急性髓系白血病Kindlins和血管生成素表达研究

本研究旨在探讨不同白血病细胞系、成人急性髓系白血病Ang-1、Ang-2、Tie-2、Kindlin-2、Kindlin-3的表达情况及其意义。采用RQ-PCR方法检测88例AML患者、9例非肿瘤患者(对照组)以及K562、KG-1a、U937、HL-60、Jurkat细胞株中Ang-1、Ang-2、Tie-2、Kindlin-2、Kindlin-3表达水平,分析阳性率及表达水平在AML患者与对照组间的差异,探讨上述5种基因之间及其与AML分型、预后的关系。结果表明,Ang-1,Ang-2,Kindlin-3在K562、KG-1a、HL-60、U937、Jurkat细胞系中均有表达,Tie-2仅表达于KG-1a、HL-60细胞系中,Kindlin-2表达于K562、KG-1a、HL-60中。5种基因均表达于AML患者及对照组中。Ang-1、Ang-2在起病时白细胞计数较高组的表达水平较高(P<0.001,P=0.001),在伴有t(8;21)和t(15;17)的AML患者中表达均较低(P<0.001,P=0.005)。Ang-1在NCCN预后良好组表达较低(P=0.020);Ang-1低表达组完全缓解率(CR)较高(P=0.027)。Kindlin-2在AML患者中表达水平较低(P=0.010),起病时白细胞计数较高组的表达水平较低(P=0.020),伴有t(8;21)和t(15;17)AML的表达均较高(P=0.016),治疗缓解后Kindlin-2及Kindlin-3表达明显升高(P<0.001,P=0.004)。结论:Ang-1与AML不良预后因素相关;Kindlin-2在AML中低表达,与AML良好预后因素相关,可能是一个预后较好的标志。     

EVI1基因阳性急性髓系白血病的临床特点与预后分析

目的探讨EVI1基因阳性急性髓系白血病(AML)患者的临床特点、预后并与EVI1基因阴性AML患者进行比较。方法观察309例AML病例,分析EVI1基因阳性AML患者的临床特征、细胞形态学、融合基因、早期死亡(ED)、CR率、总体生存率(OS)、无复发生存率(RFS)、造血干细胞移植效果等,并与EVI1基因阴性AML患者进行比较。结果 EVI1基因阳性AML患者白细胞数显著增高(P0.05),FAB分型中M4/M5比例偏高(P0.05)。EVI1阳性患者的染色体核型主要为预后较差的11q23(MLL基因阳性)、inv(3)/t(3;3)、-7等重现性染色体异常,而一些预后较好的核型如t(15;17)、t(8;21)、inv(16)发生率较低。EVI1基因阳性AML患者CR率明显低于EVI1基因阴性者(54.3%∶74.1%)(P0.05)。allo-HSCT可明显提高EVI1基因阳性AML患者OS(P0.05)。结论 EVI1基因阳性AML白细胞数高,生存期短,化疗效果差,预后不良。     

长链非编码RNA ITGB2-AS1过表达预测急性髓系白血病的不良预后（英文）

目的:确定ITGB2-AS1在AML患者中的表达水平,并进一步探讨其临床意义。方法:本研究在公共数据集(包括TCGA和GSE63270)中分析ITGB2-AS1表达水平,并使用实时定量PCR(RT-q PCR)在109名AML患者队列中进一步验证。结果:ITGB2-AS1表达水平在两个独立队列中上调(TCGA,P0.05; GSE63270,P0.05),并经本研究纳入的AML患者队列证实(P0.05)。临床上,ITGB2-AS1高表达与较大的年龄(P=0.023)和较低的完全缓解(CR)率(P=0.005)相关。多变量分析发现,高ITGB2-AS1表达是CR率(P=0.027)和总体生存时间(OS)(P=0.011)的独立预后因素,ITGB2-AS1在TCGA数据集(r=0.74,P 0.001)和本研究患者数据中(r=0.881,P 0.001)均与ITGB2表达正相关。高ITGB2表达也与较大年龄(P=0.02)和较低CR率(P=0.020)相关。高ITGB2表达预测更短的OS(P=0.028)。结论:ITGB2-AS1在AML中过表达并预测AML的不良预后。     

长链非编码RNA HOTAIRM1在急性髓系白血病中的表达

目的检测急性髓系白血病(AML)患者骨髓标本中HOTAIRM1的表达水平,探讨其与AML患者临床特征及预后的关系。方法收集117例初治AML患者(包括AML伴PML/RARa患者44例,AML伴AML1/ETO患者19例,其他类型AML患者54例)、10例AML化疗后完全缓解(CR)患者以及23例非恶性血液病患者(对照组)的骨髓液标本,采用实时荧光定量PCR检测各组HOTAIRM1的表达水平,分析其与AML患者临床特征及预后的关系,并进行生存曲线分析;同时常规检测各患者白细胞、血小板、活化部分凝血活酶时间(APTT)、纤维蛋白原和D-二聚体(D-dimer)的表达水平,分析其与HOTAIRM1的相关性。结果与对照组相比,AML伴PML/RARa组、AML伴AML1/ETO组及其他类型AML组HOTAIRM1的表达水平均明显降低(P均0.01);化疗后疗效评价为CR的AML患者较初治时HOTAIRM1的表达水平明显升高(P0.01)。临床参数分析结果表明,年龄60岁的AML患者HOTAIRM1的表达水平明显低于≥60岁患者(P=0.013),此外,在NCCN预后分层中为预后良好组的HOTAIRM1的表达水平明显低于预后中等及预后不良组(P均0.01);经首次诱导化疗后,完全缓解组较部分缓解以及未缓解组HOTAIRM1的表达水平均明显降低(P均0.01)。相关性分析结果表明,HOTAIRM1与白细胞、血小板、APTT、纤维蛋白原呈相关性分析结果表明,HOTAIRM1与白细胞、血小板、APTT、纤维蛋白原呈正相关(r分别为0.308 9、0.280 9、0.286 9、0.519 6,P均0.05),而与D-二聚体呈负相关(r=-0.526 7,P0.01)。生存曲线分析显示,高表达HOTAIRM1患者的总生存时间及无病进展时间较低表达者明显缩短(P0.01)。结论 HOTAIRM1可作为AML患者预后监测指标。     

急性髓系白血病患者131例免疫表型与预后的相关性分析

目的 探讨急性髓系白血病(AML)免疫表型与预后的相关性.方法 采用多色流式细胞术对131例AML患者进行检测,分析其免疫表型与患者年龄、初诊时WBC、PLT和Hb的关系,及其对完全缓解率(CR)的影响.结果 AML患者中髓系抗原表达阳性率最高的是CD13、CD33和髓过氧化物酶(MPO),急性早幼粒细胞白血病(M3)亚型中CD34和HLA-DR表达率较低,淋巴细胞抗原CD19和CD7表达最常见,阳性率分别为15.4%和14.6%.CD7阳性组患者的年龄明显高于阴性组患者年龄(t=-2.27,P＜0.05),CD14阳性组患者的初诊WBC计数明显高于阴性组(Z=-2.284,P＜0.05).131例AML患者的总CR率为56.5%,CD34阳性组(82例)的CR率为45.1%,CD34阴性组(49例)的CR率为75.6%,两组间差异有统计学意义(x2=11.524,P＜0.05).CD34和HLA-DR双阳性组(74例)的CR率为41.9%,单阳性组(38例)CR率为78.9%,双阴性组(19例)CR率为68.4%,3组问差异有统计学意义(Z=-3.492,P＜0.01).CD7、CD19、CD13、CD33、CD38、CD15、CD64、CD14及MPO等抗原表达阳性组和阴性组间CR率的差异无统计学意义(P均＞0.05).多因素回归分析显示,患者年龄大于60岁、初诊时WBC大于50×109/L、PLT大于30×109/L、Hb小于60 g/L以及CD34阳性是低CR率的独立风险因素.结论 AML患者年龄,初诊时WBC、PLT和Hb计数以及CD34表达与CR率有关,免疫表型的检测对于判断AML预后有一定价值,有助于指导临床治疗和判断预后.     

转录因子SOX4在急性髓系白血病中的表达水平及临床意义

目的:研究SOX4基因在急性髓系白血病(AML)中的表达水平及其与临床特征和预后之间的相关性,以探讨其在急性髓系白血病中的作用。方法:采用实时定量PCR方法检测96例初发AML患者及26例健康对照组骨髓白细胞SOX4基因的表达水平,分析其与临床特征、预后之间的相关性。结果:96例AML患者中SOX4的表达水平明显高于健康对照组(P=0.001),在M1-M5各型患者中SOX4基因表达水平无明显差异(P=0.258)。SOX4基因表达水平在不同性别、不同民族的表达情况及化疗1个疗程后缓解与否等临床特征之间无明显差异(P值均 0.05)。AML患者SOX4基因表达水平与白细胞计数、血红蛋白水平、血小板计数、原始细胞比例、网织红细胞计数等实验室指标无明显相关性(P 0.05),其与患者的总生存率OS(P=0.003)及无事件生存率EFS(P=0.023)相关。结论:SOX4基因高表达影响患者的生存率(OS、EFS),推测有可能为AML患者不良预后因素之一。     

初治急性髓系白血病患者MDR1和BAALC基因的表达情况及其与预后的关系分析

目的分析初治急性髓系白血病(AML)患者多药耐药蛋白1(MDR1)和脑和急性白血病胞质(BAALC)基因的表达情况及其与预后的关系。方法选取100例成人初治AML患者为研究对象,均接受蒽环类药物诱导化疗联合阿糖胞苷等治疗,检测MDR1和BAALC基因表达水平,分析其表达水平与AML患者临床特征、遗传学分型、治疗疗效及预后的关系。结果MDR1基因和BAALC基因高、低表达患者白细胞、血红蛋白、血小板等临床特征比较差异不显著(P0.05)。不同染色体危险度分层患者MDR1基因表达水平比较有显著差异(P0.05),BAALC基因表达水平比较无统计学意义(P0.05)。经化疗干预后,MDR1基因高表达患者CR率60.78%显著低于MDR1基因低表达87.76%(P0.05),BAALC基因高表达患者CR率67.31%略低于MDR1基因低表达81.25%,但差异无统计学意义(P0.05)。MDR1基因高、低表达患者中位OS及OS率对比,差异有统计学意义(P0.05);BAALC基因高、低表达患者中位OS及OS率对比,差异无统计学意义(P0.05)。结论与BAALC基因表达相比,初治AML患者中,MDR1基因表达对评估治疗疗效及预后的价值更高,临床可联合MDR1和BAALC基因检测以提高初治AML患者的预测准确性。     

长链非编码RNA SNHG1与儿童急性髓性白血病患病风险及预后的关联分析

目的:评估长链非编码RNA小核RNA宿主基因1(long non-coding RNA small nucleolar RNA host gene 1,lnc-SNHG1)在儿童AML患者中的表达水平与儿童AML患者的临床特征和预后的关联。方法:连续纳入209例儿童AML初治患者并纳入67例进行骨髓活检且年龄、性别与入组患者相匹配的非恶性血液疾病患者作为对照,记录所有儿童AML患者的基线资料。于治疗前采集所有受试者骨髓样本,并用qRT-PCR检测骨髓单个核细胞中lnc-SNHG1的表达水平。评估患者治疗应答并持续随访和计算患者的无事件生存期(EFS)和总体生存期(OS)。结果:儿童AML患者的lnc-SNHG1表达量显著高于对照者(P0.001),其对儿童AML患病风险预测作用的ROC曲线下面积为0.837(95%CI:0.785-0.888),并且lnc-SNHG1高表达与不良的预后危险度分级相关(P=0.004)。此外,lnc-SNHG1高表达与儿童AML患者较低的完全缓解(CR)率相关(P0.001),进一步的多元逻辑回归分析表明,lnc-SNHG1高表达是儿童AML患者不容易达到CR的独立预测因素(P0.001)。此外,与对照者相比,lnc-SNHG1高表达的儿童AML患者EFS时间(P0.001)和OS时间(P0.001)均较短。lnc-SNHG1高表达是儿童AML患者EFS时间(P=0.001)和OS时间(P=0.015)较短的独立预测因素。结论:lnc-SNHG1在儿童AML患者中高表达,并且可以作为患者不良预后的独立预测标记物。     

WT-1 mRNA定量分析在急性白血病移植后微小残留病监测中的意义

目的探讨定量检测Wilms瘤基因1(WT-1)m RNA在急性白血病患者造血干细胞移植后的疗效、预后和预测复发中的价值。方法收集84例经异基因造血干细胞移植的急性白血病患者不同治疗时间的骨髓标本,实时荧光定量聚合酶链反应技术(RQ-PCR)分析WT-1 m RNA表达水平;聚合酶链反应-短串联重复序列法(PCR-STR)分析移植后供体基因嵌合率,并进行统计学分析。结果与AML和ALL治疗前组WT-1表达水平[分别为4.13(0.77,9.26)、0.69(0.16,2.35)]比较,AML和ALL治疗后组[分别为0.51(0.06,0.91)(U=164,P0.01);0.06(0.02,0.10)(U=315,P0.01]、缓解组[分别为0(0,0.06)(U=0,P0.01);0(0,0.03)(U=0,P0.01)]表达水平均明显下降。与缓解组相比,AML复发组[3.35(2.46,5.63)(U=0,P0.01)]、ALL复发组[2.46(2.17,3.31)(U=0,P0.01)]WT-1表达水平均明显上升。15例复发患者,在临床确诊复发前的WT-1水平明显升高。移植患者WT-1水平与供体基因嵌合率呈负相关(r=-0.73,P0.05)。结论 WT-1m RNA定量分析可用于监测经造血干细胞移植急性白血病患者的微小残留病灶,评估疗效、预后及预测疾病复发风险。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。