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25 October 2017, Volume 16 Issue 05 Previous Issue    Next Issue

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Epidemiological features of major subtypes of leukemia and its incidence trends in Shanghai BAO Pingping, WU Chunxiao, ZHANG Minlu, GU Kai, XIANG Yongmei, PENG Peng, GONG Yangming, SHI Liang, ZOU Zhen. 2017, 16 (05):  484-491.  DOI: 10.16150/j.1671-2870.2017.05.007 Abstract ( 329 )   PDF (890KB) ( 65 )   Objective: To describe the patterns of leukemia incidence in Shanghai during 2008-2012 and investigate the trends of leukemia incidence in Shanghai urban area during 1973-2012 in order to provide references for designing prevention programs, research spots and control strategies on leukemia. Methods: Data of leukemia cases were collected by the Shanghai Cancer Registry. The patterns of leukemia incidence according to gender, age, and subtypes during 2008-2012 were described. Joinpoint software was used to analyze the incidence trends, and the annual percentage changes (APCs) for the whole period and time segments were estimated. The world standard population 1960 was used for calcula-ting the age-standardized incidence(ASR). Results: During 2008-2012, 4 404 new leukemia cases were diagnosed in Shanghai, accounted for 1.53% of the total cancer cases. The crude rate of leukemia was 6.78 per 100 000 for male and 5.75 per 100 000 for female, and the ASRs were 5.14 per 100 000 and 4.11 per 100 000, respectively. ASR for total leukemia in male were higher than that in female（X=3.16, P<0.01）. Acute myeloid leukemia (AML) was the major subtype of leukemia, accounted for 18.30% of the total cases, then were the acute lymphoblastic leukemia (ALL), chronic myelocy-tic leukemia (CML) and chronic lymphocytic leukemia (CML). Differed from other subtypes, acute lymphoblastic leukemia (ALL) usually occurred among young population, with the highest incidence in 0-5 age group. The incidence of other types of leukemia increased with the increase in age. During the period of 1973-2012, leukemia incidence among males was stable, while the incidence significantly decreased among females with an APC-0.39%. Incidence of ALL increased signi-ficantly among males(APC 1.12%) and remained stable among females. Incidence of CLL increased significantly in both sex, and incidence of AML decreased significantly in females. Conclusions: The incidence of leukemia in Shanghai during 2008-2012 is similar to the average level in the world, and incidence in male is higher than that in female. AML is the major subtype of leukemia. The incidence trends varies with different subtypes. During 1973-2012, incidence of leukemia in male is stable, while decreases significantly in female. The trends differ between different subtypes. References | Related Articles | Metrics

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Analysis of peripheral neuropathy following treatment with bortezomib in 114 newly-diagnosed multiple myeloma patients CAO Yafeng, WANG Jing, GU Jun, LU Hongyu, XUN Jie, LIU Yuanfang, WANG Yan, WANG Jin, CHEN Yu, CHEN Yubao, LI Jiaming, HAO Jie, MI Jianqing, CHEN Mei 2017, 16 (05):  492-497.  DOI: 10.16150/j.1671-2870.2017.05.008 Abstract ( 255 )   PDF (627KB) ( 69 )   Objective: To investigate the occurrence and development of bortezomib-induced peripheral neuropathy in newly-diagnosed multiple myeloma (MM) patients. Methods: A total of 114 newly-diagnosed MM patients receiving bortezomib based therapeutic regimen at Ruijin Hospital, Ruijin Hospital Northern Branch, Shanghai North Station Hospital and Yangpu Hospital from September 2008 to May 2017 were enrolled. According to treatment response, patients were divided into three groups: Group 1, complete remission (CR) and very good partial response (VGPR), 60 cases; Group 2, partial remission (PR), 20 cases; Group 3, stable disease (SD） and progressive disease (PD), 34 cases. The incidence, influencing factors and subsequent improvement of peripheral neuropathy（PN）after 4 treatment cycles were analyzed. Results: The overall incidence of peripheral neuropathy was 65.8%; and there were 49 cases(43.0%) in group 1, 13 cases (11.4%) in group 2 and 13 cases (11.4%) in group 3. During the 4 treatment cycles, the dose of bortezomib would be regulated if peripheral neuropathy occurred. Dose of bortezomib was compared between 3 groups by using Kruskal-Wallis test, which revealed that there was significant difference in bortezomib dose and efficacy between the 3 groups (P<0.05）. Efficacy of bortezomib was negatively correlated with peripheral neuropathy. Univariate analysis showed that albumin, beta-2 microglobulin, calcium, hemoglobin, platelets, creatinine, lactate dehydrogenase,sex and age were not the risk factors for peripheral neuropathy (correlation coefficient <0.3）. Peripheral neuropathy could be ameliorated when patients were given Vitamin B12 (P<0.05). Conclusions: For newly-daignosed MM patients, the occurrence of PN in the early treatment predicts a better treatment response to bortezomib based therapeutic regimen. Efficacy of bortezomib is negatively correlated with peripheral neuropathy in newly-diagnosed MM patients. The levels of albumin, beta-2 microglobulin, calcium, hemoglobin, platelets, creatinine, lactate dehydrogenase have no correlation with the incidence of peripheral neuropathy. The bortezomib-induced peripheral neuropathy could be reversible with the administration of Vitamin B12. References | Related Articles | Metrics

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Analysis of additional mutation pattern accompanied with CEBPA mutations in patients with the cytogenetically normal acute myeloid leukemia WANG Shu, ZHANG Yunxiang, SUI Jingni, LU Jing, FAN Huiyong, WANG Chao, CHEN Bing. 2017, 16 (05):  498-503.  DOI: 10.16150/j.1671-2870.2017.05.009 Abstract ( 510 )   PDF (579KB) ( 103 )   Objective: To investigate the different patterns of additional gene mutation accompanied with CEBPA biallelic or monoallelic mutations in patients with acute myeloid leukemia, which might be associated with different prognosis of these two kinds of mutation subtypes. Methods: A total of 152 newly diagnosed acute myeloid leukemia patients with normal karyotype were enrolled. The mutations in hot spot regions of 25 AML driver genes were screened using next-generation sequencing strategy and the discovered mutation sites were confirmed by Sanger sequencing. The difference in additional gene mutation patterns accompanied with CEBPA biallelic and monoallelic mutations were analyzed by Chi-square or Fisher's exact test. Results: In the 152 patients, CEBPA biallelic mutations were identified in 43(28.29%) cases and monoallelic mutations in 13(8.55%) cases. The ratio of more than 3 additional gene mutations in patients carried CEBPA monoallelic mutations (4 cases, 30.77%) was higher than that of the patients with CEBPA biallelic mutations (3 cases, 6.98%) (P=0.043). No NPM1 gene mutation was found in patients with CEBPA biallelic mutated, while near half of the patients (6 cases, 46.15%) had CEBPA monoallelic mutations accompanied with NPM1 mutation. CEBPA monoallelic mutated patients were more involved in genes of DNA methylation group (DNMT3A, TET2, IDH1, IDH2) than those with CEBPA biallelic mutation (7 cases, 53.85% vs 10 cases, 23.26%, P=0.046). Meanwhile, more high-risk genes (DNMT3A, FLT3-ITD, TP53) co-mutated were found in patients with CEBPA monoallelic mutations than those with CEBPA biallelic mutations. Conclusions: Compared with patients with CEBPA biallelic mutation, the CEBPA monoallelic mutation cohort have more additional gene mutations associated with adverse prognosis, and the different gene mutation patterns may lead to different prognosis. However, more large-scale investigations are needed to verify their clinical significance. References | Related Articles | Metrics

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Toll-like receptor 4 regulates the inflammation induced by lipids in smooth muscle cells WANG Yanping, CHEN Yuanyuan, WU Liping, CHEN Yafen, YANG Ke, LIU Yan 2017, 16 (05):  504-509.  DOI: 10.16150/j.1671-2870.2017.05.010 Abstract ( 195 )   PDF (880KB) ( 43 )   Objective: To investigate the mechanism of TLR4 in mediating the oxLDL-induced inflammation in smooth muscle cells (SMCs). Methods: TLR4 knockout mice and wild type C57BL/6 mice were randomly divided into control group (normal diet) and study group (high-fat diet) with 6 mice per group. Progression of atheroma was analyzed after 12 weeks in TLR4 knockout mice and wild type C57BL/6 mice. Primary SMCs of TLR4 knockout mice were cultured in vitro, and SMCs of wild type C57BL/6 were served as controls. SMCs were treated with oxLDL to induce inflammation, then TLR4 antibody was used to block TLR4 activity, and oxLDL-induced inflammation was compared between TLR4 knockout mice and wild type C57BL/6 mice. Results: High-fat diet could promote the expression of inflammatory cytokines in wild type C57BL/6 mice, but in TLR4 knockout mice there was no significant difference between the normal and high-fat diet groups. Moreover, blocking the activity of TLR4 could inhibit the oxLDL-induced inflammation in primary SMCs. Conclusions: TLR4 plays a role in regulating the oxLDL-induced inflammation in SMCs. References | Related Articles | Metrics

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Induction of fluconazole resistance in Candida glabrata and Candida parapsilosis in vitro and corresponding mechanism LIU Jinyan, WANG Ying, LI Wenjing, ZHAO Yue, MENG Lingning, ZHU Weiwei, SHI Ce, XIANG Mingjie 2017, 16 (05):  510-515.  DOI: 10.16150/j.1671-2870.2017.05.011 Abstract ( 373 )   PDF (679KB) ( 76 )   Objective: To investigate the susceptibility and mechanism of resistance to fluconazole in Candida glabrata and Candida parapsilosis isolates. Methods: Four strains(one clinical C. glabrata, one clinical C. parapsilosis, ATCC2001 and ATCC22019) were induced to be resistance strains in vitro by increasing concentrations of fluconazole. The expression levels of transporter genes and their transcription factor, and azole antifungal target gene were identified by real time-PCR. Meanwhile, the sequence of PDR1 gene of C. glabrata and MRR1, ERG11 gene of C. parapsilosis were determined by PCR based DNA sequencing. Results: C. glabrata was more prone to be resistant to fluconazole than C. parapsilosis. CDR1 was significantly overexpressed in resistant strains of C. glabrata, while MDR1 was significantly overexpressed in resistant strains of C. parapsilosis. PDR1 mutations Y932C, V847F were identified in resistant strains of C.glabrata, and MRR1 mutations P295S, I799S were found in resistant strains of C. parapsilosis. Conclusions: C. glabrata and C. parapsilosis showed different susceptibility to fluconazole resistance, and difference also occurred in resistance mechanism. And the function of new identified mutations in transcription factor needs further verification. References | Related Articles | Metrics

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Associated factors for within-day and day-to-day glycemic variability in type 2 diabetes patients LIN Ruhai, WU Xiaohong, JIANG Zhengrong, YANG Xinna, ZHUANG Duanrong, WU Lizhen. 2017, 16 (05):  516-521.  DOI: 10.16150/j.1671-2870.2017.05.012 Abstract ( 307 )   PDF (595KB) ( 73 )   Objective: To evaluate the associated factors for within-day and day-to-day glycemic variability (GV) in type 2 diabetes(T2D) patients. Methods: A total of 183 hospitalized patients with T2D receiving insulin therapy were enrolled. Continuous glucose monitoring (CGM) was performed in all the subjects. The within-day GV was evaluated by using mean amplitude of glycemic excursion(MAGE), and day-to-day GV by absolute means of daily differences (MODD). Genera-lized linear model was used to estimate associated factors for within-day and day-to-day glycemic variability. Results: CGM revealed that mean MAGE and MODD were（4.75±0.91） mmol/L and （2.62±0.76） mmol/L, respectively. For within-day glycemic variability, family history of diabetes, lower levels of C-peptide, uric acid, HDL-C were independent related factors for increase of MAGE. For day-to-day glycemic variability, duration of diabetes, glycosylated hemoglobin, aspartate aminotransferase(AST) and high density lipoprotein cholesterol （HDL-C） were positively correlated with MODD, while C-peptide and premixed insulin injection were negatively correlated with MODD. Conclusions: Family history of diabetes, duration of diabetes, HbA1c, AST, HDL-C, serum levels of C-peptide, premixed insulin injection, history of CVD and serum concentration of uric acid are significantly associated with GV parameters, which indicates that the function of pancreatic beta cells and insulin sensitivity may influence the glycemic variability in type 2 diabetes patients. Premixed insulin injection may exert a better curative effect on blood glucose control in Chinese type 2 diabetes patients. References | Related Articles | Metrics

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Analysis on changes in minerals in middle-aged and elderly patients with diabetes mellitus in Shanghai JI Pengcheng, ZHANG Shu, SUN Jing, JIANG Shihu 2017, 16 (05):  522-526.  DOI: 10.16150/j.1671-2870.2017.05.013 Abstract ( 302 )   PDF (532KB) ( 43 )   Objective: To investigate the changes in mineral levels in middle aged and elderly patients with diabetes mellitus in Shanghai. Methods: A total of 1 100 middle aged and elderly subjects undergone health examination during January 2016 to November 2016 were enrolled. Of these subjects, 264 were diabetes and 836 were non-diabetes. All the subjects were tested for minerals(calcium, magnesium) and glycosylated hemoglobin(HbA1c), and the mineral levels between diabetic and non-diabetic groups were compared. According to the level of glycosylated hemoglobin(HbA1c) <7.0 or ≥7.0, subjects with type 2 diabetes mellitus were further divided into 2 groups: well-controlled group and poor-controlled group. The correlations of HbA1c with mineral levels were examined. Results: Compared with non-diabetes, diabetic patients had a higher serum calcium level and lower magnesium level (P<0.01 or P<0.05). Patients with HbA1c ≥7 had higher level of calcium and lower level of magnesium than patients with HbA1c<7.0 (P<0.01 or P<0.05). Linear correlation analysis showed that level of HbA1c was positively correlated with serum calcium level (r=0.074, P=0.015) and negatively correlated with serum magnesium level(r=-0.120, P<0.01). Conclusions: Compared with non-diabetes, patients with diabetes have lower level of serum magnesium and higher level of serum calcium. Poor-controlled diabetic patients have lower level of serum magnesium and higher level of serum calcium than well-controlled diabetic patients. Glycosylated hemoglobin is positively correlated with serum calcium while negatively correlated with serum magnesium. References | Related Articles | Metrics

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Diagnostic value of MRI for postpartum placenta implantation SU Ming, ZHANG Jijun, LING Huawei, ZHANG Jian, DING Bei, LU Fei, LIU Yan 2017, 16 (05):  527-531.  DOI: 10.16150/j.1671-2870.2017.05.014 Abstract ( 374 )   PDF (713KB) ( 72 )   Objective: To investigate the imaging characteristics and diagnostic value of magnetic resonance imaging (MRI) for postpartum placenta implantation. Methods: Fifty-two patients with suspicious postpartum placenta implantation receiving MRI examination were enrolled. The imaging findings on MRI were analyzed in correlation with the clinical and pathological data, and diagnostic performance was calculated. Results: Of the 53 cases, 35 cases were diagnosed as placenta implantation by surgery or pathologic examination, and of them 31 were diagnosed by MRI, with a sensitivity of 88.57%, and specificity of 88.24%. The main MRI feature was placenta-myometrium interface disappearance with a diagnostic sensitivity of 91.43%. And secondly, myometrium was thinned and placenta signal was uneven(sensitivity 74.29% and 68.57%). The sensitivity and specificity of enhanced MRI examination for diagnosing postpartum placenta implantation were 54.29% and 100% respectively. Four cases of retained placenta diagnosed by preoperative MRI were confirmed to be placenta implantation by pathological examination after surgery, While 2 cases of retained placenta were misdiagnosed as placenta implantation by preoperative MRI. Conclusions: MRI is valuable for diagnosing postpartum placenta implantation. For patients with postpartum recovery time less than 4 weeks, enhanced MRI scan is recommended. References | Related Articles | Metrics

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Diagnostic value of serum procalcitonin, IL-6 and C-reactive protein for community acquired pneumonia in elderly patients WANG Linlin, ZHU Chengcheng, ZHANG Qingwu, CHEN Ting, WU Shun 2017, 16 (05):  532-536.  DOI: 10.16150/j.1671-2870.2017.05.015 Abstract ( 234 )   PDF (563KB) ( 54 )   Objective: To investigate the auxiliary diagnostic value of serum procalcitonin (PCT), interleukin-6(IL-6) and C-reactive protein(CRP) for community acquired pneumonia (CAP) among elderly patients. Methods: A total of 103 elderly inpatients with CAP during January 1 to December 31, 2016 were enrolled in this study, and 50 cases of elderly patients with upper respiratory tract infection were served as controls. Sputum bacterial culture was positive in 45 of 103 CAP patients, and was negative in the other 58 patients. Levels of PCT, IL-6 and CRP were measured in all the patients. PCT>0.25 ng/mL, IL-6>7 pg/mL, CRP>8 mg/L were taken as cut-off value of positivity, and sensitivity and specificity for CAP were measured . Receiver operating characteristic (ROC) curve of the 45 cases with positive sputum bacterial culture was used to evaluate the diagnostic performance of PCT, IL-6 and CRP for CAP. Results: Serum levels of PCT, IL-6 and CRP were higher in CAP group than in control group (P<0.05). Sensitivity of CRP for diagnosing CAP (92.2%) was higher than those of IL-6 and PCT (P<0.05), and PCT had the highest specificity (94.0%) for the diagnosis of CAP(P<0.05). Meanwhile, the sensitivity of combined detection (parallel test: positive for any item) of these three biomarkers for the diagnosis of CAP were 96.1%, which was higher than the sensitivity of CRP-92.2% (P<0.05), however, the specificity of combined detection decreased slightly to 68%. In CAP patients, Pearson correlation coefficients revealed that PCT level was positively correlated with CRP level (r=0.528, P<0.001). Area under receiver operating characteristic(ROC) curve (AUC) for PCT, CRP and IL-6 were 0.773, 0.534, and 0.542, respectivlely; when PCT>0.21 ng/mL was taken as the cut-off value, the sensitivity and specificity for diagnosing CAP were 84.4% and 79.3%, respectively. Conclusions: PCT, IL-6 and CRP could be used as biomarkers in differentiating CAP from upper respiratory tract infection in elderly patients, and the combination of PCT, IL-6 and CRP might improve the diagnostic sensitivity for CAP. Meanwhile, PCT is more valuable than IL-6 and CRP for the auxiliary diagnosis of bacterial CAP. References | Related Articles | Metrics

Medical education

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Application of microteaching method in teaching of clinical diagnosis LUO Li, ZHOU Jiru, GUO Yuhang, LI Yuying, HU Mingdong 2017, 16 (05):  561-563.  DOI: 10.16150/j.1671-2870.2017.05.022 Abstract ( 153 )   PDF (338KB) ( 44 )   Objective: To study the efficacy of microteaching method in the teaching of clinical diagnosis. Methods: A total of 280 students in 8-year program or 5-year program were divided into the testing group and control group: students in testing group were instructed with the microteaching method and students in control group were instructed with the conventional method. At the end of course, the teaching efficiency of the two groups were evaluated. Results: The academic records and learning satisfaction were all better in the testing group than those in control group. Conclusions: Microteaching method could enhance students' subjective initiation, learning ability and practice capability. References | Related Articles | Metrics