OBJECTIVE To study the risk factors and clinical characteristics of nosocomial infection in senile patients with acute myelogenous leukemia who received chemotherapy.METHODS Ninety-one cases of senile patients with acute myelogenous leukemia received 304 times of chemotherapy with etiological examination,to analyze the relationship between nosocomial infection and absolute neutrophil count in peripheral blood,the cellularity of the marrow and chronic systemic disorder.RESULTS All indicators of senile patients with acute myelogenous leukemia were higher than those of younger patients(P0.05).CONCLUSIONS Age,different stage of chemotherapy,the neutrocytopenia level and prolongation,and hypocellularity of bone marrow are related to the nosocomial infection in senile patients with acute myelogenous leukemia,and the chronic systemic disorder is not a risk factor.

Objective To study the efficacy and safety of recombinant human thrombopoietin (rhTPO)in the treatment of thrombocytopenia induced by chemotherapy in elder patients with acute myeloid leukemia. Methods 20 elder patients with acute myeloid leukemia who got CR received two cycles of consolidation chemotherapy. In the first cycle of chemotherapy(control cycle), they were transfused with platelet suspensions when they developed severe thrombocytopenia; In the second cycle of chemotherapy (treatment cycle), they were given subcutaneous injection of rhTPO 1.0μg·kg-2·d-1 for 14 days or until platelet count≥ 80×109/L with the treatment above all when platelet count ≤50×109/L. The efficacy and safety were evaluated. Results The duration of Plt count<100×109/L in the treatment cycle and the control cycle was (23.1±4.5)d and (25.8±5.7) d (P<0.005); the duration of Plt count≤20×109/L in the treatment cycle and in the control cycle was (6.8±2.6) d and (11.7±3.2) d (P<0.005). The minimal Plt count of the treatment cycle and the control cycle were (13.2±4.4)×109/L and (12.2±3.1)×109/L (P＝0.0967) respectively, and the maximal Plt count after its recovery were (239.3±48.7)×109/L and (163.5±32.4)×109/L (P<0.005) respectively. Platelet transfusion was (22.8±6.8) U in the treatment group, it was significantly lower than that in the control group (30.0±6.3) U (P<0.05).The changes of hemoglobin content, white blood cell count, Urine routine, the function of liver and kidney, the function of blood coagulation after chemotherapy in both groups were no obvious(P ＝0.0872). Transient adverse reaction was observed in 5 patients (25 %). No thrombotic incident had occurred. Conclusion rhTPO can significantly accelerate PLT recovery, reduce the degree and duration of thrombocytopenia induced by chemotherapy, and reduce platelet transfusion in the treatment of consolidation chemotherapy for the elder patients with acute myeloid leukemia. It is safe and can be recommended to use widely.

Objective To study the etiology of nosocomial infection and the risk factors in senile patients with acute myelogenous leukemia who received chemotherapy, then to explore the preventive measure. Methods 9lcases of senile patients with AML received 304 times of chemotherapy, then to analyze the rate of nosocomial infection, the infection site, the result of etiological examination and the relationship between the rate of nosocomial infection and the absolute of neutrophil count in peripheral blood and the duration of agranulocytosis. And then the results were compared with the non-senile patients with AML. Results The statistical indicators of nosocomial infection in senile patients with AML was higher than those younger ones. The rate of infection in lower respiratory tract, oral, alimentary canal, skin, anal area and the rate of sepsis in senile people was higher than those younger ones.Positive rate of fungal infection of senile patients was higher. The nosocomial infection in the patients whose absolute neutrophil count in peripheral blood was no more than 0.5×l09/L,and prolonged over 7 days was specific higher. Conclusions Senile patients with AML is the high risk group for nosocomial infection. Age, chemotherapy, the neutrocytopenia level and prolonged time are related to the nosocomial infection in senile patients with AML. It is necessary to take positive measure to control nosocominal infection and advance life quality of senile patients.

OBJECTIVETo compare therapeutic effects of acupuncture therapy and Motilium on diabetic gastroparesis.

METHODSSixty cases were randomly divided into a needling method group and a medication group, 30 cases in each group. The needling method group were treated with turtle probing the cave (a kind of needling manipulation) as main, with pair-acupoints, Zhongwan (CV 12) and Zusanli (ST 36), Neiguan (PC 6) and Sanyinjiao (SP 6) selected, once a day, two weeks constituting one course. The medication group were treated with oral administration of 10 mg Motilium, thrice each day, 30 minutes before meals, two weeks constituting one course. The therapeutic effects were observed after 2 courses.

RESULTSThe total effective rate was 93.3% in the needling method group and 73.3% in the medication group, with a significant difference between the two groups (P<0.05). The needling method group in improvement of epigastric distention and pain, eructation, nausea and vomiting was better than the medication group.

CONCLUSIONThe therapeutic effect of turtle probing the cave needling method on diabetic gastroparesis is significantly better than that of Mutilium.

Acupuncture Therapy ; methods ; Adult ; Diabetes Complications ; therapy ; Female ; Gastroparesis ; therapy ; Humans ; Male ; Middle Aged

Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.

OBJECTIVETo analyze the correlations between increased spinal cord signal intensity on magnetic resonance images (MRI) and the clinical prognosis of compressive cervical myelopathy.

METHODSSixty-six patients with cervical spondylotic myelopathy underwent surgeries through the anterior approach. In all the patients, the diagnoses were established on the basis of both neurological examination and MRI findings that showed spinal cord compression. The patients were divided into two groups according to preoperative MRI, namely isointense MRI T1/T2 signal group and iso/hyperintense MRI T1/T2 group. The JOA scores of the patients were evaluated before and at 6 and 12 months after the operation.

RESULTSThe patients were followed up for 12 to 38 months after the operation (mean 21 months), and no statistically significant difference were found in the pre- and postoperative JOA scores between the two groups (P>0.05).

CONCLUSIONThe peoperative hyperintense signals on T2 weighted MRI does not correlate to the prognosis of patients with compressive cervical myelopathy, who may also have favorable clinical outcomes after the operation.

Adult ; Cervical Vertebrae ; pathology ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prognosis ; Spinal Cord Compression ; diagnosis ; etiology ; surgery ; Spinal Osteophytosis ; complications ; diagnosis ; surgery

The study is to investigate the effect of angiotensin II (Ang II) and its receptor blockers on migration and endothelin-1 (ET-1) expression of rat vascular adventitial fibroblast subpopulations. Vascular adventitial fibroblasts were individually expanded by using cloning rings, and the effects of Ang II on the migration of adventitial fibroblast subpopulations were evaluated by Transwell. Fluorescence quantitative-PCR detected the expression of preproET-1 mRNA induced by Ang II, and its receptor antagonists losartan and PD-123319. The concentration of ET-1 was determined by ELISA. It showed that spindle shaped and epithelioid shaped cells were isolated by using cloning rings, named as spindle cells and round cells. RT-PCR showed that fibroblast subpopulations did not have leukocytes, endothelial cells and smooth muscle cells, namely pure cell lines. Compared with respective control cells, two subpopulations had transferring ability. Ang II significantly improved round cells migration in a concentration-dependent manner, and had no obvious influence on spindle cells migration. Ang II (1 x 10(-8) - 1 x 10(-6) mol x L(-1)) significantly increased the expression of preproET-1 mRNA in round cells (P < 0.01), and had no significant effect on the expression of preproET-1 mRNA in spindle cells. Losartan blocked the expression of preproET-1 mRNA induced by Ang II in round cells, and had no significant effect on the expression of preproET-1 mRNA in spindle cells. The effects of Ang II and ET-1 receptor inhibitors on the release of ET-1 were similar to the expression of preproET-1 mRNA. The results indicate that there are two cell subpopulations: round cells and spindle cells in rat vascular adventitial fibroblasts. Ang II significantly improved cells migration, and increased the expression of ET-1 in round cell subpopulation. It suggested that there may be different migratory mechanisms in two cell subpopulations, and the two subpopulations may play a different role in vascular remodeling and reparative process.
Angiotensin II ; pharmacology ; Angiotensin Receptor Antagonists ; pharmacology ; Animals ; Cell Movement ; drug effects ; Cells, Cultured ; Endothelin-1 ; genetics ; metabolism ; Fibroblasts ; cytology ; metabolism ; Imidazoles ; pharmacology ; Losartan ; pharmacology ; Male ; Pyridines ; pharmacology ; RNA, Messenger ; metabolism ; Rats ; Rats, Sprague-Dawley ; Vasoconstrictor Agents ; pharmacology

BACKGROUNDGastric varices (GV) are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate (BC), the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years' practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients.

METHODSFrom January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The "sandwich method" and the "modified sandwich method" were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up.

RESULTSA total of 635 GV cases treated with endoscopic injection using BC were collected, most of them (90.2%) suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions (95.2%). Complications occurred in 32 cases (5.2%), including hemorrhage due to early expulsion of tissue glue (3.1%), septicemia (1%) and ectopic thrombosis (0.5%), such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance (76.9%), collapse (17.3%) or remnants (5.8%) of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding (8.0%) and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1, 2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively.

CONCLUSIONSEndoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized oil.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Enbucrilate ; therapeutic use ; Endoscopy, Gastrointestinal ; methods ; Esophageal and Gastric Varices ; mortality ; therapy ; Female ; Humans ; Male ; Middle Aged ; Sclerotherapy ; adverse effects ; methods ; Tissue Adhesives ; therapeutic use

Objective:To observe the effects of Da Chaihutang on Cyclic adenosine monophosphate （cAMP）-response element binding protein （CREB）/peroxisome proliferator-activated receptor-gamma coactivator-1 alpha （PGC-1α） pathway in nutritionally obese rats and the protective mechanism on liver mitochondria. Method:A total of 120 8-week-old male SD rats were randomly divided into a control group （n=20） and an experimental group （n=100）. The rats in the control group were fed on a normal diet， while those in the experimental group were administered with a high-fat feed. Successfully modeled rats were randomly divided into a model group， a positive drug （metformin） group， and low-， medium- and high-dose Da Chaihutang groups （4.25， 8.5， and 17 g∙kg^-1， respectively）， with 20 rats in each group. After treatment with Da Chaihutang， the body weight， Lee's index， liver mitochondrial membrane potential and mitochondrial ultrastructure， PGC-1α expression and CREB phosphorylation of each group were measured and compared. Result:Compared with the control group， the model group showed increased body weight and Lee's index （P<0.01）， whereas decreased mitochondrial membrane potential， PGC-1α expression， and CREB phosphorylation level （P<0.01）. As compared with the model group， Da Chaihutang significantly reduced the body weight and Lee's index of obese rats （P<0.05， P<0.01）， enhanced liver mitochondrial membrane potential （P<0.05， P<0.01） to protect the integrity of mitochondrial structure， up-regulated PGC-1α expression and promoted CREB phosphorylation （P<0.05， P<0.01）. Conclusion:Da Chaihutang protects the structure and function of mitochondria and inhibits weight gain in obese rats by activating the CREB/PGC-1α pathway.

OBJECTIVETo study the mechanism and clinical value of miR-373 in multiple myeloma.

METHODSThe expressions of miR-373 in multiple myeloma cells and normal plasma cells were detected by RT-PCR, and the biological function of miR-373 in tumor was analyzed by MTT assay, flow cytometry, luciferase experiment and tumorgenesis experiment.

RESULTSThe miR-373 expression levels in MM patients and multiple myeloma cell lines (H929, MM1S and U266) were significantly lower than that in normal plasma cells detected by using RT-PCR (P<0.05). The proliferations of U266 and H929 cells transfected with miR-373 were significantly suppressed (P<0.05); the cell cycle of H929 cell transfected with miR-373 was arrested in the G/G phase(P<0.05) and the cell apoptosis was induced (P<0.05). Luciferase experiment revealed that miR-373 could significantly inhibit the expression of FOXM1 (P<0.05). In mouse tumorigenesis experiments, overexpression of miR-373 significantly inhibited tumor growth by decreasing FOXM1 levels (P<0.05).

CONCLUSIONmiR-373 inhibits tumor growth in MM by direct targeting FOXM1, thus miR-373 shows an important clinical significance for the treatment of MM.

Animals ; Apoptosis ; Cell Line, Tumor ; Cell Proliferation ; Forkhead Box Protein M1 ; Humans ; Mice ; MicroRNAs ; Multiple Myeloma