OBJECTIVE: To analyze the correlation between the mutational status of immunoglobulin heavy chain variable (IGHV) gene with the prognosis of patients with Waldenström macroglobulinemia (WM). METHODS: Immunoglobulin heavy chain gene (IGH) clonotypic sequence analysis was carried out to assess the mutational status of IGHV in the blood and/or bone marrow samples from 44 WM patients. The usage characteristics of IGHV-IGHD-IGHJ gene was explored. RESULTS: The most common IGHV subgroup was IGHV3, which was similar to the data from the Institute of Hematology of Chinese Academy of Medical Science. IGHV3-23 (20.45% vs. 15.44%) and IGHV3-74 (11.36% vs. 7.35%) were the main fragments used, which was followed by IGHV4 gene family (15.91% vs. 24.26%). However, no significant correlation was found between the IGHV4 usage and the prognosis of the patients. Should 98% be taken as the cut-off value for the IGHV mutation status, only 5 patients had no IGHV variant, and there was no correlation with the prognosis. Based on the X-tile analysis, 92.6% was re-selected as the cut-off value for the IGHV variant status in such patients. LDH was increased in 26 patients (59.1%) without IGHV variant (P < 0.05), whilst progression-free survival (P < 0.05) and overall survival (P < 0.05) were significantly shorter compared with those with IGHV variants. CONCLUSION The usage characteristics of IGHV-IGHD-IGHJ in our patients was similar to reported by the Institute of Hematology of Chinese Academy of Medical Science, albeit that no correlation was found between the IGHV4 usage and the prognosis of the patients. Furthermore, 98% may not be appropriate for distinguishing the IGHV variant status in WM patients.
Humans ; Immunoglobulin Heavy Chains/genetics* ; Multigene Family ; Mutation ; Waldenstrom Macroglobulinemia/genetics*

Background::NOTCH1 mutation is an essential molecular biologic aberration in chronic lymphocytic leukemia (CLL). CLL patients with NOTCH1 mutation have shown an unfavorable survival and a poor response to chemoimmunotherapy. This study aims to present the mechanisms of adverse prognosis caused by NOTCH1 mutation from the perspective of the splicing factor heterogeneous nuclear ribonucleoprotein A1 (hnRNPA1). Methods::The microarray data in Gene Expression Omnibus datasets were analyzed by bioinformatics and the function of hnRNPA1 was checked by testing the proliferation and apoptosis of CLL-like cell lines. Afterward, quantitative reverse transcription-polymerase chain reaction and Western blotting were applied to explore the relationship among NOTCH1, c-Myc, and hnRNPA1.Results::RNA splicing was found to play a vital part in NOTCH1-mutated CLL cells; hence, hnRNPA1 was selected as the focus of this study. Higher expression of hnRNPA1 validated in primary NOTCH1-mutated CLL samples could promote proliferation and inhibit apoptosis in CLL. The expression of hnRNPA1 increased when NOTCH1 signaling was activated by transfection with NOTCH1 intracellular domain (NICD)-overexpressed adenovirus vector and declined after NOTCH1 signaling was inhibited by NOTCH1-shRNA. Higher expression of c-Myc was observed in NICD-overexpressed cells and hnRNPA1 expression was downregulated after applying c-Myc inhibitor 10058-F4. Moreover, in NICD-overexpressed cells, hnRNPA1 expression decreased through c-Myc inhibition. Conclusion::Overexpression of c-Myc-dependent hnRNPA1 could promote proliferation and inhibit apoptosis in NOTCH1- mutated CLL cells, which might partly account for the poor prognosis of patients with NOTCH1 mutation.

A kind of adjustable external fixation device for lower extremity is designed. The circuit is mainly composed of TEC1-00703 semiconductor refrigeration chip, HZC-30A pressure sensor, STC89C52RC single chip microcomputer and other electrical components. It can realize the timing intelligent temperature control and meet the local fixed-point refrigeration. The design of adjustable structure and the application of intelligent air cushion can satisfy the full fixation of lower limbs of different individuals. Its operation does not need much medical knowledge. It can solve the problem of emergency transportation and follow-up treatment of lower limb injury in ice and snow sports. It has a good application prospect and universality.
External Fixators ; Fracture Fixation ; Humans ; Lower Extremity ; Refrigeration ; Semiconductors

Objective To explore the clinical value of laparoscopic ventral rectopexy for rectal prolapse.Methods From Jan 2013 to Jan 2017,26 patients with complete rectal prolapse were divided into control group (15 patients) undergoing laparoscopic rectal fixation,and 11 patients in study group were treated with rectal ventral fixation.Results There was no significant difference in operation time,bleeding volume and exhaust time between the two groups (t =1.839,0.138,0.932,all P ＞ 0.05).In the study group,2 cases had temporarily postoperative fever.Following up for 12 to 36 months,1 case recurred in the control group and 1 case in the study group.The length of rectal prolapse was about 2 cm.Of the 7 patients with constipation in the control group,symptoms disappeared in 2 cases,symptoms improved in another 2 cases,and 5 cases had new constipation.Of the 4 patients with anal incontinence,2 cases had recovered and 1 case had symptoms improved.Among the 6 patients with constipation in the study group,symptoms disappeared in 3 cases,symptoms improved in 2 cases.Of the 3 patients with pelvic prolapse,2 cases recovered and 1 case improved.The pelvic prolapse and constipation in the study group was less severe than that in the control group (x2 =4.909,P ＜ 0.05).Conclusion Laparoscopic rectal ventral fixation for the treatment of complete rectal prolapse is less traumatic,safor and more effective.

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients.Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study.According to the type of stent,the patients were divided into two groups,BMS group (n=46)and CS group (n=20).The demographic data,clinical signs and symptoms,and pre-procedure and post-procedure imaging data were followed up and recorded.The primary patency rates were calculated at 1,3,6,9,and 12 months.Results The related symptoms were improved within 2 day post-procedure.The primary patency rates of BMS group in 1,3,6,9 and 12 months were 97.83％,95.65％,69.56％,41.3％,and 34.78％ respectively.The rates of CS group were 100％,100％,95％,65％,and 60％respectively.They did not reached statistical significance for primary patency rates between two groups in 1,3,and 6 months (P ＞ 0.05 respectively).However,from 9 months after procedure,it began to show the significant difference between two groups (P ＜ 0.05).The median patency time of the CS group was (10.30±5.32) months,while BMS group was (8.52±0.49) months.The difference between the two groups was statistically significant (P=0.046).Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect.The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.

Objective To evaluate the feasibility and value of multi-detector computed tomography venography (MDCTV) and three dimensional reconstruction image in the assessment of central venous occlusive disease in hemodialysis patients,and in the value of guiding interventional treatments.Methods Sixty hemodialysis patients with swelling of upper limbs were scanned by Toshiba 128-multislice spiral computed tomography (128-MSCT) and totally 80-100 ml non-ionic contrast media was injected into each of the patients via the peripheral veins of the contralateral limb with the rate of 4 ml/s.MSCT scanning was taken by the technique of intelligent triggering after setting scanning triggering threshold,with the monitoring point set in the development of the lumen of inferior vena cava,to detect the position and degree of vascular stenosis.The images were reformed as maximum intensity projection (MIP),volume rendering (VR),curved planar reformation and threedimensional image reconstruction technique.Results MDCTV clearly demonstrated the lesion location in all cases enrolled.Seventy-five occlusive lesions were detected in the total of 60 hemodialysis patients with swelling of upper limbs by MDCTV,of which the lesions of brachiocephalic vein was 47,superior vena cava 15 and subclavian vein 13.Among the 75 stenosis lesions,the number of complete occlusive,severe,moderate and mild stenosis was 31,24,19 and only 1,respectively.MDCTV provided information coincident with that of digital subtraction angiography (DSA),which the correlation index was 0.401,while DSA showed that number of complete occlusive,severe,moderate and mild stenosis was 49,7,14 and 5,respectively.Pereutaneous transluminal angioplasty was performed in 53 patients,and stent placement was done in 40 patients.After interventional treatments,swelling of upper limbs were obviously relieved and vascular accesses got functional recovery to the extent that they could meet the requirement of hemodialysis.Conclusions MDCTV is the first choice to evaluate the condition of central venous occlusive diseases of hemodialysis patients with advantages of non-invasion,high definition and three-dimensional reconstruction.It can provide accurate evaluations of the conditions of occlusive lesions,which can be of great clinical significance to subsequent interventional therapy.

[Objective] To investigate association between the time point of sorafenib administered and suppress effect on tumor growth secondary to the increased expression of vascular endothelial growth factor (VEGF).[Methods] Fifty SD rats were performed intrahepatic implantation using tumor tissues from subcutaneous tumors in nude mice which were administered Walker 256 tumor cells.Ten days after the procedure,MR scans were used to choose forty SD rats with successful hepatic tumor transplantation among fifty experimental animals.Then they were randomly divided into four groups:(A,control group) mere injection of vascular endothelial growth factor (VEGF);(B) administration of sorafenib 72 hours prior to VEGF injection;(C) administration of sorafenib together with VEGF injection;(D) administration of sorafenib 72 hours later to VEGF injection.The tumor growth and median survival time of rodents were observed and compared.After each experimental animal died,immunohistochemical (IHC) methods were applied to detect the expression of VEGF in tumors.[Results] Ten days after the administration of sorafenib,MR showed significant growth of hepatic tumors,the tumor size in experiment group were significiant smaller,than control group (5.4 cm) with statistical significance.Median survival time of four groups were (19.6 ± 1.8) d,(31.2 ± 7.0) d,(27.4 ± 4.9) d,and (26.5 ± 4.6) d,respectively,which indicated that animals in sorafenib groups lived longer than those in control group (P ＜ 0.05).Differences can be obseverd in sorafenib groups with statistical significance existing (P ＜ 0.05).Harvest hepatic tumor tissues from dead animals and HE staining as well as IHC examination were performed.The expression of VEGF in four groups were 88.3 ± 13.6,42.8 ± 8.0,71.9 ± 15.7,and 73.6 ± 13.7.There were statistical significance between control group and sorafenib groups.And further in sorafenib groups,the expressions of VEGF also varied greatly.[Conclusion] Sorafenib can extend the survival time,reduce tumor angiogenesis.And we can conclude that administration of sorafenib before the transient increased expression of VEGF offers survival benefits than that after the evaluation of VEGF levels.

Bipolar Disorder ; blood ; immunology ; metabolism ; Depressive Disorder ; blood ; immunology ; metabolism ; Humans ; Proteomics

Objective To investigate effect of low molecular weight heparin (LMWH)on oxidative stress and renal function in elderly patients undergoing gastrectomy of stomach neoplasms. Methods 90 elderly patients undergoing radical surgery were randomly divided into LMWH group (Ⅰ group,n=45)and control group (Ⅱ group,n=45). Patients inⅠ group received a subcutaneous injection of LMWH(100 u/kg,1/d)from the time before anesthesia induction to postoperative 5 days,and patients in Ⅱ group were given equal volume of saline. Venous blood samples were collected to determine level of malondialdehyde(MDA),aldose reductase(AR)activity level,superoxide dismutase(SOD)activity level,catalase (CAT)activity level,creatinine(Cr)and blood urea nitrogen(BUN)before anesthesia induction(T0 ),at the end of the surgery(T1 ),on postoperative 1 day(T2),3 days(T3)and 5 days(T4)respectively;urine specimen were also collected to measured albumin(Alb)and N-acetyl-beta-D-amino glycosidase enzymes(NAG)at the same time points. Results There were obvious statistical differences in MDA,AR,SOD and CAT at different time points by intra-group comparison (P<0.05 ). MDA and AR rose first and then fell in two groups,and both reached the peak at T2 ,whereas SOD and CAT had the opposite trends. There were obvious statistical differences in MDA,AR,SOD and CAT at T1 ~T3 (P<0.05 ). MDA and AR inⅠgroup at T1 ,T2 and T3 was lower than those in groupⅡ(P<0.05 ),whereas SOD and CAT inⅠgroup at T1 ,T2 and T3 were significantly higher than those in group Ⅱ(P<0.05). Cr and BUN of both groups were found no significant statistical difference within the group and between groups(P>0.05).Alb/Cr of both groups at T1 and T2 were significantly higher than those at T0 (P<0.05 ),while Alb/Cr in Ⅰ group at T1 was obviously lower than Ⅱgroup(P<0.05 ).NAG/Cr in both groups at T1 ,T2 and T3 were significantly higher than those at T0 (P<0.05 ),while NAG/Cr inⅡ group at T4 was still higher than that at T0 (P<0.05 ),and NAG/Cr inⅠgroup at T1 ~T4 was obviously lower thanⅡgroup (P<0.05 ). MDA and AR in both groups at T1 ,T2 were positively correlated with Alb/Cr and NAG/Cr respectively(P<0.05 ),whereas SOD and CAT in both groups at T1 ,T2 were negatively correlated with Alb/Cr and NAG/Cr respectively(P<0.05 ). Conclusion Oxidative stress reaction resulted from radical surgery of elderly patients is associated with perioperative renal damage. LMWH could reduce oxidative stress in elderly patients,and alleviate the kidney damage,as well as protect the renal function.

Objective To investigate the reliability and practicality of Chinese version the hearing handicap in-ventory for the elderly -screening version(HHIE -S) scale for elderly hearing screening in China .Methods We compared the HHIE -S scores with results of pure -tone audiometry test .A total of 840 Chinese individuals older than 60 years filled in the scale all by themselves first ,then refilled it according to explanations of each question translated by researchers .All participants finished pure -tone audiometry test with frequencies of 0 .25 ,0 .5 ,1 .0 , 2 .0 ,and 4 .0 kHz .Sensitivity ,specificity ,positive predictive value (PPV ) ,false-negative rate and false -positive rate were compared with HHIE -S cut -off points of >8 or >10 and pure-tone averages (PTAs) greater than 25 ,40 and 60 dB HL .Analysis the area under the curve (AUC) values of receiver operating characteristic (ROC) curves for each three PTA levels .Results Cronbach's α of the scale was 0 .85 .HHIE -S scale pre -explanatory score was 7 .6 ± 10 .6 ,and post-explanatory score was 10 .8 ± 16 .7(P<0 .01) .HHIE -S> 8 points higher than H HIE-S> 10 points in the sensitivity ,positive predictive value increase ,specificity ,false-positive rate ,false negative rate decreased ,paired samples t - test sensitivity and false -negative rate (P< 0 .05) .After the guide meanwhile HHIE-S cut-off points of > 8 when grouping with PTA> 25 dB HL ,PTA> 40 dB HL and PTA>60 dB HL ,conducted ROC curve analysis ,the AUC value was 0 .70 ± 0 .03 ,0 .84 ± 0 .01 and 0 .88 ± 0 .02 .Conclusion The score of HHIE-S scale>8 points can be used when PTA> 40 dB HL as goal for hearing loss of old people , it can be more accurate after explanations ,so HHIE-S scale can be used as a preliminary hearing screening method for Chinese elderly people .