Volume 99 ·  Issue 26 ·  2019

aplastic anemia (AA) is an immune-mediated bone marrow failure disorder. The traditional theory of "seed, bug and soil" has been proved by a large number of clinical and basic studies that the reduction of "seed" and the destruction of "soil" are the result of the damage of hematopoietic stem cells and supporting hematopoietic tissue cells caused by abnormal function of T lymphocytes, respectively, and have become the basis of AA immunosuppressive therapy. The accurate diagnosis of AA is of great significance for studying the pathogenesis and treatment of AA, and targeted therapy for the pathogenesis may become a new direction of AA treatment.

Decrease in hematopoietic stem cells (HSC) is a central link in the pathogenesis of aplastic anemia (AA). In addition to increased apoptosis of HSC caused by T cell hyperfunction, HSC in AA patients may have intrinsic defects, such as telomere shortening, gene mutation, etc., which lead to damage of HSC itself and vulnerability to immune attack. Some may have clonal hematopoiesis, which leads to an increase in the probability of conversion to myelodysplastic syndrome/acute myeloid leukemia (MDS/AML). On the other hand, AA HSCs can also show PIGA gene mutation and HLA-LOH (loss of acquired heterozygosity of human leukocyte antigen) to escape immune challenge.

The pathogenesis of aplastic anemia (AA) is mainly immune abnormality, and the establishment of immune-mediated AA mouse model is beneficial to further study the pathogenesis of AA. Immune-mediated AA mouse models were prepared by virus infection, allogeneic lymphocyte infusion, whole body irradiation (TBI) and allogeneic lymphocyte infusion, etc. We successfully prepared two AA mouse models by combining interferon-γ (IFN-γ) with busulfan and TBI plus allogeneic lymph node cell infusion, respectively. The test results show that these two models are closer to the characteristics of human AA. Among them, the improved preparation method of hybrid first generation (F1) AA mice is easy to operate under domestic experimental conditions, more suitable for popularization, and is expected to become a new basic research platform of AA.

Aplastic anemia (AA) is a kind of blood system disease characterized by pancytopenia and low hematopoietic function of bone marrow. The pathogenesis is not clear at present. Traditionally, AA is believed to be the abnormality of hematopoietic tissue "seeds, worms and soil" and hematopoietic failure syndrome caused by physical, chemical or biological factors. A large number of clinical and basic studies have shown that the abnormalities of T lymphocytes, immune regulatory cells and cytokine storm in AA patients play an important role in the pathogenesis of AA.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic lung disease of unknown etiology characterized by common interstitial pneumonia (UIP) in histopathology and/or thoracic high-resolution CT (HRCT)^[1]。 The median survival of IPF patients from diagnosis is only 2 to 3 years^[1,2,3,4,5]。 Some patients may experience acute deterioration of respiratory function in a short time, which is called acute exacerbation of IPF (AE-IPF), which is an important cause of death in patients with IPF^[1,2]。 Due to the critical condition, rapid progress and poor prognosis of AE-IPF patients, the research and understanding of AE-IPF have been deepened in recent years, and the international definition and diagnostic criteria of AE-IPF have been continuously updated. In order to standardize the diagnosis and treatment of AE-IPF in China, the Interstitial Pulmonary Disease Group of Respiratory Disease Branch of Chinese Medical Association, together with experts from the Interstitial Pulmonary Disease Working Committee of Respiratory Physicians Branch of Chinese Medical Doctors Association, combined with domestic and foreign research progress, and referring to and referring to the international AE-IPF diagnosis and treatment guidelines, formulated this consensus, aiming at standardizing the diagnosis process and treatment strategy of AE-IPF in China and improving the diagnosis and treatment level of AE-IPF in China.

Since 2013, my country released the first edition of "Chinese Guidelines for Intestinal Preparation Related to Diagnosis and Treatment of Digestive Endoscopy (Draft)"^[1]Since then, with the in-depth popularization of digestive endoscopy technology in China, intestinal preparation has been paid more and more attention, and related studies have emerged at home and abroad, and many related consensus and guidelines have been published internationally^{[2,3,4,5,6,7]}。 Therefore, in order to further improve the methods and methods of intestinal preparation before endoscopic diagnosis and treatment in China and improve the quality of endoscopic diagnosis and treatment, it is necessary to summarize the relevant research at home and abroad, draw lessons from foreign evidence-based evidence and relevant guidelines, and combine the actual situation in China, and formulate a new version of the guidelines on the basis of the previous edition. In April 2019, the Digestive Endoscopy Professional Committee of Endoscopist Branch of Chinese Medical Doctors Association and the Oncology Endoscopy Professional Committee of Chinese Anti-Cancer Association invited domestic experts in relevant fields to formulate a new version of the Guidelines for Intestinal Preparation Related to Diagnosis and Treatment of Digestive Endoscopy in China, with a view to providing guidance on intestinal preparation related to endoscopic diagnosis and treatment of patients with digestive tract diseases.

To observe the dynamic changes of serum cryptococcal capsular polysaccharide antigen (CrAg) titer and chest CT of pulmonary cryptococcosis (PC) after antifungal therapy.

A retrospective study was performed for patients with PC admitted to the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from January 2015 to April 2018. Serum CrAg titers and Chest CT examination were performed for all the cases before and after treatment. The difference between immunocompetent hosts group and immunocompromised hosts group were compared and analyzed.

Eighty-two patients with PC including 46 male (56.1%) and 36 (43.9%) female were enrolled. Fifty-two (63.4%) patients were proven PC and thirty (36.6%) patients were probable PC. Forty-five (54.9%) patients had underlying diseases. Fifty-four (65.9%) patients were immunocompetent hosts and twenty-eight (34.1%) patients were immunocompromised hosts. The mean duration of treatment was (7.9±2.4) months and the mean follow-up was (24.0±10.0) months. Improvement (≥75%) in chest CT were found in 64.8% of the cases in immunocompetent group and 67.9% in immunocompromised group after 6 months′ treatment. Improvement (≥75%) was found in 88.9% of the cases with patchy infiltrates or consolidation and only 63.0% in nodular or mass-like type and mixed patterns of PC. The serum CrAg titer of 55 cases ranged from 1∶4 to 1∶160 before treatment (median 1∶40) and decreased for all cases after treatment. The serum CrAg titer became negative in 20 cases at last. Mean time of serum CrAg titer turning negative was (11.8±8.1) months. The serum CrAg titer became negative or decreased to 1∶1 in 24 cases after treatment cessation, of whom the serum CrAg titer ranged from 1∶5 to 1∶160 before treatment (median 1∶20). The serum CrAg titer of 31 cases ranged from 1∶4 to 1∶640 before treatment (median 1∶64), of whom the serum CrAg detections were still positive after treatment cessation, and CrAg titer was 1∶10 (ranged from 1∶2 to 1∶160).

In PC, chest CT improves after antifungal treatment, and the infiltrates or consolidation type of PC resolves faster than nodular or mass-like shadows and mixed patterns in CT. The serum CrAg titer decreases after antifungal treatment.

To investigate the regulation of long-chain non-coding RNA-AC024560.2 transfection on the expression of miR-30a-5p and its effect on proliferation and invasion of prostate cancer cells.

qRT-PCR was used to detect the expression of AC024560.2 in 16 prostate cancer tissues and adjacent normal tissues, prostate cancer cell lines and normal prostate epithelial cells. The cells with the lowest expression amount were transfected, and the prostate cancer cells were divided into control group (transfected with negative control plasmid) and experimental group (transfected with plasmid carrying AC024560.2). Bioinformatics predicted possible target genes for AC024560.2. qRT-PCR was used to detect the expression of AC024560.2 and target genes in the transfected cells. Western blot was used to detect the expression of downstream target proteins. Cell proliferation and invasion were analyzed by MTS assay and Transwell invasion assay.

The expression levels of AC024560.2 in prostate cancer tissues and adjacent tissues were 1.95±0.22 and 3.87±0.23, respectively (t=6.09, P<0.01). Compared with normal prostate epithelial cells, the expression of AC024560.2 in prostate cancer cell lines was significantly decreased (P<0.05), and the most significant decrease was observed in C4-2B cell lines (P<0.01). Bioinformatics predictions showed that AC024560.2 bond to miR-30a-5p, and miR-30a-5p bond to SIRT1 mRNA. The expression of AC024560.2 in the experimental group increased significantly (P<0.01), the expression of miR-30a-5p decreased significantly (P<0.01), and the expression of SIRT1 mRNA and protein increased significantly (P<0.01). After transfection with AC024560.2, the cell proliferation ability of the experimental group was significantly decreased from day 2 (P<0.05). The invasive numbers of C4-2B cells in the control group and the experimental group were 130.90±14.54 and 43.77±10.01, respectively (t=4.94, P<0.01).

AC024560.2 is lowly expressed in human prostate cancer, and may inhibit the proliferation and invasion of prostate cancer cells by regulating the expression of miR-30a-5p and SIRT1 genes. AC024560.2 may be a potential target for the treatment of prostate cancer.

To investigate the applicability of the modified memory sub-test of syndrom kurz test (SKT-M) in middle-aged and elderly Chinese.

Between March 1, 2017, and October 31, 2017, at HwaMei Hospital, 132 patients receiving elective great saphenous vein high ligation and stripping operation and 96 their accompanying dependents, 55-75 years old, were randomly divided into the SKT-M group (n=121) and auditory verbal learning test -huashan version (AVLT-H) group (n=107) using random numeral method. The two groups underwent two corresponding neuropsychological tests respectively on the day before surgery and the second day after surgery.

There was no significant difference in the baseline characteristics and all the neuropsychological indices at the two time points between patients and dependents (P>0.05). As a consequence, the data of the patients and dependents were integrated to compare the applicability of SKT-M and AVLT-H. The "low-score" ratio of SKT-M immediate recall (2.4%) was lower than that of AVLT-H test (12.1%) (χ²=8.138, P<0.01). Besides, the "low-score" ratio of SKT-M delayed recall (5.7%) was also lower than that of AVLT-H test (20.5%) (χ²=11.167, P<0.01). The influence factors of SKT-M were less than that of AVLT-H test. However, the learning effect of SKT-M immediate recall was more significant, for its first testing sore (23.1±5.4) was significantly higher than the second one (21.9±5.1) (t=-3.971, P<0.001).

The SKT-M has better applicability to 55-75 years old Chinese than AVLT-H test, but its learning effect should be noted.

To investigate the feasibility and safety of enhanced recovery after surgery (ERAS) in perioperative period of liver operation.

One hundred and sixty-six patients who underwent liver operation were enrolled as control group, and additional 170 patients were chosen as ERAS group. Preoperative and postoperative indexes of the two groups were compared.

Compared with the control group, patients in ERAS group had higher preoperative enteral nutrition support rate, lower incidence of thirst and hunger, earlier initial postoperative feeding, higher prophylactic analgesia rate, lower incidence of outbreak pain, more daily activities, lower incidence of abdominal distention and shorter hospitalization days (all P<0.05).

Application of enhanced recovery after surgery on perioperative nursing care in elective liver surgical patients is safe, and it can relieve patients' perioperative discomfort and accelerate postoperative rehabilitation.

To analyze the microbiome of diabetic foot osteomyelitis (DFO) by means of metagenome sequencing and provide evidence for identification of pathogenic bacteria in DFO.

A total of 5 patients (3 males and 2 females) with DFO hospitalized at the Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University were enrolled and infected bone specimens were obtained between September 2016 and April 2017. The mean age was (55.8±9.5) years. Metagenome sequencing was performed to explore the characteristics of microbiome, and compared with the results of 16S rRNA sequencing.

The results of metagenome sequencing showed that DFO contained diverse microorganism. Totally, 22 dominant species were obtained, Klebsiella pneumoniae (69.66%) was the most abundant, followed by Veillonella parvula (36.93%) and Prevotella intermedia (34.19%). Compared with the 16S rRNA sequencing, metagenome sequencing could obtain more species information on the basis of fewer samples. At the genus level, both sequencing techniques suggested the most dominant pathogen in DFO was anaerobe. All bone specimens had polymicrobial communities.

More microecological diversity and abundance of DFO can be found by using metagenome sequencing. At the species level, more bacteria, even bacterial strains can be identified by metagenome sequencing. At the genus level, the most abundant bacteria is anaerobe, however, at the species level, it is facultative anaerobe.

To discuss the commutability evaluation method of reference materials for fibrinogen measurement and evaluate the commutability of the Third WHO International Standard Fibrinogen Plasma (WHO 09/264), SSC/ISTH Secondary Coagulation Standard (SSC LOT4) and homemade reference materials (RM01, RM02) in order to provide suggestions on how to determine the suitable method of commutability evaluation and reliable traceability standard.

The comparability of fibrinogen among different measurement systems were evaluated and WHO 09/264 was used to calibrate each system to improve the comparability if the comparability among different systems couldn′t be accepted. Forty clinical samples and the reference materials randomly interspersed among the clinical samples were measured on Stago STA-R Evolution, Sysmex CS 5100, IL ACL TOP 700 simultaneously. Measurement results were pairwise analyzed by Deming regression and difference in bias approach according to the Clinical and Laboratory Standards Institute (CLSI) EP14-A3 protocol and the recommendations of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) working group on commutability, respectively.

The comparability of fibrinogen measurement among common systems could not meet the criterion. WHO 09/264 could improve the agreement among different measurement systems. The prediction interval of Deming regression was affected by the comparability of measurement systems, resulting in unreliable results. The difference in bias approach was more suitable because its criterion was related to the medical requirements. WHO 09/264 was commutable between Stago and Sysmex, inconclusive between Stago and IL, Sysmex and IL (The calibration effectiveness of WHO 09/264 showed that it was commutable among the three measurement systems). SSC LOT4 was commutable between Stago and Sysmex, inconclusive between Stago and IL, Sysmex and IL. RM01 and RM02 were commutable between all systems pairs assessed by difference in bias approach.

There are differences in the results of two commutability evaluation approaches. The difference in bias approach is recommended for commutability evaluation. WHO International Standard and homemade reference materials can be used as traceability standard for fibrinogen measurement.

To estimate the effect of smoking cessation on the risk of hypertension.

Literature search of PubMed, Embase, Vip and CNKI between 2001 and 2016 was performed to retrieve prospective cohort studies assessing the relative risks (RR) of smoking cessation and current smoking on hypertension. The pooled RR with 95% confidence intervals (CI) were calculated using random effects models, and subgroup analyses were employed based on participants and study characteristics.

A total of 8 eligible prospective cohort studies with 70 130 participants and 21 238 incident cases of hypertension were retrieved. The individuals aged 25-84 years, among them, 53.64% (37 618/70 130) were men and the follow-up period were 4-14.5 years. The pooled RR of hypertension was 1.08 (95%CI: 0.94-1.20) for comparing smoking cessation with current smoking and the pooled adjusted RR was 0.91 (95%CI: 0.33-2.50) (both P>0.05).

Smoking cessation did not increased risks of hypertension. Therefore, effective strategies are needed to encourage smokers to quit.

In this study, a hydrogel-coated tumor microtissue block was used to detect the sensitivity of standard chemotherapy drugs in pharyngeal tumors in vitro, namely "jelly" drug sensitivity detection method, and two patients with pharyngeal tumors were screened for common chemotherapy regimens. The results showed that one patient was treated with vincristine, irinotecan, vincristine + irinotecan + cyclophosphamide and doxorubicin. Another patient was effective with cisplatin, cisplatin +5-fluorouracil + docetaxel, cisplatin +5-fluorouracil, docetaxel, and the results were in line with clinical treatment guidelines. After preliminary exploration, this method can be used in the screening of tumor chemotherapy drugs, and it is expected to become the screening method of standard tumor chemotherapy regimen.

Helicobacter pylori (Helicobacter pylori，H. pylori) infection is closely related to peptic ulcer disease, and peptic ulcer is listed asH. pyloriHighly recommended indications for eradication therapy. For concomitantH. pyloriPatients with infected membranous nephropathy, kidney disease leads to many restrictions on clinical medication of such patients. Reasonable choice of medication timing and formulation of appropriate treatment plan have become the key issues in clinical diagnosis and treatment. This article reports a case of membranous nephropathy with 4 failures of eradication therapyH. pyloriThe infected patients were transferred from the nephrology department to the gastroenterology department due to the poor effect of hormone combined with immunosuppressant treatment and obvious gastrointestinal symptomsH. pyloriEradication treatment, successful eradication after dual therapy supplemented with probiotics and ready-for-use traditional Chinese medicine treatmentH. pylori, relief of digestive tract symptoms, and effective control of proteinuria caused by membranous nephropathy.

Digitoid dendritic cell sarcoma (IDCS) is a rare subtype of dendritic cell tumor, which is characterized by high aggressiveness, rapid progression and poor prognosis. The etiology and pathogenesis of IDCS are unknown, easily misdiagnosed, and there is no uniform treatment standard at present. This article reviews the epidemiological characteristics, pathogenesis, diagnosis and differential diagnosis, treatment and prognosis of IDCS, emphasizing the progress of its diagnosis and treatment, aiming to improve the understanding of IDCS and explore safer and more effective treatment measures.