The morphologic examination of hematologic diseases, mainly by bone marrow smear and/or blood smear needs to keep pace with the times. Several morphological methods need to be optimized and complemented. The joint examination of bone marrow smear, blood smear, bone marrow biopsy imprint and bone marrow section is a relatively complete integrated mode. Together with the meaningful new morphological test items, the reliable diagnosis of morphology can be significantly improved. At the same time, it is also necessary to expand and deepen the diagnostic thinking, integrate clinical, immunophenotype and genetic thinking, and take diagnostic evidence and rules as the criterion, which was the main theme of modern morphological inspection and diagnosis.

Objective:To investigate the value of diffusion-weighted imaging (DWI) quantitative parameters with different b values in the diagnosis of prostate cancer and its correlation with prostate cancer diagnosis to determine the optimal b values.Methods:Forty-one patients with pathologically confirmed prostate cancer who were admitted by Yuyao People's Hospital from May 2019 to April 2021 were included in this study. Forty-seven foci were selected to undergo 1.5T MR high-resolution T 2-weighted imaging (T 2WI) and DWI. Four different b values (800, 1 000, 1 500, 2 000 s/mm 2) were applied to DWI. The apparent diffusion coefficient (ADC) values and areas of tumor region were measured on different b-value ADC maps. Tumor signal intensity and area were measured on DWI. The same area in the same layer was selected as the reference area to calculate and analyze the signal intensity. Results:The ADC values of tumor area were 0.93 ± 0.21, 0.87 ± 0.19, 0.76 ± 0.17 and 0.68 ± 0.14 when b values were 800, 1 000, 1 500 and 2 000 s/mm 2, respectively, which were significantly different from the ADC values of the reference area (1.59 ± 0.26, 1.50 ± 0.27, 1.28 ± 0.25, and 1.08 ± 1.84, t = 13.53, 13.08, 11.79, 7.30, all P < 0.01). However, there was no significant difference in the signal intensity ratio (-0.26, -0.27, -0.25, -0.22) on the ADC maps of tumor area under different b values ( P = 0.52). The DWI signal intensities of tumor region were 68.2 ± 19.1, 59.5 ± 18.8, 47.9 ± 17.7, and 50.1 ± 11.5, respectively when b values were 800, 1 000, 1 500, and 2 000 s/mm 2, respectively, which were significantly different from the DWI signal intensities of reference area (49.1 ± 17.7, 38.7 ± 11.3, 25.3 ± 6.9, 19.6 ± 4.5, t = 5.02, 6.50, 9.43, 16.93, all P < 0.01). DWI signal intensity ratio of tumor region at the b value of 800 s/mm 2 was significantly different from that at the b value of 1 000, 1 500 and 2 000 s/mm 2 (0.16 vs. 0.21, 0.30, 0.33, t = 10.84, 23.27, 22.85, all P < 0.01). DWI signal intensity ratio at the b value of 1 000 s/mm 2 was significantly different from that at the b value of 1 500 and 2 000 s/mm 2 ( t = 12.34, 14.10, both P < 0.01). Conclusion:High b-value DWI ( b ≥ 1 500 s/mm 2) has a remarkable advantage in the diagnosis of prostate cancer over low b-value DWI.

OBJECTIVE: To establish a clinically applicable model of rapid identification of adverse drug reaction program (RiADP) for risk management and decision-making of clinical drug use. METHODS: Based on the theory of disproportion analysis, frequency method and Bayes method, a clinically applicable RiADP model in R language background was established, and the parameters of the model were interpreted by MedDRA coding. Based on the actual monitoring data of FDA, the model was validated by the assessing hepatotoxicity of lopinavir/ritonavir (LPV/r). RESULTS: The established RiADP model included four parameters: standard value of adverse drug reaction signal information, empirical Bayesian geometric mean value, ratio of reporting ratio and number of adverse drug reaction cases. Through the application of R language parameter package "phViD", the model parameters could be output quickly. After being encoded by MedDRA, it was converted into clinical terms to form a clinical interpretation report of adverse drug reactions. In addition, the evaluation results of LPV/r hepatotoxicity by the model were matched with the results reported in latest literature, which also proved the reliability of the model results. CONCLUSIONS In this study, a rapid identification method of adverse reactions based on post marketing drug monitoring data was established in R language environment, which is capable of sending rapid warning of adverse reactions of target drugs in public health emergencies, and providing intuitive evidence for risk management and decision-making of clinical drugs.
Databases, Pharmaceutical ; Decision Making, Computer-Assisted ; Drug Monitoring ; Drug-Related Side Effects and Adverse Reactions ; HIV Protease Inhibitors ; adverse effects ; pharmacology ; Humans ; Liver ; drug effects ; Lopinavir ; adverse effects ; toxicity ; Models, Statistical ; Reproducibility of Results ; Software ; standards

Objective: To study the diagnostic characteristics of cardiac amyloidosis (CA) by non-invasive electrocardiography (ECG) in relevant patients. Methods: We retrospectively analyzed 60 CA patients diagnosed in our hospital from 2008-08 to 2013-12 for their clinical and ECG characteristics. Results: There were 48 male and 12 female patients with the ratio of 4: 1. The ifrst time diagnosis rate was low and the average age for conifrmed diagnosis was at (54. 5±14. 2) years.①There were 32 (53. 3%) cases combining heart failure, 12 (20%) with pleural effusion, 20 (33. 3%) with atrial arrhythmia, 8 (13. 3%)with ventricular arrhythmia, 4 (6. 7%)with sino-atrial block, 15 (25%)with atrio-ventricular block, 4 (6. 7%) with left bundle branch block (LBBB), 5 (8. 3%)with RBBB and 8 (13. 3%)with intra-ventricular block.②There were 32 (53. 3%) cases with low voltage on limb leads, 52 (86. 7%) with pseudo-infarct pattern, 48 (60%) with ST-T abnormality and 30 (50%) combining low voltage on limb leads with pseudo-infarct pattern.③The patients combining pleural effusion and with pseudo-infarct pattern had the increased ratio of low voltage on limb leads, while there were still 22 (45. 8%) cases without pleural effusion had low voltage on limb leads.④ ECG characteristics for 60 CA patients were as follows: QRS duration (104±26) ms, QT interval (404±34) ms, QTc (462±35) ms; the R wave of avR 0. 17 mV, QRS wave 0.30 mV; the R wave of limb leads and V1-3 were all<0.5mV, the S wave of V1-3 were 0. 62mV, 1. 61mV, 1. 56mV; the R/S ratio of V1-3 were 0. 19, 0. 12, 0. 20 respectively. Conclusion: CA patients had the highest incidence of pseudo-infarct pattern; meanwhile, combining with low voltage on limb leads, pseudo-infarct with long Q or S wave and ST-T abnormality but normal QRS duration was helpful for differential diagnosis of CA in clinical practice.

Objective To evaluate the value and significance of testing megakaryocyte micronuclei in bone marrow smears for hematopathy diagnosis.Methods Bone marrow smears from a total of 863 cases of patients with hemopathy were collected from 2002 to 2009 at the second affiliated hospital of zhejiang university school of medicine.Smears from 25 healthy individuals were used as control.The bone marrow smears were subjected to Wright-Giemsa staining.The number of megakaryocytes, morphous and positive rate of megakaryocyte micronucleis were recorded by using low power lens and immersion objective.Statistical differences of positive rate in the different diseases, pathologic subtypes, total number and type of megakaryocyte were analyzed.Results The megakaryocyte micronucleis were round or oval with varying size, distributed in paranuclear or away from nuclear and even free in extracellular, which could be observed in large and medium megakaryocytes.The positive rate of megakaryocyte micronucleis was highest in myeloid leukemia, particularly in the subtype of M6, M2, M4 and M5b with dyshaematopoiesis.Megakaryocyte micronucleis could also be found in MA, infection and benzolism, but rarely observed in the lymphocytic leukemia.Conclution The detection of megakaryocyte micronuclei was related with its amount, size and type.There is significant difference of the postive rates of megakaryocyte micronuclei testing among the different hematopathies and pathologic subtypes.Megakaryocyte micronuclei testing should be valuable in the the diagnoses of hematopathy.

Objective To assess the cardiopulmonary exercise testing (CPET) derived performance of oxygen uptake and ventilation efficiency parameters,including oxygen uptake efficiency plateau (OUEP),oxygen uptake efficiency slope (OUES),(V)E/(V)CO2 slope and lowest (V)E/(V)CO2,in patients with end-stage chronic heart failure(CHF) and evaluate their clinical value on monitoring cardiac function and hemodynamic status.Methods A total of 26 end-stage CHF patients considered for heart transplantation were enrolled in this study.CPET,echocardiography and invasive hemodynamic examinations with Swan-Ganz flowing balloon catheter were performed.Correlation analysis was made between oxygen uptake and ventilation efficiency parameters from CPET and echocardiographic and hemodynamic parameters.Results OUEP and OUES showed good correlation with peak oxygen consumption (peak (V)O2) (r =0.535,P ＜ 0.01 ; r =0.840,P ＜ 0.001).In end-stage CHF patients,the slope of OUEP with respect to peak (V)O2 is about 32,but the slope of OUES with respect to peak (V)O2 is only about 2.The difference was 16 times.The change of OUEP was more sensitive and significant than those of OUES and peak (V)O2 (P ＜ 0.05).OUEP,peak (V)O2 (％ pred),(V)E/(V)CO2 slope and lowest (V)E/(V)CO2 were all correlated well with non-invasive hemodynamic parameters peak cardiac output (r=0.535,P＜0.01; r=0.652,P＜0.001; r=-0.640,P＜0.001 ; r=-0.606,P=0.001 respectively) and peak cardiac index (r =0.556,P＜0.01;r =0.772,P ＜0.001; r =-0.641,P ＜ 0.001 ; r =-0.620,P ＜ 0.001 respectively) derived from CPET,but not correlated with invasive hemodynamic parameters cardiac output and cardiac index at rest (P ＞0.05).Both peak (V)O2 (％ pred) and (V)E/(V)CO2 slope were significantly correlated with invasive hemodynamic parameters systolic pulmonary arterial pressure (r =-0.424,P ＜ 0.05 ; r =0.509,P ＜ 0.01) and mean pulmonary arterial pressure (r=-0.479,P＜0.05; r=0.405,P＜0.05).Peak (V)O2(％pred)was also significantly correlated with pulmonary capillary wedge pressure (r =-0.415,P ＜ 0.05),and (V)E/(V)CO2 slope was significantly correlated with pulmonary vascular resistance (r =0.429,P ＜ 0.05).Conclusions The oxygen uptake and ventilation efficiency parameters derived from CPET,including peak (V)O2,OUEP,lowest (V)E/(V)CO2 and (V)E/(V)CO2 slope etc,are objectively monitoring and evaluating cardiac function and hemodynamic status.And they are useful for optimizing clinical management of patients with end-stage CHF.

Objective To assess peak oxygen consumption (peak (V)O2) derived from cardiopulmonary exercise testing (CPET),concentrations of NT-proBNP and echocardiographic changes in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF,＜ 40％).Methods Seventy patients were included and divided into two groups according to the New York Heart Association (NYHA) classification:NYHA Ⅱ group (17 cases) and NYHA Ⅲ-Ⅳ group (53 cases).The basic clinical information,plasma concentration of NT-proBNP at rest,echocardiographic parameters and peak (V)O2 from CPET were compared between two groups.Correlation among peak (V)O2,NT-proBNP and echocardiographic parameters in this patient cohort was assessed and their abilities to discriminate the NYHA Ⅲ-Ⅳ grade were analyzed through c-Statistic.Results Left atrial diameter ((51.3 ±7.2) mm vs.(44.0 ±7.4) mm,P ＜0.001) was larger,plasma concentration of NT-proBNP (1 379-4 399 pmol/L vs.1 109-2 356 pmol/L,P ＜ 0.01) was higher and peak (V)O2 ((13.4 ± 3.5) ml · kg-1 · min 1 vs.(18.2 ± 3.7) ml · kg-1 · min-1,P ＜ 0.001) were significantly lower in NYHA Ⅲ-Ⅳ group than those in NYHA Ⅱ group.However,left ventricular end-diastolic diameter (LVEDD) and LVEF were similar between two groups.Peak (V)O2 correlated significantly with NT-proBNP (r =-0.311,P ＜ 0.01),but neither peak (V)O2 nor NT-proBNP correlated with echocardiographic parameters (LA,LVEDD and LVEF).ROC analysis showed that peak (V)O2 had the strongest discriminatory power for detecting NYHA Ⅲ-Ⅳ grade patients (AUC =0.835,P ＜0.001),followed by the NT-proBNP (AUC =0.723,P ＜0.01).Conclusion Peak (V)O2 is a more sensitive parameter to detect the disease aggravation (NYHA Ⅲ-Ⅳ grade) of the CHF patients with reduced LVEF compared to plasma NT-proBNP and echocardiographic parameters (LA,LVEDD,LVEF).

Objective To explore the diagnosis value of morphology changes of pleomorphic megakaryocytes in the bone marrow (BM) smears and BM sections in chronic MPD(CML-CP, ET,PV and PMF). Methods BM aspiration was taken in 182 patients of MPD aspiration and biopsy examination was performed synchronously to obtain the BM smears and BM sections samples. The BM smears were subjected to Wright/Giemsa stain and immunohistochemistry stain, while the BM sections were subjected to Haematoxylin-Giemsa-Fuchsin stain. The morphology of pleomorphic megakaryocytes was classified into five groups, which were Ⅰ type ( inclusion type), Ⅱtype ( hypolobulated muclei type), Ⅲ type ( giant hyperlobulated nuclei type), IV type (micro pyknotic type), and V type(extrusion type). The size of megakaryocytes clusters was recorded as no clusters(0) , predominantly small clusters of fewer than 6 cells (1) or predominantly large clusters of at least 6 cells (2) . The detection rates of various types of pleomorphic megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Results In CML-CP group, the detection rates were (3. 73±3. 84)% , (14.19 ±7. 62)% ,(5.99 ±4.67)%, (34. 37 ±10.79)%, (9.45 ±6. 87)%, (32. 28 ±7. 67)% and 3.13 ±2. 30)% ,(12.61 ± 9.28)%,(4.94±4.27)%,(35.26±9.63)%,(9.47 ±5.89)%,(34.58 ±6.81)% for I tⅠype,Ⅱ type,Ⅲ type, Ⅳtype and Ⅴ type pleomorphic megakaryocyte in BM smears and BM sections. There were no significantly differences between the BM smears and BM sections(t value were 0.524,0.510,0.645, 0.239,0.011,0. 869,all P>0.05). In ET group, the detection rate of I type [ (6.17 ±2. 89)% ] in BM smears was significantly higher than that in BM sections [ 2.42 ± 1. 28) % ] (t = 7. 183, P < 0. 01) , while the detection rate of V type [ (6. 28 ± 3. 34) % ] in BM smears was significantly lower than that in BM sections [ (10. 18± 4.03) % ] (t = 3.940, P < 0.01). Besides these, the detection rates of other types were not significantly different between the BM smears and BM sections(t value were 0.079,0. 122,1.643, 1. 638,all P>0. 05). In PV group, the detection rate of V type in BM smears [ (6. 55 ±4. 11)% ] was significantly lower than that in BM sections [ (10. 30±3. 34) % ] (t = 2. 351, P < 0.05 ). However, the detection rates of the other types were not significantly different between the BM smears and BM sections (t value were 1. 635,0. 301,0. 132,0. 704,0. 681 ,all P' >0. 05). In PMF group, the detection rate of IV type in BM smears [(13.05 ±5.24)%] was significantly lower than that in BM sections [(29.14± 8. 72) % ] (t = 5. 245, P < 0. 01). And the detection rate of normal type in BM smears [ ( 33. 58 ± 14.39)% ] was significantly higher than that in BM sections [(23. 01±7.96)%] (t =2. 132,P<0. 05). Besides these, the detection rates of the other types were not significantly different between BM smears and BM sections( t value were 0. 787,0.646,2.062,0. 869, P > 0. 05 ) . In CML-CP and PV groups, the detection rates of size of clusters were not significantly different between the BM smears and BM sections (x~2 = 2. 772, P > 0. 05 ). In ET group, the detection rate of small clusters (1) in BM smears was obviously higher than that in BM sections, however, the detection rate of larger clusters (2) in BM smears was obviously lower than that in BM sections (x~2 = 13. 748, P < 0.01). In PMF group, the detection rate of no clusters(0) in BM smears was obviously higher than that in BM sections, however, the detection rate of large clusters(2) in BM smears was obviously lowers than that in BM sections (x~2 =18.741 ,P<0. 01). Conclusions Both BM smears and BM sections can be applied to observe pleomorphic megakaryocytes. The morphology changes of pleomorphic megakaryocytes have certain reference values for identification of MPD subtypes and differential diagnosis.

ObjectiveTo examine the protective effects of 17-β estradiol on the experimental model of spinal cord injury (SCI) rats. Methods One hundred and eighty male Sprague Dawley (SD) rats, after Allen' s model, SD rats were divided into three groups: the sham group, the acute spinal cord injury (control groups) and the acute spinal cord injury supplying with 17-β estradiol treatment group. SCI was made by Allen's weight dropping, impacting on the posteriors of spinal cord T10. The content of malonyldialdehyed (MDA), glutathione (GSH), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined by chromatometry. The expressions of Caspase-3 and Bcl-2 family in the injured spinal cord were detected by immunohistochemical staining. Results The BBB scores at each time point in 17-β estradiol treatment group were significantly higher than that in SCI group (P<0.05). The contents of GSH, SOD, GSH-Px and the expression of Bcl-2 protein at the majority of time point in 17-β estradiol treatment group were significantly higher than that in SCI group(P<0.05), however, the MDA, Caspase-3 and Bax were markedly decreased (P<0.05). Conclusions This study suggests that 17-β estradiol administration might prevent the cells from SCI-induced apoptosis by triggering to reduce the oxidative stress.

ObjectiveIn order to investigate anti-ageing mechanisms of the notoginsenoside Rg1,we used Aβ_(1-42) and D-galactose to establish aging rat model. Methods Ninety rats were divided into three groups at random: sham group, model group, treatment group. Aging rat models were established by injecting peritoneally D-galactose (100 mg/kg) to the rats for 56 days and after 35 days aggregated Aβ_(1-42)(μg) was injected to the right lateral ventricle of rats. Meantime, rats were treated by intragastric administration the notoginsenoside Rg1. Then spatial memory of experimental rats was examined with the Morris water maze(MWM). The thiol antioxidants including glutathione reductase (GR) and glutathione peroxidase (GSH-Px) activities were examined by colorimetric method. The concentration of the pro-caspase-3 and Bcl-2 were examined by the immunohistochemistry and Western blotting method. Results In aging model rats escape latercies were significantly prolonged (P<0.05), while decreases were seen in the time of staying the third quadrants of platform, the number of crossing over a platform, the concentration of the GR, GSH-Px, and pro-caspase-3 as compared with the sham group(P<0.05). After treatment of the notoginsenoside Rg1, the aging model rats exhibited significant increases in the time of staying the third quadrants of platform, the number of crossing over a platform, the concentration of the GR, GSH-Px, and pro-caspase-3(P<0.05), while a decrease was observed in escape latercies as compared to control group(P<0.05). Moreover there was no significant difference in the expression of the Bcl-2(P>0.05). Conclusion The results from our study indicate that the notoginsenoside Rg1 could improve the oriented learning and memory capacity and prevent the neurodegeneration of central nervous systems in aging model rats by up-regulating the expression of the thiol antioxidants(including GR and GSH-Px) and resisting the cleavage of the pro-caspase-3.