Objective:To explore the risk factors in leukemia transformation (LT) in those with myelodysplastic syndromes (MDS) .Methods:From January 2012 to December 2020,data on 320 patients with newly diagnosed primary MDS were gathered from the MDS center. The clinical features and molecular characteristics are explored. Additionally, a retrospective analysis of risk factors for the development of acute leukemia from MDS was done.Results:The median follow-up was13.6 (0.4-107.3) months. 23.4% (75/320) of the MDS patients had LT group. Significant differences between the LT group and non-LT group can be seen in age ( P<0.001) , bone marrow blast percentage ( P<0.001) , bone marrow fibrosis ( P=0.046) , WHO classification ( P<0.001) , IPSS-R ( P<0.001) and IPSS-R karyotype group ( P=0.001) . The median number of mutation of LT group was 1 (1, 3) , that in non-LT group was 1 (0, 2) ,which had a statistical difference ( P=0.003) .At the time of the initial diagnosis of MDS, the LT group had higher rates of the TP53 mutation ( P=0.034) , DNMT3A mutation ( P=0.026) , NRAS mutation ( P=0.027) and NPM1 mutation ( P=0.017) . Compared with the mutations at first diagnosis and LT of six patients, the number of mutations increased and the variant allele frequencies (VAF) increased significantly in LT patients. Higher bone marrow blast percentage (Refer to <5% , 5% -10% : HR=4.587, 95% CI 2.214 to 9.504, P<0.001, >10% : HR=9.352, 95% CI 4.049 to 21.600, P<0.001) , IPSS-R cytogenetic risk groups ( HR=2.603, 95% CI 1.229-5.511, P=0.012) , DNMT3A mutation ( HR=4.507, 95% CI 1.889-10.753, P=0.001) , and NPM1 mutation ( HR=3.341, 95% CI 1.164-9.591, P=0.025) were all independently associated with LT in MDS patients, according to results of multivariate Cox regression. Conclusion:Bone marrow blast percentage, IPSS-R cytogenetic risk groups, DNMT3A mutation, and NPM1 mutation are independent risk factors in LT for MDS patients.

Objective:To investigate the application value of magnetic resonance dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) combined with microRNA-21 (miR-21) and miR-92a in the benign and malignant differentiation of bone tumors and the evaluation of their efficacy.Methods:A total of 120 patients with bone tumors were selected retrospectively from June 2018 to June 2019 in Panyu Hospital of Chinese Medicine, including 52 cases in the benign group and 68 cases in the malignant group. The DCE-MRI dynamic enhancement parameters and tumor tissue miR-21, miR-92a levels were compared between the two groups. The diagnostic value of DCE-MRI, miR-21, miR-92a levels of cancer tissue and their correlation were analyzed. Patients with bone malignant tumors were given comprehensive treatment. Six months after operation, according to the criteria of solid tumor curative effect, they were divided into good curative effect group and poor curative effect group. The DCE-MRI dynamic enhancement parameters [signal enhancement amplitude (SEE), early dynamic enhancement slope value (Slope), centripetal enhancement rate (DER)], miR-21, miR-92a levels of patients with different curative effects were compared.Results:The levels of SEE, Slope, DER and miR-21 a nd miR-92a in the malignant group were higher than those in the benign group ( P<0.05); The area under curve (AUC) of DCE-MRI, miR-21, miR-92a combined in the diagnosis of benign and malignant bone tumors (0.885)>Slope(0.808)>SEE(0.788)>miR-21(0.785)>miR-92a (0.740)>DER(0.660), with sensitivity 80.88%, specificity 88.46%, respectively; the DCE-MRI dynamic enhancement parameters SEE, Slope, DER were positively correlated with miR-21 and miR-92a ( P<0.05); the DCE-MRI dynamic enhancement parameters SEE, Slope, DER and miR-21, miR-92a of patients with good curative effect were lower than those with poor curative effect ( P<0.05). Conclusions:DCE-MRI dynamic enhancement parameters, miR-21, miR-92a levels are abnormally high expression in patients with bone malignant tumors, and combined detection is expected to become an important means to identify benign and malignant bone tumors and evaluate the efficacy.

OBJECTIVE: To determine the composition and distribution of beta-thalassemia-associated genotypes in Liuzhou area of Guangxi, China. METHODS: From January to December 2017, 13 847 individuals who came for premarital examination, maternity examination or health check were recruited with informed consent. The subjects were analyzed by reverse dot blotting (RDB) for 17 common beta-thalassemia-associated variants among the Chinese population. Individuals with inconsistent results by blood test, electrophoresis, and RDB were subjected to Sanger sequencing to detect rare variants of the beta globin gene. RESULTS: In total 2098 individuals were found to harbor beta-thalassemia-associated variants, which included 2075 heterozygotes (98.90%), 12 compound heterozygotes (0.57%) and 11 homozygotes (0.52%). CD41-42 (48.43%) and CD17 (31.45%) were the most common variants. Three hundred and thirty eight-individuals were found to also carry heterozygous variants of the alpha globin gene, with the most common types being --SEA/aa, -a3.7/aa, aCSa/aa, -a4.2/aa. Through Sanger sequencing, rare genotypes such as beta-32/betaN, betaCD41-42/betaIVS-II-5 and betaCD30/betaN were detected. CONCLUSION Liuzhou area has a high incidence of beta-thalassemia, but with a complex variant spectrum and clinical phenotypes different from other regions. Genetic counseling and prenatal diagnosis for the carrier population is crucial for the reduction of the related birth defects. Our result may provide valuable information for the prevention and control of beta-thalassemia in this area.
China ; Female ; Genetic Counseling ; Genetic Variation ; Genotype ; Humans ; Mutation ; Pregnancy ; Prenatal Diagnosis ; alpha-Globins ; genetics ; beta-Globins ; genetics ; beta-Thalassemia ; diagnosis ; genetics

OBJECTIVE：To evaluate the safety of PARP inhibitors in hematological system ，and to provide evidence-based evidence for rational drug use in the clinic. METHODS ：Retrieved from PubMed ，Embase，Cochrane Library ，ScienceDirect， CNKI，CBM，VIP and Wanfang data from May 2014 to June 2019，randomized controlled trials （RCTs）about PARP inhibitors or PARP inhibitors combined with chemical treatment drugs （trial group ）versus chemical treatment drugs alone ，placebo alone or chemical treatment drugs combined with placebo （control group ）were collected. After literature screening ，data extraction and quality evaluation with bias risk assessment tool recommended by Cochrane systematic evaluator manual 5.1.0，and Meta-analysis was performed by using Rev Man 5.3 software，and sensitivity analysis and publication bias analysis. RESULTS ：A total of 10 RCTs were included ，involving 3 129 patients. Meta-analysis showed that the incidence of anemia ≥grade 3 [RR＝7.27，95％CI （2.74，19.27），P＜0.000 1]，neutropenia≥grade 3 [RR＝2.46，95％CI（1.43，4.24），P＝0.001]，and leukopenia ≥grade 3 in trial group [RR ＝1.71，95％CI（1.15，2.54），P＝0.008] in trial group were significantly higher than control group. There was no statistically significant difference in the incidence of thrombocytopenia ≥grade 3 between two groups [RR ＝3.54，95％CI（0.66， 19.05），P＝0.14]. Results of sub-group analysis showed that the incidence of an emia≥grade 3 and neutropenia ≥grade 3 in the patients receiving PARP inhibitors alone ，PARP inhibitors combined with chemical treatment dr ugs as well as the incidence of leukopenia≥grade 3 in the patients receiving PARP inhibitors （No.2018FH001-096） combined with chemical treatment drugs were significantly higher than those receiving placebo alone ，chemical treatment com drugs alone or chemical treatment drugs combined with placebo （P＜0.05）. Sensitivity analysis supported the above results howerer，publication bias was possibility. CONCLUSIONS ：PARP inhibitor in the treatment of cancer can cause hematological system adverse drug reaction ，mainly manifesting as anemia ，neutropenia and leukopenia. These results should be interpreted with caution.

Objective To investigate the influence of preoperative anxiety-depression status on the postoperative pain in patients undergoing gynecologic laparoscope surgery.Methods Ninety pa-tients,aged 18-65 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,undergoing gynecologic laparoscope surgery were included in this single-center observational study.All the patients were in-terviewed by anesthetists the afternoon before surgery and completed a Hospital Anxiety and Depres-sion Scale (HADS)to evaluate the anxiety-depression status.Then the patients were divided into two groups,low HADS group (group L)(HADS score≤9)and high HADS group (group H)(HADS score>9).Patients'visual analogue scores (VAS)were recorded at the time 30 min,60 min,6 h, 12 h,24 h after operation.The correlation analysis between HADS before operation and VAS scores at different time point was performed.The use of analgesia medicine,exhausting time and complica-tions such as nausea, vomiting, dizzy, pain of shoulder and back were also recorded. Results Compared to group H,VAS score was lower in group L at 6 hour after surgery but no sig-nificant different was found at 30 min,60 min,12 h,24 h after surgery.There was a significant asso-ciation between preoperative HADS scores and VAS at 6 hour after surgery (r=0.634,P=0.01);but no significant association was found between preoperative HADS scores and VAS at the other time point after surgery.The exhausting time was significantly longer in group H than group L (P<0.05).There was no significant difference in the incidence of nausea,vomiting,dizzy or pain of shoulder and back between the two groups.Conclusion Preoperative anxiety-depression status has a positive influence on postoperative pain at 6 hour after gynecologic laparoscope surgery,and also can delay the recovery of gastrointestinal function.

Objective To investigate the prevalence and prognostic value of anemia in male and female patients with chronic systolic heart failure (CSHF).Methods Data of in-hospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei Province.Patients were divided into normal hemoglobin (Hb) group,mild anemia group,moderate anemia group,severe and extreme anemia group.According to age,body mass index (BMI) and correction of glomerular filtration rate (GFRc),patients were divided into several subgroups,respectively.Multivariate logistic regression was performed to determinate the associated factors with anemia.Kaplan-Meier curve was performed to evaluate the difference in all-cause mortality in male and female patients with anemia.Univariate and multivariate Cox proportion hazard analysis was performed to determinate the risk of all-cause mortality among different anemia group in male and female patients.Results A total of 16681 patients were enrolled.Anemia accounted for 23.79％ and 27.29％,separately,in male and female patients with CSHF.BMI and GFRc were related to anemia in both male and female patients with CSHF,while only age was related to anemia for female patients with CSHF.The hazard ratio of all-cause mortality was 1.08 (P ＜ 0.01),1.13 (P ＜ 0.O1) and 1.02 (P =0.74),respectively,for all,male and female anemia patients with CSHF,compared to normal Hb group.Compared to normal Hb group,the hazard ratio of mild anemia group,moderate anemia group,severe and extreme anemia group was 1.05 (P =0.14),1.20 (P ＜0.01) and 1.36 (P ＜0.01),respectively,for all CSHF patients;1.11 (P ＜ 0.01),1.35 (P ＜ 0.01) and 1.37 (P ＜ 0.01),respectively,for male;0.96 (P=0.48),1.08 (P=0.40) and3.47 (P＜0.01),respectively,for female.Conclusions Compared to male,female patients suffer higher prevalence of anemia in patients with CSHF.There is a significant difference in risk factors and prognosis of anemia between male and female patients with CSHF.

Objective To discuss the effect of a moving folding multifunction operating platform in operation room so as to solve time-consuming and efforts in the putting lithotomy position of repeating placement and removal surgery bed legs plate and supply the operating platform in the surgery of the upper limb, inva-sive puncture and anesthesia operation.Methods A moving folding multifunction operating platform was self-designed. A number of 160 cases undergoing operation in lithotomy position in the urology department from March to June 2016 were randomly divided into the experimental group (80 cases) and the control group (80 cases). The routine nursing method were carried out in patients in the control group, while adopted operating platform were used in patients in the experimental group. Time-consuming pre and post operation were investigated. Application effects of moving folding multifunction operating platform in 114 cases including the surgery of the upper limb, invasive puncture and anesthesia operation were evaluated.Results During continues lithotomy position surgery, time consuming of changing position and position placement in the experimental group were (209.41±33.36) s and (622.33±62.16) s respectively, while those in the control group were (665.83±90.92) s and (1118.33±88.86) s. The differences were statistically significant between two groups (t=16.324, 15.844;P<0.05). In one lithotomy position surgery, time consuming of position placement pre and post operation were reduced 44.03% (saved 8.16 minutes/surgery) compared to that in the control group. It alleviated 60 kg body burden of nurses. The safety and performance evaluation in the surgery of the upper limb, invasive puncture and anesthe-sia operation were in high levels with scores of (26.13±1.53) and (27.42±1.56) respectively.Conclusions The platform, which is practical and easy to use, contributes to meet the needs of a variety of technical operation in the operation room and helps optimizing procedure in transformation, reducing work load of nurse so as to im-prove efficiency and quality of work.

Objective: In comparison with thrombus aspiration, to study the safety and effcacy of precise intracoronary retrograde thrombolysis during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).
Methods: A total of 123 consecutive patients with acute STEMI received primary PCI in our hospital from 2014-01 to 2015-12 were enrolled.The patients were randomly divided into 2 groups: RT group, the patients received precise intracoronary retrograde thrombolysis (RT),n=60 and TA group, the patients received thrombus aspiration (TA),n=63, among them, 3 patients with failed TA were excluded. Primary end points included occurrence rates of no-lfow after PCI and ST-segment resolution (STR)≥50% at (60-90) min after PCI; primary safety end points included occurrence rates of in-hospital stroke and TIMI-hemorrhage events.
Results:①Compared with TA group, RT group showed decreased no-lfow rate after PCI (1.7% vs 15.0%),P=0.008 and increased rate of STR≥50% after PCI (65.0% vs 45.0%),P=0.028, improved LVEF by echocardiography (50.7±8.6) % vs (46.7±8.3)%,P=0.011. The in-hospital MACE occurrence rate was similar between 2 groups,P>0.05.②No in-hospital stroke or TIMI-hemorrhage events occurred in neither group.
Conclusion: Intracoronary retrograde precise thrombolysis had the similar safety to thrombus aspiration during primary PCI in patients with acute STEMI, it may reduce no-relfow rate and improve left ventricular function after PCI.

Objective To investigate the prognostic value of right ventricular end-diastolic diameter (RVDD) in patients with chronic systolic heart failure (CHF).Methods A retrospective study was conducted with clinical data of inpatients from 12 third-grade class-A hospitals of Hubei Province between 2000 to 2010,followed up by phone calls.Based on RVDD,patients diagnosed with chronic systolic CHF were divided into four groups:＞38 mm,31-38 mm,25-30 mm and ＜25 mm groups;based on prognosis,patients were divided into the death group and the survival group.Of the death group,patients were further divided into the heart failure death subgroup and the sudden cardiac death subgroup.Single-factor and multi-factor Cox survival analyses were conducted to analyze the relationships between RVDD and mortality,including all-cause mortality,CHF mortality and sudden cardiac death (SCD).Results A total of 16681 patients were enrolled in this study.They were followed up for 1-4 years,during which 6453 died.Multivariate Cox survival analysis showed that the mortality risk for patients with RVDD between 25-30 mm,between 31-38 mm,and ＞38 mm groups was 1.87,2.41,3.95 times that for patients with RVDD＜25 mm,respectively (95％CI:1.64-2.13,2.06-2.80,3.61-4.32,all P＜0.01).The risk of sudden cardiac death for patients with RVDD＞38mm was 3.82 times that for patients with RVDD＜25 mm (95％CI:2.27-5.94,P＜0.01).The areas under the ROC curve for death by the best prediction model alone and RVDD combined with the best respectively.RVDD increased the areas under the ROC curve for all cause mortality,CHF mortality and sudden cardiac death.The best prediction model combined with RVDD could discriminate between total mortality,heart failure mortality and sudden cardiac death for patients with different causes of death in multivariate analysis.Conclusions RVDD has a predictive value in the prognosis of patients with chronic systolic heart failure.RVDD increases the sensitivity and specificity of the best prediction model for total mortality prediction in patients with chronic systolic heart failure.RVDD increases the sensitivity and specificity of the best prediction model to discriminate between all-cause mortality,heart failure mortality and sudden cardiac death in patients with different causes of death.RVDD＞38 mm can serve as an indicator for the assessment of sudden cardiac death in CHF patients.

Objective:To evaluate the correlation of preoperative pain threshold and pain tolerance threshold with postoperative sufentanil consumptions in puerperae who underwent cesarean section .Methods :A total of 50 puerperae ,aged 20‐35 years , with height 155‐180 cm ,who were classified as Ⅰ ~ Ⅱ with American Society of Anesthesiologists(ASA)criteria and scheduled for cesarean section with combined spinal and epidural anesthesia (CSEA) ,were chosen .The pain threshold and pain tolerance threshold were measured with electric stimulator before CSEA .The patient controlled intravenous analgesia(PCIA) with sufen‐tanil was used for postoperative analgesia .The PCIA pump was set up with background infusion at a rate of 0 .015μg/(kg · h) and single bolus dose of 0 .023 μg/kg with 8 min lockout interval .Visual analogue score(VAS) ,as well as consumptions of sufentanil ,was recorded at 4 ,8 ,24 h after operation .Linear correlation analysis was conducted on the preoperative pain thresh‐old and pain tolerance threshold with the total sufentanil consumptions during the 24 h after operation and the VAS at the 24 h after operation .Results :The preoperative pain threshold and pain tolerance threshold measured by electric stimulation were not correlated with the VAS at the 24 h after operation and the sufentanyl consumption during the 24 h after operation(P>0 .05) . Conclusions :The preoperative pain tolerance threshold and pain threshold measured by electric stimulation cannot predict the consumptions of sufentanyl after cesarean section .