Background:Prognosis of early colorectal carcinoma( ECC)is well because of low rate of lymph-node metastasis ( LNM). How to improve the detection rate and select appropriate therapy for ECC has been an eager task in clinical practice. Aims:To analyze the pathological features of ECC treated by endoscopic resection(ER)or surgery,and evaluate the therapeutic efficacy of ER. Methods:Pathological data of 503 ECC lesions treated by ER or surgery were retrospectively analyzed. Risk factors of infiltration depth,LNM of ECC were analyzed,and therapeutic efficacy of ER was evaluated. Results:The overall detection rate of ECC was 10. 7%. The incidence of LNM was 1. 2%(6/503);the LNM incidence of mucosal high-grade neoplasia was 0%( 0/247 ),while was 2. 3%( 6/256 ) in submucosal carcinoma. The LNM incidence of submucosal superficial carcinoma treated by ER was 0%( 0/31 ). Tumor location, size,histological type and LNM had significant impacts on infiltration depth(P<0. 05). The rates of en bloc,complete and curative resection by ER were 96. 0%,94. 2% and 82. 1%,respectively. Infiltration depth was the risk factor of piecemeal,incomplete and noncurative resection of ER(P<0. 05). Conclusions:The incidence of LNM in ECC is extremely low. Accurate evaluation of character and infiltration depth of lesion before operation is helpful for selecting appropriate therapy. It should be cautious to choose ER for lesions infiltrated into submucosa,thereby to improve the therapeutic efficacy of ER.

Objective To explore the characteristics of chromosome karyotypes in patients with chronic myeloid leukemia (CML),and to provide help to individualized treatment.Methods The date of chromosome karyotypes of 313 patients and FISH of 45 of these patients with CML excluding Ph chromosome negative (Ph-) after treatment were collected from January 2014 to June 2015.Karyotypes were detected by R-banding.Results In the 313 cases,307 cases (98.08 ％) were Ph chromosome positive (Ph+) and 6 cases (1.92 ％) were Ph-.In the Ph+ patients,288 cases (93.81％) were classical Ph+,and 19 cases (6.19 ％) were variant rearrangements.There were 48 cases (15.34 ％) with additional chromosome changes in all patients,including 41 cases (13.10 ％) with classical Ph+ and 7 cases (2.24 ％) with variant rearrangements.The most common additional chromosome changes were in the following order:+der(22) Ph (35.42 ％),+8 (33.33 ％) and +21 (12.50 ％).The most frequent pattern of combination was +der(22) combined with +8 (16.67 ％),followed by +8 combined with +21 (10.42 ％).The proportion of pure Ph+ patients in chronic phase was higher than that of advanced phase,but proportion of classical Ph+ patients with additional chromosome changes in chronic phase was lower than that in advanced phase (x2 =1 11.55,P ＜ 0.01).The proportions of chronic phase and advanced phase patients with simple variant rearrangements were not different from those with complex variant rearrangements (P =0.582).The results of FISH in 45 cases were all positive,including 5 cases with 2 GIR1Y.Conclusion Karyotype analysis can reveal the instability of genetic and the characteristics of disease progression by identifying the evolution of Ph,which provides the basis for clinical doctors to choose suitable treatment.

Objective To investigate the clinical significance of I-FISH for detection of genomic abnormalities in MM. Methods Twenty newly diagnosed MM patients(seven cases at stage Ⅰ , five cases at stage Ⅱ and eight cases at stage Ⅲ according to Bataille staging) were analyzed by combining the technique of CC (R-binding stain) and I-FISH [ including GLP13q14 (RBI gene), GLP17p13. 1 (P53 gene),GLP13q14. 3(D13S319) ,GLP1q21 ,GLP14q32(IgH gene) DNA sequence probes]. These two methods were compared for the detection rates of chromosomal and genomic abnormalities in MM and the association between genomic abnormalities and Bataille stages was also analyzed. Results CC examination showed only 1 case [5% (1/20) ] was found complex chromosomal abnormalities--46,XX,-2,del(3) (p21) ,add(6)(q26) ,der(10)(q26),der(14)(q32), + mar, inc[6]. While I-FISH assay showed that 12 cases [60%(12/20) ] were found genomic abnormalities. The frequencies of RB1, D13S319 and P53 were all 30%(6/20), and the frequencies of IgH gene and 1q21 were both 20% (4/20). The detection rate of the I-FISH was much higher than CC (χ2 = 9. 09, P = 0. 001) according to paired χ2 test. Of 20 patients,6 cases had RB1 gene abnormality, 1 case at stage Ⅰ , 2 cases at stage Ⅱ and 4 cases at stage Ⅲ. Of 20 patients, 6 cases had D13S319 gene abnormality, 2 cases at stage Ⅰ , 1 case at stage Ⅱ and 3 cases at stage Ⅲ. Of 20 patients, 6 cases in 20 had P53 gene abnormality, 2 cases at stage Ⅰ and 4 cases at stage Ⅲ. Of 20 patients, 4 cases had 1q21 gene abnormality, 2 cases at stage Ⅰ and 2 cases at stage Ⅲ. Of 20 patients, 4 cases had IGH gene abnormality, 1 case at stage Ⅰ and 3 cases at stage Ⅲ. Conclusion Ⅰ-FISH has higher detection rate for the genomic abnormalities in MM and can be used in detection of MM patients in different Bataille stages.

Objective To evaluate significance of the quantification of bcr-abl mRNA in diagnosis and therapy of chronic myeloid leukemia (CML),essentiality significance for monitoring minimal residual disease. Methods Bcr-abl mRNA of 518 CML patients were detected using real-time PCR. Results Expression of bcr-abl mRNA was gradually increased among blastic phase (BP) (12.6 %),accelerated phase (AP) (25.4 %) and chronic phase (CP) (57.2 %) (P<0.05). Quantification of bcr-abl mRNA was cut down gradually after allotransplantation in the patients and becomes normal after treatment for 6 months. But quantification of bcr-abl mRNA inpatients treated with imatinib mesylate became normal after 12 months. Conclusion Real-time PCR was reliable and can be used for diagnosis,monitoring the treatment outcome,detecting the minimal residual disease,and predicting blast crisis.

Objective To investigate the value of panel fluorescence in situ hybridization (panel FISH)for detection of genomic aberrations in chronic lymphocytic leukemia(CLL). Methods Five types of fluorescein-labelled DNA probes including five sequence specific probes D13S25 for 13q14. 3, RB1, p53, ATM (11 q23)and centromeric probe for chromosome (CSP12) were used to perform fluorescence in situ hybridization assays in 17 patients with CLL. Its results were compared with that obtain by conventional cytogenetic (CC)examination. Results In 17 patients with CLL, CC examination showed that only one case (1/17) was found to have chromosomal abnormality that was simultaneous trisomies 3,8 and 18, whereas panel FISH assay showed that 10 cases (10/17) were found to have genomic aberrations including deletion of D13S25 in 4 cases,deletion of ATM in 2 cases,deletion of p53 in 1 case,deletion of D13S25 combined RB1 in 1 case and 1 case with a variety of abnormalities. Conclusions Panel FISH is a useful method for detection of genomic aberration in CLL If it is combined with CC,it can obviously enhance the detection rate of chromosomal abnormalities in CLL.

ObjectiveTo explore and analyze the effect of simulation-based learning combined with debriefing in neonatal resuscitation training.MethodsA total of 114 clinical medical staffs attended the neonatal resuscitation training course hold by Department of Neonatology, Quzhou Maternal and Child Health Hospital from November 2014 to May 2015, and were randomly assigned to observation (n=60) and control group (n=84) by coin tossing. Staffs in the observation group adopted to training skills with simulation-based learning combined with debriefing,while those in the control group were educated with traditional method. The examinations on theoretical knowledge were taken before and after the training. Operational exam and self-confident questionnaire for all staffs on each procedure taught in the course were taken at last. Scores of the exams and self-confident questionnaire were compared between the two groups witht-test and Mann-WhitneyU test.ResultsThe mean score of theoretical test rose up significantly after the training in both observation and control group (25.19±2.62 vs 20.17±3.71,t=7.725,P<0.01; 25.44±2.64 vs 18.90±4.27,t=11.170,P<0.01), but no difference was found in this score after the training between the two groups (t=0.492,P=0.624). The practical operation examination score in the observation group was higher than that in the control (34.05±1.34 vs 31.32±4.10,t=4.183,P<0.01). All questionnaires sent to the staffs were retrieved (100%), and the total values after the training in the observation group were higher than in the control (mean rank: 92.81 vs 57.99; rank sum:5 569 vs 4 872,Z=-4.96,P<0.01).ConclusionsSimulation-based learning combined with debriefing is a much more effective teaching methods for neonatal resuscitation training, which might quickly improve the resuscitation skills of clinical staffs.

Objective To evaluate target biopsy using magnifying endoscopy combined with narrow band imaging(ME-NBI) in suspicious gastric lesions.Methods A total of 113 patients with suspicious early gastric lesions under white light endoscopy(WLE) were prospectively enrolled and biopsied between May 2011 and May 2013.Further endoscopy was conducted using ME-NBI and target biopsy.All patients received endoscopic resection(ER).Outcomes of WLE biopsy and target biopsy were compared,with histology of ER specimen as golden standard.Results The overall diagnostic accuracy of WLE biopsy and target biopsy were 22.1％ (25/113) and 54.0％ (61/113),(P ＜ 0.0001).In diagnosing early gastric cancer (EGC) and high-grade intraepithelial neoplasia (HGIN),the sensitivity of target and WLE biopsy were 70.9％ and 37.9％ (P ＜ O.0001),respectively.The specificity were 90.0％ in both groups.The accuracy rates were 72.6％ and 42.5％,respectively(P ＜0.0001).The positive predictive values were 98.6％ and 97.5％ (P ＞ 0.05).The negative predictive values were 23.1％ and 12.3％ (P ＞ 0.05),respectively.The overall progression rate of target biopsy was 46.9％ (53/113).Conclusion ME-NBI target biopsy is superior to traditional WLE biopsy in diagnosis of early gastric cancer.

OBJECTIVE:To study the analgesic effect and mechanism of Gutongtie paste on model rats with formaldehyde-in-duced pain. METHODS:60 SD rats were randomly divided into blank group,model group,Gutongtie paste low-dose,medi-um-dose,high-dose groups(0.594,1.188. 2.376 g/paste,containing crude drug 0.48,0.96,1.92 g)and prednisone acetate group (ig,0.0054 g/kg,external bonding matrix). Model rats with pain was induced by formaldehyde method and immediately adminis-trated after modeling. Electronic tenderness instrument was adopted to determine the pain threshold of rats'ankle joint after adminis-tration of 1,2,3,4,6 h. After 6 h,blood sample 0.3 mL was taken from abdominal aorta then rats were sacrificed. Enzyme linked immunosorbent assay (ELISA) was conducted to determine the β-endorphin (β-EP),prostaglandin E2 (PGE2) contents;spectrophotometry was used to determine nitric oxide(NO)content in rats'serum and inflammatory tissue;and radioimmunoassay was adopted to detect the substance P content in rats'serum,inflammatory tissue and brain tissue. RESULTS:Compared with be-fore modeling,pain thresholds in model group at each period were significantly decreased (P<0.05 or P<0.01). Compared with blank group,PGE2,NO of rats,substance P content in inflammatory tissue and brain tissue in model group were significantly in-creased (P<0.05 or P<0.01). Compared with model group,pain thresholds in Gutongtie paste groups at corresponding time points were increased,PGE2 and substance P contents in inflammatory tissue and brain tissue were decreased (P<0.05 or P<0.01);β-EP and NO contents in serum in Gutongtie paste medium-dose,high-dose groups(P<0.05 or P<0.01),NO contents in serum in Gutongtie paste high-dose group were decreased(P<0.05). CONCLUSIONS:Gutongtie paste has a certain analgesic and anti-inflammatory effect,and the mechanism may be related to reducing PGE2, NO, substance P contents, increasing β-EP content.

ObjectiveTo investigate the localization and therapeutic effect of allogeneic bone marrow hematopoietic stem cell (HSC) transplantation in the rat model of liver fibrosis induced by carbon tetrachloride (CCl4). MethodsBone marrow HSCs from allogeneic Sprague-Dawley (SD) rats were isolated and cultured in vitro and labeled with 5-bromo-2′-deoxyuridine (BrdU) before transplantation. Eighteen female SD rats were randomly and equally divided into groups A, B, and C. A female rat model of liver fibrosis was established using CCl4. The rats in group A were injected with HSC-containing suspension through the caudal vein in the fourth week after CCl4 injection, while the rats in groups B and C were injected with normal saline through the caudal vein. In the eighth week, blood samples were taken from all groups. Then all rats were sacrificed, and the liver, pancreatic, and stomach tissues were collected to examine the localization of HSC and evaluate the therapeutic effect of HSC on liver damage. The double-blind method was used to statistically analyze experimental results. Comparison of continuous data between these groups was made by analysis of variance, and pairwise comparison was made by SNK-q test; comparison of categorical data between these groups was made by Kruskal-Wallis H test, and pairwise comparison was made by Nemenyi test. ResultsGroup A showed significantly improved histopathology compared with group B, while groups A and C showed approximately the same histological findings. There were significant differences in classification of liver fibrosis between groups A, B, and C (χ2=13.14, P=0.001), and groups A and C had significantly lower grades of liver fibrosis than group B (both P＜0.05). In group A, BrdU-positive cells were detected in the liver tissues of all rats, but no positive cells were detected in the pancreatic and stomach tissues; no BrdU-positive cells were detected in groups B and C. Compared with group B, groups A and C had significantly lower alanine aminotransferase and aspartate aminotransferase levels but a significantly higher albumin level (all P＜0.05). ConclusionAllogeneic HSC can be localized in the rat model of liver fibrosis and reverse the liver damage.

Objective To study the curative efficacy and safety of single-unit umbilical cord blood transplantation (sUCBT) for malignant hematologic diseases,which is provided by China's public cord blood bank.Methods We retrospectively analyzed 409 cases of malignant hematologic diseases who accepted myeloablative single-unit unrelated donor UCBT without ATG at our center between May 2008 and December 2016.A comparative analysis was made on the total nuclear cells (TNC) of the umbilical cord blood before freezing and after thawing,the cells of CD34+,the recovery rate of cells and the clinical effect of UCBT.Result 409 units of umbilical cord blood used in UCBT respectively came from eight China's public cord blood banks.The average TNC of 409 units of umbilical cord blood before freezing and after the tubular recovery were respectively 18.5 × 108 and 16.34 × 108 (p =0.000).The average recovery rate of the tubular recovery was 88.5％,and there was significant difference among cord blood banks (P =0.000).The average TNC of umbilical cord blood before freezing and transfusion were respectively 18.5 × 108 and 15.86 × 108 (p =0.000).The average recovery rate of umbilical cord blood transfusion was 85.9％,with the difference being significant among cord blood banks (P =0.000).The average number of CD34+ cells before freezing and after the tubular recovery was 11.18 × 106and 8.68 × 106 (p =0.000).The average recovery rate of CD34+ cells after the tubular recovery was 80.75 ％,with the difference being significant among the cord blood banks (P =0.000).At 42nd day after UCBT,the cumulative incidence of neutrophil engraftment was 95.4％,and the median time of the engraftment was 17 days (11-38 days).The cumulative incidence of platelet engraftment at 120th day was 84.6％,and the median time of the engraftment was 36 days (14-93 days).The cumulative incidence of erythrocyte engraftment at 60th day was 92％,and the median time of engraftment was 22 days (9d-60 days).After the umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of engraftment.The P values for cumulative incidence of neutrophil,platelet and erythrocyte engraftment were respectively 0.004,0.01 and 0.000 2,with the differences being statistically significant.At 100th day after UCBT,the cumulative incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees of acute graft-versus-host disease (aGVHD) was respectively 28.63％ and 15.7％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of aGVHD.There was no significant difference between Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees (P =0.809 and 0.68 respectively).At 3rd year after UCBT,the cumulative incidence of relapse was 15.89％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the cumulative incidence of relapse (P =0.898).At 3rd year after UCBT,the overall survival (OS) rate and disease free survival (DFS) rate were respectively 66.7％ and 59％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in OS and DFS.There was no significant difference in OS and DFS (P =0.566 and 0.703 respectively).At 3rd year after sUCBT,the rate of graft-versus-host diseases/relapse-free survival (GRFS) was 54.3％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the rate of GRFS (P =0.449).Conclusion The umbilical cord blood provided by China's public cord blood bank was used in UCBT.It has a high safety and good efficacy in treating malignant hematologic diseases.But it needs to set up the standardized and normalized quality-control system of umbilical cord blood for China's public cord blood bank.