Objective To explore the feasibility and operation methods of interforniceal diaterma keyhole approach for operative therapy of apex basilar artery aneurysm. Methods Interforniceal diaterma keyhole approach was designed to interpeduncular cistern with diaterma incision from tuber cinereum to posterior perforated substance and between bilateral mammillary bodies. The simulation operations of interforniceal diaterma keyhole approach were performed in 16 cadaveric heads by assisting with Stryker neuronavigation. Anatomic structures were observed by surgical microscope and measured by Stryker neuronavigation in the keyhole approach operations. Results The operations of interforniceal diaterma keyhole approach could be accomplished successfully in 16 cadaveric heads. The distances from bregma to superior margin of interventricular foramen, superior margin of adhaesio interthalamica, mammillary body, superior margin of aqueduct of midbrain and bifurcation of basilar artery were (68.4±4.6)mm, (66.3±6.0)mm,(86.3±5.3)mm, (82.0±7.6)mm and (91.8±5.0)mm respectively. The length of surgical window of diaterma was (9.5±2.6)mm from tuber cinereum to posterior perforated substance between bilateral mamillary bodies. The apex of basilar artery, P1 and P2 of posterior cerebral artery, superior cerebellar artery, posterior communicating artery and perforating branches from them could be exposed distinctly in interpeduncular cistern. The scope of operative exposure region was front to clivus and dorsum sellae by dissected the Liliequist panniculus, lateral to oculomotor nerve and posterior to interpeduncular fossa. The bifurcation of basilar artery apex was deviation to left in 68.8%. The bilateral posterior cerebral arteries were oblique to the anterolateral in 68.8%. There were 1-4 perforating branches from the apex of basilar artery in the included angle of bilateral posterior cerebral arteries. Conclusion Interforniceal diaterma keyhole approach is feasible for technique. It is worth of implementing and perfecting in surgical therapy of the apex basilar artery aneurysm.

Objective To explore the epidemiology, clinical and pathological characteristics,treatment and prognosis of Richter's syndrome (RS). Methods The clinical and laboratory feature,treatment, prognosis of two cases were reported, and the related literature was reviewed. Results The major symptom of two cases suffered with enlarged lymph nodes, and pathological examination indicated a diffuse large B cell lymphoma. A large number of mature small lymphocytes were found in peripheral blood and bone marrow, and the immune phenotype was consistent with chronic lymphocytic leukemia. CHOP regiment was used on two cases. One obtained complete remission, and the other cases partial remission. Conclusion RS may occur at early stage after CLL diagnosis. In some cases, the diagnosis of RS and CLL are concomitant.Prognosis of some patients of RS is unfavourable. It was important to take biopsy at early stage.

Objective To intensify the diagnosis and treatment of primary osseous Hodgkin disease (HD) and reinforce the impression of its features of pathology and imaging. Methods The clinical manifestation, laboratory examination, treatment and outcome of a patient with primary Hodgkin disease of the supermaxilla were first reported and the pertinent literatures were reviewed. Results Pain of the right supermaxilla was the first clinicM symptom. Plain X-rays showed mixed osteolytic and partially osteosclerotie lesions in the right supermaxiUa. The tumor was removed and the pathohistology was HD lymphocyte-depletion. The clinical diagnosis was primary HD of the supermaxilla (Stage Ⅰ ). The case was treated with ABVD regimen and no obviously adverse reaction appeared. Conclusion Primary osseous HD rarely presents as a malignant bone lymphoma and is easily misdiagnoed. Pathological and immunohistologic studies can be useful to confirm the diagnosis of primary osseous HD. Early diagnosis and the differentiation from other disease should be performed and the prognosis of the present-day chemotherapy regimen appears good.

Objective To investigate the efficacy and adverse events of BACOD regimen for relapsed and refractory non-Hodgkin lymphoma (NHL). Methods Sixty patients with relapsed and refractory NHL received chemotherapy of BACOD regimen: bleomycin 10 mg/m2, intravenous drip on the 2nd and 9th day;cyclophosphamide 750 mg/m2, intravenous drip on 1st day; vindesine 3 mg/m2, intravenous drip on 1st and 8th day; cytarabine 150 mg/m2, intravenous drip on 2nd-5th days; dexamethasone 10 mg/m2, intravenous drip on 2nd-5th days; every 3 weeks was one cycle. Results Eighteen cases (27.7 %) received the complete remission (CR), 30 the partial remission (PR), 13 stable disease (SD) and 4 progressive disease (PD). The overall response (CR+PR) rate was 70.8 %. The median remission time of patients with response was 11 months(2-38 months). The 1-year survival rate was 32.3 % and the 2-year survival rate was 24.6 %. The main adverse events were myelosuppression. Conclusion BACOD regimen can be used as the relief regimen of relapsed and refractory NHL.

Objective To investigate the epidemiology of patients in malignant hematologic neoplasms with fungemia and provide evidence for clinical therapy. Methods 23 cases of patients of malignant hematologic neoplasms with fungemia concurrent clinical material, the dangerous factor, the fungus colony classification as well as the treatment and the prognosis were carried on the review analysis. Results Each patient with fungemia was seriously ill with two or more predisposing factors;Candida ablicans accounted for 47%;the rate of candida parapsilosi, candida tropicalis were 17%, 12%. In the 23 cases of patients,13 cases of patients cure (56.5%), 8 cases of patients died (34.7%);2 cases of patients give up (8.6%). Conclusion Fungemia in the patients of malignant hematologic neoplasms usually occurred with predisposing factors. Important measures to reduce mortality include curing the underlying diseases, emphasis on mornitoring fungal pathogen and susceptibility tests, early diagnosis and compliance medication principles.

Objective To explore the effect of adriamycin, bleomyein, vincristine and dacarbazinum (ABVD) chemotherapy scheme executed at day I and day 8 for primary Hodgkin's lymphomas (HL). Methods 62 patients with primary HL in stages Ⅱ-Ⅳ treated in our department from October 2005 to October 2006 were divided into group A and B at random with 31 patients in each group. The patients in group A received ABVD chemotherapy scheme executed at day 1 and day 8 for 6-8 cycles. The patients in group B received ABVD chemotherapy scheme executed at day 1 and day 15 for 6-8 cycles. The patients of the groups received radiotherapy by the same doctor after chemotherapy according to the patients condition and the radiotherapy regimens were not affected by the grouping. Results The complete remission rate (CR)in group A after chemotherapy was 90. 3% (28/31);the one-year and two-year disease free survival (DFS) rates were 87. 1% (27/31) and 80.0% (20/25)respectively. The CR rate in group B after chemotherapy was 83.9% (26/31);the one-year and two-year DFS rates were 80. 6% (25/31)and 72. 0% (18/25) respectively. The discrepancy of CR rates and the one-year and two-year DFS rates between the two groups was not significant (P>0.05). The incidences of therapeutic side effecte such as myocardial iscnemia grade Ⅲ-Ⅳ liver function impair-ment,pulmonary fibrosis and serious marrow inhibition between the two groups were not significant too (P > 0.05). Average chemotherapy period for the patients in group A was 159 days; it was 69 days shorter than that in group B. Conclusion The CR rate,1-year DFS rate and 2-year DFS rate of ABVD chemotherapy scheme executed at day 1 and 8 are similar to those of ABVD chemotherapy scheme executed at day Ⅰ and 15 for primary HL in stages Ⅱ-Ⅳ. The side-effects of chemoterapy between group A and B are similar too. The chemotherapy period in group A is shortened significantly.

Objective To examine the contribution of CD4+ CD25+ regulatory T cells to liver transplant tolerance. Methods After injection of anti-CD25 monoclonal antibody (mAb, PC61), mouse orthotopic liver transplantation was performed and survivals were determined. The paraffin-embedded sections of hepatic allografts were cut and stained with hematoxylin and eosin (HE). Furthermore, the effect of CD4+ CD25+ regulatory T cells on proliferative response of CD4+ T cells and cytotoxicity of CD8+ T cells was examined by depleting these regulatory T cells. Results Depletion of these cells in the recipients but not in the donors before liver transplantation caused rejection. Histological analyses of hepatic allografts with PC61 treatment showed extensive leukocyte infiltration and tissue destruction, whereas those in the control group showed minimal changes. Moreover, elimination of CD4+CD25+ T cells resulted in the enhancement of both proliferative response of CD4+ T cells and cytotoxicity of CD8+ T cells against donor-type alloantigen. Conclusions These results suggest that CD4+CD25+ regulatory T cells were important for tolerance induction to hepatic allografts.

Objective To investigate the expression of CXCR6 in allograft rejection and effect of CXCL16/CXCR6 interaction on allograft survival Methods Intra-abdominal heterotopic heart transplantation was performed using wild type (WT) Balb/c mice (H-2d) (allogeneic) as donors or WT C57BL/6 mice (B6, H-2b) (syngeneic) as donors, and using WT B6 mice as recipients. The intragraft expression of CXCR6 and expression of CXCR6 in CD8+ T cells of the spleens from syngeneic and allogeneic recipients were examined. The allogeneic recipients were further divided into the experimental group (n = 5) and control group (n = 6) randomly. The experiment group and control group were injected with anti-CXCL16 mAb or control mAb respectively until rejection occurred. The cardiac allograft survival in experimental group and control group was evaluated. Results Rejected allografts showed higher expression of CXCR6 than syngeneic cardiac grafts. More importantly,expression of CXCR6 in CD8+ T cells was also up-regulated by allograft rejection. However, injection of anti-CXCL16 mAb could not inhibit cytotoxic activity of CD8+ T cells. Moreover, experimental group could not prolong the cardiac graft survival time as compared with control group. Conclusion Expression of CXCR6 in CD8+ T cells is up-regulated in allograft rejection.

Hepatocellular carcinoma (HCC) is well characterized as a heterogeneous disease. Its late-stage diagnosis and chemotherapy resistance make it one of the refractory tumors in China. Natural killer (NK) cells play a significant role in immune surveillance. However, NK cells become dysfunctional in the progression of HCC, leading to tumor immune escape. This article reviews the recent progress on different strategies of NK cell-based immunotherapy in treating HCC, including direct adoptive NK cell transfer, gene engineering in NK cell, NK cell receptor targeting, immunosuppressive microenvironment modification, and tumor toxicity enhancement by cytokines or traditional Chinese medicine. These NK cell-based strategies have shown promising therapeutic potential.
Humans ; Carcinoma, Hepatocellular/therapy* ; Liver Neoplasms/therapy* ; Immunotherapy ; Killer Cells, Natural ; Receptors, Natural Killer Cell ; Tumor Microenvironment

OBJECTIVETo explore the clinical and survival significance of CD20 positive adult patients with B-lineage acute lymphoblastic leukemia (B-ALL).

METHODSThe clinical features and survival of 168 adult patients with B-ALL diagnosed and treated in our department from May 2007 to July 2011 were analyzed retrospectively, 58 expressed CD20 and 110 not.

RESULTSThe sex, distribution of age, anemia, thrombocytopenia, infiltration of liver, spleen and lymph nodes, the expression of myeloid lineage marker, incidence of Ph chromosome, complete remission within 4 weeks showed no significant differences in CD20 positive and negative groups (P>0.05); median white blood cell count at diagnosis and the rate of patients with high white blood cell count in CD20 positive group were 19.2×10⁹/L and 37.9% respectively, which were significantly higher than those of 6.93 × 10⁹/L and 20.9% in CD20 negative group (P<0.05); cumulative incidence of relapse between two groups showed significant difference (P<0.05); multivariable analysis for overall survival and progress-free survival identified CD20 positivity as independent predictor.

CONCLUSIONThe expression of CD20 in adult patients with B-ALL appeared to be associated with high white blood cell count and poor prognosis.

Adult ; Antigens, CD20 ; Cell Lineage ; Disease-Free Survival ; Humans ; Leukocyte Count ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; Remission Induction ; Retrospective Studies ; Survival Analysis