CD7 expression and its prognostic significance in acute myeloid leukemia patients with wild-type or mutant CEBPA / 中华血液学杂志

Objective: To analyze the prognostic value of CD7 expression in newly diagnosed acute myeloid leukemia (AML) patients, and to further explore the correlation between CD7 expression and CEBPA mutation, and to clarify the prognostic value of CD7(+) in AML patients with wild-type (WT) or mutant-type (MT) CEBPA. Methods: The clinical data of 298 newly diagnosed non-M(3) AML patients between January 2010 and December 2016 were analyzed retrospectively. The clinical characteristics and prognosis of CD7(+) and CD7(-) patients were respectively compared in all patients, and in patients with WT and MT CEBPA. The relationship between CD7 expression and CEBPA mutation was determined by chi-square, and the effects of CEBPA mutation on survival and prognosis in CD7(+) group by Kaplan-Meier method. Results: In CD7(+) group, the frequencies of CEBPA mutation were 10.1% (single site) and 33.9% (double site) , significantly higher than those of the CD7(-) group (5.3% and 4.2%) (P=0.000) . Subgroup prognostic analysis showed a lower CR rate (P=0.001) and a higher RR (P=0.023) in CD7(+) group comparing to those of CD7(-) group in AML patients with wild type CEBPA. There were no statistical difference between CD7(+) group and CD7(-) group in overall survival (OS) and disease free survival (P>0.05) , while in the CEBPA mutant group the CD7(+) group has higher OS (P=0.019) and DFS (P=0.010) . Based on the CD7 expression and CEBPA mutation, 298 cases were divided into 3 subgroups, named as CD7(+)-CEBPA MT group, CD7(-) and CD7(+)-CEBPA WT group. The 3-year OS of the 3 groups were 80.2%, 48.0% and 30.6%, respectively (P<0.001) , and the 3-year DFS were 74.1%, 37.4% and 22.2%, respectively (P<0.001) . Conclusion: The CEBPA mutation rate was higher in CD7(+) AML patients then that of CD7(-) patients. CD7 expression has opposite prognostic significance in AML patients carrying the wild-type or mutant-type CEBPA. Based on CD7 expression and CEBPA mutation, a new risk stratification model can be established, which is helpful to guide the clinical individualized treatment for AML patients.

High expression of ENA-78 in lymphatic epithelial cells associated with cholangiocarcinoma promotes lymphangiogenesis / 医学研究生学报

ObjectiveLymphatic epithelial cells (LECs) are important links involved in lymphatic metastasis in the microenvironment of cholangiocarcinoma. This study aims to detect the modulation of inflammatory factors and chemokines secreted by LECs after stimulation of cholangiocarcinoma cells, and observe the effects of highly expressed factors on lymphangiogenesis.MethodsThe culture medium of cholangiocarcinoma (RBE, HCCC9810), LECs stimulated by cholangiocarcinoma cell culture medium (CCM), and normal LECs were prepared. Inflammatory factors and chemokines in the culture medium were detected using protein chip. The experiments are divided into the following groups, including a blank control group, CCM group, CCM coupled with Anti-ENA-78 group, Anti-ENA-78 group, ENA-78 group, ENA-78 coupled with SB2252002, and SB225002 group. The relationship between the content of factor and time was investigated using ELISA, while the relation between target factors and lymphangiogenesis obtained by cell proliferation and tubule formation assay.ResultsWe found ENA-78, IP-10, GCP-2, MCP-2, MCP-3, MIP-3a, HCC-1, and Lymphotactin expression increased in LECs supernatant after CCM stimulation. However, I-TAC, MIP-1d, IL-10, MIG, PDGF-BB, and CXCL16 factors showed down-regulation. The secretion of ENA-78 in CCM was relatively low. By ELISA, we found that the ENA-78 protein in RBE-LECs and HCCC9810-LECs gradually increased over time, and reached the plateau phase at the point of 48h. The lymphatic tube forming ability of LECs cultured in CCM was significantly increased compared with that of the control group, and this ability could be partially weakened by ENA-78 neutralizing antibodies. In the exogenous ENA-78 protein group, the lymphatic tube formation ability was as well significantly increased compared with that in the control group, and this ability could be effectively blocked by the IL-8B inhibitor.ConclusionThe increased secretion ENA-78 of lymphatic epithelial cells induced by cholangiocarcinoma may play a role in promoting lymphangiogenesis through the IL-8B receptor.

High expression of ENA-78 in lymphatic epithelial cells associated with cholangiocarcinoma promotes lymphangiogenesis / 医学研究生学报

ObjectiveLymphatic epithelial cells (LECs) are important links involved in lymphatic metastasis in the microenvironment of cholangiocarcinoma. This study aims to detect the modulation of inflammatory factors and chemokines secreted by LECs after stimulation of cholangiocarcinoma cells, and observe the effects of highly expressed factors on lymphangiogenesis.MethodsThe culture medium of cholangiocarcinoma (RBE, HCCC9810), LECs stimulated by cholangiocarcinoma cell culture medium (CCM), and normal LECs were prepared. Inflammatory factors and chemokines in the culture medium were detected using protein chip. The experiments are divided into the following groups, including a blank control group, CCM group, CCM coupled with Anti-ENA-78 group, Anti-ENA-78 group, ENA-78 group, ENA-78 coupled with SB2252002, and SB225002 group. The relationship between the content of factor and time was investigated using ELISA, while the relation between target factors and lymphangiogenesis obtained by cell proliferation and tubule formation assay.ResultsWe found ENA-78, IP-10, GCP-2, MCP-2, MCP-3, MIP-3a, HCC-1, and Lymphotactin expression increased in LECs supernatant after CCM stimulation. However, I-TAC, MIP-1d, IL-10, MIG, PDGF-BB, and CXCL16 factors showed down-regulation. The secretion of ENA-78 in CCM was relatively low. By ELISA, we found that the ENA-78 protein in RBE-LECs and HCCC9810-LECs gradually increased over time, and reached the plateau phase at the point of 48h. The lymphatic tube forming ability of LECs cultured in CCM was significantly increased compared with that of the control group, and this ability could be partially weakened by ENA-78 neutralizing antibodies. In the exogenous ENA-78 protein group, the lymphatic tube formation ability was as well significantly increased compared with that in the control group, and this ability could be effectively blocked by the IL-8B inhibitor.ConclusionThe increased secretion ENA-78 of lymphatic epithelial cells induced by cholangiocarcinoma may play a role in promoting lymphangiogenesis through the IL-8B receptor.

Application of percutaneous vertebroplasty with the second injection for poor dispersion bone cement of Kümmel disease / 中国骨伤

OBJECTIVE@#To investigate clinical effect of percutaneous vertebroplasty with second injection for poor dispersion bone cement of Kümmel disease.@*METHODS@#Eighty-eight patients with Kümmel disease were treated with vertebroplasty from February 2014 to December 2017, and 16 patients were found cement dispersion unsatisfactory during initial cement injection and were undertaken second cement injection during operation. Among patients, there were 1 male and 15 females aged from 63 to 82 years old with an average age of 72.7 years old. Distribution of fractured vertebrae were followed: 1 patient was on T₁₀, 1 patient was on T₁₁, 3 patients were on T₁₂, 8 patients were on L₁, 1 patient was on L₂, and 2 patients were on L₃. VAS and ODI score were compared before operation, 2 days after operation and the latest following-up, anterior vertebral height and local kyphosis angle of fractured vertebrae with intravertebral cleft were also observed. Postoperative complication was recorded.@*RESULTS@#All patients were followed up from 5 to 22 months with average of 14.1 months. ODI score before operation, 2 days after operation and the latest following-up were 72.3±12.1, 56.8±5.0 and 12.1±5.3 respectively; VAS score before operation, 2 days after operation and the latest following-up were 7.8±0.6, 3.0±0.4 and 2.4±0.7, respectively; ODI score at 2 days was improved compared with before operation, while ODI and VAS score at the latest following-up was improved than that of 2 days after operation. Vertebral anterior compression rate and Cobb angle of the fractured vertebrae with intravertebral cleft were respectively corrected from (37.8±5.4)% and (15.1±2.0)°preoperative, to (4.7±1.4)% and (4.4±2.2)° at 2 days after operation, (4.9±1.5)% and (4.8±2.4)° at the latest following-up, there was significant difference between before operation and 2 days after operation, while there was no difference between 2 days after operation and the latest following-up. Three patients occurred cement leakage without pulmonary embolism and neurological impairment. Four patients occurred adjacent vertebrae fracture. There was no incidence of recollapsed vertebrae during follow-up period.@*CONCLUSIONS@#Percutaneous vertebroplasty for Kümmel disease could receive satisfactory clinical results when cement dispersion was inadequate during initial cement injection by the second injection, and effectively prevent occurrence of vertebral re-collapse.

Recent application and outlooks of fluorescent diagnostic techniques in clinic / 医疗卫生装备

Current problems and demands of intraoperative diagnosis were presented. Basic theories and classification of fluorescent diagnostic techniques were introduced, and the advantages compared with traditional pathology were also analyzed.Current research and application status of fluorescent diagnostic techniques were summarized and analyzed in two aspects:spectroscopy analysis and image analysis,and it was indicated that fluorescent diagnosis was important for research and clinical application.Furthermore,future development directions of fluorescent diagnostic techniques were analyzed,and improving accuracy and combining diagnosis with clinical treatment were growing trends in fluorescent diagnostic techniques.

Application and outlooks of new minimally-invasive techniques in fetal surgery / 医疗卫生装备

Development and current problems of fetal surgery were introduced. Application and research frontiers of new minimally-invasive techniques were elaborated from the aspects of intraoperative imaging diagnosis and navigation, new-type minimally-invasive instrument,energy therapy and robot technique for diagnosis and treatment.Current bottlenecks and future outlooks of new minimally-invasive techniques in fetal surgery were analyzed. Great clinical potential of new minimally-invasive techniques in fetal surgery was stated.It's pointed out that how to integrate diagnosis and therapy and apply them to real clinical treatment would be the focus of future research.

Intelligent analysis technique of medical imaging assisted accurate diagnosis and treatment for neurosurgery / 医疗卫生装备

The difficulties of clinical diagnosis and treatment in neurosurgery were introduced in brief.The application and important meaning of the deep learning technology, multimodal fusion technology and image guidance techniques in the diagnosis and treatment of neurosurgery were elaborated.In addition,the development and challenges of precise diagnosis and treatment in neurosurgery were discussed.It's pointed out continuous progress of intelligent analysis of medical images would help achieve accurate diagnosis and treatment for neurosurgery, thus reduce the occurrence of misdiagnosis and improve the success rate of operation. Furthermore, it would promote the intelligent development of clinical diagnosis and treatment in neurosurgery.

Unilateral Wiltse intermuscular approach and contralateral decompression for the treatment of thoracolumbar burst fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects and multifidus muscle injury of different approaches, including unilateral Wiltse intermuscular approach and intramuscular approach combined with contralateral decompression, in treating thoracolumbar burst fracture.</p><p><b>METHODS</b>Forty-three patients with thoracolumbar burst fracture were enrolled in the study from January 2010 to December 2014, including 29 males and 14 females with an average age of 42.3 years old(ranged from 21 to 64 years old). The patients were treated with posterior pedicle screw fixation and unilateral decompression and were divided into Wiltse intermuscular approach group (group A) and intramuscular approach group (group B) according to surgical approach. Operation time and intraoperative bleeding were recorded for all patients; visual analogue scale(VAS) was compared 1 d preoperatively, 1 week, 12 months postoperatively between two groups; preoperation and 12 months postoperatively, the fractured vertebral canal and two-sides multifidus muscle of the same section were observed and compared by CT measure between two groups.</p><p><b>RESULTS</b>All the patients were follow-up for 14 to 21 months with an average of 16.3 months. Partial wound non-healing occurred in 3 patients and the wound ultimately healing after debridgement suture and change dressings. No screw breakage was found. There was significant difference in operation and intraoperative bleeding operation between two groups (<0.05), while there was no significant difference in VAS score of 1 d preoperatively, 1 week, 12 months postoperatively between two groups(>0.05). As for CT measurement results, postoperative vertebral canal narrow ratio was significant decreased in all patients(<0.05), while perioperative changes of the two-sides multifidus muscle cross section area and density were significant in group A (<0.05), but there was no significant difference in group B (>0.05). Neurologic status of all patients got recovery at final follow-up.</p><p><b>CONCLUSIONS</b>The method of unilateral Wiltse intermuscular approach combined with contralateral decompression for the treatment of thoracolumbar burst fracture has good clinical effects, also it is less invasive and less damage to multifidus muscle compared with intramuscular approach.</p>

Outcomes and related factors of C₅ nerve root palsy after cervical posterior single open-door laminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical outcomes and related factors of C₅ palsy following cervical laminectomy in treating multi-segments cervical spondylotic myelopathy.</p><p><b>METHODS</b>From January 2010 to June 2014, 80 patients with spondylotic myelopathy underwent C₃-C₆ open-door laminoplasty(group A) and 80 patients C₄-C₆ open-door laminoplasty (group B). The mean age was (68.4±9.2) years (44 males and 36 females) in group A and the mean age was (66.8±8.9) years (48 males and 32 females) in group B. Japanese Orthopaedic Association(JOA) score, Visual Analogue Score, incidence of C₅ palsy, time of onset, grade of muscle weakness, other accompanying cervical nerve root palsies, recovery time were used to evaluate clinical effects before operation and at last follow-up. Radiographically, changes of Cobb angle of sagittal plane from C₂-C₇, cervical range of motion, minimal spinal cord diameter on MRI were analyzed before operation and at last follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 6 to 15 months with an average of (12.4±3.2) months. No obvious differences were observed between change of VAS of cervical and upper limb, JOA, Cobb angle, cervical range of motion, minimal spinal cord diameter on MRI. C₅ nerve root palsy occurred in 7 cases (8.75%) in group A, including 4 cases of upper limb pain, 3 cases of upper limb pain, and 2 cases of residual upper limb pain and sensory loss at the last follow-up. C₅ nerve root palsy occurred in 5 cases (7.5%) in group B, 3 cases of upper limb pain, 2 cases of upper limb sensory loss, and all patients recovered normal radiation pain and sensory loss at the last follow-up. There was no significant difference in the incidence of C₅ nerve root palsy between the two groups. C₅ nerve root palsy, deltoid muscle, accompanied by neurological symptoms, recovery time were(2.3±1.0) N, 30 cases (37.5%), (11.4±1.0) weeks in group A, (2.8±0.8) N, 23 cases (28.8%), (8.2±0.8) weeks in group B, there was no significant difference on deltoid muscle decreased between the two groups, accompanied by neurological symptoms and the recovery time in group A was worse than the group B.</p><p><b>CONCLUSIONS</b>Comparison of the two kinds of operation, the probability of postoperative C₅ nerve root palsy was equal, but the C₅ nerve root palsy in patients with C₄-C₆ open-door laminoplasty showed lighter symptom and faster recovery.</p>