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To evaluate the expression of p-AKT and p-mTOR, the key proteins in PI3K/AKT/mTOR pathway in pediatric Burkitt lymphoma (BL), and to investigate the clinical and prognostic significance. Fifty-eight cases of pediatric BL and thirty cases of reactive hyperplastic lymphadenitis (RH) were collected at Children's Hospital of Fudan University from September 2011 to July 2018. Paraffin sections of tissues were immune stained for p-AKT and p-mTOR, and the expression was assessed and correlated with the clinical features and prognosis. A total of 58 cases were diagnosed and 6 cases lost the follow-up. Of the remaining 52 BL patients including 43 males and 9 females, the median age was 5 years (range: 2 to 14 years). Regarding to the correlation between the two biomarkers, Spearman test showed that p-mTOR was positively associated with the expression of p-AKT (0.759, 0.001). Of all BL patients, the positive rates of p-AKT and p-mTOR were 62.1% (36/58) and 60.3%(35/58) respectively, both significantly higher than control group (0.011, 0.035 respectively). The presence of p-AKT was significantly associated with higher lactate dehydrogenase (LDH≥573 IU/L) level in patients of the disease (0.006), while p-mTOR was increased both in the higher LDH and lower ratio of albumin to globulin (A/G) group (0.006, 0.034 respectively). Expression of p-AKT and p-mTOR did not show any statistical correlation with sex, age, St.jude stage, tumor size, B-symptom present or not, number of extra-nodal sites or international prognostic index (IPI) (0.05). Fifty-two patients had a median follow-up of 40 months (range: 5-87 months). Univariate analysis showed that p-AKT expression was significant in predicting both inferior OS (5-year estimate, 72.7% . 94.7%, (2)=4.123, 0.042) and PFS (5-year estimate, 66.7% . 94.7%, (2)=5.822, 0.016). The 5-year OS rate was 71.0% (22/31) for the p-mTOR positive cohort of patients compared to 95.2% (17/21) for p-mTOR negative group ((2)=4.881, 0.027); however, there was no statistical significance in 5-year PFS rate (0.05). Especially, the 5-year OS and PFS rate of p-AKT/p-mTOR double-positive group were significantly lower than negative control group (including absence of single p-AKT or p-mTOR expression, and absence of both) (OS: 69.0% . 95.7%, (2)=6.285, 0.012; PFS: 65.5% . 91.3%, (2)=5.405, 0.020). The results of multivariate COX proportional risk regression analysis indicated that p-AKT/p-mTOR double-positive, higher LDH and IPI score 3-5 were independent prognostic factors for both OS and PFS, and the bulky tumor (>10 cm) for PFS of pediatric BL. The expression of p-AKT and p-mTOR may be a potential reference for diagnosis and the independent prognostic indicators of pediatric BL.
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@#AIM: To explore the effects of femtosecond laser and mechanical lamellar blade excision laser <i>in situ</i> keratomileusis(LASIK)on corneal flap thickness stability and dry eye syndrome.<p>METHODS: Retrospective analysis of 80 patients with myopia who underwent LASIK in our hospital. According to different methods of flapping, it is divided into femtosecond laser group and mechanical laminating knife group. The flap thickness of the two groups of patients at different time points(1h, 1d, 1wk, 1mo, 3mo)were measured. The differences in corneal apex 1, 2, 3mm and corneal apex flap thickness in different directions were compared. The incidence of dry eye syndrome was compared between 1 and 3mo, 1a, 2a after surgery.<p>RESULTS: The apex thickness of the corneal flap of the femtosecond laser group is 99.62±4.50μm, and the thickness of the apex of the mechanical lamellar knife group is 125.25±12.81μm.The thickness of the corneal flap at different centrifugal points of the femtosecond laser flap is relatively uniform, while the thickness of the corneal flap of the mechanical lamellar knife varies greatly. The OSDI scores of the mechanical lamellar group were higher than those of the femtosecond laser group at 1, 3, 1, and 2a postoperatively(<i>P</i><0.01). At 2a of follow-up, the incidence of dry eye in the femtosecond laser group was lower than that in the mechanical lamellar group(χ<sup>2</sup>=4.692, <i>P</i>=0.030). At 1 and 2a postoperatively, the proportion of mild dry eye in the femtosecond laser group was higher than that in the mechanical lamellar group(<i>P</i>=0.044, 0.001).<p>CONCLUSION: Compared with the mechanical lamellar scalpel, the corneal flap thickness of patients with femtosecond laser LASIK is better, more uniform and less error. And the incidence of dry eye after surgery is lower, with mild dry eyes.
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@#AIM: To explore the correlation between eccentricity in the optical treatment area and tear film function and corneal morphology after orthokeratology. <p>METHODS:Eighty patients(80 eyes)with myopia who were treated with orthokeratology were selected as subjects. The eccentric distance, tear film function and corneal morphology of the patient's optical treatment area were detected at different time points before and after wearing the lens. According to the median eccentric distance, the patients were divided into low eccentricity group and high eccentricity group. The differences of tear film function and corneal morphology at different time points before and after wearing were compared between the two groups. Pearson correlation coefficient was used to analyze the correlation between total eccentricity and tear film function and corneal morphological parameters at 12mo after wearing glasses. <p>RESULTS:Compared with before wearing lenses, the corneal surface asymmetry index and corneal surface regularity index of the two groups were significantly increased at 1wk, 3, 6 and 12mo after wearing lenses(<i>P</i><0.05). Patients in the high eccentric group were more significantly elevated than in the lower eccentric group, and the differences were statistically significant(<i>P</i><0.05). The time of tear film rupture, corneal curvature, basic tear secretion, and central corneal thickness were significantly lower, and the differences were statistically significant(<i>P</i><0.05). Compared with the patients with lower eccentricity, the patients with high eccentricity group had more significant reduction in tear film rupture time and basic tear secretion, and the difference was statistically significant(<i>P</i><0.05), however, the degree of corneal curvature and central corneal thickness decreased less(<i>P</i><0.05). There was no significant difference in corneal endothelial cell density between 1wk after wearing lenses and 3mo after wearing lenses(<i>P</i>>0.05). The difference was statistically significant at 6mo and 12mo after wearing lenses(<i>P</i><0.05). At 12mo after wearing the lens, the total eccentric distance was positively correlated with the asymmetry index of the corneal surface and the regularity index of the corneal surface(<i>r</i>=0.869, 0.815; <i>P</i><0.05). At 12mo after wearing the lens, the total eccentric distance was negatively correlated with tear film rupture time, corneal curvature, basic tear secretion, and central corneal thickness(<i>r</i>=-0.865, -0.745, -0.912, -0.713; all <i>P</i><0.05), and there was no significant correlation with corneal endothelial cell density(<i>r</i>=0.185, <i>P</i>=0.199). <p>CONCLUSION:The eccentricity of the optical treatment area occurs at the beginning of wearing lenses. And the total eccentric distance has a significant correlation with the changes of tear film function and corneal morphology after keratoplasty.
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<p><b>OBJECTIVE</b>To further understand the cytogenetic characteristics of pediatric acute lymphoblastic leukemia (ALL).</p><p><b>METHODS</b>Cytogenetic abnormalities of 163 children with newly diagnosed ALL (0-17 years of age) were evaluated by conventional cytogenetic analysis and fluorescent in situ hybridization findings.</p><p><b>RESULTS</b>Chromosome abnormalities were detected in 87.7% of patients (143/163). The ploidy levels most frequently observed among ALL patients were high hyperdiploidy (51-67 chromosomes) (45 cases, 27.6%), Chromosomes X and 21 were gained in 100% of these cases. The most common genetic alterations were t(12;21)/ETV6/RUNX1 (26 cases, 16.0%), followed by t(1;19)/TCF3/PBX1 (13 patients, 8.0%), t(4;11)/MLL rearrangement and t(8;14) IGH/MYC (6 cases, 3.7%), t(9;22)/BCR/ABL(2 cases, 1.2%), and iAMP21 (1 patient, 0.6%). The no-classical structural abnormalities included dup(1q) in 20.2%, del(6q) and del(9p) in 10.4%, del(12p) in 12.9% and del(13q) in 5.5%. The incidences of t(12;21), t(1;19), t(9;22) and high hyperdiploidy were consistent with reports in Western children (P>0.25). The incidence of (9;22) seemed to be much lower in our study than that in Korea (1.5% vs 9.5%, P<0.005).</p><p><b>CONCLUSION</b>Cytogenetic findings of childhood ALL patients are similar to that of Western countries, it seems no more adverse risk factors.</p>
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Infant , Chromosome Aberrations , Chromosome Disorders , Cytogenetic Analysis , Fusion Proteins, bcr-abl , In Situ Hybridization, Fluorescence , Precursor Cell Lymphoblastic Leukemia-LymphomaABSTRACT
<p><b>OBJECTIVE</b>To improve the treatment of drug related childhood hepatic veno-occlusive disease (HVOD), clinical characteristics of 6 children with hematologic neoplasm from 2 hospitals of China Children's Leukemia Group (CCLG) treated with 6-thioguanine (6-TG) complicated with HVOD were analyzed.</p><p><b>METHOD</b>All the drug related HVOD patients were treated with CCLG acute lymphoblastic leukemia (ALL)-2008 protocol. They were from Children's Hospital of Fudan University and Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College from April 2008 to April 2009. The diagnosis was made according to the modified Seattle criteria and Baltimore criteria, including 2 or 3 of the following clinical features: hepatomegaly and upper right abdominal pain, jaundice (bilirubin ≥ 35 µmol/L), ascites or confirmed by pathology. The 6 HVOD patients' clinical manifestations, laboratory finding, imageologic and pathologic data were collected and analyzed.</p><p><b>RESULT</b>Of the 6 patients, 2 were males and 4 females. Mean age of the 6 patients was 3.89 years (range from 3 years 1 month to 4 years 11 months). The original disease was acute lymphoblastic leukemia. HVOD occurred during chemotherapy protocols of CAM (CTX + Ara-C + 6-TG) or maintenance period (MTX + 6-TG). Most of 6 HVOD patients presented with pain in liver area, hepatomegaly on imaging, elevated aminotransferase and bilirubin (often ≥ 35 µmol/L), hydroperitonia was common, one with pleural fluid, illegible hepatic veins. All the patients recovered after being treated with hepatoprotective, jaundice-relieving and supportive therapeutics, some patients were treated with low molecular weight heparin. The prognoses were good.</p><p><b>CONCLUSION</b>HVOD was a serious complication of chemotherapy with 6-TG. Hepatoprotective and jaundice-relieving and low molecular weight heparin could improve the prognosis.</p>