BACKGROUND:Tranexamic acid administered either in intra-articular route or in intravenous route can significantly reduce blood loss during total knee arthroplasty. Recent studies are stil controversial in application mode of tranexamic acid in the clinic.
OBJECTIVE:To compare the clinical outcomes of tranexamic acid in intra-articular route and intravenous route during total knee arthroplasty.
METHODS:PubMed, OVID, Web of Science, and EMBASE were searched to identify randomized control ed trials concerning the comparison of tranexamic acid in intra-articular route and intravenous route during total knee arthroplasty published before 1 May 2015. Transfusion rate, hemoglobin decline, drainage volume and thromboembolic complication rate were considered as indexes to evaluate the clinical effect, for meta-analysis.
RESULTS AND CONCLUSION:Six randomized control ed trials involving 847 patients were included. Meta-analysis results showed no significant difference between intra-articular and intravenous administration of tranexamic acid in terms of transfusion rate, hemoglobin decline, drainage volume, total blood loss, and thromboembolic complication rate. Subgroup analysis for dose regimen showed that when occlusion time of drainage tube was<2 hours. Intra-articular route of tranexamic acid showed high drainage volume and hemoglobin decline compared with the intravenous route of tranexamic acid (P<0.01). Results confirmed that during total knee arthroplasty, clinical effects of intra-articular and intravenous routes of tranexamic acid are similar during total knee arthroplasty. Moreover, it is recommended that occlusion of drainage tube can be conducted for 2 hours in intra-articular route of tranexamic acid.

Objective To retrospectively analyze the engraftment, transplant-related complications and survival after unrelated cord blood transplantation (UCBT) in patients with hematologic malignancies. Methods Fifty consecutive patients with hematological malignancies (median age, 19 years; median weight, 53 kg) were treated with UCBT in single center from April 2000 to August 2009. Thirty-nine patients were high-risk or refractory. Double UCB grafts were used for 26 patients, while single UCB graft for 24 patients. Myeloablative conditioning was given to 45 cases and non-myeloablative regimens to 5 cases. All patients were given a combination of cyclosporin A (CsA) and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. Results The median total nucleated cell (TNC) dose was 4.0 (range, 1.95-16.24)×10~7 TNC/ kginfused, and CD34~+ cell dose was 2.74(range, 0.67-29.28)×10~5/kginfused. Forty-two of 50 patients acquired engraftment with implantation rate being 86%. The median time to engraftment (absolute neutrophil count>500/mm~3 and platelets 20 000/L) was 19 and 34 days. The cumulative incidence of neutrophil engraftment by day 42 was 86.3%(95% confidence interval [CI] 0.769-0.957); the cumulative incidence of platelets engraftment by day 120 was 72.3% (95% CI 0.620-0.821). Twenty cases developed acute GVHD, and the incidence of acute GVHD of grades Ⅲ/Ⅳ by day 100 was 7.1%. The incidence of chronic GVHD within 2 years was 17.4%. During a median follow-up period of 22 months (range 4-116), Overall 6-month, 1-year and 2-year survival rate was 66.2%(95% CI 0.590-0.734), 57.4%(95% CI 0.496-0.652), 54.2%(95% CI 0.462-0.622), respectively. For the patients with non-advanced hemotologic malignancies, 6-month, 1-year and 2-year survival rate was 73.2% (95% CI 0.659-0.805), 66.1% (95% CI 0.579-0.743), and 62.2% (95% CI 0.542-0.682) respectively. Five cases relapsed. The cumulative incidence of relapse within 2 years was 16.2% (95% CI 0.099-0.225). Twenty-one cases died mainly due to infection. Conclusion UCBT could be safely and effectively used for adult patients with hematologic malignancies.

Objective:To investigate internalized and externalized behavioral problems in children with leukemia and to analyze the influencing factors.Methods:A total of 121 children match the inclusion and exclusion criteria with leukemia hospitalized in Hematology and Oncology Department of 3 hospitals in Zhengzhou city from November 2021 to March 2022 were recruited through a cluster sampling method.The general information questionnaire, Strengths and Difficulties Questionnaire (parent version), Psychological Adaptation Scale, Perceived Social Support Questionnaire and Zarit Burden Interview were used for investigation.Multiple linear regression was used to analyze the influencing factors of internalized and externalized behavioral problems in children with leukemia.Results:Among 121 children with leukemia, there were 72 males and 49 females, with the age of (7.16 ± 3.18) years.The total score of interna-lized and externalized behavioral problems in 121 children with leukemia was (6.12±3.13) points and (5.49±2.92) points, respectively.Multiple linear regression analysis showed that burden of care ( β=0.412, P<0.001), family support ( β=-0.242, P=0.003) and monthly household income per capita ( β=-0.167, P=0.036) were the influencing factors of internalized behavioral problems in children with leukemia.Burden of care ( β=0.360, P<0.001), social integration ( β=-0.223, P=0.008) and caregiver age ( β=-0.176, P=0.035) were the influencing factors of externalized behavioral problems in children with leukemia. Conclusions:Children with leukemia suffer severe internalized and externalized behavioral problems.Burden of care of the caregiver, family support and social integration are predictors of adverse emotional and behavioral problems in children.

Objective:To explore the current situation of emotional and behavioral problems in children with hematological tumors, and the relationship with caregivers′ coping styles and family cohesion.Methods:Using cross-sectional study design and cluster sampling method, caregivers of children with hematological tumors hospitalized in hematology department of five third-class hospitals in Zhengzhou from November 2020 to January 2021 were selected as the respondents. The strengths and difficulties questionnaire (parent version), simple coping style questionnaire, family cohesion scale and self-made general information questionnaire were used for questionnaire survey. Statistical analysis was performed by SPSS 24.0 software using Spearman correlation analysis and multivariate Logistic regression analysis.Results:A total of 237 questionnaires were distributed and 214 valid questionnaires were collected. The abnormal detection rates of total difficulty score, emotional symptoms, conduct problems, hyperactivity, peer interaction problems and prosocial behavior were 17.8%, 22.9%, 10.7%, 8.4%, 39.7% and 13.6% respectively. The results of correlation analysis showed that caregivers′ positive coping was negatively correlated with the total score of difficulties, hyperactivity and peer interaction problems ( r=-0.186, -0.153, -0.174, all P<0.05), and positively correlated with the score of prosocial behavior ( r=0.214, P<0.05). Caregivers′ negative coping was positively correlated with the total score of difficulties, emotional symptoms and hyperactivity ( r=0.203, 0.204, 0.170, all P<0.05). Family cohesion was negatively correlated with the total score of difficulties, emotional symptoms, conduct problems, hyperactivity and peer interaction problems ( r=-0.254, -0.225, -0.183, -0.137, -0.195, all P<0.05), and positively correlated with prosocial behavior ( r=0.235, P<0.01). Multivariate Logistic regression analysis showed that positive coping of caregivers was a protective factor of peer interaction in children ( β=-0.050, OR=0.951, 95% CI=0.907-0.996), while family intimacy was also a protective factor for children with prosocial behavior ( β=-0.045, OR=0.956, 95% CI=0.923-0.991). Conclusion:The emotional and behavior problems of children with hematological tumors are serious, and the positive coping of caregivers and family cohesion have certain predictive value for the occurrence of negative emotional behavior problems in children, so medical staff should take corresponding measures to reduce the occurrence of emotional and behavior problems in children.

Objective To evaluate the effect of pretransplant iron overload on the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with severe aplastic anemia (SAA). Methods Clinical data of 80 SAA recipients who underwent allo-HSCT for the first time were retrospectively analyzed. According to the incidence of iron overload, all recipients were divided into the iron overload group (n=20) and non-iron overload group (n=60). The engraftment rate, incidence of postoperative complications and clinical prognosis of the recipients afterallo-HSCT were statistically compared between two groups. The influencing factors of 2-year overall survival (OS) and 180 d transplantation related mortality (TRM) were analyzed by Cox proportional hazards regression model. Results The engraftment rate of neutrophils in the non-iron overload group was 98% (59/60), significantly higher than 75% (15/20) in the iron overload group (P < 0.05). The engraftment rate of platelet in the non-iron overload group was 90% (54/60), significantly higher than 65% (13/20) in the iron overload group (P < 0.05). The incidence rate of bloodstream infection in the non-iron overload group was 23% (14/60), remarkably lower than 40% (8/20) in the iron overload group (P < 0.05). The 180 d TRM of the recipients in the non-iron overload group was 17%, significantly lower than 45% in the iron overload group (P < 0.05). The 1- and 2-year OS of the recipients in the non-iron overload group were 82% and 80%, significantly higher than 50% and 44% in the iron overload group (both P < 0.05). Iron overload or not was an independent risk factor of the OS and TRM of the recipients (both P < 0.05). Conclusions Iron overload can affect the OS and TRM of SAA patients after allo-HSCT.

Objective:To explore the value of magnetic resonance diffusion tensor imaging (DTI) in evaluating cerebrovascular small vessel disease (CSVD) in patients with systemic lupus erythematosus (SLE).Methods:Eighty-two patients with SLE combined with CSVD treated at Yixing People's Hospital from January to December 2022 were selected. They were divided into acute phase infarction group (16 cases), chronic phase infarction group (26 cases), and chronic ischemic lesion group (40 cases) based on routine MRI examination results. All patients underwent DTI examination to obtain the average diffusion coefficient (DCavg) and anisotropy score (FA) of the affected and contralateral normal white matter areas, and the evaluation value of DTI for CSVD in SLE patients was analyzed.Results:The DCavg value on the affected side of 82 patients was significantly higher than that on the healthy side: (11.10 ± 3.48) 10 -3 mm 2/s vs. (8.18 ± 2.42) 10 -3 mm 2/s, and the FA value on the affected side was significantly lower than that on the healthy side: 0.28 ± 0.05 vs. 0.45 ± 0.08, with a statistical significant differences ( P<0.05). The DCavg values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were (11.88 ± 3.50), (9.69 ± 3.24) and (8.52 ± 2.34) 10 -3 mm 2/s, respectively, with statistical significant differences ( P<0.05). The FA values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were 0.28 ± 0.04, 0.33 ± 0.06 and 0.40 ± 0.07, respectively, with statistical significant differences ( P<0.05). The receiver operating characteristic curve was drawn, and the results showed that the area under the curve (AUC) of the acute phase infarction group and the chronic phase infarction group evaluated by DCavg and FA alone and in combination were 0.757, 0.756, and 0.820, respectively. The AUC of the chronic phase infarction group and the chronic ischemic focus group evaluated by DCavg and FA were 0.772, 0.776, and 0.813, respectively. The AUC value of the combined evaluation was relatively large. Conclusions:DTI has good evaluation value for CSVD in SLE patients and can accurately determine the type of CSVD.

In this paper, with B/S application and architecture, an integrated solution of PACS is designed, and the function and application of each part of PACS based on the architecture is introduced. The PACS based on this mode is safe, stable, easy to manage and upgrade and convenient for use in telemedicine.
Computer Systems ; Humans ; Radiology Information Systems ; Research ; Software ; Telemedicine

Objective To investigate the status of increased blood parathyroid hormone(PTH)level among community residents in Urumqi,and to analyze its correlation with the metabolic parameters including serum Ca and P levels. Methods In May 2013,a cross-sectional survey was conducted,when 1 473 permanent residents in Urumqi, including 844 Han and 629 Uyghurs,were selected by cluster random sampling. PTH and 25-OH vitamin D[25(OH)D] levels were detected by chemiluminescence. Blood Ca, P, Mg, albumin, and creatinine (Cr) were also measured. Based on serum 25(OH)D level,the residents were divided into vitamin D deficiency(<20 ng/ml), vitamin D insufficiency(≥20 and<30 ng/ml),and vitamin D sufficiency(≥30 ng/ml)groups. According to the PTH level,the residents were divided into PTH<65 pg/ml group and PTH≥65 pg/ml group. The metabolic parameters including Ca and P were compared among different ethnic groups. Results In the surveyed population,the rate of increased blood PTH was 12.22%,being higher in females than that in males(13.82% vs 8.45%,P=0.004)and higher in Han Chinese than that in Uyghurs(19.87% vs 6.52%,P<0.01). The proportions of residents with vitamin D sufficiency,insufficiency and deficiency were 3.34%,9.06%,and 87.60% in Uyghurs,and 10.43%,29.98%, and 59.60% in Han,respectively. The rate of 25(OH)D deficiency was significantly higher in Uyghurs than that in Han(P<0.01),especially higher in female Uyghurs(91.43%). In vitamin D deficiency group,the rate of increased serum PTH was significantly increased,higher in Uyghurs than that in Hans(22.14% vs 6.56%,P<0.01),which revealed a negative correlation with 25(OH)D(r=-0.251, P< 0.01). Conclusion 25(OH)D deficiency is prevalent among the community population in Urumqi, with ethnic differences in serum PTH level and the rate of increased blood PTH,which might be associated with vitamin D deficiency.

BACKGROUND: Umbilical cord blood hematopoietic stem cell transplantation is more and more widely used as a radical treatment for acute leukemia, but its therapeutic effect in different leukemias has not been compared. By comparing the efficacy of diseases, it can guide different patients to choose the transplantation method.OBJECTIVE: To compare and analyze the therapeutic effect of umbilical cord blood hematopoietic stem cell transplantation on acute myeloid leukemia and acute lymphocytic leukemia. METHODS: Clinical data of 306 cases of acute leukemia treated by unrelated umbilical cord blood hematopoietic stem cell transplantation were retrospectively analyzed, including 112 patients with acute myeloid leukemia and 194 with acute lymphoblastic leukemia. All patients received myeloablative conditioning without antithymocyte, and the prevention of graft-versus-host disease was cyclosporine combined with mycophenolate mofetil. RESULTS AND CONCLUSION: (1) Except that the relapse rate after acute lymphoblastic leukemia transplantation was slightly higher than acute myeloid leukemia, the efficacy of the two groups of patients after receiving unrelated umbilical cord blood hematopoietic stem cell transplantation was basically the same. (2) In the group of adolescents and young adults (aged 15-39 years), the rate of neutrophil and platelet implantation in acute myeloid leukemia was faster than in acute lymphoblastic leukemia. Among them, CD34+ cell number and pretreatment program were independent influencing factors for neutrophil implantation, while CD34+ cell number was also an independent influencing factor for platelet implantation. In this age group, the recurrence rate of acute lymphoblastic leukemia patients after transplantation was still higher than that of acute myeloid leukemia, in which chronic graft-versus-host disease was an independent influencing factor. (3) Immune reconstruction testing after transplantation suggests that cord blood CD8+ T cell reconstruction in patients with acute myeloid leukemia was better than in acute lymphoblastic leukemia patients 4 months after transplantation. (4) The above data show that pre-treatment of unrelated cord blood transplantation without antithymocyte globulin has a good effect on acute lymphocytic leukemia and acute myeloid leukemia. Department of Hematology of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China is qualified for stem cell transplantation.

Objective:To explore the correlation between rs231775 polymorphism of cytotoxic T lymphocyte-associated antigen 4 (CTLA4) gene and autoimmune thyroid disease (AITD) of Uygur in Xinjiang Uygur Autonomous Region.Methods:A total of 382 Uygur patients with AITD [including 328 Hashimoto's thyroiditis (HT) patients and 54 Graves' disease (GD) patients] diagnosed in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to December 2018 were selected as the case group, and 383 Uygur health physical examiners in the same period were selected as the control group. The whole blood genomic DNA of the study subjects was extracted, and the Sequenom-mass spectrometry analysis platform was used to determine the genotyping of CTLA4 gene single nucleotide polymorphism (SNP) locus rs231775 and analyze the genetic model, and the correlation between rs231775 polymorphism and AITD under different genetic models was compared. The logistic regression analysis model was used to analyze the influencing factors of AITD. And the thyroid function index of different genotype population was compared.Results:In the case group and the control group, the differences of CTLA4 gene rs231775 alleles (A: 41.88%, 49.35%; G: 58.12%, 50.65%) and genotype frequencies (AA: 17.80%, 23.24%; AG: 48.17%, 52.22%; GG: 34.03%, 24.54%) were statistically significant (χ 2=8.586, 9.260, P < 0.05). Compared with the control group, the genotype frequency of rs231775 in HT group, the alleles and genotype frequencies of rs231775 in GD group were significantly different (χ 2=5.997, 11.130, 10.210, P < 0.05). Under the additive and dominant models, the CTLA4 gene rs231775 was correlated with AITD [odds ratio ( OR)=0.67, 0.55, 0.63] and HT ( OR=0.69, 0.62, 0.67, P < 0.05); and correlated with GD under the additive, dominant and recessive genetic models ( OR=0.53, 0.23, 0.44, 0.34, P < 0.05). The logistic regression analysis showed that genotype, gender, age, thyroid stimulating hormone (TSH) and free thyroxine (FT 4) were independent influencing factors of AITD ( P < 0.05). Among all the subjects, the level of thyroglobulin antibody(TgAb) in the population with the recessive genotype (GG) at the rs231775 of the CTLA4 gene was higher than that in the dominant genotype (AA+AG) population ( P < 0.05). Conclusion:The CTLA4 gene rs231775 polymorphism is significantly related to AITD of Uygur in Xinjiang Uygur Autonomous Region, and the level of TgAb in GG genotype is higher than that in other genotypes.