BACKGROUND:Acute myeloid leukemia after liver transplantation is a rare complication with high mortality. OBJECTIVE:To study the clinical features of acute myeloid leukemia after liver transplantation. METHODS:One case of acute promyelocytic leukemia after liver transplantation was reported, and literatures were reviewed. RESULTS AND CONCLUSION:Case presentation was post-odontectomy bleeding with associative abnormal coagulation test at 85 months after liver transplantation. Routine blood test, bone marrow test and chromosome analysis and examination diagnosed as acute promyelocytic leukemia and promyelocytic leukemia/RARαpositive chimeric gene, and clearly diagnosed as acute promyelocytic leukemia combined with disseminated intravascular coagulation. The patient received fresh frozen plasma transfusion to correct the abnormal coagulation, and then received induction chemotherapy with retinoic acid, arsenic trioxide and daunorubicin to obtain bone marrow complete remission. The patient was treated with daunorubicin combined with cytarabine and mitoxantrone combined with cytarabine regimens after remission induction to consolidate the chemotherapy for two courses of treatment, and then subsequently subjected to arsenous acid chemotherapy, and the bone marrow was sustained for remission. During chemotherapy, the dose and type of immunosuppressive agents were adjusted, and the patient had stable liver function without serious infection or complications. The results indicate that acute myeloid leukemia is common and often occurs after liver transplantation. When the patient displays hematological abnormality, acute promyelocytic leukemia should be considered. Early diagnosis and treatment can reduce the mortality.

Objective To investigate the CT manifestations of recto-endometriosis. Methods Three pathologically proved cases of recto-endometriosis were reported, the CT features and clinical manifestations were investigated retrospectively with review of literatures. Results The patients were all menstruating females (28, 34, and 45 years old, respectively), and anal pain emerged during menses in one case. Rectal examination revealed stiff immobile mass along the rectal wall in all three cases. All the cases showed solid masses on CT scan with moderate enhancement after contrast administration. Two of them confined to the rectal walls, another involved the rectum and peri-rectal aspect. One case was misdiagnosed as well-differentiated adenocarcinoma of rectum in frozen section by biopsy specimen.Conclusion A solid mass was always found in recto-endometriosis. No characteristic CT feature was manifested. Attention should be paid to the differentiation from rectal tumors when making the diagnosis.

Objective To report the clinical experience of extracorporeal membrane oxygenation (ECMO)in the emergency management of fulminant myocarditis.Methods The patient,an 11 year-old boy,had fever for 4 day and abdominal pain,vomiting for 1 day and anuria for 12 hours.Electrocardiogram showed Ⅲ atrial-ventricular block,multifocal ventricular rhythm,bundle branch block,convulsivum multifocal ventricular tachycardia,extensive low voltage,ST-T elevation at lead Ⅰ,AVR,V1,V2,V3;and there were ST-T intrusion,T wave inversion at lead Ⅱ,Ⅲ,AVR,AVF,V4～5.Blood creatine kinase was 2 161 U/L,reatine kinase isoenzyme 109 U/L,α-hydroxybutyrate dehydrogenase 612 U/L,lactate dehydrogenase 696 U/L,troponin Ⅰ 22.1 U/L.Echocardiogram showed right atrium 4.4 mm,right ventricular 2.3 mm,severe tricuspid valve regurgitation,left ejection fraction 33％,left ventricular fractional shortening 15％,ventricular wall motion dyssynchrony.Blood lactate was 4.0 mmol/L.The patient's condition was still unstable after using dobutamin,dopamine,milrinone,furosemide,large dose methylprednisolone,intravenous human immunoglobin,phosphocreatine and so on.ECMO was used for cardio-pulmonary support.It is necessary to monitoring the consciousness,temperature,heart rate,respiration,blood pression,SaO2,urinary volume,ariterial blood gas,blood electrolytes,blood lactate,blood glucose,liver function,renal function,blood routine,activated clotting time(ACT),lower extremity blood supply and so on.ACT was maintained at 160～200 s.Heparin was used persistently[5～10 U/(kg·min)].Results ECMO system had been successfully used for 7 days.The cardiac function of the patient was improved significantly.There was no complication,such as hemorrhage,infection,and embolism.Heart arrest in the patient occurred three times,ventricular fibrillation and ventricular flutter occurred one time respectively during ECMO.The rhythm was recovered by electric defibrillation and antiarrhythmic drugs.On day 20,the patient was discharged.At the time of hospital discharge,the patient demonstrated good activity,with normal myocardial enzymes.The echocardiogram showed the size of the cardiac chambers and the contractile function of the myocardia were normal.Electrocardiogram showed Ⅰ degree atrial-ventricular block,complete right bundle branch block.Two weeks later,the electrocardiogram demonstrated complete right bundle branch block.Echocardiogram showed septal thickening(0.9 cm).Two months later,the electrocardiogram was just as that of two weeks before.Echocardiogram showed septal thickening(0.7 cm).The children had no symptom after he was discharged and acted without limitation.Conclusion ECMO is a kind of effective treatment for fulminant myocarditis.The key to desirable therapeutic effect is the timing of its application.

Objective To explore imaging features of Zinner syndrome.Methods Eight male patients with clinically diagnosed Zinner syndrome performed abdominal and pelvic CT and /or MRI scan.The radiological data was studied retrospectively.Results Eight cases showed seminal vesicle cyst with ipsilateral renal agenesis on CT and/or MR imaging ( left side, n =5; right side, n =3).The maximal diameter of seminal vesicle cysts varied from 4.2 to 7.0 cm, and appeared as oval cystic lesion with irregular contour or tube-like dilatation , which appeared low density on CT image and hypo-or hyperintensity on T 1 WI and hyperintensity on T 2 WI.Bladder compression was found in 6 cases.Fuild-fuild level in the cysts was seen in 2 cases.Remnants of ureter structure were seen in only 1 case.There was no other accompanying abnormality of urinary system.Conclusions Zinner syndrome presents with characteristic imaging features , and the key issue is differential diagnosis of seminal vesicle cysts.

Objective:To investigate the clinical effect of dexamethasone combined with urokinase on the tuberculous pleurisy.Methods:From August 2013 to May 2016,190 cases of tuberculous pleurisy patients in our hospital were selected.All the patients were randomly divided into the observation group and control group with of 95 patients in each group,both groups were treated with anti tuberculosis treatment,the control group was given urokinase treatment,the observation group was given dexamethasone combined with urokinase treatment,both groups were treated for 1 month.After treatment,the total effective rate,incidence of adverse reactions,total drainage time of pleural effusion,total amount of pleural effusion,thrombin time and prothrombin time of two groups were compared.Results:All patients were well tolerated with injection during the treatment and there was no severe complication after treatment;the total effective rates in the observation group and the control group were 88.4％ and 72.6％,which was significantly higher in the observation group than that of the control group (P＜0.05).The total drainage time and total amount of pleural effusion in pleural effusion in the observation group were 7.56± 2.44 d and 2867.33± 456.10 mL,the control group were 9.44± 2.89 d and 1989.92± 444.20 mL,the total drainage time in the observation group was significantly shorter than that of the control group,and the total amount of pleural effusion was significantly higher than that of the control group(P＜0.05).After treatment,the pleural effusion thrombin time and prothrombin time in both groups were significantly higher than those before treatment (P＜0.05),which were higher in the observation group than those of the control group (P＜0.05).Conclusion:Dexamethasone combined with urokinase could prolong the thrombin time and prothrombin time,shorten the time of drainage of pleural effusion,increase the pleural effusion amount,with good safety and clinical effect in the treatment of tuberculous pleurisy.

Objective To explore imaging findings and pathological features of ovarian collision tumors. Methods A retrospective analysis of preoperative imaging findings was performed in 8 female patients with surgical-pathological proven ovarian collision tumors. CT scans were performed in 5 cases, both CT and MRI were performed in 2 cases, and non-enhanced MR scans were performed in 1 pregnancy woman. Imaging results were compared with pathologic findings. Results Ovarian collision tumors in the eight patients consisted of 2 types tumors, originated from different ovarian tissues including surface epithelial cells, germ cell, or sex cord-stromal cell. Of the 8 ovarian collision tumors, 5 were located in the left ovary, and 3 in the right ovary. Ovarian collision tumors consisted of surface epithelial tumor and germ cell tumor (n=6) including mucinous cystadenoma and teratoma (n=4), mixed cystadenoma and teratoma (n=1), and serous cystadenoma and struma-ovarii (n=1). Ovarian collision tumors in two cases consisted of surface epithelial tumor and sex cord-stromal tumor, and were mucinous cystadenoma and fibroma, respectively. Imaging findings included:all tumors in the 8 cases presented big or huge multiple complicated cystic mass with 9 to 26 cm in diameter. Germ cell tumor or sex cord-stromal tumor in collision tumor was smaller and located inside the tumor (n=3) and on the tumor wall (n=5). The boundary between two types of tumors in ovarian collision tumor was distinct and clear. Typical imaging features and densities (signals) of different tumors in ovarian collision tumors can be found on CT or MRI. Conclusions Ovarian collision tumors has some specific imaging and pathological characteristics. Imaging examination is helpful for most accurate diagnosis of ovarian collision tumors.

Objective To explore the expressions and distributions of glial cell line -derived neurotrophic factor (GDNF)and itstyrosine kinase receptor RET in the terminal rectums of fetal rats with congenital anorectal malfor-mations (ARM)at different gestationalage,and to explore their effects on the enteric nervous system in the terminal rectum of ARMfetal rats.Methods Thirty -five SD pregnancy rats were divided into a saline group (n =1 0)and an ethylenethiourea experiment group (n =25)by simple randomized study.The fetal rats were removed from the pregnant rats at the gestational 1 6 d,1 8 d and 20 d.The fetal rats were divided into the saline control group,the ethylenethiourea control group (fetal rats without ARM)and the ethylenethiourea malformation group (ARM fetal rats)by the naked eye and dissecting microscope.HE staining was used to observe the morphology and the intestinal ganglion cells in the terminal rectum were counted.The immunohistochemical staining and Western blot methods were used to observe the distributions of GDNF and RET in the rectum at the gestational 1 6 d,1 8 d and 20 d.The quantitative real -time poly-merase chain reaction (qRT -PCR)was used to detect the expression of GDNF mRNA in the fetal rats in the terminal rectum at the gestational 1 6 d,1 8 d and 20 d.Results HE staining:the development of anorectal terminal in 3 groups of fetal rats was unclear at the gestational 1 6 d.A small amount of scattered nerve plexuses were observed in the muscu-lar layer.The nuclei were small and sparse.The axons and cytoplasms were less.The serosal layer,muscular layer,sub-mucosa,mucosal layer and glands in the terminal rectum were gradually clear in the saline control group and the ethyle-nethiourea control group at the gestational 1 8 d and 20 d.The intermuscular submucosal nerve plexuses increased gra-dually (1 1 .400 ±3.1 34 and 1 1 .200 ±3.425 at the gestational 1 8 d;66.1 00 ±4.954 and 67.600 ±5.481 at the gesta-tional 20 d).While,the layer was unclear in the ethylenethiourea malformation group and the nerve plexus was less (7.800 ±1 .989 at the gestational 1 8 d,and 25.200 ±3.048 at the gestational 20 d),and the difference was statistical-ly significant compared with 2 control groups (F =7.591 ,271 .833,all P <0.05).Immunohistochemistry satning:the expressions of GDNF and RET in all layers of the intestinal wall in the 3 groups of fetal rats were unclear at the gesta-tional 1 6 d and only a few positive cells were observed.The GDNF and RET were expressed in the mucosal layer and submucosa of the terminal rectum as well as intermuscular nerve plexus in the saline control group and the ethylene-thioured control group at the gestational 1 8 d and 20 d.With the continuous development of the embryo,their expression intensities were gradually increased.The expressions of GDNF and RET positive cells were decreased gradually in the ethylenethiourea malformation group.The difference was significant statistically compared with 2 control groups (all P <0.05).qRT -PCR:the expressions of GDNF mRNA showed no statistical difference among 3 groups at the gestational 1 6 d (P >0.05);the expressions of GDNF and RET protein were 1 03.624 ±27.533 and 1 05.1 84 ±1 9.634 at the ges-tational 1 8 d;1 51 .496 ±33.622 and 1 50.738 ±21 .423 at the gestational 20 d in 2 control groups.Compared with the ethylenethiourea malformation group (79.1 69 ±1 1 .697 at the gestational 1 8 d;94.873 ±1 1 .309 at the gestational 20 d),and the difference were statistically significant (all P <0.05).Conclusions The expressions of GDNF and its tyrosine kinase receptor RET had a certain temporal correlation in the terminal rectum of normal fetal rats at different gestational ages and ARM.Moreover,the abnormal expressions of GDNF and its tyrosine kinase receptor RET in the dis-tal rectum of ARMfetal rats can affect the development of enteric nervous system.

AIM:To evaluate the antitumor effect of caffeic acid Ge on U14 tumor bearing mice.METHODS:The tumor inhibitory ratios of caffeic acid Ge on the growth of U14 in mice was observed.Apoptosis morphological transformation of U14 cells induced by caffeic acid Ge was detected by electronic scan microscope and MG-P staining.Alteration of cell cycle was analyzed by flow cytometry.Apoptosis-related protein levels of Bax and Bcl-2 were determined by immunity histochemistry technology.MTT assay was applied to study the antitumor activities of caffeic acid Ge in U14 cell lines in vitro.RESULTS:Tumor inhibitory rates in caffeic-acid Ge groups were 38.50%,47.17% and 64.02%(from low dose to high dose)(P

Objective To investigate whether problem-based learning (PBL) is suitable for medical imaging and whether PBL is more enlightening than lecture-based learning (LBL) mode in teaching of medical imaging.Methods Thirty-two students of clinical medicine specialty in Sun Yat-sen University were selected as teaching objects and were divided into 6 groups (5 students in four groups and 6students in 2 groups).Chapters of urinary and digestive system were taught by PBL mode while the rest chapters by LBL mode.Questionnaires were handed out to teachers and students by Email after class and the valid questionnaires were analyzed qualitatively.Results Thirty-one students and 5 teachers thought they were suitable for PBL teaching; 30 students and 5 teachers were willing to continue PBL.Thirty-one students and 5 teachers thought that PBL mode could let students learn more knowledge and was more revealing.Twenty-three students thought PBL teaching spent too much time can not promote in all chapters.Three teachers worried that PBL mode would cause poor organization form and teaching plans.Conclusions PBL is suitable for medical imaging teaching.PBL could let students learn more knowledge and is more revealing compared with LBL,however,PBL is time-consuming and laborious,therefore LBL and PBL should be combined.

Objective To evaluate the reliability of Pain Vision method for assessment of labor pain.Methods Eighty-nine nulliparous parturients who were at full term and at the latent period of the first stage of labor,aged 19-31 yr,weighing 55-85 kg,were enrolled in this study.The degree of labor pain was assessed using Pain Vision method and VAS.Pain degree is calculated from two parameters,current perception threshold and pain compatible electrical current by using a somatosensory evoked potential stimulator.The former parameter was defined by the lowest electrical current detected; the latter parameter defined by the electrical current judged as being compatible with the intensity of ongoing pain.Linear correlation of VAS scores with pain degree was analyzed.Results There was no correlation between pain degree and VAS scores,and the correlation coefficient was 0.206 (P ＞ 0.05).Conclusion Pain Vision method can not be applied for objective assessment of labor pain.