复合式教学在中西医结合诊疗血液病临床教学中的应用分析

现代研究进展迅速,中医对血液病的认识也逐渐完善。相比较于单纯西医治疗,中西医结合治疗血液病在增效减毒、克服耐药等方面具有明显优势,强化现代中西医结合诊疗血液病的思维培养和临床实践十分必要。传统授课法在血液病教学上存在课时少、内容粗浅等弊端,转换教学模式是现代医学发展的必然趋势,南方医院中医科在血液病临床教学中,采取以问题为基础的教学法结合以团队为基础的教学法,实行中医特色的师带徒等方式,同时开展线上教学。多种模式结合的复合式教学,充分调动学生积极性及主动性,提高了教学效果。     

The characteristics and prognostic significance of the SET-CAN/NUP214 fusion gene in hematological malignancies: A systematic review

Background:The SET-CAN/NUP214 fusion gene resulting from chromosomal del(9)(q34.11q34.13) or t(9;9) (q34;q34) has been found in T-cell acute lymphoblastic leukemia (T-ALL), B-cell acute lymphoblastic leukemia (B-ALL), acute myeloid leukemia (AML) and myeloid sarcoma (MS). Furthermore, the SET-CAN/NUP214 fusion gene has been found in the T-ALL cell line LOUCY and the AML line MEGAL. The common features of these cases are insensitivity to chemotherapy and poor prognosis. We reviewed the characteristics and prognostic significance of the SET-CAN/NUP214 fusion gene in hematological malignancies.Methods:This systematic literature search was conducted using the PubMed, Web of Science, Embase, and Cochrane Library databases. With the inclusion and exclusion criteria, we summarized all of the papers and performed a statistical analyses.Results:In general, the SET-CAN/NUP214 fusion gene is very rare in adult acute leukemia, more frequently found in T-ALL than in other types of leukemia, and more often in males. Flow cytometry data indicated that the markers CD34, CD33, CD13, and CD7 were common in SET-CAN/NUP214 positive acute leukemia, including ALL. Fluorescence in situ hybridization and arrays are important methods for detecting the fusion gene in newly diagnosed patients and can detect chromosomal del(9)(q34) will be detected. The chromosomal karyotype may be normal or complex, and, in terms of survival analysis, transplantation results in a better prognosis than chemotherapy alone.Conclusions and implications of key findings:The presence of SET-CAN/NUP214 fusion gene may be a Minimal Residual Disease of early recurrence, and it might be a poor indicator of outcome.Limitations:The mechanism, clinical characteristics, therapy and prognosis of the SET-CAN/NUP214 fusion gene in hematological malignancies require further research.     

The effects of pulp and paper mill effluent on physiological and hematological endpoints in fingerling largemouth bass (Micropterus salmoides)

The purpose of this study was to evaluate the effects of bleached kraft mill effluent on selected physiological and hematological endpoints in fingerling largemouth bass (Micropterus salmoides). Fish were exposed for 35 days to surface water collected at sites up- and downstream from a pulp and paper mill treatment-effluent discharge. The condition factor, spleen somatic index, and pronephros cellularity were statistically significantly decreased in fish exposed to the downstream site, compared to the upstream site. There was also a shift from lymphocytes to neutrophils in peripheral blood of fish exposed to the downstream site. Hematocrit values and the liver somatic index were statistically significantly increased in fish in the downstream exposure. These results indicate that in-stream exposure to elemental-chlorine-free pulp and paper mill effluents produce a generalized stress response, leading to potential immunosuppression in fish.     

A novel role for the marrow microenvironment in initiating and sustaining hematopoietic disease

Background: The marrow microenvironment is composed of a complex network of cells and extra cellular matrix that cooperate to regulate normal hematopoiesis. There is growing evidence that microenvironmental defects can contribute to the pathogenesis of hematological malignancies. Objective/methods: We review the role of the microenvironment in inducing and sustaining hematological malignancies. Results/conclusions: Two basic mechanisms could explain the role of microenvironmental defects in the evolution of hematopoietic neoplasms. There is significant data to support the first mechanism, in which the malignant hematopoietic clone induces reversible functional changes in the microenvironment that result in improved growth conditions for the malignant cells. More recent studies from mouse models have indicated that a second mechanism involving primary microenvironmental defects can also result in malignancy.     

Oncolytic Virus Therapy with HSV-1 for Hematological Malignancies

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Distribution of complete blood count constituents in gestational diabetes mellitus

Background (Trial Design):The incidence rate of gestational diabetes is high. In the long run, it harms the health of both the mother and child. In order to understand the distribution of hematological cells with gestational diabetes mellitus (GDM), a longitudinal cohort study was conducted from 2012 to 2018.Methods:A longitudinal case control study of 1860 pregnant women was conducted between 2012 and 2018. Data of hematological parameters at 11 time points of gestational stage were obtained from a laboratory database. Repeated measures analysis and independent t-test were used to analyze the effect of the hematological parameters on GDM.Results:The trend of blood cells fluctuated with gestational age in normal controls but was more remarkable in GDM. Compared with the controls, blood neutrophils, lymphocytes, and monocytes augmented in the second trimester but decreased in the third trimester; platelet (PLT) and thrombocytocrit increased throughout the three trimesters, and red blood cell (RBC) was abundant in the last 2 trimesters in GDM.Conclusions:Peripheral blood leukocytes, platelets, and erythrocytes were significantly different during gestation between GDM and normal controls. Inflammation may also be involved in GMD.     

A COMPARATIVE STUDY OF T-CELL DEPLETED AND NON-DEPLETED MARROW TRANSPLANTATION FOR HEMATOLOGICAL MALIGNANCY

Sixteen patients with hematological malignancy received cyclophosphamide (120 mg/kg), fractionated total body irradiation (12 Gy), oral cyclosporin, and an HLA-identical sibling marrow transplant depleted of T cells by incubation with the monoclonal antibody anti-HuLy-m1 (CD2) and rabbit complement with (five patients) or without (11 patients) anti-HuLy-m8 (CD8). These 16 patients were compared historically to 84 patients with hematological malignancy receiving cyclophosphamide (120 mg/kg), fractionated total body irradiation (12 or 14 Gy), oral cyclosporin, and unmanipulated HLA-identical sibling marrow, for parameters of engraftment and graft-versus-host disease (GVHD). Graft failure occurred in one of the 16 T-cell depleted recipients and in one of the 84 non-depleted recipients. Engraftment was slightly but significantly slower in the T-cell depleted group and bacterial infections significantly more, frequent and severe than in the unmanipulated group. There was a suggestion that the severity of acute GVHD was reduced in those receiving T depleted marrow. Randomized trials will be necessary to determine if marrow T-cell depletion results in superior long-term leukemia-free survival.     

Ultrastructural Characteristics of Bone Marrow in Patients with Hematological Disease: A Study of 13 Cases

There are few transmission electron microscopic studies on bone marrow biopsies of patients with hematological disease owing to the difficulty of overcoming the artifacts of decalcification. Following the fixation of bone marrow biopsies thoroughly before a mild decalcification procedure, ultrastructural studies were performed on 13 patients with varied hematological diseases. Notable features included blood cell disorganization, fibroblast activation, myofibroblast transformation, as well as accumulation of collagen and extracellular amorphous matrix. In addition, excessive blood cell death in leukemia, apoptosis, and macrophage phagocytosis in myelodysplastic syndrome and polycythemia vera, as well as degranulation of eosinophils and megakaryocytes in chronic idiopathic myelofibrosis were predominant, respectively. The observations suggest that polyclonal fibroblast proliferation and extracellular matrix accumulation may result from inflammation resulting from excessive cell death and active material release of blood cells in the bone marrow of patients with hematological disease.     

亚高原地区大、小鼠生化指标正常参考值实验研究

目的 探讨亚高原地区SD大鼠和KM小鼠血液生化指标变化规律,确立参考值.方法 将2w龄SD大鼠和KM小鼠各60只,按饲养地区分为亚高原组(海拔1890 m)和平原组(海拔540 m),分别于4、6、10 w龄时检测血液生化指标,比较两组肝功能、肾功能、血脂及血糖的差异.结果 取得亚高原地区不同周龄、不同性别SD大鼠和KM小鼠的血液生化指标均值.亚高原组的肝功能指标普遍高于平原组,以谷丙转氨酶、谷草转氨酶、白蛋白的改变为主(P＜0.05);亚高原组肾功能指标也高于平原组(P＜0.05),特别是习服时间越长,改变越明显;亚高原组血脂指标高于平原组(P＜0.05);除平原组雄性KM小鼠血糖(GLU)高于亚高原组(P＜0.05)外,其余亚高原组大、小鼠GLU均高于平原组(P＜0.05).结论 建立了亚高原地区不同周龄、不同性别SD大鼠和KM小鼠的血液生化指标数据库,为该地区生物医学研究奠定了基础,也为亚高原地区KM小鼠和SD大鼠标准化鉴定和质量控制提供了可靠依据.     

血液病患者信号转导及转录激活子5和叉头状转录因子3的表达

目的观察恶性血液病患者外周血中单个核细胞磷酸化STAT5及Foxp3的表达水平及其相关性。方法采用蛋白磷酸化流式细胞术分别检测45例急性白血病患者(AL)、23例慢性白血病(CL)、29例骨髓增生异常综合征(MDS)、20例重型再生障碍性贫血(SAA)及38例对照组外周血单个核细胞磷酸化STAT5(P-STAT5)及Foxp3阳性细胞的百分率。结果PSTAT5表达AL组(2.29±0.79)%、CL组(2.45±0.88)%、MDS组(2.21±0.75)%都较对照组(0.54±0.15)%增高,差异具有统计学意义(P0.05),SAA组P-STAT5表达(0.43±0.17)%较对照组降低,差异无统计学意义(P0.05);Foxp3表达AL组(3.86±1.13)%、CL组(3.60±1.10)%、MDS组(4.01±1.19)%高于对照组(0.89±0.38)%,差异具有统计学意义(P0.05),SAA组Foxp3表达(0.57±0.21)%较对照组降低,差异具有统计学意义(P0.05)。AL、CL、MDS、SAA各组P-STAT5与Foxp3表达水平都呈正相关(P0.05)。结论 STAT5及Foxp3可能共同参与了AL、CL、MDS、SAA这几类恶性血液病的发生过程,同时测定可以提供有临床意义的实验依据。