Objective To investigate the clinical features of the childhood chronic myelogenous leukemia (CCML), including the pathogenesis, incidence, clinical characteristics, diagnostic criterion, prognostic significance and the treatment strategies, etc. Method The data of 148 cases of CCML were comprehensively reviewed and analyzed, and international and domestic literature in the last two decades was reviewed. Results The CCML was found to be rare with unknown etiology, and was an acquired malignant disease of clonal proliferation of hematopoietic stem cells in children. The disease included two clinical types: adult CCML and juvenile CCML. 72.3% of CCML patients were diagnosed as the adult CCML. The clinical feature of CCML consisted of fatigue, low fever, anemia, hepatomegaly, splenomegaly, and lymphadenopathy. The laboratory findings of a typical CCML patient comprised of peripheral blood leukocytosis, basophilia and eosinophilia, myeloid differentiation in different stages, and increased megakaryocytes. The immunohistochemical features of the CCML consisted of highly positive MPO and CD68, significant lowering of neutrophil alkaline phosphatase (NAP), positive for Philadelphia chromosome (Ph) or chimeric BCR/ABL gene, etc. But in most cases of juvenile CCML, the Philadelphia chromosome could not be detected. The Gleevec therapy and hematopoietic stem cell transplantation (HSCT) might give better treatment result for CCML than the traditional therapy. Conclusions CCML has its characteristic clinical feature. The key of good therapeutic result is early diagnosis and treatment. The optimal therapy for CCML is Gleevec regime and HSCT.

Objective To investigate the effect-site concentration for 50% of maximal effect (EC50 )of propofol required for loss of consciousness and onset of burst suppression and to assess the effect of target-control infusion(TCI)of remifentanil on these EC50 of propofol.Methods Sixty patients undergoning general anesthesia for scheduled surgery were randomly divided into 2 groups (n=30):group R received TCI of remifentanil with a target concentraton of 4 ng/ml 10 minutes before TCI of propofol,which started at a target plasma concentration of 1μg/ml and then increased by 1μg/ml step every 1 minute until the burst suppression ratio reach to 15%.Group N received a mock TCI of saline instead of remifentanil and the other procedures were as same as group R.During this,all patients were assessed by modified Observ-er’s Assessment of Alertness/Sedation (OAA/S)scale,the loss of consciousness was definited by modified OAA/S values less than 2,the onset of burst suppression was definited by 15% of burst suppression ratio. Results The EC50 of effect-site concentration of propofol required for loss of consciousness and onset of burst suppression were 2.35 (95%CI 2.29-2.41)and 6.31 (95%CI 6.13-6.47)μg/ml respectively.The EC50 of propofol required for loss of consciousness was decreased to 1.73μg/ml by TCI of remifentanil,but the EC50 of propofol required for onset of burst suppression did not changed by TCI of remifentanil. Conclusion TCI of remifentanil could decrease the EC50 of propofol effect-site concentration required for loss of consciousness but has no effect on the EC50 of propofol required for onset of burst suppression.

Objective To explore the changing rule of schistosomiasis endemic situation in Gaoyou City,so as to provide the evidences for schistosomiasis control in lake and marshland regions. Methods The endemic data of schistosomiasis of Gaoy?ou City from 1970 to 2009 were collected to analyze the endemic patterns of schistosomiasis in different control stages compre?hensively. Results In the first years of infection control stage(1970-1975),transmission control stage(1976-1994)and transmission interruption stage(1995-2009),the prevalence rates of schistosomiasis were 4.20%,0.80%and 0 in human and 3.00%,0.51%and 0 in cattle respectively. In 1984,the positive rate of crowd stool tests fell to 0.04%,which was reduced by 99.05%compared with that in 1970. From 1970 to 1980,the positive rates of stool tests of people and livestock were positively correlated significantly(r=0.67,P<0.05). After 1985,no local infection patients or cattle were found. No schistosome infect?ed Oncomelania hupensis snails were found from 1970 to 2009. Conclusion The comprehensive control measures have been insisted in Gaoyou City in different prevention and control stages. Although the snail situation is undulate,the prevalence of schistosomiasis steadily declines and the interruption of transmission has achieved.

Objective To summarize the clinical experience of three different treatments for gallbladder and common bile duct stones.Methods The clinical data of 180 cases of gallbladder stones combined with bile duct stones undergoing surgery from May 2010 to May 2013 were retrospectively analyzed.They were divided into three groups,A group of 60 patients underwent a period of endoscopic sphincterotomy (EST),under the second phase of laparoscopic cholecystectomy (LC);Group B 60 patients underwent laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration surgery (LCBDE) + T tube drainage;Group C 60 patients underwent conventional open cholecystectomy (OC) + bile duct exploration (OCBDE) + T tube drainage.Results A group of 53 cases completed surgery successfully,5 cases of remaining 7 patients failured in the first phase surgery,2 cases of the 5 patients did LC + LCBDE,3 of the 5 patients underwent conventional surgery.Two patients underwent the conventional surgery in the second phase surgery.B group of 57 cases completed surgery successfully,three cases convert to open surgery.All of the group C completed the surgery successfully.Group A complication was the most in the three groups (P＜0.05);group B had the shortest time of hospitalization (P＜0.05),the complication rate was lower than that in group A (P＜0.05),the complication had no significant difference between A and B.(P and group B ＞ 0.05),group B had shortest operation time (P＜0.05);no statistically significant differences were found among three groups in fasting time.Conclusion Three treatment methods have advantages as well as disadvantages,a reasonable treatment should be selected according to the specific circumstances.

Objective To evaluate the efficacy of DSA-guided percutaneous transhepatic gallbladder catheter drainage (PTGCD) in treating aged patients with acute cholecystitis complicated by severe diseases. Methods The clinical data of 15 aged patients with acute cholecystitis or complicated by severe diseases, who were encountered at authors’ hospital in the past three years and were treated with PTGCD, were retrospectively analyzed. The clinical results were discussed. Results PTGCD was successfully accomplished with single procedure in all 15 patients. Abdominal pain was relieved within one to three days, and the abdominal symptoms and signs subsided or disappeared. Reexamination of routine blood test showed that the white blood cell count decreased to normal range in 1 - 2 weeks, and complete cure was achieved in some patients. Secondary surgery was carried out in some patients after the clinical condition was improved. During the follow-up period no complications occurred in all patients except one who developed biliary leakage after the catheter was retrieved two weeks after the treatment. Conclusion For the treatment of complicated acute cholecystitis in aged patients who are not suitable to receive surgery, DSA-guided percutaneous transhepatic gallbladder catheter drainage is an ideal therapeutic means as it can significantly relieve clinical symptoms.

Objective To observe the radiosensitization effect of Aidi injection on human lung adenocarcinoma A549 cells, and to analyze its possible mechanism.Methods ① A549 cells were treated with different concentrations of Aidi injection (1.875, 3.75, 7.5, 15, 30, 60 mg/mL) for 24 hours, and in the mean time, a blank control group was set up; the effect of Aidi injection on lung adenocarcinoma A549 cells proliferation was detected by methyl thiazolyl tetrazolium (MTT) assay, and the 10% cell growth inhibitor concentration (IC10) was calculated. ② The experiments were divided into blank control, Aidi control, radiation and Aidi pretreatment groups. The Aidi control group was incubated for 24 hours by Aidi injection IC10; the radiotherapy group was given X-ray irradiation of 4 Gy followed by incubation for 24 hours; the Aidi pretreatment group was incubated for 24 hours by Aidi injection IC10 and then given X-ray irradiation of 4 Gy; the blank control group received equal volume of normal saline and was incubated for 24 hours. The survival fraction (SF) value was detected by cell colony formation assay; the protein levels of the serine phosphorylation at 139 locus of histone (γ-H2AX protein), the key protein in homologous recombination repair pathway (Rad51 protein) and the cell autophage characteristic protein (LC3 protein) were detected by Western Blot; the formation of autophagosome was observed by transmission electron microscope.Results Aidi injection possessed the suppression of the growth of human lung adenocarcinoma A549 cells, the proliferation of the cells in various Aidi groups was lower than that in the blank control group, with the increase in drug concentration, the A549 cell growth inhibition ratio (IR) was gradually increased, representing a dose dependent manner, and the IC10 was 3.09 mg/mL. Compared with the blank control group, the SF value in Aidi control group was not significantly different [(94.7±3.85)% vs. (100.0±0.00)%,P > 0.05], the SF value in radiation group was decreased [(71.8±5.9)% vs. (100.0±0.0)%,P < 0.05], and in Aidi pretreatment group, the value was further decreased compared with that in radiation group [(51.9±4.7)% vs. (71.8±5.9)%,P < 0.05]. Compared with the blank control group, the expression of γ-H2AX protein in the three treatment groups was significantly increased, the degree of increase in Aidi pretreatment group was the most obvious, and it was significantly higher than that in radiation group (gray value: 1.44±0.11 vs. 0.93±0.09,P < 0.05). But the expression of Rad51 protein was the highest in radiation group, and it was higher than that in Aidi pretreatment group (gray value: 1.37±0.07 vs. 0.78±0.04, P < 0.05). Compared with the blank control group, the LC3Ⅱ/LC3Ⅰ value in Aidi control group, radiation group and Aidi pretreatment group were increased, and the degree of increase in Aidi pretreatment group was the most significant (0.35±0.06, 0.37±0.07, 0.49±0.06 vs. 0.05±0.04, allP < 0.05). Under transmission electron microscope, compared with the blank control group, the autophagosome in all treatment groups was increased to some extent, and the degree of increase in Aidi pretreatment group was the most remarkable.Conclusion Aidi injection has the enhancing effect of radiosensitization on human lung adenocarcinoma A549 cells, and its mechanism is possibly related to the up-regulation of A549 cell autophagy level.

Background and purpose:Although bortezomib has become one of the major therapeutic agents against newly diagnosed or relapsed multiple myeloma (MM), there are some patients who become resistant to bor-tezomib and then relapse, emerging as a major obstacle to long-term survival of MM patients. It has been found that elevation of intracellular cyclic adenosine monophosphate (cAMP) levels could induce cell cycle arrest and apoptosis in MM cells,which has become an interesting approach to MM therapy. This study aimed to investigate possible effects of forskolin combined with bortezomib on bortezomib-resistant myeloma cells and further explore its mechanisms. Methods:The bortezomib-resistant MM cell lines H929-R and primary cells from patients who do not respond to bortezomib were used asin vitro models. The inlfuences of bortezomib and/or forskolin on MM cells were evaluated through cellular morphology, changes of cell distribution and apoptotic rate. Meanwhile, lfow cytometry analysis was used to detect mitochondrial transmembrane potential (ΔΨm) and the expression levels of apoptosis regulators in these cells before and after the treatment were detected by Western blot.Results:Bortezomib (20 nmol/L) synergized with forskolin (50nmol/L) to induce apoptosis of H929-R cells and bortezomib-resistant primary cells. In addition, borte-zomib synergized with forskolin to induce collapse of mitochondrial transmembrane and facilitate the degradation of anti-apoptosis proteins including Bcl-2 and Mcl-1.Conclusion:Bortezomib could synergize with forskolin to induce apoptosis in bortezomib-resistant MM cells.

As there is widely application in clinical diagnosis and treatment with complete blood count(CBC)and differential count(DC),the experts of clinical hematology laboratory in the word have paid highly attention to the review of CBC and DC.In this paper,we would like to have an introduction for the suggested criteria for action following automated CBC and WBC differential analysis obtained from The International Consensus Group for Hematology Review and Clinical and Laboratory Standards Institute (CLSI).

Objective To investigate the genotype distribution of extended-spectrum?-lactamases(ESBLs) and AmpC?-lacta- mases produced by Escherichia coli and Klebsiella pneumoniae in 10 teaching hospitals of China.Methods 90 clinical strains of E.coli and 61 strains of K.pneumoniae isolated in 2003 and confirmed to produce ESBLs were collected from 10 teaching hos- pitals in China.Analytical isoelectric focusing was used to measure the pI of the?-lactamases.Conjugation experiment was used to study the transfer of cefoxitin resistance.Plasmid-mediated AmpC enzyme genes were amplified and sequenced by multiplex polymerase chain reaction (MPCR).Results The prevalence of ESBL-producing E.coli and K.pneumoniae was about 50% in Wuhan,Nanjing and Jinan.The prevalence of ESBL-producing E.coli was lower than K.pneumoniae in Beijing.However,in other hospitals the prevalence of ESBL-producing E.coli was a little higher than K.pneumoniae.About 24.4% of ESBL-pro- ducing E.coli isolates and 19.4% of ESBL-producing K.pneumoniae isolates were resistant to cefoxitin.Cefoxitin-resistant i solate was identified in all hospitals except Shenyang.Major genotype of ESBL-producing isolates was CTX-M.The CTX-M-9 group was the most common group,followed by CTX-M-1.More K.pneumoniae isolates produced both ESBLs and AmpC en- zyme than E.coli.The genotype was CTX-M/DHA-1.The PCR results of 3 transconjugants producing both ESBLs and AmpC enzyme were the same as their donor isolates.Conclusions The genotype of ESBL-producing isolates is mainly CTX-M-9 group in these teaching hospitals.More K.pneumoniae isolates produced both ESBLs and AmpC enzyme than E.coli.Most of these isolates are due to geno type CTX-M/DHA-1,which can spread through plasmid.

The effect of initial substrate concentration on the growth,metabolic activities of Photosynthetic bacteria (PSB) in the process of hydrogen production is studied.The empirical relation of the initial substrate concentration to the specific growth rate,specific substrate consumption rate and specific hydrogen production rate of PSB are developed based on the modified Monod model.It is found that the results given by the model are well agreed with the experimental data in growth phase and stationary phase of PSB.Meanwhile,the optimal substrate concentration in the process of growth,metabolism and hydrogen production is 50 mmol/L.Furthermore,when the initial substrate concentration deviates 50 mmol/L,the activation of PSB is limited or inhibited,and the inhibiting effect is more prominent than the limiting effect.In addition,it is demonstrated that initial substrate concentration has little effect on the specific substrate consumption rate.