Application and progress of radiomics in bone and soft tissue tumors / 中国医学装备

Bone and soft tissue tumors are diverse and with complicated histologic components and significantly divergent biological behaviors.Conventional imaging examinations,such as CT,magnetic resonance imaging(MRI)and positron emission tomography(PET),are limited to the identification of anatomical structures and abnormal signals,which are difficult to meet the qualitative requirements of imaging.With the improvement of digitalization in hospitals and medical institutions,the introduction of electronic medical records and the improvement of computational power,modern intelligent medical treatment gradually evolves to the combination of human brain,big data and artificial intelligence.Researchers are committed to mining deeper image data information,and radiomics came into being.Radiomics is a method of extracting and analyzing subvisual quantitative features from medical images and quantifying tumor heterogeneity through modeling,which is of great significance in the accurate diagnosis and treatment of bone and soft tissue tumors.

Correlation Analysis between Cerebrospinal Fluid Status and Prognosis in Childhood with Acute Lymphoblastic Leukemia by Flow Cytometry / 中国实验血液学杂志

OBJECTIVE@#To study the cerebrospinal fluid (CSF) status and prognosis value in patients with newly diagnosed acute lymphoblastic leukemia (ALL) by flow cytometry (FCM).@*METHODS@#The clinical features of the 75 newly diagnosed ALL patients from September 2020 to December 2021 in our centre were retrospective analyzed, as well as the bone marrow (BM) and CSF minimal residual disease (MRD) data, and the CSF conventional cytology data. Central nervous system infiltration(CNSI) positive was as CSF MRD positive by FCM or leukemia cells detected by conventional cytology. The status of CSF were compared and analyzed by FCM and conventional cytology, the clinical features and the prognosis value of different CNSI status in these patients were analyzed.@*RESULTS@#Among 75 newly diagnosed ALL, 16 cases (21%) with CNSI positive (CNSI+) were detected by FCM, while only 2 positive cases (3%) were detected by conventional cytology. The CNSI+ rate detected by FCM was significantly higher than conventional cytology(P<0.05). Compared with CNSI- ALL patients, the median age of CNSI+ ALL patients was significantly younger, and the median platelet count was significantly lower, the difference was statistically significant (P<0.05). Up to follow-up time (August 31, 2022), four ALL patients were died, including 3 patients were CNSI- and 1 patient was CNSI+. Furthermore, three cases were primary disease relapse, including 1 case was CNSI+. There was no significant difference in overall survival (OS) rate and relapse-free survival (RFS) rate of the patients with different CNSI status.@*CONCLUSION@#Compared with conventional cytology, FCM is a more sensitive assay to evaluate the central nervous system status in ALL patients. After active treatment, there was no significant difference in OS and RFS between patients with different CNSI status at diagnosis.

Clinical Study on the Relationship between Gene Mutation Profile and Prognosis in Pediatric Acute Lymphocyte Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the gene mutation profile in children with acute lymphocyte leukemia (ALL) and to explore its prognostic significance.@*METHODS@#Clinical data of 249 primary pediatric ALL patients diagnosed and treated in the Department of Hematological Oncology of Wuhan Children's Hospital from January 2018 to December 2021 were analyzed retrospectively. Next-generation sequencing (NGS) was used to obtain gene mutation data and analyze the correlation between it and the prognosis of children with ALL.@*RESULTS@#227 (91.2%) were B-ALL, 22 (8.8%) were T-ALL among the 249 cases, and 178 (71.5%) were found to have gene mutations, of which 85 (34.1%) had ≥3 gene mutations. NRAS(23.7%), KRAS (22.9%),FLT3(11.2%), PTPN11(8.8%), CREBBP (7.2%), NOTCH1(6.4%) were the most frequently mutated genes, the mutations of KRAS, FLT3, PTPN11, CREBBP were mainly found in B-ALL, the mutations of NOTCH1 and FBXW7 were mainly found in T-ALL. The gene mutation incidence of T-ALL was significantly higher than that of B-ALL (χ2= 5.573，P＜0.05) and were more likely to have co-mutations (P＜0.05). The predicted 4-year EFS rate (47.9% vs 88.5%, P＜0.001) and OS rate (53.8% vs 94.1%, P＜0.001) in children with tp53 mutations were significantly lower than those of patients without tp53 mutations. Patients with NOTCH1 mutations had higher initial white blood cell count （128.64×109/L vs 8.23×109/L，P＜0.001）, and children with NOTCH1 mutations had a lower 4-year EFS rate than those of without mutations (71.5% vs 87.2%, P＝0.037).@*CONCLUSION@#Genetic mutations are prevalent in childhood ALL and mutations in tp53 and NOTCH1 are strong predictors of adverse outcomes in childhood ALL, with NGS contributing to the discovery of genetic mutations and timely adjustment of treatment regimens.

Clinical Analysis of Infants with Acute Lymphoblastic Leukemia (18 cases) / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical features and outcomes of infants (<1 year old) with acute lymphoblastic leukemia (IALL).@*METHODS@#The clinical manifestations, laboratory examination results, treatment and prognosis of 18 infants diagnosed with ALL at our department between January 1, 2014 and August 31, 2022 were retrospectively analyzed.@*RESULTS@#Among the 18 cases of IALL, there were 10 males and 8 females. The median age of patients was 6.5 months old (3 months-11 months old). The median white blood cell count (WBC) was 33.63×109/L ［(3.92-470)×109/L］ at initial diagnosis, including 2 patients with WBC≥300×109/L. Flow cytometric immunophenotyping showed a B-lineage infant ALL in all the 18 patients. Eight of the 18 children had abnormal chromosome karyotype analysis. Fusion gene detection showed 12 KMT2A-rearrangement of 18 patients. 15 patients underwent leukemia related mutation gene screening, among which KRAS, NRAS and FLT3 were the most common mutation genes. 4 patients underwent allogeneic hematopoietic stem cell transplantation and two survived. 14 patients received chemotherapy only and ten survived. The 3-year OS rate was (65.5±11.5)%, while the EFS rate was (46.9±12.3)%.@*CONCLUSION@#B-cell ALL and KMT2A rearrangement are prevalent in IALL. The therapeutic effect of IALL with standard childhood ALL protocal is similer to international infant specific protocal.

Clinical Analysis of Pediatric Acute Myeloid Leukemia with CCLG-AML 2015 Regimen / 中国实验血液学杂志

OBJECTIVE@#To analyze the clinical effects of CCLG-AML-2015 protocol on newly diagnosed children with acute myeloid leukemia (AML).@*METHODS@#The clinical data of 60 newly diagnosed AML children in the Department of Hematology and Oncology, Wuhan Children's Hospital from August 2015 to September 2019 were summarized, the effect of chemotherapy using the CCLG-AML-2015 regimen (hereinafter referred to as the 2015 regimen) were retrospectively analyzed. 42 children with AML treated by the AML-2006 regimen (hereinafter referred to as the 2006 regimen) from February 2010 to July 2015 were used as control group.@*RESULTS@#There were no statistical differences between the 2015 regimen group and the 2006 regimen group in sex, age at first diagnosis, and risk stratification (P>0.05). The complete remission rate of bone marrow cytology after induction of 1 course of chemotherapy (84.7% vs 73.1%, P=0.155), and minimal residual disease detection (MRD) negative (42.3% vs 41.4%, P=0.928) in the 2015 regimen group were not statistically different than those in the 2006 regimen group. The bone marrow cytology CR (98.1% vs 80.6%, P=0.004) and MRD negative (83.3% vs 52.8%, P=0.002) in the 2015 regimen group after 2 courses of induction were higher than those in the 2006 regimen group. The 5-year overall survival (OS) rate in the 2015 regimen group (62.3%±6.4% vs 20.6%±6.4%, P=0.001), the 5-year disease-free survival (EFS) rate (61.0%±6.4% vs 21.0% ±6.4% , P=0.001) were better than those in the 2006 regimen group. The 5-year OS and EFS of high-risk transplant patients in the 2015 regimen group were significantly better than those of high-risk non-transplant patients (OS: 86.6%±9.0% vs 26.7%±11.4%, P=0.000; EFS: 86.6%±9% vs 26.7%±11.4%, P=0.000).@*CONCLUSION@#The 2015 regimen can increase the CR rate after 2 courses of induction compared with the 2006 regimen. High-risk children receiving hematopoietic stem cell transplantation can significantly improve the prognosis.

Clinical Study of Intestinal Acute Graft-Versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation in Children / 中国实验血液学杂志

OBJECTIVE@#To observe the clinical characteristics, treatment and prognosis of intestinal acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children and futher evaluate the occurring risk factors.@*METHODS@#The clinical data of 136 patients undergoing allo-HSCT in Wuhan Children's Hospital Affiliated to Tongji Medical College from August 2016 to August 2020 were retrospectively analyzed, clinical characteristics of children with intestinal aGVHD were observed. The risk factors of intestinal aGVHD were assessed by logistic regression while cumulative survival were analyzed by Kaplan-Meier method.@*RESULTS@#Among 136 patients intestinal aGVHD occurred in 24 (17.6%) cases, with 4 cases of grade II, 20 cases of grade III-IV, and the median occurrence time was 28(10-63) days. The clinical manifestations were diarrhea with intermittent abdominal pain, 17 cases with nausea and vomiting, 11 cases with fresh bloody stool, and 8 cases with skin rash before intestinal aGVHD. The average time for treatment was 33(11-100) days. 18 cases received electronic colonoscopy and histopathology examination. 20 out of 24 cases achieved remission after treatment, and the total effective rate was 83.3%. Finally, 9 out of 24 cases died during the follow-up time. Survival analysis showed that the cumulative survival rate of patients with intestinal aGVHD (15/24, 62.5%) were significantly lower than those without intestinal aGVHD (101/112, 90.2%) (Log-rank test, P=0.001). Univariate analysis showed that recipient age, sex, primary disease, donor age, donor sex, donor-recipient blood type, conditioning regimen, prophylaxis of GVHD, dosage of ATG, engraft time of blood platelet and neutrophils, and number of MNC/CD34+ were not risk factors for intestinal aGVHD (P>0.05). Only the type of HSCT (χ2=16.020, P=0.001) and matched degree of HLA (χ2=15.502, P=0.001) had statistical significance with intestinal aGVHD (P<0.05). Multivariate analysis showed that only HLA-mismatched unrelated donor was the risk factor for intestinal aGVHD for children (P=0.014，OR=16，95%CI 1.735-147.543).@*CONCLUSION@#Intestinal aGVHD is a risk factor for cumulative survial of patients who received allo-HSCT in children and HLA-mismatched unrelated donor is its independent risk factor.

MRI-based assessment of effects of radiotherapy on the onset and progression of mastoiditis in patients with nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective:To analyze the effects of radiotherapy on the onset and progression of mastoiditis in patients with nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI) and to explore the risk factors for the onset of mastoiditis after radiotherapy.Methods:The onset and progression of mastoiditis of 204 NPC patients 3, 12, and 24 months after radiotherapy were analyzed based on MRI images. The multi-factor logistic regression analysis was applied to explore the risk factors of the onset of mastoiditis after radiotherapy. The cross-sectional area of the tensor veli palatini muscle was measured and the relationship between the atrophy degrees of the tensor veli palatini muscle and the onset of mastoiditis was analyzed.Results:The incidence of mastoiditis before radiotherapy was 20.6% (84/408, ears), and was 41.1% (168/408, ears), 22.3% (91/408, ears), and 19.6% (80/408, ears), respectively 3, 12, and 24 months after radiotherapy. The incidence of radiotherapy-induced mastoiditis was 35.8% (116/324, ears), 18.2% (59/324, ears), and 16.4% (53/324, ears), respectively 3, 12, and 24 months after radiotherapy. The remission rate of 63 patients (83 ears) who developed mastoiditis 3 months after radiotherapy was 63.9% (53/83, ears) and 75.9% (63/83, ears), respectively 12 and 24 months after radiotherapy. The remission rate of 54 patients (60 ears) who suffered mastoiditis before radiotherapy was 43.3% (26/60, ears), 65.0% (39/60, ears), and 73.3% (44/60, ears) 3, 12, and 24 months after radiotherapy. The multivariate analysis showed that the independent risk factors for radiotherapy-induced mastoiditis included age ≥50, clinical stages Ⅲ-Ⅳ, radiotherapy dose > 70 Gy, and tumors invading pharyngeal ostium of the eustachian tube. In addition, the atrophy degree of tensor veli palatini muscle 12 and 24 months after radiotherapy correlated with the onset of mastoiditis.Conclusions:The incidence of mastoiditis significantly increased 3 months after radiotherapy and significantly decreased 12 months after radiotherapy for NPC patients. The natural remission rate of radiotherapy-induced mastoiditis 12 months after radiotherapy was over 70%. The independent risk factors for radiotherapy-induced mastoiditis include age ≥50, clinical stages Ⅲ-Ⅳ, radiotherapy dose >70 Gy, and tumor invading pharyngeal ostium of the eustachian tube. The atrophy degree of the tensor veli palatini muscle 12 and 24 months after radiotherapy correlates with the onset of mastoiditis.

Pentoxifylline-tocopherol-clodronate combination in the treatment of localized temporal bone osteoradionecrosis / 中华放射医学与防护杂志

Objective:To determine the effects of pentoxifylline-tocopherol-clodronate combination (PENTOCLO) protocol in the treatment of localized temporal bone osteoradionecrosis (TBORN).Methods:A retrospective analysis was conducted on the clinical data of 21 patients, who suffered localized TBORN (23 ears) and were treated with the PENTOCLO protocol in Sun Yat-sen Memorial Hospital, Sun Yat-sen University from November 2020 to April 2021. The curative effects of the PENTOCLO protocol were evaluated based on the changes in ear symptoms and the extent of exposed bone before and after treatment.Results:The PENTOCLO protocol was applied for (506 ± 48) d on average. As a result, 19 ears (82.6%) became free of earache and purulent ear discharge, and two ears (8.7%) showed alleviation of symptoms. Moreover, nine ears (39.1%) exhibited re-epithelialization in the ear canal, 11 ears (47.6%) showed a decrease in exposed ear canal bone, and the osteonecrosis of three ears (13.0%) was stable.Conclusions:PENTOCLO has encouraging treatment effects on TBORN, and thus can be used as an effective nonsurgical option for localized TBORN.

Recurrent and Refractory Langerhans Cell Histiocytosis in Children Treated with the Combination of Cladribine and Cytarabine / 中国实验血液学杂志

OBJECTIVE@#To observe the efficacy and prognosis of cladribine (2-CdA) combined with cytarabine (Ara-C) regimen in the treatment of relapsed refractory Langerhans cell histiocytosis (LCH) in children.@*METHODS@#Nine patients with relapsed refractory LCH treated with the 2-CdA combined with Ara-C regimen in the Department of Hematology and Oncology of Wuhan Children's Hospital from July 2014 to February 2020 were retrospectively analyzed, and the efficacy and disease status were evaluated according to the Histiocyte Society Evaluation and Treatment Guidelines (2009) and the Disease Activity Score (DAS), the drug toxicity were evaluated according to the World Health Organization（WHO） grading criteria for chemotherapy. All patients were followed up for survival status and disease-related sequelae.@*RESULTS@#Before the treatment combining 2-CdA and Ara-C, 7 of 9 patients were evaluated as active disease worse (ADW), and 2 as active disease stable (ADS) with a median disease activity score of 8 (4-15). Of 9 patients, 6 cases achieved non active disease (NAD) and 3 achieved active disease better (ADB) with a median disease activity score of 0 (0 to 5) after 2-6 courses of therapy. All 9 patients experienced WHO grade IV hematologic toxicity and 3 patients had hepatobiliary adverse effects (WHO grade I～II) after treatment. The median follow-up time was 31(1 to 50) months with all 9 patients survived, 3 of the 9 patients experienced sequelae to the disease with 2 combined liver cirrhosis as well as cholestatic hepatitis and 1 with oral desmopressin acetate tablets for diabetes insipidus.@*CONCLUSION@#2-CdA combined with Ara-C is an effective regimen for the treatment of recurrent refractory LCH in children, and the main adverse effect is hematologic toxicity, which is mostly tolerated in children. Early treatment with this regimen may be considered for patients with multisystem LCH with risky organ involvement who have failed first-line therapy and for patients with relapse.

Correlations between subacromial impingement syndrome and acromial morphology and subacromial intervals after surgery of proximal humerus fracture / 中华创伤骨科杂志

Objective:To investigate the correlations between subacromial impingement syndrome (SIS) and acromial morphology and subacromial intervals after surgery of proximal humerus fracture.Methods:A retrospective study was conducted of the 62 patients with proximal humerus fracture who had been treated by internal fixation with a locking titanium plate from December 2014 to December 2019 at Department of Orthopedics, People's Hospital of Gaoming District. They were 40 men and 22 women, with an average age of 53.5 years (from 35 to 71 years). By the Neer classification, there were 38 three-part and 24 four-part fractures. The incidence of SIS was determined by Nikolaus's diagnostic criteria. The patients were divided into a SIS group and a non-SIS group. The acromial morphology was observed and the subacromial intervals [acromio-greater tuberosity of humerus interval (AGI) and acromio-plate interval (API)] were measured on postoperative X-ray films. The correlations were analyzed between them and SIS.Results:All patients completed treatments and follow-ups from 3 to 15 months (average, 10 months). There was no incision infection or internal fixation failure. There were 18 cases in the SIS group and 44 ones in the non-SIS group. In the SIS group, 3 cases had type Ⅰ acromion while 15 ones type Ⅱ or type Ⅲ acromion; in the non-SIS group, 20 cases had type Ⅰ acromion while 24 ones type Ⅱ or type Ⅲ acromion. The proportion of patients with type Ⅱ or type Ⅲ acromion in the SIS group was significantly higher than that in the non-SIS group ( P<0.05). AGI and API in the SIS group were (11.6±2.1) mm and (14.2±2.4) mm, significantly shorter than those in the non-SIS group [(15.7±2.8) mm and (18.5±3.2) mm] ( P<0.05). Conclusions:SIS is a common complication after surgery of proximal humerus fracture. Abnormal acromial morphology (type Ⅱ or type Ⅲ acromion), poor fracture reduction (reduced AGI), and high placement of a titanium plate (reduced API) may be all important factors leading to SIS.

Glucose Protects Cochlear Hair Cells Against Oxidative Stress and Attenuates Noise-Induced Hearing Loss in Mice / 神经科学通报·英文版

Oxidative stress is the key determinant in the pathogenesis of noise-induced hearing loss (NIHL). Given that cellular defense against oxidative stress is an energy-consuming process, the aim of the present study was to investigate whether increasing energy availability by glucose supplementation protects cochlear hair cells against oxidative stress and attenuates NIHL. Our results revealed that glucose supplementation reduced the noise-induced formation of reactive oxygen species (ROS) and consequently attenuated noise-induced loss of outer hair cells, inner hair cell synaptic ribbons, and NIHL in CBA/J mice. In cochlear explants, glucose supplementation increased the levels of ATP and NADPH, as well as attenuating H

Infection in Children with Acute Myeloid Leukemia in the Intensive Chemotherapy Period / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical characteristics of infection in children with acute myeloid leukemia (AML) after high intensive chemotherapy， so as to provide reference for prevention and control of infection.@*METHODS@#56 children diagnosed as acute myeloid leukemia in our hospital from January 2016 to August 2019 were enrolled and retrospectively analyzed, the infection rate, pathogens of disease and common location of infection during the induction and consolidation period were analyzed.@*RESULTS@#The total infection rate of the patients was 93.4%－96.4%, the average of serious infection rate was 16.0%(11.3%－19.6%), and the infection related mortality was 10.7%. Fever of unknown cause was the main reason of infection, while blood flow infections were the most common in severe infection, which were mainly caused by Gramnegative bacteria. The rate of fungal infection was 35.7% during chemotherapy.@*CONCLUSION@#Children with AML shows a high incidence of infection in each stage of chemotherapy. The serious illness caused by blood flow infection and take antifungal drugs to reduce the occurrence of fungal infection in AML patients should be paid attention.

Analysis of the Outcome and Prognostic Factors of Cyclosporine A in Children with Non-severe Aplastic Anemia / 中国实验血液学杂志

OBJECTIVE@#To summarize the long-term efficacy of cyclosporine (CsA) in the treatment of non-severe aplastic anemia (NSAA) in children, and explore the early significant indicators.@*METHODS@#Data of 36 NSAA children in Department of Hematological Oncology, Wuhan Children's Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2013 to December 2017 were analyzed retrospectively. All the children received oral CsA immunosuppressive therapy, and CsA trough concentration was checked to maintain at the rage of 200-250 μg/L after 2 weeks. The evaluation time points were at 3, 6, 12, 18 and 24 months, and assessment items were peripheral white blood cell differential count and reticulocyte's percentage and count.@*RESULTS@#The 36 NSAA cases were composed of 16 males and 20 females, whose median age was 5.46 (2.92-7.99) years old, and median follow-up time was 28.00 (10.00-38.25) months. After taking oral CsA for 24 months, the number of cumulative effective cases was 21. There were 4 cases of complete remission (CR), 17 cases of partial remission (PR), and 15 cases of non-remission (NR). The total effective rate was 58.33%, and median effect-acting time of CsA was 3.0 (0.5-10.0) months. Compared with ineffective group, neutrophil (NEU) and red blood cell (RBC) of effective group (CR+PR) began to increase significantly at the 3rd month, and hemoglobin (Hb), platelet (PLT) and white blood cell (WBC) increase significantly at the 6th month after oral CsA administration (P<0.05). Except for 2 cases who received component transfusion within 3-12 months after taking oral CsA for 3 months in effective group, the others did not need.@*CONCLUSION@#The overall effective rate of oral CsA in children with NSAA was 58.33%. Stopping blood transfusion after the 3 months of treatment may be considered as a turning point for disease outcomes, and levels of NEU, RBC at the 3rd month and Hb, PLT, WBC at the 6th month as indicators for predicting disease prognosis.

The Relationship between Plasma sST2/Reg3α Levels and Acute Graft-Versus-Host Disease in Children After Allogeneic Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

OBJECTIVE@#To explore the relationship between plasma sST2/Reg3α levels and acute graft-versus-host disease (aGVHD) in children after allogeneic hematopoietic stem cell transplantation (allo-HSCT).@*METHODS@#The clinical data of 29 pediatric patients received allo-HSCT treatment in Department of Hematology and Oncology of Wuhan Children's Hospital from January 2019 to January 2020 were collected. Peripheral blood samples were collected at 14 and 28 day after allo-HSCT. The plasma concentrations of sST2 and Reg3α were detected by Luminex assay.@*RESULTS@#Among 29 patients there were 15 males and 14 females with a median age of 53 (29-117) months. After allo-HSCT, 18 patients developed grade 0-I aGVHD; while 11 patients developed grade II-IV aGVHD. These included skin aGVHD in 6 cases, gastrointestinal aGVHD (GI-aGVHD) in 3 cases and gastrointestinal/skin aGVHD in 5 cases. Plasma sST2 level in II-IV aGVHD group showed significantly higher than that in 0-I aGVHD group at 28 days after allo-HSCT [101.81 (73.94-150.77) ng/ml vs 48.97 (28.82-56.69) ng/ml, P=0.021]. Also, the plasma sST2 level was significantly higher in GI-aGVHD group than that in no-aGVHD group at 28 days after allo-HSCT [118.74 (87.00-243.36) ng/ml vs 48.97 (23.55-61.40) ng/ml, P=0.004]. Plasma sST2 level ≥65.34 ng/ml at 28 days after allo-HSCT showed a sensitivity of 85.7% and a specificity of 87.5% in predicting II-IV aGVHD. And the patients with a plasma sST2 level ≥65.34 ng/ml showed a significantly higher incidence of II-IV aGVHD than those with plasma sST2 level of < 65.34 ng/ml after allo-HSCT (P=0.021). There was no significant difference in plasma Reg3α level between the patients with II-IV aGVHD and the non-aGVHD ones.@*CONCLUSION@#The increasing plasma sST2 level after allo-HSCT in children indicates the development of II-IV aGVHD, so sST2 is promising as a biomarker for predicting II-IV aGVHD.

Effect of the Risk Factors for Treatment-Related Death in Children with Acute Lymphoblastic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To explore the possible risk factors of death in children with acute lymphoblastic leukemia (ALL) after treatment.@*METHODS@#The clinical data of 31 children with newly diagnosed acute lymphoblastic leukemia and dead after treatment in the Hematology Oncology Department of Wuhan children's Hospital from January 1, 2016 to December 31, 2019 were retrospectively analyzed. Univariate factor analysis and multivariate Cox regression analysis were used to analyze the each indexes of ALL children, and the possible risk factors causes of death in ALL children after treatment were analyzed.@*RESULTS@#Among 230 newly diagnosed ALL children, 31 (13.4%) cases were dead. Among them, there were 12 male and 19 female. The mortality rates were 9%(12/133) for male and 19.5%(19/97) for female, which showed a significantly difference（P=0.02）； among the dead ALL children, 6 were less than 1 year old, 23 were 1-10 years old, and 2 was more than 10 years old. The mortality rates in different age groups were 46.1 % (6/13), 11.7%(23/195) and 9%(2/22), respectively, which showed a significantly difference（P=0.00）； the mortality rates of the ALL children in standard risk group, medium risk group and high risk group were 6.7% (4/59), 11.9% (13/10@*CONCLUSION@#The female, less than 1 year old at initial diagnosis, high risk ALL, WBC>50×10

Analysis of Recruitment Pattern of Related Muscles in Two Types of Active Straight Leg Raise / 中国康复理论与实践

Objective:To compare the rate of recruitment in two types of active straight leg raise (ASLR) and to investigate the activation patterns of the related muscles. Methods:From June to October, 2018, eleven healthy subjects were recruited. Surface electromyography (sEMG) signals of unilateral rectus femoris, bilateral rectus abdominis, internal oblique abdominis, external oblique abdominis and multifidus were recorded in normal ASLR (Action A) and raising leg for ten seconds (Action B). %maximal voluntary isometric contraction (MVIC) of these muscles was processed and analyzed. Results:%MVIC of ipsilateral internal oblique muscle and external oblique muscle were greater than the opposite side (t > 2.549, P < 0.05) in Action A; %MVIC of ipsilateral internal oblique muscle, external oblique muscle and rectus abdominis muscle were greater than the opposite side (t > 2.240, P < 0.05) in Action B; compared with action B, Action A had higher %MVIC of bilateral internal oblique and rectus femoris (t > 3.549, P < 0.05). Conclusion:The activation mode of ipsilateral dominance was shown in both actions, and the different motion control strategies may be adopted by the neuromuscular system in different ASLR.

Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures / 中华创伤骨科杂志

Objective@#To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures.@*Methods@#Between April 2014 and April 2017, a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics, Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures. They were 10 men and 4 women, with an average age of 36.4 years (from 23 to 57 years). The modified Stoppa approach was used exclusively in 4 cases, in combination with the iliac fossa approach in 3 ones, in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones. In all the patients, the pelvic reconstructive plate and screws and lag screws were used. The operation time, intraoperative bleeding volume, postoperative fracture reduction, fracture union time, efficacy and complications were recorded.@*Results@#The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL). There were no operative complications. By the Matta evaluation, the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures. Of this series, 13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up. The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months). Screw loosening was observed in one case and mild limitation to hip flexion in one. Follow-ups found no lateral ventral syndrome or femoral head necrosis. Their Harris hip scores at the last follow-up ranged from 70 to 94 points, averaging 84 points. The function of the affected hip was excellent in 6 cases, good in 5 and fair in 2.@*Conclusion@#The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures, leading to good short-term clinical outcomes.

Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures.Methods Between April 2014 and April 2017,a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics,Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures.They were 10 men and 4 women,with an average age of 36.4 years (from 23 to 57 years).The modified Stoppa approach was used exclusively in 4 cases,in combination with the iliac fossa approach in 3 ones,in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones.In all the patients,the pelvic reconstructive plate and screws and lag screws were used.The operation time,intraoperative bleeding volume,postoperative fracture reduction,fracture union time,efficacy and complications were recorded.Results The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL).There were no operative complications.By the Matta evaluation,the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures.Of this series,13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up.The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months).Screw loosening was observed in one case and mild limitation to hip flexion in one.Follow-ups found no lateral ventral syndrome or femoral head necrosis.Their Harris hip scores at the last follow-up ranged from 70 to 94 points,averaging 84 points.The function of the affected hip was excellent in 6 cases,good in 5 and fair in 2.Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures,leading to good short-term clinical outcomes.

Clinical characteristics and related factors of pneumonia in patients with aplastic anemia / 中国感染与化疗杂志

objective To analyze the clinical characteristics of pneumonia in patients with aplastic anemia for improving early prevention and clinical diagnosis. Methods A retrospective analysis was conducted for patients with aplastic anemia treated in our hosipital from June 2013 to April 2018. The clinical data of pneumonia were reviewed and analyzed in terms of radiological findings, pathogen distribution, and related risk factors. Results The clinical manifestations are atypical in patients with aplastic anemia. The imaging findings suggested that the infection was mainly bilateral pulmonary infection. The common pathogens were gram-negative bacteria such as Klebsiella pneumoniae. Disease type, agranulocytosis and low serum albumin level were independent risk factors for pneumonia in patients with aplastic anemia. Regular immunosuppressive therapy is a protective factor for pneumonia in patients with aplastic anemia. Conclusions The clinical manifestations of pneumonia are diverse in patients with aplastic anemia. The pathogens are mainly gram-negative bacteria. Empirical use of β-lactam-β-lactamase inhibitor combinations or quinolones is beneficial for controlling infection. Regular immunosuppressive therapy, recovery of hematopoietic function, nutritional support are effective measures to reduce the incidence of pneumonia in patients with aplastic anemia.

Relationship of PTEN/PI3K/AKT Signaling Pathway Protein Expression with Apoptosis and Drug-resistance of Children's ALL Primary Cells Treated with Daunorubicin / 中国实验血液学杂志

OBJECTIVE@#To investigate the relationship of PTEN/PI3K/AKT signaling pathway protein expression with apoptosis and drug-resistance of children's ALL primary cells treated with daunorubicin (DNR).@*METHODS@#The bone marrow mononuclear cells in newly diagnosed and untreated B-ALL children were collected and cultured. After the treatment of primary-cultured cells with DNR of final concentration 0.5 mg/L for 24 h, the cell apoptosis rate was detected by using cell apoptosis assay kit; the samples were collected at the on test of culture and after drug treatment, then expression levels of PTEN, PI3K and AKT proteins were detected by Western blot, moreover the interindex correlation was analyzed.@*RESULTS@#After DNR treatment, the apoptosis rate in PTEN low expression group was lower than that in PTEN high expression group (P＜0.05), showing high positive correlation of the cell apoptosis rate with the expression of PTEN before DNR treatment; the cell apoptosis rate in PI3K and AKT low expression group was higher than that in PI3K and AKT high expression group (P＜0.01); however, the expression of PI3K and AKT proteins was down-regulated after treatment with DNR (P＜0.01).@*CONCLUSION@#The difference of PTEN expression is present in primary cells of B-ALL children, however the change of PTEN expression is not significant after DNR treatment, suggesting that the PTEN expression correlates with DNR-resistance. The DNR can induce the apoptosis of childrens B-ALL primary cells by down-regulating the expression of PI3K and AKT signaling pathway proteins.