目的:探讨荧光原位杂交技术(fluorescence in situ hybridization,FISH)检测多发性骨髓瘤(multiple myeloma,MM)、意义未明单克隆免疫球蛋白增多症(monoclonal gammopathy of undetermined significance,MGUS)及反应性浆细胞增多症(reac...目的:探讨荧光原位杂交技术(fluorescence in situ hybridization,FISH)检测多发性骨髓瘤(multiple myeloma,MM)、意义未明单克隆免疫球蛋白增多症(monoclonal gammopathy of undetermined significance,MGUS)及反应性浆细胞增多症(reactive plasmacytosis,RP)的几种常见的异常基因,提高对几种常见浆细胞疾病的诊断及鉴别诊断水平。方法:回顾性分析2012年8月至2015年8月在中南大学湘雅医院初诊的61例MM、20例MGUS及20例RP患者的临床表现、影像学、实验室检查及FISH检测结果。结果:FISH检测61例MM患者中50例患者出现基因异常,FISH阳性检出率为81.9%,其中1q21扩增19例(31.1%)、D13S319缺失18例(29.5%)、RB1缺失10例(16.4%)、IGH易位10例(16.4%)、p53缺失7例(11.4%),出现两种或多种基因异常的阳性率为12例(19.8%);20例MGUS中FISH阳性检出率为30%,其中1q21扩增4例(20%)、IGH易位2例(10%),未发现两种或多种基因异常;而RP患者仅1例出现D13S319缺失,阳性率仅为5%。三组两两比较差异具有统计学意义(P<0.05)。结论:MM患者中FISH的阳性检出率为81.9%,明显高于MGUS及RP的患者,应用FISH可检测MM中的多种异常基因,对MM,MGUS及RP的鉴别诊断、预后判断有重要的临床参考价值。展开更多
非平稳多变量时间序列(non-stationary multivariate time series, NSMTS)预测目前仍是一个具有挑战性的任务.基于循环神经网络的深度学习模型,尤其是基于长短期记忆(long short-term memory, LSTM)和门循环单元(gated recurrent unit, ...非平稳多变量时间序列(non-stationary multivariate time series, NSMTS)预测目前仍是一个具有挑战性的任务.基于循环神经网络的深度学习模型,尤其是基于长短期记忆(long short-term memory, LSTM)和门循环单元(gated recurrent unit, GRU)的神经网络已获得了令人印象深刻的预测性能.尽管LSTM结构上较为复杂,却并不总是在性能上占优.最近提出的最小门单元(minimal gated unit, MGU)神经网络具有更简单的结构,并在图像处理和一些序列处理问题中能够提升训练效率.更为关键的是,实验中我们发现该门单元可以高效运用于NSMTS的预测,并达到了与基于LSTM和GRU的神经网络相当的预测性能.然而,基于这3类门单元的神经网络中,没有任何一类总能保证性能上的优势.为此提出了一种线性混合门单元(MIX gated unit, MIXGU),试图利用该单元动态调整GRU和MGU的混合权重,以便在训练期间为网络中的每个MIXGU获得更优的混合结构.实验结果表明,与基于单一门单元的神经网络相比,混合2类门单元的MIXGU神经网络具有更优的预测性能.展开更多
To describe myelodysplastic syndrome(MDS)/myeloproliferative neoplasm(MPN) combined with monoclonal gammopathy of undetermined significance(MGUS) in order to investigate the potential association between these 2 disea...To describe myelodysplastic syndrome(MDS)/myeloproliferative neoplasm(MPN) combined with monoclonal gammopathy of undetermined significance(MGUS) in order to investigate the potential association between these 2 diseases. Two cases of confirmed chronic myelomonocytic leukemia(CMML) combined with MGUS were reported. In addition, prior publications of cases with combined MDS or MPN with MGUS were reviewed. The first case was of a 77-year-old man whose routine blood tests showed abnormal hemogram results. The diagnosis was CMML combined with Ig M monoclonal gammopathy, and the disease course was 4 years. The CMML gradually progressed and the patient presented with anemia, thrombocytopenia, autoimmune hemolysis, and an increase in the number of immature cells in the bone marrow. Although the MGUS caused fluctuations in the concentrations of Ig M, no Ig M-associated organ damage was observed. Eventually, this patient died from a lung infection. The second case was of a 78-year-old man who sought treatment because of fever and a cough. An increase in the number of monocytes was discovered in the peripheral blood. Bone marrow smear results suggested obvious active granulocytes and an increase in the percentages of promyelocytes, myelocytes, and metamyelocytes. Unhealthy granulocytes and immature monocytes could also be observed, and the percentage of monocytes was increased. In addition, serum Ig G levels were increased, and immunofixation electrophoresis results showed Ig G-κ type M proteins. The diagnosis was CMML combined with Ig G monoclonal gammopathy. These diseases were stable and follow-up was conducted for 1 year after diagnosis. The cases in this study combined with those that were reviewed in the relevant literature indicate that the presence of these 2 diseases in the same patient might not be a coincidence. The development of the 2 diseases in case 1 was different, and we speculate that they might have had different clonal origins. Whether CMML is a risk factor for MGUS and the role of clonal plasma cells in the occurrence and development of MDS and MDS/MPN requires further studies on a larger number of cases.展开更多
Monoclonal gammopathy of undetermined significance (MGUS) is characterized by increased production of an immunoglobuling (Ig) from a clone of plasma cells and is a pre-malignant disorders in subjects older than 50 yea...Monoclonal gammopathy of undetermined significance (MGUS) is characterized by increased production of an immunoglobuling (Ig) from a clone of plasma cells and is a pre-malignant disorders in subjects older than 50 years. The prevalence of MGUS in Caucasian population is still not determined. MGUS is characterized by the presence of a monoclonal-protein(M-protein) (IgG and IgA) lower than 30 g/L, bone marrow plasma cell percentage lower than 10%, and absence of clinical signs related to multiple myeloma (MM). MGUS can be responsible for damage to organs through the production of toxic M proteins that may have autoantibody activity or deposit pathologically in the organ tissues. Many techniques are available for the characterization of M-proteins. These techniques can involve different expenses, skills, labor time, and sensitivity in detecting monoclonal proteins also at low-level. Detection of M-proteins needs of assays based on high-resolution electrophoresis and im-munofixation (or immunosubtraction). We show suggestive clinical cases where the subjects involved had not an apparent disease but they showed an interesting pattern in electrophoresis. All cases were investigated by capillary’s electrophoresis and immunofixation to confirm or not the clinical suspect, and then if the immunofixation is not exhaustive, additionally immunosubstraction is done. However in some cases, the interpretation of the peaks is not so easy. Clinical and scientific data provided evidences that immunofixaction technique can fail the identification of monoclonal components. In that cases, we opted for the immunosubtraction method as a third level test, in that cases when immunofixation failed the identification of a monoclonal protein.展开更多
Several studies have suggested a pathogenetic role of paraproteinaemias in PNS damage. Over the few last years, the presence of symptomatic or subclinical PNS lesions in CNS diseases like multiple sclerosis has been d...Several studies have suggested a pathogenetic role of paraproteinaemias in PNS damage. Over the few last years, the presence of symptomatic or subclinical PNS lesions in CNS diseases like multiple sclerosis has been described. On the other hand, CNS demyelinating lesions and cervical atrophy have been re- ported in patients affected by chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Very few cases of MGUS associated with CNS disease alone or with both CNS and PNS disease have been re- ported. Since 1999, we have been studying 16 patients (8 M, 8 F), with a mean age 60.2 ± 13.4, affected by MGUS associated with symptomatic neurological central and/or peripheral diseases. Patients affected with lymphomas, lupus erithematosus and other immunological diseases were excluded. Involvement of both PNS and CNS was not associated to a particular type of paraproteinemia: monoclonal IgM were found in 8 patients;monoclonal IgG in 6 patients and mono- clonal IgA in 1 patient and Igl in 1 patient. High anti- nervous system autoantibodies were found in 10/16 patients and antiMAG antibodies were detected in patients with paraproteinemic demyelinating neuropathy (PDN). High reactivity anti-nervous system might support the hypothesis of a pathogenetic role of MGUS in these neurological diseases. Nevertheless, at present, we cannot exclude that there is only a circumstantial association between MGUS and neurological damages, particularly concerning CNS.展开更多
Plasma cell neoplasms comprise a spectrum of diseases that include monoclonal gammopathy of undetermined signi-ficance (MGUS) and multiple myeloma (MM). Flow cytometric immunophenotyping has become an invaluable tool ...Plasma cell neoplasms comprise a spectrum of diseases that include monoclonal gammopathy of undetermined signi-ficance (MGUS) and multiple myeloma (MM). Flow cytometric immunophenotyping has become an invaluable tool as an ancillary and diagnostic test for hematologic malignancies and is being used with increasing frequency in the diag-nosis and monitoring of plasma cell neoplasms. As multiparameter flow cytometry has evolved, faster fluidics and detection systems facilitate the screening of a large number of events and the detection of multiple antigens simultaneously. This review addresses the approaches used to evaluate clonal plasma cell neoplasms and describes different surface and cytoplasmic markers and techniques that are important for the study of these diseases.展开更多
Recurrent neural networks （RNN） have been very successful in handling sequence data. However, understanding RNN and finding the best practices for RNN learning is a difficult task, partly because there are many comp...Recurrent neural networks （RNN） have been very successful in handling sequence data. However, understanding RNN and finding the best practices for RNN learning is a difficult task, partly because there are many competing and complex hidden units, such as the long short-term memory （LSTM） and the gated recurrent unit （GRU）. We propose a gated unit for RNN, named as minimal gated unit （MCU）, since it only contains one gate, which is a minimal design among all gated hidden units. The design of MCU benefits from evaluation results on LSTM and GRU in the literature. Experiments on various sequence data show that MCU has comparable accuracy with GRU, but has a simpler structure, fewer parameters, and faster training. Hence, MGU is suitable in RNN＇s applications. Its simple architecture also means that it is easier to evaluate and tune, and in principle it is easier to study MGU＇s properties theoretically and empirically.展开更多
文摘目的:探讨荧光原位杂交技术(fluorescence in situ hybridization,FISH)检测多发性骨髓瘤(multiple myeloma,MM)、意义未明单克隆免疫球蛋白增多症(monoclonal gammopathy of undetermined significance,MGUS)及反应性浆细胞增多症(reactive plasmacytosis,RP)的几种常见的异常基因,提高对几种常见浆细胞疾病的诊断及鉴别诊断水平。方法:回顾性分析2012年8月至2015年8月在中南大学湘雅医院初诊的61例MM、20例MGUS及20例RP患者的临床表现、影像学、实验室检查及FISH检测结果。结果:FISH检测61例MM患者中50例患者出现基因异常,FISH阳性检出率为81.9%,其中1q21扩增19例(31.1%)、D13S319缺失18例(29.5%)、RB1缺失10例(16.4%)、IGH易位10例(16.4%)、p53缺失7例(11.4%),出现两种或多种基因异常的阳性率为12例(19.8%);20例MGUS中FISH阳性检出率为30%,其中1q21扩增4例(20%)、IGH易位2例(10%),未发现两种或多种基因异常;而RP患者仅1例出现D13S319缺失,阳性率仅为5%。三组两两比较差异具有统计学意义(P<0.05)。结论:MM患者中FISH的阳性检出率为81.9%,明显高于MGUS及RP的患者,应用FISH可检测MM中的多种异常基因,对MM,MGUS及RP的鉴别诊断、预后判断有重要的临床参考价值。
文摘非平稳多变量时间序列(non-stationary multivariate time series, NSMTS)预测目前仍是一个具有挑战性的任务.基于循环神经网络的深度学习模型,尤其是基于长短期记忆(long short-term memory, LSTM)和门循环单元(gated recurrent unit, GRU)的神经网络已获得了令人印象深刻的预测性能.尽管LSTM结构上较为复杂,却并不总是在性能上占优.最近提出的最小门单元(minimal gated unit, MGU)神经网络具有更简单的结构,并在图像处理和一些序列处理问题中能够提升训练效率.更为关键的是,实验中我们发现该门单元可以高效运用于NSMTS的预测,并达到了与基于LSTM和GRU的神经网络相当的预测性能.然而,基于这3类门单元的神经网络中,没有任何一类总能保证性能上的优势.为此提出了一种线性混合门单元(MIX gated unit, MIXGU),试图利用该单元动态调整GRU和MGU的混合权重,以便在训练期间为网络中的每个MIXGU获得更优的混合结构.实验结果表明,与基于单一门单元的神经网络相比,混合2类门单元的MIXGU神经网络具有更优的预测性能.
文摘To describe myelodysplastic syndrome(MDS)/myeloproliferative neoplasm(MPN) combined with monoclonal gammopathy of undetermined significance(MGUS) in order to investigate the potential association between these 2 diseases. Two cases of confirmed chronic myelomonocytic leukemia(CMML) combined with MGUS were reported. In addition, prior publications of cases with combined MDS or MPN with MGUS were reviewed. The first case was of a 77-year-old man whose routine blood tests showed abnormal hemogram results. The diagnosis was CMML combined with Ig M monoclonal gammopathy, and the disease course was 4 years. The CMML gradually progressed and the patient presented with anemia, thrombocytopenia, autoimmune hemolysis, and an increase in the number of immature cells in the bone marrow. Although the MGUS caused fluctuations in the concentrations of Ig M, no Ig M-associated organ damage was observed. Eventually, this patient died from a lung infection. The second case was of a 78-year-old man who sought treatment because of fever and a cough. An increase in the number of monocytes was discovered in the peripheral blood. Bone marrow smear results suggested obvious active granulocytes and an increase in the percentages of promyelocytes, myelocytes, and metamyelocytes. Unhealthy granulocytes and immature monocytes could also be observed, and the percentage of monocytes was increased. In addition, serum Ig G levels were increased, and immunofixation electrophoresis results showed Ig G-κ type M proteins. The diagnosis was CMML combined with Ig G monoclonal gammopathy. These diseases were stable and follow-up was conducted for 1 year after diagnosis. The cases in this study combined with those that were reviewed in the relevant literature indicate that the presence of these 2 diseases in the same patient might not be a coincidence. The development of the 2 diseases in case 1 was different, and we speculate that they might have had different clonal origins. Whether CMML is a risk factor for MGUS and the role of clonal plasma cells in the occurrence and development of MDS and MDS/MPN requires further studies on a larger number of cases.
文摘Monoclonal gammopathy of undetermined significance (MGUS) is characterized by increased production of an immunoglobuling (Ig) from a clone of plasma cells and is a pre-malignant disorders in subjects older than 50 years. The prevalence of MGUS in Caucasian population is still not determined. MGUS is characterized by the presence of a monoclonal-protein(M-protein) (IgG and IgA) lower than 30 g/L, bone marrow plasma cell percentage lower than 10%, and absence of clinical signs related to multiple myeloma (MM). MGUS can be responsible for damage to organs through the production of toxic M proteins that may have autoantibody activity or deposit pathologically in the organ tissues. Many techniques are available for the characterization of M-proteins. These techniques can involve different expenses, skills, labor time, and sensitivity in detecting monoclonal proteins also at low-level. Detection of M-proteins needs of assays based on high-resolution electrophoresis and im-munofixation (or immunosubtraction). We show suggestive clinical cases where the subjects involved had not an apparent disease but they showed an interesting pattern in electrophoresis. All cases were investigated by capillary’s electrophoresis and immunofixation to confirm or not the clinical suspect, and then if the immunofixation is not exhaustive, additionally immunosubstraction is done. However in some cases, the interpretation of the peaks is not so easy. Clinical and scientific data provided evidences that immunofixaction technique can fail the identification of monoclonal components. In that cases, we opted for the immunosubtraction method as a third level test, in that cases when immunofixation failed the identification of a monoclonal protein.
文摘Several studies have suggested a pathogenetic role of paraproteinaemias in PNS damage. Over the few last years, the presence of symptomatic or subclinical PNS lesions in CNS diseases like multiple sclerosis has been described. On the other hand, CNS demyelinating lesions and cervical atrophy have been re- ported in patients affected by chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Very few cases of MGUS associated with CNS disease alone or with both CNS and PNS disease have been re- ported. Since 1999, we have been studying 16 patients (8 M, 8 F), with a mean age 60.2 ± 13.4, affected by MGUS associated with symptomatic neurological central and/or peripheral diseases. Patients affected with lymphomas, lupus erithematosus and other immunological diseases were excluded. Involvement of both PNS and CNS was not associated to a particular type of paraproteinemia: monoclonal IgM were found in 8 patients;monoclonal IgG in 6 patients and mono- clonal IgA in 1 patient and Igl in 1 patient. High anti- nervous system autoantibodies were found in 10/16 patients and antiMAG antibodies were detected in patients with paraproteinemic demyelinating neuropathy (PDN). High reactivity anti-nervous system might support the hypothesis of a pathogenetic role of MGUS in these neurological diseases. Nevertheless, at present, we cannot exclude that there is only a circumstantial association between MGUS and neurological damages, particularly concerning CNS.
文摘Plasma cell neoplasms comprise a spectrum of diseases that include monoclonal gammopathy of undetermined signi-ficance (MGUS) and multiple myeloma (MM). Flow cytometric immunophenotyping has become an invaluable tool as an ancillary and diagnostic test for hematologic malignancies and is being used with increasing frequency in the diag-nosis and monitoring of plasma cell neoplasms. As multiparameter flow cytometry has evolved, faster fluidics and detection systems facilitate the screening of a large number of events and the detection of multiple antigens simultaneously. This review addresses the approaches used to evaluate clonal plasma cell neoplasms and describes different surface and cytoplasmic markers and techniques that are important for the study of these diseases.
基金supported by National Natural Science Foundation of China(Nos.61422203 and 61333014)National Key Basic Research Program of China(No.2014CB340501)
文摘Recurrent neural networks （RNN） have been very successful in handling sequence data. However, understanding RNN and finding the best practices for RNN learning is a difficult task, partly because there are many competing and complex hidden units, such as the long short-term memory （LSTM） and the gated recurrent unit （GRU）. We propose a gated unit for RNN, named as minimal gated unit （MCU）, since it only contains one gate, which is a minimal design among all gated hidden units. The design of MCU benefits from evaluation results on LSTM and GRU in the literature. Experiments on various sequence data show that MCU has comparable accuracy with GRU, but has a simpler structure, fewer parameters, and faster training. Hence, MGU is suitable in RNN＇s applications. Its simple architecture also means that it is easier to evaluate and tune, and in principle it is easier to study MGU＇s properties theoretically and empirically.
