骨髓增生异常综合征(myelodysplastic syndrome,MDS)是一组起源于髓系定向造血干细胞或多能干细胞的异质性克隆性疾病,主要特征是无效造血和高危演变为急性髓系白血病(acute myeloid leukemia,AML),临床表现为造血细胞在质和量上出现不同程度的异常变化[1,2].1982年FAB协作组提出以形态学为基础的MDS分型,主要依据MDS患者外周血和骨髓细胞发育异常的特征进行分类.2008年WHO推出了修订的MDS分型方案,2016年进行了再次修订[3],定义了病态造血的粒系、红系、巨核系统胞质和胞核的特征,其中提到巨核细胞胞浆CD34阳性的发育异常特征.本文总结了2例巨核细胞胞浆表达CD34的MDS患者临床诊治经过,为早期诊断及治疗提供经验.

Objective:To investigate the clinical characteristics of patients with myelodysplastic syndrome (MDS)-refractory neutropenia (RN),and summarize the experience of diagnosis and treatment of one case of MDS-RN.Methods:A retrospective analysis was performed on the clinical characteristics,treatment,morphologic and cytogenetic characteristics of the bone marrow cells of the patient diagnosed with MDS-RN.Results:The chief complaint of the 58-year-old male patient was fatigue.The counts of white blood cells were 2.9 x 109/L (neutrophils 35％,lymphocytes 56％ and monocytes 9％),the hemoglobin level was 136 g/L and the counts of platelets were 182 × 109/L.The bone marrow cytology revealed hyperplasia and myelodysplasia of both granulocytes and megakaryocytes,and the granulocyte dysplasia including pseudo-Pelger,hypo-/degranulation and hyposegmentation of neutrophils,which accounted for 24％ of the total granulocytes (57.5％).Micromegakaryocytes with mono-round-nuclear could also be observed,but without erythroid dysplasia.Chromosome analysis revealed the aberration of 46,xy,add (16) q24 [20].Conclusion:For patients with MDS-refractory cytopenia with unilineage dysplasia,it is suggested to undertake cytogenetic examination and next-generation sequencing technology to detect gene mutation,besides the traditional bone marrow cytology and biopsy,to ensure an accurate diagnosis and treatment.

Objective:To investigate the clinical characteristics of myelodysplastic syndromes (MDS) with autoimmune hemolysis as early manifestation and to discuss the early diagnosis of MDS.Methods:The clinical features,diagnosis and treatment of 1 case of MDS with autoimmune hemolysis as early manifestation were analyzed retrospectively.Results:The patient was characterized with autoimmune hemolyis early,and treated with enough glucocorticoid for one month,but there was no response.Reexamination of bone marrow cytology suggested morphologic dyshematopoiesis in erythroid.The patient transformed rapidly into acute myeloid leukemia after one month.Conclusion:MDS may present with pure hemolysis during early stage.Analysis of bone marrow cells of dysplastic hematopoiesis in the diagnosis of MDS is very important.CD41 immune staining can improve the efficiency of micromegakaryocyte detection,and help the early diagnosis of MDS.

目的：建立护理岗位管理绩效考核与分配方案，探索该方案对改善护士薪酬分配体验、提高护士满意度和患者满意度的效果。方法基于护理岗位管理所要求的“多劳多得、优劳优得、效率优先、优绩优酬”的分配原则，根据护士层级、岗位、班次和工作量，结合工作服务质量评价进行护士绩效分配，比较实施前后护士工作满意度和患者满意度的差异，评价实施绩效考核与分配改革的效果。结果普外科通过实施护理岗位管理绩效考核与分配方案，护士的满意度、科室护理质量和患者满意度均有明显的提高（P ＜0．01或 P ＜0．05）。结论通过实施护理岗位管理绩效考核与分配方案，改善了普外科护士薪酬分配比例，调动了护士积极性，提高了护士和患者满意度，提升了护理质量。

目的：了解不同学历护士工作状况，分析工作压力与受教育程度间的关系，探讨其影响因素，为提高护理质量提供依据。方法：采用问卷调查法对我院150名护士工作压力、工作倦怠感进行调查分析，对调查结果进行统计学分析。结果：不同学历护士工作压力从高到低依次为本科、专科、中专；工作满意度从高到低依次为中专、专科、本科；不同学历护理人员工作压力与工作满意度呈负相关（P ＜0.01，＜0.05）。结论：不同学历护士工作压力均与工作满意度密切相关，应引起护理管理者的高度重视，寻求解决方法帮助缓解不同学历护士的工作压力，促进身心健康，有利于提高护理管理质量。

Objective To study the effect of the megakaryocyte count method for its classification results.This method can serve as the basis for its normal range.Methods The total number of megakaryocytes of bone marrow aspiration in 262 cases were counted.The number of megakaryocytes per unit area greater than 100 was included into this study.We compared the influence and classificaiton of megakaryocyte at 25,50 and 100 per unit.The megakaryocyte were found according the Bow and W shape.The impact on the classification of megakaryocytes were compared.Results The average number of megakaryocytes in the 262 cases is 48.4 ± 32.2.There was not statistically significant impact on the classification of megakaryocyte in counting of 50 and 100.But there was more promegakaryocytes and less platelet megakaryocyte through W shape.Conclusion Recommended classification 50 megakaryocyte,the megakaryocyte were found according the Bow shape.

<正>不典型慢性粒细胞白血病(atypical chronic myeloid leukaemia,aCML)是Ph染色体及bcr-abl融合基因均阴性的克隆性造血异常疾病,具有骨髓增生异常和骨髓增殖性肿瘤(MDS/MPN)的双重特性[1]。其临床特点:骨髓以成熟中性粒细胞及中、晚幼粒细胞的增多,可伴有轻度贫血、血小板减少等类似慢性粒细胞白血病(chronic myeloid leukaemia,

[目的]探讨护理安全查房在护理风险管理中的应用效果.[方法]成立护理安全查房管理小组,将各系统上报的护理不良事件及收集到的院内及外院典型案例进行分类汇总,组织相关人员集中讨论,从质量要素与系统原因进行归因分析,查找与识别护理安全隐患与风险管理漏洞,提出改进策略与防范措施;反馈与协调解决各科室、各部门之间存在的风险管理问题;介绍护理风险管理经验等,形成护理安全查房报告,通过医院内部网站和医院简讯发至各个护理单元,由护士长组织全体护理人员学习,做到信息资源共享.[结果]实施护理安全查房后,护理不良事件漏报率与发生率较查房前明显降低(P<0.05).[结论]开展护理安全查房有助于营造"无伤害"护理安全文化氛围,促使护理人员主动上报护理不良事件,提高护理人员对护理风险的识别与防范能力,减少护理不良事件的发生.

Objective:To understand the clinical features of essential thrombocythemia(ET),in order to reduce misdiagnosis and avoid complications.Methods:Clinical data of 34 patients with ET were analyzed retrospectively.Results:Among 34 patients,13 were males and 21 were females with a median age of 51 years old.Most symptomatic patients presented with dizziness,headache,limb paresthesias;3 cases were asymptomatic,confirmed by routine blood test in health examination;7 cases were confirmed by blood routinein course of cerebral infarction or myocardial infarction;5 cases presented abdominal distension or bellyache due to thrombosis of superior mesenteric vein,splenic vein or portal vein;3 cases with mild splenomegaly and underwent splenectomy.Hemorrhage occurred in 3 cases(8.8%),thrombosis in 11 cases(32.4%),and both hemorrhage and thrombosis in 2 cases(5.9%).The median platelet count at initial diagnosis was 991×109/L.Bone marrow biopsy was performed in 25 cases which showed bone marrow proliferating actively or apparent active,mainly increase of enlarged megakaryocytes with hyperlobulated nuclei.JAK2V617F mutation was detected in 3 of 12 patients.85.7% of patients responsed to hydroxyurea,90% of patients were responsive to hydroxyurea and interferon-α.Conclusions:For most symptomatic patients presenting with cerebral infarction,myocardial infarction,bellyache,splenomegaly or thrombosis,vigilance should be alert for the possibility of ET when blood routine showed PLT higher than 600×109/L.Early diagnosis may prevent complications.

OBJECTIVE:To establish a mouse model for the study of pathophysiologic mechanism and treatment of bone marrow failure (BMF).METHODS:Balb/c mice (recipient) were irradiated 5.0 Gy by gamma rays of (60)Co, and then infused 5 x 10(6) lymph node (LN) cells from DBA/2 mice (donor) in 4 hours. Pancytopenia was monitored by cell counting, bone marrow damage was assessed by histological staining and mononuclear cell counting. Serum IFN-gamma concentration was measured by ELISA. The proportion of Treg in spleen was detected by flow cytometry.RESULTS:Irradiation and infusion of LN cells led to rapid development of severe pancytopenia and BM hypoplasia, which reached the most severity at d14. The pancytopenia remained at d28 and displayed no signs of recovery. The bone marrow was full of adipose cells with scarcity of hematopoietic cells at d14 and persisted at least for 28 days, being similar to the feature of aplastic anemia. Serum IFN-gamma concentration was 6.3 fold increased \[(170.0 +/- 17.0) vs (27.7 +/- 7.1) pg/ml\] at d6. Tregs were decreased after infusion, and then increased \[(3.38 +/- 0.52)%\] and recovered to normal \[(4.04 +/- 0.44)%\] at d21. The expression level of the specific transcription factor Foxp3 was similar to normal.CONCLUSION:The MHC antigen of Balb/c mice is identical to that of DBA/2 mice, but their minor antigen differs. 5.0 Gy irradiation and then 5 x 10(6) lymphocyte infusion can induce BMF similar to the features of aplastic anemia.

Objective:To compare the coincidence of the mixed-lineage acute leukemia(MAL) diagnosed by flow cytometry (FCM) and by the bone marrow morphology and histochemical stain.Methods:To choose 12 cases of MAL patients diagnosed by FCM,and compare the corresponding FAB type results by histochemical stain. Then calculate the percent of MAL diagnosed by histochemical stain.Results:The 12 cases of MAL patients diagnosed by FCM,including 8 cases of biphenotypic acute Leukemia,3 cases of double clone leukemia and 1 case of cell line switched leukemia. Within these 12 cases of leukemia patients,7 of them were diagnosed as ALL by the bone marrow morphology and histochemical stain,3 of them as AML,and another 2 of them were not diagnosed by morphology,one of them was bone marrow necrosis and diagnosed as MAL finally by FCM.Conclusion:Only 17 percent of MAL diagnosed by FCM has the characteristic of MAL diagnosed by the bone marrow morphology and histochemical stain. the misdiagnosis rate is high. the application of FCM should be emphasized.

OBJECTIVE:To explore the role of sonic hedgehog (Shh) pathway in regulating the proliferation, migration and differentiation of hemangioblasts derived from aorta-gonad-mesonephros (AGM).METHODS:The hemangioblasts were isolated from AGM region of 11-day postcoitum (dpc) murine embryos by using the immuno-magnetic with CD34 and Flk1 monoclonal antibodies. The phenotypic analysis of hemangioblasts and AGM-derived stromal cells were detected by flow cytometry. The secretion of Shh was examined by immunohistochemical staining. The roles of Shh in regulating the proliferation, migration and differentiation of hemangioblasts in the transwell non-contact coculture system with AGM-derived stromal cells were observed by adding exogenous Shh N-Terminus and its antibody.RESULTS:The protein of Shh was highly expressed on AGM-derived stromal cells. The proliferation of hemangioblasts was promoted when co-cultured with AGM-derived stromal cells, and the effects of the latter could be blocked by antibody of Shh. The proliferation of hemangioblasts was strengthened further and kept for a long time without differentiation and apoptosis when exogenous Shh N-Terminus was added into the transwell non-contact co-culture system with AGM-derived stromal cells. When exogenous Shh N-Terminus was added into the cultural supernatant of hemangioblasts without AGM-derived stromal cells, the hemangioblasts were observed to be induced to apoptosis or differentiation after a short time of proliferation. Furthermore, the ability of migration could be promoted in the co-cultured hemangioblasts by adding exogenous Shh N-Terminus.CONCLUSION:Shh pathway probably involves in the regulation of the proliferation, differentiation, apoptosis and migration of hemangioblasts, and is regulated by the AGM microenvironment.

<正>河蟹即中华绒螯蟹,俗称螃蟹,属节肢动物门,自然分布较广,主要分布在长江中下游各地,在江苏、湖北、安徽和上海等地区已逐渐形成规模化养殖。饲料是河蟹养殖的关键,河蟹的营养需要是设计配合饲料的理论基础。国内外关于河蟹营养研究工作起步较晚,系统

Aim: To investigate the effects of Sonic hedgehog (shh) protein on bone marrow-derived endothelial progenitor cells (BM-EPC) proliferation, migration and vascular endothelial growth factor (VEGF) production, and the potential signaling pathways involved in these effects. Methods: Bone marrow-derived Flk-1 + cells were enriched using the MACS system from adult Kunming mice and then BM-EPC was cultured in gelatin-coated culture dishes. The effects of shh N-terminal peptide on BM-EPC proliferation were evaluated using the MTT colorimetric assay. Cell migration was assayed using a modified Boy den chamber technique. The production of VEGF was determined by ELISA and immunofluorescence analysis. The potential involvement of PKC and PI3K signaling pathways was explored using selective inhibitor or Western blot. Results: The proliferation, migration and VEGF production in BM-EPC could be promoted by endogenous shh N-terminal peptide at concentrations of 0.1 μg/mL to 10 μg/mL, and could be inhibited by anti-shh antibodies. Shh-mediated proliferation and migration in BM-EPC could be partly attenuated by anti-VEGF. Phospho-PI3-kinase expression in newly separated BM-EPC was low, and it increased significantly when exogenous shh N-terminal peptide was added, but could be attenuated by anti-human/mouse shh N-terminal peptide antibody. Moreover, the inhibitor of the PI3-kinase, but not the inhibitor of the PKC, significantly inhibited the shh-mediated proliferation, migration and VEGF production. Conclusion: Shh protein can stimulate bone marrow-derived BM-EPC proliferation, migration and VEGF production, which may promote neovascularization to ischemic tissues. This results also suggests that the PI3-kinase/Akt signaling pathways are involved in the angiogenic effects of shh.

The decoloring effect and feasibility to filtrate dyestuff and their mixture by pleurotus ostreatus culture was discussed. Results showed that the decoloring efficiency of malachite green, methylene blue and Congo red was more than 99%, 96% and 80% respectively while nearly 50% for bromophenol blue. The decoloring effect was not affected by mixing dyestuff solution. PH of the dyestuff solution could be regulated close to 7, and waste material from pleurotus ostreatus culture could be repeated used for 8 times, which indicated that filtration of pleurotus ostreatus culture could treat or pretreat dyestuff wastewater.

Aim: To investigate the effects of Sonic hedgehog (shh) protein on bone marrow-derived endothelial progenitor cells (BM-EPC) proliferation, migration and vascular endothelial growth factor (VEGF) production, and the potential signaling pathways involved in these effects. Methods: Bone marrow-derived Flk-1+ cells were enriched using the MACS system from adult Kunming mice and then BM-EPC was cultured in gelatin-coated culture dishes. The effects of shh N-terminal pep-tide on BM-EPC proliferation were evaluated using the MTT colorimetric assay. Cell migration was assayed using a modified Boy den chamber technique. The production of VEGF was determined by ELISA and immunofluorescence analysis. The potential involvement of PKC and PI3K signaling pathways was explored using selective inhibitor or Western blot. Results: The proliferation, migration and VEGF production in BM-EPC could be promoted by endogenous shh N-terminal peptide at concentrations of 0.1 ug/mL to 10 ug/mL, and could be inhibited by anti-shh antibodies. Shh-mediated proliferation and migration in BM-EPC could be partly attenuated by anti-VEGF. Phospho-PI3 -kinase expression in newly separated BM-EPC was low, and it increased significantly when exogenous shh N-terminal peptide was added, but could be attenuated by anti-human/mouse shh N-terminal peptide antibody. Moreover, the inhibitor of the PI3-kinase, but not the inhibitor of the PKC, significantly inhibited the shh-mediated proliferation, migration and VEGF production. Conclusion: Shh protein can stimulate bone marrow-derived BM-EPC proliferation, migration and VEGF production, which may promote neovascularization to ischemic tissues. This results also suggests that the PI3-kinase/Akt signaling pathways are involved in the angiogenic effects of shh.

目的探讨人白细胞介素-4(IL-4)启动子-590C→T多态性与特发性血小板减少性紫癜(ITP)发病的可能关系.方法酶联免疫法测定血小板相关抗体IgG及IL-4水平,采用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)的方法分析94名ITP患者和106名正常健康志愿者IL-4启动子-590C→T的基因型和等位基因频率.结果ITP组血小板相关抗体IgG[(273.71±90.45)ng/107PA]明显高于正常组[(72.35±23.32)ng/107PA],同时血清IL-4水平[(92.43±20.69)ng/L]也明显高于正常组[(46.71±11.9)ng/L];在ITP组,IL-4启动子区-590位点C等位基因频率为0.16,T等位基因频率为0.84;正常对照组C等位基因频率为0.30,T等位基因频率为0.70,两组基因型和等位基因频率有显著性差异(P＜0.05).结论ITP患者IL-4启动子-590C→T基因型和等位基因频率存在多态性;IL-4启动子-590C→T多态性可能导致ITP患者血清IL-4及PAIgG升高,在ITP的发病中起一定作用.

目前发现T细胞介导的免疫在再生障碍性贫血(再障)发病机制中起重要作用,并且已有多个独立的研究小组从再障患者外周血及骨髓中成功分离出能引起造血功能衰竭的致病相关性T细胞克隆,并证实其表型为CD4+T细胞[1,2],但这些T细胞异常增殖、活化及抑制机体造血功能的具体机制仍不清楚.我们通过改良抑制消减杂交的方法,建立CD4+T细胞的差异基因表达文库,为揭示再障病理损伤的机制提供线索.

Objective To investigate the expression of P120 catenin in the bone marrow of a rat model for myelodysplastic syndrome and its correlation with angiogenesis of the model.Methods After establishment of the model induced by the chemical mutagen dimethylbenzantharcene(DMBA),The expression of P120ctn in bone mar-row sections was measured immunohistochemically,and the bone marrow microvessels were highlighted using anti-F Ⅷ-related antigen staining.Both were quantified by Image-Pro Plus￡?and were analyzed their correlation statistically.Results P120ctn can be detected in stromal cells and microvessel endothelial cells of bone marrow.A sisnificant increase inangiogenesis and the expression of Pl20ctn were seen in MDS group compared to controls(P0.01 or P0.05).At the same time,the expression of P120ctn was positively related to angiogenesis in bone marrow.Conclusion The expression of P120ctn and angiogenesis were up-regulated in the model for myelodysplastic syndrome and both changes were correlated to some extent.

Objective To investigate the characteristic of the clinical features and the bone marrow pathology of secondary myelofibrosis.Methods Fourty-seven patients with secondary myelofibrosis in Tongji Hospital since 1995 to 2004 were analyzed retrospectively.And the relationship between myelofibrosis degree and megakaryocyte count is analyzed.Results Metastatic carcinoma is often associated with SMF and the examination of bone marrow is often dry tap or dilution.ALL or MM often associated with SMF,but by cellular examination of bone marrow can’t be diagnosed.In analysis no significant difference of the mygakaryocytes’ count and association of myelofibrosis with it was found.Conclusions When cellular examination of bone marrow is dry tap or dilution,there is SMF perhaps.Then bone marrow biopsy is useful to diagnosis.