Objective:To evaluated the clinical efficacy of a reduced-intensity preconditioning regimen for single non-blood-related umbilical cord blood transplantation (sUCBT) in the treatment of severe aplastic anemia (SAA) .Methods:The clinical data of 63 patients with SAA who underwent sUCBT from January 2021 to July 2023 at the Department of Hematology of the First Affiliated Hospital of USTC were retrospectively analyzed. Fifty-two patients received total body irradiation/total bone marrow irradiation (TMI) combined with fludarabine or a cyclophosphamide- conditioning regimen (non-rATG group) , while 11 patients received rabbit anti-human thymocyte immunoglobulin (rATG) combined with TMI, fludarabine, or the cyclophosphamide-conditioning regimen (rATG group) . All patients received cyclosporine A and mycophenolate mofetil for graft-versus-host disease (GVHD) prophylaxis. Complications post-transplantation and long-term survival were compared between the two groups.Results:The baseline parameters were balanced between the two groups ( P>0.05) . In the rATG group, all patients achieved stem cell engraftment, and in the non-rATG group, five patients had primary graft failure. There was no significant difference in the cumulative incidence of neutrophil engraftment at 42 days after transplantation or platelet engraftment at 60 days between the two groups. The incidence of grade Ⅱ-Ⅳ acute GVHD in the rATG group was significantly lower than in the non-rATG group (10.0% vs. 46.2% , P=0.032) , and the differences in the cumulative incidences of grade Ⅲ/Ⅳ acute GVHD and 1-year chronic GVHD were not statistically significant ( P=0.367 and P=0.053, respectively) . There were no significant differences in the incidences of pre-engraftment syndrome, bacterial bloodstream infections, cytomegalovirus viremia, or hemorrhagic cystitis between the two groups ( P>0.05 for all) . The median follow-up time for surviving patients was 536 (61-993) days, and the 1-year transplantation related mortality (TRM) of all patients after transplantation was 13.0% (95% CI 6.7% -24.3% ) . Among the patients in the non-rATG and rATG groups, 15.5% (95% CI 8.1% -28.6% ) and 0% ( P=0.189) , respectively, had mutations. The 1-year overall survival (OS) rate of all patients after transplantation was 87.0% (95% CI 75.7% -93.3% ) . The 1-year OS rates in the rATG group and non-rATG group after transplantation were 100% and 84.5% , respectively (95% CI 71.4% -91.9% ) ( P=0.198) . Conclusion:The preliminary results of sUCBT with a low-dose irradiation-based reduced-intensity conditioning regimen with fludarabine/cyclophosphamide for the treatment of patients with SAA showed good efficacy. Early application of low-dose rATG can reduce the incidence of acute GVHD after transplantation without increasing the risk of implantation failure or infection.

Background::With an increasing number of patients with hematological malignancies being treated with umbilical cord blood transplantation (UCBT), the correlation between immune reconstitution (IR) after UCBT and graft-versus-host disease (GVHD) has been reported successively, but reports on double-negative T (DNT) cell reconstitution and its association with acute GVHD (aGVHD) after UCBT are lacking.Methods::A population-based observational study was conducted among 131 patients with hematological malignancies who underwent single-unit UCBT as their first transplant at the Department of Hematology, the First Affiliated Hospital of USTC, between August 2018 and June 2021. IR differences were compared between the patients with and without aGVHD.Results::The absolute number of DNT cells in the healthy Chinese population was 109 (70-157)/μL, accounting for 5.82 (3.98-8.19)% of lymphocytes. DNT cells showed delayed recovery and could not reach their normal levels even one year after transplantation. Importantly, the absolute number and percentage of DNT cells were significantly higher in UCBT patients without aGVHD than in those with aGVHD within one year ( F = 4.684, P = 0.039 and F = 5.583, P = 0.026, respectively). In addition, the number of DNT cells in the first month after transplantation decreased significantly with the degree of aGVHD increased, and faster DNT cell reconstitution in the first month after UCBT was an independent protective factor for aGVHD (HR = 0.46, 95% confidence interval [CI]: 0.23-0.93; P = 0.031). Conclusions::Compared to the number of DNT cells in Chinese healthy people, the reconstitution of DNT cells in adults with hematological malignancies after UCBT was slow. In addition, the faster reconstitution of DNT cells in the early stage after transplantation was associated with a lower incidence of aGVHD.

Objective To evaluate the effect of pretransplant iron overload on the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with severe aplastic anemia (SAA). Methods Clinical data of 80 SAA recipients who underwent allo-HSCT for the first time were retrospectively analyzed. According to the incidence of iron overload, all recipients were divided into the iron overload group (n=20) and non-iron overload group (n=60). The engraftment rate, incidence of postoperative complications and clinical prognosis of the recipients afterallo-HSCT were statistically compared between two groups. The influencing factors of 2-year overall survival (OS) and 180 d transplantation related mortality (TRM) were analyzed by Cox proportional hazards regression model. Results The engraftment rate of neutrophils in the non-iron overload group was 98% (59/60), significantly higher than 75% (15/20) in the iron overload group (P < 0.05). The engraftment rate of platelet in the non-iron overload group was 90% (54/60), significantly higher than 65% (13/20) in the iron overload group (P < 0.05). The incidence rate of bloodstream infection in the non-iron overload group was 23% (14/60), remarkably lower than 40% (8/20) in the iron overload group (P < 0.05). The 180 d TRM of the recipients in the non-iron overload group was 17%, significantly lower than 45% in the iron overload group (P < 0.05). The 1- and 2-year OS of the recipients in the non-iron overload group were 82% and 80%, significantly higher than 50% and 44% in the iron overload group (both P < 0.05). Iron overload or not was an independent risk factor of the OS and TRM of the recipients (both P < 0.05). Conclusions Iron overload can affect the OS and TRM of SAA patients after allo-HSCT.

Bone tissue plays an important role in maintaining physical activity and health. The study of the biological functions of bone tissue cells and their application in tissue engineering is of great significance for clinical prevention and treatment of orthopedic-related diseases. Tea polyphenols are the main components of tea, with natural antioxidant, scavenging free radical activity and anti-inflammatory effects. Research results indicated that tea polyphenols can promote the bone remodeling process mainly by enhancing the formation of osteoblasts and reducing the occurrence of osteoclasts. In addition, tea polyphenols can also be used as surface modification molecules of artificial bone materials and are widely used in the field of bone tissue engineering. In this paper, the regulatory effects of tea polyphenols in bone tissue cells and its application in tissue engineering were reviewed, and related research contents were summarized and prospected, in order to provide reference and theoretical basis for subsequent research work.

Objective: To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly. Methods: Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed. There were 12 males and 31 females with an average age of 72 years (range, 66-78 years). All fractures were fresh and close which caused by trauma. The average time from injury to operation was 8.0 days (range, 6-11 days). According to Neer classification, 21 cases (48.8%, 21/43) were three-part fractures, 22 cases (51.2%, 22/43) four-part fractures. Visual analogue scale (VAS), Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results. Results: All operations were successfully completed. The average operation time was 141.3 minutes (range, 120-170 minutes. The mean blood loss was 407 ml (range, 250-700 ml) and intraoperative blood transfusion was 446.5 ml (range, 400-800 ml). All patients were followed up for 10.9 months (range, 6 to 16 months). All patients were discharged within 7 days after operation, and no wounds related complications occurred. The bigger and lesser tuberosities of all patients healed completely within 8 weeks. At the latest follow-up, no loosening or dislocation of prosthesis occurred, and the forward elevation was 133.0° (range, 100°-165°); external rotation was 29.5° (range, 20°-35°); internal rotation was 46.7° (range, 30°-60°). VAS score was 0.8 (range, 0-3). The Neer score was 87 (range, 73-98), with 20 cases (46.5%, 20/43) excellent, 16 cases (37.2%, 16/43) good, and 7 cases (16.3%, 7/43) fair. Constant-Murley score was 88.7 (range, 70-98). A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation, which did not affect the functional rehabilitation exercise or the stability of the prosthesis. During the follow-up, no other complications such as infection, acromial stress fracture and scapular notching were found in all patients. Conclusion The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory.

Objective To analyze the epidemiologic and clinical features of post-engraftment blood stream infection (pePSI) after unrelated cord blood transplant (UCBT) in our hospital,and provide the basis for empiric antibacterial treatment.Methods 484 patients with hematological malignancies who received single-unit high intensity myeloablative UCBT in our hospital between April 2011 and November 2017 were enrolled.The incidence,etiology of BSI and associated mortality,drug resistance rate in the post-engraftment phase were investigated.Results Totally 25 episodes of BSI among 22 patients in the post-engraftment phase were documented,and the incidence of peBSI was 5 ％.Gram-negative organisms predominated over Gram positive,with Escherichia coli being the most frequent Gram-negative organism isolated (31.5％).Among Gram positive organisms,methicillin resistant Staphylococcus (MRS) was the most frequent species isolated (66％).Nearly 33％ of Escherichia coli isolates and 60％ Klebsiella pneumonia isolates were carbapenem-resistant.All Grampositive bacteria were sensitive to vaneomyein and linezolid.Among the 22 patients,14 patients were cured and survived (63％) eventually.Conclusion The most frequent causative agents of the peBSI after UCBT were Escherichia coli,Klebsiella pneumonia and MRS,etc.Combined antibacterial treatment including a carbapenem or beta lactamase inhibitor can be used for patients suffering fever in the post-engraftment phase as empiric antibacterial therapy.Vaneomyein and linezolid can be used as the first-line therapy for Gram-positive bacteria.

Objective: To investigate the serum lipidomic profile in patients with nonalcoholic fatty liver disease (NAFLD), and to analyze the lipid metabolism characteristics of NAFLD. Methods: The subjects were divided into control group (23 patients) and pathologically confirmed NAFLD group (42 patients), and ultra-high-performance liquid chromatography-tandem mass spectrometry was used to measure serum lipidomic metabolites. The partial least squares-discriminant analysis (PLS-DA) model was established to analyze the differences in lipid metabolism with reference to the univariate analysis. The t-test and Mann-Whitney U test were used for data analysis. Results: A total of 239 lipids were identified and qualitative and quantitative analyses were performed. The PLS-DA model (R2 = 0.753, Q2 = 0.456) and the univariate analysis showed that 77 lipids were metabolized differentially between the NAFLD group and the control group (VIP > 1, P < 0.05), including free fatty acid, phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, lysophosphatidylcholine, lysophosphatidylinositol (LPI), choline plasmalogen (PlsCho), ethanolamine plasmalogen (PlsEtn), ceramide (Cer), sphingomyelin, and triglyceride (TG). Compared with the control group, the NAFLD group had significant increases in monounsaturated fatty acids (increased by 39%, t = -3.954, P < 0.05) and TGs (increased by 36%, Z = -2.662, P < 0.05), mainly TGs with low numbers of carbon atoms and unsaturated bonds, while there were reductions in TGs with high numbers of carbon atoms and unsaturated bonds. In addition, compared with the control group, the NAFLD group had significant increases in the levels of LPI (increased by 223%, t = -3.858, P < 0.05) and Cer (increased by 21%, t = -2.481, P < 0.05) and significant reductions in PlsCho (reduced by 18%, t = 3.184, P < 0.05) and PlsEtn (reduced by 20%, t = 2.363, P < 0.05). Conclusion There is a significant difference in lipid metabolism profile between NAFLD patients and healthy people, and a serum lipidomic analysis of NAFLD helps to further clarify the characteristics of lipid metabolism in patients with NAFLD.

Objective: To investigate the association between hepatic controlled attenuation parameter (CAP) and metabolic syndrome (MetS) and the correlation of CAP and its changes with the incidence of MetS. Methods: A total of 2461 subjects who underwent physical examination from July 2013 to September 2015 were enrolled. Spearman correlation analysis was used to investigate the correlation of CAP with the number of MetS components and each MetS component, and the chi-square test was used to investigate the prevalence rates of MetS and each component under different CAP levels. Logistic regression analysis was used to analyze the odds ratio (95% confidence interval (CI)) of MetS under different CAP levels. A total of 230 subjects without baseline MetS were selected; in a prospective cohort study, these subjects were divided into groups according to the baseline CAP, change in CAP, and percent change in CAP, and the chi-square test was performed to compare the incidence of MetS. The Cox regression analysis was used to analyze the values of baseline CAP, change in CAP, and percent change in CAP in predicting MetS. Results: CAP was positively correlated with the number of MetS components (r = 0.309, P < 0.01) and significantly correlated with all components. There were significant differences in the prevalence rates of MetS and its components under different CAP levels (< 238 dB/m, 238-258 dB/m, 259-291 dB/m, and ≥292 dB/m) (P < 0.05). After the adjustment for sex and age, with < 238 dB/m as a reference, the odds ratios (95% CI) of MetS in patients with CAP levels of 238-258 dB/m, 259-291 dB/m, and ≥292 dB/m were 1.784 (1.369-2.325), 2.936 (2.292-3.760), and 4.363 (3.435-5.543), respectively (all P < 0.05). Follow-up data showed that 28 patients (12.2%) developed MetS. After the adjustment for related factors, the hazard ratios (95% CI) of MetS in patients with baseline CAP > 238 dB/m, change in CAP > 30 dB/m, and percent change in CAP > 25.0% were 3.337 (1.163-9.569), 7.732 (2.453-24.366), and 11.656 (3.329-40.813), respectively (all P < 0.05). Conclusion CAP is closely associated with MetS and its components. CAP and its change can be used to predict the risk of MetS.

Objective:To assess effect of detection of plasma N terminal pro brain natriuretic peptide (NT‐proBNP) and serum cystatin C (Cys C) combined Global Registry of Acute Coronary Events (GRACE) score on heart func‐tion and prognosis in patients with acute coronary syndrome (ACS) .Methods :According to GRACE score ,a total of 136 ACS patients were divided into low risk group (n=29) ,intermediate risk group (n=39) and high risk group (n=68) .Serum Cys C level and plasma NT‐proBNP level were measured in all groups .Incidence rate of major ad‐verse cardiovascular events (MACE) within three and six months was counted .Results:Among ACS patients ,com‐pared with low risk group ,there were significant rise in levels of NT‐proBNP [ (165.80 ± 51.62) ng/L vs .(193.13 ± 74.64) ng/L vs .(985.45 ± 152.69) ng/L] and Cys C [ (0.83 ± 0.38) mg/L vs .(0.9 ± 0.25) mg/L vs .(1.23 ± 0.23) mg/L] ,left ventricular end‐diastolic diameter [six months: (50 ± 3) mm vs .(55 ± 3) mm vs .(59 ± 5) mm] ,significant reduction in left ventricular ejection fraction [LVEF ,six months: (55 ± 7)% vs .(49 ± 5)% vs . (40 ± 7)% ] ,and significant rise in incidence rate of MACE (six months:2.94% vs .9.55% vs .30.88% ) ,and a‐bove indexes in high risk group were significantly higher than those of intermediate risk group except LVEF signifi‐cantly reduced , P<0.05 or <0.01 ;Pearson correlation analysis indicated that NT‐proBNP and Cys C levels were positively correlated with GRACE score (r=0.72 , P<0.05 ; r=0.65 , P<0.05) respectively .Conclusion:NT‐proBNP and Cys C level detection combined GRACE score could exactly response heart function and prognosis .

Atrial Appendage ; physiopathology ; Catheter Ablation ; Child ; Child, Preschool ; Female ; Humans ; Male ; Tachycardia, Ectopic Atrial ; etiology ; surgery ; Tachycardia, Supraventricular ; etiology ; surgery