Gastric cancer is one of the most common malignancies worldwide. Early diagnosis and intervention is the key to improve the prognosis of patients with gastric cancer. Expression of miR-20a is up-regulated in the circulating blood of gastric cancer patients,cancer tissues and cell lines,and has been demonstrated to be closely related to the clinicopathological characteristics and prognosis of gastric cancer. MiR-20a promotes the proliferation of gastric cancer cells,regulates the self-renewal of gastric cancer stem cells,and induces chemoresistance via a variety of mechanisms. Detection of serum/ plasma miR-20a alone or in combination with other miRNAs is helpful for the early diagnosis and prediction of progression,relapse and prognosis of gastric cancer. MiR-20a has the potential to be used as a novel and noninvasive biomarker for gastric cancer.

Background:Acute kidney injury(AKI)is one of the early serious complications of acute pancreatitis(AP). Early identification and intervention have important clinical significance. Aims:To investigate the early predictive value of clinical indicators found within 48 hours after admission for AKI in patients with AP. Methods:A retrospective analysis of 205 AP patients from January 2014 to December 2014 at Renmin Hospital of Wuhan University was performed. AP patients were divided into AKI group and non-AKI group according to the KDIGO standard,the demographic characteristics,history of chronic diseases and indicators defined within 48 hours after admission such as Ranson score,BISAP score and biochemical indices were compared. The early predictive value of clinical indicators for AKI was evaluted,and strength of association between clinical indicators and AKI was assessed. Results:Compared with non-AKI group,Ranson score, BISAP score,D-dimer,PCT,blood glucose,triacylglycerol were significantly increased in AKI group(P < 0. 05),and calcium was significantly decreased(P < 0. 05). The accuracies of D-dimer,PCT,calcium were high for early prediction of AKI,and the AUC were 0. 881,0. 803 and 0. 782,respectively. Logistic regression analysis showed that D-dimer, PCT,calcium had marked correlation with AKI(OR all > 7)(P < 0. 05). Conclusions:D-dimer,PCT and calcium are effective and economical clinical indicators for the early prediction of AKI in patients with AP.

Background:As the incidence of acute pancreatitis( AP)is increasing and the mortality remains high,early identification and early intervention of patients at risk of severe acute pancreatitis(SAP)is of great clinical significance. Aims:To investigate the value of commonly used AP-related serum biochemical markers for early prediction of severity of AP. Methods:Retrospective analysis was performed in 205 AP patients in Renmin Hospital of Wuhan University from Jan. 2014 to Dec. 2014,and 92 healthy subjects were served as controls. Patients with AP were divided into mild(n = 92), moderately severe(n = 72)and severe AP(n = 41)groups. The demographic characteristics,history of chronic diseases, serum biochemical markers within 48 hours after admission,Ranson score,BISAP score and other related clinical data were collected and compared between the four groups. The diagnostic performance of these indices in predicting SAP was evaluated by ROC curve,and the correlation of these indices with SAP was assessed by Logistic regression analysis. Results:There were significant differences in Ranson score,BISAP score,D-dimer,blood calcium,procalcitonin(PCT), CRP,hypersensitive CRP(HS-CRP),triacylglycerol and blood glucose between the four groups(P < 0. 05). The area under curve(AUC)of blood calcium was 0. 838 for early prediction of SAP,which was second to that of Ranson score and BISAP score. The accuracies of PCT and D-dimer were acceptable but inferior to blood calcium,while the accuracies of other indices were considerably low. Logistic regression analysis revealed that the odds ratio of risk for SAP of Ranson score,PCT and HS-CRP were all greater than 1 000,while that of blood calcium and D-dimer were 0. 013 and 19. 479, respectively. Conclusions:Of the AP-related serum biochemical markers,blood calcium,D-dimer and PCT are the preferred early predictors for severity of AP.

[Objective] To evaluate the diagnostic values of multi-detector spiral computed tomography (MDCT) in pediatric sacrococcygeal tumors (SCT) and to improve the diagnostic ability.[Methods] 54 children (22 male and 32 female,age between 1 day and 16 years old) with pathologically confirmed SCT were involved in our study.All of them received 64-row spiral Computed Tomography before surgery,CT characteristics and clinical data were retrospectively analyzed.[Results] Pediatric SCT are more common in female children under four years old,with the germ cell tumors most common,followed by neurogenic tumors.Among the 54 SCT,39cases were malignant and 15 were benign (malignant∶ benign =2.60∶1).In CT image findings,37 cases (68％) were mainly solid mass,with 31 cases confirmed malignant by pathology.8 cases (15％) were mainly cystic,with all of them confirmed benign by pathology.9 cases (17％) were cystic-solid or with obvious necrosis in solid mass,with 8 cases confirmed malignant by pathology.[Conclusion] Malignant pediatric SCT are more common than benign SCT.Most malignant SCT are mainly solid mass or cystic-solid or with obvious necrosis in solid mass,and most benign tumors are mainly cystic.Combined with clinical data,MDCT can help to correctly diagnose SCT before surgery.

Objective To explore the clinical efficacy and safety of low﹣dose decitabine subcutaneous injection combined with arsenicals in the treatment of medium﹣ and high﹣risk myelodysplastic syndromes (MDS). Methods Eight cases of medium﹣ and high﹣risk MDS without allogeneic hematopoietic stem cell transplantation in the Affiliated Cancer Hospital of Zhengzhou University and Xinhua Area Hospital of Pingdingshan City from January 2015 to August 2018 were retrospectively analyzed. The patients were given subcutaneous injection of low﹣dose decitabine combined with arsenicals. The specific regimen was as follow:0.1-0.2 mg/kg of decitabine, subcutaneous injection 2 times/week, 4 weeks in total; arsenic injection 10 mg/time or 0.16 mg/kg, intravenous administration, 1 time/d, 4 weeks; compound Huangdai tablets 60 mg/kg per day, 3 times orally. The efficacy and adverse reactions were observed. Results In 8 patients, there were 5 male and 3 female, with an average age of 61.4 years old (44-80 years old) Eleven cases were refractory anemia with excess blasts (RAEB), 6 cases were RAEB﹣2, 1 case was refractory cytopenia with multilineage dysplasia (RCMD) with bone marrow fibrosis (MF). Three of the patients had previously received treatment with decitabine. All patients completed the treatment successfully and no treatment﹣related deaths occurred. By the end of follow﹣up, 2 patients had complete remission, 4 patients had complete bone marrow remission with hematologic improvement, 1 patient had stable disease, and 1 patient had disease progression. For 2 patients who had been treated with decitabine regimen, the regimen of re﹣administered decitabine plus arsenic was still effective. Eight patients had more than level 2 of myelosuppression, except for one patient with intestinal infection due to unclean diet and one patient with mild pulmonary infection. The remaining 6 patients had no associated infection and heart, liver, kidney and other adverse reactions. Conclusion Low﹣dose decitabine subcutaneous injection combined with arsenicals is safe and could be a new treatment for the medium﹣ and high﹣risk MDS.

Objective: To detect the expression of CRLF2 in adult Ph negative acute B lymphocytic leukemia (B-ALL) in newly diagnosed cases, and to investigate the relationship between CRLF2 and the general clinical characteristics, efficacy and prognosis. Methods: 103 cases of newly diagnosed adult B-ALL patients were investigated from Apr 2016 to Dec 2017 in the Department of Hematology, Henan Cancer Hospital. Bone marrow samples was used to detect the expression of CRLF2 in leukemic cells. The expression of CRLF2 ≥20% was defined as CRLF2-high group and <20% was defined as CRLF2-low group. The clinical characteristics and prognosis of the two groups were compared. Results: The Median overall survival (OS) and disease free survial (DFS) in CRLF2-high group were 9.0 months and 4.25 months, respectively. CRLF2-low group were 15.5 months and 10.25 months, respectively. There was a statistically significant difference in median OS and DFS between the two groups (P=0.007, P=0.000) . The 18-month OS and DFS in CRLF2-high group were 38.6% and 25.1%, respectively. CRLF2-low group were 57.8% and 42.3%, respectively. Multivariate analysis showed high expression of CRLF2 was an independent risk factor for OS (HR=2.991, 95% CI 1.429-6.261, P=0.004) and DFS (HR=2.374, 95%CI 1.146-4.960, P=0.041) in patients. Conclusion Patients with high expression of CRLF2 had poor prognosis.

Objective: To improve the knowledge and experience of ibrutinib combined with CAR-T cells in the treatment of high-risk chronic lymphoblastic leukemia (CLL) patients or small lymphocytic lymphoma (SLL) with TP53 gene aberration. Methods: One case of del (17p) CLL patients with BCL-2 inhibitor resistance was treated with ibrutinib combined with CAR-T cells, successfully bridged to allogeneic hematopoietic stem cell transplantation (allo-HSCT) , and the relative literatures were reviewed. Results: The patient was a young female with superficial lymph node enlarging at the beginning of the onset. Lymph node biopsy was confirmed as small lymphocytic lymphoma (SLL) without del (17p) . The disease progressed rapidly to CLL/SLL with del (17p) and bone marrow hematopoietic failure 2 years later. Firstly, the patient was treated with BCL-2 inhibitor (Venetoclax) , and the enlarged lymph nodes shrank significantly 2 months later. After 3 months, the disease progressed rapidly. The spleen was enlarged to 16 cm below the ribs, the neck lymph nodes was rapidly enlarged, and the superior vena cava syndrome appeared, which were mainly attributed to venetoclax resistance; so BTK inhibitor (ibrutinib) was used continuously after venetoclax discontinuation. Partial remission (PR) was achieved without lymphocytosis after 2 months, then ibrutinib was combined with CAR-T cells targeting CD19 antigen. Grade 1 of cytokine release syndrome (CRS) appeared after CAR-T cells infusion, and the complete remission (CR) was achieved after 1 month both in bone marrow and peripheral blood, with minimal residual disease (MRD) negative, then bridging allo-HSCT after 2 months of combined therapy. Conclusion CLL/SLL patients with TP53 aberration have poor prognosis because of rapid progression, drug resistance, etc. Ibrutinib combined with CAR-T cell therapy can quickly achieved complete remission.

Objective: To explore the effect of combination regimen of interferon alpha-1b, interleukin-2 and thalidomide (ITI regimen) on minimal residual disease (MRD) in patients with acute myeloid leukemia (AML) who were in hematologic remission but MRD-positive. Methods: Eighteen patients (17 from Tumor Hospital of Zhengzhou University and 1 from the First People's Hospital of Pingdingshan City) with AML admitted from July 2016 to June 2018, who were in hematologic remission but MRD-positive were treated with different doses of ITI regimen, and the MRD levels were monitored. Results: Among 18 patients who received a conventional dose of ITI regimen for 1 to 2 months, 7 patients had undetectable MRD, 3 had significant decrease in MRD levels, 3 had elevated MRD level and had hematologic recurrence. Three patients with elevated MRD level received a higher dose of ITI regimen, 2 of them turned to MRD negative and the other 1 patient had decreased MRD level. The total response rate was 72.2%, and the response rate in patients with MRD > 1.0% was 57.1% (4/7) , and that of patients with MRD < 1.0% was 81.8% (9/11) , respectively. Conclusion The ITI regimen can reduce the MRD level of patient with AML who are in hematologic remission but MRD-positive. The therapeutic effect could be improved by a higher dose administration of ITI regimen, and therapeutic effect may be negatively correlated with MRD level before treatment.

The central nervous system is one of the most sensitive targets of microwave radiation. Microwave radiation can affect spatial learning and memory and neural information transmission. The effects of microwave radiation on neurotransmitters in the hippocampus and the underlying mechanisms are still unclear. This paper reviews the effects of microwave radiation on learning/memory and neurotransmitters as well as the mechanisms of action on neurotransmitters. This paper aims to provide a scientific basis for future research in this area.