Objective To analyze the outcomes and the prognostic factors of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for acute lymphoblastic leukemia (ALL).Method From Feb.2002 to Feb.2014,a total of 95 patients with ALL were treated with alloPBSCT in our hospital.Of these,73 cases obtained the first CR (CR1),11 cases obtained late CR,7 patients were in relapse and 3 patients suffered from primarily refractory disease (PRD) before transplant.The median age was 26 (4-57) years.Conditioning regimens including total body irradiation (TBI)/ etoposide/semustine/cyclophosphamide or busulfan/semustine/cyclophosphamide were used.Matched sibling transplantation was performed on 68 patients,and matched unrelated donor transplantation was performed on 27 patients.Combination of CsA,MTX and low-dose,short-course mycophenolate mofetil was used for graft-versus-host disease (GVHD) prophylaxis.The average fellow-up was 57 months.Result Hematopoietic reconstitution was achieved in all 95 patients.Five-year estimate of overall survival (OS) was 54.3％,disease free survival (DFS) was 51.2％,relapse rate (RR) was 30.2％ and transplant-related mortality (TRM) was 24.0％.The 5 year OS and DFS were significantly longer in patients with CR1 than in late CR and relapse/PRD patients before allo-PBSCT (P＜0.001).There was no significant difference in OS between the two different conditioning regimens.Multivariate analyses revealed that Ⅱ-Ⅳ aGVHD and cGVHD were correlated with higher TRM,CR1 before allo-PBSCT and TBI were associated with a lower RR,and non Ⅱ-Ⅳ aGVHD and CR1 before allo-PBSCT were favorable factors which were associated with OS and DFS.In the patients with DFS≥1 year after allo-PBSCT,DFS and OS were shorter in patients with cGVHD (P =0.008).Conclusion Allo-PBSCT in adult ALL patients should be performed in CR1.Severe acute and chronic GVHD are not associated with improved survival.

OBJECTIVE:To systematically review the efficacy of Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy in the treatment of malignancies,and provide evidence-based reference for clinical treatment. METHODS:Re-trieved from CNKI,CBM,VIP,Wanfang Database PubMed,EMBase,Web of Science,randomized controlled trials (RCT) about Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy(test group)versus radiotherapy or chemothera-py alone(control group) in the treatment of malignancies were collected. Meta-analysis was performed by using RevMan5.3 soft-ware after data extract and quality evaluation by Cochrane 5.1.0. RESULTS:Totally 7 RCTs were enrolled,involving 567 patients. Results of Meta-analysis showed,the effective rate [OR=1.99,95%CI(1.27,3.14),P=0.003] and improvement rate of life quality [OR=2.95,95%CI(1.75,4.97),P<0.001] in test group were significantly higher than control group,cell abnormal rate [OR=0.26,95%CI(0.16,0.41),P<0.001] was lower than control group,the differences were statistically significant. There were no obvi-ous adverse reaction in 2 groups. CONCLUSIONS:Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy is effective in the treatment of malignancies.

Objective To explore the clinical value of dual-phase 99Tcm-MIBI scintigraphy in the localization and diagnosis of secondary hyperparathyroidism (SHPT).Methods A total of 20 patients (8 males,12 females; average age 49.6 years) with uremic SHPT who underwent parathyroidectomy from 2010 to 2013 were retrospectively analyzed.All patients underwent 99Tcm-MIBI SPECT/CT and 19 underwent color Doppler ultrasonography (CDUS).Post-excisional histopathology was considered as the gold standard.The diagnostic efficacies of 99Tcm-MIBI and CDUS for SHPT were calculated.The correlation between T/NT ratio in delayed imaging and the volume of excised parathyroid and the intact PTH (iPTH) were analyzed.x2 test,Pearson or Spearson correlation analysis were used to analyze the data.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 99Tcm-MIBI SPECT/CT and CDUS in the diagnosis of SHPT were 66.67％ (44/66),100％(14/14),100％ (44/44),38.89％(14/ 36),72.50％ (58/80) and 78.19％(43/55),52.38％(11/21),81.13％(43/53),47.83(11/23),71.05％ (54/76),respectively.There were significant differences in specificity and positive predictive value (x2 =9.33,9.26,both P＜0.05),but no significant differences in the sensitivity,negative predictive value and accuracy (x2 =1.97,0.04,0.46,all P＞0.05).T/NT ratio correlated with serum iPTH and parathyroid volume (r=0.638,rs =0.571,both P＜0.05).Conclusions The specificity of 99Tcm-MIBI SPECT/CT is superior to CDUS in the diagnosis of SHPT.Dual-phase 99Tcm-MIBI SPECT/CT could locate the hyperfunctional parathyroid gland and provide the basis for surgical treatment.

Objective To explore new treatment methods for old acromioclavicular dislocation. Methods Twenty-nine cases of old acromioclavicular dislocation were treated with augmenting reconstruction of acromioclavicular ligament by coracoacromial ligament and augmenting reconstruction of coracoclavicular ligament by conjoining tendon with biceps brachii muscle and coracobrachialis muscle in coracoid. Twenty-five cases were followed up with follow-up period of 3-36 months. There were 10 cases in grade Ⅱ and 15 in grade Ⅲ according to classification of Allman. Results Of 25 cases with follow-up, 16 were excellent and 9 satisfactory according to the Lazzcano standard. There were no other complications or dislocations. Conclusions Reconstruction of acromioclavicular and coracoclavicular ligaments for treatment of old acromioclavicular dislocation is an efficient method with advantage of rigid fixation and accords with micro-motion physiological function of acromioclavicular joint.

Objective: To compare the convergent sliding of bilateral pectoral myocutaneous lfap method and conventional method for treating the early stage median sternotomy wound dehiscence in patients after cardiac surgery. Method: A total of 36 relevant patients treated in our hospital from 2010-04 to 2014-04 were studied and they were divided into 2 groups: Conventional group, the patients received sufficient draining and dressing changes followed by interrupted simple suture,n=16 and Convergent sliding group, the patients received convergent sliding of bilateral pectoral myocutaneous lfap,n=20. The clinical conditions after treatment were compared between 2 groups. Results: There were 6 patients received re-suture after the ifrst debridement because of poor healing in Conventional group, no such event happened in Convergent sliding group, P<0.05. All patients were discharged and no death occurred. In Conventional group and Convergent sliding group, the open drainage time were (7.2 ± 3.2) days and (3.3 ± 1.1) days,P<0.05; hospital stay time from the first debridement and suture were (10.4 ± 5.4) days and (8.2 ± 1.9) days,P>0.05; the median hospital stay time from discovering wound problem to wound healing and discharge were 13.0 (10.75, 19.5) days and 12.0 (10.0, 13.0) days, P>0.05. Conclusion: Compared to conventional method, convergent sliding of bilateral pectoral myocutaneous lfap method may obtain the better success rate of wound debridement and suture by shorter time for treating the early stage median sternotomy wound dehiscence in patients after cardiac surgery.

ObjectiveTo study the optimal power of self-made polymeric microcapsules with liquid perfluorocarbon enhancing high intensity focused ultrasound (HIFU) ablation of normal bovine in vitro and the treatment efficacy of HIFU ablation of normal rabbit liver in vivo.Methods The experiment was divided into two parts:the first part was HIFU ablation of bovine in vitro:The bovine was injected different drugs before HIFU ablation to find the optimal power and treatment time.It was divided into four groups:①HIFU + 0.9％ NaCl(NACL) group; (② HIFU + poly( lactic-co-glycolic acid) (PLGA) group; ③ HIFU + perfluorohexane(PFH) group; ④ HIFU + PLGA + PFH group; The second part was HIFU ablation of normal rabbit liver.Similarly,It was also divided into four groups as above.Each group was undergone HIFU ablation with same parameters after ear vein injection of drug.Then the ultrasonographic changes and its value,and the actual situation of liver damage in target areas of each group were observed and compared before and after the ablation area.ResultsIn experiments of vitro bovine,gray scale changes and coagulation necrosis could be seen in the liver in group 2,3,4 with HIFU power of 150 W and treatment time of 2 s.In experiment of normal rabbit liver,the average gray-scale of group 3 and 4 were larger than that in group 1 and 2,the difference was statistically significant (P ＜0.001),and its gray change area gradually reduced with time elapsed.While there was no statistically significant difference between group 3 and 4 ( P ＞0.05).In pathological specimens,there was no significant liver damage in group 1 and 2.There was hemorrhagic necrosis and white coagulation necrosis in group 3 and 4.Conclusions The polymeric microcapsules with liquid perfluorocarbon can effectively enhance the efficacy of HIFU ablation and be used as a good synergist for HIFU.

Objective To investigate the effect of allgeneic hematopoietic stem cell transplantation (allo-HSCT) for β-thalassemia major. Methods Twenty-four β-thalassemia major patients with median age of 4 years (range: 2～15 years), 18 boys and 6 girls, received allo-HSCT.They were classified into class Ⅱ-Ⅲ according to Pesaro thalassemia classification. Twenty-three transplantations were from sibling donor and 1 was from mother, either HLA-identical (n = 23) or HLA-mismatched (5/6) (n = 1). Fifteen patients received bone marrow transplantation (BMT) plus peripheral blood stem cell transplantation (PBSCT), and 9 were subjected to umbilical cord blood transplantation (UCBT). The conditioning regimen consisted of busalphan, cyclophosphamide,fludarabine, plus hydroxyurea before transplantation. Graft-versus-host disease (GVHD) prophylaxis included CsA, methotrexate, antilymphpcute globulin, and mycophenolate mofetil. The median follow-up period was 13 months (range: 3～69). Results Of 24 patients, there were 21 cases (87. 5 %) of disease-free survival, 1 (4. 2 %) transplantation-related death, and 2 cases (8. 3 %) of rejection. Three-year overall survival and disease-free survival rate was 91.7 % and 87. 5 %respectively. The cumulative incidence of grade Ⅱ -Ⅳ acute GVHD and chronic GVHD was 16. 7 %and 20. 3 %, particularly cumulative extensive chronic GVHD was 5. 0 %. Conclusion The sibling donor BMT plus PBSCT is an effective and safe way to treat β-thalassemia major. Cord blood is an important source of hematopoietic stem cells for HSCT. The protocol GVHD prophylaxis of CsA,MTX, ATG with a low-dose and short course of MMF can effectively reduce the incidence of severe acute GVHD, improve the outcome of thalassemia transplantation.

Objective: To analyze clinical characteristics and wound repair methods and effects of patients with upper limb electric burns. Methods: Medical records of 136 patients with upper limb electric burn who met the inclusion criteria and hospitalized in our unit from January 2015 to March 2019 were retrospectively analyzed. Proportion in patients with electric burns in the same period, gender, age, admission time, categories, injury causes, injury voltage, burn area and depth of upper limb, simultaneous injury of both upper limbs, and early wound treatment measure of patients with upper limb electric burn were recorded. The main repair methods of each affected limb were classified and recorded. The overall efficacy of the patients was recorded, including postoperative wound complications and healing condition. The patients repaired with distal pedicled flaps and those with free flaps were followed up for 3 to 6 months. The survival rate of flaps were recorded, the function of affected limbs after operation was evaluated, and the satisfaction degree of patients was investigated by Curative Effect Score Table. The amputation rate, age, and burn area of upper limbs of patients caused by high-voltage and low-voltage electricity were compared. Data were processed with Wilcoxon rank sum test, chi-square test, or Fisher′s exact probability test. Results: (1) The number of upper limb electric burn patients accounted for 88.3% of 154 patients with electric burns hospitalized in the same period, including 117 males and 19 females, aged 1 year and 2 months to 72 years [(34±18) years], admitted 1 h to 48 d after injury, including 51 electricians, 32 rural migrant workers, 31 students and preschool children, and 22 patients belonging to other categories. Patients of the first two categories were mainly injured by work accidents, and those of the latter two categories mainly suffered from touching power source or power leakage. Among all the patients, 75 cases were injured by high-voltage electric burn, and 61 cases were injured by low-voltage electric burn, with burn area of upper limb from 0.2% to 16.0% [2% (1%, 5%)] total body surface area (TBSA) and area of wounds deep to bone from 0.2% to 15.0% [2% (1%, 5%)] TBSA. Two upper limbs in 54 cases were simultaneously injured, accounting for 39.7%. Early fasciotomy was performed for 73 limbs. (2) Thirteen affected limbs were treated with dressing change, 2 affected limbs were sutured directly after debridement, 56 affected limbs were repaired by skin grafting, 12 affected limbs were repaired by local flap, 45 affected limbs were repaired by distal pedicled flap, 22 affected limbs were repaired by free flap, and 40 affected limbs were amputated (accounting for 21.1%). (3) One case died of pulmonary infection, sepsis, and multiple organ failure after operation, and the rest patients were all cured. One case with avulsion of abdominal flap was repaired by skin grafting after dressing change. The anterolateral thigh flap in one case necrotized after transplantation, which was replaced by pedicled abdominal flap. Seven cases had small erosion on the pedicle or margin after transplantation of abdominal flap and were healed by dressing change. Six cases had local bruising at the distal end after transplantation of abdominal flap and were healed after conservative treatment such as hyperbaric oxygen. The other flaps survived well. (4) The survival rate of distal pedicled flap grafting was 97.8% (44/45), which was close to that of free flap grafting (95.5%, 21/22, P>0.05). The function recovery of affected limb after free flap grafting was better than that of distal pedicled flap grafting (Z=-3.054, P<0.01), but their satisfaction degree of patients was similar (Z=-0.474, P>0.05). (5) Patients with high-voltage electric burn had higher amputation rate, older age, and larger upper limb burn area than those with low-voltage electric burn (χ²=4.743, Z=-2.801, -6.469, P<0.05 or P<0.01). Conclusions Upper extremity electric burn often occurs in children, electricians, and rural migrant workers with high rate of amputation. Teachers and parents should strengthen safety education for children and manage power source of life well. Workers should improve safety awareness and operate standardly. Fasciotomy for relaxation should be performed for electric burn wound as soon as possible, and flap grafting can effectively repair wound after early debridement. The function recovery of affected upper limb repaired with free flap grafting is better.

Objective:To investigate the clinicopathological characteristics and the risk factors of lymph node metastasis(LNM) of undifferentiated early gastric cancers(EGCs) in elderly patients.Methods:The elderly patients(≥65 years old) who underwent radical gastrectomy with lymph node dissection and were diagnosed as having EGCs in Peking Union Medical College Hospital from January 2010 to August 2019 were included. The clinicopathological characteristics of undifferentiated EGCs(namely signet ring cell EGCs and poorly differentiated EGCs) were compared with those of differentiated EGCs, and the risk factors for LNM of undifferentiated EGCs in the elderly patients were analyzed with logistic regression.Results:Data of 165 elderly EGCs patients were reviewed, including 82 undifferentiated EGCs (11 signet ring cell and 71 poorly differentiated) and 83 differentiated EGCs. The overall LNM incidence was 9.1% (15/165) in elderly EGCs patients, 4.8% (4/83) and 13.4% (11/82) in differentiated and undifferentiated EGCs, respectively. Of all undifferentiated EGCs, the LNM incidence in poorly differentiated EGCs was 15.5%(11/71), and none of 11 signet ring cell EGCs had LNM. Depth of tumor invasion( P=0.019), tumor size( P=0.006), combination of ulceration( P=0.006), depressed gross type( P=0.003) were found to be associated with LNM in elderly undifferentiated EGCs patients under univariate analysis. Multivariate analysis revealed that submucosal invasion( OR=11.98, 95% CI: 1.17-122.84, P=0.037) and tumor size >2 cm ( OR=11.95, 95% CI: 1.88-76.07, P=0.009) were independent risk factors for LNM in elderly undifferentiated EGCs patients. All elderly undifferentiated EGCs patients who met the criteria for expanded indications had no LNM. Conclusion:Submucosal invasion and tumor size >2 cm are independent risk factors for LNM in elderly undifferentiated EGCs patients. The elderly EGCs patients who met the criteria for expanded indications are suitable for endoscopic submucosal dissection.

Objective:To evaluate the influence of a moisturizer containing oat kernel oil for xeroderma and water content of the stratum corneum in children.Methods:From September to December 2022, 30 children with xeroderma were treated in the Dermatology Department of Tongzhou Maternal and Child Health Hospital of Beijing; 13 were males and 17 were females, and the age was 7.33±2.63 years. This was a single-center self-controlled trial. All children applied the moisturizer on the dry skin of the bilateral limbs two time per day for 14 days, and were followed up at 7 days and 14 days. Efficacy was evaluated according to the water content of the stratum corneum, visual scale, xerosis severity scale (XSS), Specified Symptom Sum Score (SRRC), Visual Analog Scale (VAS) and so on. and side-reactions were recorded.Results:After application of the moisturizer, the median of water content in the stratum corneum was 49.00 (33.83, 87.25), 48.84 (32.58, 100.34) at 7 d and 14 d respectively, showing significant increases compared with that at baseline (median 26.51 (16.00, 47.75) ( Z=-3.075, Z=-2.911, P<0.01). The visual scale, XSS, SRRC and VAS showed that compared with the baseline at 7 d, 14 d, the skin dryness and pruritus scores improved significantly ( Z=-4.424, -4.150, -3.943, -4.400; Z=-4.744, -4.409, -4.260, -4.409, P<0.01). Conclusions:The application of this moisturizer containing oat kernel oil could effectively improve skin dryness and the water content of the stratum corneum without serious adverse reactions.