Objective To investigate the relationship between the grade of gliomas and the status of adjacent fiber tract with DTL Methods MRI and DTI were performed in 24 patients with histologically confirmed brain gliomas.Regions of interest were placed in the white matter adjacent to the tumor with the lowest FA(Faa) and in the white matter of the contralateral hemisphere(Fac).The values of Faa and Fac were measured.In the regions of the same slice, the values of ADCa and ADCc were measured. Relative fractional anisotropy ratios (rFA) and relative apparent diffusion coefficient ratios (rADC) were also calculated.The status of fiber tracts adjacent to the gliomas were characterized as displacement, infiltration or disruption.Fiber tracking using the Fiber Assignment by Continuous Tracking (FACT) method was performed to investigate the integrity of white matter tracts in the surrounding border zone of the gliomas.The correlation of rFA, rADC, the state of adjacent fiber tracts, and the grade of gliomas were analyzed statistically by using independent sample t test and tendency X2 test.Results Eleven of the 24 tumors were demonstrated as low grade gliomas (WHO grade Ⅰ-Ⅱ) and 13 were high grade giiomas (WHO grade Ⅲ-Ⅳ).The average rFA and rADC of the low grade gliomas were 0.65±0.19 and 1.43 ± 0.50 respectively.Most of fiber tracts in the periphery of the low grade gliomas were displaced or infiltrated.The average rFA and rADC of the high grade gliomas were 1.51 ± 0.39 and 1.70 ±0.27 respectively.Most of fiber tracts in the periphery of the high grade gliomas were infiltrated or disrupted.Significant difference was found for rFA (t =8.504,P =0.000) and but not for rADC(t = - 1.435 ,P =0.165) between low grade and high grade gliomas.Significant difference existed between the state of fiber tracts adjacent to ghomas and low and high-grade(X2 =5.882 ,P =0.015).Conclusions The malignancy of gliomas influences the state of fiber tracts in the vicinity of tumors, rFA can serve as a reference for distinguishment of high-grade and low-grade gliomas.DTI can depict the localization of gliomas and the adjacent fiber tracts.The state of fiber tracts can also be identified by DTI.It is helpful for the therapeutic plan of the tumors.

Objective To observe the application effect of protease combined with quadruple therapy in the remedial treatment of Helicobacter pylori(Hp)eradication failure.Methods A total of 100 patients with Hp infection who failed in initial treatment were selected as the study objects,and were divided into control group(50 cases)and observation group(50 cases),and two groups re-ceived a course of treatment for 14 days.The control group was given esomeprazole enteric-coated tab-lets,amoxicillin capsules,furazolidone tablets and colloidal bismuth pectin capsules.The observation group was given streptomycin granule and sodium bicarbonate powder on the basis of the control group.Hp eradication rates were calculated for intention to treat(ITT)analysis and per protocol(PP)analysis.The symptoms and adverse drug reactions before and after treatment were recorded in two groups.Results In the control group,18 cases were successfully eradicated,the eradication rate by ITT analysis was 36％,and the eradication rate by PP analysis was 36％.In the observation group,37 patients had negative 14C breath test results,with an eradication rate of74％by ITT analy-sis and 74％by TT analysis.There was statistical significance in the eradication rate between the two groups(P＜0.05).There was no significant difference in compliance between the two groups(P＞0.05).The improvement of abdominal pain symptoms before and after eradication was statistically significant between the two groups(P＜0.05).There was no significant difference in adverse reac-tions between the two groups(P＞0.05).Conclusion The remedial treatment regimen of strepto-mycin combined with quadruple therapy can improve the eradication rate of Hp infection patients whose initial eradication failed.

Objective To observe the application effect of protease combined with quadruple therapy in the remedial treatment of Helicobacter pylori(Hp)eradication failure.Methods A total of 100 patients with Hp infection who failed in initial treatment were selected as the study objects,and were divided into control group(50 cases)and observation group(50 cases),and two groups re-ceived a course of treatment for 14 days.The control group was given esomeprazole enteric-coated tab-lets,amoxicillin capsules,furazolidone tablets and colloidal bismuth pectin capsules.The observation group was given streptomycin granule and sodium bicarbonate powder on the basis of the control group.Hp eradication rates were calculated for intention to treat(ITT)analysis and per protocol(PP)analysis.The symptoms and adverse drug reactions before and after treatment were recorded in two groups.Results In the control group,18 cases were successfully eradicated,the eradication rate by ITT analysis was 36％,and the eradication rate by PP analysis was 36％.In the observation group,37 patients had negative 14C breath test results,with an eradication rate of74％by ITT analy-sis and 74％by TT analysis.There was statistical significance in the eradication rate between the two groups(P＜0.05).There was no significant difference in compliance between the two groups(P＞0.05).The improvement of abdominal pain symptoms before and after eradication was statistically significant between the two groups(P＜0.05).There was no significant difference in adverse reac-tions between the two groups(P＞0.05).Conclusion The remedial treatment regimen of strepto-mycin combined with quadruple therapy can improve the eradication rate of Hp infection patients whose initial eradication failed.

Objective:To analyze the correlation between clinical features and prognosis or prognostic risk factors in patients with KMT2A::AFF1 gene positive B-ALL.Methods:Retrospective cohort study was conducted. 167 cases of B-ALL admitted to the Shanghai General Hospital and the Naval Medical University Affiliated First Hospital from April 1, 2011 to July 31, 2022 were divided into groups according to gene types. 22 cases with KMT2A::AFF1 positive B-ALL were enrolled as the experimental group, 54 cases with BCR::ABL gene positive B-ALL as control group 1 and 91 cases with KMT2A::AFF1 and BCR::ABL gene negative B-All as control group 2. The median age of first diagnosis in the experimental group, control group 1 and control group 2 were 43.5(30.5, 56), 43.5(34, 55) and 32(24, 46) respectively. The median white blood cell counts of the three groups were 142.4(25.7, 247.2)×10 9/L, 37.6(15.7, 102.2)×10 9/L and 13.4(4.3, 33.0)×10 9/L, respectively. Allo-HSCT rates in three groups were 45.5%, 72.2% and 72.5% respectively. Using SPSS 26.0 software, the statistical methods of nonparametric rank sum test, chi-square test, Kaplan-Meier and Cox regression were used to analyze and compare the differences in clinical characteristics, chemotherapy and prognosis between the experimental group and the control groups, and to analyze the risk factors and the differences in prognosis of allo-HSCT in the experimental group. Results:The age difference between the experimental group and the control group 2 was significant ( Z=-2.151, P=0.031). The white blood cell count in experimental group was significantly higher than that in control group 1 ( Z=-2.363, P=0.018) and control group 2 ( Z=-4.886, P<0.001). The rate of allo-HSCT in experimental group was lower than that in control group 1(45.5% vs 72.2%, χ 2=4.890, P=0.027) and control group 2 (45.5% vs 72.5%, χ 2=5.897, P=0.015). The remission rates of the patients in three groups after receiving one course of chemotherapy were 60%(12/20), 83.3%(45/54) and 76.6%(69/90); the remission rates after two courses of chemotherapy were 25%(5/20), 7.4%(4/54) and 12.2% (11/90), and the non-remission rates of more than two courses of treatment were 15%(3/20), 9.3%(5/54) and 11.1%(10/90), respectively. The effect of chemotherapy in experimental group was worse than that in control group 1 ( Z=-1.979, P=0.048). There was no significant difference between the three groups in sex, whether the chromosome is a standard-risk karyotype, hemoglobin at the time of initial onset, platelet count and percentage of bone marrow blast cells. The overall survival rate (OS) of experimental group was significantly lower than that of control group 1 and control group 2(23.9% vs 36.7%, χ 2=7.608, P=0.006 and 23.9% vs. 44.8%, χ 2=6.442, P=0.011), and the 3-year recurrence-free survival (RFS) was also lower than that of the other two groups (14.0% vs 57.6%, χ 2=17.823, P<0.001 and 14.0% vs 48.2%, χ 2=16.432, P<0.001). There was a significant difference in the total OS rate between the experimental group and the group without allo-HSCT (45.0% vs 9.2%, χ 2=15.254, P<0.001). Univariate analysis showed that age was the risk factor of RFS in the experimental group, and allo-HSCT therapy was the protective factor of OS. Multivariate analysis showed that allo-HSCT was an independent protective factor for OS in the experimental group. Conclusions:Patients with KMT2A::AFF1 positive B-ALL had higher white blood cells, less sensitivity to chemotherapy and poor prognosis. Age was a risk factor of RFS in KMT2A::AFF1 positive B-ALL, and allo-HSCT could improve the prognosis.