The knowledge and understanding of myeloproliferative neoplasms (MPN) over the last hundred years has been reviewed in this article,focusing on clinical practice.The identification of JAK2 V617F gene mutation leads Philadelphia chromosome-negative (Ph) MPN into a new era of molecular biology.These advances not only provide a reliable diagnostic tool and important evidence for diagnosis of MPN,also induce a lot of investigation and manufacture of targeting drugs to JAK2 mutation.However,JAK2 V617F mutation is not the gold standard for the diagnosis of MPN,as unique as bcr-abl in CML.Certain routine lab results and differentiation with some other diseases are still necessary.A JAK1/JAK2 inhibitor,ruxolitinib,has been approved for clinical use,but indication should be followed.Further follow-up is needed to assess the longterm outcomes with respect to efficacy and safety.It is not time to give up conventional medicine,such as hydroxyurea or aspirin.

Objective To compare the results of HLA serological typing and gene typing in acuteleukemia before and after achieved complete remission.then make sure whether the HLA matching could be performed before remission of acute leukemia.Methods The peripheral blood samples of 20 patients with acute leukemia at onset and in complete remission were performed for the HLA serological typing and gene typing by complement-dependent microcytotoxicity(CDC)assay and PCR-sequence for specific primer. The class Ⅰ HLA antigens reaction was quoted as NIH score.and paired-sample t test Was performed.The class Ⅰand class Ⅱ HLA allele specificity of acute leukemia at onset Was compared with that in complete remission.Results No absence or change of the class Ⅰ and class Ⅱ HLA allele specificity in acute leukemia was observed before treatment and after complete remission.There were significant differences (P＜0.05) for HLA-A. B and Bw6 reaction at onset from complete remission.The expression of HLA-A, B and Bw6 was significant down-regulated.This phenomenon did not occur on Bw4 (P＞0.05).The relationship of down-regulation of class Ⅰ HLA antigens and the amount of blast in peripheral blood Was not observed.Conclusion HIA typing could be performed by molecular technique when patients with acute leukemia were diagnosed.It would shorten the period of HLA-matching,and increase the opportunity of finding an appropriate allergenic hematopoietic stem cell donor.

Humans ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; therapy

Objective To study the potential of bFGF to promote human bone marrow derived MSCs to differentiate into cardiomyogenic cells, and its effect on proliferation of MSCs. Methods MSCs isolated from adult human bone marrow were cultured in four different systems. Group A: medium with 5-aza. Group B: medium with bFGF. Group C: medium with 5-aza+bFGF. Control group: medium alone. The morphological changes of MSCs were observed. Then immunocytochemistry staining against ?-actin,cTnT,and Connixin43 was performed. The expression of Nkx2.5, GATA-4 and cTnT was detected by semi-quantitative RT-PCR. The proliferation of MSCs in different groups was measured by MTT. Results The MSCs in both group A and C partially differentiated into myogenic cells and expressed proteins of ?-actin,cTnT,and connixin43. In group A and group C, the mRNA level of Nkx2.5,GATA-4 and cTnT was higher than that of control group. In group B, mRNA level of Nkx2.5 and GATA-4 was higher than that of control group. As compared with the control group, cell proliferation was faster in group B than in group A and C. And the proliferation was faster in group C than in group A. Conclusion bFGF can promote the proliferation of MSCs significantly. When combining with 5-aza, bFGF can promote MSCs to differentiate into cardiomyogenic cells more effectively.

Objective To evaluate diagnostic accuracy based on patient history and physical examinations in medical outpatients.Methods Totally, 145 consecutive patients visiting general internal medicine clinic at a university-affiliated teaching hospital during October 10 to 17, 2008 were recruited into the study and followed-up for 12 months.Results Eighteen of 145 patients ( 12.4% ) were lost to followup.Diagnosis was confirmed by follow-up for 45 ( 35.4% ) of those with medically unexplained symptoms (MUS).Sensitivity of physical diagnosis for those with MUS was 82.2 percent, with specificity of 95.1 percent, likelihood ratios of positive and negative results of 16.9 percent and 0.19 percent, its positive and negative prediction values of 90.2 percent and 90.7 percent, and overall accuracy of 90.6 percent,respectively.Conclusions MUS was common in medical clinical practice.Preliminary diagnosis for MUS based on patient history and physical examinations has been proved remarkably reliable.Carefully selected auxiliary laboratory evaluation combined with physical diagnosis is important for management of MUS.

Accidents, Occupational ; prevention & control ; China ; Humans ; Occupational Diseases ; prevention & control ; Occupational Exposure ; prevention & control ; Occupational Health Services ; organization & administration ; Safety

Based on the software of traditional Chinese medicine inheritance support system (TCMISS), this article aims to analyze the experience and composition rules for cough from the descendant of Meng He Medical School, Xu Di-hua. The cough cases treated by Xu Di-hua were collected, and recorded into TCMISS (V2.0). Data mining methods such as Apriori algorithm and complex system entropy cluster were used to analyze the medication principles of Xu Di-hua for cough from pathogenesis and therapeutie aspects, and dig out the frequency of the herbs in prescription, core medicine and new combinations. The experience of curing cough from Professor Xu Di-hua were well found in the research. He is good at choosing prescriptions accurately, and pays attention to simultaneous use of cold and moisture drugs with combination of tonification and purgation. He is skilled in adding or reducing materia medica flexibly, as well as regulating lung to relieve cough and eliminating phlegm by clearing heat.
Algorithms ; Cough ; drug therapy ; Data Mining ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; chemistry ; therapeutic use ; Female ; Humans ; Male ; Materia Medica ; Medicine, Chinese Traditional

Objective To investigate the effects of peri-operative enteral nutrition (EN) and antibiotics on intestinal flora balance in patients with esophageal carcinoma.Methods Sixty patients were randomly divided into six groups:Group B,treated with antibiotics for 3 days and supported with EN before and after operation; Group C,treated with antibiotics for 3 days and supported with parenteral nutrition (PN) before operation and EN after operation ; Group D,treated with antibiotics for 3 days and supported with PN before and after operation ; Group E,treated with antibiotics for 7 days and supported with EN before and after operation; Group F,treated with antibiotics for 7 days and supported with PN before operation and EN after operation ; and Group G,treated with antibiotics for 7 days and supported with PN before and after operation.The first stool after surgery was obtained and tested for Bacteroides,Bifidobacterium,Lactobacillus,Escherichia coli,and Enterococcus.Ten healthy adults were enrolled as the blank control group.The numbers of the flora and ratio of Bifidobacteria to Enterococci (B/E) were compared.Complications such as incision infections,lung infections,and anastomotic fistula were recorded.Results The numbers of Bifidobacterium [(10.59 ± 0.39) vs.(10.88 ± 0.10) lg10n/ml,P =0.186),Lactobacillus [(8.59±0.31) vs.(8.72 ±0.22) lg10n/ml,P=0.534],Escherichia coli [(8.43 ±0.50) vs.(8.67 ±0.24) lg10n/ml,P=0.266],Enterococcus [(7.40 ±0.61) vs.(7.78 ±0.16) lg10n/ml,P =0.111],and B/E value [(1.2589 ± 0.0644) vs.(1.2560 ± 0.0330),P =0.825] in the Group B were not significantly different from the blank control group.The numbers of Bacteroids [(11.08 ± 0.48),P =0.139 ; (9.23 ± 0.42),P =0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000; (8.05±0.53),P=0.000vs.(11.36±0.48) lg10n/ml],Bifidobacterium [(10.19 ±0.49),P=0.062; (9.00 ±0.52),P=0.000; (9.31 ±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99 ±0.56),P =0.000 vs.(10.59±0.39) lg10n/ml],Lactobacillus [(7.99 ± 0.58),P =0.006 ; (6.84 ± 0.47),P =0.000 ; (7.72 ± 0.35),P =0.000 ; (6.93 ±0.43),P =0.000; (5.93 ±0.76),P=0.000 vs.(8.59 ±0.31) lg10n/ml],Escherichia coli [(8.19 ±0.43),P=0.258; (7.93±0.60),P=0.020; (7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P =0.000 vs.(8.43 ± 0.50) lg10n/ml],and Enterococcus [(6.90 ± 0.54),P =0.037 ; (5.89 ± 0.68),P =0.000; (6.20±0.52),P=0.000; (5.91 ±0.39),P=0.000; (5.14±0.58),P=0.000 vs.(7.40±0.61) lg10n/ml] of groups C,D,E,F,and G decreased compared with those of the Group B.The values of B/Ein the D and G groups decreased significantly when compared to the blank control group (1.1433 ±0.1350,P =0.025 ; 1.0706 ± 0.1413,P =0.000 vs.1.2560 ± 0.0330).The incidences of pulmonary infections (x2 =3.647,P =0.601) and anastomotic leak (x2 =5.000,P =0.416) among all groups were not significantly different.Conclusions EN applied 3 days before surgery and after surgery is beneficial for maintaining the balance of intestinal flora.Long-term administration of antibiotics may cause dysbacteriosis and even increase complications.

ObjectiveTo investigate the treatment strategies and factors influencing the prognosis of patients with primary gallbladder carcinoma.MethodsThe clinical data of 135 patients with primary gallbladder cancer who were admitted to the Cancer Hospital of Tianjin Medical University from January 2000 to December 2009 were retrospectively analyzed.The survival curve was drawn by the Kaplan-Meier method,and the survival rates were analyzed by using the Log-rank test.Factors which may have influences on the prognosis were analyzed by univariate analysis and COX multivariate analysis.ResultsThe overall 1-,3-,5-year survival rates of the 135 patients were 46.7％,10.4％ and 5.2％,respectively.The 1-,3-,5-year survival rates of 74 patients who received radical resection of gallbladder cancer were 68.9％,18.9％ and 9.5％,respectively.The 1-,3-,5-year survival rates of 50 patients who received palliative treatment were 24.0％,0 and 0,respectively.The 1-,3-,5-year survival rates of 11 patients who received conservative treatment were 0,0 and 0,respectively.There was no significant difference in the survival rates among patients who received different treatment methods (x2 =5.642,P ＜ 0.05 ). Of the 9 patients with gallbladder cancer who received reoperation after laparoscopic choledochotomy,the survival time of 1 patient in stage Ⅰ and 1 of the 3 patients in stage Ⅱ who received radical surgery exceeded 5 years,while the survival time of 5 patients in stage Ⅱ who received palliative treatment was shorter than 5 years.There was a significant difference in the survival time among the 3 groups of patients ( x2 =5.642,P＜0.05).Under the condition of same TNM stages ( Ⅱ,ⅢA,ⅢB,ⅣA,ⅣB),the survival rates of patients who received radical resection of gallbladder cancer were significantly higher than those who received palliative or conservative treatment ( x2 =8.971,21.250,44.153,6.696,21.722,P ＜ 0.05 ).The results of univariate analysis showed that age,CA19-9,TNM stages and treatment methods were risk factors influencing the median survival time ( x2 =8.466,3.977,9.837,5.642,P ＜ 0.05 ).The results of multivariate analysis showed that age,TNM stages and treatment methods were the independent risk factors influencing the median survival time ( Wald=5.779,14.724,11.640,P＜0.05).ConclusionThe prognosis of primary gallbladder cancer is poor.Age,TNM stages and treatment methods are the independent factors influencing the prognosis of patients with gallbladder cancer,and patients who receive radical resection have relatively good prognosis.

Objective To evaluate the effects of medical residency training program in postgraduate-year-one (PGY-1) residents at Peking Union Medical College (PUMC) Hospital.Methods PGY-I medical residents at PUMC Hospital were surveyed by a self-administered questionnaire after they completed their first year residency.Results Forty-nine residents who completed their first year residency training participated in the survey with a 100％ response rate.Before training,only a few had bedside (n =18) and on-call experiences (n =10).At the end of the one-year-training,all the residents (100％) considered themselves being improved to certain degrees,especially in clinical practice capability,and passed all the examinations.However,53.1％ and 8.2％ of all the residents agreed that they need to improve their abilities in teaching (n =26) and doctor-patient communication (n =4),respectively.All residents hoped to get further improved by taking part in various forms of teaching activities,including experience summary/sharing and basic skills training.During the first year,95.9％ of them participated in all teaching activities in medicine actively.Conclusions The tradition and current models of medical residency training program at PUMC Hospital had a significant impact on professional development of the 1st year resident physicians.It is critical to focus on basic skill training and multi-level teaching to improve residents' clinical competency.