kidney injury (AKI), of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria (KDIGOUO) could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria (KDIGOSCr).

METHODSWe conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a 2-month prospective cohort study (July 1, 2009 to August 31, 2009) involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOUOand KDIGOSCr. Hospital mortality of patients with more severe AKI classification based on KDIGOUOwas compared with other patients by univariate and multivariate regression analyses.

RESULTSThe prevalence of AKI increased from 52.4% based on KDIGOSCrto 55.4% based on KDIGOSCrcombined with KDIGOUO. KDIGOUOalso resulted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AKI classification based on KDIGOUO. Compared with non-AKI patients or those with maximum AKI classification by KDIGOSCr, those with maximum AKI classification by KDIGOUOhad a significantly higher hospital mortality of 58.4% (odds ratio [OR]: 7.580, 95% confidence interval [CI]: 4.141-13.873, P< 0.001). In a multivariate logistic regression analysis, AKI based on KDIGOUO (OR: 2.891, 95% CI: 1.964-4.254, P< 0.001), but not based on KDIGOSCr (OR: 1.322, 95% CI: 0.902-1.939, P = 0.152), was an independent risk factor for hospital mortality.

CONCLUSIONUO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

Acute Disease ; mortality ; Aged ; Creatinine ; blood ; Critical Illness ; mortality ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Kidney Diseases ; blood ; mortality ; pathology ; urine ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Risk Factors

Objective:To observe the effects of ketamine ,fentanyl and propofol intravenous injection on emergency agitation (EA) in children after anesthesia in pediatric surgery .Methods: Ninety children who suffered from emergence agitation (ASA Ⅰ-Ⅱ) after general anesthesia were selected .They aged 2-7 years old ,weighed 12-31 kg ,and the gender was not limited .They were randomly divided into 3 groups:ketamine group (group K) ,fentanyl group (group F) and propofol group (group P) ,with 30 cases in each group .Intravenous injection of ketamine 1 mg/kg ,fentanyl 1 μg/kg and propofol 1 mg/kg in 3 groups were given to three groups respectively .The degree of EA was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) Scale .Pain was assessed using the Children’s Hospital of Eastem Ontario Pain Scale (CHEOPS) and sedation was recorded with Ramsay score .The respiratory depression (SpO2 <90% ) ,the children who need breath control by hand ,re-EA and duration of patient stay in post anesthesia care unit (PACU) after treatment were also recorded .Results:PAED and CHEOPs scores significantly decreased and Ramsay scores significantly increased in all groups (P< 0 .05) after treatment .But PAED and CHEOPs values in group K was lower than that in the other two groups (P<0 .05) ,and Ramsay values were higher in group K than those in the other two groups(P<0 .05) .PAED score of group K was lower than that of F group and P group (P<0 .05) ,CHEOP score was lower than P group (P<0 .05) ,and Ramsay sedation score was higher than F group and P group (P< 0 .05) .The percent of respiratory depression ,re-EA and duration of patient stay in PACU was lower in group K than in the other two groups after treatment .Conclusions:1 mg/kg ketamine can safely and effectively treat the occurrence of EA in children after general anesthesia , and the incidence of adverse reaction is less than fentanyl and propofol .

Our previous studies have demonstrated that Fam20C promotes differentiation and mineralization of odontoblasts, ameloblasts, osteoblasts and osteocytes during tooth and bone development. Ablation of the Fam20C gene inhibits bone and tooth growth by increasing fibroblast growth factor 23 in serum and causing hypophosphatemia in conditional knockout mice. However, control and regulation of the expression of Fam20C are still unknown. In this study, we generated a transgenic reporter model which expresses green fluorescence protein (GFP) driven by the Fam20C promoter. Recombineering was used to insert a 16 kb fragment of the mouse Fam20C gene (containing the 15 kb promoter and 1.1 kb of exon 1) into a pBluescript SK vector with the topaz variant of GFP and a bovine growth hormone polyadenylation sequence. GFP expression was subsequently evaluated by histomorphometry on cryosections from E14 to adult mice. Fluorescence was evident in the bone and teeth as early as E17.5. The GFP signal was maintained stably in odontoblasts and osteoblasts until 4 weeks after birth. The expression of GFP was significantly reduced in teeth, alveolar bone and muscle by 8 weeks of age. We also observed colocalization of the GFP signal with the Fam20C antibody in postnatal 1- and 7-day-old animals. Successful generation of Fam20C-GFP transgenic mice will provide a unique model for studying Fam20C gene expression and the biological function of this gene during odontogenesis and osteogenesis.
Animals ; Calcium-Binding Proteins ; genetics ; Extracellular Matrix Proteins ; genetics ; Green Fluorescent Proteins ; genetics ; HEK293 Cells ; Humans ; Mice ; Mice, Inbred C57BL ; Mice, Transgenic ; Odontogenesis ; genetics ; Osteogenesis ; genetics

BACKGROUNDAcute kidney injury (AKI) has been recognized as a major healthcare problem affecting millions of patients worldwide. However, epidemiologic data concerning AKI in China are still lacking. The objectives of this study were to characterize AKI defined by RIFLE criteria, assess the association with hospital mortality, and evaluate the impact of AKI in the context of other risk factors.

METHODSThis prospective multicenter observational study enrolled 3,063 consecutive patients from 1 July 2009 to 31 August 2009 in 22 ICUs across mainland China. We excluded patients who were admitted for less than 24 hours (n = 1623), younger than 18 years (n = 127), receiving chronic hemodialysis (n = 29), receiving renal transplantation (n = 1) and unknown reasons (n = 28). There were 1255 patients in the final analysis. AKI was diagnosed and classified according to RIFLE criteria.

RESULTSThere were 396 patients (31.6%) who had AKI, with RIFLE maximum class R, I, and F in 126 (10.0%), 91 (7.3%), and 179 (14.3%) patients, respectively. Renal function deteriorated in 206 patients (16.4%). In comparison with non AKI patients, patients in the risk class on ICU admission were more likely to progress to the injury class (odds ratio (OR) 3.564, 95% confidence interval (CI) 1.706 - 7.443, P = 0.001], while patients in the risk class (OR 5.215, 95% CI 2.798-9.719, P < 0.001) and injury class (OR 13.316, 95% CI 7.507-23.622, P < 0.001) had a significantly higher probability of deteriorating into failure class. The adjusted hazard ratios for 90-day mortality were 1.884 for the risk group, 3.401 for the injury group, and 5.306 for the failure group.

CONCLUSIONSThe prevalence of AKI was high among critically ill patients in Chinese ICUs. In comparison with non-AKI patients, patients with RIFLE class R or class I on ICU admission were more susceptibility to progression to class I or class F. The RIFLE criteria were robust and correlated well with clinical deterioration and mortality.

Acute Kidney Injury ; epidemiology ; etiology ; pathology ; Adult ; Aged ; China ; epidemiology ; Female ; Humans ; Intensive Care Units ; statistics & numerical data ; Male ; Middle Aged ; Prospective Studies ; Risk Factors

Objective: To summarize our experience on perioperative anesthesia management under field condition after Wenchuan Earthquake. Methods: The clinical anesthesia data of 89 patients managed by the earthquake relief team of Changhai Hospital after Wenchuan Earthquake were retrospectively analyzed. The experience of perioperative anesthesia management was summarized. Results: The aneshesia methods included general anesthesia (1 pateint), ketamine anaesthesia with midazolam premedication (16 patients), epidural anesthesia (59 patients), and brachial plexus block (13 patients). All patients in our group were stable during perioperative period without anesthesia complications like respiratory depression, hypotension or oliguria. Conclusion: Under field condition, the principle of anesthesia management is to gaurantee the safety of patients, reduce physical and psychological trauma, and avoid the anesthesia complications. The anesthesia methods should be chosen according to different patients and must be properly applied.

Objective: To evaluate the clinical value of Truview™ EVO2 optic laryngoscope by comparing it with the Macintosh laryngoscope in patients receiving cervical vertebral surgery. Methods: One hundred patients scheduled for elective cervical vertebral surgery were enrolled in this randomized crossover study. After induction, the patients' glottis in group A (n=50) was displayed by Macintosh laryngoscope and the Cormack-Lehane (C/L) grade was recorded, and then optic laryngoscope was employed to display the laryngeal structure. The order of laryngoscopy attempts was reversed in group B (n=50). Parameters recorded included demographics,airway assessment features (BMI, thyromental distance, mandibular size, mouth opening, mallampati oropharyngeal scale,and neck movement), C/L grade, laryngoscopic force applied, duration of intubation, difficulties of laryngeal view and injury of upper airway. Results: There were no significant difference in demographics, airway assessment features,C/L grade and duration of intubation between the 2 groups,whereas the laryngoscopic force in group A was significantly lower than that in group B (P < 0.05). The C/L grade obtained with optic laryngoscope was 69:26:5 (I:II:III),which was significantly better than that with Macintosh laryngoscope (26:46:28,P<0.001). A poor laryngeal view of 5% was obtained with optic laryngoscope,which was significantly better than that with Macintosh laryngoscope (28%, P<0.001). There was significant association between airway assessment features and C/L grade or laryngoscopic force (P<0.05). Conclusion: The Truview™ EVO2 optic laryngoscope has better glottic view and lighter laryngoscopic force than those of Macintosh laryngoscope,and may have potential advantages for managing the difficult airways for cervical vertebral surgery.