1.The effect of cytomegalovirus and EB virus activation on hematopoietic reconstitution after intensive immunosuppressive therapy for severe aplastic anemia
Qian ZHANG ; Hong WANG ; Xiaoli LI ; Miao MIAO ; Hongxia MA ; Yaoyao SHEN ; Nan WEI ; Kai ZOU ; Wanxiu SU ; Jingqiu YU ; Depei WU ; Limin LIU
Chinese Journal of Internal Medicine 2025;64(6):514-521
Objective:To investigate the infection rate of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in patients with severe aplastic anemia (SAA) after intensive immunosuppressive therapy in combination with a thrombopoietin receptor agonist (lST+TPO-RA) as well as assess the clinical impact of treatment.Methods:A retrospective, case series study was undertaken involving patients with SAA who were admitted to Soochow Hopes Hematonosis Hospital, The First Affiliated Hospital of Soochow University, and Zhengzhou Third People′s Hospital from June 2022 to February 2025. Thirty patients with complete CMV and EBV monitoring data after IST+TPO-RA treatment were enrolled. The first activation time of CMV and EBV, the maximum viral load, the first negative conversion time, and blood routine tests within 3 days before CMV and EBV positivity, during the positive period, and within 3 days after turning negative were recorded. The patients were followed up for 9 months after the completion of IST. One-way analysis of variance was used to compare the changes of blood routine before and after virus positivity and after turning negative. The χ2 test was used to compare the viral infection rate and the therapeutic effect of IST between the two groups. Results:The 30 SAA patients comprised 15 males and 15 females with an average age of (40.0±16.9) years. Of the 30 patients, 18 (60.0%) were infected with CMV and 6 (20.0%) with EBV. Among them, 17 cases received rabbit anti-human thymocyte immunoglobulin (r-ATG) treatment (r-ATG group), 13 cases received porcine anti-human lymphocyte immunoglobulin (p-ALG) treatment (p-ALG group). The CMV infection rate was significantly higher in the r-ATG group than in the p-ALG group (15/17 vs. 3/13, χ2=13.03, P<0.001); meanwhile, the rate of EBV infection was only slightly higher in the r-ATG group than in the p-ALG group, and the difference did not reach statistical significance (5/17 vs. 1/13, χ2=2.17, P=0.196). In patients infected with CMV, neutrophil, hemoglobin, and platelet counts were significantly decreased during the infection phase, followed by significant increases after CMV clearance ( F=14.48, 11.38, 4.73; all P<0.05). No significant differences in treatment efficacy were found between the r-ATG and p-ALG groups at 3, 6, and 9 months post-IST (all P>0.05). Conclusions:This preliminary study showed that the incidence of CMV and EBV infection in patients with SAA increased after IST, with CMV infections occurring significantly more frequently than EBV infections. The CMV infection rate was significantly higher in patients treated with r-ATG than in those receiving p-ALG. CMV infection was associated with notable alterations in hematological parameters, highlighting the need for close clinical monitoring.
2.The effect of cytomegalovirus and EB virus activation on hematopoietic reconstitution after intensive immunosuppressive therapy for severe aplastic anemia
Qian ZHANG ; Hong WANG ; Xiaoli LI ; Miao MIAO ; Hongxia MA ; Yaoyao SHEN ; Nan WEI ; Kai ZOU ; Wanxiu SU ; Jingqiu YU ; Depei WU ; Limin LIU
Chinese Journal of Internal Medicine 2025;64(6):514-521
Objective:To investigate the infection rate of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in patients with severe aplastic anemia (SAA) after intensive immunosuppressive therapy in combination with a thrombopoietin receptor agonist (lST+TPO-RA) as well as assess the clinical impact of treatment.Methods:A retrospective, case series study was undertaken involving patients with SAA who were admitted to Soochow Hopes Hematonosis Hospital, The First Affiliated Hospital of Soochow University, and Zhengzhou Third People′s Hospital from June 2022 to February 2025. Thirty patients with complete CMV and EBV monitoring data after IST+TPO-RA treatment were enrolled. The first activation time of CMV and EBV, the maximum viral load, the first negative conversion time, and blood routine tests within 3 days before CMV and EBV positivity, during the positive period, and within 3 days after turning negative were recorded. The patients were followed up for 9 months after the completion of IST. One-way analysis of variance was used to compare the changes of blood routine before and after virus positivity and after turning negative. The χ2 test was used to compare the viral infection rate and the therapeutic effect of IST between the two groups. Results:The 30 SAA patients comprised 15 males and 15 females with an average age of (40.0±16.9) years. Of the 30 patients, 18 (60.0%) were infected with CMV and 6 (20.0%) with EBV. Among them, 17 cases received rabbit anti-human thymocyte immunoglobulin (r-ATG) treatment (r-ATG group), 13 cases received porcine anti-human lymphocyte immunoglobulin (p-ALG) treatment (p-ALG group). The CMV infection rate was significantly higher in the r-ATG group than in the p-ALG group (15/17 vs. 3/13, χ2=13.03, P<0.001); meanwhile, the rate of EBV infection was only slightly higher in the r-ATG group than in the p-ALG group, and the difference did not reach statistical significance (5/17 vs. 1/13, χ2=2.17, P=0.196). In patients infected with CMV, neutrophil, hemoglobin, and platelet counts were significantly decreased during the infection phase, followed by significant increases after CMV clearance ( F=14.48, 11.38, 4.73; all P<0.05). No significant differences in treatment efficacy were found between the r-ATG and p-ALG groups at 3, 6, and 9 months post-IST (all P>0.05). Conclusions:This preliminary study showed that the incidence of CMV and EBV infection in patients with SAA increased after IST, with CMV infections occurring significantly more frequently than EBV infections. The CMV infection rate was significantly higher in patients treated with r-ATG than in those receiving p-ALG. CMV infection was associated with notable alterations in hematological parameters, highlighting the need for close clinical monitoring.
3.The clinical efficacy of closed-loop rehabilitation therapy by brain-computer interface combined with exo-skeleton robotic hand for patients with hand dysfunction after cerebral infarction
Guidi ZOU ; Xiao-Kai CHEN ; Huihong TAN ; Yi LI ; Nan LI ; Yefan CAO ; Hewei WANG
The Journal of Practical Medicine 2024;40(17):2395-2400
Objective To observe the clinical efficacy of closed-loop rehabilitation therapy by brain-computer interface(BCI)combined with exoskeleton robotic hand in patients with hand dysfunction after cerebral infarction and analyze the influence of patients'cognitive function and implicit motor imagery ability on the recognition rate of BCI.Methods A total of 50 patients with cerebral infarction were randomly assigned to the observation group and the control group,25 patients in each group.Both groups received routine rehabilitation programs.In addition to the conventional rehabilitation treatment,the observation group received the closed-loop BCI rehabilitation trainingby brain-computer interface(BCI)combined with exoskeleton robotic hand.The scores of Fugl-Meyer Assessment of the Upper Extremity(FMA-UE),Action Research Arm Test(ARAT),Wolf Motor Function Test(WMFT),and Modified Ashworth scale(MAS)of the wrist flexors were compared between the two groups before and after treatment.Before intervention,the mental rotation test and Montreal Cognitive Assessment(MoCA)were used to assess the baseline implicit motor imagery ability and cognitive level of patients in the observation group.The correlation analysis between these scores and the recognition rate of BCI was conducted to analyze the relevant factors affecting the closed-loop rehabilitation effects of BCI.Results The two groups showed no significant difference in all outcomes before treatment(both P>0.05).After intervention,the observation group exhibited the significantly higher scores of FMA-UE,ARAT,and WMFT(all P<0.05),and significantly lower MAS scores of wrist and finger flexors compared with the control group(all P<0.05).In addition,the recognition rate of BCI was positively correlated with the accuracy of mental rotation test and MoCA score(P<0.05),and negatively corre-lated with the reaction time of mental rotation test(P<0.05).Conclusions Closed-loop rehabilitation training with BCI combined with exoskeleton robot hand can promote the recovery of upper limbs and hand motor function in patients with cerebral infarction.Additionally,the implicit motor imagery ability and cognitive function of patients are suggested to be used for screening the patients suitable for BCI training before the implementation of BCI treatment.
4.Comparison of the efficacy and safety between high-dose intravenous iron and oral iron in treating iron deficiency anemia: a multicenter, prospective, open-label, randomized controlled study
Qian ZHANG ; Hong WANG ; Yanming ZHANG ; Xiaoli LI ; Yaoyao SHEN ; Nan WEI ; Kai ZOU ; Wanxiu SU ; Haiping DAI ; Depei WU ; Limin LIU
Chinese Journal of Hematology 2024;45(12):1113-1118
Objective:This study aimed to compare the efficacy and safety between high-dose intravenous iron and oral iron in treating iron deficiency anemia (IDA) .Methods:This prospective randomized controlled study (1∶1) enrolled 338 patients with IDA at The First Affiliated Hospital of Soochow University, Suzhou Hongci Hematology Hospital, and Huai’an Second People’s Hospital from June 1, 2022, to January 19, 2024. Of all the patients, 169 received high-dose intravenous iron therapy and 169 received oral iron treatment for 12 weeks of observation. Focus on the hemoglobin (HGB) change from baseline to week 4, secondary focus was on the HGB and iron metabolism parameters (serum iron [SI], transferrin saturation [TSAT], total iron binding force [TIBC], serum ferritin [SF]), and changes in the fatigue score, efficacy, and treatment-related adverse effects were monitored throughout in the two treatment groups.Results:The HGB levels were improved in both treatments, but the HGB improved faster in the intravenous group compared with the oral group. HGB increased from (76.8±15.0) g/L to (118.0±13.3) g/L in the intravenous group and from (77.9±11.6) g/L to (104.3±15.0) g/L in the oral group after 4 weeks of treatment. The increase from baseline in the intravenous group (40.7±17.3) g/L was significantly higher than that in the oral group (27.2±17.5) g/L ( P<0.001). The intravenous group demonstrated a more significant early effect than the oral group in terms of iron metabolism parameter improvement. SI, TSAT, TBIC, and SF increased better from baseline at 4 weeks in the intravenous group than in the oral group ( P<0.001). Additionally, the intravenous group exhibited better fatigue scores for early improvement than the oral group ( P<0.001). The incidence of total adverse effects was similar in the intravenous group as compared to the oral group (3.5% [6/169] vs 5.9% [10/169], P=0.442) . Conclusion:High doses of intravenous iron quickly boost HGB early, causing rapid improvement in SI, TSAT, TBIC, SF, and patient fatigue scores. The patient was well tolerated.
5.Comparison of the efficacy and safety between high-dose intravenous iron and oral iron in treating iron deficiency anemia: a multicenter, prospective, open-label, randomized controlled study
Qian ZHANG ; Hong WANG ; Yanming ZHANG ; Xiaoli LI ; Yaoyao SHEN ; Nan WEI ; Kai ZOU ; Wanxiu SU ; Haiping DAI ; Depei WU ; Limin LIU
Chinese Journal of Hematology 2024;45(12):1113-1118
Objective:This study aimed to compare the efficacy and safety between high-dose intravenous iron and oral iron in treating iron deficiency anemia (IDA) .Methods:This prospective randomized controlled study (1∶1) enrolled 338 patients with IDA at The First Affiliated Hospital of Soochow University, Suzhou Hongci Hematology Hospital, and Huai’an Second People’s Hospital from June 1, 2022, to January 19, 2024. Of all the patients, 169 received high-dose intravenous iron therapy and 169 received oral iron treatment for 12 weeks of observation. Focus on the hemoglobin (HGB) change from baseline to week 4, secondary focus was on the HGB and iron metabolism parameters (serum iron [SI], transferrin saturation [TSAT], total iron binding force [TIBC], serum ferritin [SF]), and changes in the fatigue score, efficacy, and treatment-related adverse effects were monitored throughout in the two treatment groups.Results:The HGB levels were improved in both treatments, but the HGB improved faster in the intravenous group compared with the oral group. HGB increased from (76.8±15.0) g/L to (118.0±13.3) g/L in the intravenous group and from (77.9±11.6) g/L to (104.3±15.0) g/L in the oral group after 4 weeks of treatment. The increase from baseline in the intravenous group (40.7±17.3) g/L was significantly higher than that in the oral group (27.2±17.5) g/L ( P<0.001). The intravenous group demonstrated a more significant early effect than the oral group in terms of iron metabolism parameter improvement. SI, TSAT, TBIC, and SF increased better from baseline at 4 weeks in the intravenous group than in the oral group ( P<0.001). Additionally, the intravenous group exhibited better fatigue scores for early improvement than the oral group ( P<0.001). The incidence of total adverse effects was similar in the intravenous group as compared to the oral group (3.5% [6/169] vs 5.9% [10/169], P=0.442) . Conclusion:High doses of intravenous iron quickly boost HGB early, causing rapid improvement in SI, TSAT, TBIC, SF, and patient fatigue scores. The patient was well tolerated.
6.Standard Operating Procedures for Chinese Medicine Data Monitoring Committees of Clinical Studies.
Jun LIU ; Nian WANG ; Hai-Xia DANG ; Bing-Wei CHEN ; Li ZHANG ; Chong ZOU ; Cheng-Liang ZHONG ; Ju-Kai HUANG ; Qiong LIU ; Ya-Nan YU ; Meng JIANG ; Wei-Xiong LIANG ; Qi-Guang CHEN ; Yong-Yan WANG ; Chun-Ti SHEN ; Zhong WANG
Chinese journal of integrative medicine 2021;27(7):483-489
Although there is guidance from different regulatory agencies, there are opportunities to bring greater consistency and stronger applicability to address the practical issues of establishing and operating a data monitoring committee (DMC) for clinical studies of Chinese medicine. We names it as a Chinese Medicine Data Monitoring Committee (CMDMC). A panel composed of clinical and statistical experts shared their experience and thoughts on the important aspects of CMDMCs. Subsequently, a community standard on CMDMCs (T/CACM 1323-2019) was issued by the China Association of Chinese Medicine on September 12, 2019. This paper summarizes the key content of this standard to help the sponsors of clinical studies establish and operate CMDMCs, which will further develop the scientific integrity and quality of clinical studies.
7.Progress in the 16S rRNA Gene Sequencing in Forensic Science.
Guo Qing SONG ; Yu CAO ; Hui LI ; Ke MA ; Xue Ying ZHAO ; Kai Nan ZOU ; Huai Gu ZHOU
Journal of Forensic Medicine 2018;34(5):542-548
Forensic microorganism is one of the hotspots of forensic science research. Due to its conservatism and specificity, the 16S rRNA gene is found to be an ideal marker for forensic identification. With the rapid development of high throughput sequencing technology, the research on microorganisms has been gradually applied to many fields such as environment and health care. In the field of forensic science, the results of forensic microbiology research, represented by 16S rRNA gene sequencing, are also gradually applied to forensic practice, such as biological samples identification, individual identification, postmortem interval estimation, and regional inference, which not only provide clues for the investigation of cases but also complement and assist traditional methods. This paper describes the research methods and related sequencing technologies of 16S rRNA gene sequencing, summarizes its research progress, and discusses the application value and potential of 16S rRNA in forensic science.
Forensic Sciences/trends*
;
RNA, Ribosomal, 16S
;
Sequence Analysis, RNA
8.Whole Genome Sequencing of Human mtDNA Based on Ion Torrent PGMTM Platform
Yu CAO ; nan Kai ZOU ; ping Jiang HUANG ; Ke MA ; Yuan PING
Journal of Forensic Medicine 2017;33(4):368-373
Objective To analyze and detect the whole genome sequence of human mitochondrial DNA (mtDNA) by Ion Torrent PGMTM platform and to study the differences of mtDNA sequence in different tissues.Methods Samples were collected from 6 unrelated individuals by forensic postmortem examination,including chest blood,hair,costicartilage,nail,skeletal muscle and oral epithelium.Amplification of whole genome sequence of mtDNA was performed by 4 pairs of primer.Libraries were constructed with Ion ShearTM Plus Reagents kit and Ion Plus Fragment Library kit.Whole genome sequencing of mtDNA was performed using Ion Torrent PGMTM platform.Sanger sequencing was used to determine the heteroplasmy positions and the mutation positions on HV Ⅰ region.Results The whole genome sequence of mtDNA from all samples were amplified successfully.Six unrelated individuals belonged to 6 different haplotypes.Different tissues in one individual had heteroplasmy difference.The heteroplasmy positions and the mutation positions on HV I region were verified by Sanger sequencing.After a consistency check by the Kappa method,it was found that the results of mtDNA sequence had a high consistency in different tissues.Conclusion The testing method used in present study for sequencing the whole genome sequence of human mtDNA can detect the heteroplasmy difference in different tissues,which have good consistency.The results provide guidance for the further applications of mtDNA in forensic science.
9.Source Identification of Human Biological Materials and Its Prospect in Forensic Science.
Kai Nan ZOU ; Cheng GUI ; Yu GAO ; Fan YANG ; Huai Gu ZHOU
Journal of Forensic Medicine 2016;32(3):204-210
Source identification of human biological materials in crime scene plays an important role in reconstructing the crime process. Searching specific genetic markers to identify the source of different human biological materials is the emphasis and difficulty of the research work of legal medical experts in recent years. This paper reviews the genetic markers which are used for identifying the source of human biological materials and studied widely, such as DNA methylation, mRNA, microRNA, microflora and protein, etc. By comparing the principles and methods of source identification of human biological materials using different kinds of genetic markers, different source of human biological material owns suitable marker types and can be identified by detecting single genetic marker or combined multiple genetic markers. Though there is no uniform standard and method for identifying the source of human biological materials in forensic laboratories at present, the research and development of a series of mature and reliable methods for distinguishing different human biological materials play the role as forensic evidence which will be the future development direction.
DNA Methylation
;
Forensic Genetics
;
Forensic Sciences
;
Genetic Markers
;
Humans
;
MicroRNAs
;
RNA, Messenger
10.Identification of Vaginal Fluid Using Microbial Signatures.
Kai Nan ZOU ; Meng HU ; Jiang Ping HUANG ; Huai Gu ZHOU
Journal of Forensic Medicine 2016;32(4):254-256
OBJECTIVES:
To investigate the specific microbial signatures in vaginal fluid.
METHODS:
Vaginal fluid (16 samples), saliva (16 samples), feces (16 samples), semen (8 samples), peripheral blood (8 samples), urine (5 samples), and nasal secretion (4 samples) were collected respectively. The 16S rRNA genes of Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus iners, and Atopobium vaginae were amplified. PCR production was detected via a 3130xl Genetic Analyzer.
RESULTS:
The detected number of Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus iners, and Atopobium vaginae were 15, 5, 8, 14, and 3 in all vaginal fluid samples, respectively. Lactobacillus crispatus and Lactobacillus jensenii existed specifically in vaginal fluid.
CONCLUSIONS
There is a potential application value to detect Lactobacillus crispatus and Lactobacillus jensenii for the identification of vaginal fluid.
Actinobacteria/classification*
;
Blood/microbiology*
;
Body Fluids/microbiology*
;
Feces/microbiology*
;
Female
;
Genes, Bacterial
;
Humans
;
Lactobacillus/classification*
;
Nasal Cavity/microbiology*
;
Polymerase Chain Reaction
;
RNA, Ribosomal, 16S/genetics*
;
Saliva/microbiology*
;
Semen/microbiology*
;
Vagina/microbiology*

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