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15 August 2018, Volume 46 Issue 8 Previous Issue    Next Issue

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Precision diagnosis and therapy of myelodysplastic syndrome based on disease nature and our facility SHAO Zong-hong, WANG Hua-quan 2018, 46 (8):  785-788.  doi: 10.11958/20180747 Abstract ( 827 )   PDF (401KB) ( 3593 )   Abstract: The essence of myelodysplastic syndrome (MDS) is a malignant clonal bone marrow myeloid neoplasm. Both basic researches and clinical studies should firmly grasp this essence of MDS and should not be interferenced by confounding factors. Comprehensive diagnosis can improve the accuracy of MDS diagnosis by multiple indicators that reflect the malignant nature, such as cell dysplasia, function abnormalities, cytogenetic changes and gene mutations. The therapy of MDS should also eradicate the MDS clone, change the disease progression, stimulating normal hematopoiesis, prolong the survival and improve the quality of life. Related Articles | Metrics

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Mechanisms and therapies of thrombocytopenia in myelodysplastic syndrome WANG Hua-quan, LIU Jia-xi 2018, 46 (8):  789-794.  doi: 10.11958/20180451 Abstract ( 1797 )   PDF (393KB) ( 4058 )    Myelodysplastic syndromes (MDS) is a kind of bone marrow failure disease. Thrombocytopenia in patients with MDS is a frequent causes of mortality in MDS with 37% to 67% incidence. Thrombocytopenia in MDS is an independent factor predicting worse prognosis associated with increased risk of acute leukemic transformation (AML) and reduces overall survival. In addition, thrombocytopenia in MDS limits the therapeutic efficacy of disease-modifying therapies, such as azacitidine or lenalidomide. Mechanisms of thrombocytopenia in MDS are complicated, involving suppression of megakaryocytic differentiation, enhanced apoptosis, and increased platelet destruction. Platelet transfusion is still the standard treatment option for MDS combined with thrombocytopenia. Recently, novel thrombopoietin (TPO) receptor agonists have showed curative effect in MDS patients in many clinical trials, including reducing bleeding events, decreasing dependency on platelet transfusions and increasing clinical benefits of disease-modifying therapies. Several clinical trials are ongoing to assess the efficacy and safety of novel TPO receptor agonists; the results would further help guide treatment for thrombocytopenia in MDS. Related Articles | Metrics

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Etiology and treatment strategies of anemia in myelodysplastic syndromes HAN Bing, LI Hong-min, CHEN Fang-fei, WU Jie 2018, 46 (8):  794-798.  doi: 10.11958/20180561 Abstract ( 1499 )   PDF (403KB) ( 3564 )   Myelodysplastic syndrome (MDS) is a group of highly heterogeneous diseases. Anemia is the most common manifestation of MDS, which is also an important factor affecting the survival and quality of life in MDS patients. Different factors are involved in the pathogenesis of anemia of MDS, and for a particular patient, anemia maybe the results of multiple factors. In current review, we summarized the common reasons for MDS anemia including expansion of abnormal clone, immune regulation dysfunction, abnormal hematopoiesis concerning with 5q-, ineffective hematopoiesis and iron overload. Erythropoietin (EPO), immunosuppressive agent, iron chelators, immunomodulatory, transforming growth factor beta (TGF- β) pathway inhibitor, demethylation drugs and hematopoiesis stem cell transplantation may help to improve the anemia of different causes in MDS patients. Related Articles | Metrics

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The risk factors and therapeutic strategies of infection in patients with myelodysplastic syndromes TONG Hong-yan 2018, 46 (8):  799-803.  doi: 10.11958/20181155 Abstract ( 1293 )   PDF (384KB) ( 3452 )   Myelodysplastic syndrome (MDS) is a group of malignant clonal neoplasms originated in hematopoietic stem cells. Due to the continuous low peripheral blood leukocytes, the high-risk patients will also receive the treatment of demethylated drug, chemotherapy and hematopoietic stem cell transplantation. MDS are mostly the elderly, and there is a relatively high risk of infection in patients. It is known that the main cause of infection in MDS patients is neutropenia, in addition, the abnormal lymphocyte subgroups, iron overload, older age, and complications are also related factors of infection. Based on these risk factors, to evaluate the risk of infection, to provide early prevention and optimization of anti-infection treatment strategies can ultimately improve the treatment effect and prolong the overall survival time of the patients. Related Articles | Metrics

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Prognostic scoring of myelodysplastic syndromes CHANG Chun-kang, XU Feng 2018, 46 (8):  804-807.  doi: 10.11958/20181021 Abstract ( 1319 )   PDF (336KB) ( 3674 )   Myelodysplastic syndrome (MDS) is a clonal disease derived from the hematopoietic stem cells, with a high degree of heterogeneity and complexity. The prognostic evaluation of MDS is a core problem of this disease, mainly because the complex pathogenesis (genomics, epigenetics, bone marrow microenvironment and immune factors) determines the heterogeneity of clinical characteristics (heterogeneity of age, infection, risk of bleeding, and comorbidities) and differential clinical outcome (bone marrow failure and leukemia transformation). Therefore, how to comprehensively consider various prognostic factors to establish a prognostic score system to predict the prognosis and clinical outcome of patients with MDS is very important. In the past two decades, many MDS scholars have devoted themselves to the study of various MDS prognostic scoring systems. Typical prognostic scoring systems such as the International Prognostic Scoring System (IPSS) and its revisions (IPSS-R) have been widely used. In addition, based on these new prognostic factors, the prognostic scoring system has also showed good prognostic value with the discovery of many clinical markers and molecular changes. This review summarizes the prognostic scoring system and new prognostic factors of MDS in recent years for reference in clinical practice. Related Articles | Metrics

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The clinical significance of gene mutation detection in myelodysplastic syndromes CHEN Su-ning, YU Yan 2018, 46 (8):  808-810.  doi: 10.11958/20181115 Abstract ( 1203 )   PDF (299KB) ( 3696 )    Myelodysplastic syndrome (MDS), a clonal disease that arises from the expansion of mutated hematopoietic stem cells or hematopoietic progenitor cells, is usually characterized by a clinically and biologically heterogeneous group of disorders associated with cytopenias, ineffective hematopoiesis, and a tendency to evolve into acute myeloid leukemia. Currently, the diagnosis of MDS relies mainly on the morphologic and cytogenetic abnormalities. With the advance of the next generation sequencing, genetic mutations have been identified in majority of MDS patients. Here we briefly review the clinical significance of genetic mutations in the diagnosis, classification, risk stratification and treatment of MDS. Related Articles | Metrics

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The interpretation of diagnostic criteria for myelodysplastic syndromes (2017) WANG Hua-quan, YANG Li-yan, SHAO Zong-hong 2018, 46 (8):  811-814.  doi: 10.11958/20180591 Abstract ( 1289 )   PDF (330KB) ( 3694 )    Myelodysplastic syndromes (MDS) comprises a heterogeneous group of myeloid clonal neoplasms characterized by peripheral cytopenia, dysplasia and a variable clinical course with about 30% risk to transform to secondary acute myeloid leukemia (AML). In the past 15 years, diagnostic evaluations, prognostication and treatment of MDS have improved substantially. However, with the discovery of molecular markers and advent of novel targeted therapies, new challenges have emerged in the complex field of MDS. We will summarize the proposed criteria for a classification of pre- MDS conditions as well as a proposed update for minimal diagnostic criteria of MDS in the present article. Related Articles | Metrics

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The characteristics and outcome of Stenotrophomonas maltophilia bacteremia in patients with neutropenia LI Hong-zhao, HAN Yu, WU Yu-hong, FU Rong, QU Wen, XING Li-min, WANG Hua-quan, SHAO Zong-hong 2018, 46 (8):  815-818.  doi: 10.11958/20180198 Abstract ( 1045 )   PDF (341KB) ( 3598 )   Objective To investigate the characteristics and outcome of Stenotrophomonas maltophilia bacteremia in patients with neutropenia. Methods The clinical data of Stenotrophomonas maltophilia bacteremia in patients with neutropenia from January 2006 to December 2016 were respectively analyzed. Results In 32 patients with neutropenia, there were 20 cases with acute leukemia, 7 cases with severe aplastic anemian (SAA), and 5 cases of non-hodgkin lymphoma. All patients had long time to use broad-spectrum antibiotic history. Twenty-one patients had central venous catheters and eleven had peripheral venous catheters in situ. Twenty-five patients were found neutropenia due to chemotherapy, and seven cases with bone failure attributed to SAA. Seventeen patients were dead, and fifteen recovered. Drug susceptibility tests showed multiple drug resistance. Stenotrophomonas maltophilia were partially susceptive to tigercycline, trimethoprim - sulfamethoxazole, levofloxacin, cefoperazone-sulbactam. ceftazidime, minocycline and piperacillin-tazobactam. The severe neutropemia, thrombocytopenia, long duration of granulocyte reduction and polymicrobial infection were the adverse prognostic factors. Conclusion Stenotrophomonas maltophilia bacteremia in patients with neutropenia has a high mortality rate, which needs to timely diagnose and treatment with effective antibiotics. Related Articles | Metrics

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The clinical observation of relapsed or refractory acute myeloid leukemia in patients with high CD117 expression but no FLT3-ITD mutation treated with sorafenib alone XU Jian-hui 1, LIU Xiao-shu2,ZHONG Yu-xia1,HE Ying-zhi 1,DU Jing-wen1,HUANG Yu-xian1,LI Yu-hua1 2018, 46 (8):  819-823.  doi: 10.11958/20180324 Abstract ( 901 )   PDF (368KB) ( 3821 )   Objective To make a primary investigation of outcomes in relapsed or refractory (R/R) acute myeloid leukemia (AML) patients who were FLT3-ITD mutation negative and treated with sorafinib alone. Methods The clinical responses and survival of R/R AML patients who underwent sorafenib treatment only were retrospectively analyzed. The side effects and response results were assessed according to common terminology criteria for adverse events (CTCAE) v 4.0 from US National Institutes of Health and NCCN guideline. Results Four out of seven patients achieved complete remission by sorafenib treatment alone. The median time required for remission was 36 days in the four patients. Among them, only 1 patient stopped the maintenance treatment because of side effect of serious skin lesion. Three patients showed no response to sorafenib, including 2 accepted stem cell transplantation and 1 retrieved to salvage chemotherapy. All of them achieved complete remission later. One patient developed grade 1 adverse event of liver. Another one developed grade 3 skin lesion. All patients experienced neutropenia of more than 7 days without unendurable infections and early deaths. The median follow-up time for the whole cohort was more than 22 months. Three patients passed away for relapse of AML and their disease-free survival time with sorafenib ranged from 2 to 20 months. All four patients accepted stem cell transplantation were still surviving no matter whether or not they were responsive to sorafinib before. The median survival time for these seven patients was 650 days. Conclusion The R/R AML patients with negative FLT3-ITD mutation and high expression of CD117 treated with sorafenib alone have good remission and long term survival. Related Articles | Metrics

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A case report of diffuse large B-cell lymphoma combined with thyroid neoplasms with paraplegia as the clinical manifestation CAO Qiu-ying, NIU Hai-yue, QI Wei-wei, WANG Yi-hao, JIANG Hui-juan, WANG Hua-quan, SHAO Zong-hong 2018, 46 (8):  824-827.  doi: 10.11958/20180509 Abstract ( 1130 )   PDF (637KB) ( 3691 )    Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-hodgkin’ s lymphoma (NHL), which has a wide range in age of onset, and has obvious heterogeneity in clinical features, invasive areas, histomorphology, molecular genetics and immune phenotype. In addition, with the improvement of the diagnosis and treatment of malignant tumor, the report of multiple primary malignant tumors (MPMT) in the same patient is on the rise. This paper reports a case of DLBCL combined with thyroid neoplasms with paraplegia as the clinical manifestation. Related Articles | Metrics

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A case of blastic plasmacytoid dendritic cell neoplasm NIU Hai-yue, CAO Qiu-ying, QI Wei-wei, WANG Yi-hao, JIANG Hui-juan, WANG Hua-quan, SHAO Zong-hong 2018, 46 (8):  828-831.  doi: 10.11958/20180264 Abstract ( 1403 )   PDF (470KB) ( 3715 )    Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematopoietic neoplasm with high malignancy and rapid progression. BPDCN is sensitive to chemotherapy, but it is prone to relapse and drug resistance, and the survival time is short. We report a case of BPDCN hospitalized in our department. In this case, the skin lesions were the first manifestation. The diagnosis of BPDCN was confirmed by the skin biopsy. Initially, this patient was sensitive to the lymphoma chemotherapy but the disease relapsed quickly, spreading to the lungs and mediastinum. Then, we treated the patient with myeloid regimen, which was no efficacy. The patient eventually died with an overall survival of 17 months. Related Articles | Metrics

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Analysis of risk factors of nosocomial infection in hospitalized patients with myelodysplastic syndrome ZHANG Hui-tao, XIAO Hong-wen, LI Xiao-ming 2018, 46 (8):  832-836.  doi: 10.11958/20180952 Abstract ( 843 )   PDF (383KB) ( 3536 )    Objective To investigate the characteristics and risk factors of nosocomial infection in patients with myelodysplastic syndrome (MDS), and to provide a theoretical basis for the prevention and treatment of nosocomial infection in such patients. Methods A total of 226 patients with MDS hospitalized in the Department of Hematology in our hospital from January 2016 to December 2017 were selected as subjects in this study. The retrospective investigation was used to analyze the characteristics and related risk factors in hospitalized patients with hospital infection. Results A total of 52 patients were found nosocomial infection during hospitalization, with an infection rate of 23.01%, 3 cases with double infections, and 2 cases with multiple infections. Among them, 28 cases were found pathogenic bacteria and 15 cases of Gram-negative bacteria (53.6%), 4 cases of blue positive bacteria (14.3%) and 9 cases of fungi (32.1%). Univariate analysis showed that MDS revised international prognostic score (IPSS-R) risk grouping, length of hospital stay, neutrophil count, duration of neutropenia, invasive procedure, albumin content, use of hormones and use of decitabine were closely related to nosocomial infection in hospitalized patients with MDS (P＜0.05). Multivariate Logistic analysis showed that patients with lower prognostic scores for disease IPSS-R, longer hospital stay, low albumin levels, longer duration of granulocytosis, and use of decitabine during hospitalization were the independent risk factors for nosocomial infection (P＜0.05). Conclusion Targeted measures are taken to address the risk of nosocomial infections in hospitalized patients with MDS, which shorten the hospital stay, and can reduce the incidence of nosocomial infection. Related Articles | Metrics

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The challenge for allogeneic hematopoietic stem cell transplantation in acute leukemia/ myelodyplastic syndrom with TP53, TET2 or DNMT3A gene mutations ZHANG Rui 1,LIU Dai-hong2△ 2018, 46 (8):  837-841.  doi: 10.11958/20181109 Abstract ( 3977 )   PDF (368KB) ( 3727 )   Recently, much gene mutations have been detected in patients with acute leukemia or myelodysplastic syndrome (MDS) using next-generation sequencing (NSG) technology. Some of them are proved to be important prognostic markers. It has been showed that TP53, TET2 or DNMT3A gene mutations are associated with poor prognosis in acute leukemia or MDS patients. The prognosis of these patients is poor with short remission and survival. Allogeneic hematopoietic stem cell transplantation is the only way to cure these patients. However, the outcomes after transplantation are inferior to those in patients without these mutations. The hypomethylating agents or immune targeting therapy might improve their prognosis when combined with the present strategies. Here, the impact of TP53, TET2 and DNMT3A gene mutations on the prognosis after chemotherapy or transplantation is reviewed. Related Articles | Metrics

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Bone marrow microenvironment and myelodysplastic syndrome LYU Yang-yang, ZHAO Zhi-gang 2018, 46 (8):  842-846.  doi: 10.11958/20180778 Abstract ( 1105 )   PDF (342KB) ( 3548 )    The myelodysplastic syndrome (MDS) is a heterogeneous group of clonal disorders originating from hematopoietic stem cells (HSC), characterized by unilineage or multilineage dysplasia of myeloid cells, ineffective hematopoiesis, peripheral blood cytopenias and high risk of transform into acute myeloid leukemia (AML). The pathogenesis, hematopoietic function change and prognosis of MDS are closely related to the bone marrow microenvironment. Bone marrow microenvironment is a complex network system, among them, stromal cells including abnormal morphology and function of mesenchymal stem cells, impaired osteoblast differentiation, increased number of vascular endothelial cells, and decreased number of monocytes /macrophages can promote the pathogenesis of MDS. The abnormal expression of cytokines such as tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1 (SDF-1) are also closely related to the pathogenesis of MDS. Low expression of genes such as Dicer1, high expression of AURKA, and low expression of SPINT2 all contribute to the pathogenesis of MDS. Aberrant activation of Wnt/β-catenin signaling pathways, abnormal PI3K/AKT and Hh signaling pathways are also involved in the pathogenesis and progression of MDS. The study of the interaction between MDS and bone marrow microenvironment will further elucidate the pathogenesis, progress and prognosis of the disease, and will contribute to the development of targeted therapy. This review provides the research progress of bone marrow microenvironment stromal cells, cytokines, genes, and signaling pathway abnormalities in MDS. Related Articles | Metrics

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Preventive and therapeutic mechanism of ginkgo biloba extract on liver injury poisoned by xylene MI Hong-mei 1,ZHANG Na2,LIU Ning1 2018, 46 (8):  847-851.  doi: 10.11958/20180136 Abstract ( 945 )   PDF (692KB) ( 3773 )    Objective To investigate the potential effect and molecular mechanism of ginkgo biloba extract (GBE) on the expression of inflammatory factors in liver tissue of mice poisoned by xylene. Methods A total of 30 clean grade healthy Kunming mice were randomly divided into normal control group, model group and ginkgo biloba extract intervention group (GBE group). Mice of three groups were granted free access to food and water. The concentration of xylene inhalation was 110-130 mg/m3 (the air samples were collected in the box, and the gas chromatogram was measured by direct injection method) in model group and GBE group. The mice in control group inhaled air. GBE group was intraperitoneally injected with 50 mg/(kg·d) of GBE. Control and model groups were intraperitoneal injected with same amount of normal saline. After 8 weeks, mice were sacrificed, and serum and liver tissues were retained. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP) and glutamyl transpeptidase (GGT) were measured. Haematoxylin and Eosin staining was used to observe pathological changes of liver tissue. RT-PCR and Western blot assay were used to detect the expression levels of nuclear factor kappa B (NF-κB), tumor necrosis factor alpha (TNF-α) mRNA and protein in liver tissue. Results Compared with the control group, the liver tissue was damage seriously in the model group. The blood biochemical indexes (ALT, AST, TBIL, ALP and GGT) were significantly increased (P＜0.05), and the NF-κB, TNF-α mRNA and protein were significantly increased in the model group (P＜0.05). Compared with the model group, the liver tissue damage was reduced, the blood biochemical indexes (ALT, AST, TBIL, ALP and GGT) were significantly decreased (P＜0.05) and the NF-κB, TNF-α mRNA and protein were significantly down-regulated in the GBE group (P＜0.05). Conclusion Ginkgo biloba extract can reduce hepatic inflammatory response of mice poisoned by xylene through inhibiting the expression of NF-κB and TNF-α inflammatory factors. Related Articles | Metrics

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The expression of microRNAs in mice with myocardial infarction and the evaluation of cardiac function after intervention WEI Li-ping1,QI Xin1,SUN Xu-sen2,ZHANG Yu-fan2 2018, 46 (8):  851-855.  doi: 10.11958/20180437 Abstract ( 898 )   PDF (623KB) ( 5111 )    Objective To detect the expressions of miRNA - 1 and miRNA - 21 and to investigate the relationship between myocardial remodeling and changes of myocardial function. Methods The myocardial infarction model of mice were prepared. Seventy-two model mice were divided into model group (MI group), intervention group 1 (miRNA-1 blocker was injected into infarct area) and intervention group 2 (miRNA-21 lentivirus carrier was injected into infarct area), 24 mice for each group. The ultrasonic instrument was used to measure the cardiac function indexes of the myocardial infarction model and evaluate the degree of cardiac function and ventricular remodeling. Fluorescence quantitative PCR was used to detect the expressions of miRNA -1 and miRNA-21. Results The expression of miRNA-1 was elevated at 4 weeks after MI, and reached the highest expression level at 12 weeks. The expression of miRNA-1 was decreased in all periods after the injection of miRNA-1 antagonist. MiRNA-21 showed a slight increase in 4 weeks after MI, followed by a decreasing trend. After injection of miRNA– 21 lentiviral vectors, the elevated miRNA-21 expression was obtained at various times. After injection with miRNA-1 antagonist, LVDD and LVmass showed improvement in 8 weeks and 12 weeks after MI. LVEF was significantly improved in 8 weeks and 12 weeks. MiRNA-21 lentiviral vectors were injected, and LVDD was reduced in 12 weeks. LVmass and LVEF were significantly improved in 12 weeks after MI. Conclusion In the process of myocardial infarction, miRNA-1 and miRNA-21 are involved in the regulation of heart failure and ventricular remodeling. Related Articles | Metrics

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Identification of prognostic eight-gene signature model in breast cancer using integrated TCGA database JIA Xiao-chen, JIA Yong-sheng, MENG Wen-jing, TONG Zhong-sheng 2018, 46 (8):  856-861.  doi: 10.11958/20180258 Abstract ( 1547 )   PDF (444KB) ( 3809 )   Objective To establish a multi-gene prognostic model for predicting the prognosis of breast cancer using Cancer Genome Atlas (TCGA) database, and to analyze the relationship between the multi-gene prognostic model and clinical and pathological features of breast cancer. Methods The mRNA data and clinical information of breast cancer cohort were downloaded from TCGA database. Differentially expressed genes (DEGs) were identified by R language software in breast cancer tissues and normal tissues. DEGs related to overall survival of patients were selected by univariate Cox regression model, and a multi-gene signature model was identified by multivariate Cox regression model. Patients were divided into high risk cohort and low risk cohort according to prognostic index calculated by prognostic index formula based on the result of multivariate Cox regression model. Factors were analyzed by univariate and multivariate Cox regression models according to clinicopathological characteristics and prognostic index related with survival of patients with breast cancer. Survival analysis of subgroups was conducted according to age, estrogen receptor status, Her-2 receptor status, lymph node status and pathological stage. Kaplan-Meier（K-M）survival analysis was used to evaluate the prognostic prediction of the multi-gene signature in overall patients and subgroups. Results Eight DEGs were selected to conduct a survival related multi-gene signature from total of 2 142 DEGs in univariate and multivariate Cox regression model analysis including CEL， POU3F2， CYP24A1， FABP7， MURC， GCCR， LRP1B and PRSS2. Prognostic index formula was as follows： PI=0.156 × the expression of CEL + 0.112 × the expression of POU3F2-0.071 × the expression of CYP24A1-0.065 × the expression of FABP7+0.135×the expression of MURC-0.201×the expression of GCGR-0.063×the expression of LRP1B- 0.090×the expression of PRSS2. Cox regression model analysis demonstrated that age, pathological stage and eight-gene signature were validated as the novel and independent prognostic factors (P＜0.05). According to survival analysis (K-M plot), the accurate prognostic performance of eight-gene signature was confirmed in both overall patients and subgroups (except Ⅳ stage). Patients with low risk of prognostic score showed significantly longer OS compared with patients of high risk of prognostic score (P＜0.01). Conclusion The eight-gene prognostic signature can be used to predict the prognosis of breast cancer patients. It is verified in the subgroup of breast cancer according to the clinicopathological features, which is helpful to further guide the clinical treatment. Related Articles | Metrics

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A controlled study of active application morphine in the treatment of idiopathic pulmonary fibrosis SONG Zhong-hua1,ZHANG Jin-qing 2, SHU Shu-miao3,GAO Wei 4 2018, 46 (8):  861-864.  doi: 10.11958/20180133 Abstract ( 967 )   PDF (361KB) ( 3953 )    Objective To investigate the efficacy and safety of active application morphine in the treatment of idiopathic pulmonary fibrosis (IPF) with dyspnea. Methods A total of 33 IPF patients with severe dyspnea were enrolled in this study. They were divided into the observation group (16 cases) and the control group (17 cases) according to the order of admission. The control group received respiratory support, glucocorticoids and other conventional treatment, in the whole course of hospitalization, the observation group was treated with low dose of morphine 1 mg subcutaneous injection three times a day on the basis of control group. The visual analogue scale (VAS) score was recorded at different time points after admission. The length of hospital stay, the number of acute dyspnea, cumulative glucocorticoid dose and adverse reactions were recorded and compared between the two groups. Results There was no significant difference in VAS score in patients on admission between two groups. The VAS scores were significantly lower four days after admission, 2 days before discharge and at discharge in observation group than those of control group (P < 0.05). There was no significant difference in the length of hospital stay between two groups (P＞0.05). The number of acute dyspnea and cumulative glucocorticoid dose were significantly decreased in observation group than those of control group (P < 0.05). No adverse reactions related to respiratory depression were found in two groups. There were more patients with constipation symptoms in the observation group than those of control group. The nausea ratio was smaller in the observation group than that in the control group (P＜0.05). Conclusion The active application of morphine therapy can help to relieve dyspnea symptoms in IPF patients, and it is safe and effective. Related Articles | Metrics

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Comparison with different scoring system for preoperative nutritional status of gastric cancer patients with pyloric obstruction YANG Dong, ZHENG Zhi-chao△, ZHAO Yan, ZHANG Tao, LIU Yong 2018, 46 (8):  865-868.  doi: 10.11958/20171278 Abstract ( 817 )   PDF (373KB) ( 3383 )    Objective To compare patient generated subjective global assessment (PG-SGA) and nutritional risk screening table (NRS2002) scoring systems in preoperative nutritional status assessment of patients with advanced gastric cancer and pyloric obstruction. Methods A total of 114 patients from the Department of Gastric Surgery of the Liaoning Cancer Hospital were selected between July 2016 and July 2017. All patients were confirmed gastric cancer with outlet obstruction by gastroscopy and histopathology. All patients were treated with PG-SGA, NRS2002 scoring systems were used to assess the preoperative nutritional status. The serum albumin <30 g/L was used as the gold standard for the diagnosis of malnutrition. The receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of PG- SGA and NRS2002 scoring systems in patients with preoperative evaluation of nutritional status of gastric cancer with pyloric obstruction. Results Eighty cases (70.1%) were diagnosed as malnutrition by serum albumin in 114 patients. The area under the PG-SGA curve (AUC) was 0.858 and NRS2002 was 0.706. The sensitivity of PG-SGA to preoperative diagnosis of malnutrition in patients with advanced gastric cancer and pyloric obstruction was 88.75%, NRS2002 was 77.50%, the specificity of PG-SGA was 85.29%, and NRS2002 was 76.47%. Conclusion The PG-SGA scoring system is more suitable for the assessment of preoperative nutritional status in patients with advanced gastric cancer and pyloric obstruction, and has a high diagnostic efficiency. Related Articles | Metrics

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Clinical application of dual energy CT imaging and IL-1β in diagnosis of gout WU Chun-ye1,GONG Bao-qi 2, QU Jin2,LI Wei 2 2018, 46 (8):  869-872.  doi: 10.11958/20180234 Abstract ( 765 )   PDF (483KB) ( 3483 )   Objective To study the value of dual energy computed tomography（DECT）imaging and serum interleukin-1β (IL-1β) levels in the diagnosis of gout. Methods A total of 76 patients with gout treated in immunity department of Tianjin First Center Hospital from June 2015 to June 2016 were included in this study (gout group). Another 40 non-gout patients including 33 cases with rheumatoid arthritis and 7 cases with osteoarthritis were served as control group. DECT were used to detect the damaged joints of patients, and confirm the number and the position of uratecrystal. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of IL-1β in two groups. Receiver operating characteristic (ROC) curves of IL-1β were plotted to determine the area under the curve (AUC) and the best cut- off value. Results DECT scan found 349 lesions with urate deposition, mainly located at the first metatarsophalangeal joint (n=245). Five false-positive patients were detected in control group, in which 3 were perionychia pseudoshadow and 2 were foot pad pseudoshadow. The sensitivity and specificity of DECT were 100% and 87.5%, while which of IL-1β were 65.7% and 90.0%. The sensitivity and specificity of combined detection DECT and IL-1β were 100% and 95.0%. The AUC measured by IL-1β was 0.929 (0.882-0.977), and the best cut-off value of the indicator was 5 ng/L. Conclusion DECT combined with serum IL-1β detection can help for the early diagnosis of gout, and accurately location of uric acid， which has high clinical value. Related Articles | Metrics

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Novel FOXG1 mutation in a patient with congenital Rett variant: a case report NIU Yan1,ZHAO Peng1, CAI Chun-quan2,SHU Jian-bo3 2018, 46 (8):  873-877.  doi: 10.11958/20180421 Abstract ( 2831 )   PDF (683KB) ( 4211 )    Objective To summarize the clinical features of children with congenital Rett variant caused by mutation of FOXG1 and provide the reference for the diagnosis and treatment of the disease. Methods The clinical data of a patient diagnosed as congenital Rett syndrome variant type were summarized. The DNA samples of peripheral blood from the patient and her parents were extracted. The targeted high-throughput sequencing technology was used to detect the sequence of targeted genes, which were associated with the symptoms of the child. Genes were then verified by sanger sequencing. Chromosomal microarray analysis was performed to detect chromosome microdeletions and microduplications. Results The child carried the c. 506dupG, p.G169Gfs ＊ 286 heterozygous mutations on FOXG1 gene, which located in 14q12, and her parents were wild-type. After querying the HGMD, Clinvar and dbSNP databases, we found that it was not reported. This case was clearly diagnosed as congenital Rett syndrome variant type. We confirmed that the mutation locus was a new mutation. Conclusion For cases with congenital Rett variant manifestations, FOXG1 gene mutation examination is recommended, and preventive treatment of partially predictable dysfunction should be carried out. Related Articles | Metrics

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A case report of H1N1 severe pneumonia treated with mechanical ventilation in the prone position LIU Dong， ZHI Yong-le， QIN Ying-zhi 2018, 46 (8):  877-880.  doi: 10.11958/20180433 Abstract ( 768 )   PDF (851KB) ( 3770 )    Acute respiratory distress syndrome (ARDS) is an acute respiratory failure characterized by progressive respiratory dyspnea and intractable hypoxemia caused by various causes both inside and outside the lungs. At present, there is still controversy about the monitoring of prone position（PP）ventilation in patients with severe hypoxemia. This article summarized a case of severe ARDS with type A H1N1 severe pneumonia treated with PP ventilation to improve oxygenation, so as to provide reference for clinical treatment. Related Articles | Metrics

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Experience in the extraction and culture of neural stem cells WU Zeng1,DONG Xian-hui 2,LI Yuan1,JIN Xiao-fei 2,ZHOU Xiao-hong2,GAO Wei-juan2 2018, 46 (8):  881-885.  doi: 10.11958/20180440 Abstract ( 1084 )   PDF (455KB) ( 3656 )    There are many ways to extract and culture neural stem cells in vitro, but the viability and stability of neural stem cells obtained by different methods are different. By thinking about the process of extracting and culturing neural stem cells in vitro from the cerebral cortex of SD fetal rats, we summarized extraction steps, the main points of extraction, the selection basis of culture medium, selection of inoculation density, cultural method, methods of solution changing, passage time and passage methods. At last a large number of neural stem cells with high vitality and stability have been obtained and applied to the basic research of neural stem cells. Related Articles | Metrics

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Risk factors and prophylaxis of acute endophthalmitis after cataract surgery HUA Xia1,SU Long1,TANG Xin2,YUAN Xiao-yong2 2018, 46 (8):  886-890.  doi: 10.11958/20180521 Abstract ( 1034 )   PDF (375KB) ( 4153 )   Acute endophthalmitis after cataract surgery is a very serious surgical complication. Although its incidence is low, the consequences are very serious, which have been reported in many parts of the world. A variety of factors participate in its occurrence. Reasonable prevention, early clear diagnosis, and active treatment are the key to achieve good prognosis. This review summarized the recent literatures about the epidemiology, pathogen, risk factors and prevention for acute post- operative endophthalmitis. Related Articles | Metrics

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Progress in study on placenta-specific microRNAs and the pathogenesis of preeclampsia LIU Jiao1,2,LIU Guo-long2,GUO Zheng-chen2,ZHANG Yun-shan3 2018, 46 (8):  890-893.  doi: 10.11958/20180189 Abstract ( 811 )   PDF (333KB) ( 4043 )   Preeclampsia, one of the pregnancy specific diseases, is a leading cause of new onset hypertension and proteinuria after 20 weeks. The preeclampsia pathogenesis includes abnormal placentation and maternal inflammatory response. MicroRNAs are a kind of non-coding RNAs that induce post-transcriptional suppression of target gene expression. In biomedical research, microRNAs can be used as the potential biomarkers to assess the development and prognosis of diseases. Whether the abnormal expression of placental-derived microRNAs is closely related to the occurrence and development of preeclampsia is still controversial. This article reviews the relationship between placental microRNAs and pathogenesis of preeclampsia. Related Articles | Metrics

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The progress in treatment of osteoporotic tibial plateau fracture SUN Jie, BU Guo-yun, ZHANG Jin-li 2018, 46 (8):  894-899.  doi: 10.11958/20180699 Abstract ( 920 )   PDF (413KB) ( 4029 )    There are more osteoporotic fractures with the increasing aging population in China. Tibial plateau factures are intra-articular fractures, and most of which require surgical treatment. The surgical treatment of osteoporotic tibial fractures is more challenging because of the decrease in bone mineral density. The failure rate of traditional plate in the treatment of osteoporotic tibial plateau fractures is very high. The locked plate and bone strengthening technique can significantly reduce the failure rate of the surgery. With the renewal of treatment concept, intramedullary nailing technique, tibioplasty and total knee arthroplasty are applied in the initial treatment of osteoporotic tibial plateau fractures. Related Articles | Metrics

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Study on mechanism of invasion and metastasis of pancreatic cancer CHEN Xiao-yan1,JIA Jian-xin2 2018, 46 (8):  899-904.  doi: 10.11958/20180156 Abstract ( 767 )   PDF (396KB) ( 3668 )   Pancreatic cancer is a kind of malignant tumor with extremely high mortality rate, and its onset is insidious and it develops rapidly. It is very easy to have lymphatic node and liver metastasis in early stage. At present, the research on the mechanism of invasion and metastasis of pancreatic cancer is getting deeper. This review summarized mainly by miRNAs, non encoded RNAs, hypoxia and epidermal growth factor (EGF) and its receptors, CXCL12 and FOXM1, DCLK1 protein molecules, which played the role in invasion and metastasis of pancreatic cancer. They act on target genes or related signaling pathways to promote cell proliferation, inhibit cell apoptosis and promote angiogenesis and EMT in tumor cells. They also alter tumor cell metabolism, which is closely related to malignant progress, invasion and metastasis in the pancreatic cancer. Related Articles | Metrics