OBJECTIVETo investigate the therapeutic effectiveness and side effects of decitabine combined with or without cytarabine-based low dose regimen for acute myeloid leukemia in geratic patients.

METHODSClinical data of 8 geratic patients (aged over 70 years) suffered from acute myeloid leukemia from September 2009 to March 2012 were analyzed retrospectively, including age, sex, peripheral blood and bone marrow characteristics and so on. These patients were treated by an 1-hour intravenous infusion of decitabine 20 mg/mper day for 5 consecutive days every 4 weeks combined with or without low dose regimen dominantly consisting of cytarabine 20 mg per day as subcutaneous injection for seven consecutive days. The therapeutic effectiveness and side-effects were evaluated.

RESULTSAmong 8 patients, incinding 3 males and 5 females aged between 71-84 years old, their median white blood cell count was 31.2(1.38-179)× 10/L, and median bone marrow blast cell ratio was 42.7(23-94)% at the initial diagnosis.The median treatment courses was 2.5 (1-20).After treatment by this protocol,2 patients achieved complete remission(CR) (25%), 2 patients achieved partial remission (PR)(25%), 3 were not relieved, and 1 died, thus the overall response rate reached to 50% (4/8). The median overall survival time was 9.5 (2-36) months, and the overall survival time of 3 patients reached 1 year or more. The main side-effects of treatment were grade III-IV of myelosuppression (87.5%) and pneumonia (50%).

CONCLUSIONDecitabine combined with or without cytarabine-based low dose regimen is promising for the treatment of geriatric acute myeloid leukemia, thus improving the overall response rate, and prolonging overall survival time.

OBJECTIVETo compare efficacy and safety of minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures.

METHODSThe studies concerning about randomized controlled trial and non-randomized controlled trial of minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures from the time of creating database to March, 2017 were searched from PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, ISI Web of Knowledge databases, VIP, CNKI, CBM and Wan Fang. The literatures which screened by randomized controlled trial and non- randomized controlled trial were extracted and performed quality assessment by two people. Meta analysis were performed by RevMan 5.3 software and GRADE system were used to evaluate quality.

RESULTSFour randomized controlled trial and 4 non-randomized controlled trial were included, totally 493 patients. Meta-analysis results showed compared with conventional L-shaped lateral approach, minimally invasive sinus tarsal approach had shorter operative time [MD=-5.41, 95%CI(-6.71, -4.12),<0.000 01], lower incidence of postoperative complications[OR=0.10, 95%CI(0.05, 0.21),<0.000 01], and higher AOFAS score [MD=-3.09, 95%CI(-1.72, 4.46),<0.000 01] at the final follow-up. Böhler angle in conventional L-shaped lateral approach was better than that of minimally invasive sinus tarsal approach [MD=-0.80, 95%CI(-1.45, -0.14),<0.05]. While there were no significant differences in postoperative Gissanes angle [MD=0.35, 95%CI(-0.77, 1.47),>0.05] and Maryland score[MD=2.12, 95%CI(-0.71, 4.95),>0.05] between two groups.

CONCLUSIONSMinimally invasive sinus tarsal approach and conventional L-shaped lateral approach has similar clinical effect for the treatment of calcaneal fractures. However, minimally invasive sinus tarsal approach has advantages of shorter operation time, lower incidence of complication and better safety. For the limited quantity of the original studies, operative approach should be chosen according to the patient.

The open reading frame of 1-hydroxy-2-methyl-2-(E)-butenyl 4-diphosphate reductase (HDR) was cloned from Phlegmarirus carinatus by RT-PCR method and the sequence was analyzed by bioinformatics tools. After searching the transcriptome dataset of P. carinatus, one unique sequence encoding 1-hydroxy-2-methyl-2-(E)-butenyl 4-diphosphate reductase was discovered. The primers were designed according to the cDNA sequence of 1-hydroxy-2-methyl-2-(E)-butenyl 4-diphosphate reductase from the dataset. And then, the open reading frame (ORF) of 1-hydroxy-2-methyl-2-(E)-butenyl 4-diphosphate reductase, named as PcHDR1 (GenBank Accession number：JQ957845), was cloned by RT-PCR strategy with the template of mixed RNA extracted from roots, stem and leaf of P. carinatus. The bioinformatic analysis of this gene and its corresponding protein was performed. The ORF of PcHDR1 consisted of 1 437 base pairs (bp), encoding one polypeptide with 478 amino acids. The sequence comparison showed that PcHDR1 is closest with GbHDR (Ginkgo biloba),and the sequence homology was up to 78%. Bioinformatics prediction and analysis indicated that PcHDR1 protein contained a conserved domain of LytB, without transmembrane region and signal peptides. This study cloned and analyzed 1-hydroxy-2-methyl-2-(E)-butenyl 4-diphosphate reductase from P. carinatus. The result will provide a foundation for exploring the function of PcHDR1 involved in terpene biosynthesis in P. carinatus plants.

Using the latest 454 GS FLX platform and Titanium regent, a substantial expressed sequence tag (ESTs) dataset of Ephedra sinica was produced, and the profile of gene expression and function gene of which were investigated. A total of 48 389 reads with an average length of 373 bp were generated. These 454 reads were assembled into 18 801 unigenes, which were all 454 sequencing identified. A total number of 10 531 unigenes(56.0%) were annotated using BLAST searches (E-value≤1×10⁻⁵) against the Nr, Nt, TAIR, SwissProt and KEGG databases. With respect to genes related to ephedrine biosynthesis, 19 unigenes(encoding 9 enzymes) were found. A total of 97 putative genes encoding cytochrome P450s were also discovered. Data presented in this study will provide an important resource for the scientific community that is interested in the functional genomics and secondary metabolism of E. sinica.

BACKGROUNDDifferentiating intracerebral hemorrhage (ICH) from cerebral infarction as early as possible is vital for the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes.

METHODSFrom 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography (CT) or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes' discriminant model was applied to discriminate stroke subtypes.

RESULTSAmong the 1989 patients, 797, 689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure ≥180 mmHg, and age <65 years were more typical of ICH. For noncomatose stroke patients, Bayes' discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%.

CONCLUSIONSThe model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke.

Aged ; Cerebral Hemorrhage ; classification ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Stroke ; classification ; diagnosis ; Tomography, X-Ray Computed

BACKGROUNDRecently, calreticulin (CALR) gene mutations have been identified in patients with essential thrombocythemia (ET). A high-frequency of ET cases without Janus kinase 2 (JAK2) mutations contain CALR mutations and exhibit clinical characteristics different from those with mutant JAK2. Thus, we investigated the frequency and clinical features of Chinese patients of Han ethnicity with CALR mutations in ET.

METHODSWe recruited 310 Chinese patients of Han ethnicity with ET to analyze states of CALR, JAK2V617F, and MPLW515 mutations by polymerase chain reaction and direct sequencing. We analyzed the relationship between the mutations and clinical features.

RESULTSCALR, JAK2V617F, and MPLW515 mutations were detected in 30% (n = 92), 48% (n = 149), and 1% (n = 4) of patients with ET, respectively. The mutation types of CALR involved deletion and insertion of base pairs. Most of them were Type 1 (52-bp deletion) and Type 2 (5-bp insertion, TTGTC) mutations, leading to del367fs46 and ins385fs47, respectively. The three mutations were exclusive. Clinically, patients with mutated CALR had a lower hemoglobin level, lower white blood cell (WBC) count, and higher platelet count compared to those with mutated JAK2 (P < 0.05). Furthermore, a significant difference was found in WBCs between wild-type patients (triple negative for JAK2, MPL, and CALR mutations) and patients with JAK2 mutations. Patients with CALR mutations predominantly clustered into low or intermediate groups according to the International Prognostic Score of thrombosis for ET (P < 0.05).

CONCLUSIONSCALR mutations were frequent in Chinese patients with ET, especially in those without JAK2 or MPL mutations. Compared with JAK2 mutant ET, CALR mutant ET showed a different clinical manifestation and an unfavorable prognosis. Thus, CALR is a potentially valuable diagnostic marker and therapeutic target in ET.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; genetics ; Biomarkers ; analysis ; Calreticulin ; genetics ; Female ; Humans ; Janus Kinase 2 ; genetics ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Mutation ; Receptors, Thrombopoietin ; genetics ; Thrombocythemia, Essential ; genetics ; pathology ; Thrombosis ; genetics ; Young Adult

BACKGROUNDIncreased level of serum macrophage inhibitory cytokine-1 (MIC-1), a member of transforming growth factor-μ superfamily, was found in patients with epithelial tumors. This study aimed to evaluate whether serum level of MIC-1 can be a candidate diagnostic and prognostic indicator for early-stage nonsmall cell lung cancer (NSCLC).

METHODSA prospective study enrolled 152 patients with Stage I-II NSCLC, who were followed up after surgical resection. Forty-eight patients with benign pulmonary disease (BPD) and 105 healthy controls were also included in the study. Serum MIC-1 levels were measured using an enzyme-linked immunosorbent assay, and the association with clinical and prognostic features was analyzed.

RESULTSIn patients with NSCLC, serum protein levels of MIC-1 were significantly increased compared with healthy controls and BPD patients (all P< 0.001). A threshold of 1000 pg/ml of MIC-1 was found in patients with early-stage (Stage I and II) NSCLC, with sensitivity and specificity of 70.4% and 99.0%, respectively. The serum levels of MIC-1 were associated with age (P = 0.001), gender (P = 0.030), and T stage (P = 0.022). Serum MIC-1 threshold of 1465 pg/ml was found in patients with poor early outcome, with sensitivity and specificity of 72.2% and 66.1%, respectively. The overall 3-year survival rate of NSCLC patients with high serum levels of MIC-1 (≥1465 pg/ml) was lower than that of NSCLC patients with low serum MIC-1 levels (77.6% vs. 94.8%). Multivariate Cox regression survival analysis showed that a high serum level of MIC-1 was an independent risk factor for reduced overall survival (hazard ratio = 3.37, 95% confidential interval: 1.09-10.42, P= 0.035).

CONCLUSIONThe present study suggested that serum MIC-1 may be a potential diagnostic and prognostic biomarker for patients with early-stage NSCLC.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; blood ; mortality ; pathology ; surgery ; Enzyme-Linked Immunosorbent Assay ; Female ; Growth Differentiation Factor 15 ; blood ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Survival Rate

OBJECTIVETo explore the relationship among the serum D- two polymer, fibrinogen, C reactive protein and interleukin 6 and thrombus dissolution volume in acute iliac femoral venous thrombosis model rats.

METHODSA total of 60 rats were randomly divided into 3 groups: deep venous thrombosis group (DVT group), sham operation group and normal control group. In DVT group the single side of the iliofemoral vein incomplete with micro vessel was cliped under chloral hydrate anesthesia; in sham operation group the single side of the iliofemoral vein should be explored without using micro vessel clip under chloral hydrate anesthesia; the and normal control group only experienced chloral hydrate anesthesia. A positive correlation was showed between the 2 time points of D-dimer and the corresponding thrombolytic volume, and the Pearson coefficient was 0.307, and Rwas 0.412 (P<0.05).

RESULTSThe D-dimer, fibrinogen, C reactive protein and interleukin-6 levels before and after treatment of 60 rats were shown to be significantly different (P<0.05) between DVT group, sham operation group and normal control group. The D-dimer and fibrinogen level was first rised and then decreased in DVT group, sham operation group. There was a positive correlation between C reactive protein/interleukin-6 and the level of D-dimer /fibrinogen from T1 to T3 time point (P<0.05). There was a negative correlation between C reactive protein/interleukin-6 and the level of D-dimer /fibrinogen from T4 to T6 time point (P<0.05).

CONCLUSIONThe changes of serum D-dimer, fibrinogen, C reactive protein and interleukin 6 in the acute iliac femoral vein thrombosis model firstly increase and then decrease. These changes can reflect the process of blood coagulation and fibrin dissolution in the course of venous thrombosis of iliac vein.

OBJECTIVETo assess brush sign (BS) on susceptibility-weighted imaging (SWI) in prediction of hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) after intravenous thrombolysis(IVT).

METHODSPatients with acute cerebral ischemic stroke, who had major cerebral artery occlusion (internal carotid artery, middle cerebral artery M1 and M2), treated with intravenous recombinant tissue plasminogen activator (rt-PA) from August 2009 to October 2014 in the Second Affiliated Hospital, Zhejiang University School of Medicine, were enrolled in the study. All patients underwent SWI scanning. The asymmetry index (AI) was defined as the difference of intensity between ischemic and normal hemispheres on the SWI phase map; according to AI values patients were divided into 3 groups: BS=0(n=9), BS=1 (n=39) and BS=2 (n=18). The relationships between BS and HT and the clinical outcome among the 3 groups were analyzed.

RESULTSSixty-six patients aged 68 ± 13 years were included in the study, including 44 males (67%) and 22 females (33%), and 44 (67%) with acute ischemic stroke. The mean pre-treatment National Institutes of Health Stroke Scale (NIHSS) score was 13 (6-17), and the onset to needle time was (252 ± 88) min. Twenty-six (39.4%) patients had HT, including 18 cases (27.3%) with HI and 8 cases (12.1%) with PH; BS was observed more frequently in HT group than non-HT group. Binary logistic regression analysis showed that BS was independently associated with HT of patients with acute ischemic stroke following IVT (OR=2.589, 95% CI: 1.080-6.210, P=0.033). In those without reperfusion after IVT, patients with higher BS grade had higher HT rate (P=0.023).

CONCLUSIONBrush sign on SWI can be used for predicting hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke.

Administration, Intravenous ; Aged ; Aged, 80 and over ; Brain Ischemia ; diagnosis ; drug therapy ; Carotid Artery, Internal ; pathology ; Diagnostic Imaging ; Female ; Humans ; Male ; Middle Aged ; Recombinant Proteins ; administration & dosage ; therapeutic use ; Stroke ; diagnosis ; drug therapy ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; administration & dosage ; therapeutic use ; Treatment Outcome ; United States

BACKGROUNDTrichophyton rubrum is superficial fungi characteristically confined to dead keratinized tissues. These observations suggest that the soluble components released by the fungus could influence the host immune response in a cell in contact-free manner. Therefore, this research aimed to analyze whether the culture supernatant derived from T. rubrum grown in the nail medium could elicit the immune response of keratinocyte effectively.

METHODSThe culture supernatants of two strains (T1a, T XHB ) were compared for the β-glucan concentrations and their capacity to impact the innate immunity of keratinocytes. The β-glucan concentrations in the supernatants were determined with the fungal G-test kit and protein concentrations with bicinchoninic acid protein quantitative method, then HaCaT was stimulated with different concentrations of culture supernatants by adopting morphological method to select a suitable dosage. Expressions of host defense genes were assessed by quantitative polymerase chain reaction after the HaCaT was stimulated with the culture supernatants. Data were analyzed with one-way analysis of variance, followed by the least significant difference test.

RESULTSThe T. rubrum strains (T1a and T XHB ) released β-glucan of 87.530 ± 37.581 pg/ml and 15.747 ± 6.453 pg/ml, respectively into the media. The messenger RNA (mRNA) expressions of toll-like receptor-2 (TLR2), TLR4, and CARD9 were moderately up-regulated in HaCaT within 6-h applications of both supernatants. HaCaT cells were more responsive to T1a than T XHB . The slight increase of dendritic cells-specific intercellular adhesion molecule 3-grabbing nonintegrin expression was faster and stronger, induced by T1a supernatant than T XHB . The moderate decreases of RNase 7, the slight up-regulations of Dectin-1 and interleukin-8 at the mRNA level were detected only in response to T1a rather than T XHB . After a long-time contact, all the elevated defense genes decreased after 24 h.

CONCLUSIONThe culture supernatant of T. rubrum could directly and transiently activate the innate immune response of keratinocytes.

Cell Line, Tumor ; Culture Media, Conditioned ; pharmacology ; Humans ; Immunity, Innate ; drug effects ; Keratinocytes ; drug effects ; metabolism ; Trichophyton ; metabolism ; beta-Glucans ; metabolism