Objective:To explore the long-term effects of intravascular ultrasound (IVUS) guidance on patients with acute coronary syndrome (ACS) undergoing drug-eluting stents (DES) implantation.Methods:Data used in this study derived from ULTIMATE trial, which was a prospective, multicenter, randomized study. A total of 1 448 all-comer patients were enrolled between 2014 August and 2017 May. Primary endpoint of this study was target vessel failure (TVF) at 3 years, including cardiac death, target-vessel-related myocardial infarction, and clinically-driven target vessel revascularization.Results:ACS was present in 1 136 (78.5%) patients, and 3-year clinical follow-up was available in 1 423 patients (98.3%). TVF in the ACS group was 9.6% (109/1 136), which was significantly higher than 4.5% (14/312) in the non-ACS group (log-rank P=0.005). There were 109 TVFs in the ACS patients, with 7.6% (43/569) TVFs in the IVUS group and 11.6% (66/567) TVFs in the angiography group (log-rank P=0.019). Moreover, patients with optimal IVUS guidance were associated with a lower risk of 3-year TVF compared to those with suboptimal IVUS results (5.4% (16/296) vs. 9.9% (27/273),log-rank P=0.041). Conclusions:This ULTIMATE-ACS subgroup analysis showed that ACS patients undergoing DES implantation were associated with a higher risk of 3-year TVF. More importantly, the risk of TVF could be significantly decreased through IVUS guidance in patients with ACS, especially in those who had an IVUS-defined optimal procedure.

The incidence and mortality rates of primary liver cancer remain very high,posing a serious threat to the global public health.In Asia,the guidelines from the Korean Liver Cancer Association-National Cancer Center,the Japan Society of Hepatology,and the Chinese Guidelines for Diagnosis and Treatment of Primary Liver Cancer(2024 edition)have significant influence and provide important guidance for the diagnosis and treatment of primary liver cancer.These guidelines,based on their own national condition,background,evidence and clinical practice,exhibit both commonalities and divergences in the imaging diagnosis of liver cancer.This study aims to provide a more comprehensive and scientific reference for clinicians by comparing the specific contents of three guidelines regarding screening,surveillance,imaging diagnosis and staging of liver cancer,thereby promoting the standardized diagnosis and treatment of clinical practice in the primary liver cancer.

Objective:To investigate the risk factors of cement vascular leakage after vertebral augmentation for osteoporotic vertebral compression fracture (OVCF).Methods:A case-control study was conducted to analyze the clinical data of 217 patients with OVCF undergone vertebral augmentation [percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP)] in First and Second Affiliated Hospital of Kunming Medical University from October 2019 to October 2020. There were 79 males and 138 females, at the age range of 58-88 years [(73.1±6.9)years]. According to the occurrence of bone cement vascular leakage, the patients were divided into vascular leakage group ( n=39) and vascular leakage free group ( n=178). The gender, age, bone mineral density, time from injury to operation, anatomical position of injured vertebrae, degree of vertebral compression, integrity of posterior wall, intravertebral fissure sign, vertebrobasilar venous foramen, surgical approach, surgical method, cement injection period, cement injection speed, cement injection volume and cement injection area were recorded. Univariate analysis was used to detect the correlation of those indices with cement vascular leakage after vertebral augmentation. Multivariate Logistic regression analysis was used to identify the independent risk factors for cement vascular leakage after vertebral augmentation. Results:Univariate analysis showed that there was a correlation of cement vascular leakage after vertebral augmentation with time from injury to operation, degree of vertebral compression, integrity of posterior wall, intravertebral fissure sign, vertebrobasilar venous foramen, surgical method, cement injection period, cement injection speed, cement injection volume and cement injection area (all P<0.05), apart from gender, age, bone mineral density, anatomical position of injured vertebrae or surgical approach (all P>0.05). Multivariate Logistic regression analysis showed intravertebral fissure sign ( OR=7.00, 95% CI 1.57-31.30, P<0.05), vertebrobasilar venous foramen ( OR=7.52, 95% CI 1.94-29.16, P<0.01), PVP ( OR=10.98, 95% CI 2.51-47.94, P<0.01), injection of cement in thinning period ( OR=5.91, 95% CI 1.45-24.15, P<0.05), injection of large volume of cement ( OR=3.60, 95% CI 1.70-7.65, P<0.01) and marginal injection of cement ( OR=24.80, 95% CI 5.28-116.37, P<0.01) were significantly associated with cement vascular leakage after vertebral augmentation for OVCF. Conclusion:Intravertebral fissure sign, vertebrobasilar venous foramen, PVP, injection of cement in thinning period, injection of large volume of cement and marginal injection of cement are independent risk factors for cement vascular leakage after vertebral augmentation for OVCF.

Objective:To observe the efficacy and safety of the combination of agomelatine and low-dose olanzapine (AO) in the treatment of postprandial distress syndrome (PDS) with depression, anxiety and sleep disorders.Methods:From April 2019 to September 2020, PDS patients with depression, anxiety and sleep disorders in Tianjin Medical University General Hospital were selected and divided into AO group and flupentixol-melitracen (FM) group. Patients of the AO group were given oral agomelatine 25 mg and AO 1.70 mg (both once per day), and the patients of FM group were given oral FM 10.5 mg (once per day), and all patients took itopride 50 mg (three times per day) at the same time. The total treatment course was eight weeks. Nepean dyspepsia index-symptom (NDIS), patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Pittsburgh sleep quality index (PSQI) were used to evaluate the gastrointestinal symptoms, depression, anxiety and sleep disorders before treatment and two, four and eight weeks after treatment, respectively. The efficacy was evaluated according to the changes of scores of gastrointestinal symptoms before and after treatment. The adverse effects after medication were recorded. Independent sample t test and chi-square test were used for statistical analysis. Results:A total of 184 PDS patients with depression, anxiety and sleep disorders were enrolled, including 98 patients in AO group and 86 patients in FM group. At two, four and eight weeks after treatment, NDIS, PHQ-9, GAD-7 and PSQI scores of AO group and FM group were all lower than those of each group before treatment (AO group: 13.73±0.53, 10.13±0.44 and 7.87±0.31 vs. 27.08±0.84; 6.04±0.35, 4.70±0.31 and 3.81±0.22 vs. 10.04±0.50; 6.36±0.30, 5.29±0.28 and 4.21±0.19 vs. 10.71±0.51; 6.64±0.37, 5.27±0.35 and 4.09±0.30 vs. 11.14±0.42; FM group: 15.33±0.58, 11.58±0.50 and 9.80±0.35 vs. 25.10±0.79; 6.79±0.35, 5.71±0.32 and 4.86±0.30 vs. 9.11±0.46; 7.27±0.31, 6.51±0.32 and 5.21±0.27 vs. 9.79±0.44; 8.01±0.33, 6.76±0.32 and 5.78±0.32 vs. 10.44±0.32), and the differences were statistically significant (AO group: tNDIS=13.470, 17.930 and 21.530, tPHQ-9=6.488, 8.991 and 11.300, tGAD-7=7.361, 9.315 and 11.031, tPSQI=7.088, 9.736 and 12.550. FM group: tNDIS=9.921, 14.400 and 17.640, tPHQ-9=4.032, 6.106 and 7.781, tGAD-7=4.638, 5.993 and 8.840, tPSQI=5.289, 8.199 and 10.310, all P<0.05). At two, four and eight weeks after treatment, NDIS, GAD-7 and PSQI scores of AO group were all lower than those of the FM group during the same period (NDIS: 13.73±0.53 vs. 15.33±0.58, 10.13±0.44 vs. 11.58±0.50, 7.87±0.31 vs. 9.80±0.35; GAD-7: 6.36±0.30 vs. 7.27±0.31, 5.29±0.28 vs. 6.51±0.32, 4.21±0.19 vs. 5.21±0.27; PSQI: 6.64±0.37 vs. 8.01±0.33, 5.27±0.35 vs. 6.76±0.32, 4.09±0.30 vs. 5.78±0.32), and the differences were statistically significant ( tNDIS=2.018, 2.225 and 4.156, tGAD-7=2.097, 2.869 and 2.536, tPSQI=1.951, 2.359 and 3.099, all P<0.05). At eight weeks after treatment, the total effective rate of the AO group was higher than that of the FM group (94.9%, 93/98 vs. 84.9%, 73/86), and the difference was statistically significant ( χ2=5.205, P=0.026). The incidence of adverse reactions of constipation and somnolence of the AO group were both lower than those of the FM group (2.0%, 2/98 vs. 9.3%, 8/86 and 1.0%, 1/98 vs. 8.1%, 7/86, respectively), and the differences were statistically significant ( χ2=4.699 and 5.582, P=0.047 and 0.027). Conclusion:AO may be a treatment option for PDS with depression, anxiety and sleep disorders.

Objective:To investigate the clinical efficacy of ex vivo liver resection and autotransplantation (ELRA) for liver complex space-occupying lesions.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with liver complex space-occupying lesions who underwent ELRA in the First Hospital Affiliated to Army Medical University between June 2009 and May 2017 were collected. There were 36 males and 14 females, aged from 13 to 69 years, with a median age of 51 years. All patients underwent ELRA. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview. Patients were followed up according to the individual follow-up plan in the first 6 months after discharge, and then once every 3 to 6 months to detect tumor recurrence and survival up to May 2019. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers or percentages. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-rank test was used for survival analysis. Results:(1) Surgical situations: all the 50 patients underwent ELRA successfully, and postoperative pathological examination showed the R 0 resection rate was 100%(50/50). The operation time of the 50 patients were (630±186)minutes, of which 9 patients with liver benign occupation had the operation time of (684±168)minutes and 41 patients with liver malignant tumor had the operation time of (618±190)minutes. The operation time of temporary reconstruction of inferior vena cava and portacaval shunt, time of anhepatic phase, volume of intraoperative blood loss of the 50 patients were (35±9)minutes, (256±71)minutes, 2 000 mL(range, 400-10 000 mL), respectively. The remnant liver mass to standard liver mass ratio of the 50 patients was 65%±16%, of which 9 patients with liver benign occupation had the remnant liver mass to standard liver mass ratio of 63%±14% and 41 patients with liver malignant tumor had the remnant liver mass to standard liver mass ratio of 65%±17%. Of the 50 patients, 35 had vascular invasion (7 cases with liver benign occupation, 28 cases with liver malignant tumor), of which 24 (6 cases with liver benign occupation, 18 cases with liver malignant tumor) underwent in vitro vascular reconstruction, 12 (5 cases with liver benign occupation, 7 cases with liver malignant tumor) had bile duct invasion and underwent choledochojejunostomy due to the inability of the common bile duct to anastomose the ends. Two cases with liver metastasis of gastric cancer, one case with liver metastasis of colon cancer and one case with liver metastasis of pancreatic cancer underwent radical gastrectomy, radical resection of colon cancer, and pancreaticoduodenectomy, respectively. (2) Postoperative situations: the duration of postoperative hospital stay of the 50 patients were 25 days (range, 11-169 days). Of the 50 patients, 12 had pleural effusion who were treated with pleural puncture drainage, 10 had bile leakage who were treated with abdominal puncture drainage, 3 had bile duct anastomotic leakage who were treated with endoscopic nasobiliary drainage or biliary stent implantation, 6 underwent reoperation among which 4 underwent exploratory laparotomy due to abdominal hemorrhage, 1 underwent portal vein reconstruction due to abdominal hemorrhage combined with portal vein thrombosis, and 1 underwent salvage liver transplantation due to liver failure. Nine of the 50 patients died within 90 days after surgery, all of whom had liver malignant tumor. Among them, 3 died of multi-organ dysfunction syndrome caused by severe infection, 3 died of acute liver failure, 2 died of abdominal hemorrhage and 1 died pulmonary embolism. (3) Follow-up: all the 50 patients were followed up for 1 to 119 months. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 50 patients after operation were 17 months (range, 1-119 months), 68.0%, 45.9%, 41.1% and 41.9%, 33.4%, 30.8%, respectively. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 9 patients who with liver benign occupation after operation were 68 months (range, 10-114 months), 88.9%, 88.9%, 88.9% and 88.9%, 88.9%, 88.9%, respectively. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 41 patients who with liver malignant tumor after operation were 15 months (range, 1-119 months), 63.4%, 36.6%, 31.0% and 31.5%, 21.0%, 18.0%, respectively. There were significant differences in the overall and tumor-free survival rates between patients who with liver benign occupation and patients who with liver malignant tumor ( χ2=7.626, 11.766, P<0.05). Conclusions:ELRA can be applied in the treatment of liver complex space-occupying lesions. The selection criteria of patients with liver malignant tumor should be more rigorous to reduce perioperative mortality.

OBJECTIVETo establish an evaluation model of peritoneal metastasis in gastric cancer, and to assess its clinical significance.

METHODSClinical and pathologic data of the consecutive cases of gastric cancer admitted between April 2015 and December 2015 in Department of General Surgery, Zhongshan Hospital of Fudan University were analyzed retrospectively. A total of 710 patients were enrolled in the study after 18 patients with other distant metastasis were excluded. The correlations between peritoneal metastasis and different factors were studied through univariate (Pearson's test or Fisher's exact test) and multivariate analyses (Binary Logistic regression). Independent predictable factors for peritoneal metastasis were combined to establish a risk evaluation model (nomogram). The nomogram was created with R software using the 'rms' package. In the nomogram, each factor had different scores, and every patient could have a total score by adding all the scores of each factor. A higher total score represented higher risk of peritoneal metastasis. Receiver operating characteristic (ROC) curve analysis was used to compare the sensitivity and specificity of the established nomogram. Delong. Delong. Clarke-Pearson test was used to compare the difference of the area under the curve (AUC). The cut-off value was determined by the AUC, when the ROC curve had the biggest AUC, the model had the best sensitivity and specificity.

RESULTSAmong 710 patients, 47 patients had peritoneal metastasis (6.6%), including 30 male (30/506, 5.9%) and 17 female (17/204, 8.3%); 31 were ≥ 60 years old (31/429, 7.2%); 38 had tumor ≥ 3 cm(38/461, 8.2%). Lauren classification indicated that 2 patients were intestinal type(2/245, 0.8%), 8 patients were mixed type(8/208, 3.8%), 11 patients were diffuse type(11/142, 7.7%), and others had no associated data. CA19-9 of 13 patients was ≥ 37 kU/L(13/61, 21.3%); CA125 of 11 patients was ≥ 35 kU/L(11/36, 30.6%); CA72-4 of 11 patients was ≥ 10 kU/L(11/39, 28.2%). Neutrophil/lymphocyte ratio (NLR) of 26 patients was ≥ 2.37(26/231, 11.3%). Multivariate analysis showed that Lauren classification (HR=8.95, 95%CI:1.32-60.59, P=0.025), CA125(HR=17.45, 95%CI:5.54-54.89, P=0.001), CA72-4(HR=20.06, 95%CI:5.05-79.68, P=0.001), and NLR (HR=4.16, 95%CI:1.17-14.75, P=0.032) were independent risk factors of peritoneal metastasis in gastric cancer. In the nomogram, the highest score was 241, including diffuse or mixed Lauren classification (54 score), CA125 ≥ 35 kU/L (66 score), CA72-4 ≥ 10 kU/L (100 score), and NLR ≥ 2.37 (21 score), which represented a highest risk of peritoneal metastasis (more than 90%). The AUC of nomogram was 0.912, which was superior than any single variable (AUC of Lauren classification: 0.678; AUC of CA125: 0.720; AUC of CA72-4: 0.792; AUC of NLR: 0.613, all P=0.000). The total score of nomogram increased according to the TNM stage, and was highest in the peritoneal metastasis group (F=49.1, P=0.000). When the cut-off value calculated by ROC analysis was set at 140, the model could best balanced the sensitivity (0.79) and the specificity (0.87). Only 5% of patients had peritoneal metastasis when their nomogram scores were lower than 140, while 58% of patients had peritoneal metastasis when their scores were ≥ 140(χ=69.1, P=0.000).

CONCLUSIONThe risk evaluation model established with Lauren classification, CA125, CA72-4 and NLR can effectively predict the risk of peritoneal metastasis in gastric cancer, and provide the reference to preoperative staging and choice of therapeutic strategy.

Antigens, Tumor-Associated, Carbohydrate ; blood ; Area Under Curve ; CA-125 Antigen ; blood ; CA-19-9 Antigen ; blood ; Female ; Humans ; Leukocyte Count ; statistics & numerical data ; Logistic Models ; Lymphocytes ; pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; diagnosis ; Neutrophils ; pathology ; Nomograms ; Peritoneal Neoplasms ; secondary ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Assessment ; methods ; Risk Factors ; Sensitivity and Specificity ; Stomach Neoplasms ; blood ; classification ; diagnosis ; pathology

OBJECTIVETo investigate the features of clinicopathology and prognosis in young gastric cancer patients.

METHODSClinicopathological data of 90 young gastric cancer patients (≤40 years old) who received radical gastrectomy in the Department of General Surgery of Zhongshan Hospital, Fudan University from January 2013 to December 2014 were retrospectively analyzed. Survival data were obtained by follow-up and the last follow-up time was October 2016. Log-rank test and Cox regression model were used to analyze the risk factors of prognosis and these factors included gender, age, tumor size, degree of differentiation, histological type, Lauren pattern, T stage, N stage, vessel carcinoma embolus, clinical symptom, anemic condition, CA19-9 level, et al.

RESULTSThe median age of 90 patients was 35 years old, of whom, 20(22.2%) patients were ≤30 years old and 70(77.8%) patients were between 31 and 40 years old. There were 70(77.8%) female patients, 38(42.2%) patients with anemia, 11(12.8%) patients with elevated CA19-9 level and 9(10.0%) patients with family history of gastrointestinal tumors. The mean time of all the patients from presence of symptom to consultation was 8.2 months. Postoperative pathology revealed 65(72.2%) patients with poorly differentiated adenocarcinoma, 6(6.7%) patients with mucinous adenocarcinoma, 9(10%) patients with signet-ring cell carcinoma, and 10(11.1%) patients with papillary-canalicular adencarcinoma. Sixty-nine (76.7%) patients were diagnosed as advanced gastric cancer and 67(74.4%) patients were involved with lymphatic metastasis when they visited our hospital. Univariate analysis showed that gender (P=0.021), tumor size (P=0.001), depth of tumor infiltration (P=0.016), lymphatic metastasis (P=0.000), vessel carcinoma embolus (P=0.001), elevated CA19-9 level (P=0.001), and anemia (0.024) were statistically related with postoperative survival. Multivariate analysis showed that lymphatic metastasis was an independent risk factor of the poor prognosis of young patients (HR:2.774, 95%CI:1.435 to 5.364, P=0.002).

CONCLUSIONSThe majority of young gastric cancer cases are female with poorly differentiated adenocarcinoma. Most patients are diagnosed as advanced gastric cancer with lymphatic metastasis when they visit hospital at the first time. The lymphatic metastasis is an independent risk factor of prognosis in young gastric cancer patients.

Objective To investigate the prenatal diagnosis and postnatal clinical outcomes of fetal congenital choledochal cyst (CCC) to improve the recognition and treatment of fetal CCC.Methods Clinical data of 23 cases of fetal CCC which were diagnosed during routine prenatal ultrasonic examination in Jinhua Municipal Central Hospital from June 2009 to May 2015 were retrospectively analyzzed. Maternal age, gestational age at diagnosis of CCC, location and size of cyst, postnatal examination, age at operation and follow-up outcomes were recorded and statistically analyzed by Wilcoxon rank-sum test.Results (1) Among the 23 cases, six (26%) were terminated and the rest 17 continued their pregnancies (74%). (2) Results of the prenatal ultrasonography of the 23 cases indicated that hepatic portal cysts were closely related to hepatic portal veins or arteries. Six of the cysts communicated with gall bladder and eight connected to intrahepatic bile duct. The maximum diameter of the cysts in the 23 cases was 16.0-31.0 mm, averagely (24.7±3.7) mm. The maximum diameter of cysts diagnosed in the third trimester was significantly larger than that in the second trimester [ 27.0 (22.0-31.0) vs 23.0 (21.0-25.0) mm,Z=-2.134,P<0.05]. (3) Among the 17 cases of continued pregnancy, one underwent cesarean section at 35+ weeks of gestation and 16 delivered at term with the average gestational age at delivery of (38.2±1.1) weeks. All neonates were re-examined by abdominal ultrasound at 1-2 postnatal weeks and confimed prenatal diagnosed of CCC. (4) The 17 neonates were re-examined by abdominal ultrasound during the second postnatal week and the results showed that cyst size remained the same in four, decreased in one and gradually increased with the gestational age in 12 neonates. Among the 16 cases of confirmed CCC, 12 received surgery, including 11 (Ⅰa, 6;Ⅰc, 3;Ⅳb, 2) within one year-old and one (Ⅰc) around 18 months old. The prognosis was uneventful. Four out of the 16 cases rejected surgical operation and were followed up in outpatient. One neonate was diagnosed with congenital biliary atresia and transferred to Children's Hospital for operation.Conclusions When fetal abdominal cyst presented with hepatic portal cyst which communicates with gallbladder or intra-hepatic duct in ultrasonography, a congenital choledochal cyst should be taken into consideration by excluding the possibility of biliary atresia in the first place. Surgery for CCC infants without symptoms or signs is suggested to be performed around three months after birth. The postoperative prognosis of CCC is favorable, so termination is not recommended for gravidas with fetal CCC in prenatal consultation.

Objective To identify the differential inflammation factors in nephroblastoma tissue using proteomics technology and analyze its relationship with clinical stage,pathological phenotype,lymph node metastasis,vascular invasion.Methods From Jan 2010 to Dec 2014,nephroblastoma tumor tissues from 40 patients were obtained.Meanwhile,the 35 tissue near proximal kidney and 25 tissues distal kidney were also obtained.The classification of clinical stage included Ⅰ stage in 6 cases,Ⅱ stage in 12 cases,Ⅲ stage in 13 cases and Ⅳ stage in 9 cases.Other characters contained good prognosis type in 37 case,poor prognosis type in 3 cases,lymphatic metastasis in 17 cases,no sign of lymphatic metastasis in 23 cases,vascular invasion in 9 cases and non-vascular invasion in 31 cases.The SELDI-TOF-MS was used for screening differential protein peaks among three groups.Then,SPE and TRICINE-SDS-PAGE were used to separate and purificate the protein,which showed high peaks expression in tumor tissue,respectively.After in-gel digestion,we received the identification of targeted proteins according to sequence information through Nano-LC-MS/MS.Finally we compared differential expression of inflammatory peaks in different groups of clinical stage,pathological type,lymph node metastasis and vascular invasion.Results All the peaks high expression in tumor tissue,m/z12138 and m/z 13462 are identified as MIF and NAP-2.Expression of two protein peaks in tumor tissue(1437.8 + 997.3,1730.4 + 1147.8) is higher than those in proximal tissue (952.6 + 591.2,1031.1 + 1120.8) and in distal tissue(315.4 + 296.5,114.7 + 118.9),which showed the significant difference (P ＜ 0.001).According to the clinic stage classification,the expression of those protein were 678.8 + 189.0,746.2 + 238.7 in stage Ⅰ,664.0 + 202.0,1180.7 + 404.9 in stage Ⅱ,1524.7+407.9,2160.4 + 1252.3 in stage Ⅲ and 2850.2 + 861.2,2498.4 + 1290.5 in stage Ⅳ.Based on the other characters,expression of those protein were the 1271.7 + 809.2,1553.3 + 991.4 in good prognosis type,3487.2 + 166.2,3915.1 +507.3 in poor prognosis type,2207.1 +961.7,2569.5 + 1285.2 in lymph node metastasis,869.2 + 474.6,1110.2 + 433.6 in non-lymph node metastasis,2850.2 + 861.2,2498.4 +1290.5 in vascular invasion and 1027.8 + 521.3,1507.5 + 1019.9 in non-vascular invasion.All the comparison results have significant statistical difference (P ＜ 0.001).Conclusion MIF and NAP-2significantly increase in nephroblastoma tumor tissue.Meanwhile,there was obvious relationship between those protein with clinical stage,pathological type,lymph node metastasis and vascular invasion.

Objective To evaluate the treatment of current status and prognosis in childhood APL with APL2008 ,which was administrated since 2008 in our center .Methods A total of 43 children with newly diagnosed APL between 2008 to 2014 were studied retrospectively .Treatment options and current status were summarized from 28 patients who received APL2008 therapy . Results Studied 43 patients were at median age of 8 years and 4 months ,with 28 boys and 15 girls .The main clinical manifestations were infection ,anemia ,bleeding ,fever ,hepatomegaly ,splenomegaly and lymphadenopathy .The proportions of low ,intermediate and high risk groups were 27 .9% ,48 .8% and 23 .3% ,respectively .Eleven cases could be diagnosed as DIC .Bone marrow morphology showed abnormal elevation of promyelocyte .37 patients had distinctive immunophenotype such as frequent expression of CD33 , CD117 and MPO .PML/RARαfusion gene positive rate was 100% in 43 children and cytogenetic analysis were positive in 37 cases , of which specific genetic lesion in APL cells with t (15 ;17)(q22 ;q12) was found in 28 cases ,and karyotypes was found in 9 cases as infrequent chromosomal abnormalities .In 43 patients ,4 cases were early dead from intracranial hemorrhage at early stage ,and 11 cases were given up early .There were only 2 cases dead ,2 cases relapsed and 1 case lost among 28 APL children ,which enabled ef‐ficacy analysis possible .96 .4% of these 28 cases achieved HCR .The 2 year Kaplan Meier estimates of OS and EFS were 85 .9% ± 7 .6% and 80 .4% ± 8 .8% .But OS and EFS would be 94 .7% ± 5 .1% and 88 .9% ± 7 .4% if 3 patients who had non standard treat‐ment were excluded .Conclusion Childhood APL were characterized by anemia ,bleeding ,fever and infiltration .APL′s coincidence rate between PML/RARa fusion gene and morphology ,immunology and cytogenetics were 95 .3% ,90 .2% and 86 .5% ,respective‐ly .APL2008 significantly improved the prognosis of APL .