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Mao YY, Cai H, Cao XX, Feng J, Zhang L, Zhou DB, Li J. [Type of CEBPA mutations in acute myeloid leukemia and their effect on prognosis]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2024; 45:556-560. [PMID: 39134486 PMCID: PMC11310808 DOI: 10.3760/cma.j.cn121090-20240316-00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Indexed: 12/06/2024]
Abstract
Objective: To demonstrate the type of CEBPA gene mutations among patients with acute myeloid leukemia (AML), clinical characteristics, and prognostic effect on patient outcomes. Methods: Demographic data, clinical features, laboratory characteristics, and data about treatment and follow-up of 57 patients with CEBPA mutated AML diagnosed at Peking Union Medical College Hospital between April 2016 and November 2022 were collected and analyzed. Results: In total, 57 patients with CEBPA mutation accounted for 16.1% of all the 353 patients with AML, among which 28 patients had CEBPA-bZIPinf and 29 had CEBPA-other. Compared with the CEBPA-other group, the CEBPA-bZIPinf group was younger (54 vs 64 years, P=0.010), de novo AML was more common (P=0.001), and the level of bone marrow blast was higher (68.0% vs 36.3%, P=0.001). Moreover, 24 patients from the CEBPA-bZIPinf group and 19 from the CEBPA-other group received chemotherapy. The one-course complete remission (CR) rate of the CEBPA-bZIPinf group was significantly higher than that of the CEBPA-other (87.5% vs 47.4%, P=0.010) and CEBPA-wt (87.5% vs 50.3%, P=0.002) groups. After a median follow-up of 11 months, the median OS of the CEBPA-bZIPinf group was significantly longer than that of the CEBPA-wt group (not reached vs 22.1 months, P=0.012) . Conclusion: CEBPA-bZIPinf mutated AML is a unique clinical entity, with a younger age of diagnosis, better response to chemotherapy, and better prognosis.
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Cao XX, Zhang YL, Zhao SQ, Zhang Q, Chi ZL. [Clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers]. ZHONGHUA SHAO SHANG YU CHUANG MIAN XIU FU ZA ZHI 2024; 40:159-164. [PMID: 38418177 DOI: 10.3760/cma.j.cn501225-20231017-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Objective: To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers. Methods: This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital, including 11 males and 4 females, aged 31 to 72 years. The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm, with cavity diameters of 10-14 cm. Five cases were complicated with ischial tuberosity bone infection. After clearing the lesion, the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound. The flap donor area was directly sutured, and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks. The postoperative survival of the muscle flaps and skin flaps, the wound healing of the donor and recipient areas were observed. The recurrence of pressure ulcers, the appearance and texture of flaps, and scar conditions of the donor and recipient areas were followed up. Results: All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery. Two patients experienced incisional dehiscence at one week after surgery due to improper turning over, during which the incision in the recipient area was pressed on, and the wounds healed after dressing changes of 3 to 4 weeks; the wounds in the donor and recipient areas healed well in the other patients. All patients received follow-up after surgery. During the follow-up period of 6 to 12 months, none of the patients experienced pressure ulcer recurrence, and the texture, color, and thickness of the skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas. Conclusions: When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage Ⅳ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.
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Yi SH, Xiong WJ, Cao XX, Sun CY, Du J, Wang HH, Wang L, Niu T, Jiang ZX, Wei YQ, Xue H, Chu HL, Qiu LG, Li J. [Diagnosis and treatment understanding of Waldenström macroglobulinemia in China: a cross-sectional study]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2024; 45:148-155. [PMID: 38604791 PMCID: PMC11078679 DOI: 10.3760/cma.j.cn121090-20231017-00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Indexed: 04/13/2024]
Abstract
Objective: To conduct a nationwide physician survey to better understand clinicians' disease awareness, treatment patterns, and experience of Waldenström macroglobulinemia (WM) in China. Methods: This cross-sectional study was conducted from February 2022 to July 2022 by recruiting clinicians with WM treatment experience from hematology, hematology-oncology, and oncology departments throughout China. Quantitative surveys were designed based on the qualitative interviews. Results: The study included 415 clinicians from 219 hospitals spread across thirty-three cities and twenty-two provinces. As for diagnosis, the laboratory tests prescribed by physicians for suspected WM patients were relatively consistent (92% -99% recommendation for laboratory, 79% -95% recommendation for pathology, 96% recommendation for gene testing, and 63% -83% recommendation for imaging examination). However, from a physician's perspective, there was 22% misdiagnosis occurred in clinical practice. The rate of misdiagnosis was higher in lower-level hospitals than in tertiary grade A hospitals (29% vs 21%, P<0.001). The main reasons for misdiagnosis were that WM was easily confused with other diseases, and physicians lacked the necessary knowledge to make an accurate diagnosis. In terms of gene testing in clinical practice, 96% of participating physicians believed that WM patients would require gene testing for MYD88 and CXCR4 mutations because the results of gene testing would aid in confirming diagnosis and treatment options. In terms of treatment, 55% of physicians thought that the most important goal was to achieve remission, while 54% and 51% of physicians wanted to improve laboratory and/or examination results and extend overall survival time, respectively. Among patients with treatment indications, physicians estimated that approximately 21% of them refused to receive treatment, mainly owing to a lack of affordable care and disease awareness. When selecting the most appropriate treatment regimens, physicians would consider patient affordability (63% ), comorbidity (61% ), and risk level (54% ). Regimens containing Bruton tyrosine kinase inhibitor (BTKi) were most widely recommended for both treatment-naïve and relapsed/refractory patients (94% for all patients, 95% for treatment-naïve patients, and 75% for relapsed/refractory patients), and most physicians recommended Ibrutinib (84% ). For those patients who received treatment, physicians reported that approximately 23% of patients did not comply with the treatment regimen due to a lack of affordability and disease awareness. Furthermore, 66% of physicians believe that in the future, increasing disease awareness and improving diagnosis rates is critical. Conclusions: This study is the first national physician survey of WM conducted in China. It systematically describes the issues that exist in WM diagnosis and treatment in China, such as a high rate of misdiagnosis, limited access to gene testing and new drugs, and poor patient adherence to treatment. Chinese doctors believe that improving doctors' and patients' understanding of WM is one of the most urgent issues that must be addressed right now.
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Lang M, Zhou DB, Cao XX. [Mutation pedigree and treatment selection of Erdheim-Chester disease]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:876-880. [PMID: 38049347 PMCID: PMC10694082 DOI: 10.3760/cma.j.issn.0253-2727.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 12/06/2023]
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Chang L, Zhang L, Zhang Y, Feng J, Zhou DB, Cao XX. [Systemic mastocytosis: a retrospective analysis of 11 cases]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:336-339. [PMID: 37357005 DOI: 10.3760/cma.j.issn.0253-2727.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
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Dai JW, Cao XX. [Sirolimus successfully treated Erdheim-Chester disease with interferon and cytarabine treatment failure: a case report]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:347. [PMID: 37357008 DOI: 10.3760/cma.j.issn.0253-2727.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
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Guan A, Shen KN, Zhang L, Cao XX, Su W, Zhou DB, Li J. [Clinical characteristics and progression risk factors for patients with monoclonal gammopathy of undetermined significance]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:137-140. [PMID: 36948868 PMCID: PMC10033275 DOI: 10.3760/cma.j.issn.0253-2727.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Objective: To analyze the clinical presentation and progression risk factors of patients with monoclonal gammopathy of undetermined significance (MGUS) in China. Methods: We retrospectively assessed the clinical features and disease progression of 1 037 patients with monoclonal gammopathy of undetermined significance between January 2004 and January 2022 at Peking Union Medical College Hospital. Results: A total of 1 037 patients were recruited in the study, including 636 males (63.6%) , with a median age of 58 (18-94) years. The median concentration of serum monoclonal protein was 2.7 (0-29.4) g/L. The monoclonal immunoglobulin type was IgG in 380 patients (59.7%) , IgA in 143 patients (22.5%) , IgM in 103 patients (16.2%) , IgD in 4 patients (0.6%) , and light chain in 6 patients (0.9%) . 171 patients (31.9%) had an abnormal serum-free light chain ratio (sFLCr) . According to the Mayo Clinic model for risk of progression, the proportion of patients in the low-risk, medium-low-risk, medium-high risk, and high-risk groups were 254 (59.5%) , 126 (29.5%) , 43 (10.1%) , and 4 (0.9%) , respectively. With a median follow-up of 47 (1-204) months, 34 of 795 patients (4.3%) had disease progression, and 22 (2.8%) died. The overall progression rate was 1.06 (0.99-1.13) /100 person-years. Patients with non-IgM MGUS have a markedly higher disease progression rate per 100 person-years than IgM-MGUS (2.87/100 person-years vs 0.99/100 person-years, P=0.002) . The disease progression rate per 100 person-years in non-IgM-MGUS patients of Mayo classification low-risk, medium-low risk and medium-high risk groups were 0.32 (0.25-0.39) /100 person-years, 1.82 (1.55-2.09) /100 person-years, and2.71 (1.93-3.49) /100 person-years, which had statistically difference (P=0.005) . Conclusion: In comparison to non-IgM-MGUS, IgM-MGUS has a greater risk of disease progression. The Mayo Clinic progression risk model applies to non-IgM-MGUS patients in China.
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Chang L, Wang CY, Li ZH, Zhou DB, Cao XX. [Low-oxygen-affinity hemoglobinopathy Hemoglobin Sunshine Seth: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:72-74. [PMID: 36987728 PMCID: PMC10067374 DOI: 10.3760/cma.j.issn.0253-2727.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Dai JW, Cao XX. [Research progress in the treatment of adult Langerhans cell histiocytosis]. ZHONGHUA NEI KE ZA ZHI 2023; 62:97-102. [PMID: 36631045 DOI: 10.3760/cma.j.cn112138-20220106-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gao YJ, Shen KN, Feng J, Chang L, Li H, Su W, Cao XX, Zhang L, Zhou DB, Li J. [Prognostic value of translocation t(11;14) in primary light-chain amyloidosis treated with bortezomib-based regimen]. ZHONGHUA YI XUE ZA ZHI 2022; 102:2854-2860. [PMID: 36153870 DOI: 10.3760/cma.j.cn112137-20211227-02908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the prognostic value of translocation t(11;14) in newly-diagnosed primary light-chain (AL) amyloidosis patients treated with bortezomib-based regimen. Method: Clinical information of newly-diagnosed AL amyloidosis patients in Peking Union Medical College Hospital who had baseline t(11;14) data and accepted bortezomib-combined therapies from September, 2015 to September, 2021 was collected. The relationships between t(11;14) status and baseline characteristics, hematological response, organ response and prognosis were analyzed. Results: A total of 152 patients were included, aged (59.5±9.1) years and 93 cases were male (61.2%). Forty-six patients carried t(11;14) (30.3%). There was no statistical difference in the proportion of organ involved, distribution of Mayo 2004 and 2012 stages and laboratory indexes between patients with and without t(11;14) (all P>0.05). For hematological response, the difference in the rates of ≥very good partial response (VGPR) between those with t(11;14) and without after the first cycle [28.2%(11/39) vs 37.4%(34/91), P>0.05] was not statistically significant. After 3 cycles, the difference in the rates of ≥VGPR between two groups was not statistically significant [35.9%(14/39) vs 51.1%(46/90), P>0.05]. The difference in the ratio of the best hematological response reaching ≥VGPR between two groups during the first-line treatment was not statistically significant [52.2%(24/46) vs 64.2%(68/106), P>0.05]. But patients with t(11;14) had lower cardiac response rate at 3 months [15.2%(5/33) vs 34.6%(28/81), P=0.038] and 6 months [19.4%(6/31) vs 50.6%(42/83),P=0.003] than those without, but the difference in cardiac response rates at 12 months was not statistically significant [41.7%(10/24) vs 53.5%(38/71),P>0.05]. For survival, the differences in overall survival (not reached vs 50.1 months, P>0.05) and hematological event-free survival (36.2 months vs 39.9 months, P>0.05) between patients carrying t(11;14) and those without were not statistically significant. Conclusion: Patients with t(11;14) had lower cardiac response rate than those without, but their hematological response and survival are not significantly different from those free from t(11;14).
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Shen KN, Miao HL, Gao YJ, Cao XX, Zhou DB, Su W, Li J. [Efficacy and safety of daratumumab in the treatment of advanced light chain amyloidosis]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:31-34. [PMID: 35231990 PMCID: PMC8980654 DOI: 10.3760/cma.j.issn.0253-2727.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/13/2022]
Abstract
Objective: The study investigated the efficacy and safety of daratumumab in the treatment of cardiac light chain (AL) amyloidosis. Methods: We retrospectively analyzed the clinical characteristics, hematologic response, organ response, long-term survival, and adverse events of 20 patients with newly diagnosed or relapsed/refractory cardiac AL amyloidosis treated with daratumumab in Peking Union Medical College Hospitalo from January 2017 to March 2021. Results: The overall median age of 20 patients was 62 (range, 45-73) yeas, with a male to female ratio of 2.3:1. Nine patients were newly diagnosed, while 11 patients had relapsed or refractory disease. Based on Mayo 2004 cardiac AL staging system, stages Ⅱ and Ⅲ diseases were present in 20 patients respectively. Four patients died during the first cycle of daratumumab, and the remaining 16 patients completed a median of 3 (range, 1-10) cycles of treatment. Overall hematologic response rates were 80% each at 1, 3, and 6 months after treatment initiation, and 45% , 60% , and 60% of the patients achieved at least a very good partial response at 1, 3, and 6 months respectively. The median duration to hematologic response was 13 (range, 6-28) days. At 3, 6, and 12 months, 20% , 30% , and 40% of the patients respectively achieved a cardiac response, and the median days to response was 91 (range, 30-216) days. As of the last follow-up, 9 (45% ) patients died. The 1-month mortality rate of all the patients and stage IIIb patients was 25% and 40% , respectively. The 1-year overall survival rate was 48.4% . Lymphocytopenia was the most common hematological adverse event (above grade 3) . Non-hematological adverse events were mainly infusion-related reactions and infections. Conclusion: Daratumumab could induce deep and rapid hematologic response in newly diagnosed and previously treated cardiac AL amyloidosis patients. However, daratumumab was not effective in preventing the high and early mortality rate in stage Ⅲb patients.
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Zhang XM, Cao XX, He LX, Xue W, Gao JQ, Lei NF, Chen JS, Yu FH, Li MH. Soil heterogeneity in the horizontal distribution of microplastics influences productivity and species composition of plant communities. FRONTIERS IN PLANT SCIENCE 2022; 13:1075007. [PMID: 36570919 PMCID: PMC9772521 DOI: 10.3389/fpls.2022.1075007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/23/2022] [Indexed: 05/21/2023]
Abstract
Contamination of soils by microplastics can have profound ecological impacts on terrestrial ecosystems and has received increasing attention. However, few studies have considered the impacts of soil microplastics on plant communities and none has tested the impacts of spatial heterogeneity in the horizontal distribution of microplastics in the soil on plant communities. We grew experimental plant communities in soils with either a homogeneous or a heterogeneous distribution of each of six common microplastics, i.e., polystyrene foam (EPS), polyethylene fiber (PET), polyethylene bead (HDPE), polypropylene fiber (PP), polylactic bead (PLA) and polyamide bead (PA6). The heterogeneous treatment consisted of two soil patches without microplastics and two with a higher (0.2%) concentration of microplastics, and the homogeneous treatment consisted of four patches all with a lower (0.1%) concentration of microplastics. Thus, the total amounts of microplastics in the soils were exactly the same in the two treatments. Total and root biomass of the plant communities were significantly higher in the homogeneous than in the heterogeneous treatment when the microplastic was PET and PP, smaller when it was PLA, but not different when it was EPS, HDPE or PA6. In the heterogeneous treatment, total and root biomass were significantly smaller in the patches with than without microplastics when the microplastic was EPS, but greater when the microplastic was PET or PP. Additionally, in the heterogeneous treatment, root biomass was significantly smaller in the patches with than without microplastics when the microplastic was HDPE, and shoot biomass was also significantly smaller when the microplastic was EPS or PET. The heterogeneous distribution of EPS in the soil significantly decreased community evenness, but the heterogeneous distribution of PET increased it. We conclude that soil heterogeneity in the horizontal distribution of microplastics can influence productivity and species composition of plant communities, but such an effect varies depending on microplastic chemical composition (types) and morphology (shapes).
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Cao XX, Zhao L, Shi BL, Wang HY, Zhang QB, Zhong K, Sun P, Zhu BQ, Zhang LL. The influence of NaCl on the dynamic perception of the pungency sensation elicited by Sichuan pepper oleoresins. Food Res Int 2021; 149:110660. [PMID: 34600662 DOI: 10.1016/j.foodres.2021.110660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
A cross-modal interaction may exist between the perception of saltiness and the pungency elicited by Sichuan pepper oleoresin (Spo). Thirty-one hypersensitive panelists were selected to participate in this study. Spo solutions dissolved in different NaCl concentrations, ranging from 1.25 g/L to 167.9 g/L, were used as the test samples. The rated difference from control, the generalized labeled magnitude scale (gLMS), and the time-intensity (TI) method were used to determine the detection threshold (DT), the recognition threshold (RT), the intensity, and the dynamic perception of pungent sensation. The results revealed that the pungency thresholds increased significantly (p < 0.01) in the solution with a high NaCl (167.9 g/L) concentration. Furthermore, high NaCl solutions suppressed the pungency intensity at all Spo concentrations except for 0.02 g Spo/L in water (p < 0.05). The TI and principal component analysis (PCA) results showed that an increase in the Spo concentration prolonged the duration of the pungency sensation. However, the maximum intensity, the time to reach maximum intensity, the decay time of perception, and the end time of perception of the Spo solutions ranging from 2.13 g/L to 4.69 g/L were significantly reduced at medium (42.95 g/L) and high NaCl concentrations. Since the salty and pungency sensations exhibited by NaCl and Spo are common flavor combinations in food products and dishes, studying the influence of saltiness on the dynamic perception of pungent sensation not only aids the development of oral cleaners during pungency evaluation but also presents significant theoretical and practical value in creating pungent food and cuisine based on consumer preferences.
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Han HX, Cao XX, Su W, Shen KN, Zhang L, Zhou DB, Li J. [Clinical characteristics and outcome of patients with type Ⅱ cryoglobulinemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:447-451. [PMID: 34384149 PMCID: PMC8295613 DOI: 10.3760/cma.j.issn.0253-2727.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
目的 探讨Ⅱ型冷球蛋白血症患者的临床特征及预后。 方法 回顾性分析2015年5月至2020年1月北京协和医院确诊的61例Ⅱ型冷球蛋白血症患者的临床资料。 结果 61例患者中,男性26例(42.6%),中位诊断年龄为53(28~79)岁。继发病因包括丙型肝炎病毒(HCV)感染(21.3%)、乙型肝炎病毒(HBV)感染(21.3%)、自身免疫性疾病(14.8%)和血液系统肿瘤(11.5%)。31.1%患者为特发性。常见首诊症状包括皮肤紫癜、蛋白尿、血尿、肾功能不全、发热及关节痛。实验室检查显示,中位冷球蛋白水平为215.9(22.0~17 075.8)g/L,54例(88.5%)为IgM单克隆。类风湿因子(RF)升高患者占93.2%,C3下降患者占57.6%,C4下降患者占61.0%。共49例(80.3%)患者接受治疗,总体临床缓解率为75.5%,预计3年总生存率为89.3%。 结论 Ⅱ型冷球蛋白血症是一种多系统受累的全身性疾病,病因以肝炎病毒感染多见。早期诊断和干预对于改善预后有重要意义。
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He TH, Zhao AL, Niu N, Wang FD, Shi J, Li J, Cao XX. [Erdheim-Chester Disease presenting with exophthalmos, impaired vision, and retroperitoneal fibrosis: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:673-676. [PMID: 34547874 PMCID: PMC8501279 DOI: 10.3760/cma.j.issn.0253-2727.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Yang YJ, Cao XX, Wang FD, Li S, Li ML, Li J, Tian XP, Zeng XF. [The 487th case: prominent eyes, headache, blurred vision]. ZHONGHUA NEI KE ZA ZHI 2021; 60:388-392. [PMID: 33765713 DOI: 10.3760/cma.j.cn112138-20200405-00344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One 51 years old man was admitted to the rheumatology department with a history of prominent eyes, headache and blurred vision for half year. The main manifestations included retrobulbar inflammatory pseudotumor and retroperitoneal fibrosis. He was initially diagnosed as granulomatosis with polyangiitis. Prednisone and cyclophosphamide were administrated and effective. New mass of dura mater and osteosclerosis presented during follow up. Finally Erdheim Chester disease(ECD) was diagnosed by biopsy and pathological examination. Vemurafenib, a v-raf murine sarcoma viral oncogenes homolog B1 (BRAF) inhibitor, 480 mg was given twice a day. The patient's condition is stable and still in follow-up. Although ECD is a rare histiocytosis, clinicians should pay attention to its manifestations and differential diagnoses.
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Miao HL, Shen KN, Su W, Zhang L, Cao XX, Zhou DB, Li J. [Clinical presentation and prognosis in patients with light-chain amyloidosis with an ultra-high level of serum free light-chain]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:199-204. [PMID: 33910304 PMCID: PMC8081949 DOI: 10.3760/cma.j.issn.0253-2727.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical features and outcomes of patients with light-chain (AL) amyloidosis with an ultra-high level of serum free light-chain (FLC) . Methods: Five hundred and ninety-five patients with AL amyloidosis were retrospectively reviewed between January 2009 and January 2020 at Peking Union Medical College Hospital. We analyzed the clinical features and prognosis of patients with ultra-high FLC levels [difference between involved and uninvolved light chains (dFLC) >500 mg/L; n=124] and those without ultra-high FLC levels (dFLC≤500 mg/L; n=471) . Results: Patients with ultra-high FLC presented with more frequent cardiac involvement (82.3% vs 70.1%, P=0.007) , and a higher percentage of patients with 2004 Mayo Ⅲ stage (41.8% vs 33.8%, P=0.029) , but less frequent renal involvement than patients without an ultra-high FLC (59.7% vs 71.8%, P=0.009) . Patients with an ultra-high FLC achieved a lower proportion of hematologic (72.4% vs 82.3%, P=0.048) and cardiac response (37.3% vs 54.7%, P=0.016) and had shorter overall survival (13.0 months vs not reached, P<0.001) and a higher early death rate within 3 months (28.2% vs 11.3%, P<0.001) than those without an ultra-high FLC. Ultra-high FLC independently predicted worse prognosis in patients with AL amyloidosis (HR=2.279, 95%CI 1.685-3.083, P<0.001) . Conclusions: Patients with an initially ultra-high FLC represented a subgroup with more common cardiac involvement, more advanced cardiac stages, and extremely poor prognosis.
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Feng J, Zhang L, Cao XX, Zhang Y, Yang C, Cai HC, Chen M, Wang W, Zhang W, Zhu TN, Duan MH, Li J, Zhou DB. [A pediatric-inspired regimen for adolescents and young adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: results from a single center]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:399-404. [PMID: 32536137 PMCID: PMC7342075 DOI: 10.3760/cma.j.issn.0253-2727.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 12/21/2022]
Abstract
Objective: To investigate the efficacy of using a pediatric-inspired regimen for adolescents and young adults (AYA) with Philadelphia chromosome-negative (Ph(-)) acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL) at a single center in China. Methods: Clinical data of 71 consecutive newly diagnosed AYA patients with Ph(-) ALL/LBL on a pediatric-inspired regimen in Peking Union Medical College Hospital from January 2012 to November 2018 were retrospectively analyzed. Results: Median age at diagnosis was 20 years (range: 15-38) , and 46 patients (64.8%) were male. Forty-nine (69.0%) had B-ALL/LBL. Among 62 ALL patients, 22 (35.5%) were high-risk. Complete remission rate was 93.0%. At follow-up with a median time of 44 months, the estimated 5-year disease-free survival (DFS) and overall survival (OS) was 56.3% and 64.3%, respectively. There was no significant difference in 5-year OS between allogeneic hematopoietic stem cell transplantation group and the continuous chemotherapy group after completion of 4 courses of chemotherapy. The 5-year DFS and OS for the non-high-risk group was 63.1% and 73.7%, respectively, which were significantly higher than 32.0% and 44.4% for the high-risk group, respectively (P<0.001) . Conclusions: The use of pediatric-inspired regimen for AYAs with Ph(-) ALL/LBL was feasible and effective.
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Gao XM, Jia MN, Qian M, Ren HT, Zhang L, Shen KN, Cao XX, Li J. [Anti-myelin-associated glycoprotein antibody positive IgM monoclonal gammopathy related peripheral neuropathy: 11 cases and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:901-905. [PMID: 31856437 PMCID: PMC7342372 DOI: 10.3760/cma.j.issn.0253-2727.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 11/08/2022]
Abstract
Objective: To improve the understanding of rare anti-myelin-associated glycoprotein (MAG) positive IgM monoclonal gammopathy related peripheral neuropathy (IgM-PN) . Methods: Eleven cases of IgM paraproteinemia and anti-MAG antibody positive neuropathy diagnosed since 2014 in Peking Medical Union College Hospital were summarized. The medical records including clinical manifestation, lab results, treatment and prognosis were analyzed. Results: Among the 11 patients (8 male and 3 female) , the median onset age is 63 years old (range from 52 to 77 years old) . The peripheral neuropathy of 9 patients were characterized by distal onset of numbness, 6 patients suffered from muscle weakness. The nerve conduction velocity study indicated that all 11 patients had demyelinating peripheral nerve damage, which was sensory predominant and more severe in lower limbs, 6 of them had secondary axonal damage. Monoclonal IgM gammopathy was identified in all 11 patients, among which 6 were IgM κ, 2 IgG κ and IgM κ bi-clonal, 3 IgM λ. Three patients were diagnosed with Waldenström's macroglobulinaemia. The anti-MAG-IgM antibody was positive in all 11 cases. After diagnosis, 9 patients received combination chemotherapy including rituximab or rituximab treatment alone. The monoclonal IgM level declined significantly in 7 patients. The neuropathy was stable or improved. Conclusions: Anti-MAG antibody positive IgM-PN is a rare M protein related disease. In peripheral neuropathy with undetermined etiology, we suggest to screen M protein and anti-MAG antibody. Chemotherapy including rituximab or rituximab alone is recommended as first-line therapy.
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Qiu Y, Jiang XY, Luo YP, Li J, Zhou DB, Cao XX. [A 55-year-old male with anemia and monoclonal gammopathy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:783-785. [PMID: 31648486 PMCID: PMC7342450 DOI: 10.3760/cma.j.issn.0253-2727.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 11/26/2022]
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Wu YY, Cao XX, Cai H, Zhang L, Zhou DB, Li J. [Clinical features and prognosis of 17 patients with primary cold agglutinin disease]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:789-793. [PMID: 29081197 PMCID: PMC7348369 DOI: 10.3760/cma.j.issn.0253-2727.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
目的 探讨17例原发性冷凝集素病(CAD)患者的临床特征、治疗及转归。 方法 回顾性分析2007年4月至2016年10月北京协和医院确诊的17例原发性CAD患者的临床资料、治疗和转归,并检测了其中4例患者MYD88L265P突变情况。 结果 17例患者中,男女比为1.1∶1,中位年龄67(51~86)岁。7例伴有惰性淋巴瘤,包括3例华氏巨球蛋白血症/淋巴浆细胞淋巴瘤(WM/LPL),2例小淋巴细胞淋巴瘤/慢性淋巴细胞白血病(SLL/CLL)和2例脾边缘区淋巴瘤(SMZL)。患者中位HGB为67(35~127)g/L,15例存在贫血。11例患者的冷凝集素(CA)滴度≥1∶64,中位CA滴度为1∶1 024。4例行MYD88L265P突变检测的患者中1例MYD88L265P阳性。12例患者接受了药物治疗:7例使用糖皮质激素为基础的化疗,1例有效;5例使用利妥昔单抗为基础的免疫化疗的治疗,3例有效。1例患者失访,其余16例患者中位随访14(0.5~96)个月,中位总体生存时间尚未达到。 结论 CAD的临床表现多样,CA检测是诊断CAD的关键。CAD糖皮质激素治疗效果不佳,推荐利妥昔单抗治疗。
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Liu XL, Li L, Shi QL, Chen LJ, Cao XX, Li J, Liao AJ, Zou DH, Sun JN, Gao SJ, Li W, Hou J, Jin FY. [A retrospective study of the BiRd regimen in the treatment of relapsed/ refractory multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:837-841. [PMID: 29166734 PMCID: PMC7364962 DOI: 10.3760/cma.j.issn.0253-2727.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate efficacy of the BiRd regimen, a combination of clarithromycin, lenalidomide, and dexamethasone, in the treatment of patients with relapsed/refractory multiple myeloma (RRMM) . Methods: Patients with RRMM treated with BiRd between September 11, 2013 and August 1, 2016 at six centers were included to evaluate overall survival rate (ORR) , clinical benefit rate (CBR) , progression-free survival (PFS) , overall survival (OS) , as well as adverse events. Results: Of 30 patients with RRMM, 27 patients were evaluable, and ORR and CBR were 51.9% (14/27) and 66.7% (18/27) respectively, including 1 sCR (3.7%) , 3 CR (11.1%) , 3 VGPR (11.1%) , and 7 PR (25.6%) . In 13 patients with prior Rd, ORR and CBR were 38.5% (5/13) and 61.5% (8/13) respectively, of which 5 patients with ≥MR carried high-risk cytogenetic[ (e.g.17p- or t (4;14) ] together with at least one of other adverse-prognostic cytogenetic (e.g.13q- and/or 1q21+) . In 24 patients with prior bortezomib-based therapy, ORR and CBR were 45.8 and 62.5%, respectively. With a median follow-up time of 14.9 (range 1.0-33.8) months, the median PFS and OS were 12.0 (95%CI 11.6-12.4) and 27.6 (95%CI 15.1-40.1) months, respectively. The BiRd regimen was well tolerated. Conclusion: The BiRd regimen is an effective and safety protocol for RRMM, including those carrying high-risk cytogenetic markers.
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Zhang JY, Cao XX, Wen HX, Zhang HY. Correlation analysis of levels of inflammatory cytokines and nitric oxide in peripheral blood with urine proteins and renal function in patients with gestational hypertension. Exp Ther Med 2019; 17:657-662. [PMID: 30651847 PMCID: PMC6307447 DOI: 10.3892/etm.2018.7004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/10/2018] [Indexed: 12/28/2022] Open
Abstract
The aim of the study was to investigate correlations among inflammatory cytokines, nitric oxide (NO) level, urine protein, renal function and blood pressure in peripheral blood of patients with hypertensive disorder complicating pregnancy (HDCP). A total of 60 patients diagnosed with HDCP in the Obstetrics Department of Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2016 to April 2017 were selected. The patients were divided into the HDCP (n=20), mild pre-eclampsia (n=20) and severe pre-eclampsia (n=20) groups. Additionally, 20 healthy pregnant women were selected as the control group. General data of the patients were collected. NO, renal function and 24-h urine protein were measured. The systolic and diastolic blood pressure, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the HDCP group was significantly higher than that in the control group. The CRP, TNF-α and IL-6 levels in the pre-eclampsia groups were higher than those in the gestational hypertension group (P<0.05). The NO level in peripheral blood of patients in the pre-eclampsia groups was lower than that in the gestational hypertension group (P<0.05). The levels of 24-h urine protein, homocysteine (Hcy), cystatin-C (Cys-C), serum creatinine (SCr), urea and β2 microglobulin in the pre-eclampsia groups were higher than those in the gestational hypertension group (P<0.05). Gestational age and the levels of baseline blood pressure, inflammatory cytokines, 24-h urine protein and renal function have independent predictive value for the occurrence of HDCP (P<0.05). The results show that, 24-h urine protein, renal function and inflammatory cytokines are closely correlated with the occurrence of HDCP, which can reflect the severity and prognosis of the disease to a certain extent. In addition, it has important reference value for the assessment and treatment of the disease.
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Qiu M, Wen HX, Huang XL, Yi LF, Cao XX, Wang WJ. [Effect of vitamin D deficiency on cardiac autonomic nerve function in obese pre-school children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:753-757. [PMID: 30210029 PMCID: PMC7389169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/22/2018] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the effect of vitamin D (VitD) deficiency on cardiac autonomic nerve function in obese pre-school children. METHODS A total of 242 pre-school children with simple obesity were enrolled, and according to the serum 25-(OH) VitD level, they were divided into VitD deficiency group (76 children), VitD insufficiency group (83 children), and VitD sufficiency group (83 children). The three groups were compared in terms of deceleration capacity (DC) of heart rate, acceleration capacity (AC) of heart rate, and heart rate variability (HRV). The correlations of VitD level with DC, AC, and HRV were analyzed for the VitD insufficiency and VitD deficiency groups. RESULTS The VitD deficiency group had the lowest DC, root mean square of successive differences between adjacent RR intervals (RMSSD), and low-frequency power (LF) and the highest AC (P<0.05). The VitD insufficiency group had significantly lower DC, RMSSD, and LF and significantly higher AC compared with the VitD sufficiency group (P<0.05). The VitD deficiency group had significantly lower standard deviation of normal-to-normal RR intervals (SDNN) and high-frequency power (HF) than the VitD sufficiency group (P<0.05). In the VitD deficiency group, VitD level was positively correlated with DC, SDNN, standard deviation of average normal-to-normal RR intervals, RMSSD , LF, and HF and was negatively correlated with AC (P<0.05). In the VitD insufficiency group, VitD level was negatively correlated with AC (P<0.05). CONCLUSIONS Obese pre-school children with VitD insufficiency or deficiency have cardiac autonomic dysfunction, and cardiac vagal tone decreases with the reduction in VitD level.
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Qiu M, Wen HX, Huang XL, Yi LF, Cao XX, Wang WJ. [Effect of vitamin D deficiency on cardiac autonomic nerve function in obese pre-school children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:753-757. [PMID: 30210029 PMCID: PMC7389169 DOI: 10.7499/j.issn.1008-8830.2018.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the effect of vitamin D (VitD) deficiency on cardiac autonomic nerve function in obese pre-school children. METHODS A total of 242 pre-school children with simple obesity were enrolled, and according to the serum 25-(OH) VitD level, they were divided into VitD deficiency group (76 children), VitD insufficiency group (83 children), and VitD sufficiency group (83 children). The three groups were compared in terms of deceleration capacity (DC) of heart rate, acceleration capacity (AC) of heart rate, and heart rate variability (HRV). The correlations of VitD level with DC, AC, and HRV were analyzed for the VitD insufficiency and VitD deficiency groups. RESULTS The VitD deficiency group had the lowest DC, root mean square of successive differences between adjacent RR intervals (RMSSD), and low-frequency power (LF) and the highest AC (P<0.05). The VitD insufficiency group had significantly lower DC, RMSSD, and LF and significantly higher AC compared with the VitD sufficiency group (P<0.05). The VitD deficiency group had significantly lower standard deviation of normal-to-normal RR intervals (SDNN) and high-frequency power (HF) than the VitD sufficiency group (P<0.05). In the VitD deficiency group, VitD level was positively correlated with DC, SDNN, standard deviation of average normal-to-normal RR intervals, RMSSD , LF, and HF and was negatively correlated with AC (P<0.05). In the VitD insufficiency group, VitD level was negatively correlated with AC (P<0.05). CONCLUSIONS Obese pre-school children with VitD insufficiency or deficiency have cardiac autonomic dysfunction, and cardiac vagal tone decreases with the reduction in VitD level.
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