The World Health Organization (WHO) classification serves as the internationally recognized standard for diagnosing and classifying hematopoietic and lymphoid tissue tumors(WHO-HEAM). Since 2001, it has undergone multiple upgrades and revisions, updating, clarifying, and refining previous tumor diagnostic and classification standards while incorporating numerous new genetic and molecular biological subtypes. In 2022, two classification proposals emerged due to a wealth of clinical and scientific research results: the fifth edition of the WHO hematopoietic and lymphoid tissue classification (WHO-HAEM5), published in Leukemia journal; and the International Consensus Classification (ICC), published in Blood journal. These two schemes differ in their approach to classifying hematopoietic and lymphoid tissue tumors, posing challenges for clinical laboratory diagnosis and treatment.

Objective:To investigate the flow cytometric characteristics of bone marrow in patients with aplastic anemia (AA) and hypoplastic myelodysplastic syndrome (hypoMDS) and its value in differential diagnosis between AA and hypoMDS.Methods:A total of 618 patients were recruited from Shandong Provincial Hospital affiliated to Shandong First Medical University from January 2017 to December 2021, including 441 patients as controls with abnormal peripheral blood counts but confirmed to have no AA, hypoproliferative MDS, or other hematological tumors, 57 patients with AA, 52 patients with hypoMDS and 68 patients with diluted bone marrow. The proportions of bone marrow myeloid progenitor cell, lymphocyte, neutrophil and erythroid cell in bone marrow were analyzed by flow cytometry immunophenotyping. The differences between the four groups were compared by Kruskal-Wallis one-way ANOVA. The diagnostic efficacy was evaluated by the receiver operating characteristic (ROC) curve.Results:The proportion of myeloid progenitor cells in control group was [0.30%(0.20%, 0.46%)]; the proportion of myeloid progenitor cells in AA group was [0.00 (0.00, 0.04)]%, while the proportion of myeloid progenitor cells in hypoMDS group was [3.10%(1.25%, 6.71%)]. The proportion of myeloid progenitor cells in AA group was lower than that in control group( χ2=302.90, P<0.001), while the proportion of myeloid progenitor cells in the bone marrow of patients with hypoMDS was higher than that in the control group ( χ2=203.88, P<0.001). The area under the ROC curve for identifying AA and hypoMDS by the ratio of myeloid progenitor cells in bone marrow is 0.996, with the sensitivity of 96.2% and the specificity of 100% when the cutoff value is 0.21%. The proportion of bone marrow lymphocytes in control group was [10.39%(7.33%, 14.80%)]; the proportion of bone marrow lymphocytes in AA group was [52.67%(42.20%, 67.68%)], and the proportion of bone marrow lymphocytes in hypoMDS group was [24.68%(15.51%, 35.19%)]. The proportion of bone marrow lymphocytes in AA group or hypoMDS group was higher than that in control group( χ2=298.74, P<0.001; χ2=194.33; P<0.001), and the proportion of bone marrow lymphocytes in AA group is higher than that in hypoMDS group, with a statistically significant difference( χ2=104.41, P=0.002). The area under the ROC curve for identifying AA and hypoMDS by the ratio of bone marrow lymphocyte is 0.882, with the sensitivity of 78.9% and the specificity of 92.3% when the cutoff value is 41.6%. Conculsion:Patients with AA and hypoMDS could be differentiated effectively by the proportions of myeloid progenitor cell and lymphocyte in bone marrow by flow cytometry immunophenotyping.

Early intervention contributes to improving patient experience and doctor-patient relationship in the case of non-psychiatric outpatients with psychological problems.The authors studied the psychological assessment and hierarchical management for non-psychiatric inpatients at a general hospital. Measures taken include establishing multi-disciplinary and inter-department teams, building an intra-hospital joint-action system, and implementing the psychological assessment and hierarchical management for non-psychiatric inpatients.These efforts explored ways for a general hospital in psychological counseling, offering humanistic service, and transformation of medical pattern.

OBJECTIVE: Although the pathogenesis of depression remains unclear, C-reactive protein (CRP) levels are commonly elevated in depressed patients. Thus, CRP single-nucleotide polymorphisms (SNPs) that influence CRP levels may be associated with depression. In the present study, we explored whether CRP SNPs are related to depressive symptoms and antidepressants efficacy in Han Chinese patients.METHODS: We analyzed data from 440 patients with first-episode depression. We obtained genome CRP SNPs, scores of the 17-item Hamilton Rating Scale for Depression 17 (HAMD17) and its four-factor at baseline and after 6 weeks. Quantitative trait analysis was performed using UNPHASED software and curative effects were analyzed using SPSS software.RESULTS: Male patients with SNP rs1800947G exhibited lower insomnia scores and rs2794521CC exhibited lower scores of anxiety/ physical symptoms, total HAMD17 score. Female patients with rs2794521TT exhibited higher scores of insomnia and lower antidepressants efficacy.CONCLUSION: CRP SNPs rs1800947 and rs2794521 may be associated with depressive symptoms in patients with depression in a sex-specific fashion. Furthermore, rs2794521 may be a predictor of the efficacy of antidepressants in female patients.
Antidepressive Agents ; Asian Continental Ancestry Group ; C-Reactive Protein ; Depression ; Female ; Genome ; Humans ; Male ; Polymorphism, Single Nucleotide ; Sleep Initiation and Maintenance Disorders

Objective To evaluate the effect of dexmedetomidine on remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) mediated by N-methyl-D-aspartate (NMDA) receptors in spinal dorsal horn neurons of rats.Methods Thirty male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Their lumbar segments of the spinal cord were immediately removed and sliced.A total of 180 slices were selected and divided into 5 groups (n=36 each) using a random number table:blank control group (group C),remifentanil group (group R),low-dose dexmedetomidine group (group L),moderate-dose dexmedetomidine group (group M) and high-dose dexmedetomidine group (group H).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L in group R.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L and dexmedetomidine at the final concentrations of 2,4 and 6 nmol/L in L,M and H groups,respectively.The whole-cell patch-clamp technique was used to record the amplitude and time interval of NMDA receptors-mediated mEPSCs.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened in the other 4 groups (P＜ 0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in L,M and H groups (P＜0.05).Compared with group L,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in M and H groups (P＜0.05).Compared with group M,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in group H (P ＜ 0.05).Conclusion Dexmedetomidine weakens remifentanil-induced enhancement in the function of NMDA receptors in spinal dorsal horn neurons probably via the presynaptic and postsynaptie mechanisms in rats.

Objective To evaluate the role of PICK1 in remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) mediated by AMPA receptors in spinal dorsal horn neurons and in the expression of AMPA receptors in juvenile rats.Methods Thirty-six male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Eighteen rats were randomly selected,their lumbar segments of the spinal cord were immediately removed,and 108 spinal cord slices (400 μm thick,for wholecell patch-clamp recording) aud 108 spinal cord slices (5 μm thick,for immunofluorescence detection) were prepared.The 108 slices with two kinds of thickness were divided into 3 groups (n=36 each) using a random number table:blank control group (group C),remifentanil group (group R) and remifentanil plus PICK inhibitor group (group R+PlCKi).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF containing remifentanil at the fiual concentration of 4 mnol/L in group R.Spinal cord slices were incubated for 90 min in ACSF containing remifentanil at the final concentration of 4 nmol/L and 50 μmol PICK inhibitor in group R+PICKi.The whole-cell patch-clamp technique was used to record the amplitude and time interval of AMPA receptors-mediated mEPSCs.The method of immunofluorescence was used to detect the expression of AMPA receptors.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened,the expression of GluR1 and GluR3 was up-regulated,and the expression of GluR2 was down-regulated in R and R+PICKi groups (P＜0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval was prolonged,the expression of GluR3 was down-regulated,the expression of GluR2 was up-regulated (P＜0.05),and no significant change was found in GluR1 expression in group R+PICKi (P＞0.05).Conclusion PICK1 is involved in the process of remifentanil-induced mEPSCs mediated by AMPA receptors in spinal dorsal horn neurons and of expression of AMPA receptors in juvenile rats,which may be the mechanism underlying remifentanil-induced hyperalgesia.

Objective To evaluate the effect of dexmedetomidine on remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) of N-methyl-D-aspartate (NMDA) receptors in spinal dorsal horn neurons of rats.Methods Thirty male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Their lumbar segments of the spinal cord were immediately removed and sliced.The 180 slices were divided into 5 groups (n =36 each) using a random number table:blank control group (group C),remifentanil group (group R),low-dose dexmedetomidine group (group L),moderate-dose dexmedetomidine group (group M) and high-dose dexmedetomidine group (group H).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L in group R.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L and dexmedetomidine at the final concentrations of 2,4 and 6 nmol/L in L,M and H groups,respectively.The whole-cell patch-clamp technique was used to record the amplitude and time interval of mEPSCs of NMDA receptors.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened in the other 4 groups (P＜0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in L,M and H groups (P＜0.05).Compared with group L,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in M and H groups (P＜0.05).Compared with group M,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in group H (P＜0.05).Conclusion Dexmedetomidine weakens remifentanil-induced enhancement in the function of NMDA receptors in spinal dorsal horn neurons probably via the presynaptic and postsynaptic mechanisms in rats.

Objective To investigate the influence of dexmedetomidine on expressions of protein kinase c (PKC)γ, cal?cium/calmodulin-dependent protein kinase (CaMK)Ⅱαand pCaMKⅡαin spinal cord in rats with incisional pain (IP) and remifentanil-induced hyperalgesia. Methods Forty male Sprague-Dawley rats, aged 2-3 months, weighing 240-260 g, were randomly divided into 5 groups (n=8 each):blank control group (group C), remifentanil+incisional pain group (group R+I), dexmedetomidine + remifentanil + incisional pain group (group D+R+I), dexmedetomidine + remifentanil + incisional pain+phorbol myristate acetate+DMSO group (group D+R+I+P+DMSO) and dexmedetomidine+remifentanil+incisional pain+DMSO group (group D+R+I+DMSO). The incisional pain rat model was established by a plantar incision in left hind paw. Remifentanil was infused at a rate of 1.2μg·kg-1·min-1 for 90 min via the caudal vein. Dexmedetomidine was adminis?tered subcutaneously at a dose of 50μg/kg at 30 min before plantar incision. Phorbol myristate acetate and DMSO were intra?thecally injected at a dose of 10 μL. Paw withdrawal latency (PWL) to thermal stimulation and paw withdrawal threshold (PWT) to von Frey hair stimulation were measured 24 h before remifentanil infusion (T0) and at 2, 6, 24 and 48 h (T1-4) after intraveonus remifentanil injection. The rats were sacrificed after the last behavioral test and the L 4-6 segment of spinal cord was removed to determine the expressions of PKCγ, CaMKⅡαand pCaMKⅡαin spinal cord by Western blot analysis. Re? sults Compared with group C, the value of PWL was significantly shortened and PWT was significantly decreased except T0, and the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere up-regulated in other groups. Compared with group R+I, the value of PWL was significantly prolonged and PWT was significantly increased, the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere down-regulated in group D+R+I and group D+R+I+DMSO. Compared with group D+R+I, the value of PWL was significantly shortened and PWT was significantly decreased, the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere up-regulated in group D+R+I+P+DMSO. Compared with group D+R+I+P+DMSO, the value of PWL was significantly prolonged and PWT was significantly increased, the expressions of PKCγ, CaMKⅡαand pCaMKⅡαwere down-regulated in group D+R+I+DMSO. Conclusion Dexmedetomidine can reduce the expressions of PKCγ, CaMKⅡαand pCaMKⅡαin spinal cord in rats with IP and hyperalgesia induced by remifentanil.

Objective:To observe the efficacy and safety of azithromycin combined with Bailing capsules in the treatment of chron -ic obstructive pulmonary disease ( COPD) in stable phase .Methods:Totally 154 cases of COPD patients were randomly divided into the treatment group(80 cases)and the control group(74 cases).Both groups were treated with the routine symptomatic treatment , and at the same time, the control group was treated with Bailing capsules (1 g, po, tid)and the treatment group was treated with azithromy-cin tablets (250 mg, po, qd)combined with Bailing capsules(1 g, po, tid).The course of treatment was 6 months and all the patients were followed up for 6 months after the treatment.The clinical efficacy, lung function, exercise tolerance, quality of life, the times of acute exacerbation and the incidence of adverse drug reactions of the two groups were observed and compared .Results:After the treat-ment, the lung function, exercise tolerance and quality of life were improved significantly in the two groups (P<0.05 or <0.01), and all the indices in the treatment group were significantly better than those in the control group (P<0.05 or <0.01).The total ef-fective rate in the treatment group was higher than that in the control group (P<0.05).The times of acute exacerbation in the treat-ment group were lower than those in the control group (P<0.01).The adverse drug reactions showed no significant difference between the groups (P>0.05).Conclusion:Azithromycin tablets combined with Bailing capsules can improve lung function , enhance exer-cise tolerance , improve the quality of life and reduce the frequency of acute exacerbation effectively with good security in the treatment of patients with COPD in stable phase .

Objective To investigate the status of depression with anxiety symptoms, and analyze the influencing factors of anxiety symptoms from demographic data and social psychological factors. Methods Hamilton depression rat?ing scale (HAMD), Hamilton anxiety rating scale (HAMA), Eysenck personality questionnaire (EPQ), life event scale (LES), trait coping style questionnaire (TCSQ) and social support scale (SSS) were used to evaluate 729 patients with de?pression. According to HAMA scores, patients were divided into non anxiety symptoms group (HAMA<7) and anxiety symptoms group (HAMA>14). Social psychological factors were compared between two groups, and the influencing fac?tors of anxiety symptoms were analyzed. Results The incidence of anxiety symptoms in depression was 58.85% (429/729), and 119 cases (16.32%) were certainly without anxiety symptoms. Compared with the group without anxiety symp?toms, the anxiety symptoms group had higher scores on neuroticism, psychoticism, negative life events and negative cop?ing style (P<0.001), but lower scores on introversion and extroversion (P=0.010). Degree of depression (OR=9.255, 95%CI:4.726~18.127), neuroticism (OR=1.595, 95%CI:1.197~2.125), negative life events (OR=1.009, 95%CI:1.001~1.017) and negative coping style (OR=1.046, 95%CI:1.013~1.080) were the risk factors of anxiety symptoms (P<0.05). Conclu?sion The incidence of anxiety symptoms in patients with depression is high. Patients with higher degree of depression and typical neurotic personality experiencing more negative life events and those with tendency to adopt negative coping style are more susceptible to anxiety symptoms.