Allotransplantation of peripheral blood-derived hemopoietic stem cells is the best therapy for acute leukemia. With increases of only-child families, sibling donors are decreasing. Moreover, the probability is low and time consuming is long to search a matched hemopoietic stem cell donor from the Chinese Marrow Donor Program. Haploidentical stem cell transplantation would bring a hope for donor resource. However, difficult transplantation and high incidence of graft versus host disease are two risks. Based on modified regimen and cyclosporine A+short-term amethopterin, mycophenolic acid, interleukin-11, anti-lymphocyte immunoglobulin and hemopoietic stem cells mobilized by recombinant human granulocyte colony-stimulating factor can prevent graft versus host disease. This therapy succeeded in two cases with no severe graft versus host disease.

OBJECTIVE:To study curative effect of the combination of cyclosporine A,mycophenolate mofetil,anti-thymocyte globulin,interleukin-11 and short-term methotrexate as acute graft-versus-host disease(aGVHD) prophylaxis on HLA-matched unrelated donor or HLA-mismatched related donor allogenic peripheral blood stem cell transplantation(Allo-PBSCT).METHODS:Thirteen patients with haematological malignancies who underwent HLA-matched unrelated donor or HLA-mismatched related donor Allo-PBSCT with the combination of cyclosporine A as aGVHD prophylaxis at Haikou Municipal People's Hospital from September to November 2008 were selected,including 7 of unrelated donor,3 of haplotype transplantation,and 3 of 1-locus mismatched.The conditioning regimen was performed at 7 days prior to transplantation,with cyclosporine A 5-10 mg/(kg?d),12 hours per time with twice per day.From day 7 prior to transplantation,mycophenolic acid was intravenous drip once per day,then 2.5 mg/(kg?d) antithymocyte globulin at days 5-2 prior to transplantation,1.5 mg/d interleukin 11 was subcutaneous injected at day 2 prior to and 10 days after transplantation,followed by intravenous drip 15 mg/m2 amethopterin at day 1 and 10 mg/m2 at days 3,6,11 after transplantation.The drug doge was reduced and stopped gradually after 3-6 months,which could be prolonged for haplotype grafter.Recombinant human granulocyte colony-stimulating factor was injected subcutaneously at day 3 prior to transplantation,and PBSCT was collected at days 4 and 5 after medication,which was infused to patients with subclavian vein at the same day.In total(7.82-9.11)?108/kg mononuclearcell and(2.9-7.7)?106/kg CD34+ cells were infused.RESULTS:Hematopoiesis was rebuilt in all patients with 46.15%(6/13) aGVHD incidence rate,including 8 %(1/13) of Ⅲ-Ⅳ aGVHD.Up to April of 2009,all patients live and work as normal except one patient who can not visit public places.CONCLUSION:The combination of cyclosporine A,mycophenolate mofetil,anti-thymocyte globulin,interleukin-11 and short-term methotrexate is effective in the prevention of aGVHD.

Objective To explore the effects of early enteral nutrition (EN) combined with probiotics on intestinal flora and immune function in patients with severe ischemic stroke. Methods Sixty-nine severe ischemic stroke patients were admitted and continuously enrolled in Taizhou First People's Hospital from June 2017 to June 2018, and they were randomly divided into an EN combined with probiotics group (35 cases) and a simple EN group (34 cases). Early EN support was given to both groups and probiotics (Live Combined Bifidobacterium, Lactobacillus and Enterococcus capsules) was added to the EN combined with probiotics group, 0.42 g each time, 3 times a day for 14 days. The changes of serum inflammatory markers [hypersensitive C-reactive protein (hs-CRP), procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10)], intestinal flora (Bifidobacterium, Lactobacillus, Clostridium, Enterobacter, Enterococcus, Bacteroides), intestinal mucosal barrier [endotoxin, D-lactic acid, diamine oxidase (DAO), intestinal fatty acid binding protein (I-FABP) ], and immune indexes [immunoglobulins (IgA, IgG, IgM), human leukocyte DR antigen (HLA-DR)] were observed in two groups of patients after treatment. Results With the prolongation of time, Bifidobacteria, Lactobacilli, HLA-DR and IgA, IgG, IgM after EN in both groups all decreased first and then had a tendency of increase, all reaching the lowest value on the EN 3rd day and then gradually elevated arriving at the peak value on the EN 14th day, and the levels in EN combined with probiotics group were significantly higher than those in the simple EN group [Bifidobacterium (×107 cfu/g): 8.31±1.49 vs. 7.49±1.32, Lactobacillus (×107 cfu/g): 8.04±1.45 vs. 7.19 ±1.37, HLA-DR: (67.22±9.11)% vs. (61.21±9.69)%, IgA (mg/L): 170.34±40.13 vs. 149.54±38.76, IgG (g/L):4.88±0.88 vs. 4.31±0.86, IgM (mg/L): 879.47±100.82 vs. 821.52±97.75, all P < 0.05]. With the prolongation of time, the Clostridium, Enterobacter, Enterococcus, Bacteroides, hs-CRP, PCT, TNF-α, endotoxin, D-lactic acid, DAO, I-FABP after En in both groups all increased first and then had a tendency of decrease, reaching the highest level on the EN 3rd day, then gradually decreased arriving at the valley value on the EN 14th day, and the levels in the EN combined with probiotics group were significantly lower than those in the simple EN group [Clostridium (×107 cfu/g): 5.23±0.87 vs. 5.79±0.91, Enterobacter (×107 cfu/g): 7.45±1.21 vs. 8.62±1.32, Enterococcus (×107 cfu/g): 7.32±1.05 vs. 8.12±1.23, Bacteroides (×107 cfu/g): 9.16±1.35 vs. 9.87±1.42, hs-CRP (mg/L): 18.45±12.98 vs. 25.47±15.55, PCT (ng/L): 3.24±1.21 vs. 4.18±1.32, TNF-α (ng/L): 9.43±8.69 vs. 13.59±9.45, IL-10 (μg/L): 39.45±10.72 vs. 48.52±11.42, endotoxin (U/L): 6.74±2.12 vs. 9.21±3.28, D-lactic acid (mg/L): 98.74±20.74 vs. 114.78±19.89, DAO (mg/L): 21.45±8.49 vs. 29.47±9.41, I-FABP (ng/L): 1.4±0.2 vs. 1.5±0.2, all P < 0.05]. Conclusion Early EN combined with probiotics can effectively regulate the intestinal flora and intestinal mucosal barrier function, reduce the level of inflammatory response and enhance the body immunity in patients with severe ischemic stroke.

Objective To evaluate the predictive value of functional liver imaging score(FLIS)based on preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI for post-hepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma(HCC).Methods The data of HCC patients who underwent extensive hepatectomy and preoperative Gd-EOB-DTPA enhanced MRI were analyzed retrospectively.The FLIS was scored based on the three features including liver parenchyma enhancement,biliary excretion and portal vein signal enhancement in hepatobiliary phase images,and the consistency between different observers was evaluated.Logistic regression model and receiver operating characteristic(ROC)curve were used to analyze the ability of FLIS to predict the PHLF.Results PHLF occurred in 29 of 120 HCC patients(24.2%).The intraclass correlation coefficient(ICC)of FLIS evaluated by two observers was 0.944.Multivariate logistic regression analysis showed that FLIS was an independent predictor of PHLF of HCC patients[odds ratio(OR)0.520,95%confidence interval(CI)0.355-0.726;P<0.001].The area under the curve(AUC)of FLIS for predicting the PHLF was 0.709,the optimal diagnostic threshold was 4,and the corresponding sensitivity and specificity were 78.0%and 58.6%.Conclusion Preoperative FLIS can predict the PHLF of HCC patients,which may help to make more accurate treatment plans for HCC patients.

ObjectiveTo explore the possible mechanism of Bimin Formula （鼻敏方） in treating lung-spleen qi deficiency syndrome of allergic rhinitis （AR） with high mucin secretion. MethodsThirty-four SD rats were randomly divided into a blank group （8 rats）， a model group （8 rats）， a low-dose Bimin Formula group （8 rats）， and a high-dose Bimin Formula group （10 rats）. Except for the blank group， the other groups were subjected to AR lung-spleen qi deficiency rat models induced by smoking， gavage of Ginkgo biloba leaf extract， and ovalbumin. After modeling， rats in the low- and high-dose Bimin Formula groups were given Bimin Formula concentrate （concentration of 2.16 g/ml） by gavage at doses of 1.08 g/100 g and 2.16 g/100 g， respectively， while rats in the model group were given 0.5 ml/100 g of normal saline by gavage， once daily for 28 days； the blank group was not intervened. Behavioral assessments were performed after intervention. ELISA was used to detect the levels of peripheral blood total immunoglobulin E （IgE）. HE staining was used to observe the pathological changes of nasal mucosa epithelium in rats， while immunohistochemistry was used to detect the expression of transmembrane protein 16A （TMEM16A） and mucin 5AC （MUC5AC） protein in nasal mucosa. Western Blot was used to detect the expression of nuclear factor kappa B （NF-κB） protein， and RT-PCR was used to detect the expression of TMEM16A， MUC5AC， and NF-κB mRNA in nasal mucosa. ResultsHE staining showed that the nasal mucosa epithelial cell structure in the blank group was intact without shedding， swelling， or necrosis； the nasal mucosa epithelial tissue of rats in the model group was thickened and partially shed， with infiltration of eosinophils and lymphocytes visible； the pathological changes in nasal mucosa tissue of rats in the high- and low-dose Bimin Formulagroups were improved， and more improvement was showen in the high-dose group. Compared with those in the blank group， the behavioral scores and peripheral blood total IgE levels of rats in the model group significantly increased， as well as the expression of TMEM16A， MUC5AC， and NF-κB proteins and mRNA in nasal mucosa （P＜0.05 or P＜0.01）. Compared with those in the model group， the behavioral scores and peripheral blood total IgE levels of rats in the high-dose Bimin Formula group decreased， and the expression of TMEM16A， MUC5AC， and NF-κB proteins and mRNA in nasal mucosaalso decreased （P＜0.05 or P＜0.01）； the behavioral scores and peripheral blood total IgE levels of rats in the low-dose Bimin Formula group were reduced， and the expression of TMEM16A and MUC5AC proteins and mRNA in nasal mucosa， as well as the expression of NF-κB protein decreased （P＜0.05 or P＜0.01）， but the difference in NF-κB mRNA expression was not statistically significant （P＞0.05）. Compared with the low-dose Bimin Formula group， the expression of NF-κB protein in the high-dose group decreased （P＜0.01）. ConclusionBimin Formula may improve the symptoms and high mucus secretion of AR lung-spleen qi deficiency by regulating the TMEM16A/NF-κB/MUC5AC signaling pathway in nasalmucosa.