Objective To study the clinical characteristics of acute leukemia(AL) patients with cross‐lineage antigen expression . Methods Patients were diagnosed and classified by morphology ,cytochemistry and immunology assay ,and prognostic acting factor were also analyzed .Results According to FAB standards ,acute myeloid leukemia(AML)‐M2 ,acute lymphocytic leukemia (ALL)‐L2 and no‐classified type were common in 320 patients with cross‐lineage antigen expression .The immunophenotype with B and my‐eloid mixed expression was the most common(176 cases) ,followed by cross expression of antigen T and myeloid(131 cases) ,and the co‐expression of B ,T and myeloid antigen was found in only 10 cases .In lymphoid antigenpositive AML(Ly+ AML) ,CD19 anti‐gen was the most common among B lineage ,CD7 was the most common in T lineage .In myeloid antigen positive ALL(My+ ALL) , CD33 was the most common myeloid antigen .Forty‐five cases were with mixed expression of myeloid antigen and CD56 expression . Correlation existed between CD7 and CD34(P< 0 .05) ,CD19 and CD34(P< 0 .05) .There were 9 patients with CD34 ,CD7 and CD19 co‐expression ,7 patients with CD34 ,CD7 and CD56 co‐express .In Ly+ AML patients ,23 cases were with recurrent chromo‐some abnormality ,including 11 cases with t(8 ;21)(q22 ;q22) ,RUNX1‐RUNX1T1 ,3 cases with t(15;17)(q22 ;q11‐12) ,PML/RAR ,6 cases with bone marrow eosinophilia inv(16)(p13 ;q22) ,CBF beta /MYH11 ,and 3 cases with t(9;11)(p22;q23) , MLLT3‐MLL .In My+ ALL ,15 patients were with recurrent chromosome abnormality ,including 9 cases of B‐ALL with t(9;22) (q34 ;q11 .2) ,BCR‐ABL1 ,3 cases of B‐ALL with t(v ;11q23) ,MLL rearrangement ,and 3 cases of T‐ALL with 14q11 .2 .Among the presence of reproducible chromosomal abnormalities in AL ,the antigen expression of mistranslation was still with a certain fea‐ture:Ly+ AML patients often mistranslated CD19 ,CD56 ,CD2 ,and My+ ALL patients often mistranslated CD13 and CD33 .Com‐pared with the lymphoid antigennegative AML(Ly - ALL) group ,CD7+ AML group ,CD19+ AML group and CD56+ AML group had significant difference in survival curves(with P value of 0 .01 ,0 .02 and 0 .02) .There was no significant difference in survival curves between myeloid antigen negative ALL(My -ALL) group and CD13/33+ ALL group(P<0 .05) .CD7 was also positive com‐monly(53 cases) and related with CD34(P<0 .05) .So it significantly influenced the prognosis .If patients were with co‐expression of CD34 ,CD7 and CD19 ,the prognosis could be worse .Conclusion AL with cross‐lineage antigen expression might be a special type and confirmed by immunotype .Furthermore ,expression types of differentiation antigen could be critical for prognosis and sur‐vival .

Objective To investigate the expressions of Caveolin-1 and cyclin D1 and their significance in gastric cancer,and offer effective experiment evidence for the decision of gastric cancer prognosis and multitude pathway therapy.Methods The protein expression of Caveolin-1 and cyclin D1 were detected by immunohistochemistry in 120 cases of gastric cancer and 30 cases of normal gastric tissue.The correlations were analyzed between Caveolin1 and cyclin D1 expression and the clinicopathologic features of gastric cancer.Results The decreased expression of Caveolin-1 in gastric cancer may be negative correlated with tumorous differentiation degree,infiltration depth,lymphoid node metastasis and TNM stage;the increased expression of cyclin D1 in gastric cancer was positively correlated with tumorous differentiation degree,lymphoid node metastasis and TNM stage(r =- 0.297,P =0.001).Conclusion The expressions of Caveolin-1 and cyclin D1 were negatively correlated,and their negative synergy may be closely related to the occurrence,development and evolution of gastric cancer.Caveolin-1 and cyclin D1 were novel prognostic mark ers of gastric cancer,and may play an important role in the treatment of gastric cancer.

Objective To investigate the correlation between platelet-associated antibody and platelet infusion effects.Methods SEPSA was used to detect the platelet-associated antibody of 79 patients with multiple transfusions of platelet,the platelet count before and after platelet infusion was monitored and the corrected count increment (CCI) in lh and 24h were calculated,for those judged to be ineffective platelet infusion,the platelet cross-matching was first done and then received matching infusion again and the infusion effects were analysed. Results 47 cases were detected with platelet antibody positive in 79 patients,accounting for 59.5％ ,the CCI of lh and 24h after infusion in platelet antibody positive group were significantly lower than the negative group, the difference was statistically significant( t = 2. 462、2. 583, all P ＜ 0. 05 ) ;40 cases in positive group had the invalid with the invalid rate of 85.1％which was significantly higher than the negative group, the difference was statistically significant ( x2 = 34. 46, P ＜0. 05 ) ;the CCI of 1h and 24h after infusion in matching success group were significantly higher than the unsuccessful group, the difference was statistically significant( t = 2. 152、2. 230, all P ＜ 0. 05) ;27 cases in matching success group had the effective infusion with the effective rate of 87. 1％ ,which was significantly higher than the unsuccessful group, the difference was statistically significant ( x2 = 4. 34, P ＜ 0. 05). Conclusion The production of anti-platelet antibody was a major immune factor which lead to platelet transfusion refractoriness ,the blood platelet cooperative infusion could be a good solution for the platelet transfusion refractoriness.

Objective To explore the application value of serum procalcitonin(PCT)quantitative detection in diagnosing pediat-ric bloodstream infection.Methods The results of 183 cases of blood culture and simultaneous PCT detection in a hospital from February to November 2013 were analyzed retrospectively.The patients were divided into the non-bloodstream infection group and the bloodstream infection group according to the blood culture results as the golden standard.The differences of serum PCT concen-tration were compared between the two groups by the Mann-Whitney U test.Results The serum PCT concentration was 0.15 (0.065-0.55)ng/mL in the non-bloodstream infection group and 1.11(0.505-8.975)ng/mL in the bloodstream infection group, the difference was statistically significant(P =0.000);with 0.50ng/mL as the cut-off value of diagnosis,the sensitivity and the spe-cificity of PCT was 77.8% and 73.3% respectively,the positive and pegative predictive value of PCT was 24.1% and 96.8% re-spectively.Conclusion The quantitative detection of PCT can assist in rapidly diagnosing or excluding bloodstream infection and provides reference for avoiding the overuse of antibiotics or conducting the early anti-infection therapy.

Objective To explore the effect of nucleos(t)ide analog (NA)antiviral treatment on the pathological differentiation of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC)and the prognostic factors of HCC.Methods Totally 127 patients with HBV-related HCC who were hospitalized and received partial hepatectomy in First Affiliated Hospital of Harbin Medical University from March 2007 to November 2013 were included in this study.Sixteen cases received antiviral treatment before operation and the remaining 111 cases had no history of NA treatment.The differences of histopathological grading were compared between the two groups.Twenty-nine patients received antiviral treatment for the first time after surgery,and the rest 82 patients did not.All these patients were followed up for survival and recurrence.Multivariate analysis was used to explore the prognostic factors for HCC.The categorical variables were analyzed byχ2 test or Fisher exact test.Survival rate was compared with Log-rank test. Univariate or multivariate Cox regression analysis was used to explore the related factors of survival. Results The proportions of well-,moderately- or poorly-differentiated HCC in patients with antiviral treatment before surgery were 18.75 %,68.75 % and 12.5 %,respectively.Whereas the proportions in those without treatment were 16.22%,66.67% and 17.11 %,respectively.There was no significant difference in histopathological grading of HCC between the two groups (χ2=0.224,P =0.885 ).The overall median survival time was 39 months.The 6-month,1-and 2-year survival rates were 91 .7%, 77.5 % and 59.3%,respectively.The 6-month,1- and 2-year survival rate of postoperative antiviral treatment were 96.3%,92.4% and 78.5 %,respectively,which were significantly higher than those of no antiviral treatment group (85 .9%,70.0% and 48.5 %,respectively;χ2= 6.967,P = 0.008 ). Univariate analysis showed that tumor number,size,portal vein transfer,AFP level,postoperative antiviral treatment,histopathological grading,TNM staging,BCLC staging,γ-GT and PTA were prognostic factors for postoperative HCC survival.Multivariate analysis showed that AFP level (HR=1 , 95 %CI :1 .0004—1 .002,P =0.004),postoperative antiviral treatment (HR =0.38,95 %CI :0.38—0.15 ,P =0.04)and BCLC stage (B vs A:HR=1 .55 ,95 %CI :0.76—3.18;C vs A:HR=3.63,95 %CI :1 .31 —10.09,P =0.04)were independent prognostic factors.Conclusions Preoperative antiviral treatment has no impact on the histopathological grading of HCC. BCLC stage, AFP level and postoperative antiviral treatment are independent prognostic factors for HBV-related HCC.

Objective To evaluate the dose distribution of the target volume and the cranial base in nasopharyngeal carcinoma ( NPC ) treated with facial-cervical fields, and to analyze the differences of dose distribution using different isoeenters with the CT-simulator and treatment planning system (TPS). Methods Eleven patients with nasopharyngeal carcinoma were treated by conventional radiotherapy as their primary treatment. All patients were simulated by the conventional simulator and the field borders were marked with thin lead wires on the mask. Then the patients were scanned by the CT-sim with the same immobilization. The planning CT images were transferred to the TPS and the field borders were copied on the DRR, and then GTV and the cranial base were contoured on the coronal CT slices. Two isoeenters were chosen, including one in front of the 1 st cervical vertebra to measeure the depth of the nasopharynx and the other in front of the 3rd cervical vertebra to measure the depth of the upper neck. The prescription dose of 36 Gy was given in 18 fractions. Dose distributions of GTV and the cranial base were calculated with TPS. Results The actual dose of 95% volume of GTV was 33.31 -35.54 Gy (median 34.83 Gy) and 31.43 -33.36 Gy (median 32.44 Gy) when the isoeenters were set in the nasopharynx and the superior neck, respectively. The corre-sponding actual dose of 95% volume of the cranial base was 17.76 - 34.60 Gy ( median 30.28 Gy ) and 16.52 -32.60 Gy (median 28.52 Gy), respectively. Conclusions For NPC patients treated with conven-tional radiotherapy using facial-cervical fields, the actual dose of GTV and the cranial base is lower than the prescribed dose whenever the isocenter is set in the nasopharynx or the upper neck,which is more significant in the latter. The isocenter should be set in the nasopharynx when the conventional radiotherapy is applied and a boost of 4- 8 Gy should be given when the cranial base is involved.

Objective To investigate the clinical characteristics and prognosis of patients with synchronous or metachronous liver metastasis of colorectal cancer. Methods Clinical data of patients with colorectal cancer liver metastasis from 1994 to 2006 in the First Affiliated Hospital of Sun Yat-Sen University was retrospectively analyzed. The Kaplan-Meier method and long-rank test were used for bivariate comparisons. Multivariate analysis was done by the Cox regression model (Backward Wald). Results A total of 486 patients with colorectal cancer liver metastasis, including 191 synchronous and 295 metachronous liver metastasis, were analyzed. The overall 5-year cumulative survival rate was 16.2%, 9. 3% forsynchronous and 21.5% for metachronous liver metastasis respectively ( P ＜ 0. 01 ). Liver metastasis was surgically resected in 267 patients, 151 received radiofrequency ablation and 68 underwent conservative therapy with 5-year cumulative survival rates of 22. 1%, 10. 3% and 0 ( P ＜ 0. 01 ) respectively. On univariate analysis, poor prognosis was associated with older age, synchronous metastasis, higher serum CEA level, advanced N stage and poor differentiation of the primary tumor, bowel obstruction, ascites, tumor longitudinal length over 8cm, non-surgery therapy. Multivariate analysis indicated that synchronous metastasis, serum CEA level, ascites and therapy method were independent prognosis factors. Conclusions The time at which a metastasis occur, serum CEA level,ascites and curative surgical therapy determine the prognosis of patients with colorectal cancer liver metastasis. Surgical resection of metastasis in selected patients could prolong survival.

Objective: To analyze the clinical value of megakaryocytes in the diagnosis and treatment of children with immune thrombocytopenic purpura(ITP). Methods: From June 2014 to January 2018, the clinical data of 110 children with ITP diagnosed and treated in Zhucheng People's Hospital Affiliated to Weifang Medical College were analyzed and followed up for more than 1 year.The children were divided into two groups according to whether the duration of the disease was morethan 12 months(chronic group and non-chronic group). Gender, age, initial course of disease, platelet count, lymphocyte count, megakaryocyte count, white blood cell count, and initial treatment regimen were analyzed and compared between the two groups.Multivariate analysis was used to analyze the independent influencing factors of chronic ITP.The clinical value of the initial diagnosis and lymphocyte counts in evaluation of the effects of chronic ITP and initial treatment were analyzed.The clinical value of megakaryocyte in the assessment of initial treatment was analyzed. Results: The initial course of disease[(5.8±2.26)d]and megakaryocyte count[(210.28±98.67)/piece] in the chronic groupwere higher than those in the non-chronic group[(3.57±2.05)d, (165.26±78.35)/piece], and the lymphocyte count[(2.87±0.90)×10⁹/L] in the chronic groupwas lower than that in the non-chronic group[(3.66±1.12)×10⁹/L], the differences were statistically significant(t=4.824, 2.299, 3.545, all P<0.05). Megakaryocyte count was not an independent factor of chronic ITP(P>0.05). The initial course of disease was a risk factor for chronic ITP(OR=3.826), while lymphocyte count was a protective factor(OR=0.471). The initial course of disease was evaluated as AUC=0.648 for chronic ITP, with an optimal cut-off value of 4.5 days, a sensitivity of 65.4%, and a specificity of 62.5%.Lymphocyte counts was evaluated as AUC(area under the ROC curve)=0.648 for chronic ITP, the optimal cut-off value was 3.01×10⁹/L, the sensitivity was 59.4%, and the specificity was 78.2%.The initial course of disease and lymphocyte count had no significant value in evaluation of the treatment outcome (P<0.05). The initial treatment of patients with increased megakaryocyte counts was better than those with the normal level, and the difference was statistically significant(Z=6.051, P<0.05). Conclusion The initial course of disease and lymphocyte count can help to assess the duration of ITP in children.Patients with increased bone marrow megakaryocyte counts can achieve better results at initial treatment.

Blinatumomab, as a novel bispecific antibody targeting CD19 and CD3, can induce T lymphocytes to precisely target CD19 positive B lymphocytes to apoptosis. At present, it is the only bispecific antibody approved for the treatment of hematological malignancies in China. Blinatumomab is effective in the treatment of newly diagnosed, relapsed/refractory, minimal residual disease positive patients with B-cell acute lymphoblastic leukemia (B-ALL) . It can improve the survival of the patients and is well tolerated. The further study of blinatumomab can provide theoretical basis and new ideas for induction therapy, salvage therapy and subsequent hematopoietic stem cell transplantation in patients with B-ALL.

Objective:To observe the effect of different asparaginase on the incidence of drug-induced diabetes in children with acute lymphoblastic leukemia(ALL) during combined chemotherapy.Methods:A total of 100 ALL children hospitalized in Zhucheng People's Hospital from January 2016 to December 2018 were selected in this study.According to the difference of asparaginase, 67 cases were divided into L-asparaginase group, and 33 cases were divided into pegaspargase group.The demographic, clinical indicators and remission after chemotherapy were compared between the two groups, and logistic regression model was used to analyze the influencing factors of diabetes mellitus during treatment.Results:There were statistically significant differences in random blood glucose ( t=2.515, P=0.014), albumin ( t=2.407, P=0.018), serum C-peptide ( t=2.030, P=0.045) and diabetes mellitus ( t=5.380, P=0.002) between the two groups after chemotherapy ( P<0.05). During chemotherapy, drug-induced diabetes mellitus had the highest incidence in induction remission period.The incidence of the L-asparaginase group (31.3%, 21/67) was higher than that of the pegaspargase group (12.1%, 4/33) (χ 2=4.357, P=0.037). Age (χ 2=7.748, P=0.005), risk stratification (χ 2=10.500, P=0.005) and types of chemotherapeutic drugs (χ 2=7.752, P=0.005) were independent influencing factors for the occurrence of drug-induced diabetes in children with ALL during chemotherapy ( P<0.05). The older the age, the greater the risk of diabetes mellitus during chemotherapy.The risk of drug-induced diabetes mellitus in pegaspargase group was 0.107 times higher than that in L-asparaginase group.The risk of drug-induced diabetes in high-risk children was 9.916 times higher than that in low-risk children. Conclusion:Drug-induced diabetes mellitus in ALL children treated with asparaginase combined with chemotherapy mainly occurs in the early stage of chemotherapy.The risk of drug-induced diabetes mellitus in ALL children treated with L-asparaginase combined with chemotherapy is higher than that of pegaspargase.Pegaspargase combined with chemotherapy in the treatment of ALL children can effectively reduce the incidence of drug-induced diabetes during chemotherapy.