Assessing the CT findings and clinical course of ED patients with first-time versus recurrent acute pancreatitis

Study objectives

The primary objective of this study was to compare Emergency Department patients with first-time versus recurrent acute pancreatitis.

芪参补气胶囊治疗稳定期慢性阻塞性肺疾病肺气虚证的疗效观察

目的：探索芪参补气胶囊治疗稳定期慢性阻塞性肺疾病（COPD）肺气虚证的临床疗效与安全性。方法：选取2017年10月16日至2018年11月20日在新疆维吾尔族自治区克州人民医院呼吸内科门诊随诊的COPD稳定期肺气虚证患者480例作为研究对象，随机分为观察组和对照组，每组240例，进行为期52周的观察。2组患者均给予健康指导、家庭氧疗、沙美特罗替卡松粉吸入剂、竹沥胶囊等基础治疗；对照组在基础治疗上给予玉屏风胶囊口服，2粒/次，3次/d；观察组在基础治疗上给予芪参补气胶囊口服，3粒/次，3次/d。观察比较2组患者的相关指标。结果：观察组平均急性加重次数（1.62±0.93）次，对照组（1.83±0.97）次，观察组发作次数显著减少（t=2.262，P=0.012）。观察组相对于对照组的急性加重风险RR=0.869（0.763~0.988，P=0.032），降低了13.1%。伴有咳嗽、喘息、便秘或吸烟的患者，观察组急性加重风险更低（P<0.05）。观察组CAT评分、FEV1显著优于对照组（P<0.05）。观察组炎性反应指标（TNF-α、IL-6、IL-8）改善情况显著优于对照组。观察组不良事件发生率显著低于对照组。结论：芪参补气胶囊与玉屏风散均具有良好的提高免疫功能，改善COPD属肺气虚证者咳痰喘症状的作用。其中芪参补气胶囊减少急性加重风险的效果较玉屏风胶囊更好，且安全性良好，值得推广使用。     

伞骨草利尿抗炎活性及急性毒性研究＊

目的 研究伞骨草水提物的利尿和抗炎作用，以及利尿后对电解质平衡、糖代谢及肾脏功能的影响，并对伞骨草水提物安全性进行初步评价。方法 采用小鼠代谢笼法，检测盐水负荷小鼠在给药6 h后的排尿量，并分析小鼠尿液中离子浓度、血清中糖原、尿素氮和肌酐的变化；采用二甲苯致小鼠耳廓肿胀法，计算耳廓肿胀度及肿胀抑制率，角叉菜胶致大鼠足趾肿胀法，计算足趾肿胀率，小鼠急性毒性试验初步评价伞骨草水提物的安全性。结果 与对照组比较，伞骨草水提物能明显增加小鼠的排尿量，尿液中K⁺、Cl^-的浓度明显增加，高剂量组Na⁺、Ca²⁺浓度明显增加；伞骨草对小鼠血清中的糖原、尿素氮和肌酐均无明显影响；伞骨草中、高剂量对二甲苯所致小鼠耳廓肿胀和角叉菜胶所致大鼠足趾肿胀具有明显的抑制作用；伞骨草水提物24 h内小鼠单次灌胃给药急性毒性试验的LD₅₀为：12.33 g·kg^-1（相当于生药82.15 g·kg^-1），动物在4 h内出现毒性反应，主要表现为主要表现为腹泻、俯卧、竖毛、运动失调、死亡，腹泻至给药第2天恢复。结论 伞骨草水提物具有明显的利尿和抗炎作用，并且对机体的血糖水平和肾脏功能无明显影响。     

A novel prognostic scoring model for newly diagnosed FLT3-ITD-positive acute myeloid leukemia

FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) is one of the most common somatic mutations in acute myeloid leukemia (AML). However, the molecular structure characteristics and widely accepted prognostic factors for FLT3-ITD are still not well described. This study aimed to retrospectively examine 81 patients with FLT3-ITD-positive AML diagnosed and treated at the First Affiliated Hospital of Zhejiang University from December 2013 to March 2018 using the next-generation sequencing 185-gene platform. High variant allele frequency (VAF) [> 0.48, P = 0.0089 for overall survival (OS), P = 0.13 for relapse-free survival (RFS)], multiple ITDs (> 1 ITDs, P = 0.011 for OS, P = 0.033 for RFS) and longer insertion length (> 69 bp, P = 0.14 for OS, P = 0.0078 for RFS) predicted poor survival. The study further proposed an easily applicable scoring model for OS using the Least Absolute Shrinkage and Selector Operation (LASSO) Cox regression model. Also, an independent cohort of 30 patients was used for external model validation. The mode was expressed as follows: 0.659 × FLT3-ITD VAF + 0.375 × FLT3-ITD number + 0.807 × Age + 0.688 × DNMT3A + 1.939 × U2AF1 (FLT3-ITD VAF > 0.48 scored 1; FLT3-ITD number scored 1 if carried 1 ITD, 2 if carried ≥ 2 ITDs; age > 44 years scored 1, the presence of DNMT3A or U2AF1 scored 1; 0 for other conditions). It categorized patients into low-risk (L-R, score < 1, n = 20) and high-risk (H-R, score ≥ 1, n = 61) groups based on the risk score with a significant difference in survival (3-year OS, P < 0.0001; 3-year RFS, P = 0.0005). A prognostic nomogram that integrated these five factors was developed with a concordance index calculation [OS: 0.68, 95% CI (0.64-0.72)].     

丁苯酞对急性缺血性脑卒中患者淋巴细胞亚群的影响研究

目的 探讨丁苯酞对急性缺血性脑卒中患者淋巴细胞亚群变化情况的影响。方法 选取2017年1月～2018年12月期间在本院就诊的99例急性缺血性脑卒中患者,分为对照组(n=48)和研究组(n=51),对照组接受常规治疗,研究组在常规治疗基础上联合使用丁苯酞软胶囊。于治疗前后测定淋巴细胞亚群变化情况,同时对脑梗死面积、Barthel指数、美国国立卫生研究院脑卒中量表(NIHSS)评分进行比较,计算不良反应发生率。结果治疗后两组CD3+、CD4+、CD4+/CD8+水平较治疗前明显上升(P0.05),且治疗后研究组CD3+、CD4+、CD4+/CD8+水平明显高于对照组(P0.05);治疗后两组脑梗死面积较治疗前均明显变小(P0.05),Barthel指数评分较治疗前均明显增大(P0.05),NIHSS评分较治疗前均明显减小(P0.05),且治疗后研究组脑梗死面积小于对照组(P0.05),Barthel指数评分大于对照组(P0.05),NIHSS评分小于对照组(P0.05);研究组不良反应发生率(1.96%)与对照组不良反应发生率(4.17%)比较,差异无统计学意义(P0.05)。结论 急性缺血性脑卒中使用丁苯酞,则CD3+、CD4+、CD8+水平改善程度更加明显,细胞免疫功能恢复良好,缩小脑梗死面积,改善神经功能缺损,恢复日常生活能力,安全性好。     

海莲叶提取物对胃癌细胞增殖的抑制作用及对小鼠急性毒性实验

目的:探究海莲叶提取物对胃癌细胞增殖的抑制作用及对小鼠急性毒性实验。方法:先通过实验证实海莲叶提取物可对患者的胃癌细胞SGC-7091、MGC80-3可起到促进作用,应对实验小鼠皮下建立移植瘤模型,随后对小鼠注射海莲叶提取物,观察对胃癌细胞增殖的抑制情况,随后对药物的毒性进行分析。结果:给药组与溶媒对照组急性毒性反应相比显著较高,差异具有统计学意义(P<0.05)。结论:海莲叶提取物可对胃癌细胞增殖的抑制作用,并均已经在实验中得到了证实,海莲叶提取物可明显降低小鼠的急性毒性反应。     

Analysis of the role of palmitoleic acid in acute anterior uveitis

PurposeTo study the role of palmitoleic acid (PA) in the pathogenesis of acute anterior uveitis (AAU).MethodsPA levels in feces from AAU patients were measured by gas chromatography coupled with a mass spectrometer (GC-MS) and compared with samples obtained from healthy individuals. Enzyme linked immunosorbent assay (ELISA) and flow cytometry (FCM) were used to assess the effect of PA on dendritic cells (DCs) and CD4⁺T cells obtained from mice, AAU patients and healthy individuals. C57BL/6 mice were fed with PA or vehicle and experimental autoimmune uveitis (EAU) was induced with a human retinal IRBP651-670 peptide. Disease severity of EAU was evaluated by clinical manifestation and histology. Differentiation of splenic Type 1 helper T cells (Th1) and Th17 cells was evaluated by FCM. Tandem mass tag (TMT)-based proteomics analysis was used to identify differentially expressed proteins following incubation of DCs with PA.ResultsThe fecal concentration of PA was increased in AAU patients as compared with healthy individuals. In vitro, PA promoted apoptosis of DCs and inhibited the secretion of TNF-α from mouse bone-marrow-derived dendritic cells (BMDCs) as well as in DCs from AAU patients and healthy individuals. It only decreased DCs surface marker expression and IL-12p70 secretion in BMDCs and healthy individuals DCs but not in AAU patient DCs. PA-treated BMDCs inhibited Th cell differentiation from mouse naïve CD4⁺T cells and IL-17 and IFN-γ secretion in co-culture supernatants. PA also inhibited the differentiation of Th cells and secretion of IFN-γ and IL-17 in CD4⁺T cells from mice, AAU patients and healthy individuals. In vivo, PA-treated EAU mice showed milder clinical and histopathological intraocular manifestations as compared with the control group. PA feeding inhibited differentiation of splenic Th17 cells, whereas Th1 cells were not affected. Up to 30 upregulated and 77 downregulated proteins were identified when comparing PA-treated DCs with controls.ConclusionAn increased expression of fecal PA was observed in AAU patients. PA was shown to have immunoregulatory effects on DCs and CD4⁺T cells and attenuated disease severity in EAU mice.     

WT1 Expression in Peripheral Blood at Diagnosis and During the Course of Early Consolidation Treatment Correlates With Survival in Patients With Intermediate and Poor-Risk Acute Myeloid Leukemia

BackgroundUp to 55% of non-APL acute myeloid leukemias (AML) lack a molecular target suitable for standardized disease monitoring. We aimed to evaluate the prognostic significance of WT1 gene expression at early stages of intensive treatment.Patients and MethodsA total of 106 consecutive patients with intermediate and high-risk AML who had WT1 expression at diagnosis >500 copies/10⁴ ABL and who achieved remission after 1 to 2 cycles of induction treatment were analyzed. WT1 expression was measured in peripheral blood using a standardized European LeukemiaNet method. Overexpression was defined as >50 copies/10⁴ ABL. The median follow-up was 30 months.ResultsPatients with normal versus high WT1 expression after 2 cycles of chemotherapy had overall survival (OS) at 3 years of 66% versus 41% (P = .01); event-free survival (EFS) 45% versus 22% (P = .01). Prognostic significance of WT1 expression after 2 cycles of treatment was maintained in the group of patients treated with chemotherapy alone without hematopoietic stem cell transplantation in first line treatment (OS 70% vs. 36%, P = .02; EFS 35% vs. 0%, P = .03). Significant prognostic factors for EFS on multivariate analysis were the achievement of molecular remission (<50 copies of WT1) at any time during treatment (hazard ratio [HR] 0.47, P = .04) and increased WT1 expression after 2 cycles of chemotherapy (HR 2.0, P = .03).ConclusionIncreased WT1 expression after 2 cycles of chemotherapy is a negative prognostic factor for survival. WT1 remains a valuable molecular marker in AML without any leukemia-specific mutation, especially if next generation sequencing and/or digital polymerase chain reaction are not routinely available.