Objective To study the risk factors and prognosis of very/extremely low birth weight preterm (VLBW/ELBW) infants with bronchopulmonary dysplasia (BPD) during the first three years of life.Method From January 1st to December 31st,2012,a retrospective study was conducted on the VLBW/ELBW preterm infants with ＞ 28 days of hospitalization in the NICU of our hospital.The infants were assigned into BPD group (FiO2 ＞ 21％) and non-BPD group depending on the oxygen requirement on the 28th day after birth.The incidences of bronchitis,pneumonia,wheezing and re-hospitalization during the first three years of life were analyzed.The pulmonary function tests were performed at one-year-age.Independent-sapmles t test,Kruskal-wallis test and x2 test were used to compare the results between the two groups.Result A total of 72 patients were enrolled into this study.34 patients in the BPD group and 38 in the non-BPD group.The gestational age,birth weight and the use of INSURE technique of BPD group were significantly lower than non-BPD group,while the duration of hospital stays were longer than non-BPD group (P ＜0.05).The ratio of male,neonatal respiratory distress syndrome (RDS),patent ductus arteriosus (PDA),intrauterine infection,mechanical ventilation,nosocomial infection and the inhalation of high concentrations of oxygen were significantly higher in BPD group than non-BPD group (P ＜ 0.05).Incidences of bronchitis and wheezing during 0 ～ 1,1 ～ 2 and 2 ～ 3 years of age in the BPD were significantly higher than non-BPD group,separately.No significant differences existed in the incidences of pneumonia and re-hospitalization between the two groups.Pulmonary function test showed that the respiratory rate (RR) and peak tidal expiratory flow in the BPD group were significantly higher than non-BPD group,while the tidal volume,peak expiratory time and peak expiratory volume were significantly lower in BPD group than non-BPD group (P ＜ 0.05).Conclusion BPD often occurs in preterm infants with gestational age less than 32 weeks.It may cause impaired pulmonary function,characterized by obstruction in small airway,and increases the risk of bronchitis and wheezing during the first three year of life.

Objective To explore the incidence and risk factors of hepatic events and overall survival among HBsAg positive leukemia patients after allo-hematopoietic stem cell transplantation (allo-HSCT). Methods A retrospective clinical study was conducted at the bone marrow transplant unit in our hospital between March 2001 and November 2006. A total of 26 HBsAg positive leukemia patients were included in the study.18 patients received HLA-identical sibling allo-HSCT, 7 patients received HLA-mismatched related and 1 patient received HLA-identical unrelated. All the patients were free from hepatitis C infection before and after allo-HSCT. HBV serologic markers,including HBsAg、HBeAg、HBsAb、HBeAb and HBcAb were tested. 2 patients were positive for HBV-DNA before allo-HSCT. Results The cumulative incidence for acute graft vs host disease(aGVHD) grades Ⅰ-Ⅳ was 50.0%. The cumulative incidence for chronic GVHD was 25.0%. 15(57. 7%)of all the patients had abnormalities of liver function after allo-HSCT. The types of hepatic disease were reactivation of HBV and hepatic GVHD. The cumulative incidence in 5 years for hepatitis B reactivation was 33.4%, the median day of hepatitis B reactivation was 82th(65th-159th)day. The virologic and clinical outcomes were compared between two groups:one received lamivudine as prophylactic(group 1)and the other did not receive lamivudine(group 2). After transplantation,1 patient in group 1 and 7 patients in group 2 had hepatitis due to reactivation of HBV. The cumulative incidence for hepatitis B reactivation was statistically different between the two groups(P=0.006). None in group 1 but 4 in group 2 died of HBV-related hepatic failure. 10 of the 26 patients died after transplantation. The overall survival(OS) in 5 years was 59.0%. The causes of death included hepatic failure(5 cases), lung infection(3 cases) and relapse of leukemia(2 cases). By multivariate Cox analysis, development of hepatic failure was a significant predictor of mortality(P=0.000). Conclusion HBsAg positive leukemia patients often suffered from hepatic injury after allo-HSCT. The principal cause of hepatic damage was the reactivation of HBV. Hepatic failure caused by HBV was the principal reason of death. Prophylaxis with lamivudine in HBsAg positive leukemia recipients can reduce the reactivation of HBV.

Objective To explore the incidence, diagnosis and treatment of nephrotic syndrome ( NS ) following allogeneic hematopoietic stem cell transplantation ( allo-HSCT) in one single center.Methods Analysis were carried out based on the records of 1464 patients following allo-HSCT hospitalized in Peking University People's Hospital from January 1996 to April 2009, so as to evaluate the incidence and outcomes of NS. A total of 1464 patients whose survival time was longer than 100 d were enrolled. Eight patients (0.6%) had NS following allo-HSCT. Using the nested case-controlled study, 56 cases who received transplantation within the same period were selected as control group for risk factors analysis. Results The median time of NS was 488(54-1185)d after allo-HSCT. Lower extremities' edema and heavy proteinuria were present in all the patients. Two patients were accompanied with impaired renal function. Six patients suffered from chronic graft-versus-host disease (GVHD). Three patients with NS were accompanied with other symptoms of GVHD. Renal biopsy examination showed typical features of minimal change diseases in 3 patients and membranous nephropathy in 1 patient. All cases achieved complete remission (CR) after taking combined immunosuppressant agents. One patient relapsed soon after all the immunosuppressant agents were stopped. Six patients were still surviving with disease free. One patient died of the relapse of leukemia and another patient died of early discharge from hospital after allo-HSCT. The possible factors correlated with the occurrence of NS were analyzed, and the occurrence of chronic GVHD was identified as an independent factor of NS. Conclusions NS should be carefully taken into consideration when edema and proteinuria are present in patients following allo-HSCT. The occurrence of NS is probably related with chronic GVHD. NS responds well to immunosuppressant agents.

Objectlve To analyze the epidemiologic features of blood stream infection(BSI)during the period of agranulocytosis after hematopoietic stem cell transplantation(HSCT)in our hospital,and provide the basis for the empirical therapy.Methods The consecutive hematopoietic stem cell transplantation recipients conducted between January 2008 and October 2010 were studied retrospectively,to identify the current incidence,etiology for BSI and associated mortality during the period of agranulocytosis.Results Totally 75 patients were diagnosed as BSI.The incidence of BSI was 9.6%(75/784)in HSCT during the period of agranulocytosis,17.0%(75/441)in febrile patients.The pathogen testing showed that 64.4%were G-bacteria,30.1%were G+ bacterial and 5.5%were fungi.All G-bacteria except one were sensitive to carbapenems;all G+ bacteria except one were sensitive to vancomycin.Among the 75 patients,9(12.0%)experienced septic shock and 5(6.7%)died.Conclusions The pathogens of the BSI in the cohort are G-bacteria,followed by G+ bacteria and fungi.Carbapenems and vancomycin are the first drugs for the experiential therapy.

Objective To investigate the incidence and pathogenesis of fever within the first 24　hours following allogeneic peripheral stem cell transfusion and to analyze the associated risk factors.Methods Totally 114 patients received allogeneic hematopoietic stem cell transplantation(allo-HSCT)between October 2009 and August 2010 were enrolled and clinical data of febrile patients within 24 hours　following peripheral stem cell transfusion were retrospectively analyzed.Multivariate logistic regression analysis was performed to identify the risk factors for transfusion related fever.Results Thirty-two (28.1％)out of the 114 patients had a fever within 24 hours after allo-HSCT.All of them were human leukocyte antigen(HLA)mismatch transplantation.The median time of the temperature elevated was 2.5(0-18.0)hours after the infusion with a median time of the peak of 7.8(3.5-23.0)hours after the infusion.Fever was attributed to definite infection in 6 patients and no definite infection in the remaining 26 patients.None of them were hemolytic,which was attributed to transfusion related fever.Multivariate analysis showed that female donor and high count of peripheral leukocyte of donor peripheral blood were significant predictors for transfusion related fever.Conclusions Most of post-infusion fever within 24 hours after HLA mismatch related transplantation has no identifiable infectious focus.The risk factors for transfusion related fever are female donor and high number of peripheral leukocyte of donor blood.

Objective To evaluate the sensitivity and specificity of optimized sequential screening program of colorectal cancer , and provide evidence for the further optimization of colorectal cancer screening program.Methods Using cluster sampling method , 4 administrative villages were selected from Jiashan county as a census district in 2011 to 2013.Volunteers of 40 to 74 years old in the census were recruited , and tested by both optimized sequential screening ( including questionnaire survey and fecal occult blood test ) and colonoscopy for colorectal cancer.Sensitivity and specificity of different screening methods were calculated, respectively.Results A total of 2 607 volunteers took both simultaneously screening and colonoscopy at the same time.20 colorectal cancer cases , 85 advanced adenoma cases , 271 non-advanced adenomas cases , and 141 non-adenomatous polyps cases were detected.Sensitivity of optimized sequential screening for colorectal cancer , advanced adenomas , and non-advanced adenomas were 70.0%( 14/20 ) , 57.6%(49/85) and 36.5%(99/271), specificity was 68.7%(1 776/2 587), 69.2%(1 746/2 522) and 68.9%(1 610/2 336), respectively.Sensitivity of the fecal occult blood test of colorectal cancer , advanced adenomas and non-advanced adenomas were 70.0%( 14/20 ) , 47.1%( 40/85 ) and 26.6%( 72/271 ) , specificity was 79.4%(2 053/2 587), 79.9%(2 014/2 522) and 79.6%(1 860/2 336).The sensitivity of fecal occult blood test and those of optimized sequential screening for colorectal cancer , advanced adenomas was not significent (χ2 =0.00,1.91,all P values >0.05).Sensitivity of questionnaire survey of colorectal cancer, advanced adenomas and non-advanced adenomas were 10.0%(2/20), 14.1%(12/85), 12.9%(35/271), specificity was 87.6%(2 266/2 587), 87.7%(2 211/2 522), 87.6%(2 046/2 336). There were no significant difference between non-advanced adenomas.The sensitivity of advanced adenomas and non-advanced adenomas showed no significant decline when the following six term were removed from screening programs: chronic diarrhea , chronic constipation , mucus or bloody history , history of chronic appendicitis or appendectomy surgery , chronic cholecystitis or gallbladder surgery , adverse events in the history of life, while the sensitivity of colorectal cancer remained nearly the same 70.0%(14/20),52.9%(45/85),31.4%( 85/271 ) (χ2 =0.38, 1.61, all P values >0.05 ).Conclusion Current optimized sequential screening programs for colorectal cancer in China have a high sensitivity and specificity .However , further optimization is viable and necessary.

Objective To evaluate the sensitivity and specificity of optimized sequential screening program of colorectal cancer , and provide evidence for the further optimization of colorectal cancer screening program.Methods Using cluster sampling method , 4 administrative villages were selected from Jiashan county as a census district in 2011 to 2013.Volunteers of 40 to 74 years old in the census were recruited , and tested by both optimized sequential screening ( including questionnaire survey and fecal occult blood test ) and colonoscopy for colorectal cancer.Sensitivity and specificity of different screening methods were calculated, respectively.Results A total of 2 607 volunteers took both simultaneously screening and colonoscopy at the same time.20 colorectal cancer cases , 85 advanced adenoma cases , 271 non-advanced adenomas cases , and 141 non-adenomatous polyps cases were detected.Sensitivity of optimized sequential screening for colorectal cancer , advanced adenomas , and non-advanced adenomas were 70.0%( 14/20 ) , 57.6%(49/85) and 36.5%(99/271), specificity was 68.7%(1 776/2 587), 69.2%(1 746/2 522) and 68.9%(1 610/2 336), respectively.Sensitivity of the fecal occult blood test of colorectal cancer , advanced adenomas and non-advanced adenomas were 70.0%( 14/20 ) , 47.1%( 40/85 ) and 26.6%( 72/271 ) , specificity was 79.4%(2 053/2 587), 79.9%(2 014/2 522) and 79.6%(1 860/2 336).The sensitivity of fecal occult blood test and those of optimized sequential screening for colorectal cancer , advanced adenomas was not significent (χ2 =0.00,1.91,all P values >0.05).Sensitivity of questionnaire survey of colorectal cancer, advanced adenomas and non-advanced adenomas were 10.0%(2/20), 14.1%(12/85), 12.9%(35/271), specificity was 87.6%(2 266/2 587), 87.7%(2 211/2 522), 87.6%(2 046/2 336). There were no significant difference between non-advanced adenomas.The sensitivity of advanced adenomas and non-advanced adenomas showed no significant decline when the following six term were removed from screening programs: chronic diarrhea , chronic constipation , mucus or bloody history , history of chronic appendicitis or appendectomy surgery , chronic cholecystitis or gallbladder surgery , adverse events in the history of life, while the sensitivity of colorectal cancer remained nearly the same 70.0%(14/20),52.9%(45/85),31.4%( 85/271 ) (χ2 =0.38, 1.61, all P values >0.05 ).Conclusion Current optimized sequential screening programs for colorectal cancer in China have a high sensitivity and specificity .However , further optimization is viable and necessary.

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 evaluate the levels of total serum bilirubin(TSB),amplitude integrated electroencephalogram(aEEG) monitoring and brainstem auditory evoked potential(BAEP) individually and in combination for the early diagnosis of neonatal acute bilirubin encephalopathy by receiver operating charac-teristic( ROC) curve. Methods Clinical data was retrospectively analyzed. A total of 152 infants were diag-nosed with hyperbilirubinemia,including 119 cases of non-bilirubin encephalopathy group and 33 cases of bil-irubin encephalopathy group. The detection results of peak serum bilirubin,aEEG,BAEP combined with the three methods were determined with ROC curve analysis. Results The areas under ROC curve of TSB lev-el,aEEG,BAEP and in combination were 0. 900,0. 738,0. 767,0. 925,respectively,the corresponding sensi-tivity(specificity) in the cut-off point were 90. 91%(78. 15%),87. 88%(59. 66%),65. 52%(87. 91%), 93. 10%(82. 42%),respectively. It showed that the area under ROC curve of the maximum,the comprehen-sive assessment in diagnostic sensitivity and specificity of the combination of three methods were better than any single detection method by ROC curve. Conclusion The methods of TSB level,aEEG and BAEP play an important role in the diagnosis of neonatal bilirubin encephalopathy,and combination with the three meth-ods can improve the accuracy of diagnosis.

OBJECTIVETo evaluate the sensitivity and specificity of optimized sequential screening program of colorectal cancer, and provide evidence for the further optimization of colorectal cancer screening program.

METHODSUsing cluster sampling method, 4 administrative villages were selected from Jiashan county as a census district in 2011 to 2013. Volunteers of 40 to 74 years old in the census were recruited, and tested by both optimized sequential screening (including questionnaire survey and fecal occult blood test) and colonoscopy for colorectal cancer. Sensitivity and specificity of different screening methods were calculated, respectively.

RESULTSA total of 2 607 volunteers took both simultaneously screening and colonoscopy at the same time. 20 colorectal cancer cases, 85 advanced adenoma cases, 271 non-advanced adenomas cases, and 141 non-adenomatous polyps cases were detected. Sensitivity of optimized sequential screening for colorectal cancer, advanced adenomas, and non-advanced adenomas were 70.0% (14/20) , 57.6% (49/85) and 36.5% (99/271) , specificity was 68.7% (1 776/2 587) , 69.2% (1 746/2 522) and 68.9% (1 610/2 336) , respectively. Sensitivity of the fecal occult blood test of colorectal cancer, advanced adenomas and non-advanced adenomas were 70.0% (14/20) , 47.1% (40/85) and 26.6% (72/271), specificity was 79.4% (2 053/2 587), 79.9% (2 014/2 522) and 79.6% (1 860/2 336). The sensitivity of fecal occult blood test and those of optimized sequential screening for colorectal cancer, advanced adenomas was not significant (χ(2) = 0.00, 1.91, all P values > 0.05). Sensitivity of questionnaire survey of colorectal cancer, advanced adenomas and non-advanced adenomas were 10.0% (2/20), 14.1% (12/85), 12.9% (35/271), specificity was 87.6% (2 266/2 587), 87.7% (2 211/2 522), 87.6% (2 046/2 336). There were no significant difference between non-advanced adenomas. The sensitivity of advanced adenomas and non-advanced adenomas showed no significant decline when the following six term were removed from screening programs: chronic diarrhea, chronic constipation, mucus or bloody history, history of chronic appendicitis or appendectomy surgery, chronic cholecystitis or gallbladder surgery, adverse events in the history of life, while the sensitivity of colorectal cancer remained nearly the same 70.0% (14/20), 52.9% (45/85), 31.4% (85/271) (χ(2) = 0.38, 1.61, all P values > 0.05).

CONCLUSIONCurrent optimized sequential screening programs for colorectal cancer in China have a high sensitivity and specificity. However, further optimization is viable and necessary.

Adenoma ; China ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Early Detection of Cancer ; Humans ; Mass Screening ; Occult Blood ; Sensitivity and Specificity ; Surveys and Questionnaires