Objective:To study the clinical manifestations, pathologic features, diagnosis and differential diagnosis, treatment and prognosis of lymphoplasmacytic lymphoma/Waldenstr?m′s macroglobulinemia (LPL/WM).Methods:Twenty-seven cases of LPL from January 2016 to December 2020 at Guangdong Provincial People′s Hospital were collected. The clinical data, histomorphology, immunophenotype, MYD88 L265P mutation, treatment and prognosis were analyzed retrospectively.Results:There were 19 males and 8 female patients, with median age of 63 years. The most common initial symptoms were fatigue related to anemia. Bone marrow was involved in all cases, lymphadenopathy was seen in 11 cases and splenomegaly in 10 cases. Monoclonal IgM type protein was detected in 25 cases, meeting the diagnostic criteria of WM. Microscopically, bone marrow and lymph nodes were infiltrated by small lymphocytes, plasmacytoid lymphocytes or plasma cells. The cells expressed pan B-cell markers and showed immunoglobulin light chain restriction. There was no expression of CD5, and low expression of CD23 and CD10; Ki-67 index was usually low. The positive rate of MYD88 L265P mutation was 73.9% (17/23). Most of the patients were treated with rituximab combined with alkylating agents, nucleoside analogues or immunomodulators, and the few patients with relapse or progression were treated with Ibutinib. During the 3-168 months′ follow-up period, recurrence or progression were seen in nine cases. Thrombocytopenia, elevated β2-microglobulin and high-risk group were associated with recurrence or progression of the disease ( P<0.05). The overall survival (OS) and progression-free survival (PFS) of the high-risk patients were significantly lower than those of the low-medium risk patients ( P<0.05). Conclusions:LPL/WM is an exclusive diagnosis; the detection of MYD88 L265P mutation has high diagnostic value, but it is not specific. These cases should be assessed comprehensively for their clinical manifestation, serum IgM protein level and immunophenotype. The overall prognosis of LPL/WM is good, but there are still a small number of high-risk patients with rapid progress, and so the symptomatic patients should be diagnosed accurately and treated in a timely manner.

Objective: To investigate the effect of intensive insulin therapy on the immune function and prognosis of severe thoracic injuries patients with stress hyperglycemia. Methods: A retrospective case control study was performed to analyze the clinical data of 60 patients with severe chest trauma and stress-induced hyperglycemia admitted to Chongqing People's Hospital from October 2016 to October 2018. There were 31 males and 26 females, aged 25-61 years [(46.1±4.0)years]. The abbreviated injury scale (AIS) range was 3-5 points. Thirty patients received routine insulin therapy (routine treatment group) and thirty patients received intensive insulin therapy (intensive treatment group). Venous blood was collected from two groups of patients before treatment, 1 day, 3 days, 5 days and 7 days after treatment respectively. Level of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP)], and lymphocyte count (CD₁₄^＋, CD₄^＋ and CD₄^＋/CD₈^＋) were detected respectively. The incidence of nosocomial infection, length of hospital stay, mortality and incidence of hypoglycemia were compared between the two groups. Results: There were no significant differences in plasma TNF-α, IL-6 and CRP levels between the two groups before treatment (P>0.05). After treatment (1-7 days), the levels of serum TNF-α, IL-6 and CRP in the intensive treatment group were lower than those of routine treatment group (P<0.05 or 0.01). Compared with these before treatment, the levels of TNF-α, IL-6 and CRP in both groups increased to varied degrees, reaching a peak on day 3, followed by a gradual decline (P<0.05 or 0.01). There were no statistically significant differences in CD₁₄^＋, CD₄^＋、CD₄^＋/CD₈^＋ lymphocyte counts between the two groups before treatment (P>0.05). On days 3, 5, and 7 after treatment, the counts of CD₁₄^＋ lymphocytes [3 d: (0.61±0.08)×10⁹ vs. (0.55±0.09)×10^9, 5 d: (0.68±0.05)×10⁹ vs. (0.63±0.05)×10^9, 7 d: (0.77±0.07)×10⁹ vs. (0.71±0.06)×10⁹], CD₄^＋ lymphocytes [3 d: (0.29±0.04)×10⁹ vs. (0.25±0.03)×10^9, 5 d: (0.32±0.04)×10⁹ vs. (0.30±0.05)×10^9, 7 d: (0.34±0.03)×10⁹ vs. (0.32±0.06)×10⁹], CD₄^＋/CD₈^＋ lymphocytes [3 d: (0.28±0.04)×10⁹ vs. (0.26±0.06)×10^9, 5 d: (0.33±0.03)×10⁹ vs. (0.31±0.06)×10^9, 7 d: (0.35±0.03)×10⁹ vs. (0.32±0.06)×10⁹] in the intensive treatment group were higher than those in the routine treatment group. Compared with before treatment, the counts of CD14⁺ , CD4⁺ , CD4⁺ /CD8⁺ lymphocytes in the two groups were raised to different degrees after treatment for 3 days, with significant differences (P<0.05 or 0.01). Compared with routine treatment group, patients in intensive treatment group had lower incidence of nosocomial infection [57%(17/30) vs. 30%(9/30)], shorter duration of mechanical ventilation [(12.8±2.4)vs. (7.4±1.2)days], and lower hospital mortality rate [27%(8/30) vs. 10%(3/30)]. There was no significant difference in the incidence of hypoglycemia between the two groups(P>0.05). Conclusion For severe chest trauma patients with stress hyperglycemia, intensive insulin therapy can effectively improve the immunity, inhibit the inflammatory reaction, reduce the complication incidence, restore ventilation function and improve survival rate.

OBJECTIVE: To establish a method for detecting the contents of 12 toxic elements such as beryllium,vanadium and thallium in human whole blood,urine and hair by inductively coupled plasma-mass spectrometry( ICP-MS).METHODS: Whole blood( 0.25 mL) and urine( 10.00 mL) were diluted 20 times into suspension by 0.1% TritonX-100 + 0.5% nitric acid,and analyzed by ICP-MS.The hair( 0.20 g) was mixed with nitric acid and digested by microwave,then made up to 10.00 mL with purified water.The analysis was performed by ICP-MS.RESULTS: The linear correlation coefficients of all the 12 elements,such as beryllium,vanadium,chromium,manganese,cobalt,nickel,arsenic,cadmium,tin,antimony,tellurium and lead were≥0.999 5.The detection limit for whole blood and urine was 0.097-1.995 μg/L,and the detection limit for hair was 0.001-0.012 μg/g.The recovery rates for whole blood,urine and hair were 92.3%-105.0%,93.7%-115.5% and 92.5%-111.0%,respectively.The within-run relative standard deviation( RSD) were 0.7%-5.8%,0.8%-4.6% and 2.2%-8.4%,respectively; the between-run RSD were 1.6%-7.1%,3.5%-7.5% and 2.8%-8.8%,respectively.CONCLUSION: This method has good accuracy,high sensitivity and good precision,which is suitable for rapid screening for various elements in human biological samples.

Objective To observe the effect and efficacy of DPP-4 inhibitor saxagliptin on nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus.Methods Forty patients with newly diagnosed with type 2 diabetes complicated with NAFLD were divided into two groups:the saxagliptin group and the metformin group.On the basis of dietary and exercise therapies,the saxagliptin group received 0.005 g of saxagliptin daily and the metformin treatment group received 0.85-1.70 g of metformin daily.The levels of glycosylated hemoglobin(HbA1 c),triglyceride (TG),blood pressure (BP),alanine aminotransferase (ALT),liver CT and liver/spleen CT were observed before and 3 months after treatment.Results After treatment for 3 months,the TG,ALT,liver CT and liver / spleen CT of the metformin group and the saxagliptin group were significantly higher than those before treatment(P＜0.05).There was no significant difference in the TG,ALT and liver CT values between the two groups(P＞ 0.05).Conclusion In the state of diabetes mellitus complicate with nonalcoholic fatty liver,saxagliptin has a certain effect on relieving fatty liver.

OBJECTIVETo establish a method for determination of disulfiram in the workplace atmosphere by liquid chromatography.

METHODSSampling with glass fiber filter, eluting with methanol, separating with C18 column, and determination with liquid chromatography.

RESULTSThe bearing capacity of glass fiber filter exceeded 3.45 mg per piece. The elution efficiency was 97.8%∼101.0% The relative standard deviation varied from 1.09% to 1.44%. The limit of detection was 0.1 µg/ml. The minimum detectable concentration was 0.011 mg/m³ (with sampled air volume of 45 L).

CONCLUSIONThe method has high selectivity, accuracy, and precision and strong applicability.

Objective To evaluate the effects of butorphanol pretreatment on myocardial damage induced by limb ischemia/reperfusion (I/R) in rats.Methods One hundred and eight male Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 3 groups (n =36 each) using a random number table:sham operation group (group S),I/R group and butorphanol pretreatment group (group B).Limb ischemia was induced by occlusion of bilateral hind limbs for 2 h followed by reperfusion in I/R and B groups.At 10 min before ischemia,butorphanol 0.2 mg/kg was injected via the right jugular vein in group B,while the equal volume of normal saline was injected in group I/R.Six rats were chosen randomly before ischemia (baseline,T0) and at 2,6,12,24 and 48 h after reperfusion (T1-5) and blood samples were taken from the abdominal aorta for determination of the serum creatine kinase isoenzyme-MB (CK-MB) activity and cardiac troponin Ⅰ (cTnI) concentration.The animals were then sacrificed and myocardial specimens were obtained for determination of myocardial apoptosis (using TUNEL) and the expression of c-Jun N-terminal kinase (JNK) and extracellular signal-regulated protein kinase (ERK) (using Western blot analysis).Apoptosis index was calculated.Results Compared with group S,the serum CK-MB and cTnI levels were significantly increased at T1-5,and the apoptosis index and expression of JNK and ERK were increased at T2-5 in group I/R (P ＜ 0.05).Compared with group I/R,the pathological changes of myocardium were significantly reduced at T4,the serum CK-MB and cTnI levels were decreased at T2-5,the apoptosis index was decreased at T4,5,the expression of ERK was up-regulated at T2-5,and the expression of JNK was down-regulated at T2-4 (P ＜ 0.05).Conclusion Butorphanol pretreatment can reduce apoptosis in myocardial cells through activating MAPK signal transduction pathway,up-regulating ERK expression and down-regulating JNK expression,thus attenuating myocardial damage induced by limb I/R in rats.

ObjectiveTo investigate the correlation of radial artery and serum osteoprotegerin (OPG) expression and vascular calcification in patients with end stage renal disease.MethodsDiscarded radial arteries were gathered from 43 patients with end stage renal disease(end stage renal disease group)during arterial venous fistula plasty,including 24 patients with no calcification,13 patients with mild to moderate calcification and 6 patients with severe calcification,20 patients with dialysis and 23 patients without dialysis.Discarded arteries from 9 patients with upper limb trauma were chosen as control group.The yon Kossa staining,alizarin red staining and OPG immunohistochemical staining were taken and serum OPG level was measured for all the patients.ResultsSerum OPG level was significantly higher in end stage renal disease group than that in control group [(216.47±83.78) ng/L vs.(57.15±23.22) ng/L,P＜ 0.01 ].Serum OPG level in patients with no calcification,mild to moderate calcification and severe calcification[ ( 152.21±32.21 ),(248.31±53.86),(368.44±53.57) ng/L] and OPG staining value ( 1,2,4 scores) were increased gradually as vascular calcification more serious (P＜ 0.01 ).There was a positive relationship between serum OPG and vascular calcification value(alizarin red staining:r =0.517,P ＜ 0.01 ; yon Kossa staining:r =0.677,P＜ 0.01 ).Serum OPG level and OPG staining value in patients with dialysis were higher than those in patients without dialysis [ (283.57±79.02 ) ng/L vs.( 152.46±30.89 ) ng/L,2 scores vs.1 score,P ＜ 0.01 ].ConclusionsThere is relationship between serum OPG level,OPG expression of radial artery and vascular calcification.

Objective In order to discuss the evaluation of generalized sterization for dental handpieces. Methods The generalized sterization for dental handpieces were used inclued collection dental handpieces, automatically cleaned, dried and distilled with oil, packed with paper or plastics and sterized with pulse-vuccum. Results All the indexes were fitted to the standard after the generalized sterization among the dental handpieces. The valid rate was 100%. Conclusions Generalized sterization for dental handpieces are effective measures to guarantee the clinical sterization quality.

OBJECTIVE To reinforce the administration in the management of reusable medical appliances,and to ensure the quality of sterile.METHODS Every step of the integral sterilization were monitored.RESULTS The quality of every link in the course and the end quality of the reusable medical appliances were assured.All the pass-rates of routine examination and sample examination of our hospital and CDC in Zhuhai were 100%.CONCLUSIONS The process of integral sterilization in the management of reusable medical appliances can ensure the quality of sterile materials,and can prevent the nosocomial infections and guarantee the safety of patients.

OBJECTIVE To investigate the clinical degree of satisfaction to sterilizing-supplying center,and to consummate the development of the transition of its decentralized administration to centralized pattern.METHODS We designated the questionnaire of degree of satisfaction(DOS) and carried out the investigation.RESULTS The initiated DOS was 90.6%,the DOS in mid-stage(2006-2007) was 97.3%,and the DOS in the latest stage(2008) was 99.1%.CONCLUSIONS Centralized administration is effective pattern for the development of sterilizing-supplying center and important to ensure the quality of sterile materials and service for clinical medicine.