Objective To investigate the clinical characteristics and efficacy of acute myeloid leukemia (AML) with NPM1 and FLT3 mutations.Methods NPM1 and FLT3 mutations were detected in 67 patients with newly diagnosed AML by PCR-capillary electrophoresis.The relationship was analyzed between the mutations and efficacy.Results The incidence of NPM1 mutation was 10.4％ (7/67) in total AML patients and 26.1％ (6/23) in normal karyotypes AML patients.The incidence of FLT3-ITD mutation was 10.4％ (7/67) in total AML patients and 17.4％ (4/23) in normal karyotypes AML patients.The characteristics of 60 NPM1 wild type patients vs that of 7 NPMl mutation patients was as follow,platelet count (BPC) (54× 109/L vs.27.5 × 109/L,P ＜ 0.01),proportion of AML-M5 (57.1％ vs.27.3％,P ＜ 0.01),incidence of CD34+ (28.6％ vs.63.3％,P＜0.01),normal karyotypes (85.7％ vs.28.3％,P＜0.01),cases with particular fusion gene (0 vs.48.3％,P ＜ 0.01),incidence of FLt3-1TD-mutations positive (28.6％ vs.8.3％,P ＜ 0.01),and the differences were significant (P＜0.01).No statistic difference was found in white blood cell(WBC) counts,percentage of blasts in bone marrow,sex,median age and complete remission rate between the two groups (P ＞0.05).The WBC counts (26.9 × 109/L vs.8.1 × 109/L,P =0.013),percentage of blastsin in bone marrow (90％ vs.76％,P=0.014) in the FLT3-ITD mutationg positive patients were clearly higher than those in the FLT3-ITD negative patients.If not associated with FLT3-ITD mutations,mutant NPM1 appears to identify patients with improved response toward treatment.Conclusion It is necessary to detect NPM1 mutation and FLT3-ITD mutation in newly diagnosed AML patients,especially in patients with normal karyotype,which might help to molecular classification and treatment.

Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes,and to analyze factors affecting the MH closure rate.Methods This is a retrospective case study.21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study.All eyes were examined for best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,indirect ophthalmoscope,A and/or B-scan ultrasound,optical coherence tomography and visual electrophysiological examination.The BCVA was ranged from finger counting to 0.2.The axial length (AL) was ranged from 26.00 to 31.00 mm,with an average of 27.47 mm.Among 22 eyes,AL was between 26.00 mm to 27.00 mm in 9 eyes,27.10 mm to 28.00 mm in 5 eyes,28.10 mm to 29.00 mm in 3 eyes,29.10 mm to 30.00 mm in 3 eyes,and longer than 30.00 mm in 2 eyes.The diameter of MH was ranged from 227 μm to 597 μm and with an average of 432 μm.Among them,the minimum diameter was between 200 μm to 400 μm in 4 eyes,401 μm to 450 μm in 13 eyes,451 μm to 500 μm in 3 eyes,501 μm to 600 μm in 2 eyes.All the eyes were treated with PPV combined with ILMP surgery.The average follow-up time was 17 months after surgery.The efficacy was determined at the final follow up,including the MH closure,the state of macular retinoschisis and the BCVA.MH closure rate with different MH diameters and different AL were compared and analyzed.Results During the final followup,MH were fully closed in 17 eyes (77.3％),bridge-closed in 4 eyes (18.2％) and not closed in 1 eye (4.5％).Retinoschisis was resolved in 19 eyes (86.4％),partially resolved in 2 eyes (9.1％) and not changed in 1 eye (4.4％).MH with smaller diameter had higher MH closure rate (x2=12.036,P=0.032).MH with longer AL had lower MH closure rate (x2=16.095,P=0.003).The final BCVA was ranged from finger counting to 0.25.Among 22 eyes,BCVA or metamorphopsia were improved in 9 eyes (40.9％),stable in 8 eyes (36.4％).BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7％).Conclusions PPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes.After surgery,MH was closed and retinoschisis was resolved in most patients.The major factors affect the MH closure were the minimum diameter of MH and AL.

Objective To investigate the prevalence of nosocomial infections in Tianjin Children's Hospital and to provide database for monitoring and control of nosocomial infection.Methods The medical records of 6101 children admitted in the first half of 2005 and the laboratory results of isolated bacteria from clinical samples in 2005 were retrospectively investigated.Results The total nosocomial infection rate was 3.47%(212/6101),in which the surgical nosocomial infection rate was 2.66%(32/1204)and 2.95%(180/6101)infections were caused by non-surgical incisions.Respiratory tract was the most frequent infection site(119/212,56.1%).Several opportunistic pathogens were responsible for the major nosocomial infections,they were Escherichia coli,Coagulase negative staphylococcus,Enterococcus,Klebsiella pneumonia,Staphylococcus aureus and Pseudolnonas aeruginosa.Conclusion The pathogenic isolates for the infections show high resistance to most antibiotics.Monitor and control of the incidence of nosocomial infections and resistance to antibiotics should be enforced.

Objective:To investigate the efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia caused by multidrug-resistant Gram-negative (G -) bacteria. Methods:A observational study was conducted. The clinical data of 45 patients with pneumonia due to multidrug-resistant G - bacteria admitted to intensive care unit of Fujian Medical University Union Hospital from January to October in 2020 were analyzed. According to the different use methods of polymyxin B, 25 patients who received single intravenous drip (the first dose was 2.0 mg/kg, then 1.25 mg/kg, once every 12 hours) from January to April in 2020 were enrolled in the routine group, and 20 patients who received intravenous drip combined with aerosol inhalation (25 mg once every 12 hours, sputum in the airway was sucked and then sprayed aerosol) from May to October in 2020 were enrolled in the combination group. After the treatment course of polymyxin B, the total bacterial clearance rate, total clinical efficiency rate, recovery time of body temperature, time of bacterial clearance and the change of serum procalcitonin (PCT) level before and after treatment were compared between the two groups. Moreover, the incidence of adverse reactions during treatment in the two groups was observed. Results:The results of sputum culture in the routine group were Acinetobacter baumannii in 13 patients, Klebsiella pneumoniae in 5 patients, Pseudomonas aeruginosa in 6 patients, Enterobacter cloacae in 1 patient; the sputum culture results of the combination group showed that there were 5 patients of Acinetobacter baumannii, 9 Klebsiella pneumoniae and 6 Pseudomonas aeruginosa. There was no significant difference in the results of sputum culture between the two groups ( P > 0.05). The total bacterial clearance rate and the total clinical efficiency rate of the combination group were significantly higher than those in the routine group (total bacterial clearance rate: 70.0% vs. 40.0%, total clinical efficiency rate: 75.0% vs. 40.0%, both P < 0.05). The recovery time of body temperature and the time of bacterial clearance of the combination group were significantly shorter than those in the routine group [recovery time of body temperature (days): 6.0±3.9 vs. 10.2±7.3, time of bacterial clearance (days): 6.1±5.2 vs. 11.5±6.8, both P < 0.05]. No significant difference was found in serum PCT level before treatment between the two group. There was no significant difference in serum PCT level before and after treatment in the routine group [μg/L: 0.85 (0.44, 2.87) vs. 1.43 (0.76, 5.30), P > 0.05]. The serum PCT level after treatment in the combination group was significantly lower than that before treatment [μg/L: 0.27 (0.10, 0.70) vs. 0.91 (0.32, 3.53), P < 0.05], and it was significantly lower than that in the routine group [μg/L: 0.27 (0.10, 0.70) vs. 0.85 (0.44, 2.87), P < 0.01]. The incidence of renal toxicity of polymyxin B between the combination group and the routine group was not significantly different (5.0% vs. 4.0%, P > 0.05). Conclusions:The efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia due to multidrug-resistant G - bacteria is better than that of intravenous drip of polymyxin B only. The aerosolized polymyxin B will not increase the risk of renal injury.

Objective To evaluate the clinical efficacy of qi-replenishing,phlegm-resolving and stasis-diapelling formula,a Chinese compound medicine,on the patients of stable stage with chronic obstructive pulmonary disease (COPD).Methods Altogether 51 COPD patients with TCM syndrome of deficiency of lung qi,spleen qi,kidney qi and phlegm-stasis obstruction were randomly divided into Chinese medi-cation group (n =26)and control group (n =25).The patients of the control group were treated with only routine Western medication,while those of the Chinese medication group were treated with the rou-tine Western medication combined with TCMformula for consecutive four months.Results There were significant differences of forced expiratory volume in one second (FEV1 ),changes of symptom scores and COPD assessment test (CAT)scores between after treatment and before treatment in Chinese medi-cation group(P <0.05).Compared with control group,all the indexes mentioned above showed statisti-cal differences in Chinese medication group(P <0.05).Conclusion The clinical efficacy and safety of Chinese formula were proved by the means of comparison of FEV1,symptom scores and CAT scores be-tween Chinese medication group and control group.

Objective:To analyze the practical situation of clinical college tutorial system teaching from the perspective of students'needs,and provide reference for optimizing the teaching mode of clinical college tutorial system.Method:A total of 79 undergraduate students who participated in the tutorial system teaching in the clinical college of our university were selected as the research subjects.Through questionnaire surveys and one-to-one in-depth interviews,the current implementation status of the tutorial system teaching mode and students'needs and expectations for the tutorial system teaching mode were understood.Results:The overall satisfaction with the teacher-student relationship was 86.07%,and students'willingness to communicate internally was the main factor affecting communication.And 1.27%of students believed that they had no obstacles in teacher-student communication,and 98.73%of students did not want mentors to teach more than 5 students.And 69.62%of students preferred mentors to provide teaching guidance through clinical practice.Binary logistic regression analysis showed that students'perception that mentorship had no significant effect was a negative factor in teaching effectiveness(OR=0.045,95%CI:0.003-0.598).Conclusions:Taking students'needs as the starting point,strengthening the preaching of the mentorship teaching mode,reinforcing the confidence in learning,and improving the teaching programme and teaching quality evaluation system are conducive to enhancing the quality of mentorship teaching in clinical college.

Objective:To examine the survival rates and clinical characteristics of people with newly discovered non-M 3 acute myeloid leukemia (AML) who carry the ASXL1 gene mutation. Methods:From January 2016 to April 2021, the clinical information of patients with newly diagnosed non-M 3 AML at Shandong University's Qilu Hospital was retrospectively examined, and their clinical characteristics and survival were compared and analyzed. Gene mutation was detected by next-generation sequencing. Results:① The study included 256 AML patients who were initially diagnosed and had complete data, including 47 cases of ASXL1 gene mutation-positive (ASXL1 +) patients and 209 cases of ASXL1 gene mutation-negative (ASXL1 -) patients. All patients were divided into three groups: elderly (≥60 years old, n=92) , middle-aged (45-59 years old, n=92) , and young (≤44 years old, n=72) . ②WBC, and age were higher in patients with ASXL1 mutations compared to ASXL1 - patients, while complete response after the first round of treatment (CR 1) was lower ( P<0.05) . In the elderly group, WBC and the proportion of aberrant cells in nuclear cells in ASXL1 + patients were higher than those in ASXL1 - patients ( P<0.05) . In the young group, the WBC of ASXL1 + patients was higher than that of ASXL1 - patients ( z=-2.314, P=0.021) . ③IDH2 mutation and ASXL1 mutation was related ( P=0.018, r=0.34) . In ASXL1 + patients, the proportion of peripheral blasts in the high VAF group (VAF>40% ) was higher than that in the low VAF group (VAF<20% ) , and the proportion of aberrant nuclear cells was higher in the duplication and replacement mutation patients than in the deletion mutation patients ( P<0.05) . ④The overall survival (OS) and progression-free survival (PFS) of ASXL1 + patients were shorter than those of ASXL1 - patients (median, 10 months vs 20 months, 10 months vs 17 months; P<0.05) . The proportion number of aberrant cells in nuclear cells (≥20% ) , complex karyotypes, and TET2 mutation were all independent risk variables that had an impact on the prognosis of ASXL1 + patients, according to multivariate analysis ( P<0.05) . Conclusion:ASXL1-mutated non-M 3 AML patients have higher WBC in peripheral blood, a higher proportion of aberrant cells in nuclear cells, lower CR 1 rate, and shorter OS and PFS. Additionally, a poor prognosis is linked to higher VAF, duplication, and substitution mutations in the ASXL1 gene, as well as the high proportion of aberrant cells in nuclear cells, complex karyotype, and TET2 mutation.

Objective:To investigate the role of rapamycin target protein (mTOR) in lanthanum-induced injury of cerebral cortical neurons in offspring rats, and the effect on brain development, learning and memory ability of offspring rats.Methods:Thirty-two adult female and 32 male Wistar rats, were randomly divided into 4 groups according to their body weight, with 16 rats in each group (half female and half male). Female rats were fed with different amounts of lanthanum chloride[0.0 (control), 2.5, 5.0, 10.0 g/L], while male rats drank normal water. Female and male rats were mated in cages at a ratio of 1∶1. Female rats began to be exposed to lanthanum from pregnancy, while their offspring were exposed to lanthanum until 4 weeks after weaning. Morris water maze experiment was carried out in the 4 groups of offspring rats, and the effects of lanthanum on learning and memory were observed by space exploration. The cerebral cortex of offspring rats was taken, and the amount of Nissl body was observed under microscope after Nissl staining. The expression of mTOR mRNA in offspring rats cerebral cortex nerve cells was measured by real-time quantitative PCR. Western blotting was used to detect the protein content of p-mTOR in offspring rats cortical neurons.Results:Compared with the control group, the body weight of offspring rats exposed to lanthanum at 2.5, 5.0 and 10.0 g/L was significantly decreased [(121.75 ± 11.20), (110.00 ± 11.59), (98.88 ± 7.95) and (85.63 ± 7.25) g, P < 0.05], and the brain tissue coefficient and cortical coefficient were significantly increased [(1.43 ± 0.10)%, (1.56 ± 0.18)%, (1.66 ± 0.14)%, (1.89 ± 0.16)%; (0.86 ± 0.08)%, (0.94 ± 0.08)%, (1.01 ± 0.07)%, (1.08 ± 0.09)%, P < 0.05]. The brain weight [(1.63 ± 0.05), (1.61 ± 0.03) g] of 5.0 and 10.0 g/L lanthanum-exposed groups were significantly lower than those in the control group and 2.5 g/L lanthanum-exposed group [(1.73 ± 0.06), (1.70 ± 0.06) g, P < 0.05]. Compared with the control group (53.25 ± 9.93), the amounts of Nissl body in cerebral cortical neurons in different lanthanum-exposed groups (36.13 ± 3.98, 27.50 ± 5.21, 13.63 ± 5.93) were significantly decreased ( P < 0.05). The results of space exploration experiment showed that compared with the control group [(5.75 ± 1.98) times, (10.69 ± 2.96) s, (3.75 ± 1.28) times], the times of entering the target quadrant [(3.63 ± 1.41) times] and the stay time in the target quadrant [(5.12 ± 2.09) s] in 10.0 g/L lanthanum-exposed group were significantly reduced ( P < 0.05), and the times of entering the platform [(1.88 ± 0.84), (1.13 ± 1.12) times] in 5.0 and 10.0 g/L lanthanum-exposed groups were significantly reduced ( P < 0.05). There were significant differences in mTOR mRNA (1.00 ± 0.28, 0.74 ± 0.19, 0.58 ± 0.13, 0.45 ± 0.29) and p-mTOR protein expression levels (0.69 ± 0.07, 0.33 ± 0.06, 0.30 ± 0.04, 0.17 ± 0.03) in cortical tissues ( F = 8.33, 139.12, P < 0.05). Conclusion:Lanthanum exposure can damage cortical neurons, affect the brain development of offspring rats, reduce the expression of mTOR mRNA and p-mTOR protein in the brain of offspring rats, reduce the ability of space exploration and observation, resulting in the decline of learning and memory ability of offspring rats.

Objective To explore the features of frontotemporal lobes'resting-state functional connectivity(rsFC)in preschool children with autism spectrum disorders(ASD)based on functional near-infrared spectroscopy(fNIRS)and to explore the possible neurological markers for early identification of ASD.Methods Sixty-three preschool ASD children and 72 typical development(TD)children were enrolled.Selected bilateral dorsolateral prefrontal cortex(DLPFC),bilateral premotor cortex(PMC),and bilateral temporal lobe(TL)cortex as the regions of interest(ROI).Changes of Oxyhemoglobin in the 6 ROIs in resting-state were measured by using functional near-infrared spectroscopy(fNIRS).Compared the frontotemporal rsFC strength and calculate the laterality index(LI)between two groups.Results Compared with the TD group,rsFC strength was significantly lower in the ASD group(P<0.05),and the differences existed mainly within the left ROIs(0.21±0.11 vs.0.32±0.18),right ROIs(0.16±0.16 vs.0.30±0.14),bilateral DLPFCs(0.20±0.14 vs.0.39±0.17;0.15±0.13 vs.0.36±0.13),bilateral TLs(0.15±0.14 vs.0.28±0.17;0.14±0.15 vs.0.31±0.17),and between the 10 groups of ROIs-ROIs(including right DLPFC-left DLPFC,right DLPFC-right PMC,right DLPFC-left PMC,right DLPFC-right TL,right DLPFC-left TL,left DLPFC-right PMC,left DLPFC-left PMC,left DLPFC-right TL,left DLPFC-left TL,right TL-left TL).There were a significant differences in the rsFC's laterality index of DLPFC and whole-brain between the two groups(t=2.002,P=0.047;t=3.003,P=0.003),and the ASD group showed left-lateralized connectivity.Conclusion Frontotemporal lobe's resting-state functional connectivity is abnormal in preschool children with ASD,characterized by low short-range functional connectivity of bilateral DLPFCs and TLs,low long-range functional connectivity associated with DLPFCs,and left-lateralized connectivity.