Characteristics and impact factors of SARS-CoV-2 infection in adult patients with relapsed/refractory B-cell non-Hodgkin lymphoma receiving chimeric antigen receptor T-cell therapy / 中华血液学杂志

Objective: To explore the clinical characteristics and treatment of COVID-19 infection in patients with relapsed/refractory B-cell non-Hodgkin lymphoma before and after receiving chimeric antigen receptor T-cell therapy, and study the influencing factors of severe COVID-19 infection in these patients. Methods: The data of 59 patients with relapsed/refractory B-cell non-Hodgkin lymphoma who received chimeric antigen receptor T-cell therapy at the Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology and Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University between December 2017 and February 2023, and who were infected with novel coronavirus between December 2022 and February 2023 were retrospectively studied. Patients were divided into light, medium, severe, and critical groups, and the differences between the groups were analyzed using the chi-square test. A univariate logistic regression model was used to evaluate the contribution of each variable and its relationship with severe infection. The chi-square and Fisher's exact tests were used to analyze the differences between the B-cell aplasia and B-cell recovery (BCR) groups. Results: Of the 59 pre- and post-infusion infections, 39 (66.1%) led to mild COVID-19, 9 (15.3%) resulted in moderate COVID-19, 10 (16.9%) resulted in severe COVID-19, and 1 (1.7%) led to critical COVID-19. Moroever, age greater than 55 years, having received autologous hematopoietic stem cell transplantation, progressive disease status, and B-cell aplasia at the time of diagnosis of COVID-19 infection are factors affecting severe infection. Patients with B-cell aplasia had a more severe infection with COVID-19 (P<0.001), a longer duration (P=0.015), a longer antiviral therapy course (P<0.001), and a higher hospitalization rate (P<0.001) than the BCR group. Conclusion: Active prevention and treatment of COVID-19 infection remains a crucial issue requiring urgent attention in managing patients with relapsed/refractory B-cell non-Hodgkin lymphoma treated with chimeric antigen receptor T-cell therapy.

Efficacy and safety of fourth-generation CD19 CAR-T expressing IL7 and CCL19 along with PD-1 monoclonal antibody for relapsed or refractory large B-cell lymphoma / 中华血液学杂志

Objective: This study systematically explore the efficacy and safety of fourth-generation chimeric antigen receptor T-cells (CAR-T), which express interleukin 7 (IL7) and chemokine C-C motif ligand 19 (CCL19) and target CD19, in relapsed or refractory large B-cell lymphoma. Methods: Our center applied autologous 7×19 CAR-T combined with tirelizumab to treat 11 patients with relapsed or refractory large B-cell lymphoma. The efficacy and adverse effects were explored. Results: All 11 enrolled patients completed autologous 7×19 CAR-T preparation and infusion. Nine patients completed the scheduled six sessions of tirolizumab treatment, one completed four sessions, and one completed one session. Furthermore, five cases (45.5%) achieved complete remission, and three cases (27.3%) achieved partial remission with an objective remission rate of 72.7%. Two cases were evaluated for disease progression, and one died two months after reinfusion because of uncontrollable disease. The median follow-up time was 31 (2-34) months, with a median overall survival not achieved and a median progression-free survival of 28 (1-34) months. Two patients with partial remission achieved complete remission at the 9th and 12th months of follow-up. Therefore, the best complete remission rate was 63.6%. Cytokine-release syndrome and immune effector cell-associated neurotoxicity syndrome were controllable, and no immune-related adverse reactions occurred. Conclusion: Autologous 7×19 CAR-T combined with tirelizumab for treating relapsed or refractory large B-cell lymphoma achieved good efficacy with controllable adverse reactions.

Efficacy and safety analysis of the zanubrutinib-based bridging regimen in chimeric antigen receptor T-cell therapy for relapsed/refractory diffuse large B-cell lymphoma / 中华血液学杂志

Objective: To further elucidate the clinical efficacy and safety of a combination regimen based on the BTK inhibitor zebutanil bridging CD19 Chimeric antigen receptor T cells (CAR-T cells) in the treatment of relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL) . Methods: Twenty-one patients with high-risk r/r DLBCL were treated with a zanubrutinib-based regimen bridging CAR-T between June 2020 and June 2023 at the Department of Hematology, Tongji Hospital, Tongji University and the Second Affiliated Hospital of Zhejiang University, and the efficacy and safety were retrospectively analyzed. Results: All 21 patients were enrolled, and the median age was 57 years (range: 38-76). Fourteen patients (66.7%) had an eastern cooperative oncology group performance status score (ECOG score) of ≥2. Eighteen patients (85.7%) had an international prognostic index (IPI) score of ≥3. Three patients (14.3%) had an IPI score of 2 but had extranodal infiltration. Fourteen patients (66.7%) had double-expression of DLBCL and seven (33.3%) had TP53 mutations. With a median follow-up of 24.8 (95% CI 17.0-31.6) months, the objective response rate was 81.0%, and 11 patients (52.4%) achieved complete remission. The median progression-free survival (PFS) was 12.8 months, and the median overall survival (OS) was not reached. The 1-year PFS rate was 52.4% (95% CI 29.8% -74.3%), and the 1-year OS rate was 80.1% (95% CI 58.1% -94.6%). Moreover, 18 patients (85.7%) had grade 1-2 cytokine-release syndrome, and two patients (9.5%) had grade 1 immune effector cell-associated neurotoxicity syndrome. Conclusion: Zanubrutinib-based combination bridging regimen of CAR-T therapy for r/r DLBCL has high efficacy and demonstrated a good safety profile.

Synchronous tele-ultrasonography is helpful for a naive operator to perform high-quality thyroid ultrasound examinations

Purpose@#This study investigated the value of synchronous tele-ultrasonography (TUS) for naive operators in thyroid ultrasonography (US) examinations. @*Methods@#Ninety-seven patients were included in this prospective, parallel-controlled trial. Thyroid scanning and diagnosis were completed by resident A independently, resident B with guidance from a US expert through synchronous TUS, and an on-site US expert. The on-site expert’s findings constituted the reference standard. Two other off-site US experts analyzed all data in a blind manner. Inter-operator consistency between the two residents and the on-site US expert for thyroid size measurements, nodule measurements, nodule features, American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) categories, and image quality was compared. Two questionnaires were completed to evaluate the clinical benefit. @*Results@#Resident B detected more nodules consistent with the on-site expert than resident A did (89.4% vs. 56.5%, P0.75), while resident A achieved lower consistency in ACR TI-RADS categories, composition, echogenicity, margin, echogenic foci, and vascularity (all ICCs 0.40-0.75). Residents A and B had excellent consistency in target nodule measurements (all ICCs >0.75). Resident B achieved better performance than resident A for gray values, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (all P<0.05). Furthermore, 61.9% (60/97) of patients accepted synchronous TUS, and 59.8% (58/97) patients were willing to pay for it. @*Conclusion@#Synchronous TUS can help inexperienced residents achieve comparable thyroid diagnostic capability to a US expert.

Clinical characteristics and prognostic factors of 40 cases of primary systemic anaplastic large cell lymphoma / 中华血液学杂志

Objective: To analyze the clinical features and prognostic factors of primary systemic anaplastic large cell lymphoma (ALCL) . Methods: 40 ALCL cases treated in the First Affiliated Hospital of Zhejiang University from January 2013 to December 2018 were retrospectively analyzed. Results: ① With a median age of 41 (14-67) years, there were 29 males and 11 females, 36 patients (90.0%) had Ann Arbor stage Ⅲ-Ⅳ tumors, 23 patients (57.5%) were in high-intermediate or high international prognostic index (IPI) risk group. 25 patients (62.5%) had B symptoms, such as fever, emaciation and night sweat.38 patients (95.0%) had extranodal invasion, 25 patients (62.5%) had higher LDH level, and 25 patients (62.5%) had high expression of Ki-67 (80% or more) . With 22 ALK(+) patients (55.0%) and 18 ALK(-) patients (45.0%) , there was a significantly difference in the median age of the two groups [29 (14-67) years old vs 51.5 (19-67) years old, P=0.003]. ② All patients received chemotherapy, 18 cases were treated with CHOP (cyclophosphamide, doxorubicin, vindesine, prednisone) , 12 cases with ECHOP (cyclophosphamide, doxorubicin, vindesine, prednisone, etoposide) , 10 cases with other treatments and 26 patients (65.0%) obtained complete remission (CR) . ALK(-) (P=0.029, OR=13.458) and Ki-67 expression of 80% or more (P=0.04, OR=14.453) were independent factors of CR rate, the CR rate of ECHOP chemotherapy was higher than CHOP chemotherapy (P=0.026) . ③ LDH level, IPI score, ALK expression and chemotherapy regimen had significantly effect on progression free survival (PFS) and overall survival (OS) (P<0.05) . Conclusion: The study shows that primary systemic ALCL usually occurs in males, the average age of ALK(+) patients were younger than ALK(-) patients. Most patients are in stage Ⅲ-Ⅳ with extranodal invasion, more than half of the patients have B symptoms, elevated LDH, and high expression of Ki-67. The expression level of Ki-67, ALK expression, and chemotherapy regimen have prognostic value for CR rate, the LDH level, IPI score, ALK expression and chemotherapy regimen for PFS and OS. ECHOP is a better choice with improved prognosis.

Effect of electroacupuncture on NF-κB and NLRP3 inflammasome in uterine tissues of rats with primary dysmenorrhea / 针灸推拿医学（英文版）

Objective: To observe the effect of electroacupuncture (EA) on nuclear factor kappa B (NF-κB) and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome in uterine tissues of rats with primary dysmenorrhea (PD), thus to explore the possible mechanism of EA for PD. Methods: Fifty female Sprague-Dawley (SD) rats were randomly divided into a normal group, a model group, an EA at non-acupoint group, an EA at acupoint group and a Western medicine group, with 10 rats in each group. Except for the normal group, rats in the other four groups were treated with estradiol benzoate combined with oxytocin for 11 d to establish PD rat models. From day 1 of the modeling, rats in the normal group and the model group were only properly grasped without any intervention; Guanyuan (CV 4) and Sanyinjiao (SP 6) were selected for EA treatment in the EA at acupoint group; rats in the EA at non-acupoint group were treated with EA at 5 mm away from the acupoints selected above; rats in the Western medicine group were treated with ibuprofen via gavage. Rats in each group were treated for 10-day successively. On the 11th day, except for the normal group, rats in the other groups were intraperitoneally injected with oxytocin (2 U/rat), and the writhing number within 30 min in each group was compared; the pathological changes in rat uteruses were observed by hematoxylin-eosin (HE) staining, and the pathological damage scores were evaluated. Protein expression levels of NF-κB p65, phospho-NF-κB p65, NLRP3, cysteine aspastic acid-specific protease 1 (caspase-1), interleukin (IL)-1β and IL-18 were detected by Western blot. Results: Compared with the normal group, the writhing number increased significantly (P<0.05), and the extensive exfoliation of the endometrium, severe edema, and histopathological score all increased significantly in the model group (P<0.05) as well as the protein levels of NLRP3, caspase-1, IL-1β and IL-18, and the ratio of phospho-NF-κB p65/NF-κB p65 in rat uterine tissues (all P<0.05); compared with the model group, the numbers of writhing reaction decreased within 30 min (P<0.05), the endometrial exfoliation was rare, the edema degree was mild, and the histopathological scores decreased significantly (all P<0.05) in the EA at acupoint group and the Western medicine group; compared with the model group, the phospho-NF-κB p65/NF-κB p65 ratio and the NLRP3, caspase-1, IL-1β and IL-18 protein levels of rat uterine tissues in the EA at acupoint group were significantly lower (P<0.05); compared with the model group, the caspase-1, IL-1β and IL-18 protein levels of the rat uterine tissues decreased significantly (all P<0.05), and the differences in the NLRP3 and phospho-NF-κB p65/NF-κB p65 levels were statistically insignificant (all P>0.05) in the Western medicine group; compared with the Western medicine group, the phospho-NF-κB p65/NF-κB p65 ratio, also the NLRP3, IL-1β and IL-18 protein levels of the uterine tissues decreased significantly in the EA at acupoint group (all P<0.05), while the difference in the caspase-1 level was statistically insignificant (P>0.05); there were no significant differences between the EA at non-acupoint group and the model group in any indicators (all P>0.05). Conclusion: EA at acupoints significantly improves the pain and pathological damages of PD rats. The mechanism may be related to the reduced uterine inflammation via inhibiting NF-κB phosphorylation and NLRP3 activation in uteruses of PD rats.

Influence of Oxycodone Hydrochloride on Patients with Intestinal Tumor on Analgesic Effect and Immune Function after Operation / 现代生物医学进展

Objective:To investigate the effect of oxycodone hydrochloride on patients with analgesic effect and immune function of intestinal tumor after operation.Methods:50 patients with intestinal tumor from June 2014 to December 2016 who were treated in our hospital were selected randomly to divide into oxycodone group and fentanyl group with 25 cases in each group.Patients in oxycodone group were given oxycodone hydrochloride intravenous injection of 5mg 15 minutes before the end of surgery;and patients in fentany group were given fentany intravenous injection of 50ug 15 minutes before the end of surgery.Visual analogue scale (VAS),ramsey sedation score were observed at 3 h (T0),6 h (T1),12 h (T2),24 h (T3) 48 h (T4) after operation,Levels of serum tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and IL-10 CD4+,CD8+,CD4+/CD8+ and NK cells measured before anesthesia,and at T2,T3,T4 respectively.Results:At time point of T1,T2,Ramsey scores of oxycodone group were significantly lower than that of fentany group (P＜0.05),At time point ofT0,T3,T4,Ramsey scores of the two groups showed no significant difference (P＞0.05).At time point of T2,T3,T4,levels of serum TNF-α,IL-6 and IL-10 of two groups of patients were significantly higher than those of anesthesia before (P＜0.05),TNF-α,IL-6 and IL-10 ofoxycodone group was significantly lower than those of fentany group (P＜0.05).At time point ofT2,T3,T4,CD4+/at CD4+ of the two groups were significantly decreased,and CD8+ was significantly increased(P＜0.05).Levels of CD4+,CD4+/CD8+ of oxycodone group was significantly higher than that of fentany group (P＜0.05),and level ofCD8+ was significantly higher than that of fentany group.At time point of T2,T3,NK cells of two groups were significantly decreased,NK cells of oxycodone group were significantly higher than that of oxycodone group (P＜0.05).Differences among postoperative nausea,vomiting,respiratory depression,dizziness,skin itching incidence of two groups of patients were not statistically significant (P＞0.05).Conclusion:Oxycodone hydrochloride has little effect on the immune function of patients with intestinal tumor,and it is suitable for Postoperative analgesia of patients with intestinal tumor.

Therapeutic Efficacy of VICP+L-ASP/TKI on Adult Patients with B-ALL / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic efficacy of VICP+L-ASP/TKI on adult patients with B-ALL and to explore the influence factors.</p><p><b>METHODS</b>Forty-one adult B-ALL patients treated with VICP+L-ASP/TKI from August 2008 to June 2014 were following-up. The complete remission(CR) rate, toxicity, overall survival(OS) and event free survival(EFS) after induction treatment were analyzed, the therapeutic outcome of patients between different risk stratification subgroups was compared, the influence of standardized consolidatory and maintaining treatment as well as allogeneic hematopoietic stem cell transplantation(allo-HSCT) on survival time was analyzed.</p><p><b>RESULTS</b>The early death not occurred in 41 patients with B-ALL including 37 cases with CR; the CR rate of 1 course treatment was 90.2%. The follow-up time lasted to March 17, 2015, the median follow-up time was 25(9-79) months; the 1 year OS rate was 75.3%, the EFS rate was 58.3%. Analysis of risk factors showed that the initial WBC count over 30×10/L, LDH over 250 U/L and minimal residual disease(MRD) over 10after treatment were poor prognostic factors. After remission, the standardized consolidatory treatment or allo-HSCT according to the "2012 China adult ALL diagnosis and treatment expert consensus" could improve long-term survival, 3 years OS rate was 73.8% and 61.5% respectively, 3 years EFS were 63.5% and 65.7% respectively. The main toxic and side effects were hematologic reactions, the hematologic adverse reaction of IV grade was observed in 97.6%(40/41) during induction treatment.</p><p><b>CONCLUSION</b>Induction chemotherapy based on VICP+L-ASP/TKI and standardized consolidatory after remission according to the "2012 China adult acute lymphoblastic leukemia diagnosis and treatment expert consensus" can improve the therapeutic efficacy. The allo-HSCT should be actively performed for B-ALL paients with high risk(elevated initial WBC count and LDH level); at some time, the regularly monitoring MRD and adjusting therapeutic protocol according to monitoring result can promote the prognosis of adult B-ALL patients.</p>

Matrine and CYC116 synergistically inhibit growth and induce apoptosis in multiple myeloma cells / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate whether CYC116 can potentiate matrine-dependent growth inhibition and apoptosis in multiple myeloma (MM) cells.</p><p><b>METHODS</b>The dose response relationship of matrine to dexamethasone-resistant and dexamethasone-sensitive MM cells was first established. Myeloma RPMI8226 cells were treated with matrine alone or combined with CYC116 for 24 h. Cell proliferation was measured using an MTT assay and apoptosis induction was evaluated by flow cytometry. Activation of the caspase pathway and expression of apoptosis regulator proteins were detected by Western blotting.</p><p><b>RESULTS</b>Matrine significantly induced growth arrest and apoptosis in both drug-resistant and drug-sensitive MM cells. Treatment with the combination of matrine and CYC116 had a stronger cytotoxic effect on MM cells than did single drug treatments. Enhanced apoptosis observed following the combined treatment of matrine and CYC116 was associated with higher levels of activation of caspase-9, caspase-3, and poly adenosine diphosphate ribose polymerase (PARP) and down-regulation of the anti-apoptotic proteins Bcl-2 and Mcl-1 and the signaling proteins p-Akt and nuclear factor κB (NF-κB).</p><p><b>CONCLUSION</b>CYC116 enhances the growth inhibitory and apoptotic effects of matrine on MM cells.</p>

Effect of smoke water and distillation liquid on the seed germination and seedling growth of Trichosathes kirilowii / 中国中药杂志

Smoke water and distillation liquid were used to treat the seeds of Trichosathes kirilowii and to study the effects of smoke water and distillation liquid on the seed germination and seedling growth of T. kirilowii. The results showed that germination rate, germination index and germination vigor of T. kirilowii all were significantly improved with the treatment of SW and DL treatment. The activity of α-amylase were significantly increased with the treatment of SW and DL at 1:2,000. SW and DL treatment showed no significant effects on the activity of SOD. The activity of POD were markedly enhanced under the treatment of SW (1:000) and DL (1:2,000). CAT activity were increased with the treatment of SW and DL at 1:2,000 while were inhibited by SW and DL at 1:500. Seedling height and root length were increased with the treatment of SW and DL (1:1,000, 1:2,000). SW and DL treaments improved the content of chlorophyll, and moreover with the concentration of SW and DL, the stimulatory were also increased. This work demonstrated that smoke water and diatillation liquid at 1:2,000 could stimulate the seed germination and seedling growth of T. kirilowii, and it provided the references for the study of seed germination technology.

Effect of prenatal alcohol exposure on rhythmic respiratory discharge activity in medullary slices of neonatal rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of prenatal alcohol exposure on rhythmic respiratory discharge activity (RRDA) in the medullary slices of neonatal rats.</p><p><b>METHODS</b>Ten pregnant female SD rats were exposed to 0, 4%, 6%, 8%, and 10% alcohol in drinking water from 1 week before till 3 days after delivery. The medullary slices of the neonatal rats containing the medial region of the nucleus retrofacialis (mNRF) with the hypoglossal nerve rootlets were prepared and perfused with modified Kreb's solution to record RRDA from the hypoglossal nerve rootlets using suction electrodes.</p><p><b>RESULTS</b>No significant difference was found in RRDA in 50 min among the neonatal rats with prenatal exposure to 0, 4%, 6%, and 8% alcohol, but the RRDA in 10% alcohol exposure group became irregular. Prenatal exposure to increased alcohol concentrations caused attenuated RRDA attenuated in the neonatal rats, shown by shortened inspiratory time (TI), decreased respiratory frequency (RF), and reduced integral amplitude (IA) as compared with those in the control group.</p><p><b>CONCLUSION</b>Prenatal alcohol exposure inhibits RRDA in medullary slices of neonatal rats, which might be a mechanism by which maternal alcohol exposure causes suppressed offspring respiratory functions.</p>

Apoptosis of acute myeloid leukemia HL-60 cells induced by CDK inhibitor SNS-032 and its molecular mechanisms / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effects of cycle-dependent kinase (CDK) inhibitor SNS-032 on apoptosis in human acute myeloid leukemia (AML) HL-60 cells and its molecular mechanisms.</p><p><b>METHODS</b>Cultured AML HL-60 cells were treated with various concentrations of SNS-032. Cell apoptosis was determined with flow cytometry;cell viability was measured by MTT assay; the profiles of microRNA expression of HL-60 cells were analyzed by microRNA microarray;the protein expressions of JAK2/STAT3 pathway were detected by Western blotting.</p><p><b>RESULTS</b>Apoptosis of AML HL-60 cells was induced by SNS-032; the rate of apoptosis was (5.9±1.7)%, (12.1±3.1)% and (59.4±3.6)% when HL-60 cells were treated with 0,100 and 200 nmol/L SNS-032. MicroRNA microarray analysis revealed that the levels of miR-30a, miR-183, miR-20b, miR-26b, miR-20a, miR-589, miR-107, miR-181a, miR-106a, miR-17 and miR-378c were down-regulated by SNS-032,whereas the levels of miR-320a and miR-H7* were up-regulated. Western blotting showed that SNS-032 strongly inhibited phosphorylation of STAT3 and protein expression of JAK2,C-MYC and MCL-1.</p><p><b>CONCLUSION</b>CDK inhibitor SNS-032 can induce apoptosis of AML HL-60 cells, which is associated with the inhibition of MCL-1,C-MYC and JAK2/STAT3, and down-regulation of miR-17-92 family.</p>

Imatinib mesylate for chronic myeloid leukemia: in patients with initial treatment versus those with Recombinant Human IFN-α2b treatment failure / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the efficacy of imatinib mesylate (IM) for patients with newly diagnosed chronic myeloid leukemia (CML) and patients after failure of Recombinant Human interferon-α2b (IFN-α2b) therapy.</p><p><b>METHODS</b>A total of 86 patients with CML in chronic-phase, including 61 newly diagnosed cases and 25 cases of IFN-α2b failure, who received IM at 400 mg daily were retrospectively analyzed. Conventional cytogenetic analysis of R-banding was used to detect chromosome abnormalities and real-time PCR was used to detect BCR-ABL fusion gene.</p><p><b>RESULTS</b>81.9% of newly diagnosed patients and 36.0% of IFN-α2b failure patients achieved partial cytogenetic response (PCyR) by 6 months. In addition, 86.9% of newly diagnosed patients and 68.0% of IFN-α2b failure patients achieved complete cytogenetic response (CCyR) in 24 months. There was significant difference between two groups (P<0.001). The median time achieved CCyR in newly diagnosed group and IFN-α2b failure group were 6 months and 15 months, respectively. Compared with newly diagnosed group, IFN-α2b failure group showed lower rate of complete molecular remission (CMR) (70.4% vs 40.0%, P=0.033). There are 14 patients (22.9%) in newly diagnosed patients with cytogenetic resistance, among whom 4 with primary cytogenetic resistance; while there were 14 patients (56.0%) in IFN-α2b failure group with cytogenetic resistance, all of whom with primary resistance.</p><p><b>CONCLUSION</b>Compared with newly diagnosed patients, CML patients after failure of IFN-α2b therapy have a high rate of primary cytogenetic resistance and low response rate to IM.</p>

Clinical value of combined thoracoscopic and laparoscopic esophagectomy for the treatment of esophageal carcinoma / 中华消化外科杂志

Objective To investigate the clinical value of combined thoracoscopic and laparoscopic esophagectomy for the treatment of esophageal carcinoma.Methods The clinical data of 50 patients who underwent combined thoracoscopic and laparoscopic for the treatment of esophageal carcinoma at the Jiangdu People's Hospital of Yangzhou from May 2013 to August 2014 were retrospectively analyzed.The patients underwent the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection in the left lateral decubitus position, and then the patients underwent laparoscopic mobilization of the stomach and lymph node dissection in the horizontal position, finally the gastric tube was pulled out to have stapled anastomosis through left neck.The operation time, volume of intraoperative blood loss, number of lymph node dissected, amount of postoperative thoracic drainage, time to resume diet after surgery, postoperative hospital stay and results of pathological examination were collected.Patients were followed up via telephone interview and out-patient examination till September 2014.The recovery condition and survival of patients were collected.The measurement data with normal distribution were presented as (x) ± s or mean value (range).Results There was no patient transferred to open thoracic surgery or abdominal surgery.The operation time of thoracoscopic and laparoscopic procedures were (85 ±30)minutes and (55 ± 22) minutes, respectively.The total operation time was (210 ± 40) minutes.The mean volume of intraoperative blood loss was 115 mL (range, 50-210 mL) in the thoracic cavity and 65 mL (range, 30-100 mL) in the abdomen.The mean number of lymph nodes dissected was 11.3 (range, 8.0-15.0) in the thoracic cavity and 8.5 (range, 6.0-12.0) in the abdomen.The mean volume of postoperative thoracic drainage, mean time to resume diet and postoperative hospital stay were 340 mL (range, 200-650 mL) , 7 days (range, 6-8 days) and 12 days (range, 11-14 days).The 50 cases were diagnosed as esophageal squamous cell cancer and staged as T1-3N0-1M0 by postoperative pathological examination, with negative upper and lower margin.There was 1 case of anastomotic leak, 3 cases of lung infection who were cured by symptomatic treatment and 3 cases of recurrent laryngeal nerve injury after operation who recovered after 6-month follow-up.All patients were successfully followed up without recurrence and death.During the follow-up of 1-16 months, 2 patients were found anastomotic stricture at postoperative 3 months, and were cured by endoscopic dilation for 3 times.Conclusion Combined thoracoscopic and laparoscopic esophagectomy is safe and effective for the treatment of esophageal carcinoma.

The value of double contrast-enhanced ultrasound and three-dimensional contrast-enhanced ultrasound in differential diagnosis of benign and malignant gastric ulceration / 中华医学超声杂志（电子版）

Objective To investigate the value of double contrast-enhanced ultrasonography (DCEUS) in combination with three-dimension (3D) contrast-enhanced ultrasound in diagnosis of benign or malignant gastric ulceration. Methods A total of 47 patients with gastric lesions were enrolled in this study. All have the pathological results, 22 of them were benign ulceration and 25 were malignant. All patients underwent DCEUS and 3D contrast-enhanced ultrasound. On the basis of oral contrast-enhanced ultrasound agents, intravenous contrast-enhanced ultrasound agents were given at the same time. Images and data were recorded. The arrival time (AT), time to peak (TTP), infusion time (IT), baseline intensity (BI), peak intensity (PI) and enhanced intensity (EI) were calculated using the time-intensity curve (TIC). Results All benign ulcerations were imaged as small pits with slight thicken of gastric wall [(8.66±2.87) mm] using DCEUS,while malignant lesions were relatively large irregular-shape, unevenly-bottom pits with significant thicken of gastric wall [(13.98±3.63)~(20.83±3.69) mm]. 3D-DCEUS images were analyzed for gastric mucosal folds, ulceration lesions, as well as local vascularity. All ulceration lesions showed broken of gastric mucosal folds, and malignant lesion showed thickness of gastric wall as“crater”, with rich and irregular vascularity. There were no statistical differences between benign gastric ulcerations and adjacent normal gastric wall (P>0.05). Malignant gastric ulceration were compared with adjacent normal gastric wall tissue, TTP, IT and BI had no statistical differences (P>0.05), while AT, PI, and EI had statistical differences [(9.00±2.02) s vs (10.90±2.75) s, P=0.008], [(35.46±5.77) dB vs (29.73±8.72) dB, P=0.009] and [(30.76±5.76) dB vs (23.45±6.84) dB, P=0.000]. PI and EI in malignant tumors were higher than those in benign ones (P<0.05). Conclusion DCEUS could be a new method in differentiating benign and malignant gastric ulceration, which can get both the anatomy and perfusion information of gastric wall as well as lesions. 3D-DCEUS can improve the quality of the conventional ultrasound image.

Thoracoscopic and laparoscopic esophagectomy for the treatment of esophageal carcinoma:A report of 20 cases / 实用肿瘤学杂志

Objective To evaluate of safety and feasibility of thoracoscopic and laparoscopic esophagec -tomy for the treatment of esophageal carcinoma .Methods Retrospective analyses were performed on chest com-bined with laparoscopy in the treatment of 20 patients with esophageal cancer information from september 2013 to July 2014 .The patients were placed at a left lateral decubitus position ,with the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection;then in the lithotomy position .Laparoscopic mobilization of the stomach and lymph node dissection were cleared .Finally we pulled out the gastric tube from the esophageal bed to the neck and made stapled esophagogastrostomy in the left neck .Results All patients were not to be opened tho-racic surgery and abdominal surgery .The mean operation time for thoracoscopy was (90 ±30)minutes,The mean operation time for laparoscopic was(65 ±20)minutes,The total operation time was(210 ±40)minutes.The tho-racic blood loss ranged from 60 to 200 mL( mean,110 mL) ,The abdominal blood loss ranged from 30 to 100 mL (mean,60 mL).mean number of mediastinal lymph nodes resected was ranged from 8 to 15(11.2 per ease), mean number of abdominal lymph nodes resected was ranged from 6 to 12(8.4 per ease).Postoperative thoracic drainage was ranged from 200 to 650 mL( mean,350 mL) .mean time to resume oral intake was ranged from 6 to 8 days(mean,7 days),mean postoperative hospital stay was ranged from 11 to 14 days(mean,12 days),All the patients were diagnosis for esophageal squamous cell cancer after operation .Postoperative pathologicalcat staging identified stage T 1~3 N0~1 M0 .There was not tumor at the upper rejection margin and the lower margin .There was not anastomotic leak in postoperative .Postoperative lung infection in1 case.Postoperative recurrent laryngeal nerve injury in 1case.It was successfully followed up with durations 6 months.anastomotie stricture in 1 case after post-operative 3 months,And in endoscopic probe dilatation for patients with anastomotie stricture was successful in three times.20 cases were successfully followed up with durations ranged from 2 to 10 months.There was not spreaded and died in cases .Conclusion Combined thoracoscopic and laparoscopic esophagectomy can reduce trauma and postoperative complications ,which is safe and feasible therapeutic method .

Efficacy and safety of the HAA regimen as induction chemotherapy in 236 de novo acute myeloid leukemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of the HAA regimen (homoharringtonine, cytarabine and aclarubicin) as induction chemotherapy in de novo acute myeloid leukemia (AML).</p><p><b>METHODS</b>The efficacy and safety of 236 de novo AML patients who received the HAA regimen as induction chemotherapy were retrospectively analyzed. The complete remission (CR) rate was assayed. Kaplan-Meier method was used to estimate overall survival (OS) and relapse free survival (RFS), and the differences were compared by Log-rank test.</p><p><b>RESULTS</b>The overall CR rate was 78.0%, and 65.7% of the patients attained CR in the first induction cycle. The early death rate was 4.7%. The median followup time was 41(1-161) months. The estimated 5-year OS and 5-year RFS rates were 44.9% and 45.5%, respectively. The CR rates of patients with favorable, intermediate and unfavorable cytogenetics were 92.9%,78.6%and 41.7%, respectively. The 5-year OS of favorable and intermediate group were 61.1% and 45.1%, respectively. The 5- year RFS of favorable and intermediate group were 49.0% and 45.4%, respectively. The median survival time of unfavorable group was only 5 months. The side effects associated with the HAA regimen were tolerable, in which the most common toxicities were myelosuppression and infection.</p><p><b>CONCLUSION</b>The HAA regimen is associated with a higher rate of CR and longer survival time and its toxicity could be tolerated.</p>

Homoharringtonine combined arsenic trioxide induced apoptosis in human multiple myeloma cell line RPMI 8226: an experimental research / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To clarify the effects and mechanisms of homoharringtonine (HHT) monomer therapy or combination therapy with arsenic trioxide (ATO) on human multiple myeloma (MM) cell line RPMI 8226 in in vitro researches.</p><p><b>METHODS</b>Effects of HHT, ATO, and HHT combined ATO on the growth of MM cell line RPMI 8226 were detected using MTT assay. The morphological changes of cell apoptosis were detected by Hoechst staining. The early apoptosis rate was detected using flow cytometry. Expressions of Caspase-3, Caspase-9, poly-ADP-ribose polymerase (PARP), Bcl-2, Mcl-1, Bcl-xl, and AKT protein were detected by Western blot.</p><p><b>RESULTS</b>HHT and ATO inhibited the proliferation of RPM1 8226 cell line in a time- and dose-dependent manner (P < 0.05). Synergistic effects was shown in the combination group (Cl < 1). HHT and ATO induced the apoptosis of RPMI 8226 in a dose-dependent manner with typical morphological changes of apoptosis and higher early stage apoptosis rate. The enhancement in apoptotic induction was seen when two agents were combined. HHT activated expressions of Caspase-3 and PARP in a dose dependent manner at 24 h. HHT at 40 ng/mL and ATO at 8.5 micromol/L could significantly activate expressions of Caspase-3 and Caspase-9, and down-regulate expressions of anti-apoptotic proteins Bcl-xl and Mcl-1. In addition, the combination therapy of HHT at 40 ng/mL and ATO at 8.5 micromol/L inhibited phosphorylation of AKT in a time-dependent manner.</p><p><b>CONCLUSION</b>HTT, ATO, and combination therapy of HHT and ATO induced the apoptosis of RPMI 8226 cell line possibly through activating Caspase pathways, regulating expressions of Bcl-2 families, and inhibiting phosphorylation of AKT.</p>

CT image features of urinary tract inflammatory myofibroblastic tumor / 中华泌尿外科杂志

Objective To evaluate the CT image features of urinary tract inflammatory myofibroblastic tumor (IMT) for use in clinical and differential diagnosis.Methods Eight pathologically proven IMT cases were retrospectively analyzed in this study.There were six female patients and two male patients.Patient average age was 35 (13-62) years.The main clinical manifestations were hematuria and urination pain.Tumors were found in the bladder in 5 cases,in ureter in 2 cases and in urethra in 1 case.All the 8 cases accepted CT scan five of which had contrast enhanced CT scan.The imaging features were then analyzed.Results Of the IMT in bladder,CT scan showed a cauliflower like bladder tumor or round soft tissue mass with even or uneven density of 11.5-36.0 HU.Three tunors were accompanied with necrosis.Four cases had associated adjacent bladder wall thickening and two cases were found with fuzzy surrounding fat space.Ureteral lesions in two cases showed a solid mass with smooth edges and even density of 40.3 HU compared to the surrounding muscle.The urethral lesions had clear mass realm of 17.5-22.6 HU accompanied with calcification.Enhanced CT scan showed that homogeneous or heterogeneous mild to moderate enhancement was found in the tumor.Delayed phase showed consistant enhancement of 102.7-118.6 HU.Conclusion Tumor CT imaging features,particularly the significant and consistant enhancement in delayed phase,provide important information for diagnosis and differential diagnosis of the urinary tract IMT.

Image and pathology features of primary adrenal lymphoma / 中华泌尿外科杂志

Objective To evaluate the CT features of primary adrenal lymphoma and its relationship with pathology.Methods Pathologically proven primary adrenal lymphoma 6 cases were reviewed.There were 4 males and 2 females.The age was 18-62 years,average age was 51 years.5 cases was single tomur in unilateral,1 case was bilateral disease.The main clinical manifestations were abdominal pain,abdominal discomfort.All patients had CT scan and were treated surgically.Results CT scan showed the characters of adrenal little low-density soft tissue mass:the maximum diameter of 3-11 cm,irregularly shaped or ovalshaped,multi-state a clear,homogeneous or slightly inhomogeneous density,CT value was 30-40 HU.Lesions could be embedded or close to blood vessels and the ipsilateral kidney.The lesions were not enhanced arterial phase enhancement,CT value was 39-50 HU.The lesions showed vein phase of mild to moderate enhancement,CT value was 47-66 HU.At the delay of continuing to strengthen phase,CT value was 60-78 HU.The pathology charaters showed that:Diffuse of tumor cells under light microscope dense,more uniform size,and a large,granular chromatin,tumor stromal components was relatively small.There was no significant bleeding,necrosis and calcification.one lesion showed sheet,tumor cell necrosis.Conclusions CT scan characteristics and pathological features of primary adrenal lymphoma might have a certain correlation.