Objective:To conduct a nationwide physician survey to better understand clinicians’ disease awareness, treatment patterns, and experience of Waldenstr?m macroglobulinemia (WM) in China.Methods:This cross-sectional study was conducted from February 2022 to July 2022 by recruiting clinicians with WM treatment experience from hematology, hematology-oncology, and oncology departments throughout China. Quantitative surveys were designed based on the qualitative interviews.Results:The study included 415 clinicians from 219 hospitals spread across thirty-three cities and twenty-two provinces. As for diagnosis, the laboratory tests prescribed by physicians for suspected WM patients were relatively consistent (92% -99% recommendation for laboratory, 79% -95% recommendation for pathology, 96% recommendation for gene testing, and 63% -83% recommendation for imaging examination). However, from a physician's perspective, there was 22% misdiagnosis occurred in clinical practice. The rate of misdiagnosis was higher in lower-level hospitals than in tertiary grade A hospitals (29% vs 21%, P<0.001). The main reasons for misdiagnosis were that WM was easily confused with other diseases, and physicians lacked the necessary knowledge to make an accurate diagnosis. In terms of gene testing in clinical practice, 96% of participating physicians believed that WM patients would require gene testing for MYD88 and CXCR4 mutations because the results of gene testing would aid in confirming diagnosis and treatment options. In terms of treatment, 55% of physicians thought that the most important goal was to achieve remission, while 54% and 51% of physicians wanted to improve laboratory and/or examination results and extend overall survival time, respectively. Among patients with treatment indications, physicians estimated that approximately 21% of them refused to receive treatment, mainly owing to a lack of affordable care and disease awareness. When selecting the most appropriate treatment regimens, physicians would consider patient affordability (63% ), comorbidity (61% ), and risk level (54% ). Regimens containing Bruton tyrosine kinase inhibitor (BTKi) were most widely recommended for both treatment-na?ve and relapsed/refractory patients (94% for all patients, 95% for treatment-na?ve patients, and 75% for relapsed/refractory patients), and most physicians recommended Ibrutinib (84% ). For those patients who received treatment, physicians reported that approximately 23% of patients did not comply with the treatment regimen due to a lack of affordability and disease awareness. Furthermore, 66% of physicians believe that in the future, increasing disease awareness and improving diagnosis rates is critical. Conclusions:This study is the first national physician survey of WM conducted in China. It systematically describes the issues that exist in WM diagnosis and treatment in China, such as a high rate of misdiagnosis, limited access to gene testing and new drugs, and poor patient adherence to treatment. Chinese doctors believe that improving doctors’ and patients’ understanding of WM is one of the most urgent issues that must be addressed right now.

With the broad application of high-resolution computed tomography (CT) and high rates of early lung cancer screening, the number of patients diagnosed with synchronous multiple primary lung cancer (sMPLC) has been increasing. It becomes of great prominence to distinct sMPLC from intrapulmonary metastases in clinical practice. An increasing number of studies have developed high-throughput sequencing based genetic approaches to specify the molecular characteristics of sMPLC, which contributes to a better understanding of its tumorigenesis. The genetic profile of sMPLC also benefits its diagnosis, which mainly relies on its clinicopathological criteria. Here, we summarize the progresses on the diagnostic criteria for sMPLC, and also molecular features of sMPLC from the perspective of clonality analysis.

[Abstract] Objective: To explore the mechanism of miR-145-5p on malignant biological behaviors, such as pro-liferation, invasion, migration and epithelial-mesenchymal transition (EMT), of esophageal squamous cell carcinoma (ESCC) TE-10 cells. Methods: The expression of miR-145-5p in ESCC cell lines and normal cells was detected by PCR. Dual luciferase reporter gene assay was used to detect the targeted regulation between miR-145-5p and insulin-like growth factor 1 receptor (IGF1R). The expres-sions of IGF1R protein and EMT related proteins were detected by Western blotting. Transwell assay and CCK-8 assay were carried out to detect the effects of miR-145-5p/IGF1R axis on the proliferation, migration andinvasionofTE-10 cells. Results: miR-145-5p was down-regulated in ESCC cell lines with the lowest expression in TE-10 cells (P<0.01orP<0.05).Over-expression of miR-145-5p significantly inhibited proliferation, invasion, migration and EMT of TE-10 cells (P<0.01 or P<0.05). Dual luciferase reporter gene assay con-firmed that miR-145-5p targetedly down-regulated IGF1R expression (P<0.01). The restora-tion experiments further confirmed that simultaneous over-expression of miR-145-5p and IGF1R significantly attenuated the promotion effect of IGF1R on proliferation, invasion, migration and EMT of TE-10 cells (P<0.01 or P<0.05). Conclusions: Over-expression of miR-145-5p inhibits proliferation, invasion, migration and EMT of ESCC TE-10 cells by down-regulating IGF1R.

Objective:To compare the efficacy of the second generation tyrosine kinase inhibitor dasatinib combined with allogeneic hematopoietic stem cell transplantation(allo-HSCT)or chemotherapy in the treatment of Ph + acute lymphoblastic leukemia (Ph + ALL). Methods:A total of 56 Ph + ALL patients received dasatinib from January 2014 to June 2018. According to whether or not allo-HSCT was performed, they were divided into transplantation group(n=22)and chemotherapy group(n=34). The total survival rate(OS), disease-free survival rate(DFS), relapse and non-recurrence mortality(NRM)were compared between two groups. Results:The 2-year OS, DFS and cumulative recurrence rates were 69.1 % vs 47.8 %, 62.2 % vs 43.1 % and 14.6 % vs 44.1 % in transplantation and chemotherapy groups respectively. Significant inter-group differences existed in 2-year DFS, DFS and cumulative recurrence rates. The value of NRM was higher in transplantation group than that in chemotherapy group(18.6 % vs 14.1 %). However, the difference was statistically insignificant( P=0.476). Conclusions:The efficacy of dasatinib plus allo-HSCT is superior to that of dasatinib plus chemotherapy in the treatment of Ph + ALL.

Objective:To compare the efficacy of haploid hematopoietic stem cell transplantation (haplo-HSCT) and intensive immunosuppressive therapy (IST) in children with severe aplastic anemia (SAA).Methods:The medical records of children newly diagnosed as SAA in the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2018 were retrospectively analyzed.Among them, 33 patients received haplo-HSCT and 24 patients received IST that combined anti-thymocyte globulin(ATG) with Cyclosporine (CsA). The effective rate, overall survival (OS) rate, and failure free survival(FFS) rate of children in the haplo-HSCT group and the IST group were compared.Results:The median follow-up period was 25 months (9-60 months). There were 5 cases of early death in the haplo-HSCT group and 4 cases in the IST group, and the differences were not statistically significant ( P=0.822). Leaving out the early death cases, the effective rate in the haplo-HSCT group [100%(28/28 cases)] was higher than that in the IST group [30%(6/20 cases)] after 3 months of treatment, the difference was statistically significant ( χ2=27.671, P<0.01). After 6 months of treatment, the effective rate in the haplo-HSCT group [92.9%(26/28 cases)] was higher than that in the IST group [65.0%(13/20 cases)], and the difference was statistically significant ( χ2=5.943, P=0.015). After 12 months of treatment, the effective rate in the haplo-HSCT group [89.3%(25/28 cases)] was higher than that in the IST group [70.0%(14/20 cases)], but the difference was not statistically significant( P>0.05). The 3-year expected OS rate of children in the haplo-HSCT group and the IST group were 75.0% and 70.3%, respectively, with no statistically significant difference ( χ2=0.133, P=0.716). The 3-year expected FFS rate of children in the haplo-HSCT group (74.2%) was significantly higher than that in the IST group (48.7%), and the difference was statistically significant ( χ2=4.036, P=0.045). Conclusion:For children with SAA, haplo-HSCT is also an effective treatment if there is no sibling donor of hematopoietic stem cell transplantation.

Objective To investigate the efficacy and safety of domestic bortezomibˉbased chemotherapy for patients with multiple myeloma (MM). Methods The clinical data of 60 MM patients treated with domestic bortezomibˉbased chemotherapy regimen (the observation group) in the First Affiliated Hospital of Zhengzhou University from April 2018 to October 2018 were retrospectively analyzed, which were compared with 112 MM patients treated with original treatment regimen (the control group) at the same hospital from November 2010 to November 2014. According to the disease stage, the patients were divided into newly diagnosed MM (NDMM) group and relapsed refractory MM (RRMM) group, and efficacy and adverse reactions of domestic bortezomib were evaluated. Results The total response rate (ORR) of the observation group was 71.7% (43/60), severe complete response (sCR) + complete response (CR) rate was 16.7% (10/60), very good partial response (VGPR) rate was 18.3% (11/60), and partial response (PR) rate was 36.7% (22/60). The ORR of NDMM group (45 cases) and RRMM group (15 cases) was 82.2% (37/45) and 40.0% (6/15), respectively, and the difference was statistically significant (χ2＝ 9.877, P < 0.05). There was no significant difference between ISS stage Ⅰ+Ⅱ and stage Ⅲ [ORR: 75.7% (28/37) vs. 65.2% (15/23), respectively; χ2＝0.764, P >0.05]. ORR and CR rates in the NDMM group and RRMM group of the observation group and the control group were not statistically different (all P>0.05). In the treatment of bortezomibˉbased chemotherapy, the common adverse reaction was peripheral neuropathy, mostly belonging to grade 1-2. Other side effects included hematocytopenia, gastrointestinal events and herpes zoster, which could be alleviated or restored to normality after supportive treatments. One patient died of pulmonary infection, respiratory failure and septic shock during the intermittent period of chemotherapy. Conclusion ORR of domestic bortezomibˉbased chemotherapy in treatment of the patients with MM is high, and the incidence of adverse reactions shows no significant increase compared with original drugs.

Objective To investigate the efficacy and safety of maintenance treatment with low-dose decitabine after allogeneic stem cell transplantation (allo-HSCT) for high-risk acute lymphoblastic leukemia (ALL). Methods The data of 10 patients with high-risk ALL who received maintenance therapy with low-dose decitabine after allo-HSCT in the First Affiliated Hospital of Zhengzhou University from July 2016 to March 2018 was collected. The incidence of post-transplant relapse and graft-versus-host disease (GVHD) and the safety of the treatment protocol were analyzed. The cumulative incidence of relapse (CIR) rate, disease-free survival (DFS) rate and overall survival (OS) rate were estimated by Kaplan-Meier method. Results Two patients relapsed and the median relapse time of these 10 patients was 575 days after transplantation. The 1-year CIR, OS and DSF rates were 16.7%, 100.0% and 83.3%, respectively. At the end of follow-up, the DFS time after transplantation of 2 patients with p53 mutation were 23 months and 11 months, respectively. There was no induction or alleviation of GVHD caused by decitabine treatment. Nine patients developed grade Ⅰ-Ⅱmyelosuppression. Three patients had unexplained thrombocytopenia after transplantation and their platelet counts recovered after decitabine treatment. Conclusion Maintenance therapy with low-dose decitabine has low hematologic toxicity without increasing GVHD, which could be a maintenance treatment option to prevent relapse after transplantation for patients with high-risk ALL.

Objective To evaluate the different arteriographic manifestations of acute renal arterial hemorrhage,and the treatment effects of emergency interventional embolization.Methods 87 patients with renal arterial hemorrhage who were failed to conservative treatment underwent the renal arteriography to confirm the position and degree of lesion.According to the arteriographic manifesta-tions,appropriate embolic agents such as spring coil,acrylic acid microspheres and the like were used to embolize the targeted vessel. The arteriographic manifestations and embolization efficacy were retrospectively analyzed.Results Contrast medium leakage was showed by renal angiography in 43 patients,13 of whom had arterio-venous fistula (AVF)and 1 5 of whom had renal pseudoaneu-rysms (RAP).Among this 1 5 patients,there were 5 patients with arteriovenous fistula and one patiernt with artery-calyces fistula. Hemorrhage of tumor vessel was shown in 1 5 patients and renal arteriovenous malformation (RAVM)in 1.47 patients underwent renal artery CT arteriography before emergency interventional embolization.The hematuresis was completely stopped or significantly relieved in 82 of all patients.Only 3 patients with renal trauma and 2 patients with percutaneous nephroscope were still had haematu-ria.All patients were followed up for 2 years.The total effective rate of emergency interventional embolization treatment was 94.25%(82/87),and no serious complications were observed.Conclusion As a safe,effective and micro-invasive treatment,emergency in-terventional embolization therapy can be used to treat the acute renal hemorrhage effectively.It can keep the maximum renal func-tion.Though acute renal hemorrhage angiography may have different manifestations,the choice of embolic agents is the key to stop the symptom.Renal artery CTA before embolotherapy is important for the diagnosis and therapy of acute renal hemorrhage.

BACKGROUND:Cytokine induced kil er cells therapy as an effective means of adoptive immunotherapy, becomes a new way to treat acute myeloid leukemia. But, the researches about sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation in acute myeloid leukemia patients are stil less, which deserve further research.
OBJECTIVE:To observe the clinical efficiency and safety of sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation in acute myeloid leukemia M2 patients.
METHODS:Total y 45 patients with low-or intermediate-risk acute myeloid leukemia M2 were recruited in this study. Among them, 19 patients received sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation and 26 patients only received autologous peripheral blood stem celltransplantation. The relapse rate, disease-free survival, and overal survival were compared between two groups, and safety of cytokine induced kil er cells therapy was observed.
RESULTS AND CONCLUSION:(1) Compared with the patients only receiving autologous peripheral blood stem celltransplantation, the relapse rate was lower (21.05%vs. 38.46%;P<0.05), and elevated percentages of the disease-free survival and overal survival were observed in the patients receiving sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation (P<0.05). (2) The 19 patients who received sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation al completed the treatment scheme successful y. Only four patients appeared to have chil s and fever, and no more side effects were observed. These findings suggested that the sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation can improve the disease-free survival and overal survival of low-or intermediate-risk acute myeloid leukemia M2 patients without remarkable side effects, which is a safe, effective and feasible way for the treatment of acute myeloid leukemia M2.

Objective To establish a new canine model of ureter trauma to observe the protective effect of biodegradable ureteral stent on renal function following traumatic ureter injury. Methods A self-made device was used to make firearm fragment wounds unilaterally on the ureters in nine Beagle dogs (model group). The wounds were debrided and sutured and the results were evaluated by using intravenous pyelography (IVP) and radioactive renography at 40, 80 and 120 days postoperatively. Firearm fragment wounds were made to the bilateral ureters of nine Beagle dogs in the positive control group, in which a biodegradable stent was placed in one side and a double-J stent placed in the other side. Results In model group, hydronephrosis and hydroureter occurred and got worse postoperatively on the wounded side in all nine Beagle dogs, while none of these symptoms were found in any animals in the control group. The ratios of biodegradable stent side to double-J stent side were increased in renal patial concertration index and half time of kidney washout, but neither showed significant differences. However,vesicoureteral reflux (VUR) was not found in the biodegradable stent side, but in the double -J stent side. Conclusions A new canine model of firearm fragment wounds is successfully developed. Both the biodegradable and double-J stent play important roles in support and drainage and show no significant difference in aspects of renal uptake and half time of kidney washout. The biodegradable stent can effectively prevent VUR.