Objective To analyse the outcome of different regimens for the treatment to patients with aeute promyelocytic leukemia(APL)accompanied by disseminated intravagcular coagulation(DIC).Methods The outcome of different chemotherapy regimens was compared. Results The median time achieving complete remission by all-trans retinoic acid(ATRA)combined with arsenic trioxide(As2O3)or alternative of ATRA and As2O3 were 34 days and 35.5 days,respectively.The median time of CR for the patients treated with ATRA only was 62 days.There is a statistical difference where three-year disease-free survival rates of the patients given by ATRA and As2O3 or alternative of them were 78 percent and 80 percent,respectively.Compared with the patients administered with ATRA only.there is significant difference(P＜0.05).The time of improving DIC was about 16 days to 18 days.There was no significant difference among this three chemotherapy regimens.Among 15 patients with autologous henmtopeietic stem cell transplantation,the disease-free survival time of 13 cases.who have no PML-RARα gene deteced by PCR was 13.5 years except 2 cases with relapse.Conclusion The time achieving complete remission of APL was reduced dramaticaly by administering all-trans retinoic acid(ATRA)combined with arsenic trioxide(As2O3)or alternative treatment of them and principles of blood transfusion and anti-fibmolysis to improve DIC,this regimen showed a relatively higher three-year disease-free survival (DFS) rate.These cases who received hematopeietic stem cell transplantation after six mortths of remission,DFS time wag further prolonged.

Objective: To observe the therapeutic efficacy of astragalus polysaccharide (APS) in combination with three-dimensional conformal radiotherapy (3D-CRT) for elderly patients with non-small cell lung cancer (NSCLC). Methods: A total of 80 elderly patients with I～IV stage NSCLC were randomly divided into two groups. The 40 patients in the therapeutic group received radiotherapy in combination with APS. The 40 patients in the control group received radiotherapy alone. Both groups received 3D-CRT with a total dose of 50～ 70Gy, 2.0Gy/fraction, once a day, 5 times per week. The patients in the therapeutic group were treated with radiotherapy combined with injection of APS (250mg in 5% glucose) or normal saline (500 mL) intravenously once a day until the end of radiotherapy. The short-term efficacy and patients' quality of life were evaluated. The T-lymphocyte subpopulation and peripheral blood leukocyte count were also measured after treatment. Results: The short-term effective rates of the therapeutic group and the control group were 87.5% and 72.5%, respectively, without significant difference between the two groups (P＞0.05). The decrease of peripheral blood leukocyte count after treatment in the control group was significant (P＜0.05). In the therapeutic group, the T-lymphocyte subsets CD8 and CD4/CD8 were improved after treatment, with a significant difference (P＜ 0.05). But in the control group, no significant changes in T-lymphocyte subsets CD8 and CD4/CD8 were observed after treatment (P＞0.05). Patients' quality of life in the therapeutic group was superior to that in the control group, with a significant difference (P＜0.05). Conclusion: APS in combination with 3D-CRT can reduce the side effects of radiation and improve the quality of life of elderly patients with NSCLC.

Objective To observe the effect of DNA-PKCS antisense oligodeoxynucleotides (ASODN) on the radiosensitivity of lung cancer cell line A549 through transfecting DNA-PKcs ASODN into A549 cells.Methods DNA-PKCS ASODN and unrelated ODN were transfected into A549 cells (testing group and control group).These cells were irradiated with 0,0.5,1.0,2.0,4.0,6.0 or 8.0 Gy X-ray.Clo nogenic assay was performed to determine the survival fraction.The parameters Do,Dq and N for the multi target single-hit model,as well as the parameters a,13 and SF2 for the linear-quadratic model,were calculated to evaluate cell radiesensitivity.ResultsIn the control group and testing group,the α value was 0.14 and O.31 ,The βvalue was 0.030 and 0.018 ,the SF2 was 0.63 and 0.41 ,the Do was 2.38 and 2.09 ,the Dq was 1.43 and 0.60 ,respectively.In the testing group,the α value of A549 cells was increased,but the β value, SF2,DO and Dq were decreased.Conclusions DNA-PKCS ASODN can enhance the radiosensitivity of A549 cells and is a potential target in treating lung cancer.

Objective To observe the MRI imaging manifestations of the ligaments and soft tissues around the atlanto-axial joint in children with atlanto-axial rotation instability.Methods Assigned into observation group were 50 children with atlantoaxial rotatory displacement who had been treated in our hospital from January 2013 to March 2014.Another 50 healthy children were chosen as a control group who underwent health check-ups during the same period in our hospital.Both groups received MRI examinations of the ligaments and soft tissues around the atlantoaxial joint using the same equipment and methods.MRI manifestations and characteristics of the ligaments and soft tissues around the atlantoaxial joint were analyzed and compared between the 2 groups.Results In the observation group,odontoid gap asymmetry appeared on both sides,with left shift in 32 cases and right shift in 18 cases.The MRI imaging PDWI sequence showed a significant better diagnostic sensitivity than the other sequences (T1WI,T2WI and SPAIR) (P ＜ 0.05).The MRI examinations on all the children with different sequences found 50 cases of degree Ⅰ lesion in the observation group and 4 cases of degree Ⅰ lesion in the control group,and 12 cases of degree Ⅱ lesion in the observation group and none degree Ⅱ lesion in the control group,showing a significant difference between the 2 groups regarding the diagnostic sensitivity of lesions of degrees Ⅰ and Ⅱ (P ＜ 0.05).Conclusions MRI can clearly show the rotation displacement of atlanto-axial joint associated with transverse ligament,alar ligament and lesions of the surrounding soft tissues.MRI has a dcfinite diagnostic value for atlanto-axial rotation displacements in children,especially those caused by transverse ligament tear after trauma.

Objective To evaluate the safety and efficacy of 125I seed strands cavity brachytherapy for ureteral carcinoma.Methods To tally 10 patients with ureteral carcinoma underwent Carm CT and DSA guided percutaneous nephrostomy with 125I seed strands cavity brachytherapy.The technical success rate,complications,tumor local control rate,ureteral patency andsurvival time,and compared the Karnofsky scores,Girignon grade,pain score before and after treatment were evaluated.The dose related parameters were compared between pre-and post-treatment.Results 125I seed strands implantation was successfully completed in all patients with technical success rate of 100％.The mean procedure time was (12.3 ±3.8) min.No severe complications such as ureteral perforation,infection,severe bleeding occurred.Local tumor response was CR in 4 cases and PR in 6 cases,showing local control efficiency (CR + PR) 100％ after 2-3 months.Ureteral patency rate was 50％ (5/10).Postprocedure Karnofsky scores,Girignon grades,and pain scores were significantly improved (Z =-2.72,-2.88,-2.83,P＜0.01).The average follow-up time was (14.6 ±6.5) months (5-25 months),tumor progression was observed in 3 cases,stable disease in 7 cases.Nine cases were alive and one died due to multiple organ failure.The differences of D90％,mPD,V100％,V150％,V200％,CI,EI,HI between the preand post-treatment were not statistically significant (P ＞ 0.05).Conclusions 125I seed strands cavity brachytherapy for ureteral carcinoma is an effective and safe procedure without serious complications,and an effective alternative treatment for patients who are unable to undergoor refuse surgery.

Coronavirus disease 2019 (COVID-19) outbreak started in December 2019 that caused difficulties for clinical work. Practical work experience in our spinal outpatient and emergency department during the COVID-19 pandemic is summarized in this article, with combined evidence-based medical evidence to explore a standardized process of diagnosis and treatment for spinal diseases. Outpatient reservation, continuous screening, triage, and isolation, first consultation accountability system, pandemic reporting system, and online revisit were strictly followed. We hope that our experience in prevention and control of COVID-19 can help spine surgeons globally in stopping the spread of COVID-19. Spine surgeons should collaborate with infection control specialists to avoid cross-infection in hospitals and optimize treatment.

Objective To investigate the safety and effect of zoning laminectomy for the ossification of thoracic ligamentum flavum.Methods From November 2011 to December 2014,34 patients (15 males,19 females;41-76 years old,average 55.0±8.1) with ossification of thoracic ligamentum flavum (OLF) were treated by zoning laminectomy.The course of disease ranged from 1 month to 123 months (average 16.5 months).According to the anatomical characteristics and the pathological ossification process of the thoracic ligamentum flavum,we proposed the concept of "zoning",which divided each segmental thoracic OLF into three zones:"safety zone","middle zone" and "risk zone".From the features of anatomy of LF and process of OLF development,we found there is no or less cerebrospinal fluid between spinal cord and the tip of each ossified nodular masses in severe OLF,any procedures using instruments in this area have the potential to cause irreversible spinal cord injury,we defined this area as "risk zone",the "null" area of each lamina and lateral and dorsal side of nodular masses as "safety zone",and the other area as "middle zone".From "safety zone" to "risk zone" the spinal canal decreased gradually,different zone needs different surgical strategy:This surgical procedure first removed the "null" area of superior and inferior lamina and dorsal side of each segmental OLF.Next,partially or totally resected the "middle zone",exploring the lateral side of nodular masses,and the "risk zone" was exposed and isolated.Finally,dissected the lateral side of nodular masses,and then the "risk zone" was floated and resected with a directly decompressing the spinal cord.Preoperative and postoperative modified Japanese Orthopedic Association (JOA) score and neurologic functional recovery ratio were used to evaluate the surgical outcomes.Results Of the total 83 decompressed OLF segments,5 (6.0％) located in the upper thoracic spine (T1-T4),8 (9.6％) in the midthoracic spine (T5-T8),and 70 (84.4％) in the lower thoracic spine (Tg-L 1).The followed up ranged from 4 to 40 months,with an average of 21.7±9.9 months.The mean JOA score increased significant from 5.3±2.0 preoperatively to 8.8±1.8 at the final follow-up (t=1 1.566,P=0.001).Postoperative average JOA neurologic functional recovery rates were 63.2％±24.7％,including excellent in 15 cases,good in 11 cases and fair in 8 cases.The excellent and good rate was 76.5％.Twelve cases had transient CSF leakage because of dural defect.The dural defect was only treated by tightly suturing the paraspinal muscles,the subcutaneous tissue,and the skin layers.The CSF leakage lasted for 6 to 8 days after operation.Two cases with wound infection were treated with debridement and antibiotics and healed completely.One case with thoracic spinal cord transient incomplete paralysis due to a post-operative epidural hematoma was treated with an emergency operation and got recovered neurological function.Conclusion Zoning laminectomy has the advantages of safe manipulation and thorough decompression,which is an effective choice for the surgical treatment of thoracic OLF.

Proteasome activator PA28γ,also known as Ki antigen,REGγ or PSME3,is first found as Ki antigen in the serum of a patient with systemic lupus erythematosus,which belongs to 11S proteasome activator family together with PA28α and PA28β.In the amino acid sequence,PA28γ has 25%homology with PA28α and PA28β and its seven-subunit homomer is a 20S proteasome acti-vator,which mainly exists in the nucleus and participates in ubiquitin and ATP-dependent or independent protein degradation.More and more studies have reported the role of PA28γ in human immune-related diseases.This article reviews the function of PA28γ as a proteasome activator and its role in immune-related diseases including cancer,inflammation and virus infection-related diseases and other diseases in recent years,so as to reveal the role of PA28γ in the occurrence and development of immune-related diseases and its potential as a target for immunotherapy.

Objective:To explore the application value of virtual reality technology in thoracoscopic anatomical segmentectomy.Methods:Eighty-four patients with early stage non-small cell lung cancer admitted to the First Hospital of Jiaxing from December 2017 to December 2018 were enrolled in the study.They were divided into observation group and control group according to the random digital table method, with 42 cases in each group.The observation group used virtual reality technology to construct a three-dimensional digital model, and performed preoperative evaluation and simulated surgical drills and intraoperative navigation on the three-dimensional digital model, based on the preoperative evaluation and simulated surgical drill results, combined with the specific actual situation during the operation, developed and implemented individualized thoracoscopic anatomical segmentectomy.Thoracoscopy anatomical segmentectomy was routinely performed in the control group.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization, cost and incidence of postoperative complications were compared between the two groups.Results:The operation of both two groups was successfully completed, and no intraoperative thoracic surgery was performed during the operation.There was no perioperative death.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization cost and the incidence of postoperative complications in the observation group were (100.98±26.51)min, (67.98±32.96)mL, (7.79±1.32), (11.98±4.69), (4.60±1.43)d, (2.86±0.81)d, (437.14±193.86)mL, (3.76±0.31)million, 9.52%(4/42), respectively, which in the control group were (114.88±24.26)min, (104.52±52.37)mL, (6.45±0.3), (8.31±1.94), (6.50±2.55)d, (4.00±2.25)d, (667.26±415.01)mL, (4.20±0.65)million, 26.19%(11/42), respectively, the differences between the two groups were statistically significant ( t=-2.208, -3.328, 5.916, 4.678, -4.221, -3.993, -3.265, -3.968, χ 2=3.977, all P<0.05). No local recurrence or distant metastasis was found during the follow-up period. Conclusion:Virtual reality technology can provide preoperative evaluation and simulated surgical exercises and intraoperative navigation for thoracoscopic anatomical segmentectomy, which can reduce the difficulty of surgery and improve the accuracy and safety of the operation.

Objective To study the dosimetry distribution of 125Ⅰ seed chains with different radians in different curvatures of bile ducts. Methods The outlines were drawn on the papers, which are the seed chain models with different radians. Radians formula (radian length=2πr × angle/360) was used to calculate the corresponding 0°, 30°, 60°, 90°, 120°, 150° and 180° models with a radian length at 45 mm, for the total length of seed chain model was 45 mm, and the seeds, had no interval or linear arrangements. The image was transmitted to the Brachytherapy planning system for seeds implantation( TPS) to simulate the seed chains with different radians. Using TPS to delineate the tumor target area, of which the activity was set as 1. 85 × 107 Bq, and the prescription dose was 60 Gy. It was prescribed to simulate the bile duct ( diameter at 8 mm) . TPS were used to calculate the D90 and V100 of the simulated bile duct with the diameter at 8 mm, and explore dosimetry of the points at the centripetal and centrifugal sides with 5 mm vertical distance which from two endpoints and center of seed chains with different radians. Results When the radian of seed chain was 30°, the D90and the V100 were the highest (the D90 was 132 Gy; the V100 was 100%). While the radian was 60°, the D90 and the V100 were the lowest (the D90 was 45 Gy, the V100 was 68%). As the radian was 30°, the highest dose was in the center ( dose in the centripetal side was 165 Gy, and centrifugal side dose was 142 Gy) . The center has the lowest dose as the radian up to 180°(dose in the centripetal side was 90 Gy, and centrifugal side dose was 50 Gy) . Among all radians, dose in the centripetal side was always higher than centrifugal side in the center. Between two endpoints, dose in the centrifugal side was higher than centripetal. Conclusions Distribution of seed chain dosage also changed along with the change of radian. When the radian of seed chain was 30°, the D90 and the V100 were the highest. The centripetal dose was higher than that of the centrifugal side.