With the emergence of new technologies such as brain imaging, bio-sensing, human-computer interaction, cloud computing and large data, the treatment of traumatic brain injury has entered a new era. However, it must be clearly recognized that the central nervous system (CNS) trauma remains a worldwide medical problem. Based on the existing medical knowledge, it is important for promoting CNS trauma treatment levels including nerve trauma standardized treatment, professional management team, multi modal monitoring and data analysis, actively participating in domestic and international multi-center clinical research. Medical workers should dare to explore and innovate, keep up with the pace of the times, and truly achieve the overall improvement of nerve trauma.

Antineoplastic Agents, Phytogenic ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Leukemia, Myeloid, Acute ; drug therapy ; Phytotherapy ; Plants, Medicinal ; chemistry

Adult ; Anemia, Aplastic ; complications ; surgery ; Female ; Hematopoietic Stem Cell Transplantation ; Hemoglobinuria, Paroxysmal ; complications ; surgery ; Humans

BACKGROUND: The therapeutic effect of mild hypothermia in the treatment of severe brain injury has been recognized in spite of the poor understanding of its mechanism. Until now, no reports have been available to describe the changes in cerebral oxygen metabolism following serious brain and during mild hypothermia treatment.OBJETCIVE: To observe the patterns of cerebral oxygen metabolism changes during mild hypothermia treatment for severe brain injury, and explore the mechanism of the therapeutic effect of mild hypothermia.DESIGN: A clinical observation of factorial design.SETTING: Mild Hypothermia Treatment Center of Tianjin Huanhu Hospital.PARTICIPANTS: From August 1998 to January 2000, 13 patients with severe brain injury were treated in Mild Hypothermia Treatment Center of Tianjin Huanhu Hospital, including 11 males and 2 females aged 18-65 years. Diagnosis of brain contusion and laceration with subdural hematoma was established in 6 cases, epidural hematoma in 1 case, subarachnoid hemorrhage in 4 cases and diffuse axonal injury in 2 cases. Of these cases 7 were treated with conservative therapy, and 6 with internal/external decompression after surgical hematoma removal.METHODS: A blanket for controlling the body temperature was applied to induce whole-body hypothermia in the patients in the mild hypothermia treatment room with continuous intravenous infusion of chlorpromazine (100 mg), promethazine (100 mg) and atracurium besilate (400 mg) administered in 500 mL normal saline. Neurotrend-7TM multi-parameter monitoring system was used to for monitoring the dynamic changes of cerebral PO2,PCO2, pH and brain temperature to evaluate their changes after treatment.The correlation between cerebral oxygen metabolism and the scores of Glasgow Coma Scale was analyzed.MAIN OUTCOME MEASURES: Dynamic changes of cerebral PO2,PCO2, pH and brain temperature.RESULTS: All the 13 patients entered the final analysis. Eighteen hours after hypothermia, the PO2 [(2.23±1.29) kPa] was obviously increased in comparison with that before hypothermia [(1.29±0.57) kPa, t=2.449, P ＜ 0.05], and PCO2 exhibited significant decrease at hypothermia 6 hours to (7.32±0.92) kPa from the pre-treatment level of (7.75±1.07) kPa (t=2.446, P ＜ 0.05). Significant elevation of pH and descension of intracranial pressure occurred upon the achievement of hypothermia [7.06±0.15 vs 6.83±0.20 for pH, t=5.164, P ＜ 0.05;(2.03±1.01) vs (2.57±0.93) kPa for intracranial pressure, t=2.948, P ＜ 0.05].Six hours after hypothermia, the cerebral perfusion pressure was obviously higher than that before hypothermia [(9.40±1.80) vs (7.80±1.59) kPa, t=2.365,P ＜ 0.05]. PCO2 was found inversely correlated with Glasgow Outcome Scale (GOS) scores at 24 hours of hypothermia (r=-0.699, P ＜ 0.05). The variations of cerebral oxygen metabolism indices before and after mild hypothermia were positively correlated with GOS scores.CONCLUSION: Dynamic monitoring of cerebral oxygen metabolism is safe and effective, and may help in early detection of cerebral hypoxia and acidosis following severe brain injury. Mild hypothermia treatment can effectively alleviate hypoxia and acidosis following severe brain injury to improve the prognosis of the patients.

Objective To analyze the application value of digital radiography (DR) on healthy population.Methods 1449 cases of health examination on chest by DR were retrospectively studied,the physical examination results were analyzed.Results The medical examination of positive rate was 4.9％.The positive rate of women was higher than men ( x2 =11.493,P =0.001 ).the top 5 detection rate of diseases were lung old lesions,pneumonia,suspicious tumor,thickening and adhesion of pleural,senile pulmonary.Conclusion The DR examination was selected according to symptoms,medical history of participate in the examination,the check frequency was selected according to age.

Stem cells transplantation had been proved to be effective in many clinical diseases. However, microenvi-ronment can influence their growth, migration and differentiation. Under chemical microenvironment, such as hypoxia, neu-ral growing factors and different kinds of ions, stem cells had been intensively studied while little is known about their perfor-mance under physical microenvironment. The effects of mechanical forces, elasticity and rigidity of the matrix of stem cells are still to be further investigated. This article is to summarize how microenvironment controls the fate of stem cells and to re-view the measurement of the mechanical properties.

In the last twenty years, using all-trans retinoic acid (ATRA) as a differentiation inducer, Shanghai Institute of Hematology has achieved an important breakthrough in the treatment of acute promyelocytic leukemia (APL), which realized the theory of reversing phenotype of cells and provided a successful model of differentiation therapy in cancers. Our group first discovered in the world the variant chromosome translocation t(11;17)(q23;q21) of APL, and cloned the PML-RAR alpha, PLZF-RAR alpha and NPM-RAR alpha fusion genes corresponding to the characterized chromosome translocations t(15;17); t(11;17) and t(5;17) in APL. Moreover, establishment of transgenic mice model of APL proved their effects on leukemogenesis. The ability of ATRA to modify the recruitment of nuclear receptor co-repressor with PML-RAR alpha but not PLZF-RAR alpha caused by the variant chromosome translocation elucidated the therapeutic mechanism of ATRA from the molecular level and provides new insight into transcription-modulating therapy. Since 1994, our group has successfully applied arsenic trioxide (As(2)O(3)) in treating relapsed APL patients, with the complete remission rate of 70% - 80%. The molecular mechanism study revealed that As(2)O(3) exerts a dose-dependent dual effect on APL. Low-dose As(2)O(3) induced partial differentiation of APL cells, while the higher dose induced apoptosis. As(2)O(3) binds ubiquitin like SUMO-1 through the lysine 160 of PML, resulting in the degradation of PML-RAR alpha. Taken together, ATRA and As(2)O(3) target the transcription factor PML-RAR alpha, the former by retinoic acid receptor and the latter by PML sumolization, both induce PML-RAR alpha degradation and APL cells differentiation and apoptosis. Because of the different acting pathways, ATRA and As(2)O(3) have no cross-resistance and can be used as combination therapy. Clinical trial in newly diagnosed APL patients showed that ATRA/As(2)O(3) in combination yields a longer disease-free survival time. With the median survival of 18 months, none of the 20 cases in combination treatment relapsed, whereas 7 relapsed in 37 cases in mono-treatment. This is the best clinical effect achieved in treating adult acute leukemia to this day, possibly making APL the first adult curable leukemia. Based on the great success of the pathogenetic gene target therapy in APL, this strategy may extend to other leukemias. Combination of Gleevec and arsenic agents in treating chronic myeloid leukemia has already make a figure both in clinical and laboratory research, aiming at counteracting the abnormal tyrosine kinase activity of ABL and the degradating BCR-ABL fusion protein. In acute myeloid leukemia M(2b), using new target therapy degradating AML1-ETO fusion protein and reducing the abnormal tyrosine kinase activity of c-kit will also lead to new therapeutic management in acute leukemias.
Antineoplastic Agents ; therapeutic use ; Benzamides ; Fusion Proteins, bcr-abl ; genetics ; metabolism ; Humans ; Imatinib Mesylate ; Leukemia, Promyelocytic, Acute ; drug therapy ; genetics ; metabolism ; Oncogene Proteins, Fusion ; genetics ; metabolism ; Piperazines ; therapeutic use ; Protein-Tyrosine Kinases ; antagonists & inhibitors ; metabolism ; Pyrimidines ; therapeutic use ; Receptors, Retinoic Acid ; genetics ; metabolism ; Tretinoin ; therapeutic use

This article summarizes the progress of hematology in the recent tens years to show that experimental hematology used to pick up the 'hints' from clinical problems as the renewal of research directions and targets in experimental studies continuously. As the feedback, the results from lab investigations inserted into clinical practice and eventually made a quick modernization of hematology, which was actually a good model for the "translational research". The past few decades have witnessed tremendous advances in our understanding of normal hematopoiesis where genes dictate, epigenetics regulate, transcription factors mediate, and stem cells self-renew and differentiate. Dissection of disease pathogenesis not only elucidates molecular basis of disorders including hemoglobinopathy, aplastic anemia, hemophilia, hematopoietic malignancies such as leukemia and myeloproliferative disorders, but also provides therapeutic targets for drug development. Introduction of targeted therapies and combinatory targeting therapies greatly benefits hundreds of thousands of patients, and even turns acute promyelocytic leukemia from highly fatal to highly curable. In the 21st century the experimental hematology is entering the era of genomics and system biomedicine, and the pace of progress extrapolates to a prediction of hematologic neoplasms control in this century.
Animals ; Clinical Laboratory Techniques ; trends ; Hematologic Diseases ; genetics ; metabolism ; physiopathology ; Hematologic Neoplasms ; genetics ; metabolism ; physiopathology ; Hematology ; trends ; Humans

BACKGROUND: The training task for aircrew of army airmen is very heavy, the evaluation of flight personnel on psychological diathesis is performed to early discover and deal with corresponding questions.OBJECTIVE: To compare the difference of mental health between aircrew and ground crew of army airmen and provide reference data for implementing corresponding norms.DESIGN: Chester sampling investigation and paired design were applied.SETTING: the 71687 Force of Chinese PLA, the 71521 Force of Chinese PLA, Department of Epidemiology, Fourth Military Medical University of Chinese PLAPARTICIPANTS: By chester sampling, 122 aircrew and 122 ground crew of one army airmen in one stationed training troop were randomized in February 2001. The pairs were made at ratio of 1:1 according to age difference less than 3 years and same sex and nationality. The investigated persons were all male, of Han and aged varied from 23 to 52 years.METHODS: Cornell health questionnaire was adopted respectively in investigation of aircrew and ground crew of army airmen. The investigated persons finished and handed in questionnaire independently on the spot in manner of secretion and centralized filling-up. Cornell health questionnaire is composed of 18 sections, including 195 questions, involving 4 aspects,named somatic symptoms, medial and family history, general health and habit and mental symptoms. The total score of Cornell health questionnaire ≥ 30 indicates somatic and mental disturbance and the score of mental section ≥ 10 indicates mental disturbance, both of which are taken as the criteria in comparison of psychological health in receptors of two groups.MAIN OUTCOME MEASURES: Every factor score and total score in somatic and mental sections in Cornell health questionnaire for aircrew and ground crew.RESULTS: The tested results of each 122 cases in either aircrew group or ground crew group entered result analysis. Evaluated results of somatic and mental symptoms in receptors of two groups: the total score was low in Cornell health questionnaire (0-14 scores), of which, the total score in aircrew group was higher than that in ground crew group (81.5% and 59.8%,P ＜ 0.05); the score in mental section was low (0-9 scores), of which, that in aircrew group was higher remarkably than that in ground crew group (99.2% and 91.8%, P ＜ 0.01); the score for the receptors with somatic and mental disturbance (total score≥30, score in mental section ≥ 10) in aircrew group was lower than those in ground crew group (4.1% and 12.3%, P ＜ 0.05); the score for the receptors with mental disturbance (score in mental section≥ 10) in aircrew group was lower remarkably than ground crew group (0.8% and 8.2%, P ＜ 0.01). For somatic section in aircrew group, except the factors of muscle, skeleton and skin, their scores were higher than those in ground crew group (P ＞ 0.05), the scores of the rest factors were all lower than those in ground crew group, of which, the difference was significant in evaluation of factors of eye, ear, nervous system, urinary reproductive system and fatigue in comparison of two groups (P ＜ 0.05). The score of every factor in mental section of aircrew group was lower than those in ground crew group. Except tension factor, in comparison of the rest factors in two groups, the significant difference was present (P ＜ 0.05).CONCLUSION: Overall psychological health state in Cornell questionnaire of aircrew in army airmen was superior to ground crew. Aircrew still presents a part of psychological health questions, mainly in somatic section and inadaptability was the most positive response in mental section, suggesting that aircrew probably presents inadaptable phenomena.

Objective To evaluate the effects of mild-hypothermia therapy on coagulation and prognosis in patients with severe traumatic brain injury(sTBI). Methods Forty sTBI patients with Glasgow coma score(GCS) 3-8 were randomly divided into normal temperature-treatment control group(NT group)and hypothermia-treatment group(HT group),each 20 cases. Both groups were given conventional therapy,and HT group was additionally given mild-hypothermia therapy. The values of prothrombin time(PT),activated partial thromboplastin time(APTT), thrombin time(TT) and concentrations of plasma fibrinogen(Fg),D-dimer(DD)in two groups were monitored dynamically. The incidences of frequently seen blood coagulation related complications,such as delayed hematoma, hyper-fibrinolysis,cerebral infarction were counted,and 3 months after injury,the standard glasgow outcome scale (GOS)was applied to assess the prognosis. Results The values of PT,APTT and TT were significantly shorter and reached their valley values after 12 hours in NT group〔PT(s):10.6±0.8 vs. 11.6±1.2,APTT(s):16.7±1.2 vs. 20.8±1.4,TT(s):9.8±0.8 vs. 13.6±0.8〕,the concentrations of plasma Fg,DD were obviously increased and reached their peak values after 12 hours〔Fg(g/L):3.2±0.9 vs. 2.5±0.8,DD(μg/L):4 126.7±1 170.3 vs. 873.5±140.2〕,which showed that hypercoagulability appeared in the first 12 hours after injury in NT group,and after 12 hours turned into hyper-fibrinolysis. However,the values of PT,APTT,TT extended slowly until 12 hours reaching to their peak values〔PT(s):14.4±0.9 vs. 10.9±1.0,APTT(s):45.4±1.0 vs. 20.2±1.0,TT(s):25.3±1.2 vs. 13.0±0.6〕,the concentration of plasma Fg declined gradually until 12 hours to its valley value(g/L:1.8±0.7 vs. 2.3±0.6)and then back to normal,the concentration of DD rose gradually until 12 hours reaching to its peak value(μg/L:3 079.8±947.6 vs. 795.6±120.7)and then back to normal at 72 hours in HT group. The time of recovery for above indexes in HT group was earlyer than that in NT group. The incidence of delayed hematoma in NT group was higher than that of HT group(10%vs. 5%),but there was no statistical significant difference between the two groups(P>0.05),and the incidences of hyper-fibrinolysis(5% vs. 35%,P<0.05)and cerebral infarction (0 vs. 25%,P<0.05)in HT group were obviously lower than those in NT group. The rate of good therapeutic effect was higher(30% vs. 5%,P<0.05),and mortality lower(10% vs. 25%,P<0.05)in HT group than that of NT group. Conclusion Mild-hypothermia therapy can ameliorate coagulation dysfunction, reduce morbidity of coagulation related complications,and can improve the prognoses of patients with sTBI.