Combination regimens containing daratumumab for initial diagnosed acquired thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia associated with disseminated microvascular platelet-rich thrombus. Before the introduction of plasma therapy, acute TTP was almost universally fatal, which improved survival from < 10 to 80-90%. However, patients who survived an acute attack were at high risk for recurrence and long-term morbidity. It was reported that daratumumab can eradicate persistent ADAMTS13-inhibiting autoantibodies and restore ADAMTS13 activity in two patients with relapsed immune-mediated TTP without associated adverse drug reactions. Here we report a case series of patients with initial diagnosed acquired TTP treated with combination regimens containing daratumumab. All the patients achieved clinical response after the initial treatment. Three patients achieved clinical remission, one patient relapsed and one patient suffered an exacerbation during follow-up. The two patients were retreated with glucocorticoids, plasma exchange combined with daratumumab, and clinical remission was achieved again. Combination of daratumumab in the treatment of initial diagnosed acquired thrombotic thrombocytopenic purpura can rapidly restore ADAMST13 activity and turn negative for ADAMST13 inhibitors, resulting in long-term remission in patients.

Survey of Incidence and Nested PCR Detection of Sugarcane White Leaf in Different Varieties

Sugarcane white leaf (SCWL) is a devastating sugarcane (Saccharum officinarum) disease caused by a 16SrXI group phytoplasma, which is extremely harmful to sugarcane production. To determine the occurrence of SCWL in different varieties in 2018, we conducted a field survey and performed nested PCR detection of SCWL phytoplasma in cane-planting areas of Mangweng and Hepai in Gengma, Yunnan province, which are the areas most severely affected by SCWL in China. The results of the field survey showed that the symptomatic incidence of SCWL differed among varieties. The mean symptomatic incidence of SCWL on variety Yuetang60 was the highest (73.50%), and it was the lowest on Liucheng05-136 (13.67%). Using nested PCR, the SCWL phytoplasma was detected in symptomatic plants of all varieties more than 90% of the time; the SCWL phytoplasma was detected in 91 and 97% of symptomatic plants of Yingyu91-59 and Liucheng05-136 varieties, respectively. The SCWL phytoplasma was detected by PCR in 82% of the asymptomatic plant samples. The results of this study showed that field survey based on white leaf symptoms did not accurately reflect the actual occurrence of the SCWL phytoplasma.

Loss of cane and sugar yield resulting from Ceratovacuna lanigera Zehntner damage in cane-growing regions in China

Ceratovacuna lanigera Zehntner is a major leaf pest of sugarcane. Widely distributed, it affects both the yield and quality of sugarcane in China. This study aimed to assess real yield and sugar yield losses, and the effect of C. lanigera damage on emergence of newly planted and ratoon cane under current production levels. Field experiments were carried out from 2014 to 2016 in Yunnan Province China. At maturity, plants were harvested and weighed to determine yield, and the effect on sugarcane quality and sucrose content analyzed. Real yield decreased by average of 46,185 kg hm-2 (range: 37,545-61,845 kg hm-2) in damaged versus undamaged areas, with an average yield loss rate of 35.9% (28.5-45.7%). Juice yield decreased by an average of 3.01% (2.4-4.13%) and sucrose content by 6.38% (5.48-8.16%). Juice brix decreased by an average of 7.66°BX (6.95-9.05°BX) and juice gravity purity by 12.35% (8.43-19.97%). In contrast, the reducing sugar content increased by an average of 1.21% (1.01-1.3%). Emergence rates of newly planted cane decreased by an average of 26.0% (24.7-27.3%). The emergence number of ratoon cane decreased by 66,834 hm2 (57,429-76,238 hm-2) and relative emergence loss rates of ratoon cane decreased by an average of 57.8% (57.6-58.0%). These findings confirm that C. lanigera damage severely affects sugarcane yield and quality in Yunnan Province. The results will help the implementation of effective control measures, thereby supporting sustainable development of the Chinese sugar industry.

[Effectiveness and safety in bronchoscopy under anesthesia with fentanyl combined with midazolam]

Objective: To study the effectiveness and safety in bronchoscopy under anesthesia with fentanyl combined with midazolam. Methods: We randomly allocated 132 patients( male 69, female 63, median age 62.9 years)requiring bronchoscopy in Beijing Xuanwu Hospital into 2 groups during January 2015 to December 2016.The trial group included 66 patients, receiving fentanyl combined with midazolam for anesthesia, while the control group of 66 patients receiving 2% lidocaine for topical anesthesia.In the trial group, there were 37 males and 29 females, with a median age of 63 years (range 26-82). In the control group, there were 36 males and 30 females, with a median age of 62.8 years (range 30-82). The pulse, mean arterial pressure, and the oxygen saturation of the patients were recorded before anesthesia and 5 minutes after deep anesthesia was reached. Changes of vital signs and adverse reactions during the bronchoscopy were also observed. Results: The fluctuation of pulse(12.3±2.3)/min, mean arterial pressure(5.9±2.2)mmHg(1 mmHg=0.133 kPa) and oxygen saturation(4.4±1.3)%was lower in the trial group as compared to that of the control group, pulse(21.9±1.8)/min, mean arterial pressure(7.1±2.3)mmHg, oxygen saturation(13.3±4.2)%, P<0.001.Five minutes after anesthesia, the pulse(80.0±11.9)/min, the mean arterial pressure(95.0±9.7)mmHg and the oxygen saturation(90.0±5.67)%of patients in the trial group were lower than those in the control group [pulse(90.3±17.0)/min, mean arterial pressure(102.7±12.4)mmHg, oxygen saturation(96.5±3.0)%], the differences being statistically significant(P<0.001). The trial group also showed smaller fluctuation, better tolerance, and fewer adverse reaction sthan the control group. Conclusion: Fentanyl combined with midazolam is safe and effective in bronchoscopy with fewer adverse reactions, but its early effect on the vital signs should be monitored and stricter indications may be needed.

Group 16SrXI phytoplasma strains, including subgroup 16SrXI-B and a new subgroup, 16SrXI-D, are associated with sugar cane white leaf

Sugar cane white leaf (SCWL) is a serious disease caused by phytoplasmas. In this study, we performed nested PCR with phytoplasma universal primer pairs (P1/P7 and R16F2n/R16R2) for the 16S rRNA gene to detect SCWL phytoplasmas in 31 SCWL samples collected from Baoshan and Lincang, Yunnan, China. We cloned and sequenced the nested PCR products, revealing that the 16S rRNA gene sequences from 31 SCWL samples were all 1247 bp in length and shared more than 99 % nucleotide sequence similarity with the 16S rRNA gene sequences of SCWL phytoplasmas from various countries. Based on the reported 16S rRNA gene sequence data from SCWL isolates of various countries, we conducted phylogenetic and virtual RFLP analysis. In the resulting phylogenetic tree, all SCWL isolates clustered into two branches, with the Lincang and Baoshan SCWL phytoplasma isolates belonging to different branches. The virtual RFLP patterns show that phytoplasmas of the Lincang branch belong to subgroup 16SrXI-B. However, the virtual RFLP patterns revealed by HaeIII digestion of phytoplasmas of the Baoshan branch differed from those of subgroup 16SrXI-B. According to the results of phylogenetic and virtual RFLP analysis, we propose that the phytoplasmas of the Baoshan branch represent a new subgroup, 16SrXI-D. These findings suggest that SCWL is caused by phytoplasmas from group 16SrXI, including subgroup 16SrXI-B and a new subgroup, 16SrXI-D.

[Chemical synthesis and characterization of R20A-HWTX-I, a mutant of huwentoxin-I with single residue replacement]

Huwentoxin-I (HWTX-I) is a polypeptide neurotoxin purified from the venom of the spider Selenocosmia huwena. R20A-HWTX-I, a mutant of HWTX-I in which the Arg was replaced by Ala, was synthesized on solid support by using Fmoc chemistry. The synthetic mutant was oxidatively renatured in glutathione-containing buffer, and then isolated by reversed phase and specially designed ion-exchange HPLC. The chemical structure of R20A-HWTX-I was confirmed by amino acid analysis, Edman degradation and MALDI-TOF mass analysis. Physiological experiment showed that the replacement of R20 by a decreased the bioactivity of the HWTX-I by 92%, indicating that R20 is a key residue closely related to the bioactivity of the HWTX-I.

A fast numerical algorithm for electron mean energy calculation in radiation therapy

A numerical algorithm for calculating the mean energy of radiotherapy electron beams has been developed. This algorithm is fast and accurate which makes it suitable for routine clinical use. First, a Gaussian distribution of the electron energy spectrum is derived from the linear Boltzmann equation. Based on this Gaussian spectrum, and after introducing a correction to the CSDA mean energy, a recursive-iterative algorithm for the mean energy calculation is developed. The multiple-scattering correction is taken into account using Yang's pathlength distribution theory. Numerical results of the present algorithm are compared with the results obtained through Monte Carlo simulation as well as Harder's formula. Good agreement with Monte Carlo simulation is achieved. Also the new algorithm is much more accurate than the commonly-used empirical formula of Harder.

[Inhibition of demand pacemakers by myopotentials and its clinical significance]

Unipolar demand pacemaker myopotential inhibition by 5 different provocative maneuvers was studied in 48 patients with stable pacing rhythm out of 82 patients with unipolar pacemakers from 3 manufacturers implanted over the right pectoralis major to evaluate the incidence of inhibiting phenomenon and its clinical significance. Transient pacing inhibition occurred in 19 (39.6%) of the 48 patients. Among them 3 (30.0%) of 10 patients with Model 28 (EDWARDS), 6 (31.6%) of 19 patients with Model 30 (EDWARDS), 10 (71.4%) of 14 patients with Model 7550 (ELAMEDICAL), and none of the 5 patients with Model P101 (QINMING). The effective maneuvers were the right hand-to-left shoulder press (63.2% positivity), the uprising from a supine position (21.0% positivity) and the hand-to-hand press (15.8% positivity). No pacemaker myopotential inhibition had been induced by Valsalva maneuver and the left hand-to-right shoulder press. 19 patients with positive myopotential inhibition had pauses of pacemaker function lasting from 1.2 to 3.9 seconds, 13 of them with pauses more than 2 seconds. Of all 48 patients, 9 (18.7%) experienced symptoms of cerebral ischemia due to pacemaker myopotential inhibition during test, among whom 8 had ventricular standstill more than 2 seconds. This showed a close relation between symptoms and duration of the pacing inhibition. The causes of the phenomenon and its prevention were briefly discussed.

[Plasma CK-MB activity and QRS score in estimating acute myocardial infarct size]

Comparison of the peak value of plasma isoenzyme MB of creatine kinase (CK-MB) and the modified Selvester QRS score system from the standard 12-lead electrocardiogram in estimating acute myocardial infarct size and predicting hospital prognosis was performed in 52 patients with initial acute myocardial infarction (AMI). A correlation coefficient (C.C.) of 0.51 in all these patients was found. The C.C. in the patients with anterior AMI (n = 22, r = 0.64) is larger than that in inferior AMI (n = 30, r = 0.34). The prognostic value of the two methods are different. Peak CK-MB activity could predict hospital mortality and morbidity (serious arrhythmia or/and Killip AMI classification more than class III) for both anterior and inferior AMI; however, the QRS score system was significant only for anterior AMI. The clinical significance of a high ratio of peak CK-MB activity to QRS score was discussed briefly.

[Serum lipids and apolipoproteins AI, B100, CI and CII in patients with apoplexy]

Serum triglycerides, cholesterol, HDL-cholesterol and apolipoproteins (apo) AI, B100. CI and CII were determined and analyzed in 72 apoplectic patients and 64 age-matched normal subjects. Significantly increased triglycerides, low HDL-C and slightly decreased cholesterol levels were found in the apoplectics. Apo AI was slightly decreased and apo B100 slightly increased in the apoplectics compared with normal subjects. Apo CI and CII levels were significantly decreased in the apoplectics. The results are discussed.