Purpose To explore the diagnostic value of dif-ferent fluorescence in situ hybridization(FISH)signal types and chromosomal karyotyping analysis in ETV6/RUNX1-positive B-cell acute lymphoblastic leukemia(B-ALL).Methods Clini-cal data of 164 newly diagnosed ETV6/RUNX1-positive B-ALL patients were collected for retrospective analysis of chromosomal karyotyping and FISH.Results Among the 164 patients,163 positive cases were detected by FISH,among them the classic 2F1R1G signal type was found in 61 cases,and 102 cases showed non-classic signal types,with 2F1G and 1F1R2G signal types being the most common,indicating ETV6 deletion.Among them,the classic 2F1R1G signal type was found in 61 cases,and 102 cases showed non-classic signal types,with 2F1G and 1F1R2G signal types being the most common,indicating ETV6 deletion.Among the 125 children who could undergo karyoty-ping analysis,106 had a normal karyotype and 19 had an abnor-mal karyotype,with no detection of t(12;21)translocation.Conclusion FISH technology has high sensitivity in detecting ETV6/RUNX1 fusion genes,and it often manifests as non-clas-sic signal types,including ETV6 deletions.Chromosomal karyo-typing analysis helps to identify complex karyotypes and polyploidy but is not conducive to detecting t(12;21)fusion.Therefore,both FISH signal types and karyotyping analysis play indispensable roles in ETV6/RUNX1-positive B-ALL.

Objective:To explore the efficacy and safety of immunoneoadjuvant therapy with pembrolizumab combined with chemotherapy in locally advanced resectable hypopharyngeal squamous cell carcinoma patients.Methods:This study was a prospective, single arm, single center clinical study that was opened for enrollment in April 2021. Patients who met the inclusion criteria at the Cancer Hospital of the Chinese Academy of Medical Sciences were treated with neoadjuvant therapy of pembrolizumab combined with cisplatin and paclitaxel, and after treatments, received surgery and postoperative adjuvant therapy. The main endpoint of this study was postoperative pathological complete response (pCR), and other observations included adverse reactions and long-term prognoses of patients after neoadjuvant therapy.Results:By September 2023, a total of 23 patients who underwent neoadjuvant therapy and surgery were enrolled in the study and all patients were males aged 49-74 years. All patients were locally advanced stage, including 3 patients in stage Ⅲ and 20 patients in stage Ⅳ. There were 12 cases of primary lesions with posterior ring involvement accompanied by fixation of one vocal cord and 20 cases of regional lymph node metastases classified as N2. Eighteen cases received a two cycle regimen and 5 cases received a three cycle regimen for neoadjuvant therapy. The postoperative pCR rate was 26.1% (6/23), with no surgical delay caused by adverse drug reactions. The laryngeal preservation rate was 87.0% (20/23). Pharyngeal fistula was the main surgical complication, with an incidence of 21.7% (5/23). The median follow-up time was 15 months, and 3 patients experienced local recurrence.Conclusions:The immunoneoadjuvant therapy of pembrolizumab combined with chemotherapy has a high pCR rate in locally advanced resectable hypopharyngeal squamous cell carcinoma, with increased laryngeal preservation rate and no significant impact on surgical safety.

Objective In this study,we analyzed the transcriptome sequences of Kupffer cells exposed to simulated microgravity for 3 d and conducted biological experiments to determine how microgravity initiates apoptosis in Kupffer cells. Methods Rotary cell culture system was used to construct a simulated microgravity model.GO and KEGG analyses were conducted using the DAVID database.GSEA was performed using the R language.The STRING database was used to conduct PPI analysis.qPCR was used to measure the IL1B,TNFA,CASP3,CASP9,and BCL2L11 mRNA expressions.Western Blotting was performed to detect the level of proteins CASP3 and CASP 9.Flow cytometry was used to detect apoptosis and mitochondrial membrane cells.Transmission electron microscopy was used to detect changes in the ultrastructure of Kupffer cells. Results Transcriptome Sequencing indicated that simulated microgravity affected apoptosis and the inflammatory state of Kupffer cells.Simulated microgravity improved the CASP3,CASP9,and BCL2L11 expressions in Kupffer cells.Annexin-V/PI and JC-1 assays showed that simulated microgravity promoted apoptosis in Kupffer cells.Simulated microgravity causes M1 polarization in Kupffer cells. Conclusion Our study found that simulated microgravity facilitated the apoptosis of Kupffer cells through the mitochondrial pathway and activated Kupffer cells into M1 polarization,which can secrete TNFA to promote apoptosis.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Objective:To meet the demand of medical system for talents, the training of medical students' competency has become a new direction of medical education. This study aims to evaluate the effectiveness of training quality in medical graduates through the competency scale.Methods:Taking "attitude", "skill" and "knowledge" as the evaluation dimensions, the competency development was divided into four levels of "state", "explain", "apply" and "transfer", and we proposed the competence concept of "A.S.K.-SEAT" and formulated an evaluation scale. Questionnaires and behavior event interviews (BEI) were conducted in medical graduates of Shantou University in 2018. Reliability and validity of the questionnaire were evaluated and current situation of different competency items were analyzed.Results:A total of 155 questionnaires were collected with good reliability and validity, and 15 graduates participated in BEI. A total of 21 A.S.K. competency items (including five basic competency items and two discriminating competency items) and SEAT textual descriptions were finally established.Conclusion:A.S.K.-SEAT scale can provide valid references for the competency evaluation of medical graduates.

Objective:To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups.Methods:All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96 Gy (27.56-76.00 Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250 mg (100-570 mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan- Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results:The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup ( P=0.009), and there was an increasing trend in patients aged≤55 years and female patients ( P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T 4( P=0.048), N 3( P=0.005), non-IMRT treatment ( P=0.001) and hypopharyngeal carcinoma ( P=0.004) subgroups, there was an increasing trend in male ( P=0.064), high-and moderate-grade squamous cell carcinoma ( P=0.076) and non-surgical treatment subgroups ( P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years ( P=0.017 and 0.039), women ( P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma ( P=0.006 and 0.022), N 3 stage ( P=0.001 and 0.017), non-surgical treatment ( P=0.007 and 0.033) and non-IMRT treatment subgroups ( P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma ( P=0.022). Conclusion:Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N 3 stage, non-surgical treatment and non-IMRT treatment patients.

Objective:To investigate the effect of different collection procedures of COBE Spectra blood cell separator on collection of autologous peripheral blood hematopoietic stem cells in children.Methods:The clinical data of 10 children who were collected autologous peripheral blood hematopoietic stem cells with the monocytes (MNC) or fully automatic peripheral blood stem cells (AutoPBSC) programs of COBE Spectra blood cell separator in the Children's Hospital of Soochow University from July 2018 to January 2020 were retrospectively analyzed, and the children were 3-10 years old with the body weight of 15-31kg. There were 5 cases in MNC group and 5 cases in AutoPBSC group.Results:Autologous peripheral blood hematopoietic stem cells were collected for 25 times, with an average of 2.5 times (1-4 times), 10 times in MNC group and 15 times in AutoPBSC group. The number of stem cells [the median (the range)] before collection was 19.3/μl (3.5-129.0/μl) in MNC group and 9.4/μl (2.2-38.7/μl) in AutoPBSC group. The number of CD34 + cells of single collection was 1.22×10 6/kg (0.18×10 6/kg-6.30×10 6/kg) in MCN group and 0.85×10 6/kg (0.13×10 6/kg-2.64×10 6/kg) in AutoPBSC group. Correlation analysis showed that there was a positive correlation between the number of collected CD34 + cells and the number of stem cells before collection (AutoPBSC group: r=0.921, P < 0.01; MNC group: r=0.833, P=0.003). The collection efficiency was 5.4% (3.4%-11.2%) in MNC group and 10.4% (4.7%-13.9%) in AutoPBSC group, and the difference was statistically significant ( Z=2.163, P = 0.031). Conclusion:The collection effect of children's autologous peripheral blood hematopoietic stem cells with COBE Spectra blood cell separator AutoPBSC program is better than that with MNC program.

Objective:To predict and investigate the potential risk factors for the upper mediastinal metastasis of papillary thyroid carcinoma (PTC).Methods:This study was a prospective cohort study. The admission criteria were patients with untreated thyroid cancer diagnosed in Cancer Hospital, Chinese Academy of Medical Sciences from December 2013 to December 2015, and positive lymph node (cN1, including cN1a and cN1b) was diagnosed by ultrasound. All patients underwent neck to thorax enhanced Computed Tomography (CT) examination preoperatively. All patients with suspected upper mediastinal lymph node metastasis experienced suspicious regional dissection, and those who had not undergone surgery and whose postoperative pathology was non-papillary thyroid carcinoma were excluded. Kaplan-Meier method was selected for survival analysis and all the factors were analyzed by multivariate Logistic regression.Results:Of the 248 patients, 54 were prompted by postoperative pathology for upper mediastinal lymph node metastasis, 86 cases were phase T1, 94 cases were phase T2, 17 cases were phase T3 and 51 cases were phase T4, 21 cases were N1a phase and 227cases were N1b phase. There was a statistically significant difference in the T-phase and N-phase between the upper mediastinal lymph node metastasis group and no upper mediastinal lymph node metastasis group( P<0.05). Univariate analysis showed that among the preoperative relevant factors, ultrasound tumor length> 2 cm, ultrasound tumor bilaterally, CT double neck lymph node metastasis, increased thyroglobulin (Tg), and increased anti-thyroglobulin antibody (ATG) were all risk factors for upper mediastinal lymph node metastasis(all P<0.05). Among the postoperative factors, bilateral tumor, double neck lymph node metastasis, tumor invasion of the recurrent laryngeal nerve, trachea, esophagus or larynx, T3 staging, T4 staging, total number of metastatic lymph nodes>10, the number of metastatic lymph nodes in level Ⅵ>3 and >6, the proportion of metastatic lymph nodes in level Ⅵ>1/2, the number of metastatic lymph nodes in level Ⅳ> 5 and metastatic proportion >1/3 are risk factors for metastasis of upper mediastinal lymph node(all P<0.05). Multivariate analysis showed that CT indicated double neck lymph node metastasis, increased Tg, increased ATG, the proportion of metastatic lymph nodes in level Ⅵ >1/2, and in level Ⅳ>1/3 are independent risk factors for upper mediastinum lymph node metastasis(all P<0.05). The 5-year recurrence-free survival rates of the upper mediastinal lymph node metastasis group and the no upper mediastinal lymph node metastasis group were 92.3% and 94.8% respectively, and the difference was not statistically significant( P=0.307). Conclusions:For preoperative ultrasound considering the presence of lymph node metastases, enhanced neck to thorax CT should be performed routinely. When bilateral cervical lymph node metastasis is determined by CT, or endocrine tests suggest abnormally increased antibodies, attention should be paid to the upper mediastinal lymph nodes metastasis. In the course of neck dissection, if more lymph node metastases in level Ⅵ and level Ⅳ were detected, surgeons should be vigilant of the upper mediastinal metastasis. The prognosis of patients underwent complete mediastinal dissection is not significantly different from that of patients without mediastinal metastasis.

Objective:To explore the risk factors for lateral neck recurrence of central lymph node metastasis (CLMN) in papillary thyroid cancer (PTC), and to construct a model to predict the recurrence.Methods:The records of 245 consecutive PTC patients with CLMN underwent surgical treatment from 1996 to 2009 in our department were retrospectively reviewed. The threshold value of CLNM number is determined by ROC curve. The risk factors for lateral neck recurrence were determined by using Cox regression model. The identified risk factors were incorporated into a nomogram model to predict the risk of lateral neck recurrence.Results:A total of 245 patients were enrolled in the study, among them, 32 cases occurred lateral neck lymph node recurrence and 4 cases were dead of thyroid carcinoma. Multivariate analysis revealed that primary tumor size, extrathyroidal extension, the number of metastatic CLNM >3 were independent risk factors of lateral neck recurrence ( P<0.05), lateral neck recurrence was a risk factor of disease-free survival( P<0.05). The nomogram model of predicting the lateral neck recurrence was further established based on the above 3 independent risk factors, the area under the receiver operating characteristic (ROC) curve of which was 0.790. Conclusions:The nomogram model based on the independent risk factors of LN recurrence can be helpful to screen the papillary thyroid carcinoma patients with high risk of lateral neck recurrence, and provide more guidance for clinical treatment.

Objective:To predict and investigate the potential risk factors for the upper mediastinal metastasis of papillary thyroid carcinoma (PTC).Methods:This study was a prospective cohort study. The admission criteria were patients with untreated thyroid cancer diagnosed in Cancer Hospital, Chinese Academy of Medical Sciences from December 2013 to December 2015, and positive lymph node (cN1, including cN1a and cN1b) was diagnosed by ultrasound. All patients underwent neck to thorax enhanced Computed Tomography (CT) examination preoperatively. All patients with suspected upper mediastinal lymph node metastasis experienced suspicious regional dissection, and those who had not undergone surgery and whose postoperative pathology was non-papillary thyroid carcinoma were excluded. Kaplan-Meier method was selected for survival analysis and all the factors were analyzed by multivariate Logistic regression.Results:Of the 248 patients, 54 were prompted by postoperative pathology for upper mediastinal lymph node metastasis, 86 cases were phase T1, 94 cases were phase T2, 17 cases were phase T3 and 51 cases were phase T4, 21 cases were N1a phase and 227cases were N1b phase. There was a statistically significant difference in the T-phase and N-phase between the upper mediastinal lymph node metastasis group and no upper mediastinal lymph node metastasis group( P<0.05). Univariate analysis showed that among the preoperative relevant factors, ultrasound tumor length> 2 cm, ultrasound tumor bilaterally, CT double neck lymph node metastasis, increased thyroglobulin (Tg), and increased anti-thyroglobulin antibody (ATG) were all risk factors for upper mediastinal lymph node metastasis(all P<0.05). Among the postoperative factors, bilateral tumor, double neck lymph node metastasis, tumor invasion of the recurrent laryngeal nerve, trachea, esophagus or larynx, T3 staging, T4 staging, total number of metastatic lymph nodes>10, the number of metastatic lymph nodes in level Ⅵ>3 and >6, the proportion of metastatic lymph nodes in level Ⅵ>1/2, the number of metastatic lymph nodes in level Ⅳ> 5 and metastatic proportion >1/3 are risk factors for metastasis of upper mediastinal lymph node(all P<0.05). Multivariate analysis showed that CT indicated double neck lymph node metastasis, increased Tg, increased ATG, the proportion of metastatic lymph nodes in level Ⅵ >1/2, and in level Ⅳ>1/3 are independent risk factors for upper mediastinum lymph node metastasis(all P<0.05). The 5-year recurrence-free survival rates of the upper mediastinal lymph node metastasis group and the no upper mediastinal lymph node metastasis group were 92.3% and 94.8% respectively, and the difference was not statistically significant( P=0.307). Conclusions:For preoperative ultrasound considering the presence of lymph node metastases, enhanced neck to thorax CT should be performed routinely. When bilateral cervical lymph node metastasis is determined by CT, or endocrine tests suggest abnormally increased antibodies, attention should be paid to the upper mediastinal lymph nodes metastasis. In the course of neck dissection, if more lymph node metastases in level Ⅵ and level Ⅳ were detected, surgeons should be vigilant of the upper mediastinal metastasis. The prognosis of patients underwent complete mediastinal dissection is not significantly different from that of patients without mediastinal metastasis.