Objective:To observe the efficacy and safety of subretinal injection of Aflibercept for the treatment of refractory or recurrent polypoidal choroidal vasculopathy (PCV).Methods:A prospective clinical research. From January to June 2022, 18 patients of 18 eyes with PCV diagnosed in The Affiliated Eye Hospital of Nanchang University were included in the study. All patients underwent best corrected visual acuity (BCVA), indocyanine green angiography and optical coherence tomography (OCT). The BCVA examination was performed using the international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The large choroidal vessel thickness (LVCT), central retinal thickness (CRT), sub-foveal choroidal thickness (SFCT) and retinal pigment epithelium detachment (PED) height were measured by enhanced depth imaging technique of OCT. The choroidal vascular index (CVI) was calculated. There were 18 patients of 18 eyes, 11 males of 11 eyes and 7 females of 7 eyes. The age was (64.22±3.86) years old. The disease duration was (5.22±1.80) years. The patient had received intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs for (7.72±1.36) times. The logMAR BCVA of the affected eyes was 1.28±0.25. The SFCT, CRT, LVCT, PED height were (436.56±9.80), (432.44±44.29), (283.78±27.10), (342.44±50.18) μm, respectively, and CVI was 0.65±0.01. All eyes were treated with a single subretinal injection of 40 mg/ml Aflibercept 0.05 ml (including Aflibercept 2.0 mg). According to the results of OCT and BCVA after treatment, the lesions were divided into active type and static type. The active lesions were treated with intravitreal injection of Aflibercept at the same dose as before. Quiescent lesions were followed up. Examinations were performed 1-3, 6, 9 and 12 months after treatment using the same equipment and methods before treatment. The BCVA, LVCT, CRT, SFCT, PED height, CVI, interretinal or subretinal fluid, lesion regression rate, injection times, and complications during and after treatment were observed. The BCVA, SFCT, CRT, LVCT, PED height and CVI before and after treatment were compared by repeated measures analysis of variance.Results:Eighteen eyes received subretinal and/or intravitreal injection of Aflibercept (1.61±0.85) times (1-4 times). At the last follow-up, the polypoid lesions regressed in 4 eyes and PED disappeared in 1 eye. Compared with before treatment, BCVA ( F=50.298) gradually increased, CRT ( F=25.220), PED height ( F=144.16), SFCT ( F=69.77), LVCT ( F=136.69), CVI ( F=72.70) gradually decreased after treatment. The differences were statistically significant ( P<0.001). Macular hole occurred in 1 eye after treatment, and the hole closed spontaneously 3 months after treatment. No serious complications such as retinal tear, retinal detachment, endophthalmitis and vitreous hemorrhage occurred during and after treatment. Conclusion:Subretinal injection of Aflibercept is safe and effective in the treatment of refractory PCV.

Objective:To observe the efficacy and safety of vitrectomy combined with subretinal injection of alteplase (tPA) and intravitreal injection of Conbercept in the treatment of large area submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV).Methods:A retrospective clinical study. From January to September 2021, 32 eyes of 32 patients with massive SMH secondary to PCV diagnosed in the Affiliated Eye Hospital of Nanchang University were included in the study. Large SMH was defined as hemorrhage diameter ≥4 optic disc diameter (DD). There were 32 patients (32 eyes), 20 males and 12 females. The mean age was (72.36±8.62) years. All patients had unilateral disease.The duration from onset of symptoms to treatment was (7.21±3.36) days. All patients underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA examination was performed using the international standard visual acuity chart, which was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The central macular thickness (CMT) was measured by spectral domain-OCT. The average size of SMH was (6.82±1.53) DD. The logMAR BCVA 1.73±0.44; CMT was (727.96±236.40) μm. All patients were treated with 23G pars plana vitrectomy combined with subretinal injection of tPA and intravitreal injection of Conbercept. At 1, 3, 6 and 12 months after treatment, the same equipment and methods were used for relevant examinations before treatment. The changes of BCVA and CMT, the clearance rate of macular hemorrhage, and the complications during and after surgery were observed. BCVA and CMT before and after treatment were compared by repeated measures analysis of variance.Results:Compared with before treatment, BCVA gradually increased at 1, 3, 6 and 12 months after treatment, and the differences were statistically significant ( F=77.402, P<0.001). There was no significant difference in BCVA between any two groups at different time points after treatment ( P>0.05). Correlation analysis showed that BCVA at 12 months after treatment was negatively correlated with the course of disease ( r=-0.053, P=0.774). One week after treatment, macular hemorrhage was completely cleared in 30 eyes (93.75%, 30/32). The CMT was (458.56±246.21), (356.18±261.46), (345.82±212.38) and (334.64±165.54) μm at 1, 3, 6 and 12 months after treatment, respectively. Compared with before treatment, CMT decreased gradually after treatment, and the difference was statistically significant ( F=112.480, P<0.001). There were statistically significant differences in different follow-up time before and after treatment ( P<0.001). The number of treatments combined with Conbercept during and after surgery was (4.2±1.8) times. At the last follow-up, there was no recurrence of SMH, retinal interlamellar effusion and other complications. Conclusion:Subretinal injection of tPA combined with intravitreal injection of Conbercept is safe and effective in the treatment of large SMH secondary to PCV, and it can significantly improve the visual acuity of patients.

Objective:To investigate the effect of immune checkpoint inhibitors on reducing residual lymph node metastasis in patients with gastric cancer.Methods:The cohort of this retrospective study comprised patients from Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Xiamen University who had undergone systemic treatment prior to gastrectomy with D2 lymphadenectomy and had achieved Grade 1 primary tumor regression (TRG1) from January 2014 to December 2023. After exclusion of patients who had undergone preoperative radiotherapy, data of 58 patients (Nanfang Hospital: 46; First Affiliated Hospital of Xiamen University: 12) were analyzed. These patients were allocated to preoperative chemotherapy (Chemotherapy group, N=36 cases) and preoperative immunotherapy plus chemotherapy groups (Immunotherapy group, N=22 cases). There were no significant differences between these groups in sex, age, body mass index, diabetes, tumor location, pathological type, Lauren classification, tumor differentiation, pretreatment depth of invasion by primary tumor, pretreatment lymph node stage, pretreatment clinical stage, mismatch repair protein status, number of preoperative treatment cycles, or duration of preoperative treatment (all P>0.05). The primary outcome measure was postoperative lymph node downstaging. Secondary outcomes included postoperative depth of invasion by tumor, number of lymph nodes examined, and factors affecting residual lymph node metastasis status. Results:Lymph node downstaging was achieved significantly more often in the Immunotherapy group than the Chemotherapy group (pN0: 90.9% [20/22] vs. 61.1% [22/36]; pN1: 4.5% [1/22] vs. 36.1% [13/36]; pN2: 4.5% [1/22) vs. 0; pN3: 0 vs. 2.8% [1/36], Z=-2.315, P=0.021). There were no significant difference between the two groups in number of lymph nodes examined (40.5±16.3 vs. 40.8±17.5, t=0.076, P=0.940) or postoperative depth of invasion by primary tumor (pT1a: 50.0% [11/22] vs. 30.6% [11/36]; pT1b: 13.6% [3/22] vs. 19.4% [7/36]; pT2: 13.6% [3/22] vs. 13.9% [5/36]; pT3: 13.6% [3/22] vs. 25.0% [9/36]; pT4a: 9.1% [2/22] vs. 11.1% [4/36], Z=-1.331, P=0.183). Univariate analysis revealed that both preoperative treatment regimens were associated with residual lymph node metastasis status in patients whose primary tumor regression was TRG1 (χ 2=6.070, P=0.014). Multivariate analysis incorporated the following factors: pretreatment depth of invasion by primary tumor, pretreatment lymph node stage, pretreatment clinical stage, number of preoperative treatment cycles, and preoperative treatment duration. We found that a combination of immunotherapy and chemotherapy administered preoperatively was an independent protective factor for reducing residual lymph node metastases in study patients whose primary tumor regression was TRG1 (OR=0.147, 95%CI: 0.026–0.828, P=0.030). Conclusion:Compared with preoperative chemotherapy alone, a combination of preoperative immunotherapy and chemotherapy achieved greater reduction of residual lymph node metastases in the study patients who achieved TRG1 tumor regression in their primary lesions.

Objective:To investigate the effect of immune checkpoint inhibitors on reducing residual lymph node metastasis in patients with gastric cancer.Methods:The cohort of this retrospective study comprised patients from Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Xiamen University who had undergone systemic treatment prior to gastrectomy with D2 lymphadenectomy and had achieved Grade 1 primary tumor regression (TRG1) from January 2014 to December 2023. After exclusion of patients who had undergone preoperative radiotherapy, data of 58 patients (Nanfang Hospital: 46; First Affiliated Hospital of Xiamen University: 12) were analyzed. These patients were allocated to preoperative chemotherapy (Chemotherapy group, N=36 cases) and preoperative immunotherapy plus chemotherapy groups (Immunotherapy group, N=22 cases). There were no significant differences between these groups in sex, age, body mass index, diabetes, tumor location, pathological type, Lauren classification, tumor differentiation, pretreatment depth of invasion by primary tumor, pretreatment lymph node stage, pretreatment clinical stage, mismatch repair protein status, number of preoperative treatment cycles, or duration of preoperative treatment (all P>0.05). The primary outcome measure was postoperative lymph node downstaging. Secondary outcomes included postoperative depth of invasion by tumor, number of lymph nodes examined, and factors affecting residual lymph node metastasis status. Results:Lymph node downstaging was achieved significantly more often in the Immunotherapy group than the Chemotherapy group (pN0: 90.9% [20/22] vs. 61.1% [22/36]; pN1: 4.5% [1/22] vs. 36.1% [13/36]; pN2: 4.5% [1/22) vs. 0; pN3: 0 vs. 2.8% [1/36], Z=-2.315, P=0.021). There were no significant difference between the two groups in number of lymph nodes examined (40.5±16.3 vs. 40.8±17.5, t=0.076, P=0.940) or postoperative depth of invasion by primary tumor (pT1a: 50.0% [11/22] vs. 30.6% [11/36]; pT1b: 13.6% [3/22] vs. 19.4% [7/36]; pT2: 13.6% [3/22] vs. 13.9% [5/36]; pT3: 13.6% [3/22] vs. 25.0% [9/36]; pT4a: 9.1% [2/22] vs. 11.1% [4/36], Z=-1.331, P=0.183). Univariate analysis revealed that both preoperative treatment regimens were associated with residual lymph node metastasis status in patients whose primary tumor regression was TRG1 (χ 2=6.070, P=0.014). Multivariate analysis incorporated the following factors: pretreatment depth of invasion by primary tumor, pretreatment lymph node stage, pretreatment clinical stage, number of preoperative treatment cycles, and preoperative treatment duration. We found that a combination of immunotherapy and chemotherapy administered preoperatively was an independent protective factor for reducing residual lymph node metastases in study patients whose primary tumor regression was TRG1 (OR=0.147, 95%CI: 0.026–0.828, P=0.030). Conclusion:Compared with preoperative chemotherapy alone, a combination of preoperative immunotherapy and chemotherapy achieved greater reduction of residual lymph node metastases in the study patients who achieved TRG1 tumor regression in their primary lesions.

Objective:To explore the cellular protective effect and adverse reactions of amifostine in the chemotherapy of malignant solid tumor in children.Methods:A total of 62 children with malignant solid tumors receiving 253 times of chemotherapy who were admitted to the Pediatrics Single Center of Beijing Tongren Hospital from April 2018 to April 2020 were selected and divided into the experimental group (amifostine was used before chemotherapy, 113 times in total) and the control group (amifostine was not used before chemotherapy, 140 times in total) according to stratified random sampling. The self-control method was used to compare the therapeutic effects and adverse effects of the use of amifostine or not in the same child under the same chemotherapy regimen.Results:Compared with the control group, the duration of agranulocytosis [(6.7±3.0) d vs. (9.5±4.3) d, t = 3.788, P < 0.05], the duration of platelet reduction (<20×10 9/L) [(3.6±1.3) d vs. (5.4±3.2) d, t = 2.037, P < 0.05], the time of receiving recombinant human granulocyte colony-stimulating factor (rhG-CSF) treatment [(6.5±3.5) d vs. (10.0±2.8) d, t = 3.049, P < 0.05] and the time of antibiotic treatment during infection [(5.0±2.5) d vs. (8.2±2.5) d, t = 3.558, P < 0.05] in the experimental group were all shorter; the amount of platelet input required [(0.7±0.5) U vs. (1.5±0.8) U, t = 2.873, P < 0.05] was less than that of the control group. Oral mucosal ulceration occurred in only 4 (3.5%) times in the experimental group, which was lower than that in the control group [12 (8.6%) times] ( χ2 = 4.634, P = 0.033). Regardless of the cost of amifostine itself, there was a statistically significant difference in treatment cost between the experimental group and the control group ( P = 0.034), and the length of hospital stay in experimental group was relatively short ( P = 0.012). The patients were more prone to nausea and vomiting and hypocalcemia when treated with amifostine. Conclusions:Amifostine can effectively protect normal tissue cells in chemotherapy of children with malignant solid tumor and its adverse reactions are mild.

[Abstract] Objective: To develop a new type of CD7 chimeric antigen receptor modified T cell (CD7-CAR-T) for the treatment of CD7 positive acute myeloid leukemia (AML), and to observe its killing effect on CD7 positive AML cells. Methods: The CD7-CAR lentiviral vector was constructed based on the CD7 Nanobody sequence and costimulatory domain sequence of CD28 and 4-1BB. The lentiviral particles were packaged and used to co-transfect human T cells with protein expression blocker (PEBL), so as to prepare CD7- CAR-T cells. Real time cellular analysis (RTCA) was used to monitor the cytotoxicity of CD7-CAR-T cells on CD7 overexpressed 293T cells. Flow cytometry assay was used to detect the effect of CD7-CAR-T cells on proliferation and cytokine secretion of AML cells with high, medium and low CD7 expressions (KG-1, HEL and Kasumi-1 cells, respectively). Results: CD7-CAR-T cell was successfully constructed and its surface expression of CD7 was successfully blocked. Compared with T cells, CD7-CAR-T cells could significantly inhibit the proliferation of CD7-293T cells and promote the release of TNF, Granzyme B and INF-γ; in addition, CD7-CAR-T cells also significantly promoted the apoptosis (t=147.1, P<0.01; t=23.57, P<0.01) and cytokine release (P<0.05 or P<0.01) in CD7 positive KG-1 and HEL cells, but had little effect on Kasumi-1 cells that only expressed minimal CD7 antigen (t=0.7058, P>0.05). Conclusion: CD7-CAR-T cells can specifically kill CD7-positive AML cells in vitro.

Objective:To investigate the clinical features, diagnosis, treatment and prognosis of advanced clear cell sarcoma of kidney(CCSK) in children.Methods:The clinical data of 10 children with advanced CCSK hospitalized in Department of Pediatrics of Beijing Tongren Hospital, Capital Medical University from January 2014 to December 2017 were collected, and their clinical features, diagnosis, treatment and prognosis were analyzed retrospectively.Results:(1) Clinical features of CCSK: ten cases of CCSK included 6 boys and 4 girls, with the median onset age of 32 months; 7 cases were left CCSK and 3 cases were right CCSK.There were 9 cases of stage Ⅲ and 1 case of stage Ⅳ at the time of initial diagnosis, when 4 cases were misdiagnosed as other renal tumors at the time of initial diagnosis(40%, 4/10 cases). Five patients with stage Ⅲ CCSK had recurrence and metastasis during treatment and follow-up, and the main distant metastasis sites were lung, bone, liver and brain.(2) Treatment and prognosis of CCSK: seven cases received surgery combined with radiotherapy and chemotherapy, and 3 cases whose parents gave up treatment adopted non-standardized treatment.The median follow-up time was 33.5 months.Seven patients survived and 3 cases died.The 3-year overall survival rate of all 10 patients was 65.6%.The 3-year overall survival rate of stage Ⅲ was 74.1%, and that of stage Ⅳ was 0.The prognosis of stage Ⅲ was significantly better than that of stage Ⅳ( χ2=9, P=0.003). Among the 5 recurrent cases, only 1 case achieved completely remission, 2 cases achieved partially remission, 1 case suffered from disease progression and 1 case died.The 3 cases without recurrence were given standardized treatment of surgery, che-motherapy and radiotherapy, and all were completely remitted. Conclusions:CCSK is easy to be misdiagnosed, and the risk of recurrence and distant metastasis is high in stage Ⅲ patients during treatment and follow-up.Stage Ⅲ patients who actively receive standard treatment including surgery, chemotherapy and radiotherapy have good prognosis, while the mortality of patients with relapse and distant metastasis is high.

Objective To investigate the hemodynamic changes before and after Revivent surgery in patients with left ventricular apical aneurysm by cardiac magnetic resonance imaging ( CM R ) and echocardiography . Methods Twenty‐two cases with left ventricular apical aneurysm were examined by two‐dimensional and three‐dimensional transthoracic echocardiography 1 week before operation ,1 month and 12 months after operation ,by CM R 1 week before operation and 12 months after operation .Left ventricular end‐diastolic volume( LVEDV ) ,left ventricular end‐systolic volume ( LVESV ) ,left ventricular end‐diastolic diameter ( LVEDd ) , left ventricular end‐systolic diameter ( LVESd ) , left ventricular ejection fraction ( LVEF) ,stroke volume ( SV ) ,stroke output index ( SVI) ,cardiac output ( CO ) and cardiac output index ( CI) were quantitatively measured and statistical analysis were performed . Results T here were significant differences between preoperation and 1 month after operation for the measurements of LVEDV ,LVESV , LVEDd and LVEF by both CM R and echocardiography ( all P ＜ 0 .05 ) . Compared with preoperation , LVESd decreased significantly 12 months after operation ( P ＜0 .01) . However ,there were no significant differences between preoperation and 1 or 12 months after operation for the measurements of SV ,SVI ,CO and CI ( all P ＞ 0 .05 ) . T he consistency between CM R and echocardiography measurements was good . Conclusions Revivent surgery provides an effective and feasible treatment for patients with left ventricular apical ventricular aneurysm . T he dual‐modality imaging with CM R and echocardiography are reliable technical means to evaluate the changes of left ventricular heamodynamiscs during the perioperative period of Revivent

Objective To explore the treatment and prognosis of advanced stage childhood hepatoblastoma with pulmonary metastasis.Methods Fifty-six cases of advanced stage hepatoblastoma with pulmonary metastasis diagnosed through pathology from April 2006 to June 2014 in Department of Pediatrics,Beijing Tongren Hospital Affilia-ted to Capital Medical University were enrolled,among them 33 cases were males and 23 cases were females,and the median age was 2.33 years old(1 month-15 years and 1 month old).The clinical effects of multidisciplinary therapy were analyzed.Results (1)Follow-up studies were conducted till December 2016,in which 21 cases of 56 children achieved complete remission,the complete remission rate was 37.5%(21/56 cases),while 12 cases were partial re-mission and 14 cases were deceased,and the effective rate reached 58.9%(33/56 cases).The follow-up period of 41 children were over 24 months,in which the 2-year free event survival(EFS)rate was 37.5%,2-year overall survi-val(OS)rate was 75.0%,5-year survival rate was 42.4%,and the 95% average survival confidence interval was 35.7-55.9 months.(2)The OS rate of children with small age(≤3 years old)was 88.1%(36/42 cases),the ove-rall prognosis was better than that of >3 years old children(35.7%,5/14 cases)(P=0.003).The survival rate of children with complete tumor resection[OS rate was 89.2%(33/37 cases)]was significantly higher than that of the incomplete excision[OS rate was 47.4%(9/19 cases)],and the difference was statistically significant(P=0.001). The prognosis of epithelial type cases was better than that of other types,and the difference was statistically significant (P<0.05),while the fetal type prognosis was the best,and the difference was statistically significant(χ2=8.56,P=0.014).The growth of alpha fetoprotein was negatively correlated with the clinical efficacy and prognosis(r=-0.468, P=0.023).Conclusions Lung is the most common metastatic site of hepatoblastoma,and the marginal lung metasta-sis is more common.With insidious onset and poor prognosis.Therefore,it should be treated with early diagnosis and multidisciplinary therapy to improve prognosis.

Objective To investigate the changes of serum immunoglobulin IgG in peripheral blood of infants aged 0-6 months,and to compare the effects of breast feeding and artificial feeding on the immune function of infants. Methods A total of 90 neonates born from January 2016 to December 2016 were divided into three groups: breast feeding group, mixed feeding group and artificial feeding group. There were 30 newborns in each group.Peripheral blood samples were collected at postnatal 1 d,3 d,7 d, 14 d, 42 d, 3 months and 6 months respectively. Serum levels of IgG were determined by radioimmunoassay, and the contents of each group were compared. T lymphocyte subsets(CD3+, CD4+, CD8+)in peripheral blood at postnatal 6 months were detected. Results The content of IgG in serum of neonatal decreased gradually with the increase of postnatal days.The serum IgG content at postnatal 14 d in the breast feeding group, the mixed feeding group and the artificial feeding group was (95.14 ± 4.55), (90.89±4.35),(91.74±4.19)mg/L respectively,and the breast feeding group was significantly higher than the other two groups,the difference among the groups was statistically significant(F=7.965,P<0.05).The CD8+T lymphocyte cells in the breast feeding group, the mixed feeding group and the artificial feeding group was 0.389 4±0.060 1,0.294 2±0.062 6,0.308 4±0.071 6 respectively,and the breast feeding group was significantly higher than the mixed feeding group and the artificial feeding group,and the difference among the groups was statistically significant(F=4.941,P<0.05).Conclusions Breast feeding can reduce the serum IgG content of infant consumption,slowing the pace of decline,effectively improve the infant's own ability to synthesize IgG,so as to improve infant immunity,promote their healthy growth,it is worthy of clinical application.