BACKGROUND: Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is an effective method for treating multiple malignant hematological diseases and hereditary diseases.However,systematic internal organs disorders,especially pulmonary complications,are commonly following allo-HSCT,How to correctly diagnose and treat the coexistence of pulmonary infectious complications and pulmonary noninfectious complications has great importance.OBJECTIVE: To report a case suffered from pulmonary Aspergillus infection coexisted with obliterative bronchiolitis at 1 year following allo-HSCT,and to discuss the prevention,clinical manifestation and treating method by reviewing related literature.METHODS: At 373 days after allo-HSCT,the patient developed fever,dry cough,shortness of breath and dyspnea on exertion A high-resolution computed tomography of chest demonstrated that there were alveolar infiltrating in the upper,middle and lower lobe of the right lung,and the focus of infection was performed further biopsy.RESULTS AND CONCLUSION: The histopathological examination of the sample showed alveolus dilatation,epithelial cells hyperplasia,fibrinous obliteration in alveolar space and peribronchiolar lymphocytes inflammation,which were CD3(+),CD45RO(+),CD20(-),CD79a(-),MPO(-),CD34(-).Aspergillus fumigatus could be seen in the cultured biopsied tissue specimen.Pulmonary function test showed that,air flow obstruction with reduction of forced expiratory volume in one second was 59.27%.The patient was diagnosed as invasive pulmonary Aspergillus infection combined with bronchiolitis obliterans and was treated by caspofungin combined with intravenous voriconazole for invasive aspergillosis,methylprednisolone,azathioprine,intravenous immunoglobulin and azithromycin for bronchiolitis obliterans.At 40 days after treatment,the CT examination showed the focus was absorbed completely.

OBJECTIVETo study the polymorphism of c-Ha-ras 3' variable number of tandem repeat (VNTR) and its relationship with development of postmolar tumor.

METHODSThe cases of hydatidiform mole (HM) were retrospectively analyzed by amplified fragment length polymorphism-polyacrylamide gel electrophoresis. The DNA origin of HM was determined by comparison with the parents' DNA amplified results.

RESULTSAmong the samples from 15 cases, DNA from only paternal origin was found in 2 cases. DNA from both parents was in 13 cases, and of these 13 cases, 2 were found to be had balanced DNA origin, 11 had more DNA form paternal origin than DNA from maternal origin.

CONCLUSIONThe HM which has DNA from both parents origin and predominantly from paternal origin developed to postmolar tumor more frequently.

3' Flanking Region ; genetics ; DNA Mutational Analysis ; methods ; DNA, Neoplasm ; genetics ; Electrophoresis, Polyacrylamide Gel ; Female ; Genes, ras ; genetics ; Humans ; Hydatidiform Mole ; genetics ; Male ; Minisatellite Repeats ; genetics ; Nucleic Acid Amplification Techniques ; Polymorphism, Genetic ; Pregnancy ; Retrospective Studies ; Uterine Neoplasms ; genetics

Objective:To explore the effect of evidence-based nursing best practice in postoperative pain management of neurosurgery patients.Methods:From January to June 2019, a cluster sampling method was used to select 146 neurosurgery patients from Huashan Hospital, Fudan University as the control group. We examined the patient's postoperative pain management status, and applied evidence-based nursing methods to obtain best practice evidence. From July to December 2019, the clinical evidence practice application model of the Australia Joanna Briggs Institute (JBI) Evidence-Based Health Care Center was used to apply evidence to postoperative pain management in neurosurgery patients. From January to June 2020, a cluster sampling method was used to select 146 neurosurgery patients as the observation group for re-examination after the application of evidence. The Modified American Pain Society Patient Outcome Questionnaire (APS-POQ-Modified) was used to investigate the postoperative pain perception beliefs and postoperative pain degree of the two groups of patients. The qualification rate of 146 pain nursing records before and after the application of the evidence was checked and the differences were compared.Results:The scores of 7 items regarding pain perception beliefs in control group were (3.45±1.42) , (3.21±1.21) , (3.58±1.53) , (3.37±1.26) , (3.63±1.34) , (3.55±1.06) , (3.45±1.35) , and those of observation group were (2.44±1.31) , (2.35±1.21) , (2.34±1.35) , (3.06±1.17) , (2.57±1.25) , (3.05±1.02) , (3.12±1.42) , the differences between the two groups were statistically significant ( t=6.346, 6.057, 7.350, 2.166, 6.994, 4.108, 2.027; P<0.05) . In control group, the current pain degree score was (2.34±0.89) , the most severe pain degree score within 24 hours after operation was (4.44±1.17) , and the average pain degree score within 24 hours after operation was (3.21±0.75) , and the scores in observation group were (1.98±0.96) , (3.54±1.10) , (2.46±0.70) , and the differences were statistically significant ( t=3.355, 6.731, 8.808; P<0.01) . The qualification rate of pain nursing record sheet before and after the application of the evidence was 67.12% (98/146) and 82.88% (121/146) respectively, the difference was statistically significant (χ 2=9.662, P=0.002) . Conclusions:The evidence-based nursing best practice can improve neurosurgery patients' pain perception beliefs, reduce the degree of postoperative pain of patients, and increase the qualification rate of nurses' pain nursing records.

OBJECTIVEThis study was aimed to observe the efficacy of autologous stem cell transplantation (ASCT) for adult patients with acute lymphoblastic leukemia (ALL), and investigate related prognostic factors.

METHODSA total of 86 adult ALL patients underwent ASCT in Institute of Hematology and Blood Disease Hospital from November 2001 to January 2012 were followed up. Clinical characteristics and outcomes of all patients were retrospectively analyzed. Survival and univariate prognosis were analyzed by the Kaplan-Meier method and multivariate analysis by COX regression model.

RESULTSOutcomes were assessed in 81 cases, including 47 standard-risk and 34 high-risk patients. 1-, 3-, 5-, and 10-year leukemia-free survival (LFS) of standard-risk patients were (82.3±5.7)%, (76.9±6.5)%, (74.1±6.8)%, (67.4±8.9)% respectively,and relapse rates (RR) were as of (13.6±5.2)%, (21.6±6.4)%, (24.5±6.8)%, (31.3±9.0)% respectively. 1-, 3-, 5-, and 10-year LFS of high-risk patients were (55.8±8.9)%, (39.8±9.3)%, (39.8±9.3)%, (39.8±9.3)% respectively, and relapse rates (RR) were (38.8±9.2)%, (56.4±10.0)%, (56.4±10.0)%, (56.4±10.0)% respectively. T-ALL, white blood cell count(WBC) more than 30×109/L when first visited, increased LDH, positive fusion gene of TCR and bone marrow transplantation were the adverse prognostic factors. Multivariate analysis showed bone marrow transplantation was an independent adverse prognostic factor.

CONCLUSIONASCT was a choice for adult ALL patients when suitable donors were unavailable.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Transplantation, Autologous ; Young Adult

OBJECTIVETo evaluate the effect of titrated target-controlled infusion with propofol and remifentanil on anesthetics consumption and anesthesia depth in patients undergoing elective laparoscopic colorectal surgery.

METHODSSixty ASA I-III patients for elective laparoscopic colorectal surgery were enrolled. Titrated target-controlled infusion (TCI) with propofol and remifentanil was performed. Plasma concentration of the drugs was administered by titrated method to maintain bispectral index (BIS) in the range of 40-60 with systolic blood pressure (SBP) fluctuation within 20% of the basic value. BIS, SBP, plasma concentration of propofol and remifentanil were recorded at different time points. Awareness during operation was inquired postoperatively.

RESULTSDuring the entire anesthesia period, the blood pressure was stable and BIS was maintained less than 60. There was no awareness during operation. The plasma concentrations (95% confidence interval) for TCI of propofol and remifentanil were 2.55-2.65 mg/L and 4.09-4.26 μg/L respectively when existing surgical stimulation during anesthesia, and the plasma target concentration of propofol was lower than the recommended dosages.

CONCLUSIONTitrated target-controlled infusions with propofol and remifentanil for elective laparoscopic colorectal surgery can maintain proper anesthesia depth and reduce the drug consumption.

Adult ; Aged ; Aged, 80 and over ; Anesthesia, Intravenous ; methods ; Anesthetics, Intravenous ; administration & dosage ; Blood Pressure ; drug effects ; Colorectal Surgery ; Electroencephalography ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Piperidines ; administration & dosage ; Propofol ; administration & dosage

To investigate the difference of liver injury in rats gavaged with crude and processed Polygoni Multiflori Radix. The 75% ethanol extract of crude and processed Polygoni Multiflori Radix (50 g · kg(-1) crude medicine weight/body weight) were continuous oral administered to rats for 6 weeks. Serum biochemical indicators were dynamically detected, the change of liver histopathology was assessed 6 weeks later. Principal component analysis (PCA) was adopted to screen sensitive indicator of the liver damage induced by polygoni multiflori radix. Biochemical tests showed that the crude Polygoni Multiflori Radix group had significant increase of serum ALT, AST, ALP, DBIL and TBIL (P < 0.01 or P < 0.05) and significant decreases of serum IBIL and TBA (P < 0.01 or P < 0.05), while the processed Polygoni Multiflori Radix group showed no obvious changes, compared to the untreated normal group. Histopathologic analysis revealed that crude Polygoni Multiflori Radix group exhibited significant inflammatory cells infiltration in portal area around the blood vessels, tissue destruction and local necrosis of liver cells. There were not obvious pathological changes in processed Polygoni Multiflori Radix group. The results demonstrated that the injury effect of processed Polygoni Multiflori Radix on liver injury of rats was significantly lower than that of unprocessed, and that processing can effectively reduce the hepatotoxicity of Polygoni Multiflori Radix. Traditional transaminase liver function indicators were not sensitive for crude Polygoni Multiflori Radix induced liver damage. The serum content of DBIL and TBIL can reflect the liver damage induced by crude Polygoni Multiflori Radix early and can be sensitive indicators for clinical monitoring the usage of it.
Animals ; Chemical and Drug Induced Liver Injury ; etiology ; Chemistry, Pharmaceutical ; methods ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; toxicity ; Female ; Liver ; drug effects ; injuries ; Male ; Plant Roots ; chemistry ; toxicity ; Polygonum ; chemistry ; toxicity ; Rats

The aim of this study was to investigate the expression of Th17 cells and regulatory T (Treg) cells in peripheral blood of patients with immune thrombocytopenia (ITP) and to clarify the role of the Th17/Treg cell ratio imbalance in pathogenesis of ITP. Patients were divided into the pre-treatment group (active group) (n = 38) and post-treatment group (remission group) according to the platelet count and curative effect. Post-treatment group was further divided into remission group (n = 24), partial remission group (n = 10), and non-remission group (n = 4). 30 healthy subjects were enrolled in control group. Flow cytometry was used to detect the percentages of peripheral blood Th17 cells and Treg cells in CD4(+) T cells from ITP patients and controls respectively. The results showed that the percentages of Th17 cells in active group and non-remission group were significantly higher than those in control group (p < 0.05). The percentages of Th17 cells in remission group, partial-remission group were also higher than those in control group, but there were no statistically significant differences between these groups. The percentage of Th17 cells in remission group was lower than that in active group, but there was also no statistically difference between two groups. The percentages of Treg cells in active group, partial-remission group and non-remission group significantly decreased, compared with in control group (p < 0.01). The percentage of Treg cells in remission group was lower than that in control group, but there was no statistically significant difference. The ratio of peripheral blood Th17/Treg cells in active group, partial-remission group and non-remission group was higher, as compared with in control group. The ratio of peripheral blood Th17/Treg cells in remission group was higher than that in control group, but there was no statistically difference between two groups. It is concluded the percentage of Th17 cells and the ratio of Th17/Treg cells are higher in active group. The percentage of Treg cells is low in active group, partial remission and non-remission groups. The imbalance of Th17/Treg ratio may play a critical role in ITP pathogenesis.
Adolescent ; Adult ; Aged ; Blood Cell Count ; Case-Control Studies ; Female ; Flow Cytometry ; Humans ; Male ; Middle Aged ; Purpura, Thrombocytopenic ; blood ; T-Lymphocytes, Regulatory ; immunology ; Th17 Cells ; immunology ; Young Adult

OBJECTIVETo investigate the effects of lead exposure on the copper concentration in the brain and serum and the expression of copper transporters in the choroid plexus among rats.

METHODSSixty specific pathogen-free Sprague-Dawley rats were randomly divided into a control group and three lead-exposed groups, with 8 mice in each group. The lead-exposed groups were orally administrated with 500 (low-dose group)), 1 000 (middle-dose group), and 2 000 mg/L (high-dose group) lead acetate in drinking water for eight weeks. And the rats in control group were given 2 000 mg/L sodium acetate in drinking water. The content of lead and copper in the serum, hippocampus, cortex, choroid plexus, bones, and cerebrospinal fluid (CSF) was determined by inductively coupled plasma-mass spectrometry (ICP-MS). Confocal and real-time PCR methods were applied to measure the expression of copper transporters including copper transporter 1 (Ctr1), antioxidant protein 1 (ATX1), and Cu ATPase (ATP7A).

RESULTSCompared with the control group, the lead-exposed groups showed significantly higher lead concentrations in the serum, cortex, hippocampus, choroid plexus, CSF, and bones (P < 0.05) and significantly higher copper concentrations in the CSF, choroid plexus, serum, and hippocampus (P < 0.05). Confocal images showed that Ctr1 protein was expressed in the cytoplasm and cell membrane of choroid plexus in control group. However, Ctr1 migrated to CSF surface microvilli after lead exposure. Ctr1 fluorescence intensity gradually increased with increasing dose of lead, except that the middle-dose group had a higher Ctr1 fluorescence intensity than the high-dose group. In addition, the middle- and high-dose groups showed a lower ATX1 fluorescence intensity compared with the control group. Real-time PCR data indicated that the three lead-exposed groups showed significantly higher mRNA levels of Ctr1 and ATP7A compared with the control group (P < 0.05).

CONCLUSIONCopper homeostasis in the choroid plexus is affected by lead exposure to induce copper homeostasis disorders in brain tissue, which may be one of the mechanisms of lead neurotoxicity.

Adenosine Triphosphatases ; Animals ; Brain ; Cation Transport Proteins ; drug effects ; Choroid Plexus ; drug effects ; metabolism ; Copper ; metabolism ; Homeostasis ; Organometallic Compounds ; toxicity ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the risk factors of intestinal acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSThe clinical data of 534 cases of 533 patients undergoing allo-HSCT during Jan 2004 and Sep 2012 were retrospectively analyzed. The effects of donor-recipient HLA mismatching, recipient age, donor age, donor-recipient sex combination, donor-recipient relationship, HSC source, conditioning regimen with or without total body irradiation (TBI) and HLA loci on intestinal aGVHD with different severity were analyzed by Logistic regression.

RESULTSIntestinal aGVHD occurred in 123(23.0%) cases, with 86(16.1%) cases of stage 1 intestinal aGVHD(16.1%) and 37(6.9%) cases of stage 2 to 4 intestinal aGVHD. Multivariate analysis showed that donor-recipient HLA mismatching (OR=2.519, P=0.002), increasing donor age (OR=1.034, P=0.003), female donor for male recipient (OR=1.855, P=0.007) were risk factors for intestinal aGVHD, HLA-B38 (OR=0.256, P=0.032) was its protective factor. Donor-recipient HLA mismatching (OR=2.799, P=0.011), increasing donor age (OR=1.045, P=0.012), HLA-A1 (OR=4.157, P=0.002), A30 (OR=3.143, P=0.005) were risk factors for stage 2 to 4 intestinal aGVHD.

CONCLUSIONOccurrence of intestinal aGVHD and its severity are associated with donor-recipient HLA mismatching, donor age, donor-recipient sex relationships and some HLA loci.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Graft vs Host Disease ; epidemiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Intestinal Diseases ; epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplantation, Homologous ; adverse effects ; Young Adult

Objective: To analyze the morbidity, clinical characteristics, therapeutic outcomes and prognosis of cardiac lymphoma. Methods: Individual patient data were obtained from pathology defined 10 cases of cardiac lymphoma from Jan 2000 to Jun 2016. The patient’s general information, clinical manifestation, pathological diagnosis, laboratory examination, cardiac involvement feature, cardiac complications, treatment, therapeutic effect and prognosis were analyzed. Results: Of 3 918 cases of lymphoma patients, 10 cases of cardiac involvement were identified, including primary cardiac lymphoma (PCL) in 1 case, secondary cardiac lymphoma (SCL) in 9 cases. Of the 10 patients in our analysis, the male-to-female ratio was 3∶2, with a median age of 55 (19-88) years old. The most presenting complaints were dyspnea in 7 cases, followed by chest pain in 5 cases, fatigue in 2 patients and edema in 2 cases. Pathological types included diffuse large B cell lymphoma (DLBCL) in 7 cases, T cell lymphoma (T-LBL) in 1 case, Hodgkin’s lymphoma (HL) in 1 case, and Burkitt lymphoma (BL) in 1 case. The sites of the heart affected by lymphoma in the PCL patient were right and left atriums with multiple nodules; and for SCL, the sites were mainly pericardium associated with a pericardial effusion in 5 cases, a pericardial mass in 2 cases. Congestive heart failure affects 7 patients and cardiac arrhythmias were identified in 4 cases mainly sinus tachycardia, atrial fibrillation and atrioventricular block. Except one untreated because of old age and poor performance, the rest of 9 patients were treated by either chemotherapy in 4 cases or chemotherapy combined radiotherapy (including the extracardiac sites) in 5 patients. With the median follow-up of 9 months, the one PCL patient achieved partial response (PR) , progress free survival (PFS) for 6 months and the overall survival (OS) for 21 months; in the cohort of 6 SCL patients cardiac involved at diagnosis, complete response (CR) was achieved in 1 case (16.7%) , PR in 3 cases, progressing disease (PD) in 2 cases, with the median PFS for 5 months and the median OS for 19 months; and for the other 3 SCL patients cardiac involved at progression, PR was achieved in 2 case and death in 1 case, with the median PFS for 4 months and the median OS unavailable because of censored data. Conclusion Cardiac lymphoma represents a rare subset of lymphoma, the most common type is DLBCL, and the main clinical manifestations are dyspnea and chest pain, always combined by arrhythmia and congestive heart failure. The main therapeutic regimen for cardiac lymphoma includes combined chemotherapy and the prognosis for patients with either PCL or SCL is usually poor.