[Comparison of EB virus infection between short term and long term use of mycophenolate mofetil for prophylaxis of graft versus host disease after haploidentical hematopoietic stem cell transplantation]

Objective: To investigate the role of short-term use of mycophenolate mofetil (MMF) in EB viral infection and acute graft-versus host disease (GVHD) in patients receiving haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Method: Adult patients (≥14 years) who were diagnosed with hematological malignancies received haplo-HSCT in Peking University Institute of Hematology from May 2016 to December 2017 were retrospectively reviewed. The median age was 30 (14-60) years old. A total of 498 patients including 277 males and 221 females were enrolled. Donors' median age was 38 (8-66) years old. All patients were classified into long-term use of MMF (n=199), which was defined as 500 mg every 12 hours from day 9 pre-transplant to 250 mg every 12 hours from day 30 after transplant then withdrawal on day 45 to 60 after transplant, and short-term use of MMF (n=299), which was defined as 500 mg every 12 hour from day 9 pre-transplant then withdrawal till neutrophil engraftment. Kaplan-Meier model was used to analyze the cumulative incidence of EBV infection, and the Cox proportional regression model for multivariate analysis. Result: Characteristics including sex, age, disease types, mismatched HLA loci, donor-recipient relationship, donor-recipient blood type, donor age, and donor sex were comparable between two groups (all P＞0.05). According to once, the incidence of EBV viremia, defined as EBV＞10³ copies/ml at least once, in short-term group and long-term group was 19.4% (58/299) and 27.6% (55/199) respectively (P=0.046).Donor age and the duration of MMF prophylaxis (short-term group as reference) were associated with EBV viremia according to multivariate analysis [HR=1.022(95%CI 1.006-1.038),1.600(95%CI 1.059-2.418);P=0.006 and 0.026, respectively]. The incidence of grade Ⅱ-Ⅳ and Ⅲ/Ⅳ acute GVHD in long-term and short-term group was 32.2% (64/199) versus 20.7% (62/299)(P=0.005) and 10.1% (20/199) versus 8.0% (24/299) (P=0.427), respectively. Donor sex (female as reference) and duration of MMF prophylaxis (short-term group as reference) were associated with grade Ⅱ-Ⅳ acute GVHD [HR=1.908(95%CI 1.079-3.373),1.752(95%CI 1.161-2.643);P=0.026 and 0.008, respectively].There were no statistical differences in the incidence of CMV viremia, refractory CMV viremia and hemorrhagic cystitis (all P＞0.05) between the two groups. Conclusion: Short-term use of MMF can reduce EBV viremia without increasing the development of acute GVHD in haplo-HSCT patients.

Novel mechanism of hepatobiliary system damage and immunoglobulin G4 elevation caused by Clonorchis sinensis infection

Clonorchis sinensis infection is still a major public health problem. It is estimated that more than 15 million people worldwide are infected, especially in Northeast China, Taiwan, South Korea, and North Vietnam. The detection of Clonorchis sinensis eggs in feces and bile is still the only gold standard for the diagnosis of Clonorchis sinensis infection, and new detection methods are needed to improve the detection rate. After Clonorchis sinensis invades the human body, it mainly parasitizes the hepatobiliary tract. Therefore, it is closely related to hepatobiliary diseases such as cholangitis, bile duct stones, liver fibrosis, and cholangiocarcinoma. The increase in immunoglobulin G4 (IgG4) caused by Clonorchis sinensis infection is rare and there are few reports about the relevant mechanism. It may be related to the inflammatory factors interleukin (IL)-4, IL-10, and IL-13 produced by human phagocytes, T cells, B cells, and other immune cells in the process of resisting the invasion of Clonorchis sinensis. However, this finding still needs further clarification and confirmation. This article reviews the epidemiology, clinical manifestations, serology, imaging, pathogenic mechanism, and control measures of Clonorchis sinensis infection to help establish the diagnostic process for Clonorchis sinensis. We report novel mechanisms of IgG4 elevation due to Clonorchis sinensis infection to provide more experience and a theoretical basis for clinical diagnosis and treatment of this infection.

[Research progress in signal molecules and transcription factors related to the development of temporomandibular joint in embryonic stage]

Temporomandibular joint (TMJ) is a unique synovial joint in mammals. There have been many reports on the structure and function of TMJ during embryonic development.Although studies on TMJ related signal molecules and transcription factors during embryonic development have been carried out since the last century, there are few reports on the molecular genetic regulation of TMJ compared with the abundant molecular regulation information of synovial joint. The studies on signal molecules and transcription factors of TMJ embryonic development were mainly conducted in rodents.There were few studies on the regulatory molecules and their regulatory mechanisms related to the development of TMJ conducted in large mammals and human embryos. This article reviews the research progress of key signal molecules and transcription factors of TMJ in embryonic development on the basis of modern molecular biology technology in order to find more core regulatory molecules and understand their regulation mechanism on TMJ development.

[Beneficial effects and related mechanism of hawthorn leaves flavonoids on cardiac function in rats with acute myocardial infarction]

Objective: To explore the effect and related regulatory mechanism of hawthorn leaf flavonoids (FHL) on cardiac function in rats with acute myocardial infarction (AMI). Methods: Sixty SPF male Sprague-Dawley rats (9-week-old, weighing 300-350 g) were used in this study. Ten rats were assigned to sham operation group, and the remaining 50 rats were used to establish the AMI model with coronary artery ligation method, AMI was successfully established in 36 rats. AMI rats were randomly divided into AMI group and FHL low-, medium-, and high-dose groups (n=9 for each group). Rats received intraperitoneal injection (10 ml·kg-1·day-1) with physiological saline and FHL solution with concentrations of 0.3, 0.6, and 1.2 mg/ml, respectively for 4 consecutive weeks. Echocardiography was performed at the end of experiments. Left ventricular end diastolic diameter (LVEDD), left ventricular end diastolic anterior wall thickness (LAWD), left ventricular ejection fraction (LVEF) and left ventricular end diastolic pressure (LVEDP) were measured. Then the rats were sacrificed under deep anesthesia, and the left ventricular anterior wall tissue was used for pathological examinations by hematoxylin-eosin (HE) staining. Other myocardial tissue was used for in situ terminal transferase labeling (TUNEL) staining, and the apoptosis rate of cardiomyocytes was calculated. The myocardial cell apoptosis rate, the mRNA, and protein expressions of phosphatidylinositol 3β-kinase (PI3K), protein kinase B (Akt), glycogen synthetase kinase-3 (GSK3β), cyclin D1 and the protein expressions of p-Akt and p-GSK3β were detected by real-time fluorescent quantitative PCR (RT-qPCR) and Western blot respectively. Results: Compared with sham operation group, the LVEDD and LVEDP of the rats in AMI group and FHL low-, medium-and high-dose groups were increased, and the LAWD and LVEF were reduced (all P<0.05). Compared with AMI group, LVEDD and LVEDP were reduced, and LAWD and LVEF were increased in FHL low-, medium-and high-dose groups (all P<0.05). LVEDD and LVEDP decreased, and LAWD and LVEF increased in proportion to the increase of FHL dose (all P<0.05). LVEDD and LAWD values were similar between FHL low-dose and medium-dose groups (both P>0.05). HE staining results evidenced necrotic myocardial tissue, together with disordered arrangement of myocardial fibers, and a large number of inflammatory cells infiltrated in the myocardial tissue in AMI group. The myocardial damage of rats in FHL low-, medium-, and high-dose groups was less than that of AMI group. The myocardial fibers were arranged neatly, but there were still partial breaks and a small amount of inflammatory cell infiltration in the myocardial tissue and there were scattered islands of normal myocardial tissue in the infarct area of these groups. Among them, myocardial damage was the least in FHL high-dose group. The results of TUNEL staining showed that compared with AMI group, the apoptosis rate of myocardial cells was significantly reduced in FHL low-, medium-, and high-dose groups (all P<0.001), but was still higher than that in sham operation group (all P<0.001). Myocardial cell apoptosis rate decreased in proportion with increasing FHL dose (P<0.05). The RT-qPCR results showed that compared with AMI group, the expression levels of PI3K and cyclin D1 mRNA were significantly upregulated in the myocardial tissue of rats in FHL low-, medium-, and high-dose groups, but still lower than those in sham operation group (all P<0.05), and PI3K and cyclin D1 mRNA expression levels increased with the increase dose of FHL (P<0.05). Western blot results showed that compared with AMI group, the expression levels of PI3K, p-Akt, p-GSK3β, and cyclin D1 were significantly upregulated in the myocardial tissue of rats in FHL low-, medium-, and high-dose groups, but still lower than those in sham operation group (all P<0.05), and the protein expression levels of PI3K, p-Akt, p-GSK3β, and cyclin D1 increased in proportion with the increase dose of FHL (all P<0.05). Conclusion: FHL can effectively improve cardiac function in rats with AMI, and the beneficial effects may be partly mediated through activating PI3K/GSK3β/cyclin D1 signaling pathway.

[Preliminary study on the etiological characteristics and clinical treatment of medication-related osteonecrosis of the jaws]

Objective: To summarize the etiological characteristics and clinical treatment effects of 17 patients with medication-related osteonecrosis of the jaw (MRONJ). Methods: The clinical data of 17 patients with MRONJ admitted to the Department of Oral and Maxillofacial Surgery, the First People's Hospital of Jinzhong, Shanxi Province, from July 2016 to December 2019 were retrospectively analyzed, including 9 males and 8 females, aged (63.6±9.6) years old (43-82 years old). Descriptive analysis of the primary disease, onset factors, site of disease, clinical manifestations, treatment methods, and treatment effects was conducted through follow-up for at least 1 year. Results: Among the primary diseases of the 17 cases, 12 were malignant tumors, and 5 were osteoporosis. There were 13 cases with a history of a trigger event (tooth extraction or unsuited removable denture). Six cases occurred in the maxilla, 10 cases occurred in the mandible, and 1 case involved both the upper and lower jaws. For the most common medication used, bisphosphonate was used in 16 cases including 5 cases with concomitant use of angiogenesis-inhibiting drugs. There was 1 case resulted from receptor activator of NF-κB ligand (RANKL) monoclonal antibody application. The duration of medication application was (10.1±3.9) months (3-18 months). All 17 cases were treated surgically. Totally 15 patients healed well after surgical treatment and the other 2 patients, who had poor soft tissue healing after surgery, healed well after a second operation. Conclusions: Tooth extraction might be a major trigger factor for the onset of MRONJ in the mandible. The disease was more possibly occured in the mandible than in the maxilla. Appropriate surgical treatment could achieve a good clinical outcome.

[Negative effects of donor specific anti-HLA antibody on poor hematopoietic recovery in patients with hematological diseases receiving haploidentical stem cell transplantation and rituximab for desensitization]

Objective: To investigate the incidences and risk factors of poor hematopoietic reconstitution (PHR) in patients with hematological diseases who underwent haploidentical allograft and were treated with rituximab for desensitization. Methods: Eight-three donor specific anti-HLA antibody (DSA, 2000 ≤MFI<10 000) positive patients who underwent haploidentical allograft were prospectively enrolled. Rituximab (375 mg/m²) was used for desensitization day-3 of conditioning regimen. Incidence and factors associated with PHR, including primary poor graft function and prolonged thrombocytopenia, were investigated. Results: There were 22 males and 61 females with a median age of 39(range: 1-65) years. Kaplan-Meier analysis showed that the 100 day cumulative incidences of neutrophil and platelet engraftment were 93.0% and 90.7%, respectively. The incidences of PHR were 14.7%. The 3-year relapse rate, non-relapse mortality (NRM) rate, event-free survival (EFS), leukemia-free survival (DFS) and overall survival (OS) were 6.5%, 15.1%, 70.8%, 79.4% and 79.4%, respectively. Patients with DSA MFI<5 000 (group A, n=46) experienced lower PHR (4.4% vs. 27.5%, P=0.003), and higher 3-year EFS (79.5% vs. 59.8%, P=0.020) compared to those with DSA MFI≥5 000 (group B, n=37). Multivariate analysis showed that DSA MFI≥5 000 was correlated with PHR (HR=6.101, P=0.021). PHR was associated with higher NRM (HR=4.110, P=0.026), lower DFS (HR=3.656, P=0.019) and OS (HR=3.656, P=0.019). Conclusion: Our data suggest that high pre-transplant DSA level is a risk factor for PHR in patients with hematological diseases receiving haploidentical allograft and rituximab for desensitization.

[Effect analysis of sequential laser application in treating the hypertrophic scars of burn children at early stage]

Objective: To explore the effects of sequential application of intensive pulsed light and carbon dioxide laser in treating the hypertrophic scars of burn children at early stage. Methods: A retrospective cohort before-after control study in the same patients was conducted. From January 2016 to December 2018, 145 burn children with hypertrophic scar at the early stage who met the inclusion criteria were admitted to the First Hospital of Jilin University, including 82 males and 63 females, aged 1 to 12 (3 (2, 6)) years. All the children were firstly treated with intense pulsed light therapy (no anesthesia or intravenous-inhalation combined anesthesia) at an interval of once per month, and then changed to carbon dioxide laser therapy (topical anesthesia or intravenous-inhalation combined anesthesia) when the degree of scar hyperemia was reduced, at an interval of once every 3 months, for a total of 3 times. Before the first intense pulsed light treatment (hereinafter referred to as before the first treatment) and 3 months after the last carbon dioxide laser treatment (hereinafter referred to as after the last treatment), scar scoring was evaluated by Vancouver Scar Scale (VSS), and scar hyperemia (denoted as hemoglobin level) was measured with Antera 3D^® camera. The times of intense pulsed light, the time of single treatment, the anesthesia method, and the time of intravenous-inhalation combined anesthesia of intense pulsed light and carbon dioxide laser treatment were analyzed. After the last treatment, Likert Scale was used to evaluate the efficacy satisfaction of both doctors and patients. Adverse reactions were recorded during the treatment. Data were statistically analyzed with Wilcoxon signed rank sum test, and paired sample t test. Results: The color, vascular distribution, thickness, and softness scores, and total score in VSS scoring of scars of children after the last treatment were significantly lower than those before the first treatment (Z=-6.05, -10.34, -9.84, -9.28, -10.43, P<0.01). The hemoglobin level of scar of children after the last treatment was 1.86±0.24, significantly lower than 2.27±0.32 before the first treatment (t=17.65, P<0.01). A total of 411 times of intense pulsed light therapy were performed, (2.8±0.6) times per person, and the single treatment time was 35 (20, 45) s. There were 392 times (95.38%) without anesthesia, and 19 times (4.62%) with intravenous-inhalation combined anesthesia with time of 6 (5, 8) min. The single treatment time of carbon dioxide laser therapy was 5 (3, 10) min. There were 364 times (83.68%) of topical anesthesia and 71 times (16.32%) of intravenous-inhalation combined anesthesia with time of 10 (8, 15) min. After the last treatment, the efficacy satisfaction scores of doctors and patients were (4.3±0.7) and (3.8±1.0) points, respectively. Blisters occurred in 5 cases after intense pulsed light treatment, which were healed naturally after drainage. One child developed local skin infection, skin redness and swelling accompanied by purulent exudate after carbon dioxide laser treatment, which was improved after skin disinfection and external use of mupirocin ointment. No inflammatory pigmentation, worsening of hyperplasia of scar, erythema, or other skin adverse reactions or anesthetics-related adverse reactions occurred in any child. Conclusions: Sequential application of intense pulsed light and carbon dioxide laser to treat the hypertrophic scars of burn children at early stage can obviously improve the appearance and texture of scar, with higher satisfaction of doctors and patients and fewer adverse reactions.

[The effect of donor cytomegalovirus serological status on the outcome of allogeneic stem cell transplantation]

Objective: Donor cytomegalovirus (CMV) serological negative status may have an adverse effect on the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT), while there is inadequate data for Chinese people. This study is to explore the impact of donor CMV serological status on the outcome of CMV seropositive patients receiving allo-HSCT. Methods: Our study retrospectively analyzed 16 CMV seropositive patients with hematological malignancies receiving allogeneic grafts from CMV seronegative donors (antibody IgG negative) at Peking University People's Hospital from March 2013 to March 2020, which was defined as D^-/R⁺ group. The other 64 CMV seropositive patients receiving grafts from CMV seropositive donors at the same period of time were selected as matched controls through a propensity score with 1∶4 depending on age, disease state and donor-recipient relationship (D⁺/R⁺ group). Results: Patients in D^-/R⁺ group developed CMV DNAemia later than patients in the D⁺/R⁺ group (+37 days vs. +31 days after allo-HSCT, P=0.011), but the duration of CMV DNAemia in D^-/R⁺ group was longer than that of D⁺/R⁺ group (99 days vs. 34 days, P=0.012). The rate of CMV reactivation 4 times or more in D^-/R⁺ group was 4/16, significantly higher than that of D⁺/R⁺ group (4.7%, 3/64, P=0.01). The incidences of refractory CMV DNAemia (14/16 vs. 56.3%, P=0.021) and CMV disease (4/16 vs. 4.7%, P=0.01) in D^-/R⁺ group were both higher than those in D⁺/R⁺ group. In addition, the application of CMV-CTL as the second-line antiviral treatment in D^-/R⁺ group was more than that in D⁺/R⁺ group. Univariate analysis and multivariate analysis suggested that CMV serological negativity is an independent risk factor for refractory CMV DNAemia and the duration of CMV infection. The cumulative incidence of aGVHDⅡ-Ⅳ, cGVHD, 3-year probability of NRM, overall survival, and the cumulative incidence of relapse were all comparable in two groups. Conclusions: Although there is no significant effect on OS and NRM, the incidence of refractory CMV DNAemia, the frequency of virus reactivation, and the development of CMV disease in D^-/R⁺ group are higher than those in controls. Therefore, CMV seropositive donors are preferred for CMV seropositive patients.

[Comparison of prognostic significance between multiparameter flow cytometry and real-time quantitative polymerase chain reaction in the detection of minimal residual disease of Philadelphia chromosome-positive acute B lymphocytic leukemia before allogeneic hematopoietic stem cell transplantation]

目的

探讨多参数流式细胞术（MFC）与实时定量聚合酶链反应技术（RQ-PCR）两种方法检测费城染色体阳性（Ph⁺）急性B淋巴细胞白血病（B-ALL）患者异基因造血干细胞移植（allo-HSCT）前微小残留病（MRD）的预后意义。

方法

回顾性分析2014年7月至2018年2月在北京大学血液病研究所接受allo-HSCT的280例Ph⁺ B-ALL患者，同时用MFC和RQ-PCR法（检测BCR-ABL融合基因表达）检测移植前MRD。

结果

RQ-PCR与MFC检测MRD具有相关性（rs＝0.435，P<0.001）。MFC、RQ-PCR法检测移植前MRD的阳性率分别为25.7％（72/280）、60.7％（170/280）。移植前MFC-MRD阳性组患者移植后白血病3年累积复发率（CIR）明显高于MFC-MRD阴性组（23.6％对8.6％，P<0.001）。RQ-PCR检测BCR/ABL融合基因阳性组（RQ-PCR MRD阳性组）的3年CIR、非复发死亡（NRM）、无白血病生存（LFS）、总生存（OS）与BCR/ABL融合基因阴性组（RQ-PCR MRD阴性组）相比差异均无统计学意义（P>0.05）。移植前RQ-PCR MRD≥1％组比<1％组具有更高的3年CIR（23.1％对11.4％，P＝0.032）、更低的LFS率（53.8％对74.4％，P＝0.015）与OS率（57.7％对79.1％，P＝0.009）。多因素分析显示，移植前MFC-MRD阳性是影响移植后CIR的危险因素（HR＝2.488，95％CI1.216～5.088，P＝0.013），移植前RQ-PCR MRD≥1％是影响LFS（HR＝2.272，95％CI 1.225～4.215，P<0.001）、OS（HR＝2.472，95％ CI 1.289～4.739，P＝0.006）的危险因素。MFC检测MRD预测复发的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）分别为48.50％、77.56％、23.62％、87.16％。以RQ-PCR MRD≥1％预测复发的敏感性、特异性、PPV、NPV分别为23.00％、88.59％、17.15％、91.84％。移植前MFC-MRD阳性或RQ-PCR MRD≥1％二者任一成立为指标预测移植后复发的敏感性、特异性、PPV、NPV分别为54.29％、73.88％、45.70％、91.87％。

结论

MFC和RQ-PCR法检测移植前MRD水平均可预测Ph⁺ B-ALL患者移植预后。移植前MFC-MRD阳性是移植后复发的危险因素。联合使用两种方法（移植前MFC-MRD阳性状态或RQ-PCR MRD≥1％成立）可提高预测移植后复发的敏感性、阳性预测值与阴性预测值，有助于更好筛选出高危患者。

[Preliminary study on the protective effect of glycosyltransferase Colgalt2 gene deletion on acetaminophen-induced liver injury]

Objective: To investigate the protective effect of Colgalt2 gene deletion on acute liver injury induced by acetaminophen (APAP) in mice. Methods: Colgalt2(+/+) wild-type control mice and Colgalt2(-/-) mice (all C57BL/6J strains) were selected as the research subject. APAP solution was injected intraperitoneally to establish a mouse model of acute liver injury. The mouse were divided into four groups: Colgalt2(+/+) wild-type control group, Colgalt2(+/+) wild-type drug group (APAP 500 mg/kg), Colgalt2(-/-) control group, and Colgalt2(-/-) drug group (APAP 500 mg/kg). The survival rate was measured to plot survival curve. Liver function was evaluated by detecting serum ALT and AST levels. Liver histopathological changes were observed by HE staining to evaluate the condition of liver injury. Western blot was used to detect protein c-Jun N-terminal kinase (JNK)-related liver injury. Results: Compared with Colgalt2(+/+) mice, the survival rate was significantly increased after giving APAP to Colgalt2(-/-) mice (86.7% vs. 40%), and liver cell necrosis and inflammatory cell infiltrates of Colgalt2(+/+) mice were milder. Serum ALT, and AST level was significantly decreased [ALT: (5 291.9 ± 1 016.34) U/L vs. (1 616.9 ± 330.65) U/L, P = 0.000; AST: (4 978.0 ± 1 028.43) U/L vs. (1 851.0 ± 437.55) U/L, P = 0.000]. The expression level of JNK was significantly decreased in liver tissue. Conclusion: Colgalt2 gene deletion has a protective effect on acute liver injury induced by acetaminophen (APAP) in mice. Therefore, Colgalt2 may be a potential therapeutic option for acetaminophen-induced hepatotoxicity.

[Integrated management and prognosis analysis of fetus with complete transposition of the great arteries during pregnancy and perinatal period]

Objective: To investigate the prenatal diagnosis, integrated management and prognosis of fetal complete transposition of the great arteries (D-TGA) detected by ultrasonography. Methods: The prenatal diagnosis, integrated management and prognosis of 19 D-TGA fetuses found by ultrasound during pregnancy in Peking University People's Hospital from January 2014 to June 2019 were analyzed retrospectively. Results: The incidence of D-TGA was 0.12% (19/16 028) among fetuses diagnosed by ultrasound during 5 years. Among the 19 cases, there were 7 cases (7/19) of D-TGA alone, 7 cases (7/19) of D-TGA combined with ventricular septal defect (VSD), 5 cases (5/19) of D-TGA combined with other cardiac malformations; 2 cases (2/19) of D-TGA combined with extra cardiac malformations, and 1 case (1/19) of fetal growth restriction. Nuchal translucency (NT) thickening was found in 3 cases (3/19) at the first trimester of pregnancy. Among the 19 D-TGA fetuses found by ultrasound examination, 18 (18/19) had chromosome karyotype analysis of fetuses or newborns, and chromosomal abnormalities were found in 2 cases, all of which were terminated in the second trimester of pregnancy. The integrated management and multidisciplinary diagnosis and treatment of D-TGA fetuses during pregnancy and perinatal period were carried out. Nine cases (9/19) had induction in the second trimester of pregnancy, 10 cases (10/19) were delivered at term, and the gestational week of delivery was (38.3±0.7) weeks, among which 6 cases (6/10) were delivered by caesarean section due to obstetric factors, and 4 cases (4/10) were delivered by vaginal birth. The oxygen saturation was (69.2±11.3)% at birth and (77.8±6.7)% when transferred to the department of pediatrics. Except for one case lost to follow-up, the other 9 newborns received operation. The average operation time was (21.8±22.1) days after birth, 8 cases (8/9) completed one operation and 1 case (1/9) performed two operations. All of the 9 cases treated by surgery were followed up well. Conclusions: Prenatal diagnosis, individualized evaluation and integrated management during pregnancy and perinatal period should be carried out for the patients with fetal D-TGA detected by ultrasound. Fetal D-TGA is not an indication of cesarean section. The open of ductus arteriosus can be maintained with drugs when necessary after birth, and a good prognosis could be obtained through surgery.

Feasibility of the application of mixed reality in mandible reconstruction with fibula flap: A cadaveric specimen study

BACKGROUND

In recent years, a new technology, mixed reality (MR), has emerged and surpassed the limitations of augmented reality (AR) with its inability to interact with hologram. This study aimed to investigate the feasibility of the application of MR in mandible reconstruction with fibula flap.

METHODS

Computed tomography (CT) examination was performed for one cadaveric mandible and ten fibula bones. Using professional software Proplan CMF 3.0 (Materialize, Leuven, Belgium), we created a defected mandibular model and simulated the reconstruction design with these 10 fibula bones. The surgical plans were transferred to the HoloLens. We used HoloLens to guide the osteotomy and shaping of the fibular bone. After fixing the fibular segments using the Ti template, all segments underwent a CT examination. Before and after objects were compared for measurements of the location of fibular osteotomies, angular deviation of fibular segments, and intergonial angle distances.

RESULTS

The mean location of the fibular osteotomies, angular deviation of the fibular segments, and intergonial angle distances were 2.11 ± 1.31 mm, 2.85°± 1.97°, and 7.24 ± 3.42 mm, respectively.

CONCLUSION

The experimental results revealed that slight deviations remained in the accuracy of fibular osteotomy. With the further development of technology, it has the potential to improve the efficiency and precision of the reconstructive surgery.

[Effects of direct antiviral agent on the frequency of peripheral blood mononuclear cells and their activating factors sCD14s and CD163 in patients with chronic hepatitis C]

Objective: To explore the effects of direct antiviral agent (DAAs) on the frequency of peripheral blood mononuclear cells and their activating factors sCD14s and CD163 in patients with chronic hepatitis C. Methods: Data of 15 treatment-naive chronic hepatitis C patients and 10 healthy controls were collected. Patients with chronic hepatitis C were treated with DAAs for 12 weeks. Blood samples were collected at 0, 4 and 12 weeks respectively, and blood samples of healthy controls were used as controls. Flow cytometry was used to detect the frequency of classical CD14(++)CD16(-) mononuclear cells and pro-inflammatory CD14(+)CD16(+) mononuclear cells in peripheral blood. Serum sCD14s and sCD163 were detected by enzyme-linked immunosorbent assay. The comparison between the two groups was performed by t-test. The comparison between multiple groups was performed by analysis of variance, and further pairwise comparison was performed by LSD-t test. Results: Prior DAAs treatment, peripheral blood CD14(+)CD16(+) mononuclear cell frequency (18.49% ± 1.54% vs. 10.65% ± 0.83%), serum sCD14s [(64 407.38 ± 5778.49) pg/ml vs. (28 370.76 ± 2 357.68 ) pg/ml] and sCD163 [(22 853.80 ± 4 137.61) pg/ml vs. (2 934.41 ± 223.31) pg/ml] were all higher than healthy controls (P < 0.05), while the frequency of CD14(++)CD16(-) mononuclear cells in peripheral blood was lower than healthy controls (59.14%±0.54% vs. 72.75%±1.31%, P < 0.01). During DAAs treatment, CD14(+)CD16(+) mononuclear cells frequency, serum sCD14 and sCD163 were all decreased significantly. After 12 weeks of treatment, CD14(+)CD16(+) mononuclear cells had decreased to nearly normal level (12.42% ± 1.60% vs. 10.65% ± 0.83%, P > 0.05), and serum sCD14 and scd163 were still higher than those of healthy controls [sCD14: (44 390.06 ± 3 330.17) pg / ml vs. (28 370.76 ± 2 357.68) pg/ml, Scd163: (11 494.79 ± 1 836.97) pg / ml vs. (2 934.41 ± 223.31) pg / ml, P < 0.01], while the frequency of CD14(++)CD16(-)mononuclear cells had gradually increased during the course of treatment and neared healthy control level after 12 weeks of treatment. There was no statistically significant difference between the two groups (71.54) % ± 2.99% vs. 72.75% ± 1.31%, P > 0.05). Conclusion: DAAs therapy can reduce the activation of peripheral blood mononuclear cells in patients with chronic hepatitis C.

[Feasibility study of contrast injection scheme based on body mass and iodine flow rate in coronary computed tomography angiography with wide detector CT]

Objective: To investigate the feasibility of coronary computed tomography angiography (CCTA) with the individualized contrast medium injection scheme based on body mass and iodine flow rate by using wide detector CT at 100 kV. Methods: From May 2018 to July 2018,270 patients with clinically suspected coronary artery disease underwent CCTA in TEDA International Cardiovascular Hospital. They were randomly divided into three groups, 90 cases in each group: group A was 0.5 ml/kg, group B was 0.6 ml/kg, the flow rate of contrast medium injection in group A and group B was (body mass×25 mg)/the concentration of contrast medium,group C was 0.8 ml/kg and the flow rate of contrast medium was 5 ml/s. Iohexol (iodine concentration 350 mgI/ml) was used in all three groups. The CT values of the aorta root in the three groups, the CT value of the middle segment of LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery and effective dose (ED) were compared. Results: There was no significant difference in CT value of aortic root, CT value of middle LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery among group A, group B and group C (all P>0.05). The flow rates of the three groups of contrast agents were statistically different (4.5±0.5 vs 4.5±0.5 vs 5, P=0.015), and there was no statistical difference between group A and group B (P>0.05) but lower than group C (P=0.015); the amount of contrast agent in the three groups was statistically different (32±3 vs 38±4 vs 53±7, P<0.001), group A<B Group<C group; there was no significant difference in ED between the three groups (1.5±0.5 vs 1.5±0.6 vs 1.3±0.6, P=0.613). Conclusions: CCTA imaging with a wide body detector based on a 0.5 ml/kg contrast agent dosage and a flow rate of ((body mass × 25)/350) ml/s individualized injection scheme can ensure the image quality while reducing the total amount of contrast agent and realizing individualized iodine flow rate.

[Rosiglitazone inhibits hepatic stellate cell proliferation by regulating peroxisome proliferator-activated receptor gamma/ heme oxygenase-1 expression]

Objective: To investigate the effect of rosiglitazone (RGZ) on the expression of peroxisome proliferator-activated receptor gamma (PPARγ) and heme oxygenase-1 (HO-1) in hepatic stellate cells (HSCs). Methods: In vitro activated hepatic stellate cell-T6 (HSC-T6) as research subjects were divided into blank control group, RGZ intervention group, and RGZ + ZnPP-IX mutual intervention group. MTT colorimetry method was used to measure the condition of cell proliferation. ELISA was used to detect the content of hyaluronic acid (HA) and type III procollagen peptide (PIIIP) in the cell supernatant. Real-time quantative PCR, western blot and immunocytochemistry were used to detect the relative expression levels of PPARγ, HO-1 mRNA and protein. One-way analysis of variance was used to compare the sample mean between multiple groups, and LSD test was used for comparison between two groups. Results: The proliferation activity of HSC-T6 and the expressions of HA and PIIIP in the RGZ intervention group were significantly lower than those in the blank control group (P ​​< 0.01), but the relative expression levels of PPARγ and HO-1 mRNA and protein were significantly increased compared with the blank control group (PPARγ : 2.97 ± 0.22 vs. 1.07 ± 0.05, 0.96 ± 0.08 vs. 0.31 ± 0.03; HO-1: 4.28 ± 0.73 vs. 1.80 ± 0.36, 1.83 ± 0.26 vs. 0.61 ± 0.09), and the difference was statistically significant (P < 0.01). The proliferation activity of HSC-T6 and the expression of HA and PIIIP was higher in RGZ + ZnPP-IX mutual intervention group as compared with RGZ group (P < 0.05). HO-1 mRNA (3.16 ± 0.38 vs. 4.28 ± 0.73) and protein (1.31 ± 0.17 vs. 1.83 ± 0.26) relative expression levels was decreased, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the relative expression of PPARγ mRNA and protein (P > 0.05), however, there was a decreasing trend. HO-1 mRNA (1.80 ± 0.36) and protein (0.61 ± 0.09) relative expression was significantly increased in RGZ + ZnPP-IX group as compared to blank control group (P < 0.05). Immunocytochemical staining had consistency with the above results. Conclusion: The effect of rosiglitazone on inducing increased expression of PPARγ, and then inhibiting HSC proliferation activity and collagen production may be realized by regulating its downstream HO-1 expression.

[Analysis of the diagnotic results and complications of pneumoconiosis patients with different insurance types]

Objective: By comparing the diagnotic results and complications of pneumoconiosis patients with work-related injury insurance and non-work-related injury insurance, to provide reference for improving the medical insurance of pneumoconiosis patients. Methods: In May 2019, the diagnotic results and complications of 3204 patients with pneumoconiosis who were hospitalized in the second department of Hunan Prevention and Treatment Institute for Occupational Diseases from January 2017 to March 2019 were retrospectively analyzed. Results: Among the 3204 patients, 896 cases (28.0%) were in stage I, 790 cases (24.6%) were in stage II, and 1518 cases (47.4%) were in stage III. 1490 cases (46.5%) of pneumoconiosis patients have complications, mainly chronic obstructive pulmonary disease (COPD) (42.3%, 1354/3204) and lung infection (23.6%, 755/3204) . 584 cases (18.2%) were covered by work-related injury insurance, and the diagnosis of pneumoconiosis patients was mainly in the stage I (61.0%, 356/584) . 2620 cases (81.8%) were covered by non-work-related injury insurance, and the diagnosis of pneumoconiosis patients was mainly in the stage III (56.0%, 1466/2620) . The complication rate of non-work-related injury insurance patients (50.1%, 1312/2620) was higher than that of work-related injury insurance patients (30.5%, 178/584) (χ(2)=73.72, P<0.01) . Conclusion: The inpatients with pneumoconiosis in Hunan Province are still mainly covered by non-work-related injury insurance, and the diagnotic period and complication rate are significantly higher than those of work-related injury insurance patients. Therefore, pneumoconiosis patients should be provided with medical security, early diagnosis and early intervention, to prevent and delay the occurrence of complications.

[Analysis of the HIV antibody screening results among the preoperative examination patients in Beijing Tongren Hospital from 2008 to 2018]

Objective: To understand the HIV antibody screening results among the preoperative examination patients in Beijing Tongren Hospital from 2008 to 2018. Methods: A retrospective analysis of the HIV antibody screening data of thepreoperative examination patients from 2008 to 2018 in Beijing Tongren Hospital was performed with software SPSS19.0. Trend chi-square was used to analyze the positive rate, age, marital status, household registration and so on. Results: Among the 750 013 clinical patients, 428 (0.057%) cases were screened anti-HIV positive and 370(0.049%) cases were confirmed anti-HIV positive when detected with western blotting.Most of the HIV-infectedindividuals were non-Beijing nationality, accounting for 60.27%.Among the 370 HIV-infected patients, there were 334 males (90.27%) and 36 females (9.73%). The age was distributed mainly between 20-40 years old (62.43%), secondly between 40-60 years old (28.65%).361 (97.57%)HIV-infected cases were transmitted by the sex and the MSM men increased from 2008 to 2018 (trend χ²=7.307, P=0.007). There were 22 cases (5.95%) with HBsAg positive, 11 cases (2.97%) with anti-HCV positive. Among the 159 HIV-positive patients (42.97%) companied with syphilis specific antibody positive, there were 64 cases (17.30%) with TRUST tests positive. Additionally, 178 (48.11%) HIV-infected patientsfirst visited doctors because of ocular disease in the hospital; secondly, 71 (19.19%) HIV-infected patientsfirst visited the dermatology. Conclusions: The number of HIV-infected patientsmarkedly increased from 2008 to 2018. The sexual transmission is still the main pathway for HIV infection, particularly homosexual transmission. Moreover, the results indicate that it is necessary to detect HIV antibody for the ocular disease patients.

Tailoring deformation and superelastic behaviors of beta-type Ti-Nb-Mn-Sn alloys

A group of Ti-25Nb-xMn-ySn (in wt%; x = 2, 4 and y = 1, 5) alloys were designed using the "BF-d-electron superelasticity" empirical relationship and subsequently were cast in order to investigate their microstructure, deformation and superelastic behaviors. Monolithic β phase is found in all investigated alloys except in Ti-25Nb-2Mn-1Sn alloy which exhibits α"+β dual-phase microstructure. During compression testing, the Ti-25Nb-2Mn-1Sn alloy fails and demonstrates sufficient plasticity of ~ 41% and ultimate compressive strength of ~ 1800 MPa, where other alloys do not fail within the load capacity of 100 kN. Among all the investigated alloys, Ti-25Nb-4Mn-1Sn alloy exhibits the highest yield strength (~ 710 MPa) while Ti-25Nb-2Mn-1Sn alloy possesses the highest hardness (~ 244 HV). In this work, yield strength is influenced by solid solution and grain boundary strengthening while hardness is affected by the amount of constituent phases in each alloy. Additionally, Ti-25Nb-4Mn-1Sn shows highest recoverable strain (2.35%) and superelastic recovery ratio (90%) during cyclic loading-unloading up to 3% strain level, with highest total energy absorption among the investigated alloys. Moreover, all the Ti-25Nb-xMn-ySn alloys display shear bands except that Ti-25Nb-2Mn-1Sn alloy displays shear bands together with some cracks on the outer surface of compressively deformed morphologies.

[Evaluation of brain volume changes in patients with painful temporomandibular disorders using voxel-based morphometry]

Objective: To evaluate the altered brain volume of the patients with painful temporomandibular disorders (TMD) using voxel-based morphometry (VBM). Methods: One hundred forty-six TMD patients ［age (36.8±15.8) years, male/female=44/102］ and 193 normal controls (NC) ［age (43.3±15.6) years, male/female = 92/101］ were performed with 3 dimensional brain structural images at 3.0 T MR scanner from November 2011 to December 2019 in Department of Radiology, Hainan Hospital and General Hospital of Chinese PLA. The brain structural images were segmented into gray matter, white matter and cerebrospinal fluid, and the gray matter images were performed with two-samples t-test with total intracranial volume, age and gender as covariates. Results: The gray matter volume (GMV) presented significantly higher in TMD group ［(632.4±65.4) ml］ than that in NC group ［(596.1±76.3) ml］ (t=4.70, P<0.05). The brain regions with increased GMV for TMD located in left inferior temporal gyrus, bilateral fusiform gyrus, bilateral middle temporal gyrus and right lingual gyrus compared with NC. Conclusions: The temporal lobe was the targeting brain region for TMD patients with increased GMV, which should further be investigated to elucidate the neuromechanism.

[Analysis of clinicopathological features of clear cell tumor of the lung]

Objective: To analyze the clinicopathological features of clear cell tumor of the lung (CCTL). Methods: A total of 9 cases were collected from August 2008 to August 2019 in the Department of Pathology of the First Medical Center of PLA General Hospital and Hainan Hospital of PLA General Hospital. Their clinical data, pathological characteristics, immunohistochemical staining and special staining results were summarized and analyzed. Results: There were 3 males and 6 females, aged from 28 to 70 years (average 52.2 years). All tumors were located in the peripheral part of the lung, and were solitary in 8 cases, and multiple (24 nodules) in 1 case. The lesion was round or oval, with clear boundary. The diameter of the nodule was 0.5-5.5 cm. Histologically, the tumor cells were oval, short fusiform or polygonal, with obvious nucleoli. The tumor cells were mostly distributed in sheet around thin-walled vessels, and there was hyaline degeneration around the blood vessels. Neither necrosis nor mitosis could be seen. Immunohistochemical staining showed tumor cells were diffusely positive for Vimentin, and CD34, Melan-A, specific monoclonal antibody against melanoma (HMB45) and S-100 were positive with different degrees. Broad spectrum cytokeratin (CK), epithelial membrane antigen (EMA), smooth muscle actin (SMA), desmin, CD10, paired box gene 8 (PAX-8) or myomodulatory protein (Myo-D1) were all negative. The positive index of the proliferating cell nuclear antigen (Ki-67) was low. Schiff dyeing with periodate (PAS) staining was positive, PAS staining of glycogen digested by amylase (d-PAS) staining was negative. All the tumors in the nine cases were resected and patients were followed up for 5-137 months. Except 1 case was lost for follow-up, the other 8 cases survived without recurrence or metastasis of the disease. Conclusions: CCTL is a rare benign tumor, most of which are single, few of which can be multiple; histopathological characteristics and immunohistochemical staining are helpful for diagnosis and differentiated diagnosis. After complete resection, the prognosis was good. However, when histological features indicating malignancy, intense follow-up should be considered.

[Impact of splenomegaly on outcomes of allogeneic hematopoietic stem cell transplantation in patients with chronic myelomonocytic leukemia]

目的

探讨脾肿大对慢性粒-单核细胞白血病（CMML）异基因造血干细胞移植（allo-HSCT）预后的影响。

方法

对2004年至2018年在北京大学血液病研究所接受allo-HSCT后的25例CMML患者进行回顾性分析，根据预处理前2周是否伴有脾脏肿大分为脾肿大组和非脾肿大组，比较两组患者在植入、移植物抗宿主病（GVHD）、复发以及生存方面的差异。

结果

①脾肿大组15例（男8例，女7例），中位年龄45（23~61）岁；非脾肿大组10例（男、女各5例），中位年龄39（12~56）岁。两组患者基线特征差异无统计学意义（P>0.05）。②脾肿大组、非脾肿大组粒细胞植入率分别为93.3%（14/15）、100.0%（10/10），中位植入时间分别为17（11~20）d、14（11~18）d（χ²=5.303，P=0.021）；脾肿大组、非脾肿大组血小板植入率分别为80.0%（12/15）、90.0%（9/10）（P=0.212），中位植入时间分别为17（12~33）d、15（12~19）d（χ²=0.470，P=0.493）。③脾肿大组5例发生急性GVHD（Ⅰ/Ⅱ度4例，Ⅲ/Ⅳ度1例），非脾肿大组6例发生急性GVHD（Ⅰ/Ⅱ度5例，Ⅲ/Ⅳ度1例）（χ²=0.204，P=0.652）。脾肿大组、非脾肿大组移植后100 d的急性GVHD累积发生率分别为33.3%（95%CI 14.9%~51.7%）、20.0%（95%CI 2.8%~37.2%）（P=0.635）。脾肿大组5例发生慢性GVHD（广泛型3例），非脾肿大组未发生慢性GVHD（P=0.041）。④脾肿大组、非脾肿大组3年累积复发率分别为（42.7±2.6）%、（11.1±1.2）%（χ²=1.824，P=0.122），3年总生存率分别为（61.5±13.5）%、（68.6±15.1）%（χ²=0.351，P=0.554），3年无白血病生存率分别为（56.3±14.8）%、（80.0±17.9）%（χ²=1.148，P=0.284）。

结论

脾肿大可致CMML患者allo-HSCT后粒细胞植入延迟，对生存及复发无影响。

Tuning the hysteresis of a metal-insulator transition via lattice compatibility

Structural phase transitions serve as the basis for many functional applications including shape memory alloys (SMAs), switches based on metal-insulator transitions (MITs), etc. In such materials, lattice incompatibility between transformed and parent phases often results in a thermal hysteresis, which is intimately tied to degradation of reversibility of the transformation. The non-linear theory of martensite suggests that the hysteresis of a martensitic phase transformation is solely determined by the lattice constants, and the conditions proposed for geometrical compatibility have been successfully applied to minimizing the hysteresis in SMAs. Here, we apply the non-linear theory to a correlated oxide system (V_1−xW_xO₂), and show that the hysteresis of the MIT in the system can be directly tuned by adjusting the lattice constants of the phases. The results underscore the profound influence structural compatibility has on intrinsic electronic properties, and indicate that the theory provides a universal guidance for optimizing phase transforming materials.

The effect of the lattice degrees of freedom on the metal-insulator transition of VO₂ remains a topic of debate. Here the authors show that the lattice compatibility of the high temperature tetragonal phase and the low-temperature monoclinic phase strongly influences the electronic transition, as manifested in the tunability of its hysteresis via chemical substitution.

[Impact of poor graft function on cytomegalovirus pneumonia in patients who have undergone haploidentical stem cell transplantation]

Objective: To retrospectively analyze the impact of primary PGF on CMV pneumonia in patients who have undergone haplo-HSCT. Methods: The clinical data of 122 patients who underwent haplo-HSCT at the Peking University Institute of Hematology from 2011-2012 were retrospectively reviewed. The incidence rate of CMV pneumonia between PGF and good graft function (GGF) was compared, and the factors were analyzed. In addition, outcomes in PGF patients with CMV pneumonia have been described. Results: Total 122 patients were retrospectively reviewed, and of these, 26 (21.3% ) had PGF, while 96 (78.7% ) had GGF. In addition, 15 patients had CMV pneumonia, and the median time to the development of CMV pneumonia was 103 (31-262) days; the 1-year cumulative incidence of CMV pneumonia was 12.3% (95% CI 6.2% -18.4% ) . In patients with primary PGF and GGF after Haplo-HSCT, the incidence of CMV pneumonia was 30.8% (8/26) and 7.3% (7/96) , respectively (P=0.002) . Moreover, 24 patients had CMV viremia (92.3% ) , while of the 96 GGF patients, 79 (82.3% ) had CMV viremia (P=0.212) . In multivariate analysis, the results showed that primary PGF had a significant influence on CMV pneumonia (P=0.005) . Compared with those without CMV pneumonia, patients with CMV pneumonia had poorer overall survival 37.3% (95% CI 11.2% -63.4% ) vs. 78.9% (95% CI 72.0% -87.6% ) (χ(2)=16.361, P<0.001) . The 1-year overall survival (OS) was 25.0% (95% CI 0% -55.0% ) and 50.0% (95% CI 26.9% -73.1% ) (χ(2)=4.656, P=0.031) in PGF patients with (8/26) and without (18/26) CMV pneumonia. Conclusion: The incidence of cytomegalovirus pneumonia in patients with primary poor graft function increases and the survival rate decreases.

[The expression and significance of IGF1R-Ras/RAGE-HMGB1 pathway in colorectal cancer patients with type 2 diabetes mellitus]

Objective: To investigate the expression of IGF1R-Ras and RAGE-HMGB1 signaling pathways in colorectal cancer patients with type 2 diabetes mellitus and their significance. Methods: The resected cancer tissues were obtained from 59 patients with colorectal cancer (CRC), including 29 patients with type 2 diabetes mellitus (CRC/DM group) and 30 with CRC alone (CRC group). The expressions of IGF1R, Ras, RAGE and HMGB1 in cancer tissues were detected by immunohistochemistry. The differences between the two groups were compared and the relationship between the expression and clinicopathological characteristics was analyzed. Results: In CRC/DM group, the positive rates of IGF1R and Ras were both 65.5% (19/29), and 51.7% (15/29) patients had IGF1R+ Ras+ immunophenotype, which were significantly higher than those in CRC group [33.3% (10/30), 36.7% (11/30) and 20.0% (6/30); P=0.013, 0.027 and 0.011, respectively]. The expression of IGF1R and Ras in CRC / DM group was positively correlated (r=0.479, P=0.017). The positive rate of RAGE expression in CRC group and CRC/DM group was 70.0% (21/30) and 72.4% (21/29) respectively, and the positive rate of HMGB1 expression was 46.7% (14/30) and 58.6% (17/29) respectively, neither was observed with significant difference (P=0.358 and 0.838). However, the proportion of patients with RAGE+ HMGB1+ immunophenotype in CRC/DM group [55.2% (16/29)] was higher than that in CRC Group [26.7% (8/30)] which was statistically significant (P=0.026), and the expression of both proteins was positively correlated in CRC/DM group (r=0.578, P=0.003). The clinicopathological analysis showed that in both groups the expression of IGF1R, Ras, RAGE and HMGB1 had no correlation with the sex, age, differentiation degree, tumor length, T stage and lymph node metastasis (P>0.05). Conclusion: Both IGF1R-Ras and RAGE-HMGB1 pathways may be involved in the oncogenesis of colorectal cancer in patients with type 2 diabetes.

[Minimal residual disease in adults with Philadelphia chromosome negative acute lymphoblastic leukemia in high-risk]

目的

探讨高危Ph阴性急性淋巴细胞白血病（Ph⁻ALL）中微小残留病（MRD）对预后和治疗策略的影响。

方法

回顾性分析2008年1月1日至2017年12月31日收治的初治成人高危Ph⁻ALL并获得完全缓解（CR）患者的临床资料，通过Cox回归模型和Landmark分析，寻找预后相关因素。

结果

177例患者纳入研究，其中男性99例（56%），中位年龄40（16~65）岁，95例（54%）在第1次完全缓解（CR₁）后接受异基因造血干细胞移植（移植组）。多因素分析显示，巩固治疗1个疗程后MRD阴性（HR=0.52，95%CI 0.30~0.89，P=0.017）、诱导化疗4周达到CR（HR=0.43，95%CI 0.24~0.79，P=0.006）是影响患者无病生存（DFS）的有利因素，CR₁移植是影响患者DFS（HR=0.13，95%CI 0.08~0.22，P<0.001）和总生存（OS）（HR=0.24，95%CI 0.15~0.41，P<0.001）的共同有利因素。121例患者进入Landmark分析，在巩固治疗1个疗程后MRD阴性的85例患者中进行多因素分析显示，巩固治疗3个疗程后MRD阴性是影响患者DFS（HR=0.18，95%CI 0.05~0.64，P=0.008）和OS（HR=0.14，95%CI 0.04~0.50，P=0.003）的有利因素。在巩固治疗1个疗程和3个疗程后MRD均阴性的患者中，移植组患者3年DFS率有高于化疗组的趋势（75.2%对51.3%，P=0.082），但3年OS率相近（72.7%对68.7%，P=0.992）。巩固治疗1个疗程和3个疗程后MRD至少1次阳性的患者中，移植组的3年DFS率（64.8%对33.3%，P=0.006）和3年OS率（77.0%对33.3%，P=0.028）均显著高于化疗组，与这两个时间点MRD均阴性的移植患者的预后差异无统计学意义（P>0.05）。

结论

在高危成人Ph⁻ALL患者中，巩固治疗1个疗程后MRD阴性是预后良好的独立影响因素。巩固治疗1个疗程和3个疗程MRD均阴性的患者，接受移植或化疗的生存率相似。移植显著改善了巩固治疗1个疗程和3个疗程后MRD至少一次阳性患者的预后。

[The performance of visual photoscreening for Chinese preschool children aged 4 to 5 years]

Objective: To assess the accuracy of photoscreening for detecting refractive amblyopia risk factors (ARFs) in Chinese preschool children aged 4 to 5 years. Methods: A cross-sectional study. Comprehensive ocular examinations were conducted for preschool children in Nanjing, China from September to December, 2016. Photoscreening (Plusoptix A12C) was applied for refractive screening without cycloplegia. Voluntary children and children suspected of eyes abnormalities received cycloplegic retinoscopy (CR). Results of photoscreening and CR were compared using Wilcoxon signed rank test, and Bland-Altman plot were used to assess the agreement between the photoscreener and CR. According to the updated preschool vision screening guidelines from American Association for Pediatric Ophthalmology and Strabismus (AAPOS) in 2013, CR was adopted for identifying children with ARFs, which was considered as a golden standard. Based on the golden standard, the accuracy of 5 sets of referral criteria (including sensitivity standard, Matta/Silbert standard, AAPOS2013 standard, Alaska Blind Child Discovery standard, specificity standard) for photoscreener were tested. Receiver operating characteristics curves were constructed applied to evaluate the quality of the photoscreener in refractive ARFs detection and to find probably the best cut-off points. Results: In total, 1 986 children [mean age, (4.57±0.29) years] received comprehensive examinations, including 1 084 boys and 902 girls. The test ability of photoscreening was 99.04% (1 967/1 986) in the preschool children, and 96.56%(1 827/1 892) of the children got a reliable result within three screening attempts. In 538 children who had data of CR, refractive error of one child exceeded the upper limit of the photoscreener value setting, which was directly categorized as hyperopia, so in the end, 537 children were included to analyze the comparison between the two tests. The measurement values of photoscreening were lower than those of CR in sphere, cylinder and spherical equivalent [(0.75 (0.50, 1.25) D vs. 1.25 (1.00, 1.75) D, Z=-10.36, P<0.01; -0.50 (-0.75, -0.25) D vs. -0.25 (-0.75, 0.00) D, Z=-11.10, P<0.01; 0.63 (0.38, 0.88) D vs. 1.00 (0.75, 1.50) D, Z=-13.33, P<0.01]. The 95% limit of agreement cover rates between the photoscreening and CR in sphere, cylinder and spherical equivalent was 96.28% (517/537), 95.34% (512/537) and 96.65% (519/537), respectively. Based on the golden standard, 47 (8.74%) children had refractive ARFs, and the range of sensitivity, specificity, Youden index, positive predictive values and negative predictive values for detecting refractive ARFs of the 5 common used referral criteria was from 63.83% to 97.87%, from 53.36% to 97.56%, from 0.51 to 0.80, from 16.73% to 74.51% and from 96.57% to 99.62%, respectively. Considering particular refractive ARFs on the basis of the receiver operating characteristic curves, the optimal cut-off point for astigmatism was set at 1.38 D. Conclusion: Photoscreening could be an applicable tool to detect refractive ARFs in preschool children. (Chin J Ophthalmol, 2020, 56: 189-196).

[Clinical analysis of 350 cases of pneumoconiosis complicated with spontaneous pneumothorax]

Objective: To explore the clinical features of pneumoconiosis complicated with spontaneous pneumothorax to improve the diagnosis and treatment of this disease. Methods: Analyze the clinical characteristics and treatment of 350 cases of pneumoconiosis complicated with spontaneous pneumothorax in Hunan Prevention and Treatment Institute for Occupational Diseases from May 2016 to May 2018. Results: In 350 patients, 22 cases are pneumoconiosis stage I, accounting for 6.3%, 26 cases are pneumoconiosis stage Ⅱ, accounting for 7.4%, 302 cases were pneumoconiosis stage Ⅲ, accounting for 86.3%.168 cases were recurrent pneumothorax, the recurrence rate was as high as 48%.There were 232 cases occurred in winter and spring, accounting for 66.3%. Chronic obstructive pulmonary disease and pulmonary infection were 54.9% and 47.4%, respectively. 233 patients were treated with basic therapy such as high flow oxygen therapy, with an effective rate of 93.1%. 114 cases were treated with thoracic closed drainage, with an effective rate of 86%. Conclusion: Spontaneous pneumothorax is a common complication of pneumoconiosis with high recurrence rate. According to the different conditions to give different treatments in a timely manner can achieve better results.

[To evaluate the disk position of the temporomandibular joint using calcium suppressed spectral-based CT images in the patients with temporomandibular disorder]

Objective: To evaluate the application of calcium suppressed (CaSupp) spectral CT technique in evaluating disk position and measuring the thickness of the posterior band of temporomandibular joint (TMJ). Methods: The twenty-three temporomandibular disorder patients [mean age 23(12~62) years, male/female=14/9] were performed with oblique sagittal and coronal proton density weighted imaging (PDWI) and spectral CT scans from February to July, 2019 in Department of Radiology, Hainan Hospital of General Hospital of Chinese PLA, and 45 TMJ joints were evaluated. The subjects were classified into two groups according to the scanning modalities: MRI measurement group and CaSupp spectral-based CT group. The CaSupp technique were applied with the spectral-based CT images and CaSupp images were generated. The oblique sagittal and coronal CaSupp imaged were reformatted by perpendicular to the long axis of the condyle. The TMJ disk positions were evaluated on oblique sagittal and coronal images, and the maximal disk thickness were measured on the oblique sagittal images. Results: The joint position was basically consistent on MRI and CaSupp images for the 45 TMJ joints. The intra-class coefficient value was 0.843 (0.712, 0.914) for the measurement of the posterior band of the TMJ disk between MRI and CaSupp images. Bland-Altman presented that the [95.6% (43/45)] points with the difference located in the 95% agreement interval. Wilcoxon paired text demonstrated that there was no significant different for the thickness of the posterior band between MRI [2.57 (1.76, 3.65) mm] and CaSupp images [2.67 (1.74, 4.56) mm] (P=0.07). Conclusions: The CaSupp spectral-based CT could be used to evaluated the TMJ disk position and the thickness of the posterior band.

Spatiotemporal characteristics of neural activity in tibial nerves with carbon nanotube yarn electrodes

BACKGROUND

Reliable interfacing with peripheral nervous system is essential to extract neural signals. Current implantable peripheral nerve electrodes cannot provide long-term reliable interfaces due to their mechanical mismatch with host nerves. Carbon nanotube (CNT) yarns possess excellent mechanical flexibility and electrical conductivity. It is of great necessity to investigate the selectivity of implantable CNT yarn electrodes.

NEW METHOD

Neural interfaces were fabricated with CNT yarn electrodes insulated with Parylene-C. Acute recordings were carried out on tibial nerves of rats, and compound nerve action potentials (CNAPs) were electrically evoked by biphasic current stimulation of four toes. Spatiotemporal characteristics of neural activity and spatial selectivity of the electrodes, denoted by selectivity index (SI), were analyzed in detail.

RESULTS

Conduction velocities of sensory afferent fibers recorded by CNT yarn electrodes varied between 4.25 m/s and 37.56 m/s. The SI maxima for specific toes were between 0.55 and 0.99 across seven electrodes. SIs for different CNT yarn electrodes are significantly different among varied toes.

COMPARISON WITH EXISTING METHODS

Most single CNT yarn electrode with a ∼ 500 μm exposed length can be sensitive to one or two specific toes in rodent animals. While, it is only possible to discriminate two non-adjacent toes by multisite TIME electrodes.

CONCLUSION

Single CNT yarn electrode exposed ∼ 500 μm showed SI values for different toes comparable to a multisite TIME electrode, and had high spatial selectivity for one or two specific toes. The electrodes with cross section exposed could intend to be more sensitive to one specific toe.

Expression of proteinase-activated receptor-2 and transient receptor potential A1 in vagal afferent nerve of rat after lung schemia-reperfusion injury

Lung ischemia-reperfusion injury (LIRI) is a common and severe clinical complication. As the injury occurs, the pulmonary afferent nerves play an important role in regulating respiratory functions under pathophysiological conditions. The purpose of this study was to examine expression of proteinaseactivated receptor-2 (PAR2) and transient receptor potential A1 (TRPA1) in pulmonary vagal afferent nerves of LIRI and further to determine molecular mediators linking activation of PAR2 and TRPA1. A rat model of LIRI was used. Enzyme-linked immunosorbent assay (ELISA) and Western blot analysis were employed to examine pro-inflammatory cytokines (PICs, i.e., IL-1β, IL-6 and TNF-α), and the protein levels of PIC receptors, PAR2, TRPA1, and intracellular signals. In the results, IL-1β, IL-6 and TNF-α along with their receptors were amplified in afferent nerves of LIRI rats as compared with control rats. Sensory PAR2 and TRPA1 were also upregulated by LIRI. Blocking PAR2 by infusion of FSLLRY-NH2 attenuated upregulation of TRPA1 via intracellular signals, namely p38-MAPK and JNK. Moreover, blocking individual PIC receptor attenuated PAR2 and TRPA1 in pulmonary vagal afferent nerves. Our data showed specific signaling pathways leading LIRI to activation of PIC signal and activation of PAR2 and TRPA1 in pulmonary vagal afferent nerves via intracellular mediators. Targeting one or more of these signaling molecules may present opportunities to improve the abnormalities in vagal afferent nerve-mediated respiratory functions observed as LIRI occurs.

[Comparative analysis of the correlation between axillary treatment and upper limb lymphedema]

In the surgical treatment of breast cancer, "de-escalating" is becoming more popular, especially in the treatment of axilla. Axillary sentinel lymph node biopsy has become a routine treatment for axillary-negative breast cancer patients because it can effectively reduce the occurrence of upper limb lymphedema, so that some patients with sentinel lymph node negative can be exempted from axillary lymph node dissection. However, in recent years, several international clinical studies, such as AMAROS trial, explored the use of radiotherapy instead of dissection when 1 to 2 sentinel lymph nodes were positive. The results showed that radiotherapy can reduce the incidence of upper limb edema by nearly 50% compared with dissection. How to interpret the results of such non-inferiority studies, and how to treat the impact of axillary dissection and axillary radiotherapy on the occurrence of lymphedema? Based on the review of literature in recent 10 years, the incidence and hazard ratio of edema related to the two axillary treatments were compared. The conclusion is the hazard ratios are close to each other, around 3 for both arms. The results of clinical studies such as radiotherapy instead of axillary dissection need to be carefully interpreted. At the same time, axillary dissection is still suitable for some patients at current stage, and the corresponding prevention of upper limb lymphedema still needs attention.

[MRI observation of condylar location and morphology in the patients with temporomandibular disc displacement]

Objective: To evaluate the mandibular condylar location and morphology in the temporomandibular joint disorders. Methods: One hundred thirty-seven TMD patients (age 37.5±16.1 years, male/female=39/98) were performed with MRI scan for temporomandibular joint (TMJ) from November, 2011 to April, 2019 in Department of Radiology,Hainan Hospital of General Hospital of Chinese PLA and General Hospital of Chinese PLA. The patients were classified into 3 groups according the disc displacement: disc without displacement (DWoD) (185 TMJ), disc displacement with reduction (DDWR) (17 TMJ) and disc displacement without reduction (DDWoR) (72 TMJ). The location (anterior position, central position and posterior position) and morphology (oval shape, flat shape and beaklike shape) of the condylar head were observed on the sagittal PDWI, and the long and short axes were measured on the axial T2WI. Another groups were classified into 3 subgroups according to the disc displacement of bilateral TMJ: bilateral normal disc location (biND) (74 cases), unilateral disc displacement (uniDD) (40 cases) and bilateral disc displacement (23 cases). The inter-condyle angle was measured on the axial T2WI. Results: There was no significant difference for the location of condylar head among DWoD, DDWR and DDwoR groups (χ(2)=7.435, P=0.115). The rate for flat condylar shape was significantly higher in DWoD group [83.9%(115/137)] than that in DDWoR group [50.7%(34/67)], and the rate for beaklike condylar shape was significantly lower in DWoD group [16.1%(22/137)] than that in DDWoR group [49.3%(33/67)] (χ(2)=23.521, P<0.001). The length of long axis presented significantly longer in DWoD group [(17.2±2.4) mm] than that in DDWR group [(15.4±2.0) mm] and that in DDWoR group [(14.7±2.7) mm] (P<0.05). The length of short axis presented significantly longer in DWoD group [(7.3±1.2) mm] than that in DDWR group [(6.5±1.3) mm] and that in DDWoR group [(6.1±1.4) mm] (P<0.05). The inter-condyle angle presented significantly larger in biND group (136°±13°) and uniDD group (132°±14°) than that inbiDD group (124°±17°) (P<0.05). Conclusions: The mandibular condylar morphology changes significantly presented in the patients with temporomandibular disc displacement for the temporomandibular disorders.

A menopause survey of women with benign breast disease history in northwest China

Objectives: The present study aimed to determine the prevalence of menopause syndrome (MPS) and the present treatment status for menopause symptoms in women with benign breast disease history, compared with those without breast problems, and to analyze the affecting factors of medical visits and hormone replacement therapy (HRT) application for menopause symptoms. Methods: A questionnaire survey was conducted by face-to-face interview with a general sample of 8500 Chinese women aged 45-55 years from 162 villages and towns of Gansu province, China. Results: The MPS prevalence in the Benign breast disease history group was 76.60%, and was not statistically different from that of the Control group. Few of the participants had medical visits or had undergone treatment. The Benign breast disease history group was more informed of the treatment options available and more likely to start HRT. Conclusions: Most women with benign breast disease history experienced menopausal symptoms when experiencing reproductive senescence, they had more knowledge about menopause syndrome and more positive to the therapeutic than whom without breast problems.

[Haploidentical allogenetic hematopoietic stem cell transplantation for X-linked adrenoleukodystrophy]

OBJECTIVE

X-linked adrenoleukodystrophy (ALD) is a severe inherited disorder leading to rapid neurological deterioration and premature death. Allogeneic hematopoietic stem cell transplantation (HSCT) is still the only treatment that halts the neurologic symptoms in ALD. However, many patients lack suitable human leukocyte antigen (HLA) matched related donors and must rely on alternative donors for a source of stem cells. The purpose of this study was to explore the outcomes of haploidentical allogeneic stem cell transplantation for ALD patients.

METHODS

Between December 2014 and December 2018, eight children with ALD lacking HLA matched related or unrelated donors were treated with haploidentical allogeneic hematopoietic stem cell transplantation. The patients received conditioning regimen with busulfan 9.6 mg/kg, cyclophosphamide 200 mg/kg and fludarabine 90 mg/m². Graft-versus-host disease (GVHD) prophylaxis consisted of anti-human thymocyte globulin, cyclosporine A, mycophenolate mofetil and short course of methotrexate.

RESULTS

All the 8 children received allogeneic stem cell transplants from their fathers. The median age of the recipients was 8 (range: 5-12) years. The median age of the donors was 36 (range: 32-40) years. All the recipients received granulocyte colony-stimulating factor (G-CSF) mobilized bone marrow and peripheral blood-derived stem cells. The median number of total mononuclear cells dose and CD34+ dose was 10.89 (range: 9.40-12.16)×10⁸/kg and 7.06 (range: 0.74-7.80)×10⁶/kg, respectively. Neutrophil engraftment occurred a median of 11 days (range:8-13 days) after transplantation. Platelet engraftment occurred a median of 10 days (range:8-12 days) after transplantation. All the patients achieved complete donor chimerism at the time of engraftment. Four patients had grades II-IV acute GVHD and 1 had chronic graft-versus-host disease. No severe chronic GVHD occurred. Among all the children, 2 had cytomegalovirus (CMV) DNAemia and 2 Epstein-Barr virus (EBV) DNAemia. Overall, seven of them survived and had no major complications related to transplantation. One died of cerebral hernia after epilepsy 125 days after transplantation.

CONCLUSION

The preliminary observation demonstrates that haploidentical allogeneic stem cell transplantation with this novel regimen could successfully achieve full donor chimerism in ALD patients. According to our experience, haploidentical allogeneic hematopoietic stem cell transplantation is safe and feasible in the treatment of X-linked adrenoleukodystrophy.

[Analysis of causes and treatment methods of complication of early acute kidney injury in four severely burned patients]

Objective: To analyze the causes of complication of early acute kidney injury (AKI) in four severely burned patients, and to explore the related treatment methods. Methods: The clinical data of 4 patients with severe burn complicated with early AKI admitted to Guangzhou Red Cross Hospital Affiliated to Medical College of Jinan University (hereinafter referred to as our hospital) from June 2014 to December 2017 were retrospectively analyzed. All the patients were male, aged 23-33 (30±5) years old, with depth of burns ranged from deep partial-thickness to full-thickness, complicated with myofascial compartment syndrome of extremities and varying degrees of striated muscle injury, and treated in other hospitals before transfer to our hospital. The patients were numbered from small to large according to the total burn area. The total burn area of patients No. 1, 2, 3, and 4 was 10%, 80%, 90%, and 95% total body surface area respectively, their occurrence time of early AKI was 48, 11, 29, and 48 hours after injury respectively, and their time of arriving our hospital was 60, 11, 29, and 144 hours after injury respectively. Hypovolemic shock occurred in patients No. 2 and 3 at admission to our hospital. All the patients received continuous renal replacement therapy (CRRT) after admission to our hospital. Under the support of hemodynamic monitoring and organ function monitoring, the limbs complicated with myofascial compartment syndrome were incised, thorough decompression exploration was performed, and necrotic muscle tissue was removed or amputation was performed. After escharectomy and decompression of limbs, fresh granulation wounds were formed by temporarily covering wounds with Jieya dressing skin or pig skin, multiple debridements, and vacuum sealing drainage. Fresh granulation wounds and other wounds underwent staged eschar excision and shaving were covered with autologous Meek skin graft, particulate skin graft, reticular skin graft and small skin graft respectively. The treatment outcome, CRRT time, operation times, time of recovery of serum creatinine and myoglobin, length of hospital stay, and follow-up were recorded. Results: All the 4 patients were cured after transfer to our hospital. Among them, totally 5 limbs of patients No. 1 and No. 4 underwent amputation because of complication of myofascial compartment syndrome and a large amount of necrotic muscle which could not be preserved. Patients No. 1, 2, 3, and 4 were treated with CRRT for 19, 35, 14, and 25 days respectively and performed with operation for 5, 6, 10, 8 times respectively. Serum creatinine of patients No. 1, 2, 3, and 4 returned to normal on 22, 35, 37, and 48 days after transfer respectively, and their serum myoglobin returned to normal on 18, 28, 25, and 30 days after transfer respectively. Patients No. 1, 2, 3, and 4 were hospitalized for 52, 105, 148, and 156 days and discharged after basic wound healing. Follow-up for 1 to 36 months showed no abnormal renal function in 4 patients. Conclusions: The early AKI in patients No. 1 and 4 was caused by rhabdomyolysis after severe burn complicated with myofascial compartment syndrome, while that of the other 2 cases were also related to hypovolemic shock and poor renal perfusion. The success rate of early AKI treatment in severely burned patients can be effectively improved by removing the causes of diseases at the same time of CRRT and actively treating burn wounds under the support of organ function and hemodynamic monitoring.

[Comparison of umbilical cord blood transplantation and hematopoietic stem cell transplantation from HLA-matched sibling donors in the treatment of myelodysplastic syndrome-EB or acute myeloid leukemia with myelodysplasia-related changes]

目的

比较非血缘脐血干细胞移植（UCBT）与同胞HLA全相合供者造血干细胞移植（MSD-HSCT）治疗骨髓增生异常综合征伴原始细胞增多（MDS-EB）和急性髓系白血病伴骨髓增生异常相关改变（AML-MRC）的临床疗效。

方法

回顾性分析2011年2月至2017年12月接受UCBT/MSD-HSCT的MDS-EB/AML-MRC患者64例，其中MDS-EB 38例，AML-MRC 26例。

结果

①与MSD-HSCT组比较，UCBT组AML-MRC患者比例较高[52.8%（19/36）对25.0%（7/28），P=0.025]，中位年龄较低[13（1.5~52）岁对32（10~57）岁，P=0.001]。②UCBT组与MSD-HSCT组+42 d粒细胞植入率均为100%，中位植入时间分别为17.5（11~31）d、11.5（10~20）d；UCBT组+100 d血小板植入率为91.4%，中位植入时间为40（15~96）d，MSD-HSCT组+100 d血小板植入率为100.0%，中位植入时间为15（11~43）d。③UCBT组和MSD-HSCT组比较，+100 dⅡ~Ⅳ度、Ⅲ/Ⅳ度急性GVHD累积发生率、180 d移植相关死亡率、3年累积复发率、3年总生存率和3年无病生存率差异均无统计学意义（P>0.05）。④UCBT组3年慢性GVHD、重度慢性GVHD的累积发生率均低于MSD-HSCT组[28.3%（95% CI 13.4%~45.3%）对67.9%（95%CI 46.1%~82.4%），P=0.002；10.3%（95%CI 2.5%~24.8%）对50.0%（95%CI 30.0%~67.1%），P<0.001]；UCBT组3年无严重急慢性GVHD及无复发生存（GRFS）率明显高于MSD-HSCT组[55.0%（95%CI 36.0%~70.6%）对28.6%（95%CI 13.5%~45.6%），P=0.038]。

结论

UCBT治疗MDS-EB/AML-MRC患者可获得比MSD-HSCT更好的移植后生存质量。