[The clinical predictors for the prognosis of patients with osteosarcoma].

Osteosarcoma is a kind of primary malignant tumor of bone originated from mesenchymal tissue, which mainly occurs in children and adolescents, and presents the characteristics of high malignancy, rapid growth, early metastasis and poor prognosis. Currently, most of the studies at home and abroad mainly focused on therapeutic procedures. However, reliable prediction indices or evaluation systems are also pivotal for monitoring disease change, guiding treatment and evaluating prognosis. Multiple clinical predictors have been reported to be related to the prognosis of osteosarcoma, which can be roughly divided into 9 categories according to their characteristics. Each kind of predictor owns its inherent advantage and disadvantage, and full understanding of them and their characteristics can be helpful to improve the prognosis of osteosarcoma.

[Clinicopathological characteristics and therapeutic effects of adult rhabdomyosarcoma patients].

Objective: This study aimed to investigate the clinicopathological characteristics and prognosis of adult rhabdomyosarcoma (RMS) patients. Methods: The clinical data of 34 adult RMS patients were retrospectively analyzed. Based on their intervention and treatment, patients were divided into operation group (n=7), chemotherapy group (n=8) and operation plus chemotherapy group (n=19). The clinical characteristics and treatment outcomes of the three groups were compared. Results: A statically significant difference was found in IRSG surgical-pathological stage among the three groups (P=0.026), while no significant difference existed in gender, age of disease onset, primary site, tumor size, pathological subtypes and IRSG risk group in the three groups (all P>0.05). In the operation group, three CR, one PR, one SD and two PD were achieved and one CR, one PR, one SD and five PD were obtained in the chemotherapy group. While in the chemotherapy plus operation group, four CR, twelve PR, one SD and two PD were achieved. A significant difference was found in response (P=0.043) and median overall survival (OS) (P=0.036) among the three groups, which were 44.7, 26.9 and 53.6 months, respectively. Conclusions: Pleomorphic RMS was the main histological subtype for adult RMS patients, and the prognosis for adult RMS was usually poorer than that for pediatric RMS patients. Single therapeutic approach could not achieve satisfactory outcomes, while multimodal treatment consisted of surgery, chemotherapy and radiotherapy are helpful to improve the prognosis of adult patients with RMS.

[Clinical efficacy and safety of apatinib combined with chemotherapy for osteosarcoma and soft tissue sarcoma with pulmonary metastasis].

Objective: To compare the clinical efficacy and drug safety between oral apatinib combined with conventional chemotherapy and conventional chemotherapy alone for the treatment of osteosarcoma and soft tissue sarcoma patients with pulmonary metastasis. Methods: Thirty-three osteosarcoma and soft tissue sarcoma patients with pulmonary metastasis who were treated in the Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University from January 2015 to December 2017 were enrolled in this study. Patients with osteosarcoma received methotrexate, adriamycin (ADM), cisplatin (CDDP), ifosfamide (IFO) sequential regimen; patients with soft tissue sarcoma were treated with IFO and ADM regimen. Eighteen of these patients received an additional oral dose of apatinib. The patients were followed up regularly for changes in primary tumors and metastases, adverse reactions and prognosis. Results: Before treatment, the maximum diameter of pulmonary metastases in patients of apatinib group and routine treatment group were (4.46±1.70) cm and (4.53±2.00) cm, respectively, without significant difference (P=0.909). After treatment, the maximum diameter of pulmonary metastases in patients of apatinib group was (1.46±1.39) cm, significantly smaller than (3.02±1.20) cm of routine treatment group (P=0.002). After treatment, the maximum diameter of the primary lesions in the apatinib group and the conventional treatment group median decreased 0.31 cm and 0.12 cm, respectively, without significant difference (P=0.542). After treatment, the maximum diameter of the lung metastases in the apatinib group median decreased 0.59 cm, significantly more than 0.18 cm of the conventional treatment group (P=0.027). The median progression-free survival (PFS) was 9.4 months in the 33 patients. The median PFS was 9.6 months and 8.3 months in the apatinib group and the conventional treatment group, respectively, without significant difference (P=0.593). Specific adverse reactions both occurred in apatinib group and routine treatment group, mainly including oral mucosal reactions and digestive tract reactions (including nausea, vomiting and diarrhea). Conclusions: Apatinib can effectively reduce the volume of primary and metastatic lesions in patients with bone and soft tissue sarcoma accompanied by lung metastasis without reducing the survival rate or causing uncontrollable adverse reactions. The safety and clinical efficacy of apatinib are significant.

Forensic Pathology Analysis of 363 Sudden Death Cases in Yunnan Province.

OBJECTIVES: To study the epidemiological and pathological features of sudden death （SD） in Yunnan Province and to provide scientific evidence for prevention and forensic identification of sudden death. METHODS: Totally 363 SD cases were collected from the autopsies between 2009 and 2017 in the Forensic Centre of Kunming Medical University. The related factors such as etiology, age, inducing factor, time interval between the onset of disease and death, morbidity season and pathological change were retrospectively analysed. RESULTS: The incidence of SD in males was significantly higher than that of females. The peak age was ≥35-55 years. The mortality rate was relatively high within 6 h after the onset of disease. The season order with descending number of deaths was spring, summer, winter and autumn. The top ten causes of SD were coronary heart disease, sudden unexplained death （SUD）, cerebral hemorrhage, acute hemorrhagic necrotic pancreatitis, aortic dissection rupture, cardiomyopathy, pneumonia, pulmonary thromboembolism, amniotic fluid embolism and allergy. Exercise, infusion, surgery, medication and minor injury were the most common predisposing factors of sudden coronary death. Consciousness disorder or coma, chest pain or chest tightness, and abdominal pain were the most common premortem symptoms of sudden coronary death. CONCLUSIONS: The SD is more common in middle-aged males, which is the key population for the prevention of SD. For the forensic identification and prevention of SD, the attention on SUD should be paid.

[Clinical and prognostic significance of ABO promotor methylation level in adult leukemia and myelodydysplastic syndrome].

Objective: To investigate the clinical and prognostic significance of ABO promotor methylation level in adult patients with leukemia and myelodydysplastic syndrome(MDS). Methods: ABO promoter methylation level of 182 malignant hematological disease patients and 68 normal controls were detected by bisulfite sequencing PCR.Then clinical features and outcome were compared between hypermethylation group and hypomethylation group. Results: The median methylation rate of ABO promoter in newly diagnosed acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) were 46.98% and 11.01% respectively, which were both higher than that in controls (2.30%, P<0.05). The methylation rates in remission AML and ALL were 1.58% and 2.30% respectively, which were comparable with that in normal group (P>0.05). As to relapse AML and ALL, methylation rates were 41.26% and 17.50% respectively, also significantly higher than that in controls (P<0.05).In patients with chronic myeloid leukemia (CML) chronic phase, the median methylation rate was 1.00%, which was similar to normal group. But a CML patient who transformed to ALL hadextremely high methylation rate 92.56%. The median methylation rate in patients with MDS significantly elevated as 5.81% compared with that in controls (P<0.05). The median overall survival (OS) of ALL and AML (non-M3) patients with hypermethylation were 12.5 months and 15.3 months, which were significantly shorter than those with hypomethylation (24.0 months and 20.0 months)(P<0.05).The median disease-free survival (DFS) of ALL and AML (non-M3) patients with hypermethylation were 9.9 months and 12.0 months, which were significantly shorter than those with hypomethylation (22.3 months and 18.5 months), (P<0.05). Multivariable analysis suggested that ABO promoter methylation level was an independent predictive factor of OS and DFS in ALL and AML (non-M(3)) patients. Conclusion: ABO promoter hypermethylation is closely related to genesis, development and prognosis of leukemia and MDS. Hypermethylationis related to a clinical poor prognosis compare with hypomethylation.

[Analysis of 124 Suicide Cases in Wuhua District in Kunming].

OBJECTIVES: To analyze the relationship between the suicide method and the sex, age, education background and cause of suicide to provide reference for the forensic identification of suicide. METHODS: After scene investigation, external body examination, autopsy and case investigation, 124 identified suicide cases which happened in recent three years in Wuhua district in Kunming were collected. Analytical methods as chi-square test and descriptive statistics were performed by SPSS 22.0. RESULTS: In all the suicide cases, male to female ratio was 1.53∶1. The suicide methods were mainly fatal fall, hanging and drowning. The ratio of local to non-native residents was 1∶1. The suicide rate in the people with primary school or junior middle school education level was highest. The group of >10-50 years tended to choose fatal fall suicide and people over 60 years were more likely to choose hanging. People with different academic background tended to choose fatal fall suicide. The suicide methods as fatal fall and hanging were chosen because of mental and physical diseases and economic problems, while the suicides with emotional problems were more likely to choose fatal fall and poisoning. CONCLUSIONS: Suicide belongs to a kind of complex cases. For the cases of suspected suicide, complete exploration and overall consideration should be done to determine the nature of cases based on comprehensive analysis of all the influence factors.

[Effects of DNA methylation on ABO gene expression in leukemia].

Objective: To investigate the impact of promoter CpG island methylation on ABO mRNA expression in leukemia. Methods: 25 cases of leukemia and 20 cases of normal control were studied, and the leukemia cell lines K562、HL-60 and Jurkat were treated with different concentrations of decitabine. PCR-SSP was used to identify ABO genotype, RQ-PCR for ABO mRNA expression and bisulfite sequencing PCR for DNA methylation status. Results: ① The methylation of ABO promoter in acute myeloid leukemia patients (10 cases) and acute lymphoblastic leukemia patients (10 cases) were 53.85% and 18.22% respectively, which were obviously higher than those in control (20 cases, 2.33%) and chronic myeloid leukemia patients (5 cases, 2.12% ). ② ABO genotype of K562 was O1O1, which has changed little before and after decitabine treatment. ABO genotype of HL-60 and Jurkat could not been identify before treatment, but showed as O1A1 and A1O2 after treatment. ③ABO mRNA expression of K562 was 1 275.67 ± 35.86, which was obviously higher than that in HL-60 (0.54 ± 0.07, P<0.05) and Jurkat (0.82±0.16, P<0.05). ④The methylation of ABO promoter in K562, HL-60 and Jurkat were 0, 58.14%, and 96.74%. As concentration of decitabine increased, the methylation of ABO promoter were decreased and the expressions of ABO mRNA were increased in HL-60 and Jurkat, which had significant differences compared with that before treatment (P<0.05). Conclusion: The methylation of ABO promoter shows a negative correlation with ABO mRNA expression. DNA methylation was an important aspect of ABO antigens decrease in acute leukemia.