Objective:To explore the predictive value of peripheral blood CD34-positive cell count for the stem cell mobilization effect of plerixafor in patients with multiple myeloma (MM).Methods:The clinical data of 12 MM patients who used plerixafor for stem cell mobilization in the First Affiliated Hospital of Guangxi Medical University from December 2019 to February 2021 were retrospectively analyzed. The changes of peripheral blood CD34-positive cell count and the collection status of stem cell in all patients before and after the mobilization of plerixafor were analyzed.Results:Twelve patients were included in this study. These patients were in international staging system (ISS) stage Ⅱ-Ⅲ, and the induction therapy was mainly VRD regimen. The CD34-positive cell count was increased after the use of plerixafor in all patients no matter which mobilization strategies were used before plerixafor. The CD34-positive cell count was 3.63/μl (0.72-13.53/μl) and 32.11/μl (8.52-53.68/μl) before and after the use of plerixafor, and the difference was statistically significant ( Z = -0.40, P<0.001); the median increasing time was 11.50 times (1.61-23.71 times). The mobilization failure occurred in 1 patient. The CD34-positive cell count in his blood was less than 1/μl before the use of plerixafor; though increased 11.83 times after the use of plerixafor, the CD34-positive cell count was still less than 10/μl. Pearson analysis showed that among the patients with CD34-positive cell count less than 4/μl before the use of plerixafor, there was a positive correlation in peripheral blood CD34-positive cell count before and after the use of plerixafor ( r = 0.80, P = 0.032). Conclusions:The peripheral blood CD34-positive cell count has a certain predictive value for the stem cell mobilization effect of plerixafor in MM patients.

Objective To evaluate the impact of cardiopulmonary resuscitation (CPR) training on the willingness to perform on-site rescue for patients with apnea and cardiac arrest. Methods Through questionnaire survey, the analyses on the differences in the results of evaluating various indicators in CPR Willingness Questionnaire in 364 willingness (including 14 recurrent training personnel) of Yunnan Emergency Center from January 2017 to June 2018 before and after CPR training were carried out in order to observe the impact of training on willingness CPR willingness. Results A total of 364 questionnaires were distributed and 364 valid questionnaires were recovered, with a recovery rate of 100%. Compared with those before the CPR training, the analyses of the contents of the questionnaire showed that the proportions of following 6 types of volunteer who were reluctant to implement CPR on site begore training were significantly lower after CPR training [no confidence in their own operational skills: 20.3% (74/364) vs. 83.2% (303/364), being impossible to identify the patients requiring CPR: 25.5% (93/364) vs. 87.1% (317/364), fear of mouth-to-mouth artificial respiration to contract infectious diseases: 30.2% (110/364) vs. 82.4% (300/364), worried about chest compressions leading to bone fractures: 23.3% (85/364) vs. 86.8% (316/364), worried about the inaccurate positioning of chest compressions: 12.4% (45/364) vs. 82.4% (300/364) and fear of taking legal responsibility: 14.3% (52/364) vs. 89.8% (327/364)], and the differences were statistically significant (all P < 0.05); after training, the following 3 kinds of proportions of carrying out CPR were much higher than those before training [volunteers were willing to implement CPR on site for strangers: 83.2% (303/364) vs. 54.9% (200/364), volunteers were willing to implement CPR on site for friends, colleagues, classmates and other acquaintances: 83.5% (304/364) vs. 58.2% (212/364), volunteers were willing to implement CPR on site for family members: 84.6% (308/364) vs. 61.8% (225/364)], the differences being statistically significant (all P < 0.05). Conclusion CPR training for volunteers can improve their willingness to perform on-site rescue for patients with apnea and cardiac arrest, but there are still partial barriers of CPR willingness for strangers.

Objective To explore the impact of local lipiodol deposition in liver of miniature pigs on the shape and size of the necrotic area after microwave ablation (MWA).Methods Ten healthy miniature pigs were selected and equally divided into experimental group and control group (each n=5).In experimental group,transcatheter hepatic arterial embolization with lipiodol was done before microwave ablation,while only standard microwave ablation was performed in control group.Immediate post-ablation CT images were obtained.Long-axis diameter (LAD),short-axis diameter (SAD),sphericity index (SI=SAD/LAD) and volume of ablation zone were calculated.The size and shape of the ablated areas were compared between two groups.Results The mean LAD,SAD,SI and volume of ablation zone in experimental group ([4.21 ± 0.52]cm,[2.87±0.38]cm,0.69±0.10,[18.72±6.08]cm3) were larger than those in control group ([3.71±0.42]cm,[2.19±0.42]cm,0.60±0.09,[9.44±2.29] cm3;all P＜0.05).Conclusion Local deposition of lipiodol in liver parenchyma of miniature pigs can help to produce larger and rounder necrosis in the ablation zone.

OBJECTIVE:To establish HPLC-quadrupole/electrostatic field orbitrap high resolution mass spectrometry for rapid determination of aconitine,mesaconitine,hypaconitine,benzoylaconitine,benzoylmesaconine and benzoylhypacoitine in rat plasma. METHODS:Internal standard lappaconitine was added into plasma sample,and methanol precipitated protein was used for pretreatment. HPLC-quadrupole/electrostatic field orbitrap high resolution mass spectrometry was adopted. HPLC condition was as follows as Sinochrom ODS-BP C18column,mobile phase consisted of acetonitrile-1% formic acid solution(50:50,V/V),the flow rate of 0.6 mL/min,sample size of 10 μL,column temperature of 25 ℃,automatic sampler temperature of 4 ℃. Mass spectrum scanning mode was full ion monitoring model,positive ion acquisition,mass charge ratios(m/z)of ion were 646.32(aconitine), 632.30(mesaconitine),616.31(hypaconitine),604.31(benzoylaconitine),590.29(benzoylmesaconine),574.30(benzoylhypacoitine), 585.31(internal standard). Six male Wistar rats were collected and given single dose of total alkaloid extract of Aconitum carmichaeli(4 mg/kg)intragastrically. Blood samples were collected before medication(0 h)and 0.5,0.75,1.25,1.5,2,4,6, 8,10,24 h after medication. Plasma concentration was determined and pharmacokinetic parameters were calculated by using PK-Solver V2.0 software. RESULTS:The linear range of 6 kinds of aconitum alkaloids in plasma were 0.1-10 μ g/L(r>0.992). The limit of quantitation was 0.1 μ g/L. Average recovery was higher than 75%,RSDs of intra-day and inter-day,matrix effects,stability test were all lower than 15%. The tmaxof 6 kinds of aconite alkaloids were about 1.2 h;t1/2were about 10 h;cmaxof monoestertype aconite alkaloids were higher than those of diester-type aconite alkaloids. CONCLUSIONS:Established HPLC-quadrupole/electrostatic field orbitrap high resolution mass spectrometry is accurate,sensitive,simple and rapid, and can be used for plasma concentration monitoring of 6 kinds of aconitum alkaloids.

Objective To understand effects of the interventional operation on thyroid,peripheral blood indexes and chromosomal aberrations (CA) of peripheral lymphocyte of children with congenital heart disease (CHD).Methods Follow-up studies were conducted in 70 child patients undergoing cardiac catheterization and 23 with open heart surgery as control from 2010 to 2013.Postoperative follow-up examinations included thyroid ultrasound,blood routine indexes and analyses of CAs.Results Difference in thyroid ultrasound abnormality rate was not statistically significant between children with cardiac catheterization and control group (40.0％ vs.43.5％,P ＞ 0.05).There was no significant difference in white blood cell (WBC) count between interventional group and control group (P ＞ 0.05).The effects of disease type and operation time on thyroid ultrasound and WBC count were not observed (P ＞ 0.05).The frequency of chromosome aberrations,including acentric fragment,dicentrics and translocation in interventional group [(0.76 ± 0.07) ％],was higher than in control group [(0.25 ± 0.07) ％,(Z =-3.631,P ＜ 0.05],and the rates of acentric fragment and translocation were also higher in interventional group (Z =-2.531,-2.397,P ＜ 0.05).Conclusions Effect of intervention therapy on thyroid structure and WBC count in children with CHD was not observed,but the genotoxic effects remain in children with cardiac catheterization.

Objective To investigate the changes and significance of serum C reactive protein (CRP) and calcitonin (PCT) levels in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods One hundred and twenty elderly patients with AECOPD in the respiration deplartment of our hospital from January 2013 to study One hundred and twenty elderly patients with AECOPD in our hospital from January 2013 to June 2015 were selected to conduct the study and performed the subgroup analysis according to the BODE index (body weight,dyspnea,airflow,motor function index),times of acute exacerbation within 1 year after treatment and recurrence time,and other 40 healthy subjects in the outpatient department were selected as the control group.The serum PCT and CRP levels were compared among various groups.Results Serum CRP and PCT levels in AECOPD patients with grade 1-4 of BODE index were significantly higher than those in the control group (P＜0.05),moreover in the intra-group comparison of serum CRP and PCT,the grade l＜grade 2＜grade 3＜grade 4,the differences were statistically significant (P＜0.05).Serum CRP and PCT had the significantly positive correlation with the grades of BODE index in AECOPD patients (r=0.482,0.317,P＜0.05).After treatment,serum CRP and PCT levels in AECOPD patients with recurrence occurred more than 3 months were significantly lower than those in the patients with recurrence occurred within 3 months,the difference was statistically significant (P＜0.05);serum CRP and PCT levels in the patients with more than once recurrence at 1 year after discharge from hospital were significantly higher than those in the patients with recurrence ≤once,the difference were statistically significant (P＜0.05).Conclusion The serum levels of CRP and PCT in the patients with AECOPD can reflect dyspnea,airflow limitation and motor function ability,and conducts the preliminary assessment on the patient's prognosis.

Objective:To report a case of lung adenocarcinoma of stage Ⅳ with epidermal growth factor receptor (EGFR) mutation treated by Erlotinib HCL Tablets and chemotherapy combined with bevacizumab after drug resistance,and to review the related literatures.Methods:A female patient without smoking history was diagnosed with lung adenocarcinoma (stage cT3N2M1 Ⅳ) with metastatic lesions in liver and bones by chest CT,lung puncture biopsy,and whole-body PET-CT.EGFR gene test reported mutation (19 del).Through treatment of overall survival,pemetrexed disodium for injection plus carboplatin injection,gemcitabine hydrochloride for injection plus cisplatin injection,paclitaxel for injection (albumin bound) single and with bevacizumab;the overall survival (OS) was assessed as 32 months.And the period of Erlotinib HCL Tablets showed 10 months of progressive-free survival (PFS).However,due to the metastatic lesions that suppressed biliary system in liver,hyperbilirubinemia emerged (total bilirubin 304 μmol · L-1,direct bilirubin 193 μmol · L-1).Bevacizumab was adopted and the syndrome relieved (total bilirubin 70 μmol · L-1,direct bilirubin 35 μmol · L-1),yielding three months of PFS.But the bilirubin level upgraded with total bilirubin of 908 μmol · L-1.The patient died because of hyperbilirubinemia.Results:10-month PFS occupied 1/3 of OS was acquired in the patients with EGFR-mutated lung adenocarcinoma (stage Ⅳ) after treated with Erlotinib HCL Tablets.Chemotherapy combined with bevacizumab acquired 3 months of PFS after hyperbilirubinemia emerged with drug resistance and multi-lines of chemotherapy.Conclusion:EGFR-TKIs are effective in treatment of lung adenocarcinoma with EGFR mutation;bevacizumab can inhibit the formation of vessels by targeting on VEGF under the circumstance of multiple drug resistance.Therefore,chemotherapy combined with bevacizumab can be used as the fifth-line of therapy in dealing with the hyperbilirubinemia induced by lung adenocarcinoma with liver metastasis.

Objective To summarize the experience of applying choledochoscopy, duodenoscopy and laparoscopy, one-stage suturing of common bile duct, to treat cholecystolithiasis and choledocholithiasis that failed to respond to ordinary endoscopic sphincterotomy (EST). Methods Retrospectively analyzed the clinical data of twenty-five pa-tients with choledocholithiasis complicated with cholecystolithiasis. 25 cases of failure to endoscopic stone extraction underwent LC and laparoscopic common bile duct exploration with primary suture of (BD) from June 2013 to June 2015. Results One patient was converted to laparotomy with small incision. The other one had residual stones and therefore underwent a second EST. After the treatment, two patients developed hyperamylasemia, which was cured by conservative therapy; One patient had bile leakage, which was treated by percutaneous drainage with no serious complications and death. No long-term complication was found in a portion of patients followed up until now. Conclusion In properly selected patients of duodenoscopy management-failed, synchronous treatment of combined application of three endoscopies in laparoscopic surgery with primary suture of (BD) is feasible, effective and safe.

Objective:To explore the clinical value of remote ECG consultation for primary medical institutions. Methods:Remote ECG consultation data for medical institutions of different levels in Hubei Jianli county were sta-tistically analyzed.Results:In county hospitals of this area,there were 1334 cases of ECG consultation,the positive rate was 41.00% (547/1334),and the three abnormal ECG types with highest incidence rate were arrhythmia (27.29%),left ventricular hypertrophy (LVH,9.15%)and ST-T change (2.62%)in order;in rural health rooms of this area,there were 723 cases of ECG consultation,the positive rate was 55.19%(399/723),and the three ab-normal ECG types with highest incidence rate were arrhythmia (34.02%),ST-T change (11.07%)and LVH (5.39%)in order.Conclusion:The remote ECG consultation is easy to perform.It can rise the detection rate of transient abnormal ECG events in rural area,where is lack of ECG equipment and personnel,so it is worthy of ex-tending.

OBJECTIVETo investigate the profile of promoter methylation and expression of SHP-1 gene in the progression of chronic myeloid leukemia (CML).

METHODSThe expression level of SHP-1 mRNA and protein in bone marrow or peripheral blood mononuclear cells from CML patients were detected by Western blot and SYBR Green-based qRT-PCR. The methylation status of SHP-1 were assessed by methylation-specific polymerase chain reaction (MSP) assay. K562 cells were infected with the lentiviral plasmids pEX-SHP-1-puro-Lv105 (K562-SHP-1) or pEX-EGFP-puro-Lv105 (K562-EGFP). The levels of proteins and phosphorylated proteins were detected by Western blot. qRT-PCR assay was used to test the level of BCR-ABL mRNA.

RESULTSThe relative levels of SHP-1 mRNA were sharply decreased in advanced stages CML compared to chronic phase (CP)-CML (0.79±0.37 vs 1.18±0.64, P= 0.009). The level of SHP-1 protein was lower in advanced stages CML compared to CP-CML (0.57±0.02 vs 1.02±0.04, P=0.039). The frequency of SHP-1 gene promoter methylation at selected loci in CP-CML was 23.8% (10/42), and the methylated regions were detected in all advanced CML samples (P<0.01). SHP-1 was stably transfected into K562 cells and selected with puromycin. Overexpression of SHP-1 inhibited the proliferation and induced the apoptosis of K562 cells, meanwhile leaded to G0/G1 phase arrest. After transfection, the level of BCR-ABL mRNA was not affected in K562-SHP-1 cells (1.32±0.34) compared to K562-EGFP cells (1.18±0.20, P=0.644), but overexpression of SHP-1 caused a slight decrease in BCR-ABL protein in K562-SHP-1 cells compared to K562 -EGFP cells (0.78±0.15 vs 1.27±0.24, P=0.040). Overexpression of SHP-1 resulted in a remarkable decrease in MYC protein, phosphorylated forms of JAK2, STAT5, Akt and MAPK. However, the un-phosphorylated forms of these molecules were not significantly affected.

CONCLUSIONDecreased expression of SHP-1 caused by aberrant promoter hypermethylation may play a key role in the progression of CML by dysregulation of BCR-ABL, Akt, MAPK, MYC, JAK2 and STAT5 signaling.

Apoptosis ; DNA Methylation ; Disease Progression ; Fusion Proteins, bcr-abl ; Humans ; Janus Kinase 2 ; K562 Cells ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukocytes, Mononuclear ; Phosphorylation ; Protein Tyrosine Phosphatase, Non-Receptor Type 6 ; RNA, Messenger