Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi最新文献

{"title":"[The value of sequential organ failure assessment and its dynamic changes in predicting mortality in hematology intensive care unit].","authors":"J J Wang, J Zhang, B Zhang, Y C Cao, Y L Guo, P R Yu, X Q Zhang, X J Zhang, Y J Song","doi":"10.3760/cma.j.cn121090-20241130-00510","DOIUrl":"10.3760/cma.j.cn121090-20241130-00510","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the value of Sequential Organ Failure (SOFA) score and its dynamics (ΔSOFA) in predicting mortality in hematology care unit (HCU) . <b>Methods:</b> A retrospective clinical study was conducted on 79 critically ill hematologic patients admitted to the Center for Critical Care Medicine, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, between May and June 2024. SOFA scores and ΔSOFA were calculated within 2 days before and after HCU admission. The predictive value of SOFA and ΔSOFA in mortality was assessed using receiver operating characteristic (ROC) curve analysis. <b>Results:</b> Among the 79 patients, the HCU mortality rate was 54.4%. The SOFA scores on days 1-3 (D1, D2, and D3) and ΔSOFA on day 1 (ΔD_1) of all patients, leukemia patients and hematopoietic stem cell transplantation (HSCT) patients were significantly higher in the death group compared with the non-death group (all <i>P</i><0.05). ROC curve analysis revealed that the D_1, D_2, D_3 scores, and ΔD_1 significantly predicted mortality (<i>P</i><0.001), with areas under the curve (AUCs) of 0.786, 0.866, 0.901, and 0.843, respectively. The sensitivity values were 74.36%, 57.89%, 62.85%, and 86.84%, while specificity values were 70%, 100%, 100%, and 67.65%, respectively. In the HSCT group, the D_-1, D_1, D_2, D_ 3, scores and ΔD_1 were predictive of HCU mortality, with AUCs of 0.833, 0.794, 0.871, 0.846, and 0.795, respectively. Sensitivity values for these scores were 100%, 85.71%, 71.43%, 57.14%, and 57.14%, while specificity values were 73.33%, 70.59%, 91.33%, 100%, and 100%, respectively. In the leukemia group, the D_1, D_2, D_3 scores, and ΔD_1 were predictive of HCU mortality, with AUCs of 0.760, 0.829, 0.846, and 0.756, respectively. Sensitivity values were 71.43%, 78.57%, 53.85%, and 71.43%, while specificity values were 76.19%, 78.95%, 100%, and 63.16%, respectively. For all patients, the D_3 score exhibited the highest specificity, while the ΔD_1 demonstrated the highest sensitivity. For patients in both the HSCT and leukemia groups, the sensitivity and specificity values of the D_1 and D_3 scores exceeded those of the ΔD_1. <b>Conclusion:</b> For patients with hematologic critical illness, including leukemia and those undergoing HSCT hospitalized in the HCU, D_1, D_2, D_ 3 scores and ΔD_1 are significantly associated with HCU mortality.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"31-38"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Current situation and prospect of minimal residual disease in pediatric T cell acute lymphoblastic leukemia].","authors":"F F Niu, C Gao","doi":"10.3760/cma.j.cn121090-20240701-00239","DOIUrl":"10.3760/cma.j.cn121090-20240701-00239","url":null,"abstract":"<p><p>Pediatric T-cell acute lymphoblastic leukemia (T-ALL) has been attracted much attention due to its high aggressiveness and complexity of treatment. Recently, with the development of technology and clinical research, the curative effect of T-ALL in children has been significantly improved. However, the presence of minimal residual disease (MRD) is still a key factor affecting the outcomes of children with T-ALL. With the continuous development of detection methods, the clinical applications of real-time quantitative PCR, multi-parameter flow cytometry, and high-throughput sequencing technology, MRD can be detected accurately to achieve personalized and precise treatment for each patient. The purpose of this article is to review the current detection methods of MRD in T-ALL, the clinical significance of MRD monitoring and evaluation in multi-agent combined chemotherapy and hematopoietic stem cell transplantation, and applying MRD to measure the responsiveness and effectiveness of new therapies in recent T-ALLs. Research directions and potential treatment strategies in the near future were also proposed.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"97-102"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical characteristics and prognostic evaluation of patients with hematological disease and sepsis in the Hematological intensive care unit].","authors":"H T Li, D X Lu, D D Li, D Y Zhang, J Y Fu, Q Zhang, S J Fan","doi":"10.3760/cma.j.cn121090-20241204-00532","DOIUrl":"10.3760/cma.j.cn121090-20241204-00532","url":null,"abstract":"<p><p><b>Objective:</b> To identify the clinical characteristics and prognosis of patients with hematological disease and neutropenic sepsis in the hematological intensive care unit (HCU). <b>Methods:</b> A retrospective analysis was conducted on patients with hematological disease and sepsis who admitted to HCU, the First Affiliated Hospital of Harbin Medical University from October 2017 to October 2024, to examine the primary therapeutic options, prognosis, cause of death, and infectious features of sepsis. <b>Results:</b> A total of 245 septic patients were included in the study, comprising 88 cases in the neutropenic sepsis group (neutropenic group) and 157 cases in the non-neutropenic sepsis group (non-neutropenic group). Acute leukemia was more prevalent in the neutropenic group [55.68% (49/88) ]. At the time of admission to the HCU, the neutropenic group exhibited unstable vital signs, lower blood cell counts, higher inflammatory markers, elevated Sequential Organ Failure Assessment (SOFA) scores, increased creatinine levels (120.00 µmol/L <i>vs</i> 77.10 µmol/L, <i>P</i><0.01), higher total bilirubin levels (24.70 µmol/L <i>vs</i> 17.90 µmol/L, <i>P</i><0.01), and significantly elevated B-type natriuretic peptide levels (567.90 ng/L <i>vs</i> 134.50 ng/L, <i>P</i><0.01) compared with the non-neutropenic group. Furthermore, septic shock was more common in the neutropenic group [53.40% (47/88) <i>vs</i> 36.94% (58/157), <i>P</i><0.05]. The mortality rate was also higher in the neutropenic group [46.59% (41/88) ] compared with the non-neutropenic group [32.48% (51/157) ] (<i>P</i><0.05), with septic shock accounting for the majority of deaths [70.73% (29/41) ]. Infections caused by gram-negative bacteria [55.68% (49/88) vs 36.30% (57/157), <i>P</i><0.01] and fungi [14.77% (13/88) <i>vs</i> 6.36% (10/157), <i>P</i><0.05] were more common in the neutropenic group. However, lung infections were significantly less frequent in the neutropenic group (<i>P</i><0.01). Kaplan-Meier survival analysis revealed a substantially worse 28-day overall survival rate for the neutropenic group compared with the non-neutropenic group (<i>P</i><0.05) . <b>Conclusion:</b> Patients with hematological diseases and neutropenic sepsis presented with more severe clinical conditions, a higher likelihood of organ failure and septic shock, and significantly increased mortality compared with patients with non-neutropenic sepsis.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"58-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chinese expert consensus on diagnosis, treatment and management of critically ill patients in hematology intensive care unit (2025)].","authors":"","doi":"10.3760/cma.j.cn121090-20241206-00542","DOIUrl":"10.3760/cma.j.cn121090-20241206-00542","url":null,"abstract":"<p><p>Recently, survival rates for patients with hematological malignancies (HMs) have improved, but severe complications have also risen accordingly, and can escalate quickly. Establishing a hematology intensive care unit (HCU) is crucial for early detection and centralized monitoring of critically ill hematological patients, as well as the enhancement of diagnosis, treatment and prognosis and minimizing medical disputes. Based on the guidelines of intensive care unit and hematology department, combined with clinical operation experience of domestic HCU, this consensus is participated by several leading hematology centers in China. It outlines the necessity, configuration, admission standards, management, treatment principles, and strategies of HCU. An expert agreement on managing critically ill HCU patients was achieved. It is suggested that the blood centers with eligible critieria should actively establish HCU, aiming to further lowering the mortality rate of critically ill hematology patients.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"9-17"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The state of the art: diagnosis and therapeutic interventions of clonal hematopoiesis of indeterminate potential and clonal cytopenias of undetermined significance].","authors":"Z J Xiao","doi":"10.3760/cma.j.cn121090-20241228-00600","DOIUrl":"10.3760/cma.j.cn121090-20241228-00600","url":null,"abstract":"<p><p>Clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenias of undetermined significance (CCUS) are included in both fifth edition of the World Health Organization classification (WHO 2022) and International Consensus Classification (ICC). Recently three models were developed for prediction of myeloid neoplasms risk and clinical trials are initiated to investigate potential treatments for CHIP and CCUS. Challenges in diagnosis and therapeutic intervention of CHIP and CCUS were discussed.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"5-8"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Advances in complement inhibition therapy for paroxysmal nocturnal hemoglobinuria].","authors":"Y M Shi, F K Zhang","doi":"10.3760/cma.j.cn121090-20240903-00332","DOIUrl":"10.3760/cma.j.cn121090-20240903-00332","url":null,"abstract":"<p><p>Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematologic disorder. Historically, most PNH patients mainly received supportive treatment, which led to poor quality of life and high mortality rates. The advent of downstream complement C5 inhibitors has dramatically changed the natural course of PNH. These inhibitors alleviate clinical symptoms, significantly reduce severe complications, and improve survival rates. Despite their ability to control intravascular hemolysis and enhance hemoglobin levels, approximately half of the treated patients still require blood transfusions due to extravascular hemolysis (EVH) mediated by upstream complement component C3. Upstream complement inhibitors not only control IVH but also reduce the deposition of C3 fragments, thereby solving the problem of EVH and further improving the clinical outcomes of PNH patients. However, due to the cascade of complement activation and the increased accumulation of PNH red blood cells after treatment with upstream complement inhibitors, there may be an increased risk of more severe breakthrough hemolysis events. Additionally, the potential risk of infections associated with complement inhibitors is another issue that needs to be addressed.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"90-96"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Legionella infection complicating acute lymphoblastic leukemia: a case report].","authors":"L Q Han, B Zhang, J Zhang, J S Li, Y J Liu, Y X Su, Y J Song","doi":"10.3760/cma.j.cn121090-20240823-00316","DOIUrl":"10.3760/cma.j.cn121090-20240823-00316","url":null,"abstract":"","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"88-89"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Strengthen the construction of hematological intensive care unit to comprehensively improve the prognosis of patients with hematological critical illnesses].","authors":"Y Hu, Y H Wu","doi":"10.3760/cma.j.cn121090-20241225-00592","DOIUrl":"10.3760/cma.j.cn121090-20241225-00592","url":null,"abstract":"<p><p>The survival time of patients with hematological malignancies has improved significantly in recent years; however, the incidence of severe complications has also increased and may escalate rapidly alongside the progression of the primary disease. The establishment of a hematology intensive care unit (HCU) is of great clinical significance for early identification, centralized monitoring and management of hematological critically ill patients, leveraging the advantages of specialties, accurately controlling the condition, and improving the level of diagnosis and treatment in hematology. It is recommended that blood centers with adequate resources actively establish HCUs to enhance the prognosis of patients with hematological critical illnesses.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A clinical investigation of constructing a diagnostic model for sepsis-induced coagulopathy utilizing data-independent acquisition proteomics].","authors":"Q Chen, J C Song, X L Wan, J J Zeng, X M Song, L C Zhong, L P He","doi":"10.3760/cma.j.cn121090-20241219-00579","DOIUrl":"10.3760/cma.j.cn121090-20241219-00579","url":null,"abstract":"<p><p><b>Objective:</b> This study used data-independent acquisition (DIA) proteomics to analyze plasma protein expression in sepsis-induced coagulopathy (SIC), identify key biomarkers, and develop a diagnostic model. <b>Methods:</b> This prospective study included 46 adult sepsis patients from the intensive care unit. Patients were categorized into a general sepsis group (<i>n</i>=26) and an SIC group (<i>n</i>=20) based on established SIC criteria. Plasma samples underwent proteomic and bioinformatics analyses to identify differentially expressed protein (DEP) using LASSO regression and Random Forest. A diagnostic model was constructed and assessed via receiver operating characteristic (ROC) curve analysis. <b>Results:</b> The baseline data revealed that SIC patients exhibited longer prothrombin times, lower platelet counts, and higher D-dimer, fibrin degradation products, blood lactate, SOFA scores, and APACHE Ⅱ scores compared with general sepsis patients (<i>P</i><0.05). DIA proteomics identified 2 637 proteins, with 240 DEP meeting the criteria (fold change >1.5, <i>P</i><0.05), including 81 upregulated and 159 downregulated DEP. Subcellular localization analysis revealed that DEPs were predominantly extracellular and nuclear. Gene ontology (GO) annotation showed that DEP were mainly involved in cellular physiology, biological regulation, and stress response processes in biological processes. Domain annotation revealed a predominance of immunoglobulin V regions in DEP, which are crucial for antigen recognition and binding. KEGG enrichment analysis showed significant enrichment of DEP in pathways related to natural killer cell-mediated cytotoxicity, glycosylphosphatidylinositol anchor biosynthesis, tumor necrosis factor signaling, and NF-κB signaling. LASSO regression identified angiogenin and C-type lectin domain family 10 member A as key DEP. The SIC diagnostic nomogram showed an area under the curve of 0.896, with 0.731 specificity and 0.900 sensitivity. <b>Conclusion:</b> The nomogram incorporating angiogenin and C-type lectin domain family 10 member A provides an accurate tool for SIC diagnosis.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"45-52"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Safety and efficacy of mitoxantrone liposome combined chemotherapy in the treatment of mixed phenotype acute leukemia].","authors":"H W Jiang, C Lu, J He, Q Z Wei, M F Su, Y H Wu, J B Hu","doi":"10.3760/cma.j.cn121090-20241210-00554","DOIUrl":"10.3760/cma.j.cn121090-20241210-00554","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the safety and efficacy of mitoxantrone liposome (MIT-LIP) combined chemotherapy in treating mixed phenotype acute leukemia (MPAL) . <b>Methods:</b> December 2021 to November 2024, MPAL patients who underwent the MAED (MIT-LIP + cytarabine + etoposide + dexamethasone) regimen were retrospectively analyzed. Data on clinical characteristics, adverse reactions, therapeutic outcomes, and long-term prognoses were collected. <b>Results:</b> A total of 7 MPAL patients who received MAED regimen were admitted. Among them, two patients were initially diagnosed with T-ALL or B-ALL, respectively, and transformed into AML after treatment. Three patients were initially diagnosed as MPAL (B/myeloid), one as MPAL (T/myeloid), and one with MPAL (myeloid/plasmacytoid dendritic cell). Among the 7 patients, there were 3 males and 4 females, 1 chromosome abnormalities and 6 gene abnormalities, including 1 case with BCR∷ABL fusion gene. The median age was 38 years (range: 16-58 years). There was no clear related drug allergy and organ toxicity during MAED regimen, and the main adverse effect was hematological toxicity. After induced chemotherapy, all patients achieved complete remission (CR), 2 maintained MRD-negative CR and 1 maintained MRD-positive CR. The other 4 patients underwent allogeneic hematopoietic stem cell transplantation, 2 maintained MRD-negative CR, and 2 relapsed. The current median follow-up time was 12 months, the overall survival (OS) rate was 100%, the relapse-free survival (RFS) rate was 60%, and the median OS time and median RFS time were not reached. <b>Conclusion:</b> The MAED regimen demonstrates high safety and a favorable CR rate in MPAL treatment.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"64-69"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}