Volume 90  ·   Issue 22  ·  2010

At present, translational medicine has been widely concerned and recognized by scholars at home and abroad, but its definition has not been completely formed, and its understanding is different. Therefore, when we are faced with the practice of translational medicine, it is necessary to understand the ideas and practices of international first-class medical schools.

The application of new technologies such as molecular biology has renewed people's understanding of disease pathogenesis and promoted the change of people's thinking on disease diagnosis.In order to adapt to the development of the times, we need to strengthen the research on the complementary value of cell morphology methods (especially the same level methods), strengthen the connection with other scientific knowledge and the research on morphology in the new era, and further improve the level of cell morphology examination and diagnosis.

With the rapid development of materials science, electronics and information engineering and the application of their scientific research achievements in laboratory medicine, new technologies, new methods, new thinking and new models are constantly introduced into the research and development of medical examination and analysis instruments. New technologies, many functions, easy operation, fast speed, high precision, accurate results, standardization and informatization are the main trends of the development of examination methodology.

Objective To explore the role of bone marrow (BM) imprint in the diagnosis of hematological diseases.Methods Between January 2002 and June 2008,a total of 3024 cases with BM smears,imprints and sections conducted simultaneously were recruited.There were 1667 males and 1357 females with a median age of 55 years old (range:7 to 92).The cellularity on imprint and smear was evaluated with the standard cellularity on BM section.With the integrative diagnosis (including all examinations and clinical outcomes)88 the standard,the diagnostic accuracy of hematological diseases were compared between BM imprint,smear and section groups.Another 79 cases of lymphoma and 114 cases of plasma cell myeloma (PCM) were selected for a correlation analysis of tumor cell infiltration patterns.Results BM imprint contained hematopoietic and non-hematopoietic regions and cells retained integrated structure.The cellularity evaluation by imprint was superior to smear overall.In BM imprint group,the diagnostic accuracy for hypersplenism (n=130),metastatic carcinoma (n=67),refractory anemia with excess blasts,myeloproliferative neoplasm (n:174),and PCM (n=94) were better than smear group (96.9% vs 80.7%,91.0% vs 76.1%,92.6% vs 81.5%,92.5% vs 76.4%,and 97.8% vs 92.6%respectively,all P<0.05);And the diagnostic accuracy for megaloblastie anemia(n=69),acute myeloid leukemia(n=104),refractory cytopenia with unilineage dysplasia (n=15),refractory cytopenia with muhilineage dysplasia(n=22),and lymphoplasmacytic lymphoma(n=12) were higher than biopsy section group (100% vs 84.0%,91.3% vs 74.0%,86.7% vs 60.0%,90.9% vs 72.7%,and 66.6% vs 50.0%respectively,all P<0.05);And the diagnostic accuracy for myelodysplastic/myeloproliferative neoplasm (n=26) was higher than smear group (76.3%,P<0.05) and biopsy section group (78.2%,P<0.05).Excellent correlations existed between BM imprint and section of the patients with lymphoma or with PCM (r=0.90,r=0.78,both P<0.05).Conclusions BM imprint contains the characteristics of both smear and section.BM imprint is superior to smear for an evaluation of cellularity.And it is also better than section for an analysis of cytological changes.

objective To establish the suitable review criteria for ADVIA 120/2120 and those for different series of hematology analyzers.Methods A total of 2400 samples,including 6 blood neoplasms,were detected with ADVIA 120/2120 hematology analyzer,in which 1200 samples were detected by Sysmex XE-2100 and Beckman-Coulter LH750 hematology analyzers.In the meantime,blood smears were reviewed,and the results were analyzed statistically.The new review criteria were established by consulting and modifying the one as recommended by an international consensus group.Finally 300 samples were selected to validate the new review criteria.Results The results of 2400 samples detected by ADVIA 120/2120 hematology analyzer were analyzed statistically according to the international consensus review rules and blood smear positive criteria formulated by Chinese experts.The true positive rate was 22.1%(n=530),false positive rate 28.1%(n=675),true negative rate 44.3%(n=1063),false negative rate 5.5%(n=132),and the smear review rate 50.2%(n=1205).The false negative rate was over the acceptable limit of 5%.The new review criteria were established by amending the blcod smear positive criteria,i.e.increasing the percentage of band neutrophils,eosinophils,basophils and monocytes and adjusting the international consensus review rules.Then the results were re-analyzed.The true positive rate.false positive rate,true negative rate and false negative rate were 15.5%(n=371),18.7%(n=449),61.6%(n=1479) and 4.2%(n=101) respectively.The smear review rate was 34.2%(n=821) and no specimen of blood neoplasms was missed.On that basis,the current review criteria for ADVIA 120/2120,XE-2100 and LH750 hematology analyzer were proposed by adding some specific parameters.The results of 1200 samples with three instruments were analyzed according to the current criteria.And the false negative rates were 4.3%,4.6% and 4.6%,and false positive rate 14.7%,17.5%and 12.7% respectively.And no specimen of blood neoplasm Was missed.The false negative rates of three instruments were 3.8%,4.3% and 4.0% in validation teses.Conclusion The review criteria for three difierent series of hematology analyzers have been formulated for large general hospitals.

Objective To evaluate the review criteria for complete blood analysis.Methods A total of 8820 blood samples taken at our hospital were detected both by the Sysmex XE-2100 automated blood cell analyzer and double-blind method microscopy.The performance of two review criteria were evaluated by statistical analysis.The parameters,such as true and false positive rates,true and false negative rates,sensitivity,specificity,positive predictive value,negative predictive value,total effective rate,test effectiveness and re-examination rate were calculated according to the criteria of XE-2100 hematology analyzer re-examination standards coordination group of Society of Laboratory Medicine of Chinese Medical Association.And a study was conducted to determine the improved clinical effectiveness over the criteria.Results The values of true and false positive rates,true and false negative rates,sensitivity,specificity,positive predictive values,negative predictive value,total effective rate,test effectiveness and reexamination rate were 13.0%,27.2%,55.3%,4.5%,74.3%,67.0%,32.4%,92.5%,68.3%,21.2%,and 40.2% respectively.The re-examination rate decreased to 33.8% and the total effective rate increased to 74.7% according to our improved review criteria.And there Was no missed diagnosis of leukemic cells.It was found that 2069 samples (23.5%) needed manual microscopy for WBC differential analysis,847 had abnormal cells and no leukemia was missed.Conclusions The automatic blood cell analyzer and WBC differential analysis review criteria have great clinical utilities.The review criteria of blood cell analysis may be improved according to patient source and instrument performance so as to better meet the needs of clinical application.

Objective To evaluate the long-term outcomes of childhood stage Ⅲ neuroblastoma (NB) and its associated prognostic factors.Methods Children with newly diagnosed NB were enrolled into the protocol of NB-99 and followed up from January 1999 to May 2007.The relevant data were collected.And the statistics was processed by SPSS 10.0.Results Thirty children with stage ill NB were found among all 101 children with NB.There were 19 males and 11 females.The mean age at diagnosis was (33±30) months.Abdomen and thorax were by far the most common sites of primary tumor (16 and 10 respectively).Twenty-one NB children had favorable pathology classification Eleven NB children were treated according to the mediate-risk protocol,6 children received autologous stem cell transplantation (ASCT) after chemotherapy and 5 patients had no therapy of cis-retinoic acid.Follow-up was conducted for 5-96 months.A complete response or an excellent partial remission was observed in 28 patients.Seven patients relapsed or progressed at the primary tumor site or bone marrow.The estimated cumulative probabilities of event-free survival and overall survival at 4 years for these 30 patients were 74%±9% and 77%±8% respectively.On univariate analysis,pathological type,high levels of LDH and ferritin,non-therapy of cis-retinoic acid were associated with a worse survival (X2=9.48,6.82,9.17,9.06,all P<0.05).As to the multivariate estimates of hazards ratio,high levels of LDH and ferritin,no ASCT and non-therapy of cis-retinoic acid were associated with a worse survival (OR=3.95,3.44,2.64,1.27,all P<0.05).Conclusion Stage Ⅲ NB children with favorable histologic features,normal LDH,normal serum ferritin,receive ASCT,and treated with cis-retinoic acid have a lower risk of relapse.

Objective To investigate the anatomical relationships of facial nerve canal related to middle ear and mastoid surgery by multi-slice computed tomography (MSCT) and its muhiplanar reconstruction (MPR) technology.Methods High-resolution CT scanning with multislice spiral CT of temporal bones without bone abnormality of 373 ears in 187 adult patients were examined.All original images were processed by MPR. The distances between facial nerve canal (FNC) and iugular foramen (JF),lateral surface of mastoid bone (M),external acoustic canal (EAC),posterior fossa dural plate (PFD),sigmoid sinus (SS),promontory (P),cochlear window (CW),pyramidal eminence (PE),posterior semicircular canal (PSC),oval window (OW),head of malleus (MH),incus lenticular process (ILP) and lateral semicircular canal (LSC) were measured on different MPR images.These measurements were also analyzed with respects to side,gender,pneumatization and jugular foramen position differences.Results On average,FNC-JF was 5.43 mm,FNC-M 15.99 mm,FNC-EAC 4.42 mm,FNC-PFD 9.01 mm,FNC-SS 9.44 mm,FNC-P 6.02 mm,FNC-CW 6.51 mm,FNC-PE 2.64 mm,FNC-PSC 3.12 mm,FNC-OW 1.19 mm,FNC-MH 2.27 mm,FNC-ILP 3.09 mm and FNC-LSC 0.90 mm FNC-M was longer in males than that of females (P<0.05).FNC-JF and FNC-SS were longer on left side than those of the right (P<0.05).FNC-PFD was shorter on left side (P<0.05).FNC-PFD,FNC-EAC,FNC-SS and FNC-M were longer in well pneumatized mastoids than those of poorly pneumatized mastoids (P<0.05).FNC-PE was longer in poorlY pneumatized mastoids than that of well pneumatized mastoids (P<0.05).FNC-PFD,FNC-P,FNC-CW and FNC-PSC were longer in bones with jugular foramen vailation than those of bones without jugular foramen variation (P<0.05).FNC-JF,FNC-SS and FNC-M were longer in bones without iugular foramen variation than those of bones with iugular foramen variation (P<0.05).Conclusions Anatomical relationships of facial nerve canal related to middle gar and mastoid surgery can be accurately measured on MSCT-MPR images.It is helpful to avoid injuring facial nerve in middle ear and mastoid surgery.

Objective To detect the effect of extracellular Ca2+ concentrations on test results of coagulation-related parameters.Methods Blood samples of outpatient medical volunteers were collected and then different doses of calcium chloride added.The rate of platelet aggregation (n=42),prothrombin time (PT),thrombin time (TT) and activated partial thromboplastin time (APTT) (n=21) and parameters of thromboelastography (n=30) were detected according to the standard protocols by plasma turbidimetry,coagulation and recalcification respectively.Results When the plasma Ca2+ concentration was in the range of 0.1-33.7 mmol/L.the rate of platelet aggregation gradually increased with a increasing concentration of Ca2+.And the rates induced by adenosine diphosphate (ADP) and arachidonic acid (AA) were (51.8±9.6)%-(94.7±4.8)% and (64.4±12.2)%-(93.2±5.5)%respectively.When the Ca2+ concentration was 39.0 mmol/L,the rate decreased markedly [ADP(9.1±5.3)%,AA (11.1±4.5)%,both P<0.01].When the Ca2+ concentration was in the range of 0.1-33.7 mmol/L,the values of PT gradually increased with a increasing concentration of Ca2+.The values of TT changed in "V"-type and became minimum when the calcium concentration was 4.4 mmol/L The values of APTT decreased with higher calcium concentrations and could not be determined when the concentration increased above 0.5 mmol/L When the Ca2+ concentration was in the range of 0.4-27.3 mmol/L,the values of reaction time and coagulation time of thromboelastography changed in "V"-type and became nearly minimal at the Ca2+ concentration of about 2.1 mmol/L The values of a angle and maximum amplitude changed in"∧"-type and became maximal at the Ca2+ concentration of 2.1 mmol/L.Conclusions The effect of Ca2+ concentration on the testing results of coagulation-related parameters is significant.A high calcium (≥39mmol/L) can inhibit the platelet aggregation,coagulation factor activity and blood coagulation.The Ca2+ concentration of 2.1 mmol/L seems to be the optimal concentration for thromboelastography by recalcification method.

Objective To evaluated the feasibility and therapeutic effect of laparoscopic-endoscopic single-site surgery (LESS) for radical cystoprostatectomy and orthotopic ileal neobladder.Methods Between November 2008 and August 2009,8 male patients with bladder cancer underwent modified single port laparoscopic cystoprostatectomy and orthotopic ileal neobladder with a home-made muhichannel port made up of two stretchable rings and a surgical glove with trocars and valves attached to its fingers.A 4-5 cm midline incision was made in lower abdomen and the muhichannel port placed into this incision.Laparoscopic instrument was extended through the multichannel port.Another port Was placed at the umbilicus site for laparoscope.The investigators performed the modified single port transperitoneal technique with bilateral extended lymphadenectomy,laparoscopic radical cystoprostatectomy,construction of ileal neobladder extracorporeally and urethro-pouch anastomosis under laparoscopy with a slipknot running suture technique.The perioperative and postoperative data were collected and analyzed prospectively.Results In all cases,no conversion into conventional laparoscopic or open surgery was necessary.The mean operative duration,including extended lymph node dissection,was 399 min (range:355-455 min).Mean estimated blood loss Was 154 ml (range:90-210 ml).The mean postoperative hospital stay WaS 15 d (range:14-18 d).No peri-operative mortality was reported.One case had delirium 2 days postoperatively and there was no port-related complication.The pathological report confirmed surgical margins were tumor-free for all cases.The average number of removed lymph node was 20.The mean follow-up period was 6.1 months (range:2.0-10.0 months).All patients remained disease-free until the last follow-up.Conclusions With a reduction of 4 ports,modified single port laparoscopic radical cystectomy with orthotopic ileal neobladder is technically feasible with a low complication rate.Our initial outcome is encouraging,but additional work and a further follow-up are warranted to critically compare the oncological outcome with open surgery.

Objective The prevalence of cardiovascular risk factors is growing.People with metabolic syndrome (MS) plus five cardiovascular risk factors are at a higher risk of developing coronary artery disease (CAD).The effect of metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied.The present study Wag conducted to assess the prevalence,characteristics and longterm prognosis of CAD with metabolic syndrome and to determine which factor is the most influential prognostic factor of CAD.Methods The DESIRE(drug-eluting stent impact on revascularizafion) registry represented a database of 2368 CAD patients between July 2003 and September 2004.The median long-term follow-up Was 3.5 years (293-1855 days).Metabolic syndrome was based on the modified version of Adult Treatment Panel (ATP) Ⅲ Definition of Metabolic Syndrome in 2005 using body mass index (BMI) instead of waist circumference.We tested the utility of MS and its components to predict the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascu|arization.Results The presence of MACCE was predicted only by MS (OR=1.319,95% CI 1.020-1.706,P=0.035) but not other cardiovascular risk factors,such as advance age,male,smoking,high LDL cholesterol and CAD family history.MS was present in 45.6% (high fasting glucose 44.5%;high triglyceride 45.0%;low HDL 50.8%;high blood pressure 61.4%;high BMI 60.7%).Conclusion Among the traditional cardiovascular risk factors,only metabolic syndrome has a primary predictive ability for MACCE in CAD patients.

Objective To observe the effects of Tongxinluo (TXL) on repeated hypoxic tolerance in mice and explore the underlying mechanisms. Methods Mice were randomly divided into groups of repeated hypoxia (control) and TXL according to body weights. The mice in each group were exposed to acute repeated hypoxia for 0 run ( H0 ) , 1 run ( H1 ) , 3 runs ( H3 ) and 5 runs ( H5 ) . The animal's tolerance time of each hypoxic exposure was recorded. Western blot was used to measure the protein levels of hypoxia inducible factor-la (HIF-la) and vascular endothelial growth factor (VEGF) in cortex tissue. Results The hypoxic tolerance time in control and TXL groups significantly increased run by run. Both HIF-la and VEGF proteins in two groups increased gradually. Compared with control group, the tolerance time in H1 of TXL group [(18. 0±2. 4) min vs (15.6±2.0 )min] , H3[ (68. 3±13. 2) min vs (41.7±9.0) min) and H5( 85.9±7.0) min vs (51.4±14.4) min] increased (P<0.05 or P <0.01); the HIF-la protein expression in H1 of TXL group (0. 95±0. 04 vs 0.79±0. 02) , H3 (1. 01±0. 03 vs 0. 85±0.02), H5(l. 16±0.02 vs 0.92±0.03) increased (P<0. 05 or P<0. 01) ; the VEGF protein expression in H3 of TXL group (1. 14±0. 02 vs 0. 89±0.03), H5( 1. 4±0.05 vs 0.99±0. 07) increased (P <0. 05 or P <0. 01). Conclusions Under repeated hypoxia, an organism has a strong daptive ability. The rises of HIF-la and VEGF may be an adaptive mechanism. TXL can increase obviously the adaptive ability of mice to hypoxia.

Objective To investigate the serotype distribution, antimicrobial resistance patterns and molecular epidemiology of Streptococcus pneumoniae ( 5. pneumoniae) isolated from invasive pneumococcal diseases in order to provide rationales for antibiotics application and immunity control of 5. pneumoniae. Methods A total of 148 isolates of invasive S. pneumoniae were collected from blood, cerebrospinal fluid and other sterile body fluids from 15 regions between January 2005 and August 2008 nationwide. Agar dilution method was used to determine the minimal inhibitory concentrations (MICs) of penicillin and other antibiotics against these isolates. Simplified chessboard system and capsule swelling reaction were used for serotyping of S. pneumoniae. Multilocus sequence typing ( MLST) was used to determine the genetic relationship of 53 strains of serogroup-19. Results Twenty serotypes/serogroups were identified in 148 strains. The prevalent serotypes (70. 9% ) were 19A, 19F, 3, 23F, 5, 6, 14 and 9 respectively. Serotypes 19A (22. 3% , 33/148) and 19F (16. 9% , 25/148) were the most frequent type observed. And serotypes 3 (7. 4% , 11/148) and 23F(6. 8% , 10/148) were less prevalent Of all 36 strains isolated from infants under 2 years old, 33. 3% (12/36) were covered by 7-valent pneumococcal conjugate vaccine (PCV7). The resistant rates to amoxicillin/clavulanic acid, erythromycin and other antibiotics in PCV7-related pneumococcal strains were significantly higher than those in PCV7-unrelated group (P < 0. 05). Fifty-three strains of serogroup-19 were genotyped by MLST and 9 sequence types (STs) identified. ST320 (52. 8% , 28/53) and ST271 (22.6% , 12/53) were the most frequent STs. Conclusions The major serotypes of invasive S. pneumoniae are 19A, 19F, 3 and 23F. Antimicrobial-resistant S. pneumoniae has become a serious issue of public health.

Objective To observe the effects of S-adenosylmethionine (SAM) on cell proliferation, cell cycles, apoptosis and invasive capacity of gastric cancer cell lines SGC-7901 and BGC-823 and detect the methylation status and expression of c-myc and urokinase-type plasminogen activator ( uPA). Methods The effect of SAM on proliferation of SGC-7901 and BGC-823 cells were determined by MTT assay. SGC- 7901 and BGC-823 cells were treated with different concentrations of SAM(0, 2, 4 mmol/L)for 72 h. Then flow cytometry was used to detect the change of cell cycles and apoptosis; Transwell assay to detect the invasion; RT-PCR and Western blot to detect the expression of c-myc and uPA; and MSP to detect the methylation of c-myc and uPA. Results SAM displayed a growth-inhibiting effect on SGC-7901 and BGC- 823 cells in a dose- and time-dependent manner after exposure to SAM at different concentrations (0. 5±32 mmol/L) for 24, 48 and 72 h, cell proliferation were significantly restrained (all P <0. 05); 72 h IC50 SGC- 7901 5.40 mmol/L and BGC-823 4.01 mmol/L After treating SGC-7901 and BGC-823 with different concentrations of SAM, the cell percentages of G0/G1 phase significantly increased ( P < 0. 05 and P < 0.01) while the cell proliferation indices significantly decreased (P<0. 05 and P<0. 01). Compared with control group(0. 33 ±0. 09), the cell apoptosis of 2 mmol/L(5. 79 ±0. 75)and 4 mmol/L groups( 10. 19 ± 0. 60) of SGC-7901 were obviously reduced (all P <0. 01). Compared with control group (0. 95±0. 19), the cell apoptosis of 2 mmol/L (6. 23±0. 75 ) and 4 mmol/L groups (11. 82±1.14) of BGC-823 were obviously reduced (all P <0. 01). The cell invasive capacity were significantly restrained (P <0. 01 ). The invasion inhibition ratio of 2 mmol/L and 4 mmol/L groups of SGC-7901 were 51.07 % and 80.69% respectively. The invasion inhibition ratio of 2 mmol/L and 4 mmol/L groups of BGC-823 were 48. 57% and 84. 10% respectively. The expressions of c-myc and uPA significantly decreased (P <0.05 and P <0. 01). There was no expression of c-myc in 2 mmol/L group of BGC-823. The methylation of c-myc and uPA genes in two cell lines were reversed after SAM treatment. Conclusions SAM can induce the apoptosis of SGC-7901 and BGC-823, block the cell cycles at G0/G1 phase and suppress the proliferation and invasion of these two cell lines. SAM can reverse the methylation of c-myc and uPA in these two cell lines and reduce their expression. SAM may act as a methyl donor to restrain the development and progression of tumor when hypomethylation is widely present in cancer.

We found that there are some other abnormalities in bone marrow cytology of patients with megaloblastic anemia (MA), and these abnormalities have important reference significance for further understanding, diagnosis and differential diagnosis of MA pathophysiology. Based on the bone marrow examination data of 64 patients with MA, we introduce some understanding of bone marrow cytology and pathology in MA. I. Object and Method

The patient was a 23-year-old female who was seen on August 5, 2009 due to shortness of breath with fever for 1 month and aggravated for 3 days. One month ago, she developed shortness of breath and low fever, body temperature 38℃, accompanied by fatigue and dry cough. There was no fear of cold, night sweats, expectoration, hemoptysis, diarrhea, etc. Hemoglobin (Hb) was 97 g/L and reticulocytes were 1.7%. The treatment according to "iron deficiency anemia" was ineffective, and the shortness of breath progressively aggravated.

The prevalence of functional gastrointestinal disorders (FGID) in the population is about 10%-20% [1-2], accounting for about 40%-50% of gastroenterology specialist outpatients [1, 3-4]. The quality of life of FGID patients decreases significantly, even more obviously than some chronic organic diseases (such as diabetes) [1-2,5], which directly or indirectly causes the increase of medical expenses, and the important reason is that patients often combine with mental disorders.

For patients with idiopathic interstitial pneumonia without typical high-resolution CT (HRCT) cellular lung changes, if some clinical indexes can be used and combined with HRCT features to help distinguish pathological types, it will be of great value to guide the treatment. Dr. Fell of the University of Calgary, Canada conducted related research, and the results were published in the American Journal of Respiratory Critical Care Medicine (Am J Respir Crit Care Med, 2010, 181:832-837) published on April 15, 2010. The authors retrospectively analyzed the clinical data of 135 patients with idiopathic interstitial pneumonia in the database of the University of Calgary, Canada from 1995 to 2006. Among the 135 cases, 97 cases were idiopathic interstitial pulmonary fibrosis (IPF) and 38 cases were non-IPF.

Tens of thousands of firefighters and medical personnel who participated in the rescue were exposed to dust and chemicals produced by the collapse and subsequent combustion and high temperature decomposition of the World Trade Center in New York City, USA, on September 11, 2001.

A 30-year-old male was admitted to the hospital on May 16, 2009 due to distension and pain in the right upper abdomen for 1 week, and space-occupying lesions in the liver were found for 3 months. The patient was admitted to the Department of Hepatobiliary Surgery of our hospital for further diagnosis and treatment.

There are few reports of acute copper sulfate poisoning at home and abroad, mostly caused by improper induction of vomiting, which can cause hemolytic anemia and liver, kidney and other organ function damage [1]. There are no reports of acute copper sulfate poisoning combined with chemical burn.