Objective:To explore the role of PDCA cycle in the standardized residency training in the department of hematology.Methods:Thirty residents trained in the department of hematology of Peking University Third Hospital from January 2019 to September 2019 were enrolled into experimental group, and 36 residents trained from January 2018 to December 2018 were enrolled into control group. Experimental group received the PDCA cycle teaching method and control group did the traditional one. At the end of the training, the results of theory examination and practical operation skills examination of the two groups were compared. The statistical significance was analyzed on the assessment scores and teaching satisfaction between the two groups. SPSS 20.0 was used for t test. Results:Compared with the control group, the examination scores and teaching satisfaction of the residents in the experimental group were higher than those in the control group ( P < 0.05). Conclusion:The teaching mode of PDCA cycle is conducive to improving the effect of standardized residency training in the department of hematology.

Objective:To analyze the characteristics of hospital infection of hematological disease, so as to provide reference for clinical therapy. Methods: Bacterial strains and antimicrobial resistance of pa-tients with hospital infection in Department of Hematology, Peking University Third Hospital from Jan. 2011 to Dec. 2013 were identified and analyzed retrospectively. The specimens were from their blood, urine, sputum, throat swabs and etc. Results:Among the total of 168 isolates of bacteria,the majority of the bacteria strains were from sputum (42. 9%);114(67. 9%) bacteria strains were gram negative and 54(32. 1%) bacteria strains were gram positive;the pathogen testing showed that 20. 8% were Pseudo-monas aeruginosa,18. 5% Escherichia coli,17. 9% Staphylococcus aureus, 9. 5% Klebsiellar pneumonia, 5. 9% Staphylococcus epidermis and 27. 4% other bacteria ;The gram negative bacilli to cefepime, ami-kacin and carbapenems showed the lowest antimicrobial resistance rates, and S. aureus showed the lowest antimicrobial resistance rates to vancomycin and linezolid. Conclusion:Patients with hemopathy are the main population of hospital infections, the gram negative bacteria are the most common pathogens. It is very important to promptly know the change in distribution of the pathogens in order to rationally select antibiotics and reduce the incidence of bacterial infections.

ObjectiveTo analyse treatments and prognostic factors of T cell non-Hodgkin lymphoma (T-NHL). MethodsNinety-one patients with T-NHL were retrospectively analyzed, and clinical features,histopathology, laboratory data were included in Kaplan-Meier and prognostic analysis. Results Median age was 38 years,58 (63.7 ％) had high-intermediate and high risk by IPI,72 (79.1％) presented with advanced stage disease,extranodal disease was present in 64.8 ％ of patients.The overall response rate (ORR) for the whole group was 63.8 ％,and the estimated 3,5-year ORR were 55.5 ％,41.3 ％ respectively.Compared with CHOP-like regimen, the addition of etoposide could improve the survival of patients, meanwhile radiation therapy could improve the outcome of patients with NK/T cell lymphoma and mediastinal bulky disease, and consolidation chemotherapy with HSCT could improve the survival and reduce the recurrence of patients.Clinical stage,B symptoms,ECOG score,the level of LDH,extranodal involvment,anemia,initial treatment outcome, IPI score, the level of serum albumin and fibrinogen were predictive to overall survival. Cox multivariate analysis showed initial treatment outcome and B symptoms were independent prognostic factors.IPI and m-PIT were useful for stratified patients into different prognostic risk groups. Conclusion T-NHL is a heterogeneous group of malignancies with an inferior long term outcome. New treatment modality needs to be explored for these patients,and new drugs and HSCT may be good choices.

Objective To analyse the clinical characteristics,treatments and prognosis of the chemotheray-induced lung injury in malignant hematological diseases patients.Methods 26 malignant hematological diseasespatients with chemotheray-induced lung injury were collected.The clinical characteristics,chemotherapy regimen,treatments and prognosis of the patiants were retrospectively analyzed.Results Among 26 patients,10 patients were male and 16 patients were famale.The dignosis were nonHodgkin's lymphoma (16 cases),leukemia (9 cases) and multiple myeloma (1 case).The chemotherapy regimens inducing lung injure probably were R-CHOP,R-BEACOP and BEACOP in lymphoma,while they were HA,AA,DA and IA in leukemia.The symptoms of lung injury in these patients were fever,cough,hemoptysis,dyspnea,fatigue,or asymptomatic radiological examination revealed.Pulmonary diffuse infiltration and shadows were showed in CT scan.21 cases were cured by hormone therapy,5 cases died of lung injury,2 cases died of tumor recurrence after lung injury cured.There was no effect on the quality of life in most cured patients.Conclusion The lung injury induced by chemotherapy has no specific clinical characteristics and diagnostic criteria,and it could progress rapidly to cause death.But early dignosis and early hormonal treatment can obtain good therapeutic effect.The occurrence regularity and clinical characteristics should be studied furtherly.

Objective: This study aimed to investigate the clinical characteristics, treatment options, and prognosis of multiple myeloma (MM) patients complicated with extramedullary plasmacytoma (EMP). Methods:The case of MM concurrent with EMP are rare. During the period between June 2005 and June 2013, clinical experience, diagnosis, and treatment of MM with EMP cases were retrospectively analyzed. Results:Fourteen cases were diagnosed with MM complicated with EMP in the Third Hospital of Peking Uni-versity, Beijing, China. Among these 14 cases, seven were males and seven were females. The mean age of patients was 56.9 years (ranging from 40 to 80 years old). Nine of the cases were diagnosed with EMP during the preliminary diagnosis, and the remaining five cases developed EMP during the course of treatment. Among the 14 cases, six were solitary EMPs and eight were multiple EMPs. Among the multiple EMP cases, five died, one showed disease progression, and two demonstrated partial regression. Conclusion:The prognosis of MM complicated with EMP is poor. Thus, new treatment strategies should be further explored.

OBJECTIVE:To investigate the compatibility stability of Fat-soluble vitamin (Ⅱ)/Water-soluble vitamin for in-jection with common electrolytes. METHODS:Referring to clinical common dose,Fat-soluble vitamin (Ⅱ) for injection/Wa-ter-soluble vitamin for injection collective packing [containing Fat-soluble vitamin(Ⅱ) for injection 2 ampoules and Water-soluble for injection 1 ampoule] were respectively mixed with Glucose injection,Potassium chloride injection,Concentrated sodium chlo-ride injection,Sodium bicarbonate injection,Potassium aspartate injection,Potassium aspartate and magnesium aspartate injection, Sodium glycerophosphate injection,Multi-trace elements injection (Ⅱ) to obtain mixture A-H. At room temperature (25 ℃),these mixtures were investigated in terms of appearance,pH value,osmotic pressure molar concentration and the number of insolu-ble particles at 0,1,2,3,4 h. The contents of bacterial endotoxin were tested at 0,4 h. RESULTS:Within 4 h after mixing, there was no significant change in appearance of those mixtures;pH value of mixture H changed greatly (RSD=5.13%,n=5), and that of mixture D and G increased significantly. The osmotic pressure molar concentration of those mixtures had no significantly change(RSD<2%,n=5)and lower than 600 mOsmol/kg. The bacterial endotoxin tests of those mixtures were negative. Two and four hours after mixing,the number of insoluble particles ≥10 μm in mixture B was increased significantly;2,3,4 h after mix-ing,the number of insoluble particles ≥10 μm in mixture E,F,H were increased significantly;0 ,1,2,3,4 h after mixing,the number of insoluble particles ≥10 μm in mixture G was increased significantly. There was statistical significance in the number of insoluble particle ≥10 μm in above mixtures compared to mixture A at the same time point(P<0.05),but it was in line with the standard of 2015 pharmacopeia. One,two,three and four hours after mixing,the number of insoluble particle ≥10 μm in mixture D was increased significantly,there was statistical significance compared to mixture A at the same time point(P<0.05);the num-ber of insoluble particle ≥10 μm in mixture D was beyond prescribed scope of pharmacopeia at 2,3,4 h after mixing. Within 4 h after mixing,both the number of insoluble particle ≥10 μm in mixture C and the number of insoluble particle ≥25 μm in edch mixture had no significant change,in accordance with pharmacopeia standard. CONCLUSIONS:Fat-soluble vitamin (Ⅱ)/Wa-ter-soluble vitamin for injection is not suitable for mixing with Multi-trace elements injection(Ⅱ),Sodium glycerophosphate injec-tion or Sodium bicarbonate injection due to great change of pH value and the number of insoluble particles.

Objective To analyze the toxicity of dose adjusted-BEACOP (DA-BEACOP,classic CHOP regimen plus etoposide and (or) bleomycin with or without rituximab) regimen for poor-prognosis lymphoma.Methods 89 patients with poor-prognosis lymphoma who had been treated in-patient at Peking University Third Hospital during August 2002 and February 2012 were retrospectively studied.All patients received at least 1 cycle of DA-BEACOP regimen.Results 3-4 grade adverse events were observed in 74 (83.1％) patients,most of which was myelosuppression (73 cases,82.0 ％).There was not death related with the treatment.Compared to male patients,female patients suffered higher rates of grade 3-4 of toxicity (94.2 ％,33/35 vs 75.9 ％,41/54) (P =0.024).The rate of grade 3-4 of hematological toxicity in patients who were pretreated with ≥3 cycles of chemotherapy than that in patients receiving≤2 cycles of chemotherapy (95.9 ％,47/49 vs 75.0 ％,30/40) (P =0.004),while the rate of 3-4 hematological toxicity in pret-radiotherapy posed patients was higher than that in their counterparts who did not receive radiotherapy (95.9 ％,47/49 vs 75.0 ％,30/40) (P =0.022).Conclusion The DA-BEACOP regimen showed manageable toxicity in patients with poor-prognosis lymphoma.

A hydroponic experiment carried out to study the effect of five Cd levels on growth and photosynthesis of two tomato cultivars showed that the addition of 0.1 micromol/L Cd induced a slight increase in plant height of Hezuo 903 and the SPAD (the Soil-Plant Analyses Development) value of the 2 cultivars. However, at higher Cd levels, i.e., 1 and 10 micromol/L, root length and volume, plant height, and SPAD value were all significantly reduced. On an average of the 2 cultivars, exposure to 1 and 10 micromol/L Cd for 33 d reduced plant height by 18.9% and 46.4% and SPAD value by 11.2% and 31.6%, compared with control, respectively. Similarly, root length was reduced by 41.1% and 25.8% and root volume by 45.2% and 63.7%, respectively. The addition of Cd in the growth medium also had significant deleterious effect on net photosynthetic rate (Pn) and intracellular CO(2) concentration (Ci), with Pn being reduced by 27.2% and 62.1% at 1 micromol/L and 10 micromol/L Cd treatments compared to the control, respectively, while Ci increased correspondingly by 28.4% and 39.3%.
Cadmium ; toxicity ; Lycopersicon esculentum ; drug effects ; growth & development ; metabolism ; Photosynthesis ; drug effects ; Plant Leaves ; drug effects ; growth & development ; metabolism ; Plant Roots ; drug effects ; growth & development ; Seedlings ; drug effects ; growth & development ; metabolism

Objective To evaluate the efficacy of the autologous epidermal grafting combining with NB-UVB radiation on the treatment of stable vitiligo.Methods Autologous epidermal graft acquired by suction blister under negative pressure were transplanted onto the laser-abraded depigmented areas,then the narrow-band UVB radiation was given after grafting to 35 patients with stable vitiligo.The onset time and the area repigmentation of every epidermal graft 3 months latter were observed (digital image contrasted before and after treatment).The results were compared with 37 cases only treated with autologous epidermal grafting.Results Both onset time and the cure rate in combined treatment group were statistically significant (P＜0.05) as compared with control group.Conclusions The combination of autologous epidermal grafting with NB-UVB radiation can shorten the onset time of repigmentation and promote generation and extension of the melanin.

Objective To clarify the inhibitory effect of low molecular weight chitosan(LMCTS)on hepatic fibrosis induced by carbon tetrachloride (CCl4 )in the rats, and to investigate its effect on the expression of Toll-like receptor-4(TLR4 )and to lay the foundation for the development of the clinical candidate drug of liver fibrosis. Methods 72 male Wistar rats were randomly divided into blank control group, CCl4 group (model group), glycyrrhizinate (DG)group,50,100 and 150 mg·kg-1 LMCTS groups (low,middle and high doses of LMCTS groups).In addition to blank control group,the rats in the remaining groups were given 40% CCl4-vegetable oil (1.75 mL·kg-1 ),2 times per week for 8 weeks,by intraperitoneal injection to establish the model of rat hepatic fibrosis.And the rats in blank control group were injected with the same amount of 100% vegetable oil agent. From the ninth week, the rats in DG and LMCTS groups were given DG and LMCTS by intragastric administration, 1 time/week for 4 weeks. Then all rats were sacrificed, the activities of serum glutamic acid aminotransferase (ALT),aspartate aminotransferase (AST)and alkaline phosphatase (ALP)were detected with ELISA kit;the pathological changes in liver tissue were observed under light microscope, and the TLR4 expressions were detected by RT-PCR and Western blotting method. Results The serum ALT, AST and ALP activities in middle and high doses of LMCTS groups were lower than those in model group (P<0.05).The serum ALT activity in middle dose of LMCTS group was lower than that in low dose of LMCTS group (P<0.05),but the activities of AST and ALP had no statistically significant change(P>0.05).There were statistically significant differences in the serum ALT, AST and ALP activities between high dose of LMCTS group and middle dose of LMCTS group (P<0.05).There were obvious hepatocyte steatosis,inflammatory cell infiltration,collagen fiber hyperplasia and hepatic lobule damage in the rats in model group.However,all the changes in liver tissue of the rats in LMCTS group were significantly reduced, especially in high dose group. The results of RT-PCR and Western blotting method showed that the expression of TLR4 was declined in LMCTS groups compared with model group (P<0.05,P<0.01),especially in high dose of LMCTS group,and there were statistically significant differences between different doses of LMCTS groups (P<0.05).Conclusion High dose of LMCTS can decrease the serum transaminase activity of liver fibrosis rats and improve liver function,and this process may be related to declining the expression of TLR4 .