Epstein-Barr virus (EBV) associated post-transplant lymphoproliferative disorders (PTLD) are one of the most severe complications after hematopoietic stem cell transplantation (HSCT). This study includes 31 cases of aplastic anemia (AA) patients who developed PTLD after haploidentical transplantation, summarizing their clinical characteristics and categorizing them into either rituximab monotherapy group or combination therapy group based on whether their condition improved by 1 log after a single dose of rituximab. The incidence of PTLD after HSCT in children with AA was 10.16%, and the incidence of PTLD in patients with age >10 years was significantly increased ( χ2=11.336, P=0.010). Of the 31 patients, 27 were clinically diagnosed and 4 were pathologically confirmed. Finally, 15 patients were classified into the rituximab treatment group and 15 patients into the combination treatment groups. Finally three patients died, and the 2-year overall survival rate was (89.7±5.6) %. Standard pre-treatment protocols and EBV reactivation are risk factors affecting the prognosis of PTLD. There was no statistically significant difference in the impact of the two treatment schemes on prognosis.

Objective:To investigate the risk factors of invasive fungal disease after haploid hematopoietic stem cell transplantation in children with acute leukemia.Methods:Four hundred and two children (median age 10 years) with acute leukemia, undergoing haplo-HSCT at this institutute from January 2016 to December 2020,were analyzed retrospectively according to the diagnosis criteria of IFD. The basic information and preoperative indicators of the children were collected, including gender, age, primary disease, remission status of primary disease, and previous IFD history. Postoperative indicators were collected, including long-term granulocyte deficiency time, high-dose glucocorticoids, using CD25 monoclonal antibody, acute and chronic graft-versus-host disease. Count data are expressed as example (%), and comparisons between groups are made using the continuously multifactorial corrected Chi-square test or Fisher exact probability method. Logistic regression model was used to analyze the risk factors of IFD after haplo-HSCT in children.Results:Among 402 cases, 250 were male and 152 were female. The median age at transplantation was 10 years, and the age range was 9 months to 17 years 7 months. Before transplantation, 390 cases achieved complete remission of the primary disease, 9 cases had partial remission, and 3 cases had no remission. The implantation time of neutrophils ranged from +10 to 24 days, with a median time of 12 days. IFD occurred in 17 cases (4.2%), of which 3 cases (0.7%) were proven IFD and 14 cases (3.5%) were probable IFD. IFD occurred from 13 to 275 days after transplantation, with a median time of 30 days. The lungs were the most common site of infection (88.2%,15/17). The multivariate Logistic regression analysis showed that age >10 years old ( P=0.046, odds ratio =3.05, 95% confidence interval: 1.02~9.13), the use of high-dose corticosteroids ( P=0.005, odds ratio =7.72, 95% confidence interval: 1.85~32.20) were risk factors for IFD after haplo-HSCT in children. Conclusions:IFD is an important complication after haplo-HSCT in children with acute leukemia. Age >10 years and the use of high-dose corticosteroid are risk factors for IFD after haplo-HSCT in children with acute leukemia.

Objective:To investigate the radiation protection effect of furosemide intervention on 18F-2-deoxy-D-glucose ( 18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging. Methods:A total of 146 patients were randomly divided into two groups, with test group of 74 patients and control group of 72. The test group was administrated orally with furosemide of 40 mg for each one before injection, while the normal control group did not undergo special treatment. 60 and 120 min after 18F-FDG injection, the horizontal measurement of ambient dose equivalent rates was carried out at 0.5 m from the front of both chest and abdomen respectively. Results:For the test group, the ambient dose equivalent rates were measured to be (30.80±8.61) and (41.38±11.06) μSv/h 60 min after injection of 18F-FDG whereas (18.26±4.85) and (24.66±6.50) μSv/h 120 min after injection, respectively, both lower than in the control group and with statistically significant difference between the both ( t =15.36, 13.13, 18.73, 17.29, P<0.05) . No significant difference was found between mediastinal SUV max and liver SUV max in the experimental group and control group ( P>0.05) . Multivariate ANOVA showed that body surface area was a major factor influencing ambient dose equivalent rate regardless of furosemide injection ( t=-13.52, 2.96, P<0.05) , and no obvious effects of age and sex on ambient dose equivalence rate were found. Conclusions:Furosemide intervention can promote urination, effectively reduce the internal radiation exposure of the examinated patietns in the premise of not affecting the image quality, and therefore provide a better radiation protection effect.

OBJECTIVE: To explore the value of chromosomal microarray analysis (CMA) for the diagnosis of fetuses with high risk signaled by non-invasive prenatal testing (NIPT). METHODS: From June 2017 to August 2019, 628 pregnant women with high risk signaled by NIPT underwent invasive prenatal diagnosis. Amniotic fluid or cord blood samples were subjected to chromosomal karyotyping analysis or CMA. Pregnancy outcome and postnatal conditions of the fetuses were followed up. RESULTS: The positive predictive value for trisomy 21, trisomy 18, trisomy 13, sex chromosome aneuploidy, other rare trisomies and copy number variants (CNVs) among the 628 women were 86.4% (127/147), 41.7% (30/72), 12.9% (4/31), 43.7% (101/231), 16.5% (14/85) and 52.2% (35/67), respectively. In 218 samples with normal karyotype, 5.5% (12/218) of additional pathogenic CNVs and 2.3% (5/218) of loss of heterozygosity were detected by CMA. CONCLUSION CMA combined with karyotyping analysis can be used as first-tier test for prenatal diagnosis for women with high-risk signaled by NIPT.
Female ; Humans ; Karyotyping ; Microarray Analysis ; Pregnancy ; Prenatal Diagnosis ; Trisomy 13 Syndrome/genetics* ; Trisomy 18 Syndrome

Immune checkpoint inhibitors have already been the promising novel treatment of cancer therapy. The response pattern of immunotherapy is different from that of traditional cytotoxic therapies and may present delayed response, pseudoprogression or hyperprogression. Traditional RECIST is difficult to identify new treatment response patterns, thus underestimating the efficacy of immunotherapy. Therefore, a series of criteria for evaluating the efficacy of immunotherapy, such as iRECIST, emerged. This paper reviews the recent progress and application of imaging methods in the evaluation criteria of immunotherapy efficacy.

Objective: To report our experience in the prevention and control of COVID-19 in the tramatological and microsurgical wards. Methods: A retrospective study was conducted of the COVID-19 infections in the 51 medical staff and patients from 31 December, 2019 to 14 February, 2020 at Department of Traumatology and Microsurgery, Zhongnan Hospital. The prevention and control measures were upgraded after 20 January, 2020 to address the serious epidemic situation, including preventive disinfection, terminal disinfection and personnel disinfection in wards, management of emergency patients, inpatients and patients suspected of COVID-19 infection, and training, management and psychological intervention of medical staff. The outcomes resulting from different prevention and control measures before and after 20 January, 2020 were compared. Results: From 31 December, 2019 to 20 January, 2020, there were altogether 3 cases of definite COVID-19 infection and 2 ones of suspected COVID-19 infection at the department. One doctor, one technician and one nurse were diagnosed as definite COVID-19 infection while one nurse and one patient as suspected COVID-19 infection. The 4 medical staff members infected were cured and discharged before 14 February, 2020 but unfortunately the one patient infected died. After the prevention and control measures for COVID-19 infection had been upgraded since 20 January, 2020, 12 out of the 29 emergency patients at our wards had fever (body temperature ≥37.3℃) but none COVID-19 infection. All the 47 medical staff on duty at the department got trained and none of them was infected by COVID-19 or suffered from mental disorder. Conclusion In the epidemic of COVID-19, as our prevention and control measures for COVID-19 infection were adjusted and upgraded in response to the changing epidemic situation, they eliminated nosocomial infection scientifically and effectively and ensured life safety of the medical staff and patients at the department.

OBJECTIVE: To carry out prenatal diagnosis on a fetus with abnormal findings by ultrasonography and non-invasive prenatal testing. METHODS: The fetus and both parents were subjected to chromosomal karyotyping and single nucleotide polymorphism array (SNP-array) analysis. RESULTS: The karyotypes of both parents were normal. The fetus carried a 46,N,der(X;16)(q28;q22) unbalanced translocation. SNP-array analysis confirmed that the derived chromosomal fragment of the fetus has originated from 16q. The fetus was diagnosed with 16q partial trisomy syndrome. CONCLUSION Combined chromosomal karyotyping analysis and SNP-array can detect chromosomal aberrations at submicroscopic level and enable accurate diagnosis of the fetus.

We aimed to identify the effect of positive stool cultures (PSCs) on the clinical outcomes of patients undergoing haploidentical hematopoietic stem cell transplantation (haplo-HSCT) (n = 332). PSCs were observed in 61 patients (PSC group, 18.4%). Enterobacteriaceae in stool specimens was associated with a higher risk of bloodstream infection, and Candida in stool specimens was related to a higher risk of platelet engraftment failure. The cumulative incidence of infection-related mortality 1 year after haplo-HSCT in the PSC group was higher than that of the patients who showed persistently negative stool cultures (NSC group; 19.2% vs. 8.9%, P = 0.017). The probabilities of overall survival (71.4% vs. 83.8%, P = 0.031) and disease-free survival (69.6% vs. 81.0%, P = 0.048) 1 year after haplo-HSCT for the PSC group were significantly lower than those for the NSC group, particularly for patients who had Candida in their stool specimens. In multivariate analysis, Candida in stool specimens significantly increased the risk of mortality and was associated with poorer survival. Our results showed that PSC influenced the clinical outcomes after haplo-HSCT, particularly those who had Candida in their stool specimens.

Objective Using Meta-analysis method to evaluate the effect of multimedia video education and traditional education for hip replacement patients.Methods Databases including Elsevier, PubMed,EMbase,Medline,SCI,CNKI,CBM and WanFang Data were searched to collect the randomized controlled trails (RCTs) and non-RCTs regarding multimedia video education versus traditional education for hip replacement surgery patients. The retrieval time was from early available time to July 1st 2016.The data were collected and evaluated by two orthopedic nurses independently. The Meta-analysis was conducted by using RevMan5.2 software.Results A total of six RCTs and four non-RCTs involving 1197 patients were included. The results of Meta analysis showed that,the multimedia video education can improve the harris scores of one month [MD=6.95,95%CI(5.77,8.13),P<0.05],three months [MD=9.71,95%CI(7.53,11.89),P<0.05] and six months [MD=8.32,95%CI(4.46,12.17),P<0.05] after surgery,reduce the incidence of complications [OR=0.25,95%CI(0.15,0.42),P<0.05],decrease the hospital stays of patients [MD=-0.75,95%CI (-1.42,-0.08),P<0.05] and increase patients' awareness rate of rehabilitation knowledge [OR=2.55,95%CI (1.36,4.79),P<0.05].Conclusions Multimedia video education is superior to traditional education for hip replacement surgery patients,and with shorter hospital stays,lower complication rate postsurgery,multimedia video education should be promoted in clinic.

Objective To explore the clinical effect of root cause analysis (RCA) in prevention of adverse events in hematodialysis center.Methods A total of 120 patients treated in our hospital carried out root cause analysis (RCA) management in hematology center from January 2016.The incidence of adverse events,the rate of reporting and nursing satisfaction were compared before and after RCA.Results After the implementation of RCA,the incidence of adverse events was significantly lower,and rate of reporting was improved than implementation before (P ＜ 0.05);After implementation of RCA,the incidence rates of nurse-patient disputes in hemodialysis center were significantly lower than that implementation before (P ＜ 0.05);After RCA,the patient's satisfaction with hemodialysis was significantly improved compared with treatment before (P ＜ 0.05).Conclusion RCA can effectively change traditional management concept,strengthen the safety of hemodialysis care,and improve working efficacy of nursing staff and nursing quality,reduce adverse events of hemodialysis and nurse-patient disputes,and enhance patients'satisfaction.