AIM: To investigate the sequence expression o f CD158 molecule after tacrolimus (FK506), mycophenolate mofetil (MMF) combined with methylprednisone (MP) treatment for refractory chronic graft-versus-host di seases (cGVHD). METHODS: The efficacy and the side effect were observed in 6 chi ld patients with extensive cGVHD after allogeneic hematopoietic stem cell transp lantation treated with the combination of FK506, MMF and MP, meanwhile the chang es of the CD158 expressions on T lymphocytes and NK cells in peripheral blood be fore and after treatment were observed. RESULTS: The expression of CD4+CD158a+ and CD4+CD158b+ were very low before and after transplantation and treatment, there was no stati stical significance. The expression of CD3+CD158b+ and CD3+CD8+CD158b + were 4.97%?2.36% and 4.58%?2.90% respectively in five patients with acut e GVHD, and there was statistical significance compared with that of before-tran splantation (P

15.6 ?mol/L. Group B, 55 cases, Hcy≤15.6 ?mol/L). The Hcy, FBG, TC, TG, HDL-C, LDL-C, LP(a) and UA of both groups were compared. Results The concentration of FBG,LP(a) and UA of group A was higher than that of group B (P

OBJECTIVE To investigate the characteristic and prognosis of nosocomial infection in children patients with malignances during deficiency stage of neutropenia. METHODS The clinical characteristic of infections and efficiency of antibiotics were analyzed retrospectively in 174 malignances children with nosocomial infection from Jan 2000 to Jun 2005. RESULTS The incidence rate of nosocomial infection in children patients with malignances during deficiency stage of neutropenia was 67.4%.Nosocomial infection was occurred mainly in the respiratory tract,oral cavity,blood,skin,and intestinal tract of patients.The main pathogens were bacteria(86.8%),and fungal infection was 13.2%.The Gram-negative bacilli were relatively sensitive to imipenem,amikacin,ceftazidine,piperacillin/tazobactam,and ticarcillin/clavulanic acid.The Gram positive cocci were sensitive to vancomycin,imipenem,meropenem,ampicillin/sulbactam,ciprofloxcin and clindamycin.The death rate due to nosocomial infection was 44.4%. CONCLUSIONS There is higher incidence of nosocomial infection in children patients with malignances during the neutropenia stage.Good nursing,intestines disinfection,the usage of granulocyte colony-stimulating factor,a reasonable usage of antibiotics and preventing the fungal infection are good to control nosocomial infection in children malignances.

Objective To investigate the efficacies of preoperative location with titanium clip and methylene blue staining in laparoscopic colectomy.Methods The clinical data of 31 patients with colorectal polyps which could not be resected under endoscope were admitted to the Third Affiliated Hospital of Sun Yat-Sen University from August 2006 to September 2012 were retrospectively analyzed.According to the methods of preoperative location of colorectal polyps,all patients were divided into the titanium clip group (18 patients) and the methylene blue group (13 patients).Titanium clip group:enteroscopic and pathological examination were firstly performed,and then 1 or 2 titanium clips were placed at the superior and inferior part of the polyps.After enteroscopic examination,abdominal X ray examination was performed to detect the position of polyps according to the positions of the titanium clips.Methylene blue group:after colonoscopy,methylene blue of 1 mL was injected into the adjacent mucosa of the polyps,and 4 positions around the polyps were selected for the injection of methylene blue.If the 2 locating methods were failed,intraoperative enteroscopy was performed.Laparoscopic resection for intestine or mesenterium was performed according to the treatment principle of colorectal neoplasms,and the location efficacy of the 2 methods and the treatment of the 2 groups were analyzed.The measurement data and the count data were analyzed using the t test and chi-square test,respectively.Results The success rates of the titanium clip group and the methylene blue group were 15/18 and 8/13,with no significant difference between the 2 groups (x2=0.284,P ＞0.05).The polyps in 8 patients which were failed to be localized by titanium clip or methylene blue were localized by intraoperative enteroscopy,while the operation time was prolonged to (44 ± 13)minutes.No positioning errors were detected in all the 31 patients.Laparoscopic right colectomy was performed on 4 patients,laparoscopic left colectomy on 11 patients,laparoscopic sigmoid colectomy on 9 patients,laparoscopic anterior resection of rectum on 7 patients.No morbidity or mortality was detected in the 2 groups.The length of specimen,distance between the proximal margin and the superior margin of the tumor,distance between the distal margin and the inferior margin of the tumor (patients with colonic polyps),distance between the distal margin and the inferior margin of the tumor (patients with high rectal polyps),and the number of lymph node resected were (20 ± 7) cm,(11 ± 4) cm,(8.6 ± 3.1) cm,4.2 ± 1.1,8 ± 5 in the titanium clip group,and (20 ± 5) cm,(9 ± 3) cm,(9.1 ± 2.8) cm,4.6 ± 0.5,7 ± 6 in the methylene blue group,with no significant difference between the 2 groups (t =0.053,0.918,0.213,1.486,0.267,P ＞0.05).Fifteen patients had cancerization of the polyps,including 8 patients with TNM Ⅰ stage,6 with TNM Ⅱ] stage and 1 with TNM Ⅲ stage.Conclusions For patients with colorectal polyps located at the intestine above the descending colon,titanium clip locating is easy,safe and effective,and it could be the first choice for locating the colorectal polyps.Endoscopic methvlene blue staining is simple but high technique demanding.Intraoperative enteroscopy is precise for locating the polyps at the intestine below the descending colon.

BACKGROUND: Hemorrhagic cystitis (HC) is one of common complications in patients undergoing hematopoietic stem cell transplantation (HSCT). It is of great value for improvement in the HSCT outcome to describe the clinical characteristics of HC and risk factors. OBJECTIVE: To investigate the incidence of HC in children after HSCT, and to analyze its clinical characteristics and risk factors.DESIGN: Case analysis SETTING: Center of Hematopoietic Stem Cell Transplantation, Department of Pediatrics, Second Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: Experiments were performed at the Center of Hematopoietic Stem Cell Transplantation, Department of Pediatrics of Second Affiliated Hospital of Sun Yat-sen University from October 1998 to June 2004. Eighty-eight patients receiving umbilical cord blood transplantation (UCBT) and peripheral blood stem cell transplantation (PBSCT) were enrolled; 49 were males and 39 were females. The age ranged from 2 to 18 years with an average of 8.0 years. Guardians of child patients signed informed consents. The experimental procedures were approved by Medical Ethics Committee.METHODS: ①Conditioning regimens included combination of cyclophosphamide (CY, 120-200 mg/kg) with busulphan (BU, 14-20 mg/kg)-based chemotherapy and combination of CY with total body irradiation (TBI, 2-8 Gy) or total lymphoid irradiation (TLI, 2-8 Gy)-based radiotherapy. ②HC was defined according to the criteria proposed by references 7 and 8. The incidence, clinical characteristics, laboratory examination, treatment and outcome for HC were described. The association of various clinical factors including age, gender, human leucocyte antigen (HLA) typing, diseases for transplant, the type of stem cell, the type of transplantation, the occurrence of acute graft-versus-host disease (aGVHD) and cytomegalovirus (CMV) infection with the development of HC were examined.MAIN OUTCOME MEASURES: ①Incidence of HC, ②HC patient characteristics and laboratory examination, ③HC treatment and outcome, and ④risk factors analysis. RESULTS: All 88 patients were included in the final analysis. ①The incidence of HC: 16 patients (18.2%, 16/88) developed HC post-transplant with the severity graded as mild in 11 cases (68.7%) and severe in 5 cases (31.3%). ②HC patient characteristics and laboratory examination: All had hematuria and 8 cases (50.0%) had typical pollakisuria, urinary urgency, odynuria and gross hematuria; 10 cases (62.5%) had gross hematuria and 11 had proteinuria (+ to +++); Leucocytes were detected in 7 cases. ③Treatment and outcome: All patients recovered at a median of 13.5 days (range 2-53 days). ④Risk factors analysis: The incidence of HC was significantly higher in the group of ≥ 6 years old, presence of aGVHD and development of cytomegalo-virus (CMV) infection (P < 0.05-0.01). CONCLUSION: ①HC has its own clinical characteristics following HSCT in children but with good prognosis. ②The risk factors for HC are ≥ 6 years old, presence of aGVHD and CMV infection.

Objective To evaluate the preoperative nutritional status of patients with gastric carcinoma by using the European Nutritional Risk Screening 2002(NRS 2002)and its prediction for postoperative nutrition-related complications.Methods We prospectively evaluated the nutritional risk of 314 gastric cancer patients admitted in one center from 2004 to 2007 with NRS 2002 with China's normal body mass index(BMI),in terms of postoperative complications,mortality and hospital stay.Results NRS 2002 scoring system was applicable in 93.1% cases.Preoperatively 125 patients were of score≥3,accounting for 39.8% of this group.The postoperative complication rate(26.2%)was higher than 13.8% in those with normal preoperative nutritional scores(NRS 2002 score＜3)(P＜0.05);The odds ratio to develop a complication was 0.642 in patients with preoperative nutritional risk score(P＜0.05),and 1.596 in patients with clinicopathological stage of gastric cancer(P＜0.01).The correlation between length of hospital stay and nutritional risk was also assessed by Pearson correlation analysis.The Pearson coefficient was 0.177(P=0.002).Conclusion Preoperative nutrition score(NRS 2002)≥3 predicts higher postoperative complications and longer hospital stay.Preoperative nutritional support is necessary in patients with preoperative nutrition score(NRS 2002)≥3.

Objective To investigate the association between body mass index(BMI),waist circumference(WC),waist hip ratio(WHR) and the risk of colorectal adenoma,which was considered as a precancerous lesion.Methods Subjects aging from 25 to 88 years old who underwent colonoscopy at Tongji Hospital from December 2006 to December 2007 were selected and assigned into the adenoma group( n =250) and the control group(n=289) according to the findings of the colonoscopy.The body height,weight,waist and hip circumference of every subject were measured respectively.The logistic multi-factors regression analysis was applied to analyze the data.Results When obesity was determined by BMI or WC,the risk of adenorrm in pure obesity group and abdominal adiposity group was 2.48(95%CI = 1.19～5.20,P<0.05) and 1.75(95%CI=1.15～2.66,P<0.01 ),respectively.The corresponding value in male was 4.10(95%CI = 1.26～13.31,P<0.05) and 1.70(95%CI = 1.00 -2.88,P<0.05).The risk of advanced and non-advanced adenoma in pure obesity was 2.71(95%CI=1.01～7.29,P<0.05 ) and 2.39(95%CI=1.05～5.47,P<0.05) ; the risk of non-advanced adenonm in abdominal adiposity group was 2.03(95%CI=1.25～3.28,P<0.01),but no significant difference in risk of advanced adenoma was detected.When obesity was determined by WHR,no significant difference was found in any regarding.Conclusion Obesity and abdominal adiposity are associated with the risk of colorectal adenoma,beth advanced and non-advanced,which is more obvious in male.

【Objective】To observe the efficacy and side effects of hematopietic stem cell transplantation with combination of umbilical cord blood(UCB) and neonatal peripheral blood(NPB) in the treatment of β-thalassemia major.【Methods】28 mL NPB was drawn from a HLA identical neonate within 5 hours after his birth to complement stem cell of the UCB he donated for transplantation to his sibling with β-thalassemia major.Various items of hematopoiesis reconstruction were detected in UCB and NPB respectively.After conditioning with chemotherapy by using busulfan 20 mg/kg,cyclophosphamide 200 mg/kg,melphalan 90 mg/m2 and antithymocyte globulin(ATG) 90 mg/kg,the patient received the 53 mL UCB and 28 mL NPB,achieving 5.7×107/kg nucleated cells(NC),93×105/kg CFU-GM and 3.1×105/kg CD34+CD38- cells from his HLA-identical sibling.【Results】Absolute nucleated cell(ANC) reached 0.5×109/L on 14th day post transplant,and platelets reached 20×109/L on 34th day after transplant.The heterozygosity of β-654 mutation point was detected by the PCR-RDB.The sexual chromosome changed from XX pretransplant to XY posttransplant.The patient was free red blood cell transfusion from 14th day post transplant.Her hemoglobin rose progressively from 86 g/L to 110 g/L.The patient survived for 197 days free from disease after transplantation.Following up for 9 months, the donor grew and developed normally.【Conclusion】The NPB contains a lot of stem cells.The transplantation with combination of suitable NPB and UCB is an effective tactics when the UCB cells are deficient.

Objective To investigate the clinical value of nutritional risk screening 2002(NRS2002)and malnutritional universal screening tools(MUST)in the preoperative nutrition risk evaluation of patients with gastric cancer.Methods The preoperative nutritional risk of 3 14 patients who had been admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2004 to December 2007 was assessed by subjective global assessment(SGA),NRS 2002 and M UST,and the influence of nutritional risk on the incidence of postoperative complications and hospital stay was investigated.All data were analyzed by Wilcoxon test,Kappa test and Logistics regression analysis.Results Compared with SGA,the sensitivity,specificity,positive predicting value and negative predicting value were 86.7%,74.2%,86.9% and 73.8% for NRS2002,and were 73.1%,70.6%,74.8% and 68.7% for MUST.Compared with MUST,NRS2002 had a higher consistency with SGA(K_(NRS2002)=0.601,K_(MUST)=0.436).Logistic regression analysis revealed that patients with higher MUST or NRS2002 score had higher incidence of postoperative complications and longer hospital stay.In the aspect of hospital stay,the relative risk of MUST was 2.517,which was lower than 3.426 of NRS2002.The relative risk of MUST was 0.529,which was lower than 0.642 of NRS2002 in the aspect of incidence of postoperative complications.Conclusions NRS2002 and MUST are suitable for preoperative nutritional risk screening of patients with gastric cancer,and the score of NRS2002 or MUST is associated with the incidence of postoperative complications and length of hospital stay.However,NRS2002 is more accurate than MUST in the reflection of nutritional risk of patients with gastric cancer.

Objective To investigate the related risk factors of hair loss in obese patients after laparoscopic sleeve gastrectomy (LSG).Methods The retrospective case-control study was conducted.The clinical data of 54 obese patients who underwent LSG in the East Hospital of Tongji University between November 2013 and June 2015 were collected.All the patients received LSG,and postoperative hair loss of patients was observed.Factors affecting postoperative severe hair loss were analyzed,including gender,age,preoperative body mass index (BMI),postoperative excess weight loss (EWL),total bilirubin (TBil),albumin (Alb),hemoglobin (Hb),iron,zinc,copper,folic acid,vitamin B12 and vitamin D.Observation indicators:(1) follow-up and postoperative hair loss situations:cases with follow-up,follow-up time,cases with hair loss,severity of hair loss,time of hair loss,treatment of hair loss;(2) univariate analysis affecting severity of hair loss after LSG;(3) multivariate analysis affecting severity of hair loss after LSG.Follow-up using outpatient examination and Wechat was performed to detect the changes of BMI and hair loss up to September 2016.Measurement data with normal distribution were represented as (x)±s and comparison between groups was done by the t test.Comparison of count data was analyzed by the chi-square test.Multivariate analysis was done using the Logistic regression model.Results (1) Follow-up and postoperative hair loss situations:all the 54 patients were followed up for 15 months.Forty-two patients had hair loss,including 21 with slight hair loss,10 with moderate hair loss and 11 with severe hair loss.A proportion of hair loss was 6/11 in male and 36/43 in female.The onset time and end time of hair loss were (3.4± 1.4) months and (9.0± 3.6) months,respectively.Of 42 patients,15 took oral medication (6 with ferrous sulfate,5 with decavitamin and 4 with zinc gluconate oral solution) against hair loss,with no obvious improvement.During the follow-up,42 patients stopped hair loss and gradually grow new hair.(2) Univariate analysis affecting severity of hair loss after LSG:gender,postoperative EWL and folic acid were factors affecting severity of hair loss after LSG (x2 =5.161,t =-5.114,4.266,P＜0.05).(3) Multivariate analysis of affecting severity of hair loss after LSG:postoperative EWL and folic acid were independent factors affecting severity of hair loss after LSG (OR=1.039,0.499,95％ confidence interval:1.011-1.068,0.300-0.802,P＜0.05).A prediction accuracy of severity of hair loss after LSG was 85.2％.Conclusion Postoperative EWL and folic acid are independent factors affecting severity of hair loss after LSG.