Objective:To investigate the survival and prognosis of B-lineage acute lymphoblastic leukemia (B-ALL) patients with TP53 mutation.Methods:The clinical data of 479 newly diagnosed B-ALL patients treated in the First Affiliated Hospital of Soochow University from January 2016 to December 2019 were retrospectively analyzed.Results:Among 479 B-ALL patients, 34 cases (7.1%) were positive for TP53 gene mutation, and a total of 36 TP53 mutations were detected, including 10 frameshift gene mutations (27.8%) , 23 missense mutations (63.9%) and 3 nonsense mutations (8.3%) . A total of 34 (94.4%) mutations were located in the DNA binding domain (exons 5-8) .The average number of mutated genes in patients with TP53 gene mutation (2.3) and the group without TP53 gene mutation (1.1) were statistically different ( P<0.001) . The proportion of Ph positive and Ph-like positive patients in the TP53 gene mutation negative group was significantly higher than that of the TP53 mutation positive group, and the difference was statistically significant ( P<0.001) . The 3-year OS and EFS rates of the TP53 gene mutation negative group were significantly higher than those of the TP53 gene mutation positive group. The differences in OS and EFS rates between the two groups were statistically significant ( χ2= 4.694, P = 0.030; χ2= 5.080, P= 0.024) . In the multivariate analysis, failure to achieve remission (CR) after one course of induction chemotherapy was an independent adverse prognostic factor affecting OS.Of the 34 patients with TP53 mutation, 16 underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the CR 1 state, and 2 patients with recurrence after transplantation obtained CR 2 after infusion of donor-derived anti-CD19 chimeric antigen receptor T (CAR-T) cells. Among the 11 patients with TP53 gene mutation who relapsed during consolidation chemotherapy, 6 received anti-CD19 CAR T cell therapy, 4 patients achieved remission and minimal residual disease (MRD) turned negative, followed by bridging allo-HSCT, and 2 of them sustained CR. Conclusion:Missense mutations are the most common in B-ALL patients with TP53 gene mutation, and the majority of mutations were located in the DNA binding domain. B-ALL patients with TP53 gene mutation should undergo allo-HSCT as soon as possible after CAR-T cell therapy has cleared the MRD after recurrence. B-ALL patients with TP53 gene mutation still have a higher recurrence rate after allo-HSCT, and the infusion of donor-derived CAR-T cells can achieve better sustained remission.

Objective: To evaluate the clinical value of the the hypopharynx and chest esophageal carcinoma. Methods: 20 patients surgical treatment data of the hypopharynx and chest esophageal carcinoma from January 2013 to July 2019 were reviewed. Results: The simultaneous hypopharynx and esophageal carcinoma 11 cases. The heterochronic hypopharynx and chest esophageal carcinoma 9 cases. 20 cases are all squamous cell carcinoma. The synchronus operation included total pharyngolaryngo esophagectomy, gastric tube interposition pharyngo gastric anastomic, neck and mediastinal lymph nodes dissection, tracheostomy. The heterochronic operation included the first stage radical hypopharygealectomy, the second stage radical esophagealectomy. Postoperative complications included in hospital death in one, double pneumonia in 3 and anastomosis stricture in one case. Pharynx gastric fistula in 2. Swallowing function were all recovered. Conclusion Although laryngo pharyngo esophagectomy and pharyngogastric anastomoses for the hypopharynx and chest esophageal carcinoma is a simple and acceptable procedure, the quality of life is not satisfactory. And although colon interpasation for esophageal replacement is complicated the quality of life is the best.

Ballistocardiogram (BCG) and electrocardiogram (ECG) can realize the detection of cardiac function from mechanical and electrical dimensions respectively. By extracting the corresponding characteristic parameters of the two signals and carrying out joint analysis, an important cardiac physiological index such as cardiac contractility, can be reflected. To overcome the shortcomings of complication and heaviness of the existing acquisition equipment, a wearable BCG-ECG signal acquisition system is designed in this paper, which realizes BCG signal acquisition based on accelerometer and ECG signal acquisition based on conductive rubber electrodes. The signals of 6 healthy persons were collected, and BCG signals collected by piezoelectric films were used as reference signals. The waveform characteristics of signals were compared, and the difference of cardiac cycle acquisition was analyzed. The waveform characteristics of the two signals acquired by the device were consistent with the standard signals, and there was no significant difference in the acquisition of the cardiac cycle between the proposed method and the traditional method. The results show that the system can accurately collect human BCG signals and ECG signals. The system provides a basis for subsequent research on BCG signal formation mechanism and health applications.

Objective: To explore the efficacy and safety of chimeric antigen receptor T (CAR-T) cells in the treatment of central nervous system leukemia (CNSL). Methods: Two leukemia patients with CNSL were treated with CD19-CAR-T cells. The process and results of the entire treatment is reported and related literature review is conducted. Results: The patients were diagnosed as acute myeloid leukemia (AML)-M₂ with B lymphoid antigen expression and B cell acute lymphoblastic leukemia(B-ALL) by morphology and immunophenotype assay. The immunophenotype was consistent with the abnormal manifestations of AML-M₂ and B-ALL. Their clinical manifestations and laboratory tests met the diagnostic criteria of CNSL. The diagnosis was clear and the two patients were treated with CD19-CAR-T cell immunotherapy. Central nervous system symptoms were relieved. The imaging abnormalities of patient one has disappeared but cytokines release syndrome (CRS) occurred during the treatment. Cerebrospinal fluid of patient two was negative and no obvious CRS reaction was found. Conclusions CAR-T cell immunotherapy is likely to induce the remission of CNSL and improve the prognosis.

Objective To investigate imaging manifestations of desmoids-type fibromatoses (DF).Methods The CT and MRI features of 17 cases with DF were reviewed retrospectively.Resuits All of 17 cases were solitary lesions,of which 10 cases were abdominal wall shape,5 cases were abdominal wall type and 2 cases were intra-abdominal (mesentery) type.In all the cases,10 times CT and 10 MRI examinations were performed,of which 3 cases underwent CT and MRI examination.In 10 cases with CTexamination,9 cases of plain scan was density,uniform density,1 cases of abdominal DF scan showed slightly higher local density.Enhanced CT scanning was performed in 5 cases,including 4 cases of mild enhancement,and the other 1 case of intra-abdominal DF showed annular enhancement.2 cases of delayed scan showed progressive enhancement.MRI examination was performed in 10 cases,T1WI were equal signals,9 cases of T2WI and SPIR sequences were high signals,and internal signals were not uniform.One case of internal DF showed patchy,short T2 low signal,and SPIR was low signal.6 cases of DF underwent enhanced scan,the lesions showed moderate and markedly inhomogeneous enhancement,with punctate,funicular and patchy enhancement in the interior zone.Conclusion The CT and MRI features of DF have some characteristics,and MRI can reflect the histological features of lesions.

Objective To investigate imaging manifestations of desmoids-type fibromatoses (DF).Methods The CT and MRI features of 17 cases with DF were reviewed retrospectively.Resuits All of 17 cases were solitary lesions,of which 10 cases were abdominal wall shape,5 cases were abdominal wall type and 2 cases were intra-abdominal (mesentery) type.In all the cases,10 times CT and 10 MRI examinations were performed,of which 3 cases underwent CT and MRI examination.In 10 cases with CTexamination,9 cases of plain scan was density,uniform density,1 cases of abdominal DF scan showed slightly higher local density.Enhanced CT scanning was performed in 5 cases,including 4 cases of mild enhancement,and the other 1 case of intra-abdominal DF showed annular enhancement.2 cases of delayed scan showed progressive enhancement.MRI examination was performed in 10 cases,T1WI were equal signals,9 cases of T2WI and SPIR sequences were high signals,and internal signals were not uniform.One case of internal DF showed patchy,short T2 low signal,and SPIR was low signal.6 cases of DF underwent enhanced scan,the lesions showed moderate and markedly inhomogeneous enhancement,with punctate,funicular and patchy enhancement in the interior zone.Conclusion The CT and MRI features of DF have some characteristics,and MRI can reflect the histological features of lesions.

Objective The individualized treatment of breast cancer have attracted more and more attention .Different mo-lecular subtypes of breast cancer have different kinds of prognosis and therapeutic regimen .Studies have found that miR-342-3p is asso-ciated with breast cancer of hormone receptor and endocrine therapy resistance , as well as tumor cell apoptosis .This study was to fur-ther investigate the expressions of miR-342-3p in different breast cancer molecular subtypes and breast cancer cell lines to reveal the importance of miR-342-3p in individualized treatment of breast cancer . Methods A total of 90 tissue samples from patients with breast cancer surgery were collected .Three types of breast cancer cell line were cultured , including MCF-7, SKBr3 and MDA-MB-231.Real-time fluorescent quantitative PCR was applied to detect the expression of miR-342-3p in breast cancer tissue . Results Expression of the miR-342-3p increased the most in Lumina B type breast cancer tissue (1.594 ±0.465), followed by Lumina A type (1.386 ±0.443), Her-2 high expression type (1.165 ±0.337), and the lowest in the tripe negative breast cancer tissue (0.837 ± 0.351), representing significant difference (P<0.05).There was no statistical difference in the expression of the miR-342-3p as to different age groups, lymph node metastasis and tumor size, histological grading and staging (P>0.05).As to the expression of miR-342-3p in three types of breast cancer cell line , taking SKBr3 as the reference, the relative ratio was 126(118-134) and MDA-MB-231 was 0.017(0.014-0.018). Conclusion The expressions of miR-342-3p are different in different molecular subtypes and cell lines of breast cancer , which are relevant to different molecular subtypes of breast cancer , making it possible reference index for breast cancer typing and relevant to good prognosis .

Objective To investigate the efficiency and safety of allogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 yeas of age. Methods From May 2002 to January 2010, 35 patients (＞ 50 years) with malignant hematological diseases received allogeneic hematopoietic cell transplantation. In 35 patients, 18 patients were conditioned with non-myeloablative regimen and 17 patients with myeloablative regimen. The outcome,engraftment and prognosis of allogeneic hematopoietic cell transplantation were analyzed. Results The hematopoetic reconstitution was achieved in 32 of 35 patients. The median time of granulocyte count exceeding 0. 5 × 109/L was 12 days and the that of platelet count exceeding 20 × 109/L was 17days. The cumulative incidence of aGVHD was 48. 6 %, and 37. 9 % patients developed cGVHD.The estimate probability of cumulative survival at 5 years was 48. 5 %, The estimate probability of cumulative mortality rate was 51.5 %, and the estimated transplant-related mortality was 22. 9 %.The relapse rate was 11.4 %. There was significant difference except for the incidence of cGVHD.Conclusion Allogeneic hematopoietic cell transplantation may be appropriate for older patients with malignant hematological diseases.

Objective To evaluate the clinical applications and surgical methods of combined laparoscopic common bile duct (CBD) exploration with choledochoscopy. Methods From 2006 to 2009,clinical data of 42 patients with choledocholithiasis undergoing laparoscopic common bile duct exploration were retrospectively analyzed. We applied a step-by-step electric coagulating incision technique on the CBD,the step-by-step suturing technique, and the step-by-step clamping technique with alligator forceps, and soft tube irrigating technique with suctioning by selecting the proper exploration route, improving the common bile duct incision technique and calculus removing techniques. Results Procedures were successful in all the cases. There was no conversions to open surgery, no postoperative bleeding and no operative mortality. The mean operating time was 120 minutes (ranging, 90 to 150 minutes) with minimal intraoperative blood loss ( ranging, 20 to 40 ml). Ductal stone clearance was successful in 41 out of 42 patients ( 93% ). The largest number of the common bile duct stones was 16. With the diameter of stones larger than 15 mm in 18 cases in which the biggest was 30 mm. Bile leak developed in 1 patient, retained stones found in 3 patients,including intrahepatic cholelithiasis in one case. As a result, 38 out of 42 patients underwent common bile duct exploration. 35 patients were placed on T-tubes. Four patients underwent cystic duct exploration in which 3 had primary suture of the cystic duct and 1 had drainage. There was no infection and stenosis of biliary tract in the 42 followed-up cases. Conclusions Laparoscopic common bile duct exploration with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. Improving the way of operation and selecting suitable exploration can result in better clinical outcomes.

BACKGROUND: Previous research has investigated the effect of nano-zirconium dioxide-toughened hydroxyapatite (nano-ZrO2-HA) on the proliferation and differentiation of rabbit bone marrow stromal cells.OBJECTIVE: To evaluate the biocompatibility of nano-ZrO_2-HA compound.METHODS: The experiments of acute toxicity,subacute toxicity,pyrogen,hemolysis,and intramuscular implantation were performed on New Zealand rabbits,healthy adult Kunming mice,and adult rats according to "Technical Evaluation Standards of Biomedical Materials and Medical Instruments",promulgated by Chinese Board of Health.RESULTS AND CONCLUSION: Acute toxicity: All experimental animals survived.There was no significant difference in body mass before and after testing (P> 0.05).Pyrogen: Heating reaction was not tested.Hemolysis: Generally speaking,hemolytic crisis was not observed after 1 hour,and hemolytic rate was less than 5%.Intramuscular implantation: Infection did not occur in any animals,and materials were not discharged at all.Four weeks later,muscles were closely integrated with materials.A certain quantity of tissue grew into material pore,and peripheral muscle still had normal morphology and structure.Subacute toxicity:There was no significant difference in body mass and blood routine before and 2 weeks after testing.HE staining demonstrated that necrotic focus and other lesion were not observed in heart,liver,and kidney tissues under optic microscope.The results suggested that nano-ZrO_2-HA was non-toxicity,and it had no pyrogen and hemolysis effect,as well as it did not stimulate to the muscle of rabbit.Inflammatory rejection did not happen to the animal.The nano-ZrO_2-HA was closely integrated with the muscle,characterizing by great biocompatibility.Therefore,it can be used as substitution materials in clinical experiment.But it still needs to be evaluated completely.