Table of Content

20 March 2018, Volume 33 Issue 3

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Orginal Article

Changes and correlation of serum cystatin C and myeloperoxidase levels in patients with coronary slow-flow angina pectoris

YI Xuejun, ZHANG Ailing, ZHAI Jianxin

2018, 33(3):  191-195.  DOI: 10.3969/j.issn.1673-8640.2018.03.001

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bjective To investigate the changes and correlation of serum cystatin C （Cys C）and myeloperoxidase （MPO） levels in patients with coronary slow-flow angina pectoris. Methods A total of 100 patients with coronary slow-flow angina pectoris were enrolled as angina pectoris group. According to treatment efficiency,they were classified into good prognosis group （59 cases） and poor prognosis group （41 cases）. Totally,100 healthy subjects were enrolled as healthy control group. Serum Cys C and MPO levels and corrected thrombolysis in myocardial infarction（TIMI）flow frames were determined. Pearson correlation analysis was used to evaluate the correlation of serum Cys C and MPO with corrected TIMI flow frames. Logistic regression analysis was used to assess whether elevated serum Cys C and MPO levels were risk factors for poor prognosis in patients with coronary slow-flow angina pectoris. Results Serum Cys C and MPO levels and corrected TIMI flow frames in angina pectoris group were higher than those in healthy control group （P<0.001）. Serum Cys C and MPO levels in good prognosis group were lower than those in poor prognosis group （P<0.001）. Pearson correlation analysis showed that serum Cys C and MPO levels were positively correlated with corrected TIMI flow frames （r=0.705 and 0.643,P<0.05）. Logistic regression analysis showed that elevated serum Cys C and MPO levels were independent risk factors for poor prognosis [Cys C：odds ratio （OR）=4.125,95% confidence interval （CI） 3.658-4.756,P=0.000;MPO：OR=6.986,95%CI 5.356-7.967, P=0.000]. Conclusions Serum Cys C and MPO levels are related to the occurrence and development of coronary slow-flow angina pectoris,and serum Cys C and MPO are independent risk factors for poor prognosis. The dynamic determinations of serum Cys C and MPO levels can be used for evaluating the status and prognosis of patients with coronary slow-flow angina pectoris.

Influence of 5 antipsychotic drugs on liver function and heart function in the treatment of schizophrenia

KONG Lingguang, LIN Chongguang, HUANG Qianqian, LI Yanbin, XU Dali, XIE Hailong, ZHENG Cunqing, CHEN Xiaoying

2018, 33(3):  196-200.  DOI: 10.3969/j.issn.1673-8640.2018.03.002

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Objective To investigate the influence of 5 antipsychotic drugs （aripiprazole,clozapine,olanzapine,risperidone and quetiapine） on liver function and heart function in the treatment of schizophrenia. Methods A total of 192 schizophrenia patients were enrolled and randomly classified into 5 groups,including 38 cases in clozapine group,40 cases in olanzapine group,37 cases in risperidone group,35 cases in quetiapine group and 42 cases in aripiprazole group. Clozapine group received clozapine tablets orally,olanzapine group received olanzapine tablets orally,risperidone group received risperidone tablets orally,quetiapine group received quetiapine tablets orally,and aripiprazole group received aripiprazole tablets orally. The treatment course of each group was 8 weeks. The curative effect,Loewenstein Occupational Therapy Cognitive Assessment（LOTCA） score,Positive and Negative Syngrome Scale（PANSS） score,heart function,liver function and Treatment Emergent Symptom Scale（TESS） score before and after treatment were evaluated. Results The total effective rate showed no statistical significance （P>0.05）. LOTCA score was higher after treatment than that before treatment,and PANSS score was lower after treatment than that before treatment （P<0.05）. LOTCA score and PANSS score of each group after treatment had no statistical significance （P>0.05）. There were alanine aminotransferase（ALT） increasing,aspartate aminotransferase（AST） increasing and ALT+AST increasing without statistical significance （P>0.05）. Left ventricular ejection fraction and left ventricular end-diastolic diameter were lower after treatment than those before treatment （P<0.05）,and there was no statistical significance for left ventricular ejection fraction and left ventricular end-diastolic diameter of each group （P>0.05）. TESS scores of risperidone and quetiapine groups at 4 and 8 weeks were lower than those of clozapine,olanzapine and aripiprazole groups （P<0.05）. TESS scores of risperidone and quetiapine groups showed no statistical significance （P>0.05）. Conclusions Aripiprazole,clozapine,olanzapine,risperidone and quetiapine have curative effects for the treatment of schizophrenia,with a little influence on liver function and heart function,and can improve the cognitive ability of patients with psychiatric symptoms. Risperidone and quetiapine have mild adverse reactions.

Relationship of sVAP-1,liver function parameters and serum HCV RNA loads in chronic hepatitis C patients

YU Hongliang

2018, 33(3):  201-204.  DOI: 10.3969/j.issn.1673-8640.2018.03.003

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Objective To investigate the relationship of soluble vascular adhesion protein-1（sVAP-1）,liver function parameters and serum hepatitis C virus（HCV）RNA loads in chronic hepatitis C patients. Methods The clinical data of 400 chronic hepatitis C patients and 207 healthy subjects were analyzed retrospectively. Real-time fluorescence quantitation polymerase chain reaction （PCR） was used to determine HCV RNA. Double-antibody sandwich enzyme-linked immunosorbent assay （ELISA）was used to determine serum level of sVAP-1,and automatic biochemistry analyzer was used to determine liver function parameters. The results were recorded and analyzed. Results Serum sVAP-1 level in chronic hepatitis C patients was higher than that in healthy subjects （P<0.01）. Serum sVAP-1 level in chronic hepatitis C patients with alanine aminotransferase ≤50 IU/L was lower than that >50 IU/L（P<0.01）. Serum level of sVAP-1 in patients with Child-Pugh grade C was higher than those in grade A and grade B （P<0.05）. Serum sVAP-1 had positive correlations with aspartate aminotransferase and alanine aminotransferase （r=0.832 and 0.749,P<0.01） and a negative correlation with albumin （r=-0.152,P<0.05）. There was no correlation with serum HCV RNA loads （r=0.087,P>0.05）. Conclusions Serum sVAP-1 level in patients with chronic hepatitis C increases,and serum sVAP-1 is positively correlated with hepatocellular inflammatory injury in patients with chronic hepatitis C.

Screening of specific anti-mitochondrial antibody-M2 in 36 459 healthy subjects in Guiyang

YE Zhenxuan, YANG Biwei, ZHOU Wenjing, LIU Qiang, LI Hongmei, ZHANG Haiyan, REN Zhijing, ZHANG Hua

2018, 33(3):  205-208.  DOI: 10.3969/j.issn.1673-8640.2018.03.004

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Objective To screen specific anti-mitochondrial antibody （AMA）-M2 for primary biliary cirrhosis （PBC） in healthy subjects,to analyze the results of positive cases,and to evaluate the role of AMA-M2 for the early screening of PBC. Methods AMA-M2 in 36 459 healthy subjects were determined by enzyme-linked immunosorbent assay （ELISA）. The results of AMA-M2 positive cases were analyzed further. Imaging examination was used to exclude non-PBC abnormality and make diagnosis. Results A total of 438 AMA-M2 positive cases were determined. The positive rate was 1.20%. There were 0.72% males （135/18 687） and 1.70% females （303/17 772）. In the 438 AMA-M2 positive cases,39 cases had alkaline phosphatase （ALP） increasing,3 cases with gamma-glutamyltransferase （GGT） increasing,15 cases with alanine aminotransferase （ALT）increasing,7 cases with total bilirubin （TB） increasing,7 cases with direct bilirubin （DBil） increasing and 4 cases with indirect bilirubin （IBil）increasing. Combined with the results of biochemical determinations,there were 39 cases meeting the diagnostic criteria of PBC. The prevalence rate was 0.11%,in which 10 males were （59.40±13.93）years old and 29 females were （54.31±14.80） years old. Conclusions Asymptomatic patients with PBC are common in Guiyang. Carrying out AMA-M2 screening in healthy population is an effective approach for the early determination of PBC.

Preoperative peripheral blood neutrophil-to-lymphocyte ratio in the diagnosis of breast cancer

ZHAO Weiwei, XIAO Linlin, LIU Xiufen, PENG You, HUANG dingding, WANG Yuping, FENG Jing

2018, 33(3):  209-212.  DOI: 10.3969/j.issn.1673-8640.2018.03.005

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Objective To investigate the role and optimal cut-off value of preoperative peripheral blood neutrophil-to-lymphocyte ratio（NLR） in the diagnosis of breast cancer. Methods A total of 131 breast cancer patients undergoing surgery and 120 patients with benign breast disease were enrolled. Totally,95 healthy females were enrolled as healthy control group. Neutrophil（NE）and lymphocyte（LY）counts were determined by SYSMEX XT-800i automatic hematology analyzer,and NLR was calculated. The levels of carbohydrate antigen 15-3（CA15-3）,carbohydrate antigen 125（CA125）and carcinoembryonic antigen（CEA）in peripheral blood were determined by electrochemiluminescence. According to receiver operating characteristic（ROC）curve,the optimal cut-off value was determined. Results In breast cancer group,NLR,NE,LY and CA15-3 were higher than those in healthy control and benign breast disease groups（P<0.05）. The area under curve（AUC） of NLR was 0.935,the optimal cut-off value was 1.995,the sensitivity was 85.2%,and the specificity was 87.1%. Based on NLR determination,the sensitivity and specificity of the combined determination with CA15-3 were 98.0% and 92.6%,respectively could improve the sensitivity. Conclusions The optimal cut-off value of NLR is 1.995,and the sensitivity and specificity can be improved through the combined determination with CA15-3 in the diagnosis of breast cancer,which can guide the diagnosis and disease severity assessment of breast cancer.

Changes of coagulation function in early stage among rib fracture patients with mild to moderate injury severity score

YU Shouqiang, QUAN Yonghui, SUN Baolin

2018, 33(3):  213-215.  DOI: 10.3969/j.issn.1673-8640.2018.03.006

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Objective To investigate the changes of coagulation function in early stage among rib fracture patients with mild to moderate injury severity score （ISS）. Methods The changes of coagulation function in early stage among 95 rib fracture patients with mild to moderate ISS were analyzed retrospectively. The coagulation function was determined by coagulation-colorimetry method. The clinical data were collected. Results The medians（M）of abbreviated injury scale （AIS） and ISS were 3 （1-4）and 11 （2-41）,respectively. The levels of fibrinogen degradation product,fibrinogen,thrombin time and D-dimer were 6.80（4.10-17.30）mg/L,（4.23±0.45）g/L,（19.45±1.30）s and 1 560.00（757.00-4 732.00）μg/L,which were higher than their reference values（P<0.05）. The levels of antithrombin Ⅲ,international normalized ratio and activated partial thromboplastin time （APTT） were （87.30 ±14.15）%,0.97±0.08 and （29.12±4.28） s,which were lower than their reference values（P<0.05）. The levels of prothrombin and prothrombin time （PT） activity were （11.17±0.89）s and （107.91±16.76）%,with no statistical significance compared with their reference values （P>0.05）. Correlation analysis showed that ISS was rank correlated with fibrinogen degradation product and D-dimer （rs=0.283 and 0.308）（P<0.05）. AIS was rank correlated with fibrinogen degradation product and D-dimer （rs=0.224 and 0.226）（P<0.05）. Conclusions The coagulation function in early stage among rib fracture patients with mild to moderate ISS is changed obviously,mainly in high-level fibrinolytic function and coagulation state,and high-level fibrinolytic function is related to the severity of trauma.

Performance of pro-gastrin-releasing peptide assay by electrochemiluminescence immunoassay

SHEN Junfei, WU Wenhao, ZHOU Jiaye, WANG Beili, GUO Wei, PAN Baishen

2018, 33(3):  222-227.  DOI: 10.3969/j.issn.1673-8640.2018.03.009

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Objective To assess the performance of pro-gastrin-releasing peptide （ProGRP） assay by electrochemiluminescence immunoassay. Methods A total of 127 lung cancer patients [48 small-cell lung cancer （SCLC）patients and 79 non-small-cell lung cancer （NSCLC）patients],40 benign lung disease patients,60 other tumor patients,20 autoimmune disease patients and 120 healthy subjects （healthy control group） were enrolled. Serum levels of ProGRP were determined by electrochemiluminescence immunoassay,chemiluminescence microparticle immunoassay and enzyme-linked immunosorbent assay（ELISA）. The precisions,accuracies,linearities and reference intervals of the 3 methods were assessed. Receiver operating characteristic（ROC）curve was used to evaluate the diagnostic efficiency of ProGRP determination independently and ProGRP determination combined with carcinoembryonic antigen（CEA）,neuron specific enolase（NSE）and cytokeratin 19-fragment（CYFRA21-1）. The diagnostic efficiency of the 3 methods was compared. Results The within-run and between-run precisions of high-level and low-level ProGRP were 0.8%,1.2% and 0.9%,2.2%,respectively. The recoveries were 99.86% and 98.32%,respectively. There was a good linear range of 33.13-4 796.00 pg/mL. For healthy control group,the reference interval was 0-69.2 pg/mL. Pearson correlation analysis showed that there was a correlation among the 3 methods. Bland-Altman analysis showed a good consistency in low-level region among the 3 methods,but the bias was increased with the increasing results. The level of ProGRP in SCLC group was higher than those in the other groups （P<0.05）,and there was no statistical significance among the other groups （P>0.05）. The optimal cut-off value was 66.65 pg/mL. The sensitivity and specificity were 79.2% and 95.3%,respectively. The sensitivity and specificity increased to 83.3% and 96.2% for the combined determination with NSE （P<0.05）,and there was no statistical significance compared with those for the combined determination with CEA,NSE and CYFRA21-1（P>0.05）. The diagnostic efficiency of the 3 methods for SCLC had no difference（P>0.05）.Conclusions The performance of ProGRP assay by electrochemiluminescence immunoassay is accordance with expected requirements. ProGRP can be as a reliable marker for the diagnosis of SCLC.

SDS for improving direct identification of microorganisms in positive blood culturing by MALDI-TOF MS

ZHOU Chunmei, SHEN Jiajin, HUANG Shenglei, MA Yan, LI Huayin

2018, 33(3):  228-232.  DOI: 10.3969/j.issn.1673-8640.2018.03.010

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Objective To improve the direct identification of microorganisms in positive blood culturing by matrix-assisted laser desorption ionization-time of flight mass spectrometry （MALDI-TOF MS） with the pretreatment of sodium dodecyl sulfate（SDS）. Methods A total of 378 blood culturing bottles were collected from March to September in 2016. Microorganisms were enriched and purified directly from blood culturing bottles by separation gel tube,washed by SDS,and then the samples were directly identified by MALDI-TOF MS. Traditional culturing and identification processes were performed simultaneously to be a reference. The accuracy of identification by MALDI-TOF MS with or without SDS pretreatment was compared. Results A total of 87 blood culturing samples without SDS washing were determined,and there were 83 cases of single strains and 4 cases of complex strains. The accurate species identification rate was 73.5%. The remaining 286 samples washed by SDS identified 277 cases of single strains and 9 cases of complex strains,and the accurate species identification rate was 82.7%. The identification rate for Gram-positive strains increased from 65.7% to 90.5%. Improvement was more frequent in yeast identification from 11.1% to 50.0% with statistical significance（P<0.05）. Conclusions The preparation method,based on SDS washing,improves the identification rate of positive blood culturing directly by MALDI-TOF MS. It is easy-to-operation,time-saving and low-cost,which could be promoted in clinical microbiology laboratories.

Multilocus sequence typing in the molecular epidemiological study of azole-resistant Candida albicans from patients with Candida albicans vaginitis

XU Weixin, SUN Jie

2018, 33(3):  233-238.  DOI: 10.3969/j.issn.1673-8640.2018.03.011

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Objective To investigate the molecular epidemiological characteristic of azole-resistant Candida albicans from patients with Candida albicans vaginitis by multilocus sequence typing（MLST）,and to analyze the genotype difference between resistant and sensitive isolates and the relationship between genetic diversity and population. Methods The leucorrhoea specimens were collected from patients with Candida albicans vaginitis in Shanghai Jiading District Central Hospital from July 2015 to June 2016 for culturing,identification and susceptibility test in vitro. A total of 60 isolates being resistant or multi-resistant to fluconazole,itraconazole and/or voriconazole and 38 sensitive isolates were collected. All of them were analyzed by MLST. By BioNumerics 7.6 software,affinity and cluster analysis was performed. Results There were 14 sequence types（ST） in drug resistant group,9 of which had been reported,and the main types were ST310,ST1364,ST2551 and ST135. There were 19 ST in drug sensitive group,12 of which had been reported,and the main types were ST2048 and DST1474. The ratio of ST of drug resistant group to the number of isolates was lower than that of drug sensitive group,and the numbers of ST in the 2 groups showed a linear positive correlation with the number of isolates（drug resistant group：r=0.995,P=0.005;drug sensitive group：r=0.989,P=0.011）. Affinity analysis showed that the affinity of each genotype of drug resistant isolates was close to that of sensitive isolates. Cluster analysis showed that the population of drug resistant isolates formed multistage branches. ST310,ST1364 and ST2551 were in the 1st branch,and ST135 was in the 2nd branch. There was obvious clustering distribution in main ST. Conclusions Using MLST,the isolates of Candida albicans found in Shanghai Jiading District Central Hospital are multiple cloning,and the genotype distribution of drug resistant isolates is more concentrated than that of sensitive isolates. The affinity of each genotype of drug resistant isolates is close to that of sensitive isolates,and the genotypes of their populations are clustered.

Peripheral blood cell determination for acute leukemia recurrence by flow cytometry

GE Liwei, WANG Xiaoyan

2018, 33(3):  239-241.  DOI: 10.3969/j.issn.1673-8640.2018.03.012

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Objective To investigate the performance of flow cytometry （FCM） in peripheral blood cell determination in patients with acute leukemia （AL）. Methods A total of 142 patients with AL were enrolled. Their peripheral blood samples were determined by FCM. The morphological changes of bone marrow cells were determined as well,and the results were used as standard. The sensitivities and specificities of FCM for acute myeloid leukemia （AML） and acute lymphoblastic leukemia （ALL） were evaluated. The follow-up period was 12 months. The relationship of the positive rate and the negative rate of microresidual disease（MRD）with recurrence rate in peripheral blood was analyzed. Results There were 88 cases of AML,and the sensitivity and specificity of FCM were 96.6% and 33.3%, respectively. There were 54 cases of ALL,and the sensitivity and specificity of FCM were 88.9% and 44.4%, respectively. Among the 24 patients with negative MRD,6 patients had recurrence,and the recurrence rate was 25.0%. There were 88 of 118 positive MRD patients with recurrence,and the recurrence rate was 74.6%. The recurrence rate of positive MRD patients was higher than that of negative MRD patients （P<0.05）. Conclusions FCM has a good sensitivity in peripheral blood cell determination in patients with of AL and in the evaluation of AL recurrence.

Key gastric cancer-related genes and signaling pathway based on NCBI Gene Expression Omnibus

ZHANG Peng, LUO Qin, WANG Tingting, YUAN Xiangliang, SHEN Lisong

2018, 33(3):  242-247.  DOI: 10.3969/j.issn.1673-8640.2018.03.013

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Objective To identify the key gastric cancer-related genes and signaling pathway,and to analyze the parameters in the development of gastric cancer. Methods The gastric cancer-related data from the National Center for Biotechnology Information （NCBI）Gene Expression Omnibus （GEO） were downloaded. The genes of gastric cancer tissue and control tissue were screened by GEO2R analysis platform. The Gene Ontology （GO） and the Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway were performed. The influence of key genes on the survival of patients with gastric cancer was analyzed by Kaplan Meirer Plotter（KM-Plotter）. Results Based on 3 large-scale human gastric cancer datasets,1 480 differenced genes,including 879 up-regulated genes and 601 down-regulated genes, were identified. Through the analysis of GO and KEGG pathway,the differenced genes mainly enriched on cytochrome P450 family,glcuronyl transferase family and other gene clusters. Furthermore,ALDH3A1 and NEUROD1 were deemed the most important genes being related to the progression of gastric cancer. According to the expression of the important genes,there was statistical significance for survival time between high and low expression（P<0.05）. Conclusions This study demonstrates the value of using genetic data from large-scale datasets for key gastric cancer-related genes,which provides a reference for future research.

Evaluation of 2 HbA_1c POCT analyzers based on the results of external quality assessment in Shanghai

TANG Liping, OU Yuanzhu, LIU Wenbin, YU Xiaoxuan

2018, 33(3):  248-251.  DOI: 10.3969/j.issn.1673-8640.2018.03.014

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Objective To study the performance of 2 glycated hemoglobin A_1c （HbA_1c）point-of-care testing（POCT）analyzers in Shanghai. Methods External quality assessment samples were collected from remaining whole blood samples of Shanghai clinical laboratories. The mean values of 2 HbA_1c POCT analyzers （QUO-Test and NycoCard ReaderⅡglycated hemoglobin analyzers）（POCT group）were compared with the mean values of ionic exchange high pressure liquid phase method,ionic exchange low pressure liquid phase method and immuno-turbidimetry. The system bias between 2 HbA_1c POCT analyzers（±7%） was used as standard,and the bias of the mean values of the 2 HbA_1c POCT analyzers with the reference value assigned by the International Federation of Clinical Chemistry and Laboratory Medicine （IFCC）reference method was calculated. The allowable bias for trueness was ±6% as standard,and the intra-group coefficient of variation （CV）of the 2 HbA_1c POCT analyzers was calculated. Results For POCT group,the results of 2 HbA_1c POCT analyzers compared to the 3 conventional determination methods in 2015 were better than those in 2014. The bias of POCT group compared with high pressure liquid phase method was within allowable range. In 2014,the biases of QUO-Test with low pressure liquid phase method and immuno-turbidimetry were not good. The biases of NycoCard ReaderⅡ in 2014 were in good agreement with high pressure liquid phase method and immuno-turbidimetry,except low pressure liquid phase method. In 2004,for 5 quality control samples,the bias between POCT group and IFCC target value was positive bias. The bias between the mean value of QUO-Test and the target value was within the acceptable bias range except for a level of 7.7%. The bias between the mean value of NycoCard ReaderⅡ and the target value was within the acceptable bias range,which was less than that of QUO-Test. Conclusions NycoCard ReaderⅡ with conventional determination methods,especially high pressure liquid phase method has good comparability. The trueness is compliance with requirement,which can meet the needs of clinical determination.

Research progress in the relationship of apolipoprotein M with inflammatory diseases

GAO Jijuan, FANG Huanying

2018, 33(3):  252-258.  DOI: 10.3969/j.issn.1673-8640.2018.03.015

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Apolipoprotein M （apo M） is a recently-discovered lipoprotein-associated plasma protein,which is highly expressed in liver and kidney. The expression of apo M is directly regulated by transcription factors,hormones,cytokines and other factors. Abnormal expression of apo M occurs frequently at inflammatory status. Further research on its features,regulation and effects of apo M is needed. The pathogenesis,diagnostic methods and treatment methods should be investigated. This review focuses on the recent research progress of apo M regulation and its relationship with inflammatory diseases.

Research progress of Epstein-Barr virus determination and its clinical application

ZHANG Xu

2018, 33(3):  259-263.  DOI: 10.3969/j.issn.1673-8640.2018.03.016

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Diseases caused by Epstein-Barr virus （EBV） infection are increasing,such as organ transplantation-associated EBV infection. Epithelial cell source tumor is correlated with EBV infection,and it is characterized by recessive infection and is often ignored in clinic. With the development of determination methods for EBV infection,especially quantitative determination of EBV DNA,combined with the results of immunological determination,pathogens could be timely determined in early infection period. It is potential for the dynamic monitoring and prognosis evaluation of EBV-related tumors. This review focuses on the determination methods of EBV from home and abroad and the relationship between EBV-related determination and tumors.

Research progress of non-coding RNA in multiple myeloma

JI Wei, WU Hongkun, ZHOU Lin

2018, 33(3):  264-268.  DOI: 10.3969/j.issn.1673-8640.2018.03.017

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Non-coding RNA （ncRNA）is a class of RNA with a few or no capacity of protein synthesis. It includes microRNA （miRNA）and long non-coding RNA （lncRNA）. MiRNA is the shortest ncRNA expressed aberrantly in solid and hematopoietic malignancies,where it plays a pivotal function as post-transcriptional regulators of gene expression. LncRNA has been shown to be expressed aberrantly in cancer tissue and to be involved in oncogenic or tumor suppressive process in mammalian and human. This review mainly describes the biological function and potential therapeutic role of ncRNA as drug or target.