Animals ; Arteriovenous Malformations ; complications ; Child, Preschool ; Diaphragm ; blood supply ; Hemothorax ; etiology ; Humans ; Male ; Nematode Infections ; pathology ; Pleural Effusion ; etiology

Objectives To explore the differences in therapeutic efficacy between decitabine combined with low dose HAG(D+ HAG)and CAG in elderly patients with acute myeloid leukemia (AML).Methods Totally 32 elderly patients with AML in our department from July 2012 to July 2015 were retrospectively analyzed.15 patients were on a therapy of decitabine combined with low dose HAG,and 17 patients with CAG.Efficacy and side effects were compared between the two groups.Results In(D+HAG)versus CAG groups,the complete remission(CR)was 10 cases(66.7％)vs.6 cases (35.3 ％),partial remission(PR) was 2 cases (13.3％) vs.1 case(5.9 ％),non-remission(NR) was 3 cases(20％)vs.10 cases(58.8％),and the total efficacy rate(CR+PR)was 80％vs.41.2％ (P＜0.05).The side effects in two groups mainly included bone marrow depression,respiratory tract infection,gastrointestinal reaction,which were all alleviated after symptomatic treatments.The incidence rate of side effects had no statistical difference (P ＞ 0.05).Conclusions The treatment of decitabine combined with low dose of HAG is prior to CAG,and the side effects are all tolerated.So decitabine combined with low dose of HAG can be served as the first-line therapy for elderly AML patients.

Objective To investigate the quality of life and its influencing factors of families primary caregivers of dementia patients .Methods The typically self made questionnaire ,WHO quality of life measurement profile (WHOQOL‐BREF) ,zarit bur‐den of care scale(ZBI) ,social support rating scale (SSRS) et al were adopted to investigate 64 caregivers of AD patients .Results (1) The overall quality of life of family caregivers of total subjective feelings were significantly lower than the general health status of subjective feeling score (t= -2 .217 ,P=0 .030) .The field of physiological and psychology points have no statistically significant difference in comparison with Chinese norm (t= -0 .252 ,-1 .994 ,P=0 .801 ,0 .050);the field of social and environment points have statistically significant difference compared with norm(t= -3 .830 ,3 .658 ,P=0 .000 ,0 .001) .(2) caregiver who have spouse , poor parent child relationship and patients with somatic diseases and mental behavior symptoms have lower quality of life(P<0 .05) .(3)Total score of Quality of life was negatively associated with total score of care burden (r= -0 .433 ,P=0 .000) ,while was significant positive associated with total score of the social support (r=0 .346 ,P=0 .005) .(4)Marital status ,parent‐child rela‐tionship ,physical illness and social support were the main factors affecting the quality of life(r2 =0 .409) .Conclusion Strengthen the social support and psychological intervention of dementia caregivers who has a spouse ,poor parent-child relationship and poor physical condition may help to improve the quality of life .

Adult ; Female ; Humans ; Middle Aged ; Myxoma ; pathology ; surgery ; Vulvar Neoplasms ; pathology ; surgery

ObjectiveTo introduction of perforator flaps,muscle flaps pedicled by descending branch of lateral circumflex femoral artery,method and their clinical application that multiple soft tissue defects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery.MethodsFifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled bydescending branch lateral circumflex femoral artery.At first,the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lateral circumflex femoral artery was dissected at the same time the segmented perforator flap,fascia lata flap,rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium intermusculare flap were harvested in need according to distance among soft tissue defects.The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were repaired in one time.ResultsNo vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months(the average was 8.7 months).Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent,nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent.ConclusionMultiple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good recovery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand.

OBJECTIVETo study the modulatory effect of insulin on apoptosis of skeletal myoblast (L6 cells) by serum of scalded rat and its mechanism.

METHODSL6 cells cultured with DMEM medium containing 10% FBS were divided into control (C, added with 20% normal rat serum), serum from rat with scald injury (S, added with 20% serum from scalded rat), insulin (I, added with 20% normal rat serum and 100 nmol/L insulin), and serum of scalded rat + insulin (SI, added with 20% serum of scalded rat + 100 nmol/L insulin) groups according to the random number table. After being cultured for 48 hours, apoptosis was observed with Hoechst 33258 staining and its number counted, annexin V -FITC/PI double-labeling method was used to assess apoptosis rate, the protein levels of phosphorylated (p-) Akt, p-PI3K, Bax, Bcl-2, and active caspase-3 were determined by Western blotting. Data were processed with grouped or paired t test.

RESULTS(1) The amount of apoptosis with typical morphological change in S group [(59.6 +/- 3.9) per visual field] was more than that in C, I, and SI groups [(4.9 +/- 2.6), (5.5 +/- 2.1), (19.7 +/- 2.3) per visual field, with t value respectively 28.53, 29.86, 21.53, P values all below 0.01]. (2) Apoptotic rate in S group was (18.5 +/- 1.8)%, which was markedly higher than that in C, I, and SI groups [(1.1 +/- 0.6)%, (1.5 +/- 0.3)%, (7.8 +/- 0.6)%, with t value respectively 22.41, 22.83, 13.92, P values all below 0.01]. (3) Compared with those in C group, the protein levels of Bax and active caspase-3 in S group were up-regulated (1.12 +/- 0.63 vs. 0.16 +/- 0.03, 2.15 +/- 0.51 vs. 0.21 +/- 0.03, with t value respectively 3.80, 10.69, P values all below 0.01), the protein level of p-Akt was lowered (0.20 +/- 0.03 vs. 0.42 +/- 0.07, t = -8.46, P < 0.01), and the protein levels of p-PI3K and Bcl-2 showed no statistical difference (0.19 +/- 0.03 vs. 0.26 +/- 0.09, 0.17 +/- 0.03 vs. 0.28 +/- 0.07, with t value respectively -2.73, - 1.14, P values all above 0.05). The protein levels of Bax (0.40 +/- 0.14) and active caspase-3 (0.83 +/- 0.18) in SI group were lowered (t = -3.23, P < 0.05; t = 6.66, P < 0.01) and the protein levels of p-Akt, Bcl-2, and p-PI3K in SI group were elevated (0.39 +/- 0.10, 0.78 +/- 0.03, 0.47 +/- 0.12, with t value respectively 4.07, 18.71, 5.05, P < 0.05 or P < 0.01) as compared with those in S group.

CONCLUSIONSSerum from scalded rat can induce apoptosis in skeletal myoblast, and the effect can be inhibited by insulin through PI3K/Akt signal pathway.

Animals ; Apoptosis ; drug effects ; Burns ; blood ; metabolism ; pathology ; Caspase 3 ; metabolism ; Cell Line ; Insulin ; pharmacology ; Male ; Myoblasts, Skeletal ; cytology ; drug effects ; pathology ; Rats ; Rats, Wistar ; Serum ; immunology ; Signal Transduction ; bcl-2-Associated X Protein ; metabolism

ObjectiveTo study the Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL)of the elderly and explore its clinical characteristics. MethodsThe clinical manifestation,laboratory examination and treatment of two cases of EBV positive DLBCL of elderly were lescribed.Results EBV positive DLBCL of elderly onset was often between 70-79 years,usually presented with lymphadenopathy and may be extranodal,may present with massive splenomegaly,secondary immune hemolytic anemia and often had B symptom.Pathologically,this disease was characterized by a proliferation of atypical large B cells with rich reactive cells,especially T cell.ConclusionImmunohistochemically,the tumor cells of EBV positive DLBCL of elderly present with CD20 or CD79a,EBV-encoded small RNA (EBER) positive.This disease has aggressive clinical course,a poor response to standard treatment.Rituximab may be effective in a short periods,but the long effect is limited.Overall survival is short.The cause of death is mainly respiratory failure due to factor infection.

ObjectiveTo probe the indication,treatment algorithm,anesthesia method,safety and efficacy ofextracorporealshockwavelithotripsy(ESWL)incombinationwithendoscopicretrograde cholangiopancreatography (ERCP) for pancreatic duct stones.MethodsThe patients with chronic pancreatitis and large pancreatic duct stones ( ＞ 5 mm diameter) and receiving ESWL and ERCP between March and July 2011 in Changhai Hospital were prospective studied.The third generation of extracorporeal shockwave lithotripsy was applied in ESWL,and the localization of stone was determined by X-ray.No more than 5000 shocks were given per session,and ESWL was performed continuously till the calculi were fragmented,and then was cleared by ERCP.ResultsA total of 100 patients underwent ESWL during the 5 months,among whom 84 patients received ERCP treatment and 41 cases failed to deep cannulation (41/84,48.8％ ).Multiple stones were seen in 83 patients.Ninety five patients had radio-opaque stones,two patients had radiolucent calculi,while three patients had both radio-opaque and radiolucent stones.Seventy five percent,14％ and 11％ stones were located in pancreatic head,pancreatic head and body,pancreatic body and tail,respectively.A total of 175 ESWL procedures were performed,43 patients needed 2 or more sessions for successful fragmentation.Anesthesia method was mainly intravenous sedation,accounting for 96％ (168/175).ERCP was successful in 96 patients after ESWL,only 4 patients failed after ESWL. Forty one cases which failed ERCP procedures before ESWL underwent ERCP,and 37 patients (90.2％) achieved successful cannulation.Successful fragmentation ratewas 100％.Complete clearance was achieved in 78 patients,and complication rate of post-ERCP pancreatitis,fever was 1.71％ (n =3 ),0.57％ (n =1 ),and the overall complication rate was 2.28％.Conclusions ESWL is an effective,safe and necessary modality for fragmentation of large PD stones in the management of minimal invasive treatment of chronic pancreatitis.

OBJECTIVEImpulsivity is one of the core symptoms of children with attention deficit hyperactivity disorder (ADHD). In order to understand the neuromechanism of the impulsive behaviors in ADHD children, this study investigated the specific functional areas of the brain by functional MRI.

METHODSThe subjects consisted of 10 ADHD children with impulsivity, 7 ADHD children without impulsivity and 9 normal children. A functional MRI examination was performed when the subjects were instructed to finish GO and STOP tasks with the GO-STOP impulsivity paradigm. The MRI data during the two tasks of GO and STOP were averaged and the corresponding activation regions between groups were compared.

RESULTSThe data from the GO task revealed that the main activation regions of the normal children included frontal pole (superior frontal gyrus, middle frontal gyrus and medial frontal gyrus); the main activation regions of ADHD children without impulsivity were cerebellum (posterior lobe and anterior lobe bouton) and cingulated gyrus; those of ADHD children with impulsivity were medial globus pallidus and insula. The data from the STOP task showed that the main activation regions of normal children included superior frontal gyrus and middle frontal gyrus; those of ADHD children without impulsivity were middle frontal gyrus and cingulate gyrus; those of ADHD children with impulsivity were uncus and putamen. The activation regions of ADHD children with impulsivity were much fewer than the other two groups.

CONCLUSIONSThe behavior of impulsivity-control involves a number of specific functional areas in the cerebral cortex. Compared with normal children, ADHD children without impulsivity have weaker brain function and brain activation, and ADHD children with impulsivity demonstrate much fewer brain activation regions, worse brain function and little awareness of the cerebral cortex.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; physiopathology ; Brain ; physiopathology ; Child ; Humans ; Impulsive Behavior ; physiopathology ; Magnetic Resonance Imaging ; Male

Objective To investigate the pathogenic and clinical features of bloodstream infections in patients with hematological malignancies for improving clinical treatment.Methods A total of 92 patients with hematological malignancy and positive blood culture treated during the period from September 2011 to September 2016 were analyzed,including clinical manifestations,treatment and prognosis.The distribution and antibiotic resistance of pathogens were also investigated.Results Of the 92 patients with bloodstream infection,64.1％ had underlying agranulocytosis.All patients had fever.Septic shock was found in 45.7％ cases.Elevated procalcitonin was detected in 82.6％ cases.The 107 isolates from blood stream included 75 (70.1％) strains of gram negative bacteria,27 (25.2％) strains of gram positive bacteria,and 5 (4.7％) strains of fungi.Escherichia coli showed higher resistance rate to ceftriaxone (80.9％) and levofloxacin (91.3％).Klebsiella pneumoniae (31.2％) and Acinetobacter baumannii (50.0％) strains showed relatively high resistance to imipenem.Gram positive bacteria were still sensitive to vancomycin and linezolid.Overall,35 (38.0％) patients died.The initial empirical treatment regimen had significant impact on patient outcome (P＜0.05).The mortality rate of initial carbapenem-based empirical treatment was slightly lower (28.6％ vs 46.2％) than that of non-carbapenem-based initial regimen,but the difference was not significant (P=0.163).Conclusions The outcome is poor in patients with hematological malignancy complicated with bloodstream infection.The main pathogen is gram negative bacteria in such infections,associated with high antibiotic resistance.The emergence of carbapenem resistance is an issue of concern.The effectiveness of initial empirical therapy may have significant effect on patient outcome.