Objective To explore the clinical characteristics,relationship between treatment and prognosis of sarcoidosis and relationship of relapse to prednisone.Methods The clinical data of 165 patients with sarcoidosis were collected.The clinical characteristics,treatment process and prognosis,relationship of relapse with prednisone maintenance dose and course of treatment were retrospective analyzed.Results Among them,the most common involved systems were lung and lymph nodes.The involvement rates of lung,extra-thorax lymph nodes,cutaneous,ocular,salivary glands,liver & spleen,kidney and nervous system was 87.3％,51.5％,6.7％,6.1％,6.1％,4.2％,1.2％ and 1.2％ respectively.Unilateral tonsil,breast,ovary and bone involvement was seen in only 1 patient respectively with an involvement rate of 0.6％.A retrospective analysis was made for 114 cases with complete follow-up data.The mean follow-up period was (11.7 ± 5.7) (5-32) years.And 46 cases had no symptom on routine medical examinations.The most common consulted departments were respiratory,dermatological and general surgery departments.Among 74 patients on prednisone,48 patients (64.9％) were cured while 13 patients (17.6％) relapsed.Whereas in the observation group,25/38 patients (65.8％) remitted spontaneously and only 1 patient (2.6％) had recurrence.Relapse occurred more often in prednisone therapy group than in observation group (P ＜ 0.05).Longer prednisone 10-15 mg daily maintenance and a longer total course of treatment were associated with fewer recurrence(P ＜ 0.05).Conclusions The clinical manifestations of sarcoidosis vary and many patients have a self-limiting course.The most common involved systems are lung and lymph nodes.Stage Ⅰ / Ⅱ disease should be observed before prednisone therapy.Prednisone 10-15 mg daily for at least 6 months and a total course of treatment over 18 months may prevent relapse.

Objective To apply the health education intervention based on protection motivation theory in community female patients with stress urinary incontinence,in order to establish a health behavior and to control urinary incontinence.Methods 96 female patients with stress urinary incontinence were randomly divided into the control group and the experimental group by random number table method,the control group received routine health education,the experimental group received health education based on protection motivation theory.The ICI-Q-SF score,pelvic muscle exercise compliance scale score,urinary incontinence coping efficacy score were compared between the control group and the experimental group.Results The ICI-Q-SF score of the experimental group after the intervention was 5.43 ± 1.77,which was significant lower than that in the control group,7.96±2.98,t=4.88,P＜0.01.The urinary incontinence coping efficacy scores of experiment groups after the intervention was 17.63±1.85,which was higher than that in the control group,13.49±2.46,t=-9.09,P＜0.01.There were 29 cases accounted for 63.04％ with good compliance and 17 cases accounted for 36.96％ with poor compliance in experimental group after intervention,14 cases accounted for 31.11％ with good compliance and 31 cases accounted for 68.89％ with poor compliance in control group after intervention,the difference was statistically significant,x2=9.306,P＜0.05.Conclusions Health education based on protection motivation theory can promote the coping efficacy and health behavior of community female patients with stress urinary incontinence and can effectively control urinary incontinence symptom.

Objective To investigate the development of Staphylococcal scalded skin syndrome (SSSS) in patients with hematologic malignancy. Methods The clinical data of 4 cases of SSSS admitted from November 2006 to June 2008 were analyzed, and the related literatures were reviewed. Results Four patients developed SSSS all under severe immunosuppression. Two of them were in neutropenia, and the others had been intensively treated for severe graft versus host disease. They presented high fever and erythema, followed by the formation of flaccid bullae and exfoliation. Three patients recovered successfully with the treatment of vancomycin and intravenous administration of immunoglobulin. Withdraw of mmunosuppressive agents in patients following hematopoietie stem cell transplantation was helpful. Conclusions SSSS should be considered when high fever and erythema suddenly occur in patients with hematologic malignancy.

Objective To investigate the efficacy of chimeric anti-CD2 monoclonal antibody (basiliximab) on acute graft-versus-host disease (GVHD) in patients following aliogeneic hematopoietic stem cell transplantation. Methods Thirty-six patients who were suffered from acute GVHD from March 2005 to July 2007 were studied. All of them were treated with steroid first and got no response, then began basiliximab therapy. Results Thirty of 36 patients showed response to basiliximab therapy including 25 complete responses and 5 partial responses. The efficacy was associated with the degree of GVHD and the source of donor. Conclusion Patients suffered from steroid-resistant acute GVHD can be successfully treated with basiliximab.

Objective To investigate the clinical effect and safety of surgical treatment for severe, refractory hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods Patients with severe HC, who were admitted to Peking University Institute of Hematology from January 2010 to December 2015, were enrolled in this study.All patients were refractory to medical managements and received bladder surgery including mucous electrocoagulation and/or selective transcatheter arterial embolization.Results A total of 17 patients with severe HC (grade Ⅲ, n=5;grade Ⅳ, n=12) received surgical treatment, including 11 embolization and 18 mucous electrocoagulation.The median time from allo-HSCT to surgery was 107 d (46-179 d) and 75 d after HC.Eight patients only received embolization.Four patients only received mucous electrocoagulation.Five patients were given combined embolization and electrocoagulation.HC was cured in 11 patients, improved in 1 patient, which corresponded to a response rate of 70.6% and complete remission rate of 64.7%.Five patients didn′t respond to these methods.In patients with response, macroscopic hematuria disappeared 3 to 10 days after treatments whereas microscopic hematuria vanished after 25 to 32 days.Both procedures were well tolerated and no severe adverse effects were observed.Conclusion Surgery of bladder mucous electrocoagulation and/or selective arterial embolization are safe and effective for severe HC.

BACKGROUND:Currently,the dura mater is clinically repaired using autologous tissue or materials such as gelatin sponge,but all of them have their inherent defects.Therefore,there is an urgent need for a biomaterial that can promote dural repair. OBJECTIVE:The two-sided anisotropic electrospun membrane was constructed by using directional electrospinning technology and collagen self-assembly technology,and was used as a carrier for bone marrow mesenchymal stem cells to investigate various physicochemical properties and biological characteristics of the artificial dura mater. METHODS:Ordered polylactic acid electrospun fibers with double-sided(collagen protein on one side and polylactic acid on the other side)anisotropic electrospun membranes(collagen group),disordered polylactic acid electrospun membranes(disordered fiber group),and ordered oriented polylactic acid electrospun membranes(ordered fiber group)were prepared by electrospinning technique as well as collagen self-assembly technique.Scanning electron microscopy,mechanical stretching,water contact angle testing,and degradation experiments were used to characterize the physicochemical properties of the electrospun membranes.Electrospun membranes in the collagen group(bone marrow mesenchymal stem cells were inoculated on the collagen surface to obtain the stem cell-engineered electrospun membranes),disordered fiber group and ordered fiber group were cocultured with bone marrow mesenchymal stem cells.The biocompatibility of electrospun membranes was evaluated using CCK-8 assay and live/dead staining.Integrin β1 immunofluorescence staining was used to evaluate the adhesion characteristics of electrospun membranes.The stem cell-engineered electrospun membrane and the electrospun membrane in the collagen group were cocultured with bone marrow macrophages respectively.Immunomodulatory properties were assessed by detecting the expression of inflammation-related genes using inducible nitric oxide synthase(M1 type),CD206(M2 type)immunofluorescence staining,and qRT-PCR. RESULTS AND CONCLUSION:(1)The oriented electrospun fiber membrane could mimic the structure of the longitudinally aligned natural dura mater,and the addition of collagen increased the hydrophilicity of the fiber membrane by about 2-fold and the mechanical properties by 1.2-fold.(2)When cocultured with bone marrow mesenchymal stem cells,CCK-8 assay and live/dead staining suggested that the cellular bioactivity in the collagen group was significantly higher than that in the disordered fiber group and ordered fiber group.Immunofluorescence staining revealed that the expression of integrin β1 in the collagen group was about 2.6 times higher than that of the disordered and ordered fiber groups,and the cell spreading morphology was good.(3)When cocultured with bone marrow macrophages,immunofluorescence staining exhibited that the fluorescence intensity of M1 type macrophages in the stem cell-engineered electrospun membrane group was lower than that in the collagen group(P<0.01),and the fluorescence intensity of M2 type macrophages was higher than that in the collagen group(P<0.01).qRT-PCR demonstrated that proinflammatory gene tumor necrosis factor α and interleukin-1β mRNA expression in the stem cell-engineered electrospun membrane group was lower than that of the collagen group(P<0.001);anti-inflammatory genes such as interleukin-10 and transforming growth factor β mRNA expressions were higher than those in the collagen group(P<0.001).(4)The above results suggest that the stem cell-engineered amphipathic artificial dura mimics the directional structure of normal dura,with the inner surface facilitating cell growth and adhesion and the outer edge avoiding tissue adhesion,while the polarization of macrophages to the M2 subtype is promoted and the local inflammatory microenvironment is regulated through the mesenchymal stem cell paracrine component.

Objective To investigate the risk factors and prognosis of transplant-associated thrombotic microangiopathy (TA-TMA) following acute graft-versus-host disease (aGVHD),and to evaluate the factors that might influence the prognosis of TA-TMA.Methods A nested case-control study was designed.Cases with TA-TMA (n =33) and controls (n =77) matched for age at allogeneic hematopoietic stem cell transplantation (allo-HSCT) and length of follow-up were identified from a cohort of 356 patients who suffered from aGVHD after allo-HSCT between 2009 and 2011.Results The median time to presentation of TA-TMA was 3.5 (1.2-23.0) months post-HSCT.The median time from diagnosis and first-line treatment failure of aGVHD to TA-TMA diagnosis was 25 (7-257) days and 15 (5-257) days,respectively.aGVHD occurring beyond 60 days after allo-HSCT,initial grade Ⅲ-Ⅳ aGVHD,first-line treatment failure and receiving tacrolimus as second-line treatment were independently associated with the occurrence of TA-TMA,and patients with two or more risk factors were at higher risk (OR =210.0,P =0.000).Twenty-two (66.7％) TA-TMA patients died.Progressive TA-TMA was the significantly adverse factor affccting the survival of TA-TMA cases.None of therapies could improve prognosis of patients with TA-TMA.Conclusion Many characteristics of aGVHD were associated with TA-TMA,which help us to identify the individuals who are at higher risk of developing TA-TMA following aGVHD and to select the more reasonable GVHD therapeutic strategies.

Objective To estimate cervical stiffness during late pregnancy with virtual touch tissue quantification technique(VTQ) and investigate the value of predicting the outcome of labor induction. Methods Cervical length in pregnancy women at 35 -41 weeks′gestation was measured through perineum ultrasound examination before labor induction,and then VTQ was applied to measure shear wave velocity (SWV)values in region of interest(ROI),the maximum,minimum and average of SWV values were obtained from multiple SWV measurement under the VTQ mode. The outcomes of labor induction were tracked and Bishop scores were recorded,vaginal delivery and cesarean delivery groups were compared using Student′s t-test for continuous variables. ROC curve was plotted to analyze the correlation between parameters and the outcome of labor induction and to determine the most accurate SWV value and cut-off value for diagnosis.Univariate and multivariate logistic regression analysis were used to determine which of the following parameters were significant predictors of the outcome of labor induction. Results The SWV mix,SWV max and SWV mean of vaginal delivery and cesarean section were (0.92 ± 0.13)m/s,(1.37 ± 0.14)m/s,(1.13 ± 0.10)m/s and (1.03 ± 0.13)m/s,(1.74 ± 0.42)m/s,(1.36 ± 0.11)m/s,respectively, there were significant differences between vaginal delivery and cesarean section(all P < 0.05).Based on ROC curve analysis,the SWV mean value in cervix was the best value for predicting the outcome of labor induction.The cut-off value of SWV mean value was 1.23 m/s,the sensitivity,specificity and Youden index were 93.8%,83.4%,0.77,respectively.The SWV value and cervical length were closely correlated to the outcome of labor induction,especially the SWV value according to multivariate logistic analysis. Conclusions VTQ can assess the cervical stiffness with SWV values during pregnancy,and it may have an application value of predicting the outcome of labor induction.

Objective To investigate the safety and efficacy of second allogeneic hematopoietic stem cell transplantation for the relapsed hematologic malignancies. Methods The data of 25 relapsed patients received the second allogeneic transplantation as a salvage therapy in Institute of Hematology Peking University between October 1999 and March 2010 were analyzed retrospectively. Twenty-four patients relapsed at 8. 8 (1-55) months after the first transplantation, except one received the second transplantation as prophylaxis therapy. They received the second transplantation after 3(0. 3-20) months' therapy. The median time between the 2 transplants was 10. 6(0. 6-59. 0) months. Results Most of the patients were given the conditioning regimen including total body irradiation (TBI, 700-779 cGy) or modified busulfan and cyclophosphamide (BUCY, BU 12 mg). All patients survived more than 30 days and achieved sustained white blood cell engraftment. Sinus obstructive syndrome, irradiation dermatitis and acute myocardial infraction were occurred in 3 patients and recoverable. Until January 31 in 2011, with a median observation period of 9. 1 (2. 0-131. 1) months, 8 patients had been living with a overall survival (OS) of 30.9%.Twelve patients relapsed at a median 4. 4 months and 10 died of it. The other 7 patients died of transplant related complications. The non-relapsed mortality was 35. 1 %. The disease status at the 2nd transplantation was the only factor which effected the OS (P = 0. 009). Conclusions The second allogeneic transplantation is a viable option for patients relapsing after the first transplantation. Reduced intensive conditioning regimen ensures the graft engraftment and reduces transplant related toxicity.

Objective To investigate the efficacy and safety of rituximab on Epstein-Barr virus (EBV) disease post allogeneic hematopoietic stem-cell transplantation.Methods A retrospective analysis was performed based on clinical data of 26 patients diagnosed as EBV disease and received rituximab from June 2006 to March 2012 in People's Hospital,Beijing University.Eleven patients were diagnosed as posttransplant lymphoproliferative disorders (PTLD) by histopathology and remaining 15 were diagnosed as probable EBV disease.Patients received a rituximab dose of 375 mg/m2 once a week.Efficacy was evaluated as revised response criteria for non-hodgkin lymphoma (NHL),and side effects during infusion were evaluated by Common Terminology Criteria for Adverse Events.Results Patients received 78 infusions with a median of 3 (1-6) infusions in each.There were no severe side effects during the infusion of rituximab.The 1st,2nd,3rd,4th,8th week cumulative complete remission (CR) were (11.5 ± 6.3)％,(42.2 ±10.2) ％,(64.4 ± 10.0) ％,(74.6 ± 9.4) ％,(87.3 ± 7.9) ％,respectively.The overall response rate was 84.5％,and the CR rate was 73.1％.The CR rate was higher among patients with single organ involved than those with multiple organs involved (10/10 vs 9/16,P =0.023).The CR rate was higher in patients with probable EBV disease than those with PTLD (13/15 vs 6/11,P =0.095),while there was no statistically significant difference.The incidence of one-year and two-year overall survival since onset of rituximab were (55.7 ± 10.2)％ and (39.6 ± 12.4)％,respectively.Survival rate was higher among the patients with single organ involved than those with multiple organ involved (8/10 vs 5/16,P =0.041).Survival rate was higher in patients with probable EBV disease than those with PTLD(11/15 vs 2/11,P =0.015).Conclusions Rituximab appears to be safe and effective for EBV disease.Due to a potential good response in probable EBV disease,we suggest rituxmab should be given based on probable EBV disease;meanwhile the pathological results should get early if possible.Prospective trial is needed to provide evidence so as to define optimal therapy of rituxmab.