Table of Content

20 October 2021, Volume 36 Issue 10

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Standardized treatment of acute leukemia by haplo-identical stem cell transplantation

Ma Rui, Sun Yuqian

2021, 36(10):  869-873.  doi:10.3969/j.issn.1004-583X.2021.10.001

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Haplo-identical stem cell transplantation(Haplo-SCT) is one of the most rapidly developing subjects in the field of transplantation in recent years. Haplo-SCT is mainly applied in more experienced centers due to the complexity of its technics. In this review, the history and current status of Haplo-SCT in treating leukemias are summarized, and the indications, donor selection, and relapse prevention/management in the “Beijing Protocol” Haplo-SCT as well as transplant strategies in special populations including elderly people are emphatically described, with the aim of providing the basis for further standardized promotion of Haplo-SCT in domestic centers.

The standard treatment of acute lymphoblastic leukemia

Lu Wenyi, Zhao Mingfeng

2021, 36(10):  874-879.  doi:10.3969/j.issn.1004-583X.2021.10.002

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Acute lymphoblastic leukemia(ALL) is a highly heterogeneous hematological malignancy resulting from clonal proliferation of lymphoid precursor cells. In recent years, with the optimization of risk stratification model and the emergence of new drugs, such as tyrosine kinase inhibitors, monoclonal antibodies, chimeric antigen receptor T cells and other targeted drugs, the outcomes of ALL patients have been greatly improved. This article briefly described the current standards for treatment of ALL. Also, the latest progress in the therapy of ALL were discussed.

Standardized treatment of acute myeloid leukemia

Liu Qiaoxue, Wei Hui

2021, 36(10):  880-883.  doi:10.3969/j.issn.1004-583X.2021.10.003

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Acute myelogenous leukemia(AML), a malignant blood system disease characterized by clonal proliferation and differentiation of primitive hematopoietic cells, is classified to be a heterogeneous disease, and the treatment of AML should be comprehensively considered in combination with chromosomal and molecular abnormalities, prognosis risk classification and chemotherapy tolerance of patients. Common solutions for remission induction involve DA, HA and HAD solutions, and the selection on consolidation and maintenance therapeutic regimen after remission should be considered in combination with prognosis risks of patients. Up to now, for standardized treatment of AML, Hematopoietic stem cell transplantation is still one of the most important means. The treatment of gerontal patients with AML faces more severer challenges, and targeted therapy for specific sites of leukemia cells has become the most promising therapeutic regimen, and its combination with conventional induction chemotherapy will become emerging strategy and idea for treatment of gerontal patients with AML.

Standardized detection of BCR-ABL mRNA and clinical application in patients with chronic myeloid leukemia

Qin Yazhen

2021, 36(10):  884-888.  doi:10.3969/j.issn.1004-583X.2021.10.004

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BCR-ABL mRNA is the molecular marker of chronic myeloid leukemia(CML), and tyrosine kinase inhibitors(TKIs) targeting BCR-ABL mRNA has become the basic drug for CML. BCR-ABL mRNA level is the important indicator for evaluation of TKI efficacy. The mutation in ABL tyrosine kinase domain suggests mechanism of TKI resistance, which could guide the treatment strategy such as the selection of next TKIs. Standardized detection of BCR-ABLmRNA is essential for precisely guiding treatment and the guarantee for CML patients to achieve the best curative effects. Standardization is involved in sample type, testing content, laboratory protocol and report ways. This paper explored the standardized detection of quantification and mutation of BCR-ABL and clinical application in CML patients based on recent literature.

Flow cytometry in minimal residual disease detection of acute myeloid leukemia: current status and progress

Wang Hui, Chen Man

2021, 36(10):  889-895.  doi:10.3969/j.issn.1004-583X.2021.10.005

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Minimal residual disease(MRD) of acute myeloid leukemia (AML) detected by flow cytometry(FCM) has high sensitivity and coverage, which has been an important biomarker for efficacy evaluation, outcome prediction, and therapy selection. However, a number of questions remain uncertain. This paper introduced the status and problems of FCM detection in AML MRD, discussed the corresponding solutions and precautions with the new hope by the progress of FCM.

Study on standardized diagnosis and treatment of primary immune thrombocytopenia

Fu Haixia

2021, 36(10):  896-900.  doi:10.3969/j.issn.1004-583X.2021.10.006

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Primary immune thrombocytopenia(ITP) is an acquired immune-mediated thrombocytopenia disease, and its pathogenesis covers excessive destruction of platelets and insufficient production of platelets by megakaryocytes. Main clinical manifestations involve the bleeding related to thrombocytopenia and fatigue. No specific biomarker is found in the diagnosis of ITP, and other thrombocytopenic diseases should be excluded. The therapy is intended to maintain the safe level of platelets, prevent bleeding and improve the quality-of-life. The indication for therapy is platelet count ≤ 30×10 ⁹/L and/or active bleeding. Patients with some factors may increase the risk of bleeding: increased age, heavy physical activities, blood coagulation factor disorder, uncontrolled hypertension, and taking anticoagulants. These patients need to maintain platelet at a higher level. The first-line therapies involve corticosteroids and intravenous human immunoglobulin. The second-line therapies involve thrombopoietin receptor agonists(TPO-RAs), recombinant TPO(rhTPO), rituximab and splenectomy. All-trans retinoic acid(ATRA) and other third-line treatment should be considered for refractory ITP.

Effects of autologous hematopoietic stem cell transplantation in primary central nervous system lymphoma

Cheng Li, Huang Wenrong

2021, 36(10):  901-904.  doi:10.3969/j.issn.1004-583X.2021.10.007

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The effects of autologous hematopoietic stem cell transplantation(ASCT) in the whole treatment process remain to be unknown to abundant physicians due to low incidence of primary central nervous system lymphoma(PCNSL). Induction therapy based on high-dose methotrexate(HD-MTX) has significantly improved the early control rate of PCNSL, and many patients receive insufficiently thorough remission. Large-scale international clinical studies show that the rate of complete remission(CR) is less than 50% in most case; while the duration of remission remain short and recur within one year. ASCT, a consolidation therapeutic strategy, is applied to primary or relapsed and refractory PCNSL, significantly improved the rate of complete remission and long-term disease-free survival(PFS); the long-term PFS of newly treated PCNSL patients can hit 70%, and that of relapsed and refractory PCNSL patients can hit 50%. Current clinical practices confirmed that PCNSL is more common in older patients. Elderly PCNSL patients with great organ functions remained to tolerate ASCT, significant benefited from ASCT. High-dose thiotepa is preferred for ASCT conditioning regimen of PCNSL, and TBC regimen with stronger conditioning intensity is patients for young patients with better physical conditioning failing reciveing CR after early induction therapy; Older patients are supported to choose TT-BCNU or reduced TBC conditioning regimen.

Diagnosis and treatment of adult Langerhans cell histiocytosis

Cao Xinxin

2021, 36(10):  905-909.  doi:10.3969/j.issn.1004-583X.2021.10.008

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Langerhans cell histiocytosis(LCH) is an inflammatory myeloid malignancies with MAPK pathway activation mutations detectable in nearly all patients and a pronounced inflammatory state. The clinical manifestations of LCH are diversity, the most common involved organs included Bones, lungs, pituitary, ect. The primary diagnosis of LCH depends on histopathologic review of lesional tissue biopsy; the gold standard for diagnosis were expression of Cd207 (Langerlin) in immunohistochemistry and birbeck granules(BGs) by electron microscopy. LCH can be devided into localized single-system disease(SS-s), multiple sites within one single system (SS-m), and multisystem(MS) disease according to the scope of clinically involved organs. In terms of clinical classification, Local therapies may be sufficient for SS-s patients, systemic therapies might be better for SS-m or MS patients.

Epstein-Barr virus-driven hemophagocytic lymphohistiocytosis

Cui Tingting, Zhang Jia, Wang Jingshi, Wang Zhao

2021, 36(10):  910-915.  doi:10.3969/j.issn.1004-583X.2021.10.009

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Hemophagocytic lymphohistiocytosis (HLH) is the life-threatening result of inflammatory storm caused by immunological dysfunction. With the development of molecular genetics, current studies have an in-depth understanding of the HLH. For some genotype of HLH, epstein-barr virus (EBV) is an important inducement, known as the EBV-driven HLH. Currently, the Tyrosine-protein kinase ITK deficiency, magnesium transporter protein 1 (MAGT1) deficiency, CD27 deficiency, CD70 deficiency, CTP synthase 1 (CTPS1) deficiency and RAS guanyl-releasing protein 1 (RASGRP1) deficiency are found to be the genotype related to the HLH. In this review, we would summarize the epidemiology, pathophysiological characteristics, clinical manifestations and treatment of EBV-driven HLH.

Diagnostic value of UG-FNAC combined with BRAF^V600E gene detection for TIRADS category 4 thyroid nodules

Tian Shuqi, Wang Yunji, Tan Meng, Li Chunhua, Zhu Yuxiang, Yan Caifeng, Feng Shangyong

2021, 36(10):  916-921.  doi:10.3969/j.issn.1004-583X.2021.10.010

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Objective To evaluate the diagnostic value of ultrasound-guided fine needle aspiration cytology (UG-FNAC) combined with BRAF^V600E gene detection for American College of Radiology-thyroid imaging reporting and data system (ACR-TIRADS) category 4 thyroid nodules(TN). Methods A retrospective analysis involved 471 patients evaluating TN of ACR-TIRADS 4 by ultrasound examination, who admitted to Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January 2018 to June 2021, and the patients underwent preoperative UG-FNAC and BRAF^V600E gene detection. Thin-layer (liquid-based) cervical cytology and fluorescence quantitative PCR were used for detecting puncture specimens and BRAF^V600E mutation, respectively. Using postoperative pathology as the gold standard, the receiver operating characteristic (ROC) curve of TN (ACR-TIRADS 4) was constructed by UG-FNAC and BRAF^V600E detection and the combined diagnosis of the two, and the diagnostic efficacy was evaluated. Results The sensitivity(Se) and specificity(Sp) of TN (TIRADS 4) using UG-FNAC or BRAF^V600E gene detection were 75.8%, 98.8% and 56.7%, 98.8%, respectively. Se and Sp using the combination of both were 95.6% and 98.3%, respectively; areas under curve (AUC) using the combination (0.970) was higher than UG-FNAC (0.873), or BRAF^V600E detection alone (0.778)(P<0.05); AUC of TN (TIRADS 4a, 4b, and 4c ) using the combination were 0.961, 0.972, and 0.981, respectively. Conclusion UG-FNAC combined with BRAF^V600E gene detection can effectively improve the accuracy of preoperative diagnosis of TN (ACR-TIRADS 4).

Correlation of current situation of mobile games and sleep quality and emotional state in students of Hebei Medical University

Li Jianxin, Zhang Meiqi, Wang Ziyang, Sun Yaqi, Wang Yumei

2021, 36(10):  922-926.  doi:10.3969/j.issn.1004-583X.2021.10.011

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Objective To explore the correlation of current situation of mobile games and sleep quality and emotional state in students of Hebei Medical University, in order to give targeted suggestions to make time length and period of mobile games reasonable.Methods Totally 423 students who came from Departments of Psychiatry, Anesthesiology, and Integrative Medicine of Hebei Medical University were enrolled as research objects.The sociology information of the students as age, gender, place of residence, health status, family income, parents' education level, etc were collected. The current situation of mobile games included two problems time spent on mobile games every day and the most intensive period of using mobile games every day. The former was divided into four groups: <2 hours, 2-4 hours, >4-6 hours and >6 hours, while the latter was divided into five groups: early morning, morning, noon, afternoon and evening. Pittsburgh Sleep Quality Index(PSQI), Epworth Sleepiness Scale(ESS), Self-rating Anxiety Scale(SAS) were used to evaluate sleep quality. Center for Epidemiologic Studies-Depression(CES-D) was used to evaluate emotional state. The influence of the first two problems on their sleep quality and emotional state were analyzed.Results Totally 376 investigators provided valid data, and the effective recovery rate was 88.88%. Time spent on mobile games every day and the most intensive period of using mobile games every day had no effect on sleep quality and emotional state (all P>0.05), while social factors gender, smoking or no-smoking, learning interest, and interpersonal relationship had effects on sleep quality and emotional state, and the difference was statistically significant (all P<0.05).Conclusion Time spent on mobile games every day and the most intensive period of using mobile games every day were not related to sleep quality or emotional state. Male, smoking, low interest in learning, poor interpersonal relationships students spent more time in playing mobile games.

Intelligent system in out-of-hospital management of patients with type 2 diabetes mellitus

Yang Xin, Yao Shuyan, Yang Hongjie

2021, 36(10):  927-932.  doi:10.3969/j.issn.1004-583X.2021.10.012

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Objective To observe the effectiveness, safety and practicability of smart wearable devices and smart medical mobile phone App software system in out-of-hospital management of patients with type 2 diabetes mellitus(T2DM).Methods Totally 300 patients with type 2 diabetes who were hospitalized in the Department of Endocrinology, People's Hospital of Putuo District, Shanghai from January 2018 to January 2019 were randomly divided into regular group, control group and observation group, 100 cases in each group. The routine group was only given regular discharge health guidance. On the basis of the routine group, the control group was given smart wearable devices and patients managed their lives and monitor indicators by themselves. On the basis of the control group, the observation group installed the smart medical mobile phone App software system, and the medical staff and the patients managed the patients' life and monitored indicators together. The observation continued 3 months to compare blood glucose, blood lipids, body mass index(BMI), 36-Item Short-Form Health Survey(SF-36), Summary of Diabetes Self-Care Activities(SDSCA), and nurses' job satisfaction.Results Compared with regular group, improvement of blood glucose, blood lipids, BMI in observation group and control group were better than that in routine group(P<0.05), and improvement in observation group was significantly better than that in control group(P<0.05). Scores of SF-36, SDSCA and nurses' job satisfaction increased notably in observation group and control group when compared with regular group (P<0.05), and the scores were significantly higher in observation group than in control group (P<0.05).Conclusion For T2DM patients, smart wearable devices and smart medical mobile phone App software system improved quality-of-life, self-management ability, blood glucose, blood lipids and BMI, and raised nurses' job satisfaction.

Relationship between aVR lead ST-segment elevation with SYNTAX score in patients with acute non-ST-segment elevation myocardial infarction

Wang Yajie, Lin Wenhua, Jing Rui, Liu Jingjing, Lu Yujie

2021, 36(10):  933-936.  doi:10.3969/j.issn.1004-583X.2021.10.013

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Objective To explore the relationship between ST-segment elevation in lead aVR(STEaVR) and SYNTAX score(SS) in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods Totally 316 patients with NSTEMI were retrospectively analyzed. Overall clinical features, electrocardiograms(ECGs) ST elevation and depression in different leads of patients unpon admission, scores and peak values of left ventricle ejection fraction(LVEF), peak troponin Ⅰ level of the patients were counted and analyzed SS after coronary angiography. The patients with or without STEaVR were divied, the relationship between STEaVR and SS were explored.Results The number with STEaVR and without STEaVR in 316 patients was 207 cases (65.5%) and 109 cases (34.5%), respectively;the rate of patients with STEaVR gaining higher SS scores was higher when compared to those without STEaVR (50.7% vs 21.1%; P<0.01),and the incidence of left main coronary artery and/ or three-vessel disease (LM/3VD) was higher (43.5% vs 22.9%; P<0.01). Multivariate analysis showed the independent predictors for higher SS were STEaVR (OR=2.640, CI=1.404-4.963, P=0.003) and precordial ST-segment depression (OR=1.817, CI=1.053-3.135, P=0.032).Conclusion The main independent predictor for higher SS is STEaVR.

Analysis of antithrombotic therapy for symptomatic lower extremity atherosclerosis disease

Chen Jun, Zhou Yiwei, Li Xiujuan

2021, 36(10):  937-941.  doi:10.3969/j.issn.1004-583X.2021.10.014

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Objective To explore the curative effects of low-dose rivaroxaban combined with ant-platelet drugs for symptomatic lower extremity atherosclerosis disease(LEASD).Methods The data of 167 LEASD patients were retrospectively analyzed and divided into observation group and control group. Patients in observation group were treated with antithrombotic therapy using rivaroxaban (2.5 mg, bid) combined with anti-platelet drug namely cilostazol (100 mg, bid), and those in control group with the same dose of cilostazol alone (100 mg, bid). A 18-month follow-up was performed. The key observation was major adverse limb events(MALEs), major adverse cardiovascular events(MACEs) and adverse bleeding events(MBEs).Results MACEs and MALEs were significantly lower in observation group than in control group (P<0.05). No differences were statistically significant in MBEs between groups (P>0.05).Conclusion For LEASD patient, low-dose rivaroxaban combined with anti-platelet drug namely cilostazol can significantly reduce MACEs and MALEs, and improve prognosis with safety.

Value of the combination of PCT, CRP, and IL-8 to predict the effect of hormonal intervention in children with bronchitis

Meng Luming, Mao Luyi, He Muyan, Zhang Qiuyan

2021, 36(10):  942-945.  doi:10.3969/j.issn.1004-583X.2021.10.015

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Objective To explore the value of the combination of procalcitonin(PCT), C-reactive protein(CRP) and interleukin-8 (IL-8) to predict the effect of hormonal intervention(HI) in children with bronchitis.Methods Totally 100 children with bronchitis admitted to our hospital from January 2016 to January 2020 were included, all patients were treated with the intervention of correcting electrolyte acid-base balance, eliminating phlegm, anti-infection; in the meantime, the patients were given oxygen inhalation therapy using budesonide (diluted with 0.9% sodium chloride ) at 1 ml/kg^-1, twice per day (10 min once). After 1-week treatment, the short-term efficacy was evaluated based on the criteria for pediatric bronchitis of children in ' Modern Applied Pediatrics'. Blood samples were collected before treatment, the general data was compared between groups and serum indexes (PCT, CRP and IL-8) were determined; the receiver operating characteristic curve(ROC) was drawn to analyze the predictive value of the indicators for the effect of HI. Kappa test was used to analyze the consistency between the combination and clinical evaluation. Results After intervention, there were 22 (22.00%) for unsuccessful,45 (45.00%) for certain effect, 33 (33.00%) for significantly effect. The levels of serum PCT, CRP and IL -8 in effective group were significantly lower than those in ineffective group (P<0.05).The AUC of serum PCT, CRP and IL-8 was 0.715, 0.758 and 0.747, respectively. When PCT> was 4.420 μg/L, CRP>16.945 mg/L, and IL-8>14.840 ng/L, the risk of ineffective HI was increased. The AUC of the three joint prediction was 0.858, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the three joint prediction were 89.74%, 63.63%, 84.00%, 89.74% and 63.64%, respectively. the consistency between the three joint prediction and clinical evaluation was 0.534 by Kappa test (general consistency).Conclusion For children with bronchitis, the combination of PCT, CRP and IL-8 in predicting the efficacy of HI has high value, and the consistent is closer with clinical evaluation, it should be paid attention.