Clinical Focus

Diagnosis and treatment advance in marginal zone lymphoma

Huang Rong， Fan Lei

2017, 32(12): 1013-1016. doi:10.3969/j.issn.1004-583X.2017.12.001

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Indolent Bcell lymphomas deriving from marginal zone in lymph node include three specific entities: mucosaassociated lymphoid tissue (MALT) lymphoma， splenic marginal zone lymphoma (SMZL)， and nodal marginal zone lymphoma (NMZL). The clinical and molecular characteristics are distinctive for each of these entities， although some phenotypic and genetic features are overlapping. With further understanding of mechanisms of MZL， clinical diagnosis and treatment progress rapidly. This review mainly focuses on the research progresses of translational field， clinical characteristics， diagnosis and treatment in recent years.

Advances and issues of CAR T cell therapy in B cell lymphoma

Ying Zhitao， Zhu Jun

2017, 32(12): 1017-1021,1026. doi:10.3969/j.issn.1004-583X.2017.12.002

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Chimeric antigen receptor T cell (CAR T) therapy is a novel immunotherapy， which has achieved great success in the past few years. The first product directed against CD19 has been approved by Food and Drug Administration (FDA) for the treatment of relapsed/refractory diffuse large B cell lymphoma in October 2017，which brought the management of lymphoma to a new era. Here， we review the recent advances and unresolved issues in this area. Also， we share the experiences from the CAR T cell trials ongoing at Peking University Cancer Hospital.

Current treatment strategies for refractory/relapsed Hodgkin's lymphoma

Chen Yongquan， Yang Ting

2017, 32(12): 1022-1026. doi:10.3969/j.issn.1004-583X.2017.12.003

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Although Hodgkin's lymphoma (HL) is highly curable， a minority of patients still presented as refractory to the frontline treatment or relapse after completion remission.For refractory or relapsed HL (rrHL)， salvage chemotherapy followed by hematopoietic stem cell transplantation remains the standard of care. PET/CT emerged as a valid measurement for response-adapted treatment strategies in rrHL. Moreover， recent knowledges on the pathophysiology of rrHL have promoted the development of novel targeted approach， some of that have shown promise in the early clinical trials.In this review， we summarize the current treatment strategies for rrHL.

Therapeutic progress in relapse/refractory diffuse largeBcell lymphoma

Zhang Na， Gao Guangxun

2017, 32(12): 1027-1036. doi:10.3969/j.issn.1004-583X.2017.12.004

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Diffuse large Bcell lymphoma (DLBCL) is a heterogeneous lymphoid malignancy and the most commonly occurring subtype of nonHodgkin's lymphoma (NHL)， with increasing incidence， which is great harmful to human health. More than 60% of DLBLC patients can be cured with standard RCHOP regimens， however， approximately 30% of patients will develop relapsed/refractory disease that remains a major cause of mortality. With recent advances in gene expression profiling， the indepth study of the molecular basis of chemotherapy resistance， optimization of salvage chemotherapy regimen， intervention of novel drugs and using chimeric antigen receptor Tcell therapy， and so on， these therapies might provide hope for individual accurate treatment of relapsed/refractory DLBCL. In this review， we focus on the progress of novel drugs and CART therapy in relapsed/refractory DLBCL.

MicroRNAs with B cell lymphoma

Sun Cai， Sang Wei， Xu Kailin

2017, 32(12): 1037-1040. doi:10.3969/j.issn.1004-583X.2017.12.005

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MiRNAs is a class of endogenous noncoding small RNA， which is quite conservative in evolution， is one of the important mechanism of epigenetic regulation.MiRNAs participates in the differentiation， development and functional regulation of B cells.Abnormal expression or dysfunction of miRNAs will lead to the abnormal differentiation and development of B cells， and further lead to the occurrence of many diseases including lymphoma.Because of miRNAs is relatively stable in the plasma and the pathological tissue， they could become lymphoma diagnosis， assessment of prognosis and treatment response of specific molecular identification.In this article， the current miRNAs participate in the process of B cell differentiation， development and participate in the occurrence and development of lymphoma related research progress were reviewed.

Clinical feature of 95 cases in malignant tumor with pulmonary embolism

Cui Xianglia， Wan Ziruia， Hou Kelua， Wang Zihuia， Ma Zhuoa， Kuang Tuguangb，

2017, 32(12): 1041-1044. doi:10.3969/j.issn.1004-583X.2017.12.006

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Objective To explore the clinical feature of malignant tumor accompanied with pulmonary embolism (PE)， which may provide the evidence for early prevention， diagnosis and treatment. Methods Clinical data of patients diagnozed with PE and tumor during from January 2014 to December 2016 were retrospectively analyzed. Results In 95 cases of tumor with PE， the average age was (62.7±11.8) years， 56 cases (58.9%) were ≥60 years， 56 cases were with pathology of adenocarcinoma， 49 cases were complicated with lower limb DVT， 48 cases were complicated with hypertension， 18 cases were complicated with diabetes， and 14 cases were complicated with hypercholesterolemia， and 12 cases were complicated with hyperuricemia， 18 cases were diagnozed of PE before tumor， 30 cases diagnozed PE and tumor simultaneously， 47 cases diagnozed PE after tumor. 30 cases suffered from PE during chemotherapy or targeted medication. The therapies were several combinations， as 16 cases received chemotherapy with platinum drugs， 2 PE patients received thrombolytic therapy combined with low molecular weight heparin (LMWH)， 67 cases LMWH maintenance anticoagulation therapy， 22 cases LMWH bridging anticoagulation with warfarin therapy， 3 patients anticoagulation therapy of rivaroxaban. 92 (96.8%) patients were relieved after anticoagulation therapy.Conclusion Age ≥60 years， pathology of adenocarcinoma， combined DVT，with in 3 months after diagnosis of malignant tumor are at high risk of PE. Early diagnosis， prevention and treatment of patients with malignant tumor complicated with PE are key factors to reduce the mortality and improve the prognosis.

Diagnosis value of blood routine (BR)， C-reactive protein combined with procalcitonin in neonatal sepsis

Guan Yanchun， Yang Mei， Zhang Zhen， Chen Xin， Zhao Wu

2017, 32(12): 1045-1048. doi:10.3969/j.issn.1004-583X.2017.12.007

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Objective To investigate the value of blood routine (BR) combined with Creactive protein (CRP) and procalcitonin (PCT) in neonatal sepsis diagnosis. Methods The serum levels of WBC， PLT， CRP and PCT were detected in 72 patients with neonatal sepsis and 80 patients with nonsepsis. The degree of critical illness (neonatal critical illness scoring， NCIS) were achieved， the correlation between WBC，PLT，CRP，PCT and NCIS were analyzed. The ROC curves were used to evaluate the values of the three parameters in the diagnosis of neonatal sepsis. Results Serum levels of WBC，N%，PCT， CRP and WBC were significantly higher in the sepsis group than nonsepsis group， but serum PLT was significantly lower in sepsis group than nonsepsis group (P<0.01). There was positive correlation between PLT and NCIS， negative correlation between PCT and NCIS， but no correlation between WBC， N， CRP and NCIS in neonatal sepsis group before treatment.The area under receiver operating characteristic curve (AUC) of WBC， CRP and PCT were 0.89， 0.88 and 0.978，but the AUC of three biomarkers for the diagnosis of neonatal sepsis was 0.998. Conclusion BR， CRP combined with PCT plays an important role in the diagnosis of neonatal sepsis.

Predictive value of two methods of platelet function detection for VerifyNow and Multiplate in patients with acute coronary syndrome

Hu Zhiling1， Li Fang2， Li Xiang2， Wang Xiaowei3， Yang Shuang2

2017, 32(12): 1049-1052. doi:10.3969/j.issn.1004-583X.2017.12.008

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Objective To investigate the predictive value of two methods of platelet function detection for VerifyNow and Multiplate in patients with acute coronary syndrome (ACS).Methods Verify Now and Multiplate were used to detect the platelet reactivity of patients with ACS. The relationship between platelet reactivity and major adverse cardiovascular events (MACE) was explored， including allcause death， non fatal myocardial infarction， non fatal stroke， stent thrombosis and revascularization. Results After one year of followup for 120 patients with ACS， 18 patients (15%) had MACE. The platelet reactivity detected by the two methods was both associated with MACE. Logistic regression analysis found that only VerifyNow could predict the occurrence of MACE (P=0.01). VerifyNow detection showed that the incidence of MACE in patients with high platelet response (HPR) was 16%， and the incidence of MACE without HPR was 7% (OR=2.6， 95%CI=1.54.4，P=0.001). The incidence of MACE in patients with HPR was 13%， and the incidence of MACE without HPR was 9% (OR=1.5， 95%CI=0.92.5，P=0.11) without HPR. Conclusion This study demonstrated VerifyNow could predict the adverse outcomes better in patients with ACS than Multiplate.

Clinical study of calcium dibutyryladenosine cyclophosphate in prevention of subacute cardiotoxicity induced by doxorubicin chemotherapy

Miao Yandong， Quan Wuxia

2017, 32(12): 1053-1056. doi:10.3969/j.issn.1004-583X.2017.12.009

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Objective To observe the protective effect of calcium dibutyryladenosine cyclophosphate in subacute cardiotoxicity induced by doxorubicin chemotherapy. Methods Totally 47 cases of breast cancer and lymphoma were randomly divided into control group(n=23) and treatment group(n=24). Both groups received the chemotherapy regimens containing doxorubicin and the treatment group had an addition injection of calcium dibutyryladenosine cyclophosphate. Both groups received four complete cycles of chemotherapy. The ECG changes， echocardiography (left ventricular ejection fraction， LVEF)， Nterminal probrain natriuretic peptide (NTproBNP)， cardiac troponin I (cTnI) and CKMB values in both groups were observed before the chemotherapy and after two and four cycle chemotherapy.Results Upon comparing the ECG changes， LVEF， cTnI， NTproBNP and CKMB values of both groups before 48 hours of the chemotherapy and after one week of two and four cycle chemotherapy， treatment group had lesser incidence rates in abnormal ECG， decreased LVEF， increased cTnI， NTproBNP and CKMB (P<0.05). Conclusion Calcium dibutyryladenosine cyclophosphate may reduce the cardiotoxicity induced by doxorubicin chemotherapy.

Neutrophiltolymphocyte ratio and platelettolymphocyte ratio as markers in assessing disease activity in Sjogren's syndrome

Zhang Lu， Xu Ting， Xie Wen， Zhang Peirong， Wu Min

2017, 32(12): 1057-1060. doi:10.3969/j.issn.1004-583X.2017.12.010

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Objective To explore the relationships between neutropiltolymphocyte ratio (NLR)， platelettolymphocyte ratio (PLR) and disease activity in Sjogren's syndrome (SS). Methods Clinical data of sixtytwo patients with SS and fiftyone healthy controls were collected. NLR and PLR were calculated and compared between two groups through nonparametric test. Correlation among NLR， PLR and other data in SS patients were analyzed by pearson correlation and multiple linear regression. EULAR SS disease activity index (ESSDAI) was used to assess disease activity. The ROC curve was drawn to evaluate whether NLR or PLR could reflect disease activity in SS. Results In SS patients， NLR and PLR levels were higher than those of healthy controls. Both NLR and PLR were positively correlated with globulin， IgG， IgA， RF and negatively correlated with total cholesterol (TC) and low density lipoprotein cholesterol (LDLC). NLR was positively correlated with PLR as well. Multiple linear regression analysis showed NLR was correlated with PLR， TC and LDLC， while PLR was correlated with NLR， globulin， IgG and TC. The ROC curve showed PLR could reflect disease activity with higher specificity. Conclusion NLR and PLR were correlated with SS severity and may be helpful in assessing the disease activity.

Predictive value of serum neutrophil gelationase associated lipocalin and Cys-C in early diagnosis of contrast induced nephropathy

Wang Daoyang1，Guan Yanchun2， Huang Yuping1， Ma Xuxiang1， Zhou Yuye1， Li Ying1， Zong Xiaoying1

2017, 32(12): 1061-1064. doi:10.3969/j.issn.1004-583X.2017.12.011

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Objective To investigate the value of combined detection of serum neutrophil gelationase associated lipocalin（NGAL) and Cystatin C（CysC）in predicting the contrast induced nephropathy(CIN) after percutaneous coronary intervention. Methods A total of 114 patients with suspected coronary heart disease underwent PCI were included. The patients were divided into two groups: CIN (12 cases) and nonCIN (102 cases). The level of SCr， CysC and NGAL were measured before and after operation. The area under receiver operating characteristic curve (AUC) was used to assess the sensitivity of NGAL and CysC in early diagnosis of CIN.Results The serum NGAL of CIN was significantly higher than that of nonCIN at 6 hours after operation(P=0.01). The serum CysC of CIN was significantly higher than that of nonCIN at 12 hours after operation (P<0.01). The serum NGAL and CysC of CIN were significantly higher than those of nonCIN at 12 hours，24 hours，48 hours after operation(P<0.01). However， the serum SCr and CysC of CIN were not significantly higher than those of nonCIN at 6 hours after operation（P=0.46，P=0.67). The area under receiver operating characteristic curve (AUC) of NGAL，CysC and SCr were 0.81，0.75 and 0.57 at 6 hours after operation. The AUC of NGAL，CysC and SCr were 0.89，0.83 and 0.8 at 12 hours after operation. The AUC of NGAL，CysC and SCr were 0.88，0.86 and 0.85 at 24 hours after operation. The AUC of NGAL，CysC and SCr were 0.77，0.7 and 0.88 at 48 hours after operation.Conclusion For patients with coronary heart disease after PCI， serum NGAL and CysC levels can early reflect the kidney function and give an early prediction of CIN.

Clinical features of chronic obstructive pulmonary disease with lung cancer

Cai Jingjing1，2， Miao Jianlong1， Zhou Jinhua1， Zhang Yingying1，2， Liu Ruijuan1

2017, 32(12): 1065. doi:10.3969/j.issn.1004-583X.2017.12.012

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Objective In order to analyze the clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) and lung cancer， to improve the clinical understanding of COPD with lung cancer. Methods Retrospective analysis was performed in 98 patients of COPD with lung cancer and the same pospitalized period 108 patients with simple COPD. The clinical data of two groups were analyzed with statistics. Results COPD combined with lung cancer patients were significantly higher in hemoptysis or sputum bloody， chest pain， atelectasis， hoarseness， pleural effusion， weight loss than patients with COPD alone (P<0.05);The male patients with COPD combined with lung cancer were significantly more than COPD alone(86.7% vs 71.3%，P<0.05)；Patients with COPD were older than COPD with lung cancer (P<0.01)；The smoking index of COPD with lung cancer group was significantly higher than that of COPD alone (P<0.01)；The lung function classification of COPD patients with lung cancer group in the first and second grade were significantly more than those of COPD alone（62.9% vs 54.3%，P=0.047；78.7% vs 21.3%，P＜0.01）；COPD patients with lung cancer group， the highest proportion of lung squamous cell carcinoma (43.9%)， men with lung squamous cell carcinoma was common (48.2%)， women with lung adenocarcinoma was more common (53.8%). Conclusion When patients with a history of COPD had hemoptysis or sputum bloody， chest pain， atelectasis， hoarseness， pleural effusion， weight loss of clinical manifestations and signs， the possibility of lung cancer should be alerted. COPD combined with lung cancer occurs in a large number of male patients with smoking， airway obstruction in patients with COPD prone to lung cancer， lung squamous cell carcinoma is the most common pathological type.

Comprehensive evaluation of quality of health care for children with rank sum ratio in 31 provinces， autonomous regions and municipalities of China in 2015

Chen Junyi， Zhao Qianlong， Li Funlong， Guo Jiankang， Xie Qingmu， Xia Wenyan， Yang Jing

2017, 32(12): 1069-1072. doi:10.3969/j.issn.1004-583X.2017.12.013

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Objective To comprehensively evaluate the national child health care status in 2015， and horizontally compare the quality of children health care in 31 provinces， autonomous regions and municipalities of China， provide reference basis for making policies. Methods Rank sum ratio was used to comprehensively analyze the visit rate of neonates， systematical management rate of children under three years old， health care management rate of children under seven years old， proportion of infants with birth weight less than 2 500 g， mortality rate of perinatal infants and proportion of moderate to severe malnutrition among the children under five years old. Results The situation where children health care was good included Jiangsu， Shanghai， Shanxi， Zhejiang and Beijing. The situation where that was relatively poor contained Henan， Guangxi， Qinghai， Hainan， Xinjiang and Xizang. Besides， the situation where that was relatively common involved the rest provinces， autonomous regions and municipalities. Conclusion The situation of children health care is related to the level of economic development， should further increase the marginal ethnic minority areas and the low birth weight infant health care work.

Efficacy and safety of thrombolysis with recombinant tissue plasminogen activator for patients with acute mild ischemic infarction

Bian Xin1， Lu Libo1， Li Liang1， Yao Chunxu2， Fu Qiangqiang3， Ji Chengdong3

2017, 32(12): 1073-1078. doi:10.3969/j.issn.1004-583X.2017.12.014

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Objective To evaluate the efficacy and safety of thrombolysis with recombinant tissue plasminogen activator (rtPA) for patients with acute mild ischemic infarction. Methods PubMed， Cochrane Central Register of Controlled Trials， Embase， Ovid， Sinomed， Wanfang Data， VIP and Chinese National Knowledge Infrastructure (CNKI) databases were searched from inception to 31st April， 2017 to comprehensively collect randomized controlled trials (RCTs) of rtPA for acute mild ischemic infarction. The relevant data were extracted by two reviewers independently. The methodological quality of the included RCTs were assessed according to the Cochrane Handbook. Then， metaanalysis was performed by RevMan5.3 software. Pooled effect sizes were calculated using the fixed effects model when I2＜50%，P＞0.1， otherwise the random effects model were applied. Mean difference (MD) and 95% confidence interval (CI) were applied on the measurement data and Odds risk (OR) and CI on the enumeration data. Five RCTs involving 3 070 patients met the inclusion criteria. Results A total of 5 RCTs involving 4 401 patients were finally included. Trial group were given rtPA while no rtPA groups， i.e.， control group， were given the standard antiplatelet therapy or other therapies. The results of metaanalysis showed that more patients in the rtPA groups had mRS scores of 0 to 1 than no rtPA groups did at 90 days after thrombolytic therapy (OR=0.80，95%CI=0.611.06，P>0.05). As to safety， rtPA group did not show a notable change of incidence of death compared with no rtPA groups after thrombolysis (OR=0.66，95%CI0.271.64，P>0.05). However， hemorrhagic transformation (HT) rates between two groups showed significance (OR=14.09，95%CI=5.3237.31，P＜0.01). Conclusion Multiple evidence suggests that rtPA group had similar outcomes as patients receiving the standard antiplate therapy and as not receiving thrombolysis. In addition， rtPA had hemorrhagic tendency for thrombolysis purpose in patients with acute mild ischemic infarction.

Current prevalence of attention deficit hyperactivity disorder among children: a metaanalysis

Li Fulun， Xie Qingmu， Zhao Qianlong， Cheng Junyi， Wei Shuizhen， Li Aishu，

2017, 32(12): 1079-1083. doi:10.3969/j.issn.1004-583X.2017.12.015

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Objective To investigatethe prevalence of children with attention deficit hyperactivity disorder (ADHD) in China，in order to provide a basis evidence for intervention in ADHD treatment in China.Methods A computerized literature search was carried out in several databases such as Wanfang database， China Journal Fulltext Database (CNKI)， VIP database， PubMed and China biomedical database (CMB) database， a collection of China children with attention deficit hyperactivity disorder.Results Thirtythree papers up to 132 204 participants were included in this study. The total prevalence of ADHD in children was 5.5% （95%CI=4.8%6.2%）;Subgroup analysis showed the prevalence of boys was higher than that of girls，the prevalence of the western region was higher than that of central and eastern regions，the prevalence of ADHDI which was highest accounted for 3.4%（95%CI=2.5%4.3%）. Conclusion The prevalence of ADHD is higher in China and has become a serious public health issue.

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