Objective:To evaluate the effect of intraoperative optimization of regional cerebral oxygen saturation(rSO 2C) intervention on postoperative delirium(POD) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass(CPB). Methods:Two hundred and seventy-three pediatric patients of both sexes, aged 28 days-6 yr, with American Society of Anesthesiologists Physical Status classification ≤Ⅳ, scheduled for elective cardiac surgery under CPB, were divided into intervention group( n=136) and control group( n=137) based on the computer random coding. In intervention group, optimized intervention measures were given when rSO 2C was below 75% of the baseline value for more than 1 min. In control group, rSO 2C was not monitored during operation, and intraoperative management was performed according to the routine monitoring indicators of pediatric cardiac surgery under CPB. The occurrence of POD within 7 days after operation was evaluated, and the duration and first occurrence time of POD were recorded. Results:Compared with control group, no significant change was found in the incidence of POD( P>0.05), the first occurrence time of POD was significantly prolonged, and the duration of POD was shortened in intervention group( P<0.05). Conclusions:Intraoperative optimization of rSO 2C intervention can delay the time to the first occurrence of POD and shorten the duration in pediatric patients undergoing cardiac surgery under CPB.

Objective:To evaluate the effect of intraoperative optimization of regional cerebral oxygen saturation(rSO 2C) intervention on postoperative delirium(POD) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass(CPB). Methods:Two hundred and seventy-three pediatric patients of both sexes, aged 28 days-6 yr, with American Society of Anesthesiologists Physical Status classification ≤Ⅳ, scheduled for elective cardiac surgery under CPB, were divided into intervention group( n=136) and control group( n=137) based on the computer random coding. In intervention group, optimized intervention measures were given when rSO 2C was below 75% of the baseline value for more than 1 min. In control group, rSO 2C was not monitored during operation, and intraoperative management was performed according to the routine monitoring indicators of pediatric cardiac surgery under CPB. The occurrence of POD within 7 days after operation was evaluated, and the duration and first occurrence time of POD were recorded. Results:Compared with control group, no significant change was found in the incidence of POD( P>0.05), the first occurrence time of POD was significantly prolonged, and the duration of POD was shortened in intervention group( P<0.05). Conclusions:Intraoperative optimization of rSO 2C intervention can delay the time to the first occurrence of POD and shorten the duration in pediatric patients undergoing cardiac surgery under CPB.

Objective In this study,we retrospectively analyzed the imaging characteristics of dual-tracer 68Ga-prostate specific membrane antigen(PSMA)and 18F-flurodeoxyglucose(FDG)positron emission tomography(PET)/computed tomography(CT)in metastatic prostate cancer(mPCa)patients.We analyzed the uptake modes of the dual tracers,explored clinical pathological parameters affecting the 18F-FDG uptake in the lesions,and evaluated their prognostic implications for prostate specific antigen progression-free survival(PSA-PFS).Methods A total of 41 mPCa patients who underwent dual-tracer PET/CT(68Ga-PSMA and 18F-FDG)scans between September 2021 and January 2024 were retrospectively enrolled.One patient had negative uptake of both PSMA and FDG.According to the uptake patterns of the 2 tracers,the other patients,40 in total,were categorized in 2 groups,including group A consisting of 33 cases who showed PSMA and FDG dual and those who showed FDG only avidity,and group B consisting of 7 cases who showed PSMA avidity only.Comparative analyses of clinical pathological characteristics between group A and group B were conducted.The relationship between various parameters and PSA-PFS was analyzed by the Kaplan-Meier method.Results A total of 26 patients(63.4％)were diagnosed with metastatic castration-resistant prostate cancer(mCRPC),and 38 cases(92.7％)had a Gleason score of 8-9.Bone metastasis,the predominant type of distant metastasis,occurred in 36 cases(87.8％).The skeletal and distant lymph node metastases mostly showed a dual positive uptake pattern for both PSMA and FDG(85.7％[24/28]and 81.8％[9/11]).37.5％(3/8)of the metastases to organs showed FDG only positive uptake pattern.The serum levels of prostate specific antigen(PSA)in group A were significantly higher than those in group B(P=0.013).A total of 13 patients of special pathological classification(intraductal carcinoma and neuroendocrine differentiation)were all found to be in group A.Among the 41 cases,16 were lost to follow-up.Of the 25 patients who completed follow-up,9 patients,with a median PSA value of 104 ng/mL,experienced PSA progression,while the 16 other patients,with a median PSA of 0.34 ng/mL,did not incur any PSA progression.There was significant difference in the median PSA between patients showing PSA progression and those who did not show PSA progression(P＜0.001).Kaplan-Meier survival analysis revealed that the median PSA-PFS of patients of specific pathological classifications was 7 months,which was shorter than the 16 months of the patients with typical prostate cancer,with the difference between the two groups being statistically meaningful(P=0.043).The median PSA-PFS for group A was 30 months.With more than half of the patients in the group not experiencing any PSA progression,group B did not reach the median PSA-PFS(P=0.645).Conclusion Dual-tracer PET/CT imaging with 68Ga-PSMA and 18F-FDG commonly exhibits avidity for both tracers in mPCa.Serum PSA level is a reliable biomarker for predicting FDG-positive lesions.mPCa presented with intraductal carcinoma and neuroendocrine differentiation tends to exhibit FDG avidity and is more susceptible to PSA progression.

Objective: To investigate the prognosis of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) for patients with acute myeloid leukemia and MLL rearrangement. Methods: From September 2009 to May 2016, the clinical data of 47 patients with MLL-rearranged AML undergoing allo-HSCT in the First Affiliated Hospital of Soochow University were retrospectively analyzed. Results: Among 47 MLL-rearranged AML patients, 24 were male and 23 female. The median age was 30 (15-58) years old. There are 36 (76%) patients were FAB-types M4/M5. Two-year overall survival (OS), disease-free survival (DFS), relapse incidence and transplant-related mortality (TRM) were (64.4±8.4)%, (47.3±9.3)%, 41.0% and 17.9%, respectively. Of them, 45 patients were detected with 11q23 translocations, and 2 patients with normal karyotype were MLL partial tandem duplication. According to different chromosome karyotype, 47 patients were divided into three groups: 16 cases of t (6; 11), 15 cases of t (9; 11) and 16 cases of other types. Overall survival was compared between the three groups, there was no significant difference (χ²=1.509, P=0.472). On multivariate analysis, independent risk factor on OS was transplant age >45 years [HR=4.454(95%CI 1.314-15.099), P=0.016]. The multivariate analysis also confirmed the higher TRM in patients at non-CR state when transplanted [HR=10.370(95%CI 1.043-103.110), P=0.046]. Positive minimal residual disease (MRD) before transplantation was a negative prognostic factor on DFS [HR=4.236(95%CI 1.238-14.495), P=0.021] and relapse incidence (RI) [HR=5.491(95%CI 1.371-21.995), P=0.016]. Conclusion Transplant age (>45 years), allo-HSCT in non-CR state adn positive MRD before transplantation were negative prognostic factors in allo-HSCT for MLL-rearranged AML patients.

Objective:To observe the sensitivity of transcription mediated amplification (TMA),and to compare its performance with real-time reverse transcription polymerase chain reaction (real-time RT-PCR) in detecting human immunodeficiency virus RNA (HIV RNA).Methods:TMA system was established with TaqMan probes,specific primers,moloney murine leukemia virus (MMLV) reverse transcriptase,T7 RNA polymerase,and reaction substrates.The sensitivity of TMA was evaluated by amplifying a group of 10-fold diluted HIV RNA standards which were transcribed in vitro.A total of 60 plasma of HIV infected patients were measured by TMA and Cobas Amplicor HIV-1 Monitor test to observe the positive rate.The correlation and concordance of the above two technologies were investigated by linear regression and BlandAltman analysis.Results:TMA system was established successfully and HIV RNA transcribed standards at concentration of equal or more than 10 copies/mL could be detected by TMA technology.Among 60 samples of plasma from HIV infected patients,46 were positively detected and 12 were negatively amplified by both TMA and Cobas reagents;2 samples were positively tested by Cobas reagent but negatively tested by TMA system.The concordance rate of the two methods was 97.1％ and the difference of positive detection rate between the two methods was not statistically significant (P＞0.05).Linear regression was used for 46 samples which were positively detected by both TMA and Cobas reagents and showed an excellent correlation between the two reagents (r=0.997,P＜0.001).Bland-Altma analysis revealed that the mean different value ofHIV RNA levels for denary logarithm was 0.02.Forty-four samples were included in 95％ of credibility interval of concordance.Conclusion:TMA system has the potential of high sensitivity.TMA and real-time RT-PCR keep an excellent correlation and consistency in detecting HIV RNA.